public health and family welfare

8/15/2019 Public Health and Family Welfare

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Demographic and Mortality Scenario

As on 2011, India’s population stood at 1.21 billion comprising of 623.72 million (51.54%) males and 586.46

million (48.46%) females. India, which accounts for world’s 17.5 percent population, is the second most

populous country in the world next only to China

(19.4%).

The population of India has increased by morethan 181 million during the decade 2001-2011. Of

the 121 crore Indians, 83.3 crore (68.84%) live in

rural areas while 37.7 crore (31.16%) live in urban

areas, as per the Census of India’s 2011. The Average Annual Exponential Growth Rate (AAEGR) for 2001-2011 dipped sharply to 1.64 percent per

annum from 1.97% in 1991-2001 and 2.14 percent during 1981-91. Post independence the sex ratio (Number of females per 1000

males) in India had recorded decline till 1991. Sex ratio in India

has since shown some improvement. It has gone up from 927females per 1000 males in 1991 census to 933 females per 1000

males in 2001 census and to 940 females per 1000 males in

2011 Census of India. However the sex ratio among children less than 6 years of age

has worsened in the last decade to 914 per 1000 males. Haryana with 830 girls per 1000 boys, Punjab with 846

girls per 1000 boys and Jammu & Kashmir with 859 girls per 1000 boys are the States with most adverse child

sex ratios in the country. The Life Expectancy which was 49.7 years during 1970-75 increased to the level of 63.0 years in 2000-04

further improved and stood at 63.5 years during 2002-06. This has revealed decrease in death rate and the

better improvement of quality health services in India. In Kerala, a person at birth is expected to live for 74

years while in states like Bihar, Assam, Madhya Pradesh, Uttar Pradesh, etc, the expectancy is in the range of

58-61 years. The Crude Birth Rate declined from 29.5 per 1000 population in the 1991 to 22.1 in 2010. The CBR is higher

(23.7) in rural areas as compared to urban areas (18.0). Uttar Pradesh recorded the highest CBR (28.3) and

Goa the lowest (13.2). The Crude Death Rate which was 25.1 per 1000 population in 1951 came down to 9.8 in 1991 and further

declined to 7.4 in 2007. During 2008 it remained at 7.4 but came down to 7.3 in 2009. During 2010 the CDR

further declined to 7.2. The CDR is higher in rural areas (7.7) as compared to urban areas (5.8). Odisha with 8.3

has the highest CDR and Nagaland with 3.6 has the lowest CDR. MMR has reduced from 254 per 100000 live births in 2004-

06 to 212 per 100000 live births in 2007-09 (SRS). In the

four southern states, Kerala and Tamil Nadu have already

achieved the goal of a MMR of 100 per 100000 live births.

Assam at a MMR of 390 per 100000 live births remains

India’s most maternal death prone state.

The Child Mortality Rate (CMR 0-4 years) has come down from 57.3 in 1972 to 26.5 in 1991 and 13.3 in 2010.The CMR is very high in rural areas (14.9) as compared to urban areas (7.8) in 2010. The highest Child

Mortality Rate was recorded in Madhya Pradesh (20.0) and Kerala with 2.9 CMR is the best Performing State. India’s Total Fertility Rate (TFR) is at 2.5 (SRS-2010) and the target is to achieve Replacement level of Fertility

of 2.1 by 2012. While 21 States and UTs (Andaman & Nicobar Islands, Goa, Puducherry, Manipur, Tamil Nadu,




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Kerala, Tripura, Chandigarh, Andhra Pradesh, Himachal Pradesh, Jammu & Kashmir, West Bengal, Punjab, Delhi

Maharashtra, Daman & Diu, Karnataka, Mizoram, Nagaland, Sikkim and Lakshadweep) have already achieved

the replacement level, 8 States have TFR between 2.1 and 3.0. Six States/UT (Bihar, U.P, Rajasthan, M.P.,

Meghalaya, and D&N Haveli) have TFR more than 3.0.

Causes of Deaths

Communicable diseases, maternal, peri-natal and nutritional disorders constitute 38 percent of deaths. Non-

communicable diseases account for 42 per cent of all deaths. Injuries and ill-defined causes constitute 10 per cent of

deaths each. However, majority of ill-defined causes are at older ages (70 or higher years) and likely to be from non-

communicable diseases. About one-quarter of all deaths in the country are due to diarrhoeal diseases, respiratory

infections, tuberculosis and malaria.

Rural areas report more deaths (41 per cent) due to

communicable, maternal, peri-natal and nutritional

conditions. The proportion of deaths due to non-

communicable diseases is less in rural areas (40 per

cent). Injuries constitute about the same proportion(about 10 per cent) in both rural and urban areas.

Communicable diseases

Because of the existing environmental, socioeconomic and demographic factors, the developing countries like India are

vulnerable to rapidly evolving micro-organisms. During the past three decades more than 30 new organisms have been

identified worldwide including HIV, Vibrio cholerae , SARS corona virus, highly pathogenic avian influenza virus A, and

pandemic H1N1 influenza virus.

Non-communicable Diseases

Non-communicable Diseases (NCDs) account for nearly half of all deaths in India. Cardiovascular Diseases (CVD),

Cancer, Diabetes, Chronic Obstructive Lung Disease (COPD), Mental Disorders and Injuries are main causes of deathand disability due to NCDs. Unless interventions are made to prevent and control NCDs, their burden is likely to

increase substantially in future. Considering the high cost of medicines and longer duration

of treatment NCDs constitute a greater financial burden to low income groups.

While socioeconomic development tends to be associated with healthy behaviours, rapidly improving socioeconomic

status in India is associated with a reduction of physical activity and increased rates of obesity and diabetes. Increased

consumption of foods rich in salt, sugar and transfats, use of tobacco and alcohol and reduced physical activity have

increased risk of occurrence of NCDs in the country

The Social Determinants of Health

Nutrition, access to safe drinking water and sanitation, and education are the three most important proximate

determinants of health status that have an impact on both infectious disease and vital health statistics. All these three are closely related to poverty and marginalisation. Unhealthy lifestyle, tobacco, alcohol and

other substance abuse underlie much of the non-communicable disease epidemics we face.




3 Of great concern is the persistent level of malnutrition with over 40% of children and 36% of adults women

classified as undernourished. The reasons for such high levels of malnutrition and anaemia include poverty, gender inequity, specific dietary

patterns and recurrent illness, all these acting in conjunction. Patriarchy and gender discrimination contribute to malnutrition levels by early age of marriage and birth of

the first child, reduced access to nutrition during critical periods like pregnancy, lactation, adolescence and the

first five years of life, and less access to education and health care. Keeping girls in schools till they complete adolescence could be one of the most effective health measures.

MMiinn iiss t t rr y y oo f f HHee a a ll t t hh a a nn dd FFa a mm iill y y W W ee ll f f a a rr ee

Though some items like Public Health, hospitals, sanitation, etc. fall in the State list, the items having wider

ramifications at the national level like population control and family welfare, medical education, prevention of food

adulteration, quality control in manufacture of drugs etc. have been included in the Concurrent list.

The Ministry of Health and Family Welfare is instrumental and responsible for implementation of various programmes

on a national scale in the areas of Health and Family Welfare, prevention and control of major communicable diseases

and promotion of traditional and indigenous systems of medicines. Apart from these, the Ministry also assists States in

preventing and controlling the spread of seasonal disease outbreaks and epidemics through technical assistance.In addition to the 100 per cent centrally sponsored family welfare programme, the Ministry is implementing several

World Bank assisted programmes for control of AIDS, Malaria, Leprosy, Tuberculosis and Blindness in designated areas.

Besides, State Health Systems Development Projects with World Bank assistance are under implementation in various

states.

The Ministry of Health and Family Welfare comprises the following departments :

1. Department of Health and Family Welfare

2. Department of AYUSH

3. Department of Health Research

4. Department of AIDS Control The Department of Health and Family Welfare is responsible for implementation of national level

programmes for control of communicable and non- communicable diseases, hospitals and dispensaries and

medical education. The department of AYUSH takes care of promotion of indigenous systems of medicine such as Ayurveda,

Homoeo, Unani, Siddha and ongoing research in indigenous medicine. The Department of Health Research is mainly concerned with research in medical and health activities. The Department of National AIDS Control Organisation (NACO) is responsible for planning and

implementation of programmes for prevention and control of AIDS. Directorate General of Health Services (Dte. GHS) is an attached office of the Department of Health and

Family Welfare and has subordinate offices spread all over the country. The DGHS renders technical advice on

all medical and public health matters and is involved in the implementation of various health schemes.

Public health system in India

The public health system in India comprises a set of state-owned health care facilities funded and controlled by

the government of India. Some of these are controlled by agencies of the central government while some are controlled

by the governments of the states of India. All India Institutes of Medical Sciences owned and controlled by the central government. These are referral

hospitals with super speciality facilities. All India institutes presently functional are All India Institute ofMedical Sciences, New Delhi, AIIMS Bhopal, AIIMS Bhubaneshwar, AIIMS Jodhpur, AIIMS Raipur, and AIIMS

Rishikesh. Regional Cancer Centres are cancer care hospitals and research institutes controlled jointly by the central and

the respective state governments.

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4 Government Medical Colleges owned and controlled by the respective state governments. These are referral

hospitals. District Hospitals or General Hospitals: Controlled by the respective state governments and serving the

respective districts (administrative divisions in India). Taluk hospitals: Taluk level hospitals controlled by the respective state governments and serving the

respective taluks (administrative divisions in India, and smaller than districts).

Primary Health Centres: The most basic units with the most basic facilities, and especially serving rural India.HHuu mm a a nn RRee ss oo uu rr cc ee ss f f oo rr HHee a a ll t t hh

Medical Education in India

At present there are 334 medical colleges in the country. Out of which 154 medical colleges are in government sector

and the remaining 180 medical colleges in private sector. The annual intake capacity of these medical colleges is

approximately 41,500 students. The Post Graduate capacity of these medical colleges is approximately 21,100. During

the academic year 2011-12, 20 new medical colleges were established in the country.

Medical council of India

The Medical Council of India (MCI) is a statutory body governed by the Indian Medical Council Act 1956.

A major amendment to the I.M.C. Act 1956 was made in 1993 making it mandatory for obtaining the approvalof the Ministry of Health and Family Welfare for opening new medical colleges/increasing seats, starting new

courses in order to regulate the standard of medical education in the country. The I.M.C. Act 1956 was further amended in 2001 to enable the Medical Council of India to conduct Screening

Tests for Indian nationals holding foreign medical qualifications to test their skill before granting them

registration to practice medicine in India. Through the same amendment Act, it has been made mandatory for Indian students desirous of taking

admission in an under- graduate medical course in an Institute abroad to obtain an Eligibility Certificate from

the MCI stating that he/she conforms to the norms laid down by the MCI for this purpose.

The main functions of the Council are:

- Maintenance of uniform standard of medical education in India

- Maintenance of Indian Medical register;

- Reciprocity with foreign countries in the matter of mutual recognition of medical qualifications;

- Continuing medical education and granting of provisional/permanent registration of doctors with

recognized medical qualifications, registration of additional qualifications and issue of Good Standing

Certificate for doctors going abroad to Commonwealth countries.

Central Health Education Bureau

Central Health Education Bureau (CHEB) is an apex institution under Directorate General of Health Services

(DGHS) for the health education and health promotion in the country. The Bureau is located in New Delhi. The key functions of CHEB presently include imparting long-term and short-term training programmes to

different levels of health and non - health professionals.

Bachelor of Rural Health Care (BRHC)

The Government is considering to introduce a 3½ year rural health care course tentatively called Bachelor of

Rural Health Care (BRHC). The purpose of the proposed course is to generate a cadre of health care providers who by the virtue of the

way they are chosen, trained, deployed and supported would be motivated to live in and provide

comprehensive primary health care in the rural areas at the Sub-Centre level.

Pharmacy Council of India

The Pharmacy Council of India is a statutory body constituted under the Pharmacy Act, 1948. It is responsible

for the regulation of pharmacy education and practice of profession in the country for registration as a

pharmacist.

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http://en.wikipedia.org/wiki/Primary_Health_Centre,_India

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5 At present, there are 497 approved institutions.

Dental Council of India

Dental Council of India is a statutory body established under the Dentists Act, 1948 with the prime objective of

regulating dental education, profession and its ethics in the country.

Indian Nursing Council

The Indian Nursing Council is a statutory body constituted under the Indian Nursing Council Act, 1947. The

Council is responsible for regulation and maintenance of uniform standards of training for nurses, midwives,

ANMs and Lady Health Visitors in India. The Council prescribes the syllabi and regulations for various Nursing

courses.

National Commission for Human Resources for Health (NCHRH) Bill 2011

The National Commission for Human Resources for Health Bill, 2011 was introduced in the Rajya Sabha on

December 22, 2011. The Bill seeks to establish a mechanism to determine and regulate the standard of health education in the

country. It shall repeal the Indian Nursing Council Act, 1947; the Pharmacy Act, 1948; the Dentists Act, 1948

and the Indian Medical Council Act, 1956 on such date as decided by the central government.

The Bill seeks to set up the National Commission for Human Resources for Health (NCHRH), National Board forHealth Education (NBHE), and the National Evaluation and Assessment Council (NEAC). It also establishes

various professional councils at the national and state level and a NCHRH Fund to meet expenses. The permission of NCHRH is required to establish an educational institution. The person has to submit a

scheme for the institution to NCHRH which shall refer it to NEAC. NCHRH shall give permission based on

NEAC’s recommendation. In case the person is not informed of a decision within one year of submitting the

scheme, it shall be deemed to have been approved. The NBHE shall take measures to facilitate academic studies and research in emerging areas of health

education. It shall conduct a screening test for medical practitioners before they can enroll in a professional

council. Every person who wants to practice medicine, sign a medical certificate or give evidence in a court as an expert

has to be enrolled in the national or state registers to be maintained by these councils. An Indian citizen who wants to study medicine abroad has to obtain an eligibility certificate from NBHE,

certifying that he fulfils minimum norm of getting admission in an MBBS course in India. He shall not be

eligible to appear for the screening test if he has not obtained this certificate. A person may be exempted from

the test if he is enrolled as a health practitioner outside India for at least three years. Any person who obtains a degree from a government institution and leaves India for higher education, shall

endeavour to serve in India for three years. If he does not do so, his name shall be removed from the register.

If he opts to return to India, he can get his name re-entered after fulfilling such conditions as specified by

NCHRH. Any person who gets a degree from a private institution then goes abroad for higher education has to

either return to India within three years or inform the respective council of his whereabouts. If a person is aggrieved by the professional services rendered by a medical practitioner enrolled in the register,

he may file a complaint with the state council within 60 days. The council shall decide the complaint within

120 days of receiving the complaint. The Bill constitutes the National Commission for Human Resources for Health Fund to meet the expenses of the

various bodies.

National Eligibility and Entrance Test (NEET)

NEET is a national level common medical entrance examination expected to be held on 05 May, 2013 in India,

conducted by the CBSE for students of Medical Science, who wish to qualify for admission to MBBS and MD/MS. It will allow class XII students or XII passed students to sit in a single entrance examination to get admission to

almost all medical colleges in India, including private medical colleges.

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6 Under-graduate courses at the AIIMS in New Delhi and Post-graduate Institute for Medical Education and

Research in Chandigarh may be outside the NEET’s purview as these two institutes were set up by separate

laws, which need to be amended in Parliament to introduce the new system.

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National Rural Health Mission (NRHM)

The National Rural Health Mission was launched in 2005, to provide accessible, affordable and accountable

quality health services to the poorest households in the remotest rural regions. The thrust of the Mission is on establishing a fully functional, community owned, decentralized health delivery

system with inter sectoral convergence at all levels, to ensure simultaneous action on a wide range of

determinants of health like water, sanitation, education, nutrition, social and gender equality. The NRHM is about increasing public expenditure

on healthcare from the current 0.9% of the GDP to

2 to 3% of the GDP. The scheme proposes a number of new mechanism

for healthcare delivery including training local

residents as Accredited Social Health Activists(ASHA), and the Janani Suraksha Yojana

(motherhood protection program). It also aims at

improving hygiene and sanitation infrastructure. The mission has a special focus on 18 states

Arunachal Pradesh, Assam, Bihar, Chhattisgarh,

Himachal Pradesh, Jharkhand, Jammu and Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland,

Orissa, Rajasthan, Sikkim, Tripura, Uttarkhand and Uttar Pradesh. Infant Mortality Rate came down from 53 per thousand live births in 2008 to 50 per thousand live births in

2009. The scheme has been extended to whole country except Goa, Pondicherry and Chandigarh. NRHM is organized around five pillars, each of which is made up of a number of overlapping core strategies.

1. Increasing Participation and Ownership by the Community: Through an increased role for PRIs, the ASHA

programme, the village health and sanitation committee, increased public participation and NGO

participation.

2. Improved Management Capacity: Professionalising management by building up management and public

health skills in the existing workforce, supplemented by inculcation of skilled management personnel into

the system.

3. Flexible Financing: Provision of united funds to every village health and sanitation committee, to the sub-

center, to the PHC, to the CHC including district hospital.

4. Innovations in human resources development for the health sector: Contractual appointment route to

immediately fill gaps as well as ensure local residency, incentive and innovation to find staff to work in

hitherto underserved areas and the use of multiskilled and multi-tasking options.

5. Setting of standards and norms with monitoring: The prescription of the Indian Public Health Standards

(IPHS) norms marks one of the most important core strategies of the mission. This has been followed up by

a facility survey to identify gaps and funding is directed to close the gaps so identified.

Accredited Social Health Activists (ASHA) ASHA is envisaged as a trained woman community health volunteer who will reinforce community action for

universal immunizations, safe delivery, the care of the new born, prevention of water borne and communicable

diseases, improved nutrition and promotion of household sanitary toilets. There will be one ASHA per 1000 population.




7 More than 7.49 lakh Accredited Social Health Activists (ASHAs) are connecting households to health facilities.

The presence of community volunteers on this unprecedented scale has resulted in people's growing pressure

on utilization of services from the public sector health system.

Janani Suraksha Yojana (JSY) JSY is a centrally sponsored scheme aimed at reducing maternal and infant mortality rates and increasing

institutional deliveries in below poverty line (BPL) families.

The JSY, which falls under the overall umbrella of National Rural Health Mission covers all pregnant womenbelonging to households below the poverty line, above 19 years of age and up to two live births.

The Yojana is being implemented in all States and Union Territories. JSY is a 100% centrally sponsored scheme. JSY integrates help in the form of cash with antenatal care during pregnancy period, institutional care during

delivery as well as post-partum care. This is provided by field level health workers through a system of

coordinated care and health centres.

Janani Shishu Suraksha Karyakram (JSSK)

The Janani Shishu Suraksha Karyakram (JSSK) was launched on 1st June, 2011. The initiative entitles all

pregnant women delivering in public health institutions to absolutely free and no expense delivery, includingcaesarean section.

The entitlements include free drugs and consumables, free diet up to 3 days during normal delivery and up to 7

days for C-section, free diagnostics, and free blood wherever required. This initiative also provides for free

transport from home to institution, between facilities in case of a referral and drop back home. Similar entitlements have been put in place for all sick newborns accessing public health institutions for

treatment till 30 days after birth.

Scheme for Promotion of Menstrual Hygiene among Adolescent Girls (10-19 years) in Rural India The Ministry of Health & Family Welfare has rolled out a new scheme for the promotion of menstrual hygiene

among adolescent girls in the age group of 10-19 years in rural areas. This programme is aimed at ensuring that adolescent girls (10- 19 years) in rural areas have adequate

knowledge and information about menstrual hygiene and the use of sanitary napkins. This scheme is being launched in 25% of Districts in the country i.e. 152 districts across 20 States in the first

phase.

Home Based New Born Care (HBNC) A new scheme has been launched to incentivize ASHA for providing Home Based Newborn Care. ASHA will make visits to all newborns according to specified schedule up to 42 days of life. The proposed incentive is Rs. 50 per home visit of around one hour duration. The role of ASHA would be:

- recording of weight of the newborn in MCP card

- ensuring BCG , 1st dose of OPV and DPT vaccination

- both the mother and the newborn are safe till 42 days of the delivery, and

- registration of birth has been done

Mother and Child Tracking system (MCTS) Mother and Child Tracking system (MCTS) is a name-based tracking of pregnant women so that adequate and

timely feedback may be given to the health workers who may, in turn, ensure that pregnant women receive

adequate Ante-natal and Post-natal care besides encouraging institutional deliveries. The system also aims to track the new-borns so that timely and complete immunisation may be ensured to

them. MCTS has been implemented in all the States / UTs. It covers mothers from conception till 42 days after delivery. The infants are covered up to five years of age. Recently, MCTS has been included as Mission Mode Project under the National e-Governance Plan (NeGP).




8 The total number of pregnant women registered under MCTS scheme recently crossed 1 crore mark.

National Urban Health Mission (NUHM)

The proposed National Urban Health Mission (NUHM) aims to address the public health care needs of urban

population. It involves revamping/creation/upgradation of primary, secondary and tertiary health care service delivery

system in urban areas. NUHM would cover all cities/towns with a population of more than 50000. Towns below 50000 population

will be covered under National Rural Health Mission (NRHM). It would cover urban population including slum dwellers; other marginalized urban dwellers like rickshaw

pullers, street vendors, railway and bus station coolies, homeless people, street children, construction site

workers, who may be in slums or on sites. The existing Urban Health Posts and Urban Family Welfare Centres would be taken as existing infrastructure

under NUHM and will also be considered for upgradation. Intersectoral coordination mechanism and convergence will be planned between the Jawaharlal Nehru

National Urban Renewal Mission (JnNURM), Rajiv Awas Yojana (RAY) and the NUHM.

National Health Policy 2002 It aims at achieving an acceptable standard of health for the general population of the country. 11th five year plan had set the goal of achieving good health for the people, especially the poor and the

underprivileged. A comprehensive approach was advocated, which included improvements in individual health care, public

health, sanitation, clean drinking water, access to food and knowledge of hygiene and feeding practices. Importance was accorded to reducing disparities in health across regions and communities by ensuring access

to affordable health. Special attention was given to the health of marginal groups like adolescent girls, women, children, the older

persons, disabled and tribal groups.National Vector Borne Disease Control Programme (NVBDCP)

The National Vector Borne Disease Control Programme is a comprehensive programme for prevention and control of

vector borne diseases namely Malaria, Filaria, Kala-azar, Japanese Encephalitis (JE), Dengue and Chikungunya which is

covered under the overall umbrella of NRHM. Directorate of National Vector Borne Disease Control Programme

(NVBDCP) is the central nodal agency for the prevention and control of vector borne diseases.

Malaria Malaria is an acute parasitic illness caused by Plasmodium falciparum or Plasmodium vivax in India. Nine

major species of anopheline mosquitoes transmit malaria in India.

Malaria continues to pose a major public health threat in different parts of the country, particularly due to

Plasmodium falciparium as it is sometimes prone to complications and death, if not treated early. The major vector mosquito for rural malaria viz. Anophales culicifacies, is distributed all over the country and

breeds in clean ground water collections. Some of the vector species also breed in forest areas, mangroves,

lagoons, etc., even in those with organic pollutants. About 80% of malaria burden is in North-eastern (NE) states, Chhattisgarh, Jharkhand, Madhya Pradesh,

Odisha, Andhra Pradesh, Maharashtra, Gujarat, Rajasthan, West Bengal and Karnataka. The focus is on empowering grass-root workers in diagnosing and treating malaria cases even in remote and

accessible areas by scaling-up the availability of bivalent Rapid Diagnostic Kits (RDK) and Artemisinin-based

Combination Therapy (ACT). There is a need to give thrust for prevention/control of malaria (and other VBD also) in urban areas under the

Urban Malaria Scheme which is presently implemented in only 131 towns/cities. These efforts coupled with




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integrated vector control strategies including distribution of Long Lasting Insecticide Treated Nets (LLIN) in

endemic areas will greatly reduce the malaria morbidity and mortality. Bi-valant Rapid Diagnostic Kit for improving diagnostic facilities for both types of malaria (Plasmodium

Falciparum and Plasmodium Vivax) in difficult and inaccessible areas have been introduced in the programme. Performance based incentive for ASHAs in endemic areas for Malaria and Kala azar has been introduced.

Filariasis

Filaraisis is transmitted by mosquito species i.e. Culex quinquefasciatus and Mansonia annulifera/M. uniformis.The vector mosquitoes breed in polluted water in drains, crosspits etc. in areas with inadequate drainage and

sanitation. The target year for Global elimination of this disease is by the year 2020. Government of India is signatory to

the World Health Assembly Resolution in 1997 for Global Elimination of Lymphatic Filariasis. The National

Health Policy (2002) has however, envisaged elimination of lymphatic filariasis in India by 2015. The strategy of annual Mass Drug Administration (MDA) with annual single recommended dose of DEC +

Albendazole tablets is being implemented in the country since 2004. In addition, scaling up of home based foot

care and hydrocele operation have been initiated for disability alleviation.

Kala-Azar Kala-azar is caused by a protozoan parasite Leishmania donovani and spread by sandfly, which breeds in

shady, damp and warm places in cracks and crevices in the soft soil, in masonry and rubble heaps, etc. Important recent initiatives taken to control Kala-azar include case detection through rapid diagnostic kits and

improved treatment compliance by using oral drug Miltefosine. In addition, compensation to the patients for loss of wages and incentive to ASHAs/volunteers for case

detection and ensuring complete treatment have also been provided.

Japanese Encephalitis Japanese Encephalitis is a zoonotic disease which is transmitted by vector mosquito mainly belonging to Culex

vishnui group. The transmission cycle is maintained in the nature by animal reservoirs of JE virus like pigs and

water birds. Man is the dead end host, i.e. JE is not transmitted from one infected person to other. Outbreaks are common in those areas where there is close interaction between animals/birds and human

beings. The vectors of JE breed in large water bodies such as paddy fields. AES is emerging as a serious public health challenge. Given its complex etiology, medical complications and

after-effects of illness, effort is on to develop a multi-pronged strategy including safe water, sanitation,

nutrition, community education, medical attention and rehabilitation to address the problem. The disease is endemic in 14 states of which Assam, Bihar, Haryana, and Uttar Pradesh have been reporting

outbreaks.

Dengue Fever

Dengue Fever is an outbreak prone viral disease, transmitted by Aedes Aegypti mosquitoes. Aedes aegypti mosquitoes prefer to breed in man made containers, viz., cement tanks, overhead tanks,

underground tanks, tyres, desert coolers, pitchers, discarded containers, junk materials, etc. in which water

stagnates for more than a week. This is a day biting mosquito and prefers to rest in hard to find dark areas

inside the houses. The risk of dengue has shown an increase in recent years due to rapid urbanization. The disease has a seasonal pattern i.e. the cases peak after monsoon and it is not uniformly distributed

throughout the year. Dengue is a self limiting acute disease characterized by fever, headache, muscle, joint pains, rash, nausea and

vomiting. Some infections result in Dengue Haemorrhagic Fever (DHF) and in its severe from Dengue Shock

Syndrome (DSS) can threaten the patient's life primarily through increased vascular permeability and shock

due to bleeding from internal organs.




11 The association between TB and HIV has been well established, with HIV being the most potent risk factor for

progression of latent TB infection to active disease and TB being the most common opportunistic infection

among the HIV patients and also the most common cause of death in HIV patients. Response to the challenge of TB-HIV co-infection was initiated in 2001. The National framework for Joint TB-

HIV Collaborative activities articulates the policy of TB/HIV collaborative activities in the country and has

defined the mechanism and modalities for cross linkages between all the service delivery points for RNTCP and

the NACP.National leprosy eradication Programme (NLEP)

Leprosy (Hansen’s Disease), is a chronic infectious disease that primarily affects the peripheral nerves, skin,

upper respiratory tract, eyes, and nasal mucosa. The disease is caused by a bacillus (rod-shaped) bacterium

known as Mycobacterium leprae. National Leprosy Eradication Programme was launched in 1983 with the objective to arrest the disease in all

the known cases of leprosy. Since 2005, the programme is being continued with Government of India funds with technical support from

WHO and International Federation of Anti Leprosy Associations (ILEP).

A MoU was signed between Governemnt of India and International Federation of Anti LeprosyAssociations (ILEP) which provides framework for collaboration between GOI and ILEP during the period

April 2007 to March 2010.

Leprosy has been eliminated as a public health problem in 32 States / UTs covering 83% districts. Prevalence

rate of leprosy has decreased from 1.34 per 10,000 populations in 2005-06 to 0.69 per 10,000 populations in

2010-11.

National Programme of Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke Programme (NPCDCS)

National Cancer Control Program was under implementation since June 2010. This programme has been

revamped and synergized with Diabetes, CVD & stroke and named as ‘National Program for Prevention and

Control of Cancer, Diabetes, CVD & Stroke’ (NPCDCS). This programme will cover 100 districts selected on the basis of their backwardness, inaccessibility and poor

health indicators, spread over 21 States, during 2010-11 and 2011-12. The focus of the programme is on promotion of healthy life styles, early diagnosis and management of diabetes,

hypertension, cardiovascular diseases and common cancers e.g. cervix cancer, breast cancer, and oral cancer

and will cover about 200 million persons in all the districts. Objectives of the NPCDCS

- Prevent and control common NCDs through behavior and life style changes.

-

Provide early diagnosis and management of common NCDs.- Build capacity at various levels of health care facilities for prevention, diagnosis and treatment of common

NCDs.

- Train human resource within the public health setup viz doctors, paramedics and nursing staff to cope

with the increasing burden of NCDs.

- Establish and develop capacity for palliative and rehabilitative care.

National Mental Health Programme (NMHP)

National Mental Health Programme was started in 1982 with the objectives to ensure availability and

accessibility of minimum mental health care for all to encourage mental health knowledge and skills and to

promote community participation in mental health service development and to stimulate self-help in thecommunity.

An intensive national level mass media campaign on awareness generation regarding mental health problems

and reduction of stigma attached to mental disorders was undertaken under NMHP.




12 10 Centres of Excellence in Mental Health and 23 PG Departments (in 10 Institutes) in mental health specialties

have been established across the country to increase the PG training capacity in mental health as well as

improving the tertiary care treatment facility in mental health with the objective to address the shortage of

mental health professionals in the country. An exercise to amend Mental Health Act, 1987, is in progress.

National Programme for the Health Care for the Elderly (NPHCE)

National Programme for the Health Care for the Elderly (NPHCE) was initiated in June, 2010 with the main

objective of providing preventive, curative and rehabilitative services to the elderly persons at various level of

health care delivery system of the country. NPHCE is an articulation of the International and national commitments of the Government as envisaged under

the UN Convention on the Rights of Persons with Disabilities (UNCRPD), National Policy on Older Persons

(NPOP) adopted by the Government of India in 1999 & Section 20 of “The Maintenance and Welfare of Parents

and Senior Citizens Act, 2007” dealing with provisions for medical care of Senior Citizen. The programme is expected to be expanded to the entire country during the 12th Plan. Some important components: Department of Geriatric at 8 Super Specialized Institutions, Geriatric Unit at 100

District Hospitals, Rehabilitation Units at CHCs Falling Under 100 Identified Districts, Weekly geriatric clinicswill be arranged at the identified PHCs by a trained Medical Officer.

The NCD Cells constituted at the Centre, State and district level under the National Programme for Prevention

and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS) will implement and monitor NPHCE also.

National Programme for Prevention and Control of Deafness (NPPCD)

The MoH&FW, launched this programme on pilot phase basis in 2006 - 07 to prevent the avoidable hearing

loss on account of disease or injury, early identification, diagnosis and treatment of ear problems responsible

for hearing loss and deafness. In India, 63 million people (6.3%) suffer from significant auditory loss. Nationwide disability surveys have

estimated hearing loss to be the second most common cause of disability.Pilot Project on Prevention and Control of Human Rabies

To prevent human deaths due to rabies a pilot project has been initiated as a 'New Initiative' in the 11th FYP

since 2008. National Centre for Disease Control (NCDC) (previously known as NICD) is the nodal agency to coordinate

various activities under the project. It is being carried out in five cities viz; Ahmedabad, Bangalore, Delhi, Pune & Madurai.

National Tobacco Control Programme

The National Tobacco Control Programme (NTCP) aims at creating public awareness against tobacco use,

setting up of testing labs and monitoring adult tobacco surveys. 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, (COTPA)

2003 was notified in the official gazette on May 2003. The Act is applicable to all tobacco products and extends to whole of India. Provisions of the anti Tobacco Law

- Prohibition of smoking in a public place

- Prohibition of direct and indirect advertisement of cigarette and other tobacco products

- Prohibition of sale of cigarette and other tobacco to a person below the age of 18 years

- Prohibition of sale of tobacco products near the educational institutions

- Mandatory depiction of statutory warning (including pictorial warnings) on tobacco packs

- Mandatory depiction of tar and nicotine contents alongwith maximum permissible limits on tobacco packs




13 Govt, of India notified "The Cigarettes and Other Tobacco Products (Display of Board by Educational

Institutions) Rules, 2009' and provides that no person shall sell, offer for sale, or permit sale of cigarette or any

other tobacco product in an area within a radius of 100 yards of any educational institution.

National Iodine Deficiency Disorder Control Programme

Iodine is an essential micronutrient with an average daily requirement of 100 -150 micro grams for normal

human growth and development. Deficiency of Iodine can cause physical and mental retardation, cretinism,

abortion, still - birth, deaf mutism, squint besides goiter. The Government is implementing National Iodine Deficiency Disorders Control Programme (NIDDCP) formerly

known as the National Goiter Control Programme (NGCP) since 1962. The MoH & FW has banned the sale of non - iodated salt for direct human consumption under Prevention of

Food Adultration Act, 1954 w.e.f. May, 2006.

National AIDS Control Programme

Human Immunodeficiency Virus (HIV) is a lenti virus that belongs to the retroviruses group may cause HIV

infection/AIDS. Acquired Immunodeficiency Syndrome (AIDS) has emerged as one of the most serious public

health problem in the country after reporting of the first case in 1986 in India.

India has an estimated 2.4 million HIV positive persons in 2009 at an estimated adult HIV prevalence of 0.31%. The National AIDS Control Organisation (NACO), established in 1992, is a division of India's Ministry of Health

and Family Welfare that provides leadership to HIV/AIDS control programme in India through 35 HIV/AIDS

Prevention and Control Societies, and is "the nodal organisation for formulation of policy and implementation

of programs for prevention and control of HIV/AIDS in India”. In order to control the spread of HIV/AIDS, Government of India is implementing the National AIDS Control

Programme (NACP) as a 100 per cent centrally sponsored scheme. Number of annual new HIV infections has declined by more than 50% during the last decade. This is one of the

most important evidence on the impact of the various interventions under National AIDS Control Programme

(NACP) and scaled-up prevention strategies. The National AIDS Control Programme (NACP) Phase – III (2007 – 2012) has the overall goal of halting and

reversing the epidemic in India over the five year period. It seeks to integrate prevention with care, support

and treatment through a four – pronged strategy:

1. Prevention of new infections in high – risk groups and general population.

2. Providing greater care, support and treatment to larger number of persons living with HIV/AIDS (PLHA).

3. Strengthening the infrastructure, systems and human resources in prevention, care, support and treatment

programmes at the district, state and national level.

4. Strengthening the nationwide Strategic information Management System.

In 2009 India established a "National HIV and AIDS Policy and the World of Work", which sough to end

discrimination against workers on the basis of their real or perceived HIV status. Under this policy all

enterprises in the public, private, formal and informal sectors are encouraged to establish workplace policies

and programmes based on the principles of non-discrimination, gender equity, health work environment, non-

screening for the purpose of employment, confidentiality, prevention and care and support. TeachAIDS: In 2010, NACO approved the TeachAIDS curriculum for use in India, an innovation which

represented the first time that HIV/AIDS education could be provided in a curriculum which did not need to be

coupled with sex education. Later that year, the Government of Karnataka approved the materials for their

state of 50 million and committed to distributing them in 5,500 government schools. Red Ribbon Express:

- Red Ribbon Express is an AIDS/HIV awareness campaign train by the Indian Railways. The motto of the

Red Ribbon Express is “Embarking on the journey of life”.




14

- The Red Ribbon Express was launched in India on World AIDS Day, December 1, 2007. It has emerged as

the world's largest mass mobilization programme against HIV/AIDS.

- The Red Ribbon Express’ second phase was flagged off on World AIDS Day, 2009.

- In the 2 nd phase the National Rural Health Mission has also come on board with NACO. Along with the three

exhibition coaches with exhibits on HIV/AIDS, the fourth exhibition coach is on NRHM with exhibits of

H1N1, Tuberculosis, Malaria, Reproductive and Child Health services, general health and hygiene.

-

The 3rd

phase of Red Ribbon Express was launched on 12th

January 2012. The train will not only providecounseling but also help people in testing and anti-retro viral treatment.

Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)

PMSSY aims at correcting the imbalances in availability of affordable/reliable tertiary level healthcare in the

country in general and augmenting facilities for quality medical education in the under-served States. The scheme envisages setting up six institutions like the All India Institute of Medical Sciences (AIIMS), one

each in the States of Bihar (Patna), Madhya Pradesh (Bhopal), Odisha (Bhubaneshwar), Rajasthan (Jodhpur),

Chhattisgarh (Raipur) and Uttarakhand (Rishikesh); and upgradation of 13 existing medical institutions in the

first phase. I

n the 2 nd phase setting up of 2 more AIIMS like institutions and up gradation of 6 more medical collegeinstitutions will be taken up.

Rashtriya Arogya Nidhi

Previously known as National Illness Assistance Fund (NIAF), Rastriya Arogya Nidhi was set up in 1997. The

scheme provides for financial assistance to patients, living below poverty line, who are suffering from major

life threatening diseases, to receive medical treatment in Govt, hospitals. Under the scheme of Rashtriya Arogya nidhi, grants-in-aid are also provided to State Governments for setting

up State Illness Assistance Funds.

The Integrated Disease Surveillance Project (IDSP)

IDSP was launched by Ministry of Health and Family Welfare with World Bank assistance in November 2004for a period upto March 2010 to detect and respond to disease outbreaks quickly. The project has been

extended for 2 years upto March 2012 by Govt, of India. Its objective is to strengthen disease surveillance in the country by establishing a decentralized state based

surveillance system for epidemic prone diseases to detect the early warning signals, so that timely and effective

public health actions can be initiated in response to health challenges in the country at the district, state and

national level. Surveillance units have been established in all states/districts (SSU/DSU). Central Surveillance Unit (CSU)

established and integrated in the National Centre for Disease Control, Delhi.

Under the project weekly disease surveillance data on epidemic prone disease are being collected from

reporting units such as sub centres, primary health centres, community health centres, hospitals including

government and private sector hospitals and medical colleges. Urban Surveillance: It is proposed for 4 metropolitan cities of Delhi, Mumbai, Chennai and Kolkata.

Prohibition of Pre-Conception And Pre-Natal Sex Determination

In order to check female foeticide, the Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse)

Act, 1994 was enacted and brought into operation from 1st January, 1996. The Act prohibits determination and disclosure of the sex of the foetus. It also prohibits any advertisements

relating to pre-natal determination of sex. Punishments are prescribed for contravention of any of its provisions, like imprisonment up to 5 years and fine

up to Rs. 1,00,000/-in addition to cancellation of the registration/ license in the case of medical professionals/

diagnostic centres, clinics, etc..




15 The Act and the Rules framed under it have been amended with effect from 14th February, 2003 to ban

selection of sex before or after conception and to remove difficulties in the implementation of the Act keeping

in view certain directions of the Supreme Court of India. A National Support and Monitoring Cell (NSMC) has been constituted to strengthen implementation of the Act

in the country.

Universal Immunization Programme

Immunization Programme is one of the key interventions for protection of children from life threatening

conditions, which are preventable. Under the Universal Immunization Programme Government of India is providing vaccination to prevent seven

vaccine preventable diseases i.e. Diphtheria, Pertussis, Tetanus, Polio, Measles, severe form of Childhood

Tuberculosis and Hepatitis B. The vaccination schedule is as under:

- BCG (Bacillus Calmette Guerin) 1 dose at Birth (upto 1 year if not given earlier)

- DPT (Diphtheria, Pertussis and Tetanus Toxoid) 5 doses; Three primary doses at 6,10,14 weeks and two

booster doses at 16-24 months & 5 Years of age

- OPV (Oral Polio Vaccine) 5 doses; 0 dose at birth, three primary doses at 6,10 and 14 weeks and one

booster dose at 16-24 months of age- Hepatitis B vaccine 4 doses; 0 dose within 24 hours of birth and three doses at 6, 10 and 14 weeks of age.

- Measles 2 doses; first dose at 9-12 months and second dose at 16-24months of age

- TT (Tetanus Toxoid) 2 doses at 10 years and 16 years of age

- TT – for pregnant woman two doses or one dose if previously vaccinated within 3 Year Since 2006, 1 dose of SA-14-14-2 JE vaccine has been introduced under routine immunization in the high

burden districts in phased manner. All the States / UTs are asked to prepare their own State Programme Implementation Plan (PIP) for

Immunization as part ‘C’ of NRHM PIP from the year 2005-06 to address specific needs.

Pulse Polio Immunization In the pursuance of the World Health Assembly resolution of 1988, the Pulse Polio Immunization (PPI)

Programme was started nation-wide from 1995 to eradicate polio in India covering children in the age group

0-3 years. In order to accelerate the Pace of polio eradication, all children under the age of 5 years were targeted since

1996-97. The annual strategy on polio eradication is decided on the basis of recommendation of India Experts Advisory

Group (IEAG) which constituted of Indian experts; and international experts from World Health Organization

(WHO), United Nation Children Fund (UNICEF) & Centre for Disease Control (CDC) Atlanta. Of the 3 types of polio causing viruses, type 2 (WPV-2) has already been eradicated in 1999. The bivalent vaccine (bOPV) was introduced in the country for the first time in 2010. On 13th January the nation reached a major milestone in the history of polio eradication – a year without any

case of wild polio being recorded. As India reached this ‘no wild case' mark, it will no longer be considered ‘endemic' to polio. Following this, the

World Health Organisation removed India from the list of endemic nations.

Rashtriya Swasthya Bima Yojana

Rashtriya Swasthya Bima Yojana (RSBY), a scheme of Ministry of Labour. Maximum contribution is 725 per family (75 % central: 25 % state). The beneficiary would pay 30/- per

annum as registration/renewal fee. The main objective of this scheme is to provide health insurance cover to the below poverty line (BPL) workers

and their families in the unorganized sector and to improve access of BPL families to quality medical care for

treatment of diseases involving hospitalization and surgery.




16 The scheme provides the coverage for meeting expenses of primary inpatient hospitalization for medical

and/or surgical procedures including maternity benefit and newborn child, to the BPL families up to 30,000

per family. Unit of enrolment is family up to a unit of five members. This would comprise the Household Head, spouse, and

up to three dependants.

Transplantation of Human Organs (Amendment) Act 2011

Seeking to streamline the process of organ transplantation and curb instances of illegal dealings, this Amendment Bill

provides for the regulation of the transplantation of human tissue along with the transplantation of organs. It makes it

mandatory for the medical staff treating a patient at the ICU/medical unit to request relatives of brain dead patients for

organ donation and requires that all organ donation cases go through an Authorisation Committee. The Bill amends the Transplantation of Human Organs Act, 1994, which regulates removal, storage and

transplantation of human organs. In addition to human organs, the Bill seeks to regulate transplantation of

tissues of the human body. The Act permits donations from living persons who are near relatives. The Bill expands the definition of “near

relative” to include grandparents and grandchildren in addition to parents, children, brother, sister and

spouse. The doctor in an Intensive Care Unit has to inform the patient or relatives of patient about the option of organ

donation and ascertain whether they would consent to the donation. A pair of donor and recipient who are near relatives but whose organs do not medically match for

transplantation are permitted by the Bill to swap organs with another pair of such persons. The Bill enhances the penalty for unauthorised removal of human organs and for receiving or making payment

for human organs. The Bill seeks to strengthen provisions to curb commercial trade in human organs while facilitating organ

transplantation for needy patients.




17

public health and family welfare

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