Travel Advisory by Ima Regarding Zika Virus



Travel Advisory by Ima Regarding Zika Virus
Ministry of Health & Family Welfare, Government of India has issued travel advisory that pregnant women or women who are trying to become pregnant should defer/ cancel their travel to the affected areas.


All pregnant women travelling to the affected countries/ areas have been advised to strictly follow personal protective measures, especially during day time, to prevent mosquito bites and if they fall sick within two weeks of return from an affected country, they should report to the nearest health facility.

Advisory has also been issued that pregnant women who have travelled to areas with Zika virus transmission should mention about their travel during pregnancy check-up visits in order to be assessed and monitored appropriately at the health facility.

Guidelines for integrated vector management to prevent transmission by Aedes mosquito have been issued to all the States. These guidelines include vector surveillance, both for larva and adults; effective vector control through environmental management methods, personnel protection, biological control such as using larvivorous fish and using chemicals that kill adult and larval form of this mosquito. Vector surveillance and capacity building have also been done at International Airports and ports.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.
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Preparedness against Swine Flu
Government has issued advisory to all the State Governments and UTs to step up preparedness for H1N1 Influenza. This includes enhanced surveillance; capacity for laboratory diagnosis; setting up of screening centres in outpatient departments of hospitals; earmarking isolation wards including ventilator beds; stocking of personal protective equipments; to make drug Oseltamivir available and to create awareness among the public for early reporting to hospitals for treatment.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.
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Setting Up of New Cancer Research Centres
The WHO South East Asia Regional Committee, in its 68th session held in Timor Leste, adopted resolution no. SEA/RC68/R5 on 11 September 2015, on “Cancer Prevention and Control – the way forward”. The said resolution noted that many cancers are preventable, can be detected early and treated, which improves survival and quality of life. It urged the Member States, inter-alia, to develop/strengthen a comprehensive national cancer prevention and control programme, integrated within a broader multisectoral NCD action plan, with time-bound benchmarks and targets, effective governance and accountability, adequate and sustainable financing for programme implementation, monitoring and evaluation.

India has prepared and adopted a National Action Plan and Monitoring Framework for Non Communicable Diseases with 10 targets and 21 indicators.

Since adopting WHO Framework Convention on Tobacco Control (FCTC), the Government of India launched National Tobacco Control program in 2007-08 with the aim to create awareness about the harmful effects of tobacco consumption, reduce the demand and supply of tobacco products, ensure effective implementation of the provisions under “The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003” (COTPA) and help people quit tobacco use through Tobacco Cessation Centres.

Central Government supplements the efforts of the State Government for improving healthcare including prevention, diagnosis and treatment of Cancer. At present, National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) being implemented under National Health Mission (NHM) for interventions upto the district level includes awareness generation for Cancer prevention, screening, early detection and referral to an appropriate level institution for treatment. The focus is on three areas namely breast, cervical and oral Cancer. Screening guidelines have been provided to State Governments for implementation. Suspected cases are to be referred for confirmatory diagnosis by various tests including histo-pathological biopsy.

Government of India is also implementing a scheme for enhancing the tertiary care facilities for Cancer in the country. Under the said scheme, Government of India is assisting to set up/establish 20 State Cancer Institutes (SCI) and 50 Tertiary Care Cancer Centres (TCCC) in different parts of the country. The maximum assistance inclusive of State share for SCI is up to Rs. 120 crores and for TCCC is up to Rs. 45 crores.

In the Government sector, Research activities for detection and treatment of cancer are mostly carried out by Institutions/Departments such as the Indian Council of Medical Research, Department of Science and Technology and Department of Atomic Energy. The Bhabha Atomic Research Centre has developed Bhabhatron and the Society for Applied Microwave Electronics Engineering and Research (SAMEER) has developed Linear Accelerator (LINAC).

The Indian Council of Medical Research is promoting cancer research including epidemiological, clinical, basic and translational research. The ICMR has also developed protocols for the management (including treatment) of Buccal Mucosa Cancer, Gall Bladder Cancer, Stomach Cancer, Colorectal Cancer, and Tongue Cancer. Institute of Cytology and Preventive Oncology under the Indian Council of Medical Research has developed a hand held device called Magnivisualizer with inbuilt source of light that can be used in field conditions for early detection of cervical cancer and oral cancer lesions.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.
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Free Diagnostics Scheme
Public health being a State subject, the primary responsibility for providing affordable and quality health services to the population lies with the State Governments. Under the National Health Mission (NHM), States are already being supported for implementing free diagnostics initiative. Guidelines for operationalising the Free Diagnostics Initiative have also been shared with the States on 2nd July, 2015.

The Government is already providing support to States/ UTs under NHM for provision of a basket of free services for maternal health, child health, adolescent health, family planning, universal immunisation, and for major diseases such as TB, vector borne diseases such as Malaria, dengue and Kala Azar, leprosy etc. Other major initiatives for which states are being supported include Janani Shishu Suraksha Karyakram (JSSK), Rashtriya Bal Swasthya Karyakram (RBSK), Rashtriya Kishor Swasthya Karyakram (RKSK), National Health Mission Free Drugs and Free Diagnostics Service Initiatives etc. Support is also being provided to the States for roll out of Universal Health Coverage pilots.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.
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Opening of new Hospitals

Under different phases of Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), total of eighteen new AIIMS have been established/announced as on date. List of States wherein new AIIMS have been established/announced to be set up is given below:
List of States, wherein new AIIMS are being established under PMSSY
A.                   Functional AIIMS (Phase-I)
(i)           Bihar                                       :      AIIMS at Patna
(ii)         Chhattisgarh                            :      AIIMS at Raipur
(iii) Madhya Pradesh               :      AIIMS at Bhopal
(iv) Odisha                               :      AIIMS at Bhubaneshwar
(v)         Rajasthan                                :       AIIMS at Jodhpur
(vi) Uttarakhand                      :       AIIMS at Rishikesh

B.                   AIIMS (Phase-II) under construction

(i)                 Uttar Pradesh              :           AIIMS at Rae Bareli

C.                   Fresh Announcements of AIIMS (Construction yet to be started)
During Budget Speech for the year 2014-15
(i)                  Andhra Pradesh
(ii)                West Bengal
(iii)              Vidharbha in Maharashtra
(iv)              Poorvanchal in UP

During Budget Speech for the year 2015-16
(i)                  Assam
(ii)                Himachal Pradesh
(iii)              Jammu
(iv)              Kashmir
(v)                Punjab
(vi)              Tamil Nadu
(vii)            Bihar

(Hon’ble PM has announced setting up of total two AIIMS in capital cities of J&K as part of Prime Minister Development Package for J&K. This includes the AIIMS announced during Budget speech 2015-16).

Construction work at seven AIIMS has started and status of construction work is given below:

Status of Construction Work as on 15.02.2016 at six AIIMS established under Phase-I of PMSSY is given below:

Name of site
Medical College (%)
Hospital Complex (%)
Residential Complex (%)
Electrical Services (Package-III) (%)
Estate Services (Package-IV) (%)
Bhopal
91.12
80.90
99.00
84.25
49.15
Bhubaneswar
92.53
86.70
35.00 (Ph.I) & 85.00 (Ph.II)
98.36
51.35
Jodhpur
91.50
92.93
100.00
99.50
98.80
Patna
97.00
69.00
100.00
94.00
35.00
Raipur
89.51
72.97
100.00
95.69
49.74
Rishikesh
89.57
96.01 & 65.91 (False ceiling & fire door)
100.00
98.00
68.65

Status of Construction Work at AIIMS, Rae Bareli being undertaken under Phase-II of PMSSY: Construction of Housing Complex at AIIMS Rae Bareli has stated and in full swing.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.

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Expenditure on Health Research
Expenditure by Department of Health Research as a percentage of Total Expenditure for Health Budget for the year 2014-15 is approximately 10.6 per cent.

Investment is a must to solve health-related issues in the country. Though, India has done exceedingly well with limited resources in combating diseases like malaria, filariasis, kalazar, tuberculosis, leprosy, HIV/AIDs, Poliomyelitis, etc. through research and its implementation in collaboration with National Health Programs more research in the areas of disease-burden trends, translational and implementation research, expanding clinical trial network and conducting more multi-centric trials is required.

With a view to promote health research in the country by investing more expenditure , Department of Health Research has launched in 2013-14 major schemes like establishing Multi-disciplinary Research Units (MRUs) in Government Medical Colleges, Model Rural Health Research Units (MRHRUs) and Viral Diagnostic & Research Laboratories (VDRLs) to strengthen research infrastructure as well as initiated schemes for Human Resource Development.

The Minister of State (Health and FW),Shri Shripad Yesso Naik stated this in a written reply in the Rajya Sabha here today.
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Discouraging Tobacco Consumption by the People
Tobacco is the foremost preventable cause of death and disease in the world today. Globally, it kills nearly 6 million people, of which 0.6 million premature deaths can be attributed to exposure to second-hand smoke (SHS). As per the report of Tobacco Control in India (2004), nearly 8-9 lakh people die every year due to diseases attributable to tobacco use. As per the ICMR study “Assessment of Burden of Disease due to Non-Communicable Diseases (2006)”, based on analysis of published literature till 2004, the risk of disease attributable to tobacco use was 78% for stroke, 65.6% for tuberculosis, 85.2% for ischemic heart disease, 52% for acute myocardial infarction, 43% for oesophageal cancer, and 16% for lung cancer, respectively.
As per the NCDIR-NCRP Report on “Time Trends in Cancer Incidence Rate: 1982-2010”, Oral Cancers of Tongue in males showed a statistically significant increase in Age-Adjusted Incidence Rate along with Annual Percentage Change in Chennai (1.35) and Delhi (1.73). Mouth Cancers in males showed a statistically significant increase in Age-Adjusted Incidence Rate in Bhopal (2.97), Delhi (2.93), and Mumbai (1.35). The estimated incidence of Oral Cancer cases in India, State/UT-wise, for the year 2015 is given below:
Estimated incidence of Oral Cancer cases in India, State/UT-wise, for the year 2015  - Both Sexes
State/UT
2015
Jammu & Kashmir
1306
Himachal Pradesh
662
Punjab
2713
Chandigarh
107
Uttaranchal
1018
Haryana
2556
Delhi
1652
Rajasthan
6881
Uttar Pradesh
20424
Bihar
10788
Sikkim
39
Arunachal Pradesh
78
Nagaland
106
Manipur
130
Mizoram
59
Tripura
217
Meghalaya
163
Assam
1661
West Bengal
9072
Jharkhand
3359
Orissa
4083
Chhattisgarh
2582
Madhya Pradesh
7365
Gujarat
6097
Daman & Diu
40
Dadra & Nagar Haveli
42
Maharashtra
11005
Telangana
3588
Andhra Pradesh
5030
Karnataka
6029
Goa
141
Lakshadweep
7
Kerala
3282
Tamil Nadu
6670
Pondicherry
128
Andaman & Nicobar Islands
36
Total
119116
*Based on cancer incidence report (2009-2011) and the Report on Time Trends in Cancer incidence Rates (1982-2010)

The Government has taken a series of measures to deter people from consuming various tobacco products:
(i) Enactment of the “Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, (COTPA) 2003”.
(ii) Ratification of WHO Framework Convention on Tobacco Control.
(iii) Launch of the National Tobacco Control Programme (NTCP) in the year 2007-08, with the objectives to (a) create awareness about the harmful effects of tobacco consumption, (b) reduce the production and supply of tobacco products, (c) ensure effective implementation of the anti-tobacco laws and (d) help the people quit tobacco use through Tobacco Cessation Centres.
(iv) Notification of rules to regulate depiction of tobacco products or their use in films and TV programmes.
(v) Notification of rules on new pictorial health warnings on tobacco product packages.
(vi) Launch of public awareness campaigns through a variety of media.
The States/UTs are regularly advised by this Ministry to implement various provisions of tobacco control laws in letter and spirit. Besides, under the National Tobacco Control Programme, there is a provision for conducting law enforcers training in the States/UTs aimed at improving the enforcement of tobacco control laws.
The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.

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Action Plan to Achieve Child Mortality Target
India has made steady progress in reduction of Under-five Mortality Rate (U5MR) from 126/1000 live births in 1990 to 49/1000 live births in 2013 as per the Sample Registration System Report (SRS) issued by the Registrar General of India (RGI). India may come close to achieving MDG-4 target of Under 5 Mortality Rate of 42/1000 live births, provided the current trend of annual decline of 6.6 percent continues.

Ministry of Health & Family Welfare, GoI has adopted an integrated approach for Reproductive, Maternal, New Born, Child and Adolescent Health (RMNCH+A) in India to address the major causes of mortality among women and children as well as the delays in accessing and utilising health care and services. Increasingly emphasis is on establishing the ‘continuum of care’ , which includes integrated service delivery in various life stages including the adolescence, pre-pregnancy, childbirth and postnatal period, childhood and through reproductive age.

The Ministry of Health and Family Welfare has identified bottom 25% of the districts according to the composite index based on available evaluated data on representative maternal and child health indicators The LWE and tribal districts falling in bottom 50% were also declared as the “high priority districts” (HPD). Currently, 184 districts fall under this category.

The HPDs have been identified for intensification of efforts which are being supported through interventions like gap analysis, relaxation of norms for strengthening service delivery, priority interventions through life cycle approach, special strategies, packages and incentives and demand generation. To expedite all these measures, 30% higher financial allocation has been mandated for these districts. In order to monitor, the progress made by HPDs, a composite index has been developed representing the various phases of life-cycle.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.
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Updation of Cancer Data Collection Capacity
As reported by Indian Council of Medical Research (ICMR), National Centre for Disease Informatics and Research is a nodal agency for Cancer registry. It routinely collects data for Cancer registry programme. NCDIR-National Cancer Registry Programme has published a report on the data of 2009-2011 from Population Based Cancer Registries (PBCRs) in the year 2013.

Population Based Cancer Registration is a complex process. This involves active cancer registration wherein staff has to go to different sources for collection of data Elimination of duplicate registration, confidentiality issues, matching with death due to cancer as well as cause mortality also takes time.

The latest edition of National Health Profile- 2015 used the data from National Cancer Registry Programme, Indian Council of Medical Research (ICMR) Three Year Report of Population Based Cancer Registries (PBCR) : 2009-2011 (Report of 25 PBCRs in India) (February 2013) on Incidence and Distribution of Cancer

The systematic collection of data on cancer is being carried out by various Population Based Cancer Registries (PBCR) across India under the National Cancer Registry Programme of ICMR since 1982. National Cancer Registry Programme has 58 sites. All 27 erstwhile Regional Cancer Centres are part of Cancer Registry Programme. The programme is also being financially supported from National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.
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Enhancing Healthcare Expenditure
As per 12th Five Year Plan document, total public funding by the Centre and States, plan and non-plan, on core health is envisaged to increase to 1.87 per cent of GDP by the end of the Twelfth Plan. The Draft National Health Policy 2015 envisages raising progressively the public health expenditure to 2.5% of the GDP.

Stakeholder responses on the draft National Health Policy 2015, have suggested an increase in public health spending as a percent of Gross National Product beyond the current level of 1.1 percent of GDP mentioned in the draft policy.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.
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Initiatives to contain outbreak of Zika Virus
Technical guidelines and travel advisory were issued and disseminated and also made available on the website of the Ministry. States where Dengue transmission is prevalent, namely Maharashtra, Kerala, Tamil Nadu, and UT of Puducherry have been alerted. National Centre for Disease Control (NCDC), Delhi has been identified as the nodal agency for investigation of outbreak in any part of the country. Fifteen International Airports and nine major ports have displayed signages providing information for travelers on Zika virus disease and advising the travellers to report if they are returning from any of the affected countries and suffering from febrile illness. Immigration authorities at these Airports have been sensitized. Directorate General of Civil Aviation, Ministry of Civil Aviation has issued instruction to all international airlines to follow the recommended aircraft disinsection guidelines. Vector control measures have been implemented at International Airports and Ports. National Centre for Disease Control, Delhi and National Institute of Virology (NIV), Pune, have established the capacity to provide laboratory diagnosis of Zika virus disease in acute febrile stage. National Vector Borne Disease Control Programme has alerted all its field units for enhanced vector ( Aedes mosquitoes) control. National AIDS Control Organization has issued advisory for blood banks and potential blood donors to prevent transmission of Zika virus infection by blood transfusion. A 24x7 control room cum Help Line has started functioning from Dte GHS. Public has been made aware about Zika virus disease through press releases issued by Ministry of Health and Family Welfare. The situation is being monitored regularly.

There is no specific treatment for Zika virus Disease. People sick with Zika virus are advised to take plenty of rest, drink enough fluids, and treat pain and fever with paracetamol. They are also advised to take personal protective measures against mosquito bite.

National Centre for Disease Control, Delhi and National Institute of Virology (NIV), Pune, are the identified laboratories to test clinical samples and to support the outbreak investigation. No special provision is required to admit and treat a Zika virus disease patient except for provision of mosquito net. However, severe forms of disease requiring hospitalization is uncommon and fatalities are rare.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.
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Eliminating Malaria
The National Framework for Malaria Elimination in India (2016-2030) has been launched. This framework has been developed with a vision to eliminate malaria from the country and contribute to improved health and quality of life. The new framework encourages all Indian States with different levels of malaria transmission to interrupt indigenous transmission of malaria in all States/ UTs by WTO global target.

The malaria elimination activities shall be taken up in the country by categorizing the States under 3 categories, based on (Annual Parasite Incidence) API: Category 1 (elimination), Category 2 (pre elimination) and category 3 (intensified malaria control), with focus on area specific activities with stratification from macro to micro level.

The Accredited Social Health Activists (ASHAs) have already been trained and have been provided rapid diagnostic test kits (RDT) for diagnosis of Malaria.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.
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Upgrading of Health Care Infrastructure in the Country
The focus of the Government is to provide accessible, affordable and accountable quality healthcare facilities to all sections of society especially the marginalized sections in the country. The expenditure/outlay by Ministry of Health and Family Welfare and Ministry of AYUSH has increased from Rs.27885.19 crore in 2012-13 (Actual) to Rs. 31,965.00 crore in 2014-15 (RE) and to Rs. 33282.17 (BE) in 2015-16.

Public health is a state subject. The interventions under National Health Mission (NHM) are aimed towards by supplementing the efforts of the States in this direction. The Government has already taken steps towards provision of free services for maternal health, child health, adolescent health, family planning, universal immunisation programme, and for major diseases such as TB, vector borne diseases such as Malaria, dengue and kalazar and HIV/AIDS, leprosy etc. Other major initiatives for which states are being supported include Janani Shishu Suraksha Karyakram (JSSK), Rashtriya Bal Swasthya Karyakram (RBSK), Rashtriya Kishor Swasthya Karyakram (RKSK), implementation of National Health Mission Free Drugs Service Initiative and National Health Mission Free Diagnostics

Service Initiative, strengthening primary healthcare and District Hospitals and implementation of National Quality Assurance Framework. The Central Government is also implementing the Rashtriya Swasthya Bima Yojana (RSBY).

The primary responsibility to regulate the private health care sector rests with the State/UT Governments. The Central Government has enacted the Clinical Establishment (Registration and Regulation) Act, 2010, to provide a legislative framework for the registration and regulation of clinical establishments in the country and also seeks to improve the quality of health services through the National Council for Standards by prescribing minimum standards of facilities and services which may be provided. The Clinical Establishments Act has been adopted by the States of Sikkim, Mizoram, Arunachal Pradesh, Himachal Pradesh, Uttar Pradesh, Bihar, Jharkhand, Rajasthan, Uttarakhand and all Union Territories except Delhi.

The Twelfth Five Year Plan envisages increasing total public health funding on core health to 1.87 percent of GDP by the end of the Plan period. The draft National Health Policy envisages progressive increase in public health spending to 2.5% of GDP.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.

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Health For All
Public Health is a state subject. However moving towards Universal Health Coverage (UHC) wherein people are able to receive quality health services that they need without suffering financial hardship is a key goal of the Twelfth Plan. As per the Twelfth Plan document, move towards UHC is a process that will unfold over two to three plan periods. It is also one of the targets of Sustainable Development Goals that is to be achieved by 2030. The National Health Mission (NHM) represents the prime vehicle for achieving UHC.

The Government has already taken steps towards provision of free services for maternal health, child health, adolescent health, family planning, universal immunisation programme, and for major diseases such as TB, vector borne diseases such as Malaria, dengue and kalazar, HIV/AIDS, leprosy etc. Other major initiatives for which states are being supported include Janani Shishu Suraksha Karyakram (JSSK), Rashtriya Bal SwasthyaKaryakram (RBSK), Rashtriya Kishor Swasthya Karyakram (RKSK), implementation of NHM Free Drugs and Free Diagnostics Service Initiatives, roll out of Universal Health Coverage pilots, strengthening primary healthcare and District Hospitals and implementation of National Quality Assurance Framework.

The Central Government is also implementing the Rashtriya Swasthya Bima Yojana (RSBY) which provides health cover up to Rs.30,000/- for secondary care hospitalizations on a family floater basis as per the approved package rates to BPL population and 11 other defined categories of unorganised workers.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.


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