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Integration of Substance Abuse Disorders in National Rural Health Mission (NRHM). Dr. Rakesh Kumar, Dr. Kapil Yadav, Dr. Chandrakant S Pandav, Professor & Head, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi. - PowerPoint PPT Presentation
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Dr. Rakesh Kumar, Dr. Kapil Yadav, Dr. Chandrakant S Pandav,
Professor & Head,Centre for Community Medicine,
All India Institute of Medical Sciences, New Delhi
•Take Home Messages
•Background
•Public Health Approach to Substance Abuse
•Principles of successful integration
•Integration in National Rural Health Mission
•Take Home Messages
•Substance abuse is common in rural area.
•Huge prevention and treatment gap in substance
abuse.
•Public health approach can bring high dividends
•Integration into National Rural Health Mission for
efficient service delivery
Changes in the functioning of human mind and more specifically leads to a state of intoxication
•Substance abuse is common in rural area.
•Huge prevention and treatment gap in substance
abuse.
•Public health approach can bring high dividends
•Integration into National Rural Health Mission for
efficient service delivery
Drug Type Rural (n=31,159) %
Urban (N= 9538), %
Alcohol 20.1 18.3
Cannabis 3.1 1.3
Opiates 0.7 0.5
Source-NHS
Demand Reduction Supply Reduction
To protect the health of people, particularly the most vulnerable, from the dangerous effects of drug use
and from drug use disorders
Health Care
To reduce drug related diseases and social Consequences
Harm Reduction
Clinical Medicine Public health
UNIT OF STUDYUNIT OF STUDY • Individual•Population/ Community
TARGET GROUPTARGET GROUP• Mostly Patient – with disease
• Diseased and healthy individuals
VIEWPOINT OF VIEWPOINT OF
HEALTH SYSTEMHEALTH SYSTEM
• Mostly passive process
• Active process
TYPE OF CARETYPE OF CARE• Major focus on curative care
• Comprehensive care
SERVICE PROVIDERSSERVICE PROVIDERS• Majority by private sector
• Both public & private sector
BENEFITSBENEFITS
• Short term benefits• Obvious benefit
• Long term benefits • Not obvious
In Public Health – Good work means no patients
•Prevention is better than cure
•Best should not be the enemy of good
•Good for many rather than best for few
•Primary health care is NOT primitive care
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•Awareness and education
•Management through motivational counseling,
treatment, follow-up and social reintegration of
recovered patients
•Educated cadre of service providers – Drug
abuse prevention and rehabilitation
training
•
•
•Proper policy and plans
•Advocacy
•Manpower training
•Realistic tasks
•Access to drugs
•Co-ordination with other sectors
•Proper support
Launched on 12 th April, 2005 with an objective to provide effective health care to the rural population, by •improving access,•enabling community ownership•strengthening public health systems for efficient service delivery•Enhancing equity and accountability •Promoting decentralization
NRHM – Main Approaches
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COMMUNITIZE
1. Hospital Management Committee/ PRIs at all levels2. Untied grants to community/
PRI Bodies3. Funds, functions &
functionaries to local community organizations
4. Decentralized planning,5. Intersectoral Convergence
IMPROVEDMANAGEMENT
THROUGH CAPACITY
1. Block & District HealthOffice with management skills2. NGOs in capacity building
3. NHSRC / SHSRC / DRG / BRG4. Continuous skill development
support
FLEXIBLE FINANCING
1. Untied grants to institutions 2. NGOs for public
Health goals3. NGOs as implementers
4. Risk Pooling – moneyfollows patient
5. More resources formore reforms INNOVATION IN
HUMAN RESOURCEMANAGEMENT
1. More Nurses – localResident criteria
2. 24 X 7 emergencies byNurses at PHC. AYUSH
3. 24 x 7 medical emergencyat CHC
4. Multi skilling
MONITOR,PROGRESS AGAINST
STANDARDS
1. Setting IPHS Standards2. Facility Surveys
3. Independent MonitoringCommittees at
Block, District & Statelevels
BLOCKLEVEL
HOSPITAL
30-40 Villages
Strengthen Ambulance/transport ServicesIncrease availability of NursesProvide TelephonesEncourage fixed day clinics
AmbulanceTelephone
Obstetric/Surgical MedicalEmergencies 24 X 7
Round the Clock Services;
BLOCK LEVEL HEALTH OFFICE –--------------- Accountant
CLUSTER OF GPs – PHC LEVEL
3 Staff Nurses; 1 LHV for 4-5 SHCs;Ambulance/hired vehicle; Fixed Day MCH/Immunization
Clinics; Telephone; MO i/c; Ayush Doctor;Emergencies that can be handled by Nurses – 24 X 7;
Round the Clock Services; Drugs; TB / Malaria etc. tests
GRAM PANCHAYAT – SUB HEALTH CENTRE LEVEL
Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages;Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic
VILLAGE LEVEL – ASHA, AWW, VH & SC
1 ASHA, AWWs in every village; Village Health DayDrug Kit, Referral chains
100,000 Population
100 Villages
5-6 Villages
Accredit private providers for public health goals
Health Manager
Store Keeper
NRHM – Illustrative Structure
•Assessment of Community needs
•Identification of high risk individuals.
•Counseling and education of such individuals.
•Handling crisis situations in the families.
•Providing moral support.
•Organizing and participating IEC/ Awareness
programmes for various groups such as high risk
groups and schools.
•Linkages & Coordination with governmental
health systems and non-governmental
organization.
•Creation and operationalizing self help groups
•Early diagnosis (case finding / screening) and
treatment of cases including referrals
•Helping the patient to identify substance abuse
behavior and its consequences.
•Offering constant support to the patients. .
•Encouraging the patients to participate in treatment
programme and continue.
• Referring the patients to appropriate agencies and organizations for seeking economic support for starting some vocation.
•Minimizing the stigmatization and discrimination
against the patient by the community.
•Working in close liaison with governmental and non-
governmental organizations for rehabilitation of the
patients
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