512 HEALTH PROGRAMMES IN INDIA

Cancer services under national programme for prevention On 24th September 2015, Government of India notified
and control of cancer, diabetes, CVD and stroke (43) : that the rules on "tobacco pack pictorial warnings" would
1. Common diagnostic services, basic surgery, come into effect from 1st April 2016. These rules mendate
chemotherapy and palliative care for cancer cases is display of pictorial health warnings on 85 per cent of the
being made available at 100 district hospitals. principle display area of tobacco product pack on both sides
2 . Each district is being supported with Rs. 1.66 crores per (60 per cent of the picture and 25 per cent of the text).
annum for the following : National Tobacco Control Programm e (3) : In order
- Chemotherapy drugs are provided for 100 patients at to facilitate the implementation of the Tobacco Control
each district hospital. Laws, to bring about greater awareness about the harmful
- Day care chemotherapy facilities is being established effects of tobacco, and to fulfill the obligations under the
at 100 district hospitals. WHO-Framework convention on tobacco control , Govt. of
- Facility for laboratory investigations including India has launched a new National Tobacco Control
mammography is being provided at 100 district Programme in the 11th Five Year Plan. Pilot phase was
hospitals and if not available, this can be outsourced launched in 16 districts covering 9 states in 2007-08. It now
at government rates. covers 108 districts in 31 states in the country. The main
3. Home based palliative care is being provided for components of the programme are :
chronic, debilitating and progressive cancer patients at 1. Public awareness/mass media campaigns for awareness
100 districts. building and for behavioural change;
4. Support is being provided for contractual manpower 2. Establishment of tobacco product testing laboratories, to
through 1 Medical Oncologist, 1 Cytopathologist, build regulatory capacity, as required under COTPA,
1 Cytopathology technician , 2 Nurses for day care. 2003;
5. State Cancer Institutes will provide comprehensive cancer 3 . Mainstreaming the programme components as a part of
diagnosis, treatment and care services. SCI will be apex the health delivery mechanism under the NRHM
institution in the state for cancer treatment activities. framework:
6. 45 centres were to be strengthened as Tertiary Cancer 4 . Mainstream research and training on alternate crops and
Centres (TCCs) to provide comprehensive cancer care livelihood, with other nodal ministries;
services at a cost of Rs. 6.00 crore each during 2011-12. 5. Monitoring and evaluation, including surveillance, e.g.
adult tobacco survey;
TOBACCO CONTROL LEGISLATION (64) 6. Dedicated tobacco control cells for effective
implementation and monitoring of anti-tobacco initiatives;
A comprehensive tobacco control legislation titled "The 7. Training of health and social workers, NGOs school
Cigarettes and other Tobacco Products (Prohibition of teachers etc;
Advertisement and Regulation of Trade and Commerce, 8. School programme; and
Production, Supply and Distribution) Act, 2003" was passed 9. Provision of tobacco cessation facilities.
by the parliament in April. 2003 and notified in Gazette of
India on 25th Feb, 2004. The important provisons of the Act
are: I NATIONAL MENTAL HEALTH PROGRAMME
a. Prohibition of smoking in public places; The National Mental Health Programme was launched
b. Prohibition of direct and indirect advertisement of during 1982 with a view to ensure availability of Mental
cigarette and other products; Health Care Services for all, especially the community at risk
c. Prohibition of sale of cigarette and other tobacco and underprivileged section of the population, to encourage
products to a person below the age of 18 years, application of mental health knowledge in general health
d. Prohibition of sale of tobacco products near the care and social development. A National Advisory Group on
educational institutions; mental health was constituted under the Chairmanship of
the Secretary, Ministry of Health and Family Welfare for the
e. Mandatory depiction of statutory warnings (including effective implementation of the National Health Programme.
pictorial warnings) on tobacco packs; and Eleven institutions have been identified for imparting
f. Mandatory depiction of tar and nicotine contents training in basic knowledge and skills in the field of mental
alongwith maximum permissible limits on tobacco health to the primary health care physicians and para-
packs. medical personnel. At present this programme covers
The rules related to prohibition of smoking in public 517 districts in 36 states.
places came into force from the 2nd October, 2008. As per The aims of the NMHP are : (a) Prevention and treatment
rules, it is mandatory to display smoke free signages at all of mental and neurological disorders and their associated
public places. Labelling and packaging rules mandating the disabilities; (b) Use of mental health technology to improve
depiction of specified health warnings on all tobacco general health services; and (c) Application of mental health
product packs came into force from 31'1 May, 2009. principles in total national development to improve quality
On account of sustained efforts on the part of Ministry of of life (65).
Health and Family Welfare, 34 States/UTs have issued The objectives o f the programme are :
orders for implementation of the Food Safty Regulations
banning manufacture, sale and storage of gutka and pan 1. To e nsure availability and accessibility of minimum
masala containing tobacco or nicotine in the year 2014-15. me ntal health care for all in the foreseeable future ,
Besides several states/UTs have banned all forms of particularly to the most vulnerable and
smokless tobacco products such as chewing tobacco, zarda, underprivileged sections of population.
khaini and other flavoured and processed tobacco 2 . To encourage application of mental health knowledge
irrespective of name and form (6) . in general health care and in the social development.
 NATIONAL MENTAL HEALTH PROGRAMME 51
3. To promote community participation in the mental The Mental Healthcare Bill, 2013 was introduced in the
health services development, and to stimulate efforts Parliament in order to protect and promote the rights of
towards self-help in the community. persons with mental illness during the delivery of health care
in institutions and in the community and to ensure health
The programme strategies are : care, treatment and rehabilitation of persons with mental
1. Integration of mental health with primary health care illness, is provided in the least restrictive environment
through the NMHP: possible. Further, to regulate the public and private mental
2. Provision of tertiary care institutions for treatment of health sectors within a rights framework, to achieve the
mental disorders; greatest public health good and to promote principles of
3. Eradicating stigmatization of mentally ill patients and equity, efficiency and active participation of all stakeholders
protecting their rights through regulatory institutions in decision making. Suicide has been decriminalized under
like the Central Mental Health Authority, and State the Act. The bill received assent of the Hon'ble President of
Mental Health Authority. India on 07.04.2017. The Ministry has constituted a
committee of experts for formulating rules and regulations
District Mental Health Programme components are :
(a) Training programmes of all workers in the mental health under the Act.
team at the identified nodal institute in the state; (b) Public
education in mental health to increase awareness and to INTEGRATED DISEASE SURVEILLANCE
reduce stigma: (c) For early detection and treatment, the PROJECT
OPD and indoor services are provided; and (d) Providing Integrated disease surveillance project is a decentralized
valuable data and experience at the level of community to state based surveillance system in the country. This project is
the state and centre for future planning, improvement in intended to detect early warning signals of impending
service and research. outbreaks and help initiate an effective response in a timely
District Mental Health Programme has now incorporated manner in urban and rural areas. It will also provide
promotive and preventive activities for positive mental essential data to monitor progress of ongoing disease control
health which includes : programme and help allocate health resources more
- School mental health services : Life skills education in efficiently. The project was launched in Nov. 2004. It was a
schools, counselling services. 5 year project up to March 2010. The project was
- College counselling services : Through trained teachers/ restructured and extended up to March 2012. It continues in
councellors. the 12th Five Year Plan with domestic budget as integrated
Disease Surveillance Programme under National Health
- Work place stress management : Formal & Informal
sectors, including farmers, women etc. Mission for all states.
- Suicide prevention services : Counselling center at A Central Surveillance Unit (CSU) established and
district level, sensitization workshops, lEC, help lines etc. integrated in the National Centre for Disease Control, Delhi,
State Surveillance Units (SSU) at all State/UT head quarters
The National Human Rights Commission also monitors and District Surveillance Units (DSU) at all districts in the
the conditions in the mental hospitals along with the country have been established. IT network connecting 776
government of India, and the states are acting on the sites in states/district head quarters and premier institutes has
recommendations of the joint studies conducted to ensure been established with the help of National Information Centre
quality in delivery of mental care. and ISRO (Indian Space Research Organization) for data
Thrust are as (43) entry, training, video conferencing and outbreak discussions.
1. District mental health programme in an enlarged and Under the project weekly disease surveillance data on
more effective form covering the entire country. epidemic prone diseases are being collected from reporting
units such as sub-centres, PHCs, CHCs, hospitals including
2. Streamlining/modernization of mental hospitals in government and private sector hospitals and medical
order to modify their present custodial role. colleges. The data are being collected on 'S' syndromic; 'P'
3. Upgrading department of psychiatry in medical probable; and 'I.: laboratory formats using standard case
colleges and enhancing the psychiatric content of the definitions. Presently more than 90 per cent districts report
medical curriculum at the undergraduate as well as such weekly data through e-mail/portals. The weekly data
postgraduate level. are analysed by SSU/DSU for disease trends. Whenever
4. Strengthening the central and state mental health there is rising trend of illness, it is investigated by the Rapid
authorities with a permanent secretariat. Appointment Response Team to diagnose and control the outbreak. It is a
of medical officers at state headquarters in order to multi speciality team of an epidemiologist, a clinician, a
make the monitoring role more effective. microbiologist and other specialists as per requirement.
5. Research and training in the field of community The surveillance is needed to recognize cases or cluster of
mental health, substance abuse and child adolescent cases to initiate interventions to prevent transmission of
psychiatric clinics. disease or reduce morbidity and mortality; access the public
health impact of health events or determine and measure
The Mental Healthcare Act, 2017 (7) trends; demonstrate the need for public health intervention
The United Nations convention on the rights of persons programmes and resources and allocate resources during
with disabilities was ratified by the Government of India public health planning; monitor effectiveness of prevention
thus making it obligatory on the Government to align the and control measures; identify high-risk groups or
policies and laws of the country with the convention . There geographical areas to target interventions and guide analytic
was an increasing realization that persons with mental illness studies; and develop hypothesis that lead to analytic studies
constitute a vulnerable section of society and are subject to about risk factors for disease causation, propagation and
discrimination in our society. progression (66) .
5 4 HEALTH PROGRAMMES IN INDIA

In this project, different types of integration are proposed. Diarrhoea Cholera

These include : (a} Sharing of surveillance information of Jaundice Hepatitis, Laptospirosis,
disease control programmes; (b) Developing effective Dengue, Malaria,
partnership with health and non-health sectors in Yellow fever
surveillance; (c} Including non-communicable and Unusual syndromes Anthrax, Plague,
communicable diseases in the surveillance system; Emerging epidemics
(d) Effective partnership of private sector and NGOs in
surveillance activities; and (e) Bringing academic institutions The core conditions under surveillance in IDSP are as
and medical colleges into the primary public health activity follows (68) :
of disease surveillance.
(i) Regular Surveillance:
The important information in disease surveillance are - Vector borne disease Malaria
who gets the disease, how many get the disease, where did
Water borne disease Acute diarrhoeal
they get the disease, why did they get the disease, and what
needs to be done as public health response. disease (cholera)
Typhoid
The components of the surveillance activity are : Respiratory diseases Tuberculosis
(a) Collection of data Vaccine preventable diseases : Measles
(b} Compilation of data Diseases under eradication Polio
(c) Analysis and interpretation Other conditions Road traffic accidents
(Link-up with police
(d) Follow-up action computers)
(e) Feedback. Other international Plague
The prerequisite of the effective surveillance are - use of commitments
standard case definition, ensure regularity of reports and the Unusual clinical syndromes Meningoencephalitis /
action on reports. (causing death/ Respiratory distress,
hospitalization} Haemorrhagic fevers,
The classification of surveillance in IDSP is as follows : other undiagnosed
a. Syndromic diagnosis - diagnosis is made on the basis conditions
of clinical pattern by paramedical personnel and
(ii) Sentinel Surveillance:
members of the community;
Sexually transmitted HIV / HBV, HCV
b. Presumptive diagnosis - diagnosis made on typical
diseases / blood borne
history and clinical examination by medical officer;
and Other conditions Water quality
c. Confirmed diagnosis - clinical diagnosis by a medical monitoring
officer and or positive laboratory identification. Outdoor air quality
(Large urban centres}
Syndromes under surveillance (66) : (iii) Regular periodic surveys:
The paramedical health staff will undertake disease NCO risk factors Anthropometry,
surveillance based on broad categories of presentation . The Physical activity,
following clinical syndromes will be under surveillance in Blood pressure,
IDSP: Tobacco, Nutrition etc.
1. Fever: (iv) Additional state priorities:
a. Less than 7 days duration without any localizing signs Each state may identify upto five additional conditions
b. With rash for surveillance.
c. With altered sensorium or convulsions Outbreak
d . Bleeding from skin or mucus membrane In epidemiology, an outbreak is a sudden increase in
e. Fever more than 7 days with or without localizing occurrence of a disease in a particular time and place. A
signs single case of a communicable disease long absent from a
2. Cough more than 3 weeks duration population, or caused by an agent (e.g. bacterium or virus}
not previously recognized in that community or area, or
3. Acute flaccid paralysis emergence of a previously unknown disease, may also
4. Diarrhoea constitute an outbreak and should be reported and
5. Jaundice, and investigated.
6. Unusual events causing death or hospitalization. Warning signs of an impending outbreak are as
follows (67):
These syndromes are intended to pick up all priority
- Clustering of cases or deaths in time and/or space
diseases listed under regular surveillance at the level of the
community under the Integrated Disease Surveillance - Unusual increase in number of cases or deaths
Project. - Even a single case of measles, AFP, cholera, plague,
Fever with or without Malaria, Typhoid, dengue or JE
localizing signs JE, Dengue, Measles - Acute febrile illness of unknown aetiology
Cough more than 3 weeks Tuberculosis - Occurrence of two or more epidemiologically linked
Acute flaccid paralysis Polio cases of meningitis, measles
 A YUSHMAN BHARAT PROGRAMME

- Unusual isolate AYUSHMAN BHARAT PROGRAMME

Shifting in age distribution of cases
- Sudden increase/high vector density In February 2018, the Govt. of India announced two
major initiatives in health sector, with aim to cover
- Natural disasters
preventive and health promotive interventions at primary,
Summary of outbreak syndromes and trigger events for secondary and tertiary care system. They are as follows (69):
investigation (67) : 1. Health and Wellness Centre: The National Health Policy,
2017 has envisioned Health and Wellness Centers as the
Syndrome Trigger event foundation of India's health system. Under this 1.5 lakh
centers will bring health care system closer to homes of
Acute watery - A single case of severe
dehydration/death in a patient people. The health centers will provide comprehensive
stools health care, including for non-communicable diseases
> 5 years of age with diarrhoea.
and meternal and child health services. The centers
- More than 10 houses having at will also provide free essential drugs and diagnostic
least one case of loose stools services.
irrespective of age, per village or
an urban ward. 2. National Health Protection Scheme: The second flag ship
programme under Ayushman Bharat is National Health
Fever < 7 days Protection Scheme or Pradhan Mantri Jan Arogya ·
duration Yojana (PMJAY). The details are as follows (70):
(a) Only fever 5 cases in 1000 population. - 71st round of National Sample Survey Organization
(bl With rash Two similar cases in a village (NSSO) has found 85.9% of rural households and 82%
(Measles / (1000 population). of urban households have no access to healthcare
Dengue) insurance/assurance.
Two cases of fever with altered - More than 17% of Indian population spends at least 10%
(cl Altered
consciousness in the village/1000 of household budget for health services. Catastrophic
consciousness
population. healthcare related expenditure pushes families into debt.
More than 24% households in rural India and 18%
(d) Fever with Two cases of fever with bleeding in a population in urban area have met their healthcare
bleeding village or 1000 population. expenses through some sort of borrowings.
Fever with Two cases of fever with convulsions - Approximately 10. 74 crore identified families
convulsions in a village or 1000 population. (approximately 50 crore beneficiaries) will be entitled to
Fever more More than 2 cases in a village or 1000 get the benefits.
than 7 days population. - There is no cap on family size and age as well as
More than 2 cases in a village or in restriction on preexisting conditions.
Jaundice
1000 population. - PMJAY will help reduce out of pocket hospitalization
expenses, fulfill unmet needs and improve access of
Unusual event More than 2 deaths or identified families to quality inpatient care and day care
hospitalization.
surgeries.
The reporting units for disease surveillance are : - PMJAY will provide a coverage up to Rs. 5 ,00,000 per
family per year, for secondary and tertiary care
Public Health Sector Private Health Sector hospitalization through a network of Empaneled Health
Care Providers (EHCP).
Rural CHCs, District Sentinel private - The EHCP network will provide completely cashless and
hospitals practitioners. and paperless access to services for the beneficiaries at both
Sentinel hospitals. public and private hospitals. The services will include
Urban Urban hospitals, Sentinel private 1350 procedures covering pre and post hospitalization ,
ESI I Railway / nursing homes. diagnostics, medicines etc.
Medical college hospitals. sentinel hospitals, - PMJAY beneficiaries will be able to move across borders
Medical colleges, and access services across the country through the
Private and provider network seamlessly.
NGO laboratories
- The scheme is entitlement based. No formal enrolment
1. Sub-centre-health worker/ANM reports all patients process is required.
fulfilling the clinical syndrome from PHC, private - PMJAY will target poor, deprived rural families and
clinic, hospital etc. identified occupational category of urban worker's
2. PHC/CHC medical officers report as probable cases of families as per the latest Socio-Economic Caste Census
interest, where this cannot be confirmed by laboratory (SECC) 2011 data. both rural and urban. Additionally,
tests at the peripheral reporting units, and as all such enrolled families under Rashtriya Swasthya
confirmed when the laboratory information is Bima Yojna (RSBY) that do not feature in the targeted
available as in case of blood smear + ve malaria and groups as per SECC data will be include as well.
sputum AFB +ve tuberculosis. - The categories in rural and urban areas that will be
3. Sentinel private practitioners, district hospitals, covered under PMJAY are given as follows:
municipal hospitals, medical colleges, sentinel
hospitals, NGOs - medical officers report as probable For rural:
cases of interest. Total deprived Households targeted for PMRSSM who
 1 HEALTH PROGRAMMES IN INDIA

belong to one of the six deprivatio n criteria amongst

01 , 02, 03, 04, 05 and 07: NATION AL GUINEA WORM
• Only one room with kachcha walls and kachcha roof ERADIC ATION PROGRA MME
(01)
• No adult member between age 16 to 59 (02) India launched its National Guineawo rm Eradicatio n
Programm e in 1984 with technical assistance from WHO.
• Female headed household s with no adult male From the very beginning the programm e was integrated into
member between age 16 to 59 (03) the national health system at village level. With well defined
• Disabled member and no able-bodie d adult member strategies, an efficient informatio n and evaluation system,
(04) intersector al coordinati on at all levels and close collaborati on
• SC/ST household s (05) with WHO and UNICEF, India was able to significantly reduce
• Landless household s deriving major part of their the disease in affected areas. The country has reported zero
income from manual casual labour (07) cases since August 1996. In February 2000, the Internation al
Automatic ally included: Commissio n for the Certificatio n of Dracuncul iasis
Eradicatio n recommen ded that India be certified free of
• Household s without shelter dracunculi asis transmissio n (68) .
• Destitute/living on alms
The following activities are continuing as per
• Manual scavenger families recommen dations of Internation al Certificatio n Team of
• Primitive tribal groups Internation al Commissio n for Certificatio n of Dracuncul iasis
• Legally released bonded labour Eradicatio n, Geneva :
For Urban: a. Health education activities with special emphasis on
Occupatio nal categories of workers school children and women in rural areas;
• Rag picker b. Rumour registration and rumour investigati on ;
• Beggar c. Maintenan ce of guinea-wo rm disease on list of
• Domestic worker notifiable disease and continuati on of surveillanc e in
previously infected areas; and
• Street vendor/co bbler/ hawker/oth er service provider
working on streets d . Careful supervisio n of the functioning of hand pumps
and other sources of safe drinking water, and
• Constructi on worker/plu mber/maso n/labour/p ainter/ provision of additional units, wherever necessary.
welder/ security guard
• Coolie and other head-load worker YAWS ERADIC ATION PROGRA MME (9)
• Sweeper/s anitation worker/mali
• Home-bas ed worker/art isan/handi crafts worker/tai lor The disease has been reported in India from the tribal
• Transport worker/ driver/ conductor/ helper to drivers communiti es living in hilly forest and difficult to reach areas
and conductors/ cart puller/ rickshaw puller in 49 districts of 10 states, namely Andhra Pradesh, Assam,
Chhattisga rh , Gujarat, Jharkhand , Madhya Pradesh,
• Shop worker/ assistant/ peon in small establishm ent/ Maharasht ra, Orissa, Tamil Nadu and Uttar Pradesh.
helper/deli very assistant/ attendant/ waiter National Institute of Communic able Diseases is the nodal
• Electrician/ mechanic/ assembler/ repair worker agency for planning, guidance, coordinati on , monitoring
• Washer-m an/ chowkidar and evaluation of the programm e. The programm e is
As per the SECC 2011 , the following beneficiari es are implement ed by the State Health Directorate s of Yaws
automatica lly excluded: endemic states utilizing existing health care delivery system
with the coordinati on and collaborat ion of departmen t of
- Household s having motorized 2/3/4 wheeler/fishing boat tribal welfare and other related institutions .
- Household s having mechanize d 3/4 wheeler agricultura l
The number of reported cases has come down from more
equipmen t
than 3 ,500 to Nil during the period from 1996 to 2004,
- Household s having Kisan Credit Card with credit limit
since then no new case has been reported.
above Rs. 50,000/-
- Household member is a governmen t employee
NATION AL PROGRA MME FOR CONTRO L AND
- Household s with non-agricu ltural enterprises registered
TREATMENT OF OCCUPA TIONAL DISEAS ES
with Governme nt
- Any member of household earning more than Governme nt of India launched a scheme called "National
Rs. 10,000/- per month Programm e for Control and Treatment of Occupatio nal
- Household s paying income tax Diseases" in 1998-99. The National Institute of
- Household s paying profession al tax Occupatio nal Health , Ahmedaba d (ICMR) has been
- House with three or more rooms with pucca walls and identified as the nodal agency for this programm e.
roof The following research projects have been proposed by
- Owns a refrigerato r the governmen t (71) :
- Owns a landline phone 1. Prevention , control and treatment of silicosis and
- Owns more than 2 .5 acres of irrigated land with silica-tube rculosis in agate industry;
1 irrigation equipment 2 . Occupatio nal health problems of tobacco harvesters
- Owns 5 acres of more of irrigated land for two or more and their prevention ;
crop season 3 . Hazardous process and chemicals, database
- Owning at least 7 .5 acres of land or more with at least ge ne ration, documenta tion, and informatio n
one irrigation equipment . disseminat ion;
 NATIONAL WATER SUPPLY AND SANITATION PROGRAMME 1'Z
4. Capacity building to promote research, education , including better hygiene practices and encouraging water
and training at National Institute of Occupational conservation practices along with rainwater harvesting.
Disease; Swajaldhara has two components : Swajaldhara I (First
5. Health Risk Assessment and development of Ohara) is for a gram panchayat or a group of panchayats (at
intervention programme in cottage industries with block / tahsil level) and Swajaldhara II (Second Ohara) has
high risk of silicosis; and district as the project area. District water and sanitation
6. Prevention and control of occupational health hazards mission sanctions swajaldhara I. The panchayats and
among salt workers in the remote desert areas of communities have the power to plan, implement, operate,
Gujarat and Western Rajasthan. maintain and manage all water supply and sanitation
schemes. There is an integrated service delivery mechanism,
NUTRITIONAL PROGRAMME taking up conservation measures through rain water
harvesting and ground water recharge systems for sustained
Please refer to chapter 11 , for details. drinking water supply and shifting the role of government
from direct service delivery to that of planning, policy
NATIONAL FAMILY WELFARE PROGRAMME formulation , monitoring and evaluation and partial financial
See chapter 9 page 568 for details. support. On completion of the project, gram panchayat or
village water and sanitation committee manages the project.
NATIONAL WATER SUPPLY AND The programme was revised from 1st April 2009 and
SANITATION PROGRAMME named as National Rural Drinking Water Programme (60). It
is now a component of Bharat Nirman which focuses on the
The National Water Supply and Sanitation Programme creation of rural infrastructure.
was initiated in 1954 with the object of providing safe water
supply and adequate drainage facilities for the entire urban Bharat Nirman
and rural population of the country. In 1972 a special Bharat Nirman was launched by the Government of India
programme known as the Accelerated Rural Wate r in 2005 as a programme to build rural infrastructure. While
Supply Progra mme was started as a supplement to the phase-I was implemented in the period of 2005- 06 to
national water supply and sanitation programme. Inspite of 2008-09, the phase-II was implemented from 2009-10 to
increased financial outlay during the successive Five Year 2011-12. At the beginning of phase-I period, priority was
Plans, only a small dent was made on the overall problem. given to cover water quality problem and other
During the Fifth Plan, rural water supply was included in the contaminants, e .g. , arsenic and fluoride affected habitations
Minimum Needs Programme of the State Plans. The Central followed by iron , salinity, nitrate.
Government is supporting the efforts of the States in
identifying problem villages through assistance under New initiatives in 12th Five Year Plan
Accelerated Rural Water Supply Programme. A "prob/em 1. In order to raise coverage of piped water supply, toilet
village" has been defined as one where no source of safe coverage and strengthening of institutions and systems in
water is available within a distance of 1.6 km, or where water rural drinking water and rural sanitation sectors the
is available at a depth of more than 15 metres, or where water Ministry has proposed a Rural Water Supply and
source has excess salinity, iron, fluorides and other toxic Sanitation Project for low income states;
elements, or where water is exposed to the risk of cholera.
2. Enhancement of service levels for rural water supply
The stipulated norm of water supply is 40 litres of from the norm of 40 lpcd to 55 lpcd for designing of
safe water per capita per day, and at least one hand system. The target being at least 50 per cent of rural
pump/spot-source for every 250 persons. Information, population in the country to have access to water within
education and communication is an integral part of rural their household premises or within 100 metres radius,
sanitation programme to adopt proper environmental with at least 30 per cent having individual household
sanitation practices including disposal of garbage, refuse and connections, as against 13 per cent today (74).
waste water, and to convert all existing dry latrines into low
cost sanitary latrines. The priority is to evolve financially Rural Sanitation Programme (74)
viable sewerage systems in big cities and important pilgrimage
and tourist centres and recycling of treated effluents for Nirmal Bharat Abhiyan (NBA)
horticulture, irrigation and other non-domestic purposes (72) . In 2012, a paradigm shift was made in the Total
The programme was subsequently renamed as the Sanitation Campaign, by launching the Nirmal Bharat
Rajiv Gandhi National Drinking Water Mission in 1991. In Abhiyan , in the 12th Five Year Plan . The objective of NBA is
1999-2000, Sector Reform Project was started to involve to achieve sustainable behavioural change with provision of
the community in planning. implementation and sanitary facilities in entire communities in a phased manner,
management of drinking water schemes which was in 2002 saturation mode with "Nirmal Grams" as outcomes.
scaled up as the Swajaldhara Programme.
Swachh Bharat Mission
Swajaldhara (73) Swachh Bharat Abhiyan or Swachh Bharat Mission is a
Swajaldhara was launched on 25th Dec. 2002. national campaign by the government of India to clean
Swajaldhara has certain fundamental reform principles, streets, roads and infrastructure of the country. The
which need to be adhered to by the state governments and campaign was officially launched by Prime Minister of India
the implementing agencies. Swajaldhara is a community led on 2nd Oct, 2014, at Rajghat, New Delhi. It aims to
participatory programme, which aims at providing safe eradicate open defecation by year 2019, by constructing 12
drinking water in rural areas, with full ownership of the million toilets in rural India. Mission has two sub-missions ,
community, building awareness among the village namely, Swachh Bharat Mission Urban. and Swachh Bharat
community on the management of drinking water projects , Mission Gramin .
518 HEALTH PROGRAMMES IN INDIA

Swachh Bharat Mission Gramin (SBM-G) (75) Mission components

The Mission in rural India will mean improving the level The Mission has the following components :
of cleanliness in rural areas through solid and liquid waste
1. Household toilets, including conversion of insanitary
management and making gram panchayats free of open latrines into pour-flush latrines;
defecation, clean and sanitized. The programme includes
the key components of earlier sanitation schemes. 2. Community toilets;
The key objectives of the programme are as follows: 3 . Public toilets;
(a) Bring about an improvement in the general quality of life 4. Solid waste management;
in the rural areas, by promoting cleanliness, hygiene and 5. IEC & public awareness; and
eliminating open defecation; 6 . Capacity building and administrative & office expenses.
(b) Accelerate sanitation coverage in rural area to achieve By Public Toilets, it is implied that these are to be
the vision of Swachh Bharat by 2nd October 2019; provided for the floating population/ general public in places
(c) Motivate Communities and Panchayati Raj Institutions to such as markets, train station, tourist places, near office
adopt sustainable sanitation practices and facilities complexes, or other public areas where there are
through awareness creation and health education; considerable number of people passing by.
(d) Encourage cost effective and appropriate technologies By Community Toilets, it is implied that a shared facility
for ecologically safe and sustainable sanitation; and provided by and for a group of residents or an entire
settlement. Community toilet blocks are used primarily in
(e) Develop wherever required, community managed
low-income and/or informal settlements / slums, where
sanitation systems focusing on scientific solid & liquid space and/or land are constraints in providing a household
waste management systems for overall cleanliness in the toilet, These are for a more or less fixed user group.
rural areas.
All statutory towns will be covered under the mission. The
The key components of SBM-G include, start up activities special focus group under the mission are as follows:
including preparation of state plan; construction of
household toilets; construction of community sanitary i. All manual scavengers in urban areas are identified,
complexes; and capacity building of functionaries etc. Under insanitary toilets linked to their employment are
the programme, construction of toilets in government upgraded to sanitary toilets, and the manual scavengers
schools and anganwadi centres will be done by the Ministry are adequately rehabilitated;
of Human Resource Development and Ministry of Women ii. In their efforts to streamline and formalize SWM systems
and Child Development respectively. Rural School sanitation it shall be the endeavor of ULBs that the informal sector
focusing on separate toilets for girls and boys is a major workers in waste management' (rag pickers) are given
intervention which shall be implemented under the priority to upgrade their work conditions and are
programmes of the Department of School Education. enumerated and integrated into the formal system of
SWM in cities;
A duly completed household sanitary toilet shall comprise
iii. All temporary accommodation for migrants and the
of toilet unit including a substructure which is sanitary (that homeless in urban areas have adequate provision for
safely confines human faeces and eliminates the need of toilets either on the premises or linked to a public/
human handling before it is fully decomposed), a super community toilet;
structure, with water facility and hand wash unit for cleaning
and hand washing. The Mission aims that all rural families iv. Mandating that construction labour in urban areas have
have access to toilets. Incentives for construction of access to temporary toilets at all sites in urban areas,
household toilets will be available for below poverty line buildings, parks and roads where construction /
maintenance work is taking place or where construction
households, and above poverty line households restricted to
labour is temporarily housed; and
SCs/STs, small and marginal farmers, landless labourers,
physically handicapped and women headed families. v. Priority shall be accorded pro-actively to cover
households with vulnerable sections such as pensioners,
Swachh Bharat Mission-Urban (76) girl children, pregnant and lactating mothers.
Swachh Bharat Mission- Urban (SBM-U) is being Household toilet component of SBM-Urban
implemented by Ministry of Urban Development. The main
objectives of the mission are as follows: SBM (Urban) aims to ensure that -
1. Elimination of open defecation ;
(a) No households engage in the practice of open
defecation;
2 . Eradication of manual scavenging; (b) No new insanitary toilets are constructed during the
3. Modern and scientific municipal solid waste mission period; and
management; (c) Pit latrines are converted to sanitary latrines.
4. To effect behavioural change regarding healthy The target group for construction of household units of
sanitation practices; toilets, thus, is:
5. Generate awareness about sanitation and its linkage with (i) 80% of urban households engaging in open defecation;
public health ; (ii) All house holds with insanitary latrines; and
6. Capacity augmentation for ULB's; and (iii)All households with single-pit latrines.
7. To create an e nabling e nvironment for private sector These will be targeted under this component for the
participation in Capex (capital expenditure) and Opex construction of household toilets or individual household
(operation and maintenance). latrines during the mission period. The remaining 20% of
 REFERENCES

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a . Rural Health 17. Rural roads
b . Rural Water Supply 18. Energization of rural area
c. Rural Electrification 19. Development of backward areas
d. Elementary Education 20. IT enabled E-Governance
e. Adult Education
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f. Nutrition
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g. Environmental improvement of Urban Slums
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h. Houses for landless labourers
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 Millennium Development Goals
8 to Sustainable Development Goals
"Sabka sath, Sabka uikas"

burden of premature mortality, despite the fact that the vast

THE MILLENNIUM DEVELOPMENT GOALS majority of these deaths are preventable. Rates of maternal
mortality are 19 times higher in developing countries than in
I n September 2000, the UN General Assembly adopted developed countries and children in developing countries
the Millennium Declaration, establishing a global are 8 times more likely to die before they reach five years of
partnership of countries and development partners age (1). Despite substantial progress on maternal and child
committed to eight voluntary development goals, to be mortality neither MDG 4 nor MDG 5 targets were met. The
achieved by 2015. Representing ambitious moral and global under five mortalty rate reduced by 53 per cent
practical commitments, the MDGs called for action to: between 1990 and 2015, short of the targeted two thirds
(1) eradicate extreme poverty and hunger; (2) achieve reduction and the global maternal mortality ratio declined
universal primary education; (3) promote gender equality by 44 per cent, well short of the targeted 75 per cent fall.
and empower women; (4) reduce child mortality; The least developing countries continue to face the greatest
(5) improve maternal health; (6) combat HIV/AIDS, malaria challenges in improving maternal and child health,
and other diseases; (7) ensure environmental sustainability; struggling with a combination of poor coverage and quality
and (8) develop a global partnership for development. Three of health care services and public health interventions,
of the eight MDGs are focused on health, while health is also inadequate water and sanitation , poor infrastructure, low
a component of several other MDGs (nutrition, water and food security and limited education and economic
sanitation) (1). opportunity. These same countries also face obstacles in
ensuring universal access to sexual and reproductive health
The MDGs have been more influential than any other services, as well as guarding the health of adolescents, the
attempt at international target setting in the field of challenges that are shared by most world regions (1).
development. The rapid acceleration of global progress Maternal mortality is the second leading cause of death
towards the poverty reduction, gender, health and education among women aged 15-49 years, after HIV. Globally women
goals since 2000, and particularly since 2005 , is just one face a 1 in 180 lifetime risk of dying due to maternal causes,
example of their beneficial impact. The adoption of a
which are dominated by haemorrhage, hypertensive
simple, clear and time-bound framework that is compelling,
disorder, sepsis and abortion. In African region, however. the
easy to communicate and measurable has been one of the
MMR is still running at 540 per 100,000 live births, which
MDGs' great strengths, encouraging donor governments,
international agencies and country decision-makers to focus combined with the high level of fertility, translates into
attention on areas of need, and to measure the results of life-time risk of dying from maternal causes at 1 in 37 (1) .
initiatives undertaken. And while it is hard to isolate specific The target of achieving universal access to reproductive
casual effects, it seems reasonable to suppose that the health (MDG 5.B) was only added to MDG 5 in the year
intensity of focus (and investment) has been a key driver of 2007, but some progress has been made. MDG 5.B included
innovation, enabling the scale-up of new interventions, such four specific indicators : adolescent birth rate; antenatal care
as antiretroviral therapy (ART), long-lasting insecticidal nets visits; contraceptive prevalence rate; and unmet need for
(LL!Ns), artemisinin-based combination therapies (ACTs), family planning. Improvement in these areas are expected to
vaccines against pneumonia and diarrhoeal disease, and reduce maternal mortality since high fertility rates are
new and better diagnostic tests for multiple diseases. correlated with an increased life- time risk of dying from
maternal causes. Based on the current projections, the
Health in the MDG : achievements adolescent birth rate reduced from 59 births per 1000
Progress towards the MDGs has, on the whole, been women age 15-49 years in 1990 to 51 per 1000 women in
remarkable. With regard to extreme poverty, for example. 2015. Decline in the adolescent birth rate was greater in
the number of people living on less than US$ 1.25 per day developed countries (50 per cent) than in developing
has declined by more than half. from 1.9 billion in 1990 to countries (13 per cent). However, Southern Asia had an
836 million in 2015. Similarly, the proportion of impressive 47 per cent decline. With regard to
undernourished people in the developing regions has fallen recommended four or more antenatal visits, coverage in
from 23% in 1990-1992 to 13% in 2014-2016. The child developing regions nearly doubled, increasing from 31 per
undernutrition indicator target has almost been met (1). cent in 1990 to 60 per cent in 2013. Skilled birth attendance
Deaths among pregnant women. children and coverage also increased in East Asia. Pacific and Latin
adolescents account for more than one third of the global America. About 9 in 10 births now occur in health facilities.
522 MILLENNIUM DEVELOPMENT GOALS TO SUSTAINABLE DEVELOPMENT GOALS

In contrast South Asia and sub-Saharan Africa; where the remains unfinished agenda to complete work on the health
burden of maternal and newborn deaths is highest, only MDGs. These unfinished agenda is reflected in the
about 45 per cent and 46 per cent respectively are delivered Sustainable Development Goals (1).
in health facilities (1). Table 1 shows the detailed information regarding the
Despite population growth in developing regions , the indicators of health related MDGs in India, i.e. the baseline
number of deaths of children under 5 has declined from (1990) and current level data.
12.7 million in 1990 to almost 6 million in 2015 globally.
The measles vaccination helped to prevent nearly 15.6 TABLE 1
million deaths between 2000 and 2013. The number of Health-related Millennium Development Goals in India
reported measles cases also declined by 67 per cent for the
same period. The major causes of newborn mortality in Indicator Year India
2015 are prematurity, birth related complications and Goal 1 : Eradicate extreme poverty and hunger
neonatal sepsis while leading causes of child death in post Target 2 : Halue, between 1990 ond 2015,
neonatal period are pneumonia, diarrhoea, injuries and the proportion of people who suffer from hunger
malaria, which calls for efforts to ensure that all children Gl.T2.14 - Prevalence of underweight children 1990 53.4
have access to early childhood developmental care. Pre- (under-five years of age) 2015-16 33.7
primary education is likely to have an impact on child Gl.T2.15 - Proportion (%) of population below 1991 25
mortality. while improving child's chances of living. minimum level of dietary energy consumption 2011 17.5
As regards to Goal 6 - new HIV infection has reduced by
Goal 4 : Reduce child mortality
approximately 40 per cent between 2000 and 2014, from an
Target 5 : Reduce by two-thirds, between 1990
estimated 3.5 million cases to 2.1 million by 2014, 14.9
and 2015, the under-fiue mortality rate
million people living with HIV were receiving ART globally, an
G4.T5.113 - Under-five mortality rate 1990 112.0
emmense increase from just 800,000 in 2003. ART averted
(probability of dying between birth and age 5) 2015 47.7
7.6 million deaths from AIDS between 1995 and 2003.
G4.T5.114 • Infant mortality rate 1990 80.0
Over 6.2 million malaria deaths have been averted 2015 38.0
between 2000 and 2015, primarily of children under 5 years G4.T5.115 •Proportion(%) of 1 year-old 1990 32.7
of age in sub-Saharan Africa. The global malaria incidence children immunized for measles 2015 83.0
rate has fallen by an estimated 37 per cent and the mortality
rate by 58 per cent. More than 68 per cent children under 5 Goal 5 : Improve maternal health
years of age in sub-Saharan Africa were sleeping under !TN Target 6 : Reduce by three-quarters, between 1990
in 2015 as compared to 2 per cent in 2000 (1). and 2015, the maternal mortality ratio
G5.T6.116 • Maternal mortality ratio 1990 420
TB case detection rate increased from 38 per cent to
2015 167
68 per cent, while maintaining high levels of treatment
success (85 per cent or higher) since 2007 (1 , 2). G5.T6.117 • Proportion (%) of births attended 1990 89/36
by skilled health personnel 2010- 15 52.0
The spread of infectious diseases is affected by multiple Target B
socio-economic, environmental, and ecological factors as well
Contraceptive prevalence rate 1990 NA
as rapidly increasing antimicrobiological resistance . Infectious 2010-15 55
disease outbreak remains a concern to all countries, imposing Adolescent birth rate 1990 NA
a significant burden on economies and public health. Several 2013 31.5
respiratory infectious disease outbreaks have occurred since
Antenatal care coverage (3 or more) 1990 NA
2000, including the 2003 SARS epidemic and 2009 A (H 1N 1) 2006-13 50
influenza virus pandemic. Cholera is endemic in many
Unmet need for family planning 1990 NA
countries. Most recently the outbreak of Ebola virus disease in
2006- 2013 21.0
West Africa resulted in over 28000 cases and more than 11295
deaths (as of 23'd September 2015) causing considerable Goal 6 : Combat HIV/AIDS , Malaria and other diseases
concern across the globe. Target 7 : Haue halted by 2015, and begun to reuerse,
the spread of HIV/AIDS
As regards Goal 7 - The world has now met the target
relating to access to safe drinking water. In 2012, 90 per cent G6.T7.118 - HIV prevalence among young people
of the population used an improved source of drinking water 15-24 years age group % 1990 NA
compared to 76 per cent in 1990. H owever, progress has 2012 (M) 0.1
been uneven across different regions, between urban and 2012 (F) 0.1
rural areas and between rich and poor. With regard to basic 15-49 years age group 2012 0.1
sanitation, current rate of progress is too slow for the MDG G6.T7.119 - Condom use in high risk population 1990 NA
target to be met globally. In 2012 , 2.5 billion people did not 2008-12 (M) 32
have access to improved sanitation facility with 1 billion of 2008-12 (F) 17
these people still practicing open defaecation. The number G6.T7.120 - Ratio of children 1990 NA
of people living in urban areas without access to improved orphaned/non-orphaned in schools 2008- 12 72
sanitation is increasing because of rapid growth in the size of Target 8 : Haue halted by 2015, and begun to reuerse
urban population (3). the Incidence of malaria and other major diseases
G6.T8.121 - Malaria death rate per 100,000 in 1990 NA
It is generally agreed that the MDGs have been a success. children (0-4 years of age) 2006- 2010 8
They have been more influential and achieved wider public
G6.T8. l21 - Malaria death rate per 100,000 1990 NA
recognition than any other attempt of international target (all ages) 2012 2.3
setting in the field of development. However. there remain
G6.T8.121 • Malaria incidence rate per 100,000 1990 NA
several targets where progress has been limited and there
2012 1538
 SUSTAINABLE DEVELOPMENT GOALS 523
Indicator Year India They recognize that ending poverty must go hand-in-hand
with strategies that build economic growth and addresses a
G6.T8.122 - Proportion (%) of 1990 NA range of social needs including education, health, social
population in malaria risk areas
using insecticide-treated bed nets protection. raising basic standard of living, job
opportunities, while tackling climate changes and
G6.T8.122 - Proportion (%) of population 1990 NA
under age 5 with fever being treated
environmental protection. The five Ps of the new agenda are
with anti-malarial drugs 2006-2012 8 people, planet, prosperity, peace and partnership.
G6.T8.123 - Tuberculosis death 1990 NA The sustainable development has been defined as
rate per 100,000 2013 19 '·development that meets the needs of the present without
G6.T8.123 - Tuberculosis prevalence 1990 NA comprom.ising the ability of future generations to meet their
rate per 100,000 2013 211 own needs" (4). Implementation of SDGs and the success
G6.T8.l24 - Proportion (%) of smear-positive 1990 NA will rely on countries sustainable development policies,
pulmonary tuberculosis cases detected and put under plans and programmes. It will require resource mobilization
directly observed treatment short course (DOTS) 2012 64 and financing strategies. All stakeholders : governments,
G6.T8.124 - Proportion (%) of smear-positive 1990 NA civil societies, the private sector, and others are expected to
pulmonary tuberculosis cases detected cured under 2012 88 contribute to the realization of the new agenda.
directly observed treatment short course (DOTS)
The 2030 Agenda is designed to benefit all. Universal in
Goal 7 : Ensure environmental sustainability scope, the agenda will require a comprehensive, integrated
Target 9: Integrate the principles of sustainable approach to sustain development, as well as collective
deuelopment into country policies and programmes action at all levels. "Leaving no one behind" will be an
and reuerse the loss of enuironmental resources overarching theme. The paragraph 26 of the 2030 agenda
G 7.T9 .129 - Proportion (%) of population 1990 NA addresses health as follows :
using biomass fuels 2013 64 "To promote physical and mental health and well-being,
Target 10 : Halue, by 2015, the proportion of people and to extend life expectancy for all, we must achieve
without sustainable access to safe drinking water universal health coverage and access to quality health
G7 .Tl0.130 - Proportion (%) of population 1990 61 care. No one must be left behind. We commit to
with sustainable access to an improved 2011 87 accelerating the progress made to date in reducing
water source, rural newborn, child and maternal mortality by ending all
G7.T10.130 - Proportion(%) of population 1990 88 such preventable deaths before 2030. We are
with sustainable access to an improved 2012 93 committed to ensuring universal access to sexual and
water source, urban reproductive health-care services, including for family
Target 11 : By 2020 to haue achieued a significant improuement planning, information and education. We will equally
in the liues of at least 100 mi/lion slum dwellers accelerate the pace of progress made in fighting
G7.Tl 1.131 - Proportion (%) of urban 1990 44 malaria. HIV/AIDS, tuberculosis, hepatitis, Ebola and
population with access to improved sanitation 2011 60 other communicable diseases and epidemics, including
by addressing growing anti-microbial resistance and the
Goal 8 : Develop global partne rship for developme nt problem of unattended diseases affecting developing
Target 17 : In cooperation with pharmaceutical companies, prouide countries. We are committed to the prevention and
access to affordable, essential drugs in deueloping countries treatment of non-communicable diseases, including
GB.Tl 7.146 - Proportion(%) of 1990 NA behavioural, developmental and neurological disorders,
population with access to affordable 1997 80 which constitute a major challenge for sustainable
essential drugs on a sustainable basis development" (1).
Goal (G), Target (T). Indicator (I), Health is centrally positioned within the 2030 Agenda,
(Goals 2 & 3 are not pertaining to health)
with one comprehensive goal - SDG 3 : Ensure healthy lives
and promote well-being for all ages. Goal 3 includes 13
SUSTAINABLE DEVELOPMENT GOALS targets covering all major health priorities with four targets
on the unfinished and expended millennium development
In December 2015 , the Millennium Development Goals goals. four targets to address non-communicable diseases,
(MDGs) came to the end of their term, and a post-2015 mental health, injuries and environmental issues and four
Agenda, comprising of 17 Sustainable Development Goals "means-of-implementation" targets. The Universal Health
(SDGs) takes their place. World stands at the threshold of a Coverage (UHC) is the key to achievement of all targets and
new era as on 1st January 2016, the SDGs of the 2030 development of strong resilient health system. The SDGs are
Agenda for Sustainable Development officially came into not solely focused on developing countries. Thus, while
force . While progress towards the MDGs has been some targets and indicators may be more relevant for
impressive in many ways, much work remains to be done. In developing countries, SDG monitoring should in principle
health , unpresedented progress has been made in reducing cover all.
maternal and child mortality and in the fight against Even though the 2030 Agenda referes several times to the
infectious diseases; even though several global and country term ·'human right(s)" (right to development, self
MDG targets are not met. The dramatic progress of MDGs determination, an adequate standard of living, food , water
paves the way for more ambitious achievements by 2030. and sanitation, good governance and the rule of law) , it does
Notable among them are the challenges of acute epidemic not specifically mention that health is a human right (1).
d iseases, d isasters, conflict situations, the newly spreading
epidemic of noncommunicable diseases, mental health Table 2 enumerates the 13 targets of goal 3 with their
disorders, and large inequalities in all parts of the world. The proposed indicators. It shows that millennium development
new goals are unique in that they call for action by all goals on maternal mortality (3.1) child mortality (3.2) and
countries to promote prosperity while protecting the planet. infectious diseases (3.3) have been retained in SDG
524 MILLENNIUM DEVELOPMENT GOALS TO SUSTAINABLE DEVELOPMENT GOALS

TABLE 2
Sustainable Development Goal 3 : Ensure healthy lives and promote well-being for all at all ages.
Goal and targets from the 2030 Agenda Indicator
3.1
- - - - - - - - -------
By 2030, reduce the global maternal mortality ratio to less 3.1.1 Maternal deaths per 100,000 live births.
than 70 per 100,000 live births Global-216. lndia- 130 (2014- 16)
3.1.2 Proportion of births attended by skilled health personnel.
Global- 73, lndia-81 4 (2007-17)
3.2 By 2030, end preventable deaths of newborns and children 3.2.1 Under-5 mortality rate (deaths per 1,000 live births)
under 5 years of age, with a ll countries aiming to reduce Global-40.8. lndia-47.7 (2016)
neonatal mortality to at least as low as 12 per 1.000 live births 3.2.2 Neonatal mortality rate (deaths per 1,000 live births)
and under-5 mortality to at least as low as 25 per 1.000 live births. Global-18.6, lndia-25.4 (2016)
3.3 By 2030, end the epidemics of AIDS. tuberculosis, malaria and 3 .3 .1 Number of new HIV infections per 1,000 uninfected population
negelected tropical diseases and combat hepatitis. water-borne (by age group, sex and key populations).
diseases and other communicable diseases. Global- 0.25%, lndia- 0.06% (2016)
3.3.2 Tuberculosis incidence per 1,000 persons per year.
Global-140, lndia-211 (2016)
3.3.3 Malaria incident cases per 1,000 persons per year.
Global-90.8, lndia-18.8 (2016)
3.3.4 Number of new hepatitis B infections per 100,000 population in a
given year. The indicator used is infants receiving three doses of
hepatitis B vaccine %
Global-82 , lndia-70 (2014)
3.3.5 Number of people requiring interventions against
neglected tropical diseases.
Global- 1499.735 million, lndia-458.855 million (2016)
3.4 By 2030, reduce by one third premature mortality from 3.4.1 Mortality of cardiovasular disease. cancer, diabetes or
non-communicable diseases through prevention and treatment chronic respiratory disease.
and promote mental health and well-being. 3.4.2 Suicide mortality rate. Global-10.6. lndia-16.3 (2016)
3.5 Strengthen the prevention and treatment of substance abuse, 3.5.l Coverage of treatment interventions (pharmacological.
including narcotic drug abuse and harmful use of alcohol. psychosocial and rehabilitation and aftercare services)
for substance use disorders.
3 .5.2 Harmful use of alcohol, defined according to the national context
as alcohol per capita consumption (aged 15 years and older) withi
a calendar year in litres of pure alcohol.
Global-6.4, India-5.7 (2016)
3.6 By 2020, halve the number of global deaths and injuries from 3.6.1 Number of road traffic fatal injury deaths within 30 days,
road traffic accidents. per 100,000 population (age-standardized)
Global- 17.4. lndia-16.6 (2013)
3 .7 By 2030, ensure universal access to sexual and reproductive 3 .7.1 Percentage of women of reproductive age (aged 15-49) who have
health-care services, including for family planning, information their need for family planning satisfied with modern methods.
and education, and the integration of reproductive health into Global-77.4, lndia-72 (2007-17)
national strategies and programmes. 3.7.2 Adolescent birth rate (aged 10-14; aged 15- 19) per 1,000 women
in that age group. Global-43.9. lndia- 28.l (2007-17)
3.8 Achieve universal health coverage, including financial risk 3.8.1 Coverage of tracer interventions (e .g. child full immunization,
protection. access to quality essential health-care services and antiretroviral therapy, tuberculosis treatment. hypertension
access to safe, effective. quality and affordable essential medicines treatment. skilled attendant at birth, etc.)
and vaccines for all. 3.8.2 Fraction of the population protected against catasrrophic;
impoverishing out-of-pocket health expenditure
3.9 By 2030, substantially reduce the number of deaths and illnesses 3.9.1 Mortality rate attributed to household and ambient air pollution
from hazardous chemicals and air, water and soil per lac population. Global-114.1 , lndia-184 .5 (2016)
pollution and contamination. 3 .9.2 Mortality rate attributed to hazardous chemicals. water and soil
pollution and contamination per lac popu lation.
Global-11.7, India 187 (2016)
3.a Strengthen the implementation of the World Health Organization 3.a.l Age-standardized prevalence of current tobacco use
Framework Convention on Tobacco Control in all countries, among persons aged 15 years and older %.
as appropriate. Global- India-male-20.6, female- 1.9 (2016)
3.b Support the research and development of vaccines and medicines 3 .b. 1 Proportion of the population with access to affordable
for the communicable and non-communicable diseases that medicines and vaccines on a sustainable basis.
primarily affect developing countries. provide access to affordable 3 .b.2 Total net official development assistance to the med ical
essential medicines and vaccines. in accordance with the Doha research and basic health sectors.
Declaration on the TRIPS Agreement and Public Health, which
affirms the right of developing countries to use to the full the
provisions in the Agreement on Trade-Related Aspects of
Intellectual Property Rights regarding flexibil ities to protect public
health , and , in particular, provide access to medicines for all .
3.c Substantially increase health financing and the recruitment, 3.c.1. Health worker density and distribution per 10,000 population.
development, training and retention of the health workforce in Global-25 , lndia- 30.2 (2006-13)
developing countries, especially in least developed countries and
small island developing states.
3.d Strengthen the capacity of all countries, in particular developing 3.d.l Percentage of attributes of 13 core capacities that have been
countries, for early warning, risk reduction and management of attained at a specific point in time .
national and global health risks. Global-71, India-95 (2010-1 7)
The indicato r shows Global a nd Indian data .
Source : (4, 5, 7, 8 )
framework and expanded to include neonatal mortality and
SUSTAINABLE DEVELOPMENT GOALS

health-relate d and should be given special attention in

525 J
more infectious diseases such as hepatitis and waterborne strategies, policies and plans to achieve the health goal and
diseases. The target on access to sexual and reproductive in monitoring progress. Table 3 shows the targets in other
health care services (3. 7) and access to vaccines and goals linked to health SDG 3.
medicines (3.b) are also closely related to MDG targets.
At the global level the SDGs will be monitored and
Sexual and reproductive rights are addressed under MDG 5
on gender equality. The SDGs include new targets on non- reviewed using a set of global indicators developed by the
communicab le diseases and mental health (3.4). substance Inter Agency and Expert Group on SDG Indicators. The
abuse (3.5). injuries (3.6), health impact from hazardous governments will also develop their own national indicators
chemicals, water and soil pollution and contaminatio n (3.9), to assist in monitoring progress made on the goals and
and the implementat ion of the WHO framework convention targets.
on tobacco control (3.a). Target 3.d addresses reducing and Almost all targets of goal 3 can be linked to strategies and
managing national and global health risks, health financing global action plans that have been adopted by World Health
and health workforce issue in least developed countries and Assembly in recent years or are under developmen t.
small island developing states are addressed by target 3.c. However, there are few gaps, e.g., there is no mention of
Universal health care (UHC) is also a new target (3.8), which immunizatio n coverage as a specific target although it is
provides an overall framework for the implementat ion of a integral to the achievement of at least four targets that are
broad and ambitious agenda in all countries. UHC is the listed. Access to sexual and reproductive health care is
only target that cuts across all targets of health goal, as well included, but sexual and reproductive rights, violence and
as linked to health-relate d targets in other goals (1). discriminatio n against women and girls are dealt with
Health is linked to many of the non-health goals, elsewhere (goal 5), older people are mentioned in goal 2.
reflecting the fact that health affects and in turn is affected The aging population as an important implication for health
by many economic, social and environment al determinant s. system is absent except indirectly through its impact on non-
More than a dozen targets in other goals can be considered communicab le diseases and mental health.

TABLE 3
Examples of targets in other goals
linked to the health SDG 3
substantial
1.3 Implement nationally appropriate social protection systems and measures for all, including floors. and by 2030 achieve
coverage of the poor and the vulnerable.
wasting in
2.2 By 2030, end all forms of malnutrition, including achieving, by 2025. the internationally agreed targets on stunting and
older persons
children under five years of age, and address the nutritional needs of adolescent girls. pregnant and lactating women and

14.2 By 2030, ensure that all girls and boys have access to quality early childhood development. care and pre-primary education
are ready for primary education.
so that they 1•

inclusive and
Build and upgrade education facilities that are child. disability and gender sensitive and provide safe. non-violent.
14.a effective learning environments for all. ,
and other
5.2 Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual
types of exploitation.
I5.3 Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation.
Programme of
5.6 Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the
the outcome
Action of the International Conference on Population and Development and the Beijing Platform for Action and
documents of their review conferences
6.1 By 2030, achieve universal and equitable access to safe and affordable drinking water to all.
attention to
6.2 By 2030. achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special
the needs of women and girls and those in vulnerable situations.
and
6.3 By 2030, improve water quality by reducing pollution. eliminating dumping and minimizing release of hazardous chemicals
materials. halving the proportion of untreated wastewater and substantially increasing recycling and safe reuse globally.

10.4 Adopt policies. especially fiscal, wage and social protection policies. and progressively achieve greater equality.
economic
11.5 By 2030, significantly reduce the number of deaths and the number of people affected and substantially decrease the direct
protecting the
losses relative to global gross domestic product caused by disasters. including water-related disasters, with a focus on
poor and people in vulnerable situations.
16.1 Significantly reduce all forms of violence and related death rates everywhere
16.2 End abuse, exploitation, trafficking and all forms of violence against and torture of children.
Develop effective accountable and transparent institutions at all levels.
116.6

t
16.9 By 2030, provide legal identity for all, including birth registration.
small island
By 2020, enhance capacity-build ing support to developing countries, including for least-develope d countries and
to increase significantly the availability of high-quality, timely and reliable data disaggregated by income. gender,
developing states,
age. race. ethnicity, migratory status. disability. geographic location and other characteristics relevant in national contexts
Source : (1)
526 MILLENNIUM DEVELOPMENT GOALS TO SUSTAINABLE DEVELOPMENT GOALS

Fig. 1 presents these targets in a way that distinguishes TABLE 4

those that have been carried forward and enhanced from Selected SDG targets and proposed indicators
the MDGs, those that have been added and those that are linked to reproductive, maternal. newborn and
means of implementations. child health, by type of indicator
Reproductive, maternal, newbo rn and child Type of SDG Proposed indicator
health Indicator target
,__ - - ---- -- -- - - -
Multiple targets in SDG 3 and other goals refer to Impact 3 .1 Maternal mortality
reproductive, maternal, newborn and child health · 3 .2 Under-five mortality
(RMNCH). These include targets for mortality, service 3 .2 Neonatal mortality
coverage, risk factors and health determinants (Table 4). 3. 7 Adolescent birth rate
The global strategy for Women's, Children's and
3.9 Mortality due to unsafe water, sanitation
Adolescent's Health, 2016-2030 is fully aligned with the and hygiene;
SDG target and is organized around the broad themes of Mortality due to air pollution (household
"Survive-Thrive-Transform". It is an example of how a range and ambient)
of health and health-related goals and targets must be Coverage 3.1 Births attended by skilled health
addressed to improve health and well-being of women, personnel
children and adolescents. 3 .7 Family planning coverage
New in the SDGs is the emphasis on youth as a 3 .8 UHC:RMNCH 3 tracers (family planning,
vulnerable population . Though , generally a healthy group, antenatal and delivery care. full
adolescents are exposed to a range of risks and diseases. As immunization coverage. health-seeking
many health behaviours established during adolescence behaviour for suspected child pneumonia)
have profound effect over rest of the life course, they are a 37 (22) Model life table systems
population deserving more concerted attention. Globally, Risk factors, 2.2 Child stunting. child wasting, child
road injuries, HIV/AIDS and self-harm are the leading determinants overweight
causes of adolescent death. 6 1 Access to safely managed drinking-water
Reproductive, maternal, newborn and child health is one source
of the four categories of the universal health coverage 6.2 Access to safely managed sanitation
indicators: fami ly planning. antenatal care (four visits or 7 .1 Clean household energy
more) with skilled attendance at birth; full child 11.6 Ambient air pollution
immunization coverage and health-seeking behaviour for
Other Part of targets in goals on poverty,
suspected child pneumonia. The indicator for SDG target education, Qender etc.
2.2 on ending all forms of malnutrition are focused on
stunting,. wasting and overweight among children under 5 RMNCH - reproductive, maternal. newborn and child health
years of age. Children are at greater risk of stunting if they UHC - Universal health care.
are born in rural areas, poor household or to mothers Source : (4)

Target 3.8 : Achieve universal health coverage, including financial risk protection, access to
quality essential health-care services, medicines and vaccines for all.

MDG unfinished SDG 3 means of

and expanded agenda New SDG 3 targets
1mphlmentntion targets
r.=-----'== ~==---'===..
3 .1 : Reduce maternal mortality. 3.4 : Reduce mortality from NCDs and 3.a : Strengthen implementation of
3.2 : End preventable newborn and promote mental health. framework convention on tobacco
child deaths. 3.5 : Strengthen prevention and control
3.3 : End the epidemics of AIDS, TB, treatment of substance abuse. 3.b Provide accesss to medicines and
malaria and NTDs. 3.6 : Halve global deaths and injuries vaccines for all, support R&D of
and combat hepatitis. waterborne from road traffic accidents. vaccines and medicines for all.
and other communicable diseases. 3 .9 · Reduce deaths and illnesses from 3.c : Increase health financing and
3.7 Ensure universal access to sexual hazardous chemicals and air, health workforce in developing
and reproductive health-care water and so il pollution and countries.
services. contamination. 3.d : Strengthen capacity for early
warning, risk reduction and
management of health risks.

Interactions with Economic, other Social and Environmental SDGs and SDG 17 on Means of Implementation.

FIG. 1
Framework for the SDG health goal and targets.
Source : (1)
 SUSTAINABL E DEVELOPME NT GOALS 52
denied basic education. Several environment al targets and TABLE 6
indicators are also relevant to this group. They include water Summary of specific targets in global plans and
and sanitation, and air pollution (causes for diarrhoea and other internationa l agreements for
pneumonia in under 5 age group). SDG Target 3 3 on infectious diseases
Infectious diseases Specific plan-main targets 2030

The main target relating to infectious diseases is SDG 3.3, Ending the Reduce the annual number newly infected with HIV
which refers to ending the epidemic of AIDS, tuberculosis, epidemic by 90% and the annual number of people dying
of AIDS from AIDS-related causes by 80%
malaria and neglected tropical diseases, and combating (compared with 2010)
hepatitis, water-borne diseases and other communicab le
Ending the 90% reduction in TB deaths
diseases. Table 5 shows the selected targets and proposed epidemic 80% reduction in TB incidence rate (to less than 20
indicators linked to infectious diseases by type of indicator. of TB per 100.000 population)
The SDG targets for infectious diseases are very ambitious, Zero TB-affected families facing catastrophic costs
due to TB
but are in line with what a number of disease-specific strategies
and World Health Assembly resolutions have already been
exploring. For all infectious diseases, the targeted reductions
I
Ending th e
epidemic
of malaria
90% reduction in global malaria mortality rate
90% reduction in global malaria case incidence
Malaria eliminated from at least 35 countries
aimed at progressing towards elimination goals in the coming Re-establishm ent of malaria prevented in all
15 years far outstrip what has been achieved since 2000. countries identified as malaria-free
New strategies include (1) : Ending the 90% reduction in the number of people requiring
epidemic interventions against NTDs
- UNAIDS global strategy fast track: Ending the AIDS of NTDs
epidemic by 2030 and the draft WHO Global Health
Sector Strategy on HIV 2016-2021;
The End TB strategy;
I
Control
hepatitis
95% decline m new cases of chronic HBV infection
between 2010 and 2030: 80% reduction in new
cases of chronic HCV infection over the same
period: 65% reduction in HBV- and HCV-related
Global technical strategy for Malaria 2016- 2030; deaths.
NTD roadmap, and water sanitation and hygiene for Combat No one practices open defecation (by 2025)
accelerating and sustaining progress on NTDs : A Water- Everyone uses a basic drinking-wate r supply and
global strategy 2015-2020: and borne handwashing facilities at home
Draft global health sector strategy on viral hepatitis diseases Everyone uses adequate sanitation when at home
(by 2040)
2016-2021. All drinking-wate r supply, sanitation and hygiene
TABLE 5 services are delivered in progressively affordable,
Selected SDG targets and proposed indicators linked to accountable and financially and environmenta lly
infectious d iseases. by type of indicator sustainable manner
Source : (1)
Type of SDG Proposed indicator
indicator target The battle against infectious diseases need to focus on the
Impact 3.3 HIV incidence preventive efforts complement ed by rapid diagnosis and
effective treatment. A number of common strategic priorities
Tuberculosis incidence
3.3
can be identified for all infectious diseases. Importance of
3.3 Malaria incidence new drugs and vaccines to combat infectious diseases;
3.3 Hepatitis B incidence behavioural changes such as safe sex and condom use to
3.3 People requiring interventions against reduce HIV, STD and hepatitis B transmission ; harm
neglected tropical diseases reduction for people who inject drugs to prevent HIV, HBV
3.9 Mortality due to unsafe water. sanitation and HCV acquisition; use of insecticide treated nets for
and hygiene: mortality due to air malaria prevention; and improved health-care safty to
pollution (household and ambient) reduce nosocomial transmission of HIV, hepatitis and other
Coverage/ 3.8 UHC : infectious diseases tracer (ART pathogens. Preventive chemotherap y based on large-scale
system coverage. tuberculosis treatment. use of delivery of free, safe. single-dose. quality-assur ed medicines
insecticide-treated nets, access to safely at regular intervals is a cornerstone of tackling neglected
managed drinking-wate r source and tropical diseases. Child vaccination is a priority
sanitaiton) intervention to combat hepatitis B, and rotavirus vaccination
3 .d International Health Regulations (IHR) to reduce the incidence of diarrhoea. For other diseases,
capacity and health emergency continued investment in the developmen t of vaccines are
preparedness needed which may pay off in the coming 15 years.
Risk factors. 6.1 Access to safely managed drinking-wate r
determinants source Noncomm unicable diseases and mental health
6.2 Access to safely managed sanitation As shown in Table 7, unlike the MDGs, the SDGs include
7.1 Clean household energy. a specific target for noncommun icable diseases (NCDs) and
Other Part of targets in goals on poverty, several NCO-related targets. Target 3 .4 calls for a one third
education. cities, climate change etc. reduction in premature mortality from NCDs by 2030, and is
an extension of the global voluntary NCO mortality target. It
Source : (4)
defines premature NCO mortality as the probability of dying
The strategies and related documents have proposed a from any of the main NCDs between the age 30 and 70
number of more specific targets and indicators for years. Other targets include : Target 3.a on improvemen ts in
monitoring progress towards the goals, linked to the overall tobacco control; target 3 .5 on substance abuse. including
SDG target as shown in Table 6 . harmful use of alcohol along with mental health; target 3 .b
 MILLENN IUM DEVELOPMENT GOALS TO SUSTAINABLE DEVELOPMENT GOALS

on supportin g research and developm ent of vaccines and 9 . An 80% availability of the affordabl e basic technolog ies
medicine s for NCDs that primarily affect developi ng and essential medicine s, including generics, required to
countries , as well as providing access to affordabl e essential treat major NCDs in both public and private facilities.
medicine s and vaccines for NCDs; and target 3 .9 on deaths
and illnesses related to hazardou s chemical s, as well as air, Mental disorder occurs in all regions and cultures of the
water and soil pollution and contamin ation. Finally 3 .8 world. The most prevalen t being depressio n and anxiety,
target addresse s universal health care which has implication which are estimated to affect nearly one in 10 people. At its
for a wide range of NCO- related promotio n, preventio n and worst, depressio n can lead to suicide. Globally, among
treatmen t intervent ions (4) . young adults aged 15-29 years, suicide accounts for 8 .5 per
cent of all deaths and is second leading cause of death in
TABLE 7 this group after road traffic injuries (4) .
Selected SDG targets a nd proposed indicator s
linked to noncomm unicable diseases a nd Substanc e use and substanc e-use-dis order including the
mental health, by type of ind icator harmful use of alcohol cause a significan t public health
burden. Worldwide alcohol consump tion in 2015 was
Type of SDG Proposed indicator estimated to be 6 .3 litres of pure alcohol per person aged 15
indicator
---- --
target years or older. Tobacco use is a leading risk factor for NCDs
--- - ----
Impact 3.4 NCD mortality and SDG 3.a addresse s the impleme ntation of the WHO
3.4 Suicide mortality Framewo rk Conventi on on Tobacco Control: with tobacco
use selected as an indicator of progress. In 2015, over 1.1
3.9 Mortality due to air pollution (househol d
and ambient)
billion people used tobacco (4) .
Coverage. 3.8 UHC: NCDs tracers (hypertens ion Air pollution is a major risk factor for NCDs causing
risk factors treatment coverage diabetes treatment cardiova scular diseases, stroke, chronic obstructi ve
coverage, cervical cancer screening; pulmona ry disease and lung cancer as well as increasing the
tobacco use) risk of acute respirato ry infections. In 2012, ambient air
3.a Tobacco use pollution (from traffic, industrial sources, waste burning or
3.5 Substance abuse (harmful use of alcohol) residentia l fuel combusti on) caused 3 million deaths. Target
Risk factors 7.1 Clean household energy 11 .6 focuses on urban environm ental risk and includes an
determina nts indicator on the annual mean level of the particula te matter
11.6 Ambient air pollution
such as PM 2.5 and PMl0 in cities.
Other Part of targets in goals on poverty.
education , cities, etc. Injuries and v iolence
So urce : (4)
Unlike the MDGs, injuries and violence are included in
Lack of awarenes s and late detection is an issue with all multiple SDGs targets. Road traffic mJunes and
leading NCDs and it is essential to support and d evelop unintenti onal injuries are included in the health goal with
primary health-ca re services required for their early detection targets related to violence and disasters as part of other
and managem ent. An integrate d approach to NCO care is more goals as shown in Table 8 .
effective, e .g.. the monitorin g of blood pressure status should
be integrate d with monitorin g of blood cholester ol and blood TABLE 8
sugar. The preventio n of heart attacks and strokes through a Selected SDG targets and proposed indicator s linked to
"total cardiovas cular risk approach " is more cost-effective than injuries and violence, by type of indicator
treatmen t based on individual risk factor thresholds only, and Type of SDG Proposed indicator
should be part of the basic package of UHC. indicator target
The SDG targets for NCDs is based on previous UN and Impact 3.6 Deaths due to road traffic injuries
WHO declarati ons that provide strategic direction s. In the
3.9 Mortality due to unintentio nal poisoning
year 2014 the UN General Assembly adopted Outcome
Documen t on NCDs with national targets for 2025. Of these 1.5. Deaths due to disasters
11.5, 13.1
targets first target is closely linked to SDG target 3.4. The
16.1 Homicide
Global Voluntary Indicator s are as follows (1):
16.1 Conflict-related deaths
1. A 25% re lative reduction in the risk of prematur e
Coverage/ 5.2 Women and girls subjected to
mortality from CVD, cancer, diabetes or CRD; risk factorsl physical; sexual or physiological
2. AT least 10% relative reduction in the harmful use of determina nts violence
alcohol; 16.1 Population subjected to physical. sexual
3 . A 10% relative reduction in prevalen ce of insufficient or physiological violence
physical activity; Other Part of targets in goals on peaceful and
4. A 30% relative reduction in mean populatio n intake of inclusive societies, cities, poverty.
salt/sodiu m; education . etc.
5. A 30% relative reduction in prevalen ce of current Source: (4)
tobacco use;
6. A 25% relative reduction in the prevalen ce of raised Injuries sustained accidenta lly or as a result of intention al
act of violence, kill more than 5 million people worldwid e
blood pressure;
annually. It accounts for 9 per cent of global mortality.
7. Halt the rise in diabetes and obesity; The leading cause of injury deaths is road traffic injury,
8. At least 50% of eligible people receive drug therapy and followed by suicide, fall and interpers onal violence. Other
counselli ng (including glycaemi c control) to prevent importan t cause of injuries include drowning , fires and
heart attacks and strokes; and burns, poisonin g, war and conflict and natural disasters .
 SUSTAINABLE DEVELOPMENT GOALS 529
Each year about 1.25 million people die from road traffic associated with aid-spending. The SDGs in the words of
injuries and another 20-50 million people sustain non-fatal declaration are •'integrated and indivisible, global in nature
injuries as a result of road traffic collisions or crashes. Road and universally applicable·•. It is relevant to all countries and
traffic injuries are among the top 10 causes of deaths not just about developing countries.
globally and the le ading cause of death for people in 15-29 While MDGs were about limited set of human
years age group. Homicide and collective violence accounts development targets, the SDGs cover the economic
for around 10 percent of global injury related death . Four- environmental and social pillars of sustainable development
fifths of homicide victims are men and 60 percent of victims with strong focus on equity; expressed more frequently in
are of 15-44 years age group (1). the phrase "no one will be left behind".
A proposed indicator for SDG target 16. 1 is conflict death Several health targets follow on from the unfinished MDG
per lac population . In 2015, it is provisionally estimated that agenda and many are derived from World Health Assembly
152,000 people were killed in wars and conflicts resolutions and related Action Plans (1) .
corresponding to about 0 .3 per cent of global deaths (4). '
India and Sustainable Development Goals (6)
Health system
As the MDGs reached their December 2015 deadline, the
Health system strengthening is a core focus of the SDGs.
new set of Sustainable Development Goals were being
This is reflected by the fact that universal health care (UHC)
adapted by India also. There is now a remarkable
is central to the overall health goal as set out in SDG
convergence of vision underlying the priorities for the
declaration and is assigned a special target (3.8). In order to
proposed SDGs and those of the new government in India.
move towards the UHC goal, country health system needs to
Building on the MDGs, the SDGs propose to end poverty
be strengthened as well as adapted to meet the shifting
and deprivation in all forms, leaving no one behind, while
health priorities associated with demographic and
making development economically, socially and
epidemiological transition, rapidly developing technologies
environmentally sustainable. The government of India has
and changing public expectations. Table 9 shows the targets
also adopted the principle of Sabka Sath Sabka Vikas
and indicators linked to health system .
("together with all, development for all") , with pledge that
TABLE 9 the first claim on development belong to the poor. The
Selected SDG targets and proposed indicators linked to government is calling for improved sanitation, health
health systems, by type of indicator education, financial inclusion, security and dignity for all,
especially women. The priority is improving environmental
Type of SDG Proposed indicator
development with respect to water, air, soil and biosphere by
indicator target
- ---
UHC index: tracer indicators on service
treating challenges of climate change adaptation as an
Coverage/ 3.8 opportunity rather than a problem.
financial access (hospital access, health workforce
protection density by specific cadres, access to India can progress towards sustainable development in
medicines and vaccines, IHR capacities) health if health is high on the national and state agenda.
3.8 UHC: financial protection (catastrophic and This requires high political committment. India should invest
impoverishing out-of-pocket health spending) in public health and finish agenda through further
System 3.b Access to medicines and vaccines improvement in maternal and child health , confronting
3.b Research and development on health issues neglected tropical diseases, eliminating malaria, AIDS and
that primarily affect developing countries, hepatitis and increasing the fight against TB. For all these
including official development assistance (ODA) challenges. the programmes and interventions need to give
3.c Health workforce density and distribution quality services, wi th implementation of universal health
3.d IHR capacity and health emergency care. India needs to built robust health system in all aspects
preparedness and strengthen both the urban and rural components, with
17.18 Data disaggregation primary health care at its centre. More involvement of
____
17.19 Coverage of birth and death registration,
completion of regular population census. _,
private health sector is vital. India needs to develop a strong
system for monitoring, evaluation and accountability.
Source : (4) The goal of sustainable development cannot be achieved
Access to affordable medicines and vaccines on a globally without India, and the world will be watching how
sustainable basis is an indicator to SDG target 3.b which India will implement its new strategic directives.
focuses on support for research and development and on the
affordability of medicines and vaccines for communicable References
diseases and non-communicable diseases that primarily 1. WHO (2015), Health in 2015 from MDGs (Millennium Deuelopment
affect developing countries. A second indicator under SDG Goals) to SDGs (Sustainable Deuelopment Goals} .
2. WHO (2015), The Millennium Deuelopment Goals Report 2015.
target 3.b aims to capture the level of research and
3. WHO (2015), Fact Sheet No. 290, May 2015 .
development investments. 4 WHO (2016) , World Health Statistics, 2016, Monitoring Health for the
The transition from MDGs to SDGs cannot be seen solely SDGs.
as exchange of a short list of goals and targets for a longer 5. United Nations (2015). Social and Economic Council (Dec. 2015),
one. The SDGs are fundamentally different to the MDGs, as Report of the Inter-Agency and Expert Group on Sustainable
Deuelopment Goal Indicators.
is the political context in which they have been developed, 6. UN-India (2015), India and the MDGs: Towards a Sustainable Future
and as in which they will be implemented. The MDGs had a for All.
consistent and more or less singular purpose. They were 7. WHO (2018). World Health Statistics, 2018, Monitoring Health for the
about the achievement of improved human development SDGs.
outcome (primarily in terms of poverty, education and 8. Govt. of India (2018). National Health Profile 2018. Ministry of Health
health) in developing countries. They were closely and Family Welfare, New Delhi.
 I

Demo graph y and

9 Famil y Plann ing
"Delay the first, postpone the second and prevent the third"

D emography, as understood today, is the scientific study (5) FIFTH STAGE : (Declining)
of human population . It focuses its attention on three readily
observable human phenomena : (a) changes in population The population begins to decline because birth rate is
size (growth or decline); (b) the composition of the lower than the death rate. Some East European countries,
population; and (c) the distribution of population in space. It notably Germany and Hungary are experiencing this stage.
deals with five "demograph ic processes", namely fertility,
mortality, marriage, migration and social mobility. These WORLD POPULATION TRENDS
five processes are continuously at work within a population
determining size, composition and distribution . At the beginning of the Christian era, nearly 2,000 years
ago, world population was estimated to be around
Community medicine is vitally concerned with population , 250 million. Subsequent estimates of the world population,
because health in the group depends upon the dynamic and rates of increase are given in Table 1.
relationship between the numbers of people, the space which
they occupy and the skill that they have acquired in providing TABLE 1
for their needs. The main sources of demographi c statistics in World population
India are population censuses, National Sample Surveys,
registration of vital events, and adhoc demographic studies. Population Average annual growth
Year
- -
(million) rate (per cent)
Demograp hic cycle 1750 791 -
The history of world population since 1650 suggests that 1800 978 0.4
there is a demographi c cycle of 5 stages through which a 1850 1,262 0.5
nation passes: 1900 1.650 0.6
1950 2.526 11
(1) FIRST STAGE (High stationary) 1960 3,037 1.79
This stage is characterize d by a high birth rate and a high 1970 3.696 1 92
death rate which cancel each other and the population 1975 4,066 1.89
remains stationary. India was in this stage till 1920. 1980 4,432 1 72
1987 5.000 1 63
(2) SECOND STAGE (Early expanding) 1991 5.385 17
The death rate begins to decline, while the birth rate 1998 5,884 1.6
remains unchanged . Many countries in South Asia, and 2000 6,054 1.4
Africa are in this phase. Birth rates have increased in some 2003 6,3 13 1.1
of these countries possibly as a result of improved health 2007 6.655 14
conditions, and shortening periods of breast-feedin g (1) . 2008 6,734 1.2
2010 6,908 1.23
(3) THIRD STAGE (Late expanding) 2014 7,238 12
The death rate declines still further, and the birth rate 2016 7.418 1.2
tends to fall. The population continues to grow because 2018 7.621 1.2
births exceed deaths. India has entered this phase . In a
number of developing countries (e.g., China, Singapore) It required all the human history up to the year 1800 for
birth rates have declined rapidly. the world population to reach one billion. The second billion
came in 130 years (around 1930), the third billion in 30
(4) FOURTH STAGE (Low stationary) years (around 1960), the fourth billion in 15 years (in 1974),
This stage is characterize d by a low birth and low death the fifth billion in 12 years (in 1987), and the sixth billion in
rate with the result that the population becomes stationary. 12 years (1999). On October 12th 1999 world population
Zero population growth has already been recorded in became 6 billion. The 7th billion came in 2014 (after 15
Austria during 1980- 85. Growth rates as little as 0.1 were years) . It is expected to reach 8 billion by 2025 (2) .
recorded in UK, Denmark, Sweden and Belgium during About three fourths of the world's population lives in the
1980-85. In short, most industrialized countries have developing countries. The population of the ten most
undergone a demographi c transition shifting from a high populous countries of the world and their relative share is
birth and high death rates to low birth and low death rates. shown in Fig. 1. Although, in terms of population USA ranks
 WORLD POPULATION TRENDS 531
Birth and death rates
U.S.A.
327
The glaring contrasts in birth and death rates in selected
India countries are as shown in Table 3 .
1359
TABLE 3
Indonesia Birth and death rates in selected developed and
267 developing cou ntries in mid 2018
Country Birth rate Death rate
.__
India 20 6
Bangladesh 19 5
Pakistan 26 7
China
1417 Sri Lanka 16 6
Brazil Thailand 11 8
211
Myanmar 16 8
Pakistan y Nepal 20 6

'j I _ _ _ ._ _.
202 China 12 7
Japan 8 11

"""\~3F,d Singapore
UK
9
12
5
9
USA 12 8
Bangladesh
167 Source : (3)
Japan
127 Nigeria The world's birth rate fell below 30 for the first time around
197 1975 and had declined to about 19 during mid 2018 (3). In
Population in million most of the world the decline reflected falling birth rates and a
global trend towards smaller families . The outstanding
FIG . 1 examples are Singapore and Thailand . In Singapore, in 40
Ten most populous countries of the world (mid-2018) years, the birth rate fell from 23 per thousand in 1970 to 12 in
Source : (3) 2018; and, in Thailand from 37 to 11 during the same period.
TABLE 4
third in the world after India, there is a yawning gap of Reduction in the birth a nd death rates in
1032 million between the population of these two countries. selected countries. 1990- mid 2018
The United Nations has estimated that world's population
grew at an annual rate of 1.23 per cent during 2000-2010. Birth rate Death rate
Country
China registered a much lower annual growth rate of
population (0.6 per cent) during 2002-2012, as compared
1990
35
2018
19
1990
10
2018
5
-
to India (1.4 per cent) . In fact, the growth rate of China is Bangladesh
Nepal 38 20 13 6
now very much comparable to that of USA (0.9 per cent).
India 31 20 11 6
Three countries of SEAR, i.e. India (1359 million), Sri Lanka 21 16 7 6
Indonesia (267 million) and Bangladesh (167 million) are Thailand 19 11 8 8
among the most populous ten countries of the world . At Singapore 18 9 5 5
present India's population is second to that of China. China 23 12 8 7
According to UN projections India's population will reach Pakistan 40 26 11 7
1.53 billion by the year 2050, and will be the highest
population country in the world. The trend of population Source : (3)
increase in South East Asia Region countries is as shown in In all these countries, key factors in fertility decline
Table 2. included changes in government attitudes towards growth,
the spread of education, increased availability of
TABLE 2 contraceptio n and the exte nsion of services offered through
Tre nds in increase of populatio n o f SEAR countries family planning programmes , as well as the marked change
(in million) in marriage patterns.
I
1991 mid 2018 Death rates have also declined worldwide over the last
Country
decades . The global death rate declined from 11.0 (betwee n
India 843.9 1,359.8 1975-1980) to 7 per thousand population during 2018, a
Bangladesh 118 167 04 reduction of 23 per cent. The decline in the death rate of the
Bhutan 1.5 0.820 South-East Asia Region has been more marke d , from 14.1
187.7 267.9 to 7 .0 p e r 1000 popula tion.
Indonesia
Maldives 0 221 0.447 In countries with a relative young population, crude
Myanmar 42 5 54.04 death rates are mainly affected by infant and child mortality.
19.6 29.75 With improvemen t in maternal and child health services,
Nepal successful imple mentation of the expanded programme on
Sri Lanka 17.4 20.97
immunizatio n, diarrhoeal disease and acute respiratory
Thailand 56.4 66.2 infection control programmes , a s well a s with the control of
Source : (3, 4) other infectious diseases, there has been marked reduction
[ 5~3~2~ __..:::D:.:::E.:.:.:M..:::O..:::G:.:..:R:...:AP:...:H..:..Y:...:..::AN:...::D:::....:....FA:...::M:....:.:::ILY:.:....:...P.=LA:..:.:N..:.:N..:.:l.:...:N.=G_ _ _ _ __ _ _ __ _ __ _ __ _ _ __ _ _ __

in infant and child mortality rates , which are reflected in the The global population clock for the year 2016 is as follows:
declining crude death rates.
World More Less
Growth rates developed developed
countries countries
When the crude death rate is substracted from the crude
Population 7,418,151 ,841 1.254,309,821 6 ,163,842,020
birth rate, the net residual is the current annual growth rate,
exclusive of migration. The relation between the growth rate Year 147,183.065 13,714,857 138,468.215
Births per Day 403,241 37,575 365,666
and population increase is as shown in Table 5.
Minute 280 26 254
TABLE 5 Year 57,387.752 12.580,616 44,807,108
Relation between growth rate and population Deaths per Day 157,227 34,467 122,759
Minute 109 24 85
Number of years Natural Year 89,795,313 1, 134.242 88,661,107
Annual rate of required for the increase Day 246,015 3, 108 242,907
Rating
population to per Minute 171 2 169
growth%
double in size Infant Year 5,226,233 65,229 5 .160,998
deaths Day 14,318 179 14,140
Stationary population No growth
per Minute 10 0.1 10
Slow growth Less than 0.5 More than 139
Moderate growth 0.5 to 1.0 139- 70
Rapid growth 1.0 to 1.5 70-47
DEMOGRAPHIC TRENDS IN INDIA
Very rapid growth 1.5 to 2.0 47-35
.. Explosive .. growth 2.0 to 2 .5 35-28 Demographic indicators
- -..- - 2.5 to 3.0 28-23 Demographic characteristics provide an overview of its
---- --- n
3.0 to 3.5 23-20 population size, composition, territorial distribution,
3.5 to 4.0 20-18 changes therein and the components of changes such as
Source : (5) nativity, mortality and social mobility. Demographic
indicators have been divided into two parts - population
It is said that population growth rates, like railway trains, statistics and vital statistics.
are subject to momentum. They start slowly and gain Population statistics include indicators that measure the
momentum. Once in motion, it takes time to bring the population size, sex ratio, density and dependency ratio.
momentum under control. In case of the train the control
factors are mass and inertia; in population, they are age Vital statistics include indicators such as birth rate, death
distribution , marriage customs and numerous cultural, social rate, natural growth rate, life expectancy at birth, mortality
and economic factors. and fertility rates.
The world population growth rate was at, or near its These indicators help in identifying areas that need policy
peak, around 1970, when the human population grew by an and programmed interventions, setting near and far-term
estimated 1.92 per cent. The most recent data show a slight goals and deciding priorities, besides understanding them in
decline since then to 1.2 per cent in 2018. an integrated structure.
The growth rate is not uniform in the world. There are With a population of 1,359 million in the year mid 2018,
many countries in the world (e.g. , European countries) India is the second most populous country in the world, next
where the growth rate is less than 0.3 per cent per year. In only to China, whereas seventh in land area. With only
developing countries, the growth rates are excessive - it is 2.4 per cent of the world's land area, India is supporting
around 2.6 per cent in Africa, 1.1 per cent in Latin America, about 17.5 per cent of the world's population. The
0.3 per cent in Europe and industrialized countries, and population of India since 1901, average annual exponential
1.3 per cent in Asia. A population growing at 0.5 per cent growth rate (%), and the decadal growth of population (%)
per year will double in about 140 years, a population is as shown in Table 6.
growing at 3 per cent per year will double in about 20- 25 TABLE 6
years (Table 5). These differences in growth rates are largely Population of India. 1901 2011 (As per census)
the result of fertility and mortality patterns. The salient
features of population growth at a glance are as follows: Total Average Decadal
Year population annual growth rate
• Approximately 95 per cent of this growth is occurring (in million) exponential (%)
in the developing countries. growth rate (%)
• Currently, one-third of the world's population is under
the age of 15, and will soon enter the reproductive
1901 238.4 - -
1911 252.1 0.56 0.75
bracket, giving more potential for population growth. 1921 251.3 (-)0.03 (-)0.31
• The UNFPA estimates that world population is most 193 1 279.0 1.04 11.00
likely to reach 10 billion people by 2050, and 1941 318.7 1.33 14.22
20. 7 billion a century later. 1951 361.1 1.25 13.31
• The expected number of births per women, at current 1961 439.2 1.96 21.64
fertility rates (2016) is : for industrialized countries 1971 548.2 2 .20 24.80
1.6, developing countries 2.8 and for least developed 1981 683.3 2.22 24.66
countries 4.2. The global total fertility rate is 2.4. 1991 846.4 2 . 16 23.87
The rampant population growth has been viewed as the 2001 1.028.6 1.7 21.52
greatest obstacle to the economic and social advancement of 2011 1,210.1 1.64 17.64
the majority of people in the underdeveloped world. Source : (6)