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Health Issues:

Maternal and Child Healthcare


In June 2011, the United Nations Population Fund released a report on The State oI
the World's MidwiIery. It contained new data on the midwiIery workIorce and
policies relating to newborn and maternal mortality Ior 58 countries. The 2010
maternal mortality rate per 100,000 births Ior India is 230. This is compared with
253.8 in 2008 and 523.3 in 1990. The under 5 mortality rate, per 1,000 births is 68
and the neonatal mortality as a percentage oI under 5's mortality is 52. The aim oI
this report is to highlight ways in which the Millennium Development Goals can be
achieved, particularly Goal 4 Reduce child mortality and Goal 5 improve
maternal death. In India the number oI midwives per 1,000 live births is
unavailable and 1 in 140 shows us the liIetime risk oI death Ior pregnant women.
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Disease
India suIIers Irom high levels oI disease including Malaria,
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and Tuberculosis
where one third oI the world`s tuberculosis cases are in India.
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In addition, India
along with Nigeria, Pakistan and AIghanistan is one oI the Iour countries
worldwide where polio has not as yet been eradicated.
Ongoing government oI India education about HIV has led to decreases in the
spread oI HIV in recent years. The number oI people living with AIDS in India is
estimated to be between 2 and 3 million. However, in terms oI the total population
this is a small number. The country has had a sharp decrease in the estimated
number oI HIV inIections; 2005 reports had claimed that there were 5.2 million to
5.7 million people aIIlicted with the virus. The new Iigures are supported by the
World Health Organization and UNAIDS.
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Pollution
According to the World Health Organization 900,000 Indians die each year Irom
drinking contaminated water and breathing in polluted air.
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As India grapples
with these basic issues, new challenges are emerging Ior example there is a rise in
chronic adult diseases such as cardiovascular illnesses and diabetes as a
consequence oI changing liIestyles.
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Malnutrition
HalI oI children in India are underweight, one oI the highest rates in the world and
nearly same as Sub-Saharan AIrica.
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India contributes to about 5.6 million child
deaths every year, more than halI the world's total.
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Water and sanitation
Water supply and sanitation in India is a matter oI concern. As oI 2003, it was
estimated that only 30 oI India's wastewater was being treated, with the
remainder Ilowing into rivers or groundwater.
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The lack oI toilet Iacilities in
many areas also presents a major health risk; open deIecation is widespread even in
urban areas oI India,
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and it was estimated in 2002 by the World Health
Organisation that around 700,000 Indians die each year Irom diarrhoea.
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No city
in India has Iull-day water supply. Most cities supply water only a Iew hours a
day.
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In towns and rural areas the situation is even worse.
HIVJAIDS in India
India has the world's third-largest population suIIering Irom HIV/AIDS.
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However, the estimated number oI human immunodeIiciency virus (HIV)
inIections in India has declined drastically in recent yearsIrom 5.5 million in
2005 to below 2.5 million in 2007. These new Iigures are supported by the World
Health Organization and UNAIDS.
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According to the United Nations 2011
Aids report, there has been a 50 decline in the number oI new HIV inIections in
the last 10 years in India
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In 1986, HIV started its epidermic in India, attacking sex workers in Chennai,
Tamil Nadu. Setting up HIV screening centres was the Iirst step taken by the
government to screen its citizens and the blood bank.
To control the spread oI the virus, the Indian government set up the National AIDS
Control Programme in 1987 to co-ordinate national responses such as blood
screening and health education.
In 1992, the government set up the National AIDS Control Organisation (NACO)
to oversee policies and prevention and control programmes relating to HIV and
AIDS and the National AIDS Control Programme (NACP) Ior HIV prevention.
The State AIDS Control Societies (SACS) was set up in 25 societies and 7 union
territories to improving blood saIety.
In 1999, the second phase oI the National AIDS Control Programme (NACP II)
was introduced to decrease the reach oI HIV by promoting behaviour change. The
prevention oI mother-to-child transmission programme (PMTCT) and the
provision oI antiretroviral treatment were materialized.
In 2007, the third phase oI the National AIDS Control Programme (NACP III)
targeted the high-risk groups, conducted outreach programmes, amongst others. It
also decentralised the eIIort to local levels and non-governmental organisations
(NGOs) to provide welIare services to the aIIected
[bW^nmWnt p[iciW_ f[^ HIVJAIDS:
Soon aIter the Iirst cases emerged in 1986, the Government oI India established the
National AIDS Committee within the Ministry oI Health and Family WelIare.
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This Iormed the basis Ior the current apex Government oI India body Ior HIV
surveillance, the National AIDS Control Organisation (NACO). The majority oI
HIV surveillance data collected by the NACO is done through annual unlinked
anonymous testing oI prenatal clinic (or antenatal clinics) and sexually transmitted
inIection clinic attendees. Annual reports oI HIV surveillance are Ireely available
on NACO's website.
The Iirst National AIDS Control Programme (NACP) was implemented over seven
years (1992-1999), Iocused on monitoring HIV inIection rates among risk
populations in selected urban areas.
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The second phase ran between 1999 and
2006 and the original program was expanded at state level, Iocusing on targeted
interventions Ior high-risk groups and preventive interventions among the general
population.
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A National Council on AIDS was Iormed during this phase,
consisting oI 31 ministries and chaired by the Prime Minister.
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HIV/Aids was
understood not purely as a health issues, but also a development issue and as such
it was mainstreamed into all ministries and departments.
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The third stage
dramatically increased targeted interventions, aiming to halt and reverse the
epidemic by integrating programmes Ior prevention, care, support and treatment.
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By the end oI 2008, targeted interventions covered almost 932,000 oI those most at
risk, or 52 oI the target groups (49 oI FSWs, 65 oI IDUs and 66 oI
MSM).
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In 2009 India established a "National HIV and AIDS Policy and the
World oI Work", which sough to end discrimination against workers on the basis
oI their real or perceived HIV status.
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Under this policy all enterprises in the
public, private, Iormal and inIormal sectors are encouraged to establish workplace
policies and programmes based on the principles oI non-discrimination, gender
equity, health work environment, non-screening Ior the purpose oI employment,
conIidentiality, prevention and care and support.
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Researchers at the Overseas
Development Institute have called Ior greater attention to migrant workers, whose
concerns about their immigration status may exclude them Irom these policies and
leave them particularly vulnerable.
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anding
HIV spending increased in India Irom 2003 to 2007, and Iell by 15 in 2008 to
2009. Currently, India spends about 5 oI its health budget on HIV/AIDS.
Spending on HIV/AIDS may create a burden in the health sector which Iaces a
variety oI other challenges like malaria, diabetes, heart disease and cancer. Thus, it
is crucial Ior India to step up on its prevention eIIorts to decrease its spending oI
the health budget on HIV/AIDS in Iuture.
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MWdica T[a^i_m
India is quickly becoming a hub Ior medical tourists seeking quality healthcare at
an aIIordable cost. Nearly 450,000 Ioreigners sought medical treatment in India
last year with Singapore not too Iar behind and Thailand in the lead with over a
million medical tourists.
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As the Indian healthcare delivery system strives to
match international standards the Indian healthcare industry will be able to tap into
a substantial portion oI the medical tourism market. Already 13 Indian hospitals
have been accredited by the Joint Commission International (JCI). Accreditation
and compliance with quality expectations are important since they provide tourists
with conIidence that the services are meeting international standards. Reduced
costs, access to the latest medical technology, growing compliance to international
quality standards and ease oI communication all work towards India`s advantage.
It is not uncommon to see citizens oI other nations seek high quality medical care
in the US over the past several decades; however in recent times the pattern seems
to be reversing. As healthcare costs in the US are rising, price sensitivity is soaring
and people are looking at medical value travel as a viable alternative option. In the
past the growth potential oI the medical travel industry in India has been hindered
by capacity and inIrastructure constraints but that situation is now changing with
strong economic progress in India as well as in other developing nations.
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With
more and more hospitals receiving JCI accreditations outside the US, concerns on
saIety and quality oI care are becoming less oI an issue Ior those choosing to travel
Ior medical treatment at an aIIordable cost. The combined cost oI travel and
treatment in India is still a Iraction oI the amount spent on just medical treatment
alone in western countries.
In order to attract Ioreign patients many Indian hospitals are promoting their
international quality oI healthcare delivery by turning to international accreditation
agencies to standardize their protocols and obtain the required approvals on saIety
and quality oI care.
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ati[na Ra^a HWatb Mi__i[n {RHM]
The National Rural Health Mission (NRHM) was launched on April 12, 2005 by
the Prime Minister oI India with the objective oI providing accessible and
aIIordable quality health services to the poor households in the remote and rural
parts oI the country. The detailed Framework Ior Implementation was approved by
the Union Cabinet in July 2006.
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It is being operationalized throughout the
country with special Iocus on 18 States which include 8 Empowered Action Group
States (Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Uttar Pradesh,
Uttaranchal, Orissa and Rajasthan), 8 NE States, Himachal Pradesh, and Jammu
and Kashmir. These states have been classiIied as special Iocus states because they
do not have satisIactory health indicators and the government wanted to ensure that
greatest attention is given where required. Immunization is one oI the major areas
under National Rural Health Mission (NRHM) and under the NRHM
immunization programme, the Government oI India provides vaccination to
prevent six vaccine preventable diseases i.e. Tuberculosis, Diphtheria, Pertussis,
Tetanus, Polio, and Measles. In order to strengthen routine immunization, the
government has launched newer initiatives as a part oI the state Programme
Implementation Plan (PIP). These initiatives include supply oI vaccines, supply oI
vaccine van at the rate oI one per district, and mobility support to State
Immunization OIIicer, District Immunization OIIicer and other OIIicers as per the
state plan Ior monitoring and supportive supervision.
In June 2002, a pilot project Ior the introduction oI Hepatitis-B vaccine was
launched by the Prime Minister and under this pilot project, 33 districts and 15
metropolitan cities implemented Hepatitis B vaccination. AIter the success oI pilot
project, the Hepatitis B programme was expanded to 10 states, that is, Andhra
Pradesh, Himachal Pradesh, Jammu & Kashmir, Karnataka, Kerala, Madhya
Pradesh, Maharashtra, Punjab, Tamil Nadu and West Bengal in a phased manner.
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The Union Ministry is launching National Urban Health Mission (NUHM) in
Public Private Partnership mode in order to address the primary health needs oI
people who live in urban areas. NURM will complement the activities undertaken
by NRHM in rural areas. Poor Iamilies, slum dwellers, migrant workers and
extremely vulnerable population living in urban areas would be identiIied by the
Urban Local Body (ULB) and would be covered under the scheme. Those Iamilies
would then be issued a photo Family Health Card. There are 427 cities (including
state capitals) that have a population oI one lakh and above which would be
covered by NURM. Out oI these, one hundred constitute hi-Iocus cities.
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^ima^ _W^bicW_
Health care Iacilities and personnel increased substantially between the early 1950s and early
1980s, but because oI Iast population growth, the number oI licensed medical practitioners per
10,000 individuals had Iallen by the late 1980s to three per 10,000 Irom the 1981 level oI Iour
per 10,000. In 1991 there were approximately ten hospital beds per 10,000 individuals. For
comparison, in China there are 1.4 doctors per 1000 people
ational Centre for Disease Control (CDC)
ational Centre for Disease Control (CDC) (previously known as National
Institute oI Communicable Diseases) is an institute under the Indian Directorate
General oI Health Services, Ministry oI Health and Family WelIare. It was
established in July 1963 Ior research in epidemiology and control oI communicable
diseases.
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Currently it has eight branches at Alwar, Bangalore, Calicut, Coonoor,
Jagdalpur, Patna, Rajahmundry and Varanasi to advise the respective state
governments on public health.
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The origin oI NICD can be traced back to Central Malaria Bureau, which was established at
Kasauli, Himachal Pradesh, India in 1909. It was renamed as the Malaria Institute oI India in
1938 and in 1963 renamed as the NICD.
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On 30 July 2009, it was named as National Centre Ior
Disease Control.
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Doctors Irom NICD had been previously summoned to investigate potential outbreaks oI
diseases including suspected cases oI Pneumonic plague in Punjab in 2002
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, SARS oubreaks in
2004
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, meningitis outbreak in Delhi in 2005,
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and avian inIluenza in 2006.
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pWndita^W
In the mid-1990s, health spending amounted to 6 oI GDP, one oI the highest
levels among developing nations. The established per capita spending is around Rs
320 per year with the major input Irom private households (75). State
governments contribute 15.2, the central government 5.2, third-party insurance
and employers 3.3, and municipal government and Ioreign donors about 1.3,
according to a 1995 World Bank study. OI these proportions, 58.7 goes toward
primary health care (curative, preventive, and promotive) and 38.8 is spent on
secondary and tertiary inpatient care. The rest goes Ior nonservice costs.
The FiIth (197478) and Sixth Five-Year Plans and (198084) included programs
to assist delivery oI preventive medicine and improve the health status oI the rural
population. Supplemental nutrition programs and increasing the supply oI saIe
drinking water were high priorities. The sixth plan aimed at training more
community health workers and increasing eIIorts to control communicable
diseases. There were also eIIorts to improve regional imbalances in the distribution
oI health care resources.
The Seventh Five-Year Plan (198589) budgeted Rs 33.9 billion Ior health, an
amount roughly double the outlay oI the sixth plan. Health spending as a portion oI
total plan outlays, however, had declined over the years since the Iirst plan in 1951,
Irom a high oI 3.3 oI the total plan spending in FY 1951-55 to 1.9 oI the total
Ior the seventh plan. Mid-way through the Eighth Five-Year Plan (199296),
however, health and Iamily welIare was budgeted at Rs 20 billion, or 4.3 oI the
total plan spending Ior FY 1994, with an additional Rs 3.6 billion in the nonplan
budget.

CWnt^a g[bW^nmWnt_ ^[W
Critics say that the national policy lacks speciIic measures to achieve broad stated
goals. Particular problems include the Iailure to integrate health services with
wider economic and social development, the lack oI nutritional support and
sanitation, and the poor participatory involvement at the local level.
Central government eIIorts at inIluencing public health have Iocused on the Iive-
year plans, on coordinated planning with the states, and on sponsoring major health
programs. Government expenditures are jointly shared by the central and state
governments.
The 1983 National Health Policy is committed to providing health services to all
by 2000. In 1983 health care expenditures varied greatly among the states and
union territories, Irom Rs 13 per capita in Bihar to Rs 60 per capita in Himachal
Pradesh, and Indian per capita expenditure was low when compared with other
Asian countries outside oI South Asia. Although government health care spending
progressively grew throughout the 1980s, such spending as a percentage oI the
gross national product (GNP) remained Iairly constant. In the meantime, health
care spending as a share oI total government spending decreased. During the same
period, private-sector spending on health care was about 1.5 times as much as
government spending.
HWatbca^W Inf^a_t^acta^W
The Indian healthcare industry is seen to be growing at a rapid pace and is
expected to become a US$280 billion industry by 2020.
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The Indian healthcare
market was estimated at US$35 billion in 2007 and is expected to reach over
US$70 billion by 2012 and US$145 billion by 2017.
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According to the Investment
Commission oI India the healthcare sector has experienced phenomenal growth oI
12 percent per annum in the last 4 years.
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Rising income levels and a growing
elderly population are all Iactors that are driving this growth. In addition, changing
demographics, disease proIiles and the shiIt Irom chronic to liIestyle diseases in
the country has led to increased spending on healthcare delivery.
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Even so, the vast majority oI the country suIIers Irom a poor standard oI healthcare
inIrastructure which has not kept up with the growing economy. Despite having
centers oI excellence in healthcare delivery, these Iacilities are limited and are
inadequate in meeting the current healthcare demands. Nearly one million Indians
die every year due to inadequate healthcare Iacilities and 700 million people have
no access to specialist care and 80 oI specialists live in urban areas.
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In order to meet manpower shortages and reach world standards India would
require investments oI up to $20 billion over the next 5 years.
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Forty percent oI
the primary health centers in India are understaIIed. According to WHO statistics
there are over 250 medical colleges in the modern system oI medicine and over
400 in the Indian system oI medicine and homeopathy (ISM&H). India produces
over 25,000 doctors annually in the modern system oI medicine and a similar
number oI ISM&H practitioners, nurses and para proIessionals.
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Better policy
regulations and the establishment oI public private partnerships are possible
solutions to the problem oI manpower shortage.
India Iaces a huge need gap in terms oI availability oI number oI hospital beds per
1000 population. With a world average oI 3.96 hospital beds per 1000 population
India stands just a little over 0.7 hospital beds per 1000 population.
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Moreover,
India Iaces a shortage oI doctors, nurses and paramedics that are needed to propel
the growing healthcare industry. India is now looking at establishing academic
medical centers (AMCs) Ior the delivery oI higher quality care with leading
examples oI The Manipal Group & All India Institute oI Medical Sciences
(AIIMS) already in place.
As incomes rise and the number oI available Iinancing options in terms oI health
insurance policies increase, consumers become more and more engaged in making
inIormed decisions about their health and are well aware oI the costs associated
with those decisions. In order to remain competitive, healthcare providers are now
not only looking at improving operational eIIiciency but are also looking at ways
oI enhancing patient experience overall.
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India has approximately 600,000 allopathic doctors registered to practice medicine.
This number however, is higher than the actual number practicing because it
includes doctors who have emigrated to other countries as well as doctors who
have died. India licenses 18,000 new doctors a year.
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Wdit] St^acta^W [f HWatbca^W S_tWm
The Indian healthcare system can be divided into national, state, district,
community, primary health care centre and sub-centre levels. At the national level
is the Union Ministry oI Health and Family WelIare which consists oI six
departments Department oI Health and Family WelIare, Department oI AYUSH,
Department oI Health Research, Department oI NACO, Department oI AIDS
Control, and Central Health Service.
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The Union Ministry is responsible Ior the
Iormulation oI health policies and their implementation across the country. The
Department oI Health is responsible Ior providing healthcare services to the
masses. This includes organizing awareness campaigns and immunization
campaigns, providing preventive medicine (vaccines such as polio, DPT, etc.), and
public health services. The Department oI Family WelIare is responsible Ior
matters pertaining to Family WelIare, Reproductive Health, Maternal Health,
Paediatrics, InIormation, Education and Communication, Cooperation with NGOs,
International Aid Groups, and Rural Health Services. In November 2003, the
Department oI Indian Systems oI Medicine and Homoeopathy (ISM&H) was
renamed as the Department oI Ayurveda, Yoga & Naturopathy, Unani, Siddha and
Homoeopathy (AYUSH) with the objective oI the development oI Education and
Research in Iields oI Ayurveda, Yoga & Naturopathy, Unani, Siddha and
Homoeopathy systems
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. Other than these Iour departments, there is the
Directorate General oI Health Services (Dte.GHS) which supports the Department
oI Health & Family WelIare by rendering technical advice on all matters oI
medical and public health. DGHS is also involved in the implementation oI various
health services.
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DGHS manages Central Drugs Standard Control Organizations
(CDSCO), State Drugs Standard Control Organization and Central Government
Health Scheme (CGHS). The CDSCO and State Drugs Standard Control
Organization monitor the licensing oI drug manuIacturing establishments, quality
oI drugs and drug approval. The Central Government Health Scheme (CGHS)
provides comprehensive healthcare Iacilities Ior the employees oI Central
Government, retired personnel and their dependents who reside in the cities
covered by CGHS. The active employees oI the deIense services are also covered
under the CGHS.
At the state level is the State Department oI Health and Family WelIare which is
supported by the State Directorate oI Health Services. The state department`s
organization is similar to that oI the Union Ministry oI Health and Family WelIare.
Headed by the Director oI Health Services, the State Directorate oI Health Services
provides technical advice to the State Department oI Health and Family WelIare.
In the states oI Bihar, Madhya Pradesh, Uttar Pradesh, Andhra Pradesh, Karnataka
and others, regional set-ups have been created wherein each regional or zonal set-
up covers three to Iive districts and acts under the authority delegated by the State
Directorate oI Health Services. The district oIIicer who has overall control is
designated as the ChieI Medical and Health OIIicer (CMO) or District Medical and
Health OIIicer (DMO) and is responsible Ior implementing the programmes
according to the policies laid down at the state and centre levels. Healthcare
services are provided through the oIIice oI Assistant District Health and Family
WelIare OIIicer (ADHO) at the Taluka level. To provide basic healthcare services
at the community level, one Community Health Centre (CHC) has been established
Ior every 80,000 to 120,000 people. A Primary Health Centre covers about 20,000
people and is staIIed with one medical oIIicer and two health assistants. At the
lowest level in the chain is the sub-centre which serves about 5,000 people (about
3,000 in diIIicult terrain)


Social Issues- Health:Issues , vital statistics, Govt, schemes, management solution