As per the Census of India 2011, the growth rate of urbanisation during 2001-11 was 31.8 per cent which was higher than the total population growth rate of 17.6 per cent during the same period. By the year 2021, more than 432 million people will live in urban areas and this is likely to increase to 670 million by 2031. As per the report titled ‘Indian Realty—through the looking glass’, which is a joint initiative of Confederation of Indian Industry (CII) and Jones Lang Lasalle states, an estimated 843 million (84.3 crore) people in India will live in urban areas by 2050.
Urban development is a state subject and it is primarily the responsibility of state governments to provide basic amenities. However, government of India has launched various programmes to support the effort of state governments by providing financial assistance and capacity building. The government of India has recently launched the Atal Mission for Rejuvenation and Urban Transformation (AMRUT) to support the efforts of states in improving urban infrastructure and governance. The thrust areas of the Mission are water supply, sewerage facilities, septage management, storm water drains, pedestrian non-motorised and public transport facilities, parking spaces and creating green spaces. The Mission is to be implemented in 500 identified cities in the country.
The Smart Cities Mission has also been launched with the objective to promote cities that provide core infrastructure and give a decent quality of life to its citizen, a clean and sustainable environment and application of ‘smart’ solutions to improve infrastructure and services. The strategic components are area-based development plus a pan-city initiative in which smart solutions are applied city-wide. The Mission will be implemented in 100 cities in the country selected in phases. Heritage City Development and Augmentation Yojana (HRIDAY) offers strategic and planned development of heritage cities aiming at improvement in overall quality of life with specific focus on sanitation, security, tourism, heritage revitalisation and livelihoods retaining the city’s cultural identity. The scheme is to be implemented in 12 towns—Ajmer, Amaravati, Amritsar, Badami, Dwarka, Gaya, Kanchipuram, Mathura, Puri, Varanasi, Velankanni and Warangal. —Inputs from the Ministry of Urban Development, Govt, of India, March 2016.
Women suffering from Anaemia in India
As per National Family Health Survey (NFHS)-III (2005-06), prevalence of anaemia in women was 55.3 per cent. The steps taken by the government to prevent and treat anaemia amongst women are as follows:
- Ministry of Health and Family Welfare in 2013 launched the ‘National Iron Plus Initiative’ as a comprehensive strategy to combat the public health challenge of iron deficiency anaemia prevalent across the life cycle. There are age specific interventions with iron and folic acid supplementation and deworming for improving the haemoglobin levels and reducing the prevalence of anaemia for all age groups, that is children (6-59 months and 5-10 years), adolescent girls and boys (11-19 years), pregnant and lactating women and women in reproductive age group (20-49 years).
- Universal screening of pregnant women for anaemia is a part of ante-natal care and all pregnant women are provided iron and folic acid (IFA) tablets during their ante-natal visits through the existing network of sub-centres and primary health centres and other health facilities as well as through outreach activities at Village Health and Nutrition Days (VHNDs).
- Every pregnant woman is given IFA, after the first trimester, one tablet daily for 6 months during ante-natal and post-natal period. Pregnant women, who are found to be clinically anaemic, are given additional tablets.
- The Indian government has given directions to the states to identify and track severely anaemic cases at all the sub centres and primary health centres for their timely management.
- Health and nutrition education through information education communication (IEC) and behaviour change communication (BCC) to promote dietary diversification, inclusion of iron folate rich food as well as food items that promotes iron absorption.
- To tackle the problem of anemia due to malaria particularly in pregnant women and children, long lasting insecticide nets (LLINs) and insecticide treated bed nets (ITBNs) are being distributed in endemic areas.
- Health management information system and mother child tracking system is being implemented for reporting the cases of anaemic and severely anaemic pregnant women.
- Mother-Child Protection (MCP) card and safe motherhood booklet is being distributed to pregnant women for educating them on dietary diversification and promotion of consumption of IFA.
- 184 high priority districts (HPDs) have been identified and prioritised for Reproductive Maternal Newborn Child Health and Adolescent (RMNCH+A) interventions for achieving improved maternal and child health outcomes. —Inputs from the Ministry of Health and Family Welfare, Govt. of India, March 2016.
High incidence of anti microbial resistance
It is generally believed that availability of antibiotics over the counter and lack of awareness about using antibiotic drugs only as prescribed by doctors, results in inappropriate use of antibiotics. As per a recent report (2015) released by Global Antimicrobial Resistance Partnership (GARP), it is reported that resistance among common pathogens is increasing worldwide though regional patterns of resistance vary.
Common bacterial pathogens becoming resistant to antimicrobials are Staphylococcus aureus, Enterococus, Streptococcus pneumoniae, Neisseria gonorrhoeae, Neisseria meningitidis, Escherichia coli, Klebsiella pneumoniae, Typhoidal Salmonella, Shigella species, Vibrio cholerae, Mycobacterium tuberculosis and in other diseases such as malaria, kala azar, HIV etc.
It is estimated that the prevalence of multi-drug-resistant tuberculosis (MDR-TB) in India is 2-3 per cent among notified new pulmonary tuberculosis (TB) patients and around 15 per cent for re-treatment pulmonary TB patients.
While separate data on disease burden of the Indian population caused by infectious diseases is not available, it is estimated that overall communicable diseases contribute to 37 per cent of the entire disease burden.
Indian Council of Medical Research (ICMR) is carrying out surveillance of drug resistance to antibiotics through its Antimicrobial Resistance Surveillance Research Network (AMRSN) in six pathogenic groups (i) Diarrhoeagenic bacterial organisms; (ii) Enteric fever pathogens; (iii) Enterobacteriaceae causing sepsis; (iv) Gram negative non-fermenters; (v) Gram positives including Methicillin-resistant Staphylococcus aureus (MRSA); and (vi) Fungal infections. Four nodal centers for collection of data are Christian Medical College (CMC), Vellore, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh and All India Institute of Medical Sciences (AIIMS), New Delhi. The significant findings from last two years indicate that Salmonella typhi multidrug resistance (MDR) to ampicillin, chloramphenicol and trimethoprim –sulfamethoxazole is showing a downward trend. However, more than 50 per cent of bacterial isolates of Klebsiella spp. and E. coli were found to be resistant to the currently used third generation cephalosporins, but they are sensitive to carbapenams
To further regulate the sale of antibiotics, the government of India, in the year 2013, amended the Drug and Cosmetics Rules, 1945 to incorporate a new Schedule H1 containing 46 drugs which also includes third and fourth generation antibiotics and anti-TB drugs for a strict control over the sale of these drugs. The drugs falling under Schedule H1 are required to be sold in the country with the following conditions:
- The supply of a drug specified in Schedule H1 shall be recorded in a separate register at the time of the supply giving the name and address of the prescriber, the name of the patient, the name of the drug and the quantity supplied and such records shall be maintained for three years and be open for inspection.
- The drug specified in Schedule H1 shall be labelled with the symbol Rx which shall be in red and conspicuously displayed on the left top corner of the label, and shall also be labelled with the following words in a box with a red border – ‘Schedule H1 Drug-Warning’.
It is dangerous to take this preparation except in accordance with the medical advice. It is also not to be sold by retail without the prescription of a registered medical practitioner.
- An insertion has been made in the Drugs and Cosmetics Rules, 1945 to specify the withdrawal period of antibiotics in case of egg, milk, poultry and fish before these enter the human food chain. The Department of Animal Husbandry, Dairying and Fisheries has also issued advisories in 2014 addressed to all states and union territories regarding judicious use of antibiotics to prevent antimicrobial resistance (AMR).
- A National programme for containment of AMR has also been initiated in the 12th Five Year Plan with the following objectives.
- To establish a laboratory based surveillance system by strengthening laboratories for AMR in the country and to generate quality data on antimicrobial resistance for pathogens of public health importance.
- To generate awareness among health care providers and in the community regarding rational use of antibiotics.
- To strengthen infection control guidelines and practices and promote rational use of antibiotics.—Inputs from the Ministry of Health and Family Welfare, Govt. of India,March 2016.
Diseases caused by Pollution
According to World Health Organization (WHO), 2012, ischemic heart disease and chronic obstructive pulmonary disease are top two causes of death in India. Air pollution is an important risk factor of both these diseases. As per data reported to Central Bureau of Health Intelligence, number of cases of acute diarrheal diseases and typhoid reported in the year 2014 were 11.67 million and 1.71 million respectively. As per WHO Report 2015, childhood diarrhoeal diseases contribute to 10 per cent of under five deaths in the country i.e. around 1.25 lakh children are lost due to diarrhoea annually in the country.
While health is a state subject, the central government supplements the efforts of the state governments for improving health care.
Under the National Health Mission, Ministry of Health and Family Welfare, the following steps are being taken by the government for prevention and control of diarrhoea in children:
- Promotion of early and exclusive breast feeding along with appropriate complementary feeding, is being undertaken through frontline health workers namely accredited social health activists (ASHA) and auxiliary nurse midwife (ANM) at community and facility level.
- Oral rehydration salt (ORS) packets and zinc tablets are made available free of cost.
- Vitamin A supplementation programme for children up to of five years of age.
- Awareness is being created amongst mothers on sanitation and hygiene and in the communities about the causes and treatment of diarrhoea through health education.
- Antibiotics for treatment of dysentery are made available through the public health system.
- Capacity building of frontline workers and medical officers through the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) and Facility Based Integrated Management of Neonatal and Childhood Illnesses (FIMNCI).
- Use of Mother and Child Protection (MCP) card for growth monitoring to track children for status of undernutrition and timely intervention during village health and nutrition days (VHNDs)
- Surveillance activities to detect outbreaks of diarrhoea through Integrated Disease Surveillance Programme (IDSP) are also carried out.
- Intensified Diarrhoea Control Fortnight (IDCF) is being implemented as a campaign in last month of July and first month of August, since 2014, for control of deaths due to diarrhoea across all states and union territories. It includes massive awareness generation on use of ORS and zinc during diarrhoea, bringing together multiple departments to generate awareness and also reach to each under five child with one packet of ORS to be used when diarrhoea begins. Main activities include intensification of advocacy activities, awareness generation activities, diarrhoea management service provision, establishing ORS-zinc demonstration sites, ORS distribution by ASHA through home visitation, detection of undernourished children and their treatment, promotion of infant and young child feeding activities by home visits by ASHA and establishing infant and young child feeding (IYCF) corners.
State and regional level workshops are being held for in-depth planning and review as per the Integrated Action Plan for Pneumonia and Diarrhoea (IAPPD) framework. —Inputs from the Ministry of Health and Family Welfare, Govt. of India, March 2016.