BRIEF NOTES ON

NATIONAL HEALTH
PROGRAMS
FOR
DNB PEDIATRICS EXAM
 To
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SEPTEMBER 2020

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 INDEX
1 Mission Indhradhanush 4
2 Ayushman Bharat 6
3 IYCF (Infant and Young Child Feeding) 8
4 India Newborn Action Plan 10
5 Child Mortality- Indian Statistics 11
6 National De-worming Day (NDD) 14
7 MR Campaign 16
8 ’MAA’ – Mothers’ Absolute Affection 17
9 Swachh Bharat Mission 18
10 Millenium Development Goals 19
11 Anemia Mukt Bharat 20
12 RKSK 24
13 AMRIT 26
14 JSSK 27
15 RBSK 28
16 NTEP 31

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 Mission Indradhanush

Launched by the Ministry of Health and Family Welfare, Government of India in 2014.
Prior to 2014, increase in full immunization coverage was 1%
per year; and government aimed to accelerate the process of
immunization by covering 5% and more children every year, to
achieve target of >90% coverage by 2020.

Objective:
 Drive towards 90% full immunization coverage of India and sustain the same by year
2020.
 To ensure full immunization with all available vaccines for children up to two years of
age and pregnant women.
 India’s Universal Immunisation Programme (UIP) provide free vaccines against 12 life
threatening diseases -ie, Tuberculosis, Diphtheria, Pertussis, Tetanus, Polio, Hepatitis
B, Pneumonia and Meningitis due to Haemophilus Influenzae type b (Hib), Measles,
Rubella, Japanese Encephalitis (JE) and Rotavirus diarrhoea. (Rubella, JE and
Rotavirus vaccine in select states and districts).
Implementation:
 Focused and systematic immunization drive with “catch-up” campaign mode to
cover all the children who have been left out or missed out for immunization.
 Implemented in 4 phases with intensified immunisation drives selected disctricts
across the country.
Areas Under Focus
Mission Indradhanush targets 201 high priority districts in the first phase, 297 districts for
the second phase in the year 2015 and 216 districts in the third Phase during 2016.
Within the districts, the Mission focusses on high risk settlements identified by the polio
eradication programme. These are the pockets with low coverage due to geographic,
demographic, ethnic and other operational challenges. Evidence has shown that most of the
unvaccinated and partially vaccinated children are concentrated in these areas.
The following areas are targeted through special immunization campaigns:
 High risk areas identified by the polio eradication programme. These include
populations living in areas such as:
 Urban slums with migration
 Nomads
 Brick kilns

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  Construction sites
 Other migrants (fisherman villages, riverine areas with shifting populations etc.) and
 Underserved and hard to reach populations (forested and tribal populations etc.)
 Areas with low routine immunization (RI) coverage (pockets with Measles/vaccine
preventable disease (VPD) outbreaks).
 Areas with vacant sub-centers: No ANM posted for more than three months.
 Areas with missed Routine Immunisation (RI) sessions
Strategy for Mission Indradhanush:
 Meticulous planning of campaigns/sessions at all levels: Blocks, Villages, Urban
 Effective communication and social mobilization efforts: Mass media, mid media,
interpersonal communication (IPC), school and youth networks and corporates.
 Intensive training of the health officials and frontline workers: Build the capacity of
health officials and workers
 Establish accountability framework through task forces: Enhance involvement and
accountability of the district administrative and health machinery
Intensified Mission Indradhanush (IMI)
The Intensified Mission Indradhanush (IMI) has been launched by the Government of India
in 2017, to reach each and every child under two years of age and all those pregnant
women who have been left uncovered under the routine immunisation programme.
Focus on improving immunization coverage in select districts and cities to ensure full
immunization to more than 90% by December 2018, four consecutive immunization rounds
will be conducted.
Intensified Mission Indradhanush will have inter-ministerial and inter-departmental
coordination- Ministry of Women and Child Development, Panchayati Raj, Ministry of Urban
Development, Ministry of Youth Affairs among others.
The convergence of ground level workers of various departments like ASHA, ANMs,
Anganwadi workers, Zila preraks under National Urban Livelihood Mission (NULM), self-help
groups will be ensured for better coordination and effective implementation of the
programme.
Intensified Mission Indradhanush would be closely monitored at the district, state and
central level at regular intervals. It would be reviewed by the Cabinet Secretary at the
National level and will continue to be monitored at the highest level under a special
initiative ‘Proactive Governance and Timely Implementation (PRAGATI)’.
An appreciation and awards mechanism is also conceived to recognize the districts reaching
more than 90% coverage.

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 Ayushman Bharat
Ayushman Bharat, a flagship scheme of Government of India was launched as
recommended by the National Health Policy 2017, to achieve the vision of Universal Health
Coverage (UHC).
This initiative has been designed on the lines as to meet SDG and its underlining
commitment, which is "leave no one behind".
Ayushman Bharat aims to undertake path breaking interventions to holistically address
health (covering prevention, promotion and ambulatory care), at primary, secondary and
tertiary level.
Ayushman Bharat adopts a continuum of care approach, comprising of two inter-related
components, which are -
 Health and Wellness Centres (HWCs)
 Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Health and Wellness Centers (HWCs):
Around 1,50,000 Health and Wellness Centres (HWCs) by
transforming existing Sub Centres and Primary Health Centres.
These centres would deliver Comprehensive Primary Health Care (CPHC) bringing healthcare
closer to the homes of people covering both maternal and child health services and non-
communicable diseases, including free essential drugs and diagnostic services.
Pradhan Mantri Jan Arogya Yojana (PM-JAY):
 Aims at providing health insurance cover of Rs. 5 lakhs per family per year for
secondary and tertiary care hospitalization
 This scheme was earlier known as National Health Protection Scheme (NHPS) before
it was rechristened to PM-JAY, subsumed then existing Rashtriya Swasthya Bima
Yojana (RSBY)
 Aimed at the bottom 40% of poor and vulnerable population. The households
included are based on the deprivation and occupational criteria of Socio-Economic
Caste Census 2011 (SECC 2011) for rural and urban areas respectively.
 The scheme PM-JAY is completely funded by the Government, and cost of
implementation is shared between Central and State Governments.
 It is the largest health insurance/ assurance scheme fully financed by the
government (approximately 50 crore beneficiaries)
 Provides cashless access to health care services for the beneficiary at the point of
service.
 No restrictions on family size, age or gender.
 Covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses
such as diagnostics and medicines.

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 Benefits of the scheme are portable across the country i.e. a beneficiary can visit any
empanelled public or private hospital for cashless treatment.
 Public hospitals are reimbursed for the healthcare services at par with the private
hospitals.
 Cover include:
o Medical examination, treatment, and consultation
o Pre-hospitalization
o Medicine and medical consumables
o Non-intensive and intensive care services
o Diagnostic and laboratory investigations
o Medical implant services (where necessary)
o Accommodation benefits
o Food services
o Complications arising during treatment
o Post-hospitalization follow-up care up to 15 days

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 IYCF (Infant and Young Child Feeding)

WHO/UNICEF have emphasized the first 1000 days of life i.e, the 270 day in-utero and the
first two years after birth as the critical window period for nutritional interventions.
Components IYCF:
 Initiation of breastfeeding immediately after birth, preferably within one hour.
 Exclusive breastfeeding for the first six months i.e., the infants receive only breast
milk and nothing else - no other milk, food, drink or water.
 Appropriate and adequate complementary feeding from six months of age while
continuing breastfeeding.
 Continued breastfeeding upto the age of two years or beyond.
Optimal nutrition in the first two years of life – early and exclusive breastfeeding and
continued breastfeeding for two years or more, together with nutritionally adequate, safe,
age- appropriate, responsive complementary feeding starting at six months – are critical to
prevent stunting in infancy and early childhood and break the intergenerational cycle of
undernutrition. Optimal breastfeeding in the first year and complementary feeding practices
together can prevent almost one-fifth of deaths in children under five years of age.

Exclusive Breast Feeding:

Breastfeeding within the first hour of life is recognized as one of the most important actions
for infant survival. Yet in India, only 41.6 % infants start breastfeeding within one hour of
life.
Colostrum, the rich milk produced by the mother during the first few days after delivery,
provides essential nutrients as well as antibodies to boost the baby’s immune system,
reducing the likelihood of death in the neonatal period. Skin-to-skin contact with the
mother through breastfeeding fosters mother-infant bonding and keeps the child warm,
reducing the child’s risk of dying of cold (hypothermia).
Every child should start breastfeeding within one hour of life to take advantage of the
newborn’s intense suckling reflex and alert state and to stimulate breastmilk production.
Starting breastfeeding within the first hour of birth and learning to breastfeed properly –
the correct position and how to attachment – helps the mother produce more milk for her
child and reduces excessive bleeding in mothers after birth and the risk of haemorrhage, a
major cause of maternal death.
Breastmilk alone is sufficient to meet an infant’s requirement for food and water in the first
six months of life. With frequent, on-demand feedings, babies do not need water or any
other liquids even in hot climates; mother’s milk is all they need for survival and optimal
growth and development. Foods given to infants in the first six months of life do not
improve growth and, instead, are dangerous when they replace mother’s milk, because they
can result in frequent infections and poor growth and development.

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Exclusively breastfed infants are at a lower risk of diseases like diarrhoea and pneumonia,
major causes of death among children under five years. An infant who is not breastfed is
more than 14 times more likely to die from all causes than an exclusively breastfed infant.
Exclusive breastfeeding helps to increase the time between pregnancies, which naturally
helps to space births.and breastfeeding is more economical because families do not need to
spend money on expensive infant foods.
Complementary Feeding
After six months, infants need both breastmilk and complementary foods to continue to
grow strong and develop fully. Mother’s milk alone cannot give infants all the nutrition
needed during this period of fast growth and development.
However, breastmilk remains an important source of nutrients in the first two years of life.
Therefore, it is recommended that, along with complementary feeding, breastfeeding
should be continued until at least two years of age. Appropriate complementary foods are
the solid, semi-solid or soft foods given with mother’s milk after six months.
Appropriate and safe complementary feeding – ensuring that children are fed nutritionally
rich complementary foods at the right age, at the right frequency and feeding hygiene
practices are observed – is a major challenge in India.
A comprehensive programme approach to improving complementary feeding practices
includes timely introduction of age appropriate and hygienically prepared complementary
foods, counselling for caregivers on feeding and care practices and on the optimal use of
locally available foods, improving access to quality foods for poor families through social
protection schemes and safety nets, and the provision of fortified foods and micronutrient
supplements when needed.

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 India Newborn Action Plan
India Newborn Action Plan (INAP) was launched in September 2014, for accelerating the
reduction of preventable newborn deaths and stillbirths in the country
INAP is India’s committed response to the Global Every Newborn Action Plan (ENAP),
launched in June 2014 at the 67th World Health Assembly, to advance the Global Strategy
for Women’s and Children’s Health.
Goals:
 Ending Preventable Newborn Deaths to achieve “Single Digit NMR” by 2030, with all
the states to individually achieve this target by 2035.
 Ending Preventable Stillbirths to achieve “Single Digit SBR” by 2030, with all the
states to individually achieve this target by 2035

Snapshot of India Newborn Action Plan (INAP)

 Builds on existing commitments under the National Health Mission and 'Call to
Action' for Child Survival and Development
 Aligns with the Global Every Newborn Action Plan (ENAP); defines commitments
based on specific contextual needs of the country
 Aims at attaining Single Digit Neonatal Mortality Rate by 2030, five years ahead of
the global plan
 Emphasizes strengthened surveillance mechanism for tracking stillbirths
 Focuses on ending preventable newborn deaths, improving quality of care and care
beyond survival
 Prioritizes those babies that are born too soon, too small, or sick—as they account
for majority of all newborn deaths
 Aspires towards ensuring equitable progress for girls and boys, rural and urban, rich
and poor, and between districts and states
 Identifies major guiding principles under the overarching principle of Integration:
Equity, Gender, Quality of Care, Convergence, Accountability, and Partnerships
 Serves as a framework for states/districts to develop their own action plan with
measurable indicators
Six pillars of interventions:
1. Pre-conception and antenatal care
2. Care during labour and child birth
3. Immediate newborn care
4. Care of healthy newborn

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5. Care of small and Sick newborn
6. Care beyond newborn survival

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 Child Mortality- Indian Statistics

 Neonatal Mortality Rate (NMR) - 24

 Infant mortality rate (IMR)- 34
 Under 5 Mortality Rate (U5MR) - 39
(Source Annual Health Report 2018-19; MoHFW, based on 2016 SRS)

The major causes of child mortality in India as per the SRS reports (2010-13) are:
 Prematurity & low birth weight (29.8%)
 Pneumonia (17.1%)
 Diarrhoeal diseases (8.6%)
 Other non-communicable diseases (8.3%)
 Birth Asphyxia & Birth Trauma (8.2%)
 Injuries (4.6%)
 Congenital anomalies (4.4%)
 Ill-defined or cause unknown (4.4%)
 Acute bacterial sepsis and severe infections (3.6%)
 Fever of unknown origin (2.5%)
 All other remaining causes (8.4%)

The major causes of newborn deaths in India are:

 Prematurity & LBW (48%)
 Birth Asphyxia and Trauma (13%)
 Pneumonia (12%)
 Sepsis (5.4%)
 Congenital anomalies (4%)
 Diarrhoea (3%)
Interventions to decrease NMR:
 Promotion of Institutional deliveries and Essential Newborn Care-

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 Since antenatal and intra-partum events have a bearing on newborn
health, institutional deliveries are being promoted with cash incentives
in the form of Janani Suraksha Yojana (JSY). Newborn Care Corners (NBCCs)
have been operationalized at delivery points to provide essential newborn
care at the time of birth. In order to reduce out of pocket expenses, Janani
Shishu Swasthya Karyakram (JSSK) entitlements have been provided to
ensure cashless diagnosis and treatment of pregnant woman and her child till
one year of age in public health facilities. This also includes free referral
transport.
 Home Based Newborn Care and Home Based Care of Young Children (HBNC/ HBYC)
o One third of under-five child deaths are due to preventable causes such as
diarrhoea, pneumonia and measles. Nearly 35% of child mortality is
attributable to undernutrition. It also poses irreversible hindrance to
children’s cognitive development and physical growth while increasing their
susceptibility to childhood infections.
o Aditional five home visits will be carried out by ASHAs (3rd, 6th, 9th, 12th
and 15th months) under the HBYC program with the support of
Anganwadi Workers to ensure exclusive and continued breast feeding,
adequate complementary feeding, age appropriate immunization and
early childhood development. They are being paid an incentive for visiting
each newborn and post-partum mother in the first six weeks of life as per
the defined schedule.
 Facility Based Newborn Care (FBNC) is being scaled up for care of small or
sick newborns.
 Newer interventions to reduce newborn mortality have also been implemented,
including- Vitamin K injection at birth, Antenatal corticosteroids in preterm
labour, Kangaroo Mother Care and empowering ANMs to provide Injection
Gentamycin to young infants for possible serious bacterial infection.
 Still-birth Surveillance is being rolled out.

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 National De-worming Day (NDD)

Initiative of Ministry of Health and Family Welfare, Government of India to make every child
in the country worm free.
This is one of the largest public health programs reaching large number of children during a
short period.
According to World Health Organization 241 million children between the ages of 1 and 14
years are at risk of parasitic intestinal worms in India, also known as Soil-Transmitted
Helminths (STH).

About STH:
Helminths (worms) which are transmitted through soil contaminated with faecal matter are
called soil-transmitted helminths (Intestinal parasitic worms). Roundworm (Ascaris
lumbricoides), whipworm (Trichuris trichiura) and hookworms (Necator americanus and
Ancylostoma duodenale) are worms that infect people.

STH transmission:
Adult worms live in human intestines for food and survival and produce thousands of eggs
each day.
 Eggs are passed in the faeces of infected person.
 Infected people who defecate outdoors spread worm eggs in the soil.
 Eggs contaminate the soil and spread infection in several ways: ─
 Ingested through vegetables that are not carefully cooked, washed or peeled;
 ingested from contaminated water sources;
 ingested by children who play in soil and then put their hands in their mouths
without washing them.
STH infections can lead to anemia, malnutrition, impaired mental and physical & cognitive
development, and reduced school participation.
STH Infections can be prevented by:
● Using sanitary toilets, not defecating outside
● Hand-washing, particularly before eating and after using toilets
● Wearing slippers and shoes
● Washing fruits and vegetables in safe and clean water

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●Eating properly cooked food
Objective of National Deworming Day:
The objective of National Deworming Day is to deworm all preschool and school-age
children (enrolled and non-enrolled) between the ages of 1-19 years through the platform
of schools and Anganwadi Centers in order to improve their overall health, nutritional
status, access to education and quality of life.
The programme is being implemented through the combined efforts of Department of
School Education and Literacy under Ministry of Human Resource and Development,
Ministry of Women and Child Development and Ministry of Drinking Water and Sanitation
Ministry of Panchayati Raj, Ministry of Tribal Affairs, Ministry of Rural Development,
Ministry of Urban Development, and Urban Local Bodies (ULBs) also provide support to
deworming program.

NDD Implementation
NDD (first round) is conducted on February 10 each year. Bi-annual round of deworming is
recommended in the States where prevalence of STH infection is more than 20% and annual
round in other (less than 20% prevalence) states. Only two States namely Rajasthan and
Madhya Pradesh have reported less than 20% prevalence and recommended for annual
round. All the remaining States/UTs are implementing bi-annual round of deworming.
The first round of NDD was conducted in February 2015 and 8.9 crore children were
administered the deworming tablet across 11 states/UTs by achieving 85% coverage.
Thereafter 88%, 77%, 88% children were covered against the set targets in February 2016,
August 2016 and February &August 2017 rounds of NDD respectively. 26.68 crore children
have been administered albendazole till February 2018, and more than 114 crore doses of
albendazole were administered to children 1-19 years, since 2015
To increase programme outreach to private schools and maximize deworming benefits for
large number of children various awareness activities (media mix) are involved under the
programme. The awareness campaign spreads awareness about importance and benefits of
dewarming, as well as prevention strategies related to improved behaviors and practices for
hygiene and sanitation.

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 MR Campaign

WHO’s regional goal for South-East Asia region is measles elimination and Rubella/
Congenital Rubella Syndrome control by 2020.
MR vaccine is being introduced through campaign, targeting around 41 crore children in
the age group of 9 months to 15 years in a phased manner (covering ⅓ of the total
population of the country), followed by 2 doses in routine immunization at 9-12
months and 16-24 months, replacing the Measles vaccine.
MR campaign started in February, 2017 in 5 States/UTs (Karnataka, Tamil Nadu, Goa,
Lakshadweep and Puducherry), where 3.34 crore children were vaccinated against the
target of 3.43 crore with a coverage of 97%.
MR campaign has been completed in 31 States wherein 30.50 crore children were
vaccinated against the target of 31.07 crore with a coverage of 98.18%.

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 ’MAA’ – Mothers’ Absolute Affection
A National Breastfeeding Promotion Programme
Nation-wide programme for promoting breastfeeding was launched by the Ministry of
Health and Family Welfare August 2016.
MAA is an intensified programme for creating an enabling environment to ensure that
others, husbands and families receive adequate information and support for promotion of
breastfeeding.
The goal of the MAA Programme is to enhance optimal breastfeeding practices, which
includes early initiation of breastfeeding within one hour of birth, exclusive breastfeeding
for the first six months, and continued breastfeeding for at least two years, along with
feeding of safe and appropriate nutritious food on completion of six months.
The key components of the programme are:
a. Communication for enhanced awareness and demand generation through mass
media and mid media
b. Training and capacity enhancement of nurses at government institutions, and all
ANMs and ASHAs. They will provide information and counselling support to mothers
for breastfeeding
c. Community engagement by ASHAs for breastfeeding promotion, who will conduct
mothers’ meetings. Breastfeeding mothers requiring more support will be referred
to a health facility or the ANM sub-centre or the Village Health and Nutrition Day
(VHND) organized every month at the village level;
d. Monitoring and impact assessment is an integral part of MAA programme.
Progress will be measured against key indicators, such as availability of skilled
persons at delivery points for counselling, improvement in breastfeeding practices
and number of accredited health facilities; and
e. Recognition and team awards will be given to facilities showing good
performance, based on evaluation against per pre-decided criteria.

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 Swachh Bharat Mission
Swachh Bharat Mission is a massive mass movement that seeks to create a Clean India by
2019.
The father of our nation Mr. Mahatma Gandhi always puts the emphasis on swachhta as
swachhta leads to healthy and prosperous life.
Keeping this in mind, the Indian government has
decided to launch the swachh bharat mission on
October 2, 2014.
The mission will cover all rural and urban areas.
Swachh Bharat Mission for Urban Areas
The programme includes elimination of open defecation, conversion of unsanitary
toilets to pour flush toilets, eradication of manual scavenging, municipal solid waste
management and bringing about a behavioural change in people regarding healthy
sanitation practices.
Swachh Bharat Mission (Gramin)
The Nirmal Bharat Abhiyan has been restructured into the Swachh Bharat Mission
(Gramin). The mission aims to make India an open defecation free country in Five Years. It
seeks to improve the levels of cleanliness in rural areas through Solid and Liquid Waste
Management activities and making Gram Panchayats Open Defecation Free (ODF), clean
and sanitised.
Swachh Vidyalaya Abhiyan
The Ministry of Human Resource Development has launched Swachh Vidyalaya
Programme under Swachh Bharat Mission with an objective to provide separate toilets for
boys and girls in all government schools within one year. The programme aims at ensuring
that every school in the country must have a set of essential interventions that relate to
both technical and human development aspects of a good Water, Sanitation and Hygiene
Programme.
Rashtriya Swachhata Kosh
The Swachh Bharat Kosh (SBK) has been set up to facilitate and channelize individual
philanthropic contributions and Corporate Social Responsibility (CSR) funds to achieve the
objective of Clean India (Swachh Bharat) by the year 2019. The Kosh will be used to achieve
the objective of improving cleanliness levels in rural and urban areas, including in schools.

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 Millennium Development Goals
The United Nations Millennium Development Goals are eight goals that all 191 UN member
states have agreed to try to achieve by the year 2015. The United Nations Millennium
Declaration, signed in September 2000 commits world leaders to combat poverty, hunger,
disease, illiteracy, environmental degradation, and discrimination against women. The
MDGs are derived from this Declaration, and all have specific targets and indicators.
The Eight Millennium Development Goals are:
1. to eradicate extreme poverty and hunger;
2. to achieve universal primary education;
3. to promote gender equality and empower women;
4. to reduce child mortality;
5. to improve maternal health;
6. to combat HIV/AIDS, malaria, and other diseases;
7. to ensure environmental sustainability; and
8. to develop a global partnership for development.

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 Anemia Mukt Bharat
The Anemia Mukt Bharat- intensified Iron-plus Initiative aims to strengthen
the existing mechanisms and foster newer strategies for tackling anemia.
It focusses on six target beneficiary groups, through six interventions and
six institutional mechanisms to achieve the envisaged target under the
POSHAN Abhiyan.
According to the National Family Health Survey 4 (NFHS-4), 2015/16,
anemia prevalence across all ages is extremely high in India; varying
from 30 percent to 69 percent. It is also to be noted that in the last 10
years (NFHS-3, 2005/06 to NFHS-4, 2015/16), the percentage point
reduction of anemia prevalence has been extremely low in most age
groups.
Objectives
 The reduction of anemia is one of the important objectives of the POSHAN Abhiyaan
launched in March 2018.
 Complying with the targets of POSHAN Abhiyaan and National Nutrition Strategy set
by NITI Aayog, the Anemia Mukt Bharat strategy has been designed to reduce
prevalence of anemia by 3 percentage points per year among children, adolescents
and women in the reproductive age group (15–49 years), between the year 2018 and
2022.
Beneficiaries and Targets
The strategy is estimated to reach out to 450 million beneficiaries with specific
anemia prevalence targets for year 2022 to be achieved among various population groups
Strategy:
The Anemia Mukt Bharat strategy is a universal strategy and will focus on the following
interventions:
 Prophylactic Iron and Folic Acid supplementation
 Deworming
 Intensified year-round Behaviour Change Communication Campaign (Solid Body,
Smart Mind) focusing on four key behaviours
 Improving compliance to Iron Folic Acid supplementation and deworming
 Appropriate infant and young child feeding practices,
 Increase in intake of iron-rich food through diet diversity/quantity/frequency and/or
fortified foods with focus on harnessing locally available resources and
 Ensuring delayed cord clamping after delivery (by 3 minutes) in health facilities
 Testing and treatment of anemia, using digital methods and point of care treatment,
with special focus on pregnant women and school-going adolescents

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  Mandatory provision of Iron and Folic Acid fortified foods in government-funded
public health programmes
 Intensifying awareness, screening and treatment of non-nutritional causes of anemia
in endemic pockets, with special focus on malaria, haemoglobinopathies
Prophylactic Iron and Folic Acid (IFA) supplementation
 Prophylactic Iron Folic Acid supplementation given to children, adolescents, women
of reproductive age and pregnant women, irrespective of anemia is a key continued
intervention under Anemia Mukt Bharat.
 Age Group Dose and regime
 Children 6–59 months of age
o Biweekly, 1 ml Iron and Folic Acid syrup Each ml of Iron and Folic Acid syrup
containing 20 mg elemental Iron + 100 mcg of Folic Acid Bottle (50ml) to have
an ‘auto-dispenser’ and information leaflet as per MoHFW guidelines in the
mono-carton
 Children 5–9 years of age
o Weekly, 1 Iron and Folic Acid tablet Each tablet containing 45 mg elemental
Iron + 400 mcg Folic Acid, sugar-coated, pink colour
 School-going adolescent girls and boys, 10–19 years of age
 Out-of-school adolescent girls, 10–19 years of age
o Weekly, 1 Iron and Folic Acid tablet Each tablet containing 60 mg elemental
iron + 500 mcg Folic Acid, sugar-coated, blue colour
 Women of reproductive age (non-pregnant, non-lactating) 20–49 years
o Weekly, 1 Iron and Folic Acid tablet Each tablet containing 60 mg elemental
Iron + 500 mcg Folic Acid, sugar-coated, red colour
 Pregnant women and lactating mothers (of 0–6 months child)
o Daily, 1 Iron and Folic Acid tablet starting from the fourth month of
pregnancy (that is from the second trimester), continued throughout
pregnancy (minimum 180 days during pregnancy) and to be continued for
180 days, post-partum Each tablet containing 60 mg elemental Iron + 500
mcg Folic Acid, sugar-coated, red colour
Dose and regime for deworming
 Age Group Dose and regime
 Children 12–59 months of age
o Biannual dose of 400 mg albendazole (½ tablet to children 12–24 months and
1 tablet to children 24–59 months)
 Children 5–9 years of age

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 o Biannual dose of 400 mg albendazole (1 tablet)
 School-going adolescent girls and boys 10–19 years of age
 Out-of-school adolescent girls 10–19 years of age
o Biannual dose of 400 mg albendazole (1 tablet)
 Women of reproductive age (non-pregnant, non-lactating) 20–49 years
o Biannual dose of 400 mg albendazole (1 tablet)
 Pregnant women
o One dose of 400 mg albendazole (1 tablet), after the first trimester,
preferably during the second trimester

 Promotion and monitoring of delayed clamping of the umbilical cord for at least 3
minutes (or until cord pulsations cease) for newborns across all health facilities will
be carried out for improving the infant’s iron reserves up to 6 months after birth.
Simultaneously, all birth attendants should make an effort to ensure early initiation
of breastfeeding within 1 hour of birth.

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 Rashtriya Kishor Swasthya Karyakram (RKSK)
Introduction:
Health programme launched by The Ministry of Health & Family Welfare in 2014 for
adolescents, in the age group of 10-19 years, which would target their nutrition,
reproductive health and substance abuse, among other issues.
The Vision:
 The strategy envisions that all adolescents in India are able to realise their full
potential by making informed and responsible decisions related to their health and
well-being, and by accessing the services and support they need to do so.
 The implementation of this vision requires support from the government and other
institutions, including the health, education and labour sectors as well as
adolescents’ own families and communities.
Objectives
 Improve nutrition
 Reduce the prevalence of malnutrition among adolescent girls and boys
 Reduce the prevalence of iron-deficiency anaemia (IDA) among adolescent girls and
boys
 Improve sexual and reproductive health
 Improve knowledge, attitudes and behaviour, in relation to SRH
 Reduce teenage pregnancies
 Improve birth preparedness, complication readiness and provide early parenting
support for adolescent parents
 Enhance mental health
 Address mental health concerns of adolescents
 Prevent injuries and violence
 Promote favourable attitudes for preventing injuries and violence (including GBV)
among adolescents
 Prevent substance misuse
 Increase adolescents’ awareness of the adverse effects and consequences of
substance misuse
 Address NCDs
 Promote behaviour change in adolescents to prevent NCDs such as hypertension,
stroke, cardio-vascular diseases and diabetes

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Target Groups
The new adolescent health (AH) strategy focuses on age groups 10-14 years and 15-19 years
with universal coverage, i.e. males and females; urban and rural; in school and out of
school; married and unmarried; and vulnerable and under-served.
Strategies
 Strategies/interventions to achieve objectives can be broadly grouped as:
 Community based interventions
 Peer Education (PE)
 Quarterly Adolescent Health Day (AHD)
 Weekly Iron and Folic Acid Supplementation Programme (WIFS)
 Menstrual Hygiene Scheme (MHS)
 Facility based interventions
 Strengthening of Adolescent Friendly Health Clinics (AFHC)
Convergence
Within Health & Family Welfare - FP, MH (incl VHND), RBSK, NACP, National Tobacco Control
Programme, National Mental Health Programme, NCDs and IEC
With other departments/schemes - WCD (ICDS, KSY, BSY, SABLA), HRD (AEP, MDM), Youth
Affairs and Sports (Adolescent Empowerment Scheme, National Service Scheme, NYKS,
NPYAD)

Source: Vikaspedia (Accessed on 11/09/2020)

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 Affordable Medicines and Reliable Implants for Treatment (AMRIT)

Launched by Ministry for Health & Family Welfare with the aim to reduce the expenditure
incurred by patients on treatment of cancer and heart diseases.
AMRIT retail outlets
Retail outlets will sell drugs for the cancer and heart diseases at highly discounted rates. The
AMRIT pharmacy would be selling 202 cancer and 186 cardio-vascular drugs, and 148 types
of cardiac implants at very affordable prices.

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 Janani Shishu Suraksha Karyakaram

Introduction
Government of India has launched the Janani Shishu Suraksha Karyakaram (JSSK) on 1st
June, 2011. The scheme is to benefit pregnant women who access Government health
facilities for their delivery. Moreover it will motivate those who still choose to deliver at
their homes to opt for institutional deliveries.
The New Initiative
Ministry of Health and Family Welfare (MoHFW) has taken a major initiative to evolve a
consensus on the part of all States to provide completely free and cashless services to
pregnant women including normal deliveries and caesarean operations and sick new born
(up to 30 days after birth) in Government health institutions in both rural and urban areas.

The following are the Free Entitlements for pregnant women:

 Free and cashless delivery
 Free C-Section
 Free drugs and consumables
 Free diagnostics
 Free diet during stay in the health institutions
 Free provision of blood
 Exemption from user charges
 Free transport from home to health institutions
 Free transport between facilities in case of referral
 Free drop back from Institutions to home after 48hrs stay

The following are the Free Entitlements for Sick newborns till 30 days after birth.This has
now been expanded to cover sick infants:
 Free treatment
 Free drugs and consumables
 Free diagnostics
 Free provision of blood
 Exemption from user charges
 Free Transport from Home to Health Institutions

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  Free Transport between facilities in case of referral
 Free drop Back from Institutions to home

Key features of the scheme

The initiative entitles all pregnant women delivering in public health institutions to
absolutely free and no expense delivery, including caesarean section.
The entitlements include free drugs and consumables, free diet up to 3 days during normal
delivery and up to 7 days for C-section, free diagnostics, and free blood wherever required.
This initiative also provides for free transport from home to institution, between facilities in
case of a referral and drop back home. Similar entitlements have been put in place for all
sick newborns accessing public health institutions for treatment till 30 days after birth.This
has now been expanded to cover sick infants:
The scheme aims to eliminate out of pocket expenses incurred by the pregnant women and
sick new borne while accessing services at Government health facilities.

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 Rashtriya Bal Swasthya Karyakram (RBSK)
Introduction
Rashtriya Bal Swasthya Karyakram (RBSK) is a new initiative aiming at early identification
and early intervention for children from birth to 18 years to cover 4 ‘D’s viz. Defects at
birth, Deficiencies, Diseases, Development delays including disability.
It is important to note that the 0 - 6 years age group will be specifically managed at District
Early Intervention Center ( DEIC ) level while for 6 -18 years age group, management
of conditions will be done through existing public health facilities. DEIC will act as
referral linkages for both the age groups.
First level of screening is to be done at all delivery points through existing Medical Officers,
Staff Nurses and ANMs. After 48 hours till 6 weeks the screening of newborns will be done
by ASHA at home as a part of HBNC package. Outreach screening will be done by
dedicated mobile block level teams for 6 weeks to 6 years at anganwadis centres and 6
- 18 years children at school.
Once the child is screened and referred from any of these points of identification, it would
be ensured that the necessary treatment/intervention is delivered at zero cost to the family.
Target age group
The services aim to cover children of 0 -6 years of age in rural areas and urban slums in
addition to children enrolled in classes I to XII in Government and Government aided
Schools. It is expected that these services will reach to about 27 crores children in a phased
manner. The broad category of age group and estimated beneficiary is as shown below in
the table. The children have been grouped in to three categories owing to the fact that
different sets of tools would be used and also different set of conditions could be
prioritized.
Target group under Child Health Screening and Intervention Service Categories
Categories Age Coverage
Babies born at public health facilities and home Birth to 6 weeks 2 crores
Preschool children in rural areas and urban slum 6weeks to 6 years 8 crores
School children enrolled in class 1st and 12th in 6yrs to 18 yrs 17 crores
government and government aided schools
Health conditions to be screened
Child Health Screening and Early Intervention Services under RBSK envisages to cover 30
selected health conditions for Screening, early detection and free management. States and
UTs may also include diseases namely hypothyroidism, Sickle cell anaemia and Beta
Thalassemia based on epidemiological situation and availability of testing and
specialized support facilities within State and UTs.
Selected Health Conditions for Child Health Screening & Early Intervention Services
1. Neural tube defect
2. Down's Syndrome
3. Cleft Lip & Palate / Cleft palate alone

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4. Talipes (club foot)
5. Developmental dysplasia of the hip
6. Congenital cataract
7. Congenital deafness
8. Congenital heart diseases
9. Retinopathy of Prematurity
10. Anaemia especially Severe anaemia
11. Vitamin A deficiency (Bitot spot)
12. Vitamin D Deficiency, (Rickets)
13. Severe Acute Malnutrition
14. Goiter

Diseases of Childhood Developmental delays and Disabilities

15. Skin conditions (Scabies, fungal infection and Eczema)
16. Otitis Media
17. Rheumatic heart disease
18. Reactive airway disease
19.Dental conditions
20. Convulsive disorders
21. Vision Impairment
22. Hearing Impairment
23. Neuro-motor Impairment
24. Motor delay
25. Cognitive delay
26. Language delay
27. Behavior disorder (Autism)
28. Learning disorder
29. Attention deficit hyperactivity disorder
30. Congenital Hypothyroidism, Sickle cell anemia, Beta thalassemia (Optional)

Mechanisms for screening at Community & Facility level:

Child screening under RBSK is at two levels community level and facility level. While facility
based new born screening at public health facilities like PHCs / CHCs/ DH, will be by
existing health manpower like Medical Officers, Staff Nurses & ANMs, the community level
screening will be conducted by the Mobile health teams at Anganwadi Centres and
Government and Government aided Schools.
Screening at Anganwadi Centre
All pre-school children below 6 years of age would be screened by Mobile Block Health
teams for deficiencies, diseases, developmental delays including disability at the Anganwadi
centre at least twice a year. Tool for screening for 0-6 years is supported by pictorial, job
aids specifically for developmental delays. For developmental delays children would be
screened using age specific tools specific and those suspected would be referred to DEIC for
further management.

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Screening at Schools - Government and Government aided
School children age 6 to 18 years would be screened by Mobile Health teams for
deficiencies, diseases, developmental delays including disability, adolescent health at the
local schools at least once a year. The too used is questionnaire (preferably translated to
local or regional language) and clinical examination.
Composition of mobile health team
The mobile health team will consist of four members- two Doctors (AYUSH) one male and
one female, at least with a bachelor degree from an approved institution, one ANM/Staff
Nurse and one Pharmacist with proficiency in computer for data management
Suggested Composition of Mobile Health Team.
S.No Member Number
1 Medical officers (AYUSH) -1male and 1 female at least with a bachelor degree from
an approved institution 2
2 ANM/Staff Nurse 1
3 Pharmacist with proficiency in computer for data management 1
*In case a Pharmacist is not available, other paramedics –Lab Technician or Ophthalmic
Assistant

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 National Tuberculosis Elimination Program (NTEP)
At the start of 2020 the central government renamed the RNTCP the
National Tuberculosis Elimination Program (NTEP). In a lettter to all
the State Chief Secretaries of states and UTs, the commitment is
emphasised of the Union government achieving the sustainable
development goal of ending TB by 2025, five years ahead of the global
targets.
India National Strategic Plan (NSP) for TB 2017 - 2025
The Indian TB National Strategic Plan (NSP) 2017 - 2025 is the plan produced by the
government of India (GoI) which sets out what the government believes is needed to
eliminate TB in India. The NSP 2017 - 2025 describes the activities and interventions that the
GoI believes will bring about significant change in the incidence, prevalence and mortality
from TB. This is in addition to what is already going on in the country.
Visions & Goals of the National Strategic Plan
TB multimedia campaign in India, INDIAVsTB encourages people to get tested for TB, an
important part of the NS
The Vision is of a TB free India with zero deaths, disease and poverty due to tuberculosis
The Goal is to achieve a rapid decline in the burden of TB, mortality and morbidity, while
working towards the elimination of TB in India by 2025.
The requirements for moving towards TB elimination in India have been arranged in four
strategic areas of Detect, Treat, Prevent & Build.
There is also across all four areas, an overarching theme of the Private Sector. Another
overarching theme is that of Key Populations.
Targets
The targets of the National Strategic Plan are set out as consisting of both outcome and
impact indicators. There are also four main “thrust” or priority areas in the NSP which are:
 Private sector engagement;
 Plugging the “leak” from the TB care cascade (i.e. people with TB going missing from
care);
 Active case finding among key populations;
 and for people in “high risk” groups, preventing the development of active TB in
people with latent TB.
 Another “thrust” area is that of the Programmatic Management of Drug Resistant TB
(PMDT).
Detect
The aim is to detect all those people with drug sensitive TB as well as those with drug
resistant TB. The emphasis is to be on reaching TB patients seeking care from private

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providers and also finding people with undiagnosed TB in “high risk” or key populations. This
is to be done through:
 Scaling up free, high sensitivity TB diagnostic tests such as CBNAAT;
 Scaling up private provider engagement approaches;
 Universal testing for drug resistant TB;
 & Systematic screening of high risk populations.
Diagnosis
The Technical & Operational Guidelines for TB Control (TOG) describes how various tests
should be used to diagnose anyone who has signs and symptoms suggesting that they might
have TB. The tests to be used are sputum smear microscopy, chest X ray and the new CB-
NAAT test. The CB-NAAT test is beginning to be made available throughout India. There is a
diagram, or set of rules, which shows which tests should be used for different groups of
people.
Active case finding
The main objective of active case finding (ACF) is to detect TB cases early and to initiate
treatment promptly. The NSP emphasizes the need to shift from passive case finding, which
is waiting for people to seek care, to ACF which involves seeking out people in targeted
groups.
Treat
Initiate and sustain all patients on appropriate anti-tb treatment wherever they seek care.
Provide patient friendly systems and social support. This is to be done through:
 Preventing the loss of TB cases in the cascade of care by providing support systems.
The “cascade of care” means every step in the provision of treatment, from when it
is first started, to the point at which the patient finishes their treatment and is cured
of TB;
 Providing free TB drugs for all patients with TB;
 Provide daily TB drugs for all patients with TB and a rapid scale up of short course
regimens for drug resistant TB. Provide treatment approaches guided by drug
sensitivity testing.
 Providing patient friendly adherence monitoring and social support in order to
sustain TB treatment;
 & The elimination of catastrophic costs by linking eligible TB patients with social
welfare schemes including providing nutritional support.
At present TB drugs are free at government centres. The NSP plan is that eventually TB
drugs will be available free from private centre pharmacies as well. Currently it is believed
that only half of all TB patients make use of the free medicines. It is believed that making
the TB drugs available in private hospitals:

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  Nutritional support for patients with TB
It has now been announced that patients with TB will receive R500 ($8) a month for food.
There is more about all the Direct Benefit Transfer schemes for TB.
Under nutrition is a risk factor for TB in India. Under nutrition worsens the nutritional status,
generating a vicious cycle which can lead to adverse outcomes during and after treatment
for patients with active TB. This includes those with MDR-TB. So this payment is partially to
ensure that patients with TB have adequate food. There is more about food and TB and
nutrition & TB.
Prevent
Preventing the emergence of TB in susceptible populations. This is to be done through
 Scaling up air-borne infection control measures at health care facilities;
 Providing treatment for latent TB infection for the contacts of people with confirmed
TB;
 & Addressing the social determinants of TB through an approach across different
sectors. The social determinants of health are generally considered to be the
conditions in which people live and work that affect their health.

Build
Build and strengthen relevant policies. Provide extra capacity for institutions and extra
human resources capacity. This is to be done through:
 Translating high level political commitment into action;
 Restructuring the RNTCP and other institutional arrangements;
 Building supportive structures for surveillance, research and innovations. Providing a
range of interventions based on the local situation;
 Scaling up technical assistance at national and state levels;
 & Preventing the duplication of partners’ activities

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