Progress and Achievements

of

Public Health Programs in

India.

CHAITANYA.P

III MDS

Dept of Public Health Dentistry1

CONTENTS:-• Focus on Public health.

Achievement of programs related to:-

• Vector borne diseases.

• Programs on TB Control

• AIDS control programs.

• Iodine deficiency disorder control programs

• Leprosy eradication programs

• New Born action plan.

• Reproduction and child health.

2

• Progress in control of Non-communicable diseases.

• Blindness control programs.

• Rural sanitation programs.

• Conclusion

• References.

3

What are the Health Problems in India?

1. Communicable disease

2. Non-Communicable disease

3. Nutritional problems

4. Medical care problems

5. Environmental Sanitation

6. Population Problem

4

The focus of public health intervention is to improve health and quality of life through

prevention and treatment of disease.

5

National vector borne disease control programme

6

• 1953- NMCP (National Malaria Control Programme)

• 1958-NMEP (National Malaria Eradication Programme)

• 1997- EMCP (Enhanced Malaria Control Project )

• 1999-NAMP (National Anti Malaria Program )

• 2002-NVBDCP (National Vector Borne Disease Control Programme)

• 2008-NMCP (World Bank)

• 2010-New drug policy 2010

• 2012- Introduction of rapid diagnostic tests.

• 2013- New drug policy

World Malaria Day-25TH April

Intensified Malaria Control Project (IMCP) is implemented

since October 2010 for a period of five years in 7 NE States.

The project area covers a population of 46 million in 89

districts.

7

Intensified Malaria Control Project (IMCP)

• Human resource such as Consultants and support staff for

project monitoring units at state and district level and

malaria technical supervisor, (MTS) and laboratory

technicians (Lts.) at sub-district level.

• Capacity building of District VBD consultant, MTS Medical

Officer/Lab. Technicians/ Health/Volunteers as ASHA, CHV

etc.

8

• Commodities such as Long-Lasting Insecticidal Nets

(LLINs), Rapid Diagnostic tests for quick diagnosis of

Malaria, drugs Artemesinin based Combination ACT- AC

Pv total of Pf malaria Therapy (ACT) and Inj. Artesunate

for treating severe malaria cases.

• Planning & administration including mobility support,

monitoring, evaluation and operational research (studies

on drug resistance and entomological aspects)

9

10

11

12

13

Ref:-GOVERNMENT OF INDIA NATIONAL VECTOR BORNE DISEASE CONTROLPROGRAMME DIRECTORATE GENERAL OF HEALTH SERVICES last accessed on 26/2/2017

Lymphatic Filariasis

The disease is reported to be endemic in255 districts in 21 states and UTs. The population of about 650 million inthese districts is at risk of lymphaticfilariasis.

14

15

Annual Mass Drug Administration (MDA) of single dose ofDEC(DIETHYL CARBAMAZINE CITRATE) + Albendazole for a minimumfive rounds or more to the eligible population (except pregnantwomen, children below 2 years of age and seriously ill persons) tointerrupt transmission of the disease.

Home based management of lymphoedemacases and up-scaling of hydroceleoperations in identified CHCs/ Districthospitals /medical colleges.

16

Mass Drug Administration

REF:- ANNUAL REPORT- 2014-15.GOI -NATIONAL VECTOR BORNE DISEASECONTROL PROGRAMME DIRECTORATEMINISTRY OF HEALTH & FAMILYWELFARE last accessed on 26/2/2017

17

DENGUE FEVER/DENGUE HAEMORRHAGIC FEVER:-

•Dengue Fever is an outbreak prone viral disease, transmitted by Aedes mosquitoes

•The risk of dengue has increased in recent years due to rapid urbanization, and deficient water management including improper water storage practices in urban, peri-urban and rural areas, leading to proliferation of mosquito breeding sites.

The cases peak after monsoon and it is not uniformly distributed throughout the year 18

19

The Government of India in consultation with States has identified 439 sentinel surveillance hospitals with laboratory support for augmentation of diagnostic facilities in the endemic states. 15 Apex Referral Laboratories have been identified and linked with sentinel surveillance hospitals.

For early diagnosis ELISA based NS1 kits have been introduced under the programmewhich can detect the cases from 1st day of infection.IgM capture ELISA tests can detect the cases after 5th day of infection

20

21

The National Iodine Deficiency Disorders Control Programme (NIDDCP) started in our country since Dec'1989. It is a 100% Central Plan Scheme.

22

OBJECTIVES OF IDD CONTROL PROGRAMME

• Surveys to assess the magnitude of the Iodine DeficiencyDisorders.

• Supply of iodated salt in place of common salt.

• Resurvey after every 5 years to assess the extent of IodineDeficiency Disorders and the impact of iodated salt.

• Laboratory monitoring of iodated salt and urinary iodineexcretion.

• Health education & Publicity.

23

Achievements:-

• Out of 532 units of production of salt , there is an annual productionof 120lakh metric tonnes of iodised salt.

• Production & supply of iodised salt in 2013 - 58.4 Lakhs.

In 2014 – 55.08lakhs.

• Notification banning the sale of non-iodised salt for humanconsumption is issued under FSSA act 2006, FSSA regulations 2011.

• For effective implementation of national iodine deficiency disorder

Control programme 33 states have established iodine deficiencydisorder cells in state health directorate.

24

25

26

Revised National TB Control Programme (RNTCP)

• National Tuberculosis programme(NTP) 1962.

DOTS Strategy

Revised national tuberculosis control programme(RNTCP) - 1993.

• DOTS is most systematic & effective approach to revitalize TB Control programme.

27

World TB Day-24TH March

The RNTCP is being implemented following the WHO-recommended Directly Observed Treatment Short Course (DOTS) strategy that provides a sure cure for tuberculosis with 6-8 months course and is available free of cost to the patient in the entire country.

India’s DOTS programme is the largest in the world in terms of patients initiated on treatment, placing on an average of more than 1, 25,000 patients on treatment every month.Since its inception, the RNTCP has initiated over 12.8 million TB patients on treatment, thus saving more than 2.3 million lives. The programme has started responding to new challenges like TB-HIV and MDR-TB. TB-HIV collaborative services were initiated in the year 2000; currently, the entire country is implementing TB-HIV collaborative services. The program has initiated treatment of MDR-TB since 2007 and is currently being implemented in 12 states. RNTCP has prioritised MDR-TB treatment services and these will be available in the entire country by end-2011. 28

Achievements of RNTCP:-

• In 1999, the Indian expansion of RNTCP accounted for 1/3 and in 2000 and 2001 for over 1/2 of the global increase in DOTS coverage.

• In 2005 , 1.29 million TB patients - initiated on treatment.

• In 2006, 1.39 million.

• In 2007, 1.48 million - enrolled for treatment.

• In 2008 over 1.51 million patients have been initiated on treatment.

29

• India has contributed to approximately 24% of the total global new cases detection during the year 2007 as per the WHO Global Report 2009.

25% 86%Success rate

tripled

Deathratecut 7 fold

29%

4%

30

Treatment Success

rate

>85%.

NSP (new sputum

positive)case detection

rate close to the global target of

70%.

All states are currently implementing the ‘Supervision and Monitoring strategy’

Quality assured diagnostic facilities are available through more than 12,500 laboratories across the country

To improve access to tribal and other marginalized groups the programme has developed a Tribal action plan implemented with the provision of additional TB Units

31

Repeat population surveys indicate an annual decline in prevalence of disease by 12%.

Over 2500 NGOs, 19500 private practitioners, and 150 corporate in the provision of RNTCP services.

Presently, 267 medical colleges (including private colleges) have been involved in RNTCP

To supplement and support the IRL(Intermediate Reference Laboratories )network the programme is also involving Mycobacteriology laboratories of Government Medical Colleges as well laboratories in the NGO and Private Sector.

Till date, two NGO labs (CMC-vellore and BPRC-Hyderabad) have been accredited and about 12 such labs have applied for accreditation. 32

33

34

On the eve of World Tuberculosis Day, Health Minister Shri. J.P. Nadda launched Bedaquiline— new drug for Drug Resistant TB — as part of the national programme. The drug will be introduced in 104 districts across five States.Speaking at a press briefing, Mr. Nadda said the “process of fighting TB is continuous. Hence there can be no dilution and no diversion. Our attention needs to be steadfast and aggressive.” The programme would not suffer on account of budgetary allocation.The new class of drug is a diarylquinoline that specifically targets Mycobacterial ATP synthase, an enzyme essential for the supply of energy to Mycobacterium tuberculosis and most other mycobacteria.Bedaquiline is being introduced at six tertiary care centres across India. These sites have advanced facilities for laboratory testing and intensive care for patients. Bedaquiline will be given to multi-drug resistant TB patients with resistance to either all fluoroquinolone and/or all second line injectables and extensive drug resistant TB.

35

National leprosy eradication Programme

• National leprosy control programme – 1955.

• Aim is to reduce case load to 1 or <1/10,000 population.

NLCP(national leprosy control

programme)

NLEP(national leprosy eradication

programme)

1955

1983

36

World Leprosy Day-30TH January

• More emphasis is given on disability prevention & medical rehabilitation services(DPMR) services to affected persons.

• Incentive to each leprosy affected person from BPL undergoing reconstructive surgery

Rs.5,000/-

• Provided to PMR centresfor each reconstructive surgery conducted.Rs.5,000/-

37

• 41 NGO’s and 42 Government medical colleges have been strengthened for providing reconstructive surgery to leprosy affected persons for correction of disability.

• Free medical facilities like ulcers, selfcare training,counselling are provided to leprosy affected people.

• Intensive IEC campaign with a theme of ``Towards leprosy free India.’’ has been carried out in community.

• Micro cellular rubber foot ware

38

• Confirmed diagnosis of case brought by ASHA workers given an incentive of:-

• Rs-100/- - rural areas.

• Rs.250/- - urban areas.

• 33 states/UT achieved the status of leprosy elimination.

Yet to achieve elimination of leprosy.

39

40

41

World AIDS Day-1ST December

NACP YEAR

I- PHASE 1992-99

II-PHASE 1999-06

III- PHASE 2007-12

IV-PHASE 2012-17

42

PHASES OF NACP:-

• Phase-I (1992 - 1999) was implemented across the country with objective to slow the spread of HIV to reduce future morbidity, mortality, and the impact of AIDS by initiating a major effort in the prevention of HIV transmission.

• Phase-II (1999 - 2006) was aimed at reducing spread of HIV infection in India and strengthen India's capacity to respond to HIV epidemic on long term basis.

43

44

45

46

Sl. No DeliverablesTargets

(2007-12)

Achievements

up to March, 2012

1 Setting up Targeted Interventions 2,100 1,821

2

Number of adults with sexually

Transmitted Infections (STI)

symptoms accessing syndromicmanagement

150 lakh per year

(NACO and NRHM)

98.83 lakh

(during 2011-12)

3Set up blood component separation units

162 (82 existing + 80 new proposed)

159

4 Set up district level Blood Banks 39 25

5No. of ART centres established (cumulative)

250 355

6Treat persons living with HIV/AIDS

with ARV drugs3,00,000 5,16,412

7 Community Care Centres 350 253

8Integrated Counseling& Testing Centres (cumulative)

4,955 10,515

9Mothers Counseled& Tested at ICTC

75 lakh per year85.6 lakh

(during 2011-12)

10Persons Counseled& Tested at ICTC

145 lakh per year109.12 lakh

(during 2011-12)

TARGETS AND ACHIEVEMENTS UNDER NACP-III (2007-12)

47

Antiretroviral Therapy (ART) – Management of HIV/AIDS -

REF:-http://www.erewise.com/current-affairs/national-aids-control-programme-4th-phase-launched-by-naco_art5347dac085774.html#.VvehfOJ97IU

India’s position:Launched on 1st April 2004 in eight government hospitals in six high prevalence states

Currently we have 400 ART centers

Around 16,00,000 patients are registered in HIV care

6,00,000 patients are currently on ART

First line treatment is free

Alternate First line and Second line antiretroviral drugs to adults and children are given as per their eligibility.

48

NACO Annual Report 2014-15

49

50

51

The biggest achievement of the immunization program is the

eradication of small pox.

One more significant milestone is that India is free of

Poliomyelitis caused by Wild Polio Virus (WPV) for more than 33

months.

Besides, vaccination has contributed significantly to the

decline in the cases and deaths due to the Vaccine Preventable

Diseases (VPDs).

Achievements:

52

53

54

A vision and a plan for India to end preventable newborn deaths, accelerate progress, and scale up high-impact yet cost effective interventions.

June 2014 at the 67th World Health Assembly, to advance the Global Strategy for Women s and Children’s Health

55

As per the reports, the new vaccines, inactivated polio vaccine, adult JapaneseEncephalitis vaccine, Rotavirus vaccine and Measles Rubella vaccine, have been madepart of the 'India newborn' action plan.

Mission Indradhanush was launched by the Union Government of India on December25, 2014. Over the period, the Centre has reportedly covered 40 lakh children of the 90lakh it had mapped for this year.

56

57

58

Press Information BureauGovernment of IndiaMinistry of Health and Family Welfare11-August-2015 13:18 ISTAchievements under Immunization ProgrammeThe Universal Immunization Programme (UIP) has been operational in India since 1985. However, the coverage has increased by only 4% in the last 4 years i.e. at the rate of 1% per year. The Government of India launched “Mission Indradhanush” on 25 December 2014 as a special drive to expand full immunization coverage in India from 65% in 2014 to at least 90% children in the next five years.

Under “Mission Indradhanush”, 75.5 lakh children were vaccinated and a total of 19.7lakh children were fully vaccinated. In addition, a total of 20.8 lakh pregnant women were vaccinated for tetanus toxoid.

Since the launch of UIP in 1985, infant mortality rate and under-five mortality rate due to vaccine preventable diseases has decreased considerably. India’s infant mortality rate has declined from 80 per 1,000 live births in 1990 to 40 per 1,000 live births in 2013 and under-five mortality rate from 126 per 1,000 live births in 1990 to 49 per 1,000 live births in 2013. This has been possible due to child health interventions including immunization.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabhahere today. 59

India was the first country to launch the National Programme for Control of Blindness (NPCB) in 1976, as a 100% Centrally sponsored Programme

60

World Blind Day-13TH October

In 1983, national health policy in India, reiterated that blindness as public health problem.

The Programme was launched with the goal to reduce the prevalence of blindness from 1.4 to 0.3%.

India has received technical impetus and financial assistance from World Bank, WHO, DANIDA and other International NGOs for amelioration of blindness programme in the country.

Currently , the programme is not dependent on any external funding.

61

↑ SUCCESS RATE with cataract surgery with intraocular lens implantation compared to conventional surgery.

9%-1994

93%-2014

Cataract surgeries

Increased supply of ophthalmic equipment for diagnosis and treatment of common eye disorders.

62

Around 307 eye operation theatres and eye wards built in district hospitals.

Major achievements during 11th Five Year Plan (2007-12):-

· 294.07 lakh cataract surgeries were done.· 27.19 lakh free spectacles were provided to school children suffering from refractive errors.· 2.21 lakh donated eyes were collected for corneal transplantation.· 1850 Eye surgeons were trained in various fields of ophthalmology to provide better quality eye care services.

63

Major achievements during 12th Five Year Plan (2012-17):(Upto November, 2015)

· 214.98 lakh cataract surgeries· 23.06 lakh free spectacles distributed to school children suffering from refractive errors.· 1.93 lakh donated eyes collected for corneal transplantation.· 1225 Eye surgeons trained to provide better quality eye care services in various fields of ophthalmology.

64

VISION 2020 is a global initiative that aims to eliminate avoidable blindness by theyear 2020.It was launched on 18 February 1999 by the World Health Organization togetherwith the more than 20 international non-governmental organisations.

PROPOSED STRUCTURE PLAN OF VISION 2020

65

66

67

World Diabetes Day-14TH November

It was implemented in 100 backward and inaccessible districts across 21 States during 2010-12

The Programme was initiated in thesecond half of 2010.

Focus on strengthening ofinfrastructure, human resourcedevelopment, health promotion,early diagnosis, treatment andreferral.

68

Opportunistic screening of persons above the age of 30 years fordiabetes and hypertension, at the point of primary contact withany health care facility, be it the village, sub-centre, CHC andDistrict hospital.

800 doctors were trained for health promotion, prevention, earlydetection and management of diabetes, hypertension,cardiovascular diseases and stroke

69

1.41 Crore target population have been screened including 9.85 lakh population of urban slums

As on 21st January 2013,

• Health promotion activities were undertaken to generate awareness regarding lifestyle diseases.

70

• Facilities for Cardiac Care were established/strengthened in 30 district hospitals by providingfinancial assistance for establishing/strengtheningthe cardiac care unit.

• To provide early diagnosis andmanagement, NCD clinics were started in41 district hospitals and 16 CHCs.

71

Rural sanitation programmes in India:-

72

Construction of individual household tiolets for household extended to all Below PovertyLine (BPL) Households and Above Poverty Line Households (APL) ,physically handicappedand women headed households.

Assistance to Production Centres of sanitary materials and Rural Sanitary Marts, Provision ofconstruction of Community Sanitary Complexes.

Solid and Liquid Waste management (SLWM) to be taken up in project mode for each GramPanchayat (GP) with financial assistance capped for a GP on the basis of number ofhousehold to enable all Panchayats to implement sustainable SLWM projects.

Provision of extensive capacity building of the stake holders like Panchayati Raj Institutions(PRIs), Village Water and Sanitation Committees (VWSCs) and field functionaries forsustainable sanitation.

Major activities covered under Nirmal Bharat Abhiyan:-

73

A total of 31.83 lakh toilets were built between April 2014and January 2015 under this campaign, which is 25.4% ofthe target for 2014-15.Over the next 5 years, the government plans to investnearly Rs 2 lakh crore to construct 12 crore toilets acrossIndia.

74

Between April 2014 and January 2015, 31.83 lakh toilets were built. As of August2015, 80 lakh toilets have been constructed under the program.

Karnataka led all States in construction of toilets under the programme,while Punjab built the least

As of 18 March 2016, 10 districts in India were ODF.(open defecation free India).

75

The city of Mysuru in Karnataka was named the cleanest city in India after the launch of Modi’s Swachh Bharat Abhiyan.

76

77

• Health system strengthening, human resourcedevelopment and capacity building and regulation inpublic health are important areas within the healthsector.

• Making public health a shared value across the varioussectors is a politically challenging strategy, but suchcollective action is crucial.

• “The health of people is the foundation upon which alltheir happiness and all their powers as a state depend”.

CONCLUSION

78

REFERENCES:-

• National vector borne disease control programme annual report 2014-15 government

of india national vector borne disease control programme. last accessed on

25/02/2017.

• Government Of India National Vector Borne Disease Control Programme Directorate

General Of Health Services . last accessed on 25/02/2017.

• Dayaraj Cecilia Current status of dengue and chikungunya in India WHO South-East

Asia Journal of Public Health.2014;3 (1).

• National AIDS Control Programme Phase-IV | 2012-2017 strategy document –

government of India. last accessed on 25/02/2017.

• Ramesh Verma, Pardeep Khanna, Shankar Prinja, Meena Rajput, Varun Arora The

National Programme for Control of Blindness in India Australasian Medical Journal

AMJ 2011; 4(1);1-3.

79

• Govt. of India NRHM (2014-2015) Mission Document, MInistry of Health

& Family Welfare, New Delhi. last accessed on 25/02/2017.

• Govt. of India (2014), Annual Report 2014-15 MoHFW, New Delhi. last

accessed on 26/02/2017.

• Govt. of India (2008), Eleventh Five year plan (2007-2012), Social Sector,

vol II, Planning commission, Govt. of India. last accessed on 26/02/2017.

• Govt. of India (2012), Twelfth Five year plan (2012-2017), Social Sector,

vol III, Planning commission, Govt. of India. last accessed on 26/02/2017.

80

• Govt. of India (2012), National AIDS Control Programme Phase IV (2012-

2017) NACO, MoHFW, New Delhi.last accessed on 26/02/2017.

• Govt. of India (2004), National Programme for Control of Blindness in India,

MoHFW, New Delhi. last accessed on 26/02/2017.

• New medicine for drug –resistant TB launched. THE HINDU,March-22,2016.

last accessed on 27/02/2017.

• http://www.erewise.com/current-affairs/national-aids-control-programme-4th-

phase-launched-by-naco_art5347dac085774.html#.VvehfOJ97IU last accessed

on 27/02/2017.

81

82