Chapter‐5 

| Social Pharmacy
National Health Programme 
Ongoing National Health Programmes in India: 
Reproductive, Maternal,Neonatal, Child and Adolescent health
 Janani Shishu Suraksha Karyakaram (JSSK)
 Rashtriya Kishor Swasthya Karyakram(RKSK)
 Rashtriya Bal SwasthyaKaryakram (RBSK)
 Universal Immunisation Programme
 Mission Indradhanush / Intensified Misson Indradhanush
 Janani Suraksha Yojana (JSY)
 Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)
 NavjaatShishu Suraksha Karyakram (NSSK)
 National Programme for Family planning

National Nutritional Programmes

 National Iodine Deficiency Disorders Control Programme
 MAA (Mothers’ Absolute Affection) Programme for Infant and Young Child Feeding
 National Programme for Prevention and Control of Fluorosis (NPPCF)
 National Iron Plus Initiative for Anaemia Control
 National Vitamin A prophylaxis Programe
 Integrated Child Development Services (ICDS)
 Mid-Day Meal Programme

Communicable diseases
 Integrated Disease Surveillance Programme (IDSP)
 National Tuberculosis Elimination Programme
 National Leprosy Eradication Programme (NLEP)
 National Centre for Vector Borne Diseases Control
 Programme for Prevention and Control of leptospirosis
 National AIDS Control Programme (NACP)
 Pulse Polio Programme
 National Viral Hepatitis Control Program
 National Rabies Control Programme
 National Programme on Containment of Anti-Microbial Resistance (AMR)

Non-communicable diseases
 National Tobacco Control Programme(NTCP)
 National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases &
Stroke (NPCDCS)
 National Programme for Control Treatment of Occupational Diseases
 National Programme for Prevention and Control of Deafness (NPPCD)
 National Mental Health Programme
 National Programme for Control of Blindness& Visual Impairment
 Pradhan Mantri National Dialysis Programme
 National Programme for the Health Care for the Elderly (NPHCE)
 National Programme for Prevention & Management of Burn Injuries (NPPMBI)
 National Oral Health programme

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Health system strengthening programs
 Ayushman Bharat Yojana
 Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)
 LaQshya’ programme (Labour Room Quality Improvement Initiative)
 National Health Mission
 Ayushman Bharat Digital Mission (ADHM)
 PM Ayushman Bharat Health Infrastructure Mission
 

REPRODUCTIVE, MATERNAL, NEONATAL, CHILD AND ADOLESCENT HEALTH: 

Janani Shishu Suraksha Karyakaram (JSSK): 
Introduction: 
Government of India has launched Janani Shishu Suraksha Karyakaram (JSSK) on 1st June, 2011.
The scheme is estimated to benefit more than 12 million pregnant women who access Government health
facilities for their delivery. Moreover it will motivate those who still choose to deliver at their homes to opt
for institutional deliveries. . It is an initiative with a hope that states would come forward and ensure that
benefits under JSSK would reach every needy pregnant woman coming to government institutional facility.
All the States and UTs have initiated implementation of the scheme.

The following are the Free Entitlements for pregnant women:

o Free and cashless delivery
o Free C-Section
o Free drugs and consumables
o Free diagnostics
o Free diet during stay in the health institutions
o Free provision of blood
o Exemption from user charges
o Free transport from home to health institutions
o Free transport between facilities in case of referral
o 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:
o Free treatment
o Free drugs and consumables
o Free diagnostics
o Free provision of blood
o Exemption from user charges
o Free Transport from Home to Health Institutions
o Free Transport between facilities in case of referral
o Free drop Back from Institutions to home
 
Rashtriya Bal SwasthyaKaryakram (RBSK): 
 
Rashtriya Bal SwasthyaKaryakram (RBSK), an innovative and ambitious initiative, which envisages Child
Health Screening and Early Intervention Services, a systemic approach of early identification of medical

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conditions and link to care, support and treatment. This programme subsumes the existing school health
programme.
Objective - Early identification and early intervention for children from birth to 18 years to cover 4 ‘D’s viz.
Defects at birth, Diseases in children, Deficiency conditions and Developmental delays including Disabilities.
It is important to note that the 0 - 6 years age group is specifically managed at District Early Intervention
Center (DEIC) level while for 6 -18 years age group, management of conditions is done through existing
public health facilities. DEIC also acts as referral linkages for both the age groups.

Target group under Child Health Screening and Intervention Service Categories

Categories Age Group

Babies born at public health facilities and home - Birth to 6 weeks

Preschool children in rural areas and urban slum - 6weeks to 6 years

School children enrolled in class 1st and 12th in

Government and government aided schools - 6yrs to 18 yrs
 
Universal Immunization Programme: 
Immunization Programme in India was introduced in 1978 as ‘Expanded Programme of Immunization’
(EPI) by the Ministry of Health and Family Welfare, Government of India. In 1985, the programme was
modified as ‘Universal Immunization Programme’ (UIP) to be implemented in phased manner to cover all
districts in the country by 1989-90 with the one of largest health programme in the world.
Ministry of Health and Family Welfare, Government of India provides several vaccines to infants, children
and pregnant women through the Universal Immunization Programme.

About immunization
Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically
by the administration of a vaccine. Vaccines are substances that stimulate the body’s own immune system to
protect the person against subsequent infection or disease.

Vaccines provided under UIP:

 About- PCV stands for Pneumococcal Conjugate Vaccine. It protects infants and young children
against disease caused by the bacterium Streptococcus pneumoniae.
 When to give - The vaccine is given as two primary doses at 6 & 14 weeks of age followed by a
booster dose at 9-12 months of age
 Route and site- PCV is given as intramuscular (IM) injection in antero-lateral side of mid- thigh. It
should be noted that pentavalent vaccine and PCV are given as two separate injections into opposite
thighs.
fIPV
 About- fIPV stands for Fractional Inactivated Poliomylitis Vaccine. It is used to boost the protection
against poliomylitis.
 When to give- Two fractional doses of IVP are given intradermally at 6 and 14 weeks of age.
 Route and site- It is given as intradermal injection at right upper arm.
Measles/ MR vaccine
 About-Measles vaccine is used to protect children from measles. In few states Measles and Rubella a
combined vaccine is given to protect from Measles and Rubella infection.
 When to give-First dose of Measles or MR vaccine is given at 9 completed months to12 months
(vaccine can be given up to 5 years if not given at 9-12 months age) and second dose is given at 16-24
months.

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  Route and site – Measles Vaccine is given as subcutaneous injection in right upper arm.
JE vaccine
 About- JE stands for Japanese encephalitis vaccine. It gives protection against Japanese Encephalitis
disease. JE vaccine is given in select districts endemic for JE after the campaign.
 When to given- JE vaccine is given in two doses first dose is given at 9 completed months-12 months
of age and second dose at 16-24 months of age.
 Route and site- Live attenuated vaccine is given as subcutaneous injection in left upper arm and killed
vaccine is given as intramuscular injection in anterolateral aspect of mid- thigh.
DPT booster
 About-DPT is a combined vaccine; it protects children from Diphtheria, Tetanus and Pertussis.
 When to give -DPT vaccine is given at 16-24 months of age is called as DPT first booster and DPT
2nd booster is given at 5-6 years of age.
 Route and site- DPT first booster is given as intramuscular injection in antero-lateral side of mid-
thigh in left leg. DPT second booster is given as intramuscular injection in left upper arm.
Tetanus and adult diphtheria (Td) vaccine:
 About-TT vaccine has been replaced with Td vaccine in UIP to limit the waning immunity against
diphtheria in older age groups.
 When to give- Td vaccine is administered to adolescents at 10 and 16 years of age and to pregnant
women.
 Pregnant women- Td-1 is given early in pregnancy as first dose and 4 weeks after Td1, second dose
of Td as Td-2 is given. Td- Booster is given, if pregnant woman has received 2 TT/Td doses in a
pregnancy within the last 3 years.* Intra-muscular Upper Arm
 Route and site- Td is given as intramuscular injection in upper arm.

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Janani Suraksha Yojana (JSY): 
 
Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health
Mission (NRHM) being implemented with the objective of reducing maternal and neo-natal mortality by
promoting institutional delivery among the poor pregnant women. The Yojana, launched on 12th April 2005,
by the Hon’ble Prime Minister, is being implemented in all states and UTs with special focus on low
performing states. JSY is a 100 % centrally sponsored scheme and it integrates cash assistance with delivery
and post-delivery care.
The Yojana has identified ASHA, the accredited social health activist as an effective link between the
Government and the poor pregnant women in l0 low performing states, namely the 8 EAG states and Assam
and J&K and the remaining NE States. In other eligible states and UTs, wherever, AWW ((Anganwadi
workers) and TBAs or ASHA like activist has been engaged in this purpose, she can be associated with this
Yojana for providing the services.

Important Features of JSY:

 The scheme focuses on the poor pregnant woman with special dispensation for states having low
institutional delivery rates namely the states of Uttar Pradesh, Uttaranchal, Bihar, Jharkhand, Madhya
Pradesh, Chhattisgarh, Assam, Rajasthan, Orissa and Jammu and Kashmir. While these states have
been named as Low Performing States (LPS), the remaining states have been named as High
performing States (HPS).
 Tracking Each Pregnancy: Each beneficiary registered under this Yojana should have a JSY card
along with a MCH card. ASHA/AWW/ any other identified link worker under the overall supervision
of the ANM and the MO, PHC should mandatorily prepare a micro-birth plan. This will effectively
help in monitoring Antenatal Check-up, and the post delivery care.
 Eligibility for Cash Assistance: BPL Certification – This is required in all HPS states. However,
where BPL cards have not yet been issued or have not been updated, States/UTs would formulate a
simple criterion for certification of poor and needy status of the expectant mother’s family by
empowering the gram pradhan or ward member.
 
Pradhan Mantri SurakshitMatritva Abhiyan (PMSMA): 
As India strives towards achieving the Sustainable Development Goals (SDGs) and looks ahead to the
post-2015 era, progress in reducing maternal mortality becomes an important frontier. Every pregnancy is
special and every pregnant woman must receive special care’. Any pregnant woman can develop life-
threatening complications with little or no advance warning, so all pregnant women need access to quality
antenatal services to detect and prevent life-threatening complications during childbirth.
In 2007-08, India had 47% institutional deliveries (DLHS 3). However as per latest data of the Rapid
Survey on Children (2013- 14), the institutional deliveries in India are 78.7%. In spite of this massive increase
in the number of pregnant women coming to institutions for delivery, till date only 61.8% women receive first
ANC in first trimester (RSOC) and the coverage of full ANC (provision of 100 IFA tablets, 2 tetanus toxoid
injections and minimum 3 ANC visits) is as low as 19.7% (RSOC).Despite availability of treatment
guidelines, mechanisms for monitoring and supportive supervision, regular training of health care providers at
different levels across the country and the existence of outreach platforms like Village Health and Nutrition
Day (VHND), the desired coverage and quality of maternal health services is still a matter of concern.
Maternal mortality with MMR of 167 per 1, 00,000 live births still remains high even with improved access to
maternal health care services. Timely detection of risk factor during pregnancy and childbirth can prevent
deaths due to 5 preventable causes. This can only be possible if the complete range of the required services is
accessed by the pregnant women.
In view of this Pradhan Mantri SurakshitMatritva Abhiyan (PMSMA) was launched in the year
2016 under National Health Mission. The program aims to provide assured, comprehensive and quality
antenatal care, free of cost, universally to all pregnant women on the 9th of every month. A fixed day ANC is
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given every month across the country. If the 9th day of the month is a Sunday/ a holiday, then the Clinic is to
be organized on the next working day. This service is given in addition to the routine ANC at the health
facility.

Goal of the PMSMA

Pradhan Mantri SurakshitMatritva Abhiyan envisages to improve the quality and coverage of Antenatal Care
(ANC) including diagnostics and counseling services as part of the Reproductive Maternal Neonatal Child
and Adolescent Health (RMNCH+A) Strategy.

Objectives of the program:

 Ensure at least one antenatal checkup for all pregnant women in their second or third trimester by a
physician/specialist
 Improve the quality of care during ante-natal visits. This includes ensuring provision of the following
services:
 All applicable diagnostic services
 Screening for the applicable clinical conditions
 Appropriate management of any existing clinical condition such as Anaemia, Pregnancy induced
hypertension, Gestational Diabetes etc.
 Appropriate counseling services and proper documentation of services rendered
 Additional service opportunity to pregnant women who have missed ante-natal visits
 Identification and line-listing of high risk pregnancies based on obstetric/ medical history and existing
clinical conditions.
 Appropriate birth planning and complication readiness for each pregnant woman especially those
identified with any risk factor or comorbid condition.
 Special emphasis on early diagnosis, adequate and appropriate management of women with
malnutrition.
 Special focus on adolescent and early pregnancies as these pregnancies need extra and specialized care
 
NavjaatShishu Suraksha Karyakram (NSSK): 
NSSK is a programme aimed to train health personnel in basic newborn care and resuscitation, has
been launched to address care at birth issues i.e. Prevention of Hypothermia, Prevention of Infection, Early
initiation of Breast feeding and Basic Newborn Resuscitation.
Newborn care and resuscitation are important starting-point for any neonatal program and is required
to ensure the best possible start in life.

Objective is to have a trained health personal in basic newborn care and resuscitation at every delivery point.
The training is for 2 days and is expected to reduce neonatal mortality significantly in the country.
 
National Programme for Family Planning: 
India was the first country in the world to have launched a National Programme for Family Planning in
1952. Over the decades, the programme has undergone transformation in terms of policy and actual
programme implementation and currently being repositioned to not only achieve population
stabilization goals but also promote reproductive health and reduce maternal, infant & child mortality
and morbidity. Under the programme public health sector provides various family planning services at
various levels of health system.
“Mission Pariwar Vikas”
For improved access to contraceptives and family planning services in high fertility districts spreading
over seven high focus states, the Ministry of Health and Family Welfare launched “Mission Pariwar
Vikas”in 2016. Special focus has been given to 146 high fertility Districts of Bihar, Uttar Pradesh, Assam,
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Chhattisgarh, Madhya Pradesh, Rajasthan & Jharkhand, with an aim to ensure availability of
contraceptive methods at all the levels of Health Systems.

Goal - Its overall goal is to reduce India's overall fertility rate to 2.1 by the year 2025

Objective -The key strategic focus of this initiative is on improving access to contraceptives through
delivering assured services, ensuring commodity security and accelerating access to high quality family
planning services.

Key strategies include –

 Providing more choices through newly introduced contraceptives: Injectable Contraceptive, MPA
(Medroxyprogesterone acetate) under Antara program and Chaya (earlier marketed as Saheli) will
be made freely available to all government hospitals.
 Emphasis on Spacing methods like IUCD
 Revitalizing Postpartum Family Planning including PPIUCD in order to capitalize on the
opportunity provided by increased institutional deliveries. Appointment of counselors at high
institutional delivery facilities is a key activity.
 Strengthening community-based distribution of contraceptives by involving ASHAs and Focused
IEC/ BCC efforts for enhancing demand and creating awareness on family planning
 Availability of Fixed Day Static Services at all facilities.
 Emphasis on minilap tubectomy services because of its logistical simplicity and requirement of
only MBBS doctors and not post graduate gynecologists/ surgeons.
 A rational human resource development plan for IUCD, minilap and NSV be chalked up to
empower the facilities (DH, CHC, PHC, SHC) with at least one provider each for each of the
services and Sub Center’s with ANMs trained in IUD insertion
 Ensuring quality care in Family Planning services by establishing Quality Assurance Committees
at state and district levels Plan for accreditation of more private/ NGO facilities to increase the
provider base for family planning services under PPP.
 Increasing male participation and promoting Non-scalpel vasectomy.
 Demand generation activities in the form of display of posters, billboards and other audio and
video materials in the various facilities be planned and budgeted.
 Strong Political Will and Advocacy at the highest level, especially in states with high fertility rates.
 
NATIONAL NUTRITIONAL PROGRAMMES: 
National Iodine Deficiency Disorders Control Programme: 

Iodine is required for the synthesis of the thyroid hormones, thyroxine (T4) and tri-iodothyronine (T3) and
essential for the normal growth and development and well being of all humans. It is a micronutrient and
normally required around 100-150 microgram for normal growth and development. Deficiency of iodine may
cause following disorders:
 Goiter
 Subnormal intelligence
 Neuromuscular weakness
 Endemic cretinism
 Still birth
 Hypothyroidism
 Defect in vision, hearing, and speech
 Spasticity
 Intrauterine death

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  Mental retardation
In 1992, the National Goiter Control Programme (NGCP) was renamed as National Iodine Deficiency
Disorder Control Programme (NIDDCP).

Objectives:
The important objectives and components of National Iodine Deficiency Disorders Control Iodine Deficiency
Disorders Control Programme (NIDDCP) are as follows:-
 Surveys to assess the magnitude of the Iodine Deficiency Disorders.
 Supply of iodated salt in place of common salt.
 Resurvey after every 5 years to assess the extent of Iodine Deficiency Disorders and the impact of
lodated salt.
 Laboratory monitoring of iodated salt and urinary iodine excretion.
 Health education and Publicity.
 
MAA  (Mothers’  Absolute  Affection)  Programme  for  Infant  and  Young  Child 
Feeding: 
MAA - "Mother’s Absolute Affection" is a nationwide programme of the Ministry of Health and Family
Welfare in an attempt to bring undiluted focus on promotion of breastfeeding and provision of counseling
services for supporting breastfeeding through health systems. The programme has been named ‘MAA’ to
signify the support a lactating mother requires from family members and at health facilities to breastfeed
successfully.

Goal –The ‘MAA’ Programme is to revitalize efforts towards promotion, protection and support of
breastfeeding practices through health systems to achieve higher breastfeeding rates.

Objective –
 Build an enabling environment for breastfeeding through awareness generation activities, targeting
pregnant and lactating mothers, family members and society in order to promote optimal breastfeeding
practices. Breastfeeding to be positioned as an important intervention for child survival and
development.
 Reinforce lactation support services at public health facilities through trained healthcare providers and
through skilled community health workers.
 To incentivize and recognize those health facilities that show high rates of breastfeeding along with
processes in place for lactation management.

Key components of the programme are –

 Communication for enhanced awareness and demand generation through mass media and mid media;
 Training and capacity enhancement of nurses at government institutions, and all ANMs and ASHAs.
They will provide information and counseling support to mothers for breastfeeding;
 Community engagement by ASHAs for breastfeeding promotion, who will conduct mothers’
meetings. Breastfeeding mothers requiring more support will be referred to a health facility or the
ANM sub-centre or the Village Health and Nutrition Day (VHND) organized every month at the
village level;
 Monitoring and impact assessment is an integral part of MAA programme. Progress will be measured
against key indicators, such as availability of skilled persons at delivery points for counseling,
improvement in breastfeeding practices and number of accredited health facilities; and
 Recognition and team awards will be given to facilities showing good performance, based on
evaluation against per pre-decided criteria.
 

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National Programme for Prevention and Control of Fluorosis (NPPCF): 
 
Fluorosis, a public health problem is caused by excess intake of fluoride through drinking water/food
products/industrial emission over a long period. It results in major health disorders like dental fluorosis,
skeletal fluorosis and non-skeletal fluorosis.

Prevalence - Fluoride prevalence was earlier reported in 230 districts of 19 States.

Goal - The NPPCF aims to prevent and control Fluorosis cases in the country.

Objectives - The Objectives of the National Programme for Prevention & Control of Fluorosis are as follows:
 Access and use the baseline survey data of fluorosis of Ministry of Drinking water & Sanitation;
 Comprehensive management of fluorosis in the selected areas;
 Capacity building for prevention, diagnosis and management of fluorosis cases.

Strategies –
 Surveillance of fluorosis in the community and school children
 Capacity building in the form of training and man power support
 Diagnostic facilities in the form of laboratory support & equipment including ion meter to monitor the
fluoride content in water and urinary levels;
 Health education for prevention and control of fluorosis cases;
 Management of fluorosis cases by providing for corrective surgeries and rehabilitation.
 
National Iron plus Initiative for Anemia Control: 

National Iron plus Initiative

for Anemia Control –
Anemia is a serious public
health challenge in India with
more than 50% prevalence
among the vulnerable groups
such as pregnant women,
infants, young children and
adolescents. Iron deficiency
being the most common form
nutritional anemia, National
Iron+ Initiative was launched
by the Adolescent Division of
the Ministry of Health and
Family Welfare (MoHFW),
Government of India.

Aim - To reach the following age groups for supplementation of Iron & Folic Acid

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National Vitamin A prophylaxis program: 

Vitamin A is an important micronutrient for maintaining normal growth, regulating cellular

proliferation and differentiation, controlling development, and maintaining visual and reproductive functions.
Diet surveys have shown that the intake of Vitamin A is significantly lower than the recommended daily
allowance in young children, adolescent girls and pregnant women. Prevalence of clinical and sub clinical
vitamin A deficiency in India is among the highest in the world.
In the fifties and sixties many of the states reported that blindness due to Vitamin A deficiency was
one of the major causes of blindness in children below five years. A five-year long field trial conducted by
NIN showed that if massive dose Vitamin A (200,000 units) was administered once in six months to children
between one and three years of age, the incidence of corneal xerophthalmia is reduced by about 80 per cent. In
view of the serious nature of the problem of blindness due to Vitamin A deficiency, it was felt that urgent
remedial measures in the form of massive dose Vitamin A supplementation covering the entire population of
susceptible children should be undertaken. In 1970, the National Prophylaxis Programme Against
Nutritional Blindness was initiated as a centrally sponsored scheme. Under this scheme, all children between
ages of one and three years were to be administered 200,000 IU of Vitamin A orally once in six months.
In an attempt to improve the coverage, especially of the first two doses, it was decided to link Vitamin A
administration to the ongoing immunization programme during the Eighth Plan period.
Finally, in the 2006, the age group of eligible children was broadened to include children between 6
months and 5 years after reconsidering recommendations of the WHO, UNICEF and Ministry of Women and
Child Development. From all as 9 months to 5 yr. of age (oral prophylactic dose)

Aim: to decrease the prevalence of Vitamin A deficiency

Objective:
1. Prevention of vitamin A deficiency
i. Promoting consumption of Vitamin A rich food –promotion of regular dietary intake of
Vitamin A rich foods by all pregnant and lactating women and by children under 5 years of age
by increasing local production and consumption of green leafy vegetables and other plant foods
those are rich sources of carotenoids.
ii. Creating awareness about the importance of preventing Vitamin A deficiency– among the
women’s attending Antenatal clinics, immunization session, as well as women and children
registered under ICDS programme.
iii. Prophylactic Vitamin A as per the following dosage schedule:
100000 IU at 9 months with measles immunization
200000 IU at 16-18 months, with DPT booster
200000 IU every 6 months, up to the age of 5 years.
Thus, a total of 9 mega doses are to be given from 9 months of age up to 5 years.
2. Treatment of Vitamin A deficient children
i. All children with xerophthalmia are to be treated at health facilities.
ii. All children having measles, to be given 1 dose of Vitamin A if they have not received it in the
previous month.
iii. All cases of severe malnutrition to be given one additional dose of Vitamin A.
 
Integrated Child Development Services (ICDS): 

Integrated Child Development Service (ICDS) scheme was launched on 2nd October, 1975 (5th Five
year Plan) in pursuance of the National Policy for Children in 33 experimental blocks. Now the goal is to
universalization of ICDS throughout the country. The primary responsibility for the implementation of the
programme is with the Department of Women and Child Development, Ministry of Human Resources

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Development at the Centre and the nodal departments at the state which may be Social Welfare, Rural
Development, Tribal Welfare, Health and Family Welfare or Women and Child Development.

Beneficiaries:
 Children below 6 years
 Pregnant and lactating women
 Women in the age group of 15-44 years
 Adolescent girls in selected blocks

Objectives:
1. Improve the nutrition and health status of children in the age group of 0-6 years
2. Lay the foundation for proper psychological, physical and social development of the child
3. Effective coordination and implementation of policy among the various departments
4. Enhance the capability of the mother to look after the normal health and nutrition needs through
proper nutrition and health education.
 
Mid‐Day Meal Programme: 

Tamil Nadu was the first to initiate a massive noon meal programme to children. Neither a child that is
hungry, nor a child that is ill can be expected to learn. Realizing this need the Mid-Day Meal (MDM) Scheme
was launched in primary schools during 1962-63. Mid-Day Meal improves three areas:
1. School attendance
2. Reduced dropouts
3. A beneficial impact on children’s nutrition
The Central Government supplies the full requirement of food grains for the programme free of cost.
For its implementation in rural areas, Panchayats and Nagarpalikas are also involved or setting up of
necessary infrastructure for preparing cooked food. For this purpose NGOs, women’s group and parent-
teacher councils can be utilized. The total charges for cooking, supervision and kitchen are eligible for
assistance under Poverty Alleviation Programme. In several states, supplementary feeding was assisted by
food supplies from Cooperation for American Relief Everywhere (CARE) and World Food Programme
(WFP). There are problems of administration and quality of food that have affected the programme outcomes.

Objectives:
The objectives of the mid day meal scheme are:
1. Improving the nutritional status of children in classes I – VIII in Government, Local Body and
Government aided schools, and EGS and AIE centers
2. Encouraging poor children, belonging to disadvantaged sections, to attend school more regularly and
help them concentrate on classroom activities.
3. Providing nutritional support to children of primary stage in drought-affected areas
 
COMMUNICABLE DISEASES: 
Integrated Disease Surveillance Program (IDSP): 
The Integrated Disease Surveillance Program (IDSP) was initiated in assistance with World Bank, in the year
2004. The Programme continues during 12th Plan (2012–17) under National Health Mission with a budget of
Rs. 64.04 Crore from domestic budget only. The scheme aimed to strengthen disease surveillance for
infectious diseases to detect and respond to outbreaks immediately. The Central Surveillance Unit (CSU) at
the National Centre for Disease Control (NCDC), receives disease outbreak reports from the States/UTs on
weekly basis. Even NIL weekly reporting is mandated and compilation of disease outbreaks/alerts is done on
weekly basis.

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The surveillance data is collected on three specified reporting formats, namely “S” (suspected cases), “P”
(presumptive cases) and “L” (laboratory confirmed cases) filled by Health Workers, Clinicians and
Laboratory staff respectively. State/District Surveillance Units analyses this data weekly, to interpret the
disease trends and seasonality of diseases.

Objective:
To strengthen/maintain decentralized laboratory-based IT enabled disease surveillance system for epidemic-
prone diseases to monitor disease trends and to detect and respond to outbreaks in early rising phase through
trained Rapid Response Team (RRTs).

Programme Components:
 Integration and decentralization of surveillance activities through the establishment of surveillance
units at Centre, State and District level.
 Human Resource Development – Training of State Surveillance Officers, District Surveillance
Officers, Rapid Response Team and other Medical and Paramedical staff on principles of disease
surveillance.
 Use of Information Communication Technology for collection, collation, compilation, analysis and
dissemination of data.
 Strengthening of public health laboratories.
 Inter sectoral Co-ordination for zoonotic disease
 
National Tuberculosis Elimination Programme: 
Tuberculosis (TB) control activities are implemented in the country for more than 50 years. The National TB
Programme (NTP) was launched by the Government of India in 1962 in the form of District TB Centre model
involved with BCG vaccination and TB treatment. In 1978, BCG vaccination was shifted under the Expanded
Programme on Immunization. A joint review of NTP was done by Government of India, World Health
Organization (WHO) and the Swedish International Development Agency (SIDA) in 1992 and some
shortcomings were found in the programme such as managerial weaknesses, inadequate funding, over-
reliance on x-ray, non-standard treatment regimens, low rates of treatment completion, and lack of systematic
information on treatment outcomes.
Around the same time in1993, the WHO declared TB as a global emergency, devised the directly observed
treatment – short course (DOTS), and recommended to follow it by all countries. The Government of India
revitalized NTP as Revised National TB Control Programme (RNTCP) in the same year. DOTS were
officially launched as the RNTCP strategy in 1997 and by the end of 2005 the entire country was covered
under the programme.
During 2006–11, in its second phase RNTCP improved the quality and reach of services, and worked to reach
global case detection and cure targets. These targets were achieved by 2007-08. Despite these achievements,
undiagnosed and mistreated cases continued to drive the TB epidemic. TB was the leading cause of illness
and death among persons living with HIV/AIDS and large number of multidrug resistant TB (MDR-TB) cases
was reported every year. During this period for achievement of the long term vision of a “TB free India”,
National Strategic Plan for Tuberculosis Control 2012-2017 was documented with the goal of ‘universal
access to quality TB diagnosis and treatment for all TB patients in the community’.
Significant interventions and initiatives were taken during NSP 2012-2017 in terms of mandatory notification
of all TB cases, integration of the programme with the general health services (National Health Mission),
expansion of diagnostics services, programmatic management of drug resistant TB (PMDT) service
expansion, single window service for TB-HIV cases, national drug resistance surveillance and revision of
partnership guidelines.
However, to eliminate TB in India by 2025, five years ahead of the global target, a framework to guide the
activities of all stakeholders including the national and state governments, development partners, civil society
organizations, international agencies, research institutions, private sector, and many others whose work is
14 | p a g e         Notes By: Mr. Vinay D. Gaikwad 
relevant to TB elimination in India is formulated by RNTCP as National Strategic Plan for Tuberculosis
Elimination 2017-2025.
‘National strategic plan for tuberculosis elimination 2017-2025’-
RNTCP has released a ‘National strategic plan for tuberculosis 2017-2025’ (NSP) for the control and
elimination of TB in India by 2025. According to the NSP TB elimination has been integrated into the four
strategic pillars of “Detect – Treat – Prevent – Build” (DTPB).
 
National Leprosy Eradication Programme: 

Introduction
The National Leprosy Eradication Programme is a centrally sponsored Health Scheme of the Ministry of
Health and Family Welfare, Govt. of India. The Programme is headed by the Deputy Director of Health
Services (Leprosy ) under the administrative control of the Directorate General Health Services Govt. of
India. While the NLEP strategies and plans are formulated centrally, the programme is implemented by the
States/UTs. The Programmes also supported as Partners by the World Health Organization, The International
Federation of Anti-leprosy Associations (ILEP) and few other Non-Govt. Organizations.
The year 2012-13 started with 0.83 lakh leprosy cases on record as on 1st April 2012, with PR 0.68/10,000.
Till then 33 States/ UTs had attained the level of leprosy elimination. A total of 542 districts (84.7%) out of
total 640 districts also achieved elimination by March2012. A total of 209 high endemic districts were
identified for special actions during 2012-13. After thorough analysis a total of 1792 blocks and 150 urban
areas were identified for special activity plan (SAP- 2012). The States were advised to post well trained
District Leprosy Officer in all the districts where these blocks are located. In addition one officer should be
identified in each of these blocks to strengthen the process of supervision and monitoring. Active house to
house survey was the main strategy along with IEC and capacity building of the workers and volunteers. This
activity helped in detection of more than 20,000 new cases during 2012-13

Objectives:
1. Early detection through active surveillance by the trained health workers;
2. Regular treatment of cases by providing Multi-Drug Therapy (MDT) at fixed in or centers a nearby village
of moderate to low endemic areas/district;
3. Intensified health education and public awareness campaigns to remove social stigma attached to the
disease.
4. Appropriate medical rehabilitation and leprosy ulcer care services.
 
National Centre for Vector Borne Diseases Control: 
Introduction
Launched in 2003-04 by merging National anti -malaria control programme ,National Filaria Control
Programme and Kala Azar Control programmes .Japanese B Encephalitis and Dengue/DHF have also been
included in this Program Directorate of NAMP is the nodal agency for prevention and control of major Vector
Borne Diseases
List of Vector Borne Diseases Control Programme Legislations:
1) National Anti - Malaria programme
2) Kala - Azar Control Programme
3) National Filaria Control Programme
4) Japenese Encephilitis Control Programme
5) Dengue and Dengue Hemorrhagic fever

15 | p a g e         Notes By: Mr. Vinay D. Gaikwad 
1) NATIONAL ANTI - MALARIA PROGRAMME
Malaria is one of the serious public health problems in India. At the time of independence malaria was
contributing 75 million cases with 0.8 million deaths every year prior to the launching of National Malaria
Control Programme in 1953. A countrywide comprehensive programme to control malaria was recommended
in 1946 by the Bhore committee report that was endorsed by the Planning Commission in 1951. The national
programme against malaria has a long history since that time. In April 1953, Govt. of India launched a
National Malaria Control Programme (NMCP).

Objective:
 To bring down malaria transmission to a level at which it would cease to be a major public health
problem.
2) KALA -AZAR CONTROL PROGRAMME
Kala-azar or visceral leishmaniasis (VL) is a chronic disease caused by an intracellular protozoan (Leishmania
species) and transmitted to man by bite of female phlebotomus sand fly.Currently, it is a main problem in
Bihar, Jharkhand, West Bengal and some parts of Uttar Pradesh. In view of the growing problem planned
control measures were initiated to control kala-azar.

Objectives:
The strategy for kala-azar control broadly included three main activities.
 Interruption of transmission by reducing vector population through indoor residual insecticides.
 Early diagnosis and complete treatment of Kala-azar cases; and
 Health education programme for community awareness.
3) NATIONAL FILARIA CONTROL PROGRAMME
Bancroftian filariasis caused by Wuchereria bancrofti, which is transmitted to man by the bites of infected
mosquitoes - Culex, Anopheles, Mansonia and Aedes. Lymphatia filaria is prevalent in 18 states and union
territories. Bancroftian filariasis is widely distributed while brugian filariasis caused by Brugia malayi is
restricted to 7 states - UP, Bihar, Andhra Pradesh, Orissa, Tamil Nadu, Kerala, and Gujarat. The National
Filaria Control Programme was launched in 1955. The activities were mainly confined to urban areas.
However, the programme has been extended to rural areas since 1994.

Objectives:
 Reduction of the problem in un-surveyed areas
 Control in urban areas through recurrent anti-larval and anti-parasitic measures.
4) JAPANESE ENCEPHALITIS CONTROL PROGRAMME
Japanese encephalitis (JE) is a zoonotic disease and caused by an arbovirus, group B (Flavivirus) and
transmitted by Culex mosquitoes. This disease has been reported from 26 states and UTs since 1978, only 15
states are reporting JE regularly. The case fatality in India is 35% which can be reduced by early detection,
immediate referral to hospital and proper medical and nursing care. The total population at risk is estimated
160 million. The most disturbing feature of JE has been the regular occurrence of outbreak in different parts
of the country.
Govt. of India has constituted a Task Force at National Level which is in operation and reviews the JE
situations and its control strategies from time to time. Though Directorate of National Anti-Malaria
Programme is monitoring JE situation in the country.

Objectives:
 Strengthening early diagnosis and prompt case management at PHCs, CHCs and hospitals through
training of medical and nursing staff.
 IEC for community awareness to promote early case reporting, personal protection, isolation of
amplifier host, etc.;
 Vector control measures mainly fogging during outbreaks, space spraying in animal dwellings, and
antilarval operation where feasible; and

16 | p a g e         Notes By: Mr. Vinay D. Gaikwad 
  Development of a safe and standard indigenous vaccine. Vaccination for high risk population
particularly children below 15 years of age.
5) DENGUE AND DENGUE HEMORRHAGIC FEVER
One of the most important resurgent tropical infectious disease is dengue. Dengue Fever and Dengue
Hemorrhagic Fever (DHF) are acute fevers caused by four antigenically related but distinct dengue virus
serotypes (DEN 1,2,3 and 4) transmitted by the infected mosquitoes, Aedes aegypti. Dengue outbreaks have
been reported from urban areas from all states. All the four serotypes of dengue virus (1,2,3 and 4) exist in
India. The Vector Aedes Aegypti breed in peridomestic fresh water collections and is found in both urban and
rural areas.

Objectives:
 Surveillance for disease and outbreaks
 Early diagnosis and prompt case management
 Vector control through community participation and social mobilization
 Capacity building
 
National AIDS Control Programme: 

HIV infection in India is a major challenge with no State free from the virus. HIV/AIDS continues to show
itself to be one of India's most complex epidemics - a challenge that goes beyond public health, raising
fundamental issues of human rights and threatening development achievements in many areas. The need to
prevent the progression of the epidemic and provide care and support for those infected or affected is calling
for an unprecedented response from all sections of society. The National AIDS Control Organization,
Ministry of Health and Family Welfare has launched the National AIDS Control Programme- II, from
December, 1999. The new national programme in implementation sees the country on the threshold of a new
approach - marked by focusing on encouraging and enabling the States themselves to take on the
responsibility of responding to the epidemic. It is also leading to growing partnerships between government,
NGOs and civil society. 

Objectives:
1. To reduce spread of HIV infection in India
2. Strengthen India's capacity to respond to HIV/AIDS on a long term basis.
Reflecting the extreme urgency with which HIV prevention and control need to be pursued in India, the AIDS
- II project of the National AIDS Control Programme is across all States and Union Territories and a Centrally
Sponsored Scheme with 100% financial assistance from Government of India direct to State AIDS Control
Societies and selected Municipal Corporations/AIDS Control Societies.
 
Pulse Polio Programme: 

Introduction
With the global initiative of eradication of polio in 1988 following World Health Assembly resolution in
1988, Pulse Polio Immunization programme was launched in India in 1995. Children in the age group of 0-5
years administered polio drops during National and Sub-national immunization rounds (in high risk areas)
every year. About 172 million children are immunized during each National Immunization Day (NID).
The last polio case in the country was reported from Howrah district of West Bengal with date of onset 13th
January 2011. Thereafter no polio case has been reported in the country (25th May 2012).
WHO on 24th February 2012 removed India from the list of countries with active endemic wild polio virus
transmission.

17 | p a g e         Notes By: Mr. Vinay D. Gaikwad 
Objective:
The Pulse Polio Initiative was started with an objective of achieving hundred per cent coverage under Oral
Polio Vaccine. It aimed to immunize children through improved social mobilization, plan mop-up operations
in areas where poliovirus has almost disappeared and maintain high level of morale among the public.
 
National Viral Hepatitis Control Program (NVHCP): 
The National Viral Hepatitis Control Program has been launched by Ministry of Health and Family Welfare,
Government of India on the occasion of the World Hepatitis Day, 28th July 2018. It is an integrated initiative
for the prevention and control of viral hepatitis in India to achieve Sustainable Development Goal (SDG) 3.3
which aims to ending viral hepatitis by 2030. This is a comprehensive plan covering the entire gamut from
Hepatitis A, B, C, D & E, and the whole range from prevention, detection and treatment to mapping treatment
outcomes. Operational Guidelines for National Viral Hepatitis Control Program, National Laboratory
Guidelines for Viral Hepatitis Testing and National Guidelines for Diagnosis and Management of Viral
Hepatitis were also released.

Aim:
1. Combat hepatitis and achieve country wide elimination of Hepatitis C by 2030;
2. Achieve significant reduction in the infected population, morbidity and mortality associated with
Hepatitis B and C viz. Cirrhosis and Hepato-cellular carcinoma (liver cancer);
3. Reduce the risk, morbidity and mortality due to Hepatitis A and E.

Key Objectives:
1. Enhance community awareness on hepatitis and lay stress on preventive measures among general
population especially high-risk groups and in hotspots.
2. Provide early diagnosis and management of viral hepatitis at all levels of healthcare
3. Develop standard diagnostic and treatment protocols for management of viral hepatitis and its
complications.
4. Strengthen the existing infrastructure facilities, build capacities of existing human resources and raise
additional human resources, where required, for providing comprehensive services for management of
viral hepatitis and its complications in all districts of the country.
5. Develop linkages with the existing National programs towards awareness, prevention, diagnosis and
treatment for viral hepatitis.
6. Develop a web-based “Viral Hepatitis Information and Management System” to maintain a registry of
persons affected with viral hepatitis and its squeal.

National Rabies Control Programme: 
Rabies is an acute viral disease that causes fatal encephalomyelitis in virtually all the warm-blooded animals
including human. The virus is found in wild and some domestic animals, and is transmitted to other animals
and to humans through their saliva (following bites, scratches, licks on broken skin and mucous membrane).
In India, dogs are responsible for about 97% of human rabies, followed by cats (2%), and others (1%).
The disease is invariably fatal and perhaps the most painful and dreadful of all communicable diseases in
which the sick person is tormented at the same time with thirst and fear of water (hydrophobia). Fortunately,
development of rabies can be prevented to a large extent if animal bites are managed appropriately and in
time. In this regard the post-exposure treatment of animal bite cases are of prime importance.
National Centre for Disease Control (formerly National Institute of Communicable Diseases), Delhi, WHO
Collaborating Centre for Rabies Epidemiology, organized an expert consultation in 2002 to formulate national
guidelines for rabies prophylaxis to bring out uniformity in post-exposure prophylaxis practices. Due to new
interventions in this field, it has been further revised over the years.

18 | p a g e         Notes By: Mr. Vinay D. Gaikwad 
Under the 12 five-year plan, National Rabies Control Programme (NRCP) has been approved. The NRCP has
both human and animal health components.

Human Component - which is being implemented in all the states & UTs. National Centre for the Diseases
control is the nodal agency for the Human Component of the program. The strategies for the human
component are:
 Training of health professionals
 Implementing use of intra-dermal route of inoculation of cell culture vaccines
 Strengthening surveillance of human rabies
 Information Education & Communication
 Laboratory strengthening

Animal Component- which is being pilot tested in the Haryana & Chennai. The Animal Welfare Board of
India, Ministry of Environment & Forests is the Nodal agency for the Animal Component of the program. The
strategies for the animal component are:
 Population survey of dogs
 Mass vaccination of dogs
 Dog population management
 Strengthening surveillance
 
National Programme on Containment of Anti‐Microbial Resistance (AMR): 
Antimicrobial resistance in pathogens causing important communicable diseases has become a matter of great
public health concern globally including our country. Resistance has emerged even to newer & more potent
antimicrobial agents like Carbapenems.
The rapid spread of multi-resistant bacteria and the lack of new antibiotics to treat infections caused by these
organisms pose a rapidly increasing threat to public and animal health and needs to be tackled if we are to
contain the problem and prevent untreatable illness becoming a reality.
India has given due cognizance to the problem of Antimicrobial resistance (AMR) and to tackle this issue,
Government of India has launched a “National Programme on Containment of Antimicrobial Resistance”
under the 12th five-year plan (2012-2017).

The main objectives of this programme are:

 To establish a laboratory-based AMR surveillance system of 30 network labs in the country and to
generate quality data on antimicrobial resistance for pathogens of public health importance.
 To strengthen infection control guidelines and practices and promote rationale use of antibiotics.
 To generate awareness among healthcare providers and in the community about rationale use of
antibiotics.

Activities to be carried out under the programme

 Surveillance for Containment of Antimicrobial Resistance in various geographical regions.
 Rational use of antibiotics.
 Development & implementation of national infection control guidelines.
 Training and capacity building of professionals in relevant sectors.
 IEC for dissemination of information about rational use of antibiotics.
 Development of National Repository of Bacterial strains / cultures.
 
NON‐COMMUNICABLE DISEASES: 
National Tobacco Control Programme: 

19 | p a g e         Notes By: Mr. Vinay D. Gaikwad 
Introduction

Tobacco use is one of the main risk factors for a number of chronic diseases, including cancer, lung diseases,
and cardiovascular diseases. India is the 2nd largest producer and consumer of tobacco and a variety of forms
of tobacco use is unique to India. Apart from the smoked forms that include cigarettes, bidis and cigars, a
plethora of smokeless forms of consumption exist in the country.

The Government of India has enacted the national tobacco-control legislation namely, “The Cigarettes and
other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production,
Supply and Distribution) Act, 2003” in May, 2003. India also ratified the WHO-Framework Convention on
Tobacco Control (WHO-FCTC) in February2004. Further, in order to facilitate the effective implementation
of the Tobacco Control Law, to bring about greater awareness about the harmful effects of tobacco as well as
to fulfill the obligations under the WHO-FCTC, the Ministry of Health and Family Welfare, Government of
India launched the National Tobacco Control Programme (NTCP) in 2007- 08 in 42 districts of 21
States/Union Territories of the country.

Objectives:

To bring about greater awareness about the harmful effects of tobacco use and Tobacco Control Laws.
To facilitate effective implementation of the Tobacco Control Laws.
The objective of this programme is to control tobacco consumption and minimize the deaths caused by it.

The various activities planned to control tobacco use are as follows:

1. Training and Capacity Building
2. IEC activity
3. Monitoring Tobacco Control Laws and Reporting
4. Survey and Surveillance
 
National Program for Prevention and Control of Cancer, Diabetes, CVD and Stroke 
(NPCDCS): 
States have already initiated some of the activities for prevention and control of non communicable diseases
(NCDs) especially cancer, diabetes, CVDs and stroke. The Central Govt. proposes to supplement their efforts
by providing technical and financial support through National Program for Prevention and Control of Cancer,
Diabetes, CVD and Stroke (NPCDCS). The NPCDCS program has two components viz. (i) Cancer (ii)
Diabetes, CVDs and Stroke. These two components have been integrated at different levels as far as possible
for optimal utilization of the resources. The activities at State, Districts, CHC and Sub Centre level have been
planned under the programme and will be closely monitored through NCD cell at different levels.
The NPCDCS aims at integration of NCD (non-communicable diseases) interventions in the NRHM
framework for optimization of scarce resources and provision of seamless services to the end customer /
patients as also for ensuring long term sustainability of interventions. Thus, the institutionalization of
NPCDCS at district level within the District Health Society, sharing administrative and financial structure of
NRHM becomes a crucial programme strategy for NPCDCS. The NCD cell at various levels will ensure
implementation and supervision of the programme activities related to health promotion, early diagnosis,
treatment and referral, and further facilitates partnership with laboratories for early diagnosis in the private
sector. Simultaneously, it will attempt to create a wider knowledge base in the community for effective
prevention, detection, referrals and treatment strategies through convergence with the ongoing interventions
of National Rural Health Mission (NRHM), National Tobacco Control Programme (NTCP), and National
Programme for Health Care of Elderly (NPHCE) etc and build a strong monitoring and evaluation system
through the public health

20 | p a g e         Notes By: Mr. Vinay D. Gaikwad 
Objectives:
 Prevent and control common NCDs through behavior and life style changes,
 Provide early diagnosis and management of common NCDs,
 Build capacity at various levels of health care for prevention, diagnosis and treatment of common
NCDs,
 Train human resource within the public health setup via doctors, paramedics and nursing staff to cope
with the increasing burden of NCDs
 Establish and develop capacity for palliative and rehabilitative care.
 
National Programme for Control and Treatment of Occupational Disease: 
Burden of Occupational Disease in Injuries
Major occupational diseases can be divided in following categories:

1. Occupational injuries
2. Occupational lung diseases
3. Occupational cancers
4. Occupational dermatoses
5. Occupational Infections
6. Occupation toxicology
7. Occupational mental disorders
8. Others

Occupational health was one of the components of the National Health Policy 1983 and also included in
National Health Policy 2002 but very little attention has been paid to mitigate the effect of occupational
disease through proper programme. Ministry of Health and Family Welfare, Govt. of India has launched a
scheme entitled “National Programme for Control and Treatment of Occupational Diseases” in 1998-99. The
National Institute of Occupational Health, Ahmedabad (ICMR) has been identified as the nodal agency for the
same.
 
National Programme for Prevention and Control of Deafness: 
Introduction
Hearing loss is the most common sensory deficit in humans today. World over, it is the second leading cause
for ‘Years lived with Disability (YLD)’ the first being depression. There are large number of hearing
impaired young people in India which amounts to a severe loss of productivity, both physical and economic.
An even larger percentage of our population suffers from milder degrees of hearing loss and unilateral (one
sided) hearing loss against the above background, The Ministry of Health and Family Welfare, Govt. of India
launched the pilot phase of National Program for Prevention and Control of Deafness (from 2006 to 2008) in
10 States and 1 Union Territory in an effort to tackle the high incidence of deafness in the country , in view
of the preventable nature of this disability. The Programme was a 100% Centrally Sponsored Scheme during
11th Five Year Plan. However, in as per the 12th Five Year Plan, the Centre and the States will have to pool
in resources financial norms of NRHM mutas mutandis. The Programme was initiated in year 2007 on pilot
mode in 25 districts of 11 State/UTs. The Programme has been expanded to 192 districts of 20 States/UTs. In
the 12th Plan, it is proposed to expand the Programme to additional 200 districts in a phased manner probably
covering all the States and Union territories by March, 2017.

Objectives of the Programme

1. To prevent the avoidable hearing loss on account of disease or injury.
2. Early identification, diagnosis and treatment of ear problems responsible for hearing loss and deafness

21 | p a g e         Notes By: Mr. Vinay D. Gaikwad 
3. To medically rehabilitate persons of all age groups, suffering with deafness.
4. To strengthen the existing inter-sectoral linkages for continuity of the rehabilitation Program, for persons
with deafness
5. To develop institutional capacity for ear care services by providing support for equipment and material
and training personnel.
 
National Mental Health Programme: 
The Mental Health Care Act 2017 was passed on 7 April 2017 and came into force from July 7, 2018.The law
was described in its opening paragraph as "An Act to provide for mental healthcare and services for persons
with mental illness and to protect, promote and fulfill the rights of such persons during delivery of mental
healthcare and services and for matters connected therewith or incidental thereto. “This Act superseded the
previously existing the Mental Health Act, 1987 that was passed on 22 May 1987.
Recognizing that Persons with mental illness constitute a vulnerable section of society and are subject to
discrimination in our society; Families bear disproportionate financial, physical, mental, emotional and social
burden of providing treatment and care for their relatives with mental illness; Persons with mental illness
should be treated like other persons with health problems and the environment around them should be made
conducive to facilitate recovery rehabilitation and full participation in society.
The Government of India launched the National Mental Health Programme (NMHP) in 1982, keeping in view
the heavy burden of mental illness in the community, and the absolute inadequacy of mental health care
infrastructure in the country to deal with it. The district Mental Health Program was added to the Program in
1996. The Program was re-strategized in 2003 to include two schemes, viz. Modernization of State Mental
Hospitals and Up-gradation of Psychiatric Wings of Medical Colleges/General Hospitals. The Manpower
development scheme (Scheme-A & B) became part of the Program in 2009.

3 main components of NMHP -

 Treatment of Mentally ill
 Rehabilitation
 Prevention and promotion of positive mental health.

Objectives -
 To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable
future;
 To encourage the application of mental health knowledge in general healthcare and in social
development;
 To promote community participation in the mental health service development; and
 To enhance human resource in mental health sub-specialties.

Strategies -
 Integration mental health with primary health care through the NMHP
 Provision of tertiary care institutions for treatment of mental disorders
 Eradicating stigmatization of mentally ill patients and protecting their rights through regulatory
institutions like the Central Mental Health Authority, and State Mental health Authority.
 
National Programme for Control of Blindness: 
The National Programme for Control of Visual Impairment and Blindness was launched in 1976 as a 100%
centrally sponsored and incorporates the earlier Trachoma Control Programme that was started in 1963.

Goals:
22 | p a g e         Notes By: Mr. Vinay D. Gaikwad 
  To reduce the prevalence of blindness (1.49% in 1986-89) to less than 0.3%
 To establish an infrastructure and efficiency levels in the programme to be able to cater new cases of
blindness each year to prevent future backlog.

Objectives:
 To establish eye care facilities for every 5 lakh population,
 To develop human resources for eye care services at all levels the primary health centers, CHCs, sub-
district levels,
 To improve quality of service delivery and
 To secure participation of civil society and the private sector.
 
National Programme for Prevention and Management of Burn Injuries: 
“Burn” is a major Public Health Problem all over the world. As per WHO report 2014, in India, over
1,000,000 people are moderately or severely burnt every year. As per the data extrapolated from the
information received from 3 major Govt. Hospitals in Delhi, approx. 1.4 lakh people die of burn injuries
annually. This comes to one death every 4 minutes due to burns. Moreover, unlike other injuries, Burn Injury
is accompanied by trauma, scars and disfigurement, which takes years to heal both physically and
psychologically. Many of the burn injury patients require psychological counseling as well as
physiotherapeutic rehabilitation and repeated plastic surgeries for many years, thus, augmenting their financial
hardship.
However, the death and disability due to burn injury are preventable to a great extent if timely and
appropriate treatment is provided by trained personnel. Unfortunately, most of the burn victims belongs to
vulnerable group of the society, who fail to receive appropriate treatment as, in most part of India, there is no
availability of treatment facilities which provide specific treatment for burn injuries.
Under such circumstances, and keeping in view the rising number of deaths due to burn injuries, a project was
initiated during the 11th Five Year Plan by the Directorate General of Health Services, Ministry of Health &
Family Welfare, for development of burn units in identified Medical Colleges and District Hospitals. The
project is now being continued as a full-fledged National Programme in the name of ͞”NationalProgramme for
Prevention & Management of Burn Injuries (NPPMBI)͟”during the 12th Five Year Plan.

Objectives of the programme

 To reduce incidence, mortality, morbidity and disability due to Burn Injuries.
 To improve the awareness among the general masses and vulnerable groups especially the women,
children, industrial and hazardous occupational workers.
 To establish adequate network of infrastructural facilities along with trained personnel for burn
management and rehabilitation.
 To carry out research for assessing behavioral, social and other determinants of Burn Injuries in our
country for effective need based program planning for Burn Injuries, monitoring and subsequent
evaluation.
 
National Oral Health Programme: 
Oral health is important for overall health and good quality of life. Oral diseases affect all the age groups.
Some common oral diseases are dental caries, periodontal diseases, malocclusion, oral sub-mucous fibrosis,
oral cancer, cleft lip and cleft palate etc.
According to the World Health Organization (WHO), Oral health is a state of being free from chronic mouth
and facial pain, oral and throat cancer, oral sores, birth defects such as cleft lip and palate, periodontal (gum)
disease, tooth decay and tooth loss, and other diseases and disorders that affect the oral cavity.

23 | p a g e         Notes By: Mr. Vinay D. Gaikwad 
Dental caries and gum diseases affect nearly 60% and 80%, of the Indian population, respectively. Oral
diseases have also been linked to bacterial endocarditic, atherosclerosis, chronic obstructive lung diseases and
preterm low birth weight. Periodontal health has directly linked with diabetes.
Routine dental check-ups and early intervention can prevent most common dental problems. To our dismay
oral health has been neglected over the years, due to lack of awareness among general population and even the
care providers, especially in the underprivileged areas. According to the data from Dental Council of India,
72% of the population lives in villages which remain deprived from dental care.
Though some states have made progress in providing comprehensive oral health care through its primary care
system, a lot still remains to be achieved in the whole country. Therefore, oral health care delivery of the
country needs to be strengthened for efficient oral health care delivery and improvement of oral health
indicators and overall health of the population of the country
Ministry of Health and Family Welfare, Government of India has envisaged the National Oral Health Program
[NOHP] for an affordable, accessible and equitable oral health care delivery in a well- coordinated manner for
bringing about “optimal oral health” for all by 2020.

Objectives:
 • To improve the determinants of oral health
 • To reduce morbidity from oral diseases
 • To integrate oral health promotion and preventive services with general health care system
 • To encourage Promotion of Public Private Partnerships (PPP) model for achieving better oral health.
To achieve these objectives, Government of India has decided to assist the State Governments in initiating
provision of dental care along with other ongoing health programmes implemented at various levels of the
primary health care system under the umbrella of National Health Mission.
Through NOHP, states are provided necessary funds by the government of India to establish dental units
equipped with necessary trained manpower, equipment including dental chair and consumable dental
materials.
Government of India also helps in developing prototype Information, Education and Communication (IEC)
materials/Behavior Change Communication (BCC) materials for dissemination of information and to raise
awareness about Oral Health across the country.
Monitoring of programme implementation and progress of NOHP is carried out by the National Oral Health
Cell (NOHC) at central level and at state level programme is monitored by state nodal officer. Organizational

Structure of NOHP includes:

 National Oral Health Cell (NOHC)
 State Oral Health Cell (SOHC)
 District Oral Health Cell (DOHC
 
HEALTH SYSTEM STRENGTHENING PROGRAMS 
Ayushman Bharat Yojana: 
Ayushman Bharat or “Healthy India” is a national initiative launched by Prime Minister Narendra Modi as the
part of National Health Policy 2017, in order to achieve the vision of Universal Health Coverage (UHC). This
initiative has been designed on the lines as to meet SDG and its underlining commitment, which is “leave no
one behind”.
AyushmanBharat is an attempt to move from sectoral and segmented approach of health service delivery to a
comprehensive need-based health care service. Ayushman Bharat aims to undertake path breaking
interventions to holistically address health (covering prevention, promotion and ambulatory care), at primary,
secondary and tertiary level.
Ayushman Bharat adopts a continuum of care approach, comprising of two inter-related components, which
are -
24 | p a g e         Notes By: Mr. Vinay D. Gaikwad 
Establishment of Health and Wellness Centres
Pradhan Mantri Jan Arogya Yojana (PM-JAY)
1. Establishment of Health and Wellness Centres–The first component, pertains to creation of
1,50,000 Health and Wellness Centres which will bring health care closer to the homes of the people.
These centres will provide Comprehensive Primary Health Care (CPHC), covering both maternal and
child health services and non-communicable diseases, including free essential drugs and diagnostic
services.
2. Pradhan Mantri Jan Arogya Yojana (PM-JAY) –PM-JAY is one significant step towards
achievement of Universal Health Coverage (UHC) and Sustainable Development Goal - 3 (SDG3).It
aims to provide health protection cover to poor and vulnerable families against financial risk arising
out of catastrophic health episodes.
Pradhan Mantri Jan Arogya Yojana (PM-JAY) will provide financial protection (Swasthya Suraksha) to 10.74
crore poor, deprived rural families and identified occupational categories of urban workers’ families as per the
latest Socio-Economic Caste Census (SECC) data (approx. 50 crore beneficiaries). It will have offer a benefit
cover of Rs. 500,000 per family per year (on a family floater basis).
PM-JAY will cover medical and hospitalization expenses for almost all secondary care and most of tertiary
care procedures. PM-JAY has defined 1,350 medical packages covering surgery, medical and day care
treatments including medicines, diagnostics and transport.
To ensure that nobody is left out (especially girl child, women, children and elderly), there will be no cap on
family size and age in the Mission. The scheme will be cashless & paperless at public hospitals and
empaneled private hospitals. The beneficiaries will not be required to pay any charges for the hospitalization
expenses. The benefit also includes pre and post-hospitalization expenses. The scheme is an entitlement
based, the beneficiary is decided on the basis of family being figured in SECC database. When fully
implemented, the PM-JAY will become the world’s largest government funded health protection mission.
 
Pradhan Mantri Swasthya Suraksha Yojana (PMSSY): 
The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) aims at correcting the imbalances in the
availability of affordable healthcare facilities in the different parts of the country in general, and augmenting
facilities for quality medical education in the under-served States in particular. The scheme was approved in
March 2006.
The first phase in the PMSSY has two components - setting up of six institutions in the line of AIIMS; and
upgradation of 13 existing Government medical college institutions.
It has been decided to set up 6 AIIMS-like institutions, one each in the States of Bihar (Patna), Chattisgarh
(Raipur), Madhya Pradesh (Bhopal), Orissa (Bhubaneswar), Rajasthan (Jodhpur) and Uttaranchal (Rishikesh)
at an estimated cost of Rs 840 crores per institution. These States have been identified on the basis of various
socio-economic indicators like human development index, literacy rate, population below poverty line and per
capital income and health indicators like population to bed ratio, prevalence rate of serious communicable
diseases, infant mortality rate etc. Each institution will have a 960 bedded hospital (500 beds for the medical
college hospital; 300 beds for Speciality/Super Speciality; 100 beds for ICU/Accident trauma; 30 beds for
Physical Medicine & Rehabilitation and 30 beds for Ayush) intended to provide healthcare facilities in 42
Speciality/Super-Speciality disciplines. Medical College will have 100 UG intake besides facilities for
imparting PG/doctoral courses in various disciplines, largely based on Medical Council of India (MCI) norms
and also nursing college conforming to Nursing Council norms.
In addition to this, 13 existing medical institutions spread over 10 States will alsobe upgraded, with an outlay
of Rs. 120 crores (Rs. 100 crores from Central Government and Rs. 20 crores from State Government) for
each institution. These institutions are Government Medical College, Jammu, Jammu & Kashmir Government
Medical College, Srinagar, Jammu & Kashmir, Kolkatta Medical College, Kolkatta, West Bengal, Sanjay
Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, Institute of Medical Sciences,
BHU, Varanasi, Uttar Pardesh, Nizam Institute of Medical Sciences, Hyderabad, Andhra Pradesh, Sri
Venkateshwara Institute of Medical Sciences, Tirupati, Andhra Pradesh, Government. Medical College,
25 | p a g e         Notes By: Mr. Vinay D. Gaikwad 
Salem, Tamil Nadu, B.J. Medical College, Ahmedabad, Gujarat, Bangalore Medical College, Bangalore,
Karnataka, Government Medical College, Thiruvananthapuram, Kerala, Rajendra Institute of Medical
Sciences (RIMS), Ranchi and Grants Medical College & Sir J.J. Group of Hospitals, Mumbai, Maharashtra.
In the second phase of PMSSY, the Government has approved the setting up of two more AIIMS-like
institutions, one each in the States of West Bengal and Uttar Pradesh and upgradation of six medical college
institutions namely Government Medical College, Amritsar, Punjab; Government Medical College, Tanda,
Himachal Pradesh; Government Medical College, Madurai, Tamil Nadu; Government Medical College,
Nagpur, Maharashtra, Jawaharlal Nehru Medical College of Aligarh Muslim University, Aligarh and Pt. B.D.
Sharma Postgraduate Institute of Medical Sciences, Rohtak. The estimated cost for each AIIMS-like
institution is Rs. 823 crore. For upgradation of medical college institutions, Central Government will
contribute Rs. 125 crore each.
In the third phase of PMSSY, it is proposed to upgrade the following existing medical college institutions
namely Government Medical College, Jhansi, Uttar Pradesh; Government Medical College, Rewa, Madhya
Pradesh; Government Medical College, Gorakhpur, Uttar Pradesh; Government Medical College, Dharbanga,
Bihar; Government Medical College, Kozhikode, Kerala; Vijaynagar Institute of Medical Sciences, Bellary,
Karnataka and Government Medical College, Muzaffarpur, Bihar.
The project cost for upgradation of each medical college institution has been estimated at Rs. 150 crores per
institution, out of which Central Government will contribute Rs. 125 crores and the remaining Rs. 25 crore
will be borne by the respective State Governments.
It is hoped that consequent to the successful implementation of PMSSY, better and affordable healthcare
facilities will be easily accessible to one and all in the country.
 
National Health mission: 
National Health Mission (NHM) was launched by the government of India in 2013 subsuming the National
Rural Health Mission and National Urban Health Mission. It was further extended in March 2018, to continue
till March 2020.
The main programmatic components include Health System Strengthening in rural and urban areas for -
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 health care services that are accountable and responsive to people's needs.
The National Health Mission seeks to ensure the achievement of the following indicators: -
 Reduce MMR to 1/1000 live births
 Reduce IMR to 25/1000 live births
 Reduce TFR to 2.1
 Prevention and reduction of anemia in women aged 15–49 years
 Prevent and reduce mortality & morbidity from communicable, non- communicable; injuries and
emerging diseases
 Reduce household out-of-pocket expenditure on total health care expenditure
 Reduce annual incidence and mortality from Tuberculosis by half
 Reduce prevalence of Leprosy to <1/10000 population and incidence to zero in all districts
 Annual Malaria Incidence to be <1/1000
 Less than 1 per cent microfilaria prevalence in all districts
 Kala-azar Elimination by 2015, <1 case per 10000 population in all blocks
 

26 | p a g e         Notes By: Mr. Vinay D. Gaikwad