• Issues Analysis 360o

Health : 2015


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Mission Indradhanush

The Ministry of Health & Family Welfare has launched “Mission Indradhanush”, depicting seven colours of the rainbow, to fully immunise more than 89 lakh children who are either unvaccinated or partially vaccinated; those that have not been covered during the rounds of routine immunisation for various reasons. They will be fully immunised against seven life-threatening but vaccine preventable diseases which include diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis-B. In addition, vaccination against Japanese Encephalitis and Haemophilus influenza type B will be provided in selected districts/states of the country. Pregnant women will also be immunised against tetanus.

The first round of the first phase started from 7 April 2015-World Health Day- in 201 high focus districts in 28 states and carried for more than a week. This will be followed by three rounds of more than a week in the months of April, May June and July 2015, starting from 7th of each month. The 201 high focus districts account for nearly 50% of all unvaccinated or partially vaccinated children in the country. Of these, 82 districts are in just four states of UP, Bihar, Madhya Pradesh and Rajasthan and account for nearly 25% of all unvaccinated or partially vaccinated children of the country.

Within the districts, the Mission will focus on 4, 00,000 high risk settlements identified as pockets with low coverage due to geographic, demographic, ethnic and other operational challenges. These include nomads and migrant labour working on roads, construction sites, riverbed mining areas, brick kilns, and those living in remote and inaccessible geographical areas and urban slums, and the underserved and hard to reach populations dwelling in forested and tribal areas.

In addition second phase was launched on 7th October 2015 in 352 districts of the country. During second phase, four special intensified immunization drives are being conducted for 7 days starting from 7th October and are planned to be repeated on the same date for four consecutive months i.e. 7th November, 7th December 2015 and 7th January, 2016 covering all children under two years of age, and pregnant women for tetanus toxoid vaccine. Achievements of Mission Indradhanush:-

As per data available, during the first phase of Mission Indradhanush, 9.4 lakh sessions were held, during which 1.89 crore vaccines were administered to the children and pregnant women. During these immunization rounds more than 75 lakh children were vaccinated and about 20 lakh children were fully vaccinated. Also, more than 20 lakh pregnant women were vaccinated with tetanus toxoid vaccine during these four rounds. To combat the problem of diarrhea, zinc tablets and ORS packets were freely distributed to all the children to protect them against diarrhea. More than 16 lakh ORS packets and about 57 lakh zinc tablets were distributed to the children during these four rounds of Mission Indradhanush.

As per the data available on 26th Nov 2015, during Phase II of Mission Indradhanush, 4.49 lakh sessions were held, during which about 70 lakh vaccines were administered to the children and pregnant women. During these immunization rounds more than 27 lakh children were vaccinated and about 8 lakh children were fully vaccinated. Also, more than 6 lakh pregnant women were vaccinated with tetanus toxoid vaccine during these four rounds. To combat the problem of diarrhoea, zinc tablets and ORS packets were freely distributed to all the children to protect them against diarrhea. More than 5 lakh ORS packets and about 17 lakh zinc tablets were distributed to the children during these four rounds of Mission Indradhanush.

The preparation and learning during the implementation of the four rounds have led to health systems strengthening in terms of drawing up detailed micro plans; designing sturdy framework for stringent monitoring and evaluation of the immunisation rounds in the states(more than 3600 state and central level monitors have been deputed); training of nearly 9 lakh frontline workers; identification and analysis of limiting factors in different states leading to creating effective structures to mitigate them.

Maternal and Neonatal Tetanus Eliminated (MNTE)

All the States/UTs of India have been validated for Maternal and Neonatal Tetanus Elimination (MNTE) well before the global target date of December, 2015. The Maternal and neonatal tetanus validation in India started in 2003 in a phased manner. Andhra Pradesh was the first state to validate MNT elimination. Nagaland was the last state in the country where the validation exercise was completed on 17th April 2015.

A formal communication has been received from Dr. Flavia Bustreo, Assistant Director-General, WHO congratulating India on achieving the milestone of Maternal and Neonatal Tetanus elimination in 2015.

Maternal and Neonatal Tetanus Elimination (MNTE) is defined as less than one neonatal tetanus case per thousand live births per year in every district. In 1989, global deaths from Neonatal Tetanus (NT) were estimated at 7.87 lakh per year and India contributed to approximately 2 lakh deaths.

India has achieved this validation through the system strengthening including improvement of institutional delivery, which is also a proxy indicator for clean delivery and clean cord care practices and by strengthening Routine Immunization. Strategies to improve clean delivery have been included in the innovative Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karayakaram (JSSK).

Decision to Introduce New Vaccines

In a bid to protect the children from more vaccine preventable diseases, new vaccines are proposed to be introduced as part of India’s Universal Immunisation Programme (UIP). Introduction of these vaccines will be done in a phased manner over a period of time, depending upon the field level assessments and preparedness. In addition, it has been decided to introduce an adult vaccine against Japanese Encephalitis (JE) in the high burden districts. The new vaccines are:

a) Inactivated Polio Vaccine (IPV)

India is Polio free but to maintain this status, the Inactivated Polio Vaccine was introduced on 30th October 2015. The vaccine has been initially introduced in six states: Bihar, Uttar Pradesh, Madhya Pradesh, Gujarat, Assam and Punjab. This will benefit 2.7 crore children every year.

b).Adult Japanese Encephalitis (JE) vaccine

21 high burden districts have been identified in Assam, Uttar Pradesh and West Bengal for adult JE vaccination in the age-group of 15-65 years.  This will cut down deaths and morbidity due to Japanese Encephalitis in adults as welll

c) Rotavirus vaccine

Rotavirus is the leading cause of severe diarrhoea among infants and young children in the world. Each year India loses approximately 2 lakh children to diarrhoea out of which 1 lakh deaths are caused by Rotavirus. Rotavirus vaccine implemented to full scale would save approximately 1 lakh lives every year. The vaccine is planned to be introduced in first quarter of 2016 in four states initially i.e. Odisha, Himachal Pradesh, Haryana and Andhra Pradesh.

d.Measles Rubella vaccine

Measles Rubella vaccine eliminates measles and controls Rubella in the country. The vaccine will help to reduce incidence of Congenital Rubella Syndrome. As on date, approximately 25,000 cases of CRS are estimated each year and if the child survives, this adds to the disabilities in the country.

MR vaccination campaign will be carried out after appropriate planning and will cover 45 crore children.

Child Health

Special New born Care Units (SNCUs)

In order to strengthen the care of sick, premature and low birth weight newborn Special New born Care Units (SCNU) have been established at District Hospitals and tertiary care hospitals. These are 12-20 bedded units, with 4 trained doctors and 10-12 nurses and support staff with provision of 24x7 services to sick newborns. Presently 602 SNCUs are reported operational and more than 7.5 lakh newborns treated in these in 2014-15.

MoHFW provides free entitlement of care at these centres under Janani Shishu Suraksha Karyakaram. Each SNCU is expected to provide: Care at birth including resuscitation of asphyxiated newborn, sick newborn and routine postnatal care. Follow up of high risk newborn and Immunization/Referral Services are also provided for. Once the baby is discharged to home ASHA (Accredited Social Health Activist) will do the follow up of these babies for one year. District Early Intervention Centre (DEIC) have also been linked with SNCU to provide specialized care to the babies with special needs and delays.                          

National Deworming Day: A Fixed Day Fixed Site strategy

Government of India for effective deworming coverage Like many other countries across the globe, India is also endemic for Soil Transmitted Helminths. More than 241 million children are estimated to be at risk of parasitic intestinal worm infections leading to impaired physical growth, cognitive development, fatigue, internal bleeding. They also cause micronutrient deficiencies leading to poor school performance and absenteeism in children. Albendazole tablets, once in 6 months, is a simple drug proven to reduce the worm load. Understanding the negative impact of worm load in children effecting their growth and development, Ministry of Health and Family Welfare, Government of India, ambitiously launched – National Deworming Day (NDD) on 10th February, 2015 followed by mop-up activities to be carried up to 14th February, 2015 across all Government/ Government aided schools and Anganwadi centers of 11 States/UT.

NDD was implemented in 277 districts across 11 States/UT namely Assam, Bihar, Chhattisgarh, Dadra Nagar Haveli, Haryana, Karnataka, Madhya Pradesh, Maharashtra, Rajasthan, Tamil Nadu and Tripura. More than 4.70 lakh schools and 3.67 lakh Anganwadi centers were covered under the ambitious NDD program. With an achievement of 85 percent coverage, a total of 8.98 crore children aged 1-19 years, received deworming tablet against a target of 10.31 crore during the National Deworming Day. In order to accelerate efforts towards reduction of Childhood mortality, which is one of the prime goals of National Health Mission. Diarrhoea contributes to around 11 percent under-five deaths in country- most of these deaths are clustered around Summer and Monsoon season. To effectively address the issue, Intensified Diarrhoea Control Fortnight (IDCF) was implemented from 27th July to 8th August 2015, with an aim of achieving improved coverage of essential life-saving commodity of ORS, zinc dispersible tablets and practice of appropriate child feeding practices during diarrhoea.

The chief activities during IDCF involved doorstep ORS distribution by ASHA to house with under-five children, counselling for infant and young child feeding, referral of children with diarrhoea for treatment, capacity building of frontline workers for management of childhood diarrhoea, setting up of ORS-zinc corners along with multi-sectoral involvement of Anganwadi centres for growth monitoring of all children, PRI meetings on the subject of childhood diarrhoea, hand-washing sessions in schools.

ORS was pre-positioned in houses of 6.6 crore children to enable timely management of diarrhoea. 36.3 lakh children were treated with both zinc and ORS during the fortnight. 3.4 lakh ORS-zinc corners were established and 5.4 lakh schools participated and 3.2 lakhs village level meetings were undertaken.

Rashtriya Bal Swasthya Karyakram (RBSK)

The Rashtriya Bal Swasthya Karyakram (RBSK) has been launched to provide child health screening and early interventions services by expanding the reach of mobile health teams at block level. These teams will also carry out screening of all the children in the age group 0-6 years enrolled at Anganwadi Centres at least twice a year. RBSK covers 30 common health conditions. States/UTs may incorporate a few more conditions based on high prevalence/endemicity. An estimated 27 crore children in the age group of zero to eighteen years are expected to be covered in a phased manner.

The strategic interventions to address birth defects, disabilities, delays and deficiencies are:

Screening of children under RBSK- Child health screening and early intervention services to with an aim to improve the overall quality of life of children through early detection of birth defects, diseases, deficiencies, development delays including disability (4 Ds) and reduce out of pocket expenditure for the families. Dedicated mobile medical health teams (for screening purpose)  at block level, comprising of four health personnel viz. two AYUSH doctors (One Male, One Female), ANM/ SN, and a Pharmacist. Under this intervention, 10.66 crore children have been screened (FY 2014-15), so far by 9774  teams and 51.78  lakh children have been referred for management of 4 Ds, 22.18 lakh children have been managed for the 30 health conditions. In Q1 (April-June) 2015-16; 1.79 crore children have been screened; 14.03 lakh children have been referred to health facilities; 4.64 lakh children have received secondary and tertiary care.

Maternal Health

“Daksh”

For improving the skills of healthcare providers and to enhance their capacity to provide quality (Reproductive, Maternal, Neonatal, Child & Adolescent Health) RMNCH+A services, Government of India has  established five National Skills  lab ‘’Daksh’’ at Delhi and in NCR region with support from Maternal health division, Government of India and Liverpool school of tropical Medicine(LSTM) at:

  • Jamia Hamdard
  • Trained Nurses  association of India(TNAI)
  • National  Institute of Health and Family Welfare(NIHFW)
  • Safdarjung Hospital.
  • Lady Hardinge Medical College.

These skills lab will handhold and guide creating skills lab and also train state trainers. National Skills labs are being attached to all the states and UTs so that there is an optimum utilization of the National Skills lab. 30 stand-alone skills lab has been established at different states such as Gujarat, Haryana, Bihar, Maharastra, MP, West Bengal, Odisha, Tamil Nadu and Telangana. Additionally 188 MCH wings have been approved across the country which has in built skills lab.

The skills lab has  5 skill cabin and comprises of 16 skill stations where the trainees learn  40 key RMNCH+A skills through practicing skills on mannequins, simulation exercise, demonstration videos and presentation spread over 6 days. Pre validate tools like OSCE (Objective structured clinical examination), emergency drills, supportive supervision and hand holding exercise at their place of work are few things which distinct them from other training programmes. Skills labs serves as a prototype demonstration and learning facility for health care providers with competency based training. The labs have an edge over other didactic methods by providing the opportunity for repetitive skill practice, simulating clinical scenarios under the supervision of a qualified trainer.

The objectives of Skills lab are to : A) Facilitate acquisition/ reinforcement of key standardized technical skills and  knowledge by service providers for RMNCH+A services b) Ensures the availability of skilled personnel at health facilities c) Improves the quality of pre service training d) Provides continuing Nursing education / Continuing medical education. The target audience of 6 days skills lab training are Obstetricians and Gynaecologists, Paediatricians, Medical Officers, staff Nurses, Auxiliary Nurse Midwife (ANM), state trainers and faculty of Nursing School/ colleges and Medical College who can adapt it for strengthening pre service teaching.

National Skills lab ‘Daksh’ at National Institute of Health and Family Welfare(NIHFW), R.K. Puram, New Delhi was inaugurated by Shree Jagat Prakash Nadda Hon’ble Union Health and Family Welfare Minister on 9thMarch, 2015.

Till date 797 health personnel have been trained at National Skills lab with different cadre including Nursing tutors, Skills lab trainers, Professors, Medical officers, skills lab trainer etc.

The Government of India’s latest initiative of Skills Labs to target preventable causes of death directly can be a major breakthrough in saving women’s lives.

Adolescent Health

Rashtriya Kishor Swasthya Karyakram (RKSK)

The Rashtriya Kishor Swasthya Karyakram (RKSK) was launched in January 2014 with an overarching aim to address sexual and reproductive health, nutrition, injuries and violence (including gender based violence), prevention of non-communicable diseases, mental health and substance misuse related concerns of  253 million adolescents of our country through effective and coherent implementation of programmes and schemes. The short term goal is to ensure holistic health and development of adolescents and the long term outcome will be increased social and economic productivity of our nation.

The programme is underpinned by the principles of equity and inclusion; rights based approach, adolescent and community participation and strategic partnership. The key components of the program are community based interventions; facility based interventions; social and behavior change communication; and inter-sectoral convergence.

Community based interventions-

Peer Education Programme: To build a community of proactive and confident adolescents, who are well informed and are capable of taking appropriate decisions about their health and wellbeing, is one of the key drivers of RKSK programme.  The Ministry of Health and Family Welfare in its Operational Guideline for RKSK proposed to select and orient four peer educators i.e. two male and two female peer educators per village or 1000 population. These community level peer educators will receive standardized information and knowledge on sexual and reproductive health, nutrition, injuries and violence, prevention of non-communicable diseases, mental health and substance misuse through structured orientation sessions.

After orientation, peer educators are expected to form group of 15-20 boys and girls and to conduct weekly participatory sessions on adolescent health, facilitate organization of Adolescent Health Day and ensure linkages with Adolescent Friendly Health Clinics (AFHCs) and Adolescent Helpline. During the first phase of implementation of PE programme, 50% Blocks in 213 RKSK districts have been selected. Further to this, two PHC under each of these selected CHCs have been identified for roll-out of PE programme. PE selection and trainings are in the process of being conducted in all villages under the two identified PHCs, this will be facilitated by village ASHA with active involvement of ANMs, school teachers and local committees such as VHNSC.  Villages under approximately 1800 Primary Health Centres will be covered in the first phase of implementation of PE scheme. During the course of the year, around 2 lakhs peer educator will be selected through a community led and community based process and trained.   

Weekly Iron Folic Acid Supplementation (WIFS) programme

WIFS entails provision of weekly supervised IFA tablets to in-school boys and girls and out-of-school girls for prevention of iron and folic acid deficiency anaemia, and biannual albendazole tablets for helminthic control. The programme is being implemented across the country in both rural and urban areas, covering government, government aided schools, municipal schools and Anganwadi centres. Screening of targeted adolescents population for moderate/ severe anaemia and referral of these cases to an appropriate health facility; and information and counselling for prevention of nutritional anaemia are also included in the programme.

The programme is been implemented through convergence with key stakeholder ministries- the Ministry of Women and Child Development and Ministry of Human Resource Development, with joint programme planning, capacity building and communication activities. The programme aims to cover a total of 11.2 crore beneficiaries including 8.4 crore in-school and 2.8 crore out-of-school beneficiaries.

The National Health Mission (NHM)

The National Health Mission (NHM) encompasses its two Sub-Missions, the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM). The main programmatic components include Health System Strengthening in rural and urban areas, Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A), and Communicable and Non-Communicable Diseases. The NHM envisages achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people’s needs.

National Rural Health Mission (NRHM): NRHM seeks to provide accessible, affordable and quality health care to the rural population, especially the vulnerable groups. Under the NRHM, the Empowered Action Group (EAG) States as well as North Eastern States, Jammu and Kashmir and Himachal Pradesh have been given special focus. The thrust of the mission is on establishing a fully functional, community owned, decentralized health delivery system with inter-sectoral convergence at all levels, to ensure simultaneous action on a wide range of determinants of health such as water, sanitation, education, nutrition, social and gender equality.

National Urban Health Mission (NUHM): NUHM seeks to improve the health status of the urban population particularly urban poor and other vulnerable sections by facilitating their access to quality primary health care. NUHM covers all state capitals, district headquarters and other cities/towns with a population of 50,000 and above (as per census 2011) in a phased manner. Cities and towns with population below 50,000 will continue be covered under NRHM.

Progress under NHM:-

Augmentation of Human Resources

NRHM has attempted to fill the gaps in human resources by approving nearly 2.3 lakh additional  health  human  resources to  the  States,  including  10,027 Medical Offiders, 4,023 Specialists,  78,168 ANMs,  53,456  Staff  Nurses,  35,514  AYUSH  Doctors etc. on contractual basis. Apart from providing support for health human resource, NRHM has also focused on multi-skilling of doctors at strategically located facilities identified by the states e.g. MBBS doctors are trained in Emergency Obstetric Care (EmOC), Life Saving Anaesthesia Skills (LSAS) and Laparoscopic Surgery.

Accredited Social Health Activist (ASHA)

Under the Framework for Implementation of NRHM, a female community health worker called Accredited Social Health Activist (ASHA) has been engaged in each village in the ratio of one ASHA per 1000 population or one ASHA per habitation in tribal areas. Up to June, 2015, 9.15 lakh ASHAs and link workers have been selected  in  entire  country, out  of  which 8.42 lakh  have been  given the orientation training and engaged Further, 8.82 lakh ASHAs have been provided with drug kit.

Infrastructure strengthening/upgradation

NRHM seeks to strengthen public health delivery system at all levels. During the last 10 years (up to June 2015), 30,750 new constructions and 32,847 renovation/upgradation projects for various health facilities including SC, PHC, CHC, SDH and DH were sanctioned.

24x 7 Services and First Referral facilities

2,706 Referral Hospitals were strengthened to act as First Referral Units (FRUs). 13,667 PHCs/CHCs were strengthened to provide 24x7 services. 14,441 Newborn Care Corners(NBCC), 575 Special Newborn Care Units (SNCU) and 2,020 Newborn Stabilization Units NBSU)  were  established  under  NHM  to  improve  newborn  care  and  reduce  neonatal mortality and morbidity.

Mobile Medical Units

In  order to provide  services  to the  most  remote  and hard  to  reach  areas,  States  have been supported with Mobile Medical Units (MMUs). Over the 10 years of NRHM, 333 out of 672 districts have been equipped with MMUs.  So far 1,107 MMUs are operational in the country.

National Ambulance Services

31  States/UTs  have the  facility  where  people  can  dial  108  or  102 telephone number  for  calling  an  ambulance.   Dial  108  is  predominantly   an  emergency   response system,  primarily  designed  to  attend  to  patients  of  critical  care,  trauma  and  accident victims etc. Dial 102 services essentially  consist  of basic patient transport  aimed to cater the  needs  of  pregnant  women  and  children  though  other  categories   are  also  taking benefit and are not excluded.  JSSK entitlements e.g.   Free transfer from home to facility, inter facility transfer in case of referral and drop back for mother and children are the key focus of 102 service.  This  service  can  be  accessed  through  a toll  free  call  to  a Call Centre.

Presently, 7,358  Dial 108, 7,836  Dial 102 and 400  Dial 104 Emergency  Response  Service Vehicles are supported  under NHM, besides  6,290 empanelled vehicles for transportation of  patients,  particularly  pregnant  women  and  sick  infants  from  home  to public health facilities  and back.

Mainstreaming of AYUSH

Mainstreaming of AYUSH has been taken up by allocating AYUSH facilities in 10042 PHCs, 2732 CHCs, 501 DHs, 5714 health facilities above SC but below block level and 421  health facilities other than CHC at or above block level but below district level.

Community   Participation

To ensure  involvement  of the communities  in over-seeing  the provisioning  of health care and to redress  public  grievances,  31,763  Rogi  Kalyan  Samitis  or Hospital  Management Committees  at health facilities  above the Primary  Health Centre level and over 5.01 lakh Village Health  Sanitation.   Nutrition   Committee   (VHSNCs)   at village   level have been constituted across the country.

Financial   Progress

One of the key mandates of NHM has been to increase the public expenditure in health sector. Since 2005, there has been a significant improvement in the utilization. Since the inception of NRHM, Rs. 1, 34,137.31 crore (up to October 2015) has been released to States/UTs under NHM.

Reproductive and Child Health Services

The MMR, i.e. number of maternal deaths per 100,000 live births, has declined from 560 per 100,000 live births in 1990 to 167 per 100,000 live births in 2011-13. Percentage annual compound rate of decline in MMR during 2005 to 2011-13 accelerated to 5.8% from 5.1% observed during 1990 to 2005. India is poised to achieve the Millennium Development Goal of MMR at the present rate of decline.

(ii)  Infant Mortality Rate (IMR):   The IMR in India declined from 80 in 1990 to 40 in the year 2013. Percentage annual compound rate of decline in IMR during 2005-2013 has accelerated to 4.5% from 2.1% observed during 1990-2005.

Total Fertility Rate (TFR): The TFR in India declined from 3.8 in 1990 to 2.3 in the year 2013. The percentage annual compound rate of decline in TFR during 2005-2013 has accelerated to 2.9% from 1.8% observed during 1990-2005.

India achieved a historical milestone and was certified as 'Polio-free’ by WHO in March 2014 on having no wild polio case since 13th Jan, 2011.

Mother and Child Tracking System

It is a name based tracking system, launched by the Government of India as an innovative application of information technology directed towards improving the health care service delivery system and strengthening the monitoring mechanism. MCTS is designed to capture information on and track all pregnant women and children (0-5Years) so that they receive ‘full’ complement of maternal and child health services, thereby contributing to the reduction of maternal, infant and child morbidity and mortality. A total of 1, 18, 68,505 pregnant women were registered in MCTS during 2015-16 (till Oct’) which indicates a registration of 67.57% as against estimated number of pregnant women in 2015-16. Similarly, a total of 82, 38,820 children under 5 year age have been registered in MCTS till Oct, 2015.

Mother and Child Tracking Facilitation Centre (MCTFC)

MCTFC has been operationalised from National Institute of Health and Family Welfare (NIHFW). It is being operated by 80 Helpdesk Agents (HAs).  It validates the data entered in MCTS in addition to guiding and helping both the beneficiaries and service providers with up to date information on Mother and Child care services through phone calls and Interactive Voice Response System (IVRS) on a regular basis.  MCTFC is creating awareness about Government mother and child health related programmes and also seeking feedback on services being provided.

National Urban Health Mission

National  Urban  Health  Mission  (NUHM)   was  approved   as  a  Sub-Mission   under  an overarching  National  Health Mission (NHM) by the Cabinet on 1st May 2013 for providing equitable and quality primary health care services to urban population  with focus on slum dwellers and  other  vulnerable  population   like  migrant  workers,  homeless,  etc.  NUHM aims to create   Primary  health care service  delivery  infrastructure  which  is largely absent in cities/towns   by  strengthening   of  existing   Urban  Family  Welfare   Centres  (UFWCs), Urban  Health  Posts (UHPs),  dispensaries  and establishment   of new Urban Primary Health Centers (U-PHC) and Urban Community Health Centres (U-CHC) as per the need. 

Key Initiatives under NHM:

Launch of National Quality Assurance Framework for Health facilities:To improve quality of health care in over 31000 public facilities and provide a clear roadmap to states, Quality Standards for District Hospitals (DHs), CHCs and PHCs under National Quality Assurance Framework were rolled out in November, 2014.

Launch of Kayakalp- an initiative for Award to Public Health Facilities: Kayakalp- initiative has been launched to promote cleanliness, hygiene and infection control practices in public health facilities. Under this initiative public healthcare facilities shall be appraised and such public healthcare facilities that show exemplary performance meeting standards of protocols of cleanliness, hygiene and infection control will receive awards and commendation. Further, Swachhta Guidelines for public health facilities to promote Cleanliness, Hygiene and Infection Control Practices in public health facilities were released on 15th May, 2015. The Guidelines provide details on the planning, frequency, methods, monitoring etc with regard to Swachhta in public health facilities.

Launch of National Family Health Survey (NFHS)–IV: NFHS-IV was launched in mid-2014 to provide essential data and information on important emerging health and family welfare elements to track progress on key parameters and provide evidence for policy and programme. The field work of NFHS-IV is under progress. This survey results are expected in 2016 and will provide national, state and district level data.

Launch of India Newborn Action Plan (INAP): Currently, there are estimated 7.47 lakh neonatal deaths annually. In September 2014, INAP was launched for accelerating the reduction of preventable newborn deaths and stillbirths in the country - with the goal of attaining ‘Single Digit Neo-natal Mortality Rate (NMR) by 2030’ and ‘Single Digit Still Birth Rate (SBR) by 2030’. The neo-natal deaths are expected to reduce to below 2.28 lakh annually by 2030, once the goal is achieved.

Launch of Mission Indradhanush: Mission Indradhanush was launched in December 2014 to reach 90 Lakh unimmunized/partially immunized children by 2020. It has been implemented in 201 districts in 1st Phase, 297 additional Districts are to be covered in 2nd Phase.  About 20 lakh children received full immunization during the Phase-1 of Mission Indradhanush.

Approval of four new vaccines- Approval of four new vaccines namely rotavirus, Inactivated Polio Vaccine (IPV), Measles-Rubella vaccine, Japanese Encephalitis vaccine extended to adults. This will significantly reduce vaccine preventable morbidity, disability and mortality.

Free Drugs Service Initiative: An incentive of up to 5% additional funding (over and above the normal allocation of the state) under the NHM is provided to those States that introduce free medicines scheme. Under the NHM-Free Drug Service Initiative, substantial funding is available to States for provision of free drugs subject to States/UTs meeting certain specified conditions. Detailed Operational Guidelines for NHM- Free Drugs Service Initiative have also been released to the States on 2nd July 2015.

Free Diagnostics Service Initiative: The NHM- Free Diagnostics Service Initiative was launched in 2013 to provide free essential diagnostic services at public health facilities under which substantial funding was provided to States within their resource envelope. The Operational Guidelines on Free Diagnostics Service Initiative have been developed by the Central Government and shared on 2nd  July, 2015 with the states various mechanisms adopted for providing free essential diagnostic services include:-

  • Strengthening of the existing systems in public health facilities such as Lab infrastructure, provision of Lab Technician, equipment, etc.
  • Out Sourcing of High Cost -low frequency diagnostic services.
  • Contracting in of services of essential Human Resources (e.g. Radiologist, Lab Technician) on a need basis.

Bio Medical Equipment Maintenance: States have been asked to plan interventions for comprehensive equipment maintenance for all functional medical equipment/machinery. The Ministry has circulated model contract documents for guidance. Support for comprehensive equipment maintenance for all functional medical equipment/machinery is intended to ensure optimum utilisation of medical equipment.

Comprehensive Primary Health Care: Primary health care including preventive and promotive health care enables early detection and prompt treatment and serves a gate-keeping function to secondary and tertiary care, and also reduces the cost of care.    In December 2014, the MoHFW constituted a Task Force to provide a report on roll out of comprehensive Primary Health Care.   The Committee was charged with identifying current challenges to rolling out comprehensive primary health care, finalizing components of service delivery, clarifying the institutional structures and service organizations, developing guidelines for the PHC team, and coordinating with other Task Forces set up by the MoHFW working on Human resources for Health and developing Standard Treatment Guidelines. Nine areas for action to make primary health care comprehensive and universal are proposed. They include:

  • Strengthen Institutional Structures and Organization of Primary Health Care Services.
  • Improve access to technologies, drugs and diagnostics for comprehensive Primary Health Care
  • Increase utilization of Information, Communication and Technology (ICT) - empowering patients and providers
  • Promote Continuity of care- making care patient centric
  • Enhance Quality of Care
  • Focus on Social Determinants of Health
  • Emphasize Community Participation and Address Equity Concerns in Health
  • Develop a Human Resource Policy to support primary health care
  • Strengthen Governance including financing, partnerships and accountability.

States are also offered support through the PIPs of the NHM to strengthen existing sub centers, as Health and Wellness centers with a primary health care team, headed by a mid-level service provider (who would be either an AYUSH or Nurse Practitioner trained through a bridge course in primary health care or public health).  Other members of the team include the ANMs, ASHAs, and AWW of the sub center area.   One important innovation that is being planned is the provision of performance based team incentives linked to achievement of key indicators build around comprehensive primary health care. 

Kilkari & Mobile Academy: To create proper awareness among pregnant women, parents of children and field workers about the importance of Anti Natal Care (ANC), institutional delivery, Post-Natal Care (PNC) and immunization, it was decided to implement the Kilkari and Mobile Academy services in pan India in phased manner. In the first phase Kilkari would be launched in 6 states viz. Uttrakhand, Jharkhand, Uttar Pradesh, Odisha, Rajasthan (HPDs) & Madhya Pradesh (HPDs). The Mobile Academy would be launched in 4 states viz. Uttrakhand, Jharkhand, Rajasthan & Madhya Pradesh.

Kilkari is an Interactive Voice Response (IVR) based mobile service that delivers time-sensitive audio messages (Voice Call) about pregnancy and child health directly to the mobile phones of pregnant women, mothers of young children and their families. The service covers the critical time period – where the most maternal/infant deaths occur - from the 4th month of pregnancy until the child is one year old. Families subscribe to the service receive one pre-recorded system generated call per week. Each call will be 2 minutes in length and serve as reminders for what the family should be doing that week depending on woman’s stage of pregnancy or the child’s age. Kilkari services will be available to states in regional dialect.

Mobile Academy is an anytime, anywhere audio training course on interpersonal communication skills that the ASHA can access from her mobile phone.  It gives ASHAs tips on how to convince families to adopt priority RMNCH behaviors, while refreshing her existing knowledge. The course is 240 minutes long and consists of 11 chapters with 4 lessons each. At the end of each chapter there is a quiz for them and all ANM/ASHAs passes the course will be provided with a printed certificate.

These services will be hosted centrally by MoHFW and single source of information for these services will be Mother and Child Tracking System (MCTS). Also these services will be free of cost to States/ UTs and the Beneficiaries.

Launch of Nationwide Anti-TB drug resistance survey: Drug resistant survey for 13 TB drugs was launched to provide a better estimate on the burden of Multi-Drug Resistant Tuberculosis in the community. This is the biggest ever survey in the world with a sample size of 5214 patients. Results are expected by 2016.

Kala Azar Elimination Plan : To reduce the annual incidence of Kala-Azar to less than one per 10,000 population at block PHC level by the end of 2015,  Kala-Azar elimination Plan was rolled out, which inter-alia includes,

  • New thrust areas launched for UP, Bihar, West Bengal and Jharkhand.
  • New Action Plan to include active search, new drug regimen, coordinated Indoor Residual Spray (IRS) etc.
  • New non-invasive Diagnostic kit launched.
  • Criteria for incentives to States under the NHM were revised. States that show improved progress made on key Outcomes/Outputs such as IMR, MMR, immunization, number and proportion of quality certified health facilities etc. will be able to receive additional funds as incentives.

 


Vishal Thakur By - Vishal Thakur
Posted On - 1/26/2016 10:42:49 PM

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