“NATIONAL HEALTH PROGRAMMES”

Social and Preventive Pharmacy 8th sem

Presented By-
Girish Kumar Sahu
Assistant Professor
Rungta College of Pharmaceutical Science and Research, Bhilai (CG)
Table of content
 1. HIV and AIDS control programme
 2. National health programme for tuberculosis and its
functioning
 3. Integrated disease surveillance program (IDSP)
 4. National leprosy control programme
 5. National mental health programme
 6. National programme for prevention and control of deafness
 7. Universal immunization programme (UIP)
 8. National program for control of blindness
 9. Pulse polio program
NATIONAL HEALTH PROGRAMMES

 1. HIV AND AIDS CONTROL PROGRAMME

 AIDS (acquired immune deficiency syndrome) is caused by- HIV
(Human immuno virus), Family- Retroviridae. A virus that attacks
cells that help a person more vulnerable to other infection and
disease. HIV can leads to the disease AIDS. Aids is the late stage of
HIV infection that occurs when the body’s immune system is badly
damaged because of the virus.
 World AIDS Day, designated on 1 December every year since 1988,
is an international day dedicated to raising awareness of the AIDS
pandemic caused by the spread of HIV infection and mourning those
who have died of the disease.
 3.1.1 EVOLUTION AND PROGRESS OF PROGRAMME
1986 • Detection of the first AIDS case in the country 1986
• The National AIDS Committee was constituted under the Ministry of Health
and Family Welfare
1992 • India's first National AIDS Control Programme (1992-1999) was launched
• National AIDS Control Organization (NACO) was constituted
1992 • NACP I (National AIDS Control Program)launched
• 1992 National AIDS control board constituted
1999 • NACP II began
• State/ UT AIDS Control Societies (SACS) in States/Union Territories (UTs)
established
2002 • National AIDS control policy and National blood policy
2004 • Antiretroviral treatment initiated
2006 • National council on AIDS under chairmanship of Prime Minister
• 2006 National policy on Pediatric ART
2007 • NACP III launched for 5 years (2007-2012)
2012 • NACP IV launched for next 5 years (2012-2017)
2017 • Extension of phase IV (2017 -2021)
 1.2 ODJECTIVES OF NACP1 (NATIONAL AIDS CONTROL
PROGRAMME- 1)
 It was implemented to slow down the spread of HIV infections to
reduce morbidity, mortality, and the impact of AIDS in the country.
 National AIDS Control Board (NACB) was constituted and an
autonomous National AIDS Control Organization (NACO) was
set up to implement the project.
 The first phase focused on awareness generation, setting up a
surveillance system for monitoring the HIV epidemic, measures to
ensure access to safe blood and preventive services for
1.3 OBJECTIVES OF NACP-II (NATIONAL
AIDS CONTROL PROGRAMME - II)

 It was launched with World Bank credit support of USD 191

million.
 The two key objectives of NACP II were:-
 To reduce the spread of HIV infection in India and to increase
India's capacity to respond to HIV/AIDS on a long term basis.
 1.3.1 Key Policy Initiatives Taken During NACP II Included:
Adoption of National AIDS Prevention and Control Policy (2002).
Scale-up of Targeted Interventions for High-risk groups (HRGS) in high
prevalence states
Adoption of National Blood Policy.
A strategy for the Greater Involvement of People with HIV/AIDS (GIPA).
Launch of National Adolescent Education Programme (NAEP)
Introduction of counseling, testing, and Prevention of Parent to Child
Transmission (PPTCT)
Launch of National Anti-Retroviral Treatment (ART) program.
Formation of an inter-ministerial group for mainstreaming.
Setting up of the National Council on AIDS, chaired by the Prime Minister.
Setting up of State AIDS Control Societies in all states.
1.4 OBJECTIVES OF NACP-III (NATIONAL AIDS
CONTROL PROGRAMME - III)

The aim of the phase was halting and reversing the

Epidemic by end of the project period. It was aimed at
halting and reversing the HIV epidemic in India over its
five-year period by scaling up prevention efforts among
High-Risk Groups (HRG) and General Population and
integrating the with Care, Support &Treatment services
(CST) and Prevention form the two key pillars of all the
AIDS control efforts in India
1.5 OBJECTIVES OF NACP-IV (NATIONAL AIDS
CONTROL PROGRAMME - IV)

 Phase IV of the National AIDS Control Programme was

initially implemented from 2012 to 2017 The Cabinet
Committee on Economic had given its approval for the
continuation of the National AIDS control Programme-IV
(NACP-IV) from April 2017 to march 2020. the twin objective
of NACP-IV were:
Reduce new infections by 50% (2007 baseline NACP III)
Comprehensive care, support, and treatment to all persons
living with HIV/AIDS.
1.5.1 KEY PRIORITIES UNDER NACP IV
 Preventing new infections by sustaining the reach of current interventions and
effectively addressing emerging epidemics.
 Prevention of Parent to Child transmission.
 Focusing on Information, Education & Communication (IEC) strategies for
behavior change in HRG.
 Awareness among the general population, and demand generation for HIV
services.
 Providing comprehensive care, support, and treatment to eligible PLHIV.
 Reducing stigma and discrimination through Greater involvement of PLHIV
(GIPA)
 The de-centralizing rollout of services including technical Support.
 Ensuring effective use of strategic information at all levels of the program.
 Building capacities of NGO and civil society partners especially in states with
emerging epidemics.
 Integrating HIV services with health systems in a phased manner.
1.5.2 Package of services provided under NACP IV

1. Prevention Services
 Targeted Interventions for High-Risk Groups (HRGS) and Bridge Population
(Female Sex Workers (FSW), Men who have Sex with Men (MSM),
Transgenders/Hijras, Injecting Drug Users (IDU), Truckers & Migrants)
 Needle-Syringe Exchange Programme (NSEP) and Opioid Substitution Therapy
(OST) for IDU’S, Blood Safety
 Prevention Interventions for Migrant population at source, transit, and destination
 Link Worker Scheme (LWS) for HRGS and vulnerable populations in rural areas
 Prevention & Control of Sexually Transmitted Infections/Reproductive Tract
Infections (STI/RTI)
 HIV Counselling & Testing Services
 Prevention of Parent-to-Child Transmission
 Condom promotion, Information, Education & Communication (IEC) &
Behaviours Change Communication (BCC).
 Social Mobilization, Youth Interventions, and Adolescent Education Programme
2. Care, Support & Treatment Service
 Laboratory services for CD4 Testing and other investigations
 Free First line & second line Anti-Retroviral Treatment (ART) through ART
centers and Link ART Centers (LACS), Centers of Excellence (COE) & ART plus
Centers.
 Pediatric ART for children
 Early Infant Diagnosis for HIV exposed infants and children below 18 months
 HIV-TB Coordination (Cross- referral, detection, and treatment of co-infections)
 Treatment of Opportunistic Infections
 Drop-in Centers for PLHIV networks
 Launch of Third Line ART and scale-up of first and second-line ART.
 Demand promotion strategies especially using mid-media, e.g., National Folk
Media Campaign & Red Ribbon Express and buses (in convergence with the
National Health Mission).
National AIDS and STD Control Programme (NACP)
Phase-V

 National AIDS and STD Control Programme (NACP) Phase-V is a

Central Sector Scheme fully funded by the Government of India
with an outlay of Rs 15471.94 crore. The NACP Phase-V will take
the national AIDS and STD response till Financial Year 2025-26
towards the attainment of United Nations’ Sustainable
Development Goals 3.3 of ending the HIV/AIDS epidemic as a
public health threat by 2030 through a comprehensive package of
prevention, detection and treatment services.
 This includes setting-up of Sampoorna Suraksha Kendra (SSK)
for providing services through a single window model for those “at
risk” for HIV and STI covering prevention-test-treat-care
continuum.
Some of the important programmes of
NACO are:

 1. Blood safety programme

 2. Condom programming
 3. Information, education, communication and social mobilization
(IEC)
 4. Targeted interventions
 5. NGO's activities
 6. Voluntary counseling and testing
1) Blood safety programme:
 The major objective of the blood safety programme is to ensure the easily
accessible, adequate supplies of safe and quality blood and blood components for
all irrespective of economic or social status. This translates into the following
responses:
 1. To ensure organized blood-banking services at the state/district level
 2. To educate and motivate people about blood donation voluntarily
 3. To enforce quality control of blood
 The strategies plan under NACO lays down the following strategies:
 1. Strengthening the National blood transfusion services
 2 Ensuring an adequate supply of blood to all blood centers
 3. Ensuring safety of blood products
 4. Developing facilities for the production of components
 5. Developing and strengthening of effective management, monitoring and evaluation
of blood transfusion.
2) Condom Programming:
 Among the portable source of HIV transmission in our country,
heterosexual promiscuity constitutes the major route. The most successful
and practical way to prevent the transmission is the use of condoms
according to experience from all over the world and in India. While the
use of condom is easy, making a programme to cover the whole country
needed careful planning on certain issues. This issues mainly related to the
question that how to:
 1. Sensitize people for using condoms not only for the sake of family
planning but also as the best preventive step against HIV and sexually
transmitted disease (STD).
 2. Make available low cost and good quality condoms to the people all
over the country easily at the time and place when the need it.
 3. Convince the clients and the commercial sex workers, about the
importance of use of condoms as a means for preventing the HIV
transmission.
3) Information, Education and Communication
(IEC):
 The IEC strategy is being operationalized both at the state and central level. The trend
indicates that the infection is spreading from urban areas to rural areas. Therefore, the
present thrust under the programme is decentralization and strengthening. The state level
capacity in programming and management of HIV/AIDS is prevention and care. This will
help in ensuring the reach of the programme at the gross root level.
 The objectives of the IEC in the National AIDS Control Programme are :
 1. To train health workers in AIDS communication and coping strategies for strengthening
technical and managerial capabilities
 2. To create a supportive environment for the care and rehabilization of persons with
HIV/AIDS.
 3. To mobilize all factors of society to integrate messages and programmes on AIDS into
their existing activities.
 4. To raise awareness, improve knowledge and understanding among the general
population about AIDS infection and STD, routes of transmission and method of
prevention.
 4) Targeted Interventions:

 Targeted interventions are therefore, one of the most- important

components of the National AIDS Control Programme. The basic purpose
of the targeted interventions programme is to reduce the rate of
transmission among the most vulnerable and marginalized populations.
 One of the ways of controlling the disease from further spread is to carry
out direct intervention programme among these groups through
multipronged strategies, beginning from behavior change
communications, counseling, providing health care support, treatment for
STDS and creating an enabling environment that will facilitate behavior
change.
 NACO evolved the following strategy:
 1. Decentralization of implementation to the state AIDS control society
(SACS).
 2. Transparent and streamlined procedures for selection of NGOS.
 3. Capacity building of SACS and NGOs for implementing and
monitoring projects.
5) NGO's activities:

 NGO guidelines have been formulated to provide for an open and

transparent system of selection of NGOs. The funding of NGOs has been
completely decentralized to the State AIDS Control societies, These
scheme are:
 1. Community care and support
 2. School AIDS Education
 3. National AIDS Helpline and Tele-counseling
 The salient features of the plan are:
 1. Training of teachers
 2. National AIDS helpline and Tele-counseling
 3. Training of peer students, educators who have leadership qualities
and communication skills.
6) Voluntary Counseling and Testing (VCT):

 Voluntary HIV counseling and testing is the process by which an individual

undergoes counseling, enabling him or her to make an informed choice about
being tested for HIV. This decision must be the choice of the individual and he or
she must be assured that the process will be confidential.
 The potential benefits of VCT are:
 1. Emotional support
 2. Prevention of HIV related illness
 3. Safer blood donation
 4. Awareness of safe option for reproduction and infant feeding
 5. Motivation for drug related behavior
 6. Earlier access to care and treatment
 7. Improved health status through good nutritional advice
 8. Better ability to cope with HIV related anxiety
1.6 HIV SURVEILLANCE
 Surveillances are being carried out to detect the spread of the disease & to
make an appropriate strategy for prevention and control i.e. by area-
specific Targeted Interventions & Best Practice Approach.
 1.6.1 TYPES OF SURVEILLANCES:
 HIV sentinel surveillance.
 HIV sero surveillance.
 AIDS case surveillance.
 STD surveillance.
 Behavioral surveillance.
 Integration with surveillance of other diseases like TB etc.
 Out of the above most effective, one is HIV sentinel surveillance.
1.6.2 OBJECTIVES OF THE SURVEILLANCE

 To determine the level of HIV infection among the general

population as well as HRGS in different states.
 To understand the trend of the HIV epidemic among the general
population as well as HRGS in different states
 To understand the geographical spread of infection and to identify
emerging pockets
 To provide information for prioritization of the program resources &
evaluation of program impact.
 To estimate prevalence & HIV burden in the country.
 Parts of Counseling and HIV Testing Service

COUNSELLING
and HIV
TESTING
SERVICES

Integrated Prevention of HIV/TB

Counselling and parent- to-child
Testing Centers transmission of collaborative
(ICTC) HIV (PPTCT) activities
1.7 COUNSELING AND HIV TESTING SERVICE

 1.7.1 INTEGRATED COUNSELLING AND TESTING CENTRES

(ICTC):
 This is available to increase access to HIV diagnosis. It includes testing
services & community approaches at various levels of health systems like
state, district, sub-district, village/community level.
 FUNCTIONS:
 Early detection of HIV.
 Provision of basic information on modes of transmission, prevention of
HIV for promoting behavioral change and reducing vulnerability, and
linking the PLHIV to care, support & treatment.
 The person is counseled and tested for HIV at ICTC, his own free will
either (client-initiated) or as advised by a medical provider (provider-
initiated).
Two Types of ICTC:

1. Fixed facility ICTC: is located within an existing healthcare

facility/hospital/health center
2. Mobile ICTC: It is a van with a room to conduct a general
examination, counseling, and collection and processing of blood
and blood products. These are set in hard to reach areas as
temporary clinics.
 1.7.2 PREVENTION OF PARENT TO CHILD
TRANSMISSION OF HIV
 The prevention of parent-to-child transmission of HIV/ AIDS
(PPTCT) program was started in 2002. Currently, there are more
than 15,000 ICTCS in the country which offer PPTCT services to
pregnant women. The PPTCT program aims to offer HIV testing to
every pregnant woman (universal coverage) in the country, to cover
all estimated HIV positive pregnant women, and eliminate
transmission of HIV from mother-to-child.
 3.1.7.3 HIV/TB COLLABORATIVE ACTIVITIES
 NACP IV covers the HIV testing of TB patients. It is the combined
work of NACP & RNTCP (revised national tuberculosis program).
State with high HIV prevalence covers about 90% of TB patients for
HIV testing.
1.8 OUTCOME OF PROGRAMME

Capacities of State AIIDS control societies & District

AIDS prevention and control units have been
strengthened.
Technical support units were established at the National &
State level to assist in program monitoring.
State training resource centers were set up.
A strategic information management system (SIMS) has
been established with 15000 reporting units across the
country.
ART centers, ART link centers, Coe's, ICTCS were
established & Support agencies were increased.
The 2016-21 strategy by UNAIDS is a bold call to reach
all those people who were left.
It is a call to reach 90% treatment targets to protect the
health of people living with "HIV
90% of people should be aware of their infection, 90% of
that population should start on ART, and 90% out of those
taking ART should have undetectable HIV in their body
until 2020.
Target is 1.75 % reduction in the incidence of infection
from 2010-20.
Reduce in annual death rates to less than 5, 00,000 by
2020.
NATIONAL HEALTH
PROGRAMME FOR
TUBERCULOSIS
 TUBERCULOSIS
Introduction : Tuberculosis is an infectious disease usually
caused by the bacterium Mycobacterium tuberculosis . The
tuberculosis primarily affects lungs and causes pulmonary
tuberculosis . TB also affects the other parts of the body like
intestine , bones and joints , lymph glands , skin and other
tissues of the body .
Most infections do not have symptoms , in which care it is
known as latent tuberculosis . The classic symptom of active
TB is a chronic cough with blood containing sputum , fever ,
weight loss and night sweats .
Active infections occur more often in people with HIV /
AIDS and in those who smoke . Tuberculosis is spread
through the air when people who have active TB in their
lungs cough , spit , speak or sneeze . Diagnosis of active
tuberculosis is based on chest x - rays , as well as
microscopic examination and culture of body fluids . TB
relies on the tuberculin skin test or blood tests .
In 2016 , there were more than 10 million cases of active
TB which resulted in 1.3 million deaths . This makes it the
number one cause of death from an infectious disease .
More than 95 % of deaths occurred in developing
countries and more than 50 % in India , China , Indonesia ,
Pakistan and the Philippines . The number of new cases
each year has decreased since 2000 .
2. National Tuberculosis Programme ( NTP )

The National Tuberculosis Programme ( NTP ) was

started in 1962 for TB Control in India, and the
government of India launched a National Tuberculosis
Control Programme to detect as many tuberculosis cases
as possible, provide effective treatment, establish district
tuberculosis centers, extend short-course chemotherapy,
and strengthen existing state tuberculosis training and
demonstration centers.
 Nationally , there are 390 districts with fully equipped DTCs (
District Tuberculosis Centers ) staffed by a team of medical and
paramedical personnel . Another 330 TB clinics are mostly located
in big cities , caring for local populace . In addition , 17 tuberculosis
training and demonstration centers provide basic training to
paramedical personnel , including general practitioners . There are a
total of about 47,000 beds available nationwide for TB patients . The
majority of patients are treated at home , thus only serious cases or
those requiring surgical treatment are admitted .
 The National Tuberculosis Programme also stresses health education
aimed at the community and general practitioners . Booklets ,
pamphlets , radio , TV , and newspaper advertisements are utilized
for this purpose . The National Tuberculosis institute was
established in 1959 in Bangalore and it has engaged in research on
epidemiological , sociological , and operations aspects , along with
monitoring of the programme .
 The Revised National Tuberculosis Control Programme (
RNTCP ) , based on the Directly Observed Treatment , short
course ( DOTS ) strategy , began as a pilot project in 1993 and was
launched as a national programme in 1997 but rapid NTCP
expansion began in late 1998 . The nation - wide coverage was
achieved in 2006 .
 The Revised National Tuberculosis Control Programme has initiated
early and firm steps to its declared objective of universal access to
early quality diagnosis and quality TB care for all TB patients .
 Revised National Tuberculosis Control Programmme is being
implemented with decentralized services of Tuberculosis diagnosis
through 13,000 + designated microscopy centers and free treatment
across the nation through 4 lakh directly observed treatment
centers .
National Strategic Plan for 2012-2017 :

The National Strategic Plan ( NSP ) 2012-2017 was part

of the country's 12th Five Year Plan . The theme of the
NSP 2012-2017 was " Universal Access for quality
diagnosis and treatment for all TB patients in the
community " with a target of " reaching the unreached "
. The major Focus was early and complete detection of all
TB cases in the community , including drug resistant TB
and HIV associated TB , with greater engagement of
private sector for improving care to all patients .
National Strategic Plan for 2017-2025 for TB
Elimination in India :

The National Strategic Plan 2017-2025 builds on the

success and learning of the last NSP and encapsulates the
bold and innovative steps required to eliminate
Tuberculosis in India by 2030. It is crafted in line with
other health sector strategies and global efforts , such as
the draft national health policy 2015 , World Health
Organizations ( WHO ) End TB strategy , and the
sustainable Development Goals of the United Nations (
UN ) .
Objectives of Tuberculosis Control Programme :

 1. Cure the patient of TB ( by rapidly eliminating most of the bacilli ) .

 2 . Prevent death from active TB or its late effects .
 3. To provide facilities for training , teaching and research activities .
 4. To act as an open institute in the country for prevention , control and treatment of
tuberculosis and allied diseases .
 5 . Prevent the development of drug resistance ( by using combination of drugs )
 6. Decrease tuberculosis transmission to others .
 7 . To promote National Tuberculosis control programme in the country and to
formulate strategies which are socially acceptable and economically feasible in order
to assist and strengthen the programme .
 8 . To have establish Tuberculosis surveillance system in the country .
 9 . To ensure proper TB diagnosis and care management and further accelerate
reduction of TB transmission .
 10 . To extend mechanisms of tuberculosis treatment adherence and contact tracing of
points treated at private sector .
TREATMENT OF TB

 Provision of free TB drugs in the form of daily Fixed Dose Combinations

(FDCs) for all TB cases is advised with the support of Directly Observed
Treatment (DOT) . Screening of all patients for rifampicin resistance ( and for
additional drugs wherever indicated ) is done . For drug sensitive TB , daily
Fixed Dose Combinations ( FDCs ) of first - line anti - tuberculosis drugs in
appropriate weight bands for all forms of TB and in all ages should be given .
 For new TB cases , the treatment in Intensive Phase (IP) consists of eight weeks
of Isoniazid (INH) , Rifampicin , Pyrazinamide and Ethambutol (HRZE) in daily
doses as per four weights band categories and in Continuation Phase three drug
FDCs- Rifampicin , Isoniazid , and Ethambutol (HRE) are continued for 16
weeks .
 For previously treated cases of TB, the Intensive Phase is of 8
weeks, where injection streptomycin is given for 8 weeks along with
four drugs ( INH, Rifampicin, Pyrazinamide and Ethambutol ) and
after 8 weeks the four drugs ( INH , Rifampicin, Pyrazinamide and
Ethambutol ) in daily doses as per weight bands are continued for
another four weeks. In continuation phase Rifampicin, INH, and
Ethambutol are continued for another 16 weeks as daily doses. The
continuation phase in both new and previously treated cases may be
extended by 12-24 weeks in certain forms of TB like skeletal,
disseminated TB based on the clinical decision of the treating
physician .
 Nikshya poshak yojana : It is centrally sponsored scheme under
National Health Mission ( NHM ) financial incentive of Rs.500 / -
per month is provided for nutritional support to each notified TB
patient for duration for which the patient is on anti - TB treatment .
OUTCOMES OF PROGRAMME

 Efforts to end TB in India through implementation of the National

Strategic Plan (2017-2025) has completed the first three years of
implementation. During this period, the programme has seen tremendous
success and is better today, responding to which, some States / UTs have
committed to end TB even before 2025.
 24.04 lakh patients have been notified through the system, an increase of
11% over last year , with 6.7 lakh patients being notified from the
private sector.
 First line standard treatment was initiated for 22.7 lakh (94.4%) of the
notified drug sensitive TB cases. 27.74 crore populations were screened
across 337 districts in 23 States resulting in 62,958 TB cases identified.
 A total of 66,359 Multi Drug Resistant/ Rifampicin Resistant
(MDR/ RR) TB cases were notified and 56,500 (85%) of them put
on treatment, an improvement of 7.6% over last year.
 Over 94% of People Living with HIV (PLHIV) are being screened
in ART centers for TB symptoms. 2.4 lakh PLHIV were given
access to rapid molecular testing via NAAT (Nucleic Acid
Amplification Test) for TB diagnosis. More than 3 lakh PLHIV
were initiated on TB preventive therapy in 2019.
 As a result of the implementation of TB-Diabetes collaborative
framework, over 60% of the notified TB patients in the public sector
have been screened for Blood Sugar.
 INTEGRATED DISEASE
SURVEILLANCE PROGRAM
(IDSP)
3. INTEGRATED DISEASE SURVEILLANCE
PROGRAM (IDSP)
 Integrated Disease Surveillance Project (IDSP) was launched by
Hon'ble Union Minister of Health - Family Welfare in November
2004 to detect and respond to disease outbreaks quickly. The project
was restructured and extended up to March 2012. The project
continues in the plan with domestic budget as Integrated Disease
Surveillance Programme under NHM for all States.
 A Central Surveillance Unit (CSU) at Delhi, State Surveillance
Units (SSU) at all State/UT headquarters and District Surveillance
Units (DSU) at all Districts in the country have been established.
 Central Surveillance Unit
(CSU at NCDC Delhi)

State Surveillance Unit (SSU)

(SSU at State Head Quarter supported by 7
contractual positions) (36 States/UTs)

District Surveillance Unit (DSU)

(DSU at District Head Quarter supported by 3
contractual positions) (670 Districts)

Peripheral Reporting Unit (PRU)

OBJECTIVES

 To strengthen/maintain decentralized laboratory based IT. enabled

disease surveillance system for epidemic prone diseases to monitor
disease trends and to detect and respond to outbreaks in early rising
phase through trained Rapid Response Team (RRT).
 To establish a decentralized State based system for communicable
diseases to detect the EARLY WARNING SIGNALS, so that the
timely and effective public health actions can be initiated.
 To improve the efficiency of disease control programs & facilitate
sharing of relevant information with various stakeholders so as to
detect disease trends over time & evaluate control strategies.
PROGRAMME COMPONENTS

 Integration and decentralization of surveillance activities through

establishment of surveillance units at Centre, State and District
level.
 Human Resource Development, Training of State Surveillance
Officers, District Surveillance Officers, Rapid Response Team and
other Medical and Paramedical staff on principles of disease
surveillance.
 Use of Information Communication Technology for collection,
collation, compilation, analysis and dissemination of data.
 Strengthening of public health laboratories.
Functions of the District Surveillance Unit:

Centralize and analyze data from reporting units

Constitute rapid response teams and their deputation
Implement and monitor all project activities
Coordinate with laboratories, medical colleges, non
governmental organizations and private sector
Send regular feedback to the reporting units
Organize training and communication activities
Organize district surveillance committee meetings
Functions of the State Surveillance Unit:
Collect and analyze data received from districts
Coordinate activities of rapid response teams
Monitor and review the activities of district surveillance
units
Coordinate with state public health laboratories, medical
colleges and other state level institutions
Feedback trend analysis to district surveillance units
Organize and coordinate training activities
Organize meetings of the state surveillance committee
Functions of the Central Surveillance Unit:
 Execute the approved annual plan of action
 Monitor progress of implementation
 Obtain reports and statements of expenditure
 Seek reimbursement from the World Bank
 Report to the national surveillance committee
 Procure goods and services at central level
 Analyze data and send feedback to states
 Coordinate with NICD, ICMR and others
 Organize non communicable diseases surveys
 Conduct periodic review meetings with state surveillance officers
 Organize independent evaluation studies
 Produce guidelines, manuals and modules
DATA MANAGEMENT
 Under the project weekly disease surveillance data on epidemic prone
disease are being collected from reporting units such as sub centers,
primary health centers, community health centers, hospitals including
government and private sector hospitals and medical colleges.
 The data are being collected on (SPL) 'S' syndromic (used by
paramedical personal and community members); 'P" presumptive
(used by medical officers of primary and community health centers);
& ‘L’ laboratory confirmed (confirmed by test and medical officer)
formats using standard case definitions.
 Presently, more than 90% districts report such weekly data through e-
mail/portal (www.idsp.nic.in). The weekly data are analyzed by
SSU/DSU for disease trends. Whenever there is rising trend of
illnesses, it is investigated by the RRT to diagnose and control the
outbreak.
 Data analysis and actions are being undertaken by respective
State/District Surveillance Units. Media scanning and verification
cell was established under IDSP in July 2008. It detects and shares
media alerts with the concerned states/districts for verification and
response.
 24 x 7 call center was established in February 2008 to receive
disease alerts on a Toll Free telephone number (1075). District
laboratories are being strengthened for diagnosis of epidemic prone
diseases.
 Presently, about 90% districts in the country report weekly
surveillance data through portal. The weekly data gives information
on the disease trends and seasonality of diseases. Whenever there is
rising trend of illness in any area, it is investigated by Rapid
Response Team to diagnose and control the outbreak. Data analysis
and actions are being undertaken by respective States/District
Surveillance Units.
 OUTCOME OF THE PROGRAMME
Identification of outbreaks / potential outbreaks
Identification of appropriate and timely control measures
Prediction of changes in disease trends over time
Identification of problems in health systems
Improvement of the surveillance system through:
Identification of regional differences
Identification of differences between the private and the public
sectors
Identification of high-risk population groups
 On an average 30 outbreaks are reported every week by the States to
CSU. A total of 553 outbreaks were reported in 2008, 799 outbreaks
in 2009, 990 outbreaks in 2010, 1675 outbreaks in 2011 and 1584
outbreaks in 2012.
 In 2013, 1964 outbreaks have been reported. A total of 2562 media
alerts are reported in July 2008 to 31st December 2013. Majority of
the alerts are related to diarrheal diseases and vector borne diseases.
 A 24x7 call center receive disease alerts all across the country on a
toll free telephone number (1075). The call center was extensively
used during 2009 HIN1 influenza pandemic and dengue outbreak in
Delhi in 2010.
 Twelve labs have been strengthened and made functional under
IDSP for Avian/ HIN1 influenza surveillance.
National Leprosy Elimination
Programme (NLEP)
4. NATIONAL LEPROSY CONTROL PROGRAMME
 Leprosy is one of the major health and socioeconomic problems in
the country. It is a chronic infectious disease and spreads mainly by
with infected patients. The disease carried by Mycobacterium
Leprae affects mainly the peripheral nerves, partial or total loss of
cutaneous sensation in the affected areas, presence of thickened
nerves and presence of acid-fast bacilli in the skin or nasal smears.z
 The national leprosy control programme is a centrally sponsored
health scheme of the Ministry of Health and Family Welfare,
Government of India. The programme is headed by the Deputy
Director of health services (Leprosy) under the administrative
control of the Directorate General Health Services Govt. of India.
The National Leprosy eliminating programme strategies and plans
are formulated centrally, the programme is implemented by the
states.
 The programmes are also supported as partners by the World Health
Organization. The World Health assembly in May 1991 adopted a
resolution for global leprosy elimination as a public health problem
by the year 2000.
 The National Health Policy of India 2002 also set the goal of leprosy
elimination in India by the end of year 2005. The National Leprosy
Elimination Programme (NLEP) took up the challenge with active
support of the state and dedicated partners such as World Health
Organization (WHO), the international Federation of Anti Leprosy
Association (ILEP), the Sasakawa Memorial Health Foundation
(SMHF) & The Nippen Foundation (TNF), NOVARTIS
DANIDADA NLEP (1986-2003) and the World Bank (1993-2004).
NATIONAL LEPROSY PROGRAMMES:

 In 1955 Government of India launched National Leprosy Control

Programme.
 In 1983 Government of India launched National Leprosy
Elimination Programme and introduced Multiple Drug Therapy
(MDT).
 In 1993-2000 World Bank supported National Leprosy Eliminated
Programme-I.
 In 2001 to 2004 World Bank supported NLEP-II.
 In January 2005 National Leprosy Eliminated Programme continued
with Government of India funds and donor partners support.
 In December 2005, India achieved elimination as a public health
problem.
 The National Leprosy Control is in operation since 1955, as a
centrally-aided program to achieve control of leprosy through early
detection of cases and Diamino Diphenyl Sulphone (DDS) or
Dapsone monotherapy on an ambulatory basis. In 1980, the
government of India declared it’s resolve to "eliminate" leprosy by
the year 2000 and constituted a working group to advice
accordingly. In 1983, the control programme was redesigned as
National Leprosy Elimination Programme with the goal of
eliminating the disease by the turn of the country.
 World Bank supported project: The first phase of the World Bank
supported NLEP project, which was completed on 31st March 2000.
It was extended for 6 months to complete the preparation of
proposed second phase project. During the first phase, the care
detected was 3.8 million patients and care cure with multi drug
therapy (MDT) was 4.4 million old and new cases. The second
phase project of World Bank has been approved for a period of 3
years starting from June 2001.
Strategic Plan of Action (2004-2005):

 Decentralized integrated leprosy services through general health care

system.
 Carrying out house hold contact survey in detection of Multi Bacillary
(MB) and child cases.
 Early detection and complete treatment of new leprosy cases.
 Information, Education and Communication (IEC) activities in the
community to improve self-reporting to Primary Health Centre (PHC)
and reduction of stigma.
 Strengthening of Disability Prevention and Medical Rehabilitation
(DPMR) services.
OBJECTIVES OF NATIONAL LEPROSY PROGRAMME
 1. Regular treatment of cases by providing Multi Drug Therapy
(MDT) at nearby village of moderate to low endemic areas/district.
 2. Appropriate Medical rehabilitation and leprosy ulcer care
services.
 3. Intensified health education and public awareness campaigns to
remove social stigma attached to the disease.
 4. Early detection through active surveillance by the trained health
workers.
 5. To train manpower necessary to implement National Leprosy
eliminating Programme.
 6. To monitor and evaluate National Leprosy elimination
programme.
 7. To provide specialized services in the area of diagnosis, reaction,
relapse and reconstructive surgery in leprosy.
Outcomes of Programmes:

 The National Leprosy Elimination programme has achieved its

principal goal of leprosy elimination as a public health problem at
the National level, which was doubtful in the minds of many
experts. During the process of elimination, the National Programme
achieved a number of benefits for the suffering leprosy patients and
the community. To list a few of these are:
 1. Repeated mass campaigns have helped in increasing the public
awareness about leprosy, its curability, drug availability in Health
Centers, resulting in improved number of self reporting for
diagnosis and treatment.
 2. Introduction of a Simplified Information System (SIS) for NLEP
suitable for the General Health Service officials helped in
streamlining data generation, reporting and monitoring of the
programme.
 3. The Leprosy services changed from east while vertically run
programme to integrated services through the Primary Health
Services centers. This has increased accessibility of the service to
the people nearer to their home on all working days.
 4. Large number of General Health Care Staff has been trained to
make them proficient in suspecting leprosy and providing health
education to the patient, family and community members.
NATIONAL MENTAL HEALTH
PROGRAMME
5. NATIONAL MENTAL HEALTH PROGRAMME

 Introduction: Mental health is an integral component of health,

which is defined as a positive state of well being (Physical, Mental,
Social) and not merely an absence of illness.
 Psychiatric symptoms are common in the general population on both
sides of the globe. These symptoms are- Worry, tiredness, and
sleepless nights which affect more than half of the adults at some
time, while as many as one person in seven experiences some form
of diagnosable neurotic disorder.
 An expert group was formed in 1980. After several drafts and two
workshops (July 1981 and August 1982), the final draft was
submitted to the Central Council of Health and Family Welfare (the
highest policy-making body for health in the country) on 18th to
20th August 1982, which recommended its implementation.
 NATIONAL MENTAL HEALTH PROGRAMME AND
IT’S FUNCTIONING

 The Government of India launched the National Mental Health

Programme (NMHP) in 1982, keeping in view the heavy burden of
mental illness in the community, and the absolute inadequacy of
mental health care infrastructure in the country to deal with it.
 AIM:
 Prevention and treatment of mental and neurological disorders and
their associated disabilities.
 Use of mental health technology to improve general health services.
 Application of mental health principles in total national
development to improve quality of life
Major Milestones are:
 1. Child Survival and Safe Motherhood Programme (CSSM) in
1992
 2. Reproductive and Child Health (RCH I) in 1997
 3. RCH II in 1997
 4. National Rural Health Mission (NRHM) in 2005
 5. Reproductive, Maternal, Newborn, Child and Adolescent Health
(RMNCH) and strategy in 2013
 6. Nation Health Mission (NHM) in 2013
 7. INDIA New Born Action Plan (INBAP) in 2014
 Long standing need of urban health mission was accepted in May
2013 by the cabinet of the government of India and rural and urban
health mission merged to form National Health Mission in 12th Five
year plan.
World Bank Report :

 The World Bank Report (1993) revealed that the Disability

Adjusted Life Year (DALY) loss due to neuro-psychiatric disorder
is much higher than diarrhea, malaria, worm infestations and
tuberculosis if taken individually. According to the estimates
DALYS loss due to mental disorders are expected to prevent 15% of
the global burden of disease by 2020.
 The prevalence reported from these studies range from the
population of 18 to 207 per 1000 with the median 65.4 per 1000 and
at any given time, about 2-3% of the population, suffer from
seriously, incapacitating mental health disorders or epilepsy. Most of
these patients live in rural areas remote from any modern mental
health facilities.
Strategies were planned for immediate action.
These are:

 1) Center to periphery strategy: Establishment and strengthening

of psychiatric units in all districts hospitals, with outpatient clinics
and mobile teams reaching the population for mental health services.
 2) Periphery to Center Strategy: Training of an increased number
of different categories of health personnel in basic mental health
skills, with primary emphasis towards the poor and the
underprivileged, directly benefiting about 200 million people.
The Objectives of National Mental Health Programme are :

1. To ensure availability and accessibility of minimum

mental health care for all in the foreseeable future,
particularly to the most vulnerable and under privileged
sections of population .
2. To encourage application of mental health knowledge in
general health care and social development .
3. To promote community participation in the mental
health service development and to stimulate efforts
towards self help in the community.
Outcomes of Programme:
 The National Mental Health Survey 2015-2016 has revealed a huge
burden of mental disorders in the Indian Community. This finding is based
on a methodology that was scientific, uniform and standardized,
undertaken across 12 states at one point of time.
 The fact that nearly 11% of Indians above 18 years are suffering from
mental disorders and most of them do not receive care for a variety of
reasons deserves the urgent attention of our policy makers and
professionals.
 The impact is huge affecting all areas of an individual and his/her family
life affecting quality, productivity and earning potentials. This data should
be used as evidence to strengthen and implement mental health policies
and programmes and should be the driving force for future activities in
India.
6. NATIONAL PROGRAMME FOR PREVENTION
AND CONTROL OF DEAFNESS
 Hearing loss is the most common sensory problem in humans. The National
Programme for prevention and control of deafness was established by the Ministry
of health and family welfare of Government of India. As per WHO in India, there
are around 63 million people, who distress from this problem. Hearing impairment
may have a profound effect on the ability of individuals to communicate with
others, on their education, on their ability to obtain and keep employment and on
social relationship which lead to reprehension.
 The large hugeness of the problem indicates the need to have an effective method
to prevent the onset of hearing loss. Recognizing the need and based on the
principles of sound hearing government of India initiated a trial/pilot project for
the prevention and control of hearing loss in the country. The pilot project was
started in 2007. The programme has been expanded to 192 districts of 20 states. It
is exposed to expand the programme to additional 200 districts in a phased
manner probably covering all the states and union territories by March 2017.
Components of the Programme:
 1. Service Provision: Early detection and management of hearing
and speech impaired cases and rehabilitation at different levels of
health care delivery system.
 2. Awareness generation through IEC activities: For early
identification of hearing damage, especially children so that timely
management of such cases is possible and to remove the stigma
attached to deafness.
 3. Capacity building: For the district hospital, community health
centers and primary health center in respect of audiometric
infrastructure.
 4. Manpower training and development: For prevention, early
identification and management of hearing impaired and deafness
cases, training would be provided from medical college level
specialists (ENT and Audiometry) to grass root level workers.
Functions strategies of the programme:

 1. To develop human resource for ear care services

 2. To develop institutional capacity of the district hospitals
 3. To promote public awareness through effective information and
education communication strategies.
 4. Training to all the manpower
 5. Screening, early diagnosis and management
 6. To aware people about the disease i.e. we can take care of our ears
by these methods.
Precaution measures
Objectives:
 1. To strengthen the existing inter-sectoral linkage for continuity of the
rehabilitation program, for persons with deafness
 2. Early identification, diagnosis and treatment of ear problems responsible for
hearing loss
 3. To prevent the avoidable hearing loss on account of disease
 4. To identify the facilities and activities at the primary, middle and tertiary level
of health services
 5. To identify weakness and strengths, and short and long-term needs
 6. To medically cure the persons of all age groups, suffering with deafness
 7 . To construct a hearing aid using digital signal process

 Long Term Objective: To prevent and control major causes of hearing

impairment and deafness so that we can reduce total burden of this disease by
25% by the end of the 12th five year plan.
Outcomes :
 1. Decrease in the number of hearing impaired persons.
 2. Awareness among the health workers and root level workers with the
help of PHC medical officers and health officers to function with in the
community.
 3. Decrease in the Extent of various ear diseases and hearing impairment.
 4. Increase in availability of various services like prevention early
detection and identification, treatment, rehabilitation, etc. for hearing
impairment and deafness at PHC/District hospital & community health
workers.
 5. Improved service network for the persons having hearing impairment.
 6. Increased capacity building at the district hospitals to insures better care
and services.
 7. NATIONAL PROGRAMME FOR
CONTROL OF BLINDNES ( NPCB )
 Definition of Blindness under NPCB : Inability of a person to
count fingers from a distance of 6 meters or 20 feet . Vision 6/60 (
Snellen’s ) or less with the best possible spectacle correction .

 WHO definition : Vision 3/60 or less . Main causes of Blindness

are Cataract ( 62 % ) , Refractive error ( 20 % ) , Glaucoma ( 6 % ) ,
Posterior Segment Disorder ( 5 % ) Post Capsular Opacification ( 1
% ) Corneal Blindness ( 1 % ) , Surgical Complications ( 1 % ) and
Others ( 4 % ) .
TYPES OF BLINDNESS :
 Economic blindness : Inability of a person to count fingers from a distance of 6
meters or 20 feet .
 Social blindness : Vision 3/60 or diminution of field of vision to 10 degrees .
 Absolute blindness : No perception of light .
 Manifest blindness : Vision 1/60 to just perception of light .
 Curable blindness : That stage of blindness where the damage is reversible by
prompt management e.g. cataract .
 Preventable blindness : The loss of vision that could have been completely
prevented by institution of effective preventive or prophylactic measures. e.g.:-
Xerophtalmia , Trachoma .
 Avoidable blindness : The sum total of preventable or curable blindness is often
referred to as avoidable blindness .
 Visual Acuity: Sharpness of vision , measured as maximum distance a person can
see a certain object divided by the maximum distance at which a person with
normal sight can see the same object.
INTRODUCTION TO PROGRAMME
 India was the first country in the world to launch National Level Blindness
Control Programme . National Programme for Control of Blindness was
launched in the year 1976 as a 100 % Centrally Sponsored scheme with
the goal to reduce the prevalence of blindness from 1.4 % to 0.3 % . As
per Survey in 2001-02 prevalence of blindness is estimated to be 1.1 % .
Rapid Survey on Avoidable Blindness conducted under NPCB during
2006-07 showed reduction in the prevalence of blindness from 1.1 % (
2001-02 ) to 1% ( 2006-07 ).
 Programme decentralized in 1994-95 with formation of District blindness
control society ( DBCS ) in each district various activities / initiatives
undertaken during the Five Year Plans under NPCB are targeted towards
achieving the goal of reducing the prevalence of blindness to 0.3 % by the
year 2020. India is committed to reduce this burden of blindness by
adopting the strategies advocated for vision 2020- " THE RIGHT TO
SIGHT "
 OBJECTIVES OF PROGRAMME
 1. To reduce the backlog of blindness through identification and treatment of blind at
primary , secondary and tertiary levels based on assessment of the overall burden of
visual impairment in the country .
 2. Develop and strengthen the strategy of NPCB for " Eye Health " and prevention of
visual impairment through provision of comprehensive eye care services and quality
service delivery .
 3 . Strengthening and up gradation of Regional Institutes of Ophthalmology ( RIOS ) to
become center of excellence in various sub - specialties of ophthalmology .
 4 . Strengthening the existing and developing additional human resources and
infrastructure facilities for providing high quality comprehensive Eye Care in all
Districts of the country .
 5. To enhance community awareness on eye care and lay stress on preventive measures .
 6. Increase and expand research for prevention of blindness and visual impairment .
 7. To secure participation of Voluntary Organizations / Private Practitioners in eye Care .
Activities under National Programme for
Control of Blindness :

 1. Management Information system

 2. Collection and utilization of donated eyes
 3. Control of vitamin & its deficiency
 4. Monitoring and evaluation
 5. School eye screening programme
 6. IEC Activity ( Information , Education and Communication )
COMPONENTS OF PROGRAMME:

 1. Cataract surgery.
 2. Eye screening.
 3. IOL (intraocular lens) surgery
 4. Eye donation. (Eye donation fortnight -25 Aug to 8 Sep)
 5. Voluntary organization.
 6. Vit “A' prophylaxis. (Vit "A" syrup – oral – for all preschool
children)
 7. IEC activities. (World Sight Day -II Thursday of October)
 Strategies
 1. Disease control of avoidable blindness
 2 . Training of ophthalmic personnel
 3 . (IEC) Information , education and communication activities
 4. Screening of school children for identification and treatment of refractory error
 5. Participation of community and panchayathrey institutions in organizing services in rural
areas
 6. Active screening of population above 50 years of age
 7. Coverage of underserved areas for eye care through public private partnership
 8. Capacity building of health personnel
 9. Decentralized implementation of the scheme through District Blindness Control Societies
 10. Organizing screening eye camps and transporting operable cases to eye care facilities
 11. Developing institutional capacity
 12. Established 30 eye care facilities for every 5 lack persons
 13. Promoting out - reach activities and public awareness
 Goals and Objective of NPCB :
 Goals :
 1. To provide comprehensive eye care through primary health care .
 2. To reduce the prevalence of blindness to less than 0.3 % .

 Objectives of NPCB :
 1. To improve quality of service delivery .
 2. To increase the public awareness on eye care .
 3. To develop human resources for providing eye care services .
 4. Reduce the backlog of blindness .
 5 . To maintain the nutritional quality of foods .
 6 . To increase the added nutritional value of a product .
 7. To secure participation of volumatory organization private practitioners in eye
care .
 Outcomes of Programme :
 1. Rise in Cataract surgery rate
 2. Training of ophthalmologists
 3. Facilities for IOL surgery
 Cataract surgical rate is rising in India . In order that people can come for surgery in large
numbers all surgeries or operations are done in general hospital and transportation facility
also provided by hospital . Post - operative follow - up is done at the nearest vision centre and
at the next outreach camp to take place in that area . The programme also helps in reducing
fear regarding cataract surgery among people .
 There are some important points given below :
 1. Allowing family members to travel with the patient .
 2 . Providing all facilities which is available in hospital .
 3. Using local language during counsel .
 4. Sharing the stories of eye patient from the same community who had been successfully
operated on .
 There has been real increase in cataract surgery rate in the Govt . as well as in the voluntry
sector the last five years .
8. PULSE POLIO PROGRAMME

 Intorduction : In India, the Pulse Polio programme was launched in 1995.

It is done twice each year. National Immunization Day is widely known as
the Immunization Schedule for Pulse Polio. The global prevention of
polio requires both a reduction in the disease's incidence or rate and
the prevention of the virus that causes it worldwide.
 0-5 year's age group children are administered with polio drops during
national and sub - national Immunization programmes every year .
 About 172 million children are immunized during each National
Immunization Day (NID). In India last polio case was reported from
Howrah District of West Bengalin 13th Jan 2018. After that in India no
polio case has been reported. On 24th February 2012 the World Health
Organization removed the country (India) name from the list of countries
with active endemic wild polio virus transmission.
Oral vaccine:

 Oral vaccines are best vaccines for control of the pulse polio because-
 It is cheap
 It is easy to administer
 Oral vaccine directly reaches intestine and prevent from multiple disease causing
polio virus
 Indian Government conducts the pulse polio immunization for two days every
year until polio is eradicated. Monitor oral pulse vaccine coverage at district levels
 Sustain high level of routine immunization
 Children under 5 years come under Pulse Polio Programme
 Every year in December and January all children under 5 years of age are taking
two doses of oral polio vaccine until polio is eradicated.
PRINCIPLE FOR POLIO ELIMINATION

 Polio is one of the few diseases that can be eliminated because:

 1. Immunity is life long
 2. It only affects humans and there is no animal reservoir
 3. The virus can only survive for a very short time in the
environment
 4. An effective, inexpensive vaccine exists
National Programme of Pulse Polio and
its Functioning
 The Pulse Polio Programme was launched in India in 1995, with an
estimated 50,000 cases of polio annually.
 Care-based polio surveillance began in 1997 with funding from the
National Monitoring Programme for the Identification of Polio. Virus
Transmission (WHO- CNPSP-WHO) and has since been carried out by the
laboratory via Acute Flaccid Paralysis (AFP).
 The last treatment for wild virus type-2 was recorded in India in 1999.
 In 2005, India was the first country to use a monovalent (type-1) vaccine.
 India was the second research country in January 2010 to implement a
bivalent vaccine, which proved to be very successful.
Objectives
 As no case of polio has been registered for over 3 years, India has accomplished the
objective of polio destruction. The World Health Organization removed India's name
from the rundown of nations with the complex endemic transmission of wild polio
infections on 24 Feb 2012.
 1. To remain vigilant.
 2. To use a guerilla marketing strategy to maximize audience reach.
 3. To become the largest Pulse Polio Programme initiative in the world.
 4. To continue heavy screening and evaluation processes.
 5. To Start NGOs.
 6. To improve the quality of services.
 7. To boost the Pulse Polio immunization program.
 8. To implement a district-wise performance monitoring system.
 9. Improve the quality of services
 10 . NGO should be opened
 11. Fast Pulse Polio immunization programme
Strategies for Polio Elimination:
 a) Routine Immunization :
 Age limit -OPV(Oral Polio Vaccine) in the 0-1 year age group
 Doses- 3 Doses
 b) Supplementary Immunization :
 Age limit- OPV in the 0-5 year age childrens
 Doses- 4 to 6 Doses
 c) Investigation and Observation of cases of Acute Flaccid Paralysis : Monitoring data is
used to identify areas of wild polio-virus transmission
 Age Limit Below 3 years old
 Covering Percentage -100%
 d) House to House Activity to provide vaccine : During 4 to 6 days of the Pulse Polio
Programme, the teams of health workers will move from house to house and check carefully to
ensure that every single child up to 5 years of age has received the polio "Səsop
 e) Pulse Polio Booths : Pulse polio booths are very important and best platform to spread the
information regarding pulse polio vaccine. All the infants below 1 year are supposed to be
receiving a birth dose of "oral polio" vaccine, called zero dose followed by 3 doses at 6, 10 and
14 weeks of age alongside DPT (3 doses).
Functioning:
 1. Maintaining community immunity through high quality national and sub
national polio rounds each year.
 2. Environmental observation have been developed to detect polio virus
transmission.
 3. Government of India has issued guidelines which is effective since March
2014, for compulsory requirement of polio vaccination to all international
travellers for travel between India and other polio affected countries.
 4. On 25th April, 2016 India has switched from Trivalent Oral Polio Vaccine
(TOPV) to Bivalent Oral Polio Vaccine (BOPV).
 5. Identifying missing children from immunization process.
 6. Setting up of booths in all parts of the country. Arranging employees,
volunteers and vaccines.
 7. Monitoring of vaccination efficacy.
 8. Vaccines are always kept in cold storage or cold areas to protect them from
degrading.
Outcomes of the Programme
 India was declared a Polio free Nation by WHO on 27th March 2014. As
no case of polio has been identified for more than 3 years since the last
treatment was identified on 13 January 2011, India has carved the pool of
polio eradication.
 This achievement of the Polio Free Nation cannot be credited to a single
person or Government but the result of the collective work of many
stakeholders like NGO media, and celebrities who promoted that program
and played a key role in bringing awareness among the people.
 The credit also goes to the parents of all children below years of age,
which are responsible for this achievement.
 This 1" year success makes up more responsible and more such initiatives
are to be collectively taken. Any mission undertaken with clear planning
and execution will surely give the desired results.
UNIVERSAL IMMUNIZATION
PROGRAMME (UIP)
 The WHO launched a global immunization programme in 1974, called 'Expanded Programme
on immunization' to protect against the six preventable diseases- Diptheria, whooping cough,
tetanus, polio, measles and tuberculosis.
 In 1978, January Expanded Programme of Immunization was launched. The universal
immunization programme was launched in 1985. Now this programme is called as universal
child immunization.
 Universal immunization programme and its functioning: In India the universal Immunization
programme was introduced on 19th Nov. 1985. The programme was given the status of a
National Technology Mission in 1986 to provide a feeling of urgency and commitment to
achieve the goals within the specific period . Child survival and safe motherhood programme in
1992 and reproductive Child Health Programme in 1997 were launched. The Government of
India constituted a National Technical committee on child health on 11th June 2000.
 The department of family welfare established a National Technical Advisory Group of
immunization on 28th Aug 2001. A national sociodemographic goal was set up in National
Population Policy 2000, to achieve universal immunization of children against all vaccine
preventable disease by 2010.
 Universal immunization programme is one of the largest public health programme
in India. India is the largest manufacturer of the vaccines with a functional
national regulatory authority. It is centrally sponsored programme under National
Rural Health Mission. UIP targeted approximate 26 million infants and 30 million
pregnant women in India. All vaccines are procured by central government with
100% domestic funding.
 Schedule of Universal Immunisation Programme :
 The minimum vaccines that an Indian child should receive are the vaccines
recommended by the Government of India under the expanded programme of
immunisation. It includes 3 doses of tetanus toxoid given to the mother and
newborn. After birth the baby receives vaccine against seven killer preventable
diseases including BCG (against tuberculosis) oral polio vaccine, DPT vaccine,
hepatitis B and measles vaccine.
Abbreviations:
 BCG: Bacillus Calmette Guerin,
 OPV: Oral poliovirus vaccine,
 DTWP: Diphtheria, tetanus, whole cell Pertussis,
 DT: Diphtheria and tetanus toxoids,
 TT: Tetanus toxoid,
 Hep B: Hepatitis B vaccine,
 MMR: Measles, Mumps and Rubella Vaccine,
 Hib: Hemophilus influenzae Type b' Vaccine,
 IPV: Inactivated poliovirus vaccine,
 Td: Tetanus, reduced dose diphtheria toxoid,
 HPV: Human Papilloma Virus Vaccine,
 PCV: Pneumococcal Conjugate Vaccine,
 TdaP: Tetanus and Diphtheria Toxoids and a Cellular Pertussis Vaccine.
Schedule of Universal Immunization
Programme

 The vaccines recommended by the Government of India under the

expanded immunization programme are the minimum vaccines that
an Indian child should receive. It contains three doses of tetanus
toxoid for mother and infant. The baby is vaccinated against seven
killer preventable diseases after birth, including the oral polio
vaccine, BCG (against tuberculosis), DPT vaccine, hepatitis B and
the measles vaccine (Table 6.2 and 6.3).
Immunization Schedule recommended by IAP (Indian academy of
paediatrics)
Age Vaccines
Birth BCG, OPV 0, Hepatitis B-1
6 weeks IPV-1, DTWP-1. Hepatitis B-2, Hib -1, Rotavirus 1, PCV 1
10 weeks DTWP-2, II'V 2. Hib -2, Rotavirus 2, PCV 2
14 weeks DTWP-3, IPV-3, Hib -3, Rotavirus 3 , PCV
6 months OPV 1, Hep B3
9 months OPV 2, MMR-1
9-12 months Typhoid Conjugate Vaccine
12 months Hep-A 1
15 months MMR 2, Varicella 1, PCV Booster
16-18 months DTWP B1/ DTAP booster - 1, IPV B 1, Hib booster 1
18 months Hep-A2
2 years Booster of Typhoid Conjugate Vaccine
4-6 years DTwP B2/DTaP booster -2, OPV 3, MMR 3, Varicella 2,
10 - 12 years Tdap / Td, HPV (Only for females, three doses at 0, 1-2 and 6 months
Disease Protected by Vaccines used under UIP

Vaccine Disease Protected Route

BCG (Bacillus Chalmette Tuberculosis Intradermal
Guerin)
DPT (Diphtheria, Pertussis, Diphtheria Pertussis, and Intramuscular
and Tetanus) Tetanus
OPV (Oral Polio virus) Polio Oral
Measles Measles Subcutaneous
Hepatitis B Hepatitis B Intramuscular
TT (Tetanus Toxoid) Tetanus Intramuscular
JE (Japanese Encephalitis) Japanese Encephalitis (known Subcutaneous
as brain fever)
Hib containing Pentavalent Meningitis and Pneumonia Intermuscular
Vaccine ( DPT + Hep B + caused by Heamophilus
Hib) influenza type B
PRINCIPLES OF UIP
 1) Universal imimunization coverage: Sustaining demand and ensuring that all pregnant
mothers, children and adolescents are immunized as per national schedule in line with the
principles of universal health coverage
 2) Equitable access: Ensuring that the immunizations services reach out to the
underserved needy and most vulnerable populations while addressing regional inequalities
across states.
 3) High quality services and innovation: Maintaining highest possible quality in vaccine
procurement, storage, distribution and delivery services in an innovative and safe manner
using Cold Supply Chain management system.
 4) Sustainability and Partnerships: Committing resources - financial, human and
technical. that sustain immunization benefits to the people at all times and promoting
partnerships across different sectors and organizations build synergies and expand the
overall coverage of the program.
 5) Governance: Decentralized planning through a bottoms up approach to improve
operational efficiency.
 6) Management excellence and accountability: Implementation, oversight and
accountability of interventions that optimize efficient use of resources.
Strategies of Universal Immunization Programme:

 1. Polio Eradication
 2. Reducing dropout rate
 3. Strengthen institutional service at all level
 4. Strengthen coordination
 5. Strengthening micro planning process
 6. Use of new or underutilized vaccines
 7. Mass and mid-media campaign
 8. Monitoring accountability and supportive supervision
 9. Communication and social mobilization
 10. Training and capacity building
Objectives:
 1. To increase the immunization coverage
 2. To improve quality of services
 3. To eradicate the neonatal tetanus, diphtheria and pertussis by 2009.
 4. To establish sufficient, sustainable and accountable fund flow at all
levels
 5. To introduce a district wise system monitoring & evaluation
 6. To ensure that there is sustained demand and reduce social barriers to
access immunization services
 7. To establish reliable cold chain equipment and to establish a good
surveillance network
 8. To achieve self sufficiency in vaccine production and manufacturing of
cold chain equipment's.
Outcomes of the Programme:
 1. The possibility of immunization is higher for children in urban areas.
 2. The possibility of immunization increases with mother's empowerment index
 3. The possibility of immunization is higher for children in female headed households.
 4. Children from households with electricity are more likely to be immunized.
 5. Immunization chance increase with the standard of living index of children's household.
 6. The possibility of vaccination increases with mother's education level, mother's age upto
29 years, mother's exposure to mass media and mother's awareness about immunization.
 7. Boys are more likely to be immunized than girl children.
 8. In different religions, Muslim children are least likely to be immunized whereas children
from Christian and other religious minority communities are most likely to be immunized.
 9. The children's from the West Zone, North, East, South-Central and North-East are most
likely to be immunized.
 10. Increases the possibility to meet health personnel who help mother's to raise awareness
regarding immunization.