A final solution is expected from an AIDS vaccine. A number of theoretical approaches are being tested. On the one hand attempts are being made to find a vaccine that prevents infection itself, while on the other hand a vaccine that is administered to persons who are already infected and that influences the course of the infection in the good sense would be very useful. As AIDS vaccines are at present still in an experimental stage, prevention and control of the infection should be concentrated on three levels: sexual transmission, prevention of transmission via contaminated blood or needles, and mother-to-child transmission.

Information for the general population and for particular risk groups, counselling of seropositive persons, condom distribution (prostitutes), promotion of use and availability of condoms, counselling prostitutes, detection and treatment of other sexually transmitted diseases (STDs). In a number of countries it is the custom that after the death of the husband, the wife marries a brother or another member of the deceased’s family. This of course promotes transmission. In many countries the condom is still a very sensitive topic (taboo in public debates or even in private conversations within couples or family). One of the first actions to be taken in the campaign against AIDS in Thailand was the demystifying of the condom by all kinds of educational and promotional campaigns. In contrast to what is sometimes said, the promotion of condom use in tropical countries is not a hopeless task. It is being investigated whether a virocidal cream applied to the vagina offers some protection (so that women no longer have to depend on the good-will of their male partners). Circumcision of the man brings about a 2.5-fold decrease in the risk of HIV transmission from woman to man. It must be emphasised that circumcision does not give absolute protection.

Screening of blood for transfusion, limitation of blood transfusions and injections, strict sterilization of needles, syringes, etc. The intravenous drug abuse problem does not have the same proportions in Africa as it does in developed countries, though it is quite substantial in Southeast Asia. Medical personnel should avoid accidental contact with blood by wearing gloves, by not recapping needles, by putting needles immediately after use into containers with large openings, and by wearing protective clothing, masks, gloves and glasses when assisting childbirth. Hands should be washed with soap and water after contact with body fluids. Correct techniques should (of course!) be used in surgical operations. For example, during a surgical operation the handing over of a sharp instrument such as a scalpel should take place not from hand to hand, but the instrument should first be laid down, after which the next person picks it up. Making sterile needles and syringes available to drug users, as well as methadone projects, have proved useful.

Not all children born to seropositive mothers will be infected. Why some children are infected and others are not is a topic of intensive research. Seropositive women are advised to avoid conception. However, there are many women or married couples who do want a child to symbolically overcome death via their progeny. Breast-feeding should be discouraged if there is an alternative, though the latter is often not the case. Perinatal administration of Retrovir® definitely lowers the risk of transmission. In an American-European study in which Retrovir® was given IV to the mother throughout the third trimester of pregnancy and during childbirth and to the child for 4 weeks a decrease in transmission from 22% to 8% was observed. Shorter schemes with Retrovir® are also effective. Retrovir® appears to be tolerated very well by babies, with only minimal side-effects. In Third World countries Retrovir® will often be beyond the scope of many patients. Perinatal transmission can be reduced by 50% by a single administration of 200 mg nevirapine (Viramune®) to the mother during childbirth and by one dose (2 mg/kg) to the baby within the first 3 days of life. This should be a cheap strategy in Third World countries for reducing intra-partum transmission and transfer via the early maternal milk. Elective Caesarean section carries a significantly lower risk of transmission (about 10%). The advantage of a Caesarean section diminishes when the amniochorionic membranes are broken and/or the mother is already in labour. Combining prophylactic Retrovir® with elective Caesarean section can reduce the risk of vertical transmission to about 2%. The possible place of HAART in this setting is still not clear. Episiotomy, internal monitoring (in any case a luxury), forceps and vacuum extraction are best avoided in vaginal childbirth. After birth, the child should be gently aspirated, the eyes and nose flushed and given a quick bath to remove all blood. Optimal nutrition with enough vitamin A before giving birth is advised (the possibly inhibitory effect of certain retinoids on HIV is being investigated).

First lets start off with a short historical overview.

• 1346  During the siege of Caffa, the Tartars catapulted bodies of comrades who’d died of the plague into the city. Fleeing residents brought the plague throughout Europe and this led to the second epidemic of Black Death in Europe.

• During the French and Indian War, the British general at Fort Pitt ordered smallpox infected blankets be given to the Delaware Indians.

• WWI  Germans infected cattle shipped from neutral countries to allies with anthrax.

• WWII  The Japanese killed as many as 10,000 people in experiments. They dropped bags full of plague-infected-fleas in inhabited Chinese cities and outbreaks occurred.

• Cold War  US and Russia had programs to develop bioweapons. In the Biological and Toxic Weapons Convention, they decided only to do defensive research, but this was only the beginning of research in the USSR. In Sverdlovsk, the accidental release of anthrax by a military base killed 70 people.

• Iraq had a program since 1985, as reported by a UNSCOM team, and they developed and stockpiled weapons.

• 1985  Salmonella was used to prevent citizens from voting in a local election. There were over 50 cases of food poisoning, and 45 people required hospitalization.

• 1995  Release of Sarin gas in a subway in Japan. The same group tried 10 times between 1993 and 1995 to spray anthrax in Tokyo. There were no fatalities because they used an avirulent strain and didn’t refine the particle size enough.

• Anthrax letters were mailed to Tom Brokaw and others. 22 got sick, 5 died. We don’t know who did it, but they must have had an ability to weaponize anthrax.

The CDC categorized different organisms with the potential to be weapons into two groups:

1. Group A High Priority, a risk to national security, easily disseminated and transmitted p2p, High mortality rates. Might cause public panic and socail disruption, and requires special action for public health prepaqredness, The category includes bacteria and viruses. Anthrax, Botulism, plague, smallpox, tularemia, viral hemorrhagic fevers.

2. Group B  moderately easy to disseminate, moderate morbidity rate, and lower mortality rate. Require enhancements of CDC’s diagnostic capabilities and enhanced disease surveillance. This category includes Brucellosis, Epsilon Toxin of C. perfringens, food safety threats like Salmonella and Shigella, water safety threats like V. cholera, C. psittscosis, Q fever, ricin toxin, Staph enterotoxin B, typhus fever, and viral encephalitis. The problem is you can’t tell the difference between deliberate poisonings and natural outbreaks.

Selection of ASHA

• Must be a resident of the village- a women married /widow/divorced

• Age group 25-45yrs

• With formal eduaction up to 8th class, having communication skills and leadership qualities.

• Norm for selection will be one ASHA for 1000 population .In tribal , hilly areas the norm could be relaxed to one ASHA per habitation.

At present one lakh ASHA’s have been selected and trained .

Role and Responsibility of ASHA

• ASHA will take steps to craete awareness and to provide information to the community on determinants of health such as nutrition, basic sanitation and hygiene practices, healthy living condition and information about existing health services.

• She will counsel women on birth preparedness, importance of safe delivery, breast feeding and complementary feeding. Immunization, contraception and prevention of STD/RTI and care of young child

• ASHA will mobilise and facilitate them in accessing health and health related services availableat the anganwadi/sub-centre/PHC such as immunization, ante-natal checkup, post-natal checkup, supplementary nutrition and sanitation.

• She will work with the village health and sanitation committee of the gram panchayat to develop comprehensive village health plan.

• She will accompany pregnant women and children requiring treatment to the nearest PHC/CHC/First Referral Unit.

• ASHA will provide primary medical care for minor ailments such as diarrhoea, fever, and first aid for minor injuries.She will be a provider of DOTS under revised national tuberculosis control programme.

• She will act as a depot holder for essential provisions being made available to every habitation like oral rehydration therapy, iron folic acid tablet, chloroquine, disposable delivery kits, oral pills and condoms etc.Adrug kit will be provided to each ASHA.

• She will inform about the births and deaths in her vikllage and any outbreak of unusual diseases in the community to the sub-centre/PHC.

• She will promote construction of household toilets under total sanitation campaign.

Role and integration of ASHA with Anganwadi

Anganwadi worker will guide ASHA in performing the following activities:-

• Organising Health Day once/twice a month.

• AWWs and ANMs will act as a resource for the training of of ASHA.

• IEC activity through display of posters, folk dance etc.to sensitize the beneficiaries on health related issues.

• Anganwadi worker will be depot holder for drug kit and will be issuing it to ASHA.

• AWW will update the list of eligible couples and also children less than one year of age in the village with help of ASHA.

• ASHA will support the AWW in mobilising pregnant and lactating women and infants for nutrition supplement.

Role and integration of ASHA with ANM

Auxillary Nurse Midwife (ANM) will guide ASHA in performing activities:-

• She will hold weekly/ fortnightly meeting with ASHA and discuss the activities during the week.

• AWWs and ANMs will as a resource for the training of of ASHA.

• ANMs will inform ASHA regarding the date and time of outreach sesion.

• She will take help of ASHA in updating eligible couple register

• She will utilise ASHA in motivating pregnant women for coming to sub-centre for initial check ups.

• ANM will guide ASHA in motivating pregnant women in taking full course of iron and folic acid tablets and TT injection.

• ANM will orient ASHA on the dose schedule and side effects of oral pills.

• ANMs will educate ASHA on danger signs of pregnancy and labour so that she can timely identify and help beneficiary in getting further treatment.

• ANMs willinform ASHA on date, time and place for initial and periodic training schedule.

Monitoring and evaluation of ASHA’s work

Governmemt of India has set up following indicators for monitoring ASHA.

1. Process Indicators

• Number of ASHAs selected by due process

• Number of ASHAs trained

• % of ASHAs attending review meeting after one year

2. Outcome Indiactors:

• % of newborn who were weighed and families counseled

• % of children with diarrhoea who received ORS.

• % of deliveries with skilled assistance

• % of institutional deliveries

• % of JSY claims made to ASHA.

• % of of completely immunized in 12-23 months of age group

• % of unmet need for spacing contraception among BPL

• % of fever cases who received chloroquine within first week in a malaria detcted area.

3. Impact Indicators:

• IMR

• Child malnutritionrates

• Number of cases of TB /Leprosy detected as compared to previous year.

CONCLUSION

The Mission adopts a synergic approach by relating health to the determinants of good health viz. of nutrition, sanitation, hygiene and safe drinking water. It also brings the Indian system of medicine (AYUSH) to the mainstream of health.

BIBLIOGRAPHY

1. Park K, Preventive and Social Medicine.19ed.Jabalpur.Bhanot; 2007

2.Gupta Piyush, Ghai OP,Preventive and social medicine.2nd ed

Family planning as an official programme was adopted in 1952 as it was recognized that a rapidly growing population would be a more of a hindrance than help in raising the standard of living of the people.During the First and Second Five Year Plans (1951-1961), the programme was taken in amodest way with a clinical approach. The programme was recognised in the Third Plan after the publication of 1961 Census results which showed a higher growth rate than anticipated. The cliniacl approach was supplemented by extension approach under which the message, services and supplies of contraceptives were taken to the people.

In1966, a full-fledged Department of Family Planning was created. During the three Annual Plans (1966-69), the family planning programme, which was descibed as the “kingpin” of the Plan, was made the time bound and target oriented with vastly increasing funds. In the Fourth Plan, the programme was given the highest priority. The approch during this Plan aws to integrate increasingly family welfare services with those for health, maternal and child care and nutrition.The family welfare workers were converted into multipurpose workersto enable them to pay special attention to surveying to family welfare motivation and services.The Seventh Plan (1985-90) envisages new targets.

The country had adopted the long-term demographic goal of reducing the net reproduction rate to 1 by 2000 AD.

The National Family Welfare Programme has four components.

1. Administration and Organization which includes recruitment of staff, getting eqipment and supplies.

2. Training-Medical, paramedical and social workers in this field .

3. Social and Health

4. Supplies and Services.

The Centre provides 100% assistance to State Governments for dervice and educational purposes towards family planning

schemes. The central government controls the planning and financial management of the programmw, training, research and evaluation.

A Population Advisory Council headed by the Union Minister of Health and members of parliament and persons related to the field of population was set up in 1982. During the Second Plan period, family pkanning bureaus were established in every state at its headquaters with an Additional Director of Health Services and Family Planning to direct the programme.At the District level, since 1963, there are District Family Planning bureaus under the the charge of District Family Welfare Officers with facilities for publicity services, sterilization and the Intra Uterine Contraceptive application.

The District Family Welfare staff consists of

District Family Welfare Officer	1
Medical Officers	2
Extension educator	2
Information Officer	1
Statistician	1
Administrative Officer	1
Clerk/Ancillary staff	1

Urban family welfare centres are being reorganized and have established according to the population. At present there are 1499 urban family welfare centres in the country .In the rural areas, family planning programme has been integrated along with MCH service programme of the existing health care infrastructure i.e PHC.

CENTRAL

CENTRAL MINISTER OF HEALTH AND FAMILY WELFARE

SECRETARY OF HEALTH AND FAMILY WELFARE

DEPARTMENT OF FAMILY WELARE

SPECIAL SECRETARY

SECRETARIAL TECHNICAL WING WING

JOINT SECRETARY COMISSIONER

• Additional Secretary Policy Division

• Additional Secretary Aided Program Division

• Additional Secretary Plan Budget

• Additional Secretary Organized Opeartional media

• Field MCH , Media and Communication

• Additional Secretary Mass and Transport Division

• Additional Secretary Supply and Intelligence

2005-2012

Recognizing the importance of health in the proces of economic and social development and improving the quality of life of our citizens, the Government of India has launched the National Rural Health Mission to carry out necessary architectural correction in the basic health care delivery system. The program was launched on April 12, 2005 by the Prime Minister Dr. Mammohan Singh.

NRHM seeks to provide effective health care to rural poulation throughout the country wiyh special focus on 18 states, which have weak public health indicators or weak infrastructure. These 18 states of federal republic of india are following the suit by creating state level nissions underperson of respectve Chief Minister of the States.Geographically, Northern and Eastern States have more challenges on Human Development front.

DIRECTOR

Sri Chandra Mathur ,State Institute of Health and Family Welfare,Rajasthan

He is a public health specialist working for developing human resources for health .His current assignment involves him consistently in organizing in-service trainings for health professionals.

PREAMBLE

• Provision of a Health activist in each village –ASHA(Accredited Social Health Activist)

• Village Health plan prepared through panchayat implentation.

• Stregthening of Rural Hospital on IPHS.

• Integrating of Vertical Health and Family welfare.

GOALS

• Reduction of Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR) BY 50% from existing levels in next 7 years.

• Universal access to public health services such as women’s health, child’s health, water, sanitation and hygiene, immunization and nutrition.

• Prevention and control of communicable and non-communicable diseases,including

locally endemic diseases.

• Access to integrated comprehensive primary healthcare.

• Population stabilization, gender and demographic balance.

• Revitalize local health traditions and mainstream AYUSH.

• Promotion of healthy life styles.

GUIDING PRINCIPLES

• Promote Equity

• Enhance People orientation and community based approaches

• Ensure Public Health focus

• Recognize value of traditional knowledge base of commumication

• Decentralize and involve local bodies

STRATEGIES

I CORE STRATEGIES

• Promote acess to improved healthcare at household level through the female health activists (ASHA)

• Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own, control and manage public health services.

• Health Plan for each village through Village Health Committee of the panchayat .

• Stregthening sub-center through an united fund to enable local planning and action and more Multipurpose Workers(MPWs).

• Preparation and Implementation of an inter-sectoral District Health Plan prepared by the District Health Mission, including drinking water, sanitation & hygiene and nutrition.

• Stregthening existing PHCs and CHCs, and provision of 30-50 bedded CHC per lakh population for improved curative care to a normative standard.

• Integrating vertical Health and Family Welfare programs at National, State, Block, and District levels.

• Technical Support to National, State and District Health Missions, for Public Health Management.

• Stregthening capacities for data collection, assessment and review for evidence based planning, monitoring and supervision.

• Formulation of transparent policies for deployment and carer development of Human Resources for health.

• Developing capacities for preventive healthcare at all levels for promoting healthy lifestyles, reduction in consumption of tobacco and alcohol, etc

• Promoting non-profit sector particularly in under-reserved areas.

II SUPPLEMNTARY STRATEGIES

• Regulation of Private Sector including the informal rural practitioners to ensure availability of quality srvice to citizenz at reasonable cost.

• Promotion of Public Private Partnerships for achieving public health goals.

• Mainstreaming AYUSH –revitalizing local health traditions.

• Reorienting medical education to support rural health issues including regulation of Medical care and Medial Ethics.

• Effective and viable risk pooling and social health insurance to provide health security to the poor by ensuring accessible, affordable, accountable and good quality hospital care.

The mission plans to promote access to healthcare to rural households through a female health activist, ASHA. The main components are descibed below:-

COMPONENT 1: Accredition Social Health Activists (ASHA)

Every village wil have a female Accredited Socail Health Activists (ASHA) which is the refined version of community health worker, chosen by the panchayat .She will be trained on a pedagogy of public health developed and mentored through a Standing Mentoring Group at National level.She will be promoted all over the country , with special emphasis on the 18 high focus states.

Selection of ASHA

• Must be a resident of the village- a women married /widow/divorced

• Age group 25-45yrs

• With formal eduaction up to 8th class, having communication skills and leadership qualities.

• Norm for selection will be one ASHA for 1000 population .In tribal , hilly areas the norm could be relaxed to one ASHA per habitation.

At present one lakh ASHA’s have been selected and trained.

Role and Responsibility of ASHA

• ASHA will take steps to craete awareness and to provide information to the community on determinants of health such as nutrition, basic sanitation and hygiene practices, healthy living condition and information about existing health services.

• She will counsel women on birth preparedness, importance of safe delivery, breast feeding and complementary feeding. Immunization, contraception and prevention of STD/RTI and care of young child

• ASHA will mobilise and facilitate them in accessing health and health related services availableat the anganwadi/sub-centre/PHC such as immunization, ante-natal checkup, post-natal checkup, supplementary nutrition and sanitation.

• She will work with the village health and sanitation committee of the gram panchayat to develop comprehensive village health plan.

• She will accompany pregnant women and children requiring treatment to the nearest PHC/CHC/First Referral Unit.

• ASHA will provide primary medical care for minor ailments such as diarrhoea, fever, and first aid for minor injuries.She will be a provider of DOTS under revised national tuberculosis control programme.

• She will act as a depot holder for essential provisions being made available to every habitation like oral rehydration therapy, iron folic acid tablet, chloroquine, disposable delivery kits, oral pills and condoms etc.Adrug kit will be provided to each ASHA.

• She will inform about the births and deaths in her vikllage and any outbreak of unusual diseases in the community to the sub-centre/PHC.

• She will promote construction of household toilets under total sanitation campaign.

Role and integration of ASHA with ANM

Anganwadi worker will guide ASHA in performing the following activities:-

• Organising Health Day once/twice a month.

• AWWs and ANMs will act as a resource for the training of of ASHA.

• IEC activity through display of posters, folk dance etc.to sensitize the beneficiaries on health related issues.

• Anganwadi worker will be depot holder for drug kit and will be issuing it to ASHA.

• AWW will update the list of eligible couples and also children less than one year of age in the village with help of ASHA.

• ASHA will support the AWW in mobilising pregnant and lactating women and infants for nutrition supplement.

Auxillary Nurse Midwife (ANM) will guide ASHA in performing activities:-

• She will hold weekly/ fortnightly meeting with ASHA and discuss the activities during the week.

• AWWs and ANMs will as a resource for the training of of ASHA.

• ANMs will inform ASHA regarding the date and time of outreach sesion.

• She will take help of ASHA in updating eligible couple register

• She will utilise ASHA in motivating pregnant women for coming to sub-centre for initial check ups.

• ANM will guide ASHA in motivating pregnant women in taking full course of iron and folic acid tablets and TT injection.

• ANM will orient ASHA on the dose schedule and side effects of oral pills.

• ANMs will educate ASHA on danger signs of pregnancy and labour so that she can timely identify and help beneficiary in getting further treatment.

• ANMs willinform ASHA on date, time and place for initial and periodic training schedule.

Governmemt of India has set up following indicators for monitoring ASHA.

1. Process Indicators

• Number of ASHAs selected by due process

• Number of ASHAs trained

• % of ASHAs attending review meeting after one year

2. Outcome Indiactors:

• % of newborn who were weighed and families counseled

• % of children with diarrhoea who received ORS.

• % of deliveries with skilled assistance

• % of institutional deliveries

• % of JSY claims made to ASHA.

• % of of completely immunized in 12-23 months of age group

• % of unmet need for spacing contraception among BPL

• % of fever cases who received chloroquine within first week in a malaria detcted area.

3. Impact Indicators:

• IMR

• Child malnutritionrates

• Number of cases of TB /Leprosy detected as compared to previous year.

The Mission aims at strengthening PHC for quality preventive, promotive, curative, supervisory and outreach services, through:

• Adequate and regular supply of essential quality drugs and equipment to PHCs

• Provision of 24 hour service in 50% PHCs by addressing shortage of doctors, especially in high focus staes, through mainstreaming AYUSH manpower.

• Observance of Standard treatment guidelines and protocols.

• Each sub-center will have an United Fund for local action @Rs 10,000 per annum.This fund will be depoisted in a joint bank account of the ANM & Sarpanch and operated by the ANM, in consultation with the Village Health Committee.

• Supply of essential drugs,both allopathic and AYUSH, to the sub-centers,will be ensured

• Sanction of new sub-centers as per 2001 population norm

• Upgradation of existing sub-centers,including buildings for sub-centers fuctioning in rented premises will be considered.

• A key strategy of the mission is operationalizing 3222 existing Community Health Centers(30-40 beds) as 24 hour Referral Units, including posting of anaesthetics.

• Developing standards of services and cost in hospital care.

• Developing, displaying and ensuring compliants to Citizen’s Charter at CHC/ PHC level.

District becomes core unit of planning, budgeting and implementation with health plan of its own. All vertical health and family welfare programme at district and state level merge into one common District Health Mission (DHM) at the district level and the “State Health Mission” (SHM) at the state level.

District Health Plan (DHP) would be an amalgation of field responses through Village Health Plans (VHP), State and National Priorities for health , water supply, sanitation and nutrition

Total Sanitation Campaign (TSC) is presently implemented in 350 district, and is proposed to cover all districts in 10th plan. Components of the TSC include

• IEC activities

• Rural Sanitary Marts.

• Individual household toilets.

• Woman Sanitary Complex

• School Sanitation Programme.

• National Disease Control Programms for Malaria, TB, Kala Azar, Filaria, Blindness, & Iodine Deficiency and Integrated Disease Surveillance Programme shall be integrated under the mission, for improved programme delivery.

• New initiatives would be launched for the control of non communicable

• disease.

• Disease Surveillance System at village level would be strengthened.

• Mobile Medical Unit will be provided at District Level for improved outreach services.

• Since almost 75%of health services are being currently provided by the the private sector, the district institutional mechanism for Mission mst have representation of private sector.

• There is need to develop guidelines for Public-Private Partnership(PPP) in health sector and identifying areas of patnership, which are need based , thematic and geographic

• Public sector should play the lead role in defining the framework and sustaining this partnership.

• A Task Group shall be created to examine new health financing mechanisms.

• The District Health Mission should move towards paying hospitalsfor services by way of reimbursement .

• Standardization of services and costs will be done periodically by a committee of experts in each state.

• All existing CHCs will have wage component paid on monthly basis.

• Community Based Health Insurance Schemes (CBHI) will be encouraged as part of the Mission.

• The Central Government will provide subsides to cover a part of the premiums for the poor, and monitor the schemes.

While district and tertiary hospitals are necessarily located in urban centers, they form an integral part of the referral care chain serving the needs of the rural people. Medical and para-medical education facilities need to be created in states, based on need assessment.