CARL E. TAYLOR AND CECILE DE SWEEMER
Narangwal was the base for longitudinal field research that contributed to international understanding of how primary health care, family planning, and nutrition services can be provided for village people. For about thirteen years, the Rural Health Research Centre of the Indian Council of Medical Research and Johns Hopkins University's Department of International Health was located in Narangwal, a village with a population of about 1,800 located in Ludhiana District of the Indian Punjab. The project worked in twenty-six villages with a population of 35,000 distributed according to a controlled experimental design in three community development blocks with a population of over 300,000.
During the period of the Narangwal studies, the Punjab experienced dramatic social and economic change. Ludhiana District was one of the main centres of the Green Revolution of the 1960s, and, within five years, agricultural production doubled. Sudden affluence produced dramatic social change. Insatiable demand for education led to primary schools in every village and high schools and rural colleges within easy transportation range.
Rapid economic progress in the villages produced secondary improvement in patterns of health care. Starting in the 1950s the government promoted rural health services in community development blocks serving about 100,000 people. Each block had a primary health centre with at least one doctor and forty to fifty auxiliaries. Sub-centres served a population of about 5,000 and were staffed by an auxiliary nurse midwife (ANM). All services were supposed to be free, but the tremendous increase in government health personnel left little money for drugs and supplies. Filling out over thirty forms a month took up as much as 45 per cent of working time as documented in work-sampling studies ( Johns Hopkins University 1976).