11.1.social Sectors-Health Part1

Social sectors in India- HEALTH
PART 1
1 www.edutap.co.in www.rbigradeb.wordpress.com
Contents
1 INTRODUCTION ..................................................................................................................................................... 3
2 NATIONAL HEALTH MISSION ............................................................................................................................ 5
2.1 National Rural Health Mission (NRHM): ......................................................................................................... 6
2.2 National Urban Health Mission (NUHM): ........................................................................................................ 6
2.3 MAJOR INITIATIVES UNDER NRHM/NHM ............................................................................................... 6
2.4 NATIONAL URBAN HEALTH MISSION (NUHM) ................................................................................... 10
3 MATERNAL HEALTH ISSUES............................................................................................................................ 12
3.1 Accredited Social Health Activist (ASHA) ..................................................................................................... 14
3.2 Auxiliary nurse midwife (ANM): .................................................................................................................... 16
3.3 Relationship with ASHA ................................................................................................................................. 17
3.4 Anganwadi Centres: ........................................................................................................................................ 17
3.5 The RMNCH+A Approach: ............................................................................................................................ 17
3.6 Indra Gandhi Matritva Sahyog Yojana............................................................................................................ 18
3.7 Janani Suraksha Yojana................................................................................................................................... 18
3.8 Janani Shishu Suraksha Karyakaram............................................................................................................... 20
4 CHILD HEALTHCARE ......................................................................................................................................... 22
4.1 Situation of Child Mortality in India ............................................................................................................... 22
4.2 Causes of Child Mortality in India: ................................................................................................................. 23
4.3 Government Interventions: .............................................................................................................................. 23
4.4 New Born Health ............................................................................................................................................. 23
4.5 NUTRITION RELATED INTERVENTIONS ............................................................................................... 25
4.6 PNEUMONIA & DIARRHOEA RELATED INTERVENTIONS ................................................................. 26
4.7 INTERVENTIONS TO ADDRESS BIRTH DEFECTS, DISABILITIES, DELAYS AND DEFICIENCIES
27
4.8 IMMUNIZATION ACTIVITIES .................................................................................................................... 27
1 INTRODUCTION
India today, is the world’s third largest economy in terms of its Gross National Income (in
PPP terms) and has the potential to grow larger and more equitably, and to emerge to be
counted as one of the developed nations of the world. India today possesses as never before,
a sophisticated arsenal of interventions, technologies and knowledge required for providing
health care to her people.
Yet the gaps in health outcomes continue to widen. On the face of it, much of the ill health,
disease, premature death, and suffering we see on such a large scale are needless, given the
availability of effective and affordable interventions for prevention and treatment. “The
reality is straightforward. The power of existing interventions is not matched by the
power of health systems to deliver them to those in greatest need, in a comprehensive
way, and on an adequate scale".
Given the two-way linkage between economic growth and health status, there appears a
determination of the Government to leverage economic growth to achieve health outcomes
and an explicit acknowledgement that better health contributes immensely to improved
productivity as well as to equity.
Since independence, for the health sector, the context has changed in four major ways.
Firstly- Health Priorities are changing. As a result of focused action over the last decade
we are projected to attain Millennium Development Goals with respect to maternal and child
mortality. Maternal mortality now accounts for 0.55% of all deaths and 4% of all female
deaths in the 15 to 49 year age group. This is still 46,500 maternal deaths too many, and
demands that the commitments to further reduction must not flag.
However it also signifies a rising and unfulfilled expectation of many other health needs that
currently receive little public attention. There are many infectious diseases which the system
has failed to respond to – either in terms of prevention or access to treatment. Then there is a
growing burden of non-communicable disease.
The second important change in context is the emergence of a robust health care industry
growing at 15% compound annual growth rate (CAGR). This represents twice the rate of
growth in all services and thrice the national economic growth rate.
Thirdly, incidence of catastrophic expenditure due to health care costs is growing and is
now being estimated to be one of the major contributors to poverty. The drain on family
incomes due to health care costs can neutralize the gains of income increases and every
Government scheme aimed to reduce poverty.
The fourth and final change in context is that economic growth has increased the fiscal
capacity available with the government.
Therefore, the country needs a new health policy that is responsive to these contextual
changes. Other than these objective factors, the political will to ensure universal access to
affordable healthcare services in an assured mode , the promise of Health Assurance, should
be an important constituent of Health sector in India.
India's health challenges are diverse. Communicable diseases, notably Tuberculosis and
Malaria, continue to constitute a major part of the country's disease burden.
At the same time the threat of Non-communicable Disease (NCD) including diabetes,
hypertension, cancer and mental illness is clearly perceived. It is also crucially relevant that
maternal and infant mortality continue to remain unacceptably high in several parts of the
country.
The Ministry of Health & Family Welfare is implementing various schemes, programmes
and national initiatives to provide universal access to quality healthcare. The approach is to
increase access to the decentralized public health system by establishing new infrastructure in
deficient areas and by upgrading the infrastructure in the existing institutions.
As part of the plan process, many different programmes have been brought together under the
overarching umbrella of the National Health Mission (NHM) with National Rural Health
Mission (NRHM) and National Urban Health Mission (NUHM) as its two Sub-Missions.
The major programmes being implemented are Routine Immunization (RI), National Vector
Borne Disease Control Programme (NVBDCP), Revised National TB Control Programme
(RNTCP), Integrated Diseases Surveillance Programme (IDSP), National Programme for
Control of Blindness (NPCB), National Mental Health Programme (NMHP), National
Programme for Health Care of the Elderly (NPHCE) and National Programme for Prevention
and Control of Cancer, Diabetes, Cardiovascular Diseases and Strokes (NPCDCS). Besides,
central assistance is also being provided to strengthen the medical, disaster management,
redevelopment of hospitals and dispensaries etc.
By the end of the 12th Plan (i.e. 2017) the National Health Mission had endeavoured to
reduce Maternal Mortality Ratio (MMR) from 1.78 to 1 per 1000 live births, Infant Mortality
Rate (IMR) from 42 to 25 per 1000 live births, Total Fertility Rate (TFR) from 2.4 to 2.1,
prevent and reduce incidence of anaemia in women aged 15-49 years, prevent and reduce
mortality & morbidity from communicable, non-communicable, injuries and emerging
diseases and reduce household out-of pocket expenditure on total health care. India's public
spending on core health as a proportion of GDP is approximately 1.04% and the 12th Plan
goal was to increase it to 1.87% by the end of the Twelfth Plan.
Most of the goals of 12th five year plan have still not been met. This report will investigate
various challenges which hamper the achievements of these targets. Besides, all the national
health schemes will be discussed in an comprehensive manner. By the end of the report, you
will be able to answer almost all of the exam questions relating to health sector.
2 NATIONAL HEALTH MISSION
The National Health Mission (NHM) encompasses two Sub-Missions:
1. National Rural Health Mission (NRHM)

2. National Urban Health Mission (NUHM).
The main programmatic components include Health system strengthening in rural and urban
areas, Reproductive Maternal-Neonatal-Child and Adolescent Health (RMNCH+A) and
Communicable and Non Communicable Diseases. The NHM envisages achievement of
universal access to equitable, affordable & quality healthcare services that are accountable
and responsive to people’s needs.
2.1 National Rural Health Mission (NRHM):
NRHM seeks to provide quality healthcare to the rural population, especially the vulnerable
groups. Under the NRHM, the Empowered Action Group (EAG) States as well as North
Eastern States, Jammu & Kashmir and Himachal Pradesh have been given special focus. 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 such as water, sanitation, education,
nutrition, social and gender equality.
2.2 National Urban Health Mission (NUHM):

NUHM seeks to improve the health status of the urban population particularly urban poor
and other vulnerable sections by facilitating their access to quality primary healthcare.
NUHM covers all State capitals, district headquarters and other cities/ towns with a
population of 50,000 and above (as per census 2011) in a phased manner. Cities and towns
with population below 50,000 will continue be covered under NRHM.
2.3 MAJOR INITIATIVES UNDER NRHM/NHM

(Please note that you should just read through these initiatives and not learn all of them as
major and important initiatives under NHM have been covered under various other relevant
chapters in this report. The provided information will definitely help in essay writing and
interviews.)
 ASHA: Covered under maternal health care

 Rogi Kalyan Samiti/Hospital Management Society is a simple yet effective
management structure. This committee is a registered society whose members act as
trustees to manage the affairs of the hospital and is responsible for upkeep of the
facilities and ensure provision of better facilities to the patients in the hospital.
Financial assistance is provided to these committees through untied fund to undertake
activities for patient welfare. 31,763 Rogi Kalyan Samitis (RKS) have been set up
involving the community members in almost all District Hospitals (DHs), Sub-District
Hospitals (SDHs), Community Health Centres (CHCs) and Primary Health Centres
(PHCs) till date.
 The Untied Grants to Sub-Centres (SCs) has given a new confidence to our ANMs
(discussed under maternal health care) in the field. The SCs are far better equipped
now with blood pressure measuring equipment, haemoglobin (Hb) measuring
equipment, stethoscope, weighing machine etc. This has facilitated provision of quality
antenatal care and other healthcare services.
 The Village Health Sanitation and Nutrition Committee (VHSNC) is an important
tool of community empowerment and participation at the grassroots level to address
issues of environmental and social determinants. VHSNC membership includes
Panchayati Raj representatives, ASHA & other frontline workers and also
representatives of the marginalized communities. Untied grants of Rs. 10,000 are
provided annually to each VHSNC. Till date, 5.01 lakh VHSNCs have been set up
across the country. Capacity building of the VHSNC members with regards to their
roles and responsibilities including public service monitoring and planning is being
initiated in states.
 Janani Suraksha Yojana (JSY): Discussed under maternal health care
 Janani Shishu Suraksha Karyakram (JSSK): Discussed under maternal health care.
 Facility Based Newborn Care: A continuum of newborn care has been established
with the launch of home based and facility based newborn care components ensuring
that every newborn receives essential care right from the time of birth and first 48
hours at the health facility and then at home during the first 42 days of life. Newborn
Care Corners (NBCCs) are established at delivery points to provide essential
newborn care at birth.
 National Mobile Medical Units (NMMUs): Support has been provided in 333 out of
672 districts for 1107 Mobile Medical Units (MMUs) under NHM in the country. To
increase visibility, awareness and accountability, all Mobile Medical Units (MMUs)
have been repositioned as “National Mobile Medical Unit Service” with universal
colour and design.
 National Ambulance Services (NAS): As on date, 31 States/UTs have the facility

where people can dial 108 or 102 telephone number for calling an ambulance. Dial
108 is predominantly an emergency response system, primarily designed to attend to
patients of critical care, trauma and accident victims etc. Dial 102 services essentially
consist of basic patient transport aimed at the needs of pregnant women and children
though other categories are also taking benefit and are not excluded. JSSK entitlements
e.g. free transport from home to facility, inter facility transfer in case of referral and
drop back for mother and children are the key focus of 102 service. This service can be
accessed through a toll free call to a Call Centre.
 Launch of National Quality Assurance Framework for Health facilities: To improve
quality of healthcare in over 31000 public facilities and provide a clear roadmap to
States, Quality Standards for District Hospitals (DHs), CHCs and PHCs under National
Quality Assurance Framework were rolled out in November, 2014.
 Launch of Kayakalp - an initiative for Award to Public Health facilities: Kayakalp
initiative has been launched to promote cleanliness, hygiene and infection control
practices in public health facilities. Under this initiative public healthcare facilities
shall be appraised and such public healthcare facilities that show exemplary
performance meeting standards of protocols of cleanliness, hygiene and infection
control will receive awards and commendation. Further, Swachhta Guidelines to
promote Cleanliness, Hygiene and Infection Control Practices in public health facilities
were released on 15th May, 2015. The Guidelines provide details on the planning,
frequency, methods, monitoring etc. with regard to Swachhta in public health facilities.
 Free Drugs Service Initiative: An incentive of up to 5% additional funding (over and

above the normal allocation of the state) under the NHM is provided to those States
that introduce free medicines scheme. Under the NHM-Free Drug Service Initiative,
substantial funding is available to States for provision of free drugs subject to
States/UTs meeting certain specified conditions. Detailed Operational Guidelines for
NHM- Free Drugs Service Initiative was released to the States on 2nd July 2015 and is
available on NHM website.
 Free Diagnostics Service Initiative: The NHM- Free Diagnostics Service Initiative
was launched in 2013 to provide free essential diagnostic services at public health
facilities under which substantial funding was provided to States within their resource
envelope.
 Bio Medical Equipment Maintenance: States have been asked to plan interventions
for comprehensive equipment maintenance for all functional medical
equipment/machinery. The Ministry has circulated model contract documents for
guidance. Support for comprehensive equipment maintenance for all functional
medical equipment/machinery is intended to ensure optimum utilisation of medical
equipment.
 Comprehensive Primary Healthcare: Primary healthcare including preventive and
promotive healthcare enables early detection and prompt treatment and serves a gate-
keeping function to secondary and tertiary care and also reduces the cost of care.
Nine areas for action to make primary healthcare comprehensive and universal are
proposed. They include:
i) Strengthen Institutional Structures and Organization of Primary Healthcare
Services;
ii) Improve access to technologies, drugs and diagnostics for comprehensive Primary
Healthcare;
iii) Increase utilization of Information, Communication and Technology (ICT) -
empowering patients and providers;
iv) Promote Continuity of care - making care patient centric;
v) Enhance Quality of Care; o Focus on Social Determinants of Health;
vi) Emphasize Community Participation and Address Equity Concerns in Health;
vii) Develop a Human Resource Policy to support primary healthcare;
viii) Strengthen Governance including financing, partnerships and accountability and
ix) States are also offered support through the PIPs of the NHM to strengthen existing
sub centers.
 Kilkari: To create proper awareness among pregnant women, parents of children and
field workers about the importance of Ante-Natal Care (ANC), Institutional Delivery,
Post-Natal Care (PNC) and Immunization, it was decided to implement the Kilkari and
Mobile Academy services across India in phased manner. In the first phase Kilkari was
launched in 6 States viz. Uttarakhand, Jharkhand, Uttar Pradesh, Odisha, Rajasthan
High Priority Districts (HPDs) & Madhya Pradesh High Priority Districts (HPDs).
Kilkari is an Interactive Voice Response (IVR) based mobile service that delivers
time-sensitive audio messages (Voice Call) about pregnancy and child health directly
to the mobile phones of pregnant women, mothers of young children and their families.
The service covers the critical time period–where the most maternal/infant deaths
occur from the 4th month of pregnancy until the child is one year old.
Families which subscribe to the service receive one pre-recorded system generated call
per week. Each call will be 2 minutes in length and serve as reminders for what the
family should be doing that week depending on woman’s stage of pregnancy or the
child’s age. Kilkari services will be available to states in regional dialect too.
 Mobile Academy is an anytime, anywhere audio training course on interpersonal
communication skills that the ASHA can access from her mobile phone. It gives
ASHAs tips on how to convince families to adopt priority RMNCH behaviours, while
refreshing her existing knowledge. The course is 240 minutes long and consists of 11
chapters with 4 lessons each. At the end of each chapter, there is a quiz for them the
ANM/ASHAs who pass the course will be provided with a certificate.
 Launch of Nationwide Anti-TB drug resistance survey: Drug resistance survey for
13 anti TB drugs was launched to provide a better estimate on the burden of Multi-
Drug Resistant Tuberculosis within the community. This is the biggest ever such
survey in the world with a sample size of 5214 patients.
2.4 NATIONAL URBAN HEALTH MISSION (NUHM)
National Urban Health Mission (NUHM) was approved by the Union Cabinet on 1st May,
2013 as a sub-mission under an overarching National Health Mission (NHM) for providing
equitable and quality primary healthcare services to the urban population with special focus
on slum and vulnerable sections of the society. NUHM seeks to improve the health status by
facilitating their access to quality primary healthcare. The Centre-State funding pattern is
60:40 for all the States w.e.f. FY 2015-16, except the North Eastern States and other hilly
States viz. Jammu & Kashmir, Himachal Pradesh and Uttarakhand, for which the Centre-
State funding pattern is 90:10. In the case of UTs the entire NUHM programme is fully
funded by Central Government.
Under NUHM, support is provided to the States/ UTs for strengthening and up gradation of
existing infrastructure including Urban Family Welfare Centres (UFWCs), Urban Health
Posts and Primary Health Centres and HR augmentation for providing comprehensive
primary healthcare services.
Urban Health programme is being implemented through Urban Local Bodies (ULBs), in
seven metropolitan cities, viz., Mumbai, New Delhi, Chennai, Kolkata, Hyderabad,
Bengaluru and Ahmedabad.
For the remaining cities, the State Health department decides whether the Urban Health
Programme is to be implemented through health department or any other urban local body.
Under the Programme the support is being provided by the Asian Development Bank
(ADB) based on progress related to certain indicators.
Service Delivery Infrastructure
NUHM envisages setting up of service delivery infrastructure which is largely absent in

cities/ towns to specially address the healthcare needs of urban poor and provides:-
 Urban–Primary Health Centre (U-PHC): New U-PHCs are established as per gap
analysis, as per norm of one U-PHC for approximately 50,000 urban populations. The
new U-PHCs are preferably located within or near a slum for providing preventive,
promotive and OPD (consultation), basic lab diagnosis, drug/contraceptive dispensing
services, apart from counseling for all communicable and non- communicable
diseases. Annual Report 2015-16 17
 Urban-Community Health Centre (U-CHC) and Referral Hospitals: 30- 50
bedded U-CHCs are established for providing inpatient care. U-CHCs are set up in
cities with a population of above 5 lakhs.
 Outreach services: NUHM also support engagement of ANMs for conducting
outreach services for targeted groups particularly slum dwellers and the vulnerable
population for providing preventive and promotive healthcare services at the
household and community level.
Community Process Mahila Arogya Samiti (MAS): One Mahila Arogya Samiti will
cover 250-1,000 beneficiaries and about 50-100 households and act as community based
peer education group in slums.
MAS have been formed to facilitate community mobilization, monitoring and referral
with focus on preventive and promotive care, facilitating access to identified facilities and
management of grants received.
ASHA/Link Worker: One frontline community worker ASHA serves as an effective and
demand– generating link between the health facility and the urban slum population. Each
link worker/ASHA will have a well-defined service area of about 1000- 2,500
beneficiaries/between 200-500 households based on spatial consideration. However, the
states would have the flexibility to either engage ASHA or entrust her responsibilities to
MAS.
3 MATERNAL HEALTH ISSUES
Maternal health care is a rather wide term. Often, the term is confused with only the period of
time, when the women gives birth to the child. However maternal health care is a concept
that encompasses family planning, preconception, prenatal, and postnatal care.
In the Indian scenario, all the above mentioned phases are not very well defined. This stems
from the lack of education and awareness among women, traditional nature of families and
plain indifference. Now, the crisis varies with location like urban or rural, with income of the
family and even with castes like scheduled tribes.
Family planning in India has been a matter of debate since time immemorial, considering the
exploding number of people. Government has come up with various nationwide programmes
to curtail the increasing number. Despite having one of the oldest family planning programs
in the world, India has a fertility rate of 2.5 (2016) and a crude birth rate of 21/1,000 persons
(2015). Thus statistically, the number of births per female is a rather high number. Such high
rates of birth and fertility indicates that on an average woman give birth to at least two
children during their reproductive age. While that may sound perfectly normal, however in
the rural scenario women may give birth to as many as ten children irrespective of the fact
whether they can sustain them or not.
Thus often they do not get enough time to recover from childbirth. Factors like haemorrhage
(both ante and post partum), toxaemia (Hypertension during pregnancy), anaemia, obstructed
labour, puerperal sepsis (infections after delivery) and unsafe abortion cause a high maternal
mortality rate.
Maternal death is defined as death of women while pregnant or within 42 days of termination
of pregnancy from any cause related to or aggravated by pregnancy or its management. The
maternal mortality ratio is maternal death per 100,000 live births in one year.
 Globally, about 800 women die every day of preventable causes related to pregnancy
and childbirth; 20 per cent of these women are from India.
 Annually, it is estimated that 55,000 women die due to preventable pregnancy-related
causes in India.
 Good news: The Maternal Mortality Ratio – the number of maternal deaths per
100,000 live births – reduced from 212 in 2007 to 170 in 2016.
 But, additional efforts will be required for lowering the MMR, especially in the States
of Assam (300), Uttar Pradesh (285), Rajasthan (244), Odisha (222), Madhya Pradesh/
Chhattisgarh (221) and Bihar/ Jharkhand (208), which have quite high MMR as
compared to the national level, if the MDG target is to be achieved in an equitable
manner.
 Mothers in the lowest economic bracket have about a two and a half times higher
mortality rate.
In urban areas, services offered for maternal health care sees patterns of inequality. Urban
marginalisation takes place in which only the poor are excluded. Private health care services
are beyond the budget of marginalised women. While the go may go for birth and check -ups
in government run hospitals; however they never measure the survival rate of these women.
The Indian government stated that maternal health in the country had considerably improved
because 10 million women had given birth in health facilities in 2009 and into 2010. Under
its flagship National Rural Health Mission and Janani Suraksha Yojana (JSY), or Safe
Motherhood Scheme, the Indian government uses cash incentives to encourage women to
give birth in health facilities.
As a natural process, females do gain considerable amount of weight during pregnancy and
this carries on even after child birth. But many of them ignore this change and remain
unaware of the complications which arise due to them. More than 40 percent of women in
India are underweight when they begin pregnancy, according to a new study published by
Princeton University. On average, these women gain only 15 pounds throughout pregnancy –
just half of the recommended amount.
The findings are a concern as body mass and weight gain during pregnancy are important
indicators of maternal health. Babies born to undernourished mothers are more likely to be
underweight, a characteristic influencing height, cognition and productivity across a lifetime.
In this regard, government of India is trying hard to improve the situation. It has started many
schemes in this regard. Some of them are:-
3.1 Accredited Social Health Activist (ASHA)

One of the key components of all the government health schemes in rural India is to provide
every village in the country with a trained female community health activist ASHA or
Accredited Social Health Activist (presently, about 1 million of them are in service). Selected
from the village itself and accountable to it, the ASHA is trained to work as an interface
between the community and the public health system. Following are the key components of
ASHA:
 ASHA must primarily be a woman resident of the village married/ widowed/ divorced,
preferably in the age group of 25 to 45 years. (Minimum education required is 10th
standard, which is relaxed only if no woman with the required qualification is available
in the village.)
 Capacity building of ASHA is being seen as a continuous process. ASHA undergoes
series of training episodes to acquire the necessary knowledge, skills and confidence
for performing her spelled out roles.
 The ASHAs receive performance-based incentives for promoting universal
immunization, referral and escort services for Reproductive & Child Health (RCH) and
other healthcare programmes, and construction of household toilets.
 Empowered with knowledge and a drug-kit to deliver first-contact healthcare, every
ASHA is expected to be a fountainhead of community participation in public health
programmes in her village.
 ASHA will be the first port of call for any health related demands of deprived sections
of the population, especially women and children, who find it difficult to access health
services.
 She will counsel women on birth preparedness, importance of safe delivery, breast-
feeding and complementary feeding, immunization, contraception and prevention of
common infections including Reproductive Tract Infection/Sexually Transmitted
Infections (RTIs/STIs) and care of the young child.
 ASHA will mobilise the community and facilitate them in accessing health and health
related services available at the Anganwadi/sub-centre/primary health centers, such as
immunisation, Ante Natal Check-up (ANC), Post Natal Check-up supplementary
nutrition, sanitation and other services being provided by the government.
 She will act as a depot holder for essential provisions being made available to all
habitations like Oral Rehydration Therapy (ORS), Iron Folic Acid Tablet(IFA),
chloroquine, Disposable Delivery Kits (DDK), Oral Pills & Condoms, etc.
At the village level it is recognised that ASHA cannot function without adequate institutional
support. Women's committees (like self-help groups or women's health committees), village
Health & Sanitation Committee of the Gram Panchayat, peripheral health workers especially
ANMs and Anganwadi workers, and the trainers of ASHA and in-service periodic training
would be a major source of support to ASHA.
3.2 Auxiliary nurse midwife (ANM):

Auxiliary nurse midwife, commonly known as ANM, is a village-level female health worker,
who is known as the first contact person between the community and the health services.
ANMs are regarded as the grass-roots workers in the health organisation pyramid. Their
services are considered important to provide safe and effective care to village communities.
ANMs works at health sub-centres. The sub-centre is a small village-level institution that
provides primary health care to the community. The sub-centre works under the Primary
Health Centre (PHC). Each PHC usually has around six such sub-centres.
Before the launch of the NRHM in 2005, there was provision of one ANM per sub-centre.
Later it was found that one ANM was not adequate to fulfill the health care requirements of a
village. In 2005 NRHM made provision of two ANMs (one permanent and one contractual)
for each sub-centre. The ANM is usually selected from the local village to increase
accountability.
As of 2010, there were 147,069 sub-centres functioning in India, which were increased to
152,326 in March 2014. As per recent norms, there should be one sub-centre for population
of 5,000 while in tribal and hilly area population allotted for each sub-centre is 3,000.
Under NRHM, each sub-centre gets an untied fund for expenditure. The ANM has a joint
bank account with the Sarpanch (head) of the village to get such funds. ANMs use untied
fund for buying items needed for sub-centre, such as blood pressure equipment, weighing
machine, scales and for cleaning. The rate of deliveries at the sub-centre level has been
increased since the grant of untied funds via NRHM.
ANMs are expected to be multi-purpose health workers. ANM-related work includes

maternal and child health along with family planning services, health and nutrition education,
efforts for maintaining environmental sanitation, immunisation for the control of
communicable diseases, treatment of minor injuries, and first aid in emergencies and
disasters.
In remote areas, such as hilly and tribal areas where transport facility is likely to be poor,
ANMs are required to conduct home deliveries for women.
3.3 Relationship with ASHA
Depending on the area covered by the sub-centre, each ANM is supported by four or five
ASHAs. ANMs are supposed to take weekly or fortnightly meeting with ASHAs to review
work done the last week or fortnight. ANMs guides ASHAs on aspects of health care.
With the Anganwadi Worker (AWW), the ANM acts as a resource person for the training of
ASHAs. The ANM motivates ASHAs to bring beneficiaries to the institution. The ASHA
brings pregnant women to the ANM for check-ups. She also brings married couples to the
ANM for counselling on the family planning. The ASHA brings children to immunisation
sessions held by the ANM. The ASHA act as bridge between the ANM and the village.
3.4 Anganwadi Centres:

Anganwadi is a government sponsored child-care and mother-care center in India. It caters to
children in the 0-6 age group. The word means "courtyard shelter" in Hindi. They were
started by the Indian government in 1975 as part of the Integrated Child Development
Services program to combat child hunger and malnutrition.
The Anganwadi system is mainly managed by the Anganwadi worker. She is a health worker
chosen from the community and given 4 months training in health, nutrition and child-care.
She is incharge of an Anganwadi which covers a population of 1000.
There are an estimated 1.053 million anganwadi centers employing 1.8 million mostly-
female workers and helpers across the country. They provide outreach services to poor
families in need of immunization, healthy food, clean water, clean toilets and a learning
environment for infants, toddlers and pre-schoolers. They also provide similar services for
expectant and nursing mothers. According to government figures, anganwadis reach about
58.1 million children and 10.23 million pregnant or lactating women.
Anganwadis are India's primary tool against the scourges of child malnourishment, infant
mortality and curbing preventable diseases such as polio.
3.5 The RMNCH+A Approach:

Reproductive, Maternal, Newborn, Child and Adolescent Health
RMNCH+A approach has been launched in 2013 and it essentially looks to address the major
causes of mortality among women and children as well as the delays in accessing and
utilizing health care and services. The RMNCH+A strategic approach has been developed to
provide an understanding of ‘continuum of care’ to ensure equal focus on various life stages.
Priority interventions for each thematic area have been included in this to ensure that the
linkages between them are contextualized to the same and consecutive life stage. It also
introduces new initiatives like the use of Score Card to track the performance, National Iron
+ Initiative to address the issue of anaemia across all age groups and the Comprehensive
Screening and Early interventions for defects at birth , diseases and deficiencies among
children and adolescents. The RMNCH+A appropriately directs the States to focus their
efforts on the most vulnerable population and disadvantaged groups in the country. It also
emphasizes on the need to reinforce efforts in those poor performing districts that have
already been identified as the high focus districts.
184 High Priority Districts (HPDs) have been identified. These districts would receive 30%
higher per capita funding, relaxed norms, enhanced monitoring and focused supportive
supervision, and are encouraged to adopt innovative approaches to address their peculiar
health challenges.
3.6 Indra Gandhi Matritva Sahyog Yojana

Ministry/Department: Ministry of Women and Child Development
Scheme:
 Centrally Sponsored Scheme

 Conditional Maternity Benefit (CMB) for pregnant and lactating women to improve
their health and nutrition status to better enabling environment by providing cash
incentives to pregnant and nursing mothers.
 It is being implemented using the platform of Integrated Child Development Services
(ICDS) Scheme
 The beneficiaries are paid Rs.6000/ in two instalments through bank accounts or post
office accounts.
 a. The first instalment is given in third trimester i.e. seven to nine months of pregnancy
and
 b. The Second instalment is given six months after delivery on fulfilling specific
conditions.
 The beneficiaries would be pregnant women of 19 years of age and above for first two
live births (benefit for still births will be as per the norms of scheme).
 All Government/PSUs (Central & State) employees are excluded from the scheme as
they are entitled for paid maternity leave.
3.7 Janani Suraksha Yojana
Launched in 2005, is safe motherhood intervention under the National Health Mission being
implemented with the objective of reducing maternal and neo-natal (infants upto 28 days
after birth) mortality by promoting institutional delivery among the poor pregnant women.
This programme provides cash assistance with delivery and post-delivery care.
 JSY is a 100 % centrally sponsored scheme and it integrates cash assistance with
delivery and post-delivery care
 The success of the scheme is be determined by the increase in institutional delivery
among the poor families.
 The Asha as well as Aanganwadi Worker (AWW) like activists become the effective
link between Government and poor women in this programme.
 In 2013, The Ministry of Health and Family Welfare has relaxed eligibility parameters
for the Janani Suraksha Yojana (JSY), which provides financial assistance to mothers
for institutional deliveries.
 Now, Below Party Line (BPL) women can access JSY benefits irrespective of their age
and number of children.
 All women from BPL category, Scheduled Castes and Scheduled Tribes in all States
and Union Territories will be eligible for JSY benefits if they have given birth in a
government or private accredited health facility.
 BPL women who prefer to deliver at home can also get JSY benefits.
 The decision was taken after it was realised that a majority of women, who needed
JSY benefits, remained out of the purview of the scheme because they had to prove
they were 19 years of age and had no more than two children.
 A woman gets Rs.1,400 for delivery in a government facility or accredited private
facility and Accredited Social Health Activist (ASHA) gets Rs. 600 in rural areas. In
the urban areas, the amounts paid are Rs.1,000 and Rs. 400 respectively.
 However, in High Performing States (those with good health indices, such as Kerala,
Tamil Nadu and Karnataka), assistance for institutional delivery was available to
women from BPL/SC/ST households, aged 19 or above and only up to two live births
for delivery in a government or private accredited health facility.
 The financial entitlement was Rs. 700 to the mother and Rs. 600 for the ASHA in rural
areas and Rs. 600 and Rs. 400 in urban settings.
 Further, in all States/Union Territories, the scheme provided Rs. 500 to BPL women
— aged 19 or above and who deliver up to two live births — who prefer to deliver at
home. With the amendments, all women who deliver at home will be entitled to this
amount, basically for nutrition.
3.8 Janani Shishu Suraksha Karyakaram
Launched on 1st June, 2011, this scheme supplements the cash assistance given to a pregnant
woman under Janani Suraksha Yojana
 Aimed at mitigating the burden of out of pocket expenses incurred by pregnant women
and sick newborns.
 The entitlements under this programme include free drugs and consumables, free diet
up to 3 days during normal delivery and up to 7 days for C-section, free diagnostics,
and free blood wherever required.
 The following are the Free Entitlements for pregnant women:
 Free and cashless delivery
 Free drugs and consumables
 Free diagnostics
 Free diet during stay in the health institutions
 Free provision of blood
 Exemption from user charges
 Free transport from home to health institutions
 Free transport between facilities in case of referral
 Free drop back from Institutions to home after 48hrs stay
 The following are the Free Entitlements for Sick newborns till 30 days after birth.This
has now been expanded to cover sick infants:
 Free treatment
 Free drugs and consumables
 Free diagnostics
 Free provision of blood
 Exemption from user charges
 Free Transport from Home to Health Institutions
 Free Transport between facilities in case of referral
 Free drop Back from Institutions to home
 This initiative also provides for free transport from home to institution, between
facilities in case of a referral and drop back home.
 Similar entitlements have been put in place for all sick newborns accessing public
health institutions for treatment till 30 days after birth. This has now been expanded to
cover sick infants.
Apart from these major Initiatives, certain other significant schemes which have been
launched by Health Ministry are:
 Mother and Child Tracking System: (MCTS) is a name based web-based service
that captures the details of pregnant women and children up to 5 years and aims to
ensure that every pregnant woman gets complete and quality ANC and PNC and every
child receives a full range of immunization services. More than 9.58 crore pregnant
women and 8.12 crore children have been registered under MCTS till Oct, 2015.
 Comprehensive Abortion Care (CAC): is being provided as it is an important

element in the reproductive health component of the RMNCH+A strategy as 8% of
maternal deaths in India are attributed to unsafe abortions.
 Free Treatment of Sexually Transmitted Infections (STIs) and Reproductive
Tract Infections (RTIs): is being provided at health facilities as they constitute an
important public health problem in India. Studies suggest that 6% of the adult
population in India is infected with one or more RTI/STI. Syndromic case management
is being provided at the appropriate level delivery points. A policy decision has been
taken for universal testing of HIV and syphilis in all pregnant women.
 Prevention & Control of Anaemia: Under the National Iron+ Initiative, for
prevention and control of anaemia in pregnant and lactating women, iron folic acid
supplementation is being given at health facilities and also during outreach activities.
Iron Folic Acid (IFA) is now being given for six months during ANC and six months
in the PNC period. States have also been directed for line listing and tracking of
severely anaemic pregnant women by name for their timely management at health
facilities.
 “Prevention of Postpartum Haemorrhage (PPH) through Community based
advance distribution of Misoprostol” by ASHAs/ANMs has been launched for high
home delivery districts. Operational Guidelines and Reference Manual have been
disseminated to the States. However, guidelines on the above are explicit in saying that
during the counselling sessions with the pregnant women conducted by ASHAs and
ANMs, emphasis is laid on the need to register and deliver at institutions.
Our society is caught in the crossroads; emerging from the traditional methods of child birth,
government schemes and women’s rights. Caught in this confusion, many families know
what the right thing to do is, but they are blinded by superstitions and lack of information.
We as the youth should volunteer to provide information for maternal care whether it is
through Social work, or through people around us. Many aspiring doctors are blinded by
‘money’ rather than the work they ought to do. For them, it is important to remember the oath
they took- to work selflessly for the life of another.
Blaming the government is easy, but to become the change you wish to see is difficult.
A mother is all compassionate and ever sacrificing, and whenever she dies, one child is left
orphaned. So it is time that we wake up to this terrible reality about maternal health care. To
end I quote Helen Rice;
“A mother’s love is patient and forgiving when all others are forsaking, it never fails or
falters, even though the heart is breaking”
4 CHILD HEALTHCARE
India had committed to reduce child deaths by two thirds between 1990 and 2015 as pledged
in the Millennium Development Goals (MDG). This implied a reduction of Under Five
Mortality Rate (U-5MR) from 125/1000 live births in 1990 to 42/1000 live births by 2015.
This commitment was also reflected under the National Health Mission (NHM). Still, we
haven’t been able to achieve the target. Let’s try to find out the reasons about this situation
and what the government is doing about it.
4.1 Situation of Child Mortality in India

At present, the Under Five Mortality Rate in India is 48/1000 live births, Infant Mortality
Rate (IMR) is 39/1000 live births and Neo-natal Mortality Rate is 28/1000 live births.
This translates into an estimated 12.7 lakh under-5 child deaths annually.
The efforts need to be intensified to attain the target of 42/1000 live births. Four States
together contribute to 58% of all child deaths in the country, namely- Uttar Pradesh
(3.5 lakhs), Bihar (1.5 lakhs), Madhya Pradesh (1.3 lakhs) and Rajasthan (1.0 lakh).
About 45% of under-five deaths take place within the first 7 days of birth, about 57% of
within first one month of birth and approximately 81% within one year of the birth.
4.2 Causes of Child Mortality in India:

The major causes of child mortality in India (as per WHO, 2012) are - Neonatal causes
(53%), Pneumonia (15%), Diarrhoeal diseases (12%), Measles (3%) and others. Besides
these, malnutrition is a contributory factor in 33% child deaths.
4.3 Government Interventions:

Based on the identified causes of mortality, five major strategic areas have been identified to
improve child health outcomes. These are:
1. Newborn Health Interventions

2. Nutrition related interventions
3. Interventions to address pneumonia and diarrhoea
4. Interventions to address birth defects, disabilities, delays and deficiencies
5. Immunization activities
Besides the above, maternal health and family planning interventions are also linked
inextricably to child health outcomes. Therefore, the RMNCH+A approach strategizes
continuum of care across life stages as the over-arching umbrella under which these child
health interventions have been built in.
4.4 New Born Health

The Newborn Mortality Rate in India is 28/1000 live births (SRS 2013) which translates into
approximately 7.3 lakhs deaths, annually.
Newborn deaths contribute to 57% of the Under-5 deaths in the country.
After a period of stagnation (from 2003 to 2007), the decline in neo-natal mortality gained
pace with a 17% decline been recorded in the last 5 years from (2008 to 2012). More
importantly, 6% fall occurred in the each of the last two consecutive years (highest so far).
The major causes of newborn deaths in India are: Infections (31%), Prematurity (35%),
Asphyxia (20%), Congenital (9%) and Diarrhoea (2%).
India Newborn Action Plan (INAP): was launched in 2014 to make concerted efforts
towards attainment of the goals of “Single Digit Neo-natal Mortality Rate” and “Single Digit
Stillbirth Rate”, by 2030.
Government interventions for neo-natal health are as under:
Promotion of Institutional Deliveries and Essential Newborn Care: Since antenatal and
intra-partum events have a bearing on newborn health, institutional deliveries are being
promoted with cash incentives in the form of Janani Suraksha Yojana (JSY).
Newborn Care Corners (NBCCs) have been operationalized at delivery points to provide
essential newborn care at the time of birth.
In order to reduce out of pocket expenses, Janani Shishu Swasthya Karyakram (JSSK)
entitlements have been provided to ensure cashless treatment of pregnant woman and her
child till one year of age in public health facilities. This also includes free referral transport.
Home Based Newborn Care (HBNC): has been initiated by ASHAs for promotion of
essential newborn care including breastfeeding practices, early identification and referral of
neo-natal illnesses. Where ASHAs are paid an incentive for visiting each newborn and post-
partum mother in the first six weeks of life as per the schedule
Facility Based Newborn Care (FBNC) : is being scaled up for care of small or sick
newborns. 602 Special Newborn Care Units (SNCUs) have been setup in district hospitals
and medical colleges to provide round the clock services for sick newborns. More than 7.5
lakh newborn babies were treated at SNCUs in 2014-15.
Newer interventions: to reduce newborn mortality have also been implemented, including
Vitamin K injection at birth, Antenatal corticosteroids in pre-term labour, Kangaroo Mother
Care (KMC) and empowering ANMs to provide injection Gentamycin to young infants for
possible serious bacterial infection.
Maternal and Neonatal Tetanus Elimination (MNTE): WHO had set the global target
date of December, 2015 for MNTE validation. However, India has been validated for
Maternal & Neonatal tetanus elimination in May 2015, well before the target date.
4.5 NUTRITION RELATED INTERVENTIONS
 Malnutrition is considered to be the underlying cause of 33% of child deaths.

 29.4% of under-5 children are underweight, 38.7% are stunted and 15.1% are acutely
malnourished (wasted). More importantly, 4.6% of children are suffering from severe
acute malnutrition, as per the last available national survey.
 Only 44.6% newborns initiated on breastfeed within one hour of birth while, 64.9%
children breastfeed exclusively till 6 months of age.
 69.5% of children in age group 6 months-5 years and 2.9% are severely anaemic.
The strategic nutrition related interventions are as under:
Promotion of Infant and Young Child Feeding practices (IYCF): Exclusive breastfeeding
for first six months, complementary feeding beginning at six months and appropriate Infant
and Young Child Feeding practices (IYCF) are being promoted in convergence with the
Ministry of Woman and Child Development.
Establishment of Nutritional Rehabilitation Centres (NRCs): 891 NRCs have been set up
at facility level to provide medical and nutritional care to Severe Acute Malnourished
(SAM) children under 5 years of age who have medical complications. In addition, the
mothers are also imparted skills on child care and feeding practices so that the child
continues to receive adequate care at home.
National Iron Plus Initiative (NIPI): To address anaemia, NIPI has been launched, which
includes provision of supervised bi-weekly Iron Folic Acid (IFA) supplementation by ASHA
for children aged 6 to 59 months and Weekly Iron Folic Acid Supplementation (WIFS) for
children 5 to 10 years (known as WIFS-junior).
National Deworming Day (NDD): National Deworming Day, 10th February, A fixed day
strategy is implemented throughout the country in related stressed areas where children
between ages of 1–19 years (with some of States not covering the total range of age groups),
receive deworming tablet (Albendazole) during the National Deworming Day.
Bi-annual Vitamin-A Supplementation is being provided to all children aged 9 to 59
months of age. Bi-annual Vitamin-A supplementation rounds are conducted in 15 States
4.6 PNEUMONIA & DIARRHOEA RELATED INTERVENTIONS

Pneumonia and diarrhoea are leading childhood killers, responsible for 15% and 12% of
child (0-5 years) deaths, respectively.
Integrated Action Plan for Pneumonia and Diarrhoea (IAPPD) has been formulated for
four states with highest child mortality (Uttar Pradesh, Madhya Pradesh, Bihar and
Rajasthan) to address the two biggest killers of children, namely - Pneumonia and Diarrhoea.
The strategic interventions targeting pneumonia and diarrhoea are as below:
 Promotion of Integrated Management of Neo-natal and Childhood Illnesses

(IMNCI) for early diagnosis and case management of common ailments of children
with special emphasis on pneumonia, diarrhoea and malnutrition is being promoted for
care of children at community as well as facility level.
 Promotion of early detection and prompt referral of children with common ailments
like pneumonia and diarrhoea by ASHA
 Increase awareness about use of ORS and Zinc in diarrhoea: In order to increase
awareness about the use of ORS and Zinc in diarrhoea, an Intensified Diarrhoea
Control Fortnight (IDCF) was observed during July-August, 2014 with the ultimate
aim of ‘zero child deaths due to childhood diarrhoea’. During fortnight health workers
visited the households of under five children, conducted community level awareness
generation activities and distributed ORS packets to the families with children under
five years of age.
4.7 INTERVENTIONS TO ADDRESS BIRTH DEFECTS, DISABILITIES, DELAYS

AND DEFICIENCIES
Birth defects account for 9.6% of all newborn deaths and 4% of under-five mortality.
Development delays affect at least 10% children and these delays if not intercepted timely
may lead to permanent disabilities.
Rashtriya Bal Swasthya Karyakram (RBSK) has been launched to provide child health
screening and early interventions services by expanding the reach of mobile health teams at
block level. These teams will also carry out screening of all the children in the age group 0–6
years enrolled at Anganwadi Centres at least twice a year.
RBSK covers 30 common health conditions. States/UTs may incorporate a few more
conditions based on high prevalence/endemicity. An estimated 27 crore children in the age
group of zero to eighteen (0- 18) years are expected to be covered in a phased manner.
The strategic interventions to address birth defects, disabilities, delays and deficiencies are:
 Screening of children under RBSK: Child health screening and early intervention
services through early detection of birth defects, diseases, deficiencies, development
delays including disability (4 Ds) and reduce out of pocket expenditure for the
families. Dedicated mobile medical health teams (for screening purpose) at block level,
comprising of four health personnel viz. two AYUSH doctors (One Male, One
Female), ANM/SN and a Pharmacist.
 Establishment of District Early Intervention Centres (DEICs) in the districts of the
country for providing management of cases referred from the blocks and link these
children with tertiary level health services in case surgical management is required
 Birth Defects Surveillance System (BDSS) is being established to serve as a tool for
identifying congenital anomalies. It is as a collaborative effort between the Ministry of
Health and Family Welfare (MoHFW), Government of India (GoI), World Health
Organization (WHO). It is envisaged to establish at least one surveillance centre per
state, preferably in medical college.
4.8 IMMUNIZATION ACTIVITIES

Government of India is providing vaccination free of cost against nine vaccine preventable
diseases i.e. Diphtheria, Pertussis, Tetanus, Polio, Measles, severe form of Childhood
Tuberculosis, Hepatitis B across the country and Japanese Encephalitis in selected
districts and Meningitis & Pneumonia caused by Haemophilus Influenza type B in
selected states/districts under universal immunization program (UIP).
All cold chain equipment and their functionality are managed through web enabled software
to capture real time data, National Cold Chain Management Information System
(NCCMIS).
Major interventions under immunization are:
 Strengthening the Routine Immunization Programme (RIP): More than 9 million

Immunization sessions conducted annually. In order to drive toward 90% full
immunization coverage of India by year 2020, Mission Indradhanush has been
launched. It aims to ensure high coverage of children with all vaccines in the entire
country with a high focus on the 201 identified districts.
 Polio Eradication Activities: India along with South East Asia Region (SEAR) of
WHO has been certified polio free by regional certification commission of polio
eradication on 27 March 2014. Regular Sub National Immunization Days (SNIDs) are
being conducted. Inject able Inactivated Polio Vaccine (IPV) has been introduced as
an additional dose along with 3rd dose of DPT in the entire country in November 2015
as a part of polio endgame strategy.
 Introduction of New Vaccines: Pentavalent Vaccine, Rubella Vaccine (RV),
Rotavirus vaccine etc.
Mission Indradhanush
The Ministry of Health & Family Welfare has launched “Mission Indradhanush”, depicting
seven colours of the rainbow in December 2014, to fully immunize more than 89 lakh
children who are either unvaccinated or partially vaccinated; those that have not been
covered during the rounds of routine immunization for various reasons. They will be fully
immunized against seven lifethreatening vaccine preventable diseases which include
diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis-B. In
addition, vaccination against Japanese Encephalitis and Haemophilus influenza type B will
be provided in selected districts/states of the country. Pregnant women will also be
immunized against tetanus.
Pentavalent Vaccine
The Pentavalent vaccine contains five antigens i.e. Hepatitis B, Diphtheria, Pertussis, Tetanus
(DPT–current trivalent vaccine) and Haemophilus influenza b (Hib) vaccine. Pentavalent
vaccination is provided to the children at the age of 6, 10 and 14 weeks as primary dose.
NEW VACCINES
Government of India is introducing four new vaccines as per recommendations of National

Technical Advisory Group of Immunization (NTAGI) and the strategy of introduction is
as under:
1. Injectable Inactivated Polio Vaccine (IPV): Participating in Global polio Endgame

strategy, government introduced Inactivated Polio Vaccine (IPV) in addition to oral
polio drops in regular immunization in last quarter of 2015.
2. Rubella vaccine: To be initiated as Measles Rubella (MR) campaign targeting 9
months to 15 years of age in a phased manner over a period of three years.
3. Rota virus vaccine: To be given under UIP as a 3 dose vaccine along with DPT 1st,
2nd and 3rd dose in a phased manner in few states as per NTAGI recommendation and
vaccine availability. Subsequently, the vaccine will be scaled up in the entire country.
4. Adult Japanese Encephalitis Vaccine: to be used in identified affected areas.
CONTINUED IN PART 2

11.1.social Sectors-Health Part1

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Social sectors in India- HEALTH

2 NATIONAL HEALTH MISSION

The National Health Mission (NHM) encompasses two Sub-Missions:

1. National Rural Health Mission (NRHM)

2.2 National Urban Health Mission (NUHM):

2.3 MAJOR INITIATIVES UNDER NRHM/NHM

 ASHA: Covered under maternal health care

 National Ambulance Services (NAS): As on date, 31 States/UTs have the facility

 Free Drugs Service Initiative: An incentive of up to 5% additional funding (over and

Service Delivery Infrastructure

NUHM envisages setting up of service delivery infrastructure which is largely absent in

3 MATERNAL HEALTH ISSUES

3.1 Accredited Social Health Activist (ASHA)

3.2 Auxiliary nurse midwife (ANM):

ANMs are expected to be multi-purpose health workers. ANM-related work includes

3.4 Anganwadi Centres:

3.5 The RMNCH+A Approach:

3.6 Indra Gandhi Matritva Sahyog Yojana

 Centrally Sponsored Scheme

3.7 Janani Suraksha Yojana

 Comprehensive Abortion Care (CAC): is being provided as it is an important

4.1 Situation of Child Mortality in India

4.2 Causes of Child Mortality in India:

4.3 Government Interventions:

1. Newborn Health Interventions

4.4 New Born Health

Newborn deaths contribute to 57% of the Under-5 deaths in the country.

Government interventions for neo-natal health are as under:

 Malnutrition is considered to be the underlying cause of 33% of child deaths.

4.6 PNEUMONIA & DIARRHOEA RELATED INTERVENTIONS

The strategic interventions targeting pneumonia and diarrhoea are as below:

 Promotion of Integrated Management of Neo-natal and Childhood Illnesses

4.7 INTERVENTIONS TO ADDRESS BIRTH DEFECTS, DISABILITIES, DELAYS

4.8 IMMUNIZATION ACTIVITIES

Major interventions under immunization are:

 Strengthening the Routine Immunization Programme (RIP): More than 9 million

Government of India is introducing four new vaccines as per recommendations of National

1. Injectable Inactivated Polio Vaccine (IPV): Participating in Global polio Endgame

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