Escolar Documentos
Profissional Documentos
Cultura Documentos
Dr Umesh Kawalkar
INDEX
Health care Evolution of health care system in India Hospitals Health insurance sheme Private sectors Voluntary health agencies
Health Care
Multitude of services rendered to individual or communities by the agent of the health services or professional for the purpose of promoting, restoring and maintaining the health It is along with prevention, promotion and rehabilitation care and also includes medical care
Other Agencies
Defence services Railways
2) Private Sector
Private Hospitals , Nursing Homes G.P. & Dispensaries
3) Indigenous System of Medicine AYUSH 4)Voluntary Health Agencies 5)National Health Programmes
Srivastava committe (1974) recommended Creation of Village Health Guide (VHG) or community health volunteers based on its recommendation rural health scheme was launched. Rural Health Scheme has principle of Placing peoples health in people hand.
In 1977, the World Health Assembly at Alma Ata decided to launch an ambitious movement known as, Health for All (HFA) by 2000 AD. As a signatory to HFA strategy, the Government of India frame its own policy in 1983 i.e. National Health Policy
Central level
Union Ministry of Health and Family Welfare Department of Health & Family Welfare Department of AYUSH Department of Health Research Department of AIDS Control (each of which is headed by a secretary ) .
Directorate General of Health Services(Dte.GHS) is attached office of the Department of Health & Family Welfare and has subordinate at offices spread all over the country. The DGHS renders technical advice on all medical and public health matters and is involved in the implementation of various health services.
State level
Under the State Department of Health and Family Welfare in each State headed by Minister and with a Secretariat under the charge of Secretary/Commissioner (Health and Family Welfare). The State Directorate of Health Services, as the technical wing, is an attached office of the State Department of Health and Family Welfare and is headed by a Director of Health Services The area of medical education which is with the Directorate of Health Services at the State, is known as Directorate of Medical Education and Research. Some states have created the posts of Director (Ayurveda) and Director (Homeopathy)
Regional level Each regional/zonal set-up covers three to five districts and acts under authority delegated by the State Directorate of Health Services. District Level A middle level management organization and it is a link between the State as well as regional structure on one side and the peripheral level structures such as PHC as well as sub-centre on the other side.
RURAL AREAS
Through the network of Community Health workers Sub centers , PHC
Community level
For a successful primary health care programme, effective referral support is to be provided. For this purpose one Community Health Centre (CHC) has been established. Community Health Centre (CHC) has been established for every 80, 000 to 1, 20, 000 population, Provides the basic specialty services in general medicine, pediatrics, surgery, obstetrics and gynecology.
PHC is the first contact point between village community and the Medical Officer. The PHCs were envisaged to provide an integrated curative and preventive health care to the rural population with emphasis on curative, preventive, Family Welfare Services and promotive aspects of health care. There are 23391 PHCs functioning in the country.
Minimum Requirements at the Primary Health Centre for meeting the IPHS :
Medical care Maternal and Child Health Care including family planning Medical Termination of Pregnancies Management of Reproductive Tract Infections / Sexually Transmitted Infections Nutrition Services (coordinated with ICDS) School Health Adolescent Health Care Promotion of Safe Drinking Water and Basic Sanitation Prevention and control of locally endemic diseases. Disease Surveillance and Control of Epidemics Collection and reporting of vital events
Education about health National Health Programmes Referral Services Training Basic Laboratory Services Monitoring and Supervision AYUSH services as per local peoples preference Rehabilitation Selected Surgical Procedures Record of Vital Events and Reporting
COMMENTS
Majority of PHC don't have full staff Shortage & misuse of transport vehicle Few no. Female physicians so difficulty in delivering RCH services Majority of MBBS graduate were not ready to work at PHC
Sub-Centre
Most peripheral and first contact point between the primary health care system and the community. provide services in relation to maternal and child health, family welfare, nutrition, immunization, diarrhea control and control of communicable diseases programmes Also provides with basic drugs for minor ailments Sub-centre is staffed by one Female Health Worker commonly known as Auxiliary Nurse Midwife (ANM) and one Male Health Worker commonly known as Multi Purpose Worker (Male) Lady Health Visitor (LHV) and one Health Assistant (Male) located at the PHC level are entrusted with the task of supervision
Village Level
Village Health Guide Scheme Trained Local Dais ICDS Scheme ASHA scheme
VHG undergo short training at PHC for 200 hrs After training completion get working manual & kit of simple medicine Duties
T/t of simple aliments mother and child health care Family planning Health education & Sanitation
ICDS SCHEME
Anganwadi worker for the population of 1000 Undergoes training in various aspect of health nutrition, & child development Part time worker & get 1500 Rs per month Services rendered Health checkup of child maintaining growth chart Immunization Non formal preschool education Referral services Beneficiaries are nursing mothers, pregnant women, other women 15-45 yrs, children below 6 yrs & adolescent girls
she would be entitled for performance based compensation & reasonable efficiency would be able to earn Rs. 1000 per month.
ASHAs would reinforce community action for universal immunization, safe delivery, newborn care, prevention of water-borne and other communicable diseases, nutrition and sanitation. She will also help the villagers promote preventive health by converging activities of nutrition, education, drinking water, sanitation etc. Work with AWW ASHA will also assist the villagers in referral services for AYUSH/testing HIV/ AIDs, STI, RTI, also preventive, promotive health already with AWW/VHGs etc.
Comments
None of ANM workers found to be performed excellent job (>75% subtask performed well) by the Rangrao etal study in 2003 The stress to achieving the sterilizing targets left little time to attend other duties. ANM have to maintain 13 registers & submit seven reports to PHC LHV should have to support but have more on administrative supervisor than clinically competent provider Lack of physical infrastructure ; equipment & basic amenities No time for house to house visit for newborn ; perinatal care & village health level session
Shortages of doctors at PHC & specialist care also shortage Available public health specialist low Doctors and specialist in position means that it is not always that he/she present at center and performing duty .Absenteeism is very high Large no fresh graduates have no knowledge of simple procedure like immunization , nutritional advice, IV fluids inj., contraception's More urban oriented and heavily dependant on the methods used at tertiary care
URBAN AREAS
Central Govt. Health Scheme started 1954 at Delhi For the medical care facilities to central govt. employees & their family members. Later extended to other major cities URBAN HEALTH SERVICES As one of the thrust area 10 th five year plan; National population policy 200,National health policy 2002; RCH IInd phase URBAN FAMILY WELFARE CENTERS Launched during First five year plan 1083 till functioning providing promotive, preventive, curative activity
HOSPITALS
Govt. hospital mainly to serve urban area Hospitals differs from health centers
Services provided are mostly are curative No catchment area .I.E. No definite area of responsibilities Only curative staff
Apart from PHC, the present organization of health services of the Govt. sector consist Rural Hospital, Sub Divisional Hospital , District Hospitals , Specialist Hospitals & Teaching Hospitals
Health Insurance
Here the basic tenet is that a large group of people are made to share the risk that they may need health care at any point of time, thus creating a risk pool. The funds dedicated for health care are collected through prepayment and managed in such a way as to ensure that the risk of having to pay for health care is borne by all the members of the pool and not by each contributor individually.
PRIVATE AGENCIES
Very large share of health service Own account enterprises are 80% of the total health facility Most of them congregate in urban areas. Mainly curative services Available for only those who can pay.
Facts in NSS survey
Highly skewed distributions (88% health facilities at Urban & Remaining 22% in rural) Private sectors has 75% specialist & 85% technology Nearly 2/3 of doctors were concerted at urban area Private sectors accounts for 49% of bed 75% of services for dental, mental , ortho, vascular & cancer & 40% of the communicable disease were by private sectors
Voluntary Health Agency In India Indian Red Cross Society Hind Kusht Nivarn Sangh Indian Council For Child welfare TB association in India Bharat Sewak Samaj International Agency Rockefellar Foundations FORD Foundations CARE
References
Park k. Textbook of Preventive and Social Medicine 20 th edition 2009 Bhanot publications p.n. 76-82 Dr J.P. Baride Dr. A.P. Kulkarni.Textbook of community medicine 3rd edition Vora publications 2006, Bhalwar Rajvir . Textbook of Public Health And Community Medicine published by dept of community medicine , AFMC,pune 2009 J Kishors National Health Programmes of India , National policies and Legislation Realted to Health 9 th edition century publiccations