Health programme in India

National Malaria Eradication programme 

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Serval national Health programmes are being implemented as centrally sponsored schemes aimed mainly at reduction of mortality and morbodity caused by major disease. Some programmes are for Health promotion and for overall social Development

The National programmes implemented in India are as follows:_

1. National Malria Eradication programme.

1. National MALARIA ERADICATION PROGRAMM:

Malria is caused by plasmodium prasite (p.vivax ,p.falcifram,p.malarie and p.ovale) are transmitted by the bite infective female Anopheles mosquito.100 countries in the world are considered as malarious. About 300-500 million clinical casses and between 1.5-2.7 dealth ocour every year. [ 10 every second are in Africa] Resistance plasmodium falciparum cases are increasing world wide.

In India million positive casses reported annually and commonest is P.vivax. All malaria mortality is due to p. falciparum only.

Typical presentation is sudden onset of high fever with rigors and sensation of extreme cold followed by felling of burning heat, leading to profuse sweating. This occour every alternate days. However atypical presentation is also common. Due to the heavy burden of disease  in India, and fever is the cardinal symptom of malaria every fever cases is presumed to be malaria.

Malaria can be diagonsed by blood smear examination under microscope or by Dipstick test in cases of P falciparum

History of malaria control In india

The milestone in history of malaria are_ 1946

Sir Bhore commite Report_ 1953

National malaria control programme _1958

Urban malaria scheme _ 1971

Modified plan of operation [MPO]_ 1977

Malaria Action programme _ 1995

Enhanced Malaria control programme_ 1977

National Rural Health programme_ 2005

Bhore commitee:

At the time of independence of india was contributing 75 million casses with 0.8 million dealth. So a country wide comprehensive programme to control malaria was recommended in 1946 by Bhore commitee.

National malaria control programme :

In April 1953, Government of India, launched a National malaria control programme [ NMCP]

Objective of programme were_

_ To bring down malaria transmission to a level at which to a level at which it would cease to be a major public health problem.

_ To achieve malaria transmission at low level indefinitey,

_ Threafter an achievement was to be maintained by each sate.

 

Strategies under NMCP were:

1- malaria residual insecticide spray of human dewelling and cattle sheds.

2- malaria control teams were organised to carry out surveys to monitor the malaria incidence in the control areas; and

3- Anti- malaria drugs were made available for patients and were monitored.

Goods result were obtained. Number of malaria casees and dealth had decreased significantly.

National malaria Eradication programme [ NMEP]

Thre was spectacular reduction in cases and no dealth was reported in 1965. This resulted  W.H.O.; to call Eradication stragey. So, NEMP was launched, in 1958 with the objective to eradicate the malaria in 7-9 days

But threafter the programme stuffed setbacks due to various constraints like fincical, logistick, adminstrative and technical.

1. Adminstrative faliure-

-Sgortage of insecticides.

- shortage of drugs

- shortstroge of staff/workers

 

2- Technical faliure-

Resistance to insecticides,

 

3- operational faliure-

-inadequate funds

- dismantling services

- relax supervision

This resulted in resurgence of malaria during the 1970′ s . It was realized that urban areas have not received special attention in the programme that could be one of the reasons of resurgence of malaria in the country. So urban malaria scheme was stated in 1971 and later modified plan operation in 1976.

Urban malaria scheme:

Urban malaria scheme was sanctioned in 1971, when it was realized that urban malaria areas was a significant special attention in the programme that cloud br one of the reasons of resurgence of malaria in the country. So urban malaria scheme was stated in 1971 and later Modified plan of operation in 1976.

Modified plan operation

In 1977 M.P.A .- modified plan of Action launched

- objective

- Elimination of dealth from malaria

- Reduction of malaria morbidity [ cases]

- Reduction of transmission

Drug Distrution centers-

These are started only to dispense the antil-malaria tablets

Till 1994 programme was able to stabilize the the condition but there were outbreak in Rajasthan and Haryana and some northern states, which resulted to plan Malaria Action programme, which defined various risk areas.

Malaria Action plan- [ MAP]

This programme was stared in states including Maharashtra,since December 1994, Epidemiological parameters for high risk areas were identified. Every aspect of programme was reviewed and appropriate interventions were suggested.

Tribal areas -

These areas where malaria control operation have failed to contain the disease.

Epidemic prone areas-

The areas periodic fulminating malaria epidemic lave occured

Project areas-

The areas where people go to endimic areas, and areas where there are breeding places and increase man-mosquitio contact has increased,and

Trible insecticide resistant areas-

In these areas Anopheles mosquito has become resistance to conventional insecticides like DOT, BHC etc.

Urban areas-

In those cities where 80% pf malaria cases occour.

The plans differ from each  above areas but in general the strategy and measures are following.

MAP strategy -

MPWS appointed – for preparing slide & to send it to laboratory,Laboratory technician appointed,

– 1 malaria laboratory for 20-30 thousand population

Measures –

– Activie and passive surveillance  House- to House.

– Quick slide examination.

– Appropriate disposal of water.

– Improvement in Strom water drainage,

– Reduce breeding sites by drainage filling

– Indoor spray with pyrethrum in and around 50 house of malaria cases,

– Enforcement of Law making -for builders,

– malaria week -1st to 7th may.

As malaria Action programme was not able to sustain Enhanced Malaria center programme launched in 1997.

Echanced Malaria control project

In September 1997, world Bank sanctioned the Enhanced Malaria control project to strengthen the anti malaria Action in most affected areas. 100 districts were selected [ out of which some were from Maharashtra] in this project along with antil-malarial activities. IEC, Training and Management Information system, were taken in hand.