Malaria is an ancient disease as old as human civilization.

Malaria is probably one of the oldest

diseases known to mankind. Man and Malaria seem to have evolved together and it has been known
to mankind for millennia. It was always part of the ups and downs of nations; of wars and of
upheavals. Mentions of this disease can be found in the ancient Chinese, Indian and Egyptian
manuscripts. The disease supposedly had its origins in the jungles of Africa, where it is still very
much .

 National Malaria Control Programme (NMCP) was launched in 1953. Spectacular success of NMCP
enthused health planner to convert into Eradication Programme (NMEP) in 1958. The success
achieved by NMEP was short lived; due to various constraints like financial, logistic, administrative
and technical. Resurgence of malaria after 1964, reaches it’s peak in 1975, when State recorded
712 thousand malaria cases. To overcome this situation, Modified Plan of Operation was introduced
in 1977.mpant.

Reasons of resurgence in 1995 are as under

1. Unplanned growth of Urban area.

2. Absence of Bye–laws in Municipal Council/Corporation.
3. Rapid industrialization.
4. Labour aggregation at project site.
5. Population movement across the border.
6. Inadequate health service in Tribal area.
7. Suspected insecticide and drug resistance.
Objectives of National Malaria Control Programme

 To reduce morbidity due to malaria.

 To prevent deaths due to malaria.
 Industrial & Agricultural Development activities should not be affected due to malaria.
 The gains achieved so far should be maintained.
Strategy of National Malaria Control Programme
Implementation Strategies
State has developed State Implementation Plan for Malaria in tune with guidelines given by Govt. Of
India under “Malaria Action Plan 1995”. Major components of Implementation strategies are

1. Early detection and prompt treatment (EDPT)

o Identification of High Risk Area.
o Strengthening of surveillance activities.
o Decentralization of Laboratory Services.
o Availability of anti malarial drugs upto the village level.
2. Selective Vector Control
o Indoor residual spraying.
o Anti Larval Measures.
o Use of Biocides.
o Personal protection methods mainly Use of Impregnated Bednets.
o Biological Control Measures.
3. Capacity Building: Training to field staff & Non Governmental Organisations (NGOs.)
4. World Bank Assisted Enhanced Malaria Control Project to intensify malaria control
activities in tribal belt of the state.
5. Celebration of Anti Malaria Month June upto village level every year.

Activities of National Malaria Control Programme

Early Detection & Prompt Treatment (EDPT)
Identification Of High Risk Area
During the year 1995, the state experienced major malaria outbreaks especially in tribal districts of
the state more prominently in Thane, Dhule, Nasik, Yeotmal, Chandrapur & Gadchiroli. Every year
High Risk PHCs & Sub Centers are being identified as per guidelines given by Government of India
(GOI). following are the epidemiological parameters for identification of High risk area.

Recorded deaths due to malaria with Plasmodium falciparum (Pf) infection during transmission
season with evidence of local infection in an endemic area in any of the last 3 years.

Surveillance
Active Surveillance
Blood smear collection of fever cases through regular house to house visits of multipurpose workers.

Passive Surveillance
Blood smears collection of fever cases coming at Primary Health Centers, rural & cottage hospitals,
District Hospitals, & all govt. medical institutions etc.

Contact Mass Nomad (CMN)– Contact

Blood smears collection irrespective of fever of all family members of malaria positive case.

Mass
Blood smears collection irrespective of fever of all families around malaria positive case.

Nomad
Blood smears collection irrespective of fever of all persons of nomadic tribes. 

Vector Control measures

Indoor Residual Spraying Since 1999, State has stopped the use of DDT due to development of
resistance in vector species. Synthetic Pyrethroid has been introduced for IRS since 1995–96 in
Maharashtra State.
……………………………………………………………………………………………………………………
……………….. what ever you know right it ……………………………………………………………

VISION 2020: The Right to Sight[edit]

The Task Force was integrated within IAPB, becoming the "Task Force of IAPB", and
a Memorandum of Understanding to implement the "Global Initiative to Eliminate Avoidable
Blindness" was signed between IAPB and WHO. Under their joint auspices, "VISION 2020: The
Right to Sight",[5] was officially launched by Dr. Gro Harlem Brundtland, Director-General of WHO
in Geneva on February 18, 1999, and further promoted by IAPB at the Sixth Assembly in Beijing, in
September 1999. Following the launch of VISION 2020, the Task Force increased in membership,
and in 2000, it was decided to hold joint-meetings of the IAPB Executive Committee and the Task
Force, chaired by the President of IAPB.
Since the launch of VISION 2020, a major concerted international effort is being made in areas such
as advocacy, resource mobilisation, joint-planning, strengthening national capacities through human
resource development, and the transfer of appropriate technologies to developing countries. Global
technical plans were developed, highlighting the priority areas that need to be addressed in each
region, and the proposed strategies to reach the goals of VISION 2020 in these regions.
Complementing the technical plans, a business plan was developed to raise funds and implement
the programme. Regional and national workshops, and launch events in WHO/IAPB regions, have
been and are being organised to raise awareness of blindness prevention. Plans for prevention of
blindness have also been developed at both national and district level. A conservative estimate of
the productivity gain from VISION 2020 is $102 billion over the 20-year period. The costs of many of
the interventions that form the VISION 2020 initiative are relatively modest, particularly for public
health interventions, such as the distribution of Vitamin A capsules, and Mectizan for onchocerciasis.
The World Sight Day, initiated by the SightFirst Campaign of Lions Club International Foundation,
was integrated into VISION 2020, and is being held on the second Thursday of October, every year,
since 2000. The World Sight Day has proved to be an effective advocacy and awareness tool.
In May 2003, the 56th World Health Assembly of Ministers adopted a "Resolution on Elimination of
Avoidable Blindness", which calls on all member states to prepare VISION 2020 plans by 2005.
Further, member states are to establish national coordinating committees, which are to start
implementing the national plans by 2007, and to report back in 2010. The Ministers proposed a
Monitoring Committee to oversee the programme. The resolution also supports the mobilization of
resources to ensure a successful program. In response to the Resolution, a VISION 2020 Tool Kit
has been developed to provide guidance and support for Governments and health professionals.
Vision 2020

The Twenty Point Programme was initially launched by Prime Minister Indira
Gandhi in 1975 and was subsequently restructured in 1982 and again on 1986. With the introduction of
new policies and programmes it has been finally restructured in 2006 and it has been in operation at
present. The Programmes and Schemes under TPP-2006 are in harmony with the priorities contained in
the National Common Minimum Programme, the Millennium Development Goals of the United Nations
and SAARC Social Charter. The restructured Programme, called Twenty Point Programme..

Objective of Twenty Point Programme The basic objective of the 20-Point Programme
is to eradicate poverty and to improve the quality of life of the poor and the under privileged population of
the country. The programme covers various Socio-economic aspects like poverty, employment,
education, housing, health, agriculture and land reforms, irrigation, drinking water, protection and
empowerment of weaker sections, consumer protection, environment etc.
Poverty eradication, power to people, Support to farmers, Labour welfare, Food security,
Clean drinking water, Housing for all, Health for all, Education for all, Welfare of SC/ ST/ OBC and
minorities, Women welfare, Child welfare, Youth Development, Improvement of slums,
Environment protection and afforestation, Social security, Rural Roads, Energising of rural areas,
Development of Backward areas, IT enabled and e-governance.

The Rockefeller Foundation  is a private foundation based at 420 Fifth Avenue,

New York City.[3] It was established by the six-generation Rockefeller family. The Foundation was
started by Standard Oil owner John D. Rockefeller ("Senior"), along with his son John D. Rockefeller
Jr. ("Junior"), and Senior's principal oil and gas business and philanthropic advisor, Frederick Taylor
Gates, in New York State on May 14, 1913, when its charter was formally accepted by the New York
State Legislature.[4] Its stated mission is "promoting the well-being of humanity throughout the
world."[2]
Its activities have included:

 Financially supported education in the United States "without distinction of race, sex or
creed"[5]
 Helped establish the London School of Hygiene and Tropical Medicine in the United
Kingdom;
 Established the Johns Hopkins School of Public Health and Harvard School of Public Health,
two of the first such institutions in the United States; [6][7]
 Established the School of Hygiene at the University of Toronto in 1927; [8]
 Developed the vaccine to prevent yellow fever;[9][10]
 Helped The New School provide a haven for scholars threatened by the Nazis

Accredited social health activists (ASHAs) is community health

workers instituted by the government of India's Ministry of Health and Family Welfare (MoHFW) as
part of the National Rural Health Mission (NRHM).[1] The mission began in 2005; full implementation
was targeted for 2012. Once fully implemented, there is to be "an ASHA in every village" in India, a
target that translates into 250,000 ASHAs in 10 states. [2] The grand total number of ASHAs in India
was reported in July 2013 to be 870,089. [3]There are 859,331 ASHAs in 32 states and union
territories as per the data provided by the states in December 2014. This excludes data from the
states of Himachal Pradesh, Goa, Puducherry and Chandigarh, since the selection of ASHA is under
way in these states.[4] Their tasks include motivating women to give birth in hospitals, bringing
children to immunization clinics, encouraging family planning (e.g., surgical sterilization), treating
basic illness and injury with first aid, keeping demographic records, and improving village sanitation.
[6]
 ASHAs are also meant to serve as a key communication mechanism between the healthcare
system and rural populations.
Healthcare delivery system in india
1. 1. Health Care Delivery System in India Dr Utpal Sharma Assistant Professor Department of
Community Medicine SMIMS, Gangtok, Sikkim
2. 2. Illness is….. …a state in which a person’ s physical, emotional, intellectual, social or
spiritual functioning is diminished or impaired.Health is….. ……..a state of complete
Physical, Mental and Social well being and not merely an absence of disease or infirmity….
…..which allows a person to live a socio-economically productive life. Introduction
3. 3. Embraces all the goods and services designed for “prevention, promotion and
rehabilitation interventions” includes Medical CareMaintaining health Restoring and
Promoting Health care is... …….multitude of services rendered to individuals or
communities by the agents of health services or professional for the purpose of Cont….
4. 4. Health care professionals may include physicians, dentists, and other support staff.….an
institution such as a hospital or laboratory. ….a health care equipment company, ….the
health care industry, Could be a government…or… A person or organization that provides
services and/or health care personnel…. ….to deliver proper health care in a systematic way
to any individual in need of health care services. Health Care provider
5. 5. ….utilizing health care workers…thereby provide health care to individuals and
community with preventive and curative activities ….coping with the various health needs
and demands of population… Permanent countrywide system of estabilished institutions
with the objective of… Cont…. Health services
6. 6. Together these forms a system interacting with each other, supporting and controlling
each otherPersons (health care workers viz. physician, nurses) Objects(e.g hospitals,
health centres) Ideas(e.g equity) Includes… concepts ( e.g health and diseases) Cont…
System
7. 7. Components of healthcare delivery system
8. 8.  Governance and decision making Enumeration and determination of the eligible
population for these services  Financing  System of management and amenities  Range
of services offered  Nature and extend of facility and equipment  Way of these personnel
organized to work  Number and type of personnel and staff  Aspects of the design of
health services that influences the way in which they are delivered Includes…. 1. Structure
of health system
9. 9.  Participation in decision making Satisfaction with the services  Understanding the
recommendations  Utilization of services  Participation of people  Appropiate follow up 
Recommendation of treatment or management  Diagnostic procedure  Recognition of the
problem i.e diagnosis  Behavior of professionals  Consists of two parts Cont… 2.
Process of health care delivery
10. 10.  Such system could one of the reason to reduced cost of health care in developing
countries Indian system is more cost effective if health workers are skilled and effectively
supervised  India harbors a multistage (three tier) system, where majority of health care is
delivered by community health care worker  Varies from country to country  Aspects of
health that results from interventions provided by the health system 4. Flow of patients in
health care system Cont… 3. Outcomes of health care
11. 11. Provided at hospitals Tertiary health careTertiary health care Provided at PHC, CHC,
DH etc. Secondary health care Provided at the community level Primary Health care
Levels of health care
12. 12.  It was stated in the declaration that the best way to achieve HFA is by providing primary
health care…… ……… especially to vast size of underserved rural and urban poor In 1978,
the note of “Health for all” was reaffirmed and marked as the major social goal for every
country.  This is to be ensured by equitable distribution of health resources  Fundamental
principle of this concept was equity, an equal health status for all the people in all countries 
In 1977, World Health Assembly decided to launch a movement called “Health for all by
2000” Alma-Ata international conference
13. 13. Alma-Ata conference, 1978
14. 14.  Primary health care is essential health care based on practical, scientifically sound and
socially acceptable methods and technology, made universally accessible to individuals and
families in the community through their full participation and at a cost that the community and
country can afford. Primary health care is the key to attaining this target as part of
development in the spirit of social justice.  A main social target of governments,
international organizations and the whole world community in the coming decades should be
the attainment by all peoples of the world by the year 2000 of a level of health that will permit
them to lead a socially and economically productive life. - “HEALTH FOR ALL BY 2000”
Alma-Ata Declarations
15. 15. All governments should formulate national policies, strategies and plans of action to
launch and sustain primary health care as part of a comprehensive national health system
and in coordination with other sectors.It is the first level of contact of individuals, the family
and community with the national health system. It forms an integral part of the country's
health system, and of the overall social and economic development of the community.
Alma-Ata Declaration
16. 16.  ……at a cost that community and country can afford to maintain every stage of their
development in the spirit of self determination. …….made universally accessible to
individuals and families of the community through their full participation…. socially
acceptable method and technology…. scientifically sound, and practical, Essential
health care; based on Primary Health Care as defined by the World Health Organization
(WHO) in 1978 is… Primary health care
17. 17. Primary health care is essential health care made universally accessible to individuals
and acceptable to them through their full participation and at a cost the community and
country can affordCont… Definition
18. 18.  Primary Health Care includes: – Primary Care (physicians, midwivesWhat is there in
Primary Health Care..????? & nurses); – Health promotion, illness prevention; – Health
maintenance & home support; – Community rehabilitation; – Pre-hospital emergency medical
services… and… – Coordination and referral to other areas of health care.
19. 19.  Primary Health Care is different in each community depending upon: – Needs of the
residents; – Availability of health care providers; – The communities geographic location;
Some services are also provided community and hospitals  Primary Health Care involves
concerted effort to provide rural population of developing countries with least bare minimum
of health services.  It is the first level of contact with the health system to promote health,
prevent illness, care for common illnesses, and manage ongoing health problems. Cont.…
& – Proximity to other health care services in the area.
20. 20. Elements of primary health care 1. Education about prevailing health conditions and
methods to prevent and control them 2. Promotion of food supply and proper nutrition 3.
Adequate water supply and basic sanitation 4. Maternal and child health care with family
planning 5. Immunization against major infectious diseases 6. Prevention and control of
locally endemic diseases 7. Appropriate treatment of common diseases and injuries 8.
Provision of essential drugs
21. 21. Principles of primary health care Equitable distribution Community participation
Intersectoral coordination Appropriate technology
22. 22. The Central Government’s responsibility consists mainly of policy making , planning ,
guiding, assisting, evaluating and coordinating the work of the State Health Ministries.Each
state has developed its own system of health care delivery, independent of the Central
Government. States are largely independent in matters relating to the delivery of health
care to the people. India is a union of 28 states and 7 union territories. Health Care
Delivery System in India
23. 23. Health System in India The health system in India has 3 main links
24. 24. The official “organs” of health system at national level areAt the central level
25. 25. Ministry of Health and Family Welfare
26. 26. Organization Structure
27. 27.  Coordination with states Census and collection and publication of other statistical data
 Establishment and maintenance of drug standards  Regulation and development of
medical, pharmaceutical, dental and nursing professions  Promotion of research 
Administration of Central Institutes  International health relations and administration of port
quarintine Functions of MoHFW Union list
28. 28.  Poulation control and family planning Economic and social planning  Labour welfare 
Vital statistics  Control of drug and poison  Prevention of food adulteration  Prevention of
Communicable disease cont…. Concurrent List:
29. 29. Directorate General of Health Services
30. 30. Organization chart
31. 31.  Administration of post graduate training programmes Maintain medical store depots 
Control of drug standards  International health relations and quarantine of all major ports in
country and international airport.  Programming and appraisal of all health matters Specific
function  Coordination  Planning  Surveys Functions of Directorate General of Health
services General functions
32. 32.  National Medical Library Collection, compilation, analysis, evaluation and dissemination
of information  Preparation of health education material for creating health awareness
through Health Education Bureau  Implementation of national health programmes  Central
Government Health Schemes.  Conducting medical research through Indian Council of
Medical Research ( ICMR )  Administration of certain medical colleges in India Cont…
33. 33. Central Council of health
34. 34. Organization chart
35. 35. To make recommendations to the Central Government regarding distribution of grants-in-
aid.To make proposals for legislation relating to medical and public health matters. To
consider and recommend broad outlines of policy related to matters concerning health like
environment hygiene, nutrition and health education. Functions
36. 36. State Level
37. 37. There are 593 ( year 2001 census) districts in India. Within each district, there are 6
types of administrative areas. 1. Sub –division 2. Tehsils ( Talukas ) 3. Community
Development Blocks 4. Municipalities and Corporations 5. Villages and 6. PanchayatsAt
District level
38. 38. Disrtict Level Districts Tehsils /Talukas (200-600 villages) Community Development
Blocks (approx 100 Villages & 80,000 - 1.2 Lac Pop) Municipalities & Corporations Municipal
Board (10,000- 2 Lac Pop) Corporations (> 2 lac pop) Town Area Committee (5,000-10,000
Pop) Panchayats Villages
39. 39.  In broad sense the health services should be a. Comprehensive b. Accessible c.
Acceptable d. Provide scope of community participation and…. e. Available at an affordable
cost by country and commuity Institutions – Hospitals – Hospital have been the major
agency of health care system.  Clinics – Clinics involve a department in a hospital where
patients not requiring hospitalization, receive medical care.  Out patient services -Patients
 who don’t require hospitalization can receive health care in a clinic. An out patient setting is
designed to be convenient and easily accessible to the patient. Health Services
40. 40. RailwaysDefense services  Central Govt. Health Schemes d. Other agencies 
Employees State Insurance  Teaching hospitals c. Health insurance schemes  Specialist
hospitals  District hospitals/health centres  Rural hospitals  Community health centres 
Sub centres b. Hospitals/Health centres  Primary health centres  Intended to delivery
healthcare services and represented by five major sectors different from each other by health
technology 1. Public health sector a. Primary health care Health care systems
41. 41. Cont… 2. Private sector a. Private hospitals, polyclinic, nursing homes and dispensaries
b. General practitioners and clinics 3. Indigenous system of medicine a. Ayurveda and
Siddha b. Unani and Tibbi c. Homeopathy d. Unregistered practitioners 4. Voluntary health
agencies 5. National health programmes
42. 42. Primary health care in India
43. 43.  Keeping in view WHO “Health for all” by 2000 GoI formulated National health policy
2002 Subsequently in the international conference of Alma- Ata(1978)the goal of “Health for
all” by 2000 through primary health care approach was set.  In 1977, GoI launched Rural
Health Scheme based on the principle of “placing people’s health in people’s hand”
Introduction
44. 44.  These standards would help monitor and improve functioning of the health care delivery
system These standards provides basic promotive, preventive and curative primary health
care to the community and…… …….achieve and maintain an acceptable quality of care  In
order to provide quality care in the public health agencies of health care delivery IPHS are
being prescribed.  More recently GoI formulated NRHM and Indian Public Health Standards
(IPHS) in this regards Cont….
45. 45. Rural Health care system in India Primary Health Centre (PHC) A Referral unit for 4-6
Subcentres; 4-6 bedded manned with a Medical Officer in-charge and 14 subordinate
paramedical staff no. of PHCs with specialized Health Services Community Health Centre
(CHC) A 30 bedded Hospital/ Referral unit for 4 no. of PHCs with specialized Health
Services Sub Centre (SC) Most peripheral contact point of community with Primary Health
Care system; manned with one MPW(M) and MPW(F)
46. 46. The health care infrastructure in rural areas has been developed as a three tier system
and is based on the above population norms. Health Facility Population Norms Plain Area
Hilly/Tribal/Difficult Area Sub-Centre 5000 3000 Primary Health Centre 30,000 20,000
Community Health Centre 1,20,000 80,000Rural Health care system in India
47. 47.  The Ministry of Health The most peripheral and first contact point between the primary
health care system and the community. Sub Center & One Lady Health Worker (LHV) is
entrusted with the task of supervision of six Sub-Centers. Each Sub-Centre is manned by
one Male and one female Health Worker.  One SC for every 3,000 pop in hilly, tribal and
backward areas  One SC for every 5,000 pop in general and…  They are established on
the basis of Family Welfare is providing 100% Central assistance
48. 48. The sub centre are provided with basic drugs for minor ailments.Control of
communicable diseases programmes. Diarrhea control and Immunization, Nutrition,
Family welfare, Maternal and child health, Sub Centre are assigned tasks relating to
interpersonal communication …..in order to bring about behavioral change and provide
services in relation to…. Cont….
49. 49. At present, a PHC is manned by a Medical Officer supported by 14 paramedical and
other staff.The PHCs are established and maintained by the State Governments. The
PHCs were envisaged to provide an integrated curative and preventive health care to the
rural population with emphasis on preventive and promotive aspects of health care. PHC is
 the first contact point between village community and the Medical Officer. Primary Health
Center
50. 50. One PHC for every…..50,000 pop in Urban areasOne PHC for every…..30,000 pop in
Rural areas National Health Plan (1983) proposed reorganization of PHCs on the basis
of…. The activities of PHC involve curative, preventive, primitive and Family Welfare
Services. It has 4 - 6 beds for patients. It acts as a referral unit for 6 SubCentres. Cont….
51. 51. PHC Pakyong
52. 52. Basic laboratory servicesCollection and reporting of vital events Prevention and control
of locally endemic diseases Safe water supply and basic sanitation Referral services
Health education and training MCH care and family planning Health programmes
Medical care Functions of PHCs
53. 53. Staffing of PHCs Source: IPHS 2012
54. 54.  It serves as a referral centre for 4 PHCs and also provides facilities for obstetric care
and specialist consultations. It has 30 in-door beds with one OT, X-ray, Labour Room and
Laboratory facilities.  It is manned by four medical specialists i.e. Surgeon, Physician,
Gynecologist and Pediatrician and…. ……supported by paramedical and other staff. 
centers,each community health center should cover a population of 8000 to 1.2 lakh  CHCs
are being established and maintained by the State Government.  These were established
by upgrading the primary health centers Community Health Center (CHC)
55. 55.  Dressings, I Care of Routine and Emergency Cases in Surgery Functions of CHCs &
Handling all the emergency and routine cases Daily OPD  Care of Routine and
Emergency Cases in Medicine  Conducting daily OPD.  Fracture reduction and putting
splints/plaster cast.  Other management including nasal packing, tracheostomy, foreign
body removal etc.  Emergencies like Intestinal Obstruction, Haemorrhage, etc. D, and
surgery for Hernia, Hydrocele, Appendicitis etc.
56. 56.  Minimum 4 ANC check ups including Registration Maternal Health Cont… &
Minimum 48 hours of stay after delivery, 3-7 days stay post delivery for managing
Complications Managing labour using Partograph.  24 hr delivery services including
normal and assisted delivery and cesarean section 4th visit: Between 36 weeks and term
3rd visit: Between 28 and 34 weeks 2nd visit: Between 14 and 26 weeks 1st visit: Within
12 weeks—preferably as soon as pregnancy associated services
57. 57.  Safe Abortion Services Counseling, provision of Contraceptives, NSV, Laparoscopic
Sterilization Services and their follow up.  Family Planning  Management of Malnutrition
cases.  Full Immunization of infants and children against VPDs  Routine and emergency
care of sick children  Counseling on Infant and young child feeding  Essential Newborn
Care and Resuscitation  Newborn Care and Child Health Cont….
58. 58. Maternal Death review (MDR)Referral (transport) services Essential laboratory
services Blood storage facility Others School health services All National Health
Programmes delivered through CHCs Cont….