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National Programmes - PowerPoint Presentation

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National Programmes - PPT Presentation

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

national health amp child health national child amp programme care control nhm feeding program diseases newborn based school adolescent management birth reproductive

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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 launchedSlide18
Slide19

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/MOSlide21
Slide22

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

-

<38Slide31
Slide32

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

THANK YOU