Activities under National Health Mission
National Health Mission (NHM) encompassing two Sub Missions:-
1. National Rural Health Mission (NRHM)
2. National Urban Health Mission (NUHM)
It is both flexible and dynamic and it intended to ensure the achievement of universal access to health care through strengthening of health system, institutions and capabilities.
The NHM shall be a major instrument of financing and support to the states to strengthen public Health System and health care delivery. This financing to the state will be based on the states programme Implementation Plan (PIP). The PIP shall have following parts.
Part I: - NRHM RCH Flexipool
Part II: - NUHM Flexipool
Part III: - Flexible Pool for Communicable Disease
Part IV: - Flexible Pool for Non-Communicable Injury and Trauma
Part V: - Infrastructure Maintenance
Major Areas for Concerted Action Towards Health System Strengthening
1. Decentralized Health Planning:-
The District Health Action Plan is an important institutional structure for enabling decentralization Convergence and integration and is also the vehicle for promoting equity and prioritizing the needs of the most socially and economically vulnerable groups in a district.
2. Facility Based Service Delivery:-
A facility development plan has the following component: Infrastructure , equipment, human resources drugs and supplies, quality assurance systems and drugs and supplies, quality assurance systems and service provisioning. While the Indian Public Health Standards (IPHS) guide the facility strengthening plan in terms of specifications, appropriate increase in Human Resources, beds, drugs and supplies Commensurate with caseloads will be made.
3. The District Hospital:-
The District Hospital broadly serves the following roles:-
1. Provide all Secondary and considerable elements of tertiary care required.
2. Provide adequate referral support for clinical care at primary care level.
3. Serve as the preferred site for skill base dun service training
4. Provide laboratory support for public health programmes.
4. Outreach Services:-
1. Primary health facilities are the hub for delivering effective outreach services in slum areas. Outreach Services would be provided through ANMs based in UPHCs. ANMs would provide preventive, promotive and curative health care services to households through routine outreach sessions.
2. Mobile Medical Units (MMUs) to take health Services to remote, far flung, difficult to reach areas and urban slums, to provide a package of services equivalent to a primary health centre and have the necessary HR, equipment and supplies.
5. Community Process & Behaviour Change Communication:-
The ASHA plays a very important role in strengthening health system, while preserving the principle of voluntarism, local residency, community based selection, and the three key roles are:-
1. Facilitation for Health care Services.
2. Community level care provision including counseling and interpersonal communication for behavior change.
3. Social mobilization, especially for the marginalized to access essential health care services.
The ASHA would be selected at the level of 200-500 households working in a population of 1000.
2. Behaviour Change Communication (BCC):-
BCC plays an important adjunct to every programme and on a number of themes for standalone programme of its own.
BCC programme is based on systematic identification of key behavior and health care related practice and attitudes, which are detrimental to good health.
6. Health Management Information Systems (HMIS)
NHM envisages a fully functional health information system facilitating smooth flow of information for effective decision-making. A robust HMIS is essential for decentralized health planning HMIS is designed to support regular analysis of health data for decision regarding various health programs.
Health Service Delivery
1. Reproductive, Maternal, Newborn, Child Health and Adolescent (RMNCH +A) Services:-
The NHM provides an opportunity to renew the emphasis on strategies for improving maternal and Child Health through a continuum of care and the life cycle approach. The in extricable linkage between adolescent health, family planning, maternal health and child survival have been recognized. The main strategies for RMNCH +A include services for mothers , newborns, children, adolescents and women in the reproductive age group.
1. Maternal Health:-
Key strategies include improved access to skilled obstetric care through facility development, increase coverage and quality of ante-natal and post-natal care, increased access to skilled birth attendant institutional delivery; basic and comprehensive emergency obstetric care through health facility.
The Janani Suraksha Yojna (JSY) which enables institutional delivery. Another key scheme for an expanding comprehensive package of free and cashless services currently covering all pregnant women and sick infants up to the age of one year, in govt. health institutions through Janani Shishu Suraksha Karyakram (JSSK).
2. Access to Safe Abortion Services:-
This is to improve access to comprehensive abortion care, including post abortion contraceptive Counseling and services by expanding the network of facilities providing Medical Termination of Pregnancy (MTP) at FRU level.
3. Prevention & Management of RTI/STI:-
Prevention of RTI/STI to be included in BCC interventions for Community health education and as part of adolescent health education, provision of diagnosis and treatment services at health facilities. Linking up with ICTC and establishing appropriate referrals for HIV testing and RTI/STI Management.
4. Newborn and Child Health:-
This includes continuum of care from the community to facility level through provision of Home based newborn and child care from ASHAs/ANMs. Essential newborn care and resuscitation at all delivery points through established Newborn Care corners. Facility based care for Sick newborns will be provided through the New born Stabilization Units (NBSU) and special Newborn care units (SNCU)
Institutional care for sick children and provision for management of Severe Acute Malnourished children at Nutrition Rehabilitation Centre (NRC) at District hospitals. Infant & Young child Feeding (IYCF) and nutrition counseling to support early and exclusive breast feeding, complementary feeding, micro nutrient supplementation through health facilities.
5. Universal Immunization:-
Sustaining Pulse Polio in routine immunization at district level.
6. Adolescent Health:-
Adolescent Health Programme include the following priority interventions:-
1. Iron & Folic Acid Supplementation
2. Facility based adolescent health services.
3. Community based health promotion activity
7. Family Planning:-
Meeting unmet needs for contraception through provisioning of a range of family planning methods. Family planning services utilized as a key strategy to reduce maternal and child morbidity and mortality in addition to stabilizing population.
8. Addressing the declining Sex Ratio:-
Improving the adverse child sex ratio is crucial and strategies that lie within the domain of health include:-
1. Stricter enforcement of the PCPNDT Act.
2. Improve Monitoring and sensitization of the medical community.
Control of Communicable Diseases
There is provision to continue focus on communicable disease control program and disease surveillance. There is following program under communicable disease control.
1. National Vector Borne Disease Control Programme (NVBDCP):-
This is an umbrella programme for prevention and control of vector borne diseases viz Malaria, Japanese Encephalitis (JE), Dengue, Chikungunya Kala-Azar and Lymphatic Filariasis.
2. Revised National Tuberculosis Control Programme (RNTCP):-
The goal is to decrease Mortality and Morbidity due to TB and reduce transmission of infection Objectives of the programme are to achieve and maintain cure rate of at 85% among New Sputum Positive (NSP) patients and achieve and maintain case detection of at least 70% of the estimated MSP cases in community.
The Current focus of the programme is on ensuring universal access to quality TB diagnoses and treatment services to TB Patients.
3. National Leprosy Control Programme (NLEP):-
Key activities includes diagnosis and treatment of leprosy. Services for diagnosis & treatment are provided at all primary health centres.
4. Integrated Disease Surveillance Programme (IDSP):-
It is being implemented for Surveillance of Out-break of Communicable diseases. Surveillances Unit have been established at district level and reporting Unit is all Health facilities in district.
Non-Communicable Diseases (NCD)
The Schemes and interventions under the non-communicable diseases that is implemented up to the district hospital. There are following programmes:-
1. National Programme for Prevention & Control of Cancer, Diabetes Cardiovascular Diseases and Stroke (NPCDCS):-
Primary care includes primary prevention of hypertension & diabetes, screening for these disease and secondary prevention by routine follow up with medication to prevent strokes and ischemic heart Disease. This is to be linked through two way referral linkages with appropriate secondary and tertiary care provides.
2. National Programme for the Control of Blindness (NPCB):-
The focus is in Controlling Cataract blindness and also initiate activities to prevent and control blindness due to other causes. Key strategies are to increase public awareness about prevention and timely treatment of eye ointments.
3. National Mental Health Programme (NMHP):-
Managing Common mental problems severe mental diseases and mental emergencies.
4. National Programme for the Healthcare of the Elderly (NPHCE):-
The aim is to provide comprehensive health care to senior citizens through all levels of the healthcare delivery system.
5. National Programme for the Prevention & Control of Deafness (NPPCD):-
The key objectives are to prevent avoidable hearing loss, early identification, diagnosis and treatment of ear problems responsible for hearing loss and deafness.
6. National Tobacco Control Program (NTCP):-
The intervention is largely at the primordial and primary level of prevention key thrust areas include training of health and social workers including ASHAs, NGOs, School teachers, enforcement officers; JEC activities; school based programmes; monitoring tobacco control Laws.
The Primary Care list of Assured Services
The assured Services provided by a primary care unit is as follows:-
1. Reproductive and Child Health:-
Ø Care in pregnancy – all care, including identification of complications, but excluding management of complications requiring surgery and blood transfusion.
Ø All aspects of Essential Newborn Care.
Ø Care for common illness of newborn and children
Ø Universal Use of iodized salt.
Ø All aspects of prevention and management of malnutrition excepting those that require institutional care.
Ø All family planning services except female sterilization
Ø Provision of Safe abortion services – medical & Surgical.
Ø Identification and management of Anemic.
Ø Common sexual and Urogenital problem.
Ø All public health measures that lead to improve maternal and child survival and lower RCH morbidity.
Ø All health education and individual counseling measures needed for health promotion.
Ø All laboratory support needed for the same.
2. Control of Communication Diseases:-
Ø Screening for leprosy, referral on suspicion and follow up of cases with confirmed diagnosis and prescribed treatment.
Ø Referral of Suspect tuberculosis, family level screening of known patients and follow up of cases.
Ø HIV testing, appropriate referral and follow up
Ø All measures for the prevention of Vector Borne Diseases; early and prompt treatment with referral of complicated cases.
Ø Reduction in burden of water borne diseases especially diarrhea and dysentery, typhoid.
Ø Reduction of infections hepatitis B and identification and referral for the same.
Ø Primary care for other infectious diseases, presenting as fever especially ARI, UTT with referrals.
3. Non Communicable Diseases:-
Ø Screening for breast and cervical cancer in all women over the age of 30.
Ø Screening for mental disorders, Counseling and follow up to specialist initiated care.
Ø Detection of epilepsy and stroke and follow up
Ø Screening for visual impairments and referrals.
Ø Screening for diabetes and hypertension.