The mission of the National Health Mission of the Department of Health and Family Welfare, Government of Uttar Pradesh, is to improve the quality of life and status of health of the rural population with explicit and unequivocal emphasis on sustainable development measures.
The basic objectives for the implementation of the National Rural Health Mission are as follows:
- Reduction in the mortality rate of infants and mothers
- Ensure the stabilisation of the population
- The prevention and control of non-communicable and communicable diseases
- To upgrade the Ayurvedic, Yoga & Naturopathy, Unani, Siddha and Homeopathy (AYUSH) to promote a healthy lifestyle
This is the list of programmes under the National Health Mission:
- Integrated Disease Surveillance Project (IDSP)
- Routine Immunisation (RI)
- National Iodine Deficiency Disorder Control Programme (NIDDCP)
- National Leprosy Eradication Programme (NLEP)
- National Programme for Control of Blindness (NPCB)
- National Vector Borne Disease Control Programme (NVBDCP)
- Rashtriya Bal Swasthya Karyakram (RBSK)
- Rashtriya Kishor Swasthya Karyakram
- Reproductive and Child Health
- Revised National Tuberculosis Control Programme (RNTCP)
Integrated Disease Surveillance Project (IDSP):
Funded by the World Bank and launched in November 2004, the Integrated Disease Surveillance Project has the aim of strengthening a system for the surveillance of risk factors for non-communicable diseases as well as communicable diseases. To this end, the project utilises communication technology and information technology to provide a rapid response in case of sudden or impending outbreaks, as well as for analysis and data management.
The Indian Space Research Organisation (ISRO) and the Ministry of Health and Family Welfare cooperate to provide satellite linkage that will improve data transmission for this project. EDUSAT, an ISRO satellite, has been selected to provide the bandwidth for the project. The satellite deploys one national beam and 5 regional beams that encompass the entire country.
The network for the EDUSAT project would connect the Central Surveillance Unit that is located at the NICD in Delhi with the sub-hub which is in Nirman Bhawan, which is the headquarters of the Directorate General of Health Services and Ministry of Health. To cover the surveillance units in all the states and districts, there will be 800 Satellite Interactive Terminals. These will cover the surveillance units in the district and state level, medical and health institutions at the state and national level, medical colleges, and reference public health laboratories.
The linkage of the EDUSAT satellite will be utilised for the following:
- Distance training programmes for different National Health Programmes
- Data transmission
- Multimedia channel for feedback and communication
- A country-wide information highway network
- Teleconferencing for review of the different projects within the state
Routine Immunisation (RI):
The Routine Immunisation (RI) programme has a State Level Task Force and a Core Group to ensure that its objectives are met. The Chairman of the State Level Task Force is the Principal Secretary of the Government of Uttar Pradesh’s Medical, Health, & Family Welfare Department.
Other representatives from the department are also members of the programme. Other members are the representatives of the National Polio Surveillance Project (NPSP) from the World Health Organisation (WHO), the United Nations International Children’s Emergency Fund (UNICEF), Rotary, Indian Medical Association (IMA), and others. Other members include Secretaries of the Panchayati Raj, Urban Development, and Education departments. The programme is reviewed every quarter by the task force.
The Core Group at the State level provides technical support while monitoring progress regularly. It is under the Chairmanship of the National Program, Evaluation, and Monitoring’s Director General. The members of the core group include directors and assistant directors of other agencies, including partner agencies such as the National Polio Surveillance Project (NPSP) from WHO and UNICEF.
The RI monitoring is done jointly by the government, NPSP, and UNICEF. This is strengthened by the partner agencies and government. There is currently a standardised format for monitoring the RI. This will be revised by the State with support from NPSP and UNICEF. The data from each district is compiled by the NPSP district Surveillance Medical Officers (SMOs). This is then forwarded to the State RI unit of the NPSP for analysing and taking corrective measures.
National Iodine Deficiency Disorder Control Programme (NIDDCP):
Iron Deficiency Disorders (IDD) put 1.5 billion people worldwide at risk. Goitre and similar IDD problems affect another 70 million people. The National Goitre Control Programme (NGCP) was launched in 1962 by the Government of India with 100% central assistance. The objectives of this programme were the surveillance of Goitre-affected or reported areas and producing and supplying iodised salt to endemic areas. The survey at that time revealed that IDD affected people were all over the country, in both the plains and coastal areas. The Central Goitre Control Review Committee of 1983 then recommended that edible salt be universally iodised. A notification to this effect was issued under the Prevention of Food Adulteration (PFA) Act, 1954. It has recently been known that iodine deficiency can cause preventable mental retardation in children. So, there is a global focus on eliminating IDD. In 1992, the NGCP was renamed as the NIDDCP.
National Leprosy Eradication Programme (NLEP):
In 1955, the Government of India started the National Leprosy Eradication Programme (NLEP). The basis of the programme was Dapsone domiciliary treatment, implementation of survey education, and activities for treatment. A Multi-Drug Therapy (MDT) that was effective in the treatment of leprosy was found in the 1970s. This began to be widely used in the 1980s after a recommendation by the World Health Organisation (WHO). A high-level committee was established in 1981 under Dr. M.S. Swaminathan’s chairmanship to effectively manage the problem of leprosy in the country. The objective was to arrest the activity of leprosy in all known cases. The NLEP was subsequently launched in 1983. By 1996, all the districts in the country were covered under the programme. To further strengthen the campaign, a project supported by the World Bank, was launched in 1993.
Among leprosy patients, less than 20% are infectious which can become non-infectious with prolonged MDT. A single dose of MDT will kill 99.9% of leprosy bacilli under laboratory conditions. Leprosy bacilli, compared to other bacteria, multiply very slowly. Multi-bacillary patients need 1 year of MDT and paucibacillary patients need 6 months of MDT. Domiciliary treatment is advised under the programme.
National Programme for Control of Blindness (NPCB):
The objectives of the National Programme for Control of Blindness (NPCB) are:
- Development of eye care facilities in every district
- Get voluntary organisations to participate in eye care
- Identifying and treating blindness and thereby reducing the backlog
- Development of human resources to provide eye care services
- Improving the quality of service delivery
National Vector Borne Disease Control Programme (NVBDCP):
The Directorate of the National Vector Borne Disease Control Programme (NVBDCP) is a technical department under the Directorate General of Health Services, Government of India, and a central nodal agency. It deals with the control and prevention of diseases that are vector borne such as the following:
- Japanese Encephalitis
Rashtriya Bal Swasthya Karyakram (RBSK):
The Rashtriya Bal Swasthya Karyakram (RBSK) has as its objective the early identification and intervention of diseases, deficiencies, developmental delays (including disabilities), and birth defects (the 4Ds) in children from birth to the age of 18 years.
The programme states that children in the age group of 0 to 6 years will be managed at the District Early Intervention Centre (DEIC) while public health facilities will be utilised for those in the age group of 6 to 18 years. For both age groups, the DIEC will be the referral link. There is a phased establishment of DIECs in the state now.
The first level of screening is done at the delivery points through the existing doctors, nurses, and Auxiliary Nurse Midwife (ANM). The Accredited Social Health Activist (ASHA) is responsible for at-home screening of children 48 hours after birth to 6 weeks of age.
For children between 6 weeks to 6 years, mobile health teams conduct outreach screening at Anganwadi centres whereas for children between 6 to 18 years of age it is done in the schools.
Once the child is referred from these places, the required treatment or intervention is provided free of cost. Approximately 30 health conditions are chosen for the screening, early detection, and free management of these diseases. These are included under the Child Health Screening and Early Intervention Services under the RBSK.
Mobile health teams consist of two doctors who are MBBS/AYUSH/BDS, with a bachelor degree from an institution that is approved (one female and one male), one staff nurse or ANM, and one paramedical staff or pharmacist who will be proficient in data management on computers. Each team is also given one taxi permit vehicle to visit the areas identified as per the micro plan.
Health conditions for screening under Child Health Screening and Early Intervention Services:
|Defects at Birth||Deficiencies||Diseases of Childhood||Developmental Delays and Disabilities|
|Down’s Syndrome||Anaemia and severe anaemia||Skin conditions (fungal infections, scabies, eczema)||Impairment of hearing|
|Neural tube defect||Rickets (vitamin D deficiency)||Reactive airway disease||Impairment of vision|
|Congenital cataract||Bitot spot (vitamin A deficiency)||Rheumatic heart disease||Cognitive delay|
|Cleft lip and palate or only cleft lip||Goitre||Otitis media||Motor delay|
|Congenital heart diseases||Severe acute malnutrition||Convulsive disorders||Language delay|
|Talipes (club foot)||Dental conditions||Learning disorder|
|Congenital deafness||Behaviour disorder (autism)|
|Retinopathy of prematurity||Attention deficit hyperactivity disorder (ADHD)|
|Hip developmental dysplasia||Neuromotor impairment|
Optional diseases that can be included in the list are sickle cell anaemia, congenital hypothyroidism, and beta thalassemia.
The following adolescent health concerns are also included under the programme:
- Substance abuse
- Delay in menstruation cycles
- Irregular menstruation cycles
- Pain during menstruation
- Growing up concerns
- Pain or burning sensations when urinating
- Discharge or foul-smelling discharge from the genito-urinary area
Rashtriya Kishor Swasthya Karyakram (RKSK):
One-fifth of India’s population is in the age group of 10 to 19 years, which constitutes adolescents. It is necessary that the country pays attention to this age group to ensure that they grow up to be a healthy and productive force that will result in sustainable and vibrant growth for India. A healthy adolescent demographic today will result in a brighter and more prosperous country tomorrow. In order to ensure this, substantial investments have to be made in their health, education, and developmental needs.
The Rashtriya Kishor Swasthya Karyakram aims to address a wide range of adolescent developmental and health needs through the institution and implementation of an acceptable, appropriate, accessible, and effective service package. It also envisions the strengthening of the health system for more effective capacity building, communication, monitoring, and evaluation of their needs. It also emphasises the importance of different stakeholders working synergistically to achieve the objectives of the programme. This will result in improved indicators for the health and developmental issues of adolescents.
The target groups for RKSK are the 10-14 year age group and 15-19 year age group. The programme is universal, including all genders, rural and urban communities, married and unmarried, under-served and vulnerable, in-school and out-of-school.
To implement this, the programme has identified 7Cs, or 7 critical components, that have to be ensured across all areas. These components are:
There are 6 strategic programme areas that need to be addressed. These are:
- Sexual and Reproductive Health (SRH)
- Substance misuse
- Non-communicable diseases (NCD)
- Violence (that includes gender-based violence) and mental health
Objectives of the Rashtriya Kishor Swasthya Karyakram to address the needs of adolescents are as follows:
|Enhance mental health||Addressal of mental health concerns|
|Enable reproductive and sexual health||
|Prevention of injuries and violence||Promotion of favorable attitudes toward the prevention of injuries and violence (including gender-based violence)|
|Prevention of substance misuse||Increase awareness of the adverse consequences and effects of substance misuse|
|Address the conditions for non-communicable diseases (NCDs)||Promote behaviors that will prevent NCDs such as stroke, cardiovascular diseases, diabetes, and cancer|
Strategies for Achieving the Objectives:
There are 4 different strategies that help ensure that these objectives are met. Each of these strategies will address more than one objective. These strategies are:
- Community-based interventions: These include peer education (PE), menstrual hygiene scheme (MHS), quarterly adolescent health day (QAHD), and weekly iron and folic acid supplementation programme (WIFS).
- Behavioral and social change communication: Interpersonal communication is the focus here.
- Facility-based intervention: Strengthening adolescent-friendly health clinics (AFHCs).
- Convergence: With health and family welfare departments and other schemes, such as National Mental Health Programme, National Tobacco Control Programme, National Service Scheme, Adolescent Empowerment Scheme, Youth Affairs and Sports Department, etc.
Adolescent Friendly Health Clinics (AFHC): Provide a combination of services at the DH, CHC, and PHC levels.
AFHCs provide the following:
- Information - Information Education & Communication (IEC) and IPC (Interpersonal Communication)
- Printed materials, visuals, and wall writing
- Counseling on a variety of issues ranging from menstrual disorders, menstrual hygiene, personal hygiene and nutrition to sexual abuse, sexual concerns, gender violence, contraceptive use, substance misuse, depression, and promotion of healthy behaviours that will prevent non-communicable diseases
Curative services for the treatment or management of:
- Menstrual disorders
- Severe malnutrition
- Sexual concerns
- Non-communicable diseases
- Common ailments
- Substance misuse
- Sexual abuse
- Accident or violence-related injuries
- Sexually transmitted infections (STI) or RTI (reproductive tract infections)
- Sanitary napkins
- Weekly iron and folic acid supplementation
Reproductive and Child Health:
The Reproductive and Child Health Programme’s objectives are to transform three health indicators, which are infant mortality rate, maternal mortality rate, and reduction in total infertility rate. This is aligned with the outcomes that were envisioned in Vision 2020 India, National Health Policy 2002, Millennium Development Goals, Tenth Plan Document, and National Population Policy 2000.
The salient features of the RCH programme are as follows:
- Capacity building at the central, state, and district level to ensure increased implementation of the program. Its focus is on enhancing the evaluation and monitoring capabilities at the various levels. It also aims to strengthen the financial management systems.
- Extending RCH to the family welfare sector by adopting a sector-wide approach.
- Developing state and district level need-based plans which will encourage decentralisation.
- Involvement of union territories and states to built State ownership.
- Move away from micro-planning based on prescriptive schemes through flexible programming.
- Funding based on performance that will ensure that program objectives are adhered to, good performance is rewarded, and weak performance is supported.
- Programme management tools that support an outcome-driven approach through the adoption of logical frameworks.
- Optimise the utilisation of resources and infrastructural facilities through convergence, both intrasectoral and intersectoral.
- Simplification and rationalisation of assessment of external assistance through pool financing by developmental partners.
Revised National Tuberculosis Control Programme (RNTCP):
The Revised National Tuberculosis Control Programme (RNTCP) provides a comprehensive package for the control of tuberculosis (TB) through the strategy called Directly Observed Treatment Short Course (DOTS). This is the international standard for the control of TB today with 180 countries implementing it. It has been implemented in India since 1993 with nationwide DOTS coverage achieved in 2006.
The DOTS strategy ensures the diagnosis and treatment of TB patients till they are fully cured by providing a comprehensive course of medicines and a meticulous system for patient compliance monitoring.