Sixth Five Year Plan (1980-1985)

FOREWORD

" The day will dawn. Hold thy faith firm " —TAGORE

Progress in a country of India's size and diversity depends on the participation and full
involvement of all sections of the people. This is possible only in democracy. But for democracy to
have meaning in our circumstances, it must be supported by socialism which promises economic
justice and secularism which gives social equality. This is the frame for our planning.

The Planning Commission is to be congratulated on the manner in which it has worked practically
round the clock to bring out the Sixth Plan in a year as we had promised to do. The drawing up of
this plan posed special difficulties. We faced a plan gap and a budget gap at a time when the
whole world, and India more than other countries, was hard hit by inflation, the continuing rise in
the price of petroleum while the price of our raw materials remains static, as well as other political
and economic tensions and international confrontations.

In view of the severe financial constrictions and the political expectations, it is not surprising that
the Plan should be unsatisfactory to many. However, this is no reason to denigrate it. Planning is
more than the putting together of a number of Central and State Government projects. It is a
direction. And this the Sixth Plan provides. Once the nation is clear about the path to be followed,
the details can be adjusted as we go along.

Let us cast a backward glance. In the last thirty years, through our Plans we have built the
foundations of a modem, self-reliant economy. We have achieved self-sufficiency in food,
diversified our industrial structure and made significant progress in science and technology. The
continuity of the planning process, with its thrusts and checks, has lielped us to create and renew
national assets and to take up programmes for the amelioration of the weakest strata and the
uplift of the most backward regions. Economic growth must be balanced, it must ensure self-
reliance, stability and social justice. All sections should be assured that there will be no
discrimination. No society can prosper if merit is not given its due.

A developing nation must marshal its scarce resources for a concerted effort to build its capital
base in various sectors of the economy to enhance production capabilities and allow larger
savings. Increased output and a balanced inter-sectoral allocation of the incremental savings
promote further development. So the process goes on.

The progress so far achieved has been steady and substantial, although somewhat slower than
envisaged. The very process of development generates new expectations and makes fresh
demands on resources. Our goal of self-reliance was bound to strain our external resources.
Also, we were not allowed to concentrate undisturbed on our development endeavour, for there
have been frequent challenges to national security. Another factor adding to the complication of
our development is the continuous increase in population, primarily owing to the very success of
our programmes of public health and epidemic control, as a result of which infant mortality has
decreased dramatically and life expectancy risen.

We have resolutely stood up to each new challenge. We have come to a stage where we can
confidently assert that development has contributed to strengthening our nation in spite of its
regional, linguistic, social and communal diversities. It has consolidated our democracy and is
guiding our society towards socialism. We can now speak of an India in which the fruits of growth
will reach to the last. This is a stage when the planning process assumes even greater
importance.
Five-Year Plans are formulated in the perspective of long-term development. This enables us to
raise the national effort to match specific goals and meet critical challenges. Annual Plans give
operational meaning to tlie exercise. Monitoring, review and evaluation procedures help to keep
the vessel on the course. The voyage has been longer and rougher than we had imagined, but
there is little doubt about the rightness of the course we have charted.

The Sixth Plan envisages a significant augmentation in the rate of growth of the economy with an
annual growth rate of over 5 per cent. In this five-year period we expect to see progressive
reduction in the incidence of poverty and unemployment and also in regional inequalities. Greater
emphasis has been laid on the speedy development of indigenous sources of energy and infra-
structural sectors of coal, energy, irrigation and transport. High priority has been given to
agriculture and rural development and allied agricultural activities like animal husbandry, dairying,
fisheries and also the forestry sector, with accent on development and conservation. Substantial
outlays have been allocated for expansion in core sectors and also for cottage, village and small
industries as well as for programmes to provide minimum needs.

The measure of a plan is not intention but achievement, not allocation but benefit. We are
determined to implement this Plan with steadfastness of purpose. Democratic planning means
the harnessing of the people's power and their fullest participation. We sail on stormy seas. But
the Indian people have weathered many storms. Their spirit is indomitable and it will prevail. Let
us help them to bend their energies with unity and discipline in the great endeavour to reach
towards a brighter future.

Chapter 22:
HEALTH, FAMILY PLANNING AND NUTRITION

Sustained efforts towards promotion of health care services during the last 30 years have
resulted in significant improvement in the health status of the country. The mortality rate has
declined from 27.4 in 1941—51 to an estimated 14.2 in 1978. The life expectancy at birth has
gone up from about 32 years as per 1951 Census to about 52 years during 1976—81. The infant
mortality rate has come down from 146 during the fifties to 129 in 1976. The health infrastructure
has been strengthened. The country has about 50,000 sub-centres, 5,400 primary health centres
including 340 upgraded primary health centres with 30 bedded hospital, 106 medical colleges
with admission capacity of 11,000 per annum and about 5 lakh hospital beds. The per capita
expenditure on health incurred by the State has fgone up from about Rs. 1.50 in 1955-56 to about
Rs. 12 in 1976-77. The doctor population ratio though satisfactory on an average in the country
(1977), varies widely from 1 doctor for 8333 in Meghalaya to 1 doctor for 1400 in Delhi. The bed
population ratio has also improved but varies widely in urban and rural areas.

22.2 The country was declared free from smallpox in April, 1977. The National Malaria
Eradication Programme initiated in 1958 had brought down the incidence of the disease to about
1 lakh cases with no deaths in 1965 although there has been a slippage in the subsequent years.
The National Programme for Control of Leprosy, Tuberculosis, Filaria and Blindness have also
helped to reduce mortality|morbidity.

22.3 National Programmes have also been initiated for promotion of maternity and child care
such as immunization of expectant mothers against Tetanus and children against Tetanus,
Whooping Cough, Diphtheria. Tuberculosis, Polio etc., besides prophylaxis against Vitamin 'A'
and iron deficiencies. Programmes of improving the nutrition of mothers and children have also
been taken up.
22.4 Tn the field of curative services some of the State Hospitals have built m specialised
sophisticated service's comn'arable with facilities available in some of the advanced countries for
cardiac diseases, cancer and neurological, nephrological disorders.

HEALTH

Review

22.5 The programmes initiated in the earlier plans for control/eradication of major communicable
diseases and for providing curative, preventive and promotive health services backed by training
of adequate number of medical and para-medical personnel were strengthened further m the Fifth
Plan, and in the subsequent annual plans. Provision of minimum health services in the rural areas
was integrated with family planning and nutrition for vulnerable groups of population-children,
pregnant women and lactating mothers. The programmes were aimed ai:—

i. Increasing the accessibility of health services to rural areas.

ii. Correcting regional imbalances.
iii. Further development of referral services by removal of deficiencies in District/Sub-
divisional hopitals;
iv. Intensification of the control/eradication of communicable diseases especially Malaria and
Smallpox;
v. Qualitative improvement in the education and training of health personnel; and
vi. Development of referral services by providing specialist attention to common diseases in
rural areas.

22.6 The Minimum Needs Programme was the main instrument through which health
infrastructure in the rural areas was expanded and further strengthened to ensure primary health
care to the rural population. The outlays earmarked for this programme were considered almost a
prior charge on the Plan budget for medical and public health of the States. The facilities
available in selected rural dispensaries were expanded to provide preventive and promotive
health care facilities by adding the necessary health components. These functioned as subsidiary
health centres. The following table shows Ihe number of sub-centres, primary health centres and
upgraded primary health centre's with a 30 bcdded hospital set up by 31st March, 1980 vis-a-vis
targets set for 1974—79 Plan:—

Table 22.1 (Nos.)

Programme At the beginning of Target set for 1974-79 Likely achievement by 31-
Fifth Plan 1973-74 Plan (cumulative) 3-1980 (cummula-tive)
Sub-Centres . 33509 43836 50000
Primary Health Centres 5250 5351 5400
Subsidiary Health Nil Nil 1000
Centres
Upgraded Primary Nil Nil 340
Health Centres .

22.7 The programme of conversion of health workers serving in vertical public health
programmes like malaria control. TB control, smallpox etc., into multipurpose health workers
through reorientation training was assigned a high priority. This programme initiated in about 183
districts out of 400 districts in the country was completed by 31st March, 1980.
22.8 In accordance with the recommendations ol the Study Group on Medical Education and
Support Manpower, (1975) two Centrally Sponsored Schemes viz., (i) Community Health
Volunteers and (ii) Re-orientation of Medical Education were initiated in 1977. The community
health volunteers programme initiated in October 1977 had the objective of providing a trained
community health volunteer selected by the community itself for every village or a population of
1000. Under the scheme of re-orientation of Medical Education, each medical college in the
country was to adopt 3 primary health centres in the first phase with the twin objectives of
providing a rural bias to medical education and also curative health care and referral facilities to
the rural population covered.

22.9 In spite of several significant achievements, the health care system obtaining in the country
suffers from some weaknesses and deficiencies. There has been pre-occupation with the
promotion of curative and clinical services through city based hospitals which have by and large
catered to certain sections of the urban population. The infra-structure of sub-centres, primary
health centres and rural hospitals built up in the rural areas touches only a fraction of the rural
population. The concept of health in its totality with preventive and promotive health care services
in addition to the curative, is still to be made operational. Doctors and para-mcdi:als arc reluctant
to serve in the rural areas. They arc generally city oriented and their training is not adequately
adapted, to the needs of the rural areas particularly in the field of preventive and promotive

health. There has been over dependence on the States for health care measures and voluntary
and local clfort has not been able to take up responsibility in any significant measure. The
involvement of the people in solving their health problems has been almost non-existent.

22.10 The incidence of malaria has shown an upward trend since 1965. There have also been
reported cases of malaria caused by Plasmodium faliciparum parasite accounting for some
deaths. This type of malaria is also spreading from the North Eastern region where it originally
occured to other Stales. Resistance of this parasite to specific drugs has been reported. The
vector mosquitos have also developed resistance to DDT and BHC in certain areas of Gujarat
and Maharashtra. There nas been incidence of Japanese Encephalitis in certain pockets.

22.11 Of an estimated 3.2 million leprosy patients in the country, 20 per cent are infectious and
another 20 per cent suffer from various deformities. Curative and rehabilitative services for these
are necessary.

22.12 Nearly 2 per cent of the total population in the country is estimated to suffer from
radiologically active lesion of which 25 per cent are sputum positive and infectious cases. The
control measures adopted under the T.B. control programme do not appear to have made any
appreciable dent on the dimensions of the problem and the incidence of TB continues to be high.

22.13 According to the survey conducted by the Indian Council of Medical Research, out of an
estimated 9 million blind persons in the country, about 5 million could be cured by proper surgical
interference. In addition, 45 million persons were reported to be otherwise visually impaired. It
was also observed that the existing backlog of 5 million cataract cases was likely to go up by
another millioa new cases every year.

22.14 Maternal and infant mortality rates are still on a higher plateau compared to advanced and
some developing countries. The decline in the sex ratio (females per 1000 males) from 946 in
1951 to 930 in 1971 indicates the need for greater attention to maternal and child health care.
There are also considerable inter-State and regional disparties in health and medical care
standards. The general position of the Scheduled Castes/ Scheduled Tribes and other backward
classes is comparatively more unsatisfactory.

Policies and Strategy of Health Care Programme

22.15 An investment on health is investment on man and on improving the quality of his life. It is,
therefore, well recognised that health has to be viewed in its totality, as a part of the strategy of
human resources development. Horizontal and vertical

linkages have to be established among all the interrelated programmes like protected water
supply, environmental sanitation and hygiene, nutrition, education, family planning and maternity
& child welfare. Only with such linkages can the benefits of various programmes be optimised. An
attack on the problem of diseases cannot bs entirely successful unless it is accompanied by an
attack on poverty itseli which is the main cause of it. For this reason the Sixth Plan assigns a high
priority to programmes ot promotion uf gainful employment, eradication a poverty, population
control and meeting the basic human needs as integral components of the Human Resources
Development Programme.

22.16 The country has adopted the policy oi 'Health for all by 2000 AD' enunciated in Alma Ata
Declaration in 1977. Alongwith this the long term objective of population stabilisation by reducing
Net Reproduction Rate (NRR) to 1 by 1995 is to be achieved. The health care system in the
country has to be restructured and re-oriented towards these policy objectives. The strategy to be
followed over a period of 20 years upto 2000 AD, based on the recommendation of the Working
Group un Health, will be as follows:

i. Emphasis would be shifted from development of city based curative service's and super-
specialities to tackling rural health problems. A rural health care system baseu on a
combination of preventive, promouve and curative health care services would be built up
starting from the village as the base.
ii. The infra-structure for rural health care would consist of primary health centres each
serving a population of 30,000 and sub-centres each serving a population of 5,000.
These norms would be relaxed in hilly and tribal areas. The village or a population of
1000 would form the base unit where there will be a trained health volunteer chosen by
the community.
iii. Facilities for treatment in basic specialities would be provided at community health
centres at the block level for a population of 1 lakh with a 30 bedded hospital attached
and a system of referral of cases from the community health centre to the district
hospital/medical college hospita's will be introduced.
iv. Various programmes under education. v/ater supply and sanitation, control of
communicable diseases, family planning, maternal and child health care, nutrition and
school health implemented by different departments/agencies would be properly
coordinated for optimal results.
v. Adequate medical and para-medical manpower would be trained for meeting the
requirements of a programme of this order and all education and training programmes
will be given suitable orientation towards rural health care.
vi. The people would be involved in tackling theii health problems and community
participation in the health programmes would be encouraged. They would be entitled to
supervise and manage their own health programmes eventually.

The crucial indicators as at present and those desirable by 2000 AD are shown below:—

Table 22.2

Index Present level 2000 AD Target

Infant Mortality Rate (per 10001 ive 129 (1976) Below 60
birth)
Crude Death Rats (per 1000 14.2 (1978) 9.0
population)
I.ife Expectancy tit birth (in years)
Male ....... 52.6 (1976—81) 64
Female ...... 51.6 (1976—81) 64
Crude Birth Rate (per 1000 population) 33.3 (1978) 21.0
Net Reproduction Rate(NRR) 1.51(1980—81) 1.0

In substance, a reduction of 5.2 points in the death rate and 12.3 points in the birth rate by 2000
AU would be the target for achievement. The rate of infant mortality is also to be reduced by more
than 50 per cent and life expectancy raised to 64 years.

22.17 The expanded immunization programme and tile programme of prophylaxis against iron
and Vitamin 'A' deficiencies would be strengthened. The targets envisaged for Sixth Plan are
indicated in AnneKurc 22.6. All the national public healtM schemes like Malaria control, Leprosy
control, TB control etc., would be monitored towards the specific goal of adequate health care for
all envisaged for the period 1980—2000 AD.

Rural Health Programme

22.18 The mimiWHB needs programme in the State Sector woald contimie to be the mam.
instrument for development of the rural health care delivery system. It will be supplemented by
Centrally Sponsored Programme for training of medical and paramedical workers.

22.19 Minimum Needs Programme: Primary health centres at the rate of one for each community
development block had been established by the end of Fifth Plan. It was also proposed to have
one sub-centre for 10,000 population and upgrade one out of every four selected primary health
centres to a 30 bedded rural hospital to serve as a first link in the chain of referral services. Full
coverage of the backlog of primary health centres and sub-centres buildings were also
contemplated in the Fifth Plan. Although the progress of setting up of primary health centres has
been satisfactory, many of them are not having necessary buildings and other facilities. The sub-
centre programme has been proceeding very slow. These programmes would, therefore, be
accelerated over the successive plan periods to achieve by 2000 AD the objective of establishing
one primary health centre for every 30,000 population or 20,000 in tribal and hilly areas and one
sub-centre for every 5,000 population. As against the earlier policy of setting up a 30 bedded rural
hospital by upgrading one out of 4 primary health centres, a community health centre will be
established for a coverage of 1 lakh population with 30 beds and specialised medical care
services in gynaecology, paediatrics, surgery and medicine,

22.20 Keeping in view the training capacity of ANMs and other para-medicals and the constraint
of financial resources, it is proposed to establish 40,000 additional sub-centres during 1980—85
Plan raising the number of centres to an estimated 90,000 against the total requirement of about
1,22,000 centres i.e.. 74 per cent coverage on the basis of Mid 1984 estimated population. 600
additional primary health centres will be set up in areas where mostly the existing primary health
centres cater to a relatively larger population on present norms. Out of these, over 100 primary
health centres are expected to be located in tribal and hill areas. In addition, 1000 out of the
existing rural dispensaries will be converted into subsidiary health centres to accelerate the
promotion of promotive and preventive health care facilities. These will be eventually converted
into primary health centres. There will thus be 6000 primary health centres and 2000 subsidiary
health centres (1000 existing+1000 new proposed) by 1984-85 against the total requirement of
about 18,560 centres. Coverage of backlog construction works of sub-centres, primary health
centres buildings and staff quarters, besides construction works of new units to the extent
possible within the available resources will be aimed at during the Plan period. 174 primary health
centres will be upsraded to Community Health Centres with 30 bedded hospital in addition to
completion of construction works of up-eraded primary health centres already taken up. These
will be converted into community health centres, emphasising the public health aspects.

22.21 Centrally Sponsored Schemes: The minimum needs programme will be supported bv the
Centrally Sponsored Schemes of Community Health Volunteers, Employment and Training of
Multi-purpose Workers and Re-orientation of Medical Education which are all continuing
schemes.

22.22 The community health volunteers scheme is yet to be evaluated fully, although two quick
evaluations have been made. There are about 1.40 lakh community health volunteers in field as
on 1st April, 1980. It is proposed to extend the programme further during the 1980—85 Plan to
add another estimated 2.20 lakh community health volunteers raising the total number to 3.60
lakhs by 1985, with a view to cover the whole country. The States of Jammu & Kashmir, Kerala,
Tamil Nadu and the Union Territories of Arunachal Pradesh and Lakshadweep Islands are
implementing alternative schemes of health care at the grass roots level. An in-depth evaluation
of the Centrally Sponsored Community Health Volunteers Scheme as well as these alternative
schemes will be made to develop, if necessary, a modified scheme to promote health
consciousness among the rural people and provide a link between them and the primary health
centres.

Training of Multi-purpose workers is expected to be completed by 1983.

22.23 The Re-orientation of Medical Education Scheme was initiated with the twin objective of
providing curative health care facilities to the rural people and giving a rural bias to medical
education. The 106 medical colleges in the country were provided each with three mobile clinics
obtained from the UK Government for the purpose. The scheme provides lor one-time assistance
to the medical colleges for meeting a part of the recurring and non- recurring costs, the State
Governments meeting the required additional non-recurring and recurring costs. The scheme will
be continued in the Plan and each medical College would cover a whole district in due course.

22.24 Schemes to train public health and paramedical workers will be taken up in the Plan since
at present there is dearth of trained workers in various fields and the present training courses and
curricula are also not standardised in some cases. The requirements of various categories of
personnel would be identified and training programmes mounted for the required number. Full
advantage would be taken of the 10+2 system and para-medical courses would be introduced in
that system to the extent possible.

Control of Communicable Diseases

22.25 Next to rural health, the control of communicable diseases will be given priority.

22.26 Diseases like TB, Gastro-intestinal infections, malaria, filaria, infectious hepatitis, rabbies
and hook worm are inter-related to evnironment.

They accounted for 17.2 per cent of morbidity and 20.8 per cent of mortality in 1970. Other
preventable diseases like diphtheria, whooping cough, polio and tetanus accounted for 1.0 per
cent of morbidity and 0.4 per cent of mortality. Improvement of environmental sanitation and
expanded immunization programmes coupled with improved preventive and promotive facilities
through the network of hospitals, community health centres and sub-centres would be the main
strategy for control/eradication of the communicable diseases,

22.27 The ongoing programmes of control/eradication of communicable diseases like malaria,

filaria, leprosy, TB would be further intensified and fully integrated with other health care
programmes to ensure effective reach of these services through a net-work of multi-purpose
health workers under the supervision of medical officers at the primary health centres. Efforts
would also be made for involvement and participation of the community in the programmes.
Research and training components of these programmes would be stepped up towards the
objective of developing more effective alternate approaches to control of these diseases.

22.28 The details of the programmes are briefly indicated below:—

fi) Malaria: Keeping in view the current status of malaria as discussed earlier, the modified
operational plan of control initiated in 1977 will be implemented vigorously. The salient features of
the Plan are:—

• Re-organisation of malaria units to conform to geographical boundaries of the district for

better supervision bv the Chief Medical Officer of the District entrusted with the
responsibility to implement the programme:
• Linking residual insecticidal spray with incidence by continuing spraying in areas with an
annual parasite index (API) of 2 or more per 1000 population;
• Full surveillance Including focal spraying i'n areas with an API less than 2:
• Priority attention to P. falciparum infection;
• Assured supply of required quantity of anti-malarial drugs through community health
voiunteers, sub-ceatres, primary health centres, panchavat agencies, school teachers
etc.
• Multi-media publicity to arouse public awareness and participation; and
• A step up in research effort both in the laboratory and field.

A large allocation of over Rs. 400 crores has been made in the Plan for control of malaria.
Research on immunological and therapeutical aspects of Japanese Encephalitis and P.
falciparum infection would be intensified.

(ii) Filaria Control: Experimental studies have been initiated in the selected pockets of the country
for evolving an effective strategy to control the disease in rural areas. These studies will be further
intensified so as to evolve a suitable strategy by 1985 to protect the rural population susceptible
to Bancroft! filariasis. Filaria and malaria control measures would be integrated into a composite
programme for maximum utilisation of available resources and effective implementation in urban
areas.

(iii) Leprosy: The leprosy control programme will be intensified in the Plan towards the objective
of its eradication as early as possible. The programme will be directed towards the following
objectives:

a. To cover the entire endemic population of the country to the extent of 90 per cent by 1985
and 100 per cent by 1990 with a corresponding step up in disease arrested cases from
present level of 20 per cent to 40 per cent. in 1985 and 60 per cent in 1990.
b. To introduce newer drugs, multi-drug therapy and specially supervised treatment of
infectious cases and epidemiolog'cal surveillance by a network of early detection
measures.
c. To provide medico-surgical facilities to leprosy patients for rehabilitation through
reconstructive surgery, physiotherapy, occupational therapy, jobs and tools adoption etc.
d. To improve and extend training facilities in leprosy through training centres. Regional
Leprosy Training-cum-Referral Institutes and workshops.
e. Encourage the participation of voluntary agencies through financial support. Public
education and mass publicity will be stepped up to remove the social stigma attached to
the disease.
(iv) Control of Visual Impairment and Blindness:

Among the major causes responsible for visual impairment and blindne'ss, cataract accounts for
55-58 percent followed by trachoma and other eye infections 20-22 per cent. The balance is due
to injuries, malnutrition and other causes. Under the Centrally Sponsored Scheme, Ophthalmic
treatment facilities in primary health centres, rural hospitals and District hospitals will be
improved. Provision will be made for mobile units and strengthening of ophthalmic departments in
selected medical colleges and regional ophthalmic institutes. Comprehensive eye health care
facilities throueh the strengthened infrastructure should help reduce blindness in the country from
the present 1.4 per cent to about 1 per cent by 1985.

(v) Control of ofhpr diseases: Measures for control and prevention of TB and Cholera, and
maintenance

of zero incidence of small-pox would be continued. The Centrally Sponsored Scheme concerning
Sexually Transmitted Diseases programme will be integrated with general health care faculties
provided through the State Plans with etfect from 1961-82. Goitre is •one of the deficiency
diseases which will be tackled in the identified endemic pockets. Attention will be paid to vector
borne diseases which are gaining in importance in the areas covered by major irrigation projects.

Hospitals and Dispensaries

22.29 Except in the national capital and selected centres like Chandigarh and Pondicherry, E.S.I.
and Central Government Health Service Scheme, hospitals and dispensaries are under the
control ot the State Governments/Union Territory Administrations. The facilities in the hospitals of
the medical colleges/ district levels have in the past been improved and upgraded systematically
to cater to the requirements of curative services, in selected hospitals and institutions, super-
speciaiities have also been set up. These facilities are expected to provide curative facilities to
the rural population on an increasing scale under the scheme or referral services. Further
development of these hospitals would be with reference to felt needs of the region. Measures will
be taken for efficient management of the hospitals through consolidation of existing facilities and
proper maintenance of equipment and establishment of convalescent homes, poly-clinics and
Dharamshalas in the vicinity of hospitals to help reduce pressure on hospital beds would be
encouraged.

22.30 Super-specialities will be developed only to the limited extent necessary to meet the
regional requirements and to fill in critical gaps.

22.31 The rural dispensaries set up by the State Governments will be gradually oriented towards
total health care instead of providing curative facilities only. A good number of them are being
converted into subsidiary health centres in the Sixth Plan as already discussed under the
minimum needs programme.

Medical Education

22.32 Under-graduate Medical Education: From the 106 medical colleges existing at present in
the country, an estimated 11,000 doctors pass out every year. In view of the increasing
unemployment of medical graduates and also the imbalance in the ratio of doctors to para-
medica;; workers, the policy of the Government is not to increase the number of medical colleges
or the intake capacity. The emphasis would be on bringing about qualitative improvement in
medical education and training. Despite the high yearly outturn of medical graduates and growing
unemployment among them, in several States there are no doctors available to serve in the rural
primary health centres/hospitals. This phenomenon can be explained only by the fact that many
of the young medical graduates, by their background, training and career ambitions find
themselves out of place in a rural set up.

22.33 It will, therefore, be necessary in the years ahead to reonent medical education 10 meet
the requirements of rural areas, 'the Centrally Sponsored Scheme of Re-orientation of Medical
Education would be continued and the present deficiencies noted in the implementation of the
schemes set right, the Medical Council of India has also prescribed service in rural medical
institutions for six months as part of the compulsory internship. In addition, reforms in other
directions like modification of the curriculum, training of medical under-graduates in cerain fields
relevant to the problems of rural health care, community orientation etc., would be necessary.
These would be given adequate attention in the Sixth Plan.

22.34 Besides providing incentives to government doctors to serve in rural areas, it would also be
necessary to encourage private practitioners to settle in tlie rural areas so that their services
could supplement the efforts of Government in the field of rural health. This would also correct the
situation where almost every medical graduate, who comes out, looks up to Government to
provide him with a job. In fact, it is precisely this situation that has contributed to growing
unemployment amongst doctors in some States and not lack of opportunities for service. The
nationalised banks have already a scheme for providing financial assistance to professionally
qualified people for self-employment including doctors. Elforts v/ould be made to ensure that
adequate number of medical graduates are enabled to avail of this assistance. The Government
of Andhra Pradesh have initiated a scheme under which some allowance is provided to medical
practitioners who settle down in a village where there is no doctor and provide part-time service at
the nearest sub-centre. The Tamil Nadu Government have taken up the Mini-health Centre
Scheme under which financial assistance is provided to voluntary organisations which provides
medical care facilities at the village level through doctors employed on part-time basis. Based on
the experience gained from such schemes, suitable steps can be taken to promote the settling of
doctors in rural areas.

22.35 Post-Graduate Education: Post-graduate Medical Education would be rationalised to effect

a balance between the national requirements of specialities and advanced opportunities for
medical graduates.

22.36 The National Academy of Medical Sciences will be strengthened and assisted to fulfil the
objective of improving the quality of post-graduate level medical education.

22.37 Improvement of Skills: Continuing education and inservice training facilities will be
promoted to help updating the knowledge of service doctors, improve the skills of teaching
doctors and familiarise them with modern advances in medical sciences.

22.38 Improvement of facilities: Deficiencies in terms of equipment, "teaching beds", buildings,

laboratory staff etc., in the existing medical college hospitals would be assessed and steps taken
to overcome these deficiencies under a phased programme within the available resources.

Medical Research

22.39 The current health status of the country discussed earlier calls for vigorous research efforts
in several problem areas. Research on Bio-medical and public health problems, particularly
communicable diseases call for a high priority. There are also areas such as economic aspects of
health administration and management, contraceptive methods and family planning which need
attention.

22.40 Task oriented research programmes in the following fields would be initiated towards the
above objectives:
 i. Promotion of research on epidemiological, microbiological and immunological
approaches towards control of communicable dis-seases accounting for major causes of
morbidity and mortality.
ii. Research in curative practices like rehydra-tion towards the control of diarrhoeal diseases
especially among children.
iii. Research in the field of nutrition, metabolic problems, food production, processing,
preservation and distribution.
iv. Research in the field of drugs for various non-communicabJe diseases, Keeping in view
the aspects of quality, safety, toxic effects etc.
v. Close and continuous studies in the area of information support, manpower development,
appropriate technology, management and community mvolvemem. to ensure the reach of
benefits of primary health care programmes to the rural population.

22.41 Besides the Indian Council of Medical Research which would play a pivotal and
coordinating role in medical research, otner institutions such as the All India Institute of Medical
Sciences, New Delhi; Post-Graduate Institute, Chandigarh; National Institute of Communicable
Diseases, Delhi; A.I.I.H. & P.H. Calcutta; JIPMER, Pondicherry under the control of the Health
Ministry would also continue to be engaged in relevant research work. Adequate funds for
research have been earmarked for the activities of the Indian Council of Medical Research and
other institutions under the control of the Health Ministry.

22.42 Cancer research and treatment facilities will continue to be developed through a net-work
of early detection centres, cobalt units and development of selected regional research and
training centres.

Traditional Systems of Medicine and Homoeopathy

22.43 In recent years some attention has been paid to development and popularisation of
traditional systems of medicine like Ayurveda, Siddha, Unani and Homoeopathy. There are
certain States where each individual system enjoys prestige and popularity such •ms Ayurveda in
Kerala and Siddha in Tamil Nadu.

22.44 Each of these systems has now a Central Council and an attached Researcli Council.
Centrally Sponsored Schemes were initiated in the past for providing grants-in-aid to States for
promotion of postgraduate education and establishment of pharmacies with Government of India
providing 100 per cent financial assistance. These will be continued.

22.45 The State Governments liave also schemes for development of medical education, setting
up hospitals and dispensaries under these systems.

22.46 There is need for coordinated efforts for 1'ur-ther research for providing drugs for
communicable diseases like Malaria, T.B. etc. as also for such other diseases like cancer,
diabetes etc. The traditional system can also contribute to the national effort for finding effective
methods of contraception

22.47 It would be necessary to take steps in the following direction's:

i. Prevention of the growth of sub-standard teaching institutions under these systems.

ii. Adequate financial support to existing recognised institutions for improving the quality of
teaching and research.
iii. Introducing modern and scientific methods of investigation and equipping students with
adequate knowledge of subjects like physiology, pathology, anatomy etc.