Paediatric nursing

PAEDIATRIC
NURSING
FIVE YEAR PLANS
NATIONAL GOALS
NATIONAL HEALTH PROGRAMMES RELATED
TO
CHILD HEALTH
www.drjayeshpatidar.blogspot.com

INTRODUCTION
 In 1950’Planning commission was constituted
to help government to plan out integrated
development plan for the entire country.
 The Govt. of India &the planning commission
give considerable importance to health in five
year plans.
 The constitution of India had considered health
as human being's right and an asset for over all
socio economic development.
www.drjayeshpatidar.blogspot.in

OBJECTIVES OF THE “FIVE YEAR
PLANS”
 Control &eradication of various communicable
diseases, deficiency diseases, chronic diseases.
 Strengthening of medical basic health services by
establishing district health units, primary health
centres&sub centers.
 Population control.
 Development of health manpower resources & research.
 Development of indigenous system of medicine.
 Improvement of environmental sanitation.
 Drug control. www.drjayeshpatidar.blogspot.in

FIRST FIVE YEAR PLAN (1951-1956)
 AIMS:
 To fight against diseases, malnutrition and unhealthy
environment & to build up health services for rural
population for mother &children in order to improve
general health status of people.
 PRIORITIES:
 Health care of rural population.
 Health services for mother &children.
 Safe water supply & sanitation -
 Control of malaria.
 Family planning & population control.
 Education, training & health education.www.drjayeshpatidar.blogspot.in

SECOND FIVE YEAR PLAN (1956-1961)
AIMS:
 To expand existing health services to bring them within the
reach of all people so as to promote progressive improvement
of Nations health.
PRIORITIES:
 Establishment of institutional facilities for rural as well as for
urban population.
 Development of technical man power.
 Control of communicable diseases.
 Water supply & sanitation.
 Family planning &other supporting programmes.www.drjayeshpatidar.blogspot.in

THIRD FIVE YEAR PLAN(1961-66) -68
AIMS:
 To remove the shortages & deficiencies which were observed at the
end of the second five year plan in the field of health. These were
pertaining to intuitional facilities especially in rural areas, shortages
of trained personnel & supplies lack of safe drinking water in rural
areas & inadequate drainage system.
PRIORITIES:
 Safe water supply in villages & sanitation especially the drinage
programme in the urban areas.
 Expansion of intuitional facilities to promote accessibility especially
in the rural areas.
 Eradication of malaria , smallpox & control of various other
diseases.
 Family planning & other supporting services for improving health
status of people.
 Development of manpower.

FOURTH FIVE YEAR PLAN (1969-1974)
AIMS:
 To strengthen primary health center network in the rural areas
for preventive , curative & family planning services & to take
over the maintenance phase of communicable diseases.
PRIORITIES:
 Family planning programme.
 Strengthening of primary health centers.
 Strengthening of sub divisional & district hospitals to provide
effective referral support to primary health centers.
 Intensification of control programmers.
 Expansion of medical & nursing education training of Para
medical personnel to meet the minimum technical manpower
requirements. www.drjayeshpatidar.blogspot.in

FIFTH FIVE YEAR PLAN (1974-79)
AIMS:
To provide minimum level of well integrated health
,MCH &FP, nutrition & immunization services to
all the people with special reference to vulnerable
groups especially children, pregnant women &
nursing mothers, through a network of infrastructure
in all the blocks & well structured referral system .
The emphasis of the plan was on removing
imbalance in respect of medical facilities &
strengthening the health infrastructure in the rural &
tribal areas
PRIORITIES:
Priorities were based on the minimum need
programme.
- increasing accessibility of health services in rural
areas.

SIXTH FIVE YEAR PLAN (1980-1985)
AIMS:
 To workout alternative strategy & plan of action for primary health care as part of
national health system which is accessible to all section of society & especially
those living in tribal, hilly, remote rural areas & urban slums.
PRIORITIES:
 Rural health services.
 control communicable & other diseases.
 development of rural & urban hospitals dispensaries.
 improvement in medical education & training.
 medical research.
 drug control & prevention of food adulteration.
 population control & family welfare including MCH.
 water supply & sanitation.
 Nutrition.

SEVENTH FIVE YEAR PLAN (1985-1990)
AIMS:
 To plan & provide primary health care & medical services to all with special
consideration of vulnerable groups & those who are living in tribal, hilly and
remote rural areas so as to achieve the goal of health for all (HFA) by 2000
A.D. The plan emphasized on community participation, inter sectoral co-
ordination & co-operation.
PRIORITIES:
 health services in rural, tribal & hilly areas under minimum need programme.
 medical education & training.
 control of emerging health problems especially in the area of non
communicable diseases.
 MCH & family welfare.
 medical research.
 safe water supply & sanitation.
 standardization, integration & application of Indian system of medicine.

EIGHTH FIVE YEAR PLAN (1992-1997)
AIMS:
To continue reorganization & strengthening of
health infrastructure & medical service accessible
to all especially to vulnerable groups & those
living in tribal, hilly, remote rural areas etc.
PRIORITIES:
- Developing rural health infrastructure
- Medical education & training
- Control of communication diseases
- Strengthening of health service
- Medical research
- Universal immunization
- MCH & family welfare
- Safe water supply & sanitation.

NINTH FIVE YEAR PLAN (1997-2002)
 Due to same political reason the ninth five year plan couldn’t commence on 1st of
April 1997 at could commence on 19th of February 1999.
AIMS:
 The ninth plan continued with the same aim as that of right plan which was
mainly concerned with reorganization & heightening of infrastructure so as to
provide health care services accessible to all especially those living in remote
rural, hilly & tribal areas.
OBJECTIVES:
 To tackle both communicable & non-communicable diseases effectively so that
there is sustained improvement in the health status of the population
 To further intensity the efforts to improve the health status of the population by
optimizing coverage & quality care by identifying the critical gaps in
infrastructure, manpower, essential diagnostic reagents & drugs etc.

NINTH FIVE YEAR PLAN (1997-2002)
PRIORITIES:
 control of communication & non- communicable diseases.
 Efficient primary health care system as part of basic health
care services to optimize accessibility & quality care.
 strengthening of existing infrastructure.
 improvement of referral linkages.
 development of human resources, meeting increasing demands
nurses in specially & super specialist & super specialty areas.
 strengthening of existing national vertical programmers.
 involvement of practitioners from indigenous system of
medicine, voluntary & private organizations.
 inter sector co-ordination.

TENTH FIVE YEAR PLAN (2002-2007)
 Today India has a vast network of governmental, voluntary and private
health infrastructure manned by large number of medical & paramedical
persons . During the tenth plan, efforts will be further intensified to
improve the health status of the population by optimizing coverage &
quality of care by identifying & rectifying the critical gaps in
infrastructure, manpower, equipment, essential diagnostic reagents &
drugs.
AIMS:
 To improve access to and enhance the quality of primary health care in
urban & rural areas by providing on optimally functioning primary health
care system as a part of basic minimum services & to improve the
efficiency of existing health care infrastructure at primary, secondary &
tertiary care settings through appropriate institutional strengthening &
improvement of referral linkages.

TARGET
1] Reduction of poverty ratio by 5 percent points by 2007, and
by 15 percent points by 2012;
2] All children in school by 2003; all children to complete 5
year of schooling by 2007;
3] Reduction in gender gaps in literacy and wage rates by at
least 50% by 2007.
4] Reduction in the decadal rate of population growth between
2001 & 2011 to 16.2 percent
5] Increase in literacy rate to 75% within the plan period
6] Reduction of infant mortality rate to 45 percent 1000 live
birth by 2007 & to 28 by 2012.
7] Reduction of maternal mortality ratio to 2 percent 1000 live
birth by 2007 & to 1 by 2012.
8] All villages to have sustained access to potable drinking
water within the plan period.

ELEVENTH FIVE YEAR PLAN (2007-2012)
 The 10th plan aimed at providing essential primary health
care, particularly to the underprovided & underserved
segments of our population it also sought to devolve
responsibilities & funds for health care to PRIS.
However, progress to words these objectives has been slow &
targets on MMR & IMR hare been missed.
 Accessibility remains a major issue especially in areas where
habitations are scattered & women & children continue to die
en route to hospitals.
 Rural health care in most states is marked by absenteeism of
doctor/health providers, law level of skills, shortage of
medicines, inadequate supervision an/monitoring & callous
attitudes.
 There are neither rewards for service providers nor punishment
for defaulters.
 As a results, health outcomes in India are adverse compared to
others countries. www.drjayeshpatidar.blogspot.in

ELEVENTH FIVE YEAR PLAN (2007-2012)
 A comprehensive approach which encompasses individual health
care, public health, sanitation, clean drinking water, access to food &
knowledge about hygiene & feeding practice is needed.
 With concerted action including enabling pregnant women to hare
institutional deliveries & receive nutritional supplements, connecting PHCs
& CHCs by all weathers roads so that they can be reached quickly in
emergencies; (accessibility to hospital should be measured in terms of
travel time, not just distance from nearest PHC); providing home-based
neonatal care including emergency life saving measures etc; it would be
possible to achieve the millennium development goals for IMR, MMR and
for combating diseases by the end of the 11th plan.

The 11th plan will first lay emphasis on
 Integrated district health plan and second on block specific
health plans,
 Involvement of all health sectors & emphasize partnership
with NGOS ensure quality health care in rural areas & special
needs of people who are HIV positive, in particular women.
 Plan will continue to advocate fertility regulation, special
health care needs of the elderly.
 Following areas are to be strengthened:
 1] National Rural Health Mission
 2] Disability and mental health
 3] Financing health services
 4] Clean water for all
 5] Sanitation.

NATIONAL RURAL HEALTH MISSION
OBJECTIVES:
 Provision of trained & supported village health
activities, in under severed areas as per need
ensuring quality and close supervision of ASHA.
 Preparation of health action plans by panchayats as
mechanism for involving community in health.
 Strengthening SC/PHC/CHC by developing Indian
public health standards.
 Institutionalizing &substantially strengthening
district level management of health.
 Increase utilization of first referral units from less
than20%to more than75%by2010.
 Strengthening sound local health traditions & local
resource based health practices related to PHC &
public health.

TARGET
 IMR reduced to 30/1000 live births by 2012.
 MMR reduced to 100/1,00,000live births by 2012.
 TFR reduced to2.1by 2012.
 Malaria mortality reduction rate 100% by 2010 &
additional 10% by 2012.
 Kala-Azar mortality reduction rate 100%by 2010 &
sustainining elimination thereafter.
 Filarial reduction rate 70% by 2010, 80% by 2012
& eliminated by 2012.
 Dengue mortality reduction rate-
50%by2010&sustaining it at that level till 2012.
 Cataract operations increasing to 46lakh per
annum.
 Leprosy prevalence rate-reduce from 1.8per 10,000
in 2005 to less than 10,000 thereafter.
 TB DOTS Series-maintain 85%care through
mission period.

 DISABILITY&MENTAL HEALTH:
 Coping with challenges of living in a rapidly
developing society & increasing exposure to a
violent world has led to a perceptible increase in
mental stress.
 11th plan should recognize the importance of
mental health care &should concentrate on
providing counseling, medical services&
establishing help lines for all-especially people
affected by calamities, riots &violence.
 The 2001 census reveals that 2.13%of Indian
population or approximately 2.19 crore people in
India suffer from severe disability.

BHART NIRMAN
 Bharat Nirman is time –bound business plan for action
in rural infrastructure over the four year period [2005-
2009] under bharat nirman action is proposed in the
areas of:
 1] Irrigation –To create 10 million hectares of
additional irrigation capacity.
 2] Rural roads-To connect all habitations with
population above 1000 [500 in hilly/tribal areas] with
all roads.
 Rural housing-To construct 60 lakh houses for rural
poor.
 Rural water supply-
 Rural electrification
 Rural telephony www.drjayeshpatidar.blogspot.in

FINANCING HEALTH SERVICES
 Emerging health systems involves additional government expenditure. The
existing level of government expenditure on health in India is just under 1%
which is unacceptably low &efforts should be made to increase the total
expenditure at the center & the states to 2-3% of GDP.
 Clean water for all.
 Waterborne infections hamper absorptions of food even when intake is
sufficient.
 Clean drinking water is therefore vital to reduce the incidence of disease&
to check malnutrition.
 The 10th plan target of providing potable drinking water to all villages has
not been achieved.
 Sanitation.
 Rural health sanitation is covered 35%by the end of the plan.

MILLENIUM DEVELOPMENT GOALS
 INTRODUCTION
 The new century opened with new
technology, scientific development
,resources, political stability, cooperation but with
wide disparity between rich & poor in terms of
distribution of food,shelter,environmental
resources,& problems such as
illiteracy, unemployment, poor health services, poor
water supply &sanitation etc.
 These new developments & challenges have been
recognized by the world community with an
unprecedented declaration of solidarity &
determination to rid the world of poverty.
 In 2000 the UN Millennium declaration the
world leaders promised to work together to meetwww.drjayeshpatidar.blogspot.in

GOAL
 Eradicate poverty & hunger.
 Universal primary education.
 Promote gender equality & empower women.
 Reduction of child mortality.
 Improve maternal health.
 Combat HIV/AIDS, Malaria & other diseases.
 Ensure environmental sustainability.
 Development of a global partnership for development.

NATIONAL HEALTH PROGRAMMES RELATED
TO CHILD HEALTH
 Reproductive & child health programme.
 School health programme in India.
 Polio eradication pulse polio programme
 Diarrhea control programme &ORS programme.
 Prevention & control of Vitamin A deficiency among children.
 Universal Immunization programme.
 National immunization schedule.
 IMNCI
 Special nutrition programme
 Balwadi nutrition programme
 ICDS Scheme
 Mid day meal programme
 Prophylaxis against nutritional anemia
 Pilot project against micronutrient malnutrition.
 National nutritional anemia prophylaxis programme
 RNTCP (Pediatric tuberculosis)
 National HIV/AIDS control programme

REPRODUCTIVE & CHILD HEALTH
PROGRAMME
 INTRODUCTION
 The programme was formally launched on 15th October1997.
 The International conference of population &
development1994 established an international consensus on a new
approach to policies to achieve population stabilization.
 It is realized that reproductive & child health programme should
focus the needs of actual & potential clients, not only for limiting
births but also for healthy sexuality& child bearing.
 DEFINITION:- Reproductive & child health has been defined as
“People have the ability to reproduce & regulate their
fertility, women are able to go through pregnancy & child birth
safely, the outcome of pregnancies is successful in terms of
maternal &infant survival and well being, & couples are able to
have sexual relations free of fear of pregnancy & of contracting
disease.”
 The aim of programme is to improving the health status of young
women & children.

COMPONENT OF RCH
 Family planning.
 Child survival & safe motherhood.
 Clint approach to health care.
 Prevention/management of RTI/STD/AIDS.

HIGHLIGHTS OF RCH PROGRAMME
 The programme integrates all interventions of fertility
regulation, maternal& child health with reproductive
health for both women & men.
 The services to be provided are client oriented, demand
driven, high quality &based on needs of community.
 Upgradation of the level of health services for
providing various interventions & quality of care. FRU
are set up at sub-district level providing emergency
obstetric& new born care. RCH facilities OF PHCs are
upgraded.
 Facilities of obstetric care, MTP& IUD insertion in the
PHCs level are improved.IUD insertion are also
available at sub-centers.
 Specialist facilities for STD&RTI are available at all
district hospitals.

RCH PHASE (I) INTERVENTIONS
 Child survival interventions :immunization, prevention
&control of vitamin A, oral rehydration therapy &
prevention of death due to pneumonia.
 Safe motherhood interventions: antenatal check
up, immunization for tetanus, safe delivery, anemia
control programme.
 Implementation of target free approach.
 High quality training at all levels.
 IEC activities.
 RTI/STD clinics at district hospitals.
 Facility for safe abortions at PHCs by providing
equipment, contractual doctors etc.
 Community participation through panchayats, women's
group &NGOs.
 Adolescent health &reproductive hygiene.

RCH PHASE (II) INTERVENTIONS
 RCH phase II start from 1st April,2005
 The focus of the programme is to reduce maternal & child
morbidity &mortality &emphasis on rural health care.
 Strategies : Essential
Obstetric care a) institional delivery b) skilled attendance at
delivery c) ANM/LHV/SNs now been permitted to use drugs
in specific emergency situations to reduce maternal mortality.
 Emergency obstetric care a) Operationalising FRU b)
Operationalising PHCs/CHCs for round the clock delivery
services.
 Strengthening referral system.

SCHOOL HEALTH PROGRAMME OF INDIA
 School health programme is an important branch of
community health.
 First time medical examination of school children was carried
out in Baroda city.
 In1960 the GOVT. of INDIA Renuka ray committee was set
up to assess the standards of health & nutrition of school
children &suggest ways &means to improve them.
 The committee submitted report in 1961 during five year plan
with useful recommendations. then many state started
providing school health &school feeding programme.
 Modern concept, school health services is an economical &
powerful means of raising community health & more
important ,in future generations. According to that to provide
comprehensive care of the heath & well-belling of children
throughout the school year &start school health services.

OBJECTIVES
 The promotion of positive health.
 The prevention of disease.
 Early diagnosis, treatment & follow-up of defects.
 Awakening health consciousness in children.
 The provision of healthful environment.
 INDICATORS FOR ASSESSMENT OF SCHOOL HEALTH
PROGRAMME
 Indicators of children's health status.
 Indicators of ability to learn & learning achievement.
 Indicators of heath behavior.
 Indicators of the quality of school health programme &
 Policy Indicators

COMPONENTS OF SCHOOL HEALTH
PROGRAMME
 School health care services include preventive, curative & referral
services focusing on not only on student but also school staff.
 Health appraisal:-a) Regular periodic medical examination. b) Daily
inspection of students by the school teacher. c) A health record card
maintained by the teacher.
 School health education includes academic skills &knowledge
development.
 School health environment (physical & psychosocial)
 School community projects &outreach.
 Nutrition & food safety.
 Physical education & recreation.
 Mental health, counseling & social support.
 First aid & emergency care
 Dental health, eye health, education to handicapped children.
 Prevention of communicable diseases, remedial measures &follow-up.

STRATEGIES
 Vision building &strategic planning
 Advocacy
 Networking & planning
 Resource mobilization &allocation
 Capacity building
 Operations research

SCHOOL MENTAL HEALTH PROGRAMME
 School plays a crucial role in the development of
cognitive, linguistic, social, emotional& moral functions
&competencies in child.
 Common stress in children.
 Mental health &learning go hand-in-hand.
 Psychosocial issues in schools
 Comprehensive life skills education.

POLIO ERADICATION PULSE POLIO
PROGRAMME
 INTRODUCTION
The world assembly passed a resolution in May 1988
to eradicate the dreaded polio from the face of the
earth by the end of year2000.
 In 1995India took a step closer to eradicating polio,
through the strategy of National Immunization Days-
Pulse Polio Immunization .
 Polio can be caused by three types of wild polio
viruses-Type I, Type II &Type III.
 Type I polio virus is predominantly isolated in children
with paralysis.
 It is estimated that for every child with paralytic polio,
at least 100 other children are affected who have either
no symptoms or have only nonspecific symptoms of a
mild illness.
 Oral polio vaccine (Trivalent) is considered to be
effective in preventing polio.www.drjayeshpatidar.blogspot.in

STRATEGIES FOR POLIO ERADICATION IN INDIA
 Conduct Pulse Polio Immunization days every year for 3-
4years or until poliomyelitis is eradicated.
 Sustain high levels of routine immunization coverage.
 Monitor OPV coverage at district level & below.
 Improve surveillance capable of detecting all cases of AFP due
to polio & non-polio etiology.
 Ensure rapid case investigation, including the collection of
stool samples for virus isolation.
 Arrange follow-up of all cases of AFP at 60 days to check for
residual paralysis.
 Conduct outbreak control for cases confirmed or suspected to
be poliomyelitis to stop transmission.www.drjayeshpatidar.blogspot.in

CURRENT FOUR BASIC STRATEGIES TO ERADICATE
POLIO
 1)Routine Immunization –Immunize every child with at least 4 doses of oral polio
vaccine (Trivalent vaccine)
 2)National Immunization Days/Pulse Polio Immunization program/Sub-National
Immunization Days
 3)Surveillance of Acute Flaccid Paralysis-To find places with circulation of wild
poliovirus.
 ----Components---
 -Establishment &maintenance of reporting units.
 -AFP case notification.
 -AFP case investigation.
 -Stool specimen collection & transportation.
 -Outbreak response immunization
 -Active case search in the community.
 60-days follow up examination
 Cross notification &tracking of cases.
 Data management &analysis.
 Case classification
 Feedback.

CURRENT B. S.
 4)Conduct extensive house to house immunization mopping-up campaigns
 -Mopping Up
 -Operationalization – Macro planning & micro planning
 New initiatives

DIARRHEA CONTROL PROGRAMME &ORS
PROGRAMME
 The best treatment for dehydration is Oral Rehydration therapy
by Oral Rehydration salt solution.
 The latest study's findings suggest that using the low-
sodium, low-glucose& reduced osmolarity ORS formulation
reduces the need for intravenous fluids by33%
 The effect of this reduction could result in fewer children
requiring hospitalization, fewer secondary infections, a
diminished need to handle blood with its potentially dangerous
consequences, & lower health care costs.

TREATMENT PLAN-A
 Age Amount of ORS given after each loose stool
 Above2yr. 50-100ml
 2-10yr. 100-200ml
 10-above As much as wanted
 TREATMENT PLAN-B
 Age Above4month 4-11month 12-23month 2-4yr. 5-14yr.
 Weight 5kg. 5-7kg 8-10kg 11-15kg 16-29kg
 AMT.ml.200-400 400-600 600-800 800-1200 1200-2200
 15yrs or above
 30 or more kg
 2200-4000

Composition of ORS FOR 1LITER
 Constituents Composition g/l
 1)Sodium Chloride 2.6
 2)Potassium chloride 1.5
 3)Sodium citrate 2.9
 4)Glucose anhydrous 13.5
 Total Weight is 20.5
 TREATMENT PLAN-C
 Age First give 30ml/kgin Then give70ml/kg in
 Infant One hour Five hours
 Older 30Minutes Two & a half hours

Prevention & control of Vitamin A deficiency among
children
 The signs & symptoms are:
 1)Nightblindness
 2)Xerophthalmia:drying of conjunctiva &cornea
 3)Bitots spot: accumulation of foamy, cheesy material on the
conjunctiva.
 Corneal Xerosis /Ulceration
 Keratomalacia: melting or wasting of the cornea on 1/3 of the
cornea &2/3 of the cornea
 Corneal scar
 Xerophthalmic fundus

PROPHYLAXIS
 Vitamin A, schedule recommended under the National
Program for Prophylaxis against Blindness in Children caused
due to Vitamin A deficiency that is now integrated with RCH
Program, starting at 9 months.
 Five doses of vitamin A are given to all children under three
years of age.
 The first dose 1lakh units is given at nine months of age along
with measles vaccination.
 The second dose2lakh units along with DPT/OPV doses
&three doses are given 6months interval(2lakh units each).

TREATMENT
 Two doses of 2 lakh IU vitamin A are given 4weeks apart
according to program.
 Nutritional Counseling –Vitamin A rich food.

RNTCP (Pediatric tuberculosis)
 Pediatrics & TB culminated in a national workshop on the
“Management of pediatric TB under RNTCP.”
 This workshop resulted in modification of the RNTCP
guidelines for the diagnosis & treatment of pediatric patients.
 A major recommendation was that the drugs for pediatric TB
cases under RNTCP should be supplied in patient-wise boxes.
 Treatment will be based on the child's body weight &there will
be two PWBs
 One for the 6-10kg weight band,& the second for the 11-17 kg
weight band.
 DOTS programme in the world is not available for children.
 Children weighing less than 6kg will be treated with loose anti-
TB drugs.

National HIV/AIDS control programme
 The project using Nevirapine, single dose, to the mother &
child has been started from 1st October 2001 at 11 centers
viz.Maharashtra(5),Chennai(3),Bangalore(1),Hyderabad(1)&I
mphal(1).
 School AIDS Education Programme-

ROLE OF NURSE IN NATIONAL HEALTH
PROGRAMME
 Administrative role
 Supervisory role
 Educator role
 Implementer role
 Advisor role

 THE END

Paediatric nursing

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