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1 Social Sector Initiatives and Government Affirmative Actions

1. National Rural Health Mission


(a) State of Public Health Prior to Mission:
Public health expenditure was only 0.9% of GDP,
Lack of community ownership of public health programme,
Lack of integration of sanitation, hygiene, nutrition and drinking water issues,
Striking regional inequalities,
Population stabilization, especially in states with weak demographic indicators,
Curative services favour the non-poor,
Only 10% Indian have some forms of health insurance, mostly inadequate,
Hospitalized Indian spend on an average 58% of their total annual expenditure,
Over 40% of the hospitalized Indians borrow heavily or sell assets,
Over 25% of the hospitalized Indians fall below poverty line because of hospital expenses.
(b) Goal and Vision :
NRHM to have special focus on 18 states having weak public health indicators and/or
weak infrastructure,
Raising public spending on health from 0.9% of GDP to 2-3% of GDP,
Female health activist (ASHA) in each village, chosen by and accountable to Panchayat
will have a 23 days of training (on the job) spread over 12 month,
ASHA will be given a drug kit containing generic AYUSH and allopathic formulations
for common ailments,
ASHA will be an honorary volunteer, receiving performance based compensation for
promoting universal immunization, referral and escort services, construction of house-
hold toilets,
Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR),
Population stabilization, gender and demographic balance.
(c) Strategies and Plan of Action:
Train and enhance capacity of (PRIs) to own, control and manage public health services,
Health plan to each village through village Health Committee of Panchayat,
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2 Social Sector Initiatives and Government Affirmative Actions
Strengthening sub centres with an United Fund @ 10,000 per annum. Supply of essential
drugs, both allopathic and AYUSH to sub centres,
Strengthening existing PHC and CHC and provision of 30-50 beded CHC per lakh popu-
lation,
Provision of 24 hours services in 50% PHC by addressing shortage of Doctors,
Operationalizing 3222 existing community health centres (30-50 beds) as 24 hr. First
Referral Units and promotion of Rogi Kalyan Samiti (RKS) for hospital management.
Also develop, display and ensure compliance to citizens charter,
Preparation of Distt. Health Plan amalgamating village health plan and incorporating in
itself areas like water supply, sanitation, hygiene and nutrition,
National Disease Control Programme for Malaria, T.B., Kala Azar, Filaria & Iodine de-
ficiency shall be integrated. Provision of a mobile medical unit at Distt. level for improved
outreach services,
Private health services to be regulated, made transparent and accountable,
New health financing mechanism by introducing suitable user charges to be introduced,
At village level, Creation of Village Health & Sanitation Committee.
Rogi Kalyan Samiti at Hospital Level
Distt. Health Mission at Distt. Level
State Health Mission at State Level
National Mission Steering Group
Time limits for major components :
(a) Constitution of Distt./State Mission June 2005
(b) Provision of Generic Drugs Dec. 2005
(c) Preparation of village health plans 2006
(d) ASHA at village level (with Drug Kit) 2005-2008
(e) Upgradation of rural hospitals 2005-2007
(f) Mobile medical units at distt. level 2005-2008
(d) Outcomes :
Infant Mortality Rate (IMR) reduced to 30/1000,
Maternal Mortality Ratio (MMR) reduced to 100/100000,
Malaria Mortality reduction rate reduced by 50% upto 2010,
Kala-Azar mortality reduction rate 100% by 2010,
Cataract operation: will increase to 46 lacs per year by 2012,
Tuberculosis DOTS Services: Maintains 85% cure rate,
8.5 lacs ASHA workers @ one for each 2000 population,
3 Social Sector Initiatives and Government Affirmative Actions
Total Fertility Rate reduced to 2.1,
Improved facilities for institutional delivery through provision of transport, escort etc.
under Janani Suraksha Yojna (JSY) for BPL families,
Provision of household toilets.
OTHER GOVT. INITIATIVES IN HEALTH SECTOR
1. Janani Shishu Suraksha Karyakaram (Launched on June 1, 2011) :
(a) Free Care to Mothers :
Free and zero expenses delivery,
Free drugs, diagnostics, blood and consumables,
Free diet during stay in facilities,
Free transport from home to health institution, between health institutions in case of
referral and drop back home,
Exemption from all kinds of user charges.
(b) Entitlements for sick new born till 30 days after birth :
Free treatment, drugs, diagnostic, blood and other consumables,
Free transport from home to health institution, between health institutions in case of
referral and drop back home,
Exemption from all kinds of user charges.
2. National Programme for Control of Blindness :
Launched in 1976 as a 100 per cent centrally sponsored scheme for reducing blindness
to 0.3 per cent by 2020.
Main objectives:-
(a) To reduce the backlog of blindness,
(b) To develop a comprehensive eye care facility in every distt.
(c) To develop human resources for providing Eye Care Services,
(d) To improve quality of service delivery,
(e) To secure participation of private practitioners/NGOs in eye care,
(f) To enhance community awareness in eye care.
3. National Tobacco Control Programme :
The cigarettes and other Tobacco Products (Prohibition of advertisement and Regulation
of Trade and Commerce) Act 2003 is in force.
The salient features of the act are:
1. Smoking in public places is prohibited,
2. Direct and indirect advertisement of Tobacco product is prohibited,
3. Sponsoring of any event/sport by tobacco companies have been banned,
4 Social Sector Initiatives and Government Affirmative Actions
4. Sale of Tobacco products to some one below 18 years is prohibited,
5. Ban of sale of Tobacco product within a radius of 100 meter of education institution.
6. Sale without statutory warning is prohibited.
4. National Aids Control Programme (NACP):
Launched in July 2007 for a period of five years (2007-12) is a CSS scheme. Its features
are:
(a) Prevention of new infections,
(b) Providing greater care, support and treatment,
(c) Strengthening the infrastructure,
(d) Strengthening the nationwide strategic Information Management System.
People living with HIV in India in 2009 were 23.9 lac. It appears that the epidemic in
India has stabilized over the years,
Many targets of the programme has been achieved. Vast majority of new infections is
concentrated in 5-15 per cent of districts,
Condom distribution has increased,
More emphasis is given in areas with high HIV prevalence and high vulnerability,
Convergence with NRHM has begun.
5. National Mental Health Programme:
Programme was launched in 1982. An evaluation of programme was made in 2003 and
the programme was redesigned to incorporate components for effective reach and impact
on mental illness. Salient features are:
(a) Expansion of District Mental Health Programme (1996),
(b) Strengthening and modernization of mental hospitals,
(c) Research and training in mental health,
(d) Shortage of skilled manpower in mental health,
(e) Lack of awareness/stigma about mental illness,
(f) Lack of community involvement,
(g) Centre of excellence in mental health: Monetary support of 51 lakh to 1 crore to
every P.G. department of medical college,
(h) Budgetary support upto Rs.30 crore per center to be provided for capital work,
equipment and furnishing, faculty induction etc.
6. Rastriya Aryogya Nidhi: was setup in1997 to provide financial assistance to BPL patients
suffering from major life threatening diseases.
The scheme is implemented through state govt. who are expected to setup State Illness
Assistance Funds.
Applications upto Rs. 1.5 lacs are processed and sanctioned by respective state govts.
Beyond Rs. 1.5 lacs, assistance are provided by AIIMS, RML and other national level
hospitals located in different parts of the country.
5 Social Sector Initiatives and Government Affirmative Actions
7. Integrated Disease Surveillance Programme (IDSP) 2004:
Objective :
To detect early warning signals of impending outbreaks and help to initiate an effective
response in a timely manner.
Features :
To establish a decentralized state based surveillance system for communicable diseases,
To improve the efficiency of the existing surveillance activities and facilitate sharing of
relevant information,
HRD : Training of State surveillance officers, Rapid response team,
Use of ICT for collection, compilation, analysis of data,
Strengthening of Public Health Laboratories,
A 24 x 7 call centre has been established to receive disease alerts from anywhere in the
country on a toll free number 1075,
Urban surveillance is proposed for 4 metros.
8. Child Health Programme:
Objective :
The Reproductive and Child Health Programme (RCH) is meant to improve child health
and address factors contributing to infant and under five mortality.
Features :
Increasing coverage of skilled care at birth for newborns,
Implement by 2010, a new born and child health package of preventive, promotive and
curative interventions,
Strengthen and augment existing services,
Implement the multilayer strategic plan for the UIP (Universal Immunization Programme),
Infant and young child feeding,
Vitamin A, Iron and Folic Acid supplementation,
Early detection and appropriate management of Acute Respiratory Infections, Diarrhoea
and other infections,
Facility based newborn care,
Management of children with malnutrition.
9. Janani Suraksha Yojna:
It is a safe motherhood intervention under NRHM being implemented with the objective of
reducing maternal and neo-natal mortality by promoting institutional delivery. Its main
features are:
It is a 100 per cent C.S.S. and it integrates cash assistance with delivery and Post Delivery
Care,
6 Social Sector Initiatives and Government Affirmative Actions
JSY cards are issued to beneficiary,
Payment prior to discharge through bearer cheque,
Strong monitoring and supervision,
Transparency, accountability and grievance redressal mechanism is inbuilt,
Two days stay after delivery is promoted,
Programme for local awareness.
10. Prohibition of Pre-Conception and Prenatal Sex :
In order to check female foeticide, the Pre-Natal Diagnostic Techniques (Regulation and
Prevention of Misuse) Act 1994 is in operation since 01.01.1996. Its salient features are:
Act prohibits determination and disclosure of sex of the foetus,
Provision of imprisonment upto 5 years and fine upto 1,00,000.00 (One lakh),
A national inspection and monitoring committee has been constituted,
A toll free telephone no. 1800-110-500 has been created for any grievance or complaint.
11. Universal Immunization Programme (1978) :
Immunization is one of the key areas under NRHM.
Under universal immunization programme GOI is providing vaccination to prevent six
vaccine preventable diseases. They are:
Diphtheria, Pertussis, Tetanus, Polio, Measles and Severe form of childhood
tuberculosis.
To strengthen routine immunization, GOI under NRHM has launched newer initiatives
which include :
Introducing injection safety,
n Deploying additional manpower to cover urban slums,
n Training of ANM, cold chain handlers etc.,
n Taking help of ASHA and women SHG,
n Printing of immunization cards etc.
12. Family Welfare Linked Health Insurance Scheme:
Apart from providing for cash compensation to the acceptor of sterilization, there is a
system of compensation which is post operative
Rs. 50,000/- in case of death,
Rs. 30,000/- per case of incapacitation,
Rs. 20,000/- per case of cost of treatment of serious post operation complication,
In view of Supreme Court order, certain safeguards have been introduced in the steril-
ization:
1. Creation of a panel of Doctors for conducting sterilization,
2. Laying down a checklist to be followed by every doctor,
3. Uniform proforma for taking the consent of person undergoing sterilization,
4. Bringing an insurance policy uniformally in all states.
7 Social Sector Initiatives and Government Affirmative Actions
13. Rasthriya Swasthya Bima Yojana :
All distts. have been covered under the scheme from 2009-10.
Features :
Maximum contribution is Rs. 725/- per family (Centre 75 per cent + State 25 per cent),
(The beneficiary would pay Rs. 30/- as registration charges)
The scheme is for BPL families who are in unorganized sector,
Maximum coverage is Rs.30,000/- per family,
Health care facility will be cashless,
Unit of enrollment is family upto five members,
The scheme has 725 identified surgical packages,
For effective operation of the scheme, partnership is envisaged between the insurance
company, public and private sector hospitals and the state agencies.
14. UN Millennium Development Goals :
UN sponsored summit held in 2000 and attended by 189 member states agreed and signed
a declaration to achieve the following 8 goals:
1. Eradicate extreme hunger and poverty,
2. Achieve universal primary education,
3. Promote gender equality and empower women,
4. Reduction of child mortality,
5. Improvement of maternal health,
6. Combat HIV/AIDS, malaria and other diseases,
7. Ensure environmental sustainability,
8. Develop a global partnership for development.
15. Goals to be Achieved by 2015 :
According to Ministry of Statistics and Programme Implementation, the number of poor
in India is likely to be 279 million in 2015.
Seven states-Bihar, UP, Chhattisgarh, Jharkhand, M.P., Odisha and Uttrakhand account
for 64% of the countrys poor and this is likely to increase to 71% by 2015.
Indias recent rights based approach for ensuring access of the poor to food, employment,
education and information are expected to significantly improve its record of achieving
the MDG goals.
1. Sarva Shiksha Abhiyan-SSA (2001) :
Objectives :
Enrollment of all children by 2005,
Retention of all children till the upper primary stage by 2010,
8 Social Sector Initiatives and Government Affirmative Actions
Bridging the social and gender gap,
Enhancement in the learning achievement.
It has helped :
Opening of new schools (3 lacs approx.),
Construction of school building (2.5 lacs approx.),
Provision of drinking water facility (2 lac schools approx.),
Provision of toilets (3 lacs approx.),
Appointment of 10.5 lacs (approx.) teachers.
The focus of the programme is on :
Children belonging to SC/ST,
Other weaker section,
Minorities and
Urban deprived children.
2. Kasturba Gandhi Balika Vidyalaya Scheme :
Setting up of residential upper primary school, for girls of SC, ST, OBC and minority
community.
The scheme targets areas of scattered habitations.
The scheme provides for a minimum reservation of 75 per cent seats for girls from SC,
ST, OBC, minority community and 25 per cent girls from families below poverty line.
3. Mid-Day Meal Scheme (1995) :
Objectives :
Enhancing enrollment, retention and attendance.
Improving nutritional levels of the children.
n Initially started in 2408 blocks but later on it was extended to all blocks of the
country. It has the following features.
Met entirely by Central Govt. :
Supply of free food grain @ 100 gram per child per day for primary and @ 150 gram per
child per day for upper primary stage.
Assistance for Monitoring Management & Evaluation (MME) at the rate of 2 per cent of
the total cost. Shared with states 90:10 for NER states and 75:25 for other states.
Cooking cost.
Payment of honorarium @ Rs.1000/- p.m. to cook cum helper.
Assistance for the cost of construction of kitchen cum store.
Representatives of G.P./G.S., Mothers Committee are required to monitor:
9 Social Sector Initiatives and Government Affirmative Actions
1. Regularity of the Mid-day meal served,
2. Cleanliness in cooking,
3. Procurement of ingradient and fuel,
4. Implementation of varied menu,
5. Social and gender equity.
Complete transparency and accountability under RTI Act 2005.
4. Rashtriya Madhyamic Shiksha Abhiyan (2009) :
Objectives :
Enhancement of access to secondary education and improvement in its quality,
Achieving enrollment rate of 75 per cent from the present 52 per cent,
Improving quality of education,
Removal of gender, socio-economic and disability barriers,
Universal access to secondary education by 2017 and retention by 2020.
5. Launching of Saakshar Bharat :
National Literacy Mission has been recast as SAAKSHAR BHARAT with prime focus on
female literacy.
The mission has four objectives:
Impart functional literacy to 70 million adults in the age group of 15 years and beyond.
Enable the neoliberals to continue their learning beyond basic literacy.
Impart non and new literates relevant skill development programmes.
Promote learning society, by continuing education.