CHAPTER- 1 SEMESTER - V NATIONAL HEALTH PROGRAMME RELATED TO CHILD.pdf

NATIONAL HEALTH PROGRAMME RELATED TO CHILD Semester V

1. CHILD HEALTH NURSING - I
NATIONAL HEALTH PROGRAMME
RELATED TO CHILD
Mr. Sachin Sharma
Assistant Professor
Child Health Nursing Department
UNIT-1

2. INTRODUCTION:

The ministry of health, Government of India,
central health council launch programs aimed
at controlling or eradicating diseases which
cause considerable morbidity and mortality in
India.

3. HEALTH PROGRAMME
1.NATIONAL RURAL HEALTH MISSION
2.NATIONAL PROGRAMS RELATED TO MOTHER AND
CHILD CARE
1.Maternal and child health program (MCH)
2.Integrated child development service scheme (ICDS)
3.Child survival and safe motherhood program(CSSM)
4.Reproductive and child health program(RCH)
5.Integrated management of neonatal and childhood illness

4. NATIONAL PROGRAMS RELATED TO
COMMUNICABLE DISEASES
•National program of immunization
•Acute respiratory infection control program
•Diarrheal disease control program
•Revised national tuberculosis control program
•Leprosy eradication program
•National vector borne disease control programs
•National malaria eradication program
•National Filarial control program
•KALA AZAR control program
•National AIDS control program

5. NATIONAL PROGRAMS RELATED TO
CONTROL OF NUTRITIONAL
DEFICIENCY DISORDERS
1.Special Nutritional program 1970
2.Mid-day meal program. 1957
3.Anemia prophylaxis program. 1970
4.National iodine deficiency disorders control
program. 1962

6. NATIONAL PROGRAMS RELATED TO CONTROL OF
NON COMMUNICABLE DISEASE
•National School health program
•National mental health program
•National program for control of blindness
•Vitamin A deficiency control program
•National cancer control program
•National diabetes control program
•Child welfare program for disabled children
•National water supply and sanitation program
•National family welfare program
•Minimum needs program

7. NATIONAL RURAL HEALTH MISSION
12April, 2005

8. GOALS
•Reduction in IMR and MMR
•Universal access to public health services
•Prevention and control of communicable and
non communicable diseases.
•Access to integrated comprehensive primary
health care.

9. •Population stabilization, gender and
demographic balance.
•Revitalize local health traditions and
mainstream AYUSH
•Promotion of healthy life styles

10. STRATEGIES
•enhance capacity of panchayti raj institutions to
own, control and manage public health
services.
•Promote access to improve health care at house
hold level through the ASHA
•Health plan for each village through village
health committee of the panchayat
•Strengthening sub-centre through an untied
fund to enable local planning and action and
more multi-purpose workers.

11. •Prepared by the district health Mission, including
drinking water, sanitation and hygiene and nutrition.
•Technical support to National, State Block and district
levels traditions.
•Reorienting medical education to support rural
health issues including regulation of medical care
and medical ethics.
•Mainstreaming AYUSH revitalization local health.

12. National programs related to
mother and child care

13. OBJECTIVES OF MCH:-
•To reduce maternal, infant and
childhood mortality and morbidity.
•To promote reproductive health
•To promote physical and psychological
development of children and
adolescent within the family.

MATERNAL AND CHILD HEALTH
PROGRAME

14. SERVICES
Servics delivered by multipurpose health workers
•Record of occurrence of pregnancy
•identify women with anemia
•Administered 2 doses Tetanus Toxoid.
•Provide iron and folic acid tablet to pregnant
women

15. Screen women identified as pregnant for any of
the risk factor
Risk factor
Age less than
17 years or
over 35 years
height <145cm
Weight <40 kg
or >70kg.
history of
bleeding in
previous
pregnancy
history still
births
history of
cesarean
section

16. CARE OF CHILDREN
•Monitoring of growth of children to detect
malnutrition.
•Immunization
•Treatment of common ailments
•Referral cases to higher centers
•Implementation national health policies.

17. INTEGRATED CHILD DEVELOPMENT
SERVICE SCHEME (ICDS) (1975)
TARGET: holistic development of children
OBJECTIVE-
•To improve the nutritional and health status of children
in the age group 0-6 years.
•To reduce mortality, morbidity, malnutrition and school
dropout.
•To lay the foundation for proper psychological, physical
and social development of the child.

18. •To achieve effective co-ordination of policy and
implementation amongst the various
departments to promote child development
•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.

19. BENEFICIARY SERVICES
Children of below 3 years age group Health checkup
Immunization
Referral services
Supplementary nutrition
Children of 3-6 year age group Non formal preschool education
Health checkup
Immunization
Referral services
Supplementary nutrition
Expectant and nursing women Health check up
Immunization against tetanus of
expectant
Nutrition and health education
Supplementary nutrition
Other women of 15 to 45 years Nutritional and health education

20. CHILD SURVIVAL AND SAFE
MOTHERHOOD PROGRAM (1992)
AIMS
•To reduce infant mortality.
•Provide antenatal care to all
pregnant women.
•Ensure safe delivery services.
•Provides basic care to all
neonates.
•Identify and refer these
neonates, who are at risk.

21. REPRODUCTIVE & CHILD HEALTH(RCH)
1997 RCH
CSSM
Family
welfare

22. OBJECTIVES
•The program integrates all interventions of
fertility regulation, maternal and child health
with reproductive health for both men and
women.
•The service to be provided are client oriented,
demand driven, high quality and based on
needs of community through decentralized
participatory planning and target free
approach.

23. •The program up gradation of the level of facilities
for providing various interventions and quality of
care. The first referral Units (FRUs) being set-up at
sub district level provide comprehensive
emergency obstetric and new born care.
•Facilities of obstetric care, MTP and IUD insertion in
the PHCs level are improved.
•Specialist facilities for STD and RTI are available in
all district hospitals and in a fair number of sub-
district level hospitals.

24. COMPONENTS

25. SERVICES PROVIDED
For the children
•Essential newborn care
•Exclusive breastfeeding
•Immunization
•Appropriate management of ARI
•Vitamin A prophylaxis
•Treatment of anemia

26. For the mother
•Tetanus Toxoid immunization
•Prevention and treatment of anemia
•Antenatal care and early identification of maternal
complications.
•Delivery by trained personnel
•Promotion of institutional deliveries
•Management of obstetrical emergencies
•Birth spacing

27. For the Eligible couple
•Prevention of pregnancy
•Safe abortion
For RTI/STD
•Prevention and treatment of reproductive tract
infection and sexually transmitted diseases. RCH
program is a target-free program with voluntary
participation.

28. RCH PHASE – II 1
st
April, 2005
STRATEGIES
•Essential obstetric care
•Institutional delivery
•Skilled attendance at delivery
•Emergency obstetric care
•Operational delivery
•Operational PHCs and CHCs for round the clock
delivery services.
•Strengthening referral system

29. "The Integrated Management of
Childhood Illness (IMCI)"

1992

UNICEF and WHO

30. Components:
•Improvement of the case
management skills of health providers
•Improvement in the overall health
system.
•Improvement in family and
community health care practices.
•Collaboration/coordination with other
Departments

31. IMNCI Beneficiaries
•Care of Newborns and Young
Infants (infants under 2 months)


•Care of Infants (2 months to 5
years)

32. PRINCIPLES OF IMNCI GUIDELINES
•All sick young infants up to 2 months of age must
be assessed of “possible bacterial infection/
jaundice” and “diarrhea”.

•All sick children aged 2 months up to 5 years
must be examined for general danger signs and
then for cough or difficult breathing, diarrhea,
fever or ear problem.
Cont……

33. •All sick young infants and children 2 months up to 5
years must also routinely be assessed for nutritional
and immunization status and feeding problem.

•Management procedures use a limited number of
essential drugs and encourages active participation
of caretakers.
Cont…….

34. •Based on signs, the child is assigned to color coded
classification: “

- urgent hospital referral or admission


- specific medical Rx or advice


- home management

35. NATIONAL PROGRAMS
RELATED TO CONTROL OF
COMMUNICABLE DISEASE

36. •National program of immunization. 1985
•Acute respiratory infection control program
•Diarrheal disease control program (1971)
•Revised national tuberculosis control program
1962
•Leprosy eradication program 1955
•National vector borne disease control programs

37. NATIONAL PROGRAM ON
IMMUNIZATION 1974
•1974-WHO launched “Expended Programme Of
Immunization” (EPI)
• 1978-Govt. of India launched the same EPI
programme in India
•1985 –EPI renamed as Universal immunization
programme

38. OBJECTIVES
•To increase immunization coverage.
•To improve the quality of service.
•To achieve self sufficiency in vaccine production.
•To train health personnel.
•To supply cold chain equipment and establish a
good surviveillance network.
•To ensure district wise monitoring

39. Revised IMMUNIZATION SCHEDULE
Age Vaccines
Pregnant Women TT (2 doses/Booster)
Birth BCG, OPV-O, Hep B1
6 - 8 weeks DPT -1, OPV -1, Hep B2, Hib1
10-12 weeks DPT -2, OPV -2, Hib2
14-16 weeks DPT -3, OPV-3, Hep B, Hib3
7-9 months Measles
15-18 months DPT booster, OPV – Booster, Hib,MMR
2 years Typhoid
4-5 years DTP,OPV
5-10 years TT,MMR2,Hep B
15 year TT

40. ACUTE RESPIRATORY INFECTIONS
CONTROL PROGRAM
1990- Programme launched
1992- the Programme was implemented as part of CSSM

The WHO protocol puts two signs as the “entry criteria” for
a possible diagnosis of pneumonia.
cough
difficult breathing.
Patient treated with antibiotics
ampicillin 25-50 mg/kg/day
gentamicin 5.0mg/kg/day.

for a period of 7 to 10 days

41. REVISED NATIONAL TUBERCULOSIS
CONTROL PROGRAMME (RNTCP)
1962
Goal
•The goal of TB Control Program is to decrease
mortality and morbidity due to TB and cut
transmission of infection until TB ceases to be a
major public health problem in India.

42. Objectives:
•To achieve at least 85 % cure rate of the newly
diagnosed sputum smear-positive TB patients

•To detect at least 70% of new sputum smear-positive
patients after the first goal is met.

43. STRATEGY

44. COMPONENT OF DOT,s
•Political and administrative commitment
•Good quality diagnosis.
•Good quality drugs.
•The right treatment, given in the right way.
Systematic monitoring and accountability.

45. Drug dose
Drug Dose adults children
• Isoniazid
• Rifampicin
• Pyrazinamide
• Ethambutol
• Streptomycin
600 Mg/kg
450*Mg/kg
1500Mg/kg
1200 Mg/kg
750 Mg/kg
10 –15 Mg/kg
10 Mg/kg
35 Mg/kg
30 Mg/kg
15 Mg/kg

46. CATEGORIES OF TB CASES AND THEIR
TREATMENT REGIMENS
Category Characteristic of a TB
case
Treatment regimen
Intensive phase Continuation phase
Category I New sputum smear-
positive Seriously ill,
sputum smear-negative
• Seriously ill, extra-
pulmonary
2 ( HRZE )
3

24 does
4 ( HR )
3
54 does
Category II Relapse Failure
Treatment after default
Others
2(SHRZE)
3
+1( HRZE )
3
36 does
5 ( HRE )
3
66 does
Category HI Sputum smear-negative
Not seriously ill, extra-
pulmonary
2 ( HRZ )
3
24 does
4 ( HR )
3
54 does

47. CONTROL OF DIARRHEAL DISEASE
(CDD) PROGRAM (1971)
STRATEGY :
•To train medical and other health personnel in
standard case management of diarrhea.
•Promote standard case management practices
amongst private practitioners.
•Instruct mother in home management of diarrhea
and recognition sign which signal immediate care.
•Make available the ORS (oral rehydration salts)
packets free of cost

48. TREATMENT
•The rational treatment of diarrhea consists in
prevention of dehydration in a by oral rehydration
therapy(ORS)
•Breastfeeding should be continued.
•In dysentery given cotrimoxazole in addition to
ORS. If unsatisfactory response, nalidixic acid is
given for five days.
•Any program for diarrheal disease control must
include provision of portable water.

49. •Parent must be educated regarding
storage of water and food in clear utensils,
continue of breastfeeding,
using of only freshly prepared weaning foods
washing of hands with soap before handling food.

50. NATIONAL LEPROSY CONTROL
PROGRAM 1955
•1955 -national leprosy control program 1955
•1983 –national leprosy eradication program

SERVICES
•Provide domiciliary treatment (MDT)
•Provide services through mobile leprosy treatment
units with the help of PHCstaff.
•Organize health education
•deformity and ulcer care and medical rehabilitation
services.

51. NATIONAL AIDS CONTROL
PROGRAM (1987)
1987-NACP
1991 –NACP PHASE 1
1992 -National AIDS control organization
1999 –NACP PHASE 2
2011 –NACP PHASE 3

52. Objective
•Prevent infections
•care, support and treatment .
•Strengthen- infrastructure, systems and human
resources
•Strengthen the Strategic Information Management
System

53. STRATEGY
Surveillance of HIV infection as indicated
by serum positivity.
Surveillance of aids cases showing clinical
signs & symptoms.
Disease control strategies are targeted at
three main modes of spread
Sexual activity .
Self injection by drug addicts
HIV infected blood transfusion

54. Training programs for paramedical & general
practitioners to enhance their capability of
effective STD diagnosis.
Counseling for HIV & AIDS patients
Cheap availability of good quality condoms.
Licensing of blood banks, encouraging voluntary
blood donation & screening of blood for HIV,
malaria, hepatitis B & C to be mandatory for all.

55. NATIONAL VECTOR BORNE
DISEASE CONTROL PROGRAM

56. •2003- (NVBDCP) is an umbrella programme for
prevention and control of Vector borne diseases.
•1. Malaria
•2. Dengue
•3. Chikungunya
•4. Japanese Encephalitis
•5. Kala-Azar
•6. Filaria (Lymphatic Filariasis)

57. National malaria eradication program
(1953)
•1953 National Malaria Control Programme
•1958 National Malaria Eradication Programme
•1977 Modified Plan of Operation (MPO).
•1995 Implementation of Malaria Action Plan
•1997 Enhanced Malaria Control Project in tribal
districts of the State (World Bank Assisted)
•2000 National Anti Malaria Programme

58. OBJECTIVES
•To prevent death due to malaria
•Agricultural and industrial production to be
maintained by undertaking intensive anti-
malarial measures in such areas.Early case
detection and promote treatment.
•Vector control by house to house spray in rural
areas with appropriate insecticide and by
recurrent anti larval measures in urban areas.
•Health education and community participation.
•Reduction in the period of sickness

59. National Filaria control program
(1995)
ACTIVITES
•Delimitations of the problem in
unsurved areas.
•Control in urban area through:
(a) recurrent anti larval measures
(b) anti parasitic measures
•Control in rural areas through
detection and treatment of microfilaria
carriers/persons.

60. •Anti-larval measures which include weekly
spray of approval larvacides and biological
control through larvivorous fishes.
•Source reduction through environmental and
water management
•Anti parasitic measure-diagnosis and treatment.
•community awareness through education
•Annual single dose (preventive)mass drug
administration of DEC (Diethylcarbamazine
citrate tablets)

61. KALA AZAR control program (1991)
STRATEGY
•Interruption of transmission for reducing vector
population by undertaking indoor residual
insecticidal spray twice annually.
•Early diagnosis and complete treatment of kala-Azar
cases.
•Information education and communication for
community awareness and community involvement.

62. Prevention and control of DENGUE
Hemorrhagic fever
STRATEGY
•Surveillance for disease and vectors.
•Early diagnosis and prompt case management
•Vector control through community participation
and social mobilization.
•Capacity building.

63. NATIONAL PROGRAMS RELATED TO
CONTROL OF NUTRITIONAL DEFICIENCY
DISORDERS

64. •Special nutritional program 1970
•Mid-day meal program. 1957
•Anemia prophylaxis program. 1970
•National iodine deficiency disorders control program

65. SPECIAL NUTRITION PROGRAM 1970

66. OBJECTIVE
•To improve the nutritional status of preschool
children, pregnant,and lactating mother of poor
socio economic groups in urban slums,tribal
area and drought prone rural area

Child up to one
year
200kcl and 8-10g
protein/day
child 1-6 years. 300 kcal 10-12g
proteins/day
women 500 kcal 25g
protein/day

67. MIDDAY MEAL PROGRAM
(1961)

68. OBJECTIVES

•To raise the nutritional status of primary school
children
•To improve attendance and enrolment in school.
•To prevent dropouts from primary school. Children
belonging to backward classes, schedule caste,
and scheduled tribe families are given priority.

69. PRINCIPLES:-
•Should be a substitute.
•1/3 Total energy and ½ total protein
•Provided at the low cost
•It is easily prepared
•Locally available food
•Change menu frequently.

70. BENEFICIARY
School children in the age group 6-11
year

SERVICES
provides 300 calories and 8-12 g
protein/day for 200 days in year

71. ANEMIA CONTROL PROGRAM (1970)
BENEFICIARY
•Pregnant women,
•Nursing mothers,
•Women acceptors to terminal methods and IUD.
•children 5 years
Daily dose of iron and folic acid tablets
•women:80mg ferrous sulfate+0.5 mg folic acid.
•Children:180mg ferrous sulfate+0.1 mg folic
acid.(2ml liquid )

72. NATIONAL IODINE DEFICIENCY
DISORDERS CONTROL PROGRAM
(1962)
1962: NGCP launched (National Goiter Control
Programme)
1984 : The central council of health approved the Policy
of Universal salt Iodization (USI): Private sector to
produce iodized salt
1992: NGCP renamed as NIDDCP
1997: sale and storage of common salt banned

73. OBJECTIVES:-
•Surveys to assess the magnitude of the IDD.
•Supply of iodated salt in place of common salt
•Resurvey after every 5 years to assess the extent of
iodine deficiency disorders and the Impact of iodated
salt.
•Laboratory monitoring of iodated slat and urinary
iodine excretion.
•Health education & publicity.

75. 1.National school health program. 1977
2.National mental health program 1982
3.National program for control of blindness 1963
4.National cancer control program 1975-1976
5.National diabetes control program
6.Child welfare program for disabled children
7.National water supply and sanitation program 1954
8.National family welfare program 1952
9.Minimum needs program 1974-1978 (5
th
five year
plan)

76. SCHOOL HEALTH
PROGRAMME
1977

77. AIMS AND OBJECTIVES
•Promotion of positive health
•Prevention of disease
•Timely diagnosis, treatment and follow up
•Health education to Inculcate awareness about
good and bad health.
•Availability of healthful environment

78. component
•Health appraisal
•Remedial measures and follow up
•Prevention of communicable disease
•Healthful environment
•Nutritional services
•First aid facilities
•Mental health
•Dental health
•Eye health
•Ear health
•Health education
•Education of handicapped children
•School health record

79. NATIONAL MENTAL HEALTH
PROGRAM (1982)
components
•1. Treatment of Mentally ill

•2. Rehabilitation

•3. Prevention and promotion of
positive mental health.

80. OBJECTIVES

•Provision of mental health services at district level.

•Improvements of facilities in mental hospitals.

•Training of trainers of PHC personnel in mental hospital

•Program for substance use disorder.

81. NATIONAL PROGRAM FOR CONTROL OF
BLINDNESS (1976)

82. •1963: Started as National Trachoma Control Program

•1976: Renamed as National Program for prevention
of Visual Impairment and Control of Blindness

•1982: Blindness included in 20-point program

83. OBJECTIVES

•Dissemination of information about eye care.

•Augmentation of ophthalmic services so that
eye care is promptly availed off.

•Establishment of a permanent infrastructure of
community oriented eye health care.

84. BENIFICERY :- 6month -5 year children

STREATGY
Administration of vit A dose at a regular 6 month interval

VIT A ADMINISTRATION SCHEDUALE
6-11 month:-100000 IU
1-5 year:-200000 IU /6 months
Child must receive total 9 does

VITAMIN A DEFICIENCY CONTROL
PROGRAM (1970)

85. PREVENT VIT-A DEFICIENCY THROUGH

•Promotion of breastfeeding and feeding of
colostrums.
•Encourage the intake of green leafy vegetable and
yellow colored fruit.
•Increase the coverage of with measles (depletes
vitamin A stores)

86. NATIONAL CANCER CONTROL
PROGRAM
•1975-76: National Cancer Control Program
launched
•1984-86: Strategy revised and stress laid on
primary prevention and early detection of
cancer cases.
•1991-92: District Cancer Control Program
started
•2000-01: Modified District Cancer Control
Program initiated
•2004 : Evaluation of NCCP by NIHFW
•2005 : Program revised after evaluation

87. GOAL AND OBJECTIVE

•Primary prevention of cancers by health education.

•Secondary prevention i.e. early detection and
diagnosis of common cancer of cervix, mouth, breast
and tobacco related cancer by screening method.

•Tertiary prevention strengthening of the existing
institutions of comprehensive therapy including
palliative therapy.

88. •Prevention of tobacco related cancer.

•Prevention of cancer of uterine cervix.

•Strengthening of diagnostic and treatment
equipment for cancer at medical colleges and major
hospitals.

89. THE SCHEMES UNDER THE REVISED
PROGRAM ARE
•Regional cancer centre scheme
•Oncology wing development scheme
•District cancer control program
•Decentralized NGO scheme
•Research and training

90. NATIONAL DIABETES CONTROL
PROGRAM(7 FYP)
OBJECTIVES
•Identification of high risk subjects at an early stage
and imparting appropriate health education.
•Early diagnosis and management of cases
•Prevention, arrest or slowing of acute and chronic
metabolic as well as chronic cardiovascular, renal and
ocular complication of the disease.
•Rehabilitation of the partially or totally handicapped
diabetic people.

91. Child welfare program for
disabled children
DISABILITY IN FIVE YEAR PLANS

1FYP -Launched a small unit by the ministry of
education for the visually impaired in 1947.

2 FYP- under ministry of education a National Advisory
Council for the physically challenged started.

3FYP-attention was given to rural areas and facilitated
training and rehabilitation of the physically
challenged.
Cont……

92. •4FYP-more emphasis was given to preventive work.

•6FYP-national policies were made around for
provision of community oriented disability
prevention and rehabilitation services to
promote self reliance.

93. National water supply and
sanitation program 1954
OBJECTIVE
providing safe water supply and adequate
drainage facilities for the entire urban and
rural population of the country.
Cont……

94. SWAJALDHARA (2002)
Swajaldhara is a community led participatory program,
which
AIMS
•providing safe drinking water in rural areas, with full
ownership of the community,
•building awareness among the village community on
the management of drinking water projects,
• promote better hygiene practices
• encouraging water conservation practices along
with rainwater harvesting.

95. MINIMUM NEEDS PROGRAM (1974-78-5 FYP)
OBJECTIVES
•To improve the living standards of the people.
•It is the expression of the commitment of the
government for the “social and economic
development of the community particularly the
underprivileged and underserved population.”

Cont……

96. COMPONENTS:
•Rural health
•Rural water supply
•Rural electrification
•Elementary education
•Adult education
•Nutrition
•Environment improvement of urban slums
•Houses for landless laborers.

97. NATIONAL FAMILY WELFARE
PROGRAM (1952)
•1951, 100% Centrally Sponsored, concurrent list
•First country in the world
•1961 Family Welfare Dept.- created in 3rd FYP
•4th FYP - integration of Family Planning services
with MCH services
•MTP Act introduced 1972
•5th FYP(1975-80) The ministry of Family Planning
was renamed “Family Welfare”

98. ...VERY
MUCH
Thank
you...