Twelfth Five Year Plan ( )

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1 Twelfth Five Year Plan ( ) Social Sectors Volume III

2 Copyright Planning Commission (Government of India) 2013 All rights reserved. No part of this book may be reproduced or utilised in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage or retrieval system, without permission in writing from the Planning Commission, Government of India. First published in 2013 by SAGE Publications India Pvt Ltd B1/I-1 Mohan Cooperative Industrial Area Mathura Road, New Delhi , India SAGE Publications Inc 2455 Teller Road Thousand Oaks, California 91320, USA SAGE Publications Ltd 1 Oliver s Yard, 55 City Road London EC1Y 1SP, United Kingdom SAGE Publications Asia-Pacific Pte Ltd 33 Pekin Street #02-01 Far East Square Singapore Published by Vivek Mehra for SAGE Publications India Pvt Ltd, Phototypeset in 11/13pt Minion Pro by RECTO Graphics, Delhi and printed at Saurabh Printers, New Delhi. Library of Congress Cataloging-in-Publication Data India. Planning Commission Twelfth five year plan (2012/2017)/Planning Commission, Government of India. Volumes cm 1. India Economic Policy Finance, Public India. I. Title. HC435.3.I dc ISBN: (PB) The SAGE Team: Rudra Narayan, Archita Mandal, Rajib Chatterjee and Dally Verghese

3 Twelfth Five Year Plan ( ) Social Sectors Volume III Planning Commission Government of India

4 Thank you for choosing a SAGE product! If you have any comment, observation or feedback, I would like to personally hear from you. Please write to me at Vivek Mehra, Managing Director and CEO, SAGE Publications India Pvt Ltd, New Delhi Bulk Sales SAGE India offers special discounts for purchase of books in bulk. We also make available special imprints and excerpts from our books on demand. For orders and enquiries, write to us at Marketing Department SAGE Publications India Pvt Ltd B1/I-1, Mohan Cooperative Industrial Area Mathura Road, Post Bag 7 New Delhi , India us at Get to know more about SAGE, be invited to SAGE events, get on our mailing list. Write today to This book is also available as an e-book.

5 Contents List of Figures List of Tables List of Boxes List of Acronyms List of Annexures vii viii x xi xviii 20. Health Education Employment and Skill Development Women s Agency and Child Rights Social Inclusion 221

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7 Figures 20.1 Disease Burden of India, 2008 (Estimated number of deaths by cause) Disability Adjusted Life Years in India, 2009 (Estimated percentage of DALY by cause) Strategies to Prevent Pre-Term Births and Manage Pre-Term Babies Projected HRH Capacity Expansion in the Twelfth Plan GER for Secondary Education: By States/Select Countries Improvements in Literacy Levels, (%) Strategic Framework Enrolments in Higher Education (in lakh): to Gross Attendance Ratio, Trend in Unemployment Rate Unemployment Rate among Youth Child Sex Ratio 0 6 Years and Overall Sex Ratio India: Nutrition Status of Children under 3 Years (%) Inadequate Exclusive Breastfeeding in India (0 6 Months) Children Aged 6 35 Months who Received a Vitamin A Dose During Last Six Months (%) (AHS ) 199

8 Tables 20.1 Eleventh Plan Monitorable Goals and Achievements Allocation and Spending by Ministry of Health in Eleventh Plan Funding for Health in Eleventh Plan: Core and Broad Health Components State-Wise Targets on IMR and MMR in Twelfth Plan National Health Goals for Communicable Diseases Budget Support for Departments of MoHFW in Twelfth Plan ( ) Interventions to Combat Non-Communicable Diseases (NCDs) Availability of HR during Eleventh Plan and Projections for Twelfth Plan Illustrative List of Health Systems Strengthening in States Cumulative Progress under SSA up to Civil Works under SSA in the Twelfth Plan GER for Secondary Education by Social Groups ( ) RMSA: Achievement in the Eleventh Plan Centrally Sponsored Schemes for Secondary Education Roles in System Improvement Growth of Enrolment in the Eleventh Plan Growth of Enrolment in ODL Programmes in the Eleventh Plan Growth of Enrolment by Field of Study during the Eleventh Plan (in lakh) Growth of Institutions in the Eleventh Plan Growth of Central Institutions during the Eleventh Plan Enrolment Targets by Level/Type for the Twelfth Plan Funding Responsibility for Universities and Colleges Gross Budgetary Support for the Twelfth Plan LFPR and WFPR by Usual Principal and Subsidiary Status, , and (%) Persons 22.2 Estimated Number of Persons in Millions Unemployment, Wages and Consumption Expenditure, to Proportionate Share of Sectors in Employment Formal and Informal Employment in Organized and Unorganised Sector (millions) Number of Workers by Size of Enterprise in Industry and Services Number of Workers According to Usual Status (PS+SS) Approach by Broad Employment 132 Status (Million Workers) 22.8 LFPR by Usual Principal and Subsidiary Status, , and (%) by 133 Gender 22.9 WPR by Usual Principal and Subsidiary Status, , and (%) by 133 Gender Child Workforce Participation Rate by UPSS (Percentage), , and

9 Tables ix Workforce Participation Rate by Usual Principal and Subsidiary Status, by Social Group, , and (%) Unemployment Rate by Usual Principal and Subsidiary Status, by Social Group, and (%) Population and Labour Force Projections Employment Elasticity from Past Data Sectoral Growth Rates: Business-as-usual Scenario Sectoral Employment (in million): Business-as-usual Scenario Sectoral Growth Rates Twelfth Plan Scenario Sectoral EMPLOYMENTS (in million): Twelfth Plan Scenario General Education Level of Labour Force (PS+SS) in the Age Group Estimated Number of Workers (PS+SS in the age group of 15 59) by Level of Education by 141 Sector (millions), Distribution of Formally and Informally Vocationally Trained Workers (PS+SS in the age 142 group of 15 59) Within Primary, Secondary and Tertiary Sectors (%) in Apprentices in India (Under the Apprenticeship Training Act, 1961) A Typology of Training Funds Ministry-Wise Incorporation of Gender Concerns (under RFD) Monitorable Targets of Eleventh Plan and Its Achievements Existing Programmes/Schemes Incidence of Poverty across Social Groups Eleventh Plan Allocation and Expenditure for Special Schemes for SCs Rural Population Living Below Poverty Line ( , and ) (in %) Literacy Rates of STs and Total Population (in %) Female Literacy Rates of STs and Total Population (in %) Mortality and Undernutrition Eleventh Plan Allocation and Expenditure for Special Schemes for STs Literacy Rate among Religious Communities, SCs and STs Educational Levels among Different Communities Percentage Distribution of Workers by Category 252

10 Boxes 20.1 Recommendations of High Level Expert Group on Universal Health Coverage Illustrative List of Preventive and Public Health Interventions Funded and Provided by 14 Government 20.3 Public Private Partnerships (PPP) in Health Sector Institute of Liver and Biliary Sciences, Delhi: A Model of Autonomy and Sustainable 24 Financing 20.5 Flexibility and Decentralised Planning: Key Elements of National Health Mission Suggested Items in Model HR Guidelines Convergence: Village Health and Nutrition Day in North Tripura Targets for the Twelfth Plan Twelfth Plan Strategy for Elementary Education School Excellence Programme Mumbai Secondary Education: Twelfth Plan Goals CBSE Examination Reforms Pilot Project on Vocational Education under NVEQF Enrolment Target for the Twelfth Plan TISS: A Multi-Location Networked University Strategic Shift in Central Funding for State Higher Education Concept and Framework for Establishing Community Colleges Student Financial Aid Programme (SFAP) Conceptual Framework of Key Employment and Unemployment Indicators Skill Policy for Promoting India s Competitiveness in the Global Market Priority Sectors Identified in the Twelfth Plan Strategies for Expanding and Scaling up the Skill Development in Twelfth Plan Major Functions of Proposed National Skill Development Authority Good Performers in Financing Chile, Australia, South Africa, Singapore Equity Implications of User Fees Women Friendly Infrastructure Development in Kerala Declining Child Sex Ratio A Call for Urgent Action Making the Difference ICDS Restructuring Learning by Doing SNEHA SHIVIRs Early Joyful Learning-Chilli Pilli Eleventh Five Year Plan Schemes Vision for the Twelfth Five Year Plan Specific Interventions under PM s 15 PP The Jaipur Foot Story Possible Actions by Central Government Ministries to Benefit Those with Disabilities 269

11 Acronyms AAY Antodaya Anna Yojana ABL Activity-Based Learning AESDCs Adult Education & Skill Development Centres AHS Annual Health Survey AICTE All India Council for Technical Education AIDS Acquired Immuno Deficiency Syndrome AIEEE All India Entrance Exam for Engineering AITT All India Trade Test ALIs AIIMS like Institutions ALMSC Anganwadi Level Monitoring and Support Committee ANM Auxiliary Nurse & Midwife ARUNIM Association of Rehabilitation under National Trust Initiative of Marketing ARWU Academic Ranking of World Universities ASC Academic Staff College ASER Annual Status of Education Report ASHA Accredited Social Health Activist ASSOCHAM Associated Chambers of Commerce & Industry ATS Apprenticeship Training Scheme AVI Accredited Vocational Institutes AWTC Anganwadi Training Centre AWW Anganwadi Worker BESU Bengal Engineering and Science University BJRCY Babu Jagjivan Ram Chatarvas Yojana BMI Body Mass Index BPL Below Poverty Line BPO Business Process Outsourcing BRC Block Resource Centre BRGF CABE CAGR CAL CAT CBM CBSE CBUs CCD CCE CDS CES CFR CGHS CHC CHEB CIHEC CII CLAT CMB COBSE CoE CPI CPL CPMT CPPE CRC CSC CSIR CSO Backward Regions Grant Fund Central Advisory Board of Education Compounded Annual Growth Rate Computer Aided Learning Common Admission Test Community Based Monitoring Central Board of Secondary Education Community Based Organisations Conservation cum Development Continuous and Comprehensive Evaluation Current Daily Status Coverage Evaluation Survey Community Forest Rights Central Government Health Scheme Community Health Centre Central Health Education Bureau Council for Industry and Higher Education Collaboration Confederation of Indian Industries Common Law Admission Test Conditional Maternity Benefit Scheme Council of Boards of School Education Centre of Excellence Consumer Price Index Commercial Pilot Licence Combined Pre Medical Entrace Test Council for People s Participation in Education Cluster Resource Centre Common Service Centre Council of Scientific and Industrial Research Civil Society Organisations

12 xii Acronyms CSR CSS CTA CTC CTE CTET CUE CVD CWSN DALY DAPCU DEC DEI DFS DGET DHR DIC DIET DISE DLHS DNB DNT DONER DOTS DPC DPEP DRG DSLL DTH DWS EAG EBB ECCE EESC EGS EHP ELM EMR EPC Corporate Social Responsibility Centrally Sponsored Scheme Criminal Tribes Act Central Tripatite Committee College of Teacher Education Central Teacher Eligibility Test Centre for Universal Education Cardio-Vascular Diseases Children With Special Needs Disability Life Adjusted Year District AIDS Prevention & Control Unit Distance Education Council Distance Education Institution Double Fortified Salt Directorate General of Employment & Training Department of Health Research Design Innovation Centre District Institute of Education and Training District Information System of Education District Level Health Survey Diplomats of National Board De-notified Tribes Department of North Eastern Region Directly Observed Treatment Short Course District Planning Committees District Primary Education Programme Diagnostic Related Group Department of Skills and Lifelong Learning Direct-to-Home Drinking Water Supply Empowered Action Group Educationally Backward Blocks Early Childhood Care and Education Essential and Emergency Surgical Care Education Guarantee Scheme Essential Health Package Elementary (CIasses I VIII) Electronic Medical Record Engineering, Procurement and Construction ER ERP FDC FICCI FRA FRU FSSA FSSAI GAR GBPS GBS GDP GER GNM GP GPI GPS GS GVA HCR HEI HFW HH HIS HIV HLEG HMIS IAP IASE IAY IBA ICAI ICDS ICMR ICT IDD IDMI IEC Elected Representatives Enterprise Resource Planning Fixed Dose Combination Federation of Indian Chamber of Commerce & Industry Forest Rights Act First Referral Unit Food Safety and Standards Act Food Safety and Standards Authority of India Gross Attendance Ratio Gigabit Per Second Gross Budgetary Support Gross Domestic Product Gross Enrolment Ratio General Nursing and Midwifery Gram Panchayats Gender Parity Index Global Positioning System Gram Sabhas Gross Value Added Head Count Ratio Higher Education Institution Health and Family Welfare House Holds Health Information System Human Immunodeficiency Virus High Level Expert Group Health Management Information Systems Indian Academy of Pediatrics/ Integrated Action Plan Institute of Advanced Studies in Education Indira Awas Yojana Indian Banks Association Institute of Cost Accounts of India Integrated Child Development Services Indian Council of Medical Research Information and Communication Technology Iron Deficiency Disorder Infrastructure Development in Minority Institutions Information, Education and Communication

13 Acronyms xiii IEDSS IFA IFR IGMSY IGNOU IIC IIIT IIM IISER IIT IMCs IMNCI IMR IMRB IMS Act IMS INC INN INT IPC IPERPO IPHS IPOP IPR IRCAs ISCED ISM IT ITCs ITIs ITPA IUC IVRS IYCF JE JEE Inclusive Education for the Disabled at Secondary Stage Iron Folic Acid Individual Forest Rights Indira Gandhi Matritva Sahyog Yojana Indira Gandhi National Open University Inter Institutional Centre International Institute of Information Technology Indian Institute of Management Indian Institute of Science Education and Research Indian Institute of Technology Institute Management Committees Integrated Management of Neonatal and Childhood Illness Infant Mortality Rate International Marketing and Research Bureau Infant Milk Substitutes Act Infant Milk Substitute Indian Nursing Council International Non-proprietary Name Indian Institute oflnfbrmation Technology Indian Penal Code Intellectual Property Education, Research and Public Outreach Indian Public Health Standard Integrated Programme for Older Persons Intellectual Property Rights Integrated Rehabilitation Centre for Addicts International Standard Classification of Education Indian School of Mines Information Technology Industrial Training Centres Industrial Training Institutes Immoral Trafficking Prevention Act Inter University Centre Interactive Voice Response System Infant and Young Child Feeding Japanese Encephalitis Joint Entrance Exam JIPMER JKGBV JNNURM JNV JPC JRF JSS JSY KGBV KV KVKs KVY LEP LFPR LLIN LMIS LMS LWE MAEF MCDs MCS MDG MDM MDMS MES MFP MGHN MGNREGA MGNREGS MHFW MHRD MIB MIS MITI MLA MMER MMP MMR MMU Jawaharlal Institute of Post Graduate Medical Education and Research Kasturba Gandhi Balika Vidyalay Jawaharlal Nehru National Urban Renewal Mission Jawahar Navodaya Vidyalaya Joint Parliamentary Committee Junior Research Fellowship Jan Shiksha Sansthans Janani Suraksha Yojana Kasturba Gandhi Balika Vidyalaya Kendriya Vidyalaya Krishi Vigyan Kendras Kaushal Vikas Yojana Learning Enhancement Programme Labour Force Participation Rate Long Lasting Insecticide Net Labour Market Information System Learning Management System Left Wing Extremism Maulana Azad Education Foundation Minority Concentration Districts Model Cluster Schools Millennium Development Goal Mid-Day Meal Mid-Day Meals in Schools Modular Employable Skills Minor Forest Produce Merry Gold Health Network Mahatma Gandhi National Rural Employment Guarantee Act Mahatma Gandhi National Rural Employment Guarantee Scheme Ministry of Health and Family Welfare Ministry of Human Resource Development Ministry of Information and Broadcasting Management Information System Model Industrial Training Institute Member of Legislative Assembly Management, Monitoring, Evaluation and Research Mission Mode Project Maternal Mortality Ratio Mobile Medical Unit

14 xiv Acronyms MoHFW MoLE MoMA MOOC MoSJE MoTA MoU MoWCD MP MPCE M.Phil MPLADS MPR MS MSDP MSDP MSJE MSME MTP MVA MYA MYA&S NAAC NAC NACP NAS NBA NBCFDC NBHE NBT NBTTC NCD NCERT NCF NCFTE Ministry of Health & Family Welfare Ministry of Labour & Employment Ministry of Minority Affairs Massive Open Online Course Ministry of Social Justice and Empowerment Ministry of Tribal Affairs Memorandum of Understanding Ministry of Woman & Child Development Madhya Pradesh Monthly Per-capita Consumption Expenditure Master of Philosophy Member of Parliament Local Area Development Scheme Ministry of Panchayati Raj Manila Samakhya Multi Sectoral Development Plan Multi Sectoral Development Programme Ministry of Social Justice and Empowerment Ministry of Micro, Small and Medium Enterprises Medical Termination of Pregnancy Manual Vacuum Aspiration Ministry of Youth Affairs Ministry of Youth Affairs & Sports National Assessment and Accreditation Council National Advisory Council National AIDS Control Programme National Assessment Survey National Board of Accreditation National Backward Classes Finance and Development Corporation National Board for Health Education National Book Trust National Board for Trade Testing and Certification Non Communicable Disease National Council of Educational Research & Training National Curriculum Framework National Curriculum Framework for Teacher Education NCHER NCHRH NCHS NCLSE NCRB NCSC NCST NCTE NCVT NDDB NDIN NDRDA NE NEAC NEGP NER NFHS NFIDA NFSB NGO NHA NHFDC NHM NHPPT NHRDA NHSRC NICE NIDDCP NIFFT National Commission for Higher Education and Research National Commission for Human Resources in Health National Centre for Health Statistics National Centre for Leadership in School Education National Crime Records Bureau National Commission for Scheduled Castes National Commission for Scheduled Tribes National Council for Teacher Education National Council of Vocational Training National Dairy Development Board National Design Innovation Network National Drug Regulatory and Development Authority North East National Evaluation and Assessment Committee National e-governance Plan North Eastern Region National Family Health Survey National Fund for Innovative Development Activities National Food Security Bill Non-Governmental Organisation National Health Accounts National Handicapped Finance Development Corporation National Health Mission National Health Promotion and Protection Trust National Health Regulatory and Development Authority National Health System Resource Centre National Institute of Clinical Excellence National Iodine Deficiency Disorders Control Programme National Institute of Foundry and Forge Technology

15 Acronyms xv NIHFW NIN NIOS NIPPCD NIRD NISD NIT NKC NLM NMDFC NME-ICT NMMS NNMB NNP NOSS NPAN NPCC NPCDCS NPEGEL NP-NSPE NRDWP NREGA NRHM NRLM NSDC NSDCB National Institute of Health arid Family Welfare National Institute of Nutrition National Institute of Open Schooling National Institute of Public Cooperation and Child Development National Institute for Rural Development National Institute of Social Defence NationaI Institute of Technology National Knowledge Commission National Literacy Mission National Minorities Finance and Development Corporation National Mission on Education through Information and Communication Technology National Merit-cum-Means Scholarships National Nutrition Monitoring Bureau National Nutrition Plan National Overseas Scholarship Scheme National Plan of Action on Nutrition National Programme Coordination Committee National Programme for the Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke National Programme for Education of Girls at Elementary Level National Programme for Nutritional Support to Primary Education National Rural Drinking Water Programme National Rural Employment Guarantee Act National Rural Health Mission National Rural Livelihoods Mission National Skill Development Corporation National Skill Development Coordination Board NSFDC NSIGSE NSKFDC NSQF NSS NSSO NSTFDC NT NTFs NTFP NUEPA NV NVEQF OBCs ODL ODS OECD OOP OoSC ORS PCR Act PDS PEC PESA Act PET PG PGIMER PHC Ph.D PIP PISA PLHA PMAGY National Scheduled Castes Finance and Development Corporation National Scheme of Incentive to Girls for Secondary Education National Safai Karamcharis Finance and Development Corporation National Skills Qualification Framework National Sample Survey/Nutrition Surveillance System National Sample Survey Organisation National Scheduled Tribes Finance and Development Corporation Nomadic Tribe National Training Funds Non Timber Forest Product National University of Educational Planning and Administration Navodaya Vidyalaya National Vocational Education Qualifications Framework Other Backward Classes Open and Distance Learning Open Design School Organisation for Economic Co-operation & Development Out of Pocket Out of School Children Oral Rehydration Solution Protection of Civil Rights Act Public Distribution System Punjab Engineering College Panchayat Extension to Scheduled Areas Act Physical Education Teacher Postgraduate Post Graduate Institute of Medical Education and Research Primary Health Centre Doctor of Philosophy Project Implementation Plan Programme for International Student Assessment People living with HIV/AIDS Pradhan Mantri Adarsh Gram Yojana

16 xvi Acronyms PMDT PMGSY PMS PMSSY POA Act PPP PRI PS PSL PSSCIVE PSUs PTA PTG PTR PVTGs PYKKA QMT R&D RCH RDA RDK RGI RGNCS RGNFS RGSEAG RKS RMP RMSA R&R RRTCs RSBY RSC RTE RUDSETI SBA SC SCA SCAs Programmatic Management of Drug-resistant Tuberculosis Pradhan Mantri Gram Sadak Yojana Post Matric Scholarship Pradhan Mantri Swasthya Suraksha Yojana Prevention of Atrocities Act Public Private Partnership Pahchayati Raj Institution Primary School Priority Sector Lending Pandit Sunder Lal Sharma Central Institute of Vocational Education Public Sector Undertakings Parent Teacher Association Primitive Tribal Groups Pupil Teacher Ratio Particularly Vulnerable Tribal Groups Panchayat Yuva Krida Khel Abhiyan Quality Monitoring Tools Research and Development Reproductive and Child Health Recommended Dietary Allowance Rapid Diagnostic Kits Registrar General of India Rajiv Gandhi National Crèche Scheme Rajiv Gandhi National Fellowships Scheme Rajiv Gandhi Scheme for Empowerment of Adolescent Girls Rogi Kalyan Samitis Registered Medical Practitioner Rashtriya Madhyamik Shiksha Abhiyan Rehabilitation and Re-settlement Regional Resource and Training Centres Rashtriya Swasthya Bima Yojana Residential School Complex Right to Education Rural Development and Self Employment Training Institute Skilled Birth Attendants Scheduled Caste Special Central Assistance State Channelizing Agencies SCDC SCERT SCP SCR SCSP SDCs SEMIS SFAP SGSY-SP SHGs SHSRC SIA SIE SIEMAT SIHFW SII J&K SJE SKA SKP SMC SMEPWD SNT SOS SPO SPQEM SRCs SRF SRI SRMS SRS SSA SSCs ST STDCs STEP Scheduled Caste Development Corporation State Council of Educational Research & Training Special Component Plan Student Classroom Ratio Scheduled Caste Sub Plan Skill Development Centres Secondary Education Management Information System Student Financial Aid Programme Swarnajayanti Gram Swarozgar Yojana Special Projects Self Help Groups State Health System Resource Centre Supplemental Immunization Activity State Institute of Education State Institute of Educational Management & Training State Institute of Health and Family Welfare Special Industry Initiative for Jammu & Kashmir Social Justice and Empowerment Sarva Krida Abhiyan Skill Knowledge Providers School Management Committee State Mission for Empowerment of Persons with Disabilities Semi Nomadic Tribe State Open School State Project Office Scheme for Providing Quality Education in Madarasas Socio Religious Communities Senior Research Fellowship Social and Rural Institute Scheme for Rehabilitation of Manual Scavengers Sample Registration System Sarva Shiksha Abhiyan Sector Skill Councils Scheduled Tribe State Tribal Development Corporations Support to Training and Employment Programme for Women

17 Acronyms xvii STET STI TB TBA TEI TEQIP TET TFR THE TISS TLC TLE TLM TNTFP TPDS TREAD TRI TRIFED TRIPs TSC TSP TVET UEE UG State Teacher Eligibility Test Sexually Transmitted Infection Tuberculosis Traditional Birth Attendant Teacher Education Index Technical Education Quality Improvement Programme Teacher Eligibility Test Total Fertility Rate Times Higher Education Tata Institute of Social Sciences Teaching and Learning Centre Teaching Learning Equipment Teaching Learning Material Traditional Non Timber Forest Product Targeted Public Distribution System Trade Related Entrepreneurship Assistance and Development Tribal Research Institute Tribal Cooperative Marketing Development Federation of India Limited Trade-Related Aspects of Intellectual Property Rights Total Sanitation Campaign Tribal Sub-Plan Technical and Vocational Education & Training Universalisation of Elementary Education Undergraduate UGC UHC UID ULB UMDT UNCRPD UNESCO UNICEF UP UPS UPSS USA UT VEC VET VHND VHNSC VHSND VO VRCs VTPs WCD WCP WFPR WHO WTO University Grants Commission Universal Health Coverage Unique Identification Urban Local Bodies Uniform Multi-Drug Therapy Regimen United Nations Conventions on the Rights of Persons with Disabilities United Nations Educational, Scientific & Cultural Organisation United Nations International Children Emergency Fund Uttar Pradesh Upper Primary School Usual Principal Subsidiary Status United States of America Union Territory Village Education Committee Vocational Education & Training Village Health and Nutrition Day Village Health Nutrition Sanitation Committee Village Health, Sanitation and Nutrition Day Volunteer Organisations Vocational Rehabilitation Centres Vocational Training Providers Women and Child Development Women and Child Programmes Work Force Participation Rate World Health Organization World Trade Organisation

18 Annexures 22.1 Employment Across Various Sectors (in millions) , , on UPSS 160 basis 22.2 Absolute Increase/Decrease Employments Across Various Sectors (in millions) in 161 Manufacturing, , , Incidence of Unemployment for 15 Years and Above Age Group, by Level of Education, and (UPSS) in Percentage 22.4 Dependency Ratio Across India States, Census

19 20 Health Health should be viewed as not merely the absence of disease but as a state of complete physical, mental and social well-being. The determinants of good health are: access to various types of health services and an individual s lifestyle choices, personal, family and social relationships. The latter are outside the scope of this Chapter. The focus in this Chapter is on the strategy to deliver preventive, curative and public health services. Other sectors that impact on good health, such as clean drinking water and sanitation are dealt with in other Chapters of the Plan. AN OVERVIEW At present, India s health care system consists of a mix of public and private sector providers of health services. Networks of health care facilities at the primary, secondary and tertiary level, run mainly by State Governments, provide free or very low cost medical services. There is also an extensive private health care sector, covering the entire spectrum from individual doctors and their clinics, to general hospitals and super speciality hospitals The system suffers from the following weaknesses: 1. Availability of health care services from the public and private sectors taken together is quantitatively inadequate. This is starkly evident from the data on doctors or nurses per lakh of the population. At the start of the Eleventh Plan, the number of doctors per lakh of population was only 45, whereas, the desirable number is 85 per lakh population. Similarly, the number of Nurses and Auxiliary Nurse and Midwifes (ANMs) available was only 75 per lakh population whereas the desirable number is 255. The overall shortage is exacerbated by a wide geographical variation in availability across the country. Rural areas are especially poorly served. 2. Quality of healthcare services varies considerably in both the public and private sector. Many practitioners in the private sector are actually not qualified doctors. Regulatory standards for public and private hospitals are not adequately defined and, in any case, are ineffectively enforced. 3. Affordability of health care is a serious problem for the vast majority of the population, especially in tertiary care. The lack of extensive and adequately funded public health services pushes large numbers of people to incur heavy out of pocket expenditures on services purchased from the private sector. Out of pocket expenditures arise even in public sector hospitals, since lack of medicines means that patients have to buy them. This results in a very high financial burden on families in case of severe illness. A large fraction of the out of pocket expenditure arises from outpatient care and purchase of medicines, which are mostly not covered even by the existing insurance schemes. In any case, the percentage of popu lation covered by health insurance is small. 4. The problems outlined above are likely to worsen in future. Health care costs are expected to rise because, with rising life expectancy, a larger proportion of our population will become vulnerable to chronic Non Communicable Diseases (NCDs), which typically require expensive

20 2 Twelfth Five Year Plan treatment. The public awareness of treatment possibilities is also increasing and which, in turn, increases the demand for medical care. In the years ahead, India will have to cope with health problems reflecting the dual burden of disease, that is, dealing with the rising cost of managing NCDs and injuries while still battling communicable diseases that still remain a major public health challenge, both in terms of mortality and disability (Figures 20.1 and 20.2). 5. The total expenditure on health care in India, taking both public, private and household outof-pocket (OOP) expenditure was about 4.1 per cent of GDP in (National Health Accounts [NHA] 2009), which is broadly comparable to other developing countries, at similar 7% 22% 3% 7% 0.7% 0.9% 1.4% 2% 2% 5% 6% % 0.6% 0.5% Communicable Diseases (37%) Non Communicable Diseases (53%) Injuries (10%) 24% 11% Infectious and parasitic diseases Respiratory infections Perinatal conditions (h) Maternal conditions Nutritional deficiencies Cardiovascular diseases Respiratory diseases Malignant Cancer Digestive diseases Genitourinary diseases Diabetes mellitus Neuropsychiatric conditions Others Congenital anomalies Unintentional injuries Intentional injuries Source: Mortality and Burden of Disease Estimates for WHO Member States in FIGURE 20.1: Disease Burden of India, 2008 (Estimated number of deaths by cause) Dark Maroon: Communicable Diseases (43.94%) Black: Non Communicable Diseases (43.02%) Light Maroon: Injuries (13.04%) Infectious and parasitic diseases Nutritional deficiencies Cardiovascular diseases Digestive diseases Musculoskeletal diseases Oral conditions Other neoplasms Perinatal conditions (h) Maternal conditions Sense organ diseases Malignant neoplasms Genitourinary diseases Skin diseases Unintentional injuries Respiratory infections Neuropsychiatric conditions Respiratory diseases Congenital anomalies Diabetes mellitus Endocrine disorders Intentional injuries Source: Global Burden of Disease Estimates for WHO Member States FIGURE 20.2: Disability Adjusted Life Years in India, 2009 (Estimated percentage of DALY by cause)

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