mkdir -p /home/daytona/workspace/national-health-programs && cat > /home/daytona/workspace/national-health-programs/generate_pdf.py << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.units import cm, mm from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, PageBreak, HRFlowable, Table, TableStyle, KeepTogether from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY from reportlab.platypus import BaseDocTemplate, PageTemplate, Frame import reportlab.platypus as platypus # ── Page setup ────────────────────────────────────────────────────────────── doc = SimpleDocTemplate( "/home/daytona/workspace/national-health-programs/National_Health_Programs_Park.pdf", pagesize=A4, rightMargin=2*cm, leftMargin=2*cm, topMargin=2.2*cm, bottomMargin=2.2*cm, title="National Health Programs – Park's Textbook", author="Park's Textbook of Preventive and Social Medicine" ) W, H = A4 # ── Styles ─────────────────────────────────────────────────────────────────── styles = getSampleStyleSheet() cover_title = ParagraphStyle('CoverTitle', parent=styles['Title'], fontSize=26, leading=32, spaceAfter=8, textColor=colors.HexColor('#1a3a5c'), alignment=TA_CENTER, fontName='Helvetica-Bold') cover_sub = ParagraphStyle('CoverSub', parent=styles['Normal'], fontSize=13, leading=18, spaceAfter=6, textColor=colors.HexColor('#2c6496'), alignment=TA_CENTER, fontName='Helvetica') cover_note = ParagraphStyle('CoverNote', parent=styles['Normal'], fontSize=10, leading=14, spaceAfter=4, textColor=colors.HexColor('#555555'), alignment=TA_CENTER, fontName='Helvetica-Oblique') prog_heading = ParagraphStyle('ProgHeading', parent=styles['Heading1'], fontSize=15, leading=20, spaceBefore=0, spaceAfter=6, textColor=colors.HexColor('#ffffff'), fontName='Helvetica-Bold', backColor=colors.HexColor('#1a3a5c'), borderPad=6, leftIndent=0, rightIndent=0) section_heading = ParagraphStyle('SectionHeading', parent=styles['Heading2'], fontSize=11, leading=14, spaceBefore=8, spaceAfter=3, textColor=colors.HexColor('#1a3a5c'), fontName='Helvetica-Bold', borderPad=2) body = ParagraphStyle('Body', parent=styles['Normal'], fontSize=10, leading=14.5, spaceAfter=5, fontName='Helvetica', alignment=TA_JUSTIFY) bullet = ParagraphStyle('Bullet', parent=styles['Normal'], fontSize=10, leading=14, spaceAfter=3, fontName='Helvetica', leftIndent=14, bulletIndent=4, alignment=TA_JUSTIFY) source_style = ParagraphStyle('Source', parent=styles['Normal'], fontSize=8, leading=11, spaceAfter=2, fontName='Helvetica-Oblique', textColor=colors.HexColor('#888888'), alignment=TA_RIGHT) subhead = ParagraphStyle('Subhead', parent=styles['Normal'], fontSize=10.5, leading=13, spaceBefore=6, spaceAfter=3, fontName='Helvetica-Bold', textColor=colors.HexColor('#2c5f8a')) story = [] # ── Helper functions ────────────────────────────────────────────────────────── def add_program_header(title, num): story.append(Paragraph(f"Programme {num}", source_style)) # Colored header bar data = [[Paragraph(title, prog_heading)]] t = Table(data, colWidths=[doc.width]) t.setStyle(TableStyle([ ('BACKGROUND', (0,0), (-1,-1), colors.HexColor('#1a3a5c')), ('LEFTPADDING', (0,0), (-1,-1), 10), ('RIGHTPADDING', (0,0), (-1,-1), 10), ('TOPPADDING', (0,0), (-1,-1), 8), ('BOTTOMPADDING', (0,0), (-1,-1), 8), ])) story.append(t) story.append(Spacer(1, 5)) def h(text): story.append(Paragraph(text, section_heading)) def sh(text): story.append(Paragraph(text, subhead)) def p(text): story.append(Paragraph(text, body)) def b(text): story.append(Paragraph(f"• {text}", bullet)) def src(): story.append(Paragraph("Reference: Park's Textbook of Preventive and Social Medicine", source_style)) story.append(HRFlowable(width="100%", thickness=0.5, color=colors.HexColor('#cccccc'), spaceAfter=4)) def page_break(): story.append(PageBreak()) # ══════════════════════════════════════════════════════════════════════════════ # COVER PAGE # ══════════════════════════════════════════════════════════════════════════════ story.append(Spacer(1, 3*cm)) story.append(Paragraph("NATIONAL HEALTH PROGRAMMES", cover_title)) story.append(Spacer(1, 0.5*cm)) story.append(Paragraph("of India", cover_title)) story.append(Spacer(1, 1.2*cm)) # Decorative line story.append(HRFlowable(width="60%", thickness=2.5, color=colors.HexColor('#2c6496'), spaceAfter=12)) story.append(Spacer(1, 0.5*cm)) story.append(Paragraph("Based on Park's Textbook of Preventive and Social Medicine", cover_sub)) story.append(Spacer(1, 0.4*cm)) story.append(Paragraph("Prepared for MBBS University Examinations", cover_sub)) story.append(Spacer(1, 1.5*cm)) story.append(HRFlowable(width="60%", thickness=2.5, color=colors.HexColor('#2c6496'), spaceAfter=12)) story.append(Spacer(1, 1.5*cm)) story.append(Paragraph("Each programme covered in exam-ready detail (~2 pages)", cover_note)) story.append(Paragraph("Community Medicine | Preventive & Social Medicine", cover_note)) story.append(Spacer(1, 2*cm)) # Table of Contents toc_data = [ [Paragraph('<b>No.</b>', body), Paragraph('<b>Programme</b>', body)], ['1', 'National Health Mission (NHM)'], ['2', 'National Urban Health Mission (NUHM)'], ['3', 'RMNCH+A Strategy'], ['4', 'National AIDS Control Programme (NACP)'], ['5', 'National TB Elimination Programme (NTEP)'], ['6', 'Revised National TB Control Programme (RNTCP)'], ['7', 'National Leprosy Eradication Programme (NLEP)'], ['8', 'National Vector Borne Disease Control Programme (NVBDCP)'], ['9', 'Universal Immunization Programme (UIP)'], ['10', 'NPCDCS (Cancer, Diabetes, CVD & Stroke)'], ['11', 'National Mental Health Programme (NMHP)'], ['12', 'National Programme for Health Care of Elderly (NPHCE)'], ['13', 'National Programme for Prevention & Control of Deafness (NPPCD)'], ['14', 'National Programme for Control of Blindness (NPCB)'], ['15', 'National Tobacco Control Programme (NTCP)'], ['16', 'National Iodine Deficiency Disorders Control Programme (NIDDCP)'], ['17', 'National Oral Health Programme (NOHP)'], ['18', 'National Programme for Control of NCDs (NPNCD)'], ['19', 'Ayushman Bharat Programme'], ['20', 'Anemia Mukt Bharat Programme'], ['21', 'Balwadi Nutrition Programme'], ] toc_style = TableStyle([ ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#1a3a5c')), ('TEXTCOLOR', (0,0), (-1,0), colors.white), ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'), ('FONTSIZE', (0,0), (-1,-1), 9), ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#eef4fb'), colors.white]), ('GRID', (0,0), (-1,-1), 0.4, colors.HexColor('#aaaaaa')), ('LEFTPADDING', (0,0), (-1,-1), 6), ('RIGHTPADDING', (0,0), (-1,-1), 6), ('TOPPADDING', (0,0), (-1,-1), 4), ('BOTTOMPADDING', (0,0), (-1,-1), 4), ('VALIGN', (0,0), (-1,-1), 'TOP'), ]) toc_table = Table(toc_data, colWidths=[1.2*cm, doc.width - 1.2*cm]) toc_table.setStyle(toc_style) story.append(toc_table) story.append(PageBreak()) # ══════════════════════════════════════════════════════════════════════════════ # 1. NATIONAL HEALTH MISSION # ══════════════════════════════════════════════════════════════════════════════ add_program_header("1. NATIONAL HEALTH MISSION (NHM)", 1) h("Introduction") p("The Ministry of Health and Family Welfare implements various schemes, programmes and national initiatives to provide universal access to quality health care. The National Health Mission (NHM) was approved in May 2013 as an overarching umbrella under which the <b>National Rural Health Mission (NRHM)</b> and <b>National Urban Health Mission (NUHM)</b> function as two sub-Missions.") h("Main Programmatic Components") b("Health system strengthening in rural and urban areas.") b("Reproductive – Maternal – Newborn – Child and Adolescent Health (RMNCH+A).") b("Control of communicable and non-communicable diseases.") p("An important achievement of NHM has been considerable reduction in out-of-pocket expenses from 72% to 60%.") h("Historical Milestones under NHM") b("1992 – Child Survival and Safe Motherhood Programme (CSSM)") b("1997 – RCH I") b("2005 – RCH II and National Rural Health Mission") b("2013 – RMNCH+A Strategy and National Health Mission") b("2014 – India Newborn Action Plan (INAP)") b("2018 – Ayushman Bharat Programme") h("Key Interventions Under NHM") b("Promotion of institutional deliveries through <b>Janani Suraksha Yojana (JSY)</b>.") b("Capacity building of health care providers in basic and comprehensive obstetric care.") b("Operationalization of sub-centres, PHCs, CHCs and district hospitals for 24×7 obstetric care.") b("Name-based web-enabled tracking of pregnant women for ANC, intranatal and postnatal care.") b("Mother and child protection card in collaboration with Ministry of Women and Child Development.") b("Antenatal, intranatal and postnatal care including iron and folic acid supplementation.") b("Village Health and Nutrition Days in rural areas as outreach activity.") b("<b>Janani Shishu Suraksha Karyakram (JSSK)</b>: Entitles all pregnant women delivering in public institutions to absolutely free delivery including caesarean section, free drugs, diagnostics, blood and diet.") h("Infrastructure Strengthening") p("NHM aims to increase access to a decentralized health system by establishing new infrastructure in deficient areas and upgrading existing institutions. Mobile medical units, ambulance services (108 and 102), ASHAs, and Village Health and Sanitation Committees (VHSCs) have been deployed nationwide.") h("ASHA (Accredited Social Health Activist)") p("One of the most significant innovations of NRHM/NHM is the deployment of ASHAs - a female community health volunteer in each village (population ~1000). She acts as a link between the community and the health system, providing basic preventive and promotive care and referring patients appropriately.") h("Financing") p("NHM follows a flexible financing model. The centre-state sharing ratio is 60:40 for general states and 90:10 for special category/northeastern states. States prepare Annual Programme Implementation Plans (PIPs) for fund allocation.") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # 2. NATIONAL URBAN HEALTH MISSION # ══════════════════════════════════════════════════════════════════════════════ add_program_header("2. NATIONAL URBAN HEALTH MISSION (NUHM)", 2) h("Introduction") p("NUHM was launched as a sub-Mission under NHM. It seeks to improve the health status of the <b>urban population</b>, particularly slum dwellers and other vulnerable sections, by facilitating access to quality health care. NUHM covers all state capitals, district headquarters and about <b>779 other cities/towns with population ≥50,000</b> (Census 2011) in a phased manner. Cities below 50,000 are covered under NRHM.") h("Focus Population") b("Urban poor living in listed and unlisted slums.") b("Homeless, rag-pickers, street children, rickshaw pullers.") b("Construction and brick/lime-kiln workers, sex workers, other temporary migrants.") h("Key Strategies") b("Public health thrust on sanitation, clean drinking water, vector control.") b("Strengthening public health capacity of urban local bodies.") p("Seven metropolitan cities (Mumbai, Delhi, Chennai, Kolkata, Hyderabad, Bengaluru, Ahmedabad) manage NUHM through their Municipal Corporation directly.") h("Service Delivery Model") p("NUHM provides flexibility to states to choose the model best suited to address healthcare needs of the urban poor through community-led action. Services through Urban PHCs and Urban CHCs are <b>universal in nature</b>; outreach services are targeted to slum dwellers and vulnerable groups.") p("Outreach services are provided through <b>Female Health Workers (FHWs)</b> - essentially ANMs with induction training of 3–6 months – placed at Urban PHCs. They conduct immunization and ANC clinics at U-PHC and then move to respective areas for outreach on designated days.") h("Community Participation – ASHA / Link Worker") p("NUHM promotes a community health volunteer (ASHA or Link Worker) in every urban poor settlement – one ASHA for <b>1000–2500 urban poor population</b> covering about 200–500 households. Community-based institutions include:") b("<b>Mahila Arogya Samiti (MAS)</b> – 50–100 households per group.") b("<b>Rogi Kalyan Samiti</b> – for hospital-level community participation.") p("An annual grant of ₹5,000 is provided to each MAS.") h("Essential Services by ASHA in Urban Areas") b("Active promoter of good health practices with community support.") b("Facilitate awareness on essential RCH services, gender equality, age at marriage.") b("Motivation for contraception, MTP, sterilization.") b("Referral of sick children, pregnant women and newborns.") b("IEC activities on immunization, nutrition, hygiene and sanitation.") h("Financing") p("Centre-state funding ratio under NUHM is the same as NHM – 60:40 for general states and 90:10 for special category states. States develop Urban Health Action Plans as part of their annual PIP.") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # 3. RMNCH+A # ══════════════════════════════════════════════════════════════════════════════ add_program_header("3. RMNCH+A STRATEGY (Reproductive, Maternal, Newborn, Child & Adolescent Health)", 3) h("Introduction") p("RMNCH+A is a comprehensive strategy launched in <b>2013</b> under the National Health Mission to address the continuum of care from pre-pregnancy through adolescence. It integrates all reproductive, maternal, newborn, child and adolescent health services.") h("Rationale – Continuum of Care") p("The strategy recognizes that health of women and children cannot be addressed in isolation. It uses a 'life-cycle approach' ensuring that every stage of life — pre-conception, pregnancy, birth, newborn, infant, childhood and adolescence — receives appropriate services.") h("Key Components of RMNCH+A") sh("A. Reproductive Health") b("Family planning counselling and services.") b("Prevention and management of RTI/STI.") b("MTP services under MTP Act.") sh("B. Maternal Health") b("Early registration of pregnancy (within 12 weeks).") b("Minimum 4 antenatal checkups (ANC); iron-folic acid supplementation.") b("Skilled birth attendance (SBA) at all deliveries.") b("Janani Suraksha Yojana (JSY) for institutional delivery incentives.") b("Janani Shishu Suraksha Karyakram (JSSK) – free delivery and newborn care.") b("Emergency obstetric care (EmOC) at 24×7 FRUs.") sh("C. Newborn Health") b("Home-based Newborn Care (HBNC) by ASHA – 6 postnatal visits.") b("Facility-based Newborn Care (FBNC): Newborn Care Corners (NBCCs) at delivery points.") b("Special Newborn Care Units (SNCUs) at district hospitals.") b("India Newborn Action Plan (INAP) – 2014.") sh("D. Child Health") b("Integrated Management of Neonatal and Childhood Illness (IMNCI).") b("Vitamin A supplementation programme.") b("Management of Severe Acute Malnutrition (SAM) at NRCs.") b("School Health Programme under Rashtriya Bal Swasthya Karyakram (RBSK).") sh("E. Adolescent Health (+A)") b("Rashtriya Kishor Swasthya Karyakram (RKSK) – launched 2014.") b("Adolescent Friendly Health Clinics (AFHCs) – 'Aarogyam' clinics.") b("Weekly Iron and Folic Acid Supplementation (WIFS) for adolescent girls.") b("Menstrual hygiene management.") h("Key Indicators Targeted") b("Maternal Mortality Rate (MMR) reduction to < 100 per 1,00,000 live births.") b("Infant Mortality Rate (IMR) reduction to < 25 per 1,000 live births.") b("Under-5 Mortality Rate (U5MR) reduction to < 23 per 1,000 live births.") b("Reduction in Total Fertility Rate (TFR) to 2.1 (replacement level).") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # 4. NATIONAL AIDS CONTROL PROGRAMME # ══════════════════════════════════════════════════════════════════════════════ add_program_header("4. NATIONAL AIDS CONTROL PROGRAMME (NACP)", 4) h("Introduction") p("The National AIDS Control Programme was launched in India in <b>1987</b>. The Ministry of Health and Family Welfare set up the <b>National AIDS Control Organization (NACO)</b> as a separate wing to implement and closely monitor its components.") h("Aim") b("Prevent further transmission of HIV.") b("Decrease morbidity and mortality associated with HIV infection.") b("Minimize the socio-economic impact of HIV infection.") h("Milestones of NACP") p("<b>1986</b> – First case of HIV detected; AIDS Task Force set up by ICMR; National AIDS Committee established.") p("<b>1990</b> – Medium Term Plan launched for 4 states and 4 metros.") p("<b>1992</b> – NACP-I launched to slow spread of HIV; National AIDS Control Board constituted; NACO set up.") p("<b>1999</b> – NACP-II: focus on behaviour change, decentralization, NGO involvement; State AIDS Control Societies established.") p("<b>2002</b> – National AIDS Control Policy adopted; National Blood Policy adopted.") p("<b>2004</b> – Anti-retroviral treatment (ART) initiated.") p("<b>2006</b> – National Council on AIDS under PM; National Policy on Paediatric ART formulated.") p("<b>2007</b> – NACP-III launched (2007–2012).") p("<b>2014</b> – NACP-IV launched (2012–2017).") p("<b>2017</b> – National Strategic Plan (NSP) for HIV/AIDS and STIs 2017–2024.") h("NACP-IV Key Strategies") b("<b>Prevention</b>: Targeted interventions for High Risk Groups (HRGs) – FSW, IDU, MSM, transgenders.") b("<b>Treatment</b>: Free ART at ART centres; PPTCT (Prevention of Parent to Child Transmission).") b("<b>Blood Safety</b>: Voluntary blood donation; HIV testing of all donated blood.") b("<b>ICTC</b>: Integrated Counselling and Testing Centres for voluntary HIV testing.") b("<b>STI Management</b>: Syndromic case management at STI clinics.") b("<b>Condom Promotion</b>: Social marketing and free distribution.") b("<b>Linkages</b>: TB-HIV coordination; opioid substitution therapy for IDUs.") h("NSP 2017–2024 Goals (90-90-90 targets)") b("90% of all people living with HIV know their HIV status.") b("90% of all diagnosed HIV-infected people receive sustained ART.") b("90% of all people on ART achieve viral suppression.") h("Target to End AIDS by 2030 (SDG 3.3)") p("India aims to reduce new HIV infections and AIDS-related deaths by 90% by 2030, aligned with UNAIDS Fast-Track targets.") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # 5. NATIONAL TB ELIMINATION PROGRAMME # ══════════════════════════════════════════════════════════════════════════════ add_program_header("5. NATIONAL TB ELIMINATION PROGRAMME (NTEP)", 5) h("Introduction") p("The Government of India has set an <b>ambitious target of eliminating TB by 2025</b> – five years ahead of the global End TB target of 2030. The National TB Elimination Programme (NTEP) evolved from the Revised National TB Control Programme (RNTCP), which itself was built on the original National Tuberculosis Programme (NTP) initiated in <b>1962</b>.") h("National Strategic Plan (NSP) 2017–2025") p("The NSP provides the framework for NTEP. Key targets:") b("Reduce estimated TB incidence rate from 217 to 44 per 1,00,000 population by 2025.") b("Reduce estimated TB prevalence from 320 to 65 per 1,00,000 by 2025.") b("Reduce estimated TB mortality from 32 to 3 per 1,00,000 by 2025.") b("Ensure no family bears catastrophic costs due to TB (target: 0% by 2025).") h("Pillars of NTEP (Detect – Treat – Prevent – Build)") sh("1. DETECT – Expand TB Diagnosis") b("Universal Drug Susceptibility Testing (UDST) at diagnosis.") b("CBNAAT (Cartridge Based Nucleic Acid Amplification Test) / TrueNat for rapid molecular diagnosis.") b("Ni-kshay portal – web-based IT system for notification and tracking.") b("Active case finding through household surveys and community outreach.") sh("2. TREAT – Ensure Treatment Success") b("Daily regimen (daily drug intake, not intermittent) using fixed-dose combination (FDC) drugs.") b("99 DOTS (Digital adherence technology) for treatment monitoring.") b("Ni-kshay Poshan Yojana – monthly ₹500 nutritional support to all TB patients.") b("Bedaquiline and Delamanid for drug-resistant TB.") b("Shorter MDR-TB regimens (9 months).") sh("3. PREVENT – Break Transmission") b("TB preventive therapy (TPT) with 6H (Isoniazid) for contacts and PLHIV.") b("Infection control in health facilities.") b("BCG vaccination in national immunization schedule.") sh("4. BUILD – System Strengthening") b("Engagement of private sector through mandatory notification and treatment protocols.") b("Ayushman Bharat HWCs as first point of contact for TB diagnosis and treatment.") b("HR development, laboratory network expansion, drug supply chain strengthening.") h("Important Targets") b("Notification of at least 2 million patients by 2020.") b("Treatment Success Rate ≥90% in new cases.") b("Zero catastrophic out-of-pocket expenditure due to TB.") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # 6. RNTCP # ══════════════════════════════════════════════════════════════════════════════ add_program_header("6. REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME (RNTCP)", 6) h("Background") p("The National Tuberculosis Programme (NTP) has been in operation since <b>1962</b>. However, treatment success rates were unacceptably low and death and default rates remained high. Spread of multidrug-resistant TB threatened to worsen the situation.") h("Launch of RNTCP") p("In <b>1993</b>, the Government of India decided to revitalize the NTP with international agency assistance. The <b>Revised National TB Control Programme (RNTCP)</b> thus formulated adopted the internationally recommended <b>DOTS (Directly Observed Treatment Short-course)</b> strategy as the most systematic and cost-effective approach. The RNTCP has expanded rapidly and since <b>March 2006</b> covers the whole country.") h("Objectives of RNTCP") b("Achievement of at least <b>85% cure rate</b> of infectious cases through DOTS involving peripheral health functionaries.") b("Augmentation of case-finding through quality sputum microscopy to detect at least <b>70% of estimated cases</b>.") h("DOTS Strategy – Five Main Components") b("<b>Political will and administrative commitment</b>: Ensuring organized, comprehensive TB control services.") b("<b>Diagnosis by quality-assured sputum smear microscopy</b>: Decentralized, reliable, early diagnosis.") b("<b>Adequate supply of quality-assured short-course chemotherapy drugs</b>.") b("<b>Directly observed treatment (DOT)</b>: Patient observed swallowing each dose.") b("<b>Systematic monitoring and accountability</b>: Cohort analysis, quarterly reporting.") h("STOP TB Strategy (2006) Adopted by RNTCP") b("Pursuing quality DOTS – expansion and enhancement.") b("Addressing TB/HIV and MDR-TB.") b("Contributing to health system strengthening.") b("Engaging all care providers (public and private).") b("Empowering patients and communities.") b("Enabling and promoting research (diagnosis, treatment, vaccine).") h("RNTCP Infrastructure") p("RNTCP is built on the existing NTP infrastructure while incorporating DOTS elements:") b("<b>Tuberculosis Unit (TU)</b>: One per 5 lakh population; headed by Medical Officer-TB Control.") b("<b>Designated Microscopy Centre (DMC)</b>: One per 1 lakh population (rural) / 50,000 (tribal/hilly).") b("<b>Directly Observed Treatment (DOT) provider</b>: Any health worker, ASHA, or community member.") b("<b>Drug Stores</b>: Quarterly drug buffer stock maintained at all levels.") h("Treatment Categories (Old RNTCP)") b("<b>Category I</b>: New smear positive PTB, new smear negative PTB with extensive parenchymal involvement, severe forms of extrapulmonary TB. 2HRZE + 4HR.") b("<b>Category II</b>: Previously treated sputum smear positive PTB. 2HRZES + 1HRZE + 5HRE.") b("<b>Category III</b> (phased out): New smear negative, less severe EPTB. 2HRZ + 4HR.") p("Note: RNTCP has now been upgraded to NTEP with daily FDC regimens replacing intermittent therapy.") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # 7. NATIONAL LEPROSY ERADICATION PROGRAMME # ══════════════════════════════════════════════════════════════════════════════ add_program_header("7. NATIONAL LEPROSY ERADICATION PROGRAMME (NLEP)", 7) h("History") p("The <b>National Leprosy Control Programme (NLCP)</b> has been in operation since <b>1955</b> as a centrally aided programme using DDS (dapsone) monotherapy. It gained momentum during the Fourth Five Year Plan when made a centrally-sponsored programme. In <b>1980</b>, Government of India declared its resolve to 'eradicate' leprosy by the year 2000. A Working Group in 1982 recommended a revised strategy based on <b>multi-drug chemotherapy (MDT)</b>. In <b>1983</b>, the programme was redesignated <b>National Leprosy 'Eradication' Programme (NLEP)</b>.") h("Goal") p("To reduce case load to <b>1 or less per 10,000 population</b> (prevalence rate).") h("MDT Introduction and Impact") p("The World Bank supported the first project in <b>1993</b>, and a second phase from 2001–2004. After MDT introduction, recorded case load fell from <b>57.6 per 10,000 in 1981 to less than 1 per 10,000 in December 2005</b>. India achieved the goal of leprosy elimination at the national level. The programme has been integrated with the general health care system since 2002–03.") h("Components of NLEP") b("Decentralized integrated leprosy services through general health care system.") b("Capacity building of all general health services functionaries.") b("Intensified Information, Education and Communication (IEC).") b("Prevention of disability (POD) and medical rehabilitation.") b("Intensified monitoring and supervision.") h("Current Status") p("34 states/UTs have achieved elimination status. Only Chhattisgarh and Dadra & Nagar Haveli have prevalence rate >1 per 10,000. Bihar, Goa, Chandigarh and Odisha show PR >1 per 1,000 population after earlier achieving elimination. 209 high endemic districts identified for special action in 2012–13.") h("Multi-Drug Therapy (MDT) Regimens") sh("Paucibacillary (PB) Leprosy:") b("Dapsone 100 mg daily (self-administered) + Rifampicin 600 mg monthly (supervised). Duration: <b>6 months</b>.") sh("Multibacillary (MB) Leprosy:") b("Dapsone 100 mg daily + Clofazimine 50 mg daily + Rifampicin 600 mg monthly + Clofazimine 300 mg monthly. Duration: <b>12 months</b>.") h("Disability Prevention") p("NLEP focuses on prevention of disability (Grade 1 and Grade 2) and rehabilitation of those with established deformities. Reconstructive surgery camps are organized. Self-care instructions for hypesthetic hands and feet are emphasized.") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # 8. NVBDCP # ══════════════════════════════════════════════════════════════════════════════ add_program_header("8. NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (NVBDCP)", 8) h("Introduction") p("The <b>National Vector Borne Disease Control Programme (NVBDCP)</b> is implemented for prevention and control of six major vector-borne diseases in India: <b>Malaria, Filariasis, Kala-azar (Visceral Leishmaniasis), Japanese Encephalitis (JE), Dengue and Chikungunya</b>. The <b>Directorate of NVBDCP</b> is the nodal agency for planning, policy-making, technical guidance, monitoring and evaluation.") h("Vector Transmission") b("Malaria, Filariasis, JE, Dengue, Chikungunya: Transmitted by different species of <b>mosquitoes</b>.") b("Kala-azar: Transmitted by <b>sand flies (Phlebotomus argentipes)</b>.") h("Three-Pronged Strategy") sh("i. Disease Management") b("Early case detection and complete treatment (EDCT).") b("Strengthening referral services.") b("Epidemic preparedness and rapid response.") sh("ii. Integrated Vector Management (IVM)") b("Indoor residual spraying (IRS) in selected high-risk areas.") b("Insecticide-treated bed nets (ITNs/LLINs).") b("Larvivorous fish (Gambusia, Guppy) for biological control.") b("Anti-larval measures in urban areas.") b("Source reduction and minor environmental engineering.") sh("iii. Supportive Interventions") b("Behaviour change communication (BCC).") b("Public-private partnership and inter-sectoral convergence.") b("Human resource development through capacity building.") b("Operational research including drug resistance and insecticide susceptibility studies.") b("Vaccination against JE (Japanese Encephalitis vaccine).") b("Annual Mass Drug Administration (MDA) against Lymphatic Filariasis.") h("Individual Diseases") sh("Malaria") p("Programme began as National Malaria Control Programme in <b>1953</b>. Converted to eradication programme in <b>1958</b>. Drug of choice: Chloroquine for P. vivax; Artemisinin Combination Therapy (ACT) for P. falciparum. Rapid Diagnostic Tests (RDTs) for malaria diagnosis at periphery.") sh("Kala-azar") p("Target: Elimination by 2020 (PR <1 per 10,000 population at block level). Drug: Liposomal Amphotericin B (single dose). Endemic: Bihar, Jharkhand, West Bengal, UP.") sh("Filariasis (Lymphatic)") p("Annual MDA with DEC + Albendazole in endemic districts. Triple drug therapy (IDA): Ivermectin + DEC + Albendazole introduced to accelerate elimination.") sh("Dengue and Chikungunya") p("No specific treatment; symptomatic management. Vector control (Aedes aegypti) through source reduction, larval control. Anti-larval operations every 7 days to break breeding cycle.") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # 9. UNIVERSAL IMMUNIZATION PROGRAMME # ══════════════════════════════════════════════════════════════════════════════ add_program_header("9. UNIVERSAL IMMUNIZATION PROGRAMME (UIP)", 9) h("Background") p("Experience with smallpox eradication showed immunization was the most powerful and cost-effective weapon against vaccine-preventable diseases. In <b>1974</b>, WHO launched the <b>Expanded Programme on Immunization (EPI)</b> against six childhood diseases: diphtheria, pertussis, tetanus, polio, tuberculosis and measles.") h("EPI to UIP") p("India launched its own EPI in <b>1978</b>. In <b>1985</b>, EPI was expanded and renamed <b>Universal Immunization Programme (UIP)</b> with the goal of universal coverage for infants and pregnant women. It was one of the largest public health programmes globally.") h("Vaccines Under UIP") sh("For Infants:") b("<b>BCG</b> – at birth (for tuberculosis).") b("<b>OPV (Oral Polio Vaccine)</b> – at birth, 6, 10, 14 weeks; booster at 16–24 months.") b("<b>Hepatitis B</b> – at birth, 6, 10, 14 weeks.") b("<b>Pentavalent vaccine</b> (DPT+HepB+Hib) – 6, 10, 14 weeks.") b("<b>IPV (Inactivated Polio Vaccine)</b> – 14 weeks (fractional dose intradermal).") b("<b>Rotavirus vaccine</b> – 6, 10, 14 weeks (in phased roll-out states).") b("<b>PCV (Pneumococcal Conjugate Vaccine)</b> – 6, 14 weeks + booster 9 months.") b("<b>Measles-Rubella (MR)</b> – 9–12 months and 16–24 months.") b("<b>Vitamin A</b> – at 9 months along with MR dose 1.") b("<b>JE vaccine</b> – 9–12 months and 16–24 months (endemic districts).") sh("For Pregnant Women:") b("<b>TT (Tetanus Toxoid)</b> or <b>Td</b> – Early pregnancy and 4 weeks after first dose.") h("Mission Indradhanush") p("Launched in <b>2014</b> to target under-immunized and unimmunized children. Intensified Mission Indradhanush (IMI) 2.0 and 3.0 conducted to cover unreached areas. Targets 90%+ full immunization coverage.") h("Cold Chain") p("A well-maintained cold chain is essential for vaccine potency. The UIP maintains a cold chain from national level to last mile delivery. Walk-in coolers (WIC), Ice-lined Refrigerators (ILR), deep freezers at various levels.") h("Polio Eradication") p("India was declared <b>polio-free on 27th March 2014</b> (WHO certification). Pulse Polio Immunization (PPI) programme remains active for surveillance. IPV added to routine immunization to maintain immunity.") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # 10. NPCDCS # ══════════════════════════════════════════════════════════════════════════════ add_program_header("10. NPCDCS – National Programme for Prevention & Control of Cancer, Diabetes, CVD & Stroke", 10) h("Introduction") p("India is experiencing a rapid health transition with large and rising burden of <b>chronic non-communicable diseases (NCDs)</b>. In 2016, NCDs accounted for <b>60% of deaths</b> in India. The NPCDCS integrates the earlier National Cancer Control Programme with the programme for prevention of Diabetes, CVD and Stroke. During the 11th Five Year Plan, 100 identified districts in 21 states were covered; during 12th Plan, coverage extended to all districts.") h("Objectives") b("Prevent and control common NCDs through behaviour and lifestyle changes.") b("Provide early diagnosis and management of common NCDs.") b("Build capacity at various levels for prevention, diagnosis and treatment.") b("Train human resources – doctors, paramedics and nursing staff – to cope with increasing NCD burden.") b("Establish and develop capacity for palliative and rehabilitative care.") h("A. Diabetes, CVD and Stroke Component") p("Implemented in 20,000 sub-centres and 700 CHCs in 100 districts across 21 states/UTs. Strategies include:") b("Promoting healthy lifestyle through health education and mass media.") b("<b>Opportunistic screening</b> of persons above <b>30 years</b> for hypertension, diabetes, common cancers.") b("Establishment of <b>NCD Clinics</b> at CHC and District level.") b("Development of trained manpower; strengthening of tertiary level facilities.") b("Behavioural change messages: reduce salt/fat intake, increase physical activity, avoid tobacco/alcohol, eat fruits and vegetables, maintain healthy weight.") h("B. Cancer Component") p("Cancer services in districts with population ≥10 lakh include:") b("District Cancer Unit at district hospitals.") b("Day Care Cancer Unit for chemotherapy at district level.") b("Tertiary Cancer Centre (TCC) linked with medical college/teaching hospital.") b("Screening for oral, cervical and breast cancers at primary care level.") b("Cancer helpline (NCCP helpline): 1800-11-6677.") h("Key Screening Tests") b("Oral cancer: Visual inspection with acetic acid / Toluidine blue staining.") b("Cervical cancer: Visual Inspection with Acetic Acid (VIA) / Pap smear.") b("Breast cancer: Clinical Breast Examination (CBE) at sub-centre level.") h("Integration under NHM / Ayushman Bharat") p("NCD screening is now integrated into Ayushman Bharat Health and Wellness Centres (AB-HWCs) at the sub-centre and primary health care level.") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # 11. NMHP # ══════════════════════════════════════════════════════════════════════════════ add_program_header("11. NATIONAL MENTAL HEALTH PROGRAMME (NMHP)", 11) h("Introduction") p("The <b>National Mental Health Programme (NMHP)</b> was launched in <b>1982</b> to ensure availability of mental health care services for all, especially the community at risk and underprivileged sections. It encourages application of mental health knowledge in general health care and social development. At present this programme covers <b>517 districts in 36 states</b>.") h("Aims of NMHP") b("Prevention and treatment of mental and neurological disorders and their associated disabilities.") b("Use of mental health technology to improve general health services.") b("Application of mental health principles in total national development to improve quality of life.") h("Objectives") b("Ensure availability and accessibility of minimum mental health care for all, especially the most vulnerable and underprivileged.") b("Encourage application of mental health knowledge in general health care and social development.") b("Promote community participation in mental health service development and stimulate self-help efforts.") h("Programme Strategies") b("<b>Integration</b> of mental health with primary health care through NMHP.") b("<b>Provision of tertiary care institutions</b> for treatment of mental disorders.") b("<b>De-stigmatization</b>: protecting rights of mentally ill through the Central and State Mental Health Authorities.") h("District Mental Health Programme (DMHP)") p("Components of DMHP:") b("Training programmes for all mental health team workers at the identified nodal state institute.") b("Public education to increase awareness and reduce stigma.") b("OPD and indoor services for early detection and treatment.") b("Providing data and experience at community level for future planning and research.") h("Promotive and Preventive Activities under DMHP") b("<b>School mental health services</b>: Life skills education in schools, counselling services.") b("<b>College counselling services</b>: Through trained teachers/counsellors.") b("<b>Workplace stress management</b>: Formal and informal sectors including farmers and women.") b("<b>Suicide prevention services</b>: Counselling centre at district level, sensitization workshops, IEC, help lines.") h("Mental Health Act 2017") p("The Mental Healthcare Act, 2017 replaced the old Mental Health Act of 1987. It decriminalizes suicide attempt, mandates mental health insurance on par with physical illness, and establishes Mental Health Review Boards for protection of rights.") h("Targets and Current Status") p("Eleven institutions identified for training PHC physicians and paramedical personnel in basic mental health knowledge and skills. The National Human Rights Commission monitors conditions in mental hospitals jointly with the Government of India.") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # 12. NPHCE # ══════════════════════════════════════════════════════════════════════════════ add_program_header("12. NATIONAL PROGRAMME FOR HEALTH CARE OF THE ELDERLY (NPHCE)", 12) h("Introduction") p("India's elderly population (≥60 years) is growing rapidly. By 2050, elderly are projected to constitute 20% of India's population. The <b>National Programme for Health Care of the Elderly (NPHCE)</b> was launched to address the healthcare needs of the aged population by providing dedicated services at primary, secondary and tertiary levels.") h("Goal") p("To provide accessible, affordable, and high quality long-term, comprehensive and dedicated care services to an ageing population.") h("Objectives") b("Provide an infrastructure for dedicated health care of the elderly at various levels of health care delivery.") b("Build capacity of medical, paramedical and social workers in geriatric care.") b("Provide rehabilitation services to elderly persons.") b("Promote research and training in the field of geriatrics.") h("Service Delivery at Various Levels") sh("Primary Level (PHC/Sub-Centre)") b("Weekly OPD for elderly (dedicated clinic day).") b("Home-based care through ANM and ASHA for bedridden elderly.") b("Health education and prevention of age-related conditions.") sh("Secondary Level (District Hospital)") b("10-bedded Geriatric Ward in district hospital.") b("Dedicated OPD for elderly (2 days/week).") b("Physiotherapy and rehabilitation services.") b("Provision of essential aids and appliances.") sh("Tertiary Level (Medical Colleges)") b("<b>Regional Geriatric Centres (RGCs)</b> at identified medical colleges: 30-bedded units.") b("PG training in geriatric medicine.") b("Training facility for PHC doctors, nurses and paramedics.") h("Common Geriatric Conditions Addressed") b("Hypertension, diabetes, osteoarthritis.") b("Dementia and cognitive impairment.") b("Falls and fractures.") b("Sensory deficits (hearing and vision loss).") b("Depression and loneliness.") b("Malnutrition and anaemia.") h("Key Features") b("ASHAs and ANMs trained to identify and refer elderly with health problems.") b("Physiotherapy support at community level.") b("Linkage with National Social Assistance Programme (NSAP) for old-age pension.") b("Day care centres and short-stay homes for elderly without family support.") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # 13. NPPCD # ══════════════════════════════════════════════════════════════════════════════ add_program_header("13. NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF DEAFNESS (NPPCD)", 13) h("Introduction") p("Deafness and hearing impairment are major causes of disability in India. An estimated <b>63 million people in India</b> suffer from significant auditory impairment. Of all disabilities in India, hearing impairment accounts for about 7.6%. The majority (over 50%) of hearing loss cases are preventable. The <b>National Programme for Prevention and Control of Deafness (NPPCD)</b> was launched in <b>2006–07</b> to address this public health challenge.") h("Objectives") b("Prevent avoidable hearing loss on account of disease or injury.") b("Early identification, diagnosis and treatment of ear problems responsible for hearing loss and deafness.") b("Medically rehabilitate persons with deafness / hearing loss.") b("Strengthen existing inter-sectoral linkages for the social rehabilitation of persons with deafness.") b("Develop human resources for ear care.") h("Causes of Deafness Targeted") b("Chronic Suppurative Otitis Media (CSOM) – commonest preventable cause in India.") b("Noise-induced hearing loss.") b("Age-related hearing loss (presbycusis).") b("Ototoxic drug-related hearing loss.") b("Birth-related hearing loss (SNHL in neonates).") b("Wax impaction and foreign body.") h("Programme Strategy") sh("Screening") b("Neonatal hearing screening using Oto-Acoustic Emission (OAE) tests.") b("School screening programmes for early detection.") sh("Treatment") b("Surgical management of CSOM (myringoplasty, tympanoplasty) at district hospitals.") b("Provision of hearing aids to those who need them.") b("Cochlear implants for severe-profound SNHL (at tertiary centres).") sh("Human Resource Development") b("Training of ENT specialists, audiologists, speech-language pathologists.") b("Training of district-level medical officers and PHC doctors in ear care.") h("Infrastructure") b("<b>District ENT Centres</b>: Dedicated ear-care facilities at district hospital.") b("<b>Audiological and Speech Therapy Units</b> at Medical Colleges.") b("State Nodal Centres for cochlear implantation and advanced care.") h("Rehabilitation") b("Supply of hearing aids through National Trust / ALIMCO.") b("Lip reading and sign language classes.") b("Integration with ADIP (Assistive Devices for Persons with Disabilities) Scheme.") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # 14. NPCB # ══════════════════════════════════════════════════════════════════════════════ add_program_header("14. NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS (NPCB)", 14) h("Introduction") p("Blindness is a major public health problem in India. According to Park's textbook, India has approximately <b>12 million blind persons</b> – the largest number in any single country, constituting about 1/4th of the world's blind. The <b>National Programme for Control of Blindness (NPCB)</b> was launched in <b>1976</b> with the goal of reducing the prevalence of blindness from the then level of 1.4% to <b>0.3%</b>.") h("Causes of Blindness in India (Park's data)") b("<b>Cataract</b>: 62.6% – the leading cause; mostly bilateral and reversible.") b("<b>Refractive errors</b>: 19.7%.") b("<b>Corneal blindness</b>: 0.9%.") b("<b>Glaucoma</b>: 5.8%.") b("<b>Surgical complications</b>: 1.2%.") b("<b>Other causes</b>: Trachoma, Vitamin A deficiency, diabetic retinopathy.") h("Objectives of NPCB") b("Reduce prevalence of blindness from 1% to 0.3% by 2020.") b("Strengthen the existing institutions for eye care.") b("Develop human resources for eye care service delivery.") b("Enhance community awareness on eye care and prevention of blindness.") h("Strategies") sh("Cataract Surgery") b("National Eye Care programme (NPCB) performs 60–70 lakh cataract operations per year.") b("Free cataract surgery (IOL implantation) at government hospitals and through NGO camps.") b("Mobile Eye Surgical Units (MESU) for remote areas.") sh("School Eye Health") b("Vision screening for school children.") b("Free spectacle provision for children with refractive errors.") sh("Low Vision / Blindness Rehabilitation") b("Low Vision Clinics at district hospitals.") b("Braille training, orientation and mobility services.") h("National Blindness Control Programme (revised NPCB)") b("National Eye Care component added Diabetic Retinopathy, Glaucoma and Corneal Blindness control.") b("District Blindness Control Societies (DBCS) established for programme implementation at district level.") b("NGO and private sector partnerships: 'Drishti Stambh' and Sarva Shiksha Abhiyan for school-eye-health.") h("Vitamin A and Trachoma") p("<b>Vitamin A Supplementation</b>: Under UIP, given at 9 months, 16 months and bi-annually till 5 years – preventing xerophthalmia and corneal blindness. <b>Trachoma</b>: SAFE strategy (Surgery, Antibiotics, Facial cleanliness, Environmental sanitation) adopted for trachoma elimination.") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # 15. NTCP # ══════════════════════════════════════════════════════════════════════════════ add_program_header("15. NATIONAL TOBACCO CONTROL PROGRAMME (NTCP)", 15) h("Introduction") p("Tobacco use is the single largest preventable cause of premature death globally. In India, tobacco-related diseases kill approximately <b>1 million people every year</b>. The <b>National Tobacco Control Programme (NTCP)</b> was launched in the 11th Five Year Plan to facilitate implementation of tobacco control laws and fulfill India's obligations under the <b>WHO-Framework Convention on Tobacco Control (FCTC)</b>. Pilot phase launched in <b>16 districts</b> across 9 states in 2007–08; now covers <b>108 districts in 31 states</b>.") h("Legislation: COTPA 2003") p("The <b>Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA)</b> was passed in April 2003, notified on 25th February 2004. Key provisions:") b("Prohibition of smoking in public places (in force from 2nd October 2008).") b("Prohibition of direct and indirect advertisement of cigarette and other tobacco products.") b("Prohibition of sale to persons below <b>18 years</b>.") b("Prohibition of sale near educational institutions.") b("Mandatory depiction of statutory warnings including <b>pictorial warnings</b> on tobacco packs.") b("Mandatory depiction of tar and nicotine contents with maximum permissible limits.") p("From 1st April 2016, pictorial health warnings mandatory on <b>85% of principal display area</b> on both sides (60% picture + 25% text).") h("Main Components of NTCP") b("Public awareness and mass media campaigns for awareness and behavioural change.") b("Establishment of tobacco product testing laboratories.") b("Training and capacity building of programme officers at state/district level.") b("<b>Tobacco Cessation Centres (TCCs)</b>: Established across the country.") b("National Tobacco Quitline (1800-11-2356): Free telephone-based cessation support.") b("Cessation support in dental clinics and cancer hospitals.") h("Smokeless Tobacco Ban") p("34 States/UTs issued orders implementing Food Safety Regulations banning manufacture, sale and storage of <b>gutka and pan masala</b> containing tobacco or nicotine (2014–15). Several states banned all forms of smokeless tobacco.") h("Key Messages") b("No safe level of tobacco consumption.") b("Secondhand smoke causes disease in non-smokers.") b("Tobacco use is a form of addiction – quitting is difficult but achievable with support.") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # 16. NIDDCP # ══════════════════════════════════════════════════════════════════════════════ add_program_header("16. NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAMME (NIDDCP)", 16) h("Introduction") p("India commenced a <b>goitre control programme in 1962</b> based on iodized salt. After three decades, prevalence remained high. A major national programme – the <b>IDD Control Programme</b> – was initiated, promoting nationwide (rather than area-specific) use of iodized salt. Policy: to fortify all edible salt with iodine in a phased manner by end of 8th Plan.") h("Iodine Deficiency Disorders (IDD)") p("Iodine deficiency is the commonest preventable cause of mental retardation. IDD spectrum includes: goitre, hypothyroidism, cretinism, sub-clinical mental retardation, stillbirths, neonatal mortality, growth retardation, poor reproductive outcome.") h("Objectives of NIDDCP") b("Surveys to assess magnitude of IDD in districts.") b("Supply of iodized salt in place of common salt.") b("Resurveys every <b>5 years</b> to assess IDD and impact of iodized salt.") b("Laboratory monitoring of iodized salt and urinary iodine excretion.") b("Health education and publicity.") h("Significant Achievements") b("Salt Commissioner has issued licenses to 824 salt manufacturers, of which 777 have commenced production.") b("Annual production capacity: 222 lakh metric tonnes of iodized salt.") b("Production/supply of iodized salt (April–Aug 2015): 26.44 lakh tonnes produced, 25.12 lakh tonnes supplied.") b("Notification banning sale of non-iodized salt for human consumption issued under Food Safety & Standards Act 2006 and Regulations 2011.") b("34 States/UTs have established <b>IDD Control Cells</b> in their State Health Directorates.") h("Iodine Content Standards") p("As per PFA Act (now FSSAI): Iodized salt should contain:") b("At production level: not less than <b>30 ppm</b> iodine.") b("At consumer level: not less than <b>15 ppm</b> iodine.") h("Urinary Iodine Excretion (UIE) as Assessment Tool") b("UIE < 100 µg/L: Iodine deficiency.") b("UIE 100–199 µg/L: Adequate iodine intake.") b("UIE ≥ 300 µg/L: Excessive iodine intake (risk of iodine-induced hyperthyroidism).") h("IDD Prevention beyond Salt Iodization") b("Iodized oil injections in severely deficient areas.") b("Iodine fortification of water in some areas.") b("Health education in schools and communities about IDD.") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # 17. NOHP # ══════════════════════════════════════════════════════════════════════════════ add_program_header("17. NATIONAL ORAL HEALTH PROGRAMME (NOHP)", 17) h("Introduction") p("Oral health is an integral and essential component of general health. Dental caries, periodontal disease, oral cancers, fluorosis and dental trauma are the major oral health conditions affecting India. The <b>National Oral Health Programme (NOHP)</b> was launched in <b>2014–15</b> to provide equitable access to comprehensive oral health care, with focus on preventive and promotive activities integrated into primary health care.") h("Burden of Oral Disease in India") b("Dental caries: Affects over 60% of school-age children.") b("Periodontal disease: Affects approximately 90% of adult population.") b("Oral cancer: India contributes significantly to world oral cancer burden; highest rates in South/Southeast Asia.") b("Dental fluorosis: Endemic in states with high fluoride in groundwater.") h("Objectives") b("Achieve substantial reduction in morbidity due to oral disease.") b("Develop awareness about oral health and prevention of oral diseases.") b("Reduce risk factors associated with oral diseases through inter-sectoral approach.") b("Integrate oral health with the primary health care system.") b("Promote oral health at all levels of the community including school children.") h("Strategies") sh("Preventive Measures") b("Water fluoridation in deficient areas; de-fluoridation in high-fluoride zones.") b("Salt fluoridation (in pilot areas).") b("Promotion of tooth brushing with fluoride toothpaste twice daily.") b("Pit and fissure sealants for children (preventive dentistry).") sh("Promotional Measures") b("Oral health education through health workers, ANMs, ASHAs.") b("School oral health programmes: dental check-ups, tooth brushing drills.") b("Annual oral health camps at district and sub-district levels.") sh("Curative Services") b("Dental clinics at CHCs and district hospitals.") b("Mobile dental clinics for remote/tribal areas.") b("Oral cancer screening clinics at district hospitals.") h("Integration with NPCDCS") p("Oral cancer screening is incorporated in NPCDCS. Visual inspection of oral cavity for potentially malignant disorders (leukoplakia, erythroplakia, submucous fibrosis) performed at sub-centre level by trained health workers.") h("School Dental Health Programme") p("Under Rashtriya Bal Swasthya Karyakram (RBSK), dental screening is included for school-age children. Referral system to dental clinics at CHC/district hospitals is established.") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # 18. NPNCD # ══════════════════════════════════════════════════════════════════════════════ add_program_header("18. NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF NCDs (NPNCD)", 18) h("Introduction") p("Non-communicable diseases (NCDs) are the leading cause of mortality globally and increasingly in India. NCDs accounted for <b>60% of deaths in India in 2016</b>. The National Programme for Prevention and Control of NCDs (NPNCD) is a broad umbrella that encompasses specific disease-targeted programmes and integrates NCD prevention into primary health care through Ayushman Bharat Health and Wellness Centres (AB-HWCs).") h("Major NCD Categories Addressed") b("<b>Cardiovascular diseases</b> (ischemic heart disease, stroke, hypertension).") b("<b>Diabetes mellitus</b> (Type 2 DM).") b("<b>Cancers</b> (oral, cervical, breast – common in India).") b("<b>Chronic Respiratory Diseases</b> (COPD, asthma).") b("<b>Chronic Kidney Disease</b>.") b("<b>Mental health disorders</b>.") h("Risk Factors Targeted") b("Tobacco use – single biggest modifiable risk factor.") b("Physical inactivity.") b("Unhealthy diet (excess salt, fat, sugar; low fruit/vegetable intake).") b("Harmful use of alcohol.") b("Air pollution (household and ambient).") h("Strategies under NPNCD") sh("Population-Based Approach") b("Mass media campaigns for lifestyle modification.") b("WASH (Water, Sanitation, Hygiene) integration.") b("Reduction of salt in processed foods.") sh("Individual-Based Approach") b("Opportunistic screening at all health facility visits (above 30 years).") b("Community-based screening drives through ASHAs and ANMs.") b("Use of electronic health records at AB-HWCs.") sh("Health System Strengthening") b("NCD Clinics at CHC and district hospitals.") b("NCD screening protocols integrated into HMIS.") b("Essential medicines for NCDs available free at public facilities.") h("Integration with Ayushman Bharat") p("AB-HWCs are the backbone of NCD prevention in the NPNCD framework. Services include: BP measurement, blood glucose testing, BMI assessment, cancer screening (oral, breast, cervix), COPD screening (spirometry), counselling on diet, physical activity and tobacco cessation.") h("Targets (National Health Policy 2017)") b("Reduce premature mortality from NCDs by 25% by 2025.") b("Reduce per capita alcohol consumption by 10%.") b("Achieve 30% reduction in tobacco prevalence.") b("Reduce physical inactivity by 10%.") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # 19. AYUSHMAN BHARAT # ══════════════════════════════════════════════════════════════════════════════ add_program_header("19. AYUSHMAN BHARAT PROGRAMME", 19) h("Introduction") p("In <b>February 2018</b>, the Government of India announced <b>Ayushman Bharat</b> as a comprehensive initiative to move towards Universal Health Coverage (UHC) with two major components:") h("Component 1: Health and Wellness Centres (AB-HWCs)") p("The National Health Policy 2017 envisioned <b>Health and Wellness Centres</b> as the foundation of India's health system. Under Ayushman Bharat, <b>1.5 lakh existing sub-health centres and primary health centres</b> are to be upgraded to HWCs to bring health care closer to people's homes.") sh("Services at AB-HWCs:") b("Maternal and child health services.") b("Communicable disease services.") b("NCD services: screening and management of hypertension, diabetes and 3 common cancers (oral, breast, cervix).") b("Primary healthcare services incrementally added: mental health, ENT, ophthalmology, oral health, geriatric and palliative health care, trauma care.") b("Free essential drugs and diagnostic services.") b("Yoga sessions and wellness activities on lifestyle modification.") b("Electronic health records (e-Sanjeevani for telemedicine).") sh("Health Team at Sub-HWC:") b("<b>Community Health Officer (CHO)</b>: BSc/GNM nurse or Ayurveda practitioner trained in primary care; certified in 6-month certificate programme in community health.") b("Multi-purpose workers (Male and Female).") b("Accredited Social Health Activists (ASHAs).") p("Training conducted with support from IGNOU. First HWC inaugurated on <b>14th April 2018</b> in Bijapur district, Chhattisgarh. By October 2019, <b>22,559 centres operational</b> (8,075 SHC-HWCs + 11,716 PHC-HWCs + 2,769 UPHC-HWCs).") h("Component 2: Pradhan Mantri Jan Arogya Yojana (PM-JAY)") p("The second component is <b>Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)</b>. It provides:") b("<b>Health coverage of ₹5 lakh per family per year</b> for secondary and tertiary care hospitalization.") b("Covers approximately <b>10.74 crore poor and vulnerable families</b> (about 50 crore individuals) identified on the basis of Socio Economic Caste Census (SECC) data.") b("Cashless and paperless treatment at empanelled public and private hospitals.") b("Benefits portable across India – patient can use at any empanelled hospital anywhere in the country.") h("Significance") p("Ayushman Bharat is described as the world's largest government-funded health assurance scheme. It addresses the continuum of care from primary (HWCs) to secondary and tertiary (PMJAY). It operationalizes the vision of Universal Health Coverage as per SDG 3.8.") h("Achievements (as mentioned in Park's edition)") p("22,559 HWCs operational by October 2019. PMJAY has empanelled hospitals across all states. AB-HWCs are being used as platforms for TB/Leprosy screening, NCD screening, mental health services and health promotion.") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # 20. ANEMIA MUKT BHARAT # ══════════════════════════════════════════════════════════════════════════════ add_program_header("20. ANEMIA MUKT BHARAT PROGRAMME", 20) h("Introduction") p("Anaemia is a major public health problem in India affecting all age groups, particularly children, adolescent girls and women of reproductive age. The <b>Anemia Mukt Bharat (AMB)</b> programme was launched in <b>2018</b> under the Intensified National Iron Plus Initiative (I-NIPI) as part of POSHAN Abhiyaan (Nutrition Mission). Its target is to reduce the prevalence of anaemia by <b>3 percentage points per year</b> among children (6–59 months), adolescent girls and boys (10–19 years), and women of reproductive age (15–49 years) and pregnant women.") h("Anaemia Burden in India (NFHS-5, 2019–21)") b("Children 6–59 months: 67.1% anaemic.") b("Women 15–49 years: 57.0% anaemic.") b("Pregnant women (15–49 years): 52.2% anaemic.") b("Men 15–49 years: 25.0% anaemic.") h("Beneficiary Groups (6×6×6 Strategy)") p("The programme targets 6 beneficiary groups through 6 interventions delivered across 6 institutional platforms:") sh("6 Beneficiary Groups:") b("Children 6–59 months.") b("Children 5–9 years.") b("Adolescents 10–19 years (in and out-of-school).") b("Pregnant women.") b("Lactating women (0–6 months post-delivery).") b("Women of reproductive age (15–49 years) – non-pregnant, non-lactating.") sh("6 Interventions:") b("<b>Prophylactic iron and folic acid supplementation</b> – age-appropriate.") b("<b>Deworming</b> with albendazole (National Deworming Day).") b("<b>Behaviour change communication</b> for diet diversification.") b("<b>Delayed cord clamping</b> for newborns (≥3 minutes after birth).") b("<b>Testing</b> for anaemia using digital haemoglobinometers.") b("<b>Treatment</b> of moderate and severe anaemia and referral.") sh("6 Institutional Platforms:") b("Anganwadi Centre (AWC) – for < 6 years and women.") b("Primary School – for children 5–9 years.") b("Secondary/Higher Secondary Schools – for adolescents.") b("Primary Health Care facility (PHC/CHC) – for pregnant/lactating women.") b("Community outreach (Village Health & Nutrition Day).") b("Digital health platform – for tracking.") h("IFA Supplementation Schedule") b("<b>6–59 months</b>: Liquid IFA – 1 ml (20 mg elemental iron + 100 µg folic acid) twice weekly.") b("<b>5–9 years</b>: Small IFA tablet – weekly.") b("<b>10–19 years</b>: Large IFA tablet – weekly (WIFS programme).") b("<b>Pregnant women</b>: 1 large IFA tablet daily for 180 days.") b("<b>Lactating mothers</b>: 1 large IFA tablet daily for 180 days post-delivery.") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # 21. BALWADI # ══════════════════════════════════════════════════════════════════════════════ add_program_header("21. BALWADI NUTRITION PROGRAMME", 21) h("Introduction") p("The <b>Balwadi Nutrition Programme</b> was started in <b>1970</b> for the benefit of children in the <b>age group 3–6 years</b> in rural areas. It is under the overall charge of the <b>Department of Social Welfare</b>. Four national-level organizations, including the Indian Council of Child Welfare, are given grants to implement the programme. Voluntary organizations which receive the funds are actively involved in day-to-day management.") h("Implementation") p("The programme is implemented through <b>Balwadis</b> (pre-school centres), which also provide <b>pre-primary education</b> to children. Services offered include:") b("Supplementary nutrition: <b>300 kcal and 10 grams of protein</b> per child per day.") b("Pre-primary education and school readiness activities.") b("Health check-ups and referral of sick children.") b("Immunization catch-up (in coordination with health workers).") h("Significance and Phase-Out") p("Balwadis are being <b>phased out</b> because of the universalization of <b>ICDS (Integrated Child Development Services)</b>, which provides a more comprehensive package of services. ICDS started in 1975 and operates through Anganwadi Centres, which cover a wider range of services including supplementary nutrition, immunization, health check-ups, referral services, pre-school education and nutrition and health education for mothers.") h("Comparison: Balwadi vs Anganwadi") tdata = [ [Paragraph('<b>Feature</b>', body), Paragraph('<b>Balwadi</b>', body), Paragraph('<b>Anganwadi (ICDS)</b>', body)], ['Start Year', '1970', '1975'], ['Beneficiaries', '3–6 years', '<6 years + pregnant/lactating women + adolescents'], ['Department', 'Social Welfare', 'Women & Child Development'], ['Nutrition', '300 kcal + 10g protein/day', 'Supplementary nutrition as per age'], ['Services', 'Nutrition + Pre-primary ed', 'Comprehensive 6-service package'], ['Status', 'Being phased out', 'Universal/active'], ] t = Table(tdata, colWidths=[4*cm, 5*cm, 7.5*cm]) t.setStyle(TableStyle([ ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#1a3a5c')), ('TEXTCOLOR', (0,0), (-1,0), colors.white), ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'), ('FONTSIZE', (0,0), (-1,-1), 9), ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#eef4fb'), colors.white]), ('GRID', (0,0), (-1,-1), 0.4, colors.HexColor('#aaaaaa')), ('LEFTPADDING', (0,0), (-1,-1), 6), ('RIGHTPADDING', (0,0), (-1,-1), 6), ('TOPPADDING', (0,0), (-1,-1), 4), ('BOTTOMPADDING', (0,0), (-1,-1), 4), ('VALIGN', (0,0), (-1,-1), 'TOP'), ])) story.append(t) story.append(Spacer(1, 8)) h("ICDS Programme (successor to Balwadi)") p("The <b>Integrated Child Development Services (ICDS)</b> programme was started in <b>1975</b> in pursuance of the National Policy for Children. Beneficiaries: pre-school children below 6 years, adolescent girls 11–18 years, pregnant and lactating mothers. Six services provided:") b("Supplementary nutrition.") b("Immunization.") b("Health check-up.") b("Referral services.") b("Pre-school non-formal education.") b("Nutrition and health education.") p("Workers at village level who deliver the services are called <b>Anganwadi Workers (AWW)</b>. Each Anganwadi unit covers a population of about <b>400–800</b> (mini Anganwadi: 150–400). Supervision by Mukhyasevikas and Child Development Project Officers (CDPOs).") src() page_break() # ══════════════════════════════════════════════════════════════════════════════ # BACK COVER / SUMMARY # ══════════════════════════════════════════════════════════════════════════════ story.append(Spacer(1, 1*cm)) story.append(Paragraph("QUICK REVISION SUMMARY", cover_sub)) story.append(Spacer(1, 0.5*cm)) story.append(HRFlowable(width="80%", thickness=2, color=colors.HexColor('#1a3a5c'), spaceAfter=12)) summary_data = [ [Paragraph('<b>Programme</b>', body), Paragraph('<b>Year</b>', body), Paragraph('<b>Key Feature</b>', body)], ['NHM', '2013', 'NRHM + NUHM; universal health access'], ['NUHM', '2013', 'Urban slums; 1 ASHA per 1000–2500 urban poor'], ['RMNCH+A', '2013', 'Continuum of care; 5 components'], ['NACP', '1987', 'NACO; 90-90-90; NSP 2017–24'], ['NTEP', 'evolved 2020', 'TB elimination by 2025; NSP 2017–25'], ['RNTCP', '1993', 'DOTS strategy; 85% cure, 70% detection'], ['NLEP', '1983', 'MDT; <1/10,000 elimination goal'], ['NVBDCP', 'ongoing', '6 VBDs; 3-pronged strategy'], ['UIP', '1985', 'Polio-free 2014; Mission Indradhanush'], ['NPCDCS', '11th Plan', 'NCDs; opportunistic screening >30 yrs'], ['NMHP', '1982', 'DMHP; 517 districts; MHA 2017'], ['NPHCE', 'ongoing', 'Geriatric wards; RGCs at medical colleges'], ['NPPCD', '2006-07', 'Deafness; OAE screening; CSOM'], ['NPCB', '1976', 'Cataract 62.6%; IOL; 0.3% target'], ['NTCP', '2007-08 pilot', 'COTPA 2003; 85% pictorial warning'], ['NIDDCP', '1962', 'Iodized salt; 30 ppm at factory'], ['NOHP', '2014-15', 'Oral cancer; fluorosis; BCC'], ['NPNCD', 'ongoing', 'Integrated NCD prevention; AB-HWCs'], ['Ayushman Bharat', '2018', '1.5L HWCs + PM-JAY ₹5L/family'], ['Anemia Mukt Bharat', '2018', '6×6×6; 3% reduction/year'], ['Balwadi', '1970', '3–6 yrs; 300 kcal; phased out by ICDS'], ] sum_table = Table(summary_data, colWidths=[5.2*cm, 2.5*cm, doc.width - 7.7*cm]) sum_table.setStyle(TableStyle([ ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#1a3a5c')), ('TEXTCOLOR', (0,0), (-1,0), colors.white), ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'), ('FONTSIZE', (0,0), (-1,-1), 9), ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#eef4fb'), colors.white]), ('GRID', (0,0), (-1,-1), 0.4, colors.HexColor('#aaaaaa')), ('LEFTPADDING', (0,0), (-1,-1), 6), ('RIGHTPADDING', (0,0), (-1,-1), 6), ('TOPPADDING', (0,0), (-1,-1), 4), ('BOTTOMPADDING', (0,0), (-1,-1), 4), ('VALIGN', (0,0), (-1,-1), 'TOP'), ])) story.append(sum_table) story.append(Spacer(1, 1*cm)) story.append(HRFlowable(width="80%", thickness=1, color=colors.HexColor('#aaaaaa'), spaceAfter=6)) story.append(Paragraph("Reference: Park's Textbook of Preventive and Social Medicine | For MBBS University Examinations", cover_note)) # ── Build the document ─────────────────────────────────────────────────────── def add_page_number(canvas, doc): canvas.saveState() canvas.setFont('Helvetica', 8) canvas.setFillColor(colors.HexColor('#888888')) page_num = canvas.getPageNumber() text = f"National Health Programmes – Park's Textbook | Page {page_num}" canvas.drawCentredString(A4[0]/2.0, 1.2*cm, text) canvas.restoreState() doc.build(story, onFirstPage=add_page_number, onLaterPages=add_page_number) print("PDF generated successfully!") PYEOF echo "Script written"

cd /home/daytona/workspace/national-health-programs && python generate_pdf.py 2>&1

~/national-health-programs/generate_pdf.py

cd /home/daytona/workspace/national-health-programs && python generate_pdf.py 2>&1 && ls -lh National_Health_Programs_Park.pdf