National Human Development Report: 2001 - Indira Gandhi Institute ...

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NATIONAL HUMAN DEVELOPMENT REPORT 2001 HEALTH ATTAINMENTS & DEMOGRAPHIC CONCERNS 83trends in the developed world, but is adverse for females in the States ofBihar, Gujarat, Haryana, Punjab, Rajasthan and Uttar Pradesh. For Haryanaand Punjab, the sex ratio at birth, in urban areas was at sub-800 levels in1996-98. This points to the possibility of widespread prevalence of pre-natalsex determination and sex selection practices. It highlights the impact ofperverse social and cultural factors related to marriage practices and dowry,as well as role of women in household level decision making in an essentiallypatriarchal social context in these States.Two other demographic concerns that are particularly important fromthe point of a human centric approach to the development process relate tothe issue of ‘greying of the population’ and the incidence of disability in thepopulation. These have been discussed in the Chapter 6.Policies, Interventions and ProspectsIt would not be entirely incorrect to suggest that India’s approach tohealth sector development has not been sufficiently integrated with overallprocess of development. This is reflected, for instance, in the absence of anadequate policy framework that conceives and exploits inter and intrasectoral synergies between development processes directed at improvingavailability of drinking water, sanitation and public hygiene, access toelementary education, nutrition and poverty alleviation, on one hand, withawareness and access to public health and medical services, on other. Therehas been a misplaced emphasis on maintenance and strengthening of privatehealth care services, perhaps, on account of the inertia of colonialinheritance, at the expense of broadening and deepening of public healthcare system targeted at controlling the incidence of disease , particularly ofthe communicable diseases, in rural areas. There are significant rural-urbandisparities in various mortality, morbidity and nutrition indicators.Moreover, there is multiplicity of public programmes and interventions inhealth sector resulting in a thin spread of available resources, manpower andinfrastructure. In States where inter-sectoral linkages that influence healthattainments of people, have existed either for historical reasons, or have beenconsciously forged as a part of planned effort, and where the health concernsof the rural population have been reasonably addressed, results on healthattainments, as well as demographic transition have been quite impressive.The National Health Policy 1983 and the draft National HealthPolicy 2001 recognise these concerns. The Statements have highlighted aneed for time-bound programme for setting up network of comprehensiveprimary health care services, linked with extension and health education. Ittalked of intermediation through ‘health volunteers’ having appropriateknowledge and skill. It emphasised establishment of a referral system toprevent needless load on higher levels of health care hierarchy, at the sametime creating a network of super-specialty services by also encouragingprivate health care facilities for patients who can afford. While there hasbeen noteworthy success in eradication of some communicable diseases andsome are expected to be eliminated in near future, the sustainability of India’shealth care system, as it stands today, is uncertain. Moreover, there is fargreater urgency to ensure an equitable access to health care services andThe approach to healthsector development inthe country has notbeen sufficientlyintegrated with theoverall process ofdevelopment.
84HEALTH ATTAINMENTS & DEMOGRAPHIC CONCERNSNATIONAL HUMAN DEVELOPMENT REPORT 2001attain acceptable standards of good health for the population in the country.As per the Constitutional allocation of responsibilities between theCentral and State Governments, health and family welfare has beenidentified as a State subject. The main responsibility of infrastructure andmanpower building rests with the State Governments. However, the CentralGovernment has over the last five decades provided supplementary funds forcontrol of major communicable, as well as non-communicable diseases, byinitiating national level programmes, in some cases, with the help ofassistance from foreign agencies.At the time of independence, communicable diseases were a majorcause of morbidity and mortality in India. Initial efforts in public health carewere, therefore, directed to their prevention and control. Among theinitiatives, at national level, the National Anti Malaria Programme(launched in 1953); Kala Azar which is confined to 36 districts in Bihar and10 districts in West Bengal covering a population of about 7.5 million; theNational Tuberculosis Control Programme (launched in 1962); NationalLeprosy Eradication Programme (launched in 1983); National AIDSControl Programme (launched in 1992) are important interventions thathave contributed considerably in bringing down the crude death rate perthousand, from about 25 in 1951 to under 9 in 1999. However, morbidity dueto communicable diseases continues to be high in spite of renewed effort atextending the immunisation coverage of the population. Deteriorating urbanand rural sanitation, poor solid waste management and overcrowding haveescalated the prevalence of communicable diseases. The emergence of drugresistantpathogens and insecticide-resistant vectors has compounded theproblem of controlling communicable diseases. National initiatives, on somenon-communicable diseases that were perceived as major public healthproblems, have also been taken. Among these the National Goitre ControlProgramme (launched in 1962), the National Blindness Control Programme(launched in 1976), the National Cancer Control Programme (launched in1975-76), National Mental Health Programme (launched in 1982) andIntegrated Non-Communicable Disease Control Programme (launched on apilot basis in the Ninth Plan) are some of the major initiatives of the CentralGovernment. In addition, the Central Government supports bio-medicalresearch in a number of areas. The Indian Council for Medical Research isthe nodal organisation for undertaking and supervising this work.At State level, apart from the overall responsibility of providingpreventive and curative health care, the Integrated Child DevelopmentServices (ICDS) Programme, the National Mid Day Meals Programme(NMMP), various micro nutrient schemes, including those targeted forimproving intake of iron-folate, vitamin A and iodised salt, as well as foodfor work through various anti poverty programmes are some importantinitiatives aimed at addressing the problem of malnutrition and women andchild health. The ICDS programme providing services like supplementaryfeeding, immunisation against preventable childhood diseases, healthcheckups, health and nutrition education to women and pre-schooleducation for children has recorded significant success in many areas,particularly in States where the primary level health care infrastructure isrelatively well developed. The States that have done well include, Kerala,Tamil Nadu, Karnataka and Andhra Pradesh in the South, Maharashtra andGujarat in the West and West Bengal in the East. Himachal Pradesh,Haryana and Punjab have also done well but it is Rajasthan and Madhya
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indiaLong years ago we made a tryst
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NATIONAL HUMAN DEVELOPMENT REPORT 2
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iiFOREWORDNATIONAL HUMAN DEVELOPMEN
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ivCONTENTSNATIONAL HUMAN DEVELOPMEN
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2OVERVIEW NATIONAL HUMAN DEVELOPMEN
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4OVERVIEWNATIONAL HUMAN DEVELOPMENT
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6OVERVIEWNATIONAL HUMAN DEVELOPMENT
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8STATE OF HUMAN DEVELOPMENT NATIONA
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10STATE OF HUMAN DEVELOPMENTNATIONA
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Page 39 and 40: 32ECONOMIC ATTAINMENTS AND WELL-BEI
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Page 71 and 72: 64HEALTH ATTAINMENTS & DEMOGRAPHIC
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Page 121 and 122: 114GOVERNANCE FOR HUMAN DEVELOPMENT
Page 139 and 140: 132TECHNICAL APPENDIXNATIONAL HUMAN
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134BIBLIOGRAPHYNATIONAL HUMAN DEVEL
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136BIBLIOGRAPHYNATIONAL HUMAN DEVEL
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138GLOSSARYNATIONAL HUMAN DEVELOPME
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140THE STATE OF HUMAN DEVELOPMENTNA
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146INDICATORS ON ECONOMIC ATTAINMEN
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