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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5990_Библиотеки_им_академика_М_И_Перельмана.pdf
283Introduction to Health Systems
prevalence rate recorded at the country now is 0.45/10,000
population.
Objectives
1. To reduce the prevalence rate by less than 1 per thousand
population at subnational and district level.
2. Annual new case detection rate by less than 10 per lakh.
3. To reduce Grade II disability % by less than 1% among new
cases at the national level.
4. To reduce Grade II disability cases by less than 1 case per
million population at the National level.
5. Zero disability is among new child cases.
6. Zero stigma and discrimination against persons affected
by leprosy.
Leprosy Elimination in India—Strategy
The strategies of the program were as follows:
1. Decentralized integrated leprosy services through the
general healthcare system.
2. Early case detection by population survey, school survey,
contact survey, etc. and complete treatment of new leprosy
cases.
3. Carrying out household contact surveys in the detection of
multibacillary and child cases.
4. Early diagnosis and prompt multi-drug therapy (MDT)
through routine and special efforts.
5. Participation of Accredited Social Health Activists
(ASHAs) in the detection and treatment of leprosy cases
for leprosy work.
6. Strengthening of Disability Prevention and Medical
Rehabilitation (DPMR) services.
7. Intensified information, education, and communication
(IEC) activities in the community to increase self-reporting
to primary health centre (PHC) and decrease stigma.
8. Thorough observation and supervision at the Primary
Health Centre/Community Health Centre.
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XII FIVE-YEAR PLAN (FYP) (2012–2017)
The country achieved the goal of leprosy elimination as a public
health problem, i.e. prevalence rate (PR) of less than 1 case per
10,000 population at the National level by December 2005, as
set by National Health Policy 2002. Although prevalence has
come down at the national and State levels, there were districts
and blocks, which still had a prevalence rate >1 per 10,000
population and these cases will have to be provided quality
leprosy services through the GHC (general health care) system.
Further, new cases would continue to occur for a few more
years due to the long incubation period of the disease.
Thus, creating awareness for self-reporting, timely diagnosis,
and complete MDT (multi-drug therapy) treatment of leprosy
cases was necessary for the ultimate eradication of the disease.
Since the program aims for eradication, i.e. zero cases of leprosy
as the ultimate goal, sustained control measures need to be
continued during the 12th plan period.
Objectives
1. Elimination of leprosy, i.e. prevalence of <1/10,000
population in all districts of the country.
2. Strengthen Disability Prevention and Medical Rehabili-
tation of persons affected by leprosy.
3. Reduction in the level of stigma associated with leprosy.
Program Components
The following components were approved in the 12th Five Year
Plan:
1. Case detection and management.
2. Disability prevention and medical rehabilitation.
3. Information, education, and communication (IEC)
including behavior change communication (BCC).
4. Human resource and capacity building.
5. Programme management.
285Introduction to Health Systems
Activities under NLEP
1. Diagnosis and treatment of leprosy
Services for diagnosis and treatment (multi-drug therapy) are
provided free of cost by all primary health centers and Govt.
dispensaries throughout the country. Difficult to diagnose and
complicated cases and cases requiring reconstructive surgery
are referred to the district hospital for further management.
2. Training
Training of general health staff like medical officers, health
workers, health supervisors, laboratory technicians, and
ASHAs is conducted every year to develop adequate skills in
the diagnosis and management of leprosy cases.
3. Urban leprosy control
To address the complex problems in urban areas, urban leprosy
control activities are being implemented in urban areas having
a population size of more than 1 lakh. These activities include
MDT delivery services and follow-up of patients for treatment
completion, providing supportive medicines and dressing
material, and monitoring and supervision.
4. Information, education, and communication (IEC)
An intensive IEC activities campaign with a theme “Towards
leprosy free India” is conducted towards further reduction of
leprosy burden in the community, early reporting of cases,
awareness generation, and reduction of stigma and discrimi-
nation against leprosy affected persons. These activities are
carried out through mass media, outdoor media, rural media,
and advocacy meetings. More focus is given on inter inter-
personnel communication.
5. NGO services under the survey, education, and
treatment (SET) scheme
NGOs are getting grants from Govt. of India under the Survey,
Education and Treatment (SET) scheme. The various activities
undertaken by the NGOs are, IEC, prevention of impairments
and deformities, case detection, and MDT Delivery. From the
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financial year 2006 onwards, grant-in-aid is being disbursed to
NGOs through state health (seprosy) societies.
6. Disability Prevention and Medical Rehabilitation (DPMR)
For the prevention of disability among leprosy-affected persons
with insensitive hands and feet, DPMR services are provided.
Affected persons are given dressing material, supportive
medicines, and micro-cellular rubber (MCR) footwear. The
patients are also empowered with self-care procedures for
taking care of themselves. Emphasis is given to correction of
disability in leprosy-affected persons through reconstructive
surgery (RCS). Micro-cellular rubber footwear is provided for
the protection of insensitive feet.
7. Special activity in high endemic districts
Special activity including capacity building and extensive IEC,
adequate availability of MDT, regular monitoring and super-
vision, self-care practices, supply of MCR footwear in adequate
quantity, and improvement in RCS performance through camp
approach are strengthened in high endemic districts for early
case detection, treatment and to reduce the disease burden.
8. Supervision and monitoring
The program is monitored at different levels through analysis
of monthly progress reports, field visits by the supervisory
officers, and program review meetings held at the central, state,
and district levels. Emphasis is given to the assessment of new
case detection and treatment completion rate and proportion
of grade II disability among new cases for better
epidemiological analysis of the disease situation.
Major Initiatives
1. Involvement of Accredited Social Health Activists (ASHA)
ASHAs are involved in bringing out suspected cases from their
villages for diagnosis at PHC and follow-up cases for
completion of treatment. Her duties are monitored by the
287Introduction to Health Systems
concerned PHC medical officer. ASHAs are entitled to receive
incentives as below:
a. An early case before the onset of any visible deformity—
250.
b. A new case with visible deformity in hands, feet, or eye—
200
Activities performed by ASHA are as follows:
i. Search for suspected cases of leprosy to prevent
disability and to cut down transmission potential.
ii. Follow up on all cases for completion of treatment in
the scheduled time. During follow-up visits, also look
for symptoms of any reaction due to leprosy and refer
them to the health workers/PHC for treatment. This
will again reduce the chances of disability occurring in
cases under treatment.
iii. Advise and motivate disabled cases for proper care of
their hands and feet during the follow-up period. This
helps in improving the quality of life of the affected
persons and prevents further deterioration of
disabilities.
iv. Spreading awareness.
2. E-Newsletter
This is a quarterly publication from the House of Central
Leprosy Division (CLD) that shares guidelines, feedback,
experiences, and activities undertaken in the program. It serves
as one of the important tools for communication to keep
informed, update, and educate the stakeholders as well as
target groups.
3. Leprosy Case Detection Campaigns (LCDC)
LCDC is being implemented in high-endemic districts of the
country to detect hidden leprosy cases. In this campaign, every
person in a house is examined to detect all hidden cases in the
community to interrupt the transmission of the disease and
expedite the achievement of elimination status at the district
and sub-district levels.
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The important activities under LCDC are as under:
i. Scheduled meetings of various committees formed at
national, state, district, and block levels to plan and
implement the LCDC.
ii. Focused training of all health functionaries from district
to village level.
iii. House-to-house visits by a team encompassing one
ASHA and male volunteer, i.e. field level worker (FLW)
as per micro-plans prepared for local areas.
iv. Intensive IEC activities, through miking and display of
banners/posters during and before the LCDC.
v. Supervision of house to house search activities through
identified field supervisors.
vi. Scheduled meetings with community leaders/repre-
sentatives to resolve any issue that came across during
the campaign.
vii. Systematic collection and compilation of reports from
field teams and supervisors through designed formats.
viii. Prompt analyses and feedback on data received from
teams, supervisors, monitors, and medical officers to
plan corrective actions.
4. GIS Mapping
To strengthen the planning, implementation, and monitoring
of activities in the Central Leprosy Division, GIS Mapping has
been initiated. GIS mapping has enabled the visualization of
district-wise data about annual new case detection rate, and
prevalence of the disease spatially.
NATIONAL MENTAL HEALTH PROGRAM
“Mental health is a state of wellbeing characterized by the
absence of mental or behavioral disorder whereby the person
has made a satisfactory adjustment as an individual and to the
community, about emotional, personal, social and spiritual
aspects of their life”. Mental disorders are common in the
general population and account for approximately 15% of the
global burden of disease (GBD). Because of the huge burden of
289Introduction to Health Systems
mental disorders, the Government of India has been
implementing the National Mental Health Program (NMHP)
since 1982.
A national advisory group on mental health was established
for the effective implementation of the NMHP. The district
Mental Health Program was added to the program (DMHP) in
1996. The program was re-strategized in 2003 to include two
schemes, viz. Modernization of State Mental Hospitals and Up-
gradation of Psychiatric Wings of Medical Colleges/General
Hospitals.
Aims
1. Prevention and treatment of mental and neurological
disorders and associated disabilities.
2. Use of mental health technology to improve general health
services.
3. Application of mental health principles in total national
development to improve quality of life.
Objectives
1. To ensure the availability and accessibility of minimum
mental healthcare for all individuals in the community,
especially for the vulnerable and underprivileged sections
of the population.
2. To encourage the application of mental health knowledge
in general healthcare and social welfare.
3. To promote community participation in the mental health
service development.
4. To increase human resources in mental health sub-
specialties.
5. To stimulate efforts towards self-help in the community.
Main Strategies
1. Integrating mental health services with primary health
care through the NMHP.
2. Establishment of tertiary care institutions for the treatment
of mental disorders.
290 Social Pharmacy
3. Eradicating stigmatization of mentally ill patients and
protecting their rights through regulatory institutions like
the Central Mental Health Authority, and State Mental
Health Authority.
Specific Approaches
1. Diffusion of mental health skills to the periphery of health
services.
2. Appropriate task-oriented training for the existing health
staff.
3. An equitable and balanced distribution of existing health
services.
4. Integration of basic mental health care services with the
existing general health services.
5. Linkage of mental health services with the existing
community development programs.
Components of the District Mental Health Programme
District Mental Health Programme (DMHP) includes early
identification and treatment of the mentally ill, as promotive
and preventive activities for positive mental health. The main
components of DMHP are:
1. Training programs for all the mental health team workers
including psychiatrists, clinical psychologists, psychiatric
nurses, psychiatric social workers, and community nurses.
2. Education of the public regarding mental health to
increase awareness and reduce stigma.
3. Early detection and treatment of mentally ill persons.
4. Providing valuable data and experience at the level of
community to the state and center for future planning,
improvement in service, and research.
5. Provision of school mental health services including life
skills education in schools and counselling services.
6. College counseling services through trained teachers/
counselors.
7. Workplace stress management.
291Introduction to Health Systems
8. Suicide prevention services include a counseling center at
the district level, sensitization workshops, IEC, helplines,
etc.
9. Sensitization and training of health personnel at the
district and sub-district levels.
10. Awareness camps for dissemination of awareness
regarding mental illnesses and related stigma through the
involvement of local PRIs, faith healers, traditional medical
healers, teachers, leaders, etc.
11. Community participation.
12. Association with self-help groups, family and caregiver
groups, and NGOs working in the field of mental health.
The National Human Rights Commission also monitors the
conditions in mental hospitals along with the government of
India, and the states are acting on the recommendations of the
joint studies conducted to ensure quality in the delivery of
mental care.
NATIONAL PROGRAMME FOR PREVENTION AND CONTROL
OF DEAFNESS (NPPCD)
Hearing loss or deafness is the most common sensory deficit
in humans today. Deafness is defined as the inability to use
hearing as a primary channel for receiving speech, even with
amplification. Hearing loss is hearing impairment of various
degrees. In India, approximately 63 million people are suffering
from significant auditory impairment; of these, a significant
percentage are children between the ages of 0 to 14 years. The
majority of cases of hearing loss are mainly due to common
ear diseases, which if diagnosed early and managed properly,
can significantly reduce the burden of decreased hearing.
Because of the burden of the problem, there was a pressing
need to develop guidelines for the diagnosis and treatment of
patients with ear diseases. Thus, to tackle the high incidence
of hearing loss and deafness in the country, the National
Programme for the Prevention and Control of Deafness
(NPPCD) was launched by the Government of India in 2006
for early identification, diagnosis, and treatment of ear
292 Social Pharmacy
problems. The NPPCD program is implemented by the
Ministry of Health and Family Welfare with the technical
support of the Directorate General of Health Services. At the
state level, the program is being implemented by the
Department of Health and Family Welfare, a State Nodal
Officer, preferably an ENT surgeon at the Directorate/
Secretariat level, and provides technical guidance and expertise
to the State Health Society for implementation of the program
in the various districts of the state.
Objectives of the Program
1. To prevent avoidable hearing loss on account of disease or
injury.
2. Early identification, diagnosis, and treatment of ear
problems responsible for hearing loss and deafness.
3. To medically rehabilitate persons of all age groups,
suffering from deafness.
4. To strengthen the existing inter-sectoral linkages for
continuity of the rehabilitation programme, for persons
with deafness.
5. To develop institutional capacity for ear care services by
providing support for equipment, material, and training
personnel.
6. To prevent and control major causes of hearing impair-
ment and deafness, to reduce the total disease burden.
Strategy
1. To strengthen the delivery of services for ear care.
2. To develop human resources for ear care services.
3. To promote public awareness through appropriate and
effective IEC strategies with special emphasis on the
prevention of deafness.
4. To develop the institutional capacity of the district
hospitals, community health centers, and primary health
centers selected under the program.
5. To provide recurring grant-in-aid for conducting screen-
ing camps for the screening of deafness and speech-related
cases.