The Vaccination Schedule under the UIP

National Immunization Schedule

Vaccine When to give Dose Route Site

For Infants

At birth or as early as 0.1ml (0.05ml

BCG possible till one year of until 1 month Intra -dermal Left Upper Arm
age of age)

Anterolateral side
Hepatitis B Birth At birth or as early as
0.5 ml Intramuscular of mid thigh-
dose possible within 24 hours
LEFT

At birth or as early as
OPV Birth dose possible within the first 15 2 drops Oral -
days

At 6 weeks, 10 weeks &

OPV 1,2 & 3 2 drops Oral -
14 weeks

Anterolateral side
IPV (inactivated
14 weeks 0.5 ml Intramuscular of mid thigh-
Polio Vaccine)
RIGHT

Anterolateral side
Pentavelant 1,2 & At 6 weeks, 10 weeks &
0.5 ml Intramuscular of mid thigh-
3 14 weeks
LEFT

At 6 weeks, 10 weeks &

Rota Virus Vaccine 5 drops Oral -
14 weeks

9 completed months-12
months. (give up to 5 years
Measles 1st Dose 0.5 ml Subcutaneous Right Upper Arm
if not received at 9-12
months age)

1
Vitamin A, 1 ml (1 lakh
At 9 months with measles Oral -
1st Dose IU)

For children

Anterolateral side
st
DPT 1 booster 16-24 months 0.5 ml Intramuscular of mid thigh-
LEFT

OPV Booster 16-24 months 2 drops Oral

Measles 2nd dose 16-24 Months 0.5 ml Subcutaneous Right Upper Arm

16 months with DPT/OPV

nd
Vitamin A (2 to booster, then, one dose 2 ml (2 lakh
Oral -
9thdose) every 6 month up to the IU)
age of 5 years)

DPT 2nd Booster 5-6 years 0.5 ml. Intramuscular Left Upper Arm

TT 10 years & 16 years 0.5 ml Intramuscular Upper Arm

For Pregnant Women

TT – 1 Early in pregnancy 0.5 ml Intramuscular Upper Arm

TT – 2 4 weeks after TT – 1 0.5 ml Intramuscular Upper Arm

If received 2 TT doses
TT - Booster during pregnancy within 0.5 ml Intramuscular Upper Arm
last 3 years

Minimum time gap between two doses of any vaccine must be 4 weeks; two live vaccines can be given at
the same time but at different sites.

14.7.2 Introduction of Inactivated Polio Vaccine (IPV)

The planned introduction of IPV for polio eradication will represent the fastest global introduction of any
routine vaccine in recent history by a factor of 4—5X. From January 2013 to May 2015, the number of
countries making a commitment to introduce IPV has increased by 126.
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In January 2013, as we have already read above, the Global Polio Eradication Initiative (GPEI) launched the
Polio Eradication & Endgame Strategic Plan 2013-2018 which was developed with an approach to tackle
both wild and vaccine virus eradication in parallel rather than sequential manner. A coordinated withdrawal
of the type 2 component of trivalent oral polio vaccine (tOPV) from immunization programmes by April
2016 was recommended. For countries which use only tOPV in their routine infant immunization
programmes, this will require switching from tOPV to bOPV (containing only types 1 and 3) for that
purpose. Prior to this switch, it is recommended that all countries introduce at least one dose of inactivated
poliovirus vaccine (IPV) into their infant immunization schedules as a risk mitigation measure by providing
immunity in case a type 2 poliovirus re-emerges or is reintroduced.

Initially, introduce IPV at least 6 months in advance to the proposed switch date in order to provide
adequate time to enhance population immunity against type 2. It is recommended that one dose of IPV
should be administered at or after 14 weeks of age through routine immunization (RI), in addition to the
3-4 doses of OPV.

Three main risks are identified following type 2 poliovirus removal. These include immediate time-limited
risk of circulating vaccine-derived poliovirus type 2 (cVDPV2) emergence; medium- and long-term risks of
type 2 poliovirus re-introduction from a vaccine manufacturing site, research facility, diagnostic laboratory
or a bioterrorism event; and spread of virus from rare immune-deficient individuals who are chronically
infected with OPV2. All these risks have the potential to cause substantial polio outbreaks or even re-
establishment of polio virus transmission in polio-free regions.

GOVERNMENT OF INDIA INITIATIVES: Government of India (GoI) has taken following decisions
regarding polio immunization during implementation of endgame strategies in India:
• Introduction of at least single dose (0.5 ml) of intramuscular IPV (IM-IPV) administration on
antero-lateral aspect of right thigh at 14 weeks or first contact afterwards in the Routine
Immunization along with 3rd dose of DTP and OPV in 6 states viz Bihar, Uttar Pradesh, Madhya
Pradesh, Gujarat, Punjab and Assam;
• Nationally coordinated switch from tOPV to bOPV all over the country on 25th April 2016
associated with cessation of use, withdrawal, destruction and validation of all available tOPV stocks
from all over the country.
• Introduction of fractional dose (0.1 mL) intradermal IPV (ID-fIPV) at 6 and 14 weeks in Orissa,
Andhra Pradesh, Telangana, Tamil Nadu, Kerala, Karnataka, Maharashtra and Puducherry from
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 April, 2016. This change in approach from single-dose intramuscular IPV to fractional-dose
intradermal IPV is mainly due to scarcity of IPV.
Inactivated Polio Vaccine (IPV) is an injectable form of polio vaccine which can be administered alone or in
combination with other vaccines like OPV (oral polio vaccine), diphtheria, tetanus, pertussis, hepatitis B,
and haemophilus influenza.

Contraindications for IPV:

There are two contraindications for IPV:

- If anyone has a history of an allergic reaction

- If any infant has known allergy to streptomycin, neomycin, or polymyxin B as these are inactive
components for IPV

Safety of IPV: IPV is safe for premature infants. IPV can be safely administered to children with immune
deficiencies (e.g., HIV, congenital or acquired immunodeficiency, sickle cell disease). In fact, because of the
elevated risk of vaccine-associated paralytic polio after the use of OPV in patients with immune
deficiencies, IPV is universally recommended in these children.

RECENT UPDATES IN PUBLIC HEALTH : IMPORTANT FOR EXAMINATION

 SUSTAINABLE DEVELOPMENT GOALS:
The principle theme on which SDGs are aimed revolves around: People, Planet, Prosperity, Peace and
Partnership (5 – P)….. There are 17 Goals and 169 Targets in SDG.
Health related goal is Goal No. 3 with Nine targets and four sub targets. Reducing Maternal, Neonatal
and Child Mortality is still target number 1 & 2.
New focus areas for SDG in contrast to MDG are: Non-communicable disease, Road traffic accidents,
Substance abuse, Universal health coverage, Hazardous chemicals & Indoor air pollution.
SDG : Goal 3. Ensure healthy lives and promote well-being for all at all ages
3.1 by 2030 reduce the global maternal mortality ratio to less than 70 per 100,000 live births
3.2 by 2030 end preventable deaths of newborns and under-five children
3.3 by 2030 end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat
hepatitis, water-borne diseases, and other communicable diseases
3.4 by 2030 reduce by one-third pre-mature mortality from non-communicable diseases (NCDs) through
prevention and treatment, and promote mental health and wellbeing

4
3.5 strengthen prevention and treatment of substance abuse, including narcotic drug abuse and harmful
use of alcohol
3.6 by 2020 halve global deaths and injuries from road traffic accidents
3.7 by 2030 ensure universal access to sexual and reproductive health care services, including for family
planning, information and education, and the integration of reproductive health into national strategies
and programmes
3.8 achieve universal health coverage (UHC), including financial risk protection, access to quality essential
health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines
for all
3.9 by 2030 substantially reduce the number of deaths and illnesses from hazardous chemicals and air,
water, and soil pollution and contamination
3.a strengthen implementation of the Framework Convention on Tobacco Control in all countries as
appropriate
3.b support research and development of vaccines and medicines for the communicable and non-
communicable diseases that primarily affect developing countries, provide access to affordable essential
medicines and vaccines, in accordance with the Doha Declaration which affirms the right of developing
countries to use to the full the provisions in the TRIPS agreement regarding flexibilities to protect public
health and, in particular, provide access to medicines for all
3.c increase substantially health financing and the recruitment, development and training and retention of
the health workforce in developing countries,
3.d strengthen the capacity of all countries, particularly developing countries, for early warning, risk reduction, and
management of national and global health risks

1) The Swachh Bharat Abhiyan, which is already in place, would be supported, and whose success would
be measured by the reduction of water and vector borne diseases and declines in improperly managed
solid waste.
2) Balanced and Healthy Diets: This would be promoted through action in Anganwadi centers and schools
and would be measured by the reduction of malnutrition, and improved food safety.
3) Addressing Tobacco, Alcohol and Substance Abuse: (Nasha Mukti Abhiyan) Success would be judged in
terms of measurable decreases in use of tobacco, alcohol and substance abuse.

5
4) Yatri Suraksha: Deaths due to rail and road traffic accidents should decline through a combination of
response and prevention measures that ensure road and rail safety-. This concept could be expanded to
include injuries on account of other causes.
5) Nirbhaya Nari- Action against gender violence ranging from sex determination, to sexual violence would
be addressed through a combination of legal measures, implementation and enforcement of such laws,
timely and sensitive health sector responses, and working with young men.
6) Reduced stress and improved safety in the work place would include action on issues of employment
security, preventive measures at the work place including adequate exercise and movement, and
occupational health- strengthening understanding of occupational disease epidemiology and demonstrate
measurable decreases.
7) Promotion of Yoga at the work-place, in the schools and in the community would also be an important
form of health promotion, that has a special appeal and acceptability in the Indian context.

 NATIONAL HEALTH ASSURANCE MISSION

List of diseases and conditions drawn up for the preventive campaign are: measles - rubella,
malaria, cancer, diabetes, hypertension, TB and chronic pulmonary diseases, leprosy, obesity,
cataract, deafness, geriatric and AIDS.
Lifestyles are also a focus. In this area, tobacco and alcohol consumption are named others include
the merits of sanitation, public and personal hygiene, the importance of organ donation, the
promotion of blood donation and awareness of health care of the elderly
 NPCB : Goal To reduce preventable blindness to 0.3 % by 2020 , presently it is 1%.
Types of Blindness:

Economic blindness: Inability of a person to count fingers from a distance of 6 meters or 20 feet technical Definition

Social blindness: Vision 3/60 or diminution of field of vision to 10°

Manifest blindness: Vision 1/60 to just perception of light

Absolute blindness: No perception of light

Curable blindness: That stage of blindness where the damage is reversible by prompt management e.g. cataract

Preventable blindness: The loss of blindness that could have been completely prevented by institution of effective
preventive or prophylactic measures e.g. xerophthalmia, trachoma and glaucoma

6
Avoidable blindness: The sum total of preventable or curable blindness is often referred to as avoidable blindness.

 “MISSION--INDRADHANUSH” : “To achieve full immunization coverage for all children by 2020 through a
Catch-Up campaign” depicting seven colours of the rainbow, aims to cover all those children by 2020 who
are either unvaccinated, or are partially vaccinated against seven vaccine preventable diseases which include
diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis B.

 2015 onwards three new vaccines to be included are rotavirus, rubella and inactivated poliovirus vaccine
(IPV) will be made available to all children through India’s Universal Immunization Programme (UIP), while
Japanese encephalitis vaccines will be introduced in 179 endemic districts across nine states.

 IMPORTANT DATA
1. HDI, : 0. 640
2) GFR: 2.3
3) SR in India= 940/1000 / 4) 0-6 Sex ratio= 914/100
5) Lowest Sex Ratio overall= Delhi
6) Highest Sex Ratio overall= Kerala
7) Highest Sex Ratio 0-6 = Mizoram
8) Birth Rate= 20.4 9) Death Reate = 6.4
10) Growth Rate= 1.4 %
11) IMR=34/1000 LB
12) MMR=134 /Lac LB

13) < 5 Mortality = 52/1000 LB

14) % Expenditure of GDP on Health = 4.05

16) The prevalence of HIV among Pregnant women aged 15-24 years 0.39% in 2010-11.

17) The annual incidence rate (cases of malaria/1000 population) of Malaria 0.88 cases per 1000 population in
2012.

18 ) The malaria death rate in the country was 0.04 deaths per lakh population in 2012.

19) Prevalence rate of TB 249 in 2011 per 100, 000 population.

20) Mortality due to TB has reduced from 24 per lakh population in 2011.

21) During 2012, in rural India, 88.5% households had improved source of drinking water while in urban India
95.3% households had improved source of drinking water.
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 22) HIV prevalence :0.27 % (2013)

23) Prevalence of Blindness = 1.1% (2012) TARGET is to be 0.3% by 2020

24) RSBY : Funded by Ministry of Health and F Welfare

25 ) SC = 148366 , PHC = 24049 , CHC = 4833 , Medical College= 356

 ICDS Recent update

No. Category [Revised] (per beneficiary per day)
Cal(K Cal) Protein (g)
1. Children (6-72 Months) 500 12-15
2. Severely malnourished children (6-72 months) 800 20-25
3. Pregnant & Nursing Female 600 18-20

 NATIONAL URBAN HEALTH MISSION (NUHM)

 Covers all cities and towns with more than 50,000 population as well as District headquarters
and State headquarters.
 Urban Primary Health Centres (U- PHCs) and Urban Community Health Centres (U-CHCs). U-
PHCs for app. 50,000 population, preferably located near slums
 U-CHCs for providing in-patient care in cities having population above five lakhs have been
envisaged.
 NUHM also provides for engagement of ANMs for conducting outreach services to target groups
particularly slum and the vulnerable population through ASHA and Mahila Arogya Samiti (MAS).
 MAS for every 50-100 households having 250-500 population .
 One ASHA per 1000-2500 population covering approximately 200-500 households would serve as
an effective, demand-generating link between the health facility and the urban slum population.
GOALS OF NATIONAL HEALTH MISSION
1. Reduce MMR to 1/1000 live births
2. Reduce IMR to 25/1000 live births
3. Reduce TFR to 2.1
4. Prevention and reduction of anaemia in women aged 15–49 years

8
5. Prevent and reduce mortality & morbidity from communicable, non- communicable; injuries and
emerging diseases
6. Reduce household out-of-pocket expenditure on total health care expenditure
7. Reduce annual incidence and mortality from Tuberculosis by half
8. Reduce prevalence of Leprosy to <1/10000 population and incidence to zero in all districts
9. Annual Malaria Incidence to be <1/1000
10. Less than 1 per cent microfilaria prevalence in all districts
11. Kala-azar Elimination by 2015, <1 case per 10000 population in all blocks
The Nobel Prize in Physiology or Medicine 2015 was divided, one half jointly to William C. Campbell and Satoshi
Ōmura "for their discoveries concerning a novel therapy against infections caused by roundworm parasites" and the
other half to Youyou Tu "for her discoveries concerning a novel therapy against Malaria". William C. Campbell and
Satoshi Ōmura discovered a new drug, Avermectin, the derivatives of which have radically lowered the incidence of
River Blindness and Lymphatic Filariasis, as well as showing efficacy against an expanding number of other parasitic
diseases. Youyou Tu discovered Artemisinin, a drug that has significantly reduced the mortality rates for patients
suffering from Malaria.

School health Service

1. No class room should accommodate more than 40 students
2. Per capita space for students in a classroom should not be less than 10 sq ft
3. Desks should be minus type
4. Window area should be at least 25 percent of the floor space; windows should be placed on different walls for cross ventilation
5. Ventilators should not be less than 2 % of floor area
6. One urinal for 60 students and one latrine for 100 students
7. School Health Committee – 1961
8. Child labor (prohibition and regulation) act 1986- below 15 children
9. Child Marriage restraint act, 1978
10. Child guidance clinic- deal with all children or adolescents who for one reason or other, are no fully adjusted to their environment
(juvenile delinquency)
11. Orphanages- children who have no home or who for some reason could not be cared for by their parents are placed in orphanages
12. Foster homes- several type of facilities for rearing children other than in natural families. Child is provided with love, security,
affection.
13. Borstal homes- boys over 16 yrs who are too difficult to handle in a certified school or have misbehaved there- are sent to borstal
home, sentence for 3 yrs, 6 homes in India, governed by State Inspector General of India
14. Remand Homes- child is placed under the care of doctors, psychiatrist and other trained personnel- to improve the mental and
physical well being of the child.

D. Baby friendly hospital Initiative WHOI UNICEF- 10 steps

1. Helping the mother initiate breast feeding within the first hour of birth in a normal delivery and 4 hours following caesarean section
2. Encourage breast feeding on demand
3. Allow mothers and infants to remain together for 24 hours a day except for medical reasons
4. Give newborn infants no food or drink other than breast milk, unless medically indicated
5. EBF to be promoted til14-6 months
6. No advertisement, promotional material or free products for infant feeding should be allowed in the facility.

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Some important definitions to be mugged up:
1. An objective is a planned end point of all activities; it may or may not be achieved.(AI;09)

2. Target often refers to discrete activity that has to be achieved within a given time frame. These are small measurable component of
the entire goal. They permit the concept of degree of achievement.

3. Goal is define as the ultimate desired state towards which objectives and resources are directed. Goals are not constrained by time
or the existing resources nor are they necessarily attainable.

4. Mission in turn refers to attainment of a certain goal within a stipulated time period with added impetus to the program wherein all
resources and activities are to be utilized to its fullest extent to achieve the desired result. Lot of attention is also given to the
supervisory and evaluation aspect; in a nutshell it is the mode in which we function to attain the target.

Attitudes are acquired characteristics of an individual. They are more or less permanent ways of behaving. Attitudes are not learnt
from books, they are acquired by social interaction, e.g., attitude towards persons, things, situations and issues. Once formed attitudes
are difficult to change. (AIIMS May’09)

6. Belief is the psychological state in which an individual holds a proposition Values are considered subjective, vary across people and
cultures and are in many ways aligned with belief and belief systems. Types of values include ethical/moral values, doctrinal/ideological
(religious, political) values, social values, and aesthetic values. It is debated whether some values are intrinsic.
"Values are beliefs and attitudes about the way things should be. They involve what is important to us. Values are applied
appropriately when they are applied in the right area. For example, it would be appropriate to apply religious values in times of
happiness as well as in times of despair. "A way of measuring what people value is to ask them what their goals are.

I. Health committees and their recommendations:

1. Bhore committee, 1946 q
a. Setting up of national programs for health system development in the country.
b. Integration of preventive and curative services.
c. Setting up of primary health centres (PHCs).

2. Mudaliar committee, 1962

a. Looked into progress made since the Bhore committee report.
b. Strengthening of district hospitals and regional health services.

3. Chadah committee, 1963

a. Looked into the activities of the National Malaria Eradication Programme.
b. Introduced the concept of a basic health worker per 10,000 population.
Mukerji committee, 1965
a. Recommended separate staff for family welfare programme.
b. Recommended de linking of malaria activities from family planning activities.

5. Jungalwalla committee, 1967

a. Recommended integration of health services at all levels.

6. Kartar singh committee, 1973

a. Recommended that auxiliary nurse midwifes (ANMs) be replaced by ‘Female Health Workers’.
b. Introduced the concept of ‘Multipurpose Workers’.
c. One primary health center per 50,000 population, each divided into 16 sub centers of 3000 population each.

7. Shrivastav committee, 1975

a. Creation of bands of paraprofessional and semiprofessional workers from the community itself.
b. Reforms in health and medical education.

II. Health system setup

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1. At central level
a. Union ministry of health and family welfare.
b. Directorate General of Health Services (DGHS).
c. Central Council of Health.

2. At state level
a. State ministry of health
b. State Health Directorate

3. At district level
It is the principal unit of administration in India. Within district there are 6 types of administrative areas –
a. Sub-divisions
b. Tehsils
c. Community Development Blocks in rural areas (100,000 population)
d. Municipalities and Corporations in urban areas
e. Villages
f. Panchayats

4. Health Statistics of India

a. Districts: 642
e. Allopathic doctors: 767,500
f. Doctors : population – 0.5 / 1000
g. Bed : population: 0.9 / 1000
h. WHO Recommended doctor population ratio: 1:300

National Health Policy - 2017

Health Status and Programme Impact

2.4.1.1 Life Expectancy and healthy life
a. Increase Life Expectancy at birth from 67.5 to 70 by 2025.

b. Establish regular tracking of Disability Adjusted Life Years (DALY) Index as a measure of burden of disease and
its trends by major categories by 2022.

c. Reduction of TFR to 2.1 at national and sub-national level by 2025.

2.4.1.2 Mortality by Age and/ or cause
a. Reduce Under Five Mortality to 23 by 2025 and MMR from current levels to 100 by 2020.

b. Reduce infant mortality rate to 28 by 2019.

c. Reduce neo-natal mortality to 16 and still birth rate to “single digit” by 2025.
2.4.1.3 Reduction of disease prevalence/ incidence
a. Achieve global target of 2020 which is also termed as target of 90:90:90, for HIV/AIDS i. e,- 90% of all people
living with HIV know their HIV status, - 90% of all people diagnosed with HIV infection receive sustained
antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have viral suppression.

b. Achieve and maintain elimination status of Leprosy by 2018, Kala-Azar by 2017 and Lymphatic Filariasis in
endemic pockets by 2017.

c. To achieve and maintain a cure rate of >85% in new sputum positive patients for TB and reduce incidence of new
cases, to reach elimination status by 2025.

11
d. To reduce the prevalence of blindness to 0.25/ 1000 by 2025 and disease burden by one third from current levels.

e. To reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by
25% by 2025.

2.4.2 Health Systems Performance

2.4.2.1 Coverage of Health Services
a. Increase utilization of public health facilities by 50% from current levels by 2025.

b. Antenatal care coverage to be sustained above 90% and skilled attendance at birth above 90% by 2025.

c. More than 90% of the newborn are fully immunized by one year of age by 2025.

d. Meet need of family planning above 90% at national and sub national level by 2025.
e. 80% of known hypertensive and diabetic individuals at household level maintain „controlled disease status‟ by
2025.

2.4.2.2 Cross Sectoral goals related to health

a. Relative reduction in prevalence of current tobacco use by 15% by 2020 and 30% by 2025.

b. Reduction of 40% in prevalence of stunting of under-five children by 2025.

c. Access to safe water and sanitation to all by 2020 (Swachh Bharat Mission).

d. Reduction of occupational injury by half from current levels of 334 per lakh agricultural workers by 2020.

e. National/ State level tracking of selected health behaviour.

2.4.3 Health Systems strengthening

2.4.3.1 Health finance
a. Increase health expenditure by Government as a percentage of GDP from the existing 1.15% to 2.5 % by 2025.

b. Increase State sector health spending to > 8% of their budget by 2020.

c. Decrease in proportion of households facing catastrophic health expenditure from the current levels by 25%, by
2025.

2.4.3.2 Health Infrastructure and Human Resource

a. Ensure availability of paramedics and doctors as per Indian Public Health Standard (IPHS) norm in high priority
districts by 2020.

b. Increase community health volunteers to population ratio as per IPHS norm, in high priority districts by 2025.

c. Establish primary and secondary care facility as per norms in high priority districts (population as well as time to
reach norms) by 2025.

2.4.3.3 Health Management Information

a. Ensure district-level electronic database of information on health system components by 2020.

b. Strengthen the health surveillance system and establish registries for diseases of public health importance by 2020.

c. Establish federated integrated health information architecture, Health Information Exchanges and National Health
Information Network by 2025.

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3. Policy Thrust
3.1 Ensuring Adequate Investment The policy proposes a potentially achievable target of raising public health
expenditure to 2.5% of the GDP in a time bound manner. It envisages that the resource allocation to States will be
linked with State development indicators, absorptive capacity and financial indicators. The States would be
incentivised for incremental State resources for public health expenditure. General taxation will remain the
predominant means for financing care. The Government could consider imposing taxes on specific commodities-
such as the taxes on tobacco, alcohol and foods having negative impact on health, taxes on extractive industries and
pollution cess. Funds available under Corporate Social Responsibility would also be leveraged for well-focused
programmes aiming to address health goals.

3.2 Preventive and Promotive Health The policy articulates to institutionalize inter-sectoral coordination at
national and sub-national levels to optimize health outcomes, through constitution of bodies that have representation
from relevant non-health ministries. This is in line with the emergent international “Health in All” approach as
complement to Health for All. The policy prerequisite is for an empowered public health cadre to address social
determinants of health effectively, by enforcing regulatory provisions.

The policy identifies coordinated action on seven priority areas for improving the environment for health:
o The Swachh Bharat Abhiyan

o Balanced, healthy diets and regular exercises.

o Addressing tobacco, alcohol and substance abuse

o Yatri Suraksha – preventing deaths due to rail and road traffic accidents

o Nirbhaya Nari –action against gender violence

o Reduced stress and improved safety in the work place

o Reducing indoor and outdoor air pollution

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