Minor Project

On
Government Rural Development Schemes: A Study of Health
Schemes

Submitted By,

Bhaskar Singh

Reg. No.- 2010MB15

Semester-1

Under the Kind Supervision

of

Prof. Subroto Biswas

To

School of Management Studies

MNNIT, Allahabad
November,2010

I
 Certificate

This is to certify that the present project titled, “ ” submitted in the School
of Management Studies, Motilal Nehru National Institute Of Technology,
Allahabad has been carried out under my supervision and guidance. And her
present project titled is forwarded for evaluation.

Submitted By Project Super visor Head of Department

Bhaskar Singh Subroto Biswas Dr. Geetika Tripathi

II
 List of Content
1. Acknowledgement
2. Executive Summary
3. Introduction
3.1.Background
3.2.Drawbacks
3.3.History of schemes
3.4.Objectives of research
3.5.Motivation of doing research
3.6.Organisation of Report
3.7.Conclusion
4. Literature Review
4.1.Introduction
4.2.Definition of Indian health
4.3.Health practices in rural India
4.4.Health schemes
4.5.Issues
4.6.Conclusion
5. Research plan
5.1.Introduction
5.2.Research Issues
5.3.Objective of study
5.4.Research objectives
5.5.Scope of study
5.6.Research Methodology
5.7.Concluding Remarks
6. Data Analysis
6.1.Introduction
6.2.Data analysis and interpretation
7. Recommendation and Conclusion

III
List of Tables

IV
List of Figures

V
 Acknowledgement

I am very thankful to everyone who all supported me,for i have completed my

project effectively and moreover on time.
I am equally grateful to my teacher[name].she gave me moral support and
guided me in different matters regarding the topic.she had been very kind and patient
while suggesting me the outlines of this project and correcting my doubts.I thank her
for her overall supports.
Last but not the least, I would like to thank my parents who helped me a lot in
gathering different information, collecting data and guiding me from time to time in
making this project .despite of their busy schedules ,they gave me different ideas in
making this project unique.

Thanking you

VI
Executive Summary
Introduction:-
This minor project primarily deals with the implementation of the Government
health schemes that are operational in rural India, . The healthcare sector is one of India’s
largest public sectors in terms of revenue and employment, with approximately one-fifth of
public expenditure.
The objective of this Report on Rural Health schemes is to examine and address
critical macro issues including identifying barriers and providing options and strategies for
the future. This report is more than a document as it reflects the directions of the government
as developed in a spirit of partnership and mutual respect in the context of the country’s
overall efforts in health development
India’s healthcare infrastructure has failed to keep pace with the nation’s economic
growth. Emerging market conditions and a poor public healthcare system has encouraged a
shift from public to private healthcare, with private healthcare facilities now constituting
more than 80% of healthcare expenditure, including that of those who are poor.

Data Analysis:

Here we are analyzing the raw information what we got in our field visit. Analysis of
data is a process of inspecting, cleaning, transforming, and modelling data with the goal of
highlighting useful information, suggesting conclusions, and supporting decision making.
Data analysis has multiple facets and approaches, encompassing diverse techniques under a
variety of names, in different business, science, and social science domains.
For analyzing the raw data we chose SPSS (Statistical Package for the Social Sciences) as a
tool. The many features of SPSS are accessible via pull-down menus or can be programmed
with a proprietary 4GL command syntax language. Command syntax programming has the
benefits of reproducibility; simplifying repetitive tasks; and handling complex data
manipulations and analyses. Additionally, some complex applications can only be
programmed in syntax and are not accessible through the menu structure. The pull-down
menu interface also generates command syntax, this can be displayed in the output though the
default settings have to be changed to make the syntax visible to the user; or can be pasted
into a syntax file using the "paste" button present in each menu. Programs can be run
interactively or unattended using the supplied Production Job Facility. SPSS places
constraints on internal file structure, data types, data processing and matching files, which
together considerably simplify programming. SPSS datasets have a 2-dimensional table
structure where the rows typically represent cases (such as individuals or households) and the
columns represent measurements (such as age, sex or household income). Only 2 data types
are defined: numeric and text (or "string"). All data processing occurs sequentially case-by-
case through the file. Files can be matched one-to-one and one-to-many, but not many-to-
many.
The graphical user interface has two views which can be toggled by clicking on one
of the two tabs in the bottom left of the SPSS window. The 'Data View' shows a spreadsheet
view of the cases (rows) and variables (columns). Unlike spreadsheets, the data cells can only
contain numbers or text and formulas cannot be stored in these cells. The 'Variable View'

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displays the metadata dictionary where each row represents a variable and shows the variable
name, variable label, value label(s), print width, measurement type and a variety of other
characteristics. Cells in both views can be manually edited, defining the file structure and
allowing data entry without using command syntax. This may be sufficient for small datasets.
Larger datasets such as statistical surveys are more often created in data entry software, or
entered during computer-assisted personal interviewing, by scanning and using optical
character recognition and optical mark recognition software, or by direct capture from online
questionnaires. These datasets are then read into SPSS.
We did the analysis of data in two ways-
 Pie Chart- A pie chart (or a circle graph) is a circular chart divided into
sectors, illustrating proportion. In a pie chart, the arc length of each sector (and
consequently its central angle and area), is proportional to the quantity it
represents. Here we analyze responses versus No. Of cases as shown in the
following pie-charts
 Cross tabulation- Cross tabulation is the process of creating a contingency
table from the multivariate frequency distribution of statistical variables.
Heavily used in survey research, cross tabulations (or crosstabs for short) can
be produced by a range of statistical packages, including some that are
specialised for the task. Survey weights often need to be incorporated. Here
we analyze the impact of education on responses of each question.

VIII
Chapter 1

Introduction

Healthcare funding is an important issue in developing countries. The

healthcare sector is one of India’s largest public sectors in terms of revenue and
employment, with approximately one-fifth of public expenditure.

In recent times, India has experienced a steady decline in infant mortality and
also in some major communicable diseases, such as hepatitis and poliomyelitis
among infants. These improvements have helped the Indian population increase
at an annual rate of 2%. In July 2007, of India’s population of 1,0270,15 247
(males: 5, 312, 77 078 and females: 4, 957, 38169), some 300 million were
living on less than one dollar per day (below the poverty line). The overall
situation in healthcare facilities in India is unfavourable, especially for the
economically disadvantaged. It has often been stated that public healthcare is a
basic service that will assist in combating poverty. Therefore, the Government
of India must acknowledge the importance of public healthcare facilities for the
health and welfare of those who are classified as poor.

In spite of economic growth and demographic transition, the Indian healthcare

system is burdened by a rise in infectious and chronic degenerative diseases.
Infectious, contagious and waterborne diseases such as dengue fever, diarrhoea,
typhoid, viral hepatitis, measles, malaria, tuberculosis, whooping cough and
pneumonia are major contributors to disease, especially among poor and rural
Indians. Communicable diseases once thought to be under control (e.g. dengue
fever, viral hepatitis, tuberculosis, malaria, and pneumonia) are still in existence
in India, having reappeared with high levels of drug resistance, to the
disadvantage of the poor. The wealthy and middleclass sectors of Indian society
have better access to public/private healthcare facilities and are less affected.

India’s healthcare infrastructure has failed to keep pace with the nation’s
economic growth. Emerging market conditions and a poor public healthcare
system has encouraged a shift from public to private healthcare, with private
healthcare facilities now constituting more than 80% of healthcare expenditure,
including that of those who are poor.

Background: Indian Health

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India has taken great strides to improve the overall health of its people since its
independence from the United Kingdom in 1947. Improvements in health
include an increase in life expectancy by nineteen years, a decline in total
fertility to three children per woman, a 50% decrease in infant mortality and
progress in the control of communicable diseases (World Bank, 2007).
Blindness was once very high in India- more than one third of the world’s total
blind population historically lived in India. Through a collaboration of NGOs
and the private sector, the (now closed) Cataract Blindness Control Project
performed a total of 15.3 million cataract operations. According to the World
Bank, the incidence of cataract blindness has been reduced by more than half in
the areas covered (World Bank, 2007).
Despite continual government investment in the health sector in the form of
public health initiatives, the incidence of preventable disease and child-birth
complications persists. According to the Aga Khan Development Network
(AKDN), nearly 10% of children under five years old die each year from
preventable diseases such as diarrhea, pneumonia and malaria. Additionally, the
incidence of chronic disease is increasing. Moreover, remote communities do
not have access to affordable and quality health care. In response to these
issues, in 2005 the government implemented an initiative, the National Health
Mission, restructuring health departments at every level and creating the
national Rural Health Mission. Organizations such as the World Bank and the
World Health Organization have worked in conjunction with the Indian
government, supporting health, nutrition, and infectious disease projects.
Maternal and child health has also been a focus of the Indian government in its
efforts to reduce infant and child mortality: pregnant women have been targeted
to receive tetanus vaccines to decrease infant mortality rates and children are
immunized against a variety of infectious diseases and receive vitamin A
supplements through the National Program of Prevention of Blindness.
Regardless of these advances, however, the health agenda in India remains
unfinished
India ranks among the countries with the highest infant mortality rates in the
world. In 2009, the infant mortality rate in India was 50.7 per 1000 live births
(CIA World Fact Book), a statistic that is commonly used to measure overall
access to health care and is indicative of nutrition levels and treatment of acute
illnesses. The infant mortality rate indicates the government’s inability to
provide its people with adequate medical care.

1.2 Drawbacks:
It has been shown in developing countries that existing public healthcare
facilities are most effective for the poor. India has an existing widely distributed
public healthcare system but it is ailing and unresponsive. Indian policy-makers
complain of a lack of funds needed to manage the public healthcare system.

X
However it has been shown that problems in healthcare financing can be solved
in a number of ways, such as a community based health insurance scheme.
However, the Indian public healthcare system suffers from problems other than
financial. It is important to explore these other contributing factors, and identify
major issues that may be corrected, subject to budgetary constraints.

It is has been established that the number of public health facilities in India is
inadequate. A national study identified that the majority of the population
(urban 46% and rural 36%) mainly use private doctors or clinics, with only 16%
visiting public and private hospitals. The same study identified that urban
Indians prefer private hospitals, while the rural population prefers public
healthcare facilities. However, the reasons for healthcare users’ not utilizing
existing public healthcare facilities have not been determined.
1.3 History of the Schemes:

NATIONAL RURAL HEALTH MISSION

• Large number of medical and paramedical staff has been taken on contract to
augment the human resources. During the year 2009-10, about 2475 MBBS
doctors, 160 specialists, 7136 ANMs, 2847 staff nurses, 2368 AYUSH doctors
and 2184 AYUSH paramedics were appointed.
• Mobile Medical Units increased to 363 districts in 2009-10 from 310 in 2008-
09 to provide diagnostic and outpatient care closer to hamlets and villages in
remote areas.
• About 50,000 Village Health and Sanitation Committees (VHSCs) set up.
• Under National Programme for Control of Blindness, number of cataract
operation performed have registered a significant increase from about 22 lakh
operations in 2007-08 to 59 Lakh cataract operations in 2009-10.

REPRODUCTIVE AND CHILD HEALTH

• Under Navjaat Shishu Suraksha Karyakram (NSSK-New born care

programme) launched on 15th of September 2009, district level trainers have
been developed for all the erstwhile EAG States and Jammu & Kashmir, while
State level trainers have been developed in Non EAG States. 1400 trainers have
already been trained.
• Under Janani Suraksha Yojana (JSY), a safe motherhood intervention for
promoting institutional delivery, the number of beneficiaries increased from
7.39 lakh in 2005-06 to about 1 crore in 2009-10, registering an increase of 10
lakh during 2009-10.
• For the first time, Bivalent Polio Vaccine for 2 wild polio viruses (P1 and P3)
has been introduced in the immunisation programme in January 2010.

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• To obtain accurate data from across the country, a system for name based
tracking of pregnant women and children for Ante-Natal Care and immunisation
is being put in place.
The tracking system will also capture the contact numbers of the beneficiaries
and the health providers. This will help national monitoring of the health status
of each pregnant women and infants / children across the country. A help
desk/call-centre is also being established to randomly cross-check the health
services delivered to these mothers and children.
• For the first time, an Annual Health Survey has been launched to provide data
on key health indicators like the Total Fertility Rate (TFR), Crude Birth and
Death Rates, Infant Mortality Rate (IMR), etc. at the district level and Maternal
Mortality Rate (MMR) at the regional level. The survey is being conducted in
collaboration with the Registrar General of India and has been launched in the
284 districts of 9 States, namely, Bihar, Jharkhand, Madhya Pradesh,
Chhattisgarh, Uttar Pradesh, Uttarakhand, Orissa, Rajasthan and Assam. A
proposal for estimation of anaemia, malnutrition, hypertension, diabetes, testing
of iodine in salt used by households has also been approved..

COMMUNICABLE DISEASE CONTROL AND PREVENTION

• For the first time, under the National Vector Borne Disease Control
Programme (NVBDCP), 2.23 million Long Lasting Insecticidal Nets (LLINs)
distributed in 2009-10 in highly endemic malaria states, Orissa, Assam, West
Bengal and Chhattisgarh.
• For the first time in the country, National Sample Survey to estimate burden of
Leprosy is being taken up.
• DOTS-Plus programme for management of Multi Drug Resistant (MDR)-
Tuberculosis (TB) was initiated in 4 more states bringing up the total to 10
States.
• Global Fund (GFATM) has granted an amount of US $ 100 million (approx.)
for malaria control and an amount of US $ 200 million (approx.) for TB control.
• Up gradation of National Centre for Disease Control (NCDC) as Centre of
Excellence of Public Health has been taken up
• During the year 2009-10, under the National Aids Control Programme, an
additional 4 district level blood banks and 28 blood component separation units
have been established and over 60,000 blood donation camps organised. The
free Anti Retroviral Treatment (ART) programme scaled up to 269 centres, and
315,640 patients were receiving free ART as of March, 2010.
Second line ART initiated in Centres of Excellence and more than 1100 patients
enrolled.
• State of art Blood Banks are being set up in four Metropolitan cities of New
Delhi, Kolkata, Mumbai and Chennai at an estimated cost of Rs. 468 crore.
• State of art Plasma Fractionation centre is being set up in Chennai at a cost of
Rs. 250 crore to produce blood components currently being imported.

XII
• To create awareness about AIDS, second phase of specifically designed
exhibition train, red ribbon express was launched on 1st Dec. 2009 to cover 152
stations in 22 states during its 1 year journey.

NON-COMMUNICABLE DISEASE CONTROL AND PREVENTION

• To increase the availability of trained personnel required for mental health
care, 7 regional institutes have been funded against the 11 to be undertaken
during 11th Plan for production of clinical psychologists, psychiatrists,
psychiatric nursing and psychiatric social workers.
Further, support has been provided to 9 institutes for 19 PG departments during
the year 2009-
10 for manpower development. Under the Programme, an amount of Rs. 408
crore has been approved for manpower development and another Rs. 150 crore
is under approval for the revised district mental health programme in the states.
• National Policies for Geriatric Care, cardio vascular & diabetes and cancer
finalised for a total outlay of about Rs. 1519 crore.

PRADHAN MANTRI SWASTHYA SURAKSHA YOJANA

• For setting up of AIIMS like institutions, environmental clearance was

obtained for hospitals and medical colleges to be set up at Bhubaneswar, Patna,
and Jodhpur, Rishikesh, Raipur and Bhopal sites in 2009. Hostel construction in
all the places is at advance stage of completion.
• Works for Medical College Complex for all six sites have been awarded.
Award of work for construction of hospital complex is under finalization and
work likely to start by June, 2010 to be completed in two years.
• For completion of construction of college and hospital before the prescribed
time, an incentive up to Rs. 12.5 Crore shall be payable to contractor. However,
for delay beyond the prescribed time of up to 6 months, penalty up to Rs. 25
Crore shall be levied and for delay beyond six months, contractor shall be liable
to be blacklisted for a specified period.
Objective of Research:
The Objective of the study is identifying barriers for implementation of
government healthcare schemes in rural areas of Uttar Pradesh and providing
options and strategies for future. This report reflects the directions of the
government as developed in spirit of partnership and mutual respect in the
context of the country’s overall efforts in health development.
It is the government’s mandate to shape, strengthen, support and sustain a health
system where every citizen has access to readily available, qualitatively
appropriate and adequately wide ranging health services at affordable costs. The
report examines the paths travelled, the constraints faced, the efforts that are

XIII
underway and the challenges before us in the promotion of healthcare schemes
in rural areas of Uttar Pradesh.
Based on this overview, the report sets out some policy imperatives and agendas
for discussion. The objective is to have public discussions and debates that
engage people from various sections on the growth of the health sector and the
challenges we face in ensuring a healthy nation, a nation where the health needs
of the people are met with the limited resources available.
It is a sincere hope that this document will inspire all of us to take individual
and collective responsibility to work towards the improvement of health of our
country and ensure a healthier future for the people of rural areas.
1.5 Motivation of doing research:
I would rather call my research as creative work, since that is actually what I am
doing. The motivation in doing research, in being able to stay in the lab
throughout the day even during weekends is basically the idea that what you are
doing is fun. If something is fun, wouldn't you want to do it all the time?

1.6 Organization of the Report:

At first I collected data regarding the current rural situation of India, the history
of the schemes and the current working schemes. Then, we made a
Questionnaire to check the efficiency of these schemes and their present
working condition.
Thus I have divided this report into 5 chapters, first the introduction part which
deals with the present schemes and their History and giving a brief idea what we
need to do. Then the second chapter is Literature Review where all the research
papers I have consulted and the references taken and also sources from where
data have been taken. The third chapter I have decided to be kept as Research
Plan which deals with issues related to rural health and research methodology.
The chapter four describes data analysis which includes methods of data
collection. Thus, in last Chapter I end up with, Summary and conclusion for this
report. Also, I have added my personal recommendations by which the rural
health can be improved further.
Conclusion:
To improve the prevailing situation, the problem of rural health is to be
addressed both at the macro (national and state) and micro level (district and
regional), in a holistic way, with genuine efforts to bring the poorest of
The population to the centre of the fiscal policies. A comprehensive revised
National Health Policy addressing the existing inequalities, and
Work towards promoting a long-term perspective plan exclusively for rural
health is the current need.

XIV
 Chapter 2:
LITERATURE REVIEW

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2.1 Introduction
INTRODUCTION
India is drawing the world’s attention, not only because of its population
explosion but also because of its prevailing as well as emerging health profile
and profound political, economic and social transformations.
After 63 years of independence, a number of urban and growth-orientated
developmental programs having been implemented, nearly 716 million rural
people (72% of the total population), half of which are below the poverty line
(BPL) continue to fight a hopeless and constantly losing battle for survival and
health. The policies implemented so far, which concentrate only on growth of
economy not on equity and equality, have widened the gap between ‘urban and
rural’ and ‘haves and have-nots’. Nearly 70% of all deaths, and 92% of deaths
from communicable diseases, occurred among the poorest 20% of the
population.
However, some progress has been made since independence in the health status
of the population; this is reflected in the improvement in some health indicators.
Under the cumulative impact of various measures and a host of national
programs for livelihood, nutrition and shelter, life expectancy rose from 33
years at Independence in 1947 to 62 years in 1998. Infant mortality declined
from 146/1000 live births in 1961 to 72/1000 in 1999. The under 5 years
mortality rate (U5MR) declined from 236/1000 live births in 1960 to 109/1000
in 1993.1 Interstate, regional, socioeconomic class, and gender disparities
remain high. These achievements appear significant, yet it must be stressed that
these survival rates in India are comparable even today only to the poorest
nations of sub-Saharan Africa.
The rural populations, who are the prime victims of the policies, work in the
most hazardous atmosphere and live in abysmal living conditions. Unsafe and
unhygienic birth practices, unclean water, poor nutrition, subhuman habitats,
and degraded and unsanitary environments are challenges to the public health
system. The majority of the rural populations are smallholders, artisans and
laborers, with limited resources that they spend chiefly on food and necessities
such as clothing and shelter. They have no money left to spend on health. The
rural peasant worker, who strives hard under adverse weather conditions to
produce food for others, is often the first victim of epidemics.
This present paper attempts to review critically the current health status of
India, with a special reference to the vast rural population of the beginning of
the twenty first century.
HEALTH PRACTICES AND PROBLEMS IN RURAL INDIA
Rural people in India in general and tribal populations in particular, have their
own beliefs and practices regarding health. Some tribal groups still believe that
a disease is always caused by hostile spirits or by the breach of some taboo.
They therefore seek remedies through magic or religious practices. On the other
hand, some rural people have continued to follow rich, undocumented,

XVI
traditional medicine systems, in addition to the recognized cultural systems of
medicine such Ayurveda, unani, siddha and naturopathy, to maintain positive
health and to prevent disease. However, the socioeconomic, cultural and
political onslaughts, arising partly from the erratic exploitation of human and
material resources, have endangered the naturally healthy environment (e.g.
access to healthy and nutritious food, clean air and water, nutritious vegetation,
healthy life styles, and advantageous value systems and community harmony).
The basic nature of rural health problems is attributed also to lack of health
literature and health consciousness, poor maternal and child health services and
occupational hazards.
The majority of rural deaths, which are preventable, are due to infections and
communicable, parasitic and respiratory diseases. Infectious diseases dominate
the morbidity pattern in rural areas (40% rural: 23.5% urban). Waterborne
infections, which account for about 80% of sickness in India, make every fourth
person dying of such diseases in the world, an Indian. Annually, 1.5 million
deaths and loss of 73 million workdays are attributed to waterborne diseases.
Three groups of infections are widespread in rural areas, as follows.
1. Diseases that are carried in the gastrointestinal tract, such as diarrhoea,
amoebiasis, typhoid fever, infectious hepatitis, worm infestations and
poliomyelitis. About 100 million suffer from diarrhoea and cholera every year.3
2. Diseases that are carried in the air through coughing, sneezing or even
breathing, such as measles, tuberculosis (TB), whooping cough and pneumonia.
Today there are 12 million TB cases (an average of 70%). Over 1.2 million
cases are added every year and
37 000 cases of measles are reported every year.
3. Infections, which are more difficult to deal with, include malaria, filariasis
and kala-azar. These are often the result of development. Irrigation brings with
it malaria and filariasis, pesticide use has reduced a resistant strain of malaria,
the ditches, gutters and culverts dug during the construction of roads, and
expansion of cattle ranches, for example, are breeding places for snails and
mosquitoes. About 2.3 million episodes and over 1000 malarial deaths occur
every year in India.3 An estimated 45 million are carriers of microfilaria, 19
million of which are active cases and 500 million people are at risk of
developing filaria.
Every third person in the world suffering from leprosy is an Indian. (Nearly 1.2
million cases of leprosy, with 500 000 cases being added to this figure every
year.)
Malnutrition is one of the most dominant health related problems in rural areas.
There is widespread prevalence of protein energy malnutrition (PEM), anemia,
vitamin A deficiency and iodine deficiency. Nearly 100 million children do not
get two meals a day. More than 85% of rural children are undernourished (150
000 die every year).

XVII
A recent survey by the Rural Medical College, Loni (unpublished data), in the
villages of Maharashtra State, which is one of the progressive states, has
revealed some alarming facts. Illness and deaths related to pregnancy and
childbirth are predominant in the rural areas, due to the following.
1. Very early marriage: 72.5% of women aged 25–49 years marry before 18,
where the literacy rate is 80%.
2. Very early pregnancy: 75% married women had their first pregnancy below
18 years of age.
3. All women invariably do hard physical work until late into their pregnancy.
4. Fifty-one per cent of deliveries are conducted at home by an untrained
traditional birth attendant.
5. Only 28% of pregnant women had their antenatal checkup before 16 weeks of
pregnancy.
6. Only 67% of pregnant women had complete antenatal checks (minimum of
three checkups).
7. Only 30% of women had postnatal checkups.
In addition, agricultural- and environment-related injuries and diseases are all
quite common in rural areas, for example: mechanical accidents, pesticide
poisoning, snake, dog and insect bites, zoonotic diseases, skin and respiratory
diseases; oral health problems; socio psychological problems of the female,
geriatric and adolescent population; and diseases due to addictions.
The alarming rate of population growth in rural areas nullifies all developmental
efforts. The rural population, which was 299 million in 1951, passed 750
million in May 2001. Since 1951, the government has been attempting through
vertical and imported programs to combat the problems, but to no avail.
However, the new National Population Policy 20005 gave emphasis to an
holistic approach; for example, improvement in ‘quality of life’ for all, no
gender bias in education, employment, child survival rates, sound social
security, promotion of culturally and socially acceptable family welfare
methods.
Two distinct types of health status have been in evidence. The ‘rural–urban’
divide depicted in Table 1, it helps in understanding the health status of rural
people, which is far behind their urban counterparts. There are also other
divides such as ‘rich–poor’, ‘male–female’, ‘educated–uneducated’, ‘north–
south, ‘privileged–underprivileged’, etc.

HEALTH POLICY AND INFRASTRUCTURE FOR RURAL AREAS

Inappropriate

XVIII
The selective health intervention during the colonial period resulted in the so-
called ‘modern medicine’ in India. After independence, the state has chosen to
follow these ‘western models’. This system, which is highly selective,
institutionalized, centralized and top down – not by oversight but by design –
and which treats people as objects rather than subjects, has failed to address the
needs of the majority, that is to say, the rural poor and indigenous people. While
a significant portion of the country’s medical needs, especially in rural areas,
have been attended to by the indigenous health systems such as Ayurveda,
homeopathy, unani, naturopathy and folk medicine, it has been conveniently
neglected by the policy makers, and planners. The draft of the new National
Health Policy 2001, has also not given due importance to Indian systems of
medicine. The concept of a family physician with social accountability, which
has traditional roots and acceptance from the rural masses, has diminished with
the existing policies and value systems. The present westernized hospital-based
medical education and training, which is supported by public funding, has
proved beyond doubt that new doctors are not inclined to and capable of
meeting the needs of the majority of the public (i.e. rural people), which is
where their services are most required.
A recent study conducted by the Rural Medical College (unpublished data) on
the involvement of general practitioners, has revealed the following facts:
1. 80% of general practitioners practice western medicine (allopathic medicine)
without proper training.
2. 73% consider cost to be the most important factor when prescribing a drug,
without considering pharmacological properties.
3. 75% were aware of the Government-run Primary Health Center (PHC) or
village subcentres without knowing the names of the medical officer at the
PHC; half (53%) do not know the health workers in their own area.
4. About 67% had knowledge of various national health programs but only 33%
participated.
5. Over 68% received information regarding the health programs through the
media, and only 28% received information through public health staff.
6. About 74% provide family planning services, mainly oral contraceptives and
condoms. General practitioners do provide services to pregnant women (65%),
but only 35% registered them.
7. Almost all general practitioners routinely handle cases of diarrhoea, but only
29% know the exact composition of oral dehydration solution (ORS);
amazingly, none knew the right method to prepare the ORS packet.
In context of UP
Health has been a prime concern of humanity since the dawn of history
because it causes human suffering, economic loss, and social burden. India
has given ample emphasis on public health and hence considerable
progress has been achieved. An outcome of this effort is an impressive
XIX
infrastructure and human resource of health personnel in the country.

The government of Uttar Pradesh (UP) has made a conscious effort by

providing primary and secondary level healthcare services in rural areas
through its network of 18,628 sub-centers, 3,805 PHCs, 306 Community
Health Centers and 58 District Hospitals, above 10,000 medical officers
and more than one Lakh paramedics. Still, the demographic and health
scenario of Uttar Pradesh is far from satisfactory, especially in the remote
areas because of physical remoteness, poverty, and low rate of literacy and
lack of awareness about health information. Poor media reach make
communication even more difficult. Lack of awareness among the target
population is one of the important reasons for low uptake of basic health
services and has the role of Information, Education, and
Communication (IEC) is unquestionable. State has been addressing this issue.

Under the World Bank assistance, the State of Uttar Pradesh has set up an
Uttar Pradesh Health System Development Project (UPHSDP). The aim of
the UPHSDP is to gear up delivery system of the existing health care
infrastructure to provide high quality effective and responsive health
services to the people. The project also plans to have extensive publicity
campaign to create awareness about the Health & Hygiene Practices and
available services/facilities at all levels among the people.
It is in this context that the UPHSDP awarded IEC consultancy to FAITH-
TALEEM Research. Foundation to study the communication needs of the
people and help formulating a systematic approach required for developing
IEC materials useful to all three sub-systems; service providers, drug
manufacturers and traders, and the people at large whom the project aims
to benefit.
The Broad Aims of UPHSDP are to:

· Increase awareness and positive feeling about the services

provided by the State's health system, leading to increased
utilization, particularly by the poorer segments.
· Use internal communication within the States Health System to (a)
improve the quality of the care provided by service providers
through client friendly behavior, and (b) improve systems
performance through good practices in referral and waste
management. .
· Promote use .of state drinking water and good sanitary practices
including environmental hygiene, and discourage behavior
associated with injury, poisoning and smoke related diseases, and
· Encourage Rational Drug Use and Good Manufacturing Practices

XX
 by promoting better compliance and trade practice and trade
practices among retailers and wholesalers, and promoting behavior
in favour of legal drug and appropriate drug use among them

· Prepare action plan for use of IEC as tool to impart knowledge against false
myths/ perceptions.
· Prepare action plan for use of IEC for effective measures to make
system more transparent through IEC.
Prepare action plan for most optimum and cost effective mix of IEC strategy for
the department to carry out its tasks and improve its image to improve the
health care delivery system.

2.2 Various Areas of Research and their current Scenario:

National Aids Control Programme:

In 1986, following the detection of the first AIDS case in the country, the
National AIDS Committee was constituted in the Ministry of Health and Family
Welfare. As the epidemic spread, need was felt for a nationwide programme and
an organization to steer the programme. In 1992 India’s first National AIDS
Control Programme (1992–1999) was launched, and National AIDS Control
Organization (NACO) was constituted to implement the programme.

The objective of NACP-I (1992–1999) was to control the spread of HIV

infection. During this period a major expansion of infrastructure of blood banks
was undertaken with the establishment of 685 blood banks and 40 blood
component separations. Infrastructure for treatment of sexually transmitted
diseases in district hospitals and medical colleges was created with the
establishment of 504 STD clinics. HIV sentinel surveillance system was also
initiated. NGOs were involved in the prevention interventions with the focus on
awareness generation. The programme led to capacity development at the state
level with the creation of State AIDS Cells in the Directorate of Health Services
in states and union territories.

XXI
During NACP-II (1999–2006) a number of new initiatives were undertaken and
the programme expanded in new areas. Targeted Interventions were started
through NGOs, with a focus on High Risk Groups (HRGs) viz. commercial sex
workers (CSWs), men who have sex with men (MSM), injecting drug users
(IDUs), and bridge populations (truckers and migrants). The package of services
in these interventions includes Behaviour Change Communication, management
of STDs and condom promotion. The School AIDS Education Programme was
conceptualized to build up life skills of adolescents and address issues relating
to growing up. All channels of communication were engaged to spread
awareness about HIV/AIDS, promote safe behaviours and increase condom
usage. Voluntary counselling and testing facilities were established in
healthcare facilities to promote access to HIV counselling and testing. The
interventions for prevention of parent to child transmission were also started.
Free antiretroviral therapy was initiated in selected hospitals in the country.
Development of indigenous vaccine and research on microbicides are some
initiatives in HIV research. Apart from this, some policy initiatives during
NACP-II included National AIDS Prevention and Control Policy, National
Blood Policy, a strategy for Greater Involvement of People with HIV/AIDS and
National Rural Health Mission.

Phases of National AIDS Control Programme:

Phase-I (1992 - 1999) was implemented across the country with objective to
slow the spread of HIV to reduce future morbidity, mortality, and the impact of
AIDS by initiating a major effort in the prevention of HIV transmission.

Phase-II (1999 - 2006) was aimed at reducing spread of HIV infection in India
and strengthens India's capacity to respond to HIV epidemic on long term basis.

Some of the significant achievements of NACP-I & II are:

 Scaling up PMTCT and VCCTC services especially in the high

prevalence states.
 Increasing access to free ARV is one of the major achievements of
NACP-II. The national program for ARV provision has motivated other
State Governments (Kerala and Delhi) to announce provision of free
ARV from the State Exchequer which is also a good sign.
 Recognizing the need of care and support for people living with HIV and
AIDS and scaling up of Community Care Centers.
 The effectiveness of the condoms as one of the safest methods to prevent
and control the spread of HIV and other STIs has been well established.
 Initiating the process for developing draft legislation on HIV and AIDS.

XXII
With the growing complexity of the epidemic, there have been changes in
policy frameworks and approaches of the NACP. Focus has shifted from raising
awareness to behaviour change, from a national response to a decentralized
response and an increasing engagement of NGOs and networks of people living
with HIV/AIDS. The National AIDS Prevention and Control Policy and the
National Council on AIDS (NCA), chaired by the Prime Minister, provide
policy guidelines and political leadership to the response.

Phase-III (2007-2012)is based on the experiences and lessons drawn from

NACP-I and II, and is built upon their strengths. Its priorities and thrust areas
are drawn up accordingly and include the following:

 Considering that more than 99 percent of the population in the country is

free from infection, NACP-III places the highest priority on preventive
efforts while, at the same time, seeks to integrate prevention with care,
support and treatment.
 Sub-populations that have the highest risk of exposure to HIV will
receive the highest priority in the intervention programmes. These would
include sex workers, men-who-have-sex-with-men and injecting drug
users. Second high priority in the intervention programmes is accorded to
long-distance truckers, prisoners, migrants (including refugees) and street
children.
 In the general population those who have the greater need for accessing
prevention services, such as treatment of STIs, voluntary counseling and
testing and condoms, will be next in the line of priority.
 NACP-III ensures that all persons who need treatment would have access
to prophylaxis and management of opportunistic infections. People who
need access to ART will also be assured first line ARV drugs.
 Prevention needs of children are addressed through universal provision of
PPTCT services. Children who are infected are assured access to
paediatric ART.
 NACP-III is committed to address the needs of persons infected and
affected by HIV, especially children. This will be done through the
sectors and agencies involved in child protection and welfare. In
mitigating the impact of HIV, support is also drawn from welfare
agencies providing nutritional support, opportunities for income
generation and other welfare services.
 NACP-III also plans to invest in community care centers to provide
psycho-social support, outreach services, referrals and palliative care.
 Socio-economic determinants that make a person vulnerable also increase
the risk of exposure to HIV. NACP-III will work with other agencies
XXIII
 involved in vulnerability reduction such as women's groups, youth
groups, trade unions etc. to integrate HIV prevention into their activities.

The strategic objectives of NACP-III are:

 Prevent infections through saturation of coverage of high-risk groups

with targeted interventions (TIs) and scaled up interventions in the
general population.
 Provide greater care, support and treatment to more people living with
HIV/AIDS.
 Strengthen the infrastructure, systems and human resources in prevention,
care, support and treatment programmes at District, State and National
levels.
 Strengthen the nationwide Strategic Information Management System.

The specific goal of this phase is to reverse and stabilize the spread of AIDS by
reducing the rate of incidence by 60 per cent in high prevalence States and by
40 per cent in vulnerable States.

Current Scenario:

HIV situation in the country is assessed and monitored through regular annual
sentinel surveillance mechanism established since 1992.As per the recent
estimates using the internationally comparable Workbook method and using
multiple data sources namely expanded sentinel surveillance system, NFHS-III,
IBBA and Behavioral Surveillance Survey, there are 1.8 - 2.9 million (2.31
million) people living with HIV/AIDS at the end of 2007. The estimated adult
prevalence in the country is 0.34% (0.25% - 0.43%) and it is greater among
males (0.44%) than among females (0.23%). The overall HIV prevalence
among different population groups in 2007 continues to portray the
concentrated epidemic in India, with a very high prevalence among High Risk
Groups - IDU (7.2%), MSM (7.4%), FSW (5.1%) & STD (3.6%) and low
prevalence among ANC clinic attendees (Age adjusted - 0.48%).

Key Achievements under NACP:

 Promotion of voluntary blood donation has enabled reducing

transmission of HIV infection through contaminated blood from about
6.07% (1999), 4.61% (2003), 2.07% (2005), and 1.96% (2006) to 1.87%
(2007).
 The number of integrated counseling and testing centers increased from
982 in 2004, 1476 in 2005, 4027 in 2006, 4567 in 2007 and 4817 in 2008
XXIV
 (till September, 2008). The number of persons tested in these centers has
increased from 17.5 Lakh in 2004 to 37.9 Lakhs in 2008-09 (August,
2008).
 In the year 2007, a total of 3.2 million pregnant women accessed PPTCT
services at ICTCs across the country of which 18449 pregnant women
were diagnosed to be HIV positive. Of these 11460 (62%) pregnant
women and the infants born to them received prophylactic single dose
Nevirapine to prevent parent to child transmission of HIV.
 The number of STI clinics being supported by NACO has increased from
815 in 2005 to 895 in 2008. The reported number of patients treated for
STI in 2005 was 16.7 Lakh, in 2006, 20.2 Lakh and in 2007, it has
increased to 25.9 Lakh.
 As of September 2008, 5, 61,981 patients have been registered at ART
centers and 1, 77,808 clinically eligible patients are receiving free ART in
Govt. & inter-sectoral health sector. This is achieved through 179 ART
centers across 31 states. Total 159 Community Care Centers are
established across country of providing Care & Support Services to
PLHA's.
 The Targeted Intervention (TI) projects aim to interrupt HIV transmission
among highly vulnerable populations. Such population groups include -
commercial sex workers, injecting drug users, men who have sex with
men, truckers and migrant workers. As on date, 1132 Targeted
Interventions are operational in various states and UTs in the country.

Combating HIV

It is easy to fight against HIV/ AIDS if people lead by example. Also, we need
to inform others about AIDS and empower them, so that they make safe
choices.

People who may be infected with HIV need society's support and protection.
They are not a threat to society. They have the right to live their life with
dignity and continue with their jobs without losing their earning power. Every
Indian needs to uphold the dignity of people living with HIV so that they can
live secure harmonious lives.

The countrywide response to the National AIDS Control Programme of the

Government has been constructive and yielded positive results. This shows the
way forward in controlling the spread of this disease and soon making the
country AIDS free.

XXV
NATIONAL LEPROSY ERADICATION PROGRAMME

I. HISTORY OF LEPROSY IN INDIA

- In India first records of 'Leprosy Like' disease appear in the sixth century B.C.

- First described in 'Susruth Samhita' and treatment with 'Choulmoogra oil' was
known at that time.

- Leprosy was referred to as 'Kusht' in the Vedic writing.

- Initially Leprosy patients were isolated and segregated. Communities were

hostile to them and the patients were also self conscious and afraid to mix with
the community.

- Leprosoriurn to segregate the patients from the community were built in

Europe in the middle ages. Several statutory acts and laws were also enacted
during this time against them.

- In India 'The Lepers Act 1898' was enacted, which discriminated against the
Leprosy patients and segregated them socially. This act has since been repealed
by Union Government & all the States & UTs.

The Myths & the Facts about Leprosy

 
 Two common beliefs about leprosy – that it is hereditary and that it
spreads by touch – are unfounded myths. It is neither hereditary nor does
it spread through casual touch.
 Leprosy is the least infectious of all the communicable diseases. It can
take years of living in close proximity with an untreated leprosy patient to
get the disease.
 95% people are naturally immune to the leprosy germ.
 Early and regular treatment of leprosy with MDT, available free of cost at
all Government health centres and hospitals, completely cures the disease
as well as prevents any deformity and patients can live a normal life.
 The ulcers and sores that are seen in old, deformed cases of leprosy are
not signs of active disease. They result from damage done to insensitive

XXVI
 hands, feet and eyes due to lack of proper care. Such people are old, burnt
- out leprosy cases do not transmit the disease, and do not need MDT.
 The word “Leper” should no longer be used in any context. It signifies an
old – fashioned and discriminatory approach to leprosy patients. The
modern approach is to treat leprosy patients in the community so that they
continue to lead a normal life.
 

Current Leprosy Situation in India

 
 Of the total 2.66 lakh recorded leprosy cases as on 31st March 2004, 75% cases
have been contributed by 7 states: - Orissa (5%), Chhattisgarh (5%), Jharkhand
(4%), Uttar Pradesh (23%), Bihar (17%), Maharashtra (11%), West Bengal
(10%).

Before introduction of the Multi Drug Therapy (MDT) of leprosy in

early 1980s, India recorded a prevalence of 57.6 leprosy cases per
10,000 population in the year 1981. However, with concerted efforts of
National Leprosy Eradication Programme, the leprosy prevalence has
substantially come down to only 2.44 cases / 10,000 population as on
March 2004.
 
So far following 17 States/ UTs have achieved the level of leprosy
elimination i.e. PR<1 case 10,000 population: - Nagaland, Haryana,
Meghalaya, Himachal Pradesh, Mizoram, Tripura, Punjab, Sikkim,
Jammu & Kashmir, Assam, Manipur, Rajasthan, Kerala, Arunachal
Pradesh, Daman & Diu, A & N Islands and Pondicherry.

Another 7 States/UTs are very near this goal of leprosy elimination with a
PR of 1-2/10000. These are Madhya Pradesh, Karnataka, Uttaranchal,
Gujarat, Andhra Pradesh, Goa and Tamil Nadu.

XXVII
 Four nationwide Modified Leprosy Elimination Campaigns (MLECs)
with intensified community IEC have been conducted in the country as
special efforts towards early detection of leprosy cases & their prompt
MDT. The Fifth MLEC was conducted in eight high priority States during
2003-04.
The hard-to-reach areas in rural / tribal / hilly terrains as well urban
slums are given special priority for continued surveillance and prompt
MDT to leprosy patients.
 

Leprosy Treatment
 
Since the early 1980s, MDT has revolutionized the treatment of
leprosy. It is a combination of the drugs – Rifampicin, Clofazimine and
Dapsone and is virtually a guaranteed cure of leprosy as even a single
dose of MDT kills 99.9% of leprosy germs.
There are no significant side effects of MDT within prescribed doses and
a leprosy patient ceases to be infectious within a few months of starting the
course of treatment.
MDT is now available free-of-cost on all working days at all Sub –
Centres, Primary Health Centres, Govt. Dispensaries and Hospitals in
the country.
Since the introduction of MDT, 11.27 million leprosy cases have
been cured in India and all the newly detected leprosy cases are being
promptly put on MDT.
 
Highlights of National Programme Activities in India:
 

XXVIII
 A 100% centrally sponsored National Leprosy Control Programme
(NLCP) had been in operation since 1954-55. With the introduction of
highly effective MDT for cure of leprosy, the programme was
redesignated as National Leprosy Eradication Programme (NLEP) in
1983 with the objective to achieve elimination of leprosy by reducing the
caseload to less than one case per 10,000 populations.
The programme received further thrust in 1993-94 when World Bank
assisted first National Leprosy Elimination Project was started and the whole
country was brought under MDT services with strengthening of existing
services, intensive health education, trained manpower development, disability
prevention and care including reconstructive surgery. This First NLEP ended on
30th Sept. 2000. The World Bank supported 2nd NLEP started w.e.f year 2001-02
for 3 years, wherein –
 
a) a)      The NLEP has been decentralized to States/UTs and districts with
responsibilities for planning, implementation, supervision & timely
corrective measures.
b) b)      Leprosy services have been integrated with General Health Care
System in the country to increase their out reach with extensive
community education and involvement.
c) c)      All General Health Care functionaries have been oriented in leprosy
(Technical & IEC), and
d) d)      Country is successfully progressing towards leprosy elimination by
December 2005 at national level. Accordingly, NLEP Simplified
Information System has been placed in operation for concurrent
monitoring, supervision and timely corrective measures under the
programme at different levels of implementation.

XXIX
 Any person having suspected signs of leprosy should consult nearest health
worker or PHC or dispensary / hospital where the confirmation of disease is
done by medical officer and free MDT is immediately started.

National Programme for Control of Blindness

National Programme for Control of Blindness (NPCB) was launched in the year
1976 as a 100% Centrally Sponsored scheme with the goal to reduce the
prevalence of blindness to 0.3% by 2020. Rapid Survey on Avoidable Blindness
conducted under NPCB during 2006-07 showed reduction in the prevalence rate
of blindness from 1.1% (2001-02) to 1% (2006-07).

The objectives of the programme are:

 To reduce the backlog of blindness through identification and treatment

of the blind;
 To develop Comprehensive Eye Care facilities in every district;
 To develop human resources for providing Eye Care Services;
 To improve quality of service delivery;
 To secure participation of Voluntary Organizations/Private Practitioners
in eye Care.
 To enhance community awareness on eye care.

Pattern of Assistance during 11th Five Year Plan

The following are main features of the pattern of assistance during 11th Five
Year Plan:

 Keeping in view austerity measures and to avoid duplicity of work, State

Ophthalmic Cell has been merged with State Blindness Control Society.
Due to formation of National Rural Health Mission (NRHM), State
Blindness Control Society (SBCS) under NPCB has been further merged
with State Health society under NRHM. District Blindness control
society (DBCs) under NPCB has also been merged with District Health
Society under NRHM.
 Increase in assistance for commodity to various facilities to increase their
capacity for treatment of all types of eye ailments;
 Facility for India-ocular Lens (IOL) implantation expanded up to Taluka
level;
 Marginal increase in grant-in-aid to Eye Banks, Eye Donation Centers
and NGOs due to escalation of costs and to improve quality of services;

XXX
  In addition to cataract, assistance would also be provided for other eye
diseases like glaucoma, diabetic retinopathy, management of laser
techniques, corneal transplantation, vitreoretinal surgery, treatment of
childhood blindness etc.
 Assistance for construction of dedicated Eye Wards and Eye Operation
Theatres in North East States and few other states as per need;
 Assistance for appointment of Ophthalmic manpower Ophthalmic
Surgeons, Ophthalmic Assistants and Eye Donation Counsellors on
contractual basis;
 Assistance for involvement of Private Practitioners in sub-district, block
and village levels;
 Assistance for involvement of Ophthalmic equipments supplied under the
programme; Development of Mobile Ophthalmic Units with
Teleophthalmology Network and some fixed tele-models to cover
difficult hilly terrains and difficult areas;
 Critical posts of 228 Eye Surgeons and 510 Ophthalmic Assistants
sanctioned during the 9th Plan and continued during 10th Plan, would be
integrated within the State Plan in a phased manner;
 Strengthening of Management Information System and
 Intensification of IEC activities.

New Initiatives during 11th Five Year Plan

 Construction of dedicated Eye Wards & Eye OTs in District Hospitals in

North-Eastern States, Bihar, Jharkhand, J&K, Himachal Pradesh,
Uttarakhand and few other States where dedicated Operation Theaters are
not available as per demand.
 Appointment of Ophthalmic manpower (Ophthalmic Surgeons,
Ophthalmic Assistants and Eye Donation Counsellors on contractual
basis).
 Grant-in-and to NGOs for management of other Eye diseases other than
Cataract like Diabetic Retinopathy, Glaucoma Management, Laser
Techniques, Corneal Transplantation, Vitreoretinal Surgery, Treatment of
childhood blindness etc of Rs.750 per case for Cataract/IOL Implantation
Surgery and Rs.1000 per case of other major Eye Diseases as described
above.
 Development of Mobile Ophthalmic Units in NE States, Hilly States &
difficult Terrains for diagnosis and medical management of eye diseases.
 Involvement of Private Practitioners in Sub District, Blocks and village
Level.

XXXI
  Maintenance of Ophthalmic Equipments supplied to Regional Institutes
of Ophthalmology, Medical Colleges, District/Sub-District Hospitals, and
PHC/Vision Centers.

National Rural Health Mission:

National Rural Health Mission (NRHM) is not a first program on rural health in
independent India, even then, the enthusiasm and attention of the health
personnel and people toward the program is phenomenal. This may partially be
attributed to the apparent commitment and sincerity of the government, which
was rightly reflected in the confessional speech of the prime minister of India,
on April 12, 2005, on the launch of this program, when he said “We have
grievously erred in the design of many of our health programs. We have created
a delivery model that fragments resources and dissipate energies. Most
importantly, we have paid inadequate attention to the public health issues.”

The attempts to improve rural health through various programs were started as
early as in 1940 when, then British government in India set up ‘Bhore
Committee' (This committee also known as Health Survey and planning
committee was set up by government of India in 1943 to understand the health
situation in the country. The committee was headed by Sir Joseph Bhore and it
got this name of Bhore Committee. The committee submitted its
recommendations in 1946 with elaborate planning for health services delivery in
India.) to find out the ways to improve the health of the people. This was
followed by a number of other committees and programs i.e. Balawant rai
Mehta Committee (After the initial developments followed by Bhore
Committee report, this committee was set up to know the progress since Bhore
committee recommendations and, to give further suggestions to improve the
health scenario in the country), Community Development program and Basic
need programs etc. These attempts were only partially successful in changing
prevailing health scenario. The successive governments started its own program
and strategy to change the health conditions of the people without
understanding or fully investigating the reasons for the failure of the previous
programs.

Review

This NRHM aims to improve rural health by targeting phased increase in the
funding for the health up to 2-3% of the Gross Domestic Product (GDP) in
coming years. The mission also tries to correct the most of the shortcomings of
previous programs i.e. inappropriate training, lack of technical guidance,

XXXII
supervision and co-ordination and, poor community participation. Besides, this
plans to cover capacity building, public private partnership and induction of
management and public health and financial personnel.

In NRHM, the commitment of the government is palpable and categorical as the

program is time bound, with clear objectives and achievable goals it all these
factors make NRHM a different program then previous ones. The desire for
achievable targets reflected in acceptance of Indian Public Health standards
(IPHS) for Community Health Centres (CHC) accepting that BIS standards are
very much resource oriented and difficult to achieve in present conditions of the
health system in India.

It seems that before planning the NRHM, the target of meeting the Millennium
Development Goals (MDG), of which India is a signatory, were also kept in the
mind as the goals under NRHM similar to what has been envisaged in MDGs.
Another pertinent point to be noted is that NRHM addresses two of the four
major problems, identified in UN Millennium Project and associated with the
poor development of the countries. First is the problem of the poor governance
and second of the policy neglect in form of unawareness of what to do, or
neglectful of core public issues. Both of these may be taken as right step in the
direction of achieving MDGs.

The NRHM has a central functionary named Accredited Social health Activist
(ASHA). This worker has been discussed a lot amongst the people involved in
the health and, has received a lot of bouquets and brickbats from the experts.

This paper debate a few issues related to the implementation of the program.
The experts have called ASHA a resurrection of earlier Community Health
worker (CHW) or Village Health Guide (VHG), both almost 30 year old
schemes. Agreeably, ASHA is newer and modified version of CHW but lesson
learned from older scheme or causes attributed to her failure i.e. improper
selection, inadequate training, demand of fee for service, has been incorporated
in the selection. At the same time ASHA is an activist and not a worker in the
health system as the previous CHW or VHGs. Besides, ASHA is more similar
to the very successful and the world famous concept of ‘barefoot doctor’s in
China . ASHA appears to be an appropriate mix of the CHWs and idea of
barefoot doctors.

Finding a women educated up to 8th standard to function as ASHA will not be

very difficult, as apprehended by some people, as in last 2 decades, the literacy
rate of women has improved significantly. The selection procedure has some
relaxation in exceptional cases to facilitate the mechanism.

XXXIII
ASHA would not be drawing any fixed salary and would be given performance
based compensation 1, a concept which matches closely with recruitment pattern
in private organisations. This may start a new era of accountability in the health
system. Without even fixed salary, if she performs, she would get more than Rs
10,000 per annum (During the training, Directly Observed Treatment- Short
Course (DOTS) for Tuberculosis completion incentive or Allowance in Janani
Suraksha Yojana (This scheme is the modification of the earlier National
Maternity Benefit scheme, where women from the below poverty line
community are given monitory assistance to improve the nutritional status and
to encourage routine ante-natal checkups, Tetanus Toxoid immunisation and, to
go for institutional delivery.), which is reasonably good amount for a women in
rural area. Besides, there is a provision for non monetary compensation in form
of recognition, awards and state level meetings of selected ASHAs, also. This
way, success of ASHA also depends upon successful implementation of the
other national programs also 3.

Above description does not mean that ASHA is a fool proof scheme. There are
other issues related to its working which still need to be given due attention.
The attrition may be taken as one such issue. Since ASHA is a main stakeholder
in the program and it has not been planned that what should be done if an
ASHA leaves the health system. The selection of ASHA is rigorous and time
consuming besides she has to be given sufficient training to function properly so
it would take approximately one year for selecting another similar functionary.
Strategies to sustain ASHA, along with a contingency plan for a situation when
ASHA leaves the system prematurely, need to be developed.

Secondly, dependency of ASHA on Anganwadi workers (AWW) and Auxiliary

Nurse Midwife (ANM) is likely and it seems that there is hardly any freedom
for her to work independently. It may be detrimental to the system in a way that
other functionaries might start delegating their work to ASHA. The work
responsibility of ASHA and other workers need to be more clearly defined and
mutually exclusive.

Action plan in NRHM 1 discusses the making of health system functional from
the subcenters level. An untied fund of Rs 10,000 has been widely publicized as
component of strengthening the subcentres. While, it is a well known fact that
most subcenters are in operation without any available buildings, the priority
should be given to find a building for subcenters and allocation of Rs 10,000
would be useful only when there a infrastructure is available to carry out
activities. The strengthening of sub centers is of paramount importance and
allocation of this money is good but it does not solve the most important issue
of the building for the subcenters as SC are the point of first contact between the
community and the health system and it should be presentable enough.

XXXIV
More focus should be given to the continuous on job training 1 for most
functionaries as this would keep the workers motivated. Posting of another
doctor from AYUSH 1 at Primary Health Centers (PHCs) would improve the
functioning there but we still need some mechanism in place to deal with the
absentee doctors at this level.

Rogi Kalyan Samiti (RKS) scheme was started in Madhya Pradesh 1, a low
performance state and was very successful. This simply conveys that we need
not to be unnecessarily cynical 5 but try to replicate it all over the country. It is a
good step which can be extended to the all hospitals in our country in future.

The success of any program requires a system in place where no link is missing.
Functioning from the level of ASHA, subcentres, PHC has to be improved to
bring people to a referral facility. This period in improving health system at
lower level can be utilised for implementation of IPHS standards 1 at CHCs, so
the raised expectation are not marred by below par facilities at CHC. As some
experts have suggested5 a system of concurrent evaluation should be in place
and generated data may be utilised for ongoing corrective measures at all levels.

We can say, NRHM appears to be a well designed program with all components
of a successful community based program, where existing health system is
being utilised with community involvement and participation, supported by a
community volunteer.

It would be too early to predict its outcome in terms of success or failure. The
necessary political will, commitment at all levels, financial support and
budgetary allocations, good supporting and monitoring system, efficient
scientific and political leadership and, working in the coherence holds the
ability of make this program successful. We doctors can play a major role by
providing good scientific leadership. May be, NRHM is the much dreamt
program which can make ‘Health For All' and ‘Placing people's health in their
hand' a reality.

National Population Policy:

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.

XXXV
 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/counselling, 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.
If the NPP 2000 is fully implemented, we anticipate a population of 1107
million (110 crores) in 2010, instead of 1162 million (116 crores) projected by
the Technical Group on Population Projections:

Similarly, the anticipated reductions in the birth, infant mortality and total
fertility rates are:
Table 3: Projections of Crude Birth Rate, Infant Mortality Rate, and TFR,
if the NPP 2000 is fully implemented.

Year Crude Birth Infant Mortality Total fertility

Rate Rate Rate
1997 27.2 71 3.3
1998 26.4 72 3.3
XXXVI
2002 23.0 50 2.6
2010 21.0 30 2.1

Source: Ministry of Health and Family Welfare

Population growth in India continues to be high on account of :

 The large size of the population in the reproductive age-group (estimated

contribution(58 percent). An addition of 417.2 million between 1991 and
2016 is anticipated despite substantial reductions in family size in several
states, including those which have already achieved replacement levels
of TFR. This momentum of increase in population will continue for some
more years because high TFRs in the past have resulted in a large
proportion of the population being currently in their reproductive years.
It is imperative that the reproductive age group adopts without further
delay or exception the "small family norm", for the reason that about 45
percent of population increase is contributed by births above two
children per family.
 Higher fertility due to unmet need for contraception (estimated
contribution 20 percent). India has 168 million eligible couples, of which
just 44 percent are currently effectively protected. Urgent steps are
currently required to make contraception more widely available,
accessible, and affordable. Around 74 percent of the population lives in
rural areas, in about 5.5 lakh villages, many with poor communications
and transport.
 Reproductive health and basic health infrastructure and services often do
not reach the villages, and, accordingly, vast numbers of people cannot
avail of these services.
 High wanted fertility due to the high infant mortality rate (IMR)
(estimated contribution about 20 percent). Repeated child births are seen
as an insurance against multiple infant (and child) deaths and
accordingly, high infant mortality stymies all efforts at reducing TFR.
 Over 50 percent of girls marry below the age of 18, the minimum legal
age of marriage, resulting in a typical reproductive pattern of "too early,
too frequent, too many". Around 33 percent births occur at intervals of
less than 24 months, which also results in high IMR.

C. STRATEGIC THEMES
It identified 12 strategic themes which must be simultaneously pursued in
"stand alone" or inter-sectoral programmes in order to achieve the national
socio-demographic goals for 2010.
These are presented below:

XXXVII
(i) Decentralised Planning and Programme Implementation
11. The 73rd and 74th Constitutional Amendments Act, 1992, made health,
family welfare, and education a responsibility of village panchayats. The
panchayati raj institutions are an important means of furthering decentralised
planning and programme implementation in the context of the NPP 2000.
However, in order to realize their potential, they need strengthening by further
delegation of administrative and financial powers, including powers of resource
mobilization.
Further, since 33 percent of elected panchayat seats are reserved for women,
representative committees of the panchayats (headed by an elected woman
panchayat member) should be formed to promote a gender sensitive, multi-
sectoral agenda for population stabilisation that will "think, plan and act locally,
and support nationally". These committees may identify area specific
Unmet needs for reproductive health services, and prepare need-based, demand
driven, socio-demographic plans at the village level, aimed at identifying and
providing responsive, people-centred and integrated, basic reproductive and
child health care. Panchayats demonstrating exemplary performance in the
compulsory registration of births, deaths, marriages, and pregnancies,
universalizing the small family norm, increasing safe deliveries,
bringing about reductions in infant and maternal mortality, and promoting
compulsory education up to age 14, will be nationally recognized and honored.
(ii) Convergence of Service Delivery at Village Levels
Efforts at population stabilisation will be effective only if we direct an
integrated package of essential services at village and household levels. Below
district levels, current health infrastructure includes 2,500 community health
centres, 25,000 primary health centres (each covering a population of 30,000),
and 1.36 lakh subcentres (each covering a population of 5,000 in the plains and
3,000 in hilly regions) Inadequacies in the existing health infrastructure have led
to an unmet need of 28 percent for contraception services, and obvious gaps in
coverage and outreach. Health care centres are over-burdened and struggle to
provide services with limited personnel and equipment. Absence of supportive
supervision, lack of training in inter-personal communication, and lack of
motivation to work in rural areas, together impede citizens' access to
reproductive and child health services, and contribute to poor quality of services
and an apparent insensitivity to client's needs. The last 50 years have
demonstrated the unsuitability of these yardsticks for provision of health care
infrastructure, particularly for remote, inaccessible, or sparsely populated
regions in the country like hilly and forested areas, desert regions and tribal
areas. We need to promote a more flexible approach, by extending basic
reproductive and child health care through mobile clinics and counseling
services. Further, recognizing that government alone cannot make up for the
inadequacies in health care infrastructure and services, in order to resolve unmet

XXXVIII
needs and extend coverage, the involvement of the voluntary sector and the
non-government sector in partnership with the government is essential.

Since the management, funding, and implementation of health and education

programmes has been decentralised to panchayats, in order to reach household
levels, a one-stop, integrated and coordinated service delivery should be
provided at village levels, for basic reproductive and child health services.
A vast increase in the number of trained birth attendants, at least two per
village, is necessary to universalise coverage and outreach of ante-natal, natal
and post-natal health care. An equipped maternity hut in each village should be
set up to serve as a delivery room, with functioning midwifery kits, basic
medication for essential obstetric aid, and indigenous medicines and supplies
for maternal and new born care. A key feature of the integrated service delivery
will be the registration at village levels, of births, deaths, marriage, and
pregnancies. Each village should maintain a list of community midwives and
trained birth attendants, village health guides, panchayat sewa sahayaks,
primary school teachers and aanganwadi workers who may be entrusted with
various responsibilities in the implementation of integrated service delivery.

(iii) Empowering Women for Improved Health and Nutrition

 The complex socio-cultural determinants of women's health and nutrition
have cumulative effects over a lifetime. Discriminatory childcare leads to
malnutrition and impaired physical development of the girl child.
Undernutrition and micronutrient deficiency in early adolescence goes
beyond mere food entitlements to those nutrition related capabilities that
become crucialto a woman's well-being, and through her, to the well-
being of children. The positive effects of good health and nutrition on the
labour productivity of the poor is well documented. To the extent that
women are over-represented among the poor, interventions for
improving women's health and nutrition are critical for poverty
reduction.
 Impaired health and nutrition is compounded by early childbearing, and
consequent risk of serious pregnancy related complications. Women's
risk of premature death and disability is highest during their reproductive
years. Malnutrition, frequent pregnancies, unsafe abortions,RTI and STI,
all combine to keep the maternal mortality ratio in India among the
highest globally.
 Maternal mortality is not merely a health disadvantage, it is a matter of
social injustice. Low social and economic status of girls and women
limits their access to education, good nutrition, as well as money to pay
for health care and family planning services. The extent of maternal
mortality is an indicator of disparity and inequity in access to appropriate
health care and nutrition services throughout a lifetime, and particularly

XXXIX
 during pregnancy and child-birth, and is a crucial factor contributing to
high maternal mortality.
 Programmes for Safe Motherhood, Universal Immunisation, Child
Survival and Oral Rehydration have been combined into an Integrated
Reproductive and Child Health Programme, which also includes
promoting management of STIs and RTIs. Women's health and nutrition
problems can be largely prevented or mitigated through low cost
interventions designed for low income settings.
 The voluntary non-government sector and the private corporate sector
should actively collaborate with the community and government through
specific commitments in the areas of basic reproductive and child health
care, basic education, and in securing higher levels of participation in the
paid work force for women.

Child Health and Survival

 Infant mortality is a sensitive indicator of human development. High
mortality and morbidity among infants and children below 5 years occurs
on account of inadequate care, asphyxia during birth, premature birth,
low birth weight, acute respiratory infections, diarrhoea, vaccine
preventable diseases, malnutrition and deficiencies of nutrients,
including Vitamin A. Infant mortality rates have not significantly
declined in recent years.
 Our priority is to intensify neo-natal care. A National Technical
Committee should be set up, consisting principally of consultants in
obstetrics, paediatrics (neonatologists), family health,medical research
and statistics from among academia, public health professionals, clinical
practitioners and government. Its terms of reference should include
prescribing perinatal audit norms, developing quality improvement
activities with monitoring schedules and suggestions for facilitating
provision of continuing medical and nursing education to all perinatal
health care providers. Implementation at the grass-roots must benefit
from current developments in the fields of perinatology and neonatology.

 The baby friendly hospital initiative (BFHI) should be extended to all

hospitals and clinics, up to subcentre levels. Additionally, besides
promoting breast-feeding and complementary feeds, the BFHI should
include updating of skills of trained birth attendants to improve new born
care practices to reduce the risks of hypothermia and infection. Essential
equipment for the new born must be provided at subcentre levels.

 Child survival interventions i.e. universal immunisation, control of

childhood diarrhoeas with oral rehydration therapies, management of
acute respiratory infections, and massive doses of Vitamin A and food

XL
 supplements have all helped to reduce infant and child mortality and
morbidity. With intensified efforts, the eradication of polio is within
reach. However, the decline in standards, outreach and quality of routine
immunisation is a matter of concern. Significant improvements need to
be made in the quality and coverage of the routine immunisation
programme.

Meeting the Unmet Needs for Family Welfare Services

 In both rural and urban areas there continue to be unmet needs for
contraceptives, supplies and equipment for integrated service delivery,
mobility of health providers and patients, and comprehensive
information. It is important to strengthen, energise and make accountable
the cutting edge of health infrastructure at the village, sub centre and
primary health centre levels, to improve facilities for referral
transportation, to encourage and strengthen local initiatives for
ambulance services at village and block levels, to increase innovative
social marketing schemes for affordable products and services and to
improve advocacy in locally relevant and acceptable dialects.

Child Health Programme in India

In 1951, India was the first country in the world to launch a family planning
programme. Since then approaches aimed at reducing population growth have
taken a variety of forms.
Major milestones in Child Health
The current statuses of these indicators are as follows:
Infant mortality rate 60 per 1000 live births (SRS 2003)
Neonatal mortality rate 40 per 1000 live births (SRS 2003)

Background
Till 1977 the major health activity was family planning which was changed into
Family welfare programme with Maternal and Child Health becoming an
integral part of family planning programme with the vision that reduction in
birth rate has a direct relationship with reduction in infant and child mortality.
The diarrhoeal disease control programme was started in the country in 1978.
The main objective of the programme was to prevent death due to dehydration
caused by diarrheal diseases among children under 5 years of age due to
dehydration. Health education aimed at rapid recognition and appropriate
management of diarrhea has been a major component of the CSSM. Under the
RCH programme ORS is supplied in the kits to all sub-centres in the country
every year.

XLI
National Health Policy 1983 envisioned significant reduction in IMR, NMR
& CMR by 2000. All the child health programmes are directed towards
achieving these goals.
Universal Immunization Programme against six preventable diseases, namely,
diphtheria, pertusis, childhood tuberculosis, poliomyelitis, measles and neonatal
tetanus was introduced in the country in a phased manner in 1985, which
covered the whole of India by 1990. Significant progress was made under the
Programme in the initial period when more than 90% coverage
for all the six antigens was achieved.
The UIP was taken up in 1986 as National Technology Mission and became
operational in all districts in the country during 1989-90. UIP become a part of
the Child Survival and Safe Motherhood (CSSM) Programme in 1992 and
Reproductive and Child Health (RCH) Programme in 1997. Under the
Immunization Programme, infants are immunized against
tuberculosis, diphtheria, pertussis, poliomyelitis, measles and tetanus. Universal
immunisation against 6 vaccine preventable diseases (VPD) by 2000 was one of
the goals set in the National Health Policy (1983).
The ARI Control Programme was started in India in 1990.It sought to introduce
scientific protocols for case management of pneumonia with co-trimoxazole.
Initially 14 pilot districts were selected and later on new districts were included.
A review of the health facility done in 1992 revealed that although 87% of
personnel were trained and the drug supply was regular yet there were problems
in correct case classification and treatment.
Since 1992 the Programme was implemented as part of CSSM and later with
RCH.
Cotrimoxazole tablets are supplied as part of drug kit for use by different
category of workers for managing cases of Pneumonia. Under RCH-II activities
are proposed to be implemented in an integrated way with other child health
interventions.
The Child Survival and Safe Motherhood Programme jointly funded by World
Bank and UNICEF was started in 1992-93 for implementation up to 1997-98.
The Child Survival and Safe Motherhood Programme was implemented in a
phased manner covering all the districts of the country by the year 1996-97. The
objectives of the programmes were to improve the health status of infants, child
and maternal morbidity and mortality. The programmes seek to sustain high
coverage levels achieved under the Universal Immunisation
Programme (UIP) in good performance areas and strengthen the immunisation
services of poor performing areas. The programme also provides for
augmenting various activities under the Oral Rehydration Therapy (ORT)
Programme, universalising prophylaxis schemes for
control of anemia in pregnant women & control of blindness in children and
initiating a programme for control of acute respiratory infection (ARI) in
children. Under the safe motherhood component, training of traditional birth

XLII
attendants (TBA), provision of asceptic delivery kits and strengthening of first
referral units to deal with high risk and obstetric emergencies were taken up.
The approved outlay for the CSSM Programme was Rs. 1125.58
crores for the entire IDA credit facility of SDR period. The Programme yielded
notable success in improving the health status of pregnant women, infants and
children & also making a dent in IMR, MMR and incidence of vaccine
preventable diseases.
Reproductive Child Health (RCH) Programme
In order to effectively improve the health status of women and children and
Fulfil the unmet need for Family Welfare services in the country, especially the
poor and under served by reducing infant child and maternal mortality and
morbidity, Government of India during 1997-98 launched the RCH Programme
for implementation during the 9th plan period by integrating Child Survival and
Safe Motherhood (CSSM) Programme with other reproductive and child health
(RCH) services. In addition, a new component for management
of Reproductive Tract Infection (RTI) and Sexually Transmitted Infection (STI)
has also been incorporated. The RCH Programme is partly funded by World
Bank, UNICEF, UNFPA and European Commission etc. Reproductive and
Child Health Program is in 5th year of its operation and is currently operational
in entire country. The program follows a differential strategy with inputs under
the program linked to the needs of the area coupled with the capacity for
implementation. The program was reviewed extensively not only in context of
achievements during mid-term stage, but also in context of National Population
Policy.
Efforts were made to strengthen the routine immunization as well as PPI by
launching a project for Immunization Strengthening with the World Bank
assistance. The ongoing activities were accelerated and new schemes on
Financial Envelop, Dais’ Training, RCH Camps and RCH outreach services
were started to address felt gaps. The implementation of EC assisted Sector
Investment Programme has geared up, especially State/District level activities
and urban RCH component.
Currently the initiatives that are being implemented by the Department of
Family Welfare to achieve these goals are:
1. Control of deaths due to acute respiratory infection,
2. Control of deaths due to diarrheal diseases.
3. Provision of essential new born care
4. Vitamin-A supplementation to children between the ages of 6 months to 3
years.
5. Iron Folic Acid supplementation to children less than five years of age.
6. Implementation of Exclusive breast feeding upto to the age of 6 months and
appropriate practices related to complementary feeding.
7. Integrated Management of Neonatal and Childhood Illnesses (IMNCI): It
offers a comprehensive package for the management of the most common

XLIII
causes of childhood illnesses i.e. sepsis, measles, malaria, diarrhoea, pneumonia
and malnutrition. It is supported by appropriate strengthening of the health care
system and promotion of positive health care practices of the community.

National Iodine deficiency disorders control program

Iodine is an important micronutrient for the health of human beings. A lack of

iodine in the diet can lead to iodine deficiency disorders, ranging from
miscarriage, cretinism, retarded psychomotor development and goitre. Iodine
deficiency is the single most important and preventable cause of mental
retardation worldwide. Iodine deficiency leads to a much wider spectrum of
disorders, commencing with the intrauterine life and extending through
childhood to adult life.
In 1966 National Goitre Control Programme was launched in U.P. and
surveys were undertaken. Out of 70 districts 44 districts are surveyed in a
phased manner & 24 districts were found to be endemic. For effective
control of IDD the Govt. took a decision to universalize iodization of all
edible salt. Govt. of U.P. under PFA Act has banned entry of uniodised salt
from 2nd Oct. 1987. In 1992 programme was renamed as National Iodine
Deficiency Disorder Control Programme (NIDDCP).

NIDDCP focuses on the following

» Survey & resurvey to know IDD prevalence.
Supply of only iodized salt for human consumption (salt having 15ppm
»
Iodine at consumer level)
» Creating demand by consumers for iodized salt.

Structure of NIDDCP
IDD Cell: This cell was established in the Nutrition Wing of state Health
Institute, Lucknow in 1987. Additional Director, state Health Institute is the
programme officer of NIDDCP in U.P. The Additional Director is working
under the Director General, Medical & Health Services.

Main Activities of IDD Cell

NIDDCP focuses on the following
» To monitor the supply and distribution of iodized salt in the state.
» Monitoring the complete ban on the sale of non-iodized salt.
» IEC activities implementation
To coordinate the IDD surveys conducted by various agencies of GoI,
»
medical colleges.

XLIV
 Training of PHC Lab. Tech. for estimation of iodine content in iodized
»
salt.
Receive salt samples collected from districts and analyze them
»
quantitatively at state IDD Lab.
» Organize state, divisional and district level IDD workshops.
» Meeting of state coordination committee.
» Monitor the activities of district level coordination committee.

IDD Lab
The lab works under the IDD Cell and is manned by an LT & LA. Presently
officers, lab technicians and staff of nutrition wing of SHI are working in
IDD Cell & IDD Lab.

Goal
To bring down Total Goitre Rate (TGR) to less than 10%.

Objective
To ensure 90% households consume iodized salt. (15ppm at consumer
»
level)
» Supply of iodized salt through PDS.
 

Strategy
Supply & use of Iodized salt is an effective programme strategy in
preventing Iodine deficiency. The work plan would simultaneously
concentrate on increasing demand of iodized salt as well as supply of only
iodized salt (preferably powdered packet salt). Creation of demand would
be through multi-sectoral agencies such as anganwadi, medical health
workers, panchayat members, school teachers & children, NGOs.
The district monitoring system is to be strengthened. The involvement of
Public Distribution System (PDS) would also be advocated for ensuring
supply through the network of fair price shops.
For the strategy, it is necessary to train and create awareness among the
various health functionaries, ICDS functionaries, block officers, teachers,
panchayat members and the beneficiaries.
Activities
» Strengthening IDD Cell
Establishment of 3 Divisional level Labs in Gorakhpur, Devipatan and
»
Saharanpur Divisions
» Conduct surveys in 9 districts through Medical Colleges
XLV
 Health Education Workshops & Training to Nodal Officers and
»
various stakeholders
» IEC activities
» Maintenance of IDD office at State Headquarter
» Provision of funds to CMOs for district level activities
» Support to NGOs
» Monitoring
Budgetary Estimate
Activity Amount
IDD Cell      Rs.             9,86,000.00
Vehicle & POL      Rs.           12,60,000.00
Computer/Laptop/ LCD Projector      Rs.             1,25,000.00
TA & DA      Rs.                50,000.00
Estb. & Maintenance of IDD Lab      Rs.             2,50,000.00
Survey      Rs.             3,15,000.00
Health Education, Workshops & Training      Rs.           22,89,000.00
IEC Material      Rs.           19,80,000.00
Office Maintenance      Rs.             2,00,000.00
CMO Level Expense      Rs.           17,50,000.00
NGO Support      Rs.             5,00,000.00
Total Amount  Rs.        97,05,000.00

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4. Kapil U, Choudhary P. National Rural Health Mission, will it make a

difference. Indian Paeditrc 2005; 42:783-6.

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5. Wen C. Barefoot doctors in China. Nurs Dig 1975; 3(1): 26-8.

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Ministry of Health (2004d). Primary Health Care in Community-governed Non-
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Moore, J. (1993). Travel time, travel distance & travel cost in the Midland
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Pearce, J., K. Witten, et al. (2006). "Neighbourhoods and health: a GIS
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Williamson, M., A. Gormly, et al. (2006). "Otago Rural Hospitals Study: What
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2.4 Expected- Actual data:

The data which we received was mainly from the specified areas which were
neighbouring Allahabad district only, thus we were expecting data from those
areas only but in large masses but when we actually went to do the survey, we
found very few peoples at first.
Later, somehow when we were able to manage gather interest in them, they
were hiding the basic facts from us like i.e. faking age, annual income etc. Thus,
we were not able to get the actual data that which age group we were actually
surveying and whether they were falling in different income group.
Thus, there was a small difference between the data which we were expecting
from the villagers and those that we actual received.

3.5 Gap Analysis:

The gap between the actual data and expected data can be analyzed by using
two methods.

3.6 Conclusion:

In the conclusion I would say, that any attempt to take broad perspectives on the
current state of rural health in Allahabad suffers from paucity of current
(especially quantitative) information. This becomes a defining point of

LI
difference between here and other places in terms of ability to develop fully
informed policy. Observations of sector commentators on this point are
excerpted, and a discussion of implications is provided in later Section.

Chapter 3:
Research Plan

3.1 Introduction:
The aim of this evaluation study is to gather information and critically analyze
the Rural Health Development Program launched by the government.

The analysis presented here covers the following area:

a. Project description.
b. Research design and methodology.
c. Effects on training and research capacity.
d. Impact on health care delivery and research.
e. Current position and future prospects.
3.2 Research Issues:

LII
These are some research issues which we came across while conducting our
research in a particular area:
1. Low awareness: When we went with our questionnaires in our pilot
survey we come across majority of the peoples who were partially aware
or not at all aware about the operating schemes in the region. They didn’t
know which new schemes have been introduced by the government
recently or under which scheme what facilities are available to them.
Many people even didn’t bothered to know when we tried to make them
inform about the list of schemes present in their area

2. Less Transparency: No transparency is been found between government

launched schemes and those been implemented in a particular area. There
was no way to cross check whether the schemes were applied in real or
whether it remained in terms of paper only.

3. Awareness about Health Problems: While awareness is high about the

target group does not know some of the common health problems the
details. They do not have the actual knowledge of what diseases is caused by
smoking, adverse affects of contaminated water, problems caused by
stagnant water, diseases caused by different kinds of smoke, precaution in
using pesticides and menace of plastic bags for environment.

LIII
 The methodology adopted for this project was completely based on
primary information. The locale of the study was district Allahabad and
its nearby areas .The first stage included gathering information about
the general health of the rural people.

The second stage comprised determining the objective of the study and drafting
the questionnaire. The questionnaire was designed keeping in mind the
LIV
objective of the study. It was designed with due guidance of the company guide.
It was assured that the questionnaire didn’t exceed more than 10 questions per
scheme. Keeping in mind the education level of the respondents who were
mainly villagers who were either illiterate or had a very primary education.

3.3 Objective of the Study:

1. To analyze the concept and purpose, definition, policy and the practices of
rural health in the selected area of India i.e. Allahabad and the interconnections
between the prevailing political ideology in the whole country.

2. To analyze and identify the similarities and dissimilarities in the differential

Growth of Rural Health in India.

3. To analyze the relative role of primary health care Centers and in achieving
healthy rural India.

4. To critically analyze the factors associated with successful outcomes and

problems of Rural Health of India.

Percentage of People below Poverty Line

In India (1973–2004)

Years Rural Urban Combined

1973 56.4 49.0 54.9

1983 45.7 40.8 44.5

1993 37.3 32.3 36.0
2004 28.3 25.7 27.5

Table 3.1
Source: Planning Commission

3.4 Research Objective:

LV
Specific research objectives included the following:

(1) Provide a descriptive analysis of the data collected in the survey

(2) Identify the health problems in Allahabad
(3) Assess clinic demand and estimate willingness to pay for health
services.

3.5 Scope of Study:

There are few limitations when we conducted the research process for
Survey on Health, these are as follows:

1. Time Limit: The major constraint which we faced during conduction

of this research was it’s time limit. We couldn’t get into the much
details of this Survey due to lack of time. We have a fixed period of 4
months, in which we had to complete our Preparation of
Questionnaire, then analyse the data and then conduct a Survey on the
findings of our raw data. Based on this Information we had to make a
report, which limited us to depend on our primary findings.

2. Proximity of the area: As we were limited to do our research on the

villages and rural areas which were close to Allahabad district only.
Thus, we were forced to make our assumption that this is only the real
state of whole rural India.

LVI
 3.6 Research Methodology:

RESPONDENTS' PROFILE OF THE TARGET GROUP

The survey covered a total of about 100 respondents from 3 different

locations surrounding Allahabad. The sex distribution of the target group in
the sample is almost fifty-fifty; 50.3 percent males and 49.7 percent females.
The respondents consist of all age groups, 36.2 of them belong to 16 to 30
year of age and 35.6 percent come under 31 to 45 age group. . 22.1 percent
of the target group falls between 46 to 60 years of age, followed by 6.1
percent, who are above 60 years of age. The region surrounding Jhushi has
younger respondents (41.7 percent) as compared to 27.2 percent from
Phaphamau region. At the same time Phaphamau region has less
representation in the age group of 46 to 60 (27.8 percent) and above 60
years (13.9 percent).Only 7 percents are in the above 60-year age group in
other regions.

Education
Table 3.1 shows that more than half (52.2 percent) of the sample
respondents are illiterate, followed by one-fifth (26.2percent) who have
studied up to 51h standard and 13.1 percent who studied up to 9 th
standard. Further, Table 3.1 shows that 14.6 percent respondents
have studied in 10th and beyond 10 th standard. Males are more
educated than females in all the educational categories. There is a gap
of 20 percent and 9 percent among the males and females respectively
who studied up to 10 th or beyond 10th standard. Subedar Ganj region
has more illiterates (57.8 percent) and lesser number of respondents
who studied up to 10th standard and beyond (11.7 percent) than other
regions.

Occupation
The analysis of personal characteristics of the respondents in terms of
their occupation in Table 3.1 presents an interesting occupational
profile. It shows that the respondents are divided almost equally in
three major occupation categories; 28.0 percent agriculturists, 28.3
percent self employed persons and 27.2 percent housewives.

Agriculturists are more from Jhushi region (30.7 percent) than in other
regions. But it has lesser representation of housewives (14.7 percent).
From Phaphamau region the sample has lesser percentage of self

LVII
 employed persons (22.5 percent) and comparatively more
housewives (36.6 percent). .Subedar Ganj region presents slightly
different picture with minimum number of service people (4..8 percent)
and maximum percentage of people in business (10 percent).

On expected lines, very less percentage of respondents is from Type-1

location (11.3 percent) in comparison to 34.8 percent from Type-2 and 37.9
percent from Type-3 location. Type-1 location has more representation among
the self-employed persons (39.4 percent) and service holders (11.3 percent) and
business categories than from other locations. Percentage of female
respondents is lesser in agriculture, self employed and service categories.
Of course, a large number of them (54.7 percent) are housewives.

Income
Since, the sample was drawn from relatively poor parts and weaker sections
of the towns and villages. 71.1 percent of the respondents belong to
"lower income group" having annual family income up to Rs 20,000. For
other 19 percent, the annual family income is only 40,000, followed by 6.2
percent with family income more than 40,000.

Among lower Region Sex Total

income group, Phapha Subedar
Phaphamau region Jhushi mau
Other Areas
Ganj
Male Female
has
Sexmaximum
LVIII
Male 51.5 50.0 50.6- 49.8 100 50.3
Female 48.6 50.0 49.4 50.2 100 49.7
Age
16-30yrs 36.1 41.7 27.2 35.6 34.8 37.6 36.2
3 1 -45yrs 35.3 32.5 31.1 39.4 36.4 34.9 35.6
46-60yrs 22.8 19.7 27.8 21.3 22.6 21.6 22.1
60+ 5.7 6.1 13.9 3.7 6.2 6.0 6.1
Education
Illiterate 45.9 49.2 54.4 57.8 43.2 61.3 52.2
Upto 5th std 19.8 21.9 21.1 18.9 21.7 18.6 20.2
6-9 std 14.9 14.2 11.1 11.7 15.1 11.0 13.1
-10-12 std and 19.3 143 13.3 11.7 20.0 9.0 14.6
above
Occupation
Agriculture 36.7 23.1 26.1 26.1 39.4 16.6 28.0
Self employed 34.2 22.5 36.1 25.6 33.9 22.7 28.3
Service 9.0 8.6 7.8 4.8 12.1 2.2 7.2
Business 2.2 2.2 3.9 10.0 9.1 1.5 5.3
Student 1.6 2.8 2.2 1.1 1.5 2.1 1.8
House-wife 14.7 38.6 23.9 29.3 0.0 54.7 27.2
Unemployed 1.6 1.1 0.0 3.0 3.3 0.3 1.8
Retired 0.0 1.1 0.0 0.2 0.7 0.0 0.3
Income
Upto 20,000 67.4 81.7 71.1 66.5 70.0 72.2 71.1
20001-40000 25.5 10.3 15.0 21.7 19.6 18.4 19.0
40000+ 6.5 7.8 13.3 2.6 7.3 5.1 6.2
Not reported 0.5 0.3 0.6 9.3 3.2 4.3 3.7
Total 368 360 180 540 729 719 1448

Table -3.2: Percentage Distribution of the

Respondents by Location and Sex

Variables Type of Location Sex Total

Type 1 Type 2 Type 3 Male Female
Sex
Male 50.6 50.2 50.2 100 50.1
Female 49.4 49.8 49.8 100 49.7
Age

LIX
16-30yrs 34.8 35.9 37.9 34.8 37.6. 36.2
31-45yrs 42.3 35.5 29.2 36.4 34.9 35.6
46-60yrs 17.5 22.3 26.5 22.6 21.6 22.1
60+ 5.4 6.4 6.5 6.2 6.0 6.1
Education
Illiterate 50.6 49.6 56.7 43.2 61.3 52.2
Upto 5th std 19.8 23.8 16.9 21.7 18.6 20.2
6-9 std 11.9 14.8 12.5 15.1 11.0 13.1
10-12 std and 17.7 11.9 14.2 20.0 9.0 14.6
Occupation
Agriculture 11.3 34.8 37.9 39.4 16.6 28.0
Self employed 39.4 28.9 16.7 33.9 22.7 28.3
Service 11.3 5.7 4.6 12.1 2.2 7.2
Business 6.7 4.7 4.6 9.1 1.5 5.3
Student 1.9 1.0 2.5 1.5 2.1 1.8
House-wife 26.5 23.6 31.7 0.0, 54.7 27.2
Unemployed 2.5 1.2 1.7 3.3 0.3 1.8
Retired 0.6 0.0 0.4 0.7 0.0 0.3
Income
Upto 20000 75.8 70.3 67.1 .70.0 72.2 71.1
20001-40000 14.8 20.1 22.1 19.6 18.4 19.0
40000+ 6.5 6.6 5.6 7.3 5.1 6.2
Not reported 2.9 3.1 5.2 3.2 4.3 3.7
Total 480 488 480 729 719 1448

Table -3.3: Percentage Distribution of the Demographic Variables of

Respondents by Location and Sex

Scaling Techniques:

Summated scales (or Likert-type scales) are developed by utilizing the item
analysis approach wherein a particular item is evaluated on the basis of how
well it discriminates between those persons whose total score is high and those
whose score is low. Those items or statements that best meet this sort of
discrimination test are included in the final instrument. Thus, summated scales
consist of a number of statements which express either a favorable or
unfavorable attitude towards the given object to which the respondent is asked
to react. The respondent indicates his agreement or disagreement with each
statement in the instrument. Each response is given a numerical score,
indicating its favorableness or un-favorableness, and the scores are totaled to
measure the respondent’s attitude. In other words, the overall score represents
the respondent’s position on the continuum of favorable & un-favorableness
towards an issue. Most frequently used summated scales in the study of social
attitudes follow the pattern devised by Likert. For this reason they are often
referred to as Likert-type scales. In a Likert scale, the respondent is asked to

LX
respond to each of the statements in terms of several degrees, usually five
degrees (but at times 3 or 7 may also be used) of agreement or disagreement.
For example, when asked to express opinion whether one considers his job quite
pleasant, the respondent may respond in any one of the following ways:
(i) Strongly agree, (ii) agree, (iii) undecided, (IV) disagree, (v) strongly
disagree.

We find that these five points constitute the scale. At one extreme of the scale
there is strong agreement with the given statement and at the other, strong
disagreement, and between them lie intermediate points. We may illustrate this
as under:

Each point on the scale carries a score. Response indicating the least favorable
degree of job satisfaction is given the least score (say 1) and the most favorable
is given the highest score (say 5). These score—values are normally not printed
on the instrument but are shown here just to indicate the scoring pattern. The
Likert scaling technique, thus, assigns a scale value to each of the five
responses. The same thing is done in respect of each and every statement in the
instrument. This way the instrument yields a total score for each respondent,
which would then measure the respondent’s favorableness toward the given
point of view. If the instrument consists of, say 30 statements, the following
score values would be revealing.

30 × 5 = 150 most favorable response possible

30 × 3 = 90 A neutral attitude
30 × 1 = 30 most unfavorable attitude.

The scores for any individual would fall between 30 and 150. If the score
happens to be above 90, it shows favorable opinion to the given point of view, a
score of below 90 would mean unfavorable opinion and a score of exactly 90
would be suggestive of a neutral attitude. Procedure: The procedure for
developing a Likert-type scale is as follows:
1. As a first step, the researcher collects a large number of statements which
are relevant to the attitude being studied and each of the statements
expresses definite favorableness or un-favorableness to a particular point
of view or the attitude and that the number of favorable and unfavorable
statements is approximately equal.

LXI
 2. After the statements have been gathered, a trial test should be
administered to a number of subjects. In other words, a small group of
people, from those who are going to be studied finally, are asked to
indicate their response to each statement by checking one of the
categories of agreement or disagreement using a five point scale as stated
above.
3. The response to various statements are scored in such a way that a
response indicative of the most favorable attitude is given the highest
score of 5 and that with the most unfavorable attitude is given the lowest
score, say, of 1.
4. Then the total score of each respondent is obtained by adding his scores
that he received for separate statements.
5. The next step is to array these total scores and find out those statements
which have a high discriminatory power. For this purpose, the researcher
may select some part of the highest and the lowest total scores, say the
top 25 per cent and the bottom 25 per cent. These two extreme groups are
interpreted to represent the most favorable and the least favorable
attitudes and are used as criterion groups by which to evaluate individual
statements. This way we determine which statements consistently
correlate with low favorability and which with high favorability.
6. Only those statements that correlate with the total test should be retained
in the final instrument and all others must be discarded from it.

Advantages: The Likert-type scale has several advantages. Mention may be

made of the important ones.
1. It is relatively easy to construct the Likert-type scale in comparison to
Thurstone-type scale because Likert-type scale can be performed without
a panel of judges.
2. Likert-type scale is considered more reliable because under it
respondents answer each statement included in the instrument. As such it
also provides more information and data than does the Thurstone-type
scale.
3. Each statement, included in the Likert-type scale, is given an empirical
test for discriminating ability and as such, unlike Thurstone-type scale,
the Likert-type scale permits the use of statements that are not manifestly
related (to have a direct relationship) to the attitude being studied.
4. Likert-type scale can easily be used in respondent-centered and stimulus-
centered studies i.e., through it we can study how responses differ
between people and how responses differ between stimuli.
5. Likert-type scale takes much less time to construct; it is frequently used
by the students of opinion research. Moreover, it has been reported in
various research studies that there is high degree of correlation between
Likert-type scale and Thurstone-type scale.

LXII
Limitations: There are several limitations of the Likert-type scale as well. One
important limitation is that, with this scale, we can simply examine whether
respondents are more or less favorable to a topic, but we cannot tell how much
more or less they are. There is no basis for belief that the five positions
indicated on the scale are equally spaced. The interval between ‘strongly agree’
and ‘agree’ may not be equal to the interval between “agree” and “undecided”.
This means that Likert scale does not rise to a stature more than that of an
ordinal scale, whereas the designers of Thurstone scale claim the Thurstone
scale to be an interval scale. One further disadvantage is that often the total
score of an individual respondent has little clear meaning since a given total
score can be secured by a variety of answer patterns. It is unlikely that the
respondent can validly react to a short statement on a printed form in the
absence of real-life qualifying situations. Moreover, there “remains a possibility
that people may answer according to what they think they should feel rather
than how they do feel.”4 This particular weakness of the Likert-type scale is
met by using a cumulative scale which we shall take up later in this chapter. In
spite of all the limitations, the Likert-type summated scales are regarded as the
most useful in a situation wherein it is possible to compare the respondent’s
score with a distribution of scores from some well defined group. They are
equally useful when we are concerned with a program of change or
improvement in which case we can use the scales to measure attitudes before
and after the programmed of change or improvement in order to assess whether
our efforts have had the desired effects. We can as well correlate scores on the
scale to other measures without any concern for the absolute value of what is
favorable and what is unfavorable. All this accounts for the popularity of Likert-
type scales in social studies relating to measuring of attitudes.

3.7 Concluding Remarks:

In the conclusion I would say that we were able to successfully design
our way of doing research. We have developed a good research objective
to work onto and by making initial questionnaires; we started to collect
data from the villagers.
In the next 2 chapters we will discuss the various methods to collect data
and then analysing it. Also, we will summarise our findings and put on
required recommendations.

LXIII
 Chapter -4
Data Analysis

4.1 Introduction:
In this chapter the main aim of this evaluation study is to gather information and critically
analyze the data received during our Field survey.
As we were limited to do our survey on the adjoining areas surrounding Allahabad due to
time and proximity factors. We collected data from the two villages namely Hashipur and
Haripur respectively.
During our field survey we came across wide number of peoples from different age groups,
education qualifications and other varied demographic fields.
The analysis on the Sample size Surveyed is been as follows:

1. Age of the respondent

LXIV
 >60 5.98% <18 2.56%
age of the re spondent
<18
18-35
35-60
>60

Pies show counts

35-60
34.19%

57.26%

18-35

Figure no. 4.1

Analysis:- Most of the respondent we found were the age group of 18-35, followed by the
age group of 35-60. Few people were elder than 60 and least number of respondents were less
than 18 years old.
2. Education level of respondent:

education level
graduate and ab ove illiterate
high school
intermediate
illiterate graduate and abov e
16.24%

33.33% Pies show counts

intermediate
13.68%

36.75%

high schoo l

Figure No. 4.2

LXV
 Analysis:- Covering the villages in which the survey is being conducted, we found
that majority of the respondents were having the literacy level of high school(36.75%),
followed by illiterate people(33.33%).Where as education level of graduate and above
respondents(16.24%) and intermediate respondents (13.68%) is almost the same.

3. Gender

ge nder of the re spondent

male
f emale

female
Pies show counts

31.62%

68.38%

male

Figure no. 4.3

Analysis: Majority of the respondents were Male in the villages where the survey was been
conducted. Male respondents (68.38%) were found to be more than double as compared to
the female respondents (31.62%)

4. OCCUPATION:

LXVI
 occupation
f arm er
serv ice
others self em ploy ed
others

29.91% Pies show counts

farmer
46.15%

17.09%

self empl oyed

servi ce 6.84%

Figure 4.4

Analysis: Majority of the respondents answering the questionnaire were Farmers (46.15%)
followed by others(29.91%).The respondents who were self employed(17.09%) were almost
thrice of the respondents engaged in service sector(6.84%).

5. INCOME:

LXVII
 above 100000 2.56%
500001-100000 6.84% annual income of responde nt
<19000
19000-50000
500001-100000
abov e 100000

19000-50000 Pies show counts

23.93%

66.67%

<19000

Figure 4.5

Analysis: Poverty is one of the major concerns which our government should took note of in
these villages. Majority of the respondents lies in the income range of <19000 i.e.(66.67%)
followed by respondents having an income in the range of 19000-50000i.e(23.93%).Very few
respondents have an income in the range of 50001- 100000i.e(6.84%)and the respondents
having an income in the range of above 100000 were 2.56% of the total respondents.

6. MARITAL STATUS:

LXVIII
 ma rita l status of re spondent
unmarri ed married
unmarried

Pies show counts

16.24%

83.76%

married

Figure 4.6

Analysis: Majority of the respondents surveyed were married comprising of (88.76%) of the
total respondents .Where as the respondents who were unmarried were (16.24%) of the total
respondents

4.2 Interpretation of Cross tabs and Pie Charts:

In this section according to the schemes we have surveyed, analysis of cross tabs and pie
charts is been done.

4.2.1. National Rural Health Mission ( NRHM)

4.2.1.A. Awareness
(i). I am aware of this scheme.

fully aware 5.13% I a m aw a re of this sche me

f ully aware
partially aware
indiff erent
partially aware most ly unaware
unaware
unaware

35.90% 24.79%
Pies show counts
Figure 4.7

15.38%
18.80% I am aware of this scheme Total

indifferent LXIX
mo stly unaware
 mostly
fully partially indiffere unawar unawar
aware aware nt e e
EDU illiterate 0 1 16 5 17 39
high
2 13 5 8 15 43
school
intermedia
0 6 0 4 6 16
te
graduate
4 9 1 1 4 19
and above
Total 6 29 22 18 42 117

Table 4.1
Analysis :- A very small percentage of the sample is aware (5.13%) & mostly are unaware
(35.9%) . The main reason behind this is that a large portion of the sample is illiterate which
has an impact on their awareness.

(ii). I am aware of the objectives of the scheme.

full y aware 1.71%

I a m awa re of the objective s of the scheme
partially aware f ully aware
partially aware
indif f erent
mostly unaware
unaware 16.24% unaware

36.75%
Pies show counts

23.93%

indifferent
21.37%
Cross tab

mo stly unaware

Figure 4.8

I am aware of the objectives of the scheme

mostly
fully partially indiffere unawar unawar
aware aware nt e e Total
EDU illiterate 0 2 12 10 15 39
high
0 8 9 7 19 43
school
intermedia
0 4 3 3 6 16
te
graduate
2 5 4 5 3 19
and above
Total 2 19 28 25 43 117

LXX
 Table 4.2

Analysis :- A very small percentage of the sample is aware (1.71%) & mostly are unaware
(36.76%) . The main reason behind this is that a large portion of the sample is illiterate
which has an impact on their awareness.

(iii). I am aware of the criteria for the selection as an ASHA.

fully aware 4.27% I am awa re of the criteria for sele ction a s a n ASHA
unaware f ully aware
part ially aware
indiff erent
mostly unaware
17.09% unaware

partially awarePies show counts

38.46%
20.51%
mo stl y unaware

19.66%

Figure 4.9 indifferent

I am aware of the criteria for selection as an

ASHA
mostly
fully partially indiffere unawar unawar
aware aware nt e e Total
EDU illiterate 0 14 10 7 8 39
high
2 16 7 8 10 43
school
intermedia
0 6 5 3 2 16
te
graduate
3 9 1 6 0 19
and above
Total 5 45 23 24 20 117

Table 4.3

Analysis :- A very small percentage of the sample is aware (4.27%) & mostly are partially
aware (36.46%) . The main reason behind this is that a large portion of the sample is illiterate
which has an impact on their awareness.

(iv). I am aware of the hospitals for tuberculosis & oral rehydration treatment.

LXXI
 fully aware 5.13% I a m awa re of the hospitals for the trea tment for tube rculosis a nd oral rehydra tion;
unaware
f ully aware
partially aware
indiff erent
partially aware mostly unaware
12.82%
unaware
23.93%
Pies show counts

37.61%

20.51%
mo stly unaware

indifferent

Figure 4.10

I am aware of the hospitals for the treatment for

tuberculosis and oral rehydration;
mostly
fully partially indiffere unawar unawar
aware aware nt e e Total
EDU illiterate 1 5 12 17 4 39
high
2 10 6 16 9 43
school
intermedia
1 7 5 2 1 16
te
graduate
2 6 1 9 1 19
and above
Total 6 28 24 44 15 117

Table 4.4
Analysis :- A very small percentage of the sample is aware (5.12%) & a majority are mostly
unaware (37.61%) . The main reason behind this is that a large portion of the sample is
illiterate which has an impact on their awareness.

fully aware 5.13% I a m awa re of the dise ases like Reproductive Tract Infection/Sexually Transmitted Disease s
unaware f ully aware
partially aware
partially aware indiff erent
mostly unaware
19.66% unaware
17.95%

(v). I am aware of the diseases like

Pies show counts

reproductive tract infections & sexually transmitted

28.21%
29.06% diseases.
mo stly unaware

indifferent

LXXII
 Figure 4.11

I am aware of the diseases like Reproductive

Tract Infection/Sexually Transmitted Diseases
mostly
fully partially Indiffere unawar unawar
aware aware nt e e Total
EDU illiterate 0 5 12 13 9 39
high
1 7 13 10 12 43
school
intermedia
1 4 5 5 1 16
te
graduate
4 5 4 5 1 19
and above
Total 6 21 34 33 23 117

Table 4.5

Analysis :- A very small percentage of the sample is aware (5.12%) & a majority are mostly
unaware (26.81%) . The main reason behind this is that a large portion of the sample is
illiterate which has an impact on their awareness.

highly unsatisfied 6.84% I am satisfie d with the services like immunization,hea lth che ck ups
unsatisfied 5.98% f ully satisfied
fully satisfied satisfied
indiff erent
indifferent 9.40% unsatisf ied
highly unsatisfied
25.64%

4.2.1.B. Satisfaction
Pies show counts

(i). I am satisfied with the services like immunization,

health check ups
52.14%

satisfied
LXXIII
 Case Processing Summary

Figure 4.12
I am satisfied with the services like immunization, health
check ups Total
fully indiffere unsatisfie highly
satisfied Satisfied nt d unsatisfied
education Illiterate 7 26 4 1 1 39
level high school 11 18 3 5 6 43
Intermediate 5 8 3 0 0 16
graduate and
7 9 1 1 1 19
above
Total 30 61 11 7 8 117

Table 4.6

Analysis- Out of all the respondents surveyed, (62.2%) are satisfied. Analysis of crosstab
shows that The majority is constituted by illiterate section i.e.26 out of sample size of 39 and
in contrast less satisfaction is found in people educated till intermediate i.e. 0 out of 16.

(ii). Has it achieve success in improving the health of people of my village?

highly unsatisfied Has it a chieve success in improving the health of pe ople of my villa ge
fully satisfied f ully satisfied
satisfied
indiff erent
unsatisf ied
10.26%
18.80% highly unsatisfied
unsatisfied

18.80% Pies show counts

17.09% 35.04%

satisfied
indifferent

Figure 4.13

LXXIV
 Has it achieve success in improving the health of people of
my village Total
fully indiffere unsatisfie highly
satisfied satisfied nt d unsatisfied
education illiterate 4 14 13 7 1 39
level high school 9 16 3 7 8 43
intermediate 5 3 2 4 2 16
graduate and
4 8 2 4 1 19
above
Total 22 41 20 22 12 117

Table 4.7

Analysis- Out of respondents surveyed, satisfaction level has major share of 35.14%.analysis
of crosstab shows the majority is constituted by people who studied till high school i.e.16 out
of sample size of 43 and in contrast less satisfaction is found in illiterate people i.e.1 out of a
sample size of 39

(iii). I am satisfied with the ambulance services which they provide during emergency.

fully satisfied 6.84% I am satisfied with the a mbulance services which they provide during em erge nc
f ully satisfied
satisfied
satisfied indiff erent
highly unsatisfied unsatisf ied
highly unsatisfied
14.53%
34.19%
Pies show counts

17.95%

indifferent
26.50%

unsatisfied

Figure 4.14

I am satisfied with the ambulance services which they

provide during emergency Total
fully satisfied indiffere unsatisfie highly

LXXV
 satisfied nt d unsatisfied
education illiterate 2 5 6 12 14 39
level high school 3 8 6 8 18 43
intermediate 3 0 6 2 5 16
graduate and
0 4 3 9 3 19
above
Total 8 17 21 31 40 117

Table 4.8
Analysis-out of respondents surveyed, highly unsatisfied section has major share of
34.19%.analysis of crosstab shows the majority is constituted by people who studied till high
school i.e.18 out of sample size of 43 and in contrast full satisfaction is not found in anyone
who were graduate and above i.e.0 out of a sample size of 19.

(iv). I am satisfied with the cooperation of ASHA(Accredited Social Health Activist).

highly unsatisfied 8.55% I am satisfie d with the coopera tion of ASHA(Accredited Social Hea lth Activist)
fully satisfied f ully satisfied
satisfied
indiff erent
unsatisfied unsatisf ied
16.24% highly unsatisfied
17.09%
Pies show counts

20.51% 37.61%

satisfied
indifferent

Figure 4.15

I am satisfied with the cooperation of ASHA(Accredited

Social Health Activist) Total
fully indiffere unsatisfie highly
satisfied satisfied nt d unsatisfied
education illiterate 4 11 8 11 5 39
level high school 7 18 10 4 4 43
intermediate 4 7 3 2 0 16
graduate and
4 8 3 3 1 19
above

LXXVI
Total 19 44 24 20 10 117

Table 4.9
Analysis- Out of respondents surveyed, satisfaction level has major share of 37.61%.analysis
of crosstab shows the majority is constituted by people who studied till high school i.e.18 out
of sample size of 43 and in contrast least satisfaction is found in people who studied till
intermediate i.e.0 out of a sample size of 16.

4.2.2 NATIONAL FAMILY INSURANCE SCHEME

4.2.2.A. Awareness
(i) An insurance is provided to the sterilization acceptors.

An insurance is provided to ste riliza tion acceptors.

Unaware fully aware f ully aware
Partially Aware
Indiff erent
Mostly unaware
17.95% 15.38% Unaware

Pies show counts

Mostly unaware 13.68%

33.33%

19.66%
Partially Aware

Indifferent
Figure 4.16

An insurance is provided to sterilization acceptors.

Partially Mostly
fully aware Aware Indifferent unaware Unaware Total
EDU Illiterate 3 14 10 7 5 39
high school 5 13 9 4 12 43
intermediate 6 4 3 2 1 16
graduate and
4 8 1 3 3 19
above
Total 18 39 23 16 21 117

Table 4.10

Analysis :- A considerable percentage of the sample is aware (15.38%) & a majority are
partially aware (33.33%) . The main reason behind this is that they have reaped out the
benefits of this scheme .

LXXVII
 (ii). Rs.200 is provided to the person undergoing a Vasectomy & Rs. 300 is provided for
Tubectomy .
Unaware Rs.200 is provided to the pe rson undergoing a Vasectom y and Rs. 300 is provide d for tubectomy.
Fully Aware
Fully Aware
Partially aware
Indiff erent
Mostly unaware 9.40% Mostly unaware
11.97%
20.51% Unaware

Pies show counts

11.97%
Indifferent

46.15%

Partially aware

Figure 4.17

Rs.200 is provided to the person undergoing a Vasectomy and Rs.

300 is provided for tubectomy. Total
Partially Mostly
Fully Aware aware Indifferent unaware Unaware
EDU Illiterate 2 23 6 4 4 39
high school 11 16 6 3 7 43
intermediate 3 8 2 2 1 16
graduate and
8 7 0 2 2 19
above
Total 24 54 14 11 14 117

Table 4.11

Analysis :- A considerable percentage of the sample is aware (20.51%) & a majority are
partially aware (46.15%) . The main reason behind this is that they have reaped out the
benefits of this scheme .

LXXVIII
(iii). I am aware of the hospitals in my area where this scheme works.

Unaware I a m aware of the hospitals in my area where this scheme works

Fully Aware Fully Aware
Partially Aware
Indiff erent
Mostly unaware 7.69%
Mostly unaware
11.97%
18.80% Unaware

Pies show counts

Indifferent 11.97%

49.57%

Figure 4.18 Partially Aware

I am aware of the hospitals in my area where this scheme works Total

Partially Mostly
Fully Aware Aware Indifferent unaware Unaware
EDU Illiterate 2 20 7 7 3 39
high school 7 20 6 2 8 43
intermediate 5 9 1 0 1 16
graduate and
8 9 0 0 2 19
above
Total 22 58 14 9 14 117

Table 4.12

Analysis :- A considerable percentage of the sample is aware (18.80%) & a majority are
partially aware (49.67%) . The main reason behind this is that they have reaped out the
benefits of this scheme .
4.2.2.B. Satisfaction
(i). I am fully satisfied with the insurance provided to sterilization acceptors.

LXXIX
 full y satisfied 4.27% I a m fully satisfie d with the insurance provided to the sterilization a cceptors
highly unsatisfied
f ully satisfied
satisfied
indif f erent
satisfied unsatisf ied
13.68%
highly unsatisfied
26.50%
Pies show counts
unsatisfied 22.22%

33.33%

indifferent

Figure 4.19

I am fully satisfied with the insurance provided to the

sterilization acceptors Total
fully indiffere unsatisfie highly
satisfied satisfied nt d unsatisfied
education illiterate 0 8 14 11 6 39
level high school 2 11 12 10 8 43
intermediate 2 5 5 4 0 16
graduate and
1 7 8 1 2 19
above
Total 5 31 39 26 16 117

Table 4.13
Analysis: Analysis-out of respondents surveyed, indifferent level has major share of 33.33%.
Analysis of crosstab shows the majority is constituted by people who studied till high school
i.e.12 out of sample size of 43 and in contrast least satisfaction is found in people who were
graduate and above i.e. 1 out of a sample size of 19.

(ii). The Compensation that the scheme provides on failure of a sterilization operation is
satisfactory.

LXXX
 fully satisfied 5.98% The compensation that the scheme provides on failure of a sterilization operation is satisfactory.
Fully Unsatisfied
f ully satisfied
satisfied
satisfied indiff erent
unsatisf ied
12.82%
Fully Unsatisf ied
17.95%
Pies show counts
unsatisfied 22.22%

41.03%

indifferent

Figure 4.20

The compensation that the scheme provides on failure of a

sterilization operation is satisfactory. Total
fully indiffere unsatisfie Fully
satisfied satisfied nt d Unsatisfied
education illiterate 1 5 18 11 4 39
level high school 3 6 15 10 9 43
intermediate 2 4 7 2 1 16
graduate and
1 6 8 3 1 19
above
Total 7 21 48 26 15 117

Table 4.14

Analysis: Analysis-out of respondents surveyed, indifferent level has major share of 41.91%.
Analysis of crosstab shows the majority is constituted by people who were illiterate i.e.18 out
of sample size of 39 and in contrast least satisfaction is found in people who studied till
graduate and above i.e. 1 out of a sample size of 19.

(iii). Are the facilities provided at hospital satisfactory?

LXXXI
 highly unsatisfied 6.84% fully satisfied 5.98% Are the facilitie s provided at hospital satisfa ctory
f ully satisfied
satisfied
indiff erent
unsatisfied
unsatisfied
highly unsatisfied

23.08%
Pies show counts
38.46% satisfied

25.64%

indifferent

Figure 4.21

Are the facilities provided at hospital satisfactory Total

fully indiffere unsatisfie highly
satisfied satisfied nt d unsatisfied
education illiterate 3 15 10 10 1 39
level high school 2 16 11 9 5 43
intermediate 2 7 2 4 1 16
graduate and
0 7 7 4 1 19
above
Total 7 45 30 27 8 117

Table 4.15
Analysis-out of respondents surveyed, satisfaction level has major share of 38.46%.analysis
of crosstab shows the majority is constituted by people who studied till high school i.e.16 out
of sample size of 43 and in contrast full satisfaction is not found in anyone of graduate level
and above i.e.0 out of a sample size of 19.

(iv). Are the insurance facilities useful step in family planning?

LXXXII
 fully satisfied Are the insurance facilities useful step in fa mily planning
highly unsatisfied f ully satisfied
satisfied
indiff erent
unsatisf ied
15.38% 11.11%
highly unsatisfied

Pies show counts

unsatisfied 19.66% 28.21% satisfied

25.64%

indifferent

Figure 4.22

Are the insurance facilities useful step in family planning Total

fully indiffere unsatisfie highly
satisfied satisfied nt d unsatisfied
education illiterate 3 9 13 10 4 39
level high school 5 10 8 10 10 43
intermediate 2 7 5 0 2 16
graduate and
3 7 4 3 2 19
above
Total 13 33 30 23 18 117

Table 4.16
Analysis: Out of respondents surveyed, satisfaction level has major share of 28.21%.analysis
of crosstab shows the majority is constituted by people who studied till high school i.e.10
out of sample size of 43 and in contrast full satisfaction is found more in people who studied
till intermediate i.e.2 out of a sample size of 16

4.2.3 NATIONAL AIDS CONTROL PROGRAM

4.2.3.A Awareness

LXXXIII
 (i). I am aware of the National Aids Control Program

I am awa re of nationa l Aids control program

fully aware f ully aware
partially aware
unaware
indiff erent
mostly unaware
17.95% unaware
27.35%

Pies show counts

11.97% 30.77%

11.97%
mo stly unaware partially aware

indifferent

Figure 4.23

I am aware of national Aids control program

partially mostly
fully aware aware indifferent unaware unaware Total
EDU Illiterate 0 11 9 7 12 39
high school 6 14 3 5 15 43
intermediate 3 7 1 2 3 16
graduate and
12 4 1 0 2 19
above
Total 21 36 14 14 32 117

Table 4.17

Analysis :- A considerable percentage of the sample is aware (17.95%) & a majority are
partially aware (30.77%) . The main reason behind this is that they have reaped out the
benefits of this scheme .

I a m awa re of the symptom s of Aids.

fully aware f ully aware
unaware
partialy aware
indiff erent
(ii). I am aware mostly unaware
20.51% 17.09% unaware
of the symptoms
of AIDS. Pies show counts

13.68%
mo stly unaware
31.62%

17.09%
partialy aware

indifferent LXXXIV
 Figure 4.24

I am aware of the symptoms of Aids. Total

mostly
fully aware partialy aware indifferent unaware unaware
EDU Illiterate 0 11 11 9 8 39
high school 6 16 7 2 12 43
intermediate 6 3 2 3 2 16
graduate and
8 7 0 2 2 19
above
Total 20 37 20 16 24 117

Table 4.18

Analysis :- :-
A considerable percentage of the sample is aware (17.09%) & a majority are
partially aware (31.62%) . The main reason behind this is that they have reaped out the
benefits of this scheme .

(iii). I am aware about the services provided by the health centers.

LXXXV
 I a m awa re about the service provided by he alth centers.
fully aware f ully aware
unaware
partially aware
indiff erent
most ly unaware
20.51% 19.66% unaware

Pies show counts

17.09%
24.79%
mo stl y unaware

17.95% parti ally aware

indifferent

Figure 4.25
I am aware about the service provided by health
centers.
fully partially Indiffere mostly
aware aware nt unaware unaware Total
EDU Illiterate 3 11 9 6 10 39
high school 11 5 6 10 11 43
Intermediat
4 7 3 1 1 16
e
graduate
5 6 3 3 2 19
and above
Total 23 29 21 20 24 117

Table 4.19

ANALYSIS: Most of the people are partially aware of this scheme that is 24.79% and only
19.66% people are fully aware.20.51% people are unaware of this scheme In case of educated
people high school passed are highly aware of this scheme.

(iv) I AM AWARE OF THE HOSPITAL

LXXXVI
 I a m awa re of the hospita ls
unaware f ully aware
fully aware partially aware
indiff erent
mostly unaware
17.95% unaware
23.08%

Pies show counts

mo stly unaware 11.97%

14.53% 32.48%

indifferent
partially aware

Figure 4.26
I am aware of the hospitals
fully partially indiffere mostly
aware aware nt unaware unaware Total
EDU Illiterate 4 9 10 8 8 39
high school 10 14 3 5 11 43
Intermediat
5 8 2 1 0 16
e
graduate
8 7 2 0 2 19
and above
Total 27 38 17 14 21 117

Table 4.20

ANALYSIS: From the survey we got that 23.08% are fully aware of the hospitals in their
area and 17.95% are unaware of the hospitals in their area. The major problem is the illiteracy
in the village and high school student are mostly aware of the hospitals in their village.

4.2.3.B Satisfaction
(i). Are the scheme objectives useful?

LXXXVII
 fully satisfied Are the schem e obje ctives useful?
highly unsatisfied f ully satisfied
satisfied
indiff erent
unsatisf ied
16.24% 11.11%
highly unsatisfied

unsatisfied
11.11% Pies show counts
27.35% satisfied

34.19%

indifferent

Figure 4.27

Are the scheme objectives useful? Total

fully indiffere unsatisfie highly
satisfied satisfied nt d unsatisfied
education illiterate 0 9 17 5 8 39
level high school 4 13 12 6 8 43
intermediate 3 3 8 1 1 16
graduate and
6 7 3 1 2 19
above
Total 13 32 40 13 19 117

Table 4.21
Analysis: Analysis-out of respondent’s surveyed a major share of 34.19%. is found to be
indifferent Analysis of crosstab shows the majority is constituted by people who are illiterate
i.e.17 out of sample size of 39 and in contrast least satisfaction is found in people who
studied till intermediate i.e.0 out of a sample size of 16

LXXXVIII
 (ii). Are the checkups and services provided safe?

fully satisfied 7.69% Are the check ups a nd se rvice s provided sa fe

highly unsatisfied f ully satisfied
satisfied
indiff erent
unsatisf ied
17.09% satisfied highly unsatisfied

22.22%
Pies show counts
unsatisfied 15.38%

37.61%

indifferent

Figure 4.28
Are the check ups and services provided safe Total
fully indiffere unsatisfie highly
satisfied satisfied nt d unsatisfied
education illiterate 1 9 17 5 7 39
level high school 4 6 13 9 11 43
intermediate 3 5 6 1 1 16
graduate and
1 6 8 3 1 19
above
Total 9 26 44 18 20 117

Table 4.22
Analysis: Out of respondents surveyed, major share of 37.61%. is found to be indifferent.
Analysis of crosstab shows the majority is constituted by people who are illiterate i.e.17 out
of sample size of 39 and in contrast only one illiterate person is fully satisfied i.e. 1 out of a
sample size of 39

(iii). Are the information and services provided by PHC’s enough?

LXXXIX
 fully satisfied 8.55% Are the inform ations a nd se rvice s provided by P.H.Cs e nough
highly unsatisfied f ully satisfied
satisfied
indiff erent
unsatisf ied
18.80% highly unsatisfied
satisfied
24.79% Pies show counts
15.38%
unsatisfied

32.48%

indifferent

Figure 4.29

Are the information and services provided by P.H.Cs

enough Total
fully indiffere unsatisfie highly
satisfied satisfied nt d unsatisfied
education illiterate 0 9 18 4 8 39
level high school 4 6 14 9 10 43
intermediate 3 5 4 1 3 16
graduate and
3 9 2 4 1 19
above
Total 10 29 38 18 22 117

Table 4.23

Analysis: Out of respondents surveyed a major share of 32.48%. is indifferent. Analysis of

crosstab shows the majority is constituted by people who are illiterate i.e.18 out of sample
size of 39 and in contrast no illiterate person is fully satisfied i.e.0 out of a sample size of 39.

4.2.4. NATIONAL FAMILY WELFARE PROGRAMME

4.2.4. A. Awareness
(i). I am aware of this scheme.

XC
 I a m aw a re of this sche me.
Unaware Fully aware Fully aware
Partially aware
Indiff f erent
Mostly unaware
16.24% 18.80% Unaware

Pies show counts

Mostly unaware 17.95%

29.06%

17.95%
Partially aware

Indiffferen t

Figure 4.30

I am aware of this scheme. Total

Fully Partially Indiffere Mostly
aware aware nt unaware Unaware
EDU Illiterate 5 11 10 5 8 39
high school 9 11 8 8 7 43
Intermediat
4 4 0 5 3 16
e
graduate
4 8 3 3 1 19
and above
Total 22 34 21 21 19 117

Table 4.24
Analysis: From the survey we got that 18.80% are fully aware of this scheme in their area
and 16.24% are unaware of this scheme. The major problem is the illiteracy in the village and
high school student are mostly aware of this scheme.

(ii). I am aware of the reproductive age for women.

XCI
 Unaware 9.40% I a m awa re of the reproductive a ge for women
Fully aware
Partially aware
Fully aware
Mostly unaware Indiff erent
Mostly unaware
Unaware
26.50%
11.97%
Pies show counts

17.09%

Indifferent
35.04%

Partially aware

Figure 4.31

I am aware of the reproductive age for women Total

Fully Partially Indiffere Mostly
aware aware nt unaware Unaware
EDU Illiterate 6 16 7 6 4 39
high school 11 12 11 4 5 43
Intermediat
7 5 1 2 1 16
e
graduate
7 8 1 2 1 19
and above
Total 31 41 20 14 11 117

Table 4.25

Analysis: 35.04% of the people are partially aware and 9.40% are unaware of the
reproductive age for the women. Most of the educated people are aware of the reproductive
age for the women. The percentage of fully aware is 26.50%, this shows that most people are
aware of this.

(Iii). I know the advantages of the vasectomy and tubectomy.

XCII
 Unaware 8.55% I know the advantages of the va sectomy and tubectomy
Fully aware
Partially aware
Mostly unaware 9.40% Fully aware
Indiff erent
Mostly unaware
Unaware
26.50%

Pies show counts

Indifferent 13.68%

41.88%

Partially aware

Figure 4.32

I know the advantages of the vasectomy and tubectomy Total

Fully Partially Indiffere Mostly
aware aware nt unaware Unaware
EDU illiterate 6 18 8 4 3 39
high school 11 20 4 4 4 43
intermediat
8 3 3 1 1 16
e
graduate
6 8 1 2 2 19
and above
Total 31 49 16 11 10 117

Table 4.26

Analysis: The percentage of fully aware is 26.50%; this shows that most of the people are
aware of the advantages of vasectomy and tubectomy. Most of the people in the village are
partially aware of the advantages vasectomy and tubectomy. The number of educated people
is high who know the advantages of this.

(iv). I am aware of that the contraceptives are provided free of cost.

XCIII
 Unaware I a m awa re tha t the contra ceptives are provided fre e of cost.
Fully aware Fully aware
Partially aware
Indiff erent
Mostly unaware
Mostly unaware 10.26%
17.95% Unaware

16.24%
Pies show counts

14.53%
41.03%

Indifferent

Partially aware

Figure 4.33

I am aware that the contraceptives are provided free of

cost. Total
Fully Partially Indiffere Mostly
aware aware nt unaware Unaware
EDU illiterate 5 17 5 8 4 39
high school 8 17 7 6 5 43
intermediat
4 6 3 2 1 16
e
graduate
4 8 2 3 2 19
and above
Total 21 48 17 19 12 117

Table 4.27
Analysis: The percentage of the people who are fully aware that contraceptive are provided
free of cost is low that is 17.95% and most of the people are partially aware that is 41.03% .
The number of educated people are high who know that contraceptive are provided free of
cost.

4.2.4.B. Satisfaction

XCIV
 (i). I am satisfied with the services provided under this scheme.

highly unsatisfied fully satisfied 9.40% I a m satisfie d with the services provided under this scheme .
f ully satisfied
satisfied
indiff erent
unsatisf ied
10.26%
highly unsatisfied
unsatisfied
22.22% Pies show counts
32.48% satisfied

25.64%

indifferent

Figure 4.34

I am satisfied with the services provided under this scheme. Total

fully indiffere unsatisfie highly
satisfied satisfied nt d unsatisfied
education illiterate 2 12 11 10 4 39
level high school 3 12 12 10 6 43
intermediate 2 9 3 1 1 16
graduate and
4 5 4 5 1 19
above
Total 11 38 30 26 12 117

Table 4.28

Analysis: Out of respondents surveyed, satisfaction level has major share of 32.48%.
Analysis of crosstab shows the majority is constituted by people who are illiterate i.e.12 out
of sample size of 39 and in contrast full satisfaction is found only in 2 people who are
illiterate out of sample size of 39.

(ii). I am satisfied with the availability of doctor for consultation.

XCV
 highly unsatisfied 5.98% I a m satisfie d w ith the a vailability of Doctors for consultation.
full y satisfied f ully satisfied
satisfied
indiff ernt
unsatisfied
unsatisf ied
17.09% highly unsatisfied
19.66%
Pies show counts

15.38%
41.88%
i ndiffernt

sati sfied

Figure 4.35

I am satisfied with the availability of Doctors for

consultation. Total
fully indiffere unsatisfie highly
satisfied satisfied nt d unsatisfied
education illiterate 5 20 8 5 1 39
level high school 6 12 7 13 5 43
intermediate 6 7 2 1 0 16
graduate and
3 10 1 4 1 19
above
Total 20 49 18 23 7 117

Table 4.29

Analysis: Analysis-out of respondents surveyed, satisfaction level has major share of

41.88%.analysis of crosstab shows the majority is constituted by people who are illiterate
i.e.20 out of a sample size of 39 and in contrast least satisfaction is found in people who
studied till intermediate i.e.0 out of a sample size of 16

(iii). I am satisfied with the quality and effectiveness of the contraceptives provided.

XCVI
 highly unsatisfied 7.69%
fully satisfied I am satisfie d with the quality and effective ness of the contra ceptives provided.
f ully satisfied
satisfied
indiff erent
unsatisfied unsatisf ied
11.97%
highly unsatisfied
17.95%
Pies show counts

32.48%
satisfied

29.91%

indifferent

Figure 4.36

I am satisfied with the quality and effectiveness of the

contraceptives provided. Total
fully indiffere unsatisfie highly
satisfied satisfied nt d unsatisfied
education illiterate 3 14 13 9 0 39
level high school 5 11 12 9 6 43
intermediate 2 7 6 1 0 16
graduate and
4 6 4 2 3 19
above
Total 14 38 35 21 9 117

Table 4.30
Analysis: Out of respondents surveyed, satisfaction level has major share of 32.48%.
Analysis of crosstab shows the majority is constituted by people who are illiterate i.e.14 out
of a sample size of 39 and in contrast least satisfaction is found in illiterate people i.e.0 out of
a sample size of 39

(iv). Are the advices free of cost medicine a useful step?

XCVII
 highly unsatisfied fully satisfied Are the a dvice s and fre e of cost m edicines provide d a useful step
f ully satisfied
satisfied
indiff erent
unsatisfied
unsatisf ied
10.26% 12.82%
highly unsatisfied
11.97%
Pies show counts

21.37%
43.59%

indifferent
satisfied

Figure 4.37

Are the advices and free of cost medicines provided a useful

step Total
fully indiffere unsatisfie highly
satisfied satisfied nt d unsatisfied
education illiterate 1 19 9 7 3 39
level high school 5 15 11 4 8 43
intermediate 6 7 3 0 0 16
graduate and
3 10 2 3 1 19
above
Total 15 51 25 14 12 117

Table 4.31

Analysis: Analysis-out of respondents surveyed, satisfaction level has major share of

43.55%.analysis of crosstab shows the majority is constituted by people who are illiterate
i.e.19 out of a sample size of 39 and in contrast least satisfaction is found in people who have
studied till intermediate i.e.0 out of a sample size of 16

4.2.5. REPRODUCTIVE AND CHILD HEALTH CARE PROGRAMME

4.2.5. A Awareness
(i). I am aware RCH programme aims at eradication of Polio Virus.

XCVIII
 unaware 5.98% I am awa re RCH Programm e aims at era dica tion of polio virus
mo stly unaware 7.69% f ully aware
partially aware
indiff erent
mostly unaware
indifferent unaware
fully aware
10.26%
41.88% Pies show counts

34.19%

partially aware

Figure 4.38

I am aware RCH Programme aims at eradication of

polio virus
fully partially Indiffere mostly
aware aware nt unaware unaware Total
EDU illiterate 12 16 6 3 2 39
high school 22 11 4 3 3 43
intermediat
8 4 1 1 2 16
e
graduate
7 9 1 2 0 19
and above
Total 49 40 12 9 7 117

Table 4.32
Analysis: 41.88% are fully aware of that RCH programme aims at eradication of polio virus
and only 5.98% of the people are unaware of polio virus eradication. The people who are
highly educated are totally aware the eradication of the polio virus.

(ii). I am aware that the objective of the scheme is to reduce infant mortality rate.

XCIX
 unaware 5.98% I a m awa re that the objective of the scheme is to reduce infant mortality ra te.
mo stly unaware 7.69% f ully aware
partially aware
indiff erent
fully aware mostly unaware
unaware
33.33%
indifferent
17.09% Pies show counts

35.90%

partially aware

Figure 4.39

I am aware that the objective of the scheme is to

reduce infant mortality rate.
fully partially Indiffere mostly
aware aware nt unaware unaware Total
EDU illiterate 9 14 12 1 3 39
high school 12 21 4 3 3 43
intermediat
8 3 2 2 1 16
e
graduate
10 4 2 3 0 19
and above
Total 39 42 20 9 7 117

Table 4.33

Analysis: 33.33% are fully aware of that the objective of the scheme is to reduce infant
mortality rate and only 5.96% of the people are unaware. The people who are highly educated
are totally aware that the objective of the scheme is to reduce infant mortality rate.

(iii). I am aware it aims to universalize the immunization, antenatal care and skilled
attendance during delivery.

C
 unaware 5.98% I am aware it aims to universalize the immunization, ante natal care ,skilled attendance during delivery
f ully aware
mo stly unaware 8.55%
partially aware
indiff erent
mostly unaware
fully aware
unaware
indifferent 36.75%
13.68% Pies show counts

35.04%

partially aware

Figure 4.40

I am aware it aims to universalize the immunization,

ante natal care ,skilled attendance during delivery
fully partially indiffere mostly
aware aware nt unaware unaware Total
EDU illiterate 13 12 10 1 3 39
high school 14 17 3 6 3 43
intermediat
8 5 1 1 1 16
e
graduate
8 7 2 2 0 19
and above
Total 43 41 16 10 7 117

Figure 4.34

Analysis: 36.75% are fully aware of that it aims to universalize the immunization; ante natal
care, skilled attendance during delivery and only 5.98% of the people are unaware. The
people who are highly educated are totally aware that it aims to universalize the
immunization, ante natal care, skilled attendance during delivery.

(iv). I am aware of the emergency obstetric services provided under this scheme.

CI
 unaware I a m awa re of the eme rge ncy obste tric service s provided under this scheme
fully aware f ully aware
partially aware
indiff erent
mostly unaware
11.11% 17.09% unaware

mo stly unaware
22.22% Pies show counts

26.50%

partially aware
23.08%

indifferent

Figure 4.41

I am aware of the emergency obstetric services

provided under this scheme
fully partially indiffere mostly
aware aware nt unaware unaware Total
EDU Illiterate 4 10 15 7 3 39
high school 7 16 6 7 7 43
intermediat
5 1 3 4 3 16
e
graduate
4 4 3 8 0 19
and above
Total 20 31 27 26 13 117

Table 4.35

Analysis: 17.11% are fully aware of of the emergency obstetric services provided under this
scheme and only 11.11% of the people are unaware. The people who are highly educated are
totally aware of the emergency obstetric services provided under this scheme

4.2.5. B. Satisfaction

(i). I am satisfied with the neonatal care services provided in the hospital under this scheme.

CII
 highly unsatisfied 4.27% I am satisfied with ne onatal care service s provided in the hospitals under this sch
fully satisfied f ully satisfied
satisfied
indiff erent
unsatisfied unsatisf ied
18.80% highly unsatisfied
26.50%
Pies show counts

45.30%
indifferent 5.13%

satisfied

Figure 4.42

I am satisfied with neonatal care services provided in the

hospitals under this scheme. Total
fully indiffere unsatisfie highly
satisfied satisfied nt d unsatisfied
education illiterate 6 18 1 12 2 39
level high school 8 20 3 10 2 43
intermediate 5 7 1 3 0 16
graduate and
3 8 1 6 1 19
above
Total 22 53 6 31 5 117

Table 4.36
Analysis: Out of respondents surveyed, satisfaction level has major share of 45.30%.analysis
of crosstab shows the majority is constituted by people who studied till high school i.e.20 out
of a sample size of 43 and in contrast least satisfaction is found in people who studied till
intermediate i.e.0 out of a sample size of 16

(ii). I am satisfied with the delivery facilities provided in the hospitals.

CIII
 highly unsatisfied I a m satisfie d with the delivery facilitie s provided in the hospitals.
f ully satisfied
fully satisfied
satisfied
indiff erent
unsatisf ied
11.97%
20.51% highly unsatisfied

unsatisfied Pies show counts

21.37%

31.62%
14.53%

satisfied

indifferent

Figure 4.43

I am satisfied with the delivery facilities provided in the

hospitals. Total
fully indiffere unsatisfie highly
satisfied satisfied nt d unsatisfied
education illiterate 5 13 8 8 5 39
level high school 9 13 5 12 4 43
intermediate 5 6 2 2 1 16
graduate and
5 5 2 3 4 19
above
Total 24 37 17 25 14 117

Table 4.37

Analysis: Analysis-out of respondents surveyed, satisfaction level has major share of

31.62%.analysis of crosstab shows the majority is constituted by people who are
illiteratei.e.13 out of a sample size of 39 and in contrast least satisfaction is found in people
who studied till intermediate i.e.1 out of a sample size of 16

(iii). The vaccination provided for various diseases is a useful step.

CIV
 highly unsatisfied 5.13% The va ccination provided for various dise ases a useful step
unsatisfied 6.84% f ully satisfied
satisfied
fully satisfied indiff erent
unsatisf ied
highly unsatisfied
indifferent 28.21%

17.95% Pies show counts

41.88%

satisfied

Figure 4.44

The vaccination provided for various diseases a useful step Total

fully indiffere unsatisfie highly
satisfied satisfied nt d unsatisfied
education illiterate 7 19 10 3 0 39
level high school 11 16 7 4 5 43
intermediate 7 6 3 0 0 16
graduate and
8 8 1 1 1 19
above
Total 33 49 21 8 6 117

Table 4.38

Analysis: Analysis-out of respondents surveyed, satisfaction level has major share of

41.88%.analysis of crosstab shows the majority is constituted by people who are
illiteratei.e.19 out of a sample size of 39 and also least satisfaction is found in illiterate people
i.e.0 out of a sample size of 39

(iv). Is the attempt made to eradicate polio an appreciable step?

CV
 highly unsatisfied
5.13%1.71%
unsatisfied Is the attempt made to eradicate polio an a pprecia ble step?
indifferent 3.42% f ully satisf ied
satisf ied
indif f erent
unsatisf ied
highly unsatisfied

Pies show counts

49.57% fully satisfied

40.17%

satisfied

Figure 4.45

Is the attempt made to eradicate polio an appreciable step? Total

fully indiffere unsatisfie highly
satisfied satisfied nt d unsatisfied
education illiterate 17 20 1 1 0 39
level high school 18 20 2 1 2 43
intermediate 11 3 1 1 0 16
graduate and
12 4 0 3 0 19
above
Total 58 47 4 6 2 117

Table 4.39

Analysis: Analysis-out of respondents surveyed, full satisfaction level has major share of
49.57%.analysis of crosstab shows the majority is constituted by people who are illiterate
i.e.20 out of a sample size of 39 and in contrast least satisfaction is found in illiterate people
i.e.0 out of a sample size of 39.

4.3 Conclusion:
In the conclusion I would say that we were successfully able to collect the required data from
the respondents in the two villages which we have surveyed.
The data analysis across various parameters like Awareness and Satisfaction of the schemes
give us the real view of the implementation of the schemes in the rural areas. The
interpretation of the received data shows that education level of the respondents has put huge
impact on the awareness and satisfaction of the various schemes.

CVI
In the majority of the schemes, respondents who have studied till high school or intermediate
were able to respond to our questions in a better manner. Also, it’s been noticed that the
higher number of these people were aware about the current schemes launched by the
government.
In the next Chapter, the conclusion and the recommendations to run these schemes more
effectively is been discussed.

Chapter 5 :- Recommendations & Conclusion

5.1 Recommendation for different schemes :-

National Rural Health Mission

Following are four key components, which need special attention in relation to the
integration of DRR components with National Rural Health Mission (NRHM).

1. Adequately equipped PHCs and CHCs,

2. Role of health workers and allied agencies,
3. Integrated Emergency Health Management Plan,
4. Phase wise institutionalization leading to sustainability.

1. The Primary Health Centers (PHCs) and Community Health Centers (CHCs) have to be
fully equipped. In order to deal with any kind of emergency, and health related requirements,
the following action points to be taken into account:
a) At PHCs and CHCs, there should be adequate staff (including Doctors, Nurses, Health
Assistants etc). In number of districts, the health workers are yet to be sanctioned/ recruited/
positioned.
b) The required equipments and appropriate drugs should always be available, to meet the
emergency needs. In many places, quite old medical instruments are still being used (not
calibrated/ recently verified).
c) Inventorisation of PHCs and CHCs has to be carried out periodically. It should be
maintained at block level by respective Block Health Committee and to be reviewed by
District level Executive Committee.
d) There should be provision for Mobile Medical Units (MMUs) at CHC level. It is a good
way to improve the outreach emergency services especially in rural pockets.
2. The role of health workers and allied agencies is very vital, as they will be the first port
of call for any health related demands, at community level. Following are key points for
consideration in this regard:
a) There should be provision for First Aid and Disaster Management (DM) training &
retraining for health workers, including Accredited Social Health Activist (ASHA),
Aanganwadi Worker (AWW), Auxiliary Nurse Midwife (ANM) and PRI members.

CVII
b) ASHAs, ANMs, AWWs, PRI members should be part of the Village level/ Cluster level/
Block level Disaster Management Teams. And they should play active role at the time of
emergency by providing prompt medical assistance.
c) At block level, there should be identified Master Trainers available for capacity building of
concerned persons, health workers and allied agencies.
d) Trained community level workers, representatives at village level should be made
available with a drug kit for generic ailments.
3. The Integrated Emergency Health Management Plan is an ambitious work in itself
from convergence point of view. The following suggestions can help a lot in making and
utilizing this concise document:
a) District Health Societies like Governing Body and Executive Committee should take up
responsibility to prepare, update and review the Emergency Health Management Plan in line
with village to district. And block to CHC, PHC level.
b) These health plans should be well integrated with Village Disaster Management Plans,
Block Disaster Management Plans, and District Disaster Management Plans etc. So that
concerned agencies should know their role and responsibilities at the time of disaster. .
c) Health plan for each village should be prepared with the help of Village Health &
Sanitation Committee and Village Disaster Management Committee. The plan should be
vertically integrated with Health and Family Welfare programmes, and three tier PRI
structure, in context of Disaster Risk Reduction (DRR).
d) The emergency health plan should be further integrated with Village Development
Committee (VDC) in order to articulate urgent need for health services. Further at community
level, a CERT (Community Emergency Response Team) to be formed and sensitized about
health related treatments, first aid etc. So that more people can take the benefit during
emergency.
4. Phase wise institutionalization is a must to set the tone for the long term sustainability of
mainstreaming DRR with NRHM. Following are the key steps for consideration in this
regard:
a) Prior to institutionalization, a detailed pre work/ Risk Mapping have to be carried out. The
purpose is to ensure that highly vulnerable areas are being covered, from emergency medical
assistance point of view.
b) For planned institutionalization of DRR components with NRHM, the progress review of
key activities is very vital. Applicable states should utilize the Programme Committee for
Health & Family Welfare (formed under State Health Mission) to expedite the progress
against concerned issues in relation to DRR.
c) For sustainability of the programme, community ownership has to be brought in, through
the decentralized planning. For this, the implementation teams would require the
development of special skills, particularly at district and state level. Later on the community
learning can be documented and shared across.
d) In current circumstances, a grave need is being felt for Public Private Partnership (PPP) in
health sector to address the Disaster Risk Reduction. (Ex: With the help of partnership, a
grant system can be introduced). It will certainly help in the long run to sustain the
implementation of NRHM at all levels, with the involvement of public. At the outset, it can
be said that a beginning has been made so far through NRHM activities. However we still
have a long way to go. A few baby steps have been taken towards integration of DRR with
the NRHM, but these are not at all sufficient. It has been realized so far that apart from the
main issues of infrastructure, there are several other allied issues also to be addressed, like
Female involvement in health services, non availability of life saving drugs/ equipments at
health centers, doctors absenteeism in remotely located areas. As NRHM is also getting
matured and more susceptible in its 5th year of running, now it’s high time for integration as

CVIII
quickly as possible. The Implementation of above steps will surely contribute towards
building a culture of resilience and safety at all appropriate levels w.r.t. education stream.
After streamlining the integration of DRR with NRHM, the concept can be further extended
to newly born National Urban Renewal Mission (NURM), in order to expand the reach to
larger masses for safer tomorrow.

Family Planning Insurance Scheme

 As awareness about the Scheme is very less so Government should promote
awareness through campaign, Health Fare etc.
 Development of Community Based Health Insurance (CBHI) is more suitable
arrangement for providing insurance to the poor.
 Different forms and each of this form may be suitable depending on the
characteristics of the target population, their health profile, and health risks to which
the community is exposed.
 Proper and wide implementation to reach every part of rural india .
 For family planning awareness of advantages should be spread.

National AIDS Control Programme

 Alignment of structure in accordance with changing role of NACO

 Creation of clearly delineated divisions based on primary functions performed
 Clear reporting relationships and communication channels
 Facilitation of decentralized decision making
 Optimal span of control that provides for fewer hierarchical levels and subordinate
autonomy and at the same time enables close supervision
 Promotion of institutional memory and institutional learning
 Staffing to be based on skill-mix required to effectively discharge its key roles.
 To put in place designated focal points for key programme areas, given that NACO will
have to essentially function through coordination, collaboration and partnerships with
multiple agencies.
 Institutionalizing arrangements to ensure responsiveness and accountability to key
stakeholders

National Family Welfare Programme

 Improving quality, accessibility, availability, acceptability and efficiency

 Exchange of skills and expertise between the public and private sector
 Mobilization of additional resources.
 Improve the efficiency in allocation of resources and additional resource generation
 Widening the range of services and number of services providers.
 Additional MTP training centres are being recognised to accelerate the skill
development training of Community Health Centre (CHC)/PHC doctors.
 There is a need to accelerate pace of these processes and monitor the impact both in
terms of coverage, number of MTP reported and reduction in number seeking illegal
abortion and suffering adverse health consequences.

Reproductive And Child Health Programme

CIX
  The micro level action plan should follow as far as possible the guidelines set in the
RCH camp
 Repetition of RCH camp is necessary for its impact and follow up services 
 Time consumed in the inaugural function including speeches should be kept as
minimum possible (not more than 15 minutes).
 For smooth functioning and to manage the crowd efficiently one (may be BEE)
should be engaged to do the job of PRO.
 Screening of patients and filling of referral cards before RCH camp to be stressed. 
 It is necessary to have a gynecologist and pediatrician in each camp. Moreover, they
should not be engaged to treat minor ailment patients

5.3 Recommendations for society/ community:-

In order to successfully implement these health schemes, not only the Government & its
allies are responsible but also the society is largely responsible for the same.
The people should:-
1. Be more conscious towards their health. They should know at least the basics. For
example :- The correct age to get married & to conceive a child, the uses of
contraceptives, the sterilization programs being run at the various district hospitals
etc.
2. Not only Polio awareness would do, but also the awareness on various schemes
should be there with the people.
3. They should regularly attend the various health meetings organized by the Gram
Panchayat or the NGOs & these sort of activities should be appreciated & encouraged
4. People should not encourage illiteracy & poverty since these are the two major
hurdles that prevent the successful implementation of the health schemes.
5. The people especially the poor & the downtrodden should be taken to the district
hospitals for a thorough health check up & this should be undertaken by people
belonging to high income families.

5.4 Recommendations for NGOs

NGOs are required to be more innovative, flexible, and cost effective than government
organizations. Also, NGOs are believed to be especially good at reaching and mobilizing the
poor in remote rural communities and at adopting participatory processes in project
implementation. These participatory procedures “empower” the recipients rather than treating
them as mere “clients.”
More focus required on their capacity building, provision of technical support; liaison,
networking and coordination with State and District health services, monitoring the

CX
performance and documentation of best practices. Also the following measures can be
adopted-

5.5 Recommendation for Government-

1. Regional priorities: The North East region was identified as a priority area for launching a
science and technology based poverty eradication programme using ICT in a significant way.

2. Information, knowledge and skill empowerment of self-help groups (SHGs): The

microcredit supported microenterprise revolution triggered by SHGs has provided hope that a
new deal can be extended to the self-employed. For SHGs to become sustainable SHGs, it is
essential that forward linkages with markets and backward linkages with research institutions
and data management centres are established. ICT has a major role in sustaining and
extending this self-help revolution.

3. Every village a knowledge centre: There is a need for developing a master plan coupled
with a business plan for extending the benefits of ICT to all the 600,000 villages in India by
2007, which marks the 60th anniversary of our independence. The master plan should help to
link technology-knowledge-rural women and men in a symbiotic manner. The investment needs
will have to be estimated and business plans prepared. A National Alliance for ICT for Poverty
Eradication may be established for launching the Every Village a Knowledge Centre movement.
Such an alliance should include the private sector, cooperatives, NGOs, R&D institutions,
women’s associations, mass media and appropriate government agencies.

4. Domestic software development and application: Learning from past experience in rural
areas, there is a need for increasing India’s competitiveness in domestic software applications.
Government projects mainly provide static information. What is needed by rural families is
dynamic information relating to weather, markets, health and other day-to-day information
needs.

5. Community radio: Along with the internet, cable TV, local vernacular press and the All
India Radio, community radio stations and ham radio will be of immense help in communicating
up-to-date information to those who will benefit from it, as for example, fishermen in catamarans
in the ocean. Government of India should liberalise policies for the operation of community and
ham radio stations. This will help to confer the benefits of the knowledge age to every woman
and man in a village. Reaching the unreached and including the excluded will be possible only
through an integrated ICT system.

6. Technology upgradation in villages: NABARD has been operating a programme in

Himachal Pradesh with support from the Rural Infrastructure Development Fund (RIDF). This

CXI
 programme has helped to promote both e-governance and e-commerce. There is a similar
initiative in Uttaranchal with the help of IIT, Roorkee. Scope for using RIDF in other States
should be explored. This will help to convert the concept of every village a knowledge centre
into reality.

7. Content creation: The usefulness of a computer-aided knowledge centre in villages will be

directly proportional to the social, ecological and economic significance of the static and
dynamic information being provided. Hence, a consortium of content providers will have to be
developed for each agro-ecological zone. Leading industries could participate actively in such a
knowledge and skill empowerment revolution by adopting specific villages where they could
provide, in addition to monetary support, marketing and management information. There is
need for a regionally differentiated approach to content creation. Both environmental audit and
gender audit should be integrated in the procedures for monitoring and evaluation.

8. Women and ICT: The available experience indicates that rural women, whether literate or
semi-literate, are able to take to new technologies like fish to water. It is therefore important that
women managers and operators are trained in large numbers. There is also a gender
dimension to the information needed. For example, quite often women require specific health
information. Therefore, the participation of women both as managers and users of ICT should
receive specific attention. Also, a gender audit procedure should be built into the final ICT
programmes.

9. Participatory knowledge system: E-governance is invariably a passive system of

information empowerment. There is need for promoting participatory methodologies of content
creation and knowledge management. The approach to rural women and men should be one of
partnership and not patronage. In the field of agriculture, a Farmer Participatory Knowledge
System (FPKS) could replace the existing beneficiary and patronage approach to knowledge
dissemination. The information should be demand driven and should be relevant in terms of
time and space.

10. Sustainability and replicability – Role of Panchayati Raj institutions: Unless the local
communities have a sense of ownership of the knowledge management centres, it will be
difficult to sustain them. It is only a user driven and managed system that will be replicable and
capable of developing a self-propelling momentum. Women’s groups should be fully involved it
the management and also enabled to operate distance education courses. The programme
should be people oriented and not just project-centred. Affordable methods of cost sharing
should be introduced in consultation with local communities. Sustainability and replicability
should be the bottomline in the development of the National Action Plan for the “every village a
knowledge centre” movement. In this context Panchayati Raj institutions, in which one-third of
the members are women, could provide the needed space for the location of the rural
knowledge centre. The Gram Sabha and the Gram Panchayats could both play a key role in
ensuring that the knowledge centres become instruments for triggering a prosperity revolution
based on gender and social equity.

CXII
11. Promoting job-led economic growth: Increasing rural unemployment is resulting in the
unplanned expansion of urban slums. There is need for more on-farm and non-farm
employment opportunities in villages. This will be possible only if there is diversification of
farming systems and value addition to primary products through improved post-harvest
technology. Training should be with reference to market-driven skills. Small scale industries and
Khadi and village industries should receive particular attention from the point of view of the
upgradation of both technology and marketing skills. There is also need for synergy between
the private sector and public and cooperative sectors in promoting more avenues for skilled jobs
in villages.

12. Servicing and maintenance: Servicing facilities at the local level should be improved
through appropriate training and capacity building measures. This will also provide additional
employment opportunities for rural youth in villages.

13. Wake up call: In a country of over 1 billion, there are hardly about 5 million computers. 75-
80% of these computers are used in offices. Hardly 20% is available for use in development.
Therefore, there is no time to relax on the ICT front. We will be left far behind China and other
South and Southeast Asian countries if we do not launch a National ICT for Economic
Prosperity and Employment Programme. The penetration level will then increase. There is also
need to review the customs duty procedures, which are mostly obsolete and obstructive.
Needlessly inelastic rules should be dispensed with. Donations of new computers to NGOs
working in rural and backward areas should be encouraged. Branding of projects should also be
facilitated.

14. Virtual Academy for Food Security and Rural Prosperity: The Virtual Academy approach
coupled with a hub and spokes model of the kind spearheaded by MSSRF is ideal for rural
India. The Virtual Academy can help to mobilise the power of partnership and establish
beneficial linkages with national challenge programmes like drought management. MSSRF
Virtual Academy could develop linkages with other organisations devoted to the knowledge and
skill empowerment of the rural poor in different parts of the country so that it becomes a
National Academy supporting the “every village a knowledge centre” programme. There is need
for standardisation of local language websites and also names in Indian languages.
Dissemination of information should be in the local language.

15. Political commitment, public action and investment priorities: A Sub-Committee for E-
Governance has been set up by the National Development Council under the leadership of the
Deputy Prime Minister. The recommendations of this workshop could be forwarded to both the
Deputy Prime Minister and the Minister for Information and Technology for appropriate action.

CXIII
References:
1. Ashok Vikhe Patil, K.V.Somasundaram, R.C.goyal (2002), current health scenario in
rural India, Aust. J. Rural Health (2002) 10, 129–135
2. Sharon A. Keller, (1993) "Finding Information on Health Care Management: The
Health Planning and Administration Database", Reference Services Review, Vol. 14 Iss:
1, pp.85 - 86
3. Michael Calnan, Rosemary Rowe, Vikki Entwistle, (2006) "Trust relations in health
care: an agenda for future research", Journal of Health Organization and
Management, Vol. 20 Iss: 5, pp.477 - 484

4. Li Tian, Dean DellaPenna, (2001) "The promise of agricultural biotechnology for

human health", British Food Journal, Vol. 103 Iss: 11, pp.777 - 779

5.www.india.gov.in/citizen/health/health_cont_schemes.php accessed during month

September-November 2010.
6. www.mohfw.nic.in/NRHM/Documents/Mission_Document.pdf  accessed during month
September-November 2010.
7.www. pbhealth.gov.in/pdf/FW.pdf accessed during July-November 2010
8. www.mohfw.nic.in/dofw%20website/.../rchp%20frame.htm accessed during July-
November 2010
9.www.india.gov.in/sectors/health_family/national_aids.php accessed during July-
November 2010

10. . Edward R. Reynolds, Robert W. Boyce, Dean G. Haxby, Bruce A. Goldberg,

Douglass J. Stennett (2000)” Intervention Assessment in an Indian Health Service
Pharmacy “

CXIV
Annexure:

School of Management Studies

Moti Lal Nehru National Institute Of Technology
Allahabad, India

Questionnaire

Objective of Study : To study programmes{ Specially Health) of Government for

Rural Development

1) Age : (i)Below 18 (ii) 18-35 (iii) 35-60 (iv)60 and above

2) Education:

(i) Uneducated (ii) High school,

(ii) Intermediate (iv) Graduation and above.

3) Gender :

(i) Male (ii)Female.

4) Occupation :

(i) Farmer (ii) Service (iii) Self Employed

5) Economic Status :

(i) Below 40000, (ii) 40000-100000, (iii) 100000-300000

(iv) 300000 and above.

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 Section – A

Mark the following statement on scale 1-5.

Scale:
1- Completely Aware 4-Partly Aware
2- Aware to a large extent. 5-Not Aware
3- Undecided.

S.No. Question Statement 1. 2. 3. 4. 5.

National Rural Health Mission
1) I know about this scheme
2) I know about the objectives of the scheme
3) I know the criteria for selection as an ASHA
4) I know Directly Observed Treatment Short (DOTS)
course for tuberculosis and oral rehydration;
5) I know aware whom to contact if I am affected with the
diseases like Reproductive Tract Infection/Sexually
Transmitted Infection (RTIs/STIs
Family Planning Insurance Scheme
I am aware that an insurance is provided to sterilization
1) acceptors.
The central government provides Rs.300 for each Tubectomy
2) operation
I am aware that Rs.200 is provided to the person undergoing
3) a Vasectomy
I am aware of the IUD insertion & also the insurance
4) provided after undergoing the process.
I am aware of the hospitals in my area where this scheme
5) works.
National Aids Control Programme
1) I am aware of national Aids control program.
2) I am aware of the causes of HIV positive.
3) I am aware of the symptoms of Aids.
4) I am aware about the service provided by health centers.
I am aware of the contraceptives which can prevent the
5)
spread of HIV virus.

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 6) I am aware of the precautions taken.
I am aware of blood banks which are approved by
7)
national blood safety program.
8) I am aware of the health mela held in various districts.
National Family Welfare Programme
1) I am aware of this scheme.
2) I am aware of the reproductive age for women.
I am aware of the special camps organised by volunteers
3)
on family welfare in my village.
4) I know the advantages of the vasectomy and tubectomy.
I am aware that the contraceptives are provided free of
5)
cost.
The Reproductive And Child Health Programme
I am aware RCH Programme aims at eradication of polio
1) virus while selectively introducing Hepatitis B in UIP
package
I am aware that the objective of the scheme is to reduce
2)
infant mortality rate.
I am aware it aims to universalize the immunization,
3)
ante natal care ,skilled attendance during delivery.
I am aware of the emergency obstetric services
4)
provided under this scheme.
I am aware of the emergency obstetric services
5)
provided under this scheme

Section – B

Mark the following statement on scale 1-5.

Scale:
1- Completely Satisfied 4-Partly Satisfied
2- Satisfied to a large extent. 5-Not Satisfied
3- Undecided.

S.No. Question Statement 1. 2. 3. 4. 5.

National Rural Health Mission
1) I am satisfied with the services like immunization,health
check ups

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2) Has it achieve success in improving the health of people
of my village
3) Are you satisfied with their principle that some local
elected representatives will make decision for the people
in their area
4) I am satisfied with the ambulance services which they
provide during emergency.
5) I am satisfied with the cooperation of ASHA(Accredited
Social Health Activist)
6) I am satisfied with the services like immunization,health
check ups
Family Planning Insurance Scheme
I am fully satisfied with the insurance provided to the
1)
sterilization acceptors.
The sterilization programs run under the scheme are
2)
good.
I am satisfied with the compensation that the scheme
3) provides to the family of the person,who dies during the
process of the sterilization operation.
The compensation that the scheme provides on failure of
4)
a sterilization operation is satisfactory.
Janani Suraksha Yojna
1) I am satisfied with the services provided by the scheme.
I am satisfied with the availability of doctors and
2)
hospitals
3) The 24/7 delivery services at PHC level is satisfactory
4) I am satisfied with the disbursement of cash assistance.
I am satisfied with the referral transport available for the
5)
pregnant women.
National Leprosy Eradication Programme
I am satisfied with the services like Multi Drug
1)
Theraphy
I am satisfied with the behavior of the workers who
2)
provide these services.
3) M.D.T has really solved the problem
4) Leprosy disease still exists in villages.
5) Timely services are available to the patients.
National Aids Control Programme

1) I am satisfied with the Scheme objectives.

2) I am satisfied with the services provided to pregnant

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 women.
3) The injection provided in P.H.C are safe.
4) I am regularly go for check Up.
I am provided with the AIDS prevention contraceptives
5)
in Health Mela.
National Family Welfare Programme
I am satisfied with the services provided under this
1)
scheme.
I am satisfied with the quality and effectiveness of the
2)
contraceptives provided.
I am satisfied with the availability of Doctors for
3)
consultation.
I am satisfied with the information provided by health
4)
officials and activist regarding measures to be taken.
The Reproductive And Child Health Programme
I am satisfied with neonatal care services provided in
1)
the hospitals under this scheme.
I am satisfied with the services provided for eradication
2)
of polio virus.
I am satisfied with the family planning services provided
3)
under this scheme.
I am satisfied with the obstetric services that are
4)
provided.
I am satisfied with the delivery facilities provided in the
5)
hospitals.
Saloni Swasth Kishori Yojana
1) I am satisfied from the Saloni swasthya kishori yojna.

2) I am getting these tablets timely.

3) NGOs working in my village are in regular contact.

4) They taking care of your childrens’ health.

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Hindi Questionnaire:

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