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Human Development Index (HDI)

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1. DEFINITION ⭐

HDI is a composite index measuring achievement in three basic dimensions of human development: Long healthy life + Knowledge + Decent standard of living

• Introduced by UNDP (United Nations Development Programme)
• Values range from 0 to 1 (higher = better development)

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2. DIMENSIONS & INDICATORS (FLOWCHART from Park's)

DIMENSION          INDICATOR(S)
─────────────────────────────────────────────────────
Long & Healthy     Life Expectancy at Birth
Life               ↓
                   Life Expectancy Index
─────────────────────────────────────────────────────
Knowledge          Mean Years of Schooling (adults ≥25 yrs)
                   + Expected Years of Schooling (school-entering age)
                   ↓
                   Education Index
─────────────────────────────────────────────────────
Decent Standard    GNI per capita (PPP US $)
of Living          ↓
                   GNI Index
─────────────────────────────────────────────────────
                   ↓↓↓
              [GEOMETRIC MEAN of all 3]
                   ↓
              HUMAN DEVELOPMENT INDEX

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3. STEPS TO CALCULATE HDI

Step 1 - Create Dimension Index (Sub-index)

Dimension Index = (Actual value - Minimum value)
                  ─────────────────────────────────
                  (Maximum value - Minimum value)

Step 2 - Calculate HDI

HDI = Geometric Mean of 3 Dimension Indices
    = (Life Expectancy Index × Education Index × GNI Index)^(1/3)

Note: For Education, geometric mean of the two sub-indices is taken first, then equation re-applied.

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4. GOALPOSTS (Min & Max Values) - TABLE ⭐

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5. HDI CLASSIFICATION - MIND MAP

              HDI VALUE
                 │
    ┌────────────┼────────────┬────────────┐
    │            │            │            │
  <0.550     0.550-0.699   0.700-0.799   ≥0.800
    │            │            │            │
   LOW         MEDIUM        HIGH       VERY HIGH
  HDI          HDI           HDI         HDI

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6. KEY FACTS FOR EXAM ⭐⭐

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7. IMPORTANCE / SIGNIFICANCE

• More comprehensive than per capita income alone
• Income is a means, not an end - HDI goes beyond income
• Focuses on human outcomes rather than economic statistics
• Two countries with same income can have very different HDI (e.g., different life expectancy/literacy)
• Used by policy makers, media, NGOs to direct interventions
• Highlights regional disparities in human development

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8. LIMITATIONS (Bonus if time permits)

• Does not capture inequality within countries
• Does not reflect gender disparities (separate Gender Development Index exists)
• Does not include environmental sustainability
• Only 4 indicators - oversimplified

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Source: Park's Textbook of Preventive and Social Medicine (reference standard for MBBS PSM)

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Iceberg Phenomenon of Disease

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1. CONCEPT / DEFINITION ⭐

Disease in a community can be compared to an iceberg - only the tip is visible above the waterline, while the vast mass remains hidden below.

• The pattern of disease in hospitals is very different from the pattern in the community
• A far larger proportion of disease is hidden from view than is evident to physicians or the general public
• Closely related to the Spectrum of Disease

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2. THE ICEBERG DIAGRAM (Park's Fig. 10) ⭐⭐

 ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
        ▲  FLOATING TIP (VISIBLE)
        |  → Symptomatic / Clinical disease
        |  → What the PHYSICIAN SEES
 ═══════╪══════════════ WATERLINE ═════════════
        |  → Apparent ←→ Inapparent demarcation
        |
        ▼  SUBMERGED PORTION (HIDDEN MASS)
           → Subclinical cases
           → Carriers
           → Latent cases
           → Presymptomatic cases
           → Undiagnosed cases
           → What the PHYSICIAN DOES NOT SEE
 ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━

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3. COMPONENTS OF THE ICEBERG - MIND MAP

                    ICEBERG OF DISEASE
                          │
          ┌───────────────┴────────────────┐
     ABOVE WATERLINE                BELOW WATERLINE
    (Apparent Disease)            (Inapparent Disease)
          │                              │
    ┌─────┤                   ┌──────────┼──────────────┐
  Clinical │              Subclinical  Latent       Carriers
  cases    │              infections   cases            │
    │      │                   │          │       (e.g., Typhoid,
  Mild   Severe           No symptoms  Dormant      Hepatitis B)
  cases  cases               yet       infection         │
                                                  Presymptomatic
                                                     cases

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4. EXAMPLES BY DISEASE ⭐⭐

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5. SIGNIFICANCE / IMPORTANCE ⭐

1. Reservoir of infection - hidden cases act as undetected source of spread
2. True burden underestimated - hospital/clinic data does not reflect community disease load
3. Basis for Screening - justifies active search for disease in apparently healthy individuals
4. Public health challenge - detection and control of hidden portion is the goal of preventive medicine
5. Epidemiological tool - explains why incidence > reported cases

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6. WATERLINE = KEY CONCEPT

ABOVE WATERLINE              BELOW WATERLINE
─────────────────────        ─────────────────────────────
Apparent disease             Inapparent disease
Diagnosed cases              Undiagnosed / subclinical
Physician sees               Physician does NOT see
Morbidity statistics capture These are MISSED in data

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7. RELATIONSHIP WITH SPECTRUM OF DISEASE

SPECTRUM OF DISEASE (Continuous)
├── Subclinical/Inapparent ──── [BELOW waterline = Iceberg base]
├── Mild illness
├── Moderate illness            [ABOVE waterline = Iceberg tip]
├── Severe illness
└── Death

The Iceberg concept gives a better picture of sub-clinical to overt disease progression than the spectrum of disease alone.

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8. SOLUTION TO THE ICEBERG PROBLEM ⭐

DETECTION OF HIDDEN DISEASE
        │
        ├── SCREENING PROGRAMMES
        │       (mass/selective/multiphasic)
        │
        ├── ACTIVE SURVEILLANCE
        │
        ├── COMMUNITY SURVEYS
        │
        └── HEALTH CAMPS / OUTREACH

Screening = "search for unrecognized disease by rapidly applied tests in apparently healthy individuals" - this directly addresses the submerged portion of the iceberg.

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Epidemiological Triad

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1. INTRODUCTION / BACKGROUND ⭐

• The Germ Theory of disease (single cause) was found insufficient
• Example: Not everyone exposed to TB bacilli develops TB - host and environment also matter
• This demanded a broader concept synthesizing Agent + Host + Environment
• The Epidemiological Triad is based on the communicable disease model

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2. THE TRIAD DIAGRAM ⭐⭐ (Draw in exam)

              ENVIRONMENT
                  /\
                 /  \
                /    \
               /      \
              /________\
           AGENT        HOST

Disease occurs when the BALANCE between the three is disturbed Prevention = Break one leg of the triangle

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3. COMPONENT 1 - AGENT ⭐⭐

The cause of disease

Classification of Agents:

                        AGENT
                          │
        ┌─────────────────┼──────────────────┐
   BIOLOGICAL          PHYSICAL            CHEMICAL
        │                  │                  │
  Bacteria             Radiation          Poisons/toxins
  Viruses              Heat/cold          Drugs
  Fungi                Trauma             Allergens
  Parasites            Noise              Nutritional
  Rickettsia                              deficiency/excess
  Helminths

Properties of Agent (Biological) - KEY POINTS:

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4. COMPONENT 2 - HOST ⭐⭐

An organism (usually human/animal) that harbours the disease

Host Factors (Mind Map):

                      HOST FACTORS
                           │
      ┌──────────┬──────────┼──────────┬────────────┐
   INTRINSIC   GENETIC    IMMUNO-    BEHAV-      NUTRI-
   FACTORS     MAKEUP     LOGICAL    IOURAL      TIONAL
      │           │       STATUS     FACTORS     STATUS
   Age           Race        │           │          │
   Sex        Sickle cell  Immunity  Lifestyle   Under/over
   Ethnicity  trait        Natural   Habits      nutrition
              HLA type     Acquired  Occupation

Key determinants: Age, Sex, Genetic constitution, Immunity, Nutrition, Behaviour, Occupation

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5. COMPONENT 3 - ENVIRONMENT ⭐⭐

All external conditions and surroundings of the host that affect disease transmission

Three Types:

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6. ROLE OF TIME ⭐

• Added to create the "Triangle of Epidemiology" (Fig. 5, Park's)
• Accounts for:
  • Incubation period
  • Life expectancy of host/pathogen
  • Duration of illness
  • Epidemic threshold timing

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7. DISEASE STATES - INTERACTION DIAGRAM

EQUILIBRIUM (No disease)
Agent ←──── balanced ────→ Host
              ↕
          Environment

DISEASE OCCURS when:
┌──────────────────────────────────────────┐
│ Agent virulence ↑                        │
│ OR Host resistance ↓                     │
│ OR Environment favours agent over host   │
└──────────────────────────────────────────┘

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8. EXAMPLES OF TRIAD IMBALANCE

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9. LIMITATIONS OF THE TRIAD ⭐

1. Suitable mainly for infectious diseases - less applicable to chronic/non-communicable diseases
2. Does not show interaction and interdependence between factors (Web of Causation better for this)
3. Does not account for multiple causation well
4. Replaced/supplemented by: Web of Causation (MacMahon & Pugh) for chronic diseases

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10. SIGNIFICANCE / USE

USES OF EPIDEMIOLOGICAL TRIAD
         │
    ┌────┴────┐
    │         │
Understanding  Designing
disease        INTERVENTIONS
causation      │
               ├── Target AGENT (antibiotics, vaccines)
               ├── Target HOST (immunization, nutrition)
               └── Target ENVIRONMENT (sanitation, vector control)

Key principle: Break ANY ONE leg of the triangle = disease prevented/controlled

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⚡ EPIDEMIOLOGY - 30-MIN RAPID REVISION SHEET

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🔑 1. DEFINITION (Most important - learn verbatim)

"The study of the occurrence and distribution of health-related events, states, and processes in specified populations, including the study of the determinants influencing such processes, and the application of this knowledge to control relevant health problems." — IEA Definition (International Epidemiological Association)

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🔑 2. THREE CORE COMPONENTS

        EPIDEMIOLOGY
             │
    ┌────────┼────────┐
    │        │        │
FREQUENCY DISTRIBUTION DETERMINANTS
    │        │        │
  Rates &  Person    Causes/
  Ratios   Place     Risk factors
           Time

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🔑 3. AIMS (IEA - 3 Aims)

1. Describe distribution and magnitude of health & disease in populations
2. Identify aetiological factors (risk factors) in pathogenesis
3. Provide data for planning, implementation, evaluation of health services

Ultimate aim: Eliminate/reduce health problems + Promote well-being of society

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🔑 4. SCOPE OF EPIDEMIOLOGY

SCOPE OF EPIDEMIOLOGY
        │
   ┌────┴────┬──────────┬──────────┐
   │         │          │          │
Infectious  Chronic  Accidents  Mental
Diseases    Diseases             Health
   │         │
Endemic   Non-communicable
Epidemic  diseases (CHD, Ca)
   │
Health services &
Health-related states

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🔑 5. USES OF EPIDEMIOLOGY (Morris - 7 Uses) ⭐⭐

Mnemonic: History Community Planning Risk Syndrome Natural Causes = HCP RS NC

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🔑 6. TYPES OF EPIDEMIOLOGY

EPIDEMIOLOGY
      │
 ┌────┴────────────┐
 │                 │
DESCRIPTIVE    ANALYTICAL
 │                 │
Person            ├── Case-control study
Place             ├── Cohort study
Time              └── Cross-sectional study
 │                         │
Generates             Tests hypothesis
Hypothesis
                      +
                 EXPERIMENTAL
                      │
                 ├── RCT (gold standard)
                 ├── Field trials
                 └── Community trials

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🔑 7. DESCRIPTIVE EPIDEMIOLOGY - Person, Place, Time

PERSON

• Age, Sex, Race, Religion, Occupation, Marital status, Socioeconomic status

PLACE

• Country, Region, Urban vs Rural, Local patterns

TIME

• Secular trends - long-term changes over years/decades
• Cyclic trends - periodic fluctuations (seasonal, 2-3 yearly cycles)
• Point epidemic - all cases from single source at one time
• Propagated epidemic - spread person to person

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🔑 8. EPIDEMIOLOGY vs CLINICAL MEDICINE

Key quote: "Clinician interested in cases; statistician in population; epidemiologist in the RATE (relationship between cases and population)"

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🔑 9. BASIC MEASUREMENTS IN EPIDEMIOLOGY

RATES
  │
  ├── INCIDENCE RATE = New cases / Population at risk × K
  │                    (measures risk of disease)
  │
  ├── PREVALENCE RATE = All cases (new+old) / Total population × K
  │       │
  │       ├── Point prevalence (at one point in time)
  │       └── Period prevalence (over a period)
  │
  └── ATTACK RATE = Cases / Population exposed × 100
                    (used in outbreaks/epidemics)

RELATIONSHIP:
Prevalence ≈ Incidence × Duration of disease

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🔑 10. EPIDEMIOLOGICAL METHODS (Quick Overview)

OBSERVATIONAL                    EXPERIMENTAL
      │                                │
 ┌────┴────┐                    ┌──────┴──────┐
DESC.   ANALYTIC               RCT        Field/
 │        │                  (gold        Community
Person  ┌──┴──┐              standard)     trials
Place   │     │
Time   Case  Cohort
       ctrl   │
         Retrospective  Prospective
         (exposure?)   (disease?)

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🔑 11. KEY TERMS TO REMEMBER

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⚡ RAPID RECALL - EXAM SHORTCUTS

DEFINITION = IEA = Occurrence + Distribution + Determinants + Application

AIMS = 3 (Describe + Identify + Provide data)

USES = 7 (Morris)
       ↓
   H-C-P-R-S-N-C

TYPES = Descriptive → Analytical → Experimental
              ↓              ↓              ↓
        Hypothesis     Test it       Prove it (RCT)
           generated

PERSON + PLACE + TIME = 3 variables of descriptive epi

INCIDENCE = new cases (risk measure)
PREVALENCE = all cases (burden measure)
P = I × D

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⚡ COMMUNICABLE DISEASES & NATIONAL HEALTH PROGRAMMES (NHP) IN INDIA

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🔑 PART A: COMMUNICABLE DISEASE - CORE CONCEPTS

1. DEFINITION

A communicable disease is one that can be transmitted from an infected person/animal/environment to a susceptible host, directly or indirectly.

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2. CHAIN OF INFECTION (Most Exam-Important Diagram) ⭐⭐

INFECTIOUS        RESERVOIR     PORT OF      MODE OF      PORT OF      SUSCEPTIBLE
  AGENT    →      OF             EXIT    →   TRANS-    →  ENTRY    →    HOST
(pathogen)       INFECTION                  MISSION
  │                 │              │            │            │             │
Bacteria         Human          Resp.        Direct       Resp.        No immunity
Virus            Animal         tract        Contact      tract        Malnutrition
Fungi            Environment    GIT          Indirect     GIT          Genetic
Parasite         Carrier        Skin         Airborne     Skin         Age/Sex
Rickettsia                      GUT          Vector       Mucosa
                                             Vehicle
                                             Fomite

Break ANY link = Disease prevented

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3. MODES OF TRANSMISSION

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4. KEY DEFINITIONS

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5. CONTROL OF COMMUNICABLE DISEASE

CONTROL MEASURES
      │
 ┌────┴──────────────────────┐
 │                           │
AT SOURCE                AT HOST              AT ENVIRONMENT
(Agent/Reservoir)             │                      │
 │                    Immunization           Sanitation
Isolation             Chemoprophylaxis       Safe water
Quarantine            Health education       Vector control
Disinfection          Nutrition              Waste disposal
Treatment             Screening

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🔑 PART B: NATIONAL HEALTH PROGRAMMES - COMMUNICABLE DISEASES ⭐⭐

MASTER TABLE OF NHPs FOR COMMUNICABLE DISEASES

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🔑 1. NTEP - National TB Elimination Programme ⭐⭐

NTP (1962) → RNTCP (1997, DOTS) → End TB Strategy (2014) → NTEP (renamed 2020)

1. Political will & administrative commitment
2. Diagnosis by quality sputum smear microscopy
3. Adequate supply of quality short-course chemotherapy
4. Directly Observed Treatment (DOT)
5. Systematic monitoring & accountability

• Address TB/HIV + MDR-TB
• Strengthen health systems
• Engage all care providers
• Empower patients & communities
• Enable/promote research

• Cure rate ≥ 85% of infectious cases
• Case detection ≥ 70% of estimated cases

Central TB Division (CTD) - National
        ↓
State TB Cell (STO) - State
        ↓
District TB Centre (DTO) - District
        ↓
Peripheral Health Institutions (PHI)

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🔑 2. NVBDCP - National Vector Borne Disease Control Programme ⭐⭐

• IRS (Indoor Residual Spraying) - DDT/Malathion
• LLINs (Long-lasting insecticidal bed nets) - introduced 2009
• RDT (Rapid Diagnostic Test) - introduced 2005
• ACT (Artemisinin Combination Therapy) - introduced 2006 for Pf resistance
• Larval control, biological control

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🔑 3. NLEP - National Leprosy Eradication Programme ⭐

NLCP (1955) → NLEP (1983) → MDT introduced (1982 by WHO)
Goal: Elimination = <1 case per 10,000 population
India declared leprosy eliminated: 2005

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🔑 4. NACP - National AIDS Control Programme ⭐⭐

1986: First HIV case in India
1987: NACP launched
NACO set up (under MoHFW)

• 2004: ART (Antiretroviral Treatment) initiated free
• 2006: National Council on AIDS (PM as chairman)
• State AIDS Control Societies established in all states

1. Prevent further HIV transmission
2. Decrease morbidity & mortality
3. Minimize socio-economic impact

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🔑 5. NPCB - National Programme for Control of Blindness ⭐

• Launched: 1976 (100% centrally sponsored)
• Goal: Reduce blindness from 1.4% → 0.3%
• Current prevalence (2015-19 survey): 0.36%

• 66 lakh cataract operations/year
• 9 lakh free spectacles to school children/year
• 50,000 donated eyes for keratoplasty/year

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🔑 6. UNIVERSAL IMMUNIZATION PROGRAMME (UIP) ⭐⭐

EPI (1978) → UIP (1985) → Mission Indradhanush (2014)

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⚡ RAPID RECALL TABLE - NHPs at a Glance

DISEASE        PROGRAMME    YEAR     KEY STRATEGY
──────────────────────────────────────────────────
TB             NTEP         1962/97  DOTS + End TB
Malaria        NVBDCP       1953/02  ACT + LLINs + IRS
Leprosy        NLEP         1983     MDT (6/12 months)
HIV/AIDS       NACP/NACO    1987     ART + Prevention
Blindness      NPCB         1976     Cataract surgery
Filaria        NVBDCP       -        MDA (DEC + Albendazole)
Kala-azar      NVBDCP       -        Elimination by 2023
Dengue/Chik    NVBDCP       -        Vector control (Aedes)
Vaccines       UIP          1985     12 antigens covered

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National Health Programmes (NHP) for Communicable Diseases in India

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INTRODUCTION

National Health Programmes are centrally sponsored, goal-directed initiatives by the Government of India to reduce morbidity and mortality from major communicable diseases. Each programme operates through the national health care delivery system from central to peripheral level.

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OVERVIEW FLOWCHART

COMMUNICABLE DISEASE NHPs IN INDIA
              │
    ┌─────────┼──────────┬──────────────┬──────────────┐
    │         │          │              │              │
  NTEP      NVBDCP     NLEP           NACP          UIP/NIS
(TB)      (Vector-   (Leprosy)     (HIV/AIDS)    (Immunization)
          borne)
            │
     ┌──────┼────────┬────────┐
   Malaria Dengue  Filaria  Kala-azar
           Chikungunya  JE

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1. NATIONAL TB ELIMINATION PROGRAMME (NTEP) ⭐⭐

Evolution

NTP (1962) → RNTCP (1997, DOTS) → STOP TB (2006) → End TB (2014) → NTEP (renamed 2020)

Objectives

1. Cure rate ≥ 85% of infectious cases through DOTS
2. Case detection ≥ 70% of estimated cases by quality sputum microscopy

DOTS Strategy - 5 Components ⭐

STOP TB Strategy (2006) - Additional Components

• Pursuing quality DOTS expansion
• Addressing TB/HIV & MDR-TB
• Contributing to health system strengthening
• Engaging all care providers
• Empowering patients & communities
• Enabling & promoting research

End TB Strategy (2014)

Vision: Zero deaths, disease and suffering due to TB (by 2030)

NTEP Organization Structure

Ministry of Health & Family Welfare
         ↓
Central TB Division (CTD) - National level
         ↓
State TB Cell (STO) - State level
         ↓
District TB Centre (DTO) - District level
         ↓
Peripheral Health Institutions (PHI)

Key Drugs

• DOTS regimen: 2HRZE / 4HR (Isoniazid + Rifampicin + Pyrazinamide + Ethambutol)
• MDR-TB: Bedaquiline-based regimens (Group A, B, C classification)

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2. NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (NVBDCP) ⭐⭐

Diseases Covered

NVBDCP (2003)
    │
    ├── Malaria
    ├── Dengue & Chikungunya
    ├── Lymphatic Filariasis
    ├── Kala-azar (Visceral Leishmaniasis)
    └── Japanese Encephalitis (JE)

A. MALARIA - Programme Milestones

Malaria Control Strategies

ANTI-MALARIA MEASURES
        │
   ┌────┴────┬──────────────┐
   │         │              │
PARASITE   VECTOR         HOST
  │            │              │
Diagnosis    IRS (DDT/     Chemoprophylaxis
RDT/Smear    Malathion)    Presumptive
ACT/CQ       Larvicides    treatment
treatment    LLINs         IEC
             Biological
             control

B. LYMPHATIC FILARIASIS ELIMINATION

• Strategy: Annual MDA (Mass Drug Administration)
  • DEC alone (till 2007) → DEC + Albendazole (from 2007)
  • Given to all eligible persons except: pregnant women, children <2 years, seriously ill
• Target: Elimination = microfilaria prevalence <1%
• Started: 2004; All 250 endemic districts covered by 2007

C. KALA-AZAR (Visceral Leishmaniasis) Elimination

• Target: <1 case per 10,000 population at block level
• Drug of choice: Liposomal Amphotericin B (single dose)
• Vector: Phlebotomus argentipes (sandfly) - indoor residual spraying

D. DENGUE & CHIKUNGUNYA

• Vector: Aedes aegypti (breeds in clean stagnant water)
• Control: Source reduction, larvicides, personal protection
• No specific treatment / vaccine (dengue vaccine limited use)

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3. NATIONAL LEPROSY ERADICATION PROGRAMME (NLEP) ⭐⭐

Timeline

NLCP (1955) → NLEP (1983) → WHO MDT introduced (1982) → Elimination achieved (2005)

Goal

Elimination = <1 case per 10,000 population at national level India achieved elimination at national level: 2005

MDT Regimens ⭐

MDT = Monthly supervised + daily unsupervised doses

Classification of Leprosy

LEPROSY
   │
   ├── PB (1-5 skin patches, smear negative)
   │       → Tuberculoid (TT), Borderline Tuberculoid (BT)
   │
   └── MB (>5 skin patches, smear positive)
           → Borderline (BB), Borderline Lepromatous (BL), Lepromatous (LL)

Key Indicators

• ANCDR: Annual New Case Detection Rate (per 1,00,000)
• PR: Prevalence Rate (per 10,000)
• Grade II disability rate among new cases
• Child proportion among new cases (indicator of active transmission)

Strategies

• Free MDT through government services
• Disability prevention & rehabilitation
• IEC for stigma reduction
• Integration with general health services

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4. NATIONAL AIDS CONTROL PROGRAMME (NACP) ⭐⭐

Timeline

1986: First HIV case in India
1987: NACP launched → NACO set up
1992: NACP-I → 1999: NACP-II → 2007: NACP-III → 2012: NACP-IV → 2017: NSP 2017-2024

Phases of NACP

Aims of NACP

1. Prevent further HIV transmission
2. Decrease morbidity & mortality associated with HIV
3. Minimize socio-economic impact

NACO Structure

National AIDS Control Organization (NACO)
    - Under Ministry of Health & Family Welfare
         ↓
State AIDS Control Societies (SACS)
         ↓
District AIDS Prevention & Control Units (DAPCU)

Key Interventions

• Free ART (Antiretroviral Treatment) - started 2004
• ICTC (Integrated Counselling & Testing Centres)
• PPTCT (Prevention of Parent to Child Transmission)
• TI (Targeted Interventions) for high-risk groups (FSW, MSM, IDU, migrants)
• Blood safety: National Blood Policy (2002)
• Condom promotion, IEC

90-90-90 Targets (UNAIDS)

90% of people with HIV know their status
    → 90% of diagnosed on treatment
        → 90% of treated virally suppressed

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5. UNIVERSAL IMMUNIZATION PROGRAMME (UIP) ⭐⭐

Evolution

EPI launched by WHO (1974) → EPI India (Jan 1978) → UIP launched (Nov 19, 1985)
Dedicated to memory of Smt. Indira Gandhi

National Immunization Schedule (Key vaccines) ⭐

Mission Indradhanush (2014) ⭐

Reach all unvaccinated/partially vaccinated children under 2 years Target: Full immunization coverage → 90%

Cold Chain

State Vaccine Store → Regional/Divisional Store → District Store
    → CHC/PHC → Sub-Centre → Village (field worker/ANM)

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SUMMARY TABLE - QUICK RECALL ⭐⭐

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