National Health Programmes and Health Plans

What to remember

• Health planning in India moved from the Bhore Committee (1946) to the National Health Policies (1983, 2002, 2017) and the National Health Mission, which has two parts: rural (NRHM, 2005) and urban (NUHM, 2013).
• Most programmes reach the community through the sub-centre, the ANM, the ASHA and the Anganwadi worker, so the Multi-Purpose Health Assistant must know each programme's target group, service and key number.
• Disease control programmes are named by disease (TB, leprosy, malaria, blindness, HIV), while reproductive and child health programmes are named by the service (JSY, JSSK, RBSK, RKSK).

1. Health planning and committees

Health planning means setting goals for health, deciding how to reach them, and using resources well. India began planned development in 1951 with Five Year Plans. Health committees gave the main ideas.

Primary health care has the following principles: equitable distribution, community participation, intersectoral coordination, appropriate technology and focus on prevention.

2. Three-tier rural health structure

Worked example: a plain-area population of 25,000 needs 25,000 ÷ 5,000 = 5 sub-centres. A population of 90,000 needs 90,000 ÷ 30,000 = 3 PHCs.

Village-level workers: one ASHA (Accredited Social Health Activist) for about 1,000 population; one Anganwadi worker for a similar community under ICDS. A population of 4,000 therefore needs 4 ASHAs by norm.

Health and Wellness Centres (Ayushman Bharat) are upgraded sub-centres and PHCs. They offer comprehensive primary care, including screening for non-communicable diseases, and are led by a mid-level health provider. They are now also called Ayushman Arogya Mandir.

3. National Health Mission (NHM)

NHM combines the National Rural Health Mission (launched 2005) and the National Urban Health Mission (2013). Its aims are universal access to equitable, affordable and quality health care. Key features: community ownership through village health committees, ASHA, untied funds to sub-centres, strengthening of district health systems, and flexible financing. The mission works through the RMNCH+A approach, which means reproductive, maternal, newborn, child and adolescent health.

4. Reproductive, maternal, child and adolescent health programmes

Universal Immunisation Programme (UIP): covers vaccines against diseases such as tuberculosis, diphtheria, pertussis, tetanus, polio, hepatitis B, measles and others. Pulse Polio was launched in 1995, and India was certified polio-free by WHO in 2014. Vitamin A prophylaxis starts at 9 months along with measles-containing vaccine and continues at six-monthly intervals up to 5 years.

Family planning: the programme was started in 1952. It promotes spacing methods (condoms, IUCD, oral pills, injectable contraceptive) and limiting methods (male and female sterilisation). Mission Parivar Vikas focuses on districts with high fertility.

5. Disease control programmes

Worked example: in a population of 50,000, a leprosy prevalence of 4 cases gives 4 ÷ 50,000 × 10,000 = 0.8 per 10,000, which is below the elimination level.

6. Health insurance and Andhra Pradesh initiatives

Ayushman Bharat has two parts: Health and Wellness Centres for primary care and the Pradhan Mantri Jan Arogya Yojana (PM-JAY, 2018) for secondary and tertiary hospital care for poor families. Andhra Pradesh has its own health assurance scheme, now called Dr NTR Vaidya Seva (earlier Rajiv Aarogyasri and Dr YSR Aarogyasri), which covers hospital treatment for eligible families through network hospitals. The state also runs the 108 emergency ambulance and 104 mobile health services, village health clinics at village level and family doctor type outreach. Scheme names and coverage change often, so check the latest official release.

7. Role of the health assistant and ANM in programmes

The ANM registers pregnant women, gives antenatal care, immunises, conducts home visits, distributes iron tablets, contraceptives and ORS, and keeps records. The health assistant supervises the health workers, helps outbreak control, and monitors the quality of work. Records include the due list, the immunisation card and the Mother and Child Protection Card.

8. Monitoring, records and community participation

Programmes work only when the community takes part. Village Health, Sanitation and Nutrition Committees plan local action and use untied funds. The Village Health and Nutrition Day is held at the Anganwadi centre, where immunisation, antenatal care, growth monitoring and health education are given together. The ANM keeps registers for births, deaths, eligible couples, pregnant women and children, and sends monthly reports to the PHC. Supportive supervision by the health assistant and medical officer helps find gaps. Referral means sending a patient to a higher centre with a note, and the ANM follows up after return. Good records allow the due list to be updated and ensure that no mother or child is missed. Indicators such as institutional delivery, full immunisation, and antenatal registration in the first three months show how well the programmes are working.

Exam traps

• NRHM began in 2005, NUHM in 2013: do not swap them.
• JSY is a cash incentive scheme; JSSK gives free services. Do not mix the two.
• RBSK is for children (4 Ds); RKSK is for adolescents (10-19 years).
• The Bhore Committee is 1946; the Alma-Ata Declaration is 1978.
• Sub-centre norm is 5,000 (plain) but PHC norm is 30,000; CHC is 1,20,000.
• NTEP is the new name of RNTCP; the strategy name is DOTS.
• Kartar Singh Committee suggested multi-purpose workers; Shrivastava Committee suggested village health workers from the community.
• Pulse Polio started in 1995; polio-free certification was in 2014.

One-liners

• The Bhore Committee proposed integrated preventive and curative health services.
• Alma-Ata 1978 declared "Health for All" through primary health care.
• One ASHA serves about 1,000 population.
• The sub-centre is the first contact point between the community and the health system.
• A CHC works as a first referral unit with specialists.
• JSY promotes institutional delivery.
• JSSK entitles pregnant women to free transport and diet.
• RBSK screens for defects, diseases, deficiencies and developmental delays.
• RKSK is for the age group 10-19 years.
• NTEP uses the DOTS strategy.
• NLEP uses multi-drug therapy.
• National Health Policy 2017 stresses assured comprehensive primary health care.

Practice questions

1. Which committee of 1946 laid the foundation of India's modern health system with integrated preventive and curative services?

   1. Chadha Committee
   2. Bhore Committee
   3. Kartar Singh Committee
   4. Mudaliar Committee
   Answer

   B. Bhore Committee

   The Health Survey and Development (Bhore) Committee of 1946 proposed integrated services.

2. The Alma-Ata Declaration of 1978 gave the goal of

   1. Eradication of smallpox
   2. Free medical education
   3. Universal hospital insurance
   4. Health for All through primary health care
   Answer

   D. Health for All through primary health care

   Alma-Ata stressed primary health care to achieve Health for All.

3. The National Rural Health Mission was launched in

   1. 2013
   2. 1995
   3. 2011
   4. 2005
   Answer

   D. 2005

   NRHM began in 2005; NUHM followed in 2013.

4. The National Urban Health Mission was launched in

   1. 2018
   2. 2013
   3. 2005
   4. 2008
   Answer

   B. 2013

   NUHM started in 2013 and with NRHM forms the National Health Mission.

5. The Kartar Singh Committee recommended

   1. a single-purpose malaria worker
   2. multi-purpose health workers
   3. private health insurance
   4. only hospital-based care
   Answer

   B. multi-purpose health workers

   It suggested merging single-purpose workers into multi-purpose workers.

6. Janani Suraksha Yojana mainly promotes

   1. institutional delivery through a cash incentive
   2. screening for childhood defects
   3. free immunisation of adolescents
   4. iron supplementation in schools
   Answer

   A. institutional delivery through a cash incentive

   JSY gives a cash incentive to promote delivery in health facilities.

7. Free transport, diet and drugs for pregnant women and sick newborns are provided under

   1. Rashtriya Kishor Swasthya Karyakram
   2. Mission Indradhanush
   3. National Leprosy Eradication Programme
   4. Janani Shishu Suraksha Karyakram
   Answer

   D. Janani Shishu Suraksha Karyakram

   JSSK (2011) entitles mothers and sick newborns to free services.

8. The 4 Ds screened under the Rashtriya Bal Swasthya Karyakram are

   1. defects at birth, diseases, deficiencies, developmental delays
   2. disability, death, disease, disorder
   3. diarrhoea, dengue, diphtheria, dysentery
   4. diet, drugs, doctors, diagnosis
   Answer

   A. defects at birth, diseases, deficiencies, developmental delays

   RBSK screens children for defects, diseases, deficiencies and developmental delays.

9. Rashtriya Kishor Swasthya Karyakram is meant for the age group

   1. 20-29 years
   2. 10-19 years
   3. 0-5 years
   4. 5-10 years
   Answer

   B. 10-19 years

   RKSK addresses adolescents aged 10-19 years.

10. In India the DOTS strategy is used for treatment of

    1. leprosy
    2. filariasis
    3. malaria
    4. tuberculosis
    Answer

    D. tuberculosis

    DOTS (directly observed treatment) is the TB treatment strategy under NTEP.

11. The National Tuberculosis Elimination Programme was earlier known as

    1. Revised National Tuberculosis Control Programme
    2. National AIDS Control Programme
    3. National Malaria Eradication Programme
    4. Leprosy Control Programme
    Answer

    A. Revised National Tuberculosis Control Programme

    RNTCP was renamed NTEP.

12. India was certified polio-free by the World Health Organization in

    1. 2005
    2. 2014
    3. 2020
    4. 1995
    Answer

    B. 2014

    Polio-free certification for the South-East Asia Region including India came in 2014.

13. Pulse Polio Immunisation was started in India in

    1. 1995
    2. 1978
    3. 2005
    4. 1985
    Answer

    A. 1995

    The Pulse Polio campaign began in 1995.

14. Under the National Leprosy Eradication Programme, elimination is defined as less than

    1. 1 case per 1,00,000 population
    2. 1 case per 1,000 population
    3. 5 cases per 10,000 population
    4. 1 case per 10,000 population
    Answer

    D. 1 case per 10,000 population

    The elimination target is a prevalence below 1 per 10,000.

15. Which programme was started in 1982 and extended to districts in 1996?

    1. Mission Parivar Vikas
    2. National Programme for Control of Blindness
    3. National Mental Health Programme
    4. National Iodine Deficiency Disorders Control Programme
    Answer

    C. National Mental Health Programme

    NMHP began in 1982; the District Mental Health Programme was added in 1996.

16. The first contact point between the community and the health system in the rural structure is the

    1. sub-centre
    2. Community Health Centre
    3. medical college hospital
    4. district hospital
    Answer

    A. sub-centre

    The sub-centre, staffed by the ANM, is the first contact point.

17. A Community Health Centre mainly works as a

    1. village-level outreach post
    2. school health unit
    3. private clinic
    4. first referral unit with specialists
    Answer

    D. first referral unit with specialists

    CHCs provide specialist care and receive referrals from PHCs.

18. Ayushman Bharat Health and Wellness Centres are created by upgrading

    1. sub-centres and primary health centres
    2. district hospitals only
    3. medical colleges
    4. private nursing homes
    Answer

    A. sub-centres and primary health centres

    HWCs upgrade existing sub-centres and PHCs for comprehensive primary care.

19. The Pradhan Mantri Surakshit Matritva Abhiyan offers free antenatal check-up by a doctor on

    1. the 1st of every month
    2. the 9th of every month
    3. the last day of every month
    4. every Sunday
    Answer

    B. the 9th of every month

    PMSMA provides a fixed-day antenatal check-up on the 9th.

20. Weekly Iron Folic Acid Supplementation is aimed at

    1. old persons
    2. adolescents
    3. newborns only
    4. lactating women only
    Answer

    B. adolescents

    WIFS gives weekly iron-folic acid tablets to adolescents.

21. The ASHA is the village-level worker under the

    1. National Literacy Mission
    2. National Health Mission
    3. Swachh Bharat Mission
    4. Pulse Polio programme only
    Answer

    B. National Health Mission

    ASHA is the community link worker of NHM.

22. Which of the following diseases is covered by the NCVBDC?

    1. Tuberculosis
    2. HIV
    3. Leprosy
    4. Dengue
    Answer

    D. Dengue

    Vector borne diseases such as dengue, malaria and filariasis fall under NCVBDC.

23. Cataract surgery and eye donation are promoted under

    1. National Mental Health Programme
    2. National Leprosy Eradication Programme
    3. National Programme for Control of Blindness and Visual Impairment
    4. Mission Indradhanush
    Answer

    C. National Programme for Control of Blindness and Visual Impairment

    NPCB&VI works to reduce blindness.

24. Mission Indradhanush is intended to

    1. supply free spectacles
    2. screen newborns for hearing loss
    3. vaccinate children and pregnant women who were missed
    4. promote family planning only
    Answer

    C. vaccinate children and pregnant women who were missed

    It is a catch-up immunisation drive.

25. A plain area has a population of 25,000. By the norm of 5,000 per sub-centre, how many sub-centres are needed?

    1. 3
    2. 4
    3. 5
    4. 6
    Answer

    C. 5

    25,000 ÷ 5,000 = 5.

26. A plain-area population of 90,000 needs how many PHCs at one PHC per 30,000?

    1. 3
    2. 2
    3. 4
    4. 5
    Answer

    A. 3

    90,000 ÷ 30,000 = 3.

27. By the norm of one ASHA per 1,000 population, a village cluster of 4,000 people needs how many ASHAs?

    1. 2
    2. 3
    3. 8
    4. 4
    Answer

    D. 4

    4,000 ÷ 1,000 = 4.

28. A hilly area has a population of 12,000. At one sub-centre per 3,000, the sub-centres needed are

    1. 2
    2. 4
    3. 3
    4. 5
    Answer

    B. 4

    12,000 ÷ 3,000 = 4.

29. In a population of 50,000 there are 4 leprosy cases. The prevalence per 10,000 is

    1. 4
    2. 0.8
    3. 8
    4. 0.4
    Answer

    B. 0.8

    4 ÷ 50,000 × 10,000 = 0.8.

30. A population of 2,40,000 in a plain area needs how many CHCs at one per 1,20,000?

    1. 1
    2. 3
    3. 4
    4. 2
    Answer

    D. 2

    2,40,000 ÷ 1,20,000 = 2.

31. In a block with 300 pregnant women, 240 deliver in health facilities. The percentage of institutional deliveries is

    1. 80
    2. 90
    3. 75
    4. 60
    Answer

    A. 80

    240 ÷ 300 × 100 = 80.

32. A PHC in a hilly area serves 20,000 people. For 60,000 people, the number of PHCs by the hilly norm is

    1. 2
    2. 4
    3. 3
    4. 6
    Answer

    C. 3

    60,000 ÷ 20,000 = 3.

33. A health team vaccinates 180 of 200 eligible children. Coverage is

    1. 90%
    2. 85%
    3. 80%
    4. 95%
    Answer

    A. 90%

    180 ÷ 200 × 100 = 90%.

34. Statements: 1. Janani Suraksha Yojana was launched in 2005. 2. Rashtriya Bal Swasthya Karyakram is meant for adolescents aged 10-19 years. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    JSY began in 2005; RBSK is for children 0-18 years, while RKSK is for adolescents.

35. Statements: 1. NTEP uses the DOTS strategy. 2. NLEP uses multi-drug therapy. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    C. Both 1 and 2

    Both programmes use these standard approaches.

36. Statements: 1. A sub-centre serves about 5,000 population in plain areas. 2. A PHC serves about 1,20,000 population in plain areas. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    A PHC serves about 30,000; a CHC serves about 1,20,000.

37. Statements: 1. The Bhore Committee was set up in 1978. 2. The Alma-Ata Declaration was adopted in 1946. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    D. Neither 1 nor 2

    Bhore Committee was 1946 and Alma-Ata 1978; both statements swap the years.

38. Statements: 1. NHM includes both NRHM and NUHM. 2. PM-JAY is a part of Ayushman Bharat. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    C. Both 1 and 2

    NHM combines the rural and urban missions, and PM-JAY is a pillar of Ayushman Bharat.

39. Statements: 1. The Kartar Singh Committee suggested multi-purpose workers. 2. JSSK gives a cash incentive only for institutional delivery. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    JSSK gives free services; the cash incentive belongs to JSY.

40. Statements: 1. Mission Indradhanush is a catch-up immunisation drive. 2. Pulse Polio was launched in 1995. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    C. Both 1 and 2

    Both statements are accurate.

41. Statements: 1. The National Mental Health Programme began in 1982. 2. The District Mental Health Programme began in 1996. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    C. Both 1 and 2

    NMHP was launched in 1982 and DMHP followed in 1996.

42. Statements: 1. A CHC acts as a first referral unit. 2. A sub-centre is staffed by specialist doctors. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    Sub-centres are staffed by the ANM and a male worker, not specialists.

43. Match: (a) JSY, (b) RBSK, (c) RKSK, (d) PMSMA with (i) adolescents, (ii) institutional delivery incentive, (iii) child screening, (iv) 9th of the month antenatal check-up. Choose the correct pairing.

    1. a-ii, b-i, c-iii, d-iv
    2. a-ii, b-iii, c-i, d-iv
    3. a-iv, b-iii, c-i, d-ii
    4. a-iii, b-ii, c-i, d-iv
    Answer

    B. a-ii, b-iii, c-i, d-iv

    JSY-incentive, RBSK-child screening, RKSK-adolescents, PMSMA-9th of the month.

44. Match: (a) Bhore, (b) Kartar Singh, (c) Alma-Ata, (d) NHP 2017 with (i) Health for All, (ii) integrated services, (iii) multi-purpose workers, (iv) assured primary care. Choose the correct pairing.

    1. a-i, b-ii, c-iii, d-iv
    2. a-ii, b-i, c-iii, d-iv
    3. a-iii, b-ii, c-i, d-iv
    4. a-ii, b-iii, c-i, d-iv
    Answer

    D. a-ii, b-iii, c-i, d-iv

    Bhore-integration, Kartar Singh-multi-purpose, Alma-Ata-Health for All, NHP 2017-assured primary care.

45. Which programme is correctly matched with its focus?

    1. NLEP - HIV
    2. NPCB&VI - blindness
    3. NCVBDC - iodine deficiency
    4. NACP - leprosy
    Answer

    B. NPCB&VI - blindness

    NPCB&VI deals with blindness; the other pairs are wrong.