SEMONAR ON

NATIONAL VECTYOR BORNE

Diseases CONTROL PROGRAM (NVBDCP)

National, filarial control programme, National leprosy eradication

programme and non-communicable disease programme

SUBMITTED TO SUBMITTED BY

Mr. DINESH SHELVAM. S Ms. SAKUNTALA SARKAR

HOD OF COMMUNITY HEALTH NURSING IIND YEAR MSc(N)

P.I.O.N COMMUNITY HEALTH

NURSING.

MASTER PLAN

Subject : Community Health Nursing

Unit : I Unit

Topic : National vector borne disease control programme, National

filarial control programme, National leprosy eradication

programme and non-communicable disease programmes.

Date :

Time :
 Presented by : Ms. Sakuntala. Sarkar.
MSc. Nursing 2nd year
Community Health Nursing
Padmashree Institute of Nursing

Guide : Mr. Dinesh Selvam. S.

Principal.
HOD, Community Health Nursing.
Padmashree Institute of Nursing.

SL.No. INDEX

1. INTRODUCTION

2. TERMINOLOGIES

3. CONTENT
1. National Vector Borne Disease Control Programme.
 National Malaria Eradication Programme
 National Kalaazar Control Programme
 National Japanese Encephalitis Control Program
 National Dengue fever/Dengue Hemorrhagic Fever Control Programme
2. National Filaria Control Programme.
3. National Leprosy Eradication Programme.
4. Non-communicable disease programmes.
 National Program for the Control of Blindness.
 National Cancer Control Programme 1975.
 National Diabetes Control Programme.
 National Mental Health Programme 1982.
 National Iodine Deficiency Disorders Control Program (1962).
5. Responsibilities of community health nurses in national health
programmes.
4. CONCLUSION

5. JOURNAL ABSTRACT

6. BIBLIOGRAPHY

I. INTRODUCTION
Since India became free, several measures have been undertaken by the national
Government to improve the health of the people. Prominent among these measures are the
National Health Programmes, which have been launched by the central Government for the
control or eradication of communicable disease, improvement of environmental sanitation,
raising the standard of nutrition, control of population and improving rural health.

II. TERMINOLOGY
1. Mortality: Relative death rate; the proportion of deaths at particular time and place.
2. Morbidity: Relative disease rate, usually expressed as incidence or prevalence of a disease.
3. Prevalence: The proportion of existing cases of a health outcome in a population at a
particular time.
4. Eradication: Complete elimination of a disease, esp. One that is epidemic or endemic.
5. Elimination: Leaving out, omitting, removing
6. Vector borne diseases: A communicable disease transmitted by insects or other arthropods.
7. Vector: Agent that actively carries a germ to a susceptible host.
8. Communicable disease: A disease of human or animal origin caused by an infectious agent
and resulting from transmission of that agent from an infected person, animal or inanimate
source to a susceptible host. Infectious disease may be communicable or non-communicable,
(i.e., tetanus is infectious but not communicable)
9. Health education: Any combination of learning experiences designed to facilitate
adaptations of behavior conducive to health.
10. Health promotion: Strategies designed to increase the physical, social, and emotional health
and well-being of individuals, families, and communities.
11. Programme: a health care service designed to meet identified health care needs of clients.
12. Tertiary Prevention: programmes directed toward persons with clinically apparent disease,
with the aim of ameliorating the course of disease, reducing disability, or rehabilitating.
13. Strategy: It is pattern of decision in a programme that determines and reveals its objective,
purpose, produces the principle policies and plans for a achieving those goal.
14. Surveillance: Systematic and ongoing observation and collection of data concerning disease
at which are reported to the data collector.
15. Screening: The application of a test to people who are as yet asymptomatic for the purpose
of classifying them with respect to their likehood of having particular diseases.

III. OBJECTIVE
General objective: On completion of the class the group will have in depth knowledge
regarding National vector borne disease control programme, National
filarial control programme, National leprosy eradication programme and
non-communicable disease programmes.

Specific objective: After completion of the class, the group will be able to
1. Define National health programme.
2. List the types of National health programmes.
3. State the goals to be achieved by 2005- 2015
4. List of various National Vector Borne Disease Control Programmes.
5. Enumerate National Filaria Control Programme.
6. Describe about National Leprosy Eradication Programme.
7. Explain about Non-communicable disease programmes.
8. State the responsibilities of community health nurses in national health programmes.

IV. CONTENT
National vector borne disease control programme, National filarial control
programme, National leprosy eradication programme and non-communicable
disease programmes.

A. NATIONAL HEALTH PROGRAMME

 National health programs are those programs which are lunching to control various
communicable and non- communicable diseases.
Several National health programmes are being implemented a centrally sponsored
schemes aimed mainly at reduction of mortality and morbidity caused by major diseases. The
major health schemes include the National programmes for eradication of malaria, blindness,
leprosy, tuberculosis, AIDS including blood safety measures and STD control, Cancer control,
Special attention is also being paid to Trauma and Spinal Injuries. Pilot projects have also been
taken up in respect of cardio-vascular diseases, diabetes and rehabilitation of the medically
disabled.
Various international organisations like UNICEF, WHO, USAID, CARE, DANIDA have
provided to these national health programmes; these programmes came in operation from time to
time. The various National Health programmes are as follows.

B. TYPES OF NATIONAL HEALTH PROGRAMMES.

As per the recommendations of Bhore Committee, Govt. of India formulated and
launched specific programmes called “National Health Programmes” right from the inception of
Five Year Plans (from 1951) for controlling/eradicating health problems. The national health
programs (NGPs) are of three kinds.
 100% centrally sponsored programs, but implementation is by the State Governments.
 50:50 centrally sponsored programs, i.e. the implementation is by the state Govt. however
50% of the expenses are increased by the Central Govt. and remaining 50% by the State
Govt.
 Vertical programs: In this type both the implementation and incurring expenditure is by
the Central Govt. only.

C. LIST OF GOALS TO BE ACHIEVED BY 2000-2015

Eradicate Polio and Yaws 2005

Eliminate Leprosy 2005

Eliminate Kala Azar 2010

 Eliminate Lymphatic Filariasis 2015

Achieve Zero level growth of HIV/AIDS 2007

Reduce Mortality by 50% on account of TB, Malaria and 2010

Other Vector and Water Borne diseases

Reduce Prevalence of Blindness to 0.5% 2010

Reduce IMR to 30/1000 And MMR to 100/Lakh 2010

Increase utilization of public health facilities from current 2010

Level of <20 to >75%

Establish an integrated system of surveillance, National Health 2005

Accounts and Health Statistics.

Increase health expenditure by Government as a % of GDP 2010

from the existing 0.9 % to 2.0%

Increase share of Central grants to Constitute at least 25% of 2010

total health spending

Increase State Sector Health spending from 5.5% to 7% of the 2005

budget 2010
Further increase to 8%

D. VARIOUS NATIONAL HEALTH PROGRAMMES

The various National Health programmes have been grouped into the following groups.
Related to Communicable Diseases
1. National Anti-malaria Program (NAMP) 1999
2. National Filariasis Control Program 1995
3. National Kala-azar Control Programme 1991
4. National Japanese Encephalitis Control Program (2003- 04)
5. National Dengue fever/Dengue Hemorrhagic Fever Control Program (2003-2004)
6. National Leprosy Eradication Program 1983
7. National Guinea- worm Eradication Program 1983
8. National Polio Eradication programme 1995
9. Universal Immunization Programme 1985
10. Revised National Tuberculosis Control Programme 1993
11. National Acute Respiratory Infections Control Programme
12. National Diarrheal Disease Control Programme
13. National AIDS Control Program
Related to Non- Communicable Disease
14. National Program for the Control of Blindness
15. National Cancer Control Programme 1975
16. National Diabetes Control Programme
17. National Mental Health Programme 1982
18. National Iodine Deficiency Disorders Control Program (1962)

Related to Nutrition
19. National Vitamin A Prophylaxis Program (1970)
20. National Nutritional Anemia Prophylaxis Programme (1970)
21. National Special Nutrition Programme (1970)
22. National Balwadi Nutrition Programme
23. Mid- Day School Meal Programme (1962)
24. Integrated Child Development Services Scheme (1975)
Other Health Programmes
25. National Family Welfare Program (1953)
26. Reproductive and Child Health (RCH) Programme
27. All India Hospital Postpartum Programme
28. National Water supply and Sanitation Programme (1954)
29. Minimum Needs Programme (1974).
30. 20-Point Programme (1975).

1. NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (NVBDCP)

National Vector Borne Diseases Control Programme (NVBDCP) was launched in 2003-
2004 by convergence of three ongoing programmes on malaria, filarial and kalaazar and
inclusion of Japanese encephalitis and dengue/dengue haemorrhagic fever. Chikungunya
fever, which has re-emerged after more than three decades, has added to the problem of vector
borne diseases. Out of the six diseases under the programme, five are transmitted by different
kinds of vector mosquitoes, while kalaazar is transmitted by sandflies.
The transmission of vector borne diseases is dependent on the frequency of man vector
contact, which is influenced by factors such as vector density, biting time etc. Mosquito density
is directly related to water collection for mosquito breeding.
Under NVBDCP, the three pronged strategies for prevention and control of VBDs are:
 Disease management including early case detection and complete treatment,
strengthening of referral services, epidemic preparedness and rapid response.
 Integrated vector management.
 Supportive interventions include, Behaviour Change Communication (BCC),
intersectoral convergence, Public private partnership, operational research, monitoring
and evaluation.
Among the vector borne diseases malaria continues to pose serious public health threat in
different parts of the country, particularly due to pose serious public health threat in different
parts of the country, particularly due to Plasmodium falciparum, as it is sometimes prone to
complications if not treated in time. Policy (2002) has set the goal of reduction in mortality due
to malaria by 50% by 2010 and efficient morbidity control. Reduction of malaria morbidity and
morbidity and mortality is also included in Millennium Development Goals.
National Malaria Eradication Programme
The National Malaria Control Programme was launched in April 1953 which was
upgraded to National Malaria Eradication programme (NMEP) in 1958. The NMEP achieved
remarkable success during the period 1958- 1965, by which time the incidence of malaria came
down to only one lakh cases in 1965 and no deaths during the year. It also paid rich dividends to
the country worth several thousand millions of rupees in different fields like industry,
agriculture, land projects, etc., by reducing the morbidity and mortality due to malaria.
Approaches and strategies of malaria control:
As the content of control replaces that of eradication in many national programme, a
reordering of priorities in the selection of control methods must occur. These priorities and
approaches must be based on epidemiological considerations, adverse effects on health,
economy, technical feasibility, functional resources, human resources and community
participation. Recently WHO stressed a number of points relevant to future strategy of malaria
control. The main emphasis is on the need to base it on an epidemiological approach. These
aspects are discussed below.
Approaches to malaria control: Basically there are two different approaches to malaria control.
1) The management of malaria cases in the community, and
2) Active intervention to control or interrupt malaria transmission with community
participation.

A. The management of malaria cases in the community

The clinical management of malaria cases (i.e., diagnosis and treatment) to reduces
morbidity and mortality ought to be first priority. It is well within the capability of the existing
primary health care system. The health guides and multipurpose workers in India are fully
trained to detect and treat cases of malaria at the community level with support from the referral
system (i.e., PHC and higher levels). In addition, the government has also established drug
distribution centers and fever treatment depots all over the country in rural areas to cope with the
problem of detecting and treating malaria cases in endemic areas. These centres are manned by
voluntary workers from the community.
National drug policy on malaria, 2007
The new drug policy 2007 gives emphasis on complete treatment in diagnosed cases of
malaria rather than one single dose presumptive treatment to suspected case of malaria(waiting
for the diagnosis) to avoid chloroquine resistance in P. falciparum. All fever cases should be
investigated for malaria either by microscopy or by rapid diagnostic kit. The first line of
treatment of malaria is choloroquine. Resistant cases of P. falciparum malaria, the first line of
treatment is artesunate combination therapy (ACT) consisting of artesunate + sulphadoxine
/sulphalene + pyrimethamine. In case of resistance to these drugs and to treat severe and
complicated malaria, quinine is the drug of choice. ACT is not to be used for treatment of
P.vivax cases as it is not effective against P. vivax.
Confirmed P. vivax cases should be treated with chloroquine in therapeutic dose of 25
mg/kg body weight over 3 days. Primaquine can be given in a dose of 0.25 mg/kg body weight
daily for 14 days under medical supervision to prevent relapse.
Microscopically positive P. falciparum cases should be treated with chloroquine in
therapeutic dose of 25 mg/kg body weight over 3 days, and a single dose of primaquine
0.75mg/kg body weight on the first day. If RDK for only pf is used, negative cases showing
signs and symptoms of malaria without any other obvious causes, should be considered as
clinical malaria and should get full therapeutic course of chloroquine for 3 days.
When diagnosis with microscopy or RDK is not possible, a case showing signs and
symptoms of malaria without any other obvious cause, should be considered as clinical malaria
and treated with chloroquine in full therapeutic doses over 3 days in low risk areas. In high risk
areas, a single dose of primaquine (0.75 mg/kg body weight) should also be given on the first
day of treatment. Primaquine is contraindicated during pregnancy.
Severe and complicated malaria cases are to be hospitalized for treatment:
Choice of antimalarial is quinine injection preferably, 10 mg/kg body weight. I/V drip in
5% dextrose saline to be run over 4 hours. (8 hourly). Switch over to oral dose as early as
possible and total duration of treatment should be 7 days including both parenteral and oral
doses. Injectable form of artemisinine derivatives may be used for the management of severe and
complicated malaria in adults and non pregnant women only. The recommended injectable
dosages are as follows:
 Artesunate: 2.4 mg/kg body weight IM/IV followed by 1.2 mg/kg body weight after 12
hours, then 1.2 mg/kg body weight once daily for 4 days. Treatment is to be given for
total duration of 5 days.
 Artemether : 1.6 mg/kg body weight IM followed by 1.6 mg/kg body weight daily for 6
injections or 1.6 mg/kg body weight IM injections twice daily for 3 days, a total of 6
injections.
 Artether: 150 mg daily IM for 3 days in adults only.
 Artemisinine: 10 mg/kg body weight at 0 and 4 hours followed by 7 mg/kg body weight
at 24, 36, 48, and 60 hours.
Tab. Mefloquine is to be used only on plasmodium falciparum. Cases having proven
resistance to chloroquine. Drug may be obtained from drug depots after producing prescription
given by registered medical specialist and laboratory report confirming of having blood slide
positive for asexual stage of plasmodium falciparum parasite. Sulfa-pyrimethamine combination
is not effective in p. vivax cases.
Primaquine is not to be given to pregnant women, infants and glucose 6 phosphatase
deficient persons.
Toxic Hazards of Drugs
Chloroquine has few side effects. Nausea, vomiting, blurring of vision and headaches
may occur, but they are mild and transient. Cases of retinal damage have been reported but only
in persons exposed to large cumulative doses over many years. It is important to remember that
chloroquine should not be given on empty stomach. Despite reports of teratogenicity in
experimental animals, most authorities accept that pyrimethamine can safely be taken alone
during pregnancy. The teratogenic effect of pyrimethamine in man is not proved. In regard to
primaquine, although in recommended doses, no serious toxic manifestation have been
encountered so far in India, tit is useful to bear in mind the likely toxic symptoms, which may be
three types :
 Plasmocid types: this is a rare toxic manifestation involving the CNS,
 Gastrointestinal: cramps, nausea, and vomiting,
  Cardiovascular: this is probably the most serious toxic manifestation which is to be
carefully observed during the administration of the drug. Even the first dose may bring
about the warning sign of cyanosis. The surveillance worker / MPW must carefully check
for all possible toxic symptoms before he administers the daily dose of primaquine. The
case of appearance of any of the toxic symptoms discussed above, primaquine treatment
should be stopped immediately.
Mass drug administration
WHO is currently emphasizing malaria control/ eradication of which the drug treatment
is an important component. Under the revised strategy, mass drug administration has been
recommended in highly endemic areas (API more than 5 per 1000 population) as the best method
of curbing the transmission, with extensive antimosquito measures to follow. While drugs may
provide a temporary relief, the ultimate solution lies in the interruption of transmission.
Chemoprophylaxis
Chemoprophylaxis against malaria has, with the development of drug resistance, become
unreliable. Experts disagree in whether well conducted prophylaxis gives an additional benefit if
effective treatment is readily available. However, some experts feel that it can play a useful role
in reducing the risk of infection.
Chemoprophylaxis is recommended for travelers from non endemic areas and as a short
term measure for soldiers, police and labour forces serving in highly endemic areas.
Chemoprophylaxis should be complemented by personal protection where feasible and by other
methods of vector control.
The risk of serious side effects associated with long term prophylactic use of chloroquine
and proguanil is low. However anyone who has taken 300 mg of chloroquine weekly for over
five years and requires further prophylaxis should be screened twice yearly for early retinal
changes. If daily dose of 100 mg chloroquine have been taken, screening should start after three
years.
Chemoprophylaxis is still desirable for pregnant women living in areas where
transmission is very intense and leads to parasitaemias, causing low birth weight and anemia, or
to a high risk of life threatening malaria attacks. However, the choice of safe drugs is becoming
increasingly narrow, and it mat be necessary to replace chemoprophylaxis by prompt treatment
of clinical episodes or periodic treatments during pregnancy. While the choice of strategy should
be guided by the national malaria control policy, its implementation should normally be part of
antenatal care. Chemoprophylaxis should begin a week before arrival in the malarious area and
continued for at least 4 weeks or preferably 6 weeks after leaving a malarious area.
Active intervention measures
Neither chemotherapy nor chemoprophylaxis will be able to reduce significantly the
malaria prevalence or transmission. It can be obtained only when proper antimosquito measures
are introduced.
Stratification of the problem
Malaria is a complex disease, and its distribution and intensity vary from place to place.
Stratification of the problem has become an essential feature for the planning and development
of a sound control strategy to maximize the utilization of available resources. It can also provide
economical under the existing conditions. Under modified plan of operation in India endemic
areas have been stratified according to annual parasite incidence (API) as follows:
 Areas with API less than 2: and
 Areas with API more than 2 ;
This led to the abolition of earlier phasing of the antimalarial activities as attack,
consolidation and maintenance phase and re-classification of endemic areas according to API.
Vector control strategies: Vector control is still one of the primary weapons to control malaria
in endemic areas.
A. Anti-adult measures
(i.) Residual spraying: the discovery of DDT in 1940s and followed by other insecticides
revolutionized malaria control. The spraying of the indoor surfaces of houses with residual
insecticides (e.g., DDT, Malathion, and fenitrothion) is still the most effective measure to kill the
adult mosquito. It has been observed that discontinuation of spraying has very often led to the
resurgence of malaria; this implies that spraying once applied may need to be continued for an
indefinite period. If indoor spraying is to have any effect, then exhaustive coverage is needed.
Indoor house spraying reduces the longevity of the vector. Malathion and fenitrothion are
organophosphate insecticides which are being used with increasing frequency for malaria control
following the development of vector resistance to DDT.
(ii) Space application: this is a major anti-epidemic measure in mosquito borne diseases. It
involves the application of pesticides in the form of fog or mist using special equipment, the
ultra-low-volume method of pesticide dispersion by air or by ground equipment has proved to be
effective and economical, outdoor space sprays reduce vector population quickly.
(iii) individual protection: man vector contact can be reduced by other preventive measures such
as the use of repellents, protective clothing, bed nets (preferably impregnated with safe, long
acting repellent insecticides), mosquito coils, screening of houses etc. the methods of personal
protection are of great value when properly employed. However, they have rarely been used on a
large scale because of cost.
B. anti- larval measures
 Larvicides: during the first half of the 20th century, anti larval measures such as oiling
the collections of standing water or dusting them with Paris green effectively controlled
malaria (but the measures were eclipsed at the end of world war II). With the increase in
insecticide resistance, the older methods of mosquito control have now become
promising; some modern larvicides such as temphos which confer long effect with low
 toxicity are more widely used. However larviciding must be repeated at frequent intervals
and for this reason it is a comparatively costly operation.
 Source reduction: techniques to reduce mosquito breeding sites (often called source
reduction) which include drainage or filling, deepening or flushing, management of water
level, changing the salt content of water and intermittent irrigation are among the
classical methods of malaria control to which attention is being paid again. Whenever
practicable, measures for the improvement of the environment by the permanent
reduction of sources should be instituted.
 Integrated control: in order to reduce too much dependence on residual insecticides,
increasing emphasis is being put on “integrated” vector control methodology which
includes bioenvironmental and personal protection measure. This approach is important
because there is no single and simple method that would ensure control of transmission.
By mid 1995 all malaria endemic countries in the region had adopted the revised malaria control
strategy to reduce morbidity and mortality and to reduce its area of distribution. Particularly of
multidrug resistant malaria, the use of stratification approach by the majority of anti-malaria
programmes in the region has led to more cost effective interventions. Vector resistance to
insecticides has necessitated the use of more expensive pyrethroid, thereby limiting the coverage.
Malaria control added impetus as Roll Back Malaria initiative was launched by WHO, UNICEF,
UNDP and the World Bank in 1998.
The global policy for diagnosis and treatment of malaria, including preventive treatment
The government of every country affected by malaria has a national malaria control
policy covering prevention and case management. The objectives of an antimalarial treatment
policy are to: ensure rapid cure of the infection; reduce morbidity and mortality, including
malaria-related anaemia; prevent the progression of uncomplicated malaria into severe and
potentially fatal disease; reduce the impact of malaria infection on the fetus during pregnancy;
reduce the reservoir of infection; prevent the emergence and spread of drug resistance; and
prevent malaria in travellers. Current WHO recommendations for the diagnosis and treatment of
malaria are given in below;
1. The treatment of malaria infections should be based on a laboratory-confirmed diagnosis,
with the exception of children under 5 years of age in areas of high transmission in whom
treatment may be provided on the basis of a clinical diagnosis.
2. All uncomplicated P. falciparum infections should be treated with an artemisnin based
combination therapy, and P. vivax with chloroquine and primaquine.
3. Four ACTs are currently recommended for use; artemether-lumefantrine, artesunate-
amodiaquine, artesunate-mefloquine and artesunate-sulfadoxine pyrimethamine. The
choice of the ACT should be based on the efficacy of the partner medicine in the country
or area of intended deployment.
4. Patients suffering from severe malaria presenting at the peripheral levels of the health
system should be provided peripheral treatment with quinine or artemisinins, and
 transferred to a health facility where full parenteral treatment and supportive care can be
given.
5. Severe malaria should be treated parenterally with either an artemisinin derivative or
quinine until the patient can swallow, when a complete course of ACT must be
administered.
6. In areas of high transmission, intermittent preventive treatment with sulfadoxine-
pyrimethamine should be administered to pregnant women at least twice during the
second and third trimesters of pregnancy, and three times in the case of HIV positive
pregnant women. The effectiveness of intermittent preventive treatment should be
monitored in light of increasing sulfadoxine-pyrimethamine resistance.

Kalaazar control programme

Kalaazar is a tropical disease caused by the leishman Donovani parasite and marked by
enlargement of the spleen and anaemia. Kalaazar is endemic in Bihar, Jharkhand, and West
Bengal and UP.
 A control sponsored programme was launched in 1990-91 to bring down the incidence and
death rate of the disease by 75% by the year 2002.
 Elimination of kalaazar strategies are case detection and complete treatment. Interruption
of transmission through vector control.
 Monitoring supervision and evaluation. Research guidelines on prevention and control of
kala-azar.
 National health policy envisages kala-azar elimination by the year 2010.
 Strategies-
1. Interruption of transmission.
2. Early diagnosis and complete treatment of cases.
3. Health education for community awareness
Tenth five year targets are prevention of deaths by 2004 with incidence by reduction of at
least 25 percent. Zero level incidence by 2007 and elimination of kalaazar by the year 2010. To
achieve these goals Government of India has decided to provide 100% central support from the
year 2003-2004.

Japanese Encephalitis Control Programme

Japanese Encephalitis is a disease with high mortality rate and those who survive do so with
various degrees of neurological complications. During the last few years it has become a major
public health problem.
The strategies for control of Japanese Encephalitis include
 Care of the patients.
  Studies to identify the high risk groups.
 Prevention and control is early diagnosis and proper management vector control by
personal protection and use of larvivorous fishes.
 J. E vaccine for children below 3 years 0.5 ml 2 doses in an interval of 7-14days. Booster
dose after 6 months to one year.
 In children above 3 years to 15 years. 1 ml vaccine 2 doses at an interval of 7-14 days
booster dose after 6 months to one year.
 Health education should be given on keeping pigs away from human dwellings.
 Covering the body fully to avoid mosquito bites and using mosquito nets.
 Forging with Malathion for outdoor use.
 Epidemiological monitoring of the disease.
Technical support is provided, on request by the state health authorities for the outbreak
investigations and control. Insecticides used under the National Anti-Malaria programme are
used for the control JE outbreaks, where required.

Dengue Fever Control Programme

During 1996, an outbreak of Dengue was reported in Delhi. Dengue or Dengue
Hemorrhagic Fever, a viral infection is widely prevalent in India and all the 4 serotypes are
found. Since 1996, National Anti Malaria Programme (NAMP) has been monitoring
Dengue/DHF situation in the country. There has been a decline in Dengue/DHF incidence after
1996 outbreak in Delhi. However during 2001, outbreaks have been reported from Rajasthan,
Tamil Nadu, Karnataka and Gujarat.
The strategies for prevention and control of dengue fever:
 Surveillance for disease and vectors.
 Early diagnosis and prompt case management.
 Vector control through community participation and Social mobilization.
 Capacity building
There is no separate programme for prevention and control of Dengue/DHF and states tackle the
problem out of their own resources. Need based assistance, however, is being provided for
outbreak containment out of resources available under NAMP.

2. NATIONAL FILARIA CONTROL PROGRAMME

The National filarial Control Programme (NFCP) has been in operation since 1955. The
Programme has been extended to rural areas since 1994. According to recent estimates about
598 million people are exposed to the risk of infection; 21 million manifests the disease, and 27
million have filarial parasites in their blood.
 National Filaria Control Programme is being implemented through 206 filaria control
units, 199 filaria clinics and 27 survey units, primarily in endemic urban towns. In rural areas
anti filaria medicines and morbidity management services are provided through primary health
care system.
Currently, there are 206 filaria control units, 199 filaria clinics functioning in the endemic
areas for carrying:
1. Anti larval measures which include weekly spray of appeared larvicides and biological
control through larvivorous fishers.
2. Source reduction through environmental and water management.
3. Ant parasitic measures which include diagnosis and treatment of microfilaria carriers and
chosen and
4. Information, Education and Communication for community awareness.
In 1994, the NFCP has been extending to rural areas to treat the acute, and chronic filarial
cases. These activities are cared through primary health centres in endemic states.
New strategy
In 1997, a new strategy, composing of mass administration of single dose of DCC
(Diethyl Carbamazine Citrate) annually in 13 identified districts of 7 states was initiated as a
project on the basis of successful findings of the research study. The coverage of distribution was
found to be between 43.77 - 95.23% in the states.
Revised filarial control strategy
 The strategy follows the WHO recommendation of annual single dose mass drug therapy
with DEC/DEC with albandazole as a supplement to existing NFCP strategy for 5 years or
more in highly endemic districts to reduce transmission of filarial to a very significant low
level.
 In pursuit of achieving the goal of elimination of lymphatic filariasis by 2015, Government
of India has launched nationwide mass drug administration (MDA) of DEC in 202 endemic
districts of the country. To alleviate the suffering of the patients, home based morbidity
management and hydrocoelectomy at identified hospitals/CHCs has been taken up.
(For the year 2005, the mass drug administration was given, covering about 424.49 million
populations showing a coverage rate of 79.8%. During 2006 MDA was given to 286.29
million populations in 179 districts with coverage rate of 83.67%)
 All the strategy for achieving the goal of elimination is by Annual Mass Drug
Administration of DEC for 5 years or more to the population excluding children below two
years, pregnant women and seriously ill persons in affected areas to interrupt transmission of
disease. Home based management of cases who already have the disease and
hydrocelectomy operations in identified CHCs and hospitals.
The control strategy includes
  Improvement of sanitation with a special emphasis on underground drainage system of
sewage as a “source reduction” methods of control of vectors
 Anti- larval operations
 Anti- parasitic measures by detection and treatment of microfilaria carriers,
 Organizing IEC campaigns for community awareness and participation
 Conducting annual single dose mass drug administration campaigns using Diethyl
Carbamazine (DEC) or DEC plus Albendazole combination.
NFCP is implemented through filarial control units, filarial clinics and survey units.
Primary Health Care System provides treatment facilities. Thus vertical program has
become horizontal program.
The current strategy of filariasis control is based on:
 Chemotherapy
 Vector Control
a) Chemotherapy
Diethylcarbamazine: DEC is both safe and effective. The dose of DEC that is most generally
accepted for the treatment of Bancroftian filariasis is 6 mg/kg body wt/day/orally-12 days, given
preferably in divided doses after meals. For Brugian Filariasis, recommended does range from 3
to 6 mg of DEC/kg body wt/day, up to a total dose of 36-72 mg DEC/kg body weight.
Action: DEC covers rapid disappearance of MF from the circulation. It is effective in killing
MF. The effect of the drug on the adult worm is uncertain.
Side effect: Headache, nausea, vomiting, dizziness due to drug itself. It has allergic reactions due
to detention of microfilaria and adult worms eg: fever, local inflammation.
Filaria control in the community: There are 3 reasons why filariasis never causes explosive
epidemics:
 The parasite does not multiply in the insect vector
 The infective larvae do not multiply in the human host, and
 The life cycle of the parasite is relatively long, 15 years or more. These factors favour the
success of control programme.
DEC is still the only drug available for chemotherapeutic control of filariasis. The administration
of DEC can be carried out in various ways.
1. Mass therapy: In this approach, DEC is given to almost everyone in the commonly
irrespective of whether they have micro filaraemia, disease manifestations or no signs of
Injection.
2. Selective treatment: DEC is given only to those who are MF positive. It is generally
accepted that selective treatment may be made suitable in areas of low endemicity than in
highly endemic areas.
In India the current strategy is based on detection and treatment of human carriers and
filarial cases. The recommended dose in the Indian programme is 6 mg DEC per kg of body
weight daily for 12 doses, to be completed in 2 weeks.
3. DEC medicated salt: The use of DEC medicated salt is a special form of mass using very
low chosen of the drug over a long period of time. Common salt medicated with 1-4 ug of
DEC per kg has been used for filariasis control in some endemic areas of W bancrofti and B.
malayi treatment should be continued for at least 6-9 months.
Lvermenctin: Lvermectin is a semi synthetic macrolide antibiotic with a broad spectrum of
activity against a variety of nematooles and ectoparasites.
b) Vector Control
Where mass treatment with DEC is impracticable, the control of filariasis most depend
upon vector control. Vector control may also be beneficial when used in conjunction with mass
treatment.
i. Antilarval measures: The anti larval activates comprise the following
1. Chemical control:
 Mosquito larvicidal oil (MLO): is active against all preadult stages. Since it has proved to
be less efficient under field conditions and more expensive than other chemical preparations,
it is being replaced by pyrethrum oil, temephos and fenthion.
 Removal of Pistia plant: Mansonia mosquitoes, bredding are best controlled by removing
the supporting aquatic vegetation such as the pista plant from all water collections and
converting the ponds to fish or lotus culture.
 Minor Environmental Measures: Environmental management is the most efficient
approach to the problem of controlling mosquito breeding. This includes filling up of ditches
and cesspools, drainage of stagnant water and adequate maintenance of septic tanks with
soaking pits.
2. Anti-adult measures: The vector mosquitoes of filariasis have become resistant to DDT,
HCH and dieldrin. The use of these compounds for indoor resisdual sparying, tried earlier,
has been discontinued.
3. Personal prophylaxis: The most effective preventive measure is avoidance of mosquito
bites (reduction of man – mosquito contact) by using mosquito nets. Screening of houses can
substantially reduce transmission, but it is expensive.
ii. Integrated vector control
 None of the above vector control measures applied alone is likely to bring about
sustained control of filariasis vectors. An integrated or combined approach is needed to control
filariasis using all the above strategies and approaches in optimum combination.
4. NATIONAL LEPROSY “ERADICATION” PROGRAMME
The national leprosy control programme (NLCP) has been in operation since 1955, as a
centrally aided programme to achieve control of leprosy through early detection of cases and
DDS (daps one) monotherapy on an ambulatory basis. The NLCP moved ahead initially at a
slow pace, presummably for want of clear cut policies or operational objectives for nearly two
decades. The programme gained momentum during the fourth five year plan after it was made a
centrally sponsored programme. In 1980 the government of India declared its resolve to eradicate
leprosy by the year 2000 and constituted a working group to advice accordingly.
The working group submitted its report in 1982 and recommended a revised strategy
based on multi drug chemotherapy aimed at leprosy eradication through reduction in the
quantum of infection in the population, reduction in the sources of infection, and breaking the
chain of transmission of disease. In 1983 the control programme was redesignated national
leprosy eradication programme with the goal of eradicating the disease by the turn of the century.
The aim was to reduce case load to 1 or less than 1 per 10,000 populations.
The revised strategy was based on early detection of cases (by population surveys, school
surveys, contact examination and voluntary referral), short term multi drug therapy, health
education, ulcer and deformity care and rehabilitation activities. The regimens recommended by
WHO have been adapted to suit the operational and administrative requirements.
NLEP provided free domiciliary treatment on endemic districts through specially trained
staff, and in moderate to low endemic districts it provided services through mobile leprosy
treatment units and primary health care personnel. Treatment of leprosy cases with MD-T was
taken up in a phased manner, as a result the number of cases discharged as cured increased
progressively over the years.
World Bank Supported Project on NLEP;
The first phase of the World Bank supported national leprosy elimination project started
from 1993-1994 and completed on 31.3.2000. This project involved a cost of Rs. 550 crores, of
which World Bank loan was Rs. 292 crores. During this phase, the prevalence rate reduced from
24/10,000 population in 1992 before starting of 1st phase project, to 3.7/10,000 by March 2001.
The disability grade 2 and above reduced to 2.7 percent and MDT coverage increased to
99.5percent.
The 2nd phase of world bank project on NLEP started for a period of 3 years from 2001-
02.the project involved a cost of Rs.249.8 crores including world bank loan of Rs. 166.35 crores
and WHO to provide MDT drugs free of cost worth Rs. 48.00 crore. The project successfully
ended on 31st December 2004, bringing down the prevalence rate to about 2.4/10,000 and annual
detection rate to 3.3. The national leprosy eradication programme is being continued with
government of India funds from January 2005 onwards. Additional support for the programme is
continued to be received from the WHO and ILEP (international federation of leprosy
elimination) organizations. MDT is supplied free of cost as of now by NOVARTIS through
WHO.
During the year 2004-05 and 2005-06, focus of attention under national leprosy
eradication programme was shifted from endemic stated to high priority districts and blocks
based on prevalence rate where PR was more than 5/10,000 in 2004-05. And PR was more than
3/10,000 in 2005-06 was taken as cut off point. Special activities in the form of focused leprosy
elimination plan (FLEP) were carried out in identified districts and blocks in 2005-06. During
2007, after detailed scrutiny, 19 districts were identified as high priority, in which a Situational
Activity Plan (SAP-2007) was carried out during the year 2007-08. In 19 states, 275 blocks were
identified as high priority where block leprosy awareness campaigns (BLAC-IV) through
intensified IPC were conducted during September-December 2007.
Urban Leprosy Control Programme
To address the complex problems like large population size, migration, poor health infrastructure
and increasing prevalence in urban areas, there was a need for urban leprosy programme. Urban
leprosy programme has been implemented since 2005 under which assistance is being provided
by government of India to urban areas having population size of more than 1 lakh. For the
purpose of providing graded assistance, the urban areas are grouped in four categories i.e.
Township-I, Medium Cities-I, Medium Cities-II, Mega Cities(1).
Leprosy Elimination Monitoring (LEM)
The LEM is required to assess the performance of leprosy services and envisages to
collect key information on the issues like integration, quality of leprosy services like diagnosing
and treatment (MDT), drug supply management and IEC etc. the LEM exercise was carried out
with WHO assistance through the National Institute of Health and Family Welfare (NIHFW),
New Delhi, during June 2002 in the 12 priority endemic states.
The second LEM exercise was carried out in May –June 2003 in 13 states, and the third
LEM was carried out in May – June 2004 in the same 13 states. During the year 2002-03 another
such survey was carried out through an independent agency “ the Leprosy Mission” New Delhi
in the seven high endemic states of Bihar, Utter Pradesh, Madhya Pradesh, Orissa, West Bengal,
Chhattisgarh and Jharkhand with the funds of world bank supported 22nd National Leprosy
Elimination Project(2).
National Leprosy Elimination Programme (NLEP): National Action Plan for 2006-07 (11)
The National Action Plan for the year 2006-07 has been released by the Central Leprosy
Division of the DGHS. The main objectives of the plan for the period April 2005 to March 2007
are:
a. To continue the efforts to achieve elimination of leprosy;
b. To maintain the gains achieved and to continue the efforts to achieve elimination at
district and block levels;
 c. To make quality leprosy services available.
The strategies as drawn up for the second NLEP are:
1. Decentralization and institutional development.
2. Strengthening and integration of service delivery.
3. Disability care and prevention.
4. Information, education and communication, and
5. Training
1. Decentralization and institutional development: Integration of leprosy services into the
general health care system has been completed. Services are available from all PHCs and other
health centres where a medical officer is available. District nucleus has been formed to supervise
and monitor the programme. State leprosy societies formed will merge with the state health
society under the National Rural Health Mission.
2. Strengthening and integration of service delivery: Diagnosis and treatment facilities have
been made more easily available, closer to the people through daily outdoor services in the
PHC/CHC/ additional PHC/hospital. The services are available on all working days. Validation
of newly detected cases by the district societies is to continue. The medical officer should
regularly monitor the treatment records. Counselling to patients and family members is to be
made an integral component of case management. Patients difficult to diagnose or manage at the
PHC are to be referred to the referral system. Adequate stocks of MDT are available in all PHCs
at all times. Urban leprosy control services will be continued. Special emphasis is laid on female,
tribal, migratory and other vulnerable groups.
3. Disability prevention, care and rehabilitation: Reconstructive surgery (RCS) will be
promoted. Five medical colleges and 41 physical medicine and rehabilitation institutions are to
be involved for services to the leprosy disabled persons. An estimate of the leprosy disabled
persons is being carried out. Supply of MCR footwear to the needy patients will continue.
4. Community education: IEC will continue with the messages that leprosy is completely
curable; treatment is freely available and about availability of reconstructive surgery.
5. Training: district nucleus staff will give refresher training to all the medical officers and
health staff of urban areas working in municipal health centres.
With the launch of National Rural Health Mission in the country, NLEP shall be
horizontally integrated to other health services for improved programme delivery. As such the
programme will be run on the same guidelines of the Government of India as earlier, but it will
conform to the “Indian Public Health Standards” as laid down under the mission. The minimum
services available at community health centers should be diagnosis of leprosy, treatment of
cases, management of reactions and advice to the patients on disability prevention and care.
Research into the basic problems of leprosy is also part of the activities of the
programme. This is mainly carried out in the government sector, viz. the Central JALMA
Institute of Leprosy at Agra and the Central Leprosy Teaching and Training Institute at
Chingelput, Chennai supported by Regional Training and Referral Institutes at Aska (Orissa),
Raipur (Chhattisgarh) and Gouripur (West Bengal).
In the field of leprosy eradication, there is considerable element of foreign assistance
from international agencies, viz. SIDA, DANIDA, WHO, UNICEF, Damien Foundation, etc. it
is understood that presently about 285 voluntary organizations in the country are actively
engaged in anti leprosy activities, supplementing the government efforts.
Tenth Five Year Plan Goals for Leprosy elimination
The Tenth Five Year Plan goal is to bring prevalence rate of leprosy to less than 1 case per 10,
000 population and the strategies are as follow:
1. Completing horizontal integration of the programme into the general health car system by
2007. The personnel employed under NLEP will be transferred to the states;
2. Skill upgradation and redeployment of the over 30, 000 leprosy workers and laboratory
technicians so that the existing gaps in male MPWs and laboratory technicians in PHC/
CHC are filled and these workers get integrated into the primary health care system;
3. Training of the existing personnel in primary health care institutions for the early
detection and management of leprosy patients, and identification and referral of those
with complications;
4. Re-constructive surgery to improve functional status of the individuals;
5. Rehabilitation of leprosy patients; and
6. Involvement of NGOs.
Nurses Role in Leprosy Control Programme
1. Find the source of infection.
2. Assist in the examination of house hold contacts especially children.
3. Education on the early signs and symptoms of leprosy.
4. Help the patient and family understand the nature of disease.
5. Observe all patients in the clinic.
6. Demonstrate nursing care.
7. Assist with diagnosis and treatment.
8. Fallow up of patients and contacts as needed.
9. Assist up of patients and contacts as needed.
10. Assist with rehabilitation.
11. Participate in all programmes, including referring to other agencies for necessary help and
treatment.
Nursing care of the patients at home or in the community
 Encourage the patient to come regularly for treatment.
 Teach about care of hands and feet.
 Home isolation is important.
 Help them to know the importance of keeping himself clean
 Help them to know the imp0ortance of keeping himself clean.
 Help him to understand the handling of children, feeding etc if he is infectious.
 See that the drugs are taken regularly.
 Emphasis in foot wear.
 Ulcers to be dressed regularly.
 Rehabilitation of patients is important help him to understand that he can work how to
live successfully in the community.
 Help him to care for his hands and feet.
 Maintain adequate records.
 Encourage the patient to come regularly for treatment.
 Teach about care of hands and feet.
 Home isolation is very important
 Help them to know the importance of keeping them self clean.
5. NON- COMMUNICABLE DISEASE
1) National Program for the Control of Blindness
2) National Cancer Control Programme 1975
3) National Diabetes Control Programme
4) National Mental Health Programme 1982
5) National Iodine Deficiency Disorders Control Program (1962)

1) NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS (NPCB)

The National Programme for Control of Blindness (NPCB) was launched in the year 1976
as a 100% centrally sponsored programme and incorporates the earlier Trachoma Control
Programme started in the year 1968. The programme was launched with the goal to reduce the
prevalence of blindness from 1.4% to 0.3%. As per 2006-07 survey the prevalence of blindness was
1.0%.
Blindness is a social problem. There are approximately 12 million people who are blind in
India. About 80% of blindness is due to cataract alone. Vitamin A deficiency is considered a public
health problem in India. The nationwide survey of blindness conducted during 1986- 89, including
the prevalence of vitamin A deficiency in children of age from 6 months to 6 years.
The objectives of the programme are:
1. To reduce the backlog of blindness through identification and treatment of blind;
2. To develop Eye Care facilities in every district;
3. To develop human resources for providing Eye Care Services;
4. To improve quality of service delivery’
5. To secure participation of Voluntary Organizations in eye care.
Strategies of national programme for control of blindness:
Based on upon the findings of surveys conducted during 1998- 99 and 1999- 2000, the following
measures were included in the programme.
1. To make NPCB more comprehensive by strengthening services for other causes of
blindness like corneal blindness (requiring transplantation of donated eyes), refractive errors
in school going children, improving follow-up services of cataract operated persons and
treating other causes of blindness like glaucoma.
2. To shift from the eye camp approach to a fixed facility surgical approach and from
conventional surgery to IOL implantation for better quality of post operative vision in
operated patients.
3. To expand the World Bank project activities like construction of dedicated eye operation
theaters, eye wards at district level, training of eye surgeons in modern cataract surgery and
other eye surgeries and supply of ophthalmic equipment’s etc. to the whole country.
4. To strengthen participation of Voluntary Organizations in the programme and to earmark
geographic areas to NGOs and government Hospital to avoid duplication of effort and
improve the performance of Government Units like Medical College, District Hospitals, Sub
Divisional Hospitals, Community Health Centers, Primary Health Centers etc.
5. To enhance the coverage of eye care services in tribal and other underserved areas through
identification of bilateral blind patients, preparation of village wise blind register and giving
preference to bilateral blind patients for cataract surgery.
Activities under the NPCB
The various activities which are taken up under the programme are as under:
1. Cataract surgery: A target of 400 operations per lakh is set to enable the states to clear the
backlog of cataract blindness. The purpose of Cataract surgery is to restore vision of the
affected person through a package of services, and to return to normal working life.
2. Infrastructure development: Construction of eye ward, Operation Theaters and Dark Rooms
was undertaken in 7 states covered under the World Bank assisted Cataract Blindness Control
 Project.
3. Training: Faculty members of Medical Colleges have been trained as training and District For
imparting various training of other categories of manpower like PHC Medical Officers,
Ophthalmic assistants, Health workers etc. is being undertaken in various institutions by the
States as per Government of India.
4. School Eye Screening Programme: Children are being first screened by trained teachers.
Their suspected refractive error is seen by ophthalmic assistants and corrective spectacles are
prescribed or given free for persons below poverty line.
5. Collection and utilization of donated Eyes: Currently nearly 20,000 donated eyes are
collected every year in India. Hospital retrival programme is the major strategy for collection o
donated eyes, which envisage motivation of relatives of terminally ill patients, accident victims
and others with grave diseases to donate eyes.
6. IEC Activities: IEC activities are undertaken at Central, State and District Blindness Control
Societies (DBCS) level. Special campaigns for mass awareness were undertaken during Eye
Donation fortnight (25th August to 8th September) and World Sight Day (2nd Thursday of
October). At the Central level, prototype IEC material is produced and disseminated to the
States. Guidelines and training manuals are also prepared centrally and disseminated. A
quarterly newsletter has been started since July 2002.
7. Voluntary organization: It plays an important role in implementing various activities under
the programme. District Blindness Control Societies (DBCS) have been established
throughout the country under the Chairmanship of District Collector/Deputy Commissioner.
Till date, 604 DBCSs have been established and 45 eye banks in voluntary sector were
assisted to promote collection of donated eyes. Total 74 NGOs have been assisted under this
scheme so far 2006-07.  
8. Vitamin program: 5 mega doses of Vitamin A in the form of syrup, administered orally, with
an interval of 6 months, for all the pre-school children (0- 3 years) are recommended under the
National Vitamin A Prophylaxis program to prevent nutritional blindness.

2) NATIONAL CANCER CONTROL PROGRAMME

National Cancer Control Programme (NCCP) was started in 1975 in a limited form. It was
limited to establishment of Regional Cancer Centers. In 1984, the programme was revised,
strengthened and converted to National Cancer Control Programme. The objectives of the
programme include:
1. Primary Prevention: Health education on prevention of cancer.
2. Secondary Prevention: Early detection and diagnosis of common cancer such as cancer of
cervix, mouth, breast and tobacco related cancer by screening and self examination methods.
3. Tertiary Prevention: Strengthening of the existing institution for comprehensive therapy
including palliative care.
Early Diagnosis and treatment: Early detection of cancers can prevent about a third of cancer
deaths in the country.
1. Cancer Cervix: Although in the developed countries, cervical cytology (PAP smear) as a
screening measure has dramatically reduced mortality from this disease, it is not feasible
presently in the country due to lack of resources. An alternative strategy consisting of
speculum examination of cervix will be used. It has been shown to detect 40-50% of in situ
or early invasive cancers. Although this method is inferior to cervical cytology, it is more
realistic in our present situation.
2. Breast Cancer: For this breast self examination and physical examination by Female
Health Workers is to be carried out. Although there is no data from randomized controlled
trails on the efficacy of breast self examination, the approach is to be used because of
feasibility as the established screening methods like mammography are technically complex
and costly.
3. Oral Cancer: The strategy consists of disseminating information amongst physicians and
dentists that in case a suspicious lesion or growth is encountered, a simple punch or excision
biopsy can make an accurate diagnosis. Self reporting of red or white patches shall also be
encouraged through health education.
Basis of the Control Strategy
 About 40% of all cancers in India can be prevented (primary prevention)
 About one third can be detected early and cured by appropriate measures (secondary
prevention)
 Remaining need palliative treatment for relief of pain and other symptoms which at present
is to the tune of 90%
Plan of action
1. Health education for prevention regarding
 Hazards of tobacco consumption
 Genital hygiene
 Sexual and reproductive health
2. Health education for early diagnosis: This is done to increase awareness of cancer symptoms
and signs, e.g.
 White or red patches appearing in mouth
 White discharge from vagina between 35-64
 Breast self examination for lumps
Legislation
 Statutory warning that tobacco is injurious to health.
  Ban on advertisement of tobacco through mass media.
 Ban on smoking in public places, public vehicles etc., and creation of no smoking zones.
Implementation of the programme
National Cancer Control programme has been in operation since 1975. Under the
programme govt. has been providing funds to procure machinery and equipment required for
detection and treatment of cancer. This strategy has not been beneficial as there was no stress on
prevention and 80% cases were detected at late stages.
The programme was revised in 1984-85 and subsequently in December 2004. There are
seven schemes under the revised programme:
 Recognition of New Regional Canter Centers (RCCs): In order to augment
comprehensive cancer care facilities in regions of country lacking them, new RCCs are
being recognized. A onetime grant of Rs.5.00 crores is being provided to new RCCs. At
present there are 22 RCCs.
 Strengthening of Existing RCCs: A onetime grant of Rs. 3.00 crore is provided to the
existing RCCs to further strengthen the treatment facilities in the existing centers.
 Development of Oncology Wing: To correct the geographical imbalance in the cancer
treatment facilities, government instructions (medical colleges as well as hospitals) are
provided one time grant of Rs. 3.00 crore for enhancing cancer care facilities.
 Decentralization of NGO Scheme: This scheme has been devised to promote prevention
and early detection of cancers. Non government organizations will implement these
activities under the coordination of a nodal agency – an RCC or on Oncology wing. A grant
of Rs. 8000 per camp will be provided for organizing camps, IEC and early detection
activities.
 District Cancer Control Programme: It will be implemented by a nodal agency –RCC or
an Oncology wing. The aim is to strengthen district hospitals in 2-3 congruent districts for
early detection and appropriate treatment or referral. A grant-in-aid of Rs. 90.00 lakh is
provided spread over a period of 5 years.
 Cancer registry: All the cases which are diagnosed are registered in the institutions having
registry facility. In addition, one rural area in Maharashtra and five urban areas in Delhi,
Bombay, Madras, Bhopal Bangalore are also taken up for Cancer registry purposes.
 Post partum centers: Under the family welfare programme, provision for early detection of
cervical cancer at post-partum centre is being done. This facility is available at almost all the
medical colleges.

3) NATIONAL MENTAL HEALTH PROGRAMME

In 1982, the National Mental Health Programme was launched to mitigate the hardships of mentally
ill patient. The objectives of the programme to:
  Ensure availability of mental health care services to all, specially the community at risk,
underprivileged and underserved people;
 Encourage application of mental health knowledge in general health care and social
development.
The district Mental Health (DHM) Programme as component of NMHP was launched in 1996- 97
in four districts one each in Andhra Pradesh, Assam, Rajasthan and Tamil Nadu. Now it covers 94
districts in 29 states of the country. The programme (DMH) envisages a community based approach
to deal with mental health problems in the country. It includes the following interventions as
mentioned in Annual report on Health & Family Welfare 2001- 2002:
 Training of the mental health team at the identified nodal institutes within the states.
 Increase awareness about mental health problems.
 Provide services for early detection and treatment of mental illness in the community itself
with both OPD and indoor treatment and follow –up of discharge cases.
 Provide valuable data and experience at the level of community in the States and Centre for
future planning, improvement in service and research.
 Funds are provided by the Government of India to the State Governments and the nodal
institutes to meet the expenditure on staff, equipments, vehicles, medicines, stationery,
contingencies, training, IEC activities etc. for the initial period of five years on the
undertaking of the State Governments to continue the programme on their own after the
committed period of central assistance is over.
Basic Strategy of National Mental Health Programme:
Mental hospitals or mental asylums are no longer considered institutions of choice for
treating mentally ill patients as these results in isolation of the patients from the community, loss of
social skills, stigmatization, abandonment by the families, maltreatment of patients and human
rights abuse. Because of availability of new generation antipsychotic drugs which can be effectively
used to treat most patients on outpatient basis and high cost effectiveness of community based care,
strategy of community based care is preferred over obsolete strategy of mental hospitals/asylums for
managing the patients with mental illness.
This forms the basis of strategy for National Mental Health Programme are:
 To ensure availability and accessibility of minimum mental health care for all in the
foreseeable future, particularly to the most vulnerable and under privileged sections of
population.
 To encourage application of mental health knowledge in general health care and social
development.
 To promote community participation in mental health service development and to stimulate
efforts towards self-help in the community.
Proposed strategies to realize the above objectives are
The programme envisages a community based approach to the problem, which includes:
 Training of the mental health team at the identified nodal institutes within the states.
 Increase awareness about mental health problems.
 Provide services for early detection and treatment of mental illness in the community itself
with both OPD and indoor treatment and follow up of discharged cases and
 Provide valuable data and experience at the level of community in the state and centre for
future planning, improvement in service and research.
During the 11th Plan, the re-strategized National Mental Health Programme will be implemented all
over the country. The new strategy involves:
 Recognition of mental illness at par with other illnesses and extending the scope of medical
insurance and other benefits to individuals suffering from them.
 Declaration of psychotropic drugs as essential drugs under the Pharma Policy in order to
prevent price escalations.
 Greater emphasis to psychotherapeutic and a right based model of dealing with mental
health related issues.
 Inclusion of psychiatry and psychology, and psychiatric social work modules in the training
of all health care giving professionals.
 Empowering primary care doctors and support staff for provision of psychiatric and
psychological care to patients at PHCs besides educating family careers on core aspects of
the illness.
 Improving public awareness and facilitate family-career participation by empowering
members of the family and community in psychological interventions.
 Greater emphasis on public private participation in the delivery of mental health services.
 Upgrading psychiatry departments of all medical colleges to enhance better training
opportunities.
 Improvement and integration of mental hospitals with the whole of health care delivery
infrastructure that offers mental health services thus removing the stigma attached.
Since most of the cases are chronic, efforts will be made for after care and life long support. There
is substantial increase in budget allocation for the Programme from Rs. 190 crore in the tenth plan
to Rs. 884 crore in the eleventh plan.

4) NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF DIABETES

 During the past two to three decades there has been tremendous increase in diabetes and
Cardiovascular Diseases (CVD) in the developing countries including India. Non Communicable
disease accounted for 53% of all deaths in India in 2005.
Risk factors of Cardiovascular Diseases (CVD) are widely prevalent in India. In a
study among industrial employees and their family member aged 20-69 years it was observed that
50.9% of men and 51.9% of women were overweight; 30.9% of men 32.8% of women had central
obesity; and 40.2% of men and 14.9% of women reported current tobacco use. Hypertension 27.7%
and diabetes 10.1% were also common. Only 60% of the adults consume vegetables daily and 60-
80% leads a sedentary life.
India leads the global top ten countries in terms of highest number of people with diabetes
with current figure of 40.9 million followed by China having 39.8 million. As per the International
Diabetes Federation the total number of diabetics in India has doubled from 19 million in 1995 to
40.5 million in 2007. It is projected to increase to 69.9 million by 2025.
Unhealthy diets, physical inactivity and overweight are risk factors common to diabetes and
CVD. Moreover, diabetes itself is an important risk factor for coronary health disease and stroke,
the two major forms of cardiovascular diseases. It has been estimated that 80% of premature
heart disease, stroke and type 2 diabetes and 40% of cancer could be prevented through avoidance
of tobacco products and the adoption of healthy diets and regular physical activity.
As per WHO, development of an integrated approach that targets all major common risk
factors of cardiovascular diseases (CVD), diabetes mellitus (DM), cancer and chronic respiratory
diseases is the most cost-effective way to prevent and control them.
Keeping these in view Government of India has launched National Programme for
Prevention and Control of Diabetes, Cardiovascular Diseases and Stroke in January 2008. The
programme will be implemented on a pilot basis initially and subsequently expanded in a phased
manner during 11th five year plan for which an outlay of Rs. 1468 crore has been proposed.
The programme objectives are:
 To reduce the prevalence of risk factors of common non-communicable diseases (NCDs)
 To reduce morbidity and mortality due to diabetes, cardiovascular diseases and stroke
 To build capacity of health systems to tackle NCDs and improve the quality of care.
Activities during preparatory phase and pilot project:
 Establishment of National NCD Cell with the necessary manpower and infrastructure
support.
 Establishment of State NCD Cell in six states.
 Identification and establishment of six regional resource centers.
 Identification of one medical college each in all the regions of the country viz. North, South,
East, West, North-East and Central region.
  Identification of one district under each medical college for setting up of District Healthy
lifestyle centers and strengthening of district and sub-district facilities.
 Finalization of management guidelines for NCDs and their risk factors.
 Preparation and dissemination of IEC strategy.
 Preparation and dissemination of NCD resource kit.
 Health Promotion in specific settings, e.g.
 NCD prevention and management for health professionals
 Patient education packages
 Health Promotion in specific settings, e.g. rural, urban, periurban, schools and workplaces.
 Survey for risk factors and NCDs

5) NATIONAL IODINE DEFICIENCY DISORDER CONTROL PROGAMME

India commenced a goiter control programme in 1962, based on iodized salt. At the end of
three decades, the prevalence of the disease still remains high. In retrospect, it became clear that the
failure was mostly due to operational and logistic difficulties. It was realized that iodine is an
essential micronutrient for normal growth and development. In 1990 this programme renamed as
National Iodine Deficiency Control Programme. Its deficiency not only causes goiter but also
disorders such as abortions, still births, mental retardation, deafness, mutism, squint and neuromoter
defects.
Considering these various factors, the National Goitre Control Programme was renamed to
National Iodine Deficiency Control Programme to have wider coverage with the following
objectives:
 To undertake surveys to assess the magnitude of Iodine deficiency disorders(IDDs)
 To supply loaded salt in place of common salt.
 To conduct resurveys to assess the impact of control measures after every 5 years.
 To undertake monitoring of the quality of loaded salt and urinary iodine excretion.
 To conduct health education and publicity
Pilot project against Micronutrient Malnutrition is merged with NIDDCP.
The objectives of the pilot project are:
 To assess and improve the iron and vitamin A deficiency status of school children,
adolescent girls and boys, non-pregnant ladies and elderly population who are suffering
from iron and vitamin A deficiency by supplementing iron and folic acid tablets and
Vitamin A.
 To assess Zinc, zinc deficiency at home level specially soil and tablets and different foods.
  To assess the magnitude of dental caries and to prevent and control the same,
 To launch extensive IEC campaign through mass media for micronutrient malnutrition in
order to improve the dietary habits of the population.
 To coordinate with similar ongoing programmes being implemented in the country.

E. Responsibilities of Community Health Nurses in National Health Programmes

Nurses are the key personnel in providing care to people having any kind of
communicable or non communicable diseases and their contacts, in creating awareness, among
people at large, educating them regarding prevention and control of various diseases etc. They
perform the role of care giver, communicator, educator, counsellor, trainer, investigation,
coordinator etc. Following are some of the major responsibilities of community health nurse in
prevention and control of various problems; she needs to:
1) understand the various problems in the country and the programmes which have been
planned, organised and implemented to deal with all the problems;
2) be familiar with the activities of the programme to be dealt with the problems;
3) identify endemic problems of the community for whom she is working;
4) participate in community surveys to determine the extent and nature of problem;
5) identify local agencies responsible to implement specific control programme;
6) identify the role of health agency where she works in providing specific services to deal
with specific problem;
7) participate in screening of high risk cases, identification of cases with any such
communicable diseases;
8) ensure the patient is diagnoses, treatment is done, care is given;
9) find out contacts, screening is done, diagnosis is conformed, treatment is done, care is
given etc;
10) follow up of case and defaulters;
11) maintain records, compile them and send to authority;
12) refer the cases to the concerned health agency when necessary;
13) participate in information, education communication activities for people at large, school
children on various aspects of healthful living, wrong beliefs and practices,
environmental health, control of vectors, rodents etc. And specific health problems when
required;
14) Supervise, train multipurpose health workers, village health guides, dais and anganwadi
workers.
V. CONCLUSION:
The Government of India with the aim of eradicating various health problems has
launched several National health programs at different times with the network of health centres
and hospitals in rural and urban areas. The programmes were launched on priority basis through
the successive “Five year Plan” .It is very important for community health nurses to learn about
various national programmes planned and implemented by the Government to participate
effectively and intelligently in the public health work in the community.
VI. JOURNAL/ RESEARCH ABSTRACTS
1. Burden of Malaria in India: Retrospective and Prospective View

Am. J. Trop. Med. Hyg., 77(6_Suppl), 2007, pp. 69-78

Copyright © 2007 by The American Society of Tropical Medicine and Hygiene

Ashwani Kumar, Neena Valecha, Tanu Jain, AND Aditya P. Dash

National Institute of Malaria Research, Field Station, Panaji, Goa, India; National Institute of
Malaria Research, Delhi, India

In India, nine Anopheline vectors are involved in transmitting malaria in diverse geo-
ecological paradigms. About 2 million confirmed malaria cases and 1,000 deaths are reported
annually, although 15 million cases and 20,000 deaths are estimated by WHO South East Asia
Regional Office. India contributes 77% of the total malaria in Southeast Asia. Multi-organ
involvement/dysfunction is reported in both Plasmodium falciparum and P. vivax cases. Most of
the malaria burden is borne by economically productive ages. The states inhabited by ethnic
tribes are entrenched with stable malaria, particularly P. falciparum with growing drug resistance.
The profound impact of complicated malaria in pregnancy includes anaemia, abortions, low birth
weight in neonates, still births, and maternal mortality.

Retrospective analyses of burden of malaria showed that disability adjusted life years lost
due to malaria were 1.86 million years. Cost–benefit analysis suggests that each Rupee invested
by the National Malaria Control Program pays a rich dividend of 19.7 Rupees.

2. Lymphatic Filariasis in India : Problems, Challenges and New

Initiatives
Lt Col VK Agrawal, Wg Cdr VK Sashindran
Abstract
Filariasis is a major public health problem in India and inspite of
existence of the National Filaria Control Programme since 1955, currently
there may be up to 31 million microfilaraemics, 23 million cases of
symptomatic filariasis, and about 473 million Individuals potentially at risk of
infection. Over the last 10 years advances have led to new diagnostic/
treatment tools and control strategies for filariasis. The new control strategy
aims at transmission control through mass treatment and at disease control
through individual patient management. As a signatory to 50th World Health
Assembly resolution on global elimination of lymphatic filariasis in 1997,
revised filariasis control program was launched in India in 13 districts in
seven endemic states where mass drug administration was undertaken.
Single dose mass administration annually in combination with other
techniques has already eliminated lymphatic filariasis from Japan, Taiwan,
South Korea and Solomon Islands and markedly reduced the transmission in
China. Very high treatment coverage (probably > 85%) is required to
achieve interruption of transmission and elimination in India. Hence, there is
an urgent need for effective drug delivery strategies that are adapted to
regional differences.
This requires powerful advocacy tools and strategies as well as
procedures for monitoring and evaluating the impact of elimination
programme.

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