CHAPTER XVI

MEDICAL AND PUBLIC HEALTH SERVICES

(a) Public Health and Medical Facilities in Early Times

Prior to the introduction of allopathic system of medicine, people of the erstwhile Patiala princely State including the area of present Mansa District, relied upon Ayurvedic and Unani systems. With their superstitious habits, the people patronized the methods of faith cure and quackery for the cure of various ailments. People in rural areas ascribed the incidence of diseases to evil influences rather than considering them as physical disorders. Hence, the emphasis was laid on propitiating them evil spirits than providing medical assistance in whatever way it was available. They even got themselves treated from persons known for practising magic and dispensing charms. With the spread of education and scientific treatment of human ills coming nearer the reach of the people the methods of faith-cure and quackery are taken resort to by fewer people. Only two systems of medicine, viz. Ayurvedic and Unani were prevalent among the people because of the simple and familiar medicines prescribed. Ayurvedic system of medicine was developed by Indian physicians who made extensive use of herbs for preparation of various medicines. However, after the Alexander's invasion of India in 326 B.C., the Unani system of medicine was also introduced in the country. During the Mohammadan rule, the official patronage was given to Unani system and as a result, Ayurvedic system suffered a set back. But the Ayurvedic system of medicine continued to be popular with the rural people, whereas the Unani system of medicine became more popular in the towns and cities. Further, with the arrival of Britishers into India, the Allopathic system of medicine was also introduced, and in course of time, it became more popular than the Ayurvedic and Unani systems of medicines.

During the British rule in India, most of the area of the present district of Mansa was part of the princely State of Patiala. The Allopathic system of medicine was introduced in the princely State of Patiala by the rulers of Patiala. A regular Medical Department was organised by Maharaja Mohinder Singh in 1873 and placed under Surgeon-Major C.M. Calthrop, the first Medical Adviser to the State, who also had charge of the vaccination work. The Medical and Sanitary institutions and establishments of the Patiala State were under the direction of a Medical Adviser, who was an officer of the Indian Medical Service, lent by the British Government. There was a dispensary in charge of Hospital Assistant at Bhikhi.

Nowadays all the four systems of medicines, viz. Allopathy, Ayurvedic, Unani and Homeopathy are practised. Of these, allopathic medicine has become more popular after the Independence of country in 1947. Due to the State

patronage, it gained popularity and wider adoption. As on 1 April 2000, there

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were 62 Allopathic medical institutions in the district comprising 4 hospitals (out of these 3 were rural hospitals functioning at Bhikhi, Phaphre Bhaike and Bareta), 5 dispensaries, 16 community health centres/primary health centres and 37 subsidiary health centres. Besides the above institutions, an eye mobile team is working under Civil Hospital, Mansa to prevent the blindness. The Leprosy Elimination Society has also been set up under the Chairmanship of Deputy Commissioner, Mansa to eliminate leprosy from the district.

The Government realised that the indigenous systems of medicine were favoured by the people, keeping in view, the Punjab Government in 1953-54, started a programme of opening of Ayurvedic/Unani dispensaries in the State. The Directorate of Ayurveda was established in November 1956 and thereby the Government encouraged the indigenous system of medicine by affording facilities for its promotion and propagation. As on 1 April 2000, there were 12 Ayurvedic and 1 Unani dispensaries functioning in the district. Ayurvedic dispensaries are under the charge of Vaids and Unani ones are under the charge of Hakims. They are under the control of the Director of Ayurveda, Punjab.

A few practitioners in the towns practise the homeopathy. Day by day, this system of medicine is also becoming very popular and the Government has created a separate Department for Homeopathy. Two Government Homeopathic dispensaries were functioning in the Mansa District as on 1 April 2000.

(b) Vital Statistics

The registration of vital statistics is mandatory in the State. Statistics regarding births and deaths are most important for planning of health programmes. These are helpful in determining the growth rate of population and finding the percentage of deaths. The mode of collection of vital statistics prior to1901, in the erstwhile Patiala princely State was through State Patwaris and these statistics were registered in tahsils. As this system was not satisfactory, the system of Punjab for collection of vital statistics through village Chowkidars was adopted in 1901. The Civil Registration was governed by different rules adopted for urban and rural areas of the Punjab State. To keep the uniformity throughout the country, the Registration of Births and Deaths Act, 1969 was passed by Government of India. This act was enforced in Punjab State with effect from 1 April 1970, though its actual implementation started from 22 September 1972, with the notification of Punjab Registration of Births and Deaths Rules, 1972.

The Director, Health and Family Welfare, Punjab is the ex-officio Chief Registrar, Births and Deaths in the State. At the district level, Civil Surgeon is the District Registrar, Births and Deaths. The District Health officer and in his absence, Assistant Civil Surgeon, has been notified as Additional District Registrar, Births and Deaths to help the District Registrar in discharging his responsibility.

The registration area has been divided in two sectors, i.e. rural and urban

areas. The registration hierarchy in these sectors is as under:

Rural Areas.- In the rural areas, the Station House Officer of a police station has been notified as the Local Registrar Births and Deaths for the villages falling under his jurisdiction. Although it is the responsibility of the head of the household to get the vital events registered with the Local Registrar, the services of the Chowkidars are provided to the villagers who record the events in the Chowkidara book and get it registered with Local Registrar within the scheduled time limit, i.e.14 days for deaths and 7 days for births.

Urban Areas.-In the urban areas, the Municipal Corporation/Municipal Councils/Nagar Panchayats are the Local Registration Centres. The Municipal Medical Officer of Health and in his absence, Executive Officer/Secretary/ Administrator is the Local Registrar, Births and Deaths.

The birth rate, death rate and infantile mortality rate in the Mansa District from 1992 to 2000 are given below:

Year	Birth rate per thousand population	Death rate per thousand population	Infantile mortality rate per thousand live births
1992	26.2	8.3	56.2
1993	25.9	7.9	55.3
1994	25.2	7.2	54.2
1995	24.2	7.5	55.3
1996	24.9	8.1	53.6
1997	23.2	6.8	51.9
1998	22.9	6.5	50.9
1999	22.4	6.4	51.0
2000	21.9	6.3	45.0

(Source: Civil Surgeon, Mansa)

Important Causes of Mortality.- The important causes of mortality in the district are typhoid group of fevers, diabetes, heart diseases, pneumonia and respiratory diseases. The statistics regarding deaths registered from various diseases in the Mansa District, during the years 1992 to 2000 are given in Appendix I at page 286.

(c) Diseases Common to the District

The common diseases which occur in the Mansa District are typhoid group of fevers, malaria, respiratory diseases (other than tuberculosis) tuberculosis and communicable diseases (epidemic diseases) viz. cholera, plague and small pox. These common diseases are briefly described below:

(i) Fevers.- Fevers are the main cause of deaths. These include ordinary fevers, typhoid, influenza, pneumonia and other seasonal fevers. There fevers are the results of infections, unhealthy living and imbalanced diet, leading to low resistance. These fevers have become almost chronic and it is extremely difficult to eradicate them.

In the past, these fevers were cured with various medicines, including quinine. But at present, the sulpha drugs and antibiotics are becoming popular, as they have been found to be more effective. Steps have been taken by the medical authorities to control the spread of fevers through timely check-up, blood testing, inoculations and distribution of tablets, medicines and drugs. Only 6 cases of deaths due to pneumonia have been reported during the year 2000, whereas no death case had been recorded in any other category of fevers.

(ii) Respiratory Diseases.- Respiratory diseases are also among the common diseases, which are responsible for the deaths in the district. These are caused by different types of smokes, fumes, vapours of chemical gases released by the burning of charcoal, coke, etc. These gases pollute the surrounding atmosphere all the time, thus affecting the health of the people. Smoke irritates the eyes, the throat and the lungs constantly. The insanitary conditions in the slums also cause the outbreaks of these diseases. Smoky and dingy rooms without smoke outlets, windows and ventilators cause breathing troubles and respiratory diseases. Allergic diseases viz. bronchitis and asthma, etc. are also caused by environmental pollution. In order to check the spread of such diseases, the Factories Act, 1948 lays down that there should be a proper disposal of gases entering the atmosphere and any harmful effluents should be removed to far-off places, where they do not adversely affect the health of the people. These measures have brought down the mortality figures considerably. The number of deaths in the Mansa District, due to bronchitis and asthma have been decreased from 158 during the years 1992 to 11 during 2000.

(iii) Malaria.- It is caused by blood parasite called "Plasmodium" which is present in the blood of malaria patients blood. Malaria has been undoubtedly the most important public health problem, in the State. It is essentially a rural problem and general poverty and backwardness of rural area are a hurdle, which the people of affected areas cannot be expected to surmount as they have no means to do so. It was dreadful disease for years together. Malaria epidemics occur from year to year after excessive monsoon rainfall. Quinine the only remedy for malaria was distributed in rural areas through various agencies. It no doubt lowered the incidence but could not eradicate the disease. It was only after the Independence that steps were taken to control and, ultimately to eradicate malaria.

At the time of Independence, malaria was considered as one of the major public health problem and to bring down the incidence of disease, National Malaria Control Programme (NMCP) was started in the country in 1953 as a centrally sponsored scheme. To eradicate malaria this programme was converted into National Malaria Eradication Programme (NMEP) in 1958 on the advice of World Health Organisation (WHO). The main function of the NMEP was to detect malaria positive cases by collecting the blood smears of all the fever cases through the Multipurpose Health Workers from house to house visits and to eliminate the disease altogether by thorough and effective attack on mosquitoes and human reservoir by application of insecticides and administration of anti-malaria drugs. The blood slides collected by the workers/passive agencies, etc. were examined in the laboratories of the respective medical institutions and the cases declared malaria positive by the microscopic examination were given radical treatment.

The malaria unit in Mansa District is manned by 1 Assistant Unit Officer, 15 Sanitary Inspectors and 16 Laboratory Technicians besides other ministerial Class III and misc

ellaneous Class IV staff.

Malaria Clinics.-There are 16 malaria clinics in the Mansa District. The blood slide of every fever case is prepared and is examined immediately. If found positive for the malaria parasite, then radical treatment is given immediately on the same day. Data regarding surveillance and spray for the year 1992 and 1996 to 2000 is given below:

	1992	1996	1997	1998	1999	2000
Blood Slides
Collected	65,548	73,120	79,890	74,849	13,153	68,601
Examined	65,548	73,120	79,890	74,849	13,153	68,601
Malaria Cases	268	845	656	80	1	03
A.P.I	0.43	1.27	0.97	0.11	.0001	0.0043
Radical treatment	268	845	656	80	1	3
Population	6,22,065	6,62,685	6,73,711	6,80,669	6,81,871	6,87,166
P.Vivex Cases	268	837	656	80	1	02
P.Faleiparum cases	-	8	-	-	-	01
(Source: Civil Surgeon, Mansa)

(iv) Communicable Diseases.- Plague, cholera and small pox are the main communicable diseases (epidemic diseases) notified under Epidemic Disease Act, 1897 of these three, plague is not endemic whereas other two are endemic. Small pox has been eradicated; and the plague has now become non-existent. A brief description of each of these is given below:

Plague

Once plague was a most horrible disease, but now it is non-existent because no case of this disease has been reported in the Mansa District. However, anti-plague measures are adopted every year. Sanitary Inspectors and Swasth Sahaiks are deputed to destroy rats by cynogassing the rat holes, baiting with zinc phosphate and by laying rat traps. In one or two extensive DDT sprays, rats and flies are also killed along with mosquitoes. The other factor responsible for its disappearance is construction of pukka houses, wherein because of cemented floors, rats can not make holes for their hiding. As a result of these measures the district is free from this infectious disease.

Cholera

Cholera is an epidemic caused by infected food, water and drinks. Symptoms of cholera are profuse and painless diarrhoea and vomiting. No death with cholera has been reported in the district during 1992 to 2000. Incidence of cholera has been low due to various preventive measures taken by the medical authorities. These comprise, proper arrangements for the disposal of refuse, human excreta, protection of eatables and supply of safe drinking water, pollution, anti fly measures and mass inoculation of hospitals and dispensaries. Similar preventive measures are taken on the eve of various fairs held in the district so that the contagious diarrhea is not imported from outside.

Small Pox

Small pox used to be one of the leading cause of death and disfigurement of face in the past. The virulence of disease has been successfully reduced by vaccination under National Small Pox Eradication Programme (N.S.E.P), which was launched in the country in 1962-63. As a result of intensive vaccination drive, the disease has been completely eradicated from the State as well from the country. In April 1977, India had been declared small pox free country and on 8 May 1980 the World Health Organisation (WHO) declared the global eradication of small pox. In May 1981 the International Health Regulations were amended by the 34^th World Health Assembly to delete all references of small pox and small pox vaccination. All member States of WHO had officially discontinued compulsory small pox vaccination by 1982.

(v) Tuberculosis.- This is common in the district and poses a public health problem. It has been persisting because of the spread of infection and less resistance among the people. Since the cure of tuberculosis requires a sufficient and long time domiciliary treatment is carried out in the district. After diagnosis, medicines are prescribed and necessary precautions are explained to the patients so that they could continue their treatment staying at home. Previously the stress had been on treatment of cases both at sanitoria and in hospitals but now treatment is given to make cases non-infectious and thereafter the patients are advised to continue treatment at home.

National Tuberculosis Programme (NTP) has been launched in the country in 1962. NTP operates through District Tuberculosis Control Programme, which is a comprehensive control programme for the whole country especially for the rural areas. This programme envisages integration of specialized T.B service at the district headquarters with the general medical services at the periphery in the rural areas. All cases having cough, fever and weight loss from quite a long period are examined in T.B. treatment centres. The BCG. is an effective vaccination against tuberculosis. The district T.B. Officer supervises the set up to eradicate tuberculosis from the district. During the year 1999-2000, there were 7 X-Ray Centres, 9 Microscopic Centres and 44 Referral Centres in the Mansa District. The number of patients treated under National Programme for the control of Tuberculosis from 1993-94 to 1999-2000 in the Mansa District, is given below:

Year	Persons given treatment
1993-94	513
1994-95	991
1995-96	932
1996-97	931
1997-98	959
1998-99	868
1999-2000	619

(Source: Civil Surgeon, Mansa)

(d) Medical and Public Health Services

Previously medical services were divided into two wings viz. medical and health. The Civil Surgeon was responsible for the functioning of hospitals and dispensaries, medical and surgical work in the district, besides being Government medico-legal expert. The District Medical and Health Officer was in charge of the health wing and was responsible for sanitation, prevention of diseases and health promotion services in the district. He also advises the municipal councils/nagar panchayats on public health matters. Both the wings work under the control of the Director of Health Services, Punjab, Chandigarh.

In April 1964, the two wings of the health and medical services were merged, and Chief Medical Officer was made in charge of both these wings. The post of Chief Medical Officer was re-designated as Civil Surgeon in June 1974.

At the district level, Civil Surgeon is the administrative head of the Health Department. He is also an ex-officio District Registrar, Births and Deaths. A number of officers like Assistant Civil Surgeon, District Family Welfare Officer, District Health Officer, District T.B. Officer, etc, assist him in implementation of various health programmes in the district. At the block level, Senior Medical Officer looks after these programmes, who is assisted by a number of medical and Para-medical officials. Civil Surgeon is also responsible for the implementation of various National Health Programmes in the district e.g. National Family Welfare Programme, National Child Survival and Safe Motherhood Programme, National Programme for Control of Blindness, National Malaria Eradication Programme, etc.

In the Mansa District, Civil Surgeon is assisted by 62 Medical Officers, 2 Dental Surgeons, 2 Chief Pharmacists Grade I, 4 Chief Pharmacists Grade II, and 74 Pharmacists and miscellaneous Class and III and Class IV Staff.

Hospitals, Community Health Centres/ Primary Health Centres/ Subsidiary Health Centres and Dispensaries

The main objective of the Department of Health and Family Welfare is to provide positive health to people of the State. Health is defined as a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity. In order to achieve this objective, an integrated structure of health services was involved in the State integrating the curative and preventive services at all levels under one Chief Executive i.e. Director, Health and Family Welfare.

During 1999-2000, Rs 7.71 crores was spent on health services in the Mansa District.

Allopathic Medical Institutions.- As on 31 March 2000, there were 62 allopathic medical institutions in the district. The tahsil-wise and area-wise break-up is given below :

Tahsil	Rural	Urban	Total
Mansa	23	5	28
Budhlada	17	2	19
Sardulgarh	14	1	15
District Mansa	54	8	62

( Source: Civil Surgeon, Mansa)

The management-wise breakup of the above allopathic institutions is 61 State Public and 1 State Special. The list of hospitals, community health centres, primary and subsidiary health centres and dispensaries in the Mansa District is given in Appendix II on pages 287-288.

Ayurvedic and Unani Medical Institutions.-There were 12 Ayurvedic and 1 Unani Government Institutions in the Mansa District during 1999-2000.All these institutions were under the control of Director Ayurveda, Punjab, Chandigarh. Out of these 13 dispensaries,11 were functioning in the rural areas and 2 in the urban areas. The tahsil-wise break-up of these dispensaries is given below:

Tahsil	Rural	Urban	Total
Mansa	4	1	5
Budhlada	4	1	5
Sardulgarh	3	-	3

(Source: Director Ayurveda, Punjab, Chandigarh)

The detailed list of these dispensaries functioning in the Mansa District, is given in Appendix III at page 289.

Homeopathic Medical Institutions.- As on 31 March 2000,there were 2 homeopathic dispensaries in the district, one each at Mansa and Bhikhi. These dispensaries are functioning under the administrative control of the Joint Secretary, Health, who is head of the Homeopathic Department, Punjab. In each of these dispensaries, there is one Homeopathic Medical Officer and one Homeopathic Dispenser besides Class IV staff. During the year 2000, the number of patients given treatment in these dispensaries was 21,060 (13,000 in Bhikhi and 8,060 in Mansa).

Government Hospitals and Nursing Homes

Dr Inderjit Singh Gill Memorial Civil Hospital, Mansa.- Established in 1927, the hospital has 100 beds ( 50 for males and 50 for females). It is manned by 1 Senior Medical Officer, 17 Medical Officers, 2 Dental Surgeons, 5 Pharmacists, 16 Staff Nurses, 3 Laboratory Assistants, 1 Radiographer besides other allied and miscellaneous Class IV staff. The hospital has many specialist doctors in various fields viz. 1 Medicine, 2 each in Surgery and Skin, 3 in E.N.T; 1 Paedeatrician, 2 Orthopidicians,1 Ophthalmologist, 2 Gaynaecologists, 1 Radiologist and 1 Anesthetist. The hospital has 24 hour Emergency Wing. The hospital also provides facilities of Ultrasound, X-Ray, Foetal Monitor, Cardiac Monitor, Baby Incubator and Computerized E.C.G. It has its own ambulance to shift the serious patients. Besides, other tests, H.I.V. tests are done in its clinical laboratories. A blood bank also functions in the hospital.

The number of indoor and outdoor patients given treatment in the hospital during the year 2000 was 5,242 and 89,994 respectively.

Bhai Behlo Government Rural Hospital, Phaphre Bhai Ke.- It was established during 1977-78 as a 25 bedded hospital. It is manned by 2 Medical Officers, 3 Pharmacists, 1 Ophthalmic Assistant, 1 Staff Nurse besides miscellaneous Class III and IV staff. The hospital has its own X-Ray plant and clinical laboratory.

The number of indoor and outdoor patients treated in hospital during the year 2000 was 55 and 5,436 respectively.

Rural Hospital, Bhikhi.- This hospital was opened during 1977-78. It has 25 beds. It is manned by 2 Medical Officers, 3 Pharmacists, 1 Ophthalmic Assistant, 1 Senior Laboratory Technician, 1 Staff Nurse besides miscellaneous Class III and Class IV staff. The hospital has its own X-Ray plant and clinical laboratory.

The number of indoor and outdoor patients treated in the hospital during the year 2000 was 47 and 6,697 respectively.

Rural Hospital, Bareta.- It was established during 1977-78. It is a 25-bedded hospital. It is manned by 2 Medical Officers, 3 Pharmacists, 1 Staff Nurse besides miscellaneous Class III and Class IV staff. The hospital has its own clinical laboratory and X-Ray plant.

The number of indoor and outdoor patients treated in the hospital during the year 2000 was 67 and 3,735 respectively.

Blood Banks.- One blood bank has been functioning in the Mansa District at Dr Inderjit Singh Gill Memorial Civil Hospital, Mansa. Blood donation camps are organised in the district and people are persuaded to donate blood liberally for suffering humanity.

The number of blood units collected and transfused by blood bank in the district from 1993-94 to 1999- 2000 are given below:

Year	Number of Blood Units Collected Transfused
1993-94	509	317
1994-95	529	255
1995-96	461	270
1996-97	701	377
1997-98	632	300
1998-99	606	242
1999-2000	1,143	527

(Source: Civil Surgeon, Mansa)

Diseases Eradication and Control Programmes

Since Independence, several measures have been undertaken by the Central Government to improve the health of the people. Important among these measures are: the National Health Programmes, which have been launched by the Central Government for the control/eradication of various diseases, improvement of environmental sanitation, raising the standard of nutrition, control of population and improving rural health. Various international agencies like WHO, UNICEF, UNFPA, World Bank, etc. have also been providing technical and material assistance in the implementation of these programmes, which are given below:

National Family Welfare Programme

This programme was launched in the country in 1952. The concept of welfare is very comprehensive and is basically related to quality of life. The recognition of its welfare concept came only a decade and half after its inception when it was named Family Welfare Programme.

The objective of the family welfare programme is to adopt the 'small family norm' to stabilize the population of the country. The programme initially adopted the model of three-child family. In view of the seriousness of the situation, the 1980's campaign has advocated 2 child norm. A significant achievement of the family welfare programme in India has been the decline in the fertility rate from 6.4 in the 1950's to 3.7 in 1993. All efforts are being made through mass communication that the concept of small family norm is accepted, adopted and woven into life style of the people. The Family Welfare Programme aims at achieving a higher end that is to improve the quality of life of the people.

The Family Welfare Programme is a Centrally Sponsored Scheme and the States receive 100 per cent assistance from the Central Government. The Secretary to the Government of India in the Ministry of Health and Family Welfare is the overall in charge of the Department of Family Welfare, which was created in 1966. The National Institute of Health and Family Welfare acts as an apex technical institute for promoting health and family welfare in the country through education, training services, research and evaluation.

The Director, Health and Family Welfare, Punjab is officer in charge for the implementation of Family Welfare Programme in the State. He is further assisted by Joint Director (FW), Deputy Director (FW), Assistant Director (FW) and Assistant Director (IUD).

The District Family Welfare Officer, Mansa is responsible for effective realization of objectives of this programme in the district. As on 1 April 2000, there were 4 Family Welfare Centres( 2 Urban and 2 Rural) functioning in the district. A list of these centres is given in Appendix IV at page 290.

The present approach in Family Welfare Programmes is to provide a 'Cafeteria Choice' viz. conventional contraceptives, oral pills, IUD's and sterilization.

The Medical Termination of Pregnancy Act (MTP-Act) was enacted in 1971 and later on, the Government of India introduced MTP Rules, 1975. The Punjab Government notified these rules on 7 April 1976. Under these rules, the government hospitals do not require any certification. These are considered approved places for MTP, provided trained/qualified doctor is posted there. The private hospitals are required to procure the approval of the Government before functioning as MTP centres.

The progress of sterilization operations, IUD insertions and MTP in Mansa District during 1992-93 to 1999-2000 is shown in the table given below:

Year	Sterlization	I.U.D Insertions	No. of Progressive totals M.T.P Sterlization I.U.D M.T.P Insertions
1992-93	4,024	10,780	70
1993-94	4,195	11,035	116	8,219	21,815	186
1994-95	5,302	14,340	114	13,521	36,155	300
1995-96	3,820	17,614	89	17,341	53,769	389
1996-97	3,888	8,975	281	21,229	62,744	670
1997-98	3,983	10,156	225	25,212	72,900	895
1998-99	4,353	11,876	157	29,565	84,776	1,052
1999-2000	3,569	11,733	142	33,134	96,509	1,194

( Statistical Abstracts of Punjab 1992 to 2000 )

National Programme for Control of Blindness

This programme was launched in 1976 and incorporates the earlier Trachoma Control, Programme, which was started in 1968. The ultimate goal of this programme is to reduce blindness in the country from 1.4 per cent to 0.3 percent, to provide comprehensive eye care through primary health care. Each primary health centre and district hospital is provided with Ophthalmic Assistant. Since cataract is the main cause of blindness, targets have been laid down for cataract operations. The cataract is curable by simple operation. Curable cases of blindness are treated by holding eye camps at various institutions for cataract and glaucoma operations. Corneal blindness is treated by corneal transplant operation at specialized institutions. The cataract operations are done at the district and tahsil level hospitals. The District Eye Mobile Unit, Mansa was established during 1994-95. Eye Mobile Team, having Eye Surgeon, Ophthalmic Assistants and supporting staff with mobile vans, which goes from district headquarters to different villages and far off places, where eye operations are done free of cost.

The voluntary organisation have been encouraged to organise eye camps in remote rural and urban areas as per guidelines issued by the State authorities. A number of such organizations are functioning in the district and are active in providing eye health education, preventive rehabilitative and surgical services for control of blindness.

The number of patients treated/operated under National Programme for Control of Blindness from 1992-93 to 1999-2000 in the Mansa District, is given below:

Year	Number of camps organised	Number of patients examined	Number of patients operated for cataract
1992-93	12	20,095	1,654
1993-94	25	22,541	2,685
1994-95	22	37,828	2,068
1995-96	18	34,881	2,167
1996-97	16	44,618	2,352
1997-98	19	43,780	2,294
1998-99	18	47,925	2,312
1999-2000	8	38,505	1,506

( Source: Civil Surgeon, Mansa)

National AIDS Control Programme

AIDS (Acquired Immune Deficiency Syndrome) is a dreaded disease, which spreads mainly due to hetro-sexual contact and unsafe blood transfusion. Its other routes of transmission are intravenous drug abuse or perinatal spread. To control the spread of this dreaded disease, the Government of India, in 1985 constituted a task force. It began by Pilot Screening Programme of high-risk population. National AIDS Control Programme has been launched under the aegis of Union Ministry of Health and Family Welfare in 1987 at central level. In 1991, a strategic plan for prevention and control of AIDS was developed with the help of WHO and World Bank, it was implemented in 1992. The Ministry of Health and Family Welfare has set up a National AIDS Control Organisation as a separate wing to implement and closely monitor the various components of the programme.

AIDS Control Programme was launched in Punjab State during 1992-93 as a 100 per cent Centrally Sponsored Scheme. AIDS control cell has been created in the Directorate headed by Deputy Director AIDS. Civil Surgeons have been directed to designate one of their District Officers as Nodal Officer. Information about AIDS has been disseminated to the people through Health Education Camps.

The Government of India has established Surveillance Centres at different places for screening persons practicing high risk behavior and zonal Blood Testing Centres in large cities for screening all pooled plasma for HIV infection and screening blood samples received from blood banks.

One State level Surveillance Centre along with Sentinel Cenre has been established at Medical College, Amritsar. Three Zonal Blood Testing Centres have been established in the State one each in College of Amritsar and Patiala and at Civil Hospital ,Ludhiana.

No case of AIDS is reported in the Mansa District since 1992. The number of HIV positive cases in the district during the years 1992 to 2000 is given below:

Year	Number of HIV positive cases
1992	-
1993	-
1994	2
1995	1
1996	1
1997	2
1998	2
1999	2
2000	-

(Source: Director, Health and Family Welfare, Punjab, Chandigarh )

National Leprosy Eradication Programme

Leprosy is the oldest disease which is neither hereditary nor contagious. 95 per cent people are naturally immune to the leprosy germ. National Leprosy Control Programme has been launched in the country during 1955-56. With the availability of highly effective treatment of leprosy, the programme was re-designated as National Leprosy Eradication Programme in 1983 with the objective to eliminate the leprosy in the country. Punjab is a low prevalence State so for the leprosy is concerned.

In Punjab, at the State headquarter, there are Zonal Leprosy units to supervise and review the achievements under National Leprosy Eradication Programme. At each district headquarters there is one Urban Leprosy Centre. One such Leprosy Centre is functioning at Mansa under the supervision, guidance and control of District Tuberculosis-cum-Leprosy Officer.

The number of persons given treatment under the programme during the years 1994-95 to 1999-2000 is given below:

Year Persons given treatment

1994-95 4

1995-96 3

1996-97 13

1997-98 16

1998-99 25

1999-2000 21 (Source :Civil Surgeon, Mansa)

Child Survival and Safe Motherhood Programme

This programme has been introduced as a part of the overall strategy for reduction of infant mortality rate, child mortality rate, natural mortality, rate and reduction in low birth-weight babies. To achieve these objectives, Child Survival and Safe Motherhood Programme was started in the State in August 1992 with financial assistance of World Bank and UNICEF. The health measures relating to women and children prior the launching of this scheme has been included in it besides widening its scope in this respect. The important schemes run under this programme are detailed below:

Universal Immunization Programme.- After the success of Small Pox Eradication Programme, immunization was considered as the most powerful and cost effective weapon against vaccine preventable diseases. In 1974 the World Health Organisation (WHO) launched its "Expanded Programme on Immunization" (EPI) against six, most common, preventable childhood diseases viz. diphtheria, pertussis (whooping cough), tetanus, polio, tuberculosis and measles. The Government of India launched its EPI in 1978 with the objective of reducing the mortality and morbidity resulting from vaccine-preventable diseases of childhood and to achieve self-sufficiency in the production of vaccines. EPI was renamed as 'Universal Child Immunization ' (UCI) during the same year. In India, Universal Immunization Programme was started in 1985. It has two vital components! immunization of pregnant women against tetanus and immunization of children in their first year of life against six EPI target diseases. The whole of the Punjab State has been covered under the programme upto1989.

The immunization services have been provided in the State through the existing health care delivery system i.e. maternity and child health centres, primary health centres, subsidiary health centres, hospitals and dispensaries.

The achievement under the 'Universal Immunization Programme’ in the Mansa District, during the years 1992-93 and 1995-96 to 1999-2000 is given

here under:

	1992-93	1995-96	1996-97	1997-98	1998-99	1999-2000
TT(Pregnant women)	12,189	19,636	16,748	16,732	15,437	18,359
DPT(Infants)	12,766	19,511	14,596	15,507	16,382	15,649
Polio(Infants)	12,766	19,511	14,596	15,507	16,382	15,649
BCG(Infants)	13,604	19,697	16,704	16,619	16,540	17,843
Measles	12,446	19,035	15,058	15,873	17,073	14,876
DT(5 years)	13,683	15,478	15,675	16,533	15,815	22,245
TT(10 years)	9,879	14,631	14,474	13,855	12,710	20,636
TT(16 years)	8,812	13,432	12,448	12,045	12,364	17,561

( Source: Civil Surgeon, Mansa)

Prophylaxis against Nutritional Anemia Amongst Mothers and Children.- Anemia is quite common during pregnancy, because the existing nutritional deficiencies are aggravated by demand of pregnancy and nursing of children and prevalence of high incidence of worm infestation. To prevent and counter the adverse effects of these deficiencies, Iron and Folic Acid tablets are given to the mothers and children for 100 days. The achievement under the programme during the years 1992-93 to 1999-2000 is given hereunder:

Year Iron and Folic Acid tablets given

Mothers Children

1992-93 17,779 12,696

1993-94 . 19,726 31,042

1994-95 24,747 29,228

1995-96 11,831 22,963

1996-97 6,071 8,397

1997-98 11,416 9,710

1998-99 15,311 14,426

1999-2000 20,614 40,478

(Source: Civil Surgeon, Mansa)

Prophylaxis against Blindness caused due to Vitamin 'A" Deficiency.- Xerophealimia (nutritional blindness) is attributed to nutritional deficiency of Vitamin 'A'. Keratomaliacia has been the major cause of nutritional blindness in children usually between 1-3 years of age. To prevent blindness among the children caused due to Vitamin 'A' deficiency, highly concentrated solution of Vitamin ‘A’ is given to children at an interval of 6 months till the age of 3 years. The achievement under the programme during the years 1992-93 to 1999-2000 is given here under:

Year Number of children given the dose of

Vitamin 'A'

1992-93 11,727

1993-94 15,453

1994-95 30,104

1995-96 24,302

1996-97 19,703

1997-98 13,990

1998-99 14,819

1999-2000 25,954

(Source: Civil Surgeon, Mansa )

School Health Programme

Healthy children are considered to be a firm foundation of the Nation. The entire State of Punjab was brought under the School Health Programme by the year 1986. In the Mansa District, one School Health Clinic is functioning at Civil Hospital, Mansa.

Under this programme, medical check-up of all students belonging to primary and middle schools (both government and recognized private schools) is done once a year. A team of doctors visits all the schools to examine the students and provides them curative referral and follow-up services.

Health education on various health topics is given to students and teachers. The doctors also advise the school authorities about proper water supply, good sanitation, cleanliness and help them to observe health fortnights. There were 1,01,159 students examined in the Mansa District during the year 1999-2000.

Prevention of Food Adulteration Programme

The Punjab Government passed the prevention of the Food Adulteration Act in 1954 for checking the adulteration of foodstuffs. This Act replaced the Punjab Pure Food Act,1929. The Food Adulteration Programme is implemented in the State under the supervision of Director, Health and Family Welfare, Punjab who has been notified as State Food (Health) Authority. He is assisted by Additional Director, Health (Food & Drugs). At the district level Civil Surgeon has been notified as Local (Health) Authority and is responsible for the implementation of prevention of adulteration programme in the district. He is assisted by 1 District Health Officer, 1 Whole-time Food Inspector and a number of designated Food Inspectors.

The licenses for selling foodstuffs are issued by the Municipal Councils/Nagar Panchayats/ Municipal Corporations. All concerns dealing in sale, stock and preparation of edible articles are subject to inspection by the team of Food Inspectors. In order to ensure preparation of sale of genuine and pure foodstuffs, edibles and drinks, special powers have been entrusted to the inspecting staff to seize samples. These samples are sent to the State Food Laboratory, Chandigarh for chemical examination and analysis. Those found guilty of adulteration are prosecuted.

The number of samples found adulterated and prosecutions launched in the Mansa District during 1992 to 2000, are given below:

Year	Samples seized	Samples found adulterated	Prosecutions launched
1992	48	2	2
1993	116	7	7
1994	220	6	6
1995	171	7	2
1996	159	3	-
1997	140	11	11
1998	131	12	5
1999	130	1	-
2000	88	4	4

(Source: Civil Surgeon, Mansa )

(e) Sanitation

Environmental hygiene has great bearing on the health of the people. The sanitation of towns and villages, streets and lanes, the disposal of the kitchen wastes and human excreta are some of the major health problems. To solve these problems and save the people from diseases, the Government pays much attention for the sanitation and conservancy of the cities/towns and villages. The Government of India commissioned a number of schemes for this purpose, such as National Water Supply and Sanitation Programme. It envisages to prevent spread of water-borne communicable diseases such as cholera, diarrhoea and typhoid to check contamination of food, water and milk due to insanitary disposal of human excreta; to provide tapped water supply and replacement of dry latrines with flush latrines and to free the sweepers engaged in sub human system of collection, handling and transporting human excreta from this unhygienic and humiliating practice.

(i) Public Health and Sanitation in Urban Areas.- In the urban areas, sanitation work is looked after by the Municipal Councils/Nagar Panchayats. These have been entrusted with the work of providing various civil and other amenities. In the Mansa District, all the Municipal Councils/Nagar Panchayats have made arrangements for cleanliness of the towns by employing a number of scavengers. The sweepers are deployed by the Municipal Councils/Nagar Panchayats to collect the rubbish, etc, with the help of hand driven rehris and tractor trolleys from the streets, lanes and roads before dumping it into main compost grounds of the towns. The sewerage system has been introduced in the Mansa and Budhlada towns of the district. The total number of sewerage connections provided in these towns upto 31 March 2000, were 6,881.There is good provision for water supply in the municipal towns, Mansa, Budhlada and Bareta of the district. The total number of connections provided in these towns upto 31 March 2000 were 10,291.

(ii) Rural Sanitation and Water Supply.- Under the present set up, arrangement for sanitation are looked after by gram panchayats. The block development staff takes up the responsibility in respect of the area under their jurisdiction. The primary health centres established in the block area, are the chief centre of these activities. The main functions of the Public Health Department (RWS) are to provide tapped drinking water in the villages besides installing hand pumps. The installation of tubewells in the villages has taken the place of open wells for the use of drinking water purposes. Gram panchayats also look after the sanitation of villages. For providing better and hygienic living conditions in the villages, the Model Village Scheme has been started. Under this scheme a few villages are selected as model villages, where the streets are paved, drains are constructed and arrangements are made for the sullage water. As on 31 March 2000, out of 241 inhabited villages, 239 have been identified as water scarcity villages, in the Mansa District. In all the 239 water scarcity villages, water supply scheme have been commissioned in the district.

(iii) Punjab Pollution Control Board.- The main objective of the Board is to prevent, control or abate water and air pollution, maintain and restore the wholesomeness of water and the quality of air. In conformity with the objective, the Board is vested with the authority to oversee, within the State of Punjab, the application of the laws and rules relating to pollution control are: Water (Prevention and Control of Pollution) Act 1974 as amended in 1988; Water (Prevention and Control of Pollution) Cess Act 1977; Air (Prevention and Control of Pollution ), Act1981 as amended in 1987; Environment (Protection) Act, 1986; Hazardous Wastes (Management and Handling) Rules,1989 as amended in 2000; Manufacturing, Storage and Import of Hazardous Chemicals, Amendment, 2000; Public Liability Insurance Act,1991; Bio-Medical Wastes (Management and Handling) Rules,1998; Recycled Plastics Manufacture and Usage Rules, 1999 and Municipal Solid Wastes (Management and Handling) Rules, 2000.

The main functions of the Board are: Pollution Control-Regulatory Functions; Pollution Assessment; Laying down of Standards for Effluent and Emissions; Research and Development including Setting up of Demonstration Plants; Environment Awareness Programme; Advisory Role; Establishment of Laboratories and Implementation of above mentioned Acts.

In order to achieve the above functions, the general approach of the Board is: to control pollution at the source with due regard to techno-economic feasibility for liquid effluents as well as gaseous emissions; to ensure that natural waters are not polluted by discharge of untreated effluents; reuse/recycling of wastes and to use the treated effluent on land for irrigation and for industrial purpose after appropriate treatment and to minimize pollution control requirements by judicious location of new industries and relocation of existing industries wherever necessary.

The strategy of the Board is to take up highly polluting large and medium industries grossly polluted areas of the State and grossly polluted river stretches on priority basis for control of pollution; promotional measures and assistance through incentives, guidelines, development of cost effective technologies and putting up of demonstration plants are also the parts of the strategy. Efforts have also been made for creation of awareness about environmental pollution by educating the industries and local authorities to take preventive measures for the control of pollution.

There is no office of Pollution Control Board in the Mansa District. But the district falls under the control of Environmental Engineer, Regional Office, Bathinda who is under the administrative control of Senior Environmental Engineer-II, Patiala. There were 77 brick kilns, 99 rice-shellers, 2 solvent plants and 1 card board factories functioning in the district as on 31 March 2000. Out of these, 50 brick kilns, 77 rice-shellers, 2 solvent plants and 1 card board units have adopted effective pollution control devices.

Punjab Health Systems Corporation

The Corporation has been incorporated under the Punjab Health Systems Corporation Act,1996 ( The Punjab Act No. 6 of 1996) to bring more administrative flexibility for implementation of The "Second State Health System Development Project" with the World Bank assistance to upgrade health services in the State. The main functions of the Corporation are: to formulate and implement the schemes for the comprehensive development of the dispensaries and hospitals; to construct and maintain dispensaries and hospitals and maintenance of cleanliness therein; to implement National Health Programmes as per the directions of the State; to purchase, maintain and allocate quality equipment to various dispensaries and hospitals; to procure stock and distribute drugs, diet, linen and other consumables among the dispensaries and hospitals; to provide services of specialists and super-specialists in various hospitals; to enter into collaboration for super-specialists with health institutions both within the country or abroad to provide better medical care; to receive donations, funds and the like from the general public and institutions from both within and outside India; to receive grants or contributions which may be made by the Government on such conditions as it may impose, to provide for construction of houses to the employees of the dispensaries and hospitals and maintenance thereof by mobilizing resources for financing institutions; to plan, construct and maintain commercial complexes, paying wards and providing diagnostic services and treatment on payment basis and to utilise the receipts for the improvement of the hospitals and dispensaries; to run public utility service and undertake any other activity of commercial nature for the delivery of health care within or without the hospital premises directly or in collaboration with private or voluntary agency on contract basis; to engage specialized agencies or individuals in the relevant disciplines directly or from external sources for the efficient and expeditious conduct of any of the functions detailed above and to provide immediate treatment in case of emergency and for unaccompanied patients.

To provide better health services in the Mansa District, the Punjab Health Systems Corporation has taken over Civil Hospital, Mansa; Sub-divisional Hospital, Budhlada; Subdivisional Hospital, Sardulgarh and Community Health Centre, Khiala Kalan upto 31 March 2000.

Appendix I (Vide page 269)

Deaths Registered from Various Diseases in the Mansa District during 1992 to 2000

year 1992 1993 1994 1995 1996 1997 1998 1999 2000

Male 2,277 2,403 2,219 1,990 2,114 2,371 2,705 2,620 2,489

Female 1,234 1,355 1,392 1,507 1,673 1,420 1,597 1,473 1,448

Total 3,511 3,758 3,601 3,497 3,787 3,991 4,302 4,093 3,937

(Source: Civil Surgeon, Mansa )

APPENDIX II ( Vide page 274)

List of Hospitals/Primary Health Centres/ Community Health Centres/Subsidiary Health Centres/Dispensaries/Clinics in the Mansa District as on 1 April 2001

Serial No	Name of the Institution	Tahsil		Number of Beds Male female				Rural/Urban	Types of Management
1	2	3		4 5				6	7
1	Dr Inderjit Singh Gill Memorial Civil Hospital, Mansa	Mansa		50		50		Urban	State Public
2	Urban Slum Area Dispensary, Mansa	-do-		2		2		-do-	-do-
3	E.S.I Dispensary, Mansa	-do-		-		-		-do-	State Special
4	Police Line Dispensary, Mansa	-do-		-		-		-do-	State Public
Block Budhlada
5	C.H.C/P.H.C, Budhlada	Budhlada		15		15		Urban	State Public
6	Rural Hospital, Bareta	-do-		15		10		-do-	-do-
7	Mini P.H.C. Boha	-do		2		2		Rural	-do-
8	Mini P.H.C. Biroke Kalan	-do		2		2		-do-	-do-
9	Mini P.H.C. Kulrian	-do-		2		2		-do-
10 11	Mini P.H.C. Rangrial S.H.C, Barawal	-do- -do-		2 2		2 2		-do- -do-	-do- -do-
12	S.H.C.Dodra	-do		2		2		-do-	-do-
13	S.H.C, Bichhuwana	-do-		2		2		-do-	-do-
14	S.H.C, Alampur Mandran	-do-		2		2		-do-	-do-
15	S.H.C. Datewas	-d0-		2		2		`-do-	-do-
16	S.H.C,Gobindpur	-do-		2		2		-do-	-do-
17	S.H.C, Guraddi	-do-		2		2		-do-	-do-
18	S.H.C, Kanakwal	-do-		2		2		-do-	-do-
19	S.H.C, Kahangarh	-do-		2		2		-do-	-do-
20	S.H.C, Bareh	-do-		2		2		-do-	-do-
21	S.H.C, Maghanian	-do-		2		2		-do-	-do-
22	S.H.C., Bakshiwala	-do-		2		2		-do	-do-
23	S.H.C, Dalelwala	-do		2		2		-do	-do
Block Jhunir
24	C.H.C,Jhunir		Sardulgarh		15		15	-do	-do
25	Mini P.H.C. Jaurkian		-do-		2		2	-do	-do
26	Mini P.H.C., Bhainiwala		-do-		2		2	-do-	-do-
27	S.H.C. Bajewala		-do-		2		2	-do-	-do-
28	S.H.C. Bhamakalan		-do-		2		2	-do-	-do-
29	S.H.C. Makhewala		-do-		2		2	-do-	-do-
30	S.H.C.,Makha		-do-		2		2	-do-	-do-
31	S.H.C.,Mofar		-do-		2		2	-do	-do-
Block Sardulgarh
32	C.H.C./P.H.C, Sardulgarh		Sardulgarh		15		15	Urban	State Public
33	Mini P.H.C. Karandi		-do		2		2	Rural	-do-
34	S.H.C. Fatta Maluka		-do-		2		2	-do-	-do-
35	S.H.C., Ahlupur		-do-		2		2	-do-	-do-
36	S.H.C.,Kurla		-do-		2		2	-do-	-do-

List of Hospitals/Primary Health Centres/Community Health Centres/Subsidiary Health
Serial No.
Name of the Institution	Tahsil		Number of Beds Male Female			Rural/Urban	Types of Management
1	2	3		4		5	6	7
37	S.H.C., Singha	-do-		2		2	Rural	State Public
38	Focal Point Dispensary, Jatanan Kalan	-do-		2		2	-do-	-do-
Block Mansa
39	C.H.C/P.H.C,Khiala kalan	Mansa		15		15	Rural	State Public
40	Mini P.H.C,Bhaini Bagha	-do-		2		2	-do-	-do-
41	Mini P.H.C. Nangal Kalan	-do-		2		2	-do-	-do-
42	S.H.C.,Gehla	-do-		2		2	-do	-do-
43	S.H.C., Barnala	-do-		2		2	-do	-do
44	S.H.C, Khokhar Kalan	-do-		2		2	-do-	-do-
45	S.H.C., Kotli Kalan	-do-		2		2	-do-	-do-
46	S.H.C., Musa	-do-		2		2	-do-	-do-
47	S.H.C., Dalel Singh Wala	-do-		2		2	-do-	-do-
48	Focal Point Dispensary, Maan Bibrian	-do-		2		2	-do	-do-
Block Bhikhi
49	Rural Hospital,Bhikhi		Mansa		15	10	Urban	State Public
50	Bhai Behlo Government Rural Hospital, Phaphre Bhai Ke		-do-		15	10	Rural	-do-
51	Mini P.H.C.Dhai pai		-do-		2	2	-do	-do
52	Mini P.H.C.Joga		-do-		2	2	-do-	-do-
53	Mini P.H.C., Ubbah		-do-		2	2	-do-	-do-
54	S.H.C., Aklia		-do-		2	2	-do-	-do-
55	S.H.C., Dhalewan		-do-		2	2	-do-	-do-
56	S.H.C., Hiron kalan		-do-		2	2	-do	-do-
57	S.H.C.,Hodla		-do-		2	2	-do	-do
58	S.H.C., Jassarwal		-do-		2	2	-do-	-do-
59	S.H.C., Kishangarh Pharwahi		-do-		2	2	-do-	-do-
60	S.H.C., Maujo		-do-		2	2	-do	-do
61	S.H.C., Ralla		-do-		2	2	-do-	-do-
62	S.H.C., Khiwa Kalan		-do-		2	2	-do-	-do-
(Source: Civil Surgeon, Mansa)

APPENDIX III (Vide page 275)
List of Ayurvedic /Unani Institutions in the Mansa District during 1999-2000
Serial No	Name of the Institution	Ayurvedic/Unani	Rural/Urban	Tahsil
1	Mansa	Ayurvedic	Urban	Mansa
2	Bareta	-do-	-do-	Budhlada
3	Phaphre Bhaike	-do-	Rural	-do-
4	Bapiana	-do-	-do-	Mansa
5	Chakriana	-do-	-do-	-do-
6	Ubbah Burje Dhillon	-do-	-do-	-do-
7	Ghuman kalan	-do-	-do-	-do-
8	Jhunir	-do-	-do-	Sardulgarh
9	Karandi	-do-	-do-	-do-
10	Raipur	-do-	-do-	-do-
11	Kishangarh	-do-	-do-	Budhlada
12	Dharampura	-do-	-do-	-do-
13	Akanwali	Unani	-do-	-do
(Source : Director, Ayurveda, Punjab, Chandigarh)

APPENDIX IV (Vide page 277) Family Welfare Centres in the Mansa District as on 1 April 2000
Serial No	Name of the Institution and location	Rural/Urban	Type of Management	Tahsil
1	Family Welfare Unit (Post-partum Unit), Mansa	Urban	State Public	Mansa
2	Family Welfare Unit,C.H.C,Budhlada	-do-	-do-	Budhlada
3	Family Welfare Unit C.H.C, Sardulgarh	Rural	-do-	Sardulgarh
4	Family Welfare Unit, C.H.C, Khiala Kalan	-do-	-do-	Mansa
(Source: Civil Surgeon, Mansa)

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