National health programs on communicable diseases

the presentation gives the information about the national health programs conducted by the government to overcome the communicable diseases in the society,it gives the information about the drug distribution,treatment managment,halth facilities,vaccines,etc

1. KAMINENI INSTITUTE OF DENTAL SCIENCES NATIONAL HEALTH PROGRAMMES FOR COMMUNICABLE DISEASES A.MEGHANA INTERN 1

2. Introduction National Vector Borne Disease Control Programme National Anti –Malaria Programme National Filaria Control Programme Kala-Azar Control Programme National AIDS Control Programme Universal Immunization National Rural Health Mission Minimum Needs Programme Health programmes in Telangana Conclusion CONTENTS 2

3. Human health, not only influenced the immunity of society, but also social structures, culture, politics, and economics. The union ministry of health and family welfare is instrumental and responsible for implementation of various programmes on a national scale in the areas of health, prevention and control of major communicable diseases and promotion of traditional and indigenous systems of medicines.  INTRODUCTION 3

4. The first comprehensive health policy and plan document, Health Survey and Development Committee Report, i.e., Bhore Committee Report, was prepared in 1946 . EVOLUTION OF HEALTH PROGRAMMES 4 Duggal R (2014) Health planning in India. Available from http://www.cehat.org/cehat/uploads/files/a168.pdf

5. Govt of India set up a planning commission in 1950 To make assessment of the material , capital and human resources Draft developmental plans for the effective utilization of these resources 5 Duggal R (2014) Health planning in India. Available from http://www.cehat.org/cehat/uploads/files/a168.pdf

6. In post-independence national health programmes were introduced under Five year plans. Widespread national-level campaigns were started to overcome the loss by malaria, smallpox, tuberculosis, leprosy, filaria, cholera and others. 6 Duggal R (2014) Health planning in India. Available from http://www.cehat.org/cehat/uploads/files/a168.pdf

7. At the beginning of the first Five Year Plan, the B.C.G. vaccination programme was launched in the country. The National Malaria Control Programme was also launched in the same year. National Water Supply and Sanitation Programme was started in 1954 and the National Filaria Control Programme was commenced in 1955 . 7

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9. It is implemented for prevention and control of vector borne diseases namely malaria, filariasis,kalaazar , japaneese encephalitis,dengue and chikungunya. NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAM OBJECTIVES: 9

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11. This began as national malaria control programme in 1953 Later in 1958 it is converted into an eradication programme The Govt of India in 1977 evolved a modified plan of operation based on effective control rather an eradication Under this plan the endemic areas are reclassified according to the Annual P arasite I ndex [API] with different strategy for control. NATIONAL ANTI–MALARIA PROGRAMME 11

12. AREAS WITH API LESS THAN 2 Spraying : focal spraying is done around P.Falciparum cases detected under surveillance. Surveillance : active and passive surveillance is carried out fortnightly. Treatment : all detected cases should be treated radically. Epidemiological investigation :all malaria cases are to be investigated . 12

13. AREAS WITH API MORE THAN 2 a. Spraying: G eneraly 2 rounds of DDT is used.If the vector is refractory to DDT 3rounds of malathion is used. b. Entomological assesment :They carry out susceptibility tests to suggest appropriate insecticide to be used. c. Surveillance :The collection and examination of blood smears is done.Active and passive surveillance is carried out fortnightly. d. Treatment of cases :Great emphasis is laid on presumptive and radical treatment of cases. 13

14. DRUG DISTRIBUTION CENTRES AND FEVER DEPOTS Drug distribution centres are only to dispense the antimalarial tablets as per NMEP schedules. Fever treatment depots collect the blood slides in addition to the distribution of antimalarial tablets . 14

15. This scheme is launched in 1971 to reduce or interrupt malarial transmission in towns and cities. Control of urban malaria lies primarily in the implementation of civil bye laws to prevent mosquito breeding in the domestic and peri-domestic areas. Use of larvivorous fish in the waterbodies such as slow streams, ornamental ponds etc . URBAN MALARIA SCHEME 15

16. Anti – Malaria units have been reorganised in conformity with the district boundaries , making the District Malaria Officers[DMOs] responsible for the implementation of the programme . They are posted at the district head quarters. They are assisted by Asst M alarial O fficers. REORGANISATION 16

17. Surveillance is aimed at case detection.It is of 2 types. Active surveillance: This is carried out by paid workers known as “surveillance workers” These workers visit each house every fortnightly and enquire whether there is a fever case in the house . If yes collects a blood film and administers a single dose of chloroquine[600 mg ]. this is known as “presumptive treatment .” SURVEILLANCE 17

18. The search for malaria cases by the local health agencies such as the primary health centres, subcentres, hospitals, dispensaries and local medical practitioners is known as “passive surveillance” The passive agencies collect blood smears from all fever cases and also from those with the history of recent fever. After the collection of blood smear a single dose of Chloroquine is administered. PASSIVE SURVEILLANCE 18

19. In 1999 the Govt renamed National Malaria Eradication Programme as National Anti –Malaria Programme. The present strategies for prevention and control of malaria are Early case detection and prompt treatment. Integrated vector management Use of larvivorous fish Epidemic preparedness and rapid response for initiating epidemic control procedures in case of abnormal increase in malaria cases . NATIONAL ANTI-MALARIA PROGRAMME 19

20. Anti malaria month is observed every year in the month of J une throughout the country. It is prior to the onset of monsoon and transmission season. It is to enhance the level of awareness and encourage community participation through mass media campaign ,and consolidate inter-sectoral collaborative efforts with other government departments ANTI MALARIA MONTH CAMPAIGN 20

21. Insecticide resistance in vectors: DDT, M alathion, P yrethenoids Drug resistance:Chloroquine , S ulphadoxine methamine Lack of information on true disease burden. Regular outbreaks in some urban, rural and large areas Lack of trained manpower and infrastructure at grass root level Impact of climate change on malaria worsen the malaria situation DRAWBACKS OF NATIONAL ANTI-MALARIA PROGRAMMES 21

22. NATIONAL FILARIA CONTROL PROGRAMME (NFCP) - Launched in 1955. - Control measures:- • Assessing the extent of problem of filaria. • Treating & diagnosed cases with DEC. • Controlling the disease through anti-larva & anti-parasite measures in urban areas. • IEC activities for community awareness. 22

23. The strategy follows the WHO recommendation of annual single dose mass drug therapy with DEC [diethylcarbamazine] with albendazole as a supplement to existing NFCP strategy for 5years or more in endemic areas REVISED FILARIA CONTROL STRATEGY 23

24. The failure of mass DEC administration due to Community non-cooperation Insecticidal resistance in the vector . DRAWBACKS OF NATIONAL FILARIA CONTROL PROGRAMME 24

25. KALA –AZAR CONTROL PROGRAM : Launched in 1990-91. Goal- to eradicate by 2010. The strategies for elimination of Kala Azar are Enhanced case detection and complete treatment using PK39 diagnostic kits and oral drug Miltefosine for treatment of kala azar Interruption of transmission through vector control. Communication for behavioural impact and intersectoral convergence. Capacity building Monitoring supervision and evaluation 25

26. Japanese encephalitis is a disease with high mortality rate. The strategies for prevention and control include Strenghthening of the surveillance activities through sentinel sites Early diagnosis and proper case management Integrated vector control Use of larvivorous fish JAPANESE ENCEPHALITIS CONTROL PROGRAMME 26

27. During 1996 , an outbreak of dengue was reported in D elhi and other states. In view of this major outbreak a “guideline of preparation of contingency plan in case of out break/epidemic of dengue hemorrhagic fever” was prepared and sent to all states. DENGUE FEVER CONTROL PROGRAMME 27

28. This guidelines include control measures like Identification of outbreak Demarcation of affected area Containment of outbreak Case management Vector control 28

29. Widespread infrastructural activities without prior health impact assessments, Insecticide resistance Increased vector proliferation due to Improper solid waste management Deforestation International travel and trade Climate change poorly designed irrigation and water system DRAWBACKS OF DENGUE CONTROL PROGRAMME 29

30. Chikungunya is a viral disease. During 2006 there was huge outbreak of chikungunya in india . There is no specific treatment. Only symptomatic & supportive treatment is provided to patients CHIKUNGUNYA CONTROL PROGRAMME 30

31. NATIONAL LEPROSY CONTROL PROGRAM : Launched in 1955 with the objective to remove leprosy from our country. In 1983 it is redesignated as National Leprosy Eradication Programme . 31

32. Control measures:- 1) Decentralization and institutional development 2) Strengthening delivery system 3) Disability prevention ,care and rehabilitation 32

33. This programme has been implemented since 2005. It is assisted by Govt of India The urban areas are grouped into four categories Township-I Medium cities-I Medium cities –II Mega cities URBAN LEPROSY CONTROL PROGRAMME 33

34. Lack of a specific and sensitive diagnostic tool Social stigma Lack of an efficient surveillance system Irregular supply of drugs, no transport facilities No confidentiality Low knowledge of the population about the disease Misinterpretation on elimination and eradication of leprosy Poor infrastructure DRAWBACKS OF NATIONAL LEPROSY CONTROL PROGRAMME 34

35. REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME: NTCP was launched in 1962, with the objective to detect the TB cases & provide domiciliary treatment to TB patients. In 1992, revised strategy of TB was launched & renamed as RNTCP. Later, NATIONAL STRATEGY PLAN was launched to support treatment to every TB patient . 35

36. The profile of RNTCP in a state as follows S tate Tuberculosis office – state Tuberculosis Officer S tate Tuberculosis training - director and demonstration centre District Tuberculosis centre – district tuberculosis Officer Tuberculosis unit - medical officer – TB control - Senior treatment supervisor - Senior TB laboratory supervisor Microscopy centres, treatment centres DOTS provider ORGANISATION 36

37. DIAGNOSIS OF TUBERCULOSIS IN RNTCP 37

38. DOTS is a community based tuberculosis Treatment and care strategy. It ensures high cure rates through its three Components Appropriate medical treatment Supervision and motivation by a health or non health worker Monitoring of disease status by health services DIRECT OBSERVED THERAPY SHORT TERM[DOTS] 38

39. ANTI TB DRUGS 39 Tripathi KD.Essentials of Medical pharmacology. 6thed. New Delhi: Jaypee Brothers Medical publishers (p) Ltd; 2008. p.766

40. DOTS is given by peripheral health staff such as MPWS, or through voluntary workers such as teachers,anganwadi workers dais etc They are known as DOT agent and paid incentive of rs150 per patient completing the treatment. For the intensive phase,each blister pack contains one day of medication. For the continuation phase ,each blister pack contains one week supply of medication . 40

41. DOTS-plus conceived by the WHO for management of multi-drug resistant TB. This is done in RNTCP DOTS Plus sites which have access to RNTCP accredited culture and drug susceptibility testing laboratory. There will be systems in place to deliver ambulatory DOT after initial short period of in patient care to stabilize patient on the second line drug regimen . DOTS-PLUS 41

42. Control measures :- Strengthen intersectoral coordination and involving medical colleges. IEC activities. Improving laboratory facilities for sputum culture and drug sensitivity . Implementation of DOTS –plus strategy for multi drug resistant tuberculosis (MDR-TB). WORLD TB DAY: MARCH 24 TH 42

43. Lack of awareness about the TB Lack of universal access to healthcare Poor drug supplies Drug resistance Widespread irrational use Spreading HIV infection Corrupt administration DRAWBACKS OF NATIONAL TUBERCULOSIS CONTROL PROGRAMME 43

44. Overcrowding Urbanization leading to congested cities Smoking and alcoholism Poor living conditions Unhygienic habits Poor nutrition SOCIAL REASONS 44

45. This programme was launched in 1987. The Govt of India has set up National Aids Control Organisation[NACO] to monitor this programme. The Govt of India initiated programmes of prevention under the Medium term plan[1990-1992],NACP-1[1992-99], NACP-II[1999-2000] and NACP-III[2007-2012] NATIONAL AIDS CONTROL PROGRAMME 45

46. The priorities of this programme include: Prevention of new infections in population. Providing greater care, support and treatment to a large no of patients. Provision of services for prevention of parent to child transmission of HIV. Strengthening the infrastructure ,system and human resources in prevention care support and treatment programmes 46

47. This was launched in April 2002 by Govt of India. The strategies of this programme include Blood safety programmes Counselling and HIV testing STD control programme has been in operation since 1946 Condom promotion Family health awareness campaign School AIDS education programme NATIONAL AIDS PREVENTION AND CONTROL POLICY 47

48. Lack of human resources: vacancies at state and facility levels Non-availability of any training modules for them makes it difficult to understand the program and their responsibilities Social stigma and discrimination Declining funding from external donors DRAWBACKS OF NATIONAL AIDS CONTROL PROGRAMME 48

49. This programme was launched in 1984 with technical assistance from WHO. The country has reported zero cases since August 1996. In February 2000 , the International Commission for the Certification of Dracunculiasis Eradication recommended that India to be certified free of dracunculiasis. NATIONAL GUINEA –WORM ERADICATION PROGRAMME 49

50. The following activities are recommended by International Certification Team of International Commission for Certification of Dracunculiasis Eradication, Geneva: Health education activities with special emphasis on school children and women Rumour registration and rumour Investigation Maintanence of guinea worm disease on list of notifiable disease Careful supervision of functioning of hand pumps and other sources of drinking water. 50

51. National Institute of Communicable Diseases is the nodal agency for planning,guidance,coordination,monitoring and evaluation of this programme. The programme is implemented by the State Health Directorates of Yaws endemic states utilizing existing health care Delivery. The number of reported cases has come down from more than 3500 to Nil from 1996 to 2004. During 2005, till October , no new case has been reported. YAWS ERADICATION PROGRAMME 51

52. World Leprosy Day - 30 th January World Tuberculosis Day - 24thMarch World Health Day - 7th April World Malaria Day - 25th April World Hepatitis Day - 28th July World AIDS Day - 1st December SOME IMPORTANT HEALTH RELATED DAYS 52

53. In 1974 WHO has launched its Expanded programme on immunization against six most common preventable childhood diseases Diptheria Tetanus Polio Pertussis Tuberculosis Measles UNIVERSAL IMMUNIZATION PROGRAMME 53

54. In 1985 it is renamed as Universal Child Immunization. It has two vital components Immunization of pregnant women against tetanus Immunization of children in first five years of life against six target diseases. When the immunization coverge reaches more than 80 percent the disease transmission are severly disrupted and provide a degree of protection to remaining children because of herd imunity . 54

55. Pulse polio immunization programme was launched in 1995. Hepatitis -B vaccine was introduced in June 2002 Urban measles campaign with assistance of UNICEF was taken for covering urban slums during 1998 55

56. The government of india launched national rural health mission on 5 th April 2005. Plan of action to strengthen infrastructure Creation of a Cadre of Accredited Social Health Activist [ASHA]. Strengthening sub centres by [a] Supply of essential drugs both allopathic and Ayush. [b] provision for multipurpose workers, sanction of new sub centre. NATIONAL RURAL HEALTH MISSION 56

57. 3. Strengthening of PHCs Adequate supply of essential drugs and equipment to PHCs Provision of 24 hours service 4. Strengthening of Community Health Centres 57

58. A . National level Infant mortality rate reduced to 30/1000. Total fertility reduced to 2.1 Malaria mortality rate reduction Kala- azar mortality rate reduction Dengue mortality rate reduction Leprosy prevalence rate reduction GOALS TO BE ACHIEVED BY NRHM 58

59. At Community level Availability of trained community level worker at village level Health day at anganwadi on a fixed day/month for provision of immunization,antenatal and postnatal checkups and nutrition Improved facilities for institutional delivery Provision of household toilets Improved outreach services through mobile medical units . 59

60. – It was started in 1997-98. OBJECTIVES: • To develop skilled manpower. • To strengthen surveillance activities for early detection. • To strengthen laboratory support. • To institute a network of effective communication link between district and state level. SURVEILLANCE PROGRAMME FOR COMMUNICABLE DISEASES 60

61. NATIONAL WATER SUPPLY AND SANITATION PROGRAMME : It was initiated in 1954. ACTIVITIES :- • Establishing urban developmental fund • Encouraging participation low cost techniques Training to personals . 61

62. The central Govt is supporting the efforts of states in identifying problem villages. A problem village is defined as one where no source of safe water is available with in a distance of 1.6 km,or where water is available at a depth of more than 15 metres,or where water source has excess salinity, iron, flourides and other toxic elements or water is exposed to risk of cholera 62

63. Swajaldhara was launched on 25 th Dec 2002 It is a community led participatory programme, which aims at providing safe drinking water in rural areas and buiding awareness on management of drinking water projects and water conservation practices. It has 2 components Swajaldhara I is for a gram panchayat Swajaldhara II is at district level SWAJALDHARA 63

64. Jal Jeevan Mission(JJM) was launched by Hon’ble Vice President of India on 21 Oct.2022 . Vision Every rural household has drinking water supply in adequate quantity of prescribed quality on regular and long-term basis. . JAL JEEVAN MISSION 64

65. Objectives The broad objectives of the Mission are: To provide Functional House Tap Connection to every rural household. To provide functional tap connection to Schools, Anganwadi centres , GP buildings, Health centres , wellness centres and community buildings To monitor functionality of tap connections 65

66. Rural Water Supply and Sanitation Agency (KRWSA) was launched as a nodal agency to facilitate the implementation of rural water supply systems. In order to provide a better accessibility of safe drinking water to the rural area, the World Bank introduced Jalanidhi project through KRWSA. JALA NIDHI 66

67. AIMS Promote water security by protecting traditional sources, Ground Water Recharge and Rain Water Harvesting. Achieve 24 x 7 water supply Minimize stress on water resources by adopting 3 R concept. Ensure safe water through Water Quality Monitoring and Surveillance activities. 67

68. It was introduced in 1974-78. The minimum needs are : a) Nutrition b) Rural health c) Elementary education d) Adult education e) Rural water supply f) Rural road g) Rural electrification h) Rural house i ) Environmental improvement of urban slum MINIMUM NEEDS PROGRAMME 68

69. It was initiated in 1975. OBJECTIVES:- •Eradication of poverty •Raising productivity •Reducing inequality •Removing social and economic disparities •Improving quality of life 20 POINT PROGRAMME 69

70. At least 8 of the 20 points are related , directly or indirectly related to health Point 1 –Attack on rural poverty Point 7 – Clean drinking water Point 8 – Health for all Point 9 – Two-child norm Point 10- Expansion of Education Point 14 – Housing for the people Point 15 – Improvement of slums Point 17 – Protection of the environment. 70

71. NATIONAL FAMILY WELFARE SCHEMES • It was started in 1977. This programme include: 1. National family welfare programme 2. National population policy 3. National rural health mission 4. Urban family welfare schemes 5. Reproductive and child health progamme 717711

72. It was launched in 1951. OBJECTIVES: Reducing the birth rate Population control NATIONAL FAMILY WELFARE PROGRAMME 68

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74. Ayushman Bharat or “Healthy India” is a national initiative launched by Prime Minister Narendra Modi as the part of National Health Policy 2017, in order to achieve the vision of Universal Health Coverage (UHC). Ayushman Bharat adopts a continuum of care approach, comprising of two inter-related components, which are – Establishment of Health and Wellness Centres Providing Health Coverage up to 5 lakhs per family per annum. AYUSHMAN BHARAT 74

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76. Government of India launched Mission Indradhanush on 25th December 2014, to cover children who are either unvaccinated or partially vaccinated against seven vaccine preventable diseases, i.e., diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis B. The goal is to vaccinate all under-fives by the year 2020. MISSION INDRADHANUSH 76

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78. The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) aims at correcting the imbalances in the availability of affordable healthcare facilities in the different parts of the country in general, and augmenting facilities for quality medical education in the under-served States in particular. The scheme was approved in March 2006. PRADHAN MANTRI SWASTHYA YOJANA 78

79. The PMSSY has two components – Setting up of six institutions in the line of AIIMS; and upgradation of 13 existing Government medical college institutions. It has been decided to set up 6 AIIMS-like institutions, one each in the States of Bihar (Patna), Chattisgarh (Raipur), Madhya Pradesh (Bhopal), Orissa (Bhubaneswar), Rajasthan (Jodhpur) and Uttaranchal (Rishikesh) at an estimated cost of Rs 840 crores per institution 79

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81. The national maternity benefit scheme has been modified into Janani suraksha yojna It was launched on 12 th April 2005. It is a 100% centrally sponsored scheme. Under national rural health mission , it integrates the cash assistance with institutional care during antenatal ,delivery and immediate post –partum care. 81

82. Aarogyasri is the flagship scheme of all health initiatives of the State Government with a mission to provide quality healthcare to the poor. The aim of the Government is to achieve "Health for All". The scheme provides financial assistance to BPL families to meet the catastrophic health needs.. AROGYA SRI 82

83. Financial coverage provided The benefit on family is on floater basis i.e. the total reimbursement of Rs.1.50 lakhs can be availed of individually or collectively by members of the family. All transactions are cashless for covered procedures 83

84. The diseases specifically excluded from the list are high end diseases such as hip and knee replacement, and diseases covered by national programmes viz., TB, HIV/AIDS, Leprosy, Infectious diseases, Malaria, Filaria, Gastroenteritis, Jaundice etc. The scheme provides coverage for the systems like Heart, Lung, Liver, Pancreas, Kidney, Neuro-Surgery, Pediatric Congenital Malformations, Burns, Post -Burn Contracture Surgeries, Prostheses Cancer treatment ,Polytrauma. 84

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87. ` National Tobacco Control Program-2007 National Program of Health Care for the Elderly (NPHCE)-2010 87

88. National health programmes play a crucial role in maintaining health status of the community. The significance of learning about these programmes in public health dentistry is a two way street . PUBLIC HEALTH SIGNIFICANCE OF NATIONAL HEALTH PROGRAMMES 88

89. Firstly , we gain thorough knowledge regarding Aims and objectives of the programmes Strategies and management of these programmes Practical problems which arise that arise during implementation of these programmes This knowledge can be of great use while conducting oral health programmes . 89

90. Moreover we dentists can contribute to these programmes by creating awareness among the people because we interact closely with people during health campaigns.This is done by Informing people Motivating people Guiding them into action 90

91. We can contribute to the betterment of national health programmes by studying the drawbacks through surveys and research. We can conduct epidemiological studies to study the disease trends and play a role in control of these diseases. As we are aware of the epidemiology we can integrate with these programmes and contribute when there is an outbreak of an disease. 91

92. CONCLUSION: National health programmes have played a crucial role in improving the health status of citizens of the country including both rural and urban areas. They have created awareness, strengthened healthcare infrastructure, eradicated diseases,improved access to treatment thus improving the quality of lives of the people.so government has to launch many more health programmes using modern technology and create awareness from school level itself. 92

93. Peter S .Essentials of Public Health Dentistry.National Health Programmes . 7 th ed.New Delhi:Arya Medi Publishing House Pvt Ltd.2002.pg 174-176 Park K . Park’s Text book of Preventive and Social Medicine.Health programmes in India.23 rd ed.MadhyaPradesh Banarsidas Bhanot Publishers 2015.p.308-325 Ministry of Health & Family Welfare, Government of India. Strategic plan for malaria control in India 2012-2017:a five-year strategic plan. New Delhi. http://nvbdcp.gov.in/Doc/Strategic-Action-Plan-Malaria-2012-17-Co.pdf- accessed 16 June 2023 . REFERENCES: 93

94. Duggal.R [Internet] Health planning in India.[2014]Available from http://www.cehat.org/cehat/uploads/files/a168.pdf accessed 16 June 2023 National Framework for Malaria Elimination [2016] https://www.who.int/docs/defaultsource/searo/india/health-topic-pdf/national-framework-malaria-elimination-india-2016-2030.pdf?sfvrsn=606b352a_2 - accessed 16 June 94

95. THANKYOU 95