PRESENTED AT NATIONAL CONFERENCE, GUJARAT

1. वाणणिजजजक राजधानी मुंबई का एक ऐततिाससक
रेलवे-स्टेशनन,
छत्रपतत सशनवाजी मिाराज टर म$नस
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2. CHALLENGES AND SOLUTIONS IN HEALTH
CARE
CHALLENGES AND SOLUTIONS IN HEALTH
CARE
Jonils Macwan
Senior Nursing Superintendent
Indian Railway Medical Services
Vadodara

3. 33

4. DON’TGIVEUP
ATTIDUTDE
DON’TGIVEUP
ATTIDUTDE
Colonel Harland Sanders( best known for founding chicken restaurant chain
Kentucky Fried Chicken and was a 6th grade dropout. l.When he was 65, a
new interstate highway diverted trafc away from his restaurant leaving
Sanders with only his secret fried chicken recipe and a Social Security check.
So he began selling his recipe and franchise idea. According to the news, he
was rejected over 1,000 times. Then he found a partner with whom he build
the KFC franchise powerhouse (over 15,000 restaurants
Colonel Harland Sanders( best known for founding chicken restaurant chain
Kentucky Fried Chicken and was a 6th grade dropout. l.When he was 65, a
new interstate highway diverted trafc away from his restaurant leaving
Sanders with only his secret fried chicken recipe and a Social Security check.
So he began selling his recipe and franchise idea. According to the news, he
was rejected over 1,000 times. Then he found a partner with whom he build
the KFC franchise powerhouse (over 15,000 restaurants
4

5. DON’TGIVEUP
ATTIDUTDE
DON’TGIVEUP
ATTIDUTDE
Nawazuddin
Siddique
known for his intense
role and awesome
acting, is one of the
best actor Bollywood
has ever got. He
belongs to Farmers
Family, No Money,
Struggled and came
to New Delhi and
worked as a
Watchman for 4 to 5
years, look wasn’t like
a hero. He kept of
Struggling, hard
working and Finally
his Struggle Paid Him
well. A chance to
work in Peepli Live.
There has been no
Looking Back for Him
since then.
Nawazuddin
Siddique
known for his intense
role and awesome
acting, is one of the
best actor Bollywood
has ever got. He
belongs to Farmers
Family, No Money,
Struggled and came
to New Delhi and
worked as a
Watchman for 4 to 5
years, look wasn’t like
a hero. He kept of
Struggling, hard
working and Finally
his Struggle Paid Him
well. A chance to
work in Peepli Live.
There has been no
Looking Back for Him
since then. 5

6. 6

7. CHALLENGESCHALLENGES
 Uncontrolled Population Growth
Mitigating burden of disease
Infectious
Chronic degenerative
Maternal mortality, under-5 mortality, malnutrition
Healthcare fnance
Lack of healthcare related resources such as Measurement Of
Quality 7

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10. 1.CHALLENGE WHICH IS OUT OF OUR
CONTROL
1.CHALLENGE WHICH IS OUT OF OUR
CONTROL
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11. 1.CHALLENGE WHICH IS OUT OF OUR
CONTROL
1.CHALLENGE WHICH IS OUT OF OUR
CONTROL
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12. 2.BURDEN OF DISEASE2.BURDEN OF DISEASE
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13. Communicable or Infectious diseases
 Poor implementation of public health
programs
 The coordination between policy makers and
program implementers is far from what is desired for
efective rolling out of health programs. Policy and
programs are framed with inadequate knowledge of
existing bottlenecks at the feld level
 Technical insufciency: is a refection of
inexperienced strategists designing programs without
an insight of what would happen on the ground or
failure of some technique adopted.
2.BURDEN OF DISEASE2.BURDEN OF DISEASE
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14. Communicable or Infectious diseases
 Lack of environmental sanitation, safe drinking water,
Information and awareness regarding importance of
hygiene.
 Nutrition
 Despite substantial improvement in health and well-being
after independence, under-nutrition still remains a silent
emergency in India. About 40% of the world’s malnourished
children and 35% of the developing world’s low-birth weight
infants live in India . Approximately 2 million children die in
India every year, accounting for one in fve child deaths in
the world.
2.BURDEN OF DISEASE2.BURDEN OF DISEASE
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15. Communicable or Infectious diseases
 Water supply and sanitation: Millennium
Development Goal (MDG) 7 targeted the reduction by
half of the world’s population without sustainable
access to safe drinking water and basic sanitation by
2015, but even at the end of 2015 India is lagging
behind, with the country having the world’s highest
number of open defecators (597 million people or 48%
of the population) . About 60% of the generated solid
waste is collected and disposed of, but only half of it in
a sanitary manner.
2.BURDEN OF DISEASE2.BURDEN OF DISEASE
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16. 2.BURDEN OF DISEASE2.BURDEN OF DISEASE
Prevalence of non-communicable diseases
• Lack of awareness of diseases such as diabetes
and hypertension,63 million diabetic patients in
India.
• Focus is more on communicable diseases such as
tuberculosis and Polio.
• Rise of psychological disorders
• Lack of awareness and understanding
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17. 3.MATERNAL MORTALITY, UNDER-5
MORTALITY, MALNUTRITION
3.MATERNAL MORTALITY, UNDER-5
MORTALITY, MALNUTRITION
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18. 3.MATERNAL MORTALITY, UNDER-5
MORTALITY, MALNUTRITION
3.MATERNAL MORTALITY, UNDER-5
MORTALITY, MALNUTRITION
Explosive population growth (High birth rates)
Gender inequality
Childbirth at home instead of hospital
Poor education
Poor nutrition
 Lack of breastfeeding
 Vulnerable to weakness and infection
Poor immunity
According to UNICEF, 1.7 million under the age of 5 die
98000 afected with uncontrolled diarrhea 18

19. 3.MATERNAL MORTALITY, UNDER-5
MORTALITY, MALNUTRITION
3.MATERNAL MORTALITY, UNDER-5
MORTALITY, MALNUTRITION
Currently Gujarat Is 6th Among The States With Lower Maternal
Mortality Ratio. Now it is nearby 91 or below that.
Currently Gujarat Is 6th Among The States With Lower Maternal
Mortality Ratio. Now it is nearby 91 or below that.
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20. 3.MATERNAL MORTALITY, UNDER-5
MORTALITY, MALNUTRITION
3.MATERNAL MORTALITY, UNDER-5
MORTALITY, MALNUTRITION
2020

21. 3.MATERNAL MORTALITY, UNDER-5
MORTALITY, MALNUTRITION
3.MATERNAL MORTALITY, UNDER-5
MORTALITY, MALNUTRITION
Malnutrition is one of the leading causes (about 50%) of all childhood
deaths. And malnourishment at an early age can lead to long-term
consequences as it afects motor, sensory, cognitive, social and emotional
development.
Malnutrition is one of the leading causes (about 50%) of all childhood
deaths. And malnourishment at an early age can lead to long-term
consequences as it afects motor, sensory, cognitive, social and emotional
development.
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22. 4.Healthcare Finance4.Healthcare Finance
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23. 4.Healthcare Finance4.Healthcare Finance
High cost of curative medical services
Expensive health insurance( Only 24% insured and 76% are uninsured)
Poor vaccination coverage( 78% children are covered so 22% still
remained)
Inappropriate and irrational use of high tech diagnostics
The poor are more price sensitive to health care and are more likely to
report fnancial cost as a barrier for foregoing care when sufering from
illness 23

24. 5. Lack Of Healthcare Related
Resources
5. Lack Of Healthcare Related
Resources
• Workforce concentrated in urban areas
• Migration of Qualifed healthcare professionals
• Underinvestment in health care related infrastructure in certain areas
• Limited opening hours
•Limited availability of drugs
•Poor physical environments
•Poor provider training and knowledge
•Poor governance of health care sector
•Adequate regulation of public and private sector has been difcult to achieve
•Implementation of laws and codes is problematic
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25. Families Into
Deep Debt
Healthcare in
India remains one
of the largest
sectors in terms
of both
employment and
revenue
generation. It has
reported a
compounded
annual growth
rate of 16.5%,
and likely to be
worth $280 billion
by 2020.
But The ground reality is that
healthcare in India wipes out savings
and pushes families into deep debt
even after one episode of illness,
particularly crushing low-income
groups.
But The ground reality is that
healthcare in India wipes out savings
and pushes families into deep debt
even after one episode of illness,
particularly crushing low-income
groups.
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26. The gleaming glass façade of
modern hospitals paint a misleading
picture of India’s healthcare, where
one can easily assume that the
nation’s healthcare is in good
hands. Unfortunately, the facts
don’t bear this out. In India, there is
1 doctor for every 1,700 people
(World Bank Survey, 2012), against
WHO recommendation of 1 for 1000
people.
Moreover, only 48 per cent of the
1.35 million beds are functional and
relevant and about 65 per cent of
these are located in top 20 cities.
This clearly indicates the defcit in
medical professionals, and the
asymmetry and inadequacies of the
The gleaming glass façade of
modern hospitals paint a misleading
picture of India’s healthcare, where
one can easily assume that the
nation’s healthcare is in good
hands. Unfortunately, the facts
don’t bear this out. In India, there is
1 doctor for every 1,700 people
(World Bank Survey, 2012), against
WHO recommendation of 1 for 1000
people.
Moreover, only 48 per cent of the
1.35 million beds are functional and
relevant and about 65 per cent of
these are located in top 20 cities.
This clearly indicates the defcit in
medical professionals, and the
asymmetry and inadequacies of the
health system today.
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27. 5. Lack Of Healthcare Related
Resources
5. Lack Of Healthcare Related
Resources
Eforts to improve the quality of health care in India and attempts to
evaluate the impact of these eforts invariably face challenges
because of the lack of reliable administrative data.
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31.  Initiate transparency by accreditation of Hospitals
and health care providers
To bring about quality in healthcare, transparency is
imperative. For this, a system needs to be put in place that
gives accreditation to hospitals, arming patients with in-
depth and accurate information about a hospital
and its services. Patients, once they rate and review
hospitals, based on various parameters, can pass on
knowledge and their experience related to the doctors,
facilities and treatments costs etc.
TO OVERCOME THE DISCREPANCIES PREVAILING
HEALTHCARE IN OUR COUNTRY
TO OVERCOME THE DISCREPANCIES PREVAILING
HEALTHCARE IN OUR COUNTRY
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32.  SOLUTIONS:
 China's one-child policy was part of a birth planning
program designed to control the size of its population.
Distinct from the family planning policies of most other
countries (which focus on providing contraceptive
options to help women have the number of children they
want), it set a limit on the number of children parents
could have, the world's most extreme example of
population planning. But, it was disregarded.
 Family Planning Drives
 Public Awareness Programs and incentives
Uncontrolled Population GrowthUncontrolled Population Growth
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33.  Communicable Diseases
We are having National Programs such as
 Human Immunodefciency Virus Infection/Acquired
Immunodefciency Syndrome(HIV/AIDS) - Department of AIDS
Control
 Revised National TB Control Programme(RNTCP)
 National Vector Borne Disease Control Programme (NVBDCP)
 Integrated Disease Surveillance Project (IDSP)
 National Leprosy Eradication Programme(NLEP)
MITIGATING BURDEN OF DISEASEMITIGATING BURDEN OF DISEASE
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34. 1. Yes, Donations of safe and efective drugs from pharmaceutical
companies; adequate funds from foundations and bilateral donors to
deliver these donated drugs; efective global health partnerships;
efective systems of delivery; and good governance can help make
these diseases history
2. The community-directed treatment approach The community-directed
treatment(CDT) approach has been implemented across 50 000
communities in Africa and is one of the most successful innovations in
creating community ownership and building program sustainability.
Communities in hyper-endemic infectious disease areas identify amongst
themselves those who will be responsible for community-directed drug
distributions, organizing distribution according to their own cultural norms
and organizational structures
CAN SOME INFECTIOUS DISEASES BE MADE
HISTORY?
CAN SOME INFECTIOUS DISEASES BE MADE
HISTORY?
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37.  Best-buys and recommended interventions
1. Increase excise taxes and prices on tobacco products
2. Implement plain/standardized packaging and/or
3. Large graphic health warnings on all tobacco
packages.
4. Enact and enforce comprehensive bans on tobacco
advertising, promotion and sponsorship.
5. Eliminate exposure to second-hand tobacco smoke in
all indoor workplaces, public places, public transport1 •
6. Implement efective mass media campaigns that
educate the public about the harms of
smoking/tobacco use and second hand smoke.
PREVENTION OF CANCERPREVENTION OF CANCER
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38.  Increase excise taxes on alcoholic beverages
 Enact and enforce bans or comprehensive restrictions on
exposure to alcohol advertising (across multiple types of media)
 Enact and enforce restrictions on the physical availability of
retailed alcohol (via reduced hours of sale)
 Enact and enforce an appropriate minimum age for purchase or
consumption of alcoholic beverages and reduce density of retail
outlets
 Restrict or ban promotions of alcoholic beverages in connection
with sponsorships and activities targeting young people
 Provide consumer information about, and label, alcoholic
beverages to indicate, the harm related to alcohol
CONTROL ON HARMFUL USE OF
ALCOHOL
CONTROL ON HARMFUL USE OF
ALCOHOL
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39.  Reduce salt intake through the reformulation of food products to
contain less salt and the setting of target levels for the amount of
salt in foods and meals
 Reduce salt intake through the establishment of a supportive
environment in public institutions such as hospitals, schools,
workplaces and nursing homes, to enable lower sodium options
to be provided
 Reduce salt intake through a behavior change communication
and mass media campaign
 Reduce sugar consumption through efective taxation on sugar-
sweetened beverages
 Implement subsidies to increase the intake of fruits and
vegetables
UNHEALTHY DIETUNHEALTHY DIET
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40.  Implement nutrition education and counseling in
diferent settings (for example, in preschools, schools,
workplaces and hospitals) to increase the intake of
fruits and vegetables
 Implement nutrition labeling to reduce total energy
intake (kcal), sugars, sodium and fats
 Implement mass media campaign on healthy diets,
including social marketing to reduce the intake of total
fat, saturated fats, sugars and salt, and promote the
intake of fruits and vegetables
UNHEALTHY DIETUNHEALTHY DIET
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41.  Fair fnancing of the costs of health care is an issue in equity and it
has two aspects how much is spent by Government on publicly
funded health care and on what aspects? And secondly how huge
does the burden of treatment fall on the poor seeking health care?
Health spending in India at 6% of GDP is among the highest levels
estimated for developing countries. In per capita terms it is higher
than in China Indonesia and most African countries but lower than in
Thailand.
 Private expenditure trends
 How far can health insurance help?
HEALTHCARE FINANCINGHEALTHCARE FINANCING
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42. HEALTHCARE FINANCINGHEALTHCARE FINANCING
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44.  In spite of NCHRH being stalled, there is still a glimmer
of hope. The Clinical Establishments (Registration and
Regulation) Act, 2010 (the Act) has been enacted by
the Central Government to provide for registration and
regulation of all clinical establishments in the country
establishments from the public and private sectors, of
all recognised systems of medicine including single
doctor clinics (the only exception will be
establishments run by the Armed forces), with a view
to prescribing the minimum standards of facilities and
services provided by them.
NATIONAL REGULATION AND REGISTRATION
SYSTEM
NATIONAL REGULATION AND REGISTRATION
SYSTEM
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46. 1
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THE SHYAMA PRASAD MUKHERJI RURBAN
MISSION (SPMRM)
THE SHYAMA PRASAD MUKHERJI RURBAN
MISSION (SPMRM)

47.  Improving infrastructure is very important and this
does not entail building large, shiny state-of-art
hospitals. Most hospitals don't even have basic
facilities such as water supply, electricity, and not
even simple pain killers. Emergency units too, are
not well equipped to handle any emergency
treatment, and the unavailability of doctors at odd
hours at ERs is a huge problem that needs to be
addressed.
IMPROVE INFRASTRUCTUREIMPROVE INFRASTRUCTURE
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48.  The instant health advice ‘electronically’ proposed by NIDAN would add to
the quality healthcare. Similarly, either outsourcing the diagnostics based
on the Rajasthan CT/MR PPP Model could not only add to the quality results
and management but would also provide public awareness in the rural
areas for early diagnosis and planned preventive strategies. Such as
Mohalla Clinics, New Delhi.
PUBLIC PRIVATE PARTENERSHIP MODELSPUBLIC PRIVATE PARTENERSHIP MODELS
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49. SOLUTIONS TO CURB
THE CHALLENGES
• Positive Practice
environement(Work
environment,equipmen
t, materials)
•Positive team work
•Recruitment Retention
Policy
•Closing Education-
Service gap
•Workload balance
•Evidence Practice
SOLUTIONS TO CURB
THE CHALLENGES
• Positive Practice
environement(Work
environment,equipmen
t, materials)
•Positive team work
•Recruitment Retention
Policy
•Closing Education-
Service gap
•Workload balance
•Evidence Practice
CHALLENGES FOR
NURSING
PROFESSIONALS
Workplace Mental
Violations
• Lack of Recognition
• Shortage of Staf
• Non Nursing Role
• Workplace Health
Hazards
• Long Working Hours
• Immigration of Nurses
CHALLENGES FOR
NURSING
PROFESSIONALS
Workplace Mental
Violations
• Lack of Recognition
• Shortage of Staf
• Non Nursing Role
• Workplace Health
Hazards
• Long Working Hours
• Immigration of Nurses
CHALLENGES FOR US AND ITS SOLUTIONSCHALLENGES FOR US AND ITS SOLUTIONS
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50.  Administrative reforms
To give the impetus to the whole new concept the
administrative machinery needs to be integrated
and reorganized. The Medical, Health and
Education Department need to work in synergy to
achieve the objective of overall enhancement of
health. It is, therefore, possible for three
Departments to be supervised by a singular
Principal Secretary.
HEATH CARE- KEY FOR HEALTHY NATIONHEATH CARE- KEY FOR HEALTHY NATION
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52. 9408429635
RINIL MACWANRINIL MACWAN
9408429635/88492907429408429635/8849290742
jonilsmacwan2017@gmail.comjonilsmacwan2017@gmail.com
JONILS MACWANJONILS MACWAN
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