1 / 42

Prof. D K Gupta Vice Chancellor-CSMMU, (KGMU), LKO Professor and Head, Dept of Pediatric Surgery

Health Care in developing world A Road Map to Paradigm Shift. Prof. D K Gupta Vice Chancellor-CSMMU, (KGMU), LKO Professor and Head, Dept of Pediatric Surgery AllMS , New Delhi. Where are we - today. Health – Major Disparity in the world India: Poverty, illiteracy, hygiene

urbana
Download Presentation

Prof. D K Gupta Vice Chancellor-CSMMU, (KGMU), LKO Professor and Head, Dept of Pediatric Surgery

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Health Care in developing world A Road Map to Paradigm Shift Prof. D K Gupta Vice Chancellor-CSMMU, (KGMU), LKO Professor and Head, Dept of Pediatric Surgery AllMS, New Delhi

  2. Where are we - today • Health – Major Disparity in the world • India: Poverty, illiteracy, hygiene • Population explosion • Basic needs : ?? Food, water, education • New Epidemic: DM, HT, Trauma, Obesity, psychiatric problems • Cancers: Infants, Children, adults, old age • 1 million pts. die globally /year : No help • High expectations – why not ??

  3. Chronic Disease Burden • CDs result for 60% of deaths in 2005. • >80% of deaths in low to middle income countries (LMIC). • NCDs are killing more people in their prime adult years. • TB, HIV and malaria account for 10% of the global deaths.

  4. Age at death region wise Source: Global Burden of Disease, 2004 Update, used by permission

  5. Major Causes of Death, World area Source: The Global Burden of Disease: 2004 update, WHO

  6. Life style : factors

  7. Lack of Physical exercise • 2 million deaths worldwide annually. • A causal factor for; • 10-16% breast , colon cancers, diabetes • 22% of ischemic heart disease.

  8. Overweight & Obesity WHO Report: 2.3 billion overweight adults in the world Over 700 million of them will be obese by 2015.

  9. Hypertension • Responsible for 13% of deaths world-wide. • 26% of adults had hypertension in 2000, • Expected to jump to 30% by 2025 globally • 2/3 with HTN live in developing world.

  10. Disease association with Tobacco use Source: WHO Report on Global Tobacco Epidemic, 2008

  11. Health Problems in developing world • 2/3rd Population is in developing world • 2 Billion children malnourished • Infection, diarrhoea, Malnutrition : ??? • Congenital malformations (2%) • Cancers – presenting quite late • Trauma – common, 90% preventable • Life style disorders – common, early age - Hypertension, Diabetes, Obesity, - Psychiatric / mental health disorders

  12. Urban India – Medical Tourism

  13. Indian medical scenario • Vast country – limited health facilities • Facilities - Mostly in urban areas • Long distances / time to travel • Specialized services only to 20% population • Expensive hospital stay/ medical services • Limited health insurance • No insurance for serious Cong. Mal., cancers, • High IMR, MMR, TFR

  14. Indian scenario • Population: 1.2 billion • India will cross China in 2030 ( 1.45 bn.) • > 400 million children <14 yr age • GDP health Share : 1.2% • Now increased from 1.2% to 2%

  15. Special health issues • 80% villages: Poor overall development • Poor state of Primary, community & district • Poor state of Medical college, Hospitals • Poor vaccination – in rural sector • Poor education, hygiene, literacy, schooling • Inadequate Medical & Paramedical staff

  16. Special health problems in India • Mean Age : M- 65 : F- 57 yr • Old age: No shelter homes • Communicable diseases - • Snake bites • Disasters – Tsunami, Earth quakes, floods • Very high trauma – 90% preventable

  17. 90% accidents :Preventable in children • News 26-7-2012

  18. - KGMU Trauma Center caters to 5 neighboring states & Nepal - 9 more trauma centers

  19. Indian scenario • Preventive & Control programs : Govt. • Primary / Tertiary Health Care : Govt. • 80% OPD services by Private sector • 60% indoor beds in private sector • 80%: No access to modern health care • 70% cost born by the patient himself • Every 7th in the world - is an Indian

  20. Medical/ Dental Colleges(recognized / un-recognized)

  21. Medical Graduation – 6 years Post-Graduation -3 yrs more Super-specialty – 3 yrs more ( Total 12 years) + Fellowship ??

  22. Tough Life of a Institutional Doctor • Doctors are trusted & kept in high esteem • High expectations from the Role Models • Sacrifice – personal & family life • No working hours for doctors - indoor service • Tough life before, during and after operations • Must know Recent advances • Seminars, Journal clubs during training period • Preparing for Lectures, Conferences, workshops,

  23. What do people want from Govt. • Reliable & Affordable Medical services • Free treatment for major problems - Cancer, Heart, Liver, kidney, transplant • Free treatment to all those who are poor • Institutions to be only as a referral center • Availability of good quality Medicines ( 30-40% medicines are spurious) • Free Medicines to all pts. in PHC / CHC ( Generic: cost, control of quality, confidence)

  24. Emphasis is on now ; • Improvement in Mother & child care • Improve IMR from 57 to 37 • Improve MMR from 388 to 200 • Reduce TFR from 3.8 to 2.5 • Filling the medical / staff vacant posts • Develop work ethos and culture • Improve competency level

  25. Strategies to improve health • Preventive and Therapeutic : Govt. Responsibility (Polio eradicated recently) • More doctors, nurses and paramedics • Medical college each of 626 districts • Generic and quality medicines – free to all • Corporate Hospitals – super-speciality • Medical Tourism

  26. Additional health Planning • Budget increased from 1.2% to 2% • Ambulance : Free services, Joint Control rooms • Mid day meals for school children • Free Health for all Girl students • National Rural health Mission • National urban health Mission • Public Health Foundation – BPL, Insurance • Janani Baccha Suraksha Yojna (MCH Services) • National Disaster Management Authority

  27. Govt. Recent efforts - • 6 new AIIMS like Institutes • Incentives for PG seats for rural doctors (10 marks for 1 yr , max. 30 marks for 3 yr service) • New Medical Colleges – Govt. / Pvt. • PPP Model for the Rural sector • Corporate Hospitals to have PG seats. • DNB – PG seats in Big hospitals • 13000 UG and 4000 NEW PG seats

  28. Govt. New Incentives • New Colleges of Nursing • Regional Institutes of Paramedical sc. 8 RIPS • BRHC- Bachelor Rural Health Care: 3 yr course • 18 wk training for obst. and anesthesiologists • 1 yr course in Cardiology, DM, Dialysis, • Insurance cover for all • Aadhar / BPL cards to poor population

  29. Improving Health services • Health services – PHC, CHC, District • Teaching Institutions – Govt. / Pvt. • Private sector - Major share in OPD & Indoor • 4 Tier Health care delivery Model • PHC, CHC, District, • State Level with specialists • National level Hospitals for referred cases • Institutes: Transplant, Heart, Liver, Kidney, children

  30. Improvement of Health services Incentives to workers in PHC/CHC: • Local staff- others • Pharmacist, Ambulance driver • Physicians and Surgeon Minimal available Medical infrastructure • Minimal facilities for the staff/ doctors • Due respect & responsibility • Trust, freedom and Autonomy

  31. Alternate model - difficult Curative and Preventive Role • PHC : Doctors in Mobile Units, staff • Counseling on Preventive programs • National disease control program • Vaccinations – mother & child care • Distributing free medicines • Referring serious pts. to higher center • NGOs, teleconferencing for help • Visitor Nurses / paramedics for FU

  32. Role of NGs to bridge the gap

  33. Education and Awareness - Parental counseling • Keeping children away from cooking area • Away from industrial hazards • Keeping medicines / acids away • Ban on strong acids and alkalis • Ban on washing soda • Use of Seat belts in vehicles • Use of Cycle helmets and reflecting lamps

  34. Core Group Recommendations ; • Better designs : Roads, flyovers, school buses, • Better House designs: with high walls, better doors, windows, toilet sheets, glass panes • Adequate Covers – manholes, wells, • No to fire crackers around Deewali • No Kite flying from roof tops Gupta DK. Chairman – Core Group Recommendations to the Ministry, 3rd World Congress on Pediatric Esophagus , AIIMS, New Delhi. 2002

  35. International Delegation Meets Hon’ble Prime Minister of India, health concerns of Children

  36. Other health related concerns • Safe drinking water to public • Garbage disposal from city & villages • Technically sound Roads and streets • Construction of Public toilets • Proper sewage disposal • Proper hygiene at Rly. stations • Measures to prevent CDs/ NCDs • Awareness on preventing trauma

  37. Health indicators continue to be poor and high mortality rates of infants and pregnant women have been a cause of serious concern. “Government has decided to continue theNational Rural Health Mission for next five years. We are now proposing a new National Urban Health Mission in order to focus on the health challenges in our towns and cities,“ Prime Minister of India, 2012

  38. Road Map to improvement Increase in health Budget & Facilities Have Trust & commitment Give Respect & Responsibility Competency and care

  39. Expect nothing from 21st century. It is the 21st Century that expects everything from us.(Gabriel Garcia Marquez)

More Related