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Ph in india history situation & structure


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These slides explain Public Health In brief , with history related to Indian context

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Ph in india history situation & structure

  1. 1. Public Health History in India & Health situation in India Dr. Sandeep A. Chavan
  2. 2. Public Health • If the disease condition is avoided, the probability or the chance of death or disability can be reduced. • Public Health is therefore described as the science and art of preventing diseases, prolonging life and promoting health (of individuals) through organised efforts and informed choices.
  3. 3. Components of Public Health • Epidemiology – Measurement of disease conditions in relation to the population at risk. • Statistics – Collection, presentation, analysis and interpretation of epidemiological data. • Health Services – Services directed towards meeting the health needs of the people.
  4. 4. Essential Public Health Functions
  5. 5. Public Health • Public Health deals with the group of people rather than individuals. • Dimensions of public health – Health promotion – Disease prevention – Early diagnosis and prompt treatment – Disability limitation – Rehabilitation
  6. 6. Evolution of health care services in India • Christian Era – civilization started in Indus Valley – Environmental sanitation, houses with drainage • 1400 B.C. – Ayurveda and Siddha system – Developed a comprehensive concept of health • Post vedic – teaching of buddhism and Jainism • Moghul empire – Arabic system of medicine (Unani) • British Gov – British nationals, armed forces, civil servants.
  7. 7. Traditional Indian Approach • The Indian approach to health is enshrined in the concepts and principles of Ayurveda which means the ‘science of life’. • Ayurveda is one of the oldest system of health care in the World. • Ayurveda deals with both preventive and curative aspects of health. • Health defined by WHO is very similar to concepts of Ayurveda
  8. 8. Western Approach • The western approach of avoiding diseases, death and disability, traditionally focused on personal hygiene and public sanitation during the 19th Century. • This approach, combined with better food availability, paid rich dividend in the developed countries in reducing morbidity and mortality.
  9. 9. Public Health before the Colonial Period • Little is known about public health activities before the colonial period • Main stream system of health care was Ayurveda • Home-based care appeared to be the dominant feature • There appeared little organised efforts or institutional care to treat diseases and prevent deaths
  10. 10. Public Health during the British Period • Although, public health efforts were restricted to British civilian and military establishment, they had impact on Indian masses. – Mortality spikes were sharply reduced. – Mortality from cholera and plague was sharply reduced. – Diseases like malaria and gastro-enteritis continued to take heavy toll.
  11. 11. Public Health in Independent India • Evolution of public health care system in Independent India was shaped by two important factors: – The Report of First Health Survey and Development Committee (Bhore Committee) constituted during the colonial rule. – Emergence of modern medical technology for the prevention and control of diseases, especially communicable diseases.
  12. 12. Medical Technology • Mass production of antibiotics. • Availability of vaccines for diseases having high mortality and disability rates – Tetanus – Diphtheria – Pertussis (Whooping Cough) – Measles – Poliomyelitis
  13. 13. Role of different committees • 1946 – Bhore Committee (Health survey and development committee) o Integration of preventive and curative services o Development of PHC o 3 months training in PSM – Social Physician • 1962 – Mudaliar committee (Health survey and planning committee) o Strengthening of PHC and district hospital o Regional organization o Constitution of all India Health Services (like IAS) • 1963 – Chaddah committee o Malaria program services to be part of primary healthcare o Basic health worker – for 10,000 population o Family planning health assistant – for 3-4 BHWs
  14. 14. Role of different committees cont…. • 1965 – Mukerji committee o Separate staff for the family planning programme o De-link malaria activities from FP services • 1967 – Jungalwala committee o Committee on Integration of health services o Elimination of private practice by Gov. doctor o Special pay for specialized work • 1973 – Kartar singh o Committee on multipurpose worker o ANM replaced by female health worker. AT SC – 1 Male & 1 Female Healthworker o Basic health worker - replaced by male health worker – M H Supervisor o Lady health visitors designated as female health supervisor.
  15. 15. 1975: Srivastava Committee ( On med education & support manpower) o Cadre of Health Assistant ( link between med. Practitioner and MPW) o Referral service complex o Creation of a para-professinal health workers o Setting up medical and health education commission (Like UGC) 1977 : Rural Health Scheme o Training of CHWs o Reorienting medical education to the needs of rural poor 1981 – Report of the working group for Health For All
  17. 17. Progress from 1st Five year plan to 12th Five year plan Parameters First Plan 1951-56 12th Plan 2012-2017 Total SCs 725 25,020 Total PHCs NA 1,52,326 Total CHCs - 5,363 Total Bed strength 1,25,000 9,14,543 Medical colleges 42 356 Dental colleges 7 297 Allopathic doctors 65000 9,18,303 Nurses 18500 12,37,964 ANMs 12,780 6,02,919
  18. 18. 18 Crude Birth rate 21.6/1000 population per year Crude death rate(SRS 2012) 7/1000 population per year Infant mortaility rate(SRS 2012) 42/1000 live births Maternal mortality ratio(2012) 178/100000 live births Expectation of life at birth ( census2011) Male: 67.3 years & Ffemale: 69.6 years
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  23. 23. Nutritional Status Indicators  Positive health indicator Anthropometric measurements of pre-school children i. Weight ii. Height iii. Mid-arm circumference Growth Monitoring of children Prevalence of low birth weight 23
  24. 24. Health Care Delivery Indicators Equity of distribution of health resources in different parts of the country and of the provision of health care • Doctor-population Ratio – 1/1700 (Norm 1/1000) • Nurse-population ratio – 0.8/1000 (Norm 1/500) • Population-bed Ratio – 8.9/10000 24
  25. 25. 25 The present doctor-population ratio is 0.5 per 1,000 and the target by 2025 is 0.8 per 1,000. India produces 30,000 doctors, 18,000 specialists, 30,000 AYUSH graduates, 54,000 nurses, 15,000 ANMs and 36,000 pharmacists annually. Health ministry claims that there are about 6-6.5 lakh doctors available. But India would need about four lakh more by 2020 to maintain the required ratio of one doctor per 1,000 people.
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  31. 31. Organizational structure in India • Health system has 3 main links – Central, state and local or peripheral. • India is a Union of 29 states and 7 territories. • Health is the responsibility of state. • Central responsibility – Policy making – Guiding – Assisting – Evaluating – Coordinating the work of state health ministries.
  32. 32. At the centre • The union ministry of health and family welfare Headed by Cabinet minister Minister of state Deputy health minister The union ministry of health and family welfare The directorate general of health services The central council of health and family welfare.
  33. 33. At the state level • The state health administration was started in the year 1919. • The state list which become the responsibility of the state included – Provision of medical care – Preventive health services – Piligrim within the state State - management sector Directorate of health and family welfare services State ministry of health
  34. 34. At the district level • Principal unit of administration in India - District • District health organization – identifies and provide the needs of expanding rural health and family welfare programme • Within each district again, there are administrative areas • No uniform model of district health organization
  35. 35. Rural Urban Villages Panchayats Community Development Blocks Corporations Municipal Boards Town area committees Tahsil (Taluka) District Sub-division
  36. 36. Panchayati Raj – • 3 tier structure of rural local self government • Linking the village to the district Panchayat Raj Panchayat Panchayat Samiti Zilla Parishad Gram Sabha Gram Panchayat
  37. 37. Widespread existence of preventable diseases and deaths is a disgrace to the society which tolerates it...