Accessibility to Healthcare Services

National Rural Health Mission (NRHM) was launched in April 2005 to provide accessible, affordable and quality health care to the rural population, especially the vulnerable sections. Healthcare services are provided through a network of 148124 Sub centres, 23887 Primary Health Centres, 4809 Community Health Centres and 985 District Hospitals across the country. Apart from this, tertiary care to the people especially the poor and under privileged is provided through the Government Medical Colleges and other super-speciality Hospitals.

One of the key strategies NRHM is to ensure inter-sectoral convergence with other Ministries dealing with proximate determinants of health like drinking water, nutrition, sanitation and hygiene, literacy especially female education etc. Addressing inequalities through different programmes of healthcare like Janani Suraksha Yojana, Janani Shishu Suraksha Karyakram(JSSK), Universal Immunization Programme(UIP), various National Disease Control Programmes etc.is a major objective of NRHM. 

Government is taking effective steps through Schemes and programmes of different Ministries e.g., NRHM, Mahatma Gandhi National Rural Employment Guarantee Act(MNREGA), Integrated Child Development Services (ICDS), Sarva Shiksha Abhiyan(SSA), Jawaharlal Nehru National Urban Renewal Mission(JNNURM),Total Sanitation Campeign(TSC), Rajiv Gandhi National Drinking Water Mission (RGND WM) etc. to address the social determinants of health. 

The above information was laid in the Rajya Sabha today by the Union Minister for Health & Family Welfare Shri Ghulam Nabi Azad. 

Weekly Iron and Folic Acid Supplementation Programme for adolescents

The Government has decided to implement the Weekly Iron and Folic Acid Supplementation (WIFS) Programme for adolescents.           WIFS Programme is based on the empirical evidence that weekly supplementation of 100mg Iron and 500µg Folic acid is effective in decreasing prevalence of anaemia in adolescent age group. The programme is free of cost and Iron and Folic Acid deworming tablet, along with testing and counselling services would be provided completely free.

The progamme will be implemented in both rural and urban areas and will cover school going adolescent girls and boys from 6th to 12th class enrolled in government/government aided/municipal schools through the platform of Schools and out of school adolescent girls through the platform ofAganwadi centers.

This programme will cover approximately 13 Crore beneficiaries and will address the challenge of high prevalence and incidence of anaemia amongst adolescent girls and boys (10-19 years). Modalities of implementation  are as below: 

-          Administration of supervised free Weekly Iron-folic Acid Supplements of 100mg elemental iron and 500µg Folic acid to target population. 

-          Fixed day strategy under which preferably Monday to be declared as “Anaemia Control day” or “WIFS day”.

-          Screening of target groups for moderate/severe anaemia and referring these cases to an appropriate health facility.

-          Biannual de-worming (Albendazole 400mg), six months apart, for control of helminthes infestation.

-          Information and counselling for improving dietary intake and for taking actions for prevention of intestinal worm infestation.

-          Convergence with key stakeholder Ministries like Ministry of Women and child Development and Ministry of Human Resource Development. 

Adolescent Anaemia has been a long standing problem in India and the  country has a high prevalence.  However, there has been a 5% decline in incidence of anemia amongst adolescents between National Family Health Survey (NFHS)-II (1998-99) and  National Family Health Survey (NFHS)-III (2005-06).

        The prevalence of anaemia  (Haemoglobin value of <12 g% in girls and Haemoglobin value  of  < 13g% in boys) is high amongst adolescents as per the report of  NFHS-III and the National Nutrition Monitoring Bureau Survey.

        It is estimated that more than 5 Crores adolescents are anaemic in India.

        According to NFHS -III data, over 55 % of adolescent boys and girls in the age group of 15-19 years are anaemic. Adolescent girls in particular are more vulnerable to anaemia due to the rapid growth of the body and loss of blood during menstruation. According to NFHS-III, almost 56% of adolescent girls aged 15-19 years suffer from some form of anaemia. Of these, 39% are mildly anaemic while 15% and 2% suffer from moderate and severe anaemia respectively.  In India, the highest prevalence of anaemia is reported between the ages 12-13 years, which also coincides with the average age of menarche. With increase in age, the prevalence of anaemia among girls remains almost stagnant, while among boys, the prevalence rate reduces.

        The reasons for anaemia amongst adolescents are:

- Growth spurt leading to increased demandof Iron  in the body

-  Poor dietary intake of Iron

- Worm infestation and high rate of infection

- Increased loss of Iron due to onset of menstruation (in girls)

             The above information was laid in the Rajya  Sabha today by the  Union Minister for Health & Family Welfare Shri Ghulam Nabi Azad.

Bachelor of Rural Health Care

The Government is considering to introduce a 3½ year rural health care course tentatively called Bachelor of Rural Health Care (BRHC), which has been framed after taking into consideration views of various stakeholders including States. The purpose of the proposed course is to generate a cadre of health care providers who by the virtue of the way they are chosen, trained, deployed and supported would be motivated to live in and provide comprehensive primary health care in the rural areas at the Sub-Centre level.

Presently, the proposal is under examination by the Department Related Parliamentary Standing Committee on Health and Family Welfare and also by the Medical Council of India. 

The above information was laid in the Rajya Sabha today by the Union Minister for Health & Family Welfare Shri Ghulam Nabi Azad. 

Incentives for Doctors in Government Hospitals

The Ministry of Health & Family Welfare has taken following steps to check the migration of reputed doctors from Government hospitals:-

(i) the age of superannuation of Teaching Specialists has been enhanced from 62 to 65 years;

(ii) the age of superannuation of non-teaching and Public Health Specialists of CHS has been enhanced from 60 to 62 years;

(iii) The Dynamic Assured Career Progression Scheme (DACP) has been extended upto Senior Administrative Grade(SAG) posts. The CHS officer’s promotion upto Senior Administrative grade(SAG) level are made on a time bound basis without any linkage to vacancies;

(iv) The 6th Pay Commission has brought about an overall improvement in remuneration of doctors;

(v) the period of study leave for CHS doctors has been enhanced from 2 to 3 years for post graduation.

These measures have been taken during the last 3-4 years and are beginning to yield result towards retaining the doctors/specialists in Government hospitals/institutions.

The above information was laid in the Rajya Sabha today by the Union Minister for Health & Family Welfare Shri Ghulam Nabi Azad.

Achievements of MDG Commitments Made Under NRHM

The Millennium Development Goals (MDGs) 4, 5, 6 are set for the year 2015. The achievement under NRHM against these Goals are as follows:

·        The Under 5 Mortality Rates is 59 per 1000 live births in 2010.

·        The Maternal Mortality Ratio stands at 212 per 1, 00,000 Live Births during 2007-09.

·        The annual incidence of malaria (Cases of malaria/1000 population) has been halted around 1.5 since the year 2008. In case of Tuberculosis, the New Smear Positive case detection rate is 72 % and New Smear Positive Success Rate is 88%.

MDG Goal 4 requires that Under Five Mortality Rate is to be reduced by two thirds between 1990 & 2015.  This in case of India translates into a goal of reducing Under Five Mortality Rate from 118 per 1000 live births in 1990 to 39 per 1000 live births in 2015.  Between 2008 and 2010, Under Five Mortality Rate has declined by 5 points each year.  At this pace of decline, the Under Five Mortality in 2015 is expected to be 34, which is lower than goal under MDG. Further, the achievements under Revised National TB Control Programme are sufficient to meet the commitments under the MDG-6.

The steps taken to work towards achievement of MDG Goals include:

(i)                 A new initiative namely Janani Shishu Suraksha Karyakaram (JSSK) was launched on 1^st June, 2011, which entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery including Caesarean section.  The initiative stipulates free drugs, diagnostics, blood and diet, besides free transport from home to institution, between facilities in case of a referral and drop back home.  Similar entitlements have been put up in place for all sick newborns accessing public health institutions for treatment till 30 days after birth.

(ii)             For focused attention to districts having weak health indicators, 264 High Focus Districts have been identified across the country for supportive supervision and higher allocation of funds to bridge critical gaps especially in infrastructure and human resources.

(iii)           To overcome shortage of Specialists, Multi skilling of the available doctors through trainings such as Life Saving Anesthetic Skills (LSAS), Basic Emergency Obstetrics & Neonatal Care (BeMONC), Comprehensive Emergency Obstetric & Neonatal Care (CeMONC) taken up.

(iv)           To improve availability of personnel in difficult and remote areas, monetary and non-monetary incentives are provided to staff posted in such hard to reach and inaccessible areas.

(v)              Allowing contractual appointment under NRHM to immediately fill gaps so as to meet the requirement of health personnel. Nearly,      1.44 lakhs health personnel which includes doctors, specialists, nurses and paramedics have been engaged under NRHM.

(vi)           Over 8 lakhs Accredited Social Health Activists (ASHAs) have been trained and placed to bridge the gap between community and health facilities.

(vii)         Development of BCC/ IEC tools highlighting benefits of Family Planning especially on spacing methods.

(viii)      Mother and Child Protection Card in collaboration with the Ministry of Women and Child Development to monitor service delivery for mothers and children.

(ix)           Antenatal, Intranatal and Postnatal care including Iron and Folic Acid supplementation to pregnant & lactating women for prevention and treatment of anaemia.

(x)              Rapid Diagnostic Tests (RDT) and Artemisinin based Combination Therapy (ACT) scaled up for the diagnosis and treatment of all Pf malaria cases

(xi)           28 accredited labs have been set up across country to diagnose Multi Drug Resistant TB (MDR-TB).

The above information was laid in the Rajya  Sabha today by the Union Minister for Health & Family Welfare Shri Ghulam NabiAzad.

Strengthening Neo-Natal Services

In order to strengthen neonatal services in the country, funds are provided to States for establishing and running Special Newborn Care Units (SNCU), Newborn Stabilization Units (NBSU) and Newborn Baby Care Corners (NBCC). Funds are also provided to the States to train health care providers in essential newborn care through Navjat Shishu Suraksha Karyakram (NSSK). Funds have also been allocated to States for implementing Janani Shishu Suraksha Karyakram (JSSK) which provides for free care and transport of sick newborn for first 30 days of birth. In addition, funds under NRHM are provided to States for implementation of several interventions aimed at improving overall maternal and child health.

As per SRS 2010 report of Registrar General of India, Neo-natal Mortality Rate is 33 per thousand live births in India. Details are annexed for the major states.

           The medical causes of neonatal deaths  in India are Infections (29%) such as Pneumonia, Septicemia and Umbilical Cord infection;Prematurity (24%) i.e birth of newborn before 37 weeks of gestation and Asphyxia (19%)  i.e. inability to breathe immediately after birth that leads to lack of Oxygen.  Various contributing factors for neonatal mortality include (a) Home delivery by unskilled persons (b) Lack of essential new born care for asphyxia and hypothermia (c) Poor child care practices (d) Lack of early detection of sick newborn (e) Inadequate/Delayed referral mechanisms (f) Inadequate infrastructure for specialized care of sick newborn.

            The above information was laid  in the Rajya  Sabha today by the Union Minister for Health & Family Welfare Shri Ghulam Nabi Azad.

SBS/ls

ANNEXURE

Status of Neo-natal Mortality Rate in India (for Major States), SRS 2010

STATES/UTs	Neo-natal Mortality Rate (per 1000 LB)
India	33
Andhra Pradesh	30
Assam	33
Bihar	31
Chhattisgarh	37
Delhi	19
Gujarat	31
Haryana	33
Himachal Pradesh	31
Jammu & Kashmir	35
Jharkhand	29
Karnataka	25
Kerala	7
Madhya Pradesh	44
Maharashtra	22
Orissa	42
Punjab	25
Rajasthan	40
Tamil Nadu	16
Uttar Pradesh	42
West Bengal	23

Committee of Secretaries Reviews State of Preparedness to Contain H1N1

The Cabinet Secretary Shri Ajit Kumar Seth today chaired a Committee of Secretaries meeting to review the state of preparedness to contain the incidence of H1N1 virus. Secretaries from Ministry of Health and Family Welfare, Biotechnology, Pharmaceuticals were among those who attended the meeting. 

The Cabinet secretary was apprised that a central team was deputed to Pune on April 8, 2012 to investigate the outbreak of Influenza A H1N1 and their preliminary report shows that the cases and deaths reported from Pune and Pimpri-Chinchiwad are sporadic in nature. A central stockpile of Oseltamivir tablets (anti viral drug) is being maintained and D/o Pharmaceuticals is monitoring availability of raw ingredient for making the drug. There is adequate stock of drugs and vaccines for treatment of people affected by the illness and immunization of health care personnel and whosoever may require it. Vaccine manufactured by indigenous manufacturers is also available. 

The medical response system has been put on a state of preparedness. Forty five laboratories are testing samples (26 in Government sector and 19 in Private Sector). The test is done free of cost in Government laboratories/Integrated Disease Surveillance Project supported private laboratories (KMC, Manipal and CMC, Vellore). A nationwide network of laboratories in the private sector are also available for rapid diagnosis. 

It was also stated that at the time of the early warning of the cases in Pune itself, an advisory was sent to all the States/UTs about the possibility of sporadic outbreaks of H1N1 influenza. Owing to reports circulating in the media regarding mutation in the virus, expert opinion was sought from the Director, National Institute of Virology, Pune who has stated that there is no mutation to suggest change of virus to ‘dangerous form’ and that the present strain of H1N1 pandemic virus are susceptible to Oseltamivir and the currently available vaccine can be used for protection against the virus. In the first week of March almost 30% of referred samples were positive for H1N1 in Pune which has now come down to approximately 10%. 

During the period from March 1, 2012 to April 9, 2012, 689 cases of H1N1 have been reported from Maharashtra (392 cases), Karnataka (104), Andhra Pradesh (66), Rajasthan (84), Tamil Nadu (28), Delhi (6), Gujarat (5) and in Punjab, Haryana, Himachal Pradesh and Madhya Pradesh (one each). During the same period, 35 deaths have been reported, of which 15 were from Maharashtra, nine from Rajasthan, six from Andhra Pradesh, two from Gujarat and one each from Tamil Nadu, Himachal Pradesh and Madhya Pradesh. 

M/o Health & Family Welfare has been asked to monitor the situation on a day to day basis and take all possible steps to ensure that the drug and vaccine are available in sufficient stock. 

Shri Azad Calls for Greater Regional Cooperation in Health

Addressing the fourth Health Ministers’ Conference at Male, Maldives today, the Union Health and Family Welfare Minister, Shri Ghulam Nabi Azad has said that a strong and vibrant public health care system can cope with the enormous challenges emanating from demographic and epidemiological transition in the SAARC region. “We should collaborate amongst ourselves to find our own concrete solutions which are feasible, cost effective and suitable for our region”, Shri Azad said. The Minister added that full advantage of the strength and vibrancy of SAARC in addressing the common health problems of the region should be taken. The President of Maldives, Dr Mohammed Waheed inaugurated the Health Ministers’ Conference. 

Taking note of the large burden of communicable diseases and unacceptably high levels of maternal and child mortality particularly India and Pakistan, Shri Azad stated that adopting a comprehensive strategy for Diseases Surveillance for Prevention and Control of Communicable Diseases is the need of the hour. It is of paramount importance to develop and put in place a comprehensive strategy for surveillance, early detection and response to such diseases and infections, he emphasised. Among the strategies discussed during the Health Ministers’ Conference include capacity building, effective response, laboratory support, information sharing, cross border collaboration, monitoring and research. 

Shri Azad stated that there are many examples of successful strategies and programs in the region in combating dreadful diseases. Directly Observed Treatment Short-course (DOTS) strategy originated from TB research in India and is now the global paradigm in TB prevention and control. The response to HIV/AIDS in India over the last decade has yielded encouraging outcomes in terms of prevention and control of HIV whereby the number of annual new HIV infections has declined by more than 50% during the last decade from 2.7 lakh new infections in 2000 to 1.2 lakh in 2009, he elaborated. Sri Lanka is an example of public health excellence in the region with health status indicators comparable with the best in the world. Bangladesh has set an example in dramatically reducing infant and maternal mortality in the face of most crippling circumstances. 

Shri Azad also invited attention of the gathering to the issue of non-communicable diseases that have emerged as the major threat to the health of our populations. Tobacco related cancers, chronic cardio-vascular diseases, hypertension and diabetes are significantly contributing to morbidity and mortality in the region. He said India’s experience in developing laboratory capabilities and a system of quality assurance could be of great assistance to the SAARC countries. “India would welcome requests from any country in training of manpower in the fields of epidemiology, disease surveillance, diagnostic tools and techniques and Information, Communication Technology applications” Shri Azad offered. 

Shri Azad also suggested the Health Ministers of the region should meet more often to deliberate upon a selected theme or subject of common interest and agree on an action plan. “This should be followed up by interactions and workshops at the level of officials and technical experts 2-3 times a year on sharing of best practices, technological applications and innovations, and cross-border collaborations. In this regard, it is my privilege to state that India volunteers to host the next meeting of SAARC Health Ministers” Shri Azad said. 

Twenty Seven years ago SAARC was born with the objective of fostering joint action and cooperation in solving common problems, furthering regional interests and fulfilling the aspirations of the peoples of South Asia with the conviction that regional cooperation among the countries of South Asia is mutually beneficial, desirable and necessary for improving the quality of life of the peoples of the region. 

No Cause for panic about Pandemic Influenza A H1N1

The situation with respect to instances of H1N1 is well under control and is being monitored. As reported in some section of the press, the virus has not mutated to a more virulent form or changed its character. Director, National Institute of Virology, Pune has clarified that the presently circulating strain of H1N1 pandemic virus belongs to clade 6 and 7. (Clade is the medical terminology used to describe related organisms descended from a common ancestor). These clades are circulating in many countries. All are treatable with Oseltamivir (an antiviral drug which slows the spread of influenza (flu) virus). The currently available vaccine can be used, as antigenic (antigen is a substance that when introduced into the body stimulates the production of an antibody. Antigens include toxins, bacteria, foreign blood cells, and the cells of transplanted organs) differences are not significant. There is no mutation to suggest change of virus to 'dangerous form'. 

World Health Organisation while declaring the Pandemic to be over in August 2010, had conveyed that the influenza H1N1 pandemic virus would take on the behaviour of seasonal influenza virus and continue to circulate for some years to come. Hence, in the post-pandemic period, localized outbreaks of varying magnitude with significant level of H1N1 transmission are expected.Subsequent to this declaration, our country had experienced major outbreaks during the period August to October, 2010 and again from May, 2011 to July 2011. Now, in March-April, 2012, there is increased number of cases of Pandemic Influenza A H1N1 reported from the State of Andhra Pradesh, Maharashtra, Rajasthan, Karnataka and Tamil Nadu. Small pockets of population who remained unexposed to the pandemic and susceptible would be affected. In first week of March almost 30% of referred samples were positive for H1N1 in Pune which has come down to approx. 10% now. 

A large number of these cases would be presenting with mild influenza like illness and as such requires no testing or anti viral drug treatment. However, it is important to get oneself examined at the nearest hospital in the initial part of illness to detect moderate illness and other associated risk factors/ diseases that require hospitalization. The anti viral drug Oseltamivir is available free of cost through the State public health system. They are also available with retail chemists licensed to keep Schedule X drugs. A central stockpile of about 8 million doses of Oseltamivir is also maintained. As the virus is circulating with in the country, there is no need to impose any travel restrictions or screening at inter-state point of entry, railway stations etc. 

National Safe Motherhood Day Observed

“Ensuring quality services for safe motherhood” is the theme for 2012 National Safe Motherhood Day. Launching the celebrations from Jaipur today, the Minister of State for Health and Family Welfare Shri Sudip Bandyopadhyay said women are strong pillars of any vibrant society. “Sustained development of the country can be achieved only if we take holistic care of our women and children. Maternal and child mortality and morbidity indicators reflect not only how well the health system is functioning, but also the degree of equity in public service delivery, utilisation of services, the social status of women and our concern for children”, observed the Minister. 

In India, over the last decade there has been a considerable decline in MMR, IMR and TFR. However, Regional disparities are considerable and an extra impetus needs to be given to the efforts to accelerate the pace of decline in these indicators in many states, cautioned Shri Bandyopadhyay.

Over the last few decades, the country has taken many initiatives and made progress. With the implementation of schemes like Janani Suraksha Yojana by Government of India we have been able to bring the women in the institutional fold. Government of India has also taken several policy decisions to improve quality in service delivery, the Minister elaborated. Auxiliary Nurse Midwives (ANMs), Staff nurses (SNs) and Lady health visitors (LHVs) are being trained as skilled birth attendants, MBBS doctors are being trained in Essential life saving obstetric and anaesthetic skills, various types of equipments are being provided to the States, Infrastructure of the health facilities are being strengthened and new constructions are being sanctioned wherever the same is not available. “We have also launched Janani Shishu Suraksha Karyakaram (JSSK) entitling every pregnant women delivering at govt health facilities free drugs, free diagnostics, free diet , free delivery and Caesarean Section, free to and fro transportation. Similar facilities have been given to all sick neonates upto one month”, said the Minister while releasing the publicity material at the function held today during the Consultation Commemorating National Safe Motherhood Day. The Minister also gave away Health Workers Awards to best performing ANMs, ASHAs, etc. Shri Bandyopadhyay also flagged off the Hamari Beti Express alongwith Shri A A Khan, State Health Minister, Government of Rajasthan, on the occasion. The Minister hoped that deliberations during the day and way forward as deliberated would help us in not only understanding barriers in provision of quality care but also charting out a road map for future. 11th April, which is the birth anniversary of Smt Kasturba Gandhi, is being celebrated every year as National Safe Motherhood Day from 2003 onwards. On this day celebration are organized throughout the country involving different stake holders to sensitize the people, media, health professionals and health institutions about safe motherhood.