UNIT-III

NATIONAL HEALTH PROGRAMME

INTRODUCTION
National Health Programme, have been launched by the central government for the:

 Eradication of communicable disease

 Control of population and improving rural health
 Raising the standards of nutrition
 Improvement of environmental sanitation

Various international companies like WHO, UNICEF ( United Nations Children's Fund ) UNFPA
( United Nations Population Fund ),, World Bank have been providing technical and material
assistance in the implementation of these programmes.

Health care is a public right, and is the responsibility of the government to provide this care
to all the people in equal measure.

These principles have been recognised by nearly all government of the world.

In India, health care is completely or largely governmental function.

HEALTH CARE SERVICES

 The purpose of health care services is to improve the health status of the population.
 The goals to be achieved have been fixed in terms of morbidity reduction.
 Increase in expectation of life.
 Improvements in nutritional status.
 Decrease in population growth rate.

HEALTH CARE SYSTEMS

The health care system is intended to deliver the health care services.

In India it is represented by five major sectors or companies which are different from each
other by the health technology applied. These are:

1. Public health sector

2. Private sector

3. Indigenous systems of medicine

4. Voluntary health agencies

5. National health programmes

1) Public health sector

a) Primary health centre

b) Hospitals

c) Health insurance schemes

2) Private sectors

a) Private hospitals and dispensaries

b) Clinics

3) Indigenous systems of medicine

a) Homeopathy

b) Ayurveda

Objectives of the Programme:

1. To achieve an acceptable standards of good health amongst the general population of the
country.

2. To ensure a more equitable access to health services across the social and geographical
expanse of the country.

3. To increase access to the decentralising public health system by establishing new

infrastructure in deficient areas and by upgrading the infrastructure in existing institutions.

4. To regulate the import, manufacture, distribution of drugs and cosmetics through

licensing.

5. Distribution, manufacture, and sale of drugs by qualified persons only.

HIV AND AIDS

INTRODUCTION
India's AIDS control programme is globally acclaimed as a success story.

The National Aids Control Programme (NACP) launched in 1992, is being implemented as a
comprehensive programme for prevention and control of HIV/AIDS in India.

Over time, the focus has shifted from raising awareness to behaviour change, from a
national response to a more decentralised response and to increasing involvement of NGOs
and networks of PLHIV. (People living with HIV)

At the beginning of 1986, despite over 20,000 reported AIDS cases worldwide, India has no
reported cases of HIV or AIDS.

India's first case of HIV was diagnosed among sex workers.

It was noted that contact with foreign visitors had played a role in initial infections among
sex workers, and as HIV screening centres were setup across the country, there were calls for
visitors to be screened for HIV.

These calls subsided as more attention was paid to ensuring that HIV screening was carried
out in block banks.

NATIONAL CONTROL PROGRAMME FOR HIV/AID AND ITS FUNCTIONING

(The National AIDS Control Programme (NACP), launched in 1987.

Its activities covered surveillances, blood screening, and health education.

The end of 1987, out of 52, 907 who had been tested, around 135 people were found to be
HIV positive and 14 had AIDS.

Most of these initial cares had occurred through heterosexual sex, but at the end of the
1980s a rapid spread of HIV was observed among injecting drug in three northern states
(Mizoram, Nagaland, Manipur) of India bordering Myanmar (Burma).

(The National AIDS Control Programme started in 1992 was implemented with an objective
of slowing down the spread of HIV infections so as to reduce morbidity, mortality and impart
of AIDS in the country.

(the government launched a strategic plan, the Nation AIDS Control Programme (NAGP) for
HIV prevention.

This plan established the administrative and technical basis for programme management
and also set up state AIDS control societies (SAGC) in 25 states and 7 union territories.
It was able to make a number of important improvements in HIV prevention such as
improving blood safety.

In November 1999, the second phase of National AIDS Control Project (NACP II) was
launched to reduce the spread of HIV infection in India and to increase India's capacity to
respond to HIV/AIDS on a long term basis.)

The prevention of mother to child transmission (PMTCT) programme and the provision of
free antiretroviral treatment were implemented for the first time.

National AIDS control programme, third phase was launched or begun in 2007 with the
highest priority placed on reaching 80 percent of high-risk groups including sex workers,
men who have sex with men and infecting drug users with targeted interventions.

Seventeen targeted interventions are generally carried out by civil society or community
organisations in partnership with the state AIDS control societies.

They include outreach programmes focused on behaviour change through education,

distribution of condoms and other risk reduction materials, treatment of sexually
transmitted disease, linkages to health services, as well as advocacy and training of local
groups.

(The third National Aids Control Programme reversing the epidemic over its five year
period.)

The Fourth National AIDS Control Programme launched in 2012, aims to accelerate the
process of reversal and further strengthen the epidemic response in India through cautions
and well defined integration process over the next five years.

OBJECTIVES OF HIV AND AIDS CONTROL PROGRAMME

1. Safe blood transfusion

2. Reduction of sexually transmitted disease transmission

3. Prevention of HIV transmission

4. Establishment of surveillance

5. Create an enabling environment

6. Build the right capacity

7. Training of health staff

8. Reduce stigma attached with disease

9. Research and behavioural studies

10. Development of programme management

11. Strengthen the institutional framework

12. The specific objective is to reduce the rate of incidence by 60 percent in the first year of
the programme in high prevalence states to obtain the reversal of the epidemic and by 40%
in the vulnerable states to stabilise the epidemic.

13. Reduce new infections by 50% (2007 baseline of National AIDS Control Programme

14. Comprehensive care, support and treatment to all persons living with HIV/AIDS

NATIONAL AIDS CONTROL PROGRAMME AND ITS FUNCTIONING

The programme was launched in the year 1987. Ministry of health and family welfare has set
up national AIDS Control Organisation (NACO) as a separate wing to implement and closely
monitor the various components of the programme.

Aims of the programme are:

To prevent further transmission of HIV, to decrease the morbidity and mortality associated
with HIV infections and minimises the socio economic impact resulting from HIV infection.
First case of AIDS was detected in 1986.

ART initiated in 2004 (Antiretroviral therapy) National Policy on pediatric ART formulated in
2006.

National AIDS Control Programme III launched in 2007.

NACO is working on a communication strategy which is a shift from awareness generation to

bringing about behaviour change.

NACO is the nodal organisation for formulation of policy and implementation of programmes
for prevention and control of HIV/AIDS in India. In a scenario with no vaccine or drug for cure
in sight, information, awareness and education are the best ways to prevent the disease
from spreading.

Some of the important programmes of NACO are:

1. Blood safety programme
2. Condom programming

3. Information, education, communication and social mobilisation

4. Targeted interventions

5. NGO's activities

6. Voluntary counselling and testing

1) Blood safety programme: The major objective of the blood safety programme is to ensure
the easily accessible, adequate supplies of safe and quality blood and blood components for
all irrespective of economic or social status. This translates into the following responses:

1. To ensure organised blood-banking services at the state/district level

2. To educate and motivate people about blood donation voluntarily

3. To enforce quality control of blood

The strategies plan under NACO lays down the following strategies:
1. Strengthening the National blood transfusion services

2. Ensuring an adequate supply of blood to all blood centres

3. Ensuring safety of blood products

4. Developing facilities for the production of components

5. Developing and strengthening of effective management, monitoring and evaluation of

blood transfusion.

2) Condom Programming: Among the portable source of HIV transmission in our country,
heterosexual promiscuity constitutes the major route.

The most successful and practical way to prevent the transmission is the use of condoms
according to experience from all over the world and in India.

While the use of condom is easy, making a programme to cover the whole country needed
careful planning on certain issues. This issues mainly related to the question that how to:

1. Sensitive people for using condoms not only for the sake of family planning but also as the
best preventive step against HIV and STD. (Sexual transmitting diseases )

2. Make available low cost and good quality condoms to the people all over the country
easily at the time and place when the need it.
3. Convince the clients and the commercial sex workers, about the importance of use of
condoms as a means for preventing the HIV transmission.

The Following strategies have been laid down under condom programme:
1. Introducing an exclusive social marketing scheme of condom promotion by NACO

2. Strengthening programme management and monitoring systems

3. Strengthening the existing social marketing structure in the department of family welfare,
a view to fulfilling the needs and requirements of the AIDS Control Programme.

3) Information, Education and Communication (IEC): The IEC strategy is being

operationalised both at the state and central level.

The objectives of the IEC in the National AIDS Control Programme are :

1. To train health workers in AIDS communication and coping strategies for strengthening
technical and managerial capabilities

2. To create a supportive environment for the care and rehabilitation of persons with
HIV/AIDS.

3. To mobilise all factors of society to integrate messages and programmes on AIDS into their
existing activities.

4. To raise awareness, improve knowledge and understanding among the general population
about AIDS infection and STD, routes of transmission and method of prevention.

The IEC strategic plan has the following components:

1. Training

2. Advocacy at various levels

3. Inter-Sectoral collaboration

4. Involvement of NGOs

5. Use of mass media

4) Targeted Interventions: Targeted interventions are therefore, one of the most important
components of the National AIDS Control Programme.

NACO evolved the following strategy:

1. Decentralisation of implementation to the state AIDS control society

2. Transparent and streamlined procedures for selection of NGOs

3. Capacity building of SACS and NGOs for implementing and monitoring 11 projects.

5) NGO's activities: NGO guidelines have been formulated to provide for an open and
transparent system of selection of NGOs. The funding of NGOs has been completely
decentralised to the State AIDS Control Societies. These schemes are:

1. Community care and support

2. School AIDS Education

3. National AIDS Helpline and Tele-counselling

The salient features of the plan are:

1. Training of teachers

2. National AIDS helpline and Tele-counselling

3. Training of students, educators who have leadership qualities and communication skills.

6) Voluntary Counselling and Testing (VCT): Voluntary HIV counselling and testing is the
process by which an individual undergoes counselling, enabling him or her to make an
informed choice about being tested for HIV.

This decision must be the choice of the individual and he or she must be assured that the
process will be confidential.

The potential benefits of VCT are:

1. Emotional support

2. Prevention of HIV related illness

3. Safer blood donation

4. Awareness of safe option for reproduction and infant feeding

5. Motivation for drug related behaviour

6. Earlier access to care and treatment

7. Improved health status through good nutritional advice

8. Better ability to cope with HIV related anxiety

The VCT process consists of:

1. Pre test counselling

2. Port test counselling

3. Follow-up counselling
 TUBERCULOSIS
Introduction:
Tuberculosis is an infectious disease usually caused by the bacterium Mycobacterium
tuberculosis.
The tuberculosis primarily affects lungs and causes pulmonary tuberculosis.
TB also affects the other parts of the body like intestine, bones and joints, lymph glands, skin
and other tissues of the body.
The classic symptom of active TB is a chronic cough with blood containing sputum, fever,
weight loss and night sweats.
Active infections occur more often in people with HIV/AIDS and in those who smoke.
Tuberculosis is spread through the air when people who have active TB in their lungs cough,
spit, speak or sneeze.
Diagnosis of active tuberculosis is based on chest x-rays, as well as microscopic examination
and culture of body fluids. TB relies on the tuberculin skin test or blood tests.
In 2016, there were more than 10 million cases of active TB which resulted in 1.3 million
deaths.
This makes it the number one cause of death from an infectious disease.
More than 95% of deaths occurred in developing countries and more than 50% in India,
China, Indonesia, Pakistan and the Philippines.
The number of new cases each year has decreased since 2000.

National Health Programme For Tuberculosis and its functioning:

The National Tuberculosis Programme (NTP) was started in 1962 for TB Control in India.
This programme was not able to give expected results in India.
In 1962, the government of India launched a National Tuberculosis Control Programme to
detect as many tuberculosis cases as possible, provide effective treatment, establish district
tuberculosis centers, extend short-course chemotherapy, strengthen existing state tuberculosis
training and demonstration centers.

Nationally, there are 390 districts with fully equipped DTCs (District Tuberculosis Centers)
staffed by a team of medical and paramedical personnel.
Another 330 TB clinics are mostly located in big cities, caring for local people .
In addition, 17 tuberculosis training and demonstration centers provide basic training to
paramedical personnel, including general practitioners.
There are a total of about 47,000 beds available nationwide for TB patients.
The majority of patients are treated at home, thus only serious cases or those requiring
surgical treatment are admitted.
The National Tuberculosis Programme also stresses health education aimed at the community
and general practitioners. Booklets, pamphlets, radio, TV, and newspaper advertisements are
utilized for this purpose.
The National Tuberculosis institute was established in 1953 in Bangalore and it has engaged
in research on epidemiological, sociological, and operations aspects, along with monitoring
of the programme.
The Revised National Tuberculosis Control Programme (RNTCP), based on the Directly
Observed Treatment, short course (DOTS) strategy, began as a pilot project in 1993 and was
launched as a national programme in 1997 but rapid NTCP expansion began in late 1998.
The nation-wide coverage was achieved in 2006.
National Strategic Plan for 2012-2017: The National Strategic Plan (NSP) 2012-2017 was
part of the country's 12th Five Year Plan.
The theme of the NSP 2012-2017 was "Universal Access for quality diagnosis and treatment
for all TB patients in the community" with a target of "reaching the unreached".
The major Focus was early and complete detection of all TB cases in the community,
including drug resistant TB and HIV - associated TB, with greater engagement of private
sector for improving care to all patients.
During the National Strategic Plan 2012-2017 period, significant gains were made in
strengthening the support structures, programme architecture and implementation of
environment for TB control.

National Strategic Plan for 2017-2025 for TB Elimination in India:

The National Strategic Plan 2017-2025 builds on the success and learning of the last NSP and
encapsulates the bold and innovative steps required to eliminate Tuberculosis in India by
2030.

Objectives of Tuberculosis Control Programme :

The main objective of anti-TB treatment are to:
1. Cure the patient of TB (by rapidly eliminating most of the bacilli).
2. Prevent death from active TB or its late effects.
3. To provide facilities for training, teaching and research activities.
4. To act as an open institute in the country for prevention, control and treatment of
tuberculosis and allied diseases.
5. Prevent the development of drug resistance (by using combination of drugs).
6. Decrease tuberculosis transmission to others.
7. To promote National Tuberculosis control programme in the country and to formulate
strategies which are socially acceptable and economically feasible in order to assist and
strengthen the programme.
8. To have establish Tuberculosis surveillance system in the country.
9. To ensure proper TB diagnosis and care management and further accelerate reduction of
TB transmission.
10. To extend mechanisms of tuberculosis treatment adherence and contact tracing of points
treated at private sector.

Outcomes of Programmes :
Sputum smear collection was significantly higher in urban areas.
In urban areas, new TB case detection was 35% while in tribal areas, it was 42% as per
RNTCP (Revised National Tuberculosis Programme) norms. Sputum positivity was
marginally more in tribal (5.87%) than urban (3.28%) areas. Cure rate was more in urban
areas than tribal areas. There were statistically significantly high default cares in Tribal areas.

Sputum collection and sputum positivity rate were low in urban and tribal areas, but TB
screening, especially in tribal areas, was significantly low. Sputum positivity was
significantly higher in tribal areas.

Significantly low cure rate and high default rate in tribal areas warrant the need for
strengthening of RNTCP activities in tribal areas.