Smt. S.J. Patel & Smt. K.K.

Patel
Department of Social Work
S.P. University, V.V. Nagar
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Submitted TO: Submitted By:
Mrs. Bigi Thomas Tushar Patel
2014
Sr. MSW

Problems requiring urgent attention
Besides the recommended restructuring of the health services
infrastructure, precision of the medical and health manpower,
community involvement and exploit- tatting of the services of private
medical practitioners, specially those of the traditional and other
system, involvement and utilization of the services of the voluntary
agencies active in the health field, etc., it would be necessary to
devote planned, time-bound attention to some of the more important
inputs required for improved health care. Of these, priority attention
would require to be devoted to:
(I) Nutrition:
ational and regional strategies should be evolved and imple-
mented, on a time-bound basis, to ensure adequate nutrition for all
segments of the population through a well developed distribution
system, specially in the rural areas and urban slums. !ood of
acceptable quality must be available to every person in accordance
with his physical needs. "ow cost, processed and ready-to-eat foods
should be produced and made readily available. #he over-all strategy
would necessarily involve organized efforts at improving the
purchasing the purchasing power of the poorer sections of the
society. $chemes li%e employment guarantee scheme, to which the
government is committed, could yield optimal results if these are
suitably lin%ed to the ob&ective of providing adequate nutrition and
health cover to the rural and the urban poor. #he achievement of this
ob&ective is dependent on integrated socio-economic development
leading to the generation of productive employment for all those
constituting the labor force. 'mployment guarantee scheme and
similar efforts would require to be specially enforced to provide social
security for identified vulnerable sections of the society. (easures
aimed of improving eating habits, inculcation of desirable nutritional
practices, improved and scientific utilization of available food material
and the effective popularization of improved coo%ing practices would
require to be implemented. Besides, a nation-wide programmed to
promote breast-feeding of infants and eradicate- ton of various social
taboos detrimental to the promotion of health would need to be
initiated. $imultaneously, the problems of communities afflicted by
chronic nutritional disorders should be tac%led through special
schemes including the organization of supplementary feeding
programmers directed to the vulnerable sections of the population.
#he force and effect of such programmers should be ensured by
delivering them within the setting of fully integrated health care
activities, to ensure the inculcation of the educational aspects, in the
over-all strategy.
(ii) Prevention of food adulteration and maintenance of the
quality of drugs:
$tringent measures are required to be ta%en to chec% and prevent the
adulteration and contamination of foods at the various stages of their
production, processing, storage, transport, distribution, etc. #o ensure
uniformity of approach, the existing laws would require to be reviewed
and effective legislation enacted by the )enter. $imilarly, the most
urgent measures require to be ta%en to ensure against the
manufacture and sale of spurious and sub-standard drugs.
(iii) Water supply and sanitation:
#he provision of safe drin%ing water and the sanitary disposal of
wastewaters, human and animal wastes, both in urban and rural
areas, must constitute an integrated pac%age. #he enormous bac%log
in the provision of these services to the rural population and in the
urban agglomerations must be made up on the most urgent basis.
#he provision of water supply and basic sanitation facilities would not
automatically improve health. #he availability of such facilities should
be accompanied by intensive health education campaigns for the
improvement of personal hygiene, the economical use of water and
the sanitary disposal of waste in manner that will improve individual
and community health. *ll water-supply schemes must be fully
integrated with efforts at proper water management, including the
drainage and disposal efforts of proper water management, including
the drainage and disposal of wastewaters. #o reduce expenditures
and for achieving a quic% headway it would be necessary to devise
appropriate technologies in the planning and management of the
delivery systems. Besides, the involve- ment of the community in the
implementation and management of the systems would be of crucial
importance, both for reducing costs as well as to see that the
beneficiaries value and protect the services provided to them.
(iv) Environmental protection:
+hile preventive, primitive, public health services are established and
the curative services re-organized to prevent, control and treat
diseases, it would be equally necessary to ensure against the
haphazard exploitation of resources which cause ecological
disturbances leading to fresh health hazards. ,t is, therefore,
necessary that economic developed plans in the various sectors be
devised in adequate consultation with to )entral and the $tate -ealth
authorities. ,t is also vitally essential to ensure that the present and
future industrial and urban development plans are centrally reviewed
to ensure against congestion, the unchec%ed release of noxious
emissions and the pollution of air water. ,n this context, it is vital to
ensure that the sitting and location of all manufacturing units is strictly
regulated, through legal measures, if necessary. )entral and $tate
-ealth authorities must necessarily be consulted in establishing
vocational policies for industrial development and urbanization
programmers. 'nvironmental appraisal procedures must be
developed and strictly applied in according clearance to the various
developmental pro&ects.
(v) Immunization programmed:
,t is necessary to launch and organized, nation- wide immunization
programme, aimed at cent percent coverage of targeted population
groups with vaccines against preventable and communicable
diseases. $uch an approach would not only prevent and reduce
disease and disability but also bring down the existing high infant and
child mortality rate.
(vi) Maternal and Child ealth !ervices:
* vicious relationship exists between high birth rates and high infant
mortality, contributing to the desire for more children. #he highest
priority would, therefore, require to be devoted to efforts at launching
special programmers for the improvement of maternal and child
heath, with special focus on the less privileged sections of society.
$uch programmes would require to be decentralized to the maximum
possible extent, their delivery being at the primary level, nearest to
doorsteps of the beneficiaries. +hile efforts should continue at
providing refresher training and orientation to the traditional birth
attendants, schemes and programmes should be launched to ensure
that progressively all deliveries are conducted by competently trained
persons so that complicated cases receive timely and expert
attention, within a comprehensive programme providing ante-natal,
intra-natal and post- natal care.
(vii) !chool health programme:
Organized school health services, integrally lin%ed with the general,
preventive and curative services, would require to be established
within time-limited programmes.
(viii) "ccupational health services:
#here is urgent need for launching well- considered schemes to
prevent and treat diseases and in&uries arising from occupational
hazards, not only in the various industries but also in the
comparatively un-organized sectors li%e agriculture. !or this purpose,
the extended ensuring adequate coordination of efforts with general
health services. ,n their respective spheres of responsibility, the
)enter and the $tates must introduce organized occupational health
services to reduce morbidity, disabilities and mortality and thus
promote better health and increased welfare and productivity on all
fronts.
Health education
#he recommended efforts, on various fronts, would bear only
marginal results unless nation-wide health education programmers,
bac%ed by appropriate communicate- ton strategies are launched to
provide health information in easily understandable form, to motivate
the development of an attitude for healthy living. #he public health
education programmers should be supplemented by health, nutrition
and population education programmers in all educational institutions,
at various levels, $imultaneously, efforts would require to be made to
promote universal education specially adult and family education
without which the various efforts to organize preventive and promo-
tie health activities, family planning and improved material and child
health cannot bear fruit.
Management information system
*ppropriate decision-ma%ing and programmed planning in he health
and related fields is not possible without establishing an effective
health information system. * nation-wide organizational set-up should
be established to procure essential health information. $uch
information is required not only for .assisting in planning and
decision ma%ing but to also provide timely warnings about emerging
health problems and for reviewing, monitoring and evaluating the
various on-going health programmers. #he building up of a well-
conceived health information system is also necessary for assessing
medical and health manpower requirements and ta%ing timely
decisions, on a continuing basis, regarding the manpower
requirements in the future. (edical industry
#he country has built up sound technological and manufacturing
capability in the field of drugs, vaccines, bio-medical equipments, etc.
#he available %now-how requires to be adequately exploited to
increase the production of essential and life saving drugs and
vaccines of proven quality to fully meet the national requirements,
specially in regard to the national programmers to combat (alaria,
#B, "eprosy Blindness, /iarrhoeal diseases, etc. #he production of
the essential, life saving drugs under their generic names and the
adoption of economical pac%aging practices would considerable
reduce the unit cost of medicines bringing them within the reach of
the poorer sections of society, besides significantly reducing the
expenditure being incurred by the governmental organization on the
purchase of drugs. ,n view of the low cost of indigenous and herbal
medicines, organized efforts may be launched to establish herbal
gardens, producing drugs of certified quality and ma%ing then easily
available.
#he practitioners of the modern medical system rely heavily on
diagnostic aids involving extensive use of costly, sophisticated
biomedical equipment. 'ffective extensive use and to promote and
enlarge their indigenous manufacture, for such devices being readily
available, at reasonable process, for use at the health care centers.
Health insurance
Besides monishing the community resources, through its active
participation in the implementation and management of national
health and related programmers, it would be necessary to device well
considered health insurance schemes, an a $tate- wise basis, for
mobilizing additional resources for health promotion and ensuring that
the community shares the cost of the services, in %eeping with its
paying capacity.
Health legislation
,t is necessary to urgently review all existing legislation and wor%
toward a unified, comprehensive legislation in the health field,
enforceable all over the country.
Medical research
#he frontiers of the medical sciences are expanding of a phenomenal
pace. #o maintain the country0s lead in this field a well as to ensure
self-sufficiency and generation of the requisite competence in the
future, it is necessary to have an organized programme for the
building up and extension of fundamental and basic research in the
field of bio-medical and allied sciences. 1riority attention would
require to be devoted to the resolution of problems relating to the
containment and eradication of the existing, widely prevalent
diseases as well as to deal with emerging health problems. #he basic
ob&ective of medical research and the ultimate test of its utility would
involve the translation of available %now-how into simple, low-cost,
easily applicable appropriate technologies, devices and interventions
suiting local conditions, thus placing the latest technological
achievements within the reach of health personal, and to the front line
health wor%ers, in the remotest corners of the country. #herefore,
besides devotion to basic, fundamental research, high priority should
be accorded to applied, operational research including action
research for continuously improving the cost effective delivery of
health services. 1riorities would require be indemnifying and laying
down in collaboration with social scientists, planners and decision
ma%ers and the public. Basic research efforts should devote high
priority to the discovery ad development of more effective treatment
and preventive procedures in regard to communicable and tropical
diseases---Blindness, "eprosy, #.B., etc. 2ery high priority would also
have to be devoted to contraception research, to urgently improve the
effectiveness and acceptability of existing methods as well as to
discover more effective and acceptable devices. 'qually high
attention would require devoting to nutrition research, to improve the
health status of the community. #he overall effort should aim at the
blanched development of basic. )linical and problem-oriented
operational research.
Inter-sectoral co operation
*ll health and human development must ultimately constitute on
integral com- potent of the overall socio-economic developmental
process in the country. ,t is thus of vital importance to ensure effective
coordination between the health and its more intimately related
sectors. ,t is, therefore, necessary to set up standing mechanisms, of
the )enter and in the $tates, for securing inter-sectoral coordination
of the various efforts in the fields of health and family planning,
medical education and research, drugs and pharmaceutical,
agriculture and food, water supply and drainage, housing, education
and social welfare and rural development. #he coordination and
review committees, to be up, should review progress, resolve
bottlenec%s and bring about such shifts in the contents and priorities
of programmes as may appear necessary, to achieve the overall
ob&ectives. *t the community level it would be desirable to devise
arrangements for health and all other developmental activities being
coordinated under an integrated programme of rural development.
Monitoring and review of progress
,t would of crucial importance to monitor and periodically review, the
success of the efforts mode and the results achieved. !or this
purpose, it is necessary to urgently identify the base line situation and
to evolve a phased programme for the achievement of certain basic
health and family welfare goods are set out in the annexed tabular
statement. #hese goals, as well as other allied ob&ectives, would
require too be further wor%ed upon and specific targets for
achievement established by the )entral and the state governments in
regard to the various areas of functioning.
3oals for -ealth and family +elfare 1rogrammes
$l. 3oals
o. ,ndicator )urrent level 4567 4558 9888
4 9 : ; 7 <
4. ,nfant mortality rate =ural 4:< >45?6@ 499
Arban ?8 >45?6@ <8
#otal 497 >45?6@ 48< 6? below <8
1renatal mortality <? >45?<@ :8-:7
9. )rude death rate *round 4; 49 48.; 5.8
:. 1re-school child
>4-7yrs.@ mortality 9;>45?<-??@ 98-9; 47-98 48
;. (aternal mortality rate ;-7>45?<@ :-; 9-: below 9
7. "ife expectancy
Of birth >yrs.@ male 79.< >45?<-64@ 77.4 7?.< <;
<. Babies with birth weight
Below 9788 gems. >percentage@ :8 97 46 48
?. )rude birth rate *round :7 :4 9?.8 94.8
6. 'ffective couple protection
>1ercentage@ 9:.<>(arch, 69@ :?.8 ;9.8 <8.8
5. et =eproduction =ate >==@ 4.;6 >4564@ 4.4: 4.4? 4.88
48. 3rowth rate >annual@ 9.9; >45?4-64@ 4.58 4.<< 4.98
44. !amily size ;.;>45?7@ :.6 9.:
49. 1regnant mothers receiving
*nte-natal care >B@ ;8-78 78-<8 <8-?7 488
4:. /eliveries by trained birth
*ttendants >B@ :8-:7 78 68 488
4 9 : ; 7 <
4;. ,mmunizations status >B coverage@
## >for 1regnant women@ 98 <8 488
## >for school children@
48years ;8 488 488
4<years 98 ;8 488 488
/1# >children below : years@ 97 ?8 67 67
1olio >infants@ 7 78 ?8 67
B)3 >infants@ <7 ?8 68 67
/# >new school entrants>7-<years@ 98 68 67
67
#yphoid >new school entrants
7-<years@ 9 ?8 67 67
47. "eprosy---percentage of disease
arrested cases out of those
detected 98 ;8 <8 68
4<. #B---percentage of disease
arrested cases out of those
detected 78 <8 ?7 58
4?. Blindness ---,ncidence of >B@ 4.; 4 8.? 8.: