Introduction || Planning Commission
Chapter-1 || 2 || 3 || 4 || 5 || 6 || 7 || 8 || 9 || 10 || 11 || 12 || 13 || 14 || 15 || 16 || 17 || 18 || 19 || 20 || 21 || 22 || 23 || 24 || 25 || 26 || 27 || 28 || 29 || 30 || 31 || 32 || 33 || 34 || 35 || Conclusion || Appendix A || Appendix B || Appendix C || Glossary

Chapter 32:
HEALTH AND FAMILY PLANNING

The broad objective of the health and family planning programmes in the Third Plan is to expand health services, to bring about progressive improvement in the health of the people by ensuring a certain minimum of physical well-being and to create conditions favourable to greater efficiency and productivity. Increased emphasis will be laid on preventive public health services. As in the Second Plan, specific programmes have been formulated for the Third Plan for improvement of environmental sanitation, specially rural and urban water supply. control of communicable diseases, organisation of institutional facilities for providing health services and for the training of medical and health personnel, and provision of services such as maternal and child welfare, health education and nutrition. The Third Plan also accords very high priority to family planning.

2. As against outlays of Rs. 140 and Rs. 225 crores in the First and Second Plans respectively, programmes in the Third Plan involve a total outlay of about Rs. 342 crores, about Rs. 297 crores being in the States and the rest at the Centre. These amounts are distributed undei-difl'erent heads as follows :

Table 1 : Distribution of outlay
(Rs. crores.)

HEALTH

Progress And Programmes

3. During the past ten years, substantial progress has been made in various health programmes, and in several directions there have been notable advances. Measures adopted for ihe control of malaria have resulted in marked decline in the incidence of the disease. In 1958, in place of control, the programme of complete eradication of malaria was adopted. In controlling other communicable diseases like filaria, tuberculosis, leprosy and venereal diseases also appreciable progress has been made. The number of hospitals and dispensaries has increased from 8600 in 1950-51 to 12,600 in 1960-61 and of beds from 113,000 to 185,600. A basic type of health organisation providing an integrated preventive and curative service hw been established in 2800 development blocks with a population of about 200 million. At the end of the Second Plan, there were 78 institutions teaching indigenous systems of medicine, their annual intake being 1375. Facilities according to the indigenous systems arc at present available in 98 hospitals and 5372 dispensaries with a total bed strength of 2462. About 664 schemes of urban water supply and drainage entailing a total cost of Rs. 112 crores have been completed or are in progress. In addition to schemes of rural water supply implemented under the programmes for community development, locsil development works and welfare of backward classes, about 228 schemes with an estimated cost of Rs. 20 crores have been taken up under the Hcahh programme.

4. Statistics concerning birth and death rates arc subject to serious limitations, and for the period subsequent to 1951 only rough estimates can be made. Nevertheless, the following Table indicates in broad terms steady improvernent in Ihc health of the population:

Table 2 : Birth rates, death rates and expectation of life—1941-61

5. Although there has been considerable development in the field of health and in the related services, at the end of the Second Plan, certain dencicndcs were specially marked. Thus. in relation to needs the institutional facilities were quite inadequate, specially in the rural areas. Doctors were not evenly distributed

HEALTH: FIRST AND SECOND PLAN ACHIEVEMENTS AND THIRD PLAN TARGETS

between urban and rural areas and, as against concentration in many urban areas, in the rural areas generally there were shortages, and the existing institutions did not have their full complement of personnel. Progress in the control of communicable diseases was hampered in several parts of the country on account of shortages of trained personnel and to some extent also of supplies of the equipment. Despite a measure of progress in rural water supply, there were large rural tracts which lacked safe drinking water. In many urban areas problems of drainage have been accentuated on account of the rapid growth of population.

6. The broad aim in the Third Plan will he to remove the shortages and deficiencies mentioned above. A major objective is that, to a-' large an extent as possible, supplies of good drinking water should be available in most villages in the country by the end of the Third Plan. Institutional facilities will be expanded so that medical and health services reach progressively larger numbers of persons, specially in the rural areas. The programme for the eradication of malaria will be completed and efforts will be made to eradicate siLall pox and to control filaria, cholera, tuberculosis, leprosy and other communicable diseases. Drainage programmes will be undertaken on a larger scale in the urban areas.

The specific physical targets proposed for the Third Plan along with statistics of progress in the First and the Second Plans are given in summary form in the Table below :

Table 3: Achievements and targets

@ Number indicates the number in practice or in service.
N.A.—Not available.

Water Supply And Environmental Sanitation

7. Rural water supply.—Problems of rural water supply vary from region to region and often within the same region. Rural water supply schemes have been taken up, in the main, under the programmes for community development, local development works and welfare of backward classes. These are supplemented by the national water supply and sanitation programme under Health which deals with the provision of wafer supply to groups of Villages through works requiring a measure of technical skill in design and, construction. The programme gives priority, to areas of great water scarcity and salinity and those in which water-borne diseases are endemic. The expenditure incurred on this scheme during the First .and Second Plans is estimated at about Rs. 33 crores and 11,000 villages were provided with water supply through pipes.

8. surveys to ascertain the present state of rural water supply are being undertaken in a number of States. Where such surveys have not been initiated, it is necessary to arrange for them, so that for every state a correct assessment of the extent of the problem may become available as a basis for detailed programmes to be implemented during the third Plan. To achieve the objective of making supplies of good drinking water available to most villages in the country by the end of the Third Plan. it will be necessary not only to make an intensive effort, but also to ensure that at every stage there is effective corrdination between all agencies concerned in carrying out the programme of rural water supply at the dirstrict and block levels and to mobilise local initiative and contribution to the utmilise local initiative and contribution to the utmost. Experience during the First and second plans has shown that great care is needed in preparing technical designs and estimates of urual water supply schemes and in keepint down their cost.

9. Under different programmes a provision of about Rs. 67 crores is available in the Third Plan for rural water supply. Th;s includes Rs. 35 crores for the Village Water Supply Programme, about Rs. 16 crores under the plans of the States under Health, about Rs. 12 to 13 crores under the community development programme and about Rs. 3 to 4 crores under the programme for the welfare of backward classes. The greater part of the amounts provided for ihe Village Water Supply Programme are intended to be available for (a) backward areas, (b) areas not covered by community development programme, (c) pro-extension blocks, and (d) blocks which have completed their first and second stage in the community development programme. The Village Water Supply Programme is intended primarily to deal with the rural water supply at the village level. As a rule. the ceiling of Rs. 10,000 per village is to be observed. The public contribution is generally expected to be about 50 per cent, but this proportion may be changed and modified in difficult areas or in backward areas. Schemes for groups of villages which involve provision of piped water supply and works of an engineering character are to be catered for by provisions under the Health programme, but for such schemes there could be a part contribution from funds available under the Village Water Supply Programme on the scale of Rs. 10,000 per village. The Village Water Supply Programme is to be undertaken at the block level through Panchayat Samitis and Village Panchayats, the funds being routed through the organisation at the block level. It is proposed that there should be a broadly agreed programme at the local level under which all the provisions available for water supply are effectively utilised. The programme should be based on careful surveys.

10. Along with rural water supply much greater attention should now be given to the programme of rural sanitation specially to the sanitary disposal of excreta in the villages. Problems relating to the proper design and construction of village latrines and the educational and organisational aspects of the programme for their promotion have been recently studied. The broad lines of an action programme in this field may be said to be fairly established. Although, in the beginning progress may be slow, it is important that in each development block an effort should be made to create greater awareness of rural sanitation problems and to introduce the use of sanitary latrines in schools and camps for groups of houses and, where possible, in individual houses. It would facilitate the introduction of latrines if the local sanitary inspectors are trained in casting the latrine sets. With the participation of the local people these latrines can be constructed at a fairly low cost. If this work is undertaken as a block programme it should be possible to achieve substantial results within a foreseeable period. Health education'is of course a most important aspect of the programme of rural sanitation. The advantages and convenience of clean, odourless and cheap latrines arc obvious. They are no less essential for conserving the fertilizer value of human wastes and enriching the soil.

11. Urban water supply.—Urban water supply schemes are being executed by municipalities and corporations with loans provided by the Central and State Governments. The following priorities for the selection of areas for urban water supply programmes which were accepted for the Second Plan will also be observed in the Third Plan :

1. municipal areas without any protected water supply arrangements;
2. improvement or expansion of existing facilities for water supply in urban areas where the present arrangements are either inadequate or unsafe from the public health point of view :
3. pilgrim centres ; and
4. areas having piped water supply and therefore requiring new sewerage or improvement to existing sewerage to remove waste and eliminate hazards to public health.

12. Urban water supply and sanitation schemes taken up in the first two Plans were designed to provide safe water supply and drainage facilities to a total urban population of 15 million. Of these, 450 schemes will be completed by the end of the Second Plan and the rest will continue into the Third Plan. Among the important schemes taken up during the First and the Sedond Plans are : Vaitama-cum-Tansa scheme of Bombay, schemes for the improvement of water supply and drainage in the cities of Delhi, Calcutta, Madras, Bangalore, Ahmc-dabad, Kaval Towns of Uttar Pradesh, and Visa-khapatnam in Andhra. In carrying out these programmes there were certain shortfalls. These were mainly due to shortage of trained personnel. inadequate organisation and planning, and lack of materials, particularly, galvanised iron pipes, pump sets and related accessories.

13. As a result of the experience of urban water supply schemes during the Second Plan, three main suggestions may be made. In the first place, urban water supply schemes, specially the larger ones, need to be phased carefully, so that different parts of a project are in the correc't sequence with one another and at each stage certain returns on the outlays incurred are realised. The technical scrutiny of plans and estimates is important if delays arc to be avoided. Secondly, to ensure that the funds available are used to. the best advantage it would be desirable to avoid dispersing them too thinly over a large number of schemes. This implies careful selection of urban water supply schemes on the basis of suitable criteria. Thirdly, once a project is accepted, the municipal body concerned should not only accept responsibility for maintenance but also contribute to the cost of construction to an extent which may be determined by the State Government. There is also need for well-organised Public Health Engineering Departments in all States. These DepartmenTs could ensure adequate coordination between the engineering and health aspects ef various water supply schemes, whether undertaken by the State Governments or by corpora-lions and municipalities. Where this coordination has been lacking, there have been delays in execution and maintenance has been unsatisfactory. Statutory water and sewage boards, empowered to float loans and levy cesses, and set up with the object of undertaking water supply and sewage schemes within their jurisdiction are likely to be helpful in the effective and efficient management of water supply schemes.

14. A sum of Rs. 89 crores has been provided for urban water supply and drainage schemes during the Third Plan period. The number of new schemes that can be taken up against the allocation for urban water supply is necessarily limited. Along with other water supply and drainage schemes to be taken up by the States, the following important schemes will be completed or taken up : water supply and drainage schemes of Madras, Jabalpur, Bangalore, Mangalore, Delhi, Calcutta, Bombay and Kaval Towns of Uttar Pradesh, Visakha-patnam and Manjecra Water Supply schemes of Andhra Pradesh, Ernakulam-Mattancherry and Trivandrum water supply and drainage schemes <»f Kerala.

15. The urgency and importance of providing drainage and sewerage and arranging for safe disposal of sewage in towns and cities need greater attention. These facilities are at present lagging behind the water supply facilities, and it is necessary that schemes of drainage and sewerage are considered simultaneously with those for water supply and are carried out under a coordinated programme. This would insure against the risk of increased breeding of mosquitoes and deterioration in the sanitary conditions of the towns as a result of water supply schemes. It would be desirable to set apart for sewerage schemes, say, 20 to 30 per cent of the estimated cost of water supply projects in cities with a population over 100,000.

Primary Health Units. Hospitals And Dispensaribs

16. By the end of the Second Plan, 2800 primary health units will have been established, covering most of the development blocks. The number of hospitals and dispensaries will increase from 8600 in 1951 to 12,600 in 1961 and during the same period the number of beds will increase from 113,000 to 185,600. The working of primary health units during the Second Plan shows that among factors affecting the progress of this programme were (i) shortage of heaJth personnel, (ii) delays in the construction of buildings and residential quarters for staff and (iii) inadequate training facilities for different categories of staff required for service in rural areas. The need has also been felt for strengthening the primary health units and to possibility of integrating as early as may be feasible services such as those for the control of malaria, tuberculosis, etc., with the normal activities of health units. Among other steps to b» taken to improve the efficiency of primary health units, are the provision of the minimum staff required, organisation of the necessary training facilities and the integration of the activity of primary health units with other health services available in the area.

17. Difficulties have been experienced in securing a sufficient number of doctors. In order to create the necessary climate and conditions for securing personnel for rural areas, I he following measures are suggested :

1. As is the practice in some States, there should be a single cadre for personnel working in rural as well as urban areas. Service rules may stipulate that each incumbent in the cadre has to put in a certain period of servide in rural areas, before he can cross the first efficiency bar or gain the next grade. Period of service in rural areas should be taken into consideration for accelerated promotion, advance increments or selection for post graduate training.
2. Residential accommodation and other facilities should be provided for medical personnel serving in rural areas. Due account should be taken of their additional expenditure e.g. on acc'ount of the education of children.
3. Scholarships should be made available in sufficient number to students undergoing training with the obligation that they will serve in rural areas after graduation for a minimum prescribed period.
4. The services of medical practitioners both in urban and rural areas should be utilised on a part time basis in the hospitals and dispensaries and for school health service.
5. The services of qualified and properly trained graduates in indigenous systems of medicine in primary health units and sub-centres in addition to the medical officer should be utilised.

18. Further, to ensure that the standard of primary health units is maintained and special services are readily made available to them, it is necessary that these units are linked up with referral and district hospitals. Specialised services are at present concentrated in hospitals in the larger cities. To bring these services within easy reach of the population of small towns and villages, it is necessary that the bed strength of district and sub-divisional hospitals is suitably enlarged and X-ray and pathological diagnostic services -s.ad medical, surgical aad obstetrical specialist services are made available. Apart from the increase in hospital beds, out-patient departments should be organised as polyclinics, so that much of the technical equipment may be available and treatment afforded in the outpatient department itself.

19. The overall target for the Third Plan is the establishment of 2000 more hospitals and dispensaries and 54,500 additional beds.

Control of Communicable Diseases

20. Work on the control of communicable diseases, including malaria, filariasis, tuberculosis, smallpox, venereal diseases, leprosy, cholera and goitre will be undertaken on a larger scale in the Third Plan, special emphasis being placed on the eradication of malaria and smallpox. A total expenditure of Rs. 23 crores was incurred on the control of the communicable diseases in the First Plan and of Rs. 64 crores in the Second Plan. The Third Plan programmes entail a total outlay of about Rs. 70 crores.

21. Malaria eradication.—Anti-malaria measures undertaken during the first two Plans have resulted in marked decline in the annual incidence of the disease from 75 million cases in 1952-53 to about 10 million cases in 1960-61. The child spleen rate diminished from 7.7 per cent in 1956 to 1.4 per cent in 1960. Similarly. the child parasite rate decreased from 1.8 per cent to 0.2 per cent and infant parasite rate from 0.7 per cent to 0.1 per cent. By the end of the Second Plan, 390 malaria eradication units were in position. Surveillance operations have been introduced simultaneously and, as the Third Plan progresses, these units will be gradually withdrawn and only a few units will be retained, if necessary, particularly in border areas.

22. Fihria control.—Filariasis is prevalent mostly in coastal regions. Surveys conducted during the Second Plan have indicated that about 40 million persons are exposed to the infection in endemic areas. The method adopted for its control consists of mass chemotherapy, anti-mosquito measures and anti-larval measures. Filariasis is predominantly an urban problem and the essential effective long-term measure is the improvement of environmental sanitation. The number of control units was increased from 11 in 1956 to 48 in 1961. In the Third Plan, anti-filariasis measures will be continued, but priority will be given to drainage schemes in towns affected by this disease.

23. Smallpox.—Smallpox is endemic in India and is a source for the spread of infection to other countries. There has been a decline in morbidity and mortality rates from smallpox due to the vaccination campaigns which have been undertaken, but smallpox cases continue to occur during certain seasons in a year and the disease appears in epidemic form onCe in five or six years.

As smallpox is a preventible disease and as vaccination is a potent weapon for eradicating it, it has been agreed that during the Third Plan an effort should be made to eradicate the disease. Pilot schemes were initiated in all States during 1960-61. The principal items of the programme in the Third Plan would be (1) an increase in the output of vaccine lymph, (2) recruitment and training of vaccinators, and (,3) undertaking mass vaccination to cover the entire population before the next outbreak ot the disease. Action has already been initiated to increase the output of vaccine lymph.

24. Tuberculosis.—A sample survey conducted recently under the auspices of the Indian Council of Medical Research has shown that the total number of cases ol pulmonary tuberculosis in the country was roughly 5 million, ot which about 1.5 million might be infectious and that while mortality from tuberculosis is showing signs of decline, the incidence rate has remained more or less the same, both in rural and urban areas. During the Second Plan about 120 million persons were tested under the B.C.G. Vaccination Campaign. The number of tuberculosis clinics was increased from 160 in 1956 to 220 in 1961. Ten T.B. Demonstration and Training Centres were established and the number of beds for tuberculosis patients was increased from 22,000 in 1956 to 26,500 in 1961. A National T.B. Training Institute was established at Bangalore in 1959.

In the Third Plan, the B.C.G. Campaign will be intensified to cover another 100 million persons. The number of clinics will be increased from 220 to 420. In addition, 25 mobile clinics equipped with X-ray for miniature films and the mobile laboratory for collection of specimens and simple examinations will be set up for service in rural areas. Five more Tuberculosis Demonstration and Training Centres will be established. About 3500 more beds for tuber-culasis patients will be added bringing the total number of beds to 30,000 by 1966. Provision has also been made for the setting up of 7 After Care and Rehabilitation Centres.

25. Veneral diseases.—The common venereal diseases prevalent in the country are syphi-ils and gonorrhoea and the incidence is fairly high in cities, ports, industrial areas and in some of the sub-Himalayan tracts and is likely to increase with urbanisation and industrialisation. By the end of the Second Plan period 75 district clinics and 8 headquarter clinics were set up. The introduction of effective methods for the rapid diagnosis and treatment of these diseases has made it possible to reduce the reservoir of infection in the population. In the .Third Plan, 100 district clinics and 6 headquarter clinics will be set up and Procain Aluminium Monostearate (PAM) and antigens will be supplied free of cost.

26. Leprosy.—There are roughly 2 million persons suffering from leprosy in the country of whom abort 20 to 25 per cent are in the infectious stage. The incidence of disease varies from 0.5 per cent to 5.0 per cent. Leprosy is brought under control by intensive and extensive mas's scale treatment with modem drugs, especially the sulphones. By the end of the Second Plan, 135 Study and Treatment Centres ior leprosy had been set up. About 7 million persons had been surveyed and about 90,000 persons were given domiciliary treatment. The Central Leprosy Teaching and Research Institute at Chingleput has been carrying out research into various problems concerning leprosy and training the leprosy workers. The Leprosy Advisory Committee, set up in 1958, to review the leprosy control schemes has made a number of recommendations for intensifying (he leprosy control work in India such as grant of special allowance, free residential accommodation, improvement in service conditions and centralised training proarammes for workers in this field.

The programme for the control of leprosy during the Third Plan period includes the establishment of 100 more control units and the establishment of survey, education and treatment (SET) centres, besides continuing the existing programmes. A large number of voluntary organisations and social workers in antileprosy work will be associated in this programme. Every hospital and primary health unit in endemic areas would be organised as a nucleus for leprosy control work.

27. Cholera.—India has been an endemic area for cholera for a very long period. As has been pointed out by a recent expert committee there are five endemic foci in the deltaic regions of the principal rivers in the States of West Bengal, Orissa, Andhra Pradesh and Madras of which West Bengal and Orissa, are the more •••erious. To prevent frequent recurrence of cholera epidemics, these endemic foci have to he eliminated. This caa be achieved only by providing adequate supply of safe water for the population, particularly in the endemic areas and by the adoption of modern methods of sewage disposal. As a practical measure attention should first be concentrated on towns and cities where the infection spreads much more easily than in the rural areas with their relatively sparse population. By tar, the largest and most important endemic focus in India is Greater Calcutta which is situated at the very centre of the main endemic area of West Bengal. The existing system for the supply of filtered river water is an old one and has to be considerably extended. Only two-thirds of the city area is at present covered by a sewerage system. Improvement and modernisation of the water s.upplv, sewerage and drainage systems of Greater Calcutta calls for careful planning and urgent action. Water supply and sanitary conditions in the Calcutta area were reviewed recently by a team from the World Health Organisation and various steps have been recently initiated.

28. For the complete eradication of cholera, water supply and sanitation have to be improved much more extensively than has yet been possible under the First and Second Plans. In ihe 7'hird Plan a substantial programme for providing protected water supply is being undertaken. It is suggested that in the States affected by cholera a large part of this programme should be concentrated in the endemic pockets. Specific programmes for these areas should be drawn up speedily and, if necessary, an effort should be made to supplement resources avail-;ihle under the Plan. There is no reason why it should not be possible to reduce the incidence of cholera significantly during the Third Plan ;ind lo eliminate it wholly by the end of the Fourth Plan.

29. Goitre.—Goitre is endemic in the sub-Himalayan region. During the Second Plan period the Government of India, in collaboration with the UNICEF established a factory near Sambhar Lake in Rajasthan, to manufacture .'odised/iodatcd salt for distribution in some endemic districts of the Punjab. This factory is capable of producing iodised salt to meet the requirements of a population of 2.7 million, lhat is, about a third of the population at risk. To eliminate goitre completely, the production of iodised salt has to be increased and two more plants need to be installed.

30. Provision has been made in the Third Plan for the treatment and control of trachoma. Facilities for the early diagnosis of cancer and for research in this field will be expanded under the Third Plan.

Medical Education And Research

31. Statistics relating to the expansion of training facilities for medical and para-medical personnel during the first two Plans have been set out in table 3. In the Third P'an, training facilities in medical colleges and attached hospitals will be expanded further and 18 new medical colleges will be established, bringing the total number to 75. Separate Departments will he established in all medical colleges for the study of social and preventive medicine. The development programme of the All India Institute of Medical Sciences will be completed and m several' medical colleges certain departments will be upgraded and facilities for postgraduate training and research will be established.

32. The expansion of training facilities for doctors in the first two Plans has barely kept pace with the growth of population, the population-doctor ratio remaining at 6000 : 1 over the decade 1951-61. This ratio will remain unchanged under the programme for the Third Plan. in formulating which the shortage of feichers in the existing medical colleges has bad to be taken into consideration. Reference has already been made to the shortage of doctors for work in rural areas and to steps necessary for removing this deficiency. A further measure which is recommended is that a new short-term course for the training of "medical assistants" should be instituted at an early date. The trainees should work in primary health units in the rural areas for periods of 3 to 5 years after which they should be given special facilities to obtain the normal medical qualifications and continue in the public service.

33. Postgraduate medical education.—With the rapid expansion of medical colleges and the establishment of new colleges, there will be increased demand for teachers. A larger number of students have to be trained in various subjects to the postgraduate level to take up teaching positions in medical colleges. The existing facilities available for postgraduate education arc adequate for an annual average intake of about 750 students and the out-turn may be of the order of 250. It is estimated that there is already a shortage of about 2000 teachers in the existing medical colleges. For the anticipated expansion of these colleges and the establishment of new medical colleges, about 2500 teachers will be needed so that the total requirement of teachers during the Third Plan will be of the order of 4500. A provision of Rs. 3.5 crores has been made in the Third Plan for the expansion of facilities for postgraduate education. This programme has a very high priority and should be completed in the early years of the .Third Plan.

34. Dental education.—There are. at present 10 dental colleges with a total annual admission of about 280. During the Third Plan 4 new colleges will be established and some of the existing colleges will be expanded. This will raise the annual admission to 400 per year. Provision has also been made in the Third Plan for the opening of dental clinics and for dental research.

35. Medical research.—Research; programmes in the Second Plan were drawn up on the basis of the recommendations of the Indian Council of Medical Research. These include research in communicable diseases, particularly tuberculosis, trachoma, leprosy, cholera and virus diseases, The study of nutritional disorders and diseases received special attention. Studies with- a view to developing methods for preventing pollution of rivers and streams by industrial wastes were carried out. Research on diseases of viral origin has also been undertaken. Programmes for medical research to be carried out in the Third Plan have been described in the Chapter on Scientific and Technological Research. Priority will be given to the study of problems of environmental sanitation and communicable diseases. Special attention will be devoted to training of research workers in different fields in sufficient number. Research on indigenous medicine will be intensified.

Training of Ancillary Personnel

36. Although since the beginning of the First Plan, steps have been taken to expand training facilities for nurses and other ancillary personnel, shortages have continued to be acute. The relevant statistics of the progress made and the targets for the Third Plan are set out in Table 3. The problem is proposed to be dealt with in the Third Plan along the following lines :—

1. Nurses.—To improve the condition ot service for nurses and to attract larger numbers of women to this profession it is proposed that in each State, there should be a special Nursing Service and a Nurse Superintendent should advise and assist the Director of Health Services. It is also proposed that competent and experienced Nursing Sisters should be appointed in hospitals.
2. Auxiliary nurse midwives.—Auxiliary nurse midwives go through a two-year course of training. The aim is that they should eventually replace midwives in primary health units and elsewhere. Training facilities are being considerably stepped up in the Third Plan.
3. Health visitors.—The Plan as at present formulated envisages increase in the number of training institutions for health visitors from 30 to 50, the annual intake rising from 650 to 850. Considering the existing shortage of health visitors and the important role assigned to them in the rural health services, the training facilities need to be augmented to a much greater extent. It is suggested that the present training programmes in the States should be reviewed at an early date in relation to health visitors as well as other women workers required for implementing the rural health programme.;
4. Dais—Child births in rural areas are attended to mostly by dais. They, however, lack training. The general object is to give to dais a measure of reorientation and training to enable them to render better service in the villages. Provision for such training is being made in the Plan.

37. Public health engineers.—In the Third Plan, training facilities are being expanded for public health engineers, subordinate personnel as well as water works operators. In these categories, personnel are required in increasing number on account of the programmes for urban and rural water supply.

The Plan also provides for training of Sanitary inspectors, laboratory technicians, refrac-tionists, opticians and radiographers and for workers in leprosy, venereal diseases and tuberculosis. Facilities for training in health statistics are also being arranged.

38. Pharmacists.—The education of pharmacists is regulated under the Pharmacy Act, 1948, which was passed with the object of raising standards of training required for pharmacists who work in hospitals and dispensaries. The replacement of "compounders" who are now commonly employed for dispensing medicines by trained pharmacists will bs necessarily a long-term process. It is, however, important that of the additional personnel required in the Third Plan, estimated at about 6000, as large a proportion as possible should be trained pharmacists. On the present plans there appears to be a gap of about 2000, which can be mads up, in the main, through the further expansion of the existing training institution.

Health Education

39. In its widest sense health education is the very foundation of a successful public health programme. As was suggested in the First Plan, a great deal of ill health is the result of ignorance of simple rules of hygiene or of indifference to their practical application, and no single measure is likely to give a greater return in proportion to the outlay than health education. To implement the programme of health education, the Central Health Bureau was established in 1956 in the Directorate General of Health Services and several States have also set up such Bureaux. Among the most important aspects of health education are personal hygiene, environmental sanitation, prevention of communicable diseases, nutrition, physical exercise, marriage guidance, pre-natal and post-natal care, maternity and child health, etc. Health education should be undertaken as a national programme and far greater stress should be placed upon it in the work of social education in community development blocks. The Third Plan provides for increase in facilities for training in health education and for demonstration and publicity. Both in urban and rural areas there is considerable scope for orienting the existing health programmes, so as to assure for them a sound base in widespread health education.

Health Insurance

40. A beginning with health insurance has been made with the provision of health and medical facilities for industrial workers under the Employees' State Insurance Scheme and for the employees of the Central Government in Delhi under the Contributory Health Service Scheme. In the light of the experience gained, other schemes of this nature should be worked out by the Central and S