Indian Economy, 5th edition (109 page)

The government has launched a large number of programmes and schemes to address major concerns and bridge the gaps in existing health infrastructure and provide accessible, affordable, equitable health care. These include the NRHM, National Programme for Health Care of the Elderly (NPHCE), National Mental Health Programme, NPCDCS, Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), upgradation/strengthening of state government medical colleges, development of paramedical services and the Programmes of AYUSH. The details of major programmes are as follows:

NRHM (National Rural Health Mission)

The NRHM launched in 2005 aims to improve accessibility to quality health care for the rural population, bridge gaps in health care, facilitate decentralised planning in the health sector and bring about inter-sectoral convergence. The NRHM provided an overarching umbrella to the existing health and family welfare programmes including Reproductive and Child Health (RCH-II) and various programmes for control of diseases, including tuberculosis, leprosy, vector-borne diseases and blindness. The effort is to integrate all vertical programmes. All the programmes have now been brought under the District Health Society at district level and State Health Society at state level. Some of the weaknesses identified in the health delivery system in the public sector are poor upkeep and maintenance and high absenteeism of manpower in rural areas. The NRHM seeks to strengthen the public health delivery system at all levels.

Reproductive and Child Health (RCH)

The RCH Programme was launched in 1997-98 as a separate entity up to the year 2004-05 as a part of the Family Welfare Programme and was brought under the ambit of the NRHM during the Eleventh Plan. It has components such as pulse polio immunisation and routine immunisation for protection of children from life threatening conditions that are preventable such as tuberculosis, diphtheria, pertussis, tetanus, polio, and measles.

Janani Suraksha Yojana (JSY)

The JSY was launched with focus on demand promotion for institutional deliveries in states and regions where these are low. It integrates cash assistance with delivery and post-delivery care. It targets lowering of MMR by ensuring that deliveries are conducted by skilled birth attendants. The JSY scheme has shown rapid growth in the last three years, with 90.37 lakh beneficiaries in 2008-09 to 106.96 lakh beneficiaries in 2010-11. The issues of governance, transparency, and grievance redressal mechanisms are now the thrust areas for the JSY.

Janani Shishu Suraksha Karyakram (JSSK)

The JSSK is a new initiative launched on 1 June 2011 to give free entitlements to pregnant women and sick new borns for cashless delivery, C-Section, drugs and consumables, diagnostics, diet during stay in the health institutions, provision of blood, exemption from user charges, transport from home to health institutions, transport between facilities in case of referral, and drop back from Institutions to home. In order to reach out to difficult, inaccessible, backward and under-served areas with poor health indicators, 264 high focus districts in 21 states have been identified based on concentration of SC/ST population and presence of left wing extremism for focused attention. A Mother and Child Tracking System has been introduced, which provides complete data of the mothers with their addresses, telephone numbers, etc. for effective monitoring of ante-natal and post-natal check-up of mothers and immunisation services.

National Vector Borne Disease Control Programme

This Programme is being implemented for prevention and control of vector-borne diseases such as malaria, filariasis, kala-azar, Japanese encephalitis, dengue, and chikungunya.

Revised National Tuberculosis Control programme (RNTCP)

The RNTCP, a centrally sponsored ongoing scheme, is an application in India of the WHO-recommended directly observed treatment short course popularly known as DOTS. Under the programme, quality diagnosis and treatment facilities including a supply of anti-TB drugs are provided free of cost to all TB patients. More than 13,000 microscopy centres have been established in the country. During 2010-11, the programme has achieved new sputem positive case detection rate of 71 per cent and treatment success rate of 87 per cent which is in line with global argets for TB control.

National Leprosy Eradication Programme (NLEP)

The NLEP was started in 1983 with the objective of eradication of the disease. In 2005, the dreaded disease after 22 years recorded a case load less than 1 per 10,000 population at national level. The recorded prevalence further came down to 0.65 per 10,000 in March 2012.

National Programme for Control of Blindness (NPCB)

The NPCB, launched in the year 1976 as a 100 per cent centrally sponsored scheme with the goal of reducing the prevalence of blindness to 0.3 per cent by 2020, showed reduction in the prevalence rate of blindness from 1.1 per cent (2001-02) to 1 per cent (2006-07).

National Programme for Health Care of the Elderly (NPHCE)

The NPHCE aims to provide separate and specialized comprehensive health care to senior citizens at various levels of the state healthcare delivery system including outreach services. Some of the strategies include preventive and promotive care, management of illness, health manpower development for geriatric services, medical rehabilitation, and therapeutic intervention and Information Education and Communication (IEC) activities. The major components of the NPHCE are establishment of 30 bedded departments of geriatrics in 8 identified regional medical institutions, and provision of dedicated health-care facilities at district, CHC, PHC and sub-centres levels in 100 identified districts of 21 states of the country.

NPCDCS

The NPCDCS was launched during the Eleventh Five year plan. It envisages health promotion and health education advocacy, early detection of persons with high levels of risk factors through opportunistic screening and strengthening of health systems at all levels to tackle Non Communicable Disease (NCDs), and improvement of quality of care. At present the programme is being implemented in 100 districts covering 21 states.

Human Resources and Infrastructure Development in Tertiary Health Care

The Eleventh Plan also witnessed a number of initiatives to improve the availability of human resources in the health sector. With a view to strengthening government medical colleges, the land requirement norms and infrastructural requirements for opening new medical colleges have been revised. The faculty requirements have also been revised. Besides, increased intake at MBBS level has been enabled especially in the under-served states.

PMSSY

The PMSSY has been launched with the objectives of correcting regional imbalances in the availability of affordable/reliable tertiary health-care services and augmenting facilities for quality medical education in the country. These are sought to be achieved through establishing AIIMS-like institutions and upgrading existing medical college institutions. The PMSSY aims at

(i)
Construction of 6 AIIMS like institutions in the first phase at Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur, and Rishikesh and in the second phase in West Bengal and Uttar Pradesh, and

(ii)
Upgradation of 13 medical college institutions in the first phase and 6 in the second phase.

The upgradation programmes broadly envisages improving health infrastructure through construction of super speciality blocks/trauma centres, etc. and procurement of medical equipment for existing as well as new facilities. Seven more medical colleges are proposed to be upgraded, one each in Kerala, Karnataka and Madhya Pradesh and two each in Bihar and Uttar Pradesh in the third phase.

Upgradation/Strengthening of State Government Medical Colleges

This is a centrally sponsored scheme for strengthening /upgradation of state government medical colleges. The scheme envisages a one-time grant of Rs. 1350 crore to be funded by central and state governments in the ratio of 75:25. During 2009-10 to 2011-12, 70 medical colleges have been funded.

Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy (AYUSH)

Mainstreaming of AYUSH in national health care delivery is an important goal under the NRHM. A new component of upgradation of AYUSH dispensaries has been incorporated in the centrally sponsored scheme of Development of AYUSH Hospitals and Dispensaries in July 2010. Besides, a component of setting up of 50/10 bedded integrated AYUSH hospitals for North Eastern and other hilly states has been introduced in 2011.

WOMEN AND CHILD DEVELOPMENT

The Government of India pursues a three dimensional strategy for development of women, namely
social empowerment, economic empowerment
and
gender justice
which is to be continued with in the 12th Plan, too.
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The government has started several schemes and initiated many new policy initiatives for the welfare and development of women and children which also include initiatives for economic and social empowerment of women and securing gender equality in various aspects of social, economic, and political life. The scope and coverage of the schemes for women and child development have been expanding under various Plans.

Women lag behind men in many social indicators like health, education and economic opportunities. Hence they need special attention due to their vulnerability and lack of access to resources. Since national budgets impact men and women differently through the pattern of resource allocation, the scope and coverage of schemes for women and child development have been expanded with progressive increase in Plan expenditure under various Plan schemes, increased employment for women under the MGNREGA and
gender budgeting
(GB).
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The allocations for GB as a percentage of total budget have gone up from
2.79
per cent in 2005-06 to
5.91
per cent in 2012-13. Some of the important schemes and policy initiatives for economic and social empowerment of women and child development are as follows –

Integrated Child Development Services (ICDS) Scheme

The
objective
of the ICDS scheme is holistic development of children below 6 years of age and proper nutrition and health education of pregnant and lactating mothers starting with 33 projects and 4891 anganwadi centres (AWCs) in 1975.

This has now been
universalized
with cumulative approval of 7076 projects and 14 lakh AWCs including 20,000 anganwadis ‘on-demand’. A proposal for strengthening and restructuring of the ICDS Scheme (with an overall budget allocation of Rs. 1,23,580 crore) during the Twelfth Plan has been approved. Greater emphasis is being laid on awareness generation,
convergence
with the MGNREGA, and MIS-based monitoring.

Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (RGSEAG)-Sabla

Sabla
now operational in
205 selected districts
aims at “all-round development of adolescent girls” in the age group 11-18 years and making them
self-reliant
with a special focus on “out-of-school” girls. The scheme has two major components, nutrition and non-nutrition. Nutrition is being given in the form of ‘take home rations’ or ‘hot cooked meals’ to out-of-school 11-14 year old girls and all adolescent girls in the 14 -18 age group. The non-nutrition component addresses the developmental needs of 11-18 year old adolescent girls who are provided
iron-folic acid
supplementation, health check-up and referral services, nutrition and health education, counseling/guidance on family welfare, skill education, guidance on accessing public services, and vocational training. The target of the scheme is to provide nutrition to 1 crore adolescent girls in a year.

Indira Gandhi Matritva Sahyog Yojana (IGMSY)

The IGMSY is a
conditional cash transfer scheme
for ‘pregnant and lactating women’ implemented initially on
pilot
basis in 53 selected districts in the country from October 2010. The scheme is now covered under the
Direct Benefit Transfer (DBT)
programme with nine districts being included in the first phase.

National Mission for Empowerment of Women (NMEW)

This initiative for
holistic empowerment
of women through better convergence and engendering of policies, programmes, and schemes of different ministries was operationalized in 2010-11. Under the Mission, institutional structures at state level including State Mission Authorities headed by Chief Ministers and State Resource Centres for Women (SRCWs) for spearheading initiatives for women’s empowerment have been established across the country.

Rashtriya Mahila Kosh (RMK)

The RMK provides ‘micro-credit’ in a quasi-informal manner, lending to intermediate micro-credit organisations (IMOs) across states – was launched in 1993. It
focuses
on poor women and their empowerment through the provision of credit for livelihood-related activities.

Policies to address Violence Against Women

Addressing violence against women is another area which has received a lot of
recent attention
. Following the recent tragic incident of sexual assault in New Delhi, a committee of eminent jurists, headed by former Chief Justice of India
Justice J. S. Verma,
was constituted to review existing laws and examine levels of punishment in cases of aggravated sexual assault and it has submitted its recommendations.

An
Ordinance
has also been issued on sexual assault against women [Criminal Law (Amendment) Ordinance, 2013] based on the recommendations of the Justice Verma Committee. A Commission of Inquiry was also set up under the Chairpersonship of
Ms Justice Usha Mehra
, retired Judge of Delhi High Court to identify lapses on the part of public authorities and suggest measures to improve the safety and security of women in the capital.