Your SlideShare is downloading. ×
A view on                                   (Health Services)                                             In Bihar        ...
Table of ContentsSl. No                                Particulars                Page No.1.       Bihar State Health Budg...
Bihar State Health Budget: OverviewBihar Deputy Chief Minister, Sushil Kumar Modi presented Rs 65,325.87-crore annual budg...
affordable health care services, that are gender sensitive and that are directly or indirectly contributing toimproved hea...
•   Community, PRIs.    •   To increase institutional delivery by continuing with the JBSY Scheme.Child Health    •   To p...
Assigned Budget: RS. (In Crore)Budget   %          Budget   %           Budget   %            Budget    %        Budget   ...
Bihar: Current Health ScenarioThe improved governance has led to an economic revival in the state through increased invest...
Diseases: OverviewSome of the Diseases for which GIOSTAR provides treatment are:    •    Diabetes type I                  ...
The state government under the Government of India (GOI) scheme, to check non-contagious diseases, had alsolaunched a prog...
Like elsewhere in the country oral cancer is the most common form of the disease among men. About 62 per centof patients h...
Bihar Areas of FocusKala-AzarKala-azar has been occurring in India for more than a century and a half in various forms. As...
Tuberculosis (TB)TB has re-emerged as a major public health problem in India and often as an associated illness of HIV/AID...
MalnutritionMalnutrition continues to be a predominant problem of the state and its manifestation and consequences aredive...
Upcoming SlideShare
Loading in...5
×

Health services bihar

3,378

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
3,378
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
70
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Transcript of "Health services bihar"

  1. 1. A view on (Health Services) In Bihar Head Office: Regional Office: Inductus Consultants (P) LimitedInductus Consultants (P) Limited 311, N. P. Centre, C – 927, Dwarka Sector – 7, New Dak Bunglow Road Palam Extension, Dwarka, Patna - 800 001, New Delhi – 1100 045 (INDIA) Bihar, (INDIA) Tel: 011 – 43686055 Phone No. 91-612-6450221 Helpline (24X7 Support): 92346 92346 www.Inductus.in 1
  2. 2. Table of ContentsSl. No Particulars Page No.1. Bihar State Health Budget : Overview 3-62. Bihar : Current Health Scenario 73. Diseases : overview 8-104. Bihar Areas of Focus 11-135. Conclusion 14 2
  3. 3. Bihar State Health Budget: OverviewBihar Deputy Chief Minister, Sushil Kumar Modi presented Rs 65,325.87-crore annual budget for 2011-12 in the thAssembly on 25 February 2011, with road construction, human resources development, Health and waterresources cornering major part of the expenditure.The road construction, human resources development; Health, water resources will continue to be the thrustareas in 2011-12 too and announced an allocation of Rs 5,075 crore, about 21.15 per cent of the state plan of Rs24000 crore.The major Funding is coming from NRHM (National Rural Health Mission), Besides NRHM, DFID (Department ofInternational Funding) and BMGF (Bill and Melinda gates Foundation).The total financial requirement projected in the project implementation plan is around Rs. 1975.37 crore. So wehave an excess of budget as per the projection for fiscal year 2011-12.State’s Vision, Goal and Strategy For 2011-12The State’s vision for the overall development, in general, and accomplishment of the desired set of goals in healthsector under NRHM for the current year is as mentioned below: • Universal Access to Primary Health Care • Provide affordable Health Care Services • Decentralized Health Services • Community Participation in Health Care • Enhanced performance of Public Health System by improving quality and ensuring client satisfaction • Strengthen Health Management Information System • Encourage participation of Civil Society Partners in health service delivery • Private Sector Participation in Tertiary Health Care • Promotion of AYUSH Services and their mainstreaming • Mobile Medical Services for difficult areas to improve access • Environment conservation (Bio-Medical Waste Management)Bihar State has set targets and goals of reducing IMR (Infant Mortality Rate) from 52 to less than 45,MMR(Maternity Mortality Rate) from 312 to 200, TFR(Total Fertility Rate) to 3.7 from 4.0 and improves the rate ofInstitutional delivery to 70% by the end of FY 2011-12. In addition, it is aimed to reduce Birth Rate from 28.5 to 27,Death Rate to 6.7 from 7 and increase CPR from 28.8 to 45.These goals clearly indicate that the State is planning to drastically upscale availability, accessibility and utilizationof RCH (Reproductive and child health) services. These goals will be attained by a set of processes that empowerlocal communities to take decisions, plan and implement strategies that provide equitable access to quality 3
  4. 4. affordable health care services, that are gender sensitive and that are directly or indirectly contributing toimproved health indicators for the state.The Project Implementation Plan for the year 2011-12 has the following components and consists of followingsections-: • Reproductive and Child Health priority areas under RCH-II flexible pool (Sub-Components – Maternal Health, Child Health, Family Planning, ARSH, Urban RCH, Vulnerable Groups, Innovations/PPP/NGO, Infrastructure and Human Resources, Institutional Strengthening (HMIS, M&E), Training, Procurement, Programme Management). • Additionalities under NRHM (ASHA, Infrastructure, Contractual Manpower, PPP-Referral & Emergency Transport, Diagnostics, Data Centers, Procurement, Planning) • Routine Immunization • National Iodine Deficiency Disorders Control Programme (NIDDCP) • Integrated Disease Surveillance project (IDSP) • National Vector Borne Disease Control Programme (NVBDCP) (Malaria, Kalazar, JE, Dengue, Chikungunya, Filaria) • National Leprosy Elimination Programme (NLEP) • National Programme for Control of Blindness (NPCB) • Revised National Tuberculosis Control Programme (RNTCP) • Inter-Sectoral Convergence • National Tobacco Control Programme (NTCP) • Non Communicable Diseases (NCD)Main Strategies proposed to be adoptedThe strategies will be rolled out by the vast network of health care institutions and its staff under National RuralHealth Mission and its yearly implementation plan.Maternal Health: • Focus on quality antenatal care to all pregnant women by increasing the access through existing Govt. facilities. • Quality improvement of the ANC through reorientation. • To increase awareness amongst mothers and communities about the need of ANC. • Focus on 24-hour institutional delivery with basic emergency care in all PHCs and referral of obstetric emergencies. • Social mobilization for institutional deliveries by involvement of Mahila Mandals, PRIs through orientation to motivate pregnant women and their families for institutional delivery. • Focus on operationalisation of CHCs (across the state) in order to help them become venues for comprehensive emergency obstetric care. • Strengthening and upscaling transport and referral systems. • Identification and involvement of Pvt. Sector hospitals to deliver basic & comprehensive EmOC. • Ensuring clean home deliveries by skilled birth attendants in difficult and inaccessible areas. • To reduce unsafe abortion by increasing access to safe abortion in Govt. & Pvt. Facilities and promoting awareness about harmful effects of unsafe abortion amongst women. 4
  5. 5. • Community, PRIs. • To increase institutional delivery by continuing with the JBSY Scheme.Child Health • To provide routine immunization including the booster dose to all children by strengthening sub-centre level services and increasing access through Govt. and Pvt. facilities. • Prompt and ensure appropriate community level care for all sick children and neonates and prompt referral where indicated. • To increase awareness amongst mothers on benefits of immediate breast feeding and need and importance of exclusive breast feeding for 6 months and supplementary feeding from 6 month onwards. • Adequate referral arrangement and strengthening health facilities for treating a sick child or neonate when it requires hospitalization. • To standardize case management of sick newborn and children under IMNCI.Family Planning: • To raise awareness amongst couples, communities and PRIs about contraceptives and advantage of small family. • Increase the number of service delivery points and to promote contraceptive use through social marketing. • Focus on quality male & female sterilization and conduction of sterilization camps in uncovered areas. • To improve the number and skill of service providers by training of doctors on lap sterilization and NSV, training of GNMs to assist lap sterilization and ANMs on IUD insertion. • Public Pvt. Partnership for increasing contraceptive use and sterilization. Bihar NRHM PIP 2011-12Adolescent Health: • To educate and raise awareness amongst the adolescent boys and girls about human physiology, RTI, STI, HIV/AIDS and safe sex. • To open adolescent health clinic at block level. 5
  6. 6. Assigned Budget: RS. (In Crore)Budget % Budget % Budget % Budget % Budget % Budget %2006- change 2007- change 2008- change 2009- change 2010- change 2011- change2007 2008 2009 2010 2011 2012346.94 N/A 849.25 145% 692.26 -18% 1508.34 118% 2104.5 40% 2704.82 29%Source: Summary Bihar Budget Document Percentage of Health Budget Vis-à-vis State Budget 2009 – 2010 (Actual) 2010 – 2011 (BE) 2011 – 2012 (BE) The Current percentage Health budget holds in the Entire budget is 4.14% 6
  7. 7. Bihar: Current Health ScenarioThe improved governance has led to an economic revival in the state through increased investment ininfrastructure, better health care facilities, greater emphasis on education, and a reduction in crime andcorruption. Indian and global business and economic leaders feel that Bihar now has good opportunity to sustainits growth, economic development and as such have shown interest in investing in the state. A BBC article titled"Where backward Bihar leads India" talked about how the state has made strides in the areas of womensempowerment, judiciary reforms, tax reforms, and public safety.Despite efforts in the last few decades to stabilize population growth, the state’s population continues to grow at amuch faster rate than the national population. The ratio of the rural and urban population is approx. 84:16. Thepopulation of Scheduled Caste households as per NFHS 3 is 18.7% and of Other Backward Class is 58.6%respectively of the state’s total population. BPL population is 56.48% (Source: Deptt. of Rural Development, GOB-2007). 44% of the population in Bihar is under age 15; only 5% is aged 65 or above Outcome Analysis of PIP of2009-10 and 2010-11NRHM under the Ministry of Health and Family Welfare, (MOHFW), Govt of India has recently (2008) brought out adocument entitled “India Guaranteeing Quality Primary Health Care for All: An Agenda for Action”. In this book,key public health challenges have been identified state wise and have been furnished in a tabular form. For Biharthe indicators where there has been higher incidence or the performance has been low and requires greater thrustare- • Infant Mortality • Maternal Mortality • Very high out of pocket expenditures in Government hospitals • High TB Cases/suspected cases, chest symptoms • High TFR • Full immunization • Tobacco and alcohol • Age at marriage • Spousal physical or sexual violenceSome of the major Diseases in Bihar are: • AIDS • Filaria • Pneumonia/Fever • Anaemia • Guineaworm Diseases • Polio • Blindness • Hepatitis • Rabies • Cancer • Kala Azar • Sexually Transmitted Diseases • Dengue • Leprosy • Tuberculosis • Diarrhoea • Malaria • Diptheria • Measles • Encephalitis • PlagueAs per a recent sample study, nearly 31% of population in Bihar is suffering from Blood related disorder. 7
  8. 8. Diseases: OverviewSome of the Diseases for which GIOSTAR provides treatment are: • Diabetes type I • Parkinsons • Lupus • Cancer • Multiple Sclerosis • Heart and Retinal degeneration • Crohn’s • Neuropathy • Vasculitis • Osteoarthritis • Scleroderma • Paralysis • Myasthenia Gravis • Strokes • Amyotrophic Lateral Sclerosis • Spinal Cord Injuries • Sickle cell anaemia • Skin Burns • Leukaemia • Spinal Muscular Atrophy • Lymphoma • Autism • Thalassemia • Anti-Aging Treatments • AlzheimersDiabetes Type IThere is an increase in concern over the rise of diabetic patients in Bihar. Though no state-specific data is availablewith regard to actual number of diabetic patients in Bihar, around 10 percent of total 50.8 million diabetes patientsin the country are from Bihar, the health department sources said.As per the sources in Patna Medical College and Hospital (PMCH), "Lately, there has been spurt in diabetic cases inthe state especially the Type 1.Bihar government has recently taken several initiatives to check diabetes which involves signing of a MoU for aninnovative project under diabetes management programme, Changing Diabetes Barometer Project with the NovoNordisk Education Foundation (NNEF) founded by Noble laureate Novo Nordisk.The total estimated cost of the project stands at Rs 2.5 crore which aims to undertake massive diabetes controlprogrammes in Bihar by creating mass awareness, screening, education and treatment of common man along withhelping those suffering from diabetes to lead a healthy and hassle-free life.The project was initially launched in three districts: Patna, Nalanda and Bhagalpur, and will cover the entire stategradually. The state government has set a target to cover around 50 lakh people under the initiative. Nearly,23,000 people have been screened till date with 13 percent prevalence of diabetes detected. 8
  9. 9. The state government under the Government of India (GOI) scheme, to check non-contagious diseases, had alsolaunched a programme on pilot basis in two districts: Vaishali and Rohtas."Bihar, meanwhile, has become the third state in the country after Tamil Nadu and Delhi where pregnant womenare being tested for diabetes and treated free of cost.The Bihar Foundation UK is also working to create awareness through Medical Camps and free medical support.Source: PMCHVasculitisRetinal VasculitisAs per a sample study for Retinal vasculitis nearly 78.6% patients belonged to the state of West Bengal, 10%patients are from Bihar and 5.7% were from Jharkhand and Orissa each. 85.7% patients were male and 10 14.3%were female. Range of age of the patients was 12-62 years and mean age was 32.9±11.4 years. Mean age of maleand female cases were 33±11.1 and 32.4±13.6 years respectively. Among males, 38.3% cases of retinal vasculitiswere noted in third decade of life while among females, 50% cases were seen in fourth decade of life.Retinalvasculitis was bilateral in 61.4% and unilateral in 38.6% cases. 60% males had bilateral retinal vasculitis and 40%had unilateral disease; whereas in female group, 70% and 30% subjects had bilateral and unilateral disease,respectively.Source: NCBISickle cell Anaemia thBihar is the 4 state with most cases of sickle cell Anaemia preceded by Gujarat, Andhra Pradesh and Maharashtraand to be followed by Tamil Nadu.Anaemia has been included in the list of major disease in Bihar by the state government and is being taken as anarea of major concern.CancerBihar has recorded the third highest number of cancer deaths in the country, after Uttar Pradesh and Maharashtrain the year 2011.The figure of National Cancer Registry Programme of the Indian Council of Medical Research, said that 43,864people in the state have died of the disease till November 2011.Health department officials said over 40,000 new cancer cases have been diagnosed in the state in the first 11months of the year.At Mahavir Cancer Sansthan (MCS), the largest cancer hospital in Bihar, 26,000 new cases have been recorded thisyear, the second highest from any hospital in the country. 9
  10. 10. Like elsewhere in the country oral cancer is the most common form of the disease among men. About 62 per centof patients here are women who suffer from cervical and breast cancer.At Patna Medical College and Hospital (PMCH) and Indira Gandhi Institute of Medical Sciences (IGIMS) the influx ofpatients is very high.IGIMS, which has a cancer unit, runs with only three oncologists even as around 75,000 patients come to its OPDfor screening every year. A plan to upgrade the centre at an estimated cost of Rs 21 crore has been in limbo for thepast one year because of government apathy.So this could be an area of opportunity as the current system does not have the capacity to hold so many patients."On the occasion of World Lymphoma Awareness Day on September 15 it is shocking that at any given point oftime there are more than 46,000 NHL (Non Hodgkins Lymphoma) patients in India. Bihar accounts for 5 per cent ofthese patients.Apart from that the other diseases are less prevalent in the region and have been given less focus by the Biharhealth department. 10
  11. 11. Bihar Areas of FocusKala-AzarKala-azar has been occurring in India for more than a century and a half in various forms. As a collateral benefit ofmalaria eradication programme, Kala-azar prevalence was almost zero in 1965. Currently Bihar accounts for morethan 76.3% of kala-azar cases and 90.3% of deaths in the country. In the 1977 epidemic of kala-azar about one lakhpeople died. The epidemic recurred in 1992 due to lack of surveillance and harvested a death toll of almost2,50,000. The control measures put in place then were subsequently slackened from 1994 because DDT spray andsurveillance were discontinued. In 2000 the numbers were low but started rising from 2003. It is a matter ofconcern that the incidence of the disease has increased in 2005 and further in 2006. According to the AnnualReport of the Ministry of Health and Family Welfare, Government of India, 32 districts of Bihar are kala-azarendemic. The district of Muzaffarpur has the highest number of cases, followed by Vaishali, Saharsa, Samastipur,Purnia and East Champaran. The task force believes that continuous spraying of insecticides for at least five yearsin a phased manner and supervised administration of Amphotericin B could eliminate the disease. Experts say thatpoor living standards and unhygienic conditions make members of the Mushahar community in Bihar an easy preyto the disease.It has been included as the major thrust area by Dept of Health in its annual Health BudgetMalariaMalaria used to be the leading vector-borne disease of the country as well as Bihar at the time of independence.Initial efforts at malaria reduction brought down the caseload from an estimated 75 million to a record 1,00,000cases in the 1960s. But subsequently, due to various financial, technical and logistical constraints the momentumwas slackened. This led to resurgence of malaria in 1976, taking the caseload to 6.4 million. A modified plan ofaction helped reduce malaria cases by 1984. Efforts towards a further reduction were not successful due to vectorand parasite resistance to conventional insecticides and drugs, respectively, in some high endemic areas, as well ascontinuing financial and management constraints. Malaria resurfaced in 1994, which also included increase incases of Plasmodium falciparum malaria, the most dangerous strain of malaria, between 1995 and 1999. Some ofthe high endemic states are Madhya Pradesh, Chhattisgarh, Orissa, Rajasthan, Bihar and Andhra Pradesh. Thenational programme focuses on reduction of the reservoir of infection in humans by early detection and promptradical treatment, reduction in vector population through vector control measures, anti-larval measures andenhancement of community based action. This strategy is being implemented across the country along with theEnhanced Malaria Control Project (EMCP), which focuses on the high endemic districts in the high focus states. Themalaria control programme today is known as National Vector Borne Disease Control Programme, which includesmalaria, dengue, filarial, Japanese encephalitis and kala-azar. Some of the high prevalence districts of malaria inthe state are Gaya, Aurangabad, Rohtas, Munger and Jamui. 11
  12. 12. Tuberculosis (TB)TB has re-emerged as a major public health problem in India and often as an associated illness of HIV/AIDS. In Indiait continues to be a serious health threat even in the absence of HIV/AIDS due to poverty, high illiteracy and poorsanitation. For the first time, TB prevalence has been reported in health report. Bihar ranks third in TB prevalencein the country (735 per 1,00,000 persons) after Arunachal Pradesh (9096) and Manipur (804). In Bihar 96.1% ofmen have heard about TB, of which 58.5% have misconceptions about its transmission. The disease still carries ahigh level of stigma in the state, with 17.2% of those surveyed still wanting the fact of a family member’s TB keptsecret from neighbors.Japanese EncephalitisThis vector-borne disease is prevalent in about 65 districts in ten endemic states; the annual caseload is about2500 cases and 500 deaths, mostly of children below the age of five. Nearly 90% of cases are reported fromAndhra Pradesh, Uttar Pradesh, Karnataka and West Bengal. But this disease has spread to non-traditional areas aswell such as in Kerala. Control strategies continue to focus on early diagnosis, case management, vector control(two rounds of residual insecticidal spraying), fogging by Malathion insecticide, and segregation of pigs andpromotion of personal prophylaxis. While high costs limit the use of vaccination, no curative drugs exist. Thecountry as a whole also experienced more number of Japanese encephalitis cases. The no of cases started to rise in2005. The number of deaths were the highest 64 in 2005 in Bihar.LeprosyLeprosy is endemic mainly in the states of Bihar, Jharkhand, Chhattisgarh, Uttar Pradesh, West Bengal, Orissa andMadhya Pradesh. Of the total 2.66 lakh recorded leprosy cases as on 31 March 2004, 75% cases have beencontributed by seven states: Orissa (5%), Chhattisgarh (5%), Jharkhand (4%), Uttar Pradesh (23%), Bihar (17%),Maharashtra (11%), West Bengal (10%). India recorded a prevalence of 57.6 leprosy cases per 10,000 populationsin 1981.Lymphatic FilariasisFilariaris declined in the late 1980s in India, but increased from 1989 to 2000. The National Filaria ControlProgramme provides assistance to all eighteen endemic states, the most endemic being Andhra Pradesh, Orissa,Uttar Pradesh, West Bengal, Tamil Nadu, Kerala and Bihar.HIV/AIDSAccording to the National AIDS Control Organization (NACO), there were around 120,000 people living withHIV/AIDS in Bihar but only around 40,000 had been identified by the end of 2009, Bihar is in urgent need ofexpanding HIV testing facilities in the state.A Part of the vulnerability of the state lies in a population where illiteracy is still widespread despite improvingeducational levels. The state is also a major crossroads for commercial traffic, which is one way HIV is known tospread. Bihar is India’s most rural state with 89% of its population living in rural areas, so that reaching people withessential HIV information is especially difficult. A low level of HIV prevalence presents both an opportunity and adanger. The opportunity to arrest its spread is here today. The danger is that its quiet nature will expand itsdevastation tomorrow. While HIV prevalence is low at present, the state is considered highly vulnerable by theNational AIDS Control Organization (NACO). 12
  13. 13. MalnutritionMalnutrition continues to be a predominant problem of the state and its manifestation and consequences arediverse and alarming. The level of malnourishment is quite high. Of all segments of the population children andwomen appear to be more at risk than are others. Malnutrition is seen to be a major contributing factor in over50% of child mortality; states with high mortality are also generally those with high levels of malnutrition.Nutritional deficiencies have been observed to affect physical and mental development of children adversely,impairing health and productivity of work. 13

×