Indian J Pediatr 53 : 1-4, 1986

Special article Health plans in India Mrs. Mohsina Kidwai

Minister of Health and Family Welfare, Government of India The war against our old enemies, poverty, unemployment, disease and ignorance continues, hz the weeks ahead, we will review our existing policies and programmes to ensure that our basic objectives of growth with justice are realised withhl the stipulated timetable. RAJIV G A N D H I Prime Minister of India Our Seventh Five-Year Plan has commenced. We have cast the health component of the plan in consonance with our national health policy which is committed to Health for All goal. We have to pursue these ambitious but indispensable objectives in an extrcmely unfavourable and fast deteriorating international climate characterised by political tensions and conflicts. The global military expenditure is expected to reach very soon the astronomical figure of one trillion dollars. The recent recovery in the economics of some developed countries has remained weak and tenuous. M o s t of the developing countries are continuing to grapple with their problems of excessively high external debt payments liabilities, paucity of resources, low levels of

Based on the statement made at the 38th World Health Assembly, Geneva, May 1985, and at the XI Joint Conference of Central Council of Health and Central Family Welfare Council, New Delhi, September 1985. Reprints of this article are not available.

commodity prices and rising protectionism. In this situation, social services, including health services, have been the first casualty. The policy packages prescribed by international financial institutions contain elements which show scant sensitivity to the importance of the social sectors in the development process. In these circumstances, our greatest concern today in the health field is how to preserve and realise our commonly cherished goal of Health F o r All by the turn of the century. Given the resources constraint, we have to pay increasing attention to measures for the optimum utilisation of the available resources. First and foremost, we must adopt an integrated approach towards the development and provision of health services. This should include coordination between the health and related sectors as well as between various programmes and activities in the health sector itself. Utilisation of traditional systems of medicine on a wider scale can also provide health care services to a large segment of

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our population with minimum cost. In India, some of these systems namely, Ayurveda, Unani and Siddha, enjoy considerable respect and acceptability. There is a network of more than 600 hospitals, 15,000 dispensaries and nearly 250 colleges providing health care facilities and imparting instruction and training in these systems o f medicine. We are trying to further encourage and strengthen them. In a recently held WHO consultation in New Delhi, various aspects o f the role of the practitioners in these systems in the national health network were discussed and several useful suggestions made. The International Conference on population held in Mexico last year emphasised the continuing importance and urgency of effective population control policies and measures and endorsed a plaa of action to be implemented at national and international levels. I need hardly emphasise that uncontrolled population growth can negate all the achievements of development, compound our problem of combating poverty and lead to political and social tensions. The family planning programme in India aims at total human resources development by improving the quality of life of our people in all aspects. It is seen as a key to every individual's and every family's betterment. The role and status of women in this context cannot be overemphasised. As our former Prime Minister Shrimati Indira Gandhi put it : "It is also part of the right of the women to be in full health and to use their gifts to bring up healthier, better looked-after children, to have more attractive homes, to develop their personality and find deeper fulfilment in their lives". A review of the performance of the

t'amily welfare programme shows an encouraging trend. During the last 15 years,we have invested 2,350 crore rupees in the programme. Birth rates during 1970 to 1983 have declined from 37 to 33 per thousand. Even this birth rate is unacceptably high especially in the states of Uttar Pradesh, Bihar, Radasthan and Madhya Pradesh (38 per 1000 and more). 40 per cent of our population lives in Hlese four States. Action must be taken to see that these birth rates decline rapidly. The total number of acceptors of family planning methods reached a level of 16 million during 1984-85, an increase of one million over the previous year. 40 million couples are presently practising family planning. During the next plan, this number must increase to 60 million. This is a stupendous task. We must, therefore, accelerate family planning activities. One of the effective steps we took to promote the programme was the 10-week intensive campaign which was launched on the 20th March, 1985. Separate targets were fixed for this period and the performance was monitored through weekly reviews. The results were remarkable. In what was generally considered a lean period from the point of view of the family planning campaign, the actual performance registered an all time high. Here is a lesson for us. Given the will to carry forward the programme, we can indeed achieved remarkable results. Another need of the hour is the increase in adoption of the spacing methods. Two-thirds of India's population consists of people who are below the age of 40. To bring the young couples under the protection of family welfare as also to encourage, guide and prepare the

KIDWA1 : HEALTH PLANS IN INDIA parents to be in tile way of family welfare, we have to promote the spacing methods. Improving the child and maternal survival rates is all important component of the Health for All goal. As a part of the overall strategy to achieve rapid improvement in the child survival rate, *he Government of India have decided to intensify the programme of : (a) immunisation against preventive childhood diseases: we have set the goal of achieving universal immunization by the end of tile Seventh Plan. Oil 19th November f985 we launched the Universal Imunisation Programme in 30 selected districts and catchment areas of fifty medical colleges. Success in the selected districts will help us to devise suitable strategies fbr the rest of the country. (b) prophy-. laxis against anemia and. blindness; and (c) oral rehydration therapy against childhood diarrhea. It is expected that the above package of services combined with a parallel action in other related areas like safe deliveries, improvement in nutritional standardards, and provision of safe drinking water, should enable us to achieve the target of reducing child and infant mortality. We have recently also intensified various measures for the control of endemic diseases which have been afflicting the health o f our nation. For example, sustained implementation of the Malaria Control Programme has resulted in bringging down the incidence of malaria from over 6 million cases in 1976 to less than 2 million cases in 1984. We know that even now the total number is disturbing. We are determined to bring it down further. There are some ailments which require greater understanding and sym-

path3, of not only the medical men but of the entire society. Leprosy is one such major problem. We ]lave no doubt~ made significant gains in the control of this dreaded disease. Of the nearly four million people estimated to the suffering fl'om leprosy, 3.35 million cases had been detected at the end of may, 1985 and a total of 1.95 million cases have so far been discharged because of cure olarrest of tile disease. During the seventh plan period the activities have been so planned as to achieve the goal of arrest of the disease in 60 per cent o f lhe known cases by 1990. More highly endemic districts for leprosy are proposed to be brought under multi-drug treatmen! during this period. Together with cure, the leprosy patients require sympathy and opportunities of rehabilitation. Unfortunately according to tile information available, only three states have so far repealed tile Leprosy Act of 1898. Tuberculosis, continues to be a major public health problem in our country because of several factors. Some ten million people are estimated to be suffering from this disease. We have no doubt brought down the mortality rate to 53 one lakh population from 80 per one lakh only a few years back. But much more remains to be done. Our aim is to have one T.B. Centre in every district of the country and we arc working towards that goal. The Government is also laying great stress on the control of blindness. It is estimated that the country has 9 million blind people at present. The national programme for control of blindness aims at reducing the incidence of blindness fl'om the present level of 1-5 per cent to 0.3 per cent by the

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end of the century. For this, infrastructural facilities are being strengthened in district hospitals, regional institutions medical colleges and plimary health centres. The states must make the fullest use of these facilities. We have also planned for iodisation of entire edible salt for eradication of iodine deficiency diseases. We have been able to achieve considerable progress in the guinea-worm eradication programme and we hope to eradicate this disease by 1990. In the field of health, human reproduction and related areas, there are still many questions to which we do not have precise answers. We are encouraging both fundamental and applied research by committing considerably enhanced resources to medical and health research in the Seventh Five Year Plan and ensuring that the results of the research findings are fed back into the on-going national programmes. Internationally, the health sphere is witnessing scientific and technological breakthroughs of far-reaching significance. To take only one example, recombinant DNA technology offers extremely promising prospects for breakthroughs in diagnosis and treatment of diseases such as cancer, genetically linked disorders, as well as in the production of effective low cost vaccines and pharmaceuticals. It is important that the results of these advances are extended rapidly and effectively to the developing countries. A large part of the responsibility here rests upon the developing countries themselves, by way o f developing their own infrastructural and intellectual capacity to absorb and adapt such technologies. But this will be possible

only if they are provided access to these technologies at costs which are not prohibitive. Here WHO has a crucial role to play. Pressure of industrialisation and urbanisation is posing serious challenges to governments, particularly in the developing countries, in the field of en~,~ironmental health. Hazards arising from chemicals have become a matter of particular concern to all countries. Our country recently experienced the worst industrial disaster in history, in a chemical plant in Bhopal. We must now ensure that such tragedies do not recur in future. For this, we should, wherever possible, strenggthen our capacity to assess accurately, in the light of latest scientific information, the health hazards and risks of industrial and other processes, to monitor and detect such hazards before it is too late, and in cases where accidents do occur, to deal with and minimise the damages arising therefrom. The Government of India is embarked upon adopting urgent measures along these lines. Another important development in the field of environmental health, is the establishment of the Central Ganga Authority designed to improve the Ganga water system. We are convinced that inspite of the recent deterioration in the climate of international cooperation, the goal of Health for All is still within our means. By adopting appropriate measures for optimising the use of our limited resources, by sharing of resources and experiences among different countries and with the active support of the non-governmental organisations, we can certainly translate this goal which to some, may appear as a mere dream, into reality.