Health and Family Welfare

16- HEALTH AND FAMILY WELFARE

THE Ministry of Health and Family Welfare is instrumental and responsible for the implementation of various programmes on the national scale in the areas of health and family welfare, prevention and control of major communicable and non-communicable diseases as well as promoting research across the country.

Department of AIDS Control has been merged with the Department of Health & Family Welfare and now be known as the National AIDS Control Organization (NACO).

In December 2014, Department of AYUSH was made Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) with focused attention on the development of education and research in Ayurveda, yoga and naturopathy, Unani, Siddha and homoeopathy systems.

Directorate General of Health Services (DGHS) is an attached office which renders technical advice on all medical and public health matters and is involved in the implementation of various health services.

National Health Policy:

The National Health Policy (NHP) was released in 2017 after a gap of 15 years.
The policy aims to attain the highest possible level of health and well-being for all at all ages through preventive and promotive healthcare and universal access to quality health services without anyone having to face financial hardship as a consequence.
This would be achieved through increasing access, improving quality and lowering the cost of healthcare delivery.
NHP 2017 advocates allocating major proportion (two-thirds or more) of resources to primary care and aim to ensure the availability of two beds per 1,000 population distributed in a manner to enable access within the golden hour.
One of the mandates of the NHP 2017 is the use of information technology towards healthcare.

National Health Policy
National Health Mission	One of the major focus in the health sector has been to increase the funding to healthcare to at least 2 per cent of the GDP. As a step towards this goal the National Rural Health Mission (NRHM) was launched in 2005 and it morphed into National Health Mission (NHM) with the launch of National Urban Health Mission (NUHM) in 2013. Thereafter, NRHM and NUHM became two sub-missions under the overarching NHM. NHM envisages achievement of universal access to equitable, affordable and quality healthcare services that are accountable and responsive to people’s needs.
Mission Indradhanush	It was launched in 2014 to cover all those children who have been partially vaccinated or not vaccinated during routine immunization rounds. Objective: To increase full immunization coverage to at least 90 per cent children by 2020.
Maternal and Neonatal Tetanus Elimination	It is defined as less than one neonatal tetanus case per 1,000 live birth in every district per annum. India has been validated for Maternal and Neonatal Tetanus elimination in May 2015. India achieved MNT Elimination through the strengthening of health systems by innovative programmes like Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karayakaram (JSSK) to improve institutional delivery and by strengthening Routine Immunization.
New Vaccines	Inactivated Polio Vaccine (IPV): In concurrence with the World Polio End Game strategy, IPV was introduced in November 2015 in six states and expanded throughout the country by June 2016. Till August 2017, around 2.79 crore doses of IPV have been administered to children since its introduction.
	Rotavirus Vaccine: This vaccine was launched in March 2016 in Andhra Pradesh, Haryana, Himachal Pradesh and Odisha, to reduce the burden of diarrhea caused by Rotavirus. It has been expanded to five more states namely, Assam, Madhya Pradesh, Rajasthan, Tripura and Tamil Nadu. Approximately 88.73 lakh doses of Rotavirus vaccine have been administered to children since its introduction.
	Rubella Vaccine as Measles-Rubella (MR) Vaccine: MR vaccination campaign targeting children from 9 months up to 15 years of age, was launched in 2017 in five states viz., Karnataka, Tamil Nadu, Goa, Lakshadweep and Puducherry where subsequent to completion of the campaign the MR vaccine was introduced in routine immunization replacing measles-containing vaccine 1 & 2 at 9-12 months and 16-24 months of age.
	Adult JE vaccine: Japanese Encephalitis vaccination in children was introduced in 2006. However, the vaccine was expanded in the adult population of districts with high disease burden in 2015.
	Pneumococcal Conjugate Vaccine (PCV): This vaccine is provided to reduce child deaths due to pneumonia - which is a major cause of child mortality. It was launched in 2017 in 3 states i.e. in Himachal Pradesh (12 districts), Uttar Pradesh (6 districts) and Bihar (17 districts) in the first phase.
India New Born Action Plan	This was launched in 2014 with the goal of attaining “Single Digit Neonatal Mortality Rate (NMR) by 2030” and “Single Digit Still Birth rate (SBR) by 2030”.
Ayushman Bharat	Ayushman Bharat - National Health Protection Mission (AB-NHPM) a new centrally sponsored scheme was launched in 2018. This comes under Ayushman Bharat Mission anchored in the MoHFW. The Scheme has the benefit cover of ? 5 lakh per family per year. The target beneficiaries are to be more than 10 crore families belonging to the poor and vulnerable population based on the Socio-Economic Caste Census (SECC) database. With this, AB-NHPM will subsume the ongoing centrally sponsored schemes–Rashtriya Swasthya BimaYojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS). This cover will take care of almost all secondary care and most of the tertiary care procedures. To ensure that nobody is left out (especially women, children and the elderly) there will be no cap on family size and age. The benefit cover will also include pre and post-hospitalisation expenses. All pre-existing conditions will be covered from day one of the policy. A defined transport allowance per hospitalization will also be paid to the beneficiary; portable benefits including cashless benefits from any public/private empanelled hospitals across the country. The payments for treatment will be done on the package rate (to be defined by the government in advance) basis. There is the provision to partner the states through co-alliance. This will ensure appropriate integration with the existing health insurance/protection schemes of various central ministries/departments and state governments (at their own cost). State governments will be allowed to expand the scheme both horizontally and vertically. They can implement through an insurance company or directly through trust/society or a mixed model. States would need to have the State Health Agency (SHA) to implement it.
Mother’s Absolute Affection Programme	MAA-Mother’s Absolute Affection” which is an intensified programme was launched in 2016 in an attempt to bring undiluted focus on the promotion of breastfeeding.
Intensified Diarrhoea Control Fortnight	It is a programme to combat diarrhoeal mortality in children with the ultimate aim of zero child deaths due to childhood diarrhoea. Intensified Diarrhoea Control Fortnight (IDCF) is being implemented as a campaign in the month of July, since 2014, for control of deaths due to diarrhoea across all states and UTs. Under this, more than 14.7 crore under-5 children have been reached since 2014 by ASHA with prophylactic ORS.
Janani Shishu Suraksha Karyakram	JSSK scheme entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery including caesarean section.
Janani Suraksha Yojana	JSY is a safe motherhood intervention under the National Health Mission. The objective is to reduce maternal and neonatal mortality by promoting institutional delivery among poor pregnant women.
Pradhan Mantri Surakshit Matritva Abhiyan	The programme aims to provide assured, comprehensive and quality antenatal care, free of cost, universally to all pregnant women on the 9th of every month. PMSMA guarantees a minimum package of antenatal care services to women in their 2nd/3rd trimesters of pregnancy at designated government health facilities. The programme follows a systematic approach for engagement with the private sector which includes motivating private practitioners to volunteer for the campaign.

Organ Transplant:

National Organ Transplant Programme was launched for carrying out the activities as per Transplantation of Human Organs and Tissues Act, 1994 training of manpower and promotion of organ donation from deceased persons.
Under this, an apex level organization, National Organ and Tissue Transplant Organization (NOTTO) was set-up at Safdarjung Hospital, New Delhi including a National Registry (NOTTR) to provide an online system for procurement and distribution of organs and tissues and to promote deceased organ and tissue donation.

Swachh Swasth Sarvatra:

Swachh Swasth Sarvatra is a joint initiative of the Ministry of Health and Family Welfare and Ministry of Drinking Water and Sanitation launched in 2016.

Mental Health Care:

The Mental Health Care Act, 2017 adopts a rights-based statutory framework for mental health and strengthens equality and equity in the provision of mental healthcare services in order to protect the rights of people with a mental health problem to ensure that they are able to receive optimum care and are able to live a life of dignity and respect.
The Act increases accountability of both government and private sectors in the delivery of mental healthcare with the representation of persons with a mental health problem and their care-givers in statutory authorities such as central and state mental health authority.
The most progressive features of the Act are the provision of advance directive, nominated representative, special clause for women and children related to admission, treatment, sanitation and personal hygiene; restriction on the use of electro-convulsive therapy and psychosurgery.
Decriminalization of suicide is another significant facet of the Act, which will ensure proper management of severe stress as a precursor for suicide attempts.

HIV & AIDS:

HIV and AIDS (Prevention and Control) Act, 2017, aims to end the epidemic by 2030 in accordance with the sustainable development goals set by the United Nations.
A person living with AIDS cannot be treated unfairly at employment, educational establishments, renting a property, standing for a public or private office or providing healthcare and insurance services.
The Act also aims to enhance access to healthcare services by ensuring informed consent and confidentiality for HIV-related testing, treatment and clinical research.
National AIDS Control Organisation (NACO) is the nodal organization for National AIDS response in the Ministry of Health and Family Welfare.
National AIDS Control Programme is a fully funded central sector scheme implemented through State/ UT AIDS Control Societies (SACS) in states/union territories and closely monitored through District AIDS prevention and control unit (DAPCU) in 188 high priority districts.
Currently, the National AIDS Control Programme (NACP)-IV (extension) is under implementation for the period 2017-20.

Pradhan Mantri Swasthya Suraksha Yojana:

The PMSSY envisages creation of tertiary healthcare capacity in medical education, research and clinical care, in the underserved areas of the country.
PMSSY has two components-:
- Setting up of new AIIMS like institutes in underserved regions of the country
- Upgradation of existing Govt Medical Colleges (GMCs).

Medical Education:

The major step was the passage of Indian Medical Council (Amendment) Act, 2016, a uniform entrance examination for admission to Under Graduate and Post Graduate medical courses in the country.
National Eligibility-cumEntrance Test (NEET) has been introduced from the Academic Year 2016-17.
It would help curb malpractices in medical admissions especially in private medical colleges, will lead to greater transparency and ensure better standards of Medical Education.

Dental Education:

Under the Dental Council of India (DCI) framework 12 new dental colleges were established during 2014-16.

Centre for Integrative Medicine and Research:

The Centre for Integrative Medicine and Research is a pioneering initiative by AIIMS, New Delhi in quest for convergence of contemporary medicine with India’s ancient and traditional medical practices and has been envisioned as a “state-of-the-art” research centre.

Centre for Integrative Medicine and Research
Revised Tuberculosis Control Programme	Goal: To decrease mortality and morbidity due to TB and cut transmission of infection until TB ceases to be a major public health problem in India. Under the Revised National Tuberculosis Control Programme (RNTCP), the government provides support to the state /UT governments for human resource, drugs, diagnostics and consumables.
National AIDS Control Programme	It is a 100 per cent central sector scheme. More than 10 lakh people living with HIV are on ART; one lakh additional patients brought under the ambit of Anti Retro Viral (ARV) treatment in line with ‘Test and Treat’ Policy launched for covering all patients with ART cover irrespective of CD count or clinical stage.
National Tobacco Control Programme	In 2007- 08, NTCP was launched in 9 states covering 18 districts. Further, in 2008-09, the programme was upscaled to cover 12 new states covering 24 districts.
National Mental Health Programme	NMHP is being implemented to improve coverage and accessibility of mental health care in the country. Under it there is the provision of regular psychiatric OPD and IPD services at the district hospital, free supply of psychotropic drugs, ambulatory support for psychiatric patients, awareness generation activities on mental health in community and camps and outreach clinics in taluka hospitals/community health centres.
National Leprosy Eradication Programme	Objective: To reduce leprosy burden in the country by providing quality leprosy services through general health care - to achieve the elimination of leprosy as a public health problem in all states and districts i.e., reduce annual new case detection Ratio to < 1 per 100,000 populations at the national level.
Rashtriya Swasthya Bima Yojana	The objectives of (RSBY) was to provide cashless treatment in any public or private empanelled hospitals for most of the diseases that require hospitalization and will give improved access to quality health care to the beneficiaries. This Scheme has been subsumed in the Ayushman Bharat Programme.
Integrated Disease Surveillance Programme	IDSP is a centrally sponsored scheme under NHM implemented in all states and UTs. Objective: strengthening /maintaining a decentralized laboratory based IT-enabled disease surveillance system for epidemic prone diseases to monitor disease trends and to detect and respond to outbreaks in the early rising phase through trained rapid response teams.

Food Regulation:

Food Safety and Standards (FSS) Act, 2006 was enacted with the objective to consolidate the laws relating to food and for laying down science-based standards for articles of food.
This was also to regulate their manufacture, storage, distribution, sale and import to ensure availability of safe and wholesome food for human consumption.
The Food Safety and Standards Authority of India (FSSAI) was established in 2008.
FSS Act, 2006 is being implemented by all state/UT governments.

Drug Regulation:

Control over the import, manufacture, distribution and sale of drugs, cosmetics and notified medical devices in the country are regulated under the provisions of the Drugs and Cosmetics Act, 1940 & Rules, 1945.
The manufacture, sale and distribution of drugs in the country is primarily regulated by the state drug control authorities appointed by the state governments while control over drugs imported into the country and introduced for the first time is exercised by the central government through central drugs standard control organization.

Rashtriya Arogya Nidhi:

Rashtriya Arogya Nidhi (RAN) was set up in 1997 to provide financial assistance to the patients living below poverty line, who are suffering from major life-threatening diseases, to receive medical treatment at Government hospitals.
The financial assistance to such patients is released in the form of “one time grant” to the Medical Superintendent of the hospital in which the treatment is being received.
Under the scheme, the central government also provides grant-in-aid to states/union territories (with legislature) to set up State Illness Assistance Fund (SIAF) to the extent of 50 per cent of the contribution made by state government/union territories.

Health Minister’s Cancer Patient Fund:

The scheme Health Minister’s Cancer Patient Fund (HMCPF) within RAN was also set up in 2009.
In order to utilize the HMCPF, the revolving fund as under RAN has been established in 27 Regional Cancer Centres (RCCs).

Health Minister’s Discretionary Grant:

Under the scheme of Health Minister’s Discretionary Grant (HMDG), financial assistance up to ? 1,25,000/- is available to the poor and needy patients to defray a part of expenditure on hospitalization for undergoing major surgical intervention and treatment of major diseases.
The patients who are not covered under RAN, due to criterion of below poverty line and whose annual income does not exceed ? 1,25,000/- can avail the financial assistance under the scheme.

Health Research
Indian Council of Medical Research	As one of the oldest medical research bodies in the world, the ICMR was established in 1911 as the Indian Research Fund Association (IRFA). It has remained the apex and premier medical research organization in the country. ICMR has made significant scientific contributions to understanding various diseases of national importance such as malaria, Japanese encephalitis, tuberculosis, AIDS, Kala-azar, Filariasis, Leprosy and Poliomyelitis. Also, through ICMR’s Memoranda of Understandings (MoUs), it has partnered with leading universities from around the world to concentrate efforts on leading health issues such as cancer, diabetes, infectious diseases, and vaccine development.
Flagship Programmes	The India TB Research Consortium: ICMR initiated a new flagship programme to establish India TB research and development consortium Aims: To bring together all major national players (with international collaborators) to address overarching scientific questions to tackle TB in a mission mode.
Flagship Programmes	TB Diagnostic Initiative: Truenat Rif, an indigenous, cost-effective, rapid molecular diagnostic kit for TB/MDR-TB has been developed in collaboration with ICMR, DBT and the industry. Active case finding pilot project initiated in five states for bridging the gap in last-mile delivery of services amongst tribal populations.
e-Health/M-Health and use of Space Technology Tools	ICMR is focusing its efforts on using e-Health/ M-Health and promote the use of space technology tools. ICMR has developed a mobile-based disease surveillance system for malaria (MosQuit) using a mobile platform.
Disease Burden Estimation	State-level disease burden estimation launched at the Univ of Washington, the USA in collaboration with the Ministry of Health and Family Welfare, to generate state-level disease burden and risk factors estimates to improve health programmes and planning in India. Preparedness to handle Zika virus outbreak: ICMR-NIV established surveillance at 25 sites in the country for Zika testing.
Ayush Systems of Healthcare
Ayurveda	‘Ayurveda’ literally means “Science of Life”. Ayurveda is evolved from the various Vedic hymns rooted in the fundamental philosophies about life, disease and health. The Charak Samhita and Sushruta Samhita developed around 2500 BC are the main treaties of Ayurveda fully available today. According to Ayurveda, health is considered as a pre-requisite for achieving the goals of life i.e., Dharma, Artha, Kama and Moksha. Ayurveda takes an integrated view of the physical, mental, spiritual and social aspects of human beings and about the interrelationships between these aspects.
Yoga	Yoga is essentially spiritual and it is an art and science of healthy living which focuses on bringing harmony between body and mind. The word ‘Yoga’ has two meanings; the first comes from the root ‘Yujir’ or ‘Union’, the second is derived from a different root ‘yuja’ which means ‘Samadhi’ - the highest state of mind and the absolute knowledge. These two are the most important meanings of the word Yoga according to Panini, the most well-known Sanskrit grammarian.
Naturopathy	Naturopathy is a science of health and healing and a drug less therapy based on well-founded philosophy. It has its own concept of health and disease and principles of treatment. Naturopathy is a system of medicine that advocates harmonious living with constructive principles of nature on physical, mental, moral and spiritual planes.
Unani	The Unani system of medicine originated in Greece and passed through many countries before establishing itself in India during the medieval period. The fusion of traditional knowledge of ancient civilizations like Egypt, Arabia, Iran, China, Syria and India. It emphasizes the use of naturally occurring mostly herbal medicines and some medicines of animals, marine and mineral origin.
Siddha	The Siddha System of medicine is one of the ancient systems of medicine in India having its close links with Dravidian culture. The term Siddha means achievements and Siddhars are those who have achieved perfection in medicine. Eighteen Siddhars are said to have contributed towards the systematic development of this system and recorded their experiences in the Tamil language.
Homoeopathy	The physicians from the time of Hippocrates (around 400 B.C.) had observed that certain substances could produce symptoms of a disease in healthy people similar to those of people suffering from the disease. Dr. Christian Friedrich Samuel Hahnemann, a German physician scientifically examined this phenomenon and codified the fundamental principles of Homoeopathy. Homoeopathy was brought into India around 1810 A.D. by European missionaries and received official recognition by a Resolution passed by the Constituent Assembly in 1948 and then by the Parliament.
Sowa-Rigpa	Sowa-Rigpa is among the oldest surviving health traditions of the world with a living history of more than 2500 years. It has been in vogue and practised in Himalayan regions throughout particularly in Leh and Laddakh (J&K), Himachal Pradesh, Arunachal Pradesh, Sikkim, Darjeeling, etc. Sowa-Rigpa is effective in managing chronic diseases like asthma, bronchitis, arthritis, etc. Sowa- Rigpa emphasizes the importance of the five cosmological physical elements in the formation of the human body.
Ayush Healthcare Infrastructure	National AYUSH Mission (NAM) was notified in 2014 which envisages better access to AYUSH services including co-location of AYUSH facilities at Primary Health Centres (PHCs), Community Health Centres (CHCs) and District Hospitals(DHs), upgradation of existing Government AYUSH Hospitals, upgradation of existing government/ panchayat/ government-aided AYUSH dispensaries and setting up of upto 50 bedded integrated AYUSH hospitals.
Ayush Drug Quality Control	Ministry of AYUSH has a Drug Control Cell to look after and co-ordinate in matters related to Ayurvedic, Siddha, Unani and homoeopathy (ASU&H) drugs. Under the centrally sponsored initiative of the National AYUSH Mission, grant-in-aid is provided to the states for the strengthening of infrastructural, functional and regulatory capacity for manufacturing and testing of drugs and enforcement of the regulatory provisions.
Medical Education in Ayush	The Central Council of Indian Medicine (CCIM) is the statutory body constituted under the Indian Medicine Central Council Act, 1970 which lays down the standards of medical education in Ayurved, Siddha and Unani through its various regulations.