1
NATIONAL HEALTH PROGRAMS
OF INDIA
Dr. Vijay B. Lambole
Associate Professor,
Dept of Pharmacology,
SNLPCP, Umrakh.
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CONTENT
• INTRODUCTION
• NATIONAL HEALTH MISSION
• REPRODUCTIVE AND CHILD HEALTH PROGRAMS
• REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAM (RNTCP) : DOTS
STRATEGY
• NATIONAL AIDS CONTROL PROGRAM
• NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAM
• NATIONAL ANTI-TOBACCO PROGRAM
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• INTEGRATED DISEASE SURVEILLANCE PROJECT
• PROGRAMS FOR WATER AND SANITATION
• 20-POINT PROGRAM
• CONCLUSION
• REFRENCES
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6
Over the decades the public health is able to deliver best of its capacity
to bring changes in various health indicators. (Koppaka R 2011).
Reduction of child mortality
Access to safe water and sanitation
Prevention and control of HIV/AIDS
Malaria prevention and control
Tobacco control
Introduction
TB control
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Various challenges to Public Health
Poverty, Inequity
Public Demands, Marginalizing Public Health
Services, Public health delivery
Epidemiological transition
Climatic change and environmental health, New
Introduction
psychosocial issues, Rapid population growth
8
• Since India became independent, several measures have been taken
under by the National Government to Improve the health of the
people.
• Program among these measures are the NATIONAL HEALTH
PROGRAMS, which have been launched by the central government of
control/ eradication of communicable diseases, improvement of
environmental sanitation, raising the standard of nutrition, control of
Introduction
population and improving rural health.
9
• Various International agencies like WHO UNICEF UNFPA world Bank, as
also a no. of foreign agencies like SIDA DANIDA NORAD USAID have
been providing technical and material assistance in the implementation
of these programs.
Introduction
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11
Major Milestones so far are :
1992 – Child Survival And Safe Motherhood Program (CSSM)
1997 – RCH I
1997 – RCH II
2005 – National Rural Health Mission
2013 – reproductive, maternal, new-born and child
health (RMNCH) + A Strategy
2013 – National Health Mission
NHM
2014 – India Newborn Action Plan (INAP)
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• Long standing need of urban health mission was accepted in MAY 2013
by the cabinet of the government of India and rural and urban health
mission merged to form National Health Mission in 12th Five year plan.
The vision of mission is :
Attainment of Universal access to equitable, affordable and quality health
care services, accountable and responsive to people’s needs, with effective
inter-sectoral convergent action to address the wider social determinants
of health.
NHM
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GOALS
The endeavor of NHM would be to ensure achievement of following
indicators:
1) Reduce Measles, Mumps, and Rubella (MMR) to 100
2) Reduce Infant mortality rate (IMR) to 25
3) Reduce Total fertility rate (TFR) to 2.1
4) Prevention and reduction of anemia in women aged 15-19 years to
28%
5) Prevention & reduce mortality and morbidity from communicable,
non-communicable (including mental illness) ; & injuries.
6) Reduce household out of pocket expenditure on total health care
expenditure
NHM
14
7) Reduce annual incidence and mortality from tuberculosis by half
8) Reduce prevalence of leprosy to <1/10000 population and incidence to
zero in all districts
9) Annual malaria incidence to be <1/1000
10) Less than 1 percent microfilaria prevalence in all districts
11) Kala-azar elimination by 2015,<1 case per 10000 population in all blocks.
12) Sustaining dengue case fatality rate as <1%
13) Containment of outbreak of chikungunya
NHM
14) Reduce mortality from Japanese Encephalitis by 30%
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15) Reduce new infections to zero and provide comprehensive care &
support to all persons living with HIV/AIDS and treatment services for all
those who require it.
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INSTITUTIONAL STRUCTURE OF NHM:
✓ Approved by cabinet Mission steering group MSG
✓ National level
Empowered program committee EPC
✓ MSG – Union Ministry of Health & Family Welfare – policy direction to
the mission.
✓ Convenor – Secretary , Dept of Ministry of Health & Family Welfare
✓ Co-Convenor – Additional Secretary & Mission Director – Mission is
headed by him/her – with the team of Joint Secretaries.
✓ Planning, Implementing and Monitoring mission activities.
NHM
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✓ Technical support to the Centre and States – National Health Systems
Resource Centre (NHSRC)
✓Country’s apex body for training and public health research & support to
health and family welfare program – National Institute of Health & Family
welfare (NIHFW)
✓Knowledge resources of National Disease control program – National
Centre for Communicable Diseases.
✓ Additional knowledge resources – AIIMS , PGIMER & othe institutes of
NHM
public health in states.
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STATE LEVEL :
State health Headed by
mission (SHM) Chief Secretary
DISTRICT HEALTH MISSION (DHM)/CHM: Chairperson Zila Parishad/Mayor
District Health Society (DHS): District Collector
✓ These will coordinate with the other departments and links with research
institutes, public health colleges at National and State level.
NHM
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APPROACH :
✓ Increase access to decentralized health systems by establishing new
infrastructure in deficient area.
✓ Provide facility based service delivery.
✓District Hospital and Knowledge Centre (DHKC)
✓Outreach services
✓Village Health sanitation and nutrition committee ( VHSNC)
✓Behavior change communication (BCC) Programs
✓Partnership with NGOs , Civil society and for Profit Private sectors
✓Health of Tribal
✓ Undertaking two Pilot districts for Universal health coverage
✓Health management Information system (HMIS)
NHM
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Service Delivery Strategies :
• Reproductive, Maternal, Newborn , Child Health and Adolescent services
( RMNCH + A)
• Control of communicable diseases :
– National Vector Borne Diseases Control Program (NVBDCP)
– Revised National Tuberculosis control Program (RNTCP)
– National Leprosy Control Program (NLCP)
– Integrated Disease surveillance project (IDSP)
• Control of NCD :
– National Program For Prevention And Control Of Cancer, Diabetes, CVD
And Stroke (NPCDCS)
NHM
– National Program For Control Of Blindness (NPCB)
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– National Program for Health care of Elderly (NPHCE)
– National Mental Health Program ( NMHP)
– NATIONAL Tobacco Control Program (NTCP)
– National Oral Health Program (NOHP)
– National Program For Palliative Care (NPPC)
– National Program For Preventive And Management Of Burn Injuries
(NPPMBI)
– National Program For Prevention And Control Of Fluorosis (NPPCF)
– *Fluorosis is a cosmetic condition that affects the teeth
NHM
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On-demand group of
Financing : skilled and experienced
staff that agencies call
(i) NRHM/RCH Flexi-pool upon when needed.
– Mission flexipool of
NRHM
(ii) NUHM Flexi-pool – Funds Release
Sanction OrdersTo
(iii) Flexi-pool for Communicable diseases Districts Under
Mission Flexipool
(iv) Flexi-pool for NCD including injury and trauma
(v) Infrastructure maintenance
(vi) Family Welfare Central Sector Component
(vii) State : State’s Program Implementation Plan (PIP)
NHM
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Recent New Initiatives :
✓ Rashtriya Bal Swasthya Karyakram (RBSK)
✓ Rashtriya Kishore Swasthya Karyakram (RKSK)
✓ Weekly Iron Folic Acid Supplementation Program (WIFS)
NHM
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• Government of India Launched NRHM – 5th April 2005
• Period = 7 years (2005-2012)
• Extended upto 2017
• Improving rural healthcare delivery system
• Focus on 18 states :
NRHM
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• It is also bringing the Indian system of medicine (AYUSH) to the main
stream of healthcare.
AIM :To provide accessible, affordable, accountable, effective and reliable
primary health care and bridging gap in rural health care through
creation of a cadre of Accredited Social Health Activist (ASHA).
Reduction in
IMR ,MMR
Promotion of Access to Public
healthy lifestyle Health services
Goals
Mainstream
of Prev & Control
of
AYUSH
NRHM communicable
& NCDs
Integrated
Population comprehensive
NRHM
stabilization primary health
care
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Action Points:
• Provision of health activist in each village
• Village health plan prepared through panchayat involvement
• Strengthening of rural hospitals
• Integration of vertical health programs (leprosy, TB, malarial programs,
etc.) and traditional medicine
• Integration of plans at different levels
• New health financing mechanisms
NRHM
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Core Strategies:
✓ Train and enhance capacity of Panchayat Raj institutions to own, control and manage public
health services.
✓ Promote access to improved health care at household level through the female health activist.
✓ Health plan for each village through village health committee of the panchayat.
✓ Strengthening sub center through an united fund to enable local planning and action and more
Medical peace work (MPW’s).
✓ Strengthening existing PHC’s and CHC’c.
✓ Preparation and implementation of an intersect district health plan prepared by the district
health mission .
✓ Strengthening capacities for data collection, assessment and review for evidence based
planning, monitoring and supervision.
✓ Developing capacities for preventive health care at all levels by promoting healthy life styles,
NRHM
reduction in tobacco consumption, alcohol etc.
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Supplementary strategies
1. Regulation of private sector to ensure availability of quality service to
citizens at reasonable cost.
2. Mainstreaming AYUSH – revitalizing local health traditions.
3. Reorienting medical education to support rural health issues including
regulation of Medical care and Medical Ethics.
4. Effective and viable risk pooling and social health insurance to provide
health security to the poor by ensuring accessible, affordable, accountable
and good quality hospital care.
NRHM
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Plan of action/Components:
• Accredited social health activists (ASHA)
• Strengthening sub-centers
• Strengthening primary health centers
• Strengthening CHCs for first referral
• District health plan under NRHM
• Strengthening disease control program
• Public-private partnership for public health goals, including regulation of
private sector
• New health financing mechanisms
• Reorienting health/medical education to support rural health issues
NRHM
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ASHA
• Resident of the village, a woman (M/W/D) between 25-45 years, with
formal education up to 8th class, having communication skills and
leadership qualities.
• One ASHA per 1000 population.
• Around one 100,000 ASHA’s are already selected.
• Chosen by the panchayat to act as the interface between the
community and the public health system.
• Bridge between the Auxiliary nurse midwife (ANM) and the village.
• Honorary volunteer, receiving performance-based compensation .
NRHM
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• Responsibility of ASHA:
– To create awareness among the community regarding nutrition, basic
sanitation, hygienic practices, healthy living.
– Counsel women on birth preparedness, imp of safe delivery, breast
feeding, complementary feeding, immunization, contraception, STDs
– Encourage the community to get involved in health related services.
– Escort/ accompany pregnant women, children requiring treatment and
admissions to the nearest PHC’s.
– Primary medical care for minor ailment such as diarrhea, fevers
– Provider of DOTS.
– Act as a depot holder for essential provisions
NRHM
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– Role as a provider – trained for new born care and management
– Information about birth and deaths in the village, outbreak of any disease in
community to sub-centre and PHCs
– Promote construction of house-hold toilets.
ROLE AND INTEGRATION WITH ANGANWADI :
– Organizing health day once/twice a month
– Anganwadi workersand ANM train ASHA
– Information, Education and Communication (IEC) activities : display of posters and
dances etc
– Depot holder for drug kits : issue to ASHA
– Update the list of children less than one year of age with the help of ASHA
NRHM
– ASHA support mobilizing lactating and pregnant women for nutritional care.
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• Role and Integration with ANM:
– ANM and ASHA weekly/ fortnight activity meetings
– Train ASHA
– Provide ASHA date and time for out reach programs
– Provide data to ASHA updating the list of children and eligible couples
– Help in organizing health days with AWW
– Utilize ASHA for motivating pregnant women for regular check ups
– Orient ASHA on the dose schedule and side effects of oral pills
– ANM will educate ASHA for danger signs of pregnancy and labour
– Provide ASHA date time and place for training schedules.
NRHM
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Other Initiatives of NRHM:
✓ Rogi Kalyan Samiti (Patient welfare committee / Hospital Management society)
✓The united grants to sub-centres
✓The Village Health Sanitation and Nutrition Committee
✓Janani Suraksha Yojana
✓Janani Shishu Suraksha Karyakram (1st of June 2011)
✓National Mobile Medical Units
✓National Ambulance Services
✓Web Enabled mother and child tracking systems
NRHM
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Few New Initiatives :
✓ Home delivery of contraceptives by ASHA
✓ Conducting District Level Household Survey
✓ Involving ASHA in home-based new-born care
✓ Free drug and diagnostic services
✓ Weekly Iron and Folic Acid Supplementation (WIFS)
✓ Rashtriya Bal Swasthya Karyakram (RBSK) feb 2013
✓ Rashtriya Kishor Swasthya Karyakram (RKSK) jan 2014
✓ Mother and child health wings
✓ Delivery points
NRHM
✓ Universal health coverage
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Achievements:
✓8.06 lakhs/8.89 lakh ASHAs have been trained and provided with the kits
✓1.47 lakh sub-centres in the country are provided with united funds of Rs.10,000 each.
✓31,109 Rogi Kalyan Samitis have been registered
✓8,129 doctors, 70,608 ANMs, 34,605 staff nurses, 13,725 paramedics have been appointed on
contract.
✓2,127 Mobile Medical Unit (MMU) are operational
✓Emergency transport systems are operational in 12 states
✓India declared polio free country, neonatal tetanus declared eliminated in 7 states , Japanese
Encephalitis ( JE) vaccination is completed in 11 districts and 4 states.
✓Janani Suraksha Yojana (JSY) in all states, 106.57 lakh got benefitted
✓Integrated management of neonatal and childhood illness (IMNCI) started in 310 districts.
✓Monthly health and nutritional days been organized in various states
✓5.12 lakh village health sanitation and nutrition committee.
NRHM
✓School health programs in 26 states initiated.
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NUHM will focus:
1) Urban poor population living in listed and unlisted slums.
2) All other vulnerable population
3) Public Health thrust on sanitation, clean drinking water , vector control etc.
4) Strengthening public health capacity of urban local bodies.
✓ Seven metropolitan cities – Municipal corporation – NUHM
✓ Urban Health Delivery System : U-PHC, U-CHC
✓ Out reach services : Female Health workers, ANM
✓Effective participation of community in planning and management through
ASHA or link workers and through creation of community based institutions
like MAHILA AROGYA SAMITI (MAS)
NUHM
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• Definition
“People Have Ability To Reproduce And Regulate Their Fertility , Women Are Able To Go
Through Pregnancy And Their Birth Safely, the Outcome Of Pregnancy Is Successful In
Terms Of Maternal And Infant Survival And Well Being And Couples Are Able To Have
Sexual Relations Free Of Fear Of Pregnancy And Of Contracting Disease”.
RCH
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• RCH PHASE 1 PROGRAMME INCORPORATED THE 4
COMPONENT
RCH
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Main Highlights Of RCH Program Are
✓ The Program Integrates All Interventions Of Fertility Regulation,
Maternal ,Child Reproductive Health For Both Men And Women.
✓ The Services To Be Provided Are Client Oriented
✓The Program Envisages Upgradation Of The Level Of Facilities For
Providing Various Interventions And Quality Of Care. The First Referral
Units Being Set Up At Sub-district Level Provide Comprehensive
Emergency Obstetric And New Born Care.
RCH
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4.The facilities of obstetric care, MTP and IUD insertion in the PHCs level
are improved. IUD insertion facilities are also available at sub-centres.
5.Specialist facilities for STD And RTI are available in all district hospitals
and in a fair number of sub-district level hospitals.
6. The program aims at improving the out reach of services primarily for
the vulnerable population.
RCH
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RCH services and major interventions
1.Essential obstetric care
2.Emergency obstetrical care
3.24 -hour delivery services at PHCS\CHCS
4.Medical termination of pregnancy MTP act 1971
5.Control of reproductive tract infections and sexually transited diseases
6.Immunization
7.Drug and equipment kits : equipment kits supplied at various levels as
follows:
RCH
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• At sub-centre level : United Nations Office for Project Services
Drug kit A
1. Normal Delivery Kit.
Drug kit B 2.Equipment for assisted
vacuum delivery.
Mid- wifery kit 3. Equipment for assisted
forceps delivery.
Sub- centre equipment kit 4.Standard Surgical Set (for
minor procedures like
• At PHC level- PHC equipment kit
episiotomies stitching).
• At CHC level- equipment kits from kit E to kit P 5. Equipment for Manual
Vacuum Aspiration.
8.Essential newborn care 6.Equipment for New Born Care
and Neonatal Resuscitation.
9.Oral rehydration therapy 1986-87 7. IUCD insertion kit.
8.Equipment/reagents for
10.Prevention and control of vitamin A essential laboratory
investigations.
deficiency in children
RCH
47
KIT A KIT B
ftp://ftp.solutionexchange.net.in/public/mch/cr/cr-se-mch-07061001.pdf
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• Kit-E – Laparotomy set
• Kit-F – Mini– Laparotomy set
• Kit-G – IUD insertion set
• Kit-H – Vasectomy set
• Kit- I – Normal delivery set
• Kit- J – Vacuum extraction set
• Kit- k – Embryotomy set
• Kit- L – Uterine evacuation set
• Kit-M – Equipment for anesthesia
• Kit-N- Neonatal resuscitation set
• Kit-O- Equipment and reagent for blood test
• Kit-P – Donor blood transfusion set
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Under the program , doses of vitamin A are given to all children under 5 years of age.
• The first dose( 1 lakh units) is given at nine months of age along with measles
vaccination
• The second dose is given along with DPT\ OPV booster doses
• Subsequent doses ( 2 lakh units each) six months intervals
11.Acute respiratory disease control cotrimoxazole is being supplied to the health
worker through the CSSM drug kit
12.Prevention and control of anemia in children under this program of control and
prevention of anemia ,tablets containing 2mg of elemental iron and 0.1 mg of folic
acid are provided at sub-centre level .
The health workers to provide 100 tablets to children clinically found to be anemic.
RCH
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REPRODUCTIVE AND CHILD HEALTH PROGRAMME -PHASE II
RCH –PHASE II began from 1st April 2005,the focus is to reduce maternal and child
mortality and morbidity with emphasis on rural health care. The major strategies are
1) Essential obstetric care
a. Institutional delivery
b. Skilled attendance at delivery
2) Emergency obstetric care
a. operationalizing first referral units
b. operationalizing PHCS and CHCS for round clock delivery services
RCH
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✓ There are 3 critical determinants of facility
• Availability of surgical interventions
• Newborn care
• Blood storage facility on a 24 hrs
RCH
52
• NEW INTIATIVES
1. Training of MBBS doctors in life saving anesthetic skills for emergency
obstetric care.
Govt .of India is also introducing training of MBBS doctors of obstetric
management skills, prepared training plan for 16 weeks in all obstetric
management skills,inculding caesarian section operation.
2.Setting up of blood storage centres at FRUs according to government of
India guidelines
RCH
53
JANANI SURAKSHA YOJANA the national maternity benefit scheme has been
modified into a (JSY) JANANI SURAKSHA YOJANA.
• It was launched on 12th April 2005.
• It is a 100% centrally sponsored scheme
• Under national rural health mission ,it integrates the cash assistance with
institutional care during antenatal, delivery and immediate post-partum
care
RCH
54
• VANDEMATARUM SCHEME
• It is a voluntary scheme wherein any obstetric and gynaec specialist,
maternity home can volunteer
• Enrolled doctors will display ‘vandemataram logo’ at their clinics.
• Iron and folic acid tablets, oral pills, TT injections, etc. will be provided for
free distribution.
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Strategy for addressing Adolescent Reproductive and Sexual Health (ARSH)
A two-pronged strategy will be supported:
• Incorporation of adolescent issues in all the RCH training programs and all
RCH materials developed for communication and behaviour change.
• Dedicated days and dedicated timings for adolescents at PHC’s.
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Infection Management And Environment Plan
✓ IMEP which is being extended to health care facilities includes:
a) Treatment and disposal of biomedical wastes
b) Disposal of syringe waste
c) Provision of water sanitation and good hygiene conditions
RCH
57
• SAFE ABORTION PRACTICES
• Medical Method
• Termination of early pregnancy (49days) using 2 drugs
• mifeprestone followed by mesoprostol
• Manual Vacuum Aspiration
▫ Safe and simple technique for termination of pregnancy.
▫ Can be used at PHC or comparable facility
▫ WHO & state govt. are coordinating the project
RCH
58
Some Innovative State Initiatives
Gujarat
▫ Increase access to safe delivery services. It is in partnership with
private providers (Chiranjivi Yojana)
▫ A Dai Sangathan has been formed by 10 leading NGOs of the state to
facilitate interface between the health system and the community
Punjab
▫ Proposed to pay an incentive of Rs. 500/- to BPL belonging to urban
areas
▫ Purchase and supply of nutrients like iron, calcium, D-worming tablets
for pregnant mothers belonging to SC classes.
RCH
59
▫ Screening code for Ca Cervix – Tamil Nadu
▫ Subsidized Medical Practitioner (SMP) scheme- Assam, Bihar
▫ Nurse Practitioners Scheme
▫ Laparoscopic Training – Maharashtra
▫ Implementation of Health Insurance scheme on pilot basis.
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The Beginning :National Tuberculosis Control Program
• Before the Revised National Tuberculosis Program (NTCP) came into
force the existing Tuberculosis program had the following objectives:
• To identify and treat as large a number of TB patients as possible so
that infectious cases are rendered non- infectious.
• To reduce the magnitude of TB problem in the country to a level
where it ceases to be a public health problem.
RNTCP
62
Organization and administration
• Centrallevel
• Besides the Tuberculosis Division in the Directorate General Health services,
National Tuberculosis Institute, Bangalore and Tuberculosis Research Centre
at Chennai
• District level
• A district constitutes a functional unit of the NTCP and is called District
Tuberculosis Control Program
• Peripheral level
• Comprises of chest clinics and Primary Health Centers (PHC)
RNTCP
63
Program Implementation( prior to RNTCP)
Program activities were:
• Case detection
• Case treatment
• Health education
• BCG vaccination
RNTCP
64
Program performance and evolution of RNTCP
• Despite a nationwide network of facilities , NTCP failed to yield satisfactory
results. The situation did not change much.
• The case finding efficiency was only 30 of the expected level although the
mortality rate decreased to 53/100,00 population
• Government of India launched the Revised National Tuberculosis Control
Program(RNTCP) in 1997 encouraged by the results of Pilot studies were tested
in 1993-94
RNTCP
65
Evolution of TB Control in India
• 1950s-60s Important TB research at TRC and NTI
• 1962 National TB Program (NTP)
• 1992 Program Review
only 30% of patients diagnosed;
of these, only 30% treated successfully
• 1993 RNTCP pilot began
• 1998 RNTCP scale-up
• 2001 450 million population covered
• 2004 >80% of country covered
RNTCP
• 2006 Entire country covered by RNTCP
66
Revised National TB Control Program (RNTCP)
Launched in 1997 based on WHO DOTS Strategy
Entire country covered in March’06 through an unprecedented rapid
expansion of DOTS
Implemented as 100% centrally sponsored program
Govt. of India is committed to continue the support till TB ceases to be a
public health problem in the country
All components of the STOP TB Strategy-2006 are being implemented
RNTCP
67
Objectives of RNTCP
To achieve and maintain a cure rate of at least 85% among newly
detected infectious (new sputum smear positive) cases
To achieve and maintain detection of at least 70% of such cases in the
population
RNTCP
68
Strategy
1. Augmentation of organizational support at the central and state level
for meaningful coordination
2. Increase in budgetary outlay
3. Use of Sputum microscopy as a primary method of diagnosis among self
reporting patients
4. Standardized treatment regimens.
RNTCP
69
7 Augmentation of the peripheral level supervision through the creation of
a sub district supervisory unit
8.Ensuring a regular uninterrupted supply of drugs up to the most
peripheral level
9.Emphasis on training, IEC, operational research and NGO involvement in
the program
RNTCP
70
Core elements of Phase I
• The core element of RNTCP in Phase I (1997-2006)was to ensure high quality
DOTS expansion in the country, addressing the five primary components of the
DOTS strategy
• Political and administrative commitment
• Good Quality Diagnosis through sputum Microscopy
• Directly observed treatment
• Systematic Monitoring and Accountability
• Addressing stop TB strategy under RNTCP
RNTCP
71
RNTCP Phase II( 2006-11)
The RNTCP phase II is envisaged to:
• Consolidate the achievements of phase I
• Maintain its progressive trend and effect further improvement in its
functioning
• Achieve TB related Millenium Development Goals while retaining DOTS
as its core strategy
RNTCP
72
Public Private Mix (PPM) Activities for Involvement of All Health Care Providers
• Involvement of NGOs and Private Practitioners
• Schemes revised in 2008
• Presently > 2500 NGOs, 17,000 PPs involved
• Involvement of professional bodies like IMA, IAP
• Other Central government departments/PSUs
• CGHS, Railways, ESI, Mining, Shipping
• Corporate sector
• ~150 Corporate Houses participating
• Involvement of FBOs like CBCI
• Involvement of Medical Colleges
• Task Forces and Core Committees formed
• 260 Medical colleges involved
RNTCP
73
• Well Defined IEC Strategy
• Web based resource centre
• Communication facilitators provided to support IEC at district level
• Ongoing capacity building of program managers for planning and implementing need
based IEC activities
RNTCP
• WELL DEFINED IEC STRATEGY
74
Impact of RNTCP
Trends in prevalence of culture-positive and smear-positive tuberculosis in
south India(5 Blocks), 1968-2006
RNTCP
*Source: WHO Report 2008, Global Tuberculosis Control; pg 71
75
TB-HIV: Accomplishments
• 2007 – The first national frame work for TB-HIV joint collaborative activities
was developed.
◼ Developed and implemented mechanism for TB & HIV program
collaboration at all levels (National, State, District)
◼ Conducted surveillance and determined national burden of HIV in TB
patients
◼ Mainstreamed TB-HIV activities as core responsibility of both programs
(training & monitoring)
RNTCP
76
TB-HIV: Current Policies (2008)
TB/HIV activities in all States
• Coordination & Training on TB/HIV
• Intensified Case Finding (ICF)
• Referral of all HIV- TB patients for HIV care and support (CPT & ART)
• Involve NGOs
Activities in high-HIV states
• Provider-initiated HIV counseling and testing for all TB patients
• Decentralized provision of Co-trimoxazole
• Expanded TB-HIV monitoring
RNTCP
77
RNTCP- DOTS-Plus Vision
• By 2010 DOTS-Plus services available in all states
• By 2012, universal access under RNTCP to laboratory based quality assured
MDR-TB diagnosis for all retreatment TB cases and new cases who have
failed treatment
• By 2012, free and quality assured treatment to all MDR-TB cases diagnosed
under RNTCP (~30,000 annually)
• By 2015, universal access to MDR diagnosis and treatment for all smear
positive TB cases under RNTCP
RNTCP
78
TB in pregnancy :
• National strategic plan (2012-2017) [12th Five year plan]
Vision : TB Free India
Following thrust areas identified:
1) Strengthening and improving the quality of basic DOTS services
2) Further strengthen and align with health system under NRHM
3) Deploying improved rapid diagnosis at the field level
4) Expand efforts to engage all care providers
5) Strengthen urban TB control
6) Expand diagnosis and treatment of drug resistant TB
7) Improve communication and outreach
8) Promote research for development and implementation of improved tools
and strategies
RNTCP
79
Financial Resources:
1) World Bank
2) Department of International development via WHO
3) Supported by Global TB drug facility
4) Global fund to fight AIDS, Tuberculosis and malaria
5) USAID and DANIDA
6) Govt of India 100% grant-in-aid to the implementing agencies besides
free drug
RNTCP
80
81
• NACP was launched in India = 1987
• Ministry of Health and Family Welfare has set up NAC organization as a
separate wing
• AIM:
– Prevent transmission
– Decrease morbidity and mortality
– Minimize socio-economic impact
Milestones:
NATIONAL AIDS CONTROL PROGRAM
1986 – first case detected – AIDS task force set up by the ICM, National AIDS
Committee established
1990 – Medium term plan launched for 4 states and metros
1992 – NACP-I launched
1999 – NACP-II launched
2002 – National AIDS Control policy and National Blood Policy adopted
2004- ART initiated
2006 – National council of AIDS constituted under chairmanship of the Prime
Minister, National Policy of Paediatric ART formulated
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2007 – NACP III launched for 5 years (2007-2012)
2014 – NACP IV launched for 5 years (2012-2017)
National Strategy : Following components :
• Establishment of surveillance centres to cover the whole country : HIV sentinel surveillance, HIV
Sero- surveillance, AIDS Case surveillance, STD surveillance, Behavioral surveillance, Integration
with surveillance of other diseases.
• Identification of high risk group and their screening
• Issue specific guidelines for the management of detected cases and their follow up
NATIONAL AIDS CONTROL PROGRAM
• Formulating guidelines for blood bank, blood product manufacturers, blood donors and dialysis
units
• IEC activities by involving mass media and research for reduction of personal social impact of
disease
• Control of STDs
• Condom programs
Primary goal of NACP-IV is to halt and reverse the epidemic in India over the next 5 years by
integrating programs of prevention, care, support and treatment.
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PPTCT Program
• The Prevention of Parent to Child Transmission of HIV/AIDS (PPTCT)
programme was started in the country in the year 2002 following a
feasibility study in 11 major hospitals in the five high HIV prevalence states.
• Currently, there are more than 4000 Integrated Counselling and Testing
NATIONAL AIDS CONTROL PROGRAM
Centres (ICTCs) in the country, most of these in government hospitals,
which offer PPTCT services to pregnant women.
• Of these ICTCs, 502 are located in Obstetrics and Gynaecology
Departments and in Maternity Homes where the client load is
predominantly comprised of pregnant women
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MALARIA
• National Malaria control program – 1953 -75 million deaths due to malaria
• 1958 – NMCP was changed into National Malaria Eradication program
NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAM
• 1965 – Cases reduced to 0.1 million
• Early 1970s resurgence of malaria by 6.46 million cases
• 1977 – Modified plan of operations implemented
• 1997 – World Bank assisted Enhanced malaria control project (EMCP)
• 1999 – Renaming of project to National Anti-malarial program(NAMP)
• 2002 – Renaming NAMP to NVBDCP
• 2005 – Global fund assisted Intensified Malaria control project (IMCP),RDT included
• 2006 – ACT introduced
• 2008 – ACT extended and World Bank supported National Malaria Control project launched
• 2009 – Introduction of LLINs
• 2010 – new drug policy
• 2012 – Introduction of bivalent RDT
• 2013 – New drug policy 2013
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Main activities:
1) Formulating policies and guidelines
2) Technical guidance
NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAM
3) Planning
4) Logistics
5) Monitoring and evaluation
6) Coordination of activities through state/UTs and in consultation with National
Centre for disease control (NCDC),National Institute of Malarial Research (NIMR)
7) Collaboration with international organizations like the WHO, World Bank,
GFATM and other donor agencies
8) Training
9) Facilitating research through NCDC, NIMR, Regional medical research centers
10) Coordinating control activities in the inter-state and inter country border areas.
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Strategic action Plan for malaria control in India (2012-2017)
• Vision : substantial and sustained reduction in the burden of malaria in
NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAM
the near and mid-term, and elimination of malaria in the long term,
when new tools in combination with strengthening of health systems
will make national elimination possible.
• Malaria control is incorporated under the umbrella of NRHM.
• Objective : To achieve Annual Parasite Index < 1per 1000 population by
the end of 2017
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Goals:
1) Screening all fever cases suspected to malaria (60% through quality
microscopy and 40% by rapid diagnostic test
2) Testing all P.falciparum cases with full course of effective ACT and
NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAM
primaquine and all P.vivia cases with 3 days chloroquine and 14 days
primaquine.
3) Equipping all health institutions especially in high risk areas
4) Strengthening all district and sub-district hospitals.
Outcome indicators :
1) At least 80% suffering from malaria get correct,affordable,appropriate and
complete treatment within 24 hours of reporting
2) At least 80% of those at high risk of malaria get protected
3) At least 10% of population in high risk areas is surveyed annually
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• The major externally supported projects :
(I) Global Fund Supports Intensified Malaria Control Project (IMCP II) :
Implemented since October 2010 for five years involving 7 North
NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAM
East States.
(II) The World Bank Supported Project On Malaria Control And Kala-
azar Elimination: March 2009-December 2013. Financial layout was
Rs.1000 crores. Involved 93 malarial districts of 8 States and 46 Kala-
azar districts in 3 States. Phase I and II. Phase I = 50 most malarial
districts and 46 kala-azar, Phase II = rest of the malarial districts.
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• Tobacco control legislation “The Cigarettes and other tobacco product act” in
2003 April was passed by the parliament.
• NTCP : Under WHO-framewok Govt of India launch it in 11th Five year plan.
• Main Components :
1) Public awareness
2) Establishment of tobacco product testing laboratories
3) Mainstream it under NHRM
4) Mainstream research and training on alternative crops and livelihood
5) Dedicated tobacco control cells
6) Training of health and social workers
7) School programs
8) Provision for tobacco cessation facilities.
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• Launched in Nov 2004 .
• 5 year project
• It is a decentralized based surveillance system in the country.
• Detect early warning signals
• Both urban and rural areas
• Different types of integrations are proposed:
1) Sharing of surveillance information of disease control program
2) Developing effective partnership with health and non-health sectors
3) Effective partnership with private sectors and NGOs
4) Bringing academic institutions into primary public health activity of
disease surveillance.
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• Initiated in 1954
• 1972 Accelerated rural water supply program
• 5th Five year plan , the above included with the MINIMUM NEEDS PROGRAM of
the State Plan
NATIONAL WATER SUPPLY AND SANITATION PROGRAMS
• Problem Village = Where no source of safe water available in a distance of
1.6km, or at the depth of 15m or has the source of extreme salinity, iron,
fluorides and other toxic elements or where water is exposed to the risk of
cholera.
• Program renamed as RAJIV GANDHI NATIONAL DRINKING WATER MISSION in
1991.
• 2002 – Swajaldhara
• 2009 – renamed as NATIONAL RURAL DRINKING WATER PROGRAM. (Part of
BHARAT NIRMAN 2005)
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RURAL SANITATION PROGRAM:
• NIRMAL BHARAT ABHYAN – 2012
NATIONAL WATER SUPPLY AND SANITATION PROGRAMS
• SWACH BHARAT ABHYAN – 2nd Oct 2014 launched by the Prime
Minister Modi.
Vision of clean India by 2nd Oct 2019.
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• In addition to five year plan Govt of India initiated a special activity.
• Described as an agenda for national action to promote social justice and economic
growth.
• 1986 – restructured the program.
• Objectives : Eradication of poverty, raising productivity, reducing inequality,
removing social and economic disparity and improving the quality of life.
• 8 points related to health out of 20.
Point 1 : attack of rural poverty
Point 7 : Clean drinking water
Point 8 : Health for all
Point 9 : Two child norm
Point 10 : Expansion of education
20-POINT PROGRAM
Point 14 : Housing for the people
Point 15 : Improvement of slum
Point 17 : Protection of the environment.
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•There are various other National Health programs as well, like :
Rabies control program
Guinea worm eradication program
Leprosy eradication program
National program for control of blindness and deafness
National program for burn injuries and trauma
Emergency preparedness program
Universal Immunization program
YAWS control Program
National program for prevention and control of fluorosis etc.
CONCLUSION
• The major drawback of all the national program are gaps still present
between the recipients and hosts especially in the rural areas.
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• Well-planned investment, complemented by cooperation between the
research and implementation communities on research, evaluation and
training can fill these gaps and make an important contribution to
improving health.
CONCLUSION
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REFERENCES
1. TEXTBOOK PREVENTIVE AND SOCIAL MEDICINE – K.PARK – 23rd
EDITION
2. TEXTBOOK OF NATIONAL HEALTH PROGRAMS OF INDIA – J.KISHORE-
11th EDITION
3. Agarwal S et al., Need for dedicated focus on urban health within
National Rural Health Mission. Ind J Public Health 2005; 49 (3) 141-
151.
4. Govt of India National Rural Health mission (2005-2012). Ministry of
REFERENCES
Health and Family Welfare Govt. of India.
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5. Govt. of India. Accredited Social Health Activist (ASHA) guidelines.
Ministry of Health and Family Welfare Govt. of India.
6. WHO. Opportunities of Global health initiatives with health system
action agenda. Geneva ( WHO 2005-2008)
REFERENCES
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THANK YOU!