ASSIGNMENT ON

FAMILY WELFARE
PROGRAMME

Submitted To Submitted by
[Link] kaur Harpreet kaur
Associate Proffessor [Link] (N) 1st year
Meera Medical college (C.H.N)
(Abohar)

NATIONAL FAMILY WELFARE PROGRAM

HISTORY
 It was started in the year 1951.
 In 1977, the govt. of India redesignated the “national family planning programme” as the
“national family welfare programme”, and also changed the name of the ministry of health
and family planning to ministry of health and family welfare.
 It is a reflection of the government’s anxiety to promote family planning through the total
welfare of the family.
 It is aimed at achieving a higher end, i.e., to improve the quality of life of the people.
 India is the first country in the world that implemented the family welfare programme at
govt. level.
 Health is a part of concurrent list but centre provides 100% assistance to states for this
programme.
 Government has concentrated on this programme in various five-year plans though higher
priority was accorded to it after 4th five year plan.
 Due to bad effects of emergency and faulty propaganda, family planning suffered major
setback, during 1977- 1979.
 It was decided in national health policy 1983, that Net Reproduction Rate (NRR) should be 1
by the year 2000.
 The 7th five year plan placed more emphasis on the use of spacing methods between the
births of two children.
 Family welfare programme has been remained the important aspects of each five year plan,
national health

AIMS AND OBJECTIVES

 To promote the adoption of small family size norm, on the basis of voluntary acceptance. To
promote the use of spacing methods.
 To ensure adequate supply of contraceptives to all eligible couples within easy reach.
 To arrange for clinical and surgical services so as to achieve the set targets  Participation
of voluntary organizations/local leaders/local self government, in family welfare programme
at various levels.
 Using the means of mass communication and interpersonal communication to overcome the
social and cultural hindrances in adopting the programme or extensive use of public health
education for family planning.

GOALS
1. Family welfare programme has laid down the following long term goals to be achieved by
the year 2000 AD
2. Reduction of birth rate from 29 per 1000 (in 1992) to 21 by 2000 AD
3. Reduction of death rate from 10 (in 1992) to 9 per 1000.
4. Raising couple protection rate from 43.3 (in 1990) to 60 per cent
5. Reduction in average family size from 4.2 (in 1990) to 2.3
6. Decrease in Infant mortality rate from 79 (in 1992) to less than 60 per 1000 live births.
Reduction of Net Reproduction Rate from 1.48 (in 1981) to 1.
ROLE OF COMMUNITY HEALTH NURSE IN FAMILY WELFARE
SERVICES
 Community health nurse has a vast role to play in family welfare services.
 Survey work
 Collecting demographic facts
 Making list of homes and finding out housing location
 Collecting information about pregnant mothers, eligible couples, infants and children below
the school going

EDUCATIONAL FUNCTIONS AND MOTIVATION

 Explaining the importance and necessity of family planning to masses.
 Using various techniques of teaching and communication to propagate the message of
family planning to common man.
 Motivating the eligible couple to use contraceptives and educating them about its uses.
Motivating people for family planning operation or permanent contraception.
MANEGERIAL FUNCTIONS
 Conducting clinics
 Deciding the date and place of clinic
 Arranging equipments and other resources at clinics
 Arrangements and distribution of contraceptives
 Insertion and removal of IUD’S.
 Organizing family planning camps
 Arranging family planning operations (sterilization male/female) through special camps.
 Making arrangements at the camps and following aseptics techniques.
 Motivating eligible couples and preparing them for the operation.
 Assisting the doctor in operation.
 Maintaining the records
 Keeping the eligible couple register update.
 Maintaining the register of sterilization cases, contraceptives users, and pregnant mothers.
 Maintaining other records related to family planning
  PROGRAMMES RELATED TO SYSTEM
STRENGTHENING WELFARE
Programmes related to system strengthening welfare

1 National Health Mission

It includes:
 National rural health mission
 National urban health mission

 NATIONAL RURAL HEALTH MISSION

It includes:
 Jannani suraksha yogana
 Jannani shishu suraksha karyakram
 RMNC+A
 NATIONAL URBAN HEALTH MISSION
Schemes under this are:
 Rashtriya bal swastya karyakram
 Rashtriya Kishore swastiya karyakram
 Mission indhura dhannush
 Ayush bharat –national health protection mission
 NATIONAL WATER SUPPLY AND SANITATION
 MINIMUM NEEDS PROGRAMME
 TWENTY POINTS PROGRAMMES

NATIONAL HEALTH MISSION:

HISTORY
The National Rural Health Mission (NRHM), now under National Health Mission is an
initiative undertaken by the government of India to address the health needs of under-served
rural areas. Launched on 12th April 2005 by Indian Prime Minister Manmohan Singh, the
NRHM was initially tasked with addressing the health needs of 18 states that had been identified
as having weak public health indicators. The Union Cabinet headed by Dr. Manmohan
Singh vide its decision dated 1 May 2013, has approved the launch of National Urban Health
Mission (NUHM) as a Sub-mission of an overarching National Health Mission (NHM), with
National Rural Health Mission (NRHM) being the other Sub-mission of National Health
Mission.

GOALS OF NHM
1. Reduce MMR to 1/1000 live births

2. Reduce IMR to 25/1000 live births

3. Reduce TFR( total fertility rate) to 2.1

4. Prevention and reduction of anaemia in women aged 15–49 years

5. Prevent and reduce mortality & morbidity from communicable, non- communicable; injuries
and emerging diseases

6. Reduce household out-of-pocket expenditure on total health care expenditure

7. Reduce annual incidence and mortality from Tuberculosis by half

8. Reduce prevalence of Leprosy to <1/10000 population and incidence to zero in all districts

9. Annual Malaria Incidence to be <1/1000

10. Less than 1 per cent microfilaria prevalence in all districts Kala-azar Elimination by 2015,
<1 case per 10000 population in all blocks.

NATIONAL RURAL HEALTH MISSION

The National Rural Health Mission (NRHM) was launched on 12th April 2005, to provide
accessible, affordable and quality health care to the rural population, especially the vulnerable
groups.
NRHM focuses on Reproductive, Maternal, Newborn, Child Health and Adolescent
(RMNCH+A) Services. The emphasis here is on strategies for improving maternal and child
health through a continuum of care and the life cycle approach. It recognises the inextricable
linkages between adolescent health, family planning, maternal health and child survival.
Moreover, the linking of community and facility-based care and strengthening referrals between
various levels of health care system to create a continuous care pathway is also to be focussed.

STRATEGIES
CORE STRATEGIES
 Train and enhance capacity of Panchayat Raj Institutions (PRIs) to own, control and manage
public health services.
 Promote access to improved healthcare at household level through the female health activist
(ASHA).
 Health Plan for each village through Village Health Committee of the Panchayat.
 Strengthening sub - centre through an untied fund to enable local planning and action and
more Multi-Purpose Workers (MPWs).
 Strengthening existing PHCs and CHCs, and provision of 30- 50 bedded
 CHC per lakh population for improved curative care to a normative standard (Indian Public
Health Standards defining personnel, equipment and management standards).
 Preparation and Implementation of an inter - sectoral District Health Plan prepared by the
District Health Mission, including drinking water, sanitation & hygiene and nutrition.
 Integrating vertical Health and Family Welfare programmes at National, State, Block, and
District levels.
 Technical Support to National, State and District Health Missions, for Public Health
Management.
 Strengthening capacities for data collection, assessment and review for evidence based
planning, monitoring and supervision.
 Formulation of transparent policies for deployment and career development of Human
Resources for health.
 Developing capacities for preventive health care at all levels for promoting healthy life
styles, reduction in consumption of tobacco and alcohol etc.
 Promoting non-profit sector particularly in under-served areas.

SUPPLEMENTARY STRATEGIES
 Regulation of Private Sector including the informal rural practitioners to ensure availability
of quality service to citizens at reasonable cost.
 Promotion of Public Private Partnerships for achieving public health goals.
 Mainstreaming AYUSH – revitalizing local health traditions.
 Reorienting medical education to support rural health issues including regulation of Medical
care and Medical Ethics.
 Effective and viable risk pooling and social health insurance to provide health security to the
poor by ensuring accessible, affordable, accountable and good quality hospital care.

NATIONAL FAMILY WELFARE PROGRAMS & SCHEMES

UNDER NRHM

ACCREDITED SOCIAL HEALTH ACTIVIST (ASHA)

Accredited Social Health Activist (ASHA) is a trained female community health activist.
Selected from the community itself and accountable to it, the ASHA will be trained to work as an
interface between the community and the public health system. At present there are over 9
Lakh ASHAs. The ASHA scheme is presently in place in 33 states (except Goa, Chandigarh &
Pondicherry).

Selection : - Every village / large habitual ( 1000 population) will have a female community
health chosen by and accountable to the panchayat to act as the interface between the community
and the public health care system.

Qualities or Requirements for ASHA: -

ASHA must be primarily a women resident of the village – married/ widow/ Divorced and
preferably in the age group of 25 year. She should be a literate woman with formal education up
to 8th class.
Training : - These ASHA’s will be trained , on a pedagogy of and public health developed
and monitored through a national experts group incorporating best practices and implementing
through active involvement of community health resource organization. Various models of
training could be used.
- Contract plus distance learning model
- NGO/ private partnership.
- ICDS training centres and state health institutes.
- Comprehensive women’s health and empowerment model.
 ASHA would act as a bridge between the ANM and the village and be accountable to be
Panchayat.
 ASHA will made the village health plan along with AWWs, community workers and
ANM under the leadership of the Panchayat Health Samiti.

Compensation to ASHA
 ASHA will be honorary volunteer. She will receive performance based incentives for
promotive construction of household toilets, universal immunization, referral and escort
services for RCH, and other health care delivery programs.

1 JANNANI SURAKSHA YOJNA

Jannani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural
Health Mission (NRHM). It is being implemented with the objective of reducing maternal and
infant mortality by promoting institutional delivery among pregnant women. The scheme is
under implementation in all states and Union Territories (UTs), with a special focus on Low
Performing States (LPS).
Janani Suraksha Yojana was launched in April 2005 by modifying the National Maternity
Benefit Scheme (NMBS). The NMBS came into effect in August 1995 as one of the components
of the National Social Assistance Programme (NSAP). The scheme was transferred from the
Ministry of Rural Development to the Department of Health & Family Welfare during the year
2001-02. The NMBS provides for financial assistance of Rs. 500/- per birth up to two live births
to the pregnant women who have attained 19 years of age and belong to the below poverty line
(BPL) households. When JSY was launched the financial assistance of Rs. 500/- , which was
available uniformly throughout the country to BPL pregnant women under NMBS, was replaced
by graded scale of assistance based on the categorization of States as well as whether beneficiary
was from rural/urban area.

Background
About 56,000 women in India die every year due to pregnancy related complications. Similarly,
every year more than 13 lakh infants die within 1year
In order to reduce the maternal and infant mortality, Reproductive and Child Health Programme
under the National Rural health Mission (NHM) is being implemented to promote institutional
deliveries so that skilled attendance at birth is available and women and new born can be saved
from pregnancy related deaths.
Several initiatives have been launched by the Ministry of Health and Family Welfare (MoHFW)
including Janani Suraksha Yojana (JSY) a key intervention that has resulted in phenomenal
growth in institutional deliveries.

Objectives :
 Reducing maternal and infant mortality by promoting institutional delivery among pregnant
women.

TARGET GROUPS AND BENEFITS

All pregnant women belonging to the Below Poverty Line (BPL) households and ST category.
The scheme also provides performance based incentives to women health volunteers known as
ASHA (Accredited Social Health Activist) for promoting institutional delivery among pregnant
women. Under this initiative, eligible pregnant women are entitled to get JSY benefit directly
into their bank accounts. Cash entitlement for different categories of mothers is as follows:

Cash Assistance for Institutional Delivery (in Rs.)

Category Rural Area Urban Area
Mother’s ASHA’s Mother’s ASHA’s package**
package package* package
LPS 1400 600 1000 400
HPS 700 600 600 400
*ASHA package of Rs. 600 in rural areas include Rs. 300 for ANC component and Rs. 300 for
facilitating institutional delivery
**ASHA package of Rs. 400 in urban areas include Rs. 200 for ANC component and Rs. 200 for
facilitating institutional delivery

Cash assistance for home delivery

BPL pregnant women, who prefer to deliver at home, are entitled to a cash assistance of Rs. 500
per delivery regardless of the age of pregnant women and number of children.

2 JANANI SHISHU SURAKSHA KARYAKARAM (JSSK)

Government of India has launched Janani Shishu Suraksha Karyakram (JSSK) on 1st June, 2011.

The scheme is estimated to benefit more than 12 million pregnant women who access
Government health facilities for their delivery. Moreover it will motivate those who still choose
to deliver at their homes to opt for institutional deliveries. . It is an initiative with a hope that
states would come forward and ensure that benefits under JSSK would reach every needy
pregnant woman coming to government institutional facility. All the States and UTs have
initiated implementation of the scheme.

The following are the Free Entitlements for pregnant women:

 Free and cashless delivery

 Free C-Section

 Free drugs and consumables

 Free diagnostics
 Free diet during stay in the health institutions

 Free provision of blood

 Exemption from user charges

 Free transport from home to health institutions

 Free transport between facilities in case of referral

 Free drop back from Institutions to home after 48hrs stay

The following are the Free Entitlements for Sick newborns till 30 days after
birth. This has now been expanded to cover sick infants:
 Free treatment

 Free drugs and consumables

 Free diagnostics

 Free provision of blood

 Exemption from user charges

 Free Transport from Home to Health Institutions

 Free Transport between facilities in case of referral

 Free drop Back from Institutions to home

 REPRODUCTIVE, MATERNAL, NEWBORN, CHILD AND

ADOLESCENT HEALTH
INTRODUCTION

RMNCH+A approach has been launches in 2013 and it essentially looks to address the major
causes of mortality among women and children as well as the delays in accessing and utilizing
health care and services. The RMNCH+A strategic approach has been developed to provide an
understanding of ‘continuum of care’ to ensure equal focus on various life stages. Priority
interventions for each thematic area have been included in this to ensure that the linkages
between them are contextualized to the same and consecutive life stage. It also introduces new
initiatives like the use of Score Card to track the performance, National Iron + Initiative to
address the issue of anaemia across all age groups and the Comprehensive Screening and Early
interventions for defects at birth , diseases and deficiencies among children and adolescents. The
RMNCH+A appropriately directs the States to focus their efforts on the most vulnerable
population and disadvantaged groups in the country. It also emphasizes on the need to reinforce
efforts in those poor performing districts that have already been identified as the high focus
districts.

Objectives:
The 12th Five Year Plan has defined the national health outcomes and the three goals that are
relevant to RMNCH+A strategic approach as follows:

Health Outcome Goals established in the 12th Five Year Plan

 Reduction of Infant Mortality Rate (IMR) to 25 per 1,000 live births by 2017

 Reduction in Maternal Mortality Ratio (MMR) to 100 per 100,000 live births by 2017

 Reduction in Total Fertility Rate (TFR) to 2.1 by 2017

COMPONENTS OF RMNCH+A
 Maternal Health.
 Child Health.
 Immunization.
 Adolescent Health (RKSK)
 Family Planning.
RCH PROGRAMME:
Promotion of maternal and child health has been one of the most important objective of the
family welfare of India. RCH approach has been defined as “people has the ability to reproduce and
regulate their fertility, women are able to go through pregnency and child birth safety., the outcome of
pregnacnies is sucessful in terms of maternal and infant survival and well-being and couples are able to
have sexual relations free of fear of pregnancy and contracting diseases”.

This concept is in keeping with the evolution of an itegrated approach to the programmes aimed at
improving the health status of the yound women and children, namely, national family welfare
programme, universal immunization programme, oral rehydration therapy . child survival and safe
motherhood (cssm) programme
RCH PROGRAMME
The RCH programme incorporated the components relating to cssm and including two additional
components, one related to sexually transmitted diseases (STD) and other related to reproductive
tract infection.(RTI).

The programme envisages the following maternal care:

a) Immunization.
b) At least three antenatal check-ups.
c) Prevention and treatment of anaemia.
d) Early detection of maternal complications.
e) Promotion of institutional deliveries.
f) Management of obstetric emergencies.
g) Birth spacing.
h) Diagnosis and treatment of RTIs and STDs.

The packages of services for children are:

a. Essential newborn care.

b. Immunization.
c. Appropriate management of diarrhoea.
d. Appropriate management of ARI.
e. Vitamin A prophylaxis.

Essential obstetric care:

Essential obstetric care intends to provide the basic maternity services to all pregnant
women through:

1. Early registration of pregnancy (within 12-16 weeks).

2. Provision of minimum three antenatal check-ups by ANM or medical officer to monitor
progress of the pregnancy, and to detect any risk/complication so that appropriate care
including referral could be taken in time.
3. Provision of safe delivery at home or in an institution.
4. Provision of three postnatal check-ups to monitor the postnatal recovery and to detect
complication.

Emergency obstetric care:

Under the RCH programme the FRUs are strengthened through supply of emergency obstetric
kit, equipment kit and provision of skilled manpower on contract basis.

24-hours delivery services at PHCs/CHCs:

To promote institutional deliveries, provision has been made to give additional honorarium to the
staff to encourage round the clock delivery facilities at health centres.

Control of reproductive tract infection (RTI) and sexually transmitted disease (STD).

Under the RCH programme, the component of RTI/STD control is linked to HIV and AIDS
Control. It has been planned and implemented in close collaboration with National AIDs control
organization (NACO). NACO provides assistance for setting up RTI/STD clinics upto the
district level. The assistance from the central government is in the form of training of the
manpower and drug kits including disposable equipment. Each district will be assisted by two
laboratory technicians on contract basis to test blood; urine and RTI/STD tests.

Immunization:
The universal immunization programme (uip) became a part of cssm programme in 1992 and
RCH programme in1997. It will continue to provide vaccines for polio, tetanus, DPT, DT,
measles and tuberculosis. The cold chain establish so far will be maintained and additional items
will be provide to new health facilities.

Essential newborn care:

The primary goal of essential newborn care is to reduce perinatal and neonatal mortality. The
main components are resuscitation of infection, exclusive breast feeding and referral of sick
newborn. The strategies are to train medical and other health personnel in essential newborn
care, provide basic facilities for care of the low birth weight and sick newborn in FRU and
district hospitals etc.

Diarrhoeal disease control:

In the districts not implementing integrated management of neonatal and childhood illness, the
vertical programme for control of diarrhoeal disease will continue. India is the first country in the
world to introduce the low osmolarity oral rehydration solution. Zinc is to be used as an adjunct
to ORS for the management of diarrhoea. Addition of zinc would result in reduction of the
number and severity of episodes, and the duration of diarrhoea. De-worming guidelines have
been formulated. The incidence of diarrhoea is reduced by provision of safe drinking water.

Acute respiratory disease control:

The standard case management of ARI and prevention of death due to pneumonia is now an
integral part of RCH programme. Peripheral health workers are being trained to recognize and
treat pneumonia. Cotrimoxazole is being supplied to the health workers through the cssm drug
kit.

Prevention and control of vitamin A deficiency in children:

It is estimated that a large number of children suffer from sub-clinical deficiency of vitamin A.
Under the programme, doses of vitamin A are given to all children up to 5 years of age. The first
dose (1 lac units) is given at nine months of age along with measles vaccination. The second
dose (2 lac units) is given 9 months later and subsequent doses (2 lac units per dose) are given at
six months intervals.

Prevention and control of anaemia in children:

Iron deficiency anaemia is widely prevalent in young children. To manage anaemia, the policy
has been revised. Infants from the age of 6 months onwards up to the age of 5 years are to
receive iron supplements in liquid formulation in doses of 20mg elemental iron and 100mcg folic
acid per day for 100 days in a year. Children 6 to 10 years of age will receive iron in the dose of
30 mg elemental iron and 250 mcg folic acid for 100 days in a year. Children above this age
group would receive iron supplement in the adult dose.

RCH camps:
In order to make the services of specialists like gynaecologists and paediatricians available to
people living in remote areas, a scheme of holding camps has been initiated in 102 districts
covering 17 states from January, 2001. Camps are being organized in Haryana, Madhya Pradesh,
Rajasthan, Arunachal Pradesh, Uttar Pradesh and Meghalaya.

RCH out-reach scheme:

During 2000-2001, an RCH out-reach scheme was initiated to strengthen the delivery of
immunization and other maternal and child health services in remote and comparatively weaker
districts and urban slums in uttarpardesh, Madhya Pardesh, Rajasthan, Bihar, Assam, Orissa,
Gujarat, and West Bengal.

Introduction of hepatitis b vaccination:

Introduction of hepatitis b vaccine in the national immunization programme has been approved
by the government. Under this project hepatitis b vaccine will be administered to infants along
with the primary doses of DPT vaccine.

Training of dais:
A scheme for training of dais was initiated during 2001-02. The scheme is being implemented in
156 districts in 18 states /UTs of the country. The districts have been selected on the basis of the
safe delivery rates being less than 30 per cent. The scheme was extended to all the districts of
EAG states. The aim was to train at least one dai in every village, with the objective of making
delivery safe.
RCH-Phase Ⅱ:
RCH –phase Ⅱ began from 1st April, 2005. The focus of the programme is to reduce maternal
with emphasis on rural health care.

The major strategies under the second phase of RCH are:

 Essential obstetric care

a. Institutional delivery.
b. Skilled attendance at delivery.

 Emergency obstetric care

a. Operationalizing first referral units
b. Operationalizing PHCs and CHCs for round the clock delivery services.
 Strengthening referral system
a. Under RCH-Ⅱ, more flexibility has been given to the states for planning their own
interventions for achieving the goals. Accordingly, the states have prepared their project
implementation plan with indicators for achieving the desired milestones.

The government of India has given some board guidelines and strategies for achieving
the reduction in maternal mortality rate and infant mortality rate. The initiatives which
have been planned are:

Essential obstetric care:

a) Institutional delivery- To promote institutional deliveries in RCH phase Ⅱ, it is envisaged
that fifty percent of the PHCs and all the CHCs be made operational as 24-hours delivery
centres, in a phased manner, by the year 2010. These centres would be responsible for
providing basic emergency obstetric care and basic newborn resuscitation services round
the clock.
b) Skilled attendance delivery – It is now recognized globally that the countries which have
been successful in bringing down maternal mortality are the ones where the provision of
skilled attendance at every birth and its linkage with appropriate referral services for
complicated cases have been ensured. Guidelines for normal delivery and management of
obstetric complications at PHC/CHC for medical officers and for ANC and skilled
attendance at birth for ANM/LHVs have been formulated and disseminated to the states.
c) The policy decisions: ANMs/LHVs/SNs have now been permitted to use drugs in specific
emergency situations to reduce maternal mortality. They have also been permitted to
carry out certain emergency interventions when the life of the mother is at stake.

Emergency obstetric care:

 Operationalization of FRUs and skilled attendance at birth are the two activities which go
hand in hand. In view of this, simultaneous steps have been taken to ensure tackling obstetric
emergencies. It has been decided that all the first referral units be made operational for
providing emergency and essential obstetric care during the second phase of RCH. The
minimum services to be provided by a fully functional FRU are:

1. 24 hour delivery services including normal and assisted deliveries.

2. Emergency obstetric care including surgical intervention like caesarean sections.
3. New-born care.
4. Emergency care of sick children.
5. Full range of family planning services including laparoscopic services.
6. Safe abortion services.
7. Treatment of STI/RTI.
8. Blood storage facility.
9. Essential laboratory services , and
10. Referral (transport) services.

New initiatives:
1. Training of MBBS doctors in life saving anaesthetic skills for emergency obstetric care.
2. Setting up of blood storage centres at FRUs according to government of India guidelines.

NATIONAL URBAN HEALTH MISSION:

NUHM seeks to improve the health status of the urban population particularly slum dwellers and
other vulnerable sections by facilitating their access to quality primary health care. NUHM
would cover all state capitals, district headquarters and other cities/towns with a population of
50,000 and above (as per census 2011) in a phased manner. Cities and towns with population
below 50,000 will be covered under NRHM.

Goals
 Need based city specific urban health care system to meet the diverse health care needs of
the urban poor and other vulnerable sections.
 Institutional mechanism and management systems to meet the health-related challenges of a
rapidly growing urban population.
 Partnership with community and local bodies for a more proactive involvement in planning,
implementation, and monitoring of health activities.
 Availability of resources for providing essential primary health care to urban poor.
 Partnerships with NGOs, for profit and not for profit health service providers and other
stakeholders.

Nuhm Covers
NUHM would cover all State capitals, district headquarters and cities/towns with a population of
more than 50000. It would primarily focus on slum dwellers and other marginalized groups like
rickshaw pullers, street vendors, railway and bus station coolies, homeless people, street
children, construction site workers.

Funding Pattern
The centre-state funding pattern will be 75:25 for all the States except North-Eastern states
including Sikkim and other special category states of Jammu & Kashmir, Himachal Pradesh and
Uttrakhand , for whom the centre-state funding pattern will be 90:[Link] Programme
Implementation Plans (PIPs) sent by the by the states are apprised and approved by the Ministry.

SCHEMES UNDER NUHM

1RASHTRIYA BAL SWASTHYA KARYAKRAM (RBSK)

Rashtriya Bal Swasthya Karyakram (RBSK) is a new initiative aiming at early identification
and early intervention for children from birth to 18 years to cover4‘Ds:
Defect birth , Deficiencies, Diseases, Development delays including disability.
This health program was launched in 2013
Target Age Group
The services aim to cover children of 0-6 years of age in rural areas and urban slums in
addition to children enrolled in classes I to XII in Government and Government aided
Schools. It is expected that these services will reach to about 27 corers children in a phased
manner.
MechanismOf Screening At Community And Facility Level
 Screening at Anganwadi level
 Screening at school level- government and government aided
 Composition of mobile health team

2RASHTRIYA KISHOR SWASTHYA KARYAKRAM (RKSK)

The Ministry of Health & Family Welfare has launched a health programme for adolescents, in
the age group of 10-19 years, which would target their nutrition, reproductive health and
substance abuse, among other issues.
The Rashtriya Kishore Swasthya Karyakram was launched on 7th January, 2014. The key
principle of this programme is adolescent participation and leadership, Equity and inclusion,
Gender Equity and strategic partnerships with other sectors and stakeholders. The programme
envisions enabling all adolescents in India to realize their full potential by making informed and
responsible decisions related to their health and well-being and by accessing the services and
support they need to do [Link] realigns the existing clinic-based curative approach to focus on a
more holistic model based on a continuum of care for adolescent health and developmental
needs.
The Rashtriya Kishore Swasthya Karyakram (National Adolescent Health Programme), will
comprehensively address the health needs of the 243 million adolescents. It introduces
community-based interventions through peer educators, and is underpinned by collaborations
with other ministries and state governments.

OBJECTIVES:
1. Improve nutrition
Reduce the prevalence of malnutrition among adolescent girls and boys
Reduce the prevalence of iron-deficiency anaemia (IDA) among adolescent girls and boys
2. Improve sexual and reproductive health
Improve knowledge, attitudes and behaviour, in relation to SRH
Reduce teenage pregnancies Improve birth preparedness, complication readiness and provide
early parenting support for adolescent parents
3. Enhance mental health
Address mental health concerns of adolescents
4. Prevent injuries and violence
Promote favourable attitudes for preventing injuries and violence (including GBV) among
adolescents
5. Prevent substance misuse
Increase adolescents’ awareness of the adverse effects and consequences of substance misuse
6. Address NCDs
Promote behaviour change in adolescents to prevent NCDs such as hypertension, stroke, cardio-
vascular diseases and diabetes

Target Groups
The new adolescent health (AH) strategy focuses on age groups 10-14 years and 15-19 years
with universal coverage, i.e. males and females; urban and rural; in school and out of school;
married and unmarried; and vulnerable and under-served.

STRATEGIES
Strategies/interventions to achieve objectives can be broadly grouped as:
 Community based interventions
 Peer Education (PE)
 Quarterly Adolescent Health Day (AHD)
 Weekly Iron and Folic Acid Supplementation Programme (WIFS)
 Menstrual Hygiene Scheme (MHS)
 Facility based interventions
Strengthening of Adolescent Friendly Health Clinics (AFHC)
 Within Health & Family Welfare - FP, MH (incl VHND), RBSK, NACP, National
Tobacco Control Programme, National Mental Health Programme, NCDs and IEC
 Social and Behaviour Change Communication with focus on Inter Personal
Communication

3 MISSION INDHRADHANUSH

Mission Indradhanush was launched by the Ministry of Health and Family Welfare, Government
of India on December 25, 2014. Between 2009-2013 immunization coverage has increased from
61% to 65%, indicating only 1% increase in coverage every year. To accelerate the process of
immunization by covering 5% and more children every year, Indradhanush mission has been
adopted to achieve target of full coverage by 2020.

Objectives
The Mission Indradhanush aims to cover all those children by 2020 who are either unvaccinated,
or are partially vaccinated against vaccine preventable diseases. India’s Universal Immunisation
Programme (UIP) provide free vaccines against 12 life threatening diseases, to 26 million
children annually. The Universal Immunization Programme provides life-saving vaccines to all
children across the country free of cost to protect them against Tuberculosis, Diphtheria,
Pertussis, Tetanus, Polio, Hepatitis B, Pneumonia and Meningitis due to Haemophilus Influenza
type b (Hib), Measles, Rubella, Japanese Encephalitis (JE) and Rotavirus diarrhoea. (Rubella, JE
and Rotavirus vaccine in select states and districts).

Areas Under Focus

The following areas are targeted through special immunization campaigns:
1. High risk areas identified by the polio eradication programme.
These include populations living in areas such as:
 Urban slums with migration
 Nomads
 Brick kilns
 Construction sites
 Other migrants (fisherman villages, riverine areas with shifting populations etc.) and
 Underserved and hard to reach populations (forested and tribal populations etc.)
2. Areas with low routine immunization (RI) coverage (pockets with Measles/vaccine
preventable disease (VPD) outbreaks).
3. Areas with vacant sub-centre’s: No ANM posted for more than three months.
4. Areas with missed Routine Immunisation (RI) sessions: ANMs on long leave and similar
reasons
5. Small villages, hamlets, dhanis or purbas clubbed with another village for RI sessions and not
having independent RI sessions.

Strategies
a) Meticulous planning of campaigns/sessions at all levels: Ensure revision of micro plans in
all blocks and urban areas in each district to ensure availability of sufficient vaccinators and
all vaccines during routine immunization sessions. Develop special plans to reach the
unreached children in more than 400,000 high risk areas.
b) Effective communication and social mobilization efforts: Generate awareness and
demand for immunization services through need-based communication strategies and social
mobilization activities to enhance participation of the community in the routine
immunization programme through mass media, mid media, interpersonal communication
(IPC), school and youth networks and corporates.
c) Intensive training of the health officials and frontline workers: Build the capacity of
health officials and workers in routine immunization activities for quality immunization
services.
d) Establish accountability framework through task forces: Enhance involvement and
accountability/ownership of the district administrative and health machinery by
strengthening the district task forces for immunization in all districts of India

4 AYUSHMAN BHARAT–NATIONAL HEALTH PROTECTION MISSION

Ayushman Bharat - is a new Centrally Sponsored Scheme having central sector component
under Ayushman Bharat Mission anchored in the Ministry of Health and Family Welfare
(MoHFW).AB-NHPM will be rolled out across all States/UTs in all districts with an objective to
cover all the targeted beneficiaries. In March, 2018, Union Cabinet chaired by Prime Minister
Narendra Modi has approved launch of Ayushman Bharat-National Health Protection Mission
(AB-NHPM). The scheme will integrate two on-going centrally sponsored schemes viz.
Rashtriya Swasthya Bima Yojana (RSBY) and Senior Citizen Health Insurance Scheme
(SCHIS).

Services to be provided at Health & Wellness Centre

 Pregnancy care and maternal health services
 Neonatal and infant health services
 Child health
 Chronic communicable diseases
 Non-communicable diseases
 Management of mental illness
 Dental care
 Eye care
 Geriatric care Emergency medicine

Policy of (AB-NHPM)
 AB-NHPM will have a defined benefit cover of Rs. 5 lakh per family per year. This cover
will take care of almost all secondary care and most of tertiary care procedures.
 Benefits of the scheme are portable across the country and a beneficiary covered under the
scheme will be allowed to take cashless benefits from any public/private empanelled
hospitals across the country.
 The beneficiaries can avail benefits in both public and empanelled private facilities. All
public hospitals in the States implementing AB-NHPM, will be deemed empanelled for the
Scheme.
 One of the core principles of AB-NHPM is to co-operative federalism and flexibility to
states.
 To ensure that the funds reach SHA on time, the transfer of funds from Central Government
through AB-NHPMA to State Health Agencies may be done through an escrow account
directly.
 In partnership with NITI Aayog, a robust, modular, scalable and interoperable IT platform
will be made operational which will entail a paperless, cashless transaction. This will also
help in prevention / detection of any potential misuse / fraud / abuse cases.

 NATIONAL WATER SUPPLY AND SANITATION

PROGRAMME
The National Water Supply and Sanitation Programme was initiated in 1954 with the object of
providing safe water supply and adequate drainage facilities for the entire urban and rural
population of the country.
In 1972 a special programme known as the Accelerated Rural Water Supply Programme was
started as a supplement to the national water supply and sanitation programme .During the fifth
plan ,rural water supply was included in the minimum needs programme of the state plans
The Govt of India launched the International drinking water and sanitation decde programme in
[Link] were sets on coverage
 100 percent coverage for water both urban and rural ,80 percent for urban sanitation and 25
percent for rural sanitation
RURAL SANITATION PROGRAMME
Under this programme the following activities were considered
 Demand driven low cost sanitation approach
 Involvement of private bodies ,NGOS to provide sanitation facilities
 Improving sanitation in rural areas through IEC programmes and introducing the concept of
total environment sanitation
 Converting all existing dry latrines to low cost sanitary latrines
URBAN SANITATION PROGRAMME
 Providing reasonable level of sanitation facility to a large population
 Total elimination of dry latrines and manual scavenging
 Involvement of NGOs ,private sector and community
 Converting all existing dry latrines to low cost sanitary latrines
 MINIMUM NEEDS PROGRAMMES
The Minimum Needs Programme was introduced in the country in the first year of the fifth five
year plan (1974-78)

OBJECTIVES:
 Provide certain basic minimum needs and thereby improving the living standards of the
people

COMPONENTS:
Rural health
Rural water supply
Rural electrification
Adult education
Nutrition
Environment improvement of urban slums
Houses for landless labourers

TWENTY POINT PROGRAMME

The 20 point programme was launched by the government of India in [Link] programme was
its revised in 1982 and again in 1986.
The programmes are
1. Garibi hatao(poverty eradication)
2. Jan Shakti (power to people)
3. Kisan mtra (support to farmers)
4. Sharmik kalayan(labour welfare)
5. Khadya suraksha (food security)

6. Subke liye awas (housing for all )

7. Shudh piya jel (clean drinking water)
8. Jan Jan ka sqasthya (health for all)
9. Sab k liye shiksha (education for all )
10. Anusuchit jaat, jan jati, alp-sankhyakevam anya pichhre varg kalian (welfare of schedule
casts , schedules tribes ,minorities and OBCs)
11. Mahyla kalyan (women welfare )
12. Bal kalyan (child welfare)
13. Yuva vikas (youth development)
14. Paryavaran sanraksham evem van vridhi(environment protection and afforestation)
15. Basti sudhar(improvement of slums)
16. Samajakh suraksha (social security)
17. Grameen sadak (rural roads )
18. Grameen oorja (energization of rural areas )
19. Picchare kshetra ka vikas (development of backward areas )
20. E-shasan(IT enabled e Goverence )
 Research input
Has India's national rural health mission reduced inequities in maternal health services? A
pre-post repeated cross-sectional study.
Vellakkal S, Gupta A, Khan Z, Stuckler D, Reeves A, Ebrahim S, Bowling A, Doyle P.

ABSTRACT

The objective of the study is to evaluated the impacts of NRHM on socioeconomic inequities in
the uptake of institutional delivery and antenatal care (ANC) across high-focus (deprived) Indian
[Link] collected from District Level Household and Facility Surveys (DLHS) Rounds 1
(1995-99) and 2 (2000-04) from the pre-NRHM period, and Round 3 (2007-08), Round 4 and
Annual Health Survey (2011-12) from post-NRHM period were used. Inequities in institutional
delivery declined between pre-NRHM Period 1 (1995-99) and pre-NRHM Period 2 (2000-04),
but thereafter demonstrated steeper decline in post-NRHM [Link] of institutional
delivery increased among all socioeconomic groups with education. No positive impact on the
uptake of ANC was found in the early post-NRHM period 2007-08. researcher conclude In high-
focus states, NRHM resulted in increased uptake of maternal healthcare, and decline in its
socioeconomic inequity. The study suggests that public health programs in developing country
settings will have larger equity impacts after its almost full implementation and widest outreach.
SUMMARY: Today we have discussed seminar topic on national
welfare programme. It includes
 NATIONAL FAMILY WELFARE PROGRAM
History
Aims and objectives
Goals
Role of community health nursing in family welfare programme
Educational functions and managerial functions
 Programmes related to system strengthening welfare
1 National Health Mission
It includes:
 National rural health mission
 National urban health mission

 NATIONAL RURAL HEALTH MISSION

It includes :
 Jannani suraksha yogana
 Jannani shishu suraksha karyakram
 RMNC+A
 RCH
 NATIONAL URBAN HEALTH MISSION
Schemes under this are:
 Rashtriya bal swastya karyakram
 Rashtriya Kishore swastiya karyakram
 Mission indhura dhannush
 Ayush bharat –national health protection mission
 NATIONAL WATER SUPPLY AND SANITATION
 MINIMUM NEEDS PROGRAMME
 TWENTY POINTS PROGRAMMES
 BIBLIOGRAPHY:

1. [Link], “Textbook of preventive and social medicine”, 21 st edition,

Banarsidas Bhanot Publishers, Page no.478-479

2. [Link], “Essentials of Community Health Nursing”, Sixth edition,

Banarsidas Bhanot Publishers, Page no.344-357

3. Neelam Kumari, A Text Book of community Health Nursing- п , 3rd edition,

[Link] Medical Publishers, Page no.273-276

4. K.K Gulani,” Community Health Nursing principles and practices”,1 st

edition, Kumar Publishers, Page no.419-420

5. ASHA accessed from www. Google . com and [Link]

6. Department of F.W govt of India accessed from www. [Link].
7. NRHM accessed from [Link].