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NPPCF
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   NATIONAL PROGRAMME FOR PREVENTION AND   CONTROL OF FLUOROSIS   1. General Fluorosis, a public health problem is caused by excess intake of fluoride through drinking water/food products/industrial pollutants over a long period. It results in major health disorders like dental fluorosis, skeletal fluorosis and non-skeletal fluorosis. The main sources of fluoride intake are drinking water, food, dugs & industrial emissions. Most important source is drinking water. Fluoride endemicity has been reported in 230 districts of 19 States of the country. The population at risk is about 66 million while the affected population with fluorosis is about 25 million in the country. It affects all ages. In order to address the problem of fluorosis in the country, Govt. of India initiated the National Programme for Prevention and Control of Fluorosis (NPPCF) as a new health initiative during 11 th  Five Year Plan in 2008-09 in a phased manner in 100 districts of 17 States. The list of 100 districts taken up during 11 th  Plan is at Annex 1.  The programme has been expanded to another five districts in 2013-14 and will cover further 90 districts during the 12 th  Five Year plan. 2. Goal and Objectives   The NPPCF aims to prevent and control Fluorosis cases in the country. The Objectives of the National Programme for Prevention & Control of Fluorosis are as follows:   To collect, assess and use the baseline survey data of fluorosis of Deptt. of Drinking Water Supply for starting the project;   Comprehensive management of fluorosis in the selected areas;   Capacity building for prevention , diagnosis and management of fluorosis cases. 3. Strategy In the 12 th  Five Year Plan it is proposed to implement the Programme in 95 new districts in a phased manner in addition to the existing 100 districts, with the following strategy:   surveillance of fluorosis in the community;   capacity building (Human Resource) in the form of training and manpower support;    establishment of diagnostic facilities in the medical hospitals;   management of fluorosis cases including treatment surgery, rehabilitation   health education for prevention and control of fluorosis cases. NPPCF has been now been brought under the NHM umbrella to derive benefits from synergies among different interventions under NRHM and would now be funded under a common NCD flexipool. 4. Activities 1. Community Diagnosis of Fluorosis village/block/cluster wise. 2. Facility mapping from prevention, health promotion, diagnostic facilities, reconstructive surgery and medical rehabilitation point of view  –  village/block/district wise. 3. Gap analysis in facilities and organization of physical and financial support for bridging the gaps, as per strategies listed above. 4. (a) Diagnosis of individual cases and providing its management. (b) Public health intervention on the basis of community diagnosis. 5. Behaviour change by IEC. 5. Expected Outcome   The expected outcome of the National Programme for Prevention & Control of Fluorosis in the districts with the programme will be:- a) Number of fluorosis cases managed and rehabilitated b) Capacities of laboratory testing built-up c) Trained health sector manpower in Govt. set up d) Improved information base of the community 6. Programme Framework & Phasing The programme was implemented in 100 endemic districts in 17 States/UTs in a phased manner during the 11 th  Five Year Plan. Phase-I (2008-09) 6 districts were selected from each of the zones of the country based on prevalence data as collected from Department of Drinking Water Supply on fluorosis. The activities included baseline survey, community diagnosis, capacity building by setting up/strengthening laboratory for fluoride estimation, training of medical and laboratory manpower, early detection and rapid management and IEC The districts taken up during the I phase were a) Southern zone - Nellore, Andhra Pradesh and Dharampuri, Tamil Nadu (two districts) ; b) Western zone  –  Jamnagar, Gujarat ; c) Northern zone  –  Nagaur, Rajasthan ; d) Eastern zone  –  Nayagarh, Odisha ; e) Central zone  –  Ujjain, Madhya Pradesh  Phase-II (2009-2010)  Additional 14 districts were added in the Programme with the same activities as envisaged in Phase-I to be extended to these districts also. Phase-III (2010-2011) In third year, the Programme was extended to 40 more districts. Phase-IV (2011-2013) The phase IV was over a period of two years with additional districts taken up as 31 and 9 for 2011-12 and 2012-13 respectively 12 th  Five year plan: 95 new districts proposed to be taken up in12 th  Plan ( 2013-14) Five new districts were taken up. 7. Budget NPPCF is now under NHM and the ratio of sharing the funds between Centre and State is 90:10 in case of North Eastern States and 75:25 in case of other States/UTs. Budget Allocation : For 12 th  Five Year Plan is Rs. 135 crores 2013-14 Rs. 10.00 crores 2014-15 Rs.3.73 crore against proposal of Rs.32.35 crore Funds for New districts Rs. 45 lakhs For continuing districts Rs. 20 lakhs Assistance provided to States      Strengthening manpower in endemic district : Consultant Laboratory Technician Field Investigators (3) for six months ã  Purchase of equipment for lab including an Ionmeter ã  Training at various levels ã  Health Education and Publicity    Treatment including reconstructive surgery and rehabilitation 8. Technical Advisory Committee  :  Has been constituted to oversee the technical issues in the implementation of NPPCF under the Chairpersonship of Special DGHS (PH). The first meeting of the Committee was held on 21 st  march 2014    Annex 1  Year wise selected districts under National Programme for Prevention and Control of Fluorosis:  Year State Districts 2008-09  Andhra Pradesh 1. Nellore Gujarat 2. Jamnagar Rajasthan 3. Nagaur Madhya Pradesh 4. Ujjain Orissa 5. Nayagarh Tamil Nadu 6. Dharmapuri 2009-10  Assam 7. Neygaon Bihar 8. Nawada Chhattisgarh 9. Durg  Andhra Pradesh 10. Nalgonda Jharkhand 11. Palamau Karnataka 12. Mysore 13. Ballary Kerala 14. Pallakad Maharashtra 15. Chanderpur 16. Nanded Punjab 17. Sangrur Uttar Pradesh 18. Unnao 19 RaeBarelli   West Bengal 20. Bankura 2010-11  Andhra Pradesh 21. Karimnagar 22. Prakasam  Assam 23. K.Long 24. Kamrup Uttar Pradesh 25. Pratagarh 26. Firozabad Karnataka 27. Chikkaballapur 28. Kopel 29. Davangere 30. Tumkur Madhya Pradesh 31. Dhar 32. Seoni 33. Chindwara 34. Mandla Punjab 35. Firozpur Haryana 36. Mahendragarh 37. Mewat
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