Indian
Year Book
(2022-23)
Chapter – 13. Health
and Family Welfare
The Ministry of Health and Family Welfare earlier had two departments- The Department of Health & Family Welfare and the Department of Health Research. Department of AIDS Control was merged with the Department of Health and Family Welfare in 2014 and is now known as National AIDS Control Organisation (NACO).
Management of Covid-19
Ø World Health Organisation (WHO) declared Covid-19 a pandemic on March 11, 2020, and asked all countries to take urgent and aggressive action against this public health crisis. The government undertook the Covid-19 challenge upfront. It took the bold decision to announce a nationwide lockdown that involved the community.
Ø The government initiated a series of actions to prevent the entry of the disease and to contain its spread. Eleven Empowered Groups were constituted on March 29, 2020, on different aspects of Covid19 management in the country to make informed decisions on issues.
Ø Community surveillance was initiated for travel-related cases and subsequently for cases being reported from the community by Integrated Disease Surveillance Programme (IDSP). The containment plans released by the Ministry of Health and Family Welfare envisage a strategy of breaking the chain of transmission by (i) defi ning containment and buffer zones; (ii) applying strict perimeter control; (iii) intensive active house-to-house search for cases and contacts; (iv) isolation and testing of suspect cases and high-risk contacts; (v) quarantine of high-risk contacts; (vi) intensive risk communication to raise community awareness on simple preventive measures and need for prompt treatment-seeking; and (vii) strengthening of passive Infl uenza-Like Illness (ILI)/ Severe Acute Respiratory Illness (SARI) surveillance in containment and buffer zones.
Ø Three-tier arrangement of health facilities was created for appropriate management. It includes (i) Covid Care Centre with isolation beds for mild or pre-symptomatic cases; (ii) Dedicated Covid Health Centre (DCHC) with oxygen supported isolation beds for moderate cases; and (iii) Dedicated Covid Hospital (DCH) with ICU beds for severe cases. Tertiary care hospitals under Employees’ State Insurance Corporation (ESIC), defence, railways, paramilitary forces and Ministry of Steel have been leveraged for case management.
Ø To ensure accessibility of quality treatment for both Covid-19 and non-Covid-19 health issues to farfl ung areas, the use of telemedicine has been promoted in a big way. ‘eSanjeevani’, a web-based comprehensive telemedicine solution, is being utilised (in 23 states) to extend the reach of specialized healthcare services to masses in both rural areas and isolated communities.
Ø Indian Council of Medical Research (ICMR) is establishing a National Clinical Registry on Covid-19 that will provide insights into the clinical course of Covid-19 disease, its spectrum and the outcome for patients.
Pradhan Mantri Garib
Kalyan Package Insurance Scheme
Ø To support the states/UTs under the Whole of Government approach, the central government extended the Pradhan Mantri Garib Kalyan Package (PMGKP) Insurance Scheme for health workers fi ghting Covid-19 till April 2022. The scheme was launched in March 2020, initially for 90 days to provide comprehensive personal accident cover of 50 lakhs to all healthcare providers. This included community and private health workers for the care of Covid patients and for those who may come in direct contact with affected persons. The scheme is implemented through the insurance policy of the New India Assurance Company.
National Health Mission
Ø The National Health Mission (NHM) encompasses its two sub-missions, the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM). The main programmatic components include Health System Strengthening, Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A), and control of Communicable and Non-Communicable Diseases. The NHM envisages the achievement of universal access to equitable, affordable and quality health care services that are accountable and responsive to people’s needs.
Maternal and Child Health
Ø Mission lndradhanush: It was launched in 2014 to cover all those children who have been partially vaccinated or not vaccinated during routine immunisation rounds.
New Vaccines
Ø Inactivated Polio Vaccine (IPV): In concurrence with the World Polio End Game strategy, IPV was introduced in November 2015 in six states and expanded throughout the country by June 2016.
Ø Rotavirus Vaccine (RVV): This vaccine was launched in March 2016, to reduce the burden of diarrhoea caused by Rotavirus.
Ø Rubella Vaccine as Measles-Rubella (MR) Vaccine: MR vaccine is being introduced through a campaign targeting around 41 crore children in the age group of 9 months to 15 years followed by two doses in routine immunisation at 9-12 months and 16-24 months.
Ø Adult JE Vaccine: Japanese encephalitis vaccination in children was introduced in 2006. However, the vaccine was expanded in the adult population of districts with a high disease burden in 2015.
Ø Pneumococcal Conjugate Vaccine (PCV): This vaccine was launched in May 2017, to reduce child deaths due to pneumonia which is a major cause of child mortality.
Ø Tetanus and Adult Diphtheria (Td) Vaccine: Increase in immunisation coverage in children led to a shift in the age group of diphtheria cases to school-going children and adults.
Subsequently, Tetanus and Adult Diphtheria (Td) vaccine was recommended by the National Technical Advisory Group on Immunisation (NTAGI) in 2016.
Rashtriya Bal Swasthya Karyakram
Ø This initiative, launched in 2014 entails provision for Child Health Screening and Early Intervention Services through early detection and management of four Ds, i.e. defects at birth, diseases, defi ciencies, development delays including disability and free management of 32 identifi ed health conditions including surgery at tertiary health facilities.
Rashtriya Kishor Swasthya
Karyakram
Ø The Rashtriya Kishor Swasthya Karyakram (RKSK) was launched in 2014 to provide information, commodities and services to meet the diverse needs of adolescents. The programme expands the scope of adolescent health programming in India beyond sexual and reproductive health. The interventions under RKSK are:
· Weekly Iron Folic Acid Supplementation Programme entails the provision of weekly supervised IFA tablets to in-school boys and girls and out-of-school girls for the prevention of iron and folic acid defi ciency.
· The Scheme aims to ensure that adolescent girls have adequate knowledge and information about menstrual hygiene, use of sanitary napkins and environmentally safe disposal mechanism.
· Peer Educator Programme aims to ensure that adolescents are benefi tted from regular and sustained peer education covering nutrition, sexual and reproductive health, conditions for non-communicable diseases (NCDs), substance misuse, injuries and violence (including gender-based violence) and mental health.
Mother’s Absolute
Affection (MAA) Programme
Ø MAA-Mother’s Absolute Affection is an intensifi ed programme to bring undiluted focus on the promotion of breastfeeding and other infant and young child feeding practices.
Ø The goal of the MAA programme is to revitalise efforts toward the promotion, protection and support of breastfeeding practices through health systems to enhance breastfeeding rates.
Lactation Management
Centres
Ø Lactation Management Centres (LMC) are being established at high delivery load facilities to provide comprehensive support for lactation management.
Ø It includes Comprehensive Lactation Management Centres (CLMCs) and Lactation Management Units (LMUs).
Ø In CLMCs, there is a provision of Donor Human Milk (DHM) collected from the mothers who voluntarily donate their excess breast milk free of cost for the newborns who have no access to their own mothers’ milk. LMUs facilitate lactation support to the mothers so that newborns can be breastfed successfully or provided mothers’ milk.
Janani Suraksha Yojana
Ø Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Health Mission. The objective is to reduce maternal and neonatal mortality by promoting institutional delivery among poor pregnant women.
Pradhan Mantri Surakshit
Matritva Abhiyan
Ø Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) was launched in 2016. This programme aims to provide assured, comprehensive and quality antenatal care, free of cost, universally to all pregnant women on the ninth day of every month. PMSMA guarantees a minimum package of antenatal care services to women in their second or third trimesters of pregnancy at designated government health facilities. It focuses on improving the quality of care during ante-natal visits, besides identifi cation and line-listing of high-risk pregnancies based on obstetric/medical history and existing clinical conditions.
Anemia Mukt Bharat
Ø In 2018, Anemia Mukt Bharat (AMB) strategy was launched to achieve the envisaged target of a 3 per cent reduction in anaemia prevalence every year under the POSHAN Abhiyan.
Ø The six interventions under the Anemia Mukt Bharat strategy are prophylactic iron-folic acid supplementation; periodic deworming; intensifi ed year-round behaviour change communication campaign including delayed cord clamping; testing and treatment of anaemia using digital methods and point of care treatment; mandatory provision of iron-folic acid fortifi ed foods in public health programmes; and addressing non-nutritional causes of anaemia in endemic pockets, with special focus on malaria, hemoglobinopathies and fl uorosis.
Nutrition Rehabilitation
Centres
Ø Nutrition Rehabilitation Centres (NRCs) are facility-based interventions to provide medical treatment and nutritional management to under-fi ve year children suffering from Severe Acute Malnutrition (SAM) with medical complications.
Ayushman Bharat
Ø Ayushman Bharat—Pradhan Mantri Jan Arogya Yojana (ABPMJAY) was launched in 2018 subsuming the erstwhile Rashtriya Swasthya Bima Yojana (RSBY). Around 10.74 crore poor and vulnerable families (approximately 50 crore individuals) are entitled under it to cashless and paperless access to services at the point of service i.e., empanelled hospitals. This health cover includes 3 days of pre-hospitalisation and 15 days of post-hospitalisation expenses. There is no cap on family size, age or gender to ensure that all members of the benefi ciary families are covered. Also, benefi ts are portable across the country.
· Ayushman Bharat Health and Wellness Centres: The fi rst component of Ayushman Bharat pertains to the creation of 1,50,000 Ayushman Bharat-Health and Wellness Centres (AB-HWCs) by upgrading the Sub Health Centres (SHCs) and rural and urban Primary Health Centres (PHCs) to bring healthcare closer to the community. This target also includes the creation of 12,500 AYUSH HWCs by upgrading AYUSH Dispensaries and a few SHCs to provide AYUSH primary healthcare services. These centres will provide Comprehensive Primary Health Care (CPHC), by expanding and strengthening the existing Reproductive and Child Health (RCH) and Communicable Diseases services and by including services related to Non-Communicable Diseases and by incrementally adding primary healthcare services for mental health, ENT, Opthalmology, oral health, geriatric and palliative care and trauma care as well as health promotion and wellness activities like yoga.
· Ayushman Bharat Pradhan Mantri Jan Arogya Yojana: In an attempt to move from a sectoral and segmented approach to health service delivery to a comprehensive need-based healthcare service, Ayushman Bharat’s second component, Pradhan Mantri Jan Arogya Yojana was designed to be interlinked with the Health and Wellness Centres in a continuum of care approach launched in September 2018. Ayushman Bharat PM-JAY is the largest health assurance scheme in the world, fully fi nanced by the government and the cost of implementation is shared between the central and state governments. Households are included based on the deprivation and occupational criteria of SocioEconomic Caste Census 2011 (SECC 2011) for rural and urban areas respectively.
National Tuberculosis
Elimination Programme
· The National Tuberculosis Elimination Programme (NTEP) (erstwhile Revised National Tuberculosis Control Programme) is an ongoing Centrally Sponsored Scheme implementing Tuberculosis prevention and control activities in a mission mode to achieve a rapid decline in the burden of TB, morbidity and mortality, towards ending TB in India by 2025.
· Under NTEP, the government provides free diagnostics and quality assured drugs along with fi nancial assistance of Z 500 per month during treatment for all TB patients in the country. Altogether with 22,198 microscopy centres, all the districts have been linked to rapid molecular testing labs (a total of 3,760) and 689 districts have established functional DR-TB centres. TB Mukt Bharat Abhiyaan (TMBA) was launched to further build awareness about TB, address the deepseated stigma around the disease in the community, raise awareness and generate demand for free TB diagnostic and treatment services.
Mental Healthcare
Ø To address the challenge of mental illnesses, the government is implementing the National Mental Health Programme (NMHP) in the country. Under NMHP, implementation of the District Mental Health Programme (DMHP) has been approved for 692 districts of the country for early detection and management of mental disorders/illnesses.
Ø The Mental Healthcare Act, 2017, which came into force on May 29, 2018, seeks to provide mental healthcare and services for persons with mental illness and to protect, promote and fulfi l the rights of such persons during the delivery of services.
Medical Education
Ø The National Medical Commission Bill, 2019 for setting up a National Medical Commission and repealing the Indian Medical Council Act, 1956 was passed by the Parliament. The Act was notifi ed on August 8, 2019.
Ø It aims to improve access to quality and affordable medical education, ensure the availability of adequate and high-quality medical professionals in all parts of the country, promote equitable and universal healthcare that encourages a community health perspective and makes services of medical professional’s access to all the citizens.
Ø Phase-III of the Centrally Sponsored Scheme was approved in 2019 to establish 75 new medical colleges. The total cost per college is estimated at 325 crores with the fund sharing ratio of 90:10 for NE/Special Category States and 60:40 for other states.
Pradhan Mantri Swasthya
Suraksha Yojana
Ø The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) envisages the creation of tertiary healthcare capacity in medical education, research and clinical care, in the underserved areas of the country. It aims at correcting regional imbalances in the availability of affordable/reliable tertiary healthcare services and also augment facilities for quality medical education in the country. PMSSY has two components: projects involving the setting up of new AIIMS like institutes and the up-gradation of existing Government Medical Colleges (GMCs).
Indian Council of Medical
Research
Ø As one of the oldest medical research bodies in the world, the Indian Council of Medical Research (ICMR) was established in 1911 as the Indian Research Fund Association (IRFA). ICMR has spearheaded the planning, formulation, coordination, implementation, and promotion of biomedical research both in India and internationally. It has remained the apex and premier medical research organisation in the country through its commitments to research, professional development, collaboration, and knowledge dissemination. Across its disease-specifi c 26 research institutes, as well as through extramural funding to medical colleges, universities, other S&T agencies and non-governmental organisations, ICMR has made signifi cant scientifi c contributions to understanding various diseases of national importance such as malaria, Japanese encephalitis, tuberculosis, HIV/AIDS, Kala Azar, fi lariasis, leprosy and poliomyelitis.
Ø ICMR has also demonstrated its commitment to current public health concerns including nutrition, reproductive and maternal and child health, occupational and environmental health and health systems research. Its research output and impact have demonstrated considerable and constant growth.
Food Safety and Standards
Authority of India
Ø Food Safety and Standards Act was enacted in 2006.
Ø The Food Authority is assisted by Scientifi c Committee and Panels in setting standards and the Central Advisory Committee in coordinating with enforcement agencies.
Ø The Food Authority guides and regulates all persons engaged in manufacturing, processing, import, transportation, storage, distribution and retails of food, on issues of food safety and nutrition with primary responsibility for enforcement largely with the Commissioners of Food Safety of states/UTs.
Drugs
Ø SUGAM portal by the Central Drugs Standards Control Organisation (CDSCO) enables online submission of applications, their tracking, processing and grant of approvals online mainly for drugs, clinical trials, ethics committees, medical devices, vaccines and cosmetics. It provides a single-window for multiple stakeholders (Pharma Industry, Regulators, Citizens) involved in the processes of CDSCO.
e-Health
·
National Digital Health Blueprint (NDHB)
· The Committee constituted by the MoHFW to create an implementation framework for the National Health Stack (NHS) has come up with the National Digital Health Blueprint, after surveying the global best practices in the adoption of digital technologies holistically. The key features of the blueprint include a federated architecture; a set of architectural principles; a 5-layered system of architectural building blocks; Unique Health Id (UHID); privacy and consent management, national portability; Electronic Health Record (EHR), applicable standards and regulations; health analytics; and above all, multiple access channels like a call centre, Digital Health India portal and MyHealth App.
· On August 15, 2020, the National Digital Health Mission (NDHM) was implemented in the country. Currently, NDHM is being implemented in six UTs for pilot implementation.
·
Centre for Health Informatics (CHI)
· The Centre for Health Informatics (CHI) has undertaken multiple activities relating to e-Governance/ e-Health for improving the effi ciency and effectiveness of the healthcare system to achieve universal health coverage.
Sanjeevani and eSanjeevani
OPD
· Sanjeevani, the telemedicine platform of MoHFW supports two types of telecon_ ‘Ration services: Doctor-to-Doctor (it is known as eSanjeevani) and P.. ‘ent-to-Doctor (it is called eSanjeevani OPD) teleconsultations. eSanjeevani is an important component of the Ayushman Bharat Health and Wellness Centres (AB-HWCs) programme. It was rolled out in November 2019 and aims to implement teleconsultation in all the 1.5 lakh Health and Wellness Centres in a ‘hub-and-spoke’ model, by December 2022. NHM in states identifi es and sets up dedicated ‘Hubs’ in medical colleges and district hospitals to enable teleconsultation services to ‘Spokes’, set up at special health centres and primary health centres.
AYUSH Systems of
Healthcare
·
Ayurveda
· ‘Ayurveda’ literally means “Science of Life”. Ayurveda is evolved from the various Vedic hymns rooted in the fundamental philosophies about life, disease and health. The Charak Samhita and Sushruta Samhita developed around 2500 BC are the main treaties of Ayurveda fully available today. Ayurveda takes an integrated view of the physical, mental, spiritual and social aspects of human beings and the inter-relationships between these aspects.
Yoga
· Yoga is essentially spiritual and it is an art and science of healthy living which focuses on bringing harmony between body and mind. The word ‘Yoga’ has two meanings; the fi rst comes from the root ‘Yujir’ or ‘Union’, the second is derived from a different root ‘Yuja’ which means ’samadhi’—the highest state of mind and the absolute knowledge. These two are the most important meanings of the word Yoga according to Panini, the most well-known Sanskrit grammarian.
·
Naturopathy
· Naturopathy is a system of medicine that advocates harmonious living with constructive principles of nature on physical, mental, moral and spiritual planes.
·
Unani
· The Unani system of medicine originated in Greece and passed through many countries before establishing itself in India during the medieval period. It emphasises the use of naturally occurring mostly herbal medicines and some medicines of animals, marine and mineral origin. The Government of India facilitated the growth and development of Unani Medicine by recognising its utility and scope and integrating it into the healthcare delivery system. With its wide network of quality educational institutions, comprehensive healthcare facilities, state-of-the-art research institutions and quality drug manufacturing industries and on account of its utilisation by a large number of people for their healthcare needs, India has emerged as the global leader in the Unani System of Medicine.
·
Siddha
· The Siddha system is considered the mother medicine of ancient Tamils/Dravidians in South India. It provides preventive, promotive, curative, rejuvenates and rehabilitative health care with a holistic approach. Siddha system is said to be a divine and holistic system of medicine as it offers excellent medicines and lifestyle guidelines for healthy living. The Siddha system is evolved based on ninety-six tools or principles (Thathuvas) which include the physical, physiological, psychological, and intellectual aspects of every human being. According to the Siddha system, matter and energy are the two major entities, which account for the formation of the universe and its contents.
·
Homoeopathy
· The physicians from the time of Hippocrates (around 400 BC) had observed that certain substances could produce symptoms of a disease in healthy people similar to those of people suffering from the disease. Dr Christian Friedrich Samuel Hahnemann, a German physician, scientifi cally examined this phenomenon and codifi ed the fundamental principles of Homoeopathy. Homoeopathy was brought into India around 1810 AD by European missionaries and received offi cial recognition by a Resolution passed by the Constituent Assembly in 1948 and then by the Parliament.
·
Sowa-Rigpa
· Sowa-Rigpa is among the oldest surviving health traditions in the world with a living history of more than 2,500 years. It has been in vogue and practised in Himalayan regions, particularly in Leh and Laddakh (J&K), Himachal Pradesh, Arunachal Pradesh, Sikkim, Darjeeling, etc. SowaRigpa is effective in managing chronic diseases like asthma, bronchitis, arthritis, etc. The basic theory of Sowa-Rigpa is explained in terms of: (i) the body and the mind as the locus of treatment; (ii) antidote, i.e., the treatment; (iii) the method of treatment through antidote; (iv) medicines that cure the disease; and lastly (v) pharmacology. Sowa-Rigpa emphasises the importance of the fi ve cosmological physical elements in the formation of the human body.
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