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Health Care and Research Development Plan for the Future
Dr. B. J. Coyaji

As India celebrates its 54th year of Independence at the turn of the Millennium it will also mark the birth of the billionth Indian. While we can take pride in the fact that crude fertility rate and infant and maternal mortality rates have substantially reduced and life expectancy at birth has increased from 40 to 62 years. a vast majority of the Indian people still lack basic amenities like adequate housing, sanitation and safe drinking water. Literacy levels also remain unacceptably low and the maternal mortality rate is still much higher than in many developed countries.

Expanding contraceptive options, creating awareness and access to technologies and services with appropriate quality of care are the unavoidable options if we want to stabilize population growth and provide the people with a better quality of life. Continuing at the present growth rate of 2%, India’s population could well be 2 billion by 2035. A large number of our population still have very minimal access to reproductive health care services and approximately 7 million abortions are induced annually – suggesting that pregnancy termination is still the primary method of birth control.

It is therefore essential to increase the prevalence of contraceptive methods and make available in India methods whose efficacy and safety have been evaluated and adopted in other countries. Our Health Care planners will need to introduce diverse methods such as long acting injectables, sub dermal implants, vaginal rings and Emergency contraception to provide couples with a wider option to choose the method that suits them best. At the same time it is also essential to develop simple non–surgical methods of terminating pregnancy through the use of drugs like RU–486. Research into newer methods of contraception targeting men is also necessary and desirable.

The Cairo Conference of 1994 brought about a paradigm shift in focus from the narrow demographic goals of Family Planning to the broader concept of Reproductive Health. With the rising incidence of STDs and HIV infections it has become imperative for Researchers to link STD services to Family Planning and devise methods to provide protection not only against pregnancy but also against sexually transmitted diseases – the so called 'Double Protection Approach’.

Beyond the year 2000 other health problems in India will also show a complex epidemiology. Alongside the existing problems arising out of poverty and social deprivation we shall also increasingly experience problems of development i.e. affluence and modernization. New diseases of civilization and life–style related diseases will come up while at the same time older diseases and problems will resurface creating the “Double burden of Diseases”. Environmental pollution, degradation of ecosystems, urbanization and its consequences – especially for the increasing aged population, and increasing violence in society will further complicate the health scenario. This calls for urgent remedial actions the most important of which would be food security, safe drinking water supply? sanitation and effective and equitable utilization of health services.

We at KEMHRC can participate in this process – by strengthening referrals at PHC/District levels–by field level co–ordination with other NGOs and Government agencies– by increasingly involving ourselves in training, monitoring, evaluation and advocacy and by providing health education to promote a positive health attitude and involvement of the community.

W.H.O.’s new policy of “Health for All in the 21st Century” calls for promotion of health in all settings and within all sectors. Settings where people live, work, play, learn and seek health care provide different opportunities to NGOS, Academic institutions and Government agencies to combine their efforts to develop sustainable health systems. In the words of Dr. F.S.Antezana of WHO. “Health systems of the future will need to adapt more rapidly to changes in epidemiological pattern of diseases, to demographic and economic changes, to different expectations of health service users and to the opportunities offered by new technologies.”

N.G.O.s like KEM Hospital Research Center will have a crucial role to play in all of these changes needed towards the attainment of HEALTH FOR ALL in the 21st Century.