Health status of various special groups as tribals, elderly, females, disabled, migrants, and government schemes for them

1. Health status of special groups
By:
Alka Mishra
M. Sc. Nursing 1st year

2. index
• Introduction
• Health care delivery
• Special groups
» Women
» Children
» Tribal
» Aged
» Disabled
» Migrant
» Scheduled caste
• Summary
• Conclusion

3. introduction
Health is…..
……..a state of complete Physical, Mental and
Social well being and not merely an absence of
disease or infirmity….
…..which allows a person to live a
socio-economically productive life.
Illness is…..
…a state in which a person’ s physical,
emotional, intellectual, social or spiritual
functioning is diminished or impaired.

4. Conted....
Health care is...
…….multitude of services rendered to
individuals or communities by the agents of
health services or professional for the purpose of
Promoting
Restoring and
Maintaining health
Embraces all the goods and services designed for
“prevention, promotion and rehabilitation
interventions” includes Medical Care

5. Health care provider
A person or organization that provides services
and/or health care personnel….
….to deliver proper health care in a systematic
way to any individual in need of health care
services.
Could be a government…or…
….the health care industry,
….a health care equipment company,
….an institution such as a hospital or laboratory.
Health care professionals may include physicians,
dentists ,nurses and other support staff.

6. Health services
Permanent countrywide system of established
institutions with the objective of…
….coping with the various health needs and
demands of population…
…thereby provide health care to individuals and
community with preventive and curative activities
….utilizing health care workers

7. Components of healthcare delivery system

8. 1. Structure of health system
 Aspects of the design of health services that influences the way in
which they are delivered Includes….
 Number and type of personnel and staff
 Way of these personnel organized to work
 Nature and extend of facility and equipment
 Range of services offered
 System of management and amenities
 Financing
 Enumeration and determination of the eligible population for these
services
 Governance and decision making

9. 2. Process of health care delivery
Consists of two parts
Behavior of professionals
Recognition of the problem i.e. diagnosis
Diagnostic procedure
Recommendation of treatment or management
Appropriate follow up
Participation of people
Utilization of services
Understanding the recommendations
Satisfaction with the services
Participation in decision making

10. Conted....
3. Outcomes of health care
 Aspects of health that results from interventions provided by
the health system
4. Flow of patients in health care system
 Varies from country to country
 India harbors a multistage (three tier) system, where majority
of health care is delivered by community health care worker
 Indian system is more cost effective if health workers are
skilled and effectively supervised
 Such system could one of the reason to reduced cost of
health care in developing countries

11. Levels of health care
 Primary Health care
 Provided at the community level
 Secondary health care
 Provided at PHC, CHC, DH etc.
 Tertiary health care
 Provided at hospitals

12. Health Care Delivery System in India
India is a union of 28 states and 7 union territories.
States are largely independent in matters relating to the
delivery of health care to the people.
Each state has developed its own system of health care
delivery, independent of the Central Government.
The Central Government’s responsibility
 policy making ,
 planning ,
 guiding,
 assisting,
 evaluating and coordinating the work of the State Health
Ministries.

13. Health system in India

14. At centre
The official “organs” of health system at
national level are

15. Mohfw organizational chart

16. Functions of mohfw
Union list
 International health relations and administration of port quarantine
 Administration of Central Institutes
 Promotion of research
 Regulation and development of medical, pharmaceutical, dental and
nursing professions
 Establishment and maintenance of drug standards
 Census and collection and publication of other statistical data
 Coordination with states

17. Conted.....
Concurrent List:
 Prevention of Communicable disease
 Prevention of food adulteration
 Control of drug and poison
 Vital statistics
 Labor welfare
 Economic and social planning
 Population control and family planning

18. Dghs organizational chart

19. Functions of dghs
General functions
 Surveys
 Planning
 Coordination
 Programming and appraisal of all health matters
Specific function
 International health relations and quarantine of all major ports in
country and international airport.
 Control of drug standards
 Maintain medical store depots
 Administration of post graduate training programmes

20. Conted.....
 Administration of certain medical colleges in India
 Conducting medical research through Indian Council of
Medical Research ( ICMR )
 Central Government Health Schemes.
 Implementation of national health programmes
 Preparation of health education material for creating health
awareness through Health Education Bureau
 Collection, compilation, analysis, evaluation and
dissemination of information
 National Medical Library

21. Central council of health

22. functions
To consider and recommend broad outlines of
policy related to matters concerning health like
environment hygiene, nutrition and health
education.
To make proposals for legislation relating to
medical and public health matters.
To make recommendations to the Central
Government regarding distribution of grants-in-
aid.

23. State level

24. District level
• Districts
Tehsils /Talukas (200-600
villages)
Community Development Blocks
(approx 100 Villages & 80,000 -1.2 Lac
Pop)
Municipalities & Corporations
Villages
Panchayats
Town Area Committee
(5,000-10,000 Pop)
Municipal Board
(10,000- 2 Lac Pop)
Corporations (> 2 lac
pop)

25. Health care system
 Intended to delivery healthcare services and represented by five
major sectors different from each other by health technology
Public health sector
a. Primary health care
 Primary health centre
 Sub centre
b. Hospitals/Health centre
 Community health centre
 Rural hospitals
 District hospitals/health centre
 Specialist hospitals
 Teaching hospitals
c. Health insurance schemes
 Employees State Insurance
 Central Govt. Health Schemes
d. Other agencies
Defense services
Railways

26. Conted.....
2. Private sector
a. Private hospitals, polyclinic, nursing homes and
dispensaries
b. General practitioners and clinics
3. Indigenous system of medicine
a. Ayurveda and Siddha
b. Unani and Tibbi
c. Homeopathy
d. Unregistered practitioners
4. Voluntary health agencies
5. National health programmes

27. Special groups
• Special groups are the groups which would be
vulnerable under any circumstances (e.g.
where the adults are unable to provide an
adequate livelihood for the household for
reasons of disability, illness, age or some other
characteristic), and groups whose resource
endowment is inadequate to provide
sufficient income from any available source.

28. Special groups
• Women
• Children
• Tribal
• Aged
• Disabled
• Migrant
• Scheduled caste

29. Factors affecting health
Lack of job
Low paid unorganised
labour
Lack of health services
Poor nutrition
Illitrecy
Disc
rimi
nati
on

30. Women
• Gender is one of many social determinants of
health—which include social, economic, and
political factors—that play a major role in the
health outcomes of women in India.
Therefore, the high level of gender inequality
in India negatively impacts the health of
women.

31. Status of health
The low status of—and subsequent
discrimination against—women in India can
be attributed to
o cultural norms.
o Societal forces of patriarchy,
o hierarchy
o multigenerational families

32. Conted......
• Highest rate of malnourishment
• 50% of pregnant /non pregnant anaemic
• A 2012 study by Tarozzi have found the
nutritional intake of early adolescents to be
approximately equal. However, the rate of
malnutrition increases for women as they
enter adulthood.
• Furthermore, Jose et al. found that
malnutrition increased for ever-married
women compared to non-married women.

33. Key Reproductive & child health
indicators
Indicator (%)
• Female literacy 59.1
• Women with BMI below normal 38.8
• Women who had at least 3 ANC visits 42.8
• Women consumed IFA for 90 or more days 18.1
• Institutional births 31.1
• Deliveries by TBA 39.1
• Life expectancy at birth 68.3
• TFR Rural 2.7
Urban 1.9
Total 2.4
• Initiation of breast feeding with in 1 hr 21.5
• Exclusive breast feeding(0-6 Months) 48.3
• Complementary feeding (6-9 Months) 53.8

34. Other indicators
• Anaemia & malnutrition
• Reproductive health & rights
• HIV/AIDS
• Mental health
• Breast cancer
• Domestic violence

35. Trend of Birth rate, Death rate, Infant Mortality rate, Total Fertility rate,
Sex ratio at Birth and Sex ratio of children (0-4 age group), India
16.0
18.0
20.0
22.0
24.0
26.0
28.0
2008 2009 2010 2011 2012 2013
Birth rate
Total Rural Urb an
6.2
6.4
6.6
6.8
7.0
7.2
7.4
7.6
7.8
8.0
8.2
2008 2009 2010 2011 2012 2013
Death rate
Total Male Female
35
40
45
50
55
60
2008 2009 2010 2011 2012 2013
Infant mortality rate
Total Male Female
1.5
2.0
2.5
3.0
3.5
2008 2009 2010 2011 2012 2013
Total fertility rate
Total Rural Urb an
890
900
910
920
2007-09 2008-10 2009-11 2010-12 2011-13
Sex ratio at birth
Total Rural Urb an
890
900
910
920
2007-09 2008-10 2009-11 2010-12 2011-13
Sex ratio of children (0-4 age group)
Total Rural Urb an

36. Causes of maternal deaths in india
Haemorrhage
37%
Sepsis
11%
Abortion
8%
Obstructed labour
5%
Hypertensive
disorder
5%
others
34%

37. Govt initiative
All the elements of RCH- II integrated in NHM
• Essential Obstetric Care
• Quality Ante Natal care
• Post natal care for mother and newborn
• Skilled Attendance at Birth
• Provision of Emergency Obstetric and Neonatal
Care at FRUs
• Augmentation of skilled human resources for
Maternal Health

38. Conted.....
• Safe Abortion Services/ Medical termination
of Pregnancy (MTP)
• Supply of Nischay Pregnancy detection kits to
sub centres
• Maternal Death Review
• MCTS
• A Joint MCP Card
• JSSK

39. Conted.....,
• Gender Based Violence (detection & support)
• Setting up of Blood Storage Centre (BSC) at
FRUs
• Scheme for promotion of menstrual hygiene
among adolescent girls in rural India

40. Children
• A person between birth and full growth; a boy
or girl
Neonate
Under 5 yrs of age

41. Health status indicators

42. • Neonatal mortality rate 2012 31
• Immunization coverage (%) 2012, BCG 87
• Immunization coverage (%) 2012, DPT1 88
• Immunization coverage (%) 2012, DPT3 72
• Immunization coverage (%) 2012, polio3 70
• Immunization coverage (%) 2012, MCV 74
• Child marriage (%) 2002-2012*, married by 15 18.2
• Child marriage (%) 2002-2012*, married by 18 47.4

43. • Low birth weight (%) 2008-2012* 28
• Early initiation of breastfeeding (%), 2008-2012*
40.5
• Exclusive breastfeeding <6 months (%), 2008-2012*
46.4
• Introduction of solid, semi-solid or soft foods 6-8
months (%), 2008-2012* 56.1
• Breastfeeding at age 2 (%), 2008-2012* 76.8
• Underweight (%) 2008-2012*, moderate & severe
42.5
• Underweight (%) 2008-2012*, severe 15.8

44. • Stunting (%) 2008-2012*, moderate & severe 48
• Wasting (%) 2008-2012*, moderate & severe 19.8
• Overweight (%) 2008-2012*, moderate & severe 1.9
• Vitamin A supplementation full coverage (%) 201259
• Iodized salt consumption (%) 2008-2012* 71.

45. Conted.....
pnuemonia
8%
preterm
19%
asphyxia
10%
sepsis
8%
others
2%congenital
5%
diarrhoea
1%
diarrhoea
11%
measles
3%
meningitis
2%
injuries
4%
others
12%
pnuemonia
15%

46. CONTED.....
· It is estimated that 14% of the 4.2 million HIV/AIDS cases are
children below the age of 14.
· A study conducted by the ILO found that children of infected
parents are heavily discriminated-35% were denied basic amenities
and 17% were forced to take up petty jobs to augment their
income.
· Child labor in India is a complex problem and is rooted in poverty.
· Data suggests that there are 11.28 million working children in
India.
· Over 85% of this child labor is in the country’s rural areas and this
number has risen in the past decade.

47. Govt initiative
Priority interventions:
1. Home-based newborn care and prompt referral
2. Facility-based care of the sick newborn
3. Integrated management of common childhood
illnesses (diarrhea, pneumonia and malaria)
4. Child nutrition and essential micronutrients
supplementation & ICDS
5. Immunization
6. Early detection and management of defects at
birth, deficiencies, diseases and disability in
children (0–18 years)

48. Conted......
• Other Schemes Include:
– Balika Samriddhi Yojana (BSY)
– Kishori Shakti Yojana (KSY)
– Nutrition Programme for Adolescent Girls (NPAG)
– Early Childhood Education for 3-6 Age Group Children
Under the Programme of Universalization of
Elementary
– Scheme for welfare of Working Children in need of
Care and
– An Integrated Programme for Street children

49. Conted....
– Child line Services
– Central Adoption Resource Agency
– Rajiv Gandhi National Crèche Scheme For the Children
of Working Mother
– Programme for Juvenile Justice
– General Grant-in-Aid Scheme
– Pilot Project to Combat the Trafficking of Women and
Children for Commercial Sexual Exploitation in
Destination Area
– Mid-day Meal Scheme
– National Crèche Fund

50. • NEW COMPONENT
• IFA to be distributed by
ASHA during doorstep
delivery of
contraceptives; IFA
tablets to be given for 52
weeks each year
• As part of the
antenatal care
package, at all
levels of health
facilities , sub
centre and
outreach
•NEW COMPONENT
•Weekly IFA
supplementation
(WIFS) for both
adolescents boys &
girls in
Government/Governm
ent aided/municipal
schools
• 6-60 months: IFA
administered
biweekly, on fixed
days , under direct
supervision of
ASHAs ;
5-10 years: at AWC
& through schools
Children Adolescent
Reproductive
Age group
Pregnant &
lactating
women

51. Tribal health
INTRODUCTION:
• Being among the poorest and most
marginalised groups in India, tribals
experience extreme levels of health
deprivation.
• The tribal community lags behind the national
average on several vital public health
indicators, with women and children being the
most vulnerable

52. Conted....
Definition:
• A tribe is a distinct people, dependent on their
land for their livelihood, who are largely self-
sufficient, and not integrated into the national
society

53. Features of scheduled tribes
• Show primitive traits
• Have distinct culture
• Shyness of contact with public at large
• Geographical isolation
• Social & economic backwardness
• Pre- Agrarian technology
• Stagnant or declining population

54. • Tribal constitute 8.61% of the total population
(2011 Census) and cover about 15% of the
country’s area.
• 75% of them reside in central India

55. Key indicators of tribal health

56. Sex ration & child sex ratio
Indicator Sex Ratio (/1000 Female) Child Sex Ratio (/1000 Female)
2001 2011 2001 2011
Total
population
Total 933 943 927 919
Rural 946 949 934 923
Urban 900 929 907 905
Scheduled
tribes
Total 978 990 973 957
Rural 981 991 974 959
Urban 944 980 951 940

57. Literacy rate

58. Conted.....

59. Nutritional status
• Nutritional Status:
• 46.6% ST women have BMI below 18.5,
indicating a high prevalence of nutritional
deficiency.
• 68.5 % (55%)of women and 39.6 % (25%) of
men are anemic – highest among all social groups
• Only 21% of ST children age 12-35 months
received vitamin A supplements
• Among children age 6-59 months, the figure
drops further to only 14.6%.
• 76.8% of ST children are anemic - 26.3 % mild,
47.2 % moderate & 3.3 % severe

60. Disease encounter
Communicable Disease:
• Water borne and communicable diseases:
• Gastrointestinal disorders are very common,
leading to marked morbidity and malnutrition.
• Malaria and tuberculosis.
• Spectrum of viral and venereal diseases.

61. Genetic disorders
• High prevalence of genetic disorders mostly
involving red blood cells: Genetically
transmitted disorders like sickle cell anemia.
• G6PD deficiency and different forms of
Thalassaemia are also common

62. Mental health issues
• 20/1000
• 11/1000 Depression
• 3/1000 Hysteria
• 2/1000 Phobia
• 1/1000 Schizophrenia
• 0.4/1000 Mania

63. aids
• 2.9/1000 per among tribes (2.8)

64. Govt initiative
• Till June 30, 2006 there were 20097 sub-centre
functioning against a requirement of 28383 sub-
centre for tribal areas.
• The number of functioning PHCs were 3260
against a requirement of 4180 and functioning
CHCs were 446 against a requirement of 492.
• There are also 1122 Dispensaries and 120
Hospitals and 78 Mobile Clinics in Modern
Medicine .
• 1106 Dispensaries and 24 Hospitals in Ayurveda.
• 251 Dispensaries and 28 Hospitals in
Homeopathy.

65. St welfare schemes
• . Integrated Tribal Development Project
• 2. Nursery-cum-Women Welfare Centre;
• 3. Mid Day Meal Scheme
• 4. Janshala Programme
• 5. Tribal Alternate Education Programme 2002-2007
• 6. Scheme of strengthening education among scheduled tribe girls in low
• literacy districts
• 7. Incentives for education
• 8. Ashram schools
• 9. Pre matric hostels
• 10. Post matric hostels
• 11. Grant in aid schemes for welfare of scheduled tribes
• 12. Scholarships
• 13. Tribes India
• 14. National Overseas Scholarships
• 15. Book Bank Scheme
• 16. Central Sector Scheme for up gradation of merit of SC/ST students
• 17. Tribal research centre

66. Mobile medical unit
The mobile medical unit comprises a doctor, lab
technician, nurse, auxiliary mid wife and
driver. The vehicle is fitted with all necessary
equipment, including, microscope and a mini-
lab.
• Doctors will screen tribal people for diabetes,
cardiac diseases, hypertension, symptoms of
tuberculosis

67. Geriatric health
• Most developed world countries have accepted
the chronological age of 65 years as a definition
of 'elderly' or older person.
• it is many times associated with the age at which
one can begin to receive pension benefits.
• At the moment, there is no United Nations
standard numerical criterion, but the UN agreed
cut off is 60+ years to refer to the older
population.

68. CONTED.....
• Elderly or old age consists of ages nearing or
surpassing the average life span of human
beings. The boundary of old age cannot be
defined exactly because it does not have the
same meaning in all societies. Government of
India adopted ‘National Policy on Older
Persons’ in January, 1999. The policy defines
‘senior citizen’ or ‘elderly’ as a person who is
of age 60 years or above.

69. CONTED.....
• Both the share and size of elderly population
is increasing over time. From 5.6% in 1961 it is
projected to rise to 12.4% of population by
the year 2026. •

70. Health Status indicators

71. CONTED.....

72. CONTED.....

73. CONTED.....

74. CONTED.....

75. CONTED.....
• Ministry of Social Justice & Empowerment -
nodal Ministry for policies and programmes
for the Senior Citizens.
• Legislations The Maintenance and Welfare of
Parents and Senior Citizens Act, 2007 was
enacted in December 2007.
• National Policy on Older Persons (NPOP), 1999
• National Council for Older Persons

76. CONTED....
• Central Sector Scheme of Integrated
Programme for Older Persons (IPOP)
• Assistance for Construction of Old Age Homes
• International Day of Older Persons
• Ministry of Health & Family Welfare :
Separate queues for older persons in
government hospitals.
2 National Institutes on Ageing at Delhi and
Chennai have been set up
Geriatric Departments in 25 medical colleges
have been set up.

77. disabled
• A disability may be generally defined as a
condition which may restrict a person's
mental, sensory, or mobility functions to
undertake or perform a task in the same way
as a person who does not have a disability.
• Disabled population in India 2.31%
• (census- 2001)

78. Conted......
• Types of disability:
Physical - affects a person's mobility or dexterity
Intellectual - affects a person's abilities to learn
Psychiatric - affects a person's thinking processes
Sensory - affects a person's ability to hear or see
Neurological - results in the loss of some bodily or
mental functions

80. Conted...
• People with disabilities have
• same health needs
• immunization,
• cancer screening etc.
• They may experience a narrower margin of health,
because of poverty and social exclusion.
• vulnerable to secondary conditions, such as pressure
sores or urinary tract infections.
• Evidence suggests that people with disabilities face
barriers in accessing the health and rehabilitation
services they need in many settings.

81. Health status

82. Health status
• Type of loco motor disability (% distribution)
• Male Female All persons
• Deformity of limb
46 44 45
• Dysfunction of joints of limb
21 26 23
Paralysis 14 15 15
• Other (deformity of body)
9 10 10
Loss of limb 8 9 5

83. CONTED....
• Prevalence of blindness per 1,00,000
population (NSS 58th round)
• Male Female Person
• Rural 276 326 296
• Urban 163 228 194

84. CONTED....
• More than 60% reason of blindness acquired disability
due to three reasons –
• old age (nearly 25%),
• cataract (21%)
• other eye diseases (more than 15%).
Similarly about 70% of the persons with low vision also
acquired disability due to these same three reasons
• cataract
• and old age (nearly 30% each) and
• other eye diseases (more than 10%).

85. Government Initiatives for ReAdressal of Disability in
India
• National Policy for Persons with Disabilities,
2006
• Salient features
– i) Physical Rehabilitation, which includes early detection and
intervention, counselling and medical interventions and
provision of aids and appliances. development of
rehabilitation professionals;
– ii) Educational Rehabilitation which includes vocational
training; and
– iii) Economic Rehabilitation, for a dignified life in society.

86. CONTED.....
• Disability Certificates
• Components of Rehabilitation of Persons with
Disabilities :
(i) provision of assistive aids and appliances
(ii) education
(iii) vocational training
(iv) assistance for employment
(v) training in or assistance for independent living

87. CONTED.....
• Deen dayal Disabled Rehabilitation Scheme
• Grant to NGOs under FYP (working for disabled)

88. MIGRANTS
• India has a large number of international
migrants. About 5.1 million persons are
migrants by last residence from across the
international border in India (2001 census).
Neighbouring countries are the main sources
of origin of the international migrants to India
with the bulk of these migrants coming from
Bangladesh, followed by Pakistan and Nepal.
But these are migrants who have entered the
country legally

89. MIGRANTS
Employed in
• cultivation and plantations,
• brick-kilns,
• quarries,
• construction sites
• and fish processing (NCRL, 2001).
• urban informal manufacturing construction,

90. Conted....
• services or transport sectors
• casual labourers,
• head loaders,
• rickshaw pullers and
• hawkers.

91. Conted.....
• The rapid change of residence due to the
casual nature of work excludes them from the
preventive care and their working conditions
in the informal work arrangements in the city
debars them from access to adequate curative
care.

92. Health status
• Poverty is a universal determinant of health
• malnutrition,
• a poor overall health status,
• poor access to preventive and curative health
services,
• and higher mortality and morbidity rates.

93. CONTED....
• Migrants and mobile people become more vulnerable
to HIV/AIDS. By itself, being mobile is not a risk factor
for HIV/AIDS. It is the situations encountered and
behaviours possibly engaged in during the mobility or
migration that increases vulnerability and risk. Migrant
and mobile people may have little or no access to HIV
information, prevention (condoms, STI management),
health services.
• Source: International Organisation for Migration
(2005), Health And Migration: Bridging the Gap,
Geneva: International Organisation for Migration

94. Unique health problems of migrants
• Communicable diseases
• Reproductive and child health
• Violence against women
• Child labour
• 3-D jobs – dangerous, dirty and degrading.
• Maladjustment – social & psychlogical

95. Govt initiatives
• There is no specific schemes targeting the
migrant population
• Though there are some NGOs working for
migrants e.g.

96. STATUS OF DALITS
• Dalits one-sixth of the Indian population (160 million
approx).
• Literacy rate 24 per cent.
• meagre purchasing power;
• poor housing conditions;
• lack or have low access to resources and entitlements.
• In rural India they are landless poor agricultural
labourers attached to rich landowners from
generations or poor casual labourers doing all kinds of
available work.

97. CONTED.....
• In the city they are the urban poor employed as
wage labourers at several work sites, beggars,
vendors, small service providers, domestic help,
etc.,
• living in slums and other temporary shelters
without any kind of social security.
• The members of these groups face systemic
violence in the form of denial of access to land,
good housing, education, health and
employment.

98. Health status indicators
Indicator value
Neonatal mortality
Infant mortality rate
Under 5 MR
% of children vaccinated with
card
Home delivery
Disability proportion
46
66
88
34.8%
57.1%
2.20

99. Govt initiatives
• Rashtriya swasthya bima yojana
• Subsidized lone
• Overseas education loans
• Free health services for BPL family in public
and private sector hospitals

100. Conclusion
• Looking upon the given facts we can very well
make out that the health status of an
individual is significantly affected by his status
in family, society, & community. Thus changing
the social status of an individual or family will
bring the change in health status of
community.