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Millennium Development Goals in India. Confronting the Challenge of HIV/AIDS, Malaria & other diseases June 18, 2004. India’s Health System. At cross roads today. Vast health infrastructure and manpower at primary, secondary and tertiary care in government, voluntary and private sectors.
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Millennium Development Goals in India Confronting the Challenge of HIV/AIDS, Malaria & other diseases June 18, 2004
India’s Health System • At cross roads today. • Vast health infrastructure and manpower at primary, secondary and tertiary care in government, voluntary and private sectors. • Institutions manned by professionals and paraprofessionals trained in the medical colleges in modern medicine and ISM&H and paraprofessional training institutions. • Population aware of the benefits of health related technologies for prevention, early diagnosis and effective treatment for a wide variety of illnesses and accessed available services. • Technological advances and improvement in access to health care technologies, which were relatively inexpensive and easy to implement, have resulted in substantial improvement in health indices of the population and a steep decline in mortality.
(Contd.) • At the same time, communicable diseases have persisted over time • Malaria has also developed insecticide resistant vectors while others like TB are becoming increasingly drug resistant, HIV / AIDS has of late assumed extremely virulent proportion and is now projected more as a socio economic issue rather than merely a health problem. • The 1990s has also seen an increase in mortality on account of non-communicable diseases arising as a result of life style changes and increase in life expectancy.
MDG – Health related indicators • MDG indicators related to health are a mix of health outcome (prevalence & death rate) and service output measures (coverage & use of specific health interventions) • 18 health & health related indicators • ‘Health’ & ‘health related’ refer to indicators that are truly ‘health’ such as malaria prevalence or that concern critical factors for health, e.g. access to improved water supply or dietary energy consumption & so on
National Vector Borne Disease Control Programme • Tenth Plan Outlay – Rs. 1370 crore • National Vector Borne Disease Control Programme approved in 2003-04. • Annual Plan (2004-05) Interim Outlay– Rs. 269 crore • Annual Plan (2004-05) Proposed Outlay – Rs 296 crore • Proposed Additionality – Rs. 27 crore • Includes 3 ongoing programmes of Malaria, Filaria & Kala Azar; JE & Dengue / DHF have been added. • 100 percent funding provided from central budget for 7 North Eastern states and also for the 100 districts covered in 8 EMCP States under the World Bank assisted programme. For rest of the country, cost sharing on 50:50 basis.
(Contd.) • Malaria continues to be a major public health problem. • However, modified plan of action for control of malaria has moderated the reported number of cases at much less than 2.0 million from approximately 7 million in the 1970s. • Reported no. of cases during 2003 – 1.65 million (P).
(Contd.) • During the 10th Five Year Plan, (2002-07) it has been proposed to achieve an Annual Blood Examination Rate (ABER) of over 10% and Annual Parasite Incidence (API) of 1.3 or less. • The operational performance in relation to ABER and API for 2002 is as follows: Year ABER API 2002 8.93* 1.80* *Provisional
National TB Control Programme • Tenth Plan Outlay – Rs. 680 crore • Annual Plan (2004-05) Interim Outlay – Rs. 125 crore • Annual Plan (2004-05) Proposed Outlay – Rs. 140 crore. • Proposed additionality – Rs. 15 crore • Nearly 1/3rd of global TB burden is in India. • Phase-I of Revised National Tuberculosis Control Programme, which started in Sept. 1997 was successfully implemented with an outlay of Rs.749 crore with World Bank funding. • Under Phase-1 RNTCP, achievement of targets very high. 10 lakh patients have been started on treatment, more than 2 lakh lives saved and more than 20 lakh infections prevented.
(Contd.) • Against a targetted coverage of 271 million population coverage has already reached 870 million. • Aim is to bring the entire country under RNTCP by 2005 in order to meet the global targets of TB control
(Contd.) • Phase-II RNTCP consists of no cost extension of two years' (2003-2004) expanding coverage to 730 million population. • Under World Bank/DFID/DANIDA, total coverage by 2004 would be 830 million population • Global fund for AIDS, TB & malaria (GFATM) has accepted a proposal to extend RNTCP to 3 more newly constituted states to cover 56 million population.
National AIDS Control Programme • Tenth Plan Outlay – Rs. 1392.80 crore • Annual Plan(2004-05) Interim Outlay – Rs. 259 crore. • Annual Plan Proposed outlay – Rs. 476 crore. • Proposed Additionality – Rs. 217 crore. • AIDS is not only a serious public health problem but also a major development issue on account of its potential impact on productivity & economic growth.
(Contd.) • National AIDS Prevention and Control Policy as well as National Blood Policy approved. Action Plan developed for implementation. • The extended NACP Phase II (1999-2004) project at a cost of Rs. 1941.91 crore was approved in December 2003 • Funding for the extended Phase II project would also be available from CIDA, AUSAID, UNDP and Global Fund (Rs. 122.74 crore), in addition to that already available from World Bank, DFID and USAID
(Contd.) • Modalities adopted for service delivery includes: • Targetted interventions for high risk groups • Awareness generation and preventive interventions for the general population • Blood Screening and Safety • Treatment of Sexually Transmitted Infections • Prevention of Parent to Child Transmission • Voluntary Confidential Counselling & Testing Centres • Care and Support
May 2002 : International Policy Makers Conference to focus upon the search for an AIDS vaccine July 2003 : 1st National Convention of Elected Representatives organised by the Parliamentary Forum on AIDS April, 2004 :Introduced Antiretroviral treatment free of cost to one lakh patients in high prevalence States. Political Commitment
Services Package • PPTCT- 225 centers provide counseling testing & medicine • VCTC-709 (628 through SACS) • STD clinics -735 clinics • Condom Promotion – 171 million through free distribution and social marketing • Medicines for Opportunistic Infection • Community Care Centers -51 with NGOs • 17 State networks of PLHAs • ART- 8 centers (6 in high prevalence states + Delhi)
(Contd.) • Licensed Blood Banks-1938 (government, private and others) • 80 blood component separation units • 10 State of the Art Model Blood Banks • Substantial increase in Voluntary Blood donation • HIV incidence from blood transmission dropped from 9 % in 1999 to 2.99 % in 2003
Emphasis on Behaviour Change • Reaching High risk Groups through Targeted Interventions-(933 projects) through NGOs and CBOs • Awareness creation and demand generation for services – through synergized strategic response with mass media, advocacy, IPC, capacity building and partnership, networking • Emphasis on reduction of Stigma and Discrimination and creating an enabling environment • Addressing vulnerable segments - women and youth • School AIDS Education Programme (SAEP)-reaching 60,000 schools (coverage 55% of the total) • Family Health Awareness Campaigns (FHAC)
