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Give proper long and detailed explanation answer from park

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  1. Strategic action plan for malaria control in India
  2. Telemedicine
  3. Integrated vector control
  4. NIKSHAY
  5. Vatsayan Kendra (ICTC)
  6. PPTCT (HIV)
  7. IPV
  8. NPCDCS
  9. National Tobacco Control Programme
  10. IDSP (syndrome, presumptive & control)
  11. END TB STRATE
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Park's textbook NPCDCS IDSP IPV Inactivated Polio Vaccine National Tobacco Control Programme End TB Strategy ICTC Vatsayan Kendra preventive medicine India

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NPCDCS National Programme Cancer Diabetes CVD Stroke India objectives components Park's textbook

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IDSP Integrated Disease Surveillance Programme India syndromic surveillance components Park's preventive medicine

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National Tobacco Control Programme India NTCP objectives activities Vatsayan Kendra ICTC integrated counselling testing centre End TB strategy India Park

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I now have comprehensive content from Park's textbook and authoritative sources for all 11 topics. Let me compile the detailed answers:Here are detailed, comprehensive answers for all 11 important questions from your list, drawn from Park's Textbook of Preventive and Social Medicine:

Health Important Questions - Detailed Answers from Park's Textbook

1. Strategic Action Plan for Malaria Control in India

Background

Prior to 1953, India had an estimated 75 million malaria cases and 0.8 million deaths annually. The National Malaria Control Programme (NMCP) was launched in 1953, changed to the National Malaria Eradication Programme in 1958, and cases fell to 0.1 million by 1965. Resurgence occurred in the early 1970s, reaching 6.46 million cases in 1976. In 1999, the programme was renamed the National Anti-Malaria Programme (NAMP), and in 2002, it became the National Vector Borne Disease Control Programme (NVBDCP).

National Framework for Malaria Elimination in India (2016-2030)

Launched in February 2016, this framework shifted India's vision from malaria control to sustained malaria elimination.
Goals:
  • Eliminate malaria (zero indigenous cases) throughout the entire country by 2030
  • Maintain malaria-free status in areas where transmission has been interrupted
Objectives - Time-Bound Targets:
YearTarget
2022Interrupt transmission in all 26 States/UTs under Categories 1 and 2 (as of 2014); zero indigenous cases
2024Reduce incidence to less than 1 case per 1000 population in all States/UTs and their districts
2027Indigenous transmission interrupted in all States/UTs of India
2030Malaria eliminated throughout the entire country; re-establishment of transmission prevented

Classification of States/UTs (2014)

CategoryDefinition
Category 0States with zero indigenous cases (no state currently)
Category 1 - Elimination phaseAPI < 1, all districts with API < 1 (15 States/UTs)
Category 2 - Pre-eliminationAPI < 1, but some districts with API ≥ 1 (11 states)
Category 3 - Intensified controlAPI ≥ 1 (10 States/UTs)
Category 1 states include: Himachal Pradesh, Punjab, J&K, Kerala, Manipur, Puducherry, Chandigarh, Uttarakhand, Haryana, Sikkim, Rajasthan, Daman & Diu, Goa, Delhi, Lakshadweep.
Category 3 (high burden): Andaman & Nicobar, Madhya Pradesh, Jharkhand, Arunachal Pradesh, Chattisgarh, Odisha, Meghalaya, Tripura, Mizoram, Dadar & Nagar Haveli.

Strategies of the National Framework

  1. Early diagnosis and radical treatment - using RDTs and bivalent RDTs, quality microscopy
  2. Case-based surveillance and rapid response
  3. Integrated Vector Management (IVM):
    • Indoor Residual Spray (IRS)
    • Long-Lasting Insecticidal Nets (LLINs) / Insecticide Treated Bed Nets (ITNs)
    • Larval Source Management (LSM)
  4. Epidemic preparedness and early response
  5. Monitoring and evaluation
  6. Advocacy, communication, and social mobilization

National Strategic Plan for Malaria Elimination 2017-2022

Launched in 2017, this plan focuses on:
  • Focus on high-endemic areas (Andhra Pradesh, Chhattisgarh, Jharkhand, MP, Maharashtra, Meghalaya, Mizoram, Odisha, Telangana, Tripura)
  • Special strategy for P. vivax elimination - India accounts for >50% of estimated P. vivax cases globally; radical 14-day primaquine therapy needed to kill hypnozoites
  • District as the unit of planning - stratification down to sub-centre and village level based on API

Key Drug Policies

  • 2010: New Drug Policy
  • 2006: ACT (Artemisinin Combination Therapy) introduced for chloroquine-resistant P. falciparum areas
  • 2008: ACT extended to 95% of P. falciparum-predominant districts
  • 2013: New Drug Policy 2013
(Park's Textbook of Preventive and Social Medicine, Ch. 7)

2. Telemedicine

Definition: Telemedicine is the use of electronic communication and information technologies to provide or support clinical care at a distance.

In the Indian Context

Telemedicine involves the delivery of healthcare services using information and communication technologies (ICT) where participants are geographically separated. It bridges the healthcare delivery gap between urban specialists and rural populations.

Components of Telemedicine

  1. Store-and-Forward (Asynchronous): Patient data (images, records) are transmitted to a specialist, who reviews them at a later time - used in radiology, dermatology, ophthalmology
  2. Real-time (Synchronous): Live audio-video consultations between provider and patient
  3. Remote Patient Monitoring (RPM): Vital signs and health data transmitted remotely for chronic disease management

Applications in Preventive Medicine (India)

  • eSanjeevani: India's National Telemedicine Service - allows patient-to-doctor and doctor-to-doctor consultations; integrated with Ayushman Bharat Health and Wellness Centres
  • Reducing geographic barriers - connecting rural and tribal populations to specialists
  • Mental health services via telepsychiatry
  • NCD management - remote BP, diabetes monitoring
  • Outbreak response - surveillance and rapid response coordination

Telemedicine Practice Guidelines (India, 2020)

India's Ministry of Health & Family Welfare released guidelines in March 2020 under the Indian Medical Council Act, legalizing telemedicine practice by registered medical practitioners. Key points:
  • RMPs can practice telemedicine for first consults and follow-ups
  • Written, audio, video, or text-based consultations allowed
  • Prescriptions can be given via telemedicine with conditions

Advantages

  • Increased access to specialist care in remote/rural areas
  • Cost reduction for patients (saves travel)
  • Continuity of care for chronic diseases
  • Reduces burden on tertiary care centers

3. Integrated Vector Control

From Park's textbook (in the context of vector-borne diseases including filariasis and malaria):
Integrated Vector Management (IVM) is defined as a rational decision-making process for optimal use of resources for vector control. It seeks to improve the efficacy, cost-effectiveness, ecological soundness, and sustainability of disease vector control.

Principles of IVM

  1. Evidence-based decision making - decisions supported by sound entomological and epidemiological data
  2. Collaboration within the health sector and with other sectors - e.g., water management for mosquito breeding control
  3. Advocacy, social mobilization, and legislation - community engagement
  4. Capacity building - skilled human resources for implementation
  5. Integrated approach - combining biological, chemical, and environmental methods

Vector Control Methods (Integrated)

  1. Environmental management:
    • Source reduction (eliminating breeding sites)
    • Modification of water bodies
    • Drainage of stagnant water
    • Proper solid waste management
  2. Biological control:
    • Use of larvivorous fish (e.g., Gambusia, Lebistes) in water bodies
    • Bacillus thuringiensis israelensis (Bti) for larval control
  3. Chemical methods:
    • Indoor Residual Spraying (IRS) - using DDT, synthetic pyrethroids, organophosphates
    • Larviciding - application of chemicals to water bodies
    • Space spraying/fogging - for adult mosquito control during epidemics
  4. Personal protection:
    • Insecticide-treated bed nets (ITNs)
    • Long-Lasting Insecticidal Nets (LLINs)
    • Repellents, protective clothing
  5. Genetic methods: Sterile insect technique (research stage)

For Filariasis (from Park's, p.320)

"None of the above vector control measures applied alone is likely to bring about sustained control of filariasis vectors. An integrated or combined approach is needed to control filariasis using all the above strategies and approaches in optimum combination."
Key breakthroughs:
  • Single dose annual DEC treatment
  • DEC-mediated salt (cooking salt) for community-level elimination
  • Insecticide sprays and polystyrene beads to seal latrines/roof-top water tanks
  • MDA with DEC + ivermectin combination (reduces microfilaraemia >95% at 2 years)
(Park's Textbook of Preventive and Social Medicine, Ch. 8 - Vector-borne Diseases)

4. NIKSHAY - TB Surveillance System

Definition and Meaning

"NIKSHAY" is a combination of two Hindi words - "NI" (meaning eradication/destruction) and "KSHAY" (meaning tuberculosis) - together meaning eradication of TB. It is a case-based, web-based IT system developed by the Central TB Division (CTD) in collaboration with the National Informatics Centre (NIC).
Launched: May 2012

Functional Components of NIKSHAY

  1. Master management
  2. User details (authentication and access control)
  3. TB patient registration - diagnosis details, DOT provider, HIV status, follow-up, contact tracing, outcomes
  4. Laboratory details - solid and liquid culture, DST (Drug Sensitivity Testing), LPA (Line Probe Assay), CBNAAT (Cartridge-Based Nucleic Acid Amplification Test) details
  5. DR-TB patient registration - drug-resistant TB details
  6. Referral and transfer of patients between facilities
  7. Private health facility registration and mandatory TB notification
  8. Mobile application for TB notification by private practitioners
  9. SMS alerts to patients upon registration (ensuring they are aware of their enrolment)
  10. SMS alerts to programme officers (for timely action)
  11. Automated periodic reports:
    • Case finding reports
    • Sputum conversion reports
    • Treatment outcome reports

IT-Enabled Adherence Tools

  • 99 DOTS - a digital adherence tool initially implemented for HIV-TB patients, to be expanded to all TB patients with daily dosing regimen

Direct Benefit Transfer (DBT)

  • TB patients reported in NIKSHAY are linked with AADHAR and PEMS (Patient and Empowerment Management System) to deliver financial benefits (e.g., Nikshay Poshan Yojana - nutritional support of Rs. 500/month) directly to patients and their providers.

TB Notification (Related)

  • As per Government of India notification dated 7th May 2012, it is mandatory for all healthcare providers to notify every TB case to local District Health Officer/Chief Medical Officer every month in the prescribed format.

Importance

NIKSHAY ensures:
  • Complete mapping of TB patients across both public and private sector
  • Real-time tracking of treatment outcomes
  • Reduction of TB transmission by MDR-TB
  • Evidence-based programme management
(Park's Textbook of Preventive and Social Medicine, Ch. 9 - RNTCP)

5. Vatsayan Kendra / ICTC - Integrated Counselling and Testing Centre

Definition

ICTC (Integrated Counselling and Testing Centre) is a facility where a person can be counselled and tested for HIV, either of his own free will (client-initiated) or as advised by a medical provider (provider-initiated).

Functions of ICTC

  1. Early detection of HIV infection
  2. Provision of basic information on modes of transmission and prevention of HIV/AIDS
  3. Promoting behavioral change and reducing vulnerability
  4. Linking PLHIV (People Living with HIV) with prevention, care, and treatment services (ART centers, PPTCT services)

Types of ICTC

A. Fixed Facility ICTCs:
  1. Standalone ICTC (SA-ICTC):
    • High client load
    • Full-time dedicated counsellor and laboratory technician
    • Located in medical colleges, district hospitals, sub-district hospitals, CHCs
    • Provides full HIV counselling and testing services
  2. Facility-Integrated Counselling and Testing Centres (F-ICTC):
    • Set up below block level at 24x7 PHCs
    • Existing health facility staff are trained in HIV counselling and testing
    • Logistic support from DAC (Department of AIDS Control)
    • Also includes PPP-ICTCs (Public-Private Partnership ICTCs) in private facilities (for-profit/not-for-profit hospitals, laboratories, NGOs) - provided with HIV testing kits, training, quality assurance, protective kits
B. Mobile ICTC:
  • A van equipped with a room for general examination, counselling, and blood sample collection
  • Staffed by a health educator/ANM, counsellor, and laboratory technician
  • Set up as temporary clinics in hard-to-reach areas with flexible working hours
  • Provides: HIV counselling and testing, syndromic management of STI/RTI, antenatal care, immunization services, minor ailment management

Community-Based HIV Screening

  • To ensure every pregnant woman receives HIV testing and all HIV-positive pregnant women are detected, community-based screening has been integrated with PPTCT services

Scale

As of the data cited in Park's, there are more than 15,000 ICTCs in the country.

Vatsayan Kendra

"Vatsayan Kendra" is another name used in some states for these ICTC facilities, especially in the context of adolescent and youth-friendly health counselling services. They provide a range of counselling services including HIV testing, family planning advice, and STI management.
(Park's Textbook of Preventive and Social Medicine, Ch. - NACP)

6. PPTCT - Prevention of Parent-to-Child Transmission of HIV

Definition

PPTCT stands for Prevention of Parent-to-Child Transmission of HIV (previously called PMTCT - Prevention of Mother-to-Child Transmission).

Background

  • The PPTCT programme was started in India in 2002
  • Initially used single-dose Nevirapine (SD-NVP) prophylaxis for HIV-positive pregnant women during labour and for the newborn immediately after birth
  • In September 2012, India transitioned to multi-drug ARV prophylaxis (Option B of WHO 2010 recommendations) - initially in Andhra Pradesh, Karnataka, and Tamil Nadu
  • From December 2013, India adopted lifelong ART using triple-drug regimen (TDF+3TC+EFV) for all pregnant and breastfeeding women living with HIV (Option B+), regardless of CD4 count or WHO clinical stage

Goal

To offer HIV testing to every pregnant woman (universal coverage) so as to cover all estimated HIV-positive pregnant women and eliminate vertical transmission of HIV from mother to child.

Essential Package of PPTCT Services

  1. Routine offer of HIV counselling and testing to all pregnant women enrolled in antenatal care, with an "opt-out" option
  2. Ensuring involvement of spouse and other family members - moving from "ANC-Centric" to "Family-Centric" approach
  3. Provision of lifelong ART (TDF+3TC+EFV) to all pregnant and breastfeeding HIV-infected women, regardless of CD4 count and clinical stage
  4. Promotion of institutional deliveries of all HIV-infected pregnant women
  5. Provision of care for associated conditions (STI/RTI, TB, and other opportunistic infections)
  6. Nutrition counselling and psychosocial support for HIV-infected pregnant women
  7. Counselling and support for initiation of exclusive breastfeeding within 1 hour of delivery as preferred option, continued for 6 months
  8. Provision of ARV prophylaxis to infants from birth up to a minimum of 6 months
  9. Integrating follow-up of HIV-exposed infants into routine healthcare services including immunization
  10. Ensuring initiation of Co-trimoxazole Prophylactic Therapy (CPT) and Early Infant Diagnosis (EID) using HIV-DNA PCR at 6 weeks of age onwards
  11. Strengthening community follow-up and outreach through local community networks to support HIV-positive pregnant women and families

Integration with RCH

The key goal is to ensure integrated PPTCT service delivery with the existing Reproductive and Child Health (RCH) programme.
(Park's Textbook of Preventive and Social Medicine - NACP Chapter)

7. IPV - Inactivated Polio Vaccine

Definition

IPV (Inactivated Polio Vaccine), also known as the Salk vaccine, is a killed-virus vaccine containing inactivated poliovirus types 1, 2, and 3, administered by injection (intramuscular or subcutaneous or intradermal route).

Introduction in India's UIP

  • IPV was introduced in India's Universal Immunization Programme (UIP) as two fractional doses (f-IPV) given intradermally (0.1 ml ID) at 6 and 14 weeks of age in the right upper arm
  • IPV supplemented the existing OPV (Oral Polio Vaccine) schedule to address the risk of circulating vaccine-derived poliovirus type 2 (cVDPV2) after withdrawal of trivalent OPV in April 2016

Why IPV is Important

  • Wild poliovirus type 2 was eradicated globally in 1999
  • After the switch from trivalent OPV to bivalent OPV (bOPV types 1 and 3), there was no type 2 protection from OPV
  • IPV provides serum antibodies against all three poliovirus types, protecting against paralytic poliomyelitis
  • IPV induces mucosal (oropharyngeal) immunity reducing oral transmission
  • Limitation: IPV alone has minimal effect on intestinal immunity in OPV-naive individuals, so it is used alongside OPV

IPV Schedule in India (UIP)

VaccineDoseRouteAge
IPV (fractional dose)0.1 mlIntradermal6 weeks
IPV (fractional dose)0.1 mlIntradermal14 weeks

Comparison: OPV vs. IPV

FeatureOPVIPV
TypeLive attenuatedKilled/inactivated
RouteOralInjection (IM/SC/ID)
VAPP riskYes (rare)None
Intestinal immunityExcellentMinimal in naive
Serum immunityGoodExcellent
Cold chain2-8°C2-8°C
AdministrationEasy, can be given by volunteersRequires trained worker

Global Context

Global poliovirus eradication strategy now uses IPV + bOPV combination to eliminate all polio types while preventing vaccine-associated paralytic poliomyelitis (VAPP).
(Park's Textbook of Preventive and Social Medicine - Immunization Chapter)

8. NPCDCS - National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke

Background

India is experiencing a rapid health transition with a rising burden of Non-Communicable Diseases (NCDs). NCDs (CVD, cancer, chronic respiratory diseases, diabetes) account for approximately 60% of all deaths in India.

Launch

NPCDCS was launched in 2010 with the primary focus on strengthening infrastructure, human resource development, health promotion, early diagnosis, management, and referral.

Components

NPCDCS has two main components:
  1. Cancer Component - including Tertiary Cancer Centres (TCC)
  2. Diabetes, Cardiovascular Diseases and Stroke (DCS) Component

Objectives of NPCDCS

  1. Prevent and control common NCDs through behaviour and lifestyle changes
  2. Provide early diagnosis and management of common NCDs
  3. Build capacity at various levels of healthcare for prevention, diagnosis, and treatment of common NCDs
  4. Train human resources (doctors, paramedics, nursing staff) to cope with increasing NCD burden
  5. Establish and develop capacity for palliative and rehabilitative care

Package of Services

Services are provided at various levels:
  • Sub-centre level: Health promotion, screening (BP measurement, blood sugar testing, BMI measurement)
  • PHC level: Risk factor assessment, basic management, referral
  • CHC/District hospital level: Specialist care, biopsy, ECG, specialist OPD
  • Tertiary level: Oncosurgery, radiotherapy, chemotherapy, cardiac surgery

Cancer Component

  • Tertiary Cancer Centres (TCCs): Support to 20 State Cancer Institutes (SCI) and 50 TCCCs
  • SCI: One-time grant of Rs. 120 crore per institute (Centre:State ratio 60:40; 90:10 for NE/Hilly states)
  • TCCC: One-time grant of Rs. 45 crore per centre
  • Focus on cervical cancer screening (VIA/VILI), breast cancer screening (CBE/mammography), oral cancer screening (visual inspection)

Screening Activities (Three Common Cancers)

  • Cervical cancer: VIA (Visual Inspection with Acetic Acid), Pap smear
  • Breast cancer: Clinical Breast Examination (CBE), mammography
  • Oral cancer: Visual inspection of oral cavity

Integration with NHM

NPCDCS aims at integration of NCD interventions within the NHM (National Health Mission) framework for optimization of scarce resources and long-term sustainability.

9. National Tobacco Control Programme (NTCP)

Background

Tobacco use is a major public health problem in India. India has approximately 274 million tobacco users. Tobacco causes cancer, cardiovascular disease, chronic respiratory disease, and other conditions.

Launch

NTCP was launched in 2007-08 during the 11th Five Year Plan.

Primary Objectives of NTCP

  1. Create awareness about the harmful effects of tobacco consumption
  2. Reduce production and supply of tobacco products
  3. Ensure effective implementation of provisions under COTPA 2003 (Cigarettes and Other Tobacco Products Act)
  4. Support tobacco users to quit tobacco
  5. Facilitate implementation of WHO-FCTC (Framework Convention on Tobacco Control) measures

COTPA 2003 - Key Provisions

SectionProvision
Section 4Prohibition of smoking in public places
Section 5Prohibition of direct and indirect advertising, promotion, and sponsorship of tobacco products
Section 6(a)Prohibition of sale of tobacco to persons under 18 years of age
Section 6(b)Prohibition of sale within 100 yards of any educational institution
Section 7Mandatory depiction of specified pictorial health warnings on all tobacco product packs (pictorial warnings cover 85% of pack)

Organisational Structure of NTCP (3-Tier)

  1. National Tobacco Control Cell (NTCC): Set up under Ministry of Health & Family Welfare for overall policy formulation, planning, monitoring, and evaluation
  2. State Tobacco Control Cells (STCC): At state level for coordination and supervision
  3. District Tobacco Control Cells (DTCC): At district level for implementation

Key Activities Under NTCP

  1. Tobacco Cessation Centres (TCC): Established at district hospitals and medical colleges to help tobacco users quit; provide behavioral counselling and pharmacotherapy (NRT, varenicline, bupropion)
  2. National Tobacco Quitline (1800-11-2356): Free toll-free cessation support
  3. mCessation Programme: Mobile phone-based behaviour change intervention using SMS to help users quit
  4. IEC (Information, Education, Communication) activities: Mass media campaigns, school health programmes, public awareness
  5. Enforcement of COTPA: Monitoring compliance with bans on advertising, smoking in public places, pictorial health warnings

TB-Tobacco Collaboration (NTCP-RNTCP)

A National Framework for Joint TB-Tobacco Collaborative Activities has been developed to:
  • Identify tobacco users among registered TB patients and provide "Brief Advice" for cessation
  • Screen TB symptoms in tobacco users registered at TCCs
  • This is a "win-win" strategy as TB and tobacco share a common risk population

10. IDSP - Integrated Disease Surveillance Programme

Background

IDSP is a decentralized, state-based disease surveillance programme launched by the Government of India in November 2004 with financial assistance from the World Bank. A Central Surveillance Unit is set up at the National Centre for Disease Control (NCDC), New Delhi.

Objectives of IDSP

  1. Establish a decentralized district-based system of surveillance for communicable and non-communicable diseases so that timely public health actions can be initiated
  2. Detect early warning signals of impending outbreaks and help initiate effective response
  3. Integrate existing surveillance activities to avoid duplication and facilitate sharing across all disease control programmes
  4. Monitor progress of ongoing disease control programmes
  5. Allocate health resources more efficiently based on surveillance data

Three Types of Surveillance Data Collected (S-P-L Format)

FormatTypeDescription
SSyndromicBased on clinical symptoms - collected by health workers weekly at sub-centre/PHC level; captures syndromes like fever, diarrhoea, respiratory illness, jaundice
PProbableBased on clinical case definitions by medical officers at PHC/CHC/block level
LLaboratoryConfirmed laboratory-based data from designated laboratories
Data is collected weekly (Monday to Sunday) from all districts on epidemic-prone diseases.

Diseases Covered Under IDSP

Epidemic-prone diseases include:
  • Acute Diarrhoeal Disease (ADD)
  • Acute Respiratory Illness
  • Fever (unknown cause)
  • Viral Hepatitis
  • Malaria
  • Dengue/Chikungunya
  • Meningitis
  • Unusual syndromes (haemorrhagic fever, respiratory distress, meningoencephalitis)

Organisational Structure

  • Central Surveillance Unit (CSU): At NCDC, Delhi - national-level data analysis and response
  • State Surveillance Unit (SSU): In all states and UTs
  • District Surveillance Unit (DSU): In all districts - the hub of surveillance activities - responsible for data collection, analysis, and outbreak response

Rapid Response Teams (RRTs)

Whenever a rising trend of illnesses is detected in any area, it is investigated by trained Rapid Response Teams which include epidemiologists, microbiologists, entomologists, and clinicians.

Presumptive Surveillance

IDSP's syndromic ("S") component allows health workers to detect and report unusual clustering of symptoms at the community level before laboratory confirmation, enabling rapid early response.

Control Functions Under IDSP

  1. Case detection - identifying cases
  2. Outbreak investigation - field epidemiology, environmental sampling
  3. Contact tracing - for communicable diseases
  4. Containment measures - isolation, treatment, disinfection, vector control
  5. Feedback and dissemination - reporting back to states, districts, and implementing agencies

IHIP (Integrated Health Information Platform)

In November 2019, the IHIP was launched to upgrade IDSP's digital surveillance capabilities, capturing individualized patient data that can be disaggregated by age, sex, geography for more precise outbreak analysis.
(Park's Textbook of Preventive and Social Medicine - Epidemiology Chapter)

11. End TB Strategy

Background

Tuberculosis (TB) remains one of the leading infectious disease killers globally. India has the highest TB burden globally, accounting for about 27% of the world's TB cases.

WHO End TB Strategy (2014)

In 2014, the World Health Assembly unanimously approved the End TB Strategy - the first time governments set a global goal to end TB. The strategy aims to end the TB epidemic by 2035.

Three Pillars of WHO's End TB Strategy

  1. Integrated, patient-centered care and prevention
  2. Bold policies and supportive systems
  3. Intensified research and innovation

WHO Targets for End TB

  • 90% reduction in TB deaths by 2030 (vs. 2015 baseline)
  • 80% reduction in TB incidence rate by 2030 (vs. 2015 baseline)
  • Zero TB-affected families facing catastrophic costs

India's National Strategic Plan (NSP) to End TB 2020-2025

India has set an ambitious target to eliminate TB by 2025 - 5 years ahead of the global target of 2030 - in alignment with Sustainable Development Goal 3 (SDG 3: Good Health and Well-being).

India's NSP: Four Pillars (DETECT - TREAT - PREVENT - BUILD)

PillarDescription
DETECTEarly, universal and comprehensive diagnosis; CBNAAT, LPA, TrueNat for rapid diagnosis; active case finding in high-risk populations
TREATInitiate treatment for all diagnosed cases; address drug-resistant TB; daily dosing regimen (DOTS-Plus); NIKSHAY Poshan Yojana (nutritional support)
PREVENTInfection prevention and control; Latent TB Infection (LTBI) treatment; BCG vaccination; TB-HIV collaborative activities; tobacco cessation
BUILDStrengthen health systems; mandatory notification; engage private sector; increase domestic financing; community engagement

National Tuberculosis Elimination Programme (NTEP)

In 2020, the Government of India renamed the Revised National Tuberculosis Control Programme (RNTCP) to the National TB Elimination Programme (NTEP), reflecting India's accelerated goal of eliminating TB before the global target.

Key Initiatives Under End TB in India

  1. NIKSHAY - case-based web surveillance system (launched 2012)
  2. Nikshay Poshan Yojana - Rs. 500/month nutritional support to TB patients
  3. 99 DOTS - digital adherence monitoring for daily regimen
  4. CBNAAT/TrueNat rollout - rapid molecular diagnosis
  5. Universal Drug Susceptibility Testing (UDST) - all TB patients tested for drug resistance
  6. Bedaquiline and Delamanid - new drugs for MDR/XDR-TB
  7. TB Harega Desh Jeetega campaign - national awareness campaign
  8. Private sector engagement - mandatory TB notification since May 2012
  9. Joint TB-Tobacco Collaborative Activities - as comorbidity management

Key Indicators Monitored

  • Case Notification Rate (CNR) per lakh population
  • Treatment Success Rate (TSR) - target ≥90%
  • Annual Risk of Tuberculous Infection (ARTI)
  • Sputum conversion rate at 2 months
(Park's Textbook of Preventive and Social Medicine, Ch. 9 - Tuberculosis; End TB Strategy references)

Summary Table

Sr. No.TopicKey Points
1Strategic Action Plan for MalariaNational Framework 2016-2030, eliminate malaria by 2030, 4-category state classification, IVM strategies
2TelemedicineICT-based healthcare delivery, eSanjeevani, India 2020 guidelines, 3 types: store-forward, real-time, RPM
3Integrated Vector ControlIVM: environmental, biological, chemical, personal protection; MDA for filariasis
4NIKSHAYWeb IT system for TB, launched May 2012, NI+KSHAY, 11 components, SMS alerts, 99 DOTS, DBT-Aadhar linkage
5Vatsayan Kendra / ICTCHIV counselling and testing centre, 3 types (SA-ICTC, F-ICTC, Mobile ICTC), 15,000+ centres
6PPTCTStarted 2002, Option B+ (lifelong ART), 11 service components, Family-Centric approach, EID at 6 weeks
7IPVInactivated polio vaccine, 2 fractional intradermal doses at 6 and 14 weeks, no VAPP risk, protects against type 2 post-OPV switch
8NPCDCSLaunched 2010, Cancer + DCS components, 5 objectives, NCD clinics at all levels, 3 cancer screening programmes
9National Tobacco Control ProgrammeLaunched 2007-08, COTPA 2003, TCCs, Quitline 1800-11-2356, mCessation, 3-tier structure, TB-Tobacco collaboration
10IDSPLaunched 2004 (World Bank), S-P-L surveillance format, weekly reporting, RRTs, IHIP upgrade 2019
11End TB StrategyWHO 2014, India NSP 2020-2025, target 2025 (ahead of global 2030), DETECT-TREAT-PREVENT-BUILD, NTEP renamed from RNTCP in 2020
Source: Park's Textbook of Preventive and Social Medicine (26th edition), supplemented with NHM/GOI official programme guidelines and WHO End TB Strategy documents.All 11 topics have been covered in detail. Here is a quick recap of what each answer contains:
All 11 topics answered from Park's Textbook of Preventive and Social Medicine:
  1. Strategic Action Plan for Malaria - National Framework 2016-2030, 4-category state classification, time-bound targets (2022-2030), IVM strategies, NSP 2017-2022, special P. vivax strategy
  2. Telemedicine - Definition, types (synchronous/asynchronous/RPM), eSanjeevani, India's 2020 Telemedicine Practice Guidelines, advantages and applications in preventive medicine
  3. Integrated Vector Control (IVM) - Environmental, biological, chemical, personal protection methods combined; MDA for filariasis; principles from WHO/Park's
  4. NIKSHAY - Launched May 2012, meaning (NI+KSHAY = eradication of TB), all 11 functional components, 99 DOTS, DBT-Aadhar linkage, automated reports
  5. Vatsayan Kendra / ICTC - HIV counselling and testing centre, 3 types (Standalone, Facility-integrated, Mobile ICTC), 15,000+ centres, functions, community-based HIV screening
  6. PPTCT - Started 2002, evolution from SD-NVP to Option B+, all 11 essential service components, Family-Centric approach, Early Infant Diagnosis at 6 weeks
  7. IPV - Killed Salk vaccine, 2 fractional intradermal doses at 6 and 14 weeks, role after bOPV switch, OPV vs IPV comparison
  8. NPCDCS - Launched 2010, 2 components (Cancer + DCS), 5 objectives, services at all health levels, TCC/SCI funding, 3-cancer screening programme
  9. National Tobacco Control Programme - Launched 2007-08, COTPA 2003 provisions, 3-tier structure, TCCs, Quitline (1800-11-2356), mCessation, TB-Tobacco collaboration
  10. IDSP - Launched November 2004 (World Bank funded), S-P-L weekly format, CSU/SSU/DSU structure, RRTs, diseases covered, IHIP 2019 upgrade
  11. End TB Strategy - WHO 2014 strategy, India's NSP 2020-2025 (target 2025), DETECT-TREAT-PREVENT-BUILD pillars, NTEP (renamed from RNTCP in 2020), key initiatives (Nikshay Poshan Yojana, 99 DOTS, CBNAAT, Bedaquiline)

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Strategic Action Plan for Malaria Control in India

(From Park's Textbook of Preventive and Social Medicine)

Historical Background - Milestones

YearMilestone
Prior to 195375 million malaria cases; 0.8 million deaths annually
1953National Malaria Control Programme (NMCP) launched during 1st Five Year Plan
1958NMCP converted to National Malaria Eradication Programme (NMEP) - spectacular success
1965Cases reduced to 0.1 million
Early 1970sResurgence of malaria
1976Cases rose back to 6.46 million
1977Modified Plan of Operations implemented
1997World Bank-assisted Enhanced Malaria Control Project (EMCP) launched
1999Renamed to National Anti Malaria Programme (NAMP)
2002Renamed to National Vector Borne Disease Control Programme (NVBDCP)
2005Global Fund-assisted Intensified Malaria Control Project (IMCP) launched; NVBDCP integrated into NRHM; RDTs introduced
2006ACT (Artemisinin Combination Therapy) introduced in chloroquine-resistant P. falciparum areas
2008ACT extended to high Pf-predominant districts (95% Pf cases); World Bank-supported National Malaria Control Project launched
2009LLINs (Long-Lasting Insecticidal Nets) introduced
2010New Drug Policy 2010
2012Introduction of bivalent RDT
2013New Drug Policy 2013
2016National Framework for Malaria Elimination in India 2016-2030 launched
2017National Strategic Plan for Malaria Elimination 2017-2022 launched

Three-Pronged Strategy of NVBDCP

Under NVBDCP, the three-pronged strategy for prevention and control of vector-borne diseases is:
  1. Disease management - early case detection, complete treatment, strengthening referral services, epidemic preparedness and rapid response
  2. Integrated Vector Management (IVM) - Indoor Residual Spraying (IRS) in high-risk areas, insecticide-treated bed nets (ITNs), larvivorous fish, anti-larval measures, source reduction, environmental engineering
  3. Supportive interventions - Behaviour Change Communication (BCC), public-private partnership, inter-sectoral convergence, human resource development, operational research, monitoring and evaluation, web-based MIS, vaccination against JE, annual MDA against lymphatic filariasis

National Framework for Malaria Elimination in India (2016-2030)

Launched in February 2016. India's vision shifted from malaria control to sustained malaria elimination.

Goals

In line with WHO Global Technical Strategy (GTS) for Malaria 2016-2030 and Asia Pacific Leaders Malaria Alliance (APLMA) Malaria Elimination Roadmap:
  1. Eliminate malaria (zero indigenous cases) throughout the entire country by 2030
  2. Maintain malaria-free status in areas where transmission has been interrupted and prevent re-introduction

Time-Bound Objectives

Target YearObjective
2022Transmission interrupted and zero indigenous cases in all 26 States/UTs (Categories 1 and 2 as of 2014)
2024Incidence reduced to < 1 case per 1000 population in all States/UTs and their districts
2027Indigenous transmission interrupted in all States/UTs of India
2030Malaria eliminated throughout entire country; re-establishment of transmission prevented

Programme Phasing - Classification of States/UTs (2014)

States are categorized based on API (Annual Parasite Incidence) as the primary criterion, with ABER (Annual Blood Examination Rate) and SPR (Slide Positivity Rate) as secondary criteria:
CategoryDefinitionNo. of States/UTs
Category 0 - Prevention of re-establishmentStates with zero indigenous casesNone currently
Category 1 - Elimination phaseAPI < 1, all districts reporting API < 115 States/UTs
Category 2 - Pre-elimination phaseAPI < 1, but some districts reporting API ≥ 111 States
Category 3 - Intensified control phaseAPI ≥ 110 States/UTs
Category 1 States/UTs: Himachal Pradesh, Punjab, J&K, Kerala, Manipur, Puducherry, Chandigarh, Uttarakhand, Haryana, Sikkim, Rajasthan, Daman & Diu, Goa, Delhi, Lakshadweep
Category 2 States: Bihar, Tamil Nadu, Telangana, UP, Karnataka, West Bengal, Andhra Pradesh, Assam, Maharashtra, Gujarat, Nagaland
Category 3 States (High Burden): Andaman & Nicobar, Madhya Pradesh, Dadar & Nagar Haveli, Jharkhand, Arunachal Pradesh, Chhattisgarh, Odisha, Meghalaya, Tripura, Mizoram

District-Level Stratification (District as Unit of Planning)

Each district stratifies its PHCs and sub-centres into 5 strata based on API:
  1. Zero cases
  2. API > 0 to < 1
  3. API 1 to < 2
  4. API 2 to < 5
  5. API ≥ 5
This allows Category 2 states to initiate elimination activities in low-burden districts even while others are still in the intensified control phase.

Broad Strategies of the Malaria Elimination Framework

  1. Early diagnosis and radical treatment
  2. Case-based surveillance and rapid response
  3. Integrated Vector Management (IVM):
    • Indoor Residual Spray (IRS)
    • Long-Lasting Insecticidal Nets (LLINs) / ITNs
    • Larval Source Management (LSM)
  4. Epidemic preparedness and early response
  5. Monitoring and evaluation
  6. Advocacy, coordination and partnerships
  7. Behaviour Change Communication (BCC) and community mobilization
  8. Programme planning and management

Category-Specific Interventions

Category 3 - Intensified Control Phase (API ≥ 1)

  1. Massive scaling up of disease management and preventive approaches
  2. Screening of all fever cases suspected for malaria
  3. Classification of areas by local malaria epidemiology; tailored interventions
  4. Strengthening intersectoral collaboration; special interventions for tribal populations and hard-to-reach/conflict-affected areas
  5. One-stop centres or mobile clinics on fixed days in tribal areas for malaria diagnosis and treatment
  6. Timely referral and treatment of severe malaria to reduce mortality
  7. Strengthening district/sub-district hospitals as per Indian Public Health Standards for severe malaria management
  8. Robust supply chain management system
  9. Optimum surveillance using microscopy and RDTs
  10. Equipping all health institutions with microscopy, RDTs, and injectable artemisinin derivatives for severe malaria

Category 2 - Pre-Elimination Phase (API < 1, some districts API ≥ 1)

  • Setting up elimination surveillance system
  • Initiating elimination phase activities in districts where API has been reduced below 1
  • Planning based on epidemiological investigation and classification of each case and focus

Category 1 - Elimination Phase (API < 1 in all districts)

  1. All efforts directed at interrupting local transmission in all active foci
  2. Mandatory notification of each malaria case from private sector and all other health facilities
  3. Adequate case-based surveillance and complete case management
  4. Investigation and classification of all malaria foci
  5. Total coverage of all active foci by effective vector control measures
  6. Early detection and treatment using Active Case Detection (ACD) and Passive Case Detection (PCD)
  7. State and national level malaria elimination database established
  8. Interventions for mobile and migrant populations screening
  9. Effective epidemic forecasting and response system
  10. Quality assurance of all medicines and diagnostics
  11. Establishment of State Reference Laboratory - all positive slides sent for confirmation; 100% notification to laboratory after elimination achieved; immediate SMS/e-mail alert for each positive case with name, gender, address, date, parasite type

Category 0 - Prevention of Re-establishment

  1. Detect any re-introduced case
  2. Immediately notify all detected cases
  3. Determine causes of resumed local transmission
  4. Apply rapid curative and preventive measures
  5. Prevent re-introduction of malaria
  6. Maintain malaria-free status

Surveillance System

  • Active Case Detection (ACD): Blood smears collected by MPWs/ANMs during fortnightly house visits in rural areas
  • Passive Case Detection (PCD): Fever cases reporting to peripheral health volunteers/ASHAs, sub-centres, malaria clinics, CHCs, secondary/tertiary hospitals
  • ABER (Annual Blood Examination Rate): Maintained at ~10% nationally; much higher in high-endemic areas
  • About 100 million blood slides collected from fever cases annually; ~1.5 million malaria cases detected
  • RDTs deployed at ASHA level for point-of-care diagnosis
  • Programme plans to supply RDT kits to private providers in exchange for data

Special Strategy for P. vivax Elimination

India accounts for > 50% of estimated global P. vivax cases. P. vivax elimination is especially challenging because:
  1. Hypnozoites prolong parasite lifespan and are difficult to detect
  2. RDTs for P. vivax are less sensitive than those for P. falciparum
  3. Radical treatment requires 14 days of primaquine (vs. only 3 days for P. falciparum ACT)
  4. P. vivax has a longer incubation period
Special measures for P. vivax elimination:
  • Expanding bivalent RDTs and quality microscopy to detect all P. vivax infections
  • Ensuring compliance with 14-day radical primaquine treatment
  • Tackling urban malaria by targeting An. stephensi by antilarval measures

Focus on High-Endemic Areas and Tribal Population

Most malaria cases reported from: Andhra Pradesh, Chhattisgarh, Jharkhand, MP, Maharashtra, Meghalaya, Mizoram, Odisha, Telangana, and Tripura - particularly in tribal populations in foothills, forested, and conflict-affected areas.
The programme plans to scale up interventions in these areas with innovative strategies.

Key Indicators for Monitoring

IndicatorFull Form
APIAnnual Parasite Incidence = (Confirmed malaria cases / Population at risk) × 1000
ABERAnnual Blood Examination Rate = (Blood slides examined / Population) × 100
SPRSlide Positivity Rate = (Positive slides / Total slides examined) × 100
PFPRP. falciparum Proportion Rate

Drug Policy Highlights

YearPolicy
2006ACT introduced for chloroquine-resistant P. falciparum
2008ACT extended to 95% of Pf-predominant districts
2010New Drug Policy 2010
2012Bivalent RDT introduced
2013New Drug Policy 2013
Source: Park's Textbook of Preventive and Social Medicine, 26th Edition, Chapter on Vector-Borne Diseases (NVBDCP) and National Framework for Malaria Elimination, pp. 469-473.
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