PMSSY

• The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) aims at correcting the imbalances in the availability of affordable healthcare facilities in the different parts of the country in general, and augmenting facilities for quality medical education in the under-served States in particular. The scheme was approved in March 2006. 
• The first phase in the PMSSY has two components Setting up of six institutions in the line of AIIMS Upgradation of 13 existing Government medical college institutions. It has been decided to set up 6 AIIMS-like institutions, one each in the States of Bihar (Patna), Chattisgarh (Raipur), Madhya Pradesh (Bhopal), Orissa (Bhubaneswar), Rajasthan (Jodhpur) and Uttaranchal (Rishikesh) at an estimated cost of Rs 840 crores per institution. These States have been identified on the basis of various socio-economic indicators like human development index, literacy rate, population below poverty line and per capital income and health indicators like population to bed ratio, prevalence rate of serious communicable diseases, infant mortality rate etc. Each institution will have a 960 bedded hospital (500 beds for the medical college hospital; 300 beds for Speciality/Super Speciality; 100 beds for ICU/Accident trauma; 30 beds for Physical Medicine & Rehabilitation and 30 beds for Ayush) intended to provide healthcare facilities in 42 Speciality/Super-Speciality disciplines. Medical College will have 100 UG intake besides facilities for imparting PG/doctoral courses in various disciplines, largely based on Medical Council of India (MCI) norms and also nursing college conforming to Nursing Council norms. In addition to this, 13 existing medical institutions spread over 10 States will also be upgraded, with an outlay of Rs. 120 crores (Rs. 100 crores from Central Government and Rs. 20 crores from State Government) for each institution. These institutions are 

                     # Government Medical College, Jammu, Jammu & Kashmir 

                     # Government Medical College, Srinagar, Jammu & Kashmir

                     # Kolkatta Medical College, Kolkatta, West Bengal 

                     # Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow UP

                     # Institute of Medical Sciences, BHU, Varanasi, Uttar Pardesh 

                     # Nizam Institute of Medical Sciences, Hyderabad, Andhra Pradesh

                     # Sri Venkateshwara Institute of Medical Sciences, Tirupati, AP

                     # Government Medical College, Salem, Tamil Nadu 

                     # B.J. Medical College, Ahmedabad, Gujarat 

                     # Bangalore Medical College, Bangalore, Karnataka 

                     # Government Medical College, Thiruvananthapuram

, 
                     # Rajendra Institute of Medical Sciences (RIMS),Ranchi

                     # Grants Medical College & Sir J.J. Group of Hospitals, Mumbai.

• In the second phase of PMSSY, the Government has approved the setting up of two more AIIMS-like institutions, one each in the States of West Bengal and Uttar Pradesh and upgradation of six medical college institutions namely 

                     # Government Medical College, Amritsar, Punjab

                     # Government Medical College, Tanda, Himachal Pradesh

                     # Government Medical College, Madurai, Tamil Nadu 

                     # Government Medical College, Nagpur, Maharashtra

                     # Jawaharlal Nehru Medical College of Aligarh Muslim University, Aligarh

                     # Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak. 

• The estimated cost for each AIIMS-like institution is Rs. 823 crore. For upgradation of medical college institutions, Central Government will contribute Rs. 125 crore each.
•  In the third phase of PMSSY, it is proposed to upgrade the following existing medical college institutions namely

                    # Government Medical College, Jhansi, Uttar Pradesh

                    # Government Medical College, Rewa, Madhya Pradesh

                    # Government Medical College, Gorakhpur, Uttar Pradesh

                    # Government Medical College, Dharbanga, Bihar

                    # Government Medical College, Kozhikode, Kerala

                    # Vijaynagar Institute of Medical Sciences, Bellary, Karnataka 

                    # Government Medical College, Muzaffarpur, Bihar.

• The project cost for upgradation of each medical college institution has been estimated at Rs. 150 crores per institution, out of which Central Government will contribute Rs. 125 crores and the remaining Rs. 25 crore will be borne by the respective State Governments. 'PMSSY aims at correcting the imbalances in availability of affordable/reliable tertiary level healthcare in the country in general and augmenting facilities for quality medical education in the under-served States. 
• The scheme envisages setting up six institutions like the All India Institute of Medical Sciences (AIIMS), one each in the States of Bihar (Patna), Madhya Pradesh (Bhopal), Odisha (Bhubaneshwar), Rajasthan (Jodhpur), Chhattisgarh (Raipur) and Uttarakhand (Rishikesh); and upgradation of 13 existing medical institutions in the first phase. In the 2nd phase setting up of 2 more AIIMS like institutions and up gradation of 6 more medical college institutions will be taken up.

DOTS TB MDR XDR- TB

DOTS, is an acronym for Directly Observed Treatment, Short course. The DOTS strategy represents the most important public health breakthrough of the decade, in terms of lives which will be saved. It is based largely on research done in India in the field of TB over the past 35 years. As it is the only strategy effective in controlling TB on a mass basis, nearly 100 countries are following it.
DOTS has five components:
Government commitment (including both political will at all levels, and establishing a centralized and prioritized system of TB monitoring, recording and training)
Case detection by sputum smear microscopy Standardized treatment regimen directly observed by a health care worker or community health worker for at least the first two months A regular drug supply
A standardized recording and reporting system that allows assessment of treatment results
Other Notes
The technical strategy for DOTS was developed by Dr. Karel Styblo in the 1980s primarily in Tanzania.
In 1989, the World Health Organization and the World Bank began investigating the potential expansion of this strategy. In July 1990, the World Bank, under Richard Bumgarner's direction, invited Dr. Styblo and WHO to design a TB control project for China. By the end of 1991, this pilot project was achieving phenomenal results, more than doubling cure rates among TB patients. China soon extended this project to cover half the country.
In India, Government had adopted the revised strategy for TB in the form of DOTS.
Since 1993, DOTS has been pilot tested in 20 sites in India as RNTCP. In RNTCP the proportion of TB cases confirmed in the laboratory is double that of the previous programme, and the cure rate is nearly triple that of the previous programme. The operational feasibility of DOTS in the Indian context has been demonstrated, with 8 out of 10 patients treated in the programme being cured as compared to three out of 10 under the previous regime. DOTS has also been shown to prevent the emergence of multi-drug resistant
tuberculosis (MDRTB) and to reverse the trend of MDRTB in communities in which it has emerged. Also DOTS can cure TB even in HIV-positive patients. Entire country has been covered under DOTS Strategy by March 2006. The international Joint Monitoring Mission (JMM) in October 2006, has hailed it as the fastest expansion of DOTS in the world.

Isoniazid
Isoniazid / Laniazid or Nydrazid) is the classic antituberculosis medication, first discovered in 1912. It was found to be effective against tuberculosis in 1950s. However, Isoniazid is never used on its own to treat active tuberculosis because resistance quickly develops.

Rifampicin
Rifampicin is a bacteriocidal antibiotic drug. It has been used for TB along with isoniazid, ethambutol, pyrazinamide and streptomycin etc.

MDR-TB
TB that is resistant at least to isoniazid and rifampicin the two most powerful firstline anti-TB drugs is called the Multi-drug-resistant tuberculosis (MDR-TB). It develops because the when the course of antibiotics is interrupted and the levels of drug in the body are insufficient to kill 100% of bacteria. This means that even if the patient forgets to take medicine, there are chances of developing MDR-TB. MDR-TB is treated with secondline of antituberculosis drugs such as a combination of several medicines called SHREZ (Streptomycin+isonicotinyl Hydrazine+Rifampicin+Ethambutol+pyraZinamide)+MXF+cycloserine.

XDR-TB
When the rate of multidrug resistance in a particular area becomes very high, the control of tuberculosis becomes very difficult. This gives rise to a more serious problem of extensively drug-resistant tuberculosis (XDR-TB). XDR-TB is caused by strains of the disease resistant to both first- and second-line antibiotics. This confirms the urgent need to strengthen TB control. Thus, Extensively-drug resistant TB (XDR-TB) is a sub-set of MDR-TB which is further resistant to at least two more drugs which are second line drugs and is thus virtually incurable. XDR TB was first described in March 2006 following a joint survey of laboratories by the WHO, IUATLD, and CDC, Atlanta.