Dr. Suresh Amonkar, Hon'ble Health Minister, Government of Goa

It gives me great pleasure to participate in the first meeting of the National Commission on population here in New Delhi when all the States and Union Territories come together to deliberate on India's Demographic achievements and future strategies thereupon to control the population growth and improve the quality of lives.

It is a need of the hour when 16% of the world's population is in India spread over a just 2.4% of the global land area and if the current trends continue India may overtake China in 2045 to become the most populous country in the world. Therefore its time to address the unmet needs for contraception, health care infrastructure and health personnel and to provide integrated service delivery for basic reproductive and child health care. It is time that we bring our TFR to 2.1 by 2010. It is time that we achieve a stable population by 2045. We have to look at the country as a whole and all the states and Union Territories thus contribute towards this achievement.

Goa a small state on the west Coast of Indian Peninsula has achieved a decade back all the goals that were envisaged for the year 2000 and this beautiful state will always try to contribute in one way or the other towards the national achievements of the goals set in the new National Population Policy 2000.

I am very pleased to be present at this historic first meeting of the National Commission on Population and I am grateful to the Prime Minister, who is the Chairman of the Commission, for inviting me to be a member of this Commission. I would also like to congratulate the Government of India, particularly the Ministry of Health & Family Welfare for having formulated an excellent and long overdue National Population Policy. This Policy reflects very clearly the paradigm shift in the field of population by advocating the importance of widening Family Planning Programmes into reproductive healthcare involving a life-cycle approach to health rather than targeting women and men as merely contraceptive users. It also highlights the fact that in order to achieve our population and sustainable development goals, it is necessary to adopt a multi-pronged strategy which includes promotion of gender equity and equality and education particularly female education, child development, nutrition, etc.

India was among the first countries to launch a Family Welfare Programme way back in 1952 and there have been several achievements to the country's credit as a result of this programme. These include significant reductions in infant mortality rate, increase in couple protection rate, reduction in the crude death rate from 25 in 1951 to 9 in 1998 and a very significant increase in the life expectancy from 37 years to 70 years. For the first time during this decade there has also been a demographic decline which is manifest in the reduced birth rate and total fertility rate. However this success has not been uniform throughout the country and we still have a long way to go before we can reach our population stabilisation goals. There are several issues related to this which continue to be a matter of concern. Some of these are :-

Major gender inequities and inequalities particularly in respect of mortality and education. The infant mortality and child mortality rate in India are much higher for girls than for boys as a result of the lower status accorded to the girl child, and consequently less attention being given to the girl child's basic needs.

• It has been documented that there are more children out of school in South Asia than in the rest of the world put together and 2/3rd of this deprived generation are girls. In India, the gender gap is significant both in respect of female-adult literacy and girls' education. On the other hand it is well-established that where investments in female education have been made, this has substantially contributed to the achievement of demographic goals. The situation in Kerala where there is no gender gap in education is a pointer confirming this fact.

• The adverse sex ratio against women is also a matter of concern since it is unacceptable with our constitutional commitment to ensure equal opportunities for all citizens irrespective of sex, caste, colour and creed. The fact that discrimination against the girl child begins even before birth is particularly abhorrent and has contributed to this.

• Although we have reasonably good health infrastructure throughout the country, it does not consistently deliver services of acceptable quality and in many parts of our country, worker-productivity is low and the training needs ,have indicated significant gaps in the technical knowledge and skills of programme staff, particularly at the cutting-edge levels. On the other hand if demand for services is to be generated, it is absolutely essential to improve the quality of care. Keeping in view this fact, I am very happy that today's meeting of the National Population Commission will in fact focus on some of these key issues.

• The maternal mortality rate in India is also unacceptably high and needs to be rectified. Dr. Amartya Sen had pointed out that in India and China alone, 77 million women are "Missing", the result of negative social attitudes which are prevalent.

Coming to the situation in the Union Territory of Chandigarh, I am happy to inform this august gathering that compared to some of our neighbouring States, both its health and demographic profiles are significantly better. There is an excellent network of primary, intermediary and tertiaiy healthcare institutions because of which quality health care is accessible to a majority of the population. 8 mini health family welfare projects are doing a commendable job in slums and rural areas of Chandigarh. These centres are being run by a team of dedicated NGOs. However, there are significant segments of the population in Chandigarh numbering about 3 lacs out of a total population of 10 lacs, who continue to live in slum-like conditions and this adversely affects their quality of life and lack of basic facilities including healthcare and education.

Chandigarh's infant mortality rate, is 32/1000 as against the national average of 71/1000. However, surveys conducted by some of our institutions indicate that in the slum areas the infant mortality rate is substantially higher. Approximately half of these babies die in the first month. 33 per cent of the toddlers in Chandigarh suffer from under nutrition and anemia. On the other hand, the maternal mortality rate in Chandigarh is 290 per lac as against the national rate of 450 per lac.

The Reproductive and Child Health Programme (RCH) which is being actively implemented in Chandigarh since the beginning of last year is aimed at improving the health of women and children. Already, 250 doctors, paramedics and other community leaders have been trained under this programme. Training in Laproscopic sterilization and Non Scalpel Vasectomywill be given to surgeons in the near future. The impact of the programme is likely to be visible in the coming years.

Four rounds of intensified Pulse Polio immunisation were carried out in Chandigarh from October 1999 to January 2000, including the exercise of 'spot and immunise' by household visits. On the last round 1,15,230 polio drops were given to children under the age of 5. This year, Chandigarh has not reported any case of paralytic polio.

The Chandigarh Administration has given particular emphasis to the provision of specialised services in the slum areas and a number of welfare activities have been started. Priority has been given to basic education for children in these areas. The setting up of 16 slum schools which have 15,823 children on their rolls, including 7,641 girls, has been a major achievement.

I am certain that with concerted efforts, and convergence of our health and family welfare programmes, the national objectives in respect of population stabilisation shall be reached much earlier than the target year of 2010. I hope that this conference will go a long way towards the achievement of these objectives.

Hon'ble Prime Minister of India and Chairman of the National Commission on Population, Sri Atal Behari Vajpayeeji, Hon'ble Minister for Health, Dr. C P Thakurji, Hon'ble Minister of State for Health, Prof. Rita Vermaji, distinguished members of the National Commission on Population, members of the press and participants in this august gathering, it is my pleasure and a privilege to participate in the first meeting of the National Commission on Population. I congratulate Government of India for having announced a National Population Policy and for having constituted this body to address issues relating to population control, which is so crucial for the development of our nation.

I am proud to state that Andhra Pradesh has been performing well on the population control front, and that the Government of my State has given this programme a central position in the developmental efforts of the State.

Since the inception of the Family Welfare Programme, there has been a significant decline in the fertility rate. In the early 70s, 5 children were born per family. In 1998, as per the NFHS survey, this had come down to 2.25 children per family. The birth rate has declined from 35 per 1000 population in 1971 to 22.3 per 1000 population in 1998. Approximately 60% of couples in the reproductive age are now protected by contraception. The Infant Mortality Rate has also declined from 113 per 1000 live births in the early 70s to 65.8 per 1000 live births in 1998. Sustained efforts for family planning and effective delivery of Maternal and Child Health Services have helped Andhra Pradesh overcome the handicap on account of low female literacy, relatively high incidence of child labour and low age of females at the time of marriage.

Andhra Pradesh has the distinction of being the first State in the country to announce a comprehensive Population Policy in 1997 with clearly articulated demographic goals. Our goal is to reduce the Birth Rate to 13 per 1000 population, attain a Total Fertility Rate of 1.5, a Maternal Mortality Rate of 0.5 per 1000 live births and an Infant Mortality Rate of 15 per 1000 live births by 2020. The State Population Policy has been discussed on the Floor of the House and an all-party consensus has been evolved in support of the policy. The State Government has allocated Rs. 65 crores from its own funds to implement policy initiatives and programmes. The key strategy of our initiatives is decentralisation of planning and programme implementation, making family welfare a people's programme and a shift in approach from Family Planning to Reproductive and Child Health.

In order to decentralise planning and implementation, we have established District Population Stabilisation Societies; and PHC and Hospital Advisory Committees have also been constituted to ensure the active participation of elected representatives and beneficiaries in health care delivery and family welfare. These Societies and Committees have been given both administrative and financial powers for effective functioning. We now propose to establish village level structures for enhancing the ownership of the health and family welfare programmes.

Population control in Andhra Pradesh has indeed become a people-centred programme. Family Welfare has been placed high on the agenda of the Janmabhoomi programme. Under this programme, health teams have visited each and every habitation in the State at least 12 times over the last 3 years, bringing about an improvement in service delivery and encouraging health-seeking behaviour of the community. Issues relating to Family Planning and Mother and Child Health are discussed in every gram sabha. Active involvement of a large number of Self-help Groups has further contributed to widespread acceptance of the small family norm.

In order to improve the infrastructural facilities that have a bearing on the quality of services, 160 First Referral Units have been newly built and fully equipped. New buildings are under construction for 626 PHCs and renovations are being carried out for 477 PHCs. Frequent recruitment of Medical Officers and para-medical staff in the last three years has reduced the vacancies to a minimum. Doubling of the budget for drugs and streamlining their supply has improved the quality and availability of drugs. Continuous clinical management and training programmes for Medical Officers and para-medical staff seek to further improve the quality of services being delivered to the people of my State.

Several specific interventions are designed to address unmet needs. 215 Round-the-clock PHCs have been established and specialist services of Gynaecologist and Paediatrician have been provided at these PHCs and at the First Referral Units. 286 surgeons across the State have been trained in innovative techniques like Double Puncture Laparoscopy and Non Scalpel Vasectomy. We have performed 107809 DPLs and 31454 NSVs during the last year. A project for social marketing of contraceptives to meet spacing needs is under implementation from this year. A massive house-to-house survey has been completed in January 2000, which identifies the unmet need for contraception in our State, and our programmes for the
current year will address these needs.

A new scheme - Arogya Raksha - was introduced in 1999 to cover hospitalisation expenses of family planning acceptors and their children to infuse confidence among them. The Government recognises the role of institutional deliveries in reducing maternal and infant mortality. Such deliveries are encouraged through a novel scheme - Sukhibhava - that provides Rs. 300/- to every pregnant woman below-poverty-line, who has her delivery at Government hospitals or PHCs. The appointment of 8500 Community Health Workers for every habitation in the tribal areas has increased the outreach services for the tribal population. Unserved population in the urban slums is sought to be covered by establishing 192 Urban Health Centres in 74 municipalities. Each of these centres is entrusted to an NGO. Our Government has also issued orders entrusting one remote PHC in each district to an NGO - this is part of our strategy to forge a strong relationship with NGOs in the State.

As a result of all these efforts, the percentage of women receiving ante-natal care has risen from 86.6% in 1992 to 92.7% in 1998; the percentage of safe deliveries has gone up from 49.3% to 65.2% and the percentage of children with full immunisation has risen from 45% to 58.7% during the same period. These are figures from the latest NFHS survey conducted by the Government of India. The number of family planning operations has registered a significant increase from 6.3 lakh during 1997-98 to 7.33 lakh in 1998-99 and a record 7.9 lakh operations in 1999-2000.

Mere availability of health services is not enough. Women's empowerment is the key determinant of success in lowering fertility rates. Demand generation for health care services is closely related to the economic well-being and status of women in the society. Acknowledging this, Andhra Pradesh has encouraged the establishment of women's thrift and credit groups. 3.25 lakh women's groups with 50 lakh members and savings of Rs. 600 crores which is having a significant impact on improving the status of women.

Focused communication campaigns can influence attitudinal and behavioural changes. State-wide communication campaigns lay stress on eight key issues - Reproductive & Child Health, Age at Marriage, Spacing, Institutional Delivery, Immunisation, Nutrition, Small Family Norm and Male Responsibility - in Family Welfare. In fact, these issues have been discussed in every Gram Panchayat during the World Population Day functions on July 11^th and will again be discussed in each and every habitation during the ensuing Janmabhoomi Programme from 1^st to 7^th August.

Exemplary leadership shown by the Chief Minister coupled with strong political commitment and active participation by public representatives at a!) levels has greatly contributed to the widespread acceptance of the family welfare programmes. The Chief Minister in his interaction in the Gram Sabhas, starts the discussions with the Population Control Programmes and related issues, and we, his cabinet colleagues, do the same. Andhra Pradesh has effected the necessary amendments to the Panchayat Raj, Municipalities and Co-operative Societies Acts, debarring those who have more than two children from contesting in the elections. My party has also passed a resolution to the effect that party posts will be given only to those with 2 children.

In order to endorse the acceptance of small family norm, we propose to give preference to those with 2 children or less for selection to Government services with effect from 2001-02. We propose to increase the age at marriage by having registers at Panchayat level to monitor adherence to the legal norms on age at marriage. We also propose to give a thrust on spacing by enhancing the acceptability, accessibility & affordability of contraceptives.

I would like to place before the commission certain issues which need to be taken up by the Government of India. The commission may recommend a step-up in the budgetary allocations for this programme by Government of India to ensure smooth execution of all planned activities. In deciding budgetary allocations, weightage must be given for good performance on the population control front. In order to bring about greater community participation, the commission may recommend to Government of India to earmark a certain percentage of funds in Rural Development programmes to be awarded as incentives to those Gram Panchayats that perform well in family welfare programmes. The national policy document speaks of care for the aged. To encourage our tradition of caring for parents at home, benefits may be announced for families that care for the elderly in their homes. We also request that legislation may be enacted to ensure that population control and related social messages can be aired free-of-cost through the electronic media at prime time. The recent judgement of Supreme Court for payment of compensation in the case of a failure of a family planning operation, has given a set back to the family planning programme. It is internationally accepted that there will be 1-2% incidence of tubal patency when initial operative errors have been excluded. The Government of India needs to immediately take up the issue with the Supreme Court.

The Government of Andhra Pradesh is determined to provide reliable and high quality maternal and child health and contraceptive services to the people of the State. At this first and historic meeting of this distinguished body, my Government reiterates its commitment to meet the great challenges that lie ahead to achieve the goal of population stabilisation. Let us today reaffirm our resolve to participate fully in a programme, which is so crucial to the progress and development of our States and the Nation.

Jai Hind!

Hon'ble Prime Minister and Chairman of the National Commission on Population, Hon'ble Deputy Chairman of the Planning Commission and Vice Chairman of the National Commission, Hon'ble Union Ministers, Leaders of the Opposition in Parliament, Hon'ble Chief Ministers, Deputy Chairman, Rajya Sabha, Distinguished Members, Invitees, ladies and gentlemen,

It gives me great pleasure to address this august gathering, at this first meeting of the National Population Commission, on behalf of the five crore people of Kamataka,

The 21^st century has begun for India with hope for the future. The world has sat up to take note of a new, emerging power, the fifth largest economy in terms of purchasing power parity, a new leader in information technology and the largest, the most vibrant democracy in the world. And our billionth citizen Astha, as the representative of what that future holds for us, has demanded that the trust reposed by the people in their leaders, to make their world a better place, must be redeemed in full measure.

I must, at the outset, welcome the efforts of the Government of India at formulating a new National Population Policy and in setting up this Commission. The issues raised in the policy document, the goals and the strategies will be debated today and in future meetings of the Commission. I hope that this body remains active and vibrant, as much work has to be done over the next few years for the larger benefit of our people.

Let me spend a minute on the position in our State, in the area of population stabilization. Kamataka deserves pride of place in the annals of the family planning programme in India. In June 1930, the first birth control clinics in the world were started in Kamataka, one in Bangalore and the other in Mysore, to advocate small families and provide maternal health care services. Today, through our 8143 sub centres, 1676 primary health centres, 249 community health centres, 103 post partum centres and 87 urban family welfare centres, we provide facilities well above the national norms. Arid what have we achieved ? A crude birth rate of 36.9 in 1971 came down to 22 in 1998, the crude death rate declined from 14.9 to 7.9 in the same period. Our total fertility rate is now 2.13, which already approximates the national goal for 2010. The effective couple protection rate has reached 60 per cent.

But. what do cold statistics imply? In our State we are looking at improving the overall quality of life of our people, not just. restricting our numbers. We do not believe that population stabilisation measures can be taken without improving the overall health and nutritional standards of our people. We feel that the integration of health and family welfare services are absolutely essential. After all, these services merge at the level of the PHC, why then should there be two wings for healthcare at higher levels? We would hope that the policies of the Union Government would permit sufficient coordination between the two departments to obviate any difficulties in this regard.

In Kamataka, we have taken up a major initiative to improve our health systems with the setting up of a fourteen member task force to advise the Government on necessary reforms in the sector. This task force, with Dr. Sudarshan, who is a member of this Population Commission, as the Chairperson, is working on a comprehensive health policy that will also include a population policy for the State. Perhaps for the first time, such a task force of outside experts has also been given the responsibility of overseeing the implementation of reforms, at least in the initial stages.

The question of unmet need is a vexatious one. While the national policy of institutional deliveries for the safety of the mother and the child is laudable, it would be unwise to turn a Nelson's eye to the fact that even in our State, about half the deliveries are outside the formal institutional framework. Even today, the poor pregnant mother has no means, both financial and physical, to travel miles at the time of delivery. We need to go back, therefore, to the traditional midwife, but in a modem environment. We are retraining them, giving them modern kits and facilities, and are even examining the possibility of giving them an assistant for the actual delivery; after all, at the time of birth, both the mother and the child are vulnerable, and the dai cannot easily look after both. Attention to safety issues at the time of birth would improve both MMR and IMR at the same time. We need the support of the Union Government in this effort,

In our State, wherever we have a shortage of auxiliary nurse midwives, we are asking our anganwadi workers to perform the non-clinical duties of the ANMs. On the lines of the Government of India pattern of PHCs with two doctors, we have decided to provide the extra doctor in all PHCs in certain backward districts of the State.

This brings me to an important area of concern. While some States, particularly the southern States, have done well in our population stabilisation efforts, there are regional imbalances within the States which need to be rectified. For example, most parts of northern Kamataka need to be treated on a special footing in all sectors of development. Kamataka's district-wise HDI analysis indicates that there are districts which are as underdeveloped as the worst in any other part of the country. I would recommend that our population stabilisation strategies include a special, intensive efforts for backward regions even within otherwise developed areas.

We consider the reproductive health of rural women to be of prime importance. To provide better menstrual hygiene, which would reduce STI and RTI problems in rural women, we are embarking on a path breaking pilot project of educating teenage school girls and providing personal hygiene kits at a cost of up to Rs. 18 crores to our own exchequer.

There is another, related, area of concern. And that is of the pernicious HIV virus. Along with our sterilisation campaign, which is the main focus of our stabilisation programme, there is need to put inan increased effort at condom promotion. This could perhaps become the most important plank of our population programme in the future.

In Karnataka, we believe that the main determinants of good health lie outside the health sector in sanitation, water supply and literacy. We are, naturally, placing an emphasis in this direction. Though our literacy rate is about 63%, we are concerned at the low levels of female literacy and have made education for girls upto the pre-university level completely free. A major initiative towards a comprehensive village sanitation programme has been started this year. We acknowledge that the nutrition needs of children, particularly in the zero to two age group need to be addressed for reducing IMR and we are working on a combined health, nutrition and population project. However, we feel that a much larger initiative from the Centre with regard to these sectors would be necessary in the coming years.

A word about the role of the voluntary sector. In Karnataka, we have encouraged NGOs to run our primary health centres on behalf of Government. Two such are being run by NGOs in tribal areas, with great success; we are presently discussing with the FPAI for them to take over a few more and we are mandating that each of our medical colleges should provide rural service by "adopting" a few PHCs each for primary health care. We believe that the empowerment of the people can be better achieved with the involvement of the voluntary and the private sector. They also have their own skills and expertise which the Government is trying to tap.

I welcome the present initiative of the Centre. But as I said at the beginning of my speech, the effort cannot stop at a few plenary meetings of this nature, however much they are also necessary. I would recommend that a smaller representative group of Chief Ministers, State Health Ministers, Health Secretaries and experts should meet periodically and report to this apex body about the progress in our population stabilisation efforts.

And finally, I must point out that the small and happy family must include the man of the house and he must be urged to be a part of the population programme. Men seem to be indifferent to most population stabilisation measures and leave family welfare efforts to women. This must change. The man must be made an integral part of our programme and a major media initiative isrequired in this direction. As a symbolic but significant gesture, the father must find a place in the logo of the national RCH programme, along with the happy mother and child.

          I thank you, Mr. Prime Minister, for giving me this opportunity to intervene.

Hon'ble Prime Minister Thiru Atal Behari Vajpayee,
Hon'ble Union Minister of Health and Family Welfare Dr. C.P. Thakur,
Hon'ble Union Minister of State for Health and Family Welfare Smt. Rita Verma,
Hon'ble Chief Ministers of States and Union Territories,
Hon'ble Ministers of Health and Family Welfare from States and Union Territories,
Secretaries to Government of India,
State Secretaries of Health and Family Welfare and other officials,

1. Let me first congratulate the Hon'ble Prime Minister and the Government of India for constituting the National Population Commission. At the outset, I would like to appreciate the effort of Government of India in framing the National Population Policy 2000 which not only spells out goals but has also identified strategic themes and operational strategies. I would also like to thank the Hon'ble Prime Minister for providing an opportunity to the States and Union Territories to share their experiences and express their views on issues relating to population stabilisation. I am sure that the deliberations of this council will help the States and Union Territories and thereby the country in achieving the national population policy goals.

2. I would like to use this opportunity to share with this august body the success story of Tamilnadu's Family Welfare programme. Realising that family planning is now a critical input for development, our Government has been taking keen interest in population stabilisation measures. Major initiatives have therefore been launched in this direction by the State. This has resulted in improving the quality of care, bridging the gaps in the health care delivery system, thereby meeting to a large extent, the unmet needs of the rural and urban population. It has also brought Tamilnadu to the forefront of the family welfare programme. Recently, a State Level Population Commission has been constituted under my chairmanship. Our impressive record of achievements is as follows:

With 100 percent immunisation coverage, more than 84 percent institutional deliveries and 100 percent antenatal registration, Tamilnadu has emerged as a model state for family welfare and health care.

3. Tamilnadu's progress in the family welfare is the outcome of several factors including the general development of the economy. However, one of the most important factors has been the high level of political commitment for the programme and strong political will to implement it. Long before government of India introduced the Family Planning Programme in the country the great social reformer Periyar Ramasamy created a strong social movement in the state to increase the age of marriage for women and acceptance of the small family norm. This movement has been carried forward by Arignar Anna and now by the present Government. This tradition has continued along with the formal family planning programmes launched nationally. Almost all social and political leaders and even prominent administrators talk forcefully about family planning and the small family norm at any opportunity they get to interact with the people both in public meetings and social functions. This, along with specific IEC programmes has resulted in creating a 99 percent awareness of the small family norm in Tamilnadu.

4. In order to provide health care facilities to the people of the state, Tamilnadu has systematically created health infrastructure as per Govt. of India norms in respect of Health subcentres, Primary health centres, Government hospitals etc. As a result, we have at present 8682 Health subcentres, 1410 Primary health centres, 160 Taluk hospitals, 67 non-taluk hospitals, 26 district hospitals and 11 teaching medical institutions. After the present Government came to power in 1996, it was decided to improve the infrastructure facilities by providing own buildings for all the Primary Health Centres. Hence, 652 Primary Health Centres were built at a cost of Rs.51 crores purely from the state funds. On date, 94 percent of PHCs are functioning in their own buildings, the balance is under various stages of construction. Similarly 64 percent of the Health Subcentres are functioning in their own buildings. 600 are being constructed. 400 of these are through community participation. This is a unique experiment, which Tamilnadu is carrying out. To ensure 24 hour health care in rural areas, 250 Block PHCs are now functioning round the clock with additional doctors and para medical staff.

5. Knowing that uninterrupted supply of quality drugs is a key input for improving the quality of the health care delivery system, a Corporation for purchase and distribution of drugs has been established in the state called Tamil Nadu Medical Services Corporation. The Corporation has drawn up an essential drug list, procures these drugs centrally, stores them at district headquarters and ensures their distribution to all health facilities through a drug pass book system. The corporation maintains strict control on the quality of the drugs supplied. The efficiency and success of the corporation is to a large extent due to the transparency with which it functions. Right from the tender forms to the latest stock position are now available on its website. This organisation has also received the ISO 9002 certification. The entire operations of the corporation are monitored through computers.

6. To bring in additional funds and strengthen the public and private collaboration, we have taken the initiative of asking industrial houses to adopt medical institutions totally, partially or for specific purposes like repair and maintenance, provision of equipment etc. So far 69 PHCs, 5 HSCs, 24 Government hospitals have been adopted by 51 industrial houses and their contribution is about Rs.1.5 crores.

7. The State has also drawn up a standard equipment list for PHCs and HSCs. Equipments are now provided and supplied as per this list. All First Referral Units have now been equipped with ultra sonograms apart from other emergency and essential obstetric and newborn care equipments.

8. Realising that infrastructure cannot be optimally utilised without adequate training of manpower, the physical and academic infrastructure of training institutions in the state have been strengthened. The curricula have been revamped to focus on development of skills, management, and gender motivation and community mobilisation to improve the quality of care given by the providers.

9. Apart from training and sensitisation of all health providers in the State including the state level functionaries like Director of Health and Family Welfare Departments, training is now given to all Medical Officers on their induction in the PHCs. The training includes familiarisation with the ongoing Family Welfare Schemes in the State, reorientation of technical, management as well as administrative skills. Here, I would like to mention, about a unique mobility training, the state gives to its grass root level functionaries the Village Health Nurses(VHN), Sector Health Nurses(SHN) and Community Health Nurses(CHN). These female field health functionaries are the backbone of the health care delivery system, and their mobility is critical to better delivery of outreach activities. Sensitive to the ground reality that mere provision of funds and sanction of moped loans were not sufficient to make them mobile, 3 day residential camps are being organised for imparting training in moped riding. The response for this was overwhelming and there is a distinct improvement in the field level management of health services.

10. In order to effectively manage the health care delivery system, constant monitoring of inputs and outputs is required. For doing this, state has been conducting, since 1996 a vital events survey involving a huge sample of 9 million persons. More comprehensive than the sample registration system-this generated estimates of vital data gender wise, district wise and place of residence wise. It also sensitised the entire health system personnel to issues of Public Health in general and Maternal and Child Health in particular.

11. To monitor the performance of Primary Health Centres, a format compatible for reading and feeding into the computer by using an Optical Mark Reader (OMR) has been developed. Thus concurrent monitoring of the institutional activities of all PHCs like outpatient, inpatient, number of deliveries conducted is being done regularly. As a result of this close monitoring the utilisation of the institutional services is steadily increasing.

12. In order to bring down the IMR and MMR a critically important monitoring tool has been adopted by the state called the maternal death audit and infant death audit. A Medical Audit team has been formed for each revenue district with the District Health Administrator, Obstetrician and Chief Medical Officer of the First Referral Units as members A Maternal death protocol has also been developed for prompt reporting and investigation of maternal deaths. The objective of these is to determine the medical and non-medical causes of each maternal death. The team gives the report after detailed investigation which includes the viewpoints of the relatives as well as the service providers of the deceased within 15 days of the occurrence of death. The aim of this verbal autopsy is fact finding and sensitising service providers to take corrective action on systemic failures.

13. Our Government has introduced recently a new scheme of comprehensive free health checkups and treatment camps in rural areas called "Varumun Kappom". This scheme is the first of its kind in the country. During the camps more than 15 specialist doctors from the government hospitals screen the rural people with sophisticated equipments like ECG and Ultra sonogram etc. treat them and if required refer them to higher medical institutions for special treatment for which transport services are also provided by the government. Health awareness, health promotion and knowledge of avoidance of ill health are also to be imparted in these camps. So far more than 4334 camps have been held in the villages. The average attendance per camp is around 916. By December, 10 million people i.e. one sixth of the population of the state will be covered by these early detection camps. These camps have generated a massive data on morbidity patterns making it easy to draw up area wise epidemiological profiles for the whole state. This will also act as a major input in planning and designing preventive and curative health care. This is a unique programme aimed at providing services at the doorstep and improving the quality of life for the rural poor.

14. Similarly the School health programme "Vazhvoli Thittam" has been intensified during 1999. School children from first to twelfth standard are screened, treated and if required referred to a higher medical institution by a team of medical and para medical staff of the PHC based on a fixed plan of visits for schools. 72 lakh school children have been screened during 1999-2000.

15. In order to give a new thrust to the Family Welfare Programme, "State Population Policy 2000" is under preparation. A special drive to shift the exclusive burden of the programme from that of women and bring about active male participation through intensive IEC activities is under way. We are also taking initiatives for ensuring that the future generation is healthy and strong, by launching an iron supplementation programme and rubella vaccination programme for our future mothers - i.e. adolescent girls.

16. With all these initiatives the state is steadily marching forward. The natural growth rate of the state has fallen below that of Kerala and now stands at 10.7 compared to 11.9 of Kerala.

17. We have also achieved the replacement level net reproduction rate of one. India will require another 5 years to achieve this if the current tempo is maintained. Our vision is to bring about the stabilisation of the population of Tamilnadu at 7.2 crores by 2010 and we are sure we will achieve it.

18. However, we have an apprehension in our mind which the Hon'ble Prime Minister and the government of India have to dispel. Tamil Nadu has 39 Members in the Lok Sabha. At the moment, we have an assurance from the Hon'ble Prime Minister and the Government of India that consequent on reduction in population, our representation in the Lok Sabha will not get reduced. I am sure the Hon'ble Prime Minister and the Government of India will take immediate and appropriate measures by way of suitable amendment to the Constitution to ensure that Tamil Nadu and other States which have implemented Family Welfare Programmes enthusiastically and successfully to contain and stabilise the population are not penalised by a reduction in the number of their representatives in the Lok Sabha. In view of the fast approaching deadline of the year 2001, it has become imperative that the issue is addressed at the earliest and the freeze on the existing number of Lok Sabha seats allocated to the State extended till 2025 A.D. as recommended in the 'National Population Policy, 2000'.

I am sure we will have the very valuable support and encouragement of the Hon'ble Prime Minister and Government of India in realising our population stabilisation goals.

                          Thank you, Vanakkam.

Hon'ble Prime Minister, Members of National Commission of Population, Officers of Central and State Governments: I am thankful to the Chairman for providing the opportunity to participate in this august meeting and put forth our achievements and proposals in brief.

At the foremost I  would like to bring to the notice of the Hon'ble Prime Minister and other dignitaries that the annual growth rate of Union Territory population is 2.7, mainly due to the migration of population from the neighbouring States of Tamil Nadu, Kerala & Andhra Pradesh and over 40% of the patients attended to in our health care facilities are from these adjoining States. The delivery of health care poses great logistical challenges as the four regions of the Union Territory are geographically isolated at distances of 150 km. to 980 kms. from the capital, Pondicheny.

In our Union Territory, School education upto the age of 16 has been made free and compulsory. All the school children are being examined annually by the Govt. doctors and admissions to the colleges are made only on production of the student school Health record. The NGOs and private sectors including Rotary, Lions etc. have been actively involved  in our compaign to prevent school drop-outs.

In close coordination with the Anganwadi and Balwadi workers, the field staff of the Health Department have ensured 100% coverage of immunization against vaccine preventable diseases. I am happy to inform that as per UNICEF report of IPPI, the polio awareness and immunization coverage was 100% in the urban as well as rural areas and there were  un-immunised children. All such efforts have ensured a very low infact mortality rate of 21 and maternal mortality rate of 0.2.

In the arena of  Family Planning, the Union Territory has acliieved tlie best eligible couple rate  of 59.2 and fertility rate of 1.8. As a result of the high health awareness. 93% of the deliveries are conducted in the Govt. health institutions and 100% safe deliveries by trained staff. The recent rapid household surveys conducted by the Govt. of India have revealed that over 97% of the pregnant women in the U.T. have received a minimum  of three anti-natal cheek ups and also that all the abortions are conducted by the doctors only. The survey has also revealed a relatively high awareness of 60% to 100% in regard to AIDS, RTI & STI in the four regions of the U.T.

The dense network of health care facilities for the 291 villages has ensured easy accessibility of health care with in a distance of 1.18 Kms. In view of this there would not be any necessity for implementation of the maternity but concept in our Union Territory.

In spite of the above achievements, the Union Territory need to address the unmet needs for contraception, health care infra-structure and health personnel so as to provide ideal health care delivery.

Further progress in the reduction of CBR, CDR & IMR would essentially require thrust in the implementation of the RCH. The present shortfalls in the health care are primarily due to lack of health care infrastructure in the urban slums. I request the commission to provide more inputs for the coverage of population in urban slums on par will rural areas.

The proposed cash incentives for maternity benefits, small family norms, marriage after legal are etc. need to be implemented immediately and additional funds in this regard may be released to this Union Territory. The existing 330 bedded Maternity Hospital at Pondicherry has been conducting over 80 deliveries per day and there is urgent need to create additional facilities, the Union Territory Govt. has proposed to construct a new Women and Children Hospital so as to provide better health care for the women and children of the U.T. I take this opportunity to request the Chairman for additional grants in this regard.

During the past decade the main constraint has been non-creation of requisite posts due to ban on creation of additional posts. There is an immediate need to exempt the health sector from such ban for effective implementation of the National Population Policy.

In regard to the Health insurance, it is suggested that the National Illness Fund facilities may be extended to all the families who have opted for small family norms even if they are above the Below poverty line.

I appreciate and congratulate the Central Govt. for taking up the initiative for formulating the National Population Policy and convening this Meeting.

Jai Hind

Hon'ble Prime Minister Hon'ble Members of the National Commission on Population.

It gives me great pleasure to be a part in this first meeting of the National Commission on Population and I take this opportunity to heartily congratulate the Hon'ble Prime Minister for having taken the initiative for the formulation of the new National Population Policy and for convening this meeting today.

Punjab State has always had a place of pride in providing accessible health care to its people. This is evident from the fact that most of the targets set for achievement by the year 2000 AD in family welfare programmes have been achieved in Punjab. The death rate and maternal mortality rate are already better than the goals set to be achieved by 2010 AD. The birth rate in Punjab is 22.4 peri 000 against the target rate of 21 per 1000 while the birth rate in India is 26.5 peri 000. The total fertility rate in Punjab is 2.7 against the target of 2.1 while in India it is 3.3. However, Punjab has always had the inborn capacity to face every challenge and I have no doubt that it shall achieve the goals set for the year 2010AD much before that date.

I AS REGARDS THE INITIATIVE TO  MEET THE UNMET NEEDS

Punjab has identified the areas where a certain amount of unmet need still persists. The awareness regarding family planning programme is 100% but the practice of various family planning methods by the eligible couples is 66%. To meet this requirement, the Punjab Govt. is determined to provide Family Planning services to all the needy eligible couples by improving the out reach of services with quality care. It will also be ensured that supply of various contraceptives is adequate. As regards cent percent registration of ante-natal mothers is concerned, there is an unmet need of nearly 25%. As far as achievement of atleast 80% institutional deliveries is concerned, only 37% antenatal mothers are availing institutional services currently. Similarly, there is a gap of 28% in the achievement of full immunization of Infants. The shortfall in these areas is largely because of the dearth of ANMs and Nurses in our Primary Health centres and I will, therefore, urge the Government of India to provide more funds for Punjab State for hiring them on contractual basis.

II REGARDING ISSUES OF QUALITY OF CARE

To ensure quality services to ante-natal mothers, staff has been hired on contractual

basis. For the transportation of high risk mothers and emergency cases, ambulances have been made available by Punjab Health System Corporation(PHSC).

In order to improve the working skill of medical and para-medical staff, short term training courses have been organised.

Ill SYNERGY BETWEEN DIFFERENT DEPARTMENTS

The new approach to family welfare programme envisages intersectoral coordination and cooperation. The creation of Istri Sehat Sabha has been done with an aim to get coordination and cooperation from the community.

Punjab is the only State in the country where 26000 Istri Sehat Sabhas have been formed, ensuring their presence in each and every village and urban slums of the State.

IV ROLE OF MEDIA, NONGOVERNMENT ORGANISATIONS, PRIVATE SECTORS & PANCHAYATI RAJ INSTITUTIONS

In Punjab the role of Information, Education and Communication activities has always occupied a prominent place in the dissemination of information about activities of the Health Department.

I would like to assure the Hon'ble Prime Minister and all other members of the National Commission that Punjab State will not lag behind in implementing the National Population Policy and would be amongst the first in the country in achieving the targets set by it as it has been doing in the past also^ Here I would like to inform the august audience that Punjab had won National Awards in family planning for four consecutive years( 1982-1986) in the past too.

I would once again express my gratitude to the Hon'ble Prime Minister for having given me the opportunity to participate in today's meeting.

             Jai Hind.

I am of the clear view that for stabilizing the population, we will have to resort to certain practical measure along with reduction in infant mortality rate, maternal mortality rate and total fertility rate. Key to the success of any policy lies in people participation. This is also a precondition for the success of population policy of Madhya Pradesh and National Population Policy as well.

Village level democratic institution have already emerged in our state, these institutions are capable of ensuring peoples participation in various programmes.

An important initiative which we intend to take is in terms of stream lining our grass route health infrastructure. We believe that the community control of village level functionaries like male and female health workers is far more effective and efficient. We have already gone far ahead in this direction. Madhya Pradesh has the credit of initiating the implementation of the Panchayati Raj Adhiniyam 1993. State has nearly 32000 PRIs with about 4.80 lacs elected representatives.

State govt. has passed an act in 1995, which will enable District Planning Committees, popularly known as Zila Sarkar, to prepare consolidated development plan for the entire district. DPC have been made responsible for the implementation and monitoring of the population stabilization efforts in the district.

We have to bring about the gender equality and equity in society by women empowerment. Madhya Pradesh in having nearly 200,000 elected women representatives out of 4,80,000 total representatives. Women member of elected bodies have a vital role to play in the process of achieving stabilized population and implementations of reproductive health services.

State government will launch systematic campaign to make men realize their responsibility in empowering women.

State commission on women will be entrusted the responsibility of identifying barriers of gender equity and equality. Commission will also suggest measures to overcome the problems.

More attention will be paid to encourage at least 30 percent of girls in the age group 14-15 to complete elementary education.

Total literacy campaign through Padhna-Badhna Samiti covering the entire state is doing pioneering work to increase literacy among men and women. Efforts will be intensified to ensure 100 percent literacy amongst women aged 15-35 yrs.

Self-help groups will be created in each panchayat by the year 2003. These groups will be assisted to achieve economic independence.

Certain regions in Madhya Pradesh are comparatively behind other regions in term of infant mortality rate, maternal mortality rate and total fertility rate, it will be our endeavor to specifically and closely target these region and employ greater efforts to ensure that this handicap is removed.

The state is in the process of its latest human development report, which will include working out human development indices even at village level. We will make concerted efforts on such pocket of villages, Community, and social groups, which have high fertility rate.

In urban areas special efforts will be made to tackle those populations particularly slum areas, which have shown higher IMR, MMR & TFR.

The mission of the population policy of Madhya Pradesh is to improve the quality of life of the people in the state by achieving a balance between population, resources, and environment. Rapid reductions in fertility and mortality rates will be achieve for the population stabilization and improving the quality of life.

In the state of Madhya Pradesh even the poorest of poor wants to plan his family, but our resources and services are falling short in fulfilling this desire. I was deeply agonized to know that 23 percent of the total pregnancies taking place in Madhya Pradesh are unwanted.

The health system will try to reach those families who are willing to control their fertility, and the problem of unwanted pregnancies has to be seriously heeded. A pilot project has been started in the district Rajgarh to develop a framework to identify the couple with unmet need and to convert their need into acceptance through an effective service delivery system. On the success of the framework, it would be replicated in the other districts of the state.

Private sector and the non-governmental organizations have proven their ability in mobilizing the community support, demand generation and awareness creation. NGOs can play important role in providing health care services to the population in the inaccessible and remote areas. NGOs involvement in population stabilization efforts, providing reproductive health care services and to impart skill base training would be encouraged. For this purpose NGO networks will be created through Mother NGOs.

Similarly, private sector potential will be harnessed to provide quality reproductive health services. State govt. has plan to provide soft loans to medical practitioners with preference to lady medical practitioners for providing health services in areas not effectively served by the public institutions. Private sectors will also be utilized for promoting social marketing of contraceptives.

State has shown its firm determination towards the implementation of the population policy. Constitution of the State Population and Development Council under the chairmanship of the Chief Minister is in process. Other members of the council would include leader of opposition party in the state, Ministers of the concern departments and representatives form organized sectors, Women's organizations, trade unions and NGOs.

State Population Resource Centre will be established. The SPRC would provide technical support and suggest type of measures to be taken from time to time to achieve the desired goal of TFR 2.1. by the year 2011.

Some of the initiatives taken by the state government:

Legal age at marriage has been made criteria for govt. jobs and for sanctioning govt. loans and facilities.

Inclusion of Adolescent and Family life Education will be made compulsory in all future NGO projects funded by the govt. and the donor agencies.

Provision of safe drinking water.

An integrated Information, Education & Communication strategy will also be formed to create awareness among community.

Person having more than two children after 26 January 2001 would not be eligible for contesting elections for Panchayatas, Local bodies, Mandis and Cooperatives. Govt. has also taken a decision that person having more than two children after 26 January 2001 would not be eligible for govt. jobs and other govt. benefits.

Awards will be given to Panchayati Raj Institutions and Urban local bodies in the field of community support for population stabilization.

Further the planned family has to be made a thing of pride and for this people have to be involved in the programmes, to provide new insight, new direction and modern thinking to the society.

Madhya Pradesh Government has implemented its new Population Policy with the hope that its success will contribute in paving the way for the building of a modern Madhya Pradesh.

Digvijay Singh Chief Minister Madhya Pradesh