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JRD TATA MEMORIAL AWARD

forPopulation & Reproductive

Health Programmes

2008

Population Foundation of India


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JRD TATA MEMORIAL AWARD FOR POPULATION AND REPRODUCTIVE HEALTH PROGRAMMES 2008

3|Population Foundation of India

The Man and His Vision

raise an alarm in 1951, in

th e cour se of a speech, about

t h e c o n t i n u o u s a n d f a s t

g row th o f t h e In d ia s

p o p u l a t i o n a n d i t s s e r i o u s p o t e n t i a l

consequ ences t o the coun tr ys economy

and pr ogress. Realising later th e need for

non-governmental action, he founded theFamily Planning Foundation in 1970, of

w h i c h h e w a s t h e f o u n d e r C h a i r m a n .

F a m i l y P l a n n i n g F o u n d a t i o n w a s r e -

christened as the Population Foundation

of Ind ia in 1993 to r e f l ec t t he w ide r

dimensions of the population issue in a

chan ging world. Mr Tata s unique services

i n t h e c a u s e o f p o p u l a t i o n h a d b e e nrecognised by the Un ited Nat ions wh o had

chosen h im fo r t he i r p res t ig ious

Population Award for 1992. For his many

sp lendoured ach ievem ent s , Ind ia a l so

confe r r ed on h im B ha ra t R a t na , t he

highest civil ian award of the Nation in

1992.

Bh a r a t R a t n a , t h e l a t e M r J R D

Tata , was among those han dful of

w or ld c i t i zens w hom des t iny

itself so shaped to become an institution

in a life-time. He had been regarded as

one of the stalwarts among Indians in the

20 th Century, who stamped his personality

on th e coun tr ys affairs both before an dafter independence. He was the cru sader

for the promotion of family planning, both

as a t ool o f cu rb ing In d ia s r ap id ly -

increasing populat ion, and a n ent irely new

way of life in a developing society in which

a family is not mere num bers but valua ble

relationships of shared growth.

The late Mr Tata had promoted andfostered several causes in the service of

science an d nat ion. His holistic view of

the population problem had turned him

i n t o a n e q u a l l y s t r o n g h u m a n i s t ,

concerned no less with the problems of

pover ty and env i ronm ent , i n t e r tw ined

with populat ion. Mr Tata was the first to


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The Foundation

The Population Foundation of India( fo rm er ly know n as Fam i ly

P l a n n i n g F o u n d a t i o n ) w a s

established in 1970 by a dedicated group

of industrialists and population activists

led by Bhara t Ratna the late Mr JRD Tata

w h o g u i d e d i t a s t h e f o u n d e r B o a r d

Chairman u ntil his death in 1993. After

h i s d e m i s e , D r B h a r a t R a m , n o t e d

indust rialist an d a foun ding member of the

Founda tion, was i ts Boar d Chairm an.

After his demise in 2007, Mr. Hari Sh an kar

Singhania , renowned indust r ia l i s t took

o v e r a s t h e B o a r d C h a i r m a n o f t h e

foundation.

T h e F o u n d a t i o n h a s b e e n i n t h eforefront of non-governmental efforts at

population stabilisation and establishing

a ba lance between resources, environmen t

and population.

Soc ia l deve lopm ent i nc lud ing

population stabil isat ion in India should

not and cannot remain the sole concern of

the Government. It ought to be supportedand supplemented by pr ivate voluntar y

e n t e r p r i s e s . I n t h i s r e g a r d , t h e

Foundation has always worked in close co-

operation and co-ordination with official

agenc ies and p rogram m es , bo th a t t he

Centre and in the States.

In its independent role, it has tried tog u i d e a n d i n f l u e n c e t h e N a t i o n a l

P o p u l a t i o n P o l i c y a n d t o s e r v e a s a

catalytic agent to promote programmes at

d i f f e r e n t l e v e l s d i r e c t e d t o w a r d s t h e

ultimate goal of population stabilisation.

The Foundation supports innovative

r e s e a r c h , e x p e r i m e n t a t i o n a n d s o c i a laction to further the cause of population

s t ab i l i s a t ion and p rov ide a fo rum fo r

pool ing of exper iences and shar ing of

professional expertise to strengthen and

e n l a r g e t h e o p e r a t i o n a l b a s e o f t h e

Reproduct ive and Chi ld Heal th (RCH)

programmes.


Population Foundation of India |4


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The Award

Wh e n t h e f o u n d e r B o a r d

Chairman of the Foundation

Mr JRD Tata passed away in

1993, having laid a strong base for a social

m o v e m e n t t o s t a b i l i s e t h e g r o w t h o f

p o p u l a t i o n i n I n d i a a s a n e s s e n t i a l

prerequisite to attain higher qualities of

life for the Indian people, the Foundation

felt tha t it would be a fitt ing tribute t o the

g r e a t m a n i f n a t i o n a l a w a r d s w e r e

instituted in his name t o furth er the cause

fo r w hich he w as a cham pion

acknowledged all over the world.

In February 1996, the PFI Governing

B oard fo rm a l ly dec ided to ins t i t u t enational awards for th e best Stat e and th e

b e s t d i s t r i c t s w i t h o u t s t a n d i n g

p e r f o r m a n c e i n p o p u l a t i o n a n d

reproductive health and family planning

programme.


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The Significance of the Award

The process of integration of related

programmes of mat erna l and child

h e a l t h i n i t i a t e d w i t h t h e

implementation of the Child Survival and

Safe Motherhood (CSSM) Programme was

taken a s t ep fu r the r i n 1994 w hen the

International Conference on Population

and D eve lopm ent ( IC PD ) in C a i ro

r e c o m m e n d e d t h a t t h e p a r t i c i p a n t

c o u n t r i e s s h o u l d i m p l e m e n t u n i f i e d

p r o g r a m m e s f o r r e p r o d u c t i v e h e a l t h .

India took the lead by in t roducing the

target - f ree approach to fami ly welfare

programmes from April 1996. During the

9t h

P l a n , t h e R C H P r o g r a m m e ,accordingly , in tegra ted a l l the re la ted

programmes of the 8 th Plan on maternal

a n d c h i l d h e a l t h , f a m i l y p l a n n i n g ,

adolescent sexual health , etc. The concept

of RCH is to provide to the beneficiaries

n e e d b a s e d , c l i e n t c e n t r e d , d e m a n d

driven, high quality and integrated RCH

services.

It is a legitimate right of the citizens

to be ab le to expe r i ence sound

R e p r o d u c t i v e a n d C h i l d H e a l t h a n d

therefore the RCH Programme seeks to

p rov ide r e l evan t s e rv i ces for a s su r ing

R eproduc t ive and C h i ld H ea l th to a l l

citizens. RCH is even more relevant for

ob ta in ing the ob jec t ive o f popu la t ion

stabilization in the country.

The se l ec t ion o f w inner s fo r t he

A w a r d s i s n o t d e p e n d e n t j u s t o n t h e

current levels of performan ce in a nu mber

of crucial indicators. Em pha sis ha s beengiven on the change factor signifying the

pace of progress achieved over a period of

t ime. I t is well known that despite the

relatively slow performance in the field

of RCH for the country as a whole, there

are States within the country, which have


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made significant str ides in the f ield of

Reproductive and Child Health and their

achievements are comparable to the best

even in adva nced socie t i e s . These

demonst ra te t hat , g iven the leadership ,

will and conditions, such success can be

repeat ed in oth er regions. The awards are

recognit ion of this sustained effort and

will hopefully generate the much needed

i m p e t u s a n d c o n f i d e n c e a m o n g s t t h e

others that they could also achieve thesame standards. The criteria adopted for

the se lec t ion cover var ious aspects of

hum an deve lopm ent and r ep roduc t ive

heal th .

A ccord ing ly , t he f i r s t JR D Ta ta

Memorial Awards were ann ounced on J uly

29, 1997 and were given to the winning

State and districts by the Prime Minister

of India, in a function organised by the

Foundation on 13th November 1997.

The first JRD Tata Memorial Award

for the best performing State was given to

Kerala. Awards for the best performing

dis t r ic ts were given to three dis t r ic ts ,

namely, Palakkad in Kerala (in the large

population size category), Toothukudi in

Tamil Nadu (in the medium population

s i z e c a t e g o r y ) a n d K u r u k s h e t r a i n

H aryana ( in the sm a l l popu la t ion s i ze

category).

T h e s e c o n d J R D T a t a M e m o r i a l

Awards were a nn ounced on 28th July 2000

and were given to the winning state and

districts by the Union Minister of Health

an d Fa mily Welfare in a fun ction organ isedby the Foundation on 3 rd January 2001.

The second J RD Tata Memorial Awar d

for the best performing State was given to

T a m i l N a d u . A w a r d s f o r t h e b e s t

performing districts were given to three

districts, namely, Chennai in Tamil Nadu

(in the large population size category),

A l a p p u z h a i n K e r a l a ( i n t h e m e d i u m

population size category) and Jorhat in

A s s a m ( i n t h e s m a l l p o p u l a t i o n s i z e

category). Awards were also given to the

best performing district in the not so good

performing states. In this category, the

distr icts of Dehradun in the then Uttar


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P r a d e s h , P u r b i S i n g h b h u m i n t h e

ers twhi le B ihar and Cut tack in Or issa

were adjudged the winners.

The third JRD Tata Memorial Award

for the best performing st at e was given by

V ice Pres iden t o f Ind ia to H im acha l

Pradesh on November 7, 2003. Awards for

the best performing districts were given

to three districts, namely, West Godavari

i n A n d h r a P r a d e s h ( i n t h e l a r g e

population category), Churu in Rajasthan

(in the medium population category) and

Lahu l & Spiti in Hima chal Pra desh (in th e

small population category). Awards were

also given to the best performing districts

in the not so good performing states. In

this category, the districts of Ri Bhoi in

M e g h a l a y a , R a n c h i i n J h a r k h a n d a n d

Bhagalpur in B ihar were adjudged the

winners.


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Fourth JRD TATA Memorial Awards, 2008

Technical Advisory Committee

ATechnical Advisory Committee

(TAC) was formed, comprising

exper ts f rom diverse academic

a f f i l i a t i ons . The TA C gu ided the

Foundation in selection of indicators and

appropriate methodology for the selection

of state level awards.

Dr. A.K. Shiva Kumar , Senior Advisor,

U N I C E F , w a s t h e c h a i r p e r s o n o f t h e

committee. The other members were:

Dr. P.M. Kulkarni , Professor, Centre

for Study in Regional Development

(CSRD), Jawaharlal Nehru University,

New Delhi.

D r . S a r a s w a t i R a j u , P ro fes so r ,

C e n t r e f o r S t u d y i n R e g i o n a l

D e v e l o p m e n t ( C S R D ) , J a w a h a r l a l

Nehru University, New Delhi.

D r . F a u j d a r R a m , D i r ec to r and

S e n i o r P r o f e s s o r , I n t e r n a t i o n a l

I n s t i t u t e f o r P o p u l a t i o n S c i e n c e s

(IIPS), Mumbai

Award Committee

A h igh l evel Aw ard C om m i t t ee w as

constituted to go into the issue in depth

and set st andar d and ground rules for th e

awards .

Ms. J u s t i c e Le i la S e th , Former Chief

Justice of Himachal Pradesh and member

of the Governing Board of PFI, was the

Chairperson of the award committee for

the year 2008.

The other members were:

D r . M . S . S w a m i n a t h a n , no t ed

Ag r i cu l t u r a l S c ie n t i s t , M a g s a y s a y

A w a r d w i n n e r , C h a i r m a n , M . S .

Sw am ina tha n R esea rch Founda t ion

and Chairman, Advisory Council, PFI.

Mr. B. G. Deshmukh , former Cabinet


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S e c r e t a r y a n d V i c e C h a i r m a n ,

Governing Board PFI.

Dr. Abid Huss ain , former Ambas sad oro f I n d i a i n U S A a n d M e m b e r ,

Governing Board, PF I.

Prof. K. Srinivas an , former E xecut ive

Director , PFI and former Director ,

International Institute for Population

Sciences, Mumbai.

Mrs. Nirmala Buch , I.A.S (Retd.).

D r . A . K . S h i v a K u m a r , Sen io r

Advisor , UNICEF and Chai rperson

Technical Advisory Committee for the

Tata Award, 2008.

Dr. P. M. Kulka rni , Professor, Centre

for Study in Regional Development

(CSRD), Jawaharlal Nehru University,

New Delhi and Member , Technical

A dvi so ry C om m i t t ee fo r t he Ta ta

Award, 2008.

Mr. A. R. Nanda , Executive Director,

PFI .


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The MethodologySta te

For the selection of states for the

4th JRD Tata Memorial awards, it

w a s d e c i d e d b y t h e a w a r d

com m i t t ee to i ns t i t u t e tw o s t a t e l eve l

awards, one among the bigger population

category(popula t ion of 10 mi l l ion and

a b o v e ) a n d a n o t h e r a m o n g s m a l l e r

popula t ion ca tegory(popula t ion of lessthan 10 million).The selection of the states

for the state level award 2008 has been

done on the basis of 14 indicators, for

which data were compiled from various

published sources. These indicators were

f ina l i zed on the bas i s o f

r ecom m enda t ions o f t he Techn ica l

Advisory Commit tee . These indicators

have a s t rong bear ing on reproduct ive

hea lth, gender equity, family plann ing

and fertility levels of the population.

W h i l e s e l e c t i n g t h e 4 t h J R D T a t a

Memorial Awards for the states, i t was

decided by the award committee to defer

t h e d i s t r i c t l e v e l a w a r d s t i l l t h e

availability of next round of DLHS data

as due to large reorganization of districts

t h e c h a n g e w a s n o t a c c e s s e d w h i l e

selecting the best districts.


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Ind ica tors

Sl. No. In dicator Sou rc e

1 Wom en (20-24 yea rs) m ar ried befor e a ge 18 NF HS II & III

2 CP R (Con tr acept ive P reva len ce Ra te)

any methods NFHS II & III

3 Fu ll Immuniza t ion NFHS II & III

4 TFR(Tota l Fer t ilit y Ra te) NFHS II & III

5 At lea st 3 AN C(An te-n at al ch eck u ps) visit s N FH S II & III

6 Safe Delivery NFHS II & III

7 % Ch ildr en un derweigh t(weigh t for age) NFHS II & III

8 IMR (Infant Morta lity Rate) SRS (Sample Regist r a t ion

System), 1999 and 2005

9 Under Five Morta lity Rate Indirect Est imates, Census 2001

(Male/Female Ratio)

10 Child Sex Ratio(0-6 years) Census, 1991 and 2001

11 Gir ls Sch ool At ten da nce Ra te (6-14 yea rs) Cen su s, 1991 a nd 2001

12 F em ale You th (15-24 yea rs) Lit er acy Ra te Cen su s, 1991 a nd 2001

13 Literacy Rate (7 and more years) Census, 1991 and 2001

14 P la n ned Exp en dit u re on Socia l S ect or ,1997 N at ion a l H u ma n Develop men t

and 2004 Repor t ,2001 and Sta tist ica l

Abstra ct India,2001


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Sources of Data

The first seven indicators have been derived from the last two rounds of the National

Fam ily Health Su rvey (NFHS -II & III). The dat a on child sex ra tio, girls school at tenda ncerate, female youth literacy and literacy rate are from the Census of India 1991 and 2001

an d IMR is from th e SRS. The M/F (Male/Fema le) ra tio of un der five mort ality is based on

the indirect est imate from 2001 Census by Brass meth od. Social Sector includes education,

health, water supply and sanitation, urban development, information and welfare & labour.

Pla nn ed expendit ur e on social sector for t he year 1997-98 is an a vera ge of 1996-98. Similar ly,

planned expenditure for the year 2004-05 is an average of 2003-06.

As data are compiled from different sources, the base year and final year are not thesame for all the four teen indicators. Efforts have been made to compile data for th e most

recent year a nd ma king th e indicat ors compa rable. The base an d fina l year s of the different

state level indicators are as follows:

Sou rce Base Ye ar Final Year

Censu s 1991 2001

NF H S 1998-99 2005-06

SRS 1999 2005

Na tion al Hu ma n Developmen t Repor t & St at ist ica l 1997-98 2004-05

Abstract, India,2001


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Selection of the Best Performing State

Step 1 :

At first step, as it has been followed by UNDP for Human Development Index (HDI)

each variable is converted into an index ranging from 0 to 100. The index is computed as:

For pos i t ive ind icators (like use of family planning and utilization of ANC) :

Index =(State value - Minimum Value)

x 100(Maximum value - Minimum value)

For negat ive ind icators (like TFR and IMR) :

(Maximum valu e Stat e value)

Index = x 100

(Maximum va lue - Minimum value)

Step 2 :

Secondly, a composite index is computed for base year and final year on the basis of

th ese fourteen indices. This composite index is the simple avera ge of four teen in dices.

Step 3 :

Thirdly, a score is obtained for each state by combining the recent levels and changes

over the base and final years in the composite index in the ratio of 1:4.


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The Winners

After final ranking of the nineteen

bigger states (population of 10

million and above) on the basis of

composite index, Chha tt isgarh emerged

a s t h e b e s t s t a t e a n d a m o n g t h e t e n

smaller states (population of less than 10

million) Sikkim emerged as t he best st at e.

Chhattisgarh got a high score among all

the bigger states in the composite index

as t he chan ge is observed to be the highest

among all the 19 bigger states. Similarly

among 10 smaller states, Sikkim emerged

as the w inner s t a t e , a s t he change in

between the base year and the final year

for Sikkim is observed to be the highest.


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Profile of the Winners

The bes t per forming Sta tes have

t h e i r d i s t i n c t c h a r a c t e r i s t i c s ,

which have led to their success.

These relate varyingly to the historical

past, the geographical location, the ethnic

composition, the social structure, political

c o m m i t m e n t t o d e v e l o p m e n t s u c h a s

popu la t ion po l i c i e s , bu reauc ra t i cefficiency and other determinants which

contribute to the achievement . A stu dy of

some of these factors would be rewarding

for other comparable areas.

Winner among Bigger States

The 4th J RD Tata Memorial awards for

exece l l ence in r ep roduc t ive hea l th &

population programmes for the year 2008

is own by Chhattisgarh. The State with a

score of 115.8 ranked f i rs t among the

bigger states, fol lowed by Rajasthan &

Andhra Pradesh with scores of 103.5 &

100.6 respectively.

Chha tt isgarh is one of the bigger stat es

of India with a populaiton of about 21

mil l ion persons according to the 2001

Census. Chhat tisgarh was carved out from

Eastern part of Madhya Pradesh and the

State of Chhattisgarh came into existence

on 1st November 2000 as the 26th states

of the Union of India. The State has mades ign i f i can t s t r i des in deve lop ing an

educational an d health infrastr ucture an d

t r a n s p o r t a n d c o m m u n i c a t i o n

networks.These advan ces ha d a significan t

im pac t on the soc io -econom ic and

demorgraphic status of the state.

C h h a t t i s g a r h r a n k s f a v o u r a b l y i n

many of the indices used to determine the

performance of reporduct ive and chi ld

h e a t h p r o g r a m m e s i n t h e s t a t e s .

Chhatt isgarh has made improvement in

almost all th e indicators considered for t he

4 t h J R D T a t a M e m o r i a l a w a r d . F u l l


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immun izat ion for the sta te impr oved from

20.0 in 1998-99 to 48.7 in 2005-06. Similarly

for at least three ANC visits, the figure

got a boost from 33.2 in 1998-99 to 54.2 in

2 0 0 5 - 0 6 . T h e s t a t e h a s a l s o s h o w n

improvement, in safe delivery, children

underweight and infant mortality rate.

Winner among Smaller States

Sikkim a ttained sta tehood as the 22nd

stat e of the Indian Union in 1975. It is oneof the smaller states of India. It is having

population of half million according to the

2001 Census. Among the smaller states

(popu la t ion o f l e s s t han 10 m i l l i on ) ,

Sikkim ha s done well in relation to all the

indicat ors considered for t he 4th J RD Tata

Memoria l award. The s ta te has shown

r e m a r k a b l e i m p r o v e m e n t i n t e r m s o f

couple protection rate (53.8 to 57.6), full

immun ization (47.4 to 69.6), at least t hree

ANC visits (42.6 to 70.1) in between two

s u c c e s s i v e N a t i o n a l F a m i l y H e a l t h

Surveys (1998-99 and 2005-06). The state

has a lso made substant ia l reduct ion in

infant mor ta l i ty ra te a nd percentage of

c h i l d r e n u n d e r w e i g h t . T h e c h a n g e i n

between the overall index of final year and

base year was found to be highest for theSta te of Chha ttisgar h (13.5) among bigger

sta tes. For Sikkim chan ge was found to be

second highest (9.6) among sma ller sta tes.

This resu lted in selection of th e two stat es

u n d e r b i g g e r a n d s m a l l e r p o p u l a t i o n

c a t e g o r y s t a t e s f o r t h e 4 t h J R D T a t a

Memorial Awards.


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Sikkim on the Path of Development

This article is less about numbers

a n d m o r e a b ou t i d ea s a n d t h e

political economy it captures the

essence of the direction of development,

the policy instru ment s an d indeed th e flowof Government funds to the people of

Sikkim and its impact, as ha s been studied

by independent ins t i tu t ions . There are

many discrepancies and downsides, but as

all development is about tradeoffs, these

a r e b e i n g h a n d l e d a l b e i t i n a w a y b y

acknowledging their import.

Sikkims leap int o the 21 st Century

Sikkim joined the na tional mainstr eam

as the 22nd State of the Indian Union in

1 9 7 5 . S i n c e t h e n i t h a s t a k e n u p t h e

development in total coordina tion with t he

p o l i c i e s s e t o u t b y t h e P l a n n i n g

Commission of India, participating fully

f rom the 5 t h Five Y ear P lan onw ards .

Today it has attained spectacular growthin an atmosphere of peace and communal

harmony, growing at a per capita GSDP

of Rs. 26,215 (2004-05)1 and ma intaining

ra te of growth a t about 10 percent per

annum.

So the ups and downs of development

t h a t h a s p e r s i s t e d i n I n d i a h a v e a l s o

affected t he St at e. Sikkim s accelera ted

growth in th e last ten yea rs is indeed visible.

Whether it ha s been done in a significan tly

different ma nner t han others is a matt er of

debate.

1 North-East ern Region(NER), Vision 2020

*Deputy Chairman, Sikk im S tate Planning Commission, Government of Sikk im, Tashiling, Gangtok 737101, Sikkim

P.D. Rai*


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Sikkim is always described in glowing

terms by nearly all visitors who happen

to com e he re on one p re t ex t o r o the r .

They find this place gloriously calm. The

hills and mount ains da zzle. The peace and

t ranqui l l i ty thr i l l . However , they a lso

report a sudden disquiet especially after

t h e y h a v e v i s i t e d N a t h u l a a n d g o n e

thr ough the ma jor par t of Gangtok in some

detail. Pinpointing it may not be politically

cor rec t . So w e hea r sen tences l i ke

Gangtok could h ave been bet ter plann ed!

or The traffic is quite something!

The Sta te i s , geopol i t ica l ly , h ighly

stra tegic even though it is so small an ar ea

in the Eastern Himalayas. The mountain

passes of Je lepla and Nathula make i t

prized in terms of access to the Tibetan

Plateau and to the economic, social and

political exchanges. It offers the shortest

route to Lhasa, the capital of Tibet, from

Kolkata an d its sea ports a mere 1350 Km

or so. The British conquer ed Sikkim by th e

late 1800s for this very strategic reason

and Sikkim became part of India in 1975.

Always a bone of contention with China,

Sikkim is n ow acknowledged as par t of India

by that country but not after extracting

some major concessions. Tibet has been

recognized by India as part of China. Dalai

Lama is not to be highlighted, not even his

vision of a free autonomous Tibet under

China.

Size Matters

The St at es lan d size is miniscule. With

a population of a little more than half a

million it is sparsely populated, one of the

specifici t ies of mountain communities.

Indeed access to and for villagers is always

a challenge. Sikkim h as bu t only 7 percent

land out of our 7096 Sq Km which can be

made habitable by world standards2 . The

rest is too steep or wilderness . Litt le wonder

th en th at it h as over 80 percent of th e land

as Forests. Forest cover is increasing and

2 Surbana International Consultants, Strategic Urban Plan Report 2040, Singapore commissioned by GOS


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at about 40 percent. Sikkim is proud of th is

great b iodivers i ty reserve cont r ibut ing

significan tly t o India s overall r eserve.

Sikkims forests ha ve been regenera tedaf ter pol ic ies which can be considered

perhaps the greenest in India. Two most

important initiatives of the Government

have been the G reen M iss ion and the

removal of graziers f rom high a l t i tude

p a s t u r e s , s i n c e t h i s w a s b e c o m i n g

unsu sta inable. Alterna tive livelihoods h ave

been provided though implementation is

still an issue.

How can a small mounta in state ma ke

it thus far? Only from generous plan and

non plan fun ding from Governm ent of India .

Sikkims own resources ar e limited an d

only eco-tour ism an d Hydr o power is th e key

to generate any r eal level of State resources.If and when Nathula pass opens up fully

for tra de then th e Stat e will ha ve to find a

mechanism of getting a share of the trade

surpluses that will inevitably accrue. So,

Sikkims an nua l plan size and n on plan

component is main ly fun ded by assista nce

from the Centre. The State is a special

category one. Fur th ermore, in 2002 Sikkim

was assimilated into the North Eastern

Council as the eighth member. This hasopened up another pool of assistance from

th e NEC a s well as th e non-lapsa ble pool of

resources of Government of India through

the Ministry of Development of North-

Eastern Region (DONER).

Not all sections of society ar e ha ppy with

the Hydro Power projects that are being

i m p l e m e n t e d i n t h e S t a t e . H o w e v e r ,

dialogue has always been welcomed with

dissenters. Many projects have then been

modified or degra ded suita bly to take int o

accoun t t he conce rns . H ow ever , i t i s

importan t to realise that th ere is just ifiable

opposition to the implementation of these

projects. On th e other ha nd Sikkim ha s verylittle options if it wants to become free of

dependence on central funding, even for

running the Government machinery on a

d a y t o d a y b a s i s . T h e o v e r h e a d s o f

Governance are indeed very high!

The objective is tha t by 2015 the Stat e


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should be able to ta ke care of the resource

requ i r em ent s t h rough a fo rem ent ioned

routes.

Political Powe r Facilitation

The Government in th e Stat e is formed

by the leader of the Sikkim Democratic

Front Party, Dr. Pawan Chamling. Now a

very well known politician in India and is

also known as the green est Chief Minister 3 .

The recent IFMR/CDF 2008 awar d of being

the second in t e rm s o f Env i ronm enta l

Sust ainability Index (ESI) among 28 States

in In dia is in line and corr elates positively

with th e green policies of the St ate.

Chief Minister Cha mling has been at the

helm of affairs for the last 14 years a nd int o

concluding h is th ird t erm in office4 . Political

stability ha s led to an ena bling environmen twhere deepening and indeed widening of

reach of var ious schemes of Sta te and

Central Government has been facilitated.

The State also has the lowest crime rate

an d so today it is best known for being th e

most peaceful State in India. Even though

it is strategically placed with eyeball to

eyebal l contact wi th China (Tibet ) theintegra t ion wi th the mains t ream is not

really a problem.

In response to th e wishes of th e people

an d dur ing this t ime in office th ere ha s been

a huge fillip given to rural development,

health and universalisation of education.

Right from the st art about 70 percent of th e

Plan allocat ion has been used in the villages

of Sikkim. The r ura l population is over 85

percent and so in many ways this is truly

targeted spending.

Just recently Dr. Chamling personally

r e c e iv e d t h e R a s h t r i y a N i r m a l G r a m

Puraskar , for 100 percent coverage in

sanitation within the State. This is a clearindication tha t th ere is both depth an d reach

in terms of scope of the projects that are

being car ried out in th e Stat e. This is aided

in part by the network of roads that have

3 First Acknowledged by Centre For Science & Environment (CSE) survey published in Down To Earth Feb 15, 1999 issue4 Power to th e People: 14 Glorious Years of the SDF Government 1994 2008, GOS pu blication


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been built up over the last thirty years.

Being a mountain State it tries its best

to fit th e progra ms offered from Delhi to th e

mountain issues of the State. Mountainspecificities ar e un ique. Only recently ha ve

mounta in i ssues have been given some

thought and mind space in the Planning

Commission. Is there now scope for better

policy mechanisms tha t can be worked out

un iquely for moun ta in Sta tes? This question

is going to receive further impetus in the

time to come as Government grapples with

an inclusive growth agen da.

So, with a strong leadership and clear

cut people-centric direction, policies have

been formu lated t o enable opport unities for

people. Access to funds and programs, for

remote vil lages, are also facil i tated by

respective MLAs and Panchayat leaders.The way democracy has panned out here

makes th is poss ible . This accounts for

much of the appreciation that Sikkim is

cu r ren t ly r ece iv ing in the f i e lds o f

e n v ir o n m e n t m a n a g e m en t , h e a l t h a n d

education. The downside is that the rural

people of Sikkim are far more dependent

on Government largesse . This i s not ahealthy situation for sustainable growth.

Policy Planning Initiatives

Sikkim was perhaps one of the early

a d o p t e r s o f a s s e s s i n g i t s H u m a n

Developmen t In dex in 20015 . Sikk ims HDI

is close to the national index if not better.

I t was 0 .532 in 1999 and should have

i n c r e a s e d i n t h e l a s t e i g h t y e a r s .

Furthermore, Government commissioned

the making of a Vision Document in 1999

to understan d th e goals that needed to be

achieved over a sustained period of fifteen

years. Much of it ha s been a chieved though

all have not been fulfilled and lots morework is still to be done.

One of th e key initiatives ha s been for

Government to set out the direction for

g r o w t h . T h i s w a s d o c u m e n t e d i n t h e

5 Sikkim Huma n Development Report 2001, Mahendra P . Lama


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Sikk im: The P eoples Vis ion Repor t

aut hored by Ashok K. Lahiri et al from t he

NIPF P, New Delhi.

An accelerated path of eco-friendlysusta inable development th is was t o be

Sikkim s growth pa ra digm. The a im is to

build on t he st at es str engths, benefit from

post-liberalisation spurt in growth in the

rest of the coun tr y and, with judicious u se

of modern technology, in less than two

d e c a d e s , l e a v e t h e c e n t u r i e s o f

underdevelopment rapidly behind.6

A n o t h e r i m p o r t a n t a s p e c t w a s t h e

stabil ization of population. This was to

achieve by 2050 const an t popula tion of ha lf

a m illion. This goal however seems u nlikely

to be ach ieved . Even a t t ha t t im e the

dem ograph ic d iv idend has been w e l l

articulated in the document. We see someof it playing out t oday as we find th at man y

of the young people are working in al l

different parts of the country and abroad

i n t e l e v i s i o n a n d m e d i a , B P O a n d I T

i n d u s t r y a n d e m e r g i n g f i n a n c i a l

bus inesses . These auger s w e l l fo r a

pronounced impact back in Sikkim in the

years to come. Sikkim will reap its shareof this dividend but a policy to facilitate

this will have to be crafted out.

The means for achieving the overall

v i s io n h a s b e e n w e ll a r g u e d i n t h e

document. This definitely formed the basis

on which mu ch of the growth ha s ha ppened.

Policies of Government were aligned to the

means as is thought through and stated.

The Government a lso const i tu ted a

State Planning Commission and requested

Pr of. Muchkund Dubey7 to take t he post of

Deputy Chairman of the Commission in

2002. He led the team for two consecutive

th ree year ter ms. The Commission h as been

able to make planning in the State moreprofessiona l an d capa ble. Capa city building

of the officers was also done especially in

bringing out much needed reports. This

has al lowed for much debate and better

6 Sikkim Th e Peoples Vision, NIP FP , page 207 Former Foreign Secretary, GOI



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articulation of needs of the people. One of

t h e b e s t t h i n g s t h a t c a m e o u t o f t h e

Commission was the devolution of powers

and functions to the Panchayats. Districtplann ing bodies have been constitut ed and

bottom up approach of planning is now a

real i ty . Sikkim has today achieved the

status of being recognised as the 3 rd best

S t a t e t o im p l e m en t t h e 7 3 r d a n d 7 4 t h

Amendments of the Constitution of India.

In fact more th an 40 percent of women n ow

part icipate in th e Pan cha yati Raj system of

local governa nce.

M e a n w h i l e , t h e M i l l e n n i u m

Development Goals (MDG)8 i s another

im por t an t s e t o f goa l s t ow ard w hich

Government works in synchronisation for

achievement by 2015. Sikkim is doing better

than most of the other States in achievingth ese goals. Some of them h ave alr eady been

achieved. More research and surveys will

be done in the course of the next one year

to ascertain the exact position and status

of the State.

Future Challenges

Future challenges faced by Sikkim in

the short a nd medium term relate to some

fundamental issues facing India and theworld today. New economic outlooks will

ha ve to be factored in even a s globalisa tion

and its attendant problems kick in. Then

th ere is t he whole issue of climate chan ge

and making carbon friendly if not carbon

neut ra l policy fram eworks.

Food security can be looked at the first

major challenge in the short term leading

to lar ge scale vulner abil i ty of Sikkims

population. Since about 75 percent of our

food is imported the State faces the twin

cha l l enges o f i nc reas ing dom es t i c

production as well as importing food with out

hindrance. We have the national highway

31A as the only reliable entry to Sikkim.T h i s i s n o t w i t h o u t h a s s l e s f r o m o u r

n e i g h b o u r s , W e s t B e n g a l a n d t h e

G o r k h a l a n d a g i t a t o r s . F u r t h e r m o r e ,

severe landslides also have contributed to

t h i s e s p e c i a l l y a f t e r t h e s t a r t o f t h e8 United Nations MDG adopted by GA 2000 India Country Report 2005



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construction of Teesta Stage 6 low dam

project in West Bengal.

Access is also a m ajor issue when tr ying

to bring high value tourists into the State.The long route from Delhi or Kolkata and

then a four h our jour ney puts ma ny people

off. People would like to come over the

weekend and holiday an d get back as soon

as possible, especially those who can afford

to pay rather large sums. This has to be

explored as a market option and tourism

positioning in th e years to come. Sikkim will

have its own a irport by 2012.

The th i rd cha l l enge i s t ha t S ikk im

canno t g row in i so l a t ion . The r eg ion

adjoining us also has to prosper in equal

measure. For this to happen, the tussle

between the Darjeeling political movement

f o r a u t o n o m y a n d t h e W e s t B e n g a lGovernmen t h as t o be sorted out am icably.

The problem which is simmering is ha ving

a huge negative impact in the region as a

whole.

T h e f o u r t h c h a l l e n g e i s a b o u t t h e

Nat hula P ass an d how to make commercial

sense of i t a l l . This i s where there are

different schools of thought. There is the

perception of security and how does India

trade with our neighbour. The question ofTibet is always a ticklish one. Then there

are issues of scaling up th e items an d ha ving

movement of people for tourism. The final

th ought in t his is, of course, are t he people

of Sikkim ready? There is great concern on

all front s a nd so Governmen t of Sikkim is

i n d e e d t a k i n g a c a u t i o u s a p p r o a c h .

However, in the fut ure this pa ss will be one

which will perh aps change Sikkim forever.

The fifth challenge is to achieve a ma jor

breakt hr ough in t he qua lity of delivery and

a c c e s s o f e d u c a t i o n a n d h e a l t h . T h e

Government and t he Plan ning Commission

is seized of this all important issue facing

the de l ive ry sys t em of G overnm ent .Governance will have to take this up with

greater focus in the next five years. One

of the ways to deliver greater coverage for

health is to usher in Universal Financial

Inclusion, for the entire population of the

S t a t e u s i n g h i t h e r t o u n a v a i l a b l e



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technologies . This would enable bank

accoun t s t o be opened up fo r eve ry

household. This would be very useful for

cutting down on middlemen for deliveringpensions a nd pa yments for NREG Scheme.

Furthermore, all families would be linked

to some form of health and life insurance

as well. There is a lso th e issue of ensur ing

that the civil society plays a constructive

r o l e i n t h e f u r t h e r i n g q u a l i t y

t r ans fo rm a t ion tha t i s r equ i r ed in a l l

spheres of social development. There are

high hopes tha t t his will be possible but th e

key w ould be to de l ive r h igh qua l i t y

p r im ary educa t ion . M oreover , m ak ing

enough oppor tuni t ies avai lable for the

youth of Sikkim to be able to come back

a n d c o n t r i b u t e t o t h e g r o w t h a n d

development of the State is a must.Finally, there is the greatest challenge

of fiscal tr an sforma tion. From a dependent

State on Central funds and grants to that

of being indepen dent on a fiscal ba sis would

be possible by 2015. Till then t he Cent re ha s

to prime the pump. Sikkim would be able

to har ness enough of Hydro Power as well

as m ake other fiscal arr angements to be able

to pay for i ts development agenda on a

sustainable basis.



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Chhattisgarh State Map Showing Districts

Map not to scale



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Achievements of Chhattisgarh duringthe Last DecadeT. Sun dararam an*K.R. Anto ny**V.R. Ram an***

expenditure, that improved the delivery

of quality h ealth services an d in improving

the public health infrastructure and above

all that increased commun ity awareness

and support for health programmes.

O f t h e v a r i o u s h e a l t h o u t c o m e

indicators, only Infan t Morta lity Rate (IMR)

and death rates a re measurable and r eliable

o n a n a n n u a l b a s i s a n d t h e s e s h o w e d

significant declines in rural areas- thoughthey remained re la t ively unchanged in

urban areas where th ese reform m easures

had not reached. In 2003, the Rural IMR

was as poor as 77 per 1000 live births

Introduction and Summary

Chhattisgarh is among the newest

s t a t e s o f Ind ia , fo rm ed on 1 st

November 2000, by carving it out

fr o m t h e t h e n M a d h ya P r a d e s h S t a t e .

Throughout these seven years the stat es

hea l th sec to r has r ecorded ve ry good

improvements , th ough, given t he ba se-lines

with which it st art ed up, it has still a long

way to go to catch u p to na tional averageson most parameters . One of the major

contributors to this a dvance were th e health

sector reforms in the state that led to a

s ign i f i can t i nc rease in pub l i c hea l th

* Executive Director, National H ealth S ystem R esource Centre, N ew Delhi** Director, St ate Health R esource Centre, Chhattisgarh

*** Faculty, State Health Resource Centre , Chhattisgarh



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whereas presently it is 62 which is equal

to the national average.

Table-1: Mortality Trends in Chha ttisg arh

Indicators Chhattisgarh

2003 2007

Infant Mortality Rate( Tota l) 79 61

Infant Mortality Rate( Rura l) 95 62

Infant Mortality Rate (Urban) 49 50

Crude Death Rate( Tota l) 8.5 8.1

Crude Death Rate (Rural) 9.1 8.5

Crude Death Rate (Urban) 7.1 6.3

S ource: S RS , GoI

On service delivery indicators the most

rel iable are the National Family Health

Survey (NFHS) data and a compar ison

between th e NFH S-2 done in 1998-99 (the

figures for Ch hat tisgarh were pulled out of

Madhya P radesh sample an d were su fficient

for the purpose) and the NFHS-3, done in

2005-06, fur ther supports su ch a tren d.Thus complete immunisat ion r ates m ore

than doubled ( f rom 21.8% to 48.7% ) ,

children gett ing all th ree polio vaccines rose

from 57% to 85% and antenatal coverage

went up also from 57 % to 89%. The other

p a r a m e t e r t h a t c o r r e l a t e s c l o s e l y t o

declining IMR was the community level

achievement in breast feeding. In all aspects

of brea st feeding in colostru m feeding, in

early ini t iat ion of breastfeeding and inexclusive breastfeeding, the state is now

well above national a verages. Both NFH S-

3 and Distr ict Level Household Survey

(DLHS) and the independent coverage

evaluation survey done by UNICEF bears

th is out . DLHS- 3 not only confirms th ese

general tren ds but shows further steep

gains in some ar eas. For example, children

receiving measles vaccine went up from

21.1% in 2002-03 to 79.9% in 2007-08. This

outcome was a result of comprehensive

community level health education drives

tha t th e state government was able to gear

up through various measures like folk art

based commun icat ion pr ogra mm es followedup together by health depart ment st aff and

th e centr al role played by th e Mita nin.

Al so m a lnu t r i t i on m ade a m odes t

decline, much less than the improvement

in service parameters . More impor tant

c h i l d m a l n u t r i t i o n s t i l l r e m a i n s



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Comparison of Key trends under NFHS-2 and NFHS-3



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im perm iss ib ly h igh w i th ove r 52% of

children below 3 year s being ma lnourished.

Though th is improvement , reflects a m uch

be t t e r i n t e r depa r tm en t a l coord ina t ion

and better access to services, th e challenge

of addressing th e social determ inan ts of

such high malnutrition and a much more

effective outreach to these children remain.

I m p r o v e m e n t i n C o n t r a c e p t i o n

preva lence rat e was also good, but not good

enough to contain the birth rate, which is

now at 26.9. Much of the p roblem is in a ccess

to services as un met needs rema in at a h igh

20.9% (DLHS-3).

NFHS-2 NFHS-3



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Apart from above, the state was able

to record major achievements in disease

control - like:

YAWS- Disease of the underdevelopedareas- has been el iminated from the

s t a t e a n d i t i s m a r c h i n g t o w a r d s

eradication. There were 15 identified

cases of YAWS in the state in 2003,

whereas within a year , this was brought

down to zero. The Chh at tisgarh effort s

on this has been highly appreciated by

World Hea lth Orga nisation (WHO) and

our officials are now been invited to

suppor t t he Y A W S opera t ions in

coun tries like In donesia.

Th e Polio scene ha s a lso been controlled

very well during t his period. During t he

initial days of the st at e, a th reat of polio

w as p reva len t a s som e cases w erereported in the state during that time.

With effective surveil lance systems,

m a n a g e m en t a n d i m m u n i s a t i on

i n i t i a t i v e s , t h e d i s e a s e h a s b e e n

prevented as much as possible and no

case has been reported till date.

Leprosy is another disease which is

reaching th e eliminat ion st age. In 2003,

the pr evalence rat e was 7.20 per 10000

populations which have been broughtdown to 1.99 thr ough persistent efforts.

In 6 out of 16 districts national goal of

less than 1 prevalence rate has been

achieved and t he rema ining districts are

moving quickly to achieve this. Though

better case detection cri teria would

probably show a higher prevalence ,

th ere is no denying an overall decrease

an d an almost complete absen ce of new

leprosy caused deformities.

In TB control, Malaria control and in

H IV /A ID S the p rogram m es inch

forwar d. The TB control programme,

is now extended to a l l d is t r ic ts . In

Malaria cont rol, th e major achievementt h e A n n u a l P a r a s i t e I n c i d e n c e

(API), which wa s 10.6 in 2003, ha s been

brought down to 5.6, and ep idemics with

deaths which were almost an annual

feature in the past are much less now.

Sti l l , three of the southern distr icts



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w h e r e A P I i s h i g h a r e c r i t i c a l .

Blindness control too has done well

and the performance is comparable to

the best amongst the stat es. A special programme to control Sickle

C e l l A n a e m i a , a spec i f i c d i sease

prevalent in th e stat e is also being ru n.

Operational research, mass screening

a n d c o u n s e l l i n g a s w e l l a s o t h e r

measures initiated where support from

Red Cross society is a lso availed.

One of the areas where the state has

been most challenged and constrained

is in the improvement of institutional

deliveries un der th e Janani Suraksha

Y o j a n a ( J S Y ) . T h e i n s t i t u t i o n a l

delivery level has stagnated at about

16% and th i s i s r e f l ec t ive o f t he

const ra ints the s ta te i s fac ing wi th

facility based secondary services. With

t h e i m p r o v e m e n t i n f a c i l i t i e s a n d

hu man resource becoming a vai lable

w i t h i n a y e a r o f t w o , e v e n t h e s e

p a r a m e t e r s s h o u l d s t a r t s h o w i n g

considerable improvement .

Innovations that have contributed to

Chhattisgarhs achievemen ts.

When th e achievement of Chha tt isgarh

are judged, they need to be seen against abaseline. At the time of its formation about

40% of the sanctioned posts were vacant.

And each facility had less than one thirds

of th e sta ff it should ha ve by Indian P ublic

Health Standard (IPHS) recommendations

an d furth er a lmost one fifth of sub-center s,

one third of Public Health Cent res (PHCs)

were not created at all. Indeed the lack of

infrastr uctur e and development was one of

the reasons for creating a new state. The

new state had also got to create its own

institutional framework for management

and training of health staff and expand its

educational capa cities.

That the st ate was a ble to do all this was

largely due to innovative and indigenous

planning efforts linked to a wide variety of

p a r t n e r s h i p s a n d t r u s t i n com m u n i t y

processes. Not all innovations and efforts

have given immediate results and especially

in impr oved ser vice delivery in facilities th e



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states efforts must be strengthened and

sustained for one year before its impact

would be measurable. We describe below

some of th e key inn ovat ions- ma ny of which

we note are today mainstreamed into the

Nat ional Rur al Health Mission (NRHM) at

the national level . Indeed the focus on

strengthening public health systems as the

cen t r e -p i ece o f hea l th sec to r r e fo rm ,

relegating public private partnerships to a

supplement ary r ole, a major featu re of the

N R H M , w a s t h e a p p r o a c h t h a t

Chhattisgarh took at a t ime when tha t had

not yet become the major framework of

reform.

Optimising the Community Leve l

Measures- The Mitanin P rogramme:

The Mitanin Scheme of communi ty

health volunteers, which began with

much hesitation and teething troubles

ha s grown over the las t few years in to a

state level programme which serves as

an inspiration and an example for the

en t i r e coun t ry . Today abou t 60000

Mitanins or voluntary health activists

are giving their voluntary services in

every hamlet and in every nook and

corn er of th e stat e. They ha ve undergone

10 rounds of trainings including one on

e s s e n t i a l n e w b o r n c a r e a n d a n

in t eg ra t ed m anagem ent o f t he s i ck

neonate and child. They provide first

level cura tive care usin g dru gs provided

as part of Mukhyamantri Dawa Peti

Scheme. Learnings from the Mitanin

Scheme have h ad a major influence on

the design of ASHA (Accredited Social

H ea l th A c t iv i s t ) s chem e under t he

N a t i o n a l R u r a l H e a l t h M i s s i o n

laun ched by Governm ent of India . Ther e

are seven important ways in which the

M i t a n i n p r o g r a m m e d i f f e r e d w i t h

earlier large scale community health

worker programmes organised by the

government. Firstly all the Mitanins

a r e w o m e n . S e c o n d l y t h e a r e a o f

coverage was a ha bitation, which m eant

less problem of heterogeneity and more

access and what is most important a

d e c r e a s e d w o r k l o a d m a k i n g



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voluntarism feasible. Thirdly selection

was by the community, but through a

defined process and facil i tated by a

trained prerak who not only ensured

tha t t he commun ity made an informed

decision but also articulated the views

of weaker sections. Fourt hly, a str at egy

where the main motivation was social

recognition and the spirit of service,

where the honorarium in the form of

incentives for specific ta sks, didnt

becom e cen t r a l t o he r w ork . F i f th ,

training was considered and recurrent

and continued activity for the entire

dur at ion of th e progra mme an d not just

an initiating event. Sixth a nd what was

important was a full t ime dedicated,

specifically trained cadre of trainer-

f ac i l i t a to r s w ho p rov ided no t on ly

tr aining, but also monitoring and mu ch

needed on the job support. And finally

man agement of the programme th rough

sta te civil society par tner ships at every

level. The pr ecise cont ribution th at th is

p r o g r a m m e m a d e t o , t h e v i s i b l e

i m p r o v e m e n t i n s o m a n y h e a l t h

ou tcom es and se rv i ce de l ive ry

outcomes, as disaggregated from other

changes happening in this period, will

forever remain difficult to determine.

However, undeniably, five years after

i ts ini t iat ion the at t endance at each

r o u n d o f t r a i n i n g c o n t i n u e s t o b e

undiminished, Mitanins in the vas t

majority of ha mlets continue to mak e

modest daily contributions to better

commu nity health with un diminished

enth usiasm, and tens of thousa nds of

women have become empowered to

a r t i c u l a t e a v a r i e t y o f h e a l t h a n d

r e l a t e d i s s u e s . T h e s e a r e i n i t s e l f

reasons for optimism and h ope an d the

programme has become a flagship for

health sector r eform, drawing n ot only

local leaders t o attend to health issues,

b u t a l s o f i n a n c e d e p a r t m e n t s t o

sanct ion more funds for the heal th

sector..



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I m p r o v i n g P e r f o r m a n c e o f t h e

H o s p i t a l s : T h e J e e v a n D e e p

Approach : In order to improve the

q u a l i t y o f m a n a g e m e n t o f t h e

g o v e r n m e n t r u n h o s p i t a l s a n d t o

c h a n g e t h e p e r c ep t i o n s o f g e n e r a l

community about the poor quality of

services in government hospi ta ls , a

p ionee r ing hosp i t a l r e fo rm schem e

cal led the Jeevan Deep Scheme has

been put in place in the state. Under

this novel scheme a more responsive,

m o r e r e p r e s e n t a t i v e , m o r e p e o p l e

o r i e n t e d a n d m o r e t a r g e t c e n t r i c

h o s p i t a l m a n a g e m e n t c o m m i t t e e s

called Jeevan Deep Samitis have been

created for every level of government

h o s p i t a l s u p t o t h e P H C . T h e s e

committees will also have the power

to r ecom m end d i sc ip l ina ry ac t ion

aga ins t non-pe r fo rm ing o f f i c i a l s .

Under this scheme, every hospital in

th e stat e will be gra ded on t he basis of

its service quality and best hospitals

will be given Jeevan Deep gold stars,

s i l v e r s t a r s a n d b r o n z e s t a r s

respectively. The best hospital in every

district will get Rs. 2 lacs as reward

for good services. Chhattisgarh is the

pioneer state to have launched such a

peoples friendly ta rget oriented scheme.

It will be a marked departure from the

old Rogi Kalyan Samitis which were

run ning th e hospitals ear l ier . Korba,

Ambikapur and Durg are Silver Star

hospitals. The Korba District Hospital

has been since thr ough a further process

of qua lity improvement been cert ified for

ISO 9001:2000- one of the very few

public hospitals in India to have been

so certified.

D e v e l o p i n g F R U f a c i l i t i e s a n d

bridging specialist gaps: the Equip

Initiative : In ter ms of closing the ga ps

in infrast ructu re, skilled manpower an d

equipment in para l le l to address ing

quality and adequacy of utilization of

services, a n ew block by block a ppr oach

has been adopted by the state. This

appr oach goes by the a cronym EQUIP -



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Enhancing Quality in Primary health

care- and i t focuses on reduction of

matern al mortality as the quality index

a r o u n d w h i c h h e a l t h s e r v i c e s a r e

ra tiona lized. 32 blocks each has been

taken up in the first t wo years and th e

entire st at e is planned t o be covered in

another 3 years. So as to address the

specialist gaps, an innovative training

programme for multiskilling doctors,

part icularly in Emergency Obstetr ic

Care (EmoC) an d Anaesthesia, ha s beendes igned which has been repl ica ted

nat ional ly now. These t ra in ings are

condu cted in 3 top medical institut ions

of th e sta te a nd so far 96 MBBS doctors

has been bui l t capaci t ies to impar t

EMoC services as well as anaesthesia.

H ow ever on ly abou t 25% of th i s

converted into functiona l First Referra l

Unit s (FRUs), due to various opera tional

constr aint s. Despite this, the n umber of

FRUs r ose sharply an d way forwar d on

th is difficult goal becam e clear . Train ing

on essential neonatal care and some

other disciplines are also started very

recently. This way the FRU service

provis ion has been marked a much

better status in the state if compared

to past- We would l ike to note that

these f ac i l i t i e s a r e now becom ing

ava i l ab le even in som e o f t hose

facil i t ies si tuated in confl ict-r idden

areas of the state.

P l a c i n g H e a l t h i n t o P a n c h a y a t s

A g e n d a - T h e S w a s t h P a n c h a y a t

S c h e m e : Th i s i s a p rogram m e tosupport local health planning and to

enhan ce Pan chyat Raj Institutions (PRI)

role in hea lth. An indicator based h ealth

& human development index has been

prepar ed for all Pan chayats of th e stat e

which is ha mlet centred so as to capt ure

even the intra -panchayat var iations. At

present, the HHDI is ready for 9141

Panchayats out of 9820 Panchayats in

the stat e. Honble Chief Minister of the

sta te ha s declared an awar d for two top

Pa nchayat s of each block based on th is

index and also provisions are made to



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support weaker Panchayats identified

under this process. The Programme is

now in the second yea r o f

implement at ion. This program me builds

on th e commu nity m obilisation initiated

by the Mitanin pr ogramme an d takes it

forwa rd into village level compr ehen sive

health planning.

Reaching out to the pe ople in every

corner- The Mobile Medical Units:

Chhatt isgarh is a tribal state where 44

% of the area is covered with forests.Reaching out to the far-flung corners of

the state for providing health services

is ma jor cha llenge. In order to overcome

t h i s c h a l l e n g e a n d t o p r o v i d e

uninterru pted health services in tr ibal

blocks, as many as 74 mobile medical

units have been operationalised in the

s t a t e . They a re p rov id ing va luab le

services in the haat baazars of tribal

blocks in the sta te.

An innovative institutional model has

been set up in the form of state-civil

society joint initiat ive, the State Health

Resource Centre (SHRC) to shape

the reform processes and to ini t iate

them wherever i t i s necessary . The

important innovation is not only that

it is partnership between government

and civil society, but also that it has

built a model of technical assistance

which is based on indigenous t echn ical

s t rength s , la rgely opera tes within a

government financial rules and what

i s m o s t i m p o r t a n t i s b a s e d u p o n

institutional capacity building and noton extern al consu ltan cy alone. Though

t h i s h a s b e e n o n e o f t h e e a r l i e s t

innovations picked up for replication,

s i m i l a r S H R C s h a v e b e e n s l o w t o

emerge, and in retrospect one begins

to appreciate the level of innovation

a n d c h a n g e t h a t s e t t i n g t h i s u p

required.

Core Improvements:

Other than these major innovations,

th ere are var ious reform milestones set

by the NRHM that have been achieved by



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this st ate as well. These are not innovations-

in that they represent well known, almost

routine measures of a functional health

d e p a r t m e n t . Y e t i t i s o f t e n t h e

implementat ion of these core mea sures t ha t

would ha ve the ma ximum impact. We list a

few of these below:

Formation of State Health Mission

a n d D r i v i n g t o w a r d s t h e N R H M

Goals: Moving towards health for the

poor, a state health mission has been

constituted under NRHM, Chaired bythe Hon. Chief Minis ter . Sta te and

D i s t r i c t a n d B l o c k p r o g r a m m e

Management Units ar e supporting the

mission activities at respective levels.

D e c e n t r a l i s e d p l a n n i n g a n d

management of resources to address

local n eeds ha s become a reality.

Major Infrastructure Expansion:

The inadequacy in number of facilities

has been met dur ing th is per iod by

san ctioning h ealth facilities: apart from

district hospitals sa nctioned a nd in most

cases built new for all districts, 17 new

Commu nity H ealth Centres(CHCs), 200

new Primary Health Centres and 874

new sub centres have been sanctioned.

B y t h i s , t h e s t a t e h a s a c h i e v e d

popu la t ion norm s fo r c r ea t ion o f

facilities except in t he cas e of CHCs. In

terms of filling the building gaps, 26

CHCs, 39 PHCs and 201 sub centre

b u i l d i n g s a r e u n d e r c o n s t r u c t i o n -

though t he vast majority of sub-centr es

still need t o be provided with a bu ilding.

During the last 3 years, Rs 20 lacs perb lock a l loca t ions a re m ade under

various schemes for refurbishment of

available buildings in all 146 blocks.

Under the ongoing European Union

S t a t e P a r t n e r s h i p , i n f r a s t r u c t u r e

development is a major focus.

Creation of the State Inst i tute o f

Health & Family Welfare(SIHFW):

A Hu ma n Resour ce Developmen t policy

for h ealth ha s been adopted and SIHFW

has been created to take forward the

implementation of this policy. A state

of the a rt building for SIH FW ha s been



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completed an d th e institut ion ha s given

a d e q u a t e m a n p ow e r a n d l og is t i ca l

support in t erms of achieving its goals.

I t i s a i m e d t h a t t h e c a p a c i t y a n d

motivation gaps among the field force

b e a d d r e s s e d t h r o u g h s y s t e m a t i c

p l a n n i n g a n d i m p l e m e n t a t i o n o f

t r a i n i n g p r o g r a m m e s i n i t i a t e d b y

SIHFW.

S a n c t i o n o f s t a f f s e t u p f o r t h e

h e a l t h d e p a r t m e n t : A revised

administrative set up was adopted in2006 under which adequate number of

posts was sanctioned in every health

facility. Though still short of the IPHS

norms, for Chhat tisgarh it was a ma jor

step forward. .

Recruitme nt of Medical officers: For

the first time after the state formation,

and almost after a period of 15 years,

449 doctors were appointed through

Pu blic Service Commiss ion, an d of th ese

250 of th em h ave joined t he ser vices. In

addit ion AYUSH d octors h ave been u sed

to fill up medical officer posts in over

1 5 0 p r i m a r y h e a l t h c e n t r e s . R u r a l

p os t i n g o f m e d ic a l g r a d u a t e s a s a

ma nda tory condit ion of consider at ion for

post gradua tion ha s also led to over 150

doc to r s becom ing eve ry yea r on a

contractual basis. In addition to all of

this all districts are empowered to fill

up vacancies on a contra ctual basis. To

expand the pool of medical officers

available for recruitment, two more

medical col leges , one in 2002 in

B i l a s p u r , a n d a n o t h e r i n 2 0 0 7 i nJ a g d a l p u r h a v e b e e n a d d e d t o t h e

existing med ical college at Raipu r. More

colleges are planned. In order to meet

the doctor deficiency, as an immediate

measu re the sta te has pooled 398 ru ra l

medical assistants in PHCs from the

ongoing 3 year medical cour se.

Mainstreaming of Indian System s of

M e d i c i n e : T h e I n d i a n S y s t e m s o f

Medicine ha s been given top priority by

the stat e. The Raipur Ayurveda College

ha s been developed int o a model college

and t hen as a Un iversity. Drug testing



56/65


facilities, for ayurvedic drugs are now

available. Panchakarm a th erapy centres

an d speciality clinics has been sta rted

i n a n u m b e r o f A l l o p a t h i c h e a l t h

facilities so a s t o provide choice between

systems for the community in chronic

illness. As many as 86 Primary Health

Centres and Ayurvedic Dispenseries

h a v e b e e n m e r g e d . A n d a l l 6 0 0 0 0

Mitanins a re being tra ined on h ousehold

herbal remedies

Control of Food & Drugs: A state of

t he a r t D rug Tes t ing Labora to ry i s

ready for inauguration at Raipur city

un til now it was necessary to sent food/

drug samples to external laboratories

for getting the sample tests done. In

addit ion to this , mobile laboratories

have been made operational in order

to m ake co l l ec t ing sam ples f rom

rem ote and v i l l age a reas poss ib l e .

Smoking and tobacco use has been

banned in public places.

Emerging Polic ies and Initiatives:

After an extensive process of discussion

with a wide variety of stakeholders, the

Sta te Hea lth & Populat ion P olicy has been

prepar ed an d th is shall be notified soon. A

new ac t fo r r egu la t ion o f c l in i ca l

es tabl i shments under pr ivate sector i s

drafted and awaiting approval. There is a

major plan being put in place to rapidly

inc rease nur s ing educa t ion and nur se

ava i l ab i l i t y w i th in the sys t em . A B a l

Hru day Sura ksha Yojna (litera lly mean ingChild Hear t Pr otection Scheme) is proposed

as a special school health program me to help

poor ch i ld ren w i th congen i t a l ca rd i ac

d i s e a s e s . A s t a t e w i d e u r b a n h e a l t h

programme and a scheme for bui ld ing

dharamsalas in every government hospital

are also being rolled out. 5000 telephone

connections through BSNL to connect all

Sub Centres , PHCs, CHCs and dis t r ic t

hospi ta ls are under ins ta l la t ion and an

emergency ambulance sys tem is under

consideration.


A C ti Ch t H lth Sh i G th V i


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A Comparative Chart on Health-Showing Growth on Various

Health Sector Reform Areas

AREA STATUS 2003 STATUS 2008 PURPOSE/ACHIEVEMENT

Policies and Programmes

Health and Populat ion Policy Nil Finalised, awaiting approval Policy Governance

HRD Policy Nil Not ified Planned HR Development

Drug Policy Nil F inalised, await ing approva l Towards rat iona l drug use

Policy for Medically Underserved Areas Nil Under Preparat ion Reaching the unreached

Delegat ion and decentra lisat ion of powers Upto Distr ict Upto Block Grassroots governance

Mainst reaming of AYUSH Not done Achieved Holist ic approach

YAWS Cont rol (No. of cases) 15 0 Towards Eliminat ion

Polio Cont rol (No. of cases) 2 0 Towards eliminat ion

Leprosy Cont rol (Preva lence Rate) 7.2 1.99 72.36 % reduct ion

TB Control (Dist r ict Covered) 4 16 100 % coverage

Mitanin Programme (No. of Mitanins) Nil 60092 100 % coverage of rura l ar eas

Medical Facilit ies in Public Sector

No. of Medica l Colleges 2 3 1

No. of Distr ict Hospitals 9 15 6

No. of 100 bedded Civil Hospitals 8 16 8

No. of Community Health Cent res 114 129 15

No. of Funct ional F irst Referral Units 0 64 64

No. of Primary Health Cent res 512 727 215

No. of Primary Hea lth Sub cent res 3818 4728 910

Manpower

No. of Posts sanct ioned of medical officers 1455 1737 282



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AREA STATUS 2003 STATUS 2008 PURPOSE/ACHIEVEMENT

No. of Posts sanct ioned of Specialist s 247 637 390

No. Doctors promoted as specia list s 0 250 250

Doctors sanct ioned for a PHC 1 2 2 t imes

Doctors sanctioned for CHC 4 8 2 t imes

Selection of Doctors through PSC 0 448 448

Completion of Buildings

New Dist r ict hospita l 0 6 6

New CHCs 0 36 36

New PHCs 0 73 73

New Sub cent res 0 203 203

Fund Allocations

Budget out lay for Health Department 235.23 crores 485.7 crores Almost 2 t imes

Assistance Under Sanjeevni Kosh 2.49 crores 13.29 crores Almost 5 t imes

External Assistance Mobilised Less than 50 crores More than 300 crores Almost 3 t imes

Inpatient dietary a llocat ions per head 8.00 Rs 16.00 Rs 2 t imes hike

Additional Unt ied Funds per Dist r ict Hospita l pa 0 5.0 lacs 5.0 lacs for 16 facilit ies

Additional Untied Funds per CHC pa 0 2.0 lacs 2.0 lacs for 117 facilit ies

Additional Untied Funds per PHC pa 0 0.5 lacs 0.5 lacs for 517 facilit ies

Additional Unt ied funds per Sub cent re 0 0.18 lacs 0.18 lacs for 4692 facilit ies

Contd. ....



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Indicators, Indices and Ranking ofStates for the

4th JRD Tata Memorial Awards


Table 1: Inputs for Base Year in the States of India


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Table 1: Inputs for Base Year in the States of India

Census, NFHS II NFHS II NFHS II NFHS II NFHS II NFHS II NFHS II SRS Census, Census, Census, National1991 1991 1991 1991 Human

Development

Report,2001

State Sex Ratio Women CPR any Full TFR Atleast Safe % Children *IMR, Girl Female Literacy % of Plan

(0-6)-1991 (20-24) methods Immuni- three Delivery Underweight 1999 school Youth Rate(7+) Expendituremarried zation ANC attendance (15-24) on Social

by age 18 Visits rate (6-14), Literacy Sector,

1991 1997-98

Andhra Pradesh 975 64.3 59.6 58.7 2.3 80.1 65.2 37.7 66 46.1 41.0 44.1 22.46

Arunachal Pradesh 982 27.6 35.4 20.5 2.5 40.5 31.9 24.3 35 40.6 42.4 41.6 29.65

Assam 975 40.7 43.3 17.0 2.3 30.8 21.4 36.0 76 48.7 52.9 52.9 45.89

Bihar 953 71.9 23.5 12.5 3.7 15.6 25.3 54.4 63 29.1 28.3 37.5 17.26

Chhattisgarh 984 61.3 45.0 20.0 2.8 33.2 32.3 60.8 78 43.5 35.5 42.9 32.74

Delhi 915 19.8 63.8 69.8 2.4 68.2 65.9 34.7 25 76.3 75.0 75.3 51.9

Goa 964 10.1 47.5 82.6 1.8 95.7 90.8 28.6 17 84.3 85.7 75.5 42.83

Gujarat 928 40.7 59.0 53.0 2.7 60.2 53.5 45.1 63 58.0 58.4 61.3 22.97

Haryana 879 41.5 62.4 62.7 2.9 37.4 42.0 34.6 68 58.6 50.5 55.8 34.26

Himachal Pradesh 951 10.7 67.7 83.4 2.1 60.9 40.2 43.6 54 75.0 72.3 63.9 35.24

Jammu & Kashmir** 917 22.1 49.1 56.7 2.7 66.0 42.4 34.5 45 46.4 43.7 44.1 28.86

Jharkhand 979 64.1 27.6 6.5 2.8 24.5 17.5 54.3 71 34.2 30.1 41.4 17.26

Karnataka 960 46.3 58.3 60.0 2.1 71.4 59.1 43.9 58 56.1 54.8 56.0 32.31

Kerala 958 17.0 63.7 79.7 2.0 98.3 94.0 26.9 15 91.9 96.8 89.8 18.88

Madhya Pradesh 941 64.0 44.1 23.2 3.5 26.3 28.8 53.1 90 41.6 35.8 44.7 32.74

Maharashtra 946 47.7 60.9 78.4 2.5 65.4 59.4 49.6 48 66.5 67.0 64.9 20.69

Manipur 974 9.9 38.7 42.3 3.0 54.4 53.9 27.5 23 54.9 62.2 59.9 32.44

Meghalaya 986 25.5 20.2 14.3 4.6 31.3 20.6 37.9 61 42.6 56.9 49.1 37.83

Mizoram 969 11.6 57.7 59.6 2.9 75.8 67.5 27.7 14 68.2 87.2 82.3 30.35

Nagaland 993 22.9 30.3 14.1 3.8 23.1 32.8 24.1 32 54.4 70.0 61.6 36.73

Orissa 967 37.6 46.8 43.7 2.5 47.3 33.4 54.4 97 47.4 45.5 49.1 32.38

Punjab 875 11.6 66.7 72.1 2.2 57.0 62.6 28.7 53 65.4 66.5 58.5 20.67

Rajasthan 916 68.3 40.3 17.3 3.8 22.9 35.8 50.6 81 27.7 25.9 38.6 24.22

Sikkim 965 22.3 53.8 47.4 2.8 42.6 35.1 20.6 46 62.0 61.7 56.9 45.38Tamil Nadu 948 24.9 52.1 88.8 2.2 91.4 83.8 36.7 52 71.1 63.9 62.7 38.89

Tripura 967 37.7 55.5 40.7 1.9 47.2 47.5 42.6 27 56.6 62.4 60.4 43.18

Uttar Pradesh 927 64.3 27.3 20.5 4.1 14.7 21.8 52.2 84 30.4 31.6 40.7 29.6

Uttarakhand 949 25.9 43.1 34.6 2.6 19.7 34.6 41.8 52 55.2 55.9 57.8 29.6

West Bengal 967 45.9 66.6 43.8 2.3 57.0 44.2 48.7 52 47.3 56.1 57.7 22.83

Maximum 1000 100.0 100.0 100.0 6 100.0 100.0 100.0 150.0 100.0 100.0 100.0 100

Minimum 700 0 0 0 2.1 0 0 0 5 0 0 0 0

*IMR for 1998, SRS Bulletin, April 2000**1991 census figures=(2001-1981)/2+1981


Table 2: Input for the Final Year in the States of India


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Table 2: Input for the Final Year in the States of India

Census, NFHS III NFHS III NFHS III NFHS III NFHS III NFHS III NFHS III SRS Census, Census, Census, Statistical2001 2001 2001 2001 Abs

final jrd tata

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