Programmes to Check Child Mortality Rates



Programmes to Check Child Mortality Rates


As per Registrar General of India, Sample Registration System (SRS) 2013, the Infant Mortality Rate (IMR) is 40 per 1000 live births. The state wise details of IMR and rural- urban variation, is given in table below. The SRS, however, does not provide category- wise data separately for SC ST and Others.

S. No.
State/UTs
Statewise mortality rates, SRS 2013


Infant Mortality Rate


Total
Rural
Urban

INDIA
40
44
27
1
Bihar
42
42
33
2
Chhattisgarh
46
47
38
3
Himachal Pradesh
35
35
23
4
Jammu & Kashmir
37
39
28
5
Jharkhand
37
38
27
6
Madhya Pradesh
54
57
37
7
Odisha
51
53
38
8
Rajasthan
47
51
30
9
Uttar Pradesh
50
53
38
10
Uttarakhand
32
34
22
11
Arunachal Pradesh
32
36
14
12
Assam
54
56
32
13
Manipur
10
10
10
14
Meghalaya
47
48
40
15
Mizoram
35
44
19
16
Nagaland
18
18
19
17
Sikkim
22
23
15
18
Tripura
26
27
19
19
Andhra Pradesh
39
44
29
20
Goa
9
8
10
21
Gujarat
36
43
22
22
Haryana
41
44
32
23
Karnataka
31
34
24
24
Kerala
12
13
9
25
Maharashtra
24
29
16
26
Punjab
26
28
23
27
Tamil Nadu
21
24
17
28
West Bengal
31
32
26
29
A & N Islands
24
29
13

As per the Registrar General of India, Sample Registration System (SRS) 2013, the Neonatal Mortality Rate (NMR) is 28 per 1000 live births The state wise details of IMR and rural- urban variation is given in table below.. The SRS, however, does not provide category- wise data separately for SC ST and Others.
S. No.
State/UTs
Statewise mortality rates, SRS 2013


Neonatal mortality rate


Total
Rural
Urban

India
28
31
15
1
Andhra Pradesh
25
31
10
2
Assam
27
29
10
3
Bihar
28
29
11
4
Chhattisgarh
31
31
26
5
Delhi
16
24
15
6
Gujarat
26
31
16
7
Haryana
26
29
19
8
Himachal Pradesh
25
26
11
9
Jammu & Kashmir
29
31
18
10
Jharkhand
26
28
12
11
Karnataka
22
27
12
12
Kerala
6
7
3
13
Madhya Pradesh
36
39
23
14
Maharashtra
17
21
11
15
Orissa
37
39
26
16
Punjab
16
15
16
17
Rajasthan
32
36
17
18
Tamil Nadu
15
18
11
19
Uttar Pradesh
35
38
20
20
West Bengal
21
22
15

As per Registrar General of India, Sample Registration System (SRS) 2013, the Under-five Mortality Rate (U5MR) is 49 per 1000 live births The state wise details of U5MR and rural- urban variation is is given in table below. The SRS, however, does not provide category- wise data separately for SC ST and Others.
S. No.
State/UTs
Statewise mortality rates, SRS 2013


Under 5  mortality rate


Total
Rural
Urban

India
49
55
29
1
Andhra Pradesh
41
46
29
2
Assam
73
77
34
3
Bihar
54
56
37
4
Chhattisgarh
53
56
38
5
Delhi
26
40
24
6
Gujarat
45
53
28
7
Haryana
45
49
34
8
Himachal Pradesh
41
41
32
9
Jammu & Kashmir
40
42
29
10
Jharkhand
48
51
27
11
Karnataka
35
38
28
12
Kerala
12
13
9
13
Madhya Pradesh
69
75
40
14
Maharashtra
26
32
18
15
Orissa
66
70
39
16
Punjab
31
35
24
17
Rajasthan
57
63
32
18
Tamil Nadu
23
26
17
19
Uttar Pradesh
64
68
44
20
West Bengal
35
37
26

















             










The schemes/programmes/funds launched/ released to check high child mortality rate during the last three years and the current year, are as under:
To sharpen the focus on the low performing districts, 184 High Priority Districts (HPDs) have  been identified for implementation of Reproductive Maternal Newborn Child Health+ Adolescent (RMNCH+A) interventions for achieving improved maternal and child health outcomes.
India Newborn Action Plan (INAP) was launched in 2014 to make concerted efforts towards attainment of the goals of “Single Digit Neonatal Mortality Rate” and “Single Digit Stillbirth Rate”, by 2030.
Newer interventions to reduce newborn mortality have also been implemented, including- Vitamin K injection at birth, Antenatal corticosteroids in preterm labour, Kangaroo Mother Care and empowering ANMs to provide Injection Gentamicin to young infants for possible serious bacterial infection.
In order to increase awareness about the use of ORS and Zinc in diarrhoea, an Intensified Diarrhoea Control Fortnight (IDCF) is being observed during July-August, with the ultimate aim of ‘zero child deaths due to childhood diarrhoea’. During fortnight health workers visited the households of under five children, conducted community level awareness generation activities and distributed ORS packets to the families with children under five years of age.
National Iron Plus Initiative (NIPI) - To address anaemia, NIPI has been launched which includes provision of supervised biweekly iron folic acid supplementation by ASHA for all under-five children and biannual deworming.
National Deworming Day (NDD)- Recognising worm infestation as an important cause of anaemia, the first National Deworming Day (NDD) was observed on 10th February, 2015 in 11 States/UT targeting all children in the age group of 1-19 years (both school enrolled and non-enrolled). Total of 8.98 crore children received deworming tablet (Albendazole) during the National Deworming Day. The same will be observed on an annual basis.
Rashtriya Bal Swasthya Karyakram (RBSK) has been launched (Feb 2013) to provide strategic interventions to address birth defects, delays and deficiencies and reduce out of pocket expenditure for the families on treatment by expanding the reach of mobile health teams at block level and establishing District Early Intervention Centres (DEICs) in the districts.
An estimated 27 crore children in the age group of zero to eighteen years are expected to be covered in a phased manner. 13.3 lakhs have received free treatment including surgeries for congenital heart disease, cleft lip and correction of club foot etc.
Birth Defects Surveillance System (BDSS) is being established - to serve as a tool for identifying congenital anomalies. It is as a collaborative effort between the MoHFW, GoI, WHO and CDC.
Mission Indradhanush: Launched on 25th December, 2014, seeks to drive toward 90% full immunization coverage with all vaccines in the entire country by year 2020 with a high focus on the 201 identified districts.
Mission Indradhanush Phase II has begun in 352 districts across the country (279 medium priority districts + 33 districts from North Eastern States + 44 districts from Phase I districts where large number of missed out children were detected during monitoring of phase I of Mission Indradhanush).
The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.

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Innovation of Immunisation Technologies

As per SRS 2013, 1.26 million children under the age of five are estimated to die in India every year. 57 percent of under-five deaths occur in neonatal period, i.e. within the first 28 days of life, the major causes being prematurity and low birth-weight, neonatal infections, birth asphyxia and birth trauma. The major causes of under-five deaths in post-neonatal period are pneumonia and diarrhoea.

The Government has initiated a SMS based electronic vaccine intelligence network (e- VIN) to enable real time monitoring of vaccine stocks at 4476 cold chain storage points across all 160 districts of 3 states viz. Uttar Pradesh, Rajasthan and Madhya Pradesh under Global Alliance for Vaccines and Immunization (GAVI) Health System Strengthening support.

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

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Incentivising Doctors to Work in Rural Areas
Public health being a State subject, the primary responsibility to ensure availability of proper healthcare in public health facilities lies with the State Governments. However, under the National Health Mission (NHM), support is provided to States/UTs to strengthen their healthcare systems including for engaging of doctors on contractual basis based on the requirements posed by the States/UTs in their Programme Implementation Plans.

Support under NHM is provided for multi-skilling of doctors (through trainings like LSAS, EmoC), provision of incentives like hard area allowance to doctors for serving in rural and remote areas and construction of residential quarters for doctors so that they find it attractive to serve in public health facilities in such areas.

Further, in order to encourage the doctors to work in remote and difficult areas, the Medical Council of India with the previous approval of Central Government, has amended the Post Graduate Medical Education Regulations, 2000 to provide:

I. 50% reservation in Post Graduate Diploma Courses for Medical Officers in the Government service who have served for at least three years in remote and difficult areas; and,

II. Incentive at the rate of 10% of the marks obtained for each year in service in remote or difficult areas up to the maximum of 30% of the marks obtained in the entrance test for admissions in Post Graduate Medical Courses.

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

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Promotion of Health Research 



The total budget allocated for the Department of Health & Family Welfare for the financial year 2016-17 is Rs. 40, 657. 57 crores while Rs. 1, 144. 80 crores has been allocated to the Department of Health Research. This is 12.44 per cent (%) increased allocation over the financial year 2015-16. In addition to the research budget of Department of Health Research, other scientific organisations viz. Department of Science & Technology, Department of Bio-Technology and Indian Council of Agricultural Research also carry out research projects on health related topics for which separate budget is earmarked. 

 Health Research is primarily being done with the government spending on research projects. 

 In addition to the research projects of ICMR, Department of Health Research has initiated five new developmental schemes to promote health research in the country, namely, (1) Multi-Disciplinary Research Units (MRUs), (2) Model Rural Health Research Units (MRHRUs), (3) Viral Research and Diagnostic Laboratories (VRDLs), (4) Human Resource Development (HRD) and (5) Grant-in-Aid scheme (GIA). 

 The MOS H&F Welfare, Shri Shripad Naik stated this in a written reply in the Rajya Sabha here today. 

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Generic Drugs in Rural Areas 



Public Health is a state subject. Under the National Health Mission (NHM), support is provided to State for strengthening their healthcare system including support for provision of free generic drugs to those who access public health facilities including in rural areas, based on the requirement posed by the States/UTs in their Programme Implementation Plans. Under NHM, an incentive of upto 5% additional funding is provided to those states that implement policy and systems to provide free essential drugs(in generic form) to all those who access public health facilities. 

 A number of steps have been taken by the Government to promote use of generic medicines. Circulars/ instructions have been issued from time to time to all Central Government hospitals, CGHS dispensaries and State Governments for encouraging prescription of generic medicines. The Code of Medical Ethics under Indian Medical Council Regulations, 2002 also mandates prescription of drugs with generic names. Operational Guidelines on Free Drugs Service Initiative under NHM provide, inter alia that all drugs procured, distributed and prescribed under this initiative shall be generic drugs and States should also undertake IEC and orientation workshops for doctors to promote prescription of generics drugs . 

 While no such information is maintained at Central level, all the states have notified a policy to provide essential drugs (in generic form) in public health facilities. 

 Public Health being a state subject, the primary responsibility of providing improved access to generic drugs lies with the State/UT governments. Under the National Health Mission (NHM), financial support is provided to the States/UTs for strengthening their healthcare delivery system including support for provision of free generic drugs to those who access public health facilities based on the requirement posed by the States/UTs in their Programme Implementation Plans. Under NHM, an incentive of up to 5% additional funding is provided to those states that implement policy and systems to provide free drugs to all those who access public health facilities. To facilitate States to roll out free drugs service initiative, Operational Guidelines have been prepared and shared with States which provide, inter alia that all drugs procured, distributed and prescribed under this initiative shall be generic drugs and States should also undertake IEC to promote generic drugs and organise orientation workshops for doctors to promote prescription of generics drugs . 

 Further, the central government has launched the Jan Aushadhi Scheme to make available generic medicines at affordable prices to all through Jan Aushadhi Stores (JAS). 

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


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Rabies Treatment Facilities in Public Hospitals 



   

As per data made available by Central Bureau of Health Intelligence (CBHI), deaths due to rabies during the last three years in the country are as under:-

                  


Year   Deaths

2013   132
2014   104 (Provisional)
2015     98 (Provisional)


Data regarding incidents of stray dog bites is not collected centrally.

As informed by Animal Welfare Board of India under Ministry of Environment, Forest and Climate Change, the Animal Birth Control (Dogs) Rules, 2001 have been notified by Government for sterilization to control the street dog population and immunization to prevent rabies, to be implemented by the Local Authorities with the help of Animal Welfare Organisations.

Government of India is implementing “National Rabies Control Program” approved during 12th five year plan, with an objective to prevent the human deaths due to rabies and to prevent transmission of rabies. The program has two components - Human Component and animal component.

The Human Component is being implemented in all the States & UTs. National Centre for the Diseases control is the nodal agency for the Human Component of the program.

The Animal Component is being pilot tested in the Haryana & Chennai. The Animal Welfare Board of India, Ministry of Environment, Forests and Climate Change is the Nodal agency for the Animal Component of the program. 

Health is a State subject. It is primarily the responsibility of the State Governments to ensure the availability of anti- rabies vaccine. However, under the National Health Mission (NHM), funds are provided to States/UTs to strengthen their health care system including support for anti rabies vaccines based on the requirement posed by the States in their Programme Implementation Plans.

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

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Accelerated Efforts to Eliminate Malaria 



The National Framework for Malaria Elimination by 2030 has been launched in February 2016 and the same is expected to include in broader health policies by the States/UTs by end of 2016. By the end of 2017, all States are expected to bring down annual parasite incidence to less than 1 per thousand population and by the end of 2020, 15 States/Union Territories under category 1 are expected to interrupt transmission of malaria and achieve zero indigenous cases and death due to malaria. 

 Three states namely Karnataka, Gujarat and Maharashtra are envisaged to achieve Malaria Elimination before the set time line. 

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


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Selling of Medicines Banned in Foreign Countries 



A drug banned / restricted in one country may continue to be marketed in other countries as the respective Governments examine the usage, doses, indications permitted, etc. along with the overall risk-benefit ratio and take decisions on the continued marketing of any drug in that country. In India, safety issues concerning drug formulations are, as and when noted, assessed in consultation with the experts. Safety and efficacy issues relating to certain drugs which have been banned in some countries have been examined and some of these have been allowed for continued marketing subject to stipulated condition/restrictions. These include: 

 I. Nimesulide:- The manufacture, sale and distribution of Nimesulide formulation for human use in children below 12 years of age has been prohibited in the country. 

 II. Analgin:- The manufacture for sale, sale and distribution of Analgin and its formulations containing Analgin for human use was initially suspended in the country w.e.f. 18.06.2013. Subsequently, DTAB examined the issue of suspension of manufacture and sale of the said drug on 25.11.2013 in its 65th meeting and on the basis of the recommendations of the DTAB, the ban was revoked subject to the condition that manufacturers will be required to mention the following on their package insert and promotional literature of the drug:- 

“The drug is indicated for severe pain and pain due to tumour and also for bringing down temperature in refractory cases when other antipyretics fail to do so”. 

III Pioglitazone:- The manufacture for sale, sale and distribution of the drug Pioglitazone and formulations containing Pioglitazone for human use was initially suspended w.e.f. 18.06.2013. Subsequently, DTAB, after examination, recommended for revocation of the suspension of the manufacture and sale of the drug subject to certain conditions and accordingly, the suspension was revoked subject to the condition that the manufacturer shall mention on the package insert and promotional literature of the drug the following:- 

a) The drug should not be used as first line of therapy for diabetes. 

 b) The manufacturer should clearly mention the following box warning in bold red. 

“Advice for healthcare professionals: 

 I. Patients with active bladder cancer or with a history of bladder cancer, and those with uninvestigated haematuria, should not receive pioglitazone. 

 II. Prescribers should review the safety and efficacy of pioglitazone in individuals after 3–6 months of treatment to ensure that only patients who are deriving benefit continue to be treated. Pioglitazone should be stopped in patients who do not respond adequately to treatment (e.g. reduction in glycosylated haemoglobin, HbA1c). 

 III. Before starting pioglitazone, the following known risk factors for development of bladder cancer should be assessed in individuals: age; current or past history of smoking; exposure to some occupational or chemotherapy agents such as cyclophosphamide; or previous irradiation of the pelvic region. 

 IV. Use in elderly patients should be considered carefully before and during treatment because the risk of bladder cancer increases with age. Elderly patients should start on the lowest possible dose and be regularly monitored because of the risks of bladder cancer and heart failure associated with pioglitazone.” 

V. The Central Government has banned 344 Fixed Dose Combinations on 10.03.2016, as these combinations lacked therapeutic rationality/ justification. 

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


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Banning of FDC Drugs 



Fixed Dose Combinations (FDCs) containing drugs combined together for the first time are treated as ‘New Drugs’. These, therefore, require permission from the Drugs Controller General (India) [DCG(I)] before these could be licensed by the State Licensing Authorities (SLAs) for manufacture for sale in the country. Many SLAs had, despite not having the authority to grant licences for new FDCs, continued to grant licences without approval of the DCG(I). In order to address this issue, the Ministry of Health and Family Welfare issued statutory directions to the State Governments to instruct their respective drugs licensing authorities to refrain from granting such licenses. However, the practice was still not discontinued by some of the SLAs. 

 The Department Related Parliamentary Standing Committee (PSC) on Health and Family Welfare had, in its 59th Report, observed that some State Licensing Authorities had issued manufacturing licences for a very large number of FDCs without prior clearance from CDSCO and this had resulted in the availability of many FDCs in the market which have not been tested for efficacy and safety. The Committee had also noted that this could put patients at risk. 

 The Parliamentary Standing Committee had also expressed the view that those unauthorized FDCs that pose risk to patients and communities, such as a combination of two antibacterials, need to be withdrawn immediately due to the danger of developing resistance that would affect the entire population. DCG(I) had requested all State/UT Drug Controllers to ask the concerned manufacturers in their States to prove the safety and efficacy of such FDCs as had been licensed by SLAs prior to 01.10.2012 without obtaining the approval of DCG(I) within a period of 18 months, failing which, such FDCs would be considered for being prohibited for manufacture and marketing in the country. In reply, CDSCO received approximately 6320 applications from manufacturers for proving the safety and efficacy of these FDCs. On scrutiny, it was observed that many FDCs are being manufactured by a number of applicants. With the approval of the Ministry, CDSCO constituted 10 Expert Committees on 03.02.2014 for examining the safety and efficacy of these FDCs. These Committees could, however, examine only about 295 applications. Subsequent to that the Central Government appointed an Expert Committee to examine the matter. The Committee was also assisted by eminent experts in different therapeutic areas from premier Medical Institutions and hospitals. The Expert Committee, after detailed examination and deliberations recommended that some of these FDCs lacked therapeutic justification; were found to be pharmacokinetically or pharmacodynamically incompatible; had abuse potential; or could lead to antibiotic resistance in the population. The Expert Committee carried out a comprehensive review of the FDCs keeping in view the contemporary scientific knowledge and expertise. On the basis of the recommendations of the Expert Committee, the Government examined the matter further and requested the Committee to provide specific reasons in respect of each FDC that was found to be irrational. The Committee, accordingly reviewed the matter further and finalized its recommendations. After careful consideration of the matter, the Government issued show cause notices to all the manufacturers whose products were found to be irrational and who had submitted their applications to the Central Drugs Standard Control Organization. At the request of the manufacturers, additional time of three months was given to them to respond to the show cause notices. Thereafter, after due consideration of the report and replies, the Government vide Gazette Notifications S.O. Nos.705(E) to 1048(E) dated 10.03.2016 prohibited the manufacture for sale, sale and distribution for human use of 344 FDCs with immediate effect in public interest as use of such FDCs was likely to involve risk to human beings whereas safer alternatives to these drugs were available. The FDCs that have been held irrational had been licensed by the State Licensing Authorities without approval of the DCG(I). However, in case of a few of these FDCs, approval had also been given by the DCGI. 

 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 Stop Smoking Menace 



A nationally representative study on smoking and death in India (published in 2008) found that smoking causes a large and growing number of premature deaths in the country. The study estimated that in 2010, the annual number of deaths from smoking in India would be around 10 lakhs. 

 The Government has taken measures including, inter alia, the following to curb smoking: 

 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 ban smoking in public places. 

 V. Notification of rules to regulate depiction of tobacco products or their use in films and TV programmes. 

 VI. Notification of rules on new pictorial health warnings on tobacco product packages. 

 VII. Launch of public awareness campaigns through a variety of media. 

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


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Special Focus on Diabetic Prevention 



   

As per a newspaper report, an article published in Lancet Journal states that India is among the top three countries in the world with high diabetic population.  It has also been stated therein that the prevalence of diabetes has increased by 80 per cent among women in India between 1980 to 2014. 

As per International Diabetes Federation, estimated number of people with diabetes (20-79 years) in India are 65.0 million, 66.8 million and 69.1 million in 2013, 2014 & 2015 respectively.

The Indian Council of Medical Research (ICMR) has undertaken a large scale epidemiological study on Task Force Projects on diabetes “ICMR – India Diabetes Study (ICMR INDIAB) Study” which looked at the prevalence of diabetes in different States.  The prevalence of type 2 diabetes (among women aged ≥ 20 years) in 13 states of the ICMR-INDIAB Study is given in the table below:

ICMR-INDIAB STUDY

STATES/UT-WISE PREVALENCE OF TYPE 2 DIABETES AMONG WOMEN AGED ≥ 20 YEARS IN 13 STATES

State
Rural
Urban
Overall
Punjab
9.5%
9.8%
9.6%
Chandigarh
9.0%
14.3%
10.5%
Bihar
3.1%
10.0%
5.1%
Arunachal Pradesh
4.7%
5.5%
4.9%
Mizoram
2.7%
7.5%
4.2%
Tripura
1.2%
3.7%
2.0%
Jharkhand
3.1%
10.8%
5.2%
Gujarat
4.0%
10.6%
6.2%
Maharashtra
5.9%
7.6%
6.4%
Andhra Pradesh (undivided)
5.3%
11.8%
7.2%
Karnataka
5.5%
9.2%
6.6%
Tamil Nadu
7.0%
12.5%
8.6%
Overall
5.1%
9.3%
6.4%

The theme of the World Health Day 2016 was “Halt The Rise Beat Diabetes”.  

Government of India is implementing National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) which is implemented for interventions up to District level under the National Health Mission. NPCDCS has a focus on awareness generation for behavior and life-style changes, screening and early diagnosis of persons with high level of risk factors and their treatment and referral (if required) to higher facilities for appropriate management for Non-communicable Diseases including Diabetes.  The programme includes creation of awareness in the society for change of lifestyle, dietary patterns, nutrition, etc. which are the major risk factors of diabetes.   

As per the Finance Minister’s budget speech, 2016 there is a proposal for increase of excise duty on aerated waters, containing added sugar or other sweetening matter or flavoured from 18 per cent to 21 per cent.

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 Counter Diabetes



As per the International Diabetes Federation (IDF), the estimated cases of diabetes in India in the age group of 20-70 years are 66.8 million and 69.1 million in 2014 & 2015, respectively.

 While Health is a State subject, the Central Government supplements the efforts of the State Government for improving healthcare. Government of India has launched National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) which is implemented for interventions up to District level under the National Health Mission. NPCDCS has a focus on awareness generation for behavior and life-style changes, screening and early diagnosis of persons with high level of risk factors and their treatment and referral (if required) to higher facilities for appropriate management for Non-communicable Diseases including Diabetes.

 Several awareness initiatives have been undertaken including observance of World Diabetes Day, organising of screening and major awareness events at occasions such as the India International Trade Fair (IITF), Delhi.

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


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Accessible Healthcare in Rural Areas



Public Health being a State subject, the primary responsibility to provide health care facilities lies with the State Governments. To address the healthcare challenges, particularly in rural areas, the National Rural Health Mission (NRHM) was launched in 2005 to supplement the efforts of the State/UT governments to provide accessible, affordable and quality healthcare. The National Rural Health Mission (NRHM) has now been subsumed under the National Health Mission (NHM) as its Sub-Mission, along with National Urban Health Mission (NUHM) as the other Sub-Mission. Under NHM, support is being provided to States/ UTs for strengthening of their healthcare systems including support for setting up and or renovation/up-gradation of public health facilities including on basis of “Time to care norm” in hilly and desert areas, Human Resources etc. based on requirements posed by the States in their Programme Implementation Plans. Under NHM, so far support has been given for 2.89 lakhs additional HR, 30805 new construction and 32856 renovation/upgradation works and 1106 Mobile Medical units for taking healthcare to the doorsteps of the population in rural and hard to reach areas.

 To improve the availability of critical manpower to provide services in public health facilities in rural areas, financial support is provided to States under NHM, inter-alia for giving hard area allowance to doctors for serving in rural and remote areas and for their residential quarters, so that doctors find it attractive to join public health facilities in such areas. In order to encourage the doctors to work in remote and difficult areas, the Post Graduate Medical Education Regulations, 2000 has also been amended to provide:

 (i) 50% reservation in Post Graduate Diploma Courses for Medical Officers in the Government service who have served for at least three years in remote and difficult areas; and,

 (ii) Incentive at the rate of 10% of the marks obtained for each year in service in remote or difficult areas up to the maximum of 30% of the marks obtained in the entrance test for admissions in Post Graduate Medical Courses.

 To remove financial barriers to improve access healthcare, States are being supported to provide large number of services fee of cost to those who access public health facilities. Some key services included are as follows:

• Maternal Health services,

• The Universal Immunization Programme (UIP) that provides immunization against 7 vaccine preventable diseases and free TT vaccination,

• Pulse Polio Immunization [PPI],

• Family Planning supplies and services,

• Child Health services that include both Home Based and facility based New born Care,

• Communicable diseases services:

• Investigation and treatment for Malaria, Kala azar, Filaria, Dengue, JE and Chikungunya,

• Detection and treatment for Tuberculosis

• Detection and treatment for Leprosy,

 Besides the above, under the national initiative of “Janani Shishu Suraksha Karyakram” (JSSK), every pregnant woman is entitled to free delivery, including caesarean section, in public health institutions. The entitlements includes free drugs and consumables, free diagnostics, free diet, free blood wherever required, free transport from home to institution, between facilities in case of a referral and drop back home. Similar entitlements are in place for sick infants up to one year of age and cases of ante natal and post natal complications as well.

 Under the national initiative of Rashtriya Bal Swasthya Karyakram (RBSK), support is being provided to States/UTs for Child Health Screening and Early Intervention Services through early detection and early management of common health conditions classified into 4 Ds i.e Defects at birth, Diseases, Deficiencies, Development delays including disability. Treatment including surgeries at tertiary level is free of cost under this initiative.

 Support under NHM is also provided to States to provide free essential drugs and free essential diagnostics in public health facilities under the NHM - Free Drugs Service and NHM - Free Diagnostic Service.

 Under the Rastriya Swasthya Bima Yojana (RSBY) free hospital care upto Rs 30,000 is provided to poor and vulnerable families.

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


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Equipping Hospitals to Handle Natural Disasters



Since health is a State subject, no such information is maintained centrally and it is the responsibility of the respective State Government/Union Territory to make provision in this regard. There is no proposal under consideration of the Ministry of Health & Family Welfare at this stage to ask all the State Government to make at least one hospital in a district fully equipped with to handle any natural disaster.

 However, on the requests of the State Government, the Central Government sends teams of experts/doctors, equipment, medicines etc. at the time of disaster to help the State Government to handle any medical emergencies.

 As far as the Central Government Hospitals namely, Safdarjung Hospital, Dr. Ram Manohar Lohia Hospital and Lady Hardinge Medical College & associated hospitals are concerned, they are fully prepared to face any natural disaster.

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


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Efforts to Root out Diabetes



As informed by ICMR, earlier, top 3 countries in the world for diabetes prevalence were India, China and USA. But, for the past few years, China has the largest number of diabetes cases in the world. As per International Diabetes Federation (IDF) Diabetes Atlas (7th Edition), China has the largest number of cases of diabetes (109.6 million) followed by India (69.1 million) and United States of America (USA) (29.3 million) in 2015.

 While Health is a State subject, the Central Government supplements the efforts of the State Government for improving healthcare. Government of India has launched National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) which is implemented for interventions up to District level under the National Health Mission. NPCDCS has a focus on awareness generation for behavior and life-style changes, screening and early diagnosis of persons with high level of risk factors and their treatment and referral (if required) to higher facilities for appropriate management for Non-communicable Diseases including Diabetes.

 The Government of India under National Health Mission has launched Rastriya Bal Swasthya Karyakram (RBSK) in order to improve the overall quality of life of children and provide comprehensive care to all the children in the community. This programme involves screening of children from birth to 18 years of age for four Ds - Defects at birth, Diseases, Deficiencies and Development delays including disabilities.

 The Government of India has also launched Rashtriya Kishor Swasthya Karyakram (RKSK) in 2014, for adolescents in the age group of 10-19 years, which promotes behaviour change in adolescents to prevent NCDs including diabetes.

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


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Ramping up of Deworming Programme
Government of India initiated Deworming program in 11 States/UTs in 2015. Now in 2016, the deworming program has been expanded across the country reaching 27 crore children in the age group 1-19 years of age. The State-wise details are given in the table below:
Name of State/UT
Total No. of children targeted on National Deworming Day
Andaman & Nicobar Islands
106891
Andhra Pradesh
10500000
Arunachal Pradesh
529580
Assam
10028003
Bihar
43561977
Chandigarh
252786
Chattisgarh
2360937
Dadra & Nagar Haveli
118372
Daman & Diu
38690
Delhi
3594400
Goa
326378
Gujarat
5046955
Haryana
2853093
Himachal Pradesh
2314011
Jammu Kashmir
5310784
Jharkhand
12685756
Karnataka
14963173
Kerala
7602314
Lakshadweep
19000
Madhya Pradesh
15101901
Maharashtra
14947315
Manipur
1067247
Meghalaya
1166350
Mizoram
258463
Nagaland
851659
Odisha
16800000
Puducherry
437418
Punjab
9500000
Rajasthan
24968744
Sikkim
197518
Tamil Nadu
24317457
Telangana
8100000
Tripura
1084575
Uttar Pradesh
10500408
Uttarakhand
2292603
West Bengal
16032263
Total
269837021


As per the World Health Organization (WHO) database (2012), it is estimated that 241 million children (68%) between the ages of 1 – 14 years in India are at risk of parasitic intestinal worms.
The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.

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Draft Guidelines for Organ Donation 

Draft guidelines for kidney had been placed in public domain for seeking comments and suggestions from the general public. Based on the comments received, the Government has since finalized the said guidelines and issued Allocation Criteria for deceased donor kidney transplant which have been uploaded on the website of National Organ and Tissue Transplant Organization (NOTTO) namely www.notto.gov.in.  The allocation policy for organs has been developed keeping in view the ethical, legal and scientific rationale. Further, these guidelines provide for allocation of kidney in a transparent manner. Draft guidelines for Liver and Heart have been prepared/placed on the NOTTO website for seeking comments from public and stakeholders.


These guidelines concern allocation criteria of organs from cadaver donors and not the illegal trading of organs. The illegal trading and transplantation of organs is regulated in terms of the Transplantation of Human Organs and Tissues Act, 1994 and Transplantation of Human Organs and Tissues Rules 2014, which are available on the NOTTO website namely www.notto.gov.in .

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

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Role of Global Fund on TB, HIV and Malaria Control Programme 



The Global Fund plays a substantial role in care, support and treatment component of India’s National AIDS Control Programme.  At present through the New Funding Model grant Global Fund supports implementation of  ART Centres by providing cost of ARV drugs, purchasing of CD4 Machines, scale up of viral load testing, Airborne Infection Control activities, Development of IT based monitoring and evaluation system, approved operational researches, and a part of human resource costs. This is a two year grant from October 2015 to December 2017. Global Fund through its earlier grants supported Human Resource & ARV Drug costs of ART Centres.

The Global Fund support to India also plays substantial role in scaling up the diagnostic and treatment services for TB patients, especially the Drug resistant TB patients. The Global Fund has been increasing its contribution towards TB control program in India since 2003-2004.

The figures for last three years are given below.

 (Figures in crores of Rupees)

Year
Amount of Global Fund Contribution for Care , Support and treatment  in National AIDS & STD Control Programe
Total expenditure on National AIDS & STD Control Programe
%
2015-16
490.48
1601.25
30.63
2014-15
126.35
1287.39
9.81
2013-14
412.83
1473.16
28.02

There has been token provisioning of Rs. 0.01 lakh for the replenishment of Global Fund during last three years in grant of Department of AIDS Control (National AIDS Control Organization),   but no demand to replenish the Global Fund has been received as such no payment has been made by National AIDS Control Organization.

The present agreement with Global Fund under “New Funding Model “effective from October 2015 ends in December, 2017.

The Government plans to sustain the programme after year 2017 through domestic budgetary support.

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

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Certification for New TB Drug
World Health Organization has made conditional recommendation for use of Bedaquiline for treatment of Multi drug resistant TB in adult patients. An Expert Committee on Regulation of Newer anti-TB drugs in India examined the matter and approved the drug for conditional use in Revised National TB Control Programme (RNTCP).

The drug has been approved by the Drug Controller General of India under Conditional Access Programme for its use only through Revised National TB Control Programme.

The said drug has been tested in human beings by the producer, i.e. Janssen in phase II, stage 1 and stage 2 clinical trials which were conducted in different settings. A total of 515 patients were given the new drug for 24 weeks in the above mentioned trials.

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

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