Give details information about all nations health program for 10 marks
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I now have all the necessary content from Park's Textbook. Let me compile a comprehensive 10-mark answer on National Health Programs.
National Health Programmes of India
Source: Park's Textbook of Preventive and Social Medicine
Introduction
National Health Programmes (NHPs) are centrally sponsored, government-funded schemes designed to prevent, control, and eradicate diseases that contribute significantly to India's disease burden. They operate through the existing public health infrastructure - sub-centres, PHCs, CHCs, and district hospitals.
Classification of National Health Programmes
NHPs are broadly grouped into:
- Programmes for Communicable Diseases
- Programmes for Non-Communicable Diseases
- Programmes for Special Population/Conditions
- Umbrella Missions
1. National Rural Health Mission (NRHM) - 2005
Launched on 5th April 2005 for 7 years (extended to 2017), NRHM is the umbrella mission integrating multiple vertical programmes.
Aim: Provide accessible, affordable, accountable, effective and reliable primary health care; bridge the gap in rural health care through creation of ASHA (Accredited Social Health Activist).
Special focus on 18 states: 8 Empowered Action Group states (Bihar, Jharkhand, MP, Chhattisgarh, UP, Uttarakhand, Odisha, Rajasthan) + 8 North-East states + Himachal Pradesh and J&K.
Programmes integrated under NRHM:
- RCH-II
- National Vector Borne Disease Control Programme (malaria, filaria, kala-azar, dengue, JE)
- National Leprosy Eradication Programme
- Revised National TB Control Programme
- National Programme for Control of Blindness
- Iodine Deficiency Disorder Control Programme
- Integrated Disease Surveillance Project (IDSP)
Infrastructure Strengthening Plan:
- Creation of ASHA cadre - one per 1000 population
- Untied funds of Rs. 10,000 per sub-centre per annum
- 24-hour services in at least 50% of PHCs
- Community Health Centres upgraded to IPHS standards
2. Universal Immunization Programme (UIP)
India launched EPI in 1978, renamed as Universal Immunization Programme (UIP) in 1985.
Vaccines under UIP:
- BCG (at birth)
- OPV (0, 6, 10, 14 weeks + booster)
- DPT (6, 10, 14 weeks + boosters)
- Hepatitis B
- Hib (Pentavalent vaccine)
- IPV
- Measles/MR/MMR
- JE vaccine in endemic areas
- Rotavirus vaccine
- PCV (Pneumococcal Conjugate Vaccine)
Key milestones: BCG introduced 1962, TT for pregnant women 1983, Polio NIDs 1995, Hep B 2002, Mission Indradhanush 2014 (to cover all unvaccinated/partially vaccinated children).
3. National AIDS Control Programme (NACP)
Launched in 1987. Implemented by NACO (National AIDS Control Organization), set up under the Ministry of Health and Family Welfare.
Aim: Prevent further transmission of HIV; decrease morbidity and mortality; minimize socio-economic impact.
Phases:
- NACP-I (1992): Slow down spread of HIV
- NACP-II (1999): Behaviour change, decentralization, NGO involvement
- NACP-III (2007-2012): Halt and reverse the epidemic
- NACP-IV (2012-2017): Consolidation and strategic expansion
- National Strategic Plan for HIV/AIDS 2017-2024
Key strategies:
- IEC for behaviour change
- Condom promotion and distribution
- Anti-retroviral therapy (ART) - initiated 2004
- Prevention of Parent to Child Transmission (PPTCT)
- Voluntary Counselling and Testing Centres (VCTC)
- State AIDS Control Societies
4. Revised National Tuberculosis Control Programme (RNTCP)
Now called National Tuberculosis Elimination Programme (NTEP) with a goal to eliminate TB by 2025 (5 years ahead of global target).
DOTS strategy (Directly Observed Treatment Short Course) - cornerstone of RNTCP.
NSP 2017-2025 Targets:
- Reduce TB incidence to 44/lakh population by 2025
- Reduce TB mortality to 3/lakh population
- Zero catastrophic cost due to TB for affected families
- Notification of 3.6 million patients/year
Key components:
- Sputum microscopy - primary diagnostic tool
- Referral of prolonged cough cases (>2 weeks) from sub-centres
- Drug-resistant TB (DRTB) centres
- NIKSHAY portal for patient monitoring
- Ni-kshay Poshan Yojana - nutritional support of Rs. 500/month
5. National Programme for Control of Blindness (NPCB)
Launched in 1976 as a 100% centrally sponsored programme (incorporated earlier Trachoma Control Programme of 1968).
Goal: Reduce prevalence of blindness from 1.4% to 0.3% (current prevalence: 0.36% as per 2015-19 survey).
Key activities:
- 66 lakh cataract operations per year
- School eye screening - distribution of 9 lakh free spectacles/year
- Collection of 50,000 donated eyes for keratoplasty
- Coverage of diabetic retinopathy, glaucoma, vitreo-retinal surgery
- Screening of population above 50 years age
- IEC for eye care awareness
- Strengthening of Regional Institutes of Ophthalmology (RIOs)
6. National Leprosy Eradication Programme (NLEP)
Objective: Eliminate leprosy (defined as prevalence < 1 case per 10,000 population). India declared leprosy eliminated in 2005.
Key strategies:
- Multi-Drug Therapy (MDT) - free of cost
- Active case detection through surveys
- Health education to reduce stigma
- Disability prevention and rehabilitation
- Leprosy Case Detection Campaigns (LCDC)
7. National Vector Borne Disease Control Programme (NVBDCP)
Controls malaria, filaria, kala-azar (visceral leishmaniasis), dengue, chikungunya, and Japanese encephalitis.
Malaria control: Indoor residual spraying (IRS), Rapid Diagnostic Kits (RDKs), Long-Lasting Insecticidal Nets (LLINs), radical treatment with primaquine.
Filaria: Mass Drug Administration (MDA) with DEC + albendazole on National Filaria Day.
Kala-azar: Target of elimination (< 1 case per 10,000 population at block level). Treatment with Liposomal Amphotericin B.
Dengue/Chikungunya: Source reduction, vector surveillance, case management.
8. National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS)
Launched during the 11th Five Year Plan covering 100 districts in 21 states; extended to all districts during 12th Five Year Plan.
Background: NCDs accounted for 60% of deaths in India in 2016. This programme integrated the earlier National Cancer Control Programme with the NCD programme.
Objectives:
- Prevent and control common NCDs through behaviour and lifestyle changes
- Early diagnosis and management
- Build capacity at all health care levels
- Train doctors, paramedics, nurses
- Establish palliative and rehabilitative care
Strategies:
- Opportunistic screening of persons above age 30 years
- NCD Clinics at CHC and district level
- Tertiary Cancer Care Centres
- IEC for tobacco, alcohol, diet, physical activity
Cancer component: Screening for cervical, breast, and oral cancers; Rajiv Gandhi National Cancer Control Programme.
9. National Mental Health Programme (NMHP)
Launched in 1982. Currently covers 517 districts in 36 states.
Aims:
- Prevention and treatment of mental and neurological disorders
- Use of mental health technology to improve general health services
- Application of mental health principles in national development
Objectives:
- Ensure minimum mental health care for all, especially vulnerable sections
- Encourage application of mental health knowledge in general healthcare
- Promote community participation in mental health services
District Mental Health Programme (DMHP) components:
- Training programmes for mental health workers
- Public education to reduce stigma
- OPD and indoor services for early detection and treatment
- School mental health services: life skills education
- College mental health services
- Workplace stress management
- Suicide prevention services
Strategy: Integration with primary health care; tertiary care institutions for severe disorders; elimination of stigma through regulatory bodies (Central and State Mental Health Authorities).
10. National Iodine Deficiency Disorders Control Programme (NIDDCP)
Objective: Reduce iodine deficiency disorders (IDD) - goitre, cretinism, intellectual disability.
Key measures:
- Universal iodization of salt (> 15 ppm iodine at consumer level)
- Ban on sale of non-iodized salt for human consumption
- Monitoring iodine content of salt and urinary iodine excretion
- IEC activities
11. National Tobacco Control Programme (NTCP)
Key activities:
- Health education on harmful effects of tobacco and second-hand smoke
- Promoting tobacco cessation; brief advice to all smokers
- Tobacco-free premises at CHC with mandatory signages
- Setting up tobacco cessation clinics
- Dedicated tobacco control cells
- Training of health workers, NGOs, school teachers
- School programme on tobacco awareness
- Enforcement of COTPA (Cigarette and Other Tobacco Products Act)
12. National Programme for Health Care of the Elderly (NPHCE)
Services:
- Medical rehabilitation
- Geriatric clinics (twice a week at CHC level)
- Compilation of elderly data; referral for specialist care
- Home visits to disabled/bedridden persons by rehabilitation workers
13. Reproductive and Child Health (RCH) Programme
Launched in 1997 as a flagship programme replacing the earlier target-based family planning approach.
Components:
- Maternal health: antenatal care, safe delivery, postnatal care
- Child health: IMNCI, nutrition
- Family planning: spacing methods, terminal methods
- Adolescent reproductive health
- Prevention and management of STIs and RTIs
Janani Suraksha Yojana (JSY): Cash incentive for institutional delivery to reduce maternal and neonatal mortality.
Summary Table of Key National Health Programmes
| Programme | Year Launched | Target Condition |
|---|---|---|
| UIP | 1978/1985 | Vaccine-preventable diseases |
| NACP | 1987 | HIV/AIDS |
| RNTCP/NTEP | 1993/2020 | Tuberculosis |
| NPCB | 1976 | Blindness |
| NLEP | 1983 | Leprosy |
| NVBDCP | 2004 | Vector-borne diseases |
| NRHM | 2005 | Overall rural health |
| NPCDCS | 11th Plan | Cancer, Diabetes, CVD, Stroke |
| NMHP | 1982 | Mental health |
| NIDDCP | 1962 | Iodine deficiency |
| NTCP | 2007 | Tobacco control |
| RCH | 1997 | Maternal and child health |
- Park's Textbook of Preventive and Social Medicine (Park's), 25th Edition
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Here is the complete, exam-ready 20-mark level coverage of each major National Health Programme, drawn directly from Park's Textbook of Preventive and Social Medicine.
NATIONAL HEALTH PROGRAMMES OF INDIA
(20-Mark Level - Complete Detail)
Source: Park's Textbook of Preventive and Social Medicine
PROGRAMME 1: NATIONAL RURAL HEALTH MISSION (NRHM)
Background
The Government of India launched NRHM on 5th April 2005 for a period of 7 years (2005-2012), later extended to 2017. It recognizes health as central to economic and social development and focuses on improving the rural health care delivery system.
Focus States
NRHM has special focus on 18 states:
- 8 Empowered Action Group (EAG) states: Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Uttar Pradesh, Uttarakhand, Odisha, Rajasthan
- 8 North-East states: Assam, Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, Tripura
- Himachal Pradesh and Jammu & Kashmir
Main Aim
To provide accessible, affordable, accountable, effective and reliable primary health care. The key strategy is bridging the gap in rural health care through creation of a cadre of ASHA (Accredited Social Health Activist).
The mission adopts a synergic approach by relating health to determinants of good health - nutrition, sanitation, hygiene and safe drinking water. It also mainstreams AYUSH into health care.
Programmes Integrated under NRHM
- RCH-II (Reproductive and Child Health)
- National Vector Borne Disease Control Programme (malaria, filaria, kala-azar, dengue, Japanese encephalitis)
- National Leprosy Eradication Programme
- Revised National Tuberculosis Control Programme
- National Programme for Control of Blindness
- Iodine Deficiency Disorder Control Programme
- Integrated Disease Surveillance Project (IDSP)
Plan of Action to Strengthen Infrastructure
1. ASHA (Accredited Social Health Activist):
- One ASHA per 1000 population in rural areas
- Serves as a link between the community and health system
- Selected from the local community; preferably a woman with 8th standard education
- Role: mobilizer, provider of DOTS, health educator, depot holder of ORS/chloroquine/condoms, accompanies women for institutional delivery
- Receives performance-based incentives (e.g., Rs. 600 per institutional delivery under JSY)
2. Strengthening Sub-Centres:
- Supply of essential drugs (allopathic + AYUSH)
- Provision of additional ANMs where needed
- Untied funds of Rs. 10,000 per annum per sub-centre in all 18 focus states
3. Strengthening PHCs:
- Adequate and regular supply of essential drugs and equipment
- 24-hour service in at least 50% of PHCs
- One Medical Officer with AYUSH training
- Regular Gram Sabha meetings for community oversight
4. Strengthening CHCs (Community Health Centres):
- Upgrading to Indian Public Health Standards (IPHS)
- Each CHC should have: 30 beds, OT, X-ray, blood bank, labour room
- Posting of specialist doctors: surgeon, obstetrician, physician, pediatrician
5. District Health Mission:
- District Health Society to manage funds
- Preparation of District Health Action Plan (DHAP)
- Decentralization of planning and implementation
6. Flexible Funding:
- States empowered to choose and deploy their allocation
- National Disease Control Programmes integrated at district level
7. Monitoring and Evaluation:
- Community monitoring through village health committees
- Rogi Kalyan Samiti (Patient Welfare Committee) at hospitals
PROGRAMME 2: NATIONAL AIDS CONTROL PROGRAMME (NACP)
Background and Launch
NACP was launched in India in 1987. The Ministry of Health and Family Welfare set up NACO (National AIDS Control Organization) as a separate wing to implement and monitor the programme.
Aim: Prevent further transmission of HIV; decrease morbidity and mortality associated with HIV infection; minimize socio-economic impact.
Historical Milestones
| Year | Milestone |
|---|---|
| 1986 | First HIV case detected; AIDS Task Force by ICMR; National AIDS Committee established |
| 1990 | Medium Term Plan for 4 states and 4 metros |
| 1992 | NACP-I launched; National AIDS Control Board constituted; NACO set up |
| 1999 | NACP-II: Behaviour change, decentralization, NGO involvement; State AIDS Control Societies |
| 2002 | National AIDS Control Policy adopted; National Blood Policy adopted |
| 2004 | Anti-retroviral treatment (ART) initiated |
| 2006 | National Council on AIDS under PM; National Policy on Paediatric ART formulated |
| 2007 | NACP-III launched (2007-2012) |
| 2014 | NACP-IV launched (2012-2017) |
| 2017 | National Strategic Plan for HIV/AIDS and STIs 2017-2024 |
Phases of NACP
NACP-I (1992-1999): Goal - slow down the spread of HIV. Focus on surveillance, blood safety, STD control, IEC.
NACP-II (1999-2006): Goal - reduce the spread of HIV infection. Focus on behaviour change, increased decentralization, involvement of NGOs and private sector. State AIDS Control Societies established.
NACP-III (2007-2012): Goal - halt and reverse the HIV epidemic. Target: 60% reduction in annual new HIV infections. Focus on targeted interventions for high-risk groups.
NACP-IV (2012-2017): Goal - accelerate reversal and further decline of epidemic. Consolidation and strategic expansion of services.
NSP 2017-2024: Focus on 90-90-90 targets (90% know their status, 90% on treatment, 90% virally suppressed).
Key Strategies and Components
1. Targeted Interventions (TI):
- Focus on high-risk groups: Female Sex Workers (FSWs), Men who have Sex with Men (MSM), Injecting Drug Users (IDUs), transgenders, migrants, truckers
- Condom promotion and distribution
- STI treatment services
- IEC for behaviour change
2. Voluntary Counselling and Testing Centres (VCTC/ICTC):
- At district hospital level
- Two rapid tests for confirmation
- Pre- and post-test counselling
3. Prevention of Parent-to-Child Transmission (PPTCT):
- Screening of antenatal mothers with one rapid HIV test
- In 6 high-prevalence states: Tamil Nadu, Andhra Pradesh, Maharashtra, Karnataka, Manipur, Nagaland
- Referral for PPTCT services at CHC/district hospital
4. Anti-Retroviral Therapy (ART):
- Free ART through ART centres at district/medical college hospitals
- CD4 count monitoring
- Paediatric ART for HIV-positive children
- NACO guidelines for first-line, second-line regimens
5. Blood Safety:
- Voluntary blood donation promoted
- Screening of all donated blood for HIV, Hepatitis B, C, Syphilis, Malaria
- National Blood Policy (2002)
6. HIV-TB Coordination:
- Linkage with TB microscopy centres
- Co-trimoxazole prophylaxis for HIV-TB patients
- Referral linkages between NACP and RNTCP
7. Condom Programming:
- Social marketing of condoms
- Free distribution through health facilities and targeted intervention sites
8. IEC (Information, Education, Communication):
- Mass media campaigns
- School health education
- Red Ribbon Clubs in educational institutions
9. Surveillance:
- Annual HIV sentinel surveillance
- National AIDS Control Programme monitoring through NACO portal
PROGRAMME 3: NATIONAL TB ELIMINATION PROGRAMME (NTEP) / RNTCP
Background
The National Tuberculosis Programme (NTP) started in 1962 but had unacceptably low treatment success rates, with high death and default rates. In 1993, Government of India revitalized the programme as Revised National Tuberculosis Control Programme (RNTCP), adopting the internationally recommended DOTS (Directly Observed Treatment Short-course) strategy. Since March 2006, RNTCP covers the entire country. It has been renamed NTEP (National TB Elimination Programme) with a goal to eliminate TB by 2025 (5 years ahead of the global Sustainable Development Goal target of 2030).
Objectives
- Achieve at least 85% cure rate of infectious TB cases through DOTS
- Augment case finding through quality sputum microscopy to detect at least 70% of estimated cases
DOTS Strategy - Five Components
- Government commitment to sustained TB control
- Case detection by quality-assured sputum microscopy
- Standardized short-course chemotherapy under proper case management
- Uninterrupted supply of quality-assured drugs
- Recording and reporting system for programme monitoring
Diagnosis
Level-wise diagnostic approach:
- Sub-centre/ASHA level: Identification of suspects with cough >2 weeks; referral to PHC
- PHC level: Sputum smear microscopy
- Higher level: Culture on Lowenstein-Jensen (LJ) / Middlebrook media; rapid molecular tests:
- Line Probe Assay (LPA)
- GeneXpert (CBNAAT) - detects MTB and Rifampicin resistance simultaneously
- Tuberculin skin test
- Radiography
Treatment Categories
Category I: New sputum positive pulmonary TB, new severely ill smear-negative/extra-pulmonary TB
- Intensive phase: 2 months - HRZE (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol) daily
- Continuation phase: 4 months - HRE daily
Category II: Previously treated cases (relapses, failures, treatment after default)
- Intensive phase: 3 months - HRZES (with Streptomycin) daily
- Continuation phase: 5 months - HRE daily
Drug-Resistant TB (DR-TB):
- MDR-TB: Resistance to at least Isoniazid and Rifampicin
- XDR-TB: MDR + resistance to fluoroquinolones and second-line injectables
- Treated at DR-TB centres with second-line drugs (bedaquiline, linezolid, etc.)
New Initiatives
1. NIKSHAY Portal:
- Case-based web IT system launched May 2012 by Central TB Division with NIC
- Functions: TB patient registration, diagnosis details, DOT provider, HIV status, follow-up, contact tracing, treatment outcomes
- DR-TB patient registration
- Private facility TB notification
- SMS alerts to patients and programme officers
- Mobile application for TB notification
2. Mandatory TB Notification (2012):
All healthcare providers - government and private - must notify every TB case to the District Health Officer monthly.
3. Ban on TB Serology (2012):
Serological tests banned due to poor specificity.
4. Nikshay Poshan Yojana:
- Rs. 500/month nutritional support to all TB patients during treatment duration
5. 99 DOTS:
- IT-enabled adherence tool using mobile phones
- Patient calls a number after each dose; data captured and monitored
NSP 2017-2025 Targets (India):
| Indicator | Baseline 2015 | Target 2023 | Target 2025 |
|---|---|---|---|
| TB Incidence (per lakh) | 217 | 77 | 44 |
| TB Prevalence (per lakh) | 320 | 90 | 65 |
| TB Mortality (per lakh) | 32 | 6 | 3 |
| Catastrophic cost due to TB | 35% | 0% | 0% |
PROGRAMME 4: NATIONAL PROGRAMME FOR PREVENTION & CONTROL OF CANCER, DIABETES, CVD AND STROKE (NPCDCS)
Background
India is experiencing a rapid health transition. In 2016, NCDs accounted for 60% of all deaths in India. The programme was originally focused on Diabetes, CVD and Stroke. It was later integrated with the National Cancer Control Programme to form NPCDCS.
Coverage: 100 districts in 21 states during 11th Five Year Plan; extended to all districts during 12th Five Year Plan.
A. Diabetes, CVD and Stroke (DCS) Component
Objectives
- Prevent and control common NCDs through behaviour and lifestyle changes
- Provide early diagnosis and management
- Build capacity at all health care levels
- Train doctors, paramedics, nurses in public health setup
- Establish palliative and rehabilitative care
Implementation
Infrastructure: Implemented in 20,000 sub-centres and 700 CHCs in 100 districts across 21 States/UTs.
Key strategies:
- Promoting healthy lifestyle through mass media and health education
- Opportunistic screening of persons above 30 years of age for hypertension, diabetes
- Establishment of NCD Clinics at CHC and district level
- Development of trained manpower
- Strengthening tertiary-level health facilities
Behavioural Change Messages
- Reduce tobacco use
- Reduce alcohol consumption
- Increase physical activity (30 minutes/day)
- Healthy diet: more fruits, vegetables; less salt, fat, sugar
- Control body weight/BMI
Referral and Treatment Guidelines (2016)
- BP >140/90 mmHg or Random Blood Sugar >140 mg/dl → refer to Medical Officer at nearest facility
- After diagnosis: at least 1 month drug supply from PHC
- First follow-up at 3 months; annual specialist consultation at nodal CHC
- ASHA visits for treatment compliance, blood pressure/glucose monitoring at village level
- Some states have provided ASHA with BP apparatus and glucometers
Integration
- Integration with Rashtriya Bal Swasthya Karyakram (RBSK)
- Integration of AYUSH with NPCDCS
- Integration of RNTCP with NPCDCS for TB-Diabetes comorbidity management
B. Cancer Component
Screening (Three cancers prioritized)
- Oral cancer: Visual inspection for white/red patches, non-healing ulcers; Cessation of tobacco
- Cervical cancer: Visual Inspection with Acetic acid (VIA) or VIA/VILI; Screen and treat approach
- Breast cancer: Clinical breast examination; mammography at district hospitals
Treatment
- Referral to cancer hospitals
- Rajiv Gandhi National Cancer Control Programme for tertiary care
- Tobacco cessation clinics linked to NCD clinics
IEC Activities
- Warning signals of cancer (7 warning signals of cancer)
- Early detection campaigns
- Awareness about tobacco, alcohol as carcinogens
PROGRAMME 5: NATIONAL MENTAL HEALTH PROGRAMME (NMHP)
Background and Launch
Launched in 1982 to ensure availability of mental health care for all, especially the community at risk and underprivileged sections. Currently covers 517 districts in 36 states.
A National Advisory Group was constituted under the Secretary, Ministry of Health and Family Welfare. 11 institutions have been identified for training primary health care physicians and paramedical personnel in mental health.
Aims
- Prevention and treatment of mental and neurological disorders and associated disabilities
- Use of mental health technology to improve general health services
- Application of mental health principles in total national development to improve quality of life
Objectives
- Ensure availability and accessibility of minimum mental health care for all, particularly vulnerable and underprivileged sections
- Encourage application of mental health knowledge in general health care and social development
- Promote community participation in mental health services and stimulate self-help in the community
Programme Strategies
- Integration of mental health with primary health care through NMHP
- Provision of tertiary care institutions for treatment of mental disorders
- Eradicating stigmatization of mentally ill patients and protecting their rights through:
- Central Mental Health Authority
- State Mental Health Authority
- National Human Rights Commission monitoring conditions in mental hospitals
District Mental Health Programme (DMHP)
Components:
- Training programmes for all workers in the mental health team at identified nodal institutes in each state
- Public education to increase awareness and reduce stigma
- OPD and indoor services for early detection and treatment
- Data collection for future planning and research
DMHP - Promotive and Preventive Activities
- School mental health services: Life skills education in schools, counselling services
- College counselling services: Through trained teachers/counsellors
- Workplace stress management: Formal and informal sectors - including farmers, women
- Suicide prevention services:
- Counselling centre at district level
- Sensitization workshops
- IEC activities
- Helplines
Role at PHC Level (Essential Services)
- Early identification (diagnosis) and treatment of mental illness in the community
- Basic services: Diagnosis and treatment of common mental disorders - psychosis, depression, anxiety disorders, epilepsy
- Referral to higher centres
- IEC for prevention, stigma removal and early detection
- Community participation for primary prevention
Mental Health Act, 2017
The Mental Healthcare Act 2017 replaced the Mental Health Act 1987. Key provisions:
- Every person has the right to access mental health care
- Right to live in the community, not just in mental health establishments
- Advance directive for treatment
- Nominated representative concept
- Decriminalization of attempted suicide (Section 115 - presumption of severe stress)
PROGRAMME 6: UNIVERSAL IMMUNIZATION PROGRAMME (UIP)
Background
- 1962: BCG introduced as part of National Tuberculosis Programme (first vaccine in India)
- 1974: WHO launched Expanded Programme on Immunization (EPI) against 6 diseases: diphtheria, pertussis, tetanus, polio, tuberculosis, measles
- 1978: India launched its EPI with BCG, DPT, OPV, typhoid (urban areas)
- 1985: Universal Immunization Programme - UIP launched; measles added, typhoid removed; focus on children under 1 year; UNICEF renamed EPI as "Universal Child Immunization"
- Goal: Achieve universal immunization coverage
Immunization Milestones in India
| Year | Milestone |
|---|---|
| 1978 | EPI launched - BCG, DPT, OPV, Typhoid (urban) |
| 1983 | TT for pregnant women added |
| 1985 | UIP - measles added, typhoid removed |
| 1990 | Vitamin A supplementation added |
| 1995 | Polio National Immunization Days (NIDs) |
| 1997 | VVM (Vaccine Vial Monitor) introduced |
| 2002 | Hep B pilot in 33 districts |
| 2005 | NRHM launched; Auto-disable syringes introduced |
| 2006 | JE vaccine in endemic districts |
| 2010 | Hep B under UIP nationally |
| 2011 | Pentavalent vaccine (DPT+HepB+Hib) launched |
| 2014 | Mission Indradhanush, IPV introduced |
| 2016 | Rotavirus vaccine, MR vaccine, PCV introduced |
Current Vaccines under UIP
| Vaccine | Disease | Schedule |
|---|---|---|
| BCG | Tuberculosis | At birth |
| OPV | Poliomyelitis | Birth, 6, 10, 14 weeks + booster 16-24 months |
| IPV | Poliomyelitis | 6 and 14 weeks |
| Hep B | Hepatitis B | Birth, 6, 10, 14 weeks |
| Pentavalent (DPT+HepB+Hib) | Diphtheria, Pertussis, Tetanus, Hep B, Hib | 6, 10, 14 weeks |
| PCV | Pneumococcal pneumonia | 6, 14 weeks, 9 months |
| Rotavirus | Rotavirus diarrhoea | 6, 10, 14 weeks |
| Measles/MR | Measles, Rubella | 9-12 months, 16-24 months |
| JE | Japanese Encephalitis | 9-12 months (endemic areas) |
| Vitamin A | Nutritional deficiency | 9 months, then 6-monthly |
| DPT Booster | Diphtheria, Pertussis, Tetanus | 16-24 months, 5 years |
| TT/Td | Tetanus | 10 years, 16 years; Pregnant women |
Cold Chain
- Cold chain is the system of storage and transportation of vaccines at the appropriate temperature
- Temperature requirements: Most vaccines 2-8°C; OPV at -20°C (or 2-8°C short term); BCG, Measles, MMR are sensitive to heat and light
- Levels: National store → Regional store → State store → District store → PHC → Sub-centre
- ILR (Ice-Lined Refrigerator): At PHC level - maintains 2-8°C even during power failure
- Deep Freezer: For OPV storage; maintains -20°C
- Cold Box: For transportation
- VVM (Vaccine Vial Monitor): Heat-sensitive label that changes colour when vaccine is exposed to excessive heat - detects heat-damaged vaccines
Mission Indradhanush (2014)
Launched in December 2014 to fully immunize 90% of children who are unvaccinated or partially vaccinated by 2018 (originally 2020, preponed).
- Completed 6 phases (April 2015-December 2018) covering 681 districts
- 3.39 crore children reached; 81.79 lakh children immunized
- Increased full immunization coverage by 6.7% in one year (vs 1% previous rate)
- Higher increase in rural areas (7.9%) than urban (3.1%)
Intensified Mission Indradhanush (IMI 2017):
- Launched October 2017; 190 districts/urban areas across 24 states
- Focus: urban slum areas and districts with low immunization coverage
PROGRAMME 7: NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS (NPCB)
Background
Launched in 1976 as a 100% centrally sponsored programme. Incorporates the earlier Trachoma Control Programme of 1968.
Initial Goal: Reduce prevalence of blindness from 1.4% to 0.3%
Current Status: As per 2015-19 survey, prevalence is 0.36% (near target)
Main Causes of Blindness in India
- Cataract - most common (62.6%)
- Refractive errors
- Corneal blindness
- Glaucoma
- Diabetic retinopathy
- Retinal diseases
Objectives (12th Five Year Plan)
- Three signature activities:
- 66 lakh cataract operations per year
- School eye screening + distribution of 9 lakh free spectacles/year for refractive errors
- Collection of 50,000 donated eyes/year for keratoplasty
- Reduce backlog of avoidable blindness through identification and treatment at all levels
- Develop and strengthen strategy for "Eye Health for All" - comprehensive universal eye care
- Strengthen and upgrade Regional Institutes of Ophthalmology (RIOs) as Centres of Excellence
- Strengthen district hospital infrastructure with ophthalmologists
- Enhance community awareness on eye care
- Expand research for prevention of blindness
- Secure participation of voluntary organizations and private practitioners
Strategies
- Free cataract surgery through health care delivery system and NGO/private sector
- Comprehensive eye care covering: diabetic retinopathy, glaucoma, corneal transplantation, vitreo-retinal surgery, childhood blindness
- Active screening of population above 50 years of age
- School screening for refractive errors; free glasses to children from poor families
- Coverage of underserved areas through public-private partnership
- IEC for eye care awareness
- Human resource capacity building
At PHC Level
- Basic diagnosis and treatment of common eye diseases
- Refraction services
- Detection of cataract cases and referral for surgery
PROGRAMME 8: NATIONAL LEPROSY ERADICATION PROGRAMME (NLEP)
Background
India adopted MDT (Multi-Drug Therapy) for leprosy in 1983 on WHO recommendation. NLEP aimed to eliminate leprosy, defined as prevalence < 1 case per 10,000 population. India declared leprosy eliminated in December 2005.
WHO announced Global Leprosy Strategy 2016-2020: "Accelerating towards a leprosy-free world."
Definitions
- Case of Leprosy: A person showing clinical signs with or without bacteriological confirmation who has not completed a full MDT course
- Paucibacillary (PB) Leprosy: 1-5 skin lesions and/or one nerve involvement
- Multibacillary (MB) Leprosy: 6 or more skin lesions and/or more than one nerve involvement
MDT Treatment Regimen
PB Leprosy:
- Rifampicin 600 mg once monthly (supervised)
- Dapsone 100 mg daily (self-administered)
- Duration: 6 months (within 9 months)
MB Leprosy:
- Rifampicin 600 mg once monthly (supervised)
- Clofazimine 300 mg once monthly (supervised) + 50 mg daily
- Dapsone 100 mg daily (self-administered)
- Duration: 12 months (within 18 months)
Key Drugs
- Rifampicin: Highly bactericidal against M. leprae; kills 99% of viable organisms with a single 1500 mg dose; given monthly; hepatotoxic; expensive
- Dapsone: Bacteriostatic; inexpensive; side effects: haemolytic anaemia, agranulocytosis
- Clofazimine: Weakly bactericidal; anti-inflammatory; causes skin discolouration (red-brown)
Programme Strategies
- Active case detection - house-to-house surveys, school surveys, contact surveys
- Complete MDT to all detected cases - free of cost
- Leprosy Case Detection Campaigns (LCDC)
- Disability prevention and management - self-care, protective footwear, eye care, physiotherapy
- Reconstructive surgery for disability correction - 36 NGOs supported by ILEP
- Health education to reduce stigma
- Integration with general health services at PHC level
- NGO involvement - 54 NGOs get grant-in-aid; serve remote areas, slums
- ILEP (International Federation of Anti-Leprosy Associations) support for planning, monitoring, capacity building
At PHC Level (Essential)
- Health education to community about leprosy
- Diagnosis and management including reactions
- Training of leprosy patients with ulcers for self-care
- Counselling for regularity and completion of treatment, prevention of disability
PROGRAMME 9: NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (NVBDCP)
Background
NVBDCP was created by merging several disease-specific programmes:
- National Anti-Malaria Programme (NAMP)
- National Filaria Control Programme
- Kala-Azar Control Programme
- Dengue/Chikungunya Control Programme
- Japanese Encephalitis Control Programme
A. Malaria
Transmission: Plasmodium vivax (P. vivax) and P. falciparum via Anopheles mosquito
Case Detection:
- Passive: patients coming to health facility
- Active: field surveys with blood smear collection
- ASHA collects blood smears and uses Rapid Diagnostic Kits (RDKs)
Treatment:
- P. vivax: Chloroquine (3 days) + Primaquine (14 days)
- P. falciparum: ACT (Artemisinin Combination Therapy) + Primaquine single dose
- Supervised treatment by ASHA/MPW
Vector Control:
- IRS (Indoor Residual Spraying): DDT, Malathion, Synthetic pyrethroids
- Long-Lasting Insecticidal Nets (LLINs)
- Anti-larval measures: Paris green, Temephos (Abate) in water bodies
- Biological control: Gambusia fish, Bacillus thuringiensis israelensis (BTi)
- Source reduction: drainage of stagnant water, oiling
B. Lymphatic Filariasis (Filaria)
Causative organism: Wuchereria bancrofti; vector: Culex quinquefasciatus
MDA (Mass Drug Administration):
- Annual Mass Drug Administration with DEC + Albendazole on National Filaria Day
- Target: all eligible persons (2+ years) in endemic districts
Morbidity management:
- Lymphoedema: limb hygiene, exercise, elevation
- Hydrocele: hydrocelectomy surgery
C. Kala-Azar (Visceral Leishmaniasis)
Target: Elimination (< 1 case per 10,000 population at block level by 2020)
Causative organism: Leishmania donovani; vector: Phlebotomus argentipes (sandfly)
Treatment:
- First-line: Liposomal Amphotericin B (single dose) - free under NVBDCP
- Miltefosine (oral), Amphotericin B deoxycholate
Vector Control: IRS with DDT; environmental management
D. Dengue and Chikungunya
Vector: Aedes aegypti (day-biting mosquito)
Control: Source reduction (elimination of water-holding containers), biological control, community participation
Management: Symptomatic; platelet monitoring; no specific antiviral
Surveillance: Weekly reporting of suspected dengue cases
E. Japanese Encephalitis (JE)
Introduced JE vaccine in 2006 covering 104 endemic districts.
- SA 14-14-2 vaccine (imported from China)
- Children 1-15 years through campaigns; integrated into routine immunization
- Adults 15-65 years in 21 high-burden districts in Assam, UP, West Bengal
PROGRAMME 10: NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAMME (NIDDCP)
Background
Iodine Deficiency Disorders (IDD) include goitre, cretinism, intellectual disability, still births, and neonatal hypothyroidism. India has significant IDD burden due to iodine-deficient soil, especially in the Himalayan belt.
Objectives
- Reduce IDD to a public health problem (prevalence < 5% in any district)
- Universal iodization of salt
- Regular monitoring of iodine content in salt and urinary iodine excretion
Key Measures
- Universal salt iodization: All salt for human consumption must contain > 15 ppm iodine at consumer level (30 ppm at production level)
- Ban on non-iodized salt for human consumption
- Monitoring: Spot testing of salt at household level using simple test kits; urinary iodine excretion surveys
- IEC activities about importance of iodized salt
- Surveys to assess magnitude of IDD - goitre surveys, urinary iodine studies
- National IDD Control Programme coordinated by MoHFW with State governments
IDD Indicators
- Goitre rate < 5% = adequate iodine nutrition
- Median urinary iodine > 100 μg/L = adequate
- Salt iodine > 15 ppm at consumption level
PROGRAMME 11: NATIONAL TOBACCO CONTROL PROGRAMME (NTCP)
Background
Launched in 2007-08 in 21 states initially; expanded to all states. Linked to enforcement of COTPA (Cigarettes and Other Tobacco Products Act, 2003).
Objectives
- Reduce prevalence of tobacco use in India
- Improve awareness of health hazards of tobacco
- Strengthen enforcement of tobacco control laws
Key Components
1. IEC Activities:
- Health education on harmful effects of tobacco use and second-hand smoke
- Mass media campaigns - National No Tobacco Day (May 31 every year)
- Tobacco-free schools campaign
2. Tobacco Cessation:
- Brief advice to all smokers and tobacco users (5A approach: Ask, Advise, Assess, Assist, Arrange)
- Tobacco Cessation Clinics - trained counsellors; pharmacotherapy (NRT, Varenicline, Bupropion)
- National Tobacco Cessation Helpline: 1800-112-356 (iCall)
3. Regulatory Enforcement (COTPA 2003):
- Prohibition of smoking in public places (Section 4)
- Ban on tobacco advertisements, promotions and sponsorships (Section 5)
- Prohibition of tobacco product sales to minors and within 100 metres of educational institutions (Section 6)
- Health warnings on tobacco products covering 85% of pack (Section 7)
4. Infrastructure:
- Dedicated tobacco control cells at state and district levels
- District Tobacco Control Cells
5. Training and Capacity Building:
- Training of health workers, NGOs, school teachers
- School programme for awareness
- Integration with NCD prevention (NPCDCS)
At CHC Level:
- Making premises tobacco-free with mandatory signages
- Setting up tobacco cessation clinic with trained counsellor
- Promoting quitting of tobacco in the community
PROGRAMME 12: NATIONAL PROGRAMME FOR HEALTH CARE OF THE ELDERLY (NPHCE)
Background
Launched in 2010-11 in response to growing elderly population (currently ~8% of India's population; expected to reach 12.5% by 2026).
Objectives
- Provide dedicated health care services to the elderly at all levels of primary health care
- Build capacity of medical professionals in geriatric care
- Promote active and healthy ageing
Services at Different Levels
Sub-centre level:
- ASHA visits homes of disabled/bedridden elderly
- Compilation of elderly data, forwarding to district nodal officers
- Referral for specialist care
PHC level:
- Weekly health check-up clinics for elderly
- Management of common geriatric conditions (hypertension, diabetes, osteoarthritis, depression)
CHC level:
- Geriatric clinic: twice a week
- Medical rehabilitation services
- Visits by rehabilitation worker
District Hospital:
- 10-bedded geriatric ward
- Dedicated OPD for geriatric patients
Medical Colleges (Regional Geriatric Centres):
- 30-bedded geriatric unit
- Training of manpower
- Research in geriatric medicine
PROGRAMME 13: REPRODUCTIVE AND CHILD HEALTH (RCH) PROGRAMME
Background
Launched in 1997 as the flagship programme of NRHM, replacing the earlier target-based family planning programme. RCH-II was launched in 2005 with international funding (World Bank, DFID).
Approach
From a target-based approach to a client-centred, need-based, demand-driven approach.
Components
A. Maternal Health:
-
Antenatal Care (ANC):
- Minimum 4 ANC visits (WHO now recommends 8)
- Registration in first trimester
- TT immunization (2 doses or 1 booster)
- IFA (Iron-Folate Acid) tablets - 100 tablets during pregnancy
- Weight monitoring, BP, urine examination
- Abdominal examination, fundal height
- Blood group, Hb estimation, blood sugar
-
Institutional Delivery:
- Janani Suraksha Yojana (JSY): Cash incentive for institutional delivery
- BPL women in rural areas: Rs. 1400 in high-focus states, Rs. 700 in others
- ASHA incentive: Rs. 600 per delivery
- Janani Shishu Suraksha Karyakram (JSSK): Free entitlements - delivery, C-section, drugs, diet, blood, transport, referral
- Janani Suraksha Yojana (JSY): Cash incentive for institutional delivery
-
Skilled Birth Attendance:
- Training of ANMs, nurses as Skilled Birth Attendants (SBA)
- Emergency obstetric care at FRUs (First Referral Units)
-
Postnatal Care:
- 3 PNC contacts (within 48 hours, at 3-7 days, at 6 weeks)
- Breast feeding promotion, family planning counselling
B. Child Health:
-
IMNCI (Integrated Management of Neonatal and Childhood Illness):
- Assess and classify illness in children 0-5 years
- Conditions: pneumonia, diarrhoea, malaria, malnutrition, measles, ear problems
- Home-based newborn care by ASHA
-
Essential Newborn Care:
- Thermal protection, breastfeeding within 1 hour, cord care, eye care
- Management of neonatal asphyxia (resuscitation)
- Kangaroo Mother Care for LBW babies
-
Nutrition:
- Vitamin A supplementation (100,000 IU at 9 months; 200,000 IU every 6 months up to 5 years)
- Iron and Folic Acid supplementation
- Referral of SAM (Severe Acute Malnutrition) to NRCs (Nutritional Rehabilitation Centres)
-
Rashtriya Bal Swasthya Karyakram (RBSK - 2013):
- Child health screening for 4 Ds: Defects at birth, Diseases, Deficiencies, Developmental delays
- Mobile Health Teams (2 AYUSH doctors + paramedics) visit schools and Anganwadi centres
- Free treatment and corrective surgery for detected conditions
C. Family Planning:
- Spacing methods: OCP, condoms, IUD (Cu-T), injectables (DMPA)
- Terminal methods: tubectomy, vasectomy
- Demand generation and counselling by ASHA
- Mission Parivar Vikas (2016): Focus on high-TFR districts in UP, Bihar, MP, Rajasthan, etc.
D. Adolescent Health (RKSK - Rashtriya Kishor Swasthya Karyakram):
- Adolescent-friendly health services (AFHS) at PHC/CHC
- Peer educator programme
- Menstrual hygiene management
- Iron and folic acid supplementation for all adolescents (weekly)
- Nutrition, mental health, substance abuse prevention
E. STI/RTI (Sexually Transmitted and Reproductive Tract Infections):
- Detection and treatment of STIs at PHC level
- Syndromic case management
- Condom promotion
- Partner notification
Source: Park's Textbook of Preventive and Social Medicine, 25th Edition - Chapter 7 (National Health Programmes)
QUICK REVISION: PROGRAMME AT A GLANCE
| Programme | Year | Goal | Key Strategy |
|---|---|---|---|
| NRHM | 2005 | Improve rural health | ASHA, DHAP, IPHS |
| UIP | 1978/1985 | Immunize all children | Cold chain, Mission Indradhanush |
| NACP | 1987 | Prevent/control HIV | TI, ART, VCTC, PPTCT |
| RNTCP/NTEP | 1993 | Eliminate TB by 2025 | DOTS, GeneXpert, NIKSHAY |
| NLEP | 1983 | Eliminate leprosy | MDT (PB-6 months, MB-12 months) |
| NVBDCP | 2004 | Control vector-borne diseases | IRS, MDA, RDKs |
| NPCB | 1976 | Reduce blindness < 0.3% | Cataract surgery, school eye screening |
| NPCDCS | 11th Plan | Control NCDs | Screening >30 yrs, NCD clinics |
| NMHP | 1982 | Mental health for all | DMHP, anti-stigma, integration |
| NIDDCP | 1962 | Eliminate IDD | Universal salt iodization |
| NTCP | 2007 | Reduce tobacco use | COTPA enforcement, cessation clinics |
| NPHCE | 2010 | Elderly health care | Geriatric clinics, ASHA home visits |
| RCH | 1997 | Safe motherhood, child health | JSY, JSSK, RBSK, RKSK |
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