Ninth Five Year Plan | Health Care | Public Health

Ninth Five Year Plan (1997-2002

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Introduction
1.1 The Ninth Five Year Plan, launched in the 50th year of India’s Independence, will take the country into the new millennium. Much has happened in the fifty years since independence. The people of India have conclusively demonstrated their ability to forge a nation united despite its diversity, and their commitment to pursue development within the framework of a functioning, vibrant and highly pluralistic democracy. In this process democratic institutions have put down firm roots and flourished and development has also taken place on a wide front. As the millennium draws to a close, the time has come to redouble our efforts at development, especially in the social and economic spheres, so that the country will realise its full economic potential and the poorest and the weakest will be able to shape their destiny in an unfettered manner. This will require not only higher rates of growth of output and employment, but also a special emphasis on all-round human development, with stress on social sectors and a thrust on eradication of poverty. 1.2 The Approach Paper to the Ninth Five Year Plan, adopted by the National Development Council, had accorded priority to agriculture and rural development with a view to generating adequate productive employment and eradication of poverty; accelerating the growth rate of the economy with stable prices; ensuring food and nutritional security for all, particularly the vulnerable sections of society; providing the basic minimum services of safe drinking water, primary health care facilities, universal primary education, shelter, and connectivity to all in a time bound manner; containing the growth rate of population; ensuring environmental sustainability of the development process through social mobilization and participation of people at all levels; empowerment of women and socially disadvantaged groups such as Scheduled Caste, Scheduled Tribes and Other Backward Classes and Minorities as agents of socio-economic change and development; promoting and developing people’s participatory bodies like Panchayati Raj institutions, co-operatives and self-help groups; and strengthening efforts to build self-reliance. These very priorities constitute the objectives of the Ninth Plan. 1.3 Some specific areas from within the broad objectives of the Plan as laid down by the NDC have been selected for special focus. For these areas, Special Action Plans (SAPs) have been evolved in order to provide actionable, time-bound targets with adequate resources. Broadly, the SAPs cover specific aspects of social and physical infrastructure, agriculture, information technology and water policy. 1.4 The Ninth Plan is based on a careful stock taking of the strength of our past development strategy as well as its weakness, and seeks to provide appropriate direction and balance to the socio-economic development of the country. The principal task of the Ninth Plan will be to usher in a new era of growth with social justice and participation in which not only the Governments at the Centre and the States, but the people at large, particularly the poor, can become effective instruments of a participatory planning process. In such a process, the participation of public and private sectors and all tiers of government will be vital for ensuring growth with justice and equity.

.4 HEALTH 3.4.1 India was one of the pioneers in health service Planning with a focus on primary health care. In 1946, the Health Survey and Development Committee, headed by Sir Joseph Bhore recommended establishment of a well-structured and comprehensive health service with a sound

primary health care infrastructure. This report not only provided a historical landmark in the development of the public health system but also laid down the blueprint of subsequent health planning and development in independent India. 3.4.2 Improvement in the health status of the population has been one of the major thrust areas for the social development programmes of the country. This was to be achieved through improving the access to and utilization of Health, Family Welfare and Nutrition Services with special focus on under served and under privileged segment of population. Main responsibility of infrastructure and manpower building rests with the State Government supplemented by funds from the Central Government and external assistance. Major disease control programmes and the Family Welfare Programmes are funded by the Centre (some with assistance from external agencies) and are implemented through the State infrastructure. The food supplementation programmes for mothers and children are funded by the State and implemented through the ICDS infrastructure funded by the Central Government. Safe drinking water and environmental sanitation are essential pre-requisites for health. Initially these two activities were funded by the Health Department, but subsequently Dept. of Urban and Rural Development and Dept. of Environment fund these activities both in the State and Centre. 3.4.3 At the time of Independence, the country's health care infrastructure was mainly urban and clinic based. The hospitals and clinics provided curative care to patients who came to them. Outreach of services in the rural areas was very limited; there were very few preventive and rehabilitative services available. From the First five-year Plan, Central and State Governments made efforts to build up primary, secondary and tertiary care institutions and to link them through appropriate referral systems. The private and voluntary sector also tried to cater to the health care needs of the population (Table 3.4.1). Efforts to train adequate number of medical, dental and paramedical personnel were also taken up. National Programmes for combating major public health problems were evolved and implemented during the last fifty years. Efforts to further improve the health status of the population by optimising coverage and quality of care by identifying and rectifying the critical gaps in infrastructure, manpower, equipment, essential diagnostic reagents, drugs and enhancing the efficiency of the health system are underway. 3.4.4 Improvement in coverage and quality of health care and implementation of disease control programmes resulted in steep decline in the crude death rate (CDR) from 25.1 in 1951 to 9.0 in 1996. Life expectancy rose from 32 years in 1947 to 61.1 years in 1991-96 with female life expectancy (61.7 yr.) higher than the male (60.6 yr.). However, the morbidity due to common communicable and nutrition - related diseases continue to be high. Morbidity due to noncommunicable diseases is showing a progressive increase because of increasing longevity and alterations in life style. During the Ninth Plan efforts will have to be made to tackle this dual disease burden effectively so that there is sustained improvement in the health status of the population. 3.4.5 India today has a vast network of governmental, voluntary and private health infrastructure manned by large number of medical and paramedical persons. Current problems faced by the health care services include:

1. Persistent gaps in manpower and infrastructure especially at the primary health care 2. 3. 4.
level. Suboptimal functioning of the infrastructure; poor referral services. Plethora of hospitals not having appropriate manpower, diagnostic and therapeutic services and drugs, in Govt., voluntary and private sector; Massive interstate/ interdistrict differences in performance as assessed by health and demographic indices; availability and utilisation of services are poorest in the most needy states/districts.

5. Sub optimal intersectoral coordination 6. Increasing dual disease burden of communicable and noncommunicable diseases
because of ongoing demographic, lifestyle and environmental transitions,

7. Technological advances which widen the spectrum of possible interventions 8. Increasing awareness and expectations of the population regarding health care services 9. Escalating costs of health care, ever widening gaps between what is possible and what
the individual or the country can afford. 3.4.6 The Special Action Plan for Health envisages expansion and improvement of the health services to meet the increasing health care needs of the population; no specific targets have been set. 3.4.7 During the Ninth Plan efforts will be further intensified to improve the health status of the population by optimising coverage and quality of care by identifying and rectifying the critical gaps in infrastructure, manpower, equipment, essential diagnostic reagents and drugs. Efforts will be directed to improve functional efficiency of the health care system through:

a. Creation of a functional, reliable health management information system and training and
deployment of health manpower with requisite professional competence

b. Multi professional education to promote team work c. Skill upgradation of all categories of health personnel, as a part of structured continuing
education

d. Improving operational efficiency through health services research. e. Increasing awareness of the community through health education. f. Increasing accountability and responsiveness to health needs of the people by increasing
utilisation of the Panchayati Raj institutions in local planning and monitoring

g. Making use of available local and community resources so that operational efficiency and
quality of services improve and the services are made more responsive to user's needs. Approach During the Ninth Plan: 3.4.8 The approach during the Ninth Plan will be: New Initiatives in the Ninth Plan • • • • • Horizontal integration of vertical programmes Develop Disease Surveillance and Response mechanism with focus on rapid recognition,report & response at district level Develop & implement integrated Non-Communicable Disease control Programme Health Impact Assessment as a part of environmental impact assessment in developmental projects. Implement appropriate management systems for emergency,disaster, accident & trauma care at all levels of health care. Improve HMIS and logistics of supplies An absolute and total commitment to improve access to, and enhance the quality of, primary health care in urban and rural areas by providing an optimally functioning primary health care system as a part of the Basic Minimum Services; To improve the efficiency of existing health care infrastructure at primary, secondary and tertiary care settings through appropriate institutional strengthening, improvement of

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referral linkages and operationalisation of Health Management Information System (HMIS); To promote the development of human resources for health, adequate in quantity and appropriate in quality so that access to essential health care services is available to all so that there is improvement in the health status of community, periodically organise programmes for continuing education in health sciences, update knowledge and upgrade skills of all workers and promote cohesive team work; To improve the effectiveness of existing programs for control of communicable diseases to achieve horizontal integration of ongoing vertical programmes at the district and below district level; to strengthen the disease surveillance with the focus on rapid recognition, reporting and response at district level; to promote production and distribution of appropriate vaccines of assured quality at affordable cost; to improve water quality and environmental sanitation; to improve hospital infection control and waste management To develop and implement integrated non-communicable disease prevention and control program within the existing health care infrastructure; To undertake screening for common nutritional deficiencies especially in vulnerable groups and initiate appropriate remedial measures; to evolve and effectively implement programmes for improving nutritional status, including micronutrient status of the population; To strengthen programmes for prevention, detection and management of health consequences of the continuing deterioration of the ecosystems; to improve linkage between data from ongoing environmental monitoring and that on health status of the population residing in the area including health impact assessment as a part of environmental impact assessment in developmental projects; To improve the safety of the work environment and worker's health in organised and unorganised industrial and agricultural sectors especially among vulnerable groups of the population; To develop capabilities at all levels for emergency and disaster prevention and management; to implement appropriate management systems for emergency, disaster, accident and trauma care at all levels of health care; To ensure effective implementation of the provisions for food and drug safety; strengthen the food and drug administration both at the Centre and in the States; To increase the involvement of ISM&H practitioners in meeting the health care needs of the population; To enhance research capability with a view to strengthening basic, clinical and health systems research aimed at improving the quality and outreach of services at various levels of health care; To increase the involvement of voluntary, private organisations and self-help groups in the provision of health care and ensure inter-sectoral coordination in implementation of health programmes and health-related activities; To enable the Panchayati Raj Institutions (PRI) in planning and monitoring of health programmes at the local level so that there is greater responsiveness to health needs of the people and greater accountability; to promote inter-sectoral coordination and utilise local and community resources for health care.

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