Table of Contents

Health, Nutrition & Family Welfare.....................................................................................................1 1............................................................................................................................................................2 2............................................................................................................................................................3 3............................................................................................................................................................5 4............................................................................................................................................................6 5..........................................................................................................................................................11 6..........................................................................................................................................................15 7..........................................................................................................................................................17 8..........................................................................................................................................................19 9..........................................................................................................................................................20 9.5.......................................................................................................................................................26 10........................................................................................................................................................26 10.5.....................................................................................................................................................28 11........................................................................................................................................................28 11.5.....................................................................................................................................................29

Health, Nutrition & Family Welfare

Through the Plans Five Year Plans :

First Second Third Fourth Fifth Sixth Seventh Eighth

Ninth Tenth Eleventh

Health, Nutrition & Family Welfare The Division has following important functions: 1. Evolving policy and strategy guidelines pertaining to: Health & Family Welfare AYUSH Initiatives to improve nutritional status of the population; and Flagship programme National Rural Health Mission (NRHM) 2. Drawing up short, medium and long-term perspectives and goals for each of these sectors. 3. Monitoring changing trends in the health sector viz., epidemiological, demographic, social and managerial challenges. 4. Examining current policies, strategies and programmes in health & family welfare and nutrition, both in the State and in the Central Sector and suggest appropriate modifications / mid course corrections. 5. Suggesting methods for improving efficiency and quality of services. 6. Evolving priorities for basic, clinical and operational research essential for improving health status of the population. 7. Looking into inter-sectoral issues and evolve appropriate policies and strategies for convergence of services so that the population is benefitted optimally from on-going programmes. The Division represents the Planning Commission in: a. Various Committees of Ministry of Health & Family Welfare and Ministry of Women & Child Development b. EFC/SFC pertaining to Ministry of Health & Family Welfare and Ministry of Women & Child Development c. Expert Panels set up from time to time to advise the Planning Commission regarding the priorities and targets in the Plans and Programmes relating to Health, FW and Nutrition - the resources including human and material required, the training programmes to be initiated, standards of construction and equipment for health facilities and the development of health research etc. d. Scientific Advisory Groups of Indian Council of Medical Research, National Institute of Health & Family Welfare, Public Health Foundation of India, etc.

1
1st Five Year Plan
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Introduction || APPENDIX (CH-4) || APPENDIX (CH-9) || ANNEXURE (CH-12) || APPENDIX (CH-14) || AP PENDIX (CH-24) || APPENDIX (CH-29) || Conclusion Chapter- 1 || 2 || 3 || 4 || 5 || 6 || 7 || 8 || 9 || 10 || 11 || 12 || 13 || 14 || 15 || 16 || 17 || 18 || 19 || 20 || 21 || 22 || 23 || 24 || 25 || 26 || 27 || 28 || 29 || 30 || 31 || 32 || 33 || 34 || 35 || 36 || 37 || 38 ||
39

Chapter 32:

HEALTH
Health is fundamental to national progress in any sphere. In terms of resources for economic development, nothing can be considered of higher importance than the health of the people which is a measure of their energy and capacity as well as of the potential of man-hours for productive work in relation to the total number of persons maintained by the nation. For the efficiency of industry- and of agriculture, the health of the worker is an essential consideration. 2. Health is a positive state of well being in which the harmonious development of physical and mental capacities of the individual lead to the enjoyment of a rich and full life. It is not a negative state of mere absence of disease. Health further implies complete adjustment of the individual to his total environment, physical and social. Health involves primarily the application of medical science for the benefit of the individual and of society. But many other factors, social, economic and educational have an intimate bearing on the .health of the community. Health is thus a vital part of a concurrent and integrated programme of development of all aspects of community life.

MENTAL DISEASES 60. Although little information is available regarding the incidence of mental ill-health in the country, there is no doubt that mental disorder and mental deficiency are prevalent on a wide scale. The number of persons suffering from varying degrees of mental disorder who may not require hospitalization but should receive treatment and of those suffering from mental deficiency is likely to run into several millions. The existing provision for the medical care of such persons is altogether inadequate and unsatisfactory. Each State health administration, through its mental health organisation, should attempt collection of information. It is estimated that hospital accommodation should be available for 800,000 mental patients but the existing provision is a little over 10,000 beds for the country as a whole. Radical improvements are required in the existing mental hospitals in order to make them conform to modem standards. Provision should also be made for all the methods of diagnosis and treatment. Apart from such remodelling of mental hospitals, the Central Government are upgrading two mental institutions, viz; one in Bangalore and the other at Ranchi. The establishment of an All India Institute of Mental Health in association with the Bangalore Mental Hospital will involve an expenditure during the five year period of Rs. 9-7 lakhs non-recurring

and Rs. 3 -4 lakhs recurring. This expenditure is to be shared between the Central Government and the State Government of Mysore. There are hardly any psychiatric clinics. A beginning should be made in special and teaching hospitals and later extended to district hospitals. There are no facilities for training in psychological medicine in the country. It is necessary that a certain number of selected medical men with some experience of work in mental hospitals in India should be sent abroad for training. 61. The provision made by the various States and the Centre for mental hospitals is indicated below :
(Rupees in lakhs) State Mysore Saurashtra Ranchi Schemes Mental Hospital, Bangalore Training in psychiatry Mental Hospital, Ranchi total Expenditure 195156 5-00 0-04 4.00 9.04

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2
2nd Five Year Plan
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Introduction Chapter- 1 || 2 || 3 || 4 || 5 || 6 || 7 || 8 || 9 || 10 || 11 || 12 || 13 || 14 || 15 || 16 || 17 || 18 || 19 || 20 || 21 || 22 || 23 || 24 || 25 || 26 || 27 || 28 || 29 || 30 || Conclusion || Appendix

Chapter 25:

HEALTH
The general aim of health programmes during the second five year plan is to expand existing health services, to bring them increasingly within the reach of all the people and to promote a progressive improvement in the level of national health. The specific objectives are: 1. establishment of institutional facilities to serve as bases from which services can be rendered to the people both locally and in surrounding territories; 2. development of technical manpower through appropriate training programmes and employment of persons trained; 3. as the first step in the improvement of public health, institution of measures to control communicable diseases which may be widely prevalent in a community; 4. an active campaign for environmental hygiene; and 5. family planning and other supporting programmes for raising the standard of health of the people.tion if even elementary services are to reach the mass of the people in any adequate degree:

MEDICAL EDUCATION 9. The number of medical colleges has increased from 30 in 1950-51 to 34 in 1954-55 and 42 in 195556. Annual admissions have increased from about 2,500 in 1950-51 to about 3,500 by 1955. The present training facilities provide for an annual out-turn of about 2,500 doctors during the second plan. There are at present 70,000 qualified doctors in India and about 12,500 doctors will qualify during the second plan. As against this, the number of doctors needed will be about 90,000. It is considered essential that more training facilities should be provided during the second plan so that this gap may be filled. 10. As new medical colleges will take some time to function fully, the expansion of existing colleges should be given the first priority. The plan provides about Rs. 20 crores for the expansion of medical colleges and attached hospitals, establishment of Preventive Medicine and Psychiatric Departments in medical colleges, completion of the All-India Institute of Medical Sciences and schemes for upgrading certain departments of medical colleges for post-graduate training and research. The annual admissions are likely to be increased by about 400 as a result of these expansion schemes. This would, however, cover only a part of the shortfall in the number of available doctors. It would, therefore, be necessary to start some new colleges during the second plan period. An amount of Rs. 6.5 crores has been provided in the plan of the Ministry of Health for establishing new medical colleges. MEDICAL RESEARCH 24. In recent years a large number of new institutions for medical research have come into being. There is .now an institute for drug research as well as institutes for research in chest diseases, leprosy, cancer and mental health. Adequate facilities and funds should be provided to these institutions. Research institutions should also perform another essential function, namely, the training of workers in specialised fields of medical sciences. To achieve this object, research institutes should be brought into intimate association with universities. 25. An essential pre-requisite for promoting medical research is the provision of an adequate number of workers equipped for research. Since medical colleges are the main source for the recruitment of research workers in medical sciences, an atmosphere of research must be developed in these institutions. Association of research with teaching will improve the quality of teaching and foster a spirit of research among medical students, and also stimulate a proportion among them to take up research careers. In 1946 the Health Survey and Development Committee drew attention to 'the almost complete absence of organised medical research in the different departments of medical colleges'. A number of factors have contributed to this unsatisfactory position, such as excessive teaching loads, shortage of trained personnel, lack of the practice of team-work between the different departments in medical colleges and inadequacy of equipment During the past few years the Indian Council of Medical Research has given considerable support to research work in ntedical colleges. The Council has now the following programmes in view: a. grants for an increasing number of individual research workers: b. specific funds for promotion of co-operative research between various departments of a medical college, including field research; c. encouraging participation of some departments of medical colleges, especially the pre-clinical ones, in a co-ordinated programme of research in several fields of medical sciences; d. establishment, when suitable personnel are available, of special research units on a more or less semi-permanent basis for a continued programme of research in specific fields of medical sciences; and e. creation of a special fund in each institution to enable younger workers to try out their ideas in a preliminary way.

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3
3rd Five Year Plan
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Introduction || Planning Commission Chapter-1 || 2 || 3 || 4 || 5 || 6 || 7 || 8 || 9 || 10 || 11 || 12 || 13 || 14 || 15 || 16 || 17 || 18 || 19 || 2 0 || 21 || 22 || 23 || 24 || 25 || 26 || 27 || 28 || 29 || 30 || 31 || 32 || 33 || 34 || 35 || Conclusion || A ppendix A || Appendix B ||Appendix C || Glossary

Chapter 32:

HEALTH AND FAMILY PLANNING

The broad objective of the health and family planning programmes in the Third Plan is to expand health services, to bring about progressive improvement in the health of the people by ensuring a certain minimum of physical well-being and to create conditions favourable to greater efficiency and productivity. Increased emphasis will be laid on preventive public health services. As in the Second Plan, specific programmes have been formulated for the Third Plan for improvement of environmental sanitation, specially rural and urban water supply. control of communicable diseases, organisation of institutional facilities for providing health services and for the training of medical and health personnel, and provision of services such as maternal and child welfare, health education and nutrition. The Third Plan also accords very high priority to family planning.

Mental Health 43. The recent constitution by the Central Government of an Advisory Committee on Mental Health points to the growing importance of mental health services in programmes for the development of public health and medical facilities. Besides making curative services available in mental hospitals to the extent feasible, greater attention has now to be given to the provision of preventive mental hygiene services and, in particular, to the introduction of a range of training programmes. Rapid industrialisation, technological changes and the movement of population from rural to urban areas bring in their train certain tensions and problems of maladjustment which are best dealt with in their early stages. There is need for mental health orientation of medical specialists, public health personnel and social workers, specially those working in maternity and child health centres. Mental health education is also an important aspect of the health education programme. Training facilities are required on a steadily increasing scale for child psychiatrists and psychiatric social workers. In the field of education, counselling for simple personal and emotional problems, mental health education of parents and teachers on sound principles of child upbringing and training in mental hygiene of school teachers should find an appropriate plac'e in the school health programme. In view of the role of psychological factors in social life, mental hygiene measures should be regarded as a necessary element in the administration of social welfare programmes. Since so little is known regarding the new social and psychos-logical problems which are coming up as India's economy develops and becomes ever more complex, facilities should also be provided for special surveys and studies in mental health. Voluntary

organisations can help greatly in educating the general public, in supporting the work of child guidance clinics and in other ways.

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4
4th Five Year Plan
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Chapter 18:

HEALTH AND FAMILY PLANNING

Health The broad objectives of the health programmes during 196169 have been to control and eradicate communicable diseases, to piovide curative and preventive health services in rural areas through the establishment of a primary health centre in each community development block and to augment the training programmes of medical and paramedical personnel. The programmes were formulated on the basis of the repoit of the Health Survey and Planning Committee of 1961. During the Fourth Plan, efforts will be made to provide an effective base for health services in rural areas by strengthening the primary health centres. These centres render preventive and curative health services, take over the maintenance phase of communicable diseases control programmes for malaria and small-pox and become the focal points for a nation-wide family planning pi ogramme. Sub divisional and district hospitals will be strengthened to serve as ref&rral centres for Primary Health Centres. The campaigns against communicable diseases will be intensified. Medical and nursing education and training of paramedical personnel will be expanded to meet the minimum technical man-power requirements.

18.11. The Indian Council of Medical Research is mainly responsible for guiding and financing medical research. In addition to the continuation of research of applied nature in the field of communicable diseases, nutrition, maternity and child health, the Council has initiated research in a wide variety of basic problems and applied investigations clinical medicine. Of late the Council has embarked on a large scale programme of research in the field of family planning and biology of reproduction. For the purpose of carrying out an integrated and simultaneous study of science of crude drugs and classification of the Indian medicinal plants, chemical and pharmacological properties and clinical usefulness, the Council is implementing the composite drug research projects in collaboration with the Centr?! Council of Ayurvedic Research. A pilot programme for evaluating the feasibility of vector control of mosquitoes using the genetic methods is being launched. Although the Council is an autonomous body, the Director-General does not erjoy the same powers as the Director-General of similar institutes like Indian Council of Agricultural Research and Council of Scientific and. Industrial Research. The Central Research Institute, Kasauli, undertakes research studies on cholera, typhoid, rabies, and allied subjects, in addition to

produption of vaccines. The All India Institute of Hygiene and Public Health undertakes epidemiological research in communicable diseases in addition to training programmes. The National Institute of Communicable Diseases, Delhi, is concerned with research in Communicable Diseases with particular reference to microbiology, immunology and diseases of animal origin. The Vallabhai Patel Chest Institute. Delhi, undertakes research on allergy diseases also. During the Fourth Five Year Plan an outlay of Rs. 22 crores. has been earmarked for medical research, which includes Rs. 11 crores for the Indian Council of Medical Research, Rs. 2 crores for research under Indigenous Systems of Medicine, Rs. 2 crores for research institutes and Rs. 7 crores for family planning research. 18.12. During the last eight years, 70,100 general beds in Government institutions have been added, bringing the total to 255,700. The target of establishing 54,000 beds during the Third Plan was achieved. The pace of adding new beds slowed down during the subsequent years. During 196974 it is intended to add 25,900 beds. Emphasis will be placed on better health care facilities at sub-divisional and district hospitals by provision of specialist's services. 18.13. The: Primary Health Centres form the base of the integrated structure of medical services in the rural areas. By the end of the Third Plan it was intended to establish one Primary Health Centre each in Community Development Blocks. By March 1966, 4631 Centres were set up. During the three subsequent years, 288 primary health centres were established so that at the beginning of the Fourth Five Year Plan 4919 primary health centres are functioning, 261 Community Development Blocks having more than one primary health centre, 4397 having one centre and 340 Blocks having no centre. At the beginning of the Fourth; Plan, about 50% of the primary health centres haw hospital buildings and only 25% residential quarters. Suitable buildings for accommodating primary health centres, sub-centres and staff are not easily available in rural areas. The lack of buildings is one of the main obstacles in posting doctors and nurses in rural areas. In the Fourth Five Year Plan, emphasis will be on the establishment of an effective machinery for the speedy construction of buildings and im^ roving of primary health centres by providing staff, dngs and equipment. It is also proposed during tlie Fourfh Plan to establish 508 primary health centres covering 340 blocks which do not yet have a centre so that there is at least one primary health centre in each block. 18.14. The primary health centres located in the malaria maintenance phase areas will be sirens'.hened with additional staff to take up the vigilance activities in the maintenance phase of the programmes for the eradication of communicable diseases. Such an approach involving as it does the integration of heaLh and medical care, will ensure optimum use of resources and manpower and prevent duplication and wasteful expenditure on the programmes. There is enthusiasm among the public for participation in health schemes. In order to create a sense of partnership with C: overn-ment efforts, voluntary contributions should be encouraged. 18.15. Programmes relating to indigenous systems of medicine which were started in the Third Plan will continue. These pertain to education and r'search compilation of Ayurvedic and Unani pharmacopoeia estabiihment of a central medicinal plant garden at Poona and surveys of medicinal plants. Family Planning 18.16. Family Planning finds its place in tlie Plan as a programme of the highest priority. Its crucial importance is reflected in the widespread public interest that has been aroused no less than in the magnitude of the effort, organisation and finance which Government is devoting to the programme. 18.17. The estimated population in 1968 (on October 1) was 527 million. The increase in population from 365 million in 1951 to 445 million in 1961 and 527 million in 1968 has been the result of a sharp fall in mortality rate without any significant changs in the fertility rate. The birth rate appears to have remained unchanged around 41 per thousand population during the greater part of the past two decades up to 1965-66. Recent surveys carried out by the Register General and the National Sample Survey Organisation appear to indicate that the birth rate has come down to 39 per thousand population for the country as a whole, the rate being somewhat higher in rural areas. The population growth rate is estimated to be 2.5 per cent per annum. In order to make economic development yield tangible benefits for the ordinary people, it is necessary tliat the birth rate be brought down substantially as early as possible. It is proposed to aim at its reduction from 39 per thousand to 25 per thousand population within the next 1012 yeais. In order to achieve this, a concrete programme has been drawn up for creating facilities for the married popuation during their reproductives period by bringing about (i) group

acceptance of the small sized family, (ii) personal knowledge about family planning methods; and (iii) ready availability of supplies and services. 18.18. A provision of Rs. 27 crores was made in the Third Plan. The expenditure incurred was Rs. 24.86 crores. During this period, family planning bureaux were organised at the State level and in 199 districts covering all States. At the end of the Third Plan, there were 3676 rural family welfare planning centres, 7081 rural sub-centres and 1381 urban family welfare planning ce itres. These centres provide supplies services and advice on family planning Twentyeight centres were esf ablished for training in which 7641 personnel took regular courses and 34484 short-term courses. Some progress was made in research, conducted in seven demographic centres and seven communication action research centres. Eight centres conduct studies on bio-me'clica aspects of family planning. For technical support, a Central Family Planning Institute was established at Delhi. 18.19. At the end of the Third Pian. the Indian Council of Medical Research approved mass utilisation of tin1 intra-uterine contraceptive device commonly known as ihe loop. Equal emphasis was placed on the sterilisation, the condom and the intra-uterine contraceptive device (IUCD). The initial response for the loop was encouraging. During the last year of the Plan, 0.8 million IUCD insertions were made. A factory for producing IUCD was established at Kanpur. It has a daily production capacity of 30,009 loops, sufficient to take care of the country's needs. The number of sterilisation operations performed in the Third Plan period was 1.33 million. 18.20. Since April 1966 a separate Department of Family Planning has been constituted at the Centre. It co-ordinates family planning programmes at the Centre and in the States. 18.21. The facilities for IUCD insertions and sterilisations were provided not only free but 'also with some compensation to the individuals for out-of-pocket expenses, conveyance and loss of wages. These are available at static centres and mobile units. A central family planning corps was created to deploy female doctors in areas where there was a shortage. Of the conventional contraceptives, condoms constitute the most important item. A public sector factory at Trivandrum has been set up with an initial capacity for producing 144 million pieces per annum and doubling and quadrupling the production v/hen necessary. 18.22. Family Planning programming cells were located in 22 All India Radio Stations. Thirty audiovisual units were provided under the Directorate of Field Publicity for carrying on intensive campaign in selected districts. The mass education programme through films, exhibitions, wall paintings and hoardings was intensified. 18.23. During 1967-68, the number of voluntary sterilisations exceeded 1.8 million. This is more than double the earlier best performance of 0.8 million during 1966-67 and exceeded the target of 1.5 million for the year During 1968-69, 1.65 milliod sterilisations were performed. The loop programme registered about 0.47 million insertions during 1968-69 as against 0.67 million in 1967-68. The temporary set-back is the result of reported side effects like bl eeding and pain. The machinery for proper pre-insertion education and check-up and post-insertion follow-up has been strengthened. 18.24. On the eve of the Fourth Plan, five Central Institutes and 43 State Family Planning Training Centres are functioning. There are 4326 rural family welfare planning centres, 22826 rural sub-centres and 1797 urban family welfare planning centres in operation. The progress in opening sub-centres has been unsatisfactory. This is due to shortage of auxiliary nurse-mid-wives and want of suitable accommodation for female workers in the rural'areas. At the beginning of the Fourth Plan, 450 Family Planning annexes to Primary Health Centres have been cosntructed (90 completed and 360 in progress) and buildings of 2770 sub-centres have been taken up (1280 completed and 1490 in progress). Table 3 Review of Progress and Targets sl. no. (0) 1 item (1) expenditure unit (2) Rs. crores third plan ( (3) 24.86 1966-69 estimate) (4) 60.48 fourth plan (5) 315

nos. (cu-. nos. 4 rural sub-centres mulative) . (cu-. nos. 5 urban family welfare planning centres (cumulative) nos. 6 family planning training centres (including central nos. institutes) 'Outlay

2 3

district family planning bureau rural family welfare planning centres mulative) .

199 3676 7081 1381 30

303 4326 22826 1797 48

335 5225 31752 1856 51

18.25. Family Planning will remain a Centrally sponsored programme for the next ten years and the entire expenditure will be met by the Central Government. It will be ensured that performance does not lag behind with expenditure. The effort will be to achieve enduring results through appropriate education and motivation. General health services will be fully involved in the programme. 18.26. The Draft Plan outlay of Rs. 300 corres has been revised upwards to Rs. 315 crores so that the programmes can be strengthened and speeded up. The organisation of services and supplies by rural and urban centres and the compensation for sterilisation and IUCD will involve an expenditure of Rs. 269 crores. Efficiency in these services can be ensured only with a minimum network of centres and subcentres all over the country and with more intensive attention to hospitals with a large number of maternity cases and to populous districts. Rs. 46 crores will be spent on training, research, motivation, organisation and evaluation. 18.27. Keeping in view the aim to reduce the birth rate to about 32 per thousand population by 1973-74 from the present 39, it is proposed to step up the target of sterilisation and IUCD insertions and to widen the acceptance of oral and injectible contraceptives. The use of conventional contraceptives will also be stepped up so as to cover 3.24 million persons in 1969-70 and 10 million persons by 1973-74. As a result of these measures, 28 million couples are likely to be protected by 1973-74. The births expected to be prevented will aggregate to 18 million for the Plan period. 18.28. After carrying out studies on pilot projects, the Indian Council of Medical Research is of the opinion that the oral pills could be prescribed by medical practitioners for use after proper medical check up and under their supervision. As a result of this recommendation, the oral pills were introduced in the family planning programme in August 1967 as a pilot project. The results of the pilot projects have been analysed and a depth study is under way. The pill programme will be expanded both in urban and rural areas in a phased manner depending on experience gained during the expansion of the programme. 18.29. Surgical equipment will be provided in all rural and urban family welfare planning centres (nearly 7000 in number) for vasectomy operations. The efforts of these centres will be supplemented by more than 1000 mobile service units attached to district family planning bureaux. Salpingectomy is becoming popular and it is estimated that 25% of all sterilisations wil) be performed on women. To supplement the effort of hospital authorities in using general beds for salpingectomy, 3300 beds will be provided for this purpose. For intensifying, the family planning programme, some new schemes like post-partum programme, supply of surgical equipments to hospitals, intensive districts and selected area programmes, supply of vehicles at all primary health centres and strengthening of Central and State Health transport organisations have been included for implimentation during the Fourth Plan. 18.30 In addition to the present system of free distribution of conventional contracepvies through family welfare planing centres and voluntary workers (depot holders), a massive programme of distribution of condoms (Nirodh) through 600,000 commercial retail outlets will be developed and sold to consumers at 15 paise for a packet of three condoms. It is estimated that 1200 million pieces will be indigenously manufactured. 18.31. Mass education activities will be strengthened in rural areas and small towns. Traditional and cultural media like song, drama and folk entertainment will be effectively used. Extension education will be strengthened and population education v/ill be introduced. The strategy will be to bridge the gap between knowledge and adoption of family planning by couples in reproductive age-groups.

18.32. Arrangements will be made for training 10,000 medical and 150,000 para-medical personnel. In the research programmes, emphasis will be laid on the bio-medical aspect. New centres for reproductive biology and human reproduction will be established and orien-tation-cww-training courses in these subjects for teachers of medical colleges will be arranged. Demographic and communication studies will be used for efficient implementation of the programme. Its cost under various conditions will be analysed. Fertility surveys combined with KAP studies (knowledge, attitude and practice) will be carried out to evaluate the ultimate and interen-mediate objectives of the programme. 18.33. The programme of family planning is likely to be more effective and acceptable if mater lity "and child health services are integrated with family planning. This has now been done. The scheme of immunisation of infants and pre-school children with DPT, immunisation of expectant mothers against tetanus, prophylaxis a.sainst nutritional anaemia for mothers and children and nutritional programme for control of blindness caused by Vitamin 'A' deficiency among children will bs implemented through family welfare planning centres. Family planning will be effectively integrated with the .general health sei vices of primary health centres and sub-centres. ANNEXURE I Health : Selected Achievement and Targets (numbers) Sl.No. item (0) 1 2 3 4 5 6 7 8 9 10 11 12 13 (1) beds primary health centres medical colleges annual admissions dental colleges annual admissions manpower doctors* nurses1 auxiliary nurse-midwives and midwivcs control of diseases national malaria eradication programme (units) attack phase (units) consolidation phase (units) maintenance phase (units) tuberculosis control 114 clinics 15 demonstration and training centres 16 isolation beds 1 In practice. 220 10 26500 427 15 35000 502 15 35000 582 17 37500 196061 (2) 185600 2800 57 5800 10 281 70000 27000 19900 196566 (3) 240100 4631 87 10520 13 506 86000 45000 36000 1968-69 anticipated (4) 255700 4919 93 11500 15 586 102520 61000 48000 1973-74 targets (5) 281600 5427 103 13000 15 800 137930 88000 70000 393.25 30.00 93.25 270.00

390.00 393.25 393.25 390.00 80.26 112.985 170.36 70.385

142.63 209.88

ANNEXURE II Health Programmes : Level of Achievement at the beginning of Fourth Plan sl. state/union no territory . estimated population medical primary health in 1968-69 (million) colleges centres functioning no. of PHCs yet to be established (0) (1) (2) (3) (4) (5) (6) (7) sub- beds per centre 1000 s persons

states I 2 3 4 5 6 7 8 Andhra Pradesh Assam Bihar Gujarat Haryana Jammu & Kashmir Kerala 41.771 14.857 55.427 25.363 9.574 3.953 20.424 39.067 47.979 28.155 0.448 20.795 14.043 25.047 8 3 4 5 1 1 4 6 11 9 409 99 587 250 89 69 163 428 382 265 6 309 127 232 317 740 225 1 29 44 1 11 5 1 65 135 110 4 1 4 9 77 1122 0.61 300 0.45 3523 0.24 1497 0.46 482 118 0.44 1.00

1584 0.94 1220 0.32 2776 0.50 2470 0.52 15 2.25 747 659 574 0.37 0.69 0.51

Madhya Pradesh 9 Maharashtra 10 Mysore 11 Nagaland 12 Orissa 13 Punjab 14 Rajasthan

3 4 5 9 8 6

15 Tamil Nadu 38.344 16 Uttar Pradesh 87.393 17 West Bengal 42.886 union territories 18 Andaman and 0.077 Nicobar Island 19 Chandigarh 0.145 20 Dadra and Nagar Haveli 21 Delhi 22 Goa, Daman and Diu 23 Himaehal Pradesh 24 L.M.A. Island 25 Manipur 26 NEFA 27 pondicherry 28 Tripura 29 Total 0.070 3:894 0.760 3.456 0.029 0.946 0.408 0.448 1.385 527.144

1887 0.70 2902 0.37 548 0.85 1 1.00 5.51 2 34 2.80 2.40 2.30 0.60 3.44 38 0.57 2.80 0.95 22 :826 0.33 049 << Back

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2 5 15 72 7 12 74 11 23 4919

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5th Five Year Plan

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Foreword || A Review of the Economic Situation || The Perspective || Rate and Pattern of Growth || Financial Resources || Plan Outlays and Programmes of Development || Resolution of the National Development Council on Power and Irrigation Systems || Resolution of the National Development Council on the Fifth Five Year Plan || Annexures

8. Health, Family Welfare Planning and Nutrition Health Central Sector 5.1 51. In the draft Fifth Plan, an amount of Rs. 252.79 crores was provided for this sector The expenditure during the first three years is likely to be Rs. 1 52-93 crores. An outlay of Rs. 182'90 crores has been recommended for the last two years after assessing the performance of various major on-going programmes and after keeping in view the broad aspects of health strategy. 5.152. Among the Centrally sponsored schemes National Malaria Eradication Programme has been allocated Rs. 196-44 crores as against the original provision of Rs 96-71 crores in the Draft Fifth Plan. A substantial increase in the outlay for this programme has become necessary to contain the disease according to a revised strategy. Provision has also been made for more effective implementation of National Leprosy Control Programme and the National Scheme for prevention of impairment of vision and control of blindness. A pilot research project to develop a strategy for control of filaria in rural areas has also been included. Adequate provision has been made during 1 977-79 for establishing combined food and drug testing laboratories and for giving Central assistance to existing food laboratories in the States. State Sector 5.153. An outlay of Rs. 543 21 crores was provided in the draft Plan for various health programmes under the States and Union Territories. The total likely expenditure for the first three years of the Fifth Plan is estimated at Rs. 159-92 crores. For the remaining two years of the Fifth Five Year Plan i.e., 1977-79, an outlay of Rs. 185-91 crores has been recommended. 5.154. These provisions include the requirements of the on-going programmes and the reed for reasonable expansion, extension and development of rural health services. It has been ensured that all the primary health centres and sub-centres in the country would get drugs at the enhanced level of Rs.1 2,000/-per PHC and Rs. 2,000/- per sub-centre per annum. Adequate provision has also been made for medical education. General 5.155. The revised total Fifth Plan outlay for the Health Sector thus works out to Rs. 681.66 crores. The break-up of the outlay for the Central and State Sectors is given below : (Rs. crores) scheme (0) 1. central 2. centrally sponsored 3. siaies/U.Ts 1974-77 anticipated expenditure (1) 28.60 124.33 159.92 1977-79 proposed revised fifth outlay plan outlay (2) 39.06 143.84 185.91 368.87 (3) 67.66 268.17 345.83 681.66

4. Total 372.85 Family Welfare Planning Programmes

5.156. In the draft Plan an amount of Rs. 516.00 crores was provided for programmes relating to family welfare planning. The likely expenditure during the first three years of the Fifth Plan is expected to be of the order of Rs. 237.65 crores. 5.157. An outlay of Rs. 259'71 crores has been recommended for the period 1977-79. The family planning programmes wilt be carried forward in an integrated manner alongwith Health,Maternity and Child Health Care and Nutrition services on the basis of the strategy outlined in the draft Fifth Plan. Firm and bold steps envisaged in the National Population Policy to improve the tempo of the programme has been kept in view in

recommending the revised outlays. To cope with the increasing demand for sterilisation, facilities will be expanded at 1000 selected Primary Health Centres and 325 Taluka level hospitals during 1976-79. Two hundred additional post-partum centres beyond the original targets in the draft Fifth Plan are also proposed to be opened. Another unit of the Hindustan Latex Ltd. will be set up at Farakka to meet the increased demand of Nirodh. The India Population Project with Sl DA/I DA assistance will be carr.pleted by the end of the Fifth Plan. Special multi-media motivation campaigns on pilot basis will be launched in Uttar Pradesh, Andhra Pradesh, and West Bengal. Maternity and child health programmes will be vigorously pursued and furds for this purpose will be made available on the basis of performance. Research and evaluation facilities will be strengthened. Funds for completion of incomplete buildings and for construction of essential buildings for Rural Family Welfare Planning Centres have been provided. 288 New Rural Family Welfare Planning Centres will be opened in a phased manner. 5.158. A total provision of Rs. 497.36 crores has been envisaged in the revised Fifth Plan. Summary of the outlays is given in the enclosed statement (Annexure 37). Nutrition Central Sector 5.159. Indraft Fifth Ptan, an amount of Rs. 70 crores was provided in the Central Sector. Rs. 50 crores were earmarked for the Subsidiary Food and a Nutrition Scheme of the Department of Food, and Rs. 20 crores for the Applied Nutrition Programme of the Department of Rural Development. Nutrition Schemes of the Department of Food 5.160. The likely expenditure during the first three years of the Fifth Plan is placed at Rs. 6.53 crores. Under the revised Fifth Plan an outlay of Rs. 6.70 crores has been provided during 1977-79 for production of nutritions foods. An amount of Rs. 1.27 crores has also been recommended during 1977-79 for other schemes like fortification of Food Stuffs, nutrition education through mass media, Pilot Research Projects etc. An outlay of Rs. 7.97 crores has thus been recommended for 1977-79 making up a Fifth Plan provision of Rs. 14.50 crores. Applied Nutrition Programme (Deptt. of Rural Development) 5.1 61. The outlay of Rs. 20 crores provided in the draft Fifth Plan was meant for providing Central assistance to the on going Applied Nutrition Blocks, opening of 700 new blocks and maintenance of post operational blocks for one year after existence for a period of five years. Due to constraint of resources in the social Services Sector only 192 blocks were set up in the first two years (1974-76) of the Plan. The likely expenditure during the first three years of the Plan is Rs. 4.48 crores. A sum of Rs. 8.51 crores has been recommended for 1977-79. The total outlay under the revised Fifth Plan works out to Rs. 1 2.99 crores. State Sector 5.1 62. In the draft Fifth Five Year Plan, an amount of Rs. 330.00 crores was provided for the States and Union Territories, for the supplementary Feeding programmes, i. e.. Mid-day Meals Programme for the School going children and Special Nutrition Programme for the children in the age group of 0-6 years and expectant and lactating mothers. Likely expenditure during the first three years of the Plan is placed at Rs. 44.24 crores. The slow progress in the initial years of the Fifth Plan was mainly due to the financial constraint and non-availability of funds in the non-Plan budgets of the State Governments for meeting cost of food, administration and transport for the beneficiaries. For the remaining years of the Fifth Plan adequate provision has been made from the non-Plan resources of the State for beneficiaries cf special nutrition programme at the end of the Fourth Plan. After taking into account a reasonable expansion, a provision of Rs. 43.94 crores has been recommended by Planning Commision for 1977-79-The revised outlay under the Fifth Plan thus works out to Rs. 88.18 crores. A statement showing programme-wise break-up under the revised Fifth Plan is attached (Annexure 38).

ANNEXURE 37 (Chapter V.8,Para 5.158) Summary of Plan outlay for Family Welfare Planning Programmes during the Fifth Plan (Rs. crores) draft fifth plan (0) (1) 1 services and supplies 422.53 . 2 training 13.54 . programmes 1974-77 anticipated expenditure (2) 197.74 6.17 1977-79 proposed outlay (3) 221.67 5.90 revised fifth plan outlay (4) 419.41 12.07

3 mass education 22.00 6.45 6.68 13.13 . 4 research and 14.33 3.45 5.58 9.03 . evaluation 5 world bank project 19.50 15.68 9.06 24.74 . 6 maternity and child 15.00 2.73 5.84 8.57 . health 7 organisation 9.10 5.43 3.98 9.41 . 8 total 516.00 237.55 259.71 4 9 7.3 6 . * Includes provision of Rs. 1 crore for new schemes to be formulated by the Department of Family Planning. ANNEXURE 38 (Chapter V. 8,Para 5.162) Nutrition Programmes (Rs. crores) scheme sector draft fifth five year plan (2) 330.00 1974-77 anticipated expenditure (3) 44.24 1977-79 recommended outlay (4) 43.94 revised fifth plan outlay (5) 88.18

(0) 1. Minimum Needs Programme

2. subsidiary food and nutrition schemes of the union deptt. of food. 3. schemes of the union deptt. of rural development applied nutrition programme 4. total

(1) states union Territories central 50.00 centrally 20.00 sponsored

6.53 4.48

7.97 8.51

14.50 12.99

400.0.

55.25

60.42

115.67

ANNEXURE45 (Chapter V. Para 5.201) Fifth Plan- S and T Outlay ( Rs. crores) Ministry/department draft 5th plan (0) 1. 2. 3. 4. 5. 6. 7. atomic energy (r and d) space science and technology csir - dst supply n.t.h. sub-total (1-4) industry and c.s. heavy ind. industrial davelopment commerce steel and mines - steel (1) 111.13 90.00 104.50 109.98 2.50 418.11 70.00 25.00 5.00 20.00 18.33 39.85 0.53 15.00 10.29 20.00 10.00 1974-77 (2) 83.12 66.18 37.66 23.02 0.61 210.59 6.61 3.97 0.56 2.12 1.48 18.53 0.04 2.28 1.39 6.23 0.31 1977-79 (3) 84.01 62.09 44.11 35.94 1.49 227.64 22.15 6.35 1.07 4.50 5.00 22.85 0.11 6.41 5.00 12.50 0.68 total 5th plan (4) 167.13 128.27 81.77 58.96 2.10 438.23 28.76 10.32 1.63 6.62 6.48 41.38 0.15 8.69 6.39 18.73 0.99

mines gsi and ibm

8. 9. 10. 11. labour (coal mines safety) energy power

coal
electronics shipping and transport - shipping

- transport 12. 13. 14. 15. 16. 17. 18. communications tourism and c. aviation c.a.

9.00 32.28 0.80 30.00 0.50 16.00 15.00 23.75 38.00 110.16 14.84

0.20 10.87 0.18 9.05 0.27 7.35 1.13 0.03 2.49 46.55 1.21 1.40 9.92 134.17

1.80 11.52 0.20 10.53 0.50 4,73 1.22 0.50 5.99 55.93 2.50 1.80 11.40 195.24

2.00 22.39 0.38 19.58 0.77 12.08 2.35 0.53 8.48 102.48 3.71 3.20 21.32 329.41

imd Instts.
information and broadcasting pet. and chemicals petroleum

chemicals
works and housing irrigation agriculture - ICAR (excluding edn.)

forest research Others

19. health and P.P. - icmr, health & P.P. sub-total (5 to 19)

36.00 560.33

20. grand total 978.44 344.76 422.85 767.64 An additional Rs. 30 crores for INSAT-1 has been provided under the following ministries : communications Rs. 20 crores; information and broadcasting Rs. 5 crores; tourism and civil aviationRs. 5 crores. 13.2 Deptt. of Economic Affairs (a) Bank Note Press (i) continuing and expansion schemes (ii) housing scheme phase II (b) India Security Press (i) expansion and modernisation of stamp press (ii) expansion and modernisation of currency note press. (iii) housing programme (c) Security Paper Mill (i) modernisation of mill (ii) mould cover plant and other schemes (d) Bombay Mint-housing scheme (e) Hyderabad Mint-Expansion Bombay Hyderabad Hoshangabad Nasik Dewas 24.91 7.61 7.21 0.40 6.54 2.08 3.50 0.96 10.34 10.00 0.34 0.32 0.10

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6
6th Five Year Plan
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Foreword || Preface || Planning Commission Chapter 1 || 2 || 3 || 4 || 5 || 6 || 7 || 8 || 9 || 10 || 11 || 12 || 13 || 14 || 15 || 16 || 17 || 18 || 19 || 2 0 || 21 || 22 || 23 || 24 || 25 || 26 || 27 || 28 || Appendix

Chapter 22: HEALTH, FAMILY PLANNING AND NUTRITION Sustained efforts towards promotion of health care services during the last 30 years have resulted in significant improvement in the health status of the country. The mortality rate has declined from 27.4 in 194151 to an estimated 14.2 in 1978. The life expectancy at birth has gone up from about 32 years as per 1951 Census to about 52 years during 197681. The infant mortality rate has come down from 146 during the fifties to 129 in 1976. The health infrastructure has been strengthened. The country has about 50,000 sub-centres, 5,400 primary health centres including 340 upgraded primary health centres with 30 bedded hospital, 106 medical colleges with admission capacity of 11,000 per annum and about 5 lakh hospital beds. The per capita expenditure on health incurred by the State has fgone up from about Rs. 1.50 in 195556 to about Rs. 12 in 1976-77. The doctor population ratio though satisfactory on an average in the country (1977), varies widely from 1 doctor for 8333 in Meghalaya to 1 doctor for 1400 in Delhi. The bed population ratio has also improved but varies widely in urban and rural areas. 22.2 The country was declared free from smallpox in April, 1977. The National Malaria Eradication Programme initiated in 1958 had brought down the incidence of the disease to about 1 lakh cases with no deaths in 1965 although there has been a slippage in the subsequent years. The National Programme for Control of Leprosy, Tuberculosis, Filaria and Blindness have also helped to reduce mortality|morbidity. 22.3 National Programmes have also been initiated for promotion of maternity and child care such as immunization of expectant mothers against Tetanus and children against Tetanus, Whooping Cough, Diphtheria. Tuberculosis, Polio etc., besides prophylaxis against Vitamin 'A' and iron deficiencies. Programmes of improving the nutrition of mothers and children have also been taken up. 22.4 Tn the field of curative services some of the State Hospitals have built m specialised sophisticated service's comn'arable with facilities available in some of the advanced countries for cardiac diseases, cancer and neurological, nephrological disorders. 22.87 Nutritional deficiencies are wide spread due to social, cultural and economic imbalances and inadequate intake of food. Recent studies in India have shown that the chief cause of malnutritior is inadequacy of total calorie intake rather, than inadequacy of proteins. Many groups, particularly, children, pregnant women and nursing mothers have poor stores of Vitamin 'A' and iron. Kwashiorkor and marasmus are the two clinical forms of PEM which lead to both mental and physical growth retardation and impairment of immuno-competance among children. Lack of Vitamin 'A' leads to Xerophthalmia and severe forms of this deficiency may cause permanent blindness. Low levels of Vitamin 'A' among pregnant mothers lead to delivery of babies with poor stores of this Vitamin and low birth weight. Iron deficiency anaemia is an important health problem. Goitre is prevalent in the hill belts of the country. Vitamin 'A' and iron deficiencies are widely seen amongst school children, young girls, pregnant women and nursing mothers. Diarrhoea is a major public health problem among infants and young children. They are susceptible to this due to preparation of supplementary Foods in unclean utensils and contaminated water.

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7
7th Five Year Plan (Vol-2)
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HEALTH AND FAMILY WELFARE Medical Research 11.17 Medical research covers a broad spectrum of discipline, from basic work at the frontiers of modern biology to innovations for ensuring the most effective application of available knowledge. Medical research is carried out principally under the auspices of the Indian Council of Medical Research (ICMR). A detailed account of the work done under the ICMR is given in Chapter 17. A considerable amount of research work is also being carried out in the other institutions, some under the Ministry of Health and Family Welfare (including those under the DGHS). Some of the institutions which have done notable work are the National Institute of Communicable Diseases, All India Institute of Medical Sciences, New Delhi, Post-Graduate Institute, Chandigarh, National Institute of Mental Health & Neuro Sciences, Bangalore, and All India Institute of Hygiene and Public Health, Calcutta. Many medical colleges in the country also have an excellent record of research to their credit. SEVENTH PLANOBJECTIVES, GOALS AND STRATEGY 11.19 The nation is committed to attain the goal of health for all by the year 2000 AD. For developing the country's vast human resources and for the acceleration and speeding up the total socio-economic development and attaining an improved quality of life, primary health care has been accepted as one of the main instruments of action. Primary health care would be further augmented in the Seventh Plan. In the overall health development programme, emphasis will be laid on preventive and promotive aspects and on organising effective and efficient health services which are comprehensive in nature, easily and widely available, freely accessible, and generally affordable by the people. Towards this objective, the major thrusts will be in the following areas: (i) The Minimum Needs Programme would continue to be the sheet-anchor for the promotion of the primary health measures, with greater emphasis on improvement in the quality of services rendered and on their outreach. These will be backed up by adequately strengthened infrastructural facilities, and establishment of additional units where they are not available.

(ii) Health programmes suffer considerably because of poor inter-sectoral coordination and cooperation. Serious efforts for effective coordination and coupling of health and health- related services and activities, e.g., nutrition, safe drinking water supply and sanitation, housing, education information and communication and social welfare will be made as part of the package for achieving the goal of Health for All by 2000 AD. (iii) Community participation and people's involvement in the programme being of critical importance, programmes involving active participation of voluntary organisations and the mounting of a massive health education movement would be accorded priority. (iv) Qualitative improvements are required in Health and Family Planning services. Supplies and logistics require greater attention, education and training programmes need to be made more need-based and community-oriented and, since management and supervision are vulnerable areas, management information systems need to be developed. Adequate provision of essential drugs, vaccines and sera need special attention for ensuring production, pricing and distribution and universal accessibility, availability and afforda-bility. (v) Urban health services, school health services and mental and dental health services also need special efforts to ensure comprehensive coverage. Control and Constraint of Non-Communicable Diseases 11.31 Mental healthOrganised and planned mental health care activities are vital for obviating the ill-effects of major socio-economic changes. A beginning in this direction is proposed in the Seventh Plan by according priority to strengthening the existing psychiatry departments, promotion of community psychiatry by provision of drugs and services through the primary health care system and organisation of training programmes. Programme Thrusts in the Seventh Five-Year Plan (v) Considering the fact that the urban health services organisation, besides providing primary health care to the urban population, has also tc provide back-up support to the rural health organisation through the referral system anc specialist services, the need is clear for district hospitals to be provided with specialised services in important branches such as surgery, obstetrics and gynaecology, medicine, psychiatry, paediatrics, ophthalmology, anaesthesia, ENT, skin, rehabilitation and dental care. District hospitals would have to provide diagnostic facilities ir X-ray, ECG, pathology and biochemistry, including facilities for early detection of cancer. Each district hospital should also have specialists ir radiology and pathology including blood transfusion. At district levels there is need to establish epidemiological centres with a well-equipped public health laboratory to keep the morbidity anc mortality profiles of the district under constant surveillance, detect disease outbreak early anc take necessary corrective action.
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8
8th Five Year Plan (Vol-2)
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Agricultural and Allied Activities || Rural Development and Poverty Alleviation || Irrigation, Command Area Development and Flood Control || Environment and Forests || Industry and Minerals || Village and Small Industries and Food Processing Industries || Labour and Labour Welfare || Energy || Transport || Communication, Information and Broadcasting || Education, Culture and Sports || Health and Family Welfare || Urban Development || Housing, Water Supply and Sanitation || Social Welfare || Welfare and Development of Scheduled Castes and Scheduled Tribes || Special Area Development Programmes || Science and Technology ||Plan Implementation and Evaluation

HEALTH AND FAMILY WELFARE

12.1.1 Health of the people is not only a desirable goal but is also an essential investment in human resources. The National Health Policy (1983) reiterated India's commitment to attain "Health for All (HFA) by 2000 A.D". Primary health care has been accepted as the main instrument for achieving this goal. Accordingly, a vast network of institutions at primary, secondary and tertiary levels have been established. Control of communicable diseases through national programmes and development of trained health manpower have received special attention. 12.1.2 Many spectacular successes have been achieved in the country in the area of health. Small-pox stands eradicated and plague is no longer a problem. Morbidity and mortality on account of malaria, cholera and various other diseases have declined. The Crude Birth Rate and Infant Mortality Rate (IMR) have declined to 29.9 and 80 (1990 SRS data) as compared to 37 and 129 respectively in 1971. Life expectancy has risen from a mere 32 years in 1947 to 58 years in 1990. However, HFA is a long way off. Disease, disability and deaths on account of several communicable diseases are still unac-ceptably high. Meanwhile, several non-communicable diseases have emerged as new public health problems. Rural health services for delivery of primary health care are still not fully operationalised. Urban health services, particularly for urban slums, require urgent attention due to changing urban morphology. Programme Thrusts in the Eighth Plan 12.2.1 It is towards human development that health and population control are listed as two of the six priority objectives of this Plan. Health facilities must reach the entire population by the end of the Eighth Plan. The Health for All (HFA) paradigm must take into account not only high risk vulnerable groups, i.e., mothers and children, but must also focus sharply on the underpriviledged segments within the vulnerable groups. Within the HFA strategy "Health for underpriviledged" will be promoted consciously and consistently. This can only be done through emphasising the community based systems reflected in our planning of infrastructure, with about 30,000 population as the basic unit for primary health care. Mental Health Services 12.2.38 The Seventh Plan document had suggested initiation of a National Mental Health Programme with emphasis on community based approaches. However, due to fund constraints the programme has not made satisfactory progress.

12.2.39 During the Eighth Plan mental health services will be given priority. The strategies for mental health programme will be community based utilising the existing primary health care and district hospital services. A psychiatric centre in each of the districts/divisions will be established. Also, every medical college will be encouraged to start a separate Department of Psychiatry so that the required manpower, both medical and para-medical, can be trained.

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9
9th Five Year Plan (Vol-2)
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National Mental Health Programme 3.4.129 It is estimated that 10 to 15% of the population suffer from mental health problem. Qualified professionals providing mental health care are few and the outreach of services in rural area is very low. The National Mental Health Programme was initiated by the Government of India in 1982 with the objective of improving mental health services at all levels of health care (primary, secondary and tertiary) for early recognition, adequate treatment and rehabilitation of patients with mental health problems within the community and in the hospitals. However, the Programme did not make much headway either in the Seventh or Eighth Plan. Mental Hospitals are in poor shape. The States have not provided sufficient funds for mentally ill requiring inpatient treatment. The Supreme Court has directed the Centre and the States to make necessary provision for these hospitals so that the inmates do get humane and appropriate care. 3.4.130 The Mental Health Act, 1987, which came into force with effect from April 1993, requires that each State/UT set up its own State level Mental Health Authority as a Statutory obligation. Majority of the States/ UTs have complied with this and have formed a Mental Health Authority. 3.4.131 The Central Council of Health & Family Welfare reviewed the progress and resolved that the National Mental Health Programme should be accorded due priority and full-scale operational support (including social, political, professional, administrative and financial back up) are provided. 3.4.132 During the Eighth Plan, NIMHANS developed a district mental health care model in Bellary district with the following aims; 1. to provide sustainable basic mental health services to the community and to integrate these services with other health services; 2. early detection and prompt treatment of patients; 3. to provide domiciliary mental health care and to reduce patient load in mental hospital; 4. community education to reduce the stigma attached to mental illness;

5. to treat and rehabilitate patient's mental problems within their family setting. 3.4.133 During the Ninth Plan period the experience gained in implementing mental health care both in Central and State Sector will be utilised to provide sustainable mental health services at primary and secondary care levels and to build up community support for domiciliary care. IEC on mental health especially prevention of stress-related disorders through promotion of healthy lifestyle and operational research studies for effective implementation of preventive, promotive and curative programmes in mental health through existing health infrastructure will receive due attention.

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9th Five Year Plan (Vol-2)

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SOCIAL WELFARE INTRODUCTION 3.10.1 The social scenario in the country has been fast changing due to rapid urbanisation and industrialisation. The unending flow of rural population to the already crowded cities and towns in search of employment has resulted in serious problems like overcrowding, emergence of pavement/slum dwellings, breakdown of joint family system, unemployment, poverty etc. In this process, certain categories of population, who failed to cope with these rapid changes, have started lagging behind the rest of the society due to their vulnerability. They include Persons with Disabilities viz. - locomotor, visual, hearing, speech and mental; the Social Deviants, who come in conflict with law viz. - juvenile delinquents/vagrants, drug addicts, alcoholics, sex-workers, beggars etc.; and the Other Disadvantaged viz. - the elderly, the destitutes, the deserted, street children etc. All these categories need special attention of the State because of the vulnerabilities and the disabilities, they suffer from. 3.10.2 To safeguard the interests of the disadvantaged sections of the Society, the Constitution of India guarantees that no person will be denied `equality' before the law (Article 14). It also promises `right to education' and `public assistance' in the old age and disablement (Article 41). To safeguard the interests of these groups, some important legislations were also enacted. They include - the Immoral Traffic (Prevention) Act, 1956 (as amended and retitled in 1986); the Probation of Offenders Act, 1958; Juvenile Justice Act, 1986; the Prevention of Illicit Traffic in Narcotic Drugs and Psychotropic Substances Act, 1988; the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995; Prevention of Beggary Acts (State Acts) etc. Simultaneously, the Government has also undertaken many welfare-cum-developmental measures right from the First Five Year Plan with the major objective of extending preventive-cum-curative-cum-rehabilitative services to meet the special needs of these vulnerable groups. Thus, the developmental planning has been made responsive right from the beginning not only to attend to the existing problems but also to address the situations emerging from time to time. THE CURRENT SITUATION Persons with Disabilities 3.10.3 No Census, except for 1981, has ever enumerated the population of the Persons with Disabilities since Independence. However, the National Sample Survey Organisation (NSSO) conducted two country-wide Sample Surveys in 1981 and 1991. According to these Surveys, there were 136.74 lakh disabled persons in 1981 and 163.62 lakh in 1991 who were having at least one or the other of the four types of disabilities viz. - locomotor, visual, hearing and speech. The magnitude and the size of various disabilities, as revealed by the two Surveys, is given in Table 3.10.1. Table 3.10.1

Type and Magnitude of various Disabilities as per the Nation-wide Sample Surveys of NSSO in 1981 and 1991 (Figure in lakhs) -----------------------------------------------------------------------------------Type of Disability 1981 1991 ----------------------------------------Actual % Actual % Number Number ------------------------------------------------------------------------------------1. Locomotor (with or without 54.27 39.7 80.44 49.2 other disability) 2. Visual (with or without 34.74 25.4 36.26 22.2 other disability) 3. Hearing (with or without 30.19 22.1 29.24 17.8 other disability - 5 years and above) 4. Speech (with or without 17.54 12.8 17.68 10.8 other disability - 5 years and above) -----------------------------------------------------------------------------------Total 136.74 100.0 163.62 100.0 ------------------------------------------------------------------------------------ Disabled (with more than one of the 4 disabilities mentioned above) 14.5% 12.4% -------------------------------------------------------------------------------------Note : As the data of Census and NSSO are non-comparable, data of NSSO for both 1981 and 1991 have been made use of for the comparison above. 3.10.4 A comparison of the data of NSSO Surveys of 1981 and 1991 on the magnitude of the problem of disability indicates that the actual number of the disabled has also increased from 136.74 lakhs to 163.62 lakhs and their percentage to the total population in the corresponding years has marginally increased from 1.8 per cent in 1981 to 1.9 per cent in 1991. Amongst the total population of the disabled, persons with locomotor disability had the highest share of 49.2 per cent and the lowest being the victims of speech disability. While the actual number of persons with locomotor disability and visual disability have shown an increasing trend during the last decade (1981-91), persons with hearing disability have shown a decreasing trend; and the persons with speech disability remained more or less the same during the same period. But, when the percentage of their share in the total population of the disabled is considered, all the three categories except for the locomotor disability, have shown a declining trend. The high rate of 49.2 per cent in respect of the persons with locomotor disability was largely attributed to the automobile and road accidents and other industrial hazards, indicating a greater need for strict observation of road and industrial safety measures and traffic regulations. However, the major cause of polio-related locomotor disability has been brought under control by effective nation- wide immunization campaigns. 3.10.5 Although, the NSSO excluded Persons with Mental Disabilities from both the national surveys of 1981 and 1991, it, however, conducted a sample survey in 1991 on the `Persons with Delayed Mental Development'. According to the Survey, about 3 per cent of the child population (1-14 years) were estimated to have mental retardation. Amongst the adults, rough estimates indicate that while 1 per cent of them were suffering from various forms of mental disorders, 10 to 15 per cent were suffering from various mental health problems. 3.10.6 The number of leprosy affected disabled persons was estimated to be about 4 million, of whom, about one fifth were children and about 15 to 20 per cent were left with deformities. The prevalence rate was more than 5 per thousand in the 196 high endemic districts in the country. 3.10.7 As revealed by the NSSO Survey of 1991, although 80 per cent of the disabled population live in rural areas, services and institutional/infrastructural facilities available to them were mainly confined to urban areas, and the villages remained mainly unattended to/neglected. Only 10 per cent of villages had

the privilege of having Integrated Education Centres for the Disabled within a distance of less than 10 kms. The situation was much worse in respect of special schools, vocational training and other welfare institutions. Further, 97 per cent of villages did not have the facility of having special schools within a distance of 10 kms and about 96 per cent of villages did not have any facility for vocational training within that distance. Only 6 per cent of villages received rehabilitation services through mobile vans or camps. The services available for the Spastics and persons suffering from Cerebral Palsy were not only inadequate but were mainly urban centred. In the rural areas, these services were virtually absent. 3.10.8 To ensure social justice to the disabled on equitable terms, the Government of India enacted in 1995 a comprehensive legislation viz., the Persons with Disabilities (Equal Opportunity, Protection of Rights and Full Participation) Act (PDA), 1995. The Act empowers the disabled with a right to demand for an enabling environment wherein they can enjoy protection of rights, equal opportunities and full participation in various developmental activities of the country. Effective implementation of this innovative legislation, which has made a beginning at the end of the Eighth Plan, is going to be a challenge in the Ninth Plan as it promises to fulfil certain rights in favour of the persons with disabilities. Empowering the Persons with Disablilites 3.10.27 To address the problems relating to both mental disability and mental health, efforts will be made to extend convergence of the available services of health, welfare and other related sectors, including that of the voluntary sector. Special thrust will be given for the prevention, the early detection, speech and communication, vocational training, family and community orientation, etc. In all these efforts, voluntary organisations will continue to be involved very closely in view of their experience and established credentials. 3.10.28 The Ninth Plan envisages the setting up of a National Trust to ensure total care and custodianship of those with mental retardation and cerebral palsy. For the welfare and care of the Spastics, special service centres will be set up to cater to the urban slums and backward rural areas, undertake large-scale manpower development programmes, and evolve new approaches to information, dissemination and community awareness. rehabilitative services, like appropriate treatment, psychological support, day-care centres and specialised training for manpower development, especially in the area of cerebral palsy and mental retardation, will be expanded. 3.10.29 To assess the status of women and girls with disabilities, needs-assessment survey will be conducted. The findings of these surveys will be used in improvising/ developing educational, vocational training and employment packages with necessary support services for women with the ultimate goal of equipping them to become economically independent and self- reliant. In fulfilment of the `Women's Component Plan', every effort will be made to ensure that adequate funds/benefits flow to women with disabilities from all the relevant programmes. 3.10.30 Voluntary organisations, who have been playing an important role in the delivery of services for the persons with disabilities, will be supported to widen their operations so as to reach the unreached, viz. the rural disabled. They will be involved in sensitizing the rural population towards prevention, early detection, timely intervention, appropriate referral and follow-up services, rehabilitation etc. Voluntary organisations, especially working for Spastics, mentally retarded and leprosy- cured patients, will be supported with adequate funding. 3.10.31 To ensure planning for the welfare and development of the disabled more meaningfully, there is an impending need for the Office of the Registrar General and Census Commissioner, to revive their practice of 1981 Census to collect the data on the size of the population of persons with various types of disabilities and to make it available through the next Population Census of 2001 AD. 3.10.37 Programmes for the Elderly, will be taken up in the Ninth Plan to ensure their well-being and continued participation in the community. The immediate social institutions of family and the community will be mobilised to play their catalytic role in the effective implementation of the programmes for the Elderly. Priority attention will be paid to the Elderly, especially in the rural areas, in extending the most wanted health care, housing, shelter, pension etc. Also, efforts will be made to reach/disseminate information regarding various welfare measures and special concessions being extended to the `Senior Citizens', so that the rural Elderly can also come forward to enjoy these privileges along with their urban

counterparts. The insurance sector will also be encouraged to formulate special health insurance programmes for the benefit of the Elderly. In extending housing facilities, the concept of `Sheltered Homes' for the lonely/destitute Elderly will be explored with the help of private and public agencies as well as the NGOs. In order to facilitate productive ageing, the services of the Elderly will be made use of by involving them in various developmental activities. 3.10.38 The Scheme of Old Age Pension will be reviewed and efforts will be made to rationalise the same in terms of providing at least the barest minimum subsistence and expand its coverage, wherever possible. The Panchayati Raj institutions will be actively involved in the implementation of various welfare schemes particularly with regard to selection of beneficiaries and disbursement of funds. The voluntary organisations will be encouraged to set up `Homes for the Aged/Homes for the Destitutes/Homes for the Dying' so as to meet the increasing need for such services. Through effective advocacy, efforts will be made to promote awareness amongst the people to plan in advance for the old age. To develop greater sensitivity and better attention towards the needs of the Elderly, action will be initiated to expedite the finalisation/ adoption of the `National Policy on Older Persons'. 3.10.39 Amongst the disadvantaged, the Street Children are the most vulnerable. To tackle the growing problem of Street Children, the existing schemes for the welfare and development of Street Children will be reviewed and restructured keeping in view the Child's Rights with perspectives for necessary expansion. Towards this end, emphasis will be given to provide adequate health, nutrition, education, vocational training and other related services to ensure healthy development of these children so as to make them productive members of the society. The National Charter for Children evisaged in the Ninth Plan promises to ensure that no child remains illiterate, hungry or lack of medical care. In line with this, special efforts will be made to ensure that no street/destitute/orphaned child or any other child in difficult situations will be left uncovered for. The emerging threats from Drug and Psycho-tropic Substances as well as HIV/AIDS to Street Children will receive special attention. The voluntary organisations, which are already engaged in this area, will be further encouraged with necessary support to reach as many Street Children, as possible. 3.10.40 The other disadvantaged, who include the destitutes, deserted, widowed, orphaned and women and children in moral and social danger, will continue to receive priority attention in the Ninth Plan with a special focus on the child/women prostitutes. The evil of prostitution and its diverse manifestations viz. Devadasis, Basavis, Jogins etc. will be tackled not only through strict enforcement of the law but also through building strong public opinion and support along with police and community vigilance. Special programmes will be designed for economic rehabilitation of these disadvantaged women. The special package launched for the girl-child in 1997 will act as a measure to prevent the girl children from becoming victims of these types of social evils. More details are available under the Chapter on `Empowerment of Women and Development of Children'. As regards the welfare of destitute women and children, the State governments will be encouraged to continue the ongoing programmes with further expansion so as to meet the increasing need. 3.10.41 While planning, programming and budgetting various services under Social Welfare sector, special efforts will be made to ensure that a definite percentage of the benefits are earmarked for women and girl children under the Special Component Plan for Women as they are the most vulnerable to become easy victims of all types of social evils/social problems and of the emerging situations. POLICIES AND PROGRAMMES : A REVIEW 3.10.42 The policies and programmes relating to welfare and development of the persons with disabilities, the destitutes and the elderly received priority within the Social Welfare sector during the Eighth Plan. Along with these, the problems of drug abuse, prostitution, delinquency and beggary also received special attention. Persons with Disabilities 3.10.43 The major policy thrust in the Eighth Plan was to make as many Persons with Disabilities as possible active, self-dependent and productive members of the society by extending opportunities for education, vocational training and economic rehabilitation etc. Efforts were also made to integrate the services for the Persons with Disabilities covering the entire range of activities starting from early

detection, prevention, treatment, cure and rehabilitation. 3.10.48 In consonance with the policy of providing a complete package of welfare and rehabilitative services to the persons with physical and mental disabilities and to deal with their multi-dimensional problems, the four national institutes, viz. National Institute of Visually Handicapped (NIVH), Dehradun; National Institute of Orthopaedically Handicapped, (NIOH), Calcutta; National Institute of Hearing Handicapped (NIHH), Mumbai; National Institute of Mentally Handicapped, (NIMH), Hyderabad; and the other two apex level Organisations viz., the Institute of Physically Handicapped (IPH), New Delhi and the National Institute of Rehabilitation Training and Research (NIRTAR), Cuttack offered a wide range of services in the field of education, training, manpower, vocational guidance, counselling, research, rehabilitation and development of low-cost aids and appliances etc. They also offered a variety of training courses starting from short-term Certificate and Diploma Courses to three year Degree Courses in mental retardation, physio-therapy, occupational therapy, communication disorders, prosthetic and orthotic engineering, audiology, speech therapy as well as training of teachers etc. The clinical and rehabilitation units of these Institutes served as in-house laboratories for both the trainers and the trainees besides providing the base for conducting research projects and extending clinical and paramedical services to the patients. Thus, these Institutes played a significant role in meeting the training needs of the technical manpower to extend specialised services to the Persons with Disabilities in the country. Besides the regular academic courses, the National Institutes also conducted a large number of short-term training courses, seminars, orientation courses and camps etc. These provided a forum for creating awareness amongst the community at large for bringing the Persons with Disabilities population closer to the organisations working for their welfare; and providing opportunities for exchange of information, knowledge and experience amongst the academicians, professionals, doctors, village/community level workers and all those associated with the disability and welfare and development of the Persons with Disabilities. 3.10.55 In the field of health, a number of ongoing programmes have a direct bearing on the prevention and reduction of the incidence of the various disabilities. They include eradication of smallpox, leprosy, control of blindness, control of iodine deficiency disorders, national mental health programme, universal immunization programme, child survival and safe motherhood and other maternal and child health services. The National Mental Health Programme launched in 1992 with the sole objective of improving mental health services at primary, secondary and tertiary levels. Efforts were also made during the Eighth Plan to integrate mental health care with primary health care. Details of various services extended under this programme are given under the Chapter on `Health and Family Welfare'. In addition to these, while the apex institutions such as the All India Institute of Medical Sciences (AIIMS), New Delhi, Post Graduate Institute of Medical Sciences, Chandigarh and the All India Institute of Physical Medicine and Rehabilitation, Mumbai, have been extending rehabilitation services to the persons with locomotor disablility, the National Institute of Mental Health and Neuro Sciences, Bangalore has been contributing for the rehabilitation of the mentally retarded and spastics. The All India Institute of Speech and Hearing, Mysore is yet another agency which has been contributing towards rehabilitating the persons with hearing and speech disabilities. VOLUNTARY ACTION 3.10.76 The voluntary organisations, since history, have been playing a very important role in the field of social welfare. Their role as effective motivators in bringing the local government and the people together in working towards the well-being of the disadvantaged and the deprived as pressure groups in impressing upon the Government to extend social sanctions in favour of the deprived; and as an effective implementing force in translating the policies and programmes of the Government into action, has been successful in the past. Some of the voluntary organisations in the recent past have also proved their credentials in experimenting successful alternative models in providing certain specialised services for the welfare and rehabilitation of spastics/mentally retarded, drug addicts, leprosy affected, prostitutes, destitutes and the dying, street children etc. Another important area, where the voluntary sector made an effective entry is to change the mind-set/attitudes of the people to overcome the wrong and blind beliefs which are the causes for many present day social evils/problems. They can also be effective animators in generating awareness and thus, equip the target groups with necessary information about their rights and privileges besides the governmental efforts to improve the lot of the deprived and the disadvantaged groups. Therefore, efforts will be made to promote voluntary action especially in those areas where it is missing completely or weak.

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9.5
MTA 9th Five year plan
Integrated Non-communicable Disease Control Programme 52. Growing numbers of aged population, urbanisation, increasing pollution, changing lifestyles, increasing longevity, change from traditional diets, sedentary life style and increase in the stress of day to day living have led to an increase in lifestyle related disorders and non-communicable diseases. It is essential that preventive, promotive, curative and rehabilitative services for NCD are made available throughout the country at primary, secondary and tertiary care levels so as to reduce the morbidity and mortality associated with NCD. Progress and suggestions: Central sector programme provides funds for strengthening facilities for Cancer Control, setting up distinct models for replication under national mental health project and for pilot projects on Diabetes control. Some states e.g. Kerala are making efforts to implement an integrated noncommunicable disease control programme at primary and secondary care level with emphasis on prevention of Non-Communicable Disease (NCD), early diagnosis, management and building up of a referral system. Tertiary care centres are being strengthened to improve treatment facilities for management of complications. 53. An increase in NCD prevalence is anticipated over the next few decades, which is due at least in parts to changing lifestyles. Therefore, it is imperative that health education for primary and secondary prevention as well as early diagnosis and prompt treatment of NCD receive the attention it deserves RESEARCH 56. Some of the priority areas for research in non-communicable diseases are community based intervention programmes for control of Rheumatic fever and Rheumatic heart diseases, OR studies for prevention and control of mild essential hypertension and coronary heart disease at community level, assessment of unmet treatment needs of the mentally ill in rural areas, identification, management and prevention of occupational health hazards and health problems due to environmental deterioration.

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10 10th Five Year Plan (Vol-2)

Disease Burden Estimates 2.8.128 Traditionally policy makers have used mortality statistics for identifying major public health problems. In India, reliable age specific mortality data is available through SRS ; though there are lacunae in the system for ascertainment of causes of death, fairly reliable data is available on major causes of death. In addition to these data, the country has under taken surveys for estimating the prevalence of major public health problems such as morbidity in women and children, nutritional deficiencies and major communicable diseases. The estimated share of India in some of the global health problems is shown in the Text Box . In India reliable information on overall morbidity is not available. In the absence of reliable morbidity data, mortality statistics and available survey data have formed the basis on which health policy makers and programme managers evolved public health programmes and allocated funds. While this might have been the appropriate option in a situation where communicable diseases and maternal and child health problems

predominate, appropriate modification will be required as the country undergoes demographic and epidemiological transition and non communicable diseases emerge as major public health problems. In view of this, there is a need to obtain data on not only mortality but morbidity due to chronic illnesses and disabilities and take them account while formulating public health programmes. For instance, morbidity due to mental illnesses is estimated to account for about 15 per cent of the total morbidity but deaths due to psychiatric illnesses are usually less than 1 per cent of total deaths even in developed countries. 2.8.137 During the Ninth Plan, ongoing programmes for control of non-communicable diseases included two centrally-sponsored schemes (National Iodine Deficiency Disorders Control Programme, discussed in the Chapter on Nutrition, and the National Programme for the Control of Blindness discussed in this section) and one central sector scheme (the National Cancer Control Programme). During the 1990s, several pilot projects such as the national mental health programme, the diabetes control programme, cardiovascular disease control programme, prevention of deafness and hearing impairment, oral health programme and medical rehabilitation were initiated as central sector pilot projects. After completion of the pilot phase, these programmes have been merged with the Central Institutes dealing with these problems. 2.8.152 Mental health care has three aspects - restoration of health in mentally ill persons, early identification of persons who are at risk and appropriate protection and promotion of mental health in normal persons. It is estimated that 10 to 15 per cent of the population suffers from mental health problem and the stress of modern life is resulting in an increasing prevalence of mental illness. Till about three decades ago, mental health services consisted mainly of large, centralised mental hospitals. At the time of independence, there were 17 mental hospitals accommodating over 8,000 patients. Most of these hospitals had poor infrastructure and manpower and did not provide good quality mental health care. A majority of mentally ill patients did not have access to good quality psychiatric care and there was no home- based care available for them. Magnitude of Mental Health Problems It is estimated that : ten million people are affected by serious mental disorders. 20-30 million people have neurosis or psychosomatic disorders. 0.5 and 1 per cent of all children have mental retardation. 2.8.153 Soon after Independence, efforts were made to improve the access to mental health services by increasing the number of mental hospitals and opening psychiatric units in general hospitals. Providing psychiatric care through general hospitals and bringing mental health care out of the confines of mental hospitals reduced the stigma associated with treatment of mental illness, removed legal restrictions on admission and treatment and facilitated the early detection of associated physical problems. Most importantly, it ensured that the family was involved in the care and that on being discharged the patient went back to the family. Encouraged by the success in this effort, many states embarked on the development of district psychiatric units. Some states like Kerala and Tamil Nadu have a district psychiatric unit in all districts. Though others lag behind in this respect, the concept of mental health care provided as an integral part of health care system has been accepted and implemented by all states. Ambulatory treatment for psychiatric illnesses became accepted as a norm and effective, relatively inexpensive drugs for common mental disorders were made available in tertiary and secondary care institutions. 2.8.154 Currently, 50 per cent of the medical colleges have a psychiatry department. It is estimated that there is one psychiatry bed per 30,000 population. There are 20,000 beds in mental hospitals and 2,000 to 3,000 psychiatric beds in general and teaching hospitals. Fifty per cent of the psychiatric beds are occupied by patients undergoing long term treatment. However, in spite of all these facilities, even now less than 10 per cent of the mentally ill persons have access to appropriate care; prevention of mental illness and promotion of mental health remain of distant dreams. 2.8.155 The national mental health programme was initiated in 1982 with the objective of improving mental health services at all levels of health care through early recognition, adequate treatment and rehabilitation of patients. The programme also envisaged improvement in the conditions in existing mental hospitals, effective implementation of the Mental Health Act, 1987 and adequate manpower development to meet the growing needs for mental health care. The Programme did not make much headway in the Seventh Plan. 2.8.156 During the Eighth Plan, the National Institute of Mental Health and Neuro Sciences (NIMHANS) developed and implemented a district mental health care model in the Bellary district of Karnataka with the objective of: providing sustainable basic mental health services to the community and to integrate these services with health services; early detection and prompt treatment of patients with mental illness; providing domiciliary mental health care and reducing patient load in mental hospitals; community education to reduce

the stigma attached to mental illness; and treatment and rehabilitation of patients with mental illnesses within their family setting. 2.8.157 Following encouraging results, the progra- mme was expanded during the Ninth Plan to 22 districts in 20 states. It was envisaged that decentralised district-based training in essential mental health care will be provided to all health professionals so that psychiatric care will be provided in all health care facilities. Attempts were made to improve early detection of mental illness in the community, provide ambulatory care at home and follow up discharged cases. A district mental health team was to provide referral support and supervision of the mental health programme. Simple, accurate records of work done maintained by the health care providers was to be monitored by the district team. The progress in these districts has not yet been evaluated. 2.8.158 During the Tenth Plan, it is expected that states will progressively improve access to mental health care services at the primary and secondary care levels to cover all the districts in a phased manner. Psychiatry departments in medical colleges will play a pivotal role in the operationalisation and monitoring of the programme in the district in which they are located and synergistic links will be formed with other ongoing related programmes.

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10.5
MTA
New Initiatives in the Tenth Plan iv) A National Mental Health Programme to strengthen 37 government mental health institutes and the psychiatric wings of 75 medical colleges, and to pursue education, research and training http://planningcommission.nic.in/plans/mta/midterm/english-pdf/chapter-02b.pdf ~

11 11th Five Year Plan (Vol-2)

NATIONAL MENTAL HEALTH PROGRAMME (NMHP) 3.1.173 A multipronged strategy to raise awareness about issues of mental health and persons with mental illness with the objective of providing accessible and affordable treatment, removing ignorance, stigma, and shame attached to it and to facilitate inclusion and acceptance for the mentally ill in our society will be the basis of the NMHP. Its main objective will be to provide basic mental health services to the community and to integrate these with the NRHM. The programme envisages a community and more specifically family-based approach to the problem. 3.1.174 The Plan will strengthen District Mental Health Programme (DMHP) and enhance its visibility at grass root level by promoting greater family and community participation and creating para profes- sionals equipped to address the mental health needs of the community from within. It will fill up human resource gap in the field of psychiatry, psychology, psychiatric social work, and DMHP. The plan will strive to incorporate mental

health modules into the existing training of health personnel. It will also harness NGOs and CSOs help in this endeavour, especially family care of persons with mental illness, and focus on preventive and restorative components of Mental Health. The Eleventh Five Year Plan, recog- nizing the importance of mental health care, will provide counselling, medical services, and establish help lines for people affected by calamities, riots, violence (including domestic), and other traumas. To achieve these, a greater outlay will be allocated to mental health. 3.1.175 During the Eleventh Five Year Plan, the Re- strategized NMHP will be implemented all over the country with the following objectives: To recognize mental illnesses at par with other illnesses and extending the scope of medical insurance and other benefits to individuals suffering with them To have a user friendly drug policy such that the psychotropic drugs are declared as Essential drugs To give greater emphasis to psychotherapeutic and a rights based model of dealing with mental health related issues To include psychiatry and psychology, and psychiatric social work modules in the training of all healthcare giving professionals To empower the primary care doctor and support staff to be able to offer psychiatric and psychological care to patients at PHCs besides educating family carers on core aspects of the illness. To improve public awareness and facilitate family-carer participation by empowering members of the family and community in psychological interventions. To provide greater emphasis on public private participation in the delivery of mental health services. To upgrade psychiatry departments of all medical colleges to enhance better training opportunities To improve and integrate mental hospitals with the whole of health delivery infrastructure that offer mental health services thus lifting the stigma attached To provide after care and lifelong support to chronic cases.

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11.5
MTA 11th 5 year plan
National Mental Health Programme (NMHP)
7.53. Despite enhanced allocations for the implementation of NMHP as per commitments made in the Eleventh Plan, the programme has lagged behind. It was divided into two parts. 7.54. Part I of NMHP relates to human resource development, spillover schemes and continuing 123 District Mental Health Programmes (DMHPs). At least 11 centres of excellence of mental health and neurosciences are expected to be established within the Plan period by upgrading existing mental health institutions plus strengthening a number of institutions for human resource development. 7.55. The Part II of the NMHP which is yet to be launched relates to comprehensive expansion of DMHPs from existing 123 districts to 325 under served districts. This has to be done based on the findings of evaluation study conducted by the Indian Council of Market Research. 7.56. Expenditure under the programme is very low, 20.81 per cent and 33.26 per cent respectively of the approved outlays for 2007- 08 and 2008-09. During 2009-10, the expenditure is likely to be 78.57 per cent of the approved outlay (as per RE figures) . During the remaining period of Eleventh Plan, NMHP will need to be expanded to provide the much needed basic mental health services to people and to integrate these with NRHM. Box 7.3 - Redevelopment of Hospitals/Institutions Lady Hardinge Medical College & Smt. S.K. Hospital and Kalawati Saran Children(KSC) Hospital, New Delhi: Comprehensive Redevelopment Projects comprise of 3-4 phases. Phase I during the Plan, involves

increasing existing bed strength of Smt. S.K. Hospital from 877 to 1397 (additional 520 beds) and increasing bed strength of KSC Hospital from 370 to 420 (additional bed strength of 50). Regional Institute of Medical Sciences (RIMS), Imphal, Manipur: Upgradation involves repair/renovation of hospital building, construction of academic complex, new OPD building, nursing & dental wings, hostel accommodation etc. Lokapriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam: Upgradation involves construction for the main hospital building, residential quarters, hostels, mortuary, incinerator building, sewerage treatment plant, renovation of existing building, procurement of equipments & machinery and additional human resources.

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