NATIONAL HEALTH PROGRAMS RELATED TO CHILD HEALTH

Various national health programs are currently in operation for the improvement of child
health and prevention of childhood diseases.
The list of programs are:
1. Reproductive and Child Health Program.
2. Universal Immunization Program.
3. Intensified Pulse Polio Immunization Campaign and Pulse Polio Immunization
Program.
4. Integrated Child Development Services Scheme.
5. School Health Program.
6. Nutritional Program, e.g.
- Mid day Meal Program
- Special Nutrition Program.
- Nutritional Blindness Prevention Program.
Besides these, there are other several national health programs which directly
and indirectly promote child health along with other members of community.
Those programs are:
 National Tuberculosis Control Program.
 National Leprosy Eradication Program.
 National Antimalaria Program.
 Kala-azar Control Program.
 National AIDS Control Program.
 National STD Control Program.
 National Surveillance Program for Communicable Disease.
 National Iodine Deficiency Disorders Control Program.
 National Mental Health Program.
 National Cancer Control Program.
 National Diabetes Control Program.
 National Water Supply and Sanitation Program.
 Diarrheal Disease Control Program.
 Minimum Need Program.
 National Vector Borne Disease Control Program.
 National Rural Health Program
 Millenium Development Goals.

1. REPRODUCTIVE AND CHILD HEALTH PROGRAMME:

Following International Conferrence of Population Development (ICPD)

recommendations, the Government of India reorient the existing family planning and
CSSM programme into a new programme called Reproductive and Child Health (RCH).
The programme started in August 1997.

Definition:
People have the ability to reproduce and regulate their fertility, women are able to go
through pregnancy and child birth safely, outcome of pregnancies is successful in terms
of maternal and infants survival and well being and couples are able to have sexual
relations free of fear of pregnancy and of contracting diseases.
AIMS:
 To improve health status of young women and young children.
 To reduce the cost input to some extent because overlapping of expenditure
would not be necessary.
 Integrated implementation in RCH would optimize outcome at field level.

Various components of RCH programme:

1. Child survival and safe motherhood.
2. Family planning
3. prevention and management of STD and AIDS.
4. Client approach to health care. (target free approach)

Main highlights of RCH Programme:

1. Programme integrates all interventions of fertility regulations, maternal and child
health with reproductive health for both men and women.
2. Services to be provide will be client oriented, demand driven, high quality and
based on need of community through decentralized participatory planning and
target free approach.
3. Programme ugradation of level of facilities for provides various interventions and
quality of care.
1 st referral system unit being set up at sub district level will provide
comprehensive emergency obstetric and newborn care. Similarly RCH facilities at
PHC units will be upgraded.
4. It is proposed to improve facilities of obstetric care, MTP & IUD insertion in
PHC and also for IUD insertion at subcentres.
5. Programme aims at improving out reach of services primarily for vulnerable
group of people. Eg, Urbal slums, tribal population and adolescent.

PROGRAMME INTERVENTIONS:
In order to reduce maternal and child morbidity and mortality and promote sound health
of both mother and child the following interventions are executed by the department of
family welfare under the programme.

MATERNAL HEALTH INTERVENTIONS:

1. Essential Obstetric Care (EsOC): It includes the early registration of
pregnancy(within 12-16 wks), provision of minimum 3 Antenetal check ups,
promotion of institutional delivery, provision of safe delivery at home, provision
of 3 post natal care and referral services.
2. Emergency Obstetric Care (EOC): The EOC by identifying and streghthening first
referral units (FRUs) under the RCH Programme.
3. Twenty four hours delivery services at PHCs / CHCs.
4. Referral transport: Provision has been made for the transport facility with the
panchayat through district family welfare officers to be utilized by the families at
the time of obstetric emergencies.
5. Medical Termination of Pregnancy (MTP): The government of India has taken the
various steps in addressing the problems of unsafe abortion. These include:
 Provision of MTP equipments to the district hospitals, CHCs, and PHCs
wherever required.
 Assisting states / UTs for engaging doctors trained in MTP to give their
services once a week / fortnight in PHCs / CHCs and subdistrict hospitals
to overcome shortage of trained manpower.
 Provision of MTP equipments and free training in MTP techniques to non
– government organizations (NGOs).
6. Prevention , management and control of Reproductive tract infections (RTI ):
The various activities include setting up of RTI/STI clinics in FRUs, collaboration
with National AIDS contol organization for planning and implementation of
services on RTI/STI clinics; training and councelling , information , education
and communication(IEC) ;social marketing of condoms supply of RTI/STI drugs
and monitoring and evaluation.
7. Training of Traditional birth attendants : Dai training is continuing under RCH
Programme. NGOs are involved in training of dais to make it more local specific.
8. RCH Camps: have been initiated in the remote areas where the existing services
at PHC level are underutilized.

CHILD HEALTH INTERVENTIONS:

These interventions are as follows:
1.Universal Immunization Program:Under the program, the children are immunized as
per schedule against six killer diseases of the childhood namely tuberculosis, diphtheria,
pertusis, poliomyelitis, measles and neonatal tetanus.
Special efforts have been made during the past few years in some areas to improve the
coverage level, reduce dropouts and to reach identified areas with low coverage. A
special compaign with the assistance of UNICEF since 1998 has been taken up to protect
children under three in slums against measles which occurs more in overcrowded area.
Coutry is self sufficient in all vaccines except BCG and oral polio vaccines (OPV).
Indegenous capacity of BCG has been enhanced. All the efforts are taken to maintain the
efficiency of cold chain for vaccine right from the manufacturers level to the
beneficiaries level.
1. Control of acute respiratory infections ( ARIs): The standard case
management of ARI and prevention of deaths due to pneumonia is now an
integral part of RCH programme and the health workers are imparted
training in ARI management. Contrimoxazole is began supplied to the
health workers through the CSSM drug kit. Emphasis is given on IEC
activities to educate mothers on recognition of symptoms, referrals, care of
the child etc.
2. Essential newborn care: It is included as an intervention under the RCH
programme in order to accelerate the decline of IMR. The related
interventions include supply of equipments for newborn care to all the
districts; training of doctors or all other health workers on new born care
and use of equipments etc. with the assistance of neonatalogy Form of
India and WHO.
3. Oral rehydration therapy of Diarrhoea control among children:- The
government supplies ORS packets to all the states to be made available at
subcentres to prevent mortality in children due to dehydration. Each
subcentre is provided with two drug kits in a year, each containing 150
ORS packets along with other drugs.
4. Prevention and control of Vitamin A deficiency among children:- Under
the programme vitamin A drops administered to all the children under 3
years of age.
5. Border District cluster project:- This project included additional input for
improved implementation and intervention of the RCH programme to
reduce IMR and MMR by 50 percent over 4 years period.
6. National technical committee on child health:-I t has been set up to review
critically the existing programme interventions , their implementations,
assess the achievements against indicators related to prenatal, infant and
child mortality and suggest new additional cost effective feasible
intervention which help decline in the infant and child mortality.

RCH PHASE 11
RCH phase 2 began from 1st April,05. The focus of the programme is to reduce
maternal and child morbidity and mortality with emphasis on rural health care.
Major Strategies under ll phase:
1. Essential obstetric care
2. Emergency obstetric care
3. Stengthening referral system

1. Essential Obstetric care:

a) Institutional delivery:- 50 % of the PCHs and all the CHCs would made
optional as 24 hours delivery centres, in a phased manner by the year
2010. These centres would be responsible for providing basic emergency
obstetric care and essential newborn care and basic newborn resuscitation
services round the clock.
b) Skilled attendance at delivery: Guidelines for normal delivery and
management of obstetric complications at PHC / CHC for medival officers
and skilled attendance at birth for ANM LHVs have been formulated and
disseminated to the states.
c) The policy decisions:- ANMs / SNs have now been permitted to use drugs
in specific emergency situations.

2. Emergency obstetric care:- All FRUs are made operational for providing
emergency obstetric care, essential obstetric care, it includes:-
1. 24 hour delivery services including normal and assisted deliveries;
2. Emergency obstetric care including surgical interventions like caesarean
sections;
3. New- born care;
4. Emergency care of sick children;
5. Full range of family planning services including laproscopic services;
6. Safe abortion services;
7. Treatment of STI / RTI;
8. Blood storage facility;
9. Essential laboratory services;
10. Referral (transport) services.

3. Strengthening referral system:-

a) During RCH Phase 1, funds were given to the panchayat for providing
assistance to poor people in the case of obstetric emergencies . Feedback
from the states indicate that there was no active involvement of
panchayats In running the scheme.
b) In RCH Phase 11- to involve local self help group, NGOs and women
groups , whereas few others have indicated to outsource it.
c) New initiatives:- taken under RCH 11,
1. Training of MBBS doctors in life saving anaesthetic skills for
emergency obstetric care.
2. Setting up of blood storage centres at FRUs according to government
of India guidelines.
3. JANANI SURAKSHA YOJNA: The national maternity benefit scheme
has been modified into a new scheme called janani suraksha
yojna(JSY). It was launched on 12th April.2005.
The salient features of janani suraksha yojna are as followes:

a)It is a 100 percent centrally sponsored scheme;

b)Cash assistance with institutional care during antenatal, delivery and immediate post-
partum care;
c)This benefit will be given to all women , both rural and urban , belonging to below
poverty line household and aged 19 years or above , upto first 2 live births and in low
performing states, up to 3 live births.

The scale of assistance under the scheme would be as follows:-

Category Rural Area Urban area

Mother’s ASHA’s Total Mother’s ASHAs Total
Package package Rs. Package package Rs
LPS 1400 600 2000 1000 200 1200
HPS 700 - 700 600 - 600

LPS: Low performing states, HPS: High performing states.

In case of complication – assistance of 1500 rs will be given to pregnant lady. Eg, C.S

2. UNIVERSAL IMMUNIZATION PROGRAMME

In may 1974, the WHO officially launched a global immunization programme, known as
expanded programme on Immunization(EPI) to protect all children of the world against
six vaccines – preventable diseases, namely – diphtheria, whooping cough, tetanus,
polio, tuberculosis, and measles by the year 2000. EPI was launched in India in January
1978.
The programme is now called universal child immunization, 1990 – that’s the name
given to a declaration sponsored by UNICEF as part of the United Nations’ 40 th
anniversary in October 1985. It is aimed at adding impetus to the global programme of
EPI.
The Indian Version , the universal Immunuzation programme , was launched on
November 19, 1985 and was dedicated to the memory of Smt. Indira Gandhi. The
national health policy aimed at achieving universal immunization coverage of the eligible
population by 1990.

INDIAN NATIONAL IMMUNIZATION SCHEDULE:-

For infants
At birth - BCG and OPV- 0 dose
(For institutional deliveries)
At 6 weeks - BCG (if not given at given)
- DPT -1, OPV-1 and Hepatitis B-1
At 10 weeks - DPT -2 , OPV-2 and Hepatitis B-2
At 14 weeks - DPT -3, OPV -3 and Hepatitis B-3
At 9 months - Measles
b) At 16-24 months - DPT and OPV
c) At 5 – 6 years - DT – the second dose of DT should be given at an
interval of one month if there is no clear history or
documented evidence of previous immunization
with DPT
d) At 10 and at 16 years - Tetanus toxoid – The second dose of TT vaccine
should be given at an interval of one month if there
is no clear history or documented evidence of
previous immunization with DPT, DT, or TT
vaccines.
e) For Pregnant Women
Early in pregnancy - TT – 1 or Booster
One month after TT – 1 – TT- 2
The Indian Academy of Pediatrics recommended inclusion of more vaccines in the
immunization schedule. These vaccines are not included in the UIP because of financial
constraints. The immunization schedule approved by IAP is as follows:-
BCG - Birth – 2 weeks
OPV - Birth ; 6 weeks , 10 weeks and 14 weeks; 16- 18 months, 5 years
DPT - 6 weeks, 10 weeks and 14 weeks; 16 -18 months and 5 years
Hepatitis B - Birth , 6 weeks and 14 weeks or 6 weeks, 10 weeks and 14 weeks
Hib Conjugate - 6 weeks, 10 weeks and 14 weeks
Measles - 9 months
MMR - 15 Months
Typhoid - 2 years, 5 years, 8 years , 12 years
TT / TD - 10 Years, 16 years
TT - 2 doses one month apart for pregnant women , or booster dose if
previously immunized.

3. PULSE POLIO IMMUNIZATION PROGRAMME

India launched the Pulse Polio Immunization (PPI) program in 1995 as a result of World
Health Organization's (WHO) Global Polio Eradication Initiative. Under this programme,
all children under 5 years are given 2 doses of Oral Polio Vaccine (OPV) in December
and January every year until polio is eradicated.
PPI was initiated with the objective of achieving hundred percent coverage under OPV. It
aims to reach the unreached children through improved social mobilization, plan mop-up
operations in areas where poliovirus has almost disappeared and maintain high level of
morale among the public.

4. SCHOOL HEALTH PROGRAMME:

The National School Health Programme was launched in 1977 as Centrally sponsored
scheme.

Objective of the Programme:

1. To prepare younger generation to adopt measures to remain healthy so as to help them
to make the best use of educational facilities to utilize in a productive and constructive
manner, to enjoy recreation and to develop concern for others.
2. To help the younger generations to become healthy and useful citizens who will be
able to perform their role effectively for the welfare of themselves, their families, the
community at large and the country as a whole.
3. Promotion of positive health of School Children.
4. Prevention of disease.
5. Early diagnosis/treatment6/follow up/ referral.
6. Awakening of health consciousness.
7. Provision of healthful environment .

1. Health Education: Classroom instruction that addresses the physical, emotional,

mental and social aspects of health – designed to help students improve their
health, prevent illness, and reduce risky behaviors.
2. Physical Education: A planned, sequential K-12 curriculum that promotes life
long physical activity develops basic movement skills and sports skills. Physical
education shall be the environment in which students learn, practice, and are
assessed on developmentally appropriate motor skills, social skills, and
knowledge.
3. Health Services: Preventive services, education, emergency care, referrals, and
management of acute and chronic health problems – designed to prevent health
problems and injuries and ensure care for students. Can include school nursing as
well as dental services and school based/school linked health centers.
4. Nutrition Services: Integration of nutritious, affordable and appealing meals;
nutrition education, and an environment that promotes healthy eating.
5. Health Promotion for Staff: Opportunities that encourage school staff to pursue
a healthy lifestyle that contributes to their improved health status, improved
morale, and a greater personal commitment to the school's overall coordinated
health program. This personal commitment often transfers into greater
commitment to the health of students and creates positive role modeling. Health
promotion activities have improved productivity, decreased absenteeism, and
reduced health insurance costs.
6. Counseling and Psychological Services: Services that include individual and
group assessments, interventions, and referrals – designed to prevent problems
early and enhance healthy development.
7. Healthy School Environment: The physical and aesthetic surroundings and the
psychosocial climate and culture of the school. Factors that influence the physical
environment include the school building and the area surrounding it, any
biological or chemical agents that are detrimental to health, and physical
conditions such as temperature, noise, and lighting. The psychological
environment includes the physical, emotional, and social conditions that affect the
well-being of students and staff.
8. Parent/Community Involvement: An integrated school, parent, and community
approach for enhancing the health and well-being of students. School health
advisory councils, coalitions, and broadly based constituencies for school health
can build support for school health program efforts.

5. INTEGRATED CHILD DEVELOPMENT SERVICES(ICDS)

The Integrated Child Development Scheme (ICDS) comes under the purview of the
Ministry of Women and Child Development (MWCD). Recently MWCD released their
annual report (2008-2009) on child development. According to this report the ICDS
which was launched in 1975 has been working diligently to eliminate hazards to child
health and development. The following are the objectives of ICDS.

 To advance the nutritional and health standing of children in the age-group 0-6
years.
 To create a system that tackles the proper psychological, physical and social
development of the child.
 To fight the rate of mortality, morbidity, malnutrition and school dropout.
 To have all the various ministries and departments work in a coordinated fashion
to achieve policy implementation and create an effective ECCE system.
 To support the mother and help her become capable of providing of the necessary
nutritional and development needs of the child and aware of her own needs during
pregnancy.
To achieve the above objectives the ICDS aims at providing the following package of
services:

BENEFICIARY SERVICES
1. Pregnant women Health check ups
Imminization against tetanus
Supplementaru nutrition
Nutrition and health education

2. Nursing mothers Health check ups

Supplementaru nutrition
Nutrition and health education

3. Other women 15-45 years Nutrition and health services

4. Children less than 3 years Supplementary nutrition

Immunization
Health check ups
Referral services

5. Children in age group 3-6 years Supplementary nutrition

Immunization
Health check ups
Referral services
Non- formal education

6. Adolescent girls 11-18 years Supplementary nutrition

The scheme aims at providing an integrated package of services. These services include
supplementary nutrition, immunization, medical check-ups, recommendation services,
pre-school non-formal education and nutrition & health awareness. The purpose of
providing these services as a package is because each of these issues is dependent on the
other. In order to ensure that the overall care and education of the child is addressed the
MWCD envisions the scheme as a complete parcel of provisions.

The structure of ICDS is that it is a centrally funded scheme implemented through the
States and Union Territories. Originally, financially it was 100% backed by the central
government, except the supplementary nutrition, which must be provided by the State's
resources. But in 2005-2006 it was noted that many of the States were not capable of
providing adequately for supplementary nutrition in view drought, economic slowdown,
etc. Hence it was decided to support the States up to 50% of their economic norms or to
support 50% of expenses acquired by them on supplementary nutrition, whichever is less.
The reason for the Central assistance for Supplementary nutrition is to ensure that all
beneficiaries are receiving the supplements for 300 days of the year as has been laid out
in the norms of the scheme.
6. NATIONAL MALARIA ERADICATION PROGRAMME(NMEP):-
National malaria control programme was launched in APRIL 1953 which was upgraded
to National Malaria Eradication Programme(NMEP) in 1958.
Modified Plan:-
The problem was reviewed , in consultation with experts the Modified plan of
Operations, was approved by the cabinet in October 1976, which since than has been
implemented in all the states and union territories with the following objectives:
1. To prevent deaths due to malaria;
2. reduction in the period of sickness;
3. agricultural and industrial production to be maintained by undertaking intensive
anti-malarial measures in such areas;
4. to consolidate yhe achievements obtained so fae.

To attain these objectives, the modified plan of operations envisages three strategies.
These are:-
1. Early case detection and prompt treatment.
2. Vector control by house to house spray in rural areas with annual parasite
incidence(API) 2 and above per 1000 population , with appropriate insecticides
and by recurrent anti larval measures in urban areas.
3. Health education and community participation

The following efforts are mobilized to implement these strategies by:-

1. Government efforts:-Emphasis has been on the supply of anti-malarial drugs.
These are made available not only through the malaria workers, hospitals, primary
health centres, etc., but also through one or more of the various agencies like
Drug Distribution centres and Fever treatment depots.
2. People’s Participation:- To create awareness about the malaria problem among
the people , panchayat members and other public representatives are being
imparted orientation training about the occurrence , prevention, and treatment of
malaria at the P.H.C. level.
3. Research:- Various fundamental and operational researches in malaria have been
done by Indian Council Of Medical Research.
4. Training:- The National Institute of Communicable Diseases runs two cources in
Malariology and one in Entomology.
5. Publicity:-The implementation of programme are focused to the notice of the
people through Multilanguage posters, hand-bills, picture cards, flash cards, etc.
6. International Assistance:- It is attained in the form of technical guidance , drugs,
insecticides, equipments, research work etc.

7. KALA-AZAR CONTROL PROGRAMME

In 1991, the Kala Azar control programme was launched by the government of India.
The strategies for Kala-Azar control are:-
1. Interruption of transmission for reducing vector population by undertaking indoor
residual insecticidal spray twice annually,
2. Early diagnosis and complete treatment of Kala- Azar cases.
3. Information , education and communication for community awareness and
community involvement.
Government of India , with concurrence of planning commission, has decided in
principle to provide operational cost include wages for insecticide spray to Kala- Azar
endemic states from the year 2001-02.

8. NATIONAL LEPROSY ERADICATION PROGRAMME

The Government of India launched the National Leprosy Control Programme in the
year 1955 in the collaboration with the state governments to control the spread of the
diseases and render modern treatment facilities to leprosy patients.
In 1983, the National Leprosy Control Programme was enhanced to
National Leprosy Eradication Programme on the recommendations of working group
on leprosy. Thos was done because of availability of highly effective treatment for
leprosy.
The various strategies which have been under taken include as under:-
1. Information, Education and Communication(IEC):-
a)IEC kits
b) learning material in regional languages.
c)exhibition

2. Staff Motivation and Special Projects for Difficult areas:-Award based on

performance has been sanctioned under the programme for each district , state/ UT
and National level
3. NGOs Participation:-A total of 285 voluntry organizations are working in the field
of Leprosy in the country.
4. Modified Leprosy Elimination Compaign(MLEC):- Two rounds of MLEC have
been implemented.

9. NAT IONAL TUBERCULOSIS CONTROL PROGRAMME

The National Tuberculosis control Programme was launched in 1962 and

implemented through a network of District Tuberculosis Centers (DTCs).The
function of DTC has been to plan , organize district tuberculosis programme (DTP)
and implement in the entire district in association with all the health and medical
facilities located in the district so as to reach the people in rural and urban areas. In all
the DTC, a team including :-District Tuberculosis Officer(DTO. 1) , second medical
officer (1), laboratory technicians (2), Health visitors (2), X-Ray Technician (1), non
–medical team leader (1) , Statistical assistant (1), Pharmacist (1) is available.

A Revised Strategy:- laid down the following objectives:

1. To achieve at least 85 percent cure rate of infectious TB cases through
administration of directly observed intermittent short course chemotherapy (SCC)
involving peripheral workers.
2. To detect at least 70 % of estimated cases by augmenting case finding through
quality sputum microscopy.
3. To involve NGOs for IEC and improved operational research.
All patients would be given SCC free of charge. During the intensive phase
of chemotherapy all the drugs would be administered in the periphery under direct
supervision called as Direct Observed Therapy Short Term (DOTs). Anti TB drugs
would be administered by DOTs agents such as health workers (F&M), voluntary
health guides, dais, anganwadi workers , teachers etc.

10.NATIONAL MENTAL HEALTH PROGRAMME

In 1982, the national mental health programme was launched to mitigate the hardship
of mentally ill patients. The objective of the programme:-
1. to ensure availability of mental health services to all, specially the community at
risk, underpriviledged and underserved people;
2. to encourage application of mental health knowledge in general health care and
social development.
The district mental health (DMH) Programme as component of NMHP was launched
in 1996-97. the interventions as mentioned in Annual report on health and family
welfare 2001-2002:-
1. Training of mental health team
2. increase awareness about mental health problems
3. provide services for early detection and treatment of mental illnesses in
community
4. funds are provided by government of India to state governments

11. NATIONAL IODINE DEFICIENCY CONTROL PROGRAMME

National goiter cont6rol programme was launched in 1962

Objectives
1. Initial survey to identify magnitude of problem in the country;
2. Production and supply of iodized salt to the endemic regions;
3. Health Education & Publicity;
4. To undertake monitoring of the quality of iodized salt assessing urinary iodine
excretion pattern and monitoring of Iodine Deficiency disorder; and
5. Re-survey in goiter endemic regions after five years continuous supply of iodized salt
to assess the impact of the control programme. The result of re-survey in some areas has
revealed that the prevalence of goiter has not been controlled as desired.

In 1992, the National Goiter Control Programme (NGCP) was renamed as National
Iodine Deficiency Disorder Control Programme(NIDDCP).
Objectives
1. To access the magnitude of fluorosis and dental caries beside assessing the iron and
Vitamin-A deficiency in the project area;
2. To assess and improve iron and vitamin-A status in school going children, adolescent,
boys and girls, non-pregnant women, adult males and geriatric population;
3. To launch extensive information, education and communication strategy through mass
media to improve the dietary habits of the populations; and
4. To study zinc level in various food products and soil.
5. To coordinate with similar ongoing programme being implemented in the country.

Activities planned:-
A) Goiter detection, Health education and awareness activities (IEC) and activities
to determine adequacy of iodine in salt and urine will be undertaken under this
program in different target populations
a. Children 6-12 years of age
b. Women in child-bearing age (15-44 years) with special focus on pregnant
women.
B) Resurveys will be carried out in different health districts of Delhi to review
prevalence of IDD and impact of iodated salt.
C) Monitoring of salt iodization at the level of retailers.
D) IDD awareness programmes will be carried out in schools dispensaries and
public places to create awareness about IDD and salt Iodization particularly
during IDD week celebrations.
E) Organizing meetings with retailer groups/local area leaders/food inspectors
regarding adequacy of iodization of salt.

12. NATIONAL AIDS CONTROL PROGRAMME

The acquired immuno deficiency syndrome (AIDS) is caused by a known virus known as
Human immuno deficiency virus(HIV). The first case was detected in USA in 1981. The
first case in India was reported in MAY 1986.
NACP PHASE – I(1992-1999)

During this phase, the National AIDS Control Project was developed for prevention and
control of AIDS in the country.
Project Objectives:- The ultimate objective of the project was to slow the spread of HIV
to reduce future morbidity, mortality, and the impact of AIDS by initiating a major effort
in the prevention of HIV transmission. The specific objectives were:

(a) Involve all States and Union Territories in developing HIV/AIDS preventive activities
with a special focus on the major epicenters of the epidemic;

(b) Attain a satisfactory level of public awareness on HIV transmission and prevention;

(c) Develop health promotion interventions among risk behaviour groups;

(d) Screen all blood units collected for blood transfusions;

(e) Decrease the practice of professional blood donations;

(f) Develop skills in clinical management, health education and counseling, and
psychosocial support to HIV seropositive persons, AIDS patients and their associates;

(g) Strengthen and control of Sexually Transmitted Diseases (STD); and

(h) Monitor the development of the HIV/AIDS epidemic in the country.

Achievement of Phase I

1. Awareness levels that were almost insignificant have increased to about 70-80% in
urban areas even though the level of awareness in rural areas remains low at about 30%;

2. Modernisation and strengthening of blood banks;

3. Introduction of licensing system of blood banks and gradual phasing out of

professional blood donors; and

4. Availability of good quality condoms through social marketing has made a significant
increase in its use.

National AIDS Control Programme Phase II (1999-2004)

The Phase II of the National AIDS Control Programme has become effective in 1999. It
is a 100% Centrally sponsored scheme implemented in 32 States/UTs and 3 Municipal
Corporations namely Ahmedabad, Chennai and Mumbai through AIDS Control
Societies.

Aims of Phase II

1. To shift the focus from raising awareness to changing behaviour through interventions,
particularly for groups at high risk of contracting and spreading HIV;

2. To support decentralisation of service delivery to the State and Municipalities and a

new facilitating role for National AIDS Control Organisation. Program delivery would be
flexible, evidence-based, participatory and to rely on local programme implementation
plans;

3. To protect human rights by encouraging voluntary counseling and testing and

discouraging mandatory testing;

4. To support structured and evidence-based annual reviews and ongoing operational

research; and
5. To encourage management reforms, such as better managed State level AIDS Control
Societies and improved drug and equipment procurement practices. These reforms are
proposed with a view to bring about a sense of 'ownership' of the programme among the
States, Municipal Corporations, NGOs and other implementing agencies.

Key Objectives

A. To reduce the spread of HIV infection in India; and

B. Strengthen India's capacity to respond to HIV/AIDS on a long-term basis.

Project Strategies :-

A. Delivery of cost-effective Interventions against HIV/AIDS.

1. Priority targeted intervention for groups at high risk

2. Preventive Intervention for the general community

a). IEC and awareness campaigns.

b). Providing voluntary testing and counseling.

c). Reduce transmission by blood transfusion and occupational exposure.

3. Low cost AIDS care.

B. Strengthen Capacity 1. Institutional strengthening

a). Building implementation capacity at the States and Municipal levels

b). Strengthening leadership capacity of NACO
c). Expand and improve nationwide STI/HIV/AIDS sentinel surveillance
d). Training
e). Build capacity for monitoring and evaluation programme activities.
f). Increase India's capacity for research on HIV/AIDS
2. Intersectoral Collaboration
Procurement Arrangements
Indigenous System of Medicine (ISM)
Monitoring and Evaluation of the Programme
Financial Management System

13. NATIONAL CANCER CONTROL PROGRAMME

National Cancer Control Programme was started in 1975-76. Its

Goals & Objectives are: -
1. Primary prevention of cancers by health education regarding
hazards of tobacco consumption and necessity of genital
hygiene for prevention of cervical cancer.
2. Secondary prevention by early detection and diagnosis of
cancers, for example, cancer of cervix, breast cancer and the
oro-pharyngeal cancer by screening methods and patients'
education on self examination methods.
3. Strengthening of existing cancer treatment facilities, which were
inadequate.
4. Palliative care in terminal stage cancer.

Existing Schemes under National Cancer Control programme

1. Cancer registry: -All the cases which are diagnosed are registered in the
institutions havind registry facility.
2. Financial assistance for Cobalt unit installation
3. Development of Oncology Wings in Govt. Medical College hospitals
4. Assistance for Regional Research and Treatment Centres
5. Modified District Cancer Control Programme:- Modified District Cancer
Control Programme has been initiated in four states namely Uttar Pradesh, Bihar,
Tamil Nadu & West Bengal. Sixty Blocks were taken up for this project and 1200
NCD workers, 30 supervisor, doctors, and consultants have been appointed. This
was a Survey cum health education drive in which about 12 lakh women in the
age group 20-65 years were contacted. Health education about general ailments,
cancer prevention and early detection besides 'Breast Self Examination' was
imparted.

6. District cancer Control Scheme: The patients are provided treatment at the
concerned Regional Cancer Centre or the nodal institution.It is known that a large
number of cancer cases can be prevented with suitable health education and early case
detection. Accordingly the scheme for district projects regarding prevention, health
education, early detection and pain relief measures was started in 1990-91. Under this
scheme one time

14. NATIONAL SURVEILLANCE PROGRAMME FOR COMMUNICABLE

DISEASES

This programme has been launched by the government of India since 1997-98.
The programme is implemented by the state govt. through their existing
infrastructure.
Under programme the surveillance system is strengthened through :
1, training of medical and paramedical staff
2. dissemination of technical information and guidelines
3. upgradation of laboratories
4. modernization of communication and data processing system
15. NATIONAL DIABETES CONTROL PROGRAMME

India started National Diabetes Control Programme on pilot basis during 7th Five year
plan in 1987 in some districts.

Objectives:-

1. Prevention of diabetes through identification of high risk subjects and early

intervention in the form of health education;
2. Early diagnosis of disease and appropriate treatment morbidity and mortality with
reference to high risk group;
3. Prevention of acute and chronic metabolic, cardiovascular, renal and ocular
complication of the disease;
4. Provision of equal opportunity for physical attainment and scholastic achievement for
the diabetic patients; and
5. Rehabilitation of those partially or totally handicapped diabetes people.

Interventions:-grouped into 3 components

1. Health promotion for the general population

2. Disease prevention for the high risk group
3. Assessment of prevalence of risk factors

16. NATIONAL WATER SUPPLY AND SANITATION PROGRAMME

The national water supply and sanitation programme was initiated in 1954 with object of
providing safe water supply and adequate drainage facilities for the entire urban and rural
population of the country.

 In 1972 the special programme known as the accelerated rural water supply
programme was started as a supplement to the national water supply and
sanitation programme.
 SWAJALDHARA:- was launched on 25th Dec. 2002. It is a community led
participatory programme, which aims at providind safe drinking water in rural
areas , with full pwnership of the community.

17. MINIMUM NEEDS PROGRAMME

The Minimum needs Program (MNP) was introduced in the country in the first year of
the Fifth Five Year Plan (1974-78). The objective of the programme is to provide certain
basic minimum needs and thereby 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.
The programme includes the following components:

a. Rural Health
b. Rural Water Supply
c. Rural Electrification
d. Adult Education
e. Nutrition
f. Environmental improvement of Urban Slums
g. Houses for landless labourers

There are two basic principales which are to be observed in the implementation of MNP :

(a) the facilities under MNP are to be first provided to those areas which are at present
underserved so as to remove disparities between different areas;

(b) the facilities under MNP should be provided as a package to an area through
intersectoral area projects, to have a greater impact.

18. NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME

National Vector Borne Disease Control Program is popularly known as NVBDCP, It is a

comprehensive programme for prevention and control of vector Borne diseases namely
Malaria, Filaria, Kala-azar, Dengue etc.

Three strategies for prevention and control of vector borne diseases is as follows:-

1. early detection, complete treatment, strengthening of referral services

2. integrated vector management, including indoor spraying in high risk areas, anti-
larval measures in urban areas.
3. supportive interventions including bahavioural change communication, human
resource development etc.

19. MILLENIUM DEVELOPMENT GOALS

The Millennium Development Goals (MDGs) are eight international development goals
that all 193 United Nations member states and at least 23 international organizations have
agreed to achieve by the year 2015. They include eradicating extreme poverty, reducing
child mortality rates, fighting disease epidemics such as AIDS, and developing a global
partnership for development.

1. Eradicate extreme poverty and hunger:-

* Halve the proportion of people living in extreme poverty by 2015.

* Halve the proportion of people who suffer from hunger by 2015.

2. Achieve universal primary education
* Ensure that by 2015, children everywhere, boys and girls alike, will be able to
complete a full course of primary schooling.

3. Promote gender equality and empower women

* Eliminate gender disparity in primary and secondary education, preferably by 2005,
and in all levels of education no later than 2015.

4. Reduce child mortality.

* Reduce by two-thirds the under-5 mortality rate by 2015.

5. Improve maternal health

* Reduce by three-quarters the maternal mortality ratio by 2015

6. Combat HIV/AIDS, malaria and other diseases

* By 2015 halt and begin to reverse the spread of HIV/AIDS
* By 2015 halt and begin to reverse the incidence of malaria and other major diseases.

7. Ensure environmental sustainability

* Integrate the principles of sustainable development into country policies and programs
and reverse the loss of environmental resources.
* Halve by 2015 the proportion of people without sustainable access to safe drinking
water and basic sanitation
* By 2015 achieve a significant improvement in the lives of at least 100 million slum
dwellers.

8. Create a global partnership for development with targets for aid, trade and debt
relief
* Develop further an open, rule-based, predictable non discriminatory trading and
financial system
* Address the special needs both of the least developed countries and of landlocked and
small island developing countries.
* Deal comprehensively with the debt problems of developing countries through national
and international measures in order to make debt sustainable
* In cooperation with developing countries, develop and implement strategies for decent
and productive work for youth
* In cooperation with pharmaceutical companies, provide access to affordable essential
drugs in developing countries
* In cooperation with the private sector, make available the benefits of new technologies,
especially information and communications.

20. DIARRHOEAL DISEASE CONTROL PROGRAMME

The dirrhoeal disease control programme was started in 1978 with the objectives of
reducing the mortality and morbidity due to diarrhoeal diseases.
 Since 1985-86 , with the inception of the national oral rehydration therapy
programme, the focus of activities has been on the strengthening case
management of diarrhea for children under the age of 5 years and improving
maternal knowledge related to use of home available fluids, use of ORS and
continued feeding.

CONCLUSION:- Every health practitioner working in pediatric department should

thorough with each and every aspect related to laws, ethics related to child to prevent
from legal action and also to maintain the rights of children. He or she should educate
the people to avoid harmful traditions and rituals which are harmful to child as well
as mother. Government has started number of programmes to control or eradicate
various life threatening and communicable diseases for the promotion of health.

BIBLIOGRAPHY:-

1. Ball W. Jane, Bindler C.Ruth.Pediatric Nursing.4th ed.Dorling Kindersley

publishers;Pp 17-20
2. Singh Meharban.Care of newborn.6th ed.Sagar publications;Pp 141-43, 155-60
3. Gulani K.K.Community health nursing Principles and Practice.2010 ed.Kumar
Publishers;Pp 629-62
4. Park K.Text book of preventive and social medicine.20 th ed.Banarsidas Bhanot
Publishers;Pp359-91
SCHOOL HEALTH SERVICES

 Health Education: Classroom instruction that addresses the physical, emotional,

mental and social aspects of health – designed to help students improve their
health, prevent illness, and reduce risky behaviors.

 Physical Education: A planned, sequential K-12 curriculum that promotes life

long physical activity develops basic movement skills and sports skills. Physical
education shall be the environment in which students learn, practice, and are
assessed on developmentally appropriate motor skills, social skills, and
knowledge.

 Health Services: Preventive services, education, emergency care, referrals, and

management of acute and chronic health problems – designed to prevent health
problems and injuries and ensure care for students. Can include school nursing as
well as dental services and school based/school linked health centers.

 Nutrition Services: Integration of nutritious, affordable and appealing meals;

nutrition education, and an environment that promotes healthy eating.

 Health Promotion for Staff: Opportunities that encourage school staff to pursue
a healthy lifestyle that contributes to their improved health status, improved
morale, and a greater personal commitment to the school's overall coordinated
health program. This personal commitment often transfers into greater
commitment to the health of students and creates positive role modeling. Health
promotion activities have improved productivity, decreased absenteeism, and
reduced health insurance costs.

 Counseling and Psychological Services: Services that include individual and group
assessments, interventions, and referrals – designed to prevent problems early and
enhance healthy development.

 Healthy School Environment: The physical and aesthetic surroundings and the
psychosocial climate and culture of the school. Factors that influence the physical
environment include the school building and the area surrounding it, any
biological or chemical agents that are detrimental to health, and physical
conditions such as temperature, noise, and lighting. The psychological
environment includes the physical, emotional, and social conditions that affect the
well-being of students and staff.

 Parent/Community Involvement: An integrated school, parent, and community

approach for enhancing the health and well-being of students. School health
advisory councils, coalitions, and broadly based constituencies for school health
can build support for school health program efforts