National programme for prevention of deafness

1. NATIONAL PROGRAM FOR
PREVENTION OFDEAFNESS,
CANCER, NOISE AND
ENVIRONMENTAL POLLUTION
Dr. Ankit Singh [MS]

2. PREVENTION OF DEAFNESS
 INTRODUCTION
 CAUSES OF HEARING LOSS
 OBJECTIVES OF THE PROGRAM
 STRATEGIES OF THE PROGRAM
 ORGANISATIONALSTRUCTURE
 PROGRAM IMPLEMENTATION
 PROGRAMACTIVITIES
 ACHIEVEMENTS OF THE PROGRAM

3. INTRODUCTION
>Hearing loss is the most common sensory deficit in humans today
and is the second leading cause for ‘Years Lived with Disability
(YLD)’ , the first being depression.
>As per WHO estimate, in India there are approximately 63 million
people who are suffering from significant auditory impairment.
>There are 291 persons per 1 lakh population who are suffering
from severe hearing loss.
>Noise is the insidious of all industrial pollutants involving every
industry and causing severe hearing loss in every country in the
world.

4. >Occupational hearing loss includes acoustic , traumatic
injury and noise induced hearing loss.
>Noise induced hearing loss is the second most
common acquired hearing loss after age related loss.
>50% of causes of hearing impairment are preventable
and can be corrected surgically and can be rehabilitated
with the use of hearing aids , speech and hearing
therapy.

5. CAUSES OF HEARING LOSS
> Aging process
> Occupational hazards (those who are working in noisy areas)
> Wax in the ear
> Chronic ear infection
> Diseases of tympanum
> A hole in tympanic membrane
> Growths and masses in the ear & bones and cancer like diseases

6. TYPES OF DEAFNESS
>Conductive deafness : Due to defect in the conducting
mechanism of the ear namely external and middle ear.
>Sensori-neural deafness / Perceptive deafness : Due
to lesions in the labyrinth, 8th nerve & central connections.
It includes psychogenic deafness.
>Mixed deafness : Both the above mentioned types are
present.

7. NPPCD
>The Program was initiated in 2007 on pilot mode in 25
districts of 11 State/UTs.
>In first phase manner , the program was extended to 203
districts of 20 State/UTs by 2012.
>In 12th five year plan, its proposed to expand the program
to additional 200 districts in a phased manner probably
covering all the states and union territories by 2017.

8. OBJECTIVES
LONGTERM
> To reduce the total disease burden by 25% by the end of 11th five year
plan.
IMMEDIATE
>Early identification, diagnosis and treatment of ear problems
responsible for hearing loss and deafness.
> To prevent the avoidable hearing loss on account of the disease/injury.

9. > To medically rehabilitate persons of all age groups
suffering with deafness.
> To strengthen the existing intersectoral linkage for
continuity of the rehabilitation program.
> To develop institutional capacity for ear care services by
providing support for equipment, material and training
personnel.

10. STRATEGIES
> To strengthen the service delivery including rehabilitation.
> To develop human resources for ear care.
> To promote out reach activities and public awareness
through innovative and effective IEC strategies with special
emphasis on prevention of deafness.

11. ORGANISATIONAL STRUCTURE

12. HEALTH
MINISTER
Additional Secretary
Joint Secretary
Central Coordination
Committee
Secretary Health & Family
Welfare
Additional Director
General
Director General of Health
Services
Deputy Director General
Director (Public Health)
Under Secretary(Public Health)
Program Manager
Chief Medical Officer

13. COMPONENTS OF THE PROGRAM
1) Training of all the manpower
2) Infrastructure Building
3) Service provision
4) IEC activities

15. CENTRAL LEVEL
> Central Coordination Committee will be constituted at the central
level.
>This will consist of following members :
Representative of DGHS - 2
Representative of WHO - 1
ENT specialists and experts - 2
Audiologists and speech therapists - 2
Public Health expert - 1
Representative of Rehabilitation Council of India (RCI) - 1

16. > This Committee will evaluate and monitor the
implementation plan for program .
> Central Cell will be set up at the central level in the DGHS to
provide necessary leadership, technical support to the State
and District level functionaries.

17. STATE LEVEL
> State Health Society and Program Committee is placed under
NRHM
> It will function for ….
- Preparation of district plans for implementation of NPPCD ,
- Monitoring and supervise implementation of program ,
- Release and Monitoring of flow of funds to the District Health
Societies.

18. > State Technical Committee will have
State Nodal Officer ; ENT Specialist / Surgeon
Audiologist - 1
to provide technical guidance and expertise to the State
Health Society

19. DISTRICT LEVEL
> At the district level , the District Health Society and Program
Committee will function for …..
- Planning and Implementation of the program ,
- Financial and material management ,
- Social mobilization and public awareness ,
- Orientation of various functionaries of health ,
- Arrangement for Screening camps and monitoring the activities
for NGOs

20. > District Hospital will post …
District Nodal Officer ; ENT Surgeon - 1
Audiologist - 1
and they will be the key persons for the implementation of the
program in the district.
> They can also employ additional staff:
Teacher for young hearing impaired – on contractual basis, to look
after the therapy and training of young hearing impaired children
at district level.

21. PROGRAM IMPLEMENTATION
> Center of Excellence – The State Medical College – which
supports the program
> Main Focus of Activity of the Program - The District Hospital
> The program will be strengthened through training of …
- ENT doctors - Audiologist
> They would be provided with equipment for proper diagnostic,
therapeutic, & rehabilitation activities.

22. > The doctors at PHC & CHC will also be given training as well as the basic
diagnostic equipment to enable them to diagnose, treat & referthe
patients requiring treatment.
> The Multipurpose workers at the sub central level and
the gross level functionaries (AWWs, ASHA), including Mahila Mandalswill
be sensitized about the program which would facilitate in creating
awareness and mobilizing the communities.
> The School Health system will play a very important role in the program.
The ear check up will be done by the PHC or CHC doctors

23. SCREENING TESTS
1) Audiometry BERA ( Brainstem Evoked Response Audiometry)
- Simple
- Automated
- Reliable
But COST is prohibiting factor to make it available in all the
places

24. 2) Behavioral Observation Audiometry (BOA)
> Assess the baby’s response to different frequency intensity
and duration of sounds presented
> Respond to 70db noise :-
i) a new born baby – eye blink , eye widening or startle
ii) between age of 6 – 16 weeks – arousal , eye blink or
eye shift can be useful to detect to indicate hearing
impairment in early life

25. ACHIEVEMENTS
> Modules of training of doctors , multipurpose workers and
technicians have been developed.
>In some places such as Delhi, training of trainers has been
started.
>In many districts, hearing aids are distributed to poor
children.
> This program is integrated with the NRHM framework.

26. COMMENTS
> Once again loading the information about deafness and
burden of detection and mobilization of deafness on ASHA and
AWWs indicates poor planning.
>These part time workers cannot be the pillars of the health who
are neither the permanent health staff nor skilled enough to
handle.

27. >Once again a series of training program will start for
all levels of health professionals without identifying the
impact factors of previous trainings on other subjects
>In 12th Five Year Plan not much emphasis is given
on this program.
> Similarly in NRHM, it is low priority.

28. NATIONAL PROGRAMME FOR
NON-COMMUNICABLE DISEASES
• India is experiencing a rapid health transition with large and rising burden
of chronic non-communicable diseases (NCDs) especially cardiovascular
disease, diabetes mellitus, cancer, stroke, and chronic lung diseases.
• It is estimated that in 2005 NCDs accounted for 53 per cent of deaths.
• Considering the fact that NCDs are surpassing the burden of
communicable diseases in India, need for National Programme on
Prevention and Control of Diabetes, Cardiovascular Diseases and Stroke
was envisaged.
• Later on this programme was integrated with National Cancer Control
Programme, and National Programme for Prevention and Control of Cancer,
Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was launched.

29. INTRODUCTION
• Non-communicable diseases (NCDs) are the leading cause of adult
mortality and morbidity worldwide.
• It is estimated that the overall prevalence of diabetes,
hypertension, Ischemic Heart Diseases (IHD) and Stroke is
62.47, 159.46, 37.00 and
1.54 respectively per 1000 population of India (ICMR).
• There are an estimated 25 Lakh cancer cases in India.
• Considering the rising burden of NCDs and common risk factors to
majorChronic Non –Communicable Diseases, Government of India
initiated an NPCDCS during 2010-11 .

30. NCDS RISK FACTORS & MORTALITY PER YEAR
• Tobacco - 6.3 million deaths
• Alcohol - 4.9 million deaths
• Unhealthy diet - 4.9 million deaths
• Physical inactivity - 3.2 million deaths
(lancet
2012)

31. THE MAJOR OBJECTIVES OF THEPROGRAMME
• Prevent and control common NCDs through behaviour and lifestyle
changes.
• Provide early diagnosis and managementof common NCDs.
• Build capacity at various levels of health care for prevention,
diagnosis and treatment of commonNCDs.
• Train human resource within the public health set-up viz doctors,
paramedics and nursing staff to cope with the increasing burden of NCDs,
and
• Establish and develop capacity for palliative & rehabilitativecare.

32. • The focus of NPCDCS is on promotion of healthy life styles, early
diagnosis and management of diabetes, hypertension, cardiovascular
diseases & common cancers e.g. cervix cancer, breast cancer & oral
cancer.
• The programme was implemented in 100 districts spread over 21
States during 2010-12.
• Review of the initial phase of programme implementation helped to
identify the bottlenecks and accordingly the programme was re-
strategised and scaled-up.

33. CANCER COMPONENT UNDERNPCDCS
• Cancer is an important public health problem in India, with nearly 10 lakh new
cases occurring every year in the country.
• It is estimated that there are 2.8 million cases of cancer in the country at any given
point of time.
• With the objectives of prevention, early diagnosis and treatment, the National
cancer control programme was launched in 1975-76. In view of the magnitude of
the problem and gaps in the availability of cancer treatment facilities across the
country, the programme was revised in 1984-85 and subsequently in December
2004.
• During 2010, the programme was integrated with National Programme on
Prevention and Control of Diabetes, Cardiovascular Disease and Stroke.

34. THE OBJECTIVES OF THE PROGRAMME
• Primary prevention of cancers by health education
• Secondary prevention i.e. early detection and diagnosis of common
cancer such as cancer of cervix, mouth, breast and tobacco related
cancer by screening/self examination method; and
• Tertiary prevention i.e. strengtheningof the existing institutions, of
comprehensive therapy including palliativecare.

35. REGIONAL CANCER CENTRE SCHEME
The schemes under the revised programme are:
Regional Cancer Centre Scheme
• The existing regional cancer centres are further strengthened to act
as referral centres for complicated and difficult cases at the tertiary
level.
• One time assistance of Rs. 3 crores during the plan period was
provided to Regional Cancer Centres except TMH, Mumbai and
IRCH (AI1MS) for strengthening and to the CNCI, Kolkata.

36. Oncology Wing Development Scheme
• This scheme had been initiated to fill up the geographic gaps in the
availability of cancer treatment facilities in the country.
• Central assistance is provided for purchase of equipment, which
include a cobalt unit besides other equipment.
• A part of the grant can be used for the civil work but the manpower is to
be provided by the concerned state government/institution.
• The quantum of central assistance is Rs 3 crores per institution under the
scheme.

37. DECENTRALIZED NGO SCHEME
• This scheme is meant for IEC activities and early detection of cancer.
• The scheme is operated by the nodal agencies and the NGOs are given
financial assistance for undertaking health education and early
detection activitiesof cancer.

38. IEC ACTIVITIES AT CENTRALLEVEL
• IEC activities at the central level are to be initiated in order to give wider
publicity about the Anti Tobacco Legislation for discouraging consumption
of cigarettes and other tobacco related products, and for creating
awareness among masses about the ill effects of consumption of tobacco
and tobacco related products.
• Under this scheme wider publicity would also be given about the rules
being formulated for implementation of various provisions of the anti-
tobacco legislation.
• November 7th is observed as National Cancer Awareness Day in the
country.

39. RESEARCH AND TRAINING
• Training programs, monitoring and research activities are being
organized Research and training at the central level under this
scheme.
• Following training manuals have been developed under the NCCP for
capacity building in cancer control at district level:
• Manualfor health professionals
• Manual for cytology
• Manual for palliative care
• Manual for tobacco cessation

40. CANCER SERVICES UNDER NPCDCS
1. Common diagnostic services, basic surgery, chemotherapy and
palliative care for cancer cases is being made available at 100 district
hospitals.
2. Each district is being supported with Rs1.66 crores per annum for
the following.
• Chemotherapy drugs are provided for 100 patients at each district hospital.
• Day care chemotherapy facilities is being established at 100 districthospitals.
• Facility for laboratory investigations including mammography is being provided at 100
district hospitals and if not available, this can be outsourced at governmentrates.

41. 3.Home based palliative care is being provided for chronic, debilitating
and progressive cancer patients at 100 districts.
4.Support is being provided for contractual manpower through 1
Medical Oncologist, 1 Cytopathologist, 1 Cytopathology technician, 2
Nurses for day care.
5.State cancer institute will provide comprehensive cancer diagnosis,
treatment and care services. SCI will be apex institution in the state for
cancer treatment activities.
6.45 centres were to be strengthened as Tertiary Cancer Centres
(TCCs) to provide comprehensive cancer care services at a cost of
Rs. 6.00 crore each during 2011-12.

42. TOBACCO CONTROLLEGISLATION
A comprehensive tobacco control legislation titled “The Cigarettes and other
Tobacco Products (Prohibition of Advertisement and Regulation of Trade and
Commerce, Production, Supply and Distribution) Act, 2003” was passed by
the parliament in April, 2003 and notified in Gazette of
India on 25th Feb, 2004.
The important provisions of the Act are:
• Prohibition of smoking in public places
• Prohibition of direct and indirect advertisement of cigarette and other
products
• Prohibition of sale of cigarette and other tobacco products to a person
below the age of 18 years
• Prohibition of sale of tobacco products near the educational institutions

43. • Mandatory depiction of statutory warnings (including pictorial
warnings) on tobacco packs; and
• Mandatory depiction of tar and nicotine contents along with maximum
permissible limits on tobacco packs.
• The rules related to prohibition of smoking in public places came into
force from the 2nd October, 2008. As per rules, it is mandatory to display
smoke free signage at all public places. Labelling and packaging rules
mandating the depiction of specified health warnings on all tobacco
product packs came into force from 31st May, 2009.

44. NATIONAL TOBACCO CONTROL PROGRAMME
• Tobacco has been identified as the foremost cause of death and disease that is
entirely preventable. Globally tobacco use is responsible for deaths of nearly 6
million people. As per WHO, if current trends continue, by 2030 tobacco use
will kill more than 8 million people worldwide each year. It is estimated that 80
% of these premature deaths will occur among people living in low - and middle
- income countries.
• Nearly 8 - 9 lakh people die every year in India due to diseases related to
tobacco use and as per the report of ICMR, nearl y 50% of cancers in males
and 25% cancers in females in India are directly attributed to tobacco use.
• Global Adult Tobacco Survey (GATS) 2009 - 10, conducted in the age group
of 15 years and above 47.8% men and 20.3% women consume tobacco in
some form or other.

45. • In order to facilitate the implementation of the Tobacco Control Laws, to
bring about greater awareness about the harmful effects of tobacco, and
to fulfill the obligations under the WHO-Framework convention on
tobacco control, Govt. of India has launched a new National Tobacco
Control Programme in the 11th Five Year Plan(2007-12).
• Pilot phase was launched in 16 districts covering 9 states in 2007—08. It
now covers 42 districts in 21 states in the country.
• During the plan period, Tobacco Cessation Centres [TCCs] were also
established to help people who wishes to quit tobacco consumption in
any from.

46. OBJECTIVES
• Public awareness/mass media campaigns for awareness building and
behaviour change.
• Establishment of tobacco product testing laboratories, to build regulatory
capacity, as required under COTPA, 2003.
• Mainstreaming the program component as a part of the health delivery
mechanism under the National Rural Health Mission framework.
• Mainstreaming Research & training on alternate crops and livelihood in
collaboration with other nodal Ministries.
• Monitoring and Evaluation including surveillance e.g. Global Adult Tobacco
Survey (GATS)India.

47. NATIONAL TOBACCO CONTROL CELL(NTCC)
•The National Tobacco Control Cell (NTCC) is responsible for
overall policy
• formulation, planning, monitoring and evaluation of the
different activities envisaged under the programme.
•The National Cell functions under the direct guidance and
supervision of the programme in - charge from Ministry
of Health & Family Welfare i.e. Joint Secretary/Director
and the technical assistance is provided by the identified
officers from the Directorate General of Health Services i.e.
Deputy Director General (DDG) / Chief Medical Officer
(CMO).
•The NTCC is supported by Consultants in specific areas of

48. THANK YOU