1

NATIONAL HEALTH PROGRAMS
OF INDIA

Dr. Vijay B. Lambole
Associate Professor,
Dept of Pharmacology,
SNLPCP, Umrakh.
NATIONAL PROGRAMME FOR HEALTHCARE OF
ELDERLY(NPHCE)
Introduction
Keeping in view the recommendations made in the “National Policy on Older
Persons” as well as the State’s obligation under the “Maintenance & Welfare of
Parents & Senior Citizens Act 2007”, the Ministry of Health & Family Welfare
launched the “National Programme for the Health Care of Elderly” (NPHCE) during
the year 2010, in the 11th Plan period, to address various health related problems
of elderly people.

Main Strategies
Following strategies are adopted to achieve the above mentioned
objectives:

• Preventive and promotive care: The preventive and promotive health care
services such as regular physical exercise, balanced diet, vegetarianism, stress
management, avoidance of smoking or tobacco products and prevention of fall,
etc. are provided by expanding access to health practices through domiciliary
visits by trained health workers. They will impart health education to old
persons as well as their family members on care of older persons. Besides,
regular monitoring and assessment of old persons are carried out for any
infirmity or illness by organizing weekly clinic at PHCs.
• Management of Illness: Dedicated outdoor and indoor patients
services will be developed at PHCs, CHCs, District Hospitals and
Regional Geriatric Centres for management of chronic and disabling
diseases by providing central assistance to the State Governments.

• Health Man Power Development for Geriatric Services : To
overcome the shortage of trained medical and para-medical
professionals in geriatric medicine, in service training will be imparted
to the health manpower using standard training modules prepared
with the help of medical colleges and regional institutions. The post
graduate courses in geriatric medicine will be introduced in Regional
Geriatric Centres for which additional teaching and supportive
faculties are provided to these institutions.
• Medical Rehabilitation & Therapeutic Intervention: By arranging
therapeutic modalities like therapeutic exercises, training in activities of
daily life (ADL) & treatment of pain and inflammation through
physiotherapy unit at CHC, district hospital and Regional Geriatric
Centre levels for which necessary infrastructure, medicine and
equipment are provided to these identified units.

• Information, Education & Communication (IEC): Health education
programmes using mass media, folk media and other communication
channels are being promoted to reach out to the target community for
promoting the concept of healthy ageing, importance of physical
exercise, healthy habits, and reduction of stress. Camps for regular
medical check-up are being organised at various levels where IEC
activities are also specifically promoted.
NATIONAL MENTAL HEALTH PROGRAMME
(NMHP)
It is estimated that 6-7 % of population suffers from mental disorders. The
World Bank report (1993) revealed that the Disability Adjusted Life Year
(DALY) loss due to neuropsychiatric disorder is much higher than diarrhea,
malaria, worm infestations and tuberculosis if taken individually. Together
these disorders account for 12% of the global burden of disease (GBD)
and an analysis of trends indicates this will increase to 15% by 2020
(World Health Report, 2001). One in four families is likely to have at least
one member with a behavioral or mental disorder (WHO 2001). These
families not only provide physical and emotional support, but also bear
the negative impact of stigma and discrimination. Most of them (>90%)
remain un-treated. Poor awareness about symptoms of mental illness,
myths & stigma related to it, lack of knowledge on the treatment
availability & potential benefits of seeking treatment are important causes
for the high treatment gap.
The Government of India has launched the National Mental Health
Programme (NMHP) in 1982, with the following objectives:

•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;

•To encourage the application of mental health knowledge in general
healthcare and in social development; and

•To promote community participation in the mental health service
development and to stimulate efforts towards self-help in the community.
The District Mental Health Program (DMHP) was launched under
NMHP in the year 1996 (in IX Five Year Plan). The DMHP was based
on ‘Bellary Model’ with the following components:

•Early detection & treatment.

•Training: imparting short term training to general physicians for diagnosis
and treatment of common mental illnesses with limited number of drugs
under guidance of specialist. The Health workers are being trained in
identifying mentally ill persons.

•IEC: Public awareness generation.

•Monitoring: the purpose is for simple Record Keeping.
NATIONAL PROGRAMME FOR THE PREVENTION &
CONTROL OF DEAFNESS (NPPCD)

Hearing loss is the most common sensory deficit in humans today. As per
WHO estimates in India, there are approximately 63 million people, who
are suffering from Significant Auditory Impairment; this places the
estimated prevalence at 6.3% in Indian population. As per NSSO survey,
currently there are 291 persons per one lakh population who are suffering
from severe to profound hearing loss (NSSO, 2001). Of these, a large
percentage is children between the ages of 0 to 14 years. With such a
large number of hearing impaired young Indians, it amounts to a severe
loss of productivity, both physical and economic. An even larger
percentage of our population suffers from milder degrees of hearing loss
and unilateral (one sided) hearing loss.
Objectives of the programme

•To prevent the avoidable hearing loss on account of disease or injury.

•Early identification, diagnosis and treatment of ear problems responsible
for hearing loss and deafness.

•To medically rehabilitate persons of all age groups, suffering with
deafness.

•To strengthen the existing inter-sectoral linkages for continuity of the
rehabilitation programme, for persons with deafness.

•To develop institutional capacity for ear care services by providing
support for equipment and material and training personnel.
Components of the Programme:

• Manpower Training & Development – For prevention, early identification
and management of hearing impaired and deafness cases, training would
be provided from medical college level specialists (ENT and Audiology) to
grass root level workers.

• Capacity Building–for the district hospital, CHC and PHC in respect of
ENT/Audiology infrastructure.

Service Provision Including Rehabilitation – Screening camps for early
detection of hearing impairment and deafness, management of hearing
and speech impaired cases and rehabilitation (including provision of
hearing aids ), at different levels of health care delivery system.

• Awareness Generation Through IEC Activities – for early identification of
hearing impaired, especially children so that timely management of such
cases is possible aid to remove the stigma attached to deafness.

•Monitoring and Evaluation
Expected benefits of the programme

•The programme is expected to generate the following benefits in the
short as well as in the long run.

•Large scale direct benefit of various services like prevention, early
identification, treatment, referral, rehabilitation etc. for hearing impairment
and deafness as the primary health center / community health centers /
district hospitals largely cater to their need.

•Decrease in the magnitude of hearing impaired persons.

•Decrease in the severity/ extent of ear morbidity or hearing impairment in
large number of cases

•Improved service network for the persons with ear morbidity/hearing
impairment in the states and districts covered under the project.
•Awareness creation among the health workers/grassroot level workers
through the primary health centre medical officers and district officers
which will percolate to the lowest level as the lower level health workers
function within the community.

•Larger community participation to prevent hearing loss through panchyati
raj institutions, mahila mandals, village bodies and also creation of a
collective responsibility framework in the broad spectrum of the society.

•Leadership building in the primary health centre medical officers to help
create better sensitization in the grassroots level which will ultimately
ensure better implementation of the programme.

•Capacity building at the district hospitals to ensure better care. ix. State of
the art department of ENT at the medical colleges in the state/union
territory under the project.
National Programme for Control of Blindness and Visual
Impairment (NPCB&VI)
Introduction
National Programme for Control of Blindness and Visual Impairment
(NPCB&VI) was launched in the year 1976 as a 100% centrally sponsored
scheme (now 60:40 in all states and 90:10 in NE States) with the goal of
reducing the prevalence of blindness to 0.3% by 2020. Rapid Survey on
Avoidable Blindness conducted under NPCB during 2006-07 showed reduction
in the prevalence of blindness from 1.1% (2001-02) to 1% (2006-07).

Prevalence rate of blindness and targets

· Prevalence of Blindness – 1.1%. (Survey 2001-02 ).
· Prevalence of Blindness – 1. %. (Survey 2006-07).
· Current Survey (2015-18) in progress. The projected rate of prevalence of
blindness is 0.45%.
· Prevalence of Blindness target – 0.3% (by the year 2020).
Main Causes of blindness

• Cataract (62.6%)
• Refractive Error (19.70%)
• Corneal Blindness (0.90%),
• Glaucoma (5.80%),
• Surgical Complication (1.20%)
• Posterior Capsular Opacification (0.90%)
• Posterior Segment Disorder (4.70%),
• Others (4.19%)
• Estimated National Prevalence of Childhood Blindness /Low Vision is 0.80 per
thousand.
Main objectives

· To reduce the backlog of avoidable blindness through identification and
treatment of curable blind at primary, secondary and tertiary levels, based
on assessment of the overall burden of visual impairment in the
country;

· Develop and strengthen the strategy of NPCB for “Eye Health for All” and
prevention of visual impairment; through provision of comprehensive
universal eye-care services and quality service delivery;

· Strengthening and up-gradation of Regional Institutes of
Ophthalmology (RIOs) to become centre of excellence in various
sub-specialities of ophthalmology and also other partners like
Medical College, District Hospitals, Sub-district Hospitals, Vision
Centres, NGO Eye Hospitals;
· Strengthening the existing infrastructure facilities and developing
additional human resources for providing high quality comprehensive
Eye Care in all Districts of the country;

· To enhance community awareness on eye care and lay stress on
preventive measures;

· Increase and expand research for prevention of blindness and visual
impairment;

· To secure participation of Voluntary Organizations/Private Practitioners in
delivering eye Care.
Best practices adopted under the programme:

· To reach every nook and corner of the country to provide eye-care services,
provision for setting up Multipurpose District Mobile Ophthalmic Units in
the District Hospitals of States/UTs as a new initiative under the
programme. Few states have set up these Units. There is a need to
replicate the same by other States.

· Provision for distribution of free spectacles to old persons suffering from
presbyopia to enable them for undertaking near work as a new initiative
under the programme. The activity needs to be expedited in the all the
States.

• Emphasis on the comprehensive eye-care coverage by covering diseases
other than cataract like diabetic retinopathy, glaucoma, corneal
transplantation, vitreo-retinal surgery, treatment of childhood blindness
including retinopathy of pre-maturity (ROP) etc. These emerging
diseases need immediate attention to eliminate avoidable blindness from
the Country;
• Strengthening of Tertiary Eye-Care Centres by providing funds for
purchase of sophisticated modern ophthalmic equipment’s.

· Ensure setting up of super specialty clinics for all major eye diseases
including diabetic retinopathy, glaucoma, retinopathy of prematurity etc.
in state level hospitals and medical colleges all over the country.

· Linkage of tele-ophthalmology centres at PHC/Vision centres with super
specialty eye hospitals to ensure delivery of best possible diagnosis and
treatment for eye diseases, specially in hilly terrains and difficult areas.

· Development of a network of eye banks and eye donation centres linked
with medical colleges and RIOs to promote collection and timely utilization
of donated eyes in a transparent manner.
National Leprosy Eradication Programme

Introduction:

Since the inception of National Leprosy Eradication Programme (NLEP) in the
year 1983 spectacular success have been made in reducing the burden of Leprosy.
The country achieved the goal of leprosy elimination as a public health problem.
i.e. prevalence rate (PR) of less than 1 case / 10,000 population at National level
by December 2005, as set by National Health Policy 2002. Although prevalence
has come down at national and state level, new cases are being continuously
detected and these cases will have to be provided quality leprosy services through
GHC system

XII th Plan Objectives:
a.Elimination of leprosy i.e. prevalence of less than 1 case per 10,000 population
in all districts of the country.
b.Strengthen Disability Prevention & Medical Rehabilitation of persons affected
by leprosy.
c.Reduction in the level of stigma associated with leprosy.
Background:

•The National Leprosy Control Programme was launched by the Govt. of India in
1955. Multi Drug Therapy came into wide use from 1982 and the National
Leprosy Eradication Programme was introduced in 1983. Since then, remarkable
progress has been achieved in reducing the disease burden. India achieved the
goal set by the National Health Policy, 2002 of elimination of leprosy as a public
health problem, defined as less than 1 case per 10,000 population, at the National
level in December 2005.

•Following are the programme components :
• Case Detection and Management
• Disability Prevention and Medical Rehabilitation
• Information, Education and Communication (IEC) including Behaviour
Change Communication (BCC)
• Human Resource and Capacity building
• Programme Management
Initiatives:
i.Involvement of ASHA– A scheme to involve ASHAs was drawn up to bring
out leprosy cases from their villages for diagnosis at PHC and follow up cases
for treatment completion. To facilitate involvement, they are being paid an
incentive as below:
i. On confirmed diagnosis of case brought by them – Rs. 250/-
ii. On completion of full course of treatment of the case within specified
time – Pauci bacillary (PB) leprosy case – Rs. 400/- and Multibacillary
(MB) Leprosy case – Rs. 600/-.The scheme has been extended to
involve any other person who brings in or reports a new case of leprosy.
iii.An early case before onset of any visible deformity – Rs 250
iv. A new case with visible deformity in hands, feet or eye – Rs 200
E Newsletter- is a Quarterly publication from the house of CLD. NLEP
Newsletter will share guidelines, feedback/best practices, experiences and
activities undertaken in the programme in coordination with partner/
States/NGOs/Institutes/Medical Colleges & Associations etc.

In order to detect the hidden leprosy cases, Leprosy Case Detection Campaigns
(LCDC), a unique initiative of its kind under NLEP, is being implemented in high
endemic districts of the country, in line with Pulse polio Campaign by Central
Leprosy Division. In this campaign each and every person in a house in the
selected high endemic districts will be examined to detect all hidden cases in the
community.
Universal Immunisation 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) to be implemented in phased
manner to cover all districts in the country by 1989-90 with the 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.

About immunization
Immunization is the process whereby a person is made immune or resistant to
an infectious disease, typically by the administration of a vaccine. Vaccines are
substances that stimulate the body’s own immune system to protect the
person against subsequent infection or disease.
Vaccines provided under UIP:

BCG
About-BCG stands for Bacillus Calmette-Guerin vaccine. It is given to infants to
protect them from tubercular meningitis and disseminated TB
When to give – BCG vaccine is given at birth or as early as possible till 1year
Route and site- BCG is given as intradermal injection in left upper arm.

OPV
About-OPV stands for Oral Polio Vaccine. It protects children from poliomylitis.
When to give- OPV is given at birth called zero dose and three doses are given at 6,
10 and 14 weeks. A booster dose is given at 16-24 months of age.
Route and site – OPV is given orally in the form of two drops.

Hepatitis B vaccine
About – Hepatitis B vaccine protects from Hepatitis B virus infection.
When to give- Hepatitis B vaccine is given at birth or as early as possible
within 24 hours. Subsequently 3 dose are given at 6, 10 and 14 weeks in
combination with DPT and Hib in the form of pentavalent vaccine.
Route and site- Intramuscular injection is given at anterolateral side of mid thigh
Pentavalent Vaccine
About-Pentavalent vaccine is a combined vaccine to protect children from five
diseases Diptheria, Tetanus, Pertusis, Haemophilis influenza type b infection
and Hepatitis B.
When to give – Three doses are given at 6, 10 and 14 weeks of age (can be
given till one year of age).
Route and site-Pentavalent vaccine is given intramuscularly on anterolateral side
of mid thigh

Rotavirus Vaccine
About -RVV stands for Rotavirus vaccine. It gives protection to infants and
children against rotavirus diarrhoea. It is given in select states.
When to give – Three doses of vaccine are given at 6, 10, 14 weeks of age (can be
given at one year of age).
Route and site-5 drops of liquid vaccine or 2.5 ml (lyophilized vaccine) are given
orally.
PCV
About- PCV stands for Pneumococcal Conjugate Vaccine. It protects infants
and young children against disease caused by the bacterium Streptococcus
pneumoniae.
When to give – The vaccine is given as two primary doses at 6 & 14 weeks of
age followed by a booster dose at 9-12 months of age
Route and site- PCV is given as intramuscular (IM) injection in anterolateral
side of mid- thigh.
It should be noted that pentavalent vaccine and PCV are given as two
separate injections into opposite thighs

fIPV
About- fIPV stands for Fractional Inactivated Poliomylitis Vaccine. It is used to
boost the protection against poliomylitis.
When to give- Two fractional doses of IVP are given intradermally at 6 and 14
weeks of age.
Route and site- It is given as intradermal injection at right upper arm.
Measles/ MR vaccine
About-Measles vaccine is used to protect children from measles. In few states
Measles and Rubella a combined vaccine is given to protect from Measles and
Rubella infection.
When to give-First dose of Measles or MR vaccine is given at 9 completed
months to 12 months (vaccine can be given up to 5 years if not given at 9-12
months age) and second dose is given at 16-24 months.
Route and site – Measles Vaccine is given as subcutaneous injection in right
upper arm.

JE vaccine
About- JE stands for Japanese encephalitis vaccine. It gives protection against
Japanese Encephalitis disease. JE vaccine is given in select districts endemic for
JE after the campaign.
When to given- JE vaccine is given in two doses first dose is given at 9
completed months-12 months of age and second dose at 16-24 months of age.
Route and site- Live attenuated vaccine is given as subcutaneous injection in
left upper arm and killed vaccine is given as intramuscular injection in
anterolateral aspect of mid- thigh
DPT booster
About-DPT is a combined vaccine; it protects children from Diphtheria, Tetanus
and Pertussis.
When to give -DPT vaccine is given at 16-24 months of age is called as DPT first
booster and DPT 2 booster is given at 5-6 years of age.
Route and site- DPT first booster is given as intramuscular injection in antero-
lateral side of mid-thigh in left leg. DPT second booster is given as intramuscular
injection in left upper arm.

Tetanus and adult diphtheria (Td) vaccine:
About-TT vaccine has been replaced with Td vaccine in UIP to limit the waning
immunity against diphtheria in older age groups.
When to give- Td vaccine is administered to adolescents at 10 and 16 years of age
and to pregnant women. Pregnant women- Td-1 is given early in pregnancy as
first dose and 4 weeks after Td1, second dose of Td as Td-2 is given. Td- Booster is
given, if pregnant woman has received 2 TT/Td doses in a pregnancy within the
last 3 years.* Intra-muscular Upper Arm
Route and site- Td is given as intramuscular injection in upper arm.
Pulse Polio Programme

With the global initiative of eradication of polio in 1988 following World
Health Assembly resolution in 1988, 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. Around 17.4 crore children of less
than five years across the country are given polio drops as part of the drive
of Government of India to sustain polio eradication from the country.

The last polio case in the country was reported from Howrah district
of West Bengal with date of onset 13th January 2011. Thereafter no polio
case has been reported in the country. 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. It aimed to
immunize children through improved social mobilization, plan mop-up
operations in areas where poliovirus has almost disappeared and
maintain high level of morale among the public.

Steps taken by the Government to maintain polio free status in
India

• Maintaining community immunity through high quality National and
Sub National polio rounds each year.

• An extremely high level of vigilance through surveillance across the
country for any importation or circulation of poliovirus and VDPV is
being maintained. Environmental surveillance (sewage sampling) have
been established to detect poliovirus transmission and as a surrogate
indicator of the progress as well for any programmatic interventions
strategically in Mumbai, Delhi, Patna, Kolkata Punjab and Gujarat.
•All States and Union Territories in the country have developed a Rapid
Response Team (RRT) to respond to any polio outbreak in the country.
An Emergency Preparedness and Response Plan (EPRP) has also been
developed by all States indicating steps to be undertaken in case
of detection of a polio case.

•To reduce risk of importation from neighbouring countries, international
border vaccination is being provided through continuous vaccination
teams (CVT) to all eligible children round the clock. These are provided
through special booths set up at the international borders that India
shares with Pakistan, Bangladesh, Bhutan Nepal and Myanmar.

•Government of India has issued guidelines for mandatory requirement
of polio vaccination to all international travellers before their departure
from India to polio affected countries namely: Afghanistan, Nigeria,
Pakistan, Ethiopia, Kenya, Somalia, Syria and Cameroon. The mandatory
requirement is effective for travellers from 1st March 2014.
•A rolling emergency stock of OPV is being maintained to respond to
detection/importation of wild poliovirus (WPV) or emergence of
circulating vaccine derived poliovirus (cVDPV).

•National Technical Advisory Group on Immunization (NTAGI) has
recommended Injectable Polio Vaccine (IPV) introduction as an
additional dose along with 3rd dose of DPT in the entire country in the
last quarter of 2015 as a part of polio endgame strategy.

Progress
•South-East Asia Region of WHO has been certified polio free.
•India has achieved the goal of polio eradication as no polio case has
beenreported for more than 3 years after last case reported on 13
th January, 2011.

•WHO on 24th February 2012 removed India from the list of countries
with active endemic wild polio virus transmission

•There are 24 lakh vaccinators and 1.5 lakh supervisors involved in the
successful implementation of the Pulse Polio Programme
Role of WHO in Indian national program
The WHO Country Office for India is headquartered in Delhi with country-
wide presence. WHO is staffed by health professionals, other experts and
support staff working at headquarters in Geneva, six regional offices and
country offices.

The WHO India Country Cooperation Strategy 2019–2023: A Time of
Transition’ has been jointly developed by the Ministry of Health and Family
Welfare (MoH&FW) of the Government of India (GoI) and the WHO
Country Office for India. The Country Cooperation Strategy (CCS),
provides a strategic roadmap for WHO to work with the GoI towards
achieving its health sector goals, improving the health of its population and
bringing in transformative changes in the health sector.

The CCS outlines how WHO can support the MoHFW and allied Ministries
to drive impact at the country level. The CCS builds on other key strategic
policy documents including India’s National Health Policy 2017, the many
pathbreaking initiatives India has introduced — from Ayushman Bharat to
its National Viral Hepatitis Control Programme and promotion of digital
health amongst others.
This CCS not only builds upon the work that WHO has been supporting
out in the last several years, but also expands to address complex
challenges–such as the prevention of NCDs, the control of antimicrobial
resistance (AMR), the reduction of air pollution, and the prevention and
treatment of mental illnesses — WHO will further expand its collaboration
with a broader set of government sectors and other stakeholders beyond
health, under the overall guidance of the MoHFW, as well as continue to
work collaboratively with other United Nations (UN) agencies and
international partners.

WHO’s technical support to the Government of India will fall under the
following four strategic priorities to contribute India’s health agenda:
Strategic Priority 1: Accelerate progress on UHC

1. Implementing Ayushman Bharat: Health and Wellness Centres and hospital
insurance scheme
2. Monitoring and evaluation of health sector performance
3. Improving access to priority health services such as immunizations, maternal
and child health, tuberculosis, hepatitis
4. Digital health ecosystem
5. Eliminating neglected tropical diseases and control of vaccine-preventable
and vector-borne diseases
Strategic Priority 2: Promote health and wellness by addressing
determinants of health

1. Noncommunicable diseases (NCDs) action plan roll-out
2. Environmental health, including air pollution
3. Mental health promotion and suicide prevention
4. Nutrition and food safety
5. Road safety
6. Tobacco control
7. Integration of NCD and environmental risk factors in the digital health
information platform
Strategic Priority 3: Better protect the population against health emergencies

1. Disease surveillance and outbreak detection and response, including
International Health Regulation
2. Roll-out of integrated disease surveillance programme using the real-time
integrated health information platform (IHIP)
3. Preparedness for, and response to all, emergencies
4. Containment of antimicrobial resistance

Strategic Priority 4: Enhance India’s global leadership in health

1. Improving access to medical products of assured quality made in India
2. Development and information sharing of innovations in health practices and
technologies including IHIP
3. Strengthening India’s leadership in digital health