National health programmes in India

Public Health (BPH / B.Sc Public Health) · Programmes and populations · free study notes for exams, placements and interviews

In short

National health programmes are the centrally designed, state-implemented vertical and umbrella programmes through which India delivers preventive, promotive and curative services — from tuberculosis and malaria control to non-communicable diseases, mental health and publicly financed hospital insurance. Almost all of them now sit under the National Health Mission (NHM) and the Ayushman Bharat umbrella, financed jointly by the Centre and the states and run through a district-based public health system. This is the single largest topic in Public Health degree papers and the core of recruitment tests for state NHM posts (District Programme Manager, M&E Officer, Public Health Consultant), NIHFW/IIPH admissions, UPSC/state health services, and jobs with WHO-NPSP, USAID/Jhpiego, PATH, Piramal Swasthya, PHFI and CSR health teams. Interviews test programme names, targets, indicators and the arithmetic of coverage and elimination thresholds.

Explained

Architecture, financing and service delivery levels

Health is a State subject (State List, Seventh Schedule); population control and family welfare, medical education and drug standards are in the Concurrent List. The Centre therefore works through Centrally Sponsored Schemes with conditional grants and national guidelines.
National Health Mission (2013) = NRHM (2005) for rural areas + NUHM (2013) for urban areas. It is the flagship umbrella; most disease programmes are funded as its sub-missions through a single State Programme Implementation Plan (PIP) approved by the National Programme Coordination Committee, with funds flowing to State Health Societies and District Health Societies.
Cost sharing: NHM and PM-JAY are generally 60:40 Centre:State, 90:10 for the eight North-Eastern and three Himalayan states, and 100% central for UTs without a legislature.
Service levels and population norms (IPHS 2022): Sub-centre / Ayushman Arogya Mandir per 5,000 population (3,000 in hilly, tribal and desert areas); PHC per 30,000 (20,000); CHC per 1,20,000 (80,000) as the first referral unit with specialists; then sub-district and district hospitals and medical colleges.
Community-level workforce: ASHA (1 per ~1,000 rural population, performance-linked incentives), ANM/MPW (F), MPW (M), Anganwadi worker (ICDS) and the Community Health Officer (CHO) who leads the Ayushman Arogya Mandir team; mid-level health provider courses (BSc Community Health / CCCHN bridge course) feed this cadre.
Policy frame: National Health Policy 2017 targets government health spending of 2.5% of GDP by 2025 (National Health Accounts estimates place it below 2%, around 1.8–1.9% in recent years), two-thirds of the budget on primary care, and specific disease and mortality goals.

Ayushman Bharat and its components

Ayushman Arogya Mandir (AAM) — the renamed (November 2023) Health and Wellness Centre; upgraded sub-centres and PHCs delivering an expanded package of 12 service packages including NCD screening, mental health, elderly, palliative, oral, ENT and emergency care, plus free essential drugs and diagnostics.
PM Jan Arogya Yojana (PM-JAY) — cashless secondary and tertiary hospitalisation cover of ₹5 lakh per family per year, no cap on family size or age, for roughly the bottom 40% identified from SECC 2011 deprivation and occupational criteria plus state additions. Empanelled public and private hospitals are paid at fixed Health Benefit Package (HBP) rates; there is no premium paid by the beneficiary; it covers pre-existing diseases from day one, 3 days pre- and 15 days post-hospitalisation. Administered by the National Health Authority (NHA) and State Health Agencies. Since October 2024 all citizens aged 70 and above are eligible irrespective of income, through the Ayushman Vay Vandana Card.
PM-ABHIM (Pradhan Mantri Ayushman Bharat Health Infrastructure Mission, 2021) — builds urban AAMs, block public health units, critical care hospital blocks, integrated public health labs and strengthens NCDC and regional virology institutes.
Ayushman Bharat Digital Mission (ABDM, 2021) — ABHA health ID, Health Professional Registry, Health Facility Registry and consent-based record exchange; ABHA linkage is now routine in programme reporting.
Related schemes: PMBJP (Jan Aushadhi) generic medicine stores, AMRIT pharmacies, PM National Dialysis Programme, Free Drugs and Free Diagnostics Service Initiatives, National Ambulance Service (Dial 108/102) and Rashtriya Bal Swasthya Karyakram for child screening of the 4 Ds.

Communicable disease programmes

National TB Elimination Programme (NTEP) — renamed from RNTCP in January 2020; daily fixed-dose-combination regimens, universal drug-susceptibility testing with CBNAAT/Truenat, shorter all-oral regimens for drug-resistant TB, Ni-kshay case-based digital notification, Ni-kshay Poshan Yojana nutrition support (raised to ₹1,000 per month from November 2024), Ni-kshay Mitra community support and TB Preventive Treatment for contacts. TB notification is mandatory for all private providers. The programme's stated goal was elimination (an 80% incidence and 90% mortality reduction from 2015) by 2025, ahead of the SDG 2030 date; progress is behind that timeline.
National Centre for Vector Borne Diseases Control (NCVBDC) — the renamed NVBDCP, covering six diseases: malaria (elimination target 2030, category-wise district plans, LLINs, IRS, bivalent RDTs, ACT for *P. falciparum*), dengue and chikungunya (source reduction, sentinel surveillance hospitals, NS1/ELISA), lymphatic filariasis (annual MDA with DEC + albendazole, now triple-drug IDA in many districts; elimination goal 2027), kala-azar (target <1 case per 10,000 at block level, sustained in 2023–24; miltefosine replaced by single-dose liposomal amphotericin B), and Japanese encephalitis/AES (JE vaccination campaigns).
National Leprosy Eradication Programme (NLEP) — elimination as a public health problem was achieved nationally in 2005 (<1 case per 10,000); focus is now on zero transmission, MDT free of cost, active case detection (Leprosy Case Detection Campaign, Sparsh Awareness Campaign), post-exposure prophylaxis with single-dose rifampicin for contacts, disability prevention (RCS) and stigma reduction.
National AIDS and STD Control Programme (NACP) — in Phase V (2021–26); targeted interventions for key populations, ICTC testing, free ART at ART/Link ART centres, PPTCT, blood safety, condom promotion, and the 95-95-95 targets (95% diagnosed, 95% of those on ART, 95% virally suppressed) for 2025–30. Adult HIV prevalence is about 0.2%. Legal backing: the HIV and AIDS (Prevention and Control) Act, 2017 prohibits discrimination and mandates informed consent and confidentiality.
Universal Immunisation Programme (UIP) — one of the largest in the world; Mission Indradhanush / Intensified Mission Indradhanush campaigns close coverage gaps, U-WIN digitises the immunisation record, and AEFI surveillance is built in. Immunisation detail belongs with child health; here know only that UIP is the delivery platform for programme-added vaccines.
National Viral Hepatitis Control Programme (2018) — free testing and treatment for hepatitis B and C, hepatitis B birth-dose and health-worker vaccination; National Rabies Control Programme (free anti-rabies vaccine and RIG, intradermal regimens, goal of zero dog-mediated human rabies deaths by 2030).
Certified or validated milestones: guinea worm (2000), yaws (2016), polio-free certification (March 2014), maternal and neonatal tetanus elimination (2015), trachoma eliminated as a public health problem (WHO declaration, October 2024).

Non-communicable disease, mental health and life-course programmes

NP-NCD — the renamed NPCDCS; population-based screening from age 30 for hypertension, diabetes and the three common cancers (oral, breast, cervix) through AAMs, recorded on the NCD/NP-NCD portal; district NCD clinics, CCUs, cardiac care and day-care chemotherapy; expanded to include COPD, CKD, NAFLD and stroke care.
National Tobacco Control Programme (NTCP) — implements COTPA, 2003 (bans smoking in public places, advertising, sale to minors and near educational institutions, mandates 85% pictorial warnings), the Prohibition of Electronic Cigarettes Act, 2019, the National Tobacco Quitline and tobacco cessation centres; GATS-2 recorded 28.6% tobacco use among adults.
National Mental Health Programme (NMHP) and the District Mental Health Programme — manpower development through Centres of Excellence; Tele-MANAS (launched October 2022, toll-free 14416) gives 24×7 counselling in multiple languages; the Mental Healthcare Act, 2017 guarantees a right to mental healthcare, advance directives, nominated representatives and Mental Health Review Boards, and decriminalises attempted suicide; the National Suicide Prevention Strategy (2022) targets a 10% reduction in suicide mortality by 2030.
NPCB&VI — National Programme for Control of Blindness and Visual Impairment: free cataract surgery (the dominant cause), school eye screening and free spectacles, eye banks and corneal collection, diabetic retinopathy and glaucoma screening; the 2015–19 national survey put blindness at about 0.36% overall and 1.99% in those aged 50+.
Others: NPHCE (elderly care, geriatric clinics and regional geriatric centres), National Programme for Prevention and Control of Deafness, National Oral Health Programme, National Programme for Palliative Care, National Sickle Cell Anaemia Elimination Mission (2023, goal 2047), National Programme on Climate Change and Human Health, National Action Plan for Snakebite Envenoming (2024), and the National Action Plan on Antimicrobial Resistance (NAP-AMR) with AMR surveillance networks and antibiotic stewardship.
Health promotion platforms: Eat Right India and Fit India, Rashtriya Kishor Swasthya Karyakram adolescent clinics, and Swachh Bharat / Jal Jeevan Mission as determinants-side programmes.

Surveillance, outbreak response and the legal framework

IDSP → Integrated Health Information Platform (IHIP) — case-based, near-real-time, geo-tagged reporting of about 33 notifiable conditions through P (presumptive), L (lab) and S (syndromic) forms; district and state surveillance units, Rapid Response Teams and a 24×7 Central Surveillance Unit at NCDC.
NCDC runs field epidemiology training, the Epidemic Intelligence Service, zoonoses and AMR programmes; the One Health approach links human, animal and environmental surveillance.
Key statutes a programme manager must know: Epidemic Diseases Act, 1897 (amended 2020, protects healthcare personnel); Disaster Management Act, 2005 (used for COVID-19 national directions); Clinical Establishments (Registration and Regulation) Act, 2010 with minimum standards and rate-display rules in adopting states; Food Safety and Standards Act, 2006 (FSSAI); Drugs and Cosmetics Act, 1940 with CDSCO; National Medical Commission Act, 2019; Transplantation of Human Organs and Tissues Act, 1994; Pre-Conception and Pre-Natal Diagnostic Techniques Act, 1994; Mental Healthcare Act, 2017; Biomedical waste and air/water pollution law sits with the environmental-health and waste topics.
Vital statistics inputs: SRS (birth, death, IMR, MMR), NFHS (NFHS-5 is 2019–21; NFHS-6 fieldwork has been under way), Civil Registration System, Health Management Information System (HMIS), National Health Accounts, GATS, NFHS and district-level NCD/TB prevalence surveys.

Monitoring, quality and performance measurement

Programme indicators are of three kinds — input/process (ASHA vacancies, drug stock-outs, screening coverage), output (case notification rate, surgeries performed) and outcome/impact (IMR, MMR, TB incidence, API).
Quality systems: NQAS certification of facilities, Kayakalp cleanliness awards, LaQshya (labour rooms), MusQan (paediatric), and NABH entry-level accreditation for PM-JAY empanelment.
Accountability tools: Rogi Kalyan Samitis, Village Health Sanitation and Nutrition Committees, Jan Arogya Samitis at AAMs (untied funds), community-based monitoring, and NITI Aayog's Health Index ranking states on composite incremental performance.
Common classification of programmes: vertical (disease-specific, e.g. NLEP, NTEP), horizontal/integrated (NHM, AAM package), eradication (polio, guinea worm — permanent zero), elimination (leprosy, kala-azar, malaria — reduction below a defined threshold in a defined area) and control (dengue, NCDs — reduction to an acceptable level requiring continued effort).

Key points

NHM - the umbrella mission (NRHM 2005 + NUHM 2013) under which most national health programmes are financed and implemented.
Centre:State share - 60:40 generally, 90:10 for NE and Himalayan states, 100% central for UTs without a legislature.
Ayushman Bharat's four parts - Ayushman Arogya Mandirs, PM-JAY, PM-ABHIM and ABDM.
PM-JAY - ₹5 lakh per family per year, cashless, no premium, SECC-based eligibility plus all persons aged 70+ since October 2024.
AAM - Health and Wellness Centre renamed in 2023; 12 service packages led by a Community Health Officer.
NTEP - RNTCP renamed in 2020; mandatory notification, Ni-kshay portal, ₹1,000/month nutrition support, universal DST.
NCVBDC - six vector-borne diseases; malaria elimination targeted for 2030, lymphatic filariasis by 2027.
Elimination thresholds - leprosy and kala-azar <1 case per 10,000 population (national and block level respectively); malaria API <1 marks low transmission.
NACP Phase V - 2021–26, free ART, 95-95-95 targets, adult HIV prevalence about 0.2%.
NP-NCD - population-based screening from age 30 for hypertension, diabetes, oral, breast and cervical cancers.
Tele-MANAS (14416) - 24×7 national tele-mental-health service under NMHP, launched October 2022.
IHIP - case-based digital successor to IDSP for notifiable disease surveillance.
IPHS 2022 norms - sub-centre 5,000, PHC 30,000, CHC 1,20,000 population (reduced in hilly/tribal areas).
ASHA - one per ~1,000 rural population; a volunteer paid by performance-linked incentives, not a salary.
National Health Policy 2017 - government health spending target 2.5% of GDP by 2025; actual spending remains below 2%.
Eradication vs elimination vs control - permanent global zero; below a threshold in a defined area; reduction needing continued effort.
NQAS, Kayakalp, LaQshya, MusQan - the quality certification schemes attached to NHM facilities.
Milestones - polio-free certification 2014, MNT elimination 2015, yaws 2016, trachoma declared eliminated as a public health problem in 2024.

Formulas and examples

Prevalence = (existing cases at a point or period / population at risk) × K; Incidence = (new cases in a period / population at risk) × K. K = 100, 1,000, 1,00,000 as stated.

Annual Parasite Index (API) = (confirmed malaria cases in a year × 1,000) / population under surveillance — cases per 1,000 per year.

Annual Blood Examination Rate (ABER) = (blood slides/RDTs examined × 100) / population — should be ≥10% for adequate surveillance.
Slide Positivity Rate (SPR) = (positive slides × 100) / slides examined (%).

TB Case Notification Rate (CNR) = (notified cases × 1,00,000) / population per year.
Treatment success rate = (cured + treatment completed) × 100 / cohort registered (%).

Leprosy Prevalence Rate (PR) = (cases on record × 10,000) / population; New Case Detection Rate = (new cases × 1,00,000) / population.

Cataract Surgical Rate (CSR) = cataract operations in a year × 10⁶ / population — surgeries per million per year.

Per capita public health expenditure (₹) = government health expenditure / population; share of GSDP (%) = health expenditure × 100 / GSDP.

DALY = YLL + YLD, where YLL = years of life lost to premature death and YLD = years lived with disability.

Example 1 — Malaria surveillance in a district. Population under surveillance 8,00,000; 1,20,000 slides/RDTs examined in a year; 640 confirmed positive.

ABER = 1,20,000 × 100 / 8,00,000 = 15% (above the 10% minimum, so surveillance is adequate).
API = 640 × 1,000 / 8,00,000 = 0.8 per 1,000 per year.
SPR = 640 × 100 / 1,20,000 = 0.53%.
Interpretation: API < 1 places the district in the low-transmission (elimination-track) category, with a shift to case-based investigation of every positive case.

Example 2 — TB programme performance. District population 20,00,000; 3,000 cases notified in the year; estimated incidence 195 per 1,00,000; of a treatment cohort of 2,800, 2,380 were cured or completed treatment.

CNR = 3,000 × 1,00,000 / 20,00,000 = 150 per 1,00,000 per year.
Expected cases = 195 × 20,00,000 / 1,00,000 = 3,900 → notified/expected = 3,000 / 3,900 = 76.9% case detection; missing cases = 900.
Treatment success = 2,380 × 100 / 2,800 = 85% — below the 90% programme benchmark, so loss-to-follow-up and death audits are indicated.

Example 3 — PM-JAY entitlement. A family of five holds one Ayushman card. In one policy year: hospitalisation A costs ₹2.80 lakh and hospitalisation B ₹1.60 lakh (both at package rates). A third admission is quoted at ₹1.20 lakh.

Cover used = 2.80 + 1.60 = ₹4.40 lakh; balance = 5.00 − 4.40 = ₹0.60 lakh.
The third admission is covered only up to ₹60,000, leaving ₹60,000 to be met otherwise — the cover is per family per year, not per person and not per episode.

Example 4 — Leprosy indicators. Block population 4,50,000; 58 cases on record; 36 new cases detected in the year.

PR = 58 × 10,000 / 4,50,000 = 1.29 per 10,000 — above the elimination threshold of <1 per 10,000, so this block has not reached elimination even though India did nationally in 2005.
NCDR = 36 × 1,00,000 / 4,50,000 = 8.0 per 1,00,000 per year; continuing new cases, especially any child cases, indicate active transmission.

Example 5 — Public health financing. A state with population 7.0 crore spends ₹9,800 crore on health; GSDP is ₹12,00,000 crore.

Per capita = 9,800 crore / 7.0 crore = ₹1,400 per person per year.
Share of GSDP = 9,800 × 100 / 12,00,000 = 0.82% — short of the 8% of state budget / 2.5% of GDP direction set by the National Health Policy 2017.

Programme	Current name and year	Key target	Signature intervention
Tuberculosis	NTEP (2020, from RNTCP 1997)	Elimination, 2025 goal not met	Ni-kshay notification, universal DST
Vector-borne	NCVBDC (renamed NVBDCP)	Malaria 2030, filariasis 2027	LLINs, IRS, MDA
Leprosy	NLEP (1983)	Zero transmission	Free MDT, SDR-PEP
HIV/AIDS	NACP Phase V (2021–26)	95-95-95	Free ART, targeted interventions
NCDs	NP-NCD (from NPCDCS 2010)	25% relative reduction in premature NCD mortality	Screening from age 30 at AAMs
Blindness	NPCB&VI	Prevalence to 0.25%	Free cataract surgery, school eye screening
Mental health	NMHP/DMHP	Treatment-gap reduction	Tele-MANAS 14416

Concept	Eradication	Elimination	Control
End state	Permanent global zero cases	Below a defined threshold in a defined area	Reduced to an acceptable level
Interventions after success	Can stop	Must continue surveillance	Must continue fully
Indian examples	Smallpox, guinea worm	Leprosy, kala-azar, polio (region), trachoma	Dengue, NCDs, rabies (target 2030)

Where it is used

State NHM recruitment: District Programme Manager, District Data Manager, M&E Officer, NTEP/NCVBDC district consultants, Public Health Nurse — written tests ask programme names, indicators and formulae directly.
National agencies: NHA (PM-JAY claims, HBP costing, fraud analytics), NCDC (IHIP surveillance, outbreak response), NACO, NIHFW, ICMR institutes, NITI Aayog Health vertical.
Development and technical partners: WHO-NPSP field monitors, UNICEF, Jhpiego, PATH, Clinton Health Access Initiative, PHFI/IIPHs, Piramal Swasthya, Tata Trusts and corporate CSR health programmes bidding on NHM-aligned projects.
Hospitals and insurers: PM-JAY empanelment, package coding, pre-authorisation and claims audit roles in private hospital chains and third-party administrators; state scheme integration (Arogyasri in Telangana/Andhra, MJPJAY in Maharashtra, Chief Minister's Comprehensive Health Insurance in Tamil Nadu).
Health-tech and data: ABDM/ABHA integration, Ni-kshay and U-WIN dashboards, NCD portal analytics, HMIS and SRS data analysis for district health action plans.
Teaching and research: MPH/BPH dissertations on programme evaluation, implementation research, cost-effectiveness and health technology assessment (HTA India).

Interview questions

Q: What is the difference between NRHM, NUHM and NHM? A: NRHM (2005) is the rural mission and NUHM (2013) the urban mission; since 2013 both are sub-missions of the National Health Mission, which plans and funds them through a single state PIP.
Q: What exactly does PM-JAY cover and who pays the premium? A: Cashless secondary and tertiary hospitalisation up to ₹5 lakh per family per year at empanelled hospitals, with no premium from the beneficiary — the cost is shared 60:40 between Centre and state.
Q: Why was RNTCP renamed NTEP? A: To signal the shift from control to elimination, with an incidence-reduction target far more ambitious than the SDG 2030 goal, backed by universal drug-susceptibility testing, notification of private-sector cases and nutritional support.
Q: What is the elimination threshold for leprosy and kala-azar? A: Fewer than 1 case per 10,000 population — nationally for leprosy (achieved in 2005) and at block level for kala-azar (sustained in 2023–24).
Q: Define API and state what a value below 1 means. A: Annual Parasite Index is confirmed malaria cases per 1,000 population under surveillance per year; below 1 indicates low transmission, moving the district to case-based investigation and elimination-phase activities.
Q: Why is ABER reported alongside API? A: API falls if fewer slides are examined, so ABER (ideally ≥10%) shows whether the low API reflects genuine low transmission or weak surveillance.
Q: What is the difference between elimination and eradication? A: Eradication means permanent global zero cases so interventions can stop; elimination means reduction below a threshold in a defined area, with surveillance and services continuing.
Q: What does the Community Health Officer do that an ANM does not? A: The CHO is a mid-level provider who leads the Ayushman Arogya Mandir team, can diagnose and treat a defined set of conditions under standard treatment protocols, runs NCD screening and teleconsultation, and manages the Jan Arogya Samiti's untied funds.
Q: How does IHIP differ from IDSP? A: IDSP reported aggregated weekly counts on paper or spreadsheets; IHIP captures individual, geo-tagged, case-based data in near real time, enabling earlier outbreak detection and automatic alerts.
Q: A district shows 95% ANC registration but high maternal deaths. How would you investigate? A: Check the quality of the service behind the coverage figure — content of care, HMIS data validity, referral and transport delays, blood availability and specialist posts — and run maternal death reviews rather than trusting the coverage number.
Q: Which statute makes TB notification compulsory for private doctors? A: Notification is mandated by Government of India orders under the Epidemic Diseases Act, 1897, applying to all clinical establishments, laboratories and chemists, reported through Ni-kshay.
Q: What are the main criticisms of vertical disease programmes? A: They duplicate staff, reporting and supply chains, distort priorities toward funded diseases and burden the same frontline worker — which is why NHM integrated them under one plan and one package of services at the Ayushman Arogya Mandir.

Common mistakes

Using outdated programme names in exams and interviews — RNTCP for NTEP, NVBDCP for NCVBDC, NPCDCS for NP-NCD, HWC for Ayushman Arogya Mandir.
Treating Ayushman Bharat as only PM-JAY insurance and forgetting the primary-care, infrastructure and digital pillars.
Saying PM-JAY gives ₹5 lakh per person or per admission; it is per family per year and resets annually.
Confusing elimination with eradication, or quoting the leprosy threshold as per 1,00,000 instead of per 10,000.
Reporting API without ABER, or prevalence without naming the population at risk and the multiplier K.
Mixing up the population norms for sub-centre, PHC and CHC, or quoting plain norms where hilly/tribal reduced norms apply.
Quoting coverage from HMIS as if it were validated impact — survey estimates (NFHS, SRS) and programme reporting routinely differ, and the gap itself is the finding.