Health

• The WHO defines health as a state of complete physical, mental and

social well-being and not merely the absence of disease or infirmity.

Determinants of Health
• Income and social status
o Higher income and social status are linked to better health. The
greater the gap between the richest and poorest people, the
greater the differences in health.
• Education
o Low education levels are linked with poor health, more stress
and lower self-confidence.
• Social support networks
o Greater support from families, friends and communities is
linked to better health.
o Culture - customs and traditions, and the beliefs of the family
and community all affect health.
• Genetics
o Inheritance plays a part in determining life span, healthiness
and the likelihood of developing certain illnesses.
o Personal behaviour and coping skills – balanced eating, keeping
active, smoking, drinking, and how we deal with life’s stresses
and challenges all affect health.
• Health services
o Access and use of services that prevent and treat disease
influences health.
• Gender
o Men and women suffer from different types of diseases at
different ages.
• Physical environment
o Safe water and clean air, healthy workplaces, safe houses,
communities and roads all contribute to good health.
o Employment and working conditions – people in employment
are healthier, particularly those who have more control over
their working conditions.

WASH SERVICE
World Health Organization (WHO) released a report ‘Burden of disease attributable
to unsafe drinking-water, sanitation and hygiene (WASH)’.
➢ The report stated that in 2019, the use of safe WASH services could have
prevented 2.5% of all deaths and 2.9% of all Disability-Adjusted Life years
(DALYs) globally.
➢ The number of people defecating in the open in India has reduced
significantly by an estimated 450 million people.

Significance

1. Inadequate WASH services in health facilities contributes to the high

neonatal mortality rate, which is currently around 24 deaths per 1000 live
births.
 2. The risk of spreading diarrheal and waterborne diseases gets compounded
by the lack of regular handwashing and microbial contamination of water.
3. Poor sanitation can also have a ripple effect when it hinders national
development because workers are suffering from illnesses and living shorter
lives, producing and earning less, and unable to afford education and stable
futures for their children.
4. Inadequate water, sanitation and hygiene (WASH) services in India’s health
facilities contributes to the high neonatal mortality rate, which is currently
24 deaths per 1000 live births.
5. Sepsis – mainly spread in health facilities – contributes to 15 per cent of the
overall neonatal mortality and 11 per cent of maternal deaths
6. Chemical contamination of water, mainly through fluoride and arsenic, is
present in 1.96 million dwellings. Meanwhile, less than 50 per cent of the
population has access to safely managed drinking.

Initiative in India
1. Jal Jeevan Mission
2. Promotion of Menstrual hygiene:
➢ The Ministry of Health and Family Welfare implements the Scheme for
Promotion of Menstrual Hygiene among adolescent girls in the age
group of 10-19 years since 2011. The scheme is supported by the
National Health Mission
➢ The major objectives of the scheme are (i) to increase awareness among
adolescent girls on menstrual hygiene; (ii) to increase access to and use
of high-quality sanitary napkins by adolescent girls, and (iii) to ensure
safe disposal of sanitary napkins in an environment friendly manner.
Under the scheme, a pack of sanitary napkins are provided to
adolescent girls by the Accredited Social Health Activist (ASHA) at
subsidized rate of Rs. 6 per pack.

3. AMRUT The main objectives of the Atal Mission for Rejuvenation and Urban
Transformation (AMRUT) are mentioned below:
➢ To ensure a proper supply of water and a sewage connection in every
household.
➢ To develop green and well maintained open spaces and parks to
increase the amenity value of the cities.
➢ To reduce pollution by switching to public transport or through the
construction of non-motorized transport facilities such as walking and
cycling.
AMRUT 2.0 will promote circular economy of water through development of City
Water Balance Plan (CWBP) for each city focusing on recycle/reuse of treated
sewage, rejuvenation of water bodies and water conservation
Other components of AMRUT 2.0 are:
• Pey Jal Survekshan to ascertain equitable distribution of water, reuse of
wastewater, mapping of water bodies and promote healthy competition
among the cities /towns.
• Information, Education and Communication (IEC) campaign to spread
awareness among masses about conservation of water.

4. Rural WASH Partner Forum:

➢ Rural WASH Partners’ Forum is a platform created by the Government
of India, Ministry of Jal Shakti, Department of Drinking Water and
Sanitation, to support states in two of their flagship programmes, ‘Jal
Jeevan Mission’ and ‘Swachh Bharat Mission.
 ➢ The key objective of Rural WASH Partners’ Forum (RWPF) is to bring
together Development Partners on a single platform to drive innovation
in the sector, through technology, knowledge products, financing, and
capacity building.

Global Initiative
1. WHO Guidelines on Drinking water: The Guidelines for drinking-water
quality (GDWQ) promote the protection of public health by advocating for the
development of locally relevant standards and regulations (health-based
targets), adoption of preventive risk management approaches covering
catchment to consumer (Water Safety Plans) and independent surveillance to
ensure that Water Safety Plans are being implemented and effective and that
national standards are being met.
2. UN Sanitation and Hygiene fund: To fund the countries with heavy disease
burden.
3. UNICEF Strategy for WASH 2016-2030 Focus on child by building state
capacities to provide WASH Services.

Health Structure in India

At present, India’s health care system consists of a mix of public and private
sector providers of health services.
o Networks of health care facilities at the primary, secondary and
tertiary level, run mainly by State Governments, provide free or
very low-cost medical services.
o There is also an extensive private health care sector, covering
the entire spectrum from individual doctors and their clinics to
general hospitals and super speciality hospitals.
Role of Community in Health sector
Community Participation
Community participation is the process by which individuals and families
assume responsibility for their own health and of the community they live
in.
Community participation ensures the following:

1. Self-reliance and sustainability: Individuals come to know of the

health problems of the community and learn the ways and means of
overcoming these. They no longer are mere passive beneficiaries of
Government aid.
2. Overcoming cultural barriers to healthcare: They don’t remain obliged
to accept conventional solutions to their problems if these are in
conflict with local culture.
3. Better communication with the community:
Health education can penetrate better in the community if the trained
community workers are involved and motivated. Also the specific
concerns of the community are conveyed better to the planners.
4. Community can provide labour and even financial resources for
healthcare if needed.
5. The community health worker provides the first level of contact
between individuals and health care system.

Examples of community participation in India:

 • Auxiliary Nurse Midwife (ANM)
• Accredited Social Health Activist (ASHA)
• Anganwadi worker (AWW)
• Village Health Sanitation and Nutrition Committee

1. Auxiliary Nurse-Midwife (ANM), Under the current National Health

Mission (NHM), ANMs are placed at sub-centres (SC) catering to a
population of 5,000 and at Primary Health Centres (PHCs) catering to
a population of 30,000. Generally, ANMs are required to live at the
sub-centres so that they can be on call for community members
requiring their services (Maternal and child care).
2. The second is the Anganwadi Worker (AWW), who works solely in her
village and focuses on provision of food supplements to young
children, adolescent girls, and lactating women.
3. The most recently created cadre is the Accredited Social Health
Activist (ASHA), who also works solely in her village. ASHA workers
focus on promotion of MCH, including immunizations and
institutional-based deliveries, for which they receive a performance-
related fee.

ASHA
ASHA worker has been recognised for WHO global health leader award.
Background: -
• Launched in 2005 as a part of National Rural health mission, now
extended to urban areas also after the launch of National Urban
health mission in 2013.
Its genesis is in "MITANIN", initiative of Chhatisgarh started in 2002.

Functions of ASHA Workers:

1. ASHA will provide information to the community on determinants of
health such as nutrition, basic sanitation & hygienic practices, healthy
living and working conditions, information on existing health services
and the need for timely utilisation of health & family welfare services.
2. She will counsel women on birth preparedness, importance of safe
delivery, breast-feeding and complementary feeding, immunization,
contraception and prevention of common infections including
Reproductive Tract Infection/Sexually Transmitted Infections
(RTIs/STIs) and care of the young child.
3. ASHA will mobilise the community and facilitate them in accessing
health and health related services available at the Anganwadi/sub-
centre/primary health centres, such as immunisation, Ante Natal
Check-up (ANC), Post Natal Check-up supplementary nutrition,
sanitation and other services being provided by the government.
Issues faced by them: -
1. Timely payment and inadequate incentive is the biggest challenge
faced by ASHA.
2. Another issue is to work in coordination with two department
activities i.e., ICDS and health and medical department.
3. They have stated that they have joined as ASHA to support their
family but now neither they are getting enough incentive nor time for
their family as work load is getting heavier day by day.
Anganwadi worker
Crucial role in providing childcare, health and nutrition, education,
immunisation, health check-up and referral services under Integrated
Child Development Scheme.
• To guide Accredited Social Health Activists (ASHA) engaged under the
National Rural Health Mission.
• To assist in the implementation of Kishori Shakti Yojana (KSY) and
motivate and educate the adolescent girls and their parents and
community in general by organizing social awareness programmes/
campaigns etc.
• The National Education Policy puts Anganwadi at centre for
Universalisation of Early childhood care and education.

Challenges:
1. The work load of the Anganwadi staff was heavy work but the status
of the wages in low, the monthly honorarium of Anganwadi teachers
is only 7.500-8000 Rs.
2. Infrastructure related: Inadequate infrastructural facilities are a
major constraint in the effective functioning of Anganwadi’s. In
building facilities in terms of space and nature of construction are
unsatisfactory.
3. Excessive record maintenance: A total 12 registers that were
maintained by the workers.
Suggestion
• Anganwadi workers should undergo a rigorous training course before
they are appointed as in charge of ICDS Centre.
• Increase the monthly honorarium of the Anganwadi workers.

Auxiliary Midwives
Under the current National Health Mission (NHM), ANMs are placed at sub-
centres (SC) catering to a population of 5,000 and at Primary Health Centres
(PHCs) catering to a population of 30,000. Generally, ANMs are required to
live at the sub-centres so that they can be on call for community members
requiring their services (Maternal and child care).

Universal Health Coverage

• The World Health Organization (WHO) Health Assembly set the target
of “Health for All” in May 1977. These were to be achieved by the end
of 2000.
• Subsequently, in 2000, the Millennium Development Goals were
formulated by the UN with the target for achievement set for 2015.
This was followed by the Sustainable Development Goals (SDG), set by
the UN in 2016, to be achieved by 2030 by all member countries.
Features of UHC
• Universal Health Coverage — for everyone everywhere
• WHO: All people, including the poorest and most vulnerable.
• WHAT: Full range of essential health services, including prevention,
treatment, hospital care and pain control.
• HOW: Costs shared among the entire population through pre-
payment and risk-pooling, rather than shouldered by the sick. Access
should be based on need and unrelated to ability to pay.

Initiatives for UHC in India

• Mission Indradhanush, one of the largest global public health
initiatives was launched in 2014. In its four phases till date, MI has
successfully reached over 25 million children in over 528 districts.
Since 2014, Rotavirus vaccine, Pneumococcal Conjugate Vaccine
 (PCV), and the Measles-Rubella (MR) vaccine, and also the JE vaccine
for adults have also been launched.
• The Pradhan Mantri Dialysis Program has been launched to provide
free services through Dialysis Units under Free Drugs and Diagnostics
Program.
• AMRIT outlets have been established to provide subsidized medicines.
• To provide comprehensive primary care, the Government has
announced transforming 1.5 lakh sub health centres to Health and
Wellness centres in the country under Ayushman Bharat.
• Universal screening of common NCDs such as diabetes, hypertension
and common cancers at the sub-centre and Primary Health Centre
has been initiated.

PMJAY

• The Ayushman Bharat programme was launched in 2018 to address

health issues at all levels – primary, secondary, and tertiary. It has
two components:
1. Pradhan Mantri Jan Arogya Yojana (PM-JAY), earlier known as
the National Health Protection Scheme (NHPS)
2. Health and Wellness Centers (HWCs)
• Ayushman Bharat is an integrated approach comprising health
insurance and primary, secondary and tertiary healthcare. The HWCs
are aimed at improving access to cheap and quality healthcare
services at the primary level. PM-JAY will cover the financial
protection for availing healthcare services at the secondary and
tertiary levels.
• Ayushman Bharat is the largest government-funded healthcare
programme in the world with over 50 crore beneficiaries. It has been
dubbed ‘Modicare’ or the National Health Protection Mission (AB-
NHPM).

Pillars of the Scheme

• First, comprehensive health care benefits covering pre and post
hospitalization expenses.
• Two, converged and integrated within the healthcare ecosystem:
Flexibility was provided to states and Union Territories (UTs) in
choosing their mode of implementation, beneficiary database and
network of hospitals.
• Three, ensuring equity in access to health care services.
• Four, robust, scalable, and interoperable technology platforms.
 • Five, public and private partnership: Under AB PM-JAY, both public
and private hospitals have been empanelled for providing health care
services.
• Six, Aapke Dwar Ayushman: A grassroots network of frontline health
care workers, panchayat officials and village-based digital
entrepreneurs was used to undertake door-to-door mobilization of
beneficiaries across communities.

Issues in Healthcare System/ Challenges in achieving UHC

• Availability of Doctor
o India produces only 13 new medical graduates (doctors and
nurses) per annum per 100,000 persons, compared with more
than 55 in developed countries.
• Under-investment
o Primary healthcare also means that PHCs continue to remain
under-equipped and lacking supplies and drugs to provide
comprehensive primary care. Also, according to Indian public
health standard, there should be 22 beds / lakh but in Bihar it
is 6 beds /lakh.
• Insurance
o Government contribution to insurance stands at roughly at 60
percent, as opposed to 83.5 percent in the UK.
• Rural-urban disparity
o PHCs are short of more than 3,000 doctors, with the shortage
up by 200 per cent over the last 10 years to 27,421.
• Infrastructure
o The hospitals are understaffed and under-financed, forcing
patients to visit private medical practitioners and hospitals.
• Low Investment
o National Health Accounts Estimates For India (2019-20):
Government Health Expenditure’s share in country’s total GDP
increases from 1.13% (2014-15) to 1.35% (2019-20). Such low
spending leads to a perverted pattern: families end up
contributing to 48% of all healthcare expenditure.
• Governance
o Chronic absenteeism, corruption and private practice have
become very integral to our systems.

Suggestion
The High-Level Expert Group (HLEG) was set up by the Planning
Commission to define a comprehensive strategy for health for the Twelfth
Five Year Plan. The main recommendations of the HLEG are:
• Health Financing and Financial Protection
o Government should increase public expenditure on health from
the current 1.2% of GDP to at least 3% of GDP by 2022.
• Access to Medicines, Vaccines and Technology
o The Essential Drugs List should be revised and expanded, and
rational use of drugs ensured.
• Human Resources for Health
 o District Health Knowledge Institutes, a dedicated training
system for Community Health Workers, State Health Science
Universities and a National Council for Human Resources in
Health (NCHRH) should be established.

Private sector participation in Health care

15th FC has mooted a greater role for public-private partnerships (PPPs) to
ramp up the health infrastructure and scale up public spending on health
from 0.95% of GDP to 2.5% by 2024.
Public sector share in health system is only 30% and 70% is of private
sector.
Advantage of Private health care: -
o Individualised care is obviously easier in private than in government
institutions. One can choose both the treating doctor and the time
and place of treatment. In certain conditions the patient may want to
choose the method of treatment as well.
o A privatised system can also provide better nursing and allied
services. It can provide better facilities for attendants and other
caregivers. Patients and their relatives are not pushed around,
neglected and ignored.
o It is important in the matter of testing, diagnosis for covid and TB.
o Important for blood and plasma management as seen in case of covid.
o Niti Aayog has also released Model concessionaire agreement for
inviting private sector in health.

Niti Ayog on PPP Model

PPP Units to be established in District Hospitals:
Model covers prevention and treatment of 3 Non-Communicable Diseases
viz. Cardiovascular diseases, Cancers and Pulmonary diseases.
o Private partner to invest in upgrading/building and equipping the
facility and responsible for operational management and service
delivery.
o Government to provide physical space & other infrastructure in ‘as-is
where-is’ condition, provide support facilities and hospital amenities.
o User Fee to be fixed as the package rates discovered periodically
through States/ Centre Insurance Scheme(s). States which do not
have such insurance packages, could use CGHS package rates for
period when such insurance rates are not available.
o Viability Gap Funding (VGF) to be provided by the
government(s) should be used as the parameter for bidding in the
project.

Thus, privatisation has helped improve health services – their type, scope,
quality and consequences.

Challenges of Private health care

1. More than 80% of the people cannot afford high-cost private health
care.
2. Nearly 70% of population slides into poverty every year due to
outpatients’ expenditure.
3. There is a complete neglect of Primary health care.
 4. Insurance model of Ayushmann Bharat is led by private insurer who
are doing frauds and focus on accumulation of capital only.
5. Lack of doctors in rural areas. Rural Urban density is 1:4.

Use of technology in Health Sector

Telemedicine
Telemedicine is the use of telecommunications and information technology
to provide clinical healthcare at a distance.
Opportunities for telemedicine
• Telemedicine is helpful for people living in rural areas.
• Telemedicine helps overcome the shortage of health professionals.
India currently has only 0.7 physicians per 1000 people while China
and Russia have 5 and 1.5 respectively.
• Telemedicine is a better option while dealing with particularly
infectious diseases like swine flu.

Developments in Telemedicine
• The Indian government has launched the SEHAT initiative to connect
60,000 common service centres nationwide and provide health care
services to citizens. This will dovetail with the Digital India Initiative.
• In 2009, KIDROP programme was launched in Karnataka to screen
infants for retinopathy of prematurity (ROP), a leading cause of
childhood blindness. Its success has led to it being replicated in two
more States.
• E Sanjeevani platform: It offers Provider to provider (Doctor- Doctor
interaction) provider to patient interaction, where patient can visit to
community health officer through smartphone. It seeks to connect all
1,50,000 HWCs using the hub-and-spoke model by December 2022.
• Remote Shared Medical Appointment SMA): Shared medical
appointments (SMAs), or group visits, are a healthcare delivery
innovation arising from the changing demands of patient-centred
medical home (PCMH) settings and the primary care context. The
model emphasizes prompt access and improved service, increased
doctor-patient contact time, greater patient education, enhanced
prevention and disease self-management, closer attention to routine
health maintenance and performance measures, and the central role
of patient and clinician experience within the Triple Aim: enhancing
patient experience, improving population health, and reducing costs.
Example:- Aravind Eye hospital has trialled SME for patients with
glaucoma.

How can new technologies improve the hospital ecosystem ?

➢ One, Blockchain technology can help in addressing the
interoperability challenges that health information and technology
systems face.
o The health blockchain will contain a complete indexed history of
all medical data, including formal medical records and health
 data. Data will be sourced from mobile applications and
wearable sensors. This will help in seamless medical attention.
o Further, it allows for storing of data in a secure and
authenticated network. Thereby, it will prevent erosion of
Individuals’ privacy and ensure data security.
➢ Two, Big data analytics can help improve patient-based services such
as early disease detection.
➢ Three, AI and the Internet of Medical Things, or IoMT can support
medical care delivery in dispersed and complex environments through
Medical autonomous systems.
➢ Four, Cloud computing can facilitate collaboration and dataexchanges
between doctors, departments, and even institutions and medical
providers. It will enable the best treatment.

Possible challenges
• Standardization of health data
• Developing a template for sharing data
• Reengineering many of the institutional and structural arrangements
in the medical sector
• Organizational silos in bureaucracy
• Data security and Data privacy
• High investments

Opportunities in Health Care Sector

• The Indian health care sector is expected to increase to Rs. 8.6 trillion
(US$ 133.44 billion) by 2022. It is almost three times what it’s now.
• Data Analytics
o With the arrival of the National Digital Health Mission (NDHM),
the digital Health ID will come which will store the data of
patients.
o It would help in effective policy making and private players can
get an edge in introducing the new technologies in the market.
• Private investments
o With the advent of information technology and big data it would
be easy for private players to invest strategically.
• Employment opportunity
o As we know the Indian health care sector lacks a workforce,
there is a space for thousands of employees.
• Start-ups
o With the help of Government and private players an
environment of start-ups and entrepreneurship can be created
in this field.
• Medical Tourism
o India is already one of the favorite medical Tourism Destinations
in the world and in the upcoming years this sector can be
harnessed efficiently.

Possible challenges
• Standardization of health data
• Developing a template for sharing data
• Reengineering many of the institutional and structural arrangements
in the medical sector
• Organizational silos in bureaucracy
• Data security and Data privacy
• High investments

National Health Policy

• The National Health Policy, 2017 states following targets for reduction
in incidence and prevalence of certain disease conditions:
o HIV/AIDS: Achieve global target of 2020 (also termed as target
of 90:90:90)
o Eliminate Leprosy by 2018, Kala-Azar by 2017 and Lymphatic
Filariasis in endemic pockets by 2017
o Eliminate Tuberculosis by 2025: Achieving and maintaining a
cure rate of >85% in new sputum positive patients and reduce
incidence of new cases
o Reduce prevalence of blindness to 0.25/ 1000 by 2025 and
disease burden by one third from current levels
o Reduce premature mortality from cardiovascular diseases,
cancer, diabetes and chronic respiratory diseases by 25% by
2025

• Objectives
o Improve health status through concerted policy action in all
sectors and
o expand preventive, promotive, curative, palliative and
rehabilitative services provided through the public health sector
with focus on quality.
 Disease wise Study

AIDS & HIV

HIV, the virus that causes AIDS, is one of the world’s most serious public
health challenges. Around 37 million people worldwide are living with HIV.
Of these, 1.8 million are children under 15 years of age.
What is HIV ?
• HIV (human immunodeficiency virus) is a virus that attacks cells that
help the body fight infection, making a person more vulnerable to
other infections and diseases.
• If left untreated, HIV can lead to the disease AIDS (acquired
immunodeficiency syndrome).
• The human body can’t get rid of HIV and no effective HIV cure exists.
So, once you have HIV, you have it for life.
• First identified in 1981, HIV is the cause of one of humanity’s
deadliest and most persistent epidemics.

Significant gains
• As per recently released 2019 HIV estimates by the National AIDS
Control Organization (NACO)/Ministry of Health and Family Welfare
with the technical support of UNAIDS there has been a 66.1%
reduction in new HIV infections among children and a 65.3%
reduction in AIDS-related deaths in India over a nine-year period.
 • The number of pregnant women living with HIV has reduced from
31,000 in 2010 to 20,000 in 2019.
• India is the third largest HIV Infected population with an estimated 2
Million People.
• The country aims to decrease new infections by 75% between 2010
and 2020 and eliminate AIDS by 2030.

Steps taken

National AIDS Control Program (NACP)

• NACP is globally acclaimed as a success story. It was launched in
1992 as a comprehensive programme for the prevention and control of
HIV/AIDS in India.
• As of now, the government has undertaken four phases of this
programme:
• NACP IV
o Its objectives include the reduction of infection by 50% and
provide comprehensive care and support to the infected
individuals.
o The strategies implemented in this phase include:
▪ Prevention through increased focus on high-risk groups
(HRGs), vulnerable population and the general population
▪ Expanding Information, Education and Communication
(IEC) service to the general population and HRGs.
▪ Increasing access and promoting comprehensive Care,
Support and Treatment (CST)
▪ Building capacities at national, state, district and facility
levels
▪ Strengthening Strategic Information Management
Systems

90-90-90 strategy
• It is a UNAIDS programme that has the following targets:
• 90% of all people living with HIV will know their HIV status
• 90% of all people with diagnosed HIV infection will receive a
sustained antiretroviral therapy
• 90% of all people receiving ART will have viral suppression

Project Sunrise
• It aims to prevent AIDS, especially among drug addicts in North
East India

Significant gains
• As per recently released 2019 HIV estimates by the National AIDS
Control Organization (NACO)/Ministry of Health and Family Welfare
with the technical support of UNAIDS there has been a 66.1%
reduction in new HIV infections among children and a 65.3%
reduction in AIDS-related deaths in India over a nine-year period.
• The number of pregnant women living with HIV has reduced from
31,000 in 2010 to 20,000 in 2019.
 • India is the third largest HIV Infected population with an estimated 2
Million People.
• The country aims to decrease new infections by 75% between 2010
and 2020 and eliminate AIDS by 2030.

Tuberculosis
• TB is caused by a bacterium called Mycobacterium tuberculosis,
belonging to the Mycobacteriaceae family consisting of about 200
members.
• In humans, TB most commonly affects the lungs (pulmonary TB), but
it can also affect other organs (extra-pulmonary TB).
• TB is a very ancient disease and has been documented to have existed
in Egypt as early as 3000 BC.

The government aims to have a TB-free India by 2025, five years ahead of
the global target of 2030.

Steps Taken

National TB Elimination Programme (NTEP)

• 1962: The National TB Programme (NTP) was launched by GOI with
BCG vaccination at the district level.
• 1993: GOI revitalized NTP as Revised National TB Control Programme
(RNTCP).
• 1997: DOTS was launched as the RNTCP strategy. By 2006 the entire
country was covered under RNTCP.
National strategic plan for tuberculosis elimination (NSP) 2017-2025
• TB elimination has been integrated into the four strategic pillars of
“Detect – Treat – Prevent – Build” (DTPB).

Other Programmes
• The Nikshay Ecosystem (National TB information system)
• Nikshay Poshan Yojana (NPY- financial support)
• TB Harega Desh Jeetega Campaign
Global TB Report 2023
➢ The treatment coverage has improved to 80% of the estimated TB
cases, an increase of 19% over the previous year.
➢ Reduction of TB incidence by 16% in 2022 (from 2015) almost double
the pace at which global TB incidence is declining (which is 8.7%)
➢ TB mortality dropped from 4.94 lakhs in 2021 to 3.31 lakhs in 2022.
➢ Treatment success rates have improved to 88% for people treated for
drug-susceptible TB and 63% for people with Multidrug- and
rifampicin-resistant tuberculosis (MDR/RR-TB).

Non-Communicable Diseases (NCDs)

• Noncommunicable diseases (NCDs), also known as chronic diseases,
tend to be of long duration and are the result of a combination of
genetic, physiological, environmental and behavioural factors.
• The main types of NCDs are cardiovascular diseases (like heart
attacks and stroke), cancers, chronic respiratory diseases (such as
chronic obstructive pulmonary disease and asthma) and diabetes.
• According to an Indian Council of Medical Research (ICMR) report
titled “India: Health of the Nation’s States”, contribution of Non-
Communicable Diseases (NCDs) to total death in the Country was
61.8% in 2016, as compared to 37.9% in 1990.
• According to the World Economic Forum (WEF), India stands to lose $
4.58 trillion (Rs 311.94 trillion) due to non-communicable diseases
between 2012 And 2030

Death due to NCD

• One out of 4 deaths due to cardiovascular disease in the younger
population.
• Before the pandemic 63% death in India was because of this, now the
WHO surveys says it is 71%.

What happened at the time of Covid ?

• Health surveillance and screening and management of NCD has been
disrupted.
• Emergency services to such patients have been dropped.
• Higher risk to such patients if contracted to CoVID because of rise in
glucose levels.
• Cancellation of planned treatment, decreased availability of transport
and lack of staff were the main reasons for disruption.
• Lockdown has reduced mobility, and made life more sedentary, which
has a toll on life.
• Increase in consumption of tobacco, alcohol.
• Low income countries failed to include NCD services in the national
CoVID plan.

Socio-economic impacts of NCDs

• NCDs threaten progress towards the 2030 Agenda for Sustainable
Development, which includes a target of reducing premature deaths
from NCDs by one-third by 2030.
 • Poverty is closely linked with NCDs.
o The rapid rise in NCDs is predicted to impede poverty reduction
initiatives in low-income countries, particularly by increasing
household costs associated with health care.
o Vulnerable and socially disadvantaged people get sicker and die
sooner than people of higher social positions, especially because
they are at greater risk of being exposed to harmful products,
such as tobacco, or unhealthy dietary practices, and have
limited access to health services

Steps Taken
• National Programme for Prevention and Control of Cancer, Diabetes,
Cardiovascular Diseases and Stroke (NPCDCS) is being implemented
under the National Health Mission (NHM)

Rare Disease/Orphan Disease

• There is no universally accepted definition of a rare disease.
• The definition accepted in the United States is that it is a disease that
afflicts fewer than 2,00,000 people.
• This definition is also accepted by the National Organization for Rare
Disorders (NORD) in India.
• Rare diseases came to be known as orphan diseases because
pharmaceutical companies were not ready to adopt them and develop
drugs for them because of the low prevalence.
o That is why the drugs used to treat or manage rare diseases are
known as orphan drugs.
• The World Health Organization defines a rare disease as an often-
debilitating lifelong disease or disorder condition with a prevalence of
1 or less, per 1000 population.
o It is estimated that there are about 7000 rare diseases.
 o Most of the rare diseases (about 80%) are genetic and hence
affects a large number of children.
o Some rare diseases are not inherited such as some rare cancers,
some autoimmune diseases, infectious tropical diseases, etc.

Why is there a Need for Continuous Treatment ?

• Most of the rare diseases for which treatment is available are
progressive. They require continuous support and not just one-time
assistance as an interim arrangement can never be a substitute for a
policy.
• Pushes Families in Poverty
o The exorbitant cost of treatment per patient, which ranges
anywhere from ₹25 lakh and ₹4 crore per year, is out of reach
even for middle-class families.
• Significant Population Impacted
o While there is no registry of rare diseases patients in India (the
policy provided for one), according to the government's own
estimates there are between 70-90 million patients.
• Difficulty in R&D
o Rare diseases are difficult to research upon as the patient pool
is very small and it often results in inadequate clinical
experience.
o The policy envisaged a R&D framework which cannot be
attained through one time financial support.
• Not covered under Health Insurance
o Private insurance companies treat genetic disorders as pre-
existing conditions and, on that ground, exclude them from
coverage.
o Since most rare diseases are genetic, patients are routinely
denied insurance cover.

Steps taken
• National Policy for Treatment of Rare Diseases, 2021
o The government notified the National Policy for Treatment of
Rare Diseases, 2021 recently
o The document classifies rare diseases into three groups:
▪ Group 1 has disorders controllable by one-time curative
treatment, including osteopetrosis and Fanconi anaemia.
▪ Group 2 has diseases requiring long-term or lifelong
treatment with a relatively lower cost of treatment and
benefit has been documented in literature, including
galactosemia, severe food protein allergy, and
homocystinuria.
▪ Group 3 has diseases for which definitive treatment is
available, but challenges are to make optimal patient
selection for benefit, and very high cost and lifelong therapy,
covering diseases such as spinal muscular atrophy (SMA),
Pompe disease, and Hunter syndrome.
o The government has decided to provide Rs.20 lakh to poor patients
and patients covered under the Ayushman Bharat for Group 1
diseases.
 o For diseases classified under Group 3, which require life-long
expensive treatments, the government would create a digital platform
to bring together Centres for Excellence, patients undergoing
treatment and corporate donors or prospective voluntary individuals
who could help fund treatment.

Scheme Wise Study

National Health Mission

• After the success of the National Rural health Mission, the National
Health Mission (NHM) was announced in 2012 covering all the villages
and towns in the country.
• The National Health mission has two sub-missions:
1. National Rural Health Mission
2. National Urban Health Mission

Core Principles of NHM

• Universal Coverage
o The NHM shall extend all over the country, both in urban and
rural areas and promote universal access to a continuum of
cashless, health services from primary to tertiary care.
• Achieving Quality Standards
o Standards would include the complete range of conditions,
covering emergency, RCH, prevention and management of
Communicable and Non-Communicable diseases incorporating
essential medicines, and Essential and Emergency Surgical
Care (EESC).
o The objective would be to achieve a minimum norm of 500 beds
per 10 lakh population in an average district.
o For ensuring access to health care among under-served
populations, the existing Mobile Medical units would be
expanded to have a presence in each CHC.
• Continuum of Care
o The linkages between different health facilities would be built so
that all healthcare facilities in a region are organically linked
with each other, with medical colleges providing the broad
vision, leadership and opportunities for skill up-gradation.
o The potential offered by tele-medicine for remote diagnostics,
monitoring and case management needs to be fully realized.
• Decentralised Planning
o A key element of the new NHM is that it would provide
considerable flexibility to States and Districts to plan for
measures to promote health and address the health problems
that they face.
o New health facilities would not be set up on a rigid, population
based norm, but would aim to be accessible to populations in
remote locations and within a defined time period.

Janini Suraksha yojana

 1. It is implemented by National Rural health mission.
2. It is a centrally sponsored scheme.
3. It is a centrally sponsored scheme with following benefits:
➢ If an expected Pregnant Woman from rural area gets delivered at
Public Health Facility or Accredited Private Hospital will get a cash
assistance of Rs. 1400/- after delivery irrespective of age, birth
order, or income group (BPL & APL).
➢ If an expected Pregnant Woman from Urban Area gets delivered at
Public Health Facility or Accredited Private Hospital will get a cash
assistance of Rs. 1000/- after delivery irrespective of age, birth
order, or income group (BPL & APL).
➢ If an expected pregnant woman under the BPL category gets
delivered at home will get cash assistance of Rs. 500 regardless of
the pregnant woman's age and number of children.
➢ The state has implemented a DBT (Direct Bank Transfer) mode of
payment. Under this initiative, eligible pregnant women are
entitled to get JSY benefit directly into their bank account.

Janini shishu Suraksha Karyakaram

➢ A scheme by Ministry of MoHFW for pregnant women who access

government health facilities for their delivery. to absolutely free and no
expense delivery, including caesarean section. Essential care is
provided to the mother and her neonate within 48 hours.
➢ It was launched in June 2011 to eliminate out-of-pocket expenses for
institutional delivery of pregnant women and treatment of sick
infants.
➢ In 2014, the programme was extended to all antenatal & postnatal
complications of pregnancy and similar entitlements have been put in
place for all sick newborns and infants (up to one year of age)
accessing public health institutions for treatment.
➢ Benefits for mother
a. Free and cashless delivery
b. Free C-Section
c. Free drugs and consumables
d. Free diagnostics
e. Free diet during stay in the health institutions
f. Free provision of blood
g. Exemption from user charges
h. Free transport from home to health institutions
i. Free transport between facilities in case of referral
j. Free drop back from Institutions to home after 48hrs stay
➢ For sick newborns till 30 days after birth (now been expanded to also
cover sick infants)
a. Free treatment
b. Free drugs and consumables
c. Free diagnostics
d. Free provision of blood

LaQshya
 ➢ It was launched with the objective of reduction in the maternal and
newborn mortality & morbidity due to occurrence of complication
during and immediately after delivery, to improve Quality of Care
during the delivery and immediate post-partum care, stabilization of
complications and ensure timely referrals, and enable an effective two-
way follow-up system to enhance satisfaction of beneficiaries visiting
the health facilities and provide Respectful Maternity Care (RMC) to all
pregnant women attending the public health facility.
➢ It is programmed to benefit every pregnant woman and newborn
delivering in public health institutions.
➢ Under the initiative, a multi-layered strategy has been framed such as
concrete steps for infrastructure advancement, ensuring availability of
essential equipment, providing adequate human resources, capacity
building of health care workers and improving quality processes in the
labour room.
➢ The NQAS (National Quality Assurance Standards) will monitor quality
improvement in labour room and maternity OT.
➢ The LaQshya program is being implemented at all Medical College
Hospitals, District Hospitals, First Referral Unit (FRU), and
Community Health Center (CHCs) and will benefit every pregnant
woman and new-born delivering in public health institutions.

Mission Indradhanush
➢ It is a special catch-up campaign under the Universal Immunization
Program (UIP), conducted in the areas of low immunization coverage
to vaccinate all the children up to 2 years of age and pregnant women
left out or dropped out from Routine Immunization.
➢ The Mission Indradhanush aims to cover all those children who are
either unvaccinated or are partially vaccinated against vaccine
preventable diseases. India’s Universal Immunisation Programme
(UIP) provide free vaccines against 12 life threatening diseases, to 26
million children annually. The Universal Immunization Programme
provides life-saving vaccines to all children across the country free of
cost to protect them against Tuberculosis, Diphtheria, Pertussis,
Tetanus, Polio, Hepatitis B, Pneumonia and Meningitis due to
Haemophilus Influenzae type b (Hib), Measles, Rubella, Japanese
Encephalitis (JE) and Rotavirus diarrhoea. (Rubella, JE and Rotavirus
vaccine in select states and districts).

Rastriya Kishore Swasthya karyakaram

➢ RKSK is a health programme for adolescents, in the age group of 10-
19 years that was launched by the Government of India to address
health needs of adolescents including their sexual and reproductive
health, nutrition, mental health and substance abuse, gender-based
violence, and risk factors for non-communicable diseases, among
others.
Objectives
• Improve nutrition.
1. Reduce the prevalence of malnutrition among adolescent girls
and boys.
 2. Reduce the prevalence of iron-deficiency anaemia (IDA) among
adolescent girls and boys.
• Improve sexual and reproductive health.
• Reduce teenage pregnancies
• Enhance mental health.
• Prevent injuries and violence.
• Prevent substance misuse.
• Address NCDs
Target Groups
The new adolescent health (AH) strategy focuses on age groups 10-14 years
and 15-19 years with universal coverage, i.e. males and females; urban and
rural; in school and out of school; married and unmarried; and vulnerable
and under-served.

Rastriya Bal Swasthya Karyakaram

• The Ministry of Health & Family Welfare, Government of India, under

the National Health Mission launched the Rashtriya Bal Swasthya
Karyakram (RBSK), an innovative and ambitious initiative, which
envisages Child Health Screening and Early Intervention Services, a
systemic approach of early identification and link to care, support and
treatment.
Rashtriya Bal Swasthya Karyakram (RBSK) is one of its kind program
to improve the overall quality of life of children enabling all children
achieve their full potential; and also provide comprehensive care to all
the children in the community. This program involves screening of
children from birth to 18 years of age for 4 Ds- Defects at birth,
Diseases, Deficiencies and Development delays.
• Children diagnosed with identified selected health conditions are
provided early intervention services and follow-up care at the district
level. These services are provided free of cost, thus helping their
families reduce out of pocket expenditure incurred on the treatment.
To facilitate screening of children, there is a strong convergence with
the Ministry of Women and Child Development for screening children
the age group 0 – 6 years enrolled at Anganwadi centres and with the
Ministry of Human Resource Development for screening the children
enrolled in Government and Government aided schools. The newborn
is screened for birth defects in health facilities by the doctors at health
facilities and during the home visit by ASHA (peripheral health
worker).

Rastriya Arogya Nidhi

• A centrally sponsored scheme. It aims at providing financial
assistance to the patients who live under the poverty line. The scheme
covers patients suffering from diseases that are identified as life-
threatening. As a part of this scheme, patients can avail of medical
treatment at any hospital or institute providing super-speciality
facilities or at any other government hospital.
 • As a part of this scheme, this assistance is given to patients with life-
threatening diseases in the form of a ‘one time grant’. This grant is
provided to the concerned Medical Superintendent of the particular
medical institute or hospital where treatment is being provided.
• As per the Rashtriya Arogya Nidhi Guidelines, the states and union
territories within India are required to make their own State Illness
Funds. The central government then provides the funds to these State
Illness Funds. 50% of the total contribution is to be done by the State
Governments or the Union Territories for their respective funds.

Surakshit Matritva Aashwasan (SUMAN)

• It aims to provide dignified and quality health care at no cost to every

woman and newborn visiting a public health facility.
• The scheme was launched on October 10, 2019, during the 13th
Conference of Central Council of Health and Family Welfare in New
Delhi.
• All pregnant women, newborns and mothers up to 6 months of
delivery will be able to avail several free health care services under
this scheme.
• Benefits:
1. At least 4 antenatal checkups.
2. Iron Folic acid supplements
3. Tetanus, Diphtheria injection
4. Six home based newborn care visit
5. Free transport to pregnant women
6. DBT

PM Surakshit Matritva Abhiyan

• The program aims to provide assured, comprehensive and quality

antenatal care, free of cost, universally to all pregnant women on the
9th of every month.
• Under the campaign, a minimum package of antenatal care services is
to be provided to the beneficiaries on the 9th day of every month at
the Pradhan Mantri Surakshit Matritva Clinics to ensure that every
pregnant woman receives at least one checkup in the 2nd/ 3rd
trimester of pregnancy. If the 9th day of the month is a Sunday / a
holiday, then the Clinic should be organized on the next working day.
• Target beneficiaries: The programme aims to reach out to all Pregnant
Women who are in the 2nd & 3rd Trimesters of pregnancy.
• Public Health Facilities to access services under PMSMA: Rural Areas
– Primary Health centres, Community Health Centers, Rural
Hospitals, Sub – District Hospital – District Hospital – Medical College
Hospital Urban Areas – Urban Dispensaries, Urban Health Posts,
Maternity Homes
• Provision of services during PMSMA
1. All the beneficiaries visiting the Facility are first registered in a
separate register for Pradhan Mantri Surakshit Matritva Abhiyan
(PMSMA).
2. After registration, ANM ensures that all basic laboratory
investigations are done before the beneficiary is examined by the
Medical Officer.
3. The report of the investigations should ideally be handed over
within an hour and before the beneficiaries are meeting the
doctors for further checkups.
4. This will ensure identification of High-Risk status (like anemia,
gestational diabetes, hypertension, infection etc.) at the time of
examination and further advice.
5. Lab Investigations – USG, & all basic investigations – Hb , Urine
Albumin, RBS (Dip stick), Rapid Malaria test, Rapid VDRL test,
Blood Grouping, CBC ESR, USG