Interview- (Part-I)

Mains results should be out any time soon. Interview even though accounts for only 300 marks is nonetheless very crucial in getting us the service we want. A brilliant mains performance punctuated by a terrible interview score is likely to upset all our calculations. I think this is the toughest part of the entire process only for the reason that it is highly unpredictable. I intend to divide this post into two parts. Part-I is about My own preparation for the interview and some general DO's and DON'Ts for the interview. Part-II will be the factual narration of my interview as much as I can recall.


PART-I


I finished my mains on November 5, 2008 and joined the office of Mr. Shailesh Gandhi, CIC the very next day. By the time I finished writing the mains, I was so fed up with it that I decided to keep UPSC completely away from my work. I had completely forgotten about it, except for the occasional reminders that I would get from family and friends enquiring about the result. Interview preparation was the last thing on my mind and I had no plans to prepare for it until the results were out.

I still remember the day when the results were out. I was at work busy doing nothing very important. Nitin, a friend from Kanpur, called to say that the results were out and he did not make it. He did not sound too sad about not clearing it. He then asked, if I had checked mine. I said no and told him that I was not free and would check whenever I was done with my work. For some reason, I did not feel any strong urge to check my result then. Looking at my disinterestedness, he then volunteered to check it for me. I was happy to let him do the honours. Gave him my roll no, hoping that I had remembered it correctly. I think in the first instance he missed my roll no and told me it was not there. I was not too sad to hear that and told him we will work harder next year. Even before I could finish, he asked me to hang on and in the meanwhile he looked for my roll no again and found it this time in the list.

Was I happy to know that I had cleared the exam? Oh yes,there was a sense of satisfaction and relief but I was definitely not jumping with joy. Mr. Gandhi, my ever generous and caring boss distributed chocolates to every one in the office. I had to tell him and everyone at work that I still had the last hurdle to clear and clearing mains is no guarantee that I will make it to the final list. Called up home to tell my parents and my brother and then got back to work. But the call did not stop coming. Friends and family kept calling entire evening.

I had already booked my ticket to visit home for Holi and did not want to cancel it. But I was beginning to get worried now since I had very little time to brush up even the current affairs. I went ahead with my plan any way. Went home for a week, had a good Holi and came back all rejuvenated. Next day, I went to Vajiram to enquire about their mock interviews and filled up the form for a mock interview with Mr. Raveendran. It was there that I heard people talking about "Samkalp" an institute that provided guidance for interview. I was told it was somewhere near Jhandewalan and I could get information about them from the RSS Headquarter there. On my way back to home from Vajiram, I got down at the Jhandewalan metro station, went to the RSS HQ and got the no of the gentleman who was in charge of the interview Programme. I called him to find out if I could attend their programme. I was politely told, that I was very late and they will not be able to accommodate me.

I had very little time at hand. I think a week or so. I was beginning to panic now. I turned to my friends and seniors who had already gone through the grind and had come out with the flying colours. I think I spoke to Abu (a very close friend from college days and now training for Foreign Services), almost daily and discussed the probable areas that I should focus on. I also spoke to my seniors Anoop and Aparna and was benefited greatly by my interaction with them. Aparna has been a great source of encouragement and support throughout. She made me read out the answers that I had prepared for the probable questions and gave her invaluable feedback on the same.

Since, I did not even have enough time to brush up even law, there was no question of looking at pub-ad for the interview. I browsed on the net for the recent developments in the legal field and read few issues of Frontline and the Economist. Amidst all this chaos, I went and did my mock with Mr. Raveendran. That was a big morale booster. I got excellent feed back there and was little less panicky now than I was before. After a day or two, I went for one more mock at ALS. The mock interview at ALS was of great help because they not only grilled me thoroughly but also gave me valuable feedback on my body language and hand movements. I had this wonderful habit of telling "that's right sir" little too often. I was politely told that I should not be doing that since it did not sound very appropriate.I got an excellent feed back at ALS too.

While I was happy to get these feed backs, I also knew that they were only an indication of how the interview might go. I think this was some 3 days before my interview. But I was confident now and spent last 2 days going through my mains form again and preparing for all the possible questions that could be asked. I wrote the answers, rewrote them, spoke them aloud till I was satisfied with my answers.

That was how I went about my interview. Would I do it differently the second time around? The answer is NO. Is preparing for the interview in the last 10 days only a good idea? The answer is: I Do NOT KNOW. It worked for me (I got 216/300) but it might not work for you. Having said that, I believe its difficult to prepare for an interview since, it is largely the test of our personality than the knowledge that we have acquired over the years. We can not change into a different person in a short span of few months. Therefore, my advice would be to take it easy, be yourself and do not lose sleep over it.


DO's and DON'Ts


DO's

(i) Please read the mains form very carefully. It is very likely that many of the questions will revolve around the information that you have filled in the form. Please formulate answers to some of the expected questions and rehearse them well at home before the grand finale.

(ii) Do read about your Home State, Home District, Educational institution you went to in great details. Ignorance about any historical/important facts associated with these places is not bliss in the UPSC interview.

(iii) Please know the fundamentals of your graduate/post graduate subject well. Not knowing them is unpardonable. Interview isn't only the test of personality. Very often candidates are grilled on their academic background too. I was asked quite a few law related questions.

(iv) Please be well informed and well aware of the events in and outside the country. You can revise your GS notes and also read the last few issues of any decent magazine. For example: rationale for the smaller states could be a probable question because of the ongoing Telangana agitation. Resumption of dialogue with Pakistan is another example. Knowing facts might not be enough. Try and answer questions like: Does dialogue help? What are the alternatives to the dialogue? etc.etc.

(v) No doubt honesty is the best policy when it comes to the interview but brutal honesty at times might not be a brilliant idea. Certain amount of diplomacy(not dishonesty) might go a long way in improving your score card.

(vi) Mock interviews are helpful. But do not overdo it. 2 or 3 mocks from different places should be sufficent.

(vii) Do maintain eye contact. Be polite (not docile), keep the aggression to yourself, apologise if you have had the slip of the tongue. Keep an easy demeanour. Do not force a smile on yourself but do not look hassled either.


DON'Ts

(i) Do not lie to the Board. Once you are trapped in the kingdom of lies, you would never be able to get out of it.

(ii) Do not give the wrong answer if you do not know the answer. We are not expected to have an answer to every question. Say sorry if you do not know. (I said sorry several times in the course of my short interview)Do not guess unless you are asked to.

(iii) Do not jump with your answer even before the member has finished asking her question. Think it over and then answer clearly and concisely. Please be precise and do not beat around the bush. (no one has time to listen to our pearls of wisdom in extensive details)

(iv) Do not give them reasons to ask questions, to which you do not have convincing answers. For example wearing stones in all your fingers,any visible religious marks etc.

(v) People with bad sense of dressing, Please ask your friends and family to help you choose the right attire for the occasion. Being shabbily dressed is a big No. I remember a gentleman who was not wearing his tie, was asked why he was not when every one else was. I am sure he would not have been judged on that count but then why take a chance?

Quitting the Job

Quitting the job or continuing with it is one dilemma that many of us face while deciding to prepare for the civil services. Quitting your job to write civil services is definitely not an easy decision to make. Again, there is no hard and fast rule that one must quit her job in order to prepare for the civil services. There are people who manage to do both . However, I do not think there are many people who have managed to achieve that feat. I personally do not know any one who has done that. I think it is extremely difficult to manage a full time job and prepare for civil services simultaneously. The nature of the examination is such that it requires at last a year of preparation.

I was working at Amarchand Mangaldas, one of the oldest and a very reputed law firm of the country. Working for a good law firm is hugely rewarding, atleast monetarily. Less than a year into my job, I realized, I was not cut out for a corporate job. I saw no point in working as a corporate lawyer since, I was not going to be very happy doing that. Moreover Civil Services was always there at the back of my mind.

I guess, the fact that I had no family/financial obligations, made it much easier for me to quit my job. My law degree has been a great comfort factor too. I know I can always fall back on it in the event of non materialisation of civil services. Undoubtedly, the comfort of a professional degree takes off some of the stress and pressure but it could also make one complacent. I remember, everytime I would get frustated with the entire process, I would imagine myself to be a star lawyer. While it is always nice to have a professional degree as your back up option, it is equally important not to find an escape route in it.

To me, it makes complete sense to give a shot to civil services,if that's what one has been aspiring for. No one can take your professional competence away. One can always go back to one's job in the event of civil services not working out. There is absolutely no point in regretting about the missed opportunity later in your life. I would rather risk failure than regret not doing something that I had always wanted to do.

Health Care Of Rural India

It makes me wonder how eligible I am with the mere knowledge for a 10 mark question from the chapters of Community Medicine, having visited an ENT surgeon for a small furuncle and the Dermatologist for acne under insurance coverage this morning to speak of the poverty my country is struck with, complex issues which affects the lives of millions, whom I might never encounter in my whole life and yet have an impact on mine.

While adopting the Constitution on January 26, 1950, we, the people of India, dedicated ourselves to the creation of a new social order based on equality, freedom, justice and the dignity of the individual and, to the end, decided to eliminate poverty, ignorance and ill-health.

They say India has a national health policy but doesn’t have a national health service. The first part of the statement, I understand through a look at my 800 odd paged Park’s textbook of Preventive and Social medicine. The latter part, anybody would agree when they take a stroll down Dharvi, one of the worst hit slums of the alpha world city- Mumbai or a far flung off village in Bihar where people still die off Diarrhea.

As may be easily anticipated, the overall picture of the current health care is a mixture of light and shade, of some outstanding achievements whose effect is unfortunately more than offset by grave failures.

India stands at 134th position in the UN Human Development Index. When it comes to healthcare or for that matter anything, there are two Indias: One India that provides high-quality medical care to middle-class Indians and medical tourists, and the other in which the majority of the population lives—a country whose residents have limited or no access to quality care. Nearly 74% of the rural population doesn’t enjoy all the benefits of modern curative and preventive health services. Also, 73.6% of the doctors are concentrated in the urban areas and a mere 26.4% in the rural areas where a near 75% of the population lives. Not only does the wide variation exist between the rural and the urban but also the geographical distribution of hospitals vary according to local socioeconomic conditions all across the country with a wide gap between Uttar Pradesh and Kerala.

‘Health by the people, placing people’s health in people’s hands.’

Primary Health care is considered one of the greatest milestones in the history of health care in India, the very basic roots of survival for millions. The building of PHCs- the 1^st level of contact, constitute the fundamental requirement of a sound referral system and the realization of ‘Health For All’. 

One driver of growth in the healthcare sector is India’s booming population, currently 1.1 billion and increasing at a 2% annual rate. India will surpass China by 2030 and by 2050, the population is projected to reach 1.6 billion.

Figures from Rural Health Statistics reveal some startling trends. Sub-Centers, Primary Health Centers and Community Health Centers — the bedrock of rural health delivery — have grown in absolute numbers since Independence: From 725 in 1951 to 57,353 in 1981 to 1,71,687 as of March 2007. They remain the backbone of rural health-care in the absence of private sector presence.

‘Rural health care in India faces a crisis unmatched by any other sector of the economy’. - Arvind Panagariya, The Economic Times.

 Besides tremendous progress, not all Health statistics are healthy for rural India. Considering the limited facilities available in a sub-centre, 50% of the sanctioned posts of Specialists at CHCs remaining vacant,run-down infrastructure, poor supply of drugs and equipment, illegal selling of the public welfare supplies and soaring rates of chronic employee absenteeism, commission practices that exist between the rural unqualified doctors and the doctors from the health institutions in the nearest cities or the district heads; quality health-care remains a mirage for much of rural India. There is no healthy Comparison of this with the hospital (public and private) beds available in the urban areas, which are greatly uneven. While the rural poor are underserved, at least they can access the limited number of government-support medical facilities that are available to them. The urban poor fare even worse in terms of primary health care and they cannot afford to visit the private facilities that thrive in India’s cities. 

The launch of National Rural Health Mission [NRHM] 2005-2012 is a giant in the creation of a national service whose need was conceived almost 30 years before; aims to provide effective healthcare to India’s rural population, with a focus on 18 states that have low public health indicators and inadequate infrastructure. Through the mission, the government is working to increase the capabilities of primary medical facilities in rural areas through Accredited Social Health Activists (ASHA) and Link Workers and ease the burden on tertiary care centers in the cities, by providing equipment and training. It integrates multiple vertical programmes and also embraces the Indian system of medicine [AYUSH].

The new course (Bachelors of rural health care) for 3 year and six months that demands for a five-year service in a rural area is a potential solution as primary health care is the need of the hour but are we compromising rural health care just in the desperate attempt in making more doctors to bridge the gap is an intriguing question. The extension of regular MBBS study period for rural service raised a huge out cry from the students. Though it was a shrewd idea of the politicians to fill their vote banks by promising the rural population, doctors at their doorsteps; the consequences of such a bill would have changed the entire face of rural health.

Solutions including the National Rural Employment Guarantee Act (NREGA), Janani Suraksha Yojana(JSY),  fundamental reform of the long established Public Distribution System (PDS), a new Food Security bill under consideration by parliament which proposes to issue coupons direct to BPL families, Vandemataram Scheme, RCH programme and programs to encourage sustainable farming practices are being implemented for the overall development.

Indian health services have carved out meaningful programmes of health services, research and demonstration. Mobile based primary health care systems, Automated Medical records, and development of innovative roles for allied health professionals, Telecommunications and Telemedicine—the remote diagnosis, monitoring and treatment of patients via videoconferencing or the Internet. It’s only through solutions such as these that a rural population approaching 700 million can be benefitted with proper healthcare facilities. 

The misdistribution of biomedical services and the lack of penetration of public health services create a dilemma for Indian patients. They encounter a bewildering array of medical services, ranging from qualified traditional medical practitioners to untrained, self-taught purveyors of medicines and cures. This frequently accounts for this type of patient use, which may be described as “forced pluralism,” and for provider practice that is “unethical and dangerous”. This by-now entrenched pattern of inappropriate medical practice and patient abuse, calls for a review of policy, a plan for regulation, and action against the unqualified. The Government is undertaking strategies in order to harness the available local resources by incorporating the existing self -made rural health professionals to the mainstream of health care.

Private sector spending dwarfs the total healthcare being financed by the public sector. In 2003, fee-charging private companies accounted for 82% of India’s $30.5 billion expenditure on healthcare. Most of the population is forced to seek health care from the private sector and pay out of pocket at the time of illness. Eighty percent of our healthy care is met through individual household expenditure, one of the highest internationally. Studies show that an average of 24 percent of Indians are impoverished because of medical expenses.

In such circumstances there are two alternatives, either that government increases it’s spending on healthcare and to improve the quality of care in its institutions and thereby protects the poor from catastrophic health expenditure, or the poor resort to some mechanism that protects them when they fall sick. While the former option seems to be materializing in various forms in our country the only solution to provide health care facilities to the poorer sections of the society could be the community health insurance through which the basic health care needs can be taken care of.

Only 11% of the population has any form of health insurance coverage. The Employees State Insurance Act (1948), Janarogya Yojana (1996-97), Yashaswini Insurance scheme (2002)- a micro insurance initiative, in the state of Karnataka by a public–private partnership for the farmers who previously had no access to insurance. Recently launched government-sponsored health insurance schemes, such as Arogya Sree scheme (Andhra Pradesh) and Rashtriya Swasthya Bima Yojana (RSBY), target poor Indians, offering cashless cover while allowing beneficiaries to choose among empanelled public and private providers.

More state governments should pursue such initiatives so that most or all of the population can afford to purchase at least a minimum level of coverage. Also the problems such as reimbursement, a process that can take up to six months,

 should be efficiently tackled . The widespread availability of health insurance would help to drive demand for services and provide additional revenue to improve the quality of care.

‘There is a great difference between medical facilities available in Western countries and that in India. But there is a common thread — Indian medical professionals.’

The usual cycle of migration of health care professionals from villages to cities, cities to metropolitan and from the metropolises to the US and abroad where they believe are better amenities, better job satisfaction, better professional brethren, better adaptability, better experience and most importantly ‘Better Quality of Life”. Reports are that close to 38 per cent of practicing doctors and dentists in the US are of Indian origin. Ironically the migrating doctors do not hesitate to work in the rural areas of the developed nations, as the pay for doctors who prefer to work in their rural areas is more while it is just the opposite in India.

The term ‘health’ is not found in the US constitution but yet they have always taken extreme measures to provide their citizens with the 3 sentinel services- Defense, Education and Health care. In 2008, U.S. health care spending was about $7,681 per resident and accounted for 16.2% of the nation’s Gross Domestic Product (GDP); this is among the highest of all industrialized countries.

The National Health Account shows that India’s total expenditure on health amounts to 5.10% of the gross domestic product (GDP), while its per capita total expenditure on health is $80 compared to an average of over $220 spent by many other developing countries. Consider the contrast with the Bhore Committee recommendation of 15% committed to health from the revenue expenditure budget, against the WHO, which recommended 5% of GDP for health.  In this very year India spent 300 bn to hold the most expensive Common Wealth Games ever.

Does the elixir of dynamic economic growth distract us from acknowledging that the superpower status will be denied to us until our country can bestow social justice to its own citizens?

"Taking real time data and immediately feeding it back into the product, tapping local entrepreneurial talent, doing incredible marketing and education based on aspirations and not avoidance will make health care as ubiquitous as Coca- cola", said Melinda Gates in her TED talk. Only through real education can the masses be made to realize the ‘felt needs’ and they shall be more receptive to hear when their stomachs are full enough. It is through research into cheaper modalities of health care delivery like ORS, a revolution can happen.

I look forward for that day, when we can pride ourselves on our determination, enough wealth, organizational skills, intellectual and technological capacities to develop an ideal health care model such as the NHS and provide health care to every citizen in need.

Change appears to be the hallmark of this generation. This is fortunate, for change is the hope of the future. But let’s remember, true prosperity starts in the countryside.

Health Problems in India

Essay on Health Problems in India

1. Introduction

India was one of the pioneers in health service planning with a focus on primary health care. In 1946, the Health Survey and Development Committee, headed by Sir Joseph Bhose recommended establishment of a well structured and comprehensive health service with a sound primary health care infrastructure.

Social development through improvement in health status can be achieved through improving the access to and utilization of Health, Family Welfare and Nutrition service with special focus on underserved and under privileged segment of population.

Under the Constitution, health is a state subject. Central Government can intervene to assist the state governments in the area of control/eradication of major communicable and non-communicable diseases, broad policy formulation, medical and para-medical education combined with regulatory measures, drug control and prevention of food adulteration, Child Survival and Safe Motherhood (CSSM) and immunization programme.

2. National Health Programmes

(i) Kala Azar

Kala-azar is a serious public health problem endemic in Bihar and West-Bengal. Kala-azar control was being provided by the Government of India out of the National Malaria Eradication Programme (NMEP), until 1990-91. The Centre provides insecticide, anti-Kala-azar drugs and technical guidance to the affected states.

During the Ninth Plan, the focus will be on ensuring effective implementation of the programme so as to prevent outbreaks and eventually to control infection. DDT will continue to be the mainstay for insecticide spray as the vector (phlebotomus argentites) is still susceptible to DDT.

(ii) Malaria

National Anti-Malaria Programme was implemented in 1958, which reduced the annual incidence of malaria to one lakh in 1965. Deaths due to malaria were completely eliminated. But resurgence of malaria necessitated review of vigorous anti-malaria activities. The Modified Plan of, Operation (MPO) was implemented from April, 1977, which reduce the incidence of malaria to 1.66 million in 1987 from 6.47 million in 1976.

In view of the high incidence of malaria and resource, constraints in seven north-eastern states, 100 per cent Central Government assistance was provided with effect from December, 1994. For effective control of malaria, the Enhanced Malaria Control Project was launched in Septem­ber 1997, with World Bank assistance, under which 100 hard core and tribal predominant districts of Andhra Pradesh, Bihar, Gujarat, Madhya Pradesh, Maharashtra, Rajasthan and Orissa and 19 problematic towns of various states have been included.

(iii) National Filaria Control Programme

It was launched in 1955 and it took up several activities including: (i) delimitation of the problem in hitherto unsurveyed areas and (ii) control in urban areas through recurrent anti-larval measures and anti parasite measures. At present about 49.87 million urban populations is protected by anti-larval measures through 206 control units, 199 filaria clinics and 27 filaria survey units

(iv) Modified Plan of operation for NMEP during the Ninth Plan

Intensification of control activities in areas with

·         API of > 2 in the last 3 years

·         Pf rate of > 30 per cent

·         Reported deaths due to malaria

·         >25 per cent of the population is tribal.

(v) Component of the Modified Plan of Operation

·         Early diagnosis and prompt treatment.

·         Selective vector control and personal protection.

·         Prediction, early detection and effective response to out breaks.

(vi) Japanese Encephalitis

Japanese Encephalitis (JE) has been reported in the country since mid-fifties and caused by virus and spread by mosquitoes has a mortality ratio of 30 to 45 per cent.

Due to development of irrigation projects and changing pattern of water resource management there has been a progressive increase in the number of states reporting cases of J.E. in India. The National Malaria Eradication Programme (NMEP) has been implementing, the recom­mendations of the Expert Committee on J.E. control.

Under the Ninth Plan, Information, Education and Communication (IEC) activities to ensure community awareness and co-operation, for prevention and control of vector borne diseases will be intensified.

(vii) Tuberculosis

Tuberculosis is a major health problem in India. Studies carried out by the Indian Council of Medical Research (ICMR) in the fifties and sixties showed that:

·         Unlike the situation in developed countries, BCG did not protect against adult TB and BCG given at/soon after birth provided some protection against TB in infancy and early childhood.

·         Domicialiary treatment with anti TB drugs was safe and effective.

National Tuberculosis Control Programme

It was initiated in 1962 as a CSS, which aimed at earl) case detection in symptomatic patients reporting to the health system through sputum microscopy and X-ray and effective domiciliary treatment with standard chemotherpy The short course chemotherapy introduced in selectee districts in 1983, has shortened the duration of treatment to nine months.

The Revised National Tuberculosis Programme (RNTCP) was launched in the country on March 1, 1997, and is proposed to be implemented in a phased manner in 102 districts of the country, covering a population of 271 million, with the assistance of World Bank.

Under; the Ninth Plan, the NTCP (National TB Control Programme will be strengthened in 203 Short Course Chemotherapy (SCC) districts as a transitional step to adopt the RNTCF Under the Ninth-Plan, standard regime will be strengthened in the remaining non SCC districts and Central Institutions, State TB cells, and state TB Training Institutions through out the country will be strengthened.

(viii) Dengue

Dengue fever is a viral disease which is transmitted through the bites of female Aedes mosquitoes. There are four serotypes of Dengue virus which are prevalent in India since 1950. Dengue viral infection may remain a symptom atic/manifest itself either as undifferentiated febrile illness (Viral syndrome), Dengue fever (DF) or Dengu haemorrhaphic fever (DHF).

An outbreak of Dengue was reported in Delhi in 1996, when 10,252 cases and 42 deaths reported, and was also reported from U.P, Punjal Haryana, Tamil Nadu, and Karnataka. Formulation of a National Dengue Control Programme is under consideration of the Central Government.

During the Ninth-Plan efforts will be made to:

(a) Establish an organized system of surveillance and monitoring.

(b) Strengthen facilities for early diagnosis and prompt treatment.

(c) Intensify IEC efforts to ensure that all households implement pre-domestic measures to reduce breed­ing of Aedes.

(iv) Leprosy

The National Leprosy Eradication Programme (NLEP) was launched in 1983 as hundred percent centrally spon­sored schemes with the availability of Multi Drug Therapy (MDT). It became possible to cure leprosy cases within a short period (6-24 months) of treatment.

The NLEP programme was initially taken up in endemic districts and was extended to all over the country from 1994 with World Bank assistance.

The first round of Modified Leprosy Elimination Cam­paign (MLEC) is to be implemented in all the states and UTs to create mass awareness.

The target for the Ninth-Plan will be to decrease prevalence of leprosy 1/10,000 by 2002 A.D.

(x) Blindness

It is estimated that there are 12.5 million economically blind persons in India. Of these over 80 per cent of blindness is due to cataract. The National Blindness Control Programme started in 1976 as 100 per cent centrally sponsored programme with the objective of providing com­prehensive eye care services at primary, secondary and tertiary health care level and achieving substantial reduc­tion in the prevalence of eye disease in general and blindness in particular.

The activities under the programme are yet to show an impact in reducing the prevalence of blindness to the goal level of 0.3 per cent by the year 2000 A.D. A major thrust was given under the Eight Plan to strengthen the programme in Jammu and Kashmir and Karnataka.

Funds from domestic budget as well as EAP were provided for this. At the tertiary level of opthalmic care there are eleven regional institutes of ophthalmology including the apex institute, Dr. Rajendra Prasad Centre for Ophthalmic Sciences in the All India Institute of Medical Sciences, New Delhi.

The programme priorities during the Ninth-Plan is to improve the quality of cataract surgery, clear the backlog of cataract cases, improve quality of case by skill upgradation of eye case personnel, improve service delivery through NGO and Public Sector collaboration and increase coverage of eye care delivery among underprivileged population. The targets set up under Ninth-Plan are 17.5 million cataract operations and 100,000 corneal implants in between the period 1997-2002.

3. Sexually Transmitted Disease

Control of Sexually Transmitted Disease (STDs) was introduced as a national control programme by the Gov­ernment of India during the Fourth Five Year Plan (1967). Since STD was one of the major determinants for transmis­sion of HIV infection, the programme has been merged with National AIDS Control Programme (NACO). There is in­volvement of private practitioners in STD control through Indian Medical Association (IMA).

HIV

Realizing the gravity of the epidemiological nature of HIV infection, the Government of India launched a National AIDS Control Programme in 1987. In 1992, National AIDS Control Organization was established and a 5 year strategic plan was implemented with a US $ 84 million soft loan from the World Bank and another US $ 1.5 million in the form of technical assistance from the World Health Organization.

Under the Chairmanship of Minister of Health and Family Welfare, National AIDS Committee has been con­stituted.

During the Ninth Plan the focus will be more on increasing the number of HIV testing network, more effective implementation of the programme for ensuring safety of blood/blood products, augmenting STD, HIV/AIDS case facilities, strengthening Sentinel Surveillance and enhancing efforts to improve HIV/AIDs awareness, counsel­ling and care.

National AIDS Control Programme in Five-Yearly Plan

I. More effective implementation of the Programme to ensure safety of blood/blood products.

II. Increasing the number of HIV testing network.

III. Augmenting STD, HIV/AIDS case facilities.

IV. Improving hospital infection control and waste management to reduce accidental infection.

V. Improving HIV/AIDS awareness, counselling and care.

VI. Strengthening Sentinel Surveillance. Components of NACP (Phase II)

VII. Reducing HIV transmission among poor and marginalized section of community at the highest risk of infection by targeted intervention, STD control and condom promotion;

VIII. Reducing the spread of HIV among the general population by reducing blood based transmission and promotion of IEC, voluntary testing and coun­selling;

IX. Developing capacity for community based low cost care for people living with AIDS;

X. Strengthening implementation capacity at the Na­tional, States and Municipal corporations levels through the establishment of appropriate organisational arrangements and increasing timely access to reliable information and

XI. Forging inter-sectoral linkages between public, private and voluntary sectors.

4. Iodine Deficiency Disorders

Iodine Deficiency Disorders (IDD) has been recognized as a public health problem in India since mid-twenties. IDD is not only a problem in sub-Himalayan region but also in riverine and coastal areas. It is estimated that 61 million populations are suffering from endemic goitre and about 8.8 million people have mental/motor handicap due to iodine deficiency.

The National Goitre Control Programme was initiated in 1962 as a 100 per cent centrally funded, centre sector programme with the objective of conducting goitre survey, and supplying good quality iodised salt to areas having high IDD, health education and resurvey after five years. In 1985, the government decided to iodise the entire edible salt in the country by 1992 in a phased manner. To date the production of iodated salt is 42 lakh MT per annum. The NGCP was renamed and redesigned as National Iodine Deficiency Disorders Control Programme (NIDDCP) to emphasize the importance of all the IDDs.

During the Ninth-Plan the major objective of the NIDDCP programme is

(1) Production of adequate quantity of iodised salt of appropriate quality.

(2) Appropriate packaging at the site of production to prevent deterioration of quality of salt during transport and storage.

(3) Facilities for testing the quality of salt not only

at production level but also at the retail outlets and household level so that consumers get and use good quality salt

(4) IEC to ensure that people consume only good quality iodised salt.

(5) Survey of IDD and setting up of district level IDD monitoring laboratories for estimation of iodine content of salt and urinary iodine excretion.

5. Disease Surveillance Programme

National Surveillance Programme for Communicable Diseases which has potential of causing large outbreaks such as acute diarrhoeal diseases and didesa, viral hepa­titis, dengue/DHF, Japanese encephalitis, leptospirosis and plague. The objective of the programme is capacity building at the district level for strengthening the disease surveil­lance system and appropriate response to outbreaks.

6. Mental Health

The National Mental Health Programme was started in 1982. The programme did not make much headway either in the Seventh or Eight Plan. The Mental Health Act (1987), which came into existence from April 1993, requires that each State/UT set up its own state level Mental Health Authority as a statutory obligation. Majority of the State/ UTs have complied with this and have formed a Mental Health Authority.

7. Cancer

The Cancer Control Programme was initiated in 1975- 76 as 100 per cent centrally funded centre sector project. It was renamed as National Cancer Control Programme in 1985. The objectives of the programme are

I. Primary prevention of tobacco related cancers.

II. Secondary prevention of cancer cervix.

III. Extension and strengthening of treatment facilities on a national scale.

The Focus during the Ninth-Plan will be

I. Intensification of IEC activities so that people seek care at the onset of symptoms.

II. Provisions of diagnostic facilities in primary and secondary case level so that cancers are detected at early stages when curative therapy can be administered.

III. Filling up of the existing gaps in radiotherapy units in a phased manner so that all diagnosed cases do receive therapy without any delay as near to their residence as is feasible.

IV. IEC to reduce tobacco consumption and avoid life styles which could lead to increasing risk of cancers.

8. National Diabetes Control Programme

The National Diabetes Control Programme has in­cluded a pilot programme in Seventh Five Year Plan. It was initiated in Tamilnadu and in one district in J and K.

9. Guinea Worm Eradication Programme

In 1983-84, India became the first country to launch an eradication programme against the disease, which had been causing great human suffering where safe drinking water is not available. The programme was implemented through existing primary health care infrastructure along with Ministry of Rural Development and the State public health engineering departments.

10. Yaws Eradication Programme

It can be cured and prevented by a single injection of long acting (benzathine benzyl) penicillin. Yaws is amenable to eradication. The pilot project to eradicate the disease in Koraput district was started in 1996-97. The programme has been extended to districts in Madhya Pradesh, Andhra Pradesh, Maharastra and Gujarat in 1997-98 and 1998-99. The programme is proposed to be extended to all affected districts during the Ninth Plan for which Rs. 4 crore have been earmarked.

11. Medical Relief and Supplies

Medical Services are primarily provided by Central and State government, apart from Charitable, voluntary and private institution. The number of hospital beds was 8.70 lakh as on 1 January, 1996 as compared to 1.17 lakh in 1951.

12. Rural health Infrastructure

Under the Minimum Needs Programme, Government has started developing the rural health infrastructure. In rural areas service are provided through integrated health and family welfare delivery system.

13. Central Government Health Scheme

It was introduced with a view to providing medical and health care facilities to the Central Government employees and expensive reimbursement of medical expenses under Central Services (Medical Attendance) Rules, 1944. This scheme was started in Delhi/New Delhi.

14. Emergency Medical Relief

Disaster management is the responsibility of State governments, but the Directorate General of Health Service, Ministry of Health and Family Welfare, Government of India provide technical assistance to the states. The respon­sibility is discharged by the Emergency Relief Division of the Directorate, which requires constant communication with the state governments.

15. Drugs

The Drugs and Cosmetics Act, 1940, as amended from time to time, regulates import, manufacture, sale and distribution of drugs and cosmetics in the country. Under the Act, import, manufacture and sale of sub-standard, spurious, adulterated/misbranded drugs are prohibited.

16. Vaccine Production

India is self-sufficient in the production of all vaccines, including measles required for the National Immunization Programme, except Polio. Polio vaccine which is imported in bulk, is blended at the Haffkine Bio-Pharmaceuticals Corporation Ltd. (Mumbai), Bharat Immunologicals and Biologicals Corporation Ltd. (Bulandshahar, UP), Radicura Pharma (Delhi) and Bromed Pvt. Ltd. (Ghaziabad, UP).

17. Nutrition

Major nutritional problems in India are Protein Energy Malnutrition (PEM), Iodine Deficiency Disorder (IDD), Vitamin-A deficiency and anaemia. To combat these prob­lems arising from nutritional deficiencies, Government has initiated various programmes.

18. Medical Education and Research

The Indian Council of Medical Research (ICMR) was established in 1911, as the apex body in India for the formulation, coordination and promotion of biomedical research.

Medical Council of India

It was established as a statutory body under the provisions of the Indian Medical Council Act, 1933, which was later repealed by the Indian Medical Council Act, 1956, with minor amendments in 1958. A major amendment in the IMC Act, 1956 was made in 1993 to stop the mushroom growth of medical colleges/increase of seats/starting of new courses without prior approval of the Ministry of Health and Family Welfare.

Dental Council of India

It was established under the Dentists Act, 1948 with the prime objective of regulating dental education, profes­sion and its ethics in the country.

Pharmacy Council of India

The Pharmacy council of India is a statutory body constituted under the Pharmacy Act, 1948. It is responsible for regulation and maintenance of uniform standard of training of pharmacists.

National Academy of Medical Sciences

It was established as a registered society with the objective of promoting growth of medical sciences. To keep the -medical professionals abreast with new problems and update their knowledge in those fields for the required delivery of health care, a programme of Continuing Medical Education (CME) is being implemented by the Academy since 1982. Nursing Education

The Central Health Education Bureau (CHEB) was set up in 1956 and provides up-to-date information on current issues and development in health education, besides com­munication and training.

19. National Illness Assistance Fund

It has been set up in the Ministry of Health and Family Welfare with an initial contribution of Rs. 5 crore in 1997. The Fund will provide necessary financial assistance to patients livings below poverty line, suffering from life- threatening diseases, to receive medical treatment at any of the super specialty hospitals/institution or other govern­ment/private hospitals.

All the States/UTs administration has been advised to set up an Illness Assistance Fund in the respective States/UTs.

Malnutrition in India

India is home to the largest number of hungry people in the world. The Global Hunger Index
(GHI) 2010 ranks India at 67 out of 122 countries; whereas the ‘2012 Global Hunger Index’ (IFPRI)
ranks it at 65 among 79 countries. Similarly, malnutrition in India, especially among children and
women, is widespread, acute and even alarming. As per a Global Survey Report released by Save the
Children on 19th
 July 2012, India is ranked at 112 among the 141 nations as regards child development
index (CDI). And there are disparities across various sections of the society and states.
 India has relatively too little land (only 2.5% of the world’s area) for its large population (17%
of the world’s population). However, as of now, plenty of food grains and the large number of
hungry and malnourished people coexist for want of purchasing power and distributive justice.
As per ‘The State of Food Insecurity in the World 2012’, India remains home to the largest
number of undernourished people in the world: 217 million (17.5% of its population) as of 2012.
However, the status of hunger and malnutrition in India varies according different sources/estimates,
and goes up to 67% to 77%. Nevertheless, 75% Indians suffer from hunger to varying degrees, 50% of
them acutely.
Hunger and malnutrition are, to a large extent, two sides of the same coin. The recent Global
Study referred to earlier says that 42% children in India are underweight and 58% of children are
stunted by two years of age. The findings of the HUNGaMA Survey Report are also the same except
that 59%, instead of 58%, children are stunted. Moreover, hunger and malnutrition have a distinct
gender dimension and are widespread among the women/mothers. Every second woman in India is
reported anaemic. Actually, anaemia affects 75% children below 5 years, 51% women of 15-59 years
and 87% pregnant women. More than 70% women and kids have serious nutritional deficiencies. So
it is but natural for IMR and MMR to be high. Similarly, Scheduled Tribes (STs), Scheduled Castes
(SCs) and minorities ((Muslims) are greatly disadvantaged as regards hunger and malnutrition.
Moreover, 12 of the 17 major states fall into the ‘alarming’ category, and one into the ‘extremely
alarming’ category (ISHI); these 17 states comprise 95% of the population of India. Not the least,
persisting food inflation (based on WPI), 7.8% as of 15th
 October 2012, further aggravates the
problem, especially for the poor. Poverty, gender inequality and low level of awareness are,
however, the primary/major causes of hunger and malnutrition. Due recognition of the problem of poverty and hunger is there in the government at the
highest level as aptly reflected in the excerpt from the Acceptance Speech delivered by the newly
elected President of India immediately after the oath taking ceremony on 25th
 July 2012 as follows:
“Our national mission must continue to be what it was……: to eliminate the curse of
poverty….. There is no humiliation more abusive than hunger…… We must lift those
at the bottom so that poverty is erased from the dictionary of modern India.”
Government has been responding with a number of measures to overcome hunger and
malnutrition. Lately, as per the all-inclusive National Food Security Bill, 2011, introduced in the
Parliament in December 2011 and referred to its Standing Committee, the government proposes to
assist 67% of the total (rural and urban) households/people, comprising the poor, children,
pregnant/lactating mothers, aged, widows, destitutes, disabled, etc, with food and nutritional
subsidy/support in kind and cash. However, implementation of these measures leaves much to be
done and desired.
Besides, small holder agriculture merits to be promoted for food self-reliance, employment
and income generation, poverty reduction, hunger and malnutrition eradication, and distributive
justice.
Nevertheless, in a large and diverse country like India with a federal structure facing alarming
situation with regard to widespread hunger and malnutrition, it requires social will alongside political
will and well planned participatory massive decentralized efforts from top to bottom and bottom to
top by all the stakeholders – government, rural and urban local bodies, CSOs, private sector,
professional institutions, international organizations and donors to overcome the problem and
achieve ‘zero hunger and malnutrition’ rapidly, using optimally the National Alliance Against Hunger
and Malnutrition.