Although significant advancements have been made in health sector during past few years, it has failed to meet routine challenges. Repeated outbreaks of disease like Malaria, Cholera, Dengue etc. in several parts of the country have posed a great threat to the wellbeing of the population. The life expectancy of people and their changing life styles have been increasing the rate of diseases like cancer, mental health problems, cataract induced blindness, diabetes, HIV/AIDs and its nexus with tuberculosis. Although health is a State subject under the Constitution, the Department of Health of the Ministry of Health and Family Welfare in the Central Government formulates a Comprehensive Health Plan so as to take concerted measures to combat major communicable and non-communicable diseases.
The main functions of the Department of Health are :
The Plan outlay for Central Sector Health Programme in the Annual Plan 1995–96 was Rs. 670.00 crore including a foreign aid component of Rs. 225.00 crore. A major portion of outlay is for the National Health Programmes for the Control of communicable and non-communicable diseases implemented through centrally sponsored programmes. The external assistance has been sought to get the enhanced quantum of funds for programmes in critical areas mainly diseases control programme viz. leprosy, tuberculosis, AIDs and blindness.
Another major component of the Central Sector Health Programme is Purely Central Schemes through which financial assistance is given to about 80 institutions. These institutions are responsible for contribution in the field of control of communicable and non-communicable diseases, medical education, training, research and patient care. During 1995–96 Rs. 245.00 crore allocation have been made under Purely Central Schemes.
Financial Assistance to Voluntary Organisations
The Government of India have been giving financial assistance to the Voluntary Organisations for encouraging them to set up new hospitals/dispensaries in rural areas or to expand and improve the existing hospital facilities. Financial assistance is available under the following grant-in-aid schemes :
Health Minister’s Discretionary Grant
Financial assistance to the poor and indigent patients is given from the Health Minister’s Discretionary Grant to defray a part of the expenditure on hospitalisation / treatment in cases where free medical facilities are not available.
During 1994–95 assistance totalling Rs. 9.63 lakh was given to 104 individuals. A provision of Rs. 30 lakh has been made during the financial year 1995–96. The maximum ceiling of grant has been raised from Rs. 10,000/- to Rs. 20,000/- in each case. A sum of Rs. 29.97 lakh has been released to 257 patients during the financial year 1995–96.
Medical Relief and Supplies
Under the Central Government Health Scheme (CGHS), a number of new initiatives have been taken up. Expenses incurred on Intra Ocular Lens (IOL), Hearing Aids and Pacemakers have become reimbursable. In order to expedite disposal of reimbursement of medical expenses claims, powers to reimburse the cost of artifical appliances have been delegated to the administrative Ministries/Departments.
The Additional Directors/Deputy Directors of CGHS Organisations have also been delegated powers to reimburse the cost of artificial appliances to the pensioners.
National Health Programmes
The Central Government has taken certain steps to combat communicable, non-communicable and other major diseases which cause disability not only to improve the health status of India’s population but also to prevent and control disabilities. For this purposes, several National Health Programmes are directly run by the concerned ministers.
National Leprosy Eradication Programme : Currently most of the leprosy patients are in the states of Uttar Pradesh, Bihar, Madhya Pradesh and West Bengal.
National Leprosy Eradication Programme (NLEP) is implemented as a 100% Centrally sponsored scheme. The aim of NLEP is to achieve elimination of Leprosy by the year 2000 A.D. Free treatment services with combination of drugs, Multiple-Drug Therapy (MDT) are provided to all leprosy patients throughout the country through trained leprosy workers. Estimated number of persons requiring treatment for leprosy has declined from 4 million cases in 1985 to 0.54 million cases in March, 1996. More than 6.5 million leprosy patients have been cured with MDT and percentage of registered patients taking MDT treatment has increased from 10 per cent in 1985 to 96 per cent in 1996. The prevalence rate of leprosy has declined from 57.3 per thousand population in 1981 to 5.9 per thousand population in 1996. Number of new leprosy cases detected each year has remained about 0.45 million.
About 15-20 per cent children suffer with leprosy. Proportion of infectious cases varies from 15-20 per cent while 5 to 15 per cent patients suffer from various types of deformities.
Programme Objectives :
The Government of India launched National Leprosy Eradication Programme in 1982–83 with an aim to achieve elimination of leprosy by 2000 A.D. and to reduce its prevalence to <1/10,000 population. In order to achieve this several strategies were adopted including :
Financial Targets and Achievements of NLEP
Annual Plans | Approved Outlay Rs. in crore | Actual Expenditure Rs. in crore |
1992-93 | 35.00 | 173.42 (1992-95) |
1993-94 | 35.00 | |
1994-95 | 94.00 | |
1995-96 | 80.00 | 64.53 |
1996-97 | 74.00 | 68.42 (Anticipated) |
Total | 318.00 | 305.95 (Anticipated) |
Targets and Achievements of NLEP
Year | Case Detection | Case Treatment | Case Discharge | |||
Target | Achievement | Target | Achievement | Target | Achievement | |
1992-93 | 289 | 547 | 289 | 541 | 573 | 1052 |
1993-94 | 265 | 494 | 265 | 486 | 525 | 719 |
1994-95 | 224 | 429 | 224 | 419 | 424 | 626 |
1995-96 | 225 | 434 | 225 | 420 | 425 | 613 |
The impact of MDT Services has been sustantial, where MDT epidemiological impact assessed in 40 districts, where MDT programme has been in progress for past four or more years, shows that there is a marked reduction in prevalence rate (approximately 85 per cent); in annual new case detection rate (30 per cent); and deformity rate (80 per cent). The World Bank assistance has further strengthened the programme. It is expected that there would remain just over 100,000 leprosy cases and by the end of 2000 A.D., not more than 20,000 cases. This would bring in an effective break in the transmission of the disease and the goal to bring it down to less than 1 per 10,000 population set by the World Health Organisation would be achieved year-wise.
National Programme for Control of Blindness :
National Programme for Control of Blindness (NCPCB) was launched in the year 1976 as a 100 per cent centrally sponsored programme. Various activities of the programme include establishment of Regional Institute of Ophthalmology, upgradation of Medical Colleges, district hospitals and Block Level Primary Health Centres, development of mobile units, recruitment of required ophthalmic manpower in eye care units for provision of various opthalmic services. The goal is to reduce the prevalence of blindness from 1.4 per cent to 0.3 per cent by 2000 A.D.
The infrastructure developed so far and targets for the year 1995–96 are as follows :
Infrastructure | Developed / Upgraded so far | Services sanctioned during 1995-96 |
State ophthalmic Cell | 19 | - |
Medical Colleges | 81 | 1 |
District Hospitals | 418 | 3 |
DMUs | 269 | 5 |
PHCs | 5117 | 26 |
Eye Banks (Govt.) | 166 (Total) | 3 |
Eye Bank (Pvt.) | - | - |
DBCS | 456 | - |
The assistance provided to the service components under this programme has been enhanced during 1995–96, with the budget allocation raised from Rs. 40 crore during 1994–95 to Rs. 72 crore during the current year 1995–96. There is a provision of Rs. 75 crore during 1996–97.
Year | Budget Allocated Rs. in crore | Expenditure Reported Rs. in crore |
1993-94 | 25 | 19.70 |
1994-95 | 40 | 38.26 |
1995-96 | 72 | 57.51 |
1996-97 | 72 | – |
Performance of cataract operations has gone up. Target for the year 1994–95 was 24.50 lakh and 21.56 lakh operations were performed. A target of 26.20 lakh operations has been set for the year 1995–96 and 19.73 lakh operations have been performed so far.
Performance of Cataract Operations
Year | Targets | Achievements |
1992-93 | 20,00,000 | 80% |
1993-94 | 24,30.000 | 79% |
1994-95 | 24,50,000 | 88% |
1995-96 | 25,50,000 | 86% (upto Feb,96) |
1996-97 | 26,20,000 | - |
Voluntary organisations are playing an important role in this programme. District Blindness Control Societies (DBCS) are being established throughout the country under the Chairmanship of District Magistrate/District Commissioner. Till now, about 456 DBCS have been established.
External Assistance :
The following agencies have been assisting (NPCB) since 1980 :
The project is being implemented in 7 major states of the country viz. Andhra Pradesh, Madhya Pradesh, Maharashtra, Tamil Nadu, Orissa, Uttar Pradesh and Rajasthan.
Major inputs of the project are upgrading the ophthalmic services expanding the coverage in rural and tribal areas, establishment and functioning of DBCS, training of ophthalmic manpower, improving the management information systems and creating awareness about the programme in the masses.
Under the World Bank project a sum of Rs 21 crore is being allocated for the year 1994–95. Assistance of Rs. 48.60 crore was earmarked for the year 1995–96.
National Iodine Deficiency Disorders Control Programme About 54.4 million persons are suffering from endemic goitre, about 8.8 million from mental handicap, about 2.2 million are cretins and about 6.6 million have mild neurological disorders. The survey results indicate that out of 255 districts surveyed, Iodine Deficiency Disorders are a major public health problem in 222 districts. Realising the magnitude of the problem the Government of India launched a 100 per centrally assisted National Goitre Control Programme (NGCP) in 1962 with the following objectives :
Iodine deficiency manifests itself in a wide range of physical and mental disorders, the most extreme form being hypothyroidism. The survey conducted by the Central and the State Health Directorates, Indian Council of Medical Research (ICMR) and Medical Institutes have clearly demonstrated that no Indian State is free from the ill-effects of Iodine Deficiency Disorders and an estimated 63 million in the country have disorders attributable to this deficiency and about 167 million are at risk.
In August 1992, the National Goitre Control programme (NGCP) was renamed as national lodine Deficiency Disorders Control Programme (NIDDCP) with a view of wide spectrum of lodine Deficiency Disorders. On the recommendations of central council of Health in 1984, the Government took a policy decision to iodate the entire edible salt in the country by 1992. The programme started in April, 1986 in a phased manner. To date, the annual production of iodated salt in our country is 34 lakh metric tonnes per anum.
Achievements :
The achievements made under the programme from its inception to date are as under :
Information, Education and Communication (IEC) on lodine Deficiency Disorders
To intensify IEC activities, a communication package having the following highlights was finalised with UNICEF:
National Mental Health Programme :
The National Mental Health Programme was launched during Seventh Five Year Plan to ensure availability of Mental Health Care Services for all, specially for those at risk in under-privileged sections of the community. The basic emphasis was on the promotion of community participation in the Mental Health Services development as a measure of self-help and self-reliance. The National Advisory Group identified 11 institutions for the training of health workers under the programme. This training consist of imparting basic knowledge of mental health to the Primary Health Care Physicians and Para-Medical Personnel. During 1995–96, Rs. 5 lakh was allocated for this programme.
National Filaria Control Programme :
Filariasis is a major public health problem in many States of the country and about 420 million people are estimated to be living in 175 endemic districts of which about 109 million are in urban areas of which about 47 million urban population is being protected. The infection is transmitted through insect bites and results in a disabling disease causing swelling which results in tremendous enlargement of leg or foot, or other part of the body.
The National Filaria Control Programme was launched in 1955. Under the Programme the following measures were undertaken :
During the Eighth Plan anti-filarial drugs were distributed through Primary Health Care Delivery System in the rural areas of endemic States. Number of Microfilaria (Mf) carriers and disease cases detected during the last three years by the control units and filaria clinics are as follows :
Year | No. of examined | No. of +ve for Mf | Mf Rate % | No. of +ve for disease | Disease Rate % |
1992 | 3,736,744 | 50,492 | 1.4 | 40,262 | 1.10 |
1993 | 3,790,804 | 45,876 | 1.2 | 37,720 | 0.99 |
1994 | 3,960,013 | 47,427 | 1.2 | 35,219 | 0.89 |
Other Major Health Programmes As an integral part of the overall strategy for reduction of infant mortality to below 60 per thousand live births; child mortality to below 10 per thousand under five, child population and maternal mortality to below 200 per 100,000 live births by 2000 AD, the followling specific programmes have been under implementation in the country as 100 per cent centrally sponsored Family Welfare Schemes :
The care of mothers and children occupies a paramount place in the Indian health services delivery system. This is reflected from the fact that 9 out of the 17 goals listed in the National Health Policy (1983) relate to maternal and child health.
Child Survival and Safe Motherhood (CSSM) Programme:
The CSSM Programme, launched in 1992-93, is being implemented with the financial assistance of World Bank and UNICEF and has an outlay of Rs. 1125.5 crore over a seven year period. The Programme has the following components :
Universal Immunisation Programme (UIP)
Universal Immunisation Programme (UIP), launched in 1985, has been declared as one of the Technology Missions in 1986, as a part of the overall national strategy to bring down infant and maternal mortality in the country. At the beginning of the Programme in 1985-86, vaccine coverage levels ranged between 29 per cent for BCG and 41 per cent for DPT. During 1995-96 (upto February 1996) coverage levels ranged from 67 per cent for TT (PW) to 84 per cent for BCG.
Surveillance of Vaccine Preventable Diseases :
A reliable surveillance system has been developed. The immediate reporting of cases of neo-natal tetanus and poliomyelitis has been made mandatory. There has been a significant decline in the incidence of these diseases.
Impact on Infant Mortality Rate (IMR) :
The effective impact of the programme is reflected in the significant drop in the infant mortality rate from 129 in 1976 to 74 in 1993. In the States of Bihar, Madhya Pradesh, Orissa and Rajasthan, the IMR has steadily come down.
Oral Rehydration Therapy (ORT) for Diarrhoea Control Among Children
The Oral Rehydration Therapy Programme had started in 1986-87 in a phased manner with the objective to prevent diarrhoea associated deaths in children due to dehydration. Diarrhoea still remains one of the leading causes of death among children under 5 years. Oral Rehydration Salts (ORS) has been used as a drug of choice for proper case management of diarrhoea cases.
Prophylaxis Schemes
Anaemia Prevention and Control among Pregnant Women:
Anaemia, accounts for 20 per cent of the maternal deaths in the country. It is one of the major causes of maternal mortality and is an aggravating factor in hemorrhage, toxemia and sepsis. The CSSM programme, therefore, has prioritised pregnant women for Iron and Folic Acid (IFA) administration. During 1994-95, 208.00 lakh (85.8 per cent) pregnant women were provided with the recommended dosage of IFA tablets.
Prevention and Control of Vitamin A deficiency among Children :
Vitamin A deficiency, which can lead to blindness, is widely prevalent in the country, especially among the pre-school children. The CSSM programme sought to administer six-monthly doses of concentrated Vitamin-A to the children between 1 to 3 years of age. During 1994-95, 149.8 lakh (72.6 per cent) infants were administered the measles-linked dose while the DPT/OPV booster linked dose was administered to 98.6 lakh (54.8 per cent) children in the age group of 1-2 years.
Essential Maternal Care – Dais Training, Their Reporting Fees And Disposable Delivery Kits for Pregnant Women:
The data for 1992 indicates that the proportion of deliveries attended by untrained hands was high, particularly in the rural areas. With the goal to achieve 100 per cent deliveries by trained personnel the CSSM Programme accords a high priority to speed up the training of Traditional Birth Attendants (Dais). An amount of Rs. 7.50 crore has been allocated during 1994-95 for 500/250 Dais per district. The reporting fee offered to the Dais has also been enhanced from Rs. 3.00 per case to Rs. 10.00 per case. There is a provision for the supply of disposable delivery kits containing essential items for safe and hygienic delivery to pregnant women.
First Referral Units (FRUs) for Emergency Obstetric Care:
Upgrading of rural health facilities, with a post of a gynaecologist, an operation theatre, essential equipments and skill based training is being undertaken in certain districts. Easier accessibility to adequate medical care is essential for an effective referral system and for promoting timely and early referral.
Pulse Polio Immunization (PPI) The public response to Pulse Polio Immunisation was overwhelming. Mothers made a beeline for the immunization posts since early in the morning. One hundred per cent of the target was achieved. PPI was the biggest public health intervention ever to be carried out in India. All departments of the government and non-governmental organisations successfully coordinated and cooperated to achieve full coverage.
Government of India decided to implement the strategy of National Immunization Days i.e Pulse Polio Immunization, beginning in 1995 to achieve polio eradication by the year 2000A.D. In the first phase, Government decided to observe Pulse Polio Immunizaiton on the two fixed days, on these two days, Oral Polio Vaccine (OPV) was given to all children of 0 to 3 years of age in the entire country regardless of previous immunization. 8.7 crore children in the country, including 7.9 crore in the age group 0-3 years, were given a dose of Oral Polio Vaccine in the country on 9 December 1995 and equal number of 9.3 crore children including 8.5 crore in the age group 0-3 years were given a dose of Oral Polio Vaccine in the second round on 20 January 1996.
The second phase of Pulse Polio Immunization was implemented on two days i.e. on 7 December 96 and 18 January, 1997.
Rural Health Services
Several programmes and schemes are implemented under the Minimum Needs Programme to provide primary health care relevant to the actual needs of the community in the rural areas. The status of Sub-Centres, Primary Health Centres (PHCs) and Community Health Centres (CHCs) under the Minimum Needs Programme is as follows :
Sub-Centre :
A Sub-Centre is established on the basis of one Centre for every 5,000 population in the plain areas and for every 3,000 population in the hilly and tribal areas. There were 1,31,900 sub-centres functiong during the year 1995-96.
Primary Health Centres (PHCs) :
Primary Health Centres are established on the basis of one PHC for every 30,000 population in the plain areas and for every 20,000 population in hilly, tribal and backward areas. The number of PHCs functioning in the country was 21,693 during the year 1995-96.
Community Health Centres (CHCs) :
Rural hospitals, with specialist facilities were established by upgrading PHCs having 30 beds to cover a population of 80,000 - 1.20 lakh. In 1995-96 the number of functioning CHCs was 2,385.
Other Causes of Disabilities
Apart from major causes of disabilities like blindness, leprosy, polio, iodine deficiency there are other causes which have also received attention from various agencies including :
Genetic Causes of Birth Defects Many genetic diseases are due to abnormal enzymes. Experts in human genetics and medicine maintain that there are over 3200 causes of heredity disorders and in at least half of them these causes can be identified. Advancement in this extremely important field has helped to identify foetus at risk. On the basis of such a diagnosis recommendation can be made for the termination of pregnancy. With the help of the techniques of genetic counselling parents can be forewarned. Without such expert advice there is a risk that all or several children in a family would either be born with disabilities or would become disabled as they get older. Genetic counselling, genetic engineering and many other new techniques now can identify preconditions responsible for inherited disabilities. Such breakthrough have the potential of making an appreciable impact on the incidence of disability. Such expertise is as yet, available only at selected institutions in large cities and outside the knowledge and reach of ordinary people. There is a definite need to establish a network of services accessible to couples at risk and to para–medical, medical and health service personnel. Regular training and orientation of medical, health and social welfare staff is needed to advise the parents.
Abnormalities of structure, function and body chemistry result in physical, sensory or mental disabilities are caused by heredity factors, apart from environmental interference with a child’s development before, during and after birth. Heredity information, containing characteristics (including defects) is passed on from parents to a child. Many genetic disorders can be traced to modes of inheritance such as Huntington Disease (progressive deterioration of the central nervous system) or Dwarfism (retardation of bone growth). Some defects like Down’s Syndrome (popularly known as Mongolism) is present at birth and is the result of chromosomal imbalance or an error occuring during the process of cell formation at the time of conception. This is not a "heredity condition" in the sense that it is not transferred from parent’s defective genes. It is essentially a random mistake and can happen to anyone, but women over 35 years are at a greater risk than younger mothers.
Fluorosis According to the Bureau of Indian Standards (BIS) (1991), excess flouride intake can be prevented by non-consumption of high fluoride water and other food items and by increasing the intake of Calcium and Vitamin C which help in fighting against the harmful effects of fluoride.
A number of diseases can result from unsafe drinking water, fluorosis is one among these. It causes health problems such as stomach disorders, discolouration and loss of teeth, pain and stiffness in joints, backbone as well as muscles and even results in crippling a patient on a permanent basis. According to a report published by Government of India’s National Technology Mission on Drinking water, "In India today, millions of men, women and children are crippled and lead a vegetative life due to fluorosis".
For want of any proper survey the number of people who are suffering, or have been crippled, as a result of fluorosis is not precisely known. However, it has been roughly estimated that about 25 million people in the country, living in 150 districts in 15 States, are seriously affected. These 15 endemic States are : Delhi, Jammu and Kashmir, Kerala, Orissa, Bihar, Haryana, Karnataka, Madhya Pradesh, Maharashtra, Punjab, Andhra Pradesh, Gujarat, Rajasthan, Tamil Nadu and Uttar Pradesh.
Lathyrism
Lathyrism is a type of paralysis in the lower limbs. It is prevalent in Madhya Pradesh, Andhra Pradesh, Karnataka, Maharashtra, Bihar, Uttar Pradesh and also in parts of West Bengal. This is caused due to excess consumption of lathyrus sativus (Khesari Dal) and is irreversible and incurable. The disease occurs in four stages. The first stage is characterised by an awkward gait and the patient can walk without the help of a stick. The disease then advance to on-stick stage because of muscular stiffness, then due to excessive bending of knees and crossing legs, the individual is reduced to the crawling stage and eventually he becomes totally crippled. About four per cent of the total population is estimated to be affected by lathyrism in the affected areas.
The consumers of khesari dal are, of necessity, poverty stricken agricultural labourers and people belonging to socially disadvantaged and deprived groups. They have to depend on this dal for their survival and normally receive it as part of their wages from landlords. Except Bihar, Madhya Pradesh and West Bengal all State governments have prohibited the use of such dal for human consumption. The State Government of U.P. has even banned the cultivation of Khesari dal. Despite these government efforts and warnings about the risk, the dal is still being cultivated and is being consumed. The concerned government departments have drawn up value suggestions to reduce the danger of Khesari dal including ‘steeping process’ and ‘par boiling’ process which remove or reduce the poisonous substances in the dal. Some low-toxin varieties of the seeds have also been developed. Systematic research has resulted in setting up of a detoxifying plant in Rewa. However, the problems of cultivation and consumption of Khesari dal causing lathyrism continue.
Casualties from Accidents As per NSSO survey results, three to four per cent of visual disability as well as speech and hearing disability and 22 per cent of locomotor disabilities are due to injuries. According to a publication entitled Statistics of Road Accidents in India (1983-1992), by the Ministry of Surface Transport, Government of India, 54,100 persons were killed and 2,44,100 persons were injured in road accidents in India in 1990 alone. There has been nearly four times increase in the number of deaths as well as injuries during 1970-1990. According to a guessetimate, nearly half a million persons acquire disability due to transportation accidents every year in India. Ownership of motorised vehicles in India is nearly one per cent of the world’s vehicle population, yet its share of road accidents in nearly six per cent. Agricultural accidents could be largely prevented by redesigning the existing machines, like threshers and chaff cutters and also by stricter implementation of the Dangerous Machines Act and Bureau of Indian Standards (BIS) for the machines as well as by educating public with the help of print and electronic media. Accidents will always occur but their frequency and severity can be kept in check.
All human activities–occupational, recreational, domestic or transportation – are subject to accident risk and therefore sustained efforts should be made to reduce accidents, particularly those resulting in partial or total disability or death. Owing to the rapid changes in the mode of living as well as the environment in India the rate of fatal and non-fatal accidents is on increase. It is extremely complex to calculate the economic loss which results from avoidable events. Accidents are caused by falls, inside or outside home, burns, drowning, transport (railways, road traffic, air travel, travel marine), poisonous gases, poisons, dangerous drugs, riots and violence, etc.
The Research Division of the National Society for Equal Opportunities for the Handicapped (NASEOH), Bombay, has estimated that about 25,000 industrial workers acquire permanent disability every year due to industrial accidents.
Nutritional Causes According to the National Nutrition Policy, published in 1993 by the Department of Women and Child Development, Government of India, 43.8 per cent children were estimated to suffer from severe malnutrition in 1989-90, although there had been a decline during 1975-90 of 3.75 per cent in moderate malnutrition and 6.3 per cent in severe malnutrition. Combating malnutrition has been one of the objectives of the Indian Government and along with overall rise in food production and reduction in poverty level in the country, specific interventions have been planned and implemented. Some other programmes to tackle the problem of malnutrition are Special Nutrition Programme, Balwadi Nutrition Programme, Wheat-based Supplementary Nutrition Programme and Mid-day Meals Programmes in certain States. International agencies such as Care-International and USAID also have programmes to tackle this problem. The deficiency of vitamin A and protein energy malnutrition are major causes of childhood blindness. A Prophylaxis Programme Against Blindness due to Vitamin A deficiency was started by the Government in 1970. Under this programme children in 1-5 age-group are given an oral dose of 0.2 million IU of vitamin A in oil, every six months. The programme covers 30 million out of 80 million children in the target group. Over the years significant reduction in childhood blindness has been reported. Effective implementation of the programme continues. In order to strengthen the thrust the Government of India have now adopted a National Nutrition Policy to cover the multiple aspects of nutritional programmes. Under the policy, National Nutrition Council and an Inter-ministerial Coordination Committee have been set up. Linkages between the food policy, the agricultural policy, the health policy, the education policy, the rural development programmes and the nutrition policy are established to effectively tackle the problems of malnutrition.
Nutrition is essential for the body, its growth, health, maintenance and reproduction. Adequate food supply ultimately determines the nutritional status of an individual as well as the society in which he lives. Malnutrition adversely affects health, damages the supply of energy to the body and disrupts countless chemical reactions in the body. Nutrition is composed of energy factors such as calories, carbohydrates, proteins, fats and vitamins. Any imbalance or starvation in the supply, quality and quantity of these results in malnutrition and deficiency, often causing irreversible or permanent disabilities, visual impairment and mental retardation.
In recent years there has been a significant drop in the population below poverty line (56.8 per cent in 1960 to 29.0 per cent in 1987), but about 250 million out of 930 million still suffer from varying degrees of malnutrition in India.
One such major step is the scheme of Integrated Child Development Services (ICDS) which has supplementary nutrition as its main component. ICDS had covered nearly 3000 blocks - roughly 60 per cent of the country by end of 1992-93. The Beneficiaries of this programme are children below six years of age, pregnant and lactating mothers and women in 15-44 age-groups.
Ante-natal, Natal and Post-natal Causes
The 7th Plan had provided for a trained birth attendant for every 1000 population in 5,800,000 villages in India, and thus trained 5.8 lakh dais in the country (M.R. in India, A Contemporary Scene, NIMH). Low birth weight increases the risk of hazards in development for infants and children. One third of the babies born in India are of low birth weight. Early marriage, frequent pregnancies, poor nutrition and illiteracy are a few of the contributing factors. This vicious cycle, created by such factors results in harmful affects in adulthood and also in the next generation. Most government hospitals have post partum centres, yet women deliver their babies with the help of untrained dais. Many do not receive immunisation and ante/pre/post natal care. In Rajasthan, 67 per cent
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