National health programmes related to child health and welfare

National programmes related to child health in India

1. NATIONAL HEALTH PROGRAMMES FOR CHILDREN IN INDIA

2. How to achieve health By improving host resistance to environmental hazards By improving environmental safety By improving health systems designed to increase the likelihood, efficiency & effectiveness of the first two goals

3. Programmes for Communicable Diseases National Vector Borne Diseases Control Programme (NVBDCP) Revised National Tuberculosis Control Programme National Leprosy Eradication Programme National AIDS Control Programme Universal Immunization Programme National Guinea worm Eradication Programme Yaws Control Programme Integrated Disease Surveillance Programme

4. Programmes for Non Communicable Diseases National Cancer Control Program National Mental Health Program National Diabetes Control Program National Program for Control and treatment of Occupational Diseases National Program for Control of Blindness National program for control of diabetes, cardiovascular disease and stroke National program for prevention and control of deafness

5. National Nutritional Programs Integrated Child Development Services Scheme Midday Meal Programme Special Nutrition Programme (SNP) National Nutritional Anemia Prophylaxis Programme National Iodine Deficiency Disorders Control Programme

6. Programs related to System Strengthening /Welfare National Rural Health Mission Reproductive and Child Health Programme National Water supply & Sanitation Programme 20 Points Programme

7. National Health Policies National Health Policy 2002 National Population Policy 2000 National AIDS control and Prevention Policy National Blood Policy National Policy for empowerment of Women 2001 National Charter for Children National Youth Policy 2001998 National Nutrition Policy

8. Various national health programs are currently in operation for the improvement of child health and prevention of childhood diseases. The brief lists of these programms are : Reproductive and Child Health Program. Universal Immunization Program Integrated Child Development Services Scheme School Health Program Nutritional Program

9. The Reproductive and Child Health (RCH) Programme It was launched in October 1997. The main aim of the programme is to reduce infant, child and maternal mortality rates. The main objectives of the programme in its first phase were: To improve the implementation and management of policy by using a participatory planning approach and strengthening institutions to maximum utilization of the project resources To improve quality, coverage and effectiveness of existing Family Welfare services

10. To gradually expand the scope and coverage of the Family Welfare services to eventually come to a defined package of essential RCH services. Progressively expand the scope and content of existing FW services to include more elements of a defined package of essential Give importance to disadvantaged areas of districts or cities by increasing the quality and infrastructure of Family Welfare services

11. RCH-I had a number of successful and unsuccessful outcomes. Base line statistics were recorded in 1998-99 and compared to 2002-03. Percentage of women receiving any ANC rose by about 12 % to reach 77.2%. But use of government health facilities has declined. Use of contraceptives increased by 3.3 % to 52.0 %, while family planning due to spacing method rose by 3.3% to 10.7 %. Use of permanent methods did not change. Infant mortality came down from 71to 63 but the aim of universal immunization was far from reach. Polio though reduced has not met the eradication target. Not enough attention was paid to awareness of diarrhoea management and Acute Respiratory Infection danger signs hence resulting in a rise of case incidents.

12. The child health programmes is now its second phase: RCH-II. Following are the aims of the programme: Expand services to the entire sector of Family Welfare beyond RCH scope Holding States accountable by involving them in the development of the programme Decentralization for better services Allowing states to adjust and improve programmes features according to their direct needs.

13. Improving monitoring and evaluation processes at the District, state and the Central level to ensure improved program implementation. Give performance based funding, by rewarding good performers and supporting weak performers. Pool together financial support from external sources Encourage coordination and convergence, within and outside the sector to maximize use resources as well as infra structural facilities

14. The recommended package of services: For the mothers: Tetanus Toxoid Immunization Prevention and treatment of anaemia Antenatal care and early identification of maternal complications Deliveries by trained personnel Promotion of institutional deliveries Management of obstetric emergencies Birth spacing

15. For the children: Essential newborn care Exclusive breast feeding and weaning Immunization Appropriate management of diarrhoea Appropriate management of ARI Vitamin A prophylaxis Treatment of Anemia For eligible couple: • Prevention of pregnancy • Safe abortion Prevention and treatment of reproductive tract infection (RTI) and sexually transmitted diseases (STD).

16. Women of reproductive age must receive: Counselling on Importance of care of girl child Optimal timing & spacing of birth Small family norms Use and choice of contraceptives Prevention of RTI / STI Information on Availability of MTP Services IUD & sterilization services Family Planning Services Condom distribution Oral contraceptives IUD

17. Universal Immunization Programme Sponsored by Central Government Funding Pattern- It is a Centrally sponsored scheme, so the total funding is managed by the Central Government. Ministry/Department- Department of Health & Family Welfare Department Description- Universal immunization programme, UIP, was launched in 1985 in a phased manner. Immunization is one of the most cost effective interventions for disease prevention. Traditionally, the major thrust of immunization services has been the reduction of infant and child mortality.

18. Immunisaton is an important vehicle for health promotion and therefore is a true national investment. As per NFHS 3 data, full immunization coverage in Odisha was 52 percent and no immunization was 9 percent. Evaluated coverage by UNICEF in the last 3 years indicates that there is a decline in coverage of all antigens. Proportion of districts achieving 80 percent of DPT3 coverage has also decreased. As per NHFS 3, full immunization has increased to 51.8 percent of children from 12 to 23 months and sustained efforts can increase it further. Districts will provide equitable, efficient and safe immunization services to all infants and pregnant women.

19. The aim is to achieve 100 percentages of full immunization status by 2009 to 2010 and to maintain it for long. The objectives of the mission are: Contribute to global eradication of Polio by 2007. Elimination of Neonatal Tetanus, Diphtheria and Pertussis by 2009. Establish sufficient sustainable and accountable fund flow at all levels. Ensure that there is sustained demand and reduced social barriers to access immunization services.

20. The strategies of the programme are: I. Reducing drop outs rate and missed opportunities. II. Strengthen institutional training at all levels. III. Strengthen coordination and review meeting at all levels. IV. Strengthening micro planning processes in all districts and urban areas. V. Strengthening coordination with national operational guidelines, supervision practices and prioritizing poorly performing districts and under served populations. VI. Reaching the under served by influencing behavior at household level through BCC.

21. Integrated Child Development Services (ICDS) ICDS being implemented by Ministry of Women and Child Development is the world’s largest programme aimed at enhancing the health, nutrition and learning opportunities of infants, young children (O-6 years) and their mothers. It is the foremost symbol of India’s commitment to its children – India’s response to the challenge of providing pre school education on one hand and breaking the vicious cycle of malnutrition, mortality and morbidity o the other.

22. The Scheme provides an integrated approach for converging basic services through community based workers and helpers. The services are provided at a centre called the ‘ Anganwadi ’, which literally means a courtyard play centre, a childcare centre located within the village itself. The package of services provided are: Supplementary nutrition, Immunization, Health check-up Referral services, Pre-school non-formal education and Nutrition and health education

23. It is a centrally sponsored scheme implemented through the State Governments with 100% financial assistance from the Central Government for all inputs other than supplementary nutrition which the States were to provide from their own resources. However, from the year 2005-06, the Government of India has decided to provide Central assistance to States for supplementary nutrition also to the extent of 50% of the actual expenditure incurred by States or 50% of the cost norms, whichever is less.

24. School Health program School Health program is a program for school health service under National Rural Health Mission, which has been necessitated and launched in fulfilling the vision of NRHM to provide effective health care to population throughout the country. It also focuses on effective integration of health concerns through decentralized management at district with determinant of health like sanitation, hygiene, nutrition, safe drinking water, gender and social concern. The School Health Programme intends to cover 12,88,750 Government and private aided schools covering around 22 Crore students all over India

25. The School health programme is the only public sector programme specifically focused on school age children. Its main focus is to address the health needs of children, both physical and mental, and in addition, it provides for nutrition interventions, yoga facilities and counseling. It responds to an increased need, increases the efficacy of other investments in child development, ensures good current and future health, better educational outcomes and improves social equity and all the services are provided for in a cost effective manner.

26. Components of School Health Program: 1. Screening, health care and referral: Screening of general health, assessment of Anaemia /Nutritional status, visual acuity, hearing problems, dental check up, common skin conditions, Heart defects, physical disabilities, learning disorders, behavior problems, etc. Basic medicine kit will be provided to take care of common ailments prevalent among young school going children. Referral Cards for priority services at District / Sub-District hospitals.

27. 2. Immunisation : As per national schedule Fixed day activity Coupled with education about the issue 3. Micronutrient (Vitamin A & IFA) management: Weekly supervised distribution of Iron- Folate tablets coupled with education about the issue Administration of Vitamin-A in needy cases. 4. De-worming: As per national guidelines Biannually supervised schedule Siblings of students also to be covered

28. 5. Health Promoting Schools: Counseling services Regular practice of Yoga, Physical education, health education Peer leaders as health educators. Adolescent health education-existing in few places Linkages with the out of school children Health clubs, Health cabinets First Aid room/corners or clinics. 6. Capacity building 7. Monitoring & Evaluation 8. Mid Day Meal

29. NUTRITIONAL PROGRAMMES

30. INTRODUCTION The various nutritional programmes are in operation in India since 1 st five year plan period. International agencies such as WHO, UNICEF, FAO, CARE are assisting the Govt. in these programmes of India to improve nutrition of the people with special emphasis on mother & children.

31. FUNCTIONS fall in 3 categories To eradicate major causes of malnutrition. -Increase food production -Provide safe drinking water -improve environmental sanitation -control of communicable diseases -nutritional education to the masses -promoting kitchen garden

32. Cont……. Aspects specially related to women and children -to improve the employment opportunities for women -provision of better health care to parents & children -promoting breast feeding -weaning at right time

33. Cont……. Special reference to pregnant & lactating mothers -to raise nutritional status through nutritional education -promoting small handicrafts scheme through self employment

34. NATIONAL PROGRAMMES ON NUTRITION Vitamin-A Prophylaxis Program. Prophylaxis against nutritional anemia. Control of iodine deficiency disorders. Applied nutritional program. Special nutrition program. Balwadi nutrition program. Midday meal program. Integrated child development services scheme.

35. VITAMIN-A PROPHYLAXIS PROGRAMME Launched by Ministry of Health and Family Welfare in 1970. On the basis of technology developed at NIN this was launched. Component- control of Blindness Beneficiary group – preschool children 200,000 IU of oily preparation of Vitamin A ( retinol palmitate 110mg) administered orally every 6 months for every preschool child above 1 year.

36. Cont……. Age of the child Quantity of vitamin A administered At 9 th month 1,00,000 IU 15 th - 16 th months Mega dose of 2,00,000 IU 18 - 24 months 2,00,000 IU 24 - 30 months 2,00,000 IU 30 - 36 months 2,00,000 IU

37. 1 IU is equivalent to 0.3 microgram of retinol. Vitamin A deficiency increases the severity of mortality from measles and diarrhea. Increased infectious morbidity and mortality is apparent even before the appearance of xerophthalmia Improving the vitamin A status of deficient children aged 6 months to 6 years can dramatically reduce their morbidity and mortality from infection

38. Cont……. Prompt administration of large doses of vitamin A to children with moderate to severe measles, particularly if they may be vitamin A deficient, can reduce individual mortality by 50% and prevent or moderate the severity of complications.

39. PROPHYLAXIS AGAINST NUTRITIONAL ANAEMIA

40. Cont…… The programme was launched in 1970 to prevent nutritional anemia in mothers and children. the expected and nursing mothers as well as acceptors of family planning are given one tablet of iron and folic acid containing 60 mg elementary iron which was raised to 100 mg elementary iron, however folic acid content remained same (0.5 mg of folic acid).

41. Cont…... Children in the age group of 1-5 years are given one tablet of iron containing 20 mg elementary iron (60 mg of ferrous sulphate and 0.1 mg of folic acid) daily for a period of 100 days. This programme is being taken up by Maternal and Child Health (MCH) Division of Ministry of Health and Family Welfare.

42. Cont……. Now it is part of RCH programme. National programmes to control and prevent anemia have not been successful. Experiences from other countries in controlling moderately-severe anemia guide to adopt long term measures i.e. fortification of food items like milk, cereal, sugar, salt with iron. Nutrition education to improve dietary intakes in family for receiving needed macro/micro nutrients as protein, iron and vitamins like folic acid, B,C, etc. for hemoglobin synthesis is important.

43. Cont……. Nutritional Anemia Control Programme should be comprehensive and incorporate nutrition education through school health and ICDs infrastructure to promote regular intake of iron/ folic acid-rich foods, to promote intake of food which helps in absorption of iron and folic acid and adequate intake of food. The technology for the control of anemia through iron fortification of common salt has also been developed at the NIN, Hyderabad.

44. CONTROL OF IODINE DEFIECIENCY DISORDERS

45. Cont……. The government of India, launched the National Goiter control programme (NGCP) in 1962. It aimed at replacement of ordinary salt by iodised salt, particularly in the goiter endemic regions. The program of universal iodisation of edible salt was started from first April 1986 in phases with the aim of total salt iodisation by 1992.

46. Cont…… IN 1992, the NGCP was renamed as national iodine deficiency disorder control programme. The central government provides case grants for health education and publicity campaign for promoting the consumption of Iodised salt. The central government also provides cash grants for establishing IDD control cells in the state health directorates.

47. Cont…… A national reference laboratory monitoring of IDD has been set up at the bio-chemistry division of the national institute of communicable disease, Delhi. It monitors the Iodine content of salt in urine

48. Cont……. The medical and paramedical personnel monitoring laboratories have been established at the district level also in many districts in allocation of Rs.75,000/- district laboratory has been provided for this purpose.

49. SPECIAL NUTRITION PROGRAMME

50. SNP The programme was launched in the country in 1970-71 for the benefit of children below 6 years of age, pregnant and nursing mothers. Originally launched as a central programme and was transferred to the state sector in fifth Five year plan as part of the Minimum Needs Programme. AIM- To improve the nutritional status of the target groups.

51. Cont…… OBJECTIVES: To improve the nutritional status of women, pre-school children, pregnant women and lactating women in urban, slums, tribal areas and drought prove rural areas The main activities of the program are: -To provide supplementary nutrition -To provide health services, including supply of vitamin-A solution and iron and folic acid

52. Cont…….. It provides supplementary feeding of about 300 calories and 10 grams of protein to preschool children and about 500 calories and 25 grams of protein to expect at and nursing mothers for six days a week. This programme was operated under Minimum Need Programme. The programme was taken up in rural areas inhibited predominantly by lower socio-economic groups in tribal and urban slums.

53. Cont…….. Fund for nutrition component of ICD programme is taken from the SNP budget. This supplement is provided for 300 days in a year.

54. BALWADI NUTRITION PROGRAMME This programme which was started in December 1970. It is under the overall charge of the Department of Social Welfare. It is being promoted with the help of four national-level voluntary organisations , namely, the Indian Council for Child Welfare, Harijan Sewak Sangh , Bharatiya Adamjati Sewak Sangh and Central Social Welfare Board. Beneficiary group – 3 to 6 years.

55. Cont…….. Visualizes on the provision of supplementary nutrition to the extent of 300 calories and 15 grams of protein during 250 days in a year for children attending Balwadis .

56. ICDS PROGRAMME Started in 1975 in pursuance of the National Policy for children. Strong nutritional component in this programme is in the form of -Supplementary nutrition -Vitamin A prophylaxis -Iron and folic acid distribution

57. Cont……. Beneficiary group: children below 6 years adolescent girls elderly pregnant and lactating women Services: Supplementary nutrition, immunization Health checkups, medical referral services, nutrition and health education to women non formal education.

58. Cont……… Service Delivery : Anganwadi Workers Each Anganwadi unit covers a population of about 1000. A network of Mahila Mandals has been built up in ICDS Project areas to help Anganwadi workers in providing health and nutrition services.

59. Cont……… The work of Anganwadis is supervised by Mukhyasevikas. Field supervision is done by the Child Development Project Officer(CDPO).

60. APPLIED NUTRITION PROGRAMME The ANP was first introduced in 1960 in Orissa and Andhra Pradesh. It was extended there after to Tamilnadu in 1961 and Uttar Pradesh in 1962, during 1973, it was extended to all the states. Specific objectives: To make people conscious of their nutritional needs To increase production of nutrition foods and their consumption

61. Cont…. To provide supplementary nutrition to vulnerable groups through locally produced foods. Components: -Production of protective foods -Training of functionaries involved in production of these foods -Nutrition education and demonstration

62. Cont…. Specific activities: Supplementary feeding Non-formal preschool education Nutrition education Poultry forming Providing better seeds and seedling Raising kitchen gardens

63. Cont…… Beneficiaries: Children between 2-6 years, pregnant and lactating mothers. The children and women are given supplementary nutrition's worth 25paise / day / child , 50paise / women/day respectively. A single supplementary meals is given weekly for 25 days/year.

64. Applied nutrition programme

65. Cont….. Evaluation: Studies show that ANP has not generated and desired awareness for production and consumption to protective food, the community kitchens and school gardens could not function properly. In reality the program lacked effective supervision and has almost become defunct.

66. MID-DAY MEAL PROGRAMME Also known as School Lunch Programme.

67. Cont….. 1 st organised in 1957 in TamilNadu . In operation since 1961 throughout the country. AIM: 1/3 rd of the required food per day for the child be furnished through this programme .

68. Cont……. OBJECTIVE: - To improve the nutritional status of children and imparting nutritional education. - To ensure universal primary education. - To attract more children for admission to schools and retain them to improve literacy rate

69. Cont…… The feeding programme is the joint venture of the health and educational department with aid from UNICEF, CARE, and other agencies. Skimmed milk, banana, rice meals etc. are provided. Cost is fixed as 12 paise per child.

70. Cont...... Princilples : supplement, not substitute 1/3 total energy and ½ total protein low cost easily prepared locally available food change menu frequently

71. Mid day meal programme

72. Cont...... It is further planned to introduce development of vegetable gardens in schools. Adding subject on nutrition in the curriculum to motivate the young minds on the concepts of nutrition for better health. There are 70 million children who benefit through this programme in India every year.

73. Have to study the food habits of people, their views etc. Needs to impart the knowledge of importance of good nutrition without hurting their cultural habits. Needs to demonstrate simple recipes which are affordable and locally available . ROLE OF NURSE

74. Cont…… Needs to use all media of health education . Needs to identify the malnourished children and refer them appropriately to the nutrition programme. Assists in nutrition rehabilitation programme. Takes part in research activities.

75. Thank you......