National Programmes
Dr Nishant Verma
Assistant Professor
Department of Pediatrics
King George’s Medical University
Alarming figures !!!
• Deaths / yr
– 56000 women due to pregnancy related
complications
– 11.6 lac infants
– 8.7 lac newborns
• U5MR - 59/1000 live birth (Japan 3, China 18)
• IMR - 42/1000 live birth
Alarming figures !!!
Malnutrition (<3yr)
• 23 % wasted
• 45 % stunted
• 40 % underweight
54 % U5 mortality related to malnutition
Source: NFHS 3
Full antenatal check up
Early breast feeding (<1 hr)
Exclusive breast feeding
Full immunization
ORS in Diarrhea
Millennium Development goals
• 8 international
development goals
• Established at Millennium
Summit of UN in 2000
• 189 UN member states and
23 international
organizations committed to
help achieve MDG
• Target 2015
Millennium Development goals
Focus : MDG 4 and 5
Aim of National Health Programmes
•
•
•
•
•
•
•
•
•
Improve health of country
Healthy mother = Healthy child
Better pregnancy care
Better newborn care
Eliminate vaccine preventable diseases
Target malnutrition
Education
Healthy adolescents
Population control
Vertical Health Programs
• Separate Health Structures with strong central
management dedicated to the planning,
management & implementation of selected
interventions
• Advantages
– Clear objectives & targets motivate staff
– Operational planning is focused & easy to deliver
– Efficient & effective delivery
– Better ability to monitor restricted output
Contd.
• Disadvantages
– No capacity to accommodate extra work in
disasters
– Resources used for specific activities only
– No focus on overall development
– Placement of workers after completionChallenging
– Long term public motivation not sustained
– May not be cost effective in long run
Integrated Health Programs
• Advantages
– Help national development on a broader
perspective
– Inter-sectoral collaboration
– Can accommodate extra work
– Responds to community needs
– Cost effective in long run
– Holistic approach to health
Contd.
• Disadvantages
– Sometimes fail to target priority effectively
– Complex programming
Programmes for Communicable Diseases
1. National Vector Borne Diseases Control Programme
(NVBDCP)
2. Revised National Tuberculosis Control Programme
3. National Leprosy Eradication Programme
4. National AIDS Control Programme
5. Universal Immunization Programme
6. National Guinea worm Eradication Programme
7. Yaws Control Programme
8. Integrated Disease Surveillance Programme
Programmes for
Non Communicable Diseases
1. National Cancer Control Program
2. National Mental Health Program
3. National Diabetes Control Program
4. National Program for Control and treatment of
Occupational Diseases
5. National Program for Control of Blindness
6. National program for control of diabetes,
cardiovascular disease and stroke
7. National program for prevention and control of
deafness
National Nutritional Programs
1.
2.
3.
4.
Integrated Child Development Services Scheme
Midday Meal Programme
Special Nutrition Programme (SNP)
National Nutritional Anemia Prophylaxis
Programme
5. National Iodine Deficiency Disorders Control
Programme
Programs related to System
Strengthening /Welfare
1. National Health Mission
2. Reproductive and Child Health Programme
3. National Water supply & Sanitation
Programme
4. 20 Points Programme
Time line
RCH II
CSSM
ICDS
launched
1975
(adolescent
health
component
added)
(Child survival
and safe
motherhood)
1985
1997
NUHM
proposed
(RCH integrated
into NRHM; ASHA
created)
(CSSM + Family
planning)
1992
(part of NRHM)
NRHM
RCH
UIP
launched
RMNCH + A
2005
2005
2013
ICDS
• Launched on 2nd October 1975
• Objectives:
– To improve nutritional and health status of
children in 0-6 yr age group
– To lay the foundation for proper psychological,
physical and social development of children
• Services provided at Anganwadi Centre
• Grass root worker for ICDS: Anganwadi worker
ICDS : Service package
Services
Target Group
Service Provided by
Supplementary Nutrition
Children below 6 years:
Anganwadi
Worker
Pregnant & Lactating Mother Anganwadi Helper
(P&LM)
Immunization
Children below 6 years:
ANM/MO
Pregnant & Lactating Mother
(P&LM)
Health Check-up
Children below 6 years:
ANM/MO/AWW
Pregnant & Lactating Mother
(P&LM)
Referral Services
Children below 6 years:
AWW/ANM/MO
Pregnant & Lactating Mother
(P&LM)
Pre-School Education
Children 3-6 years
AWW
Nutrition & Health
Education
Women (15-45 years)
AWW/ANM/MO
and
National Health Mission
• NRHM + NUHM
• Vision of NHM
“Attainment of Universal Access to Equitable,
Affordable and Quality health care services,
accountable and responsive to people’s needs,
with effective inter-sectoral convergent action to
address the wider social determinants of health”
Source : Framework for Implementation
National health mission. Ministry of health and
family welfare Government of India 2012-2017
Core values of NHM
• ‹Safeguard the health of poor, vulnerable and disadvantaged
• Strengthen public health systems as a basis for universal
access
• Build environment of trust between people and providers of
health services
• Empower community to become active participants in the
process of attainment of highest possible levels of health
• Institutionalize transparency and accountability
• Improve efficiency to optimize use of available resources
Goals of NHM (By 2017)
1.
Reduce MMR to 100/100,000 live births (178 in 2012)
2.
Reduce IMR to 25/1000 live births (42 in 2012)
3.
Prevent and reduce mortality & morbidity from communicable, noncommunicable; injuries and emerging diseases
4.
Reduce household out-of-pocket expenditure on total health care
expenditure
5.
Reduce annual incidence and mortality from Tuberculosis by half
6.
Annual Malaria Incidence to be <1/1000
7.
Kalaazar Elimination by 2015, <1 case per 10000 population in all blocks
Components of NHM
1. RMNCH + A
2. National disease control programmes
3. Health system strengthening
RMNCH + A
• Reproductive and Maternal health (JSK/JSSK)
• Family planning
• Child health
• Immunization
• Adolescent health
National disease control programmes
• NVBDCP
• RNTCP
• NIDDCP
• NPCB
• NLEP
• IDSP
Health system strengthening
• MMU
• Patient transport services
• Infrastructure
• Human resources
• Drugs
Child Health under NHM
• The Reproductive and Child Health
programme (RCH) II under the NHM integrates
interventions that promote child health and
addresses factors contributing to IMR and
U5MR
Child Health Goals under NHM
Child health
indicator
IMR
NMR
U5MR
Current
status
(SRS 2011)
44
31
55
NHM Goal
(2017)
MDG
(2015)
<25
-
28
<38
Thrust areas under child health
program of NHM
Thrust Area 1 : Neonatal Health
• Essential new born care (at every ‘delivery’ at time of birth)
• Facility based sick newborn care (at FRUs & District
Hospitals)
• Home Based Newborn Care
Thrust Area 2 : Nutrition
• Promotion of optimal Infant and Young Child Feeding
Practices
• Micronutrient supplementation (Vitamin A, Iron Folic Acid)
• Management of children with severe acute malnutrition
Thrust areas under child health
program of NHM
Thrust Area 3: Management of Common Childhood illnesses
• Management of Childhood Diarrhoeal Diseases & Acute
Respiratory Infections
Thrust Area 4: Immunisation
• Intensification of Routine Immunisation
• Eliminating Measles and Japanese Encephalitis related
deaths
• Polio Eradication
Schemes for child health under NHM
• Facility Based Newborn and Child Care (FBNC)
• Janani Shishu Suraksha Karyakram (JSSK)
• Facility Based Integrated Management of Neonatal and Childhood Illness
(F- IMNCI)
• Integrated Management of Neonatal & Childhood Illnesses (IMNCI)
• Home Based New Born Care (HBNC)
• Navjat Shishu Suraksha Karyakram (NSSK)
• Infant and Young Child Feeding
• Nutritional Rehabilitation Centres (NRC)
• Reduction in morbidity and mortality due to Acute Respiratory Infections
and Diarrhoeal Diseases
• Supplementation with micronutrients
• Rashtriya Bal Swasthya Karyakram (RBSK)
Facility based newborn care
• To address the issue of high NMR
• Improved care of sick newborns through
– Special New Born Care Units (SNCUs): at each district
– New Born Stabilization Units (NBSUs): at CHC/FRU
– New Born Baby Corners (NBBCs): at all delivery facility
JSSK
• Launched in June 2011
• Provisions for pregnant women and sick newborn
–
–
–
–
–
Free treatment
Free drugs and consumables
Free diagnostics & Diet
Free provision of blood
Free transport from home to health institutions, or
between facilities in case of referral
– Free drop back from institutions to home
– Exemption from all kinds of user charges.
Home based newborn care
• ASHA to make visits to all newborns according
to specified schedule up to 42 days of life
• Duties
– Recording of weight of newborn,
– Ensuring BCG , 1st dose of OPV and DPT vaccination,
– Ensuring Both the mother and the newborn are safe till 42
days of delivery,
– Ensuring registration of birth has been done
• ASHA to be paid incentive of Rs 250 for 5 visits
Navjat Shishu Suraksha Karyakram
(NSSK)
• Aimed to train health personnel in basic
newborn care and resuscitation
• Has been launched to address care at birth
issues
– Prevention of Hypothermia
– Prevention of Infection
– Early initiation of Breast feeding
– Basic Newborn Resuscitation
• Training is for 2 days
Infant and Young child feeding
• Infant and Young Child Feeding is the single most
preventive intervention for child survival. It
advocates the following:– Early initiation (within one hour of birth) and exclusive
breast feeding till 6 months
– Timely complementary feeding after 6 months with
continued breast feeding till 2 yrs
Nutritional Rehabilitation Centres
• Being set up in health facilities for inpatient
management of SAM
• Counselling of mothers for proper feeding and
once they are on the road to recovery, they
are sent back home with regular follow up
Supplementation with micronutrients
Vitamin – A
– 1,00,000 IU at 9 months
– 2,00,000 IU (after 9 months) at six monthly intervals up to
five years of age
– All cases of severe malnutrition to be given one additional
dose of Vitamin A
IFA
– 6mo-5yr: 20mg elemental iron + 100mcg FA/day/child for
100 days in a year
– 6-10yr: 30mg elemental iron + 250mcg FA/day/child for
100 days in a year
– >10yr: adult dose
Rashtriya Bal Swasthya Karyakram
(RBSK)
• A new initiative aiming at early identification and
early intervention for children from birth to 18 years
to cover 4 ‘D’s
–
–
–
–
Defects at birth
Development delays including disability
Deficiencies Time of
Personnel
screening
Diseases
• Periodic
screening
Site
Birth
MO, ANM, Nurse
Delivery site
48hr – 6wk
ASHA
Home (HBNC)
6wk – 6yr
Mobile block
level teams
Anganwadi
centre
6 – 18yr
Mobile block
level teams
School
Schemes for immunization under NHM
• UIP one of the key areas of NHM since 2005
• GOI provides free vaccines against 7 diseases
– Diphtheria, Pertussis, Tetanus, Polio, Measles, Tuberculosis, Hepatitis B
• JE vaccine introduced in the routine program in 112 endemic
districts
Immunization coverage
Coverage Evaluation
Survey
(CES)
District Level
Household Survey
(DLHS)
Time Period
2009
DLHS 3 (2007-08)
Full Immunization
61.0
53.5
BCG
86.9
86.7
OPV3
70.4
65.6
DPT3
71.5
63.4
Measles
74.1
69.1
No Immunization
7.6
4.6
Schemes for adolescents health under NHM
• Adolescent reproductive and sexual health (ARSH)
• Menstrual Hygiene scheme (MHS)
• School health program (SHP)
• Weekly iron and folic acid supplementation (WIFS)
• Rashtriya Kishor Swasthya Karyakram (RKSK)
Adolescent reproductive and sexual
health (ARSH)
• Range of sexual and reproductive health services
to be provided to adolescents
• Adolescent clinics
– Counseling services, routine check-ups are provided
on fixed days and fixed time to adolescents
• ARSH training
– health functionaries made sensitive towards health
needs of adolescents through a systematic training of
5d for ANM and 3d for MO through State Institute of
Health and Family Welfare
• ARSH helpline – tele-counseling centre
School Health Program
• To address health needs of school going children and
adolescents in 6-18yr age groups in Govt and Govt
aided schools
• Biannual health screening
• Early management of disease, disability and common
deficiency
• Weekly Iron Folic acid Supplementation and biannual
deworming proposed to be linked with school Health
Programme
Weekly iron and folic acid
supplementation (WIFS)
• Intervention
– weekly supervised administration of 100mg
elemental Iron and 500ug Folic Acid
– biannual deworming
• Target population
– school going adolescent girls and boys (at
Govt/Govt. aided and municipal school)
– out of school adolescent girls (at anganwadi
kendra)
Rashtriya Kishor Swasthya Karyakram
(RKSK)
• Recently launched to address adolescent health
needs and concerns
• Apart from sexual and reproductive health, it also
includes nutrition, injuries and violence (including
gender based violence), non-communicable
diseases, mental health and substance misuse
• Shift from clinic based approach to promotion
and prevention and reaching adolescents in their
own environment, such as in schools and
communities
National programme for
Mid-day Meals in Schools
• Launched in 1995
• Provides mid-day meals to students in the school
– Primary stage – 450Kcal ; 12gm Protein
– Upper primary stage – 700Kcal ; 20gm Protein
• Advantages
–
–
–
–
–
Nutrition
School enrolment
School attendance
Social interaction
Employment
THANK YOU