Information furnished by the State Drugs Control Organizations in respect of testing of samples of drugs in the country reveal that 7 to 8 percent of samples were reported to be not of standard quality and out of this 0.2 to 0.3 percent were found to be spurious. The word "fake drug" is not defined under Drugs & Cosmetics Act,1940. However, spurious and misbranded drugs are commonly called as fake drug. As there is no restriction on movement of drug between states, it is not possible to specify any area or State where the incidence is higher.

The government is aware of the problem and had constituted expert committees from time to time to find ways and means to combat the menace of spurious drugs. The matter was also deliberated by an Expert Committee under the chairmanship of dr. R.A. Mashelkar, Director general and secretary ,CSIR which was set up in 2003 for a comprehensive review of the drug regulatory system in the country including the extent of problem of spurious drugs and remedial measures to deal with this problem effectively. The major amendments proposed relate to enhancement of penalties prescribed under the Drugs and Cosmetics Act, provision of special courts for speedy trial of drug related offences, compounding of offences, authorizing the police also to file prosecution for drug related offences and making all drug related offences cognizable and non-bailable. All this is expected to act as a strong deterrent for manufacturers of counterfeit drugs. This Ministry has already initiated the process of amending the Drugs and Cosmetics Act, 1940 to provide for stricter penalties, in pursuance of the recommendations of the Mashelkar Committee, Government of India has also launched a 5- year World Bank aided Capacity Building Project for Food Safety and Quality Control of Drugs with a total project cost of Rs. 354.25 crores. Extensive assistance is being provided to State Govts. to augment their drug testing facility by way of equipments, manpower, training and civil works under the Project and a strong IEC campaign for the education of the has also been initiated.

The government is aware of the problem and had constituted expert committees from time to time to find ways and means to combat the menace of spurious drugs. The matter was also deliberated by an Expert Committee under the chairmanship of dr. R.A. Mashelkar, Director general and secretary ,CSIR which was set up in 2003 for a comprehensive review of the drug regulatory system in the country including the extent of problem of spurious drugs and remedial measures to deal with this problem effectively. The major amendments proposed relate to enhancement of penalties prescribed under the Drugs and Cosmetics Act, provision of special courts for speedy trial of drug related offences, compounding of offences, authorizing the police also to file prosecution for drug related offences and making all drug related offences cognizable and non-bailable. All this is expected to act as a strong deterrent for manufacturers of counterfeit drugs. This Ministry has already initiated the process of amending the Drugs and Cosmetics Act, 1940 to provide for stricter penalties, in pursuance of the recommendations of the Mashelkar Committee, Government of India has also launched a 5- year World Bank aided Capacity Building Project for Food Safety and Quality Control of Drugs with a total project cost of Rs. 354.25 crores. Extensive assistance is being provided to State Govts. to augment their drug testing facility by way of equipments, manpower, training and civil works under the Project and a strong IEC campaign for the education of the has also been initiated..

Schedule- M has been amended to make it at par with International standards and it is mandatory for the manufacturers of drugs to comply with the requirement for quality control of product manufactured by them.

Source: RAJYA SABHA Unstarred Question no.503,Dated: 02.03.2007

Recognizing the need for greater international cooperation in combating counterfeit medical products, the World Health Organization (WHO) has initiated the process leading to the establishment of an organization called IMPACT ( International Medical Products Anti- Counterfeiting Taskforce) for combating the spread of counterfeits.

The establishment of the Taskforce (IMPACT) was proposed by WHO and endorsed by 160 participants at an international conference in Rome in February,2006,representin 57 national drug regulatory authorities, 7 national organizations, 12international associations of patients, health professional, pharmaceutical manufacturers and wholesalers. The Rome conference issued a set of principles and recommendations, enshrined in the 'Declaration of Rome'.

IMPACT aims at sharing expertise, identifying problems, seeking solutions, coordinating activities and working towards the common goal of fighting counterfeit medical products. The first General Meeting of IMPACT was held at Bonn,Germany,during 15 th and 16 th November,2006.

Source: RAJYA SABHA Unstarred Question No.512, Dated: 2nd March,2007

The Government has launched the National Rural Health Mission (NRHM) on 12th April,2005 throughout the country with special emphasis on 18 States with week demographic and health indications. More attention is being paid to these States to provide accessible, affordable, accountable, effective, reliable, and quality primary health care, through creation of a cadre of Accredited Social Health Activists (ASHA), improved hospital care measured through Indian Public Health Standards (IPHS), decentralization of programme to district level to improve intra and inter- sectoral convergence and effective utilization of resources. The NRHM provides for a thrust on population stabilization as well.

Special efforts to deal with population growth, in line with the National Population Policy is being attended under NRHM in the following manner.

• Improvement in functioning of public health facilities at all levels to meet unmet demands for Family Planning.
• Quality family welfare services under the RCH-II component of NRHM.
• Intensive campaign for creating awareness, especially with the help of ASHAS
• Provision for additional manpower and service at all levels of health facilities.
• Training of Medical Officers/ANMs/Nurses in skill upgradation for providing family planning services .

Source: RAJYA SABHA Unstarred Question No. 513, Dated: 2nd March,2007

The Government of India in April 2005 has launched the NRHM to improve access of people in the rural areas especially the poor women and children to quality primary health care services. Accredited Social Health Activist (ASHA) is an important strategic intervention under the Mission. The scheme which was initially introduced in only 10 high focus states under NRHM, has now been extended to NE states and tribal areas of other states. A total of 348920 ASHAs have been selected in these areas so far. In addition to ASHAs, 91013 health link workers have also been selected by the states of Andhra Pradesh, Haryana,West Bengal,Karnataka and Chhattisgarh.

The general norm is one ASHA for 1000 population . In tribal, hilly, desert areas the norms could be relaxed to one ASHA per habitation, depending on her workload.

Capacity building of ASHA is critical in enhancing her performance. The induction training of ASHA would be completed in 23 days spread in five rounds over a period of 12 months to be followed by periodic re-training for about two days ones every alternate month. ASHA training is a continuous one and that she will develop the necessary skills and expertise through continuous on the job training. For the training of ASHA, training modules based on thematic approach have been developed. For the purpose the States have constituted the District Atraining teams and Block Training teams for training of ASHA. The Block Training teams are providing training to ASHAs.

Till date i.e. 20.02.06; A total number of 225375 ASHSs have been trained.

At the national level the National Institute of Health & Family Welfare, Munirka is the Nodal Agency .At the state level, the state Institute of Health & Family Welfare (SIHFW) with the state training cell of the Dte. Of F.W oversees the processes of training, monitoring and also organizes concurrent evaluation of training programme. Credible NGOs are involved in the training of ASHAs by the Central / State Government. An ASHA Mentoring Group comprising of leading NGOs in the country set up by GOI advises the government on selection and Training of ASHAs in the country.

Source: - RAJYA SABHA Unstarred Question No.492, Dated: 2nd March 2007

There are some new schemes being introduced under National AIDS Control Programme Phase-III such as for example, Link Workers Scheme in high prevalent districts, establishment of Metro Blood Banks, Plasma Fractionation Units, Blood Storage Centers at selected CHCs in collaboration with the National Rural Health Mission and nutritional supplementation to children on anti-retroviral treatment, mainstreaming of HIV in all Government Departments, Civil Societies Organisations, and the private sector decentralization of Program implementation to district level etc.

For the NACP-III program and various schemes mentioned above, it is proposed to spend about Rs. 6800 crore from the budget over a five year period. For some of the schemes mentioned above,the amount earmarked are as under:

Link worker scheme is estimated to cost Rs. 545 crores, Metro Blood Bank -Rs. 240 crores, Plasma Fractionation Unit- Rs. 35 crores, Blood Storage Unit- Rs. 42 crores. Nutrition Support is Rs. 3 crores etc.

The NGOs are being involved for carrying out various activities under Targeted Intervention , Community Care Centers, Drop in Centers and PPTCT centers.

State AIDS Control societies (SACS) monitor performance, use of funds and achievement of targets. The NGOs are required to submit monthly, half yearly and annual reports of physical and financial targets. In 200 districts, Districts AIDS Control Units are also being established in order to closely supervise the implementation of all activities and programmes.

Source: - RAJYA SABHA Unstarred Question No. 493, Dated: 2nd March 2007

Prime Minister reviewed Dengue, Chickungunya and other vector borne diseases on 02nd November 2006 and directed that the Integrated Disease Surveillance Project should incorporate early warning system as part of disease surveillance under National Vector Borne Disease Control Programme (NVBDCP) and National Rural Health Mission (NRHM). The Prime Minister also suggested that there should be close interaction between the Ministry of Health & Family Welfare and local bodies on sharing of information, health alerts, and orientation sessions for health professionals in order to prevent the epidemic. Steps for improved sanitation and prevention of mosquitogenic conditions were also suggested.

Ministry has initiated the process to establish and Information Technology network connecting all States, District headquarters and Government Medical Colleges as well. National Informatics

Center has been asked to develop a centralized Call Centre to receive outbreak alerts. Baseline survey of laboratories in all districts covered under Phase-I and II of the programme has been carried out for their strengthening. Rapid Response Teams have also been identified & trained in these districts guidelines for action by villages and sanitation committees have been sent to States. These activities have been envisaged to help the State Governments to rapidly detect and respond to outbreak of epidemic prone diseases.

Source: - RAJYA SABHA Unstarred Question No. 496, Dated: 2nd March 2007

According to the report of the NSS 60th Round ( January-June 2004) Morbidity, Health care and the Condition of the aged, the average medical expenditure per hospitalization case, has increased from Rs. 2202 in 1996-97 to Rs. 5695 in 2004 in rural areas and Rs. 3921 to Rs. 8851 in the urban areas.

The World Health Survey-India, 2003 was conducted in six States viz, Assam, Karnataka, Maharashtra,Rajasthan,Uttar Pradesh and West Bengal. According to the findings of the survey, inter alia, 16% of the households reported that they paid their health care expenditure through borrowed sources,9% through savings (bank Account) and 11% of the households paid through income from outside the family. About seven percent of the households financed their health spending by selling household assets such as furniture, cattle, jewellery, etc. and less than one percent of households relied on health insurance to meet their health payments. The Study also indicates that a non poor household is impoverished by health payment and is pushed in to poverty in the absence of insurance coverage and lack of protectional measures by other health reimbursement scheme.

In order to provide effective health care to the rural population through out the country with special focus on 18 States with poor health indicators and weak health infrastructure, the government has launched the National Rural Health Mission in April,2005. The Mission adopt a synergistic approach by relating health to determinants of good health and the main objective is to provide accessible, affordable, accountable and reliable health care especially to the pooe and vulnerable sections of the population. Future, the gaps in the existing scenario of rural health care are being addressed through involvement of the community, the Panchayati Raj Institutions and other non- governmental organizations. An accredited social health activist will act as a link between the community and the health care system.

Source: - RAJYA SABHA Unstarred Question No.497, Dated: 2nd March 2007

As per the District Level Household Survey II (2002-04) Report, the Institutional Delivery Rate in India is 40.5% and as per the National Family Health Survey III (2005-06) Report, it is 41% all over India and 31% in the rural areas.

It is true that Institutional delivery can take care of complications during delivery and can thereby reduce maternal mortality.

The Government of India, with a riew to increase access to quality health care including services Safe Motherhood, has launched the National Rural Health Mission (NRHM) with special emphasis on improving the health status of rural population through out the country. The Mission will operate over a period of seven years from 2005 to 2012. Under the NRHM (2005-2012) and the RCH Programme Phase Ii, services will be strengthened through:

• Implementation of the Janani Suraksh Yojana (JSY) a scheme to promote Institutional delivery for reducing Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) by providing quality Maternal Care during pregnancy, delivery and immediate post-delivery period with appropriate referral transport system along with cash assistance to pregnant women with a special focus on low Performing States. In Low Performing States (LPS), all women including SC/STs delivering in the Govt. Health Center, General ward of Distt. And State Hospitals and accredited Private Institutions get the benefits of cash assistance scheme. (LPS: Uttar Pradesh, Uttaranchal,Bihar,Jharkhand,Madhya Pradesh,Chhatisgarh, Assam and Jammu & Kashmir).
• In High Performing States (HPS) and north Eastern States, all BPL women aged 19 years and above,all SC/ST women delivering in Govt. Health Centers, General wards of Distt. & State Hospitals and Accredited Private Institutions get the benefits of cash assistance.
• Appointment of Accredited Social Health Activist (ASHA) for every village with a population up to 1000' ASHA will facilitate in accessing health care services to the community and will have specific responsibility of mobilizing pregnant women for antenatal care, institutional delivery and post-natal checks and immunization to children.
• Ensuring skilled attendance at birth both in the community and Institutions.
• Operationalising 2000 Community Health Centers as First Referral Units (FRU) for providing Emergency Obstetric and Child Health Services.
• Making 50% Primary Health Centers functional for providing 24 hours delivery services, over the next five years.
• Strengthening of sub-centre by providing a fund of Rs. 10,000/- for utilizing at the sub-center to improve the services delivery. The fund shall be operated jointly by the Local Panchayat representative and ANM.
• Organizing of Village Health & Nutrition Day at Anganwadi center at least once in every month.
• Ensuring quality of services by implementing Indian Public Health Standards (IPHS) for Primary Health Care Facilities.

Source: - RAJYA SABHA Unstarred Question No. 507, Dated: 2nd March 2007

It's a social ill that continues to shame India. Nearly 45% of women in the country, aged between 20 and 24,are married off before they reach 18, the legal age to marry. What's worse, the number is over 50% in eight states.
While 61% of women in Jharkhand were married off before 18, the number stood at 60% in Bihar,57% in Rajasthan, 55% in Andhra Pradesh,53% each in Madhya Pradesh, Uttar Pradesh and West Bengal and 52% in Chhattisgarh.
Lack of education was found to be a major factor fuelling this trend. Over 71% of women who got married below the age of 18 had received no education
These are part of the finding of the latest National Family Health Survey - III,carried out in 29 states during 2005-06.
The survey, conducted by 18 research organization, including five population research centers, and designed to collect and provide vital information on population, family planning, maternal and child health, child survival, nutrition of children and status of women, also unmasks another worrying trend. Six states - Arunachal Pradesh, Punjab, Mizoram, Sikkim, Tripura and West Bengal - which reported a lower percentage of under 18 marriages among women during the NFHS-II survey conducted in 1998-99, show an upward trend in NFHS-III. Officials say more and more women in these six states are being married off at the age of 15.
The survey, which interviewed 1,24,395 women and reported a response rate of 94.5% shows that this social malady exists mostly in rural India.

Source: The Times of India, New Delhi - Dated: 23.02.07

One in every 25 girl children is murdered in India and 1.5 million girls below 15 years are married, according to data released by the Centre for Social Research (CSR) and the National Commission for women (NCW) at a seminar on "Stop violence from womb to tomb" here on Wednesday.

Female foeticide in the country increased by 49.2 percent between 1999 and 2000 and 50 per cent of women aged 18 years in India are married, the study said. "It is a national emergency and the situation is such that we will not have enough girl children," said Union Minister of State for Women and Child Development Renuka Chowdhury.

Citing the latest Lancet research data that puts the girls-to-boys ratio in the National Capital Region at 762 girls for every 1,000 boys, Ms. Chowdhury said the practice of female foeticide was rising among the urban and literate sections of society.

"The need is to remove the social prejudice and create awareness among the educated" said Ms. Chowdhury.

CSR Director Ranjana Kumari called for a total revamp of the strategy adopted in approaching the issue of violence against women, especially foeticide. "Collective strength of the civil society is the need of the moment,: said Dr. Kumari, adding: " In the silence of the hospital room, every day girl children are being aborted."

NCW member Malini Bhattacharya also called for better networking among organizations working for women. The seminar was aimed at exploring the different kinds of violence women face, right from the womb till death. Source: The Hindu 22 February, 2007, New Delhi

Government has delegated powers to National Pharmaceutical Pricing Authority (NPPA) under which it can autonomously revise the prices of drugs downwards, allowing an annual increase of 20% in case of an "unjustified price rise. Sources said in cases where the regulator feels that the price revision should be below 20% ,it will refer the case to government to take action against the pharmaceutical company.

Recently the government restored powers to NPPA under which it can control and fix prices of decontrolled drug under Section 10 (b) of the Drug Price Control Order 1995, in case of any "aberration or exorbitant increase in medicine prices".

Source: The Times of India 10 February, 2007, New Delhi

The United Nations has lauded India's population control policy focusing on reproductive health of women unlike China where family and social pressures to produce a son "are becoming immense".

It would be spending USD 60 million in the next five years to support the right of every women, man and child to enjoy a life of health and equal opportunity in India, United Nations Population Fund (UNFPA) Asia and Pacific Division director Sultan A Aziz said here today. Mr. Aziz who held high-level talks with Union health ministry officials, said the government planned to invest Rs.9 billion in the next five years in family planning and other related schemes and the world body was "very satisfied" with it.

Asked to compare the policies of the two most populous nations of the world, he said that UNFPA was satisfied with India's holistic approach to tackle the problem but had reservations about the "crude mechanism" adopted by Beijing. "The states don't have the right to regulate fertility of women. We don't support such an approach as it comes with a huge social cost." Aziz said.

Source: The Statesman 26 February, 2007, New Delhi

To provide pre-pregnancy care to India's poorest women, a scheme was launched on Wednesday 24th January 2007 that will provide free maternal healthcare benefits to an estimated 8,000 women.

Under the pilot project, which was launched in seven blocks of Agra, rural women could avail healthcare services by just showing a gift voucher at private accredited nursing homes.

The Coupon Lao, Sehat Pao voucher scheme, under USAID's Innovations in Family Planning Services (IFPS), was launched in Khandauli, Etmadpur, Bichpuri, Akola, Barauli Ahir, Fatehabad and Shamsabad.

"The programme plans to reach out to 8,000 women over the next ten years. They could avail free services in family planning and reproductive healthcare like antenatal care, institutional deliveries, post-pregnancy care and sterilizations," an official working on the project told PTI.

The project would be ultimately integrated with the Health Ministry's Janani Surakasha Yojna, under the ongoing National Rural Health Mission (NRHM), which is aimed to benefit rural women.

"Ten nursing homes have been selected and accredited to attend to patients holding the voucher. We have already decided the money with these nursing homes," he said.

"We are starting the pilot project in Agra and would expand it elsewhere. We want that through the project, families living below poverty line (BPL) across UP, Uttarakhand and Jharkhand will be able to get quality health services," he said, adding that the aim is to reduce maternal mortality and infant mortality in the country.

For the project, 720 ASHA's or accredited social health activists, have been recruited to implement the programme and identify the BPL families.

The ASHA's, who are part of NRHM, will see that families who don't have a BPL card can also benefit from the service.

"Those who don't have the BPL card could take a certificate from the village pradhan authenticating the families' economic condition," the official said.

The voucher will have a serial number and code along with a safety seal.

Source: The Hindu 25 January, 2007, New Delhi

India has adopted the new WHO Child Growth Standards, the Ministries of Women and Child Development and Health and Family Welfare, announced here on February 09.

The announcement follows the consensus arrived at a national consultation in which all leading professional bodies and institutions, State and central governments participated.

The new Growth Standards will be used across the country for monitoring and promotion of young child growth and development within the National Rural Health Mission NRHM and the Integrated Child Development Services (ICDS). Same standards will be used for research too in future. .

In all Anganwadi centres, nutritional status of the child will continue to be assessed against weight for age there will be separate charts for girls and boys.

"We consider these new standards to represent the highest quality knowledge available today on how children should grow and develop and we fully endorse their use" said Mr Cecilio Adorna, the Unicef representative to India.

'The standards", he said, "confirm that child populations from across the world have the same potential for growth and development provided they receive the care, nutrition, and health services they require and are entitled too. It is exciting to know that child populations from the researched six countries from Asia, Europe, Middle East, Africa and the Americas grow identically, and to know how exclusively breastfed healthy children develop. "

"With these new standards, parents, policy makers, programmers, health officials and child advocates, Mr Adorna hoped "will know when the nutrition and healthcare needs of children are being compromised and with the use of this tool are enabled to take well informed decisions. "

The Roll Out Plan for use of the New Growth Standards will be formulated through a consultative process led by the Health and Social Welfare of departments of various state governments and , would be included in the plan components in the 11th Five Year Plan document.

The State roll out plans will cover all aspects of implementing the new growth standards. Including supplies - growth registers, charts, standard weighing scales, Mother Child Protection cards, and capacity building at all levels.

The training on the growth charts will be an integral component of ICDS and NRHM Training. The new growth standards be incorporated in all institutional trainings - induction and in-service that involve medical colleges, nursing, auxiliary nurses and anganwadis training schools and all relevant courses conducted by the public sector, private and semi-private institutions.

Over two hundred participants attended the national consultation. The participants included policy makers, senior officials from the Ministries of Women & Child Development, Health & Family Welfare, Planning Commission, State Secretaries and their teams from both Women & Child Development, Health and Family Welfare, representatives of national academic research and training institutions related to Health, Nutrition and Child Development

Source: www.unicef.org.india

GWALIOR (M.P.): Concerned over the high maternal mortality ratio (MMR) in the country - 301 per 100,000 live births - the United Nations Children's Fund (UNICEF) has launched a new scheme to conduct maternal death inquiry. The Maternal and Perinatal Death Inquiry (MAPEDI) or the social audit - also known as verbal autopsy - is aimed at providing an understanding of the contributing factors that can be used by decision-makers and stakeholders to address obstacles to quality obstetric care and to identify ways to prevent avoidable deaths.

Survey of healthcare facilities

One such survey was conducted in Purulia district of West Bengal between July 2005 and June 2006 and its findings made the State Government order a review of every maternal death and initiate a survey of the health care facilities. All maternity beds in public sector facilities in the State have now been made non-paying for all and the Government is now working on a cashless referral transport system.

Of the 106 maternal mortalities reported, 62 per cent died during labour or delivery, 26 per cent during pregnancy and 12 per cent during abortion. As many as 61 per cent died at the health facility, 24 per cent died at home, 13 per cent en route to health facility and three per cent due to related causes. Fifty one per cent deaths were due to direct obstetric causes like bleeding, infection, eclampsia, and obstructed labour, 27 per cent due to indirect causes like anaemia, malaria, hepatitis, tuberculosis and cardiac, while 22 per cent died due to other causes.

The women were illiterate, most of them belonged to the Scheduled Castes, followed by the Scheduled Tribes and 42 per cent were below poverty line (BPL) cardholders.

According to Sudha Balakrishnan of UNICEF, husbands played a major role in deciding to seek healthcare and the women themselves had little or no role in this decision. The survey also revealed that 46 per cent sought formal health care after complications arose, 80 per cent sought formal care at some point of time and 20 per cent did not seek any.

Sadly, 16 per cent did not think the woman was sick enough, 8 per cent thought the problem required traditional care, for 23 per cent the cost and transportation was unaffordable. For another 11 per cent transport was not available at all.

A similar audit conducted on 104 maternal mortality deaths in Shivpuri and Guna districts of Madhya Pradesh indicated that 83 per cent died after delivery, 5 per cent during delivery, 11 per cent during pregnancy and one per cent after abortion.

The UNICEF has been advocating sustained political commitment and strengthening policies for safe motherhood, ensuring availability of skilled maternal heath care provider and increasing awareness of communities and families for timely recognition of danger signs and deciding for referral besides improving availability of round-the-clock emergency obstetric care services.

Source: The Hindu 12 February, 2007, New Delhi