Integrated Child Development Services (ICDS)

Integrated Child Development Service (ICDS) scheme was launched on 2nd October,
1975 (5th Five year Plan) in pursuance of the National Policy for Children in 33
experimental blocks. Now the goal is to universalization of ICDS throughout the
country.The primary responsibility for the implementation of the programme is with the
Department of Women and Child Development, Ministry of Human Resources
Development at the Centre and the nodal departments at the state which may be Social
Welfare, Rural Development, Tribal Welfare, Health and Family Welfare or Women and
Child Development.
Beneficiaries:

Children below 6 years

Pregnant and lactating women

Women in the age group of 15-44 years

Adolescent girls in selected blocks

Objectives:
1. Improve the nutrition and health status of children in the age group of 0-6 years
2. Lay the foundation for proper psychological, physical and social development of the
child
3. Effective

coordination

and

implementation

of

policy

among

the

various

departments
4. Enhance the capability of the mother to look after the normal health and nutrition
needs through proper nutrition and health education.
Mid-Day Meal Programme
Tamil Nadu was the first to initiate a massive noon meal programme to children. Neither
a child that is hungry, nor a child that is ill can be expected to learn. Realizing this need
the Mid-Day Meal (MDM) Scheme was launched in primary schools during 1962-63.
Mid-Day Meal improves three areas: 1. School attendance 2. Reduced dropouts 3. A
beneficial impact on childrens nutrition.
The Central Government supplies the full requirement of food grains for the programme
free of cost. For its implementation in rural areas, Panchayats and Nagarpalikas are also
involved or setting up of necessary infrastructure for preparing cooked food. For this
purpose NGOs, womens group and parent-teacher councils can be utilized. The total
charges for cooking, supervision and kitchen are eligible for assistance under Poverty
Alleviation Programme. In several states, supplementary feeding was assisted by food
supplies from Cooperation for American Relief Everywhere (CARE) and World Food
Programme (WFP). There are problems of administration and quality of food that have
affected the programme outcomes.
Objectives:
The objectives of the mid day meal scheme are:

1. Improving the nutritional status of children in classes I VIII in Government,

Local Body and Government aided schools, and EGS and AIE centres
2. Encouraging poor children, belonging to disadvantaged sections, to attend school
more regularly and help them concentrate on classroom activities.
3. Providing nutritional support to children of primary stage in drought-affected
areas
Pulse Polio Programme
Introduction
With the global initiative of eradication of polio in 1988 following World Health Assembly
resolution in 1988, Pulse Polio Immunization programme was launched in India in 1995.
Children in the age group of 0-5 years administered polio drops during National and
Sub-national immunization rounds (in high risk areas) every year. About 172 million
children are immunized during each National Immunization Day (NID).
The last polio case in the country was reported from Howrah district of West Bengal with
date of onset 13th January 2011. Thereafter no polio case has been reported in the
country (25th May 2012).
WHO on 24th February 2012 removed India from the list of countries with active
endemic wild polio virus transmission.
Objective :
The Pulse Polio Initiative was started with an objective of

achieving hundred per cent coverage under Oral Polio Vaccine.

It aimed to immunize children through improved social mobilization,
plan mop-up operations in areas where poliovirus has almost disappeared and
maintain high level of morale among the public.

National Program for Prevention and Control of Cancer, Diabetes, CVD and
Stroke( NPCDCS)
States have already initiated some of the activities for prevention and control of
non communicable diseases (NCDs) especially cancer, diabetes, CVDs and stroke. The
Central Govt. proposes to supplement their efforts by providing technical and financial
support through National Program for Prevention and Control of Cancer, Diabetes, CVD
and Stroke( NPCDCS). The NPCDCS program has two components viz. (i) Cancer (ii)
Diabetes, CVDs and Stroke. These two components have been integrated at different
levels as far as possible for optimal utilization of the resources. The activities at State,
Districts, CHC and Sub Centre level have been planned under the programme and will
be closely monitored through NCD cell at different levels.
The NPCDCS aims at integration of NCD (non-communicable diseases )
interventions in the NRHM framework for optimization of scarce resources and provision
of seamless services to the end customer / patients as also for ensuring long term

sustainability of interventions. Thus, the institutionalization of NPCDCS at district level

within the District Health Society, sharing administrative and financial structure of
NRHM becomes a crucial programme strategy for NPCDCS. The NCD cell at various
levels will ensure implementation and supervision of the programme activities related to
health promotion, early diagnosis, treatment and referral, and further facilitates
partnership with laboratories for early diagnosis in the private sector. Simultaneously, it
will attempt to create a wider knowledge base in the community for effective prevention,
detection, referrals and treatment strategies through convergence with the ongoing
interventions of National Rural Health Mission (NRHM), National Tobacco Control
Programme (NTCP), and National Programme for Health Care of Elderly (NPHCE) etc and
build a strong monitoring and evaluation system through the public health
Objectives:

Prevent and control common NCDs through behaviour and life style changes,

Provide early diagnosis and management of common NCDs,

Build capacity at various levels of health care for prevention, diagnosis and
treatment of common NCDs,

Train human resource within the public health setup viz doctors, paramedics and
nursing staff to cope with the increasing burden of NCDs

Establish and develop capacity for palliative and rehabilitative care.

Strategies
The Strategies to achieve above objectives are as follows:
1) Prevention through behaviour change
2) Early Diagnosis
3) Treatment
4) Capacity building of human resource
5) Surveillance, Monitoring & Evaluation Disease Outcomes
1.3.1 Prevention through behavior change:
The

major

risk

factors

to

cancer,

hypertension,

obesity,

diabetes

and

cardiovascular diseases are unhealthy diet, physical inactivity, stress and consumption
of tobacco & alcohol. Attempts will be made to prevent these risk factors by creating
general awareness about the Non Communicable Diseases (NCD) and promotion of
healthy life style habits among the community. Such interventions will be done through
the peripheral health functionaries and NGOs. The various approaches such as mass
media, community education and interpersonal communication will be used for behavior
change focusing on the following five messages:

Increased intake of healthy foods

Increased physical activity through sports, exercise, etc.;
Avoidance of tobacco and alcohol;
Stress management

Warning signs of cancer etc.

Interpersonal communication will be carried out through ASHAs/ AWWs/ SHGs/

Youth clubs, Panchayat members etc. for which education material will be developed at
central / State level to facilitate IEC/ BCC activities. These workers / groups will also
help in Social mobilization for diagnostic camps. Targeted intervention programmes will
be designed to bring awareness in schools and workplaces.
1.3.2. Early diagnosis
Strategy for early diagnosis of chronic non-communicable diseases will consist of
opportunistic screening of persons above the age of 30 years at the point of primary
contact with any health care facility, be it the village, CHC, District hospital, tertiary care
hospital etc. Opportunistic screening will have in built components of mass awareness
creation, self screening and trained health care providers. Such screening involves
simple clinical examination comprising of relevant questions and easily

conducted

physical measurements (such as history of tobacco consumption and measurement of

blood pressure etc.) to identify those individuals who are at a high risk of 7 developing
diabetes and CVD, warranting further investigation/ action. The investigations which
may not be carried out in the health facilities can be outsourced.
1.3.3. Treatment
NCD clinic will be established at CHC and District Hospital (NCD here refers to
Cancer

Diabetes,

Hypertension,

Cardiovascular

diseases

and

Stroke)

where

comprehensive examination of patients referred by lower health facility /Health Worker

as well as of those reporting directly will be conducted for ruling out complications or
advanced stages of common NCDs. Screening, diagnosis and management (including diet
counseling, Lifestyle management) and home based care will be the key functions.
1.3.4 Capacity building of human resource
Health personnel at various levels will be trained for health promotion,
prevention, early detection and management by a team of trainers at identified Training
Institutes/Centres. These Training Institutes/Centres will be identified by the State in
consultation with the Centre.
1.3.5 Supervision, monitoring and evaluation
Regular monitoring and review of the scheme will be conducted at the District,
State and Central level through monitoring formats and periodic visits and review
meetings. For the purpose, NCD cell at different levels is envisaged to supervise and
monitor the programme and also other NCD programmes. The evaluation is the integral
part of the programme and will be carried out concurrently and periodically, as & when
required.
National Mental Health Programme

Introduction
Psychiatric symptoms are common in general population in both sides of the
globe. These symptoms - worry, tiredness, and sleepless nights affect more than half of
the adults at some time, while as many as one person in seven experiences some form of
diagnosable neurotic disorder.
The Government of India has launched the National Mental Health Programme
(NMHP) in 1982, keeping in view the heavy burden of mental illness in the community,
and the absolute inadequacy of mental health care infrastructure in the country to deal
with it.
Aims
1. Prevention and treatment of mental and neurological disorders and their
associated disabilities
2. Use of mental health technology to improve general health services.
3. Application of mental health principles in total national development to improve
quality of life.
Objectives
1. To ensure availability and accessibility of minimum mental health care for all in
the foreseeable future, particularly to the most vulnerable and underprivileged
sections of population.
2. To encourage application of mental health knowledge in general health care and in
social development.
3. To promote community participation in the mental health services development
and to stimulate efforts towards self-help in the community.
Strategies
1. Integration mental health with primary health care through the NMHP;
2. Provision of tertiary care institutions for treatment of mental disorders;
3. Eradicating stigmatisation of mentally ill patients and protecting their rights
through regulatory institutions like the Central Mental Health Authority, and State
Mental health Authority.
Mental Health care
1.
2.
3.
4.
5.

The mental morbidity requires priority in mental health treatment

Primary health care at village and subcentre level
At Primary Health Centre level
At the District Hospital level
Mental Hospital and teaching Psychiatric Units

District Mental Health Programme

Components
1. Training programmes of all workers in the mental health team at the identified
Nodal Institute in the State.
2. Public education in the mental health to increase awareness and reduce stigma.

3. For early detection and treatment, the OPD and indoor services are provided.
4. Providing valuable data and experience at the level of community to the state and
Centre for future planning, improvement in service and research.
Agencies like World Bank and WHO have been contacted to support various
components of the programme. Funds are provided by the Govt. of India to the state
governments and the nodal institutes to meet the expenditure on staff, equipments,
vehicles, medicine, stationary, contingencies, training, etc. for initial 5 years and
thereafter they should manage themselves. Govt. of India has constituted central Mental
Health Authority to oversee the implementation of the Mental Health Act 1986. It
provides for creation of state Mental Health Authority also to carry out the said
functions.
The National Human Rights Commission also monitors the conditions in the
mental hospitals along with the government of India and the states are currently acting
on the recommendation of the joint studies conducted to ensure quality in delivery of
mental care.
Thrust areas for 10th Five Year Plan
1. District mental health programme in an enlarged and more effective form covering
the entire country.
2. Streamlining/ modernisation of mental hospitals in order to modify their present
custodial role.
3. Upgrading department of psychiatry in medical colleges and enhancing the
psychiatry content of the medical curriculum at the undergraduate as well as
postgraduate level.
4. Strengthening the Central and State Mental Health Authorities with a permanent
secretariat. Appointment of medical officers at state headquarters in order to make
their monitoring role more effective;
5. Research and training in the field of community mental health, substance abuse
and child/ adolescent psychiatric clinics.

Mission Indradhanush
Mission Indradhanush was launched by Ministry of Health and Family Welfare (MOHFW)
Government of India on 25th December, 2014. The objective of this mission is to ensure
that all children under the age of two years as well as pregnant women are fully
immunized with seven vaccine preventable diseases.
The Mission Indradhanush, depicting seven colours of the rainbow, targets to immunize
all children against seven vaccine preventable diseases, namely:
1. Diphtheria
2. Pertussis (Whooping Cough)

3. Tetanus
4. Tuberculosis
5. Polio
6. Hepatitis B
7. Measles.
In addition to this, vaccines for Japanese Encephalitis (JE) and Haemophilus influenzae
type B (HIB) are also being provided in selected states.
First Phase of Mission Indradhanush:
For the first phase, 201 high focus districts across 28 states in the country that have the
peak number of partially immunized and unimmunized children were identified by the
Government.
There were total four rounds in the first phase of the mission. The first round of the first
phase was started from 7th April, 2015 and continued for more than a week.
Further, second, third and fourth rounds were held for more than a week in the month
of May, June and July starting from 7th of each month. The first phase of this mission
was very successful.
The main highlights of the first phase of Mission Indradhanush are as given below:

Total 9.4 lakh sessions were organized during these four rounds of Mission
Indradhanush

About 2 crore vaccines were given to the children as well as pregnant women.

Tetanus Toxoid vaccine was given to more than 20 lakh pregnant women

75.5 lakh children were vaccinated and about 20 lakh children were fully
vaccinated.

More than 57 lakh zinc tablets and 16 lakh ORS packets were freely distributed
to all the children to protect them against diarrhoea.

Second Phase of Mission Indradhanush

The second Phase of Mission Indradhanush has been started from 7th October, 2015.
The second, third and fourth rounds of this phase will start from 7th November, 7th
December 2015 and 7th January 2016.

The aim is to achieve full immunization in 352 districts which includes 279 mid priority
districts, 33 districts from the North East states and 40 districts from phase one where
huge number of missed out children were detected.

*In selected states Pentavalent vaccine (Hepatitis B, Diphtheria, Pertussis,

Tetanus and Haemophilus influenzae type b) is given instead of DPT and Hep B.

**In Japanese Encephalitis (JE) endemic districts.

3rd to 9th doses of Vitamin A are given at 6 monthly intervals to children 2 -5

years old.

For pregnant women: Give TT-2 or Booster doses before 36 weeks of pregnancy.
However, give these even if more than 36 weeks have passed. Give TT to a woman in
labour, if she has not previously received TT.
The National Health Mission
Introduction
The Honble Prime Minister launched the NRHM on 12th April, 2005 throughout the
country with special focus on 18 states, including eight Empowered Action Group (EAG)
States, the North-Eastem States, Jammu and Kashmir and Himachal Pradesh.

The Union Cabinet vide its decision dated 1st May 2013 has approved the launch of
National Urban Health Mission (NUHM) as a Sub-mission of an over-arching National
Health Mission (NHM), with National Rural Health Mission (NRHM) being the other Submission of National Health Mission.
The NRHM seeks to provide accessible, affordable and quality health care to the rural
population, especially the vulnerable sections. The key features in order to achieve the
goals of the Mission include making the public health delivery system fully functional
and accountable to the community, human resources management, community
involvement, decentralization, rigorous monitoring and evaluation against standards,
convergence of health and related programmes form village level upwards, innovations
and flexible financing and also interventions for improving the health indictors.
Objectives:In the 12th Five Year Plan period, efforts will be made to consolidate the gains and build
on the successes of the Mission to provide accessible, affordable and quality universal
health care, both preventive and curative, which would include all aspects of a clearly
defined set of healthcare entitlements including preventive, primary and secondary
health services.
At the national level, the targets are as under :

Reduction of MMR to < 100 per 100000 live births

Reducing IMR to < 27 per 1000 live births

Reduction in NMR to < 18 per 1000 live births

Reducing TFR to 2.1

Elimination of Filaria in all 250 districts; Kala-azar in all 514 Blocks

and Leprosy in all districts

Reduction in TB prevalence and mortality by 50%

Reduction in Annual Malaria incidence to <1/1000 pop.

Reduction in JE mortality by 50%

Sustaining case fatality rate of less than 1% for Dengue

Janani Shishu Suraksha Karyakaram (JSSK)

Introduction
Government of India has launched Janani Shishu Suraksha Karyakaram (JSSK) on 1st
June, 2011.
The scheme is estimated to benefit more than 12 million pregnant women who access
Government health facilities for their delivery. Moreover it will motivate those who still
choose to deliver at their homes to opt for institutional deliveries. . It is an initiative with
a hope that states would come forward and ensure that benefits under JSSK would
reach every needy pregnant woman coming to government institutional facility. All the
States and UTs have initiated implementation of the scheme.
The following are the Free Entitlements for pregnant women:

Free and cashless delivery

Free C-Section

Free drugs and consumables

Free diagnostics

Free diet during stay in the health institutions

Free provision of blood

Exemption from user charges

Free transport from home to health institutions

Free transport between facilities in case of referral

Free drop back from Institutions to home after 48hrs stay

The following are the Free Entitlements for Sick newborns till 30 days after
birth.This has now been expanded to cover sick infants:

Free treatment

Free drugs and consumables

Free diagnostics

Free provision of blood

Exemption from user charges

Free Transport from Home to Health Institutions

Free Transport between facilities in case of referral

Free drop Back from Institutions to home