National Health programme

(Part-II)
Dr Anil Kumar Agrawal
Assisstant Professor
 The participants will learn about:
• RBSK
• RKSK
• NIDDCP
• NACP- IV
• RMNCH+A
• NCD
 Rashtriya Bal Swasthya Karyakram
(RBSK)
• It is a new initiative which provides child health
screening and early intervention for children of 0-18
yr age group specifically of rural and urban slum.
Target Group
• Birth -6 wk babies - born in govt. hospital & in home
• 6wks- 6yrs - Pre-school children in rural areas and
urban slum
• 6yrs- 18yrs -Children enrolled in 1-12th classes in
govt. and govt. added school
 Implementation:
• For new born-facility based new born screening or
Community based new born screening at home by
ASHA.
• Children upto 6yrs-AWW centre based screening by
dedicated MHT.
• 6yrs-18yrs Children- govt. and govt. added school
based screening by dedicated MHT.
• At least three MHT will be engaged to conduct
screening of children in a block.
• Frequency - once per year for school children and
-twice per year for children in AWW centers.
 Composition of mobile health team:
• MO (AYUSH)-1 male and 1 female
• Staff nurse-1
• Pharmacist -1(with computer knowledge for data
management)
Composition of tool kit (6wk-18yrs
• Vision chart,
• BP apparatus with appropriate cuff size,
• card with age appropriate developmental check list to
identify developmental delay,
• weighing scale,
• height measuring rod.
 District Early Intervention Centre (DEIC):
• The cases identified and needing referral will
be sent to DHH.
• A team consisting pediatrician, MO, SN and
paramedics will provide service and those
requiring further treatment will be referred to a
tertiary care.
 Identified Health Conditions for Children Health
Screening and Early intervention Services
Defects at Birth
1. Neural Tube Defect
2. Down’s Syndrome
3. Cleft Lip & Palate / Cleft Plate alone
4. Talipes (Club foot)
5. Developmental Dysplasia of the Hip
6. Congenital Cataract
7. Congenital Deafness
8. Congenital Heart Diseases
9. Retinopahty of Prematurity
 Deficiencies
10. Anaemia especially servere Anaemia
11. Vitamin A deficiency (Bitot spot)
12. Vitamin D deficiency (Rickets)
13. Severe Acute Malnutirtion
14. Goiter
Diseases Childhood
15. Skin conditions (Scabies, Fungal Infection
and Eczema)
16. Otitis Media
17. Rheumatic Heart Disease
18. Reactive Airway Disease
19. Dental Caries
20. Convulsive Disorders
Developmental Delays and Disabilities
21. Vision Impairment
22. Hearing Impairment
23. Neuro-Motor Impairment
24. Motor Delay
25. Cognitive Delay
26. Language Delay
27. Behavior Disorder (Autism)
28. Learning Disorder
29. Attention Deficit Hyperactivity Disorder
30. Congenital Hypothyrodism, Sickle Cell
Anaemia, Beta Thalassemia (Optional)
 RASHTRIYA KISHOR SWASTHY KARAYAKRAM
(RKSK)
• Adolescents aged 10-19 yrs constitute about 21% of
India’s population (253 million).
• Health challenges faced by them-
malnutrition,
anemia,
lack of knowledge on SRH,
substance misuse,
communicable & noncommunicable diseases,
mental health and
injury and violence(including gender base violence)
all contributing to increased morbidity and mortality not
only during adolescence but also later in their lives.
• >33% of the disease burden and almost 60% of
premature deaths among adults can be associated
with behaviour or conditions that began or
occurred during adolescence.
• By investing in adolescent health today, we invest
in the workforce, parents and leaders of tomorrow
• RKSK has been rolled out all the districts of
Odisha to address the health and developemental
requirements of adolescent boys and girls.
 Strategy of RKSK programme
• Peer education
• Quarterly Adolescent Health day(AHD)
• Adolescent Friendly Health Clinic (AFHC)
• Weekly Iron Folicacid Supplementation(WIFS)
• Menstrual Hygiene Scheme(MHS)
 Adolescent Health Day :
• will be organized on quarterly basis.
Objective:
1. to improve coverage with promotive and preventive
health intervention for adolescents.
2. to increase awareness of adolescents and stakeholders
on various determinants of adolescents health like
nutrition, injury& violence, substance abuse, mental
health and sexual& reproductive health.
3. also to create awareness about the availability of
adolescent health services especially Adolescent
Friendly Health Clinic (AFHC).
The primary focus of RKSK is to include all adolescents
(10-19yrs), both male and female from school and out
of school.
 NATIONAL IODINE DEFICIENCY DISORDER
CONTROL PROGRAMME (NIDDCP)
• National goitre control programme was
launched in1962 which aimed to provide
iodised salt to subhimalayan goitrous belt only.
Subsequent survey reported that no state is free
from IDDs.
• Hence universal iodisation of salt for human
consumption was started in a phased manner
from 1986.
• In the yr 1992, NGCP was renamed as
NIDDCP.
• Iodine is an essential micronutrient.
• required for the synthesis of thyroid hormones
i.e. thyroxine(T4) and triiodo thyronine.
• Thyroid hormone regulates a wide variety of vital
physiological function of the body including early
growth and development of brain .
• Normal daily requirement of Iodine-100-150mcg
• Deficiency produces a wide spectrum of disorders
in pregnant women, neonates, children and adults.
These are called IDDs.
 Manifestations of IDDs
• Pregnant women- abortion, still birth, impairment in brain
development of foetus leading to birth of babies who are cretins
• Neonates - Neonatal cretinism characterised by mental deficiency,
squint, hearing defect and shunted growth
• Children and adolescents - goitre, juvenile hypothyroidism,
impaired mental function, retarded physical development
• Adults - Goitre with its complication, hypothyroidism, impaired
mental function .
Prevention -Daily consumption of iodised salt about 10gm having
iodine content of 15ppm prevents the spectrum of IDD.
At the production level of iodised salt, the content of iodine should
be30 ppm.
As iodine is volatile there is gradual loss and when it reaches
household level ,the content of iodine in iodised salt should be
atleast 15ppm
 Objective of the programme-
• Survey to assess the magnitude of IDDs
• Universal iodisation of salt and its supply all over
the country
• Resurvey every five years to assess the extent of
IDDs and impact of iodise salt.
• Laboratory monitoring of iodine content of salt
and urinary excretion of iodine
• IEC for demand generation for iodised salt and
its regular consumption.
 Strategy undertaken for NIDDCP –
• Universal salt iodisation .Under prevention of
food adulteration act ,sale of non iodised salt has
been banned.
• Improvement in quality and supply of iodised salt
• Regular monitoring of iodine content of salt
starting from production site to retailer and at the
consumer household level
• Use of spot testing kit for quick checking of
iodine content of the salt samples collected from
household levels are being implemented.
 NACP-IV (National AIDS Control Programme-
Phase –IV)
• National AIDS Control Programme launched in India in 1987.
Aim:
is to prevent further transmission of HIV,
to decrease morbidity and mortality associated with HIV
infection and
to minimize the socio economic impact of HIV.
• In the yr 1992, NACP - phase -1 was launched to slow down
the spread HIV infection.
• Then in the yr 1999, NACP phase-II was started.
More focus was given on behavior change.
Involvement of NGOs was encouraged and State AIDS
Control Society was established.
ART was initiated in the year 2004
• In the year 2007, NACP phase-III was started.
Targeted intervention for the HRG was scaled up
and surveillance activity was further strengthened
• The current NACP phase-IV from 2012-17, aims:
to reduce new infection
prevent spread from HRG to the general
population
A behavior change strategy based on an effective
IEC campaign and supported by appropriate
services will be implemented.
Key Areas of NACP- IV
• Preventing new infection
• Preventing Parent To Child Transmission(PPTCT)
• Strengthening IEC for behavioural change
• Providing comprehensive care , treatment and
support for people living with HIV(PLHIV)
• Reducing stigma and discrimination through
greater involvement of people living with HIV
• Integrating HIV services with health system in a
phased manner.
 Package of prevention services :
• Targeted intervention for HRG- female sex workers,
men having sex with men, transgender, intravenous
drug users and bridge population (truckers, migrants)
• Prevention and control of RTI/STI
• Blood safety
• HIV counseling and testing
• Prevention of parent to child transmission
• Condom promotion
• IEC and behavioural change communication
• Social mobilization and adolescent education
programme
 (RMNCH + A) Approach
• RMNCH+A is a strategic approach to
reproductive, maternal, newborn, child and
adolescent health. Plus in the strategic
approach denotes the following aspects
• The inclusion of adolescence
• Linking maternal and child health to
reproductive health and other components like
family planning, HIV, Preconception and pre
natal diagnostic technique (PCPNDT)
• Linking community and facility based care.
PACKAGE OF SERVICES
 Noncommunicable diseases
• Noncommunicable diseases are not spread by
pathogens
• May be present at birth
• In other cases, noncommunicable disease may
develop as a result of a person’s lifestyle
behavior
• May develop from the effects of substances in
the environment
• or the cause may be unknown.
 Chronic Diseases
• Many noncommunicable diseases are chronic-
diseases that are present either continuously or
off and on over a long time.
• Examples: asthma
 Degenerative Diseases
• Some noncommunicable diseases cause the
body cells and tissue to break down, or
degenerate.
• Degenerative diseases are diseases that cause
further breakdown in body cells, tissues, and
organs as they progress.
• Example: multiple sclerosis
 Diseases Present at Birth
• Some babies are born with physical or mental
disabilities that are a result of genetics or birth
defects
• The causes of many birth defects are unknown
• Some may result from harmful substances in
environment (x-rays), lifestyle behaviors of the
mother (alcohol), or a defect in genes ( down
syndrome).
 Lifestyle Behaviors and Disease
• Some diseases there are certain risk factors.
• Risk factors are characteristics that increase a
person’s chances of developing a disease
• Risk factors over which people have no control
are heredity, age, gender, and ethnic group.
 Risk factors
• Lifestyle behaviors are risk factors we have
control of:
– Eating habits
– Physical activity
– Sleep habits
– Healthful lifestyles can prevent, control, or
reduce the risk of certain diseases.
 Common Noncommuincable Diseases
• Allergies
• Alzheimer’s disease
• Arthritis
• Asthma
• Cancer
• Cardiovascular disease
• Cerebral palsy
• Cystic Fibrosis
• Multiple Sclerosis
• Muscular Dystrophy
• Sickle-Cell disease
Non-communicable diseases as % of all deaths by
global region (all ages)

WORLDWIDE 59%

N.America; W Europe 88%

China, W Pacific, + some SE Asia 75%

Latin America + Caribbean 67%
S E Asia including India 51%

Sub-Saharan Africa 21%

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Distribution of deaths in the world by sex,
2004

34
GBD report 2004 update, 2008
Projected global deaths for selected causes,
2004–2030

35
GBD report 2004 update, 2008
 Summary
• Non-communicable diseases are now the most
common cause of death world wide
• Increasing rates in low and middle income
countries because of change in lifestyles
(urbanisation)
• Key risk factors have very large effects
• Interventions are effective and can reduce
burden

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