2012 icsa gs indian economics lecture 4

UPSC Civil Services Examination,2012
Health and Family Welfare in India
Incorporating the Mid-term Appraisal of Eleventh Five Year Plan

Prof. Subir Maitra,
Institute for Civil Service Aspirants, Salt Lake ,Kolkata
(in collaboration with Confedaration of Indian Industries--CII)
iasstudymat.blogspot.com
21.01.2012

Prof. S.Maitra
21 January, 2012 1

Prof. S.Maitra
21 January, 2012 2

Prof. S.Maitra
21 January, 2012 3

Prof. S.Maitra
21 January, 2012 4

Prof. S.Maitra
21 January, 2012 5

Prof. S.Maitra
21 January, 2012 6

Prof. S.Maitra
21 January, 2012 7

Prof. S.Maitra
21 January, 2012 8

Prof. S.Maitra
21 January, 2012 9

Health: Eleventh Plan Vision
•Health as a right for all citizens is the goal that the Plan will strive towards.
•A comprehensive approach that encompasses individual health care, public
health, sanitation, clean drinking water, access to food, and knowledge of
hygiene, and feeding practices.
•To transform public health care into an accountable, accessible, and affordable
system of quality services.
•Convergence and development of public health systems and services that are
responsive to the health needs and aspirations of the people.
•Public provisioning of quality health care to enable access to affordable and
reliable heath services, especially in the context of preventing the non-poor from
entering into poverty or in terms of reducing the suffering of those who are
already below the poverty line.
•Reducing disparities in health across regions and communities by ensuring
access to affordable health care.
•Good governance, transparency, and accountability in the delivery of health
services that is ensured through involvement of Panchayati Raj Institutions
(PRI)s, community, and civil society groups.

Prof. S.Maitra
21 January, 2012 10

Health: Eleventh Plan Goals

•To raise public spending on health from 0.9 per cent of GDP to 2-3
per cent of GDP, with improved arrangement for community
financing and risk pooling.
•To undertake architectural correction of the health system to
enable it to effectively handle increased allocations and promote
policies that strengthen public health management and service
delivery in the country.
•Reduction in child and maternal mortality.
•Universal access to public services for food and nutrition,
sanitation and hygiene.
•Universal access to public health care services, integrated
comprehensive primary health care, with emphasis on services
addressing women’s and children’s health and universal
immunization.
•Prevention and control of communicable and non-communicable
diseases, including locally endemic diseases.
•Population stabilization, gender and demographic balance.
•Revitalize local health traditions and mainstream AYUSH.
•Promotion of healthy lifestyles. S.Maitra
21 January, 2012
Prof.
11

Health: Eleventh Plan Objectives
•Reducing Maternal Mortality Ratio (MMR) to 1 per 1,000 live births.
•Reducing Infant Mortality Rate (IMR) to 28 per 1,000 live births.
•Reducing Total Fertility Rate (TFR) to 2.1.
•Providing clean drinking water for all by 2009 and ensuring no slip-backs.
•Reducing malnutrition among children in the age group 0–3 year to half its present level.
•Reducing anaemia among women and girls by 50 per cent.
•Raising the sex ratio in the age group 0–6 years to 935 by 2011–12, and to 950 by 2016–17.
•Malaria Mortality Reduction Rate: 50 per cent up to 2010, additional 10 per cent by 2012.
•Kala Azar Mortality Reduction Rate: 100 per cent by 2010 and sustaining elimination until
2012.
•Filaria / Microfilaria Reduction Rate: 70 per cent by 2010, 80 per cent by 2012 and
elimination by 2015.
•Dengue Mortality Reduction Rate: 50 per cent by 2010 and sustaining at that level until 2012.
•Cataract operations: Increase to 46 lakhs by 2012.
•Leprosy Prevalence Rate: Reduce from 1.8 per 10,000 in 2005 to less that 1 per 10,000
thereafter.
•Tuberculosis DOTS series: Maintain 85 per cent cure rate through entire mission period and
also sustain planned case detection rate.
In terms of systems improvements the NRHM targets were:
•Upgrade all PHCs into 24x7 PHCs by the year 2010.
•Upgrading all Community Health Centres to Indian Public Health Standards.
•Increase utilization of first referral units from bed occupancy by referred cases of less than 20
per cent to over 75 per cent.
•Engaging 4,00,000 female Accredited Social Health Activists (ASHAs).
Prof. S.Maitra
21 January, 2012 12

Prof. S.Maitra
21 January, 2012 13

Maternal Mortality Ratio (MMR)
To reach the MMR target of 100 by 2012, the required rate of decline from 254
(SRS 2004-06) has to be, on an average, 22 per year. Unfortunately, no data are
available on the progress of MMR during the Eleventh Plan period i.e. the period
beginning 2007-08. However, earlier data shows that MMR came down from 301
(SRS 2001-03) to 254 (SRS 2004-06), i.e., an average decline of 16 per year.
Achieving the Eleventh Plan target clearly requires much faster progress. State wise
decline during the pre-Eleventh Plan period varied from an average of 26 per year for
Uttar Pradesh/Uttarakhand, 20 per year for Bihar/Jharkhand, 19 per year for
Rajasthan, 18 per year for Orissa/ West Bengal to 15 per year for Madhya Pradesh/
Chhattisgarh.
When 52.2 per cent of the deliveries are conducted at home (DLHS-3, 2007-8)
and comprehensive obstetric care continues to be a problem in many States, the
scope for expanding timely access to quality institutional care is limited, particularly
for those living in remote and inaccessible areas. In such a scenario, the MMR goal
Prof. S.Maitra
of 21 January,achievable only through appropriate area specific interventions.
100 is 2012 iasstudymat.blogspot.com
14

Infant Mortality Rate (IMR)
Although IMR is showing a downward trend, but the rate of improvement here
too has to be three times that in the past so as to attain the level expected by the end
of Eleventh Plan. All India IMR was 57 in 2006 and 53 in 2008 (SRS), a decrease of 4
in two years. High focus States of NRHM have shown marginally better performance
in rural areas, where IMR has decreased by 5 in two years. Tamil Nadu has also
shown marginally better performance, a decline of 6 in two years. To achieve IMR of
28 by 2012, the required rate of decrease has to be an average of 6 per year.
Intensive and urgent efforts are required to adopt homebased newborn care based on
validated models such as the Gadchiroli model and make focused efforts for
encouraging breast feeding and safe infant and child feeding practices. While
emphasis on early breast feeding is part of ASHAs training, special training on
neonatal care for community and facility level health functionaries will facilitate a
faster reduction in IMR.
Prof. S.Maitra
21 January, 2012 15

Prof. S.Maitra
21 January, 2012 16

Prof. S.Maitra
21 January, 2012 17

Prof. S.Maitra
21 January, 2012 18

Prof. S.Maitra
21 January, 2012 19

HOME BASED NEWBORN CARE (HBNC)
•Efforts to improve home based care have proven successful at improving
child survival. Home Based Newborn and Child Care is to be provided by a
trained Community Health Worker (such as the ASHA) who guides and
supports the mother, family, and TBA in the care of newborn, and attends
the newborn at home if she is sick. The worker is supervised by a field
person (ANM/LHV or a doctor) who visits the community once in 15 days.
Community acceptance and coverage of such care has been quite good.
•The GoI approved the implementation of HBNC based on the Gadchiroli
model, where appreciable decline in IMR has been documented on the basis
of work done by a VO called SEARCH. Gadchiroli has shown how ordinary
women can do extraordinary things: a well-trained local woman can not
only lower neonatal mortality but can also bring about attitudinal change.
The women Shishu Rakshaks of Gadchiroli have managed to dispel many
myths surrounding pregnancy and have been able to ensure better
nutrition, care, immunization, and hygiene.
•The national strategy during the Plan will be to introduce and make
available high-quality HBNC services in all districts/areas with an IMR
more than 45 per 1000 live births. Apart from performance incentive to
ASHAs, an award will be given to ASHAs and village community if no
mother–newborn or child death is reported in a year.
Prof. S.Maitra
21 January, 2012 20

National Rural Health Mission
•NRHM was launched on April 12, 2005, to provide accessible, affordable and accountable quality
health services to the poorest households in the remotest rural regions. Allocation has been increased to
Rs. 12,070 crore in interim budget for 2009-10 compared to Rs. 12,050 crore in 2008-09. NRHM is
being operationalized throughout the country, with special focus on 18 states which includes 8
Empowered Action Group States (Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Uttar Pradesh,
Uttarakhand, Orissa and Rajasthan), 8 NE states, Himachal Pradesh and Jammu & Kashmir.
•The main aim of NRHM is to provide accessible, affordable, accountable, effective and reliable
primary health care facilities, especially, to the poor and vulnerable sections of the population. It also
aims at bridging the gap in rural health care services through the creation of a cadre of Accredited Social
Health Activists (ASHA) and improved hospital care, decentralization of programme to district level to
improve intra and inter-sectoral convergence and effective utilization of resources. NRHM further aims
to provide overarching umbrella to the existing programmes of health and family welfare including
RCH-II, malaria, blindness, iodine deficiency, filaria, kala-azar, tuberculosis, leprosy and for integrated
disease surveillance. Further, it addresses the issue of health in the context of sector-wide approach
towards sanitation and hygiene, nutrition and safe drinking water as basic determinants of good health in
order to have greater convergence among the related social sector departments i.e. AYUSH, Women &
Child Development, Sanitation, Elementary Education, Panchayati Raj and Rural Development. The
mission further seeks to buildgreater ownership of the programme among the community through
involvement of Panchayati Raj Institutions, NGOs and other stakeholders at national, state, district and
sub-district levels to achieve the goals of National Population Policy 2000 and National Health Policy.
The expected outcomes of the mission include reduction of IMR to below 30/1000 live births, MMR to
below 100/100,000 live births & TFR to 2.1 by 2012.
Prof. S.Maitra
21 January, 2012 21

Prof. S.Maitra
21 January, 2012 22

Prof. S.Maitra
21 January, 2012 23

Performance of NRHM:
•7.49 lakh Accredited Social Health Activists (ASHAs) have been selected though the total number of
those who have completed all training modules is low. Against the target of 6 lakh fully trained ASHAs by
2008 there are 5.19 lakh ASHAs positioned with drug kits, but their training is still to be completed. Only
about 1.99 lakh ASHAs have completed all five modules and 5.65 lakh have completed up to fourth
training module.
•4.51 lakh Village Health and Sanitation Committees (VHSCs) have been set up against the target of 6
lakh VHSCs by 2008. The operational effectiveness of the VHSCs, however, needs considerable
improvement.
•40,426 Sub-centres (SCs) have been provided two ANMs against the target of 1.05 lakh SCs by 2009.
8,745 SCs are without even a single ANM.
•8,324 Primary Health Centres (PHCs) are functional on 24X7 basis and 5,907of them have three Staff
Nurses against the target of 18,000 PHCs by 2009.
•3,966 Community Health Centres (CHCs) are functional on 24X7 basis. However, information regarding
the target of strengthening 3250 CHCs with seven specialists and nine staff nurses by 2009 is not
available. In any case, the number of CHCs/Sub-Divisional Hospitals or equivalent, which have been
upgraded to First Referral Unit (FRU) has increased from 750 (as on 31 March 2005) to 1934 (as on 31
December 2009).
•510 out of total 578 District Hospitals (DHs) have been strengthened to act as FRUs.
•29,223 Rogi Kalyan Samitis (RKSs)/Hospital Development Committees have been constituted at
PHC/CHC/DH levels against the target of 37,100 RKSs by 2009.
•State & District Societies are in place except at the State level in West Bengal. District Programme
Managers and District Accounts Managers are in position in 581 and 579 districts respectively.
•356 Districts have operational Mobile Medical Units (MMUs) against the target of 600 MMUs by 2009
(one for each district). In addition, boat clinics in Assam & West Bengal, emergency transport system in
Andhra Pradesh, Gujarat, Karnataka, Goa, Uttarakhand, Assam and Rajasthan, GPS enabled MMUs in
Gujarat, Haryana and Tamil Nadu are operational.
Prof. S.Maitra
21 January, 2012 24

Prof. S.Maitra
21 January, 2012 25

Human Resources for Health
•Measures have been taken during the Eleventh Five Year Plan period to solve
the problem of shortage of basic education infrastructure and human
resources:.
•Ensure availability of medical professionals in rural areas on a permanent
basis, posting of doctors with adequate monetary as well as non-monetary
incentives, such as suitable accommodation, class I status, preferential school
admissions for children of doctors living in remote areas, transfer or posting of
choice after a stipulated length of stay and training opportunities.
•States to expand the pool of medical practitioners including a cadre of
Licentiate Medical Practitioners and practitioners of Indian Systems of Medicine
and Homeopathy (AYUSH).
••Increase age of retirement of doctors (all Central and State Government
including Defence, Railways, etc.) to 62 years. States will be encouraged to
retain public health doctors on contract basis for further period of three years
till the age of 65 years, especially in the notified hardship areas.
•• A series of one-year duration Certificate Courses for MBBS graduates will be
launched in deficit disciplines like public health, anaesthesia, psychiatry,
geriatric care, and oncology. The private sector will also be encouraged to
participate
Prof. S.Maitra
21 January, 2012 26

Qualitative Feedback of NRHM: Voices from the Field
Accredited Social Health Activists (ASHAs)
The appointment of locally recruited women as Accredited Social Health Activists (ASHAs) who would link
potential beneficiaries with the health service system is an important element of the NRHM. The good part
is that
7.49 lakh ASHAs have been appointed; but several issues still need to be resolved. Not only is there a
lack of transparency in the selection, ASHAs are often inadequately trained. Besides, their only focus
seems to be on facilitating institutional deliveries. The ASHA who accompanies the expectant mother
faces considerable hardship because she has nowhere to stay for the duration of confinement as
institutional accommodation facilities are non-existent. They also often experience long delays in payment
of incentives.
Village Health and Nutrition Day (VHND)
An important activity of NRHM, Village Health and Nutrition Day is to
promote regular community-oriented health and nutrition activities. The
event is held on a fixed day every month to sensitise the community and is
popularly known as ‘Tika Karan Divas’. However, implementation is ad-
hoc in most villages of the high focus States. Surveys revealed that only a
few pockets in some States like Tamil Nadu, Andhra Pradesh, West Bengal
and Assam were aware of VHND. The other drawback of the programme
was that it often restricted itself to immunisation and antenatal check up
are done on the day. There is no nutrition education. To have the desired
impact, VHNDs need to be implemented with the full intended content of
activities and with regularity. This can be achieved through more active
involvement of NGOs and community based organizations.
Prof. S.Maitra
21 January, 2012 27

Janani Suraksha Yojana (JSY)
Launched to promote institutional deliveries, JSY provides cash
incentive to expectant mothers who opt for institutional delivery.
Poor women from the remote districts in Bihar, Orissa and other
States are reported to be visiting institutions to avail JSY benefits.
However, except for parts of Southern States, most public health
institutions are not well equipped for conducting deliveries at the
community or even at the block level. The beneficiaries are often
asked to purchase gloves, syringes and medicines from the market.
The general view, endorsed by visits to the field is that the health
centres and subdivisional hospitals remain understaffed and are
poorly run and maintained. A very large number are unhygienic and
incapable of catering to the patient load. Women who deliver at the
health facility are discharged a few hours after delivery. Sometimes,
deliveries take place on the way to the health facility or even outside
the locked labour rooms. Lack of co-ordination and mutual
understanding between the ANM and ASHA results in the suffering
of pregnant women.
21 January, 2012
Prof. S.Maitra
28

Maternal & Child Health
NRHM has been able to provide an extensive network of transport facilities in
States that have established emergency transport systems. On the other hand,
there is very little awareness about the Integrated Management of Neonatal and
Childhood Illnesses (IMNCI) strategy. In the event of illness of either the mother or
the neo-nate, RMPs (some times even local quacks) are consulted. Home-based
new born care based on Gadchiroli model and other community based innovations
have yet to be made an integral part of the child health strategy.

Rashtriya Swasthya Bima Yojana (RSBY)
Launch of RSBY by Ministry of Labour & Employment in 2007 has been an important step to
supplement the efforts being made to provide quality health care to the poor and
underprivileged population. It provides cashless health insurance cover up to Rs.30,000 per
annum per family. The premium is paid by the Centre and State Governments on a 75:25
sharing basis with the beneficiary paying only a registration fee.
Twenty-five States are in the process of implementing the RSBY and till February 2010, more
than 1.25 crore biometric enabled smart cards have been issued for providing health
insurance cover to more than 4 crore people, from any empanelled hospital throughout the
country. Around 4.5 lakh persons have already availed hospitalisation facility. The scheme is
now being gradually extended to the non-BPL category of workers as well. Linkages with
RSBY in public sector hospitals need to be strengthened.

Prof. S.Maitra
21 January, 2012 29

National AIDS Control Programme (NACP)
The NACP goal was to halt and reverse the epidemic in India
over the five years period of the Eleventh Plan. This was to be
done by integrating programmes for prevention, care, support
and treatment, as well as addressing the human rights issues
specific to people living with HIV/AIDS (PLWHA).. Although
the achievement of physical targets under the programme is
satisfactory, MoHFW has yet to introduce a HIV/AIDS Bill to
protect the rights of children, women and HIV infected persons
and avoid discrimination at work place. A National Blood
Transfusion Authority is to be established during the
remaining period of the Plan. Voluntary blood donation has to
be encouraged further to bridge the gap in demand and
supply of blood. Expenditure under National AIDS Control
Programme including STD control during 2007-08 and
2008-09, has been 112.60 per cent and 91.91 per cent of the
approved. Prof. S.Maitra
21 January, 2012 30

Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)
•The PMSSY envisages substantial expansion of central and state government
medical institutions. Phase 1 of PMSSY envisages establishment of six new AIIMS
like institutions at Patna (Bihar), Bhopal (Madhya Pradesh), Bhubaneswar
(Orissa), Jodhpur (Rajasthan), Raipur (Chhattisgarh) and Rishikesh (Uttarakhand).
The original estimate of each institute was Rs. 332 crore and the latest estimate
is about Rs. 820 crore. For these new ‘AIIMS like institutions’, construction of
medical colleges and hospital complexes and construction of residential
complexes have been taken up as separate activities. Construction of housing
complex at all six sites has commenced and work for medical colleges and
hospital complexes is likely to start in the second quarter of 2010-11.
The second component of PMSSY Phase 1 includes upgradation of 13 State
Government medical college institutions. These are at Government Medical
College, Jammu (Jammu & Kashmir); Government Medical College, Srinagar
(Jammu & Kashmir); Kolkata Medical College, Kolkata (West Bengal); Sanjay
Gandhi Post Graduate Institute of Medical Sciences, Lucknow (Uttar Pradesh);
Institute of Medical Sciences, BHU, Varanasi (Uttar Pradesh); Nizam Institute of
Medical Sciences, Hyderabad (Andhra Pradesh); Sri Venkateshwara Institute of
Medical Sciences, Tirupati (Andhra Pradesh); Government Medical College,
Salem (Tamil Nadu); Rajendra Institute of Medical Sciences, Ranchi
Prof. S.Maitra
21 January, 2012 31

•(Jharkhand); B.J. Medical College, Ahmedabad (Gujarat); Bangalore Medical College,
Bangalore (Karnataka); Grants Medical College & Sir J.J. Group of Hospitals, Mumbai,
(Maharashtra) and Medical College, Thiruvananthapuram, (Kerala). The outlay provided is
Rs.120 crore per institution, of which Rs. 100 crore would be borne by the Central Government
(for SVIMS, Tirupati, it is Rs.60 crore) and the remaining amount will be contributed by the
respective States. The State Governments will also provide the resources (human resources
and recurring expenditure) for running the upgraded facilities. Upgrading of two State
Government medical college institutions is over. Another four are expected to be upgraded by
July 2010, two by December, 2010 and the remaining in 2011.
•Phase II of PMSSY, approved recently, provides for the establishment of two new AIIMS like
institutions in Uttar Pradesh and West Bengal and upgrading of six State Government medical
college institutions at Government Medical College, Amritsar (Punjab); Government Medical
College, Tanda (Himachal Pradesh); Government Medical College, Nagpur (Maharashtra);
Jawaharlal Nehru College of Aligarh Muslim University, Aligarh (Uttar Pradesh); Government
Medical College, Madurai (Tamil Nadu) and Pandit B.D. Sharma Postgraduate Institute of
Medical Sciences, Rohtak (Haryana).

•Overall expenditure under PMSSY had shown improvement in 2008-09
with expenditure of 92.86 per cent as against 58.33 per cent in 2007-08.
However, the anticipated expenditure based on RE figures in the current
year (2009-10) is only 47.21 per cent of the approved outlay for 2009-10.

Prof. S.Maitra
21 January, 2012 32

AYURVEDA, YOGA AND NATUROPATHY, UNANI, SIDDHA,
AND HOMEOPATHY (AYUSH)
•There is a resurgence of interest in holistic systems of health care,
especially, in the prevention and management of chronic lifestyle related
non-communicable diseases and systemic diseases. To mainstream
AYUSH by designing strategic interventions for wider utilization of AYUSH
both domestically and globally, the thrust areas in the Eleventh Five Year
Plan are: strengthening professional education, strategic research
programmes, promotion of best clinical practices, technology upgradation
in industry, setting internationally acceptable pharmacopoeial standards,
conserving medicinal flora, fauna, metals, and minerals, utilizing human
resources of AYUSH in the national health programmes, with the ultimate
aim of enhancing the outreach of AYUSH health care in an accessible,
acceptable, affordable, and qualitative manner.
•During the Tenth Plan, the Department continued to lay emphasis on
upgradation of AYUSH educational standards, quality control, and
standardization of drugs, improving the availability of medicinal plant
material, R&D, and awareness generation about the efficacy of the systems
domestically and internationally. Steps were taken in 2006–07 for
mainstreaming AYUSH under NRHM with the objective of optimum
utilization of AYUSH for meeting the unmet needs of the population.
Prof. S.Maitra
21 January, 2012 33

Health Care Services under AYUSH
•The AYUSH sector across the country supported a network of
3203 hospitals and 21351 dispensaries. The health services
provided by this network largely focused on primary health care.
The sector has a marginal presence in secondary and tertiary
health care. In the private and not-for-profit sector, there are
several thousand AYUSH clinics and around 250 hospitals and
nursing homes for in patient care and specialized therapies like
Panchkarma.
•In clinics and nursing homes there are anecdotal reports of the
role of AYUSH in the successful management of several
communicable and noncommunicable diseases. However, there is
no macrodata available about the contribution of AYUSH to major
national programmes for the management of communicable and
NCDs. A major challenge in Eleventh Five Year Plan is to identify
reputed clinical centres and support upgradation of their facilities
via PPP schemes so that the country can boast of a national
network of high-quality clinical facilities developed for rendering
specialized health care in strength areas of AYUSH.
Prof. S.Maitra
21 January, 2012 34

AYUSH under NRHM
•Despite having a different scheme of diagnosis, drug
requirements, and treatments as compared to the mainstream
health care system, preliminary efforts to integrate AYUSH in
NRHM were initiated during the Tenth Plan. It is too early to assess
if the AYUSH interventions in NRHM have had significant health
impact by way of complementing the conventional national health
programmes. Integrating AYUSH into NRHM has the potential of
enhancing both the quality and outreach of NRHM, especially with
the availability of a large number of practitioners in this field.
Supporting strategic pilot action research projects in the Eleventh
Five Year Plan to evolve viable models of integration seems
necessary.
Mainstreaming AYUSH
•NRHM has mainstreamed AYUSH into the rural health services by
co-locating AYUSH personnel in primary health care facilities
resulting in increase in utilization of AYUSH treatment. AYUSH
practitioners are also used to fill in the position of Allopaths in
Primary Health Centres particularly in States that have a
substantial shortage of MBBS doctors. While this is a positive
development, efforts have to be made for training AYUSH
Prof. S.Maitra
practitioners in public health.
21 January, 2012
35

2012 icsa gs indian economics lecture 4

Recomendados

Recomendados

Más contenido relacionado

La actualidad más candente

La actualidad más candente (7)

Similar a 2012 icsa gs indian economics lecture 4

Similar a 2012 icsa gs indian economics lecture 4 (20)

Más de Dr. Subir Maitra

Más de Dr. Subir Maitra (20)

Último

Último (20)

2012 icsa gs indian economics lecture 4