Health Policies and Legislation

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Health Policies and legislations :

Health Policies and legislations State Institute of Health and Family Welfare, Jaipur

Health Policies: India:

Health Policies: India National Health Policy, 1983, 2002 National Population Policy, 2000 National Children Policy, August 22, 1974 National Policy for Persons with Disabilities, 2006 National Policy on Women Empowerment, 2001 National Blood Policy, 2003 National Nutrition Policy, 1993 SIHFW: an ISO 9001: 2008 certified Institution 2

National Health Policy, 1983:

National Health Policy, 1983 1983 (After 36 yrs . of independence ) A time-bound program for setting network of comprehensive primary health care services through- Intermediation with ‘Health volunteers’ Establishment of a well-worked out referral system Evenly spread specialty and super-specialty services Private-public partnership SIHFW: an ISO 9001: 2008 certified Institution 3

Basic Elements-NHP 1983 The basic elements and areas for action - :

Basic Elements-NHP 1983 The basic elements and areas for action - Nutrition Preventing food adulteration Maintaining drug quality Water supply and sanitation Environmental protection Immunization MCH services Occupational health Health education MIS Medical industry Health insurance Health legislations Medical research. School health SIHFW: an ISO 9001: 2008 certified Institution 4

Issues involved in NHP-1983 formulation :

Issues involved in NHP-1983 formulation Re-orientation of Medical education Re-structuring and Re-organizing the existing health care services Population stabilization Re-orientation of existing health personnel Role of practitioners of ISM in Health care delivery SIHFW: an ISO 9001: 2008 certified Institution 5

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Disparities and Large gap in health facilities Shortfall of SCs/PHCs/CHCs. Only 20% of the population seeking OPD services, and less than 45% seeking indoor treatment, in public hospitals. Need of rural health staff exclusively for the implementation of family welfare activities NHP-2002 Realizes SIHFW: an ISO 9001: 2008 certified Institution 6

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Ad-hoc deployment of doctors and nurses ISM can increase the reach of basic health care Need for specialists in ‘public health’ and ‘ family medicine ’ Low doctor: nurse & nurse: population ratio Urban health- neglected SIHFW: an ISO 9001: 2008 certified Institution 7

National Health Policy-2002:

National Health Policy-2002 NHP-2002 to evolve a policy structure- Which reduces the inequities in existing health services Allows the disadvantaged sections of society a fairer access to public health services. SIHFW: an ISO 9001: 2008 certified Institution 8

The considerations for NHP-2002 :

The considerations for NHP-2002 Health investment and expenditure declined Disparities in public health facilities and health standards The infrastructure facilities fall short. Shortfall in the number of SCs/PHCs/CHCs Shortage of medical personnel Less population, seeking OPD & indoor treatment services, in public hospitals Need for Public health specialists and Family Medicine SIHFW: an ISO 9001: 2008 certified Institution 9

NHP-2002 Proposes:

NHP-2002 Proposes Increase expenditure - 6% of GDP (2% as public health investment), by the year 2010. State Governments increase 7% of the Budget by 2005 and 8% of the Budget by 2010 Increased allocation 55% for the Primary health 35% for Secondary 10% for Tertiary health SIHFW: an ISO 9001: 2008 certified Institution 10

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Gradual convergence of all health programs under a single field administration To continue Vertical programs for TB , Malaria, HIV/AIDS, RCH and UIP till moderate levels of prevalence are reached. Developing the capacity of State and District Health administration SIHFW: an ISO 9001: 2008 certified Institution 11

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Ensure community monitoring More frequent in-service training of public health medical personnel, Quality of public health services Use of Generic drugs. Urban health infrastructure Mental Health Education IEC SIHFW: an ISO 9001: 2008 certified Institution 12

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Health research Private sector participation Disease surveillance Women health Medical ethics Quality standards for food and drugs Environment and Occupational health Synchronized implementation of NHP-2002 and NPP-2000 SIHFW: an ISO 9001: 2008 certified Institution 13

Objective:

Objective To achieve standard of good health To ensure equitable access to health services To increase the aggregate public health investment. SIHFW: an ISO 9001: 2008 certified Institution 14

Goals of NHP-2002 :

Goals of NHP-2002 i SIHFW: an ISO 9001: 2008 certified Institution 15

Policy prescriptions-NHP-2002 :

Policy prescriptions-NHP-2002 To increase health sector expenditure Strengthening of the primary health structure Program implementation through autonomous bodies Frequent in-service training Government-funded health research Prohibiting the use of proprietary drugs SIHFW: an ISO 9001: 2008 certified Institution 16

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An integrated disease control network National health accounts Strengthening deployment of health experts User-charges Contract employment Setting up of Medical Grants Commission Mental health services IEC Highest priority woman’s health. Food and drug standards Need to modify the existing curriculum SIHFW: an ISO 9001: 2008 certified Institution 17

National Population Policy-2000:

National Population Policy-2000 SIHFW: an ISO 9001: 2008 certified Institution 18

Population Growth in India :

Population Growth in India High wanted fertility due to the high infant mortality rate ( IMR) Higher fertility due to unmet need for contraception The large reproductive age-group cohort SIHFW: an ISO 9001: 2008 certified Institution 19

Projected Growth in Population (M) :

Projected Growth in Population (M) Year If current trend continues If TFR 2.1 achieved by 2010 Total Population Percent Increase Total Population Percent Increase 1991 846.3 - 846.3 - 1996 934.2 17.6 934.2 17.6 1997 949.9 15.7 949.0 14.8 2000 996.9 15.7 991.0 14.0 2002 1027.6 15.4 1013.0 11.0 2010 1162.3 16.8 1107.0 11.75 SIHFW: an ISO 9001: 2008 certified Institution 20

Population Pyramid:

Population Pyramid SIHFW: an ISO 9001: 2008 certified Institution 21

Population Policy of India: Milestones :

Population Policy of India: Milestones 1946: Bhore Committee Report 1952: Family Planning Program 1976: Statement of National Population Policy 1977: Policy Statement on Family Welfare Program 1983: National Health Policy - "securing the SFN, through voluntary efforts and moving towards the goal of population stabilization". SIHFW: an ISO 9001: 2008 certified Institution 22

Population Policy of India: Milestones :

1991: The National Development Council appointed a Karunakaran Committee 1993: Swaminathan Committee appointed, 1994- report submitted 1997: Cabinet approved the draft National Population Policy, document could not be placed in House of Parliament 1999: Another draft finalized placed before the Cabinet; discussed & approved 2000 : National Population Policy in existence Population Policy of India: Milestones SIHFW: an ISO 9001: 2008 certified Institution 23

Salient features of 1976 statement :

Salient features of 1976 statement Statement focused on- Minimum needs program Family planning Raising age of marriage Adoption of small family norm Research in Reproductive health and contraceptive technology Multi-media motivational strategy Education and Economic development SIHFW: an ISO 9001: 2008 certified Institution 24

Suggestions for the approach:

Suggestions for the approach 8 % of Central assistance linked to State Monetary compensation linked with terminal methods and no . of children Compulsory sterilization after 3 children Rising the marriage age Increasing level of female education Involvement & support of voluntary organizations SIHFW: an ISO 9001: 2008 certified Institution 25

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Research in reproductive biology and contraception Incentives for make Family Planning movement. Promotion of multi media communication strategy Inclusion of population education in education system Freezing the representation of States in Parliament till 2026 SIHFW: an ISO 9001: 2008 certified Institution 26

National Population Policy-2000:

National Population Policy-2000 SIHFW: an ISO 9001: 2008 certified Institution 27

Policy Objectives :

Policy Objectives Immediate To address the unmet needs for contraception, health care infrastructure, health personnel To provide integrated service delivery for basic RCH care Medium To bring the TFR to replacement levels by 2010 Long term To achieve a stable population by 2045 SIHFW: an ISO 9001: 2008 certified Institution 28

National Socio-Demographic Goals for 2010 :

National Socio-Demographic Goals for 2010 Address the unmet needs for - Basic RCH services, Supplies and infrastructure. Increase school education and reduce drop outs Reduce IMR& MMR. Promote delayed marriage for girls, preferably after 20 years of age. Contain the spread of AIDS Prevent and control communicable diseases. SIHFW: an ISO 9001: 2008 certified Institution 29

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Integrate Indian Systems of Medicine (ISM) Promote vigorously the small family norm To make family welfare a people centered program To Achieve- Universal access to health related information 100% registration of births, deaths, marriage and pregnancy. Universal immunization of children 80% institutional deliveries and 100% deliveries by trained persons SIHFW: an ISO 9001: 2008 certified Institution 30

Strategic themes of NPP-2000:

Strategic themes of NPP-2000 Decentralized Planning and Implementation Convergence of Service Delivery at all Levels Empowering Women for Improved Health Child Health and Survival Meeting the Unmet Needs for Family Welfare Services SIHFW: an ISO 9001: 2008 certified Institution 31

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Under-Served Population Groups Diverse Health Care Providers Collaboration with NGO and Private Sector Contraceptive Technology and Research on RCH Mainstreaming Indian Systems of Medicine Information, Education, and Communication

Structure :

Structure NPP 2000 to be largely implemented and managed through PRIs in coordination with the concerned State/UT administrations. Recommended structures : National Commission on Population State / UT Commissions on Population Coordination Cell in the Planning Commission Technology Mission in the Department of Family Welfare SIHFW: an ISO 9001: 2008 certified Institution 33

Promotional and Motivational measures for adoption of the SFN :

Promotional and Motivational measures for adoption of the SFN Panchayats and Zila Parishads will be rewarded for - Performance in universalizing the small family norm Achieving reductions in IMR, CBR and promoting literacy Reward to BPL Couples Who marry after the legal age of marriage, Register the marriage, SIHFW: an ISO 9001: 2008 certified Institution 34

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Have first child after age of 21 Accept the SFN, Adopt a terminal method after the birth of the second child, Promotion of survival and care of the girl child, Rs. 500 is awarded at the birth of the girl child Maternity Benefit Scheme A Family Welfare-linked Health Insurance Plan Crèches and child care centers A wider, affordable accessible choice of contraceptives Facilities for safe abortion

National Policy for Children:

National Policy for Children SIHFW: an ISO 9001: 2008 certified Institution 36

Child Welfare: Milestones:

Child Welfare: Milestones UN Convention on the Rights of the Child on 11 th Dec., 1992 The National Policy for Children Aug. 22,1974 UN Millennium Summit - MDG Sep. 30, 2000 National Charter for Children, Feb. 2004 National Plan of Action for Children 2005 The Commissions for Protection of the Child Rights Act 2005 SIHFW: an ISO 9001: 2008 certified Institution 37

National Children Policy, 1974:

National Children Policy, 1974 Policy Measures Services before and after birth Comprehensive health services Nutrition services Free and compulsory education till 14 years Informal education to drop outs Equal opportunity to weaker sections, physically challenged and delinquent children Protection against neglect, cruelty and exploitation No child <14 engaged in hazardous occupation SIHFW: an ISO 9001: 2008 certified Institution 38

National Charter for Children, 2003:

National Charter for Children, 2003 Free & compulsory education to all children (6-14) No child <14 years - in hazardous employment Promoting High Standards of Health and Nutrition Assuring Basic Minimum Needs and Security Protection from Economic Exploitation and All Forms of Abuse SIHFW: an ISO 9001: 2008 certified Institution 39

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Protection of the Girl Child Empowering Adolescents Equality - Expression, Seek and Receive Information, Association and Peaceful Assembly Protection of Children with Disabilities Family support – care, love, play, survival, growth, development

National Plan of Action for Children 2005 :

National Plan of Action for Children 2005 Reduce IMR to < 30 by 2010. Reduce CMR to < 31 by 2010. Reduce MMR to <100 by 2010. Universal equitable access and use of safe drinking water, Improved access to sanitary means of excreta disposal by 2010. 100% rural population to have access to basic sanitation by 2012. SIHFW: an ISO 9001: 2008 certified Institution 41

National Plan of Action for Children 2005 :

National Plan of Action for Children 2005 Eliminate child marriages by 2010 Eliminate disability due to poliomyelitis by 2007 To reduce the proportion of infants infected with HIV by 20 % by 2007 and 50 % by 2010, Ensuring ANC to 80 % Ensure 95 % of men and women aged 15-24 have access to care, counseling ,other HIV and prevention services. SIHFW: an ISO 9001: 2008 certified Institution 42

National Policy for Persons with Disabilities, 2006 :

National Policy for Persons with Disabilities, 2006 Focus on- Prevention of Disabilities and Rehabilitation Measures Salient features Physical Rehabilitation Educational Rehabilitation, vocational training and Economic Rehabilitation Special focus on women and children with disabilities SIHFW: an ISO 9001: 2008 certified Institution 43

National Policy for Persons with Disabilities, 2006 :

National Policy for Persons with Disabilities, 2006 Focus on- Prevention of Disabilities and Rehabilitation Measures Salient features Physical Rehabilitation Educational Rehabilitation, vocational training and Economic Rehabilitation Special focus on women and children with disabilities SIHFW: an ISO 9001: 2008 certified Institution 44

National Policy for Empowerment of Women:

National Policy for Empowerment of Women V- FYP - shift from Women welfare to women development and empowerment Mexico plan of Action (1975), Nairobi forward-looking strategies (1985), National Commission for Women (1990) Convention on Elimination of All forms of Discrimination Against Women, 1993 International Conference on Population and Development (ICPD), Cairo (1994) Beijing Declaration and Platform for Action (1995) SIHFW: an ISO 9001: 2008 certified Institution 45

Objectives:

Objectives Broad Objective To bring about the advancement, development and empowerment of Women SIHFW: an ISO 9001: 2008 certified Institution 46

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Specific Objectives Creating an environment - positive economic and social policies Enjoyment of all human rights Equal access to Participation and decision making Health care Education Employment, remuneration Occupational health & safety Social security And public office. SIHFW: an ISO 9001: 2008 certified Institution 47

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Strengthening of legal systems Changing societal attitude & community practices by participation Mainstreaming gender perspective. Elimination of discrimination and all kind of violence Building & strengthening of partnerships with civil society SIHFW: an ISO 9001: 2008 certified Institution 48

Policy Prescriptions:

Policy Prescriptions Legal-judicial system will be made more responsive and gender sensitive Equality in power sharing and active participation in decision making Mainstreaming a Gender Perspective in the Development Process Economic & Social Empowerment of women SIHFW: an ISO 9001: 2008 certified Institution 49

Institutional Mechanisms:

Institutional Mechanisms National and State Councils National and State Resource Centres Strengthen Self-Help Groups (SHGs) Women’s Component Plan adopted in IX FYP Channelize private sector investments Reviewing and strengthening legal system SIHFW: an ISO 9001: 2008 certified Institution 50

National Nutrition Policy-1993:

National Nutrition Policy-1993 SIHFW: an ISO 9001: 2008 certified Institution 51

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It advocates a comprehensive inter- sectoral strategy- For alleviating all the multi-faceted problems of under/malnutrition and its related deficiencies and diseases To achieve an optimal state of nutrition for all sections of society Special priority for women, mothers and children SIHFW: an ISO 9001: 2008 certified Institution 52

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Intervention programmes to combat malnutrition Integrated Child Development Programme-1975 Special Nutrition Programme-1970-71 Balwadi Nutrition Programme -1991-1992 Wheat Based Supplementary Nutrition Programme-1986 Mid Day Meal Programme-1962-63 Nutritional Anemia Prophylaxis Programme-1970 Goiter Control Programme-1962 National Diarrheal Disease Control Programme-1981 SIHFW: an ISO 9001: 2008 certified Institution 53

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The strategies adopted in the Ninth Plan include – Screening of all pregnant women and lactating mothers for chronic energy deficiency (CED) Identifying women with weight below 40 kg and providing adequate ante-natal, intra-partum and neo-natal care under the RCH programme Ensuring they receive food supplementation through the Integrated Child Development Services (ICDS) Scheme. SIHFW: an ISO 9001: 2008 certified Institution 54

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Pradhan Mantri Gramodaya Yojana (PMGY) to prevent the onset of under-nutrition in the age-group 6-24 months. Supplementary nutrition provided to 105 million school-going children under the National Programme of Nutritional Support to Primary Education (also popularly known as Mid-Day Meals Programme). SIHFW: an ISO 9001: 2008 certified Institution 55

National Blood Policy-2003:

National Blood Policy-2003 SIHFW: an ISO 9001: 2008 certified Institution 56

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Need of Blood Policy- For quality, safety and efficacy of blood and blood products, Well-equipped blood centers with adequate infrastructure and trained manpower For effective clinical use of blood, To attain maximum safety, the requirements of good manufacturing practices and implementation of quality system SIHFW: an ISO 9001: 2008 certified Institution 57

Policy Aim:

Policy Aim To ensure easily accessible and adequate supply of safe and quality blood and blood components To collect/procure blood free from transfusion transmitted infections , which stored and transported under optimum conditions. Ensure Transfusion under supervision of trained personnel Total quality management approach to be ensured under the policy. SIHFW: an ISO 9001: 2008 certified Institution 58

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To achieve the above aim, the following objectives are drawn: To reiterate firmly the Govt. commitment to provide safe and adequate quantity of blood, blood components and blood products. To make latest technology, adequate resources available for operating the blood transfusion services. To encourage appropriate clinical use of blood and blood products. To strengthen the manpower through human resource development. SIHFW: an ISO 9001: 2008 certified Institution 59

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To launch extensive awareness programmes for donor information, education, motivation, recruitment and retention in order to ensure adequate availability of safe blood. To encourage Research & Development in the field of Transfusion Medicine and related technology. To take adequate regulatory and legislative steps for monitoring and evaluation SIHFW: an ISO 9001: 2008 certified Institution 60

Health legislations in India :

Health legislations in India SIHFW: an ISO 9001: 2008 certified Institution 61

Pre-conception and pre-natal diagnostic techniques (PCPNDT) Act:

Pre-conception and pre-natal diagnostic techniques (PCPNDT) Act Made in 1994 Regulates and prevents misuse of the diagnostic techniques. Amended again in 2003. SIHFW: an ISO 9001: 2008 certified Institution 62

Aim:

Aim Prohibition of sex selection, Regulation of pre-natal diagnostic techniques for the purposes of detecting- Genetic abnormalities or Metabolic disorders or Chromosomal abnormalities or Certain congenital malformations or Sex-linked disorders SIHFW: an ISO 9001: 2008 certified Institution 63

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When its becomes an offence ? Service provider violating the Act. Service seeker (woman compelled to undergo the test is not punishable). Advertiser of these techniques. Complaints procedure Written complaint to Appropriate Authority. AA to act within 15 days. Delayed action to be addressed through judiciary. SIHFW: an ISO 9001: 2008 certified Institution 64

An offence under the PCPNDT Act is cognizable, non- bailable and non-compoundable. :

An offence under the PCPNDT Act is cognizable, non- bailable and non-compoundable . First offence Subsequent offence Service provider Imprisonment (3yrs.); penalty (Rs.10000); registration cancelled (5 yrs.) Imprisonment (5yrs.); penalty (Rs.50000); registration cancelled (permanently.) Service seeker Imprisonment (3 yrs.); penalty (Rs. 50000) Imprisonment (5 yrs.); penalty (Rs. 100000); Advertiser Imprisonment (3 yrs.); penalty (Rs. 10000) SIHFW: an ISO 9001: 2008 certified Institution 65

Structure of Implementing Machinery:

Structure of Implementing Machinery SIHFW: an ISO 9001: 2008 certified Institution 66

Anti-Tobacco Act:

Anti-Tobacco Act SIHFW: an ISO 9001: 2008 certified Institution 67

The Tobacco Menace in India:

The Tobacco Menace in India 800,000 deaths every year 150,000 cancers per year 4.2 million heart diseases 3.7 million lung diseases in every year It kills more people than AIDS, alcohol, cocaine, homicide, suicide, motor vehicle crashes, and fires combined! SIHFW: an ISO 9001: 2008 certified Institution 68

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55,000 children every day start using tobacco 5 million children <15 addicted to tobacco school students (10%-40%), college students (40%-70%) chew gutka & paan masala SIHFW: an ISO 9001: 2008 certified Institution 69

Aim of Anti-Tobacco legislation:

Aim of Anti-Tobacco legislation Ban advertisements on tobacco products Ban smoking in public places Prohibit sale of cigarettes to minors. Anti-tobacco health education in schools and colleges Higher taxes on tobacco products Health warnings on the packaging and labeling Penal provisions Discontinue direct and indirect subsidies and financial incentives SIHFW: an ISO 9001: 2008 certified Institution 70

Legislations related to Health in General :

Legislations related to Health in General The Epidemic Diseases Act, 1897 Indian Air Craft (Public Health) Rules, 1954 The Registration of Births and Deaths Act, 1969 The Persons with Disabilities (Equal Opportunity, Protection Of Rights And Full Participation) Act, 1995 The Biomedical Waste (Management And Handling Rules 1998) Act SIHFW: an ISO 9001: 2008 certified Institution 71

Legislation related to Women Health :

Legislation related to Women Health Hindu Marriage Act, 1955 The Special Marriage Act, 1954 Hindu Succession Act, 1956 The Maternity Benefits Act, 1961 The Dowry Prohibition Act, 1961 Hindu Adoption and Maintenance Act, 1956 The Immoral Traffic (Prevention) Act, 1956; amended in 1986 MTP Act 1971(The MTP Rules, 1975) SIHFW: an ISO 9001: 2008 certified Institution 72

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The Protection of Women against Sexual Harassment At Work Place Bill, 2007 Protection of Women from Domestic Violence Act,2005, (Come into Force on 26/10/2006) Protection of Women from Domestic Violence Act, 2005 Dowry Prohibition Act, 1961 Dowry Prohibition Rules National Commission for Women Act SIHFW: an ISO 9001: 2008 certified Institution 73

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The Pre-natal Diagnostic Techniques (Regulation & Prevention of misuse) Act, 1994 Rules, November 26, 1996, 2003 Indecent Representation of Women The Commission of Sati (Prevention) Act and rules Amendment Proposed in Immoral Traffic (Prevention) Act 1956 The Immoral Traffic (Prevention) Amendment Bill, 2006 SIHFW: an ISO 9001: 2008 certified Institution 74

Legislations related to Child Health :

Legislations related to Child Health The Child Marriage Restraint Act, 1929 Children Act, 1960 The Juvenile Justice Act, 1986 The Child Labor (Prohibition and Regulation) Act, 1986 Infant Milk substitute Act, 1992 The Juvenile Justice (Care and Protection of Children) Amendment Act 2006 The Juvenile Justice (Care and Protection of Children) Act 2000 SIHFW: an ISO 9001: 2008 certified Institution 75

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The Juvenile Justice (Care and Protection of Children) Rules The Commissions for Protection of Child Rights Act, 2005 , 2006 National Commission for protection of Child Rights Rules,2006, The Child Marriage Restraint Act, 1929 The Prohibition of Child Marriage Act, 2006 The infant Milk Substitutes, Feeding Bottles and infant Foods (Regulation of Production, Supply and Distribution) Act, 1992 , 2003 SIHFW: an ISO 9001: 2008 certified Institution 76

Legislations related to Environment :

Legislations related to Environment Factory Act, 1947 The Atomic energy Act, 1962 The Insecticides Act, 1968 The Wild Life (Protection) Act 1972 The Indian Forest Act, 1972 The Water (Prevention and Control of Pollution) Act, 1974 SIHFW: an ISO 9001: 2008 certified Institution 77

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The Forest (Conservation) Act, 1980 The Air (Prevention and Control of Pollution) Act, 1981 The Environmental (Protection) Act, 1986 The Motor Vehicle Act, 1988 The Natural Environment Tribunal Act, 1995

Legislations related to Occupation :

Legislations related to Occupation The Workmen’s Compensation Act, 1923 (Amended In 1984) The Trade Union Act 1926 The Factories Act, 1948, The Employees States Insurance Act, 1948 The Plantation Labor Act, 1951 Mines Act, 1952 Plantation Labor Act, 1951 The Employee State Insurance Act, 1948 The Consumer Protection Act (CPA) 1986 SIHFW: an ISO 9001: 2008 certified Institution 79

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The Factories (Amendment) Act, 1976 The Dangerous Machine (Regulation) Act, 1983 Legislations related to Human rights The Equal Remuneration Act, 1976 The Contract Labor (Regulation and Abortion) Act ,1976 Indecent Representation of Women (Prohibition) Act, 1986 The Commission on Sati (Prevention) Act, 1987 The Minimum Wages Act, 1948 SIHFW: an ISO 9001: 2008 certified Institution 80

Legislations related to Medical Profession :

Legislations related to Medical Profession The Indian Nursing Council Act 1947 The Dentists Act 1948 The Pharmacy Act 1948 The Indian Medical Council Act, 1956 (Amended in 1964, 1993) SIHFW: an ISO 9001: 2008 certified Institution 81

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Thank You For more details log on to www. sihfwrajasthan.com or contact : Director-SIHFW on sihfwraj@yahoo.co.in

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