RCH PROGRAMME, NPCB AND VISION 2020

from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.lib import colors
from reportlab.platypus import (
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    HRFlowable, PageBreak, KeepTogether
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from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY

OUTPUT = "/tmp/workspace/rch-npcb/RCH_NPCB_Vision2020_Parks.pdf"

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    title="RCH Programme, NPCB & Vision 2020 - Park's SPM",
    author="Park's Textbook of Preventive and Social Medicine"
)

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# ─────────────────────────────────────────────
story = []

# COVER
story.append(SP(30))
story.append(Paragraph("RCH PROGRAMME", cover_title))
story.append(Paragraph("NPCB & VISION 2020", cover_title))
story.append(SP(8))
story.append(HR())
story.append(SP(8))
story.append(Paragraph("Park's Textbook of Preventive and Social Medicine", cover_sub))
story.append(Paragraph("University Examination Reference — Complete Notes", cover_sub))
story.append(SP(6))
story.append(Paragraph("Chapters: Reproductive & Child Health | National Blindness Control | Vision 2020", note))
story.append(PageBreak())

# ═══════════════════════════════════════
# PART A – RCH PROGRAMME
# ═══════════════════════════════════════
story.append(H1("PART A: REPRODUCTIVE AND CHILD HEALTH (RCH) PROGRAMME"))
story.append(SP(4))

story.append(H2("Definition"))
story.append(highlight_box(
    '"People have the ability to reproduce and regulate their fertility, women are able to go through '
    'pregnancy and childbirth safely, the outcome of pregnancies is successful in terms of maternal and infant '
    'survival and well-being, and couples are able to have sexual relations, free of fear of pregnancy and of '
    'contracting disease."'
))
story.append(SP(6))

story.append(H2("Background / Evolution"))
story.append(B("RCH evolved from integrating several existing national programmes:"))
for item in [
    "Family Welfare Programme",
    "Universal Immunization Programme (UIP)",
    "Oral Rehydration Therapy (ORT)",
    "Child Survival and Safe Motherhood (CSSM) Programme",
    "Acute Respiratory Infection (ARI) Control",
]:
    story.append(BL(item))
story.append(B("Integrated RCH was adopted to <b>reduce cost inputs</b> (avoid overlapping expenditure) and <b>optimise outcomes</b> at field level."))
story.append(SP(4))

# ═══════════════════════════════════════
# RCH PHASE-I
# ═══════════════════════════════════════
story.append(H1("RCH PHASE – I"))
story.append(SP(4))
story.append(highlight_box("Formally launched: <b>15th October 1997</b>", bg=LIGHT_BLUE))
story.append(SP(6))

story.append(H2("Key Features of RCH Phase-I"))
story.append(B("• Incorporated components of <b>Child Survival and Safe Motherhood</b> (CSSM)"))
story.append(B("• Added <b>two new components</b>:"))
story.append(BL("Sexually Transmitted Disease (STD) control"))
story.append(BL("Reproductive Tract Infection (RTI) control"))
story.append(SP(6))

story.append(H2("Differential Approach — District Categorization"))
story.append(B("Based on <b>Crude Birth Rate</b> and <b>Female Literacy Rate</b>, all districts divided into 3 categories:"))
story.append(SP(4))
cat_data = [
    ["Category", "No. of Districts", "Description"],
    ["A", "58", "Weakest districts — got most support"],
    ["B", "184", "Intermediate districts"],
    ["C", "265", "Relatively advanced districts"],
]
story.append(box_table(cat_data, [3*cm, 4*cm, 10*cm]))
story.append(B("All districts covered in a <b>phased manner over 3 years</b>. Care components were same for all; weaker districts got more support."))
story.append(SP(6))

story.append(H2("Interventions in ALL Districts"))
for item in [
    "<b>Child Survival interventions</b> — immunization, Vitamin A (to prevent blindness), ORT, prevention of deaths due to pneumonia",
    "<b>Safe Motherhood interventions</b> — antenatal check-up, TT immunization, safe delivery, anaemia control",
    "Implementation of <b>Target Free Approach</b>",
    "High quality training at all levels",
    "<b>IEC</b> (Information, Education, Communication) activities",
    "Specially designed RCH package for <b>urban slums and tribal areas</b>",
    "District sub-projects under <b>Local Capacity Enhancement</b>",
    "<b>RTI/STD Clinics</b> at District Hospitals",
    "Facility for safe abortions at PHCs (equipment, contractual doctors)",
    "Enhanced community participation through <b>Panchayats, Women's Groups and NGOs</b>",
    "<b>Adolescent health and reproductive hygiene</b>",
]:
    story.append(BL(item))
story.append(SP(6))

story.append(H2("Interventions in Selected States/Districts (Phase-I)"))
for item in [
    "Screening and treatment of RTI/STD at sub-divisional level",
    "Additional ANM at sub-centres in weak districts for MCH care",
    "Improved delivery services and emergency care (equipment kits, IUD insertions, ANM kits at sub-centres)",
    "Referral transport for pregnant women during emergencies through Panchayat in weak districts",
]:
    story.append(BL(item))
story.append(SP(8))

# MAJOR INTERVENTIONS PHASE-I
story.append(H1("MAJOR INTERVENTIONS UNDER RCH – PHASE I"))
story.append(SP(4))

story.append(H2("1. Essential Obstetric Care (EOC)"))
story.append(B("Provides basic maternity services to all pregnant women through:"))
for n, item in enumerate([
    "Early registration of pregnancy (within <b>12–16 weeks</b>)",
    "Minimum <b>3 antenatal check-ups</b> by ANM or Medical Officer — monitor progress, detect risks, refer timely",
    "Provision of <b>safe delivery</b> at home or in institution",
    "Provision of <b>3 postnatal check-ups</b> — monitor postnatal recovery, detect complications",
], 1):
    story.append(Paragraph(f"({n}) {item}", bullet))
story.append(SP(6))

story.append(H2("2. Emergency Obstetric Care"))
story.append(B("Complications of pregnancy are <b>not always predictable</b> — hence, emergency obstetric care is an important intervention."))
for item in [
    "Under CSSM: <b>1748 Referral Units</b> identified and supported with equipment kits (E to P)",
    "Under RCH: <b>FRUs (First Referral Units)</b> strengthened with emergency obstetric kit, equipment kit, and skilled manpower on contract basis",
    "<b>Traditional Birth Attendant (TBA)</b> still plays an important role in deliveries in Indian society",
]:
    story.append(BL(item))
story.append(SP(6))

story.append(H2("3. 24-Hour Delivery Services at PHCs/CHCs"))
story.append(B("Additional honorarium provided to staff to encourage round-the-clock delivery facilities at health centres to promote institutional deliveries."))
story.append(SP(6))

story.append(H2("4. Medical Termination of Pregnancy (MTP)"))
for item in [
    "Under <b>MTP Act 1971</b>",
    "Aim: reduce maternal morbidity and mortality from unsafe abortions",
    "Central Government assistance: training of manpower, supply of MTP equipment",
    "Provision of doctors trained in MTP to <b>visit PHCs on fixed dates</b> to perform MTP",
]:
    story.append(BL(item))
story.append(SP(6))

story.append(H2("5. Control of RTI and STD"))
for item in [
    "Linked to <b>HIV and AIDS control</b>; implemented in close collaboration with <b>NACO</b>",
    "NACO provides assistance for setting up RTI/STD clinics up to district level",
    "Central assistance: training, drug kits, including disposable equipment",
    "Each district: <b>2 laboratory technicians on contract basis</b> for blood, urine and RTI/STD tests",
]:
    story.append(BL(item))
story.append(SP(6))

story.append(H2("6. Immunization"))
story.append(B("Universal Immunization Programme (UIP) became part of:"))
story.append(BL("CSSM programme — 1992"))
story.append(BL("RCH programme — 1997"))
story.append(BL("Currently under <b>National Health Mission (NHM)</b>"))
story.append(SP(6))

story.append(H2("7. Essential Newborn Care"))
story.append(B("<b>Primary goal:</b> Reduce perinatal and neonatal mortality."))
story.append(SP(3))
story.append(B("<b>Main components:</b>"))
for item in [
    "Resuscitation of newborn with asphyxia",
    "Prevention of hypothermia",
    "Prevention of infection",
    "Exclusive breast feeding",
    "Referral of sick newborn",
]:
    story.append(BL(item))
story.append(SP(3))
story.append(B("<b>Strategies:</b> Train medical and health personnel in essential newborn care; provide basic facilities for care of <b>low birth weight and sick newborns</b> in FRU and district hospitals."))
story.append(SP(6))

story.append(H2("8. Diarrhoeal Disease Control"))
for item in [
    "In districts not implementing <b>IMNCI</b> (Integrated Management of Neonatal and Childhood Illness), the vertical programme continues",
    "India is the <b>first country in the world</b> to introduce the <b>low osmolarity Oral Rehydration Solution</b>",
    "<b>Zinc</b> to be used as an adjunct to ORS for management of diarrhoea — reduces number, severity and duration of episodes",
    "<b>De-worming guidelines</b> formulated",
    "Incidence of diarrhoea reduced by provision of <b>safe drinking water</b>",
]:
    story.append(BL(item))
story.append(SP(6))

story.append(H2("9. Acute Respiratory Disease (ARD) Control"))
for item in [
    "Standard case management of ARI and prevention of deaths due to <b>pneumonia</b> is now an integral part of RCH programme",
    "Peripheral health workers trained to <b>recognize and treat pneumonia</b>",
    "<b>Cotrimoxazole</b> supplied to health workers through the drug kit",
]:
    story.append(BL(item))
story.append(SP(6))

story.append(H2("10. Prevention and Control of Vitamin A Deficiency in Children"))
story.append(B("Large number of children suffer from sub-clinical Vitamin A deficiency."))
story.append(SP(3))
va_data = [
    ["Dose", "Amount", "Age / Timing"],
    ["1st dose", "1 lakh (1,00,000) IU", "9 months of age — along with measles vaccination"],
    ["2nd dose", "2 lakh (2,00,000) IU", "After 9 months (i.e., 18 months)"],
    ["Subsequent doses", "2 lakh IU each", "Every 6 months up to 5 years of age"],
    ["Additional dose", "One extra dose", "All cases of severe malnutrition"],
]
story.append(box_table(va_data, [3.5*cm, 4.5*cm, 9*cm]))
story.append(SP(6))

story.append(H2("11. Prevention and Control of Anaemia in Children"))
story.append(B("<b>Iron Deficiency Anaemia</b> is widely prevalent in young children. Policy revised:"))
story.append(SP(3))
anaemia_data = [
    ["Age Group", "Iron Supplement Dose", "Duration"],
    ["6 months – 5 years (infants)", "20 mg elemental iron + 100 mcg folic acid/day (liquid formulation)", "100 days in a year"],
    ["6 – 10 years (children)", "30 mg elemental iron + 250 mcg folic acid/day", "100 days in a year"],
    ["Above 10 years", "Adult dose", "—"],
]
story.append(box_table(anaemia_data, [3.5*cm, 8*cm, 5.5*cm]))
story.append(SP(6))

story.append(H2("12. Training of Dais"))
for item in [
    "Scheme initiated during <b>2001–02</b>",
    "Implemented in <b>156 districts in 18 States/UTs</b>",
    "Districts selected on basis of <b>safe delivery rates &lt; 30%</b>",
    "Scheme extended to all districts of <b>EAG states</b>",
    "Aim: Train at least <b>one Dai in every village</b>",
    "Objective: Make deliveries <b>safe</b>",
]:
    story.append(BL(item))
story.append(SP(6))

story.append(H2("13. Empowered Action Group (EAG)"))
story.append(B("Constituted in Ministry of Health and Family Welfare on <b>20th March 2001</b>."))
story.append(B("Chairman: Union Minister for Health and Family Welfare."))
story.append(B("55% of India's population increase is contributed by <b>8 EAG states</b>: UP, MP, Rajasthan, Bihar, Jharkhand, Chhattisgarh, Uttarakhand, Odisha."))
story.append(SP(6))

story.append(H2("Performance Indicators Under RCH"))
for item in [
    "Maternal Mortality Rate (MMR)",
    "Infant Mortality Rate (IMR)",
    "Under 5 mortality rate (U5MR)",
    "Current Contraceptive Prevalence Rate",
    "Percentage of children fully immunized",
    "Percentage of unmet need for family planning",
    "Percentage of households reported visits by health worker in previous 3 months",
]:
    story.append(BL(item))

story.append(PageBreak())

# ═══════════════════════════════════════
# RCH PHASE-II
# ═══════════════════════════════════════
story.append(H1("RCH PHASE – II"))
story.append(SP(4))
story.append(highlight_box(
    "<b>Began:</b> 1st April 2005 &nbsp;&nbsp;|&nbsp;&nbsp; "
    "<b>Focus:</b> Reduce maternal and child morbidity and mortality with emphasis on rural health care",
    bg=LIGHT_BLUE
))
story.append(SP(6))

story.append(H2("Major Strategies Under RCH Phase-II"))
strat_data = [
    ["Strategy", "Components"],
    ["Essential Obstetric Care", "a. Institutional delivery\nb. Skilled attendance at delivery"],
    ["Emergency Obstetric Care", "a. Operationalizing First Referral Units (FRUs)\nb. Operationalizing PHCs and CHCs for round-the-clock delivery services"],
    ["Strengthening Referral System", "Involvement of SHGs, NGOs, women groups; states have proposed various modes of referral linkage"],
]
story.append(box_table(strat_data, [5*cm, 12*cm]))
story.append(SP(6))

story.append(H2("A. Essential Obstetric Care (Phase-II)"))
story.append(SP(2))
story.append(H3("(a) Institutional Delivery"))
for item in [
    "<b>50% of PHCs and ALL CHCs</b> to be made operational as <b>24-hour delivery centres</b> in phased manner by year 2010",
    "These centres responsible for providing basic emergency obstetric care, <b>essential newborn care</b> and basic newborn resuscitation round the clock",
    "Experience from <b>Andhra Pradesh and Tamil Nadu</b>: round-the-clock delivery ensured by providing <b>3–4 staff nurses/ANMs</b> at PHCs",
]:
    story.append(BL(item))
story.append(SP(4))

story.append(H3("(b) Skilled Attendance at Delivery"))
for item in [
    "Globally recognized: countries that reduced MMR are ones that ensured <b>skilled attendance at every birth</b> + appropriate referral for complications",
    "<b>WHO</b> has also emphasized that skilled attendance at every birth is essential to reduce MMR",
    "Guidelines formulated for: normal delivery and management of obstetric complications at PHC/CHC for Medical Officers; ANC and skilled attendance at birth for ANM/LHVs",
]:
    story.append(BL(item))
story.append(SP(4))

story.append(H3("(c) Policy Decisions"))
story.append(B("ANMs / LHVs / SNs are now <b>permitted to use drugs</b> in specific emergency situations to reduce maternal mortality."))
story.append(B("They are also permitted to carry out <b>certain emergency interventions</b> when the life of the mother is at stake."))
story.append(SP(6))

story.append(H2("B. Emergency Obstetric Care — First Referral Units (FRUs)"))
story.append(B("Operationalization of FRUs and skilled attendance at birth <b>go hand in hand</b>."))
story.append(B("All First Referral Units to be made operational for providing emergency and essential obstetric care during RCH Phase-II."))
story.append(SP(4))

story.append(H3("Minimum Services of a Fully Functional FRU"))
fru_data = [
    ["S.No.", "Service"],
    ["1", "24-hour delivery services including normal and assisted deliveries"],
    ["2", "Emergency obstetric care including surgical interventions (Caesarean sections)"],
    ["3", "Newborn care"],
    ["4", "Emergency care of sick children"],
    ["5", "Full range of family planning services including laparoscopic services"],
    ["6", "Safe abortion services"],
    ["7", "Treatment of STI/RTI"],
    ["8", "Blood storage facility"],
    ["9", "Essential laboratory services"],
    ["10", "Referral (transport) services"],
]
story.append(box_table(fru_data, [1.5*cm, 15.5*cm]))
story.append(SP(4))

story.append(highlight_box(
    "<b>Three Critical Determinants</b> for a facility to be 'declared' as a FRU:<br/>"
    "1. Availability of <b>surgical interventions</b> on a 24-hour basis<br/>"
    "2. Availability of <b>newborn care</b> on a 24-hour basis<br/>"
    "3. Availability of <b>blood storage facility</b> on a 24-hour basis",
    bg=LIGHT_YELLOW
))
story.append(SP(4))

story.append(H3("Infrastructure Requirements for a FRU"))
for item in [
    "Minimum bed strength of <b>20–30</b> (relaxed to 10–12 in difficult areas — NE states, underserved EAG state areas)",
    "Fully functional <b>operation theatre</b>",
    "Fully functional <b>labour room</b>",
    "Area earmarked and equipped for <b>newborn care</b> in labour room and ward",
    "Functional <b>laboratory</b>",
    "<b>Blood storage facility</b>",
    "24-hour <b>water supply and electricity supply</b>",
    "Arrangements for <b>waste disposal</b>",
    "<b>Ambulance facility</b>",
]:
    story.append(BL(item))
story.append(SP(6))

story.append(H2("C. Strengthening Referral System (Phase-II)"))
for item in [
    "During RCH Phase-I: funds given to Panchayats for assisting poor people in obstetric emergencies — <b>not actively implemented</b>",
    "In Phase-II: different states proposed different modes — SHGs, NGOs, women groups; some indicated to <b>outsource</b> referral transport",
]:
    story.append(BL(item))
story.append(SP(6))

story.append(H2("D. New Initiatives Under RCH Phase-II"))
story.append(SP(2))

story.append(H3("1. Training of MBBS Doctors in Life-Saving Anaesthetic Skills"))
for item in [
    "Emergency Obstetric Care (EmOC) recognized as most important intervention for saving pregnant women with complications",
    "Operationalisation of FRU at <b>sub-district/CHC level</b> for EmOC is a crucial strategy of RCH-II",
    "MBBS doctors trained in <b>life-saving anaesthetic skills</b> to support caesarean sections at FRUs",
]:
    story.append(BL(item))
story.append(SP(4))

story.append(H3("2. Janani Suraksha Yojana (JSY)"))
story.append(B("<b>Launched: 2005</b> — to promote institutional deliveries, especially among BPL women."))
for item in [
    "Cash incentive to pregnant women for delivering in <b>government/accredited private health institutions</b>",
    "Higher incentive in <b>Low Performing States (LPS)</b>: J&K, HP, Uttaranchal, UP, Bihar, Jharkhand, MP, Chhattisgarh, Rajasthan, Odisha, Assam, NE states",
    "Also available for deliveries at home in special circumstances",
    "ASHA acts as <b>link worker</b> facilitating JSY benefits",
]:
    story.append(BL(item))
story.append(SP(4))

story.append(H3("3. Safe Abortion Services (RCH Phase-II)"))
for item in [
    "<b>Medical method of abortion (MMA)</b>: Mifepristone (RU 486) followed by Misoprostol — safe under supervision",
    "Surgical method: Manual Vacuum Aspiration (MVA) and Electric Vacuum Aspiration (EVA)",
    "Mid-trimester abortions available at district level",
]:
    story.append(BL(item))
story.append(SP(4))

story.append(H3("4. Other Interventions Continued from Phase-I (Phase-II)"))
for item in [
    "Additional ANMs and Public Health Nurses",
    "Private anaesthetists (contractual)",
    "Safe Motherhood Consultants",
    "24-hour delivery services at PHCs and CHCs",
    "Referral transports",
    "Integrated financial envelope",
    "RCH camps",
    "Training of TBAs/Dais",
    "School health programmes",
]:
    story.append(BL(item))
story.append(SP(6))

story.append(H2("E. RMNCH+A Strategy (2013)"))
story.append(B("Reproductive, Maternal, Newborn, Child Health + Adolescent strategy launched 2013 under NHM. Continuum of care approach across life stages."))
story.append(SP(6))

story.append(H2("F. Surakshit Matritva Aashwasan (SUMAN) Programme"))
story.append(B("Provides assured, dignified, respectful healthcare at <b>no cost</b> with <b>zero tolerance for denial of services</b> for every woman and newborn visiting public health facility."))
story.append(B("Expected outcome: <i>\"Zero preventable maternal and newborn deaths and high quality of maternity care delivered with dignity and respect.\"</i>"))
story.append(SP(6))

story.append(H2("G. LaQshya Programme"))
story.append(B("<b>Launched: 2017</b> — to improve quality of care in labour room and maternity OTs in public health facilities."))
for item in [
    "Evidence-based approach — improve maternal and newborn care, provide respectful care during <b>intrapartum and postpartum periods</b>",
    "Implemented at: District Hospital (DH), Sub-district Hospital (SDH), high case load CHC, FRUs and Medical Colleges",
    "<b>2,445 public health facilities</b> identified including 193 medical colleges",
    "441 labour rooms and 392 OTs achieved state certification; 152 labour rooms and 127 OTs achieved national certification (till October 2019)",
]:
    story.append(BL(item))

story.append(PageBreak())

# ═══════════════════════════════════════
# NPCB
# ═══════════════════════════════════════
story.append(H1("PART B: NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS (NPCB)"))
story.append(SP(4))

story.append(H2("Magnitude of Blindness in India"))
story.append(B("India has approximately <b>12 million blind persons</b> — one of the largest blind populations in the world."))
story.append(B("Prevalence: <b>1.1%</b> (WHO definition: VA &lt; 3/60)"))
story.append(SP(6))

story.append(H2("Causes of Blindness in India — 2015–19 National Survey"))
causes_data = [
    ["Cause", "Percentage"],
    ["Cataract (untreated)", "66.2% — MOST COMMON"],
    ["Non-trachomatous corneal opacity", "7.4%"],
    ["Cataract surgical complications", "7.2%"],
    ["Other posterior segment disease", "5.9%"],
    ["Glaucoma", "5.5%"],
    ["Phthisis", "2.8%"],
    ["Aphakia uncorrected", "1.7%"],
    ["Diabetic retinopathy", "1.2%"],
    ["ARMD", "0.7%"],
    ["Trachomatous corneal opacity", "0.8%"],
    ["Refractive error", "0.1%"],
    ["All other globe/CNS abnormalities", "0.5%"],
]
story.append(box_table(causes_data, [10*cm, 7*cm]))
story.append(B("<i>Note: Retinopathy of Prematurity (ROP) is emerging as an important cause of childhood blindness.</i>"))
story.append(SP(6))

story.append(H2("Epidemiological Determinants"))
for label, text in [
    ("(a) Age:", "~30% of blind lose eyesight before age 20 years. Refractive error, trachoma, conjunctivitis, Vit A deficiency are important in children. Cataract, refractive error, glaucoma, diabetes — in middle age."),
    ("(b) Sex:", "Higher prevalence in females — attributed to higher prevalence of trachoma, conjunctivitis and cataract among females."),
    ("(c) Malnutrition:", "Closely related to low Vit A intake and infectious diseases (measles, diarrhoea). Keratomalacia largely in first 4–6 years of life, especially 6 months to 3 years."),
    ("(d) Occupation:", "Factory/workshop workers prone to eye injuries (dust, airborne particles, radiation, welding flash). Premature cataracts from X-rays, UV rays, heat waves."),
    ("(e) Social Class:", "Blindness is TWICE more prevalent in low socioeconomic groups — due to low standard of personal/community hygiene and inadequate health care."),
]:
    story.append(B(f"<b>{label}</b> {text}"))
story.append(SP(6))

story.append(H2("Changing Concepts in Eye Health Care"))
concepts_data = [
    ["Concept", "Description"],
    ["1. Primary Eye Care", "Inclusion of eye-care component in PHC system. Promotion, protection, on-the-spot treatment. Increases coverage through PHC approach."],
    ["2. Epidemiological Approach", "Population-level studies. Measures incidence and prevalence of diseases and risk factors. Local epidemiology determines action needed."],
    ["3. Team Concept", "Only 1 eye specialist per million people in developing countries. Gaps filled by village health workers, ophthalmic assistants, MPWs, voluntary agencies."],
    ["4. National Programmes", "Comprehensive national programmes replacing single-disease focus programmes."],
]
story.append(box_table(concepts_data, [4.5*cm, 12.5*cm]))
story.append(SP(6))

story.append(H2("NPCB — Programme Details"))
story.append(highlight_box(
    "<b>Launched: 1976</b> (with World Bank assistance in high-burden states)<br/>"
    "<b>Goal:</b> Reduce prevalence of blindness from 1.4% (1971) to <b>0.3% by 2020</b><br/>"
    "<b>Centrally Sponsored Scheme:</b> 60:40 (Centre:State) in all states | 90:10 in NE states",
    bg=LIGHT_TEAL
))
story.append(SP(6))

story.append(H2("Administrative Structure"))
admin_data = [
    ["Level", "Body"],
    ["Central", "Ophthalmology Section, Directorate General of Health Services (DGHS),\nMinistry of Health & FW, New Delhi"],
    ["State", "State Ophthalmic Cell / State Health Societies\n(merged with State Blindness Control Society after NRHM)"],
    ["District", "District Blindness Control Society\n(merged with District Health Society after NRHM)"],
]
story.append(box_table(admin_data, [3*cm, 14*cm]))
story.append(SP(6))

story.append(H2("Service Delivery and Referral System"))
ref_data = [
    ["Level", "Facility"],
    ["Tertiary", "Regional Institutes of Ophthalmology and Centres of Excellence in Eye Care; Medical Colleges"],
    ["Secondary", "District Hospital and NGO Eye Hospitals"],
    ["Primary", "Sub-district hospitals/CHCs; Mobile Ophthalmic Units; Upgraded PHCs; Link Workers/Panchayats"],
]
story.append(box_table(ref_data, [3*cm, 14*cm]))
story.append(SP(6))

story.append(H2("Key Strategies and Components of NPCB"))
for item in [
    "Strengthening of <b>service delivery infrastructure</b> at all levels",
    "<b>Human resource development</b> — training ophthalmologists and paramedical ophthalmic assistants (PMOAs)",
    "Outreach through <b>mobile ophthalmic units</b> (341 district mobile + 80 central) and eye camps",
    "<b>IEC</b> activities — case detection, referral of suspected cataract",
    "<b>School Eye Screening Programme</b>: 6–7% of children (10–14 years) have eye problems. Trained teachers screen first → ophthalmic assistants prescribe spectacles → free spectacles for BPL",
    "<b>Eye Donation and Eye Banking</b>: ~68,409 donated eyes collected in 2018–19 for corneal transplantation",
    "<b>Vision Centres</b> in all PHCs with PMOA in position",
    "Treatment of <b>other diseases</b>: diabetic retinopathy, glaucoma, refractive errors, corneal transplantation, vitreo-retinal surgery, childhood blindness",
    "Assistance for construction of dedicated eye units in <b>NE states and hilly areas</b>",
    "<b>Multipurpose District Mobile Ophthalmic Units</b> for difficult areas",
]:
    story.append(BL(item))
story.append(SP(6))

story.append(H2("NPCB at Sub-centre Level — MPW Duties"))
subcentre_data = [
    ["Type", "Duties"],
    ["Essential",
     "1. Detection of cases of impaired vision in house-to-house surveys and appropriate referral\n"
     "   — Record cases in the BLINDNESS REGISTER\n"
     "2. IEC: spreading awareness about eye problems, early detection, available treatment and referral facilities"],
    ["Desirable",
     "1. Cataract cases to be brought to district hospital by MPW/ANM/ASHAs\n"
     "2. Assisting in screening of school children for diminished vision and referral"],
]
story.append(box_table(subcentre_data, [3*cm, 14*cm]))
story.append(SP(6))

story.append(H2("Prevention of Blindness — Components for National Programme Action"))
for n, item in enumerate([
    "<b>Initial Assessment</b> — prevalence surveys to assess magnitude, geographic distribution and causes",
    "<b>Planning</b> — setting priorities; development of appropriate intervention programmes",
    "<b>Implementation</b> — evidence-based interventions",
    "<b>Evaluation</b> — monitoring programme outcomes",
], 1):
    story.append(Paragraph(f"{n}. {item}", bullet))
story.append(SP(6))

story.append(H2("NPCB&VI — Additional Initiatives for NE States (Tribal Areas)"))
for item in [
    "Assistance for construction of dedicated eye units in NE states including Sikkim and other hilly states",
    "Appointment of contractual ophthalmic manpower (surgeons, assistants, eye donation counsellors) to meet shortage",
    "Setting up of multipurpose district mobile ophthalmic units for diagnosis and medical management in difficult areas",
    "Besides cataract: assistance for diabetic retinopathy, glaucoma, refractive errors, corneal transplantation, vitreo-retinal surgery and childhood blindness",
]:
    story.append(BL(item))

story.append(PageBreak())

# ═══════════════════════════════════════
# VISION 2020
# ═══════════════════════════════════════
story.append(H1("PART C: VISION 2020 — THE RIGHT TO SIGHT"))
story.append(SP(4))

story.append(highlight_box(
    "<b>Launched by WHO: 18th February 1999</b><br/>"
    "A global initiative to <b>eliminate avoidable blindness</b>",
    bg=LIGHT_BLUE
))
story.append(SP(6))

story.append(H2("Key Distinctive Feature"))
story.append(B("One significant way this initiative <b>differs from previous ones</b>: the concept centres around <b>Rights issues</b>."))
story.append(B("Recognition of <b>sight as a fundamental human right</b> by all countries is an important catalyst of initiatives for prevention and control of blindness."))
story.append(SP(6))

story.append(H2("Objective of Vision 2020"))
story.append(B("To assist member countries in developing <b>sustainable systems</b> to eliminate avoidable blindness from major causes:"))
for item in [
    "<b>Cataract</b>",
    "<b>Xerophthalmia</b> and other causes of <b>childhood blindness</b>",
    "<b>Refractive error and low vision</b>",
    "<b>Trachoma</b> and other causes of <b>corneal blindness</b>",
]:
    story.append(BL(item))
story.append(B("...by the year <b>2020</b>."))
story.append(SP(6))

story.append(H2("India's Commitment to Vision 2020"))
story.append(B("India is committed to this initiative. The plan of action for the country is to develop sustainable systems — quality workshops in eye care for faculty of medical colleges; development of plan of action for Vision 2020."))
story.append(SP(6))

story.append(H1("GLOBAL EYE HEALTH ACTION PLAN 2014–2019"))
story.append(SP(4))

story.append(H2("Aim"))
story.append(B("Reduce avoidable visual impairment as a global public health problem and secure access to <b>rehabilitation services</b> for the visually impaired."))
story.append(SP(4))

story.append(H2("Five Principles / Approaches"))
principles_data = [
    ["#", "Principle"],
    ["1", "Universal access and equity"],
    ["2", "Human rights"],
    ["3", "Evidence-based practice"],
    ["4", "A life course approach"],
    ["5", "Empowerment of people with visual impairment"],
]
story.append(box_table(principles_data, [1.5*cm, 15.5*cm]))
story.append(SP(4))

story.append(H2("Key Features"))
for item in [
    "Addresses global trend towards <b>increasing chronic eye diseases related to ageing</b> (expected to be most prevalent causes of avoidable visual impairment in next decades)",
    "Built on <b>health system approach</b>: integration of eye care programmes into wider health care system at all levels (primary, secondary, tertiary)",
    "<b>Global Target:</b> Reduction in prevalence of avoidable visual impairment by <b>25% by 2019</b>, from baseline of 2010",
]:
    story.append(BL(item))
story.append(SP(4))

story.append(H2("Three Indicators at Goal and Purpose Level"))
ind_data = [
    ["#", "Indicator"],
    ["1", "Prevalence and causes of visual impairment"],
    ["2", "Number of eye care personnel"],
    ["3", "Cataract surgery"],
]
story.append(box_table(ind_data, [1.5*cm, 15.5*cm]))
story.append(SP(8))

story.append(HR())
story.append(B("<b>Source:</b> Park's Textbook of Preventive and Social Medicine (24th ed.), "
              "Chapter — Reproductive and Child Health Programme (pp. 511–517); "
              "Chapter — Epidemiology of Blindness and NPCB (pp. 452–456); "
              "Chapter — Vision 2020 (pp. 455–456)."))
story.append(SP(4))
story.append(B("<i>All content strictly as per Park's SPM — University Examination Reference</i>"))

# BUILD PDF
doc.build(story)
print("PDF generated at:", OUTPUT)