Dr. G Nandhini


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Dr. G Nandhini

  2. 2. What is the Human Right to Health? <ul><li>Every woman, man, youth and child has the human right to the highest attainable standard of physical and mental health, without discrimination of any kind. Enjoyment of the human right to health is vital to all aspects of a person's life and well-being, and is crucial to the realization of many other fundamental human rights and freedoms. </li></ul>
  3. 3. Human Rights relating to health <ul><li>The highest attainable standard health </li></ul><ul><li>Equal access to adequate health care and health-related services </li></ul><ul><li>Equitable distribution of food. </li></ul><ul><li>Access to safe drinking water and sanitation. </li></ul><ul><li>Adequate standard of living and adequate housing. </li></ul>
  4. 4. Human Rights relating to health <ul><li>safe and healthy environment. </li></ul><ul><li>a safe and healthy workplace </li></ul><ul><li>freedom from discrimination and discriminatory social practices. </li></ul><ul><li>education and access to information relating to health </li></ul><ul><li>appropriate environment for physical and mental development to children </li></ul>
  5. 5. Governments' Commitments to Human Right to Health <ul><li>Most governments are committed to ensuring the realization of the Human Right to Health through declarations through many forums such: </li></ul><ul><li>Earth Summit in Rio,  </li></ul><ul><li>International Conference on Population and Development in Cairo, </li></ul><ul><li>World Summit for Social Development in Copenhagen,  </li></ul><ul><li>Habitat II conference in Istanbul. </li></ul><ul><li>And many more </li></ul>
  6. 6. National Rural Health Mission and Human health rights :- the connection <ul><li>NRHM is a response by the Government to human rights related to health </li></ul><ul><li>Reaffirms Government's commitment to meet people's aspirations for better health and access to health care. </li></ul>
  7. 7. What are ethical imperative to solve the human rights issues in India ? <ul><li>Growing inequalities in access to health care . </li></ul><ul><ul><li>On one hand corporate hospitals with state-of-the-art facilities cater to the elite </li></ul></ul><ul><ul><li>On the other hand the majority are left to market forces and medical expenditure is the second highest cause of rural indebtedness. </li></ul></ul><ul><li>Health indicators like the infant mortality rate have stagnated or even worsened in some large states, despite growing national wealth </li></ul>
  8. 8. Important questions:- Can NRHM <ul><li>become part of a bold paradigm shift, from providing services through top down planning </li></ul><ul><li>build capacity and empower communities to manage their own health care needs ? </li></ul><ul><li>make an equitable reach to all rural communities? </li></ul>
  9. 9. Goals of NRHM <ul><li>Reduction in IMR & MMR. </li></ul><ul><li>Improved access to Maternal and Child Health care services, improved Nutrition and Sanitation. </li></ul><ul><li>Prevention and control of communicable and non communicable diseases. </li></ul>
  10. 10. Goals of NRHM <ul><li>Strengthening Comprehensive Primary Health Care services. </li></ul><ul><li>Achieving population stabilization and sex balance in population. </li></ul><ul><li>Mainstream AYUSH, revitalize local health tradition. </li></ul>
  11. 11. NRHM – The Concept (I) <ul><li>The National Common Minimum Programme: </li></ul><ul><li>Allocation for Public Health to go up from 0.9% of GDP to 2-3% over next 5 years. </li></ul><ul><li>Architectural correction of Health Sector to handle such increased allocations </li></ul>
  12. 12. NRHM – The Concept (I) <ul><li>Policies that strengthen public health management and service delivery in the country. </li></ul><ul><li>Focus to change from Outlays to Outcomes. </li></ul><ul><li>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. </li></ul>
  13. 13. NRHM – The Concept (II) Health Health Determinants RCH-II NDCP AYUSH General Curative Care Nutrition Sanitation & Hygiene Drinking Water Supply
  14. 14. NRHM RCH & FW Additionalities under NRHM Immuni- sation NDCP Convergence
  15. 15. Core Strategies <ul><li>PRIs to manage Public Health Services. </li></ul><ul><li>Village level female health activist (ASHA). </li></ul><ul><li>Health Plan for each village – ward . </li></ul><ul><li>Untied Fund at sub-centre. </li></ul><ul><li>Strengthening the Rural hospital for effective curative care </li></ul><ul><li>Accountable to the community – measurable outcomes </li></ul>
  16. 16. <ul><li>Upgrading all Public Health Institutions to Indian Public Health Standards (IPHS). </li></ul><ul><li>Preparation and Implementation of an inter- sectoral District Health Plan. </li></ul><ul><li>Integrating vertical Health and Family Welfare Programmes and Societies for optimal utilization of funds and infrastructure and strengthening delivery of primary healthcare. </li></ul><ul><li>Mainstreaming AYUSH </li></ul>
  17. 17. <ul><li>Infant Mortality Rate reduced to 30/1000 live births-(Kerala from10 to7) </li></ul><ul><li>Maternal Mortality Ratio reduced to 100/100,000-(Kerala from80 to 40/100,000) </li></ul><ul><li>Total Fertility Rate reduced to 2.1(in kerala to 1.5) </li></ul><ul><li>.(couple protection rate raised to 65% from 61.5 in Kerala) </li></ul><ul><li>Malaria mortality reduction rate – 50% up to 2010, additional 10% by 2012 </li></ul><ul><li>Kala Azar mortality reduction rate: 100% by 2010 and sustaining elimination until 2012 </li></ul><ul><li>Filaria/Microfilaria reduction rate: 70% by 2010, 80% by 2012 and elimination by 2015 </li></ul><ul><li>Dengue mortality reduction rate: 50% by 2010 and sustaining at that level until 2012 </li></ul><ul><li>Japanese Encephalitis mortality reduction rate: 50% by 2010 and sustaining at that level until 2012 </li></ul>Expected Outcomes National Level
  18. 18. <ul><li>Drugs for common ailments available at Sub-centre/ hospital level </li></ul><ul><li>Assured good quality hospital care by assured availability of doctors, drugs and quality services at PHC/CHC level </li></ul><ul><li>Improved facilities for institutional delivery </li></ul><ul><li>Assured healthcare under risk pooling models </li></ul><ul><li>Provision of household toilets </li></ul><ul><li>Improved outreach services through mobile medical unit </li></ul>Expected Outcomes: Community Level
  19. 19. Expected Outcomes : Community Level <ul><li>Availability of trained ASHA, with drug kit in selected states </li></ul><ul><li>Monthly Health and Nutrition Day at Anganwadi for immunization, ante & post natal care, nutrition and other services related to mother & child healthcare, and services related to disease control programmes. </li></ul><ul><li>Improved access to Universal Immunization through alternate vaccine delivery and improved mobilization services under the programme and improved quality of services by induction of Auto Disabled Syringes, </li></ul>
  20. 20. INTEGRATED SERVICE DELIVERY UNDER NRHM IDD PFA&D PEOPLE NVBDCP RNTCP NACP IDSP RCH SHP Nutrition Sanitation Water Supply Education PRI To Plan & Monitor Programme Community-Awareness-Access-Participation Women & Child Development (WCD ) NCCP N B CP
  21. 21. <ul><li>RCH </li></ul><ul><li>IMMUNISATION </li></ul><ul><li>Additionalities </li></ul><ul><li>Disease control programmes </li></ul><ul><li>Convergence </li></ul>
  22. 22. <ul><li>Broad aims under RCH II in KERALA </li></ul><ul><li>To reduce MMR to 40 per 100 000 live births </li></ul><ul><li>To reduce the IMR to 7 </li></ul><ul><li>TFR to be brought down to 1.5 </li></ul><ul><li>Incidence of RTI/STI/AIDS reduced by 75% amongst adult population and incidence of cancer detected at an early stage </li></ul><ul><li>Adolescent care and information needs, unmet needs and care-seeking behaviour of adolescents addressed </li></ul><ul><li>Quality RCH services provided for the Tribal, Coastal and Urban Slum population </li></ul>
  23. 23. Broad aims under RCH II – Contd . 7. Incidence of Gender based violence reduced in Kerala 8. Health concerns of older population addressed 9. Health Seeking Behaviour on health issues especially for RCH issues improved in the society 10. Health care of BPL, under served marginalized groups and vulnerable sections provided 11. Quality RCH services provided through Capacity Development of Health care personnel 12. Enhanced client satisfaction through improved quality of services .
  24. 24. What NRHM has achieved in terms of meeting the 10 health rights ? <ul><li>Ward Health and Sanitation committees </li></ul><ul><li>ASHAs </li></ul><ul><li>Need based BCC/IEC Activities </li></ul><ul><li>ARSH Clinics, question box in schools </li></ul><ul><li>School Health Programme and CFSI </li></ul><ul><li>Infrastructure – IPHS,NABH,NABL </li></ul><ul><li>Manpower </li></ul><ul><li>Funds-HMC-Decentralisation-LSGIs </li></ul><ul><li>Convergence-AYUSH,TSC,SWDept,Education dept </li></ul><ul><li>CAMPS- AROGYAMELAs , RCH,TRIBAL,migrant labour </li></ul><ul><li>MNGO/FNGO </li></ul><ul><li>Palliative care-Govt Policy </li></ul>
  25. 25. <ul><li>RSBY – CHIS </li></ul><ul><li>HMIS – HISP </li></ul><ul><li>CME – professional bodies, other departments </li></ul><ul><li>JSY </li></ul><ul><li>FP/FW activities </li></ul><ul><li>Immunisation – out reach, MISP,AEFI,surveillance </li></ul><ul><li>Drug availability </li></ul><ul><li>Transportation </li></ul><ul><li>ARI,ADD </li></ul><ul><li>RTI/STI services – KSACS </li></ul><ul><li>NGOs - PPP </li></ul>
  26. 26. What NRHM is planning to do in terms meeting 10 health right issues ? <ul><li>KUDUMBASREE </li></ul><ul><li>NCD </li></ul><ul><li>INFERTILITY </li></ul><ul><li>Palliative Care-integration with health dept </li></ul><ul><li>Nutrition </li></ul><ul><li>BFHI </li></ul><ul><li>DLHS – 3 </li></ul><ul><li>INTEGRATED PIP </li></ul>
  27. 27. What could be some of the parameters to be measured <ul><li>Availability of health centers in your area </li></ul><ul><li>Availability of staff and personnel </li></ul><ul><li>Availability of infrastructure, services and medicines </li></ul><ul><li>Availability of services for women and children </li></ul><ul><li>How well are institutions PHC CHC managed </li></ul><ul><li>Are the problems faced by the doctors and other personnel managed </li></ul><ul><li>Changes being introduced by NRHM </li></ul><ul><li>quality of training, actual activities and tasks performed by ASHA </li></ul>
  28. 28. What can you do to promote health as a human right ? <ul><li>Serve as ASHA members </li></ul><ul><li>Participate as volunteers for surveys </li></ul><ul><li>Motivate formation self help groups </li></ul><ul><li>Form NGOs and assist the NRHM </li></ul><ul><li>Promote Public Private Participation </li></ul><ul><li>Be a part of ‘public watch’ of NRHM and give feedback </li></ul><ul><li>Participate in NRHM day celebrations </li></ul><ul><li>STRENGTHEN WH&SCs </li></ul>
  29. 29. Thank you THANK YOU