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National Viral Hepatitis Control Program: India's Response Towards Universal Health Coverage

This program aims to combat viral hepatitis in India with a focus on priority populations and ensuring universal health coverage. It includes key objectives such as enhancing community awareness, early diagnosis, and strengthening infrastructure. The framework encompasses prevention, diagnosis, treatment, and enablers like inter-sectoral coordination and sustained domestic funding. Key interventions involve awareness, immunization, safe blood provision, and treatment centers. The operational plan includes stepwise approaches, 100% domestic budgeting, and training initiatives.

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National Viral Hepatitis Control Program: India's Response Towards Universal Health Coverage

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  1. National Viral Hepatitis Control Program • SDG goal 3.3 to ….combat viral hepatitis

  2. Universal Health Coverage Umbrella for Viral Hepatitis- India’s response Swachh Bharat MCH Immunization NACP HCW Injection Safety Surveillance Across all geographies, all people ( focus on priority groups), finances under NHM ( domestic budget), Linkages to other programs and schemes ( NCD, Ayushman Bharat)

  3. Ensuring Universal Health Coverage Ensuring Access Addressing Quality Ensuring Financing • All states and UTs • Identifying key Population- for different viruses • Addressing priority populations • Identifying appropriate intervention • Integrated approach • Avoiding duplication • Domestic funding for sustainability • Training and capacity building • Data quality • Quality services • Quality commodities

  4. Five key documents

  5. Aims • Elimination of Hepatitis C by 2030 • Reduction in the infected population, morbidity and mortality associated with Hepatitis B and C • Reduce the risk, morbidity and mortality due to Hepatitis A and E.

  6. Key Objectives • Enhance community awareness on hepatitis and lay stress on preventive measures • Provide early diagnosis and management of viral hepatitis at all levels of healthcare • Develop capacities for implementation of standard diagnostic and treatment protocols

  7. Key Objectives • Strengthen the existing infrastructure facilities • build capacities of existing human resource • raise additional human resources, only where required • Develop linkages with the existing programs/ ministerial activities • NACP, Immunisation, MH, Mo Drinking water and Sanitation • Develop a web-based “Viral Hepatitis Information and Management System” to maintain a registry of persons affected with viral hepatitis and its sequelae.

  8. Overall Framework- Snapshot • Guideline and Policy Formulation • M & E, Surveillance, Research • Central Procurement • Coordination Annual PIP and targets, State level planning & scaleup, intersectoral coordination, M & E Diagnosis, Treatment, Referral, Quality Control • Key Documents: • National Action Plan- costed; Operational plan for roll out of NVHCP; National Laboratory Guidelines for Testing of Viral Hepatitis; National Guidelines for Diagnosis and management of Viral hepatitis; Technical Guidelines for management of hepatitis B; National M & E framework and the electronic MIS

  9. Key interventions-Prevention • Awareness generation & Behavior Change Communication • Immunization for hepatitis B – birth dose, high risk groups, health care workers • Provision of safe blood and blood products • Injection Safety by Use of RUP/AD syringes in all government HCFs • Safe socio-cultural practices

  10. Key interventions-Diagnosis & Treatment • Screening - serological tests • Confirmation - molecular tests (where required) • Treatment of uncomplicated cases - at treatment centres, drug dispensation up to HWC • Treatment of complicated cases at model treatment centres • Referral and linkages • Capacity building and quality assurance

  11. Model for Diagnosis

  12. Model for Treatment Model Treatment centers for Treatment of Hepatitis B & C for complicated cases & management of other hepatitis; Phased scale up Treatment centers for Treatment of Hepatitis B & C; Refer complicated cases to Model Treatment Centers Dispensation

  13. Key Enablers for NVHCP • Inter-sectoral coordination • Harnessing Existing Capacities • Central Procurement for Economies of Scale • Community Involvement • Technical Working Groups • Supply Chain Management • Online M & E System • Sustained Domestic Funding

  14. Operationalizing the plan for testing and Treatment: the stepwise approach Inputs • Development of the National Action Plan- the guiding document • Financing the plan: 100% domestic budget, integrated planning • Constitution of Technical Resource Groups: Policy and guidelines development • Development of standard training manuals • Laboratory guidelines • Clinical Management guidelines The Process • Advocacy on World Hepatitis Day and other forums • Constitution of state steering committees • Inclusion of Viral hepatitis in State annual plans- integrated approach • Training of master trainers- over 435 across the country • Development of on line recording and reporting system • Procurement of test kits and distribution in the vast country

  15. Operationalizing the plan for testing and Treatment: the stepwise approach Outcomes / Progress till date • 95 centers functional in 22 states • 20,000 approx. patients started treatment in short duration (Sept 2018 to Sept 2019) • Consolidated the smaller projects and state programs under the National program for harmonization • Introduction of Hepatitis B testing for pregnant women • Guidance on vaccination for health care workers at risk • Guidance to shift towards RUP in government sector in a phased manner • Targeted testing started: vulnerable population groups prioritized

  16. Status update of State/UT

  17. National Viral Hepatitis Control Program

  18. National Viral Hepatitis Control Program

  19. Thank You

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