Health care environment, Health Economics, Health constraints, Planning process, Policies, political process

College Of Nursing
Madras Medical College
Chennai-03
Health care environment, Health
Economics, Health constraints,
Planning process, Policies, political
process
PRESENTED BY
EDWIN JOSE.L
MSc(nursing) I YEAR
College of nursing
Madras medical college
Chennai-03
EDWIN JOSE.L ADVANCED NURSING PRACTICE 1

INTRODUCTION
 A healthy environment is fundamental of life and attention to the effect of
environment on human health is imperative, if we are to attain the goal of
health for all.
 Our physical environment is basic determinants of health.
 Environmental health refers to the state of all substances, forces and
conditions in an individual’s surrounding that may exert an influence on
health and well being.
 When environmental conditions are favorable , health status is enhanced.

terminologies
Health -Health is a state of complete physical, mental and social
well-being and not merely the absence of disease or
infirmity.
Community health – it refers to the health status of the members of
community.
Health services – it refers to the permanent country wide system of
established institutions to cope up with various
health needs.
Health care – it refers to the medical, nursing, and dental services
provided to individual and communities for promoting,
maintaining, monitoring or restoring health.

Definition-environmental health
Environmental health is defined as “those aspects
of human health including quality of life that are determined
by physical , chemical, biological, social, and psychological
factors in the environment.
- World Health Organization
 When environmental conditions are favorable ,health
status is enhanced.
 Adverse biological, chemical ,physical, sociological forces
in environment ,separately or in combination may disrupt
healthy life styles

Florence nightingale – environmental theory
 Core concept of Nightingale’s theory is that of environment.
 She emphasize more on physical environment than psychological and social
environment.
 Environment is viewed as all the external conditions and influences
affecting the life and development of an organism and capable of
preventing, suppressing or contributing to disease or death.
 She emphasizes more on providing ventilation, light, clean water,
cleanliness and warmth so that reparative process takes place

Nightingale environmental concepts
Major area of concern elements
1.VENTILATION Fresh air-can be achieved through open windows. An outlet is needed for impure air.
2.LIGHT Beds should be placed in such a manner as to allow the patient to see out the window- the sky
and sunlight.
3.WARMTH Guarding against the loss of vital heat is essential. Chilling is to be avoided. Hot bottles and
drinks should be used to restore the heat
4.EFFULIVA (SMELLS) Sewer air is to be avoided .Fumigation and disinfections should be used but the offensive
substance is removed.
5.NOISE Intermittent sudden noise causes greater excitement than continuous noise. Whispering or
discussing a patients condition just outside his or her room is cruel.

View of theory created by nightingale

Physical environment
The basic environment compartments are physical in nature and
relate to such things as ventilation and warmth.
These base factors affect one’s approach to all other aspects of the
environment.
A patients bed must be clean ,aired, warm, dry and free from odor.
One should provide an environment in which patient can be easily
cared for by others or self.
The entire room should be well ventilated.

Psychological environment
 The effect of mind on the body was fairly well accepted in Nightingale’s time.
 She recognizes that a negative environment could cause physical stress there
by affecting the patients emotional climate.
 Therefore emphasis is placed on offering the patient a variety of activities to
keep his or her mind stimulated.
 It has two components
1.Communication
2.Advice
 Communication should not be hurried, sit Infront of the patient, place should
be in the context of environment of the patient.
 Do not Provide false hope and advice about their illness

Social environment
Observations of social environment are related to illness and is
essential to preventing disease.
Nurse must use observational powers in dealing with specific case
rather than be comfortable with data addressing the average
patient.
The patients environment not only includes the patients home or
hospital room but the total community influencing the specific
environment.

Environmental health hazards
The environmental health hazards fall into four general
categories
 Biological hazards
 Physical hazards
 Chemical hazards
 Psychosocial hazards

Biological hazards
Disease producing infectious agents in the environment
that are capable of entering the human body such as virus ,
bacteria, or other microorganisms are environmental
hazards of biological nature.
Transmission by direct contact ,contaminated water, vector
Eg. Food poisoning, respiratory infections, communicable
diseases etc……

Chemical hazards
These include toxic agents such as polychlorinated
biphenyl , asbestos, lead and pesticides such as
insecticides , herbicides and rodenticides, industrial
wastes, emissions from motor vehicles.
Studies in animals indicate that these chemicals cause
severe chronic health problems , thus posing a serious
threat to human health.
Eg. Cancer, silicosis, asbestosis etc……

Physical hazards
Natural disasters such as earthquakes, volcanos and accidents,
noise, heat, vibrations, radiations, insects rodents and certain type
of equipment fall into physical hazards.
Eg. 1. air temperature and humidity may be adversely affected in
industries that use blast furnaces,
2. Laundry equipment contributes health problems such as
respiratory disorders, dermatitis, G.I disturbances and eye
inflammations.

Psychosocial hazards
Stressors like violence, stress, substance abuse and
dependence are know threat to health of individuals
families and communities.
Feelings of wellbeing is altered by high level of noise,
overcrowding, or isolation , lack of adequate sources, or
opportunities for economic advancement.
Eg. Depression, anxiety, sleep apnea, DM, asthma etc…..

Environmental influence on health
Toxic agents
Asbestoses- linked to cause lung and G.I cancer and mesothelioma
Lead- interferes with blood formation and causes anaemia. It also
cause kidney damage, birth defects, injury to CNS, poor memory,
hair loss, hypertension, etc….
Pesticides – pesticides residues are contact poisons and tend to
accumulate in fatty tissues in living organisms and remains in the
body indefinitely.

Air polution
 Effects on health of individuals depend on the chemical properties of the
pollutant and size of particles, in turn affects the site of deposition in the
respiratory tract, adverse health effects from air pollution may range from
mild to severe.
 Eg. Mild irritation may occur when larger particles are trapped in the upper
respiratory tree.
 Severe respiratory problems may occur as a result of direct absorption of
pollutant such as carbon monoxide ,from the alveoli in to the blood.
 The risk of developing cancer or a chronic pulmonary disease increases with
prolonged exposure.

Water pollution
Health problems related to water quality involves
contamination of waterways with the microbial pathogens
found in human body wastes, faulty sewage disposal.
 Swimming pools , hot tubs, natural bathing facilities like
lakes, river, ponds are sometimes dangerously polluted
and provide a medium of vector to flourish

Noise pollution
Noise pollution is defined as any unwanted or undesirable sound
in the environment
Its effects range from mildly annoying to psychologically and
physiologically debilitating
Health problems resulting from noise pollution is temporary or
permanent hearing loss
It also affects an individuals psychological and physical health
because it disrupts communication , sleep, leisure and work
activities.

accidents
Unintentional injuries due to fall kills more people every
year and incapacitate millions of others with many lifelong
disabilities.

Soand hazardous waste
Wastes are generated in alarming rate
The amount of solid waste continues to soar, partly as a
result of todays throwaway attitude where many products
are used once and then discarded.
In addition to solid wastes the disposal of hazardous waste
is a critical issue.

Environmental issues
Major issues
Population
Food production
Natural resources
Water
Forests
Wild life
Pollution
Global warming
Acid rain

Environmental protection act in india
 The National Green Tribunal Act, 2010
 The Air (Prevention and Control of Pollution) Act, 1981
 The Water (Prevention and Control of Pollution) Act, 1974
 The Environment Protection Act, 1986
 The Hazardous Waste Management Regulations

The National Green Tribunal Act, 2010
 The National Green Tribunal Act, 2010 has been enacted with
the objectives to provide for establishment of a National Green
Tribunal (NGT)
 The main purpose is to effective and expeditious disposal of
cases relating to environment protection and conservation of
forests and other natural resources including enforcement of any
legal right relating to environment and giving relief and
compensation for damages to persons and property and for
matters connected therewith or incidental thereto.

The Air (Prevention and Control of Pollution) Act, 1981
The Air (Prevention and Control of Pollution) Act, 1981 (the "Air
Act") is an act to provide for the prevention, control and
abatement of air pollution and for the establishment of Boards at
the Central and State levels with a view to carrying out to prevent
air pollution.

The Water (Prevention and Control of Pollution) Act, 1974
 The Water (Prevention and Control of Pollution) Act, 1974 (the "Water
Act") has been enacted to provide for the prevention and control of water
pollution and to maintain or restore wholesomeness of water in the
country.
 It further provides for the establishment of Boards for the prevention and
control of water pollution with a view to carry out the aforesaid purposes.
 The Water Act prohibits the discharge of pollutants into water bodies
beyond a given standard, and lays down penalties for non-compliance.
 At the Centre, the Water Act has set up the CPCB which lays down
standards for the prevention and control of water pollution.
 At the State level, SPCBs function under the direction of the CPCB and the
State Government.

The Environment Protection Act, 1986
 The Environment Protection Act, 1986 (the "Environment Act") provides
for the protection and improvement of environment.
 The Environment Protection Act establishes the framework for studying,
planning and implementing long-term requirements of environmental
safety and laying down a system of speedy and adequate response to
situations threatening the environment.
 It is an umbrella legislation designed to provide a framework for the
coordination of central and state authorities established under the Water
Act, 1974 and the Air Act.

The Hazardous Waste Management Regulations
There are several legislations that directly or indirectly deal with hazardous waste
management. The relevant legislations are the Factories Act, 1948, the Public
Liability Insurance Act, 1991, the National Environment Tribunal Act, 1995 and rules
and notifications under the Environmental Act.
 Hazardous Wastes (Management, Handling and Transboundary) Rules, 2008,
brought out a guide for manufacture, storage and import of hazardous
chemicals and for management of hazardous wastes.
 Biomedical Waste (Management and Handling) Rules, 1998, were formulated
along parallel lines, for proper disposal, segregation, transport, etc, of infectious
wastes.
 Municipal Solid Wastes (Management and Handling) Rules, 2000, aim at
enabling municipalities to dispose municipal solid waste in a scientific manner.

Nurses role in environmental health
 Assess the environment and detect hazards when they exit
 Provide information to individuals and groups on the effects of environmental
toxins and global hazards
 Report serious environmental threats to appropriate agencies
 Develop and implement school based and workplace wellness programe
 Aid in the formulation of public policy and legislation involving the
environment
 Help prevent excessive exposure to immediate toxins and larger, global
hazards
 Help facilitate behavior change in people eg. Using public transportation,
recycling, planting co2 absorbing trees.

HEALTH ECONOMICS

introduction
 Economics represents the study of allocating scarce resources among
competing needs.
 Allocating resources refers to how each good produced is distributed to it’s
consumers.
 Economics becomes the intellectual liason between nature and technology
on the supply side and preferences and desires of consumers and overall
society on demand.
 Economics involved in health care is important on the both sides of supply
and demand equation
 It can be used to trace relationship among the health of the population ,the
size, and productivity of workforce ,and the demand for health care.

terminologies
Consumer price index – it measures the average changes in price of all types of
consumer goods and services purchased by urban wages earners and clerical workers.
Hospital status – admissions, cost per inpatient day, length of stay, outpatient visits,
occupation rates, indicates consumption and cost of consumption for hospital care
National health expenditure – it includes both public and private expenditure for
personal healthcare , medical research, construction of medical facilities, program
administration ,insurance costs and government sponsored public health programs
Personal consumption expenditure- it represents private payments for medical care
Personal health care expenditure – it indicates expenditure for consumers whether
insured or not .included all expenses for non-prescribed drugs and medicines
,household supplies and other items not covered
by insurances

Definition- health economics
Health economics is the study of distribution of health
care. It is a branch of economics concerned with issues
related to efficiency, effectiveness, value and behavior in the
production and consumption of health and health care.
-Morris

Importance of health economics
 The availability of health care can determine the quality of life and the prospect for
survival.
 The healthcare sector is very large. Health care is a major component of spending,
investment, and employment in every developed country, thus, the economic
performance of the healthcare system is crucially linked to the overall economic well-
being of a country and its citizens
 Decisions about how health care is funded, provided, and distributed are strongly
influenced by the economic environment and economic constraints
 To formulate health services
 To establish the true costs of delivering health care or to estimate all real costs like the
use of patients' time, loss of output elsewhere in the system etc….
 To estimate the effects of certain economic variables like user charges, time and
distance costs of accessibility, etc on the utilization of health services

Economics concepts in health care
1. Supply
2. Demand
3. cost

supply
 In economics, supply of a product during a given period of time means
the quantities of goods which are offered for sale at particular prices.
 Hence, supply of a commodity may be defined as the amount of that
commodity which a sellers are able and willing to offer for sale at a
particular price during a given period .
 The ability of seller to supply a commodity depends on the stock availiable
with him.
 Similarly seller should have willingness to supply a product.
 This depends upon the difference between reservation price and the
prevailing market price or the price which is offered by the buyer for that
commodity

demand
 It is the quantity and quality of services or commodities wanted or
requested.
 But the demand for health and medical care in strict economic sense, is a
function of:
Consumer’s income,
The price of medical care relative to the prices of other goods,
Preferences of consumers, including their perceptions about health
and health care.

cost
 It refers to the resources which are spent in carrying out health activities so far as the
health care sector is concerned.
 In general, costs can be classified into two broad groups:-
1. Capital costs: - These costs are borne irrespective of the workload of any health center
and are fixed. These may include- Building, i.e. the health center, hospital etc.
2. Operating costs: - These costs are related to the level or type of activity in a health
institution. Some operating costs will change daily and some from year to year.
These operating costs include:
 Salaries, wages and allowances of health staff at different levels.
 medical supplies, drugs etc.
 Transport operating costs.
 Maintenance and repairs.
 Training.
 Power.
 Other miscellaneous items.

Use of economics in health care
 Assist decision making, usually in the health sector, to
promote efficiency and equity.
 Health economics is about maximizing social benefits
obtained from the constrained health producing resources
 Introduces a thought process that recognizes scarcity

Factors influencing health economics
Extensive government intervention
Intractable uncertainty in several dimensions
Information asymmetric
Barriers to entry
Externalities and the presence of third party agent

Economic evaluatiom
1. Cost benefits analysis
2. Cost minimization analysis
3. Cost utility analysis
4. Cost effectiveness analysis

Cost benefits analysis
Cost analysis is a resource tool for financial management in
hospital or department.
 It is an economic evaluation technique that involves the
systematic collection, categorization, and analysis of program or
intervention costs, and cost of illness.

Cost minimization analysis
Compares the costs of different interventions that are assumed to
provide equivalent benefits.
Decision hinges - finding the least expensive way of obtaining the
health benefit.
Example – comparison between a Generic drug and its branded
equivalent
 Advantage – simple and easy to interpret
Disadvantage – no longer considered “valid”

Cost utility analysis
 Compare the costs and the benefits of health technologies
 Benefits are measures in HEALTHY YEARS
 Multidimensional – incorporates Quality along with Quantity of Life
 Measure of benefit – Quality adjusted life years (QALY); Disability adjusted life
years (DALYs)
Advantages – 1. To measure health care costs and interventions
2. To evaluate the effect of a nursing intervention on patient
outcomes when one of these outcomes is QOL
3. To assess cost utility for both medical interventions and nursing
interventions
4. To compare current practice and the change in practice need

Cost effectiveness analysis
 Net gain in the health or reduction in disease burden from a health
intervention in relation to cost.
 Benefits are measured in “natural units”
 e.g. life-years, mm Hg for BP, HbA1c for diabetes, Quality adjusted life
years (QALY) etc.
 Cost effective ratio = Cost/ Number of lives saved
 Advantage – least cost way of achieving the objective to see how both
cost and choice of technique
 Disadvantage – lack of ability to compare interventions across the health
sector i.e., costs can be compared but outcomes cannot.

Health Financing
 It refers to the raising of resources to pay for goods and services
related to health.
 These resources may be in the form of “cash” or “in -kind”.
MAJOR PROBLEMS IN HEALTH FINANCING:-
 Lack of funds.
 Unequal distribution of health finances.
 Rising health costs.
 Lack of coordination of health financing units.
 Wastage and in sufficiency in spending the funds

Role of nurse in health economics
 Nurses play a central role in cost containment, care quality, and patient safety.
 Nurses actively engages in leading efforts to improve patient care and reduce
costs.
 Governing on Behalf of Stakeholders.
 Monitoring Financial Performance.
 Building a Culture of Quality and Safety.
 Monitoring Quality Performance.
 Set policy that guides care delivery.
 Set strategy to help ensure the future health of a Vital community resource.
 Assume a valued community leadership role.
 Help the boards identify, clarify, and focus on the wants and needs of the
patients.

HEALTH CONSTRAINTS

introduction
Health care system worldwide are under pressure to contains
cost.
The scarcity of resources and the need to produce more with less
is an ever present reality for healthcare organization.
The increase in health care costs is a widely acknowledged
concerned among policy makers worldwide

Definition- health constraints
Health constraints is defined as “something that limits
the range of a persons action’s or freedom in the health and
health care”
--Cambridge university

Constraints to practice
Nursing versus the medical role
Nursing versus public policy issues
Nursing versus health care system concerns.

nursing versus the medical role
 Bryant Lukosius, DiCenzo, Browne, and Pinelli described important nursing
values that must be maintained in the advanced practice role which
includes practice that is patient-centered, health-focused, and holistic.
 Jones described the nursing role as a partnership between the patient
and nurse in which the focus is to assist the patient
 Miller, Snyder, and Lindeke state that they are nurses and use this
knowledge and experience in providing care”
 In many managed care organizations, however, the medical model
predominates leaving little time for the nurse to provide the nursing
aspects of care

Nursing versus public policy issues
Autonomy versus physician oversight
Credentialing.
Reimbursement
Certification.

nursing versus health care system concerns
 The movement towards health care provided by MCOs has had significant effect on
APN practice.
 A qualitative study by Cohen, Mason, Arsenie, Sargese, and Needham identified
Barriers to practice included stalled or denied request for placement on provider
panels and patient literature that describes providers only as physicians. “One of the
most striking themes they noted was “NP invisibility”
 Many private insurance companies follow this MCO model and also refuse to recognize
or reimburse NPs as primary care providers .
 BBA 1997 also places barriers on APN practice related to home health care. Current
regulations prevent APNs from being able to write admission orders or sign a plan of
care for patients requiring home health care. Only after the physician has written the
admission orders and signed the plan of care can the APN provide the needed care

Constraints in health care
 PRACTICE SETTING ISSUES
 HEALTH CARE DELIVERY SYSTEM
 LEGAL ISSUES
 ENVIRONMENTAL CONSTRAINTS IN THE COMMUNITY

PRACTICE SETTING ISSUES
 Conflict between actual and desired role - Conflict arose when APNs found
that the practice setting did not allow them to practice in a holistic manner
that was consistent with the nursing role.
 Nursing versus medical model- APN graduates experienced a conflict
between the nursing model versus medical model of practice.
 Role recognition- Although nursing has made great strides in increasing
public awareness of our various roles in health care delivery, more work
needs to be done.
 Quality management- NPs in private practice were less likely to have in
place a system for insuring continuous quality management (CQM) ,whereas
they may have been very used to maintaining CQM procedures when
working as nurses in acute care settings.

HEALTH CARE DELIVERY SYSTEM
Time issues - Heavy work loads for most nurses created conflicts
related to quantity versus quality of care delivered.
Reimbursement -Over the years reimbursement constraints to
practice, especially for NPs have steadily been decreasing.
However, these graduates indicated that there are still difficulties,
some of which could be ameliorated by making systems more
user-friendly

LEGAL ISSUES
Independent practice- APNs in independent practice help to
provide needed access to care for all people, but they can
experience various struggles in setting up and maintaining
independent practices.
Hospital privileges- many more APNs have been able to get
hospital privileges, especially those working as acute care APNs.
Certification - Since this study, certification has become a non-
issue for NPs with the new Medicare laws that require national
certification in order to bill

ENVIRONMENTAL CONSTRAINTS IN THE COMMUNITY
 Lack of food and pharmaceuticals- An area of frustration for the graduates
practicing in rural or remote communities was the lack of services available for
clients.
 Lack of long term care facilities- Another problem noted in rural communities is
the lack of facilities that provide follow up care. If long term care is not provided
in a community, it is difficult to find appropriate care for patients with chronic
health problems
 Lack of transportation -Another issue that created problems for the provider was
finding transportation for clients either to the rural clinic or to the urban center
when more advanced care was required
 Lack of phone service -The lack of phone service in rural creates many
challenges. Large parts of the Indian reservation land cannot be serviced with
either land line phones or cell phones

planning process

introduction
 The concepts of health has been changing over the years in response to
an increase awareness of health and its relevance to national progress.
 This concepts thought in consistent with the current awareness of health
care has never been totally eliminated even in the era of health for all
 Delivery of health care services is the burning issues of the present time
 The concern is to develop system which ensures need based
comprehensive health care service to people at large especially those
living in remote and backward areas using available resources as
effectively as possible.

Definition-health planning process
Health planning process is defined as “the orderly process of
defining community health problem ,identifying unmet needs and
surveying the resources to meet the needs ,establishing priority
goals that are realistic and feasible and projecting administrative
action to accomplish the purpose of the proposed program”
-World Health Organization

Purposes or importance of planning process
 Predict – planning helps to foresee about what things and situation would be like in
the future on the basis of analysis of various factor inside the organization and
outside the organization
 Reduce uncertainity – planning brings in rationality and higher degree of certainity in
achieving the objective, thus there is no wastage of effort and resources.
 Management by objectives – the first element in planning is setting goals and
objectives which gives sense of direction
 Economy in operation – helps in matching limited resources to deal with different
problems
 Controlling/checking – helps in monitoring the performance of worker
 Promote innovative and creative thinking in the planners

Characteristics of planning
Good planning should focus on the purpose
Planning is a continuous process
Health planning should be according to the requirements of the
society
Planning of health program should be precise in its objectives,
scope and nature
Planning should be documented because it serves as a blue print
for the implementation

Planning
cycle
Assessment of
environment
Data collection
and analysis
Target setting
Plan
formulation
Plan
authentication
Take adoption
and
implementation
Mid term
appraisal and
correction
evaluation
Planningcycle

Steps In health planning process
Analysis of health situation
Establishment of the objectives/goals
Assessment of the resources
Fixing the priorities
Writing the formulated plan
Implementation
Evaluation

Health planning in india
Bhore Committee (Health survey and Development Committee,1946)
Chairman : Sir Joseph Bhore
 To survey the existing health condition. Submitted report – 1948
RECOMMENDATION :
1. Integration of preventive & curative services at all administrative level.
2. Development of Primary health centres in 2 stages
Short term measures : Each PHC should cater a population of 40,000 and a sec. health
centre as supervisory, coordinating and referral institution.
In PHC 2 medical officer,4 public health nurses, one nurse, 4 midwives, 4 trained dhais, 2
sanitary inspectors, 2 health assistants, one pharmacist & 15 class IV employees.
Long term measures: Primary health units with 75 bedded hospital for each 10,000-
20,000 population
Secondary units with 650 bedded hospital

Mudaliar Committee (Health survey and planning committee,1962)
Chairman : Dr. A. L. Mudaliar
 To survey progress made in health since submission of Bhore Committee report
Recommendations
 Consolidation of First Two Five Year Plan activities.
 Strengthening district Hospitals with specialists.
 Regionalizing State Health Organization
 Each PHC with maximum of 40,000 population.
 Integration of Medical and Health Services.
 Formation of All India Health service on the pattern of Indian Administrative
Services.

Chadah Committee,1963
 Chairman: Dr.M.S.Chadah
 The arrangement for maintenance phase of national malaria eradication
programme.
RECOMMENDATION:
1. Vigilance of NMEP-PHC at Block level
2. Monthly home visit- basic health worker
3. One Multipurpose worker – 10,000 population
4. They work in Malaria EP , also in vital statistics and Family Planning
work.

Mukerji Committee, 1965
Separate staff for family planning Programme and separate staff for
Malaria Eradication Programme.
Delink Malaria Activities from Family Planning
The Family planning assistant were to do the family planning duties
only.
Basic health workers were to be utilized for purposes other than
Family planning like maintenance phase of Malaria, smallpox,
leprosy and trachoma.

Jain Committee 1966
One bed per 1000 population.
150 beds hospital at Taluka level.
Enhancing maternity facilities at each level.
Health insurance for larger population coverage.

Kartar Singh Committee,1973
 Committee on Multipurpose workers under Health & FP
 To study - the Structure for integrated services - Feasibility of multipurpose and bi-
purpose workers. - Training requirement of such workers. - utilization of mobile services
for integrated medical, public health,& family planning
Recommendations:
1. ANM newly designated as “female health workers” and Malaria worker, vaccinator etc. as
“male health workers”.
2. 1 PHC for 50,000 population & each PHC is divided into 16 sub-centre with 3000-3500
3. Each sub-center should have 1 MPHW female + 1 MPHW male.
4. Multipurpose Health Supervisor to be created.
5. The Doctor incharge of PHC is the overall charge of all workers &supervisors.

Jungalwalla Committee, 1967
 To examine problems of service condition in health.
 Defined “Integrated health service” i.e a service with a unified approach for all
problem instead of segmented approach for different problems.
Recommendations:
 Unified approach for Medical Care and conventional public health
 Unified cadre
 Common Seniority
 Recognition of extra qualification
 Equal pay for equal works
 Special pay for specialized works
 No private practice and good service conditions

Shrivastav Committee, 1975
 Group on Medical Education & Support Manpower
 To devise curriculum for Health Assistant
 To suggest improving existing medical education process.
Recommendations:
 Creation of bands of para-professionals and semi- professional health
workers (School Teacher, Gram Sevak, Post Master)
 Two cadres of Health Workers – MPHW and Health Assistant between
community and PHC doctor.
 To develop referral services complex. Establishment of Medical and
Health Education commission in line with UGC.

Rural health scheme,1977
 Primary health care should be provided within the community
through Specially trained worker ,so that the health of the
people is placed in hand of people themselves.
 Reorientation Training of multipurpose workers engaged in
communicable disease program.
 Involvement of Medical colleges in the selected PHC with
objective of re-orienting medical education to the need of rural
people.

Five Year Plan
 Formulated by Planning Commission.
 To re-build rural India, to secure balanced development of all parts of India.
BROAD OBJECTIVES:
 Control or eradication of major communicable diseases
 Strengthening of basic health services through establishment of PHC & SCs.
 Population control
 Development of health manpower resources
Five year Plan Planning Commission of India – 1950
First Five Year Plan 1951 – 56.
 Health Sector Planning includes following sectors. – Water supply and sanitation
– Control of Communicable disease – Medical Education Training and Research
– Medical Care including Hospitals, Dispensaries and PHCs – Public Health
Services – Family Planning – Indigenous system of Medicine

Goals for the Eleventh Five Year Plan
 Reducing Maternal Mortality Ratio (MMR) to 1 per 1000 live births.
 Reducing Infant Mortality Rate (IMR) to 28 per 1000 live births.
 Reducing Total Fertility Rate (TFR) to 2.1.
 Providing clean drinking water for all by 2009 and ensuring no slip-backs.
 Reducing malnutrition among children of age group 0–3 to half its present
level.
 Reducing anaemia among women and girls by 50%.
 Raising the sex ratio for age group 0–6 to 935 by 2011–12 and 950 by
2016–17.

Health policies

introduction
A policy is an established course of action determined to achieve
a desired outcome.
Government and institutions create policies to achieve their
mission but it is not limited to government and institution
Any healthcare providing ,professional organization, non profit
organization or family may make policies for members to follow.
Policy formations takes place at many levels in the society at
family, community, institution ,state, national and international
levels.

Definitions-policy
Policy:
Policy is defined as principles that govern actions directed towards given
ends,policy statements set forth a plan ,direction or goal for action.
Policies are formalized procedure that are followed by persons
responsible for delivering governmental or institutional services
-- stanhope
Health policy:
Health policy refers to the public or private rules, regulations, laws,
guidelines, that related to the pursuit of health and the delivery of health
services

Types of policies
Distributive policies:
Distributive policies extend goods and services to members of an
organization as well as distributing the cost of goods and services amongst the
members of the organization.Eg. Government policies that impact sending for
welfare ,public education, highways etc……
Regulatory policies:
Regulatory policies limit the discretion of individual of individuals and
agencies or otherwise complete certain type of behaviour. These policies are
generally thought to be best applied in situations where good behaviour can
be easily defined and bad behaviour can be easily regulated and punished
through fine. Eg. Policies related to covid

Cont…..
Constituent policy:
These create executive power entities or deal with the laws.
Miscellaneous policy:
Policies are dynamic ,they are not just static list of goals or
laws.Policy blue prints have to be implemented often with
unexpected results. Social policies are what happens on the ground
when they are implemented as well as what happens at the decision
making or legislative state.

Other types of policies
Domestic policy
Economic policy
Education policy
Environmental policy
Health policy
Foreign policy
Human resource policy
Public policy

The Stages Model

Impact of policy on nursing
Public policy has significant impact on the practice of nursing. The
ability of the individual nurse to provide care is affected by public
policy decisions.
State licensure of a registered nurse derives from legislation that
defines the scope of nursing practice
Regulations that are developed to implement legislation also
affect practicing nurses and their work environment

Spheres of nursing influence
 According to Talbot and Mason ,the nurses has an
opportunity to make an impact on policies in four aspects
of influences.
 They are
1. Government
2. Work place
3. Organizations
4. community

Government
 Laws with their accompanying rules and regulations control nursing practice
and health care.
 Nurses have been more involved in federal and state governments
,although local government provide many health care services
 Local government control school health programs, local public hospitals and
home and community health care.
 In general the nurse first must be a registered voter
 Nurses can join collective actions by working with political action
committees
 Most states have state nurses association for state and local candidates.

Work place
 Over 66% of nurses work in hospitals should be influential in setting
hospital policies, especially regarding patient care.
 Nurses can influence how quality care is delivered with controlled costs.
 Most hospitals currently require that many non-nursing tasks can be done
by nurses.
 Through collective action ,nurses serving on committees in the institution
can help eliminate these tasks.
 Nurses can even serve on the broad of trustees of the institution.

Organizations
Important influences include professional organizations such as
TNAI and many specialty organizations.
The organizations work in coalition with other health groups to
support or oppose issues.
By joining and being active in a professional organization , an
individual nurse has access to a wider range of tools and
information to use in order to influence health care policies.

community
Practical involvement with community often arises out of ones
interests in living and working in community that is supportive of
the health and well being of citizen.

Political process in nursing

introduction
 Political apathy in the nursing profession can be attributed to numerous factors,
including a lack of knowledge of the political process and public policy formation,
feelings of powerlessness, and a perceived ethical conflict between professional
values and political involvement.
 Nursing as a profession has arrived at a prestigious point in development where
the word "nurse" now is synonymous with the words "patient advocate," thus
giving the specialty an important image to fulfill.
 Numerous changes in health care delivery methods, together with politicians'
increased involvement in health care development, have left nurses in a
precarious position even though nurses are the largest group of health care
workers
 The implementation of a political role for a nurse is based on three levels of
commitment including survival, success, and significance. Survival includes
individual involvement within communities.

DEFINITION-POLITICS
Politics is defined as “the art or science concerned with guiding
or influencing guiding policy and the art or science of winning
and holding control over a government”
-Marriam webster’s dictionary
Policies are the decisions , politics is the influence of those
decision

Politics and nursing
Broader issues affecting the nursing profession are political in
nature.
Issues of pay equity or equal pay for the work of comparable value
are of concern to nurses, because they are underpaid for their
services.
Nursing shortage is another issues amongst the public that
number of nurses available to provide are inadequate.
Nowadays nurses are one participating much more efficiently in
both governmental and electoral politics.

Levels of politics in nursing
Nurse citizens:
Register to vote
Vote in every election
Keep informed about health care issues
Speak out when services on working conditions are inadequate
Join politically active nursing organizations
Join a political party

Nurse activist:
Joining politically active nursing organizations
Contacting a public official through letters, emails, phone calls
Registering people to vote
Contributing money to political campaign
Working in a campaign
Writing letter to the editors of local news paper
Inviting legislator to visit the workplace

Nurse politician:
Run for an elected office
Seek appointment to a regulatory agency
Be appointed to a governing board in the public or private
sector
Use nursing expert as a frontline policy maker who can
enhance health care and the profession.

Political issues affecting nursing
Workplace mental violence
Shortage of staff
Workplace health hazards
Long working hours
Lack of Synchronicity
Lack of recognition
Non-nursing roles

THANK YOU

Health care environment, Health Economics, Health constraints, Planning process, Policies, political process

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