Amity Institute of Pharmacy

Unit III: 10 Hours

National health programs, its objectives, functioning and outcome of
the following:
1. HIV AND AIDS control programme
2. TB
3. Integrated disease surveillance program (IDSP)
4. National leprosy control programme
5. National mental health program
6. National programme for prevention and control of deafness
7. Universal immunization programme
8. National programme for control of blindness
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9. Pulse polio programme
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1. National AIDS Control Programme IV (NACP)

Objective 1:

Reduce new infections by 50% (2007 Baseline of NACP III)

Objective 2:

Comprehensive care, support and treatment to all persons living with HIV/AIDS

The National AIDS Control Programme (NACP), launched in 1992, is being

implemented as a comprehensive programme for the prevention and control of
HIV/AIDS in India.

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KEY PRIORITIES UNDER NACP-IV ARE:

•Prevention of Parent to Child transmission.

•Providing comprehensive care, support and treatment to eligible HIV persons.

•De-centralizing rollout of services including technical support.

•Ensuring effective use of strategic information at all levels of the programme.

•Mainstreaming of HIV/AIDS activities with all key central/state level

Ministries/departments will be given a high priority

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Components
[Link] up coverage of TIs (Target Interventions) among HRG (HIGH RISK

GROUPS)

2. Scaling up of interventions among other vulnerable populations

3. Comprehensive Care, Support and Treatment

4. Strengthening institutional capacities

5. Strategic Information Management Systems (SIMS)

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OUTCOMES
1. During the third phase of NACP (2007-2012), there has been a substantial scale-
up of coverage of
•Female Sex Worker (81%)
•Injecting Drug Users (80%)
•Men having Sex with Men (64%)
•Truckers (57%)
•Migrants (40%)
through a total of 1,948 targeted interventions (TIs) (including 71 donor-supported
TIs) for high-risk groups and bridge populations.
2. Link Worker Scheme was established in 159 districts to reach out to rural HRGs
and their partners and vulnerable groups

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3. The overall condom distribution in the country has risen from 160 crore pieces
in 2006-07 to 300.79 crore pieces in 2011-12.
4. Counseling and testing services were rapidly scaled up through 4,537 stand-
alone Integrated Counseling and Testing Centres (ICTCs), 9,196 Facility
Integrated ICTCs and 1,805 under the Public and Private Partnership model.
5. The programme provided Nevirapine prophylaxis to 11,981 infected mother-
baby pairs at the time of delivery during 2011-12.
6. Care, support and treatment services are being provided through 355 ART(Anti
Retro Viral therapy) centres, 725 Link ART Centers (LACs) and 253 Community
Care Centres (CCC).
7. Over 90,000 persons were counseled for HIV and over 70,000 persons were
tested for HIV. STI treatment was provided to 11,000 persons and 80,000 persons
availed general health check-ups. The mobilization of political leaders and the
enormous support of State Governments and District administrations has been the
key to the success of this project.

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Key Concerns and Challenges for NACP-IV

•Given the experience of previous phases where the programme focused on
saturating the coverage, NACP-IV needs to advance towards focusing on ensuring
higher quality of services under interventions while sustaining the coverage.
•With increasing coverage of treatment and decreasing AIDS-related mortality, a
significant number of people are likely to require first and second-line ART treatment
during the 12th Plan period.
•International finances for HIV/AIDS programmes are shrinking. NACP-III had less
than 10% of domestic budgetary support. NACPIV will require a significantly greater
element of domestic budgetary support.
•Ensuring social protection schemes for people infected and affected with HIV/AIDS
through mainstreaming of HIV/AIDS with other ministries
•NACP-IV has to address the need for innovation within all key programme strategies
for integration of services, quality assurance at all service delivery points, coverage
saturation, treatment adherence, data quality and use, etc.

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2. TB (Tuberculosis) National Health Program- India

• The National Tuberculosis Elimination Program (NTEP) is the national health
program in India focused on TB control. It was launched in 1997 to eliminate TB
from India by 2025.
• The program has since been renamed as the Revised National Tuberculosis Control
Program (RNTCP).
The NTEP/RNTCP has several objectives, including:
• To provide quality TB diagnosis and treatment services free of cost to all TB patients
in India.
• To detect and treat all TB patients, especially those with drug-resistant TB, through a
standardized treatment regimen.
• To ensure that all TB patients complete their treatment successfully and prevent the
spread of TB.
• To integrate TB services with other healthcare services and promote community
participation in TB control.
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The NTEP/RNTCP has several strategies to achieve its objectives, including:

•Strengthening the healthcare system by improving infrastructure, human resources,

and laboratory services.
•Enhancing TB case detection through active case-finding strategies, such as contact
tracing, TB screening, and mobile clinics.
•Providing standardized TB treatment through directly observed treatment, short-
course, which involves supervised administration of TB medication.
•Promoting community participation in TB control through health education,
community mobilization, and involving community-based organizations.

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Targets:
The targets of the National Strategic Plan (NSP) are set out as consisting of both outcome
and impact indicators.
There are also four main “thrust” or priority areas in the NSP which are:
• Private sector engagement;
• Plugging the “leak” from the TB care cascade (i.e. people with TB going missing
from care);
• Active case finding among key populations;
• People in “high risk” groups, preventing the development of active TB in people
with latent TB.
Another “thrust” area is that of the Programmatic Management of Drug Resistant TB
(PMDT).
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Detect
The aim is to detect all those people with drug-sensitive TB as well as those with drug-
resistant TB. The emphasis is to be on reaching TB patients seeking care from private
providers and also finding people with undiagnosed TB in “high risk” or key populations.
This is to be done through:
•Scaling up free, high-sensitivity TB diagnostic tests such as “Cartridge based nucleic acid
amplification test (CBNAAT)”;
•Scaling up private provider engagement approaches;
•Universal testing for drug-resistant TB;
•& Systematic screening of high-risk populations.

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Diagnosis
The Technical & Operational Guidelines for TB Control (TOG) describes how various
tests should be used to diagnose anyone who has signs and symptoms suggesting that
they might have TB.
The tests to be used are
•Sputum smear microscopy,
•Chest X-ray and
•New CB-NAAT test.
The CB-NAAT test is beginning to be made available throughout India.
Active case finding
The main objective of active case finding (ACF) is to detect TB cases early and to
initiate treatment promptly. The NSP emphasizes the need to shift from passive case
finding, which is waiting for people to seek care, to ACF which involves seeking out
people in targeted groups.
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Treat
Initiate and sustain all patients on appropriate anti-TB treatment wherever they seek care.
Provide patient-friendly systems and social support.
•Providing free TB drugs for all patients with TB;
•Provide daily TB drugs for all patients with TB and a rapid scale-up of short course
regimens for drug-resistant TB. Provide treatment approaches guided by drug sensitivity
testing.
•Providing patient-friendly adherence monitoring and social support to sustain TB
treatment;
•The elimination of catastrophic costs by linking eligible TB patients with social welfare
schemes including providing nutritional support.

Prevent
Preventing the emergence of TB in susceptible populations. This is to be done through
•Scaling up air-borne infection control measures at health care facilities;
•Providing treatment for latent TB infection for the contacts of people with confirmed TB;
•& Addressing the social determinants of TB through an approach across different sectors

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3. Integrated Disease Surveillance Program (IDSP)

The Integrated Disease Surveillance Program (IDSP) is a national health program in India
that was launched in 2004. The program aims to establish a decentralized, state-based
disease surveillance system to detect and respond to disease outbreaks in a timely and
effective manner.
The objectives of the IDSP include:
•To strengthen the surveillance of communicable and non-communicable diseases in
India.
•To establish a decentralized, state-based surveillance system.
•To provide timely and effective responses to outbreaks of diseases.
•To improve the capacity of health systems to respond to public health emergencies.

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The IDSP operates at three levels: the state, district, and block levels.
•The state level, the program is managed by the State Surveillance Unit (SSU).
•The district level is managed by the District Surveillance Unit (DSU),
•The block level is managed by the Block Surveillance Unit (BSU).

The functioning of the IDSP involves various activities such as

•Case reporting,
•Outbreak investigations,
•Data analysis,
•Capacity building of health workers.
The program also involves the use of technology such as mobile applications and web
portals to improve the speed and accuracy of disease reporting and response.

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Outcomes
The outcomes of the IDSP have been mixed.
The program has contributed to the detection and control of several disease outbreaks
such as
•H1N1 influenza
•Cholera
•Dengue
•COVID-19
It has also improved the quality of disease surveillance and reporting in India.

However, there have been some challenges such as

•Inadequate resources,
•Poor quality of data,
•Lack of coordination among different levels of the health system.

Nonetheless, the IDSP remains an important national health program in India and efforts
are ongoing to address its challenges and improve its outcomes.

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IDSP ACHIEVEMENTS
•Surveillance units have been established at all States and District Headquarters (SSUs,
DSUs). Central surveillance Unit (CSU) is established and integrated in the National
Centre for Disease Control (Formerly National Institute of Communicable Diseases,
Delhi).
•Training of State/ District Surveillance teams (Training of Trainers) has been completed
for all 35 States /UTs.
•A portal under IDSP has been established for data entry and analysis, to report outbreaks
and to download reports, training modules and other material related to disease
surveillance ( [Link]).
•Presently, about 90% districts in the country report weekly surveillance data through
portal
•Media scanning and verification cell was established under IDSP in July 2008. It detects
and shares media alert with concerned State /Districts for verification and response.
•A 24×7 call center was established in February 2008 to receive disease alerts all across
the country on a toll free telephone number (1075).

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4. NATIONAL LEPROSY CONTROL PROGRAM

Leprosy, also known as Hansen’s disease, is a chronic infectious disease caused by

Mycobacterium leprous. The disease mainly affects the skin, the peripheral nerves,
mucosal surfaces of the upper respiratory tract and the eyes. Leprosy is known to
occur at all ages ranging from early infancy to very old age. Leprosy is curable and early
treatment averts most disabilities. The most widely held belief was that the disease
was transmitted by contact between cases of leprosy and healthy persons.

The National Leprosy Control Program (NLCP) is a national health program in India that
was launched in 1955.

The program is implemented by the central and state governments and supported by various
international organizations such as the World Health Organization (WHO).

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Objectives:
•The primary objective of the program is to eliminate leprosy as a public health problem in
the country.
•Early detection through active surveillance by the trained health workers
•Regular treatment of cases by providing Multi-Drug Therapy (MDT) at fixed in or centers a
nearby village of moderate to low endemic areas/district;
•Intensified health education and public awareness campaigns to remove social stigma
attached to the disease.
•Appropriate medical rehabilitation and leprosy ulcer care services.
12th plan Objectives
•Elimination of leprosy i.e., prevalence of less than 1 case per 10,000 population in all
districts of the country.
•Strengthen Disability Prevention & Medical Rehabilitation of persons affected by leprosy.
•Reduction in the level of stigma associated with leprosy.
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Strategies:
• Decentralized integrated leprosy services through General Health Care system.
• Early detection & complete treatment of new leprosy cases.
• Carrying out household contact survey in detection of Multibacillary (MB) & child
cases.
• Early diagnosis & prompt MDT, through routine and special efforts
• Involvement of Accredited Social Health Activists (ASHAs) in the detection &
complete treatment of Leprosy cases for leprosy work
• Information, Education & Communication (IEC) activities in the community to
improve self- reporting to Primary Health Centre (PHC) and reduction of stigma.

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Outcomes:
•Four premier Leprosy Institutes are working under Directorate General of Health Services,
Ministry of Health & F.W., Government of India viz.
1. Central Leprosy Teaching & Research Institute (CLTRI) Chengalpattu (Tamilnadu)
2. Regional Leprosy Training & Research Institute (RLTRI) Raipur (Chhattisgarh)
3. Regional Leprosy Training & Research Institute (RLTRI) Aska (Orissa)
4. Regional Leprosy Training & Research Institute (RLTRI), Gouripur, Bankura (West
Bengal)

• These Institutes also play important role in management of referral patients, providing
quality care to chronic ulcer and disabled patients with the help of Minor & Major
Reconstructive Surgeries.
• These Institutes also help in supervising and providing consultancy services to the State
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NLEP Units for better programme planning and implementation.
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Challenges:
•Leprosy remains a public health problem in 9 States
•Poor coverage with MDT services in some difficult to reach areas
•Hidden cases who continue to spread the infection
•Late detection of patients, many with visible deformities
•Poor treatment completion and cure
•Fear, prejudice and stigma surrounding leprosy
•Limited community awareness and involvement

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5. NATIONAL MENTAL HEALTH PROGRAM (NMHP)

• It is estimated that 6-7 % of population suffers from mental disorders.

• The World Bank report (1993) revealed that the Disability Adjusted Life Year (DALY)
loss due to neuropsychiatric disorder is much higher than diarrhoea, malaria, worm
infestations and tuberculosis if taken individually.
• One in four families is likely to have at least one member with a behavioral or mental
disorder (WHO 2001).
• These families not only provide physical and emotional support, but also bear the
negative impact of stigma and discrimination.
• Most of them (>90%) remain un-treated. Poor awareness about symptoms of mental
illness, myths & stigma related to it, lack of knowledge on the treatment availability &
potential benefits of seeking treatment are important causes for the high treatment gap.

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The Government of India has launched the National Mental Health Programme
(NMHP) in 1982, with the following objectives:
• To ensure the availability and accessibility of minimum mental healthcare for all in the
foreseeable future, particularly to the most vulnerable and underprivileged sections of the
population;
• To encourage the application of mental health knowledge in general healthcare and in
social development;
• To promote community participation in the mental health service development and to
stimulate efforts towards self-help in the community.
The District Mental Health Program (DMHP) was launched under NMHP in the year
1996 (in IX Five Year Plan). The DMHP was based on ‘Bellary Model’ with the
following components:
• Early detection & treatment.
•Training: imparting short term training to general physicians for diagnosis and treatment of
common mental illnesses with limited number of drugs under guidance of specialist.
• IEC: Public awareness generation.
• Monitoring: the purpose is for simple Record Keeping.
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The functioning of the NMHP involves a range of activities such as:

•Providing mental health services through primary healthcare centers, district hospitals, and
medical colleges.
•Conducting community-based interventions and awareness campaigns to promote mental
health and prevent mental illness.
•Setting up de-addiction centers to provide rehabilitation services for people with substance
abuse problems.
•Training healthcare professionals and community health workers in the management of
mental illness.
•Providing financial assistance to states for the development of mental health infrastructure.
Outcomes
•The outcomes of the NMHP have been mixed. While the program has made significant
progress in the development of mental health infrastructure and human resources, there are
still significant gaps in the availability and accessibility of mental healthcare services.
•Stigma and discrimination towards people with mental illness continue to be a major
challenge in India, and there is a need for greater community participation and awareness to
address these issues.

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The NMHP was re-strategized in the year 2003 (in X Five Year Plan) with the
following components:
•Extension of DMHP to 100 districts
•Up gradation of Psychiatry wings of Government Medical Colleges/ General Hospitals
•Modernization of State Mental hospitals
•IEC
•Monitoring & Evaluation Up gradation of Psychiatry wings of Government Medical
Colleges/ General Hospitals and Modernization of State Mental hospitals were the new
schemes/components.
In the XI Five Year Plan, the NMHP has the following components/schemes:
•District Mental Health Programme (DMHP)
•Manpower Development Schemes - Centers Of Excellence And Setting Up/ Strengthening
PG Training Departments of Mental Health Specialities
•Modernization Of State Run Mental Hospitals
•Up gradation of Psychiatric Wings of Medical Colleges/General Hospitals
•IEC
•Training & Research
•Monitoring & Evaluation

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Future Plans

• Sensitizing the states to the mental health needs,

• Creating mental health programme infrastructure

• Phased implementation of the programme

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6. National Program for Prevention and Control of Deafness:

The National Program for Prevention and Control of Deafness (NPPCD) is a national health
program in India that was launched in 2006. The program aims to prevent and control
deafness and hearing impairment in the country.
The objectives of the NPPCD are as follows:
•To prevent the occurrence of hearing loss by creating awareness about the causes of
hearing loss, promoting healthy habits, and early detection and intervention.
•To identify and treat ear infections, hearing loss, and other ear-related problems.
•To provide rehabilitation services to individuals with hearing loss and deafness, including
hearing aids and cochlear implants.
•To develop a database of individuals with hearing loss and deafness to plan and implement
appropriate interventions.
•To build capacity among healthcare providers and community workers for the prevention
and management of deafness and hearing impairment.

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The program is implemented through a network of primary health centers, district hospitals,
and specialized ear care centers.
The program provides free screening for hearing loss, ear infections, and other ear-related
problems. It also provides free hearing aids and cochlear implants to eligible individuals.
The outcomes of the program have been positive.
•According to the Ministry of Health and Family Welfare, the NPPCD has screened around
25 million individuals for hearing loss and provided hearing aids to more than 1.5 million
individuals.
•The program has also conducted more than 80,000 ear surgeries to treat hearing loss and
ear-related problems.
• Decrease in the magnitude of hearing impaired persons.
• Capacity building at the district hospitals to ensure better care
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However, there are challenges to the implementation of the program, including

•A shortage of trained healthcare providers
•Inadequate infrastructure
•Low awareness among the general public about the importance of ear and hearing care.
•The program continues to work towards improving its services and reaching more
individuals in need

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7. UNIVERSAL IMMUNIZATION PROGRAM

Immunization Programme in India was introduced in 1978 as ‘Expanded Programme of
Immunization’ (EPI) by the Ministry of Health and Family Welfare, Government of India.
In 1985, the programme was modified as ‘Universal Immunization Programme’ (UIP) to
be implemented in phased manner to cover all districts in the country by 1989-90 with the
one of largest health programmes in the world.
About immunization
Immunization is the process whereby a person is made immune or resistant to an infectious
disease, typically by the administration of a vaccine. Vaccines are substances that stimulate
the body’s own immune system to protect the person against subsequent infection or disease
The UIP provides vaccines for 12 vaccine-preventable diseases, which include tuberculosis,
polio, hepatitis B, diphtheria, pertussis, tetanus, measles, rubella, Japanese encephalitis,
rotavirus, pneumococcal disease, and Haemophilus influenzae type B (Hib) infection. The
vaccines are provided through a network of primary health centres, community health
centres, and district hospitals.

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• Over the years, the UIP has made significant progress in increasing immunization
coverage in the country. According to the National Family Health Survey-5 (NFHS-5)
conducted in 2019-20, the percentage of children aged 12-23 months who received all
basic vaccinations under the UIP was 62.3%. This is an improvement from 44% in
NFHS-4 conducted in 2015-16.

• Despite the progress, the UIP still faces challenges in achieving full immunization
coverage. The reasons include vaccine hesitancy, inadequate infrastructure, and
insufficient human resources. The program also needs to focus on improving the quality
of vaccination services and addressing issues related to vaccine supply chain
management.

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8. NATIONAL PROGRAM FOR CONTROL OF BLINDNESS /

NATIONAL PROGRAM FOR CONTROL OF BLINDNESS AND VISUAL
IMPAIRMENT (NPCB&VI)
• India was the first country to launch the National Programme for Control of Blindness
(NPCB) in 1976, as a 100% centrally sponsored Programme, to reduce the prevalence of
blindness and visual impairment.
• The program is implemented by the Ministry of Health and Family Welfare in
collaboration with state governments and non-governmental organizations.
• Till few years ago, NPCB was a cataract centred programme. However, currently it is
funding for the management of Diabetic Retinopathy {DR}, Glaucoma, Ocular Trauma,
Childhood Blindness, Keratoplasty, Squint, Low Vision, Retinopathy of Prematurity
{ROP} in addition to ongoing schemes through successful Public Private Partnership
(PPP).
• Eye donation fortnight is organized from 25th August to 8th September every year to
promote eye donation/eye banking.

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There are 45 million blind persons in the World, of which 12 million blind persons is in
India.
Objectives
• To reduce the backlog of blindness through identification and treatment of the
blind
• To develop comprehensive eye care facilities in every district
• To develop human resources for providing eye care services
• To improve the quality of service delivery to the affected population
• To secure the participation of voluntary organizations/private practitioners in eye
care
• To enhance community awareness of eye care
• To provide the best possible treatment for curable blindness available in the
district/region

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• The NPCB & VI has made significant progress in reducing the burden of blindness in
India.

• According to the latest National Blindness and Visual Impairment Survey conducted in
2019-2020, the prevalence of blindness in India has reduced from 1.1% in 2001-2002 to
0.5% in 2019-2020.

• The program has also increased the availability of eye care services and has provided
treatment for cataract to a large number of individuals.

• However, there are still challenges in the implementation of the program, including
a) Inadequate infrastructure,
b) Shortage of trained personnel,
c) Low awareness among the population about the importance of eye health.

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9. PULSE POLIO PROGRAM

The Pulse Polio Programme is a national health program in India launched in 1995 to
eradicate polio from the country. The program is implemented by the Ministry of Health
and Family Welfare in collaboration with state governments and non-governmental
organizations.

Children in the age group of 0-5 years are administered polio drops during National and
Sub-national immunization rounds (in high-risk areas) every year. About 172 million
children are immunized during each National Immunization Day (NID).

The last polio case in the country was reported from the Howrah district of West Bengal
with the date of onset of 13th January 2011. Thereafter no polio case has been reported in
the country (25th May 2012).

WHO on 24th February 2012 removed India from the list of countries with active endemic
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The Pulse Polio Programme aims to achieve the following key objectives:
•To achieve 100% coverage of polio vaccination: The program aims to provide polio
vaccination to all children under the age of five years through regular polio vaccination
campaigns.
•To ensure that all children receive multiple doses of the polio vaccine: The program aims to
ensure that all children receive multiple doses of the polio vaccine, as multiple doses are
necessary for long-term protection against the disease.
•To maintain high immunization coverage: The program aims to maintain high immunization
coverage for polio vaccination to prevent the re-emergence of the disease.

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Steps taken by the Government to maintain polio-free status in India

•Maintaining community immunity through high-quality National and sub-national polio
rounds each year.
•An extremely high level of vigilance through surveillance across the country for any
importation or circulation of poliovirus and VDPV is being maintained.
•All States and Union Territories in the country have developed a Rapid Response Team
(RRT) to respond to any polio outbreak in the country.
•To reduce the risk of importation from neighbouring countries, international border
vaccination is being provided through continuous vaccination teams (CVT) to all eligible
children around the clock.
•Government of India has issued guidelines effective since March 2014, for the mandatory
requirement of polio vaccination to all international travellers for travel to India and other
affected countries namely Afghanistan, Nigeria, Pakistan, Ethiopia, Kenya, Somalia Syria
and Cameroon.
•A rolling emergency stock of OPV is being maintained to respond to the
detection/importation of wild poliovirus (WPV) or the emergence of circulating vaccine-
derived poliovirus (cVDPV).
• The National Technical Advisory Group on Immunization (NTAGI) has recommended
Injectable Polio Vaccine (IPV) introduction as an additional dose along with 3rd dose of
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India to introduce Injectable Inactivated Poliovirus Vaccine (IPV)

•In May 2012, the World Health Assembly endorsed the Polio Eradication & Endgame

Strategic Plan 2013-2018, calling on countries to strengthen routine immunization

programmes and introduce at least one dose of injectable Inactivated Poliovirus Vaccine

(IPV) in all countries using only oral polio vaccine (OPV).

•India joins 125 other countries in introducing Inactivated Poliovirus Vaccine (IPV) into

routine immunization as part of the Polio Eradication and Endgame Strategic Plan in

2015. IPV would be given along with a third dose of oral polio vaccine (OPV) at 14

weeks of age for children under one year of age.

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The Pulse Polio Programme has been successful in achieving its objectives, and
India was certified polio-free by the World Health Organization (WHO) in 2014.
The program involved massive vaccination campaigns, with millions of children
being vaccinated each year. The program also involved the training of healthcare
workers and volunteers to carry out vaccination campaigns effectively.

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