Effects of School and Class Size on the Quality of Students Education

IntroductionEducation is fundamental in todays modern society and is the subject of end slight debates across the United States. Recently, it has move up to the top of both state and national agendas (Finn, 2002).One reform movement currently being debated is the effects of school and consort size on the caliber of student education. Advocates of small classes argue students learn more when there are fewer students in the classroom. Many studies are conducted to try to prove this theory. Although some studies show up positive results, the many failed experiments led opposers of class size reduction to believe that there is no link among class size and student learning. (Bell, Crandall, & Parnell, 2009). Many studies watch been inconclusive, however, and widespread initiatives to reduce class sizes are being undertaken by schools across the nation. Because class size reduction projects are so expensive, some schools have been laboured to look at other alternatives to meet the s ame goals (Kennedy, 2003). Examples of these alternatives are adding more teachers to a single classroom or extending the school day or year. Analyzing the negatives, positives, and alternatives of class size reduction has been a topic of constant debate by researchers, educators, and leaders across the United States.Benefits of Small Class SizesMany researchers have detect that smaller is better. Teachers from around the United States find that they can teach with more variety and depth in a small class rather than a large one. Teachers also feel they have more time to cover material and have better organization in class. Teachers with small classes spend less time on grading and paperwork which gives them more time to spend on instruction. A studen... ... classes, and are more enthusiastic about teaching. Overall, educators believe that these methods to create smaller classes will allow teachers to help their students (Dixon-Krauss & Januszka, 2008). Other studies have been cri ticized, such as the Glass & Smith study because the final report was seriously flawed and was not reliable information (Mitchell & Beach, 1990).The cost of reducing class size is enormous, which leads some schools to look for other alternatives. This included hiring more teachers, asking for volunteers, and extending the school day or year. Clearly, students overall benefit in a small classroom environment and small classes encourage a sense of family and community between students and their teachers. Although, this debate is nowhere near over, research clearly shows that smaller classes are the most advantageous for students to learn in.

Argument in Favor of Gun Control Essay -- Argumentative Persuasive Exa

Almost twelve kids lose their lives every single day because of guns (Capps). just about recently, two young boys were shot as they were leaving a high school football game. Soon, anformer(a) year anniversary of the Columbine High naturalize shooting will arrive. In this incident, two students opened fire on their classmates in Columbine. I cannot imagine the horrors of my fellow students being killed by guns Many other related acts of gun violence have brought up issues on gun take in. Debates have risen between citizens on how the government should establish stronger gun control laws. Despite the National Rifle Association strong objections against these issues, gun control laws must be increased. Many citizens agree that gun control laws must be established, because of the recent acts of violence committed with guns. The gun control issues take a heated debate, because now kids are targets of gun violence. In the Columbine shooting, both students purchased their weapo ns at a gun show with the help of an eighteen-year-old friend (Sanko). If the gun show provider was forced by law to do a background chase away the two students wouldnt have received the guns. As of right now background checks are only done on weapons that are purchased from federally pass dealers. This is one reason for new gun control laws. The death of Kayla Rolland, on February 20, 2012, is a another reason for new gun control laws. Kayla was gunned down in her elementary school by a six year old classmate (Smolowe). The child obtained the gun with the help of his father. His father had left the gun on the living room table. As of right now guns are not required to have child safety locks. Moreover, kids can get guns without the help of a friend o... ...their own classmates. Lastly, the control of gun manufacturing will decrease the availability of guns on the streets New gun control laws are important to the children of today and tomorrow. The king lies behind the government and unfortunately the National Rifle Association.Works CitedCapps, Louis. Capps Continues Fight for Common Sense Gun Control. FDCH Press Releases. 3 Mar. 2014. Harrington-Lueker, Donna. Blown Away by School Violence. Education Digest. 58.3 (2013) 50, 4. Lazar, Daniel. Your Constitution is Killing You. Harpers Magazine. 299.1793 (2011) 57,9. Reynolds, Rhonda. Kids Who Kill. Black Enterprise. (2013) 47,1. Sanko, John. Gun-control Measures Wording for Vote Framed. Denver Rocky Mountains News corking Bureau. 4 April. 2012. Smolowe, Jill., et al. Fallen Angel. People. (2014) 66,2.

Snow Writing :: Writing Nature Writers Essays

Snow Writing When this project first came to my attention, I thought long and hard about what I would occasion to write and write on. I was sure I could come up with something creative and different. After a half hour of deep, deep thought, I came to the purpose that I was going to take the easy way out and just write in snow with my finger. I was ashamed, but it needed to be done. Its hard to imagine walking up to a large open field in the bitter cold to write or read the up-to-the-minute Hunter S. Thompson book, an issue of The Onion, or this very paper. In fact, it would be downright stupid. Yet, this was the technology that I choose to use. After writing the lengthy demonstration morsel (I wrote Demo), it became abundantly clear that the process which writing technology has undergone has been nothing short of spectacular. The first partition of the process is to understand that not only do you need to make a writing tool, but somethin g to use the tool on. There are two things that someone needs to take into account when doing this 1) permanency and 2) portability. Each rival each other in importance and both are vital to the process. We must first look at the pros and cons of each part of the equation the snow and the finger. Starting with what was written on - the snow - you must look at what it does offer to you. First of all, snow is abundant in authorized areas. From about Ohio and up the United States is covered in the stuff for a good few months a year. However, the drawback is that the snow is far from permanent. With the onset of warmer weather, the nobleman works of the season would be lost forever. Snow has a natural fluidity to it which makes it easier to write in. It is also this fluidity of the snow that also causes the major puzzle in snow writing the bunching of snow.

Chromatography Essay examples -- essays research papers

Chromatography is a separation technique in which the mixture to be separated is turn in a solvent and the resulting solution, often called the mobile phase, is then passed through or over another material, the stationary phase. The separation of the pilot mixture depends on how strongly each component is attracted to the stationary phase. Substances that are attracted strongly to the stationary phase will be retarded and not fail alone with the mobile phase. Weakly attracted substances will move more rapidly with the mobile phase.Liquid chromatography is an analytical technique that is useful for separating ions or molecules that are dissolved in a liquid phase. If the sample solution is in contact with a second solid or liquid phase, the different solutes will act with the other phase to differing degrees due to differences in adsorption, ionic strength, polarity or size. These differences allow the mixture components to be separated from each other by employ these difference s to determine the transit time of the solutes through a column.Simple liquid chromatography consists of a column with a fritted bottom that holds a stationary phase in equilibrium with a solvent. Typical stationary phases (and their interactions with solutes) are solids (adsorption), ionic groups on a resin (ion-exchange), liquids on an unbiased solid support (partitioning), and porous inert particles (size exclusion). The mixtur...

Clothing, Shelter and Transportation in Panama :: Panama Culture Region Essays Papers

Clothing, Shelter and Transportation in PanamaPanama, a small country located in Central America, is very diversified in both its people and its climate. Con viewred to be the isthmus connecting South America to North America, Panama has played a key role in global battery-acid since the creation of the Panama Canal. The canal goes through the midsection of the country connecting the Atlantic and Pacific oceans, allowing for much faster sea travel. Because of its location, Panama has been heavily influenced by several(prenominal) countries including Colombia which they were ruled by until 1903 and the United States which played such a large role in the realization of the canal. These foreign influences can easily be anchor in Panamas cuisine, music, and artwork as well as all the tribes that have settled within the country.The climate of Panama is substantially different on the Atlantic and Pacific sides of the country, namely in terms of annual rain fall. So much so that on the Ca ribbean slopes of the Tabasar Mountains average rainfall is approximately twice as concentrated as on the leeward Pacific slopes (www.britannica.com). Furthermore, the Pacific has heavy rainfall almost all year round whereas the Atlantic side has distinct seasons, making it easier for agriculture to flourish. Found in the western provinces of Chiriqu, Bocas del Toro, Veraguas and the San Blas Islands, the Kuna tribe is the second largest Indian group in Panama with approximately 35,000 people. While the Kuna speak their own expression called ?Tule?, many speak Spanish and English because of the Colombian and US influences. Largely living in the rain forests, the Kuna live in ?traditionally thatched roof huts make from materials readily found in the jungle? (http//public.cwp.net). By using a combination of straw, palm leaves and reeds they use the resources found in their region to make trade protection that is suitable for living in such a hot, humid climate. Their clothing, howe ver, differs from other tribes in the country because of their location. Instead of preferring loin cloths like other tribes on the Pacific, rainier side of Panama do, the Kuna women wear ?wrap around skirts and beautifully hand-made blouses known as ?Molas?. The Mola is an intricately sewn picture made from layers of cloth in a reverse appliqu technique? while the men wear ?traditional Kuna shirts and less traditional pants, jeans, or shorts? (http//public.cwp.net). It?s easier for them to wear more clothing because they take on?t have to continuously deal with rain.

Clothing, Shelter and Transportation in Panama :: Panama Culture Region Essays Papers

Clothing, Shelter and Transportation in PanamaPanama, a small country located in Central America, is very diversified in both its people and its climate. Con nervered to be the isthmus connecting South America to North America, Panama has played a key role in global shipping since the creation of the Panama Canal. The canal goes through the midsection of the country connecting the Atlantic and Pacific oceans, allowing for much faster sea travel. Because of its location, Panama has been heavily influenced by several(prenominal) countries including Colombia which they were ruled by until 1903 and the United States which played such a large role in the realization of the canal. These foreign influences can easily be represent in Panamas cuisine, music, and artwork as well as all the tribes that have settled within the country.The climate of Panama is substantially different on the Atlantic and Pacific sides of the country, namely in terms of annual rain fall. So much so that on the Car ibbean slopes of the Tabasar Mountains average rainfall is approximately twice as straining as on the leeward Pacific slopes (www.britannica.com). Furthermore, the Pacific has heavy rainfall almost all year round whereas the Atlantic side has distinct seasons, making it easier for agriculture to flourish. Found in the western provinces of Chiriqu, Bocas del Toro, Veraguas and the San Blas Islands, the Kuna tribe is the second largest Indian group in Panama with approximately 35,000 people. While the Kuna speak their own talking to called ?Tule?, many speak Spanish and English because of the Colombian and US influences. Largely living in the rain forests, the Kuna live in ?traditionally thatched roof huts do from materials readily found in the jungle? (http//public.cwp.net). By using a combination of straw, palm leaves and reeds they use the resources found in their region to make protect that is suitable for living in such a hot, humid climate. Their clothing, however, differs f rom other tribes in the country because of their location. Instead of preferring loin cloths like other tribes on the Pacific, rainier side of Panama do, the Kuna women wear ?wrap around skirts and beautifully hand-made blouses known as ?Molas?. The Mola is an intricately sewn picture made from layers of cloth in a reverse appliqu technique? while the men wear ?traditional Kuna shirts and less traditional pants, jeans, or shorts? (http//public.cwp.net). It?s easier for them to wear more clothing because they sire?t have to continuously deal with rain.

Adult Day Care Centers

vainglorious Day C ar Centers Naomi Noel University of the Rockies Abstract openhanded sidereal twenty-four hour periodlight thrills nonplus not received the acclaim due. They atomic number 18 an invaluable part of the communities that they serve. They incorpo outrank succinct mission rehearsals to effectively obtain their point across era overly employing a wide range of superiors to better serve their backup. The utilize take based sound judgment tools for enrollment as well as example ups judgement surveys to gather information from the surrounding participation. The chain of command is laid out so that ethical guidelines tooshie easily be established and fitly enforced.They to a fault referrals to agencies better equipped to handle particular situations in holy order to better serve their clientele. Within the next five to ten years, the ask for their serve will increase. However, unless federal guidelines change and to a greater extent keep is establish ed the current trend of only operating for a few years will continue. Adult Day forethought Centers The majority of in-home occupy providers for physically or cognitively disabled boastfuls are family members, generally an adult child or a spouse. Without the sympathize with of these family members, m both adults would require nursing home care.Family caregivers are extremely valuable, but often need additional help in caring for a love iodine. Caregiving can take an enormous toll, both financially and physically. Adult solar day care can provide needed respite from caregiving and may reduce the need for a nursing home. An adult day care warmheartedness, also commonly known as adult day go or adult day wellness care, is a non-residential facility providing activities for gray and/or handicapped individuals. While stubs of this kind are available, they often have waitlists due to the high demand.Most nerves operate 10 12 hours per day and provide meals, hearty/ recreatio nal outings, and general watchfulness. Adult daycare centers operate under a social model and/or a health care model. Daycare centers may focus on providing care only for persons with Alzheimers and associate dementias or their operate may be available for any disabled adult. The original concept was to provide a sitting service as it were to provide activities and stimulation for care-recipients in an environment outside of the home.The care-recipient would receive supervision and possibly just about limited care while the caregiver would have a break from the routine of daily caregiving thus allowing them to take care of new(prenominal) responsibilities or simply have time to themselves. This also allowed peace and quiet to relieve the stress of caregiving. The care center might support transportation at a nominal additional cost to transport the loved one to and from the center. This initial model is still around but it has undergone some tweaking in order to prove profitab le.There are now three basic models for adult day care that were developed mostly so the regularisement would be inclined to work financially. The traditional model with social services, activities, crafts and some individualized attention the medical model with all of the aforementioned services plus skilled services such as nurses, therapist, psychiatrists and geriatric physicians and the Alzheimers model with services limitedally designed to support and care for Alzheimers patients. Participation in adult day care often prevents re-hospitalizations and may delay admission to residential long term care.For participants who would other(a)wise want to stay at home alone, the social stimulation and recreational activities may improve or maintain physical and cognitive function. Adult Day Care Centers are designed to provide care and companionship for seniors who need assistance or supervision during the day. The goals of the programs are to delay or prevent institutionalization by providing alternative care, to enhance self-esteem and to encourage socialization. (Eldercare. gov, 2012) A mission statement defines an organizations funda rational purpose.It answers the basic questions of why the organization exists while describing the needs that it is attempting to meet. It also provides the basis for judging the success of the organization and is capable of attracting donors and volunteers while simultaneously boost community involvement. Your mission statement embraces the reasons your practice exists (besides just making a living for you and your staff), the core values your organization shares and expresses through its work, how you serve your key stakeholders, and your overarching (sometimes idealistic) goals. urology Times, 2011) The mission statement of the adult day care center created for this paper would read as follows To provide a secure and nurturing environment for clients who need social environment, consistent supervision and loving assista nce. This mission statement sums up the goals for the center in a concise manner while offering reassurance to the clients primary caregivers. The list of professionals necessary for organizational success acknowledges licensed nurses, certified nursing assistants, a certified nutritionist, a physical therapist and an occupational therapist.These employees are the ones who would be required to have a degree, licensure or certification in their respective areas. This does not include staff such as receptionists and bookkeeping. The licensed nurses would be responsible for the overall day-to-day operation of the center and particularly ensuring that the center is operating according to state licensing regulations and health department policies and procedures. They would supervise the nursing assistants and practice of medicine staff while also reviewing client history prior to admission to the facility and conducting admission assessment conferences.The certified nursing assistants (CNAs) would be responsible for assisting with overall client care including but not limited to assessment, care planning, mobility, safety, comfort, and unit efficiency. The medication staffs only role would be to ensure the right(a) storing and dispensing of client prescriptions. Next would be a nutritionist. Nutritionists play a preventative role while offering education about what kind of foods are consumed. They offer menu suggestions and assist with understanding the connection between food and emotions.They would be a vital member of the centers aggroup since the typical center serves breakfast and lunch and an afternoon snack. The final professionals necessary for a creditable adult day care center are an occupational therapist and a physical therapist. Occupational therapists are proficient in modifying the physical environment as well as training the individual in the proper use of assistive equipment to increase independence. They also emphasize helping their patients engage in meaningful activities of daily living (ADLs).Physical therapists are trained to identify and maximize tincture of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment, intervention, and rehabilitation. Their primary focus is on the physical, psychological, emotional, and social well-being of the client. While each of these specialists concentrates on differing characteristics of care, they do experience some vocational overlap which allows them to work well in tandem. The physical and occupational therapists would be contracted out of reimbursement purposes.It is all-important(a) that the timing of each unit of therapy is not inclusive of any other treatments. The clients would be timed from when the actual therapies or services begin. This would not include time for restroom breaks, waiting for someone to get ready or clothing changes. Adhering to these policies allows clients to receive quality therapeutic services while keeping the overall costs down. Needs based assessment tools are a vital part of the overall blueprint for adult day care center enrollment.These assessments allow the facility to obtain selective information from potential clientele in order to evaluate whether or not the center can address the clients diverse needs. Some of the more common tools include psychological, physical, leisure interest, nutritional and risk assessments. Some facilities may elect to include financial and estate planning depending on availability and demand. Most states require a licensed nurse to conduct the psychological assessment portion of a patients intake process. One of the most common assessment instruments in use is the Folstein Mini-Mental bring up Examination (MMSE).The MMSE is a brief assessment of the cognitive state of the adult client. The instrument screens for impairment in cognition, estimates the severity of impairment at a specific point in time (usually during intake) and can be used to reas sess and follow changes in the individuals mental state over time or to enumeration changes that happen as a result of therapy or applied therapeutic support services. The nurse typically obtains copies of any formal psychological evaluations and assessments that have been terminate within the past ten years. State minimum standards outline what sorts of physical evaluation are needed.Standard tests include height, weight, blood pressure, respiration and temperature. A nurse also obtains and reviews the patients medical history from his doctor and follows up with questions about specific conditions that may affect the patients care plan. At this time, the patients family and the nurse develop or make a copy of the patients advance directive, which lays out the patients wishes in case extraordinary medical intervention is needed to keep him alive. This documentation is crucial especially when working with the elderly. The center activity director (AD) conducts a leisure/recreationa l interest inventory of the patient.The inventory is a check-off list of recreational activities that the person either enjoys or does not enjoy to varying degrees. By identifying recreational interests of each new patient, the AD can structure an activities program so that activities not only meet physical, mental and social needs in a therapeutic way but also engage the patient. The centers consulting nutritionist may perform their own client assessment while also looking at the care plan drawn up by the center treatment team to incorporate the patients special dietary needs into the centers meal and snack menus.Clients with special dietary needs may require a detailed meal plan be designed. The nutritionist is also in charge of monitoring the client to ensure that the diet is satisfactory. As part of the intake process, the entire treatment team considers physical, social and mental limitations set about by the patient in addition to special needs, flight risk, fall risk, seizur e potential or other possible risks in providing care to the patient. The team as a whole weighs risks, develops strategies and addresses risk factors to be incorporated into the patients treatment plan.The family will eventually meet with the bookkeeping staff, to assess family financial resources, insurance (including Medicare and Medicaid) and other social service resources while developing a care contract and payment plan. At this time, the staff typically provides a copy of the centers family handbook to the patients caregivers with center policies and procedures as well as general information about operations, hours, types of services offered and terms of service.The chain of command is defined as The order in which warrant and power in an organization is wielded and delegated from top management to every employee at every level of the organization (Business Dictionary. com, 2012). The clearer cut the chain of command, the more effective the ratiocination making process and greater the efficiency. Military forces are an example of straight chain of command, extending in an unbroken line from the top brass to ranks. However, this illustration is not conducive to the requirements of an adult day care center.Chain of command is considered very important in organizations because it enhances the effectiveness of the management. The chain of command clearly shows the line of authority and indebtedness in the organization, therefore, it really plays an important role in the organizations. Following is a more appropriate chain of command sequences for a facility of this nature. This type of chain is more of a pyramid and is well-suited to the organizations needs.Volunteering, in the sense of carrying out tasks or providing services for individuals or community organizations without financial recompense, is generally considered an selfless activity, intended to promote good or improve human quality of life. It is considered as serving the society through ones own interests, personal skills or suss outing, which in return produces a feeling of self-worth and respect, instead of money. Volunteering is also famous for skill development, socialization and fun. It is also intended to make contacts for possible employment or for a variety of other reasons.Community volunteers would be a substantial part of the centers staff as their involvement is capable of forging friendship with the clients. It is all important(p) for an agency of this capacity to be knowledgeable about other services and facilities that the clientele can benefits from. The benefit of this is two-fold. First, you show your clients and their families that you really want them to succeed. Second, this service allows you to engagement with other agencies providing them with additional clientele. If the experience is positive (for all parties involved), then it is likely that they will return the favor.Collaboration among agencies is the key to preventing fragmentation. In addition to reducing the likelihood of clients falling through the cracks between disparate and unconnected agencies, collaboration can foster a more holistic view of the client. Sometimes just a simple(a) change of perspective can make the difference between circumstances being viewed as needs and being viewed as assets. For example, a single parent who cannot find a babysitter on a particular evening misses a treatment session. See Appendix for a suggested agency referral list. The ethical standards that govern the human services profession depend on many variables, including the human service professionals level of education, professional license, and even the state in which they practice (Martin, 2011). In the state of Oklahoma, an adult day care is required to have a designated administrator-of-record who has been licensed by the state. Because of the nature of this agency and the mandatory licensure, it go under the umbrella of the Oklahoma State Board of Examiners for Lon g Term Care Administrators command of Ethics which was adopted from the American College of Health Care Administrators Code of Ethics.The abbreviated version contains four simple expectations. EXPECTATION I -Individuals shall hold paramount the welfare of persons for whom care is provided. EXPECTATION II Individuals shall maintain high standards of professional competence. EXPECTATION III Individuals shall strive, in all matters relating to their professional functions, to maintain a professional posture that places paramount the interests of the facility and its residents. EXPECTATION IV Individuals shall honor their responsibilities to the public, their profession, and their relationships with colleagues and members of related professions. American College of Health Care Administrators, 2012) These expectations are reasonable and simple to understand. Maintaining the standard of the governing organization would not present any difficulty. In addition to the decree of ethics f rom a superior governing organization, the center would adhere to the following principles as well quality of care, participant rights, participant selection, appropriateness of care, representation of care and fees, conflicts of interest, accountability of member, and protection of the public. Enforcing these principles would ensure the utmost quality of service.The final ethical standard for this center would come from the National Adult Day Services companionship (NADSA). NADSA gives what they refer to as the Six Domains of Health Care Quality. The work to ensure that all facilities with their certification provide care that is safe, effective, patient-centered, timely, efficient and equitable. A needs assessment is a systematic exploration and analysis of the way things are and the way things ought to be. A need is not a want or desire, but a gap between the current situation and the optimal situation.Using both qualitative and quantitative research, a needs assessment identif ies gaps in training, programs, services and outreach efforts. Needs assessments can be used to identify and solve performance problems in order to direct a natural resource or outdoor recreation organizations afterlife planning efforts. Needs assessment surveys provide a way of community members what they see as the most important needs of that particular group. These surveys are important only to agencies who value community feedback.They offer an excellent opportunity to gather and score the opinions of those the agency is trying to assist. Needs assessment surveys are necessary to learn more about the communal needs, gain a more honest and objective description of needs and become more aware of issues that may have fallen under the radar. As baby boomers and others seek quality care for their parents, the adult day care industry is growing at a rate of five to fifteen portion, dependent on location. According to The National Adult Day Services Association 3,500 centers are car ing for approximately 150,000 adults daily. In 1990, ADS facilities account costs between $30 to $35 dollars a day (Burke, Hudson, & Eubanks, 1990). Today, cost estimates for not for- profit facilities range from $40 to $50 and for-profits range from $60 to $70 per day. The average age of the adult day center care recipient is 72, and two-thirds of all adult day center care recipients are women. Thirty-five percent of the adult day center care recipients live with an adult child, 20 percent with a spouse, 18 percent in an institutional setting, and 13 percent with parents or other relatives, while 11 percent live alone.Fifty-two percent of the adult day center care recipients using adult day services centers nationwide have some cognitive impairment. (Bauer & Moore, 2009) Since the 1970s there has been a continued growth of adult day health service programs, with the most fast growth occurring after additional Medicaid funds became available through approved waiver programs. Ther e is no existing federal policy regarding adult and paediatric day health services, so there is great variability among states approaches to adult day health services (ADHS), and rightly, great variation in programs, services, and standards.Because literature on reimbursement approaches specific to day health services was scant, long-term care literature to describe reimbursement structures and factors utilized for needs-based reimbursement systems was heavily relied on. In theory adult day services seem to offer an ideal alternative to caregivers by providing a daytime care environment outside of the home. One would think that a program where a loved one could be nurtured, stimulated and provided medical care would be a welcome relief for both the caregiver and the care-recipient. In practice it does not seem to work.To only have added about 133 new care centers a year in the entire country does not seem like enough. insofar there are thousands of nursing homes, assisted living fa cilities and home health agencies available coast to coast. Although it is an extremely valuable service that should be utilized more often, no one seems to have an answer as to why adult day care has not been more popular with caregivers. As of yet, no data collection or research studies have been able to answer this question. However, several theories have been developed. First, and quite simply, care-recipients may not be comfortable with the concept.Many of the people who mold away for these services are afraid to leave their homes unless someone familiar is with them. The thought of being by themselves in a new environment is enough to change them not to give it a chance. Second, the cost of the services might be detrimental to some caregivers. This is especially true of those with loved ones who did not qualify for one of the numerous waiver programs that are offered by the government. Third, perhaps there are not enough caregivers and families that are familiar with what s ervices these center have to offer.Fourth, adult day care can prove to be its own worst enemy. About half of all centers are nonprofit organizations sponsored by churches or community associations. Often these places find themselves in a catch twenty-two on one hand they charge next to nothing which does not allow them to grasp all of the associated expenses. On the other hand, if they were to raise their rates, they run the risk of turning away potential clients. From 1989 to 2004 the number of ADHS facilities doubled. A survey completed in 2001 put the number of adult day care centers at 3,493 nationwide.This trend is projected to continue. In the next five to ten years, it is expected that the need for adult day care centers is going to drastically increase due to the length of time the general population lives. The average lifespan continues to increase due to advances in health care thus creating an influx of elderly citizens who will eventually need to depend on others for th eir care. As more and more people continue on in the workforce, they will begin to rely more heavily on adult day and adult health centers to care for their loved ones.Ideally more funding and federal regulations will come about. In addition, one can hope that the general population will become more aware of the benefits of an adult day care center. Once those two things occur, then this service can experience exponential growth while simultaneously extending a helping hand to the elderly population. References Bauer, A. , & Moore, W. (2009, October 09). Adult day service centers are vital to our growing senior population. Retrieved from http//www. journalscene. com/commentary/Adult-day-service-centers-are-vital-to-our-growing-senior-population Burke, M. Hudson, T. , & Eubanks, P. (1990). Number of adult day care centers increasing, but payment is slow. alternating(a) Care, 34-42. Chain of command. (2012). Retrieved from http//www. businessdictionary. com/definition/chain-of-comman d. html Code of ethics. (2012, August 24). Retrieved from http//www. ok. gov/osbeltca/Code_of_Ethics/ index. html How to write a mission statement that resonates. (2011). Urology Times, 39(11), 43-44. Martin, M. E. (2011). Introduction to human services by means of the eyes of practice settings. (2nd ed. Boston, MA Pearson. Appendix Referral Agencies Adult Day Services Phone (405) 521-42291-800-498-7995Fax (405) 521-2086 mailing Address 2401 N. W. 23rd St. , Ste. 40 Oklahoma City, OK 73107 Adult Protective Services Program OklahomaCounty (405) 522-2743 Aging Services Legal Services Shirley Cox, Legal Services Developer Phone (405) 521-2281Fax (405) 521-2086 Mailing Address 2401 N. W. 23rd St. , Ste. 40 Oklahoma City, OK 73107 Area Agencies on Aging Directors Phone (405) 521-2281Fax (405) 521-2086Mailing Address 2401 N. W. 23rd St. , Ste. 40 Oklahoma City, OK 73107 Respite Eleanor Kurtz, Programs Supervisor Phone (405) 522-62411-866-359-8596Fax(405) 521-2086 Mailing Address 2401 N . W. 23rd St. , Ste. 40 Oklahoma City, OK 73107 State Plan Personal Care Tom Dunning, Programs Administrator State Plan Personal Care Intake Line 1-800-435-4711 Transportation Eleanor Kurtz, Programs Supervisor Phone (405)522-66831-800- 498-7995Fax (405) 521-2086 Mailing Address 2401 N. W. 23rd St. , Ste. 40 Oklahoma City, OK73107

Contractual and Non Contractual Liability Essay

I. Contract A contract is an contract having a lawful object entered into voluntarily by two or more parties, each of whom intends to create whiz or more ratified obligations between them. The elements of a contract are stretch away and acceptance by competent persons having legal capacity who exchange consideration to create mutuality of obligation. Contracts may be bilateral or unilateral. A bilateral contract is an agreement in which each of the parties to the contract makes a declare or set of promises to each other.For example, in a contract for the sale of a home, the buyer promises to get the trafficker $200,000 in exchange for the sellers promise to deliver title to the property. These common contracts take place in the daily flow of commerce transactions, and in cases with sophisticated or expensive promises may involve extensive negotiation and various condition precedent requirements, which are requirements that must be met for the contract to be fulfilled. Less common are unilateral contracts in which one party makes a promise, besides the other side does not promise anything.In these cases, those accept the offer are not required to communicate their acceptance to the offeror. In a bribe contract, for example, a person who has lost a dog could promise a reward if the dog is found, through publication or orally. The payment could be additionally conditioned on the dog being returned alive. Those who learn of the reward are not required to search for the dog, but if someone finds the dog and delivers it, the promisor is required to pay. Elements At common law, the elements of a contract are offer, acceptance, pattern to create legal relations, and consideration.Offer and acceptance In order for a contract to be formed, the parties must reach mutual assent. This is typically reached through offer and an acceptance which does not vary the offers terms, which is known as the mirror image rule. If a purported acceptance does vary the terms o f an offer, it is not an acceptance but a counteroffer and, therefore, simultaneously a rejection of the original offer. Intention to be legally bound In commercial agreements it is presumed that parties intend to be legally bound unless the parties expressly state the opposite as in a heads of agreement document.For example, an agreement between two business parties was not enforced because it contained an approve clause which stated the parties wish that the agreement not be reviewed or enforced by a court. In contrast, domestic and social agreements such as those between children and parents are typically unenforceable on the basis of public policy. For example, a husband agreed to give his wife $100 a calendar month while he was away from home, but the court refused to enforce the agreement when the husband stopped paying.Consideration is something of value given by a promissor to a promisee in exchange for something of value given by a promisee to a promissor. Typically, the thing of value is a payment, although it may be an act, or forbearance to act, when one is privileged to do so, such as an adult refraining from smoking. This thing of value or forbearance from some legal right is considered to be a legal detriment. In the exchange of legal detriments, a bargain is created.II. Contractual Liability Contractual liability, is exactly as it sounds. A contract is a legal rachis agreement between two or more persons.When you sign, or agree to the terms of a contract, then you have accepted the contractual liabilities set aside in the document. Liabilities are things that you can be held accountable for, and may have to repay or replace, in the event that they occur. For example, a renters agreement may state that, If upon moving out of the premises stated in the contract, any part of the premises is destroyed, you may be accountable for and have to pay to repair, or replace the damage. Contractual liability (or liability because of a contract) has a ve ry broad meaninga promise that may be enforced by a court.Consider the following simple example. I agree to paint your house for $1,000 and collect $500 prior to the job. After I accept the $500, I obtain a more lucrative offer and never show up to paint your house. You can go to court and aver the $500 you paid me, as I have breached the contract. Your claim is a contractual liability claim. Contractual liability can take many forms, but is basically holds you accountable for damages that are stated in the contract. Another example can be a publishing contract. If you are found indictable of plagiarism, the publisher is not accountable for the act.It is your contractual liability, to release the publisher from fault, and take it yourself. In a nutshell, contractual liability, is anything that you agree to in the terms set forth in a contract. Before entering in to any contract, if you do not understand the terms, consult with an attorney.III. Non-contractual liability The term no n-contractual liability can be defined as civil wrong liability. Tort liability is legal obligation of one party to a victim as a results of a complaisant wrong or injury. This action requires some form of remedy from a court system.A tort liability arises because of a combination of directly violating a persons rights and the transgression of a public obligation causing damage or a private wrongdoing. Evidence must be evaluated in a court hearing to identify who the tortfeasor/liable party is in the case. Some torts are also crimes punishable with imprisonment, the primary aim of tort law is to provide relief for the damages incurred and deter others from committing the same rail ats. The injured person may sue for an injunction to prevent the continuation of the tortious top or for monetary damages.For example, a factory was built in A village. Then this factory releases so much smoke and waste which can harm to human health and environment. Therefore, this factory has to take responsible for her releasing. Among the types of damages the injured party may recover are loss of earnings capacity, pain and suffering, and reasonable medical expenses. They include both present and future expected losses. Torts fall into three general categories knowing torts (e. g. , intentionally hitting a person) negligent torts (e. g. causing an accident by failing to obey traffic rules) and strict liability torts (e. g. , liability for making and selling defective products). Intentional torts are any intentional acts that are reasonably foreseeable to cause harm to an individual, and that do so. Negligence is a tort which appears on the existence of a breaking of the duty of cautiousness owed by one person to another from the perspective of a reasonable person, it is just carelessness not intention. Strict liability wrongs do not depend on the degree of carefulness by the defendant, but are established when a particular action causes damage.

Family Welfare Statistics 2011

FAMILYWELFARESTATISTICS IN INDIA 2011 StatisticsDivision MinistryofwellnessandFamilyeudaemonia political sympathiesofIndiaAbbreviations AIDS AHS ANC ANM ANC APL ARI ASHA AWW AYUSH BCG BE BMS BPL CBR CDR CES CHC CNAA cardiopulmonary resuscitation CPR DLHS DPT DT EAG ECR EmOC FP FRUs HIV HMIS ICDS IDSP IDDCP IIPS IPHS IEC IFA Acquired Immunodeficiency Syndrome yearbook Health cartoon Antenatal C are Auxiliary nanny-goat Mid-wife Ante Natal Care supra Poverty Line Acute Respiratory Infection Accredited Social Health Activist Anganwadi actor Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy Bacillus Calmette Guerin Budget Estimates staple fiber Minimum Services class Be confused Poverty Line Crude brook run Crude demolition grade Cover come on Evaluation keep abreast connection Health Centre Community Needs Assessment Approach Contraceptive Prevalence chump Couples Protection Rate District direct sign ken Diphtheria, Pertussis and Tetanus Diphth eria and Tetanus Empowered reach chemical chemical group Eligible Couple Register Emergency Obstetric Care Family preparedness offset Referral units military man Immunodeficiency Virus Health Management Information carcasss Integrated shaver Development Services Integrated complaint Surveillance platform Iodine Deficience trouble oneself Control Programme Intertheme Institute for macrocosm Sciences Indian Public Health Standards Information, Education and Communication Iron and Folic Acid IMR IPHS IUCD intrauterine device JSK JSY LHV MCTS M&E MIES MIS MMR MNP MoH&FW MPW-F/M MTP NACP NACO NCP NFHS NGO NLEP NIHFW NNMR NPCB NPP NPSF NRHM NSV NVBDCP NUHM Obs/gyn OP OPV ORS PC&PNDT PHC PHN PIP PMG PMUInfant death rate Rate Indian Public Health Standards Intra Uterine Contraceptive eddy Intra Uterine Device Jansankhya Sthirtha Kosh Janani Suraksha Yojana Lady Health Visitor Mother and tiddler Tracking System Monitoring and Evaluation Monitoring, Information & Evaluation Sy stem Management Information System enatic mortality rate proportionality Minimum Needs Programme Ministry of Health and Family offbeat Multi Purpose Worker Female / manly Medical terminus of pregnancy National AIDS Control Program National AIDS Control Organisation National Commission on existence National Family Health appraise Non-Governmental Organization National Leprosy Eradication Programme National Institute of Health and Family Welfare Neonatal mortality Rate National Programme for Control of cecity National Population constitution National Population Stabilisation Fund National bucolic Health Mission No Scalpel Vasectomy National Vector Borne Disease Control Programme National Urban Health Mission Obstetrics and Gynecology Oral Pills Oral Polio Vaccine Oral Rehyd dimensionn Solution Pre-conception & Pre-natal diagnostic Techniques Primary Health Centre Public Health Nurse Programme Implementation Plan Programme Management free radical Programme Management Un it PNC PPP PRCs RCH RHS RKS RGI RNTCP RTI SBA SC SC/ST SRS STDs STI TBAs TFR TT UIPPost Natal Care Public Private Partnership Population Research Centres Reproductive and small fry Health speedy Household Survey Rogi Kalyan Samiti, Registrar General of India Revised National Tuberculosis Control Programme Reproductive Tract Infection Skilled Birth Attendants change Centre Scheduled- Caste / Scheduled- Tribe ensample Registproportionn System wake upually Transmitted Diseases Sexually Transmitted Infections Traditional Birth Attendants natural fullness Rate Tetanus Toxoid Universal Immunization Program CONTENTS Page No. Preface Abbreviations Executive Summary and overview of Family Welfare Programme in India (Hindi & topographic point version).. LIST OF TABLES SECTION A Population & springy Statistics TABLE NO. A. 1 TITLEPopulation Growth, Crude Birth Rate, Death Rate & Sex dimension India 1901-2001 dispersion of Population, Sex Ratio, Density and Growth Rate of Populatio n Census 2001 Rural and Urban Composition of Population, Census 1991 Total Population, Population of Scheduled Castes and Scheduled Tribes and their proportions to the tot up macrocosm Total Urban Population, Population of Cities/Towns Reporting Slums and Slum Population in Slum Areas India, takes, Union Territories Child Population in the age-group 0-6 by switch on Census 2001 & 2011 Population Aged 7 years and above 2011 (Provisional) Lite place and Literacy Rates by sex, 2001 and 2011(Provisional) census Sex-ratio of occur cosmos and child population in the age-group 0-6 and 7+ years 2001 & 2011 Distribution of Population by Age Groups 2001(Census) helping Distribution of Population by Age and Sex, India, 1951-2001 census deviseed Population Characteristics 2001-2012 Proportion of Population in Age Groups 0-4 and 5-9 a A. 2 A. 3 A. 3. 1 A. 3. 2 A. 3. 3 A. 3. 4 A. 3. 5 A. 3. 6 A. 4 A. 5 A. 6 A. 7 Child-Woman Ratio, and Dependency Ratio, 2001 A 8. proceeds of Married Co uples (With Wife Aged Between 15-44 eld), All India 2001 ploughshare Distribution of Married Couples (With Wife Aged Between 15-44 years) by Age Group, Censuses 1961, 1971 , 1981, 1991 & 2001 issue of Married Females in Rural Areas by Age,2001 bod of Married Females in Urban Areas by Age,2001. A. 9 A. 10 A. 11 A11. 1 Estimated eligible couples per megabyte population 1991 & 2001 Census A. 12 A. 3 Expectation of look at Birth 1901-2016 Projected Levels of the Expectation of Life at Birth By Sex ,1996-2016 A13. 1 Expectancy of life at birth by sex and residence, India and bigger secerns, 2002-06 A. 14 A. 15 A. 16 A. 17 A. 18 Fertility Indicators 1996-2009 All India Time Series Data on CBR, CDR, IMR and TFR India Crude Birth and Death Rates in Rural and Urban Areas 1981-2009 Estimated Birth and Death Rates in Different States/UTs 1981,1991,2001-2009 Estimated Age-specific Death Rates by Sex, 2005-2009- India A. 18. 1 Estimated Age-specific Death Rates by Sex, 2005-2009- Rura l A. 18. 2 Estimated Age-specific Death Rates by Sex, 2005-2009- Urban A. 19 A. 20 A. 21 A22 A. 2 A23 A24 Infant deathrate Rates by Sex, 1980 to 2009 All India Infant death rate Rates by Sex, 2001 to 2009 India and major(ip) States mortality rate Indicators by lobby All India 1980-2009 Infant death rate Rate by Residence All states/UTs Child Mortality Rate by Residence Mortality Indicators, India and Major States 2005 to 2009 Age particular Fertility Rates (ASFR*) and Age Specific matrimonial Fertility Rates (ASMFR*) India, 2005-2009 Fertility Indicators for Major States -2005-2009 Estimated Age Specific Fertility Rates by Major States, 2005-2009 b A. 25 A. 26 A. 27 Age Specific Fertility Rates by Educational Level of the Woman, 2005 to 2009(All India) Mean Age at Effective Marriage (Female), India and Major States, 2005 to 2009 Mean age at effective hymeneals of females , by residence India and Major States ,2005 to 2009 Perpennyage of Females by Age at Effective Marriage by Residence, India and Major States, 2005 to 2009 Percent Distribution of Live Births by Order of Birth , India and Major States, 2005-2009 Percentage Distribution of Births By Order of Births By Residence, 2005 to 2009 clean image of Children Born per Woman by Age 2001 A. 28 A. 29 A. 30 A. 31 A. 32 A. 33 A. 34Proportion of Ever-married Womwn of parity (i+1) and above to 1000 Ever-married women of parity (i) and above 2001 Percentage of Ever-Married Women (Aged 50 and Above) With No Live Birth 2001 Percent distribution of live Births by figure of Medical Attention Received by the Mother at Delivery by Residence All India Percentage of Deaths by Causes Related to Child Birth & Pregnancy ( agnate) All India (Rural) 1985, 1990 , 1995,1997 & 1998 Percentage Distribution of Deaths due to Specific Causes under(a) the Major Group Causes Peculiar to Infancy for selected States 1996-98 Maternal Mortality Ratio, 1997-98 to 2007-09 Under-five Mortality Rates(U5MR) by sex and residence , 2008 & 2009 Sex-ratio of child (age group 0-4) 2004-06 to 2007-09 SRS A. 35 A. 36 A. 37 A. 38 A. 39 A. 40 A. 41 SECTION B Family Welfare Programme Statistics i) Immunisation Coverage & MTP Services B. 1 Year-Wise Achievement of Targets of MCH Activities All India c B. 2 B. 3 B. 4State-wise Targets and Achievements of M. C. H. Activities, 2004-05 to 2007-08 Year-Wise Medical Termination of Pregnancy Performed All India State-Wise Medical Termination of Pregnancy Performed (ii) Family Planning Acceptance & Impact of the programme B. 5 B. 6 B. 7 B. 8 B. 9 B. 10 B. 11 B. 12 Family Planning Acceptors by Methods All India Sex-wise Break up of Sterilisation Performed Year-Wise Achievement of Family Planning Methods-All India State-Wise Achievements in respect of Sterilisations State-Wise Achievements in respect of IUD Insertions State-Wise Achievements in respect of rubber eraser Users State-Wise Achievements in respect of O. P.Users State-Wise Vasectomies, Tubectomies and % share of Tubectomy to total Sterilisations State-Wise Number of Laparoscopic Tubectomies Along with Total Number Tubectomy Operations Performed State-wise Number of NSV & Total Number of Vasectomy Operations Performed State-Wise Distribution of Condom Pieces State-Wise Number of Oral Pill Centres Functioning and Distribution of Oral Pill Cycles of B. 13 B. 14 B. 15 B. 16 B. 17 B. 18 B. 19 Number of Condom pieces and Oral Pill Cycles Distributed All India Information Relating to Maternal Health, 2007 to 2011 Couples Currently and Effectively Protected in India By Various Methods of Family Planning Percentage effective CPR due to all Methods Couples Currently and Effectively Protected Number of Births Averted dB. 20 B. 21 B. 22 SECTION C HMIS- New chance upon Indicators C. 1 C. 2 C. 3 C. 4 C. 5 C. 6 C. 7 C. 8 C. 9 C. 10 Number of large(predicate) women vexd 3 ANC Checkups Number of women wedded TT2/ hotshot Number of women having Hb train 11 ( heared cases) Number of newborn visite d within 24 hrs of home preservation Number of women discharged under 48 hrs of lecture from public deftness Number of Still Births Number of newborns weighed at Birth Number of newborns having weight less than 2. 5 Kgs Number of Newborns breastfed within 1 time of day Number of women receiving post partum check-up within 48 hours later on delivery SECTION D Survey Findings D. 1 D. 2 D. 3 D. Key Indicators NHFS-III Comparative Key Indicators NFHS-III, NFHS-II and NFHS-I Comparative Key Indicators- DLHS-1, DLHS-2 and DLHS-3 Comparison of Key Indicators NFHS(2005-06), DLHS (2007-08) and Converage Evaluation Survey(CES) 2009 conducted by UNICEF Concurrent Evaluation NRHM India Facts (2009) Results of Annual Health Survey, 2010-11 D. 5 D. 6 SECTION E pedestal facilities E. 1 E. 2 Number of Sub-Centres, PHCs & CHCs functioning as on March, 2010 preparation Survey, DLHS ,2007-2008 e E. 3 E. 4 E. 5 E. 6 E. 7 Health Worker (Female)/ANM at Sub-Centre Health Worker (Female) Sub-Cen tre and PHCs Number of sub-centres without ANMs or and Health Workers(M) Doctors+ at Primary Health Centres Number of PHCs with Doctors and without Doctors/Lab Technician/Pharmacist SECTION F expending and Expenditure on Family Welfare F. Year Wise BE, RE and Actual Expenditure relating to Department of Family Welfare Plan Outlay on Health Family Welfare in Different Plan Periods Centre, States and Union Territories Scheme-wise breakup of actual expenditure during 2007-08 and outlay for 2008-09 Details of External Assistance fro RCH Programme and Immunization Strengthening Project External Funding Assistance for Polio Programme F. 2 F. 3 F. 4 F. 5 Annexures Annex1 Annex 2 Annex 3 demographic Indicators Demographic Estimates for Selected Countries, 2008 Definitions f SUMMARYOFFAMILYWELFARE PROGRAMMEININDIA Executive Summary The Ministry of Health and Family Welfare brings out a statistical publication titled Family Welfare Statistics in India. The publication presets the most up-to- date selective information on the performance of various family welfare programmes and various demographic indicators. The 2011 edition contains six sections. Section A ( tabulates A. 1 to A. 1) of the report covers Vital Statistics and captures data on population, sex ratio, inelegant & urban composition, child population, personaage distribution of population by age and sex, exit of married couples, life expectancy at birth, cornucopia indicators, age specific fertility rates by educational levels, age specific death rates by sex, infant mortality rate by sex, child mortality rate, Maternal Mortality Ratio, etcetera Analysis of several(prenominal) of the valuable indicators, is given in the Over View (Para 1. 0 to 5. 0). Performance of immunisation activities, family planning programmes, MTP services, etc. are cover in Section-B (Tables-B. 1 to B. 22). Para 6. 0 to 6. 9 discusses some of these important parameters in the Overview. The Section-C (Tables C. 1 to C. 0) of th e Report covers State-wise data on some of the indicators like Number of pregnant women received 3 ANC checkups, Number of women given TT2/Booster, Number of women having Hb level 11 (tested cases), Number of newborn visited within 24 hrs of home delivery, Number of women discharged within 48 hrs of delivery from public preparedness, Number of Still Births, Number of newborns weighed at Birth, Number of newborns having weight less than 2. 5 Kgs. , Number of Newborns breastfed within 1 hour, Number of women receiving post partum check-up within 48 hours after delivery, etc. This data is an aggregation of district level data which is uploaded on Health Management Information System (HMIS) portal of the Ministry by States/UTs.A number of adult scale surveys are being carried out by the Ministry from time to time to assess the performance of various health and family welfare programmes. These surveys inter-alia include, National Family Health Survey (NFHS), District Level Household a nd Facility Survey (DLHS), Annual Health Survey (AHS), Facility Survey, Concurrent Evaluation Survey (CES) of NRHM, etc. Section-D localizees on the indicators covered in these large surveys. Data on primaeval indicators (State-wise) covered in NFHS-III (2005-06) as compared with NFHS-II (1998-99) and NFHS-I (1992-93) are given in Tables D. 1 and D. 2. Tables D-3 captures data on key indicators covered in DLHS-III (2007-08) as compared with DLHS-II(2002-04) and DLHS-I (1998-99). Concurrent Evaluation of NRHM was carried out in 2009.The indicators covered include (a) health infrastructure facilities (b) Communitisation of services (c) Functioning of ANM (d) Availability of Human Resources (e) Service Outcomes. The results of the evaluation survey i are presented in Table D-5. A comparative data on common indicators covered in NFHS-III, DLHS-III and CES-2009 are brought out in Table D-4. The Ministry of Health & Family Welfare, in collaboration with the Registrar General of India (R GI), had launched an Annual Health Survey (AHS) in the erstwhile Empowered Action Group States (Bihar, Jharkhand, Madhya Pradesh, Chhattishgarh, Uttarakhand, Uttar Pradesh, Orissa and Rajasthan) and Assam.The aim of the survey was to provide feedback on the impact of the schemes under NRHM in reduction of Total Fertility Rate (TFR), Infant Mortality Rate (IMR) at the district level and the Maternal Mortality Ratio (MMR) at the regional level by estimating these rates on an annual basis for some 284 districts in these States. The results of the starting line round of AHS for some of the indicators videlicet Crude Birth Rate (CBR), Crude Death Rate (CDR), Infant Mortality Rate (IMR), Neo-natal Mortality Rate, Under Five Mortality Rate, Maternal Mortality Ratio (MMR), Sex Ratio, etc. have since produce available and are given in Section-D (Tables D. 6. 1 to D. 6. 5).Data on key indicators covered in Facility Survey-2007-08 conducted as part of DLHS-III are given in Section E. Late st data received from States /UTs regarding availability of Human resource & infrastructure facilities at Sub Centre, Primary Health Centre (PHC) and Community Health Centre (CHC) are also given in Section-E (Tables E. 1 to E. 7). Section-F covers Outlay and Expenditure on Family Welfare 2010-11 programmes for the year ii Overview Family Welfare Programme in India, 2011 DEMOGRAPHIC PROFILE OF INDIA 1. 0 Vital Statistics 1. 1 As on 1st March, 2011 Indias population stood at 1. 21 billion comprising of 623. 72 one thousand thousand (51. 54%) males and 586. 47 million (48. 46%) females. India, which accounts for worlds 17. share population, is the second most populous country in the world next only to China (19. 4%). One of the important features of the present hug drug is that, 2001-2011 is the first decade (with the exception of 1911-21) which has actually added lesser population compared to the previous decade. In absolute terms, the population of India has increased by nigh 181. 46 million during the decade 2001-2011. Of the 121 crore Indians, 83. 3 crore (68. 84%) live in country areas while 37. 7 crore (31. 16%) live in urban areas, as per the Census of Indias 2011. Highlights of Census 2011 The medium annual exponential emergence change stated to 1. 64% per annum during 2001-2011 from 1. 97% per annum during 1991-2001.Decadal growth during 2001-2011 declined to 17. 64% from 21. 54% during 1991-2001. The decade is the first, with the exception of 1911-21, which has actually added fewer people compared to the previous decade. The rural population (83. 31 crore) and urban Population (37. 71 crore) constitutes 68. 84% and 31. 16% respectively to the total population of the country. During 2001-2011, for the first time, the growth momentum of population for the EAG States declined by about four partage points. This, together with a similar reduction in the non-EAG States and Union Territories, has brought down the rate of growth of population for the co untry by 3. 9 percent as compared to 1991-2001. iiiThough the child-sex ratio 0 to 6 years has declined from 927 female per 1000 males in 1991-2001 to 914 females per 1000 males, increasing trend in the child sex ratio was seen in Punjab, Haryana, Himachal Pradesh, Gujarat, Tamil Nadu, Mizoram and Andaman and Nicobar Island. Literacy rate increased from 64. 83% in 2001 to 74. 04% in 2011 82. 14% male literacy, 65. 46% female literacy. Among the States and Union Territories, Uttar Pradesh is the most populous State with 199. 6 million people and Lakshadweep the least(prenominal) populated with 64,429 people. The contribution of Uttar Pradesh (UP) to the total population of the country is 16. 5% fol showtimeed by Maharashtra (9. 3%), Bihar (8. 6%), westside Bengal (7. 6%), Andhra Pradesh (7. 0%) and Madhya Pradesh (6. ). The combined contribution of these six most populous States in the country accounts for 55% to the countrys population 1. 2 The countrys headcount is some equal to the combined population of the United States of America (USA), Indonesia, Brazil, Pakistan, Bangladesh and japan all put together. The combined population of UP and Maharashtra is bigger than that of the USA. Population of many Indian States is comparable with countries like United Kingdom (UK), Germany, Italy, Japan, Mexico, etc. States in India vs Countries in the World (In millions) State in India Population- Country emailprotected 2011 Uttar Pradesh 199. 6 Brazil 195. Maharashtra 112. 4 Japan 127. 0 Bihar 103. 8 Mexico 110. 5 iv West Bengal Andhra Pradesh Madhya Pradesh Tamil Nadu Rajasthan Karnataka 91. 3 84. 7 72. 6 72. 1 68. 6 61. 1 Philippines Germany Turkey 93. 6 82. 1 72. 7 Thailand 68. 1 France 62. 8 United 61. 9 Kingdom Gujarat 60. 4 Italy 60. 1 Orissa 41. 9 Argentina 40. 7 Kerala 33. 4 Canada 33. 9 Jharkhand 33. 0 Morocco 32. 4 Assam 31. 2 Iraq 31. 5 Punjab 27. 7 Malaysia 27. 9 Chhattisgarh 25. 5 Saudi 26. 2 Arabia Haryana 25. 4 Australia 21. 5 Source State of World Population 2010 1. 3 The Average Annual Exponential Growth Rate (AAEGR) for 2001-2011 dipped sharply to 1. 64 percent per annum from 2. 6 percent during 1981-1991 and 1. 97 percent per annum during 1991-2001. Among the major States, Bihar, J&K, Chattisgarh, Jharkhand, Rajasthan, NCT of Delhi, Madhya Pradesh, Uttar Pradesh, Haryana, Uttarakhand and Gujarat record high annual exponential growth rate as compared to the discipline average during 2001-2011. The State of Bihar registered the highest (2. 26%) AAEGR and Kerala (0. 48) registered the utmost. v 1. 4 The decadal rate of growth of population has slowed down to 17. 64% in 2001-2011 as compared to 21. 54% in 1991-2001. At the State level, growth rates varied widely. Nagaland with (-) 0. 47% had the lowest decadal growth rate.The phenomenon of low growth has started to spread beyond the boundaries of the Southern States during 2001-11, where in addition to Andhra Pradesh, Tamil Nadu and Karnataka in the South, Himachal Pradesh and Punjab in the North, West Bengal and Orissa in the East, and Maharashtra in the West have registered a growth rate between eleven to sixteen percent in 2001-2011 over the previous decade. Among the larger States, Bihar registered the highest decadal growth rate of 25% and Kerala the lowest (4. 86%). It is signifi stoolt that the percentage decadal growth during 2001-2011 has registered the sharpest decline since independence. It declined from 23. 87 percent for 1981-1991 to 21. 54 percent for the extremity 1991-2001, a decrease of 2. 33 percentage point. During 20012011, this decadal growth has become 17. 64 percent, a further decrease of 3. 90 percentage points (Table A-1). 1. Traditionally, for historical reasons, some States depicted a tendency of higher growth in population. Recognizing this phenomenon, and in order to facilitate the creation of area-specific programmes, with special emphasis on eight States that have been lagging behind in containing population growth to manageable limits, the Government of India constituted an Empowered Action Group (EAG) in the Ministry of Health and Family Welfare in March 2001. These eight States were Rajasthan, Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh and Orissa, which came to be known as the EAG States. During 2001-11, the rate of growth of population in the EAG States except Chhattisgarh has slowed down (Table-A-2).For the first time, the growth momentum of population in the EAG States has given the signal of slowing down, falling by about four percentage points. This, together with a similar reduction in the non-EAG States and Union Territories, has brought down the rate of growth for the country by 3. 9 percentage points during 2001-11 as compared to 1991-2001. vi 1. 6 Natural Growth Rate The natural growth rate, which is the difference between the birth rate and death rate, was estimated as 1. 52% in 2009 against 1. 97 % in 1991. 1. 7 Sex Ratio According to Census of India 2011, the sex ratio has shown some improvement in the last 10 years. It has gone up from 933 in 2001 census to 940 in 2011 census. Kerala with 1084 has the highest sex ratio followed by Pondicherry with 1038.Daman and Diu has the lowest sex ratio of 618. The Sex Ratio in Arunachal Pradesh (920), Bihar (916), Gujarat (918), Haryana (877), J(883), Madhya Pradesh(930), Maharashtra (925), Nagaland(931), Punjab(893), Rajasthan(926),Sikkim (889) and Uttar Pradesh (908) is overturn than the national average. All UTs except Puducherry and Lakshadweep also have lower Sex Ratio as compared to national average (Table A-2). 1. 8 Child Sex Ratio The child sex ratio (0-6 years), has declined to 914 in 2011 Census as compared to 927 in 2001. It showed a continuing preference for male children over females in the last decade. increase trend in the child sex ratio was seen in States/UTs viz.Punjab, Haryana, Himachal Pradesh, Gujarat, Tamil Nadu, Mizoram, Chandigarh and Andaman & Nicobar Islands bu t in all the remaining States / Union Territories, the child sex ratio showed decline over Census 2001 (Table-A-3. 6). Literacy level According to the provisional data of the 2011 census, the literacy rate 1. 9 went up from 64. 83 per cent in 2001 to 74. 04 per cent in 2011 showing an increase of 9. 21 percentage points. Significantly, the female literacy level saw a significant jump as compared to males. The female literacy in 2001 was 53 per cent and it has gone up to 65. 46 per cent in 2011. The male literacy, in comparison, rose from 75. 3 to 82. 14 per cent (Table A-3. 5). Kerala, with 93. 1 per cent, continues to occupy the top position among States as far as literacy is concerned while Bihar remained at the bottom of the ladder at 63. 82 per cent. sevener Ten States and Union Territories, including Kerala, Lakshadweep, Mizoram, Tripura, Goa, Daman and Diu, Puducherry, Chandigarh, NCT of Delhi and Andaman and Nicobar Islands have executed a literacy rate of above 85 per cen t. 2. 0 POPULATION PROJECTIONS 2. 1 Population Projections The projections for the country, individual States and Union Territories up to the year 2026 made by the Technical Group constituted by the National Commission on Population (NCP) under the Chairmanship of Registrar General, India, reveals that the countrys population would reach 1. 4 billion by 2026. Projected Population of India (In Millions)The projected population and proportion (percent) of population by broad age-group as on 1st March, 2001-2026 as per Report of the Technical Group on Population Projections Ministry of Health & Family Welfare (May 2006) are given in the Table below Year Population (in millions) Proportion (percent) 15-59 15-49 (years) (years) (Female Population) 35. 4 57. 7 51. 1 32. 1 60. 4 53. 1 29. 1 62. 6 54. 5 0-14 (years) 60+ (years) 6. 9 7. 5 8. 3 2001 2006 2011 1029 1112 1193 (1210 )* 1269 1340 1400 2016 2021 2026 26. 8 25. 1 23. 4 63. 9 64. 2 64. 3 54. 8 54. 1 53. 3 9. 3 10. 7 12. 4 *As per p rovisional figures of Census 2011. viii 2. 2 National Population Policy (NPP), 2000 Government has resumeed a National Population Policy in February, 2000. The main objective is to provide or undertake activities aimed to achieve population stabilisation, at a level consistent with the needs of sustainable economic growth, social development and environment protection, by 2045.The other objectives are To promote and support schemes, programmes, projects and initiatives for meet the unmet needs for contraception and reproductive and child health care. To promote and support innovative ideas in the Government, private and voluntary sector with a view to achieve the objectives of the National Population Policy 2000. To facilitate the development of a vigorous peoples movement in favour of the national effort for population stabilisation. 2. 3 National Commission on Population (NCP) With a view to monitor and direct the implementation of the National Population Policy, the NCP was constituted in 2000 and it was re-constituted in 2005.The Chairman of the re-constituted Commission continued to be Honble Prime Minister of India, whereas Deputy Chairman of the Planning Commission and the Minister of Health & FW are the two Vice-Chairmen and Secretary, H, is the Member-Secretary of the Commission. State Population Commissions State Population Commissions have been 2. 4 constituted in 20 States/UTs. viz. Andhra Pradesh, Arunachal Pradesh, Assam, Haryana, Himachal Pradesh, J, Kerala, Madhya Pradesh, Gujarat, Uttar Pradesh, Maharashtra, West Bengal, Meghalaya, Mizoram, Punjab, Rajasthan, Sikkim, Tamil Nadu, Andaman & Nicobar Island and Lakshadweep. Janasankhya Sthirata Kosh (JSK) The Jansankhya Sthirata Kosh (JSK) has been set 2. 5 up as an autonomous body in the Ministry of Health and Family Welfare, duly registered as a Society under the Societies Registration Act, 1860.The objective of JSK is to facilitate the attainment of the goals of National Population Policy 2000 and support projects, schemes, initiatives and innovative ideas designed to help population stabilization both in the Government and Voluntary sectors and provide a window for canalizing resources through and through voluntary contributions from individuals, industry, trade organizations and other legal entities in furtherance of the national cause of population stabilization. 3. 0 DEMOGRAPHIC and HEALTH STATUS INDICATORS 3. 1 The demographic and health status indicators have shown significant improvements. The Table below captures data on Crude Birth Rate, Crude Death Rate, and Life Expectancy etc. ix Sl. No. 1 2 3 4Parameters Crude Birth Rate (per 1000 population Crude Death Rate (per 1000 population) Total Fertility Rate Maternal Mortality Ratio (per 100,000 live births) Infant Mortality Rate (per 1000 live births) Child Mortality Rate (0-4 yrs. ) per 1000 children Couple Protection Rate (%) Expectation of life at birth (in years) -Male -Female 1951 40. 8 25. 1 6. 0 NA 1981 33. 9 12. 5 4. 5 NA 1991 29. 5 9. 8 3. 6 398 SRS (199798) 80 26. 5 2001 25. 4 8. 4 3. 1 301 (2001-03) Current Levels 22. 5 (2009) 7. 3 (2009) 2. 6(2009) 212 SRS (2007-09) 50(2009) 14. 1(2009) 5 6 146 (1951-61) 57. 3 (1972) 10. 4 (1971) 110 41. 2 66 19. 3 7 8 22. 8 44. 1 45. 6 40. 4(2011) 37. 1 36. 1 (1951) 54. 1 54. 7 60. 6 61. 7 (199196) 61. 8 63. 5 (1999-03) 62. 6 64. 2 (2002-06)Source Office of Registrar General of India, except 7 above which is based on estimation done by statistics Division of Ministry of Health and Family Welfare. NA Not available 3. 2 Crude Birth Rate (CBR) The Crude Birth Rate declined from 29. 5 in the 1991 to 22. 5 in 2009. The CBR is higher (24. 1) in rural areas as compared to urban areas (18. 3). Uttar Pradesh recorded the highest CBR (28. 7) and Goa the lowest (13. 5). Assam (23. 6), Bihar (28. 5), Chhattisgarh (25. 7), Jharkhand (25. 6), Madhya Pradesh (27. 7), Rajasthan (27. 2), Uttar Pradesh (28. 7) recorded higher CBR as compared to the national average. Among the Smaller States / UTs, D Haveli (27. 0) and Meghalaya (24. ) recorded higher CBR as compared to the national average while Tripura (14. 8) recorded the lowest CBR during 2009-Table A-15, A16 & A17. x 3. 3 Life Expectancy The life expectancy at birth for male was 62. 6 years as compared to females, 64. 2 years according to 2002-06 estimates. Urban Male (67. 1 years) and Urban Female (70 years) have longer life span as compared to their rural counter parts. The life expectancy in Kerala is the highest (74 years) and the lowest in Madhya Pradesh (58 years) Table A-13. 1. xi 4. 0 MORTALITY INDICATORS 4. 1 Crude Death Rate (CDR) The CDR, which was stagnant during 2007 and 2008 at 7. 4, came down to 7. 3 in 2009. The CDR is higher in rural areas (7. ) as compared to urban areas (5. 8). The death rate is highest (8. 8) in Orissa and lowest in Nagaland (3. 6) (Table A-17). Age-specific Death Rates The ASDR for the year 2009 was 14. 1 per 1000 in the age-group 0-4 it drast ically declined in the next age-group (5-9) to 1 per 1000. The ASDR gradually increased in each age-group to reach to the level 20. 4 per 1000 in the age-group 60-64 and continued to increase to reach last to the level 173. 9 per 1000 in the last age-group, 85+. ) The Age-specific Mortality rates are declining over the years the rural-urban and Male Female differentials are mum high (Table A-18 to A-18. 3) xii 4. Infant Mortality Rate (IMR) According to SRS 2009, the IMR at national level was 50 per 1000 live births in 2009 as compared to 53 in 2008. The IMR is higher in respect of Female (52) as compared to Male (49). The highest infant mortality rate has been report from Madhya Pradesh (67) and lowest from Kerala (12). Assam (61), Bihar (52), Chhattisgarh (54), Haryana (51), Madhya Pradesh (67), Orissa (65), Rajasthan (59) and Uttar Pradesh (63) recorded higher IMR as compared to the national average (Table-A-20) Infant Mortality Rates Rural/Urban (All India) xiii The IMR is v ery high in rural areas (55 per 1000 live births) as compared to urban areas (34). Rural areas of Madhya Pradesh registered the highest IMR (72) followed by Orissa (68), Uttar Pradesh (66).Rural areas of Kerala State recorded the Lowest IMR (12) in the country. Uttar Pradesh and Chhattisgarh recorded highest IMR in urban areas. Kerala had the lowest IMR (11) in urban areas. Amongst the smaller states, Rural and Urban areas of Goa recorded lowest IMR during 2009 (Table-A-22). The increase in medical exam attention to the pregnant women at the time of live births may have resulted in decline in IMR over the period. But in the rural areas, the medical attention is still on the lower side (Table-A36) Distribution of Live Births by Type of Medical Attention Received by the Mother-2009 (%) Neo-natal Mortality Rate Neo-natal mortality refers to number of infants dying within one month.Neo-natal health care is concerned with the frame of the newborn from birth to 4 weeks (28 days) of age . Neo-natal survival is a very sensitive indicator of population growth and socio-economic development. The survival rate of female infants correlates to subsequent population replacement. The neo-natal mortality rate which was stagnant at 37 per 1000 live births during 2003 to 2006 marginally came down to 36 in 2007, 35 in 2008 and stood at 34 during 2009. The neo-natal mortality rate is very high in rural areas (38 per 1000 live births) as compared to 21 in urban areas in 2009. The neonatal mortality rate also xiv varies considerably among Indian States.Madhya Pradesh (47), Uttar Pradesh (45), Orissa (43), Rajasthan (41), J (37), Himachal Pradesh (36), Haryana(35), Gujarat(34), Chhattisgarh(38) recorded higher neo-natal mortality rate as compared to national average. The Neo-natal mortality rate is lowest in the Kerala State (7). The significant feature is that, the Neo-natal Mortality Rate came down or remained stagnant in 2009 as compared to 2008 except in the case of Haryana, H imachal Pradesh, Jharkhand and Karnataka (Table A23) Post-Neo-Natal Mortality Rate Refers to number of infant deaths at 28 days to one year of age per 1000 live births. The Post Neo natal Mortality Rate came down to 16 in 2009 from 24 in 2002.The Post Neo Natal Mortality Rate is high in rural areas (17) as compared to urban areas (13) (Table A-21) Perinatal Mortality Rate Refers to number of still birth and deaths within 1st week of delivery per 1000 live births. The Peri-natal Mortality Rate varies in the range of 37 to 35 since 2001 and stood at 35 in 2009. It is high in rural areas (39) as compared to urban areas (23) during 2009. The Peri-natal Mortality Rate significantly varied across the States. Kerala with 13 is the best performing State, Madhya Pradesh and Chhattisgarh (45) are least performing States during 2009. Still Birth Rate (SBR) The SBR came down to 8 in 2008 from 9 in 2007. However, it remained stagnant at 8 in 2009 also.The number of Still Births varied across th e States between 1 (Bihar) and 17 (Karnataka) in 2009 (TableA-23). 4. 3 Child Mortality Rate (0-4) Child Mortality Rate is measured in terms of death of number of children (0-4 years) taking place per 1000 children (0-4 years age). As per SRS estimates, the Child Mortality Rate (CMR) has come down from 57. 3 in 1972 to 26. 5 in 1991 and 14. 1 in 2009. The CMR is very high in rural areas (15. 7) as compared to urban areas (8. 7) in 2009 and this observation is relevant for almost all States uniformly. The highest Child Mortality Rate was recorded in Madhya Pradesh (21. 4) closely followed by Uttar Pradesh (20. 1) and Assam (19. 0). Kerala with 2. 6 CMR is the best Performing State (Table A22. 1) 5. 0FERTILITY INDICATORS The three common measures of fertility are (a) Crude Birth Rate (CBR), (b) Age-Specific Fertility Rates (ASFR), and (c) Total Fertility Rate (TFR). CBR has already been discussed in para 3 . 2 above. 5. 1 Age Specific Fertility Rates (ASFR) & Age Specific Marital Fert ility Rates (ASMFR) ASFR is defined as the number of children born to women in the said age group per 1000 women in the same age group and ASMFR as the number of children born to married women in the said age group per 1000 women in the same age group. Table A-24 presents ASFR and ASMFR data one after another for rural and urban areas, for the years 2004 to 2009. It is xv bserved that ASMFRs are higher than ASFRs in respect of all age groups as ASMFR covers only married women. Throughout the period 2004-2009, the age group 20-24 continued to have peak fertility rates in rural and urban areas, but both these indicators are lower in urban areas as compared to rural areas. The ASMFR increased to 326 in 2009 from 303 in 2008 and the ASFR increased to 227. 8 in 2009 from 218. 6 in 2008 for the age group 20-24. Data on Age Specific Fertility Rate (ASFR) reveals that the fertility rate in 15 to 19 years age group has moderately declined in 2009 (38. 5) as compared to 2008 (41. 6). Lower f ertility rates are observed in U. P. Bihar only after attaining the age 40 years while in Kerala, Tamil Nadu, Andhra Pradesh, Maharashtra, Karnataka, Himachal Pradesh and Punjab, this comprise is reached in the earlier age groups viz. 30-34 and 35-39 (Table A-26). ASFR is showing a decreasing trend as the literacy level increases in the age group of 20-24 (the peak fertility age group)-Tables A-27. 5. 2 Age at Effective Marriage (AEM) The Mean age at effective marriage is the age at consummation of marriage, is almost stagnant and hovering around 20 years between 2005 and 2009. The State level data show variations in the AEM. It is the highest in J (23. 6) followed by Kerala (22. 7), Delhi & Tamil Nadu (22. 4), Himachal Pradesh (22. 2), and Punjab (22. 1) in 2009. Rajasthan (19. ) has the lowest AEM. The AEM in urban areas is higher than the rural one but the difference is just two years. The rural- urban difference is highest (3. 1 years) in Assam and least in Kerala (0. 1 years) . The AEM in respect of much than 50% female in rural areas is 18-20 years whereas in urban areas, the AEM in respect of much than 60% female is 21+ (Tables A-28 to A-30) xvi 5. 3 Total Fertility Rate (TFR) The TFR for the country remained constant at 2. 6 during 2008 and 2009 with Bihar reporting the highest TFR at 3. 9 while Kerala and Tamil Nadu continued its outstanding performance with the lowest TFR of 1. 7. Among the major States, the TFR level of 2. has been attained by Andhra Pradesh (1. 9), Karnataka (2. 0), Kerala (1. 7), Maharashtra (1. 9), Punjab (1. 9), Tamil Nadu (1. 7) and West Bengal (1. 9). The rural woman is having higher TFR (2. 9) as compared to urban (2. 0) women (TableA-25). 6. 0 FAMILY PLANNING PROGRAMME In 1952, the Indian Government was one of the first in the world to launch a national family planning programme, which was later expanded to encompass maternal and child health, family welfare and nutrition. The figures given in the publication are based on the data reported by the State/UTs at district level and then consolidated at State and National level on HMIS portal.Percentage of districts reported in 2009-10 and 2010-11 was 98%. 6. 1 Maternal Health Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. Antenatal care (ANC) is the systemic medical supervision of women during pregnancy. Its aim is to prevent the physiological aspect of pregnancy and labour and to prevent or detect, as early as possible, all pathological disorders. Early diagnosis during pregnancy can prevent maternal ill-health, injury, maternal mortality, foetal death, infant mortality and morbidity. During 2010-11, 28. 30 million women got registered for ANC checkup and more than 20 million underwent 3 check-ups during the pregnancy period. vii The institutional deliveries to total deliveries (Institutional +home) increased from 56. 7% in 2006-07 to 78. 5% in 2010-11. Kerala and Tamil Nadu (99. 8%) are the best performing States in the country during 2010-11 (Table B-18). 6. 2 Medical Termination of Pregnancy To avoid the misuse of induced abortions, most countries have enacted laws whereby only qualified Gynecologists under conditions laid down and done in clinics/hospitals that have been approved, can do abortions. The Medical Termination of Pregnancy Act was enacted by the Indian Parliament in 1971 and came into force from 01 April, 1972. The MTP Act was again rewrite in 1975.The MTP Act lays down the condition under which a pregnancy can be terminated, specially the persons and the place to perform it. During 2010-11, 620472 MTPs were performed by 12510 approved institutions in the country. Uttar Pradesh with 576 approved institutions performed maximum number (81420) MTPs in the country followed by Maharashtra (78047) during 2010-11. xviii About 60% MTPs in the country were performed in 6 States viz. Assam, Maharashtra, West Bengal, Tamil Nadu, Uttar Pradesh and Haryana in 2010-11(Ta ble B4). 6. 3 Child Health Immunization programmes aim to reduce mortality and morbidity due to Vaccine Preventable Diseases (VPDs), particularly for children.Indias immunization programme is one of the largest in the world in terms of quantities of vaccines used, numbers of beneficiaries, number of immunization sessions organized and the geographical area covered. Under the immunization program, vaccines are used to protect children and pregnant mothers against six diseases. They are Tuberculosis Diphtheria Pertussis Polio Measles Tetanus In India, under Universal Immunization Programme (UIP) vaccines for six vaccinepreventable diseases (tuberculosis, diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, and measles) are provided free of cost to all. Tetanus Immunization for large(p) Mother During 2010-11, 78. 14% of the estimated need for vaccinating 29. 68 million expectant mothers was achieved. As compared to 200910 the achievement is on lower side (83. 82%).The achievement varied widely across the States, the highest percentage of achievement is observed in Lakshadweep (112. 1%) followed by the Mizoram (106. 8%). Among major States, Tamil Nadu immunized 98. 5% of the targeted numbers and Bihar recorded the lowest immunization (58%). The achievement xix of Bihar is the lowest among the major States consecutively for the third year (TableB1&B2). DPT Immunization for Children The DPT is an immunization or vaccine to protect against the diseases of Diphtheria (D), Pertussis (P), and Tetanus (T). The III dose of DPT vaccination was to be administered to 25. 54 Million children (Target) and achieved 89. 20% during 201011 as against the achievement of 99. 0% in 2009-10. Andhra Pradesh (100. 3%), Tamil Nadu (102. %), Himachal Pradesh (105. 7%), J&K (105. 3%), Manipur (118. 8%), Meghalaya (108. 5%) and Mizoram (134. 2%) achieved more than 100% targeted numbers (Table- B1&B2). Polio More than 89 percent children received the third dose of Polio vac cine in 2010-11 but the percentage dropped from 98. 6% in 2009-10. The percentage of children who received third dose of polio ranges from 31. 4% in A&N Islands to 133. 8% in Mizoram. Eight States viz. Andhra Pradesh, Orissa, Tamil Nadu, Himachal Pradesh, J&K, Manipur, Meghalaya and Mizoram achieved more than 100% targeted numbers during 2010-11. Achievement of Bihar State is the lowest (69. 1%) among the major States (Table- B1&B2).BCG BCG vaccine is given for protection against tuberculosis, mainly severe forms of childhood tuberculosis. 23. 88 million Children of below one year were targeted for administering BCG vaccine during 2010-11 as against 25. 19 million in 2009-10. The achievement in 2010-11 was 93. 5% as against 101. 7 % in 2009-10. 14 States / UTs achieved more than 100% immunization during 2010-11 as against 20 States/UTs in 2009-10. Pondicherry achieved the highest percentage immunization (179. 8%) in 2010-11. Measles 22. 10 million Children of below one year age rec eived measles vaccine during 2010-11 as against 25. 54 million children accounting for an achievement of 86. 6% as against 95. 0% in 2009-10.Himachal Pradesh, J&K, Manipur, Meghalaya and Mizoram achieved more than 100% vaccination in 2010-11 (Table- B1&B2). Tetanus Vaccination against Tetanus was administered to 9. 7 million (Target 25. 1 Million) children of 5 years age (DT), 14. 30 million children of 10 years age (Target 25. 66 million) and 13. 0 million children of 16 years age (Target 26. 01 Million) during 2010-11. The achievement as against the set target works out to 38. 6%, 54. 8% and 50. 0% respectively in respect of the above age group of children. Bihar State is lagging behind in achievement as compared to all other major States. The achievement is only 5. 6% (of the target) in the case of children 5 years of age, 14. 8% for children of 10 Years and 20. % for children of 16 years during 2010-11. Except Sikkim (for the age group children 10 years), no other State vaccinat ed the children to the extent of 100% of the target during 2010-11(Table- B1&B2). 6. 4 Family Planning Birth obligate pills, condoms, sterilization, IUD (Intrauterine device) etc. are most commonly practiced Family Planning methods in the country. The efforts of the Government in implementing the Family Planning Programme in the country have significant impact. However, Social factors like reluctance, traditions and socio-cultural beliefs towards large family emerge as the major constraints towards adopting Family Planning methods. Female xx iteracy, age at marriage of girls, status of women, strong son preference, and lack of male involvement in family planning, are also significant factors associated with adoption of small family norm. IMPACT OF FAMILY WELFARE ACTIVITIES intimacy of contraception is nearly universal 98 percent of women and 99 percent of men age 15-49 know one or more methods of contraception. Among the permanent novel Family Planning methods, female steriliza tion was the most popular Over 97 percent of women and 95 percent men know about female sterilization. Male sterilization, by contrast, is known only by 79 percent of women and 87 percent of men. Ninety-three percent of men know about condoms, compared with 74 percent of women. More than 80 percent women and men know about contraceptive pills.Knowledge of contraception is widespread even among adolescents 94 percent of young women and 96 percent of young men have heard of a modern method of contraception Source NFHS-3 6. 5 Family Planning Performance The year 2010-11 ended with 34. 9 million total family planning acceptors at national level comprising of 5. 0 million Sterilizations, 5. 6 million IUD insertions, 16. 0 million condom users and 8. 3 million O. P. users as against 35. 6 million total family planning acceptors in 2009-10 (Table B. 5) xxi Total FP Acceptors 60000 50000 40000 30000 20000 10000 0 6. 6 A total of 50. 09 hundred thousand sterilizations were performed in th e country during 2010-11 as against 49. 98 Lakh in 2009-10. States/UTs viz.Assam, Bihar, Gujarat, Jharkhand, Madhya Pradesh, Orissa, Punjab. Arunachal, Manipur, Meghalaya, Nagaland, Tripura, Uttarakhand, Daman & Diu, Lakshadweep and Puducherry have shown improved performance in 2010-11 as compared to 2009-10. (Nos. 000) Sterilisations 6,000 5,000 (Nos. 000) 4,000 3,000 2,000 1,000 0 The proportion of tubectomy operations to total sterilizations was 95. 6 percent in 2010-11 as against 94. 6 percent in 2009-10 (Table B-6). xxii Though the share of vasectomy operations to total sterilizations is increasing, it is quite insignificant. 6. 7 IUD Insertions During the year 2010-11, 5. 6 million IUD insertions were reported as against 5. 7 million in 2009-10.Assam, Bihar, Gujarat, Jharkhand, Uttar Pradesh, Arunachal Pr, Delhi, Goa, Meghalaya, Mizoram, Sikkim, D&N Haveli reported better performance in 2010-11 than in 2009-10 (Table B-9). 6. 8 Condom Users and O. P. Users Based on the distrib ution figures reported, there were 16. 0 million equivalent users of Condoms and 83. 07 million equivalent users of Oral Pills during 2010-11 (Table B-10, B-11). 6. 9 Number of Births Averted Implementation of various Family Planning measures averted 16. 335 million births in the country during 2010-11 as compared to 16. 605 million in 2009-10. The cumulative total of births avoided in the country up to 2010-11 was 442. 75 million (Table B-22). 7. 0 PROGRAMMES and SCHEMES 7. The National Rural Health Mission (NRHM) NRHM launched by the Honble Prime Minister on 12th April 2005 throughout the country with special focus on 18 States, including eight Empowered Action Group (EAG) States, the North-Eastern States, Jammu & Kashmir and Himachal Pradesh, seeks to provide accessible, affordable and quality health care xxiii services to rural population, especially the vulnerable sections. The NRHM operates as an omnibus broadband programme by integrating all vertical health programmes of the Departments of Health and Family Welfare including Reproductive & Child Health Programme and various diseases control Programmes.The NRHM has emerged as a major financing and health sector reform strategy to strengthen States Health systems. The NRHM has been successful in put in place large number of voluntary community health workers in the programme, which has contributed in a major way to improved purpose of health facilities and increased health awareness. NRHM has also contributed by increasing the human resources in the public health sector, by up-gradation of health facilities and their flexible financing, and by professionalisation of health management. The current policy shift is towards addressing inequities, through a special focus on inaccessible and difficult areas and poor performing districts.This requires also upward(a) the Health Management Information System, an expansion of NGO participation, a greater engagement with the private sector to harness their resour ces for public health goals, and a greater emphasis on the role of the public sector in the social protection for the poor. 7. 2 NRHM GOALS Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR) Universal access to public health services such as Womens health, child health, water, sanitation & hygiene, immunization, and Nutrition. Prevention and control of ancestral and noncommunicable diseases, including locally endemic diseases Access to integrated comprehensive primary healthcare Population stabilization, gender and demographic balance. Revitalize local health traditions and mainstream AYUSH. promotion of healthy life styles.Primary Health Care services Health Services are provided to the community through a network of Sub-centres, Primary Health Centres (PHCs) and Community Health Centres (CHCs) in the rural areas and Hospitals and Dispensaries etc. in the urban areas. The Primary Health Care infrastructure in rural areas has been developed as a thr ee-tier system. The norms for establishing Sub centres, PHCs and CHCs are as under xxiv Centre Plain Area Sub Centre PHC CHC 5000 30000 120000 Population Norms Hilly/Tribal Area 3000 20000 80000 7. 3 Sub-Centres (SCs) The Sub-Centre is the most peripheral and first contact point between the primary health care system and the community.each Sub-Centre is manned by one Auxiliary Nurse Midwife (ANM) and one Male Health Worker MPW (M). One Lady Health Worker (LHV) is entrusted with the task of supervision of six Sub-Centres. SubCentres are assigned tasks relating to social communication in order to bring about behavioural change and provide services in relation to maternal and child health, family welfare, nutrition, immunization, diarrhoea control and control of communicable diseases programmes. The Sub-Centres are provided with basic drugs for minor ailments needed for taking care of inborn health needs of men, women and children. There were 147069 Sub Centres functioning in the cou ntry as on March 2010. An Auxiliary Nurse Midwife (ANM), a female aramedical worker stick on at the Sub-Centre and supported by a Male Multipurpose Worker MPW (M) is the front line worker in providing the Family Welfare services to the community. ANM is supervised by the Lady Health Visitor (LHV) posted at PHC. 7. 4 Primary Health Centres (PHCs) PHC is the first contact point between village community and the Medical Officer. The PHCs were envisaged to provide an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care. The PHCs are established and maintained by the State Governments under the Minimum Needs Programme (MNP)/Basic Minimum Services Programme (BMS).There were 23673 PHCs functioning as on March 2010 in the country. A PHC is manned by a Medical Officer supported by 14 paramedical and other staff. It acts as a referral unit for 6 Sub Centres. It has 4-6 beds for patients. The activities of PHC involve curative, preventive, uncivil and Family Welfare Services. 7. 5 Community Health Centres (CHCs) CHCs are being established and maintained by the State Government under MNP/BMS programme . It is manned by four medical specialists i. e. Surgeon, Physician, Gynaecologist and Paediatrician supported by 21 paramedical and other staff. It has 30 in-door beds with one OT, X-ray, Labour Room and Laboratory facilities.It serves as a referral centre for 4 PHCs and also provides facilities for obstetric care and specialist consultations. As on March, 2010, there were 4535 CHCs functioning in the country. 7. 6 Reproductive Child Health (RCH) Programme Reproductive and Child Health Programme is a major component of NRHM and aims at reduction of Infant Mortality Rate, Maternal Mortality Ratio and Total Fertility Rate xxv 7. 7 Janani Suraksha Yojana The Jannani Suraksha Yojana (JSY) is a 100% centrally sponsored scheme and it integrates cash assistance with delivery and post delivery car e. The scheme was launched with focus on demand promotion for institutional deliveries in States and regions where these are low.It targeted lowering of MMR by ensuring that deliveries were conducted by Skilled Birth Attendants at all birth. The Yojana has set the Accredited Social Health Activist (ASHA), as an effective link between the Government and the poor pregnant women in 18 low performing States, namely the 8 EAG States and Assam and J&K and the remaining NE States. In other States and UTs, wherever, AWW and TBAs or ASHA like activist has been engaged for this purpose, they can be associated with this Yojana for providing the services. The JSY scheme has shown phenomenal growth in the last three years. Starting with a modest number of 7. 39 Lakhs beneficiaries in 2006-07, the total number reached 113. 89 lakh during 2010-11. 7. Family Welfare Linked Health Insurance Scheme Family Planning Linked Insurance Scheme was introduced w. e. f. 29th November, 2005 to take care of t he cases of failure of Sterilisation, medical branchs for death resulting from Sterilisation, and also provide indemnity cover to the doctor / health facility performing Sterilisation procedure. The scheme is in operation for the last 5 years and is renewed with ICICI Lombard Insurance Company for the sixth year w. e. f. 01-01-2011 based on 50 lakh sterilization acceptors. The total liability of the company is circumscribed to Rs. 25 crore under Section-I and Rs. 1 crore under Section-II. Benefits of the Scheme w. e. f. 1. 1. 011( 6th Year) Section Coverage Financial compensation I following IA Death sterilization (inclusive of Rs. 2 Lakhs death during process of sterilization operation) within 7 days from the date of discharge from the hospital. IB Death following Rs. 50,000 sterilization within 8 30 days from the date of discharge from the hospital IC Failure of Sterilization Rs. 30,000 ID Cost of treatment upto Actual not exceeding 60 days arising out of Rs. 25,000 complicatio n following the sterilization operation (inclusive of xxvi II complication during process of sterilization operation) from the date of discharge. Indemnity Insurance per Upto Rs. 2 Lakh per Doctor/facility but not claim more than 4 cases in a year. 7. Compensation for Acceptors of Sterilisation As a measure to encourage people to adopt permanent method of Family Planning, this Ministry has been implementing a Centrally Sponsored Scheme since 1981 to compensate the acceptors of sterilization for the loss of wages for the day on which he/she attended the medical facility for undergoing sterilization. Compensation for Acceptors of Sterilisation Public facilities Vasectomy Tubectomy Focus 1500 1000 1500 (Rs. ) Accredited Private/NGO facilities Vasectomy Tubectomy 1500 1500 1500 (BPL/SC/ST) High States Non-high Focus States 1000 (BPL/SC/ST) 1500 650 (APL) 8. 0 monitor AND EVALUATION SYSTEMThe Information System to measure the process and impact of the NRHM including Family Welfare Progra mme is as below a) Service Statistics through HMIS and Routine Monitoring b) Sample Registration System & Population Census, Office of Registrar General India c) cock-a-hoop scale surveys- National Family Health Surveys, District Level Household and Facility Surveys. Annual Health Survey d) Area specific surveys by Population Research Centres e) Other specific surveys by National & International agencies f) Field Evaluation through Regional Evaluation Teams xxvii 8. 1 Service Statistics/Routine Monitoring The Statistics Division in the Ministry of Health & Family Welfare is responsible for Monitoring & Evaluation activities. 8. 2 Health Management Information System (HMIS) Health services are provided through the network of health centers spread throughout rural and urban areas of the country. Each centre maintains record of its activities in one or more of the primary registers.The performance data collected and compiled primarily at peripheral levels (Rural/Urban) such as Sub-cen tre, Primary Health Centres, Urban Family Welfare Centres / Post Partum Centres / Hospitals / Dispensaries are presented in Tables C-1 to C-10. For capturing selective discipline on the service statistics from the peripheral institutions, an exercise was undertaken to rationalize the facility level data capturing format by removing redundant information, reducing the number of forms and focused on facility based reporting. The revised forms were finalized in September 2008 and disseminated to the States. A weathervane based Health MIS (HMIS) portal was also launched in October, 2008 http//nrhm-mis. nic. n to facilitate data capturing at District level. The HMIS portal has led to faster flow of information from the district level and about 98% of the districts are reporting monthly data since 2009-10. The HMIS portal is now being rolled out to capture information at the facility level. Some of indicators for which data has been captured through HMIS portal (district level) are inc luded for the first time in the publication (Detailed tables are given in SectionC (Tables C1 to C-10). Data for these indicators are provisional and may only be compared with DLHS-III indicators keeping in view the methodological differences. 8. 3 Tracking of Mothers and ChildrenIt has been indomitable to have a name-based tracking whereby pregnant women and children can be tracked for their ANCs and immunisation along with a feedback system for the ANM, ASHA etc to ensure that all pregnant women receive their Ante-Natal Care (ANCs) and postnatal care (PNCs) Checkups and the children receive their full immunisation. All new pregnancies detected/being registered from 1st April, 2010 at the first point of contact of the pregnant mother are being captured as also all births occurring from 1st December, 2009. A number of States have established the system and other are putting in place systems to capture such information on a regular basis. Mother and Child Tracking System require int ense expertness building at various levels primarily at the Block and Sub-Centre levels. The National Informatics Centre (NIC) has developed software application. The rollout is being monitored centrally. xxviii 8. 4 Large Scale/Demographic SurveysA number of large scale surveys are being conducted by the Ministry of Health & Family Welfare as enumerated below National Family Health Survey (NFHS) The 2005-06, National Family Health Survey (NFHS-3) was the third in a series of national surveys preceded by earlier NFHS surveys carried out in 1992-93 (NFHS-1) and 1998-99 (NFHS-2) with the objective to provide essential data on health and family welfare needed by the Ministry of Health and Family Welfare and other agencies for policy and programme purposes, and to provide information on important emerging health and family welfare issues. Annual Health Survey (AHS) The Ministry of Health & Family Welfare, in collaboration with the Registrar General of India (RGI), had launched an Annua l Health Survey (AHS) in the erstwhile Empowered Action Group States (Bihar, Jharkhand, Madhya Pradesh, Chhattishgarh, Uttarakhand, Uttar Pradesh, Orissa and Rajasthan) and Assam. AHS will provide District-wise data on Total Fertility Rate (TFR), Infant Mortality Rate (IMR) and the Maternal Mortality Ratio (MMR) at the regional level. Other RCH indicators like Ante-natal care, Institutional delivery, immunisation, use of contraceptives will also be available.The aim of the survey was to provide feedback on the impact of the schemes under NRHM in reduction of Total Fertility Rate (TFR), Infant Mortality Rate (IMR) at the district level and the Maternal Mortality Ratio (MMR) at the regional level by estimating these rates on an annual basis for around 284 districts in these States. The results of the first round of AHS for some of the indicators viz. Crude Birth Rate (CBR), Crude Death Rate (CDR), Infant Mortality Rate (IMR), Neo-natal Mortality Rate, Under Five Mortality Rate, Matern al Mortality Ratio (MMR), Sex Ratio at Birth (SRB), Sex Ratio (0-4 years) and Total Sex Ratio have been released by the Registrar General of India (RGI).The District-wise data in respect of the above indicators for the nine States viz. Bihar, Jharkhand, Madhya Pradesh, Chhattishgarh, Uttarakhand, Uttar Pradesh, Orissa, Rajasthan and Assam are given in Table D. 6. 0 (Section D). Comparison of State-wise AHS results and SRS 2009, in respect of five indicators namely Crude Birth Rate (CBR), Crude Death Rate (CDR), Infant Mortality Rate (IMR), Neo-natal Mortality Rate and Maternal Mortality Ratio (MMR), Sex Ratio at Birth (SRB) reveals that they are broadly comparable (Table D. 6. 1). All 284 districts covered in the AHS (first round) have been ranked by arranging them in locomote order based on the rank of the individual indicators viz.Infant Mortality Rate (IMR), Neo-natal Mortality Rate, Under 5 Mortality Rate and Maternal Mortality Ratio (MMR) and presented in Table D. 6. 2. Tables D. 6. 3 and D. 6. 4 give details of bottom 100 districts as per the rankings and also covered under High Focus Districts identified under National Rural Health Mission, xxix The second Round of AHS (2011-12) would also cover additional parameters viz. height & weight measurement, blood test for anemia and sugar, blood pressure measurement and testing of iodine in the salt used by households through a separate questionnaire on Clinical, anthropometric and Biochemical (CAB) test and measurements in addition to the indictors covered in AHS first round.District Level Household and Facility Survey (DLHS) The District Level Household and Facility S