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National Health Programmes: An OverviewIssues/Commentsl Planning is rather ad hoc instead of using a comprehensive approach to the problem.l Malaria control is truly a problem requiring inter-sectoral and inter-departmentalinvolvement, which has not been achieved.l The desire to eradicate the problem has subsided and, hence, there is less commitment inimplementation.l Only temporary efforts to ward off mosquito bites are adopted.l There is no reliable and true data on the occurrence of the disease due to a lack of concernfor diagnosis, non-reporting, efforts to under-report and so forth.l The treatment pattern adopted by government providers and private practitioners is notuniformly standardized and problems of drug resistance are likely.2. National Leprosy Eradication Programme (NLEP)The National Leprosy Control Programme was launched in 1955. A not very effectivemono therapy with dapsone, along with the high drop-out rates among the patients, resultedin the accumulation of an estimated 4 million cases with a prevalence of 57/10,000population in 1981.In 1983, the programme was redesigned as the National Leprosy Eradication Programme andthe whole country was covered with multi-drug treatment (MDT) in a phased-in manner. It wasgiven a high priority by making it a 100% centrally-sponsored scheme with the goal ofelimination of leprosy (the prevalence rate reduction to less than 1 per 10,000 population) by theyear 2000. Operationally the country was divided into the following areas.l High endemic areas (districts), prevalence > 50/10,000l Moderate endemic areas (districts), prevalence 20–50/10,000l Low endemic areas (districts), prevalence < 20/10,000.Funds were released through 490 District Leprosy Societies set up under the chairmanship of theDistrict Collectors. Leprosy Control Units for every 4–5 lakh people were established in the highendemic areas. Mobile Leprosy Treatment Units were established in the non-endemic districts—two each in moderate endemic districts and one each in low endemic districts. In endemic urbanpockets, Urban Leprosy Centres were attached to general hospitals.The classification of the disease was revised and patients registered on the basis of thepresence of bacilli (pausi or multi) in the skin lesions, skin smears, and the involvement ofnerves. Accordingly, regimens of MDT were prescribed. Single-dose therapy for a single skinlesion was also introduced. Immuno-therapeutic and prophylactic vaccines have not beenrecommended.The Modified Leprosy Elimination Campaign has been introduced in some high endemic statesto increase case detection. The leprosy services are being integrated with general health careservices. Prevalence of leprosy came down from 57/10,000 in 1981 to 5.2/10,000 in 2000.29
National Health Programmes: An Overview3. Revised National Tuberculosis Control Programme (RNTCP)Tuberculosis continues to be a major public health problem. The worst affected population isthe young and economically productive age group. Lifetime risk of developing TB in TB-infectedpeople is about 10% and in HIV-infected people also infected with TB, it is 50%.India accounts for nearly one-third of the global TB burden and about three-fourths of theTB burden of World Health Organization’s (WHO’s) South-East Asia Region. It is estimatedthat in our country, 14 million people are suffering from TB, with 3–3.5 million beinghighly infectious.The National Tuberculosis Control Programme started in 1962 as a centrally-sponsoredprogramme on an equal sharing basis between the central government and the state. TheRevised National Tuberculosis Control Programme (RNTCP), popularly known as DOTS (directlyobserved treatment short-course) was pilot-tested and the programme was formally launchedon 26 March 1997, to be implemented in a phased manner. DOTS is a systematic strategy whichhas five components—(1) political and administrative commitment, (2) good quality diagnosis,(3) good quality drugs, (4) the right treatment given in the right way, and (5) systematicmonitoring and accountability.Diagnosis by microscopy is the primary strategy for case detection. Three samples of sputum(spot-early morning-spot) collected on two consecutive days from the patient are examined. Theyield of three sputum examinations is nearly as good as the results of a culture examination. Thenegative cases are diagnosed by radiological examination in accordance with the diagnosticalgorithm. Nearly 8 out of 10 patients diagnosed since 1993 were cured. The programme hasbeen expanded to more than 450 million in more than 190 districts. The RNTCP has preventedmore than 1.5 million TB infections and saved 125,000 lives. It is proposed to cover the entirecountry by 2005.4. National Filariasis Control Programme (NFCP)Approximately 420 million people in India are living with the risk of filaria infection and about44 million people are actually affected by filariasis.l 1949–55: The Indian Council of Medical Research (ICMR) conducted a pilot study in Orissa.l 1955: the NFCP was launched.l 1978: NFCP bifurcated into two components—research and training under the NationalInstitute of Communicable Diseases (NICD) and operational component under NationalMalaria Eradication Programme (NMEP).Pilot Projectsl Single-dose, mass drug administration initiated in 13 districts in seven states in 1997l Co-administration of DEC and Albendazole as Annual Mass Administration Strategyl DEC medicated salt project, undertaken at Neelaturu (Andhra Pradesh), Parbatpure (UttarPradesh), Lakshadweep, Karaikal (Pondicherry) and the Andamans.30
Page 1 and 2: Health Policy IssuesandHealth Progr
Page 3 and 4: ContentsContentsPrefaceList of Part
Page 6 and 7: I would also like to thank our tech
Page 8 and 9: List of ParticipantsIndu Kumar Pand
Page 10 and 11: List of ParticipantsMohmed ShaukatD
Page 12 and 13: List of ParticipantsR K PurohitAddi
Page 14 and 15: GlossaryGlossaryAbbreviationsAIIMSA
Page 16 and 17: GlossaryLHVLILMISMAPMCMCHMDRTBMDTM&
Page 18 and 19: GlossaryTHRTRCTRIPsTTTUUDCUIPUPUTVC
Page 20 and 21: Inaugural Sessionwould be the first
Page 22 and 23: Inaugural SessionOnly 18% of the pr
Page 24 and 25: Inaugural SessionMadhukar Gupta, Ch
Page 26 and 27: Inaugural Sessionrotational basis f
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Page 30 and 31: Public Health Issues, Priorities, a
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Page 56 and 57: Implementation of National Health P
Page 66 and 67: Use of Epidemiological Surveillance
Page 72 and 73: Designing a Surveillance SystemFurt
Page 74 and 75: Designing a Surveillance Systemsurv
Page 76 and 77: National Health Programme in Uttara
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IEC Strategies for Health in Indial
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IEC Strategies for Health in IndiaS
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IEC Strategies for Health in IndiaA
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IEC for Health Programmes in Uttara
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Session 3Private and Public SectorP
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Public-Private Interaction in Healt
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Cost Recovery Measures in Governmen
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Arogya Raksha: Health Insurance Sch
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Session 1Session 4Health Financing
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Health Financing in India: Some Iss
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Household Health Care Costs in Indi
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Session 1Session 4Access to Health
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Access to Health Services in Uttara
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Session 5STI/RTI, AIDS, and TB Cont
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Quality of RTI/STI Case Management
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HIV/AIDS: International Perspective
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HIV/AIDS in India and UttaranchalSe
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HIV/AIDS in India and UttaranchalFi
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HIV/AIDS in India and Uttaranchalpr
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Tuberculosis Control Efforts in Ind
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Session 6Other Health IssuesChairpe
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Care of the ElderlySocial care is u
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Care of the ElderlyEach group has d
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Hospital Waste ManagementSession 6H
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Hospital Waste ManagementA hospital
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Hospital Waste Managementbe without
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Hospital Waste ManagementTreatment
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Hospital Waste Management4. Tempera
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Hospital Waste ManagementTable 6. U
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Streamlining the Drug Procurement a
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Sanitation and Public Health Issues
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Ayurveda and Unani Department and t
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Specific Health Policy and Programm
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