The following are the excerpts from the 'Report to the People 2004-07' on Health & Family Welfare. The report was released by the Prime Minister, Dr. Manmohan Singh on 22^nd May, 2007. The report in full and its highlights are available on PIB website: www.pib.nic.in

HEALTHCARE

National Rural Health Mission (NRHM): With the launch of the Mission, a series of initiatives have been set in motion to effectively improve access to quality health care of people, especially those residing in rural areas, the poor, women and children.

During the period 2005-12, the Mission seeks to halve infant mortality from 60 to 30 per thousand live births, reduce total fertility rate from 3 to 2.1, bring down maternal mortality to 100 per from over 300 per lakh at present, reduce prevalence of diseases covered under the national programme for disease control, upgrade all Community Health Centres to the Indian Public Health Standards, and increase bed occupancy by referred cases in First Referral Units from less than 20% to over 75%.

The Mission's framework has a rights based approach. The framework proposes accountability at every level through a three-pronged process of community based monitoring, external surveys and stringent internal monitoring. The Citizen Charter would help the public to know their rights and entitlements at each facility. The setting up of the IPHS for each level of the health delivery system would be instrumental in the provision of minimum service guarantees at those levels.

Major initiatives like ASHA: A voluntary trained community health worker - in every village in 18 demographically weaker states (4.35 lakh ASHAs have been already selected and over two lakh trained), selection of over 90,000 link workers, provision of an additional ANM (Auxiliary Nurse Midwife) at all health sub-centres (with ANMs already put in position in nearly half the sub-centres), three staff nurses at each primary health centre and additional specialists and paramedical staff at the community health centres have already started making a difference.

Shifting of control of health facilities to panchayati raj institutions, Rogi Kalyan Samitis and contractual appointments of ANMs and other critical manpower is making healthcare delivery system more accountable, while helping ensure presence of healthcare personnel in health centres, especially in rural areas.

The Mission seeks to improve healthcare services for the underserved poor at the village level through the ASHA, improved facilities at health centres, availability of drugs for common ailments, access to immunisation, hospital delivery, nutrition and medical care at the village level. It attempts to create synergy among initiatives relating to nutrition, sanitation, hygiene and safe drinking water.

It also aims at aligning the Indian systems of medicines to facilitate healthcare. It provides additional outlays for health, while 10 ensuring empowerment at the state and district levels. With decentralisation of programmes and smooth flow of funds, it has set in position the stage for district management of health.

The Government earlier supported only construction / upgrade of sub-centres and, as a result, community / primary health centres, district hospitals etc., remained in poor condition.

The Mission is bringing about much needed correction in this. For reforms and development of human resources, a National Health Systems Resource Centre as well as state centres are being set up. More than 10 lakh monthly health days have been organised at anganwadi centres, facilitating care during pregnancy and after childbirth, immunisation of children and pregnant mothers, distribution of basic drugs, and information about basic healthcare, hygiene and sanitation etc.

Village health and sanitation committees are being set up in every village. Over 21 lakh patients have been benefited during the second year of Janani Suraksha Yojana, a scheme for promoting hospital delivery that gives cash incentives without red tape, and significant improvement have been reported in the number of hospital deliveries by a number of states.

A general template in insurance has been formulated and circulated to states with the request that states may examine the need for health insurance for poor households. It is proposed to improve outreach activities in unserved and underserved areas through mobile medical units in each district.

The Departments of Health and Family Welfare have been integrated at the Central level, while states have created single Health Societies at the state and district levels, thus effecting synergistic administrative integration of delivery mechanisms for vertical health programmes. Community health centres across the country are being upgraded as First Referral Units. Primary health centres are being made operational for round-the-clock services in a phased manner.

For the first time, all 1.42 lakh sub-centres across the country have been provided untied funds to enable them to meet some of their requirements locally. The goal of 'eliminating' leprosy, as per WHO standards, has been achieved at the national level and the few states remaining above the elimination level of one case per 10,000 population are being targeted.

The Government remains committed to wipe out poliovirus through focussed strategy and design in 2007. During 2006-07, the Mission provided total assistance to states of the order of Rs. 7,000 crore.

Clear timelines have been worked out for activities under the Mission. Fully trained ASHAs are expected to be in position for every habitation as per norms by 2008.

Systems of community monitoring and village health and sanitation committees are targeted to be in place and provided untied grants to promote local health action by 2008.

1.75 lakh sub-health centers with two ANM each, 30,000 PHCs with three staff nurses each and 6,500 CHCs with seven specialists and nine staff nurses each are targeted to be strengthened / established by 2010, beginning with 30% of the target aimed to be achieved by 2007, in order to provide service guarantees as per the IPHS.

The same timelines also apply to the strengthening of 1,800 Taluka / Sub-Divisional hospitals and 600 district hospitals.

Rogi Kalyan Samitis are targeted to be established for all the CHCs, sub-divisional hospitals and district hospitals by 2009, beginning with 50% centres / hospitals by 2007.

District Health Action Plan for the period till 2012 are to be prepared for all the districts by 2008. Health Centres at all levels will be provided untied grants as well as annual maintenance grants, beginning with 50% coverage by 2007 and full coverage by 2008.

Health centres / hospitals at various levels will be fully equipped to provide service guarantees for family welfare, vector-borne disease programmes, tuberculosis, HIV/AIDS etc., by 2010, beginning with 30% coverage by 2007.

Mobile medical 11 units are to be provided to each district by 2009, beginning with 30% coverage by 2007. Institution-wise assessment of performance against assured service guarantees will be carried out and annual reports on public health published for states and districts by 2010, beginning with a target of 30% by 2008.

HIV/AIDS: The formation of the National Council on AIDS has given direction to the National AIDS Control Programme Phase-III (NACP-III) for making AIDS everyone's business and mainstreaming HIV/AIDS concerns in programmes and schemes across relevant Ministries in order to achieve the Millennium Development Goal of halting and reversing the AIDS epidemic by 2011, rather than the global target of 2015 through scaling up of access to preventive services, counselling and testing facilities in the general population for behavior change towards a more responsible life style.

NACP-III, starting in 2007-08, will target high-risk groups in all states.

The Government will expand access to condoms and ensure universal access to blood screening and safe blood. More hospitals will provide treatment to prevent transmission of HIV/AIDS from mother to child. Support will be given to the protocol on paediatric dosage to prevent mother to child HIV transmission.

Outlays have more than doubled over the past two budgets. In addition, the Government has approved accessing financial grant of over Rs. 300 crore from the Global Fund to fight AIDS, Tuberculosis and Malaria for implementing and scaling up the Prevention of Parent to Child Transmission programme in the six high prevalence states till 2008-09.

Population Stabilization: Comprehensive health care as basic to family planning has been sought to be extended through the NRHM and is expected to contribute to population stabilization.

The use of the term population control has been dropped. The emphasis is on voluntary acceptance through awareness creation and better access rather than on a target oriented approach through directives from the State. Incentives to ASHAs under the NRHM include those for family planning.

Janani Suraksha Yojana has been launched to promote institutional deliveries. States have been advised to address population stabilization through investment in health, education and empowerment.

The learning from southern states would be formulated through appropriate strategies in the demographically weaker states after studying their peculiar conditions. The National Population Commission has been reconstituted and has met.

Pradhan Mantri Swasthya Suraksha Yojana: In order to fill the gap in tertiary healthcare infrastructure as well as facilities for quality medical education in under-served states, the Government has approved Pradhan Mantri Swasthya Suraksha Yojana for establishing six new institutions like the All India Institute of Medical Sciences in Bihar, Madhya Pradesh, Orissa, Rajasthan, Chhattisgarh and Uttarakhand as well as upgrading several more such institutions.

Each institution will consist of a 850-bed hospital providing state-of-the-art medical treatment facilities through streamlined referral system in 39 speciality / super-specialty disciplines and will provide medical education with an intake of a hundred under-graduate students every year, besides postgraduate and doctoral courses in specialty / super-specialty disciplines.

Affordable and safe medicine: A Group of Ministers is considering a draft of a National Pharmaceuticals Policy that seeks to harmonise price control issues with growth requirements of the pharmaceuticals industry and simplify the procedure for price fixation and price monitoring.

All the three Central pharmaceuticals PSEs had been sick and stood referred to the BIFR for the last 10 to 20 years. The Government has taken up their revival in mission mode. Revival packages have been approved for, Hindustan Antibiotics Ltd. and Bengal Chemicals and Pharmaceuticals Ltd. with cash infusion and waiver amounting to several hundred crore rupees.

The revival package for Indian Drugs and Pharmaceuticals Ltd. is under consideration. Restructuring of the Central Drug Standards Control Organisation into the autonomous Central Drug Authority of India will provide a better regulatory frame.

Public Health Foundation of India: The Public Health Foundation of India has been set up as a new model of public-private partnership, with the objective of making a substantial impact on public health education by building new world-class public health institutions and strengthening the existing ones, creating a critical mass of high quality faculty in the field of public health, setting standards in public health education, carrying out India-relevant research and enabling appropriate policy formulation to create meaningful career tracks for public health professionals.

Universalising ICDS: The Government has sanctioned 2.95 lakh anganwadi centres and 25,961 mini-anganwadi centres in two phases as parts of its commitment to ensure an anganwadi centre in every habitation, as per the existing population norm of one centre for a population of 1,000 (700 for tribal/hilly/desert areas), during the Eleventh Plan period for reaching out to all children below six years of age, pregnant women and lactating mothers.

With this, the number of anganwadi centres sanctioned has increased by around 40% to over 10 lakh centres in just two years. Financial norms for supply of supplementary nutrition have been doubled to two Rupees per beneficiary per day since October 2004 to ensure that the required quantity of nutrients is available to beneficiaries.

To enable state governments to provide supplementary nutrition without problems, the Union Government has decided to give support amounting to up to 50% of expenditure incurred by the state government.

New population norms for setting up anganwadi centres are being formulated. Nutrition is now provided to all pregnant women, lactating women and children, and is no longer limited to those belonging to families living below the poverty line.

The aim is that proportion of underweight children should get reduced by almost 1% every year. The Government proposes to consultatively evolve models for public-private partnership in the ICDS.

AYUSH: Bills have been tabled in Parliament to amend relevant enactments in order to prevent the growth of sub-standard colleges, by making it mandatory to seek prior permission of the Central Government for establishing new colleges, starting new and higher courses and increasing admission capacity in Ayurveda, Siddha, Unani and Homoeopathy colleges, and bringing about transparency and accountability in the functioning of the relevant Councils.

The Indian Medicine and Homoeopathy Pharmacy Bill, 2005 has also been introduced in Parliament to establish the Central Pharmacy Council for Indian Medicine and Homoeopathy to regulate and standardise pharmacy education.

In order to address domestic as well as global concerns relating to presence of heavy metals in 13 Ayurveda, Siddha and Unani formulations, mandatory testing of heavy metals for the presence of arsenic, lead, mercury and cadmium in all purely herbal Ayurveda, Siddha and Unani drugs for export purposes has been introduced.

New schemes are proposed to be introduced under the Eleventh Plan for developing accredited AYUSH Centres of Excellence in nongovernmental/private sector, providing common facilities for AYUSH industries clusters, strengthening of international cooperation and promoting public private partnership for setting up specialty clinics in AYUSH hospitals and mainstreaming of AYUSH in national health care delivery.

KR/SK/Report to the People - 61 (PIB)