national health programmes

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NATIONAL HEALTH PROGRAM IN INDIA KIRAN RANDHAWA ARMY COLLEGE OF NURSING

INTRODUCTION : : 

INTRODUCTION : VARIOUS ONGOING HEALTH PROGRAM ARE DEPICATED IN RELATION TO THE HEALTH PROBLEMS PREVALENT IN INDIA. THEY ARE: FOR POPULATION PROBLEM National family welfare program India population project Post partem program

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FOR HEALTH CARE PROBLEM Health for all Primary health care FOR ENVIRONMENTAL SANITATION PROBLEM National water supply & sanitation program Accelerated rural water supply program FOR NUTRITION PROBLEM Applied nutrition program Special nutrition program

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Balwadi nutrition program midday meal program Vitamine A prophylaxis program Iron folic acid supplementation program National nutritional anemia prophylaxis program National iodine deficiency disorder control program India population project Defluoridation of water Prevention of food adultration act National program for control of blindness CONTD….

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FOR COMMUNICABALE DISEASES PROBLEMS : S.T.D Control program Malaria action program National filaria program National tuberculosis program Modified leprosy elimination campaign Control of diarrhoeal diseases Acute respiratory infection control program Aids control program Guinea worm eradication program

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Japanese encephalitis control program Kala azar control program Dengue fever control program Universal immunization CONTD…..

DEFINITION :: 

DEFINITION : Central government along with state governments takes concurrent or cordinated measures to handle communicable diseases, non-communicable diseases or problems ,which can decreases the mortality, morbidity rate & improve the standard of living .These measures are called NATIONAL HEALTH PROGRAM .

NATIONAL ANEMIA CONTROL PROGRAM : 

NATIONAL ANEMIA CONTROL PROGRAM Started in 1970. ACTIVITIES: Tab iron / folate 120mg every day for 100 days Diet education Examination Higher dose to case Antimalarial prophylaxis Minimize intranatal bleeding

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Avability of intramuscular iron therapy , packed RBC transfusion of iron. Hook worm control measures. CONTD…..

NATIONAL MALARIA CONTROL PROGRM (1953): 

NATIONAL MALARIA CONTROL PROGRM (1953 ) NATIONAL ANTIMALARIAL PROGRAM NATIONAL MALARIA ERADICATION PROGRAM (1958) OBJETIVES: 1. Preparatory phase 2.Attack phase 3. Consolidation phase 4. Maintenance phase

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MODIFIED (1977) TWO MAIN INDICATORS : API ---- Confirmed cases during 1 year *100 Population under survellance ABER --- NO. of slides examined *100 population

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MAIN ACTIVITIES : AREAS WITH API ABOVE 2: Pyrethroids spray 2 rounds at 6 weeks interval Entamological assessment Active & passive survellance Treatment of malaria case AREAS WITH API BELOW 2: Focal spraying Active & passive survellance Radical treatment of detected cases

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Blood smear follow up examination Epidemiological investigation PRESUMPTIVE TREATMENT RADICAL TREATMENT CONTD…

NATIONAL FILARIA CONTROL PROGRAM : 

NATIONAL FILARIA CONTROL PROGRAM Started in 1955 1978 Combined with malaria control program Now it is running under vector born diseases control program Activities : Antimosquito & antilarval measures Filaria clinics Under ground drainage system Antifilarial drug

NATIONAL TUBERCULOSIS COTROL PROGRAM: 

NATIONAL TUBERCULOSIS COTROL PROGRAM Started in 1962 ACTIVITIES : Case identification Sputum examination Radiological examination BCG vaccination Monitoring & evaluation Supervision & follow up

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Control of defaulte ‘s rate Coordination with primary health care system Revised (1993) Free treatment with DOTS therapy CONTD….

NATIONAL STD CONTROL PROGRAM: 

NATIONAL STD CONTROL PROGRAM Started in 1946 5 regional STD referral , 510 district hospitals ,many STD clinics Activities: Case reporting Involvement of general practitioners Screening of cases Councelling & guidance Condom promotion

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Health education Control of prostitution ,drug abuse ,alcoholism Rehablitation of commercial sex workers Family health awareness campaign CONTD….

NATIONAL AIDS CONTROL PROGRAM : 

NATIONAL AIDS CONTROL PROGRAM Started in 1986 assisted by world bank ,WHO, the USA. NATIONAL AIDS CONTROL ORGANISATION (1992) OBJECTIVES : To arrest the HIV infection & thus to decrease future morbidity & mortality associated with AIDS. AIMS: To prevent further transmission of HIV.

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To decrease morbidity & mortality . To minimize the socioeconomic impact resulting from HIV infection . COMPONENTS: Survellance centers Screening Management of detected cases CONTD…

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Control of STDs Condom programmes Follow up Guidelines for blood bank, blood product manufacture, blood donars , dialysis units . IED activities CONTD….

UNIVERSAL IMMUNISATION PROGRAM : 

UNIVERSAL IMMUNISATION PROGRAM Started in 1978 . Objectives: To reduce the morbidity & mortality associated with 6 killer diseases of children , vaccine preventable diseases. Activities : Vaccination of children & pregnant women . Maintain records. Effective cold chain .

CONTD…. : 

CONTD…. Production &quality control . Epidemiological surveillance. Involvement of the people.

REPRODUTIVE & CHILD HEALTH PROGRAM : 

REPRODUTIVE & CHILD HEALTH PROGRAM Child survival & safe motherhood program launched in 20 Aug 1992. OBJECTIVES: To safely reduce the unwanted pregnancy & fulfilling the reproductive needs of people by providing them good services .& paying attention on stability of population , safe childhood & health of children . ACTIVITIES: Control of infection & diseases of reproductive system.

Contd…: 

Contd… Safe abortion services Sterility removal services. Control & treatment of STD’s Contraception Protection from HIV Child welfare & child health Improvement in social status of women

Contd…. : 

Contd…. Referral services Growth monitoring , nutrition education . Control on maternal morbidity & mortality . Family planning services

NATIONAL DIARRHEAL DISEASES CONTROL PROGRAM : 

NATIONAL DIARRHEAL DISEASES CONTROL PROGRAM . Launched in 1981. . National cholera control program OBJECTIVE: To reduce diarrhea associated mortality . Activities: ORS packets distribution Mass education

NATIONAL FAMILY WELFARE PROGRAM : 

NATIONAL FAMILY WELFARE PROGRAM Started in 1977. OBJECTIVES: To avoid unwanted pregnancy To bring about wanted birth To regulate the interval between pregnancies To determine the no. of child To create social welfare state.

contd: 

contd ACTIVITIES: Family planning councelling. Provision for contraceptives Management of infertility Sex education Advice on sterility Screening Premarital consultation Pregnancy tests

Contd…: 

Contd… Preparation of couple Women education Adoption services

NATIONAL WATER SUPPLY & SANNITATION PROGRAM : 

NATIONAL WATER SUPPLY & SANNITATION PROGRAM Started in 1954 Accelerated rural water supply program ---1974 National drinking water supply & sanitation program ACTIVITIES: Establishing urban developmental fund Making responsible Encouraging participation Low cost techniques

Contd…: 

Contd… Training to personals Discouraging free water supply Water supply & sanitation cell Recharging with rain water Water conservation Restrict exploitation of water Potable sea water Find other sources

NATIONAL GUINEA WORM ERADICATION PROGRAM : 

NATIONAL GUINEA WORM ERADICATION PROGRAM 1982—1983 NGEP linked with international drinking water supply & sanitation 1985– Independent appraisal ACTIVITIES : Active search Management of case & personal prophylaxis Safe water supply Health education Temporary treatment of water.

Contd…: 

Contd… Abolition of step wells. Vector control.

NATIONAL DIABETES CONTROL PROGRAM : 

NATIONAL DIABETES CONTROL PROGRAM Started during 7 th five year program Improved in 1996-1997 OBJECTIVES: Diagnosis & treatment of diabetes at primary health care centers & districts hospitals. ACTIVITIES: Primary diagnosis. Secondary diagnosis

Contd…: 

Contd… Diagnosis & treatment of complications Rehabilitation .

NATIONAL CANCER CONTROL PROGRAM: 

NATIONAL CANCER CONTROL PROGRAM Started in 1975 & amended in 1984 OBJECTIVES: PRIMARY PREVENTION SECONDARY PREVENTION TERTIARY PREVENTION Revised in 2004- 2005 Regional cancer center scheme Oncology wing development scheme

Contd..: 

Contd.. District cancer control program Decentralized scheme of financial assistance IEC activities Research & training .

NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAMME: 

NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAMME Started in 1962 Iodine deficiency can cause – abortion ,mental retardation deafness, short height & disorders of nervous system August 1992 national goiter control program changed to national iodine deficiency disorders control program . GOALS: Surveying Distribution of iodized salt Evaluation of services

Contd ….: 

Contd …. Providing health education Banned the salt without iodine IEC activities 11 crore budget for 2003 –06

NATIONAL LEPROSY CONTROL PROGRAM : 

NATIONAL LEPROSY CONTROL PROGRAM Started in 1955 OBJECTIVES: Early detection of cases Domiciliary treatment with dapsone monotherapy Health education National leprosy eradication program started in 1981

Contd….: 

Contd…. ACTIVITIES: Door to door survey Early detection & regular treatment Multidrug therapy: Rifampicin (600 mg ) Dapsone (100mg ) Education Rehabilitation

Contd…: 

Contd… Volutary agency involvement Monitoring the drug in take Defaulter retrieval action Assess & record the risk station Refrral services Submission of records.

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KALA AZAR

KALA –AZAR CONTROL PROGRAM: 

KALA –AZAR CONTROL PROGRAM Started in 1990 Serious health problem Now this program is part of VBDCP ACTION: Reduction in no. of vectors & transmission by sprinkling chemicals Primary diagnosis Health education Assist govt. of India in supervision

JAPANESE ENCEPHALITIS CONTROL PROGRAM : 

JAPANESE ENCEPHALITIS CONTROL PROGRAM Disease caused by small virus spread by mosquitoes ACTIVITIES: Treatment of patients Preparation of safe & standardized local vaccines Monitoring suspected patients Find out the risk group Antivector activities ex. Spraying , aerial spraying Antilarval measures with larvicides(fenitrothione) ,bio measures

Contd…: 

Contd… Sources reduction Measures against reservoirs Prevention from mosquito bites Immuno –prophylaxis .( inactivated mouse brain vaccine with nakayama strain 1ml s/c )

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POLIO

PULSE POLIO IMMUNIZATION PROGRAM: 

PULSE POLIO IMMUNIZATION PROGRAM Largest immunization program Initiated in 1988 OBJECTIVES: To eradicate polio from all over the world AIMS: High level of polio vaccination National immunisation day Effective surveillance

Contd…: 

Contd… Conducting vaccination rounds. ACTIVITIES : Dose of polio vaccine upto the age of 5yrs Month of december & january are selected Conducting IEC compaigns Aria wise estimation Inter sectoral coordination Maintaining records & reports

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POLIO DROP

NATIONAL MENTAL HEALTH PROGRAM : 

NATIONAL MENTAL HEALTH PROGRAM Started in 1982 OBJECTIVES: Mental health care services Linking mental health with general health Social development through knowledge of mental health ACTIVITIES: Mass education Immediate diagnosis & treatment of mental diseases.

Contd…: 

Contd… Follow-up of mental patients Training to mental health team Prevention from physical injuries & suicides Guidance & councelling clinics Assist the patient in social adjustment Providing statistics. MENTAL HEALTH ACT (1987 ) --Behaviour towards ill patient --Awareness programmes

MINIMUM NEEDS PROGRAM: 

MINIMUM NEEDS PROGRAM Introduced in 1 st yr of the 5 th five yr plan (1974 – 1978) OBJECTIVES: To provide certain basic minimum needs & therapy improving the living standards of the people. COMPONENTS: Rural health Rural water supply Rural electrification

Contd…: 

Contd… 4 . Elementary education 5. Adult education 6. Nutrition 7. Environmental improvement of slums 8. Houses for landless labour.

20- POINT PROGRAM: 

20- POINT PROGRAM Initiated in 1975 – national agenda August 20, 1986 –reconstruction of this program OBJECTIVES: Eradication of poverty , raising productivity, reducing inequalities ,removing social & economic disparties & improving the quality of life. HEALTH RELATED POINTS: Point 1 –attack on rural poverty Point 7 – clean drinking water

Contd..: 

Contd.. Point 8 – health for all Point 9 – two child norms Point 10 – expansion of education Point 14 – housing for the people Point 15 – improvement of slums Point 17 – project of the environment

NATIONAL NUTRITIONAL PROGRAM : 

NATIONAL NUTRITIONAL PROGRAM AIM: To provide additional nutrients to target groups to fill the gap between intake & requirements Emphasis has been on increased food production & supplementary feeding to the vulnerable groups. APPLIED NUTRITION PROGRAM: Introduced in 1960 To make people concious of their nutritional needs & increase production of food for required consumption . Community kitchen & school garden

Contd…: 

Contd… SPECIAL NUTRITION PROGRAM : Started in 1970 Pregnant women & lactating mothers . 300 calories & 12 gram protein to child 600 calories & 20 gram protein for women for 300 calories & 10 grams Provided supplementary nutrition , supply of vitamin A solution & IFA tablets.

Contd..: 

Contd.. BALWADI NUTRITION PROGRAM Started in 1970 for 3-6 aged children in rural areas ,under social welfare department Providing preprimary education Providing 300 calories & 10gram protein per day . MID-DAY MEAL PROGRAM: Launched in 1961 To improve children school attendance Now it is part of minimum needs program

Contd..: 

Contd.. Providing supplementary nutrients 1/3 of total calories , ½ of total protein Local preparation & of low cost . A model meal ---cereal/millet—75gm --pulses--- 30gm --oil ---- 8 gm --leafy vegetables 30gm non leafy vegetables 30gm

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NUTRITIONOL PROGRAM

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PRESENT STATUS

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REPRODUTIVE & CHILD HEALTH PROGRAM WRAI CONDUTING FOLLOWING ACTIVITIES DECENTRALIZATION CAMPAIGN MARCH TO TAJ MAHAL SYMPOSIUM DECLERATION OF NATIONAL SAFE MOTHERHOOD DAY NATIONAL SAFE MOTHERHOOD DAY 2003—2007 INTERNATIONAL CONFERENCE, “SAVING MOTHER ‘S LIFE : WHAT WORKS

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CONTD… COLLABORATION WITH MINISTRY OF HEALTH & FAMILY WELFARE ADVOCATING FOR SKILLED ATTENDANT AT BIRTH DEVELOPMENT OF GUIDELINES & PROTOCOLS FOR MCH SAFE MOTHERHOOD POLICY IMPLEMENTATION

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Four malaria success stories: How Brazil, Vietnam, India, and Eritrea successfully reduced malaria burden By Lawrence Barat, MD, MPH Senior Technical Advisor Global Health, Population, and Nutrition Group Academy for Educational Development Washington, DC October 27, 2004

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Summary In the last decade, while many countries have struggled to slow the spread of malaria, four countries—India, Brazil, Vietnam, and Eritrea-- have successfully and dramatically reduced malaria burden. The keys to these successes have been multiple, including:

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o Conducive country conditions o A sound and targeted technical approach, using a range of effective tools o Data-driven decision-making based on good surveillance and operational research o Strong leadership and commitment at all levels of government o Decentralized control of finances and implementation supported to a strong national control program o Ability of managers to efficiently navigate past bureaucratic hurdles o Infrastructure and skilled technical capacity at national and sub-national levels o Pro-active technical and programmatic support from partner agencies

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o Sufficient financing to take control activities to scale o Flexibility in approach by the World Bank

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India In 1997, the World Bank provided $165 million financing for the Enhanced Malaria Control Project (EMCP). EMCP invested in the 100 highest-risk districts in eight northern states. One of the primary objectives of EMCP was to transition India from its unsuccessful eradication strategy to a more modern control strategy. Widespread use of IRS as a major control method would be replaced with early diagnosis and prompt treatment (EDPT) of malaria cases, promotion of ITNs, use of alternative vector control methods (including environmental management and larvivorous fish), strengthening of malaria surveillance, and targeted use of IRS. Progress during the first years of the project was slow, in part because the initial project design completely excluded the state health departments from implementation activities. Districts were to be supervised directly from the National Anti-malaria Program (NAMP). After an unsatisfactory mid-term review, the project was re-designed with some funding provided to state malaria control societies.

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After the re-design, implementation took off rapidly. More than 300,000 village-based volunteers were trained in malaria case management and provided supplies of chloroquine. Laboratory capacity was greatly expanded; approximately 14 million blood slides were examined last year. Almost 2 million ITNs have been distributed and more than 20,000 larvivorous fish hatcheries established. Local governments, community groups, and NGOs have become actively involved in a number of activities, including distribution and re-treatment of ITNs, breeding and stocking of larvivorous fish, and community awareness campaigns. The impact has been dramatic. Malaria morbidity has dropped in EMCP districts by 38% or 0.5 million cases per year.

This is exemplified by the World Health Organization Alliance for the Global Elimination of Blinding Trachoma by 2020 (GET 2020), the World Health Assembly resolution 51.11, 1998, and the inclusion of trachoma as a priority under the disease control component of the Global Initiative for the Elimination of Avoidable Blindness, Vision 2020 – the Right to Sight. Evidence-based advances in knowledge and intervention strategies together with the additional financial resources now available offer opportunities for a concerted effort to control and eliminate blinding trachoma, long before the year 2020, in most countries. NATIONAL BLINDNESS CONTROL PROGRAM

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NATIONAL LEPROSY CONTROL PROGRAM

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While the number of newly detected cases is more or less stable, the registered prevalence of leprosy has been reduced substantially ( Figure 1 ). This is mainly the result of the shortening of the treatment duration and the updating of registers (Visschedijk et al., 2000). Fluctuations in case detection rates in a few countries have mostly been caused by operational aspects such as the implementation of Leprosy Elimination Campaigns (LECs) (WHO, 2000a). Unfortunately, good information about the real incidence is not available (Smith, 1997). So far, it is unlikely that MDT, which has been recommended as the preferential treatment for leprosy since 1981 (WHO, 1982), has reduced the transmission of leprosy as compared to the previously used dapsone monotherapy (ILA/ TF, 2002). Therefore, significant numbers of new cases of leprosy will continue to occur, many of them already with disabilities. Others may even develop disabilities after to come (Feenstra, 1994a). This can only be ensured by the integration diagnosis. Hence, despite the reduced prevalence, cost-effective and accessible leprosy services (diagnosis, treatment, prevention of disabilities, disability care, rehabilitation) have to be sustained for decades of leprosy services.

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AIDS CONTROL PROGRAM

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There has been considerable interest in understanding what may have led to Uganda's dramatic decline in HIV prevalence, one of the world's earliest and most compelling AIDS prevention successes. Survey and other data suggest that a decline in multi-partner sexual behavior is the behavioral change most likely associated with HIV decline. It appears that behavior change programs, particularly involving extensive promotion of “zero grazing” (faithfulness and partner reduction), largely developed by the Ugandan government and local NGOs including faith-based, women’s, people-living-with-AIDS and other community-based groups, contributed to the early declines in casual/multiple sexual partnerships and HIV incidence and, along with other factors including condom use, to the subsequent sharp decline in HIV prevalence. Yet the debate over “what happened in Uganda” continues, often involving divisive abstinence-versus-condoms rhetoric, which appears more related to the culture wars in the USA than to African social reality.

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THANK YOU THANK YOU