Alternative health system and public private partnershipDocument Transcript
1www.drjayeshpatidar.blogspot.comALTERNATIVE HEALTH SYSTEM AND PUBLIC PRIVATE PARTNERSHIPINTRODUCTIONDepartment of Indian Systems of Medicine and Homoeopathy (ISM&H) was establishedIn 1995 and renamed as Department of Ayurveda, Yoga & Naturopathy, Siddha, Unani andHomoeopathy (AYUSH) in November, 2003. There has been a three fold increase in thePlan budget of the Department in the 10th as compared as 9th Plan, most of which was onaccount of scaling up of the budget provision in the last two years of the 10th Five YearPlan i.e. 2004 –2005 and 2005 – 2006 in line with the declared policy of the CentralGovernment to increase the budgetary provision for AYUSH sector for mainstreaming it inthe national health care delivery network.Integration of AyushThe integration of Ayush is to be carried out at the State and district level:Membership of the State and District Mission and the Integrated State and District HealthSocieties of a person from Ayush so that they are part of all the decision making processes.Wherever there are CMHO complexes the Ayurveda district personnel will be housed in thiscomplex.Mainstreaming will begin in two CHCs selected for the IPHS. The infrastructure will beused for providing a greater availability of services. All the National Programmes will alsobe implemented by Ayush with regular reporting. The CMHO will ensure all the supplies tothe Ayush. The Ayush personnel will also be involved in wider publicity of all the schemesand messages. All the IEC material will be given by the IEC department to the Ayushpersonnel. Trainings also will be jointly carried out so that the skills of the Ayush personnelcan carry out the National programmes effectively.Outreach services also will be carried out through RCH camps and Sanjeevni camps,wherein the Ayush personnel will be provided with Ayurvedic medicines.
2www.drjayeshpatidar.blogspot.comMonitoring and EvaluationNRHM will build on the M and E arrangements established as part of RCH II and the IDSPto strengthen capacity for M and E as well as establish systems to enable collection of dataand disaggregate by age, gender and other categories as required. Management InformationSystems under the NRHM will be web enabled for citizen scrutiny. Civil societyorganizations will collaborate with the health system in preparing a People‟ Health Report atthe district level. . State and National reports anon People‟s health to be tabled inassemblies and parliament. Each health facility will report to their respective Panchayats-sub centers to the Gram Panchayat, Hospitals to the Rogi Kalyan Samiti, and District HeathMission to the Zila Parishad. External evaluations of the NRHM will be conducted throughprofessional organizations with involvement of civil society. The M and E will serve toinform mid course reviews and enable corrective action in a timely manner.Mainstreaming AYUSH under NRHMRationale:The Indian systems of medicine have age old acceptance in the communities in India and inmost places they form the first line of treatment in case of common ailments. Of these,Ayurveda is the most ancient medical system with an impressive record of safety andefficacy. Other components such as Yoga, Naturopathy are being practised by the youngand old alike, to promote good health. Now days, practice of Yoga has become a part ofevery day life. It has aroused a world wide awakening among the people, which plays animportant role in prevention and mitigation of diseases. Practice of Yoga preventsPsychosomatic disorders and improves an individual‟s resistance and ability to endurestressful situation. Ayurveda, Yoga, Unani, Siddha and Homoeopathy (AYUSH) arerationally recognised systems of medicine and have been integrated into the national healthdelivery system. India enjoys the distinction of having the largest network of traditionalhealth care, which are fully functional with a network of registered practitioners, researchinstitutions and licensed pharmacies.
3www.drjayeshpatidar.blogspot.comThe NRHM seeks to revitalize local health traditions and mainstream AYUSH (includingmanpower and drugs), to strengthen the Public Health System at all levels. It is decided thatAYUSH medications shall be included in the drug kit of ASHA, The additional supply ofgeneric drugs for common ailments at SC/PHC/CHC levels under the Mission shall alsoinclude AYUSH formulations. At the CHC level two rooms shall be provided for AYUSHpractitioner and pharmacist under the Indian Public Health Standards (IPHS) model. At thesame time, single Doctor PHCs shall be upgraded to two Doctor PHCs by inductingAYUSH practitioner at that level.There are 9 Ayurvedic Dispensaries, 5 Homoeopathic Dispensaries.Strategies:Integrate and mainstream ISM &H in health care delivery system including NationalProgrammes.Encourage and facilitate in setting up of specialty centres and ISM clinics.Facilitate and Strengthen Quality Control Laboratory.Strengthening the Drug Standardization and Research Activities on AYUSH.Develop Advocacy for AYUSH.Establish Sectoral linkages for AYUSH activitiesBroad ObjectivesMainstreaming of AYUSH in the health care service delivery system to strengthen theexisting public health system.Activities:Improving the availability of AYUSH treatment faculties and integrating it with theexisting Health Care Service Delivery System.Integration of AYUSH services in 314 CHC / Block PHC with appointment of contractualAYUSH Doctors.
4www.drjayeshpatidar.blogspot.comAppointment of 200 paramedics where AYUSH Doctors shall be posted.Appointment of a Data assistant to support the ISM&H Directorate.Strengthening of AYUSH Dispensaries with provision of storage equipments.Making provision for AYUSH Drugs at all levels.Establishment of specialized therapy centers in District Head Quarter Hospitals & 3 MedicalColleges.AYUSH doctors to be involved in all National Health Care programmes, especially in thepriority areas like IMR, MMR, JSY, Control of Malaria, Filaria, and other communicablediseases etc.Training of AYUSH doctors in Primary Health Care and NDCP.All AYUSH institutions will be strengthened with necessary infrastructure like building,equipment, manpower etc.One Yoga Therapy Centre will be opened in district Headquarters Hospitals to provideYogic therapy for specific diseases and also as a synergistic therapy to all other systems oftreatment.Block level School Health Programmes to be conducted twice in a year in two groupsconsisting of 100 students in each group to improve the physical and mental health of theschool children.Integration of AYUSH with ASHA.Training module for ASHA and ANMs have to be updated to incorporate information ofAYUSH.Training & capacity building to be undertaken by the Director, SIHFW, Bhubaneswar andnecessary training material for the purpose to be modified and provided accordingly.Drug kit that will be provided to ASHA will contain one AYUSH preparation in the form ofiron supplement. But other drugs which are used in the treatment of common diseases,control of communicable diseases as well as drugs promoting the maternal and child healthas well as improving quality of life could be included subsequently.
5www.drjayeshpatidar.blogspot.comDrug Management:Priority will be given to manufacture drugs in Govt. Sector Pharmacies asper their capacity. In case of any surplus funds, drugs will be procured from the marketobserving all financial formalities of theGovt.Provision of Rs. 25,000/- to supply drugs per AYUSH dispensary has been projected as perNRHM norm.Provisions of medicines for District AYUSH wings and Specialty Therapy Centres proposedto be operated in the State.Special Initiatives For Mainstreaming And Strengthening Of Ayush.Strengthening the Quality Control Laboratory:The quantum of Ayurvedic and Homoeopathic medicines used / procured in both public andprivate health sectors is huge. There has been wide ranging concern about spurious,counterfeit and sub standard drugs. In order to prevent the spread of sub standard drugs andto ensure that the drugs manufactured or sold or distributed throughout the state are ofstandard quality, drug regulation and enforcement unit has to be established in the state.The drug regulatory mechanism to be strengthened at the state level to improve the qualityof drugs used in AYUSH and ensure proper standardization. The existing State DrugTesting and Research Laboratory (ISM) at Bhubaneswar shall also be modernized andstrengthened for the purpose.Strengthening the Drug Standardization and Research Activities on AYUSH:Standardization and research is an important activity in the process of development of adrug used for preventive and curative purpose. The major drawback in the development ofAYUSH is lack of research and development activity on the drugs used for the System. It isestimated that there are 10,000/- plant species are found all over the world having medicinal
6www.drjayeshpatidar.blogspot.comproperties. The following activities will be undertaken to strengthen the drugstandardization and research activities on AYUSH:It has been proposed to evaluate the chemical, pharmacological and clinical efficacy of theplant drugs.The phytochemical entities responsible for the therapeutic activity of the plant drugs used inAYUSH system will be evaluated through intensive R & D activity.The pharmacologically viable drugs will be screened clinically under WHO guideline toestablish the therapeutic activity.Clinical trial on different diseases like Psoriasis, Liver disorders, Diabetics, Asthma will beconducted to establish the effect of various drugs used for such diseases.It has also been proposed to conduct literary research like translation of manuscripts and itspublications.Re-vitalization of the local health traditions and the knowledge of traditional drugs used byexperienced local health traditioners will be gathered and documented.Development of Herbariums and crude drug museums:Herbarium will be developed in collaboration with the Forest Dept. in 15 selected Districtsof the State.The existing Herbal gardens under the D.I.M. & H (O) will be strengthened with necessaryinfrastructure.One State Herbarium at DTL, Bhubaneswar shall be developed. This shall enable greaterresearch and study on development and innovation in AYUSH Drugs.Plant extraction centers 10 selected areas will be developed for extraction and preservationof the plants for medicinal use.Strengthening of the State and District Management System of AYUSH:It is proposed to create necessary Managerial post in the State and District level for effectivesupervision and implementation of different activities.
7www.drjayeshpatidar.blogspot.comNecessary vehicles with supporting manpower has also been proposed to strengthen thesupervisoryJoint monitoring visits to health centers to be undertaken by both AYUSH and Health CareOfficials at the District level‟s/State level.Key Components and StrategiesThe NRHM provides broad operational framework for the Health Sector. Suggestiveguidelines have been issued on key interventions like ASHA, Indian Public HealthStandards (IPHS), institutional deliveries, immunization, preparation of District ActionPlan, role of Panchayati Raj Institutions etc. The States shall have flexibility to projectoperational modalities in their State Action Plans, which would be decided in consultationwith the Mission Steering Group.Core strategies of NRHM include: Increasing Community ownership by vesting responsibility with PRIs Decentralized village and district level health planning and management Appointment of Accredited Social Health Activist (ASHA) to facilitate access to healthservices Strengthening the public health service delivery infrastructure, particularly at village,primary and secondary levels, Mainstreaming AYUSH, Improved management capacity to organize health systems and services in publichealth Emphasizing evidence based planning and implementation through improved capacity andinfrastructure, Promoting the non-profit sector to increase social participation and communityempowerment,promoting healthy behaviors, and improving intersectional convergence.
8www.drjayeshpatidar.blogspot.comSupplementary Strategies Regulation of the private sector to improve equity and reduce out of pocket expenses Foster public–private partnerships to meet national public health goals, Re-orienting medical education, Taking full advantage of local health traditionsTYPES OF AYUSH-AYURVEDAAyurveda - Concept and PrinciplesThe Body MatrixLife in Ayurveda is conceived as the union of body, senses, mind and soul. The living manis a conglomeration of three humours (Vata, Pitta &Kapha), seven basic tissues (Rasa,Rakta, Mansa, Meda, Asthi, Majja & Shukra) and the waste products of the body such asfaeces, urine and sweat. Thus the total body matrix comprises of the humours, the tissuesand the waste products of the body. The growth and decay of this body matrix and itsconstituents revolve around food which gets processed into humours, tissues and wastes.Ingestion, digestion, absorption, assimilation and metabolism of food have interplay inhealth and disease which are significantly affected by psychological mechanisms as well asby bio- fire (Agni).Panchamahabhutas
9www.drjayeshpatidar.blogspot.comAccording to Ayurveda all objects in the universe including human body are composed offive basic elements (Panchamahabhutas) namely, earth, water, fire, air and vacuum (ether).There is a balanced condensation of these elements in different proportions to suit the needsand requirements of different structures and functions of the body matrix and its parts. Thegrowth and development of the body matrix depends on its nutrition, i.e. on food. The food,in turn, is composed of the above five elements, which replenish or nourish the likeelements of the body after the action of bio-fire (Agni). The tissues of the body are thestructural whereas humours are physiological entities, derived from different combinationsand permutations of Panchamahabhutas.Health and SicknessHealth or sickness depends on the presence or absence of a balanced state of the total bodymatrix including the balance between its different constituents. Both the intrinsic andextrinsic factors can cause disturbance in the natural equilibrium giving rise to disease. Thisloss of equilibrium can happen by dietary indiscrimination, undesirable habits and non-observance of rules of healthy living. Seasonal abnormalities, improper exercise or erraticapplication of sense organs and incompatible actions of the body and mind can also result increating disturbance of the existing normal balance. The treatment consists of restoring thebalance of disturbed body-mind matrix through regulating diet, correcting life-routine andbehaviour, administration of drugs and resorting to preventive Panchkarma and Rasayanatherapy.DiagnosisIn Ayuveda diagnosis is always done of the patient as a whole. The physician takes a carefulnote of the patient‟s internal physiological characteristics and mental disposition. He alsostudies such other factors as the affected bodily tissues, humours, the site at which thedisease is located, patient‟s resistance and vitality, his daily routine, dietary habits, thegravity of clinical conditions, condition of digestion and details of personal, social,
10www.drjayeshpatidar.blogspot.comeconomic and environmental situation of the patient. The diagnosis also involves thefollowing examinations:General physical examinationPulse examinationUrine examinationExamination of the faecesExamination of tongue and eyes.Examination of skin and ear including tactile and auditory functions.TreatmentThe basic therapeutic approach is, „that alone is the right treatment which makes for healthand he alone is the best doctor who frees one from disease‟. This sums up the principalobjectives of Ayurveda, i.e. maintenance and promotion of health, prevention of disease andcure of sickness.Treatment of the disease consists in avoiding causative factors responsible fordisequilibrium of the body matrix or of any of its constituent parts through the use ofPanchkarma procedures, medicines, suitable diet, activity and regimen for restoring thebalance and strengthening the body mechanisms to prevent or minimize future occurrence ofthe disease.Normally treatment measures involve use of medicines, specific diet and prescribed activityroutine. Use of these three measures is done in two ways. In one approach of treatment thethree measures antagonize the disease by counteracting the etiological factors and variousmanifestations of the disease. In the second approach the same three measures of medicine,diet and activity are targeted to exert effects similar to the etiological factors andmanifestations of the disease process. These two types of therapeutic approaches arerespectively known as Vipreeta and Vipreetarthkari treatments.
11www.drjayeshpatidar.blogspot.comFor successful administration of a treatment four things are essential. These areThe physicianThe medicamentsThe nursing personnelThe patientThe physician comes first in order of importance. He must possess technical skill, scientificknowledge, purity and human understanding. The physician should use his knowledge withhumility, wisdom and in the service of humanity. Next in importance comes food and drugs.These are supposed to be of high quality; wide application, grown and prepared followingapproved procedures and should be available adequately. The third component of everysuccessful treatment is the role of nursing personnel who should have good knowledge ofnursing, must know the skills of their art and be affectionate, sympathetic, intelligent, neat& clean and resourceful. The fourth component is the patient himself who should becooperative and obedient to follow instructions of the physician, able to describe ailmentsand ready to provide all that may be needed for treatment.Preventive Treatment & the concepts of Aetio-PathogenesisAyurveda has developed a very vivid analytical description of the stages and events thattake place since the causative factors commence to operate till the final manifestation ofdisease. This gives this system an additional advantage of knowing that possible onset ofdisease much before the latent symptoms become apparent. This very much enhances thepreventive role of this system of medicine by making it possible to take proper and effectivesteps in advance, to arrest further progress in pathogenesis or to take suitable therapeuticmeasures to curb the disease in its earliest stage of onset.Types of TreatmentThe treatment of disease can broadly be classified as
12www.drjayeshpatidar.blogspot.coma. Shodhana therapy (Purification Treatment)b. Shamana therapy (Palliative Treatment)c. Pathya Vyavastha (Prescription of diet and activity)d. Nidan Parivarjan (Avoidance of disease causing and aggravating factors)e. Satvavajaya(Psychotherapy)f. Rasayana therapy(use of immunomodulators and rejuvenation medicines)a) Shodhana treatment aims at removal of the causative factors of somatic andpsychosomatic diseases. The process involves internal and external purification. The usualpractices involved are Panchkarma (medically induced Emesis, Purgation, Oil Enema,Decoction enema and Nasal administration of medicines), Pre-panchkarma procedures(external and internal oleation and induced sweating). Panchkarma treatment focuses onmetabolic management. It provides needed purificatory effect, besides conferringtherapeutic benefits. This treatment is especially helpful in neurological disorders, musculo-skeletal disease conditions, certain vascular or neuro-vascular states, respiratory diseases,metabolic and degenerative disorders.(b) Shamana therapy involves suppression of vitiated humours (doshas). The process bywhich disturbed humour subsides or returns to normal without creating imbalance of otherhumours is known as shamana. This treatment is achieved by use of appetisers, digestives,exercise and exposure to sun, fresh air etc. In this form of treatment, palliatives andsedatives are used.(c) Pathya Vyavastha comprises indications and contraindications in respect of diet,activity, habits and emotional status. This is done with a view to enhance the effects oftherapeutic measures and to impede the pathogenetic processes. Emphasis on do‟s anddon‟ts of diet etc is laid with the aim to stimulate Agni and optimize digestion andassimilation of food in order to ensure strength of tissues.(d) Nidan Parivarjan is to avoid the known disease causing factors in diet and lifestyle ofthe patient. It also encompasses the idea to refrain from precipitating or aggravating factorsof the disease.
13www.drjayeshpatidar.blogspot.com(e) Satvavajaya concerns mainly with the area of mental disturbances. This includesrestraining the mind from desires for unwholesome objects and cultivation of courage,memory and concentration. The study of psychology and psychiatry have been developedextensively in Ayurveda and have wide range of approaches in the treatment of mentaldisorders.(f) Rasayana therapy deals with promotion of strength and vitality. The integrity of bodymatrix, promotion of memory, intelligence, immunity against the disease, the preservationof youth, luster and complexion and maintenance of optimum strength of the body andsenses are some of the positive benefits credited to this treatment. Prevention of prematurebear and tear of body tissues and promotion of total health content of an individual are theroles that Rasayana therapy plays.Diet and Ayurvedic TreatmentIn Ayurveda, regulation of diet as therapy has great importance. This is because it considershuman body as the product of food. An individual‟s mental and spiritual development aswell as his temperament is influenced by the quality of food consumed by him. Food inhuman body is transformed first into chyle or Rasa and then successive processes involve itsconversion into blood, muscle, fat, bone, bone-marrow, reproductive elements and ojas.Thus, food is basic to all the metabolic transformations and life activities. Lack of nutrientsin food or improper transformation of food lead to a variety of disease conditionsNATUROPATHY
14www.drjayeshpatidar.blogspot.comConcepts and PrinciplesBasic Concepts In fact, Nature Cure is a way of life of which we find a number ofreferences in the Vedas and other ancient texts. The morbid matter theory, concept of vitalforce and other concepts upon which Nature Cure is based are already available in old textswhich indicate that these methods were widely practised in ancient India. The wholepractice of Nature cure based on the following three principles:Accumulation of morbid matterAbnormal composition of blood and lymphLowered vitalityNature Cure believes that all the diseases arise due to accumulation of morbid matter in thebody and if scope is given for its removal, it provides cure or relief. It also believes that thehuman body possesses inherent self constructing and self healing powers. The fundamentaldifference in Nature Cure with other systems is that its theory and practice are based onholistic view point whereas the later‟s approach is specific. Nature Cure does not believe inthe specific cause of disease and its specific treatment but takes into account the totality offactors responsible for diseases such as one‟s un-natural habits in living, thinking, working,sleeping, relaxation, sexual indulgence etc, and also considers the environmental factorsinvolved which on the whole disturbs the normal functioning of the body and lead it to amorbid, weak and toxic state. For treatment it primarily stresses on correcting all the factorsinvolved and allowing the body to recover itself. A Nature Cure physician helps in Nature‟seffort to overcome disease by applying correct natural modalities and controlling the naturalforces to work within safe limits. The five main modalities of treatment are air, water, heat,mud and space.Principles1. All disease, their cause and their treatment are one.
15www.drjayeshpatidar.blogspot.com2. The basic cause of disease is not bacteria. Bacteria develops after the accumulation ofmorbid matter when a favourable atmosphere for their growth develops in body. Basic causeis morbid matter and not the bacteria.3. Acute diseases are our friends not he enemies. Chronic diseases are the outcome of wrongtreatment and suppression of the acute diseases.4. Nature is the greatest healer. Body the capacity to prevent itself from diseases and regainhealth if unhealthy.5. In Naturopathy patient is treated and not the disease.6. In Naturopathy diagnosis is easily possible. Ostentation is not required. Long waiting fordiagnosis is not required for treatment.7. Patients suffering from chronic ailments are also treated successfully in comparatively lesstime in Naturopathy.8. After emerging, suppressed diseases can be cured by Naturopathy.9. Nature Cure treats physical, mental, social (moral) and spiritual all four aspects at the sametime.10.Nature Cure treats body as a whole instead of giving treatment to each organ separetely.11.Naturopathy does not use medicines. According to Naturopathy "Food is Medicine".12.According to Gandhi Ji "Rama Nama is the best Natural Treatment", means doing prayeraccording to one‟s spiritual faith is an important part of treatment.In short, Nature Cure includes all the available non-in vasive treatments and diagnosticmodalities which do not interefere with the body‟s natural functional capacity and healingprocess and are in affirmity with Nature‟s constructive Principles.Develoment and its StatusNaturopathy is a system of healing science stimulating the body‟s inherent power to regainhealth with the help of five great elements of nature – Earth, Water, Air, Fire and Ether.Naturopathy is a call to "Return to Nature" and to resort to simple way of living in harmonywith the self, society and environment. Naturopathy provides not only a simple practical
16www.drjayeshpatidar.blogspot.comapproach to the management of diseases, but a firm theoretical basis which is applicable toall the holistic medical care and by giving attention to the foundations of health; also offersa more economical frame work for the medicine of future generation. Though the basicNature Cure deals only with Pancha Mahabhoota‟s, the recent developments advocates thepractice of drugless therapies like Massage, Electrotherapy, Physiotherapy, Acupunctureand Acupressure, Magnetotherapy etc., Diet plays a major role, above all. History NatureCure movement started in Germany & other western countries with "Water cure"(Hydrotherapy). Water cure was synonymous with Nature Cure in those early days. Thecredit of making Water cure world famous goes to Vincent Priessnitz (1799-1851) who wasa farmer. Dr. Henry Lindlahr and others go to the extent of crediting him as "Father ofNaturopathy". The word "Naturopathy" has been coined by Dr. John Scheel in the year 1895and was propagated and popularised in the western world by Dr. Benedict Lust. A numberof Doctors of modern medicine and others became Nature Cure enthusiasts and graduallyadded a number of modalities within the fold of Naturopathy and scientifically developedthem. Nature Cure movement gained momentum in India as Mahatma Gandhi, "Father ofthe Nation" became much interested in this system and included it in his programmes. Hehas also established a Nature Cure Hospital in Uruli Kanchan, Distt. Poona, Maharashtrawhich is still functioning. Background Naturopathy adopts the following diagnosticmethods: Full life case history – covering all the facts of life, since birth.1. Facial diagnosis – the science of facial expressions by studying the various characteristicfeatures upon the body.2. Iris diagnosis – study of iris indicating the condition of various visceral organs.3. Modern clinical diagnosis to some extent.The methods applied for cure in Naturopathy are the following: -1. Water Therapy: Water is the most ancient of all the remedial agents. It is employed indifferent forms in treatment and produces several types of physiological effects depending
17www.drjayeshpatidar.blogspot.comupon temperature and duration. Hydrotherapy is employed in almost all types of diseaseconditions.2. Air Therapy: Fresh air is essential for good health. Air therapy is employed in differentpressures and temperatures in variety of disease conditions.3. Fire Therapy: Existence of all the creatures and forms depends upon “Agni” (Fire). InNature Cure treatment, different temperatures are employed through different heatingtechniques to produce different specific effects.4. Space Therapy: Congestion causes disease. Fasting is the best therapy to relievecongestion of body and mind.5. Mud Therapy: Mud absorbs, dissolves and eliminates the toxins and rejuvenates the body.It is employed in treatment of various diseases like constipation, skin diseases etc.6. Food Therapy: Most of the disease are amenable through food therapy. As you eat so willyou be physically as well as mentally. Your food is your medicine. These are the mainslogans of Nature Cure.7. Massage Therapy: Massage is generally employed for tonic, stimulant and sedativeeffects. It is an effective substitute for exercise.8. Acupressure: There are different points on hands, feet & body which are associated withdifferent organs. By applying pressure on these selected points, related organs can beinfluenced for getting rid of their ailments.9. Magneto Therapy: Magnets influence health. South and North poles of different powersand shapes are employed in treatment, by applying directly on different parts of the body orthrough charged up water or oil.10.Chromo Therapy: Sun rays have seven colours – violet, indigo, blue, green, yellow,orange and red. These colours are employed through irradiation or body or byadministering charged water, oil and pills for treatment.Practitioners have claimed that Siddha medicines are effective in reducing the highlydebilitating problems that manifest themselves among patients of HIV/AIDS. Moreresearch into the efficacy of these medicines is presently in progress.
18www.drjayeshpatidar.blogspot.comSIDDHAIntroduction and OriginSiddha system is one of the oldest systems of medicine in India . The term Siddha meansachievements and Siddhars were saintly persons who achieved results in medicine.Eighteen Siddhars were said to have contributed towards the development of this medicalsystem. Siddha literature is in Tamil and it is practised largely in Tamil speaking part ofIndia and abroad. The Siddha System is largely therapeutic in nature.History :The original Home allotted to mankind by the Creator was in the temparate and fertileregion of the East and pointedly in India. It is from here that the human race began itsculture and career. India may, therefore, be safely stated as that the first country from whichhuman culture and civilization originated and spread. According to Indian history prior toAryans migration, the Dravidian was the first inhabitant of India of whom the Tamilianswere the most prominent. The Tamilians were not only the earliest civilized but also thosewho may more considerable progress in civilization than any other early people. Thelanguages of India were divided into two great classes, the northern with Sanskrit as the pre-pondering element and the southern with Dravidian language as independent bases. Thescience of medicine is of fundamental importance to man‟s well being be and his survivaland so it must have originated with man and developed as civilization. It is, therefore ratherpointless to try to determine the exact point of time to which the beginning of these systemscould be traced They are eternal, they began with man and may end with him. The Siddha
19www.drjayeshpatidar.blogspot.comwas flouriest in south and Ayurveda prevalent in the north. Instead of giving the name ofany of individual as the founder of these systems our ancestors attributed their origin to thecreator. According to the tradition it was Shiva who unfolded the knowledge of Siddhasystem of medicine to his concert Parvati who handed it down to Nandi Deva and he theSiddhars. The Siddhars were great scientists in ancient times.According to tradition, the origin of Siddha system of medicine is attributed to thegreat Siddha Ayastiyar. Some of his works are still standard books of medicine and surgeryin daily use among the Siddha Medical practitioners.Basic ConceptsThis principles and doctrines of this system, both fundamental and applied, have a closesimilarity to Ayurveda, with specialization in Iatro-chemistry. According to this system thehuman body is the replica of the universe and so are the food and drugs irrespective of theirorigin.Like Ayurveda, this system believes that all objects in the universe including human bodyare composed of five basic elements namely, earth, water, fire, air and sky. The food, whichthe human body takes and the drugs it uses are all, made of these five elements. Theproportion of the elements present in the drugs vary and their preponderance or otherwise isresponsible for certain actions and therapeutic results.As in Ayurveda, This system also considers the human body as a conglomeration of threehumours, seven basic tissues and the waste products of the body such as faeces, urine andsweat. The food is considered to be basic building material of human body which getsprocessed into humours, body tissues and waste products. The equilibrium of humours isconsidered as health and its disturbance or imbalance leads to disease or sickness.This system also deals with the concept of salvation in life. The exponents of this systemconsider achievement of this state is possible by medicines and meditation.
20www.drjayeshpatidar.blogspot.comMateria MedicaThe system has developed a rich and unique treasure of drug knowledge in which use ofmetals and minerals is very much advocated. Some idea about the depth of knowledge thesystem possesses in the field of mineral, materia medica can be formed from the detaileddrug classification, briefly described below:There are 25 varieties of water-soluble inorganic compounds called „UPPU. These aredifferent types of alkalies and salts.There are 64 varities of mineral drugs that do not dissolve in water but emit, vapours whenput in fire. Thirty-two of these are natural and remaining are artificial.There are Seven drugs that do not dissolve in water but emit vapour on heating.The system has classified separately classes of metals and alloys, which melt when, heatedand solidifies on cooling. These include items like gold, silver, copper, tine, lead and iron.These are incinerated by special processes and used in medicine.There is a group of drugs that exhibit sublimation on heating and includes mercury and itsdifferent forms like red sulphide of mercury, mercuric chloride and red oxide of mercuryetc.Sulpher, which is insoluble in water, finds a crucial place in Siddha materia medica alongwith mercury for use in therapeutics and in maintenance of health.The above classification shows detailed knowledge and study of minerals that this systemhas evolved for treatment. In addition there are drugs obtained from animal sources. Thesystem has published and hand-book on Siddha treatment for common diseases andailments.Chemistry in Siddha :
21www.drjayeshpatidar.blogspot.comIn Siddha system chemistry had been found well developed into a science auxillary tomedicine and alchemy. It was found useful in the preparation of medicine as well as intransmutation of basic metals into gold. The knowledge of plants and mineral were of veryhigh order and they were fully acquainted with almost all the branches of science. TheSiddhars were also aware of several alchemical operations divided into several processessuch as – calcinations, sublimation, distillation, fusion, separation conjunction orcombination, congelation, cibation, fermentation, exaltation i.e. the action or process ofrefining gold, fixation i.e. bringing to the condition of being non-volatile i.e. to the state ofresisting the action of fire, purification, incineration of metals, liquifaction, extraction and soon.Even cupellation of gold and silver which is an essential process in Alchemy in which isclaimed to have been discovered by the Arabs, was known to the Siddhars long long before.They were even polypharmacists and as such were engaged in boiling, dissolving,precipitating and coagulating chemical substances. Some of their secret methods, especiallythose in fixing and consolidating certain volatile substances that could not resist the actionof fire, such as Mercury, Sulphur, Orpiment, Vermilion, Arsenic etc. continue still amystery.StrengthThe Siddha system is capable of treating all types of disease other than emergency cases. Ingeneral this system is effective in treating all types of skin problems particularly Psoriasis,STD, urinary tract infections, diseases of liver and gastro intestinal tract, general debility,postpartum anaemia, diarrhoea and general fevers in addition to arthritis and allergicdisorders.Diagnosis and Treatment
22www.drjayeshpatidar.blogspot.comThe diagnosis of diseases involve identifying it causes. Identification of causativefactors is through the examination of pulse, urine, eyes, study of voice, colour of body,tongue and the status of the digestive system. The system has worked out details procedureof urine examination which includes study of it‟s colour, smell, density, quantity and oildrop spreading pattern. It holistic in approach and the diagnosis involves the study ofperson as a whole as well as his disease.The Siddha System of Medicine emphasises that medical treatment is oriented notmerely to disease but has to take into account the patient, environment, the meteorologicalconsideration, age, sex, race, habits, mental frame, habitat, diet, appetite, physical condition,physiological constitution etc. This means the treatment has to be individualistic, whichensures that mistakes in diagnosis or treatment are minimal.The Siddha System also deals with the problems affecting the women‟s health and alot of formulations are available in the Siddha classics which can counter the problems for abetter living. The care for women‟s health starts from the first day of the girl child. TheSiddha System strongly advocates breast feeding upto the first three months of the life. TheSiddha System believes in the principle of “Food itself is medicine” and during this nursingperiod, lactating mothers are advised to take the food rich in iron, protein and fibre so as toprevent any nutritional disorders both to the child as well as the mothers. Once in 15 days,the mothers are advised to take simple remedies for de -worming so that they may not landup in anaemic conditions.For any diseases due to infection or otherwise, the treatment is individualistic onexamination of that particular patient. Once the girl child attained menarche, the SiddhaSystem has got a variety of preparations which can strengthen her reproductive system so asto deliver a healthy child in future. And also, effective treatments are available to take careof the menopausal syndromes, especially problems related to the hormonal imbalance.
23www.drjayeshpatidar.blogspot.comThe Siddha System is effective in treating chronic cases of liver, skin diseasesespecially “Psoriasis”, rheumatic problems, anaemia, prostate enlargement, bleeding pilesand peptic ulcer. The Siddha Medicines which contains mercury, silver, arsenic, lead andsulphur have been found to be effective in treating certain infectious diseases includingvenereal diseases.UNANIUNANI SYSTEM OF MEDICINEIntroduction and OriginUnani System of Medicines originated in Greece and is based on the teachings ofHippocrates and Gallen and it developed in to an elaborate Medical System by Arabs, likeRhazes , Avicenna, Al-Zahravi , Ibne-Nafis and others.Unani Medicines got enriched by imbibing what was best in the contemporary systems oftraditional medicines in Egypt, Syria, Iraq, Persia, India, China and other Middle Eastcountries. In India, Unani System of Medicine was introduced by Arabs and soon it tookfirm roots. The Delhi Sultans (rulers) provided patronage to the scholars of Unani Systemand even enrolled some as state employees and court physicians. During 13th and 17thcentury A.D. Unani Medicine had its hey-day in India. During the British rule, UnaniSystem suffered a set back due to withdrawal of State Patronage, but continued to bepracticed as the masses reposed faith in the system. It was mainly Sharifi family in Delhi,the Azizi family in Lucknow and the Nizam of Hyderabad due to whose efforts UnaniMedicine survived during the British period.
24www.drjayeshpatidar.blogspot.comUnani System has Shown remarkable results in curing the diseases like Arthritis,Leucoderma, Jaundice, Liver disorders, Nervous system disorders, Bronchial Asthma, andseveral other acute and chronic diseases where other systems have not been able to givedesired response. Now the system has crossed national boundaries and is popular amongthe masses globally.Concept and PrinciplesUnani treatment is based on its natural and remarkable diagnosis methods and is affordable.It is mainly dependent on the Temperament (Mizaj) of the patient, hereditary condition andeffects, different complaints, signs and symptoms of the body, external observation,examination of the PULSE (Nubz), urine and stool etc. Unique and special treatmentmethods like Dieto therapy (Ilaj-bil-Ghiza), Climatic therapy (Ilaj-bil-Hawa), Regimentaltherapy (Ilaj-bit-Tadbir), make it a different and remarkable and popular system.Regimental therapy includes venesection, cupping, diaphoresis, diuresis, Turkish bath,massage, cauterization, purging, emesis, exercise, leeching, etc.Dieto therapy (Ilaj-bil-Ghiza) aims at treating certain ailments by administration of specificdiets or by regulating the quantity and quality of food.Pharmacotherapy (Ilaj-bid-Dawa) is mainly dependent upon local available herbal drugswhich make the system indigenous. Similarly, surgery has also been in use in this systemfor quite long. In fact, the ancient physicians of Unani Medicine were pioneers in this fieldand had developed their own instruments and techniques. But at present only minorsurgery is in vogue in this system.In Unani Medicine, single drugs or their combination in raw are preferred over compoundformulations. Further the materia medica of Unani Medicine being vast, the medicines areeasy to get as most of them are available locally. The naturally occurring drugs used in thissystem are symbolic of life and are generally free from side-effects. Such drugs as are toxicin crude form are processed and purified in many ways before use.
25www.drjayeshpatidar.blogspot.comThe Greek and Arab physicians encouraged poly-pharmacy and devised a large number ofpoly-pharmaceutical recipes which are still in vogue. In Unani Medicine, although generalpreference is for single drugs, compound formulations are also employed in the treatment ofvarious complex and chronic disorders. Since emphasis is laid on a particular temperamentof the individual, the medicines administered are such as go well with the temperament ofthe patient, thus accelerating the process of recovery and also eliminating the risk of drugreaction.In India, the concept of research in Unani system of medicine was originally perceived byMasih-ul-Mulk Hakim Ajmal Khan in the 1920s. A versatile genius of his time, HakimAjmal Khan spotted Dr. Salimuzzaman Siddiqui – a chemist – for undertaking chemicalstudies on some important medicinal plants used in Unani Medicine. Dr.Siddiquiundertook the task visualized by Msih-ul-Mulk and his discovery of medicinal properties ofa plant, commonly known as Asrol (Pagal Booti), led to sustained research that establishedthe unique efficacy of this plant known all over the world as Rauwolfia serpentina, inneurovascular and nervous disorders, such as hypertension, insanity, schizophrenia, hysteria,insomnia and psychosomatic conditions, etc.At present the Unani system of medicine, with its own recognizedpractitioners, hospitals and educational and research institutions forms an integral part of thenational healthcare system. Today, India is considered a world leader in Unani Medicine.YOGAConcepts and Principles
26www.drjayeshpatidar.blogspot.comBasic ConceptsThe tradition of Yoga was born in India several thousand years ago. Its founders were greatSaints and Sages. The great Yogis gave rational interpretation of their experiences aboutYoga and brought a practically sound and scientifically prepared method within every one‟sreach. Yoga philosophy is an Art and Science of living in tune with Brahmand- TheUniverse. Yoga has its origins in the Vedas, the oldest record of Indian culture. It wassystematized by the great Indian sage Patanjali in the Yoga Sutra as a special Darshana.Although, this work was followed by many other important texts on Yoga, but Patanjali‟sYoga Sutra is certainly the most significant wherein no change is possible. It is the onlybook which has touched almost all the aspects of human life.Unlike earlier, Yoga today is no longer restricted to a privileged minority of hermits; it hastaken its place in our every day lives and have undergone a world wide awakening andacceptance in the last few decades. The Science of Yoga and its techniques have now beenre-oriented to suit modern sociological needs and lifestyle. Experts of various branches ofmedicine including modern medical science are realizing the role of these techniques in theprevention of disease and promotion of health.Swami Vivekananda defines Yoga as "It‟s a means of compressing one‟s evolution into asingle life or a few months or even a few hours of one‟s bodily existence". By Yoga, SriAurobindo, meant a methodological effort towards self perfection by the development ofpotentialities latent in the individual.Yoga is a science as well an art of healthy living physically, mentally, morally andspiritually. It‟s systematic growth from his animal level to the normalcy, from there to thedivinity, ultimately. It‟s no way limited by race, age, sex, religion, cast or creed and can bepracticed by those who seek an education on better living and those who wants to have amore meaningful life.
27www.drjayeshpatidar.blogspot.comYoga is not a religion; It‟s a philosophy of life based on certain psychological facts and itaims at the development of a perfect balance between the body and the mind that permitsunion with the divine i.e. perfect harmony between the individual and the cosmos.Many different interpretations of the word Yoga have been handed down over the centuries.One of the classic definition of Yoga is "to be one with divine." It does not matter whatname we use for the divine-God, Allah, Ishvara, or whatever- anything that brings us closerto understanding that there is a power higher and greater than ourselves is Yoga. When wefeel in harmony with that higher power, that too is Yoga.Ashtanga Yoga :Yoga is one among the six systems of Indian orthodox philosophy. Maharishi Patanjali,rightly called as the "Father of Yoga" compiled and refined various aspects of Yogasystematically in his "Yoga Sutras" (aphorisms). He advocated the eight fold path of Yoga,popularly known as "Ashtanga Yoga" for all-round development of human personality.They are – Yama, Niyama, Asana, Pranayama, Pratyahara, Dharana, Dhyana & Samadhi.These eight limbs are so perfectly designed that there is absolutely no scope for any additionor alteration since these are formulated on the basis of multifarious psychologicalunderstanding of human personality.The practice of Yamas – Niyamas i.e. harmlessness towards all living beings, truthfulness,honesty, celibacy, non-hoarding of wordly objects, cleanliness, contentment, austerity,control of lust, anger and infatuation, study of holy books and practice of Japa and selflessaction – all these pave way for increasing the power of concentration, mental purity andsteadiness.Hatha Yoga :Svatmarama, who wrote a treatise on this subject after experiencing the nectar of samadhi(absorption of the soul) as Hatha Yoga Vidya or Hatha Yoga Pradeepika. It gives guidelines
28www.drjayeshpatidar.blogspot.comfrom the practical point of view for a beginner to begin Yoga, which leads the studentsgradually from the culture of the body towards the sight of the soul and God-realisation.Hatha Yoga Pradeepika is divided into four chapters or Prakaranas. The first chapterexpounds Asanas, the second is on pranayama, the third is on Mudras and Bandhas and thefourth is on Pratyahara, Dharana, Dhyana and samadhi. In between these, the authorintroduces satkriyaas or the six cleansing processes. As the text begins with asanas,Satmarama‟s Yoga is called Sadanga Yoga or the six aspects of Yoga beginning with asanasand ending in Samadhi.A set of Asanas, Mudras and Pranayamas practised with faith, preseverance and insightrejuvenates the brain, heart, lungs, liver, pancreas, kidneys, bowels, nerves, muscles, tissues& glands of the body by ensuring oxygenated and balanced blood supply, kindles up theappetite, bestows control over seminal fluid, senses & mind and imparts increased vitality,vigour & longevity to the practitioner.Streams of Yoga :1. There are a large numbers of methods of Yoga catering to the needs of different persons insociety. They are broadly classified into four streams. Swami Vivekananda puts them asWork, Worship, Philosophy and Psychic control.2. Karma Yoga, the path of work, involves doing action in a skilful way. In other words, it canbe said as a way of enjoying work, doing it effortlessly. The success or failure should not beallowed to cause ripples in the mind.3. „Bhakti Yoga‟ the path of worship is a systematic method of engaging the mind in thepractice of divine love. This attitutde of love softens our emotions and tranquillises ourmind.4. Jnana Yoga, the path of philosophy, is a systematic way of tutoring the mind about therealities of life by contemplation. This will strip off the garb of Avidya (ignorance) from ourmind and the mind goes to its natural state of rest.
29www.drjayeshpatidar.blogspot.com5. Raja Yoga, the path of psychic control, is a systematic process of culturing the mind. It isbased on the 8-limbed Yoga of Patanjali.6. Yoga is a science as well as an art of healthy living. It is no way limited by race, age, sex,religion, caste, creed and any other boundaries and can be practiced by those who seek aneducation on better living and those who want to have a more meaningful life.Principles1. Yoga means a holistic approach towards the cause and treatment of disease.2. According to Yoga, most of the diseases Mental, Psychosomatic and Physical originate inmind through wrong way of thinking, living and eating which is caused by attachment.3. The basic approach of Yoga is to correct the life style by cultivating a rational positive andspiritual attitude towards all life situation.4. Yoga does not treat gross body alone, it takes into consideration all the five Kosa‟s(Sheaths) i.e. Manomaya Kosa, Annamaya Kosa, (grass Sheath) Pranamaya Kosa (ExtralBody) (Psychic Body), Vijyanmaya Kosa (intellect Sheath) and Anandamaya Kosa (Blisssheath).5. Like Ayurveda and Naturopathy Yoga also takes up the cleansing of the body as the firstmeasure to fight disease. While Ayurveda performs its pancha karma through the help ofametics purgative Yoga performs them without the help of any drug i.e. by developing fullefficiency and control of eliminative systems of the body. Which no other system of healthcare can do.6. All the systems of medicine at their best aim at curing the disease whereas Yoga aims atpreventing the disease and promoting health by reconditioning the psycho-physiologicalmechanism of the individual.7. Yoga emphasises the development of brotherhood, hormony, fraternity and equality notonly towards all human beings irrespective of colour, caste, nationality, age and sex buttowards all living beings also. This attitude renders the thinking so positive that man is
30www.drjayeshpatidar.blogspot.comliberated from all mental malice and also all the mental, psychosomatic and physiologicaldiseases arising thereof.8. The approach of Yoga is not confirmed to various disorders, it aims at bringing underperfect control of the mind, senses and pranic energy and direct them towards healthierchannels with a view to aquire mental purity, intellectual stability and spiritual bliss.9. Yoga is very wide and comprehensive system embracing all walks of human life. It is unlikeAyurvedic, Unani and Homoeopathy. It is not merely a system of treatment but has potentialto develop alround health i.e. physical, social, mental and spiritual. For social health, itprescribes the practice of Yama & Niyama and Karma Yoga. A man devoted to karma Yogalooks all the living beings as his bretherens and helps them getting rid of painful situations.This concept of "Vasudhaiv Kutmba Kama" is the basic Philosophy of Yoga.10.Yoga emphsises the practitioners to withstand the environmental influences both external &internal as well as physical & mental processes. This practice cultivates strong immunity inthem and make them capable of offering a effective ressistance to various environmentalpressures and thus, maintains behavioural equanimity and intellectural stability.11.The practice of Yama – Niyamas purifies the heart of practitioner from vices likeattachement, aversion, avarice and infatuation etc. and generates higher ethical qualities likesincerity, honesty, straightforwardness, cheerfulness, courage, detachement, patience,perseverence, tranquility, self conrol, truth, harmony and uprightness.12.Our ancient seers have very sagaciously designed the Yogic practices to invigorate theentire psychosomatic consitution of man. A set of Asanas, Mudras and Pranayamaspractised with faith, perseverance and insight rejuvenates the brain, heart, lungs, liver,pancreas, kidneys, bowels, all nerves, muscles, tissues, glands of the body by ensuringoxygenated and balanced blood supply, kindless up the appetite, bestows control overseminal fluid, senses and mind and imparts increased vitality, vigour and longevity to thepractitioners.Yoga Develoment and its Status
31www.drjayeshpatidar.blogspot.comIn our country, generations of Yogis and Scholars have contemplated their life in timelessfashion to realize that there is a meaning to life and some purpose beyond the humansufferings. They were even convinced that there is a way to escape the tragic problems oflife by diverting our mind to something more interesting and everlasting. They were alsomoved by the suffering they saw around them and wanted that the human being should befree from sufferings & ignorance, to set him on the road to freedom and live healthy . Inancient days, most of the Yogis & Sages used to live in forests. They use to eat whatever isprovided by the Nature in its natural form. Not only that the ever changing climate could notharm them a bit. They use to apply holy ash of Havana on their body to keep away thegerms & bacteria. The great Yogis and Scholars gave rational interpretations of theirexperiences and brought these within every one‟s reach by making a practically designedand scientifically prepared method of healthy living. Hence, the science of Yoga emerged tocounter all these problems and human sufferings.In the ancient days, Medicine was dominated by magical and religious beliefs which werean integral part of almost all ancient cultures and civilizations. Although primitive man maybe extinct, his progeny - the so called " Traditional Healers " , are found everywhere. Theylive close to the people and their treatment are based on various combinations of religion,magic and empiricism.The greatest Physician in Greek medicine was Hippocrates, who is often called the "Fatherof Medicine". He studied such things as climate, water, air, clothing, habits of eating &drinking and the effect they have in producing diseases. The Greeks believed that matterwas made up of four elements - Earth, Air, Fire, Water and the same is applicable to bodyalso. They also believed that the equilibrium among these elements maintains normal healthstatus.Medicine has moved from organism to organ and from organ to cell and from the cell tomolecular properties. Despite spectacular bio-medical advances and massive expenditures,
32www.drjayeshpatidar.blogspot.comthe death rate and the life expectancy in the developed countries have remained unchanged.Medicine, as practiced today has begun to bequestioned and criticised. High technology medicine seems to be getting out of hand andleading health systems in wrong directions. There is an increasing concern about the costand allocation of health resources, but the efficacy of modern medicine is fundamentallyquestioned through various points of view. Contemporary medicine is no longer solely anart and science for the diagnosis and treatment of diseases. It is also the science forprevention of disease and promotion of health. With increasing recognition of the failure ofexisting health services to provide health care, alternative ideas and methods to providehealth care have been considered and tried in large scale in the recent past.The sacred land of India, from the time immemorial contributed in its own way to the betterliving of mankind. Yoga & Naturopathy are the two of its kinds which can be the onlyanswer to the rising levels of health care problems.In recent times there is a growing awareness among the people about the efficacy and utilityof Yoga and Nature Cure in keeping one fit at physical, mental, emotional, social andspiritual planes. These systems are emerging as the effective methods and means to improvethe total personality and to build a healthy society. Above all, these systems are adopted as away of life.PUBLIC PRIVATE PARTNERSHIP-Our vision, mission and valuesVisionFacilitating and enhancing quality public service delivery by being a catalyst forefficient, effective and value-for-money best practice solutionsMission
33www.drjayeshpatidar.blogspot.comTo enable National Treasury and provincial treasuries to effectively regulate PPPsTo evolve as a dynamic and sustainable center of excellence for PPPsTo drive PPP deal flow by identifying project opportunities that yield value for allstakeholdersTo provide technical assistance to public institutions through project feasibility,procurement and management; andTo promote an enabling environment for PPPs by:o facilitating certainty in the regulatory frameworko developing best practice guidelineso providing trainingo disseminating reliable information; ando driving black economic empowerment in PPPs.Values Fairness. Empowerment. Professionalism. Integrity. Passion.PPP Unit historyIn April 1997, the South African Cabinet approved the appointment of an inter-departmentaltask team to develop a package of policy, legislative and institutional reforms to create anenabling environment for PPPs. Pioneering PPP projects were undertaken between 1997 to2000 by the SA National Roads Agency for the N3 and N4 toll roads; by the Departments ofPublic Works and Correctional Services for two maximum security prisons; by twomunicipalities for water services; and by SA National Parks for tourism concessions.
34www.drjayeshpatidar.blogspot.comDrawing early lessons from these projects and from international experience, a StrategicFramework for PPPs was endorsed by Cabinet in December 1999, and in April 2000,Treasury Regulations for PPPs were first issued in terms of the Public Finance ManagementAct (Act 1 of 1999). By mid-2000, with technical assistance funding from USAID, GTZ andDIFID, the PPP Unit was established in National Treasury with five professional staff drawnfrom both the public and private sectors.PPP Unit todayNational Treasurys PPP Unit now comprises five cross-functional desks: Financial, Legal,Business Development, Project Evaluation, and Municipal, funded almost wholly byTreasury, with the remaining donor support phasing out in 2005. Each professional staffmember gives hands-on technical assistance to a sector-specific (eg health, tourism, IT,accommodation) portfolio of registered projects, and each also gives his/her specialist (egfinancial, legal, BEE) advice on every regulated PPP project at various phases in the PPPproject cycle. All PPPDefinition-PPP as a contract between a public sector institution/municipality and a privateparty, in which the private party assumes substantial financial, technical and operational riskin the design, financing, building and operation of a project.Two types of PPPs are specifically defined:where the private party performs an institutional/municipal functionwhere the private party acquires the use of state/municipal property for its own commercialpurposes A PPP may also be a hybrid of these types.Payment in any scenario involves one of three mechanisms
35www.drjayeshpatidar.blogspot.comthe institution/municipality paying the private party for the delivery of the service, orthe private party collecting fees or charges from users of the service, ora combination of thesePPPs are good for Black Economic EmpowermentThere are key features of PPPs that make them inherently excellent for achievingBEE objectives:The long-term nature of PPPs provides an opportune instrument to grow black equity andblack management over time. Risk is clearly identified in PPPs, clearly costed andappropriately allocated, so black participants know in advance what they are committing to.The formation of private consortia in the form of special purpose vehicles (SPVs) for manyPPPs facilitates long-term beneficial partnerships between new black enterprises andexperienced, resourced companies - both as equity partners and in project management, andboth at the private party SPV and subcontracting levels.Where government is the buyer of a service, and insofar as the service is provided to theagreed standards, there is a steady revenue stream to the private party, reducing risk to newblack enterprises.Principal equity sponsors in a PPP are often also first-tier Subcontractors, buildingincentives for optimal risk management.PPPs provide significant subcontracting opportunities for black enterprises, where earlycash-flow benefits can be derived as delivery commences.PPPs have far-reaching broad-based BEE potential: through the subcontracting andprocurement mechanisms they can involve a full spectrum of large, medium and smallenterprises, and bring tangible local economic development benefits to targeted groups ofpeople.Return on equity to the private party is competitive where risk is properly assumed.
36www.drjayeshpatidar.blogspot.comThere is an increasingly strong demand for black professionals as transaction advisors toboth institutions and private parties in PPPs.CENTRALLY SPONSORED SCHEMES1. DEVELOPMENT AND UPGRADATION OF AYUSH INSTITUTES/COLLEGESThis is one of the Centrally Sponsored Schemes being implemented by the Departmentfor Development of AYUSH Institutions. This Scheme has been in operation since last threeplan periods and the present plan period. The scheme has following components:-(i) Development of UG colleges.(ii) Assistance to P.G. Medical Education(iii) Re-orientation Training Programme for AYUSH Personnel.(iv) Renovation and strengthening of Hospital wards of Govt./ Govt. aided teaching(v) Establishment of computer laboratory.(vi)Up-gradation of academy institutes to the status model Institutes of AYUSH.(i) Development of UG colleges.Assistance for equipment (Rs. 10 lakhs per college), library books (Rs. 2 lakhs per college),capital works (Rs. 50 lakhs per college) and a corpus fund Rs. 5 lakhs (one time assistance)is provided under the Development of UG College scheme. There is provision for anotheradd-on component of Pharmacy and Nursing Education but the same would be implementedonly after the Pharmacy and Nursing Education is regulated by statutory council. OnlyGovt./ Govt. aided colleges are eligible for assistance for capital The assistance under thisscheme is to be provided only once in the 10th Plan period.(ii) Assistance to PG Medical Education
37www.drjayeshpatidar.blogspot.comUnder this scheme only new Department for new Government aided institutes are eligible toreceive grant for a period of five years. The assistance is given for staffing, stipend and alsoto meet sum non-recurring expenditure.(iii)Reorientation Training programme of AYUSH PersonnelGovernment/Pvt./NGO AYUSH institutions are eligible to take up this training programmeteachers and doctors though from Government/Government aided private and non-aidedpvt.Institutions AYUSH are also available, preference will be given Government, colleges.Under this scheme rate of assistance as well as size of batch varies from category tocategory.(iv) Renovation and strengthening of Hospital wards of Govt./ Govt. aided teachingHospitals of AYUSH.One time financial assistance upto Rs. 20 lakhs for hospital will be admissible forGovernment. Institutions and Rs. 10 lakhs for Government aided institutions.(v) Establishment of computer laboratory.Use of information technology in promoting the educational standards is main aim of thescheme. Rs. 10.00 lakhs is provided as assistance to existing Government PG colleges forsetting up small computer laboratory with five P.C. alongwith other prescribedequipments.(vii) Up-gradation of academy institutes to the status model Institutes of AYUSH.
38www.drjayeshpatidar.blogspot.comThe scheme envisages development of one Model Institute of AYUSH per system perstate during the 10th plan. Government Institutes recognized by the Central Council atleast for 10 years and fulfilling at least 50% Council norms are eligible for assistance. Atotal of Rs. 3 crores is admissible for capital works (Rs. 1.5 crores) Machinery,equipment and computers (Rs. 1 crores),Books etc. (Rs. 10 lakhs) and staffing (Rs. 60lakhs).The total outlay for the scheme during the 10th Plan was Rs. 120 crores. During the firstfour years of the 10th Plan, the total expenditure was Rs. 98.08 crores. Thus the totalexpenditure is likely to exceed the original outlay for the 10th plan. During the first fouryears the number of colleges assisted under the scheme was 434. 2 statement indicatingthe physical and financial achievements are enclosed as Annexure I & II.XIth Plan ProposalSo far continuation of these schemes during the XIth Plan is concerned, it is felt thatexistence of so many components for the same purpose is not required. In view of thepast experience of implementing these schemes, this Department is of the view thatinstead of attending to a small component of assistance required for various AYUSHInstitutions, it would be appropriate to concentrate on the overall development of theseInstitutions so that they may be in a position to impart quality education in AYUSHsystems and also contribute to the effectiveness and spread of the Indian MedicineSystems.This would result in better utilization of the funds and the results are likely to be tangible.To achieve the above goal it is felt that instead of existing 6 components, the departmentmay assist only two categories colleges i.e. U.G. Colleges & P.G. Colleges and providefor fixed amount of assistance to be spent on the items actually needed by them on thebasis of a master plan.All colleges would be accredited and only those colleges which are viable and canmaintain proper standards would be supported. For this purpose a detailed list of the
39www.drjayeshpatidar.blogspot.comactivities /items can be drawn and the colleges should have flexibility in choosing fromthe same as per their needs. Besides we may have a third component pertaining to modelinstitutes. Under this component some good colleges may be selected and developed intomodel institutes which would be utilized as Centre of Excellence. For U. G. Colleges theassistance may be Rs. 2 crores per college and for P.G. Colleges the limit may be Rs. 3crores. So far as development of model institutes is concerned the amount will be decidedon the basis of the college specific plan with an upper limit of Rs. 5 crores. Then underfourth component one time capital grant of Rs. 10.00 crores for institutions to States forstarting AYUSH Pharmacy/Para Medical Courses in the existing AYUSH colleges isproposed to be provided during XIth Plan.2. HOSPITALS AND DISPENSARIESThe scheme has been designed with a view to make available the benefits of Ayurveda,Unani, Siddha, Yoga & Naturopathy andHomoeopathy to the public at large, so that people can exercise their choice in accessingthe health services and to achieve this, it was felt necessary to encourage setting up ofgeneral and specialized treatment centers of ISM&H in the allopathic hospitals.Through this scheme the Central Government intends to encourage setting up of generaland specialized treatment centers of ISM&H inallopathic hospitals and support the efforts of State Governments to improve the supplyposition of essential drugs in dispensaries situated in rural and backward areas, so thatthe faith of people in ISM&H could be enhanced.During the Tenth Plan period so far, the Department sanctioned an amount of Rs 108.00crores for setting up of 183 ISM Wings in District Hospitals, 44 Special Therapy Centreswith Indoor facility and 348 Special Clinics of ISM&H with Specific Outdoor Treatment.An amount of Rs 145.00 crores has been sanctioned for supply of essential drugs to26,000 AYUSH dispensaries during the period in the country.
40www.drjayeshpatidar.blogspot.comIn the implementation of this scheme has been observed that the implementing agenciesi.e. the concerned hospitals and dispensaries complain about the delay in the receipt ofmoney from the State Govt channels. To avoid this delay, the Planning Commission hasapproved distribution of funds through the State Govt Health Societies from the next Planperiod onwards.The State Govts complain that they are finding it difficult to provide themanpower in the absence of any fund for this purpose.XI PLAN PROPOSALThe various components under the scheme Hospitals & Dispensaries are as follows:Setting up of Speciality Therapy Centres and Speciality Clinics of ISM&H:It was felt that the physical achievements relating to these schemes had been less thansatisfactory which may be mainly due to the reason that State Governments were not ableto provide for manpower component/ experts which are essentially needed foroperationalization of these schemes. It is therefore essential to provide for manpowercomponent on outsourcing or contractual basis. Hence, it is proposed that 10% of thegrants given to States under the Scheme ofHospitals & Dispensaries may be used by States for hiring contractual Medical/ParaMedical personnel during the XIth Plan period. The responsibility of the recurringexpenditure beyond Xith Plan period will have to be borne by the States.Setting up of ISM&H Wings in District Allopathic Hospitals:Since operationalization of this scheme also depends on available of medical andparamedical staff which the State Governments are not normally able to provide for, itwill be important to keep provision for manpower component viz medical andparamedical staff and enhance the overall ceiling of the scheme to Rs 40.00 lakhs in placeof Rs 35.00 lakhs per ISM&H Wing.At present, the execution of the scheme depends on the initiative of the state Government
41www.drjayeshpatidar.blogspot.comand is on pick and choose basis. If integration is to be effected in a realistic fashion and ifa choice is to be provided to the common man, opening of an AYUSH wing be mademandatory for all District Hospitals and for which funds should be given for all theDistrict hospitals to all the States.Strengthening of existing AYUSH healthcare facilities:The Scheme of Hospital and Dispensaries should be extended to existing AYUSHHospitals & Dispensaries also since at present it caters to only allopathic facilities.This will help in recovering and strengthening certain ailing Treatment and Patient careunits which need equipment, infrastructure, medicine and training etc but the StateGovernments find it difficult to support. It is proposed to provide an assistance of Rs. 50.00lakhs to AYUSH hospitals and 15.00 lakhs to AYUSH dispensaries for their upgradation.Supply of essential medicines:This is one of the very good schemes under which funds for providing AYUSH drugs inrural,backward and remote area dispensaries are given to the States. Under this scheme, anamount of Rs 25,000/- per annum, per dispensary is given which comes to only Rs 2083/-per month per dispensary and Rs 69/- per day per dispensary. Even if a meager strength ofan average of 20 patients per dispensary per day is taken into account, the allocated sumcomes to Rs 3.45 per patient per day. It is obvious enough that the amount is quite less andtherefore it is recommended that it should be increased to Rs 50,000 per annum perdispensary. Besides, at present it is only the „rural and backward area dispensaries‟ whichare eligible for grant under this scheme despite Planning Commission agreeing to givinggrants to all the AYUSH dispensaries, the requisite amendment in the scheme was notreflected and hence there is need to do so in the 11th Plan. It is also proposed to cover alldispensaries including CHCs/PHCs/District Hospitals having AYUSH wing and alsoexisting AYUSH hospitals at those levels for supply of essential medicines. Even
42www.drjayeshpatidar.blogspot.commobile dispensaries are proposed to be covered under this. Accordingly, it is proposed toprovide essential AYUSH medicines to PHCs @ Rs. 1.00 lakh per annum, CHCs @ Rs.2.00 lakh per annum and District Hospitals having AYUSH Wing/AYUSH Hospitals @ Rs.3.00 lakhs per annum.3. DRUGS QUALITY CONTROL OF ASU & H DRUGSThe Scheme was implemented in the year 2000-01 of 9th five year plan with twosubschemes.1. To strengthen state Drug Testing Laboratories2. To strengthen state Pharmacies of ASU&H drugs.Under the scheme maximum of Rs.100.00 lakhs were provided to each State DTL andPharmacies for following components i.e. renovation of building, procurement ofsophisticated instruments and machines and human resource on contractual basis ( for DTLonly).The scheme was revised during the mid term appraisal of 10th five year plan and twomore sub-schemes were added in the scheme with slight changes in original two sub-schemes which are as under:-1. To establish/strengthen the State Drug Testing Laboratories for ASU&H drugs.2. To establish /strengthen the State Pharmacies of ASU&H drugs.3. To strengthen state Drug Controllers on ASU&H enforcement mechanism.4. To assist AS&U drug manufacturing unit to improve their infrastructure to meet GMPrequirement.Under the sub-scheme No.1, State Drug Testing Laboratories for ASU&H drugsmaximum of Rs. 150.00 Lakhs were assisted to each SDTL for the three components(Building,Machinery/equipment and manpower on contractual basis) Apart from theState
43www.drjayeshpatidar.blogspot.comDrug Testing Laboratories eminent Laboratories/universities laboratories/ researchcouncils are also eligible for grant-in-aid to strengthen their AYUSH Department with amaximum of financial assistance of Rs. 85.00 Lakhs.Under the sub-scheme No.2, to strengthen the State Pharmacies of ASU&H drugs.maximum of Rs. 200.00 Lakhs were provided to each state Pharmacies for two componentsi.e.Building as well as Machinery and Equipments. Apart from State GovernmentUniversities/Institutions of ASU&H drugs, co-operative Pharmacies and Research Councils are alsoeligible for the Central assistance.Under the sub-scheme No. 3, to strengthen state Drug Controllers on ASU&H enforcementmechanism, each State Government/Union territory are eligible for Grant-in-aid for fiveyear for the salaries of one drug controller/Licensing Authority of ASU&H drugs, druginspectors (one for 500 units), data entry operator, purchase of computer with printer andfax etc. expenditure on TA/DA/training and stationary etc.Under the sub-scheme No.4, to assist AS&U drug manufacturing unit to improve theirinfrastructure to meet GMP requirement, every AS&U drug manufacturers were assistedwith 20% incentive on the expenditure incurred by him for the infrastructure in terms ofbuilding and equipments made by them for getting GMP certificate. The maximum limit ofthe subsidy is Rs. 5.00 Lakhs.During the Xth Plan, against the total outlay of Rs 45.40 crores under this scheme theexpected expenditure/revised outlay is Rs 55.28 crores. During the 4 years of the 10th plan 8StateDrug Testing Laboratories, 15 State Pharmacies of ASU&H drugs were assisted, and tilldate 26 ASU State Drug Testing Laboratories and 43 State ASU&H Pharmacies wereassisted. In addition 13 States have been assisted to start Enforcement Mechanism ofASU&H drugs and incentives to 45 AS&U drug manufacturers for getting GMP licensehave been given under GMP Scheme.Fund have been released through respective state Governments but till date only 30% ofthe grantee institutes are functional/ partly functional due to the reasons as under:-
44www.drjayeshpatidar.blogspot.comi) State Governments are not releasing the Grant-in-aid to the concerned grantee institutewell in time.ii) Grantee institute have to award building contract to Government body like PWD etc.after completing the codal formalities from their respective Government.iii) Regarding procurement of sophisticated machinery and equipment grantee institute haveagain asked to their respective State Government to procure the instruments by tender basisor by rate contract basis.XI PLAN PROPOSALTo modify the scheme in 11th five year plan, following changes are proposed:-1. Regarding sub-scheme No.1 and 2, the scheme may not be continued as such. Onlysecond and third instalment will be released to States for completing the work ofupgradation of Drug Testing Laboratories/State Pharmacies which were taken up during theXth Plan.2. Regarding sub-scheme No.3 no more grant will be released for manpower on contractualbasis. Concerns have been expressed in the Parliament as well as in the media regardingweak quality control of AYUSH medicines. Emphasis on strengthening of State DrugTesting Laboratories has not yielded results intended. In the XIth Plan, it is proposed toinstitute a random testing of AYUSH medicines at the Central as well as at the State levelsby involving NABL accredited laboratories spread over the country. It is proposed to assistthe State by actual reimbursement of expenditure incurred on random testing of AYUSHmedicines through NABL laboratories @ Rs. 500 to Rs. 1000 per sample depending uponvarious parameters. Under this Scheme, Department of AYUSH‟s laboratories PLIM,Mohan HPL will also be eligible to do the testing and avail the assistance.3. Under the existing Drug Quality Control Scheme in Xth Plan a meager assistance of Rs.5.00 lakhs as subsidy was provided to AYUSH manufacturing units for becoming GMPcompliant.Now, the Department of AYUSH has made testing for raw materials/finishedproducts/heavy metals etc. mandatory for which manufacturing units require costlyequipments like Atomic Absorption Spectometer, HPTLC, HPLC, GLC etc. Accordingly, it
45www.drjayeshpatidar.blogspot.comis proposed to provide a back ended subsidy of Rs. 50.00 lakhs or 50% of the total projectcost whichever is less, on establishment of in-house Drug Quality Control/R&D laboratory.The assistance to be provided only to those ASU units having annual turnover below Rs.10.00 crores. This subsidy will be released to AYUSH manufacturing units through aScheduled Bank on installation of the requisite equipment and on submission of report byany State Licensing Authority or a NABL laboratory to the effect that the such unit hasstarted testing of its raw materials/finished products in their inhouse drug qualitycontrol/R&D labs.The Goal of the Mission is to improve the availability of and access to quality health care bypeople, especially for those residing in rural areas, the poor, women andchildren.1. STATE OF PUBLIC HEALTHPublic health expenditure in India has declined from 1.3% of GDP in 1990 to0.9% of GDP in 1999. The Union Budgetary allocation for health is 1.3% while the State‟sBudgetary allocation is 5.5%.-Union Government contribution to public health expenditure is 15% while Statescontribution about 85%-Vertical Health and Family Welfare Programmes have limited synergisation at operationallevels.-Lack of community ownership of public health programmes impacts levels of efficiency,accountability and effectiveness.-Lack of integration of sanitation, hygiene, nutrition and drinking water issues.-There are striking regional inequalities.-Population Stabilization is still a challenge, especially in States with weak demographicindicators.
46www.drjayeshpatidar.blogspot.com-Curative services favour the non-poor: for every Re.1 spent on the poorest 20% population,Rs.3 is spent on the richest quintile.-Only 10% Indians have some form of health insurance, mostly inadequate-Hospitalized Indians spend on an average 58% of their total annual expenditure-Over 40% of hospitalized Indians borrow heavily or sell assets to cover expenses-Over 25% of hospitalized Indians fall below poverty line because of hospital expenses.2. NATIONAL RURAL HEALTH MISSION – THE VISION• The National Rural Health Mission (2005-12) seeks to provide effective healthcare to ruralpopulation throughout the country with special focus on 18 states, which have weak publichealth indicators and/or weak infrastructure.• These 18 States are Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh,Jharkhand, Jammu & Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland,Orissa, Rajasthan, Sikkim, Tripura, Uttaranchal and Uttar Pradesh.• The Mission is an articulation of the commitment of the Government to raise publicspending on Health from 0.9% of GDP to 2-3% of GDP.• It aims to undertake architectural correction of the health system to enable it to effectivelyhandle increased allocations as promised under the National Common MinimumProgramme and promote policies that strengthen public health management and servicedelivery in the country.• It has as its key components provision of a female health activist in eachvillage; a villagehealth plan prepared through a local team headed by the Health & Sanitation Committee ofthe Panchayat; strengthening of the rural hospital for effective curative care and mademeasurable and accountable to the community through Indian Public Health Standards(IPHS); and integration of vertical Health & Family Welfare Programmes and Funds foroptimal utilization of funds and infrastructure andstrengthening delivery of primaryhealthcare.• It seeks to revitalize local health traditions and mainstream AYUSH into the public healthsystem.
47www.drjayeshpatidar.blogspot.com• It aims at effective integration of health concerns with determinants of health likesanitation & hygiene, nutrition, and safe drinking water through a District Plan for Health.• It seeks decentralization of programmes for district management of health.• It seeks to address the inter-State and inter-district disparities, especially among the 18high focus States, including unmet needs for public healthinfrastructure.• It shall define time-bound goals and report publicly on their progress.• It seeks to improve access of rural people, especially poor women andchildren, toequitable, affordable, accountable and effective primary healthcare.3. GOALS· Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR)· Universal access to public health services such as Women‟s health, child health, water,sanitation & hygiene, immunization, and Nutrition.· Prevention and control of communicable and non-communicablediseases, including locallyendemic diseases· Access to integrated comprehensive primary healthcare· Population stabilization, gender and demographic balance.· Revitalize local health traditions and mainstream AYUSH· Promotion of healthy life styles4. STRATEGIES(a) Core Strategies:• Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own,control andmanage public health services.• Promote access to improved healthcare at household level through the female healthactivist (ASHA).• Health Plan for each village through Village Health Committee of the Panchayat.• Strengthening sub-centre through an untied fund to enable local planning and action andmore Multi Purpose Workers (MPWs).
48www.drjayeshpatidar.blogspot.com• Strengthening existing PHCs and CHCs, and provision of 30-50 bedded CHC per lakhpopulation for improved curative care to a normative standard (Indian Public HealthStandards defining personnel, equipment and management standards).• Preparation and Implementation of an inter-sectoral District Health Plan prepared by theDistrict Health Mission, including drinking water, sanitation & hygiene and nutrition.• Integrating vertical Health and Family Welfare programmes at National, State, Block, andDistrict levels.• Technical Support to National, State and District Health Missions, for Public HealthManagement.• Strengthening capacities for data collection, assessment and review for evidence basedplanning, monitoring and supervision.• Formulation of transparent policies for deployment and career development of HumanResources for health.• Developing capacities for preventive health care at all levels for promoting healthy lifestyles, reduction in consumption of tobacco and alcohol etc.• Promoting non-profit sector particularly in under served areas.(b) Supplementary Strategies:• Regulation of Private Sector including the informal rural practitioners to ensureavailability of quality service to citizens at reasonable cost.• Promotion of Public Private Partnerships for achieving public health goals.• Mainstreaming AYUSH – revitalizing local health traditions.• Reorienting medical education to support rural health issues including regulation ofMedical care and Medical Ethics.• Effective and viable risk pooling and social health insurance to provide health security tothe poor by ensuring accessible, affordable, accountableand good quality hospital care.5. PLAN OF ACTION COMPONENT (A): ACCREDITED SOCIAL HEALTH
49www.drjayeshpatidar.blogspot.comACTIVISTS• Every village/large habitat will have a female Accredited Social Health Activist (ASHA) -chosen by and accountable to the panchayat- to act as the interface between the communityand the public health system. States to choose State specific models.• ASHA would act as a bridge between the ANM and the village and be accountable to thePanchayat.• She will be an honorary volunteer, receiving performance-based compensation forpromoting universal immunization, referral and escort services for RCH, construction ofhousehold toilets, and other healthcare delivery programmes.• She will be trained on a pedagogy of public health developed and mentored through aStanding Mentoring Group at National level incorporating best practices and implementedthrough active involvement of community health resource organizations.• She will facilitate preparation and implementation of the Village Health Plan along withAnganwadi worker, ANM, functionaries of other Departments, and Self Help Groupmembers, under the leadership of the Village Health Committee of the Panchayat.• She will be promoted all over the country, with special emphasis on the 18 high focusStates. The Government of India will bear the cost of training, incentives and medical kits.The remaining components will be funded under Financial Envelope given to the Statesunder the programme.• She will be given a Drug Kit containing generic AYUSH and allopathic formulations forcommon ailments. The drug kit would be replenished from time to time.• Induction training of ASHA to be of 23 days in all, spread over 12 months.On the job training would continue throughout the year.• Prototype training material to be developed at National level subject to State levelmodifications.• Cascade model of training proposed through Training of Trainers including contract plusdistance learning model• Training would require partnership with NGOs/ICDS Training Centres and State HealthInstitutes.
50www.drjayeshpatidar.blogspot.comCOMPONENT (B): STRENGTHENING SUB-CENTRES• Each sub-centre will have an Untied Fund for local action @ Rs. 10,000 perannum. This Fund will be deposited in a joint Bank Account of the ANM & Sarpanch andoperated by the ANM, in consultation with the Village Health Committee.• Supply of essential drugs, both allopathic and AYUSH, to the Sub-centres.• In case of additional Outlays, Multipurpose Workers (Male)/Additional ANMs whereverneeded, sanction of new Sub-centres as per 2001 population norm, and upgrading existingSub-centres, including buildings for Sub-centres functioning in rented premises will beconsidered.COMPONENT (C): STRENGTHENING PRIMARY HEALTH CENTRESMission aims at Strengthening PHC for quality preventive, promotive, curative, supervisoryand Outreach services, through:• Adequate and regular supply of essential quality drugs and equipment (including Supply ofAuto Disabled Syringes for immunization) to PHCs• Provision of 24 hour service in 50% PHCs by addressing shortage of doctors, especially inhigh focus States, through mainstreaming AYUSH manpower.• Observance of Standard treatment guidelines & protocols.• In case of additional Outlays, intensification of ongoing communicable disease controlprogrammes, new programmes for control of noncommunicable diseases, upgradation of100% PHCs for 24 hours referral service, and provision of 2nd doctor at PHC level (I male,1 female) would be undertaken on the basis of felt need.COMPONENT (D): STRENGTHENING CHCs FOR FIRST REFERRAL CAREA key strategy of the Mission is:• Operationalizing 3222 existing Community Health Centres (30-50 beds) as 24 Hour FirstReferral Units, including posting of anaesthetists.• Codification of new Indian Public Health Standards, setting norms for infrastructure, staff,
51www.drjayeshpatidar.blogspot.comequipment, management etc. for CHCs.• Promotion of Stakeholder Committees (Rogi Kalyan Samitis) for hospital management.• Developing standards of services and costs in hospital care.• Develop, display and ensure compliance to Citizen‟s Charter at CHC/PHC level.• In case of additional Outlays, creation of new Community Health Centres (30-50 beds) tomeet the population norm as per Census 2001, and bearing their recurring costs for theMission period could be considered.COMPONENT (E): DISTRICT HEALTH PLAN• District Health Plan would be an amalgamation of field responses through Village HealthPlans, State and National priorities for Health, Water Supply, Sanitation and Nutrition.• Health Plans would form the core unit of action proposed in areas like water supply,sanitation, hygiene and nutrition. Implementing Departments would integrate into DistrictHealth Mission for monitoring.• District becomes core unit of planning, budgeting and implementation.• Centrally Sponsored Schemes could be rationalized/modified accordingly in consultationwith States.• Concept of “funneling” funds to district for effective integration of programmes• All vertical Health and Family Welfare Programmes at District and state level merge intoone common “District Health Mission” at the District level and the “State Health Mission”at the state level• Provision of Project Management Unit for all districts, through contractual engagement ofMBA, Inter Charter/Inter Cost and Data Entry Operator, for improved programmemanagementCOMPONENT (F): CONVERGING SANITATION AND HYGIENE UNDER NRHM• Total Sanitation Campaign (TSC) is presently implemented in 350 districts, and isproposed to cover all districts in 10th Plan.• Components of TSC include IEC activities, rural sanitary marts, individual household
52www.drjayeshpatidar.blogspot.comtoilets, women sanitary complex, and School Sanitation Programme.• Similar to the DHM, the TSC is also implemented through Panchayati Raj Institutions(PRIs).• The District Health Mission would therefore guide activities of sanitation at district level,and promote joint IEC for public health, sanitation and hygiene, through Village Health &Sanitation Committee, and promote household toilets and School Sanitation Programme.ASHA would be incentivized for promoting household toilets by the Mission.COMPONENT (G): STRENGTHENING DISEASE CONTROLPROGRAMMES• National Disease Control Programmes for Malari a, TB, Kala Azar, Filaria, Blindness &Iodine Deficiency and Integrated Disease Surveillance Programme shall be integrated underthe Mission, for improved programme delivery.• New Initiatives would be launched for control of Non Communicable Diseases.• Disease surveillance system at village level would be strengthened.• Supply of generic drugs (both AYUSH & Allopathic) for common ailments at village, SC,PHC/CHC level.• Provision of a mobile medical unit at District level for improved Outreach services.COMPONENT (H): PUBLIC-PRIVATE PARTNERSHIP FOR PUBLIC HEALTHGOALS, INCLUDING REGULATION OF PRIVATE SECTOR• Since almost 75% of health services are being currently provided by the private sector,there is a need to refine regulation• Regulation to be transparent and accountable• Reform of regulatory bodies/creation where necessary• District Institutional Mechanism for Mission must have representation of private sector• Need to develop guidelines for Public-Private Partnership (PPP) in health sector.Identifying areas of partnership, which are need based, thematic and geographic.• Public sector to play the lead role in defining the framework and sustaining the partnership
53www.drjayeshpatidar.blogspot.com• Management plan for PPP initiatives: at District/State and National levelsCOMPONENT (I): NEW HEALTH FINANCING MECHANISMSA Task Group to examine new health financing mechanisms, including Risk Pooling forHospital Care as follows:• Progressively the District Health Missions to move towards paying hospitals for servicesby way of reimbursement, on the principle of “money follows the patient.”• Standardization of services – outpatient, in-patient, laboratory, surgical interventions- andcosts will be done periodically by a committee of experts in each state.• A National Expert Group to monitor these standards and give suitable advice and guidanceon protocols and cost comparisons.• All existing CHCs to have wage component paid on monthly basis. Other recurrent costsmay be reimbursed for services rendered from District Health Fund. Over the Missionperiod, the CHC may move towards all costs, including wages reimbursed for servicesrendered.• A district health accounting system, and an ombudsman to be created to monitor theDistrict Health Fund Management , and take corrective action.• Adequate technical managerial and accounting support to be provided to DHM inmanaging risk-pooling and health security.• Where credible Community Based Health Insurance Schemes (CBHI) exist/are launched,they will be encouraged as part of the Mission.• The Central government will provide subsidies to cover a part of the premiums for thepoor, and monitor the schemes.• The IRDA will be approached to promote such CBHIs, which will be periodicallyevaluated for effective delivery.COMPONENT (J): REORIENTING HEALTH/MEDICAL EDUCATION TOSUPPORT RURAL HEALTH ISSUES• While district and tertiary hospitals are necessarily located in urban centres, they form an
54www.drjayeshpatidar.blogspot.comintegral part of the referral care chain serving the needs of the rural people.• Medical and para-medical education facilities need to be created in states, based on needassessment.• Suggestion for Commission for Excellence in Health Care (Medical Grants Commission),National Institution for Public Health Management etc.• Task Group to improve guidelines/details.6. INSTITUTIONAL MECHANISMS• Village Health & Sanitation Samiti (at village level consisting of PanchayatRepresentative/s, ANM/MPW, Anganwadi worker, teacher, ASHA, community healthvolunteers• Rogi Kalyan Samiti (or equivalent) for community management of public hospitals• District Health Mission, under the leadership of Zila Parishad with District Health Head asConvener and all relevant departments, NGOs, private professionals etc represented on it• State Health Mission, Chaired by Chief Minister and co-chaired by Health Minister andwith the State Health Secretary as Convener- representation of related departments, NGOs,private professionals etc• Integration of Departments of Health and Family Welfare, at National and State level• National Mission Steering Group chaired by Union Minister for Health & Family Welfarewith Deputy Chairman Planning Commission, Ministers of Panchayat Raj, RuralDevelopment and Human Resource Development and public health professionals asmembers, to provide policy support and guidance to the Mission.• Empowered Programme Committee chaired by Secretary HFW, to be the Executive Bodyof the Mission• Standing Mentoring Group shall guide and oversee the implementation of ASHA initiative• Task Groups for Selected Tasks (time-bound)7. TECHNICAL SUPPORT• To be effective the Mission needs a strong component of Technical Support
55www.drjayeshpatidar.blogspot.com• This would include reorientation into public health management• Reposition existing health resource institutions, like Population Research Centre (PRC),Regional Resource Centre (RRC), State Institute of Health & Family Welfare (SIHFW)• Involve NGOs as resource organisations• Improved Health Information System• Support required at all levels: National, State, District and sub-district.• Mission would require two distinct support mechanisms – Program Management SupportCentre and Health Trust of India.(A) PROGRAM MANAGEMENT SUPPORT CENTRE• For Strengthening Management Systems-basic program management, financial systems,infrastructure maintenance, procurement & logistics systems, Monitoring & InformationSystem (MIS), non-lapsable health pool etc.• For Developing Manpower Systems – recruitment (induction of MBAs/CAs /MCAs),training & curriculum development (revitalization of existinginstitutions & partnerships with NGO & private sector. Sector institutions), motivation &performance appraisal etc.• For Improved Governance – decentralization & empowerment of communities, inductionof IT based systems like e-banking, social audit and right to information.(B) HEALTH TRUST OF INDIA• Proposed as a knowledge institution, to be the repository of innovation – research &documentation, health information system, planning, monitoring & evaluation etc.• For establishing Public Accountability Systems – external evaluations, community basedfeedback mechanisms, participation of PRIs /NGOs etc.• For developing a Framework for pro-poor Innovations• For reviewing Health Legislations.• A base for encouraging experimentation and action research.• For inter & intra Sector Networking with National and International Organizations.
56www.drjayeshpatidar.blogspot.com• Think Tank for developing a long-term vision of the Sector & for building planningcapacities of PRIs, Districts etc.8. ROLE OF STATE GOVERNMENTS UNDER NRHM• The Mission covers the entire country. The 18 high focus States are Uttar Pradesh, Bihar,Rajasthan, Madhya Pradesh, Orissa, Uttaranchal, Jharkhand, Chhattisgarh, Assam, Sikkim,Arunachal Pradesh, Manipur, Meghalaya, Tripura, Nagaland, Mizoram Himachal Pradeshand Jammu & Kashmir. GoI would provide funding for key components in these 18 highfocus States. Other States would fund interventions like ASHA, Programme ManagementUnit (PMU), and upgradation of SC/PHC/CHC through Integrated Financial Envelope.• NRHM provides broad conceptual framework. States would project operational modalitiesin their State Action Plans, to be decided in consultation with the Mission Steering Group.• NRHM would prioritize funding for addressing inter-state and intradistrict disparities interms of health infrastructure and indicators.• States would sign Memorandum of Understanding with Government of India, indicatingtheir commitment to increase contribution to Public Health Budget (preferably by 10% eachyear), increased devolution to Panchayati Raj Institutions as per 73rd Constitution(Amendment) Act, and performance benchmarks for release of funds.9. FOCUS ON THE NORTH EASTERN STATES• All 8 North East States, including Assam, Arunachal Pradesh, Manipur, Meghalaya,Mizoram, Nagaland, Sikkim and Tripura, are among the States selected under the Mission,for special focus.• Empowerment to the Mission would mean greater flexibilities for the 10% committedOutlay of the Ministry of Health & Family Welfare, for North East States.• States shall be supported for creation/upgradation of health infrastructure, increasedmobility, contractual engagement, and technical support under the Mission.• Regional Resource Centre is being supported under NRHM for the North Eastern States.• Funding would be available to address local health issues in a comprehensive manner,
57www.drjayeshpatidar.blogspot.comthrough State specific schemes and initiatives.10. ROLE OF PANCHAYATI RAJ INSTITUTIONSThe Mission envisages the following roles for PRIs:· States to indicate in their MoUs the commitment for devolution offunds, functionaries and programmes for health, to PRIs.· The District Health Mission to be led by the Zila Parishad. The DHM will control, guideand manage all public health institutions in the district, Sub-centres, PHCs and CHCs.· ASHAs would be selected by and be accountable to the Village Panchayat.· The Village Health Committee of the Panchayat would prepare the Village Health Plan,and promote intersectoral integration· Each sub-centre will have an Untied Fund for local action @ Rs. 10,000 per annum. ThisFund will be deposited in a joint Bank Account of the ANM & Sarpanch and operated bythe ANM, in consultation with the Village Health Committee.· PRI involvement in Rogi Kalyan Samitis for good hospital management.· Provision of training to members of PRIs.· Making available health related databases to all stakeholders, including Panchayats at alllevels.11. ROLE OF NGOs IN THE MISSION· Included in institutional arrangement at National, State and District levels, includingStanding Mentoring Group for ASHA· Member of Task Groups· Provision of Training, BCC and Technical Support for ASHAs/DHM· Health Resource Organizations· Service delivery for identified population groups on select themes· For monitoring, evaluation and social audit
58www.drjayeshpatidar.blogspot.com12. MAINSTREAMING AYUSH· The Mission seeks to revitalize local health traditions and mainstream AYUSHinfrastructure, including manpower, and drugs, to strengthen the public health system at alllevels.· AYUSH medications shall be included in the Drug Kit provided at village levels to ASHA.· The additional supply of generic drugs for common ailments at Subcentre/PHC/CHClevels under the Mission shall also include AYUSH formulations.· At the CHC level, two rooms shall be provided for AYUSH practitioner and pharmacistunder the Indian Public Health System (IPHS) model.· Single doctor PHCs shall be upgraded to two doctor PHCs by mainstreaming AYUSHpractitioner at that level.13. FUNDING ARRANGEMENTS· The Mission is conceived as an umbrella programme subsuming the existing programmesof health and family welfare, including the RCHII, National Disease Control Programmesfor Malaria, TB, Kala Azar, Filaria, Blindness & Iodine Deficiency and Integrated DiseaseSurveillance Programme.· The Budget Head For NRHM shall be created in B.E. 2006-07 at National and State levels.Initially, the vertical health and family welfare programmes shall retain their Sub-BudgetHead under the NRHM.· The Outlay of the NRHM for 2005-06 is in the range of Rs.6700 crores.· The Mission envisages an additionality of 30% over existing Annual Budgetary Outlays,every year, to fulfill the mandate of the National Common Minimum Programme to raisethe Outlays for Public Health from 0.9% of GDP to 2-3% of GDP· The Outlay for NRHM shall accordingly be determined in the Annual Budgetary exercise.· The States are expected to raise their contributions to Public Health Budget by minimum10% p.a. to support the Mission activities.
59www.drjayeshpatidar.blogspot.com· Funds shall be released to States through SCOVA, largely in the form of FinancialEnvelopes, with weightage to 18 high focus States.14. TIMELINES (FOR MAJOR COMPONENTS)Merger of Multiple Societies June 2005 Constitution of District/State Mission Provision ofadditional generic drugs at SC/PHC/CHC level December 2005 Operational ProgrammeManagement Units 2005-2006 Preparation of Village Health Plans 2006 ASHA at villagelevel (with Drug Kit) 2005-2008 Upgrading of Rural Hospitals 2005-2007 OperationalizingDistrict Planning 2005-2007 Mobile Medical Unit at district level 2005-0815. OUTCOMES(a) National Level:§ Infant Mortality Rate reduced to 30/1000 live births§ Maternal Mortality Ratio reduced to 100/100,000§ Total Fertility Rate reduced to 2.1§ Malaria mortality reduction rate –50% up to 2010, additional 10% by 2012§ Kala Azar mortality reduction rate: 100% by 2010 and sustaining elimination until 2012§ Filaria/Microfilaria reduction rate: 70% by 2010, 80% by 2012 and elimination by 2015§ Dengue mortality reduction rate: 50% by 2010 and sustaining at thatlevel until 2012§ Japanese Encephalitis mortality reduction rate: 50% by 2010 and sustaining at that leveluntil 2012§ Cataract Operation: increasing to 46 lakhs per year until 2012.§ Leprosy prevalence rate: reduce from 1.8/10,000 in 2005 to less than 1/10,000 thereafter§ Tuberculosis DOTS services: Maintain 85% cure rate through entire Mission period.§ Upgrading Community Health Centers to Indian Public Health Standards§ Increase utilization of First Referral Units from less than 20% to 75%§ Engaging 250,000 female Accredited Social Health Activists (ASHAs) in 10 States.
60www.drjayeshpatidar.blogspot.com(b) Community Level:· Availability of trained community level worker at village level, with a drug kit for genericailments· Health Day at Anganwadi level on a fixed day/month for provision of immunization,ante/post natal checkups and services related to mother & child healthcare, includingnutrition.· Availability of generic drugs for common ailments at Sub-centre and hospital level· Good hospital care through assured availability of doctors, drugs and quality services atPHC/CHC level· Improved access to Universal Immunization through induction of Auto Disabled Syringes,alternate vaccine delivery and improved mobilization services under the programme· Improved facilities for institutional delivery through provision of referral, transport, escortand improved hospital care subsidized under the Janani Suraksha Yojana (JSY) for theBelow Poverty Line families· Availability of assured healthcare at reduced financial risk through pilots of CommunityHealth Insurance under the Mission· Provision of household toilets· Improved Outreach services through mobile medical unit at district level.16. MONITORING AND EVALUATION· Health MIS to be developed up to CHC level, and web-enabled for citizen scrutiny· Sub-centers to report on performance to Panchayats, Hospitals to Rogi Kalyan Samitis andDistrict Health Mission to Zila Parishad· The District Health Mission to monitor compliance to Citizen‟s Charter at CHC level· Annual District Reports on People‟s Health (to be prepared by Govt/NGO collaboration)· State and National Reports on People‟s Health to be tabled in Assemblies, Parliament· External evaluation/social audit through professional bodies/NGOs· Mid Course reviews and appropriate correction.