Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5990_Библиотеки_им_академика_М_И_Перельмана.pdf
263Introduction to Health Systems
MAS. The NUHM would provide an annual grant of
Rs. 5000 to MAS every year.
c. Essential services rendered by the ASHA are as follows:
i. Accompany pregnant women and children requiring
treatment to the nearest UPHSC or secondary/tertiary
level healthcare facility.
ii. Act as a depot holder for essential health products like
oral re-hydration therapy (ORS), zinc, iron folic acid
tablet (IFA), chloroquine, oral pills, condoms, contra-
ceptives, sanitary napkins, etc., as appropriate to the
local community.
iii. An active promoter of good health practices.
iv. ASHA will mobilize the community and facilitate
people’s access to health and health-related services
available at the Anganwadi/PHSCs/urban secondary
and tertiary health centers, for institutional delivery,
immunization, antenatal check-ups and postnatal
checkups.
v. Carrying out preventive and promotive health
activities with Mahila Arogya Samiti.
vi. Create awareness among women, families, and
adolescents on gender equality, birth preparedness,
the importance of clean and safe delivery, nutritional
care during pregnancy, identification of danger signs
during pregnancy; breastfeeding and complementary
feeding, immunization, contraception, medical
termination of pregnancy, sterilization, spacing
methods and prevention of common infections
including reproductive tract infection (RTIs) and
sexually transmitted infection (STIs), care of the young
child, substance abuse, prevention of domestic
violence and sexual violence.
vii. Create awareness in the community on essential
determinants of health, such as nutrition, basic
sanitation and hygienic practices, healthy living and
working conditions, and timely use of available health
services and facilities.
264 Social Pharmacy
viii. Formation and promotion of Mahila Arogya Samitis
(MAS) in the community.
ix. Identify target beneficiaries and support the ANM in
conducting regular monthly outreach sessions and
tracking service coverage.
x. Maintenance of necessary information and records
about births and deaths, immunization, and antenatal
services in her assigned locality as well as any unusual
health problem or disease outbreak in the slum, and
share it with the ANM in charge of the area.
xi. Provide community-level curative care for ailments
such as diarrhea, and fevers, care for normal and sick
newborns, childhood illness, nutrition counseling, and
first aid.
xii. She will also measure blood pressure and blood and
urine sugar.
xiii. Reinforcement of appropriate community-level action
for immunization, and prevention of waterborne and
other communicable diseases like tuberculosis (DOTS),
malaria, chikungunya, Japanese encephalitis, and
leprosy.
Facilities available at Urban Primary Health Centre (UPHC)
and Urban Centre Health Centre (U CHC) are compared in
Table 5.3.
NATIONAL HEALTH PROGRAMMES
Introduction
After independence (1947), The Govt. of India has taken various
steps to improve the health status of the people. Amongst the
various actions, prominent action is the launching of National
Health Programs for the control/eradication of communicable
and non-communicable diseases, control of the population,
improvement in sanitation of the environment, standard of
nutritional status, and rural health. Many International
organizations such as The United Nations Children’s Fund
(UNICEF), WHO, UNFPA (United Nations for Population
265Introduction to Health Systems
Activities), World Bank, and foreign agencies like SIDA
(Swedish International Development Cooperation Agency),
NORAD (North American Aerospace Defence Command),
DANIDA (Danish International Development Agency), USAID
(United States Agency for International Development) have
been providing technical and material support in the effective
implementation of these programs.
The National Health Program is a government initiative in
India that aims to provide free or affordable healthcare to all
citizens of the country.
Table 5.3: Facilities available at UPHC and UCHC
Thematic Area Urban Primary Urban Centre Health
Health Centre (UPHC) Centre (UCHC)
Population One UPHC/UHC for 1 per 5 lakh population
every 50,000–60,000 in metro city1 per 2.5 lakh
population. One population in non-metro
swasthya chowki for city
every 10,000 population
Level of health- Primary Secondary (First Referral
care level)
Beds 1. 100 beds in Metro city
2. 30–50 beds in non-
metro city
Staff MOI/C—1,
2nd MO (part-time)—1
Nurse—3
LHV—1
Pharmacist—1
Lab technician—1
ANM—3–5
Public Health
Manager/Mobiliza-
tion Officer—1
Support Staff – 3
M and E unit – 1
No. of villages 29 158
covered
Community One community health
Health guide for every 10,000
Volunteer population
(ASHA/LW)
266 Social Pharmacy
The objectives of the National Health Program are to
improve the health and well-being of all citizens of India, with
a particular focus on those from low-income populations. The
key components of the National Health Program are:
1. Providing free or affordable healthcare to all citizens of
India.
2. Improving the health and well-being of all citizens of India.
3. Reducing the burden of disease and improving health
outcomes.
4. Increasing access to essential medicines and health
technologies.
5. Strengthening the capacity of the health system.
6. Addressing inequities in health outcomes.
The National Health Programs in India have been grouped
as follows:
1. Programmes for control of communicable diseases:
i. National AIDS Control Programme (NACP)
ii. Integrated Disease Surveillance Programme (IDSP)
iii. National Leprosy Eradication Programme (NLEP)
iv. National Rabies Control Programme (NRCP)
v. National Polio Eradication Program (NPEP)
vi. National Programme on Containment of Anti-Micro-
bial Resistance (AMR)
vii. National Vector Borne Disease Control Programme
(NVBDCP)
viii. National Viral Hepatitis Control Program (NVHCP)
ix. Revised National Tuberculosis Control Programme
(RNTCP)
2. Programmes for control of non-communicable diseases:
i. National Tobacco Control Programme (NTCP)
ii. National Programme for Prevention and Management
of Burn Injuries (NPPMBI)
iii. National Programme for the Health Care for the
Elderly (NPHCE)
iv. National Mental Health Program (NMHP)
267Introduction to Health Systems
v. National Programme for Control and Treatment of
Occupational Diseases
vi. National Programme for Prevention and Control of
Deafness (NPPCD)
vii. National Programme for Prevention and Control of
Cancer, Diabetes, Cardiovascular Diseases and Stroke
(NPCDCS)
viii. National Programme for Control of Blindness and
Visual Impairment
ix. Pradhan Mantri National Dialysis Programme
(PMNDP)
x. National Oral Health Programme (NOHP)
3. Programmes related to nutrition:
i. Integrated Child Development Services (ICDS)
ii. Mid-Day Meal Programme (MDMP)
iii. MAA (Mothers’ Absolute Affection) Programme for
Infant and Young Child Feeding
iv. National Programme for Prevention and Control of
Fluorosis (NPPCF)
v. National Iron Plus Initiative for Anaemia Control
vi. National Iodine Deficiency Disorders Control
Programme (NIDDCP)
vii. National Vitamin A Prophylaxis Programme
4. Programmes related to health system strengthening:
i. Ayushman Bharat Yojana
ii. LaQshya’s programme (Labour Room Quality
Improvement Initiative)
iii. National Health Mission (NHM)
iv. Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)
5. Reproductive, maternal, neonatal, child and adolescent
health:
i. Janani Shishu Suraksha Karyakaram (JSSK)
ii. Janani Suraksha Yojana (JSY)
iii. Mission Indradhanush/Intensified Misson Indra-
dhanush
268 Social Pharmacy
iv. Navjaat Shishu Suraksha Karyakram (NSSK)
v. National Programme for Family Planning
vi. Pradhan Mantri Surakshit Matritva Abhiyan (PMSM)
vii. Rashtriya Kishor Swasthya Karyakram (RKSK)
viii. Rashtriya Bal Swasthya Karyakram (RBSK)
ix. Universal Immunisation Programme (UIP)
Vertical and Horizontal Health Programs
Health services (curative and preventive) can be provided using
two types of health programs—horizontal and vertical. The
main differences between horizontal and vertical health
programs are summarized in Table 5.4.
Table 5.4: Types of health programmes
S. Vertical health program Horizontal health program
No.
1. These programs are for specific These programs are for specific
health conditions; found more health conditions; found more
frequently where poverty pre- frequently where poverty pre-
vails and epidemics flourish vails and epidemics flourish
2. Run by Govt. of India. Run by State Health Depart-
ments
3. Do get assistance from inter- Do not get assistance from
national health organizations International health organi-
zations
4. These programs imply selective These are routine programs
targeting of specific interven-
tions
5. Expert training is given to Routine training is given to
doctors paramedical staff
National Health Mission (NHM)
The government of India in 2013 launched National Health
Mission (NHM). It encompasses two Sub-Missions, the
National Rural Health Mission (NRHM) (2005–2012) and the
National Urban Health Mission (NUHM) (2005–2012). Both
missions were completed by 2012 and relaunched under the
name National Health Mission.
269Introduction to Health Systems
The main components of the program include strengthening
the health system in rural and urban areas for Reproductive-
Maternal-Neonatal-Child and Adolescent Health (RMNCH +
A), and communicable and non-communicable diseases.
Components of the National Health Mission
1. Reproductive-Maternal-Neonatal-Child and Adolescent
Health (RMNCH+A) Program
2. Integrated Disease Surveillance Programme (IDSP)
3. National Leprosy Eradication Programme (NLEP)
4. National Vector Borne Disease Control Programme
(NVBDCP)
5. Revised National Tuberculosis Control Programme
(RNTCP).
6. National Programme for Control of Blindness.
7. National Iodine Deficiency Disorders Control Programme
(NIDDCP)
8. National Programme for Prevention and Control of
Cancer, Diabetes, Cardiovascular Diseases and Stroke
(NPCDCS)
9. National Mental Health Program (NMHP)
10. National Tobacco Control Programme (NTCP)
11. National Programme for the Health Care for the Elderly
(NPHCE)
12. National Programme for Occupational Health
13. National Programme for Control of Fluorosis (NPCF)
The NHM envisages the achievement of universal access to
equitable, affordable, and quality healthcare services that are
accountable and responsive to people’s needs.
Fig. 5.2: Logo of National Health Mission
270 Social Pharmacy
National Health Mission Goals
The National Health Mission seeks to ensure the achievement
of the following goals:
1. Reduce maternal mortality rate (MMR) to 1/1000 live
births.
2. Reduce infant mortality rate (IMR) to 25/1000 live births.
3. Reduce total fertility rate (TFR) to 2.1.
4. Prevention and reduction of anemia in women aged 15–49
years.
5. Prevention and reduction of mortality and 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% microfilaria prevalence in all districts.
11. Elimination of kala-azar by 2015, <1 case per 10000
population in all blocks.
National AIDS Control Programme (NACP)
NACP was started by National AIDS Control Organization
(NACO) in the year 1992 as a vertical program.
Fig. 5.3: Logo of National AIDS Control Programme
NACP has moved through four phases. The timeline of
NACP is summarized in Table 5.5.
In 2021 NACP was merged with the National Health Mission
(NHM). World AIDS Day is on Ist December. Currently, under
the program, there are strategic plans for AIDS elimination
(2017 to 2024). According to the national strategic plan for HIV
aid elimination, India wants to end HIV aid by the year 2024.
271Introduction to Health Systems
NACP Goals
1. Zero deaths zero disease and zero stigma due to HIV.
2. To reduce 80% of new infections by 2024.
National Tuberculosis Elimination Programme (NTEP)
Tuberculosis (TB) is an infectious disease caused by
Mycobacterium tuberculosis bacteria. It spreads through the air
when a person suffering from tuberculosis cough, sneeze, or
spit. TB control efforts are initiated countrywide. In 1962
National Tuberculosis Control Programme was launched to
control TB. The program was reviewed and revised in 1993.
The Revised National TB Control Programme (RNTCP) was
launched in 1997 with the implementation of Directly Observed
Treatment, Short Course Strategy. The DOTS strategy is cost-
effective and is the international standard for TB control
programs today. In 2020, the RNTCP was further renamed the
National Tuberculosis Elimination Program (NTEP) by the
Government of India to end TB by 2025. The current logo of
NTEP is shown below.
NTEP Goals
1. To reduce mortality due to tuberculosis by 90%.
2. To end TB by 2025.
3. To reduce the incidence of TB by 80%.
There have been National Strategic Plans (NSPs) since the
start of the NTEP. The National Strategic Plan (NSP) 2017– 2025
had the national goal of eliminating TB in India by 2025. The
Table 5.5: Phases of NACP
Year NACP
1986 Post-reported case in India
1992–1999 Phase I of NACP
1999–2006 Phase II of NACP
2006–2011 Phase III of NACP
2011–2017 Phase IV of NACP
2017–2024 National Strategic Plan (NSP) to end AIDS epidemic
272 Social Pharmacy
vision is a TB-free India. NSP aims to achieve zero death, zero
disease, and zero poverty.
NTEP Strategy
1. Detect, Treat, and Prevent TB is the strategy tagline in
NTEP.
2. Universalization of CB-NAAT, i.e. everyone who presents
with cough for more than two weeks. duration will be
offered CB-NAAT at baseline.
3. Introduction of TRUE-NAT, which is an Indian version of
CB-NAAT developed by ICMR
4. Introduction of new drugs bedaquiline and delamanid.
5. Introduction of shorter and longer MDR, XDR oral drug
regimens only.
6. JEET strategy: An initiative by the government of India in
which there is a joint effort for the elimination of TB from
Indian organizations, certain international organizations,
and non-governmental organizations. The main purpose
of the JEET strategy was to increase the notification rate of
TB by private practitioners.
Technology-based initiatives under NTEP
1. NIKSHAY: It is an ICT (Information Confirmation
Technology) enabled TB surveillance system to facilitate
TB notification. It was started in 2012 for both government
and private healthcare facilities to ensure reporting and
compliance with TB treatment.
Fig. 5.4: Logo of National Tuberculosis Elimination Programme