NACO

The National AIDS Control Organization, Ministry of Health & Family Welfare has launched the National AIDS Control Programme - II, from December, 1999. It is also leading to growing
partnerships between government, NGOs and civil society. National AIDS Control Programme - II has two key objectives namely : 1. To reduce spread of HIV infection in India; and 2. Strengthen India's capacity to respond to HIV/AIDS on a long term basis. AIDS - II project of the National AIDS Control Programme will be across all States and Union Territories and a Centrally Sponsored Scheme with 100% financial assistance from Government of India direct to State AIDS Control Societies and selected Municipal Corporations/AIDS Control Societies. The funding of NGOs (except for setting up of Community Care Centres) has been completely decentralized to the State AIDS Control Societies. These schemes are : 1) Targetted Interventions 2) School AIDS Education 3) Community Care & Support 4) National AIDS Helpline and Telecounselling

Targetted Interventions
These programmes are focused to each specific target group and bring about a change in high-risk behaviour through behaviour change communication, STD services, Condom Promotion, and creation of an enabling environment.

Community Care And Support Centres's for People living with HIV/AIDS (PLWHA):
These centres provide shelter, nutritional, nursing care, recreational facilities, spiritual discourses, referral services and relevant training of families and community based organisations in care of HIV/AIDS patients. They meet specific needs of People Living with HIV/AIDS such as treatment of opportunistic infections, psycho-social support and outreach services to sensitize and trains family members to look after people living with HIV/AIDS. They also provide referral services and have linkages with other welfare organizations. These centres sometimes also take care of the last rites of those who die of AIDS.

School AIDS Education:

Young people are among the most vulnerable to the HIV infection. Students are being reached through both the curricular and non-curricular initiatives. A comprehensive training package for adolescents' education that lays emphasis on training of teachers and peer educators has been developed. The scheme is being taking up in classes IX and XI.

National AIDS Helpline and Telecounseling

Telephone counseling has proved to be one of the most effective strategies in raising awareness levels among people, dispelling myths and ignorance, and helping to create a supportive environment for access to services. Telephone counseling is specially popular in countries such as India where conservative social norms do not allow for open discussion on issues of sex and sexuality. Trained NGOs are being actively involved in providing the counselling services in this project. These projects are being funded by the State AIDS Control Societies. 1

NATIONAL LEPROSY ERADICATION PROGRAMME

Leprosy is the oldest disease known to mankind. The first evidence of a leprosy like disease was recorded in Egypt in 1400 BC. There is a clear description of leprosy in the Susrutha Samhita of the 6th Century BC. It is neither hereditary nor contagious. Leprosy is the least infectious of all the communicable diseases. Like tuberculosis to which the disease is related, droplets in the air spread leprosy germs. 95% people are naturally immune to the leprosy germ. Early treatment of symptoms - like desensitized skin patches - prevents any deformity and patients can resume a totally normal life. Ninety percent of world leprosy is now confined to 11 countries. However, India has a sizable number of the world's recorded leprosy patients. With leprosy elimination defined as less than 1 per 10,000, these five States recorded the following prevalence rates by March 2000 : 1. Bihar - 15.20 2. Orissa - 11.46 3. West Bengal - 5.44 4. Uttar Pradesh - 6.02 5. Madhya Pradesh - 4.60 Since the early 1980s MDT (Multi Drug Therapy) has revolutionized the treatment of leprosy. It is a combination of the drugs Rifampicin, Clofazimine, and Diapason and is a virtually guaranteed cure. Laboratory evidence indicates that a single does of MDT kills 99.9% of leprosy germs. MDT is now available free of charge at al Primary Health Centres. The cost will be borne by the pharmaceutical company Novartis.

VECTOR BORNE DISEASES

MALARIA Malaria is one of the major public health problems. The disease is distributed in all parts of India, except areas lying above 1800 meters altitude. Two species of the malaria causing parasite are found in India, namely P. vivax and P. falciparum. The latter parasite may lead in some proportion of cases to a disease condition, called cerebral malaria. P. Falciparum is dominant in the North-east India and tribal predominant areas of peninsular states. An organized programme for control of malaria in the country has been in operation since 1953, as a cent percent centrally sponsored scheme till 1979, and as a category-II centrally sponsored scheme (with 50:50 cost sharing with states) thereafter. This programme in now termed as the National Anti Malaria Programme (NAMP). North Eastern states are covered under 100 percent Central assistance w.e.f. December 1994. An Enchanced Malaria Control Project (EMCP) is in operation with assistance from the World bank in 100 hard core tribal districts of the seven peninsular states viz. Andhra Pradesh, Bihar, Gujarat, Madhya Predesh, Maharashtra, Orissa and Rajasthan. Malaria control strategy: 1) early case detection and prompt treatment, 2) Selective vector control, 3) promotion of personal protection methods, 4) early detection and containment of epidemics, 5) IEC (Information Education and communication) and 6) Management capacity building 2

FILARIA Filaria Clinics functioning in urban areas under the National Filaria Control Programme (NFCP). The measures taken for control of filaria are anti larval measures at weekly intervals, environmental methods of controlling mosquito breeding, biological control through larvivorous fish and anti parasitic measures through detection and treatment of microfilaria carriers. Thirteen districts in 7 states of the country namely Andhra Pradesh, Bihar, Uttar Pradesh, Kerala, Tamil Nadu, Orissa, and West Bengal have been brought under the ambit of single dose mass administration of DEC since 1997, in accordance with the global plan for elimination of filariasis.

KALA-AZAR Kala-azar is a visceral disease caused by the protozoan parasite Leishmania donovani and transmitted by the Phlebotomus argentipes and is prevalent in the states of Bihar, West Bengal and eastern Uttar Pradesh. Kala-azar control strategy envisages free treatment with Sodium Stibo Gluconate (SSG) and treatment of unresponsive cases with Pentamidine isethionate. DDT spraying is undertaken in the Kalaazar affected villages, to interrupt Kala-azar transmission. DENGUE Dengue fever is a disease transmitted by the bite of the Aedes aegypti mosquito. The Dengue situation in the country is regularly monitored by the NAMP. Symptomatic treatment of Dengue/ DHF cases, vector surveillance and control and health education are important components of dengue control in India.

NATIONAL TB CONTROL PROGRAMME

Tuberculosis (TB) is an infectious disease caused by a bacterium, Mycobacterium tuberculosis. It is spread through the air by a person suffering from TB. A single patient can infect 10 or more people in a year. India contributes about 1/3rd of the global burden of tuberculosis. Around 1.2 million TB cases are detected every year. National Tuberculosis Control Programme (NTCP) has been under implementation since 1962 on a 50:50 sharing basis between Center and State. The objective of the programme is to detect as many cases as possible and effectively treat them so as to render infectious cases as non-infectious. Since its inception the programme is integrated with the primary health care infrastructure in the states. Government of India evolved Program based on Directly Observed Treatment Short course (DOTS) strategy with the objective of curing at least 85% of new sputum positive patients and detecting at least 70% of such patients. Under the DOTS Strategy, patients swallow the drugs under direct observation of the health worker viz the DOT provider. Any responsible person of the locality/community except a family member can function as DOTS provider. In case the patient drops out/fails to attend the health facility in the scheduled day, then it is the responsibility of the DOT provider to retrieve the patient to the system and ensure completion of the treatment regimen. This facility ensures uninterrupted supply of medicines to any patient. The District TB Societies are headed by the District Collectors while the state level society is headed by the State Health Secretary. An individual, suffering from AIDS, has 10 times increased risk of developing TB disease. Around 60% of the AIDS cases reported in India have evidence of active TB. 3

NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS

National Programme for Control of Blindness was launched in the year 1976 as a 100% centrally sponsored programme with a goal to reduce the prevalence of blindness from 1.4% to 0.3%. The implementation of the programme is undertaken by District Blindness Control Societies under the chairmanship of the District Collector.

NATIONAL CANCER CONTROL PROGRAMME

Setting up of oncology wings in medical colleges. Seeting up cobalt therapy unit under the guidance of BARC.

NATIONAL IODINE DEFICIENCYDISORDERS CONTROL PROGRAMME

National Iodine Deficiency Disorders control programme aims at bringing down the prevalence of Iodine Deficiency Disorders (IDD) to below 10 percent in all the districts of the country. Iodine is an essential micronutrient. The required intake of 100-150 micrograms daily is essential for normal human growth and development. Iodine deficiency results in abortion, still birth, mental retardation, deaf-mutism, squint, dwarfism, goitre, neuromotor defects etc. The Government had launched a 100 percent centrally assisted National Goitre Control Programme (NGCP) in 1962 with the following objectives:(i) Surveys to assess the magnitude of the Iodine Deficiency Disorders. (ii) Supply of iodated salt in place of common salt. (iii) Resurveys to assess iodine deficiency disorders and the impact of iodated salt after every 5 years. (iv) Laboratory monitoring of iodated salt and urinary iodine excretion. (v) Health Education & Publicity. National Goitre control programme (NGCP) was renamed as National Iodine Deficiency Disorders Control Programme (NIDCCP).

PROGRAMME FOR COMMUNICABLE DISEASES

Ministry of Health and Family Welfare has launched the National Surveillance Programme for Communicable Diseases for detection of early warning signals of outbreaks and rapid response for prevention and control of these outbreaks and diseases.

NATIONAL MENTAL HEALTH PROGRAMME

To mitigate the hardship of mentally ill patients the National Mental Health Programme was started in 1982. The District Mental Health Programme was launched in 1996-97 in four districts, one each in Andhra Pradesh, Assam, Rajasthan and Tamil Nadu. Components are training, awareness, treatment and data collection.

DRUG DE-ADDICTION PROGRAMME

The Ministry of Health & Family Welfare is mainly involved in providing treatment services to the addicts whereas the Ministry of Social Justice & Empowerment deals with other aspects of the problem like awareness creation, counselling and rehabilitation. The Drug De-addiction Programme was started in 1987-88 with the establishment of 5 De-addiction Centres in central Institutions viz. AIIMS, New Delhi; Dr. RML Hospital, New Delhi, Lady Harding Medical College & Hospital, New Delhi; JIPMER, Pondicherry and PGI, Chandigarh. The Centre at NIMHANS, Bangalore was established later as the 6th Centre.

CENTRAL GOVERNMENT HEALTH SCHEME

The Central Government Health Scheme (CGHS) was started in 1954 with the objective of providing : (a) Comprehensive medical care facilities to the central Government employees and their family members. (b) To avoid cumbersome system of medical reimbursement

NATIONAL CARDIO-VASCULAR DISEASE CONTROL PROGRAMME

Current statistics on Cardiovascular Diseases (CVD) and Stroke are incomplete. Estimated deaths due to Rheumatic Disease are 1,41,000 annually. Prevalence rate of Rheumatic Heart Diseases, as estimated by some surveys is 1.0 to 5.4 cases per 1000 population. AIIMS is the nodal agency.

HEALTH MINISTERS DISCRETIONARY GRANT

Health Ministers Discretionary Grant scheme is a scheme being operated by the Ministry of Health & Family Welfare for providing financial assistance to the poor and needy patients to defray a part of expenditure on hospitalization for undergoing major surgical interventions and treatment of major diseases. The disease for which grants are sanctioned are Heart ailments, Kidney transplantation, Hip & knee replacement, Cancer, AIDS, Hepatitis, Eye, Tumor etc. Salient features of the schemes are:(i) Government servants (Central as well as State Government Employees) are not eligible to receive financial assistance out of the Health Ministers Discretionary Grant. (ii) The amount of the grants in any case does not ordinarily exceed Rs. 20,000/-. The grant is sanctioned as one time grant and is released to the Medical Supdt. Of the hospital where the patient is taking treatment. (iii) All grant are non-recurring nature and no recurring liability is undertaken. (iv) Re-imbursement of expenditure already incurred is not admissible. 5

(v) The sanction of grant is restricted to patients taking treatment in Govt. hospital only. (vi) For the purpose of sanctioning of financial assistance, an annual family income of up to Rs. 50,000/(rupees fifty thousand) only is taken as the upper limit for being eligible for assistance.

RASHTRIYA AROGYA NIDHI

The Department related Parliamentary Standing felt that it was essential to explore all appropriate sources of funds to assist poor patients coming to AIIMS or other Central Govt. Hospitals for their treatment of specific life threatening illness. In view of the recommendations of the above Committee, it was decided to set up a National Illness Assistance Fund under the Department of Health, Ministry of Health & Family Welfare. The name of National Illness Assistance Fund has now been changed as Rashtriya Arogya Nidhi (RAN) vide Resolution dated 8th April, 2003. The scheme provides for financial assistance to patients, living below poverty line who are suffering from major life threatening diseases, to receive medical treatment at any of the super speciality Hospitals/Institutes under the Government or other government hospitals. The financial assistance to such patients is released in the form of one-time grant, to the Medical Supdt. of the Hospital in which the treatment is being received.

HEALTH PROMOTION & EDUCATION PROGRAMME

Central Health Education Bureau (CHEB) is a national institution under the Directorate General of Health Services (Ministry of Health & F.W.) Govt. of India looking after the health promotion and health education activity in the country. The institution was created in 1956. It offers courses for various health care providers and other officers in medical field and teachers. Creates awareness among students.

MEDICAL CARE FOR REMOTE AND MARGINALISED TRIBAL & NOMADIC COMMUNITIES
Scheme was launched during IXth Five Year plan. Under this scheme following projects have been taken up by ICMR. 1. Prevention & Control of Hepatitis B infection among primitive Tribes of Andaman & Nicobar Islands. 2. Intervention for hereditary common hemolytic disorders among major Tribals of Sundergarh Distt. 3. Intervention programme for Cholera and Intestinal; Parasiptism, Vitamin A deficiency disorders among some primitive Tribal population Orissa. 4. Intervention Programme for Nutritional Anaemia and Hemoglobinopathies amongst primitive Tribal Population in India.

NATIONAL PROGRAMME FOR CONTROL AND TREATMENT OF OCCUPATIONAL DISEASES

National Programme for Control and Treatment of Occupational Diseases has been launched during the IXth Five Year Plan. Prevention control & treatment of silica Tuberculosis in Agate Industry & Occupational Health Problems of Tobacco Harvesters and their prevention.

ORAL HEALTH CARE

Almost 85% of our children and 95 to 100% of our adult population is suffering from periodontal diseases which is initially painless, chronic, self destructive leading to gradual tooth loss. 35% of all body cancers are oral cancers. About 30-35% of children suffer from maligned teeth and jaws affecting proper function.

PREVENTION OF FOOD ADULTERATION PROGRAMME

The objective is to ensure pure and wholesome food to the consumers and also to prevent fraud or deception. The Act has been amended thrice, in 1964, 1976 and in 1986 with the objective of plugging the loopholes and making the punishments more stringent and empowering Consumers and Voluntary Organisations to play a more effective role in its implementationThe subject of the Prevention of Food Adulteration is in the concurrent list of the Constitution. However, the enforcement of the Act is done mainly by the State/U.T. Governments. The Central Government primarily plays an advisory and co-ordinating role in its implementation, besides carrying out various statutory functions/ duties assigned to it under the various provisions of the Act. These include formulation of guidelines and standards for food products from the point of view of food safety, examination and approval of the labels of infant foods; ensuring quality of food imported into India, under the provision of the Act. The rule making power under the Prevention of Food Adulteration Act, 1954 (PFA Act) Act is exercised by Central Govt. in consultation with the Central Committee for Food Standards, (CCFS) a Statutory Advisory Committee under the PFA Act. Harmonisation of the standards under PFA Act and Rules with related standards under the various Orders under the Essential Commodity Act, the BIS and Agmark specifications etc. Four Central Food Laboratories have been established: (i) Food Research and Standardization Laboratory, Ghaziabad (ii) Central Food Laboratory, Calcutta are under the administrative control of the Directorate General of Health (iii) Central Food Laboratory, Pune (Government of Maharashtra) (iv) Central Food Laboratory, Mysore (CSIR)

NATIONAL FAMILY WELFARE PROGRAMME

The Family Welfare Programme was officially launched in India in 1952 with the objective of reducing the birth rate to the extent necessary to stabilise the population at a level consistent with the requirement of the national economy.

REPRODUCTIVE AND CHILD HEALTH PROGRAMME:

Government of India launched the Reproductive and Child Health (RCH) Programme in 1997 by integrating and strengthening all the existing interventions under the Child Survival and Safe Motherhood (CSSM) interventions of fertility regulation and adding the component of Reproductive Tract Infection (RTI) and Sexually Transmitted Infections (STI). The concept of RCH Programme is to provide need based, client centres, demand driven, high quality and integrated RCH services to the beneficiaries.

CHILD HEALTH
Low birth weight, diarrhoeal diseases acute respiratory infections, vaccine preventable diseases and inadequate maternal and newborn care have been identified as major causes of high infant and child mortality rates in the country. Under the RCH programme, interventions like antenatal care, improving safe deliveries, essential new born care, immunisation against six vaccine preventable diseases, control of deaths due to diarrhoea and acute respiratory infections are being implemented. The Universal Immunisation Programme(UIP) aimed at reduction in mortality and morbidity among infants, younger children and pregnant mothers was started in 1985-86. Under this programme, Vaccines are administered to Infants and Pregnant women for prevention of Vaccine preventable diseases among infants and reduction in Neo-natal tetanus and other diseases among pregnant women.

Vaccines: a) Tetanus Toxide (TT) b) Diphtheria Tetanus(DT) c) Diphtheria Pertusis Toxide(DPT) d) Oral Polio (OPV) e) Measles f) B.C.G.

NATIONAL POPULATION POLICY

A new National Population Policy has been approved by the Cabinet in its meeting held on 15th February, 2000. The Policy aims at the following objectives:-

Short term:
The immediate objective of the National Population Policy is to address the unmet needs of contraception, health infrastructure, health personnel and to provide integrated service delivery for basic reproductive and child health care.

Medium term:
The medium term objective is to bring the total fertility rates to replacement level by 2010, through vigorous implementation of intersectoral operational strategies. 8

Long term:
The long-term objective is to achieve a stable population by 2045, at a level consistent with the requirements of sustainable economic growth, social development and environmental protection. The policy states the following National Socio-Demographic Goals to be achieved by 2010:(i) Address the unmet needs for basic reproductive and child health services, supplies and infrastructure. (ii) Make school education up to age 14 free and compulsory, and reduce drop outs at primary and secondary levels to below 20 percent for both boys and girls. (iii) Reduce infant mortality rate to below 30 per 1000. (iv) Reduce maternal mortality ratio to below 100 per 100,000 live births. (v) Achieve universal immunisation of children against all vaccine preventable diseases. (vi) Promote delayed marriage for girls , not earlier than age 18 and preferably after 20 years of age. (vii) Achieve 80 percent institutional deliveries and 100 percent deliveries by trained persons. (viii) Achieve universal access to information / counselling, and services for fertility regulation and contraception with a wide basket of choices. (ix) Achieve 100 percent registration of births, deaths, marriage and pregnancy. (x) Contain the spread of Acquired Immunodeficiency Syndrome, and promote greater integration between the management of reproductive tract infections (RTI), and sexually transmitted infections(STI) and the National AIDS Control Organisation. (xi) Prevent and control communicable diseases. (xii) Integrate Indian System of Medicine (ISM) in the provision of reproductive and child health services, and in reaching out to households. (xiii) Promote vigorously the small family norm to achieve replacement levels of TFR. (xiv) Bring about convergence in implementation of related social sector programms so that family welfare becomes a people centred programme.

DEPARTMENT OF INDIAN SYSTEMS OF MEDICINE & HOMOEOPATHY

The Department of Indian Systems of Medicine & Homoeopathy was established as a separate Department in the Ministry of Health & Family Welfare in March, 1995.

MEDICINAL PLANTS BOARD

The medicinal Plants are the basic raw materials for preparation of medicines of Indian System of Medicines & Homoeopathy. The effectiveness of these systems thus mainly depend upon the use and sustained availability of genuine raw materials. The objective of establishing a Medicinal Plant Board is to have an agency which would be responsible to co-ordinate all matters related to medicinal plants, including drawing up policies and strategies for conservation, proper harvesting, cost-effective cultivation, research and development, processing, marketing of raw material in order to protect, sustain and develop this sector. Board is at New Delhi and remain under the administrative control of the Department of ISM & H, Ministry of Health & Family Welfare. The Board will be headed by the Minister (HFW) with MOS (HFW) as Vice-Chairperson and will have members representing various Departments/Organizations and functionaries. 9

The functions of Medicinal Plants Board will include:1. Assessment of the demand/supply position relating to medicinal plants both within the country and abroad. 2. Identification, inventorisation and quantification of medicinal plants according to the broad ecosystems of the country. 3. Promotion of ex-situ/in-situ conservation and cultivation of medicinal plants. 4. Improving availability of raw material of genuine quality in required quantity for the users of medicinal plants. 5. Setting up of data-base system for inventorisation, dissemination of information and facilitating the prevention of patents being obtained for medicinal use of plants which is in the public domain. 6. Matters relating to import/export of raw material, as well as value added products either as medicine, food supplements or as herbal cosmetics including adoption of better techniques for marketing of products to increase their reputation for quality and reliability in the country and abroad.

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