National Health Programs of India Dr Lipilekha Patnaik Professor, Community Medicine Institute of Medical Sciences & SUM Hospital Siksha*O" University Bhubaneswar, Odisha, IndiaLesson Objectives * To know about the National Health Programs ( NHP) in India + Understand the relevance of the National Health Programs.Introduction * Health: “a state of complete physical, mental and social well being and not merely an absence of disease of infirmity”. + Health is fundamental human right and nation has a responsibility for the health of its people. + The health problems of India may be conveniently listed under the following heads: 1, Communicable disease problems . Noncommunicable disease problems .. Nutritional problems . Environmental sanitation problen |. Medical care problems . Population problems ween= et The present concern in both developed and developing countries is not only to reach the whole population with adequate health care services but also to secure an acceptable level of health for all. Strategies: Planned program activities to develop and improve the health of the people. GOl set upa planning fommission in 1950 To make an assessment of thd[material, capital and human resources Draft developmental plans for the effective utilization of these ————————eGC ooo © After Independence > various measures to improve the health of the people and prominent among them are the Nadionusl Meuléls (Pen aes. © Various intemational agencies like WEE, UNSCIE, UNI World lek, as aiso a number of foreign cies like SHERY, ERWNEIDA. NOW and US.ANbhave been ing technical and material assistance in the implementation of these programmes. uses Programmes were launched by Government withReproductive, Maternal,Neonatal, Child and Adolescent health * Janani Shishu Suraksha Karyakaram USSK} * Rashtriya Kishor Swasthya Karyakram(RKSK] * Rashtriya Bal SwasthyaKaryakram (RBSK. * Universal Immunisation Programme * Mission Indradhanush / Intensified Misson Indradhanush * Janani Suraksha Yojana (JSY} * Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) * Navjaat Shishu Suraksha Karyakram (NSSK * National Programme for Famih nin,National Nutritional Programmes * ional lodine Deficiency Disorders Control Pre * MAA (Mothers' Absolute Affection) Programme for Infant and Young Child Feeding * National Programme for Prevention and Control of Fluorosis (NPPCF * National Iron Plus Initiative for Anaemia Control * National Vitamin A prophylaxis Programe * Integrated Child Development Services (ICDS * Mid-Day Meal ProgrammeCommunicable diseases * Integrated Disease Surveillance Programme (ID! + Revised National Tuberculosis Control Programme (RNTCP) + National Leprosy Eradication Programme (NLEP) * National Vector Borne Disease Control Programme * National AIDS Control Programme (NACP| * Pulse Polio Programme * National Viral Hepatitis Control Program. * National Rabies Control Programme * National Programme on Containment of Anti-Microbial Resistance (AMR)Non-communicable diseases + National Tabacco Control Programme(NTCP) + National Programme for Prevention and Control of Cancer, Diabetes, SE ae eee eae at cares Diates, diovascular Diseases & Stroke (NPCDCS) * Nati | Programme for Control Treat if Ceci nal Dise: + National Programme for Prevention and Control of Deafness (NPPCO} + National Mental Health Programme * National Programme for Control of Blindness& Visual impairment + Pradhan Mantri National Dialysis Programme . 1al Programme for the are for the Elderly (NPHCE] + National Programme for Prevention & Management of Burn Injuries (NPPMIBI + National Oral Health programmeHealth system strengthening programs * Ayushman Bharat Yojana * Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) * LaQshya’ programme {Labour Room Quality Improvement Initiative) * National Health Mission * National Digital Health Mission (NDHM.National Health Mission + Two sub-missions NRHM ~ National Rural Health Mission (2005) ~ converted to ‘National Health Missian™ NHM (2013) NUHM ~ National Urban Health Mission (2013) - to meet health care needs of the urban population with the focus on urban poor. * National Rural Health Mission was launched in 2008, Under NRHM, financial assistance has been provided to the States/UTS for health systems strengthening which includes o Augmentation of infrastructure, o Human resources and programme management, © Emergency response services © Mobile Medical Units, eo Community participation © Mainstreaming of AYUSH and availability of drugs and equipmentComponents of NHM: * 1. Health Systems Strengthening 9 Adoption of Indian Public Health Standards (IPHS) + 2. RMNCH + A: Reproductive, Maternal, Newborn, Child and Adolescent Health + 3.National Disease Control ProgramsGoals of NHM Beeb Reduce MMR to 1/1000 live births Reduce IMR to 25/1000 live births Reduce TFR to 2.1 Prevention and reduction of anaemia in women aged 15-49 years Prevent and reduce mortality & morbidity from communicable, non- communicable; injuries and emerging diseases Reduce household out-of-pocket expenditure on total health care expenditure Reduce annual incidence and mortality from Tuberculosis by half Reduce prevalence of Leprosy to <1/10000 population and incidence to zero in all districts Annual Malaria Incidence to be <1/1000 Less than 1 per cent microfilaria prevalence in all districts ala-azar Elimination by 2015, <1 ease per 10000 population in all K blocks.Reproductive, Maternal,Neonatal, Child and Adolescent health * Janani Shishu Suraksha Karyakaram USSK} * Rashtriya Kishor Swasthya Karyakram(RKSK] * Rashtriya Bal SwasthyaKaryakram (RBSK. * Universal Immunisation Programme * Mission Indradhanush / Intensified Misson Indradhanush * Janani Suraksha Yojana (JSY} * Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) * Navjaat Shishu Suraksha Karyakram (NSSK * National Programme for Famih nin,ee eae eae Nearly 1.3 Crore women Pleo =<-taliiiatiat Sete ty entitlements since its launch on 1st June, 2011 Cee EonJANANI SHISHU SURAKSHA KARYAKARAM (JSSK) + Government of India has launched Janani Shishu Suraksha Karyakaram (ISSK) on [st June, 2011. * Itis an initiative to reach every needy pregnant woman coming to government institutional facility and motivate these who still choose to deliver at their homes to opt Eros Exemption from user charges Free transport from home to health institutions Free transport between facilites in case of referral Free drop back from Institutions to home after gh stay Free Transport between facilities in case of referral Free drop Back from Institutions to home + Frog and cashless delivery + Free treatment, + Free C-Section + Free drugs.and consumables + Free drugs and consumables + Free diagnostics + Free diagnostics + Free provision of blood “+ Free diet during stay in the health institutions + Exemption from user charges + Free provision af blood ‘+ Free Transport from Home to Health Institutions(www, reagermaster.com) = .s v Rashtriya Kishor Swasthya Karyakram argtar fiefs earreezy osrelaesyRashtriya Kishor Swasthya Karyakram (RKSK) * The Ministry of Health & Family Welfire has launched a health programme for adolescents, inthe age group of 10-19 years, Which Would target their nutrition, reproductive health and substance abuse. + Launched on 7th January, 2014. + The RKSK (National Adolescent Health Programme),will comprehensively address the health needs of the 243 million adolescents + It introduces community-based interventions through peer educators. Objectives: + Improve Nutrition + Improve Sexual and Reproductive Health + Enhance Mental Health + Prevent Injuries and violence + Prevent substance misuseRashtriya Bal Swasthya Karyakram (RBSK) envisages Child Health Screening and Early Intervention Services. * Objective - Early identification and carly intervention for children from birth to 18 yeurs to cover 4 ‘D's viz. Defects at birth, Diseases in children, Deficiency conditions and Developmental delays including Disabilities. Target group under Child Health Screening and Intervention * Babies born at public health facilities and home- Birth to. weeks + Preschool children in rural areas and urban slum - Gweeks to 6 years + School children enrolied in class Ist and [2th in government and govemment aided schools = Gyrs to 18 yearseres Le er ae Defects at Birth Deficiencies 1 Neural tube defect 10. Anemia especialy Severe anemia 2 Dows'sSindrome 11 Vitamin A deficiency (itt spat) 43. GletLip & Palate / Cleft palate alone 12. Vitamin 0 Defiiency, (chet) 4. Talipes (lub foot) 13. Severe Acute Malnutition ‘5. Developmental dyspasia af the hip 14. Govter ‘6. Congenital cataract “7. Cangenita deafness Congenital hart dicesces 9 Retinopathy of Prematuity Diseases of Ctsnaod Developmental Selays ond Dlzobities 15, Skin coalitions (Seales, fungal infection and Eczema) 16. Ottis Media 21. Vision impairment 17, Rheumatic heart disease 22. Hearing Impalement 18, Reactive airway daease 23, Neurormotor Impairment 19.Demal conditions 224, Motor delay 20, Conwulive diced 25, Cognitive daly 26, Language delay 27, Behavior disorder (Autism) 26. Learning disorder 29, Attention defct hyperactivity disorder 30. Congenital Hypothyroidism, sickle cell anemia, Beta thalassemia (Optional)Universal Immunization ProgrammeUniversal Immunization Programme * Immunization Programme in India was introduced in 1978 as “Expanded Programme of Immunization’ (EPI) by the Ministry of Health and Family Welfare, Government of India, * In 1985, the programme was modified as ‘Universal Immunization Programme’ (UIP), one of largest health programme in the world. * Ministry of Health and Family Welfare, Government of India provides several vaccines to infants, children and pregnant women through the Universal Immunisation Programme.CoN SSSR a Bacillus Calmete Guerin (BCG), Oral Polio Vaccine (OPV)-0 dose, Bist ‘Hepatitis B birth dose OPV-1, Pentavalent-1, Rotavinis Vaccine (RVV)-1, Fractional dose of 6 Weeks Inactivated Poho Vaccine ((PV)-1, Pneumococcal Conjugate Vaccine PCy) -1" (OPV-2, Pentavalent-2, RVV-2 OPV-5, Peniavalent-3, 1PV-2, RVW-3, PCV-2° Measles & Rubella (MR)-1, JE-177 . PCV-Booster™ MR-2, JE-2**, Diphtheria, Pertussis & Tetanus (DPT)-Booster-1, OPV — Booster DFT-Booster-2 ‘Tetmms & adult Diphtiserin (Tal) Td Tél, TH? or TA-Booster” ily ‘Que doe previously vnecinated within 3 earsMISSION INDRADHANUSH The Government of India launched Mission Indradhanush on 25th December 2014, to cover children who are either unvaccinated or partially vaccinated against seven vaccine preventable diseases, j.e., diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis B. The goal is to vaccinate all under-fives by the year 2020. 201 high focus districts were covered in the first phase, Of these 82 distriets are from Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan. These 201 districts have nearly 50 per cent of all unvaccinated children of the country. The drive was through a “catch-up” campaign mode. The mission was technically supported by WHO, UNICEF, Rotary International and other donor partners.+ Government of India introduced “Intensified Mission Indradhanush (IMI)” in select districts and urban areas of the country to achieve the target of more than 90% coverage. + TMI focus on children up to 2 years of age and pregnant women who have missed out on routine immunization. However, vaccination on demand to children up to 5 years of age will be provided during [MI rounds. + Intensified Mission Indradhanush Immunization drive will be spread over 7 working days starting from 7th of every month. These 7 days do not include holidays, Sundays and the routine immunization days planned in that week.Janani Suraksha Yojana (JSY)Janani Suraksha Yojana (JSY) * Janani Suraksha Yojana (ISY) is a safe motherhood intervention under the National Rural Health Mission (NRHM) being implemented with the objective of reducing matemal and neo-natal mortality by promoting institutional delivery among the poor pregnant women. + The Yojana, launched on 12th April 2005, it integrates cash assistance with delivery and post-delivery care. + The Yojana has identified ASHA, the accredited social health activist as an effective link between the Government and the poor pregnant women. + Each beneficiary registered under this Yojana should have a JSY card along with a MCH card. ASHA/AWW/ any other identified link worker under the overall supervision of the ANM and the MO, PHC prepare a micro-birth plan. ‘This will effectively help in monitoring Antenatal Check-up, and the post delivery care.Moherspackage SHAS package =—«sRs_—=Mathespackage ASH package Rs 1400 0 i) 20 ‘a0 HPS ™ ™ | 600 600 Disbursement of Cash Assistance: AS the cash assistance to the mother is mainly Wb meet the cost of delivery, It shouldbe disbursed eecthly a the instution iseMATE "AN Ty, \\} Sms s S 4BHIYROS Oth of Every MonthPradhan Mantri Surakshit Matritva Abhiyan * Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) was launched in the year 2016 under National Health Mission. * The program aims to provide assured, comprehensive and quality antenatal care, free of cost, universally to all pregnant women on the 9th of every month. This service is given in addition to the routine ANC at the health facility. Goal of the PMSMA * Pradhan Mantri SurakshitMatritva Abhiyan envisages to improve the quality and coverage of Antenatal Care (ANC) including diagnostics and counselling services.Objectives of the program: + Ensure at least one antenatal cheekup for all pregnant women physician/specialist + Improve the quality of care during ante-natal vis following services: + All applicable diagnostic services + Screening for the applicable clinical conditions + Appropriate management of any existing clinical condition such as Anaemia, Pregnancy induced hypertension, Gestational Diabetes ete. * Appropriate counselling services and proper documentation of services rendered Additional service opportunity to pregnant women who have missed ante-natal visits * Identification and Tine-listing of high risk pregnancies based on obstetrie/ medical existing clinical conditions. ‘+ Appropriate birth planning and complication readiness for cach pregnant woman especially those identified with any risk factor or comorbid condition. + Special emphasis on early diagnosis, adequate and appropriate management of women with ‘malnutrition, * Special focus on adolescent and early pregnancies as these pregnancies need extra and specialized care heir second or third trimester by a . This includes ensuring provision of theNavjaat Shishu Suraksha KaryakramNayjaat Shishu Suraksha Karyakram (NSSK) + NSSK is a programme aimed to train health personnel in basic newborn care and resuscitation, has been launched to address care at birth issues i.e. Prevention of Hypothermia, Prevention of Infection, Early initiation of Breast feeding and Basic Newborn Resuscitation. * Objective is to have a trained health personal in basic newborn care and resuscitation at every delivery point. The training is for 2 days and is expected to reduce neonatal mortality significantly in the country.National Programme for Family PlanningNational Programme for Family Planning * India was the first country in the world to have launched a National Programme for Family Planning in 1982 * Over the decades, the programme has undergone transformation in terms of policy and actual programme implementation and currently being repositioned to not only achieve papulation stabilization goals but also promote reproductive health and reduce maternal, infant & child mortality and morbidity. * Under the programme public health sector provides various family planning Services at various levels of health system, + Launched “Mission Pariwar Vikiis"in 2016, Special focus has been given to 146 high fertility Districts of Bihay UP. Assam. Chhattisgarh, MP. Rajasthan & Jharkhand, with an aim to ensure availability of contraceptive methods at all the levels of Health Systems. * Goal «Its overall goals to reduce India's overall fetlity rate to 2.1 by the year bjective - To improve the access to comtraceptives and accelerating access to igh quality family planning services.Key strategies include - + Providing more choices through newly introduced contraceptives: Injectable Contraceptive, MPA (Medroxyprogesterone acetate) under Antara program and Chaya (earlier marketed as Saheli). * Emphasis on Spacing methods like |UCD * Revitalizing Postpartum Family Planning including PPIUCD. + Strengthening community-based distribution of contraceptives by Involving ASHAs and Focused IEC/ BCC efforts for enhancing demand and creating awareness on family planning * Availability of Fixed Day Static Se + Emphasis on minilap tubectomy services. + Ensuring quality care in Family Planning services by establishing Quality Assurance Committees s at all faci + Increasing male participation and promoting Non-scalpel vasectomy. + ‘Demand generation activities in the form of display of posters, billboards and other audio and video materials in the various facilities be planned and budgeted.National Nutritional Programmes * ional lodine Deficiency Disorders Control Pre * MAA (Mothers' Absolute Affection) Programme for Infant and Young Child Feeding * National Programme for Prevention and Control of Fluorosis (NPPCF * National Iron Plus Initiative for Anaemia Control * National Vitamin A prophylaxis Programe * Integrated Child Development Services (ICDS * Mid-Day Meal ProgrammeNational IDD ® Control ProgrammeNational Iodine Deficiency Disorders Control Programme + It isa micronutrient and normally required around 100-150 microgram for normal growth and development. Defieieney of iodine may cause following disorders: * Goiter + Subnormal intelligence + Neuromuscular weakness + Endemic eretinism Still birth * Hypothyroidism + Defect in vision, hearing, and speech + Spasticity + Intrauterine death * Mental retardationObjectives: * Surveys to assess the magnitude of the lodine Deficiency Disorders. * Supply of iodated salt in place of common salt. + Resurvey after every 5 years to assess the extent of lodine Deficiency Disorders and the impact of lodated salt. * Laboratory monitoring of iodated salt and urinary iodine excretion. + Health education and Publicity.MAA Mother's Absolute Affection Greastfeeding — A commitment, not an option!MAA (Mothers’ Absolute Affection) Programme for Infant and Young Child Feeding * MAR. "Mother's Absolute affection” is 3 nationwide programme to bring undited focus on promotion of breastfeeding and provision of counselling services for supporting breastieeding through health systems, “The programme has been named ‘MAA’ to signify the support.a lactating mother requires from family raembers and af Health facilties to breattieed suecessluly * Goal The ‘MAA Prograrnme i to revitalize efforts towards promotion, grotection and support of breastfeeding practices through health systems to achieve higher breastfeeding rates. Objective ~ Build an enabling environment for breastfeeding through awareness generation activities, targeting pregnant and lactating mothers, family members and society in order (o promote optimal breastfeeding practices. Breastfeeding to be positioned as an important intervention for iid survival and development. * Reinforce lactation support services at public health facilities through trained healthcare providers and through skilled community health workers. + Taincentivize and recognize those health facilities that show high rates of breastfeeding along with pracesses in place for lactation management,Key messages — Early initiation of breastfeeding; immediately afler birth, preferably within one hour, ‘Breast-1 alone is the best food and drink for an infant for the first six months of life. No ‘ther food or drink, not even water, is usually needed during this period, But allow infant 10 receive ORS, drops, syrups of vitamins, minerals and medicines when required for medical reasons. After 6 months of age, babies should be introduced to semi-solid, soft foad (complementary feeding) but breastfeeding should continue for up to two years and beyond, because it is an important source of nutrition, energy and protection from illness. “From the age of 6-8 months a child needs to eat two to three times per day and thereafter, three to four times per day starting at 9 months ~ in addition to breastfeeding. During an illness, children need additional fluids and encouragement to eat regular meals, and breastfeeding infants need to breastfeed more often. After an illness, children need to be ‘offered more food than usual, to replenish the energy and nourishment lost due to the illness.NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OFNational Programme for Prevention and Control of Fluorosis (NPPCF) + Fluorosis, a public health problem is caused by excess intake of fluoride through drinking water/food products/industrial emission over a long peri * Itresults in major health disorders like dental fluorosis, skeletal fluorosis and non-skeletal fluorosis, . Frevalence - Fluoride prevalence was earlier reported in 230 districts of 19 tates, * Goal - The NPPCF aims to prevent and control Fluorosis cases in the country. * Objectiv + Comprehensive management of fluorosis in the selected areas; * Capacity building for prevention, diagnosis and management of fluorosis cases.National Iron Plus Initiative (NIPI)National Iron Plus Initiative (NIPI) * The National Iron Plus Initiative (NIPI) is an attempt to look at the Iron Deficiency Anaemia comprehensively across all life stages including adolescents and women in reproductive age group who are not pregnant or lactating. * Vision 2025: Anaemia Free India: Reduction of Anaemia by 50%Interv ons + IFA Supplementation and Deworming + BCC for consumption of Iron Rich Food and IFA & Albendazole Compliance * Use of Iron Fortified Food in Public Health facilities + Test and treat nutritional anemia in school going adolescents 10-19 years and pregnant women + Test and treat non-nutritional anemia (Malaria, sickle cell anemia ete) * Delayed cord clamping at institutional deliverySe ice 5=60 months Imi of FA syrup containing 20mg of elemental ron & 100 meg of fois acid 5=10 years Tablets of 45mg elemental iron & 400 meg of folie acid 10-29 years 100mg elemental ron 8.500 meg of folic acid Pregnant & 100mg elemental iror Lactating women 8 500 mcg of folic acid ‘Women in 100mg elemental iron eprodiictive age 6 500 mcg of folic acid ‘roup oo Biweekly throughout the period 6-60months of age & deworming for children 12months & above Weekly throughout the period S- 10 years of age & biannual de- worming ‘Weekly throughoult the period +10-19yrs of age & biannual de- worming ‘Ltablet daily for 180 days, stating after the first trimester, ‘at 14-16 weeks of gestation. To ‘be repeated for 180 days post- partum Weekly throughout the reproductive period ins Through ASHA ‘Hf Syrup bottles would be handed over to all Mothers at VHNND sessions: Im schoo! through teachers In sehoo! through teachers & for ‘out of school children through AWW ANMIASHA. Through ASHA during house visit (Wot Yet Started )Deworming * The National Deworming Day launched on February 2015 is a single fixed-day approach to treating intestinal worm infections in all children aged |- 19 years, and is held on 10 February and 10 August each year. + “Tt aims to create mass awareness about the most effective and low-cost STH treatment administering albendazole tablets.Objective * To deworm all preschool and school-age children ‘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.DRUG ADMINISTRATION AT THE SCHOOL AND ANGANWADI CENTER ee Tae atarration Tapas | Wai tee af Wibcedanal | > Brag ation want We dane sOOmgtiee snr rupersion by tracer AWW Eivyras [Fall GORY of Abend |" ue educr ana ir requined sheeld Segue ‘consume some water. Gran decking water. shouldbe rable a tbe wheel/anganadh Soeeos Geperayaue Fer youu chikren the tablet should be tebe and eesed (rere twe spoons) and then administered wih water Dosage of Albendazale: If syrup is supplied, Sml for 1-2 years, on a bi-annual basis. 10ml for 2-5 years, on a bi-annual basisNational Vitamin A prophylaxis programNational Vitamin A prophylaxis program + Vitamin A is an important micronutrient for maintaining normal growth, controlling development, and maintaining visual and reproductive functions, * Diet surveys have shown that the intake of Vitamin A is significantly lower than the recommended daily allowance in young children, adolescent girls and pregnant women. + In the fifties and sixties many of the states reported that blindness due to Vitamin A deficiency was one of the major causes of blindness in children below five years, * In 1970, the National Prophylaxis Programme Against Nutritional Blindness was initiated as a centrally sponsored scheme. + Aim: to decrease the prevalence of Vitamin A deficiencyObjective: * Prevention of vitamin A deficiency + Promoting consumption af Vitawin A rich food -by all pregnant and lactating women and by children under 5 years of age by increasing local production and consumption of green leafy vegetables and other plant foods those are rich sources of earotenoids, + Creating awareness about the importance of preventing Vitamin A deficieney- among the women’s attending Antenatal elinics, immunization session, as well as women and children rogistered under ICDS programme. + Prophylactic Vitamin A.as per the following dosage schedule: 100000 IU at 9 months with measles immunization 200000 IU at 16-18 months, with DPT booster 200000 IU every 6 months, up to the age of 5 years. * Thus, a total of 9 mega doses are to be given from 9 months of age up to 5 years. + Treatment of Vitamin A deficient children + All children with xerophthalmia are to be treated at + All children having meastes, to be given I dose of Vitamin A if they have not received it in the previous month, * All cases of severe malnutrition to be given one additional dose of Vitamin A.= = gay Ye integrated Child Development ServicesIntegrated Child Development Services (ICDS) * Integrated Child Development Service (ICDS) scheme was launched on 2nd October, 1975. Beneficiaries: * Children below 6 years * Pregnant and lactating women * Women in the age group of 15-44 years * Adolescent girls in selected blocksObjectives: + Improve the nutrition and health status of children in the age group of 0-6 years + Lay the foundation for proper psychological, physical and social development of the child + Effective coordination and implementation of policy among the various departments * Enhance the capability of the mother to look after the normal health and nutrition needs through proper nutrition and health education.Services provided The ICDS Scheme offers a package of six services 1. Supplementary Nutrition Pre-school non-formal education Nutrition & health education Immunization Health check-up and Referral services aywPwnRevised Nutritional Norms in ICDS (since February, 2009) lactating mothers Beneficiaries Calories Protein (a) ‘Children (6 months to 72 months) oy dete) ‘Severely malnourished Children (SAM) 800 20-25 (6 months- 72 months) Pregnant women — and ae 1820Mid-Day Meal Programme * Tamil Nadu was the first to initiate a massive noon meal programme to children. * Mid-Day Meal (MDM) Scheme was launched in primary schools during 1962-63. Mid-Day Meal improves three areas: 1. School attendance 2. Reduced dropouts 3. A beneficial impact on children’s nutrition,Objectives: * The objectives of the mid day meal scheme are: + Improving the nutritional status of children in classes |= VIII in Government, Local Body and Government aided schools * Encouraging poor children, belonging to disadvantaged sections, to attend school more regularly and help them concentrate on classroom activities. * Providing nutritional support to children of primary stage in drought- affected areasCommunicable diseases * Integrated Disease Surveillance Programme (ID! + Revised National Tuberculosis Control Programme (RNTCP) + National Leprosy Eradication Programme (NLEP) * National Vector Borne Disease Control Programme * National AIDS Control Programme (NACP| * Pulse Polio Programme * National Viral Hepatitis Control Program. * National Rabies Control Programme * National Programme on Containment of Anti-Microbial Resistance (AMR)Integrated Disease Surveillance ProgramIntegrated Disease Surveillance Program (IDSP) * The Integrated Disease Surveillance Program (IDSP) was initiated in assistance with World bank, in the year 2004, * The scheme aimed to strengthen disease surveillance for infectious diseases to detect and respand to outbreaks immediately. * The Central Surveillance Unit (CSU) at the National Centre for Disease Control (NCDC), receives disease outbreak reports from the States/UTs on weekly basis. Objective: + To strengthen/maintain decentralized laboratory-based IT enabled disease surveillance system for epidemic-prone diseases ta monitor disease trends and to detect and respond to outbreaks in early rising phase through trained Rapid Response Team (RRTs).nt TB bam Ngei NgeinaREVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME (RNTCP) t+ * Launched in 1997 based on WHO DOTS Strategy 4 A Goal: “ne * End global tuberculosis epidemic. ‘Targets: * Ending TB by 2030 as a part of SDG & WHO End TB strategy. * Reach 90% of all people with TB and place theme on appropriate therapy.* Achieve at least 90% treatment suecess for all people diagnosed with TB. + As a part of this approach reach at least 90% key population who are most vulnerable and under served at risk population. Strategies: + Direct observed treatment short course chemotherapy (DOTS) * Involvement of nongovernmental organization: + IEC and improve operational researchIndicators: + 95% reduction by2035 in number of TB death, * 90% reduction(<10/100000) by2035 in TB incidence rate. + Zero TR effected families facing catastrophic cost due to TB by 2035.National Leprosy Eradication Program -National Leprosy Eradication Programme * The National Leprosy Eradication Programme is a centrally sponsored Health Scheme of the Ministry of Health and Family Welfare, * The year 2012-13 started with 0.83 lakh leprosy cases on record as on Ist April 2012, with PR 0.68/10,000, Till then 33 States/ UTs had attained the level of leprosy elimination. A total of 542 districts (84.7%) out of total 640 districts also achieved elimination by March2012. A total of 209 high endemic districts were identified for special actions during 2012-13. ‘Objectives: + 1. Early detection through aetive surveillance by the trained health workers; + 2. Regular treatment of cases by providing Multi-Drug Therapy (MDT) at fixed in or centres a nearby village of moderate to low endemic areas/district; + 3. Intensified health education and public awareness campaigns to remove social stigma attached to the disease, + 4. Appropriate medical rehabilitation and leprosy ulcer care services.National Vector Borne Disease Control Programme ®Launched in 2003-04 by convergence of three ongoing programmes on malaria, filaria & Kala Azar and inclusion of Japanese Encephalitis and Dengue/DHF. ®In 2007 Chikungunya fever added to this programme due to re- emergence of the diseases in 2006. ® This program is now runs under the umbrella of NHM.Diseases included under -. NVBDCP pe RL *Malaria *Filaria *Kala-azar *Japanese Encephalitis “Dengue / Dengue Hemorrhagic fevers -ChikungunyaStrategies of NVBDCP peers Renae Z.INTEGRATED iM eneNational AIDS ProgrammeNational AIDS Control Programme + HIV infection in India is a major challenge with no State free from the virus. * The need to prevent the progression of the epidemic and provide care and support for those infected or affected is calling for an unprecedented response from all sections of society. Objectives: * 1. To reduce spread of HIV infection in India + 2. Strengthen India's capacity to respond to HIV/AIDS on a long term basis.Pulse Polio Programme * Pulse Polio Immunization programme was launched in India in 1995. * Children in the age group of 0-5 years administered polio drops during National and Sub-national immunization rounds (in high risk areas) every year, About 172 million children are immunized during each National Immunization Day (NID). + The last polio case in the country was reported from Howrah district of West Bengal with date of onset 13th January 2011. * WHO on 24th February 2012 removed India from the list of countries with active endemic wild polio virus transmission. ‘Objective : * The Pulse Polio Initiative was started with an objective of achieving hundred per cent coverage under Oral Polio Vaccine.= ncaa crm = gat Con, SS ey —_ = =. = = Qregter areer Sucisiéaa bereisur eprebarat With focus on Prevention, diagnosis & management of Viral HepatitisNational Viral Hepatitis Control Program (NVHCP) * The National Viral Hepatitis Control Program has been launched by occasion of the World Hepatitis Day, 28th July 2018. * It is an integrated initiative for the prevention and control of viral hepatitis in India This is a comprehensive plan covering the entire gamut from _ Hepatitis A, B, C, D & E, and the whole range from prevention, detection. Aim: + Combat hepatitis and achieve country wide elimination of Hepatitis C by 2030; * Achieve ficant reduction in the infected population, morbidity and mortality associated with Hepatitis B and C viz, Cirrhosis and Hepato- cellular carcinoma (liver cancer); * Reduce the risk, morbidity and mortality due to Hepatitis A and E.Rabies is a major public health problem Fatal once Symptons Be 99% human cases See Tae result hom worldwice dog bites 4 out of 10 deaths are in children Zero by 30 28 Septemper - World Rabies DayNational Rabies Control Programme * Rabies is an acute viral disease that causes fatal encephalomyelitis in virtually all the warm-blooded animals including human. The virus is found in wild and some domestic animals, and is transmitted to other animals and to humans through their saliva (following bites, scratches, licks on broken skin and mucous membrane), In India, dogs are responsible for about 97% of human rabies, followed by cats (2%), and others (1%). The disease is invariably fatal and perhaps the most painful and dreadful of all communicable diseases in which the sick person is tormented at the same time with thirst and fear of water (hydrophobia). Fortunately, development of rabies can be prevented to a large extent if animal bites are managed appropriately and in time. In this regard the post-exposure treatment of animal bite cases are of prime importance.ONO deat w lg Responsible Use of Antibiotics =) Omer 2 Za xe ©) STOP Transmitting AMR or CI Res Sanitation & Hygiene lta ee mas tailedNational Programme on Containment of Anti- Microbial Resistance (AMR) * The rapid spread of multi-resistant bacteria and the lack of new antibiotics to treat infections caused by these organisms pose a rapidly increasing threat to public, * Government of India has launched a “National Programme on Containment of” Antimicrobial Resistance” under the 12th five-year plan (2012-2017). ‘The main objectives of this programme are: * To establish a laboratory-based AMR surveillance system of 30 network labs in the country and to generate quality data on antimicrobial resistance for pathogens of public health importance. + To strengthen infection control guidelines and practices and promote rationale use of antibioties. + To generate awareness among healthcare providers and in the community about rationale use of antibiotiesNon-communicable diseases * National Tabacco Control Programme (NTCP) + National Programme for Prevention and Control of Cancer, Diabetes, Ee eee eee at cares Diaties, diovascular Diseases & Stroke (NPCDCS) * Nati | Programme for Control Treat if Ceci nal Dise: + National Programme for Prevention and Control of Deafness {NPPCO} + National Mental Health Programme * National Programme for Control of Blindness& Visual impairment + Pradhan Mantri National Dialysis Programme . 1al Programme for the are for the Elderly (NPHCE] + National Programme for Prevention & Management of Burn Injuries (NPPMIBI + National Oral Health programmeNational Tobacco Control ProgrammeNational Tobacco Control Programme + Tobacco use is one of the main risk factors for a number of chrani lung diseases, and cardiovascular diseases, * India is the 2nd largest producer and consumer of tobacco and a variety of forms of tobaeco use is unique to India. + The Government of india has enacted the national tobacco-contral legislation namely, “The Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003” in May, 2003.1 + Launched the National Tobacce Coritrol Programime (NTCP) in 2007- 08, 2ases; including cancet, ‘Objectives : + [abting about greater awareness about the harmful eects of tobacco use and Tobacco Control WS, + To facilitate effective implementation of the Tabacco Control Laws. * The objective of this programme isto control tabecco consumption and minimize the deaths caused by it.NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF CANCER, DIABETES, CARDIOVASCULAR DISEASES & STROKE (NPCDCS) + Non-communicable diseases (NCDs) are the leading cause of adult mortality and morbidity worldwide. « It is estimated that the overall prevalence of diabetes, hypertension. Ischemic Heart Diseases (IHD) and Stroke is 62.47, 159.46, 37.00 and 1.54 respectively per 1000 population of India (ICMR). * There are an estimated 25 Lakh cancer cases in India. + Considering the rising burden of NCDs and common risk factors to major Chronic Non -Communicable Diseases, Government of India initiated an NPCDCS during 2010-11 .NCDs Risk factors & mortality per year + Tobacco - 6.3 million deaths + Alcohol - 4.9 million deaths + Unhealthy diet - 4.9 million deaths * Physical inactivity - 3.2 million deaths (lancet 2012)The major objectives of the programme: * Prevent and control common NCDs through behaviour and lifestyle changes. * Provide early diagnosis and management of common NCDs, + Build capacity at various levels of health care for prevention, diagnosis and treatment of common NCDs. + Train human resource within the public health set-up viz doctors, paramedics and nursing staff to cope with the increasing burden of NCDs, and * Establish and develop capacity for palliative & rehabilitative care.RISK FACTORS (RF) AND LEVEL OF NCD PREVENTION AND MANAGEMENT Soc Dt Uae LaNational Programme for Control and Treatment of Occupational diseases i a *National Programme for Control and Treatment of Occupational diseases Major occupational diseases can be divided in following categories : + Occupational injuries * Occupational lung diseases * Occupational cancers * Occupational dermatoses * Occupational Infections + Occupation toxicology * Occupational mental disorders * Others * Ministry of Health and Family Welfare, Govt. of India has launched a scheme entitled “National Programme for Control and Treatment of Occupational Diseases” in 1998-99, * The Natignal Institute of Occupational Health, Ahmedabad (ICMR) has been identified as the nodal agency for the same.A Programme for jon and Control ofNational Programme for Prevention and Control of Deafness * Hearing loss isthe mast common sensory deficit in humans today. World over, itis the second leading cause for “Years lived with Disability (YLD)" * There are large number of hearing impaired young people in India which amounts to a severe loss of productivity, both physical and economic. * The Programme was initiated in year 2007. ‘Objectives of the Programme 1, To prevent the avoidable hearing loss on account of disease or injury. 2. Early identification, diagnosis and treatment of ear problems responsible for hearing loss and deafness 3. To medically rehabilitate persons of all age groups, suffering with deafness, 4. To strengthen the existing inter-sectoral linkages for continuity of the rehabilitation Program, for persons with deafness 5, To develop institutional cap: ‘equipment and material and trai for ear care services by providing support for personnel.© Mental illness can happen to any one@ © Reach Out :National Mental Health Program + The Government of india has launched the National Mental Health Programme (NMHP) in 1982, ‘Objectives: 1. To-ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population 2.Toencourage the application of mental health knowledge in general healthcare and in social development; and 5 Torro cont ptin f rel aldei A6vlopent and tial fa towards self-help in the community ‘+ The District Mental Health Program (DMHP) was launched under NMHP in the year 1996 Early deteetion & treatment, + The main objective of DMHP isto provide Community Mental Health Services and integration of ‘mental health with General health services through decentralization of treatment from Specialized Mental Hospital based earc to primary health care services.Ainistry of Health and Formily WelfareNational Programme for Control of Blindness * The National Programme for Control of Visual Impairment and Blindness was launched in 1976 as a 100% centrally sponsored and incorporates the earlier Trachoma Control Programme that was started. in 1963. Goals: * To reduce the prevalence of blindness (1.49% in 1986-89) to less than 0.3% + To establish an infrastructure and efficiency levels in the programme to be able to cater new cases of blindness each year to prevent future backlog, Objectives: * To establish eye care facilities for every 5 lakh population, + To develop human resources for eye care services at all levels the primary health centres, CHCs, sub-district levels, * To improve quality of service delivery and * To secure participation of civil society and the private sector.School Eye Screening Programme : * Under this the children aged 10-14 years are being screened by trained teachers and those suspected to have refractory error are seen by ophthalmic assistants and corrective spectacles are prescribed or provided free of cost to the persons below poverty line.Pradhan Mantri National Dialysis Programme Providing free dialysis services to the poorPradhan Mantri National Dialysis Programme + End Stage Renal Disease continues to be a result of existing and emerging burden of non-communicable disease. Providing for renal transplant facilities for ESRD patients depends upon availability of infrastructure and robust organ donation system coupled with adequate availability of trained qualified manpower. Within the limited choices, dialysis practically remains the first and in majority of cases, the only choice for ESRD patients. + Every year about 2.2 Lakh new patients of End Stage Renal Disease (ESRD) get added in India resulting, in additional demand for 3.4 Crore dialysis every year. * Keeping this in mind, strengthening of District Hospitals by providing affordable multispecialty care including dialysis services in district hospitals would be an important step in this direction,NATIONAL PROGRAM FOR HEALTH CARE OF ELDERLY(NPHCE)National Programme for Health Care of the Elderly(NPHCE) * Projection studies indicate that the number of 60+ in Indiawill increase from 100 million in 2013 and to 198 million by 2030, + Non-communicable diseases requiring large quantum of health and social care are extremely common in old age, irrespective of socio-economic status. Disabilities resulting from these non-communicable diseases are very frequent which affect functionality compromising the ability to pursue the activities of daily living. + National Programme for Health Care for the Elderly (NPHCE) is a modest attempt to provide a comprehensive health care set up completely dedicated and tuned to the needs of the elderly, The interventions are designed to capture the Preventive, Curative and rehabilitative aspects in the geriatric field.The sion & Objectives of NPHCE The Vision * To provide accessible, affordable, and high- quality long- term, comprehensive and dedicated care services to an Ageing population; » Creating a new “architecture” for Ageing; * To build a framework to create an enabling environment for “a Society for all Ages”; + To promote the concept of Active and Healthy Ageing; » Convergence of NRHM, AYUSH & all other dept.Objec es » To provide an easy access to promotional, preventive, curative and rehabilitative services to the elderly through community based primary health care approach * To identify health problems in the elderly and provide appropriate health interventions in the community with a strong referral backup support, + Tobuild capacity of the medical and paramedical professionals as well as the care- takers within the faily for providing health care tothe elderly.National Programme for Prevention and Management of Burn InjuriesNational Programme for Prevention and Management of Burn Injuries + “Burn” is a major Public Health Problem all over the world. * As per WHO report 2014, in India, aver 1,000,000 people are moderately or severely burnt every year. Many of the burn injury patients require psychological counseling as well as physiotherapcutic rchabilitation and repeated plastic surgeries for many years, thus, augmenting their financial hardship ‘However, the death and disability due to burn injury are preventable toa great extent if timely and appropriate treatment is provided by trained personnel. A project was initiated during the [1th Five Year Plan by the Directorate General of Health Services, Ministry of Health & Family Welfare, for development of bum units in identified Medical Colleges and District Hospitals, + The project is now being continued as a full-fledged National Programme in the name of "NationalProgramme for Prevention & Management of Burn lajuries.Objectives of the programme + To reduce incidence, mortality, morbidity and disability due to Burn Injuries. * To improve the awareness among the general masses and vulnerable groups especially the women, children, industrial and hazardous occupational workers. * To establish adequate network of infrastructural facilities along with trained personnel for burn management and rehabilitation. * To carry out research for assessing behavioral, social and other determinants of Burn Injuries in our country for effective need based program planning far Burn Injuries, monitoring and subsequent evaluation.NATIONAL ORAL HEALTH PROGRAMME * Oral health is important for overall health and good quality of life. * Oral diseases affect all the age groups. Some common oral diseases are dental caries, periodontal diseases, malocelusion, oral sub-mucous fibrosis, oral cancer, cleft lip and cleft palate ete. * According to the World Health Organisation (WHO), Oral health is a state of being free from chronic mouth and facial pain, oral and throat cancer, oral sores, birth defects such as cleft lip. and palate, periodontal (gum) disease, tooth decay and tooth loss, and other diseases and disorders that affect the oral eavity. + Dental caries and gum diseases affect nearly 60% and 80%, of the Indian population, respectively, + Routine dental check-ups and early intervention can prevent most common dental problems. + Minisiry of Health and Family Welfare, Government of India has envisaged the National Oral Health Program [NOHP] for an affordable, accessible and equitable oral health care delivery ina well- coordinated manner for bringing about “optimal oral health” for all by 2020.Health system strengthening programs * Ayushman Bharat Yojana * Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) * LaQshya’ programme {Labour Room Quality Improvement Initiative) * National Health Mission * National Digital Health Mission (NDHM.YojanaAyushman Bharat Yojana . Wyre aumened by rine Nt Matenra Moc the rt Raton ih Poy 251 nore’ tachi the van of Ursa heath Coverage Ue) ee * Ayushman Bhacat adopts 3 continuum of care spgraazh, compriing of to Inarrelated componant, which ae ‘+ Estabishiment of Meaith and Wellness Condes * Prachan Mant Jan Arogya Yojana (PN) + Establishment of Health and Wellnss Cenires-the fist component pertains to creation of 1,50}000 Health aod Wellness Cenires align taper people : op i ae rr ot oe r eS raat asl nae cae tm fe i ea esa Sa + ttn i ie earl tg et Sek io 47 pat ths Eau See ete Tene es See Re oe = presay, . tion expenses ai ia sda ere arene ac al ee cea ay car procedures. + Twaraue tet oe a sary 16 Tha acai iat oe ed i Mulder ae pa hsp Thebes rawsag AREA wit Pmu-yptPradhan Mantri Swasthya Suraksha Yojana (PMSSY) The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) aims at correcting the imbalances In the availability of affordable healthcare facilities in the different parts of the country in general, and yamenting facies for quality medical education in the under-served States in particular. The scheme was approved in March 2006. + The first phase in the PNISSY has two components - setting up of six institutions in the line of AIIMS; and upgradation of 13 existing Government medical college institutions, * It has been decided to set up § AlMSctke institutions, one each in the States of Bihar (Patna) Chattisgarh (Reipur), Mada Pradesh (Bhopal) Orjsse (Bhubaneswar), Rajasthan Uodhpur) and Uttaranchal (Rishikesh) at an estimated cost of Rs 840 crores per institution. “ In addition to this, 13 existing medical institutions spread over 10 States will also be upgraded, with am outlay of RS, 120 crores (Rs. 100 crores from Central Government and Rs. 20 crores from State Government) for each institution. * In the second phase of PMSSY the Government has approved the setting up of two mare AIIMS- like institutions, ane each in the States of West Bengal and Uttar Pradesh and upgradation of six medical college’institutions. ‘+ In the third phase of PMSSY, itis proposed to upgrade some existing medical college institutions . * Its hoped that consequent to the successful implementation of PMSSY, better and affordable healthcare facilities will be easily accessible to one and all in the country.A 4 > @ LaQshya Programme for Pregnant Women LAQSHYA « ag New Born LABOUR ROOM QUALITY IMPROVEMENT INITIATIVELaQshya’ programme (Labour Room Quality Improvement Initiative) + ‘After launch of the National Health Mission (NHM), there has been substantial increase in the number of institutional deliveries * It is estimated that approximately 46% maternal deaths, over 40% stillbirths and 40% newborn deaths take place on the day of the delivery. + A transformational change in the processes related to the care during the delivery, which essentially relates to intrapartum and immediate postpartum care, is required to achieve tangible results within short period of time. * ‘LaQshya’ programme aims at improving quality of care in labour room and maternity Operation Theatre (OT). + Goal - To reduce preventable maternal and newborn mortality, morbidity and stillbirths associated with the care around delivery in Labour room and Maternity OT and ensure respectful maternity care.National Health Mission + Two sub-missions . . NRHM — National Rural Health Mission (2005) — converted to ‘National Health Mission" NHM (2013) . NUHM ~ National Urban Health Mission (2013) - to meet health care needs of the urban population with the focus on urban poor. National Rural Health Mission was launched in 2005. Under NRHM, finaneial assistance has been provided to the States/UTs for health systems strengthening which includes o Augmentation of infrastructure, o Human resources and programme management, ° Emergency FERS, services, 0 Mobile Medical Units, o Community participation including, 0 Mainstreaming of AYUSH and availability of drugs and equipmentGoals of NHM Beeb Reduce MMR to 1/1000 live births Reduce IMR to 25/1000 live births Reduce TFR to 2.1 Prevention and reduction of anaemia in women aged 15-49 years Prevent and reduce mortality & morbidity from communicable, non- communicable; injuries and emerging diseases Reduce household out-of-pocket expenditure on total health care expenditure Reduce annual incidence and mortality from Tuberculosis by half Reduce prevalence of Leprosy to <1/10000 population and incidence to zero in all districts Annual Malaria Incidence to be <1/1000 Less than 1 per cent microfilaria prevalence in all districts ala-azar Elimination by 2015, <1 ease per 10000 population in all K blocks.National Digital Health Mission (NDHM) + Introduction + The Minitry of Heath and Family Welfare Gaveramentof nda has formulated tye Nationa ital Heath Mission (NDHM) with the aim to provide the necessary support for integration of digital health infrastructure inthe country. This vsionery iniustve, stemming from the National Health Policy, 2017 intends to digitize healthcare in in + Wision Its vision isto create 9 national digital health ecosystem that supports universal health coverage in an eficent, accesible, inclusive, afardable timely and sie mannar anda sare online pattorm through {he prvi ofa wide range’ a dats, formation sndinratrcture service, du Teveraging open interoperable, standards-based digital systems, and ensures the security, confidentiality and pracy o health-related personal informatian, + Guiding principles * The NOHM has been designed, developed. deployed, operated and maintained by the Government following the guiding principles as laid out in National Digital Health Blueprint (NOHB).. + NDHM veil be rolled outin phases and four primary systems shall be launched in the first phase. Ata later stage, there is also a plan to integrate telemedicine and e-pharmacies into this,THANK U