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#HEALTH PROGRAMMES - DETAILED PSM ANSWERS

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LIST 1

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1. Strategic Action Plan for Malaria Control in India (10 marks)

Chronology of Plans:

• SAP 2007-2012 (1st plan)
• SAP 2012-2017 (2nd plan - focused on scaling up interventions in high-burden areas)
• National Strategic Plan for Malaria Elimination 2017-2022 (current - shift from "control" to "elimination")

Strategies Under SAP:

1. Case detection - both passive (patient presenting to health facility) and active (house-to-house visits in high-risk areas)
2. Early diagnosis and complete treatment
3. Sentinel surveillance

1. Indoor Residual Spray (IRS) - spraying of insecticide on walls/ceilings of houses
2. Insecticide Treated Bed Nets (ITNs) and Long-Lasting Insecticidal Nets (LLINs)
3. Anti-larval measures including source reduction (removing stagnant water)

• Rapid detection and response to outbreaks

1. Capacity building
2. Behavioural Change Communication (BCC)
3. Intersectoral collaboration
4. Monitoring and evaluation
5. Operational and applied field research

Goals of Early Diagnosis and Treatment:

1. Complete cure
2. Prevention of progression to severe malaria
3. Prevention of deaths
4. Interruption of transmission
5. Minimising risk of drug-resistant malaria

Drug Policy 2013:

• No presumptive treatment - diagnosis (RDT/microscopy) mandatory before treatment
• P. vivax: Chloroquine 25 mg/kg over 3 days + Primaquine 0.25 mg/kg/day x 14 days
• P. falciparum: Artemisinin-based Combination Therapy (ACT)

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2. Telemedicine (6 marks)

Key Features:

• Established under National Health Mission (NHM) and Health Ministry
• Reduces geographic barrier to specialist care
• Utilizes video conferencing, mobile apps, email, telephone
• Connects rural PHCs/CHCs to district/tertiary hospitals

Benefits:

1. Improved access to specialist care in remote areas
2. Reduces need for patient travel
3. Reduces referral load at higher centres
4. Cost-effective health delivery
5. Useful during disasters/pandemics

Types:

• Synchronous (real-time): Video consultation
• Asynchronous (store-and-forward): Reports/images sent for later review
• Remote Patient Monitoring: Continuous monitoring via devices

India Context:

• Telemedicine Practice Guidelines 2020 issued by Ministry of Health
• e-Sanjeevani OPD launched as national teleconsultation platform
• Used extensively during COVID-19 pandemic

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3. Integrated Vector Control (6/10 marks)

Rationale:

• No single method ensures complete control of transmission
• Emphasis on "integrated" methodology since mid-1995 for malaria-endemic countries

Components for Malaria (under SAP):

1. Indoor Residual Spray (IRS):
   • Spraying of residual insecticide on interior walls and ceilings
   • Insecticide active for 3-6 months
   • Protects sleeping population against mosquito bites
2. Insecticide Treated Bed Nets (ITNs) / LLINs:
   • Long-lasting insecticidal nets (LLINs) effective for 3-5 years
   • Personal protection + reduction in vector density
3. Anti-larval Measures / Source Reduction:
   • Drainage of stagnant water
   • Larval control using Bacillus thuringiensis israelensis (Bti)
   • Anti-larval oil, Gambusia fish (biological control)
   • Environmental management (clearing breeding sites)
4. Biological Control:
   • Larvivorous fish (Gambusia, Guppy)
   • Microbial agents
5. Personal Protection:
   • Repellents, protective clothing
   • Screening of houses

Advantages of IVM:

• Reduces insecticide resistance
• Cost-effective
• Environmentally sustainable
• Applicable to multiple vector-borne diseases simultaneously

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4. NIKSHAY (6 marks)

Key Features:

• "Ni" = Eliminate, "Kshay" = TB (Sanskrit: wasting disease)
• Online real-time case notification system for TB
• Mandatory notification of TB cases (both public and private sector) since 2012
• TB declared a notifiable disease under the Public Health Act

Functions of NIKSHAY:

1. Case registration and unique NIKSHAY ID for each patient
2. Treatment monitoring - outcome tracking (cured, failed, lost to follow-up)
3. Drug supply management - ensuring uninterrupted drug supply
4. Contact tracing - identifying and screening household contacts
5. NIKSHAY Poshan Yojana - DBT (Direct Benefit Transfer) of ₹500/month to TB patients for nutritional support
6. Real-time data available to all levels (sub-district to national)
7. Private sector inclusion - mandatory reporting from private practitioners

Importance in NTEP/END TB Strategy:

• Target to eliminate TB by 2025 (5 years ahead of global SDG target of 2030)
• NIKSHAY supports universal drug susceptibility testing
• Enables molecular epidemiology of TB

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5. Vatsayan Kendra / ICTC - Integrated Counselling and Testing Centre (6/10 marks)

Types of ICTC:

• (a) Standalone ICTC (SA-ICTC): High client load; full-time counsellor + lab technician; located in medical colleges, district hospitals, CHCs
• (b) Facility-Integrated ICTC (F-ICTC): Set up below block level at 24x7 PHCs; existing staff trained in HIV counselling and testing; supported by NACO/SACs
• (c) PPP-ICTC: Public-Private Partnership ICTCs in private hospitals, NGOs

• A van with examination room + counselling space + lab collection area
• Team: health educator/ANM + counsellor + laboratory technician
• Set up as temporary clinics in hard-to-reach/tribal areas
• Services: HIV counselling/testing, STI/RTI syndromic management, ANC, immunization, general health check-ups

• Conducted by frontline health workers (ANMs) at sub-centre level
• To detect HIV-positive pregnant women and prevent mother-to-child transmission

Functions of ICTC:

1. Pre-test counselling
2. HIV testing (voluntary or provider-initiated)
3. Post-test counselling
4. Referral to ART centre if positive
5. PPTCT services for pregnant women
6. Linkage to care and support services

Service Level Pyramid:

• Village/community level → Sub-district → District → State
• Ensures equitable access from grass-roots to apex level

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6. PPTCT - Prevention of Parent-to-Child Transmission of HIV (6/10 marks)

Key Facts:

• Launched: 2002 under National AIDS Control Programme (NACP)
• More than 15,000 ICTCs offer PPTCT services to pregnant women
• Initially used single-dose Nevirapine (SD-NVP) prophylaxis

Evolution of PPTCT Protocol:

Components of PPTCT (4 Prongs):

1. Prong 1: Primary prevention of HIV in women of reproductive age
2. Prong 2: Prevention of unintended pregnancies in HIV+ women
3. Prong 3: Prevention of HIV transmission from HIV+ mother to child
4. Prong 4: Provision of care, treatment and support to HIV+ mothers and their children and families

PPTCT Protocol (Option B+):

• All HIV+ pregnant women start life-long ART (Tenofovir + Lamivudine + Efavirenz)
• Baby given NVP syrup for 6 weeks after birth
• Baby tested at 6 weeks with DNA PCR (early infant diagnosis)
• Avoid breastfeeding if formula feeding is safe, affordable, feasible, sustainable, safe (AFASS)

Importance:

• Without intervention: 25-45% risk of MTCT
• With Option B+: MTCT reduced to <2%

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7. IPV - Inactivated Polio Vaccine (10 marks)

Types of Polio Vaccines:

IPV Schedule in India (National Immunization Programme):

• Fractional IPV (fIPV): India introduced fractional dose IPV (1/5th dose = 0.1 ml) intradermally
• Given at 6 weeks and 14 weeks along with pentavalent vaccine
• Introduced in 2016 in India's routine immunization to complement OPV

Rationale for IPV Introduction:

• After eradication of Type 2 wild poliovirus (2015), Type 2 component removed from tOPV
• Shift from tOPV (trivalent) to bOPV (bivalent - Types 1&3)
• IPV provides immunity against Type 2 (preventing VAPP from Type 2 VDPV)
• Global Polio Eradication Initiative (GPEI) recommends at least 1 dose of IPV with bOPV switch

Advantages of IPV:

1. No risk of vaccine-associated paralytic polio (VAPP)
2. Safe in immunocompromised patients
3. Cost-effective with fractional dosing
4. Boosts systemic immunity when combined with OPV

India's Status:

• India certified polio-free in March 2014
• Pulse Polio Immunization continues with bOPV
• IPV integrated into routine immunization schedule since 2016

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8. NPCDCS - National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (10 marks)

Evolution:

• Initially launched as National Programme for Prevention and Control of Diabetes, CVD and Stroke
• Later integrated with National Cancer Control Programme (NCCP)
• Combined into NPCDCS during 11th Five Year Plan
• During 11th FYP: 100 districts in 21 states
• During 12th FYP: Extended to all districts nationwide

Objectives:

1. Prevent and control common NCDs through behaviour and lifestyle changes
2. Provide early diagnosis and management
3. Build capacity at various levels of health care
4. Train human resources (doctors, paramedics, nurses)
5. Establish capacity for palliative and rehabilitative care

Implementation Level:

• Health promotion through camps, IPC, posters
• Opportunistic screening of population above 30 years - BP + blood glucose (glucometer strip method)
• Suspected cases referred to CHC/higher facility

• NCD Clinic established at CHC and district level
• Confirmation of diagnosis, initiation of treatment
• Free drugs supplied for NCDs

• District NCD Cell for coordination
• Day Care Centre for cancer chemotherapy
• Tertiary care linkage

Strategies:

• Mass media + community education + IPC for behavioural change
• Messages focus on: increased healthy food intake, physical activity, avoidance of tobacco & alcohol, stress management
• Opportunistic screening at health facilities for early detection

Cancer Component:

• Screening for oral, cervical and breast cancer
• District Early Detection & Prevention of Cancer Centre
• Palliative care units at district hospitals

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9. National Tobacco Control Programme (NTCP) (6/10 marks)

Legislative Base:

• COTPA 2003 (Cigarettes and Other Tobacco Products Act) - prohibits smoking in public places, sale to minors, misleading advertisements
• WHO FCTC (Framework Convention on Tobacco Control) - India ratified in 2004

NTCP Launch:

• Launched during 11th Five Year Plan (2007-12)
• Implemented in phased manner

Objectives:

1. Create awareness about harmful effects of tobacco
2. Reduce prevalence of tobacco use
3. Establish tobacco cessation facilities
4. Effectively implement COTPA 2003
5. Build capacity at national and state levels

Components:

1. IEC (Information, Education, Communication): Mass media campaigns, school health education
2. Tobacco Cessation Clinics (TCCs): At district hospitals and medical colleges
3. Enforcement of COTPA: Ban on smoking in public places, no sale to/by minors (<18 years), graphic health warnings on packets
4. Pictorial Health Warnings: Cover 85% of tobacco pack (Ruling 2018)
5. mCessation Programme: Mobile-based smoking cessation support
6. NCD Cell: Coordination at state/district level
7. MPOWER package (WHO):
   • Monitor tobacco use
   • Protect from tobacco smoke
   • Offer help to quit
   • Warn about dangers
   • Enforce bans on advertising
   • Raise taxes on tobacco

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10. IDSP - Integrated Disease Surveillance Programme (10 marks)

Background:

• Launched in 2004 with World Bank assistance
• Later incorporated under NHM

Objectives:

1. Establish decentralized laboratory network
2. Train personnel in disease surveillance
3. Integrate reporting from public and private sectors
4. Early warning and rapid outbreak response
5. Establish public health informatics

Reporting System - "S-P-L" Reports (Weekly):

Reporting Levels:

• Sub-district → District Surveillance Unit (DSU) → State Surveillance Unit (SSU) → Central Surveillance Unit (CSU), IDSP HQ, New Delhi

Disease Surveillance:

• 14 diseases under surveillance including: cholera, diarrhoea, typhoid, malaria, dengue, chikungunya, AEFI, influenza-like illness, acute encephalitis syndrome (AES), pneumonia, measles, etc.

Key Features:

1. Epidemic Intelligence Service (EIS): Field epidemiologists trained for outbreak investigation
2. 24x7 helpline for outbreak reporting
3. Media scanning: Monitoring media reports for unusual disease events
4. Early Warning System: Alerts generated when cases exceed threshold

Accomplishments:

• Detected and responded to multiple outbreaks (Nipah virus, COVID-19 sentinel surveillance, dengue)
• Integrated with IHIP (Integrated Health Information Platform) - the upgraded digital version of IDSP

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11. END TB Strategy / END TB STRATE (6 marks)

India's Target:

• India aims to eliminate TB by 2025 - 5 years ahead of the global SDG target of 2030
• National Strategic Plan for TB Elimination 2017-2025
• Replaced RNTCP (Revised National TB Control Programme) with NTEP (National TB Elimination Programme) from 2020

Pillars of END TB Strategy:

• Universal drug susceptibility testing (UDST)
• Early diagnosis including systematic screening of contacts and vulnerable populations
• Treatment: 4-month regimen for drug-susceptible TB
• ART for all HIV+ TB patients
• TB preventive treatment for latent TB (3HP regimen)
• Infection control

• Political commitment with adequate resources
• Universal health coverage (UHC) - no patient should face catastrophic costs
• Regulatory framework: NIKSHAY for case notification
• Social protection for TB patients (NIKSHAY Poshan Yojana - ₹500/month)

• New diagnostics: CBNAAT (GeneXpert), TrueNat, LPA
• New drugs: Bedaquiline, Delamanid for MDR-TB
• New vaccines under trial (M72/AS01E)

Targets (END TB):

• 90% reduction in TB deaths by 2030 (vs 2015)
• 80% reduction in TB incidence rate by 2030
• Zero TB-affected families facing catastrophic costs

India-Specific Measures:

1. NIKSHAY - case notification portal
2. NIKSHAY Poshan Yojana - nutritional support
3. Pradhan Mantri TB Mukt Bharat Abhiyan - community volunteers (Ni-kshay Mitra)
4. Active Case Finding in high-risk populations
5. CBNAAT/TrueNat for molecular diagnosis at PHC level

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LIST 2

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1. Mission Indradhanush (6 marks)

Rationale:

• Named after the rainbow ("Indradhanush") depicting seven colours = seven vaccines
• Target: Fully immunize 90% of children who are either unvaccinated or partially vaccinated by 2020 (target later pre-poned to 2018)

Target Population:

• All children who missed routine immunization
• Pregnant women unimmunized against tetanus

Seven Original Vaccines:

Phases:

• 6 phases completed (April 2015 - December 2018)
• Covered 681 districts
• 3.39 crore children reached; 81.79 lakh children immunized; 87.18 lakh pregnant women immunized

Impact:

• First 2 phases led to 6.7% increase in full immunization coverage in 1 year (vs only 1% annual increase previously)
• Greater improvement in rural areas (7.9%) than urban (3.1%)

Intensified Mission Indradhanush (IMI):

• Launched October 2017 in 190 districts/urban areas in 24 states
• Focus on unvaccinated and partially vaccinated children 0-2 years and pregnant women
• Conducted in 4 rounds over 7 days each

IMI 2.0 and IMI 3.0:

• IMI 2.0 (2019-2020): 272 districts in 27 states/UTs
• IMI 3.0 (2021): Conducted in all districts to recover immunization gaps created by COVID-19

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2. Essential Newborn Care (6 marks)

Primary Goal:

Main Components (from Park's):

1. Resuscitation of newborn with birth asphyxia (bag and mask ventilation)
2. Prevention of hypothermia - immediate drying and wrapping; skin-to-skin (Kangaroo Mother Care for LBW)
3. Prevention of infection - clean cord care, hand hygiene, clean delivery practices
4. Exclusive breastfeeding - initiated within 1 hour of birth
5. Referral of sick newborn to FRU/SNCU

Additional ENC Components:

• Eye care: 1% silver nitrate or 0.5% erythromycin ointment to prevent ophthalmia neonatorum
• Vitamin K injection (1mg IM) to prevent hemorrhagic disease of newborn
• Birth dose vaccines: BCG, OPV-0, Hepatitis B birth dose
• Weighing of newborn and recording
• APGAR scoring at 1 and 5 minutes

Facility-Based Newborn Care:

• NBCC (Newborn Care Corner): At labour room in all delivery points
• NBSU (Newborn Stabilization Unit): At CHC level - for sick/LBW newborns
• SNCU (Special Newborn Care Unit): At district hospital - for sick neonates needing intensive care

Home-Based Newborn Care (HBNC):

• Conducted by ASHA for newborns delivered at home
• 7 visits in first 42 days of life (Days 1, 3, 7, 14, 21, 28, 42)

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3. Janani Suraksha Yojana (JSY) (6/10 marks)

Objective:

• Promote institutional delivery particularly among BPL (Below Poverty Line) women
• Ensure cash assistance to women for delivery

Target Beneficiaries:

• BPL pregnant women (all states)
• SC/ST pregnant women (all states)
• Pregnant women in low-performing states (LPS)

Low Performing States (LPS) vs High Performing States (HPS):

ASHA's Role under JSY:

• Identify pregnant women
• Encourage institutional delivery
• Accompany the woman to the health facility
• ASHA incentive: ₹600 (rural LPS), ₹400 (urban LPS) per case facilitated

Impact:

• Dramatic increase in institutional deliveries in India - from ~40% (2005) to ~79% (2015-16 NFHS-4)
• Significant reduction in maternal mortality ratio (MMR)

Eligibility:

• Age criteria: ≥19 years for 2 live births in LPS
• In HPS: Only BPL and SC/ST women eligible

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4. Mamata Day / Village Health and Nutrition Day (VHND) (6/10 marks)

Frequency: Once a month at every Anganwadi Centre

Services Provided:

1. Immunization of children and pregnant women
2. Antenatal Care (ANC) - registration, check-up, TT injection, IFA tablets
3. Nutrition - supplementary nutrition, counselling on dietary practices
4. Growth monitoring - weighing children and plotting growth charts
5. IYCF counselling - infant and young child feeding
6. Family planning counselling and services
7. Health education on WASH (water, sanitation, hygiene)
8. Identification of malnourished children and referral
9. ORS promotion for diarrhoea management

Organizers:

• ANM (Auxiliary Nurse Midwife) - provides health services and immunization
• AWW (Anganwadi Worker) - mobilizes beneficiaries, provides nutrition services
• ASHA - mobilizes community, identifies beneficiaries, accompanies women

This is the "Mother and Child Protection (MCP)" Card day:

• Cards are updated at each Mamata Day
• Tracking of all pregnant women and children under 5 in the village

Odisha Context:

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5. HBNC - Home-Based Newborn Care & Role and Responsibility of ASHA (6/10 marks)

Schedule of ASHA Visits (7 visits in 42 days):

Role of ASHA in HBNC:

1. Promote institutional delivery (JSY)
2. Initiate exclusive breastfeeding within 1 hour of birth
3. Prevent hypothermia - ensure baby is warm, dried, wrapped
4. Clean cord care - no application of harmful substances
5. Danger signs identification: Poor feeding, high fever, seizures, jaundice, breathing difficulty → refer to SNCU/hospital
6. Kangaroo Mother Care (KMC) for LBW babies
7. Oral Zinc + ORS for diarrhoea
8. Co-trimoxazole for fast breathing (trained ASHAs in HBNC+)
9. Track immunization status and ensure complete vaccination

ASHA Incentive for HBNC:

• ₹250 for completing all 7 visits for a home-delivered baby
• Additional ₹400 for LBW home visit package

Key Responsibilities of ASHA (General):

• Village Health and Nutrition Day (VHND/Mamata Day) activities
• Mobilizing community for pulse polio, national immunization days
• Accompanying pregnant women for ANC and delivery
• Distributing ORS, IFA, chloroquine, contraceptives, condoms
• TB DOTS supporter
• Maintenance of health records

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6. RBSK - Rashtriya Bal Swasthya Karyakram (10 marks)

"4D" Framework - RBSK screens for:

1. Defects at birth (congenital conditions)
2. Deficiencies (nutritional - anaemia, vitamin D, iodine deficiency)
3. Diseases (common childhood diseases)
4. Developmental delays including disabilities

Target Age Groups:

• 0-6 weeks: Newborns screened at health facilities (NBCC/SNCU)
• 6 weeks to 6 years: Children at Anganwadi Centres
• 6-18 years: Children at Government/Government-aided schools

Screening Team - DEIC Mobile Health Teams:

• 2 teams per block (one for AWC, one for schools)
• Each team: 1 AYUSH doctor + 1 ANM/Staff Nurse + 1 Pharmacist + 1 Support person

Conditions Screened (30 conditions):

Referral Pathway:

• Screening → Referral to DEIC (District Early Intervention Centre) → Tertiary care if needed
• DEIC provides free treatment, surgery, hearing aids, spectacles, Cochlear implants, etc.

DEIC (District Early Intervention Centre):

• Established at district hospital
• Team: Paediatrician, ENT surgeon, ophthalmologist, dentist, physiotherapist, psychologist, speech therapist, orthopaedic surgeon
• Provides free treatment and referral

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7. Components of RMNCH+A (Reproductive, Maternal, Newborn, Child and Adolescent Health) (10 marks)

Why RMNCH+A?

• Recognizes the continuum of care from pre-pregnancy through childbirth to childhood and adolescence
• Addresses interconnectedness of health outcomes across the life cycle

Components/Pillars of RMNCH+A:

• Family planning services (spacing + limiting methods)
• RTI/STI prevention and treatment
• Safe abortion services (MTP)
• Adolescent reproductive health

• ANC (4 antenatal check-ups minimum; now recommended: 8 ANC contacts WHO)
• Skilled attendance at birth (Janani Suraksha Yojana)
• Emergency obstetric care at FRUs
• Janani Shishu Suraksha Karyakram (JSSK) - free delivery, free transport, free drugs, free blood for pregnant women and sick newborns
• Maternal death review
• Obstetric haemorrhage management (Misoprostol, Oxytocin)

• Home-Based Newborn Care (HBNC) - ASHA 7 visits
• NBCC, NBSU, SNCU establishment
• Essential newborn care practices
• Kangaroo Mother Care (KMC) for LBW
• Newborn screening (NBS) for congenital hypothyroidism

• Universal immunization programme (UIP)
• RBSK (Rashtriya Bal Swasthya Karyakram)
• Integrated Management of Neonatal and Childhood Illness (IMNCI)
• SAM (Severe Acute Malnutrition) management at NRCs (Nutrition Rehabilitation Centres)
• Vitamin A supplementation
• ORS-Zinc for diarrhoea
• HBNC+

• RKSK (Rashtriya Kishor Swasthya Karyakram) for 10-19 years
• WIFS (Weekly Iron and Folic Acid Supplementation): Weekly IFA (65mg elemental iron + 400 mcg folic acid) for adolescent girls and boys
• SABLA - Scheme for Adolescent Girls
• ARSH (Adolescent Reproductive and Sexual Health) clinics
• Menstrual hygiene programme
• Adolescent-friendly health services
• Peer education programmes
• Sanitary napkins at subsidized rates

Key Strategies:

1. Continuum of care approach - from preconception to adolescence
2. Convergence - with ICDS, school education, water and sanitation
3. High Impact Interventions (HIIs) in a "demand side" approach
4. Conditional cash transfers (JSY, JSSK)
5. Equity focus - reaching the unreached (tribal, urban slum, SC/ST)

Special Focus Areas in RMNCH+A:

• "High Priority Districts" (HPDs): 184 districts with worst health indicators get extra focus
• "SUMAN" (Surakshit Matritva Aashwasan): 2019 initiative to eliminate all preventable deaths in health facilities during childbirth

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QUICK REVISION SUMMARY TABLE

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Source: Park's Textbook of Preventive and Social Medicine, 27th Edition. All programmes are classified under National Health Programmes as per Park's chapters on Malaria Control, HIV/AIDS, National Immunization Programme, NCD Control, Maternal Health, and RCH/NHM.

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How to Use These Answers in Exams

• Definition (2-3 lines)
• 3-4 key components/objectives
• One distinguishing feature or table
• Brief outcome/impact

• Full definition + background
• Complete objectives list
• All components/strategies with subpoints
• Implementation levels (sub-centre → district → state)
• One comparison table if applicable
• Outcomes/impact data

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Key Numbers to Remember (Park's Exam Favourites)