National Health Programme Part 3

1st Year MSc Nursing
Medical Surgical Nursing
MIMS CON

1. NATIONAL HEALTH PROGRAMME Prepared by Ms Theertha P Krishna 1 st year Msc Nursing MIMS CON

2. NATIONAL MENTAL HEALTH PROGRAMME

3. NATIONAL MENTAL HEALTH PROGRAMME The Government of India Launched the National Mental Health Program (NMHP) in 1982, keeping in view the heavy burden of mental illness in the community & the absolute inadequacy of mental health care infrastructure in the country to deal with it.

4. AIM… 1. Prevention & treatment of mental neurological disorders & their associated disabilities. 2. Use of mental health technology to improve general health services. 3. Application of mental health principles in total national development to improve quality of life.

5. OBJECTIVES… 1. To ensure availability & accessibility of minimum mental health care for all in the foreseeable future, particularly to the most vulnerable & underprivileged sections of the population. 2. To encourage application of mental health knowledge in general health care & social development. 3. To promote community participation in the mental health services development & to stimulate efforts towards self-help in the community.

6. STRATEGIES… 1. Integration of mental health with primary health care through the NMHP; 2. Provision of tertiary care institutions for treatment of mental disorders; 3. Eradicating stigmatization of mentally ill patients & protecting their rights through regulatory institutions like the central mental health authority, & state mental health authority .

7. APPROACHES… 1. Integration of mental health care services with the existing health services. 2. Utilization of the existing infrastructure of health services & also deliver the minimum mental health care services. 3. Provision of appropriate task-oriented training to the existing health staff. 4. Linkage of mental health services with the existing community development program

8. COMPONENTS… I. Treatment: Multiple levels II. Rehabilitation III. Prevention

9. I. Treatment: Multiple levels A. Village & sub-center Level Multipurpose Workers (MPW) & Health Supervisors (HS), under the supervision of Medical Officer (MO) to be trained for: a. Management of psychiatric emergencies. b. Administration & supervision of maintenance treatment for chronic psychiatric disorders. c. Diagnosis & management of grandmal epilepsy, especially in children. d. Liaison with local school teachers & parents regardingmental retardation & behavioral problems in children. e. Counseling problems related to alcohol & drug abuse.

10. B. MO of primary Health Center (PHC) aided by HS, to be trained for: a. Supervision of MPW’s performance. b. Elementary diagnosis. c. Treatment of functional psychosis. d. Treatment of uncomplicated cases of psychiatric disorders associated with physical diseases. e. Management of uncomplicated psychosocial problems. f. Epidemiological surveillance of mental morbidity.

11. C. District Hospital: • It was recognized that there should be at least one psychiatrist attached to every district hospital as an integral part of the district health services. • The district hospital should have 30-50 psychiatric beds. • The psychiatrist in a district hospital was envisaged to devote only a part of his time to clinical care & a greater part in training & supervision of non-specialist health workers.

12. D. Mental hospitals & teaching psychiatric units : Major activities of these higher centers of psychiatric care include: a. Help in care of ‘difficult’ cases. b. Teaching. c. Specialized facilities like, occupational therapy units, psychotherapy, counseling & behavioral therapy.

13. II. Rehabilitation The components of this sub-program include treatment of epileptics & psychotics at the community level & development of rehabilitation centers at both the district level & higher referral centers.

14. III. Prevention The prevention component is to be community-based, with initial focus on prevention & control of alcohol-related problems. Later on, problems like addictions, juvenile delinquency & acute adjustment problems like suicidal attempts are to be addressed.

15. NATIONAL GUINEAWORM ERADICATION PROGRAMME

16. GUINEAWORM ERADICATION PROGRAMME India is the first country in the world to establish the National Guinea Worm Eradication Programme in 1983-84 as a centrally sponsored scheme on 50-50 sharing between Centre and States with the objective of eradicating guinea worm disease from the country.

17. GUINEAWORM ERADICATION PROGRAMME The National Institute of Communicable Diseases (NICD), Delhi worked as the nodal agency for planning, coordination, guidance and evaluation of NGWEP in the country.

18. THE IMPORTANT STRATEGY ADOPTED TO ERADICATE THE GW: 1.GW case detection and continuous surveillance through active case search operations and regular monthly reporting 2.GW case management 3.Vector Control by the application of Tempos in unsafe water sources eight times a year and use of fine nylon mesh/double layered cloth strainers by the community to filter Cyclops in all the affected villages

19. THE IMPORTANT STRATEGY ADOPTED TO ERADICATE THE GW: 4.Health education 5.Trained manpower development and 6.Provision and maintenance of safe drinking water supply on priority in GW endemic villages 7.Concurrent evaluation and operational research

20. GUINEA WORM DISEASE FREE" " Zero" incidence has been maintained since August 1996 through active surveillance and intensified field monitoring in the endemic areas. In the Meeting of WHO in February 2000 the India has been certified for the elimination of Guinea Worm Disease and on 15th February 2001 declared India as "Guinea Worm Disease Free".

21. YAWS ERADICATION PROGRAMME

22. YAWS ERADICATION PROGRAMME Yaws is a disfiguring and debilitating non-venereal disease. It is a highly infectious disease transmitted by direct (person-to-person) contact. Skin shows early lesions, which on healing show little scarring. Disease can be progressive involving bone and cartilage and causing disability.

23. Clinical Features Primary/ early stage: Primary sore or as a vesicle on the knee or near the mouth. The scabs becomes macule and later a papilloma . b) Secondary Stage: rashes resemble a raspberry " framboesia " develop. They fall off without pain. c) Tertiary or later stage: gummatous lesion near bones and joints.

24. Treatment Benzathine penicillin G is the drug of choice in a dose of 1.2 million units for all cases and contacts, and half that dose (0.6 million units) for children under 10 years of age. In penicillin sensitive cases, erythromycin or tetracycline is used in recommended doses for a period of 15 days.

25. Yaws Eradication Programme The programme was started in 1996-97 in Koraput districts of Orissa then extended to endemic states as a centrally sponsored health scheme with the objectives of: 1. Interrupting the transmission of yaws infection (no case) in the country; and 2. Eradication of Yaws (i.e. no sero reactivity to RPR/VDRL in children below 5 years of age) from the country.

26. Programme Strategy 1.Manpower development 2.Detection of cases 3.Treatment of cases and contacts 4. IEC involving multi-sectors approach

27. NATIONAL PROGRAMME FOR CONTROL AND TREATMENT OF OCCUPATIONAL DISEASES

28. NATIONAL PROGRAMME FOR CONTROL AND TREATMENT OF OCCUPATIONAL DISEASES Ministry of Health & Family Welfare, Govt. of India has launched a scheme entitled " National Programme for Control & Treatment of Occupational Diseases" in 1998-99. The National Institute of Occupational Health, Ahmedabad (ICMR ) has been identified as the nodal agency for the same.

29. Following research projects has been proposed to initiate by the Government : Prevention, control and treatment of silicosis and silico -tuberculosis in Agate Industry. Occupational health problems of tobacco harvesters and their prevention. Hazardous process and chemicals, database generation, documentation, and information dissemination

30. Following research projects has been proposed to initiate by the Government : 4. Capacity building to promote research, education, training at National Institute of Occupational Disease. 5. Health Risk Assessment and development of intervention programme in cottage industries with high risk of silicosis. 6. Prevention and control of Occupational Health Hazards among salt workers in the remote desert areas of Gujarat and Western Rajasthan.

31. Nutritional programme

32. Programme Vitamin A prophylaxis Prophylaxis against nutritional anemia IDD control programme Special nutrition programme Balwadi nutrition programme ICDS programme Mid-day meal programme Mid-day meal scheme

33. Vitamin A prophylaxis National programme for Control of Blindness is to administer a single massive dose of vitamin A containing 2,00,000 IU orally to all preschool children in the community every 6 month. Programme was launched by Ministry Of Health and Family Welfare in 1970.

34. Prophylaxis against nutritional anemia Programme was launched by Govt. of India. Distribution of iron and folic acid tablets to pregnant women and young children (1-12yrs). Control of anemia though iron fortification of common salt.

35. IDD control programme The National Goiter Control Programme launched by Govt. of India in 1962 , in the conventional goiter belt in the Himalayan region . Objective is to identify goiter endemic areas to supply iodized salt in place of common salt and to assess impact of goiter control measures over a period of time.

36. Special nutrition programme Programme started in 1970 for the nutritional benefit of children below 6 years of age, pregnant and nursing mothers. Aim is to improve the nutritional status of the target groups.

37. Special nutrition programme The supplementary food supplies about 300kcal and 10-12 grams protein per child per day. The beneficiary mothers receive daily 500 kcal and 25 grams of protein . This supplement is provided to them for about 300 days in a year.

38. Balwadi nutrition programme The programme was started in 1970 for the benefit of children in the age group 3-6 years in rural areas. The programme is implemented through Balwadis which also provide pre-primary education to these children. Food supplements provide 300kcal and 10 grams protein per child per day

39. ICDS programme Integrated child development services(ICDS ) programme was started in 1975 Supplementary nutrition, vitamin A prophylaxis and iron and folic acid distribution. Beneficiaries : pre school children below 6 years, and adolescent girls 11 to18 years.

40. ICDS programme Anganwadi Workers at village level covers a population of 1000. Mahila Mandals help anganwadi workers in providing health and nutrition services. Anganwadis is supervised by Mukhyasevikas. Field supervision by Child Development Project Officer (CDPO ).

41. Mid-day meal programme MDMP also known as School Lunch Programme. Operation since 1961. Objective ; to attract more children for admission to school and retain them so that literacy improvement of children could be brought about.

42. Principles of MDMP The meal should be a supplement and not a substitute to the home diet. The meal should supply at least 1/3 rd of total energy requirement and half of the protein need. The cost of the meal should be reasonably low.

43. Principles of MDMP The meal should be such that it can be prepared easily in schools; no complicated cooking process should be involved. Locally available foods should be used; this will reduce the cost of the meal. The menu should be frequently changed to avoid monotony.

44. MODEL MENU Foodstuff g/day/child Cereals and millets 75 Pulses 30 Oils and fats 8 Leafy vegetables 30 Non leafy vegetables 30

45. Mid-day meal scheme Also known as National Programmme of Nutritional Support to Primary Education. Launched in 15 TH August 1995 and revised in 2004. Objective : being universalization of primary education by increasing enrolment, retention and attendance and simultaneously impacting on nutrition of students in primary classes.

46. Beneficiaries of mid-day meal scheme The programme covered children of primary stage (classes I to V) in government, local body and government aided schools and extended in October 2002, to cover children studying in Education Guarantee Scheme and Alternative and Innovative Education Centres also.

47. NATIONAL WATER SUPPLY AND SANITATION PROGRAMMME

48. The programme was initiated in 1954 with the object of providing safe water supply and adequate drainage facilities for the entire urban and rural population of the country. In 1972 the Accelerated Rural Water Supply Programme was started as a supplement to the national water supply and sanitation programme.

49. A PROBLEM VILLAGE One where no source of safe water is available within a distance of 1.6km or where water is available at a depth of more than 15 metres or where water source has excess salinity, iron, fluorides and other toxic elements or water is exposed to the risk of cholera..

50. The Government of India launched the International Drinking Water Supply and Sanitation Decade Programme in 1981. 100% coverage for water, both rural and urban, 80% for urban sanitation and 25% for rural sanitation. The stipulated norm of water supply is40liters of safe drinking water per capita per day and at least one hand pump/spot source for every 250persons.

51. Swajaldhara Launched on 25 th December 2002. Community led participatory programme. Aims at, 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, including better hygiene practices and encouraging water conservation practices along with rainwater harvesting .

52. components Swajaldhara I ( First Dhara ) is for a gram panchayat or a group of panchayats ( block / tehsil level). Swajaldhara II ( Second Dhara ) has district as the project area. District water and sanitation mission sanctions Swajaldhara I.

53. MINIMUM NEED’S PROGRAMME The Minimum Needs Program (MNP ) was introduced in the country in the first year of the Fifth Five Year Plan (1974–78). The objective of the programme is to provide certain basic minimum needs and thereby 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 undeserved population .”

54. Basic principles The facilities under MNP are to be first provided to those areas which area present underserved so as to remove disparities between different areas. The facilities under MNP should be provided as a package to an area through intersectoral area projects, to have a greater impact.

55. COMPONENT OF MINIMUM NEED’S PROGRAMME Rural health Rural water supply Rural electrification Elementary education Adult education Nutrition Environmental improvement of Urban slums Houses for landless labourers

56. 1. Rural health The objectives to be achieved under MNPs : One PHC fro 30,000 population in plains and 20,000 population in tribal and hilly areas. One sub centre for a population of 5000 people in the plains and fro 3000 in tribal and hilly areas. One CHC (rural hospital) for a population of one lakh .

57. 2.Rural water supply Water supply and sanitation is a state responsibility under the Indian Constitution. State may give the responsibility to the Panchayathi Raj Institutions(PRIs) in rural areas. In the urban areas responsibility is given to the municipalities called Urban Local Bodies(ULB)

58. Water supply

59. 3. Rural electrification A village is classified as electrified if electricity is being used within its revenue area fro any purpose what so ever. The basic infrastructure such as distribution transformer and or distribution lines is made available in the inhabited locality within the revenue boundary of the village including at least one Dalit Basti as applicable.

60. 4. Elementary education Elementary education is also called primary education in India. Primary education starts at age of 5 and ends when he or she is 12 to 13 years old. In India primary education starts from Class 1 or grade 1 and goes up to Class 6/7 or Grade 6/7. Elementary education does not include Kinder Garden and pre schooling. So in India elementary education or primary school is from Class 1 through Class 7.

61. 5. Adult education According to Houle (1996) Adult education is the process by which men and women seek to improve themselves or their society by increasing their skill, knowledge or sensitiveness . According to Courtney (1989) Adult education is an intervention into the ordinary business of life-an intervention whose immediate goal is change in knowledge or competence.

62. 6.Nutrition ( a) To expand nutrition support to 11 million eligible persons. ( b) To expand “ special nutrition programme ” to all the ICDS projects ( c) To consolidate the mid-day meal programme and link it to health, portable water and sanitation.

63. 7. Environmental improvement of Urban slums Slum Areas Improvement and Clearance Act 1956 . An Act to provide for the improvement and clearance of slum areas in certain Union territories and for the protection of tenants in such areas from eviction.

64. 8. Houses for landless labourers The government's approach to rural housing has been based on four considerations: (1) Highly subsidized housing should be provided for the poor (2) The poor should use their own labour to construct their houses (3) Low-cost houses should use local materials and local skills (4) The public, the co-operative and the household sectors should be involved in housing activity. 

65. 20 POINT PROGRAMME In 1975 the Govt. of India initiated a special activity- 20 point programme. An agenda for national action to promote social justice and economic growth. On August 20,1986,programme restructured. Described as “ the cutting edge of the plan for the poor.”

66. objectives “ Eradication of poverty , raising productivity , reducing inequalities , removing social and economic disparities and improving the quality of life ”

67. LIST of 20 points Point1 :Attack on rural poverty Point2 :Strategy for rained agriculture Point3 :Beter use of irrigation water. Point4 :Bigger harvest. Point5 :Enforcement of land reforms. Point6 :Special programmes for rural labour. Point 7 : Clean drinking water

68. Point 8 : Health for all Point9 : Two-child norm Point10 : Expansion of education Point11 :Justice for SC/ST . Point12 :Equality for women Point13 :New opportunities for women. Point14 : Housing for the people

69. Point15 :Improvement of slums Point16 .New strategy for forestry. Point17 : Protection of the environment Point18: Concern for the consumer. Point19 :Energy for the villagers. Point20: A responsive administration

70. POINTS RELATED TO HEALTH Points,1,7,8,9,10,14,15 & 17 are directly or indirectly related to health.

71. LIST OF 20 POINTS-2006 Poverty Eradication Power to People Support to Farmers Labour Welfare Food Security

72. Housing for All Clean Drinking Water Health for All Education for All Welfare of Scheduled Castes, Scheduled Tribes, Minorities and OBCs

73. Women Welfare Child Welfare Youth Development Improvement of Slums Environment Protection and Afforestation

74. Social Security Rural Roads Energisation of Rural Area Development of backward Areas IT Enabled e-Governance

75. ROLE OF NURSE’S Nurses must be aware about the national health programmes, their strategy and implementation. Nurse should participate actively in such programme while working in community. Nurse must know government department and their activities noting where and whom advice can be obtained.

76. ROLE OF NURSE’S Nurse should study the various government and other forms for reports that are required weekly, monthly/ quarterly/ yearly from CH department. Find out and discuss about different social activities and self help project in the community, their value and effect upon the community.

77. ROLE OF NURSE’S In addition the responsibility includes: Case finding, case Holding, Follow up, referrals, records and education. This role or approach in community can be implemented by suing nursing process. Nurse must be active participant in each and every national health programme. As he/she is the key person for health team he/she needs to be alert, attentive and supporter.