National Health Programmes of India Health is important asset for any country. Nation has to invest in the health of citizens. National health programme is one of example of investment in health. Each country has their own national health programme with goal of healthy citizen and control of major public health problems. This goal is defining the need of national health programme in country. Even before independence, government had started to think about health of Indian citizens. Bhore Committee report was one of example. Bhore Committee reported that health is the important right of the citizen and health services should be available to all citizens irrespective to income criteria. Also it should be available from womb to tomb to each and every citizen of country India. Thereafter, several measures were taken by the Government of India to improve the health of the people. One of such measures is planning and implementation of various national health programme. Based on various committee reports and situation analysis one by one national health programmes were implemented, renamed or merged over last seven decades. The first rational level health program was launched in 1952 named as “National Family Planning Programme”. India was the first country in world who thought to do family planning with goal of lowering fertility and slow down the population growth. Some historical aspects of National Health Programmes. Year Name of Programme 1952 BCG Vaccination Programme 1952 National Family Planning Programme 1953 National Malaria Control Programme 1954 National Leprosy Control Programme 1955 National Filarial Control Programme 1958 National Malaria Control Programme converted to National Malaria Eradication Programme 1962 National Small Pox Eradication Programme 1962 National Goiter Control Programme 2) Scanned by CamScanner74 PU New Approach to Social and Preventive Pharms Year 1963, 1970 1970 1975 1976 1978 1982 1983 1985 1987 1987 1990 1992 1993 1996 1996 1997 2003 | 2003 | 2005 | 2005 | 2013 2014 2017 2020 Name of Programme Applied Nutrition Progrrame National Trachoma Control Programme All India Hospital (Post Partum) Family Planning Programme Integrated Child Development Programme National Programme form Prevention of Blindness National Family Planning Programme is renamed as National Family Welfare Programme National Leprosy Control Programme renamed as National Leprosy Eradication Programme Guinea Worm Eradication Programme Universal Immunization Programme National Diabetes Control Programme National AIDS Control Programme Control of Acute Respiratory infection Programme Child Survival and Safe Motherhood Programme Revised National Tuberculosis Control Programme Pulse Polio Programme Yaws Eradication Programme Reproductive and Child Programme National Health Policy National Vector Born Disease Control Programme Reproductive and Child Programme Phase-2 National Rural Health Mission National Urban Health Mission National Health Mission National Health policy National Tuberculosis Elimination Programme Ay 1962 | National Tuberculosis Programme aa Scanned by CamScannernational Health Programmes of India pA Key importance of National health programme Government funded and states have to spend minimum, Also there are various international agencies Tike WHO, UNICEF, UNFPA, World Bank and number of foreign agencies like SIDA, DANIDA, CARE, USAID have been providing technical and material assistance in the implementation of these programmes. that they are majority Central VISED NATION REUSE Revised National Tuberculosis Control Programme is recé Tuberculosis Elimination Programme in Jan 2020, ROL PROGRAM)- NT cently renamed as National National Tuberculosis Program (NTP) was launched in 1962.But the treatment success rates were unacceptably low and the death and default rates remained high was observed during review of high level review committee in 1992. In 1993, the Government of India decided to revitalize the NTP with the help of International Agencies. The Revised National Tuberculosis control progrmmewas thus formulated with the following objectives : 1), Achievement of at least 85 percent cure rate of infectious cases of tuberculosis, through DOTS involving peripheral health functionaries. 2). Augmentation of case finding activities through quality sputum microscopy to detect at least 70 per cent of estimated cases. The large scale implementation began in the late 1998. The programme has expanded rapidly and since 2006, it covers the whole country. Ambitious plan of TB free India is launched in 2017 with the National Strategic Plan 2017- 2025, with goal of zero death, disease and poverty due to tuberculosis. The programme has four key strategy areas detect, treat, prevent and built (DTPB). The key area of actions are private sector engagement, plugging the leak from the TB care cascade, active case finding and prevention of active TB among high risk group from latent infection. The programme Provides various free of cost quality Tuberculosis diagnosis and treatment services across the country. It employs the WHO recommended tuberculosis control strategy, DOTS irectly Observed Treatment, Short Course), to the Indian scenario. Activities under RNTCP with DTPB action- Detect (Diagnosis) - Suspected case of tuberculosis is referred to Designated Microscopic Center (OMC) for sputum microscopy to check acid fast bacilli. Diagnosis is done as per following revised algorithm Scanned by CamScanner2U New Approach to Social and Preventive Pharmacy J Presumptive 18 | patient Chest x-ray T I [ I Smear ‘Smear Negative or not Clinical suspicion] Sra Negnve is aie positive but |] gir aagest | {vallable & CXR not suggest igh pective, | | Pegivege || ButexR suggest] aa Co abl ‘suggest TB suggest TB CBNAAT PMDT evr wae MTB WTB not detected Consider | gignased Detected orCBNAAT [-—>] alternate re restnot atte | | Sasos 1 ne es Led RIF Referto sensitive | [indeterminate RiFresistant — 3} ranagement of i reinanee ——__ Repeat CBNAAT on 2nd sample Microbiologically confirmed TB || indeterminate on 2nd sample, collect fresh ‘sample for liquid culture/L PA bis J Under diagnosis there are few new initiatives - 1). Nikshay : TB surveillance using case based web based IT system. The software was launched in May 2012. It includes features like TB patient registration and details of diagnosis, DOT provider, HIV status, follow up, contact tracing, outcomes. 2). TB Notification : To ensure proper diagnosis and management of TB cases and to reduce TB transmission and the emergence and spread of MDR-TB, it is necessary to have complete information of all TB cases. All health providers are to notify every TB case to local authorities every month in a given format. If the private practitioners are notifying t a Scanned by CamScannerof India 7 authority they will be given incentive, Government has made public Private partnership in thprevention and care, Under this scheme following benifites are given to private providers- Rs 250/- on completion of every month of treatment Rs 500/- on completion of entire course of TB treatment Rs 2750/ for notification and management of a drug-sensitive patient over 6-9 months as per stcl Rs 6750/-for notification and correct management of a drug-resistant case over 24 months as per STCI Treatment - Those who are diagnosed as broadly classified into two types, prior history of TB and ne Positive in the sputum smear examination are Type 1 are the newly diagnosed patients who have no ver needed the Anti Tubercular Regime. Type 2 are the defaulters, relapsers who have a prior history of TB or were on Anti Tubercular Regime and stopped mid way. The patients are provided with short course chemotherapy free of charge as daily thpay. The treatment is divided into two phases : 1). Intensive phase, 2). Continuous phase. First line treatment of drug-sensitive TB consists of a two-months (Bweeks) intensive phase with four drug FDCs (fixed dose comintions) followed by a continuation phase of four months (16 Weeks) with three drug FDCs. For new TB cases, the treatment in intensive phase (IP) consists of eight weeks of Isoniazid (NH), Rifampicin, Pyrazinamide and Ethambutol (HRZE) in daily doses as per four weight band categories and in continuation phase three drug FDCs- Ethambutol (HRE) are continued for 16 weeks. Rifampicin, Isoniazid, and For previously treated cases of TB, the Intensive Phase is of 12 weeks, where injection Streptomycin is given for 8 weeks along with four drugs (INH, Rifampicin, Pyrazinamide and Ethambutol) and after 8 weeks the four drugs (INH, Rifampicin, Pyrazinamide and Ethambutol) in daily doses as per weight bands are continued for another four weeks. In Continuation phase Rifampicin, INH, and Ethambutol are continued for another 20 weeks as daily doses, The continuation phase in both new and previously treated cases may be extended by 12-24 Weeks in certain forms of TB like skeletal, disseminated TB based on clinical decision of the treating physician. During the Intensive phase all the drugs are administered under direct supervision called Direct Observed Therapy Short Term (DOTS). It is a community based treatment and care Scanned by CamScannerPY New Approach to Social and Preventive Pharm d treatment and the benefits of community .e benefits of superv! . ee ewe da of DOTS is that it ensures high cure rates through d support. The whole agent based ca it’s three components : + Appropriate medical treatment + Supervision + Motivation by a health or non- health worker. aff such as MPWs, or through voluntary workers such given by peripheral health st x patients and social workers etc. These people are anganwadi workers, dais, e known as DOT ‘Agent’. There are various new initiatives taken by the Government under this programme which will further help in ensuring high cure rates. Some of these are = 1. NikshyaPoshakYozana - It is centrally sponsored scheme under National Health Mission (NHM), financial incentive of Rs.500/- per month is provided for nutritional support to each notified TB patient for duration for which the patient is on anti-TB treatment. Incentives are delivered through Direct benefit transfer (DBT) scheme to bank accounts of beneficiary ICT based compliance check tools - Developed various tools to check the compliance of drug, like interactive voice response, sms reminders, mobile app for reminders with messages or videos, miss call after taking treatment etc. y Intensifying treatment activity with special groups like » TB-HIV Diabetics, Tobacco use and Alcohol dependence Poor, undernourished, economically and socially backward communities . TB control in hilly and difficult terrains Substance dependence and sexual minorities TB and pregnancy . Paediatric population | Prison Inmates and staff of prisons /jails management of extra pulmonary TB rire moo wp Scanned by CamScanner| Health Programmes of Ind, SS eee a) prevent With the objective ‘© prevent emergence of TB in susceptible population various measures are suggested as: 2) Air borne infection control measures-TB infection control is aimed at minimizing the tisk of TB transmission within popul settings. The foundation of such infection control is: @ combination of measures lation and hospital and other + Early diagnosis, and proper management of TB patients. + Health education about cough etiquettes. Cough etiquette means covering nose an can be done with a tissue, and proper disposal of sputum by patient. id mouth when coughing or sneezing. This or if the person doesn’t have a tissue they can cough or sneeze into their upper sleeve or elbow, but they should not cough or sneeze into their hands. The tissue should then be safely disposed of. + Houses should be adequately ventilated. Proper use of air borne infection control measures in health care facilities and other settings b) Contact tracing-Since transmission can occur from index case to the contact any time (before diagnosis or during treatment) all contacts of TB patients must be evaluated. These groups include: * All close contacts, especially household contacts + Incase of paediatric TB patients, reverse contact tracing for search of any active TB case in the household of the child must be undertaken. + Particular attention will be paid to contacts with the highest susceptibility to TB infection 0 Isoniazid Preventive Therapy (IPT)- Preventive therapy is recommended to Children < 6 years of age, who are close contacts of a TB patient. Children will be evaluated for active TB by a medical officer/ pediatrician and after excluding active TB he/she will be given INH Preventive therapy Inaddition to above, INH preventive therapy will be considered in following situation: © For all HIV infected children who either had a known exposure to an infectious TB case or are Tuberculin skin test (TST) positive (>=5mm induration) but have no active TB disease. : * All TST positive children who are receiving immunosuppressive therapy (e.g, Children with nephrotic syndrome, acute leukemia, etc.) Scanned by CamScannerWill reg prophylaxis for 6 months, provided congenital TB has been ruled oy . MLB ination can be given at birth even if IN preventive therapy is planng MC Close contacts of index swith proven DRT (drug resistant-TB) will be mony closely for signs and symptoms of active TB as isoniazid may not be Prophylactic in, a Ws cases. 4) BCG vaccination: It is provided at birth or as early as p ble till one year of age, neg vaccine has a protective effect against TB meningitis and disseminated TB in children, e) Addressing social determinants of TB like poverty, malnutrition, urbanization, indoor air jal coordinated activities and th. pollution, ete. require inter departmental/ mi programme is proactively facilitating this coordination. Build: Health system strengthening for TB control under the National Strategic Plan 2017-2025 is recommended in the form of building and strengthening enabling policies, empowering institutions and human resources with enhanced capacities. NVBDCP was launched in 2003-04 by merging National Anti-Malaria Control Programme, National Filaria Control Programme and Kala Azar Control Programmes, Japanese B Encephalitis and Dengue/ DHF have also been included in this programme. The nodal agency for prevention and control of major Vector Borne Diseases is the Directorate of National Anti-Malaria Program. The states are responsible for planning, implementation and supervision of the programme. The prevention and control of vector borne diseases is complex; as their transmission depends on numerous factors like ecological, biological, social and economic factors. The list of Vector Borne Diseases Control Programmes Legislations include : 1. National Anti-Malaria Programme 2. Kala Azar Control Programme 3. National Filaria Control Programme 4, Japanese Encephilitis Control Programme 5. Dengue and Dengue Hemorrhagic Fever —— Scanned by CamScanner_ yutional Health Programmes of India 81 Malaria yalaria is one of the serious public health prob yalaria was contributing to 75 million cases w jaunching of National Malaria Control Programme. The programme began in 1953 with in tool residual insecticide spray. Because of the spectacular suce: control of the disease, the programme was then converte i938 with residual insecticidal spray and lems in India. At the time of independence, ith 0.8 million deaths every year prior to the achieved in the d into an eradication programme in addition of active case search and radi of malaria. But it was never achieved eradication due to various and operational constrain. L: ‘al treatment administrative, financial ater urban malaria scheme was launched in 1971 with objective of interruption of transmission in urban areas like cities and towns, But large number of cases were seen during later years. So during later years, modified plan of action, malaria action plan, enhanced malaria control Project and roll back malaria pogramme were launched at various interval. With implementation of NVBDCP the strategy was designed. The malaria specific objectives are defined under National Framework for Malaria Elimination (2016-2030), they are 1. By 2022, transmission of malaria interrupted and zero indigenous cases to be attained in all the 26 states/ UTs that were under Categories 1 and 2. 2. By 2024, incidence of malaria to be reduced to less than 1 case per 1000 population in all states and UTs and their districts. 3. By 2027, indigenous transmission of malaria to be interrupted in all states and UTs of India. 4. By 2030, malaria to be eliminated throughout the entire country, and re-establishment of transmission prevented. The sates and UT are divided in various categories based on malaria cases and annual Parasites incidence (API). This was classified in year 2014 and taken as base line. Category-0 _ - No indiginious cases of malaria (no state/UT in this category) Category-1 = States/UT have API <1 and all districts also have API <1 (15 stat/ut) Category -2 - States/UT have API <1 but some of districts have API >= 1 (11 stat/ut) Category -3. - States/UT have API >= 1 (10 stat/ut) The main activities of the programmeare : | Formulating policies and guidelines. " Technical guidance. » Planning. Logistics, Scanned by CamScannerPV New Approacn fo social and Freventive Pha Mae, Monitoring and evaluation. Coordination of activities through the State/ Union Territories and in consultation wit 6 National organisations such as National Centre for Disease Control (NCDC), Nations Institute of Malaria Research (NIMR). 7. Collaboration with international organisations like the WHO, World Bank, GFATy, & other donor agencies. 8. Training. 9. Facilitating research through NCDC, NIMR, Regional medical research centres etc, 10. Coordinating control activities in the inter states & inter country border areas. Pargets : By the year 2020 «All the 15 states/UTs that were under category 1 in 2014 to completely interrupted Malaria transmission & achieved zero indigenous cases & deaths due to Malaria. + All 11 states/ UTs under category 2 in 2014 to enter into category 1. + 5 states/ UTs under category 3 in 2014 to enter into category 2 + 5 states under category 3 in 2014 to reduce disease burden but continue to remain in category 3. + Estimated Malaria burden at national level to reduce by 15-20% as compared to 2014. By the year 2022 + All 26 states/ UTs that were under category 1 & 2 in 2014 to interrupt Malaria transmission. + 5states/ UTs which were under category 3 in 2014 to enter under category 1. + 5states/ UTs which were under category 3 in 2014 to enter category 2. + Estimated Malaria burden at national level reduced by 30-35% as compared to 2014. By the year 2024 All states and union territories and their districts to reduce API to less than 1 case Pe 1000 population at risk, sustain zero deaths. 31 states/ UTs to interrupt transmission of malaria. 5 states/ UTs which were under category 3 in 2014 to enter into elimination phase. Scanned by CamScannernational Health Programmes of ing 83 py the year 2 Entire country to sustain status of zero indigenous cases of de consecutive years and India to initiate t aths due to malaria for 3 the process of cer "tification of malaria elimination status. KALA AZAR KaltAzat isa chronic disease and itis a main Problem in Bihar, Jharkhand, West Bengal and some parts of Uttar Pradesh, In view Of the growing problem ‘azar. The objectives are: 1. Interruption of transmission by reducing vector population through indoor residual insecticides, id te trol Kal; planned control measures were initiated to control Kala-. 2. Early diagnosis and complete treatment of Kala-Azar cases, 3, Health education programmes, Activities : 1, Enhanced case detection and comy diagnostic kits and oral drug Milte 2. Replacing DDT with synthetic pyrethroid for the interruption of transmission through vector control. 3. Capacity building . Monitoring, Supervision, evaluation. iplete treatment includin, ig introduction of rK39 rapid fosine for treatment. . Research on prevention and control of Kala-Azar. FILARIASIS The disease is endemic in 255 districts in 16 states and 5 UTs. The National Filaria Control Programme has been in operation since 1955, Objectives ; 1. Reduction of the problem in un-serveyed areas 2. Control in urban areas through recurrent anti-larval and anti parasitic measures, Activities : Filaria control strategy includes vector control through anti larval operations, source reduction, detection and treatment of microfilaria carriers, morbidity management and IEC. The strategy of lymphatic filariasis elimination is through : ~ Scanned by CamScanner84 1. Annual Mass Drug Administration of single dose of antifilarial drugs for 5 to the eligible population to interrupt transmission of the disease. 2. Home based management of lymphoma cases and up scaling of hydroce identified CHCs/ district hospital. The Government of India launched annual MDA with single dose of DEC tablets. Ty, administration of DEC + Albendazole has been upscaled since 2007. peratir, JAPANESE ENCEPHALITIS Itis a zoonotic disease caused by an Arbovirus. This disease has been reported from 26 state: and Union Territories since 1978. The total population at risk is estimated 160 million. Government of India has constituted a Task Force at National lev objectives : el with the following 1. Strengthening early diagnosis and Prompt case management at PHCs, CHCs and hospitals through training of medical and nursing staff. 2. TEC for community awareness to Promote early case reporting, personal protection, isolation of amplifier host. 3. Vector control measures mainly fogging during outbreaks, s dwellings and anti larval operatio: ns wherever feasible. 4. Development of a safe and standard ingenious vaccine. Activities ; pace spraying in animal There is no specific cure for this disease, Pigs should be kept away from human dwellings Particularly from dusk to dawn’ which is the time for mosquito biting. Use of lothes which cover the body fully to avoid mos; n ' 'quito bites. Use of bed nets is an important Precaution. Dengue and Dengue Hemorrhagic Fever urban. . mg ‘reas from all states. The following a 1 Surveillance for > Eatly diagnosis 3. disease and outbreaks, and Vector ontrol thro, Prompt case management. | ugh communit icipati, . Cnc oaa "Y Participation and social mobilisation, Scanned by CamScanneractivities setine of P i 4 “Crit e thecte fon of Contingency Plan in case of outbreak/ epidemic of Dengue/ Dengue ag cis of fever” was Prepared and sent to all the states. It includes all the important a 7 ae Control measures like identification of outbreak, case management, yector control, IEC activities about Do’s and Dont’s for prevention of dengue, monitoring and reporting ete. the GOI has taken the following steps for prevention and control of dengue : 1, Monitoring the situation through reports received from state health authorities. Amid term plan for prevention and control of dengue has been developed in 2011 and 2 circulated to the states for implementation. The main components are as follows : Surveillance : Disease and entomological surveillance. Case Management : Laboratory diagnosis and clinical management. + Vector Management : Environmental management for source reduction, chemical control, personal protection. Outbreak response : Epidemic preparedness Capacity building : Training, strengthening human resource and operational research. Behavioural change communication : Social mobilisation, information, education and communication. of urban development, rural development, Inter-sectoral coordination : with ministrie surface transport. reports, review, field visit and feed back. Monitoring and supervision : analysis of Scanned by CamScanner86 aunched in India in the year 1987. The vy of health and Fam), nisation (NACO) to closely monitor 1, The programme wi Welfare has set up National AIDS Control Orgat various components of the programme. 1 two key objectives are : 1. To reduce the spread of HIV infection in India. 2. To increase India’s capacity to respond to HIV/AIDS on a long term basis. The national strategy has the following components = + Establishment of surveillance centres to cover the whole country. + High risk group identification and their screening. Issuing specific guidelines for management of detected cases and their follow up. + Formulating guidelines for blood bank, blood product manufacturers, blood donors and dialysis units. + Information, education and communication activities by involving mass media and research for reduction of personal and social impact of the disease. + Control of sexually transmitted diseases. + Condom programme. The government of India started programmes of prevention and raising awareness under the Medium Term Plan (1990-92), NACP-1 (1992-99), NACP-2 (1999-2006) and NACP-3 (2007- 2012). Based on the lessons learnt and achievements made in Phase 1, 2, 3, India developed the Fourth National Programme Implementation Plan. The primary goal of this plan is #0 halt and reverse the epidemic in India over the next 5 years by integrating programmes for prevention, care, support and treatment. Activities : Package under NACP-4 is as follows : 1. Prevention services : + Targeted interventions for high risk groups (HRGs - female sex workers, men who have sex with men, transgenders, hijras, injecting drug users) and bridge populations (truckers and migrants). Needle syringe exchange programme and opioid substitution therapy for IDUs. Prevention interventions for migrant population at source, transit and destination. » Scanned by CamScanner87 ink worker scheme for HRGs and vulnerable population in rural areas. prevention and control of sexually transmitted infections/ reproductive tract infections. plood safety. HIV counselling and testing services. prevention of parent to child transmission. Condom promotion. Information, education and communication and behaviour change communication. Social mobilisation, youth interventions and adolescence education programme. | Work place intervention. 2 Care, support and treatment services : . Laboratory services for CD4 testing and other investigations. «Free first line and second line Anti Retroviral Therapy (ART) through ART centres and Link ART centres (LACs), centers of excellence and ART plus centres. + Paediatrics ART for children. + Early infant diagnosis for HIV exposed infants and children below 18 months. + Nutritional and psycho social support through care and support centres. + HIV/TB coordination (cross referral detection and treatment of co infection). + Treatment of opportunistic infections. + Drop-in centre for PLHIV networks. The HIV prevalence in adult population can be broadly classified into 3 group of states/ uts inthe country. These are : 1. Group 1: High prevalence states includes states of Maharashtra, Tamil Nadu, Karnataka, AP, Manipur and Nagaland where the HIV infection has crossed 5 % in mark in high tisk group and 1% or more in Antenatal women. 2 Group 2: Moderate prevalence states includes Gujarat, Goa and Puducherry where HIV infection has crossed 5 % or more among high risk groups but the infection is below 1 % in antenatal women. ‘Scanned by CamScannerme PY New Approach to Social and Preventive Pharma., 3. Group 3 : Low prevalence states includes remaining states where the HIV infection i, any of the high risk groups is still less than 5 % and is less than 1 % among antenaty women. Hence, different types of surveillance are carried out in the country to detect the spread oj the disease and for the prevention and control. The types of surveillance are : + HIV sentinel surveillance + HIV sero-surveillance + AIDS case surveillance + STD surveillance + Behavioural surveillance + Integration with surveillance of other diseases like TB etc. - HIV SENTINEL SURVEILLANCE The objectives of HIV surveillance are as follows: 1. To determine the level of HIV infection among general population as well as high risk groups in different states. 2. To understand the trends of HIV epidemic among general population as well as high risk groups. 3. To understand the geographical spread of HIV infection and to identify emerging pockets. 4, To provide information for prioritisation of programme resources and evaluation of programme impact. 5. To estimate HIV prevalence and HIV burden in the country. Services Provided : 1, First line ART : It is provided free of cost to all eligible PLHIV through ART centres. Positive cases referred by ICTCs are registered in ART centres for pre ART and ART services. Assessment is done through clinical examination and CD4 count. Patients are also provided counselling on treatment adherence, nutrition, positive prevention and positive living. 2. Alternative first line ART : It has been observed that a small number of patients initiated on first line ART experience acute/ chronic toxicity/ intolerance to first line ARV drugs, ‘hus necessitating change of ARV drugs to alternative first line drugs. Scanned by CamScanner> Health Programmes of In 89 3, Second line ART : The second-line ART began in January 2008 at two sites- GHTM, Tambaram, Chennai and J] Hospital, Mumbai. ~ Targeted Interventions for High Risk Groups : The main objective of targeted interventions is to improve health- seeking behaviour of high risk groups a nd reduce their risk of acquiring sexually transmitted infections and HIV infections. The services offered through targeted interventions include : Detection and treatment for sexually transmitted infections. + Condom distribution, + Condom promotion through social marketing. + Behaviour change communication, Creating an enabling environment with community involvement and participation. Linkages to integrated counsellirig and testing centres. Linkages with care and support services for HIV positive HRGs. PROJECT (IDSP) Integrated Disease Surveillance Project is a decentralized state based surveillance system in the country.Integrated Disease Surveillance Programme (IDSP) was launched with World Bank assistance in November 2004 to detect and respond to disease outbreaks quickly. The Project was extended for 2 years in March 2010 ie. from April 2010 to March 2012, 9 identified states (Uttarakhand, Rajasthan, Punjab, Maharashtra, Gujarat, Tamil Nadu, Karnataka, Andhra Pradesh and West Bengal) and the rest 26 states /UTs were funded from domestic budget. The Programme continues during 12th Plan (2012-17) under NRHM. The classification of surveillance in IDSP is as follows : 1. Syndromic diagnosis : diagnosis is made on the basis of clinical pattern. 2. Presumptive diagnosis : iagnosis is made on typical history and clinical examination. 3. Confirmed diagnosis : clinical diagnosis by a medical officer and or positive laboratory identification. The components of surveillance activity are : * Collection of data * Compilation of data * Analysis and interpretation Scanned by CamScanner+ Follow up action + Feedback Syndromes under surveillance : 1. Fever 2. Cough more than 3 weeks duration 3. Acute flaccid paralysis 4. Diarrhoea 5. Jaundice 6. Unusual events causing death or hospitalisation. ‘An outbreak is a sudden increase in occurrence of a disease in a particular time and place. A single case of communicable disease long absent from a population, or caused by an agent not previously recognised in that area, or emergence of a previously unknown disease may also constitute an outbreak and should be reported. Warning signs of an impending outbreak are as follows : + Clustering of cases or deaths in time and/ or space. Unusual increase in number of cases or deaths. Even a single case of Measles, AFP, Cholera, Plaque, Dengue or Japanese Encephalitis. Acute Febrile illness of unknown aetiology. Occurrence of two or more epidemiologically linked cases of Meningitis and Measles. + Unusual isolate. Shifting in age distribution of cases. + Sudden increase/ high vector density. + Natural disasters. Activities : 1. Surveillance units are established in all states districts (6SU/DSU). Central Surveillance Unit (CSU) established and integrated in the National Centre for Disease Control, Delhi. 2. Training of State/District Surveillance Teams and Rapid Response Teams (RRT) has been completed for all 35 States/UTs. 3. IT network connecting 776 sites in States/District HQ and premier institutes has been established with the help of National Informatics Centre (NIC) and Indian Space Scanned by CamScannerio “! 91 RO) for data entry, training, video conferencing and outbreak Under the project weekly disease surveillance d; fata on epidemic prone disease are bei collected from reporting units such as sub-centi i rmuty sviies, hosplidle $ res, primary health centres, community health centres, hospitals including government and private sector hospitals and medical colleges. The data are being collected on ‘S’ syndromic; ‘P’ probable; & ‘L’ laboratory formats using standard case definitions. Presently, more than 90% districts report such weekly data through e-mail/portal. The weekly data are analysed by SSU/DSU for disease trends. Whenever there is rising trend of illnesses, it is investigated by the RRT to diagnose and control the outbreak. States/districts have been asked to notify the outbreaks immediately to the system. On an average, 30-40 outbreaks are reported every week by the States. @ Media scanning and verification cell was established under IDSP in July 2008, It detects and shares media alerts with the concerned states districts for verification and response. . A 24X7 call centre was established in February 2008 to receive disease alerts on a Toll Free telephone number (1075). The information received is provided to the States/Districts surveillance Units for investigation and response. The call centre was extensively used during H1N1 influenza pandemic in 2009 and dengue outbreak in Delhi in 2010. . District laboratories are being strengthened for diagnosis of epidemic prone diseases. These labs are also being supported by a contractual microbiologist to mange the lab. 9. In 9 States, a referral lab network has been established by utilising the existing 65 functional labs in the medical colleges and various other major centres in the States and linking them with adjoining districts for providing diagnostic services for epidemic prone diseases during outbreaks. The National Leprosy Control Programme (NLCP) has been in operation since 1955, as a centrally supported programme to achieve control of leprosy through early detection of ‘ases and DDS (dapsone) mono therapy on an ambulatory basis. The NLCP initially moved ata slow pace, presumably for want of clear cut policies or operational objectives for nearly two decades, 't gained momentum during the Fourth Five Year Plan after it was made a centrally- SPonsored programme. In 1980, the Government of India declared it’s resolve to “eradicate” xy by the year 2000 and constituted a working group to advise accordingly. The reports ba Scanned by CamScannera PU New Approach to Social and Preventive Phar, from the working groups were submitted in 1982 and they recommended a revised stray, based on multi- drug chemotherapy aimed at leprosy “eradication” through reduction in the sources of infection and breaking the chain of transmission of disease. The Contra} progranume was re-designated as National Leprosy “Eradication” Programme in the yea, 1983 with the goal of eradicating the disease by the turn of the century. The aim/ objective of the programme was : + To reduce case load to 1 or less than 1 per 10000 population. Following are the programme components : 1, Case Detection and Management. 2. Disability Prevention and Medical Rehabilitation. 3. Information, Education and Communication (IEC) including Behaviour Change Communication (BCC). 4, Human Resource and Capacity building. 5. Programme Management. 6. Capacity building of all general health services functionaries. 7. Decentralised integrated leprosy services through general health care system. After introduction of MDT, the recorded case load of leprosy came down from 57.6 cases per 10000 population in 1981 to less than one at the national level in December 2005 and the country could achieve the goal of Leprosy elimination at national level as set by the National Health Policy. 34 states/ union territories achieved the status of leprosy elimination. Only 2 states/ union territories are yet to achieve elimination. Those are : Chattisgarh and Dadra and Nagar Haveli. Activities under NLEP: 1. Diagnosis and treatment of leprosy : Services for diagnosis and treatment (Multi drug therapy) are provided by all primary health centres and government dispensaries throughout the country free of cost. Difficult to diagnose and complicated cases and cases requiring reconstructive surgery are referred to district hospital for further management. Training : Medical officer, health workers, health supervisors, laboratory technicians and ASHAs training are conducted every year to develop adequate skill in diagnosis and management of leprosy cases, ye Scanned by CamScannernotional Health Programmes of india 93 ban leprosy control : 3, Urban leprosy control : To address the complex problems in urban areas, the Urban rosy control activitie i veprosy one nate are being implemented in urban areas having, population size o ‘an I lakh. These activities include MDT delivery services & follow up of patient for treatment completion, providin, rtive ici material or tr \ 1B Suy e medicine: esi nee ppor \edicines & dressing al 4. me Seon ant i activities are conducted for awareness generation and for reduction figma an ‘imi i i of st te " iscrimination against leprosy affected persons. These activities are carrie d d trough mass media, outdoor media, rural media and advocacy meetings. More focus is given on inter personnel communication. 5, NGO services under SET scheme : Presently, many NGOs are getting grants from Govt. of India under Survey, Education and Treatment (SET) scheme. The various activities undertaken by the NGOs are IEC, Prevention of Impairments and Deformities, Case Detection and MDT Delivery. 6. Disability Prevention and Medical Rehabilitation : For prevention of disability among persons with insensitive hands and feet, they are given dressing material, supportive medicines and micro-cellular rubber (MCR) footwear. The patients are also empowered with self-care procedure for taking care of themselves. More emphasis is being given on sability in leprosy affected persons through reconstructive surgery (RCS). GOI has recognised 112 institutions for conducting RCS the state government. Out of these, 60 are Govt correction of dit To strengthen RCS services, based on the recommendations of institutions and 52 are NGO institutions. 7. Special Activity in High Endemic Districts : 209 Districts had reported ANCDR (Annual New Case Detection Rate) more than 10 per lakh population. Special activity for early detection and complete treatment, Capacity building and extensive IEC, Adequate availability of MDT, Strengthening of district nucleus. 8 Supervision and Monitoring : Programme is being monitored at different level through analysis of monthly progress reports, through field visits by the supervisory officers and Programme review meetings held at central, state and district level. For better he disease situation, emphasis is given to assessment of epidemiological analysis of # 3 * 4 Rate and proportion of grade II New Case Detection and Treatment Completion disability among new cases. Scanned by CamScannerame Ww. Services for all, expecially the community at risk yyy application of mental hoot The National Mental Health Prog availability of Mental Health Cai underprivileged section of the population, to encourage knowledge in general health care and social development, The mental health py lean, burden is high and the qualified staff is limited, are b challenge for prog “A National Advisory Group on mental health wi constituted under the Chairmanship of thy. Secretary, Ministry of Health and Family Welfare for the effective implementation of thy National Health Programme. The programme was re-strategized in 2003 to include two schemes whichare: 1. Modernization of State Mental Hospitals 2. Upgradation of Psychiatric wings of medical colleges There are eleven institutions that have been identified for imparting training in basic knowledge and skills in the field of mental health to the primary health care physicians and para-medical personnel. At present this programme covers 241 districts. Mental Health Care Act 2017 was passed on 7th April 2017 and came into force from July 8, 2017. The law was described in it’s opening programme as, “An act to provide for mental ss and to protect, promote and fulfil the healthcare and services for people with mental illne: rights of such people during delivery of mental healthcare and services and for matters connected therewith or incidental thereto”. This act superseded the previously existing Mental Health Act that was passed in 1987. The aims of the NMHP are: 1. Prevention and treatment of mental and neurological disorders and their associated disabilities. 2. Use of mental health technology to improve general health services. 3. Application of mental health principles in total national development to improve quality of life. The objectives of the programme are : 1. To ensure availability and accessibility of minimum mental health care for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of population. 2. To encourage application of mental health knowledge in general health care and in the social development. Scanned by CamScanner_ sons! Health Programmes of India 2 ‘o promote community participation in the mental health services development, and to 5 gimulate efforts towards self-help in the community. _toenhance human resources in mental health sub-specialities. activities © gre programme strategies are: 1 integration of mental health with primary health care through the NMHP. 2, Provision of tertiary care institutions for treatment of mental disorders. 4 fradicating stigmatisation of mentally ill patients and protecting their rights through regulatory institutions like the Central Mental Health Authority and State Mental Health ‘Authority. pistrict Mental Health Programme components are: Service provision: provision of mental health out-patient & in-patient mental health services with a 10 bedded inpatient facility. Out-Reach Component: Satellite clinics: 4 satellite clinics per month at CHCs/ PHCs by DMHP team Targeted Interventions: Life skills education & counselling in schools, College counselling services, Work place stress management, and Suicide prevention services Sensitization & training of health personnel: at the district & sub-district levels ‘Awareness camps: for dissemination of awareness regarding mental illnesses and related stigma through involvement of local PRIs, faith healers, teachers, leaders etc Community participation: ~ Linkages with Self-help groups, family and caregiver groups & NGOs working in the field of mental health + Sensitization of enforcement officials regarding legal provisions for effective implementation of Mental Health Act. Scanned by CamScanneree. py New rrr _ 96 _ . . ——— ENTION AND CONTROL OF PTO oes 77 Bry yao nea: (NPPCD) mans today is hearing 108s. As pet WHO estima. ' en people who are suffering from significant one 5 i i 63 mil ing fro! : atin Premed prevalence at 63 percent in Indian population, a, laces ‘office (NSSO) § urvey, there are currently 291 people/ 1 i wring from severe tO profound hearing loss.A large percentag, : £0 to 14 are also suffering from significant auditory impairmey, Hence NPPC launched with the purpose of arly identification, diagnosis and treatmen ear problems responsible for hearing loss and deafness in them. me was implemented by Ministry of Health and Family Welfare wi, ral of Health Services. At the state level the programme ly Welfare. State nodal office, is being implemented by Department of Health and Famil : "» Directorate/ Secretariat level will provide technic) preferably an ENT surgeon at th H / guidance and expertise to the State Health Society for the purpose of implementation of the programme in the various districts of the state. Objective of the Programme : 1. To prevent avoidable hearing loss on account of disease or injury. diagnosis and treatment of ear problems responsible for hearing loss NATIONAL PROGRAM ‘The most common sensory deficit in ® impairment, this pl National Sample Service population who are suffe children between the ages © These program: technical support of Directorate Gene! 2. Early identification, and deafness. 3, To medically rehabilitate persons ofall age groups, suffering with deafness. 4.To strengthen the existing inter-sectoral linkages for continuity of the rehabilitation programme, for persons with deafness. 5.To develop institutional capacity for ear care services by providing suppor for equipment, material and training personnel. Activities ‘The programme has the following components : 1. Mi ini aeeiwe GENT/ ted) ~ Training is provided from medical college le*# ology) for preventi 5 pee hearing impaired and deafness case, ention, early identification and manageme © 2. Capacity building - for the distri istrict hospi amaly health centre in respect of ENT/ Audony infest health centres and pan ‘ce proviei 8 3. Service provision-Early detection and S structure, ‘anagement of hearing and speech impair cases and ilitati i an rehabilitation, at different levels of health ca deli m. re delivery system. Scanned by CamScannera| Health Programmes of India | 97 Awareness generation through IEC/BCC acti impaired, especially children so that timely remove the stigma attached to deafness, ities - for early identification of hearing 'Y management of such cases is possible and to siratesy* 1, Tostrengthen the service delivery for ear care. To develop human resource for ear care services, To promote public awareness through app: special emphasis on prevention of deafness. ropriate and effective IEC strategies with To provide hearing aid to identified children up to the age of 15 years with free service fora period of one year To develop institutional capacity of the district hospitals, community health centres and primary health centres selected under the Programme. The strategy has been approved by Steering Committee on National Programme for Frevention and Control of Deafness (NPPCD) and also validated by an expert group for inclusion in 12th Five Year Plan. The programme is expected to have the following benefits : |. Availability of services like prevention, early identification, treatment, referral, rehabilitation etc for hearing impairment and deafness as the Primary Health Centre/ Community Health Centres/ District hospitals largely cater to their needs. . Decrease in the magnitude of hearing impaired people. . Decrease in the severity/ extent of ear morbidity or hearing impairment. Improved service network/referral system for the people with ear morbidity/hearing impairment. ’. Capacity building at the district hospitals to ensure better care. . Awareness creation among the health workers through the primary health centre medical officers and district health officers, which will percolate to the lower level health workers functioning within the community. National Programme for Control of Blindness and Visual Impairment (NPCB&V1) was “eunched in the year 1976 as a 100% centrally sponsored scheme initially (now 60:40 in all Stes and 90:10 in NE States) with the goal of reducing the prevalence of blindness to 0.3% bh dA Scanned by CamScanner— 98 PU New Approach to Social and Preventiy, Pharmac, by 2020. Rapid Survey on Avoidable Blindness conducted under NPCB during 20955 showed reduction in the prevalence of blindness from 1.1% (2001-02) to 1% (2006.07) 13. in 2015-18 the survey showed the prevalence of blindness was 0.45%. Now we are in ta... year, hope the country will reached target in current year survey. ‘The common causes for blindness in country are - Cataract (62.6%) Refractive Error (19793) Corneal Blindness (0.90%), Glaucoma (6.80%), Surgical Complication (1.20%) Posterior Capsular Opacification (0.90%) Posterior Segment Disorder (4.70%), Others (4.19%), Estimated National Prevalence of Childhood Blindness /Low Vision is 0.80 per thousand, target Objectives of programme — = To reduce the backlog of avoidable blindness through identification and treatment of curable blind at primary, secondary and tertiary levels, based on assessment of the overall burden of visual impairment in the country; - Develop and strengthen the strategy of NPCB for “Eye Health for All” and prevention of visual impairment; through provision of comprehensive universal eye- care services and quality service delivery; - Strengthening and up-gradation of Regional Institutes of Ophthalmology (RIOs) to become centre of excellence in various sub-specialities of ophthalmology and also other partners like Medical College, District Hospitals, Sub-district Hospitals, Vision Centres, NGO Eye Hospitals; - Strengthening the existing infrastructure facilities and developing additional human resources for providing high quality comprehensive Eye Care in all Districts of the country; - To enhance community awareness on eye care and lay stress on preventive measures; Increase and expand research for prevention of blindness and visual impairment; - To secure participation of Voluntary Organizations/Private Practitioners i" delivering eye Care. Activities under programme - - To reach every of the country to provide eye-care services, provision for setting "P Multipurpose District Mobile Ophthalmic Units in the District Hospitals of States/UTs. Provision for distribution of free spectacles to old persons suffering from presbyopi# to enable them for undertaking near work. - Emphasis on the comprehensive eye-care coverage by covering diseas cataract like diabetic retinopathy, glaucoma, corneal transplantation, es other that vitreo-retinal ~~ Scanned by CamScanner/ Health Programmes of In 99 surgery, treatment of childhood blindness including retinopathy of pre-maturity (ROP) ete. strengthening of Tertiary Eye-Care Centres by Providing funds for purchase of sophisticated modern ophthalmic equipments. Ensure setting up of superspecialty clinics for all major eye diseases including diabetic retinopathy, glaucoma, retinopathy of prematurity etc. in state level hospitals and medical colleges all over the country. Linkage of tele-ophthalmology centres at PHC/Vision centres with superspecialty eye hospitals to ensure delivery of best possible diagnosis and treatment for eye diseases, specially in hilly terrains and difficult areas, - Development of a network of eye banks and eye donation centres linked with medical colleges and RIOs to promote collection and timely utilization of donated eyes in a transparent manner. Future plan — Setting up of more PHC/Vision Centres to broaden access of people to eye care facilities. To extend financial support to NGOs for treatment of other eye diseases like Diabetic Retinopathy, Glaucoma Management, Laser Techniques, Corneal Transplantation, Vitreoretinal Surgery, Treatment of Childhood Blindness, free of cost to poor people. Integration of existing ophthalmic surgical/ non-surgical facilities in each district, State by associating few units to next higher unit. + Inclusion of modern ophthalmic equipment in eye care facilities to make it more versatile to meet modern day requirement. Upgradation of software for Management Information System for better implementation and monitoring and monitoring. Digitalization of eye care services - IEC, messages, whats app. Groups for stakeholders etc. OBAC Tshace is identified as the foremost cause of death and disease and which is entirely Trtable. Globally tobacco use is responsible for deaths of nearly 6 million people. As per 4 ‘f current trends continue, by 2030 tobacco use will kill more than 8 million people People ha ach Year It is estimated that 80 % of these premature deaths will occur among wing in low - and middle - income countries. Scanned by CamScannera, BV New Approach to Social and Preventive Pharmac, Je die every year in India duc to diseases related to tobacco use and a, earch (ICMR), nearly 50% of cancers in males ers in females in India are directly attributed to tobacco use. Global Adult TS) WO - 10, conducted in the age group of 15 years and above 47.8%, consume tobacco in some form or other. the youth and masses > discourage the consumption of tobacco the Govt. Of India enacteq from the adverse effects of tobacco usage, secong ~ tobacco control law namely “Cigarettes and other Tobacco Products of Advertisement and Re; slation of Trade and Commerce, Production, Supply ) Act, COPTA 2003. The National Tobacco Program was launched in 2007 - party to the WHO Framework Convention on Tobacco is committed to implementing all provisions of this international treaty, ve Year Plan. Ind aware ‘s media campaigns for awareness building and behaviour change, of tobacco product testing laboratories, to build regulatory capacity, as ex COPTA, 20 the program component as a part of the health delivery mechanism under the National Rural Health Mission framework. streaming Research & training on altemate crops and livelihood in collaboration other nodal Ministries. Monitoring and Evaluation including surveillance e.g. Global Adult Tobacco Survey (GATS) India. Work done under NTCP — Operational Guidelines for implementation of National Tobac. co Programme developed and -minated to all the states and Districts, Guidelines for Implementation of pictorial health warnings and sale to minors and around educational institutions developed and disseminated to states. . Implementation of the Food Safety and Standards Authority of India Regulation in the tes. Communication to Director Generals of Police (DGP) in states to strengthen and institutionalize enforcement of COPTA. 5 scans oc es 'o Transport Secretaries in the States to make compliance to COPTA } . -ommunicatic ‘inci nL ication to Principal Secretaries (Health) in the States to make compliance to Be Scanned by CamScannertio’ y Health Programm 101 The National Tobacco Control Cell (NTCC) coordinated with all 15 state consultants for * collection of data related to price of key brand of tobacco products, ‘the NTC assisted in soliciting proposals from the district * cheda in the state of Gujarat on a systemic, cultivation areas in these two districts. administration of Anand and time bound plan to reduce tobacco ational Programme for Health care for Elderly was launched in 2010. The programme is gute oriented and basic thrust of the programme is to provide dedicated health care facilities tpthe senior citizens (>60 year of age) at various level of primary health care. Objectives - - To provide accessible, affordable, and high-quality long-term, comprehensive and dedicated care services to an Ageing population; - Creating a new “architecture” for Ageing; to build a framework to create an enabling environment for "a Society for all Ages"; To promote the concept of Active and Healthy Ageing; Convergence with National Rural Health Mission, AYUSH and other line departments like Ministry of Social Justice and Empowerment. Expected end results are - Setting up of District Geriatric Units with dedicated Geriatric OPD and 10-bedded Geriatric ward; Setting up of biweekly Geriatric Clinics and Rehabilitation units in all Community Health Centres of districts; - Setting up of weekly Geriatric Clinics in all Primary Health Centres of districts; ~ Strengthening all sub-centres of districts to provide with equipment for community outreach services; Provide training to staff of Public Health Care System in Geriatric Care. Services at various level - Sub Centre: Health Education and home based care to bedridden elderly persons and provide training to the family health care providers in looking after the disabled elderly persons. Primary Health Centre: Conducting weekly geriatric clinic health assessment of the elderly persons and simple investigation including blood sugar, etc. Scanned by CamScanner 4organi py the rehabilitation worker for bean entre: conduc 8 such patients. Aden - Community Health Centre’ rehabilitation services, domiciliary he elderly and counselling to family mem Se - District Hospitals: Dedicated Geriatric investigations Ann atory investiga 10 bedded geriatric ward, labora Dos gerviCe! Regional Gerialee Centers: Providing tertiary care services through OPD ang ‘ ddan: admission in 30 bedded ward, development of specialized human loor admi ici vell as research through MD courses in geriatric medicine as well a visits 13 for care 1D services, In-door admissions hy eye "On and rehabilitation servicag SOUtcg passed by World Health Assembly for gio) accine under Expanded Programme oy versal Immunization Programme (Up In year 1988, India committed to the resolution polio eradication. Country introduced polio vacc Immunization (EPI, 1978), and subsequently in Uni 1985), but started carrying out special polio campaigns from 1995. bivalent oral polio vaccine (bOPV) drops are being At present in routine immunization, f age and Inactivated Polio Vaccine (IPV) tg provided to all children less than five years o| children less than one year of age. National Immunization Days (NIDs) commonly known as Pulse Polio Immunization programme was launched in India in 1995, and is conducted twice in early part of each yea, Additionally, multiple rounds (at least two) of sub-National Imnvunization Days (SNIDs) have been conducted over the years in high risk states/areas. In these campaigns, children in the age group of 0-5 years are administered polio drops. The core objective of pulse polio was to develop herd immunity in community against polio virus. Historical aspect of Polio- Prior to introduction of Polio vaccine in 1978, there were estimated 2,00,000 polio cases annually. Prior to introduction of Pulse Polio Programme in 1995 there were estimated 50,000 polio cases annually. In 1997, case-based polio surveillance, started with support from WHO- National Polio Surveillance Project (WHO-NPSP). Surveillance for detection of polio virus transmission is being done through acute flaccid paralysis (AF? aspera 90mm Aga Nadaen te tee ae very high, polio virus type 1 & 3 contd a rele coverage of palo seuss nae aaa ‘0 circulate. As a result, research was conduct’ which indicated that monovalent type 1 & 3 have better sero-conversion than tOPV. Hen® monovalent vaccine type 1 was introduced followed by introncemce rnin #waedine y introduction of type 3 vaccine. Scanned by CamScannerProgr: ayina Health Programmas oth 103 2005, India was the first country to use monovalent vaccine (type 1) globally, after country jel research. In Jantiary 2010, based on country’s research, India was the second country to roduce bivalent vaccine, after Afghanistan, which proved to be very effective. int ist cases of wild polio virus, by type of virus: 24th Oct, 1999 last case of wild polio virus iype2(WPY Type 2) reported from District Aligarh, U.P rand Oct. 2010 last case of wild polio virus type 3 (WPV Type 2) reported from District pakur, Jharkhand 1nth Jan. 2011 last case of wild polio virus type 1 (WPV Type 2) from District Howrah, West Bengal WHO, on 24th February 2012, removed India from the list of “endemic countries with active polio virus transmission”. (On 27th March 2014, the Regional Certification Commission of World Health Organization certified South-East Asia Region of WHO, which includes India, as polio free country. Following steps are being taken by the Government to maintain polio free status in India as risk persist on account of ongoing transmission in other countries which may lead to importation of polio virus. Maintaining community immunity through high quality National and Sub National polio rounds each year. Polio surveillance across the country for any importation or circulation of poliovirus and Vaccine Derived Polio Virus (VDPV) is being maintained. Polio surveillance in country is considered to be of international standard as indicated by AFP rate (which is 10.78 and 10.61 respectively for 2015 and 2016 against the global minimum recommended of 2) and % adequate stool rate (which is 86 and 87 respectively for 2015 and 2016 against the global inimum recommended of 80%) as on 28th January, 2017. Environmental surveillance (sewage sampling) have been established to detect poliovirus transmission and as a surrogate indicator of the progress as well for any programmatic interventions strategically at 35 sites in Mumbai, Delhi, Patna, Kolkata, Punjab, Hyderabad, Lucknow and Gujarat. To reduce risk of importation from neighbouring countries, international border vaccination ne provided through continuous vaccination teams (CVT) to all eligible children round lock, These are provided through special booths set up at the international borders(both. vi and Road routes) that India shares with Pakistan, Bangladesh, Bhutan, Nepal and inmar, we Scanned by CamScanner— inn PU New Approach to Social and Preventive Pharmac, y Government of India has issued guidelines effective since March 2014, for mandatory requirement of polio vaccination to all international travellers for travel between India ang other polio affected countries namely Pakistan, Afghanistan, Nigeria, Ethiopia, Kenya, Somalia, Syria and Cameroon (as per the polio cases reported from these countries in year 2014) All States and Union Territories in the country have developed a Rapid Response Team (RRT) to respond to any polio outbreak in the country. Emergency Preparedness and Response Plans (EPRP) has also been developed by all States indicating steps to be undertaken in case of detection of a polio case. A rolling emergency stock of OPV is being maintained to respond to detection/importation of wild poliovirus (WPV) or emergence of vaccine derived poliovirus (VDPV). As part of Polio Endgame Strategy, India has switched from trivalent Oral Polio Vaccine (tOPV) to Bivalent Oral Polio Vaccine (bOPV) on 25th April, 2016 both in polio campaigns and routine immunization. The country has been validated free of tOPV after the switch. As a risk mitigation measure, country has introduced Inactivated Polio Vaccine across the country in all states. men C ents MCQ TYPE QUESTIONS (1 Marks Each) 1. Which was the first national health programme of India? a) BCG Vaccination Programme b) National Malaria Control Programme ©) National Family Planning Programme 4) Allof above Nikshay 2 i i % 'y Poshak Yozana is part of which national health Programme? a) National Family Planning Programme = b) ° qd National Malaria Control Programme National Tuberculosis Elimination Programm None of above . 3. All of followine +-- - Scanned by CamScanner