National health programm

NHP in COMMUNITY HEALTH NURSING

1. NATIONAL HEALTH PROGRAMMES PRESENTEDBY: PURVI PATEL Dept. OF Community H ealth N ursing MBNC

2. Introduction India being developing country is facing various problems which are being solved via national health programme. The government of India is not only recognised the health care organisation & delivery system to provide three tier health services via a network of health centres & hospitals in rural & urban areas, but also launched various national health programmes to deal with the specific health problems

3. National health programmes Collaboration with many national and international health agencies such as WHO, UNICEF, UNFPA, world bank, SIDA,DANIDA,USAID and many more, the Indian government has launched various health programmes to improve the health status of Indian people.

4. National health programmes :- National ARI control programme - Revised national tuberculosis control programme National malaria eradication programme (NMEP) National filarial control programme (NFCP) National kala azar control programme Japanese encephalitis prevention & control programme National programme for prevention & control of dengue, dengue hemorrhagic fever.

5. National leprosy eradication programme (NLEP) National tuberculosis control programme (NTCP) National programme for control of blindness (NPCB) National immunization programme (NIP) National mental health programme (NMHP) National iodine deficiency disorder & control programme

6. National AIDS control programme (NACP) National cancer control programme (NCCP) National guinea worm eradication programme National safe water & sanitation programme  

7. National Acute Respiratory Infection Control Programme ARI are the most common of the human ailments. In young infants, young children and those with impaired respiratory tract there is increased morbidity and mortality. Types of ARI: 1. acute upper respiratory infections. 2. acute lower respiratory infections.

8. Objectives: To reduce the mortality under 5 years of age due to pneumonia To reduce the severity of mortality from pneumonia in children. To reduce the incidence of acute lower respiratory infections. To reduce the severity and complications from acute upper respiratory infections. To rationalize the use of drugs in ARI.

9. Classification of illness 0-2 years: very sever disease Severe pneumonia Pneumonia not severe No cough or cold 0-2 years: Very severe disease Severe pneumonia

10. 2-5 years: Danger sign: child is unable to drink convulsion strider in the calm child sever malnutrition Severe pneumonia. Respiratory rate increased .

11. Management of ARI Treat fever Treat wheezing Antibiotic Nebulize 0.5ml + 2ml n/s salbutamol Provide good food Assess the apical pulse & respiration

12. REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME (RNTCP) NATIOANAL TUBERCULOSIS PROGRAMME has been in operation since 1962. Treatment success rates were very low and death rates remained high. RNTCP (1993) was formulated and adopted internationally recommended directly observed treatment short course ( DOTS)

13. objective of RNTCP: Achievement of at least 85% cure rate of infections cases of tuberculosis through DOTS involving peripheral health functioning. Promotion of case finding activities through quality sputum microscopy to detect at least 70% of estimated cases. Involvement of non governmental organization in IEC and research activities.

14. In 2006 STOP TB strategy was announced by WHO and adopted by RNTCP Quality DOTS Addressing TB/HIV and MDR Contributing to health system strengthening Engaging all health care providers Empowering patients and communities Promoting research ( diagnosis, treatment & vaccine )

15. Organization State tuberculosis office – state tuberculosis officer State tuberculosis training and demonstration centre- director District tuberculosis centre- district tuberculosis officer Tuberculosis unit- MO Senior treatment supervisor senior TB laboratory supervisor DOTS provider

16. Treatment under RNTCP Case finding is positive Suspected TB patient are screened through 3 sputum smear examination. Sputum microscopic examination is done at CHC,PHC or TB dispensaries. All patients are provided short course chemotherapy free of cost. All drugs are administered under direct supervision

17. Drugs are supplied in patients wise boxes containing the full course of treatment and packaged in blister packs. For intensive phase: each blister pack contains one days medication For continuation phase: each blister pack contains one week’s supply of medication.

18. RNTCP PHASE-II (PERIOD OF 5 YEARS 2006- 2011) Phase II of the RNTCP is a step towards achieving the TB related millennium development goals target. To decrease mortality and morbidity due to TB and cut transmission of TB. DOTS remain the core strategies TB –HIV coordinator, urban coordinator and communication facilitator have been introduced at state, district and sub district level.

19. DOTS - PLUS The programmatic management of drug resistant TB ( PMDT) services for quality diagnosis and treatment of drug resistant . TB cases were initiated in 2007 in Gujarat and Maharashtra. Cat- IV regimen to become more effective, it has been decided to replace ofloxacine with levofloxacin . It recognized the diagnosis of MDR- TB us laboratory based.

20. National malaria eradication programme (NMEP)   (1958) Introduction : This programme started in 1950, but later on upgraded to national malaria eradication programme in 1955. The problem was reviewed in constitution with experts the modified plan of operation was approved by the cabinet in October 1976.

21. Main activities of the programme. Formulating policies and guidelines Technical guidance Planning Logistics Monitoring and evaluation Coordination of activities through the state and consultation with national organization. Collaboration with international organizations like WHO, world bank etc Training Coordinating control activities Facilitates research

22. Objectives of NMEP : To prevent death due to malaria. Reduction in the period of sickness. To bring down malaria morbidity. To intensify anti malarial measures for bringing back agricultural & industrial production. To consolidate the gains achieved so far.

23. Strategies of NMEP: Early case detection & prompt treatment. Vector control by house to house spray of anti larval measures. Health education & community participation. Indoor residual spray   Use of insecticide treated bed nets Epidemic preparedness and early response Efforts to implement strategies :   Government efforts Peoples participation Research Training Publicity Internal assistance

24. National filarial control programme (NFCP)   It started in 1955. In 1978 urban malarial scheme was merged with this programme. Activities:- Survey & case detection in omitted places. Antilarval measures. Antifilaria measures. Detection & treatment of microfilaria carriers/persons.

25. Strategies Weekly spray of approved larvicide & biological control vi larvivorous fishes. Environment & water management . Detection and treatment of microfilaria carriers. Information, education & communication for community. Administration of single dose of Diethyl carbmazine citrate . (DEC) + albendazole These activities are done via filarial control units (FCU) VHG is trained for an effective primary case in antifilria activities.

26. National kala azar control programme (NKCP )   Kala azar is a serious public health problem in Bihar, West Bengal & Jharkhand. In 1991 the kala azar control programme was launched by govt. of India. Strategies:   Interruption of transmission for reducing vector population by insecticidal spray twice annually. Early diagnosis & complete treatment. Information, education & communication for community awareness & involvment .

27. Capacity building Monitoring, supervision and evaluation Develop research guideline on prevention and control of kala azar and circulate to all states. an incentive of an amount Rs. 100 is being provided to the health workers or ASHA for referring a suspected cases of kala azar and to ensure complete treatment after confirmation.

28. Japanese encephalitis prevention & control programme (JEPC)   It is a disease with high mortality rate & is caused by flavivirus group. It transmitted from animals to human by mosquito. The programme was launched in 1979. Strategies: Early diagnosis & prompt case management Vector control by anticipatory insecticide spray indwelling & fogging for epidemic containment. Care of patient. Clinical surveillance of suspected cases.

29. Programme for prevention & control of dengue/ dengue hemorrhagic fever Dengue / DHF is a viral infection & widely prevelant in India. There has been a decline in dengue / DHF incidence after 1996. Strategies: Surveillance for disease & vectors. Early diagnosis & prompt case management. Vector control via community participation & social mobilization. Capacity building. There is no separate programme for prevention & control of DF/DHF. The resources are available under NMEP.

30. Chikangunya fever It is debilitating non fetal viral illness, re emerging in the country after a gap of three era. Since the same vector is involved in the transmission of dengue and chikangunia strategies are also same as a dengue fever.

31. National leprosy eradication programme (NLEP)   In 1983 National leprosy control programme (NLCP) was enhanced to National leprosy eradication programme (NLEP) because of highly effective treatment for leprosy. The National leprosy eradication commission was set up under the chairmanship of union minister of health & family welfare. The board in accordance with eradication commission help to guide & making decision, coordination, planning implementation & surveillance of various activities of NLEP.

32. Components Decentralized integrated leprosy services through general health care system. Capacity building Information, education and communication Prevention of disability and medical rehabilitations Monitoring and supervision

33. Major initiatives More focus has now been given to new case detection. Treatment completion rate has been under taken as an important indicators. Provide disability prevention and medical rehabilitation services to leprosy affected persons. Dressing materials, supportive medicine and ulcer kits.

34. Micro cellular rubber footwear. An amount of Rs. 5000 is provided as incentive to each leprosy affected person from BPL family. Support is also provided to government institutions in the form of Rs. 5000 per reconstructive surgery conducted. There are 612 self settled colonies in the country where more than 50,000 leprosy affected persons reside. Free medical facilities given to them. Urban leprosy control programme was initiated in 2005.

35. NATIONAL AIDS CONTROL PROGRAMME National AIDS control programme was launched in india in the year 1987. Ministry of health and family welfare has set Up National AIDS control organization (NACO) as separate wing to implement and closely monitor the various components of the programme.

36. Aims: To prevent further transmission of HIV. To decrease morbidity and mortality associated with HIV infections. To minimize the socio economic impact resulting from HIV infections.

37. Important milestone of AIDS control programme 1986 First case detected National AIDS Committee established 1987 National AIDS control programme launched 1990 Medium term plan launched for four states & four metros 1992 NACP- I launched National AIDS control board constituted NACO set up 1999 NACP-II begins State AIDS control societies established 2002 National AIDS control policy adopted 2004 Anti retroviral treatment initiated 2007 NACP- III launched for five years ( 2007-2012) 2012 NACP- IV launched for 5 years ( 2012-2017)

38. Services under NACP- IV Prevention services: Targeted interventions for high risk groups( female sex workers, men who have sex with men, trans genders, injecting drugs uses) Prevention interventions for migrant populations. Link workers scheme and vulnerable populations in rural area. Prevention and control of STD. Blood safety

39. HIV counseling and testing services Prevention of parent to child transmission Condom promotion IEC and behavior change communication Work place interventions Care, support and treatment services Laboratory services Free first line and second line ART through ART centre. Pediatric ART for children HIV/TB Coordination Treatment of opportunistic infections

40. National AIDS control Policy Launched in the year 2002. It includes following: blood safety programme Counseling and HIV testing STD control programme HIV surveillance School AIDS education programme IEC and social mobilization Red ribbon express project Family health awareness project Anti retroviral therapy (ART)

41. National Programme for control of blindness (NPCB)   Introduction -The National Health Programme for the control of blindness was established in1976 as 100% centrally sponsored program. The national trachoma control program which was launched in 1963 the national prophylaxis programme against blindness due to vitamin A deficiency launched in 1970 were incorporated in NCPB.   Goal - The goal of NCPB is to reduce the prevalence of blindness from 1.5% to 0.3% lakh person.  

42. Revised strategies Strengthening services for others causes of blindness, refractive errors like corneal blindness, refractive error in school children, improving follow up services for cataract operated persons. To shift from the eye camp approach to a fixed facility surgical approach. Construction of eye operation theaters, eye wards at district level. To promote participation of voluntary organizations in the programme.

43. Improve the performance of government hospitals. To enhance coverage of eye care services in tribal and other underserved areas.

44. Objectives: To reduce blindness through identification and treatment of blind. To develop eye care facilities in every district. To develop human resources for providing eye care services. To improve quality of service delivery. To secure participation of voluntary organization.

45. Administration Central - ophthalmology section, DGHS State – state ophthalmic cell, state health society District – district blindness control society

46. Service delivery & referral system Tertiary level - regional institutes of ophthalmology and medical colleges Secondary level – district hospital and NGO eye hospital Primary level – sub district level hospitals/ CHC/ upgraded PHC

47. New initiatives proposed under the programme School eye screening programme for children aged 12-14years. Collection and utilization of donated eyes. Construction of dedicated eye wards and eye operation theaters in district hospitals. Appointment of ophthalmic surgeons and ophthalmic assistants in districts hospitals. appointment of eye donation counselors on contract basis in eye banks

48. Grant in aids for NGO’s for management of other eye diseases other than cataract like diabetic retinopathy, glaucoma etc. Telemedicine n ophthalmology Involvement of private practitioners Vitamin A supplements to take care of childhood blindness Setting up of 5 centres for excellence for eye care services.

49. National diabetes control programme Government of India started national diabetes control programme on pilot basis during 7 th five year plan in 1987 in some district of Tamil nadu , J &K and Karnataka, but due to lack of funds this programme could not be expanded further in remaining years.

50. Objectives: Prevention of diabetes through identification of high risk subjects and early interventions in the form of health education. Early diagnosis of disease and appropriate treatment morbidity and mortality with reference to high risk group. Prevention of acute and chronic metabolic, cardiovascular, renal and ocular complication of the disease.

51. Provision of equal opportunity for physical attainment and scholastic achievement for diabetic patients. Rehabilitations of those partially or totally handicapped diabetes people.

52. Elements of comprehensive national diabetes programme are Primary prevention (development of risk factors) Secondary prevention (development of diabetes) Tertiary prevention ( complication through early diagnosis and effective monitoring, treatment and care of people with diabetes.

53. National cancer control programme Cancer is important public health problem in India. Nearly 7-9 lakh new cases during every year in the country. The national cancer control programme was launched in the year 1975-76. Objective: prevention, early diagnosis and treatment of cancer. The programme was revised in 1984-85 and subsequently in december 2004.

54. The schemes under revised programme are Regional cancer control scheme Oncology wing development scheme Decentralized NGO scheme IEC activities at central level Research and training

55. Tobacco control legislation A comprehensive tobacco control legislation titled “ the cigarettes and other tobacco products ( prohibition of advertisements and regulation of trade and commerce, production, supply and distribution) act 2003 was passed by the parliments in april 2003.

56. The important provisions of the act are: Prohibition of smoking at public places. Prohibition of direct and indirect advertisement of cigarette and other products. Prohibition of sale of tobacoo products and cigarette to a person below the age of 18 years. Prohibition of sale of tobacoo products near the educational institutions. Tar and nicotine contents along with maximum permissible limits on tobacco packs.

57. Expanded programme of immunization In this programme immunization services to the targeted children under one year old child and pregnant women. The national immunization strategies have been developed based on the framework reflected in the global vaccine action plan. (2011) The efforts have been made to accomplish the vision of decade of vaccine by delivering universal access to immunization.

58. Its functions focus to achieve the following objectives To maintain the country status of “ free of poliomyelitis” To achieve the regional elimination targets for measles in 2020 & congenital rubella syndrome control. To sustain the elimination status of maternal and neonatal tetanus elimination. To get vaccination coverage targets in every district and community

59. To introduce new vaccine and technologies. To contribute the effort in achieving the millennium development goal for target of reducing child mortality.

60. Pulse polio programme Pulse polio immunization programme was launched in india in 1995. Children in the age group of 0-5 years administered polio drops during national and sub national immunization rounds every year.

61. progress The last polio case in the country was reported from Howrah district of west bengal with the date of 13 th january 2011. there after no polio case has been reported in the country. There are 24 lakh vaccinators and 1.5 lakh supervisors involved in the successful implementation of the pulse polio programme

62. Steps taken by the government to achieve target of polio eradication Special booth are established in area bordering neighboring countries like wagha border and attari train station in punjab and munabo train stations in barmer district rajsthan , to ensure that all children from across the border are given polio drops. Continuation of already existing enviornmental surveillance across at four sites.

63. A rolling emergency stock of OPV is being maintained. An expert sub group will be established to discuss issues related to OPV switch in routine immunization and possibility of IPV introduction in the country. Implemented to ensure sanitation, hygiene and clean drinking water in addition to vaccinating each and every child OPV. Migratory populations being identified and covered.

64. National family welfare programme Launched in 1951 Objective: “reducing the birth rate to the extent necessary to stabilize the population at a level consistent with the requirement of the national economy.” It is being implemented as a 100% centrally sponsored programme.

65. "The Family Welfare Programme in India is recognised as a priority area, and is being implemented as a 100% Centrally sponsored programme. As per Constitution of India, Family Planning is in the Concurrent list. The approach under the programme during the First and Second Five Year Plans was mainly "Clinical" under which facilities for provision of services were created. However, on the basis of data brought out by the 1961 census, clinical approach adopted in the first two plans was replaced by "Extension and Education Approach" which envisaged expansion of services facilities along with spread of message of small family norm.

66. Objectives: Universal access to quality family Planning services so that the small-family norm becomes a reality   Total coverage of registration of births, deaths and marriages Full access to information on birth limitation methods and freedom of choice, especially to women, for planning their families Reduction of Infant Mortality Rate to below 30 per thousand live births, incidence of low birth weight and maternal mortality rate Immunization against vaccine preventable diseases Elimination of incidence of girls being married below the age of 18 Increase in the percentage of deliveries conducted by trained persons to 100 per cent Contain Sexually Transmitted diseases, especially AIDS Universalisation of ‘primary’ education and reduction in the dropout rates at primary and secondary levels to below 20 per cent for boys and girls

67. Terms and references: To formulate programmes aimed at achieving the socio-demographic goals enumerated in National Population Policy 2000. To introduce information technologies and management information systems, at district and sub-district levels, to monitor availability and access to contraceptives, drugs and vaccines as well as to services, in the near and far flung areas To improve the existing systems for logistics To implement the paradigm shift in the management of programmes for population stabilization by incorporating diverse health care providers. Accrediting private medical practitioners and assigning to them defined satellite populations for whom they will provide basic health services; Involving the non-medical fraternity;

68. To impart new dynamism to the family welfare programme, several new initiatives were introduced and ongoing scheme were revamped in the eight plan. Motivating people for adaptation of small family norms. Reduction in the population growth rate has been recognized as one of the priority objective. To assess the needs for reproductive and child health at PHC level and undertake area specific micro planning. To provide need based, high quality, integrated reproductive and child health care reducing the infant and maternal mortality morbidity resulting in a reduction in level of fertility.

69. ICDS PROGRAMME The integrated child development scheme has been started by the government of india in 1975. Which is an instrumental in improving the health and wellbeing of mothers and children under 5 by providing health and nutrition education, health services, supplementry food and pre school education.

70. Objectives of the programme To improve the nutritional status of preschool children. To lay the foundation of proper psychological development of the child. To reduce the incidence of mortality, morbidity malnutrition and school drop out. To achieve effective coordination of policy and implementation in various departments to promote the child development. Proper nutrition and health education.

71. Target group Beneficiary services Pregnant women Health check up TT Supplemenatry nutrition Health education Lactating mother Health check up Supplemenatry nutrition Health education Children less than 3 years Supplementry nutrition Health check up Immunization Referral services Children below 3-6 years Supplementary nutrition Health check up Immunization referral services Non formal education

72. component 1. health check up 2. Immunization 3. supplemenatry nutrition 4. referral services 5. early childhood care and pre school education 6. nutritional and health education

73. Adolescent girls scheme General health check up Immunization Treatment of minor ailments Deworming Prophylactic measures against anemia, IDD, Vitamin deficiency referral

74. Anganwadi centre It is the focal point for delivery of ICDS services. Located in village Anganwadi is run by AWW, Supported by a helper AWW Is the first point of contact for family experiencing Nutrition and health problems.

75. Functions of Anganwadi workers Monitor growth of children Provide non formal pre school education Provide supplementary nutrition Give health and nutritional education Referral for sick children Provide health service in collaboration with ANM/ASHA Implement adolescent girls scheme

76. Programme monitoring at central level Supplementary nutrition ( under five children, pregnant and lactating mother) Pre school education (3-6 years) Immunization, health check up and referral services At state level Field visit Information on number meeting on nutrition and health education & vacancy position of ICDS functionaries.

77. At block level Child development project officer is the in charge of an ICDS project. A supervisor, under the CDPO is required to supervise 25 AWC on an average. CDPO is required to send the monthly progress report by the 7 th day of the following month to state government. The monthly and half yearly progress reports of anganwadi worker have also been prescribed.

78. Adolescent health programme “ Adolescere ” meaning to grow, to mature. Its is time of physical and emotional change as the body mature and the mind becomes more questioning and independent. Period of preparation for undertaking grater responsibilities including healthy responsible parenthood.

79. Adolescent health programmes Kishori shakti yojana – to improve the health and nutritional status of girls Balika samridhi yojana – to delay the age of marriage Reproductive and child health programme Adolescent friendly health services national AIDS control programme Family life education

80. Kishori shakti yojana Adolescent girl who are unmarried and belong to families below the poverty line and school drop-outs are attached to the local anganwadi centres for six monthly of learning and training activities.

81. Objectives: To improve nutritional and health status of girls in age group of 11-18 years. To provide required literacy and numeracy skills through the non formal stream of education. To stimulate a desire for more social exposure and knowledge and help them improve their decision making capacities. To train and equip the adolescent girls to improve home based and vocational skills.

82. To promote awareness of health , hygiene, nutrition and family welfare, home management and child care. Measures to facilities their marriage only after attainment the age of 18 years and if possible, even later. To gain a better understanding of their environment related social issues and the impact on their lives. To encourage adolescent girls to initiate various activities to be productive and useful members of the society.

83. Balika samridhi yojana Launched by government of india in 1997. Objectives: To change negative family and community attitudes towards the girl child at birth and towards her mother. To improve enrollment and retention of girl children in schools, to increase the age of marriage of girls and to assist the girl to undertake income generation activities.

84. Coverage Balika samriddhi yojna is being implemeted in both rural and urban areas. targeted group : Girl child belong to families below the poverty line are given benefit, who are born on after 1997.the benefits are restricted to two girl children in a household irrespective of number of children in the household.

85. Benefits: a post birth grant amount of Rs. 500/- Procedure for obtaining the benefit: ICDS infrastructure in rural areas and health department in urban area. The application form are available with anganwadi workers in the villages and with health functionaries in urban.

86. Payment at maturity: Attaining 18 years of age Certificate of municipality The implementing agency authorizes the bank or post office to withdraw.

87. Reproductive and child health Adolescent reproductive and sexual health ( ARSH) Services provided to all adolescent married and unmarried girls and boys. Promotive services: Focus care during antenatal period Counselling & provision of emergency contraceptives Information on SRI services

88. Preventive services Services for TT and prophylaxsis against nutritional anemia. Nutritional counselling Services for early and safe transmission of pregnancy and management of post abortion complications. Curative services : Treatment for common RTI/STIs Treatment & counselling of menstrual disorders

89. Referral services Integrated counselling and testing centre Prevention of parent to child transmission Outreach services: Periodic health check up and community camps. Periodic health education activities. Co curriculum activities.

90. Adolescent friendly health services AFHS provides broad range of preventive, promotive & curative services. AFHS in india is first taken by safdarjan hospital in new delhi .

91. Packages of health services Monitoring of growth & development Monitoring of behaviour problems. Offer information & counselling on developmental changes, personal care & ways of seeking help. Reproductive health including contraceptives, STI treatment , pregnancy care & post abortion management.

92. Integrated counselling and testing for HIV. Management of sexual violence. Mental health services including management of substance abuse. The national institutes of research in reproductive health started in mumbai for providing specialized sexual & reproductive services. RCH-II has a strategy to provide services for adolescent health in public health facilities & primary health care level during routine hours and on dedicated days & times.

93. National AIDS control programme Under NACO adolescent education programme developed which focuses primarily on prevention through awareness building. Relevant messages on safe sex, sexuality and relationship are developed and disseminated for youth via posters, booklets, panels and printed material.

94. The adolescent education programme Co curriculum adolescent education in class- IX-XI. Skill education in classes I-VIII Inclusion of HIV prevention education in pre services and in services teacher training and teacher education programme. Incorporating measures to prevent stigma and discrimination against learner and educators and life skills education and education policy for HIV prevention.

95. YUVA- youth unite for victory on AIDS YUVA comprising seven youth organisation , nehru yuva kendra sangathan , national service scheme, indian red cross society. Goal is to have an “ AIDS prepared campus, AIDS prepared community and AIDS prepared country” Prevention, education and life skills for promoting healthy and safe behaviour and practices among young people.

96. Red ribbon club (RRC) The club is established in every school and college to provide youth with access to information on HIV/AIDS and voluntary blood donation. The club also works towards promotion of life skills to bring about behavioural change among the youth.

97. Family life education To understand the importance of the institution of family, its changing compositions and structure, functions, family roles and responsibilities and interrelationship between family resources and family welfare. To appreciate physical, physiological, psychological and social changes and developments during the process of growing up, contraception and adolescent pregnancy .

98. To understand the significance of marriage, responsible parenthood, changing gender roles and male responsibilities in the family life. To develop positive attitude and responsible behaviour towards various issues of family life and to appreciate traditional family values.

99. Strategies for promotion of adolescent health A- adoption of healthy life style D- develop appropriate strategy discourage early marriage and teenage pregnancy. O- organize adolescent clinic L – life skill training, legal support, parents E- educate about sexuality, safe sex, spirituality, responsible parenthood S- safe, secure and supportive enviornment C- counselling , in school inclusive of family life education E- Enable & empower for experience sharing T- Training for income generation, teen clubs.

100. Iodine deficiency control programme India launched goiter control programme in 1962 based on iodized salt. National iodine deficiency disorder control programme (NIDDCP) was launched during 1988-89 at the state health directorate as 100% centrally sponsored scheme with the creation of IDD cell.

101. Objectives: To emphasis the wider implications of iodine deficiency with focus on provision of iodated salt and identification of endemic areas. To orient all the medical & paramedical staff of health department about the eider spectrum of iodine deficiency disorder. To make aware of all the officers and field workers of the other department like social welfare, education, food & civil supply. To aware the masses through school network about IDD and Iodized salt.

102. To monitor quality of iodized salt in the field by field salt testing kits and as well as by the laboratory method. To provide recommendation to the traders, wholesalers, retailers and the consumers for proper preservation of iodized salt. To conduct survey to know the impact of the intervention

103. Description of Iodized salt Iodized salt is a common salt to which a small quantity of iodine is added. Iodized salt looks ,tastes and smells exactly like common salt. It can be used for cooking purpose as well as table salt. IDD CELL: IDD control cell at the state health directorate eligible for central assistance shall be as follows: Technical officer -1 Statistical assistant-1 LDC/Typist-1

104. Health education activities Every year 21 october is celebrated as” global IDD prevention day” in the country and the following week till 27 october is observed as global IDD week. To create awarness about IDD and importance of consumption of iodized salt several competitions like slogan writing, eassy writing, painting etc is organized among school children. Posters, folders, handbills, flex chart on IDD are prepared with the assistace of IEC section.

105. Action plan Goiter survey for all district Awareness programme in schools and blocks. Printing of IEC materials & distribution, wall painting in PHCs. Celebration of global IDD prevention day on 21 ST OCT. Strengthening of IDD monitoring laboratory. Regular salt analysis by field salt testing kit and titration method.

106. National nutritional anemia prophylaxis programme Nutritional anemia is a serious public health problem. Anemia is wide spread in the country. It especially affects women in the reproductive age group and young children. Women are anemic. Nutritional anemia , due to iron and folic acid deficiency is directed or indirected responsible for about 20% of maternal death. Cause the incidence of premature births, low birth weight and perinatal mortality.

107. Strategies Significantly decreasing the prevalence and incidence of anemia in women in reproductive age group, especially pregnant and lactating women and pre school children. Promotion of regular consumption of foods rich in iron. Provisions of iron and folate supplemets in the form of tablets to the high risk group. Identification and treatment of severely anemic cases.

108. The programme is implemented through the primary health centres and sub centres . MHW and other paramedicals working in the PHC are responsible for the distribution of iron tablets to pregnant and lactating mother. ICDS programme under the department of women and child development assist in the distribution of iron tablets to children and mothers in the ICDS blocks and for imparting education to mother on prevention of nutritional anemia.

109. Prevention nutritional anemia Promoting consumption of iron rich food. Regular intake of iron and folic acid rich foods. Mothers attending antenatal clinic, immunization sessions. Regular consumption of iron rich food such as green leafy vegetables, cereals such as wheat, ragi ,, bajara , jowar , pulses jaggery must be promoted. Vitamin C promote absorption of iron. Like lemon, orange, gauva , amla , green mango.

110. Promoting consumption of iron and folic acid supplements all pregnant women irrespective of hemoglobin levels, must be provided with the recommended dose of iron folic acid supplements. Preschool children especially in tribal area and ICDS blocks, should be given on priority the recommended dosage of iron and folic acid supplements. Growth monitor cards, registers used for monitoring the growth of preschool children under the ICDS Programme. Recording and monitoring the distribution of iron and folic acid supplements.

111. Mid day meal programme It is also known as school lunch programme. Operated since 1961 throughout the country. Aims : to attract more children for admission to schools and retain them so that literacy improvement of children could be brought about.

112. Objectives : To address class room hunger and encourage poor children, belonging to disadvantaged sections, to attend school regularly and help them to concentrate on classroom activities. To improve the nutritional status of the children in class I-VIII in government, local body and government aided schools. Provide nutritional support to children in drought affected areas during summer vacation.

113. Mid day meal scheme Mid day meal is also known as national programme of nutritional support to primary education. It was launched as a centrally sponsored scheme in 15 th august 1995 and revised in 2004. Being universalization of primary education by increasing enrollment, retention and attendance impacting on nutrition of students in primary classes.

114. Principles to formulate mid day meal for school children The meal should be supplement and not a subtitude for the home diet. The meal should supply at least one third of the total energy requirement and half of the protein need. The cost of the meal should be reasonably low. It can be prepare easily in schools, no complicated cooking process should be involved. Locally available foods should be used. Menu should be frequently changed to avoid monotony.

115. NATIONAL GUINEA WORM ERADICATION PROGRAMME India launched this programme in 1984 with technical assistance form WHO. The country has reported zero cases of dracnculiasis since august 1996. The international commission for the dracunculisis eradication recommended that india be certified free of dracunculiasis transmission.

116. The following activities are continuing as per recommendations of international certification team Health education for school children and women in rural areas. Rumor registration and rumor investigation Continuation of surveillance Careful supervision of the functioning of the hand pumps and other sources of safe drinking water.

117. National water supply and sanitation programme This programme was initiated in 1954 with the objective of providing safe water supply and adequate drainage facilities for the entire population of country. 1972 special programme known as “ accelerated rural water supply programme” was started as a supplement to the national water supply and sanitation programme.

118. The government of India launched the international drinking water supply and sanitation decade programme in 1981. Target were set on coverage – 100% coverage for water, both in urban and rural and 80% for urban sanitation and 25 % for rural sanitation. Swajaladhara Launched on 25 th dec 2002. Providing safe drinking water in rural area, with full ownership of community, building awareness among the village community. Better hygiene practice and encouraging water conservation practice along with rain water harvesting.

119. Minimum needs programme It was introduced in the first year of the fifth five year plan (1974-78). Objective: to provide basic minimum needs and thereby improving the living standards of people. Principles: Facilities provided those area which are at present underserved. Inter- sectoral area projects to have a greater impact.

120. Components: Rural health Rural water supply Rural electrification Elementary education Adult education Nutrition Enviornmental improvement of urban slums Houses for landless labourers

121. 20 point programme This programme was described as an agenda for national action to promote social justice and economic growth. On 20 august 1986, the existing 20 point programme was reconstructed with the following objectives.

122. Components 1.Employment generation under the National Rural Employment Guarantee Act. 2. Swaranjayanti Gram Swarojgar Yojana . 3. Sampoorna Grameen Rojgar Yojana . 4. Self Help Groups 5. Distribution of Waste land to landless. 6. Minimum Wages Enforcement (including Farm Labour ) 7. Food security: 8. Rural Housing- Indira Awaas Yojana . 9. EWC/LIG Houses in Urban Areas. 10. Rural Area - Accelerated Rural Water Supply Programme

123. 11. Immunisation of Children. 12. Sanitation Programme in Rural Areas. 13. Institutional Delivery. 14. SC Families Assisted. 15. ST Families Assisted. 16. Universalisation of ICDS Scheme. 17. Functional Anganwadis . 18. Number of Urban poor families assisted under seven point charter viz. Land tenure, housing at affordable cost, water, sanitation, health, education and social security. 19.supply of electricity 20. Rehabilitation of handicapped and orphans.

124. National mental health programme first draft 1981 by 70 mental health professional Second draft august 1982 group by expert psychiatry, medical profession, experts education, administration, law, social welfare.

125. Objectives: Basic mental health care to the needy especially the poor from rural, slum or tribal areas. Application of mental health knowledge in general health care and in social development. Promotion of community participation in mental health services development and increase of efforts towards self help in the community. Prevention and treatment of mental and neurological disorders and their associated disabilities. Use of mental health technology to improve general health services.

126. Approaches: Integration of mental health care services with the existing general health services. Utilization of existing infrastructure of health services and also deliver the minimum mental health care services. Appropriate task oriented training to the existing health staff. Linkage of mental health services with the existing community development programme.

127. components 1. treatment 2. rehabilitation 3. prevention 1. a. Health supervisors will be trained: Management psychiatric emergency Administration and supervision of maintenance, treatment for chronic psychiatric condition. Recognize and management of epilepsy. Counseling in problem with alcoholism, drug abuse

128. 1. b. at PHC Medical officer will be trained Supervision of mental health task Assessment and diagnosis of cases using flow chart Treatment and functional psychosis Treatment of uncomplicated cases associated with medical conditions with appropriate drugs Epidemiological surveliance of mental morbidity

129. 1.c. district hospital Psychiatry specialist attached to every dist hospital. Medical consultation to medical officers to treat difficult cases. 30-50 bed attached to dist hospital and provide brief treatment for acute cases needing ECT, higher doses of psychotropic medication. Mental hospitals & treatment psychiatric units. Formation of centre of mental heath education.

130. 2. rehabilitation Treatment of epileptics and psychotics at the community levels and development of rehabilitation centers at both the district and higher referral centers 3. prevention It is community based at community level with limited involment of health personnel. Initial focus on prevention and control of alcohol related problems.

131. Re-strategized NMHP Formally launched oct 22 nd 2003 at new delhi . Strengthening medical colleges to improve psychiatric treatment facilities with adequate manpower. Mordernization of mental hospitals. Research and development of programmes in the field of community mental health. Promoting intersectoral collaboration and linkage with other national programme Provision of psychotopic drugs Involvement of private sectors and NGOs. Organization public mental health education

132. District mental health programme Govt. of india launched a scheme of DMHP under NMHP in 1986 by assisting the state governments to implement the programme in one district. To provide sustainable basic mental health services to the community and to integrate these services with other health services. To take pressure off the mental hospitals. To reduced the stigma attached towards mental illness

133. Nurses role in national health programme Meeting the basic needs Conducting occupational therapy, recreational therapy, individual and group therapy Mental health education to the individual and families and public in general. Training to professional and non professional working at the taluka and PHC. Supervise the multipurpose workers in mental healthcare delivery.

134. Thank you