National Health Programmes

1. National Health Programmes Nithyashree B V LECTURER YNC

2. INTRODUCTION: • According to democratic principles, it is the moral and constitutional responsibility of the government of India to provide health and social services to the citizens of country. • Medical care and education are the basic components of social services. • Several programs are put forth by the government for the welfare of the population but since the population of the weaker section is very large, the benefits of several government programs do not reach them adequately.

3. Government of India, is making efforts to provide health services to the grass root level right from the time of independence, yet due to population explosion, this objective is difficult to attain. • To attain “health for all” nation needs extensive health system or machinery, so that the services can be made available to each person.

4. NATIONAL HEALTH PROGRAMS: • Ever since India became free, government of India has been putting efforts earnestly to improve the health status of the people by • improvement of sanitation, • living condition, • nutritional status, • control / eradication of diseases both communicable and non communicable, • getting assistance from various international health organisations such as UNICEF, WHO, WORLD BANK and also from foreign agencies like DANIDA, DISA, NORAD and USAID in the form of various technical and material assistance.

5. As per the recommendations of Bhore committee, government of India formulated and launched specific programs called ‘national health programs’. • The national health programs are of 3 kinds: • 100% centrally sponsored but implemented by state governments • 50 : 50 centrally sponsored programs • Vertical programs

6. The national health programs are grouped into the following groups:

7. Related to communicable disease • National anti malaria program ( NAMP) 1999 • National filariasis control program • National kalaazar control program • National Japanese encephalitis control program • National dengue fever/haemorrhagic fever control program • National leprosy eradication program( NLEP) • National guinea worm eradication program • National polio eradication program • Universal immunisation program • Revised national tuberculosis control program • National acute respiratory infections control program • National diarrhoeal disease control program • National AIDS control program

8. Related to non communicable disease • National program for control of blindness • National cancer control program • National diabetes control program • National mental health program • National iodine deficiency disorder control program

9. Related to nutrition • National vitamin A prophylaxis program • National nutritional anaemia prophylaxis program • National special nutrition program • National balwadi nutrition program • Midday school meal program • Integrated child development service scheme

10. Other health programs • National family welfare program • Reproductive and child health program • All India hospital post partum program • National water supply and sanitation program • Minimum needs program • 20 point program • National rural health mission • Millennium development goals • National rural health mission • The millennium development goals

11. NATIONAL AIDS CONTROL PROGRAMME • Human Immunodeficiency Virus (HIV) is a virus that belongs to the retroviruses group may cause HIV infection/AIDS. Acquired Immunodeficiency Syndrome (AIDS) has emerged as one of the most serious public health problem in the country after reporting of the first case in 1986.

12. The initial cases of HIV/AIDS were reported among commercial sex workers in Mumbai and Chennai and injecting drug users in the north-eastern State of Manipur. • The disease spread rapidly in the areas adjoining these epicentres and by 1996 Maharashtra, Tamil Nadu and Manipur together accounted for 77 percent of the total AIDS cases. • Out of these, Tamil Nadu reporting almost half the number of cases in the country.

13. BURDEN OF DISEASE • World • According to UNAIDS/WHO estimates, 11 men, women and children were infected per minute during 1998. More than 95% of all HIV-infected people now live in developing world.

14. India • In the recent years it has spread from urban to rural areas and from individuals practicing risk behaviour to the general population. • More and more women attending antenatal clinics are being found testing HIV-positive thereby increasing the risk of perinatal transmission. One in every 4 cases of HIV positive reported is a woman • About 84% of the infections occur through the sexual route (both heterosexual and homosexual).

15. According to the HIV Estimations 2012,the estimated number of people living with HIV/AIDS in India was 20.89 lakh in 2011. • The adult (15-49 age-group)HIV prevalence at national level has continued its steady decline from estimated level of 0.41% in 2001 to 0.27% in 2011. But still, India is estimated to have the third highest number of estimated people living with HIV/AIDS, after South Africa and Nigeria (UNAIDS Report on the Global AIDS epidemic 2010).

16. ATTRIBUTABLE FACTORS OF THE HIV SPREAD ARE: • 1. Labour migration and mobility in search of employment from economically backward to more advanced regions; • 2. Low literacy levels leading to low awareness among the potential high risk groups; • 3. Gender disparity; • 4. High prevalence of Sexually Transmitted Infections and Reproductive Tract Infections both among men and women;

17. 5. The social stigma attached to sexually transmitted infections also hold good for HIV/AIDS, even in a much more serious manner. This coupled with lack of awareness results in reporting of full-blown AIDS cases in cities like Mumbai and Chennai; 6. There have been cases of refusal of AIDS patients in hospitals and nursing homes both in Government and private sectors. This has compounded the misery of the AIDS patients;

18. 7. Isolation of AIDS cases in the wards creates a scare among the general patients; 8. At some occasions, discrimination at workplace leads to loss of employment; 9. The treatment options are still in the trial stage and too expensive; 10. Still no effective vaccine is available;

19. Few facts on HIV-India • In 1986, Chennai became the first state to witness the first ever HIV positive case in India • Today, world’s third highest population of people with HIV live in India (2.27 million) 39% females and 3.5% children are infected Unprotected sex (87.1% heterosexual and 1.5% homosexual) is the major route of HIV Transmission • Transmission from Parent to Child is 5.4% • Use of infected blood and blood products accounts for 1.1% cases

20. Injecting Drug Use claims 1.7% infections and is the predominant route of transmission in north-eastern states • The new infections (yearly) among adult population reduced from 2,74,000 in 2000 to 1,16,000 in 2011 – 57% fall. • The HIV prevalence in adults has fallen from .41% (2.4 million) in 2001 to .27% (2 million) in 2011. • Total 400 ART centres in India support 4,86,173 people living with HIV out of which 4,57,948 are adults and 28,225 are children

21. Milestone 1986 : first case of HIV detected , AIDS task force set by ICMR. 1990 : medium term plan launched for 4 states & 4 metro

22. National AIDS Control Programme-IV

23. Milestones 1990, Medium Term Plan (1990-1992)was launched 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 developedfor the period 2012-2017.

24. On February 12, 2014 Government of India launched the fourth phase of its anti-AIDS/HIV strategy, the National AIDS Control Programme, NACP VI, under the banner of National AIDS Control Organisation (NACO) which falls directly under the Department of AIDS Control, Ministry of Health and Family Welfare.

25. The five year programme (2012-17) aims at sustaining and building up on the results of NACP III Phase, which lasted from Jul 2007 to mid 2012. The two years lag in the next phase has been attributed to shortage of funds due to unavailability of donors.

26. This brought the programme to a pause for nearly 18 months. Given the fact that 2.27 million people suffer from AIDS in our country, this break could seriously dampen the hopes of the People Living with HIV (PLHIV).

27. Objectives Objective 1:  Reduce new infections by 50% (2007 Baseline of NACP III)  Objective 2:  Comprehensive care, support and treatment to all persons living with HIV/AIDS

29. Strategies • Strategy 1:Intensifying and consolidating prevention services, with a focus on HRGs and vulnerable population. • Strategy 2:Increasing access and promoting comprehensive care, support and treatment • Strategy 3:Expanding IEC services for • (a) general population and • (b) high risk groups with a focus on behaviour change and demand generation. • Strategy 4:Building capacities at national, state, district and facility levels • Strategy 5:Strengthening Strategic Information Management Systems

30. Guiding principles for NACP- IV will continue to be: • 1. Continued emphasis on three ones - one Agreed Action Framework, one National HIV/AIDS Coordinating Authority and one Agreed National M&E System.(monitoring and evaluation) • 2. Equity • 3. Gender • 4. Respect for the rights of the PLHIV(people living with HIV) • 5. Civil society representation and participation • 6. Improved public private partnerships. • 7. Evidence based and result oriented programme implementation.

31. Cross-cutting Areas of Focus • 1. Quality • 2. Innovation • 3. Integration • 4. Leveraging Partnerships • 5. Stigma and Discrimination

32. Key priorities under NACP-IV Preventing new infections Prevention of Parent to child transmission Focusing on IEC strategies for behaviourchange in HRG, awareness among general population and demand generation for HIV services Providing comprehensive care, support and treatment to eligible PLHIV Integrating HIV services with health systems in a phased manner

33. New Initiatives under NACP-IV Scale up of programmes to target key vulnerabilities Establishment of Metro Blood Banks and Plasma Fractionation Centre Scale-up of Opioid Substitution Therapy for IDUs Scale-up and Strengthening of Migrant Interventions atSource, Transit & Destinations Female Condom Programme Scale up of Second Line ART

34. Package of services provided under NACP-IV Prevention Care, Support and Treatment High risk populations Low risk populations People living with HIV/AIDS • Targeted intervention • Needle-Syringe Exchange Programme and Opioid Substitution Therapy for IDUs • PreventionInterventions for Migrant population at source, transit and destination • Link Worker Scheme for HRGs in rural areas • Prevention & Control of STI/RTI • Blood Safety • HIV Counseling & Testing Services • Prevention of mother to child transmission • Condom promotion • Social Mobilization, Adolescent and Youth Interventions Programme • Laboratory services for CD4 Testing • Free First line & second line ART • Pediatric ART for children • Early Infant Diagnosis for HIV • Nutritional and Psycho-social support through Community Care Centres • Treatment of Opportunistic Infections

35. Targeted intervention • Key risk groups covered under Targeted Intervention programme - High risk group - Bridge population • To provide services, such as behaviourchange communication, condom promotion, clean needle and syringe for people who inject drugs, STI care, referrals for HIV and Syphilis testing and linkages with Anti-Retroviral Treatment

36. Link Workers Scheme Community-based intervention Provide services to high risk groups, vulnerable population, bridge population and PLHIV in rural areas IEC under Link Worker Scheme: Mid-media programmes include wall writings, wall paintings, folk performances and hoardings. Rural interventions continue to be challenge owing to inadequate infrastructures, poor outreach initiatives and stigma associated with HIV

37. Prevention & treatment of RTI/STI Counselors are provided at designated STI/RTI Clinics Colour-coded STI/RTI kits provided for free supply at all government STI/RTI clinics, CHC/ PHC and NGOs All HRG population receives packages of - Free consultation and treatment for their symptomatic STI complaints - Quarterly medical check-up - Bi-annual syphilis and HIV screening

38. Blood safety Increase regular voluntary blood donation Promote component preparation Enhance blood access through well coordinated blood transfusion services Establish Quality Management Systems to ensure Safe and quality Blood

39. Condom promotion Condom Social Marketing Programme(CSMP) was launched by NACO Establishment of rural outlets, non-traditional outlets and outlets in TI project areas and truckers’ halt-points Consistent condom use promoted through Folk Media Campaign, Red Ribbon Express Campaign, Migrant Campaigns and Health Camps across various programmeStates. NACO completed implementation of scaled-up FC Programme

40. Secondary Health Care Primary Health Care District Hospitals HIV Clinics Integrated Counselling Testing Specialised Care facilities ART Centres PLHA Community Care Centres The entry point Home care Link ART CENTRES Tertiary Health Care LINKAGE FOR CARE SUPPORT & TREATMENT NGO & Peer Groups

41. IEC & Mainstreaming • Mass media campaign • Long formal radio or TV program • Red ribbon express project • Advertisement through newspaper • Hoarding • Folk media • Mainstreaming activities • Inter Ministerial conference • Training of frontline worker • Greater involvement of PLHIV • Social protection

42. CAPACITY BUILDING • In order to provide uniform, quality training to different categories of staff working with NGOs/CBOs, like program managers, counsellors, finance accountants, outreach workers, peer educators and link workers, NACO has institutionalized the training and capacity building process with the establishment of the State Training and Resource Centres (STRC).

43. STRCs function with the objectives of - • 1) ensuring need based training of TIs as per NACP III’s technical and operational guidelines; • 2) enhancing the capacity of NGOs and civil society organizations in proposal development for NACP funded targeted intervention projects; • 3) undertaking operational research and evaluation of TIs. • STRCs have been established in 14 states and 6 more are being established. Training modules for programme managers have been developed and modules for rest of project staff are in process

44. Monitoring & evaluation • HIV sentinel surveillance system: Information gathered through HIV sentinel surveillance, AIDS case surveillance and STD surveillance helps in tracking the epidemic and provides the direction to the programme. • A nationwide computerised management information system (CMIS) provides programme monitoring and evaluation.

45. StrategicInformation Management Unit (SIMU) • To maximize effective use of all available information and implement evidence based planning, to address strategic planning, monitoring and evaluation, surveillance and research. • SIMU assists NACP in tracking the epidemic and the effectiveness of the response and help assess how well NACO, SACS and all partner organizations are fulfilling their commitment to meet agreed objectives. • NACP envisages a robust Strategic Information Management System (SIMS) which focuses on programme monitoring, evaluation and surveillance, and knowledge gathering.

46. Thank you

47. REPRODUCTIVE AND CHILD HEALTH PROGRAMME

48. Definition of RCH RCH approach is defined as “people have the ability to reproduce and regulate their fertility, women are able to go through pregnancy and child birth safely, th 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 of pregnancy and contracting diseases”

49. Historical Background • 1952- National Family Planning Programme • 1977- National Family Welfare Programme • 1985- Universal Immunization Programme • 1992- Child Survival And Safe Motherhood Programme • 1997- RCH (Phase-1) • 2005- RCH (Phase-11)

50. Aim of this concept • Improving the health status of young women and young children