Public Health Care In India

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  • 1. Public Health care : India An Overview State Institute of Health & Family Welfare, Jaipur
  • 2. Constitutional commitment: Health: State subject Central List International Health, Port Health Research Technical & Scientific Education State List All other Health issues Concurrent list Epidemics SIHFW: an ISO 9001: 2008 certified Institution 2
  • 3. Mile stones: NRHM-2005 NHP-2002 NPP-2000 RCH-1996 UIP-1985 NHP-1983 Alma Ata-1978 (HFA) Juggling Small pox eradicated-July 5, 1975 Priorities NFPP-1952 India Joins WHO-1948 HSDC-1946 SIHFW: an ISO 9001: 2008 certified Institution 3
  • 4. Ø NO Health Policy for 36 years Ø Committees and Commissions Ø Single issue addressed by Committee Ø Comprehension was missing Ø recommendations- reiterations of Bhore Committee. Ø Individual “Health” Programs - situational exigency. Ø Uni-purpose workers later baptized as Multi- purpose. Ø Programs worked in complete isolation till 1980 (e.g. NTCP). Ø Fragmented approach to Health SIHFW: an ISO 9001: 2008 certified Institution 4
  • 5. Still…62 yrs. of Health Services – Crude Death Rate ? – Crude birth rate ? – Life expectancy ? – S.pox & G. worm eradicated – Leprosy eliminated – IMR ? – Infrastructure – expanded SIHFW: an ISO 9001: 2008 certified Institution 5
  • 6. Public Health Ø Well developed administrative system Ø Skills Ø Reasonable Infrastructure - Poor health outcomes Ø Design Ø Misdirected efforts SIHFW: an ISO 9001: 2008 certified Institution 6
  • 7. 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 SIHFW: an ISO 9001: 2008 certified Institution 7
  • 8. Bhore Committee, 1946 PHCS : nodal points for Health care Phased expansion Prevention stressed Population based SIHFW: an ISO 9001: 2008 certified Institution 8
  • 9. Health –State subject ? • Centralized planning • Decentralized implementation • Fiscal control of central Govt. • Centre dictates States for Objectives & Priorities SIHFW: an ISO 9001: 2008 certified Institution 9
  • 10. 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 SIHFW: an ISO 9001: 2008 certified Institution 10
  • 11. Core functions of Public Health Ø Monitoring health situation Ø Disease surveillance Ø Health promotion Ø Regulations Ø Partnerships Ø Planning & Policies Ø HRD Ø Reducing impact of emergencies on health SIHFW: an ISO 9001: 2008 certified Institution 11
  • 12. 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) SIHFW: an ISO 9001: 2008 certified Institution 12
  • 13. Public Health– Dilemma: • Equity and Equality • Quantity and Quality • Public/Private/ Voluntary sector • Education/ Persuasion/ Coercion • Professional/ Para Prof/ Auxiliaries • Privatization/ Disinvestment SIHFW: an ISO 9001: 2008 certified Institution 13
  • 14. Service delivery:3-tier structure Tertiary care DH Secondary Care CHC Primary PHC care SC Underutilized for- Services Supplies Funding SIHFW: an ISO 9001: 2008 certified Institution 14
  • 15. Committees & Commissions Ø 1959-62 Mudaliar committee (Health Survey And Planning Committeee) • Health services restructuring Ø 1963: Chaddah committee • TOR-Malaria Ø 1964:Mukherjee committee • Family planning Ø 1964-67:Junglewala committee • Integration Of Health Services Ø 1972-73:Kartar Singh committee • MPW scheme Ø 1974-75:Srivastav committee • Medical Education & Support Man-Power SIHFW: an ISO 9001: 2008 certified Institution 15
  • 16. Problems: • Indirectly related to • Directly affecting Health health – Diseases – Environment • Communicable – Education • Non Communicable – Empowerment • New emerging – Fertility • Population • Growth rate • Total Fertility – Nutrition • Malnutrition • Obesity SIHFW: an ISO 9001: 2008 certified Institution 16
  • 17. Problems-Why • Access • Availability • Utilization SIHFW: an ISO 9001: 2008 certified Institution 17
  • 18. 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 SIHFW: an ISO 9001: 2008 certified Institution 18
  • 19. CHCs – IPHS Vs PG seats (March 2008) 4500 4276 4000 3500 3000 2500 2000 1529 1444 1500 1000 894 897 708 698 500 338 337 0 SIHFW: an ISO 9001: 2008 certified Institution 19
  • 20. Rural : Urban Differentials Sector Pop. IMR/ <5Mortality Weight For Per Age- BPL (%) 1000 Per % of (NHP 07- Live 1000 Children 08) Births (2009, SRS) (NFHS III) Under ref. period 3 years ‘04-’05 (<2SD) India 27.5 53 74.3 44.9 Rural 28.2 58 82 45.6 Urban 25.7 36 51.7 32.7 SIHFW: an ISO 9001: 2008 certified Institution 20
  • 21. Differentials in Health Status Among States Better Pop. IMR <5Mort- Weight MMR Leprosy Malaria (Oct. For Age- States BPL 2009 ality % of (SRS cases +ve (%) SRS) (NFHS Children Spl. per Cases (NHP III) Under Bulletin 10000 (NHP 07- 5 years , Apr. populatio 07-08) 08)@ (<2SD) ‘09)$ n (NHP (NFHS 07-08) III) 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 @ref. period ‘04-’05 $ ref. period 2004-06 SIHFW: an ISO 9001: 2008 certified Institution 21
  • 22. Health status Differentials among Socio-Economic Groups(NFHS III) Indicator Infant <5 Mortality % Children Mortality 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 SIHFW: an ISO 9001: 2008 certified Institution 22
  • 23. Total Govt. Expenditure on Health as % of GDP 1.2 Source: CBHI, NHP, 2006 1.05 1 0.96 0.91 0.91 0.88 0.9 0.86 0.81 0.83 0.8 0.74 0.63 0.61 0.6 0.49 0.4 0.2 0.22 0 SIHFW: an ISO 9001: 2008 certified Institution 23
  • 24. Goals : 2000-2015 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 2010 and Other Vector and Water Borne diseases 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 2010 current Level of <20 to >75% Establish an integrated system of surveillance, 2005 National Health 24 SIHFW: an ISO 9001: 2008 certified Institution
  • 25. Health care Governance in India SIHFW: an ISO 9001: 2008 certified Institution 25
  • 26. 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 SIHFW: an ISO 9001: 2008 certified Institution 26
  • 27. 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 SIHFW: an ISO 9001: 2008 certified Institution 27
  • 28. 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 SIHFW: an ISO 9001: 2008 certified Institution 28
  • 29. 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 SIHFW: an ISO 9001: 2008 certified Institution 29
  • 30. 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 SIHFW: an ISO 9001: 2008 certified Institution 30
  • 31. District Health Care Administration SIHFW: an ISO 9001: 2008 certified Institution 31
  • 32. District An Administrative unit Defined Geographical boundary and Population § Peripheral most Planning unit § A self contained segment of National Health System SIHFW: an ISO 9001: 2008 certified Institution 32
  • 33. District Health Organization CMHO PMO (Rural),Preventive (Urban),Curative Dy.CMHO Program Officers (registered society-DHS) Block CM&HO CHC Pop.-80000-120000 Beds(30) Specialists(7-IPHS) Referral PHC Pop.20-30000 Primary health Medical Officer(2-IPHS) SC (3-5000)HW-M/F SBA/AWW/VHG/ ASHA SIHFW: an ISO 9001: 2008 certified Institution 33
  • 34. 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 SIHFW: an ISO 9001: 2008 certified Institution 34
  • 35. 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 SIHFW: an ISO 9001: 2008 certified Institution 35
  • 36. 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 SIHFW: an ISO 9001: 2008 certified Institution 36
  • 37. 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 SIHFW: an ISO 9001: 2008 certified Institution 37
  • 38. • Sub-Centre (3-5000) • Manpower- Male & Female Health Worker, Additional ANM under IPHS/ NRHM • Support manpower- – VHG – SBA – AWW – ASHA – Jan Mangal Couples SIHFW: an ISO 9001: 2008 certified Institution 38
  • 39. Thank You For more details log on to www. sihfwrajasthan.com or contact : Director-SIHFW on sihfwraj@yahoo.co.in