Upload
kirby-galloway
View
32
Download
2
Tags:
Embed Size (px)
DESCRIPTION
Public Health in India Moving Ahead?. Prof. Shiv Chandra Mathur [email protected]. - PowerPoint PPT Presentation
Citation preview
Public Health in IndiaMoving Ahead?
Prof. Shiv Chandra [email protected]
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.
3/26/2011 Shiv Chandra Mathur 2
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.
3/26/2011 3Shiv Chandra Mathur
7%
8%36%
11%
7% 2%
29%
CVD
Chronic resp. ds.
Other chronic ds
Communicable ds, perinatal,maternal conditions & nutritionaldeficiencies
Injuries
Cancer
Diabetes
Deaths In India (2005)
Source : WHO3/26/2011 4Shiv Chandra Mathur
Children Under 3 Who Are Underweight
All India
1998-99 46.7%2005-06 45.9%
Negligible change in 7 years
Source: NFHS – 3, 2005-06
3/26/2011 5Shiv Chandra Mathur
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, 2005-063/26/2011 6Shiv Chandra Mathur
Children (6-35 months) who are Anemic (%)
All India
1998-99 74.2% 2005-06 79.1%
Situation worsened in 13 states; improves in 7
Source: NFHS – 3, 2005-06
3/26/2011 7Shiv Chandra Mathur
Children 12-23 months fully immunized (BCG, measles and 3 doses each of polio/DPT)
All India
1998-99 42.0% 2005-06 43.5%
Negligible improvement …
Source: NFHS – 3, 2005-06
3/26/2011 8Shiv Chandra Mathur
ACTUAL AND PROJECTED NUMBERS OF ACTUAL AND PROJECTED NUMBERS OF DEATHS IN INDIA BY CAUSE 1990DEATHS IN INDIA BY CAUSE 1990 AND AND 20202020
0.0
2.0
4.0
6.0
1990 2020Nu
mb
er o
f d
eath
s (m
illio
ns)Communicable diseasesCardiovascular diseasesOther non-communicable diseasesInjuries
3/26/2011 9Shiv Chandra Mathur
2000 2025
No. of Persons with HYPERTENSION
118 Million 214 Million
No. of Persons with DIABETES
32 Million 69.8 Million
No. of Persons Dying from TOBACCO
900,000 2 Million +
RISING CHRONIC DISEASE BURDENS
3/26/2011 10Shiv Chandra Mathur
SICK INDIVIDUALS
ARISE FROM
SICK POPULATIONS
- Geoffrey Rose
3/26/2011 11Shiv Chandra Mathur
• 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
NEGLECTED CHRONIC DISEASES CARRY ECONOMIC COSTS
3/26/2011 12Shiv Chandra Mathur
“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
3/26/2011 13Shiv Chandra Mathur
HandicapsLack Of Sufficient Public Health Expertise
needed for
• Policy Development
• Program Design, Delivery And Evaluation
• Health System Management
• Public Health Research
3/26/2011 Shiv Chandra Mathur 14
BIOLOGICAL SCIENCES
EPIDEMIOLOGY & ALLIED SCIENCES
ECONOMICS AND MANAGEMENT
SOCIAL SCIENCES
PUBLIC HEALTH
3/26/2011 15Shiv Chandra Mathur
SCIENCE DISCOVERS
TECHNOLOGY DEVELOPS
PUBLIC HEALTH DELIVERS3/26/2011 16Shiv Chandra Mathur
CRAFTING CREDIBLE PUBLIC SYSTEMS IN HEALTH
NRHM - MAKING MDGs ACHIEVEABLE
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.
3/26/2011 18Shiv Chandra Mathur
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.
3/26/2011 19Shiv Chandra Mathur
NRHM has created in each Indian Village
1.A worker : she is ASHA2.An institution : that is VH&SC3.An event : which is VHND.
3/26/2011 Shiv Chandra Mathur 20
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,
3/26/2011 21Shiv Chandra Mathur
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.
3/26/2011 Shiv Chandra Mathur 22
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%
3/26/2011 23Shiv Chandra Mathur
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.
3/26/2011 Shiv Chandra Mathur 24
What Doctors in Public Systems can do further?
1. Strengthen medical care2. Help strengthen HMIS3. Sanitary Stringency4. Induce Behavior Change5. Disease Surveillance6. Educate on Better Food Practices7. Rational Drug Use
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 3/26/2011 26Shiv Chandra Mathur