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Alternative health system and public private partnership

  1. 1. 1www.drjayeshpatidar.blogspot.com ALTERNATIVE HEALTH SYSTEM AND PUBLIC PRIVATE PARTNERSHIP INTRODUCTION Department of Indian Systems of Medicine and Homoeopathy (ISM&H) was established In 1995 and renamed as Department of Ayurveda, Yoga & Naturopathy, Siddha, Unani and Homoeopathy (AYUSH) in November, 2003. There has been a three fold increase in the Plan budget of the Department in the 10th as compared as 9th Plan, most of which was on account of scaling up of the budget provision in the last two years of the 10th Five Year Plan i.e. 2004 –2005 and 2005 – 2006 in line with the declared policy of the Central Government to increase the budgetary provision for AYUSH sector for mainstreaming it in the national health care delivery network. Integration of Ayush The 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 Health Societies 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 this complex. Mainstreaming will begin in two CHCs selected for the IPHS. The infrastructure will be used for providing a greater availability of services. All the National Programmes will also be implemented by Ayush with regular reporting. The CMHO will ensure all the supplies to the Ayush. The Ayush personnel will also be involved in wider publicity of all the schemes and messages. All the IEC material will be given by the IEC department to the Ayush personnel. Trainings also will be jointly carried out so that the skills of the Ayush personnel can 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.
  2. 2. 2www.drjayeshpatidar.blogspot.com Monitoring and Evaluation NRHM will build on the M and E arrangements established as part of RCH II and the IDSP to strengthen capacity for M and E as well as establish systems to enable collection of data and disaggregate by age, gender and other categories as required. Management Information Systems under the NRHM will be web enabled for citizen scrutiny. Civil society organizations will collaborate with the health system in preparing a People‟ Health Report at the district level. . State and National reports anon People‟s health to be tabled in assemblies 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 Heath Mission to the Zila Parishad. External evaluations of the NRHM will be conducted through professional organizations with involvement of civil society. The M and E will serve to inform mid course reviews and enable corrective action in a timely manner. Mainstreaming AYUSH under NRHM Rationale: The Indian systems of medicine have age old acceptance in the communities in India and in most 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 and efficacy. Other components such as Yoga, Naturopathy are being practised by the young and old alike, to promote good health. Now days, practice of Yoga has become a part of every day life. It has aroused a world wide awakening among the people, which plays an important role in prevention and mitigation of diseases. Practice of Yoga prevents Psychosomatic disorders and improves an individual‟s resistance and ability to endure stressful situation. Ayurveda, Yoga, Unani, Siddha and Homoeopathy (AYUSH) are rationally recognised systems of medicine and have been integrated into the national health delivery system. India enjoys the distinction of having the largest network of traditional health care, which are fully functional with a network of registered practitioners, research institutions and licensed pharmacies.
  3. 3. 3www.drjayeshpatidar.blogspot.com The NRHM seeks to revitalize local health traditions and mainstream AYUSH (including manpower and drugs), to strengthen the Public Health System at all levels. It is decided that AYUSH medications shall be included in the drug kit of ASHA, The additional supply of generic drugs for common ailments at SC/PHC/CHC levels under the Mission shall also include AYUSH formulations. At the CHC level two rooms shall be provided for AYUSH practitioner and pharmacist under the Indian Public Health Standards (IPHS) model. At the same time, single Doctor PHCs shall be upgraded to two Doctor PHCs by inducting AYUSH practitioner at that level. There are 9 Ayurvedic Dispensaries, 5 Homoeopathic Dispensaries. Strategies: Integrate and mainstream ISM &H in health care delivery system including National Programmes. 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 activities Broad Objectives Mainstreaming of AYUSH in the health care service delivery system to strengthen the existing public health system. Activities: Improving the availability of AYUSH treatment faculties and integrating it with the existing Health Care Service Delivery System. Integration of AYUSH services in 314 CHC / Block PHC with appointment of contractual AYUSH Doctors.
  4. 4. 4www.drjayeshpatidar.blogspot.com Appointment 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 Medical Colleges. AYUSH doctors to be involved in all National Health Care programmes, especially in the priority areas like IMR, MMR, JSY, Control of Malaria, Filaria, and other communicable diseases 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 provide Yogic therapy for specific diseases and also as a synergistic therapy to all other systems of treatment. Block level School Health Programmes to be conducted twice in a year in two groups consisting of 100 students in each group to improve the physical and mental health of the school children. Integration of AYUSH with ASHA. Training module for ASHA and ANMs have to be updated to incorporate information of AYUSH. Training & capacity building to be undertaken by the Director, SIHFW, Bhubaneswar and necessary 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 of iron 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 health as well as improving quality of life could be included subsequently.
  5. 5. 5www.drjayeshpatidar.blogspot.com Drug Management: Priority will be given to manufacture drugs in Govt. Sector Pharmacies as per their capacity. In case of any surplus funds, drugs will be procured from the market observing all financial formalities of the Govt. Provision of Rs. 25,000/- to supply drugs per AYUSH dispensary has been projected as per NRHM norm. Provisions of medicines for District AYUSH wings and Specialty Therapy Centres proposed to 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 and private 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 and to ensure that the drugs manufactured or sold or distributed throughout the state are of standard 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 quality of drugs used in AYUSH and ensure proper standardization. The existing State Drug Testing and Research Laboratory (ISM) at Bhubaneswar shall also be modernized and strengthened 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 a drug used for preventive and curative purpose. The major drawback in the development of AYUSH is lack of research and development activity on the drugs used for the System. It is estimated that there are 10,000/- plant species are found all over the world having medicinal
  6. 6. 6www.drjayeshpatidar.blogspot.com properties. The following activities will be undertaken to strengthen the drug standardization and research activities on AYUSH: It has been proposed to evaluate the chemical, pharmacological and clinical efficacy of the plant drugs. The phytochemical entities responsible for the therapeutic activity of the plant drugs used in AYUSH system will be evaluated through intensive R & D activity. The pharmacologically viable drugs will be screened clinically under WHO guideline to establish the therapeutic activity. Clinical trial on different diseases like Psoriasis, Liver disorders, Diabetics, Asthma will be conducted 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 its publications. Re-vitalization of the local health traditions and the knowledge of traditional drugs used by experienced 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 Districts of the State. The existing Herbal gardens under the D.I.M. & H (O) will be strengthened with necessary infrastructure. One State Herbarium at DTL, Bhubaneswar shall be developed. This shall enable greater research and study on development and innovation in AYUSH Drugs. Plant extraction centers 10 selected areas will be developed for extraction and preservation of 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 effective supervision and implementation of different activities.
  7. 7. 7www.drjayeshpatidar.blogspot.com Necessary vehicles with supporting manpower has also been proposed to strengthen the supervisory Joint monitoring visits to health centers to be undertaken by both AYUSH and Health Care Officials at the District level‟s/State level. Key Components and Strategies The NRHM provides broad operational framework for the Health Sector. Suggestive guidelines have been issued on key interventions like ASHA, Indian Public Health Standards (IPHS), institutional deliveries, immunization, preparation of District Action Plan, role of Panchayati Raj Institutions etc. The States shall have flexibility to project operational modalities in their State Action Plans, which would be decided in consultation with 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 health services  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 public health  Emphasizing evidence based planning and implementation through improved capacity and infrastructure,  Promoting the non-profit sector to increase social participation and community empowerment, promoting healthy behaviors, and improving intersectional convergence.
  8. 8. 8www.drjayeshpatidar.blogspot.com Supplementary 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 traditions TYPES OF AYUSH- AYURVEDA Ayurveda - Concept and Principles The Body Matrix Life in Ayurveda is conceived as the union of body, senses, mind and soul. The living man is 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 as faeces, urine and sweat. Thus the total body matrix comprises of the humours, the tissues and the waste products of the body. The growth and decay of this body matrix and its constituents revolve around food which gets processed into humours, tissues and wastes. Ingestion, digestion, absorption, assimilation and metabolism of food have interplay in health and disease which are significantly affected by psychological mechanisms as well as by bio- fire (Agni). Panchamahabhutas
  9. 9. 9www.drjayeshpatidar.blogspot.com According to Ayurveda all objects in the universe including human body are composed of five 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 needs and requirements of different structures and functions of the body matrix and its parts. The growth 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 like elements of the body after the action of bio-fire (Agni). The tissues of the body are the structural whereas humours are physiological entities, derived from different combinations and permutations of Panchamahabhutas. Health and Sickness Health or sickness depends on the presence or absence of a balanced state of the total body matrix including the balance between its different constituents. Both the intrinsic and extrinsic factors can cause disturbance in the natural equilibrium giving rise to disease. This loss of equilibrium can happen by dietary indiscrimination, undesirable habits and non- observance of rules of healthy living. Seasonal abnormalities, improper exercise or erratic application of sense organs and incompatible actions of the body and mind can also result in creating disturbance of the existing normal balance. The treatment consists of restoring the balance of disturbed body-mind matrix through regulating diet, correcting life-routine and behaviour, administration of drugs and resorting to preventive Panchkarma and Rasayana therapy. Diagnosis In Ayuveda diagnosis is always done of the patient as a whole. The physician takes a careful note of the patient‟s internal physiological characteristics and mental disposition. He also studies such other factors as the affected bodily tissues, humours, the site at which the disease is located, patient‟s resistance and vitality, his daily routine, dietary habits, the gravity of clinical conditions, condition of digestion and details of personal, social,
  10. 10. 10www.drjayeshpatidar.blogspot.com economic and environmental situation of the patient. The diagnosis also involves the following examinations: General physical examination Pulse examination Urine examination Examination of the faeces Examination of tongue and eyes. Examination of skin and ear including tactile and auditory functions. Treatment The basic therapeutic approach is, „that alone is the right treatment which makes for health and he alone is the best doctor who frees one from disease‟. This sums up the principal objectives of Ayurveda, i.e. maintenance and promotion of health, prevention of disease and cure of sickness. Treatment of the disease consists in avoiding causative factors responsible for disequilibrium of the body matrix or of any of its constituent parts through the use of Panchkarma procedures, medicines, suitable diet, activity and regimen for restoring the balance and strengthening the body mechanisms to prevent or minimize future occurrence of the disease. Normally treatment measures involve use of medicines, specific diet and prescribed activity routine. Use of these three measures is done in two ways. In one approach of treatment the three measures antagonize the disease by counteracting the etiological factors and various manifestations 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 and manifestations of the disease process. These two types of therapeutic approaches are respectively known as Vipreeta and Vipreetarthkari treatments.
  11. 11. 11www.drjayeshpatidar.blogspot.com For successful administration of a treatment four things are essential. These are The physician The medicaments The nursing personnel The patient The physician comes first in order of importance. He must possess technical skill, scientific knowledge, purity and human understanding. The physician should use his knowledge with humility, 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 following approved procedures and should be available adequately. The third component of every successful treatment is the role of nursing personnel who should have good knowledge of nursing, 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 be cooperative and obedient to follow instructions of the physician, able to describe ailments and ready to provide all that may be needed for treatment. Preventive Treatment & the concepts of Aetio-Pathogenesis Ayurveda has developed a very vivid analytical description of the stages and events that take place since the causative factors commence to operate till the final manifestation of disease. This gives this system an additional advantage of knowing that possible onset of disease much before the latent symptoms become apparent. This very much enhances the preventive role of this system of medicine by making it possible to take proper and effective steps in advance, to arrest further progress in pathogenesis or to take suitable therapeutic measures to curb the disease in its earliest stage of onset. Types of Treatment The treatment of disease can broadly be classified as
  12. 12. 12www.drjayeshpatidar.blogspot.com a. 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 and psychosomatic diseases. The process involves internal and external purification. The usual practices 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 on metabolic management. It provides needed purificatory effect, besides conferring therapeutic 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 by which disturbed humour subsides or returns to normal without creating imbalance of other humours 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 and sedatives 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 of therapeutic measures and to impede the pathogenetic processes. Emphasis on do‟s and don‟ts of diet etc is laid with the aim to stimulate Agni and optimize digestion and assimilation of food in order to ensure strength of tissues. (d) Nidan Parivarjan is to avoid the known disease causing factors in diet and lifestyle of the patient. It also encompasses the idea to refrain from precipitating or aggravating factors of the disease.
  13. 13. 13www.drjayeshpatidar.blogspot.com (e) Satvavajaya concerns mainly with the area of mental disturbances. This includes restraining the mind from desires for unwholesome objects and cultivation of courage, memory and concentration. The study of psychology and psychiatry have been developed extensively in Ayurveda and have wide range of approaches in the treatment of mental disorders. (f) Rasayana therapy deals with promotion of strength and vitality. The integrity of body matrix, promotion of memory, intelligence, immunity against the disease, the preservation of youth, luster and complexion and maintenance of optimum strength of the body and senses are some of the positive benefits credited to this treatment. Prevention of premature bear and tear of body tissues and promotion of total health content of an individual are the roles that Rasayana therapy plays. Diet and Ayurvedic Treatment In Ayurveda, regulation of diet as therapy has great importance. This is because it considers human body as the product of food. An individual‟s mental and spiritual development as well as his temperament is influenced by the quality of food consumed by him. Food in human body is transformed first into chyle or Rasa and then successive processes involve its conversion 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 nutrients in food or improper transformation of food lead to a variety of disease conditions NATUROPATHY
  14. 14. 14www.drjayeshpatidar.blogspot.com Concepts and Principles Basic Concepts In fact, Nature Cure is a way of life of which we find a number of references in the Vedas and other ancient texts. The morbid matter theory, concept of vital force and other concepts upon which Nature Cure is based are already available in old texts which indicate that these methods were widely practised in ancient India. The whole practice of Nature cure based on the following three principles: Accumulation of morbid matter Abnormal composition of blood and lymph Lowered vitality Nature Cure believes that all the diseases arise due to accumulation of morbid matter in the body and if scope is given for its removal, it provides cure or relief. It also believes that the human body possesses inherent self constructing and self healing powers. The fundamental difference in Nature Cure with other systems is that its theory and practice are based on holistic view point whereas the later‟s approach is specific. Nature Cure does not believe in the specific cause of disease and its specific treatment but takes into account the totality of factors responsible for diseases such as one‟s un-natural habits in living, thinking, working, sleeping, relaxation, sexual indulgence etc, and also considers the environmental factors involved which on the whole disturbs the normal functioning of the body and lead it to a morbid, weak and toxic state. For treatment it primarily stresses on correcting all the factors involved and allowing the body to recover itself. A Nature Cure physician helps in Nature‟s effort to overcome disease by applying correct natural modalities and controlling the natural forces to work within safe limits. The five main modalities of treatment are air, water, heat, mud and space. Principles 1. All disease, their cause and their treatment are one.
  15. 15. 15www.drjayeshpatidar.blogspot.com 2. The basic cause of disease is not bacteria. Bacteria develops after the accumulation of morbid matter when a favourable atmosphere for their growth develops in body. Basic cause is morbid matter and not the bacteria. 3. Acute diseases are our friends not he enemies. Chronic diseases are the outcome of wrong treatment and suppression of the acute diseases. 4. Nature is the greatest healer. Body the capacity to prevent itself from diseases and regain health 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 for diagnosis is not required for treatment. 7. Patients suffering from chronic ailments are also treated successfully in comparatively less time 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 same time. 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 prayer according to one‟s spiritual faith is an important part of treatment. In short, Nature Cure includes all the available non-in vasive treatments and diagnostic modalities which do not interefere with the body‟s natural functional capacity and healing process and are in affirmity with Nature‟s constructive Principles. Develoment and its Status Naturopathy is a system of healing science stimulating the body‟s inherent power to regain health 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 harmony with the self, society and environment. Naturopathy provides not only a simple practical
  16. 16. 16www.drjayeshpatidar.blogspot.com approach to the management of diseases, but a firm theoretical basis which is applicable to all the holistic medical care and by giving attention to the foundations of health; also offers a more economical frame work for the medicine of future generation. Though the basic Nature Cure deals only with Pancha Mahabhoota‟s, the recent developments advocates the practice of drugless therapies like Massage, Electrotherapy, Physiotherapy, Acupuncture and Acupressure, Magnetotherapy etc., Diet plays a major role, above all. History Nature Cure movement started in Germany & other western countries with "Water cure" (Hydrotherapy). Water cure was synonymous with Nature Cure in those early days. The credit of making Water cure world famous goes to Vincent Priessnitz (1799-1851) who was a farmer. Dr. Henry Lindlahr and others go to the extent of crediting him as "Father of Naturopathy". The word "Naturopathy" has been coined by Dr. John Scheel in the year 1895 and was propagated and popularised in the western world by Dr. Benedict Lust. A number of Doctors of modern medicine and others became Nature Cure enthusiasts and gradually added a number of modalities within the fold of Naturopathy and scientifically developed them. Nature Cure movement gained momentum in India as Mahatma Gandhi, "Father of the Nation" became much interested in this system and included it in his programmes. He has also established a Nature Cure Hospital in Uruli Kanchan, Distt. Poona, Maharashtra which is still functioning. Background Naturopathy adopts the following diagnostic methods: Full life case history – covering all the facts of life, since birth. 1. Facial diagnosis – the science of facial expressions by studying the various characteristic features 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 in different forms in treatment and produces several types of physiological effects depending
  17. 17. 17www.drjayeshpatidar.blogspot.com upon temperature and duration. Hydrotherapy is employed in almost all types of disease conditions. 2. Air Therapy: Fresh air is essential for good health. Air therapy is employed in different pressures and temperatures in variety of disease conditions. 3. Fire Therapy: Existence of all the creatures and forms depends upon “Agni” (Fire). In Nature Cure treatment, different temperatures are employed through different heating techniques to produce different specific effects. 4. Space Therapy: Congestion causes disease. Fasting is the best therapy to relieve congestion 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 will you be physically as well as mentally. Your food is your medicine. These are the main slogans of Nature Cure. 7. Massage Therapy: Massage is generally employed for tonic, stimulant and sedative effects. It is an effective substitute for exercise. 8. Acupressure: There are different points on hands, feet & body which are associated with different organs. By applying pressure on these selected points, related organs can be influenced for getting rid of their ailments. 9. Magneto Therapy: Magnets influence health. South and North poles of different powers and shapes are employed in treatment, by applying directly on different parts of the body or through 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 by administering charged water, oil and pills for treatment. Practitioners have claimed that Siddha medicines are effective in reducing the highly debilitating problems that manifest themselves among patients of HIV/AIDS. More research into the efficacy of these medicines is presently in progress.
  18. 18. 18www.drjayeshpatidar.blogspot.com SIDDHA Introduction and Origin Siddha system is one of the oldest systems of medicine in India . The term Siddha means achievements and Siddhars were saintly persons who achieved results in medicine. Eighteen Siddhars were said to have contributed towards the development of this medical system. Siddha literature is in Tamil and it is practised largely in Tamil speaking part of India 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 fertile region of the East and pointedly in India. It is from here that the human race began its culture and career. India may, therefore, be safely stated as that the first country from which human culture and civilization originated and spread. According to Indian history prior to Aryans migration, the Dravidian was the first inhabitant of India of whom the Tamilians were the most prominent. The Tamilians were not only the earliest civilized but also those who may more considerable progress in civilization than any other early people. The languages 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. The science of medicine is of fundamental importance to man‟s well being be and his survival and so it must have originated with man and developed as civilization. It is, therefore rather pointless to try to determine the exact point of time to which the beginning of these systems could be traced They are eternal, they began with man and may end with him. The Siddha
  19. 19. 19www.drjayeshpatidar.blogspot.com was flouriest in south and Ayurveda prevalent in the north. Instead of giving the name of any of individual as the founder of these systems our ancestors attributed their origin to the creator. According to the tradition it was Shiva who unfolded the knowledge of Siddha system of medicine to his concert Parvati who handed it down to Nandi Deva and he the Siddhars. The Siddhars were great scientists in ancient times. According to tradition, the origin of Siddha system of medicine is attributed to the great Siddha Ayastiyar. Some of his works are still standard books of medicine and surgery in daily use among the Siddha Medical practitioners. Basic Concepts This principles and doctrines of this system, both fundamental and applied, have a close similarity to Ayurveda, with specialization in Iatro-chemistry. According to this system the human body is the replica of the universe and so are the food and drugs irrespective of their origin. Like Ayurveda, this system believes that all objects in the universe including human body are composed of five basic elements namely, earth, water, fire, air and sky. The food, which the human body takes and the drugs it uses are all, made of these five elements. The proportion of the elements present in the drugs vary and their preponderance or otherwise is responsible for certain actions and therapeutic results. As in Ayurveda, This system also considers the human body as a conglomeration of three humours, seven basic tissues and the waste products of the body such as faeces, urine and sweat. The food is considered to be basic building material of human body which gets processed into humours, body tissues and waste products. The equilibrium of humours is considered 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 system consider achievement of this state is possible by medicines and meditation.
  20. 20. 20www.drjayeshpatidar.blogspot.com Materia Medica The system has developed a rich and unique treasure of drug knowledge in which use of metals and minerals is very much advocated. Some idea about the depth of knowledge the system possesses in the field of mineral, materia medica can be formed from the detailed drug classification, briefly described below: There are 25 varieties of water-soluble inorganic compounds called „UPPU. These are different types of alkalies and salts. There are 64 varities of mineral drugs that do not dissolve in water but emit, vapours when put 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, heated and 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 its different forms like red sulphide of mercury, mercuric chloride and red oxide of mercury etc. Sulpher, which is insoluble in water, finds a crucial place in Siddha materia medica along with mercury for use in therapeutics and in maintenance of health. The above classification shows detailed knowledge and study of minerals that this system has evolved for treatment. In addition there are drugs obtained from animal sources. The system has published and hand-book on Siddha treatment for common diseases and ailments. Chemistry in Siddha :
  21. 21. 21www.drjayeshpatidar.blogspot.com In Siddha system chemistry had been found well developed into a science auxillary to medicine and alchemy. It was found useful in the preparation of medicine as well as in transmutation of basic metals into gold. The knowledge of plants and mineral were of very high order and they were fully acquainted with almost all the branches of science. The Siddhars were also aware of several alchemical operations divided into several processes such as – calcinations, sublimation, distillation, fusion, separation conjunction or combination, congelation, cibation, fermentation, exaltation i.e. the action or process of refining gold, fixation i.e. bringing to the condition of being non-volatile i.e. to the state of resisting the action of fire, purification, incineration of metals, liquifaction, extraction and so on. Even cupellation of gold and silver which is an essential process in Alchemy in which is claimed 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, especially those in fixing and consolidating certain volatile substances that could not resist the action of fire, such as Mercury, Sulphur, Orpiment, Vermilion, Arsenic etc. continue still a mystery. Strength The Siddha system is capable of treating all types of disease other than emergency cases. In general 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 allergic disorders. Diagnosis and Treatment
  22. 22. 22www.drjayeshpatidar.blogspot.com The diagnosis of diseases involve identifying it causes. Identification of causative factors 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 procedure of urine examination which includes study of it‟s colour, smell, density, quantity and oil drop spreading pattern. It holistic in approach and the diagnosis involves the study of person as a whole as well as his disease. The Siddha System of Medicine emphasises that medical treatment is oriented not merely to disease but has to take into account the patient, environment, the meteorological consideration, age, sex, race, habits, mental frame, habitat, diet, appetite, physical condition, physiological constitution etc. This means the treatment has to be individualistic, which ensures that mistakes in diagnosis or treatment are minimal. The Siddha System also deals with the problems affecting the women‟s health and a lot of formulations are available in the Siddha classics which can counter the problems for a better living. The care for women‟s health starts from the first day of the girl child. The Siddha System strongly advocates breast feeding upto the first three months of the life. The Siddha System believes in the principle of “Food itself is medicine” and during this nursing period, lactating mothers are advised to take the food rich in iron, protein and fibre so as to prevent 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 land up in anaemic conditions. For any diseases due to infection or otherwise, the treatment is individualistic on examination of that particular patient. Once the girl child attained menarche, the Siddha System has got a variety of preparations which can strengthen her reproductive system so as to deliver a healthy child in future. And also, effective treatments are available to take care of the menopausal syndromes, especially problems related to the hormonal imbalance.
  23. 23. 23www.drjayeshpatidar.blogspot.com The Siddha System is effective in treating chronic cases of liver, skin diseases especially “Psoriasis”, rheumatic problems, anaemia, prostate enlargement, bleeding piles and peptic ulcer. The Siddha Medicines which contains mercury, silver, arsenic, lead and sulphur have been found to be effective in treating certain infectious diseases including venereal diseases. UNANI UNANI SYSTEM OF MEDICINE Introduction and Origin Unani System of Medicines originated in Greece and is based on the teachings of Hippocrates and Gallen and it developed in to an elaborate Medical System by Arabs, like Rhazes , Avicenna, Al-Zahravi , Ibne-Nafis and others. Unani Medicines got enriched by imbibing what was best in the contemporary systems of traditional medicines in Egypt, Syria, Iraq, Persia, India, China and other Middle East countries. In India, Unani System of Medicine was introduced by Arabs and soon it took firm roots. The Delhi Sultans (rulers) provided patronage to the scholars of Unani System and even enrolled some as state employees and court physicians. During 13th and 17th century A.D. Unani Medicine had its hey-day in India. During the British rule, Unani System suffered a set back due to withdrawal of State Patronage, but continued to be practiced 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 Unani Medicine survived during the British period.
  24. 24. 24www.drjayeshpatidar.blogspot.com Unani System has Shown remarkable results in curing the diseases like Arthritis, Leucoderma, Jaundice, Liver disorders, Nervous system disorders, Bronchial Asthma, and several other acute and chronic diseases where other systems have not been able to give desired response. Now the system has crossed national boundaries and is popular among the masses globally. Concept and Principles Unani 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 and effects, different complaints, signs and symptoms of the body, external observation, examination of the PULSE (Nubz), urine and stool etc. Unique and special treatment methods like Dieto therapy (Ilaj-bil-Ghiza), Climatic therapy (Ilaj-bil-Hawa), Regimental therapy (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 specific diets or by regulating the quantity and quality of food. Pharmacotherapy (Ilaj-bid-Dawa) is mainly dependent upon local available herbal drugs which make the system indigenous. Similarly, surgery has also been in use in this system for quite long. In fact, the ancient physicians of Unani Medicine were pioneers in this field and had developed their own instruments and techniques. But at present only minor surgery is in vogue in this system. In Unani Medicine, single drugs or their combination in raw are preferred over compound formulations. Further the materia medica of Unani Medicine being vast, the medicines are easy to get as most of them are available locally. The naturally occurring drugs used in this system are symbolic of life and are generally free from side-effects. Such drugs as are toxic in crude form are processed and purified in many ways before use.
  25. 25. 25www.drjayeshpatidar.blogspot.com The Greek and Arab physicians encouraged poly-pharmacy and devised a large number of poly-pharmaceutical recipes which are still in vogue. In Unani Medicine, although general preference is for single drugs, compound formulations are also employed in the treatment of various complex and chronic disorders. Since emphasis is laid on a particular temperament of the individual, the medicines administered are such as go well with the temperament of the patient, thus accelerating the process of recovery and also eliminating the risk of drug reaction. In India, the concept of research in Unani system of medicine was originally perceived by Masih-ul-Mulk Hakim Ajmal Khan in the 1920s. A versatile genius of his time, Hakim Ajmal Khan spotted Dr. Salimuzzaman Siddiqui – a chemist – for undertaking chemical studies on some important medicinal plants used in Unani Medicine. Dr.Siddiqui undertook the task visualized by Msih-ul-Mulk and his discovery of medicinal properties of a plant, commonly known as Asrol (Pagal Booti), led to sustained research that established the unique efficacy of this plant known all over the world as Rauwolfia serpentina, in neurovascular and nervous disorders, such as hypertension, insanity, schizophrenia, hysteria, insomnia and psychosomatic conditions, etc. At present the Unani system of medicine, with its own recognized practitioners, hospitals and educational and research institutions forms an integral part of the national healthcare system. Today, India is considered a world leader in Unani Medicine. YOGA Concepts and Principles
  26. 26. 26www.drjayeshpatidar.blogspot.com Basic Concepts The tradition of Yoga was born in India several thousand years ago. Its founders were great Saints and Sages. The great Yogis gave rational interpretation of their experiences about Yoga and brought a practically sound and scientifically prepared method within every one‟s reach. Yoga philosophy is an Art and Science of living in tune with Brahmand- The Universe. Yoga has its origins in the Vedas, the oldest record of Indian culture. It was systematized 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‟s Yoga Sutra is certainly the most significant wherein no change is possible. It is the only book 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 has taken its place in our every day lives and have undergone a world wide awakening and acceptance in the last few decades. The Science of Yoga and its techniques have now been re-oriented to suit modern sociological needs and lifestyle. Experts of various branches of medicine including modern medical science are realizing the role of these techniques in the prevention of disease and promotion of health. Swami Vivekananda defines Yoga as "It‟s a means of compressing one‟s evolution into a single life or a few months or even a few hours of one‟s bodily existence". By Yoga, Sri Aurobindo, meant a methodological effort towards self perfection by the development of potentialities latent in the individual. Yoga is a science as well an art of healthy living physically, mentally, morally and spiritually. It‟s systematic growth from his animal level to the normalcy, from there to the divinity, ultimately. It‟s no way limited by race, age, sex, religion, cast or creed and can be practiced by those who seek an education on better living and those who wants to have a more meaningful life.
  27. 27. 27www.drjayeshpatidar.blogspot.com Yoga is not a religion; It‟s a philosophy of life based on certain psychological facts and it aims at the development of a perfect balance between the body and the mind that permits union 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 what name we use for the divine-God, Allah, Ishvara, or whatever- anything that brings us closer to understanding that there is a power higher and greater than ourselves is Yoga. When we feel 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 Yoga systematically 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 addition or alteration since these are formulated on the basis of multifarious psychological understanding 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 selfless action – all these pave way for increasing the power of concentration, mental purity and steadiness. 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
  28. 28. 28www.drjayeshpatidar.blogspot.com from the practical point of view for a beginner to begin Yoga, which leads the students gradually 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 chapter expounds Asanas, the second is on pranayama, the third is on Mudras and Bandhas and the fourth is on Pratyahara, Dharana, Dhyana and samadhi. In between these, the author introduces 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 asanas and ending in Samadhi. A set of Asanas, Mudras and Pranayamas practised with faith, preseverance and insight rejuvenates the brain, heart, lungs, liver, pancreas, kidneys, bowels, nerves, muscles, tissues & glands of the body by ensuring oxygenated and balanced blood supply, kindles up the appetite, 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 in society. They are broadly classified into four streams. Swami Vivekananda puts them as Work, Worship, Philosophy and Psychic control. 2. Karma Yoga, the path of work, involves doing action in a skilful way. In other words, it can be said as a way of enjoying work, doing it effortlessly. The success or failure should not be allowed to cause ripples in the mind. 3. „Bhakti Yoga‟ the path of worship is a systematic method of engaging the mind in the practice of divine love. This attitutde of love softens our emotions and tranquillises our mind. 4. Jnana Yoga, the path of philosophy, is a systematic way of tutoring the mind about the realities of life by contemplation. This will strip off the garb of Avidya (ignorance) from our mind and the mind goes to its natural state of rest.
  29. 29. 29www.drjayeshpatidar.blogspot.com 5. Raja Yoga, the path of psychic control, is a systematic process of culturing the mind. It is based 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 an education on better living and those who want to have a more meaningful life. Principles 1. 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 in mind 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 and spiritual 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 (Extral Body) (Psychic Body), Vijyanmaya Kosa (intellect Sheath) and Anandamaya Kosa (Bliss sheath). 5. Like Ayurveda and Naturopathy Yoga also takes up the cleansing of the body as the first measure to fight disease. While Ayurveda performs its pancha karma through the help of ametics purgative Yoga performs them without the help of any drug i.e. by developing full efficiency and control of eliminative systems of the body. Which no other system of health care can do. 6. All the systems of medicine at their best aim at curing the disease whereas Yoga aims at preventing the disease and promoting health by reconditioning the psycho-physiological mechanism of the individual. 7. Yoga emphasises the development of brotherhood, hormony, fraternity and equality not only towards all human beings irrespective of colour, caste, nationality, age and sex but towards all living beings also. This attitude renders the thinking so positive that man is
  30. 30. 30www.drjayeshpatidar.blogspot.com liberated from all mental malice and also all the mental, psychosomatic and physiological diseases arising thereof. 8. The approach of Yoga is not confirmed to various disorders, it aims at bringing under perfect control of the mind, senses and pranic energy and direct them towards healthier channels 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 unlike Ayurvedic, Unani and Homoeopathy. It is not merely a system of treatment but has potential to develop alround health i.e. physical, social, mental and spiritual. For social health, it prescribes the practice of Yama & Niyama and Karma Yoga. A man devoted to karma Yoga looks 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 in them and make them capable of offering a effective ressistance to various environmental pressures and thus, maintains behavioural equanimity and intellectural stability. 11.The practice of Yama – Niyamas purifies the heart of practitioner from vices like attachement, aversion, avarice and infatuation etc. and generates higher ethical qualities like sincerity, 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 the entire psychosomatic consitution of man. A set of Asanas, Mudras and Pranayamas practised with faith, perseverance and insight rejuvenates the brain, heart, lungs, liver, pancreas, kidneys, bowels, all nerves, muscles, tissues, glands of the body by ensuring oxygenated and balanced blood supply, kindless up the appetite, bestows control over seminal fluid, senses and mind and imparts increased vitality, vigour and longevity to the practitioners. Yoga Develoment and its Status
  31. 31. 31www.drjayeshpatidar.blogspot.com In our country, generations of Yogis and Scholars have contemplated their life in timeless fashion to realize that there is a meaning to life and some purpose beyond the human sufferings. They were even convinced that there is a way to escape the tragic problems of life by diverting our mind to something more interesting and everlasting. They were also moved by the suffering they saw around them and wanted that the human being should be free from sufferings & ignorance, to set him on the road to freedom and live healthy . In ancient days, most of the Yogis & Sages used to live in forests. They use to eat whatever is provided by the Nature in its natural form. Not only that the ever changing climate could not harm them a bit. They use to apply holy ash of Havana on their body to keep away the germs & bacteria. The great Yogis and Scholars gave rational interpretations of their experiences and brought these within every one‟s reach by making a practically designed and scientifically prepared method of healthy living. Hence, the science of Yoga emerged to counter all these problems and human sufferings. In the ancient days, Medicine was dominated by magical and religious beliefs which were an integral part of almost all ancient cultures and civilizations. Although primitive man may be extinct, his progeny - the so called " Traditional Healers " , are found everywhere. They live 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 "Father of 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 matter was made up of four elements - Earth, Air, Fire, Water and the same is applicable to body also. They also believed that the equilibrium among these elements maintains normal health status. Medicine has moved from organism to organ and from organ to cell and from the cell to molecular properties. Despite spectacular bio-medical advances and massive expenditures,
  32. 32. 32www.drjayeshpatidar.blogspot.com the death rate and the life expectancy in the developed countries have remained unchanged. Medicine, as practiced today has begun to be questioned and criticised. High technology medicine seems to be getting out of hand and leading health systems in wrong directions. There is an increasing concern about the cost and allocation of health resources, but the efficacy of modern medicine is fundamentally questioned through various points of view. Contemporary medicine is no longer solely an art and science for the diagnosis and treatment of diseases. It is also the science for prevention of disease and promotion of health. With increasing recognition of the failure of existing health services to provide health care, alternative ideas and methods to provide health 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 better living of mankind. Yoga & Naturopathy are the two of its kinds which can be the only answer to the rising levels of health care problems. In recent times there is a growing awareness among the people about the efficacy and utility of Yoga and Nature Cure in keeping one fit at physical, mental, emotional, social and spiritual planes. These systems are emerging as the effective methods and means to improve the total personality and to build a healthy society. Above all, these systems are adopted as a way of life. PUBLIC PRIVATE PARTNERSHIP- Our vision, mission and values Vision Facilitating and enhancing quality public service delivery by being a catalyst for efficient, effective and value-for-money best practice solutions Mission
  33. 33. 33www.drjayeshpatidar.blogspot.com To enable National Treasury and provincial treasuries to effectively regulate PPPs To evolve as a dynamic and sustainable center of excellence for PPPs To drive PPP deal flow by identifying project opportunities that yield value for all stakeholders To provide technical assistance to public institutions through project feasibility, procurement and management; and To promote an enabling environment for PPPs by: o facilitating certainty in the regulatory framework o developing best practice guidelines o providing training o disseminating reliable information; and o driving black economic empowerment in PPPs. Values  Fairness.  Empowerment.  Professionalism.  Integrity.  Passion. PPP Unit history In April 1997, the South African Cabinet approved the appointment of an inter-departmental task team to develop a package of policy, legislative and institutional reforms to create an enabling environment for PPPs. Pioneering PPP projects were undertaken between 1997 to 2000 by the SA National Roads Agency for the N3 and N4 toll roads; by the Departments of Public Works and Correctional Services for two maximum security prisons; by two municipalities for water services; and by SA National Parks for tourism concessions.
  34. 34. 34www.drjayeshpatidar.blogspot.com Drawing early lessons from these projects and from international experience, a Strategic Framework 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 Management Act (Act 1 of 1999). By mid-2000, with technical assistance funding from USAID, GTZ and DIFID, the PPP Unit was established in National Treasury with five professional staff drawn from both the public and private sectors. PPP Unit today National Treasury's PPP Unit now comprises five cross-functional desks: Financial, Legal, Business Development, Project Evaluation, and Municipal, funded almost wholly by Treasury, with the remaining donor support phasing out in 2005. Each professional staff member 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 (eg financial, legal, BEE) advice on every regulated PPP project at various phases in the PPP project cycle. All PPP Definition- PPP as a contract between a public sector institution/municipality and a private party, in which the private party assumes substantial financial, technical and operational risk in the design, financing, building and operation of a project. Two types of PPPs are specifically defined: where the private party performs an institutional/municipal function where the private party acquires the use of state/municipal property for its own commercial purposes A PPP may also be a hybrid of these types. Payment in any scenario involves one of three mechanisms
  35. 35. 35www.drjayeshpatidar.blogspot.com the institution/municipality paying the private party for the delivery of the service, or the private party collecting fees or charges from users of the service, or a combination of these PPPs are good for Black Economic Empowerment There are key features of PPPs that make them inherently excellent for achieving BEE objectives: The long-term nature of PPPs provides an opportune instrument to grow black equity and black management over time. Risk is clearly identified in PPPs, clearly costed and appropriately 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 many PPPs facilitates long-term beneficial partnerships between new black enterprises and experienced, resourced companies - both as equity partners and in project management, and both at the private party SPV and subcontracting levels. Where government is the buyer of a service, and insofar as the service is provided to the agreed standards, there is a steady revenue stream to the private party, reducing risk to new black enterprises. Principal equity sponsors in a PPP are often also first-tier Subcontractors, building incentives for optimal risk management. PPPs provide significant subcontracting opportunities for black enterprises, where early cash-flow benefits can be derived as delivery commences. PPPs have far-reaching broad-based BEE potential: through the subcontracting and procurement mechanisms they can involve a full spectrum of large, medium and small enterprises, and bring tangible local economic development benefits to targeted groups of people. Return on equity to the private party is competitive where risk is properly assumed.
  36. 36. 36www.drjayeshpatidar.blogspot.com There is an increasingly strong demand for black professionals as transaction advisors to both institutions and private parties in PPPs. CENTRALLY SPONSORED SCHEMES 1. DEVELOPMENT AND UPGRADATION OF AYUSH INSTITUTES/COLLEGES This is one of the Centrally Sponsored Schemes being implemented by the Department for Development of AYUSH Institutions. This Scheme has been in operation since last three plan 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 another add-on component of Pharmacy and Nursing Education but the same would be implemented only after the Pharmacy and Nursing Education is regulated by statutory council. Only Govt./ Govt. aided colleges are eligible for assistance for capital The assistance under this scheme is to be provided only once in the 10th Plan period. (ii) Assistance to PG Medical Education
  37. 37. 37www.drjayeshpatidar.blogspot.com Under this scheme only new Department for new Government aided institutes are eligible to receive grant for a period of five years. The assistance is given for staffing, stipend and also to meet sum non-recurring expenditure. (iii)Reorientation Training programme of AYUSH Personnel Government/Pvt./NGO AYUSH institutions are eligible to take up this training programme teachers and doctors though from Government/Government aided private and non-aided pvt.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 to category. (iv) Renovation and strengthening of Hospital wards of Govt./ Govt. aided teaching Hospitals of AYUSH. One time financial assistance upto Rs. 20 lakhs for hospital will be admissible for Government. 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 the scheme. Rs. 10.00 lakhs is provided as assistance to existing Government PG colleges for setting up small computer laboratory with five P.C. alongwith other prescribed equipments. (vii) Up-gradation of academy institutes to the status model Institutes of AYUSH.
  38. 38. 38www.drjayeshpatidar.blogspot.com The scheme envisages development of one Model Institute of AYUSH per system per state during the 10th plan. Government Institutes recognized by the Central Council at least for 10 years and fulfilling at least 50% Council norms are eligible for assistance. A total 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. 60 lakhs). The total outlay for the scheme during the 10th Plan was Rs. 120 crores. During the first four years of the 10th Plan, the total expenditure was Rs. 98.08 crores. Thus the total expenditure is likely to exceed the original outlay for the 10th plan. During the first four years the number of colleges assisted under the scheme was 434. 2 statement indicating the physical and financial achievements are enclosed as Annexure I & II. XIth Plan Proposal So far continuation of these schemes during the XIth Plan is concerned, it is felt that existence of so many components for the same purpose is not required. In view of the past experience of implementing these schemes, this Department is of the view that instead of attending to a small component of assistance required for various AYUSH Institutions, it would be appropriate to concentrate on the overall development of these Institutions so that they may be in a position to impart quality education in AYUSH systems and also contribute to the effectiveness and spread of the Indian Medicine Systems. 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 department may assist only two categories colleges i.e. U.G. Colleges & P.G. Colleges and provide for fixed amount of assistance to be spent on the items actually needed by them on the basis of a master plan. All colleges would be accredited and only those colleges which are viable and can maintain proper standards would be supported. For this purpose a detailed list of the
  39. 39. 39www.drjayeshpatidar.blogspot.com activities /items can be drawn and the colleges should have flexibility in choosing from the same as per their needs. Besides we may have a third component pertaining to model institutes. Under this component some good colleges may be selected and developed into model institutes which would be utilized as Centre of Excellence. For U. G. Colleges the assistance may be Rs. 2 crores per college and for P.G. Colleges the limit may be Rs. 3 crores. So far as development of model institutes is concerned the amount will be decided on the basis of the college specific plan with an upper limit of Rs. 5 crores. Then under fourth component one time capital grant of Rs. 10.00 crores for institutions to States for starting AYUSH Pharmacy/Para Medical Courses in the existing AYUSH colleges is proposed to be provided during XIth Plan. 2. HOSPITALS AND DISPENSARIES The scheme has been designed with a view to make available the benefits of Ayurveda, Unani, Siddha, Yoga & Naturopathy and Homoeopathy to the public at large, so that people can exercise their choice in accessing the health services and to achieve this, it was felt necessary to encourage setting up of general and specialized treatment centers of ISM&H in the allopathic hospitals. Through this scheme the Central Government intends to encourage setting up of general and specialized treatment centers of ISM&H in allopathic hospitals and support the efforts of State Governments to improve the supply position of essential drugs in dispensaries situated in rural and backward areas, so that the faith of people in ISM&H could be enhanced. During the Tenth Plan period so far, the Department sanctioned an amount of Rs 108.00 crores for setting up of 183 ISM Wings in District Hospitals, 44 Special Therapy Centres with 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 to 26,000 AYUSH dispensaries during the period in the country.
  40. 40. 40www.drjayeshpatidar.blogspot.com In the implementation of this scheme has been observed that the implementing agencies i.e. the concerned hospitals and dispensaries complain about the delay in the receipt of money from the State Govt channels. To avoid this delay, the Planning Commission has approved distribution of funds through the State Govt Health Societies from the next Plan period onwards.The State Govts complain that they are finding it difficult to provide the manpower in the absence of any fund for this purpose. XI PLAN PROPOSAL The 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 than satisfactory which may be mainly due to the reason that State Governments were not able to provide for manpower component/ experts which are essentially needed for operationalization of these schemes. It is therefore essential to provide for manpower component on outsourcing or contractual basis. Hence, it is proposed that 10% of the grants given to States under the Scheme of Hospitals & Dispensaries may be used by States for hiring contractual Medical/Para Medical personnel during the XIth Plan period. The responsibility of the recurring expenditure 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 and paramedical staff which the State Governments are not normally able to provide for, it will be important to keep provision for manpower component viz medical and paramedical staff and enhance the overall ceiling of the scheme to Rs 40.00 lakhs in place of Rs 35.00 lakhs per ISM&H Wing. At present, the execution of the scheme depends on the initiative of the state Government
  41. 41. 41www.drjayeshpatidar.blogspot.com and is on pick and choose basis. If integration is to be effected in a realistic fashion and if a choice is to be provided to the common man, opening of an AYUSH wing be made mandatory for all District Hospitals and for which funds should be given for all the District hospitals to all the States. Strengthening of existing AYUSH healthcare facilities: The Scheme of Hospital and Dispensaries should be extended to existing AYUSH Hospitals & Dispensaries also since at present it caters to only allopathic facilities. This will help in recovering and strengthening certain ailing Treatment and Patient care units which need equipment, infrastructure, medicine and training etc but the State Governments find it difficult to support. It is proposed to provide an assistance of Rs. 50.00 lakhs 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 in rural, backward and remote area dispensaries are given to the States. Under this scheme, an amount 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 of an average of 20 patients per dispensary per day is taken into account, the allocated sum comes to Rs 3.45 per patient per day. It is obvious enough that the amount is quite less and therefore it is recommended that it should be increased to Rs 50,000 per annum per dispensary. Besides, at present it is only the „rural and backward area dispensaries‟ which are eligible for grant under this scheme despite Planning Commission agreeing to giving grants to all the AYUSH dispensaries, the requisite amendment in the scheme was not reflected and hence there is need to do so in the 11th Plan. It is also proposed to cover all dispensaries including CHCs/PHCs/District Hospitals having AYUSH wing and also existing AYUSH hospitals at those levels for supply of essential medicines. Even
  42. 42. 42www.drjayeshpatidar.blogspot.com mobile dispensaries are proposed to be covered under this. Accordingly, it is proposed to provide 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 DRUGS The Scheme was implemented in the year 2000-01 of 9th five year plan with two subschemes. 1. To strengthen state Drug Testing Laboratories 2. To strengthen state Pharmacies of ASU&H drugs. Under the scheme maximum of Rs.100.00 lakhs were provided to each State DTL and Pharmacies for following components i.e. renovation of building, procurement of sophisticated instruments and machines and human resource on contractual basis ( for DTL only). The scheme was revised during the mid term appraisal of 10th five year plan and two more 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 GMP requirement. Under the sub-scheme No.1, State Drug Testing Laboratories for ASU&H drugs maximum of Rs. 150.00 Lakhs were assisted to each SDTL for the three components (Building,Machinery/equipment and manpower on contractual basis) Apart from the State
  43. 43. 43www.drjayeshpatidar.blogspot.com Drug Testing Laboratories eminent Laboratories/universities laboratories/ research councils are also eligible for grant-in-aid to strengthen their AYUSH Department with a maximum 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 components i.e.Building as well as Machinery and Equipments. Apart from State Government Universities/ Institutions of ASU&H drugs, co-operative Pharmacies and Research Councils are also eligible for the Central assistance. Under the sub-scheme No. 3, to strengthen state Drug Controllers on ASU&H enforcement mechanism, each State Government/Union territory are eligible for Grant-in-aid for five year for the salaries of one drug controller/Licensing Authority of ASU&H drugs, drug inspectors (one for 500 units), data entry operator, purchase of computer with printer and fax etc. expenditure on TA/DA/training and stationary etc. Under the sub-scheme No.4, to assist AS&U drug manufacturing unit to improve their infrastructure to meet GMP requirement, every AS&U drug manufacturers were assisted with 20% incentive on the expenditure incurred by him for the infrastructure in terms of building and equipments made by them for getting GMP certificate. The maximum limit of the subsidy is Rs. 5.00 Lakhs. During the Xth Plan, against the total outlay of Rs 45.40 crores under this scheme the expected expenditure/revised outlay is Rs 55.28 crores. During the 4 years of the 10th plan 8 State Drug Testing Laboratories, 15 State Pharmacies of ASU&H drugs were assisted, and till date 26 ASU State Drug Testing Laboratories and 43 State ASU&H Pharmacies were assisted. In addition 13 States have been assisted to start Enforcement Mechanism of ASU&H drugs and incentives to 45 AS&U drug manufacturers for getting GMP license have been given under GMP Scheme. Fund have been released through respective state Governments but till date only 30% of the grantee institutes are functional/ partly functional due to the reasons as under:-
  44. 44. 44www.drjayeshpatidar.blogspot.com i) State Governments are not releasing the Grant-in-aid to the concerned grantee institute well 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 have again asked to their respective State Government to procure the instruments by tender basis or by rate contract basis. XI PLAN PROPOSAL To 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. Only second and third instalment will be released to States for completing the work of upgradation of Drug Testing Laboratories/State Pharmacies which were taken up during the Xth Plan. 2. Regarding sub-scheme No.3 no more grant will be released for manpower on contractual basis. Concerns have been expressed in the Parliament as well as in the media regarding weak quality control of AYUSH medicines. Emphasis on strengthening of State Drug Testing Laboratories has not yielded results intended. In the XIth Plan, it is proposed to institute a random testing of AYUSH medicines at the Central as well as at the State levels by involving NABL accredited laboratories spread over the country. It is proposed to assist the State by actual reimbursement of expenditure incurred on random testing of AYUSH medicines through NABL laboratories @ Rs. 500 to Rs. 1000 per sample depending upon various 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 GMP compliant.Now, the Department of AYUSH has made testing for raw materials/finished products/heavy metals etc. mandatory for which manufacturing units require costly equipments like Atomic Absorption Spectometer, HPTLC, HPLC, GLC etc. Accordingly, it
  45. 45. 45www.drjayeshpatidar.blogspot.com is proposed to provide a back ended subsidy of Rs. 50.00 lakhs or 50% of the total project cost 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 a Scheduled Bank on installation of the requisite equipment and on submission of report by any State Licensing Authority or a NABL laboratory to the effect that the such unit has started testing of its raw materials/finished products in their inhouse drug quality control/R&D labs. The Goal of the Mission is to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children. 1. STATE OF PUBLIC HEALTH Public health expenditure in India has declined from 1.3% of GDP in 1990 to 0.9% of GDP in 1999. The Union Budgetary allocation for health is 1.3% while the State‟s Budgetary allocation is 5.5%. -Union Government contribution to public health expenditure is 15% while States contribution about 85% -Vertical Health and Family Welfare Programmes have limited synergisation at operational levels. -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 demographic indicators.
  46. 46. 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 rural population throughout the country with special focus on 18 states, which have weak public health 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 public spending 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 effectively handle increased allocations as promised under the National Common Minimum Programme and promote policies that strengthen public health management and service delivery in the country. • It has as its key components provision of a female health activist in eachvillage; a village health plan prepared through a local team headed by the Health & Sanitation Committee of the Panchayat; strengthening of the rural hospital for effective curative care and made measurable and accountable to the community through Indian Public Health Standards (IPHS); and integration of vertical Health & Family Welfare Programmes and Funds for optimal utilization of funds and infrastructure andstrengthening delivery of primary healthcare. • It seeks to revitalize local health traditions and mainstream AYUSH into the public health system.
  47. 47. 47www.drjayeshpatidar.blogspot.com • It aims at effective integration of health concerns with determinants of health like sanitation & 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 18 high 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, to equitable, 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 locally endemic diseases · Access to integrated comprehensive primary healthcare · Population stabilization, gender and demographic balance. · Revitalize local health traditions and mainstream AYUSH · Promotion of healthy life styles 4. STRATEGIES (a) Core Strategies: • Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own,control and manage public health services. • Promote access to improved healthcare at household level through the female health activist (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 and more Multi Purpose Workers (MPWs).
  48. 48. 48www.drjayeshpatidar.blogspot.com • Strengthening existing PHCs and CHCs, and provision of 30-50 bedded CHC per lakh population for improved curative care to a normative standard (Indian Public Health Standards defining personnel, equipment and management standards). • Preparation and Implementation of an inter-sectoral District Health Plan prepared by the District Health Mission, including drinking water, sanitation & hygiene and nutrition. • Integrating vertical Health and Family Welfare programmes at National, State, Block, and District levels. • Technical Support to National, State and District Health Missions, for Public Health Management. • Strengthening capacities for data collection, assessment and review for evidence based planning, monitoring and supervision. • Formulation of transparent policies for deployment and career development of Human Resources for health. • Developing capacities for preventive health care at all levels for promoting healthy life styles, 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 ensure availability 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 of Medical care and Medical Ethics. • Effective and viable risk pooling and social health insurance to provide health security to the poor by ensuring accessible, affordable, accountable and good quality hospital care. 5. PLAN OF ACTION COMPONENT (A): ACCREDITED SOCIAL HEALTH
  49. 49. 49www.drjayeshpatidar.blogspot.com ACTIVISTS • 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 community and 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 the Panchayat. • She will be an honorary volunteer, receiving performance-based compensation for promoting universal immunization, referral and escort services for RCH, construction of household toilets, and other healthcare delivery programmes. • She will be trained on a pedagogy of public health developed and mentored through a Standing Mentoring Group at National level incorporating best practices and implemented through active involvement of community health resource organizations. • She will facilitate preparation and implementation of the Village Health Plan along with Anganwadi worker, ANM, functionaries of other Departments, and Self Help Group members, 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 focus States. 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 States under the programme. • She will be given a Drug Kit containing generic AYUSH and allopathic formulations for common 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 level modifications. • Cascade model of training proposed through Training of Trainers including contract plus distance learning model • Training would require partnership with NGOs/ICDS Training Centres and State Health Institutes.
  50. 50. 50www.drjayeshpatidar.blogspot.com COMPONENT (B): STRENGTHENING SUB-CENTRES • Each sub-centre will have an Untied Fund for local action @ Rs. 10,000 per annum. This Fund will be deposited in a joint Bank Account of the ANM & Sarpanch and operated 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 wherever needed, sanction of new Sub-centres as per 2001 population norm, and upgrading existing Sub-centres, including buildings for Sub-centres functioning in rented premises will be considered. COMPONENT (C): STRENGTHENING PRIMARY HEALTH CENTRES Mission aims at Strengthening PHC for quality preventive, promotive, curative, supervisory and Outreach services, through: • Adequate and regular supply of essential quality drugs and equipment (including Supply of Auto Disabled Syringes for immunization) to PHCs • Provision of 24 hour service in 50% PHCs by addressing shortage of doctors, especially in high focus States, through mainstreaming AYUSH manpower. • Observance of Standard treatment guidelines & protocols. • In case of additional Outlays, intensification of ongoing communicable disease control programmes, new programmes for control of noncommunicable diseases, upgradation of 100% 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 CARE A key strategy of the Mission is: • Operationalizing 3222 existing Community Health Centres (30-50 beds) as 24 Hour First Referral Units, including posting of anaesthetists. • Codification of new Indian Public Health Standards, setting norms for infrastructure, staff,
  51. 51. 51www.drjayeshpatidar.blogspot.com equipment, 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) to meet the population norm as per Census 2001, and bearing their recurring costs for the Mission period could be considered. COMPONENT (E): DISTRICT HEALTH PLAN • District Health Plan would be an amalgamation of field responses through Village Health Plans, 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 District Health Mission for monitoring. • District becomes core unit of planning, budgeting and implementation. • Centrally Sponsored Schemes could be rationalized/modified accordingly in consultation with 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 into one 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 of MBA, Inter Charter/Inter Cost and Data Entry Operator, for improved programme management COMPONENT (F): CONVERGING SANITATION AND HYGIENE UNDER NRHM • Total Sanitation Campaign (TSC) is presently implemented in 350 districts, and is proposed to cover all districts in 10th Plan. • Components of TSC include IEC activities, rural sanitary marts, individual household
  52. 52. 52www.drjayeshpatidar.blogspot.com toilets, 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 CONTROL PROGRAMMES • National Disease Control Programmes for Malari a, TB, Kala Azar, Filaria, Blindness & Iodine Deficiency and Integrated Disease Surveillance Programme shall be integrated under the 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 HEALTH GOALS, 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
  53. 53. 53www.drjayeshpatidar.blogspot.com • Management plan for PPP initiatives: at District/State and National levels COMPONENT (I): NEW HEALTH FINANCING MECHANISMS A Task Group to examine new health financing mechanisms, including Risk Pooling for Hospital Care as follows: • Progressively the District Health Missions to move towards paying hospitals for services by way of reimbursement, on the principle of “money follows the patient.” • Standardization of services – outpatient, in-patient, laboratory, surgical interventions- and costs 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 guidance on protocols and cost comparisons. • All existing CHCs to have wage component paid on monthly basis. Other recurrent costs may be reimbursed for services rendered from District Health Fund. Over the Mission period, the CHC may move towards all costs, including wages reimbursed for services rendered. • A district health accounting system, and an ombudsman to be created to monitor the District Health Fund Management , and take corrective action. • Adequate technical managerial and accounting support to be provided to DHM in managing 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 the poor, and monitor the schemes. • The IRDA will be approached to promote such CBHIs, which will be periodically evaluated for effective delivery. COMPONENT (J): REORIENTING HEALTH/MEDICAL EDUCATION TO SUPPORT RURAL HEALTH ISSUES • While district and tertiary hospitals are necessarily located in urban centres, they form an
  54. 54. 54www.drjayeshpatidar.blogspot.com integral 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 need assessment. • 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 Panchayat Representative/s, ANM/MPW, Anganwadi worker, teacher, ASHA, community health volunteers • Rogi Kalyan Samiti (or equivalent) for community management of public hospitals • District Health Mission, under the leadership of Zila Parishad with District Health Head as Convener and all relevant departments, NGOs, private professionals etc represented on it • State Health Mission, Chaired by Chief Minister and co-chaired by Health Minister and with 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 Welfare with Deputy Chairman Planning Commission, Ministers of Panchayat Raj, Rural Development and Human Resource Development and public health professionals as members, to provide policy support and guidance to the Mission. • Empowered Programme Committee chaired by Secretary HFW, to be the Executive Body of 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

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