Health has always been a high priority area in any country. It has been recognised as an important component in the process of economic and social development. It does not simply mean absence of diseases, rather it is a state of complete physical, mental and social well-being. Sanitation and hygiene, nutrition as well as safe drinking water are the basic determinants of good health. The indicators like infant mortality and maternal mortality rates, life expectancy and nutrition levels, birth rate and death rate, along with the incidence of communicable and non-communicable diseases reflects the health status in an economy. The existence of proper and well-defined health care facilities are vital not only for having a healthy productive workforce and promoting general welfare, but also for attaining the goal of population stabilisation as well as enhancing the overall quality of life of people.

Over the years, India has built up a vast health infrastructure and manpower, with a wide variety of hospitals and dispensaries being set up at different levels and run both by public and private sectors. They are being managed by qualified doctors and trained nurses. Expansion in access to healthcare services combined with technological advancements in this field has resulted in substantial improvement in health indices of the population and a steep decline in mortality rates. Under the mandate of National Common Minimum Programme (NCMP) of the Government of India, health is one of the major thrust areas with special focus on primary health care.

The health sector in India has been fragmented between the Centre and the States. Items like public health, hospitals, sanitation, etc. comes under the State list of the Constitution, while the items having wider ramification at the national level like population control and family welfare, medical education, prevention of food adulteration, quality control in manufacture of drugs etc. have been included in the Concurrent list.

At the Central level, the Ministry of Health and Family Welfare is a nodal authority for the growth and development of health care sector in the country. It is instrumental and responsible for implementation of various programmes on a national scale in the areas of health and family welfare, prevention and control of major communicable diseases as well as promotion of traditional and indigenous systems of medicines. It also assists States in preventing and controlling the spread of seasonal disease outbreaks and epidemics through financial and technical support. The Ministry comprises of the following departments:- (i) Department of Health and Family Welfare; and (ii) Department of Ayurveda,Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH).

The Department of Health and Family Welfare aims to provide high-quality and superior health care facilities in an effective and time-bound manner as well as tackle the menace of communicable and non-communicable diseases, especially in rural areas and in those areas where incidence of diseases is high. It is looking after all the activities, programmes and policies relating to promotion of family welfare in the country, which includes various measures in regard to population stabilisation, mother and child care, education for family planning, etc. The Directorate General of Health Services (DGHS) is an attached office of the Department and renders technical advice on all medical and public health related matters as well as is involved in the implementation of various health schemes.

While, the Department of Ayurveda,Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) is responsible for designing, formulating and implementing policy in order to promote and propagate Indian systems of medicine, both within India and abroad. There are six systems of medicine and health care in the country. These are:- Ayurveda, Unani, Siddha, Yoga, Naturopathy and Homoeopathy. The main objectives of the Department are to:-

• Attain global leadership for country in the field of traditional medicine



• Upgrade the educational standards in the Indian systems of medicines and Homoeopathy colleges in the country



• Evolve pharmacopoeial standards for Indian systems of medicine and Homoeopathy drugs



• Draw up schemes for promotion, cultivation and regeneration of medicinal plants used in these systems



• Promote good health and expand the outreach of health care



• Improve the quality of teachers and clinicians;



• Ensure affordable AYUSH services and drugs which are safe and efficacious



• Facilitate availability of raw drugs which are authentic and contain essential components



• Integrate AYUSH in health care delivery system and national programmes



• Re-orient and prioritize research in AYUSH.
  

The Ministry has been implementing various National Health Programmes in the country, namely:-

• National Vector Borne Disease Control Programme (NVBDCP)



• National Filaria Control Programme



• National Leprosy Eradication Programme



• Revised National TB Control Programme



• National Programme for control of Blindness



• National Iodine Deficiency Disorders Control Programme



• National Mental Health Programme



• National Aids Control Programme



• National Cancer Control Programme



• Universal Immunization Programme

In order to build a healthy nation as well as to provide preventive, promotive and curative care services to its people, the Ministry has been undertaking several policy measures and initiatives. The most important being the formulation of National Health Policy (NHP) in 2002, which aims to achieve an acceptable standard of good health amongst the general population of the country. The policy document envisages certain targets for scaling-up health investments to control all communicable diseases and expanding as well as strengthening secondary and tertiary health care for the benefit of common man. It covers all aspects of health care and focuses on the need for enhanced funding and organisational restructuring of the public health initiatives at the national level in order to facilitate more equitable access to the health facilities; efficient delivery of public health infrastructure; education of health care professionals; health research; enforcement of quality standards for food and drugs; women's health; etc.

The policy involves following strategies for achievement of its goals, such as:-

1. Disease management including early case detection and complete treatment, strengthening of referral services, epidemic preparedness and rapid response
   
   



2. Integrated vector management (for transmission risk reduction) including indoor residual spraying in selected high areas, use of insecticide treated bed nets, use of larvivorous fish, anti larval measures in urban areas including bio-larvicides and minor environmental engineering
   
   



3. Supportive interventions including behaviour change communication, public-private partnership (PPP) and inter-sectoral convergence, human resource development through capacity building, operational research including studies on drug resistance and insecticide etc.

Another major step in this direction has been the launching of National Rural Health Mission (NRHM) for the period 2005-12 in order to make substantial improvement in the basic health care delivery system in the country. The main objective of NRHM is to provide accessible, affordable, effective and reliable primary health care facilities, especially to the poor and vulnerable sections of population. It aims at bridging the gap in rural health care services through creation of a cadre of Accredited Social Health Activists (ASHA); increasing public expenditure on health; reduction of regional imbalance in health infrastructure; decentralisation of programme to the district level to improve intra and inter-sectoral convergence and promote effective utilisation of resources; induction of management and financial personnel into district health system; as well as operationalization of community health centers into functional hospitals in order to meet Indian Public Health Standards in each block of the Country. The broad goals of the Mission are:-

• Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR).
  
  



• Universal access to public health services such as women’s health, child health, water, sanitation and hygiene, immunization and nutrition.
  
  



• Prevention and control of communicable and non-communicable diseases, including locally endemic diseases.
  
  



• Access to integrated comprehensive primary health care.
  
  



• Population stabilization, gender and demographic balance.
  
  



• Revitalize local health traditions and mainstream AYUSH.
  
  



• Promotion of healthy life styles.
  
  



• Implementation of existing programmes of the Ministry.

NRHM is being operationalised throughout the country, with special focus on 18 states which have weak public health indicators and/or weak infrastructure. These 18 States are Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu & Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura, Uttaranchal and Uttar Pradesh.

Besides, the Ministry has been conducting periodic surveys, like the National Family Health Surveys (NFHS) and the District Level Household Surveys (DLHS), to assess the impact and outcomes of its various health and welfare programmes. For instance, NFHS is a large-scale multi-round survey conducted in a representative sample of households throughout India. It provides State and National information for India on fertility, infant and child mortality, practice of family planning, maternal and child health, reproductive health, nutrition, anaemia, utilization and quality of health and family planning services. Three rounds of the survey have been conducted so far with a view to create a comprehensive demographic and health database in India. Each successive round of NFHS have two specific goals:-

1. To provide essential data on health and family welfare needed by the Ministry and other agencies for policy and programme purposes and
   
   



2. To provide information on important emerging health and family welfare issues.

International Institute for Population Sciences (IIPS), Mumbai, has been designated as the nodal agency, responsible for providing coordination and technical guidance for all these surveys. The first NHFS (NFHS-1) was conducted during the year 1992-93, followed by NHFS-2 during 1998-99 and NFHS-3 during 2005-06. NFHS-3 not only covers the aspects like maternal and child health, family planning, immunization, fertility and child mortality, but also provide information on several new and emerging issues including:-

• Perinatal mortality, male involvement in family welfare, adolescent reproductive health, high-risk sexual behaviour, family life education, safe injections, tuberculosis and malaria
  
  



• Family welfare and health conditions among slum and non-slum dwellers in eight cities (Chennai, Delhi, Hyderabad, Indore, Kolkata, Meerut, Mumbai and Nagpur)
  
  



• HIV prevalence for adult women and men at the national level and for each of the six high HIV prevalence States, namely, Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland and Tamil Nadu.

The survey has been conducted in all 29 States and key survey indicators have been estimated at the national level, for each State, for major metropolitan areas, and for slum and non-slum areas in selected cities.

Also, the Ministry has developed a broad institutional framework to carry out the regulatory and developmental activities in the field of AYUSH:-

• The regulatory framework consists of two statutory bodies, namely, the Central Council of Indian Medicine (for Ayurveda, Siddha and Unani) and the Central Council of Homoeopathy (CCH) for laying down minimum standards of education, recommending recognition of medical qualifications, registration of practitioners and the laying down of ethical codes.
  
  



• There are National educational institutions such as the National Institute of Ayurveda at Jaipur, the National Institute of Siddha at Chennai, the National Institute of Homoeopathy at Kolkata, the National Institute of Naturopathy at Pune, the National Institute of Unani Medicine at Bangalore and the Morarji Desai National Institute of Yoga at Delhi. These institutions aim to regulate and develop high standards of education, teaching, training and research in all aspects of Indian medicine systems.
  
  



• The Department of AYUSH operates two apex laboratories, namely, the Pharmacopoeial Laboratory for Indian Medicine (PLIM) and the Homoeopathy Pharmacopoeial Laboratory(HPL), both at Ghaziabad to carry out the research work in the field of medicines.
  
  



• The Indian Medicines Pharmaceutical Corporation Ltd. (IMPCL), a Public Sector Undertaking under the Department, manufactures classical Ayurveda and Unani drugs.
  
  



• The National Medicinal Plants Board coordinates all the matters relating to medicinal plants, including drawing up policies and strategies for conservation, proper harvesting, cost-effective cultivation, research and development, processing, marketing of raw material in order to protect, sustain and develop this sector. Its main functions are:-
  
  
  1. Assessment of demand/supply position relating to medicinal plants both within the country and abroad
     
     
  
  
  
  2. Advise concerned Ministries/ Departments/ Organizations/ State/ UT Governments on policy matters relating to schemes and programmes for development of medicinal plants
     
     
  
  
  
  3. Identification, inventorisation and quantification of medicinal plants
     
     
  
  
  
  4. Promotion of ex-situ/in-situ cultivation and conservation of medicinal plants
     
     
  
  
  
  5. Promotion of co-operative efforts among collectors and growers as well as assisting them to store, transport and market their produce effectively
     
     
  
  
  
  6. Undertaking and awarding scientific, technological research and cost-effectiveness studies
     
     
  
  
  
  7. Encouraging the protection of patent rights and other intellectual property rights concerned with it etc.
     
     



• There is a 'Drug Control Cell' which deals with matters pertaining to licensing and regulation of drugs and the control of misbranded/adulterated and spurious Ayurvedic, Unani and Siddha Drugs and other related matters. It is also concerned with the Traditional Knowledge Digital Library (TKDL) and matters relating to Intellectual Property Rights (IPR).
  
  



• There are four Research Councils, namely:-
  
  
  1. Central Council for Research in Ayurveda & Siddha (CCRAS)
     
     
  
  
  
  2. Central Council for Research in Unani Medicine (CCRUM)
     
     
  
  
  
  3. Central Council for Research in Homoeopathy (CCRH)and
     
     
  
  
  
  4. Central Council for Research in Yoga & Naturopathy (CCRYN)
     
     
  These Councils are the apex bodies for research in the concerned systems of medicine and are fully financed by the Government of India. They continue to initiate and guide, develop and coordinate scientific research in different aspects of respective systems, both fundamental and allied. Their research activities have been reviewed to ensure that they undertake meaningful research under fixed parameters within specified period and disseminate research findings for the benefit of educationists, researchers, physicians, manufacturers and common man.

As a result of all such measures, India has achieved impressive demographic transition owing to the decline of crude birth rate, crude death rate, total fertility rate and infant mortality rate. As per the available information, the crude birth rate (CBR) declined from 40.8 births per thousand population in 1951 to 29.5 in 1991 and further to 23.8 in 2005. Similarly, there has been a sharp decline in crude death rate (CDR) from 25.0 deaths per thousand population in 1951 to 9.8 in 1991 and further to 7.6 in 2005. The total fertility rate (average number of children likely to be born to a woman between 15-40 years of age) has decreased from 6.0 in 1981 to 2.9 in 2004. The maternal mortality rate has also declined from 437 per one lakh live births in 1992– 93 to 301 in 2001-03. The infant mortality rate, which was 110 in 1981, has declined to 58 per 1000 live births in 2004. While, the child mortality rate has decreased from 57.3 in 1972 to 17.0 in 2004. As far as family planning is concerned, the District Level Household Survey (DLHS) conducted in 2002-04, has revealed that 45.7% eligible couples are currently using any one of the family planning methods as against 22.8% in 1981. The total number of acceptors of different family planning methods enrolled in the country during the year 2006-07 has been 29.44 million (provisional). At present, there are approximately 7.25 lakh registered practitioners, 3194 hospitals and 21290 AYUSH dipensaries all over the country. But, since health is a key social services sector in India, lot more efforts and incentives are needed to improve the health care delivery system in the country and promote general well-being of the people.

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