Editorial

Vol. VII Number 4 Oct.-Dec., 2005

Newsletter

National Institute

of Health

and Family Welfare

Inside

Events

Visitors to the Institute

Training Courses

Nuggets

Promotions/Retirements

For Restricted Circulation

User Charges in Public Health Facilities

An increase in prices of oil during the expenditure on salary in the wake of the 1970s world over witnessed an Fifth Pay Commission reduced the explosive growth in the external debt of budget allocation to public health care many developing countries. The need facilities which adversely affected the for more foreign exchange to import oil quality of health care. led to the devaluation of currencies of these countries. Increased debt Any payment made by the beneficiaries together with the sharp rise in the directly to the health care providers at the interest rates forced the countries to time of delivery of health care services is borrow for repayment of loans. The user charge. Firstly, user charges are international financial institutions justified as a revenue generated to provided conditional loans to these improve the financial sustainability for countries to overcome the crisis. Thus, delivery of health care services. the countries were forced to undertake Secondly, it influences consumer structural adjustment programmes in behaviour and controls demand for the 1980s and 1990s as per the health care services, especially hospital recommendations of these financial facilities. The key argument is that if the establishments. Directly or indirectly, health systems provide free health care, health sector reform was a part of this many people will over-use the services, programme. The economic crisis and over-burdening an already stressed the subsequent introduction of health system. Thirdly, user-fee is structural adjustment programmes necessary to improve the quality of compelled many countries to cut down health care services. Proponents of user their budget on social sectors; including charges argue that user-fee (i) would health. Ultimately, governments in help empower the community which developing countries were unable to manages the expenditures of the health deliver free health care services to all as care facilities; and (ii) would lead to a basic right of citizens and introduced political acceptance as an insurance user charges in health care along with mechanism which protects individuals social and private health insurance against out-of-pocket expenses due to schemes. illness.

In India, rising fiscal deficits of the At micro level, there are large variations Central and the State Governments in health care facilities across the have affected investments in the health countries and within the countries. In sector (the combined estimate of fiscal sub-Sahara African countries, a rise in deficits of the Central and State their revenues through user charge was Governments is estimated at 10 per by 15-45 per cent of their non-salary cent of the GDP). Public spending on expenditure whereas in China, it was health care expenditures incurred by about 36 per cent of the total government the health departments of Central and spending on health. There is a State Governments was gradually substantial evidence to say that decreased to 0.9 per cent of the GDP utilisation of health care services from 1.05 per cent during the mid- declined only after the introduction of 1980s. According to the World Bank user-fee in some countries like Burkina report (2001), the increase in the Faso, Ghana, Kenya, Lesotho,

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Mozambique, Swaziland and Zimbabwe while studies have if people do not demand preventive services, they still require also shown that utilisation of health care facilities improved them, and therefore, public finance is often used to supply in some countries like Benin, Burundi, Cameroon, Guinea, these services free of cost like diagnostic tests under national Senegal and Sierra Leone. However, experiences of user- disease control programmes viz. TB, leprosy, malaria, etc. fee in Gambia, Mali, Nigeria, Uganda, Zaire, and Zambia showed mixed results. In the Democratic Republic of The differences in the tariff of user charges have been observed Congo, the implementation of user charges reduced the in different districts. This is primarily due to the lack of follow-up utilisation of services of district hospitals but increased the by both hospital authorities and district officials. In most of the utilisation of services of PHCs. States, at least part of user-fee revenue is retained and used for

the maintenance of buildings, equipment, etc. but in some, the Currently, almost all the States in India have introduced resources are not utilized properly. According to the report of user-fee in Government health care facilities for people National Commission on Macro-economics and Health (2005), above the poverty line. The experiences show that there are inefficiency in resource use and geographical inequity in methodological differences in levying, collecting and utilizing user-fee revenues were found in Andhra Pradesh. utilizing user-fee not only in different States, but also in However, the problem of unspent revenue is found, where different districts within a State. For example, there are societies manage the health care facilities, primarily due to differences in charges for therapeutic and diagnostic complicated procedures. Therefore, the local management services; types of out-patient and in-patient services, etc. In should have the freedom to utilize the funds in a rational way, some cases, revenue is raised through even services and instead of getting permission from higher levels of the facilities, which are not directly related to the use of medical administration for spending on different items. services such as parking charges, commercial use of hospital premises for pharmacy counter, etc. There are Proper record management, exemption of poor from user options for depositing and utilizing the generated funds. The charges, periodical and timely audit of the accounts, collected revenue is deposited in the Government Treasury transparency and computerisation of information, income and or part of the funds is used for the improvement of those expenditure and representation by local community are likely to specific facilities. Few States have formed societies to improve the functioning of user charges system. Clear collect and utilize the funds locally. The local management procedures and orientation to any new user charge regime is, committee of the institutions decides on levy of fee as well therefore, essential. User-fee is an additional source of income as manner of utilization of funds for improvement of facilities but the State Governments should not reduce allocations to and services. hospitals, or else, this would have an adverse effect on the

quality improvements. A decline in financial support from 16.7 Experiences show that shifting from 'free health care per cent in 2001-02 to 10 per cent in 2003-04 deteriorated the service' to 'user charges' is of course politically sensitive. quality of health care services provided by Andhra Pradesh For instance, the Government of Kerala had to roll back the Vaidya Vidhana Parishad which looks after all district, sub-hospital fee hike which was introduced as a part of the district and community health facilities. reform process because the 'hike in hospital charges' was highly opposed by the public, various political parties and Exemptions for patients categorised as 'below poverty line' social organizations. The section of the people who were (BPL) are almost universal across the country. The operational availing of medical services almost free of cost could not problem lies in identifying BPL patients correctly which could tolerate the changes. Therefore, publicizing a draft policy protect the poor from incurring direct or indirect costs of falling and seeking the views of the public, before implementation ill. A well-designed exemption mechanism has not been can help building public acceptance and support. implemented effectively. If ration cards are available to the

majority of them and BPL cards are distinguishable by colour- The 'type of health care service' to be charged is another code or otherwise, they may be used for identification. Often issue for discussion here in the context of user-fee. The pre- there are problems in identifying the poor. An alternative dominant idea is the use of concept of externalities i.e. in strategy to protect the poor individuals is to introduce a sliding certain cases the health of an individual has a direct scale of user charges which has been introduced in Haryana influence on the health of others; for example, infectious or and Maharashtra. It is also important to provide exemption for communicable diseases, such as tuberculosis. In a private preventive/promotive services, children under 5 years, market, people may not demand enough services to both pregnant women, geographical areas, people in hazardous

occupations, senior citizens, disabled persons and emergency prevent and treat such health problems adequately and care.hence both are typically financed by the governments. Even

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efficiency of the health care services. To ensure public support Applying uniform user charges for the entire State may not for user-charges, patients must feel rapid and tangible be appropriate. Based on the requirement of hospitals, the improvements in the quality of health care services delivered. criteria and management mechanism may be defined to Besides, retaining a maximum amount of user-fee revenue at spend the money wisely. However, in order to prioritise the the collecting health center itself, efforts should also be made to views of the potential clientele, the management should evolve a clear-cut policy for the management of user-fee, include non-officials such as representatives of NGOs, training of key staff and exemption of the poor is needed to health activists, elected representatives, etc.make the 'user charge' a success.

It is observed that user charges are unlikely to cover more (The Editor-in-Chief acknowledges the help rendered by Dr. than 20 per cent of a hospital's running costs. The K.S. Nair, Assistant Research Officer, Department of Planning evaluation of the Rajasthan MRS indicates that cost and Evaluation, in preparing the Editorial)recovery ranges from 4 per cent to 25 per cent of the

hospital budget. Evaluation of user charges in Andhra Pradesh shows a negative impact on access to health care services by the poor while the Rajasthan evaluation specifically denies any negative impact on access by the poor. Recent evaluations in Andhra Pradesh and Maharashtra (NCMH, 2005) reveal that the number of poor The Institute observed World AIDS Day on 1 December 2005. people accessing to public health facilities decreased, particularly for in-patient services because the imposition of An AIDS awareness week was organized by the Institute at user charges forced them to seek health care at a later Rangpuri, the Field Practice Demonstration Area (FPDA) of the

Institute, from 23 November to 2 December 2005. During this stage or they resort to self-treatment. This study showed st

week, the 1 year MD (CHA) and DHA students of the Institute that overall utilization has increased by 26 per cent in in-interacted with the community members, both male and patient care and 19 per cent in out-patient care but the female, and school students to assess their knowledge increase in utilization by the poor has decreased to 14 per regarding HIV/AIDS. Based on the responses received from

cent in in-patient care and 7 per cent in out-patient care. them, the students launched a sensitisation programme for the benefit of the community members and school students at

Giving autonomy to the hospitals, like in Madhya Pradesh, Rangpuri through their street play, question and answer has also opened up the possibility of accessing to alternate session, health talk, quiz, etc. Appropriate IEC materials on the

subject were also used by the students to supplement their sources of financing which include sponsorships, sensitization programme. As part of the event, a function was donations, renting of hospital space and infrastructure for organized under the overall guidance and supervision of Dr. commercial use, etc. They can become supplementary (Smt.) M. Bhattacharya, Professor and Head, Department of sources of funding for government services but they will not CHA, on 1 December 2005 at Rangpuri Chowpal at 10.00 a.m. offer a complete solution to the problems of inadequate and she gave away prizes to the successful participants in the

funding. Of course, several States have already recognised quiz competition.these possibilities and have included them in their guidelines. Adopting user charges other than nominal out-patient registration charges would, according to the current interpretation of the law, make a charging hospital subject to the provisions of the Consumer Protection Act (CPA). The liability under the CPA continues even if every patient is not charged. So, user charges can help the users to claim their rights as consumers and the CPA would make the health care providers accountable.

The impact of user charges depends to a large degree on how well they are implemented, otherwise, they may make things worse. This refers to both the implementation and communication of an exemption policy and transparency in the collection of fund and its use. If it is implemented properly, user charge can raise revenues to (i) improve access, (ii) reduce inequity, and (iii) increase the overall

AIDS Awareness Week

Events

Smt. Anjali Gopalan, NAAZ Foundation, delivering a lecture on Reducing Stigma and Enhancing Care and Support for HIV/AIDS Patients on the occasion of World AIDS Day in the Institute.

December 2005

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On the last day of the programme, a lecture on 'Reducing Stigma and Enhancing Care and Support for HIV/AIDS Patients' was delivered by Smt. Anjali Gopalan, NAAZ Foundation, New Delhi, in the Institute, which was followed by a skit/play by the Ist year M.D. (CHA) and DHA students.

To denounce communalism and serve the victims of communal riots, the Institute organised ‘Communal Harmony Campaign’ from 19 to 25 November, 2005.

! Shri Vikas Mathur, Accounts Officer, Institute of Government Accounts and Finance, Ministry of Finance, delivered a lecture on ‘GPF Rules’ to the faculty and staff members of the Institute on 28 October 2005.

! Shri P. Majumdar, Senior Accounts Officer, Institute of Government Accounts and Finance, Ministry of Orientation of Managers of Old Age Homes for Strengthening Finance, delivered a lecture on ‘Conduct Rules’ to the Health Services to the Elderlyfaculty and staff members of the Institute on 9 December 2005. Coordinator: Prof. A.M. Khan

Co-coordinator: Smt. Vandana BhattacharyaAssociate: Shri Ramesh Gandotra Dates: 3- 8 October 2005

Health Management Consortium MeetingThe Institute had the privilege of receiving the following visitors during the quarter:

Chief Coordinator: Prof. N.K. SethiCoordinator: Dr. (Smt.) Rajni BaggaProf. Sue Hill, Department of Health, The United Kingdom;Associates: Shri Ramesh Gandotra and Prof. Nawn Maslin, Department of Health, The United

Shri Ghanshyam Karol Kingdom;Dates: 17 -18 October 2005Prof. John Catford, Dean, Daekin University, Australia;

Dr. Hande Harmanchi, WHO Headquarter, Geneva; Professional Training on Capacity Building for Senior Health Dr. Alan Myles, WHO Headquarter, Geneva;Officials of Maharashtra in Communication Skills under National Shri K. Dhanavel, IAS, PS to the Union Minister for Health Rural Health Mission and Family Welfare, Ministry of Health and Family Welfare,

Government of India;Shri D.S. Moorthy, OSD to the Union Minister for Health and Coordinator: Prof. T. MathiyazhaganFamily Welfare, Ministry of Health and Family Welfare, Co-coordinator: Shri M.P. MeshramGovernment of India; and Associates: Shri Ramesh Chand and Shri V.R. Muthukumar, Ist PA to the Union Minister for Health Shri Lakhan Lal Meena and Family Welfare, Ministry of Health and Family Welfare, Dates: 17 -22 October 2005Government of India.

Training Course on Dynamics of Health System and Role of Besides, students from the following colleges visited:NGOs

Desh Bandhu Gupta College, University of Delhi;Coordinator: Dr. T. BirHans Raj College, University of Delhi;Co-coordinator: Prof. A.M. KhanSher-E-Kashmir Institute of Medical Sciences, Srinagar, Associates: Dr. (Smt.) A.M. Elizabeth and J&K; and

Km. Rita RaniCollege of Nursing, Bharati Vidyapeeth Deemed University, Dates: 17- 28 October 2005Pune.

Communal Harmony Week

Lectures

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Training Courses and Workshops

Visitors to the Institute

Prof. N.K. Sethi, Director, NIHFW, (sitting fourth from left) with the members of the coordinating team and participants of the National Workshop on Strategies for Strengthening Emotional and Mental Health Professional Institutions/Institutions of Higher Learning.

Workshop on Strategies for Strengthening Emotional and Mental Health Professional Institutions/Institutions of Higher Learning

Chief Coordinator: Prof. N.K. SethiCoordinator: Dr. (Smt.) Rajni Bagga Associates: Shri Ghanshyam Karol and

Shri Ramesh Gandotra Dates: 10- 11 November 2005

National Level Orientation Workshop on Training for Skilled Attendants at Birth

Coordinator: Prof. (Km.) K. KalaivaniCo-coordinator: Dr. (Smt.) Bindoo SharmaAssociates: Shri S.C. Garg Dates: 27- 28 December 2005

Professional Development Course in Management, Public Health and Health Sector Reforms for District Medical Officers

Training Course for Trainers of District Programme and PMU Officials

Course Director: Prof. N.K. SethiNodal Officer: Prof. (Smt.) M. Bhattacharya

Coordinator: Dr. (Smt.) S. MenonCoordinators: Dr. (Smt.) Rajni Bagga and

Co-coordinator: Dr. (Smt.) Renu ParuthiDr. V.K. Tiwari,

Associates: Dr. (Smt.) Vandana Bhatnagar Co-coordinators: Dr. Sanjay Gupta, Dr. T. Bir and

and Shri R.B. MathurSmt. Reeta Dhingra

Dates: 7- 11 November 2005Dates: 28 November 2005-3 February

2006Training Course on IT Application in Libraries and Information Management

Training-cum-Workshop on Counselling Skills for Health ProfessionalsCoordinator: Shri Salek Chand

Co-coordinator: Km. Sangita GuptaCoordinator: Dr. (Smt.) Rajni BaggaAssociates: Shri G.G. Halkar and Smt. Hans Co-coordinator: Dr. (Smt.) Uma VasudevaKumari Associates: Shri Ramesh Gandotra and Dates: 7- 11 November 2005

Shri Ghanshyam Karol Dates: 21- 25 November 2005

A Two-day Workshop on Contraceptive Update

Coordinator: Dr. (Smt.) S. MenonCo-coordinator: Dr. (Smt.) Savita MehtaDates: 29 November- 1 December 2005

NLEP Management Training Course for CMOs

Coordinator: Dr. Gyan SinghCo-coordinators: Dr. (Smt.) Uma Vasudeva and

Dr. U. DattaAssociates: Shri S.P. Singh and Shri Y.K. SinghalDates: 7- 9 December 2005

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Participants of Professional Training on Capacity Building for Senior Health Officials of Maharashtra in Communication Skills under National Rural Health Mission perform a skit during their field visit.

Prof. N.K. Sethi, Director, NIHFW, (sitting fourth from left) with the members of the coordinating team and participants of the Training Course for the Trainers of District Programme and PMU o fficials.

December 2005

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Director's Activities

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Training Course on Training Technology (9-20 January 2006)Training Course for Master Trainers on Human Resource Management for Senior Health Administrators (16-20 January 2006)Training Course on Hospital Administration for Senior Health Administrators (6- 24 February 2006)

Besides his regular activities in the Institute, Prof. N.K. Sethi, Director, participated as an expert in several scientific Centre, New Delhi, on 11 December 2005;meetings, seminars, workshops, symposia, etc. organised by Meeting on Optimisation of Direct Recruitment in Civilian various national and international organizations during Posts, held at the MOHFW, Nirman Bhawan, New Delhi, October-December 2005. Some of his significant activities on 15 December 2005; andinclude: Meeting regarding Professional Development Course

Launch of campaign on Anaemia Eradication, organized with Dr. P.L. Sanjeeva Reddy, Director, Indian Institute of by SUKARYA, in five villages of Gurgaon, Haryana, on 2 Public Administration, New Delhi, on 29 December 2005.October 2005;Meeting on Research Project Proposals and In addition, Prof. Sethi inaugurated and delivered the key-Compendium of Research Projects of Department of note address in the National Conference on Future of Health Family Welfare since 1977, held at the Ministry of Health System in India, at Indian Institute of Health Management and and Family Welfare, Nirman Bhawan, on 6 October Research, Jaipur, Rajasthan, on 17 December 2005.2005;Meeting on Immunization Strengthening under National Rural Health Mission (NRHM), organized by WHO/SEARO, on 7 October 2005; Prof. (Smt.) M. Bhattacharya, Head, Department of Presentation on PNDT Issues at MOHFW, Nirman Community Health Administration, served as an expert Bhawan, on 24 October 2005; member in the following meetings:Meeting on Immunisation at the WHO office, New Delhi, § Meeting on Review of Strategies of Kala-azar under on 28 October 2005; the Integrated Vector-Borne Diseases Control National Cancer Awareness Day at the India Habitat Programme at the Office of National Anti-malaria Centre, New Delhi, on 7 November 2005; Programme (NAMP), New Delhi, on 21 October National Core-Group meeting on Professional 2005; Development Course at the Office of the European § Meeting of Task Force on Surveillance Round 2005, Commission, on 8 November 2005; at National AIDS Control Organization (NACO), New Mentoring Group meeting for Capacity Building of ASHA Delhi, on 29 October 2005; andunder NRHM at the MOHFW, Nirman Bhawan, on 29 § Post-Round Review meeting on HIV Sentinel November 2005; Surveillance 2005 for the North-Eastern States in Meeting on Technical Assistance Arrangements for Dimapur, Nagaland, on 5 December 2005; for the NRHM and RCH-II at Manesar, Haryana, on 1 and 2 Western region in Panjim, Goa, on 12 December December 2005; 2005; and for the Northern States, in Ranchi, Governing Body Meeting of the Council for Social Jharkhand, on 19 December 2005.Development (CSD), New Delhi, on 9 December 2005;Annual Conference of Indian Confederation of Healthcare Accredation (ICHA), at India International

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Prof. (Smt.) M. Bhattacharya giving away a prize to a woman on the occasion of World AIDS Day at Rangpuri, FPDA. Also seen in the

stpicture are the 1 year MD (CHA) and DHA students of the Institute.

Forthcoming Training Courses

Nuggets

December 2005

Besides, Prof. Bhattacharya delivered a lecture on GIS in Dr. (Smt.) Pikee Saxena, Lecturer, attended the th National Convention on Adolescent Friendly Health Health at the IX Annual Conference of Indian Association of

Services/Clinics: Addressing the Reproductive and Preventive and Social Medicine, at Jammu Medical Sexual Health Needs of Young People at India Habitat College, J&K, during 2-3 October 2005. She presented a Centre, New Delhi, on 11 December 2005.model for Estimating Excess Deaths due to AIDS in the

workshop on Model-Based Estimation and Projection of Dr. Sanjay Gupta, Senior Lecturer, delivered a lecture HIV/AIDS, at IRMS (ICMR), New Delhi, on 25 October 2005. on National Health Policy-2002 at AHA House, NOIDA, She also visited Karnataka to monitor the quality of data Uttar Pradesh, on 27 October 2005.collected in relation to the Annual Sentinel Surveillance for

HIV infection 2005, on 22 November 2005.Dr. (Smt.) Pushpanjali Swain, Senior Lecturer, attended the 9th International Seminar of the Australian Institute Prof. A.M. Khan, Head, Department of Social Sciences, of Demography, Saint Dents, Reunion Island, on 7 was awarded the Vayo Shreshtha Samman by Helpage October 2005.India in collaboration with the Ministry of Social Justice

and Empowerment on 1 October 2005.

Besides, Prof. Khan took a session on Population Growth, Demographic Trends and Related Issues at the Haryana Institute of Public Administration, Gurgaon, Haryana, on 25 October 2005. He also delivered a lecture on Decentralisation in Health Care Delivery at the State Institute of Health and Family Welfare, Chandigarh, Punjab, on 10 November 2005.

Dr. (Smt.) Gita Bamezai, Reader, delivered a lecture on Pre-test and Post-test Counselling for HIV/AIDS in the Directorate General of Armed Force Services, Ministry of Defence, Hissar Cantonment, Haryana, on 2 December 2005.

Dr. M.M. Misro, Reader, presented a paper on Assessment of Sperm Parameters in Male Infertility in the Conference of Indian Medical Association at Ludhiana, Punjab, during 21-23 October 2005.

Dr. T.G. Shrivastav, Reader, attended the National Symposium on Comparative Endocrinology and Reproductive Physiology, organized by the Department of Zoology, University of Delhi, during 17-19 November 2005.

Dr. T. Bir, Reader, attended the National Conclave on Towards Millennium Development Goals on Health, organized by the Confederation of Indian Industries at Hotel Crown Plaza, New Delhi, on 29 November 2005.

Dr. (Smt.) A.U. Singh, CMO, attended the National Convention on Adolescent Friendly Health Services/Clinics: Addressing the Reproductive and Sexual Health Needs of Young People at India Habitat Centre, New Delhi, on 11 December 2005.

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Academic Advancements

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Km. Kiran Rangari, Assistant Research Officer; Shri Sankar Prasad Chaki, Research Assistant; and Shri Anupam Basu; Research Assistant; of the Department of the Reproductive and Bio-medicine, have been awarded Doctorate Degree by the Nagpur University, Maharashtra; Vidyasagar University, West Bengal, and Burdwan University, West Bengal; respectively.

Shri A.A. Alim Khan, Photographer, has been awarded Master's Degree in Journalism by Sagar University, Madhya Pradesh.

Retirements

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The Institute gratefully acknowledges the services rendered by the following staff members:

Shri Rameshwar, Section Officer;

Shri A.K. Verma, Asst. Research Officer;

Shri Dhani Ram, Assistant;

Shri H.C. Pandey, Sr. Technical Assistant (Lab.);

Smt. Champa Verma, DEO, Gr.-B; and

Shri Attar Singh, Clinic Attendant.

Editorial Board

Editor-in-Chief

Editor

Assistant Editor

Members

Layout and Execution

Prof. N.K. Sethi

Prof. T. Mathiyazhagan

Mr. Bishnu Charan Patro

Prof. (Mrs.) M. BhattacharyaDr. (Mrs.) S. Menon

Dr. (Mrs.) Gita BamezaiMr. Salek Chand

Mr. Ravi TiwariMr. Ambika Prasad

Printed and Published by the National Institute of Health and Family WelfareMunirka, New Delhi-110 067

December 2005/550E.mail: editor@nihfw.org Web Site: www.nihfw.org

Journal

Health and Population :Perspectives and Issues

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Invitation to Authors

Subscription

The Institute publishes its quarterly Journal, Health and Population: Perspectives and Issues regularly. It is circulated both at national as well as at international levels. It includes articles of scientific and educational interest in the areas of health services, family welfare, population, hospital administration, materials management, IEC, social sciences and other allied disciplines.

The Journal is indexed in the following:

Index Medicus for WHO South-East Asia Region, WHO, New Delhi.Cambridge Scientific Abstracts, Bethesda, MD, USA.IndMED: A Bibliographic Database of Indian Bio-Medical Research, New Delhi.Indian National Scientific Documentation Centre, New Delhi.EMBASE, The Excerpta Medica Database, Netherlands.All India Index to Periodical Literature in English Database, Hyderabad.CAB Abstracts, CAB International Publishing, Wallingford, The United Kingdom.Global Health Database, CAB International Publishing, Wallingford, The United Kingdom.

We take this opportunity to invite original papers from academicians, researchers, subject matter specialists, programme officers, health administrators and policy makers on Health and Family Welfare.

Typed written paper may be sent in to the Editor, “Health and Population: Perspectives and Issues”, National Institute of Health and Family Welfare, Munirka, New Delhi-110 067, India, in triplicate together with its floppy.

In IndiaLife Membership: Rs.500/- (for individual only)Annual: Rs.100/-Single Copy: Rs. 25/-

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Revision of National Health Programme Series

NIHFW has a large number of publications in different areas of health and family welfare. The following publications on National Health Programme Series have recently been revised and are available for sale:

National Non-communicable Diseases Rs. 15.00

Control Programme

National Iodine Deficiency Disorders Control Rs. 25.00

Programme

National Leprosy Eradication Programme Rs. 15.00

National Tuberculosis Control Programme Rs. 20.00

National Programme for Control of Blindness Rs. 25.00

Reproductive and Child Health Programme: Rs. 40.00

Flagship Programme of NRHM

Yaws Eradication Programme Rs. 25.00

National AIDS Control Programme Rs. 40.00

(Postal Charges will be extra)

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