INDIA NEWBORN ACTION PLAN (INAP) j

M onitoring and Evaluation (33) with ENAP - i.e., 2025, 2030, and 2035.
A comphrehensive assessment of targets would be done Following core indicators (dashboard indicators) have
in 2020, which will help plan course corrections, if any, in been selected for monitoring, based on direct relevance to
on-going interventions. Further, from the year 2020, the the action plan framework, targets, goals, and review of
‘milestones will be reviewed every five years keeping in sync current data availability.
Dashboard indicators for INAP
IL,ivul and focus areas Indicators
Impact level indicators - Birth registration
- Stillbirth rate
- Early neonatal mortalty rate
- Neonatal mortality rate
- Percentage of neonatal deaths to under-5 deaths
~ Survival rate of newborns discharged from SNCU/NICU at one year of age
- Cause-specific neonatal mortality
Pre-conception & antenatal care ~ Births to women aged 15-19 years out of total births (teenage pregnancy)
- Percentage of pregnant women who received full ANC
- Percentage of pregnant women detected and treated with severe anaemia
~ Percentage of pregnant women detected and treated with PIH
Care duringlabourand child birth ~ Percentage of safe deliveries (institutional + home deliveries
by SBA)
~ Percentage of preterm births
- Caesarean section rate
- Percentage of women with preterm labour (< 34 weeks) receiving at least one dose of
antenatal corticosteroid
~ Intra-partum stilbirth rate
Immediate newborn care ~ Percentage of newborns breast-fed within one hour of birth
- Percentage of newboms delivered at health facillty receiving vitamin K at birth
- Percentage of labour room staff trained in Naviat Shishu Suraksha Karyakram
- Percentage of newborns weighed at birth
~ Percentage of low birth weight babies
Care of healthy newborn ~ Percentage of newboms received complete schedule of home visits under HBNC by ASHAs
- Percentage of sick newborns identified during home visitsby ASHAS
- Exclusive breast-feeding rate
Percentage of mothers stayed for 48 hrs in the facility
- Percentage of newborn received birth dose of Hepatitis B, OPY and BCG
Care of small and sick newborn - Percentage of district hospitals with functional SNCU
- Percentage of facilities with SNCUs having functional KMC units
- Percentage of female admissions is SNCU
~ Mortality rate in newborns with admission weight <1800 gm
Percentage of newborn deaths due to birth asphyxia
- Percentage of newborns with suspected sepsis receiving pre-referral dose of gentamicin by ANM
Care beyond survival - Percentage of newboms screened for birth defects (facility + community)
Percentage of newborns with any defect seen as birth
Percentage of newborns discharged from SNCU followed up il one year of age:
- Percentage of distrcts with functional Distrit Early Intervention Centre (DEIC)

NATIONAL PROGRAMME FOR PREVENTION Diabetes, Cardiovascular Diseases and Stroke was
AND CONTROL OF CANCER, DIABETES, envisaged. Later on this programme was integrated with
National Cancer Control Programme, and National
CARDIOVASCULAR DISEASES AND Programme for Prevention and Control of Cancer, Diabetes,
STROKE (NPCDCS) Cardiovascular Diseases and Stroke (NPCDCS) came into
existence. During the 11th Five Year Plan period, 100
India is experiencing a rapid health transition with large identified districts in 21 states have been covered under the
and rising burden of chronic non-communicable diseases programme (6).
(NCDs) especially cardiovascular disease, diabetes mellius, A. Diabetes, Cardiovascular Disease and Stroke
cancer, stroke, and chronic lung diseases. It is estimated that
 HEALTH PROGRAMMES IN INDIA
‘The major objectives of the programme are as follows (4) : diseases etc. to identify individuals who are at a high-risk of
Prevent and control common NCDs through behaviour developing diabetes, hypertension and CVDs warranting
and lifestyle changes. further investigation/action. Detailed investigation will be
Provide early diagnosis and management of common done in respect of persons those who are at high-risk of
CDs developing NCDs on screening and those who are referred
from CHCs. They shall provide regular management and
- Build capacity at various levels of health care for annual assessment of persons suffering from cancer, diabetes
prevention, diagnosis and treatment of common NCDs. and hypertension. People with established cardiovascular
- Train human resource within the public health set-up diseases shall also be managed at district hospital. They shall
viz doctors, paramedics and nursing staff to cope with provide home based palliative care for chronic, debilitating
the increasing burden of NCDs, and and progressive patients. Apart from clinical services, district
- Establish and develop capacity for palliative & hospital shall be involved in promotion of healthy lifestyle
rehabilitative care.
through health education and counselling to the patients and
their attendants.
The programme is to be implemented in_ 20,000 Urban health check-up scheme for diabetes and high
sub-centres and 700 community health centres (CHCs) in blood pressure
100 districts across 21 States/UTs and the strategies include
promoting _ healthy lifestyle through massive health The scheme has the following objectives
education and mass media efforts at country level, . To sereen urban slum population for diabetes and high
opportunistic screening of persons above the age of blood pressure.
oo

30 years, establishment of Non-Communicable Disease To create database for prevalence of diabetes and high
(NCD) Clinic at Community Health Centre (CHC) and blood pressure in urban slums.
District level, development of trained manpower and To sensitize the urban slum population about healthy
strengthening of tertiary level health facilities. For long-term lifestyle.
@

sustainability of the programme, service delivery will be The blood sugar and blood pressure will be checked for
through existing public health infrastructure and systems. all 230 years and all pregnant women of all age.
The various approaches such as mass media, community
education and interpersonal communication will be used for The NCD cells at the centre, state and district will
behavioural change focusing on the following messages : implement and monitor the National Programme for
-~ Increased intake of healthy foods Prevention and Control of Cancer, Diabetes, CVD and
- Increased physical activity Stroke (NPCDCS) in various states. The national NCD cell
has been established at the centre.
- Avoidance of tobacco and alcohol B. Cancer component under NPCDCS
~ Stress management Cancer is an important public health problem in India,
Activities at Sub-Centre with nealy 10 lakh new cases occurring every vear in the
country. It is estimated that there are 2.8 million cases of
Health promotion for behaviour and lifestyle change will cancer in the country at any given point of fime. With the
be carried out by organizing various camps, interpersonal objectives of prevention, early diagnosis and treatment, the
communications, posters, banners, etc. Opportunistic national cancer control programme was launched in
screening of population above 30 years will be carried out 1975-76. In view of the magnitude of the problem and gaps
using BP measurement and blood glucose by strip method in the availability of cancer treatment facilities across the
The suspected cases of diabetes and hypertension will be country, the programme was revised in 1984-85 and
referred to CHCs of higher health facility for further subsequently in December 2004. During 2010, the
diagnosis and management. For screening of diabetes, programme was_integrated with National Programme on
glucometer optium xceed, optium test strips and auto Prevention and Control of Diabetes, Cardiovascular Disease
disabled lancets are being procured at central level and and Stroke. The objectives of the programme are :
provided fo the concerned states as per their requirements a. Primary prevention of cancers by health education;
from time to fime.
b. Secondary prevention ie. early detection and
Activities at CHC diagnosis of common cancer such as cancer of cervix,
NCD clinic at CHC shall do the diagnosis by required mouth, breast and tobacco related cancer by
investigations/test like blood sugar measurement, lipid screening/self examination method; and
profile, ultrasound, X-ray and ECG etc., management and c. Tertiary prevention i.e. strengthening of the existing
stabilization of common CVD, diabetes and stroke cases institutions. of comprehensive therapy including
(out- patient as well as in-patients). One of the nurses palliative care.
appointed under the programme shall undertake home visits The schemes under the revised programme are :
for bedridden cases, supervise the work of health workers
and attend monthly clinics being held in the villages on a 1. Regional Cancer Centre Scheme
random basis. Complicated cases of diabetes, high blood The existing regional cancer centres are being further
pressuré etc. shall be referred from CHC to the district strengthened to act as referral centres for complicated and
 NPCDCS
2. Oncology Wing Development Scheme TOBACCO CONTROL LEGISLATION (49)
This scheme had been initiated to fill up the geographic A comprehensive tobacco control legislationtitled “The
gaps in the availability of cancer treatment facilities in the Cigarettes and other Tobacco Products (Prohibition of
country. Central assistance is provided for purchase of Advertisement and Regulation of Trade and Commerce,
equipment, which include a cobalt unit besides other Production, Supply and Distribution) Act, 2003” was passed
equipment. A part of the grant can be used for the civil work by the parliament in April, 2003 and notified in Gazette of
but the manpower is to be provided by the concerned state India on 25th Feb, 2004. The important provisons of the Act
government/institution. The quantum of central assistance is are
Rs. 3 crores per institution under the scherne. a. Prohibition of smoking in public places;
3. Decentralized NGO scheme b. Prohibition of direct and indirect advertisement of
This scheme is meant for IEC activities and early cigarette and other products;
detection of cancer. The scheme is operated by the nodal <. Prohibition of sale of cigarette and other tobacco
agencies and the NGOs are given financial assistance for products to a person below the age of 18 years,
undextaking health education and early detection activities d. Prohibition of sale of tobacco products near the
of cancer. educational institutions;
4. IEC activities at central level e. Mandatory depiction of statutory warnings (including
IEC activities at the central level are to be initiated in pictorial warnings) on tobacco packs; and
order to give wider publicity about the Anti Tobacco f. Mandatory depiction of tar and nicotine contents
Legislation for discouraging consumption of cigarettes and alongwith maximum permissible limits on tobacco
other tobacco related products, and for creating awareness packs
among masses about the ill effects of consumption of The rules related to prohibition of smoking in public
tobacco and tobacco related products. Under this scheme places came into force from the 2nd October, 2008. As per
wider publicity would also be given about the rules being rules, it is mandatory to display smoke free signages at all
formulated for implementation of various provisions of the public places. Labelling and packaging rules mandaing the
anti-tobacco legislation. November 7th is observed as depiction of specified health warnings on all tobacco
National Cancer Awareness Day in the country. product packs came into force from 31+ May, 2009.
5. Research and training National Tobacco Control Programme (3) - In order
to facilitate the implementation of the Tobacco Control
Training programmes, monitoring and research activities Laws, to bring about greater awareness about the harmful
will be organized at the central level under this scheme. effects of tobacco, and to fulfill the obligations under the
Following training manuals have been developed under the WHO-Framework convention on tobacco control, Govt. of
NCCP for capacity building in cancer control at district India has launched a new National Tobacco Control
level - Programme in the 11th Five Year Plan. Pilot phase was
a. Manual for health professionals launched in 16 districts covering 9 states in 2007-08. It now
b. Manual for cytology covers 42 districts in 21 states in the country. The main
<. Manual for palliative care components of the programme are
d. Manual for tobacco cessation 1. Public awareness/mass media campaigns for awareness
Cancer services under national programme for prevention building and for behavioural change;
and control of cancer, diabetes, CVD and stroke (6) : 2. Establishment of tobacco product testing laboratories, to
build regulatory capacity, as required under COTPA,
1. Common diagnostic services, basic surgery,
chemotherapy and palliative care for cancer cases is 3. Mainstreaming the programme components as a part of
being made available at 100 district hospitals. the health delivery mechanism under the NRHM
2. Each district is being supported with Rs. 1.6 crores per framework;
annum for the following.
- Chemotherapy drugs are provided for 100 patients at 4. Mainsiream research and training on alternate crops and
each district hospital. livelihood, with other nodal ministries;
- Day care chemotherapy facilities is being established 5. Monitoring and evaluation, including surveillance, e.g.
at 100 district hospitals. adult tobacco survey;
- Facility for laboratory investigations _including 6. Dedicated tobacco control cells for _effective
mammography is being provided at 100 district implementation and monitoring of anti~tobacco
hospitals and if not available, this can be outsourced initiatives;
at government rates. 7. Training of health and social workers, NGOs school
3. Home based palliative care is being provided for teachers etc;
chronic, debilitating and progressive cancer patients at 8. School programme; and
100 districts. 9. Provision of tobacco cessation facilities.
4. Support is being provided for contractual manpower