Health care in Canada is delivered through a publicly funded health care system,

informally called Medicare, which is mostly free at the point of use and has most services provided
by private entities.[2] It is guided by the provisions of the Canada Health Act of 1984.

Current status[
The government attempts to ensure the quality of care through federal standards. The
government does not participate in day-to-day care or collect any information about an
individual's health, which remains confidential between a person and their physician. [4] Canada's
provincially based Medicare systems are cost-effective partly because of their administrative
simplicity. In each province, each doctor handles the insurance claim against the provincial
insurer. There is no need for the person who accesses healthcare to be involved in billing and
reclaim. Private health expenditure accounts for 30% of health care financing. [5] The Canada
Health Act does not cover prescription drugs, home care or long-term care, prescription glasses
or dental care, which means most Canadians pay out-of-pocket for these services or rely on
private insurance.[4] Provinces provide partial coverage for some of these items for vulnerable
populations (children, those living in poverty and seniors). [4] Limited coverage is provided for
mental health care.

Benefits and features

A health card is issued by the Provincial Ministry of Health to each individual who enrolls for the
program and everyone receives the same level of care.[7] There is no need for a variety of plans
because virtually all essential basic care is covered, including maternity but excluding mental
health and home care.[8] Infertility costs are not covered fully in any province other than Quebec,
though they are now partially covered in some other provinces.[9] In some provinces, private
supplemental plans are available for those who desire private rooms if they are hospitalized.
Cosmetic surgery and some forms of elective surgery are not considered essential care and are
generally not covered. For example, Canadian health insurance plans do not cover non-
therapeutic circumcision.[10] These can be paid out-of-pocket or through private insurers. Health
coverage is not affected by loss or change of jobs, health care cannot be denied due to unpaid
premiums (in BC), and there are no lifetime limits or exclusions for pre-existing conditions. The
Canada Health Act deems that essential physician and hospital care be covered by the publicly
funded system, but each province has some license to determine what is considered essential,
and where, how and who should provide the services. The result is that there is a wide variance
in what is covered across the country by the public health system, particularly in more
controversial areas, such as midwifery or autism treatments.

Revised National Tuberculosis Control

Program (RNTCP) is the state-run tuberculosis (TB) control initiative of
the Government of India. As per the National Strategic Plan 2012–17, the program has a vision
of achieving a "TB free India", and aims to achieve Universal Access to TB control services. [1] The
program provides, various free of cost, quality tuberculosis diagnosis and treatment services
across the country through the government health system.

History[edit]
India has had an ongoing National TB Program (NTP) since 1962.
In order to overcome these lacunae, the Government decided to give a new thrust to TB control
activities by revitalising the NTP, with assistance from international agencies, in 1993. The
Revised National TB Control Programme (RNTCP) thus formulated, adopted the internationally
recommended Directly Observed Treatment Short-course (DOTS) strategy, as the most
systematic and cost-effective approach to revitalise the TB control programme in India. Political
and administrative commitment, to ensure the provision of organised and comprehensive TB
control services was obtained. Adoption of smear microscopy for reliable and early diagnosis
was introduced in a decentralized manner in the general health services. DOTS was adopted as
a strategy for provision of treatment to increase the treatment completion rates. Supply of drugs
was also strengthened to provide assured supply of drugs to meet the requirements of the
system.
Large-scale implementation of the RNTCP began in 1997
The Government of India took up the massive challenge of nationwide expansion of the RNTCP
and covering the whole country under RNTCP by the year 2005, and to reach the global targets
for TB control on case detection and treatment success. The structural arrangements for funds
transfer and to account for the resources deployed were developed and thus the formation of the
State and District TB Control Societies was under- taken. The systems were further strengthened
and the programme was scaled up for national coverage in 2005.

Program strategy
The program initially adopted the WHO-DOTS strategy which consisted of the five components
of strong political will and administrative commitment, diagnosis by quality assured sputum
smear microscopy, uninterrupted supply of quality assured Short Course chemotherapy drugs,
Directly Observed Treatment (DOT) and systematic monitoring and Accountability. The DOTS
strategy achieved and sustained the target detection rate of 70% of all estimated cases and a
cure rate of 85% in new cases and led to the decrease in incidence of TB in the country.
With progress in achieving objectives outlined in the DOTS Strategy of the 11th Five year Plan,
the program defined the new targets of Universal Access to TB care. Under the 12th Five Year
Plan of Government of India as the National Strategic Plan for 2012–17. The plan hopes to
achieve detection of at-least 90% the total estimated cases and a cure rate of 90% in new and
85% in re-treatment cases.[1] Following are the key components:
Case finding and diagnostics:

 Early identification of all infectious TB cases. Improved integration with the general health
system, and leverage field staff for home-based case finding.
 Improve communication and outreach
 Screening clinically and socially vulnerable risk groups for TB.
 Develop improved sputum collection and transportation systems.
 Deployment of higher-sensitivity diagnostic tests for TB suspects (and incorporate new
tests) and decentralized DST services
 Catch patients already diagnosed through notification from all sources, improved referral
for treatment mechanisms, and deployment of laboratory and private provider notification
Patient friendly treatment services:

 Promptly and appropriately treating TB, increasingly guided by DST.

 Making DOTS more patient friendly through increased communitization of DOT; pilot
incentives/offsets for patient costs to help patients complete treatment and better monitoring
through information technology.
 Improving partnerships between public and private sector—establish 'Indian Standards
for TB Care' which can be used to engage providers using existing private treatment and
improve care with some public sector support and supervision.
 Research will guide improvements in regimens and delivery systems.
 National Treatment Committee/TWG for regular review of regimens, all treatment related
technical guidance
Scale-up of Programmatic Management of Drug Resistant TB:

 Developing network of C&DST laboratories and strengthening of reference laboratories

 Decentralized DST at district level for early MDR detection
 Improved information system for PMDT
 Manpower support for additional workload by aligning with NRHM health blocks and
rationalization of number of patients per STS
 Improved drug management of second-line anti-TB drugs
Scale-up of joint TB-HIV collaborative activities:

 Activities will aim at early, rapid TB diagnosis with high sensitivity tests for HIV-infected
TB suspects and ART for all HIV-infected TB patients, with transport support.
Integration with health systems:

 Integrating the RNTCP with the overall health system will increase effectiveness and
efficiencies of TB care and control which has been depicted in the picture.
 In rural areas the RNTCP can focus integration through the National Rural Health
Mission.
 In urban areas the RNTCP can integrate through the private sector and the evolving
National Urban Health Mission.
Control TB: compared to today's activities, success will:

 Accelerate decline in incidence and prevent 22 lakh TB cases

 Reduce TB deaths by 75%, and save 17 lakh lives from TB
 Contain MDR TB: avert 1 lakh MDR cases and reduce incidence by 50%
 Quicker diagnosis of more TB patients,more effective treatment in future direct economic
expenditure on TB cases prevented and
 Leadership for India: Sustain India's global leadership in TB treatment and control.

Diagnosis of pulmonary TB under RNTCP

Diagnosis is made primarily based on sputum smear examination. X-rays play a secondary role
in the standard diagnostic algorithm for pulmonary tuberculosis. As a national health program,
RNTCP pays more attention to the sputum-positive pulmonary tuberculosis patients (who are
likely to spread the disease in the community) than people with other, non-pulmonary forms of
the disease.

Treatment categories and drug regimens

Standardized treatment regimens are one of the pillars of the DOTS
strategy. Isoniazid, Rifampicin, Pyrazinamide, Ethambutol, and Streptomycin are the primary
antitubercular drugs used. Most DOTS regimens have thrice-weekly schedules and typically last
for six to nine months, with an initial intensive phase and a continuation phase.
Based on the nature/severity of the disease and the patient's exposure to previous anti-
tubercular treatments, RNTCP classifies tuberculosis patients into two treatment categories.
New treatments and old treatments..

Public private partnership under RNTCP

In India a sizable proportion of the people with symptoms suggestive of pulmonary tuberculosis
approach the private sector for their immediate health care needs. There is need for regularizing
the varied anti-tubercular treatment regimens used by general practitioners and other private
sector players. The treatment carried out by the private practitioners vary from that of the RNTCP
treatment. Once treatment is started in the usual way for the private sector, it is difficult for the
patient to change to the RNTCP panel. Studies have shown that faulty anti-TB prescriptions in
the private sector in India ranges from 50% to 100% and this is a matter of concern for the
healthcare services in TB currently being provided by the largely unregulated private sector in
India.

Second phase of RNTCP

In the first phase of RNTCP (1998–2005), the programme’s focus was on ensuring expansion of
quality DOTS services to the entire country. The future holds a different set of challenges
including MDR TB and HIV/TB
The RNTCP has now entered its second phase, approved for a period of five years from October
2006 to September 2011, in which the programme aims to firstly consolidate the gains made to
date, to widen services both in terms of activities and access, and to sustain the achievements.
The second phase aims to maintain at least a 70% case detection rate of new smear positive
cases as well as maintain a cure rate of at least 85%. This needs to be done in order to achieve
the TB-related targets set by the Millennium Development Goals for 2015 and to achieve TB
control in the longer term. Today India's TB control program needs to update itself with the
international TB guidelines as well as provide an optimal anti TB treatment to the patients
enrolled under it or it will land up being another factor in the genesis of drug resistant
tuberculosis.

The Reproductive and Child Health (RCH) Programme was launched in October 1997. The main
aim of the programme is to reduce infant, child and maternal mortality rates. The main objectives
of the programme in its first phase were:

 To improve the implementation and management of policy by using a participatory

planning approach and strengthening institutions to maximum utilization of the project
resources

 To improve quality, coverage and effectiveness of existing Family Welfare services

 To gradually expand the scope and coverage of the Family Welfare services to
eventually come to a defined package of essential RCH services.

 Progressively expand the scope and content of existing FW services to include more
elements of a defined package of essential
 Give importance to disadvantaged areas of districts or cities by increasing the quality and
infrastructure of Family Welfare services.
The child health programmes is now its second phase: RCH-II. Following are the aims of
the programme:
Expand services to the entire sector of Family Welfare beyond RCH scope
Holding States accountable by involving them in the development of the programme
Decentralization for better services
Allowing states to adjust and improve programmes features according to their direct
needs.
Improving monitoring and evaluation processes at the District, state and the Central level
to ensure improved program implementation.
Give performance based funding, by rewarding good performers and supporting weak
performers.
Pool together financial support from external sources
Encourage coordination and convergence, within and outside the sector to maximize use
resources as well as infra structural facilities