Contents of the Chapter:

• Intoduction
• Emergency Medical Relief Health
• National Rural Health Mission
• Child Health Programme
• National Vector Borne Disease Control Programme

• Universal Immunization Programme
• Family Welfare Linked Health Insurance Scheme

• National Leprosy Eradication Programme
• National Tobacco Control Programme
• National AIDS Control Programme
• National Cancer Control Programme
• MCQs for Final Practice

Introduction

• The Ministry of Health and Family Welfare comprises the following departments:

• Department of Health and Family Welfare
• Department of AYUSH
• Department of Health Research
• Department of AIDS Control

• The National Health Policy 2002 aims at achieving an acceptable standard of health for the general population of the country. Keeping in line with this broad objective, the Eleventh Five Year Plan had set upon itself the goal of achieving good health for the people, especially the poor and the underprivileged.

• Conscious and vigorous efforts continued to be made during the current year to step up funding of the health sector as part of the endeavour to ensure that allocations for health in the public domain reach 3 per cent of the GDP by 2012.

• The major thrust in this direction in the National Rural Health Mission (NRHM) which aims at major qualitative improvements in standards of public health and health care in the rural areas through strengthening of institutions, community participation, decentrali-zation and innovative methods of reaching all habitations. While the Mission was formally launched in 2005 and has taken a while to effectively go on stream, early indications reflect its positive impact. Simultaneously, provision of tertiary health care and increasing human resources to ensure availability of larger number of health care providers have engaged the attention of the Government.

• Considerable upgration of facilities and infrastructure is now under way in 13 medical colleges in the States to provide super speciality treatment under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY). Under the scheme work has commenced on construction of six institutions on the pattern of the All India Institute of Medical Sciences. Under the second phase of the PMSSY it is proposed to establish two more AIMS like institutions—one each in Uttar Pradesh and West Bengal—and another six medical colleges have been taken up for upgradation of facilities. Under the National Mental Health Programme, 11 State Mental Hospitals and Institutes have been identified for being developed into Centres of Excellence to upgrade the facilities and provide for creation of more manpower resources in Mental Health. For better surveillance and epidemiological monitoring of infectious diseases, it is proposed to upgrade the National Institute of Communicable Diseases to a National Centre for Disease Control on the lines of CDC in the United States.

National Rural Health Mission (NRHM)

• The National Rural Health Mission was launched by the Prime Minister on 12 April 2005, to provide accessible, affordable and accountable quality health services to the poorest households in the remotest rural regions. The National Common Minimum Programme (NCMP) mandates an increase in expenditure in health sector from current level of 0.9 per cent of the GDP to 2 to 3 per cent of the GDP from 2005-12.

• The National Rural Health Mission represents a major departure from the past, in that central government health financing is now directed to the development of state health systems rather than being confined to a select number of national health programmes.

• The expected outcomes of the Mission include reduction of IMR to below 30/1000 live births, MMR to below 100/100,000 live birth and TFR to 2.1 by 2012.

National Uraban Health Mission (NUHM)

• The proposed National Urban Health Mission (NUHM) aims to address the public health care needs of urban population. Addressing the needs of public health care service for urban population would involve revamping/creation/upgradation of primary, secondary and tertiary health care service delivery system in urban areas. This will be done by investing in health professionals, appropriate technology, creating new & up gradation and utilization of existing infrastructure and strengthening the extant health care service delivery system. Reognizing the seriousness of the problem, urban health will be taken up as thrust area for the 12th Five Year plan.

National Vector Borne Disease Control Programme (NVBDCP)

• The National Vector Borne Disease Control Programme is a comprehensive programme for prevention and control of vector borne diseases namely Malaria, Filaria, Kala-azar, Japanese Encephalitis (JE), Dengue and Chikungunya which is covered under the overall umbrella of NRHM.

Malaria

• Malaria is an acute parasitic illness caused by Plasmodium falciparum or Plasmodium vivax in India. Nine major species of anopheline mosquitoes transmit malaria in India. The main clinical presentation is with fever with chills, however, nausea and headache can also occur. There are 9 species of Malaria vectors in India, out of which the major vector mosquito for rural malaria viz. Anophales culicifacies, is distributed all over the country and breeds in clean ground water collections. Other important Anopheline species namely An. minimus and An. fluviatilis is the breed in running channels, streams with clean water.

Filariasis

• Filaraisis is transmitted by mosquito species i.e. Culex quinquefasciatus and Mansonia annulifera/M. uniformis. The vector mosquitoes breed in polluted water in drains, crosspits etc. in areas with inadequate drainage and sanitation. The disease is endemic in 250 districts in 20 states and UTs. The population of about 600 million is at risk of lymphatic filariasis. The target year for Global elimination of this disease is by the year 2020. Government of India is signatory to the World Health Assembly Resolution in 1997 for Global Elimination of Lymphatic Filariasis. The National Health Policy (2002) has however, envisaged elimination of lymphatic filariasis in India by 2015.

Kala-Azar

• Kala-azar is caused by a protozoan parasite Leishmania donovani and spread by sandfly, which breeds in shady, damp and warm places in cracks and crevices in the soft soil, in masonry and rubble heaps, etc. Proper sanitation and hygiene are critical to prevent sand fly breeding. The National Health Policy (2002) of Govt. of India has set the goal for elimination of Kala-azar from the country by 2010. World Bank is providing assistance in 46 districts in 3 states namely Bihar, Jharkhand and West Bengal. Kala-azar is endemic in 52 districts (31 in Bihar, 4 in Jharkhand, 11 in West Bengal and 6 in UP). The Kala-azar Control programme was launched in 1990-91.

Japanese Encephalitis

• Japanese Encephalitis is a zoonotic disease which is transmitted by vector mosquito mainly belonging to Culex vishnui group. The transmission cycle is maintained in the nature by animal reservoirs of JE virus like pigs and water birds. Man is the dead end host, i.e. JE is not transmitted from one infected person to other. The population at risk is about 300 million. JE has been reported from different parts of the country. The disease is endemic in 14 states of which Assam, Bihar, Haryana, and Uttar Pradesh have been reporting outbreaks.

Dengue Fever/Dengue Haemorrhagic Fever

• Dengue Fever is an outbreak prone viral disease, transmitted by Aedes Aegypti mosquitoes. The case fatality rate which was 3.3 per cent in 1996 had come down to 0.57 per cent in 2009 till November because of better management of Dengue cases in the country following National guidelines.The Government of India in consultation with States has identified 137 sentinel surveillance hospitals with laboratory support for augmentation of diagnostic facilities in the endemic states. Further, for advanced diagnosis and back-up support 13 Apex Referral Laboratories have been identified and linked with sentinel surveillance hospitals. To make these functional test kits are provided through National Institute of Virology, Pune and cost is borne by GOI.

Chikungunya

Chikungunya is a debilitating non-fatal viral illness caused by Chikungunya virus which has re-emerged in the country after a gap of three decades. In India a major epidemic of Chikungunya fever was reported during the last millennium viz., 1963 (Kolkata), 1965 (Puducherry and Chennai in Tamil Nadu, Rajahmundry, Vishaka-patnam and Kakinada in Andhra Pradesh, Sagar in Madhya Pradesh and Nagpur in Maharashtra) and 1973 (Barsi in Maharashtra). This disease is also transmitted by Aedes mosquito. It is not a contagious disease. Out of 35 States/UTs 16 were affected: Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu, Madhya Pradesh, Gujarat, Kerala, Andaman and Nicobar Islands, Delhi, Rajasthan, Puducherry, Goa, Orissa, West Bengal, Lakshadweep and Uttar Pradesh.

National Leprosy Eradication Programme (NLEP)

• The National Leprosy Control Programme was launched in 1955 based on dapsone monotherapy. Multi Drug Therapy came into wide use from 1982 and National Leprosy Eradication Programme was launched in 1983 with the objective to arrest the disease in all the known cases of leprosy. In 1991, the World Health Assembly resolved to eliminate leprosy at a global level by the year 2000. Since 2005, the programme is being continued with Government of India funds with technical support from WHO and International Federation of Anti Leprosy Associations (ILEP).

• The recorded leprosy case load has come down from 57.6 cases per 10,000 population in 1981 to less than one at national level in December 2005 and the country could achieve the goal of leprosy elimination at National level (i.e. prevalence rate of less than 1 case/10,000 population) as set by National Health Policy, 2002.

• During the year 2010-11, a total of 1.27 lakh new cases were detected & treated with MDT. There were 83053 leprosy cases on record at the end of March, 2011.

National Programme for Control of Blindness (NPCB)

• National Programme for Control of Blindness (NPCB) was launched in the year 1976 as a 100 per cent centrally sponsored scheme with the goal of reducing the prevalence of blindness to 0.3 per cent by 2020.

National Tobacco Control Programme

• A comprehensive tobacco control legislation titled “The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003” was notified in the official gazette on 19 May 2003. The Act is applicable to whole of India and covers all types of tobacco products.

• In order to facilitate the implementation of the Tobacco Control Laws to bring about greater awareness about the harmful effects of Tobacco and to fulfill the obligation(s) under the WHO FCTC, Ministry of Health and Family Welfare has launched a new National Tobacco Control Program (NTCP) in the 11th Five Year Plan. The pilot programme at present is under implementation in 42 districts in 21 states in the country. The main components of NTCP are :

1. Public awareness/mass media campaigns for awareness building and for behavioural change.
2. Establishment of tobacco product testing laboratories, to build regulatory capacity, as required under COTPA, 2003.
3. Mainstreaming the programme components as a part of the health delivery mechanism under the NRHM framework.
4. Mainstream Research and Training on alternate crops and livelihoods with other nodal Ministries.
5. Monitoring and Evaluation including surveillance e.g. Adult Tobacco Survey.

National AIDS Control Programme

• In order to control the spread of HIV/AIDS, Government of India is implementing the National AIDS Control Programme (NACP) as a 100 per cent centrally sponsored scheme. Launched in July 2007, NACP Phase-III (2007-2012) has the goal to halt and reverse the epidemic in the country over the next 5 years by integrating programmes for prevention, care, support and treatment. The programme has adopted a four pronged strategy:

1. Prevention of new infections in high risk groups and general population.
2. Providing greater care, support and treatment to larger number of PLHA.
3. Strengthening the infrastructure, systems and human resources in prevention, care, support and treatment programmes at the district, state and national level.
4. Strengthening the nationwide Strategic Information Management system.

• These are being achieved by upscaling targeted interventions among the high risk groups, behaviour change communication for improved awareness, expanding, counselling and testing services, blood safety, support and treatment of HIV infected persons including the treatment of opportunistic infections, provision of anti-retroviral drugs and mainstreaming of HIV intervention strategies.

• According to the HIV Sentinel Surveillance 2008-09, the estimated People Living with HIV in India in 2009 was up to 23.9 lakh, with an estimated adult HIV prevalence of 0.31 per cent. The data shows that the epidemic in India has stabilized over the years.

• The Red Ribbon Express has emerged as the world’s largest mass mobilization programme against HIV/AIDS. Building upon the success of the first phase of the Red Ribbon Express project (2007-08), NACO launched the second phase of the project on 1 December 2009 to commemorate the World AIDS Day.

• Prevalence among Antenatal Clinic attendees, Patients with Sexually Transmitted Infections, Female Workers and Men having Sex with Men is declining. Vast majority of new infections and existing burden of disease concentrated in 5-15 per cent of districts.

• Impressive gains have been made in Anti Retroviral Therapy services, upscaling of Integrated Counselling and Testing Centres and Identifying People Living with HIV/AIDS (PLHA). Convergence with NRHM has begun. However, more progress is required in areas like supply chain management and laboratory services.

National Iodine Deficiency Disorders Control Programme

• Iodine is an essential micronutrient with an average daily at 100-150 micrograms for normal human growth and development. Deficiency of Iodine can cause physical and mental retardation, cretinism, abortions, stillbirth, deaf mutism, squint and various types of goitre. Results of sample surveys conducted in 325 districts covering all the States/Union Territories have revealed that 263 districts are endemic where the pevalence of Iodine Deficiency Disorders is more than 10 per cent. It is estimated that more than 71 million persons are suffering from goitre and other Iodine Deficiency Disorders.

• The Government is implementing the National Iodine Deficiency Disorders Control Programme (NIDDCP) formerly known as National Goitre Control Programme (NGCP) since 1962 a 100 per cent centrally assisted programme with a focus on the provision of iodised salt, IDD survey/resurvey, laboratory monitoring of Iodated salt and Urinary Iodine excretion, health education and publicity. Government of India has banned the sale of non-iodated salt in the entire country for direct human consumption under Prevention of Food Adulteration Act, 1954 with effect from 17 May 2006.

National Mental Health Programme (NMHP)

• National Mental Health Programme was started in 1982 with the objectives to ensure availability and accessibility of minimum mental health care for all to encourage mental health knowledge and skills and to promote community participation in mental health service development and to stimulate self-help in the community. During 9th five year plan, District Mental Health Programme was started (1996) based on Bellary Model developed by NIMHANS, Bangalore. During the plan period, 27 districts were covered under DMHP. At present DMHP is covering 123 districts in nearly all states and UTs.

Centres of Excellence in Mental Health

• Centres of excellence in the field of mental health are being established by upgrading and strengtheing identified existing mental health hospitals/institutes for addressing acute manpower gap and provision of state-of-the-art mental health care facilities in the long run. The Budgetary support of up to 30 crore per centre would be provided for capital work, equipment and furnishing, faculty induction and retention for the plan period.

National Programme for Prevention and Control of Cancer, Diabetes, Cardio Vascular Diseases And Stroke (NPCDCS)

National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stoke (NPCDCS) is a new initiative in the 11th Five Year Plan. The NPCDCS aims at reducing the burden of Non-Communicable Diseases (NCDs) such as cancer, diabetes, cardiovascular diseases and stroke which are major factors reducing potentially productive years of human life, resulting in huge economic loss. The NPCDCS has been approved at a total outlay of Rs. 1230,90 crores for the remaining period of the 11th Five Year Plan. This includes Rs. 499.38 crores for NPDCS and Rs. 731.52 crores for Cancer Control Programme. The expenditure will be met on cost sharing basis with the participating States at ratio of 80:20. The programme has been initiated in 30 Districts of 21 States during 2010-11. Another 70 has been added during 2011-12.
The major objectives of the programme are briefly listed below :

• Prevent and control common NCDs through behaviour and life style changes,
• Provide early diagnosis and management of common NCDs.
• Build capacity at various levels of health care facilities for prevention, diagnosis and treatment of common NCDs.

Health Minister’s Cancer Patient Fund: Cancer treatment is highly expensive and prolonged. Chemotherapy may cost anywhere between 5000 to 5 lakh per cycle. Certain drugs cost even up to 40,000 per dosage once a week, for treatment cycle involving 6 to 12 weeks. To provide financial assistance to the poor and the needy BPL cancer patients Health Minister’s Cancer Patient Fund has been established with a corpus of 100 crore. The entire amount has been released to Rashtriya Arogya Nidhi so that cancer treatment is more affordable and accessible.

PUBLIC HEALTH EMERGENCIES

Preparedness and Response for Avian Influenza

• The National Centre for Disease control (NCDC). Delhi has been identified as the nodal agency to investigate any suspected cases/outbreak. National institute of Virology (NIV), Pune was identified as the apex laboratory. National stockpile of Oseltamivir (Tamiflu) personal protective equipments were maintained. The preparedness measures came handy in responding to Avian Influenza outbreaks in the States of West Bengal, Assam and Sikkim. In all these States Avian influenza outbreak in poultries were contained and there was no human case of Avian influenza.

Pandemic Influenza-Preparedness and Response

• Illness like Influenza caused by influenza A (H1N1), a re-assorted influenza virus, was reported from Mexico on 18 March 2009 and rapidly spread to affect 208 countries. World Health Organization has raised the pandemic alert level to 6, declaring pandemic of influenza H1N1 of moderate severity.

Prevention of Food Adulteration Programme

• The Ministry of Health and Family Welfare is responsible for ensuring safe food to the consumers. Keeping this in view, a legislation called “Prevention of Food Adulteration Act, 1954” was enacted. The objective envisaged in this legislation was to ensure pure and wholesome food to the consumers and also to prevent fraud or deception. The Act has been amended thrice in 1964, 1976 and in 1986 with the objective of plugging the loopholes and making the punishments more stringent and empowering Consumers and Voluntary Organisations to play a more effective role in its implementation. The subject of the Prevention of Food Adulteration is in the concurrent list of the Constitution.

• The Central Advisory Board appointed by the Government of India in 1937 and the Food Adulteration Committee appointed in 1943, reviewed the subject of Food Adulteration and recommended for Central legislation. The Government of India, therefore, enacted a Central Legislation called the Prevention of Food adulteration Act (PFA) in the year 1954 which came into effect from 15 June 1955. The Act repealed all laws, existing at that time in States concerning food adulteration.

• The Ministry of Health and Family Welfare is designated as the National Codex Contact Point in India to examine and formulate India’s views on the agenda for the various meeting of Codex Alimentarius Commission, a joint venture of FAO/WHO dealing with International Food Standards and its subsidiary committees. The Ministry of Health and Family Welfare constituted a National Codex Committee (NCC) and an Assistant Director General (PFA) has been working as Liaison Officer for NCC.

• The provisions under PFA Rules have been amended nearly 360 times and standards of around 250 articles of food which are of mass consumption have been prescribed. There are 72 food laboratories in the country at District/Regional or State level in addition to four Central Food Laboratories set up by the Central Government. Almost every State has got one or more laboratories depending upon its need. About 12 of these laboratories are under the administrative control of the local bodies whereas the remaining ones are under the administrative control of the State Government.

The Food Safety and Standards Act, 2006: With the coming into effect of the Food Safety and Standards Act, 2006 (FSSA) enacted by Parliament in August 2006, the Prevention of Food Adulteration Act, 1954 stands repealed from the date on which Food Safety and Standards Act comes into force on such date as the Central Government may decide by notification in the Gazette.

Medical Council of India

• The Medical Council of India (MCI) was established as a statutory body under the provisions of the Indian Medical Council Act 1933 which was later repealed by the Indian Medical Council Act 1956 with minor amendments in 1958. A major amendment to the I.M.C. Act 1956 was made in 1993 making it mandatory for obtaining the approval of the Ministry of Health and Family Welfare for opening new medical colleges/increasing seats, starting new courses in order to regulate the standard of medical education in the country. The I.M.C. Act 1956 was further amended in 2001 to enable the Medical Council of India to conduct Screening Tests for Indian nationals holding foreign medical qualifications to test their skill before granting them registration to practice medicine in India.

• The main functions of the Council are maintenance of uniform standard of medical education both at the undergraduate and the postgraduate levels; maintenance of Indian Medical register; reciprocity with foreign countries in the matter of mutual recognition of medical qualifications; continuing medical education and granting of provisional/permanent registration of doctors with recognized medical qualifications, registration of additional qualifications and issue of Good Standing Certificate for doctors going abroad to Commonwealth countries. At present there are 264 medical colleges in the country out of which 185 medical colleges have been recognized by MCI and 90 new medical colleges have been permitted by the Central Government to conduct MBBS courses. The admission capacity in these colleges is approximately 30,122 students per year.

Central Health Education Bureau

• Central Health Education Bureau (CHEB) is an apex institution which had a humble beginning on 6 December 1956 under Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare, Government of India, for the health education and health promotion in the country.

Rashtriya Arogya Nidhi

• Rashtriya Arogya Nidhi was set up in 1997 to provide financial assistance to patients, living below poverty line, who are suffering from major life threatening diseases to receive medical treatment in Government Hospitals. Under the scheme of Rashtriya Arogya nidhi, grants-in-aid are also provided to State Governments for setting up State Illness Assistance Funds.

National Programme for Health Care of the Elderly (NPHCE)

• In spite of the existing policy and legal provision, currently, dedicated health care facilities for the elderly are almost non existing and consequently the older people are bound to share the health facilities with general population. Another big problem being faced in providing health care to the elderly is lack of trained manpower in the field of geriatric health care because Geriatric is yet to be recognized as a medical specialty in our country.

• Now, with unravelling of disease burden and complexity of old age, morbidity and disability among the elderly, need for dedicated and multidisciplinary health arrangement is being felt. Keeping in view the commitments made in “National Policy on Older Persons” as well as obligation under the “Maintenance & Welfare of Parents & Senior Citizens Act 2007”, Ministry of Health and Family Welfare has initiated a new programme for elderly in the name of “National Programme for Health Care of Elderly” (NPHCE).

• The NPHCE has been approved by the Hon’ble Minister of Finance on 10th June, 2010 at an expenditure of Rs. 288.00 crores for the remaining period of the 11th Five Year Plan. This includes 20% share of State Governments (excluding the expenditure of regional Medical Institute) amounting to Rs. 48.00 crores. The Government of India’s share would be Rs. 240.00 crore. The programme has been initiated in 30 Districts of 21 States during 2010-11. Another 70 have been added during 2011-12.

National Academy of Medical Sciences (India), New Delhi

• The National Academy of Medical Sciences (NAMS), New Delhi was established in 1961 as a Non-Official body of Bio-Medical scientists with the object of promotion and encouragement of merit in medical sciences. The fellowship of the Academy became a coveted hallmark of distinction accorded in recognition for outstanding achievements in sciences, education, services, etc. The Academy awards Fellowships to the most distinguished men of science. The Academy has also been implementing the Continuing Medical Education (CME) Programme since 1982.

Integrated Disease Surveillance Project (IDSP)

• The integrated Disease Surveillance Project (IDSP) was launched by the Ministry of Health and Family Welfare in November 2004 for a period of March, 2010. The project has been extended for 2 years up to March 2012 by Government of India.

• To establish a decentralized state based surveillance system for communicable diseases to detect the early warning signals, so that timely and effective public health actions can be initiated in response to health challenges in the country at the district, state and national level.

Child Health Programme

• The Reproductive and Child Health programme (RCH) II under the National Rural Health Mission (NRHM) comprehensively integrates interventions that improve child health and address factors contributing to infant and under-five mortality. Reduction of infant and child mortality has been an important tenet of the health policy of the Government of India and it has tried to address the issue right from the early stages of planned development. The National Population Policy (NPP) 2000, the National Health Policy 2002, the Eleventh Five Year Plan (2007-12) and National Rural Health Mission (NRHM - 2005-2012) have laid down the goals for child health.

Child Health Situation in India

• Infant Mortality Rate: Infant mortality is defined as the probability of dying before the first birthday. As per the Sample Registration System 2010, the Infant, Mortality Rate (IMR) for the country is 47 per 1000 live births.

• Of the 9.7 million under-five deaths globally, 2.1 million are in India alone.
• 52 percent of under-five deaths continue to occur in the first month of life.
• 37 per cent of all infant deaths in India are concentrated in two states (Uttar Pradesh [UP] and Bihar.
• 70 per cent of all infant deaths in India are concentrated in eight states (Bihar, UP, Madhya Pradesh, Orissa, Rajasthan, Andhra Pradesh, Maharashtra and Gujarat).
• Regional disparities remain a concern, with the IMR varying greatly between rural and urban areas (61 and 37, respectively) and states (ranging from 72 in Madhya Pradesh to 12 in Manipur).
• The primary causes of neonatal deaths are:

• sepsis,
• low birth weight, and
• Asphyxia.

• The primary causes of child deaths are:

• Pneumonia
• Diarrhoea, and
• In some States, Malaria, Meningitis and Measles.

Situation Analysis

• 38 per cent of newborns in the developing countries start breastfeeding within one hour of birth while only 25 per cent of mothers initiate breastfeeding within 1 hr of birth: the proportion has however increased significantly in all states in last two years.

• 46 per cent of children are exclusively breasted for six months.
• In India 43 per cent of children under age five are under weight. 8.3 million infants in India have low birth weight (less than 2500 grams).

Components of Child Health Care Include

• Essential newborn care
• Immunisation
• Infant and young child feeding
• Vitamin A, Iron and Folic Acid supplementation
• Early detection and appropriate management of Acute Respiratory Infections, Diarrhoea and other infections.
• Integrated management of neonatal and childhood illnesses (IMNCI) and Pre-Service.
• Facility Based Newborn Care
• Home Based care of Newborns
• Management of children with malnutrition.

Janani Suraksha Yojana

• JSY is a safe motherhood intervention under the National Rural Health Mission (NRHM) being implemented with the objective of reducing maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women. JSY is a 100 per cent centrally sponsored scheme and it integrates cash assistance with delivery and post-delivery care. The scheme focuses on the poor pregnant woman with special dispensation for states having low institutional delivery rates namely the States of Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam, Rajasthan, Orissa and Jammu and Kashmir.

Janani Shishu Suraksha Karyakram (JSSK)

• Government of India has launched Janani Shishu Suraksha Karyakram (JSSK) on 1st June, 2011. The initiative entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery, including caesarean section. The entitlements include free drugs and consumables, free diet up to 3 days during normal delivery and up 7 days for C-section, free diagnostics, and free blood wherever required, This initiative also provides for free transport from home to institution, Similar entitlements have been put in place for all sick newborns accessing public health institutions for treatment till 30 days after birth. The scheme is estimated to benefit more than 12 million pregnant woman who access Government health facilities for their delivery.

Navjat Shishu Suraksha Karyakram (NSSK)

• NSSK is a programme aimed to train health personal in basis newborn care and resuscitation, has been launched to address care at birth issues i.e. Prevention of Hypothermic, Prevention of Infection, Early initiation of Breast feeding and Basic Newborn Resuscitation. Newborn care and resuscitation is an important starting-point for any neonatal program and is required to ensure the best possible start in life. The objective of this new initiative is to have trained heath personal in Basic newborn care and resuscitation at every delivery point.

Family Planning Programme

In 1952, India launched the world’s first national programme emphasizing family planning to the extent necessary for reducing birth rates “to stabilize the population at a level consistent with the requirement of national economy.” The objectives, strategies and activities of the Family Planning division are designed and operated towards achieving the family welfare goals and objectives stated in various policy documents (NPP: National Population Policy 2000, NHP: National Health Policy 2002, and NRHM: National Rural Health Mission) and to honour the commitments of the Government of India (including ICPD: International Conference on Population and Development, MDG: Millennium Development Goals and others).

Contraceptive Services Under the National Family Welfare Programme

The public sector provides a wide range of contraceptive services for limiting and spacing of births at various levels of health. The salient features of the family planning services are as follows :

• Counselling, access to and provision of good quality services and follow-up care are emphasized in all services.
• GOI is promoting ‘Fixed Day Static Services’ (FDS) approach in sterilization services within the public health system with the aim of increasing access to sterilization services.
• In states with high un-met need for limiting methods, sterilization camps are continued till the time FDS is implemented effectively.
• Revised compensation scheme for sterilization acceptors to compensate the wage loss is continued in all the states.
• ‘National Family Planning Insurance Scheme’ (NFPIS) covers service providers in both public and accredited private facilities.
• ‘Quality Assurance Committees’ (QACs) have been constituted in all the states and districts.
• The division is repositioning IUD as short and long term spacing method.
• Regional contraceptive updates for service providers in all states, with special focus on High Focus States (HFS).
• Emergency Contraception Pills (ECPs) are effective for preventing conception due to unplanned/unprotected sex.

Increasing Male Participation in Planned Parenthood, including ‘No Scalpel Vasectomy’ (NSV)

• The No Scalpel Vasectomy (NSV), a modified male sterilization technique, was introduced in 1997 in the National Family Welfare Programme as a simple and safe technique with very little chance of complications compared to female sterilization.

Promotion of IUDs as a Short and Long Term Spacing Method

• GOI introduced Copper T 380 A with an effectiveness period of 10 years in 2002 to promote the use of spacing method, both for short term and long term. In 2006, GOI launched “Repositioning IUCD in National Family Welfare Programme”.

Prohibition of Pre-Conception and Pre-Natal Sex Determination

• In order to check female foeticide, the Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994 was enacted and brought into operation from 1 January 1996. The Act prohibits determination and disclosure of the sex of the foetus. It also prohibits any advertisements relating to pre-natal determination of sex. Punishments are prescribed for contravention of any of its provisions, like imprisonment up to 5 years and fine up to 1,00,000/- in addition to cancellation of the registration/licence in the case of medical professionals/diagnostic centres, clinics, etc. In order to make the Pre-Conception and Pre-Natal Diagnostic Techniques Act and the rules framed thereunder even more effective and stringent, the Central Government is considering to further amend the Act and the Rule.

Universal Immunization Programme

• Immunization programme in India was introduced in 1978 as Expanded Programme of Immunization. This gained momentum in 1985 as Universal Immunization Progrmame (UIP) and implemented in phased manner to cover all districts in the country by 1989-90. UIP became a part of Child Survival and Safe Motherhood Programme in 1992. Since, 1997, immunization activities have been an important component of National Reproductive and Child Health Programme. Immunization is one of the key areas under National Rural Health Mission (NRHM) launched in 2005.

Under the Universal Immunization Programme, Government of India is providing vaccination to prevnt six vaccine preventable diseases, i.e. Diphtheria, Pertussis, Tetanus, Polio, Measles and severe form of Childhood Tuberculosis. The vaccination schedule is as under:

• BCG (Bacillus Calmette-Guerin)—at Birth (upto 1 year if no given earlier).
• DPT (Diphtheria, Pertussis and Tetanus Toxoid).
• Primary three doses at 6, 10, 14 weeks and two booster doses at 16-24 months and 5 years of age.
• OPV (Polio) - 6-10, 14 weeks and at 16-24 months of age and birth dose for institutional delivery.
• Measles - 9-12 months of age.
• TT (Tetanus Toxiod)— 10 years and 16 years of age.
• TT - for pregnant woman two doses or one dose if previously vaccinated within 3 years. Latr on, Hepatitis B and JE vaccins wre added in select areas in the Universal immunization Programme.

Pulse Polio Immunization

• In pursuance of the World Health Assembly resolution of 1988, in addition to administration of routine OPV through the Universal Immunization Programme, the Pulse Polio Immunization (PPI) Programme was launched in 1995-96 to cover all children below the age of 3 years. In order to accelerate the pace of polio eradication, the target age group was increased from 1996-97 to all children under the age of 5 years. From 1999-2000 house to house vaccination of missed children was also introduced to vaccinate children missed during the fixed booth based vaccination of children.

Progress

1. The last polio case in the country was reported from Howrah district of west Bengal with date of onset 13th January 2011. Thereafter no polio case has been reported in the country (20th July 2012).

2. WHO on 24th February 2012 removed India from the list of countries with active endemic wild polio virus transmission.

FAMILY WELFARE LINKED HEALTH INSURANCE SCHEME

Rashtriya Swasthya Bima Yojana

• Rashtriya Swasthya Bima Yojana (RSBY), a scheme of Ministry of Labour was launched on 1 October 2007 and rolled out from 1 April 2008 in a phased manner. The scheme is implemented in most of the states, initially on pilot basis. However, the Government has decided to take up all the districts in 2009-10 itself. Maximum contribution is _ 725 per family (75 per cent. 25 per cent) [Central: State share]. The beneficiary would pay _ 30/- per annum as registration/ renewal fee.

• The main objective of this scheme is to provide health insurance cover to the below poverty line (BPL) workers and their families in the unorganized sector and to improve access of BPL families to quality medical care for treatment of diseases involving hospitalization and surgery through an identified network of health care providers as cashless.

• The scheme has 725 identified common surgical packages apart from medical procedures. In addition to the package list other procedures are also covered. This covers entire cost of treatment of the patient from date of reporting to his discharge from hospital and 5 days after discharge and any complication while in hospital, making the transaction truly cashless to the patient.

• As on 30 June 2009 scheme has been rolled out in 120 districts of 18 States on various dates in 2008-2009. Total 60,59,599 family smart cards have been issued covering 3,07, 97,995 members.

National Commission on Population

• The National Commission on Population was constituted in May 2000 to review, monitor and give direction for the implementation of the National Population Policy (NPP), 2000 with a view to meeting the goals set out in the Policy, to promote intersectoralcoordination, involve the civil society in planning and implementation, facilitate initiatives to improve performance in the demographically weaker States in the country and to explore the possibilities of international cooperation in support of the goals set out the National Population Policy.

• The National Commission of Population was reconstituted on 11 April 2005 with 40 members under the Chairmanship of the Prime Minister. Minister of Health and Family Welfare and the Deputy Chairmen of the Planning Commission are Vice Chairman of the Commission.

National Board of Examinations

• The National Board of Examinations was established in 1975 on the basis of the Report of a Working Group set up by the Government of India. The National Board functioned as a wing of the National Academy of Medical Sciences from 1975 to 1982 and the Government of India, afater a review, took a policy decision to make it an independent autonomous body with effect from 1 March 1982 under the Ministry of Health and Family Welfare.

• The NBE is the only examining body of its kind in the country in the field of medical sciences. Continuing evaluation of quality and validity of the measurement mechanism and standards of examinations by constant interaction with experts in various disciplines of modern medicine and allied specialities are among its important activities.

Health Minister’s Discretionary Grants (HMDG):

• Financial Assistance to the poor and indigent patients is given from the Health Minister’s Discretionary Grant to defray a part the expenditure on hospitalization/ treatment in Government Hospital as these patients cannot be considered for financial assistance under Rashtriya Arogya Nidhi due to income of above poverty line, but less than 50,000/- per annum.

Sample MCQ:

1. Consider the following statements about ‘Janani Suraksha Yojana’:

1. It is a Safe motherhood intervention under the NRHM being implemented with the objective of reducing maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women.
2. It is a 100 percent centrally sponsored scheme and it integrates cash assis-tance with delivery and post delivery care.

Which of the above statements is / are correct?

1. 1 only
2. 2 only
3. Both 1 & 2
4. Neither 1 nor 2

2. Consider the following statements:

1. The National Rural Health Mission was launched by the Government of India in April 2005 to provide accessible, affordable and accountable quality health services to the poorest households in the remotest rural regions.
2. The expected outcome of the mission include reduction of IMR to below 30/1000 live birth, MMR to below 100/1000 live birth and TFR to 2.1 by 2012.

Which of the above statements is / are correct?

1. 1 only
2. 2 only
3. Both 1 & 2
4. Neither 1 nor 2