INTRODUCTION

The National Health Programme (NHP) has been implemented and modified accordingly since
1990. Its first version, adopted by the Council of Minister's Committee on Economy and Social
Policy, was based on the WHO strategy "Health for all by the year 2000".
The NHP attempts, for the first time, to commit governmental bodies, all sectors of the national
economy and the whole society to health promotion, and its guiding principle is to support and
promote prevention (primary, secondary and tertiary) as a key element of health care, aimed at
reversing the trend of still growing incidence of diseases and excess mortality.

This principle was reflected in eight targets included already in its first version.
In 1993 the National Health Programme was modified in order "...to update its objectives and
targets and to make them more realistic... to alter the approach to the attainment of objectives
and to issue relevant executive regulations designed to establish legal mechanisms for financing
and supervising the NHP implementation.

The guiding principles and the structure of the Programme were also modified.
The development of the present, namely the third version of the National Health Programme (for
1996-2005) had been preceded by a thorough analysis and evaluation of activities undertaken to
date by different sectors.

The objectives and guiding principles which underpinned the decision to modify the Programme
were the need:

 to adjust the plan of action to present living conditions and health needs and problems of the
population (e.g. rapid economic and social changes resulting from the process of transformation
bring about multivarious health hazards);
 to enlarge the body of participants and performers involved in the NHP implementation, with
particular reference to self-governments and local communities;
 to seek more effective means of cooperation between performers at all levels;
 to improve monitoring and evaluation of the outcomes;
 To benefit from new national and international experiences, and modern methods for health
promotion and prevention of certain diseases.
This Programme, developed by a team of experts in cooperation with the Intersectional Task-
Force for National Health Programme Coordination, and the Section of Health Programmes at
the Department of Systemic Transformations in Health Care, Ministry of Health and Social
Welfare, adopted by the Council of Ministers on 3 September 1996 as a governmental document,
sets objectives and guiding principles of the public health policy in Poland by the year 2005.
The concept and structure of individual sections have been slightly altered in comparison to
previous versions, and now it is a flexible programme which can be further modified and
amended without changing the whole document.
Let us hope that the experience gained to date in implementation of the former versions of the
National Health Programme, and better understanding of the fundamental principle according to
which individuals themselves are, to great extent, responsible for their own health and the health
of the others will contribute to the success of concerted action for better health and better quality
of life in Poland.
DEFINITION :
National Health programs are a coordinated and comprehensive set of health promotion and
protection strategies implemented at the population that includes programs, policies, benefits,
environmental supports, and links to the surrounding community designed to encourage the
health and safety of all
People.

LIST NATIONAL HEALTH PROGRAMMES IN INDIA

National Health Mission
Communicable Diseases
1. Revised National TB Control Programme (RNTCP)
2. National Leprosy Eradication Programme
3. National Filarial Control Programme
4. National Aids Control Programme
5. Integrated Disease Surveillance Project (IDSP)
6. National Vector Borne Disease Control Programme (NVBDCP)
Non-Communicable Diseases, Injury & Trauma
1. School Health Programme
2. National Programme on Prevention and Control of Diabetes, CVD and Stroke
3. National Programme for Prevention and Control of Deafness
4. Universal Immunization Programme (RTI ACT, 2005)
5. National Cancer Control Programme
6. National Mental Health Programme
7. National Iodine Deficiency Disorder Control Programme
8. National Programme for Control of Blindness
9. National Programme for Prevention and Control of Fluorosis (NPPCF)
10. National Tobacco Control Program
11. National Programme for Health Care of the Elderly (NPHCE)

Other programs
1. Pradhan Mantri SwasthyaSuraksha Yojana (PMSSY)
Ministry of Social Welfare
2. ICDS schemeMinistry of Social Welfare
3. Mid-day meal program
Ministry of Rural Development
4. Rajiv Gandhi National Drinking Water Mission

DEFINITION:
According to Indian constitution, family Welfare programme is a “State Subject “but for proper
coordination it is centrally sponsored item, comprising of four components:
1-Administration and organization which includes recruitment of staff, getting equipment and
supplies.
2-Training-medical, paramedical and social workers in this field.
3-Social and health education.
4-Supplies and services.
OBJECTIVES:
1-To decline the rate of population.
2- To apply small family norm to stabilize the population.
3- To educate the couples about contraception.
4- To take up universal immunization and safe motherhood.
5-Promotion of maternal and child health has been one of the most important objectives of the
Family Welfare Programme in India.
FAMILY WELFARE PROGRAMS ARE BROADLY CLASSIFIED IN THREE GROUPS:
1-Maternal health
2-Child health
3-Family planning
1-Maternal health PROGRAMME:
It was launched in October 1997. Maternal Health programme is an important aspect for the
development of any country in terms of increasing equity & reducing poverty. The survival and well-
being of mothers is not only important in their own right but are also central to solving large broader,
economic, social and developmental challenges. Maternal Mortality Ratio is one of the important
indicators of the quality of health services in the country. India has made remarkable progress in
reducing maternal deaths in the last two decades.The RCH Programme incorporates the
components covered under the Child Survival and Safe Motherhood Programme and includes
an additional component related to reproductive tract infection and sexually transmitted
infection.
In order to improve maternal health at the community level a cadre of community level skilled
birth attendant who will attend to the pregnant women in the community is being considered.
The need for bringing down maternal mortality rate significantly and improving maternal health
in general has been strongly stressed in the National Population Policy 2000.
MATERNAL MORTALITY
In the last decades, the life expectancy of the population in India has shown remarkable
improvement from 41 at birth in 1961 to the present day of 65 years. Yet, over a 100,000
women in India continue to die of pregnancy related causes every year.
The Maternal Mortality Ratio in India is 407 per 100,000 live births. Pregnant women received
at least four antenatal checkup but only 10.6 per cent had taken four ante natal checkups. In
Uttar Pradesh and Bihar, the content and quality of antenatal care was very poor.
Maternal Mortality Ratio (MMR) has declined from 301 per 100,000 live births in 2001-03 to 254 in
2004-06 and further declined to 212 in 2007-09 and 178 in 2010-12 as per RGI-SRS data. The pace of
decline has shown an increasing trend from 4.1% annual rate of decline during 2001-03 to 5.5% in 2004-
06, 5.8% in 2007-09 to 5.7% in 2010-12. India's MMR declined much faster than the global MMR during
the period 1990 to 2010 with India showing an annual rate of decline of 5.6% as compared to 2.4% at
the global level.
REPRODUCTIVE AND CHILD HEALTH PROGRAMME:
Reproductive and child health programme has been defined as people have the ability to
reproduce and regulate their fertility women’s are able to go through pregnancy and child birth
safely the outcomes of pregnancies is successful in terms of maternal and infant survival and
couples are able to have sexual relations free from fear of pregnancy.

THE MAIN HIGHLIGHTS OF THE RCH PROGRAMME ARE:

1. The programme integrates all interventions of fertility regulation, maternal health. Child
health with reproductive health for both men and women.
2 The services to be provided will be client oriented high quality and based on needs of the
community.
3. It is proposed to improve the facilities of obstetric care, MTP and IUD insertion.
4. Specialist facilities for STD and RTI will be available in all district hospital.

Stages of RCH programme

The Reproductive and Child Health (RCH) Programme was launched in October 1997. The main
aim of the programme is to reduce infant, child and maternal mortality rates. The main
objectives of the programme in its first phase were:
 To improve the implementation and management of policy by using a participatory
planning approach and strengthening institutions to maximum utilization of the project
resources
 To improve quality, coverage and effectiveness of existing Family Welfare services
 To gradually expand the scope and coverage of the Family Welfare services to
eventually come to a defined package of essential RCH services.
 Progressively expand the scope and content of existing FW services to include more
elements of a defined package of essential
 Give importance to disadvantaged areas of districts or cities by increasing the quality
and infrastructure of Family Welfare services
RCH-I had a number of successful and unsuccessful outcomes.
The child health programmes is now its second phase:
RCH-II.
Following are the aims of the programme:
 Expand services to the entire sector of Family Welfare beyond RCH scope
 Holding States accountable by involving them in the development of the programme
 Decentralization for better services
 Allowing states to adjust and improve programmes features according to their direct
needs.
 Improving monitoring and evaluation processes at the District, state and the Central
level to ensure improved program implementation.
 Give performance based funding, by rewarding good performers and supporting weak
performers.
 Pool together financial support from external sources
 Encourage coordination and convergence, within and outside the sector to maximize
use resources as well as infra structural facilities
COMPONENTS OF RCH PROGRAMME:
1. Medical termination of pregnancy
2. Essential obstetric care.
3. Emergency obstetric care.
4.24 hours delivery services at PHC/CHC
5. Immunization.
6. Essentialnew-born care.
7. Oral rehydration therapy.
1. Medical Termination of Pregnancy Act:
The Medical Termination of Pregnancy Act, 1971 has been under implementation since 1972,
considering the fact that a large number of unsafe abortions still take place. Providing more
facilities for MTP services has been taken into consideration under the ongoing Reproductive
and Child Health Programme. Efforts are being made to provide for the unmet need of safe
abortion services and to improve utilization of existing facilities and further expand the facility
so as to make safe abortion services accessible to all women in the country. Country including
the women in rural areas. At present Govt of India under the RCH programme is undertaking
the training of medical personnel in MTP technique, for improving the awareness and
knowledge of the community. The MTP Act, 1971 has also been amended with the objective of
delegating power to a Committee at the district level to facilitate recognition of more centers
where MTPs can be undertaken the major causes of these deaths have been identified as
hemorrhage (both ante and post-partum), toxemia (Hypertension during pregnancy),Anemia
delivery) and unsafe abortion.
2. ESSENTIAL OBSTETRIC CARE
Essential obstetric care intends to provide the basic maternity services to all pregnant women.
The RCH Programme aims at providing at least 4 antenatal checkups during which weight and
blood pressure check, abdominal examination, immunization against tetanus, iron and folicacid.
Early registration of pregnancy. Provision of safe delivery in home or in an institution and
provision of three postnatal checkups to monitor the postnatal recovery.
3. EMERGENCY OBSTETRIC CARE
Emergency obstetric care is an important intervention to prevent maternal mortality and
morbidity. Under the RCH programme the FRUs will be strengthened through supply of
emergency obstetric kit and provision of skilled manpower on contract basis.

4. 24-HOURS DELIVERY SERVICES AT PHCs/CHCs

To promote institutional deliveries provision has made to give honorarium to the staff to
encourage round the clock delivery facilities at health centers .
5. IMMUNIZATION
The universal immunization programme become a part of RCH programme in 1997 .It will
continue to providevaccines for polio, tetanus DPT DT, measles and Tuberculosis. The cold
chain established so far will be maintained.
6. ESSENTIAL NEW BORN CARE
The primary goal of essential newborn care is to reduce perinatal and neonatal mortality. The
main component are :
Resuscitation of newborn with asphyxia,
Prevention of hypothermia,
Prevention of infection and exclusive breast feeding.
The strategies are to train medical and other health personnel in essential newborn care
provides basic facilities for care of low birth weight.

7. ORAL REHYDRATION THERAPY

Diarrhea is one of the leading cause of child mortality. Oral rehydration therapy programme
started in 1986-87 is being implemented through RCH programme. Supplies of ORS packet to
the state are being organized by central govt. twice a year 150 packets of ORS are provided as a
part of drug kit supplies to all subcenters in the country. Adequate nutritional care of the child
with diarrhea and proper advice to mother on feeding are two important areas of this
programme.
THE MATERNAL AND CHILD HEALTH PROGRAMME:
While it is true that health services should be made available to the entire population, there is a distinct
advantage in providing special services to mothers and children or making them the primary focus of
health services, especially when health resources are very limited.
The most valuable benefit that could be derived from improving maternal and child health is to alleviate
the grief and suffering of countless families. If this is achieved, then it can be truly claimed that quality of
life has been improved.
GOALS:
The maternal and child health programme embraces the following goals for the year 2000, which were
agreed to by almost all nations at the 1990 World Summit for Children:
• A one-third reduction of the 1990 under-five death rates or to 70 per 1000 live births, whichever is
less.
• A halving of the 1990 maternal mortality rates.
• A one-third reduction of the 1990 child deaths from acute respiratory infections.
• Basic education for all children and completion of primary education by at least 80 per cent - girls as
well as boys.
• Clean water and safe sanitation for all communities.
• Acceptance in all countries of the Convention of the Rights of the Child, including improved protection
for children in especially difficult circumstances.
• Universal access to high-quality family planning information and services.
SAFE MOTHERHOOD:
Safe motherhood encompasses a series of initiatives, practices, protocols and service delivery
guidelines designed to ensure that women receive high-quality gynecological, family planning,
prenatal, delivery and postpartum care, in order to achieve optimal health for the mother, fetus
and infant during pregnancy, childbirth and postpartum.

Links to Reproductive Health

Unsafe motherhood consists in maternal mortality or morbidity due to preventable pregnancy

and childbirth-related causes.

Safe motherhood decreases maternal and infant mortality and morbidity. Although, most
maternal and infant deaths can be prevented through safe motherhood practices, millions of
women worldwide are affected by maternal mortality and morbidity from preventable causes.
 Every minute of every day, somewhere in the world and most often in a developing country, a
woman dies from complications related to pregnancy or childbirth. That is 515,000 women, at a
minimum, dying every year.

Nearly all maternal deaths (99 percent) occur in the developing world--making maternal
mortality the health statistic with the largest disparity between developed and developing
countries. New Born babies are also under going this terrible fate, anencephalic babies that suffer
from this die days or it not weeks after birth.

For every woman who dies, 30 to 50 women suffer injury, infection, or disease. Pregnancy-
related complications are among the leading causes of death and disability for women age 15-49
in developing countries.

When a mother dies, children lose their primary caregiver, communities are denied her paid and
unpaid labour, and countries forego her contributions to economic and social development. A
woman's death is more than a personal tragedy--it represents an enormous cost to her nation, her
community, and her family. Any social and economic investment that has been made in her life
is lost. Her family loses her love, her nurturing, and her productivity inside and outside the home.

2- FAMILY PLANNING:

Red Triangle
Red Triangle: It was during the Fourth Five year Plan that communication efforts began to be
much more meaningful. The famous Red Triangle symbol for family planning was conceived
during this period and a national campaign was launched for advocating one children- enough".
The campaign for male contraception-the Condom under the brand name ‘Nirodh’ as the first
social marketing effort which carried professional communication orientation was also initiated
about this time. The Satellite Instructional Television Experiments (SITE) programme helped
assess the impact of TV programmes about family planning on the beliefs and practices of the
rural communities. Population policy is the general refer policy intended to decrease the birth
rate.

NATIONAL POPULATION POLICY

Population policy is the general refer policy intended to decrease the birth rate. In 1976 India
forms the first national population policy.
OBJECTIVES OF NATIONAL POPULATION POLICY:
1- To bring total fertility rate replacement level by 2010.
2- The long term objective is to achieve the requirement of suitable economic growth and Social
development.
GOALS OF NATIONAL POPULATION POLICY (2010)
 Parliament adopt the revised national population with the goal of improving the quality of life
and standard of living its goal are:
1. Make school education free up to the age of 14 yrs.
2. Reduce infant and maternal mortality rate.
3. Achieve universal immunisation of children is against all vaccine preventable diseases.
4. Promote delayed marriage for girls not earlier than 18 yrs.
5. Achieve institutional deliveries by trained persons.
6. Prevent and control communicable diseases.
7. To managed urbanisation.
8. To improved housing sanitation and reduce poverty.
SMALL FAMILY NORMS:
A significant achievement of the family welfare programme has been decline the fertility rate.
India adopts the goal of the two child norm by the end of the century. The size of the of family
affects the quality of the life of the human being.
Family size affect the family in the following spheres of life:
1 Basic human needs
2 Income and growth of economy and saving.
3 Food and nutrition, quality and quantity.
4 Uses of land and urban public system
5 Education particularly that of children.

ADVANTAGES TO MOTHER
1. In a small planned family a mother can maintain her health.
2. Mother will have less strain and worry due to limited number of children.
3. Mother will have more time and energy to give proper attention and love to her children.
4. Mother can save child’s health
ADVANTAGES FOR THE CHILD:
1. Child will get proper nutrition, education, parental care and love.
2. Child can provide social economic base for the family.
CHILD HEALTH
A major determinant of child health is a health of his or hermother. Child health is adversely
affected if the mother is malnourished.
RIGHTS OF CHILD:
1. Right to develop in atmosphere of love and affection.
2. Right to enjoy the benefits of social security.
3. Right to free education.
4. Right to full opportunity for play.
5. Right to name and nationality.
6. Right to special care if handicapped.
7. Right to learn to be useful manner

COMPONENTS OF CHILD HEALTH

1. Under five clinic
2. Special nutrition programme.
3. Mid-day meal programme.
4. Universal immunization programme
UNDER FIVE CLINIC
COMPONENT OF UNDER FIVE CLINIC ARE :
I. CARE IN ILLNESS
It means care and treatment of sick children’s. It is also the basic philosophy of the Under-five
clinic to give nurse effective training and responsibility for the child health care services.
ii.PREVENTIVE CARE: Preventive care is the care you receive to prevent illnesses or diseases. It also
includes counseling to prevent health problems. Providing these services at no cost is based on the idea
that getting preventive care, such as screenings and immunizations, can help you and your family stay
healthy.
iii. IMMUNIZATION: In 1974 WHO launched this programme.It is one of the health goal was to
immunize all children’s against six diseases.
IV.ORAL REHYDRATION: It was started in 1986-87 he child living in a poor community will suffer
an attack of diarrheal infection. Every episode of diarrhoea lowers the child nutritional level.
The home use of ORT has opened the way for a reduction of child health.
V. HEALTH EDUCATION:
This represents the health education which the mother automatically receives. She is told to
keep the child clean. She should bring the child for immunization.
VI. GROWTH MONITORING
One of the basic activities of the under-five clinic is growth monitoring i.e. to weight the child
periodically. When the child weight is plotted on the growth chart against his/her age gives
what is known as the growth curve. This will help the health worker to detect early onset of
growth failure.
2. SPECIAL NUTRITION PROGRAMME
This programme was started in 1970 for the nutritional benefits of the children under 6 yrs. of
age, pregnant and nursing mother. The supplementary food supplies about 300 Kcal and 10-12
grams of protein per child per day and mother receive 500 Kcal and 25 grams of protein. The
mainaim of special nutrition programme is to improve the nutritional status of the target group.
3. MID DAY MEAL PROGRAMME:
This programme has been in operation since 1961 throughout the country. It is also known as
school lunch programme. The major objectives of this programme is to attack more children’s
for admission to the school In formulating mid-day meal programme following principles should
be kept in mind
-The meal should be supplement
-The meal should supply at least one third of the total energy requirement
-The cost of the meal should be reasonable low.
-The menu should be frequent change.
4. UNIVERSAL IMMUNIZATION PROGRAMME
WHO launched Expandable programme on immunization to prevent from the six killer diseases.
The immunization services are being provided through the existing health care system
NURSES ROLE
 ROLE OF NURSE IN MATERNAL HEALTH PROGRAMME
1. The nurse should instruct the client to have nutritive diet during pregnancy
2. The nurse should instruct the women to have rich caloric food to help in growth and
development.
3. The pregnancy diet should be light and easily digestible.
4. The nurse should tell the client to have supplementary iron therapy from 16 weeks onwards.
5. The nurse tell the mother for rest and sleep.
6. The nurse tell the mother to wear loose cloths.
7. The nurse should instruct the client to consult with the dentist for dental care.
8. The nurse should tell the women to avoid travelling in the vehicle.
9. The nurse should tell the mother to have proper immunization during pregnancy.
ROLE OF NURSE IN FAMILY PLANNING PROGRAMME :
1. Explain everything about Family Planning to the people
2. Explain the method of family planning
3. Explain the benefits of family planning
4. Explain the adverse effects of family planning
5. The nurse should explain about the women about the oral pills and tell them to take regularly
those pills.
6. If she missed 2 pills in the first two weeks she should take two pills on each of the next two
days.
7. The nurse should tell them how long the pills can be continued.
The nurse should tell the sideeffects of these methods.
ROLE OF NURSE IN CHILD HEALTH PROGRAMME :
1. The nurse should instruct the mother the proper nutrition for growth and development of
children.
2. The nurse should tell the mother that breast milk is
compulsory forinfant.
3. The nurse should tell the client that breast feeding also encourages the maternal infant
bonding.
4. The nurse should tell the client to provide vitamin d supplement to the child for limited skin
exposure.
5. The nurse should instruct the mother for frequent feed.The nurse should instruct the mother
for frequent feed.
6. The nurse should tell the mother to take proper care of the infant from infections.
7. The nurse should instruct the mother to maintain the proper hygiene of the infant.
The nurse should explain the mother that breast milk contain macrophage which help
In limiting the infection.

GENERAL ROLE OF NURSE IN HEALTH AND FAMILY WELFARE PROGRAMME

1. ADMINISRTATIVE ROLE
The nurse who are in senior position participates in the organisation of family wealfear
programme at national, regional or community level and development of nursing activities.
2. SUPERVISIOY ROLE
As a supervisor nurse should encourage their staff to watch carefully for indication that mother
or couples would on how to space their children and so on.

3. FUNCTIONAL ROLE
The primary role of nurse is case finding, making referral, routine clinical function and to help
the client choose one of the simplest methods of contraception.
4. EDUCATIONAL ROLE
Nurses must have sound knowledge of family wealfear, services available in family wealfear
programme and they must be able to transmit this knowledge effectively.
5. AS A RESEARCHER
Nurses are essential members of the multidisciplinary research team. Nurses know to keep
careful records and reports relating to their nursing activities. These provides valuable data
upon which research may be based.
6. ROLE IN EVALUATION
Evaluation is an important part of planning for nursing services
7. RECORDS AND REPORTS
Nurse record and report clients family planning activities and this provide valuable data upon
which research may based.