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Health Programs in India - Community Medicine (Comprehensive)

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OVERARCHING FRAMEWORK: NATIONAL HEALTH MISSION (NHM)

• National Rural Health Mission (NRHM) - launched 2005
• National Urban Health Mission (NUHM) - launched 2013

1. Health system strengthening in rural and urban areas
2. Reproductive - Maternal - Newborn - Child and Adolescent Health (RMNCH+A)
3. Control of communicable and non-communicable diseases

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MAJOR MILESTONES IN MATERNAL-CHILD HEALTH PROGRAMS

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1. AYUSHMAN BHARAT PROGRAMME (2018)

a. Health and Wellness Centres (HWCs)

• National Health Policy 2017 envisioned 1.5 lakh HWCs to bring healthcare closer to homes
• Services: Maternal and child health, communicable diseases, NCD management (hypertension, diabetes, 3 common cancers - oral, breast, cervix)
• Incrementally adding: mental health, ENT, ophthalmology, oral health, geriatric/palliative care, trauma care
• Free essential drugs and diagnostic services
• Run by Community Health Officer (CHO) - a BSc/GNM Nurse or Ayurveda Practitioner with 6-month certificate in community health
• First HWC inaugurated: 14 April 2018, Bijapur, Chhattisgarh

b. AB-PMJAY (Pradhan Mantri Jan Arogya Yojana)

• Health coverage up to Rs. 5 lakh per family per year
• Covers ~10.74 crore poor and vulnerable families
• Beneficiaries identified through Socio Economic Caste Census (SECC) data

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2. NATIONAL FAMILY WELFARE PROGRAMME

Janani Suraksha Yojana (JSY)

• Promotes institutional deliveries
• Cash incentive to pregnant women who deliver in public health institutions

Janani Shishu Suraksha Karyakram (JSSK)

• Entitles all pregnant women delivering in public health institutions to absolutely free and no-expense delivery, including caesarean section
• Includes free drugs, diagnostics, blood, diet, and referral transport

LaQshya Programme (2017)

• Launched by MOHFW to improve quality of care in labour rooms and maternity OTs in public health facilities
• Evidence-based approach for intrapartum and postpartum care
• Implemented at District Hospitals, Sub-district Hospitals, high case-load CHCs, FRUs, and medical colleges
• 2,445 public health facilities including 193 medical colleges identified

National Family Planning Indemnity Scheme

• Provides compensation to beneficiaries/nominees in case of death, complications following sterilization

Postpartum Programme

• Provides family planning services to mothers in the immediate postpartum period

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3. PROGRAMMES UNDER RMNCH+A

Village Health and Nutrition Day

• Organized once a month at anganwadi centres
• Services: antenatal/postpartum care, institutional delivery promotion, immunization, family planning, nutrition

Anaemia Mukt Bharat Programme

• Addresses malnutrition with focus on first 1,000 days of the child
• Part of Poshan Abhiyaan

Name-Based Web-Enabled Tracking

• Tracks pregnant women to ensure antenatal, intranatal, and postnatal care

Mother and Child Protection (MCP) Card

• Monitors service delivery for mothers and children in collaboration with Ministry of Women and Child Development

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4. NATIONAL TUBERCULOSIS ELIMINATION PROGRAMME (NTEP)

• Goal: Eliminate TB by 2025 (5 years ahead of global SDG target)
• Integrated with the National Health Mission
• DOTS (Directly Observed Treatment - Short course) is the backbone strategy
• Organization at sub-district level (Tuberculosis Unit level): Case detection, treatment, follow-up
• A major organizational change in NTEP is mainstreaming with NHM

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5. NATIONAL LEPROSY ERADICATION PROGRAMME (NLEP)

• Integrated leprosy services through general health care system
• Early detection and complete treatment of new leprosy cases
• Household contact survey for early detection
• Involvement of ASHA in detection and treatment completion
• Strengthening of Disability Prevention and Medical Rehabilitation (DPMR) services
• District Leprosy Cell for technical support to primary health care

1. Leprosy Case Detection Campaign (LCDC)
2. Focused Leprosy Campaign
3. Special plan for hard-to-reach areas

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6. NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (NVBDCP)

a. Malaria

• Surveillance activities by Health Worker (Male)
• Collection of blood smears from fever cases
• Coordination with ASHAs and FTDs
• Administration of radical treatment; use of Rapid Diagnostic Kits (RDKs)
• Spray operations using DDT/insecticides

b. Kala-azar (Visceral Leishmaniasis)

• Identify fever cases >15 days duration
• Guide suspected cases to nearest PHC/CHC
• Health education

c. Japanese Encephalitis (JE)

• Identify fever cases with encephalitis symptoms
• Referral to PHC/CHC; record keeping for follow-up

d. Filariasis

• Identification of lymphoedema/elephantiasis and hydrocele cases
• Training of drug distributors for Mass Drug Administration (MDA) with DEC + Albendazole on National Filaria Day

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7. NATIONAL MENTAL HEALTH PROGRAMME (NMHP)

• Prevention and treatment of mental and neurological disorders and their associated disabilities
• Use of mental health technology to improve general health services
• Application of mental health principles in national development

1. Ensure availability and accessibility of minimum mental health care for all, especially vulnerable sections
2. Encourage application of mental health knowledge in general health care
3. Promote community participation in mental health services

1. Integration of mental health with primary health care through NMHP
2. Provision of tertiary care institutions
3. Eradicating stigmatization through Central Mental Health Authority and State Mental Health Authority

• Training of mental health workers at nodal state institute
• Public education to reduce stigma
• OPD and indoor services for early detection and treatment
• Data collection for planning and research

• School mental health services (life skills education, counselling)
• College counselling services
• Workplace stress management
• Suicide prevention services (counselling centers, helplines)

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8. NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF CANCER, DIABETES, CVD AND STROKE (NPCDCS)

Cancer Component:

• IEC for prevention and early symptom awareness
• Early detection with warning signals (change in bowel/bladder habits, bleeding per rectum, blood in urine, lymph node enlargement, breast lumps, non-healing oral ulcers, etc.)
• Referral of suspected cancer cases
• PAP smear (desirable)

Other NCD Diseases (DM, HTN, CVD, Stroke):

• Healthy dietary habits
• Increased physical activity
• Avoidance of tobacco and alcohol
• Stress management

• History, blood pressure measurement, blood/urine sugar, ECG

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9. NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAMME (NIDDCP)

• IEC activities to promote consumption of iodized salt
• Monitoring of iodated salt through salt testing kits
• Surveys to identify iodine deficiency in populations

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10. NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF FLUOROSIS (NPPCF)

• Addresses fluorosis in fluoride-endemic areas
• Health education on safe water sources and nutrition

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11. NATIONAL PROGRAMME FOR HEALTH CARE OF THE ELDERLY (NPHCE)

• Medical rehabilitation services
• Geriatric clinic: twice a week
• Home visits to disabled/bedridden persons by rehabilitation workers
• Compilation of elderly data from PHCs for district nodal officers

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12. NATIONAL LEPROSY ERADICATION PROGRAMME

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13. NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF DEAFNESS (NPPCD)

• Early detection and referral of hearing impairment and deafness
• Basic diagnosis and treatment of common ear diseases (wax, otomycosis, otitis externa, ear discharge)
• IEC services for prevention and early detection

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14. PREVENTION OF PARENT-TO-CHILD TRANSMISSION (PPTCT) - HIV

• Integrated with Reproductive and Child Health (RCH) programme
• Routine offer of HIV counselling and testing to all pregnant women
• ARV prophylaxis for HIV-positive mothers and their newborns

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KEY HEALTH INFRASTRUCTURE SUPPORTING PROGRAMS

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SUMMARY TABLE: KEY NATIONAL HEALTH PROGRAMMES

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