Public Health care in India

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Public Health care : India An Overview:

Public Health care : India An Overview State Institute of Health & Family Welfare, Jaipur

Constitutional commitment: Health: State subject Central List International Health, Port Health Research Technical & Scientific Education State List All other Health issues Concurrent list Epidemics :

Constitutional commitment: Health: State subject Central List International Health, Port Health Research Technical & Scientific Education State List All other Health issues Concurrent list Epidemics 2 SIHFW: an ISO 9001: 2008 certified Institution

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Mile stones: NRHM-2005 NHP-2002 NPP-2000 RCH-1996 UIP-1985 NHP-1983 Alma Ata-1978 (HFA) Small pox eradicated-July 5, 1975 NFPP-1952 India Joins WHO-1948 HSDC-1946 Juggling Priorities 3 SIHFW: an ISO 9001: 2008 certified Institution

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NO Health Policy for 36 years Committees and Commissions Single issue addressed by Committee Comprehension was missing Recommendations- reiterations of Bhore Committee. Individual “Health” Programs - situational exigency. Uni -purpose workers later baptized as Multi-purpose. Programs worked in complete isolation till 1980 (e.g. NTCP). Fragmented approach to Health 4 SIHFW: an ISO 9001: 2008 certified Institution

Still…62 yrs. of Health Services:

Still…62 yrs. of Health Services Crude Death Rate ↓ Crude birth rate ↓ Life expectancy ↑ S.pox & G. worm eradicated Leprosy eliminated IMR ↓ Infrastructure – expanded 5 SIHFW: an ISO 9001: 2008 certified Institution

Public Health:

Public Health Well developed administrative system Skills Reasonable Infrastructure - Poor health outcomes Design Misdirected efforts 6 SIHFW: an ISO 9001: 2008 certified Institution

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Five year Plan Period Major areas addressed I 1951-55 Infrastructure II 1956-61 Industry III 1961-66 Panchayat & Green Revolution IV 1969-74 Expenditure , Agriculture V 1974-79 Agriculture VI 1980-85 Health , Technology VII 1985-89 Poverty, Agriculture & Justice VIII 1992-97 Pop., Agriculture , Poverty IX 1997-02 Employment, Basic facilities X 2002-07 HRD, Industry, Technology XI 2007-12 Education, Health, Empowerment 7 SIHFW: an ISO 9001: 2008 certified Institution

Bhore Committee, 1946:

Bhore Committee, 1946 PHCS : nodal points for Health care Phased expansion Prevention stressed Population based 8 SIHFW: an ISO 9001: 2008 certified Institution

Health –State subject ? :

Health –State subject ? Centralized planning Decentralized implementation Fiscal control of central Govt. Centre dictates States for Objectives & Priorities 9 SIHFW: an ISO 9001: 2008 certified Institution

Health care in India:

Health care in India Entitlements by policy and not rights Focus on preventive and promotive care Grossly under-provided facilities Poor investments hitherto Declining public expenditures and new investments Structural Adjustment programming under World Bank dictate 10 SIHFW: an ISO 9001: 2008 certified Institution

Core functions of Public Health:

Core functions of Public Health Monitoring health situation Disease surveillance Health promotion Regulations Partnerships Planning & Policies HRD Reducing impact of emergencies on health 11 SIHFW: an ISO 9001: 2008 certified Institution

Health- A Dynamic Phenomenon :

Health- A Dynamic Phenomenon Health System ought to be, for- a. Rising costs, b. Changing political situations, and c. Social contexts (expectations of people from System) 12 SIHFW: an ISO 9001: 2008 certified Institution

Public Health– Dilemma: :

Public Health– Dilemma: Equity and Equality Quantity and Quality Public/Private/ Voluntary sector Education/ Persuasion/ Coercion Professional/ Para Prof/ Auxiliaries Privatization/ Disinvestment 13 SIHFW: an ISO 9001: 2008 certified Institution

Service delivery:3-tier structure:

Service delivery:3-tier structure DH CHC Underutilized for- Services Supplies Funding 14 SIHFW: an ISO 9001: 2008 certified Institution PHC SC

Committees & Commissions:

Committees & Commissions 1959-62 Mudaliar committee (Health Survey And Planning Committeee ) Health services restructuring 1963: Chaddah committee TOR-Malaria 1964: Mukherjee committee Family planning 1964-67:Junglewala committee Integration Of Health Services 1972-73:Kartar Singh committee MPW scheme 1974-75:Srivastav committee Medical Education & Support Man-Power 15 SIHFW: an ISO 9001: 2008 certified Institution

Limits to Modern Medicine:

16 Limits to Modern Medicine Spectacular Advances – Low Cost Nutrition , Immunization, Antibiotics, Aseptic surgery, Maternal and child care, Healthy life styles Grey Areas – High Cost Degenerative diseases, Autoimmune diseases, Malignancies Dark Areas Idiopathic , Iatrogenic, Hospital Infections, Progressive, irreversible disorders 16 SIHFW: an ISO 9001: 2008 certified Institution

Problems::

Problems: Indirectly related to health Environment Education Empowerment Directly affecting Health Diseases Communicable Non Communicable New emerging Fertility Population Growth rate Total Fertility Nutrition Malnutrition Obesity 17 SIHFW: an ISO 9001: 2008 certified Institution

Problems-Why:

Problems-Why Access Availability Utilization 18 SIHFW: an ISO 9001: 2008 certified Institution

Challenges :

Challenges Manpower- Number & Norms Rural / Urban differential Geographical divide across States S-E groups –accessibility/ reach Gaps between Policy & Action Health sector expenditure Newer Infections 19 SIHFW: an ISO 9001: 2008 certified Institution

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20 SIHFW: an ISO 9001: 2008 certified Institution

Rural : Urban Differentials:

Sector Pop. BPL (%) (NHP 07-08) ref. period ‘04-’05 IMR/ Per 1000 Live Births (2009, SRS) <5Mortality Per 1000 (NFHS III) Weight For Age- % of Children Under 3 years (<2SD ) India 27.5 53 74.3 44.9 Rural 28.2 58 82 45.6 Urban 25.7 36 51.7 32.7 Rural : Urban Differentials 21 SIHFW: an ISO 9001: 2008 certified Institution

Differentials in Health Status Among States :

Better States Pop. BPL (%) (NHP 07-08)@ IMR (Oct. 2009 SRS) <5Mort-ality (NFHS III) Weight For Age- % of Children Under 5 years (<2SD) (NFHS III) MMR (SRS Spl . Bulletin, Apr. ‘09)$ Leprosy cases per 10000 population (NHP 07-08) Malaria +ve Cases (NHP 07-08) Kerala 15.0 12 16.3 22.9 95 0.23 1804 Bihar 41.4 56 84.8 55.9 312 1.04 1707 Raj. 22.1 63 85.4 39.9 388 0.19 57482 UP 32.8 67 96.4 42.4 440 0.94 93383 Differentials in Health Status Among States @ref. period ‘04-’05 $ ref. period 2004-06 22 SIHFW: an ISO 9001: 2008 certified Institution

Health status Differentials among Socio-Economic Groups(NFHS III) :

Health status Differentials among Socio-Economic Groups(NFHS III) Indicator Infant Mortality <5 Mortality % Children Underweight Under 3 years (<2SD ) India 57 74.3 44.9 Social Inequity S/C 50.7 65.4 47.9 S/T 43.8 53.8 54.5 OBC 42.2 54.5 43.2 Others 36.1 42.1 33.7 23 SIHFW: an ISO 9001: 2008 certified Institution

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24 SIHFW: an ISO 9001: 2008 certified Institution

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25 SIHFW: an ISO 9001: 2008 certified Institution

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Eradicate Polio and Yaws 2005 Eliminate Leprosy 2005 Eliminate Kalazar 2010 Eliminate Lymphatic Filariasis 2015 Achieve Zero level growth of HIV/AIDS 2007 Reduce Mortality by 50% on account of TB, Malaria and Other Vector and Water Borne diseases 2010 Reduce Prevalence of Blindness to 0.5% 2010 Reduce IMR to 30/1000 And MMR to 100/ Lakh 2010 Increase utilization of public health facilities from current Level of <20 to >75% 2010 Establish an integrated system of surveillance, National Health 2005 Goals : 2000-2015 26 SIHFW: an ISO 9001: 2008 certified Institution

Health care Governance in India:

Health care Governance in India 27 SIHFW: an ISO 9001: 2008 certified Institution

Health System’s Organization-India:

Health System’s Organization-India Central Govt. Planning Commission National Development Council CCHFW MOHFW FW Medical & Public Health ISM&H Secretary Secretary Secretary Jt.Secy . Addl.Secy . Director Director Jt.Secy . Jt.Secy . DGHS Addl.DGHS 28 SIHFW: an ISO 9001: 2008 certified Institution

Role of Central Govt. in Health Care:

Role of Central Govt. in Health Care Policy formulation Maintaining International health relations Administration of central health institutions Regulating Medical education through statutory bodies-MCI/DCI/Councils Medical & Public health research-funding Standards- laying & maintenance(Drugs/Education) Coordination-Other ministries/States/Statutory bodies Central Health Acts Negotiation with International agencies 29 SIHFW: an ISO 9001: 2008 certified Institution

Functions of Dept of Family Welfare:

Functions of Dept of Family Welfare Policy preparation & Planning Information collection & Evaluation Contraceptive-Research /Supply Seeking International support EPI/UIP/CSSM/RCH/ARI/ORT-Trainings & area development IEC Rural Health Paraprofessional training NGO support Development of Sub-center 30 SIHFW: an ISO 9001: 2008 certified Institution

Functions of Medical & Public Health:

Functions of Medical & Public Health Health Policy preparation National Health Programs conduction Drug Control PFA enforcement Diseases control-Communicable/Non-communicable Supplies & Disposal Maintenance CME & Trainings Medical Education & Research Vital statistics & Health intelligence International support 31 SIHFW: an ISO 9001: 2008 certified Institution

Organization at State level:

Organization at State level Rajasthan Government Minister Medical Education MoH & FW Secretary-ME Principal Secretary-Health Secretary-FW Principals Directors (Service divisions) (Medical Education) FW Public Health AIDS IEC Addl. Directors Jt. Directors Dy. Directors State Program Officers Zonal Directors 32 SIHFW: an ISO 9001: 2008 certified Institution

District Health Care Administration:

District Health Care Administration 33 SIHFW: an ISO 9001: 2008 certified Institution

District:

District An Administrative unit Defined Geographical boundary and Population Peripheral most Planning unit A self contained segment of National Health System 34 SIHFW: an ISO 9001: 2008 certified Institution

District Health Organization:

District Health Organization CMHO PMO (Rural),Preventive (Urban),Curative Dy.CMHO Program Officers (registered society-DHS) Block CM&HO C H C Pop.-80000-120000 Beds(30) Specialists(7-IPHS) Referral P H C Pop.20-30000 Primary health Medical Officer(2-IPHS) SC (3-5000) HW-M/F SBA/AWW/VHG/ ASHA 35 SIHFW: an ISO 9001: 2008 certified Institution

Functions of District Health System:

Functions of District Health System Liaison between Field units & Headquarter Field reports Inspections Meetings Implementation of Policy & Programs District level planning & Action Plans Rationale use of Finance & Resources Communication Management Plans/Schedules/Progress/Problems Control & Monitoring 36 SIHFW: an ISO 9001: 2008 certified Institution

Problem Areas at District:

Problem Areas at District Quantity v/s Quality Cluttered Policy guidelines Decentralization on papers Roles/Responsibilities poorly defined Program integration ? HMIS-generation & use ? Managerial skills Donor initiative – “Societies” Resource restriction 37 SIHFW: an ISO 9001: 2008 certified Institution

Rural Health services:

Rural Health services Institution– Primary Health Centers(20-30000) Functions- Medical Care RCH services Immunization Child Health Obstetric services MTP NHP School Health Environment Health/ Nutrition education Management 38 SIHFW: an ISO 9001: 2008 certified Institution

Manpower at PHC:

Manpower at PHC Existing Recommended (IPHS) Medical Officer 1 2(one AYUSH or LMO) Pharmacist 1 1 Nurse-midwife (Staff 1 3 (for 24-hour PHCs) (Nurse) (2 may be contractual) Health workers (F) 1 1 Health Educator 1 1 Health Asstt . (M&F) 2 2 Clerks 2 2 Laboratory Technician 1 1 Driver 1 Optional/vehicles out-sourced . Class IV 4 4 Total 15 17/18 39 SIHFW: an ISO 9001: 2008 certified Institution

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Sub-Centre (3-5000) Manpower- Male & Female Health Worker, Additional ANM under IPHS/ NRHM Support manpower- VHG SBA AWW ASHA Jan Mangal Couples 40 SIHFW: an ISO 9001: 2008 certified Institution

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Thank You For more details log on to www. sihfwrajasthan.com or contact : Director-SIHFW on sihfwraj@yahoo.co.in