HEALTH CARE DELIVERY CONCERNS

NATIONAL HEALTH PROGRAMME

FAMILY WELFARE PROGRAMME
INTERSECTORAL COORDINATION
ROLE OF NGO

By:- firoz qureshi

Dept. psychiatric nursing
 INTRODUCTION
Community health nursing occurs in context of
health care delivery system and this system influence
community health nursing practice. Due to lack of
emphasis on health promotion in health care delivery
system increases the need for health promotion
efforts by community health nurses .Therefore Heath
and health care concern throughout the world has
developed a system for addressing these concerns.
 Health care delivery concerns
Throughout the world approximately
4.5 million children die each year
from diarrheal diseases, while
communicable diseases of all kinds
remains a serious problem in the last
10 years . An assessment of the health
status is required to make a plan for
the Health care delivery services.
This assessment will bring out major
health problem which are the major
health care concerns.
 Health Concerned Areas
1.Communicated disease Problem
Malaria ,TB, Diarrhoeal diseases, Acute Respiratory Infection,
Leprosy, Filaria , AIDS , Kala Azar, Meningitis, Viral Hepatitis
,Japanese Encephalitis , Enteric Fever, Helmenthis infection ,
Immunization problem.

2.Nutrional problem
Protein- Energy Malnutrition
Nutritional Anaemia
Low Birth Weight
Iodine Deficiency Disorder
Endemic Flurosis
Health Concerned Areas Cont...
3. Medical Care Problems
Lack of medical care professionals.
Over crowding in hospital as a result of migration of
people from rural areas.
Scarcity of resources.
Inequitable distribution of services.
Chronic Diseases and Mental health problem.
Adolescent Pregnancy.
Health Concerned Areas Cont...
4.Evironmental Sanitation Problem
Lack of Safe water.
Primitive method of excreta disposal.
Global concern over radiation.
Destruction of Ozone layer.
Air pollution.
Lead poisoning.

Chemical contamination of food supplies.

Health Concerned Areas Cont...
5. Population Problems
The population explosion has inevitable consequences
in all aspects of development, employment, education,
housing, health care, sanitation and environment .The
countrys growth is 1.93% and the Governments goal is
to reduce it to 1%.
6.Human Response to Disasters
Natural and manmade disasters are affecting large
number. e.g. Toxic chemical leak in Bhopal in 1985.
International efforts coordinated by WHO and
International Red Cross have lead to the development
of disaster planning groups throughout the world.
NATIONAL HEALTH PROGRAMMES
To improve the health status of people, to control
communicable diseases, improvement of environment
sanitation, control of population etc. the Central Government
launched the National Health Programmes.

A)Programmes for Communicable Diseases

1. National Vector Borne Diseases Control Programme
(NVBDCP)
2. Revised National Tuberculosis Control Programme
3. National Leprosy Eradication Programme
4. National AIDS Control Programme
5. Universal Immunization Programme
6. National Guinea worm Eradication Programme
7. Yaws Control Programme
8. Integrated Disease Surveillance Programme
 NATIONAL HEALTH PROGRAMMES Cont...

B)Programmes for Non Communicable Diseases

1. National Cancer Control Program
2. National Mental Health Program
3. National Diabetes Control Program
4. National Program for Control and treatment of
Occupational Diseases
5. National Program for Control of Blindness
6. National program for control of diabetes,
cardiovascular disease and stroke
7. National program for prevention and control of
deafness
NATIONAL HEALTH PROGRAMMES Cont...

C)National Nutritional Programmes

Integrated Child Development Services
Scheme
Midday Meal Programme
Special Nutrition Programme (SNP)
National Nutritional Anemia Prophylaxis
Programme
National Iodine Deficiency Disorders Control
Programme
NATIONAL HEALTH PROGRAMMES Cont...

D)Programs related to System Strengthening

/Welfare
1. National Rural Health Mission
2. Reproductive and Child Health Programme
3. National Water supply & Sanitation Programme
4. 20 Points Programme
NATIONAL HEALTH PROGRAMMES Cont...

1. National Anti-Malarial Programme (NMCP)

National Malarial Programme was launched in
April 1953 and was based on spraying with DDT .
It also paid rich dividends to the country in
different fields like agriculture, land projects and
industry which changed the strategy and launched
National Malaria Eradication Programme in 1958
and renamed as National Anti-Malarial Programme
in 1999 .
NATIONAL HEALTH PROGRAMMES Cont...
2. National Filaria Control Programme
It has been in operation since 1955.It was merged with the
urban malaria scheme for maximum utilisation of available
resources. It includes vector control through anti-larval
operations, source reduction, detection and treatment of
microfilaria carriers, morbidity management and IEC.

3. National Leprosy Eradication Programme

National Leprosy Control Programme has been in operation
since 1955, as a centrally aided programme to achieve control
of Leprosy through early detection of cases and DDS
(Dapsone) monotherapy on an ambulatory basis.
NATIONAL HEALTH PROGRAMMES Cont...
3.National Leprosy Eradication Programme Cont...
In 1983, it was redesigned as National Leprosy Eradication
Programme which was based on yearly detection of cases( by
Population surveys, school surveys and voluntary referrals),
short term multi drug therapy, health education, ulcer and
deformity care and rehabilitation activities.
4. National Tuberculosis Programme
It has been in operation since 1962 and its objectives were to
reduce tuberculosis in the community to that level when it
ceases to be a public health problem and to detect the
maximum number of TB cases,to vaccinate newborns and
infants with BCG and to undertake the objectives in an
integrated manner through all the existing health institutions
in the country.
NATIONAL HEALTH PROGRAMMES Cont...
4. National Tuberculosis Programme Cont...
In 1992, the government of India, WHO, and World Bank together reviewed
the NTP and this programme is known as Revised National Tuberculosis
Control Programme which aims augmentation of case finding activities,
involvement of NGOs, IEC and improved operational research.

5. National AIDS Control Programme

It was launched in 1987 which aimed at to reduce the spread of HIV
infection in India and to strengthen Indias capacity to respond to
HIV/AIDS on the long term basis.
In April 2002, National AIDS Prevention and control policy were approved
by government of India, which aimed in reduction of the impact of epidemic
and to bring about a zero transmission rate of AIDS by the year 2007.
NATIONAL HEALTH PROGRAMMES Cont...
5.National AIDS Control Programme Cont...
In April 2002, National AIDS Prevention and control
policy were approved by government of India, which
aimed in reduction of the impact of epidemic and to bring
about a zero transmission rate of AIDS by the year 2007.

6.National Programme for Control of Blindness

It was launched in 1976 which aimed to strengthen
service delivery, developing human resources for eye care,
promoting out reach activities and public awareness; and
to establish eye care facilities for every 5 lakh persons.
Vision 2020:The Right to Sight to reduce avoidable
blindness by the year 2020.
NATIONAL HEALTH PROGRAMMES Cont...
7.Iodine Deficiency Disorders Control Programme
It is in operation since 1962.Its essential component are
use of iodized salt in place of common salt, monitoring and
surveillance, manpower training and mass communication.

8. Universal Immunisation Programme.

In 1974, the WHO launched its Expanded programme on
Immunisation(EPI) against six preventable childhood
diseases(Diphtheria, Pertusis, tetanus, polio, TB and
Measles).
Universal Immunisation Programme, was started in India
in 1985.It has two vital components: Immunisation of
pregnant women against tetanus, and immunisation
against six EPI targeted childhood diseases.
Introduction of Hepatitis-B Vaccine, Urban Measles
Campaign and Neonatal Tetanus Elimination.
NATIONAL HEALTH PROGRAMMES Cont...
9. National Cancer Control Programme
It was launched in 1975-76 with objectives of prevention, early
diagnosis, treatment.
It was revised in 1984-85 with objective of primary, secondary,
tertiary prevention.

10. National Water Supply And Sanitation Programme

It was launched in 1954 with object of providing safe water supply
and adequate drainage facilities for the entire urban and rural
population of the country.

11.Minimum Need Programme

It was introduced in the first year of the Fifth Five Year Plan
(1974-1978) with the objective to provide certain basic minimum
needs and thereby improve the living standards of the people.
NATIONAL HEALTH PROGRAMMES Cont...
12. 20-Point Programme
It was launched in 1975, by the Government of India with
the objective to promote social justice and economic growth.
Point 1:Attack on rural poverty
Point 7:Clean drinking water
Point 15:Improvement of slums
Point 17:Protection of the environment

13.National Mental Health Programme

It was launched during 1982 with a view to ensure
availability of Mental Health Care Services for all, especially
at risk and underprivileged section of the population, to
encourage and social development.
NATIONAL HEALTH PROGRAMMES Cont...
13.National Mental Health Programme Cont...
Aims
Prevention and treatment of mental and neurological
disorders and their 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.
14. Reproductive and Child Health Programme
It was launched on 15 October 1997 which
incorporated family planning, child survival
and safe motherhood component, client approach
to health care and prevention / management of
reproductive tract infection, STD and AIDS.
NATIONAL HEALTH PROGRAMMES Cont...
14. Reproductive and Child Health Programme continued.....
The main highlights of RCH Programme are:
1.It integrates all interventions of fertility regulation, maternal and
child health with reproductive health for both men and women.
2. The services to be provided are client oriented, high quality and
based on needs of community.
3. It envisages up gradation of the level of facilities for providing
various intervention and quality of care. The First Referral
Units (FRUs) being set up at sub-district level provide
comprehensive emergency obstetric and new born care.
4. Facilities of obstetric care, MTP and IUD insertion in the
PHCs level are improved. IUD facilities are also available at
sub-centres.
5. The programme aim at improving the out-reach of services
primarily for the vulnerable group of population.
 NATIONAL HEALTH PROGRAMMES Cont...
14. Reproductive and Child Health Programme continued.....
RCH Phase II
It began form 1st April 2005.whose focus is to reduce maternal and
child morbidity and mortality with emphasis on rural health care. Its
component include essential and emergency obstetric care and
strengthening referral system.

15. National Guinea-Worm Eradication Programme

India launched this Programme in 1984 with technical assistance
from WHO.

16.Degue Fever Control Programme:

An outbreak was reported in1996.Since then dengue has been
reported. It includes all aspect of control measure like identification
of outbreak, vector control, case management, IEC activities,
monitoring and reporting, etc.
NATIONAL HEALTH PROGRAMMES Cont...
17.National surveillance Programme For Communicable
Diseases:
It was launched by Ministry of Health and Family Welfare
for detection of early warning signals of outbreak emerging
and re-emerging infectious diseases, and rapid response for
prevention and control of these outbreak and diseases.

18.National Rural Health Mission:

The Government of India launched this programme on 5 th
April, 2005 for a period of 7 years (2005-2012). The main
aim is to provide accessible, affordable, accountable, effective
and reliable primary health care, and bridging the gap in the
rural health care through creation of a cadre of Accredited
Social Health Activist(ASHA).
NATIONAL HEALTH PROGRAMMES Cont...
19.Nutritional Programme:
A)Vitamin A Prophylaxis Programme:
One of the component of National Programme for Control of
Blindness is to administer single dose of vitamin A containing
200,000 IU orally to all to al preschool children in the
community every 6 month through peripheral health workers.
B)Prophylaxis against nutritional anaemia:
It consist of distribution of iron and folic acid tablets to
pregnant women and young children (1-12 years). MCH in
urban centres in urban areas, primary health centres in rural
areas and ICDS project are engaged in the implementation of
this programme.
C)Control of iodine deficiency disorder.
NATIONAL HEALTH PROGRAMMES Cont...
D)Special nutritional programme
It was started in 1970 for the nutritional benefit of children
below 6 years of age, pregnant and nursing mother. The
supplementary food supplies about 300kcal and 10-12grams of
protein per child per day .The mother receive daily 500kcal
and 25grams of protein. It is provided for 300 days in a year.
E)Balwadi nutritional programme:
It was started in 1970 for the benefit of children in the age
group of 3-6 years in rural areas. It provides 300kcal and 10
grams of protein per child per day.
F) ICDS(Integrated Child Development Scheme):
It was started in 1975 for preschool children below 6 years and
adolescent girls 11-18 years, pregnant and lactating mother.
NATIONAL HEALTH PROGRAMMES Cont...
G)Mid- day meal programme is also known as School Lunch
Programme:
It has been in operation since 1961 with the objective to attract
more children for admission to schools and retain them so that
literacy improvement of children could be brought.

20. Kala Azar Control Programme:

A centrally sponsored programme was launched in 1990-91
with 3 strategies which includes reducing vector population,
insecticidal spray twice annually, early diagnosis and complete
treatment and health education for community awareness.
 NATIONAL HEALTH PROGRAMMES Cont...

21.Japanese Encephalitis Control Programme:

It is a disease with high mortality rate. The strategies are care of patient,
development of safe and standard vaccine, to identify high risk group by
measuring blood level of antibodies, epidemiological monitoring of
disease for implementation of prevention and control measures.

22.National Diarrheal disease Control Programme:

It was launched in 1981 with strategies as follows-
a)ORS packet available. At each sub centre 300 packets/ year are stocked.
Each village health guide is given 100 packets a year.
b)Mass education is imparted to make people aware of correct feeding of
preschool children and prevention of dehydration through liberal use of
home available fluids.
NATIONAL FAMILY WELFARE PROGRAMME
India launched the National Family Welfare Programme in
1951 with the objective of reducing the birth rate to the extent
necessary to stabilize the population at level consistent with the
requirement of National economy. The Family Welfare
Programme in India is recognised as a priority area, and is
being implemented as a 100%centrally sponsored programme.
During 3rd Five Year Plan(1961-1966) Family was declared
as the very centre of planned development. The emphasis was
laid on education approach for motivating the people for
acceptance of small family norm.
1965-Introduction of Lippes Loop
1966-Department of Family Planning by Ministry of Health.
1966-1969-The Family planning infrastructure (PHCs, sub
centres ,district and state bureaus) was strengthened.
NATIONAL FAMILY WELFARE PROGRAMME
4th Five Year Plan(1969-74)-The Government of India gave
top priority to programme which was made an integral part of
MCH activities of PHCs and sub centre.
1970-An All India Postpartum Programme introduced.
1972-The Medical Termination Of Pregnancy(MTP) was
introduced.
5th Five YEAR Plan(1975-1980)-Major changes.
April 1976-The country framed National Population Policy.
1977-The Ministry of Family Planning was renamed as
Family Welfare. The launching of Rural Health Scheme and
involvement of local people (e.g. Health Guides, trained Dais)
in Family Welfare Programme at grass root level were aimed
at accelerating the pace of progress of programme.
NATIONAL FAMILY WELFARE PROGRAMME

1978-Alma Ata Declaration.

Sixth Five Year Plan(1980-1985)
1982-National Health Policy formed and was approved by
parliament in 1983. It laid a goal to attain 2-child family norm
through the attainment of birth rate of 21 and death rate of 9 per
thousand population by the year 2000.
Seventh Five Year Plan(1985-90)
1985-86- The Universal Immunisation Programme aimed in
reduction of mortality and among infants and children due to
vaccine preventable disease.
The oral rehydration therapy was also started in view of
diarrhoea was a leading cause of death in children.
MCH was implemented to improve health status of mother.
NATIONAL FAMILY WELFARE PROGRAMME
For spacing births:
a) Condoms
b) Oral Contraceptive Pill
c) Intra Uterine Devices (IUD)
Terminal Methods:
a) Tubectomy ;i ) Mini Lap Tubectomy ii) Lapro
Tubectomy
b)Vasectomy; i ) Conventional Vasectomy ii) No-Scalpel
Vasectomy

1992-Child Survival and Safe Motherhood (CSSM)

Programme.
1994-Implementation of Unified Reproductive and Child
Health Programme (RCH).
NATIONAL FAMILY WELFARE PROGRAMME
Ninth Five Year Plan(1997-2002)-The concept of RCH is to
provide need based, client oriented, demand driven, high
quality integrated services.
2000-The Government of India evolved a more detailed and
comprehensive National Population Policy to promote family
welfare.

X Five Year Plan objectives: Reduction in the decadal rate of

population growth between 2001 and 2011 to 16.2%; Increase
in Literacy Rates to 75 per cent within the Tenth Plan period
(2002 to 2007) Reduction of Infant mortality rate (IMR) to 45
per 1000 live births by 2007 and to 28 by 2012.
NATIONAL FAMILY WELFARE PROGRAMME

Goals: XI FYP; Reducing MMR to 100, Reducing IMR to 28,

Reducing TFR to 2.1. Providing clean drinking water for all by
2009. Reducing malnutrition among children of age group 03 to
half its present level. Reducing anaemia among women and girls
by 50%. Raising the sex ratio for age group 06 to 935 by 2011
12 and 950 by 201617.

AncillaryMeasures
The age for marriage has been raised to 18 years for girls and 21
for boys.
Group incentives are offered to Doctors, Panchayats, teachers and
cooperative societies to promote family welfare.
Donation to government, local bodies and recognised NGOs for
family welfare work are exempt from income tax.
NATIONAL FAMILY WELFARE PROGRAMME

Impact
The awareness about family planning was nil
before the launching of the programme has gone
up to 60% in rural and almost 90% in urban
areas.
The pregnancy rate has declined by more than
50% , particularly in urban areas. The birth rate
has declined to 27/1000 population.
 INTERSECTORAL COORDINATION
Intersectoral Coordination is the primary health care.
It is a crucial component for promotion of intersectoral
linkages which is required for effective implementation of
health services throughout the country.
It ensure convergence of basic social service in order to bring
all health sector services providers into closer and more
responsive working relationships for the benefit of the
society.
This will enable better equity and wider coverage.
 INTERSECTORAL COORDINATION
The Health Care System is intended to deliver health care
services. It operates in context of socio-economic and political
framework of country. In India, it is represented by 5 major
sectors which differ from each other.

1.Public Sector(PHC, Hospitals, Insurance Scheme etc.)

2.Private Sector(Private hospitals, polyclinics, Nursing homes,
dispensaries, general practitioners and clinics)
3.Indegeneous System of Medicine (Ayurveda, Unani, Homeopathy,
Siddha etc)
4.Voluntary Agencies
5.National Health Programmes
 Intersectoral Coordination Cont..
Voluntary Health Agencies
A Voluntary Health Agency is defined as an organisation that
is administered by an autonomous board which holds meetings,
collect funds for its support chiefly from private sources and
expends money whether with or without paid worker, in
conducting a programme directed primarily to furthering the
public health by providing health services or education, or by
advancing research or legislation for health, or by a
combination of these activities.
Functions

1. Supplementing the work of government agencies.

2. Pioneering
3. Education
 Intersectoral Coordination Cont...
Function cont...
3.Demonstration
4.Guarding the work of Government Agencies
5.Advancing Health Legislation

Voluntary Health Agencies are

Indian Red Cross Society in 1920.
Hind Kusht Nivaran Sangh in 1950 with headquarters in
New Delhi.
Indian Council for Child Welfare in 1952.
Tuberculosis Association Of India in 1939.
Bharat Sevak Samaj in 1952.
 Voluntary Health Agencies cont...
Central Social Welfare Board in August 1953.
The Kasturba Memorial Fund in 1944.
Family Planning Association of India in 1949 with
headquarters at Mumbai.
All India Womens Conference, 1926.
The All India Blind Relief Society, 1949.
Professional Bodies
International agencies.
 NON-GOVERNMENTAL ORGANISATION
DEFINITION
UN says A non-governmental organization
(NGO) is a not-for-profit, voluntary citizens
group, which is organized on a local, national or
international level to address issues in support of
the public good.
Some of the Ngos are Rockefeller Foundation,
Ford Foundation, International Red Cross, TNAI,
All India Womens conference, Indian Medical
Association, World Federation of Medical
Education etc.
 ROLE OF NGO
Development and Operation of Infrastructure:
Community-based organizations and cooperatives can acquire,
subdivide and develop land, construct housing, provide
infrastructure and operate and maintain infrastructure such as
wells or public toilets and solid waste collection services. They
can also develop building material supply centres and other
community-based economic enterprises. In many cases, they
will need technical assistance or advice from governmental
agencies or higher-level NGOs.

Supporting Innovation, Demonstration and Pilot Projects:

NGO have the advantage of selecting particular places for
innovative projects and specify in advance the length of time
which they will be supporting the project - overcoming some
of the shortcomings that governments face in this respect.
 ROLE OF NGO
Supporting Innovation, Demonstration and Pilot Projects
Cont...
NGOs can also be pilots for larger government projects by virtue
of their ability to act more quickly than the government
bureaucracy.

Facilitating Communication:
NGOs use interpersonal methods of communication, and study the
right entry points whereby they gain the trust of the community
they seek to benefit. They would also have a good idea of the
feasibility of the projects they take up. The significance of this role
to the government is that NGOs can communicate to the policy-
making levels of government, information about the lives,
capabilities, attitudes and cultural characteristics of people at the
local level.
 ROLE OF NGO Cont....

Facilitating Communication Cont...

NGOs can facilitate communication upward from people to the
government and downward from the government to the people.
Communication upward involves informing government about
what local people are thinking, doing and feeling while
communication downward involves informing local people
about what the government is planning and doing. NGOs are
also in a unique position to share information horizontally,
networking between other organizations doing similar work.

Technical Assistance and Training:

Training institutions and NGOs can develop a technical
assistance and training capacity and use this to assist both CBOs
and governments.
 ROLE OF NGO Cont....
Research, Monitoring and Evaluation:
Innovative activities need to be carefully documented and
shared - effective participatory monitoring would permit the
sharing of results with the people themselves as well as with
the project staff.
Advocacy for and with the Poor:
In some cases, NGOs become spokespersons or ombudsmen for
the poor and attempt to influence government policies and
programmes on their behalf. This may be done through a
variety of means ranging from demonstration and pilot projects
to participation in public forums and the formulation of
government policy and plans, to publicizing research results
and case studies of the poor.
 ROLE OF NGO Cont....
Advocacy for and with the Poor Cont...
Thus NGOs play roles from advocates for the poor to
implementers of government programmes; from agitators and
critics to partners and advisors; from sponsors of pilot projects to
mediators.
Provides valuable resources in promoting health care.