Chapter - 13: Health And Family Welfare

• 04 Nov 2024

Introduction 

• The Ministry of Health and Family Welfare (MoHFW) 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. 
• It also guides the states towards implementing health programmes, 
• medical education, regulation (drugs and devices) and health infrastructure. 
• The Ministry has two departments namely the Department of Health & Family Welfare and the Department of Health Research. 
• The Ministry of AYUSH is responsible for the development of education and research in Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy systems. Further, technical advice on all medical and public health matters is made through the Directorate General of Health Services (DGHS), an attached office under MoHFW.

Management of Covid-19 

• India's National Covid-19 vaccination programme was launched in 2021. 
• Achievements during its journey of more than 2 years: 
  • Administration of 1.03 crore beneficiaries on a singular day. 
  • Administration of 1.33 crore beneficiaries on a singular day. 
  • Administration of more than 2.5 crore beneficiaries on a singular day. 
• By September 2023: 
  • Total vaccine doses administered across the country: 220.67 crores. 
  • First dose administered: 102.58 crore, which accounts for 97 percent of the eligible population aged 12 years and above. 
  • Second dose administered: 95.21 crore, which accounts for 90 percent of the eligible population aged 12 years and above. 
  • Precaution doses administered: 22.88 crore 

Initiatives, Policies and Schemes 

National Health Mission (NHM) 

• Goal: Increase funding in the healthcare sector to at least 2% of the GDP. 
• The National Health Mission (NHM) includes: 
  • National Rural Health Mission (NRHM): Launched and approved in 2005. 
  • National Urban Health Mission (NUHM): Launched and approved in 2013. 
• Objective: Achieve universal access to: 
  • Equitable, affordable, and quality healthcare services. 
  • Services that are accountable and responsive to people’s needs. 
• Focus Areas to Strengthen Healthcare System: 
  • Reproductive-Maternal-Neonatal-Child and Adolescent Health (RMNCH+A) interventions. 
  • Control of communicable and non-communicable diseases. 

Mission Indradhanush (MI) 

• Launched in 2014. 
• Objective: Achieve 90% full immunization coverage. 
• Target Group: Unvaccinated and partially vaccinated pregnant women and children. 
• Focus Areas: Areas with low immunization rates and hard-to-reach areas. 
• Intensification: Renamed to 'Intensified Mission Indradhanush (IMI)'. 
  • Aim: Expedite the achievement of 90% full immunization coverage. 
  • Special emphasis on urban areas and inter-ministerial coordination. 
• Phases: Eleven phases have been conducted since inception. 
• Achievements: Vaccinated 4 crore children and 1.12 crore pregnant women in 701 districts. 
• During COVID-19 Pandemic: 
  • Rounds: Two rounds were conducted (IMI 3.0 and 4.0). 
  • Objective: Rapidly vaccinate remaining and newly eligible children and pregnant women. 
• IMI 5.0: 
  • Phases: Three phases nationwide. 
  • Goal: Eliminate measles and rubella from the country. 
• Status (By September): 
  • Children Vaccinated: 5.06 crore. 
  • Pregnant Women Vaccinated: 1.26 crore 

Rashtriya Bal Swasthya Karyakram 

• Launched in 2014. 
• Objective: Provide Child Health Screening and Early Intervention Services 
• Focus Areas: 
  • Early detection and management of health issues 
• Four Ds Addressed: 
  • Defects at birth                  
  • Diseases 
  • Deficiencies 
  • Development delays including disability 
• Health Conditions Managed: 
  • 32 identified health conditions 
• Service Provision: 
  • Includes free surgery at tertiary health facilities 
• Coverage: 
  • Target Age Group: 0-18 years 
  • Implementation: Phased rollout across the country 

Rashtriya Kishor Swasthya Karyakram 

• Launched in 2014. 
• Objective: Provide information, commodities, and services for adolescents' diverse needs. 
• Purpose: Prevent iron and folic acid deficiency 
• Target Group: 
  • In-school boys and girls 
  • Out-of-school girls 
• Implementation: 
  • Nationwide coverage 
  • Rural and urban areas 
• Coverage Locations: 
  • Government schools 
  • Government-aided schools 
  • Anganwadi centres 

Mother's Absolute Affection (MAA) Program 

• Aim: Bring undiluted focus on: 
  • Promotion of breastfeeding. 
  • Enhancement of infant and young child feeding practices. 
• Goal of the MAA programme: 
  • Revitalize efforts towards protection and support of breastfeeding practices. 
  • Enhance breastfeeding rates through health systems. 
• Key components of the programme include: 
  • Awareness generation. 
  • Promotion of breastfeeding. 
  • Interpersonal counseling at the community level. 
  • Skilled support for breastfeeding at delivery points. 
  • Monitoring and award/recognition 

Janani Shishu Suraksha Karyakram (JSSK) 

• Coverage: Pregnant women and sick infants up to 1 year 
• Benefits: 
  • Free services, drugs, diagnostic services 
  • Blood transfusion, diet, and transport 
• Objective: No out-of-pocket expenditure for beneficiaries 

Janani Shishu Suraksha Karyakram (JSSK) 

• Coverage: Pregnant women and sick infants up to 1 year. 
• Offerings: 
  • Free services, drugs, and consumables 
  • Diagnostic services 
  • Hospital diet 
  • Transport 
• Beneficiaries (Till August 2023): 12.97 crores 

Surakshit Matritva Aashwasan (SUMAN) 

• Objective: Assured, dignified, and quality healthcare 
• Coverage: Every woman and newborn at public health facilities 
• Goal: Zero preventable maternal and newborn deaths. 

Ayushman Bharat Digital Mission (ABDM) 

• Foundation: 
  • Built upon the Jan Dhan, Aadhaar, and Mobile (JAM) trinity 
  • Launched in 2021. 
• Objective: 
  • Create a seamless online platform for a wide range of data, information, and infrastructure services 
• Features: 
  • Standards-based digital systems 
  • Ensuring confidentiality and privacy of health-related personal information 
• Longitudinal Health Records: 
  • Enable access and exchange with consent 
• Health ID: 
  • Acts as a health account for individuals 
  • Linked to personal health records 
  • Accessible and viewable via mobile application 
• Healthcare Registries: 
  • Health Professionals Registry (HPR) 
  • Healthcare Facilities Registry (HFR) 
  • Repository of all healthcare providers across various systems of medicine 
• Benefit: 
  • Ensures ease of doing business for healthcare service providers

Pradhan Mantri Garib Kalyan Package Insurance Scheme

• To support the states/UTs under the Whole of Government approach, the central government extended the Pradhan Mantri Garib Kalyan Package (PMGKP) Insurance Scheme for health workers fighting Covid-19 
• The scheme was launched in March 2020, initially for 90 days to provide comprehensive personal accident cover of `50 lakh to all healthcare providers. 
• The scheme is implemented through the insurance policy of New India Assurance Company. 
• To simplify and streamline the insurance claim process, a new system of approval for claims was put in place. 
• Based on this certificate, the insurance company will settle the claims within 48 hours.

National Tuberculosis Elimination Programme (NTEP) 

• Objective: 
  • Centrally-Sponsored programme to prevent and control Tuberculosis (TB) 
  • Aim for a rapid decline in TB burden, morbidity, and mortality 
• Target: 
  • Aim towards ending TB in India by 2025 
• Services Provided: 
  • Free diagnostics 
  • Quality-assured drugs 
• Financial Assistance: 
  • ₹500 per month provided during the course of treatment for all TB patients 
• Infrastructure: 
  • 24,027 microscopy centres  

TB Mukt Bharat Abhiyaan (TMBA) was launched to further build awareness about TB, address the deep-seated stigma around the disease in the community, raise awareness, and generate demand for TB diagnostic and treatment services. 

National Policy for Rare Diseases (NPRD) 2021 

• Launched in 2021. 
• Objective: 
  • Treatment of rare disease patients 
• Identification: 
  • Diseases categorized into 3 groups 
• Financial Support: 
  • Up to ₹50 lakhs for patients with certain rare diseases 
• Treatment Coverage: 
  • Covers diseases and treatments listed in the policy 

Digital Portal for Rare Diseases 

• Website: 
  • https://rarediseases.nhp.gov.in 
• Features: 
  • Provides information and aids in the treatment of patients suffering from rare diseases 

Mental Healthcare 

• National Mental Health Programme (NMHP): 
  • Implemented by the government to address mental illnesses. 
• District Mental Health Programme: 
  • Approved for 692 districts of the country 
  • Focuses on early detection and management of mental disorders. 
• Addressing the Shortage of Mental Health Professionals: 
  • Development schemes implemented for the establishment of Centers of Excellence. 
  • Strengthening/establishment of Post Graduate (PG) Departments in mental health specialties. 
• Mental Healthcare Act, 2017: 
  • Provides for mental healthcare and services for persons with mental illness 
  • Aims to protect, promote, and fulfill the rights of such persons during the delivery of services

Achievements    

• Malaria 
  • Achievements (2015-2022): 
    • Reduction of 85% in malaria morbidity 
    • Reduction of 78.38% in malaria mortality 
  • 2023 Statistics (till July-provisionally): 
    • 31.1% increase in malaria cases 
    • 50% decrease in malaria deaths compared to 2022 
• Kala-azar 
  • 2022 (P) Achievements: 
    • 99.84% (632 out of 633 blocks) achieved the elimination target of ≤1 KA case/10,000 population 
  • 2023 Statistics (up to July): 
    • No block reported >1 case per 10,000 population 
    • 379 Kala-azar cases and 225 post-Kala-azar Dermal Leishmaniasis (PKDL) cases were reported. 
• Lymphatic Filariasis (LF) 
  • Achievements (till August 2023): 
    • 136 out of 339 LF endemic districts achieved microfilaria rate ≤1% verified by Transmission Assessment Survey (TAS-I) and stopped Mass Drug Administration (MDA) 
• Dengue and Chikungunya 
  • Case Fatality Rate (CFR) Achievements: 
    • Sustained at 0.1% as per national target due to better case management 
    • Decrease from 0.3% in 2014 to 0.1% in 2022 and 2023 (prov. till August 2023) 

Medical Education 

National Medical Commission Bill, 2019 

• Purpose: 
  • Establish a National Commission 
  • Repeals the Indian Medical Council Act, 1936 
• Aim: 
  • Improve access to affordable medical education 
  • Ensure the availability of quality medical professionals nationwide 
  • Promote universal healthcare with a community health perspective 
  • Make medical professionals accessible to all citizens 
• Formation: 
  • National Medical Commission was constituted in 2020.

National Nursing and Midwifery Commission Act, 2023

• Purpose: 
  • Introduce transformative changes in nursing education and practice in India. 
• Key Features: 
  • Sets standards in nursing education and services. 
  • Enhances professional accountability, transparency, and quality. 
• Commission Structure: 
  • Establishes National and State Commissions with autonomy. 
  • Introduces fixed tenures for members and chairpersons to ensure consistency and accountability. 
• Education and Skills: 
  • Emphasizes uniform admission criteria. 
  • Focuses on the maintenance and development of soft skills among registered professionals.

Research Institution 

Indian Council of Medical Research 

•  The Indian Council of Medical Research (ICMR) was established in 1911 as the Indian Research Fund Association (IRFA). 
•  It is an apex and a premier medical research organization in the country, working 
• towards public health concerns, including nutrition, reproduction, and maternal and 
• child health, occupational and environmental health, and health systems research. 
•  The 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. 
• The ICMR does research collaborates across the globe and partners with leading 
• institutions to fight leading health issues, infectious diseases, and vaccine development. 
•  ICMR has been at the forefront in the fight against Coronavirus since its beginning in 
• Wuhan, Hubei province of China (December 2019) and detection of first case in Kerala in India (January 2020).

Regulators

The Food Safety and Standards Authority of India (FSSAI) 

• Established in 2008, under the Food Safety and Standards (FSS) Act, 2006 to regulate standards for food articles, their manufacture, storage, distribution, sale and import to ensure the availability of safe and wholesome food for human consumption and matters connected to it. 

Drugs and Cosmetics Act, 1940 & Rules, 1945 

• 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 Act. 
• 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 new introduction is exercised by the central government through the Central Drug Standard Control Organization (CDSCO). 

Ayush Systems of Healthcare 

• The Ministry of AYUSH was formed in 2014 to ensure the optimal development and 
• propagation of AYUSH systems of health care. 
•  AYUSH group of health care systems includes: 
  • Ayurveda 
  • Yoga 
  • Naturopathy 
  • Unani 
  • Siddha 
  • Homeopathy 
  • Sowa-Rigpa
• 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 up to 50 bedded integrated AYUSH hospitals. 
• The Ministry of Ayush has a Drug Control Cell to look after and co-ordinate matters related to Ayurvedic, Siddha, Unani, and Homeopathy (ASU&H) drugs. 
• The Central Council of Indian Medicine (CCIM) is the statutory body constituted under the Indian Medicine Central Council Act, of 1970 which lays down the standards of medical education in Ayurveda, Siddha, and Unani through its various regulations. 
• Similarly, homoeopathy medical education is being regulated by the Central Council of Homoeopathy (CCH) through its various regulations under the Homoeopathy Central Council Act, 1973. 
• Sowa-Rigpa is effective in managing chronic diseases like asthma, bronchitis, arthritis, etc. 
• It has been in vogue and practised in the Himalayan region throughout particularly in Leh & Ladakh, Himachal Pradesh, Arunachal Pradesh, Sikkim, Darjeeling etc. 
• Sowa-Rigpa emphasizes the importance of the five cosmological physical elements in the formation of the human body, the nature of disorders, and the remedial measures.