National health Programme related to child health

National health programme related to child health

1. N ATIONAL H EALTH P ROGRAMME R ELATED T O C HILD W ELFARE Surendra Sharma Associate Professor Amity College of Nursing

2. INT R OD U C T I O N: The ministry of health, Government of India , central health council launch programs aimed at controlling or eradicating diseases which cause considerable morbidity and mortality in India.

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

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

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

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

7. NATIONAL RURAL HEALTH MISSION 12A PRIL , 2005

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

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

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

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

12. N ATIONAL PROGRAMS RELATED TO MOTHER AND CHILD CARE

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

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

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

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

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

18.  To achieve effective co-ordination of policy and implementation amongst the various departments to promote child development  To enhance the capability of the mother to look after the normal health and nutritional needs of the child through proper nutrition and health education.

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

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

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

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

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

24. COMPO N E N TS prevention of RTI/STD adol s cvence child survival safe familly mothrhood welfre and planning community parti c ipation client part i cipa t i on

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

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

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

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

29. "The Integrated Management of Childhood Illness (IMCI)" 1992 UNICEF and WHO

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

31. IMNCI B ENEFICIARIES  Care of Newborns and Young Infants (infants under 2 months)  Care of Infants (2 months to 5 years)

32. PRINCIPLES OF IMNCI GUIDELINES  All sick young infants up to 2 months of age must be assessed of “possible bacterial infection / jaundice ” and “ diarrhea ”.  All sick children aged 2 months up to 5 years must be examined for general danger signs and then for cough or difficult breathing , diarrhea , fever or ear problem. Cont……

33.  All sick young infants and children 2 months up to 5 years must also routinely be assessed for nutritional and immunization status and feeding problem.  Management procedures use a limited number of essential drugs and encourages active participation of caretakers. Con t …….

34.  Based on signs, the child is assigned to color coded classification: “ - urgent hospital referral or admission - specific medical Rx or advice - home management

35. NATIONAL PROGRAMS RELATED TO CONTROL OF COMMUNICABLE DISEASE

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

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

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

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

40. ACUTE RESPIRATORY INFECTIONS CONTROL PROGRAM  1990- Programme launched  1992- the Programme was implemented as part of CSSM The WHO protocol puts two signs as the “entry criteria” for a possible diagnosis of pneumonia.  cough  difficult breathing. Patient treated with antibiotics  ampicillin 25-50 mg/kg/day  gentamicin 5.0mg/kg/day. for a period of 7 to 10 days

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

42. O B J E C TIV ES :  To achieve at least 85 % cure rate of the newly diagnosed sputum smear-positive TB patients  To detect at least 70% of new sputum smear- positive patients after the first goal is met.

43. STR A TEGY

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

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

46. CATEGORIES OF TB CASES AND THEIR TREATMENT REGIMENS Category Characteristic of a TB case Treatment regimen Intensive phase Continuation phase Category I New sputum smear- positive Seriously ill, sputum smear-negative • Seriously ill, extra- pulmonary 2 ( HRZE ) 3 24 does 4 ( HR ) 3 54 does Category II Relapse Failure Treatment after default Others 2(SHRZE) 3 +1( HRZE ) 3 36 does 5 ( HRE ) 3 66 does Category HI Sputum smear-negative Not seriously ill, extra- pulmonary 2 ( HRZ ) 3 24 does 4 ( HR ) 3 54 does

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

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

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

50. NATIONAL LEPROSY CONTROL PROGRAM 1955  1955 -national leprosy control program 1955  1983 –national leprosy eradication program SERVICES  Provide domiciliary treatment (MDT)  Provide services through mobile leprosy treatment units with the help of PHCstaff.  Organize health education  deformity and ulcer care and medical rehabilitation services.

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

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

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

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

55. NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAM

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

57. N ATIONAL MALARIA ERADICATION PROGRAM (1953)  1953 National Malaria Control Programme  1958 National Malaria Eradication Programme  1977 Modified Plan of Operation (MPO).  1995 Implementation of Malaria Action Plan  1997 Enhanced Malaria Control Project in tribal districts of the State (World Bank Assisted)  2000 National Anti Malaria Programme

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

59. N ATIONAL F ILARIA CONTROL PROGRAM (1995) ACTIVITES  Delimitations of the problem in unsurved areas.  Control in urban area through: (a) recurrent anti larval measures (b) anti parasitic measures  Control in rural areas through detection and treatment of microfilaria carriers/persons.

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

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

62. P REVENTION AND CONTROL OF DENGUE H EMORRHAGIC FEVER STRATEGY  Surveillance for disease and vectors.  Early diagnosis and prompt case management  Vector control through community participation and social mobilization.  Capacity building.

63. NATIONAL PROGRAMS RELATED TO CONTROL OF NUTRITIONAL DEFICIENCY DISORDERS

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

65. SPECIAL NUTRITION PROGRAM 1970

66. OBJECTIVE  To improve the nutritional status of preschool children, pregnant,and lactating mother of poor socio economic groups in urban slums,tribal area and drought prone rural area Child up to one year 200kcl and 8-10g protein/day child 1-6 years. 300 kcal 10-12g proteins/day women 500 kcal 25g p r otein / day

67. MIDDAY MEAL PROGRAM (1961)

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

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

70. BENEFICIARY  School children in the age group 6-11 year SERVICES  provides 300 calories and 8-12 g protein/day for 200 days in year

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

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

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

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

75. S CHOOL H EALTH P ROGRAMME 1977

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

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

78. NATIONAL MENTAL HEALTH PROGRAM (1982) components  1. Treatment of Mentally ill  2. Rehabilitation  3. Prevention and promotion of positive mental health.

79. OBJECTIVES  Provision of mental health services at district level.  Improvements of facilities in mental hospitals.  Training of trainers of PHC personnel in mental hospital  Program for substance use disorder.

80. NATIONAL PROGRAM FOR CONTROL OF BLINDNESS (1976)

81.  1963 : Started as National Trachoma Control Program  1976 : Renamed as National Program for prevention of Visual Impairment and Control of Blindness  1982 : Blindness included in 20-point program

82. OBJECTIVES  Dissemination of information about eye care.  Augmentation of ophthalmic services so that eye care is promptly availed off.  Establishment of a permanent infrastructure of community oriented eye health care.

83. BENIFICERY :- 6month -5 year children STREATGY Administration of vit A dose at a regular 6 month interval VIT A ADMINISTRATION SCHEDUALE  6-11 month:-100000 IU  1-5 year:-200000 IU /6 months  Child must receive total 9 does VITAMIN A DEFICIENCY CONTROL PROGRAM (1970)

84. PREVENT VIT-A DEFICIENCY THROUGH  Promotion of breastfeeding and feeding of colostrums.  Encourage the intake of green leafy vegetable and yellow colored fruit .  Increase the coverage of with measles (depletes vitamin A stores)

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

86. GOAL AND OBJECTIVE  Primary prevention of cancers by health education.  Secondary prevention i.e. early detection and diagnosis of common cancer of cervix, mouth, breast and tobacco related cancer by screening method.  Tertiary prevention strengthening of the existing institutions of comprehensive therapy including palliative therapy.

87.  Prevention of tobacco related cancer.  Prevention of cancer of uterine cervix.  Strengthening of diagnostic and treatment equipment for cancer at medical colleges and major hospitals.

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

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

90. C HILD WELFARE PROGRAM FOR DISABLED CHILDREN DISABILITY IN FIVE YEAR PLANS 1FYP -Launched a small unit by the ministry of education for the visually impaired in 1947. 2 FYP- under ministry of education a National Advisory Council for the physically challenged started. 3FYP- attention was given to rural areas and facilitated training and rehabilitation of the physically challenged. Cont……

91.  4FYP- more emphasis was given to preventive work .  6FYP- national policies were made around for provision of community oriented disability prevention and rehabilitation services to promote self reliance.

92. N ATIONAL WATER SUPPLY AND SANITATION PROGRAM 1954 OBJECTIVE providing safe water supply and adequate drainage facilities for the entire urban and rural population of the country. Cont……

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

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

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

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

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