Health Planning

in India
 National Health Planning
❑
“The orderly process of defining community health problems, identifying unmet
needs and surveying the resources to meet them, establishing priority goals that
are realistic and feasible and projecting administrative action to accomplish the
purpose of the proposed program”
❑
Goals - Long-term , desired end point
❑
Target- Quantifiable, Achievable, mid-term end products
❑
Objective- Short term end points
❑
Impact indicator of a programme- Target or objectives
Planning Cycle
Bhore Committee 1946

● Appointed in 1943
● Submitted 1946

● HEALTH SURVEY & DEVELOPMENT

COMMITTEE
Bhore Committee- Recommendations
1. Integration of preventive and curative services
at all administative levels.
2. Primary health centre Developnent.
a) Short term.
b) Long term ( 3 million plan).
3. Social Physicians.(3 months training)
Mr.Bhore IPS 1946 with 3 million plans BD
 Health Committees in India
❑
Bhore Committee: 1946
❑
Appointed in 1943, submitted report on 1946
❑
Known as 3 million plan, Health Survey and Development Committee
❑
Concept of social physician, integration of preventive and curative service,
development of primary health centers.
Mudaliar Committee,1962
● A.L Mudaliar
● Appointed 1959
● HEALTH SURVEY & PLANNING COMMITTEE
Major Recommendations
● Consolidation of advances made in I & II FYPns
● Constitution of All India Health Services on the
pattern of Indian Administrative Service.
Mudaliyar Committee: 1962
❑ Health Survey and Planning Committee.
❑ Recommended for All India Health service, strengthening of district
hospitals
CHADAH COMMMITEE 1963
Maintenance phase of Malaria Eradication
Programme
●Basic Health Worker per 10,000 population
❑ Chadah Committee: 1963
❑ To study the arrangements necessary for the maintenance phase of the
National Malaria Eradication Program.
❑ 1 Basic Health Worker/ 10,000 population
MUKERJI COMMITTEE, 1965
❑Mukherjee Committee: 1965
❑Delink malaria activities from family planning
MUKERJI COMMITTEE,1966
Worked out Basic health services which should
be provided at block level, and some
consequential strengthening required at higher
level.
JUNGALWALA COMMITTEE, 1967

● Committe on Integration of Health Services

● Recommendations
Unified cadre, common seniority, recognition of
extra qualification, equal pay for equal work,
special pay for special work, no private practice
and good working conditions.
❑ Jungalwallah Committee: 1967
❑ Committee on Integration Health Service
❑ Unified cadre, common seniority, equal pay for equal work, no private
practice
KARTAR SINGH COMMITTEE,1973

The committee on multipurpose health

worker under health and family planning.
Female health workers, male health workers
ANM to be replaced by Female Health Workers.
LHV as Female Health Supervisor
 SHRIVASTAV COMMITTEE,1975
● Group on medical education and support manpower
● ROME scheme
● Rural Health Scheme 1977

Recommendations
Referral service complex, creation of bands of
paraprofessional and semi professional health workers
from with in the community.
BAJAJ COMMITTEE,1986
“Expert Committee for Health Manpower Planning,
Production and Management“
●National Medical & Health Education Policy.
●National Health Manpower Policy.
●Educational Commission for Health Sciences
●Health Science Universities in various states and
union territories
Sarojini Varadappan Committee,1990
● High power committee on nursing and
nursing profession
● Post basic BSc nursing degree to continue
● Masters in nursing programme to be increased
and strengthened.
● Doctorate in nursing programme to be started
in selected university.
● Continuing education and staff development for
nurses.
Working group on nursing education &
manpower ,1991
● By 2020 the GNM programme to be phased
out
● Curriculum of BSc nursing to be modified
● Staffing norm should be as per INC
PRIMARY
HEALTH CARE
●
1978 Alma-Ata declaration
●
Primary Health Care
●
FACE In
●
ELEMENTS
●
ORS-Appropriate technology.
 Primary Health Care in India
❑
Essential health care, provided through Sub Centre, Primary Health Centre.
❑
Hallmarks of primary health care: Affordability, Accessibility, Availability
❑
Principles of PHC:
❑
Equitable distribution
❑
Appropriate technology
❑
Public participation
❑
Intersectoral Coordination
 Essential elements of PHC
1. Health Education
2. Locally endemic disease prevention and control.
3. Immunization against major infectious diseases.
4. Maternal and child health care including family planning.
5. Essential drugs arrangement.
6. Nutritional food supplements.
7. Treatment of communicable and non-communicable diseases.
8. Safe water and sanitation.
 Health planning in India
❑
Planning Commission:
❑
Established in March 1950, dissolved in April 2014.
❑
First 5 year plan on 1951
❑
12th five year plan (2012 -2017)
❑
NITI Ayog:
❑
National Institution for Transforming India, Established on Jan 1, 2015
❑
Central Council of Health:
❑
Based on article 263.
NITY AYOG
 5 Year plans
12th Plan
❑
Reduction of IMR to 25
❑
Reduction of MMR to 100.
❑
Reduction of TFR to 2.1
❑
Raising child sex ratio in the 0- 6 years age group from 914 to 950
❑
Prevention and reduction of anemia among women aged 15-19
years to 28%
❑
Prevention and reduction of burden of communicable and NCD.
 Health and Indian constitution
❑
India is a federal country, matters of health are carried by both Union and State
governments. Duties are assigned by article 246 of Indian Constitution, based on which
there is
❑
Union list:
❑
Census, Maintenance of drug standards, Immigration and emigration
❑
International Health Relations and port quarantine, etc.
❑
Regulation of medical and paramedical professions
❑
Administration of institutions like AIIMS, AII of Hygiene and Public Health, Kolkata
 Health and Indian constitution
❑
India is a federal country, matters of health are carried by both Union and State
governments. Duties are assigned by article 246 of Indian Constitution, based on
which there is;
❑
Concurrent list:
❑
Prevention of extension of communicable diseases
❑
Prevention of adulteration of foodstuffs
❑
Vital statistics
❑
Population control and Family Planning.
 Health Organization in India - Central
❑
MoHFW
❑
Union Ministry of Health and Family Welfare, headed by Union health minister.
❑
Department of Health
❑
Department of Family Welfare (1976)
❑
Ministry of AYUSH
❑
Established in 2014, current AYUSH minister is Sripad Nayik
❑
DGHS:
❑
Directorate General of Health Service
❑
Principal advisor to Govt, in health related matters.
 Health Organizations in India - State
❑
MoHFW:
❑
Headed by state health minister, assisted by health secretariate
❑
State Health Directorate:
❑
To provide technical assistance and advice to health ministry.
❑
It may be divided into,
❑
DME : Directorate of Medical Education
❑
DHS : Directorate of Health Service
 Health organization in India - District
❑
DISTRICT:
❑
The principal unit of administration in India, administer under Collector.
❑
Tahsils (Talukas) – 200 to 600 villages, headed by tahasildar
❑
Community Development Blocks - 100 villages/ 80,000- 1.2 lakh population
❑
Grama panchayats & Villages
❑
Urban area:
❑
Town area committees - Population ranging between 5,000 and 10,000.
❑
Municipal Boards - 10,000 and 2 lakhs.
❑
Corporations - Above 2 lakhs.
 Panchayati Raj
❑
Introduced in 1991 by 73rd and 74th constitutional amendment. It comprised of,
❑
Village level :
❑
Grama Sabha , Grama Panchayat, Nyaya Panchayat
❑
Block level :
❑
Panchayat samiti
❑
Comprised of 100 villages
❑
Cater Population of 80,000 – 1.2 lakh.
❑
District level :
❑
Zilla parishad
 Community Development Program
❑
CDP was launched on 2nd October 1952 for the all-round development of the
rural areas. - program "of the people, for the people, by the people“
❑
Integrated Rural Development Program (IRDP) April 1978 to eliminate rural
poverty and improve the quality of life of the rural poor.
❑
Training of Rural Youth for Self Employment (TRYSEM)
❑
Supply of Improved Toolkits to Rural Artisans (SITRA)
 Health care delivery in India
❑
PUBLIC HEALTH SECTOR
❑
PRIVATE SECTOR
❑
INDIGENOUS SYSTEMS OF MEDICINE
❑
VOLUNTARY HEALTH AGENCIES
❑
NATIONAL HEALTH PROGRAMMES
 Sub - centre
❑
SUB-CENTRE:
❑
Peripheral outposts of health delivery system, first contact point between primary health care
system and the community.
❑
Eligible Couple Register is keeping at sub centre.
❑
Cater a population of
❑
3,000 in hilly areas
❑
5,000 in planes.
❑
Staffs in sub centre:
❑
Auxiliary Nurse Midwife - 1
❑
Multi-Purpose Worker - 1
 Sub - centre
❑
Categorization of sub-center
❑
Type A sub-centre: Provide all recommended services except that the
facilities for conducting delivery.
❑
Type B/ MCH sub-centre: Provide all recommended services including
facilities for conducting deliveries at the sub-centre itself.
 Primary Health Centre
❑
Nucleus of peripheral health, first contact point between village community and
Medical Officer
❑
Idea first brought by Bhore Committee
❑
Catering population
❑
30,000 in plane area
❑
20,000 in hilly areas/ tribal
 Community Health Centre
❑
First Referral Unit (FRU).
❑
For every 80,000 population in hilly area, every 1.2 lakh population in plane area.
❑
IPHS standards:
❑
Routine and emergency cases in surgery and medicine
❑
Maternal and child health including newborn care
❑
Family planning programs
❑
School health and adolescent health services
❑
Blood storage facility, Diagnostic services
❑
Referral services
 Village Health Care workers in India
❑
ASHA
❑
Accredited Social Health Activist
❑
Established under NRHM program.
❑
Anganwadi workers
❑
Based on ICDS program.
❑
Both ASHA and Anganwadi workers for population of 1000.
❑
Village Health Guides
❑
Trained Dais
 Review questions
1) Recommended numbers of the population for Primary 2) Recommended number of population for Primary
Health Centres for a tribal area is: health centers & subcenters for the tribal area is:
1.50,000 1.30,000 & 5000 respectively
2.30,000 2.20,000 & 3000 respectively
3.20,000 3.30,000 & 3000 respectively
4.10,000 4.20,000 & 5000 respectively

3) Panchayati Raj includes the following except: 4) Anganwadi worker demonstrating the preparation of
1.Gram Panchayat homemade ORS to the mothers of under-five children, is an
2.Gram Sabha example of?
3.Nyaya Panchayat 1.Intersectoral Coordination
4.Nyaya Sabha 2.Community Participation
3.Appropriate technology
4.All of the above
 6) Which of the following is a set point framed for long term
5) All are grass root level worker except: plans but is yet something that cannot be quantified or
1.Anganwadi worker measured?
2.Village health assistant 1.Target
3.Dai 2.Goal
4.Health assistant .
3.Objective
4.Mission

7) 3-Million plan” was proposed by: 8) Match the following names of health committees in India:
1.Kartar Singh Committee A – Bhore Committee
2.Mudaliar Committee B – Mudaliar Committee
3.Srivastava Committee C – Jungal wallah Committee
4.Bhore Committee D – Kartar Singh Committee
  I – Health Survey & Development Committee
II – Committee on MPWs under Health & Family planning
III – Committee on Integration of Health Services
IV – Health Survey & Planning Committee
• A-I, B-III, C-II, D-IV
•A-I, B-IV, C-III, D-II
•A-VI, B-I, C-III, D-II
• A-I, B-IV, C-II, D-III
 
9) A group on Medical Education & Support Manpower was
popularly known as:
1.Kartar Singh Committee
2.Mudaliar Committee
3.Srivastava Committee
4.Bhore Committee
10) Planning Cycle has got several steps:
Monitoring & evaluation – a
Programming & implementation – b
Assessment of resources – c
Analysis of existing health situation – d
The logical sequence in the planning cycle would be
•a b c d
•d c b a
•d b c a
•c d b a
 Community
Helath Nursing
Zodiac Academy
Demography &
Family planning
 Introduction
●
In 2021- Global population- 7.9 billion
●
India – 138 crores, 2060- 160 crores
●
Kerala in 2021 is estimated to
be 35,336,581
●
Global average life expectancy of 72.6
years
●
India’s life expectancy at birth inched up to
69.7
 Demography
Demography deals with scientific study of human population.
Demography focuses attention on
 Changes in population size, composition of population, distribution of
population in space
Demographic processes –

Fertility, Mortality, Migration

Marriage and Social mobility.

Types of demography
●
Formal: deals with gathering, collating, analyzing, and
presenting population data.
●
Social: study of population patterns within a social context. 
Basic demographic equation
Terms
●
Demographic transition
●
Demographic window
●
Demographic dividend
●
Demographic gift
●
Demographic trap
●
Epidemiological transition
 Demographic Transition Cycle
Stage I:
 High stationary [India till 1921]
 High birth rate and death rate
Second stage:
 Early expanding [India till 1970]
 High birth rate but death rate declining
Third stage:
 Late expanding [Now India]
 Birth rate tends to declining and death rate declining, but BR>DR
Fourth stage:
 Low stationary, BR-low, DR- low
Fifth stage:
 Declining , BR<DR
 Census
Every 10 year, first census on 1881 and last on 2011
Registrar General and Census commissioner of India (Vivek Joshy), MHA
With a population of 1.36 billion (2014), India is the second most populous
country.
 Population Density: 324/ 819 per square km
 Sex Ratio: 940/ 1084 females per 1000 males
 Literacy: 74%/ 94%
 Dependency ratio = Children (0-14years) + Old age (>65)/ working
population
SRS
Civil registration system
Population pyramid
●
A population pyramid is the graphical representation
of the distribution of the population by sex, and age
group.
●
It takes the shape of a pyramid when the population
is growing.
●
Population pyramids are also known as age
pyramids because it is a graphical representation of
age.
 Fertility Related Statistics
 Birth Rate:
Number of live birth /mid year population.
20.4 and 14.3/ 1000 population.
Crude Death rate is about 6.4/ 1000 population.

General Fertility Rate (GFR)

It is the "number of live births per 1000 women in the reproductive age-group
(15-44) in a given year".
 Fertility Related Statistics
  Total Fertility Rate (TFR)
The average number of children a
woman would have if she were to
pass through her reproductive years
bearing children at the same rates.
It indicate the magnitude of
‘completed family size’
Total Fertility Rate of India is 2.3/
1.8 (2016)
 Fertility Related Statistics
  Gross Reproduction Rate (GRR)
Average number of girls that would be born to a woman if she
experiences the current fertility pattern throughout her reproductive
span (15-49), assuming no mortality.

Net Reproduction Rate (NRR)

Number of daughters a newborn girl will bear during her lifetime
assuming fixed age-specific fertility and mortality rates.
NRR 1 is equivalent of 2 child norm (replacement level)
 Fertility Related Statistics
  Eligible couples:
 A currently married couple with wife in reproductive age group (15–45 years)
 150 -180 couples per 1000 population in India.
 EC register, a basic document for organizing family planning work, is maintained at Sub
centre

Target Couple:
 Couples who have had 2-3 living children.

Couple Protection Rate (CPR):

 Is an indicator of prevalence of contraceptive practice in a community
 Net Reproduction Rate of 1 can be achieved if: CPR >60%
 Family Planning in India
India was the first country in world adopted National Family Planning, 1952.
In 1977, GOI redesignated it as National Family Welfare Program.

Small family norm:

 The objective of National Family Welfare program is to promote two child norm on
voluntary basis.
 Indicated by inverted triangle and the motto is
 Sons or daughter two will do
 Second child after 3 years
 Universal immunization

National Population Policy:1976

 NPP 2000 aims to reduce IMR <30 and MMR <100
 Objective is to bring TFR to replacement level by 2010

Dharmendra Kumar Tyagi, better known as Deep Tyagi or DK Tyag

 Contraceptives
 Preventive methods help woman to avoid unwanted pregnancies.
Temporary/ Spacing methods
Barrier methods
Hormonal methods
Intra Uterine Devices
Miscellaneous
Permanent/ Sterilization:
Female sterilization - Tubectomy
Male sterilization - Vasectomy
 Barrier Methods
Barrier methods prevent the meeting of sperm and ovum.
Protection against Sexually Transmitted Diseases (STD).
Manufactured in India at HLL, Trivandrum.

Physical methods:
Male condom (NIRODH) made of polyurethane
Female Condom, intra-vaginal device
Vaginal diaphragm/ DUTCH cap, act as a cervical barrier
Chemical methods:
Foams, creams, suppositories, etc. containing Nonoxynol
Combined:
Vaginal sponge (TODAY):
 Hormonal Methods
ORAL PILLS:
Combined Oral Pills:
Contain Progesterone and Estrogen
Best method for newly married couples.
For 21 days, starting on 5th day of menstrual cycle.
Govt. preparation: MALA N, MALA D, contain packet of 28 tablets (21 OCP)
Ethinyl Estradiol (30mcg) + Levanorgestrel (150 mcg)
Progesterone only pills / Mini pills:
Micro pill, has to take throughout the cycle, useful in lactation
Once in a month pill: Long acting estrogen, quinestrol
Post coital/ morning after pill : Greatest protection within 72 hours
Male pill: Gossypol, from cotton seeds
 Hormonal Methods
Depot formulations:
Injectable:
Depot Medroxy Progesterone Acetate (DMPA), 150mg every 3 months, IM.
Nor Ethisterone Enanthate (NET - EN), 200mg, every 2 months, IM.
DMPA SC – provera 104.
Sub dermal implants:
Placed beneath skin of fore arm, effectiveness over 5 years.
Eg: Norplant
Vaginal rings:
 Hormonal Methods
MoA:
 Preventing ovulation by blocking pituitary LH or FSH
Beneficial effects:
 100% contraception if taken correctly.
 Protection on ovarian cyst, ovarian cancer, PID, ectopic pregnancy, benign breast disorders
(fibroadenoma), iron deficiency anemia.
Adverse effects:
 Most common side effect is breakthrough bleeding
 Thrombosis, hypertension, elevated blood sugar, hyperlipidemia, weight gain, headache,
carcinoma cervix, cholestatic jaundice, etc.
Contraindications:
 Liver disease, thrombo embolic diseases, hypertension
 Ca breast, undiagnosed uterine bleeding.
 Intra Uterine Devices
Mechanism of action:
 Induce foreign body reaction in uterus, make it unfavorable for fertilization and
implantation.
 Ideal for spacing between births
Classification:
 I generation:
 Non medicated
 Eg: Lippes Loop (BaSo4), Grafenberg’s ring
 II generation: Copper IUD.
 Eg: Cu T 200 (4 years), Cu T 380 A (10 years), Nova T (5years) etc.
 Number: Surface area of copper in sq.mm
 III generation: Hormone releasing
 Eg: Progestasert, Levonorgestril.
 Intra Uterine Devices
Timing of insertion:
 Within 10 days of beginning of menstrual cycle
 Immediately after abortion or after postpartum
 Post puerperal insertion 6-8 weeks after delivery.
Side effects of IUD:
 Bleeding is the most common side effect followed by pain
 Pelvic infection (Actinomycetes), uterine perforation
 Ectopic pregnancy, Expulsion, pregnancy.
Contraindications of IUD:
 Suspected pregnancy, Pelvic Inflammatory Disease
 Menorrhagia, Previous ectopic.
 Carcinoma cervix or endometrium
 Post conceptional methods
Oral Contraceptive pills:
Levenorgestril 0.75mg two doses at 12 hour interval.
Yuzpe method: 100mcg estradiol + 0.5mg Levenorgestril
Post coital IUD:
Within 5 days, most effective emergency contraception
Menstrual regulation:
Aspiration of uterine contents (within 6 -14 days)
Menstrual induction:
Use of Prostaglandins.
Abortion:
Termination of pregnancy before fetus become viable (<20 weeks/ < 1000gm)
 Miscelleneous methods
Abstinence
Coitus interruptus
Safe period/ Rhythm method/ Calendar method
Natural family planning methods:
Basal Body Temp
Cervical Mucus method / Billing method
Symptothermic method
Breast feeding
Birth Control Vaccines: HCG
 Terminal/ Permenant methods
Vasectomy:
 Male sterilization, by cutting the vas deference
 NSV: Non Scalpel Vasectomy
 Not sterile immediately after procedure, for next 30 ejaculations, so use
another contraceptive.

Tubectomy:
 Female sterilization, by ligation or cutting the fallopian tubes
 Laparoscopic / Minilaprotomy
 PPS (Post-Partum Sterilization)
 Contraception
Contraceptive Efficacy:
Pearl Index (Contraceptive failures)
Life table analysis
 Family welfare services
ICDS,1975:
Anganwadi workers for every 1000 population
MCH tasks like health checkup, immunization, supplementary nutrition, etc.
Rural Health Scheme, 1977:
Proposed for extensive training of Local Dais and Village Health Guides for
conducting safe deliveries and related activities.
National Health Policy of 1983:
Set goals for reducing IMR less than 30 and MMR less than 1 per 1000 live
births.
Child Survival and Safe Motherhood Program:1992
RCH Program: 1997
 Family welfare services
NRHM: April 5, 2005 currently running all activities of MCH.
Janani Suraksha Yojana:
Focus on promoting institutional deliveries.
Janani Shishu Suraksha Karyakram:
Government of India launched JSSK scheme on 1 June, 2011.
It recommended for free institutional deliveries and cash assistance.
Vandematharam Scheme:
Voluntary MCH services by private doctors
Mission Parivar Vikas

The mission is being implemented in 146 high focus districts
that house 44% of the country’s population, with the highest
total fertility rates of 3 and more in the country.

The high focus districts are in the seven states of Uttar
Pradesh, Bihar, Madhya Pradesh, Rajasthan, Jharkhand,
Chhattisgarh and Assam.

The main objective of the Mission Parivar Vikas family
planning initiative is to bring down the Total Fertility Rate
(TFR) to 2.1, which is when the population starts
stabilizing, by the year 2025.
MTP Act
●
The Medical Termination of Pregnancy Act, 1971
(“MTP Act”) was passed due to the progress made in
the field of medical science with respect to safer
abortions.
●
The new Medical Termination of Pregnancy
(Amendment) Act 2021 expands the access to safe
and legal abortion services on therapeutic, eugenic,
humanitarian and social grounds to ensure universal
access to comprehensive care.
 MTP Act, 1971
When:
 Period of gestation must be ‘less than 20 weeks:
 0 – 12 weeks: Opinion of one doctor is sufficient
 12 – 20 weeks: Opinions of 2 doctors required
Indications:
 Humanitarian
 Eugenic
 Therapeutic
 Social
 Failure of vasectomy:
Who can perform:
 MD (Gyn-Obs) or 6-months Housemanship in Gyn-Obs
 04
Occupational Health
Nursing
 Ergonomics
Ergonomics:
Ergonomics principles involve fitting of job to the worker in order to achieve
best mutual adjustment of man and his working environment.

Eugenics:
Set of beliefs and practices that aim to improve the genetic quality of a human
population.
Francis Galton is considered as the founder.
 Ergonomics
Euphenics:
The science of making phenotypic improvements to humans after birth,
generally to affect a problematic genetic condition.
Eg: FA supplements and spina bifida

Euthenics:
Study of the improvement of human functioning and well-being by
improvement of living conditions.
Eg: environmental sanitation
 Occupational Hazards - Physical
Heat:
Most common physical hazard
Effective working temperature is identified as 20 – 27C
Heat stroke, dehydration
Cold:
Trench foot, frost bite
Chilblains/ Pernio: chill burns
Light:
Chronic exposure with dim light - miner’s nystagmus
Noise:
Auditory/ Nonauditory
Deafness, noise level >160dB
 Occupational Hazards - Physical
Pressure:
Caisson disease
Vibration:
White fingers, fingers become highly sensitive to spasm
UV radiation:
Welders flash keratitis
Ionizing radiation:
Maximum permissible level of occupational exposure - 5rem/ year/ whole body
 Occupational Hazards
Biological Hazards:
Anthrax, Leptospirosis, Brucellosis, Tetanus, fungal infections, etc.

Chemical Hazards:
Local action: dermatitis
Inhalation: respirable dust (<5microns)
The most common dust diseases in India are silicosis and anthracosis.
 Pneumoconiosis
Inhalation of dust within the size range of 0.5 – 3 micron can enter into lungs directly,
known as “respirable dust”

Byssinosis:
 Inhalation of cotton fiber dust
 Monday morning fever

Bagassosis:
 Inhalation of sugar cane dust.
 Due to Thermophilic Actinomycetes sacchari
 Prevention - spraying bagasse with fungicides (2% Propionic acid)

Farmer’s lung:
 Inhalation of hay or grain dust.
 Pneumoconiosis
Silicosis:
Inhalation of SiO2 particles, development of dense nodular fibrosis
On Chest X-ray: snow storm appearance
Anthracosis:
Inhalation of coal dust, Progressive massive Fibrosis
Siderosis:
Iron dust inhalation
Asbestosis:
Cause Mesothelioma of pleura
Ground glass appearance in chest X-ray
 Lead Poisoning

Lead poisoning occurs – inhalation, ingestion and through skin

Normal blood levels average about 25μg/100 ml
>70μg/100 ml blood is generally associated with clinical symptoms.
Clinical features:
Abdominal colic, obstinate constipation, loss of appetite, blue-line on the
gums, stippling of red cells, anaemia, wrist drop and foot drop.
Diagnosis: Coproporphyrin, Amino levulinic acid in urine.
Management: Gastric lavage, chelating agents -d-penicillamine, Ca- EDTA.
 Occupational Cancers

Skin cancer - 75 per cent of occupational cancers are skin cancer.

Cancer bladder –Dyeing (aniline) industry, rubber, gas & electric cable industries.
Leukemia - Exposure to benzol, roentgen rays and radio-active substances.
 Prevention of occupational disorders
Preplacement examination:
Foundation of an efficient occupational health service

Periodical examination:
Secondary level of prevention

Notification:
 Prevention of occupational disorders - Engineering
Substitution:
Replacement of a harmful material by a harmless one, or one of lesser toxicity.
Eg: white phosphorus by phosphorus sesquisulphide in the match industry.

Enclosure:
Prevent the escape of dust and fumes into the factory atmosphere.

Isolation:
Offensive process in a separate building so that workers not directly exposed.
 Legislations

Factories Act 1948, 1987

 Defines factory as an establishment employing 10 or more workers where power is
used, and 20 or more workers where power is not used.
 The Act prohibits employment of children below the age of 14 years.
 Maximum working hours - 48hrs/ weeks
 1000 workers - appointment of 'Safety Officers'
 250 workers - canteen
 30 women workers –creches
 500 workers- Welfare Officer.
 Legislations

Employees State Insurance act, 1948

 Applicable wherein 10 or more persons were employed

 Union Minister for Labour is the Chairman of ESI corporation .

 Sickness benefit – 91 days

 Extended sickness benefit of maximum 2 years

 Temporary disablement benefit is about 90% of the wages

 RAJIV GANDHI SRAMIK KALYAN YOJANA –unemployment allowance for the

employees covered under ESI scheme.
 Legislations
Sickness Absenteeism:
Worker’s absence from his regular work when he is scheduled to work

Environmental sanitation at work place:

Standard space of 500 Cubic feet per every worker.
Light: Precision work – 50 to 75 foot candles, regular work – 6 to 12 foot candles

Article 24:
Prohibition of child labor
 National Institutions

National Environmental Engineering Research Institute at Nagpur

The All India Institute of Hygiene and Public Health, Kolkata.