National health programs of India

NATIONAL HEALTH
PROGRAMS
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Contents
INTRODUCTION
Various National Health Programs
 VECTORBORNE DISEASE CONTROL PROGRAMMES
 NATIONAL ANTI-MALARIA PROGRAMME
 NATIONAL FILARIA CONTROL PROGRAMME (NFCP)
 KALA-AZARCONTROL PROGRAMME
 JAPANESE ENCEPHALITIS CONTROL (JE)
 DENGUE FEVERCONTROL
 NATIONAL LEPROSY CONTROL PROGRAMME (NLCP)
 NATIONAL TUBERCULOSIS PROGRAMME (NTP)
 NATIONAL AIDS CONTROL PROGRAMME
 NATIONAL PROGRAMME FORCONTROL OF BLINDNESS
 IODINE DEFICIENCY DISORDERS PROGRAMME (IDD)

 UNIVERSAL IMMUNIZATION PROGRAMME
 NATIONAL RURAL HEALTHMISSION
 REPRODUCTIVE ANDCHILDHEALTHPROGRAMME
 NATIONAL GUINEA - WORMERADICATION PROGRAMME
 YAWS ERADICATION PROGRAMME
 NATIONAL CANCERCONTROL PROGRAMME
 THE NATIONAL MENTAL HEALTHPROGRAMME
 THE NATIONAL DIABETES CONTROL PROGRAMME
 NATIONAL PROGRAMME FORCONTROL & TREATMENT OF
OCCUPATIONAL DISEASES
 NUTRITIONAL PROGRAMME
 NATIONAL SURVEILLANCE PROGRAMME FORCOMMUNICABLE
DISEASES
 INTEGRATEDDISEASE SURVEILLANCE PROJECT
 NATIONAL WATERSUPPLY ANDSANITATION PROGRAMME

 MINIMUMNEEDS PROGRAMME (MNP)
 20-POINT PROGRAMME
 HUMAN RABIES CONTROL PROGRAMME
 LEPTOSPIROSIS CONTROL PROGRAMME
 DRUG DE-ADDICTION PROGRAMME
 NATIONAL ORAL HEALTHCARE PROGRAMME
 NATIONAL PROGRAMME FORPREVENTION ANDCONTROL OF
FLUOROSIS
 NATIONAL PROGRAMME FORPREVENTION ANDCONTROL OF
DIABETES, CARDIOVASCULARDISEASES ANDSTROKE
 NATIONAL ORGAN TRANSPLANT PROGRAMME
CONCLUSION
REFERENCES

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Introduction:
He alth : “a state o f co m ple te physical, m e ntaland so cialwe ll
be ing and no t m e re ly an abse nce o f dise ase o r infirm ity”.
Fundamental human right nation has a responsibility for the health of its
people.
The assessment of health status and health problems is the first requisite for
any development of national health programs
The health problems of India may be conveniently listed under the following
heads:
1. Communicable disease problems
2. Nutritional problems
3. Environmental sanitation problems
4. Medical care problems
5. Population problems

 The present concern in both developed and developing
countries is not only to reach the whole population with
adequate health care services but also to secure an acceptable
level of health for all.
 Strategies: Planned program activities to develop and improve
the health of the people.
GOI set up a planning commission in 1950
To make an assessment of the material, capital and human
resources
Draft developmental plans for the effective utilization of these

 After Independence  various measures to improve the health of the
people and prominent among them are the National Health
programmes.
 Various international agencies like WHO, UNICEF, UNFPA, World
Bank, as also a number of foreign agencies like SIDA, DANIDA,
NORADand USAIDhave been providing technical and material
assistance in the implementation of these programmes.

 These Programmes were launched by Government with following
objectives:

VECTORBORNE DISEASE CONTROL
PROGRAMMES
 Directorate of National Anti Malaria Program
(NAMP) is the national nodal agency
 Malaria,
 Filaria,
 Japanese Encephalitis,
 Kala-azarand
 Dengue/Dengue Haemorrhagic Fever.

NATIONAL ANTI-MALARIA PROGRAMME
 was launched in India in April 1953 & was operational till
1958.
 Indoorresidual spraying with DDT twice a year in endemic
areas.
 Results of the programme were highly successful 80 %
reduction incidence of malaria.
 GOI changed the strategy from malaria control to eradication,
and launched the National Malaria Eradication Programme in
1958.
 Preparatory, Attack, Consolidation and Maintenance Phases.
 programme was highly successful in initial stages But setbacks

Revised strategy
Modified Plan of Operation (MPO) operation fromApril 1977.
 Flexibility in the policies according to the epidemiological situation &
local conditions
1. Objectives:
 to prevent deaths due to malaria
 to reduce malaria morbidity
 to maintain agricultural and industrial production and
 to consolidate the gains so far achieved.
2. Reclassification of Endemic Areas: API ≥ 2 should be taken up for
spray operations.
4. Areas with API < 2
Spraying, Surveillance, Treatment, Follow-
up, Epidemiological Investigation
3. Areas with API ≥ 2
Spraying, Entomological Assessment,
Surveillance

5. Drug distribution centres and fevertreatment depots
6. Urban Malaria Scheme
7. P. falciparum containment: introduced from October 1977,
through the assistance of Swedish International Development
Agency (SIDA) to prevent/contain/control of P. falciparum .
8. Research: to identify P. falciparum sensitivity to chloroquine
9. Health education: public to enlist their cooperation
10. Reorganization: The District Health Officer (DHO) responsible
for the implementation of the programme.
The programme which was vertical before, is now horizontal and
integrated with the general health services from the district level
to the periphery.

Surveillance: The timely collection and examination of blood
smears is a key element in MPO.
Parameters of malaria surveillance
 Annual parasite incidence (API)
 Annual blood examination rate (ABER)
 Annual falciparumincidence (AFI)
 Slide positivity rate (SPR)
 Slide falciparumrate (SFR).

Malaria control through primary health care: approved by WHO
in 1978.
Malaria Action Plan (MAP) was launched in 1995.
High risk areas were identified and provided with one Fever Treatment
Depot per 1000 population
Enhanced malaria control project: launched on 30th September
1997 with World Bank support for a period of 5 years.
 Early case detection and treatment;
 Selective vectorcontrol and personal protection methods
 Epidemic planning and rapid response;
 Inter-sectoral coordination, institutional management capabilities
strengthening
 Use of larvivorous fish.

Urban Malaria Scheme - launched in 1971
About 10 per cent of the total cases of malaria are reported from urban areas.
Intensified Malaria Control Project: with assistance from Global Fund
forAIDS, Tuberculosis and Malaria.
Anti-malaria month campaign: month of June

NATIONAL FILARIA CONTROL PROGRAMME
(NFCP)
 Started from 1955.
 In June 1978, NFCPwas merged with UMS
Filaria control strategy includes:
 Vectorcontrol through anti larval operations,
 Source reduction, detection and treatment of microfilaria carriers,
 Morbidity management and
 IEC
Revised Filaria Control Strategy

KALA-AZARCONTROL PROGRAMME
 A centrally sponsored programme was launched in 1990-91.
 Incidence & Death rate of the disease decreased by 75 % by year
2002.
The strategies forKala-azarelmination are:
 Enhanced case detection (PK39) rapid diagnostic kits and oral drug
Miltefosine
 Interruption of transmission through vectorcontrol
 Capacity building
 Monitoring, supervision and evaluation
In view of the success achieved so far, National Health Policy
envisages kala-azarelimination by the year2010.

JAPANESE ENCEPHALITIS CONTROL (JE)
High mortality rate and those who survive do so with various
degrees of neurological complications.
Strategies:
Indoorresidual spray is not effective

Objectives:
 Early case management
 Vaccination is recommended forchildren between 1 to 15 years of
age.
 Health education and Interpersonal communication
 Emphasis should be given on keeping pigs away fromhuman
dwellings, orin pigsties
 Use of clothes which coverthe body fully, bed nets
 Use malathion foroutdoorfogging as outbreakcontrol measure
Community should be given full information about signs and
symptoms of the disease and available health facilities early
reporting is important to avoid complications

DENGUE FEVERCONTROL
 In view of the major outbreak of the disease in 1996 a
"Guideline of Preparation of Contingency Plan in case of
outbreak/epidemic of Dengue/Dengue haemorrhagic fever"
was prepared and sent to all states.
It includes all the important aspects of control measures like
 Identification of outbreak,
 Demarcation of affected area,
 Containment of outbreak,
 Case management,
 Vector control,
 IEC activities about do's and don’ts,
 Monitoring and reporting.

NATIONAL LEPROSY CONTROL PROGRAMME
(NLCP)
 In operation since 1955(centrally aided programme)
 To achieve control of leprosy through early detection of cases and
DDS (dapsone) monotherapy.
Renamed as National Leprosy "Eradication"Programme (1983)with
the goal of eradicating the disease by the turn of the century.
 The aim was to reduce case load to ≤1 per 10,000 population.

Modified Leprosy Elimination Campaign (MLEC):
 A mid - termappraisal (April 1997 ) indicated that progress of the
programme is uneven in some states.
 Short termorientation training to health staff including volunteers
 Increase public awareness about leprosy
 House to house search  conducted throughout country for 6 days.
Special Action Project forElimination of Leprosy (SAPEL) forRural
and Leprosy Elimination Campaigns (LECs) forUrban Areas
 Designed for early detection and prompt MDT of leprosy cases,
along with proper IEC in the difficult and inaccessible rural/tribal
areas
World BankSupported Project on NLEP
 The first phase completed on 31st March 2000

Evaluation: During the 1st phase - case detection was 3.8 million
patients (target of 2 million) and case cure with MDT was 4.4
million old and new cases (target of 3.17 million).
 Second phase (World Bank ) June 2001 to 31st December2004.
Strategies of the project were:
 Decentralization of NLEP
 Integration of leprosy services with general health care system
 Surveillance of early diagnosis and prompt MDT
 Intensified IEC using local and mass media approaches
 Prevention of disability
 Monitoring & evaluation on regularbasis
The programme is continuing on the same guidelines, with GOI funds
WHO& IFLE

Leprosy Elimination Monitoring (LEM)
 Required to assess the performance of leprosy services and
envisages to collect key information on the issues like integration,
quality of leprosy services, drug supply management and IEC etc.
With the launch of National Rural Health Mission, NLEP
horizontally integrated to other health services for improved
programme delivery.
Foreign assistance from SIDA, DANIDA, WHO, UNICEF, Oamien
Foundation, etc and about 285 voluntary organizations in the
country
 Recently India has achieved the "leprosy elimination target by
2005".

NATIONAL TUBERCULOSIS PROGRAMME
(NTP)
 since 1962
Objectives :
(a) Long term objectives - to reduce tuberculosis in the community to that level
when it ceases to be a public health problem
 One case infects less than one new person annually
 The prevalence of infection in the age group < 14 years is brought down to
<1%.
(b) Operational or short term objectives
 to detect maximum number of TB cases among the OP and treat them
effectively
 to vaccinate newborns and infants with BCG
 to undertake above objectives in an integrated manner
District Tuberculosis Programme (DTP): It is the backbone of the
NTPby National Tuberculosis Institute, Bangalore, and was accepted by
the GOI for implementation in 1962.
The activities of DTC include case finding and free treatment

Revised National Tuberculosis Control Program: GOI, WHO & World
Bank
 to provide standardized treatment and diagnostic facilities to all TB patients.
 RNTCP phase II is built upon infrastructure of previous NTP with elements of
DOTS.
The salient features
 Achievement of infectious cases Chemotherapy functionaries
 Augmentation of case finding activities through quality sputum microscopy
and
 Involvement of NGOs, IEC and improved operational research.
Lab Network: appropriate, available, affordable & accessible diagnostic
services
 Sputum microscopy with External Quality Assessment (EQA), and Drug
Resistance Surveillance (DRS)
Initiation of treatment

DOTS is co m m unity-base d tube rculo sis tre atm e nt and care
strate g y which co m bine s the be ne fits o f supe rvise d tre atm e nt,
and the be ne fits o f co m m unity-base d care and suppo rt.
It ensures high cure rates through its three components:
 appropriate medical treatment,
 supervision and motivation (DOT 'Agent')
 monitoring of disease status by the health services
DOTS-Plus: by the WHO and several of its partners.
 Recognizing that the treatment of MDR- TB cases is very
complex, treatment is to follow the internationally
recommended DOTS-Plus guidelines and will be done in
designated DOTS-Plus sites.

Drug resistance surveillance (DRS) underRNTCP
 Aim: determine prevalence of antimicrobacterial drug
resistance
 Prevalence of drug resistance indicator of the
effectiveness of TB control activities
Paediatric tuberculosis:
National workshop on the 'Management of paediatric TB under
RNTCP’ (2003) modification of the existing RNTCP
guidelines for the diagnosis and treatment of paediatric
patients.
Drugs for paediatric TB cases under RNTCP should be

TB-HIV co-ordination: RNTCP and NACO  Jo int Actio n Plan
for TB-HIV coordination.
Objective : reduce TB-associated morbidity and mortality in
People Living with HIV/AIDS
Phase I 2001activities initiated in 6 high HIV-prevalence states
Phase II in 2003  activities being extended to 8 additional
states
 The immediate priority of the activities is to consolidate the co-
ordination in the VCTC - RNTCP cross referral mechanism
(pilot-tested in Maharashtra).

Achievements of RNTCP
 Treatment success rate increased from 25 % (1998) to 86 %
(2004).
 Death rate has been brought down from 29 per cent to 4 per
cent.
Financial resources
 First phase  World Bank till 30th
Sept 2005
 Second phase World Bank, WHO
 Global TB Drug Facility (GDF), Global Fund to Fight AIDS,
Tuberculosis and Malaria (GFATM), the United States
Agency for International Development (USAID) and

NATIONAL AIDS CONTROL PROGRAM
 launched in 1987.
 In the year 1992, the MoHFW set up a National AIDS Control
Organization as a separate wing to implement and monitor the
various components.
 Phase I 1992-1997
 Phase II 1999-2006
The National AIDS Control Programme Phase II has two key
objectives:
1. To reduce the spread of HIV infection in India
2. To strengthen India's capacity to respond to HIV-AIDS on long
termbasis.
 During 2003-2004 the programme on the prevention and control of
HIV/AIDS has been given a more balanced combination of initiatives

The initiatives are as follows:
A. Prevention
1. Highriskpopulations
 Targeted interventions
 STDtreatment
 Condomprogramming
 Multisectoral collaboration
 PPP
2. Low riskpopulations
 Holistic IEC and social mobilization
 Safe blood
 Voluntary counselling and testing
 Sensitizing youth and adolescents
B. Care
Low cost careandsupport
 PPTCT
 Management of HIV-TBco-infection
 Treatment of opportunistic
infections
 Piloting ART
 PEP
C. Collaboration
Inter-sectoralcolIaboration
 Involvement of ministries and
departments
 Workplace interventions
 PPP
 Partnership with otherstakeholders
 Involvement of PLHA

D. Build Capacities
InstitutionalStrengthening
 Programme management
 Surveillance
 AIDS vaccine initiatives
 Operations research
 Training
Evidencebasedplanning
 Annual sentinel surveillance
 AIDS case detection
 Mapping of high riskgroups
 Behavioural surveillance

Blood safety programme: To ensure safe collection, processing,
storage and distribution of blood and blood products.
Professional blood donation has been prohibited in the country since
1st January 1998.
Testing of every unit of blood is mandatory for detecting infections like
HIV, hepatitis B, malaria, syphilis & HCV.
National AIDS Prevention and
Control Policy(April 2002)
Objectives: reduction of the impact of
epidemic and to bring about a zero
transmission rate of AIDS by year 2007.

COUNSELLING ANDHIV TESTING: voluntary basis with appropriate
pre-test and post-test counselling.
 VCT is a non-coercive, confidential, and cost effective approach that
provides information, education and communication to motivate
behaviour change in HIV- positive individuals.
 VCT is a key entry point for a range of interventions

STD CONTROL PROGRAMME: has been in
operation in India since 1946.
Since HIV is transmitted more easily in the presence of
another STD, early diagnosis & treatment is now
recognized as one of major strategies to control spread
of HIV.
CONDOM PROMOTION:
The three major areas in which NACO has made
significant progress

HIV SURVEILLANCE: to identify trends of seropositivity in high and low
risk groups.
 Different types of surveillance activities are being carried out  to make
appropriate strategy for prevention and control  area specific targeted
intervention and best practice approach.
The types of surveillance are:
 HIV Sentinel Surveillance,
 HIV Sero-Surveillance,
 AIDS Case Surveillance,
 STDSurveillance,
 Behavioural Surveillance, and
 Integration with surveillance of otherdiseases like tuberculosis etc.

SCHOOL AIDS EDUCATION PROGRAMME: focuses towards student
youth to raise awareness level and develop a safe and responsible
life-style.
 A training module called "Le arning fo r life " has been prepared &
distributed to all states.
 Colleges and universities "Unive rsity Talk AIDS Pro je ct" in
collaboration with the Department of Sports and Youth Affairs.
INFORMATION, EDUCATION, COMMUNICATION AND SOCIAL
MOBILIZATION:
Objectives:
 to raise awareness, knowledge and understanding about AIDS,
STD, routes of transmission & method of prevention
 to promote desirable practice such as avoiding multiple sex partner,
use of condom,
 to mobilize all sectors of society

NATIONAL AIDS TELEPHONE HELPLINE: computerized 4 digit number
1097, with a voice response system linked with a telephone helpline.
FAMILY HEALTH AWARENESS CAMPAIGN (FHAC): an effort
to address the key issues related to reproductive health in the country.
The period of the campaign is of 15 days and dates are decided by the states
as per their convenience.
Objectives:
 To raise the awareness levels regarding HIV/AIDS
 To make people aware about the services available under the public sector
 To facilitate early detection and prompt treatment of RTI / STD cases
 To strengthen the capacity of medical and paramedical professionals
 To use safe blood from licensed blood banks, and blood storage centres,
 To be aware that HIV can be transmitted from the infected mother to her baby
during pregnancy, delivery, and breast-feeding.

PREVENTION OF HIV TRANSMISSION FROMMOTHERTOCHILD: using
Nevirapine, single dose, to the mother and child has been started from 1st
October 2001.
The results of the study are encouraging
ANTI-RETROVIRALTREATMENT: ART at government hospitals, free of cost,
for HIV cases in the six high prevalence states of Tamil Nadu, Andhra
Pradesh, Maharashtra, Karnataka, Manipur, Nagaland and Delhi.
The priority categories are pregnant HIV women, children upto 15 years of
age and full-blown AIDS cases.
PEPFORHEALTHCAREWORKERS: The anti-retroviral drugs in combination of
2-3 drugs have been shown to be prophylactic when given within 2 hours
of exposure.
NACO has developed guidelines for post - exposure treatment and the drugs

NATIONAL PROGRAMME FORCONTROL OF
BLINDNESS
 was launched in the year 1976 and incorporated the earlier
trachoma control programme started in the year 1968.
Revised Strategies:
 To make NPCB more comprehensive
 To shift from eye camp approach to a fixed facility surgical
approach
 To expand the World Bank project
 To strengthen participation of Voluntary Organizations
 To enhance coverage of eye care services in tribal, under-
served areas

SCHOOLEYESCREENINGPROGRAMME: first screened by trained teachers.
Children suspected to have refractive error are seen by ophthalmic assistants
and corrective spectacles are prescribed or given free for persons BPL.
COLLECTION & UTILIZATION OF DONATEDEYES: Hospital retrieval
programme
 Eye donation fortnight is organized from 25th August to 8th Sept every year
to promote eye donation/eye banking.
 Lions International and its branches, Rotary International and its branches,
NSPB India etc. are encouraged to organize eye camps.
 The programme also includes regular eye checkup and provision of vitamin
A prophylaxis.

EXTERNALLY AIDEDPROJECTS
 WorldBankassisted cataract blindness controlproject: The
project was implemented from1994-95 to June 2002.
The project was rated as "highly successful".
 DanishAssistanceto NPCB: 1998-2003  funds were utilized
for the training, dev of management information system, supply
of equipment, preparation of health education material &
support to Karnataka.
 WHOassistanceforpreventionof blindness: development of plan
of action for "Vision 20 20 : The Right to Sight" initiative.
It is a global initiative to reduce avoidable (preventable and

IODINE DEFICIENCY DISORDERS
PROGRAMME (IDD)
 Started in 1962, based on iodized salt.
 Operational difficulties such as inadequate production, difficulties in
prevention of sale of uniodized salt in endemic areas  having little
impact on the goitre problem in the country.
The IDD Control Programme - A major national programme - in which
nation-wide, rather than area-specific use of iodized salt.
 As a national policy to fortify all edible salt in a phased manner by
end of 8th Plan.
Components of programme are•use of iodized salt
•monitoring & surveillance,
•manpowertraining and
•mass communication.
•use of iodized salt
•monitoring & surveillance,
•manpowertraining and
•mass communication.

 31 States and UTs have completely banned the use of salt
other than iodized salt and have set up Iodine Deficiency
Disorder Control Cells to ensure effective implementation of
the programme.
 Evaluation: prevalence of goitre has declined from 41.2 % to
31.8 % in Hamirpur and from 49.53 % to 16.9 % in Buldhana.
 GOI-UNICEF Project 1993-95 was approved for 13 selected
endemic States for extensive monitoring and IEC activities of
the programme.

UNIVERSAL IMMUNIZATION PROGRAMME
 In 1974, the WHO launched its "Expanded Programme on
Immunization" (EPI) against six, most common, preventable
childhood diseases (diphtheria, pertussis (whooping
cough), tetanus, polio, tuberculosis and measles).
 "Expanded"  adding more disease controlling antigens of
vaccination schedules, extending coverage to all corners of
a country and spreading services to reach the less
privileged sectors of the society.
 UNICEF in 1985 renamed it as "Universal Child
Immunization" (UCI).
 Absolutely no difference between these two programs
The GOI launched its EPI in 1978.
Universal Immunization Programme was started in India in
1985.
It has two vital components:

Aim:
 to achieve 100 % coverage of pregnant women with 2 doses of TT
(or a booster dose),
 at least 85 % coverage of infants with 3 doses each of DPT, OPV, 1
dose of BCG & 1 dose of measles vaccine by 1990.
 1985-86 vaccine coverage ranged 29 % forBCG and 41 % for
DPT.
 2004 coverage levels of 80 % TT forpregnant women, 73 % for
BCG, 64 % forDPT, 56 % formeasles and 70 %forOPV.

 PULSEPOLIOIMMUNIZATION PROGRAMME: launched in year 1995.
 children under five years of age are given additional oral polio drops in
December and January every year on fixed days.
 INTRODUCTION OFHEPATITIS-BVACCINE: Pilot project was initiated in
June 2002. infants along with the primary doses of OPT vaccine on 6th,
10th and 14th week.
 URBAN MEASLESCAMPAIGN: A special campaign, with assistance of
UNICEF during 1998.
 To cover all unprotected children up to the age of 3 years with single
dose of measles vaccine.
 NEONATALTETANUS ELIMINATION: to cover all women in reproductive
age group with three doses of tetanus toxoid vaccine through a campaign
approach.
 Intensification of immunization programme has contributed to a significant decline

NATIONAL RURAL HEALTHMISSION
 Recognizing the importance of health in the process of
economic and social development and to improve the QOL,
the GOI launched "National Rural Health Mission" (NRHM) on
5th April, 2005 till 2012.
 The mission adopts a synergic approach by relating health to
determinants of good health viz. of nutrition, sanitation,
hygiene and safe drinking water.
 Brings the Indian system of medicine (AYUSH) to the
mainstream of health care.

Aim:
 To provide accessible, affordable, accountable, effective and
reliable primary health care, and
 Bridge the gap in rural health care through creation of a
cadre of Accredited Social Health Activist (ASHA).
The mission will be instrument to integrate multiple vertical
programmes along with their funds at the district level.
 RCHII
 National VectorBorne Disease Control Programmes,
 National Leprosy Eradication Programme
 Revised National Tuberculosis Control Programme
 National Programme forControl of Blindness
 Iodine Deficiency DisorderControl Programme,
 Integrated Disease Surveillance Project.

Monitoring and evaluation underNRHM
 A baseline survey is to be taken up at the
district level incorporating facility survey
(including private facilities) and households to
help the mission in fixing decentralized
monitorable goals and indicators.
 Planning commission is to be the eventual
monitor of the outcomes.
 External evaluation is also to be taken up at
frequent intervals.

REPRODUCTIVE ANDCHILDHEALTH
PROGRAMME
 Integrated approach
 family welfare programme, universal immunization
programme, oral rehydration therapy, child survival and
safe motherhood programme and acute respiratory
infection control etc.
 Integrated RCH programme would help in reducing the
cost inputs
 RCH phase I  components relating child survival and
safe motherhood and included two additional components,
STD & RTI.
 RCH programme differential approach the weaker
districts get more support and sophisticated facilities are
proposed for relatively advanced districts.
 The programme was formally launched on 15th October

Highlights of the RCHprogramme:
RCH phase I interventions at district level
Interventions in All Districts
 Child Survival interventions: immunization, Vitamin A, oral
rehydration therapy and prevention of deaths due to pneumonia.
 Safe Motherhood interventions e.g. antenatal check up,
immunization for tetanus, safe delivery, anaemia control programme.
 IEC activities.
 Specially designed RCHpackage forurban slums and tribal areas.
 RTI/STDClinics at District Hospitals
 Facility forsafe abortions

ChildSurvivalandSafeMotherhoodProgramme:
introduced in 1992 integrated all the schemes for better compliance.
 Early registration of pregnancy
 To provide minimumthree antenatal check-ups
 Universal coverage of all pregnant women with TT immunization
 Advice on food, nutrition and rest
 Detection of high riskpregnancies and prompt referral
 Clean deliveries by trained personnel
 Birth spacing, and
 Promotion of institutional deliveries

RCH- phase II began from 1st April, 2005. The focus of the programme
is to reduce maternal and child morbidity and mortality with emphasis
on rural health care.
Strategies under RCH-II are:
 Essential Obstetric Care
 Emergencyobstetric care
 Strengtheningreferralsystem
More flexibility has been given for planning their own interventions
states prepared their Project Implementation Plan (PIP) with
indications for achieving the desired milestones.
New Initiatives
 Training of MBBS doctors in life saving anaesthetic skills for
emergency obstetric care
 Setting up of blood storage centres at FRUs

JANANI SURAKSHA YOJANA : National Maternity Benefit scheme on 12th
April,2005.
 The objectives of the scheme are reducing maternal mortality and infant
mortality through encouraging delivery at health institutions, and focusing at
institutional care among women in below poverty line.
Features:
 It is a 100 per cent centrally sponsored scheme
 Benefit of cash assistance
VandemataramScheme: A voluntary scheme
 any obstetric & gynecologist, maternity home, nursing home,
lady/MBBS Dr.
 The enrolled doctors will display 'Vandemataram logo' at their clinic.
 Iron and Folic Acid tablets, oral pills, TT injections will be provided by
the respective DMO for free distribution.
Safeabortionservices: Abortion is a major cause of maternal
mortality and morbidity
 Medical methodof abortion
 ManualVacuumAspiration(MVA)

DIARRHOEAL DISEASES CONTROL
PROGRAMME
 Proposed by WHO 1980
Components
 Short term:
 Appropriate clinical management- Oral Rehydration Treatment
 India is the first country to launch the new modified ORS in 2004
osmalality of Na reduced to 75 mmol/litre
 Long term:
 BetterMCHcare practices
 Preventive strategies
 Preventing diarrhoeal epidemics

DDCPin India
 First started in India in 1978 with objective of reducing the
mortality and morbidity due to diarrhoeal diseases.
 National Oral Rehydration Therapy Programme in 1985-86
 Strengthening of case management
 Improving maternal knowledge related to home based available fluid
 Use of ORS and continued feeding
 From 1992-93 the programme became a part of Child
Survival And Safe Motherhood Programme

IntegratedManagement of ChildhoodIllness (IMCI)
 Integrated approach as it is important for child health
programmes to look beyond the treatment of a single
disease.
 The Indian version of IMCI has been renamed as Integrated
Management of NeonatalandChildhoodIllness (IMNCI).
 Central pillar of child health interventions under the RCH II
strategy.
Major highlights
 Inclusion of 0-7 days age in the programme
 Incorporating national guidelines on malaria, anaemia,
vitamin-A supplementation and immunization schedule

NATIONAL GUINEA - WORMERADICATION
PROGRAMME
 launched in 1984 with technical assistance from WHO.
 With well defined strategies, an efficient information and
evaluation system, intersectoral coordination at all levels and
close collaboration with WHO and UNICEF, India was able to
significantly reduce the disease in affected areas.
 During January 1998 Sixth Independent Evaluation
Programme was conducted in different parts of the country 
the reported zero guinea worm status in India and absence of
disease transmission.
 In February 2000, the International Commission for the
Certification of Dracunculiasis Eradication  certified free of
dracunculiasis transmission.

YAWS ERADICATION PROGRAMME
 programme to interrupt the transmission of infection was
initiated as a central sector health scheme in Koraput district in
96-97
 In India its reported from the tribal communities living in hilly
forest and difficult to reach areas.
The programme strategy
 manpowerdevelopment,
 detection of cases,
 simultaneous treatment of cases and contacts and
 IEC activities harnessing multi sectoral apporach.
 National Institute of Communicable Diseases is the nodal
agency for planning, guidance, coordination, monitoring and
evaluation of the programme.

NATIONAL CANCERCONTROL PROGRAMME
 launched in 1975-76
 Cancer is an important public health problem in India.
 It is estimated that there are 2-2.5 million cases of cancer in the country at
any given point of time.
 Programme was revised in 1984-85 and subsequently in December 2004.
Objectives are:
 Primary prevention of cancers by health education;
 Secondary prevention i.e. early detection and diagnosis by screening/self
examination
 Tertiary prevention i.e. strengthening of institutions of comprehensive
therapy

The schemes underthe revised programme are:
Regional CancerCentreScheme
OncologyWingDevelopment Scheme
District CancerControl Programme: scheme for district projects
regarding prevention, health education, early detection and pain
relief measures was started in 1990-91
DecentralizedNGOscheme: meant for IEC activities & early detection of
cancer.
IEC activities at centrallevel: initiated in order to give wider publicity
about anti tobacco legislation for discouraging consumption of
tobacco
November7th is observed as National CancerAwareness Day in the
country.

Researchandtraining
 Manual forhealth professionals
 Manual forcytology
 Manual forpalliative care
 Manual fortobacco cessation
CancerAtlas: Under NCRP the ICMR has developed an Atlas
of Cancer in India based on the information collected for the
year 2001-02 from 105 collaborating centres to have an idea of
the pattern of cancer across the country.

THE NATIONAL MENTAL HEALTH
PROGRAMME
 was launched during 1982
Aims
 Prevention & treatment of mental & neurological disorders
 Use of mental health technology to improve general health services
 Application of mental health principles to improve QoL.
The programme strategies are:
 Integration of mental health with primary health care
 Provision of tertiary care institutions
 Eradicating stigmatization
The National Human Rights Commission also monitors the conditions in
the mental hospitals along with the GOI, and states are currently
acting on recommendations of the joint studies conducted to ensure
quality in delivery of mental care.

THE NATIONAL DIABETES CONTROL
PROGRAMME
 was started on a pilot basis during seventh five year plan in
some districts of Tamil Nadu, Karnataka and Jammu and
Kashmir, but due to paucity of funds in subsequent years, this
programme could not be expanded further.
Objectives:
 Identification of high risk subjects at an early stage
 Early diagnosis and management of cases
 Prevention, arrest or slowing of metabolic complications of
disease
 Rehabilitation of partially or totally handicapped diabetic
people.

NATIONAL PROGRAMME FORCONTROL &
TREATMENT OF OCCUPATIONAL DISEASES
 launched in 1998-99.
The following research projects have been proposed by the
government:
 Prevention, control & Rx of silicosis and silicotuberculosis in agate
industry.
 Occupational health problems of tobacco harvesters and their
prevention.
 Hazardous process and chemicals, database generation,
documentation, and information dissemination.
 Health Risk Assessment & development of intervention programme
in cottage industries with high risk of silicosis.
 Prevention and control of occupational health hazards among salt
workers in the remote desert areas of Gujarat and Western
Rajasthan.

NUTRITIONAL PROGRAMME
GOI have initiated large scale supplementary feeding programs and
programs aimed at overcoming specific deficiency diseases through
various ministries to combat malnutririon.
Vitamin- A prophylaxis programme: one of the components of
NPCB.
Single massive dose of an oily preparation of vitamin-A containing
200,000 IU orally to all preschool children every 6 months by
peripheral workers.
Evaluation of the program revealed significant reduction in vit-A
deficiency.
Prophylaxis against nutritional anaemia: launched by GOI in
fourth five year plan consists of distribution of Fe and folic acid to
pregnant women and children.
Fortification of common salt with iron has been approved by GOI as a
public health approach to reduce the prevalence anaemia.

Control of iodine deficiency disorders: by using iodized salt.
 Economical, convenient & effective means of mass administration in
endemic areas.
 Another method is by use of iodized oil for intramuscular injection.
Recently NIN Hyderabad successfully developed a process to
produce iodized oil.
Special nutrition programs: started in 1970 for the nutritional
benefit of children below 6 years of age, pregnant women and nursing
women for300 days in a year.
 This program was launched as a central program and was
transferred to state in fivth five year plan as a part of minimum needs
program. This program is gradually being merged into ICDS.
Balwadi nutrition program: for the benefit of children in the age
group of 3-6 years and implemented through Balwadis which also

ICDS program: started in 1975 in pursuance of the national policy for
children.
Strong nutritional component in this programis vit-A supplementation and
iron and folic acid distribution forpreschool children below 6 years and
adolescent girls 11 to 18 years of age and pregnant women.
Mid-day meal programme: also known as School lunch
programme launched in 1961.
The major objective is to attract more children for admission into
schools & retain them.
Mid-day meal scheme: aka National Programme of Nutritional
Support to Primary Education launched on August 15th
1995 and
revised in 2004.
Objectives: universalization of primary education by increasing
enrolment retention and attendance and simultaneously impacting
on nutrition of students in primary classes.

NATIONAL SURVEILLANCE PROGRAMME FOR
COMMUNICABLE DISEASES
 Outbreak of plague (1994), malaria (1995) and dengue
haemorrhagic fever (1996) highlighted the urgency for
strengthening disease surveillance system
 In 1997, a model district surveillance plan was drafted in
1998 a concept plan was dev by the National Apical Advisory
Committee.
 The district  basic unit which receives the report, analyse
and monitorthe diseases.
 District Epidemiology Cell  State Epidemiology Centre 
National Institute of Communicable Diseases.

INTEGRATEDDISEASE SURVEILLANCE
PROJECT
 Decentralized state based surveillance system in the
country.
 Intended to detect early warning signals of
impending outbreaks and help initiate an effective
response in a timely manner.
 It will also provide essential data to monitor
progress of on-going disease control programme
and help allocate health resources more efficiently.
 launched in Nov. 2004 as a 5 year project.

The important informations in disease surveillance are
 who gets the disease,
 how many get the disease,
 where did they get the disease,
 why did they get the disease,
 What needs to be done as public health response.
The classification of surveillance in IDSP is as follows:
a. Syndro m ic diag no sis
b. Pre sum ptive diag no sis
c. Co nfirm e d diag no sis

NATIONAL WATERSUPPLY & SANITATION
PROGRAMME
 initiated in 1954
Objective:
 providing safe water supply and adequate drainage
facilities for the entire urban and rural population of the
country.
 In 1972 a special programme known as the Accelerated
Rural WaterSupply Programme was started as a
supplement.
 V Plan  Rural water supply included in the Minimum
Needs Programme
 GOI launched the International Drinking Water Supply

Targets – 100 % coverage for water, 80 % for urban
sanitation and 25 % forrural sanitation.
Swajaldhara: launched on 25th Dec. 2002.
community led participatory programme
Aims at providing safe drinking water in rural areas,
with full ownership of the community and
encouraging water conservation practices along
with rainwater harvesting.

MINIMUMNEEDS PROGRAMME (MNP)
Introduced in the first yearof the Fifth Five YearPlan (1974-78)
It is the expression of the commitment of the government for the
"social and economic development of the community particularly
the underprivileged and underserved population".
Objective: To provide certain basic minimumneeds
The programme includes the following components:
 Rural Health
 Rural WaterSupply
 Rural Electrification
 Elementary Education
 Adult Education
 Nutrition
 Environmental improvement
 Houses forlandless labourers
Two basic principles
 Facilities are to be first provided to those areas
which are at present underserved
 Facilities should be provided as a package to
an area through intersectoral area projects, to
have a greater impact.

20-POINT PROGRAMME
 Started in 1975 by GOI and restructured in 1986.
 As an agenda for national action to promote social justice and economic
growth.
 Objectives : "eradication of poverty, raising productivity, reducing
inequalities, removing social and economic disparities and improving the
QoL".
 8 of the 20 points are related, directly or indirectly to health.
 Point 1-Attackon rural poverty
 Point 7-Clean drinking water
 Point 8-Health forall
 Point 9-Two-child norm
 Point 10-Expansion of education
 Point 14-Housing forthe people
 Point 15-Improvement of slums
 Point 17-Protection of environment
20 Point Programme constitutes the Charterforthe SE development.

HUMAN RABIES CONTROL PROGRAM
Objectives
 Prevention of human deaths due to rabies
 Reducing the transmission of disease in animals
Targets : reduction of rabies deaths in human beings by atleast 50% in pilot
project areas.
The programme involves two components:
Human component:
 Availability of tissue culture vaccines and facilities of wound wash at anti
rabies clinics
 Strengthening of surveillance
Veterinary component:
 Free of cost vaccination to the dog population
 Enforcement of licensing and obligatory registration of dogs
 Training

LEPTOSPIROSIS CONTROL PROGRAMME
Objectives: Establish the surveillance in the country and
to reduce the mortality and morbidity due to
Leptospirosis in India.
Pilot project is proposed to carry out in Kerala and South
Gujarat with reduction in mortality and morbidity as the
indicator for effective implementation of the programme.

DRUG DE-ADDICTION PROGRAMME
 Started in 1987-88 with the establishment of 6 drug de-
addiction and restructured in 1992-93.
 The revised scheme proposed to reduce the health
costs and social cost due to drug abuse and promote a
drug free healthy lifestyle, by strengthening existing
centers in a phased manner.

NATIONAL ORAL HEALTHCARE PROGRAMME
 centrally sponsored pilot project started in 1999.
 Initially implemented in Maharastra, Punjab, Delhi,
Kerala and NE States.
The project focuses on primary prevention with 3
components-
 oral health education,
 IEC material and
 training modules.

At the age of 18 years,
85% should retain all
theirteeth.
To achieve 25%
reduction in
edentulousness at the
age of 65 years &
above.
To reduce numberof
new cases of Oral
Cancers and
precancerous lesions
DMFT 6-12 yrs <2 (~4
at present)
Decrease incidence of
oro-dental diseases to
<40%
To reduce high
prevalence of
periodontal diseases to
lowerprevalence.
Oral Health forall by
the year2010.
To achieve 50%
reduction in
edentulousness between
the age of 35-44 years.
To achieve 50%
reduction in present
level of malocclusion &
dento-facial
deformities.

NATIONAL PROGRAMME FORPREVENTION &
CONTROL OF DIABETES, CARDIOVASCULAR
DISEASES ANDSTROKE
 Pilot Project initiated by Government of India in
1995-96.
Aim:
 To prevent and control common non communicable
disease risk factors through an integrated approach
and
 Reduce premature mortality and morbidity
Long termgoals:
 Should focus on preventing and reducing risk factors
common to these diseases
 Reduce morbidity and mortality due to these
diseases

NATIONAL PROGRAMOF HEALTHCARE OF
THE ELDERLY
 National policy on older persons, 1999 has emphasized the
major issues relevant to the elderly population and the need to
provide specialized geriatric services at various levels of health
care.
 To improve the access to promotive, preventive, curative and emergency
health care among elderly persons
 by providing comprehensive health care to the elderly and training health
professionals in geriatrics

and developing scientific solutions to specific elderly health problems.

NATIONAL ORGAN TRANSPLANT PROGRAMME
 proposes to impart health education of general
public through TV, Radio, Newapaper, etc
oversee establishment and functioning of
ORBO network on all India basis and involve
district through District Organ Transplant
Programme.

 Chairman of national human rights commission reviewed the
situation in the country and suggested for a national programme.
Goal:
 To prevent and control fluorosis in the country
 To assess the fluoride content in all sources of drinking water, food
and intake of industrial pollutants at the district level.
The programme is to be implemented in five districts of the five zones
of the country during the first two years and then the same would
expand in 100 districts of 19 endemic states.
Expected outcomes
NATIONAL PROGRAMME FORPREVENTION
ANDCONTROL OF FLUOROSIS

Evaluation
 ICDS phase-III
Implementation Completion Report of World Bankassisted ICDS-III/WCDProject Borrower’s
[Government of India] Evaluation Report December2006

 studies conducted have revealed that in projects
where able leadership has been provided, a high
level of immunization, vitamin A and iron and folic
acid coverage reduction in infant and early
childhood mortality, birth rate, prevalence of PEM,
incidence of low birth weight babies.
 Psychological development of children covered
under the ICDS scheme has been reported to be
better.
Umesh Kapil, Integrated Child Development Services (ICDS) Scheme : A
ProgramforHolistic Development of Children in India Indian Joumal of
Pediatrics, Volume 69-July, 2002

Evaluation report leprosy
 Leprosy has not yet been eradicated and GOl and the three
state governments need assistance to finally eliminate the
disease.
 Collaboration and integration processes need further support
from DANLEP.
 Support to the new districts/areas not yet benefitting from
DANLEP assistance is necessary to ensure full coverage in the
three states of the innovative components of the project.
 The training activities still need to be developed into
manageable modules to ensure their reproduction and
application in other areas of the country.
Evaluation Report Danish Assistance to The National Leprosy Eradication Programme
Institute (KIT), Amsterdam Associates, Copenhagen November 1996

CONCLUSION
 Even though more than 35 programs were launched, only
few have been very successful, like the malaria control
program, Tuberculosis control program, immunization
program and blindness control program.
 The main reasons for failure of most of the programs are lack
of funds from Government and poor participation from the
people. Hence educating public to utilize the health services
provided to them, and a more serious commitment on the
part of government is necessary to carry out all programs
successfully.
 Some of the presently emerging conditions due to change in
life style like the non communicable diseases also have not
been given importance.

References
1. K. Park, Parks text book of Preventive and Social Medicine 19th
edition
page no 185-188, 346-378.
2. R.K. Srivastava, Report of working group on communicable and non-
communicable diseases for the Eleventh Five year plan, September
2006, page no 4-365.
3. Editorial, Indian Journal of Community Medicine Vol. XXIX, No.1, Jan.-
Mar., 2004.

National health programs of India

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