4.1 Need for a Sectoral Approach

Several recommendations are suggested in the subsequent chapters. They are meant for

restructuring of the health services infrastructure

increase of the medical and health manpower

community involvement

Government’s focus on preventive and primary health

provision of free or affordable medical aid to the indigent and needy by providing appropriate safety nets

exploiting the services of private medical practitioners

utilising traditional and other systems of medicine

involvement and utilisation of the services of the voluntary agencies active in the health field

modes for financing the envisaged additional expenditure on health and

enlarged role for the private sector and NGO’s participation in health delivery

Though all of the above are critical for reforming the health sector, simultaneously, it would be necessary to devote planned, time-bound attention to some of the more important inputs required for improved health care. Of these, some of the areas which require priority attention are discussed in this section.

4.2 Nutrition

National and regional strategies should be evolved and implemented, on a time-bound basis, to ensure adequate nutrition for all segments of the population through a well developed distribution system, specially in the rural areas and urban slums. Food of acceptable quality must be available to every person in accordance with his physical needs. Low cost, processed and ready-to-eat foods should be produced and made readily available. The over-all strategy would necessarily involve organised efforts at improving the purchasing power of the poorer sections of the society.

Schemes like employment guarantee scheme, to which the government is committed, could yield optimal results if these are suitably linked to the objective of providing adequate nutrition and health cover to the rural and the urban poor. The achievement of this objective is dependent on integrated socio-economic development leading to the generation of productive employment for all those constituting the labour force. Employment guarantee scheme and similar efforts would require to be specially enforced to provide social security for identified vulnerable sections of the society.

Measures aimed at improving eating habits, inculcation of desirable nutritional practices, improved and scientific utilisation of available food material and the effective popularisation of improved cooking practices would need to be implemented. Besides, a nation-wide programme to promote breast-feeding of infants and eradication of various social taboos detrimental to the promotion of health would need to be initiated. Simultaneously, the problems of communities afflicted by chronic nutritional disorders should be tackled through special schemes including the organisation of supplementary feeding programmes directed to the vulnerable sections of the population. The force and effect of such programmes should be ensured by delivering them within the setting of fully integrated health care activities, to ensure the inculcation of the educational aspects, in the over-all strategy.

4.3 Prevention of Food Adulteration and Maintenance of the Quality of Drugs

Stringent measures are required to be taken to check and prevent the adulteration and contamination of foods at the various stages of their production, processing, storage, transport and distribution. To ensure uniformity of approach, the existing laws would require to be reviewed and effective legislation enacted by the Centre. Similarly, the most urgent measures require to be taken to ensure against the manufacture and sale of spurious and sub-standard drugs.

4.4 Water Supply and Sanitation

The provision of safe drinking water and the sanitary disposal of wastewater, human and animal wastes, both in urban and rural areas, must constitute an integrated package. The enormous backlog in the provision of these services to the rural population and in the urban agglomerations must be made up on the most urgent basis. The provision of water supply and basic sanitation facilities would not automatically improve health. The availability of such facilities should be accompanied by intensive health education campaigns for the improvement of personal hygiene, the economical use of water and the sanitary disposal of waste in a manner that will improve individual and community health.

All water-supply schemes must be fully integrated with efforts at proper water management, including the drainage and disposal of wastewater. To reduce expenditures and for achieving a quick headway it would be necessary to devise appropriate technologies in the planning and management of the delivery systems. Besides, the involvement of the community in the implementation and management of the systems would be of crucial importance, both for reducing costs as well as to see that the beneficiaries’ value and protect the services provided to them.

4.5 Environmental Protection

While preventive, promotive and public health services are established and the curative services re-organised to prevent, control and treat diseases, it would be equally necessary to ensure against the haphazard exploitation of resources that cause ecological disturbances leading to fresh health hazards. It is, therefore, necessary that economic development plans in the various sectors, are devised in adequate consultation with central and the state health authorities. It is also vitally essential to ensure that the present and future industrial and urban development plans are centrally reviewed to ensure against congestion, the unchecked release of noxious emissions and the pollution of air water. In this context, it is vital to ensure that the siting and location of all manufacturing units is strictly regulated, through legal measures, if necessary.

Central and state health authorities must necessarily be consulted in establishing locational policies for industrial development and urbanisation programmes. Environmental appraisal procedures must be developed and strictly applied in according clearance to the various developmental projects.

4.6 Immunisation Programme

It is necessary to launch an organised, nation-wide immunisation programme, aimed at 100 % coverage of targeted population groups with vaccines against preventable and communicable diseases. Such an approach would not only prevent and reduce disease and disability but also bring down the existing high infant and child mortality rate.

A vicious relationship exists between high birth rates and high infant mortality, contributing to the desire for more children. The highest priority would, therefore, require to be devoted to efforts at launching special programmes for the improvement of maternal and child heath, with special focus on the less privileged sections of society. Such programmes would require to be decentralised to the maximum possible extent. Their delivery should be at the primary level, nearest to doorsteps of the beneficiaries.

Efforts should continue at providing refresher training and orientation to the traditional birth attendants. Schemes and programmes should be launched to ensure that progressively all deliveries are conducted by competently trained persons so that complicated cases receive timely and expert attention, within a comprehensive programme providing ante-natal, intra-natal and post-natal care.

4.8 School Health Programme

Organised school health services, integrally linked with the general, preventive and curative services, would require to be established within time-limited programmes.