1535975311475 national family welfare programme 2

NATIONAL FAMILY
WELFARE PROGRAMME

 Launched in 1952
 It is 100% centrally sponsored programme
 Under ministry health and family welfare
 1977 the government of india redesignated the
“national family planning program” as the national
family welfare program.

 Concept:
 Quality of Life:
 Centrally sponsored program.
 It emphasis is on a child family.
 Also emphasis is on spacing methods along with
terminal methods
 Promote family planning.
 Motivate families

Aims and objectives:
 To promote the adoption of family size.
 To promote the use of spacing methods
 To ensure adequate supply of contraceptives.
 To arrange for clinical and surgical services.
 Participation of voluntary organizations.
 Using the means of mass communication

Strategies:
 Integration with health services
 Integration with maternity and child health
 Concentration in rural areas
 Literacy
 Brest feeding
 Raising the age for marriage
 Minimum needs program
 Incentives
 Mass media

MATERNAL AND CHILD
HEALTH PROGRAM

 Definition:
According to WHO (1976) maternal and child health
services can be defined as promoting, preventing, therapeutic
or rehabilitation facility or care for the mother or the child.

 Aims:
 Reducing maternal, perinatal, infant and child mortality and
morbidity rates.
 Child survival.
 Promoting reproductive health
 Ensure birth of healthy child
 Prevent malnutrition
 Prevent communicable diseases
 Early diagnosing and treatment of the health problems.
 Health education and family planning services

Components:
 Maternal health
 Family planning
 Child health
 School health
 Handicapped children
 Care of the children in special setting

REPRODUCTIVE AND
CHILD HEALTH PROGRAM

Definition:
Reproductive and child health approach has been
defined as “people have the ability to reproduce and regulate
their fertility, women are able to go through pregnancy and
child birth safely, the outcome of pregnancies is successful in
terms of maternal and infant survival and well being, and
couples are able to have sexual relations, free of fear
pregnancy and of contracting disease”.

Components:
 Family planning
 Child survival and safe motherhood component.
 Client approach to health care
 Prevention/management of RTI/STD/AIDS

Highlights of RCH program:
 The program integrates all interventions of fertility regulation,
maternal and child health with reproductive health for both men
and women.
 Client oriented.
 Upgradation of the level of facilities
 Facilities of obstetric care
 Specialist facilities for STD and RTI.
 The program aims improving the outreach of services primarily
for the vulnerable group of population who have been, till now
effectively left out of planning.

Interventions:
 Child survival interventions
 Safe motherhood interventions
 Implementation of target free approach
 High quality training at all levels.
 IEC activities.
 Specially designed RCH package for urban slums and
tribal areas
 District sub projects under local capacity enhancement

 RTI/STD clinics at district hospitals.
 Facility for safe abortions at PHCs by providing
equipment, contractual doctors etc.
 Enhanced community participation through panchayat,
women groups and NGOs.
 Adolescent health and reproductive hygiene.

Interventions in selected states/districts:
 Screening and treatment of RTI/STD at sub-divisional
level
 Essential obstetric care.
 Emergency obstetric care.
 Additional ANM at sub centers.
 Improved delivery services.
 Facility of referral transport.

 Maternal health care was a part of Family welfare
program from its inception
 Interventions were introduced as vertical schemes
namely
◦ NNAP
◦ TT immunization of pregnant women.
◦ Dias training program.

 In 1992, the child survival and safe motherhood program
integrated at all the schemes for better compliance.
◦ Early registration of pregnancy
◦ To provide minimum 3 ante natal check ups.
◦ Universal coverage of all pregnant women with TT immunization
◦ Advice on food, nutrition and the rest.
◦ Detection of high risk pregnancies and prompt referral.
◦ Clean deliveries by trained personal
◦ Birth spacing
◦ Promotion of institutional deliveries

Major Interventions:
 Essential obstetric care
 Emergency obstetric care
 24 hour delivery service at PHC/CHC
 Medical termination of pregnancy
 Control of RTI/STD
 Immunization
 Essential new born care
 Diarrhoeal disease control

 Prevention and control of Vitamin A Deficiency in
children
 Prevention and control of Anaemia in children
 Acute respiratory disease control

Initiatives taken after adoption of national population
policy.
 RCH campus
 RCH out – reach scheme
 Border district cluster strategy
 Introduction of hepatitis B vaccination project
 Training of Dias
 Empowered action group
 District survey

 Began from 1st April 2005
 Focus of the program: Reduce maternal and child
morbidity and mortality with emphasis on rural health
care

The major strategies:
 Essential obstetric care
◦ Institutional delivery
◦ Skilled attendance at delivery
 Emergency obstetric care
◦ Operationalizing FRUs
◦ Operationalizing PHCs and CHCs

New Initiatives:
 Training of MBBS doctors in life saving
 Setting up of Blood storage centers at FRUS

 Type of National Maternity benefits scheme modified
into new scheme – JSY.
 Launched on 12th April 2005.
Objectives:
 Reducing Maternal mortality and infant mortality

Salient Features:
 100% centrally sponsored scheme.
 Under NRHM it integrates the benefits of cash
assistance and institutional care.
 This benefit will be given to all women both rural and
urban belonging to BPL.

Eligibility of cash assistance:
 In low performing state
◦ All women including those from SC/ST delivering in govt
health centers.
 In high performing state
◦ BPL women, Aged 19 years and above
◦ SC/ST pregnant women

Limitation of cash assistance:
 In low performing state,
◦ All births delivered in health care
 In high performing state.
◦ Only for first 2 deliveries

 Voluntary scheme
 Doctor can volunteer themselves for providing safe
motherhood services
 The enrolled doctors will display mandematharam logo
at their clinic
 Fe, oral pills and TT will be provided by the respective
DMO to the vandematharam doctors for free
distribution.

Facilities:
 Safe abortion services
◦ Medical method of abortion
◦ Manual vaccum aspirtation
 Village health and nutrition day
 Maternal death review
 Pregnancy tracking

Child health components:
 Nutrition rehabilitation centers
 Integrated management of neonatal and childhood
illness
 Sick newborn care unit
 Home based new born care

Quality indicators used to monirot RCH
programme:
 Number of antenatal cases registered
 Number of antenatal woman who had 3 ANC
 Number of high risk pregnancy referred
 Number of pregnant woman who had two doses of TT
injection
 Number of pregnant woman under prophylaxis and
treatment of anaemia

 Number of deliveries by trained and untrained birth
attendant
 Number of cases with complications referred to
PHC/FRU
 Number of newborn with birthweight recorded
 Number of women given 3 postnatal check ups
 Number of RTI/STD cases detected

 Number of children fully immunized
 Number of adverse reactions reported after
immunization
 Number of ARI and diarrhoea under 5 years treated
 Number of cases motivated and followed up for
contraception

INTEGRATED
MANAGEMENT OF
NEONATAL AND
CHILDHOOD ILLNESS

 Over the last 3 decades the annual number of deaths among
children less than 5 years of age has decreased by almost a
third.
 However, this reduction has not been evenly distributed
throughout the world. Every year more than 10 million
children die in developing countries before they reach
their fifth birthday.
39
Introduction

 Seven in 10 of these deaths are due to acute respiratory
infections (mostly pneumonia), diarrhoea, measles,
malaria, or malnutrition - and often to a combination of
these illnesses.
 In India, common illnesses in children under 3 years of age
include fever (27% ), acute respiratory infections (17% ),
diarrhoea (13% ) and malnutrition (43%) – and often in
combination (National Family Health Survey .
40

 Infant Mortality Rate continues to be high at 68/1000 live
births and Under Five Mortality Rate at 95/1000 live births
per year.
 Neonatal mortality contributes to over 64% of infant deaths
and most of these deaths occur during the first week of life.
41

 Health problem(s) the child may have;
 Severity of the child’s condition; and
 Actions that can be taken to care for the child (e.g. refer
the child immediately, manage with available resources, or
manage at home).
42
Evidence-based Syndrome
Approach

 The IMNCI strategy includes both preventive and curative
interventions that aim to improve practices in health
facilities, the health system and at home.
 At the core of the strategy is integrated case management
of the most common neonatal and childhood problems
with a focus on the most common causes of death.
43
COMPONENTS OF THE
INTEGRATED APPROACH

 Improvements in the case-management skills of health
staff through the provision of locally-adapted guidelines
on Integrated Management of Neonatal and Childhood
Illness and activities to promote their use;
 Improvements in the overall health system required for
effective management of neonatal and childhood illness;
 Improvements in family and community health care
practices.
44
The strategy includes three main
components

 Depending on a child’s age, various clinical signs and
symptoms differ in their degrees of reliability and
diagnostic value and importance. Therefore, the IMNCI
guidelines recommend case management procedures based
on two age categories:
◦ Young infants age up to 2 months
◦ Children age 2 months up to 5 years
45
THE PRINCIPLES OF INTEGRATED
CARE

 All sick young infants up to 2 months of age must be
assessed for “possible bacterial infection / jaundice”. Then
they must be routinely assessed for the major symptom
“diarrhoea”.
 All sick children age 2 months up to 5 years must be
examined for “general danger signs” which indicate the
need for immediate referral or admission to a hospital.
They must then be routinely assessed for major symptoms:
cough or difficult breathing, diarrhoea, fever and ear
problems.
46

 All sick young infants and children 2 months up to 5 years
must also be routinely assessed for nutritional and
immunization status, feeding problems, and other potential
problems.
 Only a limited number of carefully selected clinical signs
are used, based on evidence of their sensitivity and
specificity to detect disease. These signs were selected
considering the conditions and realities of first-level health
facilities.
47

 A combination of individual signs leads to an infant’s or a
child’s classification(s) rather than a diagnosis. Classification(s)
indicate the severity of condition(s). They call for specific
actions based on whether the infant or child (a) should be
urgently referred to a higher level of care, (b) requires specific
treatments (such as antibiotics or antimalarial treatment), or (c)
may be safely managed at home. The classifications are colour
coded: “pink” suggests hospital referral or admission, “yellow”
indicates initiation of specific treatment, and “green” calls for
home management.
48

 IMNCI management procedures use a limited number
of essential drugs and encourage active participation of
caretakers in the treatment of infants and children.
49

50
IMNCI CASE
MANAGEMENT
PROCESS

For all sick children age up to 5 years who are brought
to a first-level health facility
ASSESS the child: Check for danger signs (or possible
bacterial infection/Jaundice). Ask about main symptoms. If a
main symptom is reported, assess further. Check nutrition
and immunization status. Check for other problems.
51

CLASSIFY the child's illness: Use a colour-coded
triage system to classify the child's main symptoms
and his or her nutrition or feeding status.
IF URGENT
REFERRAL is
needed and possible
IF NO URGENT
REFERRAL is
needed or possible
52

Identify urgent
pre-referral treatment(s)
needed for the child's
classifications.
IDENTIFY TREATMENT
needed for the child's
classifications: identify
specific medical treatments
and/or advice.
TREAT THE CHILD:
Give urgent prereferral
treatment(s) needed.
TREAT THE CHILD: Give the
first dose of oral drugs in the clinic
or advise the child's caretaker.
Teach the caretaker how to give
oral drugs and how to treat local
infections at home. If needed, give
immunizations.
53

REFER THE CHILD: Explain to
the child's caretaker the need for
referral. Calm the caretaker's fears
and help resolve any problems.
Write a referral note. Give
instructions and supplies needed to
care for the child on the way to the
hospital.
COUNSEL THE
MOTHER: Assess the child's
feeding, including
breastfeeding practices, and
solve feeding problems, if
present. Advise about feeding
and fluids during illness and
about when to return to a
health facility. Counsel the
mother about her own health.
FOLLOW-UP care: Give follow-up care when the child returns to
the clinic and, if necessary, reassess the child for new problems.
54

National nutritional anaemia
prophylaxis program

 Was started in 1970.
 Centrally sponsored scheme.
Objectives:
 Aims at significantly decreasing the prevalence and
incidence of anaemia.

Specific Objectives:
 Asses the baseline prevalence of nutrition anaemia.
 Anti anaemia treatment.
 Prophylaxis program.
 Continuous monitoring.
 To asses periodically the HB level.
 Motivate the mother

Activities:
 Promotion of regular consumption of food rich in
iron.
 Supply of iron and folate supplements.
 Identification and treatment of severely aneamic
cases.

Organization:
The program is implemented through
primary health centers and its sub centers. The
multi purpose worker female and other para medics
in the PHCs are responsible for the distribution of
IFA tablets to beneficiaries.

NATIONAL PROGRAMME
FOR CONTROL OF
BLINDNESS

Launched in the year 1976
100% centrally sponsored
scheme
Goal: to reduce the prevalence of
blindness from 1.4 to .3 percent

REVISED STRATEGIES
 Strengthening services
 To shift from the eye camp approach to a fixed
facility surgical approach
 To expand the world bank project activities
 To strengthen participation of voluntary
organization
 To enhance the coverage of eye care services

OBJECTIVES
To reduce the backlog of blindness
To develop eye care facilities
To develop human resources for
providing eye care services

To improve quality of service
delivery
To secure participation of voluntary
organizations
To enhance community awareness
on eyecare

1535975311475 national family welfare programme 2

ADMINISTRATION
Central ophthalmology section, directorate general
of health services , ministry of health &
FW, New delhi
State State ophthalmic cell, directorate of health
services , state health societies
District district blindness control society

SERVICE DELIVERY AND REFERRAL SYSTEM
Tertiary level
Secondary level
Primary level

SCHOOL EYE SCREENING PROGRAMME
First screened by trained teachers
Children suspected to refractive error
are seen by ophthalmic assistants and
corrective spectacles are prescribed
or given free for persons below
poverty line

COLLECTION AND UTILIZATION OF DONATED
EYES:
MAJOR strategy :collection of donated eyes
Eye donation

NEW INITIATIVES:
Construction of dedicated eye wards
Appointment of ophthalmic surgeons
Appointments of ophthalmic assistant in
PHC
Appointment of eye donation counsellors
Grant in aid for NGOs

Special attention to clear cataract
backlog
Telemedicine
Involvement of private practioners
Vitamin A supplementation
Setting up of 5 centres for excellence
for eye care services

EXTERNALLY AIDED PROJECT
 World bank assisted cataract blindness control project
 DANISH assistance
 WHO assistance
VISION 2020
o Target diseases
o Human resource development

NATIONAL AIDS CONTROL
PROGRAMME

 HIV infection first detected in India in 1986, when 10 HIV
positive samples were found from a group of 102 female sex
workers from Chennai.
• In 1986 Government set up an AIDS Task Force under ICMR
and established a National AIDS Committee (NAC) chaired
by Secretary, Department of Health and Family Welfare.
 In 1987, National AIDS Control Programme was initiated,
with help from the World Bank.
 In 1989, a Medium Term Plan for AIDS Control was
developed with the support of the WHO.

 First National AIDS Control Programme (NACP-I) was
launched in 1992.
 NACP-II launched in 1999: decentralization of
programme implementation to State level and greater
involvement of NGOs.
 NACP- III implemented during 2007-2012: scaling up HIV
prevention interventions for HRG and general population,
and integrate them with Care, Support & Treatment
services.
 NACP-IV has been developed for the period 2012-2017

OBJECTIVE
 Slow and prevent the spread of HIV through a major effort to prevent HIV
transmission.
KEY STRATEGIES
 Focus on raising awareness, Blood safety, Prevention among high-risk
populations,
 Improving surveillance
ACHIEVEMENTS
 National AIDS response structures at both the national and state levels and provided
critical financing.
 Strong partnership with the World Health Organization(WHO) and later helped mobilize
additional donor resources.
 Established the State AIDS Control Cells
 Improved blood safety.
 Expanded sentinel surveillance and improved coverage and reliability of data.
 Improved condom promotion activities.
 National HIV testing policy.

NACP II
OBJECTIVE
 Reduce the spread of HIV infection in India through
behavior change and increase capacity to respond to HIV on
a long-term basis.
KEY STRATEGIES
 Targeted Interventions for high-risk groups
 Preventive interventions for general populations
 Involvement of NGOs
 Institutional strengthening

ACHIEVEMENT
 At the operational level 1,033 targeted interventions set up, 875
Voluntary counseling and testing centers (VCTC) and 679 STI clinics
at the district level.
 Nation-wide and state level Behavior Sentinel Surveillance (BSS)
surveys were conducted
 Prevention of parent-to-child transmission (PPTCT) programme was
expanded.
 A computerized management information system (CMIS) created.
 HIV prevention and care and support organizations and networks were
strengthened.
 Support from partner agencies increased substantially

NACP III
OBJECTIVE
 Reduce the rate of incidence by 60 per cent in the first year of the
programme in high prevalence states to obtain the reversal of the
epidemic, and by 40 percent in the vulnerable states to stabilise the
epidemic.
STRATEGIES
 Prevention – Targeted intervention (TI), ICTC, blood safety,
communication, advocacy and mobilisation, condom promotion.
 Care, support and treatment – ART, Pediatric ART, Center for
excellence, Community Care Centers.
 Capacity building – establishment, support and capacity
strengthening, training, managing programme implementation and
contracts, mainstreaming/private sector partnerships.
 Strategic information management – monitoring and evaluation.

ACHIEVEMENTS
 There were 306 fully functional ART Centres against the target of 250 by
March 2012
 Nearly 12.5 lakh PLHIV were registered and 420000 patients were on ART.
 612 Link ART centre (LAC) had been established wherein, 26023 PLHIV
were taking Services
 There were 10 Centres of Excellence,
 7 Regional Pediatric centres also functional.
 259 Community Care Centres across the Country
 6000 condoms & 6000 village information centres established
 3000 Red ribbon clubs established
 Link Workers training module updated

NACP IV
 Launched on 12 February 2014
 Total budget outlay Rs 14295 crores.
 Goal: Accelerate Reversal and Integrate Response

 Objective 1:
◦ Reduce new infections by 50% (2007 Baseline of NACP III)
 Objective 2:
◦ Provide comprehensive care and support to all persons living
with HIV/AIDS and treatment services for all those who
require it.

Key
Strategie
s under
NACP-IV
Intensify
&consolidat
e
preventive
services
Increase
access
&promote
comprehensi
ve care,
support &
treatment
Expanding
IEC
services
Capacity
building
Strengtheni
ng Strategic
Information
Managemen
t system

CHILD SURVIVAL AND
SAFE MOTHERHOOD
PROGRAMME

o Launched in 1991
 Objectives to reduce maternal mortality to less than 2, infant
mortality to less than 50 per 1000 livebirths; and child mortality (1
to 4 years of age) to below 10 by 2000 A.D. This is to be achieved
through improvement and expansion of Maternal Child Health
(MCH) services at village, sub-centre, PHC and CHC levels;
improving the access to MCH services at village and sub-centre
level, focusing on high IMR districts and improvement in support
systems such as training, supply, communication, monitoring and
evaluation.

Specific objectives
 To reduce infant mortality rate from 80 to 75 by 1995;
and to 50 by 2000 A.D.
 To reduce child (1-4 years) mortality rate from 41.2 to
10.
 To reduce maternal mortality rate from 5 to 2 per 1000
livebirth.
 To achieve polio eradication by 2000 A.D.
 To eliminate neofiatal tetanus by 1995.

 To prevent 95 per cent measles death5 and 90 per cent
cases of measles by 1995.
 To ensure prevention of 70 per cent diarrhoea1 deaths
and reduce diarrhoeas cases by 25 per cent.
 To prevent 40 per cent deaths due to Acute Respiratory
Infections. (Source : Child Survival and Safe
Motherhood Programme Guidelines, Ministry of Health
and Family Welfare, Government of India, 1992).

Services provided to children and pregnant mothers
include:
For Pregnant Women :
◦ Anaemia prophylaxis and therapy (100 per cent coverage).
◦ Antenatal check-ups, at least 3 check-ups (100 per cent
coverage).
◦ Referral of those with high risks and complications.
◦ Care at birth and promotion of clean delivery.
◦ Birth time and spacing

For Children :
◦ New born care at home.
◦ Primary Immunization by 12 months (100 per cent coverage).
◦ Vitamin A prophylaxis (9 months to 3 years) (100 per cent
coverage).
◦ Correct management of pneumonia at home/at health
facilities.
◦ ORT at home/health facility; ORS in every village for
management of diarrhoea.

BABY FRIENDLY
HOSPITAL INITIATIVE

In India, BFHI was Launched in 1992 as a part of “
INNOCENT DECLARATION” on breast feeding

 Improving the care of pregnant women, mothers
and newborns at health facilities that provide
maternity services for protecting, promoting and
supporting breastfeeding ( International Code of
Marketing of Breast milk Substitutes)

1) All the hospital should have a written
breast feeding policy, that is routinely
communicated to all the health care staff.

2) PROVIDING TRAINING TO ALL
HEALTH CARE PROFESSIONALS TO
DEVELOP THE SKILL FOR
IMPLEMENTING THE POLICY

3) INFORM ALL PREGNANT WOMEN
ABOUT THE BENEFITS AND
MANAGEMENT OF BREAST FEEDING

4) HELP MOTHER TO PROVIDE BREAST
FEDDING WITHIN HALF AN HOUR OF
BIRTH

5) SHOW MOTHER HOW TO BREAST FED AND
HOW TO MAINTAIN LACTATION EVEN IF THEY
SHOULD BE SEPERATED FROM THEIR INFANTS.

6) GIVE NEWBORN INFANT NO FOOD OR
DRINK OTHER THAN BREAST MILK,
UNLESS MEDICALLY INDICATED
7) PRACTICE ROOMING –IN.ALLOW
MOTHERS AND INFANTS TO REMAIN
TOGETHER 24 HOURS A DAY.

8) ENCOURAGE BREAST FEEDING
ON DEMAND

9) GIVE NO ARTIFICIAL DUMMIES
OR SOOTHERS TO BREAST FEEDING
INFANTS.

10) FOSTER THE ESTABLISHMENT OF
BREAST FEEDING SUPPORT GROUPS
AND REFER MOTHER TO THEM ON
DISCHARGE FROM THE HOSPITAL OR
CLINIC.

INTEGRATED CHILD
DEVELOPMENT SERVICE

 STARTED IN THE YEAR 1975
 Ministry of social and women’s welfare
 For the welfare of the children and development of human
resources
Beneficiaries:
 Children up to 6 years
 Adolescent girls (11-18) years
 Pregnant women
 Nursing mothers
 Women of 15 to 45 years

Objectives
1. To improve the nutritional status of preschool children
0-6 years of age group.
2. To lay the foundation of proper psychological
development of the child
3. To reduce the incidence of mortality, morbidity,
malnutrition and school drop out
10
6

4. To achieve effective coordination of policy and
implementation in various departments to promote
child development
5. To enhance the capability of the mother to look after
the normal health and nutritional needs of the child
through proper nutrition and health education.
10
7

Services Provided
 Nutrition
◦ Supplementary nutrition
◦ Growth monitoring and promotion
◦ Micronutrient supplementation/ promotion
 Pre-school non-formal education
 Health
◦ Immunization
◦ Periodic health check-ups
◦ Referral services
◦ Nutrition and health education
10
8

Target Groups
Beneficiaries Services Provided
Pregnant women Health check-ups,
TT Vaccination,
Supplementary nutrition,
Health education.
Nursing Mothers Health check-ups,
Supplementary nutrition,
Health education
Children less than 3 years Supplementary nutrition,
Health check-ups,
Immunization,
Referral services
Children between 3-6 years Supplementary nutrition,
Health check-ups,
Immunization,
referral services,
Non formal education
Adolescent girls 11-18 years Supplementary nutrition,
Health education 10
9

National PROGRAMME FOR
PREVENTION AND
CONTROL OF DEAFNESS

OBJECTIVES:
 To prevent avoidable hearing loss
 Early identification, diagnosis and treatment
 Medical rehabilitation
 To strengthen the existing inter-sectoral linkages
 To develop institutional capacity

Components:
Manpower training and development
Capacity building
Service position
Awarness generation

Strategies:
 To strengthen the service delivery for ear care
 Promote public awareness
 To develop institutional capacity

RAJIV GANDHI NATIONAL
CRECHE SCHEME FOR THE
CHILDREN OF WORKING
MOTHERS

Creches are designed to provide
group care to children , usually up to 6 years
of age , who need care, guidance and
supervision away from their home during the
day

OBJECTIVES:
 To provide day care facilities
 To improve nutrition and health services
 To promote physical cognitive, social and
emotional development of children
 To educate empower parents

SERVICES:
 Daycare facilities
 Early stimulation for children
 Supplementary nutrition
 Growth monitoring
 Health check up
TARGET GROUP:
Children of 6 months to 6 years
Coverage:
As on January 2015, there are 23293 functional
creches

National Iodine Deficiency
Disorders Control Programme

GOALS
To Reduce the prevalence of Iodine
Deficiency Disorders below 10% in the
entire country by 2012
Achieve Universal Access to Iodized Salt
Source: 11th Five Year Plan, Govt. of India

OBJECTIVES
1. Surveys to assess the magnitude of the Iodine
Deficiency Disorders
2. Supply of Iodated salt in place of common salt.
3. Re-survey after every 5 years to assess the extent
of Iodine Deficiency Disorders and the impact of
iodated salt.
4. Laboratory Monitoring of Iodated Salt and Urinary
Iodine Excretion
5. Health Education & Publicity

 Launched in 1961
Objective:
o Attract more children for admission to school and
retain them.

Principles
 Meal should be a suppliment
 Meal should supply at least one third of total energy
requirement
 Cost should be reasonably low
 The meal should be such in that it can be prepared by easily
in schools , no complicated cooling process should be
involved
 Locally available foods
 Frequent change of menu

MODEL MENU:
FOOD STUFF g/day/child
Cereals and millets 75
pulses 30
Oils and fats 8
Leafy vegetables 30
Non –leafy vegetables 30

Vision of the NHM
 “Attainment of Universal Access to Equitable,
Affordable and Quality health care services,
accountable and responsive to people’s needs, with
effective inter-sectoral convergent action to address the
wider social determinants of health”.

About National Health Mission (NHM):
 The vision of the National Health Mission (which
encompasses the National Rural Health Mission
(NRHM) and the National Urban Health Mission
(NUHM) as its two Sub-Missions) is universal access
to equitable, affordable and quality health care
services.
 NHM in the 12th Plan are synonymous with those of
the 12th Plan, and are part of the overall vision.

Goals:
The endeavor would be to ensure achievement of those
indicators
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
5. Prevent and reduce mortality & morbidity from
communicable, noncommunicable; injuries and emerging
diseases

6. Reduce annual incidence and mortality from Tuberculosis by
half
7. Reduce prevalence of Leprosy to <1/10000 population and
incidence to zero in all districts
8. Annual Malaria Incidence to be <1/1000
9. Less than 1 per cent microfilaria prevalence in all districts
10. Kala-azar Elimination by 2015, <1 case per 10000 population in
all blocks

Components of NHM
 NHM Finance
 NHM- Health Systems Strengthening
 Reproductive, Maternal, Newborn, Child Health and
Adolescent - (RMNCH+A) Services
 National disease control programmes

NHM has six financing components:
(i) NRHM-RCH Flexi pool,
(ii) NUHM Flexi pool,
(iii) Flexible pool for Communicable disease,
(iv) Flexible pool for Non communicable disease
including Injury and Trauma,
(v) Infrastructure Maintenance and
(vi) Family Welfare Central Sector component.
The fund flow from the Central Government to
the states/UTs would be as per the procedure
prescribed by the Government of India.
Financial management capabilities for managing
the funds provided to the State Health
Societies./PIP
Components of NHM
1 NHM Finance

2 NHM- Health Systems Strengthening
 Adoption of the Indian Public Health Standards and
Quality standards
 Skill gaps and Standard Treatment Protocols
 Quality Improvement Programmes

The progress made under health system
strengthening
•Infrastructure: strengthen public health delivery
system at all levels as per IPHS
More than 27,400 new construction works have been
sanctioned till December 2013, since the inception of the Mission
The numbers of First referral Units (FRUs) has increased
significantly from 940 in 2005 to 2653 in 2013-14.
 There are now 8743 PHCs which are working round the
clock, compared to 1263 in 2005.

•Human Resources
In 2013,the total number of technical HR supported
under NRHM increased to 1.49 lakh, which includes
23079 doctors/ specialists including AYUSH doctors,
35172 Staff Nurses, 20011 para-medics including
AYUSH paramedics and 70891 ANMs. 590 District
Programme Managers, 601 District Accounts
Managers, 4579 Accountants at Block level and 4541
Accountants at PHC level ,ASHA

Free drugs; NHM Free Drugs Service Initiative.
Mobile Medical Units (MMUs); All Mobile Medical
Units are being repositioned as “National Mobile
Medical Unit Service” with universal colour and
design. As of December, 2014 there were about 1301
operational MMUs in 368 districts across the country

Emergency response services and patient transport system
28 States have the facility where people can dial 108 or 102
telephone number for calling an ambulance
● 108 is emergency response system, primarily designed to
attend to patients of critical care, trauma and accident
victims etc.
● 102 services essentially consist of basic patient transport
aimed to cater the needs of pregnant women and children
though other categories are also taking benefit and are not
excluded.
102 & 108 ambulances have been repositioned as “National
Ambulance Service” with universal colour and design.

3 Reproductive, Maternal, Newborn, Child Health and
Adolescent - (RMNCH+A) Services
February 2013, India took the lead in articulating
‘A Strategic approach to Reproductive Maternal, Newborn,
Child and Adolescent health (RMNCH+A)’.
 Maternal Health
 Access to safe abortion services
 Prevention and Management of Reproductive Tract Infections (RTI)
and Sexually Transmitted Infections.
 Gender Based Violence
 Newborn and Child Health
 Universal Immunization
 Child Health Screening and Early Intervention Services
 Adolescent Health
 Family Planning
 Addressing the Declining Sex Ratio
 Cross cutting areas

Initiatives
Reproductive health
New Strategic focus on Spacing
Methods and other family
planning services
 Safe Abortion Services
Maternal health
 Janani Shishu Suraksha
Karyakram (JSSK) 2011
 State of the art Maternal and Child
Health Wings (MCH wings) for
providing quality obstetric and neonatal
care
 Janani Suraksha Yojana 2005
Institutional deliveries in India have
risen sharply from 47% in 2008 to over
84 % now.
Targets achieved 2014
The Total Fertility Rate has declined
from 3.2 in 2000 to 2.4 in 2012 [2.1]
 Rate of decline of TFR has
accelerated by 52.3% during 2006-
2011 as compared to 2000-2005.
 decline in growth rate, since
independence, from 21.54% in 1990-
2000 to 17.64% in 2001-2011.
 In 2011, MMR in the country has
declined to 178 against a global
MMR of 210.[1/1000]

Mother and Child Tracking System (MCTS) &
Mother and Child Tracking Facilitation Centre (MCTFC)
•The facilitation centre has 80 helpdesk agents .
•The facilitation centre will act as a supporting framework to MCTS and help in
validating the data entered in MCTS by making phone calls to pregnant women
and parents of children and health workers.
•Get their feedback on various mother and child care services, programmes
and initiatives like JSSK, JSY, RBSK, NATIONAL IRON PLUS INITIATIVE
(NIPI), contraceptive distribution by ashas etc
•Check with ASHA and ANMS regarding availability of essential drugs and
supplies like ors packets and contraceptives.

Newborn /Child health- initiatives
Targets achieved 2012 -14 Initiatives have been started to
provide both home based care
and facility based
care.[2011]
 Treatment and referral of sick
newborns at health facilities
New born Care Units
(SCNU) in district hospitals
 Newborn Stabilisation Unit
(NBSU), which is 4 bedded
unit providing basic level of
sick newborn care , established
at Community Health Centres/
First Referral Units.
 2012 /India’s child mortality
of 52 per 1000
 Live births is close to the
global average of 48
 Number of child deaths has
been reduced from
approximately 30 lakhs in
1990 to nearly 14 lakhs in
2012. [ 21/1000 live
birth]

•Newborn Care Corners (NBCC) are established at
delivery points and providers trained in basic newborn care
and resuscitation through Navjaat Shishu Suraksha
Karyakram (NSSK).
•The Home Based Newborn Care Scheme launched in
2011
•National Iron Plus Initiative launched in 2013 to bring
about renewed emphasis on tackling high prevalence of
anaemia, comprehensively, across all age groups.

Universal Immunization
 Under the Universal Immunization Programme (UIP)
, vaccination is provided free of cost against seven
vaccine preventable diseases i.e. Diphtheria,
Pertussis, Tetanus, Polio, Measles, severe form of
Childhood Tuberculosis and Hepatitis B.

• Vitamin A supplementation, children between nine months
to five years are given six monthly doses of Vitamin A.
 Nutritional Rehabilitation Centres have been
established for providing medical and nutritional care.
 Tribal areas and high focus districts are prioritised for
setting up these units.

Integrated Management of Neonatal and Childhood
Illnesses (or IMNCI).2009
The strategy also addresses aspects of nutrition, immunization,
and other important elements of disease prevention and health
promotion.
The strategy includes three main components:
 (i) Improvements in the case-management skills of health staff
 (ii) Improvements in the overall health system required for
effective management of neonatal and childhood illnesses;
 (Iii) Improvements in family and community health care
practices.

Rashtriya Bal Swasthya Karyakram: RBSK/2013
A recent initiative :
● Expanding focus from child survival to a more
comprehensive approach of child survival and
development and improving the overall quality of life
● RBSK includes provision for Child Health Screening
and Early Intervention Services through early detection
and management of 4 Ds i.e Defects at birth, Diseases,
Deficiencies, Development delays including disability.

4 NDCPS
National disease control programmes
 National Vector Borne Diseases Control Programme (NVBDCP)
 Revised National Tuberculosis Control Programme (RNTCP)
 Integrated Disease Surveillance Programme (IDSP)
 National Programme for Prevention and Control of Cancer, Diabetes,Cardiovascular
Diseases and Stroke (NPCDCS)
 National Programme for the Control of Blindness (NPCB)
 National Mental Health Programme (NMHP)
 National Programme for the Healthcare of the Elderly (NPHCE)
 National programme for the Prevention and Control of Deafness
 (NPPCD)
 National Tobacco Control Programme (NTCP)
 National Oral Health Programme (NOHP):
 National Programme for Palliative Care (NPPC):
 National Programme for the Prevention and Management of Burn
Injuries (NPPMBI):
 National Programme for Prevention and Control of Fluorosis
 (NPPCF)

Components of NHM
NHM
FINANCE
STRENGTHING
HEALTH
SERVICES
(RMNCH+A)
Services
NDCPS
NRHM NUHM

National Rural Health Mission (NRHM)
 NRHM seeks to provide equitable, affordable and quality
health care to the rural population, especially the vulnerable
groups.
 Thrust of the mission is on establishing a fully functional,
community owned, decentralized health delivery system with
inter-sectoral convergence at all levels,
 to ensure simultaneous action on a wide range of
determinants of health such as water, sanitation, education,
nutrition, social and gender equality.
 Initiated in 2005

National Urban Health Mission (NUHM) approved
by the cabinet on 1st May 2013:
To improve the health status of the urban population
particularly slum dwellers and other vulnerable sections
facilitating their access to quality primary health care.
 NUHM would cover all state capitals, district headquarters
and other cities/towns with a population of 50,000 and above
(as per census 2011) in a phased manner.
 Under NUHM, a provision of Rs 1000 Crores has been made
in 2013-14.

New initiatives:
1 Union ministry of health & family welfare has put in place program guidelines
for implementing the national dialysis program in district hospitals on PPP
mode.
•The swachh bharat abhiyan launched by the prime minister on 2nd october
2014, focuses on promoting cleanliness in public spaces.
•Award to public health facilities/ kayakalpa awards implementing national
.
•Implementing national free essential diagnostics service initiative so as to
ensure the availability of basic diagnostics tests for service users in public health
facilities
•The free essential drugs initiative also expected to ensure a responsive supply
of quality drugs to facilities and promote rational drug use.

Introduction to
NGO
A Non Governmental Organization
(NGO) is any non-profit, voluntary
citizens' group which is legally
constituted, organized and operated
on a local, national or international
level.
They are Task-oriented and driven by
people with a common interest

NGOs
Classification
By the level
of
Orientation
Charitable
Orientation
Service
Orientation
Participatory
Orientation
Empowering
Orientation
By the level
of Operation
Community
Based
Organization
s
City Wide
Organization
s
National
NGOs
International
NGOs

Advantages of NGOs
→ Ability to experiment freely
→ Flexible in adapting to local needs
→ Enjoy Good rapport with people
→ Ability to communicate at all levels
→ Ability to recruit experts and highly motivated staff
→ Less restrictions from the Government

Disadvantages of NGOs
 Lack of funds
 Lack of dedicated leadership
 Inadequate trained personnel
 Misuse of Funds
 Monopolization of leadership
 Lack of public participation
 Centralization in Urban Areas
 Lack of Coordination

ROLE OF NGOs
 Advocacy for maternal child health interventions
 Promotion of small healthy family
 Improving community participation
 Counseling
 Act as a link between the community and health care
providers
 Gender sensitivity and advocacy regarding providing
adequate care for the girl child
 BFHI

• Advocacy for the introduction of semi solid at the right
time
• Social marketing of contraceptives
• Sensitizing the community regarding the adverse
consequence of sex determination and sex selective
abortions

REVISED NATIONAL
TUBERCULOSIS CONTROL
PROGRAMME

RNTCP
 GOI –WHO revised strategy for control of TB in India
 RNTCP application of WHO – DOTS launched in 1993
as pilot project covering 2.35 – 20 million population
(1993-1997)

OBJECTIVES
The objectives of the programme are to:
 To achieve and maintain cure rate of at least 85%
among New Sputum Positive (NSP) patients.
 To achieve and maintain case detection of at least 70%
of the estimated NSP cases in the community.

RNTCP Organization structure:
State level

Directly
observed
treatment
(DOT) is one
element of
the DOTS
strategy
An observer
watches and
helps the
patient
swallow the
tablets
Direct observation
ensures treatment
for the entire
course
• with the right
drugs
• in the right doses
• at the right
intervals
Directly Observed Treatment

ANTI-TUBERCULAR DRUGS
Medication Drug action Dose(Thrice a
week)***
Dose in
children(mg/kg)
Isoniazid Bactericidal 600 mg 10-15
Rifampicin Bactericidal 450 mg* 10
Pyrazinamide Bactericidal 1500 mg 30-35
Ethambutol Bacteriostatic 1200 mg 20-25
Streptomycin Bactericidal 0.75 g** 15
* Patients who weigh 60 kg or more at the start of treatment are given an
extra 150mg dose of Rifampicin
** Patients over 50 years of age are given 0.5g of streptomycin
*** Adult patients weighing <30kg receive drugs in patients-wise from the
weight band suggested for pediatric patients

1535975311475 national family welfare programme 2

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