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HEALTH

National Health Policy

The National Health Policy 2002 aims at achieving an acceptable standard of health for the general
population of the country.

Keeping in line with this broad objective, the Eleventh Five Year Plan had set upon itself the goal of
achieving good health for the people, especially the poor and the underprivileged. To achieve the objective,
a comprehensive approach was advocated, which included improvements in individual health care, public
health, sanitation, clean drinking water, access to food and knowledge of hygiene and feeding practices.

Importance was accorded to reducing disparities in health across regions and communities by ensuring
access to affordable health. Special attention was given to the health and marginal groups like adolescent
girls, women, children, the older persons, disabled and tribal groups, with due recognition to gender issues,
as the cross-cutting theme across all schemes.

The country has a well-structured 3-tier public health infrastructure, comprising Community Health Centres,
Primary Health Centres and Sub-Centres spread across rural and semi-urban areas and tertiary medical care
providing multi-specialty hospitals and medical colleges located almost exclusively in the urban areas.

However, the progress has been quite uneven across the regions (large scale interstate variations), gender
(male-female differences) as well as across space to be made during the then year to step-up funding of
the health in the public domain reach 3 per cent of the GDP by 2012.

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1.

2.

3.

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Draft National Health Policy 2015

Intro
a.

On Dec 31, 2014, Govt. placed draft National Health Policy, 2015 in public domain.

b.

Feedback on the draft was to be submitted until February 28, 2015.

List of proposals
a.

Health as a fundamental right (national health right act)

b.

Health budget target to 2.5% of GDP

c.

Explore creation of health cess on the lines of education Cess.

d.

Ensure universal access to free drugs, diagnostics in Govt. hospitals.

Proposals
Health as a fundamental right
i.

The Centre shall enact a National Health Rights Act, which will make ensuring health as a
fundamental right (like education), whose denial will be an offence.

ii.

The States would voluntarily opt to adopt this by a resolution of their Legislative Assembly.

Notes

a.

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iii. The States which have achieved a per capita public health expenditure rate of over Rs. 3,800
per capita (at current prices) should be in a position to deliver on this (and though many States
are some distance away, there are States which are approaching or have even reached this
target).

v.

1.

Not only developed, but many of the developing nations have laws that do so. Nations like
brazil and Thailand have made significant progress towards universal health coverage, and
such a law is a major contributory factor.

2.

A number of international covenants to which we are joint signatories give us such a

mandate; Courts rulings also see health care as a fundamental right; and a constitutional
obligation flowing out of the right to life

But the draft also questions whether India has reached the level of development in economic
and health systems to make this a justiciable right

Health budget target to 2.5% of GDP

i.

On the issue of increasing health spending, the draft says it accepts that for achieving MDGs
we need to increase in public health expenditure from 4 to 5 per cent of the GDP.

ii.

However as we saw that even the NHP 2002 target of 2 per cent was not met, and taking into
account the financial capacity of the country to provide this amount and the institutional
capacity to utilize the increased funding in an effective manner, it is proposed to raising public
health expenditure to 2.5 per cent of the GDP.

SC

b.

Why

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iv.

iii. Even for reaching this level will take a longer time frame
iv.

40% of this would need to come from Central expenditures.

Explore creation of health cess on the lines of education Cess.

d.

Ensure universal access to free drugs, diagnostics in Govt. hospitals.

GS

c.

Communicable Diseases
Revised National Tuberculosis Control Programme
The Government of India is implementing the Revised National Tuberculosis Control Programme in the
country. Under this programme, diagnosis and treatment facilities including anti-TB drugs are provided free
of cost to all TB patients. Designated microscopy centres have been established for quality diagnosis for
every one lakh population in the general areas and for every 50,000 population in the tribal, hilly and
difficult areas. More than 13000 microscopy centres have been established in the country. Treatment
centres (DOT Centres) have been established near to residence of patients to the extent possible, both,
in Urban and Rural areas.

All Government Hospitals, Community Health Centres (CHC), Primary Health Centres (PHC), Sub
Centres are DOT centres. In addition NGOs, Private Practitioners (PPs) involved under the RNTCP,
community volunteers, Anganwadi workers, women self-help groups etc. also function as DOT providers/
DOT Centres. Drugs are provided under direct observation and the patients are monitored so that they
complete their treatment. Programmatic Management of Drug Resistant TB (PMDT) services, for the
management of multidrug resistant tuberculosis (MDRTB) and TBHIV collaborative activities for TBHIV
co-infection are being implemented throughout the country.

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Integrated Disease Surveillance Programme (IDSP)

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
i.e. from April 2010 to March 2012, World Bank funds were available for Central Surveillance Unit (CSU) at
NCDC & 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 NHM with outlay of Rs. 640 Crore from domestic
budget only.
Surveillance units have been established in all states/districts (SSU/DSU). Central Surveillance Unit
(CSU) established and integrated in the National Centre for Disease Control, Delhi.

Training of State/District Surveillance Teams and Rapid Response Teams (RRT) has been completed for
all 35 States/UTs.

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 Research Organization (ISRO) for data
entry, training, video conferencing and outbreak discussion.

Under the project weekly disease surveillance data on epidemic prone disease are being collected from
reporting units such as sub centres, 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 (www.idsp.nic.in). The weekly data are analyzed 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, 3040 outbreaks are reported every week by the States. 553 outbreaks were reported and responded to by
states in 2008, 799 outbreaks in 2009, 990 in 2010, 1675 outbreaks in 2011, 1584 outbreaks in 2012, 1964
outbreaks in 2013, 1562 outbreaks in 2014 and 311 outbreaks have been reported till 15th March 2015.

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 total of 3063 media alerts were
reported from July 2008 to November 2014 and 122 till 31st March 2015. Majority of alerts were related
to diarrhoeal diseases, food poisoning and vector borne diseases.

A 24X7 call center 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. 2,77,395 lakhs calls have been received from beginning till 30th
June, 2012, out of which 35,866 calls were related to Influenza A H1N1. From November 2012, a total
of 50,811 calls received till November 2013 out of which 1499 calls were related to H1N1.

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 and an annual grant of Rs 2 lakh per
annum per lab for reagents and consumables. Till date 29 States (65 labs) have completed the procurement.
In addition, a network of 12 laboratories has been developed for Influenza surveillance in the country.

In 9 States, a referral lab network has been established by utilizing the existing 65 functional labs in the
medical colleges and various other major centers in the States and linking them with adjoining districts
for providing diagnostic services for epidemic prone diseases during outbreaks. Based on the experience

Notes

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gained, the plan will be implemented in the remaining 26 States/UTs. A total of 23 identified medical
college labs in Bihar, Assam, Odisha, Tripura, Kerala, Haryana, Jammu & Kashmir and Manipur has been
added to the network during 2012-13 to provide support in adjoining districts.

Considering the non-availability of health professionals in the field of Epidemiology, microbiology and
Entomology at district and state levels, MOHFW approved the recruitment of trained professionals under
NHM in order to strengthen the disease surveillance and response system by placing one Epidemiologist
each at state/district head quarters, one Microbiologist and Entomologist each at the state head quarters.
The post of a Veterinary Consultant at State Surveillance Unit has been approved by the MOHFW
recognizing the Mission Statement of One Health Initiative. 408 Epidemiologists, 181 Microbiologists, 25
Entomologists and 3 Veterinary Consultants are in position as on 31st March 201

National Vector Borne Diseases Control Programme (NVBDCP)

The National Vector Borne Disease Control Programme is a comprehensive programme for prevention and
control of vector borne diseases namely Malaria, Filaria, Kala-azar, Japanese Encephalitis (JE), Dengue and
Chikungunya which is covered under the overall umbrella of NRHM.

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Malaria

The areas vulnerable to malaria are largely tribal, difficult, and remote, forested and forest fringe inaccessible
areas with operational difficulties. The high transmission areas are the North Eastern States and largely
tribal areas of Andhra Pradesh, Chhattisgarh, Gujarat, Jharkhand, Madhya Pradesh, Maharashtra, Odisha
and Rajasthan.

Government of India launched the National Malaria Control Programme (NMCP) in 1953.

The State governments are responsible for the planning, implementation, supervision and monitoring of
the programme.

North Eastern states are being provided 100 per cent support by Government for implementation of the
programme including operational cost.

"Malaria Control and Kala-Azar Elimination" has been approved by World Bank for a period of 5 years
starting from 2008-09.

Filariasis

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Filariasis is transmitted by mosquito species culex quinquefasciatus and mansonia annulifera/ M. uniformis.
The vector mosquitoes breed in polluted water in drains, cross-pits etc. in areas with inadequate drainage
and sanitation.

The disease is endemic in 250 districts in 20 states and UTs.

The target year for global elimination of this disease is by the year 2020.

Government of India is signatory to the World Health Assembly Resolution in 1997 for Global Elimination
of Lymphatic Filariasis.

The National Health Policy (2002) has however, envisaged elimination of Lymphatic Filariasis in India
by 2015.

Dengue Haemorrhagic Fever Control Programme

Dengue fever is an outbreak-prone viral disease, transmitted by aedes aegypti mosquitoes.

West Bengal, Delhi, Kerala, Tamil Nadu, Gujarat, Karnataka, Maharashtra,Rajasthan, Punjab and Haryana
are the worst affected states.

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The Directorate of National Vector Disease Control has provided detailed guidelines for the prevention and
control of dengue to the affected states. Intensive health education activities through print, electronic and
inter-personal media, outdoor publicity as well as an inter-sectoral collaboration with civil society organizations
(NGOs, CBOs, SHGs), PRIs, Municipal bodies have been emphasized. Regular supervision and monitoring
is conducted by the programme.

The government of India in consultation with the states has identified 137 sentinel surveillance hospitals
with laboratory support for augmentation of diagnostic facilities in the dynamic states.

To make these functional, test kits are provided through National Institute of Virology, Pune and cost is
borne by GOI. Contingency grant is also provided to meet the operational costs.

Since there is no specific treatment for Dengue, the stress is on methods and ways of prevention of disease
with measures like control and prevention of mosquito breeding conditions in residential/ workplace areas
and minimizing the man-

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mosquito contact. In this stance, community awareness and participation are conducive for effective
control of Dengue.
In addition, enactment and enforcement of appropriate Civic bye-laws and Building bye-laws should also
be stressed upon in all urban areas to prevent mosquito breeding conditions in line with the Delhi,
Mumbai, Goa, Chandigarh health administrations.

Japanese Encephalitis Control Programme

Govt. of India in collaboration with state initiated various public health measures to contain JE of which
introduction of JE Vaccination Programme is most pertinent.

JE vaccination Programme was launched during 2006 for children between 1 and 15 years of age in 11
districts of the 5 states of Uttar Pradesh, Bihar, Assam, Karnataka and West Bengal with using single dose
live attenuated SA-14-14-2 vaccine.

SC

GS

Kala -Azar Control Programme

Kala-azar is caused by protozoan parasite leishmania donovani and spread by sand fly, which breeds in
shady, damp and warm places in cracks and crevices in the soft soil, in masonry, and rubble heaps, etc.
Proper sanitation and hygiene are therefore critical to sand fly breeding.

The National Health Policy (2002) of Govt. of India had set the goal of elimination of Kala-Azar from
the country by 2010. In pursuance to achieve the elimination goal, case detection and treatment compliance
has been strengthened and Rapid Diagnostic Test in 39 and oral drug miltefosine have been introduced.

The Kala-Azar Control programme was launched in 1990-91.

Chikungunya
Chikungunya is a debilitating non-fatal viral illness caused by Chikungunya virus which has re-emerged in
the country after a gap of three decades. In India a major epidemic of Chikungunya fever was reported
during the last millennium viz. 1963 (Kolkata), 1965 (Puducherry and Chennai in Tamil Nadu, Rajahmundry,
Vishakhapatnam and Kakinada in Andhra Pradesh, Sagar in Madhya Pradesh and Nagpur in Maharashtra)
and 1973 (Barsi in Maharashtra).

This disease is also transmitted by Aedes mosquito.

During 2006, total 1.39 million clinically suspected Chikungunya cases werereported in the country. Out
of 35 states/ union territories 16 were affected: Andhra Pradesh,Karnataka, Maharashtra, Tamil Nadu,

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Madhya Pradesh, Gujarat, Kerala, Andaman and Nicobar Islands, Delhi, Rajasthan, Puducherry, Goa,
Odisha, West Bengal, Lakshadweep, and Uttar Pradesh.

Eliminating Discrimination Against Persons Affected by Leprosy (EDPAL) Bill, 2015

In april 2015, The Law Commission of India has submitted its Report No. 256 on "Eliminating Discrimination
Against Persons Affected by Leprosy" to the Union Minister of Law and Justice. The report also provides a
model draft law to eliminate discrimination faced by Persons affected by Leprosy.
In 2014, India had the largest number of new Leprosy cases globally (58%). From 2005 till 2014, the National
Leprosy Eradication Programme (NLEP) recorded a rate of 1.25 to 1.35 lakh new cases every year. A majority
of these are children, who are threatened with isolation and discrimination at a young age.

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Although Leprosy may cause irreversible disabilities, with medical advances, it is now a completely curable
disease. However, a major obstacle is the social stigma associated with Leprosy, and many persons affected
by Leprosy continue to be outcast from society. Another problem is that of Indian laws, which continue to
directly and indirectly discriminate against Persons affected by Leprosy.
In 2010, the United Nations General Assembly unanimously adopted a Resolution on the Elimination of
Discrimination against Persons affected by Leprosy, accompanied by Principles and Guidelines listing out
measures to improve the living conditions of such persons. Additionally, the United Nations Convention on
the Rights of Persons with Disabilities, 2007 ("UNCRPD") promotes, protects and ensures the full and equal
enjoyment of all human rights and fundamental freedoms by all persons with disabilities.

SC

India has signed and ratified the UNCRPD, and is also a member of the UN General Assembly that unanimously
passed the Resolution on the Elimination of Leprosy. However, the Indian government has taken no action
to modify or repeal any leprosy laws, or to eliminate discrimination against persons affected by Leprosy. This
is now an urgent need, and is the focus of this report of the Law Commission.

GS

Accordingly, along with its report and recommendations on the issue, the Law Commission has prepared a
model draft legislation, titled "Eliminating Discrimination Against Persons Affected by Leprosy (EDPAL) Bill,
2015". This draft law contains principles of non-discrimination and equal protection before law that must be
guaranteed to all persons affected by Leprosy or members of their family. It also seeks to promote the social
inclusion of persons affected by Leprosy and their family members through affirmative action.
The key Aspects of the Draft law are as follows:
Repeal and amendment of certain laws: Besides the repeal of the Lepers Act, 1898, the Law Commission
recommends the repeal of discriminatory provisions in various personal laws. It also recommends including
persons affected by Leprosy among the list of persons eligible for legal aid under the Legal Services Act,
1987.

2.

Measures against discrimination: The Law Commission recommends that persons affected by leprosy
and their family members must not be discriminated against in any institution. It also guarantees to such
persons the right to access healthcare, adequate housing, education, employment and other such basic
amenities.

3.

Land Rights: Persons affected by leprosy are usually made to relocate to "Leprosy Colonies" in India, but
they do not have land rights, and are constantly under fear of eviction. The Law Commission recommends
that title and ownership of property in Leprosy Colonies should be legalized, and if land rights cannot
be given, alternative settlement options must be explored.

Notes

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Right to Employment: Many employers misuse existing employment laws to terminate services of
persons who are diagnosed with Leprosy. The draft law prohibits the termination of employment of such
persons solely due to their association with Leprosy.

5.

Educational and training opportunities: The Law Commission recommends that the draft law should
ensure the admission of Persons affected by Leprosy and their family members in schools, colleges and
other institutes, as educational qualifications are necessary to allow them access to employment
opportunities.

6.

Appropriate use of Language: The use of the term 'leper' and similar terms carries negative connotation,
hampers efforts for the inclusion of Persons affected by Leprosy into society, and affects their sense of
dignity as human beings. The Law Commission recommends that the term 'leper' and other such terms
in all government and private documents should be replaced with 'persons affected by Leprosy' or a
similar term.

7.

Right to Freedom of Movement: The draft law ensures that persons affected by Leprosy are guaranteed
the right of travel in public transport and the right to obtain a driving license.

8.

Concessions during treatment: The draft law seeks to provide relevant concessions and monetary benefits
to persons affected by Leprosy who are undergoing treatment, for their travel, lodging during treatment
and medicines.

9.

Social Awareness: Creating awareness regarding the cure and transmission of Leprosy is the best way to
address the discrimination and stigma against persons affected by Leprosy and their family. The Law
Commission recommends that awareness about the disease, its treatment and curability should be conducted
through campaigns and programmes in schools, hospitals, government institutions and private
establishments.

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4.

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10. Welfare Measures: The draft law imposes specific duties upon establishments to execute certain welfare
measures to foster an environment for financial and social growth of persons affected by Leprosy and
their families. It also creates Central and State Commissions to strictly enforce such measures, and
provides for accountability measures in case of non-enforcement.

National Leprosy Eradication Programme

The National Leprosy Control Programme was launched in 1955 based on dapsone - monotherapy. Multi
Drug Therapy came into wide use from 1982.

National Leprosy Eradication Programme was launched in 1983 with the objective to arrest the disease
in all the known cases of leprosy.

In 1991, the World Health Assembly resolved to eliminate leprosy by the year 2000.

Since 2005, the programme is being continued with government of India funds with technical support
from WHO and International Federations of Anti Leprosy Associations (ILEP).

Since integration of the programme with GHC system in 2002-03, leprosy diagnosis and treatment
services are available at all PHCs and govt. hospitals in the country.

Following are the Components of the Programme:

Decentralized integrated leprosy services through General Health Care System,

2.

Capacity building of all general health services functionaries,

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3.

Intensified information, Education and Communication (IEC),

4.

Prevention of disability and medical rehabilitation and

5.

Monitoring and Supervision. Spectacular success has been achieved against the disease after introduction
of MDT.

By the end of March 2009, 0.86 lakh cases were on record and 1.34 lakh new cases were detected
during 2008-09. In 2009-10, by the end of September, 76,064 new leprosy cases were detected. Out
of these cases, 48 per cent were MB cases. 10.1 per cent child cases, 35.2 per cent were visible
deformity cases.

Other Schemes
1. National Health Mission (NHM)
Launched in 2013 by subsuming the NRHM and National Urban Health Mission (NUHM) as submissions.

b.

Aim - to enable universal access to equitable, affordable, and quality health care services.

c.

NRHM (National Rural Health Mission)

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a.

i.

Launched in - 2005

ii.

Area Coverage - whole nation (i.e. rural areas in all states)

SC

iii. Some national programs under NRHM

1.

National vector borne diseases control program (NVBDCP),

2.

National leprosy eradication program (NLEP),

3.

Revised national tuberculosis control program (RNTCP),

d.

It's on the lines of DOTS (Directly observed treatment short-course); DOTS is a strategy
recommended by WHO.

GS

a.
4.

National program for control of blindness (NPCD),

5.

National iodine deficiency disorders control program (NIDDCP),

6.

Janani Suraksha Yojana (JSY)

NUHM (National Urban Health Mission)

i.

Launched in - 2013

ii.

Area coverage - cover all cities/ towns with a population of more than 50,000 and all district
headquarters with a population above 30,000.
1.

Other towns would continue to be covered under the NRHM.

2. National Rural Health Mission (NRHM)

The National Rural Health Mission was launched by the Prime Minister on 12th April 2005, to provide
accessible, affordable and accountable quality health services to the poorest households in the remotest
rural regions. The detailed framework for implementation that facilitated a large range of interventions
under NRHM was approved by the Union Cabinet in July 2006.

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Under the NRHM, the difficult areas with unsatisfactory health indicators were classified as special focus
states to ensure greatest attention where needed.

The 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, like water, sanitation, education, nutrition, social and gender equality.

From narrowly defined schemes, the NRHM is shifting the focus to a functional health system at all
levels, from the village to the district.

The NRHM has increased public expenditure on health care from 0.9 per cent of the GDP to 2 to 3 per
cent of the GDP. The architectural correction under NRHM is organized around five pillars, each of
which is made up of a number of overlapping core strategies. These are:
Increasing Participation and Ownership by the Community: This is sought to be achieved through
an increased role for PRIs, the ASHA programme, the village health and sanitation committee,
increased public participation in hospital development committees, district health societies in the
district and village health planning efforts and by a special community monitoring initiative and also
through a greater space for NGO participation.

2.

Improved Management Capacity: the core of this is professionalize management by building up

management and public health skills in the existing workforce, supplemented by inculcation of
skilled management personnel into the system.

3.

Flexible Financing: The central strategy of this pillar is the provision of united funds to every village
health and sanitation committee, to the sub-center, to the PHC, to the CHC including district
hospital.

4.

Innovations in Human Resources Development for the Health Sector: the central challenge of the
NRHM is to find definitive answers to the persistent questions about ensuring adequate recruitment
for the public health system and adequate functionality of those recruited. Contractual appointment
route to immediately fill gaps as well as ensure local residency, incentive and innovation to find staff
to work in hitherto undeserved areas and the use of multi-skilled and multitasking options are
examples of other innovations that seek to find new solutions to old problems.

5.

Monitoring and Evaluation: It involves

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1.

Independent evaluation of ASHAs/JSY by UNEPA/UNICEF/GTZ in 8 states.

Immunization coverage evaluated by UNICEF.

Independent monitoring by identified institutions like Institute of Public Auditors of India.

Phase 1 of the community monitoring in 9 states namely Rajasthan, Odisha, Maharashtra,

Madhya Pradesh, Tamil Nadu, Chhattisgarh, Jharkhand, Karnataka and Assam has been
completed.

Concurrent evaluation by several independent agencies is in progress.

District wise Annual Health Survey for high focus states are in pipeline.

3. Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)

Launched in 2006

b.

Aim

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c.

i.

correcting the imbalances in availability of affordable / reliable tertiary level health care and

ii.

To augment facilities for quality medical education in the underserved areas.

How to achieve this aim

New AIIMS have been setup

ii.

Existing Government Medical Colleges/Institutions are upgraded to super specialty levels.

How many - there are 4 phases

i.

ii.

AIIMS
1.

Under phase 1, 6 AIIMS were setup which have become functional (

2.

Under phase 4, four AIIMS (each at Andhra Pradesh, Vidarbha region (Maharashtra), West
Bengal and Poorvanchal) are proposed to be established.

Up-gradation of Colleges

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d.

i.

1.

In 1st 3 phases 58 medical colleges will be upgraded

2.

Under phase 4, 12 more medical colleges are proposed to be upgraded (source - eco survey
2014-5).

SC

4. National Programme For Prevention and Control of Cancer, Diabetes, Cardiovascular Disease
and Stroke (NPCDCS )
a.

launched in the year 2010-11

b.

It was launched in 100 districts across 21 states. See whether it has been extended

c.

Main activities under it

Awareness: Promotion of healthy lifestyle through massive health education and mass media efforts
at country level.

ii.

Screening and detection: Screening over seven crore adult population (30 years & above) for diabetes
and hypertension, early diagnosis of NCDs and treatment at early stages.

GS

i.

iii. Special cells: Establishment of Non Communicable Disease (NCD) clinics at CHC and district level,
development of trained manpower and strengthening of tertiary level health facilities.
iv.
d.

Training of manpower

Major lifestyle diseases

i.

Cancer

ii.

Diabetes

iii. Heart diseases (i.e. cardiovascular diseases, strokes etc)

1.

Notes

iv.

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A stroke is the rapid loss of brain function(s) due to disturbance in the blood supply to the
brain.

Mental stress, depression, hypertension, mental disorder

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v.

Alzheimer's Disease

vi. Obesity

5. Human Resources, Infrastructure Development/ Upgradation in Tertiary Health Care

a.

With a view to strengthening the medical education infrastructure in the country, the Government has
initiated two new Centrally Sponsored Schemes, i.e.,
i.

the 'Establishment of New Medical Colleges attached with District/ Referral hospitals' with a corpus
of Rs. 10,971.1 crore and

ii.

the "Upgradation of existing State Government/ Central Government medical colleges to increase
MBBS seats in the country" with a corpus of Rs. 10,000 crore

6. Mission Indradhanush (2015)

launched - Jan 2015

b.

Type - An immunization scheme

c.

Aim - To achieve full immunization coverage by 2020 for all those children who are either unvaccinated/
partially vaccinated against '7' vaccine preventable diseases
i.

e.

SC

Target Area- will be carried out in 201 high focus districts in the first phase and 297 districts will be
targeted for the second phase in 2015.
i.

f.

These 7 diseases are diphtheria, whooping cough, tetanus, polio, tuberculosis, measles, and hepatitis
B.

Of the 201 districts, 82 districts are in just four states of UP, Bihar, Madhya Pradesh and Rajasthan
and nearly 25% of the unvaccinated or partially vaccinated children of India are in these 82 districts
of 4 states.
Background of Launch -

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d.

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a.

i.

Between 2009-2013 immunization coverage has increased from 61% to 65%, indicating only 1%
increase in covesrage every year.

ii.

To accelerate the process of immunization by covering 5% and more children every year, the Mission
Mode has been adopted to achieve target of full coverage by 2020, he stated.

How to Achieve this Aim i.

Immunization drive will be through a catch-up campaign mode where the aim is to cover all the
children who have been left out or missed out for immunization.

ii.

Mass media, interpersonal communication, and sturdy mechanisms of monitoring and evaluating the
scheme are crucial components of Mission Indradhanush, said the Minister

National Programme For Control of Blindness

National Programme for Control of Blindness (NPCB) was launched in the year 1976 as a 100 per cent
centrally sponsored scheme with the goal of reducing the prevalence of blindness to 0.3 per cent by 2020.

Main Objectives of the Programme

To reduce the backlog of blindness through identification and treatment of blind;

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To develop comprehensive eye care facility in every district;

To develop human resources for providing eye care services;

To improve quality of service delivery;

To secure participation of voluntary organizations /private practitioners in eye care; and

To enhance community awareness on eye care.

National Aids Control Programme

National AIDS Control Programme (NACP) is a 100 per cent centrally-sponsored scheme.

Launched in July 2007, NACP Phase-3 (2007-12) has the goal to halt and reverse the epidemic in the
country over the next five years by integrating programmes for prevention, care, support and treatment.

The programme has adopted a four-pronged strategy:

Prevention of new infections in high risk groups and general population.

2.

Providing greater care, support and treatment to larger number of PLHA.

3.

Strengthening the infrastructure, systems and human resources in prevention, care, support and treatment
programmes at the district, state and national level.

4.

Strengthening the nationwide Strategic Information Management System.

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National Iodine Deficiency Disorders Control Programme

The Government is implementing the National Iodine Deficiency Disorders Control Programme (NIDDCP)
formerly known as National Goitre Control Programme (NGCP) since 1962, a 100% centrally assisted
programme with a focus on the provision of Iodated salt, IDD survey/ resurvey, laboratory monitoring
of Iodated salt and Urinary Iodine excretion, health education and publicity.

Government of India has banned the sale of non-iodated salt in the entire country for direct human
consumption under Prevention of Food Adulteration Act, 1954 with effect from 17th May, 2006.

GS

Yaws Eradication Programme (Yep)

Yaws Eradication Programme (YEP) was launched as a central sector health scheme in 1996-97 in Koraput
district, Odisha, which was subsequently extended to cover all 49 Yaws endemic districts in ten states
during Ninth Plan period.

The programme basically aims to reach the unreached tribal areas of the country.

The National Institute of Communicable Diseases has been identified as the nodal agency for the planning,
monitoring and evaluating the programme.

India declared elimination of Yaws in 2008. An amount of Rs. 50 lakhs was allocated to financial year
2008-09.

National Cancer Control Programme

Cancer is an important public health problem with 7 to 9 lakh cases occurring every year. At any point
of time, it is estimated that there are nearly 25 lakh cases in the country. Four lakh deaths are estimated
to occur every year due to cancer.

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The National Cancer Control Programme was launched in 1975-76 with the objectives of primary
prevention, early detection, treatment and rehabilitation.

A National Strategic Task Force has been constituted to formulate a strategy for the National Cancer
Control Programme for the Eleventh Five Year Plan.

In order to cater to the changing needs of the disease, the programme has undergone three revisions with
the third revision completed in December 2004. Under the revised programme, the primary focus is on
correcting the geographic imbalance in the availability of cancer care facilities across the country.

There are 5 schemes under the Revised Programme:

Recognition of new Regional Cancer Centres (RCCs) by providing a one-time grant of Rs.5.00 crore.

2.

Strengthening of existing RCCs by providing a one-time grant of Rs. 3.00 crore.

3.

Development of Oncology Wing by providing enhanced grant of Rs. 3.00 crore to the Government
institutions (Medical Colleges as well as government hospitals).

4.

District Cancer Control Programme by providing the grant-in-aid of Rs. 90.00 lakh spread over a period
of 5 years.

5.

Decentralised NGO Scheme by providing a grant of Rs. 8000 per camp to the NGOs for IEC activities.

As of now, there are 25 Regional Cancer Centres providing comprehensive cancer care services. There
are 210 institutions possessing radiotherapy installations.

A National Strategic Task Force has been constituted to formulate a strategy for the National Cancer
Control Programme for the Eleventh Five Year Plan.

Training: In order to increase the capacity of the health staff at all levels of health care, training manuals
have been developed in cancer control, tobacco cessation, cytology and palliative care.

Onconet-India: C-DAC Trivandrum has been entrusted with the responsibility of preparing the DPR for
Operationalisation of Onconet India. Under the project all 25 RCCs will be linked with each other and
also each RCC would in turn be linked to 5 peripheral centres.

Membership of IARC: India has become a member of the International Agency for Research in Cancer
that shall provide a fillip to cancer research in the country.

National Cancer Awareness Day : November 7th, the birth anniversary of Madame Curie is observed
as the National Cancer Awareness Day. Number of banners are displayed for creating awareness among
the general masses about cancer on the day.

Health Minister's Cancer Patient Fund Under "RAN": The "Health Minister's Cancer Patient Fund"
(HMCPF) within the Rashtriya Arogya Nidhi (RAN) Scheme has also been set up in 2009. In order to
utilize the HMCPF, it is proposed to establish the revolving fund like RAN in the Various Regional Cancer
Centre(s) (RCCs) which are getting fund for equipments from Cancer Programme of Govt. of India.

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National Family Health Survey (NFSH)

The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted in a representative
sample of households throughout India. The NFHS is a collaborative project of the International Institute
for Population Sciences (IIPS), Mumbai, India; ORC Macro, Calverton, Maryland, USA and the EastWest Center, Honolulu, Hawaii, USA.

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The Ministry of Health and Family Welfare (MoHFW), Government of India, designated IIPS as the
nodal agency, responsible for providing coordination and technical guidance for the NFHS.

NFHS was funded by the United States Agency for International Development (USAID) with supplementary
support from United Nations Children's Fund (UNICEF). IIPS collaborated with a number of Field
Organizations (FO) for survey implementation. Each FO was responsible for conducting survey activities
in one or more states covered by the NFHS. Technical assistance for the NFHS was provided by ORC
Macro and the East-West Center.

The first National Family Health Survey (NFHS-1) was conducted in 1992-93. The survey collected
extensive information on population, health, and nutrition, with an emphasis on women and young
children. Eighteen Population Research Centres (PRCs), located in universities and institutes of national
repute, assisted IIPS in all stages of conducting NFHS-1. All the state-level and national-level reports for
the survey have already been published (48 reports in all).

The second National Family Health Survey (NFHS-2) was conducted in 1998-99 in all 26 states of India
with added features on the quality of health and family planning services, domestic violence, reproductive
health, anemia, the nutrition of women, and the status of women. The results of the survey are currently
being published.

The third National Family Health Survey (NFHS-3) was carried out in 2005-2006. Eighteen Research
Organizations including five Population Research Centres carried out the survey in 29 states of India. The
funding for NFHS-3 is provided by USAID, DFID, the Bill and Melinda Gates Foundation, UNICEF,
UNFPA, and MoHFW, GoI. ORC Macro, USA, is providing technical assistance for NFHS-3, and the
National AIDS Control Organization (NACO) and the National AIDS Research Institute (NARI) are
providing technical assistance for the HIV component.

Recently, the Union government has decided to discontinue the country's most reliable and widely tracked
health survey, the National Family Health Survey (NFHS), the fourth round of which was to be conducted
in 2012-13, in a move that has been criticized by development experts. The ministry of health and family
welfare is instead planning to roll out an integrated national health survey-(NHS) that will replace three
existing ones-NFHS, the district-level health survey (DLHS) and the Annual Health Survey (AHS) conducted
across nine priority states by the office of the census commissioner.

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Central Government Health Scheme

The "Central Government Health Scheme" (CGHS) provides comprehensive health care facilities for the
Central Govt. employees and pensioners and their dependents residing in CGHS covered cities.

Started in New Delhi in 1954, Central Govt. Health Scheme is now in operation in Allahabad ,Ahmedabad,
Bangalore, Bhubhaneshwar, Bhopal, Chandigarh, Chennai, Delhi, Dehradun, Guwahati, Hyderabad, Jaipur,
Jabalpur, Kanpur, Kolkata, Lucknow, Meerut, Mumbai, Nagpur, Patna, Pune, Ranchi , Shillong, Trivandrum
and Jammu.

The Central Govt. Health Scheme is applicable to the following categories of people residing in CGHS
covered cities:

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1.

All Central Govt. Servants paid from Civil Estimates (other than those employed in Railway Services
and those employed under Delhi Administration except members of Delhi Police Force).

2.

Pensioners drawing pension from Civil Estimates and their family members - (Pensioner residing in
non- CGHS areas also may obtain CGHS Card from nearest CGHS covered City)

3.

Hon'ble Members of Parliament

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4.

Hon'ble Judges of Supreme Court of India

5.

Ex-Members of Parliament

6.

Employees & Pensioners of Autonomous Bodies covered under CGHS (Delhi)

7.

Ex-Governors and Ex-Vice Presidents

8.

Former Prime Ministers

9.

Former Judges of Hon'ble Supreme Court of India and Hon'ble High Courts

10. Freedom Fighters

Allopathic

Homeopathic

Indian System of Medicines i.e.

1.

Ayurveda

2.

Unani

3.

Yoga

4.

Sidha System

The main components of the Scheme are:

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It provides service through following categories of systems:-

The dispensary services including domiciliary care.

F. W. & M.C.H. Services

Specialists consultation facilities both at dispensary, polyclinic and hospital level including X-Ray, ECG
and Laboratory Examinations.

Hospitalization.

Organization for the purchase, storage, distribution and supply of medicines and other requirements.

Health Education to beneficiaries.

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Gandhigram Institute Of Rural Health And Family Welfare Trust (GIRHFWT)

The trust was established in 1964 with financial support from the Ford Foundation, Government of India
and Government of Tamil Nadu.

The broad objectives are..:

Conducting research studies in the field of Reproductive and Child Health, Rural Health, and Family
Health Activities

2.

Organizing training programs in Reproductive and Child Health, Health and Family Welfare Programs
for Personnel from the State and those from other States.

3.

Developing newer methodologies for implementing Reproductive and Child Health, and other Health
programs.

Notes

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The Health and Family Welfare Training Centre at GIRHFWT is one of 47 such training centres in the
country. At Gandhi-gram Institute of Rural Health and Family Welfare Trust (GIRHFWT), HFWTC
functions as a Central Training Institute (CTI). It trains Health and Health-related functionaries working
in Primary Health Centres, Corporations/ Municipalities, and Tamilnadu Integrated Nutrition Projects.

Pulse Polio Immunization Programme

In the pursuance of the World Health Assembly resolution of 1988, in addition to administration of
routine Oral Polio Vaccine (OPV) through the Universal Immunization Programme, the Pulse Polio
Immunization (PPI) Programme was launched in 1995-96 to cover all children below the age of 3 years.

In order to accelerate the pace of polio eradication, the target age group was increased from 1996-97 to
all children under the age of 5 years.

Till 1998-99, the PPI programme consisted of vaccination of children at fixed booths on the National
Immunization Days (NIDs) held twice, separated by six weeks, during the winter season. In spite of very
good coverage during NIDs, 5-6 percent of children were being missed even in the PPI programme.

During 1999-2000 therefore, in addition to booth immunization, a house-to-house search of missed children
and vaccinating them on the next 1-3 days following each NID/Sub NID was undertaken. The house-tohouse programme resulted in identification and vaccination of 2.3 crore children who had never been
vaccinated earlier.

Total number of children vaccinated during each NID round in the country is about 17 crore.

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Prohibition of Pre-Conception and Pre-Natal Sex Determination

In order to check female foeticide, the Pre- Natal Diagnostic Techniques (Regulation and Prevention of
Misuse) Act, 1994 was enacted and brought into operation from 1st January, 1996.

The Act prohibits determination and disclosure of the sex of the foetus.

It also prohibits any advertisements relating to pre-natal determination of sex.

Punishments are prescribed for contravention of any of its provisions, like imprisonment up to 5 years
and fine up to Rs. 1,00,000/- in addition to cancellation of the registration/ license in the case of medical
professionals/ diagnostic centres, clinics, etc..

The Act and the Rules framed under it have been amended with effect from 14th February, 2003 to ban
selection of sex before or after conception and to remove difficulties in the implementation of the Act
keeping in view certain directions of the Supreme Court of India.

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Janani Suraksha Yojana

Janani Suraksha Yojana (JSY) comes under the bigger umbrella of National Rural Health Mission (NRHM)
and was launched in April, 2005 by way of modifying the existing National Maternity Benefit Scheme
(NMBS).

While NMBS is linked to provision of better diet for pregnant women from BPL families, JSY integrates
the cash assistance with antenatal care during the pregnancy period, institutional care during delivery and
immediate post-partum period in a health centre by establishing a system of coordinated care by village
level health worker.

The JSY is a 100% centrally sponsored scheme.

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The Yojana has identified ASHA (Accredited Social Health Activist) as an effective link between the
Government and the poor pregnant women in low performing states, namely the 8 EAG states and Assam
and J&K, the remaining NE States and tribal districts of all other States.

The main role of ASHA is to facilitate pregnant women to avail services of maternal care and arrange
referral transport.

The scheme focuses on the poor pregnant woman with special dispensation for states having low institutional
delivery rate namely the states of Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Madhya Pradesh,
Chhattisgarh, Assam, Orissa, Rajasthan and Jammu and Kashmir.

The benefits would also be available to such pregnant women falling in the above category even though
not registered under JSY previously during pregnancy period but requiring institutional care for delivery
including management of complications like obstructed labour, PPH, eclampsia, PP sepsis etc.

Each village of 1000 population is expected to have one ASHA or an equivalent worker registered with
the sub-centre and the PHC of that concerned village, who would be working under the supervision of
the ANM and in tandem with the AWW. Under JSY, her main role would be:

OR
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1. To organize delivery care services for the registered expectant mother,

2. To assist in immunization of the new born,

3. To act as a propagator/motivator of family planning services,

Notes

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4. Cash Assistance for Institutional Delivery Payment to the expectant mother,

17