National health mission राष्ट्रीय स्वास्थ्य मिशन

abstract image. National health mission राष्ट्रीय स्वास्थ्य मिशन.

JANANI SHISHU SURAKSHA KARYAKARAM (JSSK). INTRODUCTION Government of India has launched Janani Shishu Suraksha Karyakaram (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..

(JSSK). 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.

JANANI SURAKSHA YOJANA (JSY). JananiSurakshaYojana (JSY) is a safe motherhood intervention under the National Health Mission. It is being implemented with the objective of reducing maternal and neonatal mortality by promoting institutional delivery among poor pregnant women. The scheme, launched on 12 April 2005 by the Hon’ble Prime Minister, is under implementation in all states and Union Territories (UTs), with a special focus on Low Performing States (LPS). JSY is a centrally sponsored scheme, which integrates cash assistance with delivery and post-delivery care. The Yojana has identified Accredited Social Health Activist (ASHA) as an effective link between the government and pregnant women..

Important Features of JSY. The scheme focuses on poor pregnant woman with a special dispensation for states that have low institutional delivery rates, namely, the states of Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam, Rajasthan, Orissa, and Jammu and Kashmir. While these states have been named Low Performing States (LPS), the remaining states have been named High Performing states (HPS)..

Eligibility for Cash Assistance. Category Rural area Total Urban area Total Mother’s package ASHA’s package* Mother’s package ASHA’s package** (Amount in Rs.) LPS 1400 600 2000 1000 400 1400 HPS 700 600 1300 600 400 1000.

RASHTRIYA BAL SWASTHYA KARYAKRAM(RBSK). Under National Rural Health Mission, significant progress has been made in reducing mortality in children over the last seven years (2005-12). Whereas there is an advance in reducing child mortality there is a dire need to improving survival outcome. This would be reached by early detection and management of conditions that were not addressed comprehensively in the past. According to March of Dimes (2006), out of every 100 babies born in this country annually, 6 to 7 have a birth defect. This would translate to around 17 lakhs birth defects annually in the country and accounts for 9.6% of all the newborn deaths. Various nutritional deficiencies affecting the preschool children range from 4 per cent to 70 per cent. Developmental delays are common in early childhood affecting at least 10 percent of the children. These delays if not intervened timely may lead to permanent disabilities including cognitive, hearing or vision impairment. Also, there are group of diseases common in children viz. dental caries, rheumatic heart disease, reactive airways diseases etc. Early detection and management diseases including deficiencies bring added value in preventing these conditions to progress to its more severe and debilitating form and thereby reducing hospitalization and improving implementation of Right to Education. Rashtriya Bal Swasthya Karyakram (RBSK) is an important initiative aiming at early identification and early intervention for children from birth to 18 years to cover 4 ‘D’s viz. Defects at birth, Deficiencies, Diseases, Development delays including disability..

Adolescent Reproductive & Sexual Health Programme (ARSH).

Rashtriya 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 Kishor Swasthya Karyakram was launched on 7th January, 2014. The key principles 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 so. To guide the implementation of this programme, MOHFW in collaboration with UNFPA has developed a National Adolescent Health Strategy. It 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 Kishor 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 (RKSK):. Improve Nutrition Improve Sexual and Reproductive Health Enhance Mental Health Prevent Injuries and violence Prevent substance misuse.

MENSTRUAL HYGIENE SCHEME(MHS). Background The Ministry of Health and Family Welfare has introduced a scheme for promotion of menstrual hygiene among adolescent girls in the age group of 10-19 year in rural areas. The major objectives of the scheme are: To increase awareness among adolescent girls on Menstrual Hygiene To increase access to and use of high quality sanitary napkins to adolescent girls in rural areas. To ensure safe disposal of Sanitary Napkins in an environmentally friendly manner. The scheme was initially implemented in 2011 in 107 selected districts in 17 States wherein a pack of six sanitary napkins called “ Freedays ” was provided to rural adolescent girls for Rs. 6. From 2014 onwards, funds are now being provided to States/UTs under National Health Mission for decentralized procurement of sanitary napkins packs for provision to rural adolescent girls at a subsidized rate of Rs 6 for a pack of 6 napkins. The ASHA will continue to be responsible for distribution, receiving an incentive @ Rs 1 per pack sold and a free pack of napkins every month for her own personal use. She will convene monthly meetings at the Aanganwadi Centres or other such platforms for adolescent girls to focus on issue of menstrual hygiene and also serve as a platform to discuss other relevant SRH issues. A range of IEC material has been developed around MHS, using a 360 degree approach to create awareness among adolescent girls about safe & hygienic menstrual health practices which includes audio, video and reading materials for adolescent girls and job-aids for ASHAs and other field level functionaries for communicating with adolescent girls..

NATIONAL DEWORMING DAY (NDD). The National Deworming Day is an initiative of Ministry of Health and Family Welfare, Government of India to make every child in the country worm free. This is one of the largest public health programs reaching large number of children during a short period. More than 836 million children are at risk of parasitic worm infections worldwide. According to World Health Organization 241 million children between the ages of 1 and 14 years are at risk of parasitic intestinal worms in India, also known as Soil-Transmitted Helminths (STH)..

STH transmission:. Adult worms live in human intestines for food and survival and produce thousands of eggs each day. Eggs are passed in the faeces of infected person. Infected people who defecate outdoors spread worm eggs in the soil. Eggs contaminate the soil and spread infection in several ways: ─ Ingested through vegetables that are not carefully cooked, washed or peeled; ingested from contaminated water sources; ingested by children who play in soil and then put their hands in their mouths without washing them..

Objective of National Deworming Day:. The objective of National Deworming Day is to deworm all preschool and school-age children (enrolled and non-enrolled) between the ages of 1-19 years through the platform of schools and Anganwadi Centers in order to improve their overall heal Key stakeholders: The Ministry of Health & Family Welfare, Government of India is the nodal agency for providing all States/UTs with guidelines related to National Deworming Day (NDD) implementation at all levels. The programme is being implemented through the combined efforts of Department of School Education and Literacy under Ministry of Human Resource and Development, Ministry of Women and Child Development and Ministry of Drinking Water and Sanitation Ministry of Panchayati Raj, Ministry of Tribal Affairs, Ministry of Rural Development, Ministry of Urban Development, and Urban Local Bodies (ULBs) also provide support to deworming program. th , nutritional status, access to education and quality of life..

NDD Implementation. NDD (first round) is conducted on February 10 each year. Bi-annual round of deworming is recommended in the States where prevalence of STH infection is more than 20% and annual round in other (less than 20% prevalence) states. Only two States namely Rajasthan and Madhya Pradesh have reported less than 20% prevalence and recommended for annual round. All the remaining States/UTs are implementing bi-annual round of deworming. The first round of NDD was conducted in February 2015 and 8.9 crore children were administered the deworming tablet across 11 states/UTs by achieving 85% coverage. Thereafter 88%, 77%, 88% children were covered against the set targets in February 2016, August 2016 and February &August 2017 rounds of NDD respectively. 26.68 crore children have been administered albendazole till February 2018, and more than 114 crore doses of albendazole were administered to children 1-19 years, since 2015 To increase programme outreach to private schools and maximize deworming benefits for large number of children various awareness activities (media mix) are involved under the programme. The awareness campaign spreads awareness about importance and benefits of dewarming , as well as prevention strategies related to improved behaviors and practices for hygiene and sanitation..

National Tuberculosis Elimination Programme (RNTCP).

National Tuberculosis Elimination Programme (RNTCP).

Detect : The first objective of NSP is to find all drug sensitive TB cases (DS-TB) and drug resistant TB cases (DRTB) with an emphasis on reaching TB patients seeking care from private providers and undiagnosed TB cases in high-risk populations (such as prisoners, migrant workers, people living with HIV/AIDS, contacts etc.). Early diagnosis and treatment of TB cases in the community is an important step in TB elimination, which will help in decreasing the risk of transmission of disease to others, poor health outcomes, and social and economic hardships of the patient and their family. Notification of TB cases : Notification of all TB patients from all health care providers is made mandatory by Ministry of Health and Family Welfare, Government of India since 2012. All health care providers (clinical establishments run or managed by government (including local authorities), private, or NGO sectors, and /or individual practitioners) should notify every TB case to local health authorities (district health officer, chief medical officer of a district, and municipal health officer of a municipal corporation/ municipality) every month. With its amendment in 2015, all laboratories are also included to notify TB cases. Till now, only medical practitioners, hospitals and laboratories were notifying TB patients to government health system, now according to ‘Mandatory TB notification Gazette for private practitioners, chemists and public health staff’ March 2018, all chemists will also inform about TB patients for whom they have dispensed the TB drugs. TB patients themselves are also encouraged to notify themselves. Every TB patient will be attempted to reach out by the local public health authority, namely, District Health Officer or Chief Medical Officer of a District and Municipal Health Officer of urban local bodies, so that the incentives and support to patients, families and communities can be properly extended..

NIKSHAY : To facilitate TB notification, RNTCP has developed a case-based web-based TB surveillance system called “NIKSHAY” (https://nikshay.gov.in ) for both government and private health care facilities. Future enhancements under NIKSHAY are for patients support, logistics management, direct data transfers, adherence support and to support interface agencies which are supporting programme to expand the reach. Public private partnership : For promotion of public-private mix (PPM) in TB prevention and care, private providers are provided incentives for TB case notification, and for ensuring treatment adherence and treatment completion. The incentives are provided through direct beneficiary transfer. The incentives to the Private Sector TB Care Provider are as follows : Rs 250/- on notification of a TB case diagnosed as per Standards for TB Care in India (STCI) Rs 250/- on completion of every month of treatment Rs 500/- on completion of entire course of TB treatment Rs 2750/ for notification and management of a drug-sensitive patient over 6-9 months as per STCI Rs 6750/-for notification and correct management of a drug-resistant case over 24 months as per STCI Free drugs and diagnostic tests to TB patients in private sector- Free drugs and diagnostic tests are provided to TB patients seeking treatment from private health sector. There are two approaches for ensuring access to free drugs and diagnostic tests to TB patients in private sector, first is access to programme- provided drugs and diagnostics through attractive linkages; and second is reimbursement of market- available drugs and diagnostics. Significant cost reduction of select diagnostics is achieved by ‘Initiative for Promoting Affordable and Quality TB Tests’ (IPAQT). 131 private sector labs networked to provide four quality tests for TB at or below the ‘ceiling prices. For TB diagnosis more than 14,000 designated microscopy centres spread across the country. Cartridge Based Nucleic Acid Amplification Tests (CBNAAT) / Line Probe Assay (LPA) have been established at district levels for decentralised molecular testing for drug resistant TB. Reference laboratories have been established at state and national levels which provide culture and dug sensitivity test (DST) services as well as molecular diagnosis..

Treat : Next step under the programme is initiation and sustaining all TB patients on appropriate anti-TB treatment wherever they seek care, with patient friendly system and social support. 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). (DOT is a specific strategy, to improve adherence by any person observing the patient taking medications in real time. The treatment observer does not need to be a health-care worker, but could be a friend, a relative or a lay person who works as a treatment supervisor or supporter. If treatment is incomplete, patients may not be cured and drug resistance may develop). 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. First line treatment of drug-sensitive TB consists of a two-months (8weeks) intensive phase with four drug FDCs followed by a continuation phase of four months (16 Weeks) with three drug FDCs..

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 weight 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 12 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 20 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 clinical decision of the treating physician. Patients eligible for retreatment should be referred for a rapid molecular test or drug susceptibility testing to determine at least rifampicin resistance, and preferably also isoniazid resistance status. On the basis of the drug susceptibility profile, a standard first-line treatment regimen (2HRZE/4HR) can be repeated if no resistance is documented; and if rifampicin resistance is present, shorter regimen for MDR-TB (multi drug resistant TB) regimen should be prescribed according to WHO’s recent drug resistant TB treatment guidelines. RNTCP has introduced Bedaquiline CAP for MDR-TB under conditional access programme in 2016 across six sites, with a country wide scale up plan in 2017-2020. Nikshya poshak yozana : 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. Incentives are delivered through Direct benefit transfer (DBT) scheme to bank accounts of beneficiary*..

Expending options for ICT based treatment adherence support mechanism s:.

Intensifying TB control activities in following key populations is addressed in NSP:.

Prevent : With the objective to prevent emergence of TB in susceptible population various measures are indicated as: Scale up air-borne infection control measures at health care facilities Treatment for latent TB infection in contacts of bacteriologically-confirmed cases Address social determinants of TB through intersectoral approach. a) Air borne infection control measures -TB infection control is a combination of measures aimed at minimizing the risk of TB transmission within population and hospital and other settings. The foundation of such infection control is: Early diagnosis, and proper management of TB patients. Health education about cough etiquettes and proper disposal of sputum by patient. Cough etiquette means covering nose and mouth when coughing or sneezing. This can be done with a tissue, or if the person doesn’t have a tissue they can cough or sneeze into their upper sleeve or elbow, but they should not cough or sneeze into their hands. The tissue should then be safely disposed of. Houses should be adequately ventilated. Proper use of air borne infection control measures in health care facilities and other settings.

b) Contact tracing - Since transmission can occur from index case to the contact any time (before diagnosis or during treatment) all contacts of TB patients must be evaluated. These groups include: All close contacts, especially household contacts In case of paediatric TB patients, reverse contact tracing for search of any active TB case in the household of the child must be undertaken. Particular attention will be paid to contacts with the highest susceptibility to TB infection c) Isoniazid Preventive Therapy (IPT) - Preventive therapy is recommended to Children < 6 years of age, who are close contacts of a TB patient. Children will be evaluated for active TB by a medical officer/ pediatrician and after excluding active TB he/she will be given INH preventive therapy In addition to above, INH preventive therapy will be considered in following situation: For all HIV infected children who either had a known exposure to an infectious TB case or are Tuberculin skin test (TST) positive (>=5mm induration) but have no active TB disease. All TST positive children who are receiving immunosuppressive therapy (e.g. Children with nephrotic syndrome, acute leukemia, etc.). A child born to mother who was diagnosed to have TB in pregnancy will receive prophylaxis for 6 months, provided congenital TB has been ruled out. BCG vaccination can be given at birth even if INH preventive therapy is planned. Close contacts of index cases with proven DR-TB (drug resistant-TB) will be monitored closely for signs and symptoms of active TB as isoniazid may not be prophylactic in these cases..

d) BCG vaccination - It is provided at birth or as early as possible till one year of age. BCG vaccine has a protective effect against meningitis and disseminated TB in children. e) Addressing social determinants of TB like poverty, malnutrition, urbanization, indoor air pollution, etc. require inter departmental/ ministerial coordinated activities and the programme is proactively facilitating this coordination . BUILD Health system strengthening for TB control under the National Strategic Plan 2017-2025 is recommended in the form of building and strengthening enabling policies, empowering institutions and human resources with enhanced capacities..

Ayushman Bharat is National Health Protection Scheme , which will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization. Ayushman Bharat - National Health Protection Mission will subsume the on-going centrally sponsored schemes - Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS) . IMPLEMENTATION STRATEGY At the national level to manage, an Ayushman Bharat National Health Protection Mission Agency (AB-NHPMA) would be put in place. States/ UTs would be advised to implement the scheme by a dedicated entity called State Health Agency (SHA). They can either use an existing Trust/ Society/ Not for Profit Company/ State Nodal Agency (SNA) or set up a new entity to implement the scheme. States/ UTs can decide to implement the scheme through an insurance company or directly through the Trust/ Society or use an integrated model..

Salient Features. Ayushman Bharat - National Health Protection Mission will have a defined benefit cover of Rs. 5 lakh per family per year. 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. Ayushman Bharat - National Health Protection Mission will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database. The beneficiaries can avail benefits in both public and empanelled private facilities. To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis. One of the core principles of Ayushman Bharat - National Health Protection Mission is to co-operative federalism and flexibility to states. For giving policy directions and fostering coordination between Centre and States, it is proposed to set up Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at apex level Chaired by Union Health and Family Welfare Minister. States would need to have State Health Agency (SHA) to implement the scheme. To ensure that the funds reach SHA on time, the transfer of funds from Central Government through Ayushman Bharat - National Health Protection Mission 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..

Major Impact. Ayushman Bharat - National Health Protection Mission will have major impact on reduction of Out of Pocket (OOP) expenditure on ground of: Increased benefit cover to nearly 40% of the population, (the poorest & the vulnerable) Covering almost all secondary and many tertiary hospitalizations. (except a negative list) Coverage of 5 lakh for each family, (no restriction of family size) This will lead to increased access to quality health and medication. In addition, the unmet needs of the population which remained hidden due to lack of financial resources will be catered to. This will lead to timely treatments, improvements in health outcomes, patient satisfaction, improvement in productivity and efficiency, job creation thus leading to improvement in quality of life..

EXPENDITURE INVOLVED. The expenditure incurred in premium payment will be shared between Central and State Governments in specified ratio as per Ministry of Finance guidelines in vogue. The total expenditure will depend on actual market determined premium paid in States/ UTs where Ayushman Bharat - National Health Protection Mission will be implemented through insurance companies. In States/ UTs where the scheme will be implemented in Trust/ Society mode, the central share of funds will be provided based on actual expenditure or premium ceiling (whichever is lower) in the pre-determined ratio..

NUMBER OF BENEFICIARIES. Ayushman Bharat - National Health Protection Mission will target about 10.74 crore poor, deprived rural families and identified occupational category of urban workers' families as per the latest Socio-Economic Caste Census (SECC) data covering both rural and urban. The scheme is designed to be dynamic and aspirational and it would take into account any future changes in the exclusion/ inclusion/ deprivation/ occupational criteria in the SECC data..

HOME BASED CARE OF NEW BORN AND YOUNG CHILD (HBYC).

HOME BASED CARE OF NEW BORN AND YOUNG CHILD (HBNC).