National Programmes

Dr Nishant VermaAssistant Professor

Department of PediatricsKing 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

Exclusive breast feeding

Full immunization

ORS in Diarrhea

Full antenatal check up

Early breast feeding (<1 hr)

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 completion-

Challenging– 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 Programme3. National Leprosy Eradication Programme4. National AIDS Control Programme5. Universal Immunization Programme6. National Guinea worm Eradication Programme7. Yaws Control Programme8. Integrated Disease Surveillance Programme

Programmes for Non Communicable Diseases

1. National Cancer Control Program2. National Mental Health Program3. National Diabetes Control Program4. National Program for Control and treatment of

Occupational Diseases5. National Program for Control of Blindness6. National program for control of diabetes,

cardiovascular disease and stroke7. National program for prevention and control of

deafness

National Nutritional Programs

1. Integrated Child Development Services Scheme2. Midday Meal Programme3. Special Nutrition Programme (SNP)4. National Nutritional Anemia Prophylaxis

Programme5. 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

1985 1992 1997 2005

UIP launched

CSSM(Child survival

and safe motherhood)

RCH(CSSM + Family

planning)

RCH II(adolescent

health component

added)

20132005

NRHM(RCH integrated

into NRHM; ASHA created)

RMNCH + A(part of NRHM)

NUHM proposed

1975

ICDS launched

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 packageServices Target Group Service Provided by

Supplementary Nutrition Children below 6 years:Pregnant & Lactating Mother (P&LM)

Anganwadi Worker and Anganwadi Helper

Immunization Children below 6 years:Pregnant & Lactating Mother (P&LM)

ANM/MO

Health Check-up Children below 6 years:Pregnant & Lactating Mother (P&LM)

ANM/MO/AWW

Referral Services Children below 6 years:Pregnant & Lactating Mother (P&LM)

AWW/ANM/MO

Pre-School Education Children 3-6 years AWW

Nutrition & Health Education

Women (15-45 years) AWW/ANM/MO

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, non-

communicable; 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

• 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 under NHM

Child Health Goals under NHM

Child health indicator

Current status

(SRS 2011)

NHM Goal (2017)

MDG (2015)

IMR 44 <25 28NMR 31 - -

U5MR 55 - <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 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

Thrust areas under child health program of NHM

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

• 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.

JSSK

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– Diseases

• Periodic screening

Time of screening

Personnel Site

Birth MO, ANM, Nurse Delivery site48hr – 6wk ASHA Home (HBNC)6wk – 6yr Mobile block

level teamsAnganwadi centre

6 – 18yr Mobile block level teams

School

• 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

Schemes for immunization under NHM

Immunization coverageCoverage 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

• 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)

Schemes for adolescents health under NHM

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

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