Ministry of Health and Family Welfare Notable Achievements and Initiatives- 2015

YEAR ENDER 2015

1. Mission Indradhanush

The Ministry of Health & Family Welfare has launched “Mission Indradhanush”, depicting seven colours of the rainbow, to fully immunise more than 89 lakh children who are either unvaccinated or partially vaccinated; those that have not been covered during the rounds of routine immunisation for various reasons. They will be fully immunised against seven life-threatening but vaccine preventable diseases which include diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis-B. In addition, vaccination against Japanese Encephalitis and Haemophilus influenza type B will be provided in selected districts/states of the country. Pregnant women will also be immunised against tetanus.

The first round of the first phase started from 7 April 2015-World Health Day- in 201 high focus districts in 28 states and carried for more than a week. This will be followed by three rounds of more than a week in the months of April, May June and July 2015, starting from 7^th of each month. The 201 high focus districts account for nearly 50% of all unvaccinated or partially vaccinated children in the country. Of these, 82 districts are in just four states of UP, Bihar, Madhya Pradesh and Rajasthan and account for nearly 25% of all unvaccinated or partially vaccinated children of the country.

Within the districts, the Mission will focus on 4, 00,000 high risk settlements identified as pockets with low coverage due to geographic, demographic, ethnic and other operational challenges. These include nomads and migrant labour working on roads, construction sites, riverbed mining areas, brick kilns, and those living in remote and inaccessible geographical areas and urban slums, and the underserved and hard to reach populations dwelling in forested and tribal areas.

In addition second phase was launched on 7^th October 2015 in 352 districts of the country. During second phase, four special intensified immunization drives are being conducted for 7 days starting from 7th October and are planned to be repeated on the same date for four consecutive months i.e. 7th November, 7th December 2015 and 7th January, 2016 covering all children under two years of age, and pregnant women for tetanus toxoid vaccine.

Achievements of Mission Indradhanush:-

As per data available, during the first phase of Mission Indradhanush, 9.4 lakh sessions were held, during which 1.89 crore vaccines were administered to the children and pregnant women. During these immunization rounds more than 75 lakh children were vaccinated and about 20 lakh children were fully vaccinated. Also, more than 20 lakh pregnant women were vaccinated with tetanus toxoid vaccine during these four rounds. To combat the problem of diarrhea, zinc tablets and ORS packets were freely distributed to all the children to protect them against diarrhea. More than 16 lakh ORS packets and about 57 lakh zinc tablets were distributed to the children during these four rounds of Mission Indradhanush.

As per the data available on 26th Nov 2015, during Phase II of Mission Indradhanush, 4.49 lakh sessions were held, during which about 70 lakh vaccines were administered to the children and pregnant women. During these immunization rounds more than 27 lakh children were vaccinated and about 8 lakh children were fully vaccinated. Also, more than 6 lakh pregnant women were vaccinated with tetanus toxoid vaccine during these four rounds. To combat the problem of diarrhoea, zinc tablets and ORS packets were freely distributed to all the children to protect them against diarrhea. More than 5 lakh ORS packets and about 17 lakh zinc tablets were distributed to the children during these four rounds of Mission Indradhanush.

The preparation and learning during the implementation of the four rounds have led to health systems strengthening in terms of drawing up detailed micro plans; designing sturdy framework for stringent monitoring and evaluation of the immunisation rounds in the states(more than 3600 state and central level monitors have been deputed); training of nearly 9 lakh frontline workers; identification and analysis of limiting factors in different states leading to creating effective structures to mitigate them.

2. Maternal and Neonatal Tetanus Eliminated (MNTE)

All the States/UTs of India have been validated for Maternal and Neonatal Tetanus Elimination (MNTE) well before the global target date of December, 2015. The Maternal and neonatal tetanus validation in India started in 2003 in a phased manner. Andhra Pradesh was the first state to validate MNT elimination. Nagaland was the last state in the country where the validation exercise was completed on 17th April 2015.

A formal communication has been received from Dr. Flavia Bustreo, Assistant Director-General, WHO congratulating India on achieving the milestone of Maternal and Neonatal Tetanus elimination in 2015.

Maternal and Neonatal Tetanus Elimination (MNTE) is defined as less than one neonatal tetanus case per thousand live births per year in every district. In 1989, global deaths from Neonatal Tetanus (NT) were estimated at 7.87 lakh per year and India contributed to approximately 2 lakh deaths.

India has achieved this validation through the system strengthening including improvement of institutional delivery, which is also a proxy indicator for clean delivery and clean cord care practices and by strengthening Routine Immunization. Strategies to improve clean delivery have been included in the innovative Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karayakaram (JSSK).

3. Decision to Introduce New Vaccines

In a bid to protect the children from more vaccine preventable diseases, new vaccines are proposed to be introduced as part of India’s Universal Immunisation Programme (UIP). Introduction of these vaccines will be done in a phased manner over a period of time, depending upon the field level assessments and preparedness. In addition, it has been decided to introduce an adult vaccine against Japanese Encephalitis (JE) in the high burden districts. The new vaccines are:

a. Inactivated Polio Vaccine (IPV)

India is Polio free but to maintain this status, the Inactivated Polio Vaccine was introduced on 30^th October 2015. The vaccine has been initially introduced in six states: Bihar, Uttar Pradesh, Madhya Pradesh, Gujarat, Assam and Punjab. This will benefit 2.7 crore children every year.

b. Adult Japanese Encephalitis (JE) vaccine

21 high burden districts have been identified in Assam, Uttar Pradesh and West Bengal for adult JE vaccination in the age-group of 15-65 years. This will cut down deaths and morbidity due to Japanese Encephalitis in adults as well.

c. Rotavirus vaccine

Rotavirus is the leading cause of severe diarrhoea among infants and young children in the world. Each year India loses approximately 2 lakh children to diarrhoea out of which 1 lakh deaths are caused by Rotavirus. Rotavirus vaccine implemented to full scale would save approximately 1 lakh lives every year. The vaccine is planned to be introduced in first quarter of 2016 in four states initially i.e. Odisha, Himachal Pradesh, Haryana and Andhra Pradesh.

d. Measles Rubella vaccine

· Measles Rubella vaccine eliminates measles and controls Rubella in the country. The vaccine will help to reduce incidence of Congenital Rubella Syndrome. As on date, approximately 25,000 cases of CRS are estimated each year and if the child survives, this adds to the disabilities in the country.

· MR vaccination campaign will be carried out after appropriate planning and will cover 45 crore children.

4. Child Health

Special New born Care Units (SNCUs)

In order to strengthen the care of sick, premature and low birth weight newborn Special New born Care Units (SCNU) have been established at District Hospitals and tertiary care hospitals. These are 12-20 bedded units, with 4 trained doctors and 10-12 nurses and support staff with provision of 24x7 services to sick newborns. Presently 602 SNCUs are reported operational and more than 7.5 lakh newborns treated in these in 2014-15.

Graph showing the progressive increase in number of SNCUs along with the number of admissions (For 2015-16, data is till September 2015)

MoHFW provides free entitlement of care at these centres under Janani Shishu Suraksha Karyakaram. Each SNCU is expected to provide: Care at birth including resuscitation of asphyxiated newborn, sick newborn and routine postnatal care. Follow up of high risk newborn and Immunization/Referral Services are also provided for. Once the baby is discharged to home ASHA (Accredited Social Health Activist) will do the follow up of these babies for one year. District Early Intervention Centre (DEIC) have also been linked with SNCU to provide specialized care to the babies with special needs and delays.

National Deworming Day: A Fixed Day Fixed Site strategy

Government of India for effective deworming coverage

Like many other countries across the globe, India is also endemic for Soil Transmitted Helminths. More than 241 million children are estimated to be at risk of parasitic intestinal worm infections leading to impaired physical growth, cognitive development, fatigue, internal bleeding. They also cause micronutrient deficiencies leading to poor school performance and absenteeism in children. Albendazole tablets, once in 6 months, is a simple drug proven to reduce the worm load.

NDD launch by the Honorable HFM at Jaipur

Understanding the negative impact of worm load in children effecting their growth and development, Ministry of Health and Family Welfare, Government of India, ambitiously launched – National Deworming Day (NDD) on 10th February, 2015 followed by mop-up activities to be carried up to 14th February, 2015 across all Government/ Government aided schools and Anganwadi centers of 11 States/UT.

NDD was implemented in 277 districts across 11 States/UT namely Assam, Bihar, Chhattisgarh, Dadra Nagar Haveli, Haryana, Karnataka, Madhya Pradesh, Maharashtra, Rajasthan, Tamil Nadu and Tripura. More than 4.70 lakh schools and 3.67 lakh Anganwadi centers were covered under the ambitious NDD program. With an achievement of 85 percent coverage, a total of 8.98 crore children aged 1-19 years, received deworming tablet against a target of 10.31 crore during the National Deworming Day.

Number of Children dewormed against the target-

Number of sites where deworming was undertaken on NDD

Intensified Diarrhoea Control Fortnight (27 July- 8 August 2015)

In order to accelerate efforts towards reduction of Childhood mortality, which is one of the prime goals of National Health Mission. Diarrhoea contributes to around 11 percent under-five deaths in country- most of these deaths are clustered around Summer and Monsoon season. To effectively address the issue, Intensified Diarrhoea Control Fortnight (IDCF) was implemented from 27th July to 8th August 2015, with an aim of achieving improved coverage of essential life-saving commodity of ORS, zinc dispersible tablets and practice of appropriate child feeding practices during diarrhoea.

The chief activities during IDCF involved doorstep ORS distribution by ASHA to house with under-five children, counselling for infant and young child feeding, referral of children with diarrhoea for treatment, capacity building of frontline workers for management of childhood diarrhoea, setting up of ORS-zinc corners along with multi-sectoral involvement of Anganwadi centres for growth monitoring of all children, PRI meetings on the subject of childhood diarrhoea, hand-washing sessions in schools.

ORS was pre-positioned in houses of 6.6 crore children to enable timely management of diarrhoea. 36.3 lakh children were treated with both zinc and ORS during the fortnight. 3.4 lakh ORS-zinc corners were established and 5.4 lakh schools participated and 3.2 lakhs village level meetings were undertaken.

ORS & Zinc Corners

Involvement of schools

Rally by school children to advocate hand washing practices

Rashtriya Bal Swasthya Karyakram (RBSK)

The Rashtriya Bal Swasthya Karyakram (RBSK) has been launched to provide child health screening and early interventions services by expanding the reach of mobile health teams at block level. These teams will also carry out screening of all the children in the age group 0-6 years enrolled at Anganwadi Centres at least twice a year. RBSK covers 30 common health conditions. States/UTs may incorporate a few more conditions based on high prevalence/endemicity. An estimated 27 crore children in the age group of zero to eighteen years are expected to be covered in a phased manner.

The strategic interventions to address birth defects, disabilities, delays and deficiencies are:

Screening of children under RBSK- Child health screening and early intervention services to with an aim to improve the overall quality of life of children through early detection of birth defects, diseases, deficiencies, development delays including disability (4 Ds) and reduce out of pocket expenditure for the families. Dedicated mobile medical health teams (for screening purpose) at block level, comprising of four health personnel viz. two AYUSH doctors (One Male, One Female), ANM/ SN, and a Pharmacist. Under this intervention, 10.66 crore children have been screened (FY 2014-15), so far by 9774 teams and 51.78 lakh children have been referred for management of 4 Ds, 22.18 lakh children have been managed for the 30 health conditions. In Q1 (April-June) 2015-16; 1.79 crore children have been screened; 14.03 lakh children have been referred to health facilities; 4.64 lakh children have received secondary and tertiary care.

5. Maternal Health

“Daksh”

For improving the skills of healthcare providers and to enhance their capacity to provide quality (Reproductive, Maternal, Neonatal, Child & Adolescent Health) RMNCH+A services, Government of India has established five National Skills lab ‘’Daksh’’ at Delhi and in NCR region with support from Maternal health division, Government of India and Liverpool school of tropical Medicine(LSTM) at:

1. Jamia Hamdard

2. Trained Nurses association of India(TNAI)

3. National Institute of Health and Family Welfare(NIHFW)

4. Safdarjung Hospital.

5. Lady Hardinge Medical College.

These skills lab will handhold and guide creating skills lab and also train state trainers. National Skills labs are being attached to all the states and UTs so that there is an optimum utilization of the National Skills lab. 30 stand-alone skills lab has been established at different states such as Gujarat, Haryana, Bihar, Maharastra, MP, West Bengal, Odisha, Tamil Nadu and Telangana. Additionally 188 MCH wings have been approved across the country which has in built skills lab.

The linkages of National Skills lab with states are:

Skills Lab	States
TNAI	UP, Uttarakhand, Karnataka ,Kerala Chandigarh, D&N Haveli, Nagaland
LHMC	Assam ,JK ,Tamil Nadu, Punjab, Arunachal Pradesh, Meghalaya, Mizoram
NIHFW	Odisha, Rajasthan, Haryana, AP, Goa, HP, Sikkim, Daman & Diu,
Jamia Hamdard	MP, Chattisgarh, West Bengal, Telangana, A&N island, Puducherry
SJH	Bihar, Jharkhand, Maharastra, Gujarat, Lakshadweep, Manipur, Tripura

The skills lab has 5 skill cabin and comprises of 16 skill stations where the trainees learn 40 key RMNCH+A skills through practicing skills on mannequins, simulation exercise, demonstration videos and presentation spread over 6 days. Pre validate tools like OSCE (Objective structured clinical examination), emergency drills, supportive supervision and hand holding exercise at their place of work are few things which distinct them from other training programmes. Skills labs serves as a prototype demonstration and learning facility for health care providers with competency based training. The labs have an edge over other didactic methods by providing the opportunity for repetitive skill practice, simulating clinical scenarios under the supervision of a qualified trainer.

The objectives of Skills lab are to : A) Facilitate acquisition/ reinforcement of key standardized technical skills and knowledge by service providers for RMNCH+A services b) Ensures the availability of skilled personnel at health facilities c) Improves the quality of pre service training d) Provides continuing Nursing education / Continuing medical education. The target audience of 6 days skills lab training are Obstetricians and Gynaecologists, Paediatricians, Medical Officers, staff Nurses, Auxiliary Nurse Midwife (ANM), state trainers and faculty of Nursing School/ colleges and Medical College who can adapt it for strengthening pre service teaching.

National Skills lab ‘Daksh’ at National Institute of Health and Family Welfare(NIHFW), R.K. Puram, New Delhi was inaugurated by Shree Jagat Prakash Nadda Hon’ble Union Health and Family Welfare Minister on 9^thMarch, 2015.

Till date 797 health personnel have been trained at National Skills lab with different cadre including Nursing tutors, Skills lab trainers, Professors, Medical officers, skills lab trainer etc.

The Government of India’s latest initiative of Skills Labs to target preventable causes of death directly can be a major breakthrough in saving women’s lives.

Glimpses of 6 day training at National skills lab

6. Family Planning

(1) Expanding Basket of Choices:

Three new choices are now being introduced in the National Family Planning program.

a. Injectable DMPA: The Drugs Technical Advisory Board (DTAB) agreed to the introduction of the injectable contraceptive DMPA in the public health system under the National Family Planning Programme.

b. POP: Progesterone only pill for the lactating mothers

c. Centchroman: A non-hormonal once a week pill.

(2) Improved Contraceptive Packaging:

The packaging for Condoms, OCP and ECP has now being improved so as to influence the demand for these commodities.

7. Adolescent Health

Rashtriya Kishor Swasthya Karyakram (RKSK)

The Rashtriya Kishor Swasthya Karyakram (RKSK) was launched in January 2014 with an overarching aim to address sexual and reproductive health, nutrition, injuries and violence (including gender based violence), prevention of non-communicable diseases, mental health and substance misuse related concerns of 253 million adolescents of our country through effective and coherent implementation of programmes and schemes. The short term goal is to ensure holistic health and development of adolescents and the long term outcome will be increased social and economic productivity of our nation.

The programme is underpinned by the principles of equity and inclusion; rights based approach, adolescent and community participation and strategic partnership. The key components of the program are community based interventions; facility based interventions; social and behavior change communication; and inter-sectoral convergence.

Community based interventions-

Peer Education Programme

To build a community of proactive and confident adolescents, who are well informed and are capable of taking appropriate decisions about their health and wellbeing, is one of the key drivers of RKSK programme. The Ministry of Health and Family Welfare in its Operational Guideline for RKSK proposed to select and orient four peer educators i.e. two male and two female peer educators per village or 1000 population. These community level peer educators will receive standardized information and knowledge on sexual and reproductive health, nutrition, injuries and violence, prevention of non-communicable diseases, mental health and substance misuse through structured orientation sessions.

After orientation, peer educators are expected to form group of 15-20 boys and girls and to conduct weekly participatory sessions on adolescent health, facilitate organization of Adolescent Health Day and ensure linkages with Adolescent Friendly Health Clinics (AFHCs) and Adolescent Helpline. During the first phase of implementation of PE programme, 50% Blocks in 213 RKSK districts have been selected. Further to this, two PHC under each of these selected CHCs have been identified for roll-out of PE programme. PE selection and trainings are in the process of being conducted in all villages under the two identified PHCs, this will be facilitated by village ASHA with active involvement of ANMs, school teachers and local committees such as VHNSC. Villages under approximately 1800 Primary Health Centres will be covered in the first phase of implementation of PE scheme. During the course of the year, around 2 lakhs peer educator will be selected through a community led and community based process and trained.

Weekly Iron Folic Acid Supplementation (WIFS) programme

WIFS entails provision of weekly supervised IFA tablets to in-school boys and girls and out-of-school girls for prevention of iron and folic acid deficiency anaemia, and biannual albendazole tablets for helminthic control. The programme is being implemented across the country in both rural and urban areas, covering government, government aided schools, municipal schools and Anganwadi centres. Screening of targeted adolescents population for moderate/ severe anaemia and referral of these cases to an appropriate health facility; and information and counselling for prevention of nutritional anaemia are also included in the programme.

The programme is been implemented through convergence with key stakeholder ministries- the Ministry of Women and Child Development and Ministry of Human Resource Development, with joint programme planning, capacity building and communication activities. The programme aims to cover a total of 11.2 crore beneficiaries including 8.4 crore in-school and 2.8 crore out-of-school beneficiaries.

Scheme for Promotion of Menstrual Hygiene among Adolescent Girls in Rural India

The Ministry of Health and Family Welfare has launched Scheme for Promotion of Menstrual Hygiene among adolescent girls in the age group of 10-19 years in rural areas as part of the Adolescent Reproductive Sexual Health (ARSH) in RCH II, with specific reference to ensuring health for adolescent girls. The major objectives of the scheme are:

- To increase awareness among adolescent girls on Menstrual Hygiene

- To increase access to and use of high quality sanitary napkins to adolescent girls in rural areas.

- To ensure safe disposal of Sanitary Napkins in an environmentally friendly manner.

Under the scheme a pack of 6 sanitary napkins is provided under the NRHM’s brand ‘Freedays’. These napkins are sold to the adolescents girls at Rs. 6 for a pack of 6 napkins in the village by the Accredited Social Health Activist (ASHA). On sale of each pack, the ASHA gets an incentive of Rs. 1 per pack besides a free pack of sanitary napkins per month. This initial model of the scheme was rolled out in 112 selected districts in 17 States through central supply of sanitary napkin packs.

Since 2015-16, the scheme had been decentralized and funds were approved in the State Programme Implementation Plans for procurement of sanitary napkin packs, for safe storage and disposal, and for training of ASHA and nodal teachers. The states have been advised - to undertake procurement of sanitary napkins packs at prices decided through competitive bidding. The funds have been approved for state-level procurement of sanitary napkin packs in 162 districts across 20 states in 2015-16 RoPs.

Facility based interventions:-

1. Strengthening of existing Adolescent Friendly Health Clinics (AFHC )

2. Setting up of new AFHCs

3. Ensuring availability of trained human resource at AFHCs- medical officer, ANM and counsellors

Adolescent Friendly Health Clinics act as the first level of contact of primary health care services with adolescents. These clinics are being developed across all level of care to cater to diversified health and counselling need of adolescent girls and boys. These broad objectives will be achieved through establishment of optimally functional AFHCs at District Hospitals, Community Health Centres and Primary Health Care centres in prioritized districts.

Trainings of medical officer, ANMs and counsellors positioned in AFHCs are being ensured through development of a structured training plan for capacity building. The training of human resource positioned in AFHCs operationalized in RKSK districts is being prioritized. Adolescent Health Division of Ministry of Health and Family Welfare has already completed National Level Training of Trainers for Medical Officers, ANMs/LHVs and Counsellors. These master trainers are further providing state/district level training to service providers at designated district training sites.

Convergence:-

Under RKSK, convergence structures have been institutionalized with constitution of State Committee for Adolescent Health and District Committee for Adolescent Health. The committees will be holding regular meetings with both intra-departmental and inter-departmental representation.

- Within Health & Family Welfare – Family Planning, Maternal Health, Rashtriya Bal Swathya Karyakram, NACP, National Tobacco Control Programme, National Mental Health Programme, Non-communicable Disease and IEC

- With other departments/ schemes - WCD (ICDS, BSY, SABLA), HRD (AEP, MDM), Youth Affairs and Sports (Adolescent Empowerment Scheme, National Service Scheme, NYKS, NPYA)

Social and Behaviour Change Communication with focus on Inter Personal Communication:-

Communication material for WIFS, Menstrual Hygiene Program and issue related to Adolescent Pregnancy has been developed and shared with States.

After wide spread consultations, a comprehensive communication strategy has been developed by AH division in collaboration with UNICEF country office. The strategy provides overall guidance to state and district programme managers on formulation of communication campaign for adolescents on six priority areas identified under RKSK. An implementation guideline has also been developed to supplement the communication strategy and to aid its roll-out. Both the strategy and implementation guideline were shared with state programme mangers during the National Review of RKSK programme in June 2015. To further strengthen the understanding of communication for adolescent health, strategy has also been shared with state and district level managers during RKSK regional reviews held in November- December 2015.

Extensive Media Campaign for WIFS has been organized with support from UNICEF country office which includes write-ups from subject experts and articles on Nutrition, Anaemia and WIFS program in prominent newspapers across all the States besides engagement with UNICEF goodwill ambassador Priyanka Chopra for awareness generation on Nutrition and Anaemia in adolescents.

8. The National Health Mission (NHM)

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 in rural and urban areas, Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A), and Communicable and Non-Communicable Diseases. The NHM envisages achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people’s needs.

National Rural Health Mission (NRHM): NRHM seeks to provide accessible, affordable and quality health care to the rural population, especially the vulnerable groups. Under the NRHM, the Empowered Action Group (EAG) States as well as North Eastern States, Jammu and Kashmir and Himachal Pradesh have been given special focus. The thrust of the mission is on establishing a fully functional, community owned, decentralized health delivery system with inter-sectoral convergence at all levels, to ensure simultaneous action on a wide range of determinants of health such as water, sanitation, education, nutrition, social and gender equality.

National Urban Health Mission (NUHM): NUHM seeks to improve the health status of the urban population particularly urban poor and other vulnerable sections by facilitating their access to quality primary health care. NUHM covers all state capitals, district headquarters and other cities/towns with a population of 50,000 and above (as per census 2011) in a phased manner. Cities and towns with population below 50,000 will continue be covered under NRHM.

Progress under NHM:-

Augmentation of Human Resources

NRHM has attempted to fill the gaps in human resources by approving nearly 2.3 lakh additional health human resources to the States, including 10,027 Medical Offiders, 4,023 Specialists, 78,168 ANMs, 53,456 Staff Nurses, 35,514 AYUSH Doctors etc. on contractual basis. Apart from providing support for health human resource, NRHM has also focused on multi-skilling of doctors at strategically located facilities identified by the states e.g. MBBS doctors are trained in Emergency Obstetric Care (EmOC), Life Saving Anaesthesia Skills (LSAS) and Laparoscopic Surgery.

Accredited Social Health Activist (ASHA)

Under the Framework for Implementation of NRHM, a female community health worker called Accredited Social Health Activist (ASHA) has been engaged in each village in the ratio of one ASHA per 1000 population or one ASHA per habitation in tribal areas. Up to June, 2015, 9.15 lakh ASHAs and link workers have been selected in entire country, out of which 8.42 lakh have been given the orientation training and engaged Further, 8.82 lakh ASHAs have been provided with drug kit.

Infrastructure strengthening/upgradation

NRHM seeks to strengthen public health delivery system at all levels. During the last 10 years (up to June 2015), 30,750 new constructions and 32,847 renovation/upgradation projects for various health facilities including SC, PHC, CHC, SDH and DH were sanctioned.

24x 7 Services and First Referral facilities

2,706 Referral Hospitals were strengthened to act as First Referral Units (FRUs). 13,667 PHCs/CHCs were strengthened to provide 24x7 services. 14,441 Newborn Care Corners(NBCC), 575 Special Newborn Care Units (SNCU) and 2,020 Newborn Stabilization Units NBSU) were established under NHM to improve newborn care and reduce neonatal mortality and morbidity.

Mobile Medical Units

In order to provide services to the most remote and hard to reach areas, States have been supported with Mobile Medical Units (MMUs). Over the 10 years of NRHM, 333 out of 672 districts have been equipped with MMUs. So far 1,107 MMUs are operational in the country.

National Ambulance Services

31 States/UTs have the facility where people can dial 108 or 102 telephone number for calling an ambulance. Dial 108 is predominantly an emergency response system, primarily designed to attend to patients of critical care, trauma and accident victims etc. Dial 102 services essentially consist of basic patient transport aimed to cater the needs of pregnant women and children though other categories are also taking benefit and are not excluded. JSSK entitlements e.g. Free transfer from home to facility, inter facility transfer in case of referral and drop back for mother and children are the key focus of 102 service. This service can be accessed through a toll free call to a Call Centre.

Presently, 7,358 Dial 108, 7,836 Dial 102 and 400 Dial 104 Emergency Response Service Vehicles are supported under NHM, besides 6,290 empanelled vehicles for transportation of patients, particularly pregnant women and sick infants from home to public health facilities and back.

Mainstreaming of AYUSH

Mainstreaming of AYUSH has been taken up by allocating AYUSH facilities in 10042 PHCs, 2732 CHCs, 501 DHs, 5714 health facilities above SC but below block level and 421 health facilities other than CHC at or above block level but below district level.

Community Participation

To ensure involvement of the communities in over-seeing the provisioning of health care and to redress public grievances, 31,763 Rogi Kalyan Samitis or Hospital Management Committees at health facilities above the Primary Health Centre level and over 5.01 lakh Village Health Sanitation. Nutrition Committee (VHSNCs) at village level have been constituted across the country.

Financial Progress

One of the key mandates of NHM has been to increase the public expenditure in health sector. Since 2005, there has been a significant improvement in the utilization. Since the inception of NRHM, Rs. 1, 34,137.31 crore (up to October 2015) has been released to States/UTs under NHM.

Reproductive and Child Health Services

(i) The MMR, i.e. number of maternal deaths per 100,000 live births, has declined from 560 per 100,000 live births in 1990 to 167 per 100,000 live births in 2011-13. Percentage annual compound rate of decline in MMR during 2005 to 2011-13 accelerated to 5.8% from 5.1% observed during 1990 to 2005. India is poised to achieve the Millennium Development Goal of MMR at the present rate of decline.

(ii) Infant Mortality Rate (IMR): The IMR in India declined from 80 in 1990 to 40 in the year 2013. Percentage annual compound rate of decline in IMR during 2005-2013 has accelerated to 4.5% from 2.1% observed during 1990-2005.

(iii) Total Fertility Rate (TFR): The TFR in India declined from 3.8 in 1990 to 2.3 in the year 2013. The percentage annual compound rate of decline in TFR during 2005-2013 has accelerated to 2.9% from 1.8% observed during 1990-2005.

(iv) India achieved a historical milestone and was certified as 'Polio-free’ by WHO in March 2014 on having no wild polio case since 13th Jan, 2011.

Mother and Child Tracking System

It is a name based tracking system, launched by the Government of India as an innovative application of information technology directed towards improving the health care service delivery system and strengthening the monitoring mechanism. MCTS is designed to capture information on and track all pregnant women and children (0-5Years) so that they receive ‘full’ complement of maternal and child health services, thereby contributing to the reduction of maternal, infant and child morbidity and mortality. A total of 1, 18, 68,505 pregnant women were registered in MCTS during 2015-16 (till Oct’) which indicates a registration of 67.57% as against estimated number of pregnant women in 2015-16. Similarly, a total of 82, 38,820 children under 5 year age have been registered in MCTS till Oct, 2015.

Mother and Child Tracking Facilitation Centre (MCTFC)

MCTFC has been operationalised from National Institute of Health and Family Welfare (NIHFW). It is being operated by 80 Helpdesk Agents (HAs). It validates the data entered in MCTS in addition to guiding and helping both the beneficiaries and service providers with up to date information on Mother and Child care services through phone calls and Interactive Voice Response System (IVRS) on a regular basis. MCTFC is creating awareness about Government mother and child health related programmes and also seeking feedback on services being provided.

National Urban Health Mission

National Urban Health Mission (NUHM) was approved as a Sub-Mission under an overarching National Health Mission (NHM) by the Cabinet on 1st May 2013 for providing equitable and quality primary health care services to urban population with focus on slum dwellers and other vulnerable population like migrant workers, homeless, etc. NUHM aims to create Primary health care service delivery infrastructure which is largely absent in cities/towns by strengthening of existing Urban Family Welfare Centres (UFWCs), Urban Health Posts (UHPs), dispensaries and establishment of new Urban Primary Health Centers (U-PHC) and Urban Community Health Centres (U-CHC) as per the need.

The approvals conveyed under NUHM for the last two years i.e. 2013-2014 and 2014-15 are as follows:

- Strengthening of 3,995 existing facilities such as Urban Family Welfare Centers, Urban Health Posts and dispensaries as Urban Primary Health Centers (U-PHCs)

- 1,426 new U-PHCs were sanctioned

- Support provided for strengthening of 99 First Referral Units (FRUs)

- Establishment of 35 new Urban Community Health Centers

- 2,353 full-time Medical officers, 2,973 part-time Medical officers, 17,584 ANMs, 7,209 Staff Nurses, 2,978 Pharmacists and 3,231 Lab Technicians were approved

- For slum habitation – 92,173 Mahila Arogya Samitis (MAS) and 56,002 ASHAs approved (One MAS covers 50-100 households and one ASHA covers 200 to 500 households)

Key Initiatives under NHM:

Launch of National Quality Assurance Framework for Health facilities: To improve quality of health care in over 31000 public facilities and provide a clear roadmap to states, Quality Standards for District Hospitals (DHs), CHCs and PHCs under National Quality Assurance Framework were rolled out in November, 2014.

Launch of Kayakalp- an initiative for Award to Public Health Facilities: Kayakalp- initiative has been launched to promote cleanliness, hygiene and infection control practices in public health facilities. Under this initiative public healthcare facilities shall be appraised and such public healthcare facilities that show exemplary performance meeting standards of protocols of cleanliness, hygiene and infection control will receive awards and commendation. Further, Swachhta Guidelines for public health facilities to promote Cleanliness, Hygiene and Infection Control Practices in public health facilities were released on 15th May, 2015. The Guidelines provide details on the planning, frequency, methods, monitoring etc with regard to Swachhta in public health facilities.

Launch of National Family Health Survey (NFHS)–IV: NFHS-IV was launched in mid-2014 to provide essential data and information on important emerging health and family welfare elements to track progress on key parameters and provide evidence for policy and programme. The field work of NFHS-IV is under progress. This survey results are expected in 2016 and will provide national, state and district level data.

Launch of India Newborn Action Plan (INAP): Currently, there are estimated 7.47 lakh neonatal deaths annually. In September 2014, INAP was launched for accelerating the reduction of preventable newborn deaths and stillbirths in the country - with the goal of attaining ‘Single Digit Neo-natal Mortality Rate (NMR) by 2030’ and ‘Single Digit Still Birth Rate (SBR) by 2030’. The neo-natal deaths are expected to reduce to below 2.28 lakh annually by 2030, once the goal is achieved.

Launch of Mission Indradhanush: Mission Indradhanush was launched in December 2014 to reach 90 Lakh unimmunized/partially immunized children by 2020. It has been implemented in 201 districts in 1st Phase, 297 additional Districts are to be covered in 2nd Phase. About 20 lakh children received full immunization during the Phase-1 of Mission Indradhanush.

Approval of four new vaccines- Approval of four new vaccines namely rotavirus, Inactivated Polio Vaccine (IPV), Measles-Rubella vaccine, Japanese Encephalitis vaccine extended to adults. This will significantly reduce vaccine preventable morbidity, disability and mortality.

Free Drugs Service Initiative: An incentive of up to 5% additional funding (over and above the normal allocation of the state) under the NHM is provided to those States that introduce free medicines scheme. Under the NHM-Free Drug Service Initiative, substantial funding is available to States for provision of free drugs subject to States/UTs meeting certain specified conditions. Detailed Operational Guidelines for NHM- Free Drugs Service Initiative have also been released to the States on 2nd July 2015.

Free Diagnostics Service Initiative: The NHM- Free Diagnostics Service Initiative was launched in 2013 to provide free essential diagnostic services at public health facilities under which substantial funding was provided to States within their resource envelope. The Operational Guidelines on Free Diagnostics Service Initiative have been developed by the Central Government and shared on 2nd July, 2015 with the states various mechanisms adopted for providing free essential diagnostic services include:-

- Strengthening of the existing systems in public health facilities such as Lab infrastructure, provision of Lab Technician, equipment, etc.

- Out Sourcing of High Cost -low frequency diagnostic services.

- Contracting in of services of essential Human Resources (e.g. Radiologist, Lab Technician) on a need basis.

Bio Medical Equipment Maintenance: States have been asked to plan interventions for comprehensive equipment maintenance for all functional medical equipment/machinery. The Ministry has circulated model contract documents for guidance. Support for comprehensive equipment maintenance for all functional medical equipment/machinery is intended to ensure optimum utilisation of medical equipment.

Comprehensive Primary Health Care: Primary health care including preventive and promotive health care enables early detection and prompt treatment and serves a gate-keeping function to secondary and tertiary care, and also reduces the cost of care. In December 2014, the MoHFW constituted a Task Force to provide a report on roll out of comprehensive Primary Health Care. The Committee was charged with identifying current challenges to rolling out comprehensive primary health care, finalizing components of service delivery, clarifying the institutional structures and service organizations, developing guidelines for the PHC team, and coordinating with other Task Forces set up by the MoHFW working on Human resources for Health and developing Standard Treatment Guidelines. Nine areas for action to make primary health care comprehensive and universal are proposed. They include:

- Strengthen Institutional Structures and Organization of Primary Health Care Services.

- Improve access to technologies, drugs and diagnostics for comprehensive Primary Health Care

- Increase utilization of Information, Communication and Technology (ICT) - empowering patients and providers

- Promote Continuity of care- making care patient centric

- Enhance Quality of Care

- Focus on Social Determinants of Health

- Emphasize Community Participation and Address Equity Concerns in Health

- Develop a Human Resource Policy to support primary health care

- Strengthen Governance including financing, partnerships and accountability.

States are also offered support through the PIPs of the NHM to strengthen existing sub centers, as Health and Wellness centers with a primary health care team, headed by a mid-level service provider (who would be either an AYUSH or Nurse Practitioner trained through a bridge course in primary health care or public health). Other members of the team include the ANMs, ASHAs, and AWW of the sub center area. One important innovation that is being planned is the provision of performance based team incentives linked to achievement of key indicators build around comprehensive primary health care.

Kilkari & Mobile Academy: To create proper awareness among pregnant women, parents of children and field workers about the importance of Anti Natal Care (ANC), institutional delivery, Post-Natal Care (PNC) and immunization, it was decided to implement the Kilkari and Mobile Academy services in pan India in phased manner. In the first phase Kilkari would be launched in 6 states viz. Uttrakhand, Jharkhand, Uttar Pradesh, Odisha, Rajasthan (HPDs) & Madhya Pradesh (HPDs). The Mobile Academy would be launched in 4 states viz. Uttrakhand, Jharkhand, Rajasthan & Madhya Pradesh.

Kilkari is an Interactive Voice Response (IVR) based mobile service that delivers time-sensitive audio messages (Voice Call) about pregnancy and child health directly to the mobile phones of pregnant women, mothers of young children and their families. The service covers the critical time period – where the most maternal/infant deaths occur - from the 4th month of pregnancy until the child is one year old. Families subscribe to the service receive one pre-recorded system generated call per week. Each call will be 2 minutes in length and serve as reminders for what the family should be doing that week depending on woman’s stage of pregnancy or the child’s age. Kilkari services will be available to states in regional dialect.

Mobile Academy is an anytime, anywhere audio training course on interpersonal communication skills that the ASHA can access from her mobile phone. It gives ASHAs tips on how to convince families to adopt priority RMNCH behaviors, while refreshing her existing knowledge. The course is 240 minutes long and consists of 11 chapters with 4 lessons each. At the end of each chapter there is a quiz for them and all ANM/ASHAs passes the course will be provided with a printed certificate.

These services will be hosted centrally by MoHFW and single source of information for these services will be Mother and Child Tracking System (MCTS). Also these services will be free of cost to States/ UTs and the Beneficiaries.

Launch of Nationwide Anti-TB drug resistance survey: Drug resistant survey for 13 TB drugs was launched to provide a better estimate on the burden of Multi-Drug Resistant Tuberculosis in the community. This is the biggest ever survey in the world with a sample size of 5214 patients. Results are expected by 2016.

Kala Azar Elimination Plan : To reduce the annual incidence of Kala-Azar to less than one per 10,000 population at block PHC level by the end of 2015, Kala-Azar elimination Plan was rolled out, which inter-alia includes,

- New thrust areas launched for UP, Bihar, West Bengal and Jharkhand.

- New Action Plan to include active search, new drug regimen, coordinated Indoor Residual Spray (IRS) etc.

- New non-invasive Diagnostic kit launched.

Criteria for incentives to States under the NHM were revised. States that show improved progress made on key Outcomes/Outputs such as IMR, MMR, immunization, number and proportion of quality certified health facilities etc. will be able to receive additional funds as incentives.

9. Nursing Sector

School for ANM &GNM

The Government of India has initiated action for opening of 132 Auxiliary Nurse Midwife (ANM) and 137 General Nursing and Midwifery (GNM) schools in 278 identified districts in 29 states under Central Sponsored Scheme-Strengthening/Upgradation of Nursing Services, where there is preferably no such school. As on date, Govt. has approved for establishment of 128 ANM School and 137 GNM Schools. Funds to the tune of Rs. 725.oo Crore have already been released (Centre: State share as 85:15). The components that are covered under the scheme include civil work, laboratory equipment, teaching aids, library, computers, furniture, transport, rent for building for 18 months or till construction is completed, salary of staff, contingencies, etc. Objective of the Scheme:-

- To meet the shortage of Nurses.

- The Government has initiated action for the opening of 132 Auxiliary Nurse Midwife (ANM) and 137 General Nursing Midwifery (GNM)) schools in those districts of 23 high focus states the country where there is no such school. This will create 13500 additional intake capacities of candidates per year. So far 128 ANM schools and 137 GNM schools have been approved across the Country.

The Govt. of India has also initiated works under another Scheme - Development of Nursing Services by way of Training of Nurses, upgradation of School of Nursing into College of Nursing and by giving Florence Nightingale National Awards Nurses who work for the people. Objective of the Scheme are-

- In order to update knowledge and skills of nursing personnel, continuing nursing education programme has been started in various specialty areas.

- To increase the availability of Graduate Nurses.

10. New Initiatives

Indian Nurses Live Register: - In order to get the latest, correct and real-time census of the current human resources in the field of Nursing in India, MOHFW has initiated the development of a technology platform called the Live Register in collaboration with INC. The Live Register will include capturing up-to date and latest information of the currently practicing nurses, which would help the Government of India in better manpower planning and for making policy level decisions for the nursing professionals in India. The proposed system would help in providing a uniform registration across all the states. It will also help in linking reciprocal system and the migration of the nurses abroad. This provides us the real-time census of data as to how many nurses are presently working in India and outside India.

Nursing Scheme Monitoring System: - Ministry of Health and Family Welfare, GoI has developed a software module, namely, “Nursing Scheme Monitoring Software” to effectively monitor the implementation of the Schemes and to expedite the processes. This will help in knowing the exact status of Schemes both physical / financial progress and facilitate in better Planning and budgeting for both the Centre and State Governments.

National Nursing and Midwifery Portal: - The Nursing and Midwifery Portal is an online resource centre for State Nursing Councils and the entire nursing & midwifery cadre. The portal aims to bring all the nursing related information like Government Of India Initiatives in the field of Nursing, Information regarding Nursing and Midwifery education and human resource availability in the country (according to INC statistics), Circulars, Notifications, Job Opportunities, Publications, Journals, Pre-service and in-service education, e-learning and links to other related website under a common umbrella for easy access by the various stake holders. The e-learning modules will be added in the in-service education section on the website to provide new areas of knowledge related to nursing to the registered nursing professionals through e-learning mode.

11. National Programme for Control of Blindness

India was the first country to launch the National Programme for Control of Blindness in 1976 as a 100% centrally sponsored scheme with the goal to reduce the massive burden of avoidable blindness, mainly due to cataract and trachoma, to 0.3% by 2020 from its current level of 1.49%.

Millions of people in India were suffering from avoidable blindness. A strategy was, therefore, developed to bring the ophthalmic eye care providers under one umbrella, provide them technical know-how, supply necessary equipments, develop logistics, train the requisite staff required and launch an outreach programme to take eye care services to the far flung and remote areas of the country, where eye care services were severely lacking.

The three signature blindness control activities that were undertaken at mega level included cataract operation by various partners, the collection of corneas from deceased eye donors and school eye screening scheme to pick up eye defect like refractive errors, squint and amblyopia, vitamin A deficiency with associated xero-phthalmia and night blindness. A massive initiative was launched to treat and eradicate trachoma.

Four major surveys to find out major causes of avoidable/unavoidable blindness were undertaken during the years, 1974, 1986-89, 2001-02 and 2006-07. Cataract and refractive errors emerged to be the major causes of avoidable blindness.

World Bank Project under NPCB

Looking at the gravity of blindness in India, funds were mobilized from World Bank during the years 1994-2002 for development of eye care infrastructure, supply of ophthalmic equipments, training of manpower etc. Consequently, the prevalence of blindness in the country came down from 1.40% during 1986-89 to 1.1% during 2001-02.

Decentralized Approach during 10^th Five Year Plan (2002-2007)

The programme continued with the same enhanced zeal with the provision of funds from domestic budget and technical know-how from a number of agencies including WHO. State Blindness Control Societies were formed, under whose supervision, District Blindness Control Societies started functioning and delivering eye-care services in all the districts of the country. The concept/aim was to establish a bottom up approach in dealing with blindness through multi sectoral and coordinated efforts. These societies are responsible for identifying the blind in every village, organize diagnostic screening camps at suitable locations, arrange transportation of patients to the designated surgical facilities and ensure follow up.

NGO Eye Hospitals from all over the country contributed in tackling blindness in a major way, thus bringing down prevalence of blindness. Regional Institutes of Ophthalmology, Medical Colleges, District Hospitals, Sub-district Hospitals became major partners of NPCB in implementation of the programme in Government Sector. By the end of 10^th Five Year Plan, the prevalence of blindness came down to 1% (rapid survey 2006-07).

11^th Five Year Plan (2007-12)

During 11^th Plan, NPCB became a comprehensive eye care programme by including provision for treatment/management of other eye diseases like, diabetic retinopathy, glaucoma, corneal transplantation, vitreo-retinal surgery, treatment of childhood blindness, involvement of private practitioners, construction of eye wards and eye OTs in backward and remote areas, in addition to already existing activities including cataract operations, distribution of free spectacles to school children suffering from refractive errors, eye banking, IEC, training to ophthalmic personnel, development of eye care infrastructure in medical colleges, district hospitals etc, .An amount of approx. Rs.1092.80 crore were spent during the 11^th Five Year Plan to carry out the NPCB activities.

Major achievements during 11^th Five Year Plan (2007-12):-

· 294.07 lakh cataract surgeries were done.

· 27.19 lakh free spectacles were provided to school children suffering from refractive errors.

· 2.21 lakh donated eyes were collected for corneal transplantation.

· 1850 Eye surgeons were trained in various fields of ophthalmology to provide better quality eye care services.

12^th Five Year Plan (2012-17)

During the 12^th Plan, the NPCB activities shall be pursued with enhanced vigour, zeal, technical input and funds. Upgraded revised targets have been set for expanding volume of eye care services. In addition to the ongoing activities, following new initiative have been included under the programme:

- Provision for launching Multipurpose District Mobile Ophthalmic Units for the outreach activities to cover remote, underserved areas including hilly terrains of North East region.

- Provision for distribution free spectacles to old persons suffering from pressbyopia.

Major achievements during 12^th Five Year Plan (2012-17):

(Upto November, 2015)

· 214.98 lakh cataract surgeries

· 23.06 lakh free spectacles distributed to school children suffering from refractive errors.

· 1.93 lakh donated eyes collected for corneal transplantation.

· 1225 Eye surgeons trained to provide better quality eye care services in various fields of ophthalmology.

Implementation of the scheme in North-Eastern States

Development of eye care infrastructure in NE States including Sikkim has remained a priority area under the programme. In addition to taking care of cataract and other eye diseases, major activities initiated for development of eye care services in these States include setting up of tele-ophthalmology units to intensify coverage area and construction of Eye OTs/Wards in District Hospitals for development of eye care infrastructure.

Conclusion

With the inclusion of modern sophisticated ophthalmic equipments, skilled manpower, intensification of IEC, strengthening of Government sector hospitals and involvement of NGO eye hospitals in various eye care activities, the programme is marching with steady pace towards achieving its ultimate goal of bringing down the level of avoidable blindness in the country to the desired level of 0.3% by the year 2020.

12. National Programme for Health Care of the Elderly (NPHCE)

Keeping in view the recommendations made in the “National Policy on Older Persons” as well as the State’s obligation under the “Maintenance & Welfare of Parents & Senior Citizens Act 2007”, the Ministry of Health & Family Welfare has initiated the “National Programme for the Health Care of Elderly” (NPHCE) during the 11^th Plan period to address various health related problems of elderly people.

The objectives of the NPHCE are:-

· To provide easy access to preventive, promotive, curative and rehabilitative services to the elderly.

· To make use of the community based primary health care approach and strengthen capacity of the medical and paramedical professionals as well as the care-takers within the family for caring practices of the elderly.

· To identify health problems in the elderly and provide appropriate health interventions in the community with a strong referral backup support.

· To provide referral services to the elderly patients through district hospitals, medical colleges and strengthen health manpower development in the field of geriatric medicine,

· Development of treatment models for the elderly persons in our country.

The programme was initiated in October, 2010 towards the end of the XI Plan i.e. 2010-11and 2011-12 in 100 backwards and remote districts of 21 States. The major component of the NPHCE during 11^th Five Year Plan were establishment of 30 bedded Department of Geriatric in 8 identified Regional Medical Institutions (Regional Geriatric Centres) in different regions of the country and to provide dedicated health care facilities in District Hospitals, CHCs, PHCs and Sub Centres level in 100 identified districts of 21 States. Funds have so far been released to 24 States/UTs (covering 104 districts) and all the 8 Regional Geriatric Centres (Regional Medical Institutes) selected under the programme.

It was proposed to cover the remaining districts under the programme during the 12^th Five Year Plan in a phased manner (@ 100 districts per year and develop 12 additional Regional Geriatric Centres in selected Medical Colleges of the country (in the first three years).

The regional institutions will provide technical support to the geriatric units at district hospitals whereas district hospitals will supervise and coordinate the activities down below at CHC, PHC and Sub-Centres.

Developing Geriatric Department in Medical Colleges

The following eight Regional Medical Institutions (Regional Geriatric Centres) in different regions of the country has been selected under the programme in 2010-12 (11^th FYP).

1. All India Institute of Medical Sciences, New Delhi

2. Institute of Medical Sciences, Banaras Hindu University, Uttar Pradesh

3. Sher-e-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir

4. Govt. Medical College, Thiruvananthapuram, Kerala

5. Guwahati Medical College, Guwahati, Assam

6. Madras Medical College, Chennai, Tamil Nadu

7. SN Medical College, Jodhpur, Rajasthan

8. Grants Medical College & JJ Hospital, Mumbai, Maharashtra

It is proposed to develop 12 additional Regional Geriatric Centres in selected Medical Colleges of the country in addition to 8 Regional Geriatric Centres being developed during the 11^th Plan in the first three years. The regions and Medical College proposed are:

§ Punjab, Haryana & Chandigarh- PGIMER, Chandigarh

§ Uttar Pradesh- KGIMS, Lucknow

§ Jharkhand- Ranchi Medical College, Ranchi

§ West Bengal- Kolkata Medical College, Kolkata

§ Andhra Pradesh- Nizam Institute of Medical Sciences, Hyderabad

§ Karnataka- Bangalore Medical College, Bengaluru

§ Gujarat- B.J.Medical College, Ahmadabad

§ Maharashtra- Government Medical College, Nagpur

§ Orissa- S.C.B. Medical College, Cuttack

§ Tripura- Agartala Medical College, Agartala

§ Madhya Pradesh- Gandhi Medical College, Bhopal

§ Bihar- Patna Medical College, Patna

These centres will provide tertiary level of care for referred cases, undertake training programmes and research in the field of Geriatrics. Each of these Medical College will have a Department of Geriatrics with 30 beds and OPD facilities including academic and research wing. These institutes will ensure initiation of 2 PG seats for MD in Geriatric Medicine. Support will be provided for –

Construction/renovation/extension of the existing building and furniture of department of Geriatrics.

Machinery and Equipment
Video Conferencing Unit
Drugs and consumables
Research Activities
Human Resources (Contractual)
Training to faculty members of medical colleges and doctors from district hospitals

District Hospital

Identified District hospital will be strengthened /upgraded for management of the elderly. It will have 10 bedded Geriatric Ward and run a Geriatric OPD on a daily basis for care of the elderly. There will be a dedicated Physiotherapy Unit in all the District Hospitals with bed strength of 100 and above. Support will be provided for –

· Construction/renovation/extension of the existing building and furniture of Geriatric Ward and OPD

· Machinery and Equipment

· Drugs and consumables

· Training of doctors and staff from CHCs and PHCs

· Public Awareness and IEC

· Human Resource

· Transport of referred/serious patients

· Home based care for bed ridden cases

Miscellaneous cost for communication
TA/DA, POL, Contingency

Sub-District:

Geriatric Clinics will be set up in all CHCs and PHCs of the selected districts. Aids and appliances required by elderly will be made available. It is proposed to provide support for home-based care for rehabilitative services at the door step of such elderly patients. In case of emergency, transport and referral services will be provided to the elderly persons. Annual check-up of all the elderly at village level will be organized by PHC/CHC.

A. Community Health Centres (CHCs):

Geriatric clinic will be held twice a week at CHCs. A Rehabilitation Worker will be employed on contract for Physiotherapy and medical rehabilitation services for the elderly. CHC will also be supported with certain appliances and aids for the elderly. Domiciliary visits for bed-ridden elderly and counseling to family members for home based care of such patients will made by the rehabilitation worker. Financial support will be provided for -

· Machinery and Equipment

· Training & IEC

· Transport of referred cases

· Home based care for bed ridden elderly & counselling

· Transport and referral services

· Consumables

B. Primary Health Centres (PHCs):

PHC Medical Officer will be in-charge for coordination, implementation & promoting health care of the elderly. A weekly geriatric clinic will be held at PHC level by trained Medical Officer. Financial assistance will be provided for –

· Machinery and Equipment

· Training & IEC

· Home based care for bed ridden cases

· Transport of referred cases

· Consumables, etc.

Sub Centres (SCs)

The ANM / Male Health Workers will be trained for health care of the elderly. Support will be given for certain appliances and aids for the elderly. Home based care will be facilitated for bed ridden cases. Support will be provided for

· Aids and Appliances

· Transport of referred cases

· IEC activities

· Consumables etc.

It is proposed that the remuneration of contractual manpower proposed in the programme will be at par with the HRD under NRHM or posts in other NCD Programmes with a 5% annual increment.

National Centre of Aging (NCA)

The proposal for National Centre for Aging could not be considered during 11^th Plan. It is proposed to support development of two National Institute of Aging one in New Delhi and another in Chennai attached to AIIMS and Madras Medical College respectively.

(i) Human Resource Development: MD in Geriatric Medicine is already a MCI approved course. Medical colleges to be covered under the scheme of Regional Geriatric Centre will have provision for 2 PG seats in Geriatric Medicine. Apart from this, a 6 month certificate course in geriatric medicine will be developed for training of in service candidates in these colleges. Every medical college will train 6 candidates at a time and there will be 2 session each year.

(ii) Research: Research areas will be identified on priority which will include clinical, programmatic and operational research. Grants made available to Regional Geriatric Centres will be used for this purpose.

(iii) Technical advice will be provided by an Expert Group under the Chairpersonship of DGHs. The members will be experts in the field of geriatric from across the country and includes representatives of Dte.GHS and the Ministry of H&FW.

Achievements so far during the year 2015-16

· As on date 104 districts of 24 States/UTs have been covered under this programme. Amount to the tune of Rs. 17544.71 lakhs has been released for this purpose upto financial year 2014-15. No separate allocation of funds has been made for National Programme for Health Care of the Elderly (NPHCE), during 2015-16. NPHCE is the part of NCD flexible pool under the National Health Mission for which total allocation at BE stage for 2015-16 is Rs. 527.36 crores.

· Approval of the Hon’ble HFM and Hon’ble Finance Minister has been obtained to continue and expand the tertiary level activities of NPHCE

· Guidelines relating to establishment of 02 National Centres of Ageing (NCAs) are being finalized in consultation with all stakeholders and also the administrative approval has been issued to All India Institute of Medical Sciences (AIIMS), New Delhi and Madras Medical College (MMC) Chennai, for setting up of National Centres of Ageing.

· Guidelines relating to Regional Geriatric Centres and District level activities of NPHCE are also being finalized.

· 04 Regional Review Meetings for East, North East, South and North Zone, have been held with various States and UTs to review implementation of NPHCE in States/UTs.

· A Review Meeting has been held to assess the physical and financial progress in respect of the 8 RGCs under NPHCE.

· MoU with International Institute for Population Sciences (IIPS), Mumbai, for implementation of Longitudinal Ageing Study in India (LASI) was signed. Longitudinal Ageing Study in India (LASI) project is to be conducted by International Institute for Population Sciences (Deemed University), Mumbai under tertiary level activities for the National Programme for Health Care of the Elderly (NPHCE). The main objectives of the study are to provide comprehensive evidence based on health and well-being of the elderly population in India. LASI is designed to cover four major subjects and policy domain of adult and older population of India i.e. Health, Health Care & Health Financing, Social Factors and Economic Situation.

Expected Outcomes (till 31st March, 2017)

· 20 institutions with capacity to produce 40 postgraduates (MD) in Geriatric Medicine per year

· Additional 6400 beds in District Hospitals and 600 beds in Medical Colleges for the Elderly

· Geriatric Clinics in the OPD and Physiotherapy units in the District Hospitals and about 32000 Geriatric Clinics in CHCs/PHCs

· Free aids and appliances to elderly population at Sub-Centres

· Improvement in life expectancy and better quality of life of the elderly population

13. National Programme for Prevention and Control of Fluorosis

The Government of India initiated the National Programme for Prevention and Control of Fluorosis (NPPCF) in 2008-09 with an aim to preventand control fluorosis in the country. So far, the programme has been expanded to cover 111 districts in 18 States in a phased manner.

Objectives of NPPCF:

To collect, assess and use the baseline survey data of fluorosis of Ministry of Drinking Water and Sanitation for starting the project;
Comprehensive management of fluorosis in the selected areas;
Capacity building for prevention, diagnosis and management of fluorosis cases.

Strategy of NPPCF:

· surveillance of fluorosis in the community;

· capacity building (human resource) in the form of training and manpower support;

· establishment of diagnostic facilities in the medical hospitals;

· management of fluorosis cases including treatment surgery, rehabilitation

· health education for prevention and control of fluorosis cases.

Activities:

Community Diagnosis of Fluorosis village/block/cluster wise.
Facility mapping from prevention, health promotion, diagnostic facilities, reconstructive surgery and medical rehabilitation point of view – village/block/district wise.
Gap analysis in facilities and organization of physical and financial support for bridging the gaps, as per strategies listed above.

(a) Diagnosis of individual cases and providing its management.

(b) Public health intervention on the basis of community diagnosis.

· Behaviour change by IEC.

· Training

Assistance provided to States:

Strengthening manpower in endemic district:

Consultant

Laboratory Technician

Field Investigators (3) for six months

• Purchase of equipment for lab including an Ionmeter

• Training at various levels

• Health Education and Publicity

• Treatment including reconstructive surgery and rehabilitation

Funds for New districts-Rs. 45 lakhs with breakup as follows:

(Rs. in lakhs)

S. No	Activities	12^th Plan
1.	Salary of one consultant / per month and Salary of 3 Field Investigators for 6 months including travel & contingencies	9.00
2.	District Laboratory Equipments (Non-recurring)	10.00
3.	Recurring expenditure for laboratory diagnosis facilities including salary of Laboratory Technician / per month	3.50
4.	Training of medical and para-medical districts level	3.00
5.	One Coordination Meeting at district level	1.00
6.	Medical management of fluorosis cases including treatment, surgery, rehabilitation	15.50
7.	Health Education and publicity	3.00
	T O T A L	45.00

For continuing districts-Rs. 20 lakhs

Budget Allocation: For 12th Five Year Plan budget is Rs. 135 crores

For 2013-14 - Rs. 10.00 crore

For 2014-15 - Rs. 3.73 crore

For 2015-16 - Rs.2.26 crore.

Two training of trainers (TOT’s) were held at National Institute of Nutrition, Hyderabad to train about 50 persons (State Nodal Officers, District Nodal Officer and District Consultant NPPCF). A joint strategy for IEC is being developed by Ministry of Health & Family Welfare and Ministry of Drinking Water and Sanitation for Fluoride and Arsenic affected areas. To achieve this, joint meetings were held between Hon’ble Ministers and Secretaries of Ministry of Health & F.W. and M/o Drinking Water and Sanitation followed by a Video Conference of Secretaries of the two Ministries with the State Secretaries of the two departments on 13 May, 2015. List of 50 districts across 11 States have been identified for Joint IEC campaign with Ministry of Drinking Water and Sanitation. A review meeting with the State Nodal Officers, NPPCF of all affected States was held at New Delhi on 6^th November 2015 along with the Regional Directors (H&FW) of concerned States.

Review of NPPCF in Prakasam and Guntur districts of Andhra Pradesh was undertaken. Further, 3 districts in West Bengal (Nadia, Murshidabad, South 24 Praganas) affected by arsenic were also visited by Senior Officer of the Directorate.

14. Oral Health Programme

India has a high prevalence of oral diseases and it is well established that oral diseases are a public health problem and have a great impact on systemic health. Poor oral health can cause poor aesthetics, affects mastication adversely, causes agonizing pain and can lead to loss of productivity due to loss of man-hours.

As per the data from Dental Council of India, there are approximately 1, 52,679 registered dentists for the population of about 121 million. Though India is producing a large number of dental graduates, most of the rural areas in the country do not have service providers for common oral diseases and hence about 72.6% of the rural population remains neglected. Apart from this fact, the issue of accessibility (reaching to the health services) also exists, as it becomes a costly affair for the rural population to seek oral health related treatment. Promotion of healthy lifestyles with respect to oral health needs to be considered. World Health Assembly in 2005 included Oral Health with other non-communicable diseases (NCDs) for health promotion & disease prevention strategies.

Objectives:-

a) Improvement in the determinants of oral health e.g. healthy diet, oral hygiene improvement etc and to reduce disparity in oral health accessibility in rural & urban population.

b) Reduce morbidity from oral diseases by strengthening oral health services at Sub district/district hospital to start with.

c) Integrate oral health promotion and preventive services with general health care system and other sectors that influence oral health; namely various National Health Programmes (National Tobacco Control Program, School Health Programme, National Program for Prevention & Control of Fluorosis, National Program for Prevention & Control of CVD, Diabetes & Stroke etc) education, social welfare, women and child development, etc.

d) Promotion of Public Private Partnerships (PPP) for achieving public health goals

National Oral Health Programme

Taking into account the oral health situation in the country, Government of India has initiated a National Oral Health Programme to provide integrated, comprehensive oral health care in the existing health care facilities with the following objectives:

a. To improve the determinants of oral health

b. To reduce morbidity from oral diseases

c. To integrate oral health promotion and preventive services with general health care system

d.To encourage Promotion of Public Private Partnerships (PPP) model for achieving better oral health.

In order to achieve above listed objectives, Government of India has decided to assist the State Governments in initiating provision of dental care along with other ongoing health programmes implemented at various levels of the primary health care system. Funding has been made available through the State PIPs for establishment of a dental unit [at district level or below]

This dental unit equipped with necessary trained manpower, equipments including dental chair and support for consumables would be provided to the states through the NOHP. These units, according to the level of saturation of state’s own dental units, may be established at district hospitals or in the health facilities below the level of district hospitals.

Manpower

Manpower, if required, [such as a Dental Surgeon, a Dental Hygienist & a Dental Assistant] may be appointed on contractual basis.

Equipment

Equipments for the dental unit such as dental chair, x-ray machine and other supportive instruments may also be procured by the State Government.

Consumables

The sanctioned funds can be used for procurement of consumables required for the unit. The National Oral Health Cell will also help in imparting training to the Oral health manpower as well as general health manpower for better integrated approach to better oral health. In order to increase the level of awareness, the Government of India will help preparation of prototype Information, Education and Communication (IEC) materials/Behavior Change Communication (BCC) materials for dissemination of information.

- The National Oral Health Cell will also help in imparting training to the Oral health manpower as well as general health manpower for better integrated approach to better oral health.

- In order to increase the level of awareness, the Government of India will help preparation of prototype Information, Education and Communication (IEC) materials/Behavior Change Communication (BCC) materials for dissemination of information.

- Public Private Partnership model may also be utilized with the private dental colleges; various dental associations and community based organizations to promote community based oral health awareness and service delivery, wherever feasible.

- The National Oral Health Cell (NOHC) will be monitoring the implementation and progress of the programme from time to time through established mechanisms.

- The National Oral Health Programme (NOHP) was started as a National Programme in FY 2014-15. The program constitutes two separate activities i.e (i) Activities up to district level which is under the umbrella of NHM (ii) Tertiary level activities for IEC, training and research activities.

NHM Components:- NOHP supports the Health Facilities [District level and below] of the states to improve the dental care infrastructure and manpower for an efficient oral health care delivery to the rural population.

· Manpower support [Dentist, Dental Hygienist, Dental Assistant]

· Equipments including dental Chair

· Consumables for dental procedures

Progress FY 2014-15:- As on 31st March 2015, funds to the tune of Rs 1.72 Crore have been released to 9 States [Himachal Pradesh, Mizoram, Jammu & Kashmir, Madhya Pradesh, Rajasthan,Sikkim,Gujarat,Nagaland, Arunachal Pradesh]. NOHP has been able to support the States/UTs to start new or augment the existing dental care units in the public health facilities at District/Sub district level. In the process 18health facilities have received support fully/partially to strengthen the oral health care service for the community.

Progress FY 2015-16:- NPCC meeting for all states/UTs have been conducted and the proposals of 28 states/UTs have been considered for support through the program. A total approval of Rs12.8 Crore has been recommended to NHM finance for releases to support activities under NOHP. Till date approvals to the tune of Rs 12.51 Crore has been communicated to 27 states/UTs by NHM division for supporing NOHP.

15. Indian Council of Medical Research ICMR

Department of Health Research (DHR) through Indian Council of Medical Research (ICMR), aims at bringing modern health technologies to people by encouraging innovations related to diagnostics, treatment methods as well as prevention-vaccines, translating the innovations into products/ processes by facilitating evaluation/testing in synergy with other departments and introducing these innovations into public health service through health systems research.

Infrastructure Development–Establishment of new research facilities

Establishment of Multi-Disciplinary Research Units

Total 62 Multi-Disciplinary Research Units (MRU) in different Medical Colleges have been approved and funds were released to 48 Medical Colleges in 25 States/UTs in Government Medical Colleges with the aim to strengthen health infrastructure at the periphery and create an environment of research in medical colleges.

Establishment of Model Rural Health Research Units

Model Rural Health Research Units (MRHRU) is being set up in 5 States to take new technologies from lab to field for benefit of the society.

Establishing a Network of Laboratories for managing epidemics & natural calamities

- A Network of viral diagnostic and research laboratories is being rolled out to build capacity for handling outbreaks, managing epidemics & natural calamities across the length and width of the country. Work has been initiated for 5 Regional, 11 state level and 35 Medical College Level labs.

- These labs will be connected to Asia’s first BSL IV laboratory at NIV, Pune to deal with most dangerous lethal infections like hemorrhagic fevers, agents of bioterrorism, etc.

Establishment of new Centres in un-served and Deficit Health Research Areas

- Centre on vaccine preventable diseases

- ICMR Field Unit at Keylong in Lahaul & Spiti areas of Himachal Pradesh

- Samrat Ashok Tropical Disease Research Centre at RMRI, Patna with a 200 bedded hospital for research on tropical diseases is ready.

- Establishment of National Animal Resource Facility for Biomedical Research, Hyderabad: The Institution will be the first of its kind for quality laboratory animals for basic and applied biomedical research in the Country. The Cabinet has approved the proposal.

Reaching to the people

- Tribal Health Research Forum: A Network of 16 ICMR Institutes. Research programme on hypertension, nutrition and TB started with a goal of improving health of tribal and other marginalized communities.

- Vector Borne Diseases Science Forum: Multi-centric programmes on malaria, filariasis, JE/AES initiated. Ambitious public-private partnership for malaria elimination in Jabalpur to be initiated. New triple drug therapy project with NVBDCP to support filariasis elimination. Indigenous production of Insecticide impregnated papers for insecticide resistance developed by VCRC, Puducherry.

Legislation: Regulatory Issues

- Assisted Reproductive Technologies (Regulation) Bill: To accreditate, supervise and regulate the services of Assisted Reproductive Technologies clinics and banks in the Country (to regulate medical, social, ethical and legal aspects of surrogacy), a draft Assisted Reproductive Technology (Regulation) Bill has been developed and is at advance stage of enactment.

- Establishment of Medical/Health Technology Assessment Board for Technology Choice: To develop guidelines and provide guidance for introduction of cost-effective technologies/strategies for public health.

Translational Research-Support to Govt. Initiatives of Make in India Campaign

ICMR is working on various indigenously developed medical technologies/devices/kits etc which are cost effective and applicable in primary health care system. Following major technologies have been developed and launched.

Affordable Indigenous Technologies launched recently

- Vaccine for Japanese Encephalitis (JE)

- Test for molecular diagnosis of Thallassemia

- Magnivisualizer for cervical cancer screening

- Strips and detection system(s) for Diabetes

- New test for detection of pathogenic bacteria in food and Technologies for Vitamin A and Ferritin estimations

- Development of PCR based diagnosis procedure for visceral leishmaniasis from Urine samples- (Non-invasive method)

- Novel noninvasive method for diagnosis of visceral leishmaniasis by rK39 testing of sputum samples

Technologies Ready for Launch

- Diagnostic kit for lung fluke disease (paragonimiasis)

- Kits for leptospirosis – prevalent in Karnataka, Gujarat, Tamil Nadu and several other states.

- Kit for diagnosis of chlamydial infection prevalent in women.

- Kits for hormone assays: for various sex hormones useful for reproductive health problems

- Cooling jacket for persons exposed to hot atmosphere

Research Highlights from ICMR

- Established National Anti Microbial Resistance Surveillance Network

- Established National Hospital Based Rotavirus Surveillance Network

- Research cum Intervention project on AES/JE

- ICMR-INDIAB, an epidemiological study on diabetes was completed in 5 states.

- A Centre for Advanced Research for Innovations in Mental Health and Neurosciences: Manpower

- Development and Translational Research at NIMHANS, Bangalore has been initiated.

- A stroke registry was set up in rural and urban population of Bangalore and Ludhiana.

- DHR/ICMR guideliens for diagnosis and treatment of rickettsial infections in the country.

- TF study launched towards establishment of National Institute of Zoonosis at Nagpur.

Dealing with Sickle Cell Anemia and G6 PD Deficiency

- Satellite Centre of NIIH at Chandrapur Maharashtra has started working on screening and management of sickle cell diseases.

- Providing mobile phones to sickle cell disease families has given a tremendous response and by giving necessary medical advises helped to reduce morbidity and mortality.

- Genetic Counseling has helped the 19 tribal couples at risk having Sickle Cell babies opting for prenatal diagnosis to avoid birth of affected child.

- Prenatal diagnosis for preventing the birth of babies with severe genetic disorders like haemoglobinopathies, haemophilia, severe immuno-deficiencies, anemia was offered to more than 100 families.

- G6Pd deficiency was found to be problem among the tribals of Gujarat, Madhya Pradesh and Chattisgarh and irrational use of anti-malarial drugs are matter of concern.

Other Blood Disorders

- Established the molecular diagnostic facility laboratory at Agartala Medical College, Tripura which has helped in diagnosis of different haemoglobin abnormalities and enzymopathies to the population of Tripura

- Complementation groups in Indian Fanconi anemia (FA) patients are discovered as 30% patients of FA remain undiagnosed molecularly.

- Registry for rare blood groups like Bombay Phenotype is available. ,Work on rare donor registry is initiated.

- Techniques for non-invasive foetal RhB typing are being established.

M-Health/E-Health

- Development of MoSQuIT - A mobile based diseases surveillance system for malaria using mobile platform developed by Regional Medical Research Centre (RMRC), Dibrugarh in collaboration with CDAC, Pune and deployed in Tengaghat PHC of Assam with 10 sub-centres.

- Mobile Edutainment for TB prevention, curative TB Management, Entertainment (TB related mobile games).

- Development of Cancer Web Portal for cancer awareness among the public developed by ICPO, Noida.

- Learning Progarmme in Health Research: NIE-NPTEL (National Programme on Technology Enhanced Learning) planning to launch various courses in Health Research including areas of bio-ethics, good clinical lab practices, Research Methods, etc.

- Partograph: Plotting of partograph during labour using software has been developed in collaboration with IIT Delhi. This can be used by peripheral health workers to monitor progress of labour, send electronic message to referral centres for seeking advice or information; and it can also be used as a self-learning tool or teaching aid. Field validation of the software is ongoing.

Important Databases/ Knowledge bases

Tuberculosis (Developed by NIRTH, Chennai)

A. TBDRUGS -Database of Drugs for Tuberculosis

B. DDRTB- Database for Drug Resistant Tuberculosis

Nutrition (Developed by NIN, Hyderabad)

A. Food and Nutrition Database

B. Diet Calculator with recipes and Recommended dietary Guidelines

C. National Food Borne Disease Surveillance Portal

Addressing Impact of Climate Change on Human Health and Promoting use of Space Technology tools like Remote Sensing/GIS in Diseases mapping/early warning

- Development of Japanese Encephalitis (JE) Early Warning system for Upper Assam

- Determined Climate suitability for Cholera using weather parameters

- Map for filariasis in 3 blocks of Orissa

- Impact of deforestation on malaria vectors in Sonitpur, Assam

- Mapping of village level ecological risk of malaria

- Mapping of dengue mosquito breeding in Delhi

- Niche modeling of Kala-azar vector

- Up-scaling of Models for predicting filariaisis (LYMFASIM and GERM).

- Communication about nutrition in rural areas through Space Technology

- Early warning System for outbreaks of malaria and dengue using satellite data (vegetation index/Temperature Condition Index)

Human Resource Development in the area of Health Research: Support to Skill India

- To attract young graduates, both from medical and allied disciplines to research, ICMR has tried to create a variety of programs as mentioned below

- ICMR-Junior Research Fellowship, Senior Research Fellowships, Post-Doctoral Fellowship

- Short Term Studentship (STS) Program

- Fellowships for training abroad in identified areas (6 to 12 months)

- Fellowships to women candidate having break in career

International Cooperation in Health Research

- Ongoing partnerships in Health Research (under 7 MOUs) with various international organizations/agencies during last one year.

- Total 28 exchange visits of Scientists were arranged for various international collaborative programmes/projects.

- MOU signed with National Institute for Health and Care Excellence (NICE), UK

- International Research Co-operation – Seventy Seven projects approved by Health Ministry’s Screening Committee

- Total 12 Scientist and 6 Senior Scientists were selected for ICMR International Fellowship during 2015-16.

Key Challenges

The ICMR is committed to the vision of Govt. of India in addressing the current health challenges of persistent and new communicable diseases, increasing non-communicable diseases, emerging infections, climate change related problems with triple burden due to trauma and disabilities and need for more focused efforts on marginalized and vulnerable population. ICMR has identified following challenges for future Research:

- Strengthen efforts to eliminate diseases like filariasis, leishmaniasis, and leprosy.

- Control/management of malaria, dengue/ chikungunya /lung fluke and HIV

- Support in developing vaccines for cholera, typhoid, chikungunya, Japanese Encephalitis (JE), tuberculosis (TB) etc.

- Strengthening the National Anti-Microbial Resistance Surveillance Network (AMRSN)

- Twin problems of under nutrition and increasing percentage of childhood obesity, micronutrient deficiencies, toxicity due to arsenic and fluoride, pesticides etc.

- Adequate availability of drugs and devices at affordable prices.

Other Initiatives of the ICMR/Success Stories

- In a bid to promote inter-department collaboration a DHR/ICMR and MHRD joint Workshop on Medical Devices was held in Sep 2014 and an Exhibition was hosted at Rashtrapati Bhavan in March 2015. Forty Six innovative technologies of public health significance were displayed in the Exhibition. Researchers from various ICMR, IITs, IIM (A), DBT, DST, DeitY, DRDO, ISRO, Ministry of textile and industry, ASSOCHAM, FICCI and PHD Chamber of commerce participated in these events. Report of the workshop is available on website.

- Management of Acute Coronary Event Registries: Structured data capture of acute coronary syndromes is the first step in improvement of quality of treatment.The feasibility study was undertaken under in 13 public and private hospitals across India and recruited 1515 confirmed ACS patients ≥ 18 years. A web based secure electronic data capture and management system was developed to expedite data collection from dispersed sites. MACE registry Feasibility study showed that establishment of multicentric hospital based registry of ACS through a web based system in India is feasible. Pilot Study is ongoing. The study will enroll 10,000 patients admitted in public and private hospitals. The 12 participating nodal registries will each take up sub-registries with and without PCI facility.We feel that as the system matures and gets greater acceptability among caregivers, the data may help in not only standardizing 'Best Practices' but also rating institutions. The registry has a great potential for evolving low cost methods of ACS care across institutions with varying infrastructure and capacities.

- A stroke registry was set up in rural and urban population of Bangalore and Ludhiana. The study was completed in this year. A model for urban and rural stroke registries has been developed.

- Report of Jai Vigyan study on Rheumatic Fever and Rheumatic Heart Disease has been placed on website. The study observed (i) Prevalence of RHD in 5-14-year-old students ranged from 0.2 to 2.2/1000 (median 2) (ii).Secondary prevention of RHD is possible through registry approach is possible (iii) Heterogeneity of Group A Streptococcus strains isolated from different parts of the country was observed, making development of vaccine using N terminal of M protein of GAS isolates difficult. Translation Research: Upscaled to Punjab State’s “School Rheumatic and Congenital Heart Disease Control Program” in 2008 and is still continuing in the state.

- A comprehensive clinical and neuropsychological test battery for use in the Indian context for patients with Vascular Cognitive Impairment has been developed. Validation exercises for this tool have been undertaken this year. The tool will help in detection of mild cognitive impairments.

- A multi centric study on Prevalence of Hearing Impairment has been initiated covering six major regions of India viz North, South, East West, Central and North-East. The study will assess prevalence of mild, moderate and severe hearing loss in the community.

- Neuro-Muscular Disorder is a disease which has no treatment and very poor prognosis.Tthere is no clue as to why it happens. Therefore, ICMR has finalized projects to look into the Genotypes underlying Duchenne Muscular Dystrophy phenotypes besides A comprehensive clinical assessment, genetic testing and rehabilitation .Projects will be undertaken on–DMD/BMD and SMA studies as well as Project On Limb Girdle Muscular Dystrophy

- Preparation and dissemination of SOPs - published the complete set of study protocols and SOPS in a high impact peer-reviewed journal that is also available as an open access resource (Balakrishnan et al. 2015). This study has generated one of the largest datasets of direct household level 24-hr PM2.5 measurements in India.

- The exposure-response relationships from the Adult Respiratory health fill a critical gap in the national and global literature for potential effects of air pollution on young, non-smoking populations.

- Birth and adult cohorts have been created and maintained to examine health effects from air pollution exposures at one site in Tamil Nadu.

- The large base of exposure information generated in the study has allowed the development of exposure models that could be based on information on household, land use or demographic variables that are more easily collected.

- Evidence from this study could pave the way to include reduction of air pollution exposures in intervention efforts. This could for e.g. include behavioral changes to reduce exposures from household solid fuels during pregnancy and for young children, shifts to cleaner sources of household energy in rural households currently dependent on solid fuels and improvements in urban air quality management programs.

- The First Report of Development of an Atlas of Cancer in Punjab State for the years 2012-2013 completed. The First report for the combined years 2012 and 2013 for districts and centres gives an idea of the prevailing patterns of cancer by district in Punjab State. Under this project, a cost-effective design and plan using advances in modern electronic information technology, was conceived, to collate and process relevant data on cancer.

- The Patterns of Care and Survival Studies in Cancer Breast, Cervix and Head & Neck Cancers for the year 2006-2008 is under publication. The main findings are:

- In locally advanced cervical cancer significant survival benefit was observed when treated with a combination of radiation with cisplatin than radiation alone

- The same observation was seen in patients with locally advanced cancers of the oro and hypo-pharynx.

- In cancer of the breast a high proportion of early stage patients had mastectomy with poorer survival compared to breast conserving surgery which is the usual practice.

- Development of Software Applications Programme with specific modules is a primary mandate of the NCDIR and as part of Translational Research is a major activity of the centre. An overview of the applications is given immediately after this section.

- The report of North East Cancer Atlas (other than areas where PBCRs exist) has been prepared.

- Population Based Cancer Registry at Patiala –The data for 2011-2012 has been finalised. Data has been published by PBCR Patiala in form of a report.

- Review – PBCRs: As per the PBCR Review system formulated by NCDIR, with the purpose of improvement in various issues of PBCR i.e. coverage, timely data submission, data quality etc. A detailed study of each registry has been carried out and a document has been prepared.

- To verify the completeness of data obtained through Punjab cancer atlas we have conducted a cross-sectional survey of almost 1, 00,000 individuals (around 25000 families) in four districts of Malwa region in Punjab. Those are, Muksar, Batinda, Mansa, and Barnala. During the same study we have planned to get the estimate of magnitude of other three NCDs, i.e., diabetes, CVD, and stroke.

- Making cancer a Notifiable Disease - Karnataka State: Government of Karnataka vide notification No. HFW 189 CGM 2015 dated 25.07.2015 has made cancer a Notifiable Disease in Karnataka State.

- Radiotherapy Module with Discharge summary: An intranet software module for Radiotherapy (RT) department, based on the RT chart used by JIPMER, Regional Cancer Centre, Puducherry has been developed by NCDIR-NCRP, Bangalore. Once data has been captured with this module, the related data on HBCR and POCSS will be uploaded to NCRP-NCDIR website. So the registry staff can retrieve the case from their HBCR login and fill the remaining information. This module has the provisions to generate the hard copy of the RT chart and also the discharge summary which will be given to the patient at the time of completion of treatment.

Software Development at NCDIR

- Hospital Based Cancer Registry (HBCR) – Pattern of Care and Survival Studies (POCSS) Data Entry

- HBCR-HIV Data Entry

- Onset Young Diabetes Registry data entry software.

- Independent modules: Pathology Data Entry with outputs/reports; Radiotherapy Data Entry; Surgical Oncology Data Entry; Medical Oncology Data Entry

- E-Monitoring: Online Data status for RCCs and budget estimation; Online Data Status - HBCRs, POCSS, Pathology, Radiotherapy etc.; Online registration for independent modules; Core Form stock; HBCR File Maintenance; QC Management ; Data Entry Operators daily data entry count

- Ongoing Software development : Dynamic data entry, JIPMER RT Module

- Population Based Cancer Registry

- PBCRDM 2.1.1: New version of PBCRDM 2.1

- Data Entry Programme (www.pbcrindia.org):

- Dynamic table generation (www.pbcrindia.org):

- Book Report Generator:

Other software development

- Stroke Registry:

- Punjab Cancer Atlas Survey

Admin Softwares

- File Movement for Administrative Department

- Annual Maintenance Contract(AMC) Management

- Application for Biometrics Attendance Report Generation

Occupational Health

Biomass fuel use and adverse neonatal/perinatal outcome

- The study observed that low birth weight, lesser head circumference, neonatal death, less developed genitalia and need to stay at nursery was more frequent with mothers using biomass fuel when compared with other fuel users.

- Significantly increased risk of ‘low birth and ‘need of newborn to stay in neonatal care unit’ in the form of calculated odds ratio was observed in biomass fuel users.

- Coal and wood were major source for VOCs and particulates exposure during cooking followed by kerosene and LPG.

Health hazards of workers in ceramic industries and iron foundries

- Sleeplessness, muscle cramps and fatigue, excessive feeling of thirst, heavy sweating, elevated body temperature and headaches were main responses of workers during their daily work schedule.

- General systemic health complaints as reported were musculoskeletal discomforts, digestive discomforts, respiratory discomforts, cardiovascular discomforts and visual discomforts.

- Among ceramic workers, pain in lower extremities and upper extremities was reported due to awkward posture of work for long hours and manual material handling. Among iron foundry workers, workers reported of lower back pain followed by knee pain and legs pain.

Seroprevalence of human brucellosis among veterinarians

- Human brucellosis was found positive in 13.15% of the subjects using traditional RBPT screening test.

- Recent or acute infection was found positive by IgM ELISA in 15.52% cases and possible chronic infections was observed in 19.47% which is diagnosed based upon IgG antibodies titre and gives >90% accuracy of the result.

Long-Term Exposure to Lead and Musculoskeletal Disorders

- Blood lead level among lead exposed workers was associated with odds of musculoskeletal morbidities. The Hb%, serum calcium, magnesium and handgrip in both hands were lower in workers with musculoskeletal disorders.

- Highly sensitive C-reactive protein, an inflammatory marker was significantly increased in lead exposed workers having MSD compare to non-symptomatic subjects.

- Workers having MSD has shown decreased muscle strength in both hands as compared to non-symptomatic workers.

Coal miners and Health effects

- The common respiratory complaints observed among coal miner was cough in 29 (6.6%) workers of which only 17 (3.9%) had productive cough.

- Breathlessness and haemoptysis was reported by only 11 (2.5%) and 3 (0.7%) coal miners respectively. The other symptoms observed among coal miners were tiredness (3.4%), backache (6.6%) and difficulty in hearing (5.2%).

- Similarly in the resident groups only 7 (2.5%) reported cough of which 4 (1.4%) had productive cough.

Utility of Personal Cooling Garment for use in Outdoor Hot Environment

- Study suggests that PCG provided a practical and economical way of alleviating the discomfort and physiological effects of heat stress when environmental control is not practical.

- Developed PCG device was demonstrated at: (1) Rashtrapati Bhawan, New Delhi on 11 Mar 2015, (2) Vibrant Gujarat Exhibition from 7-13 January 2015, and (3) PCG technology transfer to Industrial partner Soothe Healthcare Pvt. Limite, Noida.

Other Initiatives:-

- Interdepartmental Collaborations between ICMR Institutes and IIMs IITs are being targeted through signing of MOUs. The aim is to undertake collaborative innovative translation research projects in the areas of public health.

- School based interventions for prevention of CAD and affordable technologies for neurological disorders are being planned.

- A Centre for Advanced Research for Innovations in Mental Health and Neurosciences: Manpower Development and Translational Research at NIMHANS, Bangalore has been initiated.

Medicinal Plants

- In continuation of the series Reviews on Indian Medicinal Plants three volumes (Vols. 14-16) covering monographs on 680 Medicinal Plants species with botanical names (L-M) are in the press.

- Quality Standards on 35 Medicinal Plants were developed and monographs published as Vol. 13 of the series Quality Standards of Indian Medicinal Plants.

- A MoU between ICMR and Pharmacopoeal Commission of Indian Medicine (PCIM), Ministry of Ayush was signed on 10.4.15 under which 120 PRS generated through extramural projects of ICMR were transferred to PCIM along with all spectral data for characterization and Quality Assurance of Ayurveda, Siddha & Unani Drugs (ASU) drugs. This will lead to wider acceptance of Traditional Medicines in India and abroad, as quality assurance is the key issue. Volume 4 of the Phytochemical Reference Standards (PRS) of Selected Indian Plants is being finalized.

- Two Task force meetings were convened on Diabetes and its complications as well as stress induced sleep disorders to review the research leads available and identifying the research gaps, and develop a strategy in National perspective towards positioning of the drug considering the disease burden, market size, USP (unique selling point) and sustainability of the product with low risk and high gain by involving industrial representatives, clinicians and Ayurvedic experts etc.

- A compendium on the safety aspects of important Indian Medicinal Plants is being compiled.

- Regular updating of the website developed exclusively on the divisions activities which is hyperlinked with the Councils main website. This website gives abridged digitized version of the publications brought out by the Division.

- Retrieval and dissemination of information.

- Human resource development. A three days’ Workshop-cum-training program sponsored by ICMR on Standardization of Medicinal Plants and their Products was organized at Shoolini University of Biotechnology and Management Sciences, Solan, Himachal Pradesh from March 22-24, 2015.

- This program aimed to update the professionals working in the industry and academia on latest developments in the technologies, methodologies and regulatory requirements for Medicinal Plants and herbal products.

International Health

Joint Working Group (JWG) and Joint Steering Committee (JSC) Meetings

Following JWG/JSC meetings under various MoUs and Joint Statements have been held:

- ICMR-MRC working level meeting at New Delhi on 23rd April, 2015 (through videoconference)

- Indo-US Joint Steering Committee on Diabetes at New Delhi on 29th April, 2015 (through videoconference)

- 1st JWG meeting between India and Indonesia at Nirman Bhawan, New Delhi (under bilateral prog. Of MOH&FW).

The International Workshops/ meetings held under Bilateral/multilateral programmes

- SAFHeR Foundation workshop in Clinical & Laboratory Medicine Research on 9-12th Feb., 2015 at NIOP, New Delhi.

- India-ASEAN workshop on Malaria Research held on 11th – 15th May, 2015 at NIMR, New Delhi under DST coordinated programme.

The following MoUs have been signed during this period:

- Memorandum of Understanding between ICMR and University of Sydney, Australia for collaboration in Health Research signed in Jan./March, 2015

- Memorandum of Intent between ICMR & FORTE, Sweden was signed on 2nd June, 2015 in Stockholm.

- Letter of Intent between ICMR, DBT & the National Institute of Allergy & Infectious Diseases, National Institute of Health, USA for collaboration on Anti-Microbial Resistance Research was signed on 25th June, 2015 in MoH&FW, New Delhi.

- Memorandum of Understanding between ICMR and the Centers for Disease Control and Prevention, USA on collaboration in Environmental and Occupational Health & Injury Prevention and Control was signed on 25th June, 2015 at MoH&FW, New Delhi.

- Memorandum of Understanding among National Cancer Institute (NCI) of AIIMS, MoH&FW, Govt. of Republic of India, ICMR and the Department of Biotechnology, Ministry of Science & Technology, Govt. of Republic of India and the National Cancer Institute of the National Institute of Health, Govt. of the United State of America (USA) for Cooperation on Cancer Research, Prevention, Control and Management was signed on 25th June, 2015 at MoH&FW, New Delhi.

- MoU between ICMR and Drugs for Neglected Diseases Initiative (DNDi), Switzerland was signed on 15th October, 2015 at New Delhi.

- Memorandum of Understanding between Medical Research Council, UK & ICMR was signed on 10th November, 2015 at New Delhi.

- GoI approvals obtained for ICMR-NHMRC, Australia; LSHTM, UK (Ready to be signed).

- Pending ICMR MoUs for GoI clearances – Indo-US, MCH; ICER, USA; ICAV, Canada; BMGF, USA.

Exchange Visits

A total of 28 exchange visits of scientists / officials to and from India were arranged during the period under reference for various international collaborative programmes / projects.

Health Ministry’s Screening Committee (HMSC)

The research projects involving foreign assistance and/or collaboration in biomedical/health research are submitted by the Indian investigators to ICMR for approval of Govt. of India through Health Ministry’s Screening Committee (HMSC) and the International Health Division of ICMR acts as the Secretariat for HMSC. The projects are peer reviewed by the concerned Technical Divisions at ICMR and then placed before the HMSC for consideration and decision. During the period, seven meetings of Health Ministry’s Screening Committee were organized, wherein 104 projects were considered and out of which 75 projects were approved for international collaboration / assistance with agencies from USA, Canada, UK, New Zealand, Australia, Norway EU and several other foundations and foreign universities. Out of which, seven projects are co-funded by ICMR.

International Fellowship Programme

- Selection Committee Meeting of ICMR-International Fellowships for Indian Biomedical Scientists for 2015-16 was held on 30th June, 2015 wherein 12 Young Scientists & 6 Senior Scientists have been selected and will avail training during 2015-16 of which 3 senior fellows & 3 young fellows have left for availing ICMR International Fellowship for 2015-16.

- Reports of 10 Young & 4 Senior Scientists who availed fellowship during 2014-15 have been uploaded on ICMR website.

- The Selection Committee Meeting of ICMR International Fellowship from Developing Countries was held on 13th April, 2015 of which Mr. Mohammed Soloman Ali, Jimma University, Ethiopia was selected for ICMR International Fellowship at NIRT, Chennai for a period of 6 months.

- In this connection, the approvals from MOH, MEA and MHA have been obtained by ICMR.

Transfer of biological material for commercial purposes

- Announcement made for submission of applications for transfer of human biological material for commercial purposes and/or research and development of commercial products with deadlines 30th April, 2015 and 31st July, 2015 were made.

- 236 cases were considered and 162 approved by the Committee in its three meetings held on 25th Feb., 2015, 26th May, 2015 and 26th Aug., 2015.

- Call for applications with next deadline of 31st January, 2016 will be uploaded on ICMR website.

Biological and Toxin Weapons Convention related work

- ICMR is part of an Inter-Ministerial Committee which advises the Disarmament and International Security Affairs (DISA) Division of Ministry of External Affairs, GOI for the negotiations on the Biological and Toxin Weapons Convention during various consultations.

- The activities related to Biological Weapons Convention in coordination with Ministry of External Affairs, GoI are coordinated. (The activity was handed over to the Div. of International Health in March, 2011).

- On request from the DISA, Division of Ministry of External Affairs, GoI; representative of ICMR participates (as part of the Indian delegation led by MEA, GoI), in the annual meetings of State Parties to the Biological Weapons Convention (BWC) held in Geneva for discussions/inputs on items such as cooperation and assistance, with a particular focus on strengthening cooperation and assistance; review of developments in the field of science and technology related to the Convention; strengthening national implementation and how to enable fuller participation in the Confidence Building Measures (CBMs).

Joint Call for Proposals

Call for proposals under ICMR/BMBF (Germany) uploaded on ICMR website on 15th Oct. 2015 with a deadline to submit the proposal till 6th January, 2016.

Other initiatives

- Satellite Centre of NIIH at Chandrapur Maharashtra has started working on screening and management of sickle cell diseases.

- G6Pd deficiency was found to be problem among the tribals of Gujarat, Madhya Pradesh and Chhattisgarh and irrational use of anti-malarial drugs are matter of concern.

- Providing mobile phones to sickle cell disease families has given a tremendous response and by giving necessary medical advises helped to reduce morbidity and mortality.

- Genetic Counselling has helped the 19 tribal couples at risk having Sickle Cell babies opting for prenatal diagnosis to avoid birth of affected child.

- Prenatal diagnosis for preventing the birth of babies with severe genetic disorders like haemoglobinopathies, haemophilia, severe immuno-deficiencies, anemia was offered to more than 100 families.

- Complementation groups in Indian Fanconi anemia (FA) patients are discovered as 30% patients of FA remain undiagnosed molecularly.

- 20 Blood Bank Officers and Technicians from all over the country have been trained in Blood Banking procedures. Recently training was also given to Blood Bank Offices and Technicians from North East States of India.

- Registry for rare blood groups like Bombay Phenotype is available; work on rare donor registry is initiated.

- Techniques for non-invasive foetal RhB typing are being established.

- Revitalization of Traditional Medicine: Regional Medical Research Centre, Belgaum with the mandate to work on Traditional Systems of Medicine, initiated its activities on documentation, conservation and scientific evaluation of traditional ethnomedicinal practices. The leads were identified for chronic conditions like arthritis and diabetes and are being taken up for clinical studies. The Centre is aiming towards Centre of Excellence in non-codified traditional systems of medicine and also National Institute of Traditional Medicine. The efforts in this direction are being made to achieve the target by taking up the robust observational studies to create evidence for the age old system of traditional healing, by scientific evaluation of the claims for their safety and efficacy and through validation by clinical trials.

- Social & Behavioural Research: ICMR has initiated 16 new projects in different aspects of Gender & Health and social-behavioural aspects. A new joint initiative of ICMR-ICSSR has been taken and through a call for proposals in the designated identified priority areas, about 250 proposals have been received: These studies have looked into social and behavioural aspects of health of people including women/gender issues and marginalized groups and Dalits and youths and would suggest intervention/policy measures for effective delivery and better utilization of services. This would lead to better health of people of the country.

- Dengue awareness campaign at Community college of Madurai Institute of Social Sciences (MISS), Madurai: Madurai Institute of Social Sciences (MISS) is one among the leading academic college under Madurai Kamaraj University. A team of Scientists from CRME, Madurai visited MISS on 4th November 2015 to create awareness on dengue prevention. A total of 40 students participated in this programme. They were taught about the current situation of dengue in various parts of our country including in this part of region and their major role to play with the community. The programme was inaugurated by the Community college Principal and Dr. T. Mariappan delivered the training to the students. The class room training held on 4th November 2015 at community college (MISS) with more specifically on vector mosquitoes Aedes aegypti and Ae. albopictus and its role on transmission of dengue and source of breeding habitats and its control measures with emphasis on source reduction measures. They were provided with IEC materials to talk to the people in various villages in and around Madurai to reduce dengue incidence. Dr. T. Mariappan was accompanied with technical staff of CRME Mr. V. Murugesan and K. Moorthi along with the required training materials.