Faster economic growth in the last decade has raised the
expectations of the people. People expect better services and quality care. One
unintended side effect of faster growth has been widening of disparities.
Twelfth five year plan aims at faster, sustainable, and more inclusive growth.
In this background the programmes that aim at providing employment and income
generation or benefit the poor directly will receive due attention. The
examples of these programme include, Mahatma Gandhi National Rural Employment
Guarantee Act, Sarva Shiksha Abhiyan, Mid-Day Meal Programme, Pradhan Mantri
Gram Sadak Yojana, Integrated Child Development Services, National Rural Health
This chapter covers health and related aspects, e.g. women’s empowerment, nutrition, water supply and sanitation.
Performance during the 11th Plan
There is constraint of non-availability of end line data. Available data indicates that there has been progress in all the indicators except in child sex ratio, where it has rather declined. Progress in other indicators has also been short of goals.
Maternal Mortality Ratio (MMR): It declined to 212 (2007-09)
against the goal of 100 per lakh live births. Only Kerala (81) and Tamilnadu
(97) could achieve this goal, with Manarashtra (104) being close to the goal.
Performance has been sluggish mainly due to EAG states and Assam where combined
average for MMR was 308 in 2007-09.
Infant Mortality Rate (IMR): It declined by 5 per cent per year during 2006-11 compared to 3 per cent over the preceding five years. However, IMR of 44 is still short of the target of 28 Total Fertility Rate (TFR): It declined at rate of 2.8 per cent per year from 2.8 to 2.5 during 2006-10 compared to 2 per cent during the preceding five years. However, still the target of 2.1 Could not be achieved.
Child Sex Ratio (0-6 years): It has deteriorated further from 927 (census 2001) to 914 (census 2011) instead of achieving the target of 935.
Malnutrition and Anaemia:Progress on these could not be assessed due to non-availability of data.
Infrastructure: Though most CHCS and 34% PHCS have been operationalised as 24X7 facilities and the number of FRUS has doubled, yet the goal of eleventh plan to meet IPHS standards for all public facilities and provide emergency obstetric care at all CHCS has not been achieved. Access to safe abortion services is yet not available at all CHCS,which is contributing to continuing high maternal mortality.
Health Personnel: ASHA programme has been quite successful. Despite considerable improvement in position of health personnel there has been a gap between staff in position and staff required at the end of the Plan. It was 52 per cent for ANM and nurses, 76 per cent for doctors, 88 per cent for specialists and 58 per cent for pharmacists. These shortages have been due to delay in recruitment as well as postings not being based on work-load or sanctions Public health cadre as envisioned in the 11th Plan to manage NRHM is not yet in place. Although training capacity has been increased for all categories of personnel, yet huge gaps remain in comparison to the requirement.
Service Delivery: Full immunisation coverage of children and full antenatal care and institutional deliveries although increased during the 11th Plan period, yet these are short of targets. Utilisation of public facilities for chronic diseases has been low in most states indicating poor quality of service. High unmet need for contraception is still a problem. The Eleventh Plan commitment of providing access to essential drugs at public facilities has also not been realised.
Community Involvement: Though Rogi Kalyan Samitis (RKS) are in position in most public facilities, Village Health and Sanitation Committees have been set up in most villages, yet, their potential in terms of empowering communities, improving accountability and responsiveness of public health facilities is yet to be fully realised.
Governance of Public Health System: The 11th Plan had suggested governance reforms in public health system, such as performance linked incentives, devolution of powers and functions to local health care institutions and making them responsible for the health of the people living in a defined geographical area. These have been partially achieved through NRHM.
Disease Control Programmes: There has been decline in cases and deaths due to vector borne diseases, tuberculosis and leprosy. However, due to non existence of a robust surveillance system at the community level, these diseases are still under estimated.
To prevent and control NCDS, viz. cancer, diabetes,
cardiovascular disease and stroke, programme has been launched during 11th Plan
in 100 districts of the country. NCD programmes need to be integrated within
NRHM to provide preventive, testing, care and referral services. performance
linked incentives, devolution of powers and functions.
Despite enhanced allocations for the National Mental Health Programme, it has lagged behind due to non-availability of qualified mental health professionals at district and sub-district levels.
By: Against the target to halt and reverse the HIV/AIDS epidemic in India, there has been a reduction of new HIV infections in the country by 57 per cent. Gaps in the programme include low rate of coverage of Anti-Retroviral Therapy among infected adults and children, low levels of opioid substitution therapy among injection drug users (3 per cent), testing of pregnant women for HIV and Syphilis (23 per cent) and low Anti-Retroviral coverage for preventing mother to child transmission. There is scope for greater integration with NRHM to avoid duplication of efforts, as in reaching non-high risk groups and distribution of condoms.