Report on a consultation to the USAID/India integrated rural health and population project

Report is based on review of health, nutrition, and population documents and interviews with appropriate Indian officials. A substantial reduction in infant mortality in India depends upon improved antenatal care; better maternal nutrition during pregnancy and lactation; prompt, simple, and accessible treatment of diarrheal diseases and respiratory infections in infants; and improved nutritional status among infants and young children. Existing programs must include alternatives to sterilization (which has received almost sole emphasis to date) such as I.U.D.'s, condoms, and oral contraceptives. Also needed are better evaluation and logistical supply systems. To successfully implement the proposed project, India's state and national governments should: (1) allow peripheral health workers to use one or two antibiotics under carefully specified circumstances and enlist the support of prominent Indian physicians who accept this approach; (2) recruit intelligent middle-aged women who have borne children and practice family planning to be community health workers; (3) recruit Indians with good management skills and insight into the problems of the health care system; (4) develop evaluation procedures, define measureable standards for evaluating health care workers and the entire health care system, collect baseline data, and devise a methodology for collecting the minimal essential evaluation and monitoring information; and (5) assign priority to the development of pilot health centers which demonstrate an optimum health care methodology in concrete terms and provide a setting for training community health volunteers and other workers.