QUESTION 1: MATERNAL MORTALITY RATIO (MMR)

Definition of Maternal Mortality Ratio (MMR)

Determinants of Maternal Mortality

A. Medical/Direct Obstetric Causes (80% of maternal deaths)

• Obstetric haemorrhage (25% - single most common cause, typically postpartum)
• Sepsis/infections
• Hypertensive disorders of pregnancy (eclampsia, preeclampsia)
• Obstructed labour and prolonged labour
• Complications of abortion
• Anaemia (chronic)
• Complications of anaesthesia and caesarean section

B. Socio-Economic and Cultural Determinants

• Illiteracy and low education level
• Low socioeconomic status
• Early age of marriage
• Low female empowerment
• Traditional preference for home deliveries
• Early/closely spaced pregnancies
• Malnutrition and poor nutritional status
• Violence against women
• Environmental conditions and poor sanitation

C. Access to Healthcare

• Inadequate or delayed antenatal care
• Lack of skilled birth attendance
• Absence of emergency obstetric care facilities
• Poor referral systems
• Inadequate access to basic/emergency obstetric services

India's MMR Status

• National MMR: 113 per 100,000 live births (2016-18)
• Significant variation by region:
  • EAG states + Assam (high burden): MMR 161
  • Southern states (better): MMR 67
  • States with highest MMR: Assam (215), Uttar Pradesh (197), Bihar (149), Madhya Pradesh (173), Rajasthan (164)

• Haemorrhage, sepsis, abortion, hypertensive disorders, obstructed labour, anaemia

Plan to Reduce MMR in Your PHC

1. Health System Strengthening

• Ensure availability of skilled birth attendants at all deliveries
• Establish First Referral Units (FRUs) for emergency obstetric care
• Ensure availability of key drugs, equipment, and supplies
• Strengthen ambulance services and referral systems
• Establish MCH wings and mother-child tracking systems

2. Antenatal Care Interventions

• Early registration of pregnancy (first visit within first trimester)
• Minimum 4 antenatal check-ups with standardized content
• Screening and management of high-risk pregnancies (hypertension, diabetes, TB, malaria)
• Iron and folic acid supplementation for all pregnant women
• Tetanus prophylaxis and antimalarial prophylaxis as indicated
• Early detection and management of complications

3. Maternal Nutrition and Health

• Dietary counselling and supplementation
• Correction of anaemia (screening and treatment)
• Micronutrient supplementation
• Management of medical conditions (TB, diabetes, hypertension)

4. Safe Delivery Practices

• Promotion of institutional deliveries
• Training of birth attendants in clean delivery practices
• Prevention of infection during labour and postpartum period
• Emergency management protocols (haemorrhage, eclampsia, obstructed labour)

5. Community and Social Measures

• Awareness campaigns about safe motherhood
• Female education and empowerment programs
• Community involvement through ASHA/ANM workers
• Addressing cultural barriers to institutional delivery
• Gender violence prevention programs
• Socioeconomic development initiatives

6. Policy Implementation

• Janani Suraksha Yojana (institutional delivery incentives)
• RMNCH+A programme implementation
• Safe motherhood component of RCH programme
• Free delivery and maternal services

QUESTION 2: CHILDHOOD ILLNESSES & LOW BIRTH WEIGHT

Common Causes of Childhood Illnesses in India

1. Acute Respiratory Infections (ARI)
2. Diarrhoeal diseases
3. Malaria
4. Measles and vaccine-preventable diseases
5. Nutritional deficiencies (particularly protein-energy malnutrition)
6. Neonatal causes (prematurity, low birth weight, birth asphyxia)
7. Congenital anomalies

• Perinatal/neonatal causes (prematurity, LBW)
• Diarrhoea
• ARI/pneumonia
• Malaria
• Malnutrition

LOW BIRTH WEIGHT (LBW) - EPIDEMIOLOGY IN INDIA

Definition

• Birth weight less than 2.5 kg (≤2499 g)
• Measured preferably within first hour of life

Magnitude in India

• Incidence: 18.6% of babies born in India (compared to 4% in developed countries)
• One of the highest rates globally
• Major contributor to perinatal, neonatal, and infant mortality

Global Burden

• 15 million preterm births globally (2015)
• India accounts for 3.5 million preterm births - highest globally
• More than 90% of extremely preterm babies (< 28 weeks) in low-income countries die within days

Classification of LBW Babies

1. Preterm Babies (birth before 37 weeks)

• Extremely preterm: < 28 weeks
• Very preterm: 28 to < 32 weeks
• Moderate to late preterm: 32-37 weeks
• Born too early with immature organs; normal intrauterine growth for their gestation

2. Small-for-Date (SFD)/Small-for-Gestational-Age (SGA) Babies

• Birth weight < 10th percentile for gestational age
• Result of intrauterine growth retardation
• More common in India (majority of LBW cases)

Epidemiology of LBW in India

• Maternal malnutrition (major - 33% of adult women BMI < 18.5)
• Maternal anaemia (chronic)
• Short maternal stature
• Very young maternal age (adolescent pregnancies)
• High parity and close birth spacing
• Maternal infections (malaria, UTI, sexually transmitted infections)
• Hard physical labour during pregnancy
• Low socioeconomic status
• Low maternal education
• Early marriage

• (a) Short gestation (preterm) - more common in developed countries
• (b) Foetal growth retardation - majority in India

Significance of LBW

• Birth weight is the single most important determinant of infant survival, growth, and development
• Infant mortality rate is 20 times greater in LBW babies vs. normal birth weight
• Accounts for half of all perinatal deaths and one-third of all infant deaths
• LBW babies become victims of:
  • Protein-energy malnutrition
  • Infections
  • Developmental delays
  • Long-term health problems (hypertension, diabetes)
• Reflects inadequate maternal nutrition, ill-health, and inadequate prenatal care

Measures to Reduce LBW in India

A. Direct Interventions (Addressing Modifiable Risk Factors)

• Dietary supplementation for malnourished pregnant mothers
• Iron and folic acid tablet distribution
• Food fortification and enrichment programs
• Even small dietary improvements in last trimester can significantly increase birth weight

• Early diagnosis and treatment of:
  • Malaria
  • Urinary tract infections
  • Sexually transmitted infections (syphilis, etc.)
  • Cytomegalovirus, toxoplasmosis, rubella
• Antimalarial prophylaxis and treatment
• Prevention of blood-borne infections

• Screening for hypertension, pre-eclampsia, toxaemia
• Management of diabetes and gestational diabetes
• Treatment of chronic maternal conditions

• Counselling on rest during pregnancy
• Maternity leave with full wages (government support)

• Family planning programs
• Increased birth intervals reduce LBW risk

B. Indirect Interventions

• Family planning and contraceptive services
• Health and nutrition programs for adolescent girls and young women
• Avoidance of smoking and harmful substances
• Improved sanitation and environmental conditions
• Improved socioeconomic conditions
• Educational programs for women
• Empowerment of women

C. Antenatal Care Package

• 4-visit focused antenatal care minimum
• Early pregnancy registration
• Micronutrient supplementation (calcium, iron, folic acid)
• Screening and management of maternal conditions
• Education on nutrition, hygiene, and delivery preparedness
• Identification of high-risk pregnancies

D. Health and Nutrition Programs

• Iron and Folic Acid Supplementation Programme
• Pre-pregnancy nutrition counselling
• Management of anaemia in reproductive age women
• Nutrition education through ASHA/ANM workers

E. Community and Social Measures

• Community awareness on importance of:
  • Adequate nutrition during pregnancy
  • Antenatal care attendance
  • Skilled delivery
  • Birth spacing
• Community involvement through health workers
• Gender violence prevention
• Female education initiatives
• Improved water, sanitation, and hygiene (WASH)

F. Healthcare System Interventions

• Skilled antenatal care by trained personnel
• Emergency obstetric care availability
• Referral systems for high-risk pregnancies
• Management of preterm labour with steroids and antibiotics
• Kangaroo Mother Care for preterm LBW babies
• Neonatal intensive care when available

LONG ESSAY ANSWERS - Community Medicine (Park's Textbook)

QUESTION 1 (Part A)

Discuss the various causes of Road Traffic Accidents (RTAs) and the methods to control and prevent them. (5+5 = 10 marks)

INTRODUCTION

A. CAUSES OF ROAD TRAFFIC ACCIDENTS

I. Human/Host Factors

II. Vehicle/Agent Factors

• Large numbers of old, poorly maintained vehicles on roads
• Poor brakes, defective lights, and steering failures
• Large numbers of motorcycles, scooters, and mopeds (unstable and offer little protection)
• Overloaded buses and trucks
• Lack of safety features (airbags, ABS)

III. Environmental/Road Factors

• Defective roads - potholes, poor road conditions
• Poor street lighting
• Defective layout of crossroads and intersections
• Absence or defective speed breakers
• Bad weather - fog, rain, poor visibility
• Unusual behaviour of men and animals on roads (especially in India)
• Absence of pedestrian crossings, footpaths, and cycle lanes

IV. Special Risk Groups

• Vulnerable road users - pedestrians, cyclists, and motorcyclists account for nearly 48% of deaths on roads
• In India (2017):
  • Pedestrians: 35.1% of deaths
  • Motorcyclists: 30.9% of deaths
  • Motor vehicle occupants: 26.4%
  • Cyclists: 7.0%
• Children and young people under 25 years account for over 30% of those killed

B. PREVENTION AND CONTROL OF RTAs

1. Data Collection

• A basic reporting system for all accidents must exist
• National data supplemented by special surveys and in-depth studies
• Police records as the starting point
• Detailed environmental data (road, vehicle, weather) must be collected
• Without adequate data collection, no effective counter-measures are possible

2. Safety Education

• "If accident is a disease, education is its vaccine"
• Safety education must begin with school children
• Drivers need training in proper vehicle maintenance and safe driving
• Young people to be educated about risk factors, traffic rules, and safety precautions
• Training in first aid
• Changing fatalistic attitudes about accidents

3. Promotion of Safety Measures

4. Legislation and Enforcement

• Speed limit laws and enforcement - speed zones of 30 km/h in residential/school areas
• Drink-driving laws - BAC limit of 0.05 g/dl or below
• Sobriety checkpoints and random breath testing (reduces alcohol-related crashes by 20%)
• Compulsory helmet and seatbelt laws
• Ban on mobile phone use while driving
• Stricter licensing laws and fitness tests for drivers

5. Road Engineering and Design

• Improved road design - proper crossroads, roundabouts
• Adequate street lighting
• Proper speed breakers and traffic signals
• Separate lanes for cyclists and pedestrians
• Footpaths and pedestrian crossings
• Road markings and signage

6. Vehicle Safety

• Regular vehicle fitness inspection
• Mandatory safety features (seat belts, airbags, ABS)
• Ban on overloaded vehicles
• Roadworthiness standards for all vehicles

7. Emergency Medical Services

• Well-organized pre-hospital emergency care system
• Trained first responders and paramedics
• Adequate trauma centres and hospitals
• Golden hour concept - prompt treatment saves lives

8. Intersectoral Approach

• Involvement of police, transport department, health, education, and public works
• National Road Safety Policy
• Sustainable Development Goals (SDG) target - reduce road traffic deaths and injuries by 50% by 2030

QUESTION 2 (Part A)

Define Maternal Mortality. Discuss the causes of and prevention of maternal mortality. (1+4+5 = 10 marks)

DEFINITION OF MATERNAL MORTALITY

"The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from unintentional or incidental causes."

Total female deaths due to complications of pregnancy, childbirth, or within 42 days of delivery / Total live births in the same area and year × 1,00,000

• Direct obstetric deaths - result from obstetric complications of pregnancy, labour, puerperium, incorrect treatment, or omissions (e.g., haemorrhage, eclampsia, obstructed labour)
• Indirect obstetric deaths - result from pre-existing disease aggravated by pregnancy (e.g., cardiac disease, renal disease)
• Late maternal death - death from direct/indirect obstetric causes after 42 days but within 1 year of termination of pregnancy

A. CAUSES OF MATERNAL MORTALITY

I. Direct Obstetric Causes

II. Indirect Causes (~20% of deaths)

• Anaemia - affects half of all pregnant women; severe anaemia increases haemorrhage risk
• Malaria - malaria-endemic areas; ~10,000 pregnant women die from malaria annually
• Tuberculosis
• Hepatitis
• Cardiovascular diseases (cardiac lesions aggravated by pregnancy)
• Diabetes
• HIV/AIDS
• Renal diseases
• Intestinal parasites

III. Social Correlates/Determinants

• Economic circumstances and poverty
• Cultural practices and beliefs
• Nutritional status (malnutrition)
• Environmental conditions
• Violence against women
• Illiteracy and low female education
• Low level of women's empowerment
• Traditional preference for home deliveries
• Early age of marriage
• Lack of access to healthcare
• Inadequate antenatal care

B. PREVENTION OF MATERNAL MORTALITY

"The problem of maternal mortality is principally one of applying existing obstetric knowledge through antenatal, intranatal and postnatal services." - Park

Preventive Measures:

• Blood pressure monitoring
• Weight and fundal height
• Haemoglobin estimation
• Urine albumin and sugar
• Foetal position and heart sounds

• Iron and folic acid tablets (100 days minimum)
• Calcium supplementation
• Correction of anaemia

• Clean delivery practices
• Oxytocics after delivery
• Hand hygiene and asepsis

• Eclampsia - monitor BP, use anticonvulsants (MgSO4)
• Malpresentations - early detection and referral
• Ruptured uterus prevention

• Hypertension, diabetes, tuberculosis, malaria, cardiac disease

• Women with bad obstetric history
• High-risk pregnancies (anaemia, hypertension, elderly primigravida, etc.)

• Limiting children to not more than 2
• Adequate spacing of births (at least 2-3 years)

Government Programmes (India):

Social Measures:

• Improving female literacy and education
• Economic empowerment of women
• Active community involvement
• Socioeconomic development
• Eliminating harmful cultural practices
• Addressing gender violence

SDG Target: Reduce global MMR to less than 70 per 1,00,000 live births by 2030

PART B - SHORT ESSAYS (5 marks each)

SHORT ESSAY 1: Rights of the Child

Introduction

• Article 24 - Prohibits employment of children below 14 years in factories
• Article 39 - Prevents abuse of children of tender age
• Article 45 - Provides free and compulsory education until age 14

UN Declaration of the Rights of the Child (1959)

1. Right to develop in an atmosphere of affection and security, preferably under parental care
2. Right to enjoy social security benefits - nutrition, housing, and medical care
3. Right to free education
4. Right to full opportunity for play and recreation
5. Right to a name and nationality
6. Right to special care if handicapped
7. Right to be among the first to receive protection and relief in times of disaster
8. Right to develop in healthy conditions, freedom and dignity as a useful member of society
9. Right to be brought up in a spirit of understanding, tolerance, friendship, peace and universal brotherhood
10. Right to enjoy these rights regardless of race, colour, sex, religion, or national/social origin

Convention on the Rights of the Child (CRC), 1989

• Non-discrimination
• Best interests of the child
• Right to life, survival and development
• Respect for the views of the child

Key Date

SHORT ESSAY 2: Juvenile Delinquency - Causes and Prevention

Definition

• Juvenile = boy under 16 years OR girl under 18 years
• In broader sense, includes all deviations from normal youthful behaviour - incorrigible, ungovernable, habitually disobedient youth

Incidence

• In the USA: 2% of children aged 7-17 years attend juvenile courts
• In India: Juvenile delinquency is on the increase due to urbanization, industrialization, and cultural changes
• Highest incidence: Children aged 15 and above
• Gender: Boys 4-5 times more than girls

Causes

1. Biological Causes

• Hereditary defects
• Feeble-mindedness
• Physical defects
• Glandular imbalance
• Chromosomal anomaly - XYY males ("super males") show severe personality disturbance; extra Y chromosome associated with tendency for delinquency and crime (research from Scotland)

2. Social Causes

• Broken homes - death/separation of parents, step-parents
• Disturbed home conditions - poverty, alcoholism, parental neglect
• Ignorance about child care
• Too many children in family
• Lack of parental supervision

3. Other Causes

• Absence of recreation facilities and cheap/unhealthy recreation
• Sex-thrillers, cinemas, television, social media
• Urbanization and industrialization
• Slum-dwelling
• Peer pressure and bad company

Preventive Measures

• Parents should be prepared for parenthood
• Needs of children must be recognized and met
• A well-adjusted family is the cornerstone of prevention

• Healthy teacher-pupil relationship
• Teachers can detect early signs of maladjustment
• School as a second home

• Recreation facilities
• Parent counselling
• Child guidance clinics
• Educational facilities
• General health services
• Juvenile Justice system (Juvenile Justice Act, 2015 in India)

SHORT ESSAY 3: 'Targeted Interventions' in HIV Control

Definition

Rationale

• HIV transmission is not uniform - it clusters in specific populations
• High Risk Groups serve as a "bridge" to the general population
• Targeting these groups gives maximum impact per rupee spent

High Risk Groups (HRGs) under NACP (National AIDS Control Programme)

Components of Targeted Interventions

• Peer-led outreach to reach HRGs in their natural settings
• Building trust, distributing Information, Education and Communication (IEC) materials
• Condom promotion and distribution

• Diagnosis and treatment of Sexually Transmitted Infections (STIs)
• STIs increase HIV transmission risk 3-10 times
• Syndromic management of STIs

• Promoting consistent condom use
• Reducing number of sexual partners
• Needle/syringe exchange for IDUs

• Clean needles and syringes for IDUs
• Buprenorphine/methadone substitution therapy

• Integrated Counselling and Testing Centres (ICTCs)
• Regular HIV testing for HRGs

• Referral to ART centres for HIV-positive individuals
• Follow-up and retention in care

Implementation in India (NACP)

• Implemented under National AIDS Control Programme (NACP)
• NACO (National AIDS Control Organization) oversees
• State AIDS Control Societies (SACS) implement at state level
• NGOs are the primary implementing agencies
• Scaling up TIs was a key strategy in NACP-III and NACP-IV

SHORT ESSAY 4: Yellow Fever Vaccine

Yellow Fever - Brief Overview

• Causative agent: Flavivirus fibricus (Group B arbovirus, Togavirus family)
• Vector: Aedes aegypti (urban) and forest mosquitoes (jungle)
• Reservoir: Monkeys (jungle), Man (urban)
• Endemic zones: 47 countries in Africa and Latin America; ~900 million at risk

The 17D Vaccine

Nature

• Live attenuated vaccine prepared from a non-virulent 17D strain
• Grown in chick embryo and subsequently freeze-dried (lyophilized)
• Approved for international use

Administration

• Route: Subcutaneous (at insertion of deltoid muscle)
• Dose: 0.5 ml - single dose irrespective of age
• Immunity appears: 7th day after vaccination
• Duration: Lasts possibly for life (previously required boosters every 10 years; WHO now states single dose provides lifelong protection)

Storage

• Must be stored between +5°C to -30°C (preferably below 0°C) until reconstituted
• Heat sensitivity is a major drawback in tropical mass campaigns
• After reconstitution: Keep on ice, away from sunlight
• Discard if not used within 30 minutes of reconstitution

Contraindications

• (a) Children aged under 9 months (routine) or under 6 months during epidemic
• (b) Pregnant women - except during yellow fever outbreak when infection risk is high
• (c) People with severe allergy to egg protein
• (d) People with severe immunodeficiency (symptomatic HIV/AIDS, thymus disorder)

Adverse Reactions

• Mild reactions (myalgia, headache, low-grade fever): 2-5% of vaccinees, 5-10 days after vaccination
• Anaphylaxis: Very rare, mainly in those allergic to eggs

Important Drug Interaction

• Cholera vaccine and yellow fever vaccine interfere with each other
• Should be given 3 weeks or more apart

International Health Regulations

• Yellow fever vaccination certificate required by many countries for travelers
• Compulsory vaccination for travelers going to/from endemic areas
• Vaccination must be recorded in International Certificate of Vaccination (Yellow Card)

SHORT ESSAY 5: Levels of Health Care

Introduction

Three Levels of Health Care

(a) Primary Health Care (First Level)

• First level of contact between individual and health system
• Provides "essential" health care - the most basic and fundamental care
• A majority of health complaints can be satisfactorily dealt with at this level
• Closest to the people - community-based
• In India: Primary Health Centres (PHCs) and Sub-Centres (SCs)
• Services: Preventive, promotive, curative, rehabilitative for common conditions
• Community participation is key
• Population served: 1 PHC per 30,000 population (rural); 1 Sub-centre per 5,000 population

(b) Secondary Health Care (Second Level / First Referral Level)

• Deals with more complex problems that cannot be managed at primary level
• Essentially curative services
• Serves as the First Referral Level in the health system
• In India: District Hospitals and Community Health Centres (CHCs)
• Services: Specialist consultations, surgeries, investigations, inpatient care
• Population served: 1 CHC per 1,00,000 population; 1 District Hospital per district

(c) Tertiary Health Care (Third Level)

• Offers super-specialist care
• Provided by regional/central level institutions
• Provides: Highly specialized care, planning and managerial skills, teaching for specialized staff
• Supports and complements actions at primary level
• In India: Medical college hospitals, AIIMS, PGI, regional specialized hospitals

Summary Table

Importance of Referral System

• Ensures appropriate care at each level
• Prevents overburdening of higher-level facilities
• Promotes continuity of care
• Makes health services cost-effective and efficient

SHORT ESSAY 6: Elements of Evaluation of Health Services

Definition of Evaluation

Steps of Evaluation (General)

1. Determine what is to be evaluated
2. Establish standards and criteria
3. Plan the methodology
4. Gather information
5. Analyze the results
6. Take action
7. Re-evaluate

Types of Evaluation

Elements (Components) of Evaluation

• Physical (distance, travel, time)
• Economic (travel cost, fees charged)
• Social and cultural (caste, language barriers)

Key Indicators of Evaluation

• Structure indicators: staff strength, equipment availability
• Process indicators: ANC coverage %, vaccination rates
• Outcome indicators: MMR, IMR, disease prevalence

SHORT ESSAY 7: Health Problems of the Aged

Elderly in India

• Defined as persons 60 years and above
• India has ~138 million elderly (2021); projected to reach 300 million by 2050
• Special challenges: "triple evils" of poverty, loneliness, and ill-health

Categories of Health Problems

(1) Problems Due to the Ageing Process (Senescence)

• Senile cataract - leading cause of blindness in elderly
• Glaucoma
• Nerve deafness
• Osteoporosis - affects mobility, fracture risk
• Emphysema - reduced lung capacity
• Failure of special senses - vision, hearing, smell, taste
• Changes in mental outlook - depression, confusion

(2) Problems Associated with Long-Term (Chronic) Illness

• Atherosclerosis, coronary artery disease, hypertension
• Lipoid deposition in arteries → calcification → narrowing
• Leading cause of death in developed countries

• Risk rises rapidly after age 40
• Prostate cancer common after 65
• Leading cause of death in developed countries

• Bones become fragile due to decalcification
• Fracture neck of femur - very common geriatric problem
• More accidents in the home than outside

• ~75% of diabetics are over 50 years
• Leading cause of death as population ages

• Fibrositis, myositis, neuritis, gout
• Rheumatoid arthritis, osteoarthritis, spondylitis
• Cause more discomfort and disability than any other chronic disease in elderly

• Chronic bronchitis, asthma, emphysema
• Of major importance in upper decades of life

• Benign prostatic hyperplasia (BPH) in men
• Urinary incontinence

(3) Mental Health Problems

• Dementia (Alzheimer's disease - most common form)
• Depression (very common, often under-diagnosed)
• Confusion, delirium
• Social isolation and loneliness

(4) Social Problems

• Retirement and loss of economic independence
• Social isolation and loneliness
• Neglect by family members
• Poverty and financial insecurity
• Loss of role in society

Preventive and Social Measures

• Primary prevention: Regular exercise, healthy diet, no smoking/alcohol, BP control
• Secondary prevention: Screening for cancer, diabetes, hypertension, osteoporosis
• Tertiary prevention: Rehabilitation, physiotherapy
• Social support: Old-age homes, day care centres, pension schemes (IGNOAPS - Indira Gandhi National Old Age Pension Scheme)
• HelpAge India - largest NGO for elderly in India (free cataract operations, mobile medicare units)
• Active ageing policy - keeping elderly engaged and productive

SHORT ESSAY 8: District Mental Health Program (DMHP)

Background

National Mental Health Programme (NMHP)

• Launched in 1982 based on recommendations of expert groups
• Objectives:
  1. Prevention and treatment of mental disorders
  2. Rehabilitation of mentally ill
  3. Prevention of and providing care in epilepsy
  4. Application of mental health principles in general health care

District Mental Health Programme (DMHP)

Launch

• Started as a pilot project in 1996 in Bellary district, Karnataka (under NMHP)
• Expanded to all districts of India under the 12th Five Year Plan

Objectives

1. Provide community-based mental health services accessible to all
2. Provide mental health care at district level through a trained team
3. Integrate mental health with general health services
4. Reduce stigma and improve awareness about mental disorders

Components of DMHP

• Psychiatrist (team leader)
• Clinical psychologist
• Psychiatric social worker
• Psychiatric nurse

• OPD services at district hospital
• Inpatient care (beds at district hospital)
• 24-hour emergency services
• Community outreach through mobile teams
• School mental health programme
• IEC activities to reduce stigma
• Training of primary care physicians and ASHA/ANM workers

• Training general health staff to identify and manage common mental disorders
• Referral of complex cases to district/tertiary centers
• Supply of essential psychiatric drugs at PHC level

• Identify children with learning disabilities, behavioral problems
• Mental health education for school children and teachers

• Awareness programmes
• Identification of high-risk individuals
• Crisis counselling services

Achievements under DMHP/NMHP

• Services now available at district level in all states
• Increased awareness and reduced stigma
• Supply of psychotropic medicines improved at primary level
• Training of ~30,000 general health workers in mental health

Mental Health Act, 2017

NOTE: The two long essay answers (Q1: Road Traffic Accidents and Q2: Maternal Mortality) were comprehensively answered in the previous session above. Together with these 8 short essays, all questions on the paper are now covered.