1535975311475 national family welfare programme 2

NFWP

1. NATIONAL FAMILY WELFARE PROGRAMME

2. Launched in 1952 It is 100% centrally sponsored programme Under ministry health and family welfare 1977 the government of india redesignated the “national family planning program” as the national family welfare program.

3. Concept: Quality of Life: Centrally sponsored program. It emphasis is on a child family. Also emphasis is on spacing methods along with terminal methods Promote family planning. Motivate families

4. Aims and objectives: To promote the adoption of family size. To promote the use of spacing methods To ensure adequate supply of contraceptives. To arrange for clinical and surgical services. Participation of voluntary organizations. Using the means of mass communication

5. Strategies: Integration with health services Integration with maternity and child health Concentration in rural areas Literacy Brest feeding Raising the age for marriage Minimum needs program Incentives Mass media

6. MATERNAL AND CHILD HEALTH PROGRAM

7. Definition: According to WHO (1976) maternal and child health services can be defined as promoting, preventing, therapeutic or rehabilitation facility or care for the mother or the child.

8. Aims: Reducing maternal, perinatal , infant and child mortality and morbidity rates. Child survival. Promoting reproductive health Ensure birth of healthy child Prevent malnutrition Prevent communicable diseases Early diagnosing and treatment of the health problems. Health education and family planning services

9. Components: Maternal health Family planning Child health School health Handicapped children Care of the children in special setting

10. REPRODUCTIVE AND CHILD HEALTH PROGRAM

11. Definition: Reproductive and child health approach has been defined as “people have the ability to reproduce and regulate their fertility, women are able to go through pregnancy and child birth safely, the outcome of pregnancies is successful in terms of maternal and infant survival and well being, and couples are able to have sexual relations, free of fear pregnancy and of contracting disease”.

12. Components: Family planning Child survival and safe motherhood component. Client approach to health care Prevention/management of RTI/STD/AIDS

13. Highlights of RCH program: The program integrates all interventions of fertility regulation, maternal and child health with reproductive health for both men and women. Client oriented. Upgradation of the level of facilities Facilities of obstetric care Specialist facilities for STD and RTI. The program aims improving the outreach of services primarily for the vulnerable group of population who have been, till now effectively left out of planning.

14. Interventions: Child survival interventions Safe motherhood interventions Implementation of target free approach High quality training at all levels. IEC activities. Specially designed RCH package for urban slums and tribal areas District sub projects under local capacity enhancement

15. RTI/STD clinics at district hospitals. Facility for safe abortions at PHCs by providing equipment, contractual doctors etc. Enhanced community participation through panchayat , women groups and NGOs. Adolescent health and reproductive hygiene.

16. Interventions in selected states/districts: Screening and treatment of RTI/STD at sub-divisional level Essential obstetric care. Emergency obstetric care. Additional ANM at sub centers. Improved delivery services. Facility of referral transport.

17. Maternal health care was a part of Family welfare program from its inception Interventions were introduced as vertical schemes namely NNAP TT immunization of pregnant women. Dias training program.

18. In 1992, the child survival and safe motherhood program integrated at all the schemes for better compliance. Early registration of pregnancy To provide minimum 3 ante natal check ups. Universal coverage of all pregnant women with TT immunization Advice on food, nutrition and the rest. Detection of high risk pregnancies and prompt referral. Clean deliveries by trained personal Birth spacing Promotion of institutional deliveries

19. Major Interventions : Essential obstetric care Emergency obstetric care 24 hour delivery service at PHC/CHC Medical termination of pregnancy Control of RTI/STD Immunization Essential new born care Diarrhoeal disease control

20. Prevention and control of Vitamin A Deficiency in children Prevention and control of Anaemia in children Acute respiratory disease control

21. Initiatives taken after adoption of national population policy . RCH campus RCH out – reach scheme Border district cluster strategy Introduction of hepatitis B vaccination project Training of Dias Empowered action group District survey

22. RCH phase II

23. Began from 1 st April 2005 Focus of the program: Reduce maternal and child morbidity and mortality with emphasis on rural health care

24. The major strategies: Essential obstetric care Institutional delivery Skilled attendance at delivery Emergency obstetric care Operationalizing FRUs Operationalizing PHCs and CHCs

25. New Initiatives: Training of MBBS doctors in life saving Setting up of Blood storage centers at FRUS

26. Janani Suraksha Yojana

27. Type of National Maternity benefits scheme modified into new scheme – JSY. Launched on 12 th April 2005. Objectives: Reducing Maternal mortality and infant mortality

28. Salient Features: 100% centrally sponsored scheme. Under NRHM it integrates the benefits of cash assistance and institutional care. This benefit will be given to all women both rural and urban belonging to BPL.

29. Eligibility of cash assistance: In low performing state All women including those from SC/ST delivering in govt health centers. In high performing state BPL women, Aged 19 years and above SC/ST pregnant women

30. Limitation of cash assistance: In low performing state, All births delivered in health care In high performing state. Only for first 2 deliveries

31. Vandematharam scheme

32. Voluntary scheme Doctor can volunteer themselves for providing safe motherhood services The enrolled doctors will display mandematharam logo at their clinic Fe, oral pills and TT will be provided by the respective DMO to the vandematharam doctors for free distribution.

33. Facilities: Safe abortion services Medical method of abortion Manual vaccum aspirtation Village health and nutrition day Maternal death review Pregnancy tracking

34. Child health components: Nutrition rehabilitation centers Integrated management of neonatal and childhood illness Sick newborn care unit Home based new born care

35. Quality indicators used to monirot RCH programme: Number of antenatal cases registered Number of antenatal woman who had 3 ANC Number of high risk pregnancy referred Number of pregnant woman who had two doses of TT injection Number of p regnant woman under prophylaxis and treatment of anaemia

36. Number of deliveries by trained and untrained birth attendant Number of cases with complications referred to PHC/FRU Number of newborn with birthweight recorded Number of women given 3 postnatal check ups Number of RTI/STD cases detected

37. Number of children fully immunized Number of adverse reactions reported after immunization Number of ARI and diarrhoea under 5 years treated Number of cases motivated and followed up for contraception

38. INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS

39. Over the last 3 decades the annual number of deaths among children less than 5 years of age has decreased by almost a third. However , this reduction has not been evenly distributed throughout the world. Every year more than 10 million children die in developing countries before they reach their fifth birthday. <#> Introduction

40. Seven in 10 of these deaths are due to acute respiratory infections (mostly pneumonia), diarrhoea, measles, malaria, or malnutrition - and often to a combination of these illnesses. In India, common illnesses in children under 3 years of age include fever (27% ), acute respiratory infections (17% ), diarrhoea (13% ) and malnutrition (43%) – and often in combination (National Family Health Survey . <#>

41. Infant Mortality Rate continues to be high at 68/1000 live births and Under Five Mortality Rate at 95/1000 live births per year. Neonatal mortality contributes to over 64% of infant deaths and most of these deaths occur during the first week of life. <#>

42. Health problem(s) the child may have; Severity of the child’s condition; and Actions that can be taken to care for the child (e.g. refer the child immediately, manage with available resources, or manage at home). <#> Evidence-based Syndrome Approach

43. The IMNCI strategy includes both preventive and curative interventions that aim to improve practices in health facilities, the health system and at home. At the core of the strategy is integrated case management of the most common neonatal and childhood problems with a focus on the most common causes of death . <#> COMPONENTS OF THE INTEGRATED APPROACH

44. Improvements in the case-management skills of health staff through the provision of locally-adapted guidelines on Integrated Management of Neonatal and Childhood Illness and activities to promote their use; Improvements in the overall health system required for effective management of neonatal and childhood illness; Improvements in family and community health care practices . <#> The strategy includes three main components

45. Depending on a child’s age, various clinical signs and symptoms differ in their degrees of reliability and diagnostic value and importance. Therefore, the IMNCI guidelines recommend case management procedures based on two age categories: Young infants age up to 2 months Children age 2 months up to 5 years <#> THE PRINCIPLES OF INTEGRATED CARE

46. All sick young infants up to 2 months of age must be assessed for “ possible bacterial infection / jaundice ”. Then they must be routinely assessed for the major symptom “diarrhoea”. All sick children age 2 months up to 5 years must be examined for “general danger signs” which indicate the need for immediate referral or admission to a hospital. They must then be routinely assessed for major symptoms: cough or difficult breathing, diarrhoea, fever and ear problems . <#>

47. All sick young infants and children 2 months up to 5 years must also be routinely assessed for nutritional and immunization status, feeding problems, and other potential problems. Only a limited number of carefully selected clinical signs are used, based on evidence of their sensitivity and specificity to detect disease. These signs were selected considering the conditions and realities of first-level health facilities. <#>

48. A combination of individual signs leads to an infant’s or a child’s classification(s) rather than a diagnosis. Classification(s) indicate the severity of condition(s). They call for specific actions based on whether the infant or child (a) should be urgently referred to a higher level of care, (b) requires specific treatments (such as antibiotics or antimalarial treatment), or (c) may be safely managed at home. The classifications are colour coded: “pink” suggests hospital referral or admission, “yellow” indicates initiation of specific treatment, and “green” calls for home management . <#>

49. IMNCI management procedures use a limited number of essential drugs and encourage active participation of caretakers in the treatment of infants and children. <#>

50. <#> IMNCI CASE MANAGEMENT PROCESS

51. For all sick children age up to 5 years who are brought to a first-level health facility ASSESS the child: Check for danger signs (or possible bacterial infection/Jaundice). Ask about main symptoms. If a main symptom is reported, assess further. Check nutrition and immunization status. Check for other problems. <#>

52. CLASSIFY the child's illness: Use a colour -coded triage system to classify the child's main symptoms and his or her nutrition or feeding status. IF URGENT REFERRAL is needed and possible IF NO URGENT REFERRAL is needed or possible <#>

53. Identify urgent pre-referral treatment(s) needed for the child's classifications. IDENTIFY TREATMENT needed for the child's classifications: identify specific medical treatments and/or advice. TREAT THE CHILD : Give urgent prereferral treatment(s) needed. TREAT THE CHILD : Give the first dose of oral drugs in the clinic or advise the child's caretaker. Teach the caretaker how to give oral drugs and how to treat local infections at home. If needed, give immunizations. <#>

54. REFER THE CHILD: Explain to the child's caretaker the need for referral. Calm the caretaker's fears and help resolve any problems. Write a referral note. Give instructions and supplies needed to care for the child on the way to the hospital. COUNSEL THE MOTHER : Assess the child's feeding, including breastfeeding practices, and solve feeding problems, if present. Advise about feeding and fluids during illness and about when to return to a health facility. Counsel the mother about her own health. FOLLOW-UP care : Give follow-up care when the child returns to the clinic and, if necessary, reassess the child for new problems. <#>

55. National nutritional anaemia prophylaxis program

56. Was started in 1970. Centrally sponsored scheme. Objectives: Aims at significantly decreasing the prevalence and incidence of anaemia .

57. Specific Objectives: Asses the baseline prevalence of nutrition anaemia . Anti anaemia treatment. Prophylaxis program. Continuous monitoring. To asses periodically the HB level. Motivate the mother

58. Activities: Promotion of regular consumption of food rich in iron. Supply of iron and folate supplements. Identification and treatment of severely aneamic cases.

59. Organization: The program is implemented through primary health centers and its sub centers. The multi purpose worker female and other para medics in the PHCs are responsible for the distribution of IFA tablets to beneficiaries.

60. NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS

61. Launched in the year 1976 100% centrally sponsored scheme Goal: to reduce the prevalence of blindness from 1.4 to .3 percent

62. REVISED STRATEGIES Strengthening services To shift from the eye camp approach to a fixed facility surgical approach To expand the world bank project activities To strengthen participation of voluntary organization To enhance the coverage of eye care services

63. OBJECTIVES To reduce the backlog of blindness To develop eye care facilities To develop human resources for providing eye care services

64. To improve quality of service delivery To secure participation of voluntary organizations To enhance community awareness on eyecare

65. ADMINISTRATION Central ophthalmology section, directorate general of health services , ministry of health & FW, New delhi State State ophthalmic cell, directorate of health services , state health societies District district blindness control society

66. SERVICE DELIVERY AND REFERRAL SYSTEM Tertiary level Secondary level Primary level

67. SCHOOL EYE SCREENING PROGRAMME First screened by trained teachers Children suspected to refractive error are seen by ophthalmic assistants and corrective spectacles are prescribed or given free for persons below poverty line

68. COLLECTION AND UTILIZATION OF DONATED EYES: MAJOR strategy :collection of donated eyes Eye donation

69. NEW INITIATIVES: Construction of dedicated eye wards Appointment of ophthalmic surgeons Appointments of ophthalmic assistant in PHC Appointment of eye donation counsellors Grant in aid for NGOs

70. Special attention to clear cataract backlog Telemedicine Involvement of private practioners Vitamin A supplementation Setting up of 5 centres for excellence for eye care services

71. EXTERNALLY AIDED PROJECT World bank assisted cataract blindness control project DANISH assistance WHO assistance VISION 2020 Target diseases Human resource development

72. NATIONAL AIDS CONTROL PROGRAMME

73. HIV infection first detected in India in 1986, when 10 HIV positive samples were found from a group of 102 female sex workers from Chennai. In 1986 Government set up an AIDS Task Force under ICMR and established a National AIDS Committee (NAC) chaired by Secretary, Department of Health and Family Welfare. In 1987, National AIDS Control Programme was initiated, with help from the World Bank. In 1989, a Medium Term Plan for AIDS Control was developed with the support of the WHO.

74. First National AIDS Control Programme (NACP - I) was launched in 1992. NACP - II launched in 1999: decentralization of programme implementation to State level and greater involvement of NGOs. NACP - III implemented during 2007-2012: scaling up HIV prevention interventions for HRG and general population, and integrate them with Care, Support & Treatment services. NACP - IV has been developed for the period 2012-2017

75. OBJECTIVE Slow and prevent the spread of HIV through a major effort to prevent HIV transmission. KEY STRATEGIES Focus on raising awareness, Blood safety, Prevention among high-risk populations, Improving surveillance ACHIEVEMENTS National AIDS response structures at both the national and state levels and provided critical financing. Strong partnership with the World Health Organization(WHO) and later helped mobilize additional donor resources. Established the State AIDS Control Cells Improved blood safety. Expanded sentinel surveillance and improved coverage and reliability of data. Improved condom promotion activities. National HIV testing policy.

76. NACP II OBJECTIVE Reduce the spread of HIV infection in India through behavior change and increase capacity to respond to HIV on a long-term basis. KEY STRATEGIES Targeted Interventions for high-risk groups Preventive interventions for general populations Involvement of NGOs Institutional strengthening

77. ACHIEVEMENT At the operational level 1,033 targeted interventions set up, 875 Voluntary counseling and testing centers (VCTC) and 679 STI clinics at the district level. Nation-wide and state level Behavior Sentinel Surveillance (BSS) surveys were conducted Prevention of parent-to-child transmission (PPTCT) programme was expanded. A computerized management information system (CMIS) created. HIV prevention and care and support organizations and networks were strengthened. Support from partner agencies increased substantially

78. NACP III OBJECTIVE Reduce the rate of incidence by 60 per cent in the first year of the programme in high prevalence states to obtain the reversal of the epidemic, and by 40 percent in the vulnerable states to stabilise the epidemic. STRATEGIES Prevention – Targeted intervention (TI), ICTC, blood safety, communication, advocacy and mobilisation , condom promotion. Care, support and treatment – ART, Pediatric ART, Center for excellence, Community Care Centers. Capacity building – establishment, support and capacity strengthening, training, managing programme implementation and contracts, mainstreaming/private sector partnerships. Strategic information management – monitoring and evaluation.

79. ACHIEVEMENTS There were 306 fully functional ART Centres against the target of 250 by March 2012 Nearly 12.5 lakh PLHIV were registered and 420000 patients were on ART. 612 Link ART centre (LAC) had been established wherein, 26023 PLHIV were taking Services There were 10 Centres of Excellence, 7 Regional Pediatric centres also functional. 259 Community Care Centres across the Country 6000 condoms & 6000 village information centres established 3000 Red ribbon clubs established Link Workers training module updated

80. NACP IV Launched on 12 February 2014 Total budget outlay Rs 14295 crores . Goal: Accelerate Reversal and Integrate Response

81. Objective 1: Reduce new infections by 50% (2007 Baseline of NACP III) Objective 2: Provide comprehensive care and support to all persons living with HIV/AIDS and treatment services for all those who require it.

82. STRATEGIES UNDER NACP-IV

83. CHILD SURVIVAL AND SAFE MOTHERHOOD PROGRAMME

84. Launched in 1991  Objectives  to reduce maternal mortality to less than 2, infant mortality to less than 50 per 1000 livebirths ; and child mortality (1 to 4 years of  age) to below 10 by 2000 A.D. This is to be achieved through improvement  and expansion of Maternal Child Health (MCH) services at village, sub-centre, PHC and CHC levels; improving the access to MCH services at village and sub-centre level, focusing on high IMR districts and improvement in support systems  such as training, supply, communication, monitoring and evaluation. 

85. Specific objectives  To reduce infant mortality rate from 80 to 75 by 1995; and to 50 by 2000 A.D.  To reduce child (1-4 years) mortality rate from 41.2 to 10.  To reduce maternal mortality rate from 5 to 2 per 1000 livebirth .  To achieve  polio eradication by 2000 A.D.  To eliminate neofiatal tetanus by 1995. 

86. To prevent 95 per cent measles death5 and 90 per cent cases of measles by 1995.  To ensure prevention of 70 per cent diarrhoea1 deaths and reduce diarrhoeas cases by 25 per cent.  To prevent 40 per cent deaths due to Acute Respiratory Infections. (Source : Child Survival and Safe Motherhood Programme Guidelines, Ministry of Health and Family Welfare, Government of India, 1992). 

87. Services provided to children and pregnant mothers include:  For Pregnant Women :  Anaemia prophylaxis and therapy (100 per cent coverage).  Antenatal check-ups, at least 3 check-ups (100 per cent coverage).  Referral of those with high risks and complications.  Care at birth and promotion of clean delivery.  Birth time and spacing

88. For Children : New born care at home.  Primary Immunization by 12 months (100 per cent coverage).  Vitamin A prophylaxis (9 months to 3 years) (100 per cent coverage).  Correct management of pneumonia at home/at health facilities.  ORT at home/health facility; ORS in every village for management of diarrhoea . 

89. BABY FRIENDLY HOSPITAL INITIATIVE

90. In India, BFHI was Launched in 1992 as a part of “ INNOCENT DECLARATION” on breast feeding

91. Improving the care of pregnant women, mothers and newborns at  health facilities that provide maternity services for protecting, promoting and supporting breastfeeding (  International Code of Marketing of Breast milk Substitutes )

92. 1) All the hospital should have a written breast feeding policy, that is routinely communicated to all the health care staff.

93. 2) PROVIDING TRAINING TO ALL HEALTH CARE PROFESSIONALS TO DEVELOP THE SKILL FOR IMPLEMENTING THE POLICY

94. 3) INFORM ALL PREGNANT WOMEN ABOUT THE BENEFITS AND MANAGEMENT OF BREAST FEEDING

95. 4) HELP MOTHER TO PROVIDE BREAST FEDDING WITHIN HALF AN HOUR OF BIRTH

96. 5) SHOW MOTHER HOW TO BREAST FED AND HOW TO MAINTAIN LACTATION EVEN IF THEY SHOULD BE SEPERATED FROM THEIR INFANTS.

97. 6) GIVE NEWBORN INFANT NO FOOD OR DRINK OTHER THAN BREAST MILK, UNLESS MEDICALLY INDICATED 7) PRACTICE ROOMING –IN.ALLOW MOTHERS AND INFANTS TO REMAIN TOGETHER 24 HOURS A DAY.

98. 8) ENCOURAGE BREAST FEEDING ON DEMAND

99. 9) GIVE NO ARTIFICIAL DUMMIES OR SOOTHERS TO BREAST FEEDING INFANTS.

100. 10) FOSTER THE ESTABLISHMENT OF BREAST FEEDING SUPPORT GROUPS AND REFER MOTHER TO THEM ON DISCHARGE FROM THE HOSPITAL OR CLINIC.

101. INTEGRATED CHILD DEVELOPMENT SERVICE

102. STARTED IN THE YEAR 1975 Ministry of social and women’s welfare For the welfare of the children and development of human resources Beneficiaries: Children up to 6 years Adolescent girls (11-18) years Pregnant women Nursing mothers Women of 15 to 45 years

103. Objectives To improve the nutritional status of preschool children 0-6 years of age group. To lay the foundation of proper psychological development of the child To reduce the incidence of mortality, morbidity, malnutrition and school drop out <#>

104. 4. To achieve effective coordination of policy and implementation in various departments to promote child development 5. To enhance the capability of the mother to look after the normal health and nutritional needs of the child through proper nutrition and health education. <#>

105. Services Provided Nutrition Supplementary nutrition Growth monitoring and promotion Micronutrient supplementation/ promotion Pre-school non-formal education Health Immunization Periodic health check-ups Referral services Nutrition and health education <#>

106. Target Groups Beneficiaries Services Provided Pregnant women Health check-ups, TT Vaccination, Supplementary nutrition, Health education. Nursing Mothers Health check-ups, Supplementary nutrition, Health education Children less than 3 years Supplementary nutrition, Health check-ups, Immunization, Referral services Children between 3-6 years Supplementary nutrition, Health check-ups, Immunization, referral services, Non formal education Adolescent girls 11-18 years Supplementary nutrition, Health education <#>

107. National PROGRAMME FOR PREVENTION AND CONTROL OF DEAFNESS

108. OBJECTIVES: To prevent avoidable hearing loss Early identification, diagnosis and treatment Medical rehabilitation To strengthen the existing inter- sectoral linkages To develop institutional capacity

109. Components: Manpower training and development Capacity building Service position Awarness generation

110. Strategies: To strengthen the service delivery for ear care Promote public awareness To develop institutional capacity

111. RAJIV GANDHI NATIONAL CRECHE SCHEME FOR THE CHILDREN OF WORKING MOTHERS

112. Creches are designed to provide group care to children , usually up to 6 years of age , who need care, guidance and supervision away from their home during the day

113. OBJECTIVES: To provide day care facilities To improve nutrition and health services To promote physical cognitive, social and emotional development of children To educate empower parents

114. SERVICES: Daycare facilities Early stimulation for children Supplementary nutrition Growth monitoring Health check up TARGET GROUP: Children of 6 months to 6 years Coverage: As on January 2015, there are 23293 functional creches

115. National Iodine Deficiency Disorders Control Programme

116. GOALS To Reduce the prevalence of Iodine Deficiency Disorders below 10% in the entire country by 2012 Achieve Universal Access to Iodized Salt Source: 11 th Five Year Plan, Govt. of India

117. OBJECTIVES Surveys to assess the magnitude of the Iodine Deficiency Disorders Supply of Iodated salt in place of common salt. Re-survey after every 5 years to assess the extent of Iodine Deficiency Disorders and the impact of iodated salt. Laboratory Monitoring of Iodated Salt and Urinary Iodine Excretion Health Education & Publicity

118. MID –DAY MEAL PROGRAMME

119. Launched in 1961 Objective : Attract more children for admission to school and retain them.

120. Principles Meal should be a suppliment Meal should supply at least one third of total energy requirement Cost should be reasonably low The meal should be such in that it can be prepared by easily in schools , no complicated cooling process should be involved Locally available foods Frequent change of menu

121. MODEL MENU: FOOD STUFF g/day/child Cereals and millets 75 pulses 30 Oils and fats 8 Leafy vegetables 30 Non –leafy vegetables 30

122. NATIONAL HEALTH MISSION

123. Vision of the NHM “Attainment of Universal Access to Equitable, Affordable and Quality health care services, accountable and responsive to people’s needs, with effective inter- sectoral convergent action to address the wider social determinants of health”.

124. About National Health Mission (NHM): The vision of the National Health Mission (which encompasses the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM) as its two Sub-Missions) is universal access to equitable, affordable and quality health care services. NHM in the 12th Plan are synonymous with those of the 12th Plan, and are part of the overall vision.

125. Goals: The endeavor would be to ensure achievement of those indicators 1. Reduce MMR to 1/1000 live births 2. Reduce IMR to 25/1000 live births 3. Reduce TFR to 2.1 4. Prevention and reduction of anaemia in women aged 15–49 years 5. Prevent and reduce mortality & morbidity from communicable, noncommunicable ; injuries and emerging diseases

126. 6. Reduce annual incidence and mortality from Tuberculosis by half 7. Reduce prevalence of Leprosy to <1/10000 population and incidence to zero in all districts 8. Annual Malaria Incidence to be <1/1000 9. Less than 1 per cent microfilaria prevalence in all districts 10. Kala- azar Elimination by 2015, <1 case per 10000 population in all blocks

127. Components of NHM NHM Finance NHM- Health Systems Strengthening Reproductive, Maternal, Newborn, Child Health and Adolescent - (RMNCH+A) Services National disease control programmes

128. NHM has six financing components : ( i ) NRHM-RCH Flexi pool, ( ii) NUHM Flexi pool, (iii) Flexible pool for Communicable disease, ( iv) Flexible pool for Non communicable disease including Injury and Trauma, ( v) Infrastructure Maintenance and ( vi) Family Welfare Central Sector component . The fund flow from the Central Government to the states/UTs would be as per the procedure prescribed by the Government of India . Financial management capabilities for managing the funds provided to the State Health Societies ./PIP Components of NHM 1 NHM Finance

129. 2 NHM- Health Systems Strengthening Adoption of the Indian Public Health Standards and Quality standards Skill gaps and Standard Treatment Protocols Quality Improvement Programmes

130. The progress made under health system strengthening Infrastructure: strengthen public health delivery system at all levels as per IPHS More than 27,400 new construction works have been sanctioned till December 2013, since the inception of the Mission The numbers of First referral Units (FRUs ) has increased significantly from 940 in 2005 to 2653 in 2013-14. There are now 8743 PHCs which are working round the clock, compared to 1263 in 2005.

131. Human Resources In 2013,the total number of technical HR supported under NRHM increased to 1.49 lakh , which includes 23079 doctors/ specialists including AYUSH doctors, 35172 Staff Nurses, 20011 para -medics including AYUSH paramedics and 70891 ANMs. 590 District Programme Managers, 601 District Accounts Managers, 4579 Accountants at Block level and 4541 Accountants at PHC level ,ASHA Mainstreaming of AYUSH

132. Free drugs ; NHM Free Drugs Service Initiative. Mobile Medical Units (MMUs); All Mobile Medical Units are being repositioned as “ National Mobile Medical Unit Service ” with universal colour and design. As of December, 2014 there were about 1301 operational MMUs in 368 districts across the country

133. Emergency response services and patient transport system 28 States have the facility where people can dial 108 or 102 telephone number for calling an ambulance ● 108 is emergency response system, primarily designed to attend to patients of critical care, trauma and accident victims etc . ● 102 services essentially consist of basic patient transport aimed to cater the needs of pregnant women and children though other categories are also taking benefit and are not excluded. 102 & 108 ambulances have been repositioned as “ National Ambulance Service” with universal colour and design.

134. 3 Reproductive, Maternal, Newborn, Child Health and Adolescent - (RMNCH+A) Services February 2013, India took the lead in articulating ‘A Strategic approach to Reproductive Maternal, Newborn, Child and Adolescent health (RMNCH+A)’. Maternal Health Access to safe abortion services Prevention and Management of Reproductive Tract Infections (RTI) and Sexually Transmitted Infections. Gender Based Violence Newborn and Child Health Universal Immunization Child Health Screening and Early Intervention Services Adolescent Health Family Planning Addressing the Declining Sex Ratio Cross cutting areas

135. Initiatives Reproductive health New Strategic focus on Spacing Methods and other family planning services Safe Abortion Services Maternal health Janani Shishu Suraksha Karyakram (JSSK) 2011 State of the art Maternal and Child Health Wings (MCH wings) for providing quality obstetric and neonatal care Janani Suraksha Yojana 2005 Institutional deliveries in India have risen sharply from 47% in 2008 to over 84 % now. Targets achieved 2014 The Total Fertility Rate has declined from 3.2 in 2000 to 2.4 in 2012 [2.1] Rate of decline of TFR has accelerated by 52.3% during 2006-2011 as compared to 2000-2005. decline in growth rate, since independence, from 21.54% in 1990-2000 to 17.64% in 2001-2011. In 2011, MMR in the country has declined to 178 against a global MMR of 210.[1/1000]

136. Mother and Child Tracking System (MCTS) & Mother and Child Tracking Facilitation Centre (MCTFC) The facilitation centre has 80 helpdesk agents . The facilitation centre will act as a supporting framework to MCTS and help in validating the data entered in MCTS by making phone calls to pregnant women and parents of children and health workers. Get their feedback on various mother and child care services, programmes and initiatives like JSSK, JSY, RBSK, NATIONAL IRON PLUS INITIATIVE (NIPI), contraceptive distribution by ashas etc Check with ASHA and ANMS regarding availability of essential drugs and supplies like ors packets and contraceptives.

137. Newborn /Child health- initiatives Targets achieved 2012 -14 Initiatives have been started to provide both home based care and facility based care.[2011] Treatment and referral of sick newborns at health facilities New born Care Units (SCNU) in district hospitals Newborn Stabilisation Unit (NBSU), which is 4 bedded unit providing basic level of sick newborn care , established at Community Health Centres / First Referral Units. 2012 /India’s child mortality of 52 per 1000 Live births is close to the global average of 48 Number of child deaths has been reduced from approximately 30 lakhs in 1990 to nearly 14 lakhs in 2012. [ 21/1000 live birth]

138. Newborn Care Corners (NBCC) are established at delivery points and providers trained in basic newborn care and resuscitation through Navjaat Shishu Suraksha Karyakram (NSSK). The Home Based Newborn Care Scheme launched in 2011 National Iron Plus Initiative launched in 2013 to bring about renewed emphasis on tackling high prevalence of anaemia , comprehensively, across all age groups.

139. Universal Immunization Under the Universal Immunization Programme (UIP) , vaccination is provided free of cost against seven vaccine preventable diseases i.e. Diphtheria, Pertussis , Tetanus, Polio, Measles, severe form of Childhood Tuberculosis and Hepatiti s B.

140. Vitamin A supplementation, children between nine months to five years are given six monthly doses of Vitamin A. Nutritional Rehabilitation Centres have been established for providing medical and nutritional care. Tribal areas and high focus districts are prioritised for setting up these units.

141. Integrated Management of Neonatal and Childhood Illnesses (or IMNCI).2009 The strategy also addresses aspects of nutrition, immunization, and other important elements of disease prevention and health promotion. The strategy includes three main components: ( i ) Improvements in the case-management skills of health staff (ii) Improvements in the overall health system required for effective management of neonatal and childhood illnesses; (Iii) Improvements in family and community health care practices.

142. Rashtriya Bal Swasthya Karyakram : RBSK/2013 A recent initiative : ● Expanding focus from child survival to a more comprehensive approach of child survival and development and improving the overall quality of life ● RBSK includes provision for Child Health Screening and Early Intervention Services through early detection and management of 4 Ds i.e Defects at birth, Diseases, Deficiencies, Development delays including disability.

143. 4 NDCPS National disease control programmes National Vector Borne Diseases Control Programme (NVBDCP) Revised National Tuberculosis Control Programme (RNTCP) Integrated Disease Surveillance Programme (IDSP) National Programme for Prevention and Control of Cancer, Diabetes,Cardiovascular Diseases and Stroke (NPCDCS) National Programme for the Control of Blindness (NPCB) National Mental Health Programme (NMHP) National Programme for the Healthcare of the Elderly (NPHCE) National programme for the Prevention and Control of Deafness (NPPCD) National Tobacco Control Programme (NTCP) National Oral Health Programme (NOHP): National Programme for Palliative Care (NPPC): National Programme for the Prevention and Management of Burn Injuries (NPPMBI): National Programme for Prevention and Control of Fluorosis (NPPCF)

144. Components of NHM NRHM NUHM

145. National Rural Health Mission (NRHM ) NRHM seeks to provide equitable, affordable and quality health care to the rural population, especially the vulnerable groups. Thrust of the mission is on establishing a fully functional, community owned, decentralized health delivery system with inter- sectoral convergence at all levels, to ensure simultaneous action on a wide range of determinants of health such as water, sanitation, education, nutrition, social and gender equality . Initiated in 2005

146. National Urban Health Mission (NUHM) approved by the cabinet on 1st May 2013: To improve the health status of the urban population particularly slum dwellers and other vulnerable sections facilitating their access to quality primary health care. NUHM would cover all state capitals, district headquarters and other cities/towns with a population of 50,000 and above (as per census 2011) in a phased manner. Under NUHM, a provision of Rs 1000 Crores has been made in 20 13-14.

147. New initiatives: 1 Union ministry of health & family welfare has put in place program guidelines for implementing the national dialysis program in district hospitals on PPP mode. The swachh bharat abhiyan launched by the prime minister on 2nd october 2014, focuses on promoting cleanliness in public spaces. Award to public health facilities/ kayakalpa awards implementing national . Implementing national free essential diagnostics service initiative so as to ensure the availability of basic diagnostics tests for service users in public health facilities The free essential drugs initiative also expected to ensure a responsive supply of quality drugs to facilities and promote rational drug use.

148. NGOs

149. Introduction to NGO A Non Governmental Organization (NGO) is any non-profit, voluntary citizens' group which is legally constituted, organized and operated on a local, national or international level.   They are Task-oriented and driven by people with a common interest

150. Advantages of NGOs Ability to experiment freely Flexible in adapting to local needs Enjoy Good rapport with people Ability to communicate at all levels Ability to recruit experts and highly motivated staff Less restrictions from the Government

151. Disadvantages of NGOs Lack of funds Lack of dedicated leadership Inadequate trained personnel Misuse of Funds Monopolization of leadership Lack of public participation Centralization in Urban Areas Lack of Coordination

152. ROLE OF NGOs Advocacy for maternal child health interventions Promotion of small healthy family Improving community participation Counseling Act as a link between the community and health care providers Gender sensitivity and advocacy regarding providing adequate care for the girl child BFHI

153. Advocacy for the introduction of semi solid at the right time Social marketing of contraceptives Sensitizing the community regarding the adverse consequence of sex determination and sex selective abortions

154. REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME

155. RNTCP GOI –WHO revised strategy for control of TB in India RNTCP application of WHO – DOTS launched in 1993 as pilot project covering 2.35 – 20 million population (1993-1997)

156. OBJECTIVES The objectives of the programme are to: To achieve and maintain cure rate of at least 85% among New Sputum Positive (NSP) patients . To achieve and maintain case detection of at least 70% of the estimated NSP cases in the community .

157. RNTCP Organization structure : State level

158. Directly Observed Treatment

159. ANTI-TUBERCULAR DRUGS Medication Drug action Dose(Thrice a week)*** Dose in children(mg/kg) Isoniazid Bactericidal 600 mg 10-15 Rifampicin Bactericidal 450 mg* 10 Pyrazinamide Bactericidal 1500 mg 30-35 Ethambutol Bacteriostatic 1200 mg 20-25 Streptomycin Bactericidal 0.75 g** 15 * Patients who weigh 60 kg or more at the start of treatment are given an extra 150mg dose of Rifampicin ** Patients over 50 years of age are given 0.5g of streptomycin *** Adult patients weighing <30kg receive drugs in patients-wise from the weight band suggested for pediatric patients