9th Five Year Plan (Vol-2)
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Human and Social Development
Sectoral Overview || Basic Minimum Services || Education || Health || Family Welfare || Indian System of Medicine and Homoepathy || Housing, Urban Development, Water Supply and Civic Amenities || Empowerment of Women and Development of Children || Empowerment of the Socially Disadvantaged Groups || Social Welfare || Labour and Labour Welfare || Art and Culture || Youth Affairs and Sports



3.1.1 Human development and improvement in quality of life are the ultimate objectives of all Planning. This is to be achieved through policies and programmes aimed at promotion of both equity and excellence. Planning takes into account the resources required for human development and human resources available for carrying out the Plan. India, the second most populous country in the world, has no more than 2.5% of global land but is the home of 1/6th of the world's population. Living in a resource poor country with high population density, planners perceived in the figures of 1951 census the potential threat posed by rapid population growth to the developmental activities, efforts to improve per capita income, availability of food, clothing, education and employment, prevention of environmental deterioration and enhancement of the quality of life. India became the first country in the world to formulate and implement the National Family Planning Programme in 1952 with the objective of "reducing birth rate to the extent necessary for stabilisation of the population at a level consistent with the requirement of the National economy".

3.1.2 The benefits of national economic progress reach different segments of the population through different channels at different rates. The needs of people above the poverty line and an improvement in their standards of living can be achieved through optimum utilisation of existing market mechanism; but market mechanism may not improve access to available facilities or fully meet the essential needs of the population with poor purchasing power.

Population projections

Population projections are required for planning adequate investments for:

  • Essential necessities such as food, shelter and clothing.
  • Essential prerequisites for human development such as education, employment and health care
  • Optimal utilisation of the available human resources for economic and social development.

Economic growth improves the employment opportunities; employment improves purchasing power; but these alone may not be sufficient to improve the quality of the life. Social sector planning ensures that appropriate policy and programme initiatives are taken and adequate investment is provided by the State in the social sector so that the poorer and vulnerable segments of the population can access essential commodities, facilities and services based on their need and not ability to pay. It is expected that these efforts will accelerate human development and this, in turn, will ensure that the population becomes a major resource for developmental activities and acts as an important driving force for growth and development of the economy.

Population projections

3.1.3 Right from 1958 the Planning Commission has been constituting an Expert Group on Population Projections prior to the preparation of each of the Five Year Plans so that the information on the population status at the time of initiation of the Plan and population projections for future are available during the preparation of the Plan.

Population projections 1996-2016

The population will increase from 934 million in 1996 to 1264 million in 2016 Between the periods 1996-2001 and 2011-2016 there will be a decline of :

  • CBR   from    24.10      to    21.41
  • CDR from       8.99       to     7.48
  • NGR from       1.51%   to    1.39%
  • IMR
    male from 63 to 38
    Female   from       64 to 39

The data from the population projections have been utilised not only for planning to ensure provision of essentials necessities such as food, shelter and clothing but also for the prerequisites for human development such as education, employment and health care. Over the years there has been considerable refinement in the methodology used for population projections and substantial improvement in the accuracy of predictions. The projections made by the Standing Committee on Population Projection in 1988 for the year 1991 was 843.6 million; this figure was within 0.3% of the 846.3 million reported in the Census 1991.

3.1.4 In 1996, prior to the formulation of the Ninth Plan, the Planning Commission had constituted a Technical Group on Population Projections, under the Chairmanship of Registrar General India, to work out the population projections for the country for the period 1996 to 2016 on the basis of census 1991 and other available demographic data. The Group worked out the projections for the population of the country (Table 3.1.1) and the major States for the period 1991-2016 . The age and sex-wise distribution of the projected population is given in Table 3.1.2 Population pyramids for the period 1971 to 2016 (drawn on the basis of census figures for 1971,1981 and 1991 and on the basis of population projections for the period from 1996-2016) is shown in Figure 1.

3.1.5 Demographic transition is a global phenomenon. The transition is from high fertility, high mortality, stable population scenario, to low fertility, low mortality and stable population scenario. India is currently in the second stage of transition; the rate of fall in birth rate exceeds fall in death rates and for the first time after three decades the population growth rate has fallen below 2%. Surveys undertaken in the country have unequivocally shown that awareness about contraception is universal; there is substantial unmet need for contraception. The short term goals during the Ninth Plan period will be to assess and meet all the felt needs for maternal and child health care and contraception; the focus will be on meeting the unmet needs for contraception and achieving reduction in the high desired level of fertility through programmes for reduction in IMR/MMR. The medium and long term goals will be to continue this process enabling the couples to achieve their reproductive goals and simultaneously enable the country to accelerate the pace of demographic transition and achieve population stabilisation as early as possible. Early population stabilisation will enable the country to achieve its developmental goal of improvement in economic status and quality of life of the citizens. Along with the demographic transition, there is concurrent ongoing socioeconomic, educational, information technology transition. These will improve access, enhance the awareness and promote optimal utilisation of the available services. By bringing about an accelerated convergence of all these favourable factors it will be possible not only to hasten the pace of demographic transition but also improve the quality of life.

Effective implementation of RCH Programme and achievement of targets set for CBR would avert about 1 million births and 1,40,000 infant deaths in 2002 AD. If the goals of RCH Programme are met, India could achieve TFR of 2.1 at the national level a decade earlier than current projections. A reduction in birth rate of this magnitude would prevent an otherwise inevitable increase in number of births due to rise in reproductive age population two to three decades later, lead to population stabilisation earlier and at a substantially lower figure than the current projections.

Implications of ongoing demographic transition to the social sector planning:

Economic Implications

3.1.6 Population growth and its relation to economic growth has been a matter of debate for over a century. The early Malthusian view was that population growth is likely to impede economic growth because it will put pressure on the available resources, result in reduction in per capita income and resources; this, in turn, will result in deterioration in quality of life. Contrary to the Malthusian predictions, several of the South East Asian countries have been able to achieve economic prosperity and improvement in quality of life inspite of population growth. This has been attributed to the increase in productivity due to development and utilisation of innovative technologies by the young educated population who formed the majority of the growing population.

Economic implications of demographic transition

The next two decades will witness:

  • Increase in the 15-59 age group from 519 –800 million
  • Low dependency ratio

Challenge is to ensure:

  • Adequate investment in HRD
  • Appropriate employment with adequate emoluments

Opportunity is to:

  • Utilise available abundant human resources to accelerate economic development

These countries have been able to exploit the dynamics of demographic transition to achieve economic growth by using the human resources as the engine driving the economic development; improved employment with adequate emoluments has promoted saving and investment which in turn stimulated economic growth.

3.1.7 However, it is noteworthy that not all countries which have undergone demographic transition have been able to transform their economies. Sri Lanka in South Asia which underwent demographic transition at the same time as South East Asian countries still continues to have poor economic indices. It is likely that population growth or demographic transition can have favourable impact on economic growth only when there are optimal interventions aimed at human resource development and appropriate utilisation of available human resources.

3.1.8 For India the current phase of demographic transition with low dependency ratio and high working age group population represents both a challenge and an opportunity. The challenge is to utilise these human resources fully, give them appropriate jobs with adequate emoluments; if this challenge is met through well planned schemes for employment generation which are implemented effectively, there will be improved national productivity and personal savings rates; appropriate investment of these savings will help the country to achieve the economic transition from low economic growth - low per capita income to high economic growth - high per capita income. It is imperative to make the best of this opportunity so as to enable the country and its citizens to vault to the high income- high economic growth status.

Interstate differences:

3.1.9 The projected values for the total population in different regions (Fig. 2), Total Fertility Rate (TFR) and the probable year by which the replacement level TFR of 2.1 will be achieved by different States and India, if the pace of decline in TFRs observed during 1981-93 continues in the years ahead and expectation of life at birth are shown in Tables 3.1.3, 3.1.4 and 3.1.5. There are marked differences between States in size of the population, population growth rates and the time by which TFR of 2.1 is to be achieved . If the present trend continues, most of the Southern and the Western States are likely to achieve TFR of 2.1 by 2010. Urgent energetic steps to assess and fully meet the unmet needs for maternal and child health (MCH) care and contraception through improvement in availability and access to family welfare services are needed in the States of UP, MP, Rajasthan and Bihar in order to achieve a faster decline in their mortality and fertility rates. The performance of these States would determine the year and size of the population at which the country achieves population stabilisation.



Interstate differences

There are massive interstate differences in population, population growth rates, time by which TFR of 2.1 and population stabilisation will be achieved.

These differences will have major impact on

  • Health and nutritional status
  • Education and skill development
  • Appropriate employment with adequate emoluments
  • Rural – urban and interstate migrations
  • Social and economic development.

Efforts are to provide adequate inputs to improve performance so that the disparities between states will be narrowed.

3.1.10 There are also marked differences between States in socio-economic development. Increasing investments and rapid economic development are likely to occur in the States where literacy rates are high, there is ready availability of skilled work force and adequate infrastructure. In these States, population growth rates are low. If equitable distribution of the income and benefits generated by development is ensured, substantial increase in per capita income and improvement in quality of life could occur in these States in a relatively short time.

3.1.11 In majority of States with high population growth rates, the performance in the social and economic sector has been poor. The poor performance could be the outcome of a variety of factors including paucity of natural, financial or human resources. Poverty, illiteracy and poor development co-exist and reinforce each other. In order to promote equity and reduce disparity between States, special assistance has been provided to the poorly performing States. The benefits accrued from such assistance has to a large extent depended upon :

  1. the States' ability to utilise the available funds and improve services and facilities, and
  2. community awareness and ability to utilise the available services.

3.1.12 In spite of the additional assistance provided, improvement in infrastructure, agriculture and industry have been sub-optimal and the per capita income continues to be low in most of the poorly performing States. These States also have high birth rates and relatively low literacy rates. It is imperative that special efforts are made during the next two decades to break this vicious self perpetuating cycle of poor performance, poor per capita income, poverty, low literacy and high birth rate so that the further widening of disparities between States in terms of per capita income and quality of life is prevented. In addition to the special assistance available to poorly performing States, additional Central assistance from Basic Minimum Service (BMS) programme will also be available during the Ninth Plan period for achieving these objectives.

3.1.13 The higher population growth rates and low per capita income in poorly performing States are likely to have a major impact on several social sector programmes. The health status of the population in these States is poor; the health sector programme will require inputs not only for improving infrastructure and manpower, but also increasing efficiency and improving performance. The Family Welfare Programme has to address the massive task of meeting all the unmet needs for MCH and contraception so that there is a rapid decline in mortality and fertility rates. Due to high birth rate, the number of children requiring schooling will be large. The emphasis in the education sector on primary education is essential to ensure that the resource constraints do not result in an increase in either proportion or number of illiterates. Emphasis on prevocational and vocational training in schools will enable these children to acquire skills through which they will find gainful employment later.

3.1.14 The available data from census shows that until 1991 both internal and international migration has been negligible. The Technical Group while computing the population projection upto 2016, has assumed that the component of migration between major States and from India will be negligible. This assumption may not be valid if there is further widening of the disparity between States in terms of economic growth and employment opportunity. Given the combination of high population growth, low literacy and lack of employment opportunities in the poorly performing States, there may be increasing rural to urban migration as well as interstate migration especially of unskilled workers. Such migration may in the short run assist the migrants in overcoming economic problems associated with unemployment. However, the migrant workers and their families may face problems in securing shelter, education and health care. It is essential to build up a mechanism for monitoring these changes. Steps will have to be taken to provide for the minimum essential needs of the vulnerable migrant population.

Changes in Labour Force

3.1.15 Currently, India's population is undergoing a relatively slow but sustained demographic transition . During the next two decades, the proportion of the population in the age-group 20-60 years in the country will be very large, because of the high birth rates during the last three decades. Increasing literacy and decreasing birth rates may result in more women seeking economically productive work outside home. Planners have to ensure that there is sustained high economic growth rate, in sectors which are labour-intensive to ensure adequate employment generation for productively utilising this massive work force. This challenging task could be viewed as a major opportunity; this large group of literate, skilled, aware men and women if utilised as human resource could trigger off a period of rapid economic development.

3.1.16 During the next two decades, there will be a substantial reduction in birth rates and therefore a reduction in the proportion of the dependent child population. The proportion of the dependent population beyond 60 years is relatively small and will expand relatively slowly over the next two decades. Thus for the next two or three decades the country will have relatively low dependency ratios. If the massive work force in age-group 20-60 years get fully employed and adequately paid, the relatively low level of dependent children and elders might result in increased savings and investments at household level; this in turn will improve the availability of resources for accelerated economic growth.

Sex Ratio

3.1.17 The reported decline in the sex ratio during the current century has been a cause for concern (Figure 3). The factors responsible for this continued decline are as yet not clearly identified. However, it is well recognised that the adverse sex ratio is a reflection of the gender disparity. Appropriate steps to correct this will be taken during the Ninth Plan period. There is an urgent need to ensure that all sectors collect and report data on sex disaggregated basis; this will be of help in monitoring for evidences of gender disparity; continued collection, collation, analysis and reporting of sex disaggregated data from all social sectors will also provide a mechanism to monitor whether girls and women have equal access these services.

average sex ratio at birth for the period 1981-90 for the major States and India are given in Figure 4. The observed sex ratio of 110 is much higher than the internationally accepted sex ratio at birth of 106.

3.1.18 The SRS based estimates of

There had been speculations as to whether female infanticide, sex determination and selective female foeticide are at least in part responsible for this. The Government of India has enacted a legislation banning the prenatal sex determination and selective abortion. Intensive community education efforts are under way to combat these practices, especially in pockets from where female infanticide and foeticide have been reported. Higher childhood mortality in girl children is yet another facet of the existing gender disparities and consequent adverse effect on survival. In the reproductive age- group the mortality rates among women are higher than those among men. The continued high maternal mortality is one of the major factors responsible for this. Effective implementation of the Reproductive and Child Health Programme is expected to result in a substantial reduction in maternal mortality. At the moment, the longevity at birth among women is only marginally higher than that among men. However over the next decade the difference in life expectancy between men and women will progressively increase. Once the reproductive age group is crossed the mortality rates among women are lower. The proportion of women in the over- 60 age- group is expected to increase. Steps to ensure that these women do get the care they need are being taken by concerned Departments including the Departments of Health, Family Welfare and Women and Child Development.

Increasing Longevity

3.1.19 The projected level of expectation of life at birth 1996-2016 is shown in Table 3.1.6. It is obvious that over the next three decades the country will be facing a progressive increase both in the proportion and number of persons beyond 60 years of age. Over the next 20 years, there will be a small but significant increase in number and proportion of persons in the group over 60 years of the age; the subsequent decades will witness massive increase in this age group.

Increasing longevity:

  • The population of elderly (>60 years) will increase from 62.3 million in 1996 to 112.9 million in 2016
  • Improved health care has added "Years to life"
  • Increased social sector investment is needed to add "Quality of life to years"

It is noteworthy that women out number men in the 65+ age group; it is expected that over the next two decades longevity in women will substantially increase. Increasing longevity will inevitably bring in its wake increase in the prevalence of noncommunicable diseases. The growing number of senior citizens in the country poses a major challenge; the cost of providing socio-economic security and health care to this population has to be met; currently several region and culture specific innovative interventions to provide needed care to this population are underway; among these are efforts to reverse the trend of break up of joint families. If these efforts succeed, it will be possible to provide necessary inputs for the care of rapidly increasing senior citizens population in the subsequent two decades.

3.1.20 Majority of the people in their sixties will be physically and psychologically fit and would like to participate both in economic and social activities. They should be encouraged and supported so that they do lead a productive life and also contribute to the national development. Senior citizens in their seventies and beyond and those with health problems would require assistance. So far, the families have borne major share in caring for the elderly . This will remain the ideal method; however there are growing number of elderly without family support; for them, alternate modes for caring may have to be evolved and implemented. Improved health care has "added years to life". The social sectors have to make the necessary provisions for improving the quality of life of these senior citizens so that they truly " add life to years."

Population projections and their implications for the FW programme

3.1.21 The projected populations of India in the three major age groups (less than 15, 15-59, 60 years or above) are shown in Figure 5.

3.1.22 There will be a marginal decline in the population less than 15 years of age (352.7 million to 350.4 million). The health care infrastructure will therefore be not grappling with ever increasing number of children for providing care and they will be able to concentrate on

Age group < 15 years

There will be no increase in numbers Focus will be to improve

  • quality and coverage of health and nutrition services and achieve improvement in health and nutrional status
  • improve access to education and skill development
  1. improving quality of care;
  2. focus on antenatal, intranatal and neonatal care aimed at reducing neonatal morbidity and mortality;
  3. improve coverage and quality of health care to vulnerable and underserved adolescents;
  4. promote intersectoral coordination especially with ICDS programme so that there is improvement in health and nutritional status;
  5. improve coverage for immunization against vaccine preventable diseases.

3.1.23 The economic challenge is to provide needed funds so that these children have access to nutrition, education and skill development. The challenge faced by the health sector is to achieve reduction in morbidity and mortality rate in infancy and childhood, to improve nutritional status and eliminate ill-effects of gender bias.

Age Group 15-59 years

  • There will be an increase from 519-800 million in two decades
  • They will be requiring wider spectrum of health care services and improvement in quality of services
  • Family Welfare programme has to cater to :
  • Maternal and child health services
  • Contraceptive care
  • Gynaecological problems
  • RTI /STD management

3.1.24 There will be a massive increase of population in the 15-59 age group (from 519 million to 800 million). The RCH care has to provide the needed services for this rapidly growing clientele. The populations in this age group is more literate and has greater access to information; they will therefore have greater awareness and expectation regarding both the access to a wide spectrum of health care related services and the quality of these services. The Family Welfare Programme has to cater to wider spectrum of health care needs of this population – including maternal and child health care, contraceptive care, management of gynaecological problems, STD/RTI/HIV management and control; quality of services need also be improved.

3.1.25 There will be a substantial increase in the population more than 60 years (62.3 million to 112.9 million). In the next two decades. increasing numbers of the population beyond 60 years would necessitate provisions for management of some of the major health problems in this age group including early detection and management of cancers.

Age group 15-59

Challenge is the massive increase in the number of people in this age group. They will:

  • need wider spectrum of services
  • expect better quality of services
  • expect fulfillment of their felt needs for MCH/FP care

Opportunity is that if their felt needs are met through effective implementation of RCH programme, it is possible to accelerate demographic transition and achieve rapid population stabilisation.

3.1.26 There has been a paradigm shift in Family Welfare Programme; centrally defined method specific targets have been replaced by community based need assessment and decentralised planning and implementation of the programme to fulfil these needs. The ongoing educational, info-technology and socio-economic transition have raised awareness and expectations of the population. It has been recommended that a Population Policy is drawn up to provide reliable and relevant policy frame work for the programmes in the Family Welfare and the related social sectors, for measuring and monitoring the delivery of services and their demographic impact in the new millenium.

3.1.27 Any projection of expected levels of achievement in the demographic indices by the end of the Ninth Plan has to take into consideration the pace of improvement in these indicators during the Eighth Plan and the additional policy and programme measures envisaged to accelerate the pace of achievement during the Ninth Plan. The projections regarding expected levels of achievement have been worked out at two different levels, one on the basis of the assumption that the trend observed with regard to these parameters in the last 15 years will continue during the Ninth Plan period and the second on the assumption that the additional policy and programme initiatives provided during the Ninth Plan period will result in the acceleration of the pace and result in substantial improvement during the Ninth Plan period. The expected levels of achievement under these two sets of assumptions for CBR is 24 and 23/1000. A difference in the birth rate of this magnitude would make the difference of about one million births in 2002 AD alone. Similarly if the Programme achieves, the accelerated decline in IMR (from 56/1000-50/1000) over 140 thousand infant deaths will be averted in 2002 AD. These achievements may be the beginning of a major acceleration in pace of demographic transition and improving health status of the population.

Health Implication of the demographic transition

3.1.28 It was earlier assumed that population growth demographic transition will lead to overcrowding, poverty, undernutrition, environmental deterioration, poor quality of life and increase in disease burden. In recent years this view has been challenged. The period during demographic transition with increase number and proportion of persons in the age group 15-59 years may, if appropriate health services are made available, lead to substantial improvement in the health status of the population. The increase in population at this stage of demographic transition is mainly among younger, better educated and healthy population with low morbidity and mortality rate. The challenge for the health sector is to promote healthy life styles, improving access to and utilisation of health care and achieve substantial reduction in mortality and morbidity. Occupational health and environmental health programme need be augmented to ensure that working population remain healthy and productive. If these challenges are fully met, it is possible to accelerate reduction in morbidity and mortality rate in this age group.

3.1.29 There will be a small but significant increase in the elderly in the next decade. The impact of growing number of senior citizens is likely to result in substantial increase in for health care needs especially for management of noncommunicable diseases in this population. Increasing availability and awareness about technological advances for management of these problems, rising expectations of the population and the ever escalating cost of health care are some of the challenges that the health care system has to cope with. Health care delivery systems will have to gear up to taking up necessary preventive, promotive, curative and rehabilitative care for this population.

3.1.30 From foregoing paragraphs it is obvious that the on-going demographic transition is both a challenge and an opportunity. The challenge is to ensure human development and optimum utilisation of human resources. The opportunity is to utilise available human resources to achieve rapid economic development, human development and improvement in quality of life. It has to be realised that demographic transition does not occur in isolation. Simultaneously, there are ongoing economic transition, education transition, health transition and reproductive health transition. All these affect human development. If there is synergy between these transitions; the transitions can be completed rapidly; there will be substantial improvement in human development and economic development. The focus of planners, programme implementers and the people during the next two decades will have to be in achieving the synergy so that India can achieve rapid improvement in economic and social development.

Social sector Planning

3.1.31 Social sector planning ensures that appropriate policy and programme initiatives are taken and adequate investments are provided to the social sector so that the poorer and more vulnerable segments of the population have access to essential services and needed facilities. The chapter on human and social development deals with the achievements and proposed plans in social sectors and services listed in the box.

Sectors covered in the chapter on Human and Social Development

  • Basic Minimum Services
  • Special Action Plan
  • Health
  • Family Welfare
  • Education, Culture, Youth Affair and Sports
  • Labour, Employment and Manpower
  • Urban Development (including urban basic services)
  • Empowerment of Women and Development of Children.
  • Empowerment of the Socially Disadvantaged Groups
  • Social Welfare.

Basic Minimum Services:

3.1.32 Providing integrated essential services to the population has been an objective of the social sector planning right from the first Plan period. The community development Block was the instrument of such development in rural areas during the first four Plan periods. The initial focus was on provision of these services to the underserved rural population during the first two decades. However, by the mid- seventies, urban migration and explosive expansion of the urban population outstripped the existing services. It became imperative to invest in the provision of basic services to the urban population and urban development also.

3.1.33 In an attempt to provide greater focus and ensure achievement of objectives through careful monitoring, the Minimum Needs Programme (MNP) was formulated in the Fifth Plan. Over the last four Plans earmarked funds were provided under the MNP for establishment of a network of facilities and services for social consumption according to national norms throughout the country. The review of progress achieved so far indicates that the investment has brought about improvement in infrastructure and services available; however, the targets set are unlikely to be achieved within the time-frame.

The Seven Basic Minimum Services are:

  • Primary health care services
  • Provision of safe-drinking water
  • Universalisation of primary education
  • Housing assistance to shelterless
  • Nutrition support
  • Streamlining of PDS with a focus on the poor
  • Connectivity of unconnected villages.

It is also a matter of concern that the performance under MNP was sub optimal in states where the access to these services were poor prior to the initiation of the programme and over years the disparities in availability of services between States and between districts has widened.

3.1.34 Recognising that the access to basic minimum services to all in urban and rural areas is for improvement in the quality of life of the citizens, the Conference of Chief Ministers held in 1996, resolved that the core of the social development plan for the seven Basic Minimum Services should be initiated in a time bound fashion. Among these Primary Health Care, Primary Education and Provision of Safe-drinking water have been accorded higher priority, with a target of universal coverage by 2000 AD.

Special Action Plan for Social infrastructure

3.1.35 The Special Action Plan (SAP) envisages expansion and improvement of the social infrastructure - health care, education, housing (urban and rural), water supply and sanitation (urban and rural). For some sectors eg. housing specific targets to be achieved with in a defined time frame has been set; for other sectors such as health the efforts are to achieve substantial expansion and improvement of availability and quality of services. The details of the Special Action Plan goals and the strategy for achievement of these goals is discussed under each of the sectoral programmes.


Major areas of concern are:

  • Continued high morbidity due to communicable diseases
  • Rising disease burden due to non-communicable diseases
  • Escalating cost for health care

Focus during Ninth Plan will be on:

  • Providing integrated preventive, promotive, curative and rehabilitative services in primary, secondary and tertiary health care institutions with appropriate referral linkages.


3.1.36 Increasing realisation that healthy human resource is an essential prerequisite for all developmental activities has led to interest and investment "in" and "for" health even under severe resource constraints. Over the last 5 decades India has built a massive health care infrastructure to provide access to health care in urban and rural areas. National Programmes for combating major health problem has been evolved and implemented through this health infrastructure. These efforts have resulted in steep decline in death rate and rise in life expectancy. Some States like Kerala have health indices comparable to developed countries achieved relatively at a low cost. Though there has been a steep fall in mortality rates through out the country, disease burden due to morbidity continues to remain high. Yet another cause of concern is the continued high and rising morbidity rates due to communicable and non-communicable diseases and nutritional problems. Rapid technological improvements in health care and increasing population awareness about these have further widened the gap between what is possible and what is feasible within the resources available for the individual and in the country. The focus during the Ninth Plan is therefore, on providing integrated preventive, promotive, curative and rehabilitative services for communicable and non-communicable diseases through appropriate strengthening of existing Primary Health Care Infrastructure by filling in the existing gaps in physical infrastructure and manpower and ensuring their optimal utilisation both in urban and in rural areas.

Family Welfare Programme

3.1.37 Technological advances, improvement in quality and coverage of health care, implementation of disease Control Programmes, IEC campaigns, and increasing literacy have led to increased utilisation of available health services and resultant steep decline crude death rate from 25.1 in 1951 to 9.8 in 1991. Life expectancy rose from 32 years in 1947 to 59.4 years in 1989-93. In contrast, the reduction in Crude Birth Rate (CBR) has been less steep declining from 40.8 in 1951 to 29.5 in 1991. As a result the annual exponential population growth rate has been over 2% in the period between 1961 and 1991.

3.1.38 There is usually a lag period between fall in infant mortality rates and decline in birth rates because the population has to recognise the fall in mortality rates and respond to the change by reduction in the desired fertility level. Awareness about and access to Family Welfare services have shown substantial improvement during the last two decades. Because of these factors there has been a steeper fall in birth rate and annual population growth rate during the Eighth Plan period. Reduction in population growth rate was one of the major objectives of during the Eighth Plan and continues to be a major objective during Ninth Plan. It is expected that with vigorous effective implementation of Reproductive and Child Health Care programme the rate of decline in population growth will be accelerated during the Ninth Plan period.

3.1.39 It is obvious that the decline in fertility and mortality rates have occurred in all States, the rate of decline was slower in some States like U.P. and Bihar; even within the same state there are substantial differences between districts. It is imperative that efforts are made to remove or minimise inter and intra state differences in the vital indices. For this purpose the NDC Committee recommended that there should be:

  1. decentralised area specific planning based on the need assessment
  2. emphasis on improved access and quality of services to women and children
  3. creation of district level data base on quality and coverage indictors for monitoring of the programme

3.1.40 The Dept of Family Welfare has started implementing these recommendations. From 1.4.96 the centrally defined method specific targets for Family Planning have been replaced by:

  1. need assessment and fulfillment through decentralised PHC based planning and implementation of the programme.
  2. improved access and quality of comprehensive reproductive and child health services.

3.1.41 It is envisaged that this shift will enable the increasingly aware population to access available facilities so that they fulfill their reproductive goals and enable the nation to rapidly attain population stabilisation and improvement in quality of life of all the citizens.

3.1.42 The large size of the population in the age group 15-50 (60%), unmet need for contraception (20%) and high wanted fertility because of high IMR (20%) are the three major causes for the current high birth rates. During the Ninth Plan efforts will be to meet all the unmet needs for contraception by 2002 AD, and to achieve a reduction in the IMR and MMR through effective implementation of Reproductive and child health Programme .

3.1.43 If all these efforts to provide essential services to the population to meet their reproductive goals succeed, it might be possible for the country to achieve the TFR of 2.1 at 2010; this achievement in turn will enable the country to achieve population stabilisation at a substantially lower level well head of the projected year for population stabilisation. It should however be realised that even if all the efforts for achieving TFR of 2.1 are successful country's population will continue to grow during the next few decades. Adequate provision for meeting the minimum essential needs of this growing population and social sector provision to enable them to access requirements for human development have to be made during the next few decades.

Education, Culture, Youth Affairs and Sports

3.1.44 Education holds the key for increasing awareness of the population of the methods for improving their quality of life through appropriate utilisation of available resources, opportunities and facilities. Ample data exists to clearly demonstrate that investment in primary education specially education to women and girl children can play an important role in improving and sustainable on-going developmental efforts. The commitment for universal primary education and adult literacy in the past has resulted in marked improvement in literacy rates over the last five decades; however the target of universal primary education continues to elude achievement. In view of this, a special thrust under BMS will be given during the Ninth Plan so that the Nation achieves full literacy by 2005. Prevocational, vocational training in school and technical training aimed at providing skilled human resource for accelerated industrial and agrarian development is another thrust area of the Ninth Plan. Adequate opportunities will be provided for higher education as it is necessary for meeting the human resources required for the tasks of planning, teaching, research and similar activities. In order that the country's requirement of social scientists, creative artists and theoreticians is adequately catered to appropriate investment will be ensured in these areas of higher education. Youth will be involved in the task of nation building focussing their energies strongly in programmes of environmental protection as well as health and family-life education. Creating widespread awareness for physical and mental fitness starting from the school stage onwards and making youth and sports activities an integral part of every stage of education will be cherished goals.

Labour Employment and Manpower

3.1.45 India is the country with the second largest population in the world. Planned optimal utilisation of the human resources will not only fuel economic development but also ensure improvement in human resources of life of the citizens. Manpower development to provide adequate labour force, of appropriate skills and quality to different sectors essential for rapid socioeconomic development and elimination of the mismatch between skills required and skills available has been the major focus of activity during the last fifty years. Employment generation in Public, private and voluntary sectors as well as providing enabling environment for both wage and self employment has received due attention both in urban and rural areas. Attempts have also been made to eliminate bonded labour, employment of children and women in hazardous industries and minimising occupational health hazards.

3.1.46 In addition to the attention paid for employment generation, elimination of such undesirable practices as child labour, bonded labour, ensuring workers safety and social security, labour welfare and providing necessary support measures for sorting out problem relating to employment of both male and female workers in different sectors will receive priority attention during the Ninth Plan period. It is also envisaged that the employment exchanges will be reoriented so that they become the source of labour related information, employment opportunities and provide counseling and guidance to employment seekers.

Urban Development, Housing, Water Supply and Civic Amenities

3.1.47 Rapid urbanisation over the last fifty years has resulted in steep increase in urban population; urban India contributes 45-50% of the GDP. The projections regarding urban population made by the Technical Group on Population projections is given in Table 3.1.6. Ongoing accelerated economic growth is expected to further increase growth of urban population. In spite of all the developmental efforts the demand for urban basic services like safe drinking water supply, sanitation including management of solid and liquid waste, urban transport has by far outstripped the availability. The needs for improvement in the urban infrastructure have not been fully met and there has been a perceptible deterioration in urban environment. During the Ninth Plan period this challenging task of meeting the felt needs for urban basic services and development of urban infrastructure will be addressed through decentralisation, innovative mechanisms for funding the urban basic services programme as also devising new methodologies for dealing with sub-sectoral issues.

Empowerment of women and development of children

3.1.48 Ample data exist indicating that undernutrition and child mortality rates are higher in girls; to a large extent this has been attributed the existing gender disparity in feeding practices and health care seeking behaviour of the parents. Health education efforts are underway to eliminate these. The National Plan of Action for the Girl Child on the theme of "survival protection and development" has been evolved and is being implemented by the concerned Departments. Efforts for universalisation of ICDS and intersectoral cooperation between concerned sectors to improve both child survival and development are underway. These efforts will be continued and augmented in the Ninth Plan period.

3.1.49 Empowerment of women to be the agents of social change and development has been recognised as one of the major objectives during the Ninth Plan. With increasing literacy, awareness about opportunities, reduction in family size and time required for childbearing and child rearing, it is likely that there will be increasing number of women who will be seeking employment on full time or part time basis. Their entry into this sphere of economic activity and income generation will be of considerable significance specially to small scale sector, home-based agro, agriculture and handicrafts production. While encouraging this development, it is essential to take steps to prevent economic exploitation of women; efforts will be directed to prevent or reduce the potential adverse health impact of dual stress of household work and economically productive activities on women. The draft National Policy on empowering, when it comes into action, is expected to meet these goals.

Empowerment of Socially Disadvantaged Groups

3.1.50 One of the objectives of Planning is to ensure equitable distribution of yields of development among all segments of population. In order to ensure equity social welfare, and developmental programmes have been taken up over the last five decades among the disadvantaged segments of the population. Developmental activities had been directed towards socio-economic upliftment of disadvantaged groups such as SCs, STs, OBCs and minorities. The initial efforts during the fifties and sixties were through designing and implementation of programmes for the welfare of these groups; removal of economic and social disability prevalent amongst special groups through educational development, economic development and provision of social justice were the focus of efforts during the seventies and eighties. These efforts did improve the situation to some extent but large segments of these groups still did not get covered through the ongoing programmes. The thrust during the Ninth Plan will be to improve coverage, empower these groups and to provide an enabling environment for them to thrive and develop, so that they become agents of social change and economic development.

Social Welfare:

3.1.51 Social Welfare deals with the Welfare and Development of those vulnerable groups who fail to cope up with the rapid socioeconomic changes and started lagging behind the rest of the society. They include - persons with disabilities, social deviants who come in conflict with law, and the other disadvantaged. Since Independence efforts were made to improve the lot of these people through effective policies and programmes. However, a lot needs to be done to ensure their well-being. Therefore, the Ninth Plan proposes to adopt a three - fold strategy specific to each group namely, empowering the disabled, reforming the social deviants and caring for the other disadvantaged.

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