The Reproductive and Child Health (RCH) Approach was adopted in 1995, following the ICPD Programme of Action, 1994. The details of the package of essential services to be offered under this programme are discussed in an earlier section of this Chapter. Here, special attention to the Programme for the Prevention and Control of HIV/AIDS is being given.
Services for HIV/AIDS: The national AIDS Control Organization (NACO) is the apex body for planning and coordinating the National AIDS Control Programme in various parts of the country. The States are provided with cent percent financial assistance for implementing the Programme.
The seven components of the Centrally Sponsored Scheme for AIDS Control are as follows:
1. Emphasis on the involvement of Non-Government Organisations (NGOs).
2. Intervention Programmes among persons with high risks behaviour, such as sex workers, truck drivers, non-student youth, etc.
3. Providing home based care services to HIV positive persons.
4. Making available the necessary diagnostic facilities at every district hospital.
5. Strengthening the STD (Sexually Transmitted Diseases) programme.
6. Screening of all ante-natal mothers for STD’s including HIV.
7. Creation of an AIDS Control Cell in the Directorate of Health Services in each State and Union Territory for planning, coordinating, implementing and monitoring all the activities of the cell.
In 1998, government sponsored autonomous AIDS Control Societies were set up in various states and in large metropolitan cities, such as Mumbai.
Development of Health Services in India
This is the first time in the history of the country that a National Health Policy has been declared. In the past, the health services and programmes were based on the recommendations of several committees set up by the Government from time to time.
The first such Committee was set up prior to Independence in 1943 and was called the Health Survey and Development Committee (popularly known as the Bhore Committee after its Chairman).
The report was submitted in 1946. After Independence, the Health Survey and Planning Committee (popularly known as the Mudaliar Committee after its Chairman) was set up in 1959, to further build on the framework provided by the Bhore Committee.
The report was submitted in 1963. Both these Committees emphasised that it was necessary to integrate public health and curative services with an outreach to the rural areas through Primary Health Centres and sub-centres.
Emphasis was laid on nutrition, health education, maternal and child health, communicable diseases, environmental hygiene, medical research and development of the pharmaceutical industry.
The committee on Multipurpose Workers appointed in 1972 and known as the Kartar Singh Committee, mainly made recommendations regarding the structure for integrated services as the peripheral and supervisory levels and examined the feasibility of having multipurpose workers in the field.
The objective of the Multipurpose Workers’ Scheme was to increase the accessibility of health care services as well as to increase population coverage of these services.
The Committee on Health Services and Medical Education (popularly called the Srivastava Committee after its Chairman) was appointed in 1974 to recommend “a suitable curriculum for training a cadre for Health Assistants so that they can serve as a link between the qualified medical practitioners and the Multipurpose Workers.
Thus forming an effective team “to deliver health care, family welfare and nutritional services to the people,” and “to suggest steps for improving the existing medical educational processes so as to provide due emphasis on the problems particularly relevant to national requirements.” The recommendations of this committee related mainly to the following four points:
1. Organisation of the basic health services within the community itself and the training of personnel needed for the purpose;
2. Organisation of an economic and efficient programme of health services to bridge the community with the first level referral centre, viz the PHC (including the strengthening of the PHC itself);
3. The creation of a National Referral Services Complex by the development of proper linkages between the PHC and higher level referral and service centres; and
4. To create the necessary administrative and financial machinery for the reorganisation of the entire programme of medical and health education from the point of view of the objectives and needs of the proposed programme of national health services.
As described earlier the Community Health Worker’s Scheme, introduced in October 1977, aims to provide preventive and promotional health services to the rural population by organizing a cadre of community health workers.
In April 1982, the Government of India set up a working group (popularly known as the Krishnan Committee after its Chairman) to suggest ways to reorganise and improve the service delivery outreach system for providing primary health care in urban slums.
Based on the recommendations of this working group, which were approved by the Cabinet Committee and the Central Council of Health and Family Welfare in August 1982, the scheme of Urban Health Posts was evolved.
This scheme involves the restructuring of the existing Urban Family Welfare Centres and the establishment of Urban Health Posts in the slums and slum-like areas with additional inputs in manpower and infrastructural facilities.