NATIONAL HEALTH PROGRAMME RELATED TO CHILD WELFARE

PRESENTED BYMahaveer Swarnkar

M.Sc. Pediatric Nursing

INTRODUCTION:

The ministry of health, Government of India, central health council launch programs aimed at controlling or eradicating diseases which cause considerable morbidity and mortality in India.

HEALTH PROGRAMME1. NATIONAL RURAL HEALTH MISSION

2. NATIONAL PROGRAMS RELATED TO MOTHER AND CHILD CARE

1. Maternal and child health program (MCH)

2. Integrated child development service scheme (ICDS)

3. Child survival and safe motherhood program(CSSM)

4. Reproductive and child health program(RCH)

5. Integrated management of neonatal and childhood illness

NATIONAL PROGRAMS RELATED TO COMMUNICABLE DISEASES National program of immunization Acute respiratory infection control program Diarrheal disease control program Revised national tuberculosis control program Leprosy eradication program National vector borne disease control programs National malaria eradication program National Filarial control program KALA AZAR control program National AIDS control program

NATIONAL PROGRAMS RELATED TO CONTROL OF NUTRITIONAL DEFICIENCY DISORDERS

1. Special Nutritional program 1970

2. Mid-day meal program. 1957

3. Anemia prophylaxis program. 1970

4. National iodine deficiency disorders control program. 1962

NATIONAL PROGRAMS RELATED TO CONTROL OF NON COMMUNICABLE DISEASE National School health program National mental health program National program for control of blindness Vitamin A deficiency control program National cancer control program National diabetes control program Child welfare program for disabled children National water supply and sanitation program National family welfare program Minimum needs program

NATIONAL RURAL HEALTH MISSION 12APRIL, 2005

GOALS Reduction in IMR and MMRUniversal access to public health servicesPrevention and control of communicable and

non communicable diseases.Access to integrated comprehensive primary

health care.

Population stabilization, gender and demographic balance.

Revitalize local health traditions and mainstream AYUSH

Promotion of healthy life styles

STRATEGIES enhance capacity of panchayti raj institutions to

own, control and manage public health services. Promote access to improve health care at house

hold level through the ASHA Health plan for each village through village

health committee of the panchayat Strengthening sub-centre through an untied fund

to enable local planning and action and more multi-purpose workers.

Prepared by the district health Mission, including drinking water, sanitation and hygiene and nutrition.

Technical support to National, State Block and district levels traditions.

Reorienting medical education to support rural health issues including regulation of medical care and medical ethics.

Mainstreaming AYUSH revitalization local health.

NATIONAL PROGRAMS RELATED TO MOTHER

AND CHILD CARE

OBJECTIVES OF MCH:- To reduce maternal, infant and

childhood mortality and morbidity. To promote reproductive health To promote physical and psychological

development of children and adolescent within the family.

MATERNAL AND CHILD HEALTH PROGRAME

SERVICES

Servics delivered by multipurpose health workers Record of occurrence of pregnancy identify women with anemia Administered 2 doses Tetanus Toxoid. Provide iron and folic acid tablet to pregnant

women

Screen women identified as pregnant for any of the risk factor

Risk factor

Age less than 17 years or over 35 years

height <145cm

Weight <40 kg or

>70kg.

history of bleeding in

previous pregnancy

history still births history of

cesarean section

CARE OF CHILDREN Monitoring of growth of children to detect

malnutrition. Immunization Treatment of common ailments Referral cases to higher centers Implementation national health policies.

INTEGRATED CHILD DEVELOPMENT SERVICE SCHEME (ICDS) (1975)

TARGET: holistic development of children

OBJECTIVE- To improve the nutritional and health status of children in

the age group 0-6 years. To reduce mortality, morbidity, malnutrition and school

dropout. To lay the foundation for proper psychological, physical

and social development of the child.

To achieve effective co-ordination of policy and implementation amongst the various departments to promote child development

To enhance the capability of the mother to look after the normal health and nutritional needs of the child through proper nutrition and health education.

BENEFICIARY SERVICES

Children of below 3 years age group

Health checkup Immunization Referral services

Supplementary nutrition

Children of 3-6 year age group Non formal preschool education

Health checkup Immunization Referral services

Supplementary nutritionExpectant and nursing women Health check up

Immunization against tetanus of expectant

Nutrition and health education Supplementary nutrition

Other women of 15 to 45 years Nutritional and health education

CHILD SURVIVAL AND SAFE MOTHERHOOD PROGRAM (1992)

AIMS To reduce infant mortality. Provide antenatal care to all

pregnant women. Ensure safe delivery services. Provides basic care to all

neonates. Identify and refer these neonates,

who are at risk.

REPRODUCTIVE & CHILD HEALTH(RCH)

1997 RCH

CSSM

Family welfare

OBJECTIVES The program integrates all interventions of

fertility regulation, maternal and child health with reproductive health for both men and women.

The service to be provided are client oriented, demand driven, high quality and based on needs of community through decentralized participatory planning and target free approach.

The program up gradation of the level of facilities for providing various interventions and quality of care. The first referral Units (FRUs) being set-up at sub district level provide comprehensive emergency obstetric and new born care.

Facilities of obstetric care, MTP and IUD insertion in the PHCs level are improved.

Specialist facilities for STD and RTI are available in all district hospitals and in a fair number of sub-district level hospitals.

COMPONENTS

familly welfre and planning

prevention of RTI/STD

adolscvence

child survival

safe moth-rhood

community participation

client partici-pation

SERVICES PROVIDED

For the children Essential newborn care Exclusive breastfeeding Immunization Appropriate management of ARI Vitamin A prophylaxis Treatment of anemia

For the mother Tetanus Toxoid immunization Prevention and treatment of anemia Antenatal care and early identification of

maternal complications. Delivery by trained personnel Promotion of institutional deliveries Management of obstetrical emergencies Birth spacing

For the Eligible couple Prevention of pregnancy Safe abortion

For RTI/STD Prevention and treatment of reproductive tract

infection and sexually transmitted diseases. RCH program is a target-free program with voluntary participation.

RCH PHASE – II 1ST APRIL, 2005STRATEGIES Essential obstetric care Institutional delivery Skilled attendance at delivery Emergency obstetric care Operational delivery Operational PHCs and CHCs for round the clock

delivery services. Strengthening referral system

"The Integrated Management of Childhood Illness (IMCI)"

1992

UNICEF and WHO

Components: Improvement of the case management

skills of health providers Improvement in the overall health

system. Improvement in family and community

health care practices. Collaboration/coordination with other

Departments

IMNCI BENEFICIARIES

Care of Newborns and Young Infants (infants under 2 months)

Care of Infants (2 months to 5 years)

PRINCIPLES OF IMNCI GUIDELINES

All sick young infants up to 2 months of age must be assessed of “possible bacterial infection/ jaundice” and “diarrhea”.

All sick children aged 2 months up to 5 years must be examined for general danger signs and then for cough or difficult breathing, diarrhea, fever or ear problem.

Cont……

All sick young infants and children 2 months up to 5 years must also routinely be assessed for nutritional and immunization status and feeding problem.

Management procedures use a limited number of essential drugs and encourages active participation of caretakers.

Cont…….

Based on signs, the child is assigned to color coded classification: “

- urgent hospital referral or admission

- specific medical Rx or advice - home management

NATIONAL PROGRAMS RELATED TO CONTROL

OF COMMUNICABLE DISEASE

National program of immunization. 1985 Acute respiratory infection control program Diarrheal disease control program (1971) Revised national tuberculosis control program

1962 Leprosy eradication program 1955 National vector borne disease control programs

NATIONAL PROGRAM ON IMMUNIZATION 1974

1974-WHO launched “Expended Programme Of Immunization” (EPI)

1978-Govt. of India launched the same EPI programme in India

1985 –EPI renamed as Universal immunization programme

OBJECTIVES To increase immunization coverage. To improve the quality of service. To achieve self sufficiency in vaccine production. To train health personnel. To supply cold chain equipment and establish a

good surviveillance network. To ensure district wise monitoring

REVISED IMMUNIZATION SCHEDULEAge Vaccines

Pregnant Women TT (2 doses/Booster)

Birth BCG, OPV-O, Hep B1

6 - 8 weeks DPT -1, OPV -1, Hep B2, Hib1

10-12 weeks DPT -2, OPV -2, Hib2

14-16 weeks DPT -3, OPV-3, Hep B, Hib3

7-9 months Measles

15-18 months DPT booster, OPV – Booster, Hib,MMR

2 years Typhoid

4-5 years DTP,OPV

5-10 years TT,MMR2,Hep B15 year TT

ACUTE RESPIRATORY INFECTIONS CONTROL PROGRAM

1990- Programme launched 1992- the Programme was implemented as part of CSSM

The WHO protocol puts two signs as the “entry criteria” for a possible diagnosis of pneumonia.

cough difficult breathing.

Patient treated with antibiotics ampicillin 25-50 mg/kg/day gentamicin 5.0mg/kg/day.

for a period of 7 to 10 days

REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME (RNTCP) 1962

Goal The goal of TB Control Program is to decrease

mortality and morbidity due to TB and cut transmission of infection until TB ceases to be a major public health problem in India.

OBJECTIVES:

To achieve at least 85 % cure rate of the newly diagnosed sputum smear-positive TB patients

To detect at least 70% of new sputum smear-positive patients after the first goal is met.

STRATEGY

DOTS

COMPONENT OF DOT,S

Political and administrative commitment Good quality diagnosis. Good quality drugs. The right treatment, given in the right way.

Systematic monitoring and accountability.

DRUG DOSE

Drug Dose adults children • Isoniazid• Rifampicin• Pyrazinamide• Ethambutol • Streptomycin

600 Mg/kg450*Mg/kg 1500Mg/kg 1200 Mg/kg750 Mg/kg

10 –15 Mg/kg10 Mg/kg 35 Mg/kg 30 Mg/kg 15 Mg/kg

CATEGORIES OF TB CASES AND THEIR TREATMENT REGIMENS

Category Characteristic of a TB case

Treatment regimen

Intensive phase Continuation phase

Category I New sputum smear-positive Seriously ill, sputum smear-negative • Seriously ill, extra-pulmonary

2 ( HRZE )3

24 does

4 ( HR )3

54 does

Category II Relapse Failure Treatment after default Others

2(SHRZE)3

+1( HRZE )3

36 does

5 ( HRE )3

66 does

Category HI Sputum smear-negative Not seriously ill, extra-pulmonary

2 ( HRZ )3

24 does

4 ( HR ) 3

54 does

CONTROL OF DIARRHEAL DISEASE (CDD) PROGRAM (1971)

STRATEGY : To train medical and other health personnel in

standard case management of diarrhea. Promote standard case management practices

amongst private practitioners. Instruct mother in home management of diarrhea

and recognition sign which signal immediate care.

Make available the ORS (oral rehydration salts) packets free of cost

TREATMENT The rational treatment of diarrhea consists in

prevention of dehydration in a by oral rehydration therapy(ORS)

Breastfeeding should be continued. In dysentery given cotrimoxazole in addition to

ORS. If unsatisfactory response, nalidixic acid is given for five days.

Any program for diarrheal disease control must include provision of portable water.

Parent must be educated regarding storage of water and food in clear utensils, continue of breastfeeding, using of only freshly prepared weaning foods washing of hands with soap before handling

food.

NATIONAL LEPROSY CONTROL PROGRAM 1955

1955 -national leprosy control program 1955 1983 –national leprosy eradication program

SERVICES Provide domiciliary treatment (MDT) Provide services through mobile leprosy treatment

units with the help of PHCstaff. Organize health education deformity and ulcer care and medical rehabilitation

services.

NATIONAL AIDS CONTROL PROGRAM (1987)

1987-NACP

1991 –NACP PHASE 1

1992 -National AIDS control organization

1999 –NACP PHASE 2

2011 –NACP PHASE 3

Objective Prevent infections care, support and treatment . Strengthen- infrastructure, systems and human

resources Strengthen the Strategic Information Management

System

STRATEGY

Surveillance of HIV infection as indicated by serum positivity.

Surveillance of aids cases showing clinical signs & symptoms.

Disease control strategies are targeted at three main modes of spread Sexual activity .  Self injection by drug addicts HIV infected blood transfusion

Training programs for paramedical & general practitioners to enhance their capability of effective STD diagnosis.

Counseling for HIV & AIDS patients Cheap availability of good quality condoms. Licensing of blood banks, encouraging voluntary

blood donation & screening of blood for HIV, malaria, hepatitis B & C to be mandatory for all.

NATIONAL VECTOR BORNE DISEASE CONTROL

PROGRAM

2003- (NVBDCP) is an umbrella programme for prevention and control of Vector borne diseases.

1. Malaria 2. Dengue 3. Chikungunya 4. Japanese Encephalitis 5. Kala-Azar 6. Filaria (Lymphatic Filariasis)

NATIONAL MALARIA ERADICATION PROGRAM (1953) 1953 National Malaria Control Programme 1958 National Malaria Eradication Programme 1977 Modified Plan of Operation (MPO). 1995 Implementation of Malaria Action Plan 1997 Enhanced Malaria Control Project in tribal

districts of the State (World Bank Assisted) 2000 National Anti Malaria Programme

OBJECTIVES

To prevent death due to malaria Agricultural and industrial production to be

maintained by undertaking intensive anti-malarial measures in such areas.Early case detection and promote treatment.

Vector control by house to house spray in rural areas with appropriate insecticide and by recurrent anti larval measures in urban areas.

Health education and community participation. Reduction in the period of sickness

NATIONAL FILARIA CONTROL PROGRAM (1995)

ACTIVITES Delimitations of the problem in

unsurved areas. Control in urban area through:

(a) recurrent anti larval measures

(b) anti parasitic measures Control in rural areas through detection

and treatment of microfilaria carriers/persons.

Anti-larval measures which include weekly spray of approval larvacides and biological control through larvivorous fishes.

Source reduction through environmental and water management

Anti parasitic measure-diagnosis and treatment. community awareness through education Annual single dose (preventive)mass drug

administration of DEC (Diethylcarbamazine citrate tablets)

KALA AZAR CONTROL PROGRAM (1991)

 STRATEGY Interruption of transmission for reducing vector

population by undertaking indoor residual insecticidal spray twice annually.

Early diagnosis and complete treatment of kala-Azar cases.

Information education and communication for community awareness and community involvement.

PREVENTION AND CONTROL OF DENGUE HEMORRHAGIC FEVER

STRATEGY Surveillance for disease and vectors. Early diagnosis and prompt case management Vector control through community participation and

social mobilization. Capacity building.

NATIONAL PROGRAMS RELATED TO CONTROL OF NUTRITIONAL

DEFICIENCY DISORDERS

Special nutritional program 1970 Mid-day meal program. 1957 Anemia prophylaxis program. 1970 National iodine deficiency disorders control

program

SPECIAL NUTRITION PROGRAM 1970

OBJECTIVE To improve the nutritional status of preschool

children, pregnant,and lactating mother of poor socio economic groups in urban slums,tribal area and drought prone rural area

Child up to one year

200kcl and 8-10g protein/day

child 1-6 years. 300 kcal 10-12g proteins/day

women 500 kcal 25g protein/day

MIDDAY MEAL PROGRAM (1961)

OBJECTIVES

To raise the nutritional status of primary school children

To improve attendance and enrolment in school. To prevent dropouts from primary school. Children

belonging to backward classes, schedule caste, and scheduled tribe families are given priority.

PRINCIPLES:-

Should be a substitute. 1/3 Total energy and ½ total protein Provided at the low cost It is easily prepared Locally available food Change menu frequently.

 

BENEFICIARY School children in the age group 6-11

year

SERVICES provides 300 calories and 8-12 g

protein/day for 200 days in year

ANEMIA CONTROL PROGRAM (1970)

BENEFICIARY Pregnant women, Nursing mothers, Women acceptors to terminal methods and IUD. children 5 years

Daily dose of iron and folic acid tablets women:80mg ferrous sulfate+0.5 mg folic acid. Children:180mg ferrous sulfate+0.1 mg folic

acid.(2ml liquid )

NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAM (1962)

1962: NGCP launched1984 : The central council of health approved the Policy of Universal salt Iodization (USI): Private sector to produce iodized salt1992: NGCP renamed as NIDDCP1997: sale and storage of common salt banned

OBJECTIVES:-

Surveys to assess the magnitude of the IDD. 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 iodated salt.

Laboratory monitoring of iodated slat and urinary iodine excretion.

Health education & publicity.

NATIONAL PROGRAMS RELATED TO CONTROL OF

NON COMMUNICABLE DISEASE

1. National school health program. 1977

2. National mental health program 1982

3. National program for control of blindness 1963

4. National cancer control program 1975-1976

5. National diabetes control program

6. Child welfare program for disabled children

7. National water supply and sanitation program 1954

8. National family welfare program 1952

9. Minimum needs program 1974-1978 (5th five year plan)

SCHOOL HEALTH PROGRAMME

1977

AIMS AND OBJECTIVES

Promotion of positive health Prevention of disease Timely diagnosis, treatment and follow up Health education to Inculcate awareness about

good and bad health. Availability of healthful environment

COMPONENT Health appraisal Remedial measures and follow up Prevention of communicable disease Healthful environment Nutritional services First aid facilities Mental health Dental health Eye health Ear health Health education Education of handicapped children School health record

NATIONAL MENTAL HEALTH PROGRAM (1982)

components 1. Treatment of Mentally ill

2. Rehabilitation

3. Prevention and promotion of positive mental health.

OBJECTIVES

Provision of mental health services at district level.

Improvements of facilities in mental hospitals.

Training of trainers of PHC personnel in mental hospital

Program for substance use disorder.

NATIONAL PROGRAM FOR CONTROL OF BLINDNESS (1976)

1963: Started as National Trachoma Control Program

1976: Renamed as National Program for prevention of Visual Impairment and Control of Blindness

1982: Blindness included in 20-point program

OBJECTIVES

Dissemination of information about eye care.

Augmentation of ophthalmic services so that eye care is promptly availed off.

Establishment of a permanent infrastructure of community oriented eye health care.

BENIFICERY :- 6month -5 year children

STREATGY

Administration of vit A dose at a regular 6 month interval

VIT A ADMINISTRATION SCHEDUALE6-11 month:-100000 IU 1-5 year:-200000 IU /6 monthsChild must receive total 9 does

VITAMIN A DEFICIENCY CONTROL PROGRAM (1970)

PREVENT VIT-A DEFICIENCY THROUGH

Promotion of breastfeeding and feeding of colostrums. Encourage the intake of green leafy vegetable and

yellow colored fruit. Increase the coverage of with measles (depletes

vitamin A stores)

NATIONAL CANCER CONTROL PROGRAM

1975-76: National Cancer Control Program launched

1984-86: Strategy revised and stress laid on primary prevention and early detection of cancer cases.

1991-92: District Cancer Control Program started

2000-01: Modified District Cancer Control Program initiated

2004 : Evaluation of NCCP by NIHFW 2005 : Program revised after evaluation

GOAL AND OBJECTIVE

Primary prevention of cancers by health education.

Secondary prevention i.e. early detection and diagnosis of common cancer of cervix, mouth, breast and tobacco related cancer by screening method.

Tertiary prevention strengthening of the existing institutions of comprehensive therapy including palliative therapy.

Prevention of tobacco related cancer.

Prevention of cancer of uterine cervix.

Strengthening of diagnostic and treatment equipment for cancer at medical colleges and major hospitals.

THE SCHEMES UNDER THE REVISED PROGRAM ARE

Regional cancer centre scheme

Oncology wing development scheme

District cancer control program

Decentralized NGO scheme

Research and training

NATIONAL DIABETES CONTROL PROGRAM(7 FYP)

OBJECTIVES Identification of high risk subjects at an early stage

and imparting appropriate health education. Early diagnosis and management of cases Prevention, arrest or slowing of acute and chronic

metabolic as well as chronic cardiovascular, renal and ocular complication of the disease.

Rehabilitation of the partially or totally handicapped diabetic people.

CHILD WELFARE PROGRAM FOR DISABLED CHILDREN

DISABILITY IN FIVE YEAR PLANS

1FYP -Launched a small unit by the ministry of education for the visually impaired in 1947.

2 FYP- under ministry of education a National Advisory Council for the physically challenged started.

3FYP-attention was given to rural areas and facilitated training and rehabilitation of the physically challenged.

Cont……

4FYP-more emphasis was given to preventive work.

6FYP-national policies were made around for provision of community oriented disability

prevention and rehabilitation services to promote self reliance.

NATIONAL WATER SUPPLY AND SANITATION

PROGRAM 1954

OBJECTIVEproviding safe water supply and adequate drainage facilities for the entire urban and rural population of the country.

Cont……

SWAJALDHARA (2002)

Swajaldhara is a community led participatory program, which

AIMS providing safe drinking water in rural areas, with full

ownership of the community, building awareness among the village community on

the management of drinking water projects, promote better hygiene practices encouraging water conservation practices along with

rainwater harvesting.

MINIMUM NEEDS PROGRAM (1974-78-5 FYP)

OBJECTIVES To improve the living standards of the people. It is the expression of the commitment of the

government for the “social and economic development of the community particularly the underprivileged and underserved population.”

Cont……

COMPONENTS: Rural health Rural water supply Rural electrification Elementary education Adult education Nutrition Environment improvement of urban slums Houses for landless laborers.

NATIONAL FAMILY WELFARE PROGRAM (1952)

1951, 100% Centrally Sponsored, concurrent list First country in the world 1961 Family Welfare Dept.- created in 3rd FYP 4th FYP - integration of Family Planning services

with MCH services MTP Act introduced 1972 5th FYP(1975-80) The ministry of Family Planning

was renamed “Family Welfare”

THANK

YOU

...VERY MUCH

Thank you...