INDIAN ADMINISTRATION

The democratic nature of the Indian sub-continent has been

engraved in its Constitution. A country that firmly believes that the
government is ‘by the people, for the people, of the people’ the Indian
administration decides and acts for all the citizens without any biases.
While the Constitution of India is unique, the administration is
predominantly divided into three divisions.

Indian Administration is carried out by the Parliament. Parliament

is the supreme legislative body of a country. Indian Parliament comprises
of the President and the two Houses, Lok Sabha (House of the People)
and Rajya Sabha (Council of States). Any bill can become an act only
after it is passed by both the houses of the Parliament and assented by the
President. The Parliament House is a circular building designed by the
British architect Herbert Baker in 1912.

Constitution of India

The Constitution of India was passed by the Constituent Assembly

of India on November 26, 1949, and came into effect on January 26,
1950. The Indian constitution was prepared by Dr.Babasaheb Ambedkar.
The Constitution of India is the world’s lengthiest written constitution
having 395 articles and 8 schedules. The Constitution of India is the basic
law of the country. It lays down the basic structure of the government
administration under which its people are to be governed. It establishes
the main organs of the government - the executive, the legislature and the
judiciary.

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Indian General elections

Indian Administration include all general elections held in India

from 1951 to present day. In 1947, India attained her independence. The
Constitution of India came into force on January 26, 1950. The first
general elections under the new Constitution were held during the year
1951-52 and the first elected Parliament came into being in April, 1952,
the Second General elections in April, 1957, the Third General elections
in April, 1962, the Fourth General elections in March, 1967, the Fifth
General elections in March, 1971, the Sixth General elections in March,
1977, the Seventh General elections in January, 1980, the Eighth General
elections in December, 1984, the Ninth General elections in December,
1989, the Tenth General elections in June, 1991, the Eleventh General
elections in May, 1996, the Twelfth General elections in March, 1998 and
Thirteenth General elections in October, 1999 and the Fourteenth General
elections in May 2004.

Indian Administration introduces you to the National Identity

Elements of India. These symbols are intrinsic to the Indian identity and
heritage. All Indians across the world are proud of these National
Symbols as they instill a sense of pride and patriotism in every Indian’s
heart. The National Symbols of India are

National Anthem-- Jana-Gana-Mana-Adhinayaka, Jaya He

National Tree --Indian fig tree
National Song --Vande Mataram
National Calendar --based on the Saka Era
National Animal --tiger
National Bird --Peacock
National Flower --Lotus
National Fruit – Mango

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Indian Prime Ministers

The Prime Minister of India is the Head of the Union

Governnment.Indian Administartion is carried in the name of the
President but the prime minister is the head of the Union Government.
After India’s independence from Britain in 1947, Jawaharal Nehru
became the first prime minister. The present Indian Prime Minister is Dr.
Manmohan Singh.

Indian Paramilitary forces

Paramilitary Forces of India is regarded as the second largest of the

world .Paramilitary forces act as auxiliary forces deployed for counter
insurgency or anti terrorist missions. Indian Paramilitary Forces are
Assam Rifles ,Border Security Force ,Central Industrial Security Force,
Central Reserve Police Force ,Rapid Action Force ,Indo-Tibetan Border
Police, Rashtriya Rifles, Defence Security Corps , Railway Protection
Force ,Indian Home Guard, Civil Defence, Special Security Bureau ,
National Security Guards, Special Protection Group ,Special Frontier
Force, etc. They help the Indian Administration in counter insurgency
and in other domestic problems.

Indian Flag

India’s flag is made up of three horizontal bands of colour; they

are, (top to bottom), saffron yellow, white and green. The saffron yellow
symbolizes the spiritual nature of India, as saffron is the colour worn by
sadhus or Hindu holy men. The white bar symbolizes peace, while green
symbolizes wealth through agriculture. In the middle of the flag is a blue
wheel, symbolizing the importance of truth and honesty. This part of
Indian administration have a detailed description about Indian flag, its
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origin, meaning, Geographical and political facts, flags and ensigns of
India.

HEALTH CARE SYSTEM

In India, the hospitals are run by government, charitable trusts and

by private organizations. The government hospitals in rural areas are
called the (PHC)s primary health centre. Major hospitals are located in
district head quarters or major cities. Apart from the modern system of
medicine, traditional and indigenous medicinal systems like Ayurvedic
and Unani systems are in practice throughout the country. The Modern
System of Medicine is regulated by the Medical Council of India,
whereas the Alternative systems recognised by Government of India are
regulated by the Department of AYUSH (an acronym for Ayurveda,
Yunani, Siddha & Homeopathy) under the Ministry of Health,
Government of India. PHC's are non-existent in most places, due to poor
pay and scarcity of resources. Patients generally prefer private health
clinics. These days some of the major corporate hospitals are attracting
patients from neighboring countries such as Pakistan, countries in the
Middle East and some European countries by providing quality treatment
at low cost. In 2005, India spent 5% of GDP on health care, or US$36 per
capita. Of that, approximately 19% was government expenditure, but now
the situation is changing.

Healthcare Infrastructure

The Indian healthcare industry is seen to be growing at a rapid pace

and is expected to become a US$280 billion industry by 2022. The Indian
healthcare market is currently estimated at US$35 billion and is expected
to reach over US$75 billion by 2012 and US$150 billion by 2017.

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According to the Investment Commission of India the healthcare sector
has experienced phenomenal growth of 12 percent per annum in the last 4
years. Rising income levels and a growing elderly population are all
factors that are driving this growth.In addition, changing demographics,
disease profiles and the shift from chronic to lifestyle diseases in the
country has led to increased spending on healthcare delivery.

Even so, the vast majority of the country suffers from a poor
standard of healthcare infrastructure which has not kept up with the
growing economy. Despite having centers of excellence in healthcare
delivery, these facilities are limited and are inadequate in meeting the
current healthcare demands. Most public health facilities lack efficiency,
are understaffed and have poorly maintained or outdated medical
equipment.

Approximately one million people, mostly women and children,

die in India each year due to inadequate healthcare. 700 million people
have no access to specialist care and 80% of specialists live in urban
areas.In addition to poor infrastructure India faces a shortage of trained
medical personal especially in rural areas where access to care is
altogether limited.

According to WHO statistics there are over 250 medical colleges in

the modern system of medicine and over 400 in the Indian system of
medicine and homeopathy (ISM&H). India produces over 250,000
doctors annually in the modern system of medicine and a similar number
of ISM&H practitioners, nurses and para professionals. Better policy
regulations and the establishment of public private partnerships are
possible solutions to the problem of manpower shortage.

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 India faces a huge need gap in terms of availability of number of
hospital beds per 1000 population. With a world average of 3.96 hospital
beds per 1000 population India stands just a little over 0.7 hospital beds
per 1000 population. Moreover, India faces a shortage of doctors, nurses
and paramedics that are needed to propel the growing healthcare industry.
India is now looking at establishing academic medical centers (AMCs)
for the delivery of higher quality care with leading examples of The
Manipal Group & All India Institute of Medical Sciences (AIIMS)
already in place.

As incomes rise and the number of available financing options in

terms of health insurance policies increase, consumers become more and
more engaged in making informed decisions about their health and are
well aware of the costs associated with those decisions. In order to remain
competitive, healthcare providers are now not only looking at improving
operational efficiency but are also looking at ways of enhancing patient
experience overall.

Central government role

Critics say that the national policy lacks specific measures to

achieve broad stated goals. Particular problems include the failure to
integrate health services with wider economic and social development,
the lack of nutritional support and sanitation, and the poor participatory
involvement at the local level.

Central government efforts at influencing public health have

focused on the five-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. Goals and strategies

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are set through central-state government consultations of the Central
Council of Health and Family Welfare. Central government efforts are
administered by the Ministry of Health and Family Welfare, which
provides both administrative and technical services and manages medical
education. States provide public services and health education.

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, from 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 of South
Asia. Although government health care spending progressively grew
throughout the 1980s, such spending as a percentage of the gross national
product (GNP) remained fairly constant. In the meantime, health care
spending as a share of total government spending decreased. During the
same period, private-sector spending on health care was about 1.5 times
as much as government spending.

Healthcare in urban India

Behaviours between middle and upper class citizens from the four
largest metros in India – Delhi, Chennai, Kolkata and Mumbai - appear to
vary widely. In general, those in Chennai appear to be more
“westernized” in their attitude towards medical treatment, i.e. they are
least likely to cite a chemist/pharmacist or the Internet as the source most
frequently used to obtain health-related information, and are most likely
to cite allopathy while least likely to cite homeopathy as their preferred
system of medical treatment. Those in Kolkata appear to have a strong
relationship with their healthcare provider but are generally more
traditional in their attitudes towards medical treatment. Those in Delhi are

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most likely to have a positive view of medical care in India but also tend
to be more traditional in their attitudes towards medical treatment.
Finally, those in Mumbai are most likely to have a negative view on
healthcare in India and also appear to have a weak relationship with their
healthcare providers

Primary services

Health care facilities and personnel increased substantially between

the early 1950s and early 1980s, but because of fast population growth,
the number of licensed medical practitioners per 10,000 individuals had
fallen by the late 1980s to three per 10,000 from the 1981 level of four
per 10,000. In 1991 there were approximately ten hospital beds per
10,000 individuals. However for comparison, the in China for
comparison there are 1.4 doctors per 1000 people.

Primary health centers are the cornerstone of the rural health care
system. By 1991, India had about 22,400 primary health centers, 11,200
hospitals, and 27,400 clinics. These facilities are part of a tiered health
care system that funnels more difficult cases into urban hospitals while
attempting to provide routine medical care to the vast majority in the
countryside. Primary health centers and subcenters rely on trained
paramedics to meet most of their needs. The main problems affecting the
success of primary health centers are the predominance of clinical and
curative concerns over the intended emphasis on preventive work and the
reluctance of staff to work in rural areas. In addition, the integration of
health services with family planning programs often causes the local
population to perceive the primary health centers as hostile to their
traditional preference for large families. Therefore, primary health centers

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often play an adversarial role in local efforts to implement national health
policies.

Health care facilities and personnel increased substantially between

the early 1950s and early 1980s, but because of fast population growth,
the number of licensed medical practitioners per 10,000 individuals had
fallen by the late 1980s to three per 10,000 from the 1981 level of four
per 10,000. In 1991 there were approximately ten hospital beds per
10,000 individuals. However for comparison, the in China for
comparison there are 1.4 doctors per 1000 people.

Primary health centers are the cornerstone of the rural health care
system. By 1991, India had about 22,400 primary health centers, 11,200
hospitals, and 27,400 clinics. These facilities are part of a tiered health
care system that funnels more difficult cases into urban hospitals while
attempting to provide routine medical care to the vast majority in the
countryside. Primary health centers and subcenters rely on trained
paramedics to meet most of their needs. The main problems affecting the
success of primary health centers are the predominance of clinical and
curative concerns over the intended emphasis on preventive work and the
reluctance of staff to work in rural areas. In addition, the integration of
health services with family planning programs often causes the local
population to perceive the primary health centers as hostile to their
traditional preference for large families. Therefore, primary health centers
often play an adversarial role in local efforts to implement national health
policies.

According to data provided in 1989 by the Ministry of Health and

Family Welfare, the total number of civilian hospitals for all states and
union territories combined was 10,157. In 1991 there was a total of

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811,000 hospital and health care facilities beds. The geographical
distribution of hospitals varied according to local socioeconomic
conditions. In India's most populous state, Uttar Pradesh, with a 1991
population of more than 139 million, there were 735 hospitals as of 1990.
In Kerala, with a 1991 population of 29 million occupying an area only
one-seventh the size of Uttar Pradesh, there were 2,053 hospitals.
Although central government has set a goal of health care for all by 2000,
hospitals are distributed unevenly.

By the late 1980s, there were approximately 128 medical colleges

-roughly three times more than in 1950. These medical colleges in 1987
accepted a combined annual class of 14,166 students. Data for 1987 show
that there were 320,000 registered medical practitioners and 219,300
registered nurses. Various studies have shown that in both urban and rural
areas people preferred to pay and seek the more sophisticated services
provided by private physicians rather than use free treatment at public
health centers.

Indigenous or traditional medical practitioners continue to practice

throughout the country. The two main forms of traditional medicine
practiced are the ayurvedic (meaning science of life) system, which deals
with causes, symptoms, diagnoses, and treatment based on all aspects of
well-being (mental, physical, and spiritual), and the unani (so-called
Galenic medicine) herbal medical practice.

A vaidya is a practitioner of the ayurvedic tradition, and a hakim

(Arabic for a Muslim physician) is a practitioner of the unani tradition.
These professions are frequently hereditary. A variety of institutions offer
training in indigenous medical practice. Only in the late 1970s did official
health policy refer to any form of integration between Western-oriented

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medical personnel and indigenous medical practitioners. In the early
1990s, there were ninety-eight ayurvedic colleges and seventeen unani
colleges operating in both the governmental and nongovernmental
sectors.

The majority of the Indian population is unable to access high

quality healthcare provided by private players as a result of high costs.
Many are now looking towards insurance companies for providing
alternative financing options so that they too may seek better quality
healthcare. The opportunity remains huge for insurance providers
entering into the Indian healthcare market since75% of expenditure on
healthcare in India is still being met by ‘out-of-pocket’ consumers. Even
though only 10% of the Indian population today has health insurance
coverage, this industry is expected to face tremendous growth over the
next few years as a result of several private players that have entered into
the market. Health insurance coverage among urban, middle- and upper-
class Indians, however, is significantly higher and stands at
approximately 50%.

The Insurance Regulatory and Development Authority (IRDA) is

the governing body responsible for promoting insurance business and
introducing insurance regulations in India.

Health insurance has a way of increasing accessibility to quality

healthcare delivery especially for private healthcare providers for whom
high cost remains a barrier. In order to encourage foreign health insurers
to enter the Indian market the government has recently proposed to raise
the foreign direct investment (FDI) limit in insurance from 26% to 49%.
Increasing health insurance penetration and ensuring affordable premium
rates are necessary to drive the health insurance market in India.

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Medical Tourism

India is becoming a location for medical tourists seeking health

care at lower costs than in other countries.

HEALTH CARE DELIVERY

The challenge that exists today in many countries is to reach the

whole population with adequate health care services and to ensure their
utilization. The “large hospital” which was chosen hitherto for the
delivery of health services has failed in the sense that it serves only a
small part of the population, that too, living within a small radius of the
building and the services rendered are mostly curative in nature.
Therefore it has been aptly said that these large hospitals are more ivory
towers of diseases than centres for the delivery of comprehensive health
care services. Rising costs in the maintenance of these large hospitals and
their failure to meet the total health needs of the community have led
many countries to seek ‘alternative’ models of health care delivery with a
view to provide health care services that are reasonably inexpensive, arid
have the basic essentials required by rural population.

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HEALTH STATUS AND HEALTH PROBLEMS

An assessment of the health status and health problems is the first

requisite for any planned effort to develop health care services. This is
also known as Community Diagnosis. The data required for analysing the
health situation and for defining the health problems comprise the
following:

1. Morbidity and mortality statistics,

2. Demographic conditions of the population.
3. Environmental conditions which have a bearing On
4. Socio-economic factors which have a direct effect on health.
5. Cultural background, attitudes, beliefs, and practices which affect
health.
6. Medical and health services available.
7. Other services available,

An analysis of the health situation in the light of the above data will
bring out the health problems and health needs of the community. These
problems are then ranked according to priority or urgency for allocation
of resources. A brief description of current demographic and mortality
profile and the health problems of India is given in the following pages.

1. Demographic profile

A major concern today is population explosion. The demographic

profile is characterised by:

• large population base

• high fertility both in terms of birth rate and family size
• low or declining mortality

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 • “young” population (about 35.35 per cent of the population) is
below the age of 15 years the proportion of illiterate population is
close to 34.62 per cent: this explains why the decline in birth rate
has been so slow dependency ratio of 62 per 100; that is, every
economically productive member has to support almost one
dependent.

2. Mortality profile

During the last few decades, there has been a notable improvement
in the health status of the population. The death rate has steadily declined
from 21 (1965) to 7.5 (2004). The life expectancy at birth has gone up
considerably since 1951, recording an estimated 65.3 years during 2001-
2002. The mortality rates for a number of infectious and communicable
diseases have also registered a decline (e.g., cholera, tuberculosis,
malaria).

However, a deeper study reveals distressing situation. India’s

health standards are still low compared to those in developed countries.
While in the world as a whole, the IMR is about 54 per 1000 live births,
and in the developed countries as low as 5, in India it is as high as 58.
Our life expectancy of about 65.3 years lags behind by almost 12-15
years compared to that in developed countries where it is currently
between 76 and 80 years.

The current urban death rate (during 2003) was 6.0 and the rural
death rate 8.7 per 1000 of population. There were also considerable
interstate variations in death rate, as for example, during 2003 the death
rate in Uttar Pradesh was 9.8 as compared to the national average of 8.2
and 6.4 in Kerala. Among the states, Kerala had the lowest IMP of 11 per

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1000 live births and Orissa had the highest IMP of 83 per 1000 live
births.

The death rate is the highest in the age group 0-4 years. This is as a
result of malnutrition and infection. 15 to 25 per cent of total deaths are
attributed to infectious and parasitic diseases.

The HEALTH PROBLEMS of India may be conveniently grouped

under the following heads:

1. Communicable disease problems

2. Nutritional problems

3. Environmental sanitation problems

4. Medical care problems

5. Population problems

Communicable disease problems

Communicable diseases continue to be a major problem in India.

Diseases considered to be of great importance today are (a) Malaria
Malaria continues to be a major health problem in India. With the
implementation of modified operations, the upsurge of malaria cases
dropped down from 6.75 million cases in 1976 to 2.1 million cases in
1984. Since then, the epidemiological situation has not shown any
improvement. Although total malaria cases has declined compared to
previous years, the proportion of has increased. Malaria cases has
increased in Goa, Madhya Pradesh and Orissa. During 2005 there were
940 reported malaria deaths in the country. The reported incidence is
about 1.8 million cases with slide positivity rate of about 2.32%. There
appears little prospect of malaria eradiation in ‘the foreseeable future.
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(b) Tuberculosis : Tuberculosis is another leading public health problem
in India. About 30 per cent of the total population are infected (tuberculin
positive). 1.5 per cent have radiologically active disease of the lungs of
which 0.4 per cent are sputum-positive cases. According to official
estimates, India has .nearly 12.7 million cases of pulmonary tuberculosis
of which about 3.4 million are sputum-positive. The number of deaths is
estimated to be nearly 400,000 every year, (c) Diarrhoeal diseases
Diarrhoeal diseases constitute one of the major causes of morbidity and
mortality, specially in children below 5 years of age. They are responsible
for 7.1 lakh deaths each year. Outbreaks of diarrhoeal diseases (including
cholera) continue to occur in India due to poor environmental conditions.
(d) ARI: Acute repiratory diseases are one of the major causes of
mortality and morbidity in children below 5 years of age. It is estimated
that about 13.6 percent hospital admissions and 13 percent inpatient
deaths in paediatric wards are due to ARI. (e) Leprosy Leprosy is another
major public health problem in India. During the year 2003—2004, total
of 2.20 lakh new cases were detected, out of which child cases were
14.91% and deformity grade II and above was 1.8%. 35.26 per cent of
these cases are estimated to be multibacillary. All the States and Union
Territories report cases of leprosy. However, there are considerable
variations not only between one State and another, but also between one
district and another. The prevalence rate of leprosy is about 2.3 per
10,000 population. The proportion of infectious cases varies between 6-8
percent. In short, India accounts for about 60% of the leprosy cases in the
world. (f) Filaria The problem is increasing in magnitude every year,
having risen from 25 million at risk in 1953 to 553 million presently. Of
these 109 million are living in urban areas and the rest in rural areas.
There are estimated to be at least 6 million attacks of acute filarial disease
per year, and at least 45 million persons currently have one or more
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chronic filarial lesions. (g) AIDS The problem of AIDS is increasing in
magnitude every year. Since AIDS was first detected in the year 1986, the
cumulative number of AIDS cases has risen to 124995 by the end of
August 2006. It Is estimated that by the end of year 2005 there were
about 5.7, million HIV positive cases in the country. (h) Others Kala-
azar, meningitis, viral hepatitis, Japanese encephalitis, enteric fever and
helminthic infestations are among the other important communicable
disease problems in India. The tragedy is that most of these diseases can
be either easily prevented or treated with minimum input of resources. In
fact most of the developed countries of the world have overcome many of
these problems by such measures as manipulation of environment,
practice of preventive medicine and improvement of standards of living.

2. Nutritional problems

From the nutritional point of view, the Indian society is a dual

society, consisting of a small group of well fed and a very large group of
undernourished. The high income groups are showing diseases of
affluence which one finds in developed countries.

The specific nutritional problems in the country are

(a) Protein-energy malnutrition Insufficiency of food - the so-

called “food gap”- appears to be the chief cause of PEM, which is a major
health problem particularly in the first years of life. The great majority of
cases of PEM, nearly 80 per cent are mild and moderate cases. The
incidence of severe cases is into 2 per cent in preschool age children. The
problem exists in all the States and the nutritional marasmus is more
frequent than kwashiorkor. (b) Nutritional anaemia India has probably
the highest prevalence of nutritional anaemia in women and children.

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About one-half of non-pregnant women and young children are estimated
to suffer from anaemia. 60 to 80 per cent of pregnant women are
anaemic. 20 to 40 per cent of maternal deaths are attributed to anaemia.
By far the most frequent cause of anaemia is iron deficiency, and less
frequently folate and vitamin B 2 deficiency. (c) Low birth weight This
is a major public health problem in many developing countries. About 30
per cent of babies born are of low birth weight (less than 2.5 kg), as
compared to about 4 per cent in some developed countries. Maternal
malnutrition and anaemia are mainly responsible for this condition
(d) Xerophthalmia (nutritional blindness) About 0.04 per cent of total
blindness in India is attributed to nutritional deficiency of vitamin A.
Keratomalacia has been the major cause of nutritional blindness in
children usually between 1-3 years of age, Subclinical deficiency of
vitamin A is also widespread and is associated with increased morbidity
and mortality from respiratory and gastro-intestinal infections.
(e) Iodine deficiency disorders: Goitre and other iodine deficiency
disorders (IDDI have been known to be highly endemic in sub-
Himalayan regions. Reassessment of the magnitude of the problem by the
Indian Council of Medical Research showed that the problem is not
restricted to the “goitre belt” as was thought earlier, but is extremely
prevalent in other parts of India as well. Studies showed that the
prevalence rate in some parts of Himachal Pradesh was 28.7 per cent (in
Sirmor) and 34.5 per cent (in Mandi); 45.8 per cent in Ropar in Punjab;
64.4 per cent in Champaran, Bihar; 35.6 per cent in Darjeeling, West
Bengal; and 27 per cent in Arunachal Pradesh. (25). (f) Others Other
nutritional problems of importance are lathyrism and endemic fluorosis in
certain parts of the country. To these must be added the widespread
adulteration of foodstuffs.

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3. Environmental sanitation

The most difficult problem to tackle in this country is perhaps the

environmental sanitation problem, which is multifaceted and
multifactorial. The great sanitary awakening which took place in England
in 1840’s is yet to be born. The twin problems of environmental
sanitation are lack of safe water in many areas of the country and
primitive methods of excreta disposal. Besides these, there has been a
growing concern about the impact of “new” problems resulting from
population explosion, urbanization and industrialization leading to
hazards to human health in the air, in water and in the food chain. At the
United Nations Water Conference in Argentina, in 1977, it was
recommended that the priority should be given to the provision of safe
water supply and sanitation services for all by the year 1990, and the
period 1981-1990 was designated as the “International Water Supply’ and
Sanitation Decade”. As of year 2000 safe water is available to most of the
urban and 85 per cent of the rural population; and adequate facilities for
waste disposal to 29 per cent of the urban and two per cent of the rural
population. The problem is gigantic.

4. Medical care problems

India has a national health policy. It does not have a national health
service. The financial resources are considered inadequate to furnish the
costs of running such a service. The existing hospital-based, disease-
oriented health care model has provided health benefits mainly to the
urban elite. Approximately 80 per cent of health facilities are
concentrated in urban areas. Even in urban areas, there is an uneven
distribution of doctors. With large migrations occurring from rural to
urban areas, urban health problems have been aggravated and include

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overcrowding in hospitals, inadequate staffing and scarcity of certain
essential drugs and medicines. The rural areas where nearly 74 per cent of
the population live, do not enjoy the benefits of the modern curative and
preventive health services. Many villages rely on indigenous systems of
medicine. Thus the major medical care problem in India is in equable
distribution of available health resources between urban and rural areas,
and lack of penetration of health services to the social periphery. The
HFA/2000 movement and the primary health care approach which lays
stress on equity, intersectoral coordination and community participation
seek to redress these imbalances.

5. Population problem

The population problem is one of the biggest problems facing the

country, with its inevitable consequences on all aspects of development,
especially employment, education, housing, ‘health care, sanitation and
environment. The country’s population has already reached one billion
mark by the turn of the century.

RESOURCES

Resources are needed to meet the vast health needs of a

community. No nation, however rich, has enough resources to meet all
the needs for all health care. Therefore an assessment of the available
resources, their proper allocation and efficient utilization are important
considerations for providing efficient health care services. The basic
resources for providing health care are :

(i) Health manpower

(ii) Money and material; and

(iii) Time

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Health manpower

The term “health manpower” includes both professional and

auxiliary health personnel who are needed to provide the health care. An
auxiliary is defined by WHO as “technical worker in a certain field with
less than full professional training”. Health manpower requirements of a
country are based on (i) health needs and demands of the population; and
(ii) desired outputs. The health needs in turn are based on the health
situation and health problems and aspirations of the people.

Health manpower planning is an important aspect of community

health planning. It is based on a series of accepted ratios such as doctor-
population ratio, nurse-population ratio, bed-population ratio, etc. They
are given in Table 5. The country is producing annually, on an average
26,449 allopathic doctors; 9,865 Ayurvedic graduates; 1525 Unani
graduates; 320 Siddha graduates and :12785 Homoeopathic graduates.

Suggested norms for health personal

Category of personnel Norms suggested

Doctors 1 per 3500 population
Nurses 1 per 5000 population
Health worker 1 per 5000 population in plain area
and 3000 population in tribal and
hill areas
Trained dai One for each village
Health assistant (male and female) Provides supportive super : vision
to 6 health worker (male/female)
Pharmacists 1 per 10000 population
Lab technicians 1 per 10000 population

Although the averages are they vary widely within satisfactory on a

national basis, the country. There is also maldistribution of health
manpower between rural and urban areas. Studies in India have shown
that there is a concentration of doctors (up to 73.6 per cent) in urban areas
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where only 26.4 per cent of population live. This maldistribution is
attributed to absence of amenities in rural areas, lack of job satisfaction,
professional isolation, lack of rural experience and inability to adjust to
rural life.

The national averages of doctor-population ratio, population-bed

ratio and nurse to doctor ratio in some countries are shown in Table
below.

Health manpower in some countries 2004

Doctors per Beds per Nurses per Midwives

Country 1000 10000 1000 per 1000
population population population population
India 0.7 8.9 0.8 0.47
Nepal 0.21 1.5 0.22 0.24
Bangladesh 0.26 3.36 0.14 0.18
Sri Lanka 0.55 29 1.58 0.16
Thailand 0.37 22.3 2.82 0.01
Myanmar 0.36 6.3 0.38 0.60

Health manpower requirements are subject to change, both

qualitatively and quantitatively, as new programmes, projects and
philosophies are introduced into the health care system. For example,
there has been a change from unipurpose to multipurpose strategy in
recent years. Then came the goal of Health for All. In addition, national
health programmes such as tuberculosis control, leprosy eradication and
control of blindness needed more trained workers and technicians. Thus
during the past decade many new categories of health manpower have
been introduced. They include village health guides, multipurpose
workers, technicians, ophthalmic assistants, etc. The below table shows
the total health manpower current stock under the “rural health scheme”.

Health man-power in rural India as on Sept. 2005

22
 Category In Position
1. ANM 133194
2. MPW (male) 61907
3. Health Assistant (Female) / LHV 17371
4. Health Assistant (Male) 20181
5. Doctors in PHCs 20308
6. Specialists:
(a) Surgeon 1207
(b) Gynaecologist and Obstetrician 1215
(c) Physician 884
(d) Paediatrician 675
Total Specialists at CHC 3550
7. Radiographer 1337
8. Pharmacist 17708
9. Lab. Technician 12284
10 Nurse Midwife 28930
.
11 BEE 2645
.

Money and material

Money is an important resource for providing health services.

Scarcity of money affects all parts of the health delivery system. In most
developed countries, government expenditure for health lies between 6 to
12 per cent of GNP In underdeveloped countries it is less than 1 per cent
of the GNP and it seldom exceeds 2 per cent of the GNP. This translates
into an average of a few dollars per person per year in the
underdeveloped countries as compared to several hundred dollars in
developed ones. To make matters worse, much of the spending is for
services that reach only a small fraction of the population.

To achieve Health for All, WHO has set as a goal the expenditure
of 5 per cent of each country’s GNP on health care. At present India is
spending about 3 per cent of GNP on health and family welfare
development.

23
 Since money and material are always scarce resources they must be
put to the most effective use, with an eye on maximum output of results
for investment. Since deaths from preventable diseases such as whooping
cough, measles, tuberculosis, tetanus, diphtheria, malnutrition frequently
occur in developing countries, the case is strong for investing resources
on preventing these diseases rather than spending money on multiplying
prestigious medical institutions and other establishments which absorb a
large portion of the national health budget. Management techniques such
as cost-effectiveness and cost-benefit analysis are now being used for
allocation of resources in the field of community health.

Time

Time is money, someone said. It is an important dimension of

health care services. Administrative delays in sanctioning health projects
imply loss of time. Proper use of man-hours is also an important time
factor. For example, a survey by WHO has shown that an Auxiliary
Nurse Midwife spends 45 per cent of her time in giving medical care; 40
per cent in travelling; 5 per cent on paper work; and only 10 per cent in
performing duties for which she has been trained. Such studies may be
extended to other categories of health personnel with a view to promote
better utilization of the time resource.

To summarise, resources are needed to meet the many health needs

of a community. But resources are desperately short in the health sector
in all poor countries. What is important is to employ suitable strategies to
get the best out of limited resources.

HEALTH CARE SERVICES

24
 The purpose of health care services is to improve the health status
of the population. In the light of Health for All by 2000 AD, the goals to
be achieved have been fixed in terms of mortality and morbidity
reduction, increase in expectation of life, decrease in population growth
rate, improvements in nutritional status, provision of basic sanitation,
health manpower requirements and resources development and certain
other parameters such as food production, literacy rate, reduced levels of
poverty, etc.

The scope of health services varies widely from country to country

and influenced by general and ever changing national, state and local
health problems, needs and attitudes as well as the available resources to
provide these services. A comprehensive list of health syj&s_aa\1 be
found in the Re ort of the WHO Expert Committee (1961) on “Planning
of Public health services”.

There is now broad agreement that health services should be (a)

comprehensive (b) accessible (c) acceptable d) provide scope for
community participation, and (e) available at a cost the community and
country can afford. These are the essential ingredients of primary health
are which forms an integral part of the country’s health system, of which
it is the central function and main agent for delivering health care.

HEALTH CARE SYSTEM

The health care system is intended to deliver the health ‘care

services. It constitutes the management sector and involves organizational

25
matters. It operates in the context of the socioeconomic and political
framework of the country. In India, it is represented by five major sectors
or agencies which differ from each other by the health technology applied
and by the source of funds for operation. These are :

1. PUBLIC HEALTH SECTOR’

(a) Primary Health Care
Primary health centres
Sub- centres
(b) Hospitals/Health Centres
Community health centre-.Rural hospitals
District hospital/health centre
Specialist hospitals
Teaching hospitals
(c) Health Insurance Schemes
Employees State Insurance
Central Govt. Health Scheme
(d) Other agencies
Defence services
Railways
2. PRIVATE SECTOR
(a) Private hospitals, polyclinics, Nursing homes, and dispensaries
(b) General practitioners and clinics

3. INDIGENOUS SYSTEMS OF MEDICINE

Ayurveda and Siddha

Unani and Tibbi Homoeopathy

26
 Unregistered practitioners

4. VOLUNTARY HEALTH AGENCIES

5. NATIONAL HEALTH PROGRAMMES

PRIMARY HEALTH CARE IN INDIA

In 1977, the Government of India launched a Rural Health Scheme,

based on the principle of “placing people’s health in people’s hands”. It is
a three tier system of health care delivery in rural areas based on the
recommendation of the Shrivastav Committee in 1975. Close on the heels
of these recommendations an International conference at Alma-Ata in
1978, set the goal of an acceptable level of Health for All the people of
the world by the year 2000 through primary health care approach. As a
signatory of the Alma-Ata Declaration, the Government of India is
committed to achieving the goal of Health for All through primary health
care approach which seeks to provide universal comprehensive health
care at a cost which is affordable.

Keeping in view the WHO goal of “Health for All” by 2000 AD,
the Government of India evolved Healthy Policy based on primary health
care approach. It was approach by Parliament in 1983. The National
Health Policy has laid down a plan of action for reorienting and shaping
the existing rural health Infrastructure with specific goals to be achieved
by 1985, 1990 and 1995 within the framework of the Sixth (1980-85) and
Seventh (1985-90) Five Year Plans and the new 20 point Programme.
Steps are already under way to implement the National Health Policy
objectives towards achieving Health for All by the year 2000. These and
described below:

1. Village level

27
 One of the basic tenets of primary health care is universal coverage
and equitable distribution of health resource. That is, health care must
penetrate into the farthest reaches of rural areas, and that everyone should
have access to it. To implement this policy at the village level, the
following schemes are in operation:

a. Village Health Guides Scheme

b. Training of Local Dais ,

c. ICDS Scheme

a. Village Health Guides Scheme

A Village Health Guide is a person with an aptitude for social

service and is not a full time government functionary. The Village Health
Guides Scheme was introduced on 2nd October 1977 with the idea of
securing people’s participation in the care of their own health. The
scheme was launched in all States except Kerala, Karnataka, Tamil Nadu,
Arunachal Pradesh and Jammu and Kashmir which had alternative
systems (e.g., Mini-health Centres in Tamil Nadu) of providing health
services at the village level.

The Health Guides are now mostly women. A circular was issued
by Government of India in May 1986 that male Health Guides would be
replaced by female Health Guides. The Health Guides come from and are
chosen by the community in which they work. They serve as links
between the community and the governmental infrastructure. They
provide the first contact between the individual and the health system.

The guidelines for their selection are

28
(a) they should be permanent residents of the local community, preferably
women

(b) they should be able to read and write, having minimum formal
education at least up to the VI standard

(c) they should be acceptable to all sections of the community and

(d) they should be able to spare at least 2 to 3 hours every day for
community health work.

After selection, the Health Guides undergo a short training in

primary health care. The training is arranged in the nearest primary health
centre, subcentre or any other suitable place for the duration of 200 hour
spread over a period of months. During the training period they receive a
stipend of Rs.200 per month.

On completion of training, they receive a working manual and a kit

of simple medicines belonging to the modern and traditional systems of
medicine in vogue in that part of the country to which they belong.
Broadly the duties assigned to health guides include treatment of simple
ailments and activities in first aid, mother and child health including
family planning, health education and sanitation. The’ manual or
guidebook gives them detailed information about medical care of
common illnesses — of what they can and cannot do. In practical terms,
they know exactly hat should be done when confronted with a situation,
when they can begin treatment by themselves and when they should refer
the patient immediately to the nearest health centre.

The Health Guides are free to attend to their normal vocation. They
are expected to do community health work in their spare time of about 2

29
to 3 hours daily for which they are paid an honorarium of Rs.50 per
month and drugs worth Rs.600 per annum. As the training involves
expenditure, the in will not train another Health Guide from the same
village before three years. As of date, there are 3.23 lakh village Health
Guides functioning in the country. The training programme is being
continued during the Ninth Plan Period (1997—2002) to achieve the
national target of one Health Guide for each village or 1000 rural
population.

b. Local dais

Most deliveries in rural areas are still handled by untrained dais

who are often the only people immediately available to women during the
perinatal period. An extensive programme has been undertaken, under the
Rural Health Scheme, to train all categories of local dais (traditional birth
attendants) in the country to improve their knowledge in the elementary
concepts of maternal and child health and sterilization, besides obstetric
skills. The training is for 30 working days. Each dai is paid a stipend of
Rs.300 during her training period. Training is given at the PHC,
subcentre or MCH centre for 2 days in a week and on the remaining four
days of the week they accompany the Health worker (Female) to the
villages preferably in the dai’s own area. During her training each dai is
required to conduct just under the guidance and supervision of the HW
(F). ANM or HA (F). The emphasis during training is on asepsis that
home deliveries are conducted under safe hygienic conditions thereby
reducing the maternal and infant mortality.

After successful completion of training, each dai is provided with a

delivery kit and a certificate. She is entitled to receive an amount of Rs.
10 per delivery provided the case is registered with the subce7PHC To

30
each infant registered by her, she will receive j36). These dais are also
expected to play a vital role in propagating small-family norm since they
are more acceptable to the community. Although the national target is to
train one local dai in each village, the Eighth Five Year Plan’s objective
was to train all untrained dais practising in the rural areas.

c. Anganwadi Worker

Angan literally means a courtyard. Under the ICDS (Integrated

Child Development Services) Scheme, there is an anganwadi worker for a
population of 1000. There are about 100 such workers in each ICDS
Project. As of date over 5671 ICDS blocks are functioning in t e country.
The anganwadi worker is selected from the community she is expected to
serve. She undergoes training in various aspects of health, nutrition, and
child development for 4 months. She is a part-time worker and is paid an
honorarium of Rs.200-250 per month for the services rendered, which
include health check up, immunization, supplementary nutrition, health
education, non-formal pre-schoo1 education and referral services. The
beneficiaries are especially nursing mothers, other women (15-45 years)
and children below the age of 6 years. Along with Village Health Guides,
the anganwadi workers are the community’s primary link with the health
services and all other services for young children.

2. Sub-centre level

The sub-centre is the peripheral outpost of the existing health

delivery system in rural areas. They are being established on the basis of
one sub-centre for every 5000 population in general and one

31
frV0U0iTltionin hilly, tribal and backward areas. As on 30th Sept. 2005,
146026 sub-centres were established in the country.

Each sub-centre is manned by one male and one female

multipurpose health worker. At present the functions of a sub-centre are
limited to mother and child health care, family planning and
immunization. It is proposed to extend the facilities at all sub-centres for
IUD insertion and simple laboratory investigations like routine
examination of urine for albumin and sugar. Creation of these facilities
would go a long way in securing greater acceptance of IUD and early
detection of complications of pregnancy. The work at sub-centres is
supervised by male and female health assistants. According to the revised
norm, one female ill supervise the work of 6 female HWs. The job
descriptions of these workers have been published as Manuals by the
Rural Health Division of the ministry of Health and Family Welfare.

3. Primary health centre level

The concept of primary health centre is not new to India. The

Bhore committee in 1946 gave the concept of a primary health centre as a
basic health unit, to provide, as close to the people as possible, an
integrated curative and preventive health care to the rural population,
with emphasis on perventive and promotive aspects of health care. The
Bhore Committee aimed at having a health centre to serve a population of
10,000 to 20,000 with 6 medical officers, 6 public health nurses and other
supporting staff. But in view of the limited resources, the Bhore
Committee’s recommendations could not be fully implemented, even
after a lapse of 60 years.

32
 The health planners in India have visualized the primary health
centre and its sub-centres as the proper infrastructure to provide health
services to the rural population. The, Central Council of Health at its first
meeting held in January 1953 had recommended the establishment of
primary health centres in community development blocks to provide
comprehensive health care to the rural population The number of primary
health centres established since then had increased from 725 during the
First Five Year Plan to 5484 by the end of the Fifth Plan (1975-1980) -
each PHC covering a population of 100,000 or more spread over some
100 villages in each community development block. These centres were
functioning as(peripheral health service institutions with little or no
community involvement/ Increasingly, these centres came under criticism
as they were not able to provide adequate health coverage, partly because
they were poorly staffed and equipped, and partly because they had to
cover a large population of one lakh or more. The Mudaliar Committee in
1962 had recommended that the existing primary health centres should be
strengthened and the population to be served by them to be scaled down
to 40,000.

The Declaration of Alma-Ata Conference in 1978 setting the goal

of Health for All by 2000 AD has ushered in a new philosophy of equity,
and a new approach, the primary health care approach. The National
Health Plan (1983) proposed reorganization of primary health centres on
the basis of one PHC for every 30,000 rural population in the plains, and
one PHC for every 20,000 population in hilly, tribal and backward areas
for more effective coverage. As on 30th Sept. 2005, 3236 Primary health
centres have been established in the country.

Functions of the PHC

33
 The functions of the primary health center in India cover all the 8
“essential” elements of primary health care as outlined in the Alma-Ata
Declaration. They are

1. Medical care
2. MCH including family planning
3. Safe water supply and basic sanitation
4. Prevention and control of locally endemic diseases
5. Collection and reporting of vital statistics
6. Education about health
7. National Health Programmes - as relevant
8. Referral services
9. Training of health guides, health workers, local dais and health
assistants
10.Basic laboratory services

It is proposed to equip the primary health centres with facilities for

selected surgical procedures (e.g., vasectomy, tubectomy, MTP and
minor surgical procedures) and for paediatric care. In order to reorient
medical education (ROME Programme) towards the needs of the country
and community care, three primary health centres have been attached to
each of the medical colleges.

Staffing Pattern

At present in each community development block, there are one ,or

more PHCs each of which covers 30,000 rural population. In the new set-
up each PHC will have the following staff:
34
 At the PHC level:

Medical officer 1
Pharmacist 1
Nurse mid-wife 1
Health worker (female)/ANM 1
Block Extension Educator 1
Health assistant (male) 1
Health assistant (female)/LHV 1
U.D.C. 1
L.D.C. 1
Lab. technician 1
Driver (subject to availability of vehicle) 1
Class IV 1
15

At the sub-centre level:

Health worker (female)/ANM 1

Health worker (male) 1
Voluntary worker 1
(paid Rs. 100 per month as honorarium)
3

Notwithstanding the strong criticism of primary health centres it must

be emphasized that their establishment is a valuable national asset. Their
establishment is the fruit of many years of great efforts to increase the
outreach of the health services.

4. Community Health Centres

As on 31st March 2003, 3076 community health centres were

established by upgrading the primary health centres, each community
health centre covering a population of 80,000 to 1.20 lakh (one in each
community development block) with 30 beds and secialists in surgery,
medicine, obstetrics and gynecology, an paediatrics wit -ray and
laboratoiy facilities/ For strengthening preventive and promotive aspects
of health care, a new non-medical post called community health officer
35
has been created at each community health centre. The community health
officer is selected from amongst the supervisory category of staff at the
PHC and district level with minimum of 7 years experience in rural
health programmes. Some states have not accepted this scheme and have
opted for a second medical officer.

The specialists at the community health centre may refer a patient

directly to the state level hospital or the nearest/ appropriate Medical
College Hospital, as may be necessary, without the patient having to go
first to the sub-divisional or District Hospital.

Indian Public Health Standards for Community health centres

In order to provide quality care in CHCs, Indian Public Health

Standards (IPHS) are being prescribed to provide optimal expert care to
the community and achieve and maintain an acceptable standard of
quality of care. These standards would help monitor and improve the
functioning of the CHCs.

Every CHC has to provide following services which can be known

as the assured services:

1. Care of routine and emergency cases in surgery:

a. This includes incision and drainage, and surgery for hernia.
hydrocele, appendicitis, haemorrhoids, fistula. etc.
b. Handling of emergencies like intestinal obstruction,
haemorrhage. etc.
2. Care of routine and emergency cases in medicine:
Specific mention is being made of handling of all emergencies in
relation to the national health programmes as per guidelines like
dengue / DHF, cerebral malaria, etc. Appropriate guidelines are
36
 already available under each programme, which should be compiled in
a single manual.
3. 24-hour delivery services, including normal and assisted deliveries.
4. Essential and emergency obstetric care including surgical
interventions like caesarean sections and other medical interventions.
5. Full range of family planning services including laproscopic services.
6. Safe abortion services.
7. Newborn care.
8. Routine and emergency care of sick children.
9. Other management, including nasal packing, tracheostomy, foreign
body removal etc.
10.All the national health programmes (NHP) should be delivered
through the CHCs. Integration with the existing programmes like
blindness control, Integrated Disease Surveillance Project, is vital to
provide comprehensive services.

a. RNTCP: CHCs are expected to provide diagnostic services

through the microscopy centres which are already established in

the CHCs, and treatment services as per the technical guidelines
and operational guidelines for tuberculosis control.
b. HIV/AIDS Control Programme services will be provided.
c. National Vector-Borne Disease Control Programme: The CHCs
are to provide diagnostic and treatment facilities for routine and
complicated cases of malaria, filaria, dengue, Iapanese
Encephalitis and Kala-azar in the respective endemic zones.
d. National Leprosy Eradication Programme: The minimum
services that are to be available at the CHCs are for diagnosis

37
 and treatment of cases and reactions of leprosy along with
advice to patient on prevention of deformity.
e. National Programme for Control of Blindness: The eye care

services that should be available at the CHC are diagnosis and

treatment of common eye diseases refraction services and
surgical services including cataract by lOL implantation at
selected CHCs optionally. 1 eye surgeon is being envisaged for
every 5 lakh population.
f. Under Integrated Disease Surveillance Project, the related
services include services for diagnosis for malaria, tuberculosis,
typhoid and tests for detection of faecal contamination of water
and chlorination level. CHC will function as peripheral
surveillance unit and collate, analyse and report information to
District Surveillance Unit. In outbreak situations, appropriate
action will be initiated.
11.Others :
a. Blood storage facility
b. Essential laboratory services
c. Referral (transport) services

The staff for community health centre are as follows:

Existing clinical manpower

1. General Surgeon 1
2. Physician 1
3. Obstetrician / Gynecologist 1
4. Paediatrician 1

Existing clinical manpower

1. Anaesthetist (essential for the utilization of 1

the surgical facilities. They may be on

38
 contractual appointment or hiring of
services from private sectors on case-to-
case basis)
2. Eye surgeon (for every 5 lakh population 1
as per vision 2020 approved plan of
action)
3. Public health programme manager, also 1
designated as Block Surveillance Officer
(Will be responsible for surveillance,
coordination of NHPs, management of
ASHA’s training etc. The appointment
will be on contractual basis)

Existing support manpower

Nurse - midwife * 7+1

Dresser (certified by Red Cross/St. Johns 1
ambulance)

Pharmacist / compounder 1
Lab. Technician 1
Radiographer 1
Ophthalmic assistant ** 0-1
Ward boy / nursing orderly 2
Sweepers 3
Chowkidar
OPD attendant
Statistical assistant / Data entry operator 5***
OT attendant
Registration clerk
Total essenhal 21-22+2

* 1 ANM and 1 PHN for family welfare will be appointed under the
ASHA scheme.

39
** Ophthalmic assistant may be placed wherever it does not exist through
redeployment or contract basis.

*** flexibility may rest with the state for recruitment of personnel as per
requirements.

HEALTH INSURANCE

There is no universal health insurance in India. Health insurance is

at present limited to industrial workers and their ‘families. The Central
Government employees are also covered by the health insurance, under
the banner “Central Govt. Health Scheme”.

Employees State Insurance Scheme

The ESI scheme, introduced by an Act of Parliament in 1948, is a

unique piece of social legislation in India. It has introduced for the first
time in India the principle of contribution by the employer and employee.
The Act provides for medical care in cash and kind, benefits in the
contingency of sickness, maternity, employment injury, and pension for
dependents on the death of worker because of employment injury. The
Act covers employees drawing wages not exceeding Rs.10,000 per
month.

The ESI Scheme as on 31st March

No. of implemented centres (2005) 718

No. of employers covered (2006) 3 lacs

No. of insured persons (2006) 91.48 lacs

No. of beneficiaries (2006) 354 lacs

40
No. of Regional Offices / SRO’s (2006) 35

No. of ESI hospitals/annexes (2005) 186

No. of ESI dispensaries (2005) 1427

No. of Panel Clinics (2005) 2100

SERVICE PERFORMANCE (per year) (2002)
OPD attendances 650 lacs

No. of hospital admissions 7.00 lacs

No. of cash benefit payments 42 lacs

No. of insured persons on the payrolls of permanent 1.68 lacs

disablement benefits
No. of dependants on the payrolls of family pension 62000

Total expenditure on medical benefits Rs. 770 crores

Total expenditure on cash benefits Rs. 312 crores

Central Government Health Scheme

The central Government Health Scheme (previously known as

Contributory Health Service Scheme) for the Central Government
employees was first introduced in New Delhi in 1954 to provide
comprehensive medical care to Central Government employees. The
scheme is based on the principle of cooperative effort by the employee
and the employer, to the mutual advantage of both.

41
 The facilities under the scheme include (a) out-patient care through
a network of dispensaries (b) supply of necessary drugs (c) laboratory and
X-ray investigations (d) domiciliary visits (e) hospitalization facilities at
Government as well as private hospitals recognized for the purpose (f)
specialist consultation (g) paediatric services including immunization (h)
antenatal, natal and postnatal services (i) emergency treatment (j) supply
of optical and dental aids at reasonable rate, and (k) family welfare
services.

The scope of the scheme has been gradually extended over the
years to cover cities outside Delhi as well as other sectors of population
such as the employees of the autonomous organizations, retired Central
Govt. servants, widows receiving family pension, Members of
Parliament, ExGovernors and retired judges. The Scheme now covers
besides Delhi, the cities of Mumbai, Allahabad, Meerut, Kanpur, Patna,
Kolkata, Nagpur, Chennai, Hyderabad, Bangalore, Jaipur, Pune,
Lucknow Ahmedabad, Bhubaneswar and Jabalpur.

The scheme which started with 16 allopathic dispensaries in 1954

covering 2.3 lakh beneficiaries has now 320 dispensaries/hospitals in
various systems of medicine and provides service to about 42.76 lakh
beneficiaries. There is also a yoga centre under the scheme in Delhi.

The Employees State Insurance Scheme and the Central

Government Health Scheme cover two large groups of wage earners in
the country. They are well-organized health insurance schemes, and are
providing reasonable medical care plus some essential preventive and
promotive health services. Experience in other countries has shown that
health insurance is a logical step towards nationalization of health
services.

42
OTHER AGENCIES

Defence Medical Services

Defence services have their own organization for medical care to

defence personnel under the banner ‘Armed Forces Medical Services”.
The services provided are integrated and comprehensive embracing
preventive, promotive and curative services.

Health Care of Railway Employees

The Railways provide comprehensive health care services through

the agency of Railway Hospitals, Health Units and clinics. Environmental
sanitation is taken care of by Health Inspectors in big stations. A chief
Health Inspector supervises the division’s work. Heath check-up of
employees is provided at the time of entry into service, and thereafter at
yearly intervals. There are lady medical officers, health visitors and
midwives who look after the MCH and School Health Services.
Specialists’ services are also available at the Divisional Hospitals.

PRIVATE AGENCIES

In a mixed economy such as India s, private practice of medicine

provides a large share of the health services available. There has been a
rapid expansion in the number of qualified allopathic physicians from
about 50,000 at the time of Independence to about 7.67 lakhs in 2005 and
the doctor- population ratio for the country as a whole is 1 1428. The
general practitioners constitute 70 per cent of the medical profession.
Most of them tend to congregate in urban areas. They provide mainly
curative services. Their services are available to those who can 1iäy. The
43
private sector of the health care services is not organized. Some statutory
bodies like the Medical Council of India and the Indian Medical
Association regulate some of the functions and activities of the large
body of private registered medical practitioners.

INDIGENOUS SYSTEMS OF MEDICINE

The practitioners of indigenous systems of medicine (e.g.,

Ayurveda, Siddha, Homoeopathy, etc.) provide the bulk of medical care
to the rural people. Ayurvedic physicians alone are estimated to be about
4.38 lakhs (21). Studies indicate that nearly 90 per cent of Ayurvedic
physicians serve the rural areas. Most of them are local residents and
remain very close to the people socially and culturally. In recent years
there has been considerable state patronage to foster these systems of
medicine. Many ayurvedic dispensaries are state - run. The Govt. of India
has established a National Institute of Ayurveda in Jaipur and a National
Institute of Homoeopathy in Kolkata. A Central Council of Indian
Medicine was established in 1971 to prescribe minimum standards of
education in Indian medicine. The Govt. of India is studying the question
of how indigenous systems of medicine could best be utilized for more
effective or total health coverage.

VOLUNTARY HEALTH AGENCIES

The voluntary health agencies occupy an important place in

community health programmes. “A voluntary health agency may be
defined as an organisation that is administered by an autonomous board
which holds meetings, collects funds for its support chiefly from private
sources and expends money, whether with or without paid workers, in
conducting a programme directed primarily to furthering the public health

44
by providing health services or health education, or by advancing
research or legislation for health, or by a combination of these activities”.
The one country where voluntary health agencies have developed and
flourished to an enormous extent is the United States. Even in 1945, it
was estimated that there were more than 20,000 voluntary agencies in the
United States, The voluntary health agencies have been compared to
“motor trucks” which can penetrate the by-ways, and the official agencies
to ‘Railway Trunk Lines” which must run on tracks established by law.

FUNCTIONS

The types of service rendered by voluntary health agencies have

been classified as

(a) SUPPLEMENTING THE WORK OF GOVERNMENT AGENCIES

It is well known that government agencies cannot provide comMete
service because they operate under financial and statutory restrictions.
The voluntary health agencies can help strengthen the work of
government agencies by lending personnel, or by contributing funds for
special equipment, supplies or services.

(b) PIONEERING The voluntary health agencies are in a position to

explore ways and means of doing new things. Research is one form of
pioneering. When the efforts sudceed and bear fruit, the government
agencies can step in and take over the project for the benefit of the larger
numbers, The family planning programme in India is an example of
pioneering by the voluntary agencies which first spearheaded the
movement, in the fate of much opposition. When the importance of
family planning was realised, the government accepted family planning
as a national policy.

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(c) EDUCATION There is unlimited scope for health education in India.
The government agencies cannot cope with the problem, unless it is
supplemented by voluntary effort on the part of the people.

(d) DEMONSTRATION By putting up demonstrations and experimental

projects, the voluntary health agencies have advanced the cause of public
health. The demonstration of bore hole latrines by the Rockefeller
Foundation to solve the problem of hookworm in India is a case in point.
The bore-hole latrine and its modification have since become an essential
part of the environmental sanitation programme in India.

(e) GUARDING THE WORK OF GOVERNMENT AGENCIES By

setting a good example the voluntary health agencies can always guide
and criticise the work of government agencies.

(f) ADVANCING HEALTH LEGISLATION The voluntary agencies can

also mobilise public opinion and advance legislation on health matters for
the benefit of the whole community.

VOLUNTARY HEALTH AGENCIES IN INDIA

Indian Red Cross Society

The Indian Red Cross Society was established in 1920. It has a

network of over 400 branches all over India. It has been executing
programmes for the promotion of health, prevention of disease and
mitigation of suffering among the people. Its activities are

(a) RELIEF WORK When disaster strikes any part of the country in the
shape of earth-quakes, floods, drought, epidemics, etc., the Red Cross

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Society immediately mobilises all its resources and goes to the rescue of
the affected people.

(b) MILK AND MEDICAL SUPPLIES A number of hospitals,

dispensaries, maternity and child welfare centres, schools and orphanges
receive assistance from the society every year. The assistance given
consists mainly of milk powder, medicines, vitamins and other supplies.

(c) ARMED FORCES The Fare of the sick and the wounded among the
members of the forces is one of the primary obligations of the Red Cross.
The Society runs a well- equipped hospital, ‘the Red Cross Home’ in
Bangalore - the only one of its kind in India and the Far East - for
permanently disabled ex-servicemen.

(d) MATERNAL AND CHILD WELFARE SERVICES There are a large

number of maternity and child welfare centres all over India, either
directly administered by or are affiliated to the Red Cross. There is a
bureau of Maternity and Child Welfare, which provides technical advice
and financial aid to schemes for establishing model maternity and child
welfare centres.

(e) FAMILY PLANNING Several States in India are running family

planning clinics under the auspices of the Indian Red Cross.

(f) BLOOD BANK AND FIRST AID Some of the State branches have
started blood banks. The St. John Ambulance Association in India which
is part of Red Cross has trained several lakh men and women in first aid,
home nursing and allied subjects.

2. Hind Kusht Nivaran Sangh

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 The Hind Kusht Nivaran Sangh was founded in founded in 1950
with its headquarters in New Delhi. Its precursor was the Indian Council
of the British Empire Leprosy Relief Association (B.E.L.R.A.). which
was renamed as LEPRA in 1950. The programme of work’ of the Sangh
includes rendering of financial assistance to various leprosy homes and
clinics, health education through publications and posters, training of
medical workers and physiotherapists, conducting research and field
investigations, organising All-India Leprosy workers Conferences and
publication of ‘Leprosy in India’, a quarterly journal. The Sangh has
branches all over India and works in close cooperation with the
Government and other voluntary agencies.

3. Indian Council for Child Welfare

Indian Council for Child Welfare was established in 1952. It is

affiliated with the International Union for Child Welfare. Since its
formation, the I.C.C.W. has built up a network of State Councils and
district councils all over the country. The services of I.C.C.W. are
devoted to secure for India’s children those “opportunities and facilities,
by law and other means” which are necessary to enable them to develop
physically, mentally, morally, spiritually and socially in a healthy and
normal manner and in conditions of freedom and dignity.

4. Tuberculosis Association of India

The Tuberculosis Association of India was formed in 1939. It has

branches in all the States in India. The activities of this Association
comprise organising a T.B. Seal campaign every year to raise funds,
training of doctors, health visitors and social workers in antituberculosis
work, promotion of health education and promotion of consultations and

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conferences. The following institutions are under the management of the
Association The New Delhi Tuberculosis Centre, the Lady
Linlithgow.Sanatorium at Kasauli, the King Edward VII Sanatorium at
Dharampur and the Tuberculosis Hospital at Mehrauli.

5. Bharat Sevak Samaj

The Bharat Sevak Samaj which is a non-political and non- official

organization was formed in 1952. One of the prime objectives of the
Bharat Sevak Samaj (B.S.S.) is to help people to achieve health by their
own actions and efforts. The B.S.S. has branches in all the States and in
nearly all the districts in villages is one of the important activities of the
important activities of the B.S.S.

6. Central Social Welfare Board

The Central Social Welfare Board is an autonomous organization under

the general administrative control of the Ministry of Education. It was set
up by the Government of India in August 1953. The functions of the
Board are

(1) surveying the needs and requirements of voluntary welfare

organizations in the country (2) promoting and setting up of social
welfare organizations on a voluntary basis (3) rendering of financial aid
to deserving existing organizations and institutions. The Board initiated,
in 1968, “Family and Child Welfare Services” in rural areas for the
welfare of women and children. The activities of these projects comprise
teaching of craft, social education, literacy classes, maternity aid for
women, distribution of milk, balwadis, and organisation of play centres
for children. The Board has also started a scheme of Industrial

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Cooperatives to help the lower-middle class women in urban areas
supplement their family income by doing paid work.

7. The Kasturba Memorial Fund

Created in commemoration of Kasturba Gandhi, after her death in

1944, the Fund was raised with the main object of improving the lot of
women, especially in the villages, through gram-sevikas. The trust has
nearly a crore of rupees and is actively engaged in various welfare
projects in the country.

8. Family Planning Association of India

The Family Planning Association was formed in 1949 with its

headquarters at Mumbai. It has done pioneering work in propagating
family planning in India. The Association has branches all over the
country. These branches are running family planning clinics with grants-
in-aid from the Government. The Association has trained several hundred
doctors, health visitors and social workers. One of the activities of the
Headquarters is to answer enquiries on family planning by
correspondence or by personal interviews.

9. All India Women’s Conference

It is the only women’s voluntary welfare organisation in the

country. Established in 1926, it has now branches all over the country.
Most of the branches are running MCI-I. Clinics, Medical centres, and
adult education centres, milk centres and family planning clinics.

10. The All-India Blind Relief Society

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 The All-India Blind Relief Society was established in 1946 with a
view to coordinate different institutions working for the blind. It
organises eye relief camps and other measures for the relief of the blind.

11. Professional bodies

The Indian Medical Association, All India Licentiates Association,

All India Dental Association, The Trained Nurses Association of India
are all voluntary agencies of men and women who are qualified in their
respective specialities and possess registerable qualifications. These
professional bodies conduct annual conferences, publish journals, arrange
scientific sessions and exhibitions, foster research, set up standards of
professional education and organise relief camps during periods of
natural calamities.

12. International agencies

The Rockefeller Foundation, Ford Foundation, and CARE

(Cooperative for Assistance & Relief Everywhere) are examples of
voluntary international health agencies.

HEALTH PROGRAMMES IN INDIA

Since India became free, several measures have been undertaken

by the National Government to improve the health of the people.
Prominent among these measures are the NATIONAL HEALTH
PROGRAMMES, which have been launched by the Central Government
for the control/eradication of communicable diseases, improvement of

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environmental sanitation, nutrition, control of population and rural health.
Various international agencies like WHO, UNICEF, UNFPA, World
Bank, as also as also a number of foreign agencies like DANIDA
NORAD and USAID have been providing technical and material
assistance in the implementation of these programmes.

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