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National Health Programs of India - Complete Guide for Rural Hospital Doctors
Source: Park's Textbook of Preventive and Social Medicine + Ministry of Health & Family Welfare (updated 2025-26)
FRAMEWORK: National Health Mission (NHM)
The National Health Mission (NHM) is the overarching umbrella under which all major health programs operate. It has two sub-missions:
| Sub-Mission | Year | Focus |
|---|---|---|
| NRHM - National Rural Health Mission | 2005 (converted to NHM 2013) | Rural populations, 18 priority states |
| NUHM - National Urban Health Mission | 2013 | Urban poor |
NHM merges all vertical programs into a single District Health Mission at district level and State Health Mission at state level.
PART 1: INFRASTRUCTURE & DELIVERY (NRHM)
As a rural hospital doctor, this is your daily operational framework.
Key Components
1. ASHA (Accredited Social Health Activist)
- One ASHA per 1,000 population (relaxed to one per habitation in tribal/hilly/desert areas)
- Must be a resident woman (married/widow/divorced), age 25-45 years, minimum 8th class education
- Roles: escort patients to facilities, distribute contraceptives, home-based newborn care, track MCH cases
- Your rural hospital works through ASHA for community linkage
2. Rogi Kalyan Samiti (RKS) - Patient Welfare Committee
- Registered society managing hospital affairs
- Responsible for hospital upkeep and patient facilities
- Receives untied funds for patient welfare activities
- Set up in all DHs, SDHs, CHCs and PHCs (32,005 RKS by March 2015)
- As a rural hospital doctor, you must know how to work with the RKS for hospital management
3. Village Health, Sanitation and Nutrition Committee (VHSNC)
- Community-level committee at village level
- Mandated to address health, sanitation AND nutrition
4. Indian Public Health Standards (IPHS)
- Standards for infrastructure, staff, equipment and management at each level (SC, PHC, CHC, DH)
- Your hospital must meet IPHS norms
5. Mother and Child Tracking System (MCTS)
- Name-based tracking of every pregnant woman, infant and child up to 3 years
- Tracks antenatal care, institutional delivery, postnatal care, immunization
- Tracks severely anaemic women, low birth weight babies, sick neonates
NRHM Infrastructure (Tiered System):
Village Level → ASHA + Sub-Centre (ANM)
PHC Level → 24-hour services, AYUSH integration
CHC Level → 30-50 bed First Referral Unit (FRU), 24 hours
District Level → District Hospital + Mobile Medical Unit
PART 2: RMNCH+A (Reproductive, Maternal, Newborn, Child & Adolescent Health)
This is the most important program cluster for a rural hospital.
Maternal Health Programs
A. Janani Suraksha Yojana (JSY)
- Conditional cash transfer to promote institutional delivery
- Targets: BPL women, SC/ST women, all women in low-performing states
- Cash incentive to mother + ASHA for every institutional delivery
B. Janani Shishu Suraksha Karyakaram (JSSK)
- Free and cashless services for pregnant women and sick newborns at government facilities
- Covers: free delivery (including C-section), free drugs, free diagnostics, free diet, free transport (to and from facility, between referral)
- Sick newborns up to 30 days covered
C. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)
- Free antenatal checkup on 9th of every month at all government health facilities
- Minimum package: weight, blood pressure, abdominal examination, lab investigations
Child Health
D. Rashtriya Bal Swasthya Karyakram (RBSK) - Launched February 2013
- Child health screening and early intervention
- Screens for 4 Ds: Defects at birth, Diseases, Deficiencies, Developmental delays (including disability)
- Covers children from birth to 18 years
E. Universal Immunization Programme (UIP)
- BCG, OPV, DPT, Hepatitis B, Hib, IPV, Measles-Rubella, PCV, Rotavirus, JE (in endemic areas)
- Mission Indradhanush - to cover all unvaccinated/partially vaccinated children
F. Vitamin A Supplementation
- 9 months to 5 years; every 6 months
G. National Iron Plus Initiative (2013)
- IFA (Iron-Folic Acid) supplementation for all age groups: pregnant women, lactating mothers, children, adolescents, women in reproductive age
- WIFS (Weekly Iron and Folic Acid Supplementation) for adolescents 10-19 years - rolled out in 32 states
Adolescent Health
H. Rashtriya Kishor Swasthya Karyakram (RKSK) - Launched January 2014
- Targets 253 million adolescents
- Peer-led interventions at community level
- Covers: nutrition, life skills, mental health, NCDs, substance misuse, gender-based violence, reproductive health
PART 3: COMMUNICABLE DISEASE PROGRAMS
1. National TB Elimination Program (NTEP) - formerly RNTCP
| Feature | Detail |
|---|---|
| Goal | "TB Mukti Bharat" - TB-free India by 2025 (5 years ahead of SDG 2030) |
| Strategy | DTPB pillars: Detect, Treat, Prevent, Build |
| Diagnosis | Free molecular testing (CBNAAT/TrueNat), sputum microscopy at DMC |
| Treatment | Free daily fixed-dose combination (FDC) therapy |
| Financial incentive | Nikshay Poshan Yojana - Rs. 500/month nutritional support during treatment |
| HIV-TB | Linkage with HIV program; all TB patients tested for HIV |
| Drug Resistance | DST for all diagnosed cases; free bedaquiline/delamanid |
Your role in rural hospital: Refer presumptive TB cases for DMC testing, initiate DOT (Directly Observed Treatment), ensure Nikshay portal registration, contact tracing.
2. National Vector Borne Disease Control Programme (NVBDCP)
Launched 2003-04 by merging multiple programs. Covers:
| Disease | Key Intervention at Rural Level |
|---|---|
| Malaria | Rapid Diagnostic Test (RDT), blood smear; ACT for P. falciparum, Chloroquine for P. vivax; Indoor Residual Spraying (IRS), LLINs |
| Dengue | Platelet monitoring, supportive care, source reduction (container survey) |
| Kala-azar (Visceral Leishmaniasis) | Free Miltefosine/Liposomal Amphotericin B; target: elimination (<1 case/10,000 population) |
| Filariasis | Annual Mass Drug Administration (MDA) - DEC + Albendazole |
| Japanese Encephalitis | JE vaccine in endemic districts; vector control |
| Chikungunya | Supportive care; vector control |
Your role: Conduct RDTs, report weekly to IDSP, participate in MDA campaigns, IRS supervision.
3. National Leprosy Eradication Programme (NLEP)
| Feature | Detail |
|---|---|
| Started | 1955 as NLCP; restructured to NLEP 1983 |
| Goal | Eliminate leprosy (< 1 case/10,000 population) |
| Treatment | Free MDT (Multi-Drug Therapy) - Rifampicin + Dapsone + Clofazimine |
| Updated April 2025 | New WHO-aligned protocol: 3-drug MDT for BOTH PB (Pauci-bacillary) and MB (Multi-bacillary) cases |
| Classification | Based on lesion count and nerve involvement (revised 2023, implemented April 2025) |
| Grade 2 Disability | Reconstructive surgery, physiotherapy, MCR footwear provided free |
Your role: Skin smear, clinical diagnosis, initiate MDT, track grade 2 disability, manage reactions (Type 1 - reversal, Type 2 - ENL).
4. National AIDS Control Programme (NACP) - Phase IV
| Feature | Detail |
|---|---|
| Body | NACO (National AIDS Control Organisation) |
| Free services | ART (Antiretroviral Therapy) at ART centres, free CD4 count, VL testing |
| ICTC | Integrated Counseling and Testing Centre - free HIV testing |
| PPTCT | Prevention of Parent-to-Child Transmission - all pregnant women tested |
| Key populations | FSW, MSM, IDU - targeted interventions |
| Opioid substitution therapy | Available at ICTC/OST centres |
Your role: Refer for ICTC testing, screen all pregnant women, initiate ART linkage, report to IDSP.
5. Integrated Disease Surveillance Programme (IDSP)
- Decentralized disease surveillance at district, state and national levels
- Weekly reporting (S - Syndromic, P - Presumptive, L - Laboratory) to District Surveillance Unit (DSU)
- Outbreak detection and rapid response
- Your rural hospital is a reporting unit - weekly/outbreak reports are mandatory
6. National Programme for Control of Blindness (NPCB)
| Feature | Detail |
|---|---|
| Target | Blindness prevalence < 0.25% (current 0.36%) |
| Cataract Surgery Rate (CSR) | Target > 3,000 per million per year |
| Free services | Cataract surgery, glasses, low vision services |
| District level | District Blindness Control Society (DBCS) |
| Screening | PHC/rural hospital - screen and refer cataracts, glaucoma, diabetic retinopathy |
| Vitamin A | Bitot's spots target < 0.5% |
| Netra Jyoti Abhiyan (2025) | Recent camp-based initiative for eye care outreach |
Your role: Screen, record vision acuity, refer cataracts to district/tertiary eye care, Vitamin A supplementation.
PART 4: NON-COMMUNICABLE DISEASE (NCD) PROGRAMS
7. NPCDCS - National Programme for Prevention & Control of Cancer, Diabetes, CVD & Stroke
- Screening at CHC/DH level for:
- Oral cancer, cervical cancer, breast cancer
- Diabetes (glucometer/glucostrips provided under NRHM)
- Hypertension, CVD risk
- Stroke
- Common infrastructure and manpower shared with NPHCE and other NCD programs
- Cervical Cancer Campaign (February 2026): Free HPV vaccine to ~1.15 crore girls aged 14 years
Your role: Opportunistic screening at OPD, BP recording, blood glucose, refer to NCD clinic.
8. National Mental Health Programme (NMHP)
- Free psychiatric services at district hospitals
- District Mental Health Programme (DMHP) at district level
- Manpower: psychiatrist, clinical psychologist, social worker
- Community awareness; suicide prevention
- Integration with primary care
Your role: Screen for depression/psychosis, provide basic counseling, refer to DMHP, treat epilepsy (phenytoin/valproate provided free).
9. National Programme for Prevention & Control of Deafness (NPPCD)
- Early identification of hearing impairment (newborn screening)
- Free hearing aids to BPL patients
- Training of PHC/CHC staff in audiometry
10. National Iodine Deficiency Disorder Control Programme (NIDDCP)
- Mandatory iodization of salt
- IDD surveys
- Urine iodine level monitoring
- You must ensure iodized salt use is promoted in your community
11. National Tobacco Control Programme (NTCP)
- MPOWER strategy (WHO)
- Tobacco cessation clinics at district hospitals
- COTPA enforcement
- Nicotine Replacement Therapy available
12. National Programme for Health Care of Elderly (NPHCE)
- Weekly geriatric OPD at PHC/CHC level
- Free drugs for elderly (BPL)
- District Geriatric Units at district hospitals
- Dedicated beds for elderly
13. National Oral Health Programme (NOHP)
- Oral health promotion and preventive services
- Screening for oral cancer integrated with NPCDCS
14. National Programme for Prevention & Control of Fluorosis (NPPCF)
- Screening in endemic areas (high fluoride groundwater districts)
- Defluoridation of water
PART 5: OTHER KEY PROGRAMS
15. National Family Planning Programme
| Method | Rural Provision |
|---|---|
| Condoms | Free via ASHA/Sub-centre |
| OCP/ECP | Free via ASHA (home delivery) |
| Copper-T (IUCD) | Sub-centre/PHC level |
| Sterilization | Free at CHC/DH (Minilap/Laparoscopic) |
| MTP | Up to 20 weeks at approved CHC/DH |
16. School Health Programme
- Annual health checkup of school children
- RBSK mobile health teams cover schools
- Deworming (Albendazole) - National Deworming Day (February 10, August 10)
17. Pradhan Mantri Jan Arogya Yojana (PM-JAY) / Ayushman Bharat
- Health insurance coverage of Rs. 5 lakh per family per year for secondary and tertiary care
- Covers ~55 crore (500 million) beneficiaries (bottom 40% of population)
- Your rural hospital may be empanelled - cashless treatment for eligible beneficiaries
- Ayushman Bharat - Health and Wellness Centres (HWC): upgraded Sub-Centres and PHCs providing comprehensive primary health care
PART 6: QUICK REFERENCE - YOUR ROLE AS RURAL HOSPITAL DOCTOR
| Program | Your Mandatory Responsibility |
|---|---|
| NTEP | Sputum collection, CBNAAT referral, DOT initiation, Nikshay registration |
| NVBDCP | RDT/blood smear for malaria, weekly fever case reporting |
| NLEP | Skin/nerve examination, MDT initiation, disability grading |
| NACP | PPTCT for all ANC, ICTC referral, ART linkage |
| IDSP | Weekly S/P/L report to DSU, outbreak reporting within 24 hours |
| RMNCH+A | ANC registration (early 1st trimester), JSY/JSSK, JSSK cashless delivery |
| Immunization | Cold chain maintenance, VPD case reporting |
| NPCDCS | Opportunistic screening at OPD (BP, blood sugar, oral/cervical/breast exam) |
| NPCB | Vision screening, cataract referral |
| NMHP | Basic psychiatric care, epilepsy management, DMHP referral |
| IDSP Reporting | MANDATORY weekly reporting even if zero cases |
KEY DATES / RECENT UPDATES (2025-26)
- April 1, 2025: NLEP new 3-drug MDT protocol for ALL leprosy cases (both PB and MB)
- February 2026: Free HPV vaccine campaign for girls aged 14 years (cervical cancer prevention)
- 2020: RNTCP renamed to NTEP (National TB Elimination Programme)
- 2013: NRHM expanded to NHM; NUHM added
- NTEP goal: TB elimination by 2025 (5 years ahead of SDG 2030)
Sources: Park's Textbook of Preventive and Social Medicine, 25th ed. | Ministry of Health & Family Welfare, PIB 2025-26 | DGHS.mohfw.gov.in | AMBOSS India National Health Programs (updated April 2026)
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