GoM proposal 31 st October, 2012 Directorate of National Vector - - PowerPoint PPT Presentation

Meeting of Health Secretaries Under the Chairmanship of Secretary (Health & Family Welfare) to deliberate on approved GoM proposal

31st October, 2012

Directorate of National Vector Borne Disease Control Programme (Directorate General of Health Services) Ministry of Health and Family Welfare

• Govt. of India

1

Cabinet approval

• n

18.10.2012 for Prevention and Control of Japanese Encephalitis (JE)/Acute Encephalitis Syndrome (AES) as recommended by GoM

2

Goal

Reduce morbidity, mortality and disability in children due to JE/AES.

3

Reported JE/AES Cases and Deaths

4

2871 4110 3855 4975 5167 8249 7286 663 995 684 779 679 1169 1065 23.09 24.21 17.74 15.66 13.14 14.17 14.62 0.00 5.00 10.00 15.00 20.00 25.00 30.00 1000 2000 3000 4000 5000 6000 7000 8000 9000 2006 2007 2008 2009 2010 2011 2012 till 29.10.2012 CFR (%)

• No. of Cases and Deaths

Year Cases Deaths CFR

ASSAM

TAMIL NADU

JE/AES 60 High Priority Districts

Assam 10 Districts Bihar 15 Districts West Bengal 10 Districts Tamil Nadu 5 Districts Uttar Pradesh 20 Districts

5

SONITPUR TINSUKHIA JORHAT DHEMAJI DIBRUGARH GOLAGHAT BARPETA LAKHIMPUR SIBSAGAR UDALGURI

ASSAM

• No. of districts under GoM – Assam

District under GoM- 10

6

• No. of districts under GoM – Bihar

GAYA PATNA SARAN ARARIA SIWAN NAWADA CHAMPARAN WEST NALANDA CHAMPARAN EAST VAISHALI DARBHANGA MUZAFFARPUR SAMASTIPUR GOPALGANJ JEHANABAD

BIHAR

District under GoM- 15

7

VILLUPURAM MADURAI KARUR THANJAVUR THIRUVARUR

TAMIL NADU

• No. of districts under GoM – Tamil Nadu

District under GoM- 5

8

• No. of districts under GoM – Uttar Pradesh

KHERI HARDOI SITAPUR GONDA BASTI BAHRAICH BALLIA MAU AZAMGARH DEORIA SAHARANPUR RAEBARELI BALRAMPUR KUSHINAGAR GORAKHPUR SRAWASTI KANPUR(DEHAT) MAHARAJGANJ SANT KABIR NAGAR

UTTAR PRADESH

District under GoM- 20

9

BANKURA BARDHAMAN JALPAIGURI HUGLI BIRBHUM MALDAH PASCHIM MEDINIPUR DARJILING HOWRA DAKSHIN DINAJPUR

WEST BENGAL

• No. of districts under GoM – West Bengal

District under GoM- 10

10

Objectives-(1)

• Strengthen and expand JE vaccination in

affected districts;

• Strengthen surveillance, vector control,

case management and timely referral of serious and complicated cases;

• Estimate disability burden due to JE/AES,

and to provide for adequate facilities for physical, medical, neurological and social rehabilitation;

11

Objectives-(2)

• Provide fixed monthly compensation to

families having children with disability due to JE/AES;

• Increase access to safe drinking water and

proper sanitation facilities to the target population in affected rural and urban areas.

• Improve nutritional status of children at

risk of JE/AES;

• Carry out intensified IEC/BCC activities

regarding JE/AES.

12

Participating Ministries

• Health and Family Welfare
• Drinking Water and Sanitation
• Social Justice and Empowerment
• Women and Child Development
• Urban Development
• Rural Development

13

Activities to be taken by Ministries/Departments

Strengthening of Public Health Activities as per Model Action Plan

• Model action plan including public health measures

developed.

• The model action plan envisages community based

surveillance, entomological surveillance, vector control, and IEC/BCC capacity building involving community volunteers

• This action plan to be implemented in 60 high

priority districts of 5 states.

14

Activities to be taken by Ministries/Departments

JE Vaccination in Campaign and Routine modes

• Vaccination most effective tool available against Japanese

Encephalitis

• 109 districts covered under JE vaccination as part of

Universal Immunization Programme (UIP).

• 62 new districts to be brought under JE vaccination in

phased manner

• New areas will also be covered based on epidemiological

evidence

• The total Estimated Cost for Japanese Encephalitis-

Campaign and Routine Immunization in 171 Districts is Rs. 200.71 cr.

15

Activities to be taken by Ministries/Departments

Better Clinical Management of JE/AES Cases

• Early detection of symptoms of by doctors helps in

quick referral of serious cases to well-equipped hospitals.

• For achieving above objective capacity building of

medical and para-medical staff and adequate facilities at district hospitals essential.

• 10 bedded well-equipped intensive care unit (ICU)

in 60 priority districts to be established.

• The total estimated cost for Establishment of

Pediatric Intensive Care Unit at District Hospitals is Rs 549.21 cr.

16

Activities to be taken by Ministries/Departments Strengthening

• f

Surveillance and Diagnostic Facilities

• 54 JE surveillance and diagnostic centers

already established.

• For further strengthening the surveillance, 20

new sites in 5 states.

• The total estimated cost for Estimated Cost

for Establishing 20 New Surveillance Sites and Strengthening of existing 54 sites at Medical College/District Hospitals is Rs 13.54cr.

17

Activities to be taken by Ministries/Departments

Physical Medicine and Rehabilitation

• 30 to 40 per cent of surviving children suffer from

physical and/or mental impairment.

• For addressing above issue 10 physical medicine

and rehabilitation centre to be established at identified medical colleges.

• The centre will be equipped to provide specialized

care to persons with loco-motor & neurological disorders with focus on reducing disability & handicap.

• The total Establishing PMR Dept at 10 Identified

Medical Colleges in 5 states is Rs 168.55 cr.

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Activities to be taken by Ministries/Departments

Establishing District Counseling Centres

• Rehabilitation of the surviving disabled patients is an

important component of the overall programme strategy

• 10 medical colleges across 5 States have been

identified for addressing this problem and for providing physical rehabilitation to AES/JE affected patients.

• These patients as well as their parents/attendants

need to be counseled as some of the post recovery sequelae involve, loss of speech and hearing, irritability, locomotor and behavioural disorder.

• The total Establishing Counseling Centre at 60 District

Hospitals in 5 States to Rs. 13.30 crores.

19

Activities to be taken by Ministries/Departments

Monitoring, Supervision and Coordination

• AES/JE problem in the country suggests a multi-

pronged approach involving different Ministries for effectively talking the menace at the grass- root level.

• The inter-Ministerial/departmental convergence

requires an intensive monitoring, supervision and coordination at MOH&FW.

• For this purpose a estimated cost of Monitoring

Supervision and Coordination Rs.49.83 crores has been proposed.

20

Role of Responsibilities

• f other

Ministries

21

Ministry wise Allocation

S. No. Ministry/ Department Estimated Costs (Rs. In crore) 1. Ministry of Health and Family Welfare 1131.49 2. Ministry of Drinking Water and Sanitation DW - 750.23

• Sani. – 1551.34

Total – 2301.57 3. Ministry

• f

Housing and Urban Poverty Alleviation 418.00 3. Ministry of Social Justice and Empowerment 9.19 4. Ministry of Women and Child Development 177.85 Total 4038.10

22

Activity wise Health Ministry Allocation for Prevention & Control of JE/AES

S. No. Sub-Component Estimated Cost (Rs. in Crore) 1 Strengthening Public Health Activities in 60 districts 101.34 2 JE Vaccination 200.72 3 Establishment of Pediatric ICUs at 60 district hospitals 549.21 4 Establishmentof 20 New JE/AES Surveillance Sites 13.54 5 Establishmentof PMR Dept. at 10 Medical Colleges 168.55 6 Establishmentof 60 District Counselling Centres 13.30 7 Research-Cum-Intervention Projects 35.00 8 Monitoring& Coordination 49.83 Total 1131.49

Ministry of Drinking Water and Sanitation

The Ministry of Drinking Water and Sanitation will undertake following activities to improve supply of drinking water and its quality in 60 priority districts

• Installation of new IM-II hand pumps to replace public shallow hand

pumps.

• Mini water supply scheme in habitations where JE/AES cases are

reported, with energized deep bore-well and stand posts with adequate number of taps and provision for chlorination. In States/habitations where piped water supply schemes are existing in the affected areas, they can alternatively utilize this fund for extension of pipelines, installation of disinfection units like UF/AC, UV, Electro-chlorinator, and related activities for controlling bacteriological contamination.

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Cont…….

• Water safety measures for drinking water sources in the

affected areas; immediate repairs of hand pump platform, raising of hand pump platforms in flood prone areas, construction of soakage pits, chlorination, etc.

• Solid and Liquid waste management in the affected

habitations/districts.

• Awareness generation and capacity building of local

community and field level engineers and technicians.

• Water quality testing of all public sources in the 60 districts

with sample testing for virological examination.

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Activities to improve access to sanitation facilities

• Effective demand generation for sanitation

facilities through awareness creation and IEC

• Incentivising BPL households for construction

and usages of sanitation facilities.

• Providing interest free loans out of revolving

fund to APL households.

• Providing sanitation facilities in schools and

anganwadis housed in government buildings

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For initial phase of the Programme, following state- wise releases be considered for 60 priority districts

State

• No. of

District s (Rs. in crore) Drinking Water Sanitation Drinking Water & Sanitation Assam 10 70 50 120 Bihar 15 75 60 135 Tamil Nadu 5 20 10 30 Uttar Pradesh 20 200 120 320 West Bengal 10 40 60 100 Total 60 405 300 705

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Ministry of Housing and Urban Poverty Alleviation (HUPA)

• The Ministry of Housing and Urban Poverty Alleviation has

estimated slum households and slum population at 4.77 lakh and 24.9 lakh respectively in identified 66 municipalities in 43 districts.

• It has been estimated by HUPA that average cost of

providing safe drinking water per household works out to

• Rs. 8700 (approx.).
• The Ministry of HUPA will provide safe drinking water to

each slum household in the identified municipalities at an estimated cost of Rs. 418 crore for a period of 5 years.

• This includes cost of provision as well as operation and

maintenance of water supply.

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Ministry of Social Justice and Empowerment

• The Ministry of Social Justice and Empowerment fulfils its

mandate of providing rehabilitation services to target populations through a network of national institutes, composite regional centres, and district disability rehabilitation centres established across the country.

• The Ministry is also operating various schemes, including

Scheme

• f

Assistance to Disabled Persons for Purchase/Fitting of Aids/Appliances and Deendayal Disabled Rehabilitation Scheme (DDRS) for promoting physical, psychological, social, educational and economic rehabilitation

• f persons with disabilities to enhance their quality of life and

also to enable them to lead a life with dignity.

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Cont………

• The Ministry will also assist the needy persons with

disabilities in procuring durable, sophisticated and scientifically manufactured, modern, standard aids and appliances that can promote their physical, social and psychological rehabilitation on priority basis in 60 districts.

• Similarly, the Ministry will provide grants-in-aid to voluntary

agencies under Deendayal Disabled Rehabilitation Scheme (DDRS) to provide services for pre-school and early intervention, special education, vocational training, community based rehabilitation, and psycho-social rehabilitation in identified 60 districts

30

Ministry of Human Resource Development (Department of School Education)

Children with disabilities due to JE/AES need special facilities for their education for which this Ministry has been assign following roles and responsibilities

• A joint team consisting of officials from Ministry of Human

Resource Development, National Institute of Mental Health and Neuro Sciences (NIMHANS) and Ministry of Social Justice and Empowerment will develop the curriculum.

• The Ministry of Social Justice and Empowerment will set up

special schools and training centres under Deendayal Disabled Rehabilitation Scheme (DDRS) in 60 districts based on assessed needs of affected children.

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Ministry of Women and Child Development

• Poor nutrition is an important risk factor for JE/AES. Therefore, it is critical

that special efforts are made to improve the nutritional status of the children in affected areas.

• The Ministry of Women and Child Development will take steps to improve

the monitoring of feeding of children at the Anganwadi centres with the help of district and state authorities under Integrated Child Development Services (ICDS) in 60 priority districts.

• The Ministry will also take special measures to train and sensitize

Anganwadi workers and their supervisors regarding JE/AESat an estimated cost of Rs. 27.85 crore for 5 years as shown below:

Category Batch Size Cost per Course & per Batch in Rs.

• No. of

Courses per Year (Rs. in Crore) Cost for 1st Year Cost for 5th Years Instructors of AWTCs 25 170000 10 0.17 0.85 Anganwadi Workers 50 20000 2700 5.40 27.00 Total 5.57 27.85

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Cont………

• The Ministry will also provide additional Take Home Ration

(THR) to the moderately undernourished children enrolled under ICDS in 60 most affected districts.

• Currently ICDS does not provide additional THR to

moderately undernourished children.

• Therefore, as a special measure, the Ministry of Women and

Child Development will provide THR to moderately undernourished children in 60 priority districts at an estimated cost of Rs. 150.00 crore (Rs. 50 lakh per district for 60 districts for 5 years).

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Monitoring, Supervision & Coordination

• The complexity involved in the implementation of this

National Programme with inputs, support and supervision from various Ministries/Departments is self-evident.

• Therefore, a Committee will be set up under the

Chairmanship of the Secretary, Department of Health & FW, Ministry of Health and Family Welfare with Secretaries and/or their representatives from the Ministries/Departments

• f

Drinking Water & Sanitation, Women & Child Development, Social Justice & Empowerment, Housing & Urban Poverty Alleviation, School Education and Health Research to supervise and monitor the activities of the Programme in coordination with various stakeholders including State Governments.

34

Cont……

• The Committee will decide on measurable and

time-bound monitoring indicators in respect of each Ministry/Department and monitor the progress on six-monthly basis against the agreed indicators.

• The Committee will also set up a Task Force

consisting of officials and experts from participating Ministries/Departments for making field visits, interacting with state and district authorities and coordinating with other ground level functionaries, besides assessing the progress of different components on the ground.

35

Ministry wise Allocation

S. No. Ministry/ Department Estimated Costs (Rs. In crore) 1. Ministry of Health and Family Welfare 1131.49 2. Ministry of Drinking Water and Sanitation DW - 750.23

• Sani. – 1551.34

Total – 2301.57 3. Ministry

• f

Housing and Urban Poverty Alleviation 418.00 3. Ministry of Social Justice and Empowerment 9.19 4. Ministry of Women and Child Development 177.85 Total 4038.10

36

Activity wise Health Ministry Allocation for Prevention & Control of JE/AES

S. No. Sub-Component Estimated Cost (Rs. in Crore) 1 Strengthening Public Health Activities in 60 districts 101.34 2 JE Vaccination 200.72 3 Establishment of Pediatric ICUs at 60 district hospitals 549.21 4 Establishmentof 20 New JE/AES Surveillance Sites 13.54 5 Establishmentof PMR Dept. at 10 Medical Colleges 168.55 6 Establishmentof 60 District Counselling Centres 13.30 7 Research-Cum-Intervention Projects 35.00 8 Monitoring& Coordination 49.83 Total 1131.49

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