India dr rahul

HEALTH CARE SYSTEM OF
INDIA
PRESENTED BY-
Dr. RAHUL SHRIVASTAVA
(BDS,MPH)

INTRODUCTION
India, officially the Republic of India , is a country in South
Asia. It is the Seventh-largest country by area, the Second
most populous country with over 1.2 billion people, and the
most populous democracy in the world.
Bounded by the Indian Ocean on the south, the Arabian
Sea on the south-west, and the Bay of Bengal on the south-
east, it shares land borders with Pakistan to the west; China,
Nepal and Bhutan to the north-east; and Burma and
Bangladesh to the east. In the Indian Ocean, India is in the
vicinity of Sri Lanka and Maldives; in addition,
India's Andaman and Nicobar Island share a maritime border
with Thailand and Indonesia.

• Home to the ancient Indus valley civilization and a region of
historic trade routes and vast empires, the Indian
subcontinent was identified with its commercial and cultural
wealth for much of its long history.
• Four religions—Hinduism, Buddhism, Jainism and Sikhism —
originated here, whereas Judaism, Zoroastrianism, Christianity
and Islam arrived in the 1st millennium and also helped shape
the region's diverse culture.
• India became an independent nation in 1947 after a struggle
for independence that was marked by non-violence resistance
led by Mahatma Gandhi.
• The Indian economy is the world's tenth-largest by nominal
GDP and third-largest by purchasing power parity (PPP).

Following market-based economic reforms in 1991, India
became one of the fastest-growing major economies; it is
considered a newly industrialized country.
However, it continues to face the challenges of :-
• Poverty
• Corruption
• Malnutrition
• Inadequate public healthcare
• Terrorism.

• A nuclear weapons state and a regional power, it has
the third-largest standing army in the world and ranks ninth
in military expenditure among nations.
• India is a federal constitutional republic governed under
a parliamentary system consisting of 29 states and 7 union
territories. India is a pluralistic, multilingual, and a multi-
ethnic society. It is also home to a diversity of wildlife in a
variety of protected habitats.

GOVERNMENT OF INDIA
• India is a federation with a parliamentary system governed
under the Constitution of India, which serves as the country's
supreme legal document.
• It is a constitutional republic and representative democracy, in
which "majority rule is tempered by minority rights protected
by law".
• Federalism in India defines the power distribution between
the federal government and the states.
• The government abides by constitutional checks and
balances.
• The Constitution of India, which came into effect on 26
January 1950, states in its preamble that India is
a sovereign, socialist, secular, democratic republic.

NATIONAL SYMBOLS
• Flag - Tricolour
• Emblem - Sarnath Lion Capital
• Anthem- Jana Gana Mana
• Song - Vande Mataram
• Currency - INR (Indian rupee)
• Calendar - Saka
• Game - Hockey
• Flower - Lotus
• Fruit -Mango
• Tree - Banyan
• Bird - Indian Peafowl
• Land animal - Tiger
• Aquatic animal River - Dolphin
• River - Ganga or Ganges

Economic indicators
• GDP: Gross domestic product (million current US$) 2012 18,75,213
• GDP per capita (current US$) 2012 1516.3
• Balance of payments, current account (million US$) 2012 -91471
• Agricultural production index (2004-2006=100) 2012 130
• Food production index (2004-2006=100) 2012 129
• Unemployment (% of labour force) 2012 ...
• Unemployment (% of labour force) 2010 3.5
• Unemployment (% of labour force) 2005 4.4

• Employment in industrial sector (% of employed) 2012 24.7 July of the
preceding year
to June of the
current year.
Excludes Leh
and Kargil of
Jammu and
Kashmir
districts, some
villages in
Nagaland, Andaman and
Nicobar Islands.
• Employment in industrial sector (% of employed) 2010 22.4 July of the preceding
year to June of the
current year. Excludes
Leh and Kargil of
Jammu and Kashmir
districts, some villages in
Nagaland, Andaman and
Nicobar Islands.

• Employment in agricultural sector (% of employed) 2012 47.2 July of the
preceding year to
June of the current
year. Excludes Leh
and Kargil of Jammu
and Kashmir districts,
some villages in
Nagaland, Andaman
and Nicobar Islands.
• Employment in agricultural sector (% of employed) 2010 51.1 July of the preceding
year to June of the
current year. Excludes
Leh and Kargil of
Jammu and Kashmir
districts, some
villages in Nagaland,
Andaman and
Nicobar Islands.

• Labour force participation, adult female pop. (%) 2012 28.8
• Labour force participation, adult female pop. (%) 2010 28.6
• Labour force participation, adult male pop. (%) 2012 80.9
• Labour force participation, adult male pop. (%) 2010 80.8
• Tourist arrivals at national borders (000) 2012 6578 Excludes
nationals
residing
abroad.
• Tourist arrivals at national borders (000) 2010 5776 Excludes
nationals
residing
abroad.

Social indicators
• Population growth rate (average annual %) 2010-2015 1.2
• Urban population growth rate (average annual %) 2010-2015 2.5
• Rural population growth rate (average annual %) 2010-2015 0.8
• Urban population (%) 2013 32.0
• Population aged 0-14 years (%) 2013 29.1
• Population aged 60+ years 2013 9.0/7.7
(females and males, % of total)
• Sex ratio (males per 100 females) 2013 107.1
• Life expectancy at birth (females and males, years) 2010-2015 68.1/64.6
• Infant mortality rate (per 1 000 live births) 2010-2015 43.8
• Fertility rate, total (live births per woman) 2010-2015 2.5
• Contraceptive prevalence (ages 15-49, %) 2006-2012 54.8
• International migrant stock mid-2013 5338.5/0.4
(000 and % of total population)
• Refugees and others of concern to UNHCR mid-2013190957
• Education: Government expenditure (% of GDP) 2006-2012 3.2
• Education: Primary-secondary gross enrolment ratio 2006-2012 86.5/87.9
(f/m per 100)
• Education: Female third-level students (% of total) 2006-2012 41.8
• Intentional homicides (females and males, per 100 000) 2008-2010 1.5/3.9
• Seats held by women in national parliaments (%) 2014 11.4

• India's form of government, traditionally described as "quasi-
federal" with a strong center and weak states, has grown
increasingly federal since the late 1990s as a result of political,
economic, and social changes.
• The federal government comprises three branches:-
1. Executive
2. Legislative
3. Judicial

Executive: - The President of India is the head of state and is
elected indirectly by a national electoral college for a five-year
term. The Prime Minister of India is the head of government and
exercises most executive power. Appointed by the president, the
prime minister is by convention supported by the party or political
alliance holding the majority of seats in the lower house of
parliament. The executive branch of the Indian government
consists of the president, the vice-president, and the Council of
Ministers—the cabinet being its executive committee—headed by
the prime minister. Any minister holding a portfolio must be a
member of one of the houses of parliament. In the Indian
parliamentary system, the executive is subordinate to the
legislature; the prime minister and his council are directly
responsible to the lower house of the parliament.

Legislative: - The legislature of India is the bicameral parliament.
It operates under a Westminster-style parliamentary system and
comprises the upper house called the Rajya Sabha ("Council of
States") and the lower called the Lok Sabha ("House of the
People“. The Rajya Sabha is a permanent body that has 245
members who serve in staggered six-year terms. Most are
elected indirectly by the state and territorial legislatures in
numbers proportional to their state's share of the national
population. All but two of the Lok Sabha's 545 members are
directly elected by popular vote; they represent
individual constituencies via five-year terms. The remaining two
members are nominated by the president from among
the Anglo-Indian community, in case the president decides that
they are not adequately represented.

Judicial: - India has a unitary three-tier independent judiciary that
comprises the Supreme Court, headed by the Chief Justice of
India, 24 High Courts, and a large number of trial courts. The
Supreme Court has original jurisdiction over cases involving
fundamental rights and over disputes between states and the
center; it has appellate jurisdiction over the High Courts.It has the
power both to declare the law and to strike down union or state
laws which contravene the constitution. The Supreme Court is
also the ultimate interpreter of the constitution

SUB-DIVISIONS
Sr. No. STATES CAPITAL
1 Andhra Pradesh
2 Arunachal Pradesh Itanagar
3 Assam Dispur
4 Bihar Patna
5 Chhattisgarh Raipur
6 Goa Panaji
7 Gujarat Gandhinagar
8 Haryana Chandigarh
9 Himachal Pradesh Shimla
10 Jammu & Kashmir Srinagar (Summer), Jammu (Winter)
11 Jharkhand Ranchi
12 Karnataka Bangaluru
13 Kerala Thiruvananthapuram
14 Madhya Pradesh Bhopal

Sr. No. STATES CAPITAL
15 Maharashtra Mumbai
16 Manipur Imphal
17 Meghalaya Shillong
18 Mizoram Aizawl
19 Nagaland Kohima
20 Odisha Bhubaneswar
21 Punjab Chandigarh
22 Rajasthan Jaipur
23 Sikkim Gangtok
24 Tamil Nadu Chennai
25 Telangana Hyderabad
26 Tripura Agartala
27 Uttarkhand Dehradun
28 Uttar Pradesh Lucknow
29 Vishalandhra Secundrabad
30 West Bengal Kolkata

Sr. No. UNION TERRITORY CAPITAL
1 Andaman & Nicobar Island Port Blair
2 Chandigarh Chandigarh
3 Dadra & Nagar Haveli Silvasa
4 Daman & Diu Daman
5 Lakshadweep Kavaratti
6 Puducherry Puducherry
7 Delhi (NCT - National Capital
Territory)

HISTORY OF INDIA
The Indus valley civilization saw its genesis in the holy land now
known as India around 2500 BC. The people inhabiting the Indus
River valley were thought to be Dravidians, whose descendants
later migrated to the south of India. The deterioration of this
civilization that developed a culture based on commerce and
sustained by agricultural trade can be attributed to ecological
changes. The second millennium BC was witness to the
migration of the bucolic Aryan tribes from the North West
frontier into the sub continent. These tribes gradually merged
with their antecedent cultures to give birth to a new milieu.

The Aryan tribes soon started penetrating the east, flourishing
along the Ganga and Yamuna Rivers. By 500 BC, the whole of
northern India was a civilized land where people had knowledge of
iron implements and worked as labor, voluntarily or otherwise. The
early political map of India comprised of copious independent
states with fluid boundaries, with increasing population and
abundance of wealth fueling disputes over these boundaries.
Unified under the famous Gupta Dynasty, the north of India
touched the skies as far as administration and the Hindu religion
were concerned. Little wonder then, that it is considered to be
India’s golden age. By 600 BC, approximately sixteen dynasties
ruled the north Indian plains spanning the modern day Afghanistan
to Bangladesh. Some of the most powerful of them were the
dynasties ruling the kingdoms of Magadha, Kosla, Kuru and
Gandhara.

Known to be the land of epics and legends, two of the world’s
greatest epics find their birth in Indian settings - the Ramayana,
depicting the exploits of lord Ram, and the Mahabharta detailing
the war between Kauravas and Pandavas, both descendants of King
Bharat. Ramayana traces lord Ram’s journey from exile to the
rescue of his wife Sita from the demonic clutches of Ravana with
the help of his simian companions. Singing the virtues of
Dharma(duty), the Gita, one of the most priced scriptures in Indian
Mythology, is the advice given by Shri Krishna to the grief laden
Arjun, who is terrified at the thought of killing his kin, on the battle
ground.
Mahatma Gandhi revived these virtues again, breathing new life in
them, during India’s freedom struggle against British Colonialism.
An ardent believer in communal harmony, he dreamt of a land
where all religions would be the threads to form a rich social fabric.

INDEPENDENCE OF INDIA
India wrested its independence from Britain in 1947 after a long
freedom struggle led largely by the Indian National Congress and
its visionary leaders, especially, Mahatma Gandhi. From 1920,
the freedom movement leaders began highly popular mass
campaign against the British Raj using largely peaceful methods.
India’s acquisition of independence resulted in the formation of
two countries, India and Pakistan. Following the controversial
partition of India, rioting broke out, leaving some 500,000 dead.
Also, this period saw one of the largest mass migrations ever
recorded in modern history, with a total of 12 million Hindus,
Sikhs and Muslims moving between the newly created nations of
India and Pakistan.

LANGUAGES SPOKEN
• Assamese
• Bengali
• Bodo
• Dogri
• Hindi
• Gujarati
• Kannada
• Kashmiri
• Konkani
• Maithili
• Malayalam
• Manipuri
• Marathi
• Nepali
• Oriya
• Punjabi
• Sanskrit
• Santali
• Sindhi
• Tamil
• Telugu
• Urdu

CUSTOMS & CELEBRATIONS IN INDIA
The country celebrates Republic Day (Jan. 26), Independence
Day (Aug. 15) and Mahatma Gandhi's Birthday (Oct. 2). Diwali is
the largest and most important holiday to India, according
to National Geographic. It is a five-day festival known as the
festival of lights because of the lights lit during the celebration to
symbolize the inner light that protects them from spiritual
darkness. Holi, the festival of colors, also called the festival of
love, is popular in the spring.

FOOD
• When the Moghul Empire invaded during the sixteenth century, they left a
significant mark on the Indian cuisine, according to Texas A&M
University. Indian cuisine is also influenced by many other countries. It is
known for its large assortment of dishes and its liberal use of herbs and
spices. Cooking styles vary from region to region.
• Wheat, Basmati rice and pulses with chana (Bengal gram) are important
staples of the Indian diet. The food is rich with curries and spices,
including ginger, coriander, cardamom, turmeric, dried hot peppers, and
cinnamon, among others. Chutneys — thick condiments and spreads
made from assorted fruits and vegetables such as tamarind and tomatoes
and mint, cilantro and other herbs — are used generously in Indian
cooking.
• Many Hindus are vegetarians, but lamb and chicken are common in main
dishes for non-vegetarians. The Guardian reports that between 20 percent
and 40 percent of India's population is vegetarian.
• Much of Indian food is eaten with fingers or bread used as utensils. There
is a wide array of breads served with meals, including naan, a leavened,
oven-baked flatbread, and bhatoora, a fried, fluffy flatbread common in
North India and eaten with chickpea curry.

ARCHITECTURE & ARTS
• The most well-known example of Indian architecture is the Taj Mahal,
built by Mughal emperor Shah Jahan to honor his third wife, Mumtaz
Mahal. It combines elements from Islamic, Persian, Ottoman Turkish
and Indian architectural styles. India also has many ancient temples.
• India is well known for its film industry, which is often referred to as
Bollywood. The country's movie history began in 1896 when the
Lumière brothers demonstrated the art of cinema in Mumbai,
according to the Golden Globes. Today, the films are known for their
elaborate singing and dancing.
• Indian dance, music and theater traditions span back more than 2,000
years, according to Nilima Bhadbhade, author of “Contract Law in
India” (Kluwer Law International, 2010). The major classical dance
traditions — Bharata Natyam, Kathak, Odissi, Manipuri, Kuchipudi,
Mohiniattam and Kathakali — draw on themes from mythology and
literature and have rigid presentation rules.

CLOTHING
Indian clothing is closely identified with the colorful silk saris
worn by many of the country’s women. The traditional clothing
for men is the dhoti, an unstitched piece of cloth that is tied
around the waist and legs. Men also wear a kurta, a loose shirt
that is worn about knee-length. For special occasions, men wear
a sherwani, which is a long coat that is buttoned up to the collar
and down to the knees. The Nehru jacket is a shorter version of a
sherwani.

SPORTS
• Field hockey is the official national sport in India.
• Cricket is considered the most popular sport in India.
• A large number of football is played in the Indian state
of WestBegal. The city of Kolkata is the home to the largest stadium
in India, and the second largest stadium in the world by
capacity, Salt Lake Stadium.
• Chess is commonly believed to have originated in northwestern
India during the Gupta empire, where its early form in the 6th
century was known as chaturanga.
• Other games which originated in India and continue to remain
popular in wide parts of northern India include Kabaddi, Gilli-danda,
and Kho kho.
• Traditional southern Indian games include Snake boat
race and Kuttiyum kolum.
• In 2011, India inaugurated a privately built Buddh International
Circuit, its first motor racing circuit. The 5.14-kilometre circuit is
in Greater Noida, Uttar Pradesh, near Delhi. The first Formula
One Indian Grand Prix event was hosted here in October 2011.

HEALTH SYSTEM OF INDIA
• Under the Indian Constitution, health is a state subject. Each
state therefore has its own healthcare delivery system in
which both public and private (for profit as well as non-profit)
actors operate. While states are responsible for the
functioning of their respective healthcare systems, certain
responsibilities also fall on the federal (Central) government,
namely aspects of policy-making, planning, guiding, assisting,
evaluating and coordinating the work of various provincial
health authorities and providing funding to implement
national programmes.

• The organization at the national level consists of the Union
Ministry of Health and Family Welfare (MoHFW). In each State,
the organization is under the State Department of Health and
Family Welfare that is headed by a State Minister and with a
Secretariat under the charge of the Secretary/Commissioner
(Health and Family Welfare) belonging to the cadre of Indian
Administrative Service (IAS).The Indian systems of medicine
consist of both Allopathy and AYUSH (Ayurveda, Yoga, Unani,
Siddha and Homeopathy).
• Each regional/zonal set-up covers 3–5 districts and acts under
authority delegated by the State Directorate of Health Services.
The district level structure of health services is a middle level
management organisation and it is a link between the State and
regional structure on one side and the peripheral level structures
such as Primary Healthcare (PHC) and Sub-Centre on the other.

NATIONAL RURAL HEALTH MISSION
• The National Rural Health Mission (NRHM), launched in 2005, is
the first health programme in a “Mission Mode” to improve the
health system and the health status of the people, especially for
those who live in the rural areas, and provide universal access to
equitable, affordable and quality healthcare which is accountable
and at the same time responsive to the needs of the people. The
programme is a comprehensive package of pro-motive,
preventive, curative and rehabilitative services to be delivered to
the community through a process of inter-sectorial co-ordination
with other service departments and active community
participation. Various national programmes like immunisation,
tuberculosis control, leprosy elimination, cancer control etc. have
been integrated under the NRHM programme that also addresses
the social determinants of health and delivery of the same with
the active participation of Panchayat Raj Institutions (local
governance) for its sustainability.

• The programme will help achieve goals set under the National
Health Policy and the Millennium Development Goals. It also
seeks to revitalize and integrate local health traditions of
medicine (Ayurveda, Yoga and Naturopathy, Unani, Siddha and
Homoeopathy: AYUSH) into the public health system. Health is for
the first time being seen as a component of development
package.
• The NRHM sought to increase public spending on health, reduce
regional imbalances in health infrastructure, pool resources,
integrate various organisational structures and vertical national
programmes, decentralise and achieve district management of
health programmes, and turn community health centres into
functional hospitals meeting certain standards. The NRHM has a
special focus on rural areas in 18 States which have weak public
health indi-cators and/or weak infrastructure.

• At the village level the government has promoted the concept of
having an accredited fe-male social health activist (ASHA) in order to
facilitate household access to healthcare. Village Health Committees
of the Panchayat Raj are responsible for putting in place Village
Health Plans. The NRHM also calls for the preparation and
implementation of an inter-sectorial District Health Plan prepared
by the District Health Mission. Such a plan should include provisions
for drinking water, sanitation, hygiene and nutrition.
• The NRHM also has provisions for capacity building aimed at
strengthening the National, State and District Health Missions, for
example through data collection, assessment and review for
evidence-based planning, monitoring and supervision.
• The institutional design of the National Rural Health Mission
includes a number of entities at different levels – village, district,
state and central (See Appendix ). In consultation with the Mission
Steering Group, it is up to each State to choose state-specific
models.

HEALTH INSURANCE
• Health Insurance in India is in its infancy. There are several
insurance schemes operated by the Central and State
governments, such as the Rashtriya Swasthya Bima Yojana
(RSBY) which targets Below Poverty Line (BPL) families, the
Employees’ State Insurance Scheme (ESIS) and the Central
Government Health Scheme (CGHS). There are also public
and private insurance companies as well as several
community-based organisations. An esti-mated 300 million
people are believed to be covered by health insurance in
India. Of these, approximately 243 million are covered by
different forms of government-sponsored insur-ance
schemes while approximately 55 million rely on commercial
insurers.

GROWING PRIVATE SECTOR
• The National Health Policy welcomes the participation of the
private sector in all areas of health activities. The policy also
encourages the setting up of private insurance instruments for
increasing the scope of the coverage of the secondary and
tertiary sector under private health insurance packages.
• Today India is experiencing a growing reliance on private
healthcare providers who currently treat 78 per cent of
outpatients and 60 per cent of inpatients. Private healthcare
providers include everything from private hospitals that
promote medical tourism by offering world-class services to
foreign clients and Indians who can afford it, to private
doctors with little medical knowledge or formal training at the
other end of the extreme.

Furthermore, the strength of the private sector is illustrated by the
fact that it controls 80 per cent of doctors, 26 per cent of nurses, 49
per cent of beds and 78 per cent of ambulatory services.14 Private
actors are now present in all areas of healthcare, including health
financing, education, as well as equipment manufacturing and
services. The heavy increase in private healthcare providers can be
viewed as a result of lacking quality care offered by public providers,
shortages of doctors and overcrowding at public healthcare
facilities.15 This subsequently results in about 72 per cent of out-of-
pocket expenses that are directed at medicines and put significant
pressure on the individual.16 It is not uncommon that some are
driven below the poverty line due to the costs they incur in order to
access healthcare services.

An overview of private healthcare, insurance,
available medical services, diseases to be aware of
and what to do in an emergency…
• The Indian health system includes public and private hospitals
as well as specialized Ayurvedic hospitals offering this
traditional Indian system of alternative medicine. English-
speaking doctors are easy to find, as most Indian doctors
speak fluent English. All major cities and medium-sized urban
centers have private hospitals that provide an excellent
standard of care.
• Health insurance only covers hospitalization and emergency
costs. Other care must be paid for upfront, but even privately
it is extremely reasonable compared to other countries, so
medical costs should not be a significant expense.
• Most western expats working in India take out private health
cover, either independently or as an employee benefit. As
such, foreigners should head to or call a private hospital in an
emergency, as the quality of treatment and care is likely to be
better than a state hospital.

GOVERNMENT-FUNDED HEALTHCARE
• Publicly funded government hospitals provide basic care only
and often lack adequate infrastructure. They can also be
crowded and waiting times can be long. Government hospitals
are often understaffed, which is why a family member usually
attends to the patient during a hospital stay.
• Though the cost of care is less at these government hospitals,
the standard is inferior compared to private hospitals, and in
general western expats opt for private healthcare.

THE PRIVATE SECTOR
• Most locals and expats prefer to use the services of private
hospitals and clinics. These offer a high standard of care that
is at the same level as North American and European
countries. Private hospitals are modern and well equipped,
and the doctors are highly qualified and often trained abroad.
The following private hospital groups have good reputations
and are located in all major cities:
• Apollo
• Fortis
• Manipal
• Max
• The cost of medical care is very reasonable compared to other
countries. Some hospitals practice double-pricing, with higher
fees for foreigners. These fees can be negotiable.

DOCTORS AND CLINICS
• General practitioners are available in hospitals, clinics and in
private practices. The best way to find a doctor is to ask for
recommendations from friends, co-workers or neighbors.
Embassies and consulates can also provide a list of
recommended doctors.
• There are hundreds of medical facilities across the country.
Your health insurance provider will normally provide details of
the options in your locality. In addition, the following links
provide contact information for a range of hospitals and
clinics.

PHARMACIES
• All types of prescription medicines and health care products
are available in India at a very low cost. Doctors provide
prescriptions for certain medications but some pharmacies do
not always ask for them.
• Pharmacies are easily found in almost every street in all Indian
cities. These can be simple roadside stalls or bigger shop-like
businesses. Some may display green or red crosses.

DENTAL PROCEDURES
There are many qualified dentists in India operating in private
practices offering high-quality dental care and procedures at
very reasonable rates. Health insurance does not cover dental
care but if a dental procedure requires hospitalization, this may
be covered.

• Literacy Rates: M 82 % & F 65 %
• Sex Ratio: 940 / 1000
• Fertility Rate: 2.6
• IMR: 47 / 1000
• MMR: 230 / 100,000
• Life Expectancy 69.9 years (2009 est.)
Source: Census of India, 2011

India’s healthcare system is characterized by multiple systems
of medicine, mixed ownership patterns and different kinds of
delivery structures. Public sector ownership is divided between
Central & State governments, municipals and Panchayats (local
governments). The facilities include teaching hospitals,
secondary level hospitals, first-level referral hospitals
(community health centers/rural hospitals), dispensaries;
primary health centers, sub-centers, and health posts. Also
included are public facilities for selected occupational groups
like organized work force (Employees State Insurance Scheme),
defense, government employees (Central Government Health
Scheme – CGHS), railways, post and telegraph and mines
among others. The private sector (for profit/not for profit) is
the dominant sector and services range from 1000+ bed
hospitals to even 2-bed facilities).

TOP 10 CAUSES OF DEATH
Source: WHO World Health Statistics 2006
• Ischemic heart disease 15 %
• Lower respiratory infections 11%
• Cerebrovascular disease 7 %
• Perinatal conditions 7%
• Chronic obstructive pulmonary disease 5%
• Diarrheal disease 4%
• Tuberculosis 4%
• HIV/AIDS 3%
• Road traffic accidents 2%
• Self-inflicted injuries 2%

HISTORY 0F 5-Years HEALTH PLAN
Plan Notes
First Plan
(1951 - 56)
It was based on Harrod-Domar Model.
Community Development Program launched in 1952
Focus on agriculture, price stability, power and transport
It was a successful plan primarily because of good harvests in the
last two years of the plan
Second Plan
(1956 - 61)
Target Growth: 4.5%
Actual Growth: 4.27%
Also called Mahalanobis Plan named after the well known
economist
Focus - rapid industrialization
Advocated huge imports through foreign loans.
Shifted basic emphasis from agriculture to industry far too soon.
During this plan, prices increased by 30%, against a decline of 13%
during the First Plan

Third Plan
(1961 - 66)
|Target Growth: 5.6%
At its conception, it was felt that Indian economy has
entered a take-off stage. Therefore, its aim was to
make India a 'self-reliant' and 'self-generating'
economy.
Based on the experience of first two plans, agriculture
was given top priority to support the exports and
industry.
Complete failure in reaching the targets due to
unforeseen events - Chinese aggression (1962), Indo-Pak
war (1965), severe drought 1965-66
Three Annual Plans (1966-
69) Plan holiday for 3years.
Prevailing crisis in agriculture and serious food shortage
necessitated the emphasis on agriculture during the
Annual Plans
During these plans a whole new agricultural strategy
was implemented. It involving wide-spread distribution
of high-yielding varieties of seeds, extensive use of
fertilizers, exploitation of irrigation potential and soil
conservation.
During the Annual Plans, the economy absorbed the
shocks generated during the Third Plan
It paved the path for the planned growth ahead.

Fourth Plan
(1969 - 74)
Target Growth: 5.7%
Main emphasis was on growth rate of agriculture to enable
other sectors to move forward
First two years of the plan saw record production. The last
three years did not measure up due to poor monsoon.
Influx of Bangladeshi refugees before and after 1971 Indo-
Pak war was an important issue
Fifth Plan
(1974-79)
Target Growth: 4.4%
Actual Growth: 3.8
The fifth plan was prepared and launched by D.D. Dhar.
It proposed to achieve two main objectives: 'removal of
poverty' (Garibi Hatao) and 'attainment of self reliance'
Promotion of high rate of growth, better distribution of
income and significant growth in the domestic rate of
savings were seen as key instruments
The plan was terminated in 1978 (instead of 1979) when
Janta Party Govt. rose to power.
Rolling Plan
(1978 - 80)
There were 2 Sixth Plans. Janta Govt. put forward a plan for
1978-1983. However, the government lasted for only 2
years. Congress Govt. returned to power in 1980 and
launched a different plan.

Sixth Plan
(1980 - 85)
Target Growth: 5.2% Actual
Growth: 5.66%
Focus - Increase in national income, modernization of
technology, ensuring continuous decrease in poverty and
unemployment, population control through family planning, etc.
Seventh Plan
(1985 - 90)
Target Growth: 5.0% Actual
Growth: 6.01%
Focus - rapid growth in food-grains production, increased
employment opportunities and productivity within the framework
of basic tenants of planning.
The plan was very successful, the economy recorded 6% growth
rate against the targeted 5%.
Eighth Plan
(1992 - 97)
The eighth plan was postponed by two years because of political
uncertainty at the Centre
Worsening Balance of Payment position and inflation during 1990-
91 were the key issues during the launch of the plan.
The plan undertook drastic policy measures to combat the bad
economic situation and to undertake an annual average growth of
5.6%
Some of the main economic outcomes during eighth plan period
were rapid economic growth, high growth of agriculture and allied
sector, and manufacturing sector, growth in exports and imports,
improvement in trade and current account deficit.

Ninth Plan
(1997- 2002)
Target Growth: 6.5%
It was developed in the context of four important
dimensions: Quality of life, generation of productive
employment, regional balance and self-reliance.
Tenth Plan
(2002 - 2007)
Goals:
To achieve 8% GDP growth rate
Reduction of poverty ratio by 5 percentage points by 2007.
Providing gainful high quality employment to the addition
to the labour force over the tenth plan period.
Universal access to primary education by 2007.
Reduction in gender gaps in literacy and wage rates by
atleast 50% by 2007.
Reduction in decadal rate of population growth between
2001 and 2011 to 16.2%.
Increase in literacy rate to 72% within the plan period and
to 80% by 2012.
Reduction of Infant Mortality Rate (IMR) to 45 per 1000
live births by 2007 and to 28 by 2012.

Tenth Plan
(2002 - 2007)
Goals:
Increase in forest and tree cover to 25% by 2007 and 33% by
2012.
All villages to have sustained access to potable drinking water
by 2012.
Cleaning of all major polluted rivers by 2007 and other
notified stretches by 2012.
Eleventh Plan
(2007 - 2012)
Goals:
Accelerate GDP growth from 8% to 10%. Increase agricultural
GDP growth rate to 4% per year.
Create 70 million new work opportunities and reduce
educated unemployment to below 5%.
Raise real wage rate of unskilled workers by 20 percent.
Reduce dropout rates of children from elementary school
from 52.2% in 2003-04 to 20% by 2011-12. Increase literacy
rate for persons of age 7 years or above to 85%.
Lower gender gap in literacy to 10 percentage point. Increase
the percentage of each cohort going to higher education from
the present 10% to 15%.

Eleventh Plan
(2007 - 2012)
Goals:
Reduce infant mortality rate to 28 and maternal mortality ratio to 1 per
1000 live births
Reduce Total Fertility Rate to 2.1
Provide clean drinking water for all by 2009. Reduce malnutrition among
children between 0-3 years to half its present level.
Reduce anemia among women and girls by 50%.
Raise the sex ratio for age group 0-6 to 935 by 2011-12 and to 950 by
2016-17
Ensure that at least 33 percent of the direct and indirect beneficiaries of
all government schemes are women and girl children
Ensure all-weather road connection to all habitation with population 1000
and above (500 in hilly and tribal areas) by 2009, and ensure coverage of
all significant habitation by 2015
Connect every village by telephone by November 2007 and provide
broadband connectivity to all villages by 2012
Increase forest and tree cover by 5 percentage points.
Attain WHO standards of air quality in all major cities by 2011-12.
Treat all urban waste water by 2011-12 to clean river waters.
Increase energy efficiency by 20 percentage points by 2016-17.

HIV/AIDS Assets and Strategic Focus
• Strategic Focus
CDC opened an office in India in 2001 to assist the Indian
National AIDS Control Program’s fight against a
concentrated HIV epidemic affecting most-at-risk
populations such as intravenous drug users (IDU), men
who have sex with men (MSM), and commercial sex
workers (CSW). Sexual transmission accounts for the vast
majority of HIV incidence with variance in prevalence
varies across states. CDC’s efforts to address the epidemic
include HIV/AIDS prevention, care and treatment,
workforce capacity building, and monitoring and
evaluation activities.

• Strengthening Surveillance and Health Information Systems
CDC works with partners to design, implement, and evaluate HIV
strategic information systems and to provide training for the use of
data needed for HIV prevention, care and treatment programs. A
key element of the HIV/AIDS National Program s a single monitoring
and evaluation system for data driven decision-making to support
effective approaches in halting and reversing India’s HIV epidemic.
• Building Capacity for Laboratory Systems
CDC is supporting the implementation of quality assurance/control
for HIV testing in national and state reference laboratories in India.
CDC also trains laboratory workers.

HIV/AIDS in India
•0.3% Estimated Prevalence
(Age 15–49)
•170,000 Estimated Deaths (2009)
•N/A Million Estimated Orphans
•320,074 Reported Number of People
Receiving ART
•1,100,000 – 1,400,000 Estimated
Number of People Needing ART
SOURCE:
UNAIDS Report on the Global AIDS
Epidemic, November,
2010

Notable Accomplishments
• Structural Reform CDC supported the Government of India’s
National AIDS Control Organization (NACO) in a major
structural reform by constituting District AIDS Prevention and
Control Units (DAPCUs) in over 180 districts with high HIV
prevalence in order to decentralize response to the epidemic
• National Health Information System CDC also supported the
development of a national Strategic Information Management
System (a web-based monitoring and evaluation system which
captures data at various levels - reporting units, district and
state levels) to help guide program level decision making.
• Laboratory Quality Assessment CDC coordinated with NACO in
a quality assessment of all state and regional reference
laboratories. CDC is currently engaged in regional workshops
for equipment calibration and biosafety for all state and
regional labs.

All travelers
You should be up to date on routine vaccinations while traveling to any destination.
Some vaccines may also be required for travel.
Routine vaccines Make sure you are up-to-date on routine vaccines before every
trip. These vaccines include measles-mumps-rubella (MMR)
vaccine, diphtheria-tetanus-pertussis vaccine, varicella
(chickenpox) vaccine, polio vaccine, and your yearly flu shot.

Most travelers
Get travel vaccines and medicines because there is a risk of these diseases in
the country you are visiting.
Hepatitis A CDC recommends this vaccine because you can get hepatitis
A through contaminated food or water in India, regardless of
where you are eating or staying.
Typhoid You can get typhoid through contaminated food or water in
India. CDC recommends this vaccine for most travelers,
especially if you are staying with friends or relatives, visiting
smaller cities or rural areas, or if you are an adventurous
eater.

Some travelers
Ask your doctor what vaccines and medicines you need based on where you are going, how
long you are staying, what you will be doing, and if you are traveling from a country other
than the US.
Hepatitis B You can get hepatitis B through sexual contact, contaminated needles,
and blood products, so CDC recommends this vaccine if you might have
sex with a new partner, get a tattoo or piercing, or have any medical
procedures.
Malaria Talk to your doctor about how to prevent malaria while traveling. You may
need to take prescription medicine before, during, and after your trip to
prevent malaria, especially if you are visiting low-altitude areas. See
more detailed information about malaria in India.

Japanese
Encephalitis
You may need this vaccine if your trip will last more than a month,
depending on where you are going in India and what time of year
you are traveling. You should also consider this vaccine if you
plan to visit rural areas in India or will be spending a lot of time
outdoors, even for trips shorter than a month. Your doctor can
help you decide if this vaccine is right for you based on your
travel plans. See more in-depth information on Japanese
encephalitis in India.
Rabies Rabies can be found in dogs, bats, and other mammals in India,
so CDC recommends this vaccine for the following groups:
•Travelers involved in outdoor and other activities (such as
camping, hiking, biking, adventure travel, and caving) that put
them at risk for animal bites.
•People who will be working with or around animals (such as
veterinarians, wildlife professionals, and researchers).
•People who are taking long trips or moving to India
•Children, because they tend to play with animals, might not
report bites, and are more likely to have animal bites on their
head and neck.

Yellow Fever There is no risk of yellow fever in India. The government
of India requires proof of yellow fever vaccination only if
you are arriving from a country with risk of yellow fever.
This does not include the US. If you are traveling from a
country other than the US, check this list to see if you
may be required to get the yellow fever
vaccine: Countries with risk of yellow fever virus (YFV)
transmission.
For more information on recommendations and
requirements, see yellow fever recommendations and
requirements for India. Your doctor can help you decide if
this vaccine is right for you based on your travel plans.

CHALLENGES
1. Challenges for national registries
a) Unique identifier missing –
The PCBRs are taken up in English (not local languages). The NCRP
uses a standard code form for many of the entries, used across all the
registries. All staff have been trained and manuals developed. The
aim is to keep the quality of the registry data at international
standard.
In the handling of data from the PBCRs regular quality checks,
according to the international agencies for research on cancer under
the WHO are employed. However, the main focus is on duplicate
elimination. As India does not yet have a unique personal identifier.
One patient could go to a lab and then go to a consultation, and
finally to the treating hospital, generating three data sets submitted
to the PBCR. The system software is developed to be able to identify
these three data sets as belonging to the same individual.

The duplicate checks software will detect any permutation of “first
name”, “middle name”, and “last name” and put it up as a potential
duplicate. The software will also detect the phonetics in case the
same name is spelled differently. Actually, names are classified and
divided into 4–5 different zones as North Indian names are different
from South Indian names or East Indian names. Potential duplicates
are sent back to the district registries for guidance. As can be
imagined from the above, duplication detection and deletion is a
major exercise.
The Government of India has initiated a process to provide each
citizen with a unique identification number (Aadhaar number). The
process of providing Aadhaar Numbers to citizens began in 2010 and
as of March 2013 300 million numbers have been assigned (25 per
cent of the population). One of the future uses of the Aadhaar might
be to create “healthcare and patient record databases”.

Incidence data under the NCRP is fairly good, but coverage is a
challenge. The 27 PBCRs cover 7.45 per cent of the Indian
population. They represent 16 States and one Union Territory (UT).
The remaining 15 States and 5 UTs are still not covered, although
there is pressure from the MoHFW and the concerned states to be
included, with their own PBCRs. Within this 7.45 per cent of India’s
population, 70–80 per cent of those who get cancer will be
registered in one of the 27 PBCRs. Although there is a commitment
from the hospitals that are participating, there are logistical issues
that reduce the “coverage number”.

b) State Legislation Needed to Make Cancer a Reportable Disease
Generally NCRP has a good collaboration with the hospitals/centers,
but cancer is not yet a compulsory reportable disease. The NCRP
and the MoHFW have tried to persuade several states to make it
compulsory, but this has not happened yet, with the exception of
Punjab (where a documented higher incidence of cancer than the
Indian average had moved the state government to make reporting
of cancer cases compulsory). In other states, there may be issues in
the medical community due to lack of awareness or other priorities
within the healthcare system.

c) Staff Shortage Affects Reporting –
Healthcare providers are all very busy, particularly considering the
high patient burden at most clinics, so they would like to have a
simpler mechanism for reporting or separate personnel to do this
work. In addition, if they provide the data, they would like to have
something in return, if not money. These are some of the issues
that the NCDIR is trying to address through further development of
its software. The aim is to be able to provide participating
healthcare providers with the results of their patients, what their
survival is and a comparison of the provider’s own patients’
survival to others. The reluctance at some hospitals (to spend time
reporting cancer cases) is not dependent on whether it is a private
or a government hospital. However, in general the government
hospitals have many cases waiting and they therefore need
additional staff to record the data that the registries re-quest. To
some extent the NCDIR provides this, but more can be done.

2. Challenges in Performance Data Collection
When it comes to clinical and performance data collection and
analysis the situation has improved under the NRHM, but it is
mainly the public healthcare system that contributes. There is no
legal mandate for private actors to provide this type of data
(although they are mandated to report communicable diseases to
the IDSP). In 2010, the Central government passed the Clinical
Establishment Act, which also mandates private actors to provide
clinical and performance data. However, this central legislation must
first be approved by each state assembly.
Seven states have already approved the new legislation and the
National Health Minister is pressing the other 28 states/UTs to
approve the legislation.
Under the new legislation private practitioners would need to
report how many patients they are seeing and what disease they
have.

The process of health registries will get a major boost in the 12th
Plan (2012–2017) as it proposes a composite Health Information
System (HIS)82 that would incorporate the following:
1. Universal registration of births, deaths and cause of death.
Maternal and infant death reviews.
2. Nutritional surveillance, particularly among women in the
reproductive age group and children under six years of age.
3. Disease surveillance based on reporting by service providers
and clinical laboratories (public and private) to detect and act
on disease outbreaks and epidemics.
4. Out-patient and in-patient information through Electronic
Medical Records (EMR) to reduce response time in
emergencies and improve general hospital administration.
5. Data on Human Resources within the public and private health
system .

6. Financial management in the public health system to streamline
resource allocation and transfers, and accounting and payments
to facilities, providers and beneficiaries. Ultimately, it would
enable timely compilation of the National Health Accounts on an
annual basis.
7. A national repository of teaching modules, case records for
different medical conditions in textual and audio-visual formats
for use by teaching faculty, students and practitioners for
Continuing Medical Education.
8. Tele-medicine and consultation support to doctors at primary
and secondary facilities from specialists at tertiary centers.
9. Nation-wide registries of clinical establishments, manufacturing
units, drug-testing laboratories, licensed drugs and approved
clinical trials to support regulatory functions of Government.
10. Access of public to their own health information and medical
records, while preserving confidentiality of data.
11. Programme monitoring support for National Health Programmes
to help identify programme gaps.

Further, the 12th plan should encourage quality certification of public
hospitals. One type of certification involves certification of quality of
care in terms of the input standards – infrastructure, human
resources, drugs and equipment, and the outputs in terms of the
packages of services available. This certification ensures that the
hospital lives up to the Indian Public Health Standards. Another form
of certification relates to the organization of work and processes
central to providing ethical, efficient and effective quality care. Such
certification is relatively independent of the level of inputs. It only
certifies that there is a quality management system in place that
ensures the best quality of outputs for the level of inputs currently
available. Quality certification should not remain limited to standards
of infrastructure but it should have thrust on comprehensive in-house
quality assurance for both infrastructural and service delivery. A good
quality service delivery should be first certified by district and State
quality assurance cells/committees before any third party
certification.

The 12th plan envisages that every district would announce as part of
its five year strategic district plan, the package of services each facility
would guarantee such that taken together the district health system
would ensure universal access to good quality of comprehensive
Reproductive and Child Health (RCH) services, emergency care and
trauma related services, infectious diseases management and chronic
disease management. Such a district plan would become the
instrument to be used for programme audit by the government and for
social audit and community monitoring purposes.
One of the most important areas where persistence and quality is
needed is in the state level institutions of management and
governance. Governance institutions need to function as good
governance and need to have the necessary separation from
management functions. The governing boards of the State and District
Health Societies and Rogi Kalyan Samitis must perform different
functions from the executive committees. The programme
management units must function as secretariats of the executive
committees.

An accountability framework needs to be built with clearly defined
responsibilities for all officers at all levels. Involvement of
communities should be strengthened to ensure that the
accountability framework is implemented effectively. The principles
of good governance are to be emphasized and practices such as the
display of expenditures on the district and state websites on a
monthly basis could be mandated to ensure transparency in the
12th Plan.
One direction of change would be to integrate the various steps
undertaken by the Ministry of Health and Family Welfare over
different periods into one integrated ‘National Health Survey’ with
a periodicity of three years. Meanwhile, programme evaluation of
specific strategies would be continued using appropriate
methodologies to assess the contribution of each programme to
the overall goals.

CHENNAI FETP
• In 2001, the Indian government established a Field
Epidemiology Training Program (FETP) based in the
National Institute of Epidemiology in Chennai. This
FETP is one of many programs within the Indian
Council for Medical Research.
• The FETP is a 2-year in-service training program in
applied epidemiology. It trains public health leaders
while providing epidemiologic services to health
authorities in India. The program places emphasis on
service as scholars pursue a 2-year Masters of Applied
Epidemiology awarded through the Sree Chitra Tirunal
Institute for Medical Sciences and Technology, in
Kerala. Scholars spend 25% of their time in classroom
instruction and 75% in field assignments.

• FETP graduates serve as field
mentors for current scholars and
expand in-service training in disease
detection and response regionally.
• Linkages with other institutes and
state partners enable the FETP
scholars to undertake investigations
of emerging infectious diseases and
other acute and chronic public health
threats and help foster linkages with
the public health laboratories in the
country.
Training people according to the same
principles and then having them work
together as a team. That is how the system
improves.
Dr. GNV Ramana, World Bank, Delhi

Delhi FETP
In 2006, a second FETP was started in Delhi as a degree-
granting program, offering a Masters of Public Health in Field
Epidemiology. The program takes in recent graduates with an
MBBS degree (but also non-medical graduates), typically in
their late 20s and from the central and northern regions of
India..
This program is based within the Ministry of Health, in the
National Institute for Communicable Diseases. It is
developing, in collaboration with the Integrated Disease
Surveillance Program, a multi-tiered, multiple-level, core
competency framework. This tiered approach provides an
appropriate amount of competency-based training for public
health professionals serving at many different levels of
government. At the base of the pyramid, training involves
short courses and at the apex is the two-year FETP. Whatever
the level, the goal is mentored competency-based training.

Partners
• Centers for Disease Control and Prevention, Atlanta
• National Institute of Epidemiology, Chennai
• Various State Health Departments (Secretaries of Health and
Directors of Public Health)
• World Health Organization, country office
• US Embassy, Delhi
• Indian Council for Medical Research, Delhi
• Sree Chitra Tirunal Institute for Medical Sciences and
Technology, Thiruvananthapuram, Kerala
• National Institute of Communicable Diseases, Delhi

PROGRAMS ACCOMPLISHMENTS
• The FETPs have matured and contributed to the
strengthening of the Indian public health system. Key
achievements have been made in the areas of outbreak
investigations, surveillance, operational research, health
systems, and training methodology.
• In addition, the curriculum is now online through the
WHO Virtual Resource Center, which provides learning
materials in the form of lectures, case-studies,
presentations, and scientific articles; it is accessible at
http://searo.who.int/phi.

• The Chennai FETP scholars have investigated more than
75 outbreaks using analytical epidemiology methods. The
FETP covered the classical outbreak-prone pathogens in
India, including bacteria (e.g., cholera, anthrax,
leptospirosis), viruses (e.g., measles, hepatitis E,
chikungunya), parasites (e.g., malaria, kala-azar), and
toxic agents (e.g., organo-phosphorous). Timely
investigations led to evidence-based recommendations to
reduce morbidity and mortality.

Updates on CDC’s Polio Eradication Efforts
December 19, 2014
• CDC Continues to Support the Global Polio Eradication Effort
• The eradication of polio is an important priority for the Centers for Disease Control
and Prevention (CDC). We are closer than we have ever been to eradicating polio and
it is critical that we take advantage of this opportunity.
• On December 2, 2011, CDC Director Thomas R. Frieden, MD, MPH, activated CDC’s
Emergency Operations Center (EOC) to strengthen the agency’s partnership
engagement through the Global Polio Eradication Initiative (GPEI), which is committed
to completing the eradication of polio. On December 14, 2011, Dr. Frieden enlisted
the support of the entire CDC community to become active participants in an
intensified effort to eradicate polio worldwide.
• CDC’s Involvement
• In the final push toward global polio eradication, CDC continues its close
collaboration with partners, including the World Health Organization (WHO),
the United Nations Children's Fund (UNICEF), Rotary International, and the
Bill and Melinda Gates Foundation to ensure a coordinated global and
country-level response.
• CDC polio eradication activities and staff have moved into the EOC
operational structure to ensure maximum use of CDC resources to support
polio eradication, and to scale up timely technical expertise and support for
polio-infected countries (Afghanistan, Cameroon, Equatorial Guinea, Ethiopia,
Iraq, Nigeria, Pakistan, and Syrian Arab Republic) and for countries at risk of
polio outbreaks, in coordination with GPEI partners.

• A few additional examples of CDC polio eradication activities include:
• An in-depth review of priority countries’ polio eradication plans to
assess program gaps and training needs, and elaboration of plans for
CDC’s engagement in those countries.
• Publication of several joint World Health Organization Weekly
Epidemiologic Record/CDC Morbidity and Mortality Weekly Reports
(MMWR) highlighting polio eradication progress related
to Nigeria, Afghanistan and Pakistan, risk assessment for polio
outbreaks, possible eradication of wild poliovirus type 3, polio-free
certification in SEARO and progress towards worldwide eradication.
• Collaboration with GPEI partners on detailed country-plans for
expanded technical and management support, including assistance with
outbreak responses, surveillance reviews, vaccination campaign
planning and monitoring, and data management.
• The development of indicators for monitoring polio vaccination
campaign performance in the areas of planning, implementation, and
evaluation.
• Review of WHO proposed outbreak response protocols for all polio-
affected and at risk countries.

TB in India
• Capital City: New Delhi
• Area*:3.29 million sq. km. (1.27 million sq. mi.)
• Population (est.), 2010*: 1.17 billion (urban 29%)
• Estimated TB Incidence, 2010**: 185/100,000
Estimated TB Prevalence, 2010**: 256/100,000
Adult HIV Prevalence Rate, 2009***: 0.3%
• Number of people living with HIV (PLHIV),
2009***:2,400,000
• Percent of tested TB patients who were HIV+, 2010**:
9%
*Source: www.state.gov
**Source: WHO Global TB Control Report 2011
***Source: UNAIDS, Report on the Global AIDS Epidemic, 2010

Recent Accomplishments & Ongoing Collaborations
• Operational Research Protocols Developed: CDC/DTBE facilitated a series of
three operational research workshops, organized by WHO, CDC, and the
International Union Against TB and Lung Disease (IUATLD) in Bangalore. The
workshops aimed to develop operational research capacity for 26 public
health experts associated with the TB Program by taking participants through
all phases of operational research, including protocol development, data
analysis, and report writing.
• TB Infection Control: CDC/DTBE *organized a national steering body for
infection control, helped the national TB program develop the first National
Guidelines on Airborne Infection Control, created a standard curriculum, and
trained public health professionals at national and state levels for pilot
testing national guidelines.
• Implementation and evaluation of rapid diagnostics: CDC/DTBE and WHO
will support a large scale demonstration project for deployment of new high-
sensitivity TB diagnostics tests and innovative new delivery mechanisms to
achieve the national target of universal access to quality TB diagnosis and
treatment.
*DTBE(Division of Tuberculosis Elimination)

REFERENCES
• http://en.wikipedia.org/wiki/India
• http://www.indexmundi.com/india/
• http://india.gov.in/india-glance/profile
• http://www.bbc.com/news/world-south-asia-
12557384
• https://data.un.org/CountryProfile.aspx?crNa
me=INDIA
• http://www.nti.org/country-profiles/india/

SPECIAL THANKS
TO
Dr. UMASHANKAR
Dr. PRIYA NANDIMATH
Dr. N.S.N.RAO
Dr. RAMESH KANBARGI
HAVE A NICE DAY

India dr rahul

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