Public health in india moving ahead
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Public Health in India Moving Ahead?. Prof. Shiv Chandra Mathur [email protected]

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Public health in india moving ahead

Public Health in IndiaMoving Ahead?

Prof. Shiv Chandra Mathur

[email protected]


Public health in india moving ahead

Objective of this presentation is to let viewers get an overview on the progress of Public Health in India, and the contribution of interventions by health systems in the public sector in this process particularly in context of first decade of the new millennium.

Shiv Chandra Mathur


Understanding india

Understanding India

  • Over a billion people in over a million places.

  • Persistence of poverty and under nutrition.

  • Low public exp./high out of pocket on health.

  • Regional disparities – Kerala/Bihar.

  • Large unregulated private sector

  • Medicalized versus health – water, sanitation.

  • Several systems concurrently

  • Human resource challenges - urban - rural.

Shiv Chandra Mathur


Public health in india moving ahead

Deaths In India (2005)

Shiv Chandra Mathur

Source : WHO


Children under 3 who are underweight

Children Under 3 Who Are Underweight

All India

1998-9946.7%

2005-06 45.9%

Negligible change in 7 years

Source: NFHS – 3, 2005-06

Shiv Chandra Mathur


Anemia

Anemia

Married women (15-49 years) who are anemic (%)

1998-99 51.8%

2005-06 56.1%

Situation worsened in 13 states; improves in 7

Source: NFHS – 3, 2005-06

Shiv Chandra Mathur


Children 6 35 months who are anemic

Children (6-35 months) who are Anemic (%)

All India

1998-9974.2%

2005-06 79.1%

Situation worsened in 13 states; improves in 7

Source: NFHS – 3, 2005-06

Shiv Chandra Mathur


Children 12 23 months fully immunized bcg measles and 3 doses each of polio dpt

Children 12-23 months fully immunized (BCG, measles and 3 doses each of polio/DPT)

All India

1998-9942.0%

2005-06 43.5%

Negligible improvement …

Source: NFHS – 3, 2005-06

Shiv Chandra Mathur


Public health in india moving ahead

Shiv Chandra Mathur


Public health in india moving ahead

RISING CHRONIC DISEASE BURDENS

Shiv Chandra Mathur


Public health in india moving ahead

SICK INDIVIDUALS

ARISE FROM

SICK POPULATIONS

- Geoffrey Rose

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Public health in india moving ahead

NEGLECTED CHRONIC DISEASES CARRY ECONOMIC COSTS

  • In 2005, it is estimated that India lost 9 billion USD in national income from premature deaths due to heart disease, stroke and diabetes.

  • These losses are expected to cumulatively lead to 237 billion USD over the next 10 years.

Source: World Health Organization

Shiv Chandra Mathur


Public health in india moving ahead

“Medicine has imperceptibly led us into the social field and placed us in a position of confronting directly the great problems of our time”.

- Rudolf Virchow, Report on the Typhus Epidemic in Upper Silesia, 1848

Shiv Chandra Mathur


Handicaps

Handicaps

Lack Of Sufficient Public Health Expertise

needed for

  • Policy Development

  • Program Design, Delivery And Evaluation

  • Health System Management

  • Public Health Research

Shiv Chandra Mathur


Public health in india moving ahead

BIOLOGICAL SCIENCES

EPIDEMIOLOGY & ALLIED SCIENCES

ECONOMICS AND MANAGEMENT

PUBLIC HEALTH

SOCIAL SCIENCES

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Public health in india moving ahead

SCIENCE DISCOVERS

TECHNOLOGY DEVELOPS

PUBLIC HEALTH DELIVERS

Shiv Chandra Mathur


Crafting credible public systems in health

CRAFTING CREDIBLE PUBLIC SYSTEMS IN HEALTH

NRHM - MAKING MDGs ACHIEVEABLE


What is the change

What is the Change ?

  • Health – a priority in States as never before.

  • Public health thrust recognized.

  • NRHM – A platform for innovations.

  • NRHM – A Framework for decentralization.

  • Human Resource as priority.

  • Community Worker – connecting households

  • A statement that public systems can deliver.

  • Managers of the system – professional skills.

Shiv Chandra Mathur


Nrhm in india has made a difference

NRHM in India has made a difference

  • A true partnership with States.

  • Space for innovations.

  • Distrust to trust.

  • Community institutions as focus.

  • Public health focus – addressing local specific mortality and morbidity.

  • Building capacities for local action.

  • Recognizing the need for management skills.

Shiv Chandra Mathur


Nrhm has created in each indian village

NRHM has created in each Indian Village

  • A worker : she is ASHA

  • An institution : that is VH&SC

  • An event : which is VHND.

Shiv Chandra Mathur


Examples of innovations

Examples of Innovations

  • Making PHCs 24X7 in Tamil Nadu – 3 Nurse model.

  • Assam’s initiative – Boat Clinics

  • Rajasthan’s initiative – CMJRK; SNCUs.;108

  • MP’s initiative –HSC Delivery, SNCUs.

  • Haryana’s initiative – Free drugs, 102; surgery package.

  • Gujarat’s initiative – Chiranjeevi, 108,

Shiv Chandra Mathur


Examples of innovations1

Examples of Innovations

  • Kerala’s initiative –Ban private practice; Quality.

  • Bihar – Block pooling; PPPs – Diagnostics.

  • Chhatisgarh – Mitanin, VHSCs.

  • Orissa – ASHAs; AYUSH doctors;

  • Andamans – High salary for Specialists; RKS.

Shiv Chandra Mathur


The impact of nrhm 1

The impact of NRHM - 1

  • MMR significantly down – 450 to 230 - SRS.

  • IMR decline – 60 in 2004; 53 in 2008; <50now

  • TFR steadily declining – 2.9 in 05 to 2.6 in 2008.

  • Institutional deliveries – 41% to 73%

Shiv Chandra Mathur


The impact of nrhm 2

The impact of NRHM - 2

  • TB, Malaria, NPCB, Surveillance better.

  • Substantial addition of human resources.

  • Infrastructure – more and better managed.

  • Doctors, drugs and diagnostics – OPD, IPD.

Shiv Chandra Mathur


What doctors in public systems can do further

What Doctors in Public Systems can do further?

Strengthen medical care

Help strengthen HMIS

Sanitary Stringency

Induce Behavior Change

Disease Surveillance

Educate on Better Food Practices

Rational Drug Use


Public health in india moving ahead

A Health Professional Must

ELUCIDATE - As a health researcher

EDUCATE - As an informed facilitator

ALLEVIATE - As a care giver

ADVOCATE- As a health activist

and if need be

AGITATE- As a concerned citizen

Shiv Chandra Mathur


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