National Health Programs

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  • My Name is Sandheere dear sir i study daffodil International University department of public health special RCH program sir please this lecture is very nice prepared i will appriate really if u send it to me my Gmail is sandheere11@gmail.com. thnks
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  • respected sir! its really a very top class presentation on this topic, i appreciate your effort sir, plz send me a copy of this on mmandal109@gmail.com, it will be very helpful. thank you
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  • sir, please send the slides to me for teaching purpose on my email ravisathe7@yahoo.com
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  • very good presentation sir.pl mail me to roddamanilk4@gmail.com
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  • Wounderfull effort you have done sir, please can you mail me this Id:banashankarmaski@gmail.com please sir, thank you.
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National Health Programs

  1. 1. National Health Programs State Institute of Health and Family Welfare, Jaipur
  2. 2. Programs address to Environment NGCP NWSSP Host Agent UIP RNTCP HIV/AIDS MAP NFWP NLEP NPCB SIHFW: an ISO 9001:2008 certified Institution 2
  3. 3. Mile stones NRHM-2005 NHP-2002 NPP-2000 RCH-1996 UIP-1985 NHP-1983 Alma Ata-1978 Small pox eradicated-July 5, 1975 NFPP-1952 India Joins WHO-1948 HSDC-1946 SIHFW: an ISO 9001:2008 certified Institution 3
  4. 4. Programs NRHM-2005 NVBDCP-2004 NHP-2002 NPP-2000 NSPCD-1997- (IDSP-2004) RCH-1996 CSSM-1992 NACP-1987 UIP-1985 NGCP-1962 NIDDCP-1992 NFWP-1977 NPPVICB-1976 NCCP-75-76 NTCP-1962 RNTCP-1993 NFCP-1955 NLCP-1955 NMEP-1953 NFPP-1952 SIHFW: an ISO 9001:2008 certified Institution 4
  5. 5. Program components — Need — Goals & Objectives — Strategy — Approach — Activity — Indicators — Monitoring & Evaluation — Financing SIHFW: an ISO 9001:2008 certified Institution 5
  6. 6. Major Programs — National AIDS Control Program — National Cancer Control Program — National Diarrheal Disease Control Program — National Filaria Control Program* — National Family Welfare Program — National Iodine Deficiency Disorders Control Program — National Leprosy Eradication Program SIHFW: an ISO 9001:2008 certified Institution 6
  7. 7. — National Malaria Eradication Program* — National Program for Control of Blindness & Visual Impairment — National Reproductive and Child Health Program — National Program for surveillance Program for Communicable diseases — National Tuberculosis Control Program (Revised) (* Programs are merged into National Vector Borne Disease Control Program since 2003-04) SIHFW: an ISO 9001:2008 certified Institution 7
  8. 8. Minor Programs — National Mental Health Program — National Japanese Encephalitis control Program* — National Diabetes Control Program — National Kala-azar Control Program* — National Water Supply and Sanitation Program SIHFW: an ISO 9001:2008 certified Institution 8
  9. 9. National Family Welfare Program (NFWP) SIHFW: an ISO 9001:2008 certified Institution 9
  10. 10. National Family Welfare Program Ø 1951, 100% Centrally Sponsored, concurrent list Ø First country in the world Ø Family Welfare Dept.- created in 3rd FYP Ø 4th FYP - integration of Family Planning services with MCH services Ø MTP Act introduced 1972 SIHFW: an ISO 9001:2008 certified Institution 10
  11. 11. Approach — 1st and 2nd FYP- “Clinical” — 2nd FYP - “Target approach” — 3rd FYP – “Extension & Education” approach — 4th Plan - Post Partum scheme, reduce CBR to 32 — 5th Plan – NFPP replaced by NFWP, reduce CBR to 30 — 6th Plan - Net Reproduction Rate (NRR) of 1, family size to 2.3 — 7th Plan - spacing methods, community participation and promotion of MCH care SIHFW: an ISO 9001:2008 certified Institution 11
  12. 12. Approach — VII FYP ?Area Development Projects ?India Population Project-VIII & IX ?India Population Project-VIII & IX ?Differential planning scheme ?Increasing involvement of NGOs ?UIP & CSSM ?TFA SIHFW: an ISO 9001:2008 certified Institution 12
  13. 13. IX FYP Indicator If current If acceleration envisaged in Approach trend Paper to the Ninth Five Year Plan is continues achieved. CBR 24/1000 23/1000 IMR 56/1000 50/1000 TFR 2.9 2.6 CPR 51% 60% NNMR 35/1000 MMR 3/1000 SIHFW: an ISO 9001:2008 certified Institution 13
  14. 14. — X FYP – – Objectives: ?Reduction in the decadal rate of population growth between 2001 and 2011 to 16.2%; ?Increase in Literacy Rates to 75 per cent within the Tenth Plan period (2002 to 2007) ?Reduction of Infant mortality rate (IMR) to 45 per 1000 live births by 2007 and to 28 by 2012 SIHFW: an ISO 9001:2008 certified Institution 14
  15. 15. X-FYP ØPopulation Policy ØNRHM – IMR,MMR,TFR – Unmet Needs- Increasing Contraceptive choices – Male involvement – Social marketing – Private sector involvement – Infrastructure strengthen – Involvement of PRI – IEC – Training SIHFW: an ISO 9001:2008 certified Institution 15
  16. 16. XI FYP ?Targets ?Reduce IMR to 28 and MMR to 1 per 1000 live births ?Reduce TFR to 2.1 ?Provide clean drinking water for all by 2009 and ensure that there are no slip-backs ?Reduce malnutrition among children of age group 0-3 to half its present level ?Reduce anemia among women and girls by 50% by the end of the plan – Family planning insurance Scheme – Jansankhya Sthirata Kosh SIHFW: an ISO 9001:2008 certified Institution 16
  17. 17. Goals: XI FYP Ø Reducing MMR to 100 Ø Reducing IMR to 28 Ø Reducing TFR to 2.1 Ø Providing clean drinking water for all by 2009 Ø Reducing malnutrition among children of age group 0–3 to half its present level. Ø Reducing anemia among women and girls by 50%. Ø Raising the sex ratio for age group 0–6 to 935 by 2011–12 and 950 by 2016–17. SIHFW: an ISO 9001:2008 certified Institution 17
  18. 18. Empowered Action Groups Ø GOI constituted an EAG w.e.f. 20th March,2001 Ø To facilitate the preparation of area-specific programs, Ø With special emphasis on eight states [Rajasthan, UP, Bihar, MP, Orissa, Chhattisgarh, Jharkhand, Uttaranchal] SIHFW: an ISO 9001:2008 certified Institution 18
  19. 19. Role of the EAG Ø Ensuring appropriate policy development at the Centre, Ø Provisioning for technical assistance to the member States, Ø Addressing issues of coordination between member states and departments Ø Deploying financial resources, as appropriate and feasible. SIHFW: an ISO 9001:2008 certified Institution 19
  20. 20. Family Planning Insurance scheme Ø To encourage people to adopt permanent method of Family Planning Ø Centrally Sponsored Scheme since 1981 to compensate the acceptors of sterilization for the loss of wages Ø Implemented through ICICI Lombard General insurance Company Ø Compensation: (w.e.f-07.09.07) Ø Compensation in case of adverse event (w.e.f. January 1st, 2009) SIHFW: an ISO 9001:2008 certified Institution 20
  21. 21. Family Planning Insurance scheme: Compensation: (w.e.f-07.09.07) In Govt. facilities- Cate Intervention Acc Moti Dru Sur Anes Sta OT Ref Ca gory epto vato gs geo theti ff Ass res mp r r n st nur tt. hm mgt. se ent High Vasectomy (all) 1100 200 50 100 - 15 15 10 10 focus Tubectomy(all) 600 150 100 75 25 15 15 10 10 states Non Vasectomy (all) 1100 200 50 100 - 15 15 10 10 high Tubectomy(BPL, 600 150 100 75 25 15 15 10 10 focus SC/ST only) 250 150 100 75 25 15 15 10 10 states Tubectomy( APL only) SIHFW: an ISO 9001:2008 certified Institution 21
  22. 22. In Pvt. facilities- Category Type of operation Facili Motiv Total ty ator High Vasectomy (All) 1300 200 1500 Focus Tubectomy (All) 1350 150 1500 States Non High Vasectomy (All) 1300 200 1500 focus Tubectomy 1350 150 1500 states (BPL+SC/ST) SIHFW: an ISO 9001:2008 certified Institution 22
  23. 23. Jansankhya Sthirata Kosh Ø National Population Stabilization Fund - registered as an autonomous Society Ø Combination of government and civil society Ø Working to promote innovations Ø Promote initiatives which leverage the strength of different economic and social sectors Ø To reach out needy population groups SIHFW: an ISO 9001:2008 certified Institution 23
  24. 24. Ø Observation of World Population Day Ø Prerna Awards at Dhaulpur and Jodhpur in Rajasthan and Nabarangpur in Orissa Ø Working with the Private Sector Medical Specialists to enhance services for contraception. Ø Induction of professional people [NGOs, CII, FICCI, IASP, IPHA, IAP & SM, FOGSI etc] Ø Material Development and display for IEC/BCC SIHFW: an ISO 9001:2008 certified Institution 24
  25. 25. Innovative Strategy under JSK “Prerna” “Prerna” provides reward for specific parenthood Ø Girl’s marriage after 19 years - Rs.5000 Ø First birth after 21 years - Rs.7000 (girl) Rs 5000 (boy) Ø 3 years gap between first and second child with sterilization of 1 parent after the 2nd child (Reward of Rs.7000/ if it’s a girl child & Rs 5000/ if it’s a boy) SIHFW: an ISO 9001:2008 certified Institution 25
  26. 26. Conditions for getting rewards Ø Couple must belong to any of the 46 districts identified Ø Must belong to BPL category Ø Preference given to younger couples Ø Only those couples who have completed registration of marriage and registration of the birth of each child Ø The award shall be given in form of Kisan Vikas Patra in the name of Couple and will be given at a public function SIHFW: an ISO 9001:2008 certified Institution 26
  27. 27. “Santushti” Ø Motivate private gynecologists to perform 100 tubectomy/vasectomy, doctors are paid according to already notified compensation rates (Rs 1500 per case) Ø MOU is signed between the district CMHO and private facilities Ø Funding is provided by JSK through the Collector and CHMO Ø Initiated in Madhya Pradesh, Rajasthan and Orissa Ø 64 MOUs and around 1600 sterilization operations [until Aug 09] SIHFW: an ISO 9001:2008 certified Institution 27
  28. 28. Virtual Resource Centre (VRC) Ø VRC is a virtual resource/documentation centre Ø Provides access to films, posters, photos Ø Subjects like anemia, gender, maternal and infant mortality, sex ratio, adolescent health, spacing etc. Ø Media, Researchers, Students NGOs and General public has access to it Ø Inter-university and school level quiz competitions SIHFW: an ISO 9001:2008 certified Institution 28
  29. 29. National AIDS Control Program SIHFW: an ISO 9001:2008 certified Institution 29
  30. 30. National AIDS Control Program HIV/ AIDS A Acquired must do something to acquire I Immune ability to fight disease D Deficiency S Syndrome cluster of symptoms characteristic of disease Ø First case: 1986 Ø National AIDS control program: 1987 Ø NACO: 1992 SIHFW: an ISO 9001:2008 certified Institution 30
  31. 31. HIV/ AIDS prevalence criteria Ø High: > 1% in Ante-natal women Ø Moderate: < 1% in Ante-natal, > 5% in STD/other high risk behavior Ø Low: < 1% in Ante-natal & < 5% in STD/other high risk behavior SIHFW: an ISO 9001:2008 certified Institution 31
  32. 32. Some facts Ø One disease Ø Two Viruses Ø Three transmission modes- • Sexual • Vertical • IV Drug/Blood SIHFW: an ISO 9001:2008 certified Institution 32
  33. 33. Ø Four interventions • Communication • Counseling • Condoms • Care of PLWA Ø Five owe responsibility • Individual • Family • Community • Care providers • Media SIHFW: an ISO 9001:2008 certified Institution 33
  34. 34. Facts – 2007 Source: Annual Report NACO-2008-09 People living with HIV/AIDS 1.8-2.9 million Adult Prevalence – 0.34% Males - 0.44% Females - 0.23% Prevalence: Antenatal clinic HIV : 0.48% STD clinic HIV : 3.6% IDU HIV : 7.2% MSM HIV : 7.4% Female sex worker HIV : 5.1% SIHFW: an ISO 9001:2008 certified Institution 34
  35. 35. NACP Phase-I (1992-99) Key Objective- — Slow the spread — Reduce- morbidity/mortality/impact SIHFW: an ISO 9001:2008 certified Institution 35
  36. 36. NACP-I Components: — Strengthening management Capacity — Promoting public awareness & comm. Support — Improving blood safety from 30 to 90% & rational use — Controlling STDs — Building surveillance & clinical mgt. capacity SIHFW: an ISO 9001:2008 certified Institution 36
  37. 37. Key factors affecting project — New program, little capacity to address — Society & professionals unaware of HIV — Difficult to identify, reach & cover risk group — Linkages to STD/Tuberculosis inadequate — Borrower’s & recipients non-familiarity with project processing requirement — Lack of ownership by States — Lack of uniformity of process & infra- structural support — Delay in release of funds SIHFW: an ISO 9001:2008 certified Institution 37
  38. 38. NACP phase-II(1999-2004) — Nov.9, 1999 — 100% Centrally sponsored — 32 States/UTs & 3 Municipal Corporations — Participatory Planning- NACO/State/NGOs /Private sector/ stake holders-Approved by Cabinet-August 26, 1999 SIHFW: an ISO 9001:2008 certified Institution 38
  39. 39. NACP Phase-II: Key Objectives • Reduce spread of HIV in India • Strengthen India’s capacity to respond to HIV/AIDS on a long term basis SIHFW: an ISO 9001:2008 certified Institution 39
  40. 40. NACP-Phase II: Objectives: • Shift in focus (Awareness Behavior) • Encouraging voluntary testing • Support structured & evidence based • Reviews & ongoing operational research • Encourage Mgt. Reforms & Ownership • Decentralization- Program delivery to be -Flexible -Evidence based -Participatory -Local base SIHFW: an ISO 9001:2008 certified Institution 40
  41. 41. NACP Phase-II : Components: • Delivery of cost effective interventions • Strengthening capacity SIHFW: an ISO 9001:2008 certified Institution 41
  42. 42. NACP Phase- II Performance Indicators — HIV prevalence-5% in Maharashtra 3% in TN+AP+Manipur & Karnataka < 1% in other States — Reduce blood borne transmission <1% — Awareness level of 90% in youth & Rep. Age group — Condom use level of not < 90% among high risk groups-CSWs. SIHFW: an ISO 9001:2008 certified Institution 42
  43. 43. India responds-Dec.2001 — 11 care &support centres — 145 voluntary testing centres established — 77 National Telephone help lines#1097 — 115000 mothers counseled, transmission rate down to 9.6% — National AIDS Control Policy — National HIV Testing Policy — National Blood Policy SIHFW: an ISO 9001:2008 certified Institution 43
  44. 44. National AIDS control policy Aims at- — Prevention through awareness about implications & providing protection measures — Provide enabling social environment to people & families with HIV/AIDS — Improve services, for PLWA, in hospitals & at home through community health care SIHFW: an ISO 9001:2008 certified Institution 44
  45. 45. AIDS Control strategy — Program management — Surveillance & Research — IEC & Social mobilization through NGOs — Control of STDs — Condom programming — Blood safety — Impact reduction SIHFW: an ISO 9001:2008 certified Institution 45
  46. 46. NACP-III (2006-2111) Goals and Objectives • Halt and reverse the epidemic • Integrate Programs for prevention, care & support and treatment SIHFW: an ISO 9001:2008 certified Institution 46
  47. 47. National AIDS Control Program Phase III Objective Ø Prevent infections Ø care, support and treatment to PLHA. Ø Strengthen- infrastructure, systems and human resources Ø Strengthen the Strategic Information Management System SIHFW: an ISO 9001:2008 certified Institution 47
  48. 48. National AIDS Control Program Phase III Specific objective ØReduce new infection as estimated in the first year of the program by: • Sixty per cent (60%) in high prevalence states • Forty per cent (40%) in the vulnerable states so as to stabilize the epidemic. SIHFW: an ISO 9001:2008 certified Institution 48
  49. 49. Strategy — Targeted Interventions — The Link Worker Scheme — Preventive interventions for the general population — Sexually Transmitted Infections (STI) Services — Mainstreaming HIV for multi-sectoral response — Condom Promotion — Blood Safety — Other activities for Blood safety SIHFW: an ISO 9001:2008 certified Institution 49
  50. 50. Strategy — Care, Support and Treatment PLHA — Institutional Strengthening and Capacity Building — Strategic Information Management — Monitoring and Evaluation — Improving CMIS and overall Reporting — HIV Sentinel Surveillance SIHFW: an ISO 9001:2008 certified Institution 50
  51. 51. Mainstreaming HIV Ø Constitution of the State Councils on AIDS (SCA) Ø Greater Involvement of People Living with HIV (GIPA) under NACP-III Ø Mainstreaming with civil society organizations SIHFW: an ISO 9001:2008 certified Institution 51
  52. 52. Blood Safety Aims Ø Ensure provision of safe and quality blood Ø Ensure reduction in the transfusion Strengthening of Blood bank facilities through: • District level Blood Banks • Blood Component Separation Units • Blood Storage centres • Blood Refrigerated Vans SIHFW: an ISO 9001:2008 certified Institution 52
  53. 53. Care, Support and Treatment for People Living with HIV/AIDS (PLHA) NACP III includes Comprehensive management of PLHA with respect to ØTreatment and prevention of opportunistic infection ØART ØPsychosocial support ØHome based care ØPositive prevention and impact mitigation SIHFW: an ISO 9001:2008 certified Institution 53
  54. 54. The target for National ART program Ø Free ART to 300000 adult, 40000 pediatric PLHA by 2012 through 250 ART and 650 link ART centres. Ø Achieve and maintain high levels of adherence and minimize numbers lost to follow up Ø Involve inter sectoral partners, NGOs and Private partners Ø Provide comprehensive care, support and treatment through 350 Community Care centres by 2012 SIHFW: an ISO 9001:2008 certified Institution 54
  55. 55. Monitoring and Evaluation Ø Development of an integrated M&E Plan for NACP-III Ø Strengthening systems for better M&E Ø Improving Component Specific M&E – ART centres – ICTC – STI/RTI Reporting – Community Care centres SIHFW: an ISO 9001:2008 certified Institution 55
  56. 56. HIV Sentinel Surveillance Ø Surveillance in India was started from 1985 Ø NACO established in 1992, sentinel surveillance for HIV/AIDS in India. SIHFW: an ISO 9001:2008 certified Institution 56
  57. 57. Objectives of HIV Sentinel Surveillance Ø Determine the level of HIV infection Ø Understand the trends of HIV epidemic Ø Understand the geographical spread of HIV infection Ø Provide information for planning the Program Ø Estimate HIV Prevalence and HIV burden SIHFW: an ISO 9001:2008 certified Institution 57
  58. 58. National Vector Borne Disease Control Program (NVBDCP) SIHFW: an ISO 9001:2008 certified Institution 58
  59. 59. National Vector Borne Disease control Program (NVBDCP) NAMP NFCP Kala-azar control Program Dengue/Dengue Hemorrhagic fever and Japanese Encephalitis (J.E.) merged as NVBDCP SIHFW: an ISO 9001:2008 certified Institution 59
  60. 60. Malaria Control Program Ø 1953 : NMCP launched Ø 1958 : NMEP launched Ø 1971 : Urban Malaria Scheme (UMS) Ø 1976 : Resurgence with peak- 6.47M cases Ø 1977 : MPO & PfCP Ø 1979 : Centrally sponsored, 50:50 basis Ø 1985 : 2 million cases Ø 1991 : Peak in Pf cases Ø 1994 : Epidemic: Eastern India & Western Raj Ø 1995:Malaria Action Plan Ø Sept.1997: EMCP Ø Apr. 1999: NAMP Ø 2004: NVBDCP SIHFW: an ISO 9001:2008 certified Institution 60
  61. 61. 2000000 1869403 1915363 Malaria: India 1900000 1816569 Source: CBHI NHP, 2008 1800000 1780777 1700000 1600000 Cases 1500000 1508927 Deaths 1400000 1300000 1366517 1200000 1100000 1000000 900000 800000 700000 600000 500000 400000 300000 200000 1006 100000 949 0 963 1704 1331 8878 2003 2004 2005 2006 2007 2008* SIHFW: an ISO 9001:2008 certified Institution 61
  62. 62. Malaria: Cases Rajasthan Source: CBHI NHP, 2008 57482 142738 55043 2003 2004 2005 2006 99529 2007 2008* 105022 52286 SIHFW: an ISO 9001:2008 certified Institution 62
  63. 63. Malaria Situation in India Total Cases (2008-09 Sept.): India : 1075588 Rajasthan : 26787 Total Deaths (2008-09 Sept.): India : 754 Rajasthan : Nil SIHFW: an ISO 9001:2008 certified Institution 63
  64. 64. Measuring Malaria Human indices i. Annual Parasite Index (API) ii. Annual Blood Examination Rate (ABER) iii. Annual Falciparum Index (AFI) iv. Slide positivity rate (SPR) v. Slide Falciparum Rate (SFR) SIHFW: an ISO 9001:2008 certified Institution 64
  65. 65. Malaria Control A. Management of cases ØDiagnosis- Blood slide (Thick & Thin) ØTreatment i. Presumptive (With Chloroquine) ii. Radical iii. Mass drug administration (in areas with API>5) ØChemoprophylaxis SIHFW: an ISO 9001:2008 certified Institution 65
  66. 66. Malaria Control B. Interruption in Transmission Vector control: 1. Anti adult measures- a. Indoor residual spraying (IRS) b. Space application c. Genetic control SIHFW: an ISO 9001:2008 certified Institution 66
  67. 67. National Drug Policy: Malaria 2008 Ø Treatment-1: a. chloroquine (25 mg/Kg fpr 3 days + Primaquine (0.75 mg. /Kg for one day Or b. Artesunate (4 mg/Kg for 3 days)+sulpha pyrimethamine (25/1.25 mg/ Kg single dose) +Primaquine (0.75 mg /Kg single dose) Ø Treatment-2: Chloroquine (25 mg/Kg for 3 days+Primaquine (0.25 mg/ Kg for 14 days) Ø Treatment-3: Chloroquine (25 mg/Kg for 3 days) SIHFW: an ISO 9001:2008 certified Institution 67
  68. 68. Suspected (Clinically) Malaria Cases Microscopy result Available Not Available Rapid diagnostic Kit Falciparum Vivax Negative Available Not Available Treatment-1 Treatment-2 Faliciparum Negative Take slide Treatment 3 Treatment-1 Slide Falciparum Vivax Negative Primaquine 0.75 mg/kg single dose or ACT + Primaquine in qualified areas Primaquine 0.25mg/kg for 14 days SIHFW: an ISO 9001:2008 certified Institution 68
  69. 69. Malaria Control Strategies — Early Case Detection & Prompt Treatment (EDPT) — Vector Control Chemical Control Biological Control — Personal Prophylatic Measures — Community Participation — Environmental Management & Source Reduction Methods — Monitoring and Evaluation of the Program SIHFW: an ISO 9001:2008 certified Institution 69
  70. 70. National Iodine Deficiency Control Program SIHFW: an ISO 9001:2008 certified Institution 70
  71. 71. Problem Statement — World’s single most significant cause of preventable brain damage and mental retardation. — 261 million suffering from brain damage (10 million cretins) — 130 countries, 13% of world’s population. • 9 million persons affected. • 2.2 billion people live in ID areas • 167 million at risk of IDD • Goiter- 54.4 million SIHFW: an ISO 9001:2008 certified Institution 71
  72. 72. Problem Statement • IDD mental/motor handicaps - 8.8 million • 1984-86: ICMR multi centric study • 14 districts in 9 States • Goiter prevalence 21.1% • Endemic cretinism : 0.7% • India : 241 of 617 Districts are Goiter endemic • 140 million people are estimated to be living in goiter endemic regions • 51% HH consuming iodized salt (State of World’s Children, 2009-UNICEF) SIHFW: an ISO 9001:2008 certified Institution 72
  73. 73. Turning point of the program : 1983 — Questions asked by Mrs. Indira Gandhi ?What is Iodine Deficiency? ?Why should I be interested in National Goitre Control Program (NGCP)? ?How is it going to contribute towards PM’s 20 point Program? SIHFW: an ISO 9001:2008 certified Institution 73
  74. 74. National Iodine Deficiency Control Program SIHFW: an ISO 9001:2008 certified Institution 74
  75. 75. Program Developments — 1962: NGCP launched — 1984 : Policy of Universal salt Iodization(USI) : Private sector to produce iodized salt — 1992: NGCP renamed as NIDDCP — 1995: Independent survey evaluation of USI in MP, New Delhi and Sikkim — 1997: sale and storage of common salt banned — 1998-99: NFHS II : 71% using iodized salt — 13th Sept 2000: ban on sale of common salt lifted by the GoI, States continued the ban SIHFW: an ISO 9001:2008 certified Institution 75
  76. 76. Goal : To decrease overall IDD prevalence (goiter) to <5% in the school children 6-12 years. Objectives : • Surveys to assess the magnitude of the IDD. • Supply of iodated salt in place of common salt • Resurvey after every 5 years to assess the extent of iodine deficiency disorders and the Impact of iodated salt. • Laboratory monitoring of iodated slat and urinary iodine excretion. • Health education & publicity. SIHFW: an ISO 9001:2008 certified Institution 76
  77. 77. Spectrum of IDD Fetus: Abortion, Still Birth, Congenital Anomalies, Prenatal mortality, Infant mortality, Neurological cretinism (mental deficiency, deaf mutism, squint) Neonate:Neonatal Goiter, Neonate Hypothyroidism Child and adolescent: Juvenile Hypothyroidism, Impaired Mental function, Growth retardation Adult: Goiter, Hypothyroidism, Impaired mental function SIHFW: an ISO 9001:2008 certified Institution 77
  78. 78. Classification of goiter Grade 0: No palpable or visible goiter Grade 1: A mass in the neck with enlarged thyroid, palpable but not visible Grade 2: Swelling in the neck that is palpable as well as visible SIHFW: an ISO 9001:2008 certified Institution 78
  79. 79. Strategy A. Essential components of IDDCP – Ensuring availability of iodized salt ?30 PPM at production level ?15 PPM of iodine at consumer level – Awareness generation to increase consumption level up to 90% – Iodized salt is most economical convenient and effective means of mass prophylaxis SIHFW: an ISO 9001:2008 certified Institution 79
  80. 80. B. Iodine monitoring through lab ?Iodine excretion determination ?Determination of iodine in water, soil and food ?Determination of iodine salt Fortified salt with iron and iodine neonatal hypothyroidism is a sensitive point to environmental iodine deficiency C. Manpower training D. Mass communication SIHFW: an ISO 9001:2008 certified Institution 80
  81. 81. Comprehensive Action Plan — Creating Demand for iodized salt in Community — Improving Monitoring of quality of iodized salt — Increasing outlets and access to low cost adequately iodized salt — Improving iodized salt production — Advocacy with Policy Makers and Program Managers SIHFW: an ISO 9001:2008 certified Institution 81
  82. 82. Initiatives - Rajasthan — Reinforce sampling of salt under PFA — Training of concerned paramedical and health staff at various level with the help of UNICEF — Component will be included in School Health Program — District nodal officer are directed to send regular reports to IDD cell SIHFW: an ISO 9001:2008 certified Institution 82
  83. 83. — Strengthening of IDD monitoring lab. — Monitoring included in IDSP — 10 Districts has been taken for developing labs in CM&HO’s office for examination of Iodized salt (Bikaner, S.Ganganagar, Barmer, Sirohi, Chittorgarh, Banswara, Jhalawar, Bhartpur, Nagaur, Alwar) SIHFW: an ISO 9001:2008 certified Institution 83
  84. 84. Achievements • Salt manufacturing license issued to 930 units • 26 States have totally banned non-iodized salt • 29 States and UTs have established IDD cells • Intensive IEC campaigns • Standards for iodized salt • National reference laboratory set up • Ban on sale of non iodized salt SIHFW: an ISO 9001:2008 certified Institution 84
  85. 85. National Program for prevention of Visual Impairment and Control of Blindness SIHFW: an ISO 9001:2008 certified Institution 85
  86. 86. Global Scenario — 314 million visually impaired, 45 million blind. — Aged and females are more at risk — 87% of visually impaired in developing countries. 82% of visually impaired are 50+ — Age-related impairment is increasing. — Cataract - leading cause — Refractive errors correction could give normal vision to >12 million children (ages five to 15). — 85% of all visual impairment is avoidable SIHFW: an ISO 9001:2008 certified Institution 86
  87. 87. Chronological developments 1963: Started as National Trachoma Control Program 1976: Renamed as National Program for prevention of Visual Impairment and Control of Blindness(100% Centrally Sponsored) 1982: Blindness included in 20-point program “2020-the right to sight”. SIHFW: an ISO 9001:2008 certified Institution 87
  88. 88. Objectives Ø Reducing the Blindness prevalence from 1.4% to 0.3% by 2020 Ø Provide high quality of eye care Ø Expand coverage of eye care to the affected population & under-served areas Ø Reduce backlog of blindness Ø Develop institutional capacity for eye care services SIHFW: an ISO 9001:2008 certified Institution 88
  89. 89. Strategies Ø Decentralized DBCS Ø Active screening of population above 50 years of age. Ø Involvement of voluntary Organization Ø Participation of community and PRI Ø Development of eye care services and improvement in quality of eye care. Ø Screening of school children Ø Public awareness Ø Specific focus on illiterate women in rural areas. Ø To make eye care comprehensive SIHFW: an ISO 9001:2008 certified Institution 89
  90. 90. Indicators: — Cataract operation in bi-lateral blind. — Cataract surgery in female. — Cataract surgery in SC/ST population. — Cataract surgery in different facilities. — Cataract surgery in different age groups. SIHFW: an ISO 9001:2008 certified Institution 90
  91. 91. Initiatives (2009-10): — Free surgery for cataract cases in rural areas. — Free transportation for patients. — Free medicine for all types of eye ailments. — Free spectacles for post operative care. — Free spectacles for poor school students. — Treatment of backlog cataract cases. — All schools would be covered for SES. SIHFW: an ISO 9001:2008 certified Institution 91
  92. 92. Initiatives (2009-10) • Vit- A supplementation and immunization coverage. • Modern treatment at Medical College and DH. • one Eye Bank & 2 Eye Donation Centres • Establishment of one RIO,Cuttack. • ASHA: be trained and assigned to create awareness. incentive of Rs 175/- per cataract case, out of the fund earmarked under Cataract Operation. • Contractual Ophthalmology Assistants created SIHFW: an ISO 9001:2008 certified Institution 92
  93. 93. Implementing agencies District Blindness Control Society (DBCS) Composition Chairman : District Collector Vice chairman : Chief Medical & Health Officer Members : Medical Superintendent of District hospital District Education Officer Representatives of NGOs President of IMA Ophthalmic surgeon of Mobile surgical unit An eminent practicing Ophthalmologist Member secretary : District Blindness Control Coordinator SIHFW: an ISO 9001:2008 certified Institution 93
  94. 94. Functions of DBCS Ø Plan, Implement and Monitor Ø Draw list of voluntary agencies/ private hospitals/ NGOs Ø Coordination with Health & other departments Ø Raise funds and monitor use of funds SIHFW: an ISO 9001:2008 certified Institution 94
  95. 95. Achievements Year Target Achievement % Surgery with IOL 2002-03 4000000 3857133 77 2003-04 4000000 4200138 83 2004-05 4200000 4513667 88 2005-06 4513000 4905619 90 2006-07 4500000 5040089 93 2007-08 5000000 5404406 94 2008-09 6000000 192805 - SIHFW: an ISO 9001:2008 certified Institution 95
  96. 96. National Leprosy Eradication Program SIHFW: an ISO 9001:2008 certified Institution 96
  97. 97. National Leprosy Eradication Program — 1955 -NLCP — 1970s -Multi Drug Therapy. Dapsone treatment continued. — 1982 -MDT came into use from 1982, — 1983 –NLEP — 1993-2000- The 1st phase of WB supported NLEP implemented — 1998-2004:Modified Leprosy Elimination Campaign — 2005 - India achieved elimination National Level. SIHFW: an ISO 9001:2008 certified Institution 97
  98. 98. NLEP: phased approach achievements — 1st phase(1993-1994)- prevalence rate reduced 24 (1992) to 3.7/10,000 — 2nd phase (2001-02 to 2003-04) – Decentralization, integration, Elimination — PR – 0.84 /10,000 pop. (March 31, 2006) (Elimination-1/10,000) SIHFW: an ISO 9001:2008 certified Institution 98
  99. 99. Case Load: 31 Dec.2005 5% 5% Orrisa 4% Chattishgarh Jharkhand 40% Uttar Pradesh 22% Bihar West Bengal Other 12% 12% 6 states(41% pop. and 61% case load) with PR >1/10000-March31, 2006 SIHFW: an ISO 9001:2008 certified Institution 99
  100. 100. 30 Leprosy trend – PR & ANCDR Source : MoHFW 25.9 25 20 PR ANCDR 15 10 8.4 7 5.5 5.9 5.9 5.3 4.4 5 4.9 3.7 4.2 3.3 3.2 2.3 2.4 1.43 1.3 0 0.95 1991 1995 2000 2001 2002 2003 2004 2005 2006 SIHFW: an ISO 9001:2008 certified Institution 100
  101. 101. Objectives Ø Render all case non-infectious in shortest time by: • Early detection & treatment • Interrupting transmission Ø Prevent deformities Ø Eradicate Leprosy Ø MDT throughout Ø Prevalence-<1/10000 by 2002 SIHFW: an ISO 9001:2008 certified Institution 101
  102. 102. Strategy Ø Decentralization of NLEP to States & Districts Ø Integration of leprosy services with General Health Care System Ø Leprosy Training of GHS functionaries Ø Surveillance for early diagnosis & prompt MDT, through routine and special efforts Ø Intensified IEC using Local and Mass Media approaches Ø Prevention of Disability & Care SIHFW: an ISO 9001:2008 certified Institution 102
  103. 103. Elimination Strategy — Strategic Plan of Action (2004-05) — Focused Leprosy Elimination Plan (FLEP- 2005) — Intensified Supervision And Monitoring — Modified Leprosy Eradication Program (1997) SIHFW: an ISO 9001:2008 certified Institution 103
  104. 104. Strategic Plan of Action (2004-05) — Intensified focused action in 72 districts (PR > 5) and 16 moderately endemic districts with more than 2000 leprosy cases detected during 2003-04. — Increased efforts put on IEC, Training and Integrated Service Delivery in 86 medium priority districts. — Intensified IEC through Leprosy Counseling Centres in 836 blocks (PR > 5) SIHFW: an ISO 9001:2008 certified Institution 104
  105. 105. Strategic Plan of Action (2006-07) — Provision of quality services with — proper referral for management of reactions, — complications and correction of deformity — in districts with PR > 1 — 29 districts and 433 blocks — Activities proposed: – Experienced district nucleus staff – Vehicle – Orientation for all the PHC Medical Officers – Situational analysis within the district – IEC , supervision and monitoring SIHFW: an ISO 9001:2008 certified Institution 105
  106. 106. Focused Leprosy Elimination Plan (FLEP-2005) — 42 high priority districts with PR > 3/10,000 located in 7 endemic states. — Increased efforts put on IEC, Training and Integrated Service Delivery — In 552 blocks (PR > 3) as on 31.03. 05, a two weeks long Block Leprosy Awareness Campaign (BLAC-II) through Intensified IEC and Leprosy Counseling Centres at PHC level during the period Sept.-Oct. 2005. M.Os reoriented SIHFW: an ISO 9001:2008 certified Institution 106
  107. 107. Modified Leprosy Eradication Program (1997) In order to address these challenges a few areas were identified for intensive efforts. These are- ØTraining ØIntensified IEC ØDetection and immediate MDT SIHFW: an ISO 9001:2008 certified Institution 107
  108. 108. Approach ØPrevalence based categorization – Endemic : >5/1000 – Moderate : 3-5/1000 – Low : <2/1000 ØPlan of Action – Preparatory phase – Intensive phase – Maintenance phase SIHFW: an ISO 9001:2008 certified Institution 108
  109. 109. Treatment — MDT since 1982 — Rifampicin, clofazimine and dapsone — Single dose of MDT kills 99.9% of leprosy germs. — Free-of-cost on all working days at all SC, PHC, Govt. Dispensaries and Hospitals SIHFW: an ISO 9001:2008 certified Institution 109
  110. 110. Issues in treatment with Multi Drug Therapy (MDT) ØPrioritize (based on resources) • Multibaciliary • Paucibacilliary resistant to Dapsone • Other Paucibacilliary ØDelivery • Adequate, Efficient, Flexible • Referral • Integration with primary care SIHFW: an ISO 9001:2008 certified Institution 110
  111. 111. Challenges Ø Further simplify and shorten the regimen Ø Abolish classification for treatment purposes Ø Identify areas and communities not yet covered Ø Actively change the negative image of leprosy Ø Focus more on analysis of detection trends than on prevalence Ø Develop an integrated community-based strategy for rehabilitation SIHFW: an ISO 9001:2008 certified Institution 111
  112. 112. States and Districts according to endemicity levels have been categorized and accordingly action plan developed for- Ø8 States with prevalence rate less than 5/ 10000 with – Active case finding – Promoting self reporting (Voluntary reporting by cases-VRC) – IEC & Training SIHFW: an ISO 9001:2008 certified Institution 112
  113. 113. Ø 14 States with prevalence rate 1-5/10000 – VRC – Staff training &IEC – Detection of paucibacilliary cases Ø 13States with prevalence rate less than 1/ 10000 – Intensified IEC – Detection of paucibacilliary cases SIHFW: an ISO 9001:2008 certified Institution 113
  114. 114. Revised National Tuberculosis Control Program (RNTCP) SIHFW: an ISO 9001:2008 certified Institution 114
  115. 115. Revised National Tuberculosis Control Program (RNTCP) Issues in Tuberculosis: Ø Case finding-Access to/ Availability of, sputum microscopy Ø Treatment-continuity, regularity & compliance Ø Drug resistance-MDR-TB (Every one who breathes should be concerned) Ø Dual Epidemic-HIV/AIDS & Tuberculosis. SIHFW: an ISO 9001:2008 certified Institution 115
  116. 116. Chronological Developments Ø 1956-61: ØTuberculosis Research Center at Chennai (1956) ØNational Tuberculosis Institute established at Bangalore (1959) ØDistrict Tuberculosis Program (1961) Ø 1962: National Tuberculosis Control Program (NTCP) Ø 1975:Tuberculosis included in 20-point Program Ø 1993: Pilot phase of RNTCP Ø 1998: Stop TB initiative Ø 1999: RNTCP -second largest program in the World Ø 2003:>900,000 cases on treatment- largest cohort of cases, SIHFW: an ISO 9001:2008 certified Institution 116
  117. 117. National Tuberculosis Control Program (NTCP) — Domiciliary treatment — Use of a standard drug regimen of 12-18 months duration — Treatment free of cost — Priority to newly diagnosed patients, over previously treated patients — Treatment organization fully decentralized — Efficient defaulter system/mostly self- administered regimen — Timely follow up SIHFW: an ISO 9001:2008 certified Institution 117
  118. 118. NTCP: Punctuations — Managerial weakness, — Inadequate funding, — Over-reliance on x-ray, — Non-standard treatment regimen, — Low rates of treatment completion, — Lack of systematic information on treatment outcomes. SIHFW: an ISO 9001:2008 certified Institution 118
  119. 119. RNTCP-Goals ØTo cure at least 85% of new smear positive cases of Tuberculosis ØTo detect at least 70% of sputum positive cases after reaching 85% cure rate SIHFW: an ISO 9001:2008 certified Institution 119
  120. 120. Strategy: Directly Observed Treatment with Short course Chemotherapy (DOTS) Ø Political& Administrative commitment. Ø Good Quality diagnosis Ø Good Quality drugs Ø Right treatment administered rightly Ø Systematic Monitoring and Accountability SIHFW: an ISO 9001:2008 certified Institution 120
  121. 121. DOTS Strategy interventions Ø Case detection Ø Adequate Drug supply Ø Short Course chemotherapy given under direct supervision. Ø Systematic Monitoring and Accountability Ø Political will & Advocacy Ø System rather than Patient – Accountable for Drug compliance SIHFW: an ISO 9001:2008 certified Institution 121
  122. 122. Achievements under RNTCP (2007-08) — Treatment success rates tripled from 25% to 86% in 2008 — NSP CDR of 70% (2007) and 72% (2008) — TB death rates reduced from 29% to 4% — TB mortality reduced from 42 in 1990 to 28/100,000 population in 2006 (WHO Global TB Report 2008). — The prevalence of TB reduced from 568 in 1990 to 299/100,000 population by 2006 (WHO Global TB Report, 2008) SIHFW: an ISO 9001:2008 certified Institution 122
  123. 123. Performance: 2007-08 (source TB India 2009) — No. of suspects examined 6817390 — No. Of smear positive diagnosed : 911823 — Percentage of smear positive among suspects: 13% — Registered for treatment: 1517333 SIHFW: an ISO 9001:2008 certified Institution 123
  124. 124. Performance: 2007-08 (source TB India 2009) — Annual Case detection rate : 132 — New smear+ patients reg. For treatment: 616016 — 3 month conversion rate of new smear positive patients : 90% — Cure rate of new smear positive patients : 84% — Success rate of new smear positive patients : 87% SIHFW: an ISO 9001:2008 certified Institution 124
  125. 125. RNTCP performance (Q4 2008) Suspects examined: 1.65 million Sputum +ve : 207144 Registered for Treatment:351593 New S+ve case detection rate: 67% SIHFW: an ISO 9001:2008 certified Institution 125
  126. 126. Treatment regimen under RNTCP — Category-I – New sputum smear positive – Seriously ill sputum -ve – Seriously ill extra pulmonary SIHFW: an ISO 9001:2008 certified Institution 126
  127. 127. Treatment regimen under RNTCP — Category-II – Sputum smear +ve relapse – Sputum smear +ve failure – Sputum smear +ve treatment after default SIHFW: an ISO 9001:2008 certified Institution 127
  128. 128. Treatment regimen under RNTCP — Category-III – Sputum smear –ve not seriously ill, – Extra pulmonary not seriously ill SIHFW: an ISO 9001:2008 certified Institution 128
  129. 129. Treatment regimen under RNTCP Category Intensive phase Continuation phase I 2 (HRZE) 3 4 (HR) 3 II 2 (HRZES) 3 5 (HRE) 3 + 1 (HRZE) 3 III 2 (HRZ) 3 4 (HR) 3 The figures outside the bracket refer to number of months while those after the bracket indicate number of doses per week SIHFW: an ISO 9001:2008 certified Institution 129
  130. 130. Organization structure Health Minister Health Secretary DGHS Add. Secretary Joint Secretary DDG (TB) CMO RNTCP TB NGOs Consultants Specialist CMO CMO Deputy Electronic Drug Training Director (Adm.) Connectivity SIHFW: an ISO 9001:2008 certified Institution cell 130
  131. 131. Organization structure : state Level Health Minister Health Secretary DMHS Special State TB Cell STO, Deputy Secretary STO, MO, Acc., IE C, Off., SA, DEO Nodal Point for Dist. TB Centre DTO, MO- TB control DTC(15%), LT, DEO, Driv 1/0.5 m (0.25 m in Hilly er Tuberculosis MO-TC, STS, STLS /difficult/tribal area) unit 1/0.1 m (0.05 m in Microscopy MO, LT (20%) hilly/difficult/tribal area) Centre DOT Provider – 0.25 m (TC), 0.005 DOT Centre MPW, NGO m (SC) SIHFW: an ISO 9001:2008 certified Institution PP,Comm Vol , 131
  132. 132. Emerging issues Ø MDR-TB Ø TB and HIV Ø XDR-TB Ø NGO Involvement Ø Role of Medical Colleges Ø Private sector involvement Ø Participation of corporate sector Ø Pediatric TB SIHFW: an ISO 9001:2008 certified Institution 132
  133. 133. Impact of the program Ø TB mortality has reduced from 42/100,000 population in 1990 to 28/100,000 population in 2006 (WHO global TB report 2008). Ø Prevalence of TB has reduced from 568/100,000 population in 1990 to 299/100,000 by the year 2006 (WHO global TB report 2008). Ø Repeat population surveys conducted by TRC indicate an annual decline and prevalence of disease by 12% SIHFW: an ISO 9001:2008 certified Institution 133
  134. 134. Terms used under RNTCP — New case: A patient with sputum smear +ve and who never had taken anti- tubercular drugs for less than 4 weeks — Relapse: A patient treated and declared cured in past and now returns with sputum +ve smear. — Failure:A patient on anti-tubercular treatment who remains or becomes sputum positive after 5 months or later during Short Course Chemotherapy. SIHFW: an ISO 9001:2008 certified Institution 134
  135. 135. — Cured: S+ve patient who completed treatment and had negative smear on two occasions (one immediately after treatment completion). Initially S-ve who received full course , or a S+ve who completed treatment with S-ve at the end of initial phase but no or only one negative smear during continuation and none at the end — Transfer in: Patient recorded and registered in one area and transferred into another area for completing treatment — Transferred out: Patient transferred to another area register. SIHFW: an ISO 9001:2008 certified Institution 135
  136. 136. Scheme of Evaluation of RNTCP: Objectives- — To validate the reported cure rates for last quarter — To assess program performance and Logistics & Financial Management — To give recommendations for improving quality of Recording & Reporting — To give recommendations for improving performance SIHFW: an ISO 9001:2008 certified Institution 136
  137. 137. Evaluation of RNTCP: Internal Evaluation Team- — State TB Officer — STDC Director (in states where STDC exists) — DTO of District other than one being evaluated — One WHO consultant of District not being evaluated — One WHO consultant of District other than one being evaluated — DTO & RNTCP staff of district being evaluated SIHFW: an ISO 9001:2008 certified Institution 137
  138. 138. Evaluation of RNTCP: Selection of Districts — Frequency- Quarterly — 2 Districts ?One with good performance ?Second with poor performance SIHFW: an ISO 9001:2008 certified Institution 138
  139. 139. Evaluation of RNTCP: Selection of Microscopy centres- — Total of 5 MCs ?MC in DTC ?2 MCs from MCs that are examining higher no. of TB suspects from the enlisted 4, randomly ?2 MCs randomly from all the remaining enlisted MCs SIHFW: an ISO 9001:2008 certified Institution 139
  140. 140. Evaluation of RNTCP: Selection of DOT centres- — DOT centres in each of the 5 MCs — 5 other DOT centres like- ?Attached to medical college ?STDC ?ESI ?Railways ?NGOs ?Private sector ?Aanganwadi ?DOT centres with 50+ patients SIHFW: an ISO 9001:2008 certified Institution 140
  141. 141. Evaluation of RNTCP: Selection of Patients- 42 Patients 36 NSP 6 others 2 patients who are not NSP 30 NSP from those 6 from DOT from DOT centre registered in last 2 quarters centres in in DTC and 2 DTC & 2 selected MCs (6 from each of the 5 MCs selected MCs) 1 NSP in IP phase and 1 with just finished IP From each centre SIHFW: an ISO 9001:2008 certified Institution 141
  142. 142. Evaluation of RNTCP: Data Collection-Instruments — Basic information of District — Form 1- for review of recording & Reporting — Form 2-for interviewing DTO & his team — Form 3-for reviewing MCs — Form 4-for reviewing DOT centres — Form 5-for interviewing patients & checking consistency of records between TB Register, Lab. Register and treatment cards of 36 cases SIHFW: an ISO 9001:2008 certified Institution 142
  143. 143. Data Collection-Instruments — Form 6- for consistency of records between TB Register, Lab. Register and treatment cards of NSP Patients where outcome records are available — Form 7-for summary of selected indicators — Form 8-for non NSP Patients — Form 9-for observations at TU — Form 10-for recording overall observations SIHFW: an ISO 9001:2008 certified Institution 143
  144. 144. Reporting results of Internal Evaluation: To Central TB division- — Form no. 1, 7, 10 just after IE by e-mail. — Hard copy within 2 days — Form 1, 2, 6, 7, 8, 9 10 (one copy each) — Form no. 3 -5 for 5 MCs — Form no. 10 -10 for 10 DOT centres — Form no. 5 – 5 copies SIHFW: an ISO 9001:2008 certified Institution 144
  145. 145. National Cancer Control Program SIHFW: an ISO 9001:2008 certified Institution 145
  146. 146. Cancer : India — 8-9 lakh cases every year — 25 lakh cases at any point of time — 4 lakh deaths every year — 40% cancers related to tobacco use — Cancers – oral, lungs, cervix, breast account for 50% deaths SIHFW: an ISO 9001:2008 certified Institution 146
  147. 147. National Cancer Registry Program (NCRP) • Initiated 1982 by ICMR • Gives magnitude and patterns of cancer • Types of registries v Population Based Cancer Registry - 21 v Hospital Based Cancer Registries - 6 SIHFW: an ISO 9001:2008 certified Institution 147
  148. 148. Goals & objectives of NCCP — Primary prevention by health education — Secondary prevention i.e. early detection and diagnosis — Strengthening of existing cancer treatment facilities — Palliative care in terminal stage of the cancer. SIHFW: an ISO 9001:2008 certified Institution 148
  149. 149. Evolution of NCCP 1975-76: National Cancer Control Program launched 1984-86: Strategy revised and stress laid on primary prevention and early detection of cancer cases. 1991-92: District Cancer Control Program started 2000-01: Modified District Cancer Control Program initiated 2004 : Evaluation of NCCP by NIHFW 2005 : Program revised after evaluation SIHFW: an ISO 9001:2008 certified Institution 149
  150. 150. National Cancer Control Program 1975-76 Goals & Objectives — Primary prevention of cancers by health education — Secondary prevention by early detection and diagnosis of cancers, — Strengthening of existing cancer treatment facilities — Palliative care in terminal stage cancer. SIHFW: an ISO 9001:2008 certified Institution 150
  151. 151. Intervention aimed at Determinants — Tobacco – Education- School/ addicts/ women – Legislation- Sale/ Advertising/ public place smoking – Taxation — Diet – Restrict-Fat/ nitrites/Afflatoxins/Additives/ oil reheating – Encourage- Fiber/Fruits/ Vegetables — Sexual practices – Delay age of marriage/ stick to one/ less no. of children/ BF — Occupation & environment – Legislation/ Safety measures — Infective agents – Vaccination/Safe Sex SIHFW: an ISO 9001:2008 certified Institution 151
  152. 152. Service delivery in Cancer control — District Cancer Control societies- structure – District Collector – CM & HO – Rep. of Health services/Med. Colleges/ RCC/ NGOs — Role- – Fund generation – IEC/ Early detection/ Screening/ Palliative care SIHFW: an ISO 9001:2008 certified Institution 152
  153. 153. Area Cancer Agency Approach Objectives Outcome Pri. Prev. TRC People Education/ Reduce Reduce NGOs Media tobacco use Incidence & by 30% mortality Screening Cervix Hlth. One pap at Screen Reduce Services 40 yrs./ pap 80%of incidence for high risk eligible by 50% in 5 yrs. Early Oral cavity Doctor/ Oral self Detect 80% Reduce detection Breast Paramedic. exam./ in early mortality BSE stage by30% Treatment Oral MC Surgery Effective Reduce cervix Local RT treatment mortality by breast trained 30% doctors Palliative All HW/People Ensure Community Quality incurable availability care death SIHFW: an ISO 9001:2008 certified Institution 153
  154. 154. Services under NCCP- PHC — Health education — Health promotion — Home care — Early detection — Palliative care and pain relief SIHFW: an ISO 9001:2008 certified Institution 154
  155. 155. Services under NCCP- District level — Health Promotion — Home Care/ — Early Detection — Pain Relief/Palliative Care Treatment of common cancers — Histopathology — Endoscopy SIHFW: an ISO 9001:2008 certified Institution 155
  156. 156. Services under NCCP- Medical college without Oncology unit — Health Promotion — Home Care — Early Detection — Pain Relief/Palliative Care — Treatment of common cancers — Training of medical officers/paramedical personnel — Preventive oncology-early detection/ Registration/ mobile units — Radiotherapy with cobalt-60 units SIHFW: an ISO 9001:2008 certified Institution 156
  157. 157. Services under NCCP- Medical college with Oncology unit — Diagnosis and staging by clinical/ histopathological/ biochemical/ radiological/ endoscopical/ immunological/ isotope — Treatment-Radiotherapy/ surgery/ chemotherapy/ radiation — Training of Med. /Paramedical — Maintain hospital based registry SIHFW: an ISO 9001:2008 certified Institution 157
  158. 158. Services under NCCP- Regional cancer centre — Health Promotion — Home Care — Early Detection — Pain Relief/Palliative Care/Comprehensive Cancer treatment — Organize screening Program/Cytology training/ — Basic and applied research/Training of all categories of personnel — Cancer Registries — Epidemiology SIHFW: an ISO 9001:2008 certified Institution 158
  159. 159. Existing Schemes under (NCCP) June 1, 2008 — Recognition of New Regional Cancer Centres (RCCs) — Strengthening of existing Regional Cancer Centres — Development of Oncology Wing — District Cancer Control Program — Decentralized NGO Scheme SIHFW: an ISO 9001:2008 certified Institution 159
  160. 160. Achievements — Regional Cancer Centres: 27 RCC, including 6 NGOs — Oncology wing: 246 institutions with radiotherapy facilities — District Cancer Control Program: 28 districts — IEC Activities: health magazine ‘Kalyani’ SIHFW: an ISO 9001:2008 certified Institution 160
  161. 161. Achievements — National Cancer Awareness Day — Onconet- India: Telemedicine Services including tele-consultations, tele-referral, tele- pathology etc — Membership of International Agency for Research on Cancer :India has become a member SIHFW: an ISO 9001:2008 certified Institution 161
  162. 162. New initiatives — Logistics- Pap smear kits/Can scan software — Outreach activities by medical colleges — Training — Supply of Morphine — Telemedicine and supply of computer hardware and software. — IEC activities. — Modified District Cancer Control Program — National Cancer Awareness Day — Training of cytopathologists and cytotechnicians SIHFW: an ISO 9001:2008 certified Institution 162
  163. 163. Modified District Cancer Control Program — 4 States-UP/TN/Bihar/WB — 60 Blocks — 30 Doctors — 12 lac women(20-65 Yrs.) — Health education about-general ailments, cancer prevention and early detection besides 'Breast Self Examination' was imparted SIHFW: an ISO 9001:2008 certified Institution 163
  164. 164. Global WHO Cancer Control Strategy — People-centered — Equity — Ownership — Partnership & Multi-sectoral approach — Sustainability — Integration within broad framework of delivery — Evidence based strategy SIHFW: an ISO 9001:2008 certified Institution 164
  165. 165. National Mental Health Program SIHFW: an ISO 9001:2008 certified Institution 165
  166. 166. Mental Health: Problem Statement Mental Disorders — 6-7% of population — 12% of Global Burden of Disease (GBD) — 20% of world's children and adolescents — One child psychiatrist for every 1-4M — 800,000 people commit suicide every year, 86% of them in low- and middle-income countries. — Mental disorders-risk factors for CD and NCD SIHFW: an ISO 9001:2008 certified Institution 166
  167. 167. — No Mental Health Policy — No data collection system — Mental health disorders • Schizophrenia • Bipolar disorder • Organic psychosis • Major depression SIHFW: an ISO 9001:2008 certified Institution 167
  168. 168. Mental Health Resources: India (per 10,000 population) — Total Psychiatric beds: 0.25 — Psychiatric beds in mental hospitals: 0.2 — Psychiatric beds in general hospitals: 0.05 — Psychiatric beds in other settings: 0.01 — No. of Psychiatrists: 0.2 — No. of Neurosurgeons: 0.06 — No. of Psychiatric Nurses: 0.05 — No. of Neurologists: 0.05 — No. of Psychologists: 0.03 — Number of Social Workers: 0.03 (Source: Mental Health Atlas, 2005, WHO) SIHFW: an ISO 9001:2008 certified Institution 168
  169. 169. National Mental Health Program • National Mental Health Program, 1982, re-strategized 2002 • 28 crore (IX FYP), 190 crore (X FYP), 1000 crore (XI FYP) • District Mental Health Program 1995 • Synchronization with NRHM SIHFW: an ISO 9001:2008 certified Institution 169
  170. 170. National Mental Health Program • Legislation • Mental Health Act , 1987 • Juvenile Justice Act, 1986 • The Persons With Disabilities (Equal Opportunity, Protection Of Rights And Full Participation) Act, 1995 • Narcotic Drugs and Psychotropic Substances Act (Amended 2001) SIHFW: an ISO 9001:2008 certified Institution 170
  171. 171. Objectives • Ensure availability and accessibility of minimum mental health care for all • Encourage mental health knowledge and skills • Promote community participation in mental health service development and to stimulate self-help in the community. SIHFW: an ISO 9001:2008 certified Institution 171
  172. 172. Strategies — Expansion of DMHP to 100 districts all over the country. — Modernization of Mental Hospitals. — Up-gradation of Psychiatry wings of Govt. Medical Colleges/General Hospitals. — IEC Activities. — Research & Training in Mental Health for improving service delivery SIHFW: an ISO 9001:2008 certified Institution 172
  173. 173. District Mental Health Program DMHP – 123 districts Upgradation of Psychiatric wings of 75 Government Medical Colleges/General Hospitals Modernization of 26 Mental Hospitals. SIHFW: an ISO 9001:2008 certified Institution 173
  174. 174. Components — Establish Centres of Excellence in Mental Health by upgrading and strengthening of mental hospitals — Provide impetus for development of Manpower in Mental Health — Spill over of 10th Plan schemes for modernization of state run mental hospitals and up gradation of psychiatric wings of medical colleges/general hospitals. — Counseling in schools, colleges, work place SIHFW: an ISO 9001:2008 certified Institution 174
  175. 175. Components — Research-huge gap needs to be addressed — IEC-remove stigma attached to mental illnesses. — NGOs and Public Private Partnership for implementation of the Program to increase outreach of community — Monitoring Implementation & Evaluation SIHFW: an ISO 9001:2008 certified Institution 175
  176. 176. Thank You For more details log on to www. sihfwrajasthan.com or contact : Director-SIHFW on sihfwraj@yahoo.co.in

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