Recent updates (24th Edition of Park)

History of medicine

SDGs – 17 goals / 2030

Sustainable Development Goals

The Sustainable Development Goals (SDGs) are a proposed set of targets relating to
future international development. They are to replace the Millennium Development Goals once they
expire at the end of 2015. The SDGs were first formally discussed at the United Nations Conference on
Sustainable Development held in Rio de Janeiro in June 2012 (Rio+20).
One of the main outcomes of the Rio+20 Conference was the agreement by member
States to launch a process to develop a set of Sustainable Development Goals (SDGs), which will build
upon the Millennium Development Goals and converge with the post 2015 development agenda.
July 2014, the UN General Assembly's Open Working Group on Sustainable
Development Goals (OWG) forwarded a proposal for the SDGs to the Assembly. The proposal
contained 17 goals with 169 targets covering a broad range of sustainable development issues.
December 2014, the UN General Assembly accepted the Secretary-General's
Synthesis Report which stated that the agenda for the post-2015 SDG process would be based on the
OWG proposals

Goal 1 End poverty in all its forms everywhere

Goal 2 End hunger, achieve food security and improved nutrition and promote sustainable
agriculture

Goal 3 Ensure healthy lives and promote well-being for all at all ages

Goal 4 Ensure inclusive and equitable quality education and promote lifelong learning opportunities
for all

Goal 5 Achieve gender equality and empower all women and girls

Goal 6 Ensure availability and sustainable management of water and sanitation for all

Goal 7 Ensure access to affordable, reliable, sustainable and modern energy for all

Goal 8 Promote sustained, inclusive and sustainable economic growth, full and productive
employment and decent work for all

Goal 9 Build resilient infrastructure, promote inclusive and sustainable industrialization and foster
innovation

Goal 10 Reduce inequality within and among countries

Goal 11 Make cities and human settlements inclusive, safe, resilient and sustainable

Goal 12 Ensure sustainable consumption and production patterns

Goal 13 Take urgent action to combat climate change and its impacts

Goal 14 Conserve and sustainably use the oceans, seas and marine resources for sustainable
development

Goal 15 Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage
forests, combat desertification, and halt and reverse land degradation and halt biodiversity
loss

Goal 16 Promote peaceful and inclusive societies for sustainable development, provide access to
justice for all and build effective, accountable and inclusive institutions at all levels

Goal 17 Strengthen the means of implementation and revitalize the global partnership for sustainable
development
Concept f Health & Disease

Global reference list of Core health indicators (100) – Page 28

Relating to goals of SDGs

Set of 100 indicators prioritized by global community to provide concise information on health
situation at national & international levels

Health status indicators

Mortality by age and sex
• Life expectancy at birth
• Adult mortality rate between 15 and 60 years of age
• Under-five mortality rate
• Infant mortality rate
• Neonatal mortality rate
• Stillbirth rate

Mortality by cause
• Maternal mortality ratio
• TB mortality rate
• AIDS-related mortality rate
• Malaria mortality rate
• Mortality between 30 and 70 years of age from cardiovascular diseases,
• cancer, diabetes or chronic respiratory diseases
• Suicide rate
• Mortality rate from road traffic injuries

Fertility
• Adolescent fertility rate
• Total fertility rate

Morbidity
• New cases of vaccine-preventable diseases
• New cases of IHR-notifiable diseases and other notifiable diseases
• HIV incidence rate
• HIV prevalence rate
• Hepatitis B surface antigen prevalence
• Sexually transmitted infections (STIs) incidence rate
• TB incidence rate
• TB notification rate
• TB prevalence rate
• Malaria parasite prevalence among children aged 6–59 months
• Malaria incidence rate
• Cancer incidence, by type of cancer
Risk factors indicators
Nutrition
• Exclusive breastfeeding rate 0–5 months of age
• Early initiation of breastfeeding
• Incidence of low birth weight among newborns
• Children under 5 years who are stunted
• Children under 5 years who are wasted
• Anaemia prevalence in children
• Anaemia prevalence in women of reproductive age

Infections
• Condom use at last sex with high-risk partner

Environmental risk factors

• Population using safely managed drinking-water services
• Population using safely managed sanitation services
• Population using modern fuels for cooking/heating/lighting
• Air pollution level in cities

Non-communicable diseases
• Total alcohol per capita (age 15+ years) consumption
• Tobacco use among persons aged 18+ years
• Children aged under 5 years who are overweight
• Overweight and obesity in adults (Also: adolescents)
• Raised blood pressure among adults
• Raised blood glucose/diabetes among adults
• Salt intake
• Insufficient physical activity in adults (Also: adolescents)

Injuries
• Intimate partner violence prevalence

Service coverage indicators

Reproductive, maternal, newborn, child and adolescent
• Demand for family planning satisfied with modern methods
• Contraceptive prevalence rate
• Antenatal care coverage
• Births attended by skilled health personnel
• Postpartum care coverage
• Care-seeking for symptoms of pneumonia
• Children with diarrhoea receiving oral rehydration solution (ORS)
• Vitamin A supplementation coverage
Immunization
• Immunization coverage rate by vaccine for each vaccine in the national schedule

HIV
• People living with HIV who have been diagnosed
• Prevention of mother-to-child transmission
• HIV care coverage
• Antiretroviral therapy (ART) coverage
• HIV viral load suppression

HIV/TB
• TB preventive therapy for HIV-positive people newly enrolled in HIV care
• HIV test results for registered new and relapse TB patients
• HIV-positive new and relapse TB patients on ART during TB treatment

Tuberculosis
• TB patients with results for drug susceptibility testing
• TB case detection rate
• Second-line treatment coverage among multidrug-resistant tuberculosis (MDR-TB)
cases

Malaria
• Intermittent preventive therapy for malaria during pregnancy (IPTp)
• Use of insecticide treated nets (ITNs)
• Treatment of confirmed malaria cases
• Indoor residual spraying (IRS) coverage

Neglected tropical diseases

• Coverage of preventive chemotherapy for selected neglected tropical diseases

Screening and preventive care

• Cervical cancer screening

Mental Health
• Coverage of services for severe mental health disorders

Health systems indicators

Quality and safety of care
• Perioperative mortality rate
• Obstetric and gynaecological admissions owing to abortion
• Institutional maternal mortality ratio
• Maternal death reviews
• ART retention rate
• TB treatment success rate
• Service-specific availability and readiness
Access
• Service utilization
• Health service access
• Hospital bed density
• Availability of essential medicines and commodities

Health workforce
• Health worker density and distribution
• Output training institutions

Health information
• Birth registration coverage
• Death registration coverage
• Completeness of reporting by facilities

Health financing
• Total current expenditure on health (% of gross domestic product)
• Current expenditure on health by general government and compulsory schemes
• (% of current expenditure on health)
• Out-of-pocket payment for health (% of current expenditure on health)
• Externally sourced funding (% of current expenditure on health)
• Total capital expenditure on health (% current + capital expenditure on health)
• Headcount ratio of catastrophic health expenditure
• Headcount ratio of impoverishing health expenditure

Health security
• International Health Regulations (IHR) core capacity index

ICD – 11 (Due in 2018)

The International Classification of Functioning, Disability & Health (ICF) – Page 55

The ICF is a framework for organizing & documenting information of functioning & disability

It provides a standard language and conceptual basis for the definition and measurement of disability
and also classification & codes

It organizes information in two parts

Part 1 - Functioning & disability
Body function & body structure
Activities and participation

Part 2 – Contextual factors

Environmental factors
Personal factors
It is used as a holistic approach to management of patients which can result
• Better patient experience
• A bio-psycho-social-spiritual approach to patient care
• Improved health outcomes
• Strengthening of health system

Immunization (UIP)

Open vial policy – 2015

• For DPT, TT, Hepatitis B, OPV & Liquid Pentavalent – upto 28 days
• Not applicable to BCG, Measles & JE vaccine
• BCG & Measles – 4 hrs & JE – 2 hrs after reconstitution discarded

Shake test

The shake test is how you check whether freeze-sensitive vaccines (pentavalent, PCV10, TT or HepB)
have been subjected to freezing temperatures, which are likely to have damaged them. To perform the
shake test, follow the steps below:

Step 1 — Prepare a frozen control vial: Take a vial of vaccine of the same type and batch number as the
vaccine you want to test, and from the same manufacturer. Freeze the vial until the contents are solid (at
least 10 hours at –10°C) and then let it thaw. This is the frozen control vial (the middle vial in Figure
6.10). Mark the vial clearly so that it is easily identifiable and will not be used by mistake.

Step 2 — Choose a test vial: Take a vial (or vials) of vaccine from the batch that you suspect has been
frozen. This is the suspected frozen test vial (on the left in Figure 6.10).

Step 3 — Shake the control and test vials: Hold the frozen control vial and the suspected frozen test vial
together in one hand and shake them vigorously for 10–15 seconds.

Step 4 — Allow the vials to rest: Leave both vials to rest by placing them on a table side by side and not
moving them further. A freeze-sensitive vaccine that has not been frozen appears as a uniformly cloudy
liquid (see the vial on the right in Figure 6.10). After freezing, the vaccine tends to form flakes that
quickly settle at the bottom of the vial to form a sediment when you leave it to rest after vigorous
shaking. The speed at which the flakes settle is called the sedimentation rate. Note that some vials have
large labels that conceal the vial contents. This makes it difficult to see the sedimentation process. In
such cases, turn the control and test vials upside down and observe sedimentation taking place in the
neck of the vials.

Step 5 — Compare the vials: Observe the difference in sedimentation rates in the frozen control and
suspected frozen test vials for a maximum of 30 minutes. View both vials against the light to compare
the sedimentation rate. If the vaccine in the suspected test vial shows a much slower sedimentation rate
than the vaccine in the frozen control vial, you can conclude that the test vaccine has most probably not
been frozen and can be used.
JE vaccine
• UP, WB, Karnataka, Assam & Bihar
• 1st dose – 9-12 months
• 2nd dose – 16-24 months
• 0.5 ml SC Left upper arm
• Diluent used – Phosphate buffer
• Maximum age – 15 years

Rotavirus vaccine
• Andhra Pradesh, Haryana, Himachal Pradesh and Odisha (26th Mar 2016)
• Expanded in phase wise manner
• 3 doses – 6,10 & 14 weeks
• 5 drops – oral
• Maximum age – Till 1 year
Pentavalent vaccine
• 3 doses – 6,10 & 14 weeks
• IM – 0.5 ml at Anterolateral side of mid thigh (Left)
• Maximum age – Till 1 year
• Booster 1 - 16-24 months - DPT - IM 0.5 ml at Anterolateral side of mid thigh (Left)
• Booster 2 – DPT – 0.5 ml IM Left Upper arm

IPV
• One dose at 14 weeks
• 0.5 ml IM Anterolateral side of mid thigh (Right)
• Upto 1 yr age

Communicable diseases

Ending preventable child deaths from pneumonia and diarrhoea by 2025

The Integrated Global Action Plan for prevention & control of Pneumonia & Diarrhoea (GAPPD)

Goals by 2025:
• reduce mortality from pneumonia in children less than 5 years of age to fewer than 3
per 1000 live births;
• reduce mortality from diarrhoea in children less than 5 years of age to fewer than 1
per 1000 live births;
• reduce the incidence of severe pneumonia by 75% in children less than 5 years of age
compared to 2010 levels;
• reduce the incidence of severe diarrhoea by 75% in children less than 5 years of age
compared to 2010 levels; reduce by 40% the global number of children less than 5
years of age who are stunted compared to 2010 levels.

Coverage targets: to achieve these goals, the following targets will need to be maintained or reached

By the end of 2025:

• 90% full-dose coverage of each relevant vaccine (with 80% coverage in every
district);
• 90% access to appropriate pneumonia and diarrhoea case management (with 80%
coverage in every district);
• at least 50% coverage of exclusive breastfeeding during the first 6 months of life;
• virtual elimination of paediatric HIV.

By the end of 2030:

• universal access to basic drinking-water in health care facilities and homes;
• universal access to adequate sanitation in health care facilities by 2030 and in
homes by 2040;
• universal access to handwashing facilities (water and soap) in health care facilities
and homes;
• universal access to clean and safe energy technologies in health care facilities and
homes.
Tuberculosis

For year 2014

Incidence of TB = 167 per 100000 population
Prevalence of TB = 195 per 100000 population
TB death rate = 17 per 100000 population
MDR TB: New = 2.2% & Retreatment = 15%

New guidelines 2016 – Daily regimen

• Daily medicine
• Dosing according to four weight bands (25-39 kg / 40-54 kg / 55-69 kg / > 70 kg)
• Fixed drug combinations (single tablet contains all 4 drugs)
• HRE in continuation phase (not HR)

Treatment categories
n Cat 1 – New patients
IP – 2 HRZE / CP – 4 HRE

n Cat 2 – Retreatment
IP – 2 HRZES / 1 HRZE / CP – 5 HRE

Weight Number of tablets to be consumed Inj.

category Streptomycin
Intensive phase Continuation phase (gm)
HRZE HRE
75/150/400/275 mg 75/150/275 mg per
per tab tab
25-39 kg 2 2 0.50

40-54 kg 3 3 0.75

55-69 kg 4 4 1

≥70 5 5 1

The End TB strategy

Vision - A world free of TB. Zero deaths, disease and suffering due to TB.

Goal - End the global tuberculosis epidemic.

Indicators
• 95% reduction by 2035 in number of TB deaths compared with 2015.
• 90% reduction (< 10/100000) by 2035 in TB incidence rate compared with 2015.
• Zero TB-affected families facing catastrophic costs due to TB by 2035.
Principles
1. Government stewardship and accountability, with monitoring and evaluation.
2. Strong coalition with civil society organizations and communities.
3. Protection and promotion of human rights, ethics and equity.
4. Adaptation of the strategy and targets at country level, with global collaboration.

Pillars and components

1. Integrated, patient-centered care and prevention.
• Early diagnosis of tuberculosis including universal drug-susceptibility testing, and
systematic screening of contacts and high-risk groups.
• Treatment of all people with tuberculosis including drug-resistant tuberculosis,
and patient support.
• Collaborative tuberculosis/HIV activities, and management of co-morbidities.
• Preventive treatment of persons at high risk, and vaccination against tuberculosis.

2. Bold policies and supportive systems.

• Political commitment with adequate resources for tuberculosis care and
prevention.
• Engagement of communities, civil society organizations, and public and private
care providers.
• Universal health coverage policy, and regulatory frameworks for case
notification, vital registration, quality and rational use of medicines, and infection
control.
• Social protection, poverty alleviation and actions on other determinants of
tuberculosis.

3. Intensified research and innovation.

• Discovery, development and rapid uptake of new tools, interventions and
strategies.
• Research to optimize implementation and impact, and promote innovations.

Global Plan Targets – 90-90-90 targets

• Reach 90% of all people with TB and place all of them on appropriate therapy -
first line, second line or preventative TB therapy.
• As part of this approach reach at least 90% of the key populations who are
the most vulnerable and under served at risk populations.
• Achieve at least 90% treatment success for all people diagnosed with TB
through affordable treatment services along with adherence and social support.
Polio Eradication and Endgame Strategic Plan 2013-18

Objective 2 of the Endgame Plan calls for the introduction of at least one dose of
inactivated polio vaccine (IPV) into routine immunization schedules by the end of 2015, strengthened
routine immunization services, and withdrawal of oral polio vaccine (OPV) in a phased manner, starting
with the switch from trivalent to bivalent OPV in April 2016.

April 25, 2016: “National Switch Day”

• In routine immunization, tOPV à bOPV
• With OPV3, IPV one dose
• All tOPV vaccines will be destroyed.
• Type 2 virus will also be destroyed in all laboratories (except NIV, Pune)
Malaria (2015) Dengue (2014) JE (2015)
1.13 million cases Cases = 40425 Cases – 8079
287 deaths Deaths = 131 Deaths - 1112
67% Pf cases
API – 0.9 / ABER – 9.6%

National Framework for Malaria Elimination in India (2016-2030) (Page 434)

VISION
Eliminate malaria nationally and contribute to improved health, quality of life and alleviation of poverty.

GOALS
In line with the WHO Global Technical Strategy for Malaria 2016–2030 (GTS) and the Asia Pacific
Leaders Malaria Alliance Malaria Elimination Roadmap, the goals of the National Framework for
Malaria Elimination in India 2016–2030 are:.
• Eliminate malaria (zero indigenous cases) throughout the entire country by 2030;
and
• Maintain malaria–free status in areas where malaria transmission has been
interrupted and prevent re-introduction of malaria.

OBJECTIVES
The Framework has four objectives:
• Eliminate malaria from all 26 low (Category 1) and moderate (Category 2)
transmission states/union territories (UTs) by 2022;
• Reduce the incidence of malaria to less than 1 case per 1000 population per year
in all states and UTs and their districts by 2024;
• Interrupt indigenous transmission of malaria throughout the entire country,
including all high transmission states and union territories (UTs) (Category 3) by
2027; and
• Prevent the re-establishment of local transmission of malaria in areas where it has
been eliminated and maintain national malaria-free status by 2030 and beyond.

No. Categories of states/UTs Definition

Category Phase
Category 0 Prevention of re-establishment phase States/UTs with zero indigenous cases of
malaria
Category 1 Elimination phase States/UTs including their districts reporting an
API < 1/1000.
Category 2 Pre-elimination phase States/UTs with an API < 1/1000 but some of
their districts are reporting an API > 1/1000

Category 3 Intensified control phase States/UTs with an API > 1/1000

Zika virus disease

Key facts
• Zika virus disease is caused by a virus transmitted primarily by Aedes
mosquitoes.
• People with Zika virus disease can have symptoms including mild fever, skin
rash, conjunctivitis, muscle and joint pain, malaise or headache. These symptoms
normally last for 2–7 days.
• There is scientific consensus that Zika virus is a cause of microcephaly and
Guillain-Barré syndrome. Links to other neurological complications are also
being investigated.

Introduction
• Zika virus is a mosquito-borne flavivirus that was first identified in Uganda in
1947 in monkeys through a network that monitored yellow fever.
• In July 2015 Brazil reported an association between Zika virus infection and
Guillain-Barré syndrome.
• In October 2015 Brazil reported an association between Zika virus infection and
microcephaly

Signs and symptoms

• The incubation period - few days.
• The symptoms are similar to other arbovirus infections such as dengue, and
include fever, skin rashes, conjunctivitis, muscle and joint pain, malaise, and
headache.
• These symptoms are usually mild and last for 2–7 days.

Transmission
• Bite of infected Aedes mosquitoes (usually bite during the day, peaking during
early morning and late afternoon/evening).
• Sexual transmission of Zika virus is also possible.
• Other modes of transmission such as blood transfusion are being investigated.

Diagnosis
• Infection with Zika virus may be suspected based on symptoms and recent history
of travel (e.g. residence in or travel to an area with active Zika virus
transmission).
• A diagnosis of Zika virus infection can only be confirmed through laboratory tests
on blood or other body fluids, such as urine, saliva or semen.

Treatment
• Zika virus disease is usually mild and requires no specific treatment.
• Symptomatic treatment - plenty of rest, drink enough fluids, and treat pain and fever
with common medicines.
• If symptoms worsen, they should seek medical care and advice. There is currently no
vaccine available.
Prevention
Mosquito bites
• Protection against mosquito bites - wearing clothes (preferably light-coloured) that
cover as much of the body as possible; using physical barriers such as window
screens or closing doors and windows; sleeping under mosquito nets; and using insect
repellent containing DEET, IR3535 or icaridin according to the product label
instructions.
• Special attention and help should be given to those who may not be able to protect
themselves adequately, such as young children, the sick or elderly.
• Travellers and those living in affected areas should take the basic precautions
described above to protect themselves from mosquito bites.
• To cover, empty or clean potential mosquito breeding sites in and around houses
such as buckets, drums, pots, gutters, and used tyres.
• Health authorities may also advise that spraying of insecticides be carried out

Sexual transmission
• Safer sex (including using condoms) or abstain from sexual activity throughout
the pregnancy.
• People returning from areas where local transmission of Zika virus occurs should
adopt safer sexual practices or abstain from sex for at least 8 weeks after their
return, even if they don’t have symptoms.
• Those planning a pregnancy should wait at least 8 weeks before trying to
conceive if no symptoms of Zika virus infection appear, or 6 months if one or
both members of the couple are symptomatic

WHO response
WHO is supporting countries to control Zika virus disease by taking actions outlined in the “Zika
Strategic Response Framework”:
• Define and prioritize research into Zika virus disease by convening experts and
partners.
• Enhance surveillance of Zika virus and potential complications.
• Strengthen capacity in risk communication to engage communities to better
understand risks associated with Zika virus.
• Strengthen the capacity of laboratories to detect the virus.
• Support health authorities to implement vector control strategies aimed at
reducing Aedes mosquito populations.
• Prepare recommendations for the clinical care and follow-up of people with
complications related to Zika virus infection, in collaboration with experts and
other health agencies
HIV AIDS (2015)
No. of PLWHA – 36.7 million
People new infected – 2.1 million
AIDS related deaths – 1.1 million

HIV prevalence in high risk groups (2014-15)

IDU – 9.9%
TG – 8.8%
MSM – 4.3%
Truck drivers – 2.59%
FSW – 2.2%
Migrants – 0.99%

ANC – 0.29%

HIV/AIDS: WHO RECOMMENDATIONS ON ART (2016): Page 370

• Start ART to all patients (any clinical stage & any CD4 count) with priority to those with
Clinical stage 3 or 4 or CD4≤350 cells/mm3
• All pregnant & lactating women to start ART irrespective of clinical stage & CD4 count &
should continue it lifelong
• First line therapy: 1 NNRTI + 2 NRTIs (including Zidovudine/Tenofovir)
TLE (Tenofovir + Lamivudine + Efavirenz)
• Second line therapy: PI + 2NRTIs (including Zidovudine/Tenofovir)

Chapter – Demography & Family planning

World population reached 7th billion – 2014 (8th billion expected by 2025)
World population – 7.4 billion / Annual growth rate – 1.2%

Demographic trends in India

• Population – 1328 million (mid 2016)
• CBR-20/1000 & CDR-7/1000 (2015)
• Sex ratio at birth – 906 females per 1000 males (2014) (Kerala – 974 & Haryana – 866)
• Density of population: no. of persons living per sq.km. - 401 (2016)
• Family size: 2.4 (2015)
• Life Expectancy: India – 67 years for males and 70 years for females. (2015)
Chapter – Maternal & Child health (Page 592)

MCH – current level of achievements

A) FP indicators-
CBR – 20 per 1000 (2015)
TFR – 2.4 (2015)
Couple protection rate – 55% (2010-15)

B) Morality indicators
IMR – 36/1000 (2015)
NMR – 28/1000 (2015)
MMR – 167/100000 (2011-13)
U5MR – 48/1000 (2015)
C) Services - % coverage
BCG – 91%
DPT3/OPV3 – 83%
HBV3 – 70% (2015)
Measles – 83%
Infants (fully immunized) – 77.3%
Pregnant women – TT – 87%

ANC visits - At least once – 74%

At least 4 – 45% (2010-15)
Institutional deliveries – 79%
Deliveries by trained personal- 52%

D) Prevalence of LBW – 18.5% (2014)

The Global strategy for women’s, children’s and adolescents’ health (2016–2030)

VISION
By 2030, a world in which every woman, child and adolescent in every setting realizes their rights to
physical and mental health and well-being, has social and economic opportunities, and is able to
participate fully in shaping prosperous and sustainable societies

OBJECTIVES AND TARGETS aligned with the Sustainable Development Goals (SDGs)

SURVIVE - End preventable deaths

• Reduce global maternal mortality to less than 70 per 100,000 live births
• Reduce newborn mortality to at least as low as 12 per 1,000 live births in every country
• Reduce under-five mortality to at least as low as 25 per 1,000 live births in every country
• End epidemics of HIV, tuberculosis, malaria, neglected tropical diseases and other
communicable diseases
• Reduce by one third premature mortality from non-communicable diseases and promote mental
health and well-being
THRIVE - Ensure health and well-being
• End all forms of malnutrition and address the nutritional needs of children, adolescent girls, and
pregnant and lactating women
• Ensure universal access to sexual and reproductive health-care services (including for family
planning) and rights
• Ensure that all girls and boys have access to good-quality early childhood development
• Substantially reduce pollution-related deaths and illnesses
• Achieve universal health coverage,including financial risk protection and access to quality
essential services, medicines and vaccines

TRANSFORM - Expand enabling environments

• Eradicate extreme poverty
• Ensure that all girls and boys complete free, equitable and good-quality primary and secondary
education
• Eliminate all harmful practices and all discrimination and violence against women and girls
• Achieve universal and equitable access to safe and affordable drinking water and to adequate and
equitable sanitation and hygiene
• Enhance scientific research, upgrade technological capabilities and encourage innovation
• Provide legal identity for all, including birth registration
• Enhance the global partnership for sustainable development

MCH indicators

Maternal Mortality Rate

• India - 167 per 100000 LB (2015)
• Highest-Assam (300) / UP (285)
• Lowest - Kerala (61) / Maharashtra (68) / TN (79)
• MDG 5 -Reduce Maternal mortality by 3/4th (2015)
• MDG Target (2015) – 109
• SDG Target (2030) – < 70/100000 LB

Perinatal Mortality Rate

• India-24 per 1000 LB (2014)
• High -Orissa (33) / Chattisgarh (31)
• Low - Kerala (9)

Neonatal Mortality Rate

• India - 26 per 1000 LB (2014)
• Highest - Odisha (36) / MP (35)
• Lowest - Kerala (6)
• SDG Target (2030) – < 12/1000 LB

Post-neonatal Mortality Rate

• India - 13 per 1000 LB (2014)
• Highest - Assam (23) / MP (17)
• Low - Kerala (5) / TN (6) / Maharashtra (6)
Infant Mortality Rate
• India - 39 per 1000 (2014) / 38/1000 LB (2015)
• High - MP (52) / Assam (49)
• Low - Kerala (12) / TN (20) / Maharashtra (22)
• MDG 4 - Reduce Child mortality by 2/3rd (2015)
• MDG Target (2015) – 27

Under - 5 Mortality Rate

• U5MR (2014) – 45 per 1000 LB / 43/1000 LB (2015)
• MDG Target (2015) – 42
• SDG Target (2030) – < 25/1000 LB

Juvenile Justice (Care and Protection of Children) Act, 2015

The Act came into force from 15 January 2016
It aims to replace the existing Indian juvenile delinquency law, Juvenile Justice (Care and Protection of
Children) Act, 2000, so that juveniles in conflict with Law in the age group of 16–18, involved in
Heinous Offences, can be tried as adults.

Safe water & sanitation

People with access to safe drinking water – 94% (2015) (Page 743)
People with access to adequate sanitation – 40%

Swachh Bharat Abhiyan (2014-2019) Page no.500

"Swachh Bharat Mission" is a national campaign by the Government of India, The
campaign was officially launched on 2 October 2014.This campaign aims to accomplish the vision of a
'Clean India' by 2 October 2019, the 150th birthday of Mahatma Gandhi.
Specific objectives are
• Eliminate open defecation by constructing toilets for households, communities
• Eradicate manual scavenging
• Introduce modern and scientific municipal solid waste management practices
• Enable private sector participation in the sanitation sector
• Change people’s attitudes to sanitation and create awareness
The program plans to construct 12 crore toilets in rural India by October 2019, at a projected cost
of Rs.1.96 lakh crore
Bio-Medical Waste (Management and Handling) Rules, 2016
The Employees State Insurance Act,1948
Amendment (2010)
• From Sept 2016 – Act covers all employees getting upto Rs.21000 per month
• Employees getting daily wages of below Rs. 100 are exempted from payment of
contribution
• Maternity benefit – 26 weeks / Confinement expenses – Rs. 5000
• Funeral expenses – Rs.10000

National Health Policy – 2015 (Page 910)

Goal - The attainment of the highest possible level of good health and well-being, through a preventive
and promotive health care orientation in all developmental policies, and universal access to good
quality health care services without anyone having to face financial hardship as a consequence.

Objectives –

• Improve population health status through concerted policy action in all sectors and expand
preventive, promotive, curative, palliative and rehabilitative services provided by the public
health sector.

• Achieve a significant reduction in out of pocket expenditure due to health care costs and
reduction in proportion of households experiencing catastrophic health expenditures and
consequent impoverishment.
• Assure universal availability of free, comprehensive primary health care services, as an
entitlement, for all aspects of reproductive, maternal, child and adolescent health and for the
most prevalent communicable and non-communicable diseases in the population.

• Enable universal access to free essential drugs, diagnostics, emergency ambulance services, and
emergency medical and surgical care services in public health facilities, so as to enhance the
financial protection role of public facilities for all sections of the population.
• Ensure improved access and affordability of secondary and tertiary care services through a
combination of public hospitals and strategic purchasing of services from the private health
sector.

• Influence the growth of the private health care industry and medical technologies to ensure
alignment with public health goals, and enable contribution to making health care systems more
effective, efficient, rational, safe, affordable and ethical.

Achievements during 12th Five year plan (2012-17) (Page 915)

Total no. of districts 707

No. of Subcentres 153655
No. of Primary health centres 25308
No. of Community health centres 5396
No. of Medical colleges 404
Annual admissions to medical colleges 54348
No. of Allopathic doctors 93886
Population problems - India demographic profile at a glance (Page 931)

Criteria Figures
Total population (2015) 1311 million
Crude birth rate (2015) 20
Crude death rate (2015) 7.0
Annual growth rate (2011) 1.6%
Population doubling time (at current growth rate) 30 years
Adult literacy rate (2011) 74%
Population density (2015) 401 / sq.km
Sex ratio (2012-2014) 906 females per 1000 males
Population above 60 yrs age 8.3%
Average family size (2014) 2.4
Age at marriage, females (2014) 22.3 yrs
Annual per capita income (2013-14) Rs.74920
*SRS-2014 & 2015

Doctor population ratio = 7 per 10000 population (Page 934)

Bed population ratio = 9 beds per 10000 population

Categorization of Sub centres (IPHS) (Page 937)

Sub-centres have been categorized into two types - Type A and Type B.

Type A sub-centres Type B sub-centres

All facilities except the facilities for delivery MCH Sub-Centre

Sub-centres in the following situations may be
included in this category.
a) No adequate space and physical infrastructure
for conducting deliveries
b) Situated in the vicinity of other higher health
facilities like PHC/CHC/ FRU/Hospital, where
delivery facilities are available
c) Sub-centres in headquarter area
d) Sub-centres where at present no delivery or
occasional delivery may be taking place
This would include following types of Sub-
centres:
a) Centrally or better located Sub-centres with
good connectivity to catchment areas.
b) They have good physical infrastructure
c) They already have good case load of deliveries
from the catchment areas.
d) There are no nearby higher level delivery
facilities.

Essential staff – 1 ANM & 1 Male health worker Essential staff – 2 ANMs & 1 Male health worker
Desirable – 1 + 1 ANM Desirable – 1 Staff nurse or 1 ANM
(If 2 or more deliveries in a month)

Categorization of Primary health centres (IPHS) (Page 941)

From Service delivery angle, PHCs may be of two types, depending upon the delivery case load –
Type A PHC: PHC with delivery load of less than 20 deliveries in a month,
Type B PHC: PHC with delivery load of 20 or more deliveries in a month

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