National Health Mission (NHM)

Ministry of Health and Family Welfare

2 Sub-mission

National Urban Health Mission (NUHM)
National Rural Health Mission (NRHM)

Accredited Social Health Activist (ASHA workers)

Objectives

Reduce MMR to 1/1000 live births
Reduce IMR to 25/1000 live births
Reduce TFR (Total Fertility Rate ) to 2.1
Prevention and reduction of Anaemia in women aged 15– years.
Reduce annual incidence and mortality from Tuberculosis by half.

Reduce prevalence of Leprosy to <1/10000 population
Annual Malaria incidence to be <1/10000
Less than 1 percent Microfilaria prevalence in all districts
Kala-azar Elimination by 2015,

Prevent and reduce mortality & morbidity (being diseased) from communicable, noncommunicable; injuries and emerging diseases.
Reduce household out-of-pocket expenditure on total health care expenditure.

National Nutrition Mission NNM

Also POSHAN Abhiyaan

Ministry of Women and Child Development (WCD) as the nodal ministry along with Ministry of Drinking Water and Sanitation and Ministry of Health and Family Welfare

Objectives

Will strive to reduce the level of stunting, under-nutrition, anemia and low birth weight babies.
Ensure convergence with various programmes
Incentivizing States/ UTs for achieving goals
IT enabled Real Time Monitoring (ICT-RTM);
Evaluation; weighing efficiency, measuring height and making nutrition visible; Social audits
Jan Andolan - to educate the people on nutritional aspects, Nutrition Resource Centres
On-line Course on Nutrition for Children, Nutrition message from folk songs and songs on WASH, sending messages on nutrition and also creating ring-tones,
Yoga for children at AWCs; strengthening human resources
All the states and districts will be covered in a phased manner; to begin with the worst affected

Targets

Aims to bring down Anaemia among young children, women and adolescent girls by 3% every year

To bring down stunting in children to 25 percent by 2022

National Nutrition Monitoring Bureau (NNMB)

Indian Council of Medical Research (ICMR), established National Nutrition Monitoring Bureau (NNMB) in the year 1972

National Health Policy 2017

Universal and affordable health coverage

Aims at achieving Universal health coverage and delivering quality health care services to all at affordable cost.
Guarantees health care services to all Indian citizens, particularly the underprivileged.

Health and Wellness centre

Policy aims to move away from ‘sick care’ to ‘wellness' - thrust on prevention and health promotion

In order to provide access and financial protection at secondary and tertiary care levels, the policy proposes free drugs, free diagnostics and free emergency care services in all public hospitals.
Raising public health expenditure to 2.5% of the GDP in a time bound manner by 2025 (Now, it is 1.15)
Higher weightage given to States with poor health indicators and they will receive more resources
Public hospitals and facilities being periodically measured and certified for quality
Policy supports voluntary service in rural and under-served areas on pro-bono basis by recognized healthcare professionals under a 'giving back to society’ initiative
- Strongly advocated establishing a public health management cadre to improve the quality of health services by having dedicated, trained and exclusive personnel to run public health facilities.
- All India Health Care service
Proposes establishment of National Digital Health Authority (NDHA) to regulate, develop and deploy digital health across the continuum of care
The NHP, 2017 advocates a positive and proactive engagement with the private sector for critical gap filling towards achieving national goals.

Goals

wants to reduce out-of-pocket “catastrophic” health expenditure by households by 25% from current levels by 2025
wants to increase the utilisation of public health facilities by 50% from the current levels by 2025

Pros:

Cons:

Explicit mentioning of Right to Health is not provided
Only assurance policy but no legal guarantee.

National Digital Health Mission NDHM

by Ministry of Health & Family Welfare
NDHM is a voluntary healthcare programme that aims to reduce the gap among stakeholders such as doctors, hospitals, citizens etc by connecting them in an integrated digital health infrastructure
National Health Authority, attached office of MoHFW, will design, build, roll-out and implement the NDHM.
HealthID, DigiDoctor, Health Facility Registry (HFR), Personal Health Records (PHR), Electronic Medical Records (EMR), Consent Manager and Gateway -

National Technical Advisory Group on Immunization (NTAGI)

An advisory body that recommends vaccines for India’s Universal Immunization Programme
Recently, Jan 2018, NTAGI gave green signal to the introduction of Human Papillomavirus (HPV) Vaccine [Cervical Cancer]

It is the second leading cause of cancer deaths among women in India (cervical cancer)

National Institute of Nutrition NIN

India’s premi nutrition research institute present in Hyderabad under Indian Council of Medical Research
Mission: To enable food and nutrition security conducive to good health, growth & development and increase productivity, so as to achieve the national nutrition goals as per the national nutrition policy
It is organising Conference on “Nutrition Before, Beyond and During First 1000 Days of Life – Evidence to Action”2018 marks NIN Centenary (1918-2018) Celebrations.
NOTE: NNM is under Min of W&CD while National Institute of Nutrition is under Min of H & FW

Indian Council of Medical Research ICMR

Under Ministry of Health and Family Welfare
Apex body in India for the formulation, coordination and promotion of biomedical research
Conduct, coordinate and implement medical research for the benefit of the Society

Translating medical innovations in to products/processes and introducing them in to the public health system

Governing Body of the Council is presided over by the Union Health Minister.
Controls

National Institute of Nutrition
National Nutrition Monitoring Bureau (NNMB)

India Hypertension Management Initiative
India State Level Disease Burden Report
Compiles National Essential Diagnostics List NEDL

Ayushman Bharat Programme

It has two components

National Health Protection Scheme
Health and Wellness centre

National Health Protection Scheme

Also Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Also called Pradhan Mantri Rashtriya Swasthya Suraksha Mission PMRSSM

Ministry of Health and Family Welfare
AB-NHPM will have a defined benefit cover of Rs. 5 lakh per family per year.
This cover will take care of almost all secondary care and most of tertiary care procedures. (except a negative list)
There will be no cap on family size and age in the scheme
The benefit cover will also include pre and post-hospitalization expenses
A defined transport allowance per hospitalization will also be paid to the beneficiary.
Benefits of the scheme are portable across the country
Beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empaneled hospitals across the country.
Earlier, the Rashtriya Swasthya Bima Yojana (RSBY), provided limited coverage of only 30,000, usually for secondary care
The choice of whether to administer NHPS through a trust or an insurance company will be left to individual States
Financial viability

Despite a high coverage offered to the few who fall sick in any year, because the rest in the large pool do not need it that year.
Wherein the healthy cross-subsidise the sick at any given time
Criteria

AB-NHPM will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database,
Rural areas

include families having only one room with kucha walls and kucharoof;
families having no adult member between age 16 to 59;
female headed households with no adult male member between age 16 to 59;
disabled member and no able bodied adult member in the family;
SC/ST households;
Landless households deriving major part of their income from manual casual labour,
Also, automatically included families in rural areas having any one of the following: households without shelter, destitute, living on alms, manual scavenger families, primitive tribal groups, legally released bonded labour

Urban areas

11 categories

Costs

To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis. The package rates will include all the costs associated with treatment. Keeping in view the State specific requirements, States/ UTs will have the flexibility to modify these rates within a limited bandwidth.
Paperless, Cashless transaction
In partnership with NITI Aayog, a robust, modular, scalable and interoperable IT platform will be made operational which will entail a paperless, cashless transaction.

Cooperative federalism

States will be free to choose the modalities for implementation
States are given flexibility to implement through insurance company or directly through Trust/ Society or a mixed model
States would need to have State Health Agency (SHA) to implement the scheme

Ayushman Bharat National Healt Protection Mission Council

For giving policy directions and fostering coordination between Centre and States
Chaired by Union Health and Family Welfare Minister

Ayushman Bharat National Health Protection Mission Governing Board
Ayushman Bharat - National Health Protection Mission Agency

Manage the AB-NHPM at the operational level in the form of a Society.
States would need to have State Health Agency (SHA) to implement the scheme

Subsume the on-going centrally sponsored scheme “Rashtriya Swasthya Bima Yojana” (R ) and Senior Citizen Health Insurance Scheme (SCHIS)

Health and Wellness centre

Envisioned under National Health Policy, 2017
1.5 lakh Health and Wellness centres will bring health care system closer to the homes of people
These centres will provide comprehensive health care, including for non-communicable diseases and maternal and child health services
Augmented by induction of non-physician healthcare providers such as nurse practitioners, in addition to the existing staff, the HWC will provide essential drugs and basic diagnostic free of cost
Various vertical disease control programmes will find convergence at this delivery point
Contribution of private sector through CSR and philanthropic institutions in adopting these centres is also envisaged

ECHO clinics

ECHO (Extension for Community Healthcare Outcomes) is a concept of weekly or fortnightly virtual clinics using teleconferencing by best specialists to reach out to underserved areas.
ECHO clinics do not provide care directly to patients like in telemedicine. Instead, they equip primary healthcare clinicians in remote areas with the knowledge and support to manage complex cases.
It helps in bringing specialist c are and knowledge to areas where there is none

Red Line Campaign

To tackle the problem of growing misuse of antibiotics across the country, prescription only antibiotics will be marked with a vertical red line on the packets
The red line antibiotics packets should be consumed on doctor’s advice and t patients need to complete the full course prescribed by the doctor.
This Red line campaign launched in February 2016 by the Union Ministry of Health and Family Welfare to tackle the problem of growing misuse of antibiotics across the country.

Family Participatory Care

FPC means involving the family of sick and preterm new-born as partners in caregiving and decision making in the new born care facilities.
FPC initiative is under Norway India Partnership Initiative (NIPI) which aims to reduce neonatal and infant mortality by strengthening capacities and improving access and utilization of public health services.

India New Born Action Plan

Aimed at achieving single digit Neonatal Mortality and Stillbirth Rate by 2030.
Implemented within the existing Reproductive, Maternal, New-born, Child and Adolescent health (RMNCH+A) framework of the National Health Mission (NHM).
Build and strengthen surveillance capacity and expand the availability of standardized and accurate data on congenital anomalies

Food Safety and Standards Authority of India FSSAI

Statutory Food Safety and Standard Act, 2006 under Ministry of Health and Family Welfare

Not Ministry of Consumer Affairs, Food and Public Distribution

To establish a single reference point for all matters relating to food safety and standards
It requires food firms to provide scientific evidence that their product is safe.
The Act does not apply to any farmer, fisherman, farming operations, crops, livestock, aquaculture, supplies used/produced in farming, products of crops produced by a farmer/fisherman at initial production level.
Draft Food Safety and Standards (Organic Foods) Regulations, 2017
Food Safety and Standards (Fortification of Foods) Regulations, 2018

National Health Profile of India NHP

Released by Central Bureau of Health Intelligence, Directorate General of Health Services, Ministry of Health and Family Welfare
The objective of this publication is to create a versatile database of health information of India which is comprehensive, up-to-date and easily accessible to all stakeholders in the healthcare sector
NHP provides recent trends in demography, disease profile (communicable and non-communicable/lifestyle diseases) and available health resources that define a country’s health statusNHP provides relevant information to the planners, policy makers, health administrators, research workers and others engaged healthcare sector to take informed decisions.

Epidemic Disease Act, 1897

Objective: For better prevention of the spread of dangerous epidemic diseases

Backdrop: The British-era Act was mainly u sed to control plague in the late 1800s
Empowers both central and state govts to take “exceptional measures and prescribe regulat ons” contain spread of disease
Health is a state subject, but by invoking Section 2 of the Epidemic Act, advisories and directions of the Ministry of Health and Family Welfare are enforceable across the country
Penalty for disobedience
Routinely enforced. Ex: In 2009, to tackle the swine flu outbreak in Pune,

Limitations

No benchmark to determine that a particular disease needs to be declared as an epidemic.

Epidemic Disease Act fails to define “dangerous”, “infectious”, or “contagious disea an “epidemic"

No provisions on the isolation and the sequencing required for dissemination of drugs/vaccines, and the quarantine measures and other preventive steps
Does not describe the government’s duties and citizen rights in the time of epidemic

Epidemic Diseases (Amendment) Ordinance, 2020

Amend the Epidemic Diseases Act, 1897
To protect healthcare service personnel and property including their living/working premises against violence during epidemics
Definition of Healthcare personnel

A person who is at risk of contracting the epidemic disease while carrying out duties related to the epidemic. It includes

any public and clinical healthcare service providers such as doctors, nurses, paramedical workers and community health workers;
any other person empowered under the Act to take measures to prevent the outbreak of the disease or spread thereof;
any person declared as such by the State Government, by notification in the Official Gazette

Acts of violence
Punishments, compensation, cognisable and non-bailable
Investigation in 30 days and trail in 1 year
The burden of proof for the offence falls on the guilty.

Issue: Only applicable during epidemic times

SUN (Scale Up Nutrition) Movement

Global initiative began in 2009 with the development of Scale Up Nutrition Framework.
It unites peopleâ from civil society, the United Nations, donors, businesses and researchers
It is a collective effort to improve maternal and child nutrition.
To realise the vision of a world without hunger and malnutrition

Global Nutrition Targets

By World Health Assembly to achieve by 2025
Six targets are

Achieve a 40% reduction in the number of children under-5 who are stunted (low height for age);
50% reduction of anaemia in women of reproductive age;
30% reduction in low birth weight;
No increase in childhood overweight;
Increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%;
Reduce and maintain childhood wasting (low weight for height) to less than 5%

According to the Global Nutrition Report 2020, India is likely to miss global nutrition targets by 2025.

AYUSH/ Indian Systems of Medicine

Ayurveda

Focus more on healthy living than treatment of diseases
It personalizes the healing process
Ex: Panchakarma is an ayurvedic treatment

All India Institute of Ayurveda (AIIA) has been established at Sarita Vihar, New Delhi 2017

Yoga and Naturopathy

Yoga is bringing harmony b/w mind and body

Naturopathy is an art and science of healthy living and a drugless system of healing based on well-founded philosophy. It has its own

concept of health and disease and also principle of treatment

Unani

Introduced in India by the Arabs and Persians around the eleventh century
Involving the use of herbal remedies, dietary practices, and alternative therapies, Unani medicine addresses the prevention and treatment of disease.

Siddha

Siddhars were saintly persons who achieved results in medicine
Eighteen Siddhars were said to have contributed towards the development of this medical system.
It is largely therapeutic in nature.

Homeopathy

Based on the belief that the body can cure itself
It use tiny amounts of natural substances, like plants and minerals which are believed to stimulate the healing process

Others

Sowa Rigpa

Sowa Rigpa - the science of healing
It originated in Tibet and popularly practiced in countries namely, India, Nepal, Bhutan, Mongolia, and Russia
Traditional Medical system of the Himalayan belt in India.
It has been popularly practiced in Sikkim, Arunachal Pradesh, Darjeeling (West Bengal), Himachal Pradesh, Union Territory of Ladakh and now all over India.
Nov 2019, National Institute for Sowa-Rigpa in Leh as an autonomous organization under the Ministry of AYUSH is approved to be established
The majority of theory and practice of Sowa-Rigpa is similar to “Ayurv da”