Upon the successful completion of the course the students will be
able to:
1. Describe the meaning of rural health.
2. Identify rural health issues and service needs by
appraising the health and medical condition and their
determining factors.
Urban health - issues and challenges.
Kindly note that this presentation focusses more specifically on the Indian scenario even though the concepts are applicable everywhere
India is rapidly becoming urbanised. By 2030, around 40% of the country's population will live in urban areas. The extent to which India's health system can provide for this large and growing city-based population will determine the country's success in achieving universal health coverage and improved national health indices. In The Lancet Global Health, Sundeep Salvi and colleagues1 offer a glimpse into India's urban health situation by reporting on the medical symptoms and diagnoses and the characteristics of patients who sought treatment from qualified primary health-care practitioners across 880 cities and towns on one day in 2011.
Urban health - issues and challenges.
Kindly note that this presentation focusses more specifically on the Indian scenario even though the concepts are applicable everywhere
India is rapidly becoming urbanised. By 2030, around 40% of the country's population will live in urban areas. The extent to which India's health system can provide for this large and growing city-based population will determine the country's success in achieving universal health coverage and improved national health indices. In The Lancet Global Health, Sundeep Salvi and colleagues1 offer a glimpse into India's urban health situation by reporting on the medical symptoms and diagnoses and the characteristics of patients who sought treatment from qualified primary health-care practitioners across 880 cities and towns on one day in 2011.
A process aimed at encouraging people to want to be healthy, to know how to stay healthy, to do what they can individually and collectively to maintain health and to seek help when needed.
Indicator is a variable which gives an indication of a given situation or a reflection of that situation.
Health Indicator is a variable, susceptible to direct measurement, that reflects the state of health of persons in a community.
Indicators help to measure the extent to which the objectives and targets of a programme are being attained.
In this presentation you will get the knowledge about changing concepts of health.
the changing concepts of health has been categorised as follows:
1.Biomedical concept
2.Ecological concept
3.Psychological concept
4.Holistic concept
Primary health centers are the corner stone of rural health services .
It act as a referral unit for 6 sub centers and refer out cases to CHCs.
It covers a population of 30,000 in plain area and 20,000 in hilly and tribal area.
There are 4-6 beds for patients and some diagnostic facilities are also available.
The National Health Mission (NHM) encompasses
its two Sub-Missions, the National Rural Health
Mission (NRHM) and the National Urban Health
Mission (NUHM). The main programmatic
components include Health system strengthening
in rural and urban areas, ReproductiveMaternal-Neonatal-Child and Adolescent Health
(RMNCH+A) and Communicable and NonCommunicable Diseases. The NHM envisages
achievement of universal access to equitable,
affordable & quality healthcare services that are
accountable and responsive to people’s needs.
A process aimed at encouraging people to want to be healthy, to know how to stay healthy, to do what they can individually and collectively to maintain health and to seek help when needed.
Indicator is a variable which gives an indication of a given situation or a reflection of that situation.
Health Indicator is a variable, susceptible to direct measurement, that reflects the state of health of persons in a community.
Indicators help to measure the extent to which the objectives and targets of a programme are being attained.
In this presentation you will get the knowledge about changing concepts of health.
the changing concepts of health has been categorised as follows:
1.Biomedical concept
2.Ecological concept
3.Psychological concept
4.Holistic concept
Primary health centers are the corner stone of rural health services .
It act as a referral unit for 6 sub centers and refer out cases to CHCs.
It covers a population of 30,000 in plain area and 20,000 in hilly and tribal area.
There are 4-6 beds for patients and some diagnostic facilities are also available.
The National Health Mission (NHM) encompasses
its two Sub-Missions, the National Rural Health
Mission (NRHM) and the National Urban Health
Mission (NUHM). The main programmatic
components include Health system strengthening
in rural and urban areas, ReproductiveMaternal-Neonatal-Child and Adolescent Health
(RMNCH+A) and Communicable and NonCommunicable Diseases. The NHM envisages
achievement of universal access to equitable,
affordable & quality healthcare services that are
accountable and responsive to people’s needs.
A Conceptual Model of Rural Development IndexAI Publications
Rural Areas are deprived of basic amenities such as access to drinking water, electricity, toilets and sewage systems giving rise to unhygienic conditions in the rural areas. Lack of healthcare facility in terms of infrastructure and staff has aggravated problems of health leading to infant mortality, death of pregnant mothers, decreased average life span in rural areas. Poor quality of teaching fraternity and non availability of infrastructure are major reason for illiteracy and unemployment. Non-agricultural income such as animal husbandry, sericulture and vocational trainings that supplement the agricultural income that needs to be focused. Mechanization should be the priority in enhancing agricultural yield followed by storage and transportation facility to the market in raising agricultural income. Excessive use of fertilizers and pesticides due to lack of knowledge among farmers contribute to water as well as air pollution deteriorating the environment. The disposable income spent on cultural aspects needs to be taken into consideration in assessing the status of the rural area. There is a need to assess rural areas from five dimensions such as economic, education, health, environment and disposable income in understanding present level of development in rural areas. Cause and effect diagram is established contributing to the development of specified domains. The conceptual index is a composition of Result Index and Cause Index. This distinction aids in examining the result index to measure the current level of rural development and cause index to evaluate the process of rural development for policy makers in identifying the areas of improvement in the overall development of the rural area.
Overview of strategies of public health services in a typical.pptxAshok Pandey
3.1 Advocacy of public health perspective in the urban and rural municipalities for establishment of public- health focused section/unit and program plan
3.2 Incorporation of public health core actions (promotive, preventive, protective, control and encouragement for early detection and treatment of diseases) and intervention, such as educational policy-regulatory, infrastructural, community organizational and managerial interventions in municipal health plans supported by human resources for implementation
3.3 Mobilization of local clubs and organizations
3.4 Inter-organizational coordination, cooperation and resource mobilization
3.5 Excessive use of local (specifically in rural setting) and mass media (specifically in urban setting)
3.6 Establishment of public health service centers at wards
3.7 Special roles and functions of public health practitioners at the local health and medical service centers in the rural and urban settings
Unit 4: International public health 18 hours
4.1 Need for developing specific public health perspective to international health: global aspirations regarding health and disease
a. Global aspiration on health: healthy world population;
healthy planet; health as fundamental human rights
b. Universal coverage of health services
c. Concept of global philosophy on Sarbajanahitaya
(Universal good for world people; SarbajanaSukhhaya
(Universal happiness)
4.2 Definition of international health, ,international public health
and synonymous term global health
4.3 Characteristics of international health
4.4 Historical background of international public health movement
4.5 Significant forces affecting to international health
4.6 Current international health issues demanding global public
health action
A review of GLOBALIZATION, A Very Short Introduction by Manfred B. StegerAshok Pandey
Manfred B. Steger is a political scientist and author known for his work on globalization. "GLOBALIZATION: A Very Short Introduction" is one of the books in the "Very Short Introductions" series published by Oxford University Press. These books provide concise and accessible introductions to a wide range of topics. In "GLOBALIZATION: A Very Short Introduction," Manfred B. Steger explores the concept of globalization and its impact on the world. He discusses the economic, political, cultural, and social dimensions of globalization and provides readers with a comprehensive overview of the subject. The book delves into the historical roots of globalization, its contemporary manifestations, and the debates surrounding its effects on various aspects of society.
Critics
Globalization refers to the increasing interconnectedness and interdependence of countries and economies through the exchange of goods, services, information, and ideas. While globalization has brought about significant economic growth and technological advancement, Marxists often critique it from several angles:
a. Exploitation: Marxists argue that globalization can exacerbate global economic inequalities, as multinational corporations exploit cheap labor in developing countries to maximize profits.
b. Imperialism: Some Marxists see globalization as a form of imperialism, where powerful nations and multinational corporations dominate and exploit weaker nations and their resources.
c. Cultural Homogenization: Critics within the Marxist tradition contend that globalization can lead to cultural homogenization, as Western values and consumer culture become dominant worldwide, erasing local traditions and identities.
d. Capital Mobility: Globalization has facilitated the movement of capital across borders, allowing multinational corporations to evade taxes and regulations, which can undermine the power of nation-states.
In summary, Marxism provides a critical framework for analyzing the impact of globalization on societies and economies, emphasizing issues of class struggle, exploitation, and inequality. While Marxism has influenced various social and political movements, its application to contemporary globalization debates remains a complex and evolving topic.
- The meaning and definition of the Hypothesis.
- The Nature of Hypothesis.
- The Importance and Use of Hypothesis in Research Methodology.
- The Sources of Hypothesis.
- The Relationship Between Variables and Hypothesis.
- The Types of Hypothesis.
- Formulating a Good Hypothesis.
- Characteristics of a Good Hypothesis.
- Hypothesis Testing.
- Errors in Hypothesis Testing
National Conference on Comprehensive Sexuality Education 24 – 25 May 2023, Ka...Ashok Pandey
National Conference on Comprehensive Sexuality Education
24 – 25 May 2023, Kathmandu
Intervention on Comprehensive Sexuality Education: A Mixed Methods Systematic Review
Finalizing and Reviewing the Health Research Proposal_Ashok.pptxAshok Pandey
To acquaint the participants with health research process, and
To enhance knowledge and skill of the participants for the development of health research proposal.
Desired subject areas for tourism and development of Arghakhanchi districts: Agriculture, Tourism, Education, Technical education, Health, Hydropower related, Industries, Physical Infrastructures, Startup sectors and viability. Home Stay viability wit the area selection.
https://www.ratopati.com/story/350218/sushila
Project Management equips the business professional with leading methodologies and practices in the health project management field. Public health professional need to manage different health related programme intervention, development and evaluation. Professionals need to accompany the knowledge about the project management and this chapter describes all the matters of project management. Project management is a requirement for professionals in many fields, with many employers now identifying project management skills as vital for corporate success.
Public Opinion and Compliance Survey on Tobacco Control and Legislations in N...Ashok Pandey
Nepal passed a comprehensive tobacco control law in April 2011
From May 15, 2015, picture and text warnings must be placed on 90 percent
Nepal received the Bloomberg award for advancing ahead with the biggest-ever pictorial graphic health warnings
NHEICC, being a focal point for tobacco control, is conducting various programs for the effective implementation of the enforced law.
SPSS is short for Statistical Package for the Social Sciences, and it's used by various kinds of researchers for complex statistical data analysis. The SPSS software package was created for the management and statistical analysis of social science data.
This course has been designed to equip the student with the basic research design including research methods in health sciences. The course aims to impart basic knowledge on different types of study design
This course has been designed to equip the student with the basic sampling methods in health sciences. The course aims to impart basic knowledge on sample size, sample selection, etc.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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Surgical Site Infections, pathophysiology, and prevention.pptx
Rural health (Public health)
1. Rural, Urban and International
Health
Fourth Semester
Brief Bio
Ashok Pandey, MPH/BPH, DGH
Associate Research Fellow
PRI
2. Unit 1: Rural public health 10 hours
1.1 Need for developing specific public health perspective to work in
rural settings
1.2 Definition of rural settings including operational meaning of village
municipalities in Nepal
1.3 Social, cultural, economic, occupational, geographical characteristic of
rural communities and their relation on the health.
1.4 Factors affecting rural-urban migration (push-pull factors) and its
effect on rural lives with particular instances of Nepal
1.5 Strength of rural setting in promoting public health
1.6 Adverse effect on health risk and disease in urban areas such as
inadequate and contaminated water supply, inadequate access to
sanitation, adverse climate, rural violence, physical work-pressure, loss of
productive population due to international labour migration, insecure
residential status, poor structural quality of housing, inadequate access
to public health medical facilities
4/25/2022 Ashok Pandey 2
3. 1.7 Major health and disease issues in rural setting and their
determinants such as cultural, social, industrial, economic, political,
environmental
1.8 Rural health appraisal and identification of nature of public health
and medical care demand in rural setting
1.9 Overview of government, NGOs and private sector public health and
medical care services to meet the public health and medical care demand
in rural settings
a. Primary health care and essential health care through health facilities
b. Public health and medical care related services of health section of
Rural Municipalities
c. Role of Rural Municipalities in preventing disease and promoting the
health of rural population.
1.10 Expected outcomes of public health services in the rural settings
such as healthy village dwellers, healthy village, growth of rural economy
4/25/2022 Ashok Pandey 3
4. Definition of rural communities
There is no international standard for defining rural areas, and standards may vary
even within an individual country (WHO).
The most commonly used methodologies fall into two main camps:
• population-based factors and
• geography-based factors.
Rural is usually areas that are sparsely settled places away from the influence of large
cities and towns. People in rural areas live in villages, on farms and in other isolated
houses, as in pre-industrial societies.
Rural areas usually have an agriculture character though many areas are characterized
by an economy based on logging, mining, petroleum and natural gas exploration, or
tourism.
4/25/2022 Ashok Pandey 4
5. The methodologies used for identifying
rural areas include;
• population size,
• population density,
• distance from an urban center,
• settlement patterns,
• labor market influences,
4/25/2022 Ashok Pandey 5
6. Rural area
• English dictionary defined rural area as a geographic area that is
located outside cities and towns
• Usually those areas having fewer than 1000 persons per square mile
and less than 20,000 people.
The rural poor depend largely; on
• agriculture,
• fishing and forestry,
• and related small-scale industries and services.
People living in rural areas also have;
• poorer socioeconomic conditions, (high rates of poverty amongst)
• less education,
• higher mortality rates when compared to their urban counterparts
4/25/2022 Ashok Pandey 6
7. Why rural areas characterized by poverty?
Numerous characteristics of a country's economy and society, as
well as some external influences, create rural poverty
• political instability and civil war;
• systemic discrimination on the basis of gender, race, ethnicity,
religion, or class
• ill-defined property rights or unfair enforcement of rights to
agricultural land and other natural resources;
• high concentration of land ownership and irregular rental
arrangements;
• corrupt politicians
4/25/2022 Ashok Pandey 7
8. Contd..
• economic policies that discriminate against or exclude the rural
poor from the development process
• market imperfections owing high concentration of land and other
assets and imperfect public policies;
• natural causes (for example, climatic changes)
• The right to adequate land and water is importance in reducing
rural poverty in many developing countries.
• large and rapidly growing families
4/25/2022 Ashok Pandey 8
9. 1.1 Need for developing specific public health
perspective to work in rural settings
1. Address a rural health issue. Evidence-informed practice
includes population health assessment, surveillance, research and
program evaluation to generate evidence (e.g., unaffordable food,
poverty, high rates of obesity and smoking rates, low uptake of flu
immunization).
2. Integrate multiple levels of community support (e.g., health
professionals, government, community organizations, consumers).
3. Adopt and modify existing programs (e.g., changing the
intensity, length and scope of a disease prevention program).
4/25/2022 Ashok Pandey 9
10. Contd..
4. Meet the cultural needs of the population (e.g., integrating healing
components in programs).
5. Deliver a flexible program responsive to the demands of rural
populations (e.g., home-based services, telemedicine, mobile
clinics).
6. Provide a no-cost, low-cost or subsidized program.
7. Provide simple, accurate educational materials, resources and
information for ease of reading (e.g., brochures, fact sheets,
posters).
4/25/2022 Ashok Pandey 10
11. 8. Build on existing strengths in social capital (e.g., sense of
belonging, inclusion, trust, reciprocity, participation in community
life).
9. Build on existing physical environments (built and natural; e.g.,
delivering programs in schools and government buildings); promote
the natural environment (e.g., walking trails, lakes, walkable
communities).
10. Promote existing local programs, services and resources.
11. Use health professionals other than physicians and specialists to
provide clinical services.
12. Utilize and adopt a rural outreach model.
Contd..
4/25/2022 Ashok Pandey 11
12. 2. Definition of rural settings including
operational meaning of village municipalities in
Nepal
The Federal Democratic Republic of Nepal (Nepali: संघीय लोकतान्त्रिक गणतरि
नेपाल Sanghīya Loktāntrik Ganatantra Nepāl) is a country situated in South Asia
between India and China.
Administratively Nepal is divided into Provinces, Districts and Municipalities.
Municipalities are classified as urban municipality and rural municipality. Rural
municipality called Gaun palika in Nepali.
Urban municipality categorized into 3 level:
1. Metropolitan city (Mahanagarpalika)
2. Sub metropolitan city (Upmahanagarpalika) and
3. Municipality (Nagarpalika)
4/25/2022 Ashok Pandey 12
13. • Fulfilling the requirement of the new constitution of Nepal 2015,
all old municipalities and villages (which were more than 3900 in
number) are restructured in total 753 new Municipalities and
Villages.
• All old 75 district development committees (DDC) are also
replaced by new 77 District Coordination Committee (DCC) which
will have much less power than DDC.
• At present there are 6 Metropolitan Cities,11 Sub-Metropolitan
Cities, 276 Municipalities and 460 GaunPalik (also referred to as
Rural Municipality).
• As of 20 September 2015 Nepal is divided into 7 provinces. They
are defined by schedule 4 of the new constitution, by grouping
together the existing districts.
4/25/2022 Ashok Pandey 13
14. Contd..
• Two districts however are split in two parts ending up in two
different provinces.
• Municipalities are the cities having at least some minimum criteria
of population and infrastructure and declared as a municipality by
the government.
• There are 283 municipalities in Nepal.
• The capital city Kathmandu is a Metropolitan city and there are
other five Metropolitan cities Bharatpur, Biratnagar, Pokhara,
Lalitpur & Birganj.
• There are 11 Sub-metropolitan Cities and 276 Municipalities.
4/25/2022 Ashok Pandey 14
15. 3. Social, cultural, economic, occupational,
geographical characteristic of rural communities and
their relation on the health.
• Poverty (unstable income, unemployment, dependency on
spouses, low paying and seasonal jobs, poor public transportation,
non-affordable child care, housing and healthy foods).
• Limited health care and support services (fewer nurses, family
physicians and specialists available; little choice, it is difficult to
get relief when women are often the caregivers 24 hours a day).
4/25/2022 Ashok Pandey 15
16. • Economic conditions
lack of affordable housing and employment, those who leave often
end up in poverty, women on farms are often more financially
dependent as they do not receive a wage for their work and have no
unemployment insurance or pension and they leave behind their
lifetime investment for themselves and the legacy of their children.
• Lack of access to services
distant from many specialized services for family violence, services
have been centralized in urban areas, dispersed and complex
delivery and locations of services for needed lawyers, social
services, mental health, school counselors etc.
Contd..
4/25/2022 Ashok Pandey 16
17. Contd..
Geographical characteristic of rural communities and their relation
on the health.
• Geographic isolation (being far from neighbours makes it hard to
establish and maintain social networks, emergency services are
often delayed)
• Geographical location and isolation (it is easier to hide the abuse,
lengthy response times, lack of access to people to help in an
emergency and lack of public transportation).
• Stress of multiple roles (work long hours, juggle family, farm,
volunteering and caring for family members)
4/25/2022 Ashok Pandey 17
18. Contd..
• Lack of confidentiality
hard to preserve confidentiality, social stigma may be a deterrent to
getting help, fear of exposure, strong ethic of self-sufficiency, belief
that family matters are private and lack of trust in service providers.
• Attitudes
slow to admit that domestic violence is a serious problem, stigma
attached if they go to mental health services, hard to admit to abuse
because they feel it is their fault, leaving means leaving a way of life,
one’s home and one’s community, disruption of leaving is even
greater for farm women as there is no separation between home
and work.
4/25/2022 Ashok Pandey 18
19. Characteristics of rural life
• More space; greater distances between residents and services
• Cyclic/seasonal work and vacation activities
• Informal social/professional interactions
• Access to extended relationship systems
• Residents are related or acquainted
• Small enterprises
• fewer large industries
• Economic orientation to land and nature (e.g., agriculture, mining, fishing)
• High-risk occupations are more prevalent
• schools are social organizations
• Preference for interacting with localities
• Mistrust of newcomers to the community
4/25/2022 Ashok Pandey 19
20. • Push-Pull considerations
• Both are affecting rural-urban migrations.
• “Pull” of the cities may determine the destination.
• Migrants are pulled toward cities:
• Prospect of jobs and higher incomes.
• Most early urbanization was the result of pull considerations.
• Pushed out of rural areas:
• “Push” factors predominate as the motivation to move.
• Poverty, lack of land, declining agricultural work, war, and famine.
• Play more importance today than push considerations.
20
4/25/2022 Ashok Pandey
1.4 Factors affecting rural-urban migration (push-pull
factors) and its effect on rural lives with particular
instances of Nepal
21. Factors affecting Migration
• The factors contributing to migration and movement both within and
outside a country have been broadly classified into four main groups
• 1) Push Factors,
• 2) Pull Factors,
• 3) Stick Factors and
• 4) Stay Factors.
24. Factor Condition Issues
Instability / Disasters
/ Wars / Famines
Push Creation of refugees. Cities as safe heavens.
Expectation of jobs Pull Higher wages but higher living costs. Large
labor markets. Informal sector dominant.
Deterioration of rural
life
Push Demographic growth. Land tenure (landless
peasants). Mechanization (surplus labor).
Transportation Intervening
opportunities
Increased mobility. Lower costs. Construction
of roads and rails. Access to rural markets.
More and better
services
Pull Better schools and health services. Access to
water and electricity. Overcrowding and
pollution.
24
4/25/2022 Ashok Pandey
25.
26. Push and pull factors
• Economic migration - to find work or follow a particular career path.
• Social migration - for a better quality of life or to be closer to family or
friends.
• Political migration - to escape political persecution or war.
• Environmental - to escape natural disasters such as flooding.
27. Push factors Examples
• There is poor electricity
• Rural roads are bad
• There is no pipe borne water
• There is no good school
• There is no job opportunity
• There is poor health care service
• There is under development
28. Rural push factors include
• poverty,
• inequitable land distribution,
• environmental degradation,
• high vulnerability to natural disasters, and violent conflicts
• while urban pull factors include
• better employment and
• education opportunities,
• higher income,
• diverse services, and
• less social discrimination in the cities
29. Pull Factors
• Better opportunities in the city
• Better wage in the city
• Improved living condition
• There are good schools in the city
• Good electricity supply in the city
• There is pipe borne water
• There is better health care service
30. Urban Pull factors
• more jobs.
• higher wages.
• better living conditions.
• better education and health services.
• better facilities.
• less chance of natural disasters.
31. Stay factors
• in the cities, are those factors that prevent from returning to the rural
areas once they have moved to urban centers.
• There is usually a reluctance to disrupt their new lifestyle or risk the
disruption of their children’ education or break newly formed cultural
and social bonds.
32. stick factors
• These include levels of morale among health workers, rewards and
incentives, training/continuing education, social values and cultural
ties.
33. ‘Push’ and ‘pull’ factors influencing health
workforce migration
• Low pay (absolute and/or relative)
• Poor/dangerous working
conditions
• Unemployment
• Lack of resources
• Limited career opportunities
• Limited educational opportunities
• Economic/political instability
• Higher pay, opportunities for
remittance
• Better working conditions
• Better resourced health system
• Career opportunities
• Provision for post-basic education
• Higher standard of living
• Travel opportunities
• Aid work, political stability
Push Factors Pull Factors
34. Schematic of the factors affecting migration
and movement of health workers.
35. 1.5 Strength of rural setting in promoting
public health
• Less likely to be diagnosed with a new case of cancer than urban
counterparts.
• Better reported quality of life than urban counterparts.
• Lower stress levels and a stronger sense of community than urban
counterparts.
• Death rates due to cancer are lower in rural populations for some
specific cancers (e.g. breast cancer).
4/25/2022 Ashok Pandey 35
36. Contd..
• Strong social networks and connections
• Emphasis on relationships with family and neighbors
• Supportive communities
• Common shared values and collective interest in improving health
• Smaller scale and scope of programs, which may accelerate
opportunity
• Willingness and confidence to confront challenges
• Centralized communication channels
• Creativity and devotion to achieving success
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37. 1.6 Adverse effect on health risk and disease in urban areas such as
• inadequate and contaminated water supply,
• inadequate access to sanitation,
• adverse climate,
• rural violence,
• physical work-pressure,
• loss of productive population due to international labour migration,
• insecure residential status, poor structural quality of housing,
• inadequate access to public health medical facilities
4/25/2022 Ashok Pandey 37
38. 1.7 Major health and disease issues in rural setting and
their determinants such as cultural, social, industrial,
economic, political, environmental
• Higher poverty rates, which can make it difficult for participants to pay
for services or programs
• Cultural and social norms surrounding health behaviors
• Low health literacy levels and incomplete perceptions of health
• Linguistic and educational disparities
• Limited affordable, reliable, or public transportation options
• Unpredictable work hours or unemployment
• Lower population densities for program economies of scale coverage
• Availability of resources to support personnel, use of facilities, and
effective program operation
• Lack of access to healthy foods and physical activity options
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39. Major issues
The major problems in many rural areas are
• poverty,
• illiteracy,
• unemployment,
• crime,
• social evils,
• lower living standards,
• lack of facilities, services, and health.
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40. The Five Barriers to Rural Healthcare Access
• Workforce Shortages.
• Distance, Transportation & Internet.
• Health Insurance Coverage.
• Social Stigma and Privacy Issues.
• Poor Health Literacy.
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41. In Nepal, Contagious, infectious and waterborne diseases such
as diarrhoea, amoebiasis, typhoid, infectious hepatitis, worm
infestations, measles, malaria, tuberculosis, whooping cough,
respiratory infections, pneumonia and reproductive tract
infections dominate the morbidity pattern, especially in rural areas.
4/25/2022 Ashok Pandey 41
42. 1.8 Rural health appraisal and identification of nature
of public health and medical care demand in rural
setting
4/25/2022 Ashok Pandey 42
43. Participatory Rural Appraisal (PRA)
• Participatory Rural Appraisal (PRA) is considered one of the popular
and effective approaches to gather information in rural areas.
• This approach was developed in early 1990s with considerable shift in
paradigm from top-down to bottom-up approach, and from
blueprint to the learning process.
• It is a shift from extractive survey questionnaires to experience
sharing by local people.
• It is used to gain in-depth understanding of community or situation
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45. Participatory Rural Appraisal (PRA)
• Participatory: people are involved in the process – a ‘bottom-up’
approach that requires good communication skills and attitude of
facilitator
• Rural: This techniques can be used in any situation, urban and rural
setting, with literature and illiterate people.
• Appraisal: Find out of information about problems, needs, and
potentiality of target groups/communities.
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46. Participatory Rural Appraisal (PRA)
• PRA is intended to enable local communities to conduct their own
analysis and to plan and take action
• An approach and methods of learning about rural life and conduction,
from, with and by rural people.
• PRA extends into analysis, planning and action
• PRA closely involves villagers and local officials in the entire process
(Robert Chambers, 1992)
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47. PRA – Key Principles
Participation – participation by the communities
Flexibility – time and resource available
Teamwork – conduct by locals
Optimal ignorance – both time and money
Systematic – generated data, qualitative in nature
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49. PRA and RRA
RRA PRA
Learning rapidly and directly from
people/communities
Learning with people/communities
Researcher/Project Staffs learn and obtain
information
Communities also learn, sensitize and
capacitated
Information is gathered and used according
to the needs of the project (or assignment)
Facilitate community to analyze, and take
decision as per need of community
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50. Relevant participatory tools
• PRA Tools:
• Mapping: Social / Resource Map, transect walks
• Ranking: Problem tree, Wellbeing ranking, matrix ranking
• Visualization: Venn diagrams, timelines, spider diagrams, seasonal calendar, mobility
map
• Social information: Citizen score card, records card,
• Beneficiaries assessment:
• Interviewing: Focus group discussion (FGD), semi-structured interview, Key informant
interview (KII)
• Participatory observation
• TOP:
• Focused conversation
• Workshop
• Other tools:
• Spider diagram
• SWOT analysis
• H-form of evaluation
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51. Selection of appropriate tool
Purpose
People
Process
• Purpose – WHY
• Nature of information
• People/ stakeholder – WHO
• Nature of participants
• Level of participation – we expect
• Process – HOW
• Resource
• Facilitator/Team
• Setting
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52. Social/Resource Map
Social mapping: Maps
usually drawn by a group of
villagers either on the
ground using chalk or on a
large sheet of paper. The
maps provide information
about the physical
characteristics of the
community, about the socio-
economic conditions and
how the participants
perceive their community.
A social map shows the social profile of a locality and provides insights into the social aspects and social life.
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55. Transect Walk
Transect walk: Involves walking
with the villagers through an area
and discussing about different
aspects of land-use and agro-
ecological zones in the village
observed during the walk.
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56. 1.9 Overview of government, NGOs and private sector public health
and medical care services to meet the public health and medical
care demand in rural settings
a. Primary health care and essential health care through health
facilities
b. Public health and medical care related services of health section
of Rural Municipalities
c. Role of Rural Municipalities in preventing disease and promoting
the health of rural population.
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57. Overview of government
Structure of Health System in Nepal
There is health
section in rural
municipality level
which include one
health coordinator
to supervise and
monitor the health
institutions and
program under
rural municipality
level.
58. Major activities under DoHS
• Under Natinal Immunization Programme :
• Rotavirus Vaccination guideline and Hygiene Promotion through Routine
Immunization guideline
• Conducted ToT and orientation on Rotavirus Vaccine introduction and
hygiene promotion
• Launched Rotavirus vaccine in National Immunization Program from 18
Ashad 2077 (02 July 2020) throughout the country
• Development and distribution of flipchart and stickers- BCC materials for
prevention of COVID-19 at EPI clinics
• Distribution of iron folic acid supplement to pregnant and post partum
women to reduce anemia and micronutrient (Baal vita) to infant under
National Nutrition Programme
59. • Under National safemoherhood programme:
• For the reduction in Maternal and neonatal mortality and morbidity Maintain
MNH activities at community level including the Birth Preparedness Package
(jeevansuraksha flipchart and card) and distribution of Matri SurakshaChakki
(misoprostol) to prevent postpartum haemorrhage (PPH) in home deliveries
• Under National Family planning programme
• Provision of regular comprehensive FP service including post-partum and post
abortion FP services
• Provision of long acting reversible services
• Permanent FP Methods or Voluntary Surgical Contraception (VSC)
• FP strengthening program through the use of decision-making tool (DMT)and
WHO medical eligibility for contraceptive (MEC) wheel
• Planning and addressing unmet need of FP
60. • National Adolescents sexual and Reproductive health
• Develop program guideline of cervical cancer screening, obstetric
fistula, pelvic organ prolapse
• Uterine prolapse surgery at federal hospital
• Vaccines against cervical cancer (vaccines)
• Free screening for cervical cancer, breast cancer and fistula at
provincial hospitals
• Surgery of Vault prolapse, fistula surgery at provincial hospitals
• Surgical treatment of uterine prolapse at provincial hospitals
61. Primary health care and essential health care
through health facilities in rural settings
• Primary Health Care centre
• Health Post
• Urban Health center
• Community Health unit
• Expanded program on immunization
• Community Outreach clinic
• Female community Health volunteer
62. Function of Primary Health Care
• Medical Care
• Maternal and Child health care including family planning
• Safe water supply and basic sanitation
• Prevention and control of locally endemic diseases
• Collection and reporting of vital statistics
63. Function of Health post
• To provide health services including basic health care and
preventive medication in remote rural areas.
• Active in various activities including health education on nutrition
improvement, maternal health service, child health service,Family
planning programme,immunization, Environmental cleaning,TB
and Leprosy control etc.
• Health post monitor the activities of FCHVs as well as community
based activities by PHC outreach clinics and EPI clinic
64. PHC/ORC clinic
• Primary Health Care Outreach (PHC/ORC) program was established in 1994
(2051 BS) with an aim to improve access to some basic health services
including family planning and safe motherhood services for rural households.
• PHC/ORC clinics are the extension of PHCCs, HPs at the community level.
• At PHCC and HP level, ANMs, AHW are responsible for carrying out the PHC
outreach services.
65. Role of FCHV
• The main role of FCHV will be concentrated on the health promotional activities of mothers
and children in their working area. Besides, they will also help in promoting utilization of
available health services and raise awareness on health through Mothers group.
• FCHV will help in various health programs such as family planning, safer motherhood,
newborn care, immunization, nutrition, communicable and epidemic diseases, acute
respiratory diseases and diarrheal diseases control, environmental sanitation, health
education and other national programs
• FCHVs distribute condoms and pills, ORS packets and vitamin A capsules, treat pneumonia
cases, refer serious cases to health institution and motivate and educate local people on
healthy behaviour.
• FCHV will also provide recommended services like drug distribution and diseases
management as directed by Nepal government based on community based approach
66. • NGOs fill the gaps, but their services are selective and cover
limited geographic areas
• NGOs, while being not-for-profit organizations, rarely give free
health care
• They do, on the other hand, have adequate staff, equipment, and
supplies
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NGO
67. A non-governmental organization (NGO) is any non- profit,
voluntary citizens' group which is organized on a local, national or
international level
Include organizations engaged in public service, based on ethical,
social, religious
Formal/ Informal groups or organization ( Formal groups -military
units, corporations, churches, court systems, trade, universities,
sports teams and charities) (Informal groups - employees of an
organization who have a common interest)
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68. The role of NGOS in development
• Providing goods and services
• Assisting the government achieve its development
• Helping citizens to voice their aspirations, concerns and alternatives for
consideration by policy makers
• Helping to enhance the accountability and transparency of government and
local government programs and of officials.
• Community health promotion and education (such as hygiene and waste
disposal)
• Managing emerging health crises (HIV/AIDS, Hepatitis B)
• Community social problems (juvenile crimes, run- away, street children,
prostitution)
• Environmental (sustainable water and energy resources)
• Economic (micro loans, skills training, financial education and consulting)
• Development and operation of infrastructure (construction of hospitals and
healthcares, school, public toilets etc. and infrastructure construction)
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69. • Women's issues (women's and child health care, rights, counseling, literacy
issues)
• Maintaining the international health relations
• Conducting and funding the medical and public health research for
improvement of health service
• To maintain the intersectoral coordination in health care delivery system
• Supporting innovation, demonstration and pilot projects in healthcare
delivery system
• Conduct reviews and assessment of existing health programs
• Technical assistance and training for health care delivery
• Advocacy for and with the government programmes of health care from
partners and advisors as well as sponsors
• Can provide valuable resources in promoting health care
• Implementing the mutually agreed programme of collaboration
• Assist national policy formation in health care
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70. • Action, research and training in service provision, outreach,
technical and research inputs in specific areas;
• Advocacy, lobbying and information sharing through networks and
building wider alliances for health goals and sharing information;
• Policy dialogue and development, policy strategy research and
analysis
• Monitoring and ‘watchdog’ roles and protection of consumer
interests.
• Fundraising, resource mobilisation and financial contributions.
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71. NGOs play a crucial role in advancing and improving the
effectiveness of deworming in the context of School Health and
Nutrition (SHN) programmes.
With experienced staff, technical expertise and strong local and
national links, NGOs are able to pilot and scale-up model SHN
programmes (including deworming) and carry out operational
research. NGOs also influence national policy and advocate for and
support the development and implementation of national SHN
programmes.
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72. 1.10 Expected outcomes of public health services in the
rural settings such as healthy village dwellers, healthy
village, growth of rural economy
• Household habits and their contribution to health
• A house with appropriate sanitation, water and power has to be accompanied by
healthy and clean household habits.
• A basic requirement is a cooking option where smoke is kept out of the house, as are
measures for disposing of soiled water, separation of waste into appropriate
categories and disposal, avoiding stagnation of water, preventing the access of
mosquitoes to stagnant/stored water.
• In addition, habits like routine hand washing using soap, sterilization of utensils
used to feed babies, drinking boiled water, washing of food before cooking,
preventing access of vectors to the food, ensuring personal hygiene-periodic cutting
of nails and hair, regular bathing, wearing clean clothes, proper use and disposal of
sanitary napkins etc. are very much required for a healthy life.
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73. Contd..
• Health of mothers and children in a village
• An enabling environment is required to be created for ensuring the
health of women and children.
• Each expectant mother must be able to avail the facilities of
immunization, better nutrition and regular health checkups as early as
possible.
• Apart from expectant mothers, absolute and uncompromising
individual attention is required for ensuring complete immunization
and breast feeding for each newborn and child.
• Marriage at an early age and early pregnancies may lead to multiple
issues related to health of mother and child.
• Consecutive pregnancies are another cause leading to poor health of
mother and child. Counseling service to couples along with affordable
family planning measures can be achieved by leveraging the existing
schemes.
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74. Disease control
• Most communicable diseases are preventable.
• Life style diseases (diabetes, hypertension, high
cholesterol, stroke) are also on the rise even in rural areas.
• These diseases, collectively known as non-communicable
diseases, are important causes of premature death in the
young and middle-aged.
• The problem of substance abuse is also increasing, along
with alcohol intake and tobacco abuse.
• Most often accidents and diseases can change the status of
a family from a prosperous one to a destitute one.
• Disease control requires concerted effort and education.
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75. Healthy Village
• Healthy Village as a concept was first proposed by WHO/EMRO in
1989, in a Technical Consultation on Urban Environmental Health,
which was held in the WHO Regional Office in Alexandria, Egypt.
• Healthy Village is a holistic approach intended to address the
critical environmental health problems in rural areas.
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76. Healthy Village approaches
The Healthy Village concept has been developed to address the environmental and other
related health and social issues in an integrated fashion.
• They aim to promote and mobilize health and environmental measures and considerations
at the village and the local levels.
• They aim to facilitate collaboration between health and other sectors at the local level.
• They aim to raise community awareness and standards of health and hygiene education.
• They place a high priority on improving environmental services (water supply, sanitation,
village cleanliness, etc.).
• They aim to stimulate and strengthen local-level decision-making, community initiatives
and participation, and resource mobilization.
• They encourage and promote the use of appropriate technology and local know-how
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77. Healthy Village activities
• The Healthy Village concept may include the following.
• Forming a village committee, made up of villagers, to oversee activities and
mobilize the community and facilitate their participation and contribution.
• Forming a compatible committee at the district or provincial/governorate level,
represented by the district or provincial local authorities and agencies, to
support village-level activities.
• Conducting diagnostic surveys with full community involvement to identify the
priority problems and available resources.
• Raising community awareness and conducting health and hygiene education.
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78. Contd..
• Improving the water supply and sanitation systems, solid refuse collection and
disposal, and food safety.
• Evaluating housing conditions and providing advice for the improvement of houses.
• Training the locals in "do-it-yourself" house building that takes into account
appropriate health and environmental considerations.
• Surveying the economy and identifying/creating employment opportunities through
local-level income generation activities.
• Trying to maintain the natural ecology of the village and beautifying the surroundings
by planting trees and flowers, draining stagnant or septic waters, maintaining roads
and pathways, etc.
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79. Expected outcomes of public health services in
the rural settings such as village dwellers
• Village dwellers: Village habitant
• Fulfillment of basic health services
• Regular organizing of PHC/ORC and EPI Clinic in community
level
• Referral to municipal, provincial and central level hospital in
emergency