Program Section

Objective

• To improve the safety and efficacy of family welfare services.
• To implement a State specific Safe Abortion Policy, which covers availability of safe abortion services and emergency contraception at all levels of health care.
• To increase access to spacing methods with specific focus on improving IUD utilization
• To shift the camp approach to Fixed Day Service (FDS) approach in all the Primary Health Centres.
• To increase access of prospective clients for terminal family planning methods, especially in pockets of higher order birth.
• To promote NSV as a method for increasing male participation in family planning.
   

Strategies

• Ensuring proper implementation of Family Welfare Programme through periodical review and monitoring along with supportive supervision.
• Ensuring availability of MVA trained doctors at the PHC level to offer safe abortion services and information and services for early confirmation of pregnancy and emergency contraception.
• Social Marketing of condoms, OCP and ECP by ASHAs / AWW / VHN / staff nurse.
• Accelerating the training for the new IUD insertion programme among VHN / ANM / Staff nurses to offer a conscious choice for those not willing to go in for permanent methods
• Organization of IUD insertion camps at the PHC level on ANC clinic and immunization day (ie. Wednesday) and during MMU visits to reach eligible unprotected mothers.
• Widening the choice of clients for availability of sterilization service –laparoscopic surgery, mini lap etc.
• Adopting a combination of fixed day (Thursday) and camp approach for NSV and improving NSV performance through training and BCC.
• Improving operative and post operative care practices to bring down morbidity and mortality due to sterilization.

Sterilization Compensation

On the guidelines of Government of India, Tamil Nadu Government is implementing the increased rate of compensation to the sterilization acceptors for BPL and APL category for the sterilization done in the Government Institutions and accredited Private Hospitals. The financial estimate for the sterilization acceptors for the year 2010 – 11 has been worked out in the following lines.

1. The classification of APL / BPL acceptors for all the sterilization cases done in the Government Hospitals are being collected by this Directorate for 2009-10 and worked out for 2010-11 on the same lines at the rate of Rs.1000/- for BPL / SC / ST and Rs.650/- for APL acceptors of tubectomy and Rs.1,500/- for all vasectomy cases and Rs.20/- for each IUD insertion in Government Institutions.
2. The classification of APL / BPL acceptors for all the sterilization cases done in the Voluntary Organisations and Approved Nursing Homes are being collected by this Directorate for 2009-10 and worked out for 2010-11 on the same lines at the rate of Rs.1,500/- for BPL / SC / ST acceptors of tubectomy and Rs.1,500/- for all vasectomy cases.
3. 10% increase over the performance of 2010-11 is taken into account for estimating performance for 2011-12.

Review meetings

The Review Meetings are conducted every month at State level and District level to improve the performance and strengthening the Monitoring system. For the year 2011-12, it is proposed to conduct two State level Regional Review Meetings once in three months to monitor and improve the Family Welfare Performance. The Deputy Director of Medical, Rural Health Services and Family Welfare, the Mass Education and Information Officer / District Extension Educator, the Statistical Assistant and Junior Administrative Officer will be called for the review meeting. The Principal Secretary to Government, the Mission Director, State Health Mission and the Director of Family Welfare will conduct Regional review meetings every month.

Monitoring and supervisory visits to Districts / Facilities

The Director of Family Welfare, Officers of this Directorate and Staff of Demographic and Evaluation Cell are visiting the districts.

• To monitor the Family Welfare Performance activities.
• Proper Implementation of various Family Welfare schemes.
• To assess the quality of services by carrying out sample check of Family Welfare acceptors and
• To ensure the maintenance of proper records and registers, etc.,.

Performance based rewards to institutions and providers

In order to encourage the District Officers, Institutions, Medical Officers and field staff who rendered their best services in the field of Family Welfare Programme, It is planned to honour the Best Performing Institutions during the year 2011-12 by means of an award. This Award will create healthy competition among various institutions to perform well in family welfare programme particularly under Male Sterilisation and other family welfare methods. The Institutions deserve encouragement by recognizing their efforts and services through award of prizes on the basis of Institution performance.

M & E

Printing of Eligible Couple Register:

Family Welfare cum Eligible Couple Register is the basic record to plan and implement the Family Welfare Programme. Every year during the month of February –March, the Eligible Couple Registers are updated in the Rural and Urban areas and the no. of eligible couples who underwent terminal methods and number of Eligible Couples practicing spacing methods like IUD, OP Users and C.C. Users are estimated. Based on the number of Unprotected Eligible Couples, the field staffs motivate the couples for terminal and spacing methods.

Orientation Workshop on Technical Manuals of Family Planning

Quality of care in sterilization services is a major thrust area in the National Family Welfare Programme for addressing the unmet need in terminal methods. Poor quality of service in terms of technical inputs, processes, interpersonal communications, and limited choice leads to unsatisfied clients which result in under utilization of services as well as morbidity and mortality.

As there is a need to conduct an Orientation Workshop on the following subjects in this State to update the knowledge of Programme Managers and Services providers.

1. Standards of Female and Male Sterilisations
2. Quality Assurance in Family Planning Sterilisations.
3. FDS Approach
4. SOP for camps
    

Procedures for Insurance claims and Settlement.

The aim is to assess the service quality and enable programme managers and service providers both in public and accredited private facilities to provide quality sterilization services. They will be encouraged to take remedial measures and corrective steps for ensuring adherence of procedure prescribed in the manuals.

It is planned to conduct two batches of State Level Orientation Workshops, one for northern region and another for south region. At this workshop, Deans, Joint Director of Health Services, Deputy Director of Medical and Rural Health Services and Family Welfare of all Districts, Deputy Director of Health Services, Project Officers of all Post Partum Centres, Voluntary Organisation, NGOs and Staffs of Insurance dealing hands of all District Family Welfare Bureau will be invited to attend the workshops. Around 250 participants will be expected to participate in each workshop.
 

Tamil Nadu started Immunization programme against these six Vaccine Preventable Diseases during 1978. In order to strengthen the Programme, Universal Immunization Programme (UIP) was launched during 1985 with the aim of achieving 100 % coverage of Infants and Pregnant women.

Annually, around 12.0 pregnant women and 11.0 lakhs infants are being targeted under Immunization programme. The State has reported more than 95 % coverage over the years.

 

* upto March 2015

Pulse Polio Immunization (PPI)

Pulse Polio Immunization campaign was introduced in the year 1995-96. The State had so far conducted 19 series of Pulse Polio Immunization campaign covering 70 lakhs Children under the age of 5 years by administering 2 doses of Oral Polio Vaccine in each round. During 2015, two rounds of pulse polio immunization campaigns have been conducted on 18-01-2015 and 22-02-2015 as part of the Nationwide Intensified Pulse Polio Immunization campaign in order to prevent the importation of polio virus and to sustain the zero polio status.

JE Vaccination

JE vaccination is implemented in selected endemic districts viz., Cuddalore, Villupuram, Virudhunagar, Madurai, Thiruvarur, Trichy, Perambalur, Ariyalur, Thanjavur, Tiruvannamalai, Pudukottai, Karur and Tiruvallur to prevent Japanese Encephalitis.

Pentavalent with new Hib Vaccine

Being a good performing States, GoI have selected Tamil Nadu to implement Pentavalent vaccination. The programme has been implemented from 21-12-2011.

Pentavalent vaccine consisting of DPT, Hepatitis B and Hib is now implemented in all districts which will replace the Hepatitis-B and DPT primary vaccinations besides the new addition of Hib (Haemophilus influn type B). The newly added Hib will prevent serious disease like pneumonia and meningitis. The main advantages of giving Pentavalent vaccination to the children are (1) Protection against 5 life threatening disease. (2) Number of pricks reduced to a child.

Immunization Special Campaign 2015

The Ministry of Health & Family Welfare (MoHFW) GoI, launched Mission Indradhanush in December 2014 to achieve more than 90% full immunization coverage in the country by 2020(from 65% to 90%). A special drive to vaccinate all unvaccinated and partially vaccinated children below 2 year and Pregnant Women under UIP. The government has identified 201 high focus districts across the country that have nearly 50% of all unvaccinated or partially vaccinated children in the country.

In Tamilnadu, the following 8 districts Coimbatore, Kancheepuram, Madurai, Thiruchirapalli, Thirunelveli, Thiruvallur, Vellore and Virudhunagar were identified in the first phase. In the second phase, another 16 Health Unit Districts were being included viz. Nilgiris, Tiruppur, Namakkal, Erode, Karur, Salem, Chennai Corporation, hill areas of districts and urban slum areas of all corporations viz. Dindigul, Palani, Thanjavur, Tuticorin, Dharmapuri, Krishnagiri, Tiruvannamalai, Theni and Kallakurichi.

National Programme for Control of Blindness

The National Programme for Control of Blindness was launched in 1976 to prevent and reduce the prevalence of blindness in the country. It was extended and functioned as the Word Bank assisted Cataract Blindness Control Project till 30.6.2002. The scheme was then converted into a Centrally Sponsored Scheme and is funded as part of the National Rural Health Mission (NRHM) from the year 2005-06.

The main objective of the programme is to reduce the prevalence of preventable blindness. Towards this goal, the Tamil Nadu State Blindness Control Society was formed as a separate entity from 1.4.1996. The Tamil Nadu State Blindness Control Society has been merged with the State Health Society after the implementation of NRHM in the state. The Project Director in charge of the programme is a senior Ophthalmologist of the rank of Additional Director of Medical Education, who is responsible for the smooth implementation of the scheme. He works under the administrative control of the Secretary to Government, Health Department and the financial control of the Mission Director, State Health Society. The District Blindness Control Societies which were formed to govern the activities of the National Blindness Control Programme with the Collector is the Chairman of the Society have also been merged with the District Health Societies formed under NRHM. Each district has a District Programme Manager who is a senior Ophthalmologist in the district.

TAMIL NADU STATE BLINDNESS CONTROL SOCIETY (TNSBCS)

Blindness is a major problem throughout India. National Programme for Control of Blindness (NPCB) was launched in the year 1976 as a 100% centrally sponsored programme with the goal of achieving a prevalence rate of blindness to 0.3% of population. The four pronged strategy of the programme is :

• Strengthening service delivery
• Developing human resources for eye care
• Promotion outreach activities and public awareness
• Developing institutional capacity.
   

The implementing of the programme was decentralized in 1994-1995 with formation of District Blindness Control Society in each district of the country. The Society has taken various steps top create awareness among the public regarding the need for the Eye donation. On 1.4.1996, the Tamil Nadu State Blindness Control Society was formed as a separate entity, to give thrust to the goal by planning, execution and monitoring at the District level. The Tamil Nadu State Blindness Control Society is functioning under the control of Mission Director, State Health Society, National Rural Health Mission, and Chennai with effect from 01.04.2007. The Project Director is the Secretary of the Society for the implementing of the scheme. Every district in the state has one District Blindness Control Society to govern the activities of the National Programme for Control of Blindness.

For effective implementation and monitoring of the work at District level, a District Blindness Control Society has been formed in all the Districts. The District Blindness Control Society conducts eye camps with the help of Voluntary Organisations and District Mobile Ophthalmic Units, provides financial assistance to Voluntary Organisations for performing Cataract Operations, undertakes propaganda activities under health education programme in the District and monitors the implementation of the Blindness Control Programme in District level as per the directions of Government of India/State Government/State Blindness Control Society. District Blindness Control Societies are under the Chairmanship of the District Collectors.

The Cataract, being the major cause for the avoidable blindness, was given importance and various infrastructure facilities like base eye wards, dark rooms etc., have been built till 2002 and are now in use. The State has been a pioneer in tackling blindness, particularly arising from cataract.

• During the year 2012-13 - 6,17,581 persons have been benefitted by cataract surgery.
• During 2013-14 up to March.14, 590382 persons have been benefitted by cataract surgery.
• Target achieved is 131%.
• Against GOI target of 4,50,000 cataract.

 

Government has taken the following measures to increase the cataract surgeries in

1. The District Blindness Control Societies are permitted to hire private Ophthalmic Surgeons to do cataract surgeries in Government Institutions and pay Rs.150/- per cataract case.
2. The District Blindness Control Society is permitted to hire private staff nurses trained in the field of ophthalmic surgery to assist cataract surgeries in Government Institutions and to pay Rs.50/- per cataract case.

The following activities will be carried out during 2104-15

1. Performing cataract operations and fix Intra Ocular Lens (IOL)
2. The other eye diseases like Glaucoma, Retinal diseases, Childhood blindness are also treated in the Madras Medical College and other Medical Colleges in the State with infrastructure facilities provided during the year 2012-13 and 2013-14.
3. Screening of school children for detection of refractive error and provide free spectacles to poor children.
4. Collection of eyes for transplantation in persons with corneal blindness.
5. Providing training to eye surgeons in modern cataract surgery and other specialty procedures.
6. Enhancing capacities for eye care services in public sector by providing assistance to hospitals at various levels.
7. Development of eye banks and eye donation centres to facilitate collection and processing of donated eyes. Eye bank has been functioning at Regional Institute of Ophthalmology and Government Ophthalmic Hospital, Chennai in co-ordination with Lions International and also at Government Medical College Hospitals at Salem, Coimbatore and Vellore.

Vector Borne Disease Control Programme (VBDC)

MALARIA

In Tamil Nadu, Malaria is confined to some of the Urban, Coastal and Riverine areas such as Corporation of Chennai, Ramanathapuram, Paramakudi, Thoothukudi, Kanyakumari, Krishnagiri, Dharmapuri and Thiruvannamalai.

Malaria screening facility is available in all PHCs and Government hospitals. All fever cases have been screened for malaria by collecting blood smears through Active Case Detection and Passive Case Detection. These slides are being examined within 24 hours and if malaria is confirmed, radical treatment being given within 48 hours as per NVBDCP drug schedule.

Due to intensive control measures carried out by the department, the incidence of malaria has been declined considerably. For the year 2013, malaria incidence (15050 cases) has been decreased by 20% when compared with the year 2012 (18869 cases). In TamilNadu, 56.6% of cases are reported from Chennai, 4.4% from other urban malaria scheme towns and 39% were reported from rural areas.

The goal of 12th five year plan for malaria is to reduce (API) Annual Parasitic Incidence <1 in all districts/state. It has been achieved in all Health Unit Districts except in Ramanathapuram HUD and in Corporation of Chennai. Even in these areas there has been a considerable reduction in API from the year 2012 & 2013

• Ramanathapuram API: 2012- 5.61 & 2013- 3.07
• Corporation of Chennai API: 2012- 2.34 & 2013- 1.79

DENGUE

Dengue Fever (DF), an outbreak prone viral disease is transmitted by Aedes mosquitoes. DF is characterized by fever, headache, muscle and joint pains, rash, nausea and vomiting. Some infection results in Dengue Haemorrhagic Fever (DHF).DF and DHF are caused by the four dengue viruses DEN 1, 2, 3 and 4, which are closely related antigenically. Infection with one serotype provides lifelong immunity to that virus but not to the others.

Aedes aegypti (Ae aegypti) is the main vector species of DF/DHF in India and is common in most of the urban areas on account of deficient water management, presence of non-degradable tyres and long-lasting plastic containers as well as increasing urban agglomerations and in many instances inability of the community to respond to the need to eliminate mosquito breeding sites. Overhead tanks, ground water storage tanks are usually the primary habitats. Aedes aegypti breeds almost entirely in manmade water receptacles found in and around households, construction sites, and factories. Natural larval habitats are rare, but include tree holes, leaf axles and coconut shells. The population of Ae aegypti fluctuates with rainfall and humidity. During the rainy season, when survival is longer, the risk of virus transmission is greater. The rural spread of Aedes is a relatively recent occurrence associated with increase in breeding sites.

In Tamil Nadu,for diagnosis of the disease, the Government of India has identified 30 Sentinel Surveillance Hospitals including Medical College Hospitals, Zonal Entomological Teams, Institute of Vector Control and Zoonoses, Hosur, and District Headquarters Hospitals-Cuddalore and Ramanathapuram and 1 Apex laboratory (King Institute of Preventive Medicine and Research, Guindy) for diagnosis of Dengue and Chikungunya. The Public Health department in coordination with the local bodies and other departments regularly undertake anti larval measures by source reduction of vector breeding places like artificial containers such as broken utensils, discarded tyres, plastic waste cups and broken bottles for the control of Aedes mosquitoes which spread dengue fever.

The State which had reported 13204 cases in 2012 was able to reduce it to 6,122 cases in 2013. During the year 2014 (up to 15.05.2014) 590 Cases are reported with nil death. The Indian medicines such as Papaya juice extract, Nilavembu and Malaivembu kudineer along with conventional medicine are used for the control of Dengue. Daily surveillance is carried out and the disease is now under control.

CHIKUNGUNYA

Chikungunya is caused by a virus and is transmitted to humans by Aedes mosquitoes. There is a decline in Chikungunya cases due to the control measures taken by the Government. 859 cases were reported during 2013,during the year 2014 (up to 15.05.2014) 161 Cases are reported. The prevention and control measures against Chikungunya are carried out in an integrated manner with the Dengue control measure.

JAPANESE ENCEPHALITIES CONTROL PROGRAMME

Japanese Encephalitis (JE) is a mosquito borne zoonotic viral disease. The virus is maintained in animals, birds, pigs, which act as the natural hosts. Pigs & wild birds are reservoirs of infection and are called as amplifier hosts in the transmission cycle, while man and horse are dead end hosts. The virus does not cause any disease among its natural hosts and transmission continues through mosquitoes belonging to culex mosquito(vishnui group). Vector mosquito is able to transmit JE virus to a healthy person after biting an infected host with an incubation period ranging from 5 to 14 days.

There are 12 endemic Districts in the State namely Perambalur , Villupuram, Cuddalore, Tiruvannamalai, Virudhunagar, Tiruchirapalli, Thanjavur, Tiruvarur, Madurai, Pudukottai, Karur and Thiruvallur districts. JE Vaccination campaign with SA 14-14-2 type of JE Vaccine is carried out in all these districts in a phased manner since2007 for the children 1-15 years of age .All these districts are fully covered under routine Immunisation as on 2014.

Japanese Encephalitis Control Units at Cuddalore, Villupuram, and Perambalur with Monitoring Unit in Chennai are carrying out Japanese Encephalitis Vector Control activities.

Acute Encephalitis Syndrome (AES) Surveillance is being carried out in District Headquarters Hospitals, Medical College Hospitals and major private hospitals. Serum samples are taken from the AES cases for diagnosis of JE. Lab diagnosis is done in 7 Sentinel Surveillance Hospitals which includes King Institute of Preventive Medicine and six Medical College Hospitals. 77 AES cases with 8 deaths and 33 JE cases with no death have been reported in 2013.

Considering the complexity of JE/AES (Acute Encephalitis Syndrome) problem ,a comprehensive National Programme on Prevention and Control of JE/AES with the participation of concerned Ministries/ Departments has been launched. The goal of the Programme is to reduce morbidity, mortality and disability in children due to JE/AES. Tamil Nadu is one of the five States where this programme has been started.

JE vector monitoring is being carried out regularly in the endemic districts. Fogging operation is being carried out in villages where suspected JE cases are reported.

FILARIA

The National Filaria Control Programme is being implemented in Tamil Nadu since 1957. There are 14 filaria endemic districts namely, Kancheepuram, Thiruvallur, Vellore ,Cuddalore, Villupuram, Trichy, Perambalur, Pudukottai, Thiruvannamalai, Thanjavur, Thiruvarur, Ariyalur, Nagapattinam , Kanniyakumari in the State.Under Filaria Control Programme , 25 Filaria Control Units have been established which carry out disease control activities are carried out in 43 urban areas through Night Clinics (44) and Filaria and Malaria Clinics(42) and conduct anti larval operation.Larvicides and tablets (Di-ethyl Carbamazine (DEC) and Albendozole ) are procured from GoI funds. The entire operational cost is met by the State Government.

Single dose Mass DEC Drug Administration programme (MDA) is being carried out from 1997-98 in all endemic districts. The Mass Drug Administration programme was conducted in 14 endemic districts with the objective to bring down the mf rate to less than 1, namely, Kancheepuram, Thiruvallur, Cuddalore, Villupuram, Trichy, Perambalur, Pudukottai, Thiruvannamalai, Thanjavur, Thiruvarur, Ariyalur, Kanyakumari, Nagapattinam, Vellore and certain villages of Tirunelveli, Thoothukudi, Karur, Krishnagiri, Virudhunagar and Madurai and 64 wards in Chennai Corporation till 2012. In 2013, MDA was conducted in Vellore, Thiruvannamalai, Perambalur and Virudhunagar districts where the mf rate is more than 1. It is proposed to conduct MDA only in Tiruvannamalai & Cuddalore District during 2014.

In the districts with mf rate less than 1, Transmission Assessment Survey (TAS) using Immuno Chromatography Test Cards to detect the antigenemia. Based on MDA will stopped or continued. So far Thiruvarur (2012), Perambalur & Ariyalur (2013) has completed TAS. It is also planned to conduct TAS in remaining district in phased manner.

Govt.of Tamilnadu is giving financial support of Rs.400/- for LF Grade IV patients. Morbidity management kit is issued to LF patients for self care practice. Hydroceletomy are being conducted.

LEPTOSPIROSIS

Leptospirosis being one of the reemerging infection of zoonotic origin. It requires timely diagnosis, treatment and control measures. Leptospirosis is being reported from most of the districts of TamilNadu. To strengthen the surveillance system and for early diagnosis of leptospirosis, 7 leptospirosis clinics are functioning in Thiruvallur and Madurai Districts. For screening of fever cases, IgM ELISA kits are procured and supplied to the 9 Zonal Entomological Teams and Institute of Vector Control & Zoonoses, Hosur. Outbreak investigation of leptospirosis is carried out by Zonal Entomological Teams and IVCZ, Hosur. 2887 leptospirosis cases have been reported during the year 2013 and no death has occurred.

National Mental Health Programme (NMHP)

Activities Under District Mental Health Programme-Tamil Nadu

• We have established a ten bed psychiatric ward at All Government Head Quarters Hospitals of DMHP Implemented Districts to treat any kind of major Psychiatric Illness.
• Specialized Clinic for Counseling and Psychotherapy was also established in all the Govt. Head Quarters Hospital.
• Basic psychiatric treatment was initiated at PHCs level where essential psychiatric medicines were available which is not feasible in any other part of the country.
• A mobile psychiatric team comprising of a Psychiatrist, Psychologist, Psychiatric Social worker and pharmacist is formed.
• Weekly Psychiatric clinic is conducted in all the Taluk level Govt. Hospitals of DMHP implemented districts

 

Children with Developmental Disorder (Autism)

Under NRHM innovative scheme this special project was approved in the year 2011-12. This Pilot Project is implemented through NGO M.S.Chellamuthu Trust & Research Foundation with technical support on training from NIMHANS, Bangalore.by establishing 4 Child Guidance Clinics in the hospital setup at a cost of Rs.100.54 lakhs. The programe has been started during June 2012. Children with autism are usually branded as mentally retarded and are socially separated. To reduce such event of branding Autism as mental retardation this project is piloted.

Activities:

• Establishment of Child Guidance Clinic- the repair and renovation works in 4 Child Guidance Clinics have been completed.
• The distribution of survey formats and reporting formats among the field staff (AWW/VHN in 15 Blocks) has been completed.
• The identification of Developmental Disorders with Children has been started from 1.6.2013.
• Block Level Steering Committee meeting have been conducted by the concerned Block Medical Officer/ Urban Medical Officer on 3rd Tuesday every month.

National Programme for Palliative Care (NPPC)

Four NGOs were shortlisted namely SCOPE India, Cuddalore, Sudharsana Palliative Care of Trichirapally, RMD Pain and Palliative Care Trust of Chenna and Dean Foundation, Chennai.

The Pilot Project was initiated on February 2012 with the support and guidance of SHS & NRHM as a Pilot Project initiative. One block area was given to each NGO in the districts of Kancheepuram, Trichy, Tiruvallur and Villupuram namely Kancheepuram block, Andhanallur Block, Ellapuram Block and Koliyanur Block respectively covering 169 panchayats in a population of around 4.2 lakhs.

Clinical care services, procedures done for the patient vary and provide pain relief initially by non-narcotic analgesic drugs and when threshold level increases tablet morphine was provided. Home service includes hydration, dressing, enema, ascitis tapping, maggot removal, pressure sore dressing, management with home made diapers, sponge bath, eye care, oral care were provided by a team of personnel with adopting proper protocol for clinical treatment to give a dignified living in prior to the end of the life. The survey captured both ambulant and bedridden patients who need pain and palliative care.

National Programme for Prevention and Control of Deafness (NPPCD)

Tamil Nadu is the first state to pilot and extend the national program throughout the state is a short span of time. It started in 2007-08 when pilot program was launched through rehabilitation department and taken over by NRHM. The pilot districts are Thanjavur, Villupuram and Vellore with extension of first phase to 16 districts and later to the entire state. It is functioning through an established State Nodal Center at Institute of Otolaryngology, Madras Medical College, Chennai and through District Nodal Officer in the revenue districts. All activities are with the approval of program division through PIP. It also planned to take it to the primary health centre level by establishing a weekly clinic and Taluk Hospitals with ENT equipments.

• District Head Quarters hospitals have been equipped with instruments for investigations and surgery required for Ear diseases.
• Primary Health Centres have been supplied with basic ENT kit for diagnosing Ear diseases.
• Nearly 200 ENT surgeons have been trained for ear surgery at the State Nodal Centre – Madras Medical College.
• Provision has been made for ENT faculty from Medical Colleges to help the ENT surgeon at the corresponding district hospitals while doing surgery.
• Skill training to Audiometricians has been approved and conducted at the State Nodal Centre , Madras Medical College.
• Provision has been made to issue Hearing Aid to childrens.
• Sensitisation programme has been given to Doctors, staff nurse, non medical personnel and primary school teachers.

National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke

Government of Tamil Nadu have already initiated World Bank supported the activities for prevention and control of Non Communicable Diseases (NCDs) like diabetes, HT, Cancer Cervix and Cancer Breast where in it is proposed to supplement the state’s efforts by providing technical and financial support through NPCDCS/NPHCE Government of India started National Program for Prevention and Control of Cancer, diabetes, Cardio Vascular diseases and stroke (NPCDCS) and National programme for health care for elderly (NPHCE).

The NPCDCS aims at integration of NCD interventions in the NRHM framework for optimization of scarce resources and provision of seamless services to the end customer / patients as also for ensuring long term sustainability of interventions. Thus, the institutionalization of NPCDCS at district level within the District Health Society, sharing administrative and financial structure of NRHM becomes a crucial programme strategy for NPCDCS. The NCD cell at District will ensure implementation and supervision of the programme activities related to health promotion, early diagnosis, treatment and referral, and further facilitates partnership with laboratories for early diagnosis including the monitoring of NPHCE.

Goals

• To improve the health outcomes of the people of Tamil Nadu especially the poor and disadvantaged by strengthening Health Systems.
• To reduce the morbidity and mortality due to Non Communicable Diseases through Opportunistic screening, treatment and follow up of individuals reporting at Government health facilities in Tamil Nadu.
• Availability of NCD Clinic with facilities for screening in all Government Health Facilities.
• Provision of screening services for men aged 30 years and above for Hypertension and Diabetes Mellitus.
• Screening of women aged 30 years and above for Hypertension, Diabetes Mellitus, Cervical and Breast Cancers.
• Referral for Confirmatory tests or for further evaluation.
• Referral for treatment of complications.
• Maintenance of Forms, Cards and Registers.
• Online data entry and reporting system.

Integrated Disease Surveillance Project (IDSP)

Integrated Disease Surveillance Project (IDSP) was launched in August 2005 and implemented from 2006 in Tamil Nadu. The Programme continues during 12th Plan under NRHM is to detect and respond to disease outbreaks quickly.

1. Surveillance of Communicable Disease

The IDSP is a nucleus of collecting data pertaining to communicable disease burden from various health facilities both Govt. as well as private hospitals. The data collection is being done on Daily / Weekly / Monthly basis depending upon the health situation.

IDSP online data entry (weekly) is being done by respective District Surveillance Units in the website www.idsp.nic.in, monitored by State and Central Surveillance Unit.

Satellite Interactive Terminal (SIT) has been established in 48 units for distance learning and sharing of information on disease surveillance and monitoring of control activities. Video conferencing through interwise is conducted on weekly basis with all District Surveillance Units.

1.1 Weekly Analysis and Forecast

The collected data are analysed at State and District Level and the health problems are being addressed to the Deputy Directors of Health Services concerned for remedial action. The IDSP Unit also forecasts impending outbreak/ epidemic to the districts from the data collected periodically and also helps in formulating health planning for prevention of occurrence of outbreak / epidemic. Regular weekly alert are send to the District.

1.2 Daily Reporting

Daily Line List of admitted cases of ADD, Fever Syndrome, AES, AEFI and Jaundice and all Lab confirmed cases with epidemic potential are being collected and sent on daily basis to SSU through email in the prescribed format from the following units viz., Government Medical College Hospitals and laboratories, Government Head Quarters / Taluk Hospitals and laboratories, Primary Health Centres and laboratories, Private Hospitals and laboratories and Zonal Entomological Team laboratories. Clustering of cases is being identified and warning signals are sent to the concern district for remedial action.

Data reported under IDSP are being shared and reconciled at the State Level with the other vertical programs like Vector Borne Disease Control Program and Vaccine Preventable Diseases to have uniformity in reporting and documentation.

1.3 Outbreak Reporting

State and District Surveillance Units notify the outbreaks immediately. Rapid Response Team (RRT) visits the affected area for investigation and sends a First Information Report (FIR) to District Surveillance Unit. DSU send the FIR to SSU and CSU immediately and also update in the Web portal. Consolidated and Follow-Up of the outbreaks sent to CSU on every Monday, including Nil reports. This has facilitated overall improvement in outbreak reporting in the State through IDSP.

2. Human Resources

State Surveillance Unit

The Joint Director of PH&PM (Epidemics) has been designated as State Surveillance Officer, The State Surveillance unit of IDSP is functional at the Directorate of Public Health and Preventive Medicine with the following contractual manpower: Epidemiologist, Consultant Training, Veterinary Consultant, Microbiologist, Entomologist, Data Manager, Consultant Finance and 2 Data Entry Operators.

District Surveillance Unit

The Deputy Directors of Health Services at revenue districts have been designated as District Surveillance Officers (DSO) in 32 districts with the following contractual manpower Epidemiologist, Microbiologist, Data Manager, Data Entry Operator at DSU and Government Medical College, Lab. Technician, Lab Attendant.

3. Laboratory Strengthening

Laboratory services are an important component of disease surveillance. IDSP is giving due importance to laboratory based surveillance. Eight Government Medical Colleges have been included under State Referral Lab Network in addition to two Priority District Labs, to facilitate laboratory investigations particularly during outbreaks. There is a drastic improvement in the laboratory confirmation of outbreaks reported in Tamil Nadu in 2012-13 (Up to Nov 2012) when compared to the previous years. This has been due to the effective co-ordination and involvement of the Medical College Referral Lab Network, Priority District Labs, 9 Zonal Entomological Teams (ZET), Institute of Vector Control and Zoonoses, Hosur and King Institute of Preventive Medicine, Chennai. The vision is to have a District Public Health Laboratory (DPHL) in each revenue district to be established in a phased manner over a period of time.

3.1 Priority District Labs

The laboratories attached to the District Head Quarters Hospitals at Cuddalore and Ramanathapuram have been identified as Priority District labs by Govt. of India. Elisa Reader & Washer and Binocular Microscope have been procured and installed in these labs. Microbiologists are appointed and the laboratory is fully equipped to investigate bacterial culture, isolation, sensitivity testing and serological investigation.

3.2 District Public Health Laboratories (DPHLs)

Based on the success of the Priority District Labs, the District Public Health Lab formed in 30 Districts by Posting 1 Microbiologist, 1 Lab Tech, 1 Lab Attendant, DPHL is functional at Distinct Head Quarters Hospital and the laboratory is fully equipped to investigate bacterial culture, isolation, sensitivity testing and serological investigation.

Functions of DPHL

• Sample lifting during outbreaks
• District Hospital Surveillance
• Ensuring OT sterility in the PHCs and GHs.
• Lab quality management (Calibration of equipments, Bio medical waste management)
• Early Warning Signals” of Impending Epidemics
• Confirmation of Epidemic Prone Diseases
• Key Component of “Rapid Response Team”
• Training for Lab Tech at PHC
   

3.3 Medical Colleges Referral Lab Network

The Government Medical Colleges have good laboratory infrastructure and trained manpower to investigate all the communicable diseases specified under IDSP. Eight Govt. Medical Colleges have been identified under Medical College State Referral lab Network Plan. These Medical Colleges have been selected based on their strategic location to cover the linked districts. The Department of Microbiology of the concerned medical colleges is the focal point of lab activity and the Prof & Head of Department of Microbiology is the Nodal Person for all lab activities connected with IDSP.

S.No	Medical College Lab Network	Districts Covered
1	Madras Medical College	Thiruvallore, Kancheepuram & Villupuram
2	Vellore Medical College	Vellore & Thiruvanamalai
3	Salem Medical College	Salem, Dharmapuri, Krishnagiri & Namakkal
4	Trichy Medical College	Trichy, Perambalur, Karur & Pudukottai
5	Thanjavur Medical College	Thanjavur, Thiruvarur & Nagapattinam
6	Coimbatore Medical College	Coimbatore, Erode, Nilgiris & Tiruppur
7	Madurai Medical College	Madurai, Dindigul, Theni, Virudhunagar & Sivaganga
8	Tirunelveli Medical College	Tirunelveli, Tuticorin & Kanyakumari

4. Training

Training of doctors in Government Medical Colleges and Government Hospitals and PHCs under IDSP is been conducted every year. which has improved the reporting from the Government hospitals at Secondary and Tertiary levels.

In Tamil Nadu RNTCP is implemented since 2001.Today RNTCP covers 33 districts in Tamil Nadu with a total population of 771.26 lakhs. In the year 2016 about 766375 presumptive TB cases were screened and 82055 patients were registered for TB. There are 461 TB units and 829 Designated Microscopy Centres across the state to carry on the diagnosis and treatment of TB. The total TB case notification in Tamil Nadu is 122 cases per lakh for the year 2016, an overall increase of 17/lakh from 2015.

TB-HIV collaborative activities are well established in the state with 705 co-located Designated Microscopic Centres (DMC) with Integrated Counselling and Testing Centres (ICTCs). All Presumptive TB cases as well as diagnosed cases are referred for HIV testing and all clients attending ICTC’s and HIV positive cases from ART centres are referred to RNTCP for screening for any TB infection. Tamil Nadu has a TB HIV co-infection rate of 5%. ‘3 - I’ project is also fully implemented in all the Districts. All patients referred from ART centres are tested using CBNAAT & all PLHIV without TB are given chemoprophylaxis with INH 300 mg daily for 6 months to prevent them from developing TB later. 99 Dots, an ICT based tool for surveillance of drug intake by co-infected cases has also been implemented throughout the State.

There is good coordination with NDSP & all diagnosed TB cases are also tested for diabetes and diabetic cases are also screened for TB.

The State has also implemented Programmatic Management of Drug Resistant TB services since 2009.In the year 2016 about 75578 presumptive Multi Drug Resistant (MDR) TB cases were tested by CDST for MDR TB and around 1561 patients were diagnosed with RR/MDR TB .There are 33 Gene X-pert machines in the state along with 3 LPA labs catering to the MDR diagnostic services to cover all the districts. There are 3 labs with MGIT (liquid culture) & 6 CDST labs with solid culture facilities. Second IRL in Madurai also will be fully functional with LPA, MGIT & Solid culture. For every 10 million population one Drug Resistant TB centre has been established and as such 6 DR TB centres are functional & the 7th one is under up gradation. Establishing of District level DRTB Centres are in the pipeline for decentralization of .MDR treatment initiation at District level.

Bed aquiline the latest potent drug for treatment of TB has been introduced in Tamil Nadu from 2016 May & so far 57 cases have been registered. There are 2 State Drug Stores, one in Chennai and the other at Trichy and 31 district drug stores for drug procurement, storage and distribution of RNTCP drugs as per norms for distributing patient wise boxes free of cost to patients. Case based web based notification with real time entries of TB cases on NIKSHAY portal is done regularly.

National Leprosy Eradication Programme

The National Leprosy Eradication Programme is a centrally sponsored Health Scheme of the Ministry of Health and Family Welfare, Govt. of India. While the NLEP strategies & plans are formulated centrally, the programme is implemented by the States/UTs. The Programme is also supported as partners by the World Health Organization, the International Federation of Anti-leprosy Associations (ILEP) & certain Non Governmental organizations.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. It usually affects the skin and peripheral nerves, but has a wide range of clinical manifestations. The disease is characterized by long incubation period generally 5 to 7 years and is classified as pauci bacillary or multi bacillary, depending on the bacillary load. Leprosy is a leading cause of permanent physical disability. Timely diagnosis and treatment of cases, before nerve damage has occurred, is the most effective way of preventing disability due to leprosy. The earliest records of a ‘leprosy like’ disease come from Egypt, dating as far back as 1400 BC. In China and India the first records appeared in the sixth century BC. In China, a disciple of Confucius named Pai-Nie suffered from a disease resembling lepromatous leprosy, which was known at that time as ’li’ or ‘lai’. In India, leprosy was first described in the SusruthSamhita and treatment with ‘Chaulmoogra’ oil was known at that time.

Initially, leprosy patients were isolated and segregated. Communities were hostile to them and the patients were also self conscious and afraid to mix with the community. Leprosaria to segregate the patients from the community were built in Europe in the middle ages. Several statutory acts and laws were also enacted during that time against them. A drug “Chaulmoogra” oil was used for leprosy treatment until “Dapsone” was discovered with anti leprosy effects during 1940s. It was in 1970s when multi drug therapy (MDT) consisting of Rifampicin, Clofazimine and Dapsone were identified as cure for leprosy which came into wide use from 1982 following the recommendations of WHO. Since then the services for leprosy patients gradually changed from institutional to outpatient care through health centres and field clinics. Gradually the infected and cured leprosy patients began to be accepted by the Community as a result of intensive health education and visibly successful results of MDT.

Milestones in NLEP

• 1955 - National Leprosy Control Programme (NLCP) launched.
• 1983 - National Leprosy Eradication Programme launched.
• 1983 - Introduction of Multidrug therapy (MDT) in Phases.
• 2005 - Elimination of Leprosy at National Level.
• 2012 - Special action plan for 209 high endemic districts in 16 States/UTs.
   

In Tamil Nadu, during the year 1954-55 National Leprosy Eradication Programme (NLEP) was launched. The main objective of this scheme is to identify the cases early and cure them completely. The prevalence rate of the Leprosy in 1983 was 118 per 10,000 population. In 2005, the prevalence of leprosy declined to less than one per 10,000 population and the State achieved leprosy elimination status. The prevalence rate is 0.43 per 10,000 population as on February, 2017. In 2016 - 17, Intensive activities are carried out in 31 high endemic blocks & 242 New Leprosy cases were detected where new case detection rate is more than 10 per 1, 00,000 population. Re-constructive Surgery has been done to 96 patients as on February, 2017 and special varieties of chappals were given to 8201 patients. Self-Care kit to deformed Leprosy patients issued is 12748. At present, 5680 Leprosy affected persons are receiving pension of Rs.1000/- per month other than those already availing the pensions under the Old Aged Pension scheme.

National Iodine Deficiency Disorder Control Programme

The national Iodine Deficiency Disorder Control Programme is implemented in the State from 1991 and the state IDD Cell started functioning from 1.7.1994 onwards.

Objective

To promote consumption of iodised salt through various activities

Activities

• To identify the problem districts through Goitre surveys
• Take control measures through dietry supplementation of iodised salt through IEC activities.
• Spot testing of the Salt samples for the retailers
• Spot testing of the kitchen salt samples
• Testing of Non-Statutory salt samples in Food Analysis Laboratories for the Iodine content in salt.
• Supply of IEC materials to the PHCs
• Regular review of the programme at District Level by the Deputy Directors & at State level by the Director
• Celebration of Global IDD prevention day throughout Tamil Nadu involving NGOs, Public, School Children for creating awareness among the community
   

Notification of Govt

A notification under the prevention of Food Adulteration Act has been issued banning the sale of Non-iodised salt for edible purpose. The Government have issued orders for sale of iodised salt through fair price shops by both Tamil Nadu Civil Supplies and Co-operatives in public distribution system in pouches in all districts.

Proposed Activities

• It is also planned to give wide publicity throughout the state about the importance of consumption of iodised salt to prevent iodine Deficiency Disorders among the community through Health education programmes in schools, Radio jingles, Television, Wall paintings, distribution of pamphlets, books etc., during Trade fair and other notified festivals.
• Conduct of clinical survey for prevalence of Goitre amongst the students in all the Govt & Govt aided schools
   

Spot testing of the Salt samples for the retailers and spot testing of the kitchen salt samples are being done to assess the presence of iodine and know the availability and use of iodised Salt. During 2009-10 (Upto Oct ) 78,153 salt samples were tested from shops. In that 8.2% samples are of nil iodine content, 28.6 % is less than 15ppm and 63.2% is more than 15ppm. Now statutory salt samples are lifted and tested to know the iodine content in salt.
Non-Statutory salt samples are being lifted and sent to Food Analysis Laboratories for analysis to know the Iodine content in salt.
Global IDD prevention day 2009 was celebrated throughout Tamil Nadu involving NGOs, Public, School Children for creating awareness among the community. Goitre survey will be conducted in two districts during 2009-10 as per the Govt. of India guidelines after receipt of funds from the Govt. of India. It is also planned to give wide publicity throughout the state about the importance of iodised salt to prevent iodine Deficiency Disorders among the community through Health education programmes in schools, Radio jingles, Television, Wall paintings, distribution of pamphlets, books etc., during Trade fair and other notified festivals.