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

NATIONAL HUMAN DEVELOPMENT REPORT 2001 HEALTH ATTAINMENTS & DEMOGRAPHIC CONCERNS 85Pradesh that have of late made significant strides in improving theimplementation of ICDS programme in their State. The National Mid DayMeal Programme (NMMP) was initiated in 1995 to improve nutritionalstatus and learning achievements of school-going children and, moreimportantly, their enrolment and attendance in schools. The programme hasbeen modelled after a similar initiative in Tamil Nadu showed considerablesuccess in attaining the stated objectives of the programme. The availabilityof cooked meal in schools has been found to not only improve enrolment andattendance levels of the school going children but has provided criticalnutrition supplements to the children. In the States where cooked mealswere substituted by dry rations as, forinstance, in Andhra Pradesh, theA Diagnosis of India’s Health Care Servicesresults have not been as encouraging.In fact in a recent judgement ofIndia’s has a large network of public, voluntary and private health carethe Supreme Court it has beeninfrastructure manned by an equally large number of medical personnel anddirected only cooked meals are to beparamedics. Some ailments of India’s health care system includes:given under this programme.• Persistent gaps in manpower and infrastructure, with wide inter-StateMuch of the success of thesedifferences, especially at the primary health care level, disproportionatelyinitiatives, both for preventive, asimpacting less developed and rural areas;well as curative health care services• Sub-optimal functioning of the existing infrastructure, poor referral services;depends on availability of health• Significant proportion of hospitals not having appropriate manpower,care infrastructure, traineddiagnostic and therapeutic services and drugs, particularly in public sector;manpower and public provisioning• Increasing dual disease burden of communicable and non-communicableof resources. At the national level,diseases because of persisting poverty along with ongoing demographic,the functional primary healthcarelifestyle and environmental transitions;infrastructure, including Sub-• Increased dependence of people on private health care services, often leadingCentres, Primary Health Centresto indebtedness in rural areas;and Community Health Centres• Escalating costs of health care, ever widening gaps between what is possiblenearly meets the existing norms (forand can be afforded;1991 population) formulated, taking• Technological advances, though, widen the spectrum of possible interventionsinto account population, density andbut are well beyond the financial reach of majority;terrain. At present, the national• Inadequate integration of indigenous and alternative system of medicinesnorms envisage a Sub-Centre forwith the allopathic stream;population of three to five thousand;• Inadequate integration of public interventions in the area of drinking water,a Primary Health Centre forsanitation, urban waste disposal with public health programmes therebypopulation of twenty to thirtyfailing to exploit potential synergies that reinforce health attainments ofthousand; and a Community Healthpeople;Centre for four Primary Health• There is, perhaps, a misplaced emphasis on development and maintenance ofCentres. The number of Primaryprivate health care services at the expense of a broadening and deepening ofHealth Centres doctors at thepublic health care system targeted, essentially, at controlling the incidence ofnational level exceeds thecommunicable diseases in rural areas;requirement as per the norms. There• In case of preventive health care, among the five levels of prevention, namelyare, however, shortages in the— health promotion; specific protection; early diagnosis and promptavailability of para-medics, as well astreatment; disability limitation; and rehabilitation — there is little that hasspecialists at the Community Healthbeen done by way of strengthening the institutional and delivery mechanismCentres, which undermines theirof public policy and programmes, at least, in case of the last two; andfunctioning as referral units. The• Continuation of a universally free public health care system — preventive asdisparities across States and withinwell as curative — is unsustainable in its present form. Moreover, there isStates between regions forinadequate policy movement on creating an alternative, accessible,infrastructure, as well as foraffordable, viable and dependable health care system for majority of themanpower are quite striking. Forpopulation.instance, the indicator — births