9th & 10th five year plan

health topics in five year plan

1. FIVE YEAR PLAN ( 9 th AND 10 th ) Prakash Kumar Raul Kumar Patel

2. INTRODUCTION Five Year Plan is defined as any plan for National economic or industrial development specifying goals to be reached within a period of five years. (Random House Dictionary)

3. ORIGIN OF FIVE YEAR PLANS Five year plans were first introduced in the erstwhile Soviet Union in 1928 for controlled and rapid economic development. Much of the Soviet Industrial successes were a result of the implementation of its five year plans. In 1950, India’s prime minister Jawaharlal Nehru, impressed by the soviet system, adopted five year plans as a model for economic development.

4. NINETH (1997-2002) The Ninth Five-Year Plan came after 50 years of Indian Independence. : PM Gujral promise to announce NPP. 2000: draft statement on National Population Policy of 1996 was finally modified and ratified by parliament. 2000: National Population Commission .  The morbidity due to common communicable and nutrition - related diseases continue to be high. Morbidity due to non-communicable diseases was showing a progressive increase because of increasing longevity and alterations in life style. During the Ninth Plan efforts be made to tackle this dual disease burden effectively so that there would sustained improvement in the health status of the population.

5. Current problems faced by the then health care services : The crude death rate (CDR) from 25.1 in 1951 to 9.0 in 1996. Life expectancy rose from 32 years in 1947 to 61.1 years in 1991-96 with female life expectancy (61.7 yr.) higher than the male (60.6 yr.) Persistent gaps in manpower and infrastructure especially at the primary health care level. Suboptimal functioning of the infrastructure; poor referral services . Availability and utilization of services were poorest in the most needy states/districts . Technological advances which widen the spectrum of possible interventions Escalating costs of health care, widening gaps between what is possible and what the individual or the country can afford.

6. Objectives Reduction in the population growth rate. To meet all the felt-needs for contraception. To reduce the infant and maternal morbidity and mortality. Strategies: To assess the needs for reproductive and child health at PHC level and undertake area-specific micro planning. To provide need based, demand-driven, high quality, integrated reproductive and child health care.

7. Efforts directed to improve functional efficiency of the health care system: Creation of a functional, reliable health management information system and training and deployment of health manpower with requisite professional competence Multi professional education to promote team work Skill upgradation of all categories of health personnel Improving operational efficiency through health services research. Increasing awareness of the community through health education. Increasing accountability and responsiveness to health needs of the people by increasing utilisation of the Panchayati Raj institutions in local planning body. Making use of available local and community resources so that operational efficiency and quality of services improve and the services were made more responsive to user's needs.

8. Approach During the Ninth Plan: Implementation of all recommendations by NDC sub committee. Abolished: Method specific targets for family planning. Decentralised planning: based on assessment of community needs. State specific goals: process and impact parameters for maternal and child health and contaceptive care ; used for monitoring progress. I mprove access to, and enhance the quality of, primary health care in urban and rural areas . Quality through up-grading the skills of human resources and referral network. To improve the effectiveness of existing programs for control of communicable diseases. To develop and implement integrated non-communicable disease prevention and control program within the existing health care infrastructure. contd ...

9. To undertake screening for common nutritional deficiencies especially in vulnerable groups and initiate appropriate remedial measures. To strengthen programs for prevention, detection and management of health consequences of the continuing deterioration of the ecosystems . To develop capabilities at all levels for emergency and disaster prevention and management. To ensure effective implementation of the provisions for food and drug safety. To increase the involvement of ISM&H practitioners in meeting the health care needs of the population . To increase the involvement of voluntary, private organizations and self-help groups in the provision of health care. To enable the Panchayati Raj Institutions (PRI) in planning and monitoring of health programs at the local level.

10. New Initiatives in the Ninth 5yr. Plan: Horizontal integration of vertical programs. Develop Disease Surveillance and Response mechanism with focus on rapid recognition,report and response at district level. Develop and implement integrated Non-Communicable Disease control Programme . Health Impact Assessment as a part of environmental impact assessment in developmental projects. Implement appropriate management systems for emergency, disaster, accident and trauma care at all levels of health care. Improve HMIS and logistics of supplies.

11. Operational strategy for the Ninth Plan: State specific strategies Urban Health and Family Welfare Services Involvement of Local Self-Government Institutions Quality and Accountability in Health Care Bio-medical and Health Care Technologies Health Insurance Monitoring mechanism National Education Policy in Health Sciences Education Commission in Health Sciences Universities of Health Sciences Health Manpower Planning http://planningcommission.nic.in/plans/planrel/fiveyr/9th/vol2/v2a3-4.htm#Table 3.4.1 http://planningcommission.nic.in/plans/planrel/fiveyr/9th/vol2/v2c3-4.htm

12. AIM OF TENTH (2002-2007) The primary aim of the 10th Five Year Plan is to renovate the nation extensively, making it competent enough with some of the fastest growing economies across the globe and meet the United Nations Millennium Development Goals (MDG) targets.

13. MILLENNIUM DEVELOPMENT GOALS (MDG) To be achieved by 2015. 189 nations-and signed by 147. 8 MDGs- 21 quantifiable targets- measured by 60 indicators .

14. OBJECTIVES / TARGETS During that period there was high fertility because mainly of: High proportion between reproductive ages High unmet need. High wanted fertility due to high IMR & other socio-economic reasons. Hence the government put the following targets.:: Reduction of poverty ratio by 5 percentage points by 2007 and 15 percent by 2012 . Reduction in gender gaps in literacy and wage rates by at least 50% by 2007. Reduction in the decadal rate of population growth between 2001 and 2011 to 16.2%

15. Increase in Literacy Rates to 75 per cent within the Tenth Plan period (2002 to 2007) Reduction of Infant mortality rate (IMR) to 45 per 1000 live births by 2007 and to 28 by 2012 Reduction of Maternal Mortality Ratio (MMR) to 2 per 1000 live births by 2007 and to 1 by 2012 All villages to have sustained access to potable drinking water within the Plan period Cleaning of all major polluted rivers by 2007 and other notified stretches by 2012

16. FOCUSES DURING TENTH FIVE YEAR PLAN Reorganization and restructuring the existing government health care system including Indian system of Medicine and Homeopathy. Development of appropriate two way referral systems . Building up an efficient and effective logistic system. Improvement in the quality of care at all levels and settings. Evolving treatment protocols for the management of common illness and diseases – promotion of rational, use of diagnostic and drugs.

17. Improving content and health quality of education of health professionals and Para professionals . Skill up gradation of all health care providers through Continuing Medical Education and reorientation programs. Research and development to save major health problems and emerging diseases. Building up a fully functional, accurate health management information system. Building up an effective system of disease surveillance and response to at all levels . Improving the efficiency of the existing health care system in the government, private and voluntary sectors and building up appropriate linkages between them.

18. Increasing the involvement of voluntary and private organization, self help groups and social marketing organization to improve access to health care. Devolution of responsibilities and funds to Panchayati Raj institutions. Improving the safety of the work environment. Developing capabilities at all levels for emergency and disaster prevention and, management effective implementation of the provision for food and drug safety. Screening for common nutritional deficiencies especially in vulnerable groups and initiating appropriate remedial measures.

19. INITIATIVES TAKEN (RURAL AREAS) In the 10th plan health system reforms has been suggested to improve health services that include: Strengthening and appropriately relocating Sub center/ PHCs Merger, restructure, relocating of taluk , sub divisional and rural hospitals, dispensaries and block level PHCs ; integrating them with the existing infrastructure to fill the gap Utilizing fund from the Basic Minimum services , additional central assistance, Pradhan Mantri Gramodaya Yojana to fill critical gaps in manpower and facilities. Easy appointment of Doctors for PHCs Reducing the use of mobile health clinics as they are expensive. Hand over of PHCs to NGOs. Training of MBBS in certain specialties (Obstetric, anesthesia, radiology) to fill the gap in specialist in first referral units.

20. (URBAN AREAS) Urban primary health care institutions providing health and family welfare services to the population within 1-3 Km of dwellings by recognizing the existing institutions and linking them to secondary and tertiary care institutions are envisaged. Secondary health care institutions strengthened by seeking the World Bank loans and building up of referral services in tenth plan. Tertiary health care institutions were suffering from resource crunch. Efforts were made to recover cost from people above the poverty line. This help autonomy and encourage decentralized planning.

21. OTHER INITIATIVES Hospital infection control and waste management incorporated as an essential routine activity in all health care institutions at all levels of care. Horizontal integration of National leprosy elimination and tuberculosis control programs has been initiated. The pace of integration increased for such convergence for other programs also. Rehabilitation of disabled persons Creation of an epidemiological database. Special efforts made for accident and trauma management 2005: RCH II 2005: NRHM :: JSY

22. Objectives reached 1. Primary health centers 23,236 2. Sub centers 146.026 3. Community health centers 3,346 4. Total beds 9,14,530 5. Medical colleges 242 6. Nursing colleges B.Sc.(N) colleges M.Sc.(N) colleges 399 54 7. Nursing Schools ANM Training Schools GNM Training Schools 440 979 8. Annual admissions in medical colleges 26,449 9. Dental colleges 205

23. 12. ANMs 506,925 13. Health visitors 50,393 14. Health workers(f) 133,194 15. Health workers (m) 61,907 16. Block extension educator 2,645 17. Health assistant male 20,181 18. Health assistant female 17,371 19. Village health guides 3.23 Lakh 20. Infant Mortality Rate 34.61/1000 21. Maternal Mortality Rate 4.5/1000 10. Allopathic doctors 767,500 11. Nurses 865,135

24. PROMOTIONAL AND MOTIVATIONAL MEASURES FOR ADOPTION OF THE SMALL FAMILY NORM: Panchayats and Zila Parishads will be rewarded and honoured for exemplary performance in universalising small family norm, achieving reduction in IM & BR. Balilka Samridhi Yojana (Department of Women and Child Development) provide cash incentive of Rs.500 at the birth of the girl child of BR1 or 2 . Maternity Benefit Scheme (Department of Rural Development) provide cash incentive of Rs. 500 to mothers who have their first child after 19 years of age, for BR 1 and 2 child only . A Family Welfare linked Health Insurance plan – Rs. 5000 (for hospitalisation ). Couples below the poverty line will be rewarded for their active involvement in Family Planning activities . A personal accident insurance cover – sterilized spouse. Creches and child care centers were opened in rural and urban slums .

25. A wider and affordable choice of contraceptives- at diverse delivery point Strengthen the facilities of safe abortion. Products and services – affordable through innovative social marketing schemes. Soft loans to local entrepreneurship & encouraged to run ambulance services . Ensures mobility of the ANMs. Increased vocational training schemes for girls, leading to self-employment will be encouraged. Strict enforcement of the Child Marriage Restraint Act, 1976 . Strict enforcement of the Pre-Natal Diagnostic Act, 1994 .

26. Reward for BPL couples for: For marriage after the legal age of marriage Register the marriage First child after the mother reaches the age of 21 Accept the small family norm Adopt a terminal method after the birth of 2 nd child. The 42nd Constitutional amendment : Lok Sabha and Rajya Sabha seats are frozen on the basis of 1971 census were valid up to 2001 that is further extended till 2026. 79th Amendment Bill of 1992 disqualify a person for being a member of either house of legislature of a state, if he/she has more than 2 children.

27. Positive features of policy: “commitment of the government towards voluntary and informed choices and consent of citizens while availing of reproductive health care services, and continuation of the target free approach in administrating family planning services”. Weakness of the policy: Population is not integrated with the health: it has population stabilisation rather than health and well being of the population as a goal. Link the provision of continued facilities to urban slums dwellers with their observance of the small family norms.

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