Dr Nishant Verma Assistant Professor Department of Pediatrics King Georges Medical University Alarming figures Deaths yr 56000 women due to pregnancy related complications 116 ID: 373979
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Slide1
National Programmes
Dr Nishant VermaAssistant ProfessorDepartment of PediatricsKing George’s Medical UniversitySlide2
Alarming figures !!!
Deaths / yr56000 women due to pregnancy related complications11.6 lac infants 8.7 lac newbornsU5MR - 59/1000 live birth (Japan 3, China 18)
IMR - 42/1000 live birthSlide3
Alarming figures !!!
Malnutrition (<3yr)23 % wasted45 % stunted40 % underweight54 % U5 mortality related to malnutition
Source: NFHS 3Slide4
Exclusive breast feeding
Full immunization
ORS in Diarrhea
Full antenatal check up
Early breast feeding (<1 hr)Slide5
Millennium Development goals
8 international development goals Established at Millennium Summit of UN in 2000189 UN member states and 23 international organizations committed to help achieve MDGTarget 2015Slide6
Millennium Development goalsSlide7
Focus : MDG 4 and 5Slide8
Aim of National Health Programmes
Improve health of countryHealthy mother = Healthy childBetter pregnancy careBetter newborn careEliminate vaccine preventable diseasesTarget malnutritionEducation Healthy adolescentsPopulation controlSlide9
Vertical Health Programs
Separate Health Structures with strong central management dedicated to the planning, management & implementation of selected interventionsAdvantages
Clear objectives & targets motivate staffOperational planning is focused & easy to deliver
Efficient & effective delivery
Better ability to monitor restricted outputSlide10
Contd
.DisadvantagesNo capacity to accommodate extra work in disasters
Resources used for specific activities only
No focus on overall development
Placement of workers after completion-Challenging
Long term public motivation not sustained
May not be cost effective in long runSlide11
Integrated Health Programs
AdvantagesHelp national development on a broader perspective
Inter-sectoral collaboration
Can accommodate extra work
Responds to community needs
Cost effective in long run
Holistic approach to healthSlide12
Contd.
DisadvantagesSometimes fail to target priority effectivelyComplex programming Slide13
Programmes for Communicable Diseases
National Vector Borne Diseases Control Programme (NVBDCP)Revised National Tuberculosis Control ProgrammeNational Leprosy Eradication ProgrammeNational AIDS Control Programme
Universal Immunization Programme
National Guinea worm Eradication Programme
Yaws Control Programme
Integrated Disease Surveillance ProgrammeSlide14
Programmes for
Non Communicable DiseasesNational Cancer Control ProgramNational Mental Health Program
National Diabetes Control Program
National Program for Control and treatment of Occupational Diseases
National Program for Control of Blindness
National program for control of diabetes, cardiovascular disease and stroke
National program for prevention and control of deafnessSlide15
National Nutritional Programs
Integrated Child Development Services SchemeMidday Meal Programme
Special Nutrition Programme (SNP)
National Nutritional Anemia Prophylaxis Programme
National Iodine Deficiency Disorders Control ProgrammeSlide16
Programs related to System
Strengthening /WelfareNational Health Mission Reproductive and Child Health Programme
National Water supply & Sanitation Programme
20 Points ProgrammeSlide17
Time line
1985
1992
1997
2005
UIP launched
CSSM
(Child survival and safe motherhood)
RCH
(CSSM + Family planning)
RCH II
(adolescent health component added)
2013
2005
NRHM
(RCH integrated into NRHM; ASHA created)
RMNCH + A
(part of NRHM)
NUHM proposed
1975
ICDS launchedSlide18Slide19
ICDS
Launched on 2nd October 1975Objectives:To improve nutritional and health status of children in 0-6 yr age groupTo lay the foundation for proper psychological, physical and social development of childrenServices provided at Anganwadi CentreGrass root worker for ICDS: Anganwadi
workerSlide20
ICDS : Service package
ServicesTarget GroupService Provided by
Supplementary NutritionChildren below 6 years:
Pregnant & Lactating Mother (P&LM)
Anganwadi Worker and Anganwadi Helper
Immunization
Children below 6 years:
Pregnant & Lactating Mother (P&LM)
ANM/MO
Health
Check-up
Children below 6 years:
Pregnant & Lactating Mother (P&LM)
ANM/MO/AWW
Referral Services
Children below 6 years:
Pregnant & Lactating Mother (P&LM)
AWW/ANM/MO
Pre-School Education
Children 3-6 years
AWW
Nutrition
&
Health Education
Women (15-45 years)
AWW/ANM/MOSlide21Slide22
National Health Mission
NRHM + NUHMVision of NHM “Attainment of Universal Access to Equitable, Affordable and Quality health care services, accountable and responsive to people’s needs, with effective inter-sectoral convergent action to address the wider social determinants of health”
Source : Framework for Implementation National health mission. Ministry of health and family welfare Government of India 2012-2017Slide23
Core values of NHM
Safeguard the health of poor, vulnerable and disadvantagedStrengthen public health systems as a basis for universal access Build environment of trust between people and providers of health servicesEmpower community to become active participants in the process of attainment of highest possible levels of healthInstitutionalize transparency and accountability
Improve efficiency to optimize use of available resourcesSlide24
Goals of NHM (By 2017)
Reduce MMR to 100/100,000 live births (178 in 2012)Reduce IMR to 25/1000 live births (42 in 2012
)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
Annual Malaria Incidence to be <1/1000
Kalaazar
Elimination by 2015, <1 case per 10000 population in all blocksSlide25
Components of NHM
RMNCH + ANational disease control programmesHealth system strengtheningSlide26
RMNCH + A
Reproductive and Maternal health (JSK/JSSK)Family planningChild healthImmunizationAdolescent healthSlide27
National disease control programmes
NVBDCPRNTCPNIDDCPNPCBNLEPIDSPSlide28
Health system strengthening
MMUPatient transport servicesInfrastructureHuman resourcesDrugs Slide29
The Reproductive and Child Health programme (RCH) II under the NHM integrates interventions that promote child health and addresses factors contributing to IMR and U5MR
Child Health under NHMSlide30
Child Health Goals under NHM
Child health indicator
Current status (SRS 2011)
NHM Goal (2017)
MDG
(2015)
IMR
44
<25
28
NMR
31
-
-
U5MR
55
-
<38Slide31Slide32
Thrust areas under child health program of NHM
Thrust Area 1 : Neonatal HealthEssential new born care (at every ‘delivery’ at time of birth)Facility based sick newborn care (at FRUs & District Hospitals)Home Based Newborn CareThrust Area 2 : NutritionPromotion of optimal Infant and Young Child Feeding PracticesMicronutrient supplementation (Vitamin A, Iron Folic Acid)
Management of children with severe acute malnutritionSlide33
Thrust Area 3: Management of Common Childhood illnesses
Management of Childhood Diarrhoeal Diseases & Acute Respiratory InfectionsThrust Area 4: ImmunisationIntensification of Routine ImmunisationEliminating Measles and Japanese Encephalitis related deathsPolio EradicationThrust areas under child health program of NHMSlide34
Schemes for child health under NHM
Facility Based Newborn and Child Care (FBNC)Janani Shishu Suraksha Karyakram (JSSK)
Facility Based Integrated Management of Neonatal and Childhood Illness (F- IMNCI)Integrated Management of Neonatal & Childhood Illnesses (IMNCI)Home Based New Born Care (HBNC)
Navjat
Shishu
Suraksha
Karyakram
(NSSK)
Infant and Young Child Feeding
Nutritional Rehabilitation Centres (NRC)
Reduction in morbidity and mortality due to Acute Respiratory Infections and Diarrhoeal Diseases
Supplementation with micronutrients
Rashtriya
Bal
Swasthya
Karyakram
(RBSK)Slide35
Facility based newborn care
To address the issue of high NMRImproved care of sick newborns throughSpecial New Born Care Units (SNCUs): at each districtNew Born Stabilization Units (NBSUs): at CHC/FRUNew Born Baby Corners (NBBCs): at all delivery facilitySlide36
Launched in June 2011Provisions for pregnant women and sick newborn
Free treatmentFree drugs and consumablesFree diagnostics & DietFree provision of bloodFree transport from home to health institutions, or between facilities in case of referralFree drop back from institutions to homeExemption from all kinds of user charges.
JSSKSlide37
Home based newborn care
ASHA to make visits to all newborns according to specified schedule up to 42 days of lifeDutiesRecording of weight of newborn,Ensuring BCG , 1st dose of OPV and DPT vaccination,Ensuring Both the mother and the newborn are safe till 42 days of delivery, Ensuring registration of birth has been doneASHA to be paid incentive of Rs 250 for 5 visitsSlide38
Navjat Shishu
Suraksha Karyakram (NSSK)Aimed to train health personnel in basic newborn care and resuscitationHas been launched to address care at birth issues Prevention of HypothermiaPrevention of Infection
Early initiation of Breast feedingBasic Newborn ResuscitationTraining is for 2 daysSlide39
Infant and Young child feeding
Infant and Young Child Feeding is the single most preventive intervention for child survival. It advocates the following:-Early initiation (within one hour of birth) and exclusive breast feeding till 6 monthsTimely complementary feeding after 6 months with continued breast feeding till 2 yrsSlide40
Nutritional Rehabilitation Centres
Being set up in health facilities for inpatient management of SAMCounselling of mothers for proper feeding and once they are on the road to recovery, they are sent back home with regular follow upSlide41
Supplementation with micronutrients
Vitamin – A1,00,000 IU at 9 months2,00,000 IU (after 9 months) at six monthly intervals up to five years of ageAll cases of severe malnutrition to be given one additional dose of Vitamin AIFA 6mo-5yr: 20mg elemental iron + 100mcg FA/day/child for 100 days in a year
6-10yr: 30mg elemental iron + 250mcg FA/day/child for 100 days in a year>10yr: adult doseSlide42
Rashtriya Bal Swasthya
Karyakram (RBSK) A new initiative aiming at early identification and early intervention for children from birth to 18 years to cover 4 ‘D’s Defects at birthDevelopment delays including disabilityDeficienciesDiseases
Periodic screening
Time of screening
Personnel
Site
Birth
MO, ANM, Nurse
Delivery
site
48hr – 6wk
ASHA
Home (HBNC)
6wk – 6yr
Mobile block level teams
Anganwadi
centre
6
– 18yr
Mobile block level teams
SchoolSlide43
UIP one of the key areas of NHM since 2005
GOI provides free vaccines against 7 diseases Diphtheria, Pertussis, Tetanus, Polio, Measles, Tuberculosis, Hepatitis BJE vaccine introduced in the routine program in 112 endemic districts
Schemes for immunization under NHMSlide44
Immunization coverage
Coverage Evaluation Survey
(CES)
District Level Household Survey
(DLHS)
Time Period
2009
DLHS 3 (2007-08)
Full Immunization
61.0
53.5
BCG
86.9
86.7
OPV3
70.4
65.6
DPT3
71.5
63.4
Measles
74.1
69.1
No Immunization
7.6
4.6Slide45
Adolescent reproductive and sexual health (ARSH)
Menstrual Hygiene scheme (MHS)School health program (SHP)Weekly iron and folic acid supplementation (WIFS)Rashtriya Kishor Swasthya Karyakram
(RKSK)
Schemes for adolescents health under NHMSlide46
Adolescent reproductive and sexual health (ARSH)
Range of sexual and reproductive health services to be provided to adolescentsAdolescent clinicsCounseling services, routine check-ups are provided on fixed days and fixed time to adolescentsARSH traininghealth functionaries made sensitive towards health needs of adolescents through a systematic training of 5d for ANM and 3d for MO through State Institute of Health and Family WelfareARSH helpline –
tele-counseling centreSlide47
School Health ProgramTo address health needs of school going children and adolescents in 6-18yr age groups in Govt and Govt aided schools
Biannual health screeningEarly management of disease, disability and common deficiencyWeekly Iron Folic acid Supplementation and biannual deworming proposed to be linked with school Health ProgrammeSlide48
Weekly iron and folic acid supplementation (WIFS)
Intervention weekly supervised administration of 100mg elemental Iron and 500ug Folic Acid biannual dewormingTarget populationschool going adolescent girls and boys (at Govt/Govt. aided and municipal school)out of school adolescent girls (at anganwadi kendra)Slide49
Rashtriya Kishor
Swasthya Karyakram (RKSK)Recently launched to address adolescent health needs and concernsApart from sexual and reproductive health, it also includes nutrition, injuries and violence (including gender based violence), non-communicable diseases, mental health and substance misuse
Shift from clinic based approach to promotion and prevention and reaching adolescents in their own environment, such as in schools and communitiesSlide50
National programme
for Mid-day Meals in SchoolsLaunched in 1995Provides mid-day meals to students in the schoolPrimary stage – 450Kcal ; 12gm ProteinUpper primary stage – 700Kcal ; 20gm ProteinAdvantages
NutritionSchool enrolmentSchool attendanceSocial interaction
EmploymentSlide51
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