NATIONAL LEPROSY

ERADICATION
PROGRAMME
 Started as National Leprosy Control Programme
(NLCP)

 Operation since 1955 to achieve control of leprosy

through early detection and Dapsone Monotherapy.

 In 1983, the control programme was redesignated

National Leprosy Eradication Programme with the
goal of eradicating the disease by the turn of the
century.
 COMPONENTS OF THE PROGRAMME

1. Decentralised integrated leprosy services

through general healthcare system.

2. Capacity building of all general health services

functionaries

3. Intensified information, education and

communication

4. Prevention of disability and medical

rehabilitation

5. Intensified monitoring and supervision.

 MILESTONES OF LEPROSY ERADICATION
 1955: National Leprosy Control Programme (NLCP)

 1980: Govt. of India declared to resolve to eradicate leprosy by year

2000

 1982: Multi Drug Therapy (MDT) aimed at leprosy eradication

 1983: National Leprosy Eradication Programme with goal of reduce

case load to 1 or <1 per 10000 population

 1993: World Bank support phase I

 2001-02: World Bank support phase II

 2002-03: NLEP integrated with general health care system

 2004: Govt. of India funds programme with technical support from

WHO & International Federation of Anti- leprosy association (ILEP)
 MAJOR INITIATIVES
 New case detection: main indicator programme monitor

 Treatment completion rate

 DPMR ( Disability Prevention & Medical Rehabilitation)

i. Dressing material, supporting medicine & ulcer kit to leprosy

affected person
ii. Microcellular rubber footwear
iii. NGO’s, medical colleges strengthen for reconstructive surgery for
correction of disability
iv. Amount of 5000/- for leprosy affected person for BPL family
undergoing reconstructive surgery
v. Support to govt. institution in form of 5000/- per reconstructive
surgery conducted
 Involvement of ASHA, in bringing out
suspected leprosy cases and follow up of
confirmed cases.

 Provisionof self settled colonies for leprosy

affected persons.

 IntensiveIEC campaign “Towards Leprosy

Free India”.
 Reduce leprosy burden

 Reduce stigma and discrimination

DISABILITY PREVENTION & MEDICAL
REHABILITATION (DPMR)
DPMR planned to be carried out in a 3 tier system:

Primary level care Secondary level care

• PHC
• CHC • All district hospitals
• Sub divisional hospital • District nucleus unit
• Urban leprosy centres

Tertiary level care

• Central govt. institute

• ICMR institute
• ILEP supported leprosy
hospitals
• All PMR institutes and
Dept. of Medical College
 PROGRAMME STRATEGY
 Integrated leprosy services through general health care
system

 Early detection and complete treatment of new leprosy

cases.

 Carrying out household contact survey for early detection of

cases.

 Involvement of Accredited Social Health Activist (ASHA) in

the detection and completion of treatment of leprosy cases
on time.

 Strengthening of disability prevention and medical

rehabilitation (DPMR) services.
 IEC: INFORMATION EDUCATION &
COMMUNICATION

 Behaviour change in community against

stigma and discrimination against leprosy
affected person.

 Making the public aware about:

 Availability of MDT
 Correction of deformity through surgery
 Leprosy affected person can live a normal life with
his family.
 UNIVERSAL
IMMUNISATION
PROGRAMME
 IN1974, WHO launched ‘Expanded
Programme on Immunisation’ against 6 target
diseases:

Measles

Tetanus Diphtheria

Tuberculosis Pertussis

Polio
 ‘Expanded’ meant adding more disease
controlling vaccines, coverage to all corners of
a country and spreading services to reach less
privileged parts of society .

 In 1984, UNICEF renamed as ‘Universal Child

Immunisation’.

 Both WHO & UNICEF had the same goal: to

achieve universal immunisation by 1990.
 KEY ROLES

 Routine immunisation

 Campaigns (polio, measles and japanese encephalitis)

 Monitoring adverse events following immunisation

 Vaccines and cold storage logistics

 Strategic communication

 Immunisation trainings
 EVOLUTION OF THE PROGRAMME
 1974- Expanded Programme of Immunisation (EPI)

 1985- Universal Immunisation Programme (UIP)

 1986- Technology Mission on Immunisation

 1992- Child Survival & Safe Motherhood (CSSM)

 1997- Reproductive Child Health (RCH 1)

 2005- National Rural Health Mission (NRHM)

 UNDER UIP FOLLOWING VACCINES ARE
PROVIDED:

1. BCG (Bacillus Calmette Guerin)

2. DPT (Diphtheria, Pertussis, Tetanus toxoid)

3. OPV (Oral polio vaccine)

4. Measles

5. Hepatitis B

6. TT (Tetanus toxoid)

7. JE vaccination

8. Hib containing Pentavalent vaccine (DPT+ HepB + Hib)

 VARIOUS CAMPAIGNS

Introduction of
Pulse Polio Introduction to
Japanese
Immunisation Hepatitis B
encephalitis
Programme Vaccine
vaccine

Introduction of Introduction of
Measles vaccine Pentavalent Mission
Second Vaccine Indradhanush
Oppurtunity (DPT+HepB+Hib)
 STATE PROGRAMME IMPLEMENTATION PLAN
(PIP)
 Support for alternate vaccine delivery from PHC to sub centre and outreach
sessions.

 Deploying retired manpower to carry out immunization activities in urban

slums and underserved areas, where services are deficient.

 Mobility support to district immunisation officer as per state plan for

monitoring and supportive supervision.

 Review meeting at the state level at 6 monthly intervals.

 Training of ANM, cold chain handlers, mid-level managers, refrigerator

mechanics etc.

 Support for mobilization of children to immunization session sites by ASHA,

women self-help groups.

 Printing of immunization cards, monitoring sheet, cold chain chart, vaccine

inventory charts etc.
 SCOPE AND ELIGIBILITY

 India has one of the largest UIPs in terms of

quantities of vaccines used, number of
beneficiaries covered, geographical spread and
human resources involved.

 Under the UIP, all vaccines are given free of cost

to the beneficiaries as per the National
Immunisation Schedule.

 The UIP covers all sections of society across the

country with the same high quality vaccines.
 ACHIEVEMENTS

 Thebiggest achievement of the immunisation

programme is the eradication of smallpox.

 One more significant milestone is that India

is free of Poliomyelitis for more than 33
months.

 Besides,vaccination has contributed

significantly to the decline of the cases and
deaths due to the Vaccine Preventable
Disease (VPDs)
NATIONAL HEALTH
MISSION
 The National Health Mission (NHM) was approved in
May 2013.
 The NHM encompasses two submissions:

National
National Rural
Urban Health
Health Mission
Mission
(NRHM)
(NUHM)
 VISION OF NHM

 Attainment of Universal access to

equitable, affordable and quality
healthcare services, accountable and
responsive to people’s needs with effective
inter- sectoral convergent action to address the
wider social determinants of health.
 MAJOR MILESTONES
 1992- Child Survival and Safe Motherhood
Programme (CSSM)

 1997- RCH I

 2005- RCH II

 2005- National Rural Health Mission

 2013- RMNCH+ A Strategy

 2013- National Health Mission

 2014- India Newborn Action Plan (INAP)

 CORE VALUES
 Safeguard the health of the poor, vulnerable and
disadvantaged, and move towards a right based approach to
health through entitlements and service guarantees.

 Strengthen public health systems as a basis for universal

access and social protection against the rising costs of healthcare.

 Build environment of trust between people and providers of

health services.

 Empower community to become active participants and the

process of attainment of highest possible levels of health.

 Institutionalize transparency and accountability in all

processes and mechanisms

 Improve efficiency to optimize use of available resources

 GOALS

 The endeavour would be to ensure achievement of those

indicators:

 Reduce MMR to 1/1000 life births

 Reduce IMR to 25/1000 life births

 Reduce TFR to 2.1

 Prevention and reduction of anaemia in women aged 15 -

49 years

 Prevent and reduce mortality and mobility from

communicable, non-communicable, injuries and emerging
diseases
 Reduce annual incidence and mortality from
tuberculosis by half

 Reduce prevalence of leprosy to < 1/10000

population and incidence to zero in all districts

 Annual Malaria Incidence to be < 1/1000

 Less than 1% microfilaria prevalence in all

districts

 Kala-azar elimination by 2015, < 1 case per 10000

population in all blocks.
 COMPONENTS OF NHM

 NHM Finance

 NHM – Health System Strenghtening

 Reproductive, Maternal, New born, Child Health and

Adolescent- (RMNCH + A) services

 National disease control programmes

NATIONAL URBAN HEALTH
MISSION
 National Urban Health Mission (NUHM) seeks to
improve the health status of the urban population
particularly slum dwellers and other vulnerable
section by facilitatiing their access to quality health
care.

 NUHM would cover all state capitals, district

headquarters and about 779 other cities/towns with a
population of 50,000 and above in a phased manner.

 Cities and towns below 50000 population will be

covered by NRHM.
 FOCUS
1. Urban poor population living in listed and unlisted
slums

2. All other vulnerable populations such as homeless,

rag pickers, street children, rickshaw pullers,
construction and brick and lime- kiln workers, sex
workers and other temporary migrants

3. Public health thrust on sanitation, clean drinking

water, vector control etc.

4. Strengthening public health capacity of urban local

bodies.
 TARGETS
 Reduce IMR to 25/1000 live births.

 Reduce MMR to 1/1000 life births

 Reduce TFR to 2.1

 Reduce annual incidence and mortality from tuberculosis by half

 Reduce prevalence of leprosy to < 1/10000 population and

incidence to zero in all districts

 Annual Malaria Incidence to be < 1/1000

 Less than 1% microfilaria prevalence in all districts

 Kala-azar elimination by 2015, < 1 case per 10000 population in all

blocks
 ACHIEVEMENTS
 IMR reduced from 42 in 2012 to 34 in 2016.

 MMR has reduced to 1.3 in 2014-16.

 TFR has reduced to 2.3 in 2015.

 Tuberculosis incidence is at 204 per lakh population and

mortality at 31 per lakh population in 2017.

 Leprosy prevalence rate is <1/10000 population.

 Annual malaria incidence is <1/1000.

 Out of 225 endemic districts, 222 have reported mf rate of less

than 1%.

 Out of 633 block PHCs, 539 have reported <1 case per 10000.
 COMPONENTS
1. ASHA (Accredited Social Health Activists)

2. Strengthening sub- centres

3. Strengthening Primary health centres

4. Strengthening of CHCs for first referral care

5. District health plan

6. Converging sanitation and hygiene under NRHM

7. Strengthening disease control programmes

8. Public-private partnership for public health goals, including regulation of private

sector.

9. New health financing mechanisms.

10. Reorienting health/medical education to support rural health issues.

 IMPACT LEVEL TARGETS OF NUHM
 Reduce IMR by 40%(in urban areas)- National Urban IMR down to
20 per 1000 live births by 2017.
40% reduction in U5MR and IMR
Achieve universal immunisation in all urban areas.

 Reduce MMR by 50%

50% reduction in MMR(among urban population of the state/country)
100% ANC coverage (in urban areas)

 Achieve universal access to reproductive health including 100%

institutional delivery.

 Achieve replacement level fertility.

 Achieve all targets of diseases control programmes.

URBAN HEALTHCARE DELIVERY MODEL

 The urban health delivery model would basically

comprise of an Urban Primary Health Care for
provision of healthcare with outreach and
referral linkages.
Public or empanelled
secondary/tertiary
private providers

Urban primary
health centre

Community outreach
service
NATIONAL RURAL HEALTH
MISSION
 The National Rural Health Mission (NRHM)
was launched on 12 April 2005 to provide
accessible, affordable and accountable quality
health services to the poorest households in
the remotest rural regions.

 Under the NRHM, the difficult areas with

unsatisfactory health indicators were classified
as special focus states to ensure greatest
attention were needed.
 CHALLENGES OF PUBLIC HEALTH IN
RURAL AREA
 Integration of sanitation, hygiene, nutrition and drinking
water issues needed in the overall sectoral approach for
health.

 Striking regional inequalities.

 The challenge of population stabilization especially in states

with weak demographic indicators.

 Undue importance of curative services that favour non-poor.

 For every Rs.1 spent on poorest 20% population, Rs.3 spent on

the richest quintile.

 About 10% Indians had some form of health insurance, mostly

inadequate.
 PRINCIPLES
 To promote equity, efficiency, quality and accountability in
Public Health Systems.

 Enhance people orientation band community- based

approaches.

 Ensure public health focus.

 Recognize value of traditional knowledge base of

communities.

 Promote new innovations, methods and process

development.

 Decentralize and involve local bodies.

 GOALS
 Reduction in Infant mortality rate (IMR) and maternal mortality
ratio (MMR)

 Universal access to public health services such as women’s health,

water, sanitation and hygiene, immunisation and nutrition.

 Prevention and control of communicable and non-communicable

diseases, including locally endemic diseases.

 Access to integrated comprehensive primary healthcare.

 Population stabilization, gender and demographic balance.

 Revitalize local health traditions and mainstream AYUSH.

 Promotion of healthy lifestyles.

 VISION

 Provide effective healthcare to rural population

throughout the state.

 Increase public spending on health with increased

arrangement for community financing and risk
pooling

 Undertake architectural correction of the health

system to enable it to effectively handle increased
allocations and promote policies that strengthen
public health management and service delivery in the
state.

 Revitalise local health traditions and mainstream

AYUSH into the public health system.
 Effectively integrate health concerns through
decentralized management at district level with
determinants of health like sanitation and hygiene,
nutrition, safe drinking water, gender and social
concerns.

 Set time bound goals and report publicly of progress.

 Improve access of rural people, especially poor women

and children to equitable, affordable, accountable and
effective primary health care.
 OBJECTIVES

 ASHA: Provision of trained and supported

health activist in underserved areas as per need.
Ensuring quality and close supervision of ASHA.

 Health Action Plan: Preparation of health

action plans by panchayat as mechanism for
involving community in health.

 IPHS: Strengthening SC/PHC/CHC by

developing Indian Public Health Standards.
 FRU: Increase utilisation of First Referral Units from
less than 20% (2002) to more than 75% by 2010.

 District: Institutionalising and substantially

strengthening district level management of health.

 AYUSH: Strengthening sound local health traditions

and local resource based practices related to PHC and
public health.
 EXPECTED OUTCOMES FROM THE MISSION
 IMR reduced to 30/1000 live births by 2010.

 MMR reduced to 100/100000 live births by 2012.

 TFR reduced to 2.1 by 2012.

 Malaria mortality reduction rate- 50% by 2010, additional

10% by 2012

 Kala-azar mortality reduction rate- 100% by 2010 and

sustaining elimination until 2012.

 Filarial reduction rate- 70% by 2010, 80% by 2012 and

elimination by 2015.
 Dengue mortality reduction rate- 50% by 2010 and
sustaining it at that level till 2012

 Japanese encephalitis mortality reduction rate- 50% by

2010 and sustaining it at that level till 2012

 Cataract operations increasing to 46 lakh per annum until

2012.

 Leprosy prevalence rate- reduce from 1.8 per 10000 in 2005

to less than one per 10000 thereafter.

 TB DOTS series- maintain 85% cure rate through entire

missing period.

 Upgrading all CHCs to Indian Public Health Standards.

NRHM INFRASTRUCTURE

Block
Level
hospital

Cluster of GPs-
PHC level

Gram Panchayat-
Sub health centre level

Village level-
ASHA, AWW, VH, SC