HEALTH

            "Improvement in the health status of the population has been one of the major thrust areas in social development programmes of the country. This was to be achieved through improving the access to and utilization of Health, Family Welfare and Nutritional Services with special focus on under-served and under-privileged segments of population".

                                - Tenth Plan Documents of the Planning Commission of India  

            Natural wholesomeness of the body, mind and spirit is called health. The contact of life with unpleasantness is called disease.  Improvement in the health status of a population is recognized as instrumental for increasing productivity and economic growth, as well as an end itself. The health system in the country is a mix of the public and private sector, with the NGO/Civil society sector playing small but important role. Some of the important health indicators include: -

·     Life expectancy and longevity,

·     Infant Mortality Rate (IMR),

·     Maternal Mortality Rate (MMR),

·     Nutritional Deficiency,

·     Morbidity,

·     Increasing burden of communicable and non-communicable diseases.  

At the time of independence, communicable diseases were a major cause of morbidity and mortality in the country. After launching following national programme the crude death rate per thousand has reduced from 25 in 1951 to under 9 in 2000.

·     National Anti-Malaria Programme,

·     Kala Azar Control Programme,

·     National Tuberculosis Control Programme,

·     Leprosy Eradication Programme,

·     National AIDS Programme.

  National initiatives on non-communicable diseases included: -

·     National Goitre Control Programme,

·     National Cancer Control Programme,

·     National Mental Health Programme,

·     Integrated Non-communicable Disease Control Programme,

·     Pulse Polio Immunization.

        Other initiatives include ICDS (Integrated Child Development Services), National Mid-Day Meals Programme, various micro-nutrient schemes, vitamin "A" and iodised salt, clean drinking water and sanitation etc.

The approach to health sector development in the country has not been sufficiently integrated with the overall process of development. There are large gaps in the availability of health care and in related services, such as maternal and childcare, clean drinking water and access to basic sanitation facilities for the masses. Our population, especially the poor do not have even minimum access to many facilities created.  

A Comprehensive Strategy for Better Health  

            Rural health care in most states is marked by absenteeism of doctor/health providers, low levels of skills, shortage of medicines, inadequate supervision/monitoring, and callous attitudes. There are neither rewards for service providers nor punishments to defaulters. As a result, health outcome in India is poor as compared to bordering countries, like Sri Lanka as well as countries of South East Asia, like China and Vietnam. 

        The health care delivery system needs oversight/stewardship at all levels. It requires both strong policies and institutions. However, given our socio-cultural and economic diversity, interventions have to be evidence based and area specific.

Past shortcomings notwithstanding, we can reach the Millennium Development Goals (MDGs) for IMR and MMR by the end of the 11th Five Year Plan. However, this will require action on many fronts---enabling pregnant women to have deliveries in medical institutions and receive nutritional supplements; connecting Primary Health Care (PHC) and Community Health Centre (CHC) by all weather roads so that they can be reached quickly in emergencies; expanding access to clean drinking water; and improving sanitation.  

National Rural Health Mission

          A seven year National Rural Health Mission (NRHM), which spans the duration of the 11th Five Year Plan, has been launched to address infirmities and problems across rural primary health care (see Box). One objective of the mission is to co-opt and converge the public health approach into primary health care. Another objective is to genuinely empower and support Panchayati Raj Institutions to manage, administer and be accountable for health services at community levels. Supervision of health sub-centres by gram panchayats will improve attendance of staff, motivate appropriate quality of care and provide constant feedback on patient satisfaction. The NRHM will also converge the management of health delivery across all systems of medicine (including Indian System of Medicine, ISM) at primary health care levels.  

At present the health care system suffers from a severe shortage of trained personnel. Across the States 6% to 30% posts of doctors remain vacant and random checks showed that from 29% to 67% doctors were absent. This problem of unavailability of doctors can be redressed if we mobilize doctors who are trained under Indian Systems of Medicine (ISM). Currently, there is no sustained dialogue between the ISM and modern systems of medicine. There are close to half a million institutionally qualified ISM practitioners, not included in the public sector supported primary health care (except for 40,000 employed  by the government). The trained ISM practitioners represent a valuable human resource at village and block levels. This could be leveraged and co-opted into providing primary health care. Kerala has fully combined the administration and delivery of the Modern and Indian Systems of Medicines, with outstanding outcomes in terms of access and quality of care. Himachal Pradesh is following the same route. The scope for generalizing such experiments needs to be explored.  

Financing Health Services

                  In order to energize health systems for improving health outcomes, innovative financing mechanisms are critical. Publicly supplied health care depends on how health care providers are paid. Providers should be paid only if they actually perform a service or otherwise satisfy the customer (the patient or the village health committee). Fees for health services delivered will encourage accountability.

            A system of private-public partnership could be experimented with. Some states have such systems. We should explore an entitlement system for pregnant women to have professionally supervised delivery. This will empower them to exercise choice, as well as, create competition in the health service sector. Contracting out of well-specified and delimited projects, such as immunization can help enhance accountability.

            Global experience has shown that private health insurance is characterized by serious market failures. Community Based Health Insurance (CBHI) is emerging as a promising concept. CBHI initiatives, coupled with social mobilization, are expected to improve the quality of health care and expand the health care interventions as per the requirements.

Clean Water for all

            Clean drinking water is vital to reduce the incidence of disease and also to reduce malnutrition. Waterborne infections hamper absorption of food even when intake is sufficient. The 10th Plan target of providing potable drinking water to all villages has clearly not been achieved. Under Bharat Nirman, it is now planned to cover the 55067 uncovered habitations in 4 years (2005-09). Rural water supply is, however, beset with the problem of sustainability, maintenance and water quality. Out of the 14.22 lakh habitations in the country, of which more than 95% were covered prior to Bharat Nirman, about 2.8 lakh habitations have slipped back from either fully covered to partially covered category. Another 2.17 lakh habitations have problem with the quality of water. Out of this about 60,000 habitations are facing the serious problem of salinity or arsenic and fluoride contamination. Under Bharat Nirman, it is also proposed to tackle the habitations that have slipped back or have problems with water quality. The 11th Five Year Plan must emphasize full and timely realization of the Bharat Nirman targets.

            Sustainability needs to be addressed by moving away from ground water to surface water resources wherever possible. Where alternate sources do not exist, or are not cost effective, ground water recharge measures will be insisted upon in the vicinity of the project.

            It will also be necessary to move away from state implemented and managed projects to community owned and managed projects, such as the Swajaldhara Programme. The Swajaldhara had a limited provision of 20% of allocation of the Accelerated Rural Water Supply Programme (ARWSP) in the 10^th Five Year Plan. It will need to be up scaled so that more and more schemes are community managed, reducing the maintenance burden and responsibility of the state. The Twelfth Finance Commission funds for this purpose will need to be fully utilized by the States.  

Sanitation

          Rural sanitation coverage was only 1% in the 1980s. With the launch of the Central Rural Sanitation Programme in 1986, the coverage improved to 4% in 1988 and then to 22% in 2001. The programme was modified as Total Sanitation Campaign in 1999 changing the earlier supply driven, high subsidy and departmentally executed programme to a low subsidy, demand driven one, with emphasis on hygiene education. Five hundred and forty districts are covered by the programme and the population coverage is expected to increase to about 35% by the end of the 10th Five Year Plan.

            Lack of sanitation is directly linked to a number of waterborne diseases and it is now generally acknowledged that unless 100% coverage of the community is achieved with proper solid waste management, health indicators do not show significant improvement. Since the subsidy regime in the current programme is only for below poverty line (BPL) families, for full coverage to be achieved, the above poverty line (APL) families will have to be motivated to switch over from open defecation to the use of toilets. The information, education and communication (IEC) campaign must therefore, receive increased attention in the 11th Five Year Plan. The cost norms for individual household toilets are being revised and a solid waste management component being included in the programme. With these measures and focused IEC, coverage under the programme is expected to increase significantly in the 11th Five Year Plan.

            Linkage of rural sanitation with the rural health mission has also now been recognized as a necessity and the required steps are being taken. The Nirmal Gram Puraskar, a reward scheme for 100% open defecation free communities has been a motivating factor and is picking up momentum as can be seen from the number of communities competing for the Puraskar. It is expected that with the allocation of the required funds in the 11^th Five Year Plan, the MDGs can be met by 2010, and full coverage achieved between 2012 and 2015.  

Works done by Utthan:-

          Utthan has started a dispensary at Kotwa village with the help of Central Council of Research in Unani Medicine (CCRUM) and is providing curative health programmes to 96 villages of Kaurihar Block.  

Family Welfare:  

          The current high population growth rate continues to be so due to:-

·      The large size of the population in the reproductive age-group estimated contribution 60 percent;

·      Higher fertility due to unmet needs for contraception, estimated contribution 20 percent;

·      High wanted fertility due to prevailing high IMR, estimated contribution about 20 percent.

While the population growth contributed by the large population in the reproductive age group will continue in the foreseeable future, the remaining 40 percent of the growth can be substantially reduced by meeting the unmet needs for contraception and felt needs for maternal and child health to reduce IMR.  

Reductions in fertility, mortality and population growth rate are our major objectives of the Eleventh Five Year Plan. These objectives will be achieved through meeting all the felt needs for health care of women and children as under:-

·     Restructuring of the existing infrastructure;

·     Ensuring skill up-gradation of the personnel;

·     Providing good quality integrated reproductive and child health services;

·     Improving the logistic of supply;

·     Operationalizing the referral system;

·     Involvement of the PRI in planning, monitoring and mid-course correction of the programme at local level;

·     Effective Intersectoral coordination between concerned sector; and

·     Effective information, education, communication & motivation.  

Utthan implemented Reproductive and Child Health (RCH) programme as per following details:-

            Utthan worked as mother NGO in the districts of following states:-

            Uttar Pradesh (separately registered in UP)

§      Allahabad

§      Pratapgarh

            Madhya Pradesh (separately registered in MP)

§      Rewa

§      Satna

            Chhattisgarh (separately registered in CG)

§      Bilaspur

§      Surguja

Pulse Polio Immunization (PPI):

            In Kaushambi district Utthan along with its 40 Field Level Non-Governmental Organizations  made all attempts to achieve zero incidence of polio through following activities:-

·      Identification of infants and under 5 year age children in the area;

·      100% vaccination for polio under universal immunization programme;

·      Completion of four nation wide PPI programme;

·      Surveillance to detect all cases of polio; and

·      Controlling spread of infection around detected polio cases by immunization of children in the surrounding areas.

Service Delivery in Tribal and Backward Areas by Utthan:

            In the backward and tribal areas, government healthcare system is either inadequate or non-existent. Therefore Utthan started following activities in Sidhi, Korea, Surguja and Bilaspur districts:

·      Delivery of RCH services;

·      Nutritional care (micro and macro nutrition);

·      Help to anaemic mothers;

·      Immunization of children;

·      Safe drinking water and sanitation;

·      Adolescent Health Programmes;

·      Detection and treatment of RTI/STI and other gynaecological problems;

·      Screening and clinic base services and counselling for sickle cell anaemia;

·      School Health Programme; and

·      Personnel hygiene.

Health Delivery by Utthan:

            Utthan has started following activities in 96 villages to provide "health for all".

·      Universal coverage in immunization (100% immunization of all infants against six vaccine preventable diseases and polio);

·      Providing food and nutrition to all through food for work scheme;

·      Safe drinking water for all;

·      Health check-up of each individual and distribution of health card to them;

·      Creating health, hygiene and sanitation awareness;

·      Reducing incidence of cholera, typhoid, malaria and diarrhoea etc.

·      Treating tuberculosis (TB), leprosy and eye diseases;

·      Better outreach of reproductive and child health programme (RCH);

·      Removing micro-nutrient deficiency through use of vegetables, fruits and medicinal plants;

·      Participatory implementation of AIDS control programmes; and

·      Treating the people by ayurvedic, unani, siddha, yoga, naturopathy, homoeopathy, and other healing traditions.

MEDICINAL PLANTS:  

India is one of the 12 mega diversity countries of the world immensely rich in medicinal and aromatic plants occurring in diverse ecosystems. The country has used plant based medicine both for primary health care and for chronic diseases for centuries. Recently, there is a swing towards the use of herbal drugs and medicinal plants. In the wake of change, the global uses and domestic demand for medicinal plants, has naturally increased. Most of these plants grow in the wild as a natural component of vegetation of a particular region and the supply chain is carried out informally. The Task Force on Conservation and Sustainable use of Medicinal Plants set up by the Planning Commission has concluded that this trade is secretive and exploitative, leading to unsustainable practices in the quest for profit. In the absence of a scientific system for collection and fostering regeneration of such plants, several species have either been completely lost or become endangered. Industry constantly faces the problem of raw material supply and its quality. However, in absence of developed trade, growers of medicinal plants find it difficult to market their produce. Adulteration and substitution of drugs is reported to be rampant in a near absence of an enforcement system. Meanwhile, several ingredients of Indian medicines have found application in many allopathic drugs used in the treatment of cancer, blood pressure, heart disease, diabetes etc. Patents on the medicinal use of Indian Plants are being filed and granted.

In order to position the medicinal plants sector on a path of quick growth and to address all issues related to cultivation, post harvest technology, processing, manufacturing, research, patenting and marketing, a Medicinal Plants Board has been set up in November 2000 which is mandated to coordinate and help overcome the main weaknesses which have affected this sector that include absence of a cultivation policy for medicinal plants, an inadequate data base and absence of standardization in production, packaging and marketing. This vacuum presents a huge opportunity for increasing the market size through cultivation and value addition. A whole new vista beyond AYUSH has opened up with the growth of herbalism and the green movement. We have to develop cultivation and collection practices for medicinal plants, setting safety and quality standards for herbal raw materials, extracts and intermediaries and encouraging the development of the medicinal plant sector for domestic consumption and export. More specifically we should try to:

·     Encourage the cultivation of 32 plants identified by three expert groups;

·     Seek registration of cultivators and traders to bring about accountability and foster quality consciousness;

·     Seek to provide technical and financial support for ventures that lead to better processes for cultivation and preparation of intermediaries and finished products.

·     Give a thrust to agricultural, forestry, AYUSH and other scientific research institutes to come together to provide improved technology for production of medicines, toiletries, cosmetics, herbal products, fumigation agent, fertilizers and insecticides through the use of medicinal plants;

·     Seek to refine processes and undertake trials on promising remedies already identified by the national level research councils in conjunction with the science and technology (S&T) institutions and industry; and

·     This can be achieved through the mechanism of a mission mode programme with a revolving fund which will be replenished with the proceeds;

Utthan has done following work in the field of medicinal plants development:

·     Collection of germplasm of 40 species;

·     Developed agro-technique and organic cultivation of these species;

·     Standardized practices for collection, drying and marketing of the crude drugs; and

·     Creating an awakening about use of crude drugs for health care.

Health Education in Schools

            Health extension workers of Utthan are regularly visiting schools of Kaushambi & Allahabad districts and educating students about preventive health care as under: -

·     Clean drinking water is vital to reduce incidence of diseases.

·     Lack of sanitation is directly linked to a number of diseases.

·     Consumption of fruits, vegetables, medicinal plants can keep people healthy

·      A diet low in fibre and high in simple sugar can be major factor to excess weight gain.

·      Alcohol should be avoided since it acts like a fat and promote weight gain.

·      Smoking is harmful and should be avoided.

·      Adequate intake of iron and calcium is necessary.

·      Chromium deficiency impairs glucose tolerance, increases circulating insulin level & boosts blood sugar level.

·     Zinc is needed as it enhances the effectiveness of insulin.

·     Forty-five minutes walking increases the metabolic rate.

·     Yoga is useful in many ways.

Dispensary at Kotwa – Mubarakpur 

            With the help of Central Council of Research in Unani Govt. of India Utthan is serving people of 96 villages of Kaurihar block through a dispensary since 1999. Qualified and dedicated doctors have earned name & fame in the area.

Abhinav Health Care Centre

            With the help of Uttar Pradesh Health Service Development Programme (UPHSDP) Lucknow Utthan is running Abhinav Health Centre at Kataula village to provide curative health care to the people. Every day on an average 50 people are provided health care from this center.