HEALTH PROGRAMMES AND SCHEMES :

Currently 26 Health Programmes and Schemes are operating under the Health Department.
The Priority schemes and programmes identified are :-

The performance of some of the major health programme are :-

1.    NATIONAL TB CONTROL PROGRAMME (NTCP)

                Prevalence of TB is high in the State. A modest estimate of active TB cases in Manipur is 30,000 of which 25% (8000) cases are sputum positive and infections. This gives prevalence rate of 1.8 % compared to 1.5% for the country.   

            The NTCP is in operation in Manipur since 1962.To begin with there was only one TB clinic in Imphal. At present there are six Dist. TB Centre viz. Imphal, Churachandpur, Chandel, Ukhrul, Senapati and Tamenglong. Two mini DTCs are also functioning in two Districts. namely Bishnupur and Thoubal. Imphal and Churachandpur centers were upgraded to SCC (Short Course Chemotherapy) centres are provided with X-Ray machines and effective medicines are supplied by the Central Government for sputum +ve patients. From 1998, Imphal Dist. has been included for implementation of Revised national TB Control Programme (RNTCP) with World Bank Assistance. The objective of RNTCP is to cure at least 85% of the newly detected Tb cases with supervised treatment called directly Observed Treatment Short Course Chemotherapy (DOTS). The central Government has agree to provide 100% assistance for drugs of TB patients in the State w.e.f. 1999-2000 and for implementation of RNTCP to all the remaining Districts. RNTCP in the remaining 7 Districts. have been implemented from 21st January, 2002.

            During 2001-02, 2834 TB patients have been diagnosed and given treatment of which 1473 patient are sputum positive cases. During the year 2001-02 number of cured patients were 749. 

2.    NATIONAL ANTI MALARIA PROGRAMME (NAMP) :

Malaria has been a big problem for the State.

        In 1994 the number of malaria cases rose to a pack of 7492 cases with 68% pf resulting in 55 deaths.
        The programme was converted to 100 % CSS from Dec.1994 guidelines malaria situation has been
        under Control.

Existing Infrastructure and Facilities :

                The State has adequate surveillance machinery. All the Health Institution up to PHC level have been provided facilities for blood smear examination. At present  2059 Drug Distribution centres (DDC) and 680 Fever Treatment Depots (FTD) are functioning in the State.

Epidemiological Data for the past 2 years :

3.    NATIONAL LEPROSY ERADICATION PROGRAMME (NLEP) :

        The programme is in operation since 1955 as control programme. The prevalence of leprosy was 6 per 1000 population during the early eighties. The objective of the programme is to bring down  the prevalence to 0.1 per 1000 population.

        NLEP has been going on as a vertical programme but the state has already proposed to Government of India for integration of leprosy services with General Health Care Service.

        Currently the programme is conducted through the following service units :

                     Under World Bank assisted project (1996-97 - 2001-2002) Govt. of India provided cash assistance to the 8 Districts Leprosy Societies constituted to assist in implementing the programme. So far the World has released Rs. 537.27 lakhs.

                    To augment the programme Modified Leprosy Elimination Campaign is launched. The first campaign was done from 8 to 14 March 1999 during which 14.59 lakhs population were covered.

                    2nd round Modified Leprosy Elimination Campaign was held from December, 1999 to Feb, 2000 about 80% of Medical Officers and 70% of Para  Medical staff were given training.

4. NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS (NPCB):

            The survey conducted by the NPCB/WHO in 1986-89 put the prevalence of blindness in Manipur at 0.65%. The aim is to bring down the prevalence level to below 0.3% by the end of 2000 A.D.

Existing infrastructure :

 Performance of NPCB

Cataract Operation :

5. NATIONAL IODINE DEFICIENCY DISORDER CONTROL PROGRAMME (NIDDCP):

  Iodine deficiency is a major public health problem in Manipur. The prevalence rate is 13% (1996).

        The objective of the programme is to reduce the prevalence rate to below 5% and ensure consumption by all households iodised salt of above 15 PPM.

        The Government of Manipur has already issued ban notification to the entry sale, storage ,transportation of non-iodised salt. IEC activities and monitoring  of salt samples through IDD monitoring lab and through field testing kits are the mainstay of the programme. Against the consumption of the iodised salt by household in 1970,the percentage of households consuming iodised salt has reached 96% in 2001-02.

6. NATIONAL AIDS CONTROL PROGRAMME :

HIV infection and AIDS is affecting the State in an epidemic from. Even before implantation of the National AIDS Control Programme w.e.f.1992-93 surveillance for HIV infection was started in the State since 1986. The first HIV infection was confirmed in 1990.

The Data On HIV infection is tabled below :-

        The sero- positivity rate of 157.66 per 1000 samples screened is highest in India. The programme is run by the Manipur State AIDS Control Society. The first phase of the project ended 1998. The 2nd phase of the project 1999-2004 is under progress.

        During the first phase of the project, emphasis was given to Information, Education and communication (IEC), 100% of the units of blood to be transfused on medical ground are screened, STD clinics had been strengthened training programme of Medical Officers and Para- Medical had been done, AIDS education is incorporated as curriculum in the school syllabus from VI to X, two Hospice centres for terminally ill AIDS cases had been established, RIAC (Rapid Intervention and Care Project) for IDU is on the way, intervention activities for commercial sex worker, truck drivers, man having sex with man are also established Construction of a 100 bedded hospital for AIDS case is under progress, surveillance is a continuing progress, a capacity building  for empowerment of women for the sexual behavior is another area where emphasis is given.

            The second phase of the project 1999 to 2002 had been launched on the 15th December,1999 with the following approved activities.

        Component I     :   Target Interventions for IDUs, CSWs, MSMs and STD patients
        Component I   I :   Safe blood imitative, IEC, Counseling (Voluntary counseling & testing)
        Component III   :    Programme Strengthening, Programme Management, Surveillance, Research
                                       and  Development, Monitoring and Evaluation.
        Component V  :    Inter- sartorial collaboration with Public and Private Sectors.
                    IDU        -   Intravenous Drug Users
                    CSW     -   Commercial Sex Workers
                    MSM     -    Men Having Sex with Men.
                    STD       -   Sexually Transmitted Diseases
                    HIV         -   Human Immuno deficiency Virus

        Currently 28 targeted intervention projects are in operation as on March, 2002 to deal with people with high risk behavior, the performance of the projects are highlighted in the table below :

Family health Awareness Campaign :

              Family Health Awareness Campaign is being taken up by Manipur State AIDS Control Society as a part of its Nation-wide Campaign.      

            The objective of the Family Health Awareness Campaign is to increase the level of awareness among the people about HIV / AIDS and STD and to reduce the prevalence of Sexually Transmitted Diseases (STDs) which has direct bearing on HIV transmission.

        Strategy of the Campaign is Mainly of four fold i.e.

1. Intensified IEC Campaign including house to house visit and intersonal communication by Intersectoral
    Coordination and organizing HIV /AIDS and STD awareness sessions at the camps / sub-centres and
     referral and suspected cases to the PHCs and CHCs.

2.    Treatment of STD cases through syndromic management including medical examination by PHC
       doctors with provision of drugs.

3.    Supervision of the activities by State observers.

4.  Evaluation : The first Family  Health  Awareness Campaign was conducted in Manipur during 29th
     April, to 1st May,1999 in five districts of Manipur (Imphal East, Imphal West, Thoubal, Churachandpur
     and Chandel) as a part of Nation-wide campaign.

7.        DISTRICT MENTAL HEALTH PROGRAMME (DMPH)   :

                        It has been taken up as a project in Imphal East District w.e.f.October,2000    under sponsorship of Ministry of Health and Family Welfare ,Welfare, Govt of India and implemented through Manipur State Mental Health Authority at JN. Hospital, Imphal as a nodal Institute.

            Manipur State Mental Health  Authority is formally  launched in Imphal East Dist. Manipur on 10th October, 2000 with the "Observance if the Mental health Day"

        The 1st Phase of the project lasting from October, 2000- Sep, 2001 is completed.

 Objective are :

        1.    To provide sustainable basic mental health services to the community and to integrate these services with other health services with other health services.

        2.    Early detection, treatment of patients within the community itself.

        3.   To see that patients and their relatives do not have to travel long distance to go to the hospital or nursing home in the  cities.

        4. To take pressure off the mental hospitals

        5.    to reduce the stigma attached towards mental illness through change of attitude and public education.  

       6.    To treat and rehabilitate mental patients discharged from the mental hospital within the community.

IEC Activities :

    Awareness programme were having different institutions and places
    publication of health education materials

Training :

    Training of community level workers such as teachers, Social Workers, Religious Leaders, Panchayat members, Anganwadi Workers and Community health Guides etc.

    Training of Nursing personnel's and Medical Officers

Treatment of mental ill Persons:
        During the year under the report a total 1981 patients were treated in the Psychiatry Department of JN hospital.
        For effective implementation of the DMHP, outreach clinic services are also held

Expenditure :

    Day to-day expenditure is maintained by member Secretary Manipur State mental Authority. And audited account is to be submitted to the MCH & FW, Govt. of India at the end of the September,2000 of 1st week of October 2000. The programme has completed its 1st phase and already submitted a Status Report to the Ministry of health and Family Welfare, Govt. of India.

        The 1st years of the 2nd phase is now in progress and audited statement of the amount of the 2nd phase is to be submitted to the Ministry of Health & Family Welfare, Govt. of India in the 1st week of October, 2002.

8.    PREVENTION OF FOOD ADULTERATION :

   The Govt. of India passed the Prevention of Food Adulteration Act 1945 in a bid to insure availability of whole some quality food. Food standards are being laid down by the central Committee of Food Standards. Any food that does not conform to minimum standard is said to be adulterated.

The State Government framed the Manipur Prevention of Food Adulteration rules in 1958 with subsequent amendments in the year 1965,1978 and 1995. However the act is not yet effectively implemented in the state due to lack of infrastructure and manpower particularly the lack of a legally tenable Food testing Laboratory, enforcement staff and organised District Units. Currently food samples are to Guwahati Assam for testing which is causing undesirable delay in receiving the reports and taking up appropriate actions in time. however the importance of PFA cannot be over emphasised and assuming greater importance with the opening of Indo Myanmar Food Trade.

Progress achieved :

A basic food testing laboratory has been functioning under the State Health Department since October 1994 which was inherited from the Department of Science & Technology which was formally running it. Till date the Food testing laboratory has no building of its own. It is being housed in the special ward of  District Hospital, Imphal.

        The Food Testing Laboratory (FTL) is currently manned by the following staff engaged on  contract basis.

However the staff requirement of a legally tenable FTL is as under.

  The post of Public Analyst have been created during 2000-01 but still lying unfilled

The medical Department has also proposed during 2001-02 for creation of the post of Chemist (Sr. Analyst) and Food technologist (Jr. Analyst) and Lab Assistant for FTL Imphal.     

Regarding the enforcement staff against the requirement of 11Food Inspector in the State (2 for Imphal Municipality area and one for each of the 9 District), The State health Department has 6 post of Food Inspectors of which 3 are lying vacant. Thus only 3 F00d Inspectors are currently serving under the State health Department. There is another Food inspector under the Imphal Municipality area. More recently 9 post of District food Inspectors were created by vacating 9 posts of Male Health Supervisors. However the posts are yet to be filled up.

One post of State Food Inspector was created by vacating one post of Microscopist and the post has been filled up.

Further M.O.i/c, CHC, Moreh has been notified as the local health authority.

The current enforcement staff are :
 

       Imphal Municipality

There are been many proposal submitted to Government of India of strengthening of PFA Scheme in the State.

So far the Government of India has approved to the establishment of Food testing Laboratory in Imphal and Moreh with central Assistance. The FTL at Moreh is primary for testing rice (to be) imported from Myanmar.

The government of India released Rs.16.00 lakhs in total for strengthening of FTL in the State (Rs. 9.00 lakhs during 1997 and Rs.9.00 lakhs during 2000). However encashment & utilisation of the fund was permitted during March 2002 only.

The whole amount was drawn during 2001-02 & utilised as under :

More recently during 2001-02 the World Bank has sent positive signals to support a 5 year capacity building project for the existing 2 Food Testing Laboratories at Moreh and Imphal .The capacity of the building is in terms of buildings, furniture, equipment and manpower.

 The staff to be recruited for strengthening of the state units under the project are as under :

The commitment from the State Government that the above staff recruited shall be sustained after completion of the project as one of the pre-condition for funding by the World Bank.

    As none of the above posts has been created it is necessary to plan for creation of the posts for the State Health Dept. and Charge the salaries from the World Bank during the project period and from the State Budget as soon as the period is over.

9.    DRUG DE- ADDICTION PROGRAMME :

        BACKGROUND :- Addiction to alcohol and marijuana has been there in the State but not to a remarkable extent.

     From the seventies onward with the invasion of western pop & drug culture, abuse of psychotropic drugs were popularised in the state by students students who studied in the big cities of the country. 

    From last seventies injectable heroin (a highly addictive narcotic drug) produced in the golden Triangle (Area incompromising the tri junction of Myanmar, Thailand & Laos controlled by drug lords) became easily available in the State by smuggling through the state's perforated border with Myanmar which is difficult to seal.

With this there was a surge in the number of drug the youths. Injection became the preferred route for drug abuses and drug taking became a group activity with sharing of injection equipment (needles &syringes) and practice of risk behavior conducive to the spread of HIV injection.

The entailing social, economic and medical problems became insurmountable.

1.    The State is estimated as having about 20,000 hard core drug addicts mostly (95%) heroin IDUs. Even murders have been committed for drugs. Number of patients diet of drug overdose.

2.    HIV infection in the state were rapidly accelerated and primary attributed to IDUs 60 % of IDUs are infected with HIV.

3.   within a short span of 1 years Manipur State achieved   the highest prevalence of HIV infection in the country ,courtesy to the IDUs.

4.    HIV infection which was once an exclusive of IDUs has spread to the general population.

Drug De-Addiction Centres :-

government of India seeing the gravity of the situation started giving central support to the establishment of Drug De-Addiction Centres in the State since 1990 in the order to provided the addicts, proper detoxifications and counseling services.

The DDAC are to be established as an extension of existing hospitals.

A non- recurring grant of Rs.8.00 lakhs as cost of building and a recurring annual grant of Rs.2.00 lakhs for medicine and other revenue expenditure are provided by Government of India for each centre directly to the C.M.Os / Programme Officers. The staff requirement including salaries, furnishing and diet etc. for DDAAACs are to be provided by the State Government.

The services to be provided by a DDAC are :-

The first DDAC was established in 19990 at old District hospital Campus Imphal and in August 1991 it was upgraded to 30 bedded capacity.

Besides the Government of India has also released one Maruti Gypsy each for the following centres at (1) Imphal (2) Churachandpur and (3) Moreh

Further or Community Based Drug Demand reduction was launch in Thoubal District from 1996 (Sep:)-1999 as a pilot project & carried out the following activities :-
1. Survey in Thoubal District
2. Substitution Therapy

ACHIEVEMENT OF THE DEPARTMENT DURING -2002

Construction of an Observation  Block of Primary Health Centre, Kumbi has also been completed and inaugurated by the Hon'ble Minister (IFCD), Manipur on 10th june,2002.

    The Health Department also give special emphasis on the AIDS Control programe. A programe under the name and style of "Prevention of Mother to Child Transmission of HIV Project" has been launched throughout the entire and breadth of the State by the Hon'ble Chief Minister, Manipur on 4th June,2002.

    The Health Department also extended the services of Specialists, Doctor, Para - Medical staff and provides drugs and vehicles in the organisation of health Camps by the NGOs at farflug and topographically difficult areas for the benefit of the general public at places; (i) Terakhul, Sawombung, (ii) Thanga Tongbram Leikai, (iii) Serou Village, (iv) Chandrakhong, Leirongthel & Khoirem Village (v) Ngarien Village, (vi) Moreh, (vii) Jiribam, (viii) Kasom Khullen, Mawoi Khunthek, Bungdung Village and (ix) Moreh Buddhist Temple.

Now, being the Malaria- affected season, special intervention activities to check malaria transmission are taken -up. As a measure, DDT spray operation covering a total population of 5.28 lakhs in 1190 villages covering all the districts all the State has been stated from 10th April April, 2002.

The Implementation of all other National Health Programme in the State are also counting in active phase.

        Initiation has been  made on the project proposal for strengthening of Casualty and Emergency Services of -(a) JN Hospital, Imphal (b) District Hospital, Senapati and (d) Community Health Centre, Nungba out of the fund from the 10th Plan of north Eastern Council (NEC)