Conference
of
District Magistrates
(11th April 2001 : New Delhi)
proceedings
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Shri.
K.C. Pant, Vice Chairman, NCP inaugurating the Conference, Smt. Krishna
Singh, Member Secretary, NCP, Dr. K. Venkatasubramanian, Member, Planning
Commission, Dr. D. N. Tiwari, Member, Planning Commission & Smt.
Seema Rizvi, Member NCP are also seen. |
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Government
of India
National Commission on Population
Indian Council of Medical Research |
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| National
Population Policy - 2000 |
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| The
immediate objective of NPP 2000 is to address the unmet needs
for contraception, health care infrastructure, health personnel
and to provide integrated service delivery for basic reproductive
and child health care. The medium-term objective is to bring
the TFR to replacement level by 2010, through vigorous implementation
of inter-sectoral operational strategies. The long-term objective
is to achieve a stable population by 2045, at a level consistent
with the requirement of sustainable economic growth, social
development, and environmental protection. |
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| Strategic
Themes |
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| (i) |
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Decentralised
planning and programme implementation |
| (ii) |
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Convergence
of service delivery at village level |
| (iii) |
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Empowering
women for improved health and nutrition |
| (iv) |
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Child
health and survival |
| (v) |
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Meeting
the unmet needs for family welfare services |
| (vi) |
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Under-served
population Groups |
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|
| (a) |
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Urban slums |
| (b) |
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Tribal
communities, hill area populations and displaced and
migrant populations |
| (c)
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Adolescents
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| (d) |
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Increased
participation of men in planned parenthood |
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(vii) |
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Diverse
health care providers |
(viii) |
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Collaboration
with and commitments from the Non-Government Organisations
and the private sector |
(ix) |
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Mainstreaming
Indian Systems of Medicine and Homoeopathy |
(x) |
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Contraceptive
technology and research on reproductive and child health |
(xi) |
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Providing
for the older` population |
(xii) |
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Information,
Education, and Communication |
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| States
with Decadal Population Growth Rates 20% Higher than All India
- Census 2001 (21.34 + 4.25 =25.59) |
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State
|
Decadal
Growth |
| J &
K |
29.04 |
| Haryana
|
28.06 |
| Rajasthan |
28.33 |
| Uttar
Pradesh |
25.80 |
| Bihar
|
28.43 |
| NE
States |
>
26.0 |
| |
| Share
in Population |
= 35% |
| Share
in TFR Gap |
=
65% |
|
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| Distribution
of Districts by TFR Category |
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STATES |
<2.1 |
2.1
- 2.5 |
2.5
- 3 |
3
- 3.5 |
3.5
- 4 |
>4 |
Total |
| ANDHRA
PRADESH |
17 |
4 |
2 |
0 |
0 |
0 |
23 |
| BIHAR |
0 |
0 |
1 |
9 |
31 |
2 |
43 |
| GOA |
2 |
0 |
0 |
0 |
0 |
0 |
2 |
| GUJRAT |
4 |
6 |
4 |
5 |
0 |
0 |
19 |
| HARYANA |
1 |
8 |
6 |
1 |
1 |
0 |
17 |
| HIMACHAL
PRADESH |
6 |
3 |
2 |
1 |
0 |
0 |
12 |
| KARNATAKA |
11 |
4 |
1 |
4 |
0 |
0 |
20 |
| KERALA |
13 |
1 |
0 |
0 |
0 |
0 |
14 |
| M.
P. |
0 |
3 |
11 |
27 |
4 |
0 |
45 |
| MAHARASHTRA |
9 |
10 |
10 |
1 |
0 |
0 |
30 |
| ORISSA |
0 |
2 |
14 |
14 |
0 |
0 |
30 |
| PUNJAB |
4 |
9 |
4 |
0 |
0 |
0 |
17 |
| RAJASTHAN |
0 |
0 |
5 |
16 |
9 |
0 |
30 |
| TAMILNADU |
21 |
2 |
0 |
0 |
0 |
0 |
23 |
| UTTAR
PRADESH |
0 |
0 |
3 |
13 |
43 |
9 |
68 |
| WEST
BENGAL |
4 |
7 |
2 |
6 |
0 |
0 |
19 |
| NORTH
EAST |
5 |
6 |
11 |
17 |
18 |
10 |
67 |
| DELHI
& UTS |
4 |
1 |
2 |
1 |
0 |
0 |
12 |
| TOTAL |
107 |
68 |
80 |
116 |
110 |
23 |
504 |
|
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| Selected
Indicators (%) for Districts Falling in Different TFR Category |
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| Indicator |
Estimated TFR Category |
<2.1 |
2.1-25 |
2.5-3 |
3-3.5 |
>3.5 |
| Births
order 3 or more |
23.2 |
34.5 |
42.2 |
50.8 |
60.4 |
| Est_TFR |
1.66 |
2.32 |
2.76 |
3.22 |
3.78 |
| Full
ANC |
73.7 |
51.4 |
32.0 |
24.2 |
18.9 |
| Institutional
Deliveries |
74.5 |
50.3 |
36.6 |
25.8 |
17.2 |
| Complete
Immunisation |
83.2 |
72.0 |
60.8 |
46.1 |
33.9 |
| Sterilisation |
48.0 |
40.9 |
36.5 |
29.6 |
15.9 |
| Girls
Marrying above 18 Years of Age |
81.0 |
76.6 |
66.5 |
55.6 |
45.9 |
| Female
Literacy |
46.9 |
39.2 |
31.0 |
23.6 |
20.5 |
| Non-ST |
93.7 |
89.9 |
85.0 |
83.0 |
78.1 |
|
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| Verbatim
Proceedings of the District Magistrates Conference |
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| Mrs.
Krishna Singh, Member Secretary, National Commission on Population |
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| On
behalf of the National Commission on Population (NCP) I take
this opportunity to welcome the District Magistrates (DMs) who
have come from Uttar Pradesh, Madhya Pradesh, Rajasthan, Jharkhand,
Manipur, Meghalay, Mizoram, Nagaland, Gujarat, Haryana, Jammu
& Kashmir and Arunachal Pradesh as also the representatives
of the Health & Family Welfare departments of the State
of Bihar whose District Magistrates could not be present because
of panchayat elections in the State. The representatives from
Assam had a similar problem. Looking back to my earlier days
as a DM, I recall the multifarious responsibilities that you
are required to shoulder. Though singling out or prioritizing
one aspect of development is often very difficult for you, the
issue for consideration today is likely to encompass all aspects
of development. |
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Shri
K.C. Pant, the esteemed Vice-Chairman of the NCP who is also
the Deputy Chairman of the Planning Commission has been giving
us all guidance for our activities. I thank the Vice- Chairman
for sparing his valuable time to preside over this important
conference. I also welcome Dr. K. Venkatsubramanian and Dr.
D.N. Tiwari, Members of the Planning Commission, Secretaries
to the Government of India, senior officers of Planning Commission,
the Registrar General of India, Hon’ble Members of the
National Commission on Population and some eminent journalists
present here. We have with us representatives of the Indian
Council of Medical Research (ICMR), Voluntary Health Association
of India (VHAI), Centre for Policy Research, Indian Institute
of Management, Lucknow, Family Planning Association of India
and Population Foundation of India. |
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After the inaugural address by our esteemed Vice Chairman, Registrar
General of India has agreed to give a presentation on the key
results of the Census 2001. This will be followed by a presentation
by Dr. Padam Singh, on behalf of NCP and ICMR about the salient
features and the rate of growth of population in the demographically
sensitive States. The District Magistrates would be given an
opportunity to express their views, which would be followed
by discussions on important issues. Members of the NCP, who
are present here, will also share their views. Dr. K. Venkatsubramanian,
Planning Commission Member, in-charge of education and health
will preside over the second session of discussions. The formal
agenda of the conference will end with a vote of thanks by Dr.
K. Srinivasan of the Population Foundation of India, who is
also a member of the NCP. At the end of the conference, I would
urge that we draft out an acceptable resolution, which will
be the basis for a continued working relationship between the
District Administration and the National Commission on Population.
I would now request Hon’ ble Vice-Chairman, NCP to kindly
give his inaugural address. |
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The NCP has taken the initiative to convene this meeting of
DMs of those districts which have been identified as backward
on the basis of certain generally accepted social, economic
and demographic indicators. The main idea is to make the issue
of population stabilization one of wider public concern and
make it a peoples’ programme rather than keeping the same
as the concern of a few departments of the Central and State
Governments. |
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Shri
K. C. Pant, Vice-Chairman, National Commission on Population
& Deputy Chairman, Planning Commission |
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This
is somewhat an unusual meeting. Generally at the Central Government
we organize meetings with State Chief Secretaries, the Chief
Ministers and so on. We have met the Chief Secretaries of some
of the key provinces just a few weeks back whose DMs are also
represented here. We have chosen to call so many DMs who are
naturally occupied with various responsibilities in their own
districts, because their role is pivotal. I am aware that sometimes
Districts Magistrates do not stay long enough in their districts
to be able to do what we need. I would request the State Governments
to appoint officers at the District Magistrates’ level
who should remain in the districts for the next few years and
be in-charge of implementing the programmes which have been
set forth in the National Population Policy and which should
guide all of us, the essence of which may well come through
the resolution later in the day. |
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As
you know India was the first country to adopt an official policy
for population stabilization. China at that time took the line
that there was no need to control the numbers. Over the last
40-50 years, China changed its policy and has now succeeded
in bringing down its numbers dramatically. Bringing down numbers
does not mean in absolute terms but reducing the rate of growth
of the numbers. The latest figure for China was 1.2 billion.
At the present pace we may well overtake them in 50-years or
so, and that is for experts to see. I think that our ability
to tackle this whole question has to be based on a clear cut
analysis of the present situation. Ours is not the only country
which is concerned with the growing numbers or the rate of growth
of numbers, but several countries of the world have adopted
official polices for population stabilization. Among them are
Egypt, Thailand, Malaysia and China. The religious leaders in
some of these countries like in Malaysia propagate the message
amongst the people after prayers in religious places. This is
not an issue, which should be looked at from a narrow point
of view. The larger point of view is that if we want the children
of today to have better life tomorrow, we should be able to
develop faster and move rapidly in pace with the developing
changes in the world. Then with the resources available we can
educate each child, look after health care of each person, have
a proper security, and in the ultimate analysis, we can open
the door of opportunity for the future generations in a world
which will be somewhat different from the 20th century in the
sense that possession of knowledge will be one of the most important
determining factors in the quality of life of any individual
or any nation. There is enough evidence that acquisition of
knowledge particularly education of girls is an important factor
in promoting the population stabilization message. |
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Women
must have some freedom of choice. That is not possible without
education, which again is not possible without universalizing
education. All these desirable thrusts that we give to population
whether in terms of social indicators, economic indicators or
in terms of infrastructure, all of these ultimately converge
and the convergence is then directly impinging on the question
that we have before us today. So, it is not that DMs have come
here to talk only about population stabilization, but to understand
the inter linkages. The Government has a host of schemes relating
to girls’ education, drinking water, age of marriage and
other indicators like infant mortality and nutrition so that
the child mortality goes down straightway. The reason why we
have called DMs of only 133 districts in the country is because
on the basis of a set of indicators – social, economic
and demographic- they were identified as sensitive for achieving
the goals set out in the National Population Policy. The size
of one’s family is essentially a question of choice. However,
individuals can be motivated and once motivated they may go
for further advice about following various methods for achieving
the small family norm. Dissemination of the message of the small
family norm is very important and it must then be succeeded
by your ability to provide an administrative framework in which
every individual who decides to accept your advice can get his
needs and whichever method of contraception one wants to follow,
he/she should be able to get it. Meeting the unmet needs for
contraception should be one of your prime responsibilities. |
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Today,
the demographic picture in the county is rather uneven. Some
of the States have done very well and even in the states that
have not done well, some of the districts have done fairly well.
If you have a look at the pattern that has emerged, you will
find that the states in the south and west have done reasonably
well in the direction of better social indicators as well as
better population growth figures. The problem states are mostly
in the North like U.P, M.P., Bihar, Rajasthan and Orissa. While
we were preparing the National Population Policy, these were
the States which emerged as requiring special attention. I think
the element of coercion that entered in family planning in the
70s at the time of emergency, had its maximum impact in these
States. So, coercion is not the way. People talk of incentives
and discentives. This I leave to the states. It is for them
to judge. But coercion does not pay. It is not necessary that
every State has identical conditions in bringing down the rate
of growth of population. |
|
It is very interesting to look at the experience of some of
the States doing well in the population front. In Kerala, social
indicators are excellent. In Tamil Nadu, the IMR is higher and
the female literacy is lower than in Kerala. During last few
years, Andhra Pradesh has made rapid progress with regard to
age at marriage, literacy and primary health infrastructure.
They are firmly committed to this programme both at the political
level and at the administrative level. The message I want to
give you is that if the administration is committed to something,
which deserves the highest priority, then they can bring about
changes and make it people’s movement as Mrs. Krishna
Singh mentioned earlier. Because ultimately administrative aspect
becomes important and looking at the example of Andhra Pradesh,
the linkage is obvious. There are about 25-30% unmet needs.
Therefore, there must be no question of any unmet need being
left out. The administrative part must be taken care of in a
time bound manner taking into account the fact that National
Population Policy has laid down the goal of reaching the replacement
level TFR of 2.1% by 2010 and the population has to stabilize
by 2045. Some experts felt that this was very difficult. I am
an optimist and we can go even faster. While going faster, we
must take care of some other aspects like providing primary
health services like labour rooms in villages and connect them
to habitations. Using the funds that are being made available
for rural roads and linking these facilities to the habitation
centres straightway, you create an opportunity for women to
reach these clean labour rooms. Another important thing is the
availability of doctors. Do they go to rural areas and slum
areas? In rural areas, you have to monitor this very closely
and I would suggest that if the doctors you post do not go there,
you should think of those available in the area even if they
are private doctors. They can be taken on contract basis. Fix
the days on which couples can go to get advice of experts. We
can also have a referral system. After all most of deliveries
are natural without any complication. We can see that our nutritional
programme works better and make sure the health of children
as we have 33% underweight children born in India. We have higher
maternal mortality rate. Unless these factors come down drastically,
particularly, in these states, thinking of merely controlling
the population is not sensible. All these factors must impinge
on this.
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|
The Planning Commission provide drinking water schemes to every
State, every district, but we do not look after their maintenance.
We find that 90% of the villages have clean drinking water.
But after 15 years or 10 years or 5 years, you find many of
those schemes no longer working because maintenance is no longer
proper and because of various other factors sub-soil water has
gone down. What I am saying is that these factors are in fact
related. When it comes to the lives of individual families,
ensuring a better quality of life is very relevant to our total
holistic view of the population problem. I would request you
to take with you this broad concept and I would also request
you to get yourselves personally involved. The best way you
can involve yourselves is to see that the multiplicity of agencies
working at the ground level are fully coordinated. I know that
they all work in compartments, but you have to break those compartments
at the district level and below. In fact, DMs should have the
nodal responsibility fixed on an officer who then is able to
look across all the schemes for proper utilization of human
resources available for the implementation of these schemes.
If there is convergence of various activities you can reduce
the amount you spend on wages and salaries. By this way perhaps,
you can spend a little more on medical care, on medicine and
nutrition. All these are important things which we cannot do
from here. We cannot compel the State Governments to do this,
but DMs are in a position to help, to advice their seniors at
the State level and slowly we must evolve a culture in which
a holistic view of the problem of population stabilization.
While tackling it, introduce element of efficiency, accountability
and strict monitoring. Concurrent monitoring of these programmes
is necessary, if we are to achieve the goals. Monitoring after
a gap in time, as is the case in CAG reports, may not serve
the purpose. |
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Shri
Waseem Akhtar, Collector, Jhabua |
|
There
is 86% tribal population in my district. Tribals live in hamlets
rather than compact villages. Normally, a sub-centre has to
cover 3,000 population in tribal areas and an ANM has to cover
about 10-12 sq. kms. This norm of sub-centre in tribal areas
should be lessened for providing better services. The sub-health
centres basically don’t have instruments and facilities
which should be provided in tribal areas. We tried to upgrade
these sub-centres as delivery centres through the funds provided
by ITDP and the JGS. The panchayats take over the upgradation
and renovation of their sub-centres. |
|
We
have introduced 10- years register for the registration of birth,
death, marriage and pregnancy in Jhabua district. This has become
the part of the panchayat and the community is involved in the
registration of all these. The panchayat committee goes into
details of what has come out every month. Flow of data is as
follows. This three tier flow of data is fully computersied.
Only Jhabua is doing such kind of registration since last year.
(Vice Chairman asked to send a copy of this). All the national
programmes like DBCS, Leprosy and TB are given yearly targets
to Sarpanchs on the basis of the population. The involvement
of the community should start from the bottom and this would
yield good results because the Sarpanch is also accountable
for implementation of all the programmes. |
|
We
have tried to integrate the ICDS programmes with RCH. We normally
have Mahila Jagriti Shivir. It is working very well. We had
3000 sterilisations two years back and this year we did 8,000. |
|
| In
our State, we have an 11 - Sutri Karyakram. There is a nodal
officer in each village for the monitoring of 11 programmes
including health. It has been started 3 months back. On the
20th and 21st of each month, nodal officer goes to the village
and makes an account of the 11-sutras- whether ANMs is coming
or MPW is coming, what are the demands which have been created
in terms of copper Tee, IUD, oral pills and condoms. The nodal
officer reports to the Chief Executive Officer of the Janpad.
Nodal Officer is closely associated with the village.
|
|
| We
have about 4000 women’s self help groups in Jhabua with
a total of 50,000 members. We have 2,20,000 households. We have
already covered about 25% of the households under self-help
groups. Our target group of 50,000 can be very well motivated.
The self-help groups are working as an informal group to raise
their standard. We have Integrated School Health Programme for
a generation which is non-literate and which cannot be covered
under many parameters. 8,000 teachers have been trained and
special books on school health have been introduced and from
this year, this would be one of the items of primary or middle
level school education. We covered the entire population under
pulse polio programme in a limited time and if RCH could be
termed as a mission and if it works on a mission mode, I think
there would be more impact on population. Jhabua has distinction
as one of the district covered under this programme. All our
612 Panchayat Headquarters have TV and special programmes have
been beemed on it. So health programmes are continuously being
beemed and we are using this as one of the resources. |
| |
| Shri
S.N. Mishra, Collector, Sidhi (M.P.) |
| |
| We
are following almost the same strategies as spelt out by the
DM, Jhabua. I have two observations; firstly, State have more
and more religious structures in the district like Sidhi, one
of the most rural districts of M.P. We have created special
health centres. The number of ANMs and MPWs is generally based
on post sanctioned earlier i.e. for 3,000 to 5,000 population.
Now the population has increased two fold but the strength of
ANMs and MPWs is the same. So we have to involve Anganwadi Workers
and others because the district like Sidhi where there are more
then 19,000 villages, we have 1400 Aanganwadi centres each having
one Aanganwadi worker. States have to pay more attention on
the availability/accessibility of contraceptives, condoms, etc.
for birth control. In a district like Sidhi, there are terrains/
hilly regions and one has to reach these sub-health centres
minimum 10-15 kilometers away. Therefore last year, we started
the depots in every village and more than 50 lakh condoms have
been distributed through these depots involving Panchayati Raj
Institutions (PRIs). We have very good network of NGOs. We have
70-gram panchayats, more than 10,000 ward members out of which
one-third are women. The last point I would like to state is
that infrastructural facility must be made available in the
village for safe delivery. In my district, there are 280 sub
health centres out of which only 90 are having buildings. We
have Sampark Adhikari in every three villages and one nodal
officer of inspector level rank and we receive progress report
every third week related to all these parameters. We are looking
after all these activities at district level. Block development
officers (BDOs) are looking after at block levels. Every month
we sit together and discuss the points and work out a strategy
accordingly.
|
| |
| nsonÙk]
ftykf/kdkjh] vyhx<+ |
| |
| esjs
eq[;r% nks lq>ko gSa% |
|
1.
vkerkSj ij xkWao esa yM+fd;ksa dh 'kknh 14-15 o"kZ dh mez
esa rFkk yM+dksa dh 'kknh 17-18 o"kZ dh mez esa dj nh tkrh
gS tks fd gekjs oSf/kd izko/kku esa fu/kkZfjr fookg dh vk;q
vFkkZr~ yM+fd;ksa ds fy, 18 o"kZ ,oa yM+dksa ds fy, 21
o"kZ ls de gS A vr% esjk lq>ko gS fd gesa yM+fd;ksa
ds fookg dh mez 18 ls c<+kdj 21 o"kZ ,oa yM+dksa ds
fookg dh mez 21 ls c<+kdj 24 djus ds ckjs esa fopkj djuk
pkfg,A bldks fØ;kfUor djkus ds fy, ge dqN Incentives
vkSj Dis-incentives ds }kjk gh achieve dj ldrs gSA |
| |
| 2.
xzke Lrj ij LokLF; lfefr;ksa dh lgHkkfxrk dks c<+kus dh vko';drk
gSA |
|
| /kkfeZd
tuizfrfuf/k;ksa dks cqykdj mudkss ifjfLFkfr;ksa ls ifjfpr fd;k
tk jgk gS vkSj muds ek/;e ls turk esa ftyk] rglhy ,oa Cykd Lrj
ij tutkxj.k vfHk;ku pyk;k tk jgk gS A blls ftys esa fofHkUUk
lk{kjrk fe'ku] Pulse Polio Programme bR;kfn esa vPNs ifj.kke
vk jgs gSa A gekjs tuin us iwjs ns'k esa] izfr'kr ds fglkc ls]
laiw.kZ lk{kkjrk vfHk;ku esa f}rh; LFkku izkIr fd;k gS A ;g
eq[;r% lkeqnkf;d lgHkkfxrk ds dkj.k gqvk gSA |
|
SIPFSA
Project tks xr 3
o"kZ ls py jgk gS] mlls tux.kuk ifj.kke 2001 ds vuqlkj
gekjh decennial
growth 29.95 izfr'kr
ls ?kVdj 22.08
izfr'kr gks xbZ gS vFkkZr~ 7.87
izfr'kr dh deh vkbZ gS A 1997 ds Lrj ls Sterilization
performance esa 154
izfr'kr dh o`f) gqbZ gS A bl dk;ZØe esa Hkh /kkfeZd usrkvksa
dk vPNk
lg;ksx gS A |
| |
| Ms.
Monica Garg, DM, Rampur |
| |
| I
would like to talk about my experience in this area when I was
Chief Development Officer (CDO) in Kanpur during 1995-96. At
that time, we had a population of about 26 lakhs in the city
but there was no infrastructure in urban areas and most of the
population was ‘ floating population’. They used
to come as labourers and go back. It was very difficult to keep
track with all of them. So, we tried to mobilize the community
and we formed some community development societies in 109 slums.
From the ICDS efforts were made to spread the message of Family
Planning. We organized a few camps also. We had DUDA (district
urban development authority) working in the city area. We got
funds from SIPFSA and we recruited two female doctors on contract
basis in this project. We organized RCH camps and associated
the community with us to involve people for popular support.
We integrated other welfare measures with these programmes like
old age pension, widow pension etc.which were decided on the
spot. We also got some loan application filled and completed
the formalities like issuing caste certificate or income certificate
on the spot. We took all the Tehsil staff and visited camps
in slum areas and the response was overwhelming. The ICDS workers
got involved with them to such an extent that we gave some registers
for maintaining records. It was found after a gap of one and
half year that they had recorded all marriages in that period.
Registers are basically maintained for keeping record of registration
of births, deaths and marriages. We organized camps on immunization
also. We issued follow up action and the presence of female
doctors was quite successful. In the rural areas, we found shortage
of ANMs because the ANMs used to live in cities. With the help
of SIPFSA funds, we hired a vehicle and divided the ANMs in
two areas; we dropped them in the villages in the morning and
collected them in the evening. This ensured the presence of
ANMs for at least 3-days a week in villages and it also helped
in providing the project of DUDA –SIPFSA and family planning
services at the doorsteps. We insisted on spacing method, less
on sterilization and in the process we gained a lot of goodwill
from all the communities and all the religions. About the general
issues, I agree with the two child norm and some disincentives
for those who do not follow it and I would like to draw the
attention to the fact that there is still a preference for a
son. So what measures can be taken to improve the status of
girls and women in the society. We must have reservation for
women irrespective of class and irrespective of caste because
there are problems in others castes and class of the society
and community also.
|
| |
| Shri
S.C. Jain, Deputy Commissioner, Faridabad |
| |
The
population pressure has been tremendous in the highly industrialized
districts of Faridabad and Gurgaon. The increase of population
from 1991 to 2001 has been 48.79% as against overall percentage
of 22.24% in the remaining 17 districts of the State. This is
primarily because the workers and labourers have migrated from
Bihar, U.P. and Rajasthan with the result that the density of
population, which was 687 in 1991, has gone up to 1020 in 2001.
From this it can be judged how the pressure of population has
increased at present in the district. We have 5 hospitals, 19
dispensaries 19 PHCs. In view of the rush of the population,
these are hardly sufficient to meet the growing needs. The population,
which has migrated, is illiterate labourers and have formed
96 clusters in my district. We have tried to provide education
to them. My firm conviction (on the basis of my experience in
my district) is that illiteracy is the main hindrance in family
planning. In 1991, population of my district was 13.7 lakhs
and now, it has increased to 21.9 lakhs, an increase of 48%.
Out of this population, 28% is the minority population, which
is again illiterate. By providing them education literacy figure
has gone up from 42% in 1991 to 56% in 2001. Recently, a survey
was conducted in my district. It was found that out of 40,771
couples, 38% had interest in family planning after 3 or more
children. Primarily because of illiteracy nobody wants to go
for one child or two because they feel insecure. Secondly, nobody
wants to go for Family Planning if a couple has two daughters.
Thirdly, in the minority communities, there is a strong resistance
and we, of course, have tried to motivate them. On 5th April
2001, a meeting of ICDS workers and ANMs was held. They have
been assigned the job of backward areas and the feedback was
encouraging especially because of the illiteracy factors and
of course, other factors like those having one child could not
come forward. We have 19 PHCs located in rural areas but we
do not have vehicles and doctors. The government has made a
policy that on his first assignment a doctor has to serve in
rural areas for at least 3 years, but in practice they are serving
in urban areas and drawing their salary against their posts
in rural areas. |
| |
| J.C.
Mohanty, Collector, Kota, Rajasthan |
| |
| One
question which is often discussed in the field is that Government
of India policy and the state policy is clear that we have to
give up the earlier strategy of motivation or whatever small
kind of attention to coercion and concentrate on only RCH and
quality family planning service delivery. At the village level,
it is the ANM or MPW or the local workers on whose shoulders
all kinds of responsibility are placed. She has to cater to
nearly 100 families, whose unmet need etc. are to be met. Also
she has to look after the immunization and other programmes,
which are in 20 points programme activity. She often finds it
very difficult to handle it.
|
|
| Secondly,
the impression that is going around is that, it is an ANM programme
at the village level. Sometimes the collectors, tehsildars or
BDOs, who are asked to push it, include it in their agenda.
Largely, the community and the women do not consider it as their
own programme. One must underline the fact that the sense of
urgency is largely absent in the rural areas. In the case of
PRIs family planning does not find priority at all to be included
in the list of 10 items to be addressed. They do not discuss
it as a primary agenda in their own Gram Sabha. If we leave
this programme to ANM, I am afraid, in spite of the best interventions
and in spite of the Collectors occasionally pushing it, there
will be no sustainability. Somebody has to take over this programme
and ANM would maximum give technical aid at the maximum. This
experiment as far as replacement of ANM is concerned is quite
useful. ICDS women reside in the village, and she is a part
of village culture and has greater acceptability. Swasthya Karmi
Scheme of Rajasthan has come out very successful. The point
is that why the Sarpanch or the community should not take this
as their programme. How it can be done, I don’t know.
|
|
Often groups have not yet taken family planning as their major
goal except in ICDS. Women and child development, of course,
has accepted it as one of its priority areas. Other departments
have yet to take it as their priority thing.
|
|
Sir, in 2000-2001, literacy society of the district adopted
family planning and population stabilization as one of the parent
programmes. They brought out magazines in which they put the
gist of the Rajasthan and National policies in their own languages.
All the Janchetna Kendras were also used as Jansankhya Chetna
Kendras and each one of these kendras was asked to form a women
group of each 20 women and discuss the policy, whether it is
acceptable, good or bad. What they did they took in every village
a Sankalp Patras of people who have already adopted family planning
and are willing to promote the same among those who have not
adopted it. In December 2000 nearly about 53000 people have
signed these Sankalp patra and they have been identified as
potential volunteers to work for family planning. Now, they
have been grouped and I am requesting the Commission to provide
funds for their training. And some kind of agency in the model
of literacy mission may succeed. The TLC body is, as all of
us know, the best model which is able to produce results.
|
|
Lastly, somebody has said about private sector hospitals. All
of us have organized camps but would not like our own wives
to attend the camp. Lack of privacy and the conditions that
exist in these camps are appalling. But somehow the camps carry
on. I was told in a recent conference that in Bhopal, somebody
has put up private hospital and Government of MP is giving Rs.400
or 500 per operation and that gentleman charges full operation
charges of Rs. 700 or 800. They say it comes out to be successful
so why do we not replicate that model to other areas.
|
| |
| Shri
J. K. Banthia, RGI on Civil Registration System (CRS) |
| |
CRS is such an important aspect and the NCP has been really
concerned about it. In a personal audience with the Deputy Chairman
of the Planning Commission, he has expressed his great concern
about the lack of attention being paid by some of the bigger
States about CRS. It was decided that the State Governments
should be sensitized on this. I would like to take this opportunity
to draw attention to this. The five States in the country, where
overall Civil Registration System is not functioning satisfactorily
are basically UP, Bihar, Rajasthan, Assam and Andhra Pradesh.
In these States, birth and death registration on the whole is
less than 40%. I would request the District Magistrates of even
those states which are doing reasonably well but are in no way
near 100% birth and death registration, to devote some time
to monitor the progress in the registration of births and deaths.
This is a continuous activity-births and deaths take place everyday.
Census is done once in a decade and it allows us to know some
of the important aspects of fertility and mortality through
indirect techniques, but if we have Civil Registration Data,
it would be possible for us to monitor several health programs
particularly, on family planning and so on. In most of the States,
there is a committee under the chairmanship of District Magistrate
to monitor births and deaths. Ultimately it is done by the village
panchayats or gram panchayats or the municipal corporations,
but DMs are the final coordinating authority. The Deputy Chairman
has expressed his deep concern and he also felt that possibly
throughout the country, the DMs should be made responsible for
Civil Registration System. We are trying to find out how to
bring it about and to give it a legal backing also. My request
to DMs is to find out what is happening in Civil Registration
System, it is really important for several reasons – legal,
social and health. So many important schemes are governed by
this. If you pay little more attention to this, things would
be much better in the country.
|
| |
| Shri
A. K. Awasthi, DM, Meerut. |
| |
| I
would like to focus on three aspects : |
|
(i)
The Urban Slums: The problem is that most of our family
planning and health services are now being provided in rural
areas and there is absolutely no urban health infrastructure
that is available in cities. I would suggest that in a district
like Meerut we spend about 50 crores on development, if we could
divert say rupees one crore in urban areas, it can do produce
some results. |
|
(ii)
We have SIPFSA project going on in our state where voluntary
workers are trained and they are given Rs.100/- a month. They
go door to door. If we can implement this campaign in urban
as well as rural areas, if we get around 1,000 workers, it can
really do wonders. We have been able to reduce total growth
of population from about 25% during 1981-91 to 20% during 1991-2000.
We have this SIPFSA project for the last three years doing very
successfully. |
|
(iii)
Contrary to the belief that the minority population is not readily
accepting the family planning projects, I would like to say
that if we provide the facilities at doorstep, it could really
be very successful. Even women from minority communities are
ready to accept but it has to be provided at the doorstep. We
are in a vicious cycle where we say that we provide education,
minimum basic needs, etc. but unless and until we provide direct
family planning services at the door step, the cost of providing
these infrastructure are much higher than going at the door
step. On a population of 1,000, if we have one committed worker
from within that population, I think we can do wonders. Even
China had adopted one child norm. We should adopt at least two
child norm. The message of “Hum Do Hamare Do” has
somehow got lost over the years. Even the population policy
that we have does not really come out very clearly on this. |
| |
Shri
S.M. Hussain, Dy. Commissioner, Baramulla (J&K) |
| |
The population of my district is around 12-lakhs comprising
of near about 14 community development blocks, out of which
7 are border blocks. The position of family planning scenario
is that in border blocks, which are very much far flung and
located on the LOC, have very low literacy rate. The other aspects
of development have also got affected adversely. In other 7
blocks, the literacy rate is better and accordingly, the people
have taken over to the family planning and since 1991, there
is a lot of incremental progress in respect of family planning
targets. I have seen that mind of people is now changing. The
common masses are coming forward. But there are certain shortcomings
like non-availability of infrastructure in the border areas
like Uri and Guress just on the edge of the LOC. The people
in these area could have come forward, of course, because of
the socio-economic commitment to their families. But because
of infrastructural facilities not reaching them, inaccessibility
and terrain topography and many other factors contribute to
not coming forward to the extent, as it should have been. The
position in Uri is not so bad but in Guress it is very bad.
|
|
There
are around 130-villages in Uri. Most villages are very much
inaccessible, but we are now opening roads and developing connectivity
for them and getting them closer to the district headquarters.
We have 70% ANMs in position, but we have no doctors. One Gynecologist
is available, of course, at district headquarters. Lately, our
government has now appointed some doctors on ad-hoc basis. But
some doctors did not join at these far-flung places and, therefore,
posts remain again vacant. Similarly, the position of health
facility is not that adequate in Guress. Even in the plain area
like Baramulla, the position is not that satisfactory. In order
to achieve the goal of population stabilization, it is very
essential to fill the post of ANMs in the areas where they are
supposed to work. They must have some residential accommodation
available for them in backward areas to attend to their legitimate
duties. Otherwise, there must be transport facilities for them
so that they can commute to their place of posting and back
to native place. Also, kits are not available at the time when
these are required at various places. Timely arrangement of
kits is very much essential so that any moment, couples can
avail that facility at the place wherever it is desired. We
must be in a position to make these kits reach to the doorsteps. |
|
When people are asked to come to the districts headquarters
or to the PHCs, sometimes doctors of the particular specialty
are not available. So, the particular prospective beneficiary
goes back to the home without getting any thing done or to a
private doctor where he or she has to pay a lot of money. The
State Government is going to convert one particular hospital
- DP Dar hospital for family welfare exclusively. I would suggest
that they must be properly financed and funded for achieving
the goal as envisaged in the programme. Similarly, the maternity
centres, which are located at the PHC level or at the sub district
hospital level or at the district level, had to be extended
over rural areas where people are generally not in a position
to come out. To create awareness to this programme amelioration
of socio-economic problems of the family is required. It is
better to have these centres extended over to those areas where
from people are not supposed to come to the district headquarter
and they would get these facilities percolated down to them
at their native places. |
| |
| Jh
y{eh dkar 'kqDyk] ftykf/kdkjh] cLrh |
| |
eSa
xzke iapk;r] {ks=kh; iapk;r rFkk ftyk iapk;r ds }kjk tokgj dk;ZØe
;kstuk dks lqfu;ksftr <+ax ls ykxw djus ds ckjs esa tksj
nsuk pkgrk gw¡ A ;kstuk vk;ksx ds ek/;e ls ,d nh?kZdkyhu
;kstuk vkjaHk dj ;kstuk esa de ls de 30 izfr'kr /kujkf'k LokLF;
lsokvksa ij [kpZ djus ds fy, xzke iz/kku dks fn;k tkuk pkfg,]
rHkh xkzeh.k turk dk m)kj gks ldrk gS A xkze iz/kku rFkk xkze
iapk;r lnL; bl dk;ZØe ds izfr lfØ; gks tk,a rks
;g dk;ZØe cgqr lQy gks ldrk gS A |
|
| izkbejh
Ldwy vkSj gkbZLdwy ds cPpksa dks Ldwy dh i<+kbZ ds lkFk&lkFk
ifjokj fu;kstu ds ckjs esa Hkh i;kZIr tkudkjh nh tkuh pkfg,]
rkfd muesa dk;ZØe ds izfr txk:drk iSnk gks A bl izdkj
ifjokj fu;kstu dk;ZØe dks i;kZIr lQyrk fey ldrh gS A
vkt u lgh ijUrq vkus okys le; esa blds vkSj Hkh vPNs ifj.kke
ns[kus dks feysaxs A izkbZejh vkSj gkbZ Ldwy ds cPpksa dh tkx:drk
ds lkFk gh lkjk ns'k tkx:d gks tk,xk A xk¡o dh uofookfgr
L=kh dks vkjaHk ls gh bl dk;ZØe dh tkudkjh nh tkuh pkfg,
A ge ifjokj dY;k.k dh ;kstuk rks cukuk pkgrs gSa] ijUrq dgha
u dgha fnDdr gS A xHkZfujks/kd xksfy;ksa dk xk¡o esa i;kZIr
vHkko gS A bldh i;kZIr O;oLFkk gksuh pkfg, rkfd bl dk;ZØe
dks vkaxuokM+h ds ek/;e ls lQy cuk;k tk, A blls ifjokj fu;kstu
ds dk;ZØe dks i;kZIr lQyrk fey ldrh gS A |
| |
| Shri
Keshav Chandra, DM, Lower Subansiri (Arunachal Pradesh) |
| |
The
population growth rate in the district in absolute terms and
in terms of rate of growth is not as alarming as in other parts.
Sex ratio is better than all India level, that is, 985. 0 to
6-population ratio is also quite good. It is 17,582 in my district
as compared to total population of the district is 97,614. The
main problem of the district is probably certain norms and social
traditions existing in northeast, which is absolutely binding.
There is a problem of child marriage. The girl child is often
married to older people and in lieu of cattle which is called
Mithun. Polygamy is another practice and whenever we take recourse
to Cr. PC and IPC there is very strong opposition of the whole
community as such. The whole tribe virtually comes to the street
and because of a depleted police strength, it is very difficult
to control the situation. We have launched an NGO in each district
registering it with our own efforts. The name of the NGO in
my district is “Gurapto” which in local words means
awakening. My friends in other districts have launched NGO called
Udan for the same purpose. |
|
Because
of the existing guidelines that the funding of these NGOs would
start only after three years of existence, it has become very
difficult for us to cater to the financial needs of these NGOs.
We have already redeemed at least 12 girl children. The moment
we formulated this, I have sent to CAAPART 6-7 months back the
registration and the specific problems. Representatives from
the Government of India have come to my district. I have given
a copy and personally accompanied them to all the places. In
fact, all inmate girl children were also introduced to them.
Total literacy rate in 1991 census was 24.24% which has gone
up to 36.90 showing an increase of 12%. The female literacy
is of concern. |
|
| The
biggest problem of districts in Arunachal Pradesh is remoteness.
The area of my district is 10,135 sq. km. Some times it takes
24 days in a stretch to go to a village walking on foot in my
own district. Because of non-availability of infrastructure
in remote areas, I cannot provide the basic minimum requirement
of a house and other schooling facilities. I have to appreciate
workers who are going and staying to carry out their duties.
I have the whole list of places. How much time does it take
from district headquarter to all these places.
|
|
Education sector is also facing the same problem of infrastructure.
Teachers and school buildings are not available. Books do not
reach on time and sometimes we feel totally helpless. It is
very difficult to finance text books to be carted by helicopters
because there is no policy as such to finance it. In Arunachal
Pradesh the total literacy campaign (TLC) was not launched.
So, this year they are taking up in three districts. My suggestion
is that probably we can accelerate the process of this total
literacy mission. In northeast, everybody is asking how much
financial incentive he is getting. A token incentive can do
very good in northeast if it cannot do substantially good in
other parts of the country. |
|
| Our
main thrust should be on promotion of NGOs specially those which
are working in emancipation of girl children who are married
in early age. We have mid day meal program, but in remote areas,
it is very difficult to cart rations. There is a plant like
palm tree called “Tashe”. They use to cut stem of
that tree and use to grind it in the form of powder and use
it in flour. They make chapattis out of it and it is very hygienic
in real remote parts. When I was posted in China border, I had
also eaten it because rice was not available. |
| |
| Dr.
R. N. Pandeya, District RCH Officer, Lohardaga (Jharkhand) |
| |
| Lohardaga
is a tribal dominated rural district where lot of issues has
been taken up. I may state about only a few major issues which
are prevailing in my district. The Total Fertility Rate (TFR)
in my district is very high (3.92) and the couple protection
rate (CPR) is very low (25). The net productivity rate is more
than 2. The WHO has recommended the RCH programme to be completely
based on the medical rather than health delivery system. We
have to reduce the infant mortality rate (IMR) up to a level
of below 30 or reduce the maternal mortality rate (MMR) which
is very high (4.05 in 1991 and 5.04 in 1999). The causes for
maternal mortality are anti partum during labour or post partum,
anemia and unsafe delivery or septic abortion. The IMR is about
72. The major causes of IMR are infection, diarrhea, diseases
which can be prevented by proper immunization schedule and low
weight of newborn baby. The ICDS workers, teachers, Anganwadi
workers, mahila mandal etc. are there to support the services.
The problem is who will really make aware people or the community
about the initial dangerous signs so that they can refer the
cases to the community health centre as the first referral unit?
Who will make aware about the risk groups in pregnancy? Among
all pregnancies, 15% are bound to develop complications for
which a nearby referral unit must be there. If we are not going
to take guarantee of survival of kids or assure the safe motherhood,
the people will not accept our all sorts of measures of family
planning. My suggestion is to give training to ANMs to know
her job properly. Lot of vacancies are there. Out of 167 posts
of the ANMs and male workers, only 92 are working today and
it is decreasing day by day because every year one or two are
going to be retired. Also, 90% doctors are not properly trained.
If we are having the will, we can control population growth
but only by improving the different parameters. We may prepare
a short-term action plan and a long-term action plan to achieve
our goals.
|
| |
| Shri
B. Lyngdoh, Dy Commissioner, West Khasi Hills District, Meghalaya |
| |
The area of my district is 5247 sq. kms. and the population
is little less than 3 lakhs. There are problems in my district
like lack of infrastructural facilities and PHCs. The larger
part of the district is inaccessible bordering with Bangladesh
and hence, amenities cannot be reached to the poor people in
those areas. |
|
Out
of 7 districts in Meghalaya, 5-districts have been identified
as having high TFR. We have held meetings at the district level
with district officers as well as industrialists and we have
formulated the Action Plan of how best we can reduce the fertility
rate within a short time. Recently, the Government constituted
a State Commission on Population. Though we are faced with various
constraints, I hope we would be able to bring down the fertility
rate within a short time. |
| |
| Manoj
Singh, DM, Muzaffarnagar |
| |
In my district, there is tremendous pressure from below for
girl education and I would suggest that we adopt some policy
for reimbursement of fees of girls and create infrastructure.
There are 31 Nyay Panchayats in my district where we don’t
have any Inter college. Many people are willing to open Inter
colleges and we are providing them land also. There should be
social responsibility of individual for population stabilisation.
This calls for devising some disincentives specially in the
regions of high fertility rate. We should have various sub-strategies
where we could have restriction on various issues like reservation,
issue of license, quota etc. Whatever population bonus we have,
we should train them and utilise for our productive purposes.
China has utilised the population bonus in the age-group of
15-45 that is working population and that is why most goods
of China are cheap. There are many illiterate people among young
population and minority community, specially among Muslims.
They are willing persons who require skill training for being
part of national production process.
|
| |
| Manoj
Kumar Singh, DM, Pilibhit |
| |
|
Shri
J.K. Banthia, Registrar General of India, addressing the DMs. |
| |
|
Shri
Manoj Kumar Singh, DM, Pilibhit - speaking on the occasion |
| |
Whether it is rural area or urban area, people belonging to
rich or poor, everyone has realised the need to have a small
family. The only bigger problem which they face is the availability
of supplies or methods to make their family smaller. We have
generated demand needs for contraceptives and other things.
Accessibility to this is quite important. In Pilibhit we have
started one new thing 2-3 months back. Couples already have
2-3 children when we reach them. We have prepared a marriage
register for all gram panchayats and all wards and on 3rd of
every month we collect data from them and by 10th of month we
computerize it giving one copy to CMO and one copy to an NGO
selected for Pilibhit city. Dy CMOs along with ANMs are visiting
PHCs in rural areas and give tips to couples about how to have
small family providing them a gift of one packet of condoms
and a packet of sanitary napkins. We are getting condoms from
family planning programmes and sanitary napkins are tied up
with the district Red Cross Society. In most of the rural areas,
the use of sanitary napkins is almost zero, we have exposed
them to use it. The total gift packet costs around Rs.100 but
the idea is to give them tips within one month of marriage about
the options available with them.
|
|
We
found that 60-70% of rural people still believe and depend on
rural doctors. I suggest to provide contraceptive marketing
through them and use them purposefully because our medical infrastructure
is not competent enough to take the load in coming days. |
|
lHkk
jkt flag] ftykf/kdkjh] dkuiqj nsgkr |
|
gekjk
/;ku vHkh dsoy target couples ij gSA ge lHkh dk;ZØe dsoy
mUgha ij dsfUnzr djrs gSaA ;fn ge ?kj ds cqtqxZ vkSj cPpksa
dks Hkh ifjokj fu;kstu vkSj lhfer ifjokj ls gksus okys Qk;nksa
ls voxr djk,a rks blds vPNs ifj.kke lkeus vk,axsA ikBîiqLrdksa
dk fu%'kqYd forj.k] bafnjk vkokl ;kstuk bR;kfn dks Hkh disincentive
ds :i esa /;ku esa j[kuk iM+sxkA |
|
Dr.
P.N. Shukla, CMO, Hamirpur |
|
After Uttaranchal, Bundekhand area under which Hamirpur district
belongs is the most backward area. There are 62-posts of medical
officers out of which 27 are lying vacant. We don’t have
50% doctors in our PHCs. We have sufficient number of ANMs but
we don’t have medical officers. I suggest that all posts
have to be filled on priority basis and there should be some
laws to enforce them to work at the place of posting.
|
| |
Shri
P. Talitemjen Ao, Commissioner & Additional Chief Secretary,
Government of Nagaland |
|
The provisional figures of the population in the 2001 census
has registered a little high growth rate. The factors contributing
to this are the counting of certain influx of foreign nationals
also in the latest census. The whole state is tribal populated
living in compact villages. If a family has got 2-3 daughters,
it keeps on producing children till a male child comes. This
increasing population has given rise to social evils like beggary,
people are not taking care of those people without land and
sometimes out of employment. We are aware of the adverse effects
on the society and realize the need to check and bring down
the population to a manageable level. |
|
Since the whole State is tribal populated with minor differences
in the traditions and customs we have a State plan of Action
instead of district wise plan. We will try to control the influx
of foreigners which is a problem not only in Nagaland but in
other States having common border with Bangladesh. Towards improvement
and enhancement of quality supply, we are going to take certain
actions on social services, education, medical healthcare, drinking
water and surface transport. The network of road transport is
very important for us because the entire State is dependent
on it. The quality of water is the State is generally safe.
It does not require purification on a large scale. The health
care services are quite manageable because villages are not
spread out in different hamlets. We plan to create awareness
through school education, churches and NGOs so that people become
aware of adopting small family norms and accept young people
as assets rather than liability on the society. We are trying
to use churches as a platform as almost everyone in the village
goes to church because churches also runs youth programmes,
Sunday school programmes apart from worship services and they
are cooperating.
|
| |
| Ms.
Dimple Verma, DM, Bulandshahar |
| |
We have defined the age of marriage for boys and girls but as
all of us are aware that there is lack of sex education in our
education system. So what I suggest is that we could have counseling
agency at least to start with, in urban areas or areas surrounding
the urban areas who could go and at least tell the couples who
are going to get married that these are the family planning
methods you can adopt because people get married and by the
time, they are aware of the family planning methods, they already
have two to three children.
|
|
(Shri K.C. Pant, Vice Chairman intervened : Can we all agree
on what the DM of Pilibhit is doing? If we collect the data
on marriages and approach the newly wed couples, organize the
NGOs to approach each of them individually along with the ANMs
and the doctors and counsel them about the methods of delaying
the first child.)
|
|
With the level of education of females in UP and especially
the district which I am heading-Bulandshahar has mix population,
minorities are in large numbers there I feel that even today,
not only in urban areas but in rural areas, one cannot imagine
of women coming out and going to a shop and ask for contraceptive.
She cannot go even to PHC or CHC and say that she wants a copper-T.
Because our PHCs are not having female doctors women feel inhibited
to go there. Perhaps, the Government could think in terms of
strengthening those gaps. The system of dais is working but
that needs to be covering but as my colleague stated that people
still feel free with the quacks, with the dais etc.
|
|
(Shri K.C. Pant, Vice Chairman intervened : Knowing the state
of finances of UP and Bihar, I don’t recommend new addition
to the staff. The question is what can we do with the existing
staff.)
|
|
Sir regarding the staff available with the system, if you make
a analysis of postings of doctors, you will find female doctors
don’t go in the rural areas. You will find female doctors
are posted only in the cities but they don’t go in the
villages. For this, there has to be administrative and political
will to post the women doctors in the rural areas. With this,
I would like to sum up my points. One is Counselling Agency
before marriage; the second point is availability of family
planning advice and devices at all levels, rural, urban, and
for ladies and gents; third point is girls education linking
it up with certain incentives and number four is sex education.
|
|
Shri
H. C. Joshi, DM, Haridwar |
|
We
have already done two things in each village. Where there is
no health worker, we have included ICDS workers, because they
are in large numbers and for each village, we have nominated
them and they are already working very well. Hence no additional
financial burden to the State. A 10 days training have already
been imparted to them and now these family planning methods
have already been given to them. And secondly, we should have
certain incentives. I would like to suggest a system of having
Green Card holders. We can give them priority in employment,
housing, self employment projects, PCO, loans, permits for transport,
and daily commodities at subsidized rates. We have already surplus
foodgrains so we can think of giving it on subsidized rates
to promote the small family norm. These are certain suggestions
for consideration. |
|
Shri
Kuldeep Ranka, DM, Jaisalmer |
|
Sir, I would like to discuss about some of the issues related
to gender in family planning. My friends have talked about contraceptives.
Contraceptives are readily available everywhere but there is
a problem of disposal of contraceptives. In fact, women would
like to go in for some specific methods. In case we can have
injectibles instead of contraceptives it is better. I recently
learnt from Dr. Kothari of ICMR that Bangladesh has successfully
tried this and population growth has been controlled due to
the use of injectibles. If we can have that system probably,
it is much easier to use and also it does not have any syndrome
of using family planning method. It is very difficult to identify
whether injectibles are linked to family planning or not. Secondly,
Sir, women in the rural areas especially in the district like
Jaisalmer where minority community is in great proportion, have
a socially regressive structure. There normally sterilisation
is adopted by women. I interacted with lot of medical and health
workers, anganwadi workers and women and I asked them why women
would undergo sterilisation, why not the male. Their normal
reaction was that men would get weaker. I said it is wrong you
can also be weak. They also said that it looks bad if a woman
sits home while man undergoes operation. After some more persuasion,
I came to know that the sterilization of men gets failed after
some time and if a woman gets conceived, then she has to face
the social humility and if the sterilisation of women gets failed
then there is no problem because it remains in the womb and
they can see it. So this social stigma is still there. So we
should have semen checking after the sterilisation is carried
out for males. This will in no way help the people to understand
that it is not foolproof. But it would certainly help in understanding
that male can also undergo sterilization.
|
|
Then,
Sir, coming to Jaisalmer in particular, the area of Jaisalmer
district is about 38 thousand sq. kms. Now whatever developmental
indicators we consider, whether it is access to safe drinking
water, access to pucca roads or any medical or health infrastructure,
it is very poor. Because all our policies take population as
one of the criterion, whether it is safe drinking water, whether
it is Rajiv Gandhi Drinking Water Mission or whether it is Pradhan
Mantri Gramodaya Sadak Yojana, in all the schemes, we have to
take population as a central criteria. In districts like Jaisalmer
or Barmer, which we have seen prominently in various transparencies,
unless we take the distance factor into account, not much can
be achieved in the population control area. I think another
interesting feature which was shown in the transparency was
that though the female literacy rate has increased three times
in just ten years in Jaisalmer district and male literacy rate
by about 1.5 times, the population growth rate has again increased
over the last decade and it is one of the highest in Rajasthan
even now. So we have to take into account other factors. The
demand may be there in the rural areas but unless we cover it
with quality services, unless people get these services at reasonable
distances, unless they have access to medical staff, who are
behaviorally oriented for fulfilling the needs, I think we cannot
achieve the goal of population stabilization. Apart from District
Magistrates, health workers, medical officers, whether Govt.
sector or the private sector, they have to be involved, their
behavior has to be changed. When a person comes to them for
sterilization, he should not be refused on the ground that I
have this problem today, you come after one week. Because a
person who travels 40 km or 60 km, spends one day of wage and
spends 100 rupees, 200 rupees or 500 rupees on transportation,
probably cannot afford that. So service should be provided at
the will of the customer. We are living in today’s global
trade concept so I think, this is where we have to work very
hard and I think one better way would be to involve the private
sector in this. The Govt. has its own limitations, its reach
cannot be extended everywhere. If we can think of something
where family planning can become commercially viable, then probably
the private sector can participate in far-flung areas also and
better results can come out. |
|
Shri
K. Moses Chalai, Deputy Commissioner, Temenglong, Manipur |
|
There is a very high growth of population in my district after
1971. the concept and changes in the minds of the people are
coming for small family sizes. In most part of the state it
is true that the small size of family means two plus three or
four. But it is perhaps better than two plus seven or eight.
One of the problems that we find is that the issue of population
control measures is not really focussed as it should be. We
need to focus very strong IEC campaign holding camps to reach
out to the people. In many districts, it was noticed that the
concept of population control is against the religious sentiments
which has to be presented and shown in right perspective.
|
|
My district is not a big district but it becomes really huge
because of very bad communication because to reach some places
it takes 2-3 days. Mission of population control in such districts
can only be successful if TB and Leprosy kind of dedicated mission
approach is adopted. Actual execution really needs to go on
to the district. There is no continuity of doctor at place of
posting in my district. We need to train only those doctors
who are really keen to stay at a place for at least 3-4 years.
Easy availability of contraceptives is, of course, one area
where much needs to be done and the involvement of NGOs should
go a long way. There are 16-government doctors in my district
concentrated mainly at district headquarter and sub-division.
|
|
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|
Mrs.
Krishna Singh, Member Secretary, NCP |
| |
| I
have communicated to all the District Magistrates about updating
the data relating to 13 indicators that are being referred to
and we have received replies from about 60 DMs. Nutrition, drinking
water, rural connectivity etc. continue to remain the key issues.
We are not confining our attention only to a single item say
birth order of 3 and above. At the end of the conference, we
will bring for your consideration a set of indicators covering
a broad spectrum of social, economic and demographic issues.
After your approval, it will be our endeavour to seek your assistance
and suggestions for regular collection and updating of information
with regard to these generally accepted indicators. |
| |
| Ms.
Rami Chhabra, Member, NCP |
| |
| I
want to highlight a few points on the work within the system
and outside the system. Now there is universal awareness about
family planning. This has to be linked with the main issue of
quality services being reached out to people in a humane and
compassionate manner. I completely share the perception of Ms.
Krishna Singh Member Secretary, NCP about the need for monitoring
of 13 indicators.
|
|
| I
also feel that the terminology of BIMARU States needs to be
changed. The districts that are represented here have a very
disproportionate incidence of higher birth order. To ensure
delivery of quality services, both terminal and non-terminal
methods, on an on-going basis is a challenge that we have to
consider very strongly. There are huge gaps in the infrastructure
and you must bother to fill these infrastructural gaps and maximize
the efficiency of the existing infrastructure.
|
|
| If
literacy is brought to the people, if rural development is brought
and if other departments carry out their part, then the target
of family planning will automatically be achieved. We cannot
turn Anganwadi workers into simple depot holders or can they
take over the responsibilities of the ANMs. You have to work
on convergence in a way that get your ANM to move in and support
village level workers.
|
|
| I
remember going to Gandhigram and seeing a famous retired lady
– Dr. Kaushalya, whose family planning centre at that
time was known for hundreds of miles around Annamalai. She had
put up bamboo poles and thatched roofs. Having performed an
operation in the most sterile conditions, inside an operation
theatre, she used to allow women after first 12 hours or so
to move into a shade where they could lie on the floor on bamboo
chicks and have family members coming to attend them. The budget
that was given for feeding in a hospital with bread, milk and
egg was sufficient to cover sambhar and rice that those people
wanted. It became virtually the only help to people who came
there from distant places. That is the perfect medical services
which could link people with such type of places.
|
| |
| Dr
S. C. Gulati, IEG, Delhi |
| |
| Emphasis
has already been made on the third and higher order births.
We have taken out only 133 districts on the basis of 13 indicators.
The kind of indicators and the monitoring of the RCH programmes
has to be done decentralized and you have to prioritize those
indicators in your own district in your own manner because nutrition
may not be a problem in Punjab but may be so somewhere in U.P.
Delhi situation cannot be interpreted in the form of female
foeticides. Juvenile sex ratio has also gone down in Gujarat
and Maharashtra. Kerala has already gone down in juvenile sex
ratio. We have conducted lot of services in U.P., particularly
in Muslim dominated areas. Some people are talking about disincentives
and incentives which may be justified in a certain manner. RCH
services should not be done at the cost of family planning and
we should not go only by 3+ birth indicators.
|
| |
| Shri
R. C. Joshi, Institute for Media Communication |
| |
| I
would like to draw attention to the vital role of mass education
– based on my association with family planning mass education
since its evolution in 1964. Due to limitation of resources
we could never mount a high powered “Frequency & Reach”
campaign. A “Frequency & Reach” campaign is
woven around a central theme and motif – a symbol to identify
the programme and a meaningful slogan which may quickly reach
into the minds of the people. It has been proved, repeatedly,
that the impact of one meaningful motif and message, communicated
repeatedly, is much greater than many messages, communicated
– sporadically.
|
|
In
1964 the FP programme had no media set up. Pretested multi-media
campaigns were, however, launched during 1964-65 by mobilizing
the resources available with other organizations. These campaigns
brought about a spurt in FP adoption. This stimulated approval
of a broad based multi-media Family Planning Mass Education
programme and setting up of a Mass Education Media Division
in the new Department of Family Planning in March 1966. |
|
| A
broad based multimedia campaign was then attempted in December
1966. At that time the birth rate was around 40 and the goal
was to bring it down to 25, as early as possible. The data indicated
that of the 40 children per 1,000 population then born in a
year, the first child to a couple accounted for 9, the second
for 8 and the third fo 7 children. The remaining 16 being the
4th, 5th and other children. Thus, if no one had more than 3
children, the birth rate would come down to 24. |
|
The
available studies indicated that of the couples already having
3 children, only 10 percent wanted another child now. The doctor
was respected and associated with giving the right advice. The
emphasis being on limitation, the slogan “2 or 3 children
enough - Accept the doctor’s advice” was coined,
pretested and adopted. |
|
| After
much debate the equilateral inverted ‘Red Triangle”
was adopted as the ‘symbol’ for family planning
– since in could be called by name, is easy to draw, had
no previous connotation and with repeated use could be made
to represent family planning. The red color was chosen as in
the Indian context, it is associated with auspiciousness and
gaiety, and in modern context, with danger and stop.
|
|
| An
in depth review of the programme reveals that other things remaining
more or less same, the ups and downs of family planning adoption
and birth rate decline are related to the ups and downs of effective
mass education. This hypothesis is confirmed by the impact of
the broad based multimedia campaign specially harnessing Radio,
TV and Film - launched during 1983-84 to promote spacing.
|
|
After
the emergency backlash India’s birth rate had revolved
around 33 - 33.9 during the 7 years 1977 – 1983. The 1983
- 84 multimedia campaign to promote spacing – “Doosara
Bachcha Teen Saal Baad” = “Second child after three
years” – (followed by the advice use Nirodh or adopt
Copper-T or the Pill) contributed to the birth rate dropping
from 33.9 in 1984 to 32.9 in 1985 – a drop of 1 point
in one year !
|
|
| Shri
Joshi pointed out that the first child of is desired early to
prove “normalcy”. Out of the eight couples having
their second child, if only one fourth decide to wait for one
year the birth rate in that year would come down by 2 points
and so on. Thus really effective promotion and adoption of the
spacing methods can bring down the birth rate dramatically. |
| |
| Prof.
S. Chakraborty, IIM, Lucknow |
| |
| Primarily
based on my little experience working with colleagues in U.P.
both in bureaucracy and in the PMS Department of U.P., I feel
that the matter of convergence in service delivery is an extremely
important matter and my experience suggest that we perhaps need
to do some more home work when it comes to actual delivery mechanism
at various districts. DM is the only person in the district,
who is interested in the integrated services, everybody else
is departmental employee. The point is to bring out people from
their extreme departmental mentality to an integrated mentality.
I stress on this very important aspect which I feel is the issue
of convergence. Other point I would like to submit for your
consideration is the subject of population, because by default
it has become a subject of medical department. I do not think
that family planning is a branch of medicine or population is
a disease which can be cured through only looks. It is much
more than that. Now, the question is whose subject is population,
who actually handles it when it comes to the crunch. It needs
to be looked at. |
|
| We
have been talking about participation of the community, panchayat
and whosoever else. We need to work regarding quality of participation
which is perhaps crucial. Another point is regarding private-public
partnership. I have recently completed a study sponsored by
the World Bank on the “Dynamic Structure of Private Health
Care in India” with special emphasis on UP. In my study,
it was found particularly in urban areas that private sector
is present in a fairly significant manner. There are certain
resources available with the private sector and they seem to
be willing to participate with the public sector. Whether partnership
is with an NGO or with other agencies.
|
|
| I
feel, there is need of looking at the most critical layer of
the mind set, the layer at which things get looked at, is the
layer of daily activities i.e. what should be done by X and
what should be done by Y. Unless there is fairly close watch
on the mind set, daily activities are not sustainable and also
the management control system of one particular sector can hardly
be imposed on the other sector. Each sector has its strength
because of its own system. How best we can exploit that strength
and make it composite for better services should really be of
concern.
|
| |
| Ms.
Asha Das, Secretary, Social Justice & Empowerment |
| |
| All
the aspects connected with the population control have been
brought out and also the linkages between population control
and issues such as health care, mortality rate, nutritional
status, literacy levels, sanitation and productivity. My predecessors
also mentioned convergence problems which are of immense importance.
The services that are available today are our problem areas
on account of the fact that a large number of services are available
but they do not reach people who need them. I feel that we should
ensure that the population control takes place at a sustained
level and on a long-term basis these issues are sorted out.
It requires a lot of initiatives and concerns by all the collectors.
The grass root level workers which includes local bodies, the
NGOs and other organizations are the basis of providing services.
Those who do not have access to education, who do not really
live in a healthy environment can be guaranteed basic minimum
health care facilities so that productivity increases. In the
ministry of social justice and empowerment, we deal with most
of these basic issues and categories which need to be targeted
more than others. The schedule castes, the weaker sections like
minority, backward classes, those below poverty line and/or
very close to poverty line are the ones which we have to target.
We need to be aware of the programmes which need to be pursued
in a concerted manner at the grass root level. We can evaluate
and formulate schemes and send them to the states or districts,
we can ask NGOs in an adhoc manner and implement the programme.
But unless and until the concerted effort at your level (DMs
level) is made to reach out to these people, we will not be
in a position to reach a healthy environment leading to population
control on a long term basis.
|
|
Therefore,
I take this opportunity to mention some of the schemes of our
Ministry which have a direct bearing on the quality of life
and the status of the families. To begin with 5% of the population
in the country suffers from disability, out of it 70% is preventive.
We would like you to take on some of the programmes that we
have with regard to disability. Disability is one area where
we would like you to take specifically because it can be prevented
through the ICDS infrastructure and also through disseminating
information through the Panchayati Raj Institutions (PRIs).
During last one year, we have introduced a couple of new programmes.
One is the scheme for aid and appliance which is an ongoing
programme and we have written to every district to organize
special programmes/ camps to provide aids and appliances. Secondly,
we have set up about 107 district centres out of which only
25 have become operational meant to providing rehabilitation
and composite rehabilitation centres. I am sure, some of you
are already aware of these. The other important scheme which
we have been implementing is on the scavenging. This practice
is continuing and rampant in the entire country and it has impact
on the pollution, on the intake that we have and on the health
and status of the people apart from the fact that it affects
the dignity of the people who do the work. We have modified
this scheme to rehabilitate through formation of groups and
money is available through cooperation as loan and as subsidy
to fund them to set up alternate jobs. Scavenging per se cannot
be eradicated unless and until the programmes for providing
sanitation or latrines construction are taken up in right earnest
and that would require conversion of wet into dry latrines and
rural sanitation programme to be converged. Removal of scavenging
also requires that in your areas you formulate rules and ensure
that any construction now coming up in rural and urban areas
will have a latrine which is constructed along with the house.
It will not only have impact on reducing disability, but also
help to reduce mortality both infant and maternal and increase
the productivity improving the health status of the people who
live there. |
|
| We
implement our programmes through about 300 NGOs for development
of SCs, minorities, backward classes as also for the areas of
social defence for children. Last year, we had sent district-wise
list of all NGOs funded by us and the amounts given to all district
collectors. I do not expect, to get response from large number
of them, practically very few have responded. But we do expect
once we have circulated the list, you will be interested in
ensuring that the organizations function well, the money given
to them are properly utilized, you will ask your officer to
see them and give us feedback so that we can see that the money
is spent for the people that is meant for. We have about 70
organizations whom we inspected ourselves with the help of others.
Large number of them was found to be not providing services.
But we are taking remedial steps. |
|
| I
will be sending a list again and I would request you to see
that they are inspected and to send us report if they are not
performing very well. We have programmes for scholarships. One
of the basic reasons for controlling population is the co-relation
between literacy levels and the population. We have a large
number of programmes for SCs and backward classes giving scholarships
to pre metric and post metric level, the money is made available
to State Governments. Unfortunately, we are always getting reports
that they are not being disbursed in time and students get them
when the entire academic year is over. I would be grateful if
you would look into this also. |
|
| We
have corporations for extending financial help to all categories
of SCs, handicapped, minorities and backward classes. I would
request you to prepare projects within your jurisdiction for
upgrading the status and income levels of the poorer segments
and while tying them up with subsidies available to you and
various other schemes to take loan portion from respective corporations
that we have. We have circulated a note to all of you about
the same. |
| |
| Dr.
K. Venkatsubramanian, Member, Planning Commission |
| |
| I
will be very brief though I am a Professor who used to speak
for hours. But now my role is different. I want to be specific
and to the point. Ms. Asha Das, Secretary, Social Justice &
Empowerment who spoke before me has made my job easier. She
made very elaborate remarks which we must bear in mind. I am
not going to talk about unmet needs of population stabilization
in sustainable development as the pillars of development, these
are all known to you. I want you to take immediate action. I
want you to be men of action. While I was studying in Columbia
University for my Ph.D. in Economics, I found a beautiful line
in American Airforce – if a thing is difficult, it can
be done at once; if it is impossible, it takes a little time
to accomplish. So, that must be our spirit, we must go ahead. |
|
| There
should be dedication to your programmes. You must be convinced
why education comes first. If you educate one lady, the lady
will automatically say, “I do not want more child. There
is a quotation “Son is a son till he gets his wife and
daughter is a daughter throughout her life”.
|
|
My
advise would be just have little conferences at village level
with womens’ groups. This will do more and it will not
cost more. For small conferences at district, block and panchayat
level, Planning Commission will give you grant. I have seen
100% literacy in Pondicherry. This is because we had made compulsory
for every lady to join the adult literacy camp. Finally, I will
say that the main job is to get all the girl children educated. |
|
| I
would like to offer a clarification on BIMARU. BIMARU is not
a bad term. Bihar has contributed something excellent to India.
Ashoka came from Bihar, Dr. Rajendra Prasad came from Bihar,
Budha was produced by Bihar etc. We can run quite a bit slow.
Therefore, BIMARU is a term of challenge and let us pray for
the welfare of the great country which produced great things
and great ideas. |
| |
| Dr.
K. Srinivasan, Population Foundation of India |
| |
| This
has been one of the most enlightening conferences which I have
attended because within a short time, I was able to catch up
the type of problems, the type of bureaucratic and political
constraints that you face in your districts and even within
these constraints the type of innovative programmes that you
have introduced in your districts during the last few years
are interesting. Whatever progress has been achieved so far
are against so many odds. This should be a beginning of some
type of close and regular interaction with the DMs. I think
we should have the common objective of improving conditions
of people in this country. We should put our shoulders together
and I am sure that this type of conference convened regularly
can serve the purpose of not only exchange of ideas on problems
but also monitoring the progress of these districts. Let me
thank the NCP, Shri Pantji, who spent the whole of the forenoon
with great interest and taking down notes of the suggestion
that you were telling. I thank member of the planning commission
Dr. K. Venkatsubramanian, Members of the NCP, Ms. Seema Rizvi
the Minister of State, Govt. of U.P., all DMs and representatives
from districts and also the media. |
| |
|
|
|
| |
|
| |
| List
of Participants at DMs Conference |
| |
S.
No. |
Name
& Designation |
Name
of Organization/State/District |
1. |
Sh.K.C.Pant,
Vice Chairman |
National
Commission on Population |
2. |
Dr.
K.Venkatasubramanian, Member |
Planning
Commission |
3. |
Ms.
Seema Rizvi, Member |
National
Commission on Population |
4. |
Dr.
D.N.Tewari, Member |
Planning
Commission |
5. |
Sh.R.Srinivasan,
Member |
National
Commission on Population |
6. |
Ms.
Rami Chhabra, Member |
National
Commission on Population |
7. |
Shri
Narender Mohan, MP, Member |
National
Commission on Population |
8. |
Ms.
Krishna Singh, Member Secretary |
National
Commission on Population |
9. |
Sh.V.Asokan,
Director |
National
Commission on Population |
10. |
Sh.
R.K. Parmar, Under Secretary |
National
Commission on Population |
11. |
Sh.C.S.Mishra,
Research Officer |
National
Commission on Population |
12 |
Sh.J.K.Banthia |
Registrar
General India |
13. |
Ms.
Asha Das, Secretary |
Social
Justice and Empowerment |
14. |
Sh.
S.K.Naik, Secretary |
Min.
of Tribal affairs |
15. |
Smt.
Shailja Chandra, Secretary |
ISM&H
|
16 |
Sh.
K. Narayanan Unni, Dy. RGI |
Office
of RGI |
17. |
Dr.S.C.Srivastava,
Director |
Deptt.
Family Welfare |
18. |
Sh.M.N.Sinha,
DS, |
D/o
Family Welfare Govt.of India |
19. |
Sh.G.H.Ratra,
US, |
D/o
Elementary Education |
20. |
Ms.
Alka Aggarwal, Technical Director |
NIC,
Planning Commission |
21. |
Sh.
Pooran Singh, Sr. Geographer |
Office
of RGI |
22. |
Sh.
Dinesh, Geographer |
Office
of RGI |
23 |
Dr.
R.P.Singh, Assistant RGI |
Office
of RGI |
24 |
Dr.
Padam Singh, Additional D.G. |
ICMR
|
25 |
Dr.
B.N.Saxena, Research Professor |
Centre
for Policy Research |
26 |
Ms.
Nina Puri, President |
Family
Planning Association of India |
27 |
Sh.
Rajendra C. Joshi, Vice President |
Institute
for Media Communication |
28. |
Dr.
M.C.Kapilashrami, Director |
National
Institute of Health and Family Welfare |
29 |
Dr.
K.Srinivasan, Executive Director |
Population
Foundation of India |
30. |
Dr.
S.C.Gulati, Director |
Population
Reseach Centre, Delhi |
31. |
Dr.Charan
D.Wadhwa, Officiating President |
Centre
for Policy Research, New Delhi |
32. |
Prof.
S.Chakraborty, Dean |
IIM,
Lucknow |
33. |
Mrs.
Ranbir Gujaral, Secretary |
Indian
Nursing Council, |
34. |
Sh.
S.M.Shah Nawaz, Editor |
Mustaqbil,
New Delhi |
35. |
Ms.
Revati |
NDTV,
New Delhi |
36. |
Sh.
Dev Prakash, |
Press
Information Bureau, New Delhi |
37. |
Sh.
Palash Kumar |
AFP |
38. |
Ms.Monika
S. Garg, DM |
Rampur,
U.P. |
39. |
Dr.
P.N.Shukla CMO |
Hamirpur,
U.P. |
40. |
Sh.
Rohit Kansal, DC |
Budgaon,
J&K |
41. |
Dr.
M.A.Baig, CMO |
Maharajganj,
U.P. |
42. |
Sh.
J.D.Sangma, ADM |
South
Garo Hills, Meghalaya |
43 |
Sh.B.Lingdoh,
DC |
West
Khasi Hills, Meghalaya |
44. |
Sh.S.N.Marak,
ADM |
Ri-Bhoi,
Meghalaya |
45. |
Sh.A.K.Awasthi,
DM |
Meerut,
U.P. |
46. |
Sh.
Deepak Trivedi, DM |
Saharanpur,
U.P. |
47. |
Dr.
Kashi Ram, Dy.CMO |
Mahoba,
U.P. |
48. |
Sh.R.J.Swarnkar |
Hathras,
U.P. |
49. |
Dr.S.C.Pandey,
CMO |
Bhadohi,
U.P. |
50. |
Dr.C.K.Gupta,
CMO |
Hardoi,
U.P. |
51. |
Dr.Daya
Prakash, CMO |
Farrukhabad,
U.P. |
52. |
Dr.M.M.Sethi,
Dy. CMO |
Banaras,
U.P. |
53. |
Dr.P.N.Singh,
CMO |
Mau,
U.P. |
54. |
Dr.Y.S.Sachan,
Dy.CMO |
Fatehpur,
U.P. |
55. |
Sh.R.N.Tripathi,
DM |
Azamgarh,
U.P. |
56. |
Ms.
Dimple Verma, DM |
Bulandshahar,
U.P. |
57. |
Sh.Ram
Chandra, Addl.DM |
Bahraich,
U.P. |
58. |
Sh.R.R.Upadhyay,
DM |
Badaun,
U.P. |
59. |
Dr.S.Aier,
Coordinator |
SPC,
Nagaland |
60. |
Sh.V.Sakhil,
Secretary |
H
& FW, Nagaland |
61. |
Sh.Talitemjen,
Addl. Chief Secretary & Commissioner |
Nagaland |
62. |
Sh.Rama
Shankar Singh |
Bijnour,
U.P. |
63. |
Sh.C.N.Dubey |
Lalitpur,
U.P. |
64. |
Sh.Sabha
Raj Singh, DM |
Kanpur
Dehat, U.P. |
65. |
Sh.G.N.Mishra,
DHBIO |
Kanpur
Dehat, U.P. |
66. |
Sh.
Varesh Kumar, DM |
Mainpuri,
U.P. |
67. |
Sh.
Manoj Kumar Singh, DM |
Philibhit,
U.P. |
68. |
Sh.
Manoj Kumar, DM |
Muzaffarnagar,
U.P. |
69. |
Dr.
Rajneesh Gupta, DM |
Ferozabad,
U.P. |
70. |
Sh.R.C.Mandal,
CMO |
Katihar,
Bihar |
71. |
Dr.
Ram Yash Ram, CMO |
Madhubani,
Bihar |
72. |
Dr.G.K.Vishwakarma,
DTO |
Gonda,
U.P. |
73. |
Dr.
Umesh Kumar, Dy.CMO |
Pratapgarh,
U.P. |
74. |
Sh.
Laxmi Kant Shukla, CDO |
Basti,
U.P. |
75. |
Dr.R.N.Pandeya,
Distt. RCH Officer |
Lohardaga,
Jharkand |
76. |
Sh.
Waseem Akhtar, Collector |
Jhabua,
M.P. |
77. |
Ms.
Shashi Jain, Spl Commissioner |
M.P. |
78. |
Sh.S.N.Mishra,
Collector |
Sidhi,
M.P. |
79. |
Dr.O.P.Tiwari,
DIO |
Deptt.
of Health, Jhabua, M.P. |
80. |
Sh.
Amrit Abhijit, CDO |
Mathura,
U.P. |
81. |
Sh.
Keshav Chandra, Dy. Commissioner |
Lower
Subansiri, Arunachal Pradesh |
82. |
Sh.
Chandra Bhushan, Dy. Commissioner |
East
Kameng, Arunachal Pradesh |
83. |
Sh.
Sajjan Singh Yadav, Dy. Commissioner |
Tewang,
Arunachal Pradesh |
84. |
Sh.
Kumar Dulom |
Arunachal
Bhavan, New Delhi |
85. |
Sh.D.S.Hazarika,
OSD |
Assam
Bhawan, New Delhi |
86. |
Sh.R.K.Varma,
Addl.Res.Commissioner |
Uttaranchal |
87. |
Sh.H.C.Joshi,
DM |
Haridwar,
Uttaranchal |
88. |
Dr.S.P.Singh,
CMO, |
Haridwar,
Uttaranchal |
89. |
Sh.K.Moses
Chalai, Dy. Commissioner |
Tamanglong,
Manipur |
90. |
Dr.S.R.Singh,
Dir (FW) |
Manipur |
91. |
Sh.L.Gangte,
Commissioner (FW) |
Manipur |
92. |
Sh.Anand
Kumar, Collector |
Dholpur,
Rajasthan |
93. |
Sh.
Kuldeep Ranka, Collector |
Jaisalmer,
Rajasthan |
94. |
Sh.M.S.Khan,
Collector |
Sikar,
Rajasthan |
95. |
Sh.
Shikhar Aggarwal, Collector |
Jalore,
Rajasthan |
96. |
Sh.
Tanmay Kumar, Collector |
Alwar,
Rajasthan |
97. |
Sh.
Rajat Mishra, Collector |
Jodhpur,
Rajasthan |
98. |
Sh.
Moolchand Arya, Collector |
Barmer,
Rajasthan |
99. |
Sh.R.C.Bora,
CM&HO |
Barmer,
Rajasthan |
100. |
Sh.A.P.Singh,
DC |
Hazaribagh,
Jharkhand |
101. |
Sh.Satendra
Singh, DC |
Giridih,
Jharkhand |
|
|
| |
| Resolution
adopted at the Conference of District Magistrates held on 11.4.2001
at Vigyan Bhavan, New Delhi |
| |
The
Conference of District Magistrates convened by the National
Commission on Population unanimously resolved to take effective
measures to achieve the socio-demographic goals outlined in
the National Population Policy-2000 with special emphasis: |
|
| i) |
|
To
vigorously promote the small family norm using all available
means of communication and fully meet the unmet needs
for basic reproductive and child health services with
a view to reach the replacement level of fertility at
the earliest; |
| ii) |
|
To
improve the quality of life of the people by providing
basic needs like drinking water, sanitations, supplementary
nutrition and rural roads; |
| iii) |
|
To
increase the level of literacy and make education upto
14 years free and compulsory; |
| iv) |
|
To
achieve 100 percent registration of births, deaths and
marriages; |
| v) |
|
To
achieve universal immunization of children against all
vaccine preventable diseases; |
| vi) |
|
To
devise special strategies for dealing with problems relating
to minorities, tribals, slum dwellers and other disadvantaged/deprived
sections; |
| vii) |
|
To improve the monitoring of the implementation of various
programmes related to population stabilization and assist
the NCP/State Commission on Population in collecting reliable
statistics on social, economic and demographic indicators;
and |
| viii) |
|
To
make every citizen feel that the above agenda leads to
definite development. |
| |
|
|
|
MONITORING
OF SOCIAL, ECONOMIC AND DEMOGRAPHIC INDICATORS HAVING A BEARING
ON POPULATION STABILISATION |
| |
In addition to the information/data made available by the Central
Departments/State Governments, the National Commission of Population
is interested to collect statistics through direct linkages
to the district/block/village level administrations in respect
of the following indicators. |
|
| 1. |
|
Total
Fertility Rate |
| 2. |
|
Sex
ratio |
| 3. |
|
Percentage
of couples using Family Planning methods |
| 4. |
|
Child
mortality up to the age of 2 |
| 5. |
|
Maternal
Mortality Rate |
| 6. |
|
Percentage
of women receiving skilled attention during deliveries |
| 7. |
|
Percentage
of children (12-24 months) getting complete immunisation
|
| 8. |
|
Nutritional
status of children below 6 years |
| 9. |
|
Percentage
of girls marrying below 18 years of age |
| 10. |
|
Percentage
of births, deaths and marriages registered |
| 11. |
|
Literacy
rate - males and females |
| 12. |
|
Enrolment
of children in schools up to the age of 14 and the rate
of dropouts |
| 13. |
|
Percentage
of households with safe drinking water and sanitation |
| 14. |
|
Percentage
of villages connected by pucca road |
|
| |
| Proforma
for District Action Plans (DAP) |
| |
| 1. |
|
|
Map
of the District |
| 2. |
|
|
Facts
about the District |
| |
(a) |
|
Area |
| |
(b) |
|
Population
in 1981, 1991 and 2001 |
| |
(c) |
|
Data
relating to 14 Social, Economic and Demographic Indicators |
| |
(d) |
|
Existing
Health &Family Welfare Infrastructure in the District |
| |
(e) |
|
Gaps
in infrastructure and Manpower for providing Health &
Family Welfare services including alternative systems of
medicine such as ISM & H |
| |
(f) |
|
Reasons
for high population growth in the district/sub-district
level formation, urban local bodies, panchayats etc. with
emphasis on special constituents like minorities, tribals
and slum dwellers
|
| 3. |
|
|
Proposed
Action Plan for the District for Population Stabilization
|
| |
|
|
|
| |
(a) |
Indicator |
Current
|
Short |
Medium
|
Long
|
level |
term |
term |
term |
i. |
Total
Fertility Rate |
|
|
|
|
ii. |
Third
and higher order births |
|
|
|
|
iii. |
Couple
protection rate |
|
|
|
|
iv. |
Infant
mortality rate |
|
|
|
|
v. |
Maternal
mortality rate |
|
|
|
|
vi. |
Complete
child immunization |
|
|
|
|
vii. |
Literacy
rate |
|
|
|
|
viii. |
Drinking
water & sanitation facilities |
|
|
|
|
ix. |
Supplementary
nutrition to children below 6 years |
|
|
|
|
x. |
Girls
marrying below 18 years of age |
|
|
|
|
xi. |
Percentage
of birth, death, marriages registered |
|
|
|
|
(b) |
Strategies
for achieving the above objectives - short term,
medium term & long term |
|
|
|
|
(c) |
Implementation
& Monitoring Mechanism with provision for linkage
with the NCP |
|
|
|
|
(d) |
Arrangements
for coordinating and convergence of various service
providers at different levels in the district.
|
|
|
|
|
|
| |
|
|
|
| 4. |
|
|
Summary |
|
PROPOSED
MONITORING SYSTEM |
|
|
|
| National
Population Policy - 2000 |
| |
| Objectives |
| |
The
immediate objective of the NPP 2000 is to address the
unmet needs for contraception, health care infrastructure, and
health personnel, and to provide integrated service delivery
for basic reproductive and child health care. The medium-term
objective is to bring the TFR to replacement levels
by 2010, through vigorous implementation of inter-sectoral operational
strategies. The long-term objective is to achieve
a stable population by 2045, at a level consistent with the
requirements of sustainable economic growth, social development,
and environmental protection. |
|
In
pursuance of these objectives, the following National Socio-Demographic
Goals to be achieved in each case by 2010 are formulated: |
| |
| National
Socio-Demographic Goals for 2010 |
| |
(1) |
|
Address
the unmet needs for basic reproductive and child health
services, supplies and infrastructure. |
(2) |
|
Make
school education up to age 14 free and compulsory, and
reduce drop outs at primary and secondary school levels
to below 20 percent for both boys and girls. |
(3) |
|
Reduce
infant mortality rate to below 30 per 1000 live births.
|
(4) |
|
Reduce
maternal mortality ratio to below 100 per 100,000 live
births. |
(5) |
|
Achieve
universal immunization of children against all vaccine
preventable diseases. |
(6) |
|
Promote
delayed marriage for girls, not earlier than age 18 and
preferably after 20 years of age. |
(7) |
|
Achieve
80 percent institutional deliveries and 100 percent deliveries
by trained persons. |
(8) |
|
Achieve
universal access to information/counseling, and services
for fertility regulation and contraception with a wide
basket of choices. |
(9) |
|
Achieve
100 per cent registration of births, deaths, marriage
and pregnancy. |
(10) |
|
Contain
the spread of Acquired Immunodeficiency Syndrome (AIDS),
and promote greater integration between the management
of Reproductive Tract Infections (RTI) and Sexually Transmitted
Infections (STI) and the National AIDS Control Organisation. |
(11) |
|
Prevent
and control communicable diseases. |
(12) |
|
Integrate
Indian Systems of Medicine (ISM) in the provision of reproductive
and child health services, and in reaching out to households. |
(13) |
|
Promote
vigorously the small family norm to achieve replacement
levels of TFR. |
(14) |
|
Bring
about convergence in implementation of related social
sector programs so that family welfare becomes a people
centred programme. |
|
| |
| Operational
Strategies |
| |
| (i)
Decentralised Planning and Programme Implementation & |
| |
(ii)
Converge Service Delivery at Village Levels |
|
1.
Utilise village self help groups to organise and provide basic
services for reproductive and child health care, combined with
the ongoing Integrated Child Development Scheme (ICDS) Village
self help groups are in existence through centrally sponsored
schemes of: (a) Department of Women and Child Development, Ministry
of HRD, (b) Ministry of Rural Development, and (c) Ministry
of Environment and Forests. Organise neighbourhood acceptor
groups, and provide them with a revolving fund that may be accessed
for income generation activities. The groups may establish rules
of eligibility, interest rates, and accountability for which
capital may be advanced, usually to be repaid in installments
within two years. The repayments may be used to fund another
acceptor group in a nearby community, who would exert pressure
to ensure timely repayments. Two trained birth attendants and
the aanganwadi worker (AWW) should be members of this group.
|
|
2.
Implement at village levels a one-stop integrated and coordinated
service delivery package for basic health care, family planning
and maternal and child health related services, provided by
the community and for the community. Train and motivate the
village self-help acceptor groups to become the primary contact
at household levels. Once every fortnight, these acceptor groups
will meet, and provide at one place 6 different services for
(i) registration of births, deaths, marriage and pregnancy;
(ii) weighing of children under 5 years, and recording the weight
on a standard growth chart; (iii) counseling and advocacy for
contraception, plus free supply of contraceptives; (iv) preventive
care, with availability of basic medicines for common ailments:
antipyretics for fevers, antibiotic ointments for infections,
ORT /ORS1 for childhood diarrhoeas, together with standardised
indigenous medication and homeopathic cures; (v) nutrition supplements;
and (vi) advocacy and encouragement for the continued enrolment
of children in school up to age 14. One health staff, appointed
by the panchayat, will be suitably trained to provide guidance.
Clustering services for women and children at one place and
time at village levels will promote positive interactions in
health benefits and reduce service delivery costs. |
|
3.
Wherever these village self-help groups have not developed for
any reason, community midwives, practitioners of ISMH, retired
school teachers and ex-defence personnel may be organised into
neighbourhood groups to perform similar functions. |
|
4.
At village levels, the aanganwadi centre may become the pivot
of basic health care activities, contraceptive counseling and
supply, nutrition education and supplementation, as well as
pre-school activities. The anganwadi centres can also function
as depots for ORS/basic medicines and contraceptives. |
|
5.
A maternity hut should be established in each village to be
used as the village delivery room, with storage space for supplies
and medicines. It should be adequately equipped with kits for
midwifery, ante-natal care, and delivery; basic medication for
obstetric emergency aid; contraceptives, drugs and medicines
for common ailments; and indigenous medicines/supplies for maternal
and new-born care. The panchayat may appoint a competent and
mature midwife, to look after this village maternity hut. She
may be assisted by volunteers. |
|
6.
Trained birth attendants as well as the vast pool of traditional
dais should be made familiar with emergency and referral procedures.
This will greatly assist the Auxiliary Nurse Midwife (ANM) at
the subcentres to monitor and respond to maternal morbidity/emergencies
at village levels. |
|
7.
Each village may maintain a list of community mid-wives, village
health guides, panchayat sewa sahayaks, trained birth attendants,
practitioners of indigenous systems of medicine, primary school
teachers and other relevant persons, as well as the nearest
institutional health care facilities that may be accessed for
integrated service delivery. These persons may also be helpful
in involving civil society in monitoring availability, quality
and accessibility of reproductive and child health services;
in disseminating education and communication on the benefits
of smaller and healthier families, with emphasis on education
of the girl child; and female participation in the work force. |
|
8. Provide a wider basket of choices in contraception, through
innovative social marketing schemes to reach household levels. |
|
Comment : Meaningful decentralisation
will result only if the convergence of the national family welfare
programme with the ICDS programme is strengthened. The focus
of the ICDS programme on nutrition improvement at village levels
and on pre-school activities must be widened to include maternal
and child health care services. Convergence of several related
activities at service delivery levels with, in particular, the
ICDS programme, is critical for extending outreach and increasing
access to services. Intersectoral coordination with appropriate
training and sensitisation among field functionaries will facilitate
dissemination of integrated reproductive and child health services
to village and household levels. People will willingly cooperate
in the registration of births, deaths, marriages and pregnancies
if they perceive some benefit. At the village level, this community
meeting every fortnight, may become their most convenient access
to basic health care, both for maternal and child health, as
well as for common ailments. Households may participate to receive
integrated service delivery, along with information about ongoing
micro-credit and thrift schemes. Government and non-government
functionaries will be expected to function in harmony to ensure
integrated service delivery. The panchayat will promote this
coordination and exercise effective supervision.
|
| |
(iii) Empowering Women for Improved Health and Nutrition
|
| |
1.
Create an enabling environment for women and children to benefit
from products and services disseminated under the reproductive
and child health programme. Cluster services for women and children
at the same place and time. This promotes positive interactions
in health benefits and reduces service delivery costs. |
|
2.
As a measure to empower women, open more child care centres
in rural areas and in urban slums, where a woman worker may
leave her children in responsible hands. This will encourage
female participation in paid employment, reduce school drop-out
rates, particularly for the girt child, and promote school enrolment
as well. The aanganwadis provide a partial solution.
|
|
3.
To empower women, pursue programmes of social afforestation
to facilitate access to fuelwood and fodder. Similarly, pursue
drinking water schemes for increasing access to potable water.
This will reduce long absences from home, and the need for large
numbers of children to perform such tasks.
|
|
4.
In any reward scheme intended for household levels, priority
may be given to energy saving devices such as solar cookers,
or provision of sanitation facilities, or extension of telephone
lines. This will empower households, in particular women.
|
|
5.
Improve district, sub-district and panchayat-level health management
with coordination and collaboration between district health
officer, sub-district health officer and the panchayat for planning
and implementation activities. There is need to: |
|
 |
|
Strengthen the referral network between the district health
office, district hospital and the community health centres,
the primary health centres and the subcentres in management
of obstetric and neo-natal complications.
|
|
|
Strengthen community health centres to provide comprehensive
emergency obstetric and neo-natal care. These may function
as clinical training centres as well. Strengthen primary
health centres to provide essential obstetric and neo-natal
care. Strengthen subcentres to provide a comprehensive
range of services, with delivery rooms, counseling for
contraception, supplies of free contraceptives, ORS and
basic medicines, together with facilities for immunisation.
|
|
|
Establish rigorous problem identification mechanisms through
maternal and peri-natal audit, from village level upwards. |
|
|
| 6.
Ensure adequate transportation at village level, subcentre levels,
zila parishads, primary health centres and at community health
centres. Identifying women at risk is meaningful only if women
with complications can reach emergency care in time. |
|
7.
Improve the accessibility and quality of maternal and child
health services through: |
|
|
|
Deployment of community mid-wives and additional health
providers at village levels; cluster services for women
and children at the same place and time, from village
level upwards, e.g. ante-natal and post-partum care, monitoring
infant growth, availability of contraceptives and medicine
kits; and routinised immunisations at subcentre levels.
|
|
|
Strengthen the capacity of primary health centres to provide
basic emergency obstetric and neo-natal health care. |
|
|
Strengthen the capacity of primary health centres to provide
basic emergency obstetric and neo-natal health care. |
|
|
Involve
professional agencies in developing and disseminating
training modules for standard procedures in the management
of obstetric and neo-natal cases. The aim should be to
routinise these procedures at all appropriate levels. |
|
|
Improve
supervision by developing guidance and supervision checklists. |
|
|
8.
Monitor performance of maternal and child health services at
each level by using the maternal and child health local area
monitoring system, which includes monitoring the incidence and
coverage of ante-natal visits, deliveries assisted by trained
health care personnel and postnatal visits, among other indicators.
The ANM at the subcentre should be responsible and accountable
for registering every pregnancy and child birth in her jurisdiction,
and for providing universal ante-natal and post-natal services. |
|
| 9.
Improve technical skills of maternal and child health care providers
by: |
|
|
|
Strengthening skills of health personnel and health providers
through classroom and on-the-job training in the management
of obstetric and neo-natal emergencies. This should include
training of birth attendants and community midwives at
district-level hospitals in life-saving skills, such as
management of asphyxia and hypothermia. |
|
|
Training
on integrated management of childhood illnesses for infants
(l week - 2 months). |
|
|
| 10.
Support community activities such as dissemination of IEC material,
including leaflets and posters, and promotion of folk jatras,
songs and dances to promote healthy mother and healthy baby messages,
along with good management practices to ensure safe motherhood,
including early recognition of danger signs. |
|
| 11.
Programme development, comprising: |
|
|
|
Partnership
in family health and nutrition. The aanganwadi worker
will identify women and children in the villages who suffer
from malnutrition and/or micro-nutritional deficiencies,
including iron, vitamin A, and iodine deficiency; provide
nutritional supplements and monitor nutritional status. |
|
|
Convergence,
strengthening, and universalisation of the nutritional
programmes of the Department of Family Welfare and the
ICDS run by the Department of Women and Child Development,
ensuring training and timely supply of food supplements
and medicines. |
|
|
Include
STD/RTI and HIV/AIDS prevention, screening and management,
in maternal and child health services. |
|
|
Provide
quality care in family planning, including information,
increased contraceptive choices for both spacing and terminal
methods, increase access to good quality and affordable
contraceptive supplies and services at diverse delivery
points, counseling about the safety, efficacy and possible
side effects of each method, and appropriate follow-up. |
|
|
12.
Develop a health package for adolescents. |
|
13.
Expand the availability of safe abortion care. Abortion is legal,
but there are barriers limiting women's access to safe abortion
services. Some operational strategies are: |
|
|
|
Community-level education campaigns should target women,
household decision makers and adolescents about the availability
of safe abortion services and the dangers of unsafe abortion.
|
|
|
Make safe and legal abortion services more attractive
to women and household decision makers by (i) increasing
geographic spread; (ii) enhancing affordability; (iii)
ensuring confidentiality and (iv) providing compassionate
abortion care, including post-abortion counseling. |
|
|
Adopt updated and simple technologies that are safe and
easy, e.g. manual vacuum extraction not necessarily dependant
upon anaesthesia, or non-surgical techniques which are
non-invasive. |
|
|
Promote collaborative arrangements with private sector
health professionals, NGOs and the public sector, to increase
the availability and coverage of safe abortion services,
including training of mid-level providers. |
|
|
Eliminate the current cumbersome procedures for registration
of abortion clinics. Simplify and facilitate the establishment
of additional training centres for safe abortions in the
public, private, and NGO sectors. Train these health care
providers in provision of clinical services for safe abortions. |
|
|
Formulate and notify standards for abortion services.
Strengthen enforcement mechanisms at district and sub-district
levels to ensure that these norms are followed.
|
|
|
Follow norms-based registration of service provision centres,
and thereby switch the onus of meticulous observance of
standards onto the provider. |
|
|
Provide competent post-abortion care, including management
of complications and identification of other health needs
of post-abortion patients, and linking with appropriate
services. As part of post-abortion care, physicians may
be trained to provide family planning counseling and services
such as sterilisation, and reversible modern methods such
as lUDs, as well as oral contraceptives and condoms.
|
|
|
Modify syllabus and curricula for medical graduates, as
well as for continuing education and in-house learning,
to provide for practical training in the newer procedures.
|
|
|
Ensure services for termination of pregnancy at primary
health centres and at community health centres.
|
|
|
14.
Develop maternity hospitals at sub-district levels and at community
health centres to function as FRUs for complicated and life-threatening
deliveries. |
|
15.
Formulate and enforce standards for clinical services in the
public, private, and NGO sectors.
|
|
16.
Focus on distribution of non-clinical methods of contraception
(condoms and oral contraceptive pills) through free supply,
social marketing as well as commercial sales.
|
|
17.
Create a national network consisting of public, private and
NGO centres, identified by a common logo, for delivering reproductive
and child health services free to any client. The provider will
be compensated for the service provided, on the basis of a coupon,
duly counter-signed by the beneficiary, and paid for by a system
to be devised. The compensation will be identical to providers
across all sectors. The end-user will choose the provider of
the service. A group of management experts will devise checks
and balances to prevent misuse. |
| |
| (iv)
Child Health and Survival |
| |
1.
Support community activities, from village level upwards to
monitor early and adequate antenatal, natal and post-natal care.
Focus attention on neo-natal health care and nutrition. |
|
2.
Set up a National Technical Committee on neo-natal care, to
align programme and project interventions with newly emerging
technologies in neo-natal and peri-natal care. |
|
3.
Pursue compulsory registration of births in coordination with
the ICDS Programme. |
|
4.
After the birth of a child, provide counseling and advocacy
about contraception, to encourage adoption of a reversible or
a terminal method. This will also contribute to the health and
wellbeing of both mother and child. |
|
5.
Improve capacities at health centres in basic midwifery services,
essential neo-natal care, including the management of sick neo-nates
outside the hospital. |
|
6.
Sensitise and train health personnel in the integrated management
of childhood illnesses. Standard case management of diarrhoea
and acute respiratory infections must be provided at subcentres
and primary health centres, with appropriate training, and adequate
equipment. Besides, training in this sector may be imparted
to health care providers at village levels, especially in indigenous
systems.
|
|
7.
Strengthen critical interventions aimed at bringing about reductions
in maternal malnutrition, morbidity and mortality, by ensuring
availability of supplies and equipment at village levels, and
at sub centres. |
|
8.
Pursue rigorously the pulse polio campaign to eradicate polio. |
|
9.
Ensure 100 percent routine immunisation for all vaccine preventable
diseases, in particular tetanus and measles. |
|
10.
As a child survival initiative, explore promotional and motivational
measures for couples below the poverty line who marry after
the legal age of marriage, to have the first child after the
mother reaches the age of 21, and adopt a terminal method of
contraception after the birth of the second child. |
|
11.
Children form a vulnerable group and certain sub-groups merit
focused attention and intervention, such as street children
and child labourers. Encourage voluntary groups as well as NGOs
to formulate and implement special schemes for these groups
of children. |
|
12.
Explore the feasibility of a national health insurance covering
hospitalisation costs for children below 5 years, whose parents
have adopted the small family norm, and opted for a terminal
method of contraception after the birth of the second child. |
|
13.
Expand the ICDS to include children between 6-9 years of age,
specially to promote and ensure 100 percent school enrolment,
particularly for girls. Promote primary education with the help
of angawadi workers, and encourage retention in school till
age 14. Education promotes awareness, late marriages, small
family size and higher child survival rates. |
|
14.
Provide vocational training for girls. This will enhance perception
of the immediate utility of educating girls, and gradually raise
the average age of marriage. It will also increase enrolment
and retention of girls at primary school, and likely also at
secondary school levels. Involve NGOs, the voluntary sector
and the private sector, as necessary, to target employment opportunities. |
|
(v)
Meeting the Unmet Needs for Family Welfare Services |
|
1.
Strengthen, energise and make publicly accountable the cutting
edge of health infrastructure at the village, subcentre and
primary health centre levels. |
|
2.
Address on priority the different unmet needs detailed in Appendix
IV, in particular, an increase in rural infrastructure, deployment
of sanctioned and appropriately trained health personnel, and
provisioning of essential equipment and drugs. |
|
3.
Formulate and implement innovative social marketing schemes
to provide subsidised products and services in areas where the
existing coverage of the public, private and NGO sectors is
insufficient in order to increase outreach and coverage. |
|
4.
Improve facilities for referral transportation at panchayat,
zilla parishad and primary health centre levels. At subcentres,
provide ANMs with soft loans for purchase of mopeds, to enhance
their mobility. This will increase coverage of ante-natal and
post natal check-ups, which, in turn, and will bring about reductions
in maternal and infant mortality. |
|
5.
Encourage local entrepreneurs at village and block levels to
start ambulance services through special loan schemes, with
appropriate vehicles to facilitate transportation of persons
requiring emergency as well as essential medical attention. |
|
6.
Provide special loan schemes and make site allotments at village
levels to facilitate the starting of chemist shops for basic
medicines and provision for medical first aid. |
|
(vi)
Under-Served Population Groups |
|
(a)
Urban Slums |
|
1.
Finalise a comprehensive urban health care strategy. |
|
2.
Facilitate service delivery centres in urban slums to provide
comprehensive basic health, reproductive and child health services
by NGOs and private sector organisations, including corporate
houses.
|
|
3.
Promote networks of retired government doctors and para-medical
and non-medical personnel who may function as health care providers
for clinical and non-clinical services on remunerative terms.
|
|
4.
Strengthen social marketing programmes for non-clinical family
planning products and services in urban slums. |
|
5.
Initiate specially targeted information, education and communication
campaigns for urban slums on family planning, immunization,
ante-natal, natal and post-natal check-ups and other reproductive
health care services. Integrate aggressive health education
programmes with health and medical care programmes, with emphasis
on environmental health, personal hygiene and healthy habits,
nutrition education and population education.
|
|
6.
Promote inter-sectoral coordination between departments/municipal
bodies dealing with water and sanitation, industry and pollution,
housing, transport, education and nutrition, and women and child
development, to deal with unplanned and uncoordinated settlements.
|
|
7.
Streamline the referral systems and linkages between the primary,
secondary and tertiary levels of health care in the urban areas. |
|
8.
Link the provision of continued facilities to urban slum dwellers
with their observance of the small family norm. |
| |
(b)
Tribal Communities, Hill Area Populations and Displaced and
Migrant Populations |
| |
1.
Many tribal communities are dwindling in numbers, and may not
need fertility regulation. Instead, they may need information
and counseling in respect of infertility. |
|
2.
The NGO sector may be encouraged to formulate and implement
a system of preventive and curative health care that responds
to seasonal variations in the availability of work, income and
food for tribal and hill area communities and migrant and displaced
populations. To begin with, mobile clinics may provide some
degree of regular coverage and outreach. |
|
3.
Many tribal communities are dependent upon indigenous systems
of medicine which necessitates a regular supply of local flora,
fauna and minerals, or of standardised medication derived from
these. Husbandry of such local resources and of preparation
and distribution of standardised formulations should be encouraged. |
|
4.
Health care providers in the public, private and NGOs sectors
should be sensitised to adopt a "burden of disease"
approach to meet the special needs of tribal and hill area communities. |
| |
(c)
Adolescents |
| |
1.
Ensure for adolescents access to information, counseling and
services, including reproductive health services, that are affordable
and accessible. Strengthen primary health centres and subcentres,
to provide counseling, both to adolescents and also to newly
weds (who may also be adolescents). Emphasise proper spacing
of children.
|
|
2.
Provide for adolescents the package of nutritional services
available under the ICDS programme.
|
|
Comment: Improvements in health status
of adolescent girls has an inter-generational impact. It reduces
the risk of low birth weight and minimizes neo-natal mortality.
Malnutrition is a problem that seriously impairs the health
of adolescent and adult women and has its roots in early childhood.
The causal linkages between anaemia and low birth weight, prematurity,
perinatal mortality, and maternal mortality has been extensively
studied and established.
|
|
3.
Enforce the Child Marriage Restraint Act, 1976, to reduce the
incidence of teenage pregnancies. Preventing the marriage of
girls below the legally permissible age of 18 should become
a national concern.
|
|
Comment: It will promote higher retention
of girls at schools, and is also likely to encourage their participation
in the paid work force.
|
|
4.
Provide integrated intervention in pockets with unmet needs
in the urban slums, remote rural areas, border districts and
among tribal populations.
|
| |
(d)
Increased Participation of Men in Planned Parenthood
|
| |
1.
Focus attention on men in the information and education campaigns
to promote the small family norm, and to raise awareness by
emphasising the significant benefits of fewer children, better
spacing, better health and nutrition, and better education.
|
|
2.
Currently, over 97 percent of the sterilisations are tubectomies.
Repopularise vasectomies, in particular the no-scalpel vasectomy,
as a safe, simple, painless procedure, more convenient and acceptable
to men.
|
|
3.
In the continuing education and training at all levels, there
is need to ensure that the noscalpel vasectomy, and all such
emerging techniques and skills are included in the syllabi,
together with abundant practical training. Medical graduates,
arid all those participating in "inservice" continuing
education and training, will be equipped to handle this intervention.
|
| |
(vii)
Diverse Health Care Providers |
| |
1.
At district and sub-district levels, maintain block-wise data
base of private medical practitioners whose credentials may
be certified by the Indian Medical Association (IMA). Explore
the possibility of accrediting these private practitioners for
a year at a time, and assign to each a satellite population,
not exceeding 5,000 (depending upon distances and spread), for
whom they may provide reproductive and child health services.
The private practitioners would be compensated for the services
rendered, through designated agencies. Renewal of contracts
after one year may be guided by client satisfaction. This will
serve as an incentive to expand the coverage and outreach of
high quality health care. Appropriate checks and balances will
safeguard misuse.
|
|
2.
Revive the earlier system of the licensed medical practitioners
who, after appropriate certification from the IMA, may participate
in the provision of clinical services.
|
|
3.
Involve the non-medical fraternity in counseling and advocacy
so as to demystify the national family welfare effort, such
as retired defence personnel, retired school teachers, and other
persons who are active and willing to get involved.
|
|
4.
Modify the under/post-graduate medical, nursing, and paramedical
professional course syllabi and curricula, in consultation with
the Medical Council of India, the Councils of ISMH, and the
Indian Nursing Council, in order to reflect the concepts and
implementation strategies of the reproductive and child health
programme and the national population policy. This will also
be applied to all in-service training and educational curricula
as well.
|
|
5.
Ensure the efficient functioning of the First Referral Units
i.e. 30 bed hospitals at block levels which provide emergency
obstetric and child health care, to bring about reductions in
Maternal Mortality Ratio (MMR) and Infant Mortality Rate (IMR).
In many states, these FRUs are not operational on account of
an acute shortage of specialists i.e. gynaecologist/obstetrician,
anaesthetist, and pediatrician. Augment the availability of
specialists in these three disciplines, by increasing seats
in medical institutions, and simultaneously enable and facilitate
the acquisition of in-service post-graduate qualifications through
the National Board of Medical Examination and open universities
like IGNOU in larger numbers. As an incentive, seats will be
reserved for those in-service medical graduates who are willing
to abide by a bond to serve for 5 years at First Referral Units
after completion of the course. States would need to sanction
posts of Specialists at the FRUs. Further, these specialists
should be provided with clear promotion channels.
|
| |
(viii)
(a) Collaboration with and Commitments from the Non-Government
Sector |
| |
1.
There remain innumerable hurdles that inhibit genuine long-term
collaboration between the government and non-government sectors.
A forum of representatives from government, the non-government
organisations, and the private sector may identify these hurdles,
and prepare guidelines that will facilitate and promote collaborative
arrangements.
|
|
2.
Collaboration with and commitments from NGOs to augment advocacy,
counseling and clinical services, while accessing village levels.
This will require increased clinic outlets as well as mobile
clinics.
|
|
3.
Collaboration between the voluntary sector and the NGOs will
facilitate dissemination of efficient service delivery to village
levels. The guidelines could articulate the role and responsibility
of each sector.
|
|
4.
Encourage the voluntary sector to motivate village-level self-help
groups to participate in community activities.
|
|
5.
Specific collaboration with the non-government sector in the
social marketing of contraceptives to reach village levels will
be encouraged.
|
| |
(viii)
(b) Collaboration with and Commitments from Industry
|
| |
1.
The corporate sector and industry could, for instance, take
on the challenge of strengthening the management information
systems in the seven most deficient states, at primary health
centre and subcentre levels. Introduce electronic data entry
machines to lighten the tedious work load of ANMs and the multi-purpose
workers at subcentres and the doctors at the primary health
centres, while enabling wider coverage and outreach.
|
|
2.
Collaborate with non-government sectors in running professionally
sound advertisement and marketing campaigns for products and
services, targeting all segments of the population, from village
level upwards, in other words, strengthen advocacy and IEC,
including social marketing of contraceptives.
|
|
3.
Provide markets to sustain the income-generating activities
from village levels upwards. In turn, this will ensure consistent
motivation among the community for pursuing health and education-related
community activities.
|
|
4.
Help promote transportation to remote and inaccessible areas
up to village levels. This will greatly assist the coverage
and outreach of social marketing of products and services.
|
|
5.
The social responsibility of the corporate sector in industry
must, at the very minimum, extend to providing preventive reproductive
and child health care for its own employees (if >100 workers
are engaged).
|
|
6.
Create a national network consisting of voluntary, public, private
and non-government health centres, identified by a common logo,
for delivering reproductive and child health services, free
to any client. The provider will be compensated for the service
provided, on the basis of a coupon system, duly counter-signed
by the beneficiary and paid for by a system that will be fully
articulated. The compensation will be identical to providers,
across all sectors. The end user exercises choices in the source
of service delivery. A committee of management experts will
be set up to devise ways of ensuring that this system is not
abused.
|
|
7.
Form a consortium of the voluntary sector, the non-government
sector and the private corporate sector to aid government in
the provision and outreach of basic reproductive and child health
care and basic education.
|
|
8.
In the area of basic education, set up privately run/managed
primary schools for children up to age 14-15. Alternately, if
the schools are set up/managed by the panchayat, the private
corporate sector could provide the mid-day meals, the text -books
and/or the uniforms.
|
| |
(ix)
Mainstreaming Indian Systems of Medicine and Homeopathy
|
| |
1.
Provide appropriate training and orientation in respect of the
RCH programme for the institutionally qualified ISMH medical
practitioners (already educated in midwifery, obstetrics and
gynaecology over 5-1/2 years), and utilise their services to
fill in gaps in manpower at appropriate levels in the health
infrastructure, and at subcentres and primary health centres,
as necessary.
|
|
2.
Utilise the ISMH institutions, dispensaries and hospitals for
health and population related programmes,.
|
|
3.
Disseminate the tried and tested concepts and practices of the
indigenous systems of medicine, together with ISMH medication
at village maternity huts and at household levels for ante-natal
and post-natal care, besides nurture of the newborn.
|
|
4.
Utilise the services of ISMH 'barefoot doctors' after appropriate
training and orientation towards providing advocacy and counseling
for disseminating supplies and equipment, and as depot holders
at village levels.
|
| |
(x)
Contraceptive Technology and Research on RCH
|
| |
1.
Government will encourage, support and advance the pursuit of
medical and social science research on reproductive and child
health, in consultation with ICMR and the network of academic
and research institutions.
|
|
2.
The International Institute of Population Sciences and the Population
Research Centres will continue to review programme and monitoring
indicators to ensure their continued relevance to strategic
goals.
|
|
3.
Government will restructure the Population Research Centres,
if necessary.
|
|
4.
Standards for clinical and non-clinical interventions will be
issued and regularly reviewed.
|
|
5.
A constant review and evaluation of the community needs assessment
approach will be pursued to align programme delivery with good
management practices and with newly emerging technologies.
|
|
6.
A committee of international and Indian experts, voluntary and
non-government organisations and government may be set up to
regularly review and recommend specific incorporation of the
advances in contraceptive technology and, in particular, the
newly emerging techniques, into programme development.
|
| |
(xi)
Providing for the Older Population
|
| |
1.
Sensitize, train and equip rural and urban health centres and
hospitals towards providing geriatric health care.
|
|
2.
Encourage NGOs and voluntary organizations to formulate and
strengthen a series of formal and informal avenues that make
the elderly economically self reliant. |
|
3.
Tax benefits could be explored as an encouragement for children
to look after their aged parents. |
| |
(xii)
Information Education and Communication |
| |
1.
Converge I EC efforts across the social sectors. The two sectors
of Family Welfare and Education have coordinated a mutually
supportive IEC strategy. The Zila Saksharta Samitis design and
deliver joint IEC campaigns in the local idiom, promoting the
cause of literacy as well as family welfare. Optimal use of
folk media has served to successfully mobilize local populations.
The state of Tamil Nadu made exemplary use of the IEC strategy
by spreading the message through every possible media, including
public transport, on mile stones on national high ways as well
as through advertisement and hoardings on roadsides, along city/rural
roads, on billboards, and through processions, films, school
dramas, public meetings, local theatre and folk songs.
|
|
2.
Involve departments of rural development, social welfare, transport,
cooperatives, education with special reference to schools, to
improve clarity and focus of the IEC effort, and to extend coverage
and outreach. Health and population education must be inculcated
from the school levels.
|
|
3.
Fund the nagar palikas, panchayats, NGOs and community organizations
for interactive and participatory IEC activities.
|
|
4.
Demonstration of support by elected leaders, opinion makers,
and religious leaders with close involvement in the reproductive
and child health programme greatly influences the behaviour
and response patterns of individuals and communities. This serves
to enthuse communities to be attentive towards the quality and
coverage of maternal and child health services, including referral
care. Public leaders and film stars could spread widely the
messages of the small family norm, female literacy, delayed
marriages for women, fewer babies, healthier babies, child immunization
and so on. The involvement and enthusiastic participation of
elected leaders will ensure dedicated involvement of administrators
at district and sub-district levels. Demonstration of strong
support to the small family norm, as well as personal example,
by political, community, business, professional, and religious
leaders, media and film stars, sports personalities, and opinion
makers, will enhance its acceptance throughout society.
|
|
5.
Utilise radio and television as the most powerful media for
disseminating relevant sociodemographic messages. Government
could explore the feasibility of appropriate regulations, and
even legislation, if necessary to mandate the broadcast of social
messages during prime time.
|
|
6.
Utilise dairy cooperatives, the public distribution systems,
other established networks like the LIC at district and sub-district
levels for IEC and for distribution of contraceptives and basic
medicines to target infant/childhood diarrhoeas, anaemia and
malnutrition among adolescent girls and pregnant mothers. This
will widen outreach and coverage.
|
|
7.
Sensitise the field level functionaries across diverse sectors
(education, rural development, forest and environment, women
and child development, drinking water mission, cooperatives)
to the strategies, goals and objectives of the population stabilisation
programmes.
|
|
8.
Involve civil society for disseminating information, counseling
and spreading education about the small family norm, the need
for fewer but healthier babies, higher female literacy and later
marriages for women. Civil society could also be of assistance
in monitoring the availability of contraceptives, vaccines and
drugs in rural areas and in urban slums. |
|
|
|
|
 |
|
|
