Health system and National Health Programs in India.pptx

Health system and national health programme

1. Health system and National Health Programs in India Introduction to health systems and all ongoing National Health programs in India, their objectives functioning, outcome, and the role of pharmacists

2. Introduction : A health system, also known as a health care system, is an organization of people, institutions, and resources that provide health care services to specific populations. Different countries around the world have different types of health systems with different types of organizational structure. Every nation has its own health system based upon their needs and available resources. In a broader sense these health systems concentrate primarily on primary health care and public health measures.

3. Health System - Definition as per WHOA health system is made up of all organizations, individuals, and activities whose primary goal is to promote, restore, or preserve health. This encompasses, both, initiatives to alter health determinants and more direct health-improving actions. A health system is, therefore, more than the pyramid of publicly owned facilities that deliver personal health services. It includes, for example, a mother caring for a sick child at home; private providers; behavior change programmes ; vector-control campaigns; health insurance organizations; occupational health and safety legislation. It includes inter-sectoral action by health staff, for example, encouraging the ministry of education to promote female education, a well-known determinant of better health.

4. National Health Programs in India The current health policy and systems in India have evolved based on the report on the Health Survey and Development Committee, commonly referred to as the Bhore Committee Report, 1946. At present the Union Ministry of Health and Family Welfare is responsible for implementation of various programs on national scale (e.g. National AIDS Control Program, Revised National Tuberculosis Program) in the areas of health and family welfare, prevention and control of major communicable diseases, and promotion of traditional and indigenous systems of medicines and setting standards and guidelines, which state governments can adapt. India has a mixed health-care system which includes public and private health care service providers. Out of these, a private health care provider is mostly located in urban areas and provides secondary and tertiary care health care services. The public health care system in rural India has been developed as a three-tier system based on the population norms.

5. Aim of National Health Programmes Universal access to public health services such as women's health, child health, drinking water, sanitation and hygiene, nutrition and universal immunization. Reduction of infant mortality and maternal mortality. Prevention and control of communicable and non-communicable diseases. Population stabilization, gender and demographic balance. Access to integrated comprehensive primary health care. Promotion of healthy lifestyles.

6. Key Policy Principles of NHP Professionalism, Integrity and Ethics Equity Affordability Universality Patient Centred and Quality of Care Accountability Inclusive Partnerships Pluralism Decentralization Dynamism and Adaptiveness

7. Non Communicable Disease Control Programmes . National Programme for prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and stroke (NPCDCS) National Programme For Control Of Blindness and Visual Impairment (NPCBVI) National Mental Health Programme (NMHP) National Programme for Healthcare of Elderly (NPHCE) Health System and National Health Programs in India 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 Prevention and Management of Burn Injuries (NPPMBI)

8. 2. Other Non Communicable disease Control Programmes National Organ Tissue and Transplant Organization (NOTTO) National Programme for Prevention and Control of Fluorosis (NPPCF) National Iodine Deficiency Disorders Control Programme 3. Communicable Disease Control Programme National Vector Borne Disease Control Programme (NVBDCP) list of Vector Borne Diseases Control Programme Legislations: National Anti-Malaria programme Kala-Azar Control Programme National Filaria Control Programme Japanese Encephalitis Control Programme Dengue and Dengue Haemorrhagic fever

9. Revised National Tuberculosis Control Programme (RNTCP) National Leprosy Eradication Programme (NLEP) Integrated Disease Surveillance Programme (IDSP) 4. National Health Programme under NCDC National Programme on Climate Change and Human Health (NPCCHH) Integrated Disease Surveillance Programme (IDSP) Guinea Worm Eradication Programme (GWEP) Antimicrobial Resistance (AMR) Containment Yaws Eradication Programme (YEP) National Viral Hepatitis Surveillance Programmes National Rabies Control Programme New Programme for Prevention and Control of Leptospirosis Inter-Sectoral coordination for Prevention and Control of Zoonotic Diseases

10. 1. National AIDS Control Programme Health System and National Health Programs in India HIV infection is a big problem in India, with no state immune to the virus. HIV/AIDS continues to be one of India's most complicated diseases, posing a problem that extends beyond public health, raising basic questions of human rights and jeopardizing development gains in a variety of areas. The need to halt the spread of the pandemic and offer care and assistance to individuals who have been infected or impacted necessitates an extraordinary reaction from all segments of society. India's AIDS Control Program is widely regarded as a success story across the world. The National.

11. AIDS Control Programme (NACP), which began in 1992, is being implemented in India as a comprehensive HIV/AIDS preventive and control programme . Over time, the emphasis has evolved from raising awareness to behavior modification, from a national response to a more decentralized response, and from increased engagement of NGOs and networks of people living with HIV.

12. NACP I Launched by Government of India in the year 1992. Under this program, an autonomous National AIDS Control Organization (NACO) was set up to implement the project. Objectives of NACP I Slow down the spread of HIV infections in order to reduce morbidity, mortality and impact of AIDS in the society. Create awareness. Setting up surveillance system for monitoring HIV epidemic. Measures to ensure access to safe blood and preventive services for high risk population.

13. B. NACP II Launched in the year 1999 with World Bank credit support of USD 191 million. Key policy initiatives taken during NACP II includes adoption of National AIDS Prevention and Control Policy (2002), Scale up of Targeted Interventions for High Risk groups in high prevalence states, Adoption of National Blood Policy, launch of National Adolescent Education Programme , launch of National Anti-Retroviral Treatment (ART) programmes . Objectives of NACP II Reduce the spread of HIV infection in India. Increase India's capacity to respond to HIV/AIDS on long term basis.

14. C. NACP III: Launched in July 2007 based on a strong structure of policies, programmes , schemes, operational guidelines, rules and norms. Objectives of NACP III: Halting and reversing the HIV epidemic in India over its five year period Sealing up

15. D. NACP IV NACP IV implemented from 2012 to 2017 and further extended up to March 2020. Objectives of NACP IV Reduce new infections by 50% by considering 2007 as baseline. Comprehensive care, support and treatment to all persons living with HIV/AIDS. Prevention of new infections by strengthening present interventions and effectively addressing emerging epidemics. Prevention of parent to child transmission. Reducing stigma and discrimination.

16. Functioning of NACP NACP functions in two different areas as discussed below. Functions related to Prevention Targeted interventions for HRGs. Bridge population (Female sex workers), men who have sex with men, transgender and hijras, Injecting Drug Users, truckers and migrants. Needle syringe Exchange Programme and Opioid Substitution Therapy (OST) for IDUs. Prevention and intervention for migrant population at source, transit and destination. HIV Counselling and Testing Services. Condom promotion. Social mobilization, youth interventions and Adolescent Education Programme .

17. 2. Functions Related to Care, Support and Treatment Services Laboratory services for CD4 count testing. Free first line and second line Anti-Retroviral Treatment (ART) through ART center Paediatric ART for children . Early infant diagnosis for HIV exposed infants and children of the age below 18 months Treatment of opportunistic infections.

18. 2. National Leprosy Eradication Programme (NLEP) National Leprosy Control Programme (NLCP) was launched by the Government of India in the year 1954-55. Under this, in the year 1983 National Leprosy Eradication Programme was introduced with a prime objective of controlling the disease by reducing infections in the society and reduction in infective source. The programme got assistance from the World Bank in the year 1993-94.'Leprosy-free India' is the vision of NLEP. The programme was initiated with the mission of providing quality leprosy services free of cost to all sections of the population with easy accessibility, through the integrated healthcare system, including care for disability after cure of the disease.

19. Objectives of NLEP To reduce the prevalence rate less than 1/10,000 population at sub national and district level. Reduction in Grade II disability %< l among new cases at national level. To reduce Grade II disability cases < 1 case per million populations at National level. Zero disabilities among new child cases. Zero stigma and discrimination against person suffering from leprosy.

20. Functioning of NLEP: Integrated anti-leprosy services through the General Health Care system. Early detection and complete treatment of new leprosy cases. Carrying out household contact surveys for early detection of cases. Involvement of Accredited Social Health Activist (ASHA) in the detection and completion of treatment of Leprosy cases on time. Strengthening of Disability Prevention and Medical Rehabilitation (DPMR) services. Information, Education and Communication (IEC) activities in the community to improve self-reporting to Primary Health Centre (PHC) and reduction of stigma. Intensive monitoring and supervision at Health and Wellness Center and Block Primary Health Centre or Community Health Centre

21. Outcome of NLEP. As per the report of March 2015, the overall national prevalence of leprosy is 0.67/10,000 population Grade I and grade II deformity was 5.18% and 4.61% respectively. Annual New Case Detection Rate (ANCDR) in the year 2012-13 was 10.78 and in the year 2013-14 it was 9.98/ 100000 populations, at reduction of about 7.4% in ANCDR About 33 states/ union territories had already achieved the level of elimination i.e. Prevalence Rate less than 1 case/ 100000 population. A total of 111 institutions (Govt.-60 and NGO- 51) have been established for the conduct of reconstructive surgery to correct the disability in person suffering from leprosy.

22. 3. Revised National TB Control Programme For the last 50 years, Tuberculosis (TB) control activities have been conducted in India. In 1962, Government of India launched the National TB Programme (NTP) in the form of District TB centre model. In 1993, WHO declared TB as a global emergency and recommended the implementation of Directly Observed Treatment- Short Course (DOTS) by all the nations of the world. Based on these recommendations, Government of India re-implemented NTP as Revised National TB Control Programme (RNTCP) in 1993. A DOT was officially launched as the RNTCP strategy in the year 1997 and by the end of year 2005, the entire country was covered under the programme .

23. Objectives of RNTCP Elimination of TB in India by 2025: For this RNTCP has released a National Strategic Plan for tuberculosis 2017-2025 (NSP) for the control and elimination of TB in India by 2025. Find all Drug Sensitive (DSTB) TB cases and Drug Resistant TB (DRTB) cases. Emphasis on reaching TB patients seeking care from private providers and undiagnosed TB cases in high risk populations (e.g. prisoners, migrant workers, HIV/AIDS patients).Early diagnosis and treatment.

24. Functioning of RNTCP. Free diagnosis and treatment of TB patients. Provision for rapid diagnosis. Testing of all TB patients for drug resistance and HIV. Management of associated diseases. Treatment adherence support. Nutritional assistance to TB patients. For promotion of public-private mix in TB prevention and care, private providers are given incentives for TB case notification and for ensuring treatment adherence and treatment completion

25. Outcome of RNTCP RNTCP through the implementation of NSP 2017-2025, has seen tremendous success. Due to this, some states and union territories have committed to end TB even before 2025. By the involvement of private providers about 24 lakh TB patients have been notified. First line standard treatment was initiated for 22 lakh of the notified drug sensitive TB cases. About 27 crore population was screened across 337 districts in 23 States resulting in the identification of 62,958 TB patients. About 94% of the people living with HIV are being screened in ART centres for TB symptoms. In the year 2019, more than 3 lakh people living with HIV were initiated on TB preventive therapy.

26. 4. National Iodine Deficiency Disorders Control Programme : Iodine is an essential micronutrient required daily at 100-150 µg for normal growth and development. Physical and mental retardation, cretinism, stillbirth, deaf mutism and goiter are some of the diseases associated with iodine deficiency. The government of India launched the National Goitre Control Programme (NGCP) in 1962. In the year 1992 NGCP was renamed as National Iodine Deficiency Disorders Control Programme

27. Objectives Surveys to assess the magnitude of Iodine Deficiency Disorders (IDD) in the districts. Supply of iodized salt in place of common salt. Resurveys to assess iodine deficiency disorders and the impact of iodized salt after every 5 years in the districts. Laboratory monitoring of iodized salt and urinary iodine excretion. Health Education and Publicity.

28. Functioning The Ministry of Health and Family Welfare is the nodal Ministry for implementation of National Iodine Deficiency Disorders Control Programme (NIDDCP). Human resource of State IDD Cell i.e. Technical Officer, Statistical Assistant and LDC, and State IDD monitoring laboratory i.e. Lab Technician and Lab Assistant. Health education and publicity activities including global IDD Day activities. Conducting district IDD survey or resurvey to assess magnitude of IDD Procurement of salt testing kits by State or UTs for IDD endemic districts for creating awareness at the community level about consumption of iodized salt and monitoring of salt for presence of adequate iodine at household level (since 2013-14) Performance based incentive to ASHA at Rs. 25/- per month for conducting 50 salt samples testing by STK at household/community level (since 2013-14).

29. Outcome Over the years the Total Goiter Rate (TGR) in the entire country is reduced significantly. Over Production of iodized salt in the country reached 65.00 lakh MT which is adequate to meet the requirement of population. The consumption of adequately iodized salt at household level has been increased from 51.1% (as per NFHS III report 2005-06) to 71.1% (as per CES report, 2009). Regulation 2.3.12 of Food Safety and Standards (Prohibition and Restriction on Sales), Regulation, 2011 restricts the sale of common salt for direct human consumption unless the same is iodized.

30. 5. National Mental Health Programme : The government of India started National Mental Health Program (NMHP) in the year 1982 to address the over burden of mental disorders and shortage of qualified professionals in the field of mental health. Objectives To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future. To encourage the application of mental health knowledge in general healthcare and in social development. To promote community participation in the mental health service development. To enhance human resource in mental health subspecialties.

31. Functioning Implementation of basic mental health care services at the community level. Life skills education and counselling in schools. College counselling services. Workplace stress management. Suicide prevention services.

32. Outcome: Execution of activities related with mental health in partnership with Non-Government Organizations or Agencies. Rehabilitation and recovery services to persons with mental illness by giving drug and psychotherapy in order to prevent relapse. Created opportunity for people recovering from mental illness for successful community living.

33. 6. National Programme for Palliative Care (NPPC) National Programme for palliative care is a Central Government project with 40% share from the states(10% in case of North East states and Hill states). Palliative care is a type of supportive care provided in terminally ill patients like cancer and AIDS patients. Objective Improve the capacity to provide palliative care service delivery within government health programs such as the National Program for Prevention and Control of Cancer, Cardiovascular Disease, Diabetes, and Stroke; National Program for Health Care of the Elderly; the National AIDS Control Program; and the National Rural Health Mission. Refine the legal and regulatory systems and support implementation to ensure access and availability of Opioids for medical and scientific use while maintaining measure for preventing diversion and misuse.

34. Encourage attitudinal shifts amongst healthcare professionals by strengthening and incorporating principles of long term care and palliative care into the educational curricula (of medical, nursing, pharmacy and social work courses). Promote behavior change in the community through increasing public awareness and improved skills and knowledge regarding pain relief and palliative care leading to community owned initiatives supporting the health care system. Develop national standards for palliative care services and continuously evolve the design and implementation of the National program to ensure progress towards the vision of the program.

35. Functioning: Initiation of activities through National Program for Prevention and Control of cancer, cardiovascular diseases, diabetes and stroke. Provision of essential funding to build capacity within the key health programs form non-communicable diseases including cancer, HIV/AIDS. Outcome The programme has a provision of funding of Rs. 15 lakh for the strengthening of infrastructure of palliative care unit, OPD. The programme has also budget provision for the appointment of physician, nurses and multitask worker

36. 7. National Oral Health Programme (NOHP) The National Oral Health Programme (NOHP) was launched by the Government of India in order to address the issue of prevalence of oro -dental diseases and its impact on social health. Objectives To improve the determinants of oral health. To reduce morbidity from oral diseases by strengthening oral health services at health facilities located in the districts. To integrate oral health promotion and preventive services with general health care system and other sectors that influence oral health. Integrate Promotion of Public Private Partnerships (PPP) for achieving public health goals.

37. Functioning: Establishment of model dental clinic at district level. Appointment of dental surgeons, dental hygienist and dental assistant on contract basis. Support with respect to dental chair along with supportive equipment's and materials. General oral health training of all the health care staff, special training of nodal medical officer.

38. 8. National organ transplant programme (NOTP) The scarcity of organs is almost universal, although Asia lags far behind the rest of the globe. Even in Asia, India trails far behind other countries. It's not that there aren't enough organs available for transplant. Almost everyone who dies naturally or in an accident is a prospective donor. Even yet, a large number of patients are unable to identify a donor. Objective . To organize a system of organ and Tissue procurement and distribution for transplantation. To promote deceased organ and Tissue donation. To train required manpower. To protect vulnerable poor from organ trafficking. To monitor organ and tissue transplant services and bring about policy and programme corrections/ changes whenever needed

39. Functioning National Network division of National Organ and Tissue Transplant Organization (NOTTO) would function as apex center for all India activities of coordination and networking for procurement and distribution of organs and tissues and registry of Organs and Tissues Donation and Transplantation incountry . Framing policy guidelines and protocols for various functions. Compilation and publication of registry data from States and regions. Creating awareness, promotion of deceased organ donation and transplantation activities. Monitoring of transplantation activities in the regions and States and maintaining data-bank in this regard.

40. Outcomes: Establishment of Regional Organ and Tissue Transplant Organization. Establishment of State Organ and Tissue Transplant Organization. A website by the name www.notto.nic.in has been hosted where information with regards to the organ transplantation can be obtained. An online system through a website is being developed for establishing a network for Removal and Storage of Organs and Tissues from deceased donors and their allocation and distribution in a transparent manner. A computerized system of State or Regional and National Registry of donors and recipients is also going to be put in place.

41. 9. National Programme for Control of Blindness and Visual Impairment (NPCB and VI) National Programme for Control of Blindness and Visual Impairment (NPCB and VI) was launched in the year 1976 by the Central Government of India. Now all the states contribute 40% share of the fund whereas North East States contribute 10% of the budget with a goal of reducing the prevalence of blindness in the country. Objective To reduce the backlog of avoidable blindness through identification and treatment of curable blind at primary, secondary and tertiary levels, based on assessment of the overall burden of visual impairment in the country. Develop and strengthen the strategy of NPCB for "Eye Health for All" and prevention of visual impairment; through a provision of comprehensive universal eye-care services and quality service delivery.

42. Functioning Setting up Multipurpose District Mobile Ophthalmic Units in the District Hospitals of States or UTs. Distribution of free spectacles to old persons suffering from presbyopia. Comprehensive eye-care coverage by covering diseases other than cataract like diabetic retinopathy, glaucoma, corneal transplantation, vitreo -retinal surgery, treatment of childhood blindness including Retinopathy of Prematurity (ROP) etc. Strengthening of Tertiary Eye-Care Centres by providing funds for purchase of sophisticated modern ophthalmic equipment.

43. Outcome Achieved 95% target set for cataract operation for three consecutive years (2014-15 to 2016-17). Successful implementation of School Eye Screening Programme . Successfully given treatment or management of eye diseases such as Diabetic retinopathy, glaucoma, childhood blindness, keratoplasty etc. Collection of donated eyes for corneal transplantation at a number above the set target.

44. 10. National Tobacco Control Programme In order to protect the youth and masses from the adverse effects of tobacco usage, second hand smoke (SHS) and to discourage the consumption of tobacco the Government of India enacted a comprehensive tobacco control law namely "Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act. 2003 (COTPA, 2003). The National Tobacco Control Programme was launched in 2007-08.

45. Objectives Public awareness or mass media campaigns for awareness building and behaviour change. Establishment of tobacco product testing laboratories, to build regulatory capacity, as required under СОРТА, 2003. Mainstreaming the program component as a part of the health delivery mechanism under the National Rural Health Mission framework. Mainstreaming Research and training on alternate crops and livelihood in collaboration with other nodal Ministries.. Monitoring and Evaluation including surveillance, e.g. Global Adult Tobacco Survey (GATS) India

46. Functioning The National Tobacco Control Cell (NTCC) is responsible for overall policy formulation, planning, monitoring and evaluation of the different activities envisaged under the programme The National Cell functions under the direct guidance and supervision of the programme in-charge from Ministry of Health and Family Welfare i.e. Joint Secretary or Director. 5-15Technical assistance is provided by the identified officers from the Directorate General of Health Services i.e. Deputy Director General (DDG) or Chief Medical Officer (CMO). Global Adult Tobacco Survey India 2009-10 was carried out in all 29 states of the country and 2 union Territories of Chandigarh and Pondicherry, covering about 99.9% of the total population of India. Global Youth Tobacco Survey India 2009 was carried out in grades 8, 9 and 10 covering age groups13-15 years.

47. Outcome Operational Guidelines for implementation of National Tobacco Programme developed and disseminated to all the states and Districts. Guidelines for Implementation of pictorial health warnings and sale to minors and around educational institutions developed and disseminated to states. Implementation of the Food Safety and Standards Authority of India Regulation in the States. Communication to Director Generals of Police (DGP) in states to strengthen and institutionalize enforcement of COPTA. Communication to Transport Secretaries in the States to make compliance to COPTA. Communication to Principal Secretaries (Health) in the States to make compliance to COPTA. The National Tobacco Control Cell (NTCC) coordinated with all 15 state consultants for collection of data related to price of key brand of tobacco products.

48. 11. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) Non-communicable Diseases (NCDs) such as Cardiovascular Diseases (CVD), Cancer, Chronic Respiratory Diseases, and Diabetes are estimated to account for almost 60% of all fatalities in India. Since 2010, the Indian government has been implementing the National Programme for the Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) up to the district level as part of the National Health Mission.

49. Objectives: Health promotion through behaviour change with involvement of community, civil society, community based organizations, media etc.. Screening at all levels in the health care delivery system from sub- centre and above for early detection of diseases covered under the program including management and follow up. To build capacity at various levels of health care for prevention, early diagnosis, treatment, rehabilitation, Information Education Communication or Behaviour Change Communication (IEC/BCC activity), operational research and rehabilitation. To provide logistic support for diagnosis and cost effective treatment at primary, secondary and tertiary levels of health care.. To support for development of database of NCDs through Surveillance System and to monitor NCD morbidity and mortality and risk factors.

50. Functioning: Population Based Screening (PBS) for NCDs namely diabetes, hypertension and common cancers (oral, breast and cervix) has been expanded to more than 400 districts. Screening is being provided through trained frontline workers (ASHA and ANM) and suspected cases are referred to Medical Officers at PHC. Initiation of NCD App for capturing patient wise data and further follow up from PBS districts. Under Ayushman Bharat, NCDs are included in the spectrum of services being offered at Health and Wellness Centres . Pradhan Mantri National Dialysis Program (PM-NDP) is being implemented in 35 States/UT in 496Districts. Prevention, early detection and treatment of rheumatic fever and rheumatic heart diseases.

51. "National Framework for Joint Tuberculosis-Diabetes collaborative activities" has been developed to articulate a national strategy for 'bi-directional screening, early detection and better management of Tuberculosis and Diabetes comorbidities in India. The National Multi-sectoral Action Plan for prevention and control of NCDs has been developed through a series of consultations with various stakeholders including other Ministries or Departments.. Inclusion of prevention and management of Chronic Obstructive Pulmonary Disease (COPD) and Chronic Kidney Disease (CKD) in the program. India Hypertension Management Initiative (in collaboration with ICMR).. Opportunistic screening of common NCDs including Diabetes, Hypertension and Cancer, is being done among the attendees of the India International Trade Fair (IITF) at Pragati Maidan, New Delhi during 14-27 November, every year.

52. Outcome. Around 6.61 crore persons attended NCD Clinics and were screened for common NCDs like Diabetes, Hypertension, CVDs and common Cancers during 2019-20. More than 1.1 crore population has been covered under Population Based Screening so far. In addition, during outreach activities, 5.6 crore NCD check up were conducted.

53. 12. National Programme for Prevention and Control of Deafness (NPPCD) The most frequent sensory deficiency in people today is hearing loss. According to WHO estimates, around 63 million persons in India have substantial hearing impairment, putting the estimated prevalence at 6.3% of the Indian population. National Programme for Prevention and Control of Deafness (NPPCD) was initiated on pilot basis in the year 2006-07 (January 2007) covering 25 districts of 10 states and 1 UT and has been expanded to 228 districts of 27 States or Union Territories in a phased manner.

54. Objectives: To prevent avoidable hearing loss on account of disease or injury. Early identification, diagnosis and treatment of ear problems responsible for hearing loss and deafness To medically rehabilitate persons of all age groups, suffering with deafness. . To strengthen the existing inter-sectoral linkages for continuity of the rehabilitation programme , for persons with deafness. To develop institutional capacity for ear care services by providing support for equipment, material and training personnel.

55. Functioning Manpower training and development - For prevention, early identification and management of hearing impaired and deafness cases, training would be provided from medical college level specialists (ENT and Audiology) to grass root level workers. Capacity building - for the district hospital, community health centres and primary health centre in respect of ENT or Audiology infrastructure. Service provision - Early detection and management of hearing and speech impaired cases and rehabilitation, at different levels of health care delivery system Awareness generation through IEC or BCC activities - for early identification of hearing impaired, especially children so that timely management of such cases is possible and to remove the stigma attached to deafness.

56. Outcome Availability of various services like prevention, early identification, treatment, referral, rehabilitation etc. for hearing impairment and deafness as the primary health centre or community health centres or district hospitals largely cater to their need. Decrease in the magnitude of hearing impaired persons. Decrease in the severity or extent of ear morbidity or hearing impairment. Improved service network or referral system for the persons with ear morbidity or hearing impairment. Awareness creation among the health workers or grassroots level workers through the primary health centre medical officers and district health officers, which will percolate to the lower level health workers functioning within the community. Capacity building at the district hospitals to ensure better care.

57. 13. National Vector Borne Disease Control Programme : Directorate of National Vector Borne Disease Control Programme (NVBDCP) is the central nodal agency for prevention and control of six Vector Borne Diseases (VBDs) i.e. Malaria, Dengue, Lymphatic Filariasis, Kala-azar, Japanese Encephalitis and Chikungunya in India. Objectives To bring down malaria transmission to a level at which it would cease to be a major public health problem Interruption of transmission by reducing vector population through indoor residual insecticides Early diagnosis and complete treatment of Kala-azar cases Health education programme for community awareness Reduction of filaria problem in un-surveyed areas.

58. Control of filaria in urban areas through recurrent anti-larval and anti-parasitic measures. Strengthening early diagnosis and prompt case management of Japanese Encephalitis (JE) at PHCs, CHCs and hospitals through training of medical and nursing staff.. IEC for community awareness to promote early case reporting, personal protection, isolation of amplifier host, etc. Vector control measures mainly fogging during outbreaks, space spraying in animal dwellings, and antilarval operation where feasible. . Development of a safe and standard indigenous vaccine. Vaccination for high risk population particularly children below 15 years of age. Surveillance for dengue disease and outbreaks. Early diagnosis and prompt case management. Vector control through community participation and social mobilization. Capacity building.

59. 14. National Programme for Prevention and Management of Trauma and Burn Injuries: Accidental injury is one of the primary causes of death and morbidity in India. Road traffic accidents are a leading source of disability, sickness, and death in India. According to the Ministry of Road Transport and Highways, road injuries are one of the top four primary causes of mortality and health loss among those aged 15 to 49. According to the data, the overall number of road accidents in the country in 2017 was 4,64,910, with 4,70,975 people injured and 1,47,913 people killed. This would equate to 53 accidents and 16 deaths each hour on average. This programme was started on pilot mode under the 9th and 10th FYP as "Pilot Project for strengthening emergency facilities along the highways“

60. Objectives: To establish a network of trauma care facilities to reduce the incidence of preventable deaths due to traffic accidents by observing golden hour principle. To develop proper referral and communication network between ambulances and trauma centers and within the trauma centres . To develop National Injury Surveillance, Trauma Registry and Capacity Building Centre for collection, compilation, analysis and dissemination of information for policy formulation and preventive interventions. To develop trauma registry centres for ensuring delivery of quality services. To develop a National Trauma System Plan. To improve awareness through IEC activities.

61. Functioning: The 11th FYP was approved for developing a network of 140 Trauma Care Facilities (TCF) in the Govt. Hospitals along the Golden Quadrilateral highway corridor Outcome During the 11th FYP, a total 116 TCF were identified and funded in 17 states for establishing Trauma Care Facilities. Out of these, 105 TCFs are functional as reported by State Government. During 12th FYP, a total of 80 Medical Colleges or District Hospitals have been approved for financial assistance in 22 states/UTs. National Injury Surveillance, Trauma Registry and Capacity Building Centre have been established at Dr. RML Hospital. The website is already launched by the name of www.nisc.gov.in .

62. A 6 months course curriculum on Neurotrauma has been developed for General Surgeons. First Aid course developed in consultation with AIIMS and WHO and released by MoS (AKC), MoHFW during the Road Safety Week 2019.. Medical First Aid training imparted to 300 Airport Rescue and Fire Fighting (ARFF) Personnel, Terminal staff and Airport Health Organization staff at Delhi International Airport.

63. Role of Pharmacist in National Health Programmes: Health Services: Pharmacists as medicine specialists, are responsible for providing medications and services that are effective, safe and of high quality in order to achieve optimal health outcomes. To achieve this, the pharmacists must be competent in their field and should have up-to date knowledge.

64. 2. Health Workforce Pharmacists who function well are attentive to their patients' requirements and preferences. In reality, integrating patients in health care decision-making has resulted in higher satisfaction and less complaints about supplied treatments. a product-oriented to a patient-centered pharmacy service, it is critical to priorities patients' needs and treat them with dignity. 3. Health Information. Pharmacists are the most accessible health care providers, and they participate in health screening and surveillance initiatives, such as verifying vaccination status and recognizing possible public health concerns.

65. 4. Medical products, vaccines and technologies The complexity of pharmacy practice continues to grow as a result of an ever-expanding array of new related medicinal goods, vaccines, and technology. Pharmacists duties include not just medicinal items, but also vaccinations and medical equipment, particularly Those requiring specific understanding about uses and hazards. 5. Health Finance: Pharmacists promote the provision of cost-effective health care through the sensible use of medicinal items and current technology in an effort to safeguard the society from financial hardship.

66. 6. Leadership and Governance Pharmacists can take part in public health policy development, linking disease prevalence and drug utilization. Pharmacists can enable development of effective health policies and can contribute in disease prevention to a great extent. Pharmacists can help with crises by establishing response plans and procedures, and can help with resource mobilization by optimizing medicine use and distribution.