WELFARE DEPARTMENTS

THE PUBLIC HEALTH DEPARTMENT

Organisation

THE PUBLIC HEALTH of the district is looked after by three agencies, viz., the Public Health Department of the State, local bodies and village panchayats.

At the head of the Public Health Department is the Director of Public Health for Maharashtra who has his headquarters at Poona. The whole area of the new State is divided into four divisions and each division is directly under the charge of the Deputy Director of Public Health Services. The district of Jalgaon is included in the Bombay Division. The Deputy Director of Public Health Services, Bombay Division, has his headquarters at Poona temporarily. The District Health Officer represents the Public Health Department, and is the head of the district for all public health matters except malaria which is under care of a Malaria Medical Officer of Glass II cadre. He is directly under the control of the Deputy Director of Public Health (Malaria and Filaria) whose headquarters are at Poona. The District Health Officer organises measures on public sanitation and hygiene in fairs and festivals: investigates the causes, origin and spread of diseases, both epidemic and endemic, and adopts preventive measures to control such diseases especially cholera, small-pox, plague, guinea worm and enteric infections. He inspects and advises municipalities, village panchayats and other village authorities about health, sanitation, drainage and water-supply; inspects child welfare, maternity, family planning and leprosy centres, and looks to industrial and school hygiene, recommends the issue of licenses for cinema theatres and other places of public amusement, inspects sites for school buildings, factories, burial grounds, village extensions, etc., and gives opinion on their suitability from the public health point of view. He also carries out health education with the help of his subordinate staff. The District Health Officer and the Malaria Medical Officer for the district have under them an adequate staff and the necessary equipment.

Primary Health Centres.

The Medical Officers in charge of primary health centres are responsible for rendering preventive as well as curative medicines to the population within the area comprising the primary health centre. At present (1960) there are six primary health centres in this district located at Edlabad, Varangaon, Talegaon, Khedgaon. Adawad and Wadadi.

It is posed to establish primary health centres at Jamner, Bhadgaon, Amalner and Parola.

Maternal and child Health Cenrtes.

There are two maternal and child health centres in the district working under the supervision of the Medical Officers in charge of District Local Board Dispensaries at Bhadgaon and Bodwad. Each centre is staffed with two nurse-midwives- They attend to about 10,000 people.

Epidemic Medical Officers.

The main duty of the Epidemic Medical Officer is to control epidemics, and in non-epidemic times to adopt inter-epidemic measures (i.e., measures for prevention of possible epidemics), and also to render medical relief in rural areas. An epidemic van has been provided for the district and the Epidemic Medical Officers have to rush to the spot on the first report of an outbreak of an epidemic disease.

Sanitary Inspectors.

The district is divided into five circles and one Sanitary Inspector is placed in charge of each circle. The one posted at district headquarters is designated as Senior Sanitary Inspector who has to supervise all other circles in the district besides his own. The Sanitary Inspector is responsible for all public health matters in his charge, including assistance in the control of epidemics. He conducts regular inspection of the work of vaccinators. With the intention of improving the standard of vaccination and the sanitation in rural areas, Government have a scheme to replace the existing vaccinators by persons holding the qualifications of a Sanitary Inspector. The latter are styled as Sanitary Sub-Inspectors.

Vaccinators.

The main duty of vaccinators is to carry out vaccination in their respective areas. They also assist in the execution of anti-epidemic measures, and in sanitation of villages with the help of the sanitary squads under them. The main duty of the squad is to improve the sanitation of the villages which have no panchayats. They construct soakage pits, manure pits, trench latrines, drain and fill mosquito breeding sites and also clean the surroundings of the schools, wells, etc.

Mukadam.

The Mukadam supervises and guides the squads in their work. In times of epidemics the services of squads are utilised for anti-epidemic measures under the supervision and guidance of Sanitary Inspectors and Epidemic Medical Officers.

Obligatory duties of Local Bodies.

Public vaccination and execution of measures necessary for public health are the obligatory duties of municipalities in urban areas, and of the District Local Boards in rural areas. The District Health Officer advises these bodies in respect of public health and sanitary problems.

Municipalities.

There are 13 municipalities in the district, of which four arc borough municipalities (viz., Jalgaon, Bhusawal, Amalner and Chalisgaon) and the rest district municipalities. There are four Sanitary Inspectors in Jalgaon Municipality, three in Bhusawal, two in Chalisgaon, and one each in the remaining municipalities except Savda. The municipalities receive Government: subsidy towards the pay and allowances of the Sanitary staff. The Sanitary Inspectors bring to the notice of the Medical Officer of Health or the Chief Officer of the municipality, the defects noticed by them during their rounds, and the Medical Officer of Health or the Chief Officer takes action according to the powers vested in him by the byelaws. There is one vaccinator for Jalgaon, one for Bhusawal and one for Amalner. These are Government vaccinators and a contribution towards their pay and allowances is recovered by Government from the municipalities concerned.

District Local Board.

There is no Health Officer or Sanitary Inspector in the employ of the District Local Board. There are 22 vaccinators (including two candidate vaccinators) under its employ. The expenditure on pay and allowances of vaccinators is borne by Government in the first instance and subsequently fixed contribution is recovered from the District Local Board. In times of epidemics, if the expenditure exceeds Rs. 10.000, only fifty per cent grant-in-aid is sanctioned by Government. In villages having panchayats. sanitation is looked after by the panchayats who appoint the conservancy staff under the supervision of the Revenue Department. The sanitary arrangements made by the village panchayats are inspected by the officers of the Public Health Department, and the defects are brought to the notice of the President. The village panchayats are empowered to levy taxes to enable them to meet the expenses towards improvements of the village water-supply, etc. In villages which have no panchayats the District Local Board deals directly with complaints relating to sanitary conditions, water-supply, etc.

Chief Diseases.

The following table gives the number of deaths due to chief diseases in Jalgaon district from 1951 to 1959:—

NUMBER OF DEATHS DUE TO CHIEF DISEASES IN JALGAON DISTRICT

The important diseases prevailing in this district are tuberculosis, leprosy, and epidemic diseases like cholera and small-pox.

Chief Diseases.

Leprosy.

Government of Maharashtra have established a Leprosy Subsidiary Centre at Savda, taluka Raver, to treat leprosy patients in the selected project area of Yawal and Raver talukas. The centre carries out survey, education and treatment. It conducts clinics at (1) Raver, (2) Savda, (3) Nimbhora, (4) Khiroda in Raver taluka and (5) Yawal, (6) Hingone, (7) Padaise and (8) Faizpur in Yawal taluka.

In addition to the above centre two other institutions, viz., Purva Khandesh Kushta Sewa Mandal and the Gandhi Memorial Leprosy Foundation Unit, Jamner, are engaged in controlling leprosy in jalgaon district.

Malaria.

A Malaria survey of this district was carried out for the first time in 1948-49. The cumulative spleen rate was 23.9 per cent for the whole district, and Malaria was found to be prevalent throughout the district.

The examination of blood smears for child parasite rate and infant parasite rate showed that the child parasite rate was 16.05 per cent and infant parasite rate was 17.08 per cent, the parasite found being P. vivax and P. falciparum. The entomological work during the survey period showed that A. culicifacies is the vector species, and the transmission starts from July and ends in December.

The measures to control Malaria were started in the year 1953 with the establishment of National Malaria Control Unit in the district. Two rounds of spray per year with D. D. T. 75 per cent wettable powder were given in the district from 1953 onwards except during the years 1956 and 1957 when only one round was given. These spraying operations, twice a year during the transmission season, are continued, and the results achieved are as under:—

All the spraying operations are managed by this Unit except in the three borough municipalities, where the insecticide is supplied by Government and the labour and spraying equipment by the municipalities.

From the year 1958, the Malaria Control Programme is converted into the Malaria Eradication Programme. The spraying operations will be discontinued from 1961-62 and those of surveillance will commence and last up to 1964. It is expected that Malaria would be eradicated completely by 1964 with the full co-operation of the people.

Tuberculosis.

During the year 1958, 808 deaths were recorded on account of this disease.

Guinea-worm.

This is not a common disease in the district as the main supply of water in all the towns and villages is either from rivers or draw wells.

Epidemics.

In urban areas it is the statutory duty of the municipalities to provide special medical aid, and accommodation for the sick in the time of epidemic diseases, and to take such measures as may be required to prevent the outbreak or to suppress and prevent recurrence of the disease. In rural areas this responsibility rests with the District Local Board. According to Government Resolution, General Administration Department, No. 1773/33, dated the 23rd April 1945. the Board is required to set apart annually a lump sum equal to average of the amount spent during the preceding three years for expenditure in connection with epidemics. A grant is placed at the disposal of the Director of Public Health for the emergency measures. The Collector is empowered to take action in consultation with the District Health Officer if he finds the measures taken by the Board inadequate. Similar powers have also been conferred on the Collector in respect of urban areas. The District Local Board is helped in its task by the District Health Officer and the nucleus staff under him. The services of the Dispensary Medical Officers and the Subsidised Medical Practitioners are also utilised.

The incidence of cholera and small-pox during the nine years, i.e., from 1951 to 1959 is given below:—

INCIDENCE OF CHOLERA AND SMALL-POX IN JALGAON DISTRICT.

Cholera.

Cholera.—-The main season for outbreak of cholera is the rainy season, but occasionally in summer also, when there is scarcity of water, spread of infection takes place through rivers and water sources. The infection may also spread into the district from the adjoining Dhulia, Nasik and Buldana districts. Well in advance of the summer season the sanitary staff is directed to undertake disinfection of water-supplies, and a temporary staff of inoculators is appointed to perform anti-cholera inoculations on a mass scale particularly in those villages which are situated on the riversides, and which are threatened every year by cholera. In times of epidemics, the sanitary staff and the epidemic medical officers take preventive measures. Segregation and treatment of cases is undertaken by the epidemic medical officers, with the help of the staff of the primary health centres. If the existing staff of the district proves inadequate, the Director of Public Health, Poona, is requested to send one of the mobile hospital units.

Small-pox.

Small-pox.—Small-pox prevails every year in a mild epidemic form and the disease is brought under control mainly by means of mass vaccinations.

Plague.

Plague.—The disease is completely absent from the district since 1948. This district has seldom been visited by plague even in the past.

Fairs.

FAIRS: Every year the following fairs arc held in the district and these are managed by the local bodies:—

The sanitary arrangements of these fairs are organised by the respective village panchayats and the municipalities under the supervision of the staff of the Public Health Department. Pilgrim tax is not levied at any of the jatras in the district.

Famine Relief.

FAMINE RELIEF: When famine and scarcity conditions are declared to exist in the district, the District Health Officer is under the general orders of the Collector in so far as medical and sanitary arrangements for scarcity or famine relief works are concerned.

Health Propaganda

HEALTH PROPAGANDA: Health propaganda is carried on by all the Propaganda. members of health staff. Magic lantern, lectures and health talks are given on subjects such as nutritious food, prevention of blindness, school hygiene, leprosy, tuberculosis, malaria, small-pox, cholera, typhoid, etc. At the time of fairs public health exhibitions are arranged where models and posters on health are exhibited, and educative films shown by the propaganda van of the department.

School Hygiene and Medical Inspection of School Children.

SCHOOL HYGIENE: The Epidemic Medical Officers and Medical Officers in charge of the primary health centres carry on regular medical examination of school children during the course of their tours, and distribute drugs for minor ailments, and vitamin tablets to children suffering from deficiency diseases. Propaganda with the help of magic lantern or films is carried on to educate school children in personal hygiene.

Vital Statistics.

VITAL STATISTICS: The compilation of statistics of birth and  deaths for Jalgaon is done in the office of the Assistant Director of Public Health, in charge of Epidemiology and Vital Statistics, Poona. In the municipal area, the municipality concerned maintains the register of births and deaths, and forwards monthly extracts to the Assistant Director of Public Health, in charge of Epidemiology and Vital Statistics, Poona. In rural areas the register is maintained by village officers and monthly extracts are sent by them to the taluka officers for transmission to the Assistant Director of Public Health concerned.

Water Supply.

WATER SUPPLY: There are only two towns in Jalgaon district which have a piped water supply, viz., Jalgaon and Bhusawal. Two other towns and a few villages have also recently installed water storage system, and made distribution through pipes at stand-posts only. Under the Block Development activities, schemes for sinking wells for portable water-supply in the villages arc being executed.

Malaria Organization.

MALARIA ORGANISATION: The undermentioned staff works in the Malaria Organisation in Jalgaon under the guidance of Medical Officer, National Malaria Eradication Programme Unit.

Medical Officer.

THE MEDICAL OFFICER (Class II) guides the spraying operations in the whole district, which are carried out between 16th May to 15th October each year, and then carries out an annual survey for assessment of results.

Assistant Unit Officer.

ASSISTANT UNIT OFFICER: The Medical Officer is assisted in his day-to-day work by the Assistant Unit Officer, who is a Class ill Officer.

Malaria Supervisor.

MALARIA SUPERVISOR: The whole district is divided into five sub-units. Four of those sub-units are in charge of a Malaria Supervisor, who is a Class III Officer and assisted by a Malaria Inspector, who is a trained Sanitary Inspector. The fifth sub-unit is in charge of a Malaria Inspector. The most important duty of the Malaria Supervisor and Malaria Inspector is to carry out the spraying operations in their areas properly with the help of the spraying squads. During the non-spraying season they are expected to help the Medical Officer in carrying out the survey and examination of blood smears and all other work. They have also to maintain proper records and accounts of the materials given to them for the work. Each sub-unit is provided with a vehicle for carrying men and material during the spraying seasons.

Malaria Inspector.

MALARIA INSPECTOR: The Malaria Inspectors are expected to help the Malaria Supervisors in the spraying operations, proper maintenance of records and accounts and in all other work relating to the sub-unit.

Technicians.

TECHNICIANS: There are two technicians who are Class III Officers. They examine the blood smears collected in the field during the survey period, and keep an up-to-date record of all the laboratory work in the unit office. They also examine and keep record of all the blood smears received from various dispensaries in the district.

Insect Collector.

INSECT COLLECTOR: There are two Insect Collectors who visit one village a day and collect mosquitoes from each "catching station" in that village. There are six houses fixed in each village as catching stations. There are 12 villages between two Insect Collectors in four talukas—Chopda, Yawal, Pachora and Bhadgaon. The numbers and species of mosquitoes caught are carefully recorded.

Havildar.

HAVILDAR: In this district there are 41 havildars appointed for five months during the spraying season from 16th May to October. They carry out the DDT spraying operations in the area allotted to them, and maintain proper records and accounts of materials issued to them from time to time for the above job. They work under the direct guidance and supervision of the Malaria Supervisor and Malaria Inspector. Each havildar has a batch of five sepoys under him who carry out actual spraying.

Office.

OFFICE: The office of the Malaria Eradication Unit, Jalgaon, has the required staff on the establishment side and the necessary equipment for the spraying of DDT.

Other Activities.

The Malaria Eradication Programme in the major municipalities, i.e., with a population of 40,000 and over is carried out by the municipalities. The Government gives them the insecticides emulsifier and solvents. Expenditure on labour and equipment is to be borne by the municipality concerned. In the district there are three such municipalities, viz., (1) Jalgaon, (2) Amalner and (3) Bhusawal.

Spraying Operations.

In the whole district except in the three major municipalities, two rounds are carried out with 75 per cent wettable powder (DDT) from 16th May to 15th October, each round having two and a half months duration. In the three municipalities only one round of spraying is carried out in July and August with Technical DDT (100%).

Assessment of Results.

For the assessment of results 11 villages are selected from where at least 20,000 children are examined to determine the spleen rate. Five thousand blood smears from children between 2 years and 10 years are collected to determine the child parasite rate and 1,000 smears are collected from children below 12 months to determine the infant parasite rate.

Morbidity Figures.

The total patients attending the various dispensaries in the district and the number of malaria cases are collected from 17 dispensaries in the district which are functioning for over a long period.

Family Planning.

It has now been generally recognised that family planning is of vital importance in the context of our rapidly growing population and poor economic conditions. To raise the standard of living of the community and to ensure health and happiness of families birth rate needs to be reduced. To achieve this object, rural family planning centres are opened in association with primary health centres and maternal and child health centres. Rural family planning centres were established at the primary health centres at Adavad and Edlabad, till the end of 1959. Urban centres are opened by voluntary organisations and local bodies on grant-in-aid basis. The grant-in-aid is sanctioned by Government of India on recommendations from the Director of Public Health, Poona.

In addition to the existing staff of the primary health centres, a social worker or a field worker is attached to the centre in order to promote the cause of family planning among the public. Family planning has become a part of the general public health programme. Contraceptives approved by Government of India are distributed according to the Central Government's instructions. The Family Planning Officer at the Directorate at Poona directs, co-ordinates and guides all family planning activities.

Leprosy.

LEPROSY: TO control the spread of leprosy Government has established one Leprosy Subsidiary Centre at Savda, The centre started functioning since January 1958. The activities are concentrated in a selected area. The following staff has been sanctioned for the centre as per pattern prescribed by Government of India: one Medical Officer (Class II), one Medical Social Worker, four Non-Medical Assistants or Health Visitors and other subordinate staff. The activities of the centre include: (1) case finding programme through leprosy surveys, (2) treatment of all leprosy cases, (3) follow up of healthy contacts of patients, (4) publicity and health education regarding leprosy and (5) welfare activities for the patients and dependents.

Three Survey, Education and Treatment Units have also been established, viz., at Jalgaon, Edlabad and Chalisgaon. The object of the Survey, Education and Treatment Units is to control the spread of leprosy in a given area by mass treatment of all leprosy cases by modern methods. These Units are attached to Civil Hospital and Dispensaries. One trained Leprosy Assistant has been appointed at each unit. He works under the supervision of the Medical Officer in charge of the dispensary or hospital. Each Unit covers a population of 50,000. A Leprosy Assistant visits the village, makes friendship with the people and gives them information about the disease.

The voluntary organisation known as Purva Khandesh Kushta Seva Mandal, Bhusawal, is also doing anti-leprosy work. The Government has paid grant-in-aid to this Institution for establishment of one Survey, Education and Treatment Unit in municipal area of Bhusawal taluka and the other at Varangaon in Bhusawal taluka.

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