national health programs

1. INTRODUCTION
At the time of independence, the public health situation was very precarious. The
country was faced with many serious public health problems. The Government of India not
only re-organized the health care organization and delivery system to provide three tier health
services through a network of health centres and hospitals in rural and urban areas, but also
launched various national vertical programmes to deal with specific health problems such as
communicable diseases, environmental sanitation, population explosion, poor nutrition etc.
faced by the country. The programmes were launched on priority basis through the successive
"Five Year Plan' periods utilizing resources available in the country..These efforts resulted in
considerable improvement in health status of people in the country. Smallpox has been
eradicated, guinea worm and yaws are near eradication, plague has almost remained in control,
cholera epidemics and deaths are infrequent and fewer. There has been improvement in access
to safe water supply, diagnostic laboratory facilities and services, communication facilities,
health services infrastructure etc.
It is very important to learn about various national programmes planned and
implemented by the Government to participate effectively and intelligently in the public health
work in the community. The national programmes with an intention to help nurses to be
knowledgeable about these programmes and to be able to implement whenever and wherever
required.
The national health programs related to child health are the following:
1. National health mission
2. Integrated child development service scheme
3. Reproductive and child health programme
4. Child survival and safe motherhood
5. Janani suraksha yojana
6. Integrated management of neonatal and childhood illness
7. School health programme
8. Universal immunization programme
9. Pulse polio immunization programme
10. Nutritional programme
NATIONAL HEALTH MISSION:
The ministry of health and family welfare is implementing various schemes and programmes and
national initiatives to provide universal access to the decentralized health system by establishing new
infrastructure in deficient areas and by upgrading the infrastructure in existing institutions. The National
Health Mission was approved in May 2013. The main programmatic components include health system
strengthening in rural areas, reproductive –maternal-newborn-child and adolescent health and control of
communicable and non-communicable diseases.

2. National urban health mission: it seeks to improve the health status of the urban population
particularly slum dwellers and other vulnerable section by facilitating their access to quality health care.
The NUHM focus on:
 Urban poor population living in listed and unlisted slums.
 All other vulnerable population such as homeless, rag pickers, street children, rickshaw pullers,
construction workers, sex workers and other temporary migrants.
 Public health thrust on sanitation, clean drinking water, vector control etc.
 Strengthening public health capacity of urban local bodies.
National rural health mission: the govt. of India launched the NRHM on 5th April 2005 for a
period of 7 years (2005-2012) and recently extended upto 2017. The main aim of NRHM is to provide
accessible, affordable, accountable, effective and reliable primary health care and bridging the gap in rural
health care through creation of a cadre of accredited social health activist (ASHA). The programmes
integrated into NRHM are RCH-II, national vector borne disease control programmes against malaria,
filarial, kala-azar, dengue and Japanese encephalitis, national leprosy eradication programme, RNTCP,
national control of blindness, iodine deficiency disorder control programme and integrated disease
surveillance project..
INTEGRATED CHILD DEVELOPMENT SERVICE (ICDS) SCHEME:
This programme was launched in 1975 by the Ministry of Social Welfare to improve
the health of and welfare of children 0-6 years of age group and develop mothers capability to
look after their children. The ICDS programme is an inter-sectoral programme which seeks to
directly reach out to children, below six years, especially from vulnerable groups and remote
areas. The Scheme provides an integrated approach for converging basic services through
community-based workers and helpers. The Services are provided at a centre called the
Anganwadi.
OBJECTIVES:
1. To improve the nutritional and health status of children in the age group 0-6 years.
2. To lay the foundations for proper psychological, physical and social development of
the child.
3. To reduce mortality and morbidity, malnutrition and school dropouts.
4. To achieve an effective coordination of policy and implementation among the various
departments working for the promotion of child development.
5. To enhance the capability of the mother and nutritional needs of the child through
proper nutrition and health education.

3. A package of six services is provided under the ICDS Scheme:
BENEFICIARY SERVICES
Pregnant women Health check up
Immunization against tetanus
Supplementary nutrition
Nutrition and health education
Nursing mothers Health check up
Supplementary nutrition
Nutrition and health education
Other women 15-45 years Nutrition and health education
Children less than 3 years Supplementary nutrition
Immunization
Health check up
Referral services
Children in age group 3-6 years Supplementary nutrition
Immunization
Health check up
Referral services
Non-formal education
Adolescent girls 11-18years Supplementary nutrition
Nutrition and health education
Delivery of services:
1. Supplementary nutrition: It is given to children below 6 years and nursing and expectant
mothers from low income group. The type of food depends upon local availability, type
of beneficiary, location of the project, etc. supplementary nutrition is given 300days in
a year. Nutrition education and health education is given to mothers of children
suffering from 1st degree of malnutrition. Supplementary nutrition is given to children
suffering from2nd and 3rd degree malnutrition. Children suffering from 4th degree
malnutrition are recommended hospitalization.
2. Immunization: Immunization of children against 6 preventable disease is being done,
while for pregnant mothers immunization against tetanus is recommended.
3. Non-formal pre-school education: Children between the ages 3-6 years are imparted
non-formal preschool education in an anganwadi in each village with about 1000
population. The objective is to provide opportunities to develop desirable attitude,
values and behavior pattern among children. Locally produced toys and inexpensive
materials are used in organizing play and creative activity.

4. 4. Health Check-up: This includes health care of children less than six years of age,
antenatal care of expectant mothers and postnatal care of nursing mothers. Besides
immunization expectant mothers are given iron and folic acid tablets along with protein
supplements and a minimum of 2 physical examination is done. The various health
services include regular health check-ups, immunization, management of malnutrition,
treatment of diarrhea, deworming and distribution of simple medicines, etc.
5. Nutrition: It is a very strong component of this programme and includes supplementary
nutrition and prophylaxis administration of vitamin A and iron and folic acid. The
beneficiaries are both children under six and mothers (expectant and nursing). The
grading of nutritional status is done by, measuring the weight of the child and plotting
the weight in growth chart and comparing it with normal growth chart. Nutrition and
health education is done for mothers covering all possible messages on child care,
nutrition, hygiene, safe motherhood etc.
REPRODUCTIVE AND CHILD HEALTH PROGRAMME(RCH):
Reproductive and child health approach has been defined as "people have the ability to
reproduce and regulate their fertility, women are able to go through pregnancy and child birth
safely, the outcome of pregnancies is successful in terms of maternal and infant survival and
well being, and couples are able to have sexual relations, free of fear of pregnancy and of
contracting disease".
The concept is in keeping with the evolution of an integrated approach to the
programme aimed at improving the health status of young women and young children which
has been going on in the country namely family welfare programme, universal immunization
programme, oral rehydration therapy, child survival and safe motherhood programme and acute
respiratory infection control etc. It is obviously sensible that integrated RCH programme would
help in reducing the cost inputs to some extent because overlapping of expenditure would not
be necessary and integrated implementation would optimise outcomes at field level.
The RCH phase-I programme incorporated the components relating child survival and
safe motherhood and included two additional components, one relating to sexually transmitted
disease (STD) and other relating to reproductive tract infection (RTI).
The RCH programme was based on a differential approach. Inputs in all the districts
were not kept uniform. While the care components was same for all districts, the weaker
districts got more support and sophisticated facilities were proposed for relatively advanced
districts. On the basis of crude birth rate and female literacy rate, all the districts were divided
into three categories. Category A having 58 districts, category B having 184 districts and
category C having 265 districts. All the districts were covered in a phased manner over a period
of three years. The programme was formally launched on 15th October 1997.

5. RCH phase-I interventions at district level were as follows :
 Interventions in all districts
 Child Survival interventions i.e. immunization, Vitamin A (to prevent blindness), 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.
 Implementation of Target Free Approach.
 High quality training at all levels.
 IEC activities.
 Specially designed RCH package for urban slums and tribal areas.
 District sub-projects under Local Capacity Enhancement.
 RTI/STD Clinics at District Hospitals (where not available)
 Facility for safe abortions at PHCs by providing equipment, contractual doctors etc.
 Enhanced community participation through Panchayats, Women's Groups and NGOs.
 Adolescent health and reproductive hygiene.
Interventions in selectedStates/Districts.
 Screening and treatment of RTI/STD at sub-divisional level.
 Emergency obstetric care at selected FRUs by providing drugs.
 Essential obstetric care by providing drugs and FHN/ Staff Nurse at PHCs.
 Additional ANM at sub-centres in the weak districts for ensuring MCH care.
 Improved delivery services and emergency care by providing equipment kits, IUD
insertions and ANM kits at sub-centres.
 Facility of referral transport for pregnant women during emergency to the nearest
referral centre through Panchayat in weak districts.
THE MAJOR INTERVENTIONS UNDER RCH-PHASE 1
Essential obstetric care:
Essential obstetric care intends to provide the basic maternity services to all pregnant
women through-
(1) Early registration of pregnancy (within 12-16 weeks).
(2) Provision of minimum three antenatal check ups by ANM or medical officer to monitor
progress of the pregnancy and to detect any risk/complication so that appropriate care
including referral could be taken in time.

6. (3) Provision of safe delivery at home or in an institution, and
(4) Provision of three postnatal check ups to monitor the postnatal recovery and to detect
complications.
Emergency obstetric care:
Complications associated with pregnancy are not always predictable, hence, emergency
obstetric care is an important intervention to prevent maternal morbidity and mortality. Under
the CSSM programme .1748 Referral Units were identified and supported with equipment kit
E to kit F. However, these FRUs were not fully operational because of lack of manpower and
adequate infrastructure. Under the RCH programme the FRUs were strengthened through
supply of emergency obstetric kit, equipment kit and provision of skilled manpower on contract
basis etc. Traditional Birth Attendant still plays an important role during deliveries in our
society.
24-Hour delivery services at PHCs/CHCs:
To promote institutional deliveries, provision has been made to give additional
honorarium to the staff to encourage round the clock delivery facilities at health centres.
Medical Termination of Pregnancy:
MTP is a reproductive health measure that enables a woman to opt out of an unwanted
or unintended pregnancy in certain specified circumstances without endangering her life,
through MTP Act 1971. The aim is to reduce maternal morbidity and mortality from unsafe
abortions. The assistance from the Central Government is in the form of training of manpower,
supply of MTP equipment and provision for engaging doctors trained in MTP to visit PHCs on
fixed dates to perform MTP
Control of reproductive tract infections (RTI) and sexually transmitted diseases (STD):
Under the RCH programme, the component of RTI/STD control is linked to HIV and
AIDS control. It has been planned and implemented in close collaboration with National AIDS
Control Organization (NACO). NACO provides assistance for setting up RTI/STD clinics upto
the district level. The assistance from the Central Government is in the form of training of the
manpower and drug kits including disposable equipment. Each district is assisted by two
laboratory technicians on contract basis for testing blood, urine and RTI/STD tests.
Essential newborn care:
The primary goal of essential newborn care is to reduce perinatal and neonatal
mortality. The main components are resuscitation of newborn with asphyxia, prevention of

7. hypothermia, prevention of infection, exclusive breast feeding and referral of sick newborn.
The strategies are to train medical and other health personnel in essential newborn care, provide
basic facilities for care of low birth weight and sick new borns in FRU and district hospitals
etc.
Diarrhoeal disease control:
In the districts not implementing Integrated Management of Neonatal and Childhood
Illness, the vertical programme for control of diarrhoeal disease will continue. India is the first
country in the world to introduce the low osmolarity Oral Rehydration Solution. Zinc is to be
used as an adjunct to ORS for the management of diarrhoea. Addition of Zinc would result in
reduction of the number and severity of episodes and the duration of diarrhoea. De-worming
guidelines have been formulated. The incidence of diarrhoea is reduced by provision of safe
drinking water.
Acute respiratory disease control:
The standard case management of ARI and prevention of deaths due to pneumonia is
now an integral part of RCH programme. Peripheral health workers are being trained to
recognize and treat pneumonia. Cotrimoxazole is being supplied to the health workers through
the drug kit.
Prevention and control of vitamin A deficiency in children:
It is estimated that large number of children suffer from sub-clinical deficiency of
vitamin A. Under the programme, doses of vitamin A are given to all children under 5 years of
age. The first dose (1 lakh units) is given at nine months of age along with measles vaccination.
The second dose (2 lakh units) is given after 9 months. Subsequent doses (2 lakh units each)
are given at six months intervals upto 5 years of age. All cases of severe malnutrition to be
given one additional dose of vitamin A.
Prevention and control of anaemia in children:
Iron deficiency anaemia is widely prevalent in young children. To manage anaemia, the
policy has been revised. Infants from the age of 6 months onwards upto the age of 5years are
to receive iron supplements in liquid formulation in doses of 20mg elemental iron and 100mcg
folic acid per day for 100 days in a year. Children 6-10 years of age will receive iron dose of
30mg elemental iron and 250mcg folic acid for 100days in a year. Children above this age
group would receive iron supplement in adult dose.
Introduction of Hepatitis B Vaccination:

8. Introduction of Hepatitis B in the National Immunization Programme has been
approved by the Government. Under this project hepatitis B vaccine will be administered to
infants alongwith the primary doses of DPT vaccine.
Training of dais:
A scheme for training of dais was initiated during 2001-02. The scheme is being
implemented in 156 districts in 18 states/UTs of the country. The districts have been selected
on the basis of the safe delivery rates being less than 30 per cent. The scheme was extended to
all the districts of EAG states. The aim was to train at least one Dai in every village, with the
objective of making deliveries safe.
Empowered Action Group (EAG):
An Empowered Action Group has been constituted in the Ministry of Health and Family
Welfare, with Union Minister for Health and Family Welfare as chairman on 20th March 2001.
District Surveys
There is no regular source of data to indicate the reproductive health status of women. The
RCH programme conducts district based rapid household survey to assess the reproductive
health status of women. The key indicators are :
 Percentage of pregnant women with full ANC;
 Percentage of institutional deliveries and home deliveries;
 Percentage of home deliveries by trained birth A attendant;
 Current contraceptive prevalence rate;
 Percentage of children fully immunized;
 Percentage of unmet need for family planning; and
 Percentage of household reported visits by health worker in previous 3 months.
RCH - PHASE II
RCH-phase II began from 1st April, 2005. The focus of the programe is to reduce
maternal and child morbidity and mortality with emphasis on rural health care.
The major strategies under the second phase of RCH are:
 Essential obstetric care
 Institutional delivery
 Skilled attendance at delivery
 Emergency obstetric care:
 Operationalizing FRU

9.  Operationalizing PHC’s and CHC’s for round the clock delivery service.
 Strengthening referral system:
During RCH phase-I, funds were given to the Panchayat for providing assistance to
poor people in the case of obstetric emergencies. Feedback from the states indicate that there
was no active involvement of Panchayats in running the scheme. Based on these experiences
different states have proposed different modes of referral linkage in RCH Phase II. Some of
them have indicated to involve local self help groups, NGOs and women groups, whereas few
others have indicated to outsource it.
CHILD SURVIVAL AND SAFE MOTHERHOOD PROGRAM:
This program was initiated in 1992.
The components of this program are:
 Advice on breastfeeding
 Care of the newborn infant: the main aim of cssm is to reduce infant mortality. The
strategy is to provide antenatal care to all pregnant women, ensure safe delivery
services, provide basic care to all neonates, identify and refer these neonates who are at
risk.
 Resuscitation: if infant fails to cry within 15-20 seconds that is time taken to wipe his
body and wrap him in a clean cloth, steps should be initiated for resuscitation.
 Low birth weight infants: almost 25-30 percent of neonates in many developing
countries have birth weight less than 2500gm. Weight of neonates can be recorded by
ordinary spring balance.
 Pregnant women: essential care for all, early detection of complications, emergency
care for those who need it and counseling to reproductive aged group women and the
various information available such as MTP, IUD, family planning etc.
JANANI SURAKSHA YOJANA:
The National Maternity Benefit scheme has been modified into a new scheme called
Janani Suraksha Yojana ( JSY), It was launched 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
families.
The sailent features of JSY are as follows:

10.  It is a 100 percent centrally sponsored scheme.
 Under NRHM, it inetegrates the benefit of cash assistance with institutional care during
antenatal, delivery and immediate post partum care. The benefit will be given to both
rural and urban, belonging to below poverty line household and aged 19years or above
upto first two live births. The benefit will be extended to the third child if the mother of
her own accord chooses to undergo sterilization in the health facility where she
delivered, immediately after delivery.
INTEGRATED MANAGEMENT OF NEONATALAND CHILDHOOD
ILLNESS:
IMNCI strategy is one of the main intervention under the RCH-II/NRHM. The
objective is to reduce deaths and the frequency and severity of illness and disability and to
contribute to improved growth and development.
Major components:
1. Improvement in case management skills of health staff through appropriate guidelines.
2. Improvement in the overall health system.
3. Improvement in family and community healthcare practices.
The strategy encompasses a range of interventions to prevent and manage the commonest major
childhood diseases.
Pre-service IMNCI:
Pre-service IMNCI has been accepted as an important strategy to scale up MNCI by
Govt, of India and is being included in the curriculum of medical colleges of the country. This
will help in providing the much needed trained IMNCI manpower in the public and private
sector.
Facility based IMNCI (F-IMNCI):
F-IMNCI is the integration of the facility based care package with the IMNCI package,
to empower the health personnel with the skill to manage new born and childhood illness at the
community level as well as the health facility. It focuses on providing appropriate inpatient
management of the major causes of neonatal and childhood mortality such as asphyxia, sepsis,
low birth weight, pneumonia, diarrhoea, malaria, meningitis and severe malnutrition in
children.
Facility based newborn care.:
As more sick children are screened at the peripheries through IMNCI and referred to
the health facilities, care of the sick newborn and child at CHCs, FRUs, district hospitals and

11. medical college hospitals assumes priority. Equipping the facilities to provide the requisite
level of care and simultaneously enhancing the capacity of the medical officers at these
facilities to handle such cases thus becomes important. The setting up of SNCUs at district
hospitals, stabilization units at CHCs, and newborn care corners at all facilities offering
delivery facilities, is thus a key activity.
Newborn Care Corner (NBCC):
NBCC is a space within the delivery room in any health facility where immediate care
is provided to all newborns at birth. This area is mandatory for all health facilities where
deliveries are conducted, As of March 2014; about 13653 NBCC’s are operational in the
country.
Newborn Stabilization Unit (NBSU):
NBSU is a facility within or in close proximity of the maternity ward where sick and
low birth weight newborns can be cared for during short periods, All FRUs/CHCs need to have
a neonatal stabilization unit, in addition to the newborn care corner, it requires space for 4
bedded unit and two beds in post natal ward for rooming-in, As of March 2014, 1737 NBSU’s
are functional in the country.
Special Newborn Care Unit (SNCU):
SNCU is a neonatal unit in the vicinity of the labor room which is to provide special
care (all care except assisted ventilation and major surgery) for sick newborns. Any facility
with more than 3,000 deliveries per year should have an SNCU. The minimum recommended
number of beds for an SNCU at a district hospital is 12. However, if the district hospital
conducts more than 3,000 deliveries per year, 4 beds should be added for each 1,000 additional
deliveries. A 12 bedded unit will require 4 additional adult beds for the step down. As of March
2014, 507 SNCU’s are functional in the country.
Triage of sick newborns:
Triage is sorting of neonates to rapidly screen sick neonates for prioritizing
management. Newborns are classified as emergency (requiring urgent interventions and
emergency measures). Priority (sick needing rapid assessment and admission to SNCU) and
non-urgent (though urgent attention not needed, they are in need of further assessment and
counseling).

12. A. CRITERIA FOR ADMISSION TO NBSU
Newborn presenting with any of the following signs to a facility with neonatal
stabilization unit requires admission for initial stabilization and transfer to SNCU :
 Apnea or gasping
 Respiratory distress (Rate>70/min with severe retractions/grunt)
 Hypothermia <35.4°C
 Hyperthermia (>37.5°C) I - Central cyanosis
- Shock (cold periphery with capillary filling time (CFT) 3 seconds and weak and
fast pulse)
 Significant bleeding that requires blood or component transfusion
 Newborns, who after assessment and stabilization, can be managed at stabilization unit
 Newborns with respiratory distress, having respiratory rate 60-70/min without grunting
or retractions (for observation and oxygen therapy)
 Newborns with gestation less than 34 weeks or weight <1800 g (for observation and
assisted feeding)
- Newborns with hypothermia and hyperthermia who are haemodynamically
stable after initial stabilization
- Newborns with jaundice requiring phototherapy
- Neonates with sepsis who are haemodynamically stable, for observation and
antibiotic therapy.
- (Others would require referral to an SNCU after stabilization, if an SNCU and
an appropriate referral is available in the district)
B. CRITERIA FOR ADMISSION TO SNCU
I. Criteria for admission to SNCU and criteria for transfer to step-down unit and discharge are
as follows :
Any newborn with following criteria should be immediately admitted to the SNCU :
 Birth weight < 1800 g or gestation <34 weeks
 Large baby (>4.0 kg)

13.  Perinatal asphyxia
 Apnea or gasping
 Refusal to feed
 Respiratory distress (rate>60/min or grunt/retractions)
 Severe jaundice (appears <24 hrs/stains palms and soles/lasts>2 weeks)
 Hypothermia <35.4°C, or hyperthermia (>37.5 C)
 Central cyanosis
 Shock (cold periphery with CFT>3 seconds, and weak and fast pulse)
 Coma, convulsions or encephalopathy
 Abdominal distension
 Diarrhoea/dysentery
 Bleeding
 Major malformations
II. Criteria for transfer from SNCU to the Step-Down:
 Newborn whose respiratory distress is improving and does not require oxygen
supplementation to maintain saturation.
 Newborn on antibiotics for completion of duration of therapy
 Low birth weight newborn (less than 1800 g), who are otherwise stable (for adequate
weight gain).
 Newborn with jaundice requiring phototherapy but otherwise stable.
 Newborn admitted for any condition, but are now thermodynamically and
hemodynamically stable.
III. Criteria for discharge from SNCU
 Newborn is able to maintain temperature without radiant warmer.
 Newborn is haemodynamically stable (normal CFT, strong peripheral pulse)
 Newborn accepting breast-feeds well.

14.  Newborn has documented weight gain for 3 consecutive days; and the weight is more
than 1.5
 Primary illness has resolved.
 In addition to the above, mother should be confident of taking care of the newborn at
home.
HOME BASED NEWBORN CARE (HBNC):
Home based newborn care is aimed at improving newborn survival. The strategy of
universal access to home based newborn care must complement the strategy of institutional
delivery to achieve significant reduction in postpartum and neonatal mortality and morbidity.
The major objective of HBNC is to decrease neonatal mortality and morbidity through :
 The provision of essential newborn care to all newborns and the prevention of
complications.
 Early detection and special care of preterm and low birth weight newborns
 Early identification of illness in the newborn and provision of appropriate care and
referral.
 Support the family for adoption of healthy practices and build confidence and skills of
the mother to safeguard her health and that of the newborn.
OUT PATIENT HEALTH FACILITY:
Check for danger signs
 Convulsions
 Lethargy/uncounsciousness
 Inability to drink/breastfeed
 Vomiting
Assess main symptoms
 Cough/difficulty in breathing
 Diarrohea
 Fever

15. (pink) (yellow) (green)
Fig: The integrated case management process
SCHOOL HEALTH PROGRAMS:
A beginning was made in this program in 1996 by undertaking examination of school
pupils by camp approach during 3days or two consecutive months every year. Doctors, dentists,
teachers and paramedical workers were deployed for the purpose. Students requiring specific
interventions were referred to near by despensaries/hospitals for treatment. The program could
be made more efficient by better record keeping and follow up.
Urgent referral
Out-patient health
facility
-pre referral
treatments
-advise parents
-refer child
Treatment of out
patient health
facility
Out patient health
facility
-treat local
infection
-give oral drugs
-advise and teach
care taker
-follow up
Home management
Care taker is
counseled on how
to:
-give oral drugs
-Treat local
infections at home
-continue feeding
-when to return
immediately
-follow up
Referral facility
-emergency triage
and treatment
(ETAT)
-diagnosis
-treatment
-monitoring
-follow up

16. National rural health mission has taken cognizance of the potential impact of the school
health programme on the health of the students, their families and the generations to come and
brought this initiative to forefront within the context of the reproductive and child health.
An effective school health, hygiene and nutrition offers several benefits:
 It responds to an increased need
 It increases the efficacy of other investments in child development
 It ensures good current and future health
 It ensures better educational outcomes
 It improves social equity
 It is highly cost effective strategy
 Essential elements of school health are:
 Health-related school policies
 Provision of safe (physically and psycho socially) and supportive environment
 Health, hygiene and nutrition education
 School based health and nutrition services
 Health screening and referral linkage with health services for remedial and preventive
measures
 Health education
 Addressing nutritional issues, particularly anemia and malnutrition
 Providing safe and supportive environment in schools
UNNIVERSAL IMMUNIZATION PROGRAMME:
The Universal Immunization Programme (UIP) became a part of CSSM programme in
1992 and RCH programme in 1997. It will continue to provide vaccines for polio, tetanus,
DPT, DT, measles and tuberculosis.
In May 1974, the WHO officially launched a global immunization programme, known
as Expanded Programme on Immunization (EPI) to protect all children of the world against six
vaccine-preventable diseases, namely - diphtheria, whooping cough, tetanus, polio,
tuberculosis and measles by the year 2000. EPI was launched in India in January 1978.
The Programme is now called Universal Child Immunization, 1990-that's the name
given to a declaration sponsored by UNICEF as part of the United Nations' 40th anniversary in
October 1985. It is aimed at adding impetus to the global programme of EPI.

17. The Indian version, the Universal Immunization Programme, was launched on
November 19, 1985 and was dedicated to the memory of Smt. Indira Gandhi. The National
Health Policy was aimed at achieving universal immunization coverage of the eligible
population by 1990.
To strengthen routine immunization, Government of India has planned the State
Programme Implementation Plan. It consists of:-
(a) Support for alternate vaccine delivery from PHC to sub-centre and outreach sessions.
(b) Deploying retired manpower to carry out immunization activities in urban slums and
underserved areas, where services are deficient.
(c) Mobility support to district immunization officer as per state plan for monitoring and
supportive supervision.
(d) Review meeting at the state level with the districts at 6 monthly intervals.
(e) Training of ANM, cold chain handlers, mid-level managers, refrigerator mechanics
etc.
(f) Support for mobilization of children to immunization session sites by ASHA, women
self-help groups,etc
(g) Printing of immunization cards, monitoring sheet, cold chain chart vaccine inventory
charts etc.
In addition, central government is supporting in supplies of auto-disposable syringes,
downsizing the BCG vial from 20 doses to 10 doses to ensure that BCG vaccine is available in
all immunization session sites, strengthening and maintenance of the cold chain system in the
states, and supply of vaccines and vaccine van.
PULSE POLIO IMMUNIZATION PROGRAMME:
Pulse Polio Immunization Programme was launched in the country in the year 1995.
Under this programme children under five years of age are given additional oral polio drops in
December and January every year on fixed days. From 1999-2000, house to house vaccination
of missed children was also introduced. In addition, large scale multi-district mop-ups have
been conducted. The last case of polio in the country was reported from Howrah of West

18. Bengal with date of onset of disease on 13th January 2011. Thereafter no polio case has been
reported in the country. On 27th March 2014, India declared as non-endemic country for polio.
The term "pulse" has been used to describe this sudden, simultaneous, mass
administration of OPV on a single day to all children 0-5 years of age, regardless to previous
immunization. PPIs occur as two rounds about 4 to 6 week apart during low transmission
season of polio, i.e. between November to February. In India, the peak transmission is from
June to September. The dose of OPV during PPIs are extra doses which supplement, and do
not replace the doses received during routine immunization services. The children including 0-
1 year old infants should receive all the scheduled doses and PPI doses. There is no minimum
interval between PPI and scheduled OPV doses. An important improvement in PPI during 1998
has been the use of vaccine vial monitor. Colour monitors or labels are put on vaccine bottles.
Each label has a circle of deep blue colour. Inside it is a white square which changes colour and
gradually becomes blue, if vaccine bottle is exposed to higher temperature. When the colour of
the white square becomes blue like that of surrounding circle, the vaccine should be considered
ineffective. Thereby, the health worker can easily ascertain that the vaccine being given is
effective or not. This mechanism has been made mandatory in all vaccine procurements since
1998. This quality assurance will ensure that the children will have better protection against
polio in 1999 and thereafter.
INTRODUCTION OF HEPATITIS-B VACCINE
In 2010-2011, Government of India universalized hepatitis B vaccination to all
States/UTs in the country. Monovalent hepatitis B vaccine is given as intramuscular injection
to the infant at 6th, 10th and 14th week along with primary series of DPT and polio vaccines.
In addition one dose of hepatitis B is given at birth for institutional deliveries within 24 hours
of birth.
INTRODUCTION OF JAPANESE ENCEPHALITIS VACCINE
The programme was introduced in 2006. The JE vaccine is being integrated into routine
immunization in the districts where campaign had already been conducted to immunize the
new cohort of children by vaccinating with two doses at 9-12 months and 16-24 months.
INTRODUCTION OF MEASLES VACCINE SECOND OPPORTUNITY
In order to accelerate the reduction of measles related morbidity and mortality, second
opportunity for measles vaccination is being implemented. The National Technical Advisory
Group on immunization recommended introduction of 2nd dose of measles vaccine to children
between 9 months and 10 years of age through supplementary immunization activity (SIA) for
states where evaluated coverage of first dose of measles vaccination is less than 80 per cent. In

19. states, with coverage of measles vaccination more than 80 per cent, the second dose of vaccine
will be given through routine immunization at 16-24 months.
INTRODUCTION OF PENTAVALENT VACCINE (DPT + Hep-B + Hib)
India introduced pentavalent vaccine containing DPT, hepatitis B and Hib vaccines in
two states viz. Kerala and Tamil Nadu under routine immunization programme from December
2011. DPT and hepatitis B vaccination require 6 injections to deliver primary doses. With the
introduction of pentavalent vaccine, a new antigen, i.e., Hib has been added which protects
against haemophilus influenzae type B (associated with pneumonia and meningitis) and the
number of injections are reduced to 3. The vaccine has been expanded to 6 more states, i.e.,
Haryana, Jammu and Kashmir, Gujarat, Karnataka, Goa and Puducherry in 2012-13. Further
expansion is planned to 11 states in October 2014 and rest of 16 states from April 2015.
MISSION INDRADHANUSH
The Government of India launched Mission Indradhanush on 25th December 2014, to
cover children who are either unvaccinated or partially vaccinated against seven vaccine
preventable diseases, i.e., diphtheria, whooping cough, tetanus, polio, tuberculosis, measles
and hepatitis B. The goal is to vaccinate all under-fives by the year 2020. Under the programe,
four special vaccination campaigns will be conducted between January and June 2015.
Intensive planning and monitoring experience of pulse polio immunization programe will be
used. 201 high focus districts will be covered in the first phase. Of these 82 districts are from
Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan. These 201 districts have nearly 50 per
cent of all unvaccinated children of the country. The drive will be through a "catch-up"
campaign mode. The mission will be technically supported by WHO, UNICEF, Rotary
International and other donor partners.
NUTRITIONAL PROGRAMS:
NATIONAL PROGRAMS OF MID-DAY MEALS IN SCHOOL:
With a view to enhancing enrolment, retention and attendance and simultaneously
improving nutritional levels among children, the National Programme of Nutritional Support
to Primary Education (rechristened National Programme of Mid-Day Meals in Schools in
2007) was launched as a centrally sponsored scheme on 15th August 1995, initially in 2408
blocks in the country.
The programme provides a mid-day meal of 450 kcal and 12 g of protein to children at
the primary stage. For children at the upper primary stage, the nutritional value is fixed at 700
kcal and 20 g of protein. Adequate quantities of micronutrients like iron, folic acid and vitamin

20. A are also recommended. The programme has helped in protecting children from classroom
hunger, increasing school enrolment and attendance, improved socialization among children
belonging to all castes, addressing malnutrition, and social empowerment through provision of
employment to women.
SPECIAL NUTRITIONAL PROGRAM:
To improve the nutritional status of preschool children, pregnant and lactating mother
of poor socio-economic groups in urban slums, tribal areas and drought prone area
ANEMIA CONTROL PROGRAM (1970):
Beneficiaries are pregnant women, nursing mothers, women acceptors to terminal
methods and IUD and children 5years of age. Daily dose of iron and folic tablets for women:
80mg ferrous sulphate + 0.5mg folic acid. For children: 180mg ferrous sulphate +0.1 mg folic
acid(2ml liquid)
NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAM:
It was launched in the year 1962. Its main objective is to assess the magnitude of the
IDD, supply iodized salt in place of common salt, resurvey after every 5 years to assess the
extend of iodine deficiency disorders and the impact of iodized salt, laboratory monitoring of
iodised salt, health education and publicity.
CONCLUSION:
In achieving the highest level of global public health security possible, it is important
that each sector recognizes its global responsibility. Acknowledging one own roles and
responsibilities for global public health helps in identify the risk and transforming the lives of
the people.
REFERENCES:
BOOKS:

21. 1. Park K. Park’s textbook of Preventive and Social Medicine. 23rd ed. Jabalpur, India:
M/s Banarsidas Bhanot Publishers; 2015. P. 445-458
2. Gulani KK. Community health nursing: principles and practices. 2nd ed. Delhi, India:
Kumar Publishing House; 2013. P. 738-743
3. Data P. Pediatric Nursing. 2nd ed. New Delhi, India: Jaypee Brothers Medical
Publishers (P) Ltd; 2010. P. 34
4. Parthasarathy A.IAP textbook of Pediatrics.4th ed. New Delh, India:. Jaypee Brothers
Medical Publishers (P) Ltd; 2010. P. 201-211.
5. Behrman, Kliegman, Jenson. Nelson textbook of Pediatrics. 17th ed. New Delhi,India:.
Jaypee Brothers Medical Publishers (P) Ltd; 2009. P. 77.
INTERNET:
1. Child health programmes in India. available at URL: http://mohfw.nic.in .
2. National health programmes related to child health and welfare. Available at URL:
https://www.healthtap.com .
3. Reproductive and child health programme. Available at URL: www.childindia.org.in