Rajendra Singh Negi*
Prof A.R. Dangwal**
Uttarakhand is the first state of the Union of India which declared its health policy in 2002. The aim of this policy was to control diseases within a stipulated timeframe. No doubt the objective was praiseworthy, but it was premature to decide the target without a proper exercise, including the assessment of the infrastructure and the human resources of the newly constructed state. As a result, the health policy has failed to achieve its targets in time.
With respect to health communication, the World Health Organization (WHO) defines it in its Health Promotion Glossary: “Health communication is a key strategy to inform the public about health concerns and to maintain important health issues on the public agenda. The use of the mass and multimedia and other technological innovations to disseminate useful health information increases awareness of specific aspects of individual and collective health as well as importance of health in development1”.
Statement of Problem
The health policy of Uttarakhand has still not been properly assessed. This paper tries to find out whether the health goals were achieved or not within the stipulated time. .
Review of Literature
As such no specific literature is available on the topic. The health policy of Uttaranchal/Uttarakhand was reviewed in 2009 by the US Agency for International Development (USAID) under the title “The Health and Population Policy of Uttarakhand: A Review”. It found that the timeframe for achieving the policy objectives was not sufficient because the severe human resource crunch, including shortage of personnel who have multiple roles and responsibilities, affected the overall delivery of the programmes. The quantity and quality of resources for service delivery was insufficient and the infrastructure and supplies were inadequate.
The management information system was not being utilized optimally for sound decision making. Interdepartmental communication was inadequate. A key finding was that access to health service and the quality of facilities had improved to some degree. The accredited social health activists had become an important source of information about health issues and the available services. It is to be made clear that the study was made in August 2009 (pdf, available on internet) but some goals/targets of the policy were targeted to be achieved in 2010. Hence, it was a premature assessment.
To analyse the facts in a given timescale, a descriptive methodology was used. For the purpose of this study, the facts and goals decided at the time of framing the policy were taken into consideration. Hence, mainly secondary sources were used for the present study.
The main aim of this study was to know the achievements within the overall status of the health policy, till and after the targeted period.
The Health Policy
The major objectives2 of the health policy of Uttarakhand are:
- Eradication of polio by 2005.
- By the end of 2004 reduce leprosy rate to below one person per 10,000.
- Fifty per cent reduction in deaths caused by TB, malaria and other vector and water- borne diseases by 2010.
- Reduce the prevalence of blindness from around 1 to 0.3 per cent by 2010.
- Up to 50 percent reduction in diseases caused by Iodine deficiency by 2010.
- Reduce RTIs to below 10 per cent among men and women by 2007.
- By 2005, increase HIV/ AIDS awareness from the present 36 per cent 70 percent.
- To achieve zero level of growth in HIV/AIDS infection by 2007.
Status of Achievements
Some of the objectives with regard to major diseases and their achievements are presented in the table below:
|Polio||Eradication up to 2005||Not achieved|
|Leprosy||At the end of 2004|
leprosy rate reduced
below 1 person per
|TB and Malaria||50% reduction in deaths|
caused by TB & Malaria
|Blindness||Reduce the prevalence of|
blindness from around
1 to 0.3 per cent by 2010.
|Iodine deficiency||Up to 50% reduction in|
the diseases caused by
Iodine deficiency by 2010.
|RTI infection||Reduce RTIs to below 10%|
among men and women
|HIV/AIDS awareness||By 2005 increase HIV/ AIDS|
awareness from 36% to 70%.
|AIDS||By 2007 reduce HIV/AIDS|
transmission to zero.
Source: Health and Family Welfare Department, Govt. of Uttarakhand.
Polio: The target date for eradication of polio was 2005, but it was not achieved. This target was achieved in 2010 when no polio case was reported3 .
Leprosy: The target to reduce the rate of leprosy to below 1 per 10 thousand by 2004 was achieved three months after the targeted date in 2005.
TB, Malaria and other Vector and Water-borne diseases:
The goal was to reduce the death caused by TB, malaria and other viruses by 50 per cent by 2010. The death rate caused by TB was 3 to 4 per cent during the period 2004 to 2010, according to the data provided by the health and family welfare department, Uttarakhand, under the Right to Information Act. Previously, the death rate was 29 per cent, as per the National TB Control Programme (www.tbcindia.org). But Uttarakhand was not mentioned in it specifically. TB India 2002, RNTCP annual status report (available on http://www.tbcindia.org) says that TB deaths came down seven -fold in India and TB deaths were four per cent in 2002. As per the State TB Control Officer, Uttarakhand, the status remained almost same in the state. New Smear Positive TB cases detected were between 3040 and 5409 annually during 2004- 20105. According to the National TB Control Programme in Uttarakhand, the implementation status, recorded in the Uttarakhand State Report6 ,”The whole state is covered under RNTCP, but in the state level performance (based on quarterly reports for the first quarter of 2009) there is downward trend and the overall performance is not good. No deaths were reported due to malaria from 2002 to 2010, but cases are regularly increasing7.”
Blindness: The goal was that loss of eyesight be reduced from one per cent to 0.3 per cent by the end of 2010, but the state achieved only 0.56 per cent reduction till 14 July 20118.
Iodine Deficiency: The health policy targeted to achieve 50 per cent reduction in diseases caused by Iodine deficiency by 2010. In this regard no specific information was provided by the health department of Uttarakhand in response to an inquiry under the RTI act. The department provided only general information based on a survey conducted by the technical support of the Himalayan Institute, Jollygrant, Dehradun, under which IDD (Iodine deficiency) prevalence rate during 2001-2002 was highest in Dehradun at 5.3 per cent. During 2002-03 Chamoli district’s IDD prevalence rate was 1.4 per cent. Tehri Garhwal IDD prevalence rate was 1.36 per cent and Nainital district’s rate was 4.6 per cent. In 2003-04, Udham Singh Nagar district’s IDD prevalence rate in general public was 2.7 per cent and Pithorgarh district’s rate was 4.43 per cent. Again, a survey of five districts (Tehri Garhwal, Almora, Nainital, Chamoli and Dehradun) was conducted in 2009-10 by an NGO, Sharnam. The survey reported that “68.46 per cent families use good quality Iodine salt”. It was based on the information given by the Joint Director (under RTI Act). It is clear that the prevalence rate of IDD has been reduced, but it is not clear whether the health policy target was achieved or not in time9.
RTIs (Reproductive Tract Infections/Sexually-transmitted Infections): The target in such cases was to reduce infection cases below 10 per cent by 2007 in both males and females. According to the NFHS-3 (2005-06) the RTI/STI infection prevalence rate was reported to be 0.3 per cent in males and 1.2 per cent in females10 ,but there was no base line to determine whether the target was achieved or not.
AIDS: By 2005 the target for increasing HIV/AIDS awareness was to reach 70 per cent from 36 per cent and HIV/AIDS transmission was to be reduced to zero by 2007. The National BSS (2006) says that among the general population in Uttarakhand, HIV/AIDS awareness is 84 per cent, but the target for reduction of HIV/AIDS transmission to zero was not achieved till 3 Oct, 201111. In 2009 HIV/AIDS prevalence rate in Uttarakhand was 0.10 per cent while at the national level it was 0.31 per cent. The website of Uttarakhand health department (http://health.uk.gov.in/pages/display/94-uttarakhand-health-population-policy) shows that only one goal relating to leprosy was achieved by 30 August, 2013. It means that the other goals have not been achieved. The information provided by the health department (under the RTI Act) says that the leprosy goal was achieved three months later than the targeted time. Thus, it is clear that no goal was achieved within the time frame of the policy.
It is clear that the major objectives of the health policy of Uttarakhand were not achieved in time. There are many reasons for it but clearly it was done without proper homework. This is the major cause of the total failure to achieve the objectives. Now experts are saying that it was not possible to reduce AIDS transmission to zero till 2007. However, the state government claims in its website that the leprosy goal was achieved while in the information provided by the health department under the RTI act, it was found that the target was achieved three months after the stipulated time.
The state government publicity emphasised on services offered but the delivery system was not improved accordingly. The limited human resource available, lack of co-ordination in departments and failure to motivate the employees were also among the major causes for the failure of the health policy. Rather than give publicity to the health services, the health department should have properly utilized the media for spreading awareness about the targets for controlling various diseases along with the motivation of the employees, health workers, NGOs etc. for timely achievements of the stated goals. No doubt, the quality of health services was improved but till today the availability of affordable health services is beyond the reach of the common man. It contradicts the motto of the government which is, “Health for All”.
- World Health Organization, Health Promotion Glossary (1998), Geneva.
- Health and Population Policy of Uttarakhand, December 2002.
- पत्र संख्या-8प/रा.का./प्रति./2/2010/21877 कार्यालय, महानिदेशक, चिकित्सा स्वास्थ्य एवं परिवार कल्याण, उत्तराखण्ड देहरादून
- पत्रांक 11प/रा.कु.स./195/2011/1807/ राज्य कुष्ठ अधिकारी, उत्ताराखण्ड आर.टी.आई संदर्भ में प्रत्युत्तर
- पत्र संख्या-10प/रा.का./क्षय/आर.एन.टी.सी.पी/सू.अ./2011-12/260 राज्य क्षय नियंत्रण अधिकारी, उत्तराखण्ड
- पत्र संख्या-14प/खाद्य/सू.अ./2/2008/22193 (आर.टी.आई संदर्भ में प्रत्युत्तर)
- पत्र संख्या-8प/रा.का./अ.नि./2011-12/22201 (आर.टी.आई संदर्भ में प्रत्युत्तर)
- पत्र संख्या-8प/रा.का./1/2010/24304 (कार्यालय-महानिदेशक चिकित्सा, स्वास्थ्य एवं परिवार कल्याण, उत्तराखण्ड देहरादून। (आर.टी.आई, प्रत्युत्तर))
- पत्रांक- 12P/NP/USACS/RTI/2011&12/1728 (आर.टी.आई संदर्भ में प्रत्युत्तर)
- पत्र संख्याः केम्प-1/2011-12 (आर.टी.आई. के संदर्भ USACS, PIO का प्रत्युत्तर)