First AIDS case in India was detected in 1986 • No. of persons living with HIV in India is 5. 134 million approximately • Estimated adult HIV prevalence is 0. 36% • 39. 3 % of the infection are in children • 3. 8% of the infection are in children • Andhra Pradesh , Karnataka, Maharashtra and Tamilnadu contribute 63% of HIV infected persons. • Transmission of infection o 84. 6 % – Sexual route o 4. 34% – Perental route o 1. 8 % – Injection drug use o 1. 9% – Contaminated blood and blood products.
o HIV prevalence among high risk groups is 6 to 8 times greater than that among the general population o __________ protective rate among the screened general population is 27 per 1000 Realizing the gravity of epidemiological situation of HIV infection prevailing in the country , the Government of India launched a National AIDS control program in 1987 (NACP). In 1982 , National AIDS control organization (NACO) was established to closely monitor the NACP. NACP-II was formulated by Government of India with two key objectives • To reduce the spread of HIV infection in India.
• Strengthen India’s capacity to respond to HIV/ AIDS on a long term basis. The total outlay for the second phase of NACP-II is Rs. 2064. 65 Crore Program Strategy 1. Blood safety : Testing of every unit of blood for HIV , Hepatitis B, Hepatitis C, Syphilis and malaria is made mandatory. Professional blood donation has been prohibited since January 1998. 154 zonal blood testing centers and 9 HIV reference centers are functioning. HIV tests are supplied to District level blood banks. There are 1854 licensed blood banks in the country.
It has been decided to establish minimum of one VCTC( Voluntary counseling and testing centers) in each district. 2. Control of sexually transmitted diseases : 5 regional STD reference centers and 504 STD clinics usually located at the district hospitals and the skin and STD departments of medical colleges are strengthened by providing equipments , materials, drugs, consumables and training of health personnel. Guidelines have been developed for simplified STD treatment , condom promotion has been taken up in a big way by NACO with regard to quality control of condoms, social marketing of condoms and involvement of NGO’s 3.
HIV surveillance – A need based HIV/ AIDS surveillance system has been established in the country and modified in response to the changing need and scenario . 62 surveillance centers and 9 HIV reference centers have been set up in the country. In order to know the trend of HIV infection amongst various groups , 115 additional sentinel sites were established 4. Information , education, communication , and social mobilization : The objective is to raise awareness, improve knowledge and understanding among the general public about HIV , routes of transmission and method of prevention.
The mass multimedia lime TV , newspapers have played a big role in this regard. Over 90 universities, 953 colleges, 12. 5 lakh students have been covered under “ University Talks AIDS” programs. AIDS hotlines with 1097 toll free numbers have been established in major cities answering queries relating to HIV/AIDS 5. Priority targeted intervention for populations at high risk: This aims to reduce the spread of HIV in groups at high risk by identifying target populations and providing personal counseling . This is largely done by NGOs.
965 targeted intervention projects have been taken up for various risk groups. 6. Low cost care of HIV/AIDS patients : Financial assistance is provided for home based and community based care including the availability of cost effective interventions for common opportunistic infections. Necessary funds have been provided to all medical colleges and large hospitals to ensure availability of drugs, 60 community care to terminally ill AIDS patients. 39 Govt medical colleges and referral hospitals have started free anti- retro- viral therapy. 7.
Institutional strengthening: This aims to strengthen effectiveness and technical sustainability at National state and municipal levels. The state AIDS control societies have been established as autonomous bodies in all states and union territories and municipal corporations of Mumbai, Chennai and Ahmedabad. Necessary staff has been provided to these societies to ensure enhancement of technical and managerial capacity of these societies for the implementation of the program. Key activities to monitor the progression of HIV/ AIDS epidemic in the country are 1.
HIV sentence surveillance through 670 sentinel sites 2. AIDS case surveillance by adopting standard AIDS case definition in indian context 3. Development of information system 4. STD surveillance for reporting on both etiological and syndromic approach 5. Behavioural surveillance through an outside agency. Research priorities of the program : 6. Development of indigenous vaccine 7. Operational Research 8. Inter sectoral collaboration : This component would promote collaborations amongst the public , private and voluntary sectors.
The activities would be co- ordinated with other programs within the ministry of health and family welfare and other central ministries. Collaboration would focus on learning from the innovative HIV/AIDS programs that exist in other sectors and sharing in the working of generating awareness. The present program is based on sound public health principles. It targets high risk and general populations with emphasis on voluntary testing instead of mandatory testing, prioritizing care and support needs with human right concerns and laying emphasis on prevention programs.
It is possible to reduce the number of new infections to a minimal level in the next 3 to 4 years with larger scale intervention programs. The Ministry of Health , NACO and the state AIDS control societies as part of their mass mobilization efforts mounted the AASHA( AIDS Awareness Sustained Holistic Action ) campaign in Andhra Pradesh followed by GOONJ in Chandigarh world AIDS day in celebrated on December 4, HIV/ AIDS is no longer just a health problem but a social and development issue of grave cocern. In the In the absence of __________, the only vaccine right now is the “ Knowledge vaccin” .
Empowering people with correct and authentic information is the need of the hour. Sex education is being made part of the school curriculum with specific chapters being incorporated from class VIII. With the epidemics moving from the high risk groups to the general population , efforts have to be made to strengthen messaging communication and advocacy and to bring about the desired behavior change. NATIONAL RURAL HEALTH MISSION PREABLE :
Recognizing the importance of health in the process of economic and social development and improving the quality of life of our citizens , the govt.of India has reserved to launch the National Rural Health Mission STATE OF PUBLIC HEALTH : • Public health organization in India has declined from 1. 3 % of GDP in 1990 to 0. 9% of GDP in 1999. • Union Government contribution to public health expenditure is 15% while states contribute 85%. • Vertical health and family welfare programmes have limited synergisation at operational levels • Lack of community ownership of public health programmes impacts level of efficiency, accountability and effectiveness.
• Lack of integration of sanitation, hygiene, nutrition and drinking water issues. • Population stabilization is still a challenge. • Curative services favor the non poor. For every Rs 1 on the poorest / Rs3 is spent on richest • Only 10% Indians have some form of health insurance THE VISION • The National Rural health Mission ( 2005-12) seeks to provide effective healthcare to rural population throughout the country with focus on 18 states which have weak public health indicators.
• These 18 states asre – Arunachal pradesh, Assam, Bihar, Chattisgarh, Himachal Pradesh, Jharkand, J and K, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajashthan, Sikkim, Tripura, Uttaranchal and U. P • The mission is an articulation of the commitment of the Govt. to raise public spending on health from 0. 9% of GDP to 2-3% of GDP • It aims to undertake architectural correction of the health system to enable it to effectively handle increased allocation as promised under the National Common Minimum Programme.
• It has as its key component provision of a female health activist in each village • It seeks to revitalize local health traditions and mainstream AYUSH into the public health system. • Effective integration of health concerns with determinants of health like sanitation , hygiene, nutrition and safe drinking water through a district plan for health • It seeks decentralization of programmes for district management of health. • It shall define time bound goals and report publicity on their progress. • It seeks to improve access of rural people equitable , affordable, accountable and effective primary healthcare.
GOALS
• Reduction in Infant Mortality Rate and maternal mortality rate • Universal access to public health services such as women’s health , child health, water sanitation and _______immunization and nutrition • Prevention and control of communicable and non communicable diseases including locally endemic diseases • Access to integrated comprehensive primary health care • Population stabilization , gender and demographic balance • Revitalize local health traditions and mainstream AYUSH.
• Promotion of healthy life styles STRATEGIES – CORE – SUPPLEMENTARY CORE STRATEGIES• Train and enhance the capacity of Panchayatraj institutions to own control and manage public health services • Promote access to improved healthcare at household level through the female health activist (ASHAA) • Health plan for each village through village health committee of the Panchayat • Strengthening sub center through an united fund to enable local planning and action and more multipurpose workers.
• Strengthening existing PHCs and CHCs and provision of 30-50 bedded CHC per lakh population • Preparation and implementation of an intersectoral district health plan prepared by the District health mission • Integrating vertical health and family welfare programme at national , state , block and district levels • Technical support to national , state , and district health missions. • Strengthening capacities for data collection , assessment and review for evidence based planning , monitoring and supervision • Formulation of transparent policies for deployment and career development of human resources for health • Promoting non profit sector particularly in under served areas.
SUPPLEMENTARY STRATEGIES :
• Regulation of private sector including informal rural practitioneers to ensure availability of quality service to citizens at reasonable cost • Promotion of Public private partnerships for achieving public health goals. • Main streaming AYUSH • Reorienting medical education including regulation of medical care and medical ethics.
• Effective and viable risk pooling and social health insurance to provide health security to the poor PLAN OF ACTION: COMPONENT A Accredited Social Health Activists • Every village will have a female accredited social health Activist (ASHA) – chosen by and accountable to the Panchayat – to act as interface to the panchayat – to act as interface between.