NATIONAL HEALTH PROGRAMMES

Introduction: India being developing country is facing various problems which are being solved via national health programme. The government of India is not only recognised the health care organisation & delivery system to provide three tier health services via a network of health centres & hospitals in rural & urban areas, but also launched various national health programmes to deal with the specific health problems like communicable & non communicable diseases, environmental sanitation, population explosion, poor nutrition etc. the govt. of India also availed technical &

material assistance from international agencies like WHO, USAID, SIDA, DANIDA etc. National health problems: Communicable disease. Population problem Nutrition Environmental sanitation Medical care

National health programmes: National malaria eradication programme (NMEP) National filarial control programme (NFCP) National kala azar control programme Japanese encephalitis prevention & control programme National programme for prevention & control of dengue, dengue hemorrhagic fever. National leprosy eradication programme (NLEP) National tuberculosis control programme (NTCP) National programme for control of blindness (NPCB) National immunization programme (NIP) National mental health programme (NMHP) National iodine deficiency disorder & control programme National AIDS control programme (NACP) National cancer control programme (NCCP) National guinea worm eradication programme National yaws eradication programme (NYEP) National safe water & sanitation programme

1.National malaria eradication programme (NMEP) Introduction: This programme started in 1950, but later on upgraded to national malaria eradication programme in 1955. The problem was reviewed in constitution with experts the modified plan of operation was approved by the cabinet in October 1976. Objectives of NMEP: To prevent death due to malaria. Reduction in the period of sickness. To bring down malaria morbidity. To intensify anti malarial measures for bringing back agricultural & industrial production. To consolidate the gains achieved so far.

Strategies of NMEP: 1. Early case detection & prompt treatment. 2. Vector control by house to house spray of anti larval measures. 3. Health education & community participation.

Efforts to implement strategies: Government efforts Peoples participation Research Training Publicity Internal assistance

Action in area with annual parasite incidence>2 A spraying 2 or 3 rounds of D.D.T. Assessment by entomologist for an effective insecticide. Active & passive surveillance. Parasite treatment & routine treatment

Action in area with API<2 Focal spraying around P. falciparum cases. Every fortnightly active & passive surveillance. PT & RT of all cases. MP follows up smear on RT & later monthly for yr. Epidemiological investigation.

DDC:- Drug distribution centres to dispense chloroquine tablets. FTD:- Fever treatment depots to collect MP smears & to dispense chloroquine.

Urban Malaria Control Scheme:- to reduce urban malaria transmission. Surveillance:- is watch over the disease:-(A) Active surveillance: health workers covers a population of 10,000 & collects smear from fever cases gives PT later if positive assistance. (B) Passive surveillance:- when fever cases comes to centres or hospitals procedures or MP smears, PT, RT are attended. Target of 15% of OPD cases are given as target under passive surveillance. To create awareness about malaria & its prevention 1 -7 may is celebrated as Malaria Weak every year. I. 2. National filarial control programme (NFCP) It started in 1955. In 1978 urban malarial scheme was merged with this programme. Activities:a) Survey & case detection in omitted places. b) Antilarval measures. c) Antifilaria measures. d) Detection & treatment of microfilaria carriers/persons. Strategies: i. Weekly spray of approved larvicide & biological control vi larvivorous fishes. ii. Environment & water management. iii. Information, education & communication for community. iv. Administration of single dose of diethyl carbmazine citrate. These activities are done via filarial control units (FCU) VHG is trained for an effective primary case in antifilria activities. 3. National kala azar control programme (NKCP) Kala azar is a serious public health problem in Bihar, West Bengal & Jharkhand. In 1991 the kala azar control programme was launched by govt. of India. Strategies: Interruption of transmission for reducing vector population by insecticidal spray annually. Early diagnosis & complete treatment. Information, education & communication for community awareness & involvemement.. twice
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gives RT. 4 MPW are supervised by 1 health

4. Japanese encephalitis prevention & control programme (JEPC) It is a disease with high mortality rate & is caused by flavivirus group. It transmitted from animals to human by mosquito. The programme was launched in 1979. Strategies: Early diagnosis & prompt case management. Vector control by anticipatory insecticide spray in dwelling & fogging for epidemic containment. Care of patient. Clinical surveillance of suspected cases. Identify the high risk groups by measuring the blood level of antibodies. Epidemiological monitoring of the disease for effective implementation of preventive & control measures. 5. Programme for prevention & control of dengue/ dengue hemorrhagic fever Dengue / DHF is a viral infection & widely prevelant in India. There has been a decline in dengue / DHF incidence after 1996. Strategies: Surveillance for desease & vectors. Early diagnosis & prompt case management. Vector control via community participation & social mobilization. Capacity building. There is no separate programme for prevention & control of DF/DHF. The resources are available under NMEP. 6. National leprosy eradication programme (NLEP) In 1983 National leprosy control programme (NLCP) was enhanced to National leprosy eradication programme (NLEP) because of highly effective treatment for leprosy. The National leprosy eradication commission was set up under the chairmanship of union minister of health & family welfare. The board in accordance with eradication commission help to guide & making decision, coordination, planning implementation & surveillance of various activities of NLEP. Strategies: Early detection via survey. Contact examination. Regular short term multi drug therapy (MDT) Rehabilitation activities

Health education.

The world bank assistance: In 1993-94 world bank assistance sanctioned 302 crore Rs for 409 dist. of India for a period of 6 yrs. The world bank assistance is used for:Extension of MDT services Strengthening of existing services. Health education & training services. Disability & ulcer care including reconstructive surgery. Manpower development.

Infrastructure:

the programme is implemented via the establishment of leprosy control units ;

survey, education & treatment i.e. SET. These units are consisting of:- Medical officer Non medical officer Para medical workers 01 02 20

One PMW covers 15-20 thousand population & expected to examine at least 8000 persons per yr. One medical supervisor is for 5 PMW. The SET unit is attached to PHC. The various strategies which have been under taken are:- Information, education & communication for community awareness & involvement. Staff motivation & special project for difficult areas. NGOs. Participation. Modified leprosy elimination campaign (MLEC).

7. National tuberculosis control programme (NTCP) This is a major public health problem in India with high mortality & morbidity rates. NTCP was launched in 1962 via a network of district T.B. centers (DTC) with a support of 47,600 TB beds & 330 TB clinics in urban areas. The primary objective of DTC is to detect TB cases & provide domiciliary treatment to TB patients. The function of DTC has been to plan & organize DTP & implement in the entire district. In all DTC a team including :-DIST. T.B. officer Medical officer Lab. Technician Health visitor X-ray technician 01 01 02 02 01

Non medical team leader Statistical assistant Pharmacist

01 01 01

DMO is given direct charge for implementation of DTP. MPW at PHC /CHC/SC level are also involved in DTP. Objectives of NTCP:(A) Long term objectives: a) To reduce TB in the community to that level when it ceases to a public health problem. b) (B) The prevalence of infection in age group below 14 yrs.

short term objectives: a) To detect max. no. of TB cases. b) To vaccinate newborns & infants with BCG. c) To undertake the above objectives in an integrated manner.

REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME (RNTCP) A revised strategy for TB control programme was evolved in 1992 with following objectives:a) To achieve at lest 85% cure rate of infectious TB cases via administration of DOTs. b) To detect at least 70% of estimated cases via quality sputum microscopy. c) To involve NGOs for improved operational research. Components of RNTCP: Political commitments. Sputum microscopy Short course chemotherapy with uninterrupted drug supply. Direct observation. Accountability.

8. National health programme for control of blindness (NPCB) Introduction-The National Health Programme for the control of blindness was established in1976 as 100% centrally sponsored program. The national trachoma control program which was launched in 1963 the national prophylaxis programme against blindness due to vitamin A deficiency launched in 1970 were incorporated in NCPB. Goal- The goal of NCPB is to reduce the prevalence of blindness from 1.5% to 0.3% lakh person. Objectives(1) To establish eye care facilities for every 5 lakh persons.
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(2) To develop human resources for eye care services at all level e.g. P.H.C, C.H.C, subcenter, sub-district and district level. (3) Improve quality of service delivery. (4) To service participation of civil society and the private sector. To achieve these activities the varies activities are under taken by the central government, the state government and in all over the country. An agreement was also signed by government of India and the government of Denmark to provide support for the development of services under the NPCB in 1998-2002. Activities1. Cataract surgeries- A Target of 400 operations per lakh is set to enable the states to clear the back log of cataract blindness. The purpose of cataract surgery is to restore vision of the affected person through a package of services and to return to normal working life. 2. Strengthening of infrastructure- Construction of eye ward, operation theatres and darkroom was under taken in 7 states covered under the World Bank assisted cataract control project. 3. Training- Government of India is imparting training in implantation of intraocular lens surgery. 4. Drug and commodities-Drug, medicines and other consumables as well as spectacles are poured locally by the district blindness control societies out of grants given to them consumable items like suture IOL are also produced centrally. 5. Information education and communication activities-In 1999-2000 IECA are under taken central, state and provide such materials like poste, video radio; jingles etc are produced in all major regional language. 6. Management information system-software has to develop to facilities data compilation and analysis of various activities under NCBP. 7. External Assistance-The external assistance is provided by DANINDA World Bank and WHO, An agreement was signed between the government of India and the government of Denmark to provide support for the development of services under NPCB and also voluntary organization such as international Lion club there branches etc play an important role in caring some of the activities. Revised strategieDuring 1998-1999 and 1999-2000 varies surveys, studies have been revealed To make NCEB more comprehensive by strengthening services for other causes of blindness like corneal blindness, refractive error in school going children, improving follow up services of cataract operated persons and treating other causes of blindness like glaucoma. To shift from the eye camp approach to fixed faculty surgical approach and from conventional surgery to IOL implantation for better quality for post operative patient. blindness

To expand the world bank projected activity like construction of dedicated eye operation theatre eye ward at district level e.g. training of eye surgeon. To strengthen participation of voluntary organization in the programme and to earn mark geographic area to NGO and government hospital to avoid duplication of effort and improve the performance of government units.

National mental health programme (NMHP) In 1982 the national mental health programme was launched to mitigate the hardships of mentally ill patient. A national advisory group on mental health illness was formed under the chairmanship of seceratary, ministery of health and family welfare for the effective implementation of the National health programme. The district mental health as component of NHMP was launched in 1996-97 in 45 districts on the recommendations of the central council of health in 1995. Objective :To ensure availability of mental health care services to all specially the community at risk under privileged and under served people. To encourage application of mental health knowledge in general care and social development.

ActivitiesThe programme DMH envisages a community based approach with mental health problem. It includes the following intervention are Training of the mental health team at the identified nodal institution with in the states. Awareness about the mental health problems. Provide services for early detection and treatment of mental illness in the community itself with both IPD and OPD treatment. Provide valuable data and experiences at the level of community in the state and centre for future planning improvement in services and research. Funds are provided by the government of India to the state government and the nodal institutes to meet the expenditure on staff, equipments, vehicles, medicines, stationary etc. Training to the trainers at the state level is being provided regularly by the National institute of mental health and neurosciences, Banglore under the National mental programme. The districts mental health programme was extended to seven districts in 1997-1978. A budgetary allocation of rs 28.00 crores has been made during the 9 five year plan for the National mental health programme. Tertiary care hospitals: There are about 37 state run mental health hospitals in India in addition there are about 40-50 psychiatric nursing homes, hospitals in the private sector. The tertiary care institutions which are well know in the public sector are National Institute of Mental Health and Neurosciences Banglore, central institute of psychiatry, Ranchi and The institutes of Human behaviour and Allied sciences.
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Human rights of mentally ill patients: 1. The mental health Act 1987 by the government of India. 2. The National human Rights commission. 10.National water supply and sanitation programme (NWSP) The national water and sanitation programme was launched in 1954 by the government of India. In 1972 a special programme was started as the accelerated rural water supply programme was a supplement to the national water supply and sanitation programme. During the 5
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year plan rural water supply was included in the minimum needs

programme of the state plan. In 1981 government of India launched the national drinking water supply and sanitation decade programme. In the peoples of village as one where on source of water is available within the distance of 1.6 km or where water is available at depth of more than 15 meters where sources has excess salinity,iron,floride and other toxic elements or where water is exposed to the risk of cholera and gunieaworm.Information,education and communication is an integral part of rural sanitation programme to adopt proper environmental sanitation practices including disposal of garbage refuse and waste water and convert all existing dry latrines in low cost sanitary latrines. Objectives; To providing safe and clean water supply and adequate drainage facilities for the entire urban and rural population, 11.Universal immunization programmes (UIP) In may 1974 the WHO officially launched a global immunization programme known as expanded programme on immunization to protects all children of the world against 6
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vaccine

preventable

disease

namely

diphtheria,

whooping

cough,tetanus,polio,tuberculosis and meales by year 2000. Expended immunization programme was launched in India in January 1978. The programme is now universal child immunization, 1990 that is the name given 40 universal in October 1985. In Indian version the universal immunization programme was launched November 19, 1985 was dedicated to the memory to smt Indra Gandhi. The national health policy aimed achieving universal immunization coverage of the eligible population by 1990.In 1985 universal immunization programme was started in India. Objectives; To reducing the mortality and morbidity resulting form vaccine preventable disease of childhood and to achieve self sufficiency in the production of vaccines.
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Components- It has two vital components 1. Immunization of pregnant women against tetanus 2. Immunization of children in there 1 Year of life against 6 killer diseases 12.National iodine deficiency control programme (NIDCP) It was India recommended a goitre control programme in 1962 based on iodized salt. At the end of three decade the prevalence of disease remain still high as a result the major national programme the iodine deficiency disorder control programme has been initiated in which nation wide rather than area specific use of iodized salt is being promoted. It was realised that iodine is an essential micro-nutrients for normal growth and developments. Its deficiency not only causes goitre but also other disorder such as abortion, goitre, stillbirth, mental retardation, defafness, mutism, squint and neuromotor was renamed to national iodine deficiency disorder control programme. Objectives: 1. To undertake surveys to asses the magnitude to iodine deficiency disorder. 2. To supply iodinated salt in the place of common salts. 3. To conduct resurvey to asses the impact of located salt and urinary iodine execration. 4. To conduct health education and publicity. 5. Irregular distribution of iodised salt for varying periods. 6. Coordination between departments of food and civil supply. Health and wholesale dealers. 13. National cancer control programme (NCCP) The cancer control programme was started in 1975 in a limited form. It was limited to establishment of regional cancer. In 1984 the programme was revised strengthened and converted to national cancer control programme. In 1990-91 district cancer programme was started in selected districts. Objectives: 1. Primary preventionHealth education on prevention of cancer. 2. Secondary preventionEarly detection and diagnosis of common cancer. 3. Tertiary preventionstrengthening of the existing institution for comprehensive therapy including palliative care. National cancer control programme1. Regional cancer centre. 2. Cancer registry. 3. Development of oncology wings in government medical college hospitals. 4. Cobalt therapy installation.
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5. District cancer control scheme. 6. Involvement of voluntary organization. 7. Postpartum centres 8. New initiatives. 9. Modifying district cancer control programme.(2000-01). 14. National guinea worm eradication programme The guinea worm disease is a vector born disease caused by nematode parasite. It affects subcutaneous tissues usually of leg and feets.The disease was endemic in 7 states Andhra Pradesh, Karnataka, Madhya Pradesh Rajasthan, Tamilnadu.Tamilnadu started vigours anti guinea worm measure in 1981. It has no indigenous cases. It was observed that disease could be eradicated by simple measure hence the government of India started the national guinea worm eradication programme in 1983-84 during the 6 five year plan. Activities1. The major activities include control of vector with temperas in the concentration of 1mg/litre. 2. Provision of safe drinking water. 3. Treatments of dected cases 4. Health education. The last cases of guinea worm disease was reported form Rajasthan during July 1996.India was declared free of guinea worm disease by W.H.O on 15
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July feb2001.The

programme was planned and implemented by national institute of communicable disease NICD(Delhi). 15.National yaws eradication programme (NYEP) Yaws is a contagious disease transmitted direct by person to person contacted and caused by Treponema pertenue. The infection is manifested by skin lesion which on healing show little scarring. The disease can be progressive where in bone and state of India cartilage get affected leading to disability and disfiguring but the disease can be cured and prevented by a single injection of long acting penicillin i.e. benzathine penicillin. Yaws has been endemic in 9 state of India e.g. Andhrapradesh, Maharashtra, Orrisa, Tamilnadu etc found in remote inaccessible hilly and forest tribal areas.Durning 1997 as many as 8515 cases of yaws were reported and treated. Therefore a pilot project of yaws eradication programme was a state in 1996-97 for unindividual koraput district orissa in March 1999 the programme was extended to all the endemic states. Programme strategies1. Detection of cases- It is done by making house to house visit by trained paramedical workers and community level functionaries at interval. 2. Treatment of cases and contact- Distribution of benzathine penicillin.
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3. Information and communication education- ICE is using different methods and health education material for early detection of disease its treatment prevention of contact. 4. Involvement of other sectors- Involvement of other sectors such as ministry of information and broad casting education. The yaw programme is planned organized, coodinated monitored by national institute of communicable disease and implemented by the stat health directorate of yaws. As a result of this programme the number of yaws cases comes down from 8515 in 1997 and 168 cases in2001
RESPONSIBILITIES OF COMMUNITY HEALTH NURSE IN NATIONAL HEALTH PROGRAMMES:-

Nurses are the key personnel in providing care to people having any kind of communicable or noncommunicable diseases and their contacts, in creating awareness, among people at large, educating them regarding prevention and control of various diseases etc. they perform the role of caregiver, communicator, educator, councelor, trainer, investigator, co-ordinator etc. Major responsibilities of community health nurse in prevention and control of various problems; she needs to:1) Know and understand the various problems in the country and the programmes which have been planned, organised and implemented to deal with all the problems. 2) Familiar with the activities of the programme to be dealt with the problems.

3) Identify endemic problems of the community for whom she is working. 4) Participate in community surveys to determine the extent and nature of problem. 5) Identify local agencies responsible to implement specific control programme, 6) Identify the role of health agency where she works in providing specific services to deal with specific problem. 7) Participate in screening of high risk cases, identification of cases with any such communicable/ non-communicable diseases, 8) Ensure the patient is diagnosed, treatment is done, care is given, 9) Trace/find out contacts, screening is done, diagnosis is confirmed, treatment is done, care is given etc. 10) Follow up of case and defaulters. 11) Maintain records, compile them and send to authority. 12) Refer the cases to concerned health agency when necessary. 13) Educate the patient and concerned family members regarding necessary care, preventive measures, precautions to be followed, disinfection of excrements, soiled articles and articles used by the patients as and when necessary in certain conditions. 14) Participate in regular immunization programme and particular to any specific problem condition when necessary. 15) Participate in information, education communication activities for people at large, school children on various aspects of healthful living, wrong beliefs and practices, environment health, control of vectors, rodents etc. and specific health problems when required.

16) Supervise, train multipurpose health workers, village health guides, dais and aganwadi
workers.