“Discover how India successfully implemented the National Mental Health Program (NMHP) and Yaws Eradication Program (YEP), transforming public health with community-based strategies.”

National Mental Health Program (NMHP) and Yaws Eradication Program (YEP) are two of India’s most impactful public health initiatives, addressing the mental health burden and eradicating a debilitating skin infection, respectively.

National Mental Health Program (NMHP)

Introduction:

• Launch Year: 1982
• Purpose: Tackle the significant burden of mental disorders in India.

Important Milestones:

• 1996: Introduction of the District Mental Health Program (DMHP).
• 2003: Program re-strategized with two new schemes:
  1. Modernization of state mental hospitals.
  2. Upgradation of psychiatric wings in medical colleges and general hospitals.
• 2009: Inclusion of Manpower Development Schemes (Scheme-A and B).

Objectives:

1. Guarantee accessible and basic mental health care for all.
2. Integrate mental health knowledge into general health care and social development.
3. Promote community participation and enhance human resources in mental health sub-specialties.

Components:

1. District Mental Health Program (DMHP):
   • Provides basic mental health services at the community level.
   • Operating in 241 districts, with plans to expand nationwide.
   • Financial support: ₹83.2 lakhs per district.
   • Staffing includes psychiatrists, clinical psychologists, psychiatric nurses, and others.

Outreach Services:

• Satellite clinics at CHCs/PHCs.
• Target interventions: Life skills education, stress management, suicide prevention.
• Training for health personnel and awareness camps.
• Community participation with NGOs, self-help groups, and caregivers.
• Legal sensitization for enforcement officials.

Public-Private Partnership (PPP) Model:

• Collaboration with NGOs for mental health activities.
• Financial support: ₹5 lakhs per NGO.

Day Care Centers:

• Offer rehabilitation and recovery services.
• Financial support: ₹50,000 per center per month (₹6 lakhs/year).

Residential/Long-term Continuing Care Centers:

• For chronically mentally ill individuals unable to return to their families.
• Financial support: ₹75,000 per center per month (₹9 lakhs/year).

Mental Health Care at Community Health Centers (CHCs):

• Outpatient and inpatient services for emergency psychiatry patients.
• Counseling services available.
• Staffing: Medical officer and clinical psychologist or psychiatric social worker.

Mental Health Services at Primary Health Centers (PHCs):

• Outpatient services and counseling for social care benefits.
• Mental health promotion and proactive case finding.
• Staffing: Two community health workers.

1. Mental Health Services at Medical Colleges/Teaching Hospitals:
   • Supervised by the head of the psychiatry department.
   • Financial support: ₹15 lakhs per year.

Thrust Areas of Mental Health Services:

• Strengthening and modernizing mental health hospitals.
• Upgrading psychiatric wings in medical colleges.
• Improving psychiatric curriculum and promoting research in community mental health.

Yaws Eradication Program (YEP)

Introduction:

• Yaws: A disfiguring and disabling non-venereal skin infection caused by Treponema pallidum subspecies pertenue.
• WHO Criteria: Set for the eradication of yaws in 1960.

Program Launch:

• Year: 1996-97
• Location: Initiated in Koraput district, Orissa.
• Expansion: During the 9th Plan period, the program expanded to 10 endemic states. These states are Andhra Pradesh, Orissa, Maharashtra, Madhya Pradesh, Chhattisgarh, Tamil Nadu, Uttar Pradesh, Jharkhand, Assam, and Gujarat.

Program Strategies:

1. Manpower Development: Training and deployment of health workers.
2. Detection: Active case search to recognize yaws cases.
3. Treatment: Concurrent treatment of detected cases and their contacts using benzathine penicillin (single dose).
4. Health Education: Multisectoral approach to educate the public on yaws prevention and treatment.

Achievements:

• Case Reduction: Reported cases in the 10 endemic states reduced from 3,500 in 1996 to 46 in 2003.
• Elimination: No new yaws cases reported after November 2003.
• Formal Declaration: India declared yaws-free on 19th September 2006.

Global Context:

• WHO Target: Eradicate yaws globally by 2020.
• International Verification: In October 2015, WHO’s International Verification Team visited five yaws-endemic states in India. After their assessment, WHO recommended issuing a “Certificate of Eradication of Yaws” to India.

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COURSES

GNM

BSC NURSING

Read more: “National Mental Health Program (NMHP) and Yaws Eradication Program (YEP): A Comprehensive Success Story”

Explore how NPCDCS tackles cancer in India through prevention, early diagnosis, and treatment, with a focus on strengthening healthcare infrastructure and tobacco control.

Introduction: NPCDCS (National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke) was initiated to address the rising burden of noncommunicable diseases in India. Cancer, a significant global health issue, is a major focus of this program. NPCDCS integrates efforts to prevent, diagnose early, and manage cancer effectively across the country.

Introduction NPCDCS:

• NPCDCS was initiated. This was in response to the growing burden of noncommunicable diseases (NCDs) like diabetes, cardiovascular diseases, and stroke in India.
• Focus: Health promotion, disease prevention, strengthening healthcare infrastructure, early diagnosis, and management of NCDs.

Objectives:

1. Prevention & Control: Implement behavior and lifestyle changes to reduce common NCDs.
2. Early Diagnosis: Offer early detection and management of NCDs.
3. Capacity Building: Strengthen healthcare systems at various levels to manage NCDs.
4. Training: Educate doctors, paramedics, and nurses to handle the increasing NCD burden.
5. Palliative Care: Develop capacity for palliative and rehabilitative care.

Strategies:

1. Behavioral Modification: Promote healthy lifestyles, including physical activity, healthy diet, and avoiding tobacco and alcohol.
2. Early Diagnosis & Treatment: Enhance early detection and prompt management of NCDs.
3. Human Resource Training: Strengthen and train healthcare professionals.
4. Surveillance & Evaluation: Implement monitoring and evaluation mechanisms.

Implementation:

• The program will be rolled out in 20,000 sub-centers. It will also be implemented in 700 community health centers (CHCs). These will be spread across 100 districts in 21 States/UTs.

Significance:

• With NCDs causing a significant part of deaths, NPCDCS aims to mitigate the rising tide of these diseases in India.

Activities at Various Healthcare Levels

Subcenter Activities:

1. Health Promotion:
   • Organize health camps on NCDs.
   • Conduct individual, group, and mass education using audiovisual aids.
2. Opportunistic Screening:
   • Screen individuals aged 30+ for blood pressure and blood glucose levels using strip techniques.
3. Referral System:
   • Refer suspected cases to higher healthcare facilities like Community Health Centers (CHCs).

Community Health Center (CHC) Activities:

1. Diagnostic Services:
   • Conduct blood sugar tests, lipid profiles, ultrasounds, X-rays, and ECGs.
2. Management of Complications:
   • Resolve complications related to cardiovascular diseases (CVD), diabetes, and stroke.
3. Referral of Complicated Cases:
   • Refer complex cases to district hospitals.
4. Home Visits:
   • Staff nurses visit bedridden patients to assess care provided by health workers.

District Hospital Activities:

1. Screening:
   • Screen individuals aged 30+ at risk of diabetes, hypertension, and cardiovascular diseases.
2. Detailed Investigations:
   • Conduct in-depth investigations for at-risk individuals.
3. Patient Management:
   • Offer regular management for patients with cancer, diabetes, hypertension, and cardiovascular diseases.
4. Palliative Care:
   • Offer home-based palliative care for chronic patients.
5. Health Education:
   • Engage in health education and promotion activities.

Urban Health Scheme for Diabetes and Hypertension:

1. Slum Population Screening:
   • Screen slum residents for diabetes and hypertension.
   • Assess blood pressure and blood sugar for all individuals aged 30+.
2. Data Collection:
   • Create a statistical database for slum areas.
3. Lifestyle Promotion:
   • Promote healthy lifestyles within the community.
4. Monitoring and Control:
   • The NCD cell at the center will supervise control activities effectively.

Cancer Prevention and Control Components under NPCDCS

Introduction:

• Cancer is a significant global health issue, with an estimated 2-8 million cases at any given time in India.
• The National Cancer Control Program (NCCP) began in 1975-76, focusing on prevention, early diagnosis, and treatment. It was revised in 1984-85 and 2004, and integrated into the NPCDCS in 2010.

Key Components:

1. Regional Centers:
   • Strengthened to act as effective referral centers for cancer care.
2. Oncology Wing Development Scheme:
   • Oncology wings established in hospitals with ₹3 crores of central assistance for accessible cancer treatment.

Objectives of Cancer Control:

1. Primary Prevention:
   • Health education to prevent cancer, focusing on lifestyle changes and awareness.
2. Secondary Prevention:
   • Early detection and diagnosis of common cancers (breast, cervix, mouth) through self-examination and screening.
3. Tertiary Prevention:
   • Strengthening healthcare services for advanced cancer care.

Decentralized NGO Scheme:

• IEC Activities: NGOs are supported in conducting Information, Education, and Communication (IEC) activities on cancer awareness.

IEC Activities at Central Level:

• Focuses on publicizing anti-tobacco legislation, like the harmful effects of smoking.

Research and Training:

• Manuals developed for district-level capacity building in health professions, cytology, palliative care, and tobacco cessation.

Cancer Control Services Under NPCDCS:

• Diagnosis, surgeries, chemotherapy, and palliative care are provided in 100 district hospitals.
• Financial support of ₹1.66 crore/year per district for:
  • Chemotherapy drugs for 100 patients.
  • Day care chemotherapy services.
  • Facilities for cancer investigations (e.g., mammography).
  • Home-based palliative care for cancer patients.
  • Contractual manpower support, including medical oncologists, cytopathologists, technicians, and nurses.

Strengthening Tertiary Care Centers:

• 45 tertiary care centers were upgraded for comprehensive cancer services with an investment of ₹26 crores in 2011-12.

Tobacco Control Legislation:

The Cigarettes and Other Tobacco Products Act (COTPA), 2003:

• Prohibits smoking in public places.
• Bans direct and indirect tobacco advertisements.
• Prohibits sale of tobacco products to individuals under 18 years old.
• Bans sale of tobacco products near educational institutions.
• Requires statutory warnings and depiction of tar/nicotine content on tobacco packs.
• Allows smoking areas in specific places like large hotels, restaurants, and airports.

Implementation:

• Smoking in public places was banned on October 2, 2008, with mandatory smoke-free signage.
• Health warnings on tobacco products became mandatory from March 31, 2009.

National Tobacco Control Program:

• Launched in 2007-08 under the 11th Five Year Plan, as part of WHO’s Framework Convention on Tobacco Control (FCTC).
• Objectives:
  • Raise public awareness through mass media for behavior change.
  • Set up tobacco testing labs and regulatory capacities.
  • Integrate tobacco control with the National Rural Health Mission (NRHM).
  • Promote research and training on different crops and livelihoods.
  • Implement surveillance like the Global Adult Tobacco Survey (GATS).
  • Set up tobacco control cells for anti-tobacco initiatives.
  • Incorporate tobacco cessation programs into school health initiatives.

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COURSE

GNM

BSC NURSING

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