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National Health Mission (NHM)

Last updated on October 22, 2022 by ClearIAS Team

To ensure that health services are properly distributed to the underprivileged, the Ministry of Health and Family Welfare established the National Health Mission in 2013. The NHM has had a great impact on the health services in the country since its implementation. Read here to know in detail about the mission.

The National Health Mission (NHM) encompasses two Sub-Missions:

• The National Rural Health Mission (NRHM) (2005)
• The National Urban Health Mission (NUHM) (2013)

The main programmatic components include:

• Health System Strengthening
• Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A)
• Communicable and Non-Communicable Diseases.

The NHM envisages the achievement of universal access to equitable, affordable & quality healthcare services that are accountable and responsive to people’s needs.

Table of Contents

The goals for NHM have been set specific for states-

• State-specific innovations would be encouraged.
• Process and outcome indicators will be developed to reflect equity, quality, efficiency, and responsiveness.
• Targets for communicable and non-communicable diseases will be set at the state level based on local epidemiological patterns and taking into account the financing available for each of these conditions.

The aim is to achieve the following indicators:

• Reduce Maternal Mortality Rate to 1/1000 live births
• Reduce Infant Mortality Rate to 25/1000 live births
• Reduce Total Fertility Rate to 2.1
• Prevention and reduction of anemia in women aged 15–49 years
• Prevent and reduce mortality & morbidity from communicable, and non-communicable; injuries and emerging diseases
• Reduce household out-of-pocket expenditure on total healthcare expenditure
• Reduce annual incidence and mortality from Tuberculosis by half
• Reduce the prevalence of Leprosy to <1/10000 population and incidence to zero in all districts
• Annual Malaria Incidence to be <1/1000
• Less than 1 percent microfilaria prevalence in all districts
• Kala-azar Elimination by 2015, <1 case per 10000 population in all blocks

NHM support is also provided for the provision of a range of free services related to maternal health, child health, adolescent health, family planning, universal immunization program , and for major diseases such as Tuberculosis, vector-borne diseases like Malaria, Dengue and Kala Azar, Leprosy, etc.

National Rural Health Mission (NRHM)

The National Rural Health Mission (NRHM) was launched in 2005.

It aims to provide accessible, affordable, and quality health care to the rural population, especially vulnerable groups.

Under the NRHM, the Empowered Action Group (EAG) States, as well as the North Eastern States, Jammu, Kashmir, and Himachal Pradesh, have been given special focus.

The thrust of the mission is on establishing a fully functional, community-owned, decentralized health delivery system with inter-sectoral convergence at all levels, to ensure simultaneous action on a wide range of determinants of health such as water, sanitation, education, nutrition, and social and gender equality.

Institutional integration within the fragmented health sector was expected to provide a focus on outcomes, measured against Indian Public Health Standards for all health facilities.

The key features of the mission:

• making the public health delivery system fully functional and accountable to the community, human resources management
• community involvement, decentralization, rigorous monitoring & evaluation against standards
• the convergence of health and related programs from the village level upwards
• innovations and flexible financing and interventions for improving health indicators.

Mobile Medical Units (MMUs) & Teleconsultation services are also being implemented to improve access to healthcare, particularly in rural areas.

At the National level, the NHM has a Mission Steering Group (MSG) headed by the Union Minister for Health & Family Welfare and an Empowered Programme Committee (EPC) headed by the Union Secretary for Health & FW. The EPC will implement the Mission under the overall guidance of the MSG.

National Urban Health Mission (NUHM)

The National Urban Health Mission (NUHM) as a sub-mission of the National Health Mission (NHM) was approved in 2013.

NUHM envisages meeting the healthcare needs of the urban population with a focus on the urban poor , by making available to them essential primary healthcare services and reducing their out-of-pocket expenses for treatment.

This will be achieved by strengthening the:

• existing health care service delivery system
• targeting the people living in slums
• converging with various schemes relating to wider determinants of health like drinking water, sanitation, school education, etc. implemented by the Ministries of Urban Development, Housing & Urban Poverty Alleviation, Human Resource Development, and Women & Child Development.

The goals of the NUHM are:

• Need-based city-specific urban health care system to meet the diverse health care needs of the urban poor and other vulnerable sections.
• Institutional mechanisms and management systems to meet the health-related challenges of a rapidly growing urban population.
• Partnership with the community and local bodies for more proactive involvement in the planning, implementation, and monitoring of health activities.
• Availability of resources for providing essential primary health care to urban poor.
• Partnerships with NGOs, for-profit and not-for-profit health service providers, and other stakeholders.

NUHM would cover all State capitals, district headquarters, and cities/towns with a population of more than 50000.

It would primarily focus on slum dwellers and other marginalized groups like rickshaw pullers, street vendors, railway and bus station coolies, homeless people, street children, and construction site workers.

Funding scheme: The center-state funding pattern will be 75:25 for all the States except North-Eastern states including Sikkim and other special category states of Jammu & Kashmir, Himachal Pradesh, and Uttarakhand, for whom the center-state funding pattern will be 90:10 .

The Programme Implementation Plans (PIPs) sent the by the states are apprised and approved by the Ministry.

Other initiatives under NHM

• Janani Shishu Suraksha Karyakram (JSSK): Under which free drugs, free diagnostics, free blood and diet, and free transport from home to institution, between facilities in case of a referral and drop back home is provided.
• Rashtriya Bal Swasthya Karyakram (RBSK) : It provides newborn and child health screening and early intervention services free of cost for birth defects, diseases, deficiencies, and developmental delays to improve the quality of survival.
• Implementation of Free Drugs and Free Diagnostics Service Initiatives
• PM National Dialysis Programme
• Implementation of National Quality Assurance Framework in all public health facilities including in rural areas.

As part of Ayushman Bharat, the States are supporting the establishment of 1.5 lakh Health and Wellness Centres across the country by December 2022 for the provision of comprehensive primary care that includes preventive healthcare and health promotion at the community level with a continuum of care approach.

Further Ayushman Bharat , Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) provides health coverage up to Rs 5 Lakh per family per year to around 1074 crore poor and vulnerable families as per Socio-Economic Caste Census (SECC) .

Achievements of NHM

In the years of implementation, the NHM has enabled the achievement of the Millennium Development Goals (MDGs) for health.

It has also led to significant improvements in maternal, new-born, and child health indicators, particularly for maternal mortality ratio, and infant and under-five mortality rates, wherein the rates of decline in India are much higher than the global averages and these declines have accelerated during the period of implementation of NHM.

• Improved core health outcomes and increased access to health services
• Growth in public health facilities
• There was also a sustained focus on the health of tribal populations, those in Left Wing Extremism areas, and the urban poor.
• National Ambulance services for providing “free pick up and drop back” facilities to pregnant women and sick infants.
• Human Resource Augmentation: NHM supports states for engaging service delivery HR such as doctors, nurses, and health workers and also implements the world’s largest community health volunteer program through the ASHAs.
• The National Health Mission enabled the design and implementation of reforms specifically related to Governance and Technology
• Addressing high Out-of-Pocket Expenditure (OOPE)

NHM-supported health system reforms have resulted in the development of resilient health systems, albeit at different stages of maturity.

It has enabled the successful scaling up of existing interventions and the addition of newer reforms given the rapid transitions from rural to urban, gradual demographic transition to aging populations, increasing burden of chronic diseases, and the emergence of newer infectious diseases.

-Article written by Swathi Satish

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National Health Mission (NHM)

For the purpose of health systems strengthening in urban and rural areas, the Indian government launched the National Health Mission (NHM) in 2013. NHM encompasses two sub-missions, namely National Rural Health Mission and National Urban Health Mission. The government extended it in March 2018, to continue until March 2020.

( Note: Information listed in this page has been sourced from the website of National Health Mission.)

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Types of National Health Mission

National rural health mission (nrhm).

Launched in April 2005, the National Rural Health Mission focuses on providing accessible, affordable and quality healthcare to the rural population, particularly the vulnerable groups. Under the National Rural Health Mission , the Empowered Action Group States and the North Eastern States, Jammu and Kashmir and Himachal Pradesh are given special focus. The mission aims to establish a fully functional, community-owned, decentralized health delivery system, with inter-sectoral convergence at every level. This has been undertaken to ensure simultaneous action on a range of determinants of health, like water, sanitation, nutrition, education, social and gender equality.

National Urban Health Mission (NUHM)

NUHM seeks to improve the health status of the urban population, especially slum dwellers and other vulnerable sections, by providing them access to quality primary healthcare. National Urban Health Mission covers all district headquarters, state capital and other cities whose population is over 50,000 (as per census 2011) in a phased manner. Cities and towns whose population is less than 50,000 are covered under NRHM.

Health Scheme Provide By Government of India

Features Benefits Of National Health Mission (NHM)

Features of National Health Mission

The features of National Health Mission are as follows:

• It encompasses the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM).
• It aims to provide equitable, affordable & quality healthcare services
• ASHA, Rogi Kalyan Samiti/Hospital Management Society, Janani Suraksha Yojana (JSY) and The Village Health Sanitation and Nutrition Committee (VHSNC) are some of the major initiatives under National Health Mission.
• Web-based monitoring system Health Management Information System has been put in place by the Ministry for monitoring health programmes under National Health Mission

Benefits of National Health Mission

The benefits of National Health Mission are as follows:

• It provides affordable and quality healthcare to the rural population.
• It has strengthened the healthcare infrastructure.
• It has brought down maternal mortality among the poor pregnant women.
• The prevalence of tobacco use and number of tobacco users have reduced.
• The Janani Shishu Suraksha Karyakram entitles pregnant women to give birth in public health institutions at no expense.

Components of National Health Mission (NHM)

Rmnch+a - reproductive, maternal, newborn, child and adolescent health.

Improving the health of mothers and their children as well as ensuring their survival are vital to the achievement of national health goals under the NHM. SDG Goal 3 focuses on bringing down maternal, new-born and child mortality. Innovative strategies have evolved under the national programme to deliver evidence-based interventions to different population groups.

Following the “Call to Action (CAT) Summit” in February, 2013, the Ministry of Health & Family Welfare introduced Reproductive, Maternal, Newborn Child plus Adolescent Health (RMNCH+A) to influence the key interventions for reducing maternal and child morbidity and mortality.

Health Systems Strengthening

Quality standards have been prescribed for clinical protocols, administrative and management processes and support services. Skill sets and standard treatment protocols for providing quality RCH services and training packages have been designed. Additionally, the creation of a hospital management society with untied funds, enabling public participation, has contributed to improved quality of care.

Non-Communicable Disease Control Programmes

Non-communicable diseases are one of the leading causes of mortality and morbidity. The government has initiated a number of national programs for their prevention and control. These include:

• National Programme for prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & stroke (NPCDCS)
• National Programe For Control Of Blindness & Visual Impairment (NPCBVI)
• National Oral Health Programme (NOHP)
• National Programme for Palliative care (NPPC)
• National Programme for Prevention & Management of Burn Injuries (NPPMBI)
• National Mental Health Programme (NMHP)
• National Programme for healthcare of Elderly (NPHCE)
• National Programme for the Prevention & Control of Deafness (NPPCD)
• National Tobacco Control Programme (NTCP)
• Other Non-Communicable disease Control Programmes

Communicable Disease Control Programme

With a view to limit instances of communicable diseases, the government has initiated the following programs:

• National Vector Borne Disease Control Programme (NVBDCP)
• Revised National Tuberculosis Control Programme (RNTCP)
• National Leprosy Eradication Programme (NLEP)
• Integrated Disease Surveillance Programme (IDSP)

Infrastructure Maintenance

Releases to State Health & FW Society Infrastructure Maintenance for 2014-15, 2015-16, 2016-17, 2017-18 and 2018-19 are listed on the website of National Health Mission.

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Initiatives for Community Participation Under NHM

Some of the initiatives for community participation under National Health Mission are as follows:

Rogi Kalyan Samiti: This committee is a registered society whose members act as trustees, managing the hospital affairs. It is responsible for maintaining the facilities and ensuring provision of better facilities for the patients in the hospital. Financial assistance through untied fund is provided for the purpose of undertaking activities for patient welfare. 31,763 Rogi Kalyan Samitis have been established, involving the members of the community in nearly all District Hospitals (DHs), Sub-District Hospitals (SDHs), Community Health Centres (CHCs) and Primary Health Centres (PHCs).

Accredited Social Health Activist (ASHA): Over 9.15 lakh ASHAs are in place across the nation. They serve as facilitators, mobilizers and providers of community level care. ASHA is the first port of call in the community, particularly for marginalized sections of the population, with a focus on women and children.

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Objectives achievements of national health mission (nhm), objectives of national health mission.

National Health Mission endeavours to:

• Bring down MMR to 1/1000 live births
• Bring down IMR to 25/1000 live births
• Bring down TFR to 2.1
• Prevention and reduction of anaemia in women from the ages 15 to 49 years
• Prevent and reduce mortality & morbidity from communicable, noncommunicable; emerging ailments and injuries.
• Bring down household out-of-pocket expenses on overall health care expenditure
• Bring down annual incidence and mortality from Tuberculosis by half
• Bring down prevalence of leprosy to <1/10000 population and incidence to zero in all districts
• Annual malaria incidence to be <1/1000 10
• Less than 1% microfilaria prevalence in all districts
• Kala-azar elimination by 2015, <1 case per 10000 population in all blocks

Achievements of National Health Mission

• National Tobacco Control Programme is in-force in around 612 districts in all States/UTs.
• Tobacco use has gone down by 6 percentage points from 34.6% to 28.6% from 2009-10 to 2016-17. Tobacco users have come down by around 81 lakhs
• The National Tobacco Cessation Quitline Services was launched.
• 'mCessation' initiative introduced to help tobacco users quit through text-messaging via mobile phones.
• Regulating the use of cigarettes and other tobacco products in TV programmes and films.
• Established the ‘Global Knowledge Hub for Smokeless Tobacco’.
• Acceded to the Protocol to Eliminate Illicit Trade in Tobacco Products under Article 15 of the WHO Framework Convention on Tobacco Control.
• Issued an advisory to ban Electronic Nicotine Delivery System, including Heat-Not-Burn devices, e-Cigarettes, Vape, e-Sheesha, e-Nicotine Flavoured Hookah, and similar devices that allow nicotine delivery besides other than for the purpose and to the extent, as may be approved under the Drugs and Cosmetics Act, 1940 and Rules made thereunder.
• Three national tobacco testing laboratories have been set up.

National Health Mission - Janani Suraksha Yojana

Janani Suraksha Yojana is a safe motherhood intervention whose objective is to reduce the mortality rate of mothers and new-born babies by promoting institutional delivery. The scheme aims to encourage poor pregnant women to give birth in registered health institutions, where medical staff are on-hand, in case something goes wrong. Janani Suraksha Yojana integrates cash assistance along with delivery and post-delivery care. The success of the scheme can be determined by the increase in institutional delivery among the poor families.

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The NHM was introduced with the aim to provide universal access to equitable, affordable and quality healthcare services that are responsive to the needs of the country's citizens. Many states have shown improved progress in healthcare facilities as well as the health of the individuals following the implementation of various initiatives under NHM. The mission, launched by the government in 2013, is set to continue until March 2020.

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राष्ट्रीय स्वास्थ्य मिशन   हिमाचल प्रदेश

National Health Mission   Himachal Pradesh

NHM Himachal Pradesh

The overarching National Health Mission (NHM) encompasses its two Sub-Missions, The National Rural Health Mission (NRHM) and The National Urban Health Mission (NUHM). The main programmatic components include Health Systems Strengthening, Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A), and Communicable and Non-communicable Diseases. The NHM envisages achievements of universal access to equitable. Affordable & quality health care services that are accountable and responsive to people’s needs and to improve the health status of the majority vulnerable sections by facilitating their access to primary health care.

For the effective implementation of the National Health Mission in the State, a separate Mission Directorate (NHM) has been created within the Directorate of Health Services, headed by the Mission Director.

Ms. M. Sudha Devi

Ms. Priyanka Verma

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List of National Health Programs along with Brief Description of Each

For an updated list till December, 2023 click here

1. National Health Mission Communicable Diseases 1. Revised National TB Control Programme(RNTCP) 2. National Leprosy Eradication Programme (For video lecture on NLEP click link: http://www.ihatepsm.com/resource/national-leprosy-eradication-programme-... ) 3. National Filaria Control Programme 4. National Aids Control Programme 5. Integrated Disease Surveillance Project (IDSP) 6. National Vector Borne Disease Control Programme (NVBDCP) Non-Communicable Diseases, Injury & Trauma 1. School Health Programme 2. National Programme on Prevention and Control of Diabetes, CVD and Stroke 3. National Programme for Prevention and Control of Deafness 4. Universal Immunization Programme (RTI ACT, 2005) 5. National Cancer Control Programme 6. National Mental Health Programme 7. National Iodine Deficiency Disorder Control Programme 8. National Programme for Control of Blindness (For video lecture on NPCB click link: http://www.ihatepsm.com/resource/national-program-control-blindness-npcb ) 9. National Programme for Prevention and Control of Fluorosis (NPPCF) 10. National Tobacco Control Program 11. National Programme for Health Care of the Elderly (NPHCE) Other programs 1. Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) Ministry of Social Welfare 2. ICDS scheme Ministry of Social Welfare 3. Mid-day meal program Ministry of Rural Development 4. Rajiv Gandhi National Drinking Water Mission (RGNDWM)

National Health Mission National Rural Health Mission was launched in 2005. Under NRHM, financial assistance has been provided to the States/UTs for health systems strengthening which includes o Augmentation of infrastructure, o Human resources and programme management, o Emergency response services, o Mobile Medical Units, o Community participation including  Engagement of ASHAs,  Involvement of Rogi Kalyan Samitis, o Mainstreaming of AYUSH and availability of drugs and equipment Two sub-missions NRHM – National Rural Health Mission (2005) – converted to ‘National Health Mission’ NHM (2013) NUHM – National Urban Health Mission (2013) - to meet health care needs of the urban population with the focus on urban poor - Components of NHM: 1. Health Systems Strengthening o Adoption of Indian Public Health Standards (IPHS) 2. RMNCH + A: Reproductive, Maternal, Newborn, Child and Adolescent Health Maternal Health o Janani Shishu Suraksha Karyakaram o Janani Suraksha Yojna

Child Health o Rashtriya Bal Swasthya Karayakaram o Facility based new-born and child care o IMNCI o Facility based IMNCI (F - IMNCI) o Home based newborn care o Navjat shishu suraksha karyakram o Nutritional rehabilitation centres o Reduction in morbidity and mortality due to ARI and diarrhoea o Supplementation with micronutrients Immunisation o UIP and o Pulse Polio programs Adolescent Health (RKSK) o Adolescent friendly health clinics o Weekly Iron and Folic acid supplementation (WIFS) o Menstrual Hygiene Scheme Family Planning National Disease Control Programs

Goals of NHM Reduce MMR to 1/1000 live births 2. Reduce IMR to 25/1000 live births 3. Reduce TFR to 2.1 4. Prevention and reduction of anaemia in women aged 15–49 years 5. Prevent and reduce mortality & morbidity from communicable, non- communicable; injuries and emerging diseases 6. Reduce household out-of-pocket expenditure on total health care expenditure 7. Reduce annual incidence and mortality from Tuberculosis by half 8. Reduce prevalence of Leprosy to <1/10000 population and incidence to zero in all districts 9. Annual Malaria Incidence to be <1/1000 10. Less than 1 per cent microfilaria prevalence in all districts 11. Kala-azar Elimination by 2015, <1 case per 10000 population in all blocks

National Vector Borne Disease Control Programme For prevention and control of vector borne diseases i.e. o Malaria, o Dengue, o Lymphatic Filariasis, o Kala-azar, o Japanese Encephalitis and o Chikungunya Guidelines for Indoor Residual Spray (IRS) Using insecticide treated net (ITNS) and long lasting insecticide treated nets (LLINS) Use of Larvivorous Fish for Vector Control Guideline for Supply, Distribution and Communication on Long Lasting Insecticidal Nets – Orissa 2009 Guidelines on Proper Storage, Safe Handling and Disposal of Insecticides Environmental Codes of Practice (ECoP)

Revised National TB Control Programme (RNTCP) Testing and screening for Pulmonary TB 1.1 Testing: • Any person with symptoms and signs suggestive of TB including cough >2 weeks, fever >2 weeks, significant weight loss, haemoptysis etc. and any abnormality in chest radiograph must be evaluated for TB. • Children with persistent fever and/or cough >2 weeks, loss of weight / no weight gain, and/or contact with pulmonary TB cases must be evaluated for TB. Diagnostic technology 2.1 Microbiological confirmation on sputum: • All patients (adults, adolescents, and children who are capable of producing sputum) with presumptive pulmonary TB should undergo quality-assured sputum test for rapid diagnosis of TB (with at least two samples, including one early morning sample for sputum smeer for AFB) for microbiological confirmation. 2.2 Chest X-ray as screening tool: • Where available, chest X-ray should be used as a screening tool to increase the sensitivity of the diagnostic algorithm. Treatment with DOTS o initial intensive phase and continuation phase o drug regimen according to the category of the patient o follow up using sputum microscopy o drug resistant TB treatment National Leprosy Eradication Programme Decentralized integrated leprosy services through general health care system Early detection and complete treatment of new leprosy cases House hold contact survey for Multibacillary and child cases Early diagnosis and prompt MDT MB case: Rifampicin, Dapsone and Clofazimine, 12 pulses in 18 months PB case: Rifampicin and Dapson, 6 pulses in 9 months Involvement of ASHA’s for early detection and completion of MDT Disability prevention and Medical Rehabilitation (DPMR) services IEC for reduction of stigma and encourage self-reporting to PHCs Intensive monitoring at PHC/CHC level Integrated Disease Surveillance Program (IDSP) o Integrated Disease Surveillance Programme (IDSP) was launched with World Bank assistance in November 2004 to detect and respond to disease outbreaks quickly o Surveillance units have been established in all states/districts o IT network connecting 776 sites in States/District HQ and premier institutes has been established with the help of National Informatics Centre (NIC) and Indian Space Research Organization (ISRO) for data entry, training, video conferencing and outbreak discussion o Under the programme weekly disease surveillance data on epidemic prone disease are being collected from reporting units such as sub centres, primary health centres, community health centres, hospitals including government and private sector hospitals and medical colleges. o The data are being collected on ‘S’ syndromic; ‘P’ probable; & ‘L’ laboratory formats using standard case definitions o States/districts have been asked to notify the outbreaks immediately to the system o Media scanning and verification cell (MSVC) was established under IDSP in July 2008 to improve Event-Based Surveillance & to catch unusual health events reported in the media o District laboratories are being strengthened for diagnosis of epidemic prone diseases

National Iodine Deficiency Disorders Control Program o Surveys to assess the magnitude of the Iodine Deficiency Disorders. o Supply of iodated salt in place of common salt. o Resurvey after every 5 years to assess the extent of Iodine Deficiency Disorders and the impact of lodated salt. o Laboratory monitoring of iodated salt and urinary iodine excretion. o Health education & Publicity. National AIDS Control Program o National AIDS Control Organisation is a division of the Ministry of Health and Family Welfare that provides leadership to HIV/AIDS control programme in India through 35 HIV/AIDS Prevention and Control Societies o The objective of NACP-I (1992-1999) was to control the spread of HIV infection o During NACP-II (1999-2006) a number of new initiatives were undertaken o Targeted Interventions were started through NGOs, with a focus on High Risk Groups (HRGs) viz. commercial sex workers (CSWs), men who have sex with men (MSM), injecting drug users (IDUs), and bridge populations (truckers and migrants). o Behaviour Change Communication, o management of STDs and o condom promotion o Efforts towards Infection Control and Waste Management have already been introduced under NACP Phase III o development of guidelines on ICWM, o training manuals, training of various categories of medical and other technical professionals, o special focus and guidelines on needles disposal and management for IDU interventions, o ensuring adequate supplies for Personal Protective Equipment and o inclusion of IC activities through TI monitoring reports o NACP phase IV is scheduled to start from April 2012 o Strategy 1: Intensifying and consolidating prevention services with a focus on (a) high-risk groups and vulnerable population and (b) general population. o Strategy 2 Expanding IEC services for (a) general population and (b) high-risk groups with a focus on behavior change and demand generation. o Strategy 3: Increasing access and promoting comprehensive care, support and treatment o Strategy 4: Building capacities at national, state, district and facility levels o Strategy 5: Strengthening Strategic Information Management Systems o key priorities under NACP-IV are: o Preventing new infections by sustaining the reach of current interventions and effectively addressing emerging epidemics. o Preventing Parent-to-child transmission. o Focusing on IEC strategies for behavior change in HRG, awareness among general population and demand-generation for HIV services o Providing comprehensive care, support and treatment to eligible PLHIV. o Reducing stigma and discrimination through Greater involvement of PLHIV (GIPA) o Ensuring effective use of strategic information at all levels of programme o Building capacities of NGO and civil society partners especially in states of emerging epidemics. o Integrating HIV services with the health system in a phased manner. o Mainstreaming HIV/AIDS activities with all key central- and state-level Ministries/departments and leveraging resources of the respective departments o Leveraging social protection and insurance mechanisms

National Programme for Control of Blindness (lecture available at: http://www.ihatepsm.com/resource/national-program-control-blindness-npcb ) o Organizational Structure

o Strategies To reduce the backlog of avoidable blindness – through identification and treatment of the curable blind at all the three (primary, secondary and tertiary) levels To develop Comprehensive Eye Care facilities in every district as the strategy for controlling blindness and not just curative, i.e. “Eye Health for All” Upgradation of Regional Institutes of Ophthalmology (RIO’s) to become centers of excellence in the sub-specialties of ophthalmology To improve quality of service delivery by strengthening the existing infrastructure facilities and additional human resources for these To enhance community awareness on eye care especially PREVENTIVE measures Encourage research for prevention of blindness and visual impairment To secure participation of Voluntary Organizations/Private Practitioners in eye Care. Active screening of population above 50 years of age for cataract (reducing backlog) Screening of children for refractive errors and provision of free glasses to the needy Coverage of the underserved areas with eye care Capacity building by improving the quality of skill of eye care providers IEC activities for creating awareness on eye care in the community RIO’s, ophthalmology institutes and medical colleges to be improved and strengthened District hospitals also to be strengthened by upgrading infrastructure and contractual staff and funds Emphasis on PRIMARY eye care and establish vision centers on all PHC’s Creating Multipurpose District Mobile Ophthalmic Units for improving coverage Vision 2020: Right to Sight For lecture on NPCB click: http://www.ihatepsm.com/resource/national-program-control-blindness-npcb

National Mental Health Program The Government of India has launched the National Mental Health Programme (NMHP) in 1982, objectives: To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population To encourage the application of mental health knowledge in general healthcare and in social development; and To promote community participation in the mental health service development and to stimulate efforts towards self-help in the community The District Mental Health Program (DMHP) was launched under NMHP in the year 1996 Early detection & treatment. 1. District Mental Health Programme (DMHP) The main objective of DMHP is to provide Community Mental Health Services and integration of mental health with General health services through decentralization of treatment from Specialized Mental Hospital based care to primary health care services. 2. The DMHP envisages a community based approach to the problem, which includes:  Training of mental health team at identified nodal institutions  Increase awareness & reduce stigma related to Mental Health problems  Provide service for early detection & treatment of mental illness in the community (OPD/ Indoor & follow up)  Provide valuable data & experience at the level of community at the state & center for future planning & improvement in service & research.  The team of workers at the district under the program consists of 1. a Psychiatrist, 2. a Clinical Psychologist, 3. a Psychiatric Social worker, 4. a Psychiatry/Community Nurse, 5. a Program Manager, 6. a Program/Case Registry Assistant and 7. a Record Keeper

National Program for Prevention and Control of Diabetes, CVD and Stroke The pilot phase of the National Programme for Prevention and Control of Diabetes, Cardiovascular Diseases and Stroke (NPDCS) was launched in January, 2008 On a pilot basis, the NPDCS has been initiated in10 districts in10 States NPDCS is aimed at prevention and control of NCDs using o Health promotion and health education advocacy o Early detection of people with high levels of risk factors will be done through ‘opportunistic screening’. o Capacity building of health systems at all levels will be carried out to tackle NCDs and improve the quality of care District NCD Programmes will include ‘District Health Promotion Centres’ and the ‘District NCD Cells’ for o Creating awareness on lifestyle related diseases with a focus on the adoption of healthy lifestyles at schools, community, work places etc. and o Providing opportunistic screening and targeted intervention to reduce mortality and morbidity due to diabetes, CVD and stroke NPDCS has been integrated with the National Rural Health Mission (NRHM) For screening of diabetes, support for Glucometers, Glucostrips and lancets would be provided to the state under NRHM. The common infrastructure/manpower envisaged can be utilized for early detection of cases, diagnosis, treatment, training and monitoring of different program such as o National Program for Prevention Control of Cancer, Diabetes, CVDs and Stroke (NPCDCS) o National Program for Health Care of Elderly (NPHCE) o National Tobacco Control Program (NTCP) and o National Mental Health Program (NMHP)

National Programme for Prevention and Control of Deafness (NPPCD) OBJECTIVES OF THE PROGRAMME 1. To prevent avoidable hearing loss on account of disease or injury 2. Early identification, diagnosis and treatment of ear problems responsible for hearing loss and deafness 3. To medically rehabilitate persons of all age groups, suffering with deafness 4. To strengthen the existing inter-sectoral linkages for continuity of the rehabilitation programme, for persons with deafness 5. To develop institutional capacity for ear care services by providing support for equipment, material and training personnel COMPONENTS OF THE PROGRAMME 1. Manpower training and development – For prevention, early identification and management of hearing impaired and deafness cases, training would be provided from medical college level specialists (ENT and Audiology) to grass root level workers 2. Capacity building – for the district hospital, community health centers and primary health center in respect of ENT/ Audiology infrastructure 3. Service provision–Early detection and management of hearing and speech impaired cases and rehabilitation, at different levels of health care delivery system 4. Awareness generation through IEC/BCC activities – for early identification of hearing impaired, especially children so that timely management of such cases is possible and to remove the stigma attached to deafness. District Hospital: It is proposed to strengthen the ear care services at district level by providing manpower support such as 1. one ENT Surgeon, 2. one Audiologist, 3. one Audiometric Assistant and 4. one Instructor for hearing impaired At each district on contractual basis

Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) was announced in 2003 with objectives of correcting regional imbalances in the availability of affordable/ reliable tertiary healthcare services and also to augment facilities for quality medical education in the country. PMSSY has two components: 1. Setting up of AIIMS like institutions and 2. Upgradation of Government medical college institutions. Six AIIMS-like institutions, one each in the States of 1. Bihar (Patna), 2. Chhattisgarh (Raipur), 3. Madhya Pradesh (Bhopal), 4. Orissa (Bhubaneswar), 5. Rajasthan (Jodhpur) and 6. Uttaranchal (Rishikesh) Have been setup under the PMSSY scheme

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[THE ASSESSMENT OF THE RESEARCH POTENTIAL OF THE AMBULATORY-POLYCLINICAL INSTITUTIONS OF THE MOSCOW HEALTHCARE SYSTEM]

Affiliations.

• 1 Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department, 115088, Moscow, Russia.
• 2 Directorate for the coordination of the activities of medical organizations of the Moscow Department of Health, 115280, Moscow, Russia.
• 3 Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department, 115088, Moscow, Russia, [email protected].
• 4 Diagnostic Center No. 5 with an outpatient department of the Moscow Department of Health, 127572, Moscow, Russia.
• 5 Children's City Polyclinic No. 110 of the Moscow City Health Department, 127490, Moscow, Russia.
• 6 Moscow City Health Department, 127006, Moscow, Russia.
• 7 Consultative and Diagnostic Polyclinic No. 121 of the Department of Healthcare of the City of Moscow, 117042, Moscow, Russia.
• 8 Sechenov First Moscow State Medical University (Sechenov University), 119991, Moscow, Russia.
• 9 City Polyclinic No. 2 of the Moscow City Health Department, 117556, Moscow, Russia.
• PMID: 34792886
• DOI: 10.32687/0869-866X-2021-29-s2-1331-1337

Scientific research and their inclusion in the health care system is an important part of modern medical science. To study the readiness of primary care physicians as well as administration staff to introduce a research component into the national health care system, "The Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department" conducted an online survey of two groups of respondents - physicians of primary care settings (n = 593) and heads of outpatient clinics in Moscow (n = 168) in 2021. The results of the study show the insufficient involvement of primary care doctors in research activities in their working places: more than half do not consider scientific activities as a priority, motivating it by the lack of conditions, practical skills, age and health status as well as high level of employment, although they do not reject it in the future. Heads of Moscow primary health care settings demonstrate similar answers. According to their opinion, research activities are poorly represented in organizations of this type, and most likely the situation will not be changed in the near future; about half do not have sufficient information about the number of employees engaged in scientific work and are rarely familiar with their topics (often extensive, represented by various fields of medicine); about one third of managers reported participating in research projects of Moscow City Department of Health. The study made it possible to identify barriers that prevent the introduction of research components into the activities of Moscow primary health care organizations, which should be taken into account when making managerial decisions.

Keywords: health care; outpatient clinic; research activities.

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Clinical Trial of Efficacy, Safety, and Immunogenicity of Gam-COVID-Vac Vaccine Against COVID-19 (RESIST)

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Randomized, double-blind (blinded for the trial subject and the study physician), placebo controlled, multi-center clinical trial in parallel assignment of efficacy, immunogenicity, and safety of the Gam-COVID-Vac combined vector vaccine against the SARS-CoV-2-induced coronavirus infection in adults in the SARS-СoV-2 infection prophylactic treatment.

The trial will include 40,000 volunteers aged 18+. After screening, they will be randomized (3:1) into two groups - a reference group of 10,000 volunteers receiving placebo and a study group of 30,000 volunteers receiving the Gam-COVID-Vac combined vector vaccine against the SARS-СoV-2-induced coronavirus infection.

The trial subjects will be randomized into five age strata: 18-30, 31-40, 41-50, 51-60, and 60+ years.

The PCR test for SARS-CoV-2 RNA detection at the visit is performed during screening and before the second administration of the vaccine/placebo

Each subject will participate in the trial for 180±14 days after the first dose of the study drug/placebo and will have one screening visit and five on-site visits to the study physician during the said period. The study drug/placebo will be administered intramuscularly during vaccination visits 1 and 2 (day 0 and day 21±2). Subsequent observation visits 3, 4, and 5 will be made on days14±2, 28±2, 35±2,42±2, and 180±14 respectively. During the observation visits, vital signs will be assessed in all trial subjects and changes in the subjects' condition and wellbeing compared to the previous visit will be recorded. Observation visits may be remote, through the telemedicine consultation (TMC).

Additionally, the trial subjects will be able to have remote consultations with the physician through the TMC.

Blood samples will be taken from certain subjects during the following visits to assess the immunogenicity parameters listed below:

Virus-neutralizing activity (300 subjects) ×3 Interferon gamma (107 subjects) ×3 CD4 and CD8 cell count and ratio (50 subjects) SARS-CoV-2 glycoprotein-specific antibodies titer (9,520 subjects) ×3 Determination of the titer of SARS-CoV-2 nucleocleocapsid protein-specific antibodies(9,520 subjects) ×3

Blood sampling will be performed on the day of injecting the first dose of the study drug/placebo immediately prior to the study drug administration Blood sampling for immunogenicity parameters assessment will be only carried out in specially selected study centers.

Blood samples will be taken from 9,520 trial subjects. All four immunogenicity parameters may be assessed in one trial subject.

Trial subjects data will be collected using electronic case report forms and electronic questionnaires to be filled by trial subjects.

Percentage of study subjects with antibodies

to the N-protein of the SARS - CoV-2 virus that appeared after

vaccination

Inclusion Criteria:

• Written informed consent of a subject to participate in the trial
• Males and females aged ≥18 y.o.;
• Negative HIV, hepatitis, and syphilis test results
• Negative anti-SARS CoV2 IgM and IgG antibodies test carried out with the enzyme immunoassay method
• Negative COVID-2019 PCR test result at the screening visit
• No COVID-2019 in the past medical history
• No contact with COVID-2019 diseased persons within at least 14 days before the enrollment (according to trial subjects)
• Consent to use effective contraception methods during the trial
• Negative urine pregnancy test at the screening visit (for child-bearing age women)
• Negative drugs or psychostimulants urine test at the screening visit
• Negative alcohol test at the screening visit
• No evident vaccine-induced reactions or complications after receiving immunobiological products in the past medical history
• No acute infectious and/or respiratory diseases within at least 14 days before the enrollment.

Exclusion Criteria:

• Any vaccination/immunization within 30 days before the enrollment;
• Steroids (except hormonal contraceptives) and/or immunoglobulins or other blood products therapy not finished 30 days before the enrollment
• Immunosuppressors therapy finished within 3 months before the enrollment
• Pregnancy or breast-feeding
• Acute coronary syndrome or stroke suffered less than one year before the enrollment
• Tuberculosis, chronic systemic infections
• Drug allergy (anaphylactic shock, Quincke's edema, polymorphic exudative eczema, atopy, serum disease), hypersensitivity or allergic reaction to immunobiological products, known allergic reactions to study drug components, acute exacerbation of allergic diseases on the enrollment day
• Neoplasms in the past medical history (ICD codes C00-D09)
• Donated blood or plasma (450+ ml) within 2 months before the enrollment
• History of splenectomy;
• Neutropenia (absolute neutrophil count <1,000/mm3), agranulocytosis, significant blood loss, severe anemia (hemoglobin <80 g/L), immunodeficiency in the past medical history within 6 months before the enrollment
• Active form of a disease caused by the human immunodeficiency virus, syphilis, hepatitis B or C
• Anorexia, protein deficiency of any origin
• Big-size tattoos at the injection site (deltoid muscle area), which does not allow assessing the local response to the study drug/placebo administration
• Alcohol or drug addiction in the past medical history
• Participation in any other interventional clinical trial
• Any other condition that the study physician considers as a barrier to the trial completion as per the protocol
• Study center staff or other employees directly involved in the trial, or their families.

If a subject has any contraindications to vaccination based on the Guidelines on Detection, Investigation and Prevention, of Vaccination-induced Side Reactions (approved by the Ministry of Healthcare of Russia on Apr. 12, 2019, the vaccination may be postponed for a period of time specified in the document.

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About Migration

Health Assessment for Immigration Purposes

The International Organization for Migration (IOM) and its office in Moscow provides technical support in organizing Health Assessments to assess the health of migrants in specialized healthcare institutions of Moscow in accordance with the visa requirements of the country of entry.

You can find the visa medical requirements in detail on the official website of the relevant embassy and consular service.

To get the detailed information on the medical examination please choose the country of destination.

To book an appointment please press country of destination link and study the information provided.

If the applicant is younger than 18, please send a booking request to [email protected] or call +7 495-660-77-84. Our Call-center operation hours - weekdays - Mondays to Thursdays from 9 a.m. till 5 p.m., on Fridays from 9 a.m. till 4 p.m.

1, 2 January - New Year Day

5 January - Russian Orthodox Christmas Day Holiday

8 March - International Women’s Day

10 April - Eid Al-Fitr

1 May - Spring and Labour Day

9 May - Victory Day

12 June - Day of Russia

17 June - Eid Al-Adha

Kindly note international payments are not supported at the moment.

To book an appointment and to check what medical test you are requested to undergo please send Medical request information and forms (if any) at  [email protected]

Please bring with you the following:

• Passport (valid original); in exceptional cases where your original passport is not available your original National Passport will be accepted;
• Recent colour photos;
• Medical Request Form (if any);
• Any medical reports on past or current medical conditions;
• Vaccination records (optional);
• Eyeglasses or lenses, if you wear them.

Please fill in the  questionnaire  print it out, and bring it with you.

The cost of Medical examination depends on the amount of tests requested. The payment could be made in Rubles only. Only online or bank payments are accepted.

Medical examination site is located in Moscow, Rastorguevskiy pereulok, 3, city polyclinic №220 sub-brunch, 4th floor, room 412 (metro station Ulitsa 1905 goda).

Additional information:

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