National Health

Programmes
 Outline of Presentation

• Introduction
• Classification of National Health
Programmes
• Salient features of the recent National
Health Programmes
• Role of the PHC in
Implementation of in National
Health Programmes
 Major Milestones in Health Sector in India
National Health Policy
2017
Introduction of RMNCH+A 2013 / NHM
NUHM & Constitution
of NHM National Rural Health Mission 2005
MDGs , Reproductive Child Health Program II 2004
2000
Reproductive Child Health Program I 1996
National Pulse Polio Program 1995
Child Survival and Safe Motherhood Program 1992

Universal Immunization Program 1985

Alma Ata
National Health Policy 1983
Declarati
o n 1978 National Family Welfare Program 1978
National Family Planning Program 1952

Bhore Committee Recommendation 1946

 National Health Mission
NRHM‐ National Commu‐ Non Infra‐
RMNCH+ Urban Commu
‐
nicable structure
A Health ‐ nicable
Diseases Maintenance
Mission Diseases
1. Maternal Health
NPCDCS( cancer diabetes &
2. Child Health stroke)
RNTCP (TB)
3. Family Planning NPCB (Blindness)
NLEP(Leprosy)
4. Immunization NTCP (Tobacco)
NVBDCP
5.104/108 NMHP (Mental Health)
ambulances(Integrated IDSP (Disease
Ambulance System) Surveillance) NPHCE (Elderly)
6. PCPNDT NPPCD (Deafness)
7.Rashtriya Bal NOHP (Oral Health)
Swasthya Karyakram
8.Rashtriya Kishore Swasthya
Karyakram
7. ASHA/VHSNC/Civil works/untied
funds etc
 Classification of National Health
Programmes
I. Programmes related to
provision of health care
II. Programmes aimed at
controlling communicable
diseases
III.Programmes aimed at controlling
non- communicable diseases
IV.Programmes related to Maternal
and Child Health
and Special
 National Rural Health Mission
• NRHM - development of State Health System.
• NRHM - organized around Five pillars
i. Increasing Participationand Ownership by
the Community
ii. Improved Management Capacity
iii. Flexible Financing
iv. Innovation of HumanResources
Developmentfor the Health Sector
v. Setting of standards and norms with
monitoring
 Plan of Action under NRHM
• Accredited Social Health Activist
(ASHA)
• Strengthening of Health Sub Centres
• Strengthening of Primary Health
Centres
• Strengthening of Community Health
Centres
• District Health Plan
• Converging Sanitation and Hygiene
• Strengthening Disease Control
Programme
•
 National Urban Health Mission
• Aim : Address the health concerns of
the urban poor by rationalizing and
strengthening the existing facilities.
• Ensuring Community Participation in
planning and management of health
services by community Institutions like
Mahila Arogya Samiti (20-100
households and Rogi Kalyan Samiti.
• Urban Social Health Activist (USHA)
1for1000- 2500 urban poor population in
200- 500households
Urban Health Care Delivery Model

Referral

Public/Privatee
Secondary/Tertiary
Primary Urban Health
Centre
Centre(PUHC)1for 50,000pop /1for Primary Level
25,000‐30,000 slum pop

Sub‐primary level
Swsthya Chowki 1for10,000 pop
1ANM and 1MCW
Community level

Community Out reach Services

Community Risk Pooling under
NUHM
Seed Money and
Performance
Grant

Interest saving
on s
Mahila
Arogya
Samiti(MAS
) Saving
Smal s I
l n
loan Slum t
s Women e
r
e
s
t
 II. Programmes aimed at
controlling Communicable
Diseases
1. National Vector borne diseases Control
Programme (NVBDCP)
2. National Leprosy “Eradication”
Programme (NLEP): National Action
Plan
3. Revised National Tuberculosis
Control Programme (RNTCP)
Phase II
4. National AIDS Control Programme
Phase III
5.Integrated Disease Surveillance
1.National Vector borne diseases
Control Programme (NVBDCP)
• This program is concerned with the
prevention and control of vector borne
diseases namely Malaria, Dengue, Kala azar,
Filariasis, Chikungunya fever and Japanese
Encephalitis.

• Launched in 2003‐04 by merging NAMP,NFCP & Kala

Azar Control programmes .Japanese B Encephalitis and
Dengue/DHF have also been included in this Program

• Directorate of NAMP is the nodal agency for

prevention and control of major Vector Borne Diseases
 Three Pronged Strategy under NVBDCP

1. Disease management
2. Integrated Vector
management (for
transmission risk reduction)
3. Supportive Interventions
Behaviour Change
Communication(BCC) Public Private
Partnership(PPP)
 Essential in endemic areas
• Diagnosis and Management of Vector borne Diseases is to be
undertaken as per NVBDCP guidelines for PHC/CHC:
• Diagnosis of Malaria cases, microscopic confirmation and
treatment.
• Cases of suspected JE and Dengue to be provided symptomatic
treatment, hospitalization and case management as per
the protocols.
• Complete treatment to Kala‐azar cases in Kalaazar endemic
areas as per national Policy.
• Complete treatment of microfilaria positive cases with DEC and
participation in and arrangement for Mass Drug
Administration (MDA) along with management of
side reactions, if any. Morbidity management of
Lymphoedema cases.
 NATIONAL LEPROSY
ERADICATION PROGRAM
 Milestones Of Leprosy Eradication
• 1848 – Leper Act , British India abolished later.
• 1948 – Hind Kusht Nivaran Sangh
• 1955 – National leprosy Control Program
• 1980 – Dapsone
• 1982 – MDT
• 1983 – National Leprosy Eradication Program( MDT started)
• 1991 – World Health Assembly resolution to eradicate leprosy
by 2000AD.
• 1998‐2004 – Modified Leprosy Elimination Program
• 2005 Dec – Prevalence rate 0.95 /10,000 and government
declared achievement of elimination target.
• 2005 – NRHM covers NLEP .
• 2012 ‐ Special action plan for 209 high endemic districts
16 States/UTs
 Objectives Of NLEP
1. To achieve elimination
2. To accomplish integration
3. To proceed with endemic states
 Strategies in NLEP
• Early detection
• Regular treatment
• Public awareness campaigns
• Medical rehabilitation
 Essential
• Health education to community regarding
Leprosy.
• Diagnosis and management of Leprosy and its
complications including reactions.
• Training of leprosy patients having ulcers for
self‐care.
• Counselling for leprosy patients for regularity/
completion of treatment and prevention of
disability
 Evolution of TB Control in India
• 1950s‐60s Important TB research at TRC and
NTI National TB Programme (NTP)
• 1962 Programme Review
• 1992 » only 30% of patients
diagnosed;
» of these, only 30% treated successfully
• 1993 RNTCP pilot began
• 1998 RNTCP scale‐up
• 2001 450 million population covered
• 2004 >80% of country covered
• 2006 Entire country covered by RNTCP
 Revised National TB Control Program
(RNTCP)

• Launched in 1997 based on WHO DOTS Strategy

– Entire country covered in March’06 through an unprecedented
rapid expansion of DOTS

• Implemented as 100% centrally sponsored

program
– Govt. of India is committed to continue the support till TB ceases
to be a public health problem in the country

• All components of the STOP TB Strategy‐2006 are

being implemented
 Objectives of RNTCP

• To achieve and maintain a cure rate

of at least 85% among newly
detected infectious (new sputum
smear positive) cases

• To achieve and maintain detection

of at least 70% of such cases in the
population
 contd.
• Augmentation of the peripheral
level supervision through the
creation of a sub district supervisory
unit
• Ensuring a regular uninterrupted
• supply of ondrugs training,
up to the
IEC, most
peripheral level
Emphasi operational involvement
and NGOin
s the
research
program
 Core elements of Phase I
• The core element of RNTCP in Phase I (1997-
2006)was to ensure high quality DOTS
expansion in the country, addressing the five
primary components of the DOTS strategy
– Political and administrative commitment
– Good Quality Diagnosis through
sputum Microscopy
– Directly observed treatment
– Systematic Monitoring and
Accountability
– Addressing stop TB strategy under
RNTCP
 RNTCP Phase II( 2006-
11)
• The RNTCP phase II is envisaged to:

– Consolidate the achievements of

phase I
– Maintain its progressive trend
and effect further improvement
in its functioning
– Achieve TB related MDG goals while
retaining DOTS as its core
strategy
 RNTCP Phase II
• Access services to hard-to-reach
areas.
• Strengthen intersectoral
coordinationand involving Medical
colleges
• IEC activities.
• Improving laboratory facilities for
sputum culture and drug sensitivity
• Implementation of DOTS –Plus
strategy for Multi Drug Resistant
Tuberculosis (MDR-TB)
• Paediatric patient-wise drug boxes
 Essential
• All PHCs function as DOTS Centres
to
deliver treatment as per toRNTCP treatment
guidelines through DOTS providers and
treatment of common complications of TB and
side effects of drugs, record and report on
RNTCP activities as per guidelines. Facility for
Collection and transport of sputum samples
should be available as per the RNTCP
guidelines
 National AIDS Control
Programme (NACP)
1992‐NACP‐I
1998 NACP II
2007‐2012 NACP III (with an objective to " halt
and reverse the HIV epidemic In India" by the end
of the project.
There is a steady decline in overall prevalence and
nearly 50 percent decrease in new infections over
the last ten years. NACP IV aims to consolidate the
gains of NACP III.
 Objective of NACP IV
• Reduce new infections by 50
percent (2007 Baseline of NACP
III.
• Provide comprehensive care and
support to all persons living with
HIV/AIDS and treatment services for
all those who require it.
 This will be achieved through the
following strategies:‐
• Intensifying and consolidating prevention
services with a focus on (a) high-risk groups and
vulnerable population and
(b) general population.
Expanding Information, Education and
Communication (IEC) services for (a) general
population and (b) High-Risk Groups (HRGS) with a
focus on behaviour change and demand
generation.
Increasing access and promoting comprehensive
Care, Support and Treatment (CST)
Building capacities at National, State, District
and facility levels
Strengthening Strategic Information
Management Systems.
 Essential
• IEC activities to enhance awareness and
preventive measures about STIs and
HIV/AIDS, Prevention of Parents to Child
Transmission (PPTCT) services.
• Organizing School Health Education Programme.

• Condom Promotion & distribution of condoms to

the high risk groups.
• Help and guide patients with HIV/AIDS
receiving ART with focus on adherence.
 Desirabl
•
e
Integrated Counseling
services.
and Testing Centre, STI

• Screening of persons practicing high-risk

behaviour with one rapid test to be conducted at
the PHC level and development of referral
linkages with the nearest ICTC at the District
Hospital level for confirmation of HIV status of
those found positive at one test stage in the high
prevalence states.
• Risk screening of antenatal mothers with one
rapid test for HIV and to establish referral
linkages with CHC or District Hospital for PPTCT
services in the six high HIV prevalence states
(Tamil Nadu, Andhra Pradesh, Maharashtra,
Karnataka, Manipur and Nagaland) of India.
• Linkage with Microscopy Centre for HIV-TB
coordination
 III.Programmes aimed at controlling
Non- Communicable Diseases(NCDs)
1. National Programme for Prevention and
Control of Diabetes, Cardiovascular
Diseases and Stroke
2. National Programme for Control of
Blindness (NPCB)- New Initiatives
3. National Mental Health
Programme(NMHP)
4. National Programme for
Prevention and control of Deafness
5. National Oral Health Programme
6. Integrated Disease Surveillance
Project
 National Programme for Prevention and
Control of Diabetes, Cardiovascular
Diseases and Stroke - Components
1. Health Promotion for general population
2. Professional Education
3. Diagnosis and Management
4. Surveillance of Risk factors
5. Community Participation
 Cancer
• Essential
• IEC services for prevention of cancer and
early symptoms.
• Early detection of cancer with warning signals
like change in Bladder/Bowel habits, bleeding
per rectum, blood in urine, lymph node
enlargement, Lump or thickening in Breast,
itching and/or redness or soreness of the nipples
of Breast, non healing chronic sore or ulcer in
oral cavity, difficulty in swallowing, obvious
change in wart/mole, nagging cough or
hoarseness of voice etc.
• Referral of suspected cancer cases with early
warning signals for confirmation of the
diagnosis. Desirable PAP smear
 Other NCD Diseases
• Essential a. Health Promotion Services to
modify individual, group and community
behaviour especially through;
• i. Promotion of Healthy Dietary Habits.
• ii. Increase physical activity.
• iii. Avoidance of tobacco and alcohol.
• iv. Stress Management.
• Early detection, management and referral of
Diabetes Mellitus, Hypertension and other
Cardiovascular diseases and Stroke through
simple measures like history, measuring blood
pressure, checking for blood, urine sugar and
ECG. Desirable Survey of population to identify
vulnerable, high risk and those suffering from
disease.
National Programme for Control
of Blindness (NPCB)
 Chronological
developments
1963: Started as National Trachoma
Control Program
1976: Renamed as National
preventi Program forImpairment
of Visual
on and
Control Sponsored) Blindness(100
Centrally
of
1982: Blindness included% in 20-point
program

“2020-the right to sight”.

 Objectives
 Reducing the Blindness prevalence
from 1.4% to 0.3% by 2020
 Provide high quality of eye care
 Expand coverage of eye care
to the affected population &
under-served areas
 Reduce backlog of blindness
 Develop institutional capacity
for eye care services
 Cataract operation in bi-lateral
blind.
 Cataract surgery in female.

 Cataract surgery in SC/ST

population.
 Cataract surgery in different
facilities.
 Cataract surgery in different age
groups.
 Initiative
s cataract cases in rural
 Free surgery for
areas.
 Free transportation for patients.

 Free medicine for all types of eye

ailments.
 Free spectacles for post operative care.

 Free spectacles for poor school

students.
 Treatment of backlog cataract cases.

 All schools would be covered for SES.

 Initiative
 Vit- A s
supplementationand
immunization coverage.
 Modern treatment at Medical College and
DH.
 one Eye Bank & 2 Eye Donation Centres
 Establishment of one RIO,Cuttack.
 ASHA: be trained and assigned to
create awareness. incentive of Rs
175/- per cataract case, out of the fund
earmarked under Cataract Operation.
 Contractual Ophthalmology Assistants
created
 National Mental Health
Programme (NMHP) –Thrust areas
1. District Mental Health Programme to
cover the entire country and be more
effective
2. Modernization /Streamlining of
Mental Hospitals
3. Upgrading Dept of Psychiatry in
Medial Colleges and enhancing
the psychiatric content.
4. Research and Training in the field of
community mental health, substance
abuse and child adolescent psychiatric
 Essential
• Early identification (diagnosis) and
treatment of mental illness in the
community.
• Basic Services:
• Diagnosis and treatment of common
mental disorders such as psychosis,
depression, anxiety disorders and epilepsy
and referral).
• IEC activities for prevention, stigma
removal, early detection of mental
disorders and greater participation/role
of Community for primary
National Programme for Prevention
and control of Deafness- Activities
• Training of all the manpower
• Infrastructure building
• Screening, Early diagnosis
and Management
• Provision of Surgical and
Rehabilitative services as well as
provision of hearing aid
• IEC activities
 Essential
• Early detection of cases of
hearing impairment and deafness
and referral.
• Basic Diagnosis and treatment
services for common ear diseases
like wax in ear, otomycosis,
otitis externa, Ear discharge etc.
• IEC services for prevention,
early detection of hearing
impairment/deafness and greater
participation/role of community in
primary prevention of ear problems.
National Oral Health Programme
Components
1. Oral Health Education
2. Formulation of Basic Package on
oral Health should be locally
developed
3. Manpower and Infra structure
requirement for Primary and
Secondary Prevention of Oral
Diseases.
 Essential Oral health
promotion and check ups &
appropriate referral on
identification
Integrated Disease
Surveillance Project (IDSP)
- Activities
1. Decentralizing and
Integrating Surveillance
Mechanism
2. Upgradation of
laboratories
3. Information Technology
and Communication
4. Human Resources and
Development
5. Operational Activities
and Response
 Essential
• a. Weekly reporting of epidemic prone diseases in S, P &
L forms and SOS reporting of any cluster of cases
(formats for the data collection are added in Annexures
11, 11A, 11B, 11C).
• b. PHC will collect and analyse data from Sub-Centre and
will report information to district surveillance unit.
• c. Appropriate preparedness and first level action in
out-break situations.
• d. Laboratory services for diagnosis of Malaria,
Tuberculosis, and tests for detection of faecal
contamination of water (Rapid test kit) and
chlorination level.
 National Programme of Health
Care of Elderly : Strategies
1. Home Based Health Service –
early warning system and
Psychological support
2. Community based Health Centre
for the elderly providing a base
for Educational and Preventive
activity
3. Improved Hospital based Support
Service with focused health care
needs
• Essential IEC activities on healthy
aging. Desirable
• Weekly geriatric clinic at PHC for
providing complete health
‘assessment of elderly persons,
’Medicines, Management of chronic
diseases and referral services.
 4.National Programme for Control and
Treatment of Occupational Diseases
• Data base generation, documentation
and information dissemination on
hazardous process
• Capacity building
• Health Risk Assessment
• Prevention and Control of Occupational
health Hazards
 National Programme for Prevention &
Management of Burn Injuries
(NPPMBI)‐
• The programme is being implemented
through State Government Medical Colleges
and District Hospitals
 Objectives of the programme
• To reduce incidence, mortality, morbidity and
disability due to Burn Injuries.
• To improve the awareness among the general
masses and vulnerable groups especially the
women, children, industrial and hazardous
occupational workers.
• To establish adequate network of infrastructural
facilities along with trained personnel for burn
management and rehabilitation.
• To carry out research for assessing
behavioral, social and other determinants of Burn
Injuries in our country for effective need based
program planning for Burn Injuries, monitoring
and subsequent evaluation.
 Focus areas of the programme
• (i) Prevention
• (ii) Treatment
• (iii) Rehabilitation and
• (iv) Training.
 Prevention
• Activities related to electronic media will be
undertaken through Doordarshan, Cable
TV, Internet, Mobile phone SMS, CCTVs at the
railway stations, hospitals, schools and
• other public places.
Activities for print media will be taken up
newspapers, advertisements, through
magazines,
charts, folders for disseminating information.posters,
• Conventional methods like melas, rallies
and quiz, folk dance etc will also be
utilized.
• Awareness campaignfor school children and
college students will be organized.
• Outdoor publicity will be done in form of
Hoardings, Wall Paintings, Neon Signs, Kiosks, Bus
Panels, etc.
 Treatment
• The burn unit in a District
Hospital will have 6 beds (4
general beds + 2 acute care beds)
and other facilities.
• In order to prevent infection, there
will be packaged type air
cooled/water cooled units with
requisite number of air
changers.
 Rehabilitation
• Follow up and rehabilitation services
will be provided to restore
functional capacity of burn
patients thereby, enabling the
patients to achieve functional
independence and better quality of
life.
• Existing Physiotherapy units will
be strengthened by adding
more equipment, and by
providing Physiotherapists and
Community Based Rehabilitation
 Training
Under this component, surgeons,
medical officers, paramedics and
multi-disciplinary workers will be
imparted hands
in Injury on training at
“Burn Management” the
identifie Central and Trainin
d State g
Centres.