NATIONAL LEPROSY CONTROL PROGRAMME

NATIONAL CONTROL PROGRAMME FOR LEPROSY AND ITS FUNCTIONING

 The national leprosy control programme is a centrally sponsored health scheme of
the Ministry of Health and Family Welfare, Government of India.
 The programme is headed by the Deputy Director of health services (Leprosy) under
the administrative control of the Directorate General Health Services Govt. of India.
 The National Leprosy eliminating programme strategies and plans are formulated
centrally, the programme is implemented by the states.
 The programmes are also supported as partners by the World Health Organization.
 The World Health assembly in May 1991 adopted a resolution for global leprosy
elimination as a public health problem by the year 2000.
 The National Health Policy of India 2002 also set the goal of leprosy elimination in
India by the end of year 2005.
 The National Leprosy Elimination Programme (NLEP) took up the challenge with
active support of the state and dedicated partners such as World Health Organization
(WHO), the international Federation of Anti Leprosy Association (ILEP), the Sasakawa
Memorial Health Foundation (SMHF) & The Nippen Foundation (TNF), and the World
Bank (1993-2004).
 Leprosy is one of the major health and socioeconomic problems in the country.
 It is a chronic infectious disease and spreads mainly by with infected patients.
 The disease carried by M. Leprae affects mainly the peripheral nerves, partial or total
loss of cutaneous sensation in the affected areas, presence of thickened nerves and
presence of acid-fast bacilli in the skin or nasal smears.

NATIONAL LEPROSY PROGRAMMES:

1. In 1955 Government of India launched National Leprosy Control Programme.

2. In 1983 Government of India launched National Leprosy eliminated Programme and
3. introduced multiple Drug Therapy.
4. In 1993-2000 World Bank supported National Leprosy Eliminated Programme-I.
5. In 2001 to 2004 World Bank supported NLEP-II.
6. In January 2005 National Leprosy Eliminated Programme continued with
Government of India funds and donor partners support.
7. In December 2005, India achieved elimination as a public health problem.
8. The National Leprosy Control is in operation since 1955, as a centrally-aided program
to achieve control of leprosy through early detection of cases and Diamino Diphenyl
Sulphone (DDS) or Dapsone monotherapy on an ambulatory basis.
9. In 1980, the government of India declared its resolve to "eliminate" leprosy by the
year 2000 and constituted a working group to advice accordingly.
 10. Programme with the goal of eliminating the disease as National Leprosy Elimination
by the turn of the country.

World Bank supported project:

 The first phase of the World Bank supported NLEP project, which was completed on
31st March 2000.
 It was extended for 6 months to complete the preparation of proposed second phase
project. During the first phase, the care detected was 3.8 million patients and care
cure with multi drug therapy (MDT) was 4.4 million old and new cases.
 The second phase project of World Bank has been approved for a period of 3 years
starting from June 2001.

Strategic Plan of Action (2004-2005):

 A strategic plan of action was drawn up with the following focus.
 Intensified focused action with strong supervisory support in 72 high priority districts
with rarely endemic districts having more than 2000 leprosy cases detected during
2003-04.
 Carrying out house hold contact survey in detection of Multi Bacillary (MB) and child
cases.
 Early detection and complete treatment of new leprosy cases.
 Information, Education and Communication (IEC) activities in the community to
improve self-reporting to Primary Health Centre (PHC) and reduction of stigma.
 Strengthening of Disability Prevention and Medical Rehabilitation (DPMR) services.

OBJECTIVES OF NATIONAL LEPROSY PROGRAMME

1. Regular treatment of cases by providing Multi Drug Therapy (MDT) at nearby village of
moderate to low endemic areas/district.

2. Appropriate Medical rehabilitation and leprosy ulcer care services.

3. Intensified health education and public awareness campaigns to remove social stigma
attached to the disease.

4. Early detection through active surveillance by the trained health workers.

5. To train manpower necessary to implement National Leprosy eliminating Programme.

6. To monitor and evaluate National Leprosy elimination programme.

7. To provide specialised services in the area of diagnosis, reaction, relapse and

reconstructive surgery in leprosy.

Outcomes of Programmes:
The National Leprosy Elimination programme has achieved its principal goal of leprosy
elimination as a public health problem at the National level, which was doubtful in the minds
of many experts about five years back.

During the process of elimination, the National Programme achieved a number of benefits
for the suffering leprosy patients and the community.

To list a few of these are:

1. Repeated mass campaigns have helped in increasing the public awareness about leprosy,
its curability, drug availability in Health Centers, resulting in improved number of self
reporting for diagnosis and treatment.

2. Introduction of a Simplified Information System (SIS) for NLEP suitable for the General
Health Service officials helped in streamlining data generation, reporting and monitoring of
the programme.

3. The Leprosy services changed from east while vertically run programme to integrated
services through the Primary Health Services centers. This has increased accessibility of the
service to the people nearer to their home on all working days.

4. Large number of General Health Care Staff has been trained to make them proficient in
suspecting leprosy and providing health education to the patient, family and community
members.

NATIONAL MENTAL HEALTH PROGRAMME

Introduction

Mental health is an integral component of health, which is defined as positive state of well
being (Physical, Mental, Social) and not merely an absence of illness.

Psychiatric symptoms are common in general population in both sides of the globe.

These symptoms are- Worry, tiredness and sleepless nights which affects more than half of
the adults at some time, while as many as one person in seven experiences some form of
diagnosable neurotic disorder.

An expert group was formed in 1980. After several drafts and two workshops (July 1981 and
August 1982), the final draft was submitted to the Central Council of Health and Family
Welfare (the highest policy making body for health in the country) on 18th to 20th August
1982, which recommended its implementation.

NATIONAL MENTAL HEALTH PROGRAMME AND ITS FUNCTIONING

The Government of India launched the National Mental Health Programme (NMHP) in 1982,
keeping in view the heavy burden of mental illness in the community, and the absolute
inadequacy of mental health care infrastructure in the country to deal with it.

AIMS:
Prevention and treatment of mental and neurological disorders and their associated
disabilities

Use of mental health technology to improve general health services

Application of mental health principles in total national development to improve quality of

life

Major Milestones are:

1. Child survival and Safe Motherhood Programme (CSSM) in 1992

2. RCH I in 1997

3. RCH II in 1997

4. National Rural Health Mission in 2005

5. RMNCH and strategy in 2013

6. Nation Health Mission in 2013

7. INDIA New Born Action Plan (INBAP) in 2014

Long standing need of urban health mission was accepted in may 2013 by the cabinet of the
government of India and rural and urban health mission merged to form National Health
Mission in 12th Five year plan.

World Bank Report: The World Bank Report (1993) revealed that the Disability Adjusted Life
Year (DALY) loss due to neuro-psychiatric disorder is much higher than diarrhea, malaria,
worm infestations and tuberculosis if taken individually.

According to the estimates DALYs loss due to mental disorders are expected to prevent 15%
of the global burden of disease by 2020.

The prevalence reported from these studies range from the population of 18 to 207 per
1000 with the median 65.4 per 1000 and at any given time, about 2-3% of the population,
suffer from seriously, incapacitating mental health disorders or epilepsy.

Most of these patients live in rural areas remote from any modern mental health facilities.

Strategies s were planned for immediate action. These are:

1) Center to periphery strategy: Establishment and strengthening of psychiatric units in all

districts hospitals, with outpatient clinics and mobile teams reaching the Population for
mental health services.

2) Periphery to Center Strategy: Training of an increased number of different categories of

health personnel in basic mental health skills, with primary emphasis towards the poor and
the underprivileged, directly benefiting about 200 million people.

The Objectives of National Mental Health Programme are :

1. To ensure availability and accessibility of minimum mental health care for all the
population

2. To encourage application of mental health knowledge in general health care and social
development

3. To promote community participation in the mental health service development and to

stimulate efforts towards self help in the community

Outcomes of Programme:
 The National Mental Health Survey 2015-2016 has revealed a huge burden of mental
disorders in the Indian Community.
 This finding is based on a methodology that was scientific, uniform and standardised,
undertaken across 12 states at one point of time.
 The fact that nearly 11% of Indians above 18 years are suffering from mental
disorders and most of them do not receive care for a variety of reasons.
 The impact is huge affecting all areas of an individual and his/her family life affecting
quality, productivity and earning potentials.
 This data should be used as evidence to strengthen and implement mental health
policies and programmes and should be the driving force for future activities in India.
 The National Mental Health Policy, Mental Health Action Plan, Mental Health Bill,
several national programmes for children, youth, elderly, women and others, India is
at an opportune and appropriate juncture to build population centred and public
health oriented mental health programmes for the coming years.

NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS

Introduction
National programme for Control of Blindness was introduced in year 1976.
The National Blindness programme was very important programme to control the public
health problem in 1983.
The main motive of this programme to reduce the Blindness prevalence rate.
The main goal of National Programme control Blindness to 0.3% by the year 2020.

NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS AND ITS

FUNCTIONING
Rapid survey on Avoidable Blindness conducted under National Programme to control
blindness during 2006 to 2007 showed reduction in the prevalence of blindness from 1.1%
(2001-2002) to 1% (2006-2007).

Activities under National Programme for Control of Blindness:

1. Management Information system
2. Collection and utilization of donated eyes
3. Control of vitamin & its deficiency
4. Monitoring and evaluation
5. School eye screening programme
6. IEC Activity (Information, Education and Communication)

Functioning:
1. Target diseases
2. Human resources development
3. Infrastructure development

1) Target diseases: The target diseases identified for vision 2020 in India include:
1. Glaucoma
2. Refractive errors and low vision
3. Diabetic retinopathy
4. Trachoma (Focal)
5. Cataract ( cloudiness in the eye )
6. Childhood blindness

2) Human Resources Development:

Primary Health Care is a fundamental concept of the World Health Organisation for
improvement in health.
All the elements of primary health care can contribute to the prevention of blindness.
Primary health care workers play very important role to control the blindness.
There are some programmes for Human Resources Development.
These are:
1. Research Programmes
2. Development Programmes
3. Skill Programme
4. Education Programme
5. Training Programme
6. Planning Programme
7. Motivation Programme
8. Evaluation Programme
9. Performance Programme

Strategies:
1. Disease control of avoidable blindness
2. Training of ophthalmic personnel
3. Information, education and communication activities
4. Screening of school children for identification and treatment of refractory error
5. Participation of community and institutions in organising services in rural areas
6. Active screening of population above 50 years of age
7. Coverage of underserved areas for eye care through public private partnership
8. Capacity building of health personnel
9. Decentralised implementation of the scheme through District Blindness Control Societies
10. Organising screening eye camps and transporting operable cases to eye care facilities
11. Developing institutional capacity
12. Established 30 eye care facilities for every 5 lack persons
13. Promoting out-reach activities and public awareness

Goals and Objective of NPCB:

Goals:
1. To provide comprehensive eye care through primary health care.
2. To reduce the prevalence of blindness to less than 0.3%.

Objectives of NPCB:
1. To improve quality of service delivery.
2. To increase the public awareness on eye care.
3. To develop human resources for providing eye care services.
4. Reduce the backlog of blindness.
5. To maintain the nutritional quality of foods.
6. To increase the added nutritional value of a product.
7. To secure participation of voluntary organisation private practitioners in eye care.

Outcomes of Programme:
1. Cataract surgery rate
2. Trading of ophthalmologists
3. Facilities for IOL surgery
Cataract surgical rate is rising in India.
In order that people can come for surgery in large numbers all surgeries or operations are
done in general hospital and transportation facility also provided by hospital.
There are some important points given below :
1. Allowing family members to travel with the patient.
2. Providing all facilities which is available in hospital.
3. Using local language during counsel.
4. Sharing the stories of eye patient from the same community who had been successfully
operated on.
There has been real increase in cataract surgery rate in the Govt. as well as in the voluntry
sector the last five years.

PULSE POLIO PROGRAMME

NATIONAL PROGRAMME OF PULSE POLIO AND ITS FUNCTIONING

Introduction
 Pulse Polio programme was launched in 1995 in India.
 It is conducted twice in each year.
 National Immunisation day is commonly known as Pulse Polio Immunisation
Programme. The global elimination of Polio involves both decrease in the frequency
or rate of the disease and the worldwide elimination of the virus that causes it.
 0-5 year's age group children are administered with polio drops during national and
sub-national Immunisation programmes every year.
 About 172 million children are immunised during each National Immunisation Day
(NID). In India last polio case was reported from Howrah District of West Bengal-in
13th Jan 2018. After that in India no polio case has been reported.
 On 24th February 2012 the World Health Organisation removed the country (India)
name from the list of countries with active endemic wild polio virus transmission.

PRINCIPLE FOR POLIO ELIMINATION

Polio is one of the few diseases that can be eliminated because:
1. Immunity is life long
2. It only affects humans and there is no animal reservoir
3. The virus can only survive for a very short time in the environment
4. An effective, inexpensive vaccine exists

NATIONAL PROGRAMME OF PULSE POLIO AND ITS FUNCTIONING

 In 1995 the Pulse Polio Programme was introduced in India and there were estimated
50,000 polio cases annually.
 In 1997, care based polio surveillance started with Support from (WHO-CNPSP-
WHO) National programme surveillance for detection of polio virus transmission is
being done through Acute Flaccid Paralysis (AFP) with laboratory since then.
 In 1999 in India last care of wild virus type 2 was reported.
 India was the first country to use monovalent vaccine (type 1) in 2005.
 India was the 2nd researcher country to introduce bivalent vaccine in January 2010,
which proved to be very effective.

Functioning:
1. Maintaining community immunity through high quality national and sub national polio
rounds each year
2. Environmental observation have been developed to detect polio virus transmission
3. Government of India has issued guidelines which is effective since March 2014, for
compulsory requirement of polio vaccination to all international travellers for travel between
India and other polio affected countries
4. On 25th April, 2016 India has switched from Trivalent Oral Polio Vaccine (TOPV) to
Bivalent Oral Polio Vaccine (BOPV)
5. Identifying missing children from immunisation process
6. Setting up of booths in all parts of the country. Arranging employees, volunteers and
vaccines.
7. Monitoring of vaccination efficacy.
8. Vaccines are always kept in cold storage or cold areas to protect them from degrading off

Strategies for Polio Elimination:

All countries are using several key strategies to remove the Polio from the whole world.
There are some important strategies which are given below:
a) Routine Immunisation
b) Supplementary Immunisation Activities (SIAs)
c) Investigation and Monitoring of cases of acute flaccid paralysis.
d) House to house activity
e) Using pulse polio booth

a) Routine Immunisation:
Age limit
OPV in the 0-1 year age group
OPV (Oral Polio Vaccine)
Doses: 3 doses

b) Supplementary Immunisation:
Age limit
OPV in the 0-5 year age children
Doses: 4-6 weeks

c) Investigation and Observation of cases of acute flaccid paralysis:

Monitoring data is used to identify areas of wild polio-virus transmission
Age Limit
Covering Percentage
Below 3 years old
100%
Oral vaccine:Oral vaccines are best vaccines for control of the pulse polio because-
It is cheap
It is easy to administer
Oral vaccine directly reaches intestine and prevent from multiple disease causing polio virus
When the vaccine gets flushed out of the body in the form of stool, it may spread to other
children who may not have been immunised
Indian Government conducts the pulse polio immunisation for two days every year until polio
is eradicated
Monitor oral pulse vaccine coverage at district levels
Sustain high level of routine immunisation
Children under 5 years come under Pulse Polio Programme
Every year in December and January all children under 5 years of age are taking two doses of
oral polio vaccine until polio is eradicated.

d) House to House Activity to provide vaccine:

During 4 to 6 days of the Pulse Polio Programme, the teams of health workers will move
from house to house and check carefully to ensure that every single child up to 5 years of age
has received the polio doses.

e) Pulse Polio Booths :

Pulse polio booths are very important and best platform to spread the information regarding
pulse polio vaccine.
All the infants below 1 year are supposed to be receiving a birth dose of "oral polio" vaccine,
called zero dose followed by 3 doses at 6, 10 and 14 weeks of age alongside DPT (3 doses).

Objectives:
1. India has accomplished the objective of Polio destruction as no polio case has been
accounted for over 3 years.
2. On 24th Feb 2012 the World Health Organisation removed India's name from the rundown
of nations with dynamic endemic wild Polio Infection Transmission.
3. To remain vigilant
4. To use guerrilla marketing strategy to maximise audience reach
5. To become largest Pulse Polio Programme initiative in the world
6. To continue heavy screening and evaluation processes
7. Not a single child should miss the immunisation and leaves any chance for polio
occurrence
8. Introduce a district-wise system for monitoring of performance
9. Improve the quality of services
10. NGO should be opened
11. Fast Pulse Polio immunisation programme

Outcomes of the Programme :

 India was declared as a Polio free Nation by WHO on 27th March 2014.
 India has achieved the goal of polio eradication as no polio case has been reported for
more than 3 years after last care reported on 13th January, 2011.
 This achievement of Polio Free Nation cannot be credited to a single person or Govt.
but it is the result of collective work of many stake holders like NGO's, media,
celebrities who promoted these programmes and played a key role in bringing
awareness among the people.
ii) Increase in number of trained ophthalmologists
iii) Better Facilities for eye surgeries

UNIVERSAL IMMUNISATION PROGRAMME (UIP)

  The WHO launched a global immunisation programme in 1974, called 'Expanded
Programme on immunisation to protect against the six preventable diseases-
Diphtheria, whooping cough, tetanus, polio, measles and tuberculosis.
 In 1978, January Expanded Programme of Immunisation was launched.
 The universal immunisation programme was launched in 1985.
 Now this programme is called as universal child immunisation.

Universal immunisation programme and its functioning:

 In India the universal Immunisation programme was introduced on 19th Nov. 1985.
 The programme was given the status of a National Technology Mission in 1986 to
provide a feeling of urgency and commitment to achieve the goals within the specific
period.
 Child survival and safe motherhood programme in 1992 and reproductive Child
Health Programme in 1997 were launched.
 The Government of India constituted a National Technical committee on child health
on 11th June 2000.
 The department of family welfare established a National Technical Advisory Group of
immunisation on 28th Aug 2001.
 A national sociodemographic goal was set up in National Population Policy 2000, to
achieve universal immunisation of children against all vaccine preventable disease by
2010.
Vaccine
Bacillus calmette-Guerin, OP
Diphtheria Pertussis Tetanus, OP
Age
Birth
6 Week
Route of Administration
Intradermal
Intramuscular
Diphtheria Pertussis Tetanus, OP. 10 Weeks Intramuscular
Diphtheria Pertussis Tetanus, OP. 14 Weeks. Intramuscular
Measles. 9 Months Subcutaneously
Universal immunisation programme is one of the largest public health programme in India.
India is the largest manufacturer of the vaccines with a functional national regulatory
authority.
It is centrally sponsored programme under National Rural Health Mission. UIP targeted
approximate 26 million infants and 30 million pregnant women in India.
All vaccines are procured by central government with 100% domestic funding.

Schedule of Universal Immunisation Programme:

The minimum vaccines that an Indian child should receive are the vaccines recommended by
the Government of India under the expanded programme of immunisation.
It includes 3 doses of tetanus toxoid given to the mother and newborn.
After birth the baby receives vaccine against seven killer preventable diseases including BCG
(against tuberculosis) oral polio vaccine, DPT vaccine, hepatitis B and measles vaccine.

14 weeks - 16 weeks. >OPV3 + DPT3 + Hepatitis B 3rd dose

9 months (completed) > Measles
15-18 months. >1st Booster dose of OPV + DPT + Hib + MMR
4-6 years. >2nd Booster dose of OPV + DPT
10 years. >Tetanus toxoid
16 years. >Tetanus toxoid

Strategies of Universal Immunisation Programme:

1. Polio Eradication
2. Reducing dropout rate
3. Strengthen institutional service at all level
4. Strengthen coordination
5. Strengthening micro planning process
6. Use of new or under-utilised vaccines
7. Mass and mid-media campaign
8. Monitoring accountability and supportive supervision
9. Communication and social mobilisation
10. Training and capacity building

Objectives:
1. To increase the immunisation coverage
2. To improve quality of services
3. To eradicate the neonatal tetanus, diphtheria and pertussis by 2009.
4. To establish sufficient, sustainable and accountable fund flow at all levels
5. To introduce a district wise system monitoring & evaluation
6. To ensure that there is sustained demand and reduce social barriers to access immunization
services
7. To establish reliable cold chain equipment and to establish a good surveillance network
8. To achieve self sufficiency in vaccine production and manufacturing of cold chain
equipments

Outcomes of the Programme:

1. The possibility of immunisation is higher for children than urban areas.
2. The possibility of immunisation increases with mother's empowerment index.
3. The possibility of immunisation is higher for children in female headed households.
4. Children from households with electricity are more likely to be immunised.
5. Immunisation chance increase with the standard of living index of children's household.
6. The possibility of vaccination increases with mother's education level, mother's age upto
29 years, mother's exposure to mass media and mother's awareness about immunisation.
7. Boys are more likely to be immunised than girl children.
8. In different religions, Muslim children are least likely to be immunised whereas children
from Christian and other religious minority communities are most likely to be immunised.
9. The children's from the West Zone, North, East, South-Central and North-East are most
likely to be immunised.
10. Increases the possibility to meet health personnel who help mother's to raise awareness
regarding immunisation.

INTEGRATED DISEASE SURVEILLANCE PROGRAMME

 The Integrated Disease Surveillance Programme (IDSP) is a nationwide system in
India, started in 2004, aimed at early detection and long-term monitoring of diseases
  Surveillance programme is based on collecting only the information that is required to
achieve, control objectives of diseases.
 Data requested may differ from disease to disease and some disease may have specific
information needs, requiring specialised systems.
 The surveillance activities that are well developed in one area may act as driving
forces for strengthening other surveillance activities offering possible synergies and
common resources.
 Surveillance may be defined as "ongoing systematic collection, analysis and
explanation of data and the distribution of information to those, who need to know in
order that action may be taken."
 Integrated Disease Surveillance Programme is a localised, state based surveillance
programme in the country.
 It is intended to detect early warning signals of impending outbreaks and help to
initiate an effective response in a timely manner.

Elements of Surveillance Activity:

 Analysis and interpretation
 Follow up action
 Collection of data
 Feed back of Integrated Disease Surveillance Programme
 Compilation of data

Types of Surveillance in Integrated Disease Surveillance Programme (IDSP):

1) Syndromic
2) Presumptive
3) Confirmed
1. Syndromic Information: of diseases on the basis of clinical pattern by paramedical
personnel and members of community.
2. Presumptive: Diagnosis made on typical history, pattern and clinical examination by
medical officers.
3. Confirmed: Clinical diagnosis by medical officer confirmed by positive laboratory
investigation.

Functions and Strategies of IDSP:

1. Several activities are combined into one integrated activity to take advantage of similar
surveillance functions, skills resources and target populations.
2. To integration with medical collages both private college and government college.
3. District level is the basic functional unit for integrating surveillance functions.
4. To provide essential data to monitor progress of ongoing disease.
5. Help to identify areas of health priority where more inputs are necessary.
6. Improving sub-district mobility and communication.
7. Modernisation and computerisation of state and district epidemiology cell.
8. Strengthening of epidemiological capabilities at state and district level by training of
district RRT (Rapid Responsibility Team).
9. Developing of state/district laboratories.
10. Clear case definition and reporting mechanism.
11. A good network of motivated people.
12. Reduce duplication in reporting.
13. Share resources among disease control programmes.
14. Developing/Improving sub-district mobility and communication.
15. Efficient communication system.
16. Translate surveillance and laboratory data into specific and timely public health action.
17. Distribute resources among disease control programmes.
18. Strengthen district level surveillance and response for priority disease.
19. Good feedback and rapid response.
20. All surveillance activities are co-ordinated.
Core Functions
 Detection
 Registration
 Reporting
 Resources
 Confirmation
 Analysis
 Response
 Feed back
Support Functions
 Training
 Supervision
 Resources