January 2011
Government Initiative: Help at Hand At the dawn of a new decade, the public healthcare system in India still battles the old enemy. National health programmes and schemes are the promising tools to succeed in this battle against deadly diseases. M Neelam Kachhap presents a report on major schemes and programmes of the Ministry of Health and Family Welfare, which will hugely impact the health of the nation in the coming decade During the last decade, India witnessed major efforts at strengthening public health system in the form of various National Health Programmes. From disease control programmes to control of blindness and deafness and recently non-communicable diseases and geriatric care; the National Health Programmes address a gamut of public health problems. Hence, it is essential for us to know how these programmes are progressing and how they are going to change the topography of the health of the nation. It is no secret that good health planning in India will enable the country to establish a healthcare system which will be socially acceptable, medically sound, and cost-effective enough for every Indian. However, the benefits of these programmes elude the people as majority of the masses do not know about these schemes. Realising the gap in information, we present this quick guide, giving details of key features of national health programs and achievements in the year 2009-2010. *Controlling the Odds* The National Vector Borne Disease Control Programme is a comprehensive programme for prevention and control of diseases namely Malaria, Filaria, Kala-azar, Japanese Encephalitis (JE), Dengue and Chikungunya, which is covered under the overall umbrella of National Rural Health Mission (NRHM). *Achievement* Malaria which used to cause 75 million cases in early 1950s has been reduced to less than two million cases per year. Malaria Control Programme in India underwent a dramatic policy and programme shift in 2009 with the scaling up of the three most effective tools of malaria prevention and control-Long Lasting Insecticidal Nets (LLINs) for use by community, Rapid Diagnostic Kits (RDKs) for rapid diagnosis of Falciparum malaria in remote areas of high endemic states and supply of Artemissinin-based Combination Therapy (ACT) as the first line of treatment for P.falciparum malaria. To address human resource issue, the Government of India(GOI) is supplementing the efforts of state governments by providing about 10,000 health workers in malaria-endemic states. To reduce morbidity and transmission in urban setup the GOI has launched the The Urban Malaria Scheme. Kala-azar : With each diagnosis and supply of drugs like milefosine, deaths on account of kala-azar have started declining rapidly. An incentive of Rs 100 is being provided to the health workers/ASHA for referring a suscepted case of kala-azar and to ensure complete treatment after confirmation. *Filariasis* : To achieve elimination of lymphatic filariasis, the GOI during 2004 launched annual Mass Drug Administration (MDA) with annual single recommended dose of DEC tablets in addition to scaling up home based foot care and hydrocele operation. However, the coverage of population under this scheme is low and will require more efforts from the community to reduce the disease burden. *Japanese Encephalitis (JE)* : GOI launched JE vaccination programme as an integral component of Universal Immunisation Programme. During 2008 and 2009 children between 1-15 years in 21 and 23 districts respectively have been vaccinated bringing the total number vaccinated districts to 83 in highly infectious states. Since early reporting of cases is crucial to avoid any complication and mortality, community is given full information about the signs and symptoms as well as availability of health services at health centres/hospitals. Dengue and chikungunya are also being tackled. A strategic action plan has been developed for prevention and control of dengue and issued to the endemic States for implementation. For chikungunya the overall strategies for prevention and control are same as in dengue such as symptomatic management of cases, reduction of breeding sources, personal protection and intensive IEC and capacity building. *Reforming Life* The National Leprosy Control Programme was launched in 1955 based on dapsone monotherapy. However, 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. The programme seeks to further reduce the leprosy burden, provide sustainable quality leprosy services through GHC system, enhance disability prevention and medical rehabilitation services, reduce stigma and discrimination against persons affected with leprosy and their family members, capacity building of GHC staff and strengthening, monitoring and supervision. More emphasis is being given on providing Disability Prevention and Medical Rehabilitation (DPMR) services to leprosy affected persons. *Successful Attempt* Spectacular success has been achieved against the disease after introduction of MDT. 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. For the first time in the country, National Sample Survey to estimate burden of Leprosy is being taken up. In the year 2009-2010, free medical facilities like care of ulcers, self care training, counselling and MCR footwear were provided to leprosy affected persons residing in 612 self settled colonies though the paramedical workers/NGOs on weekly/fortnightly basis. An amount Rs 5000 is provided as incentive to each leprosy affected person from BPL family undergoing reconstructive surgery in government identified institutions to compensate loss of wages during their stay in hospital. Support is also provided to government institutions/PMR centres in the form of Rs 5000 per RCS conducted, for procurement of supply and material and other ancillary expenditure required for the surgery. *TB or not TB* After running the National Tuberculosis Control Programme (NTCP) for 31 years the government launched the Revised National Tuberculosis Programme (RNTCP). An application in India of the WHO-recommended Directly Observed Treatment, Short Course (DOTS) strategy to control TB with the objective of curing at least 85 per cent of new sputum positive TB patients and detecting at least 70 per cent of such patients, was launched in the country in March 1997 and is being implemented in a phased manner. *Stronghold* Concerted efforts under the RNTCP for over a decade have led to decline of TB prevalence from 586 cases per lakh population in 1990 to 283 cases per lakh population in 2007. Treatment success rates have tripled from 25 per cent in the pre-RNTCP era to 86 per cent presently. TB death rates have been cut seven-fold from 29 per cent in the pre-RNTCP era to four per cent presently. Quality assured Sputum Microscopy diagnostic facilities are available through more than 12,700 laboratories across the country. India has successfully negotiated a grant from Global Fund of about Rs. 1,000 crores for scaling up of MDT treatment DOTS-Plus plan throughout the country. DOTS-Plus services have already been initiated in 10 states and will be available in all the states by the end of 2010-11. The RNTCP employs the Public Private Mix (PPM) which is the strategy to diagnose and treat TB patients reporting to all sectors of healthcare under RNTCP through a mix of different types of healthcare providers. Recognising the problem and impact of TB on urban slum population RNTCP intends to provide greater levels of access to its services to the urban slum population. *Sight Savers* Launched as a 100 per cent centrally sponsored programme, the National Programme for Control of Blindness was initiated 36 years ago to reduce prevalence of blindness from 1.4 - 0.3 per cent. *Advancements* The emphasis over the years has been given to cataract operation, training of ophthalmic surgeons, and distribution of free spectacles to school children, with targets being achieved in full measure even as collection of donated eyes is yet to pick up. The focus areas for the 11th five year plan besides cataract include childhood blindness, refractive error and low vision, corneal blindness, glaucoma, diabetic retinopathy and trachoma. The programme also provides recurring grant in aid to NGOs for management of other eye diseases, other than cataract, like diabetic retinopathy, glaucoma management, laser techniques, corneal transplantation, vitreoretinal surgery, treatment of childhood blindness etc. GOI has development of mobile ophthalmic units with tele-ophthalmology network in North-East, hilly states difficult terrain underserved states and few fixed models in other states for diagnosis and medical management of eyes diseases - diabetic retinopathy. *Adding Nutrition* In 1962 the government launched National Goitre Control Programme which was later renamed National Iodine Deficiency Disorders Control Programme (NIDDCP). It aims at bringing down the prevalence of Iodine Deficiency Disorders (IDD) to below 10 per cent in all the districts of the country. *Sprinkling Success* The Ministry of Health & Family Welfare has issued notification banning the sale of non Iodised salt for direct human consumption in the entire country with effect from 17th May, 2006 under the Prevention of Food Adulteration (PFA) Act 1954. Visible goitre and cretinism has reduced significantly in the country. For effective implementation of NIDDCP 31 States/UTs have established Iodine Deficiency Disorders Control Cells in their State Health Directorate. On 21st October, 2009 Global IDD Prevention day was observed throughout the country. Messages on benefits of consumption of iodated salt in prevention and control of IDD were published in national and regional news papers on the eve of Global IDD Day. *Right Stimulus* National Mental Health Programme (NMHP) 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 selfhelp in the community. *New Beginning* An evaluation of NMHP was undertaken in 2003 and the programme was re-strategised to incorporate components for effective reach and impact on mental illnesses. There is a shift in the approach of mental healthcare services. From hospital based care (institutional), the approach now is towards providing community based mental healthcare, as majority of mental disorders do not require hospitalisation and can be managed at community level. Under the NMHP, 11 state mental hospitals and institutes have been identified to be developed into 'Centres of Excellence' to upgrade the facilities and provide for creation of more man powers resources in mental health. *Act of Preventing* The National AIDS Control Programme (NACP) Phase-III (2007-2012) has the overall goal of halting and reversing the epidemic in India over the five-year period. It places the highest priority on preventive efforts while, at the same time, seeking to integrate prevention with care, support and treatment. The specific objective is to reduce new infection as estimated in the programme's first year by 60 per cent in high prevalence states so as to obtain reversal of the epidemic; and by 40 per cent in the vulnerable states so as to stabilise the epidemic. *Targetted Help* In the last year GOI established 1311 targeted intervention projects, which among them covered an estimated 53.4 per cent of all female sex workers, and 74.2 per cent of IDU and 78.3 per cent of MSM and transgender populations. In addition 5210 ICTCs were established, which tested over 140 lakh people including 59 lakh pregnant women. Of the 19723 who tested positive, about 12083 were put on nevirapine. During the year 2009-10, under the NACP, an additional four district level blood banks and 28 blood component separation units have been established and over 60,000 blood donation camps were organised. The free Anti Retroviral Treatment (ART) programme scaled up to 269 centres, and 315,640 patients were receiving free ART as of March, 2010. Second line ART was initiated in Centres of Excellence and more than 1100 patients were enrolled. To create awareness about AIDS, second phase of specifically designed exhibition train, red ribbon express was launched on 1st December 2009 to cover 152 stations in 22 states during its one year journey. *Reaching Out* National Cancer Control Programme was launched in 1975-76 with the objectives of primary prevention, early detection, treatment and rehabilitation. In view of the magnitude of the problem and the requirement to bridge the geographical gaps in the availability of cancer treatment facilities across the country, the programme was revised in 1984-85 and subsequently in December 2004. *What's New* Onconet- India: To facilitate telemedicine services and continued medical education, all 27 Regional Cancer Centres (RCC) will be linked with each other and also each RCC would in turn be linked to four peripheral centres. Telemedicine Services including tele-consultations, tele-referral, tele-pathology etc. will be provided. The budget for the project is Rs13.25 crores. Early detection, treatment, follow-up and management of cancer cases are the main services to be provided by this project. *Health Minister's Cancer Patient Fund* Health Minister's Cancer Patient Fund (HMCPF) within the Rashtriya Arogya Nidhi (RAN) has also been set up in 2009. In order to utilise the HMCPF, it is proposed to establish the revolving fund like RAN in the various RCCs. The financial Assistance to the Cancer Patients up to Rs.1, 00,000/- would be processed by the concerned Institute on whose disposal, the revolving fund has been placed. Initially, 27 Regional Cancer Centres has been proposed, at whose revolving funds of (Rs 10 lakhs) have been released. During the current financial year 2009-10 i.e. till November,2009, a sum of Rs 250 lakhs have been released to Regional Cancer Centres *Sign of Sound* Hearing loss is the most common sensory deficit in humans today. As per thw World Health Organisation (WHO) estimates in India, there are approximately 63 million people, who are suffering from Significant Auditory Impairment (SAI).This places the estimated prevalence at 6.3 per cent in Indian population. The National Programme for Prevention and Control of Deafness (NPPCD) was launched in January 2007 with the primary objectives of preventing avoidable hearing loss on account of disease or injury, early identification, diagnosis and treatment of ear problems responsible for hearing loss and deafness, to medically rehabilitate persons of all age groups, suffering with deafness, to strengthen the existing inter-sectoral linkages for continuity of the rehabilitation programme,for persons with deafness. and lastly to develop institutional capacity for ear care services by providing support for equipment and material and training personnel. *Development Phase* A pilot phase has been implemented in 25 districts derived from 10 states and a union territory till March 2008. In the current year (2009-10) 41 new districts have been included in the programme. Funds for distribution of hearing aids were given to 25 districts in which approximately 1500 Hearing aids (BTE) have been given to the hearing impaired children belonging to families having monthly income of less than Rs 6500 per month. The NPPCD is being integrated under the NRHM framework and State Governments have been requested to reflect the requirement of NPPCD in their District Plan/State Programme Implementation Plans (PIPs) for 2010-11. *Alpha Version* Considering the fact that Non-Communicable Diseases (NCDS) are surpassing the burden of communicable disease in India and the existing health system mainly focussed on communicable diseases need for National Programme for Prevention and Control of Diabetes, Cardiovascular Diseases and Stroke (NPDCS) was envisaged. *Pilot Programme* During the 11th Five Year Plan, an outlay of Rs 1660.50 crore has been provided for the programme. A pilot scheme has been launched in January, 2008 with the aim to prevent and control NCDS using health promotion and health education advocacy, early detection of persons with high level of risk of developing disease through opportunistic screening and capacity building of health system at all levels to tackle NCDs and improvement of quality of care and developing trained manpower at various health care set-ups in Districts/States. The programme is being implemented in phased manner with a piloting being done in the first phase. Subsequently, the programme is proposed to be implemented across the country. *Achievements* Under the Pilot project, health promotion activities were undertaken in 300 schools (30 in each district) and at 15 workplaces (1-2 workplace per district) in all the 10 States. 22,008 persons were screened for diabetes, hypertension, heart diseases and stroke (as reported by States; Gujarat, Kerala, Punjab, Sikkim and Andhra Pradesh) 2192 were found to be diabetic (9.95 per cent), 3774 (17.74 per cent) as hypertensive, 1080 (4.9 per cent) as suffering with CVD and 101 (0.45 per cent) had stroke. *Warning Smoke* 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 Programme (NTCP) in the 11th Five Year Plan. *Humble Beginning* Pilot phase of NTCP was launched in 2007-08 in 18 districts covering nine states. In the 2008-09 it has been up scaled up to 24 new districts covering 12 states. At present is the programme is under implementation in 42 districts in 21 states in the country. The GOI is also conducting the first Adult Tobacco Survey (ATS), with technical support from CDC and WHO. The ATS will provide the baseline estimates of the prevalence of tobacco use, ascertain levels of awareness about the ill-effects of tobacco usage and also the status of implementation of the tobacco control laws. *Geriatric Care* With an outlay of Rs. 288 crores, National programme for healthcare of elderly has been launched recently. The programme addresses the issues of elderly by way of introducing a comprehensive healthcare set up completely dedicated and tuned to the needs of the elderly with interventions designated to capture the preventive, curative and rehabilitative aspects in the geriatric through various interventions at all verticals of the present public health system. It is also believed that decentralisation of such a comprehensive package of services (including prevention, diagnosis and early treatment) would reduce patient flow to city hospitals, reduce out of-pocket expenses among the affected families and save lives due to timely treatment. Effort has been made to integrate and synergise all these programs at various levels. *References: Major Schemes and Programmes Government of India New Delhi November, 2000 (Revised Edition) Annual report to the people on health, MOHFW, September 2010. www.mohfw.nic.in* http://www.expresshealthcaremgmt.com/201101/anniversaryspecial15.shtml -- You received this message because you are subscribed to the Google Groups "Mental Health Advocacy (News 'N Views) India" group. 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