PUBLIC health in India

//PUBLIC health in India

PUBLIC health in India

The topic of Public Health in India covers the following topics

  • Maternal care, reproductive health, newborn care and related topics in addition with Govt schemes
  • Immunization program (preventive health care) in India
  • Malnutrition and related topics with Govt schemes
  • AYUSH
  • Some topics like multi drug resistance (TB control), clinical trials

The above topics should be read in detail. Below are few important details of various topic. We suggest that you make proper notes of these:

Maternal and newborn health in India:

Maternal health and also reproductive health includes health in pregnancy, child birth and post partum period (prenatal or ante natal care:during pregnancy, post natal care: after child birth, neo natal care: till child is 28 days old)
Key indicators:

  • Maternal mortality rate: female deaths per 100,000 live births during or within 42 days of childbirth (MDG-goal 5 to reduce MMR between 1990-2015 by 75% and ensure universal access to reproductive health)
  • Infant mortality rate: infant means under age of 1;infants deaths per 1000 live births
  • Child and UNDER-5 mortality is the same i.e. child deaths per 1000 live births (MDG: reduce child mortality by 2/3rd between 1990-2015)

RECENT DATA (according to NRHM website)

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From a Maternal Mortality Rate (MMR) of 437 per 100,000 live births in 1990-91, India requires to reduce MMR to 109 per 100,000 live births by 2015 as per MDG. However, despite this progress, India is expected to fall short of the 2015 target by 26 points (135 per 100,000).

Why India has high maternal mortality rate?
Blood loss during child birth, anemia among women, lack of institutional delivery system and adequate healthcare, lack of literacy, early marriage and pregnancy etc

  • Safe motherhood depends on the delivery by trained personnel, particularly through institutional facilities.
  • By 2015, it is expected that India will be able to ensure only 62 percent of births in institutional facilities with trained personnel. Thus, universal coverage remains to be achieved (source UNDP)

GOVT INTERVENTIONS

NATIONAL HEALTH MISSION : (having sub component of NRHM and NUHM cities above 50000 pop) under MOFCW
Targets of NHM1

  • Reduce MMR to 1/1000 live births
  • Reduce IMR to 25/1000 live births
  • Reduce TFR to 2.1
  • Prevention and reduction of anaemia in women aged 15–49 years
  • Prevent and reduce mortality & morbidity from communicable, non- communicable; injuries and emerging diseases
  • Reduce household out-of-pocket expenditure on total health care expenditure
  • Reduce annual incidence and mortality from Tuberculosis by half
  • Reduce prevalence of Leprosy to <1/10000 population and incidence to zero in all districts
  • Annual Malaria Incidence to be <1/1000
  • Less than 1 per cent microfilaria prevalence in all districts
  • Kala-azar Elimination by 2015, <1 case per 10000 population in all blocks

JANANI SURAKSHA YOJNA (under NRHM)
To decrease the neo-natal and maternal deaths happening in the country by promoting institutional delivery of babies SY is a 100% centrally sponsored scheme and it integrates cash assistance with delivery and post-delivery care approach is to focus on low performing states (wrt MMR)

ASHA (under JSY,NRHM):

  • Every village/large habitat has a female Accredited Social Health Activist (ASHA) – chosen by and accountable to the Panchayat.
  • She acts as the interface between the community and the public health system and schemes related to health, nutrition and hygiene- including toilets under Nirmal Bharat Abhiyan (now Swacch Bharat).
  • She also generates awareness about female infanticide, family planning, STD/HIV
  • She carries a Drug Kit containing generic AYUSH, allopathic drugs for common ailments, Rehydration Therapy (ORS), Iron Folic Acid Tablet(IFA), chloroquine, pills, condoms etc.
  • She receives performance based incentive depending on number of children immunized under Polio vaccination drive, No. of institutionalized deliveries under Janani Suraksha Yojana, no. of pregnant no. of TB patients covered under DOTS therapy and so on.

Indira Gandhi Matritva Sahyog Yojana (IGMSY)

  • By Women and Child Development Ministry under “National mission for empowerment of women.” (NOT by Health Ministry)
  • To compensate mothers for wage-loss during childbirth and childcare.
  • Available to all women for first two children.
  • Not available to women who get paid maternity leave.
  • Conditional cash transfer via Direct benefit transfer (DBT)
  • Condition: she should get pre-natal checkups, get vaccination for infant, attend counseling session etc.

Janani Shishu Suraksha yojna

  • Free drugs, Diet, Medical checkup, transport to home, and caesarean deliveries.

(Recently India has been declared free from maternal and new born tetanus (MNT) which was as major cause for high IMR.)

MALNUTRITION

Group of conditions in children (or adults) generally related to poor quality or insufficient quantity of nutrient intake, absorption or utilization

Two major types of nutrition:

  1. Protein –energy malnutrition (ACUTE-wasting or thinness, CHRONIC-stunting or shortness, ACUTE and CHRONIC- underweight)
  2. Micro nutrient deficiencies (iron, vitamin A, iodine etc)

Govt schemes:

INDIA NEWBORN ACTION PLAN
Launched in sept 2014 by health ministry; 7 Lakh newborn die each year in india, IMR: 29 deaths/1000 ; target to reduce IMR to single digit by 2030

6 strategies of INAP

  • preconception and antenatal care
  • care during labour and child birth
  • immediate newborn care
  • care of healthy newborns
  • care of small and sick newborns
  • care beyond newborn survival.

Will also take Help from ASHA workers, Indian academy of pediatricians, NGOs and philanthropists like Bill Gates

National Nutrition Mission

  • When? 2014, January
  • Who? Health ministry
  • Why? To reduce malnutrition among women and children under age of 3Target: 200 high burden district
  • Criticism : One component not yet implemented: reducing Anaemia among adolescent girls.
  • How? Training Anganwadi workersNutrition councils at District level; ICT for monitoring progress: Anganwadi workers to collect child data using tablet / mobile.

RBSK(Rashtriya Bal Swashtya Karayakaram) and WIFS(weekly Iron Folic and Supplements)

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What is Hidden hunger?

  • If Government give free/ subsidized wheat and rice then hunger will be eliminated only from ‘energy / carbohydrates’ angles.
  • But Deficiency in micronutrients and vitamins will continue. This is hidden hunger. Every third person in world suffers from Hidden hunger. (total 2 billion)

Why hidden hunger?

  • During adolescence, pregnancy- higher amount of micronutrient needed but people lack the money / awareness to change died habits accordingly.
  • Solutions: iodized salt, fortified flour, bio-fortification of crops, PDS reform, Education.

Integrated Child Development Services (ICDS) Scheme

BY MO women and child development. It was launched on 2nd October 1975. Today, ICDS scheme represents one of the world’s largest and most unique programmes for early childhood development.

ICDS is the foremost symbol of India’s commitment to her children – India’s response to the challenge of providing pre-school education on one hand and breaking the vicious cycle of malnutrition, morbidity, reduced learning capacity and mortality, on the other.

Objectives
The Integrated Child Development Services (ICDS) Scheme was launched in 1975 with the following objectives:

  • to improve the nutritional and health status of children in the age-group 0-6 years;
  • to lay the foundation for proper psychological, physical and social development of the child;
  • to reduce the incidence of mortality, morbidity, malnutrition and school dropout;
  • to achieve effective co-ordination of policy and implementation amongst the various departments to promote child development; and
  • to enhance the capability of the mother to look after the normal health and nutritional needs of the child through proper nutrition and health education.

Services
The above objectives are sought to be achieved through a package of services comprising:

  • supplementary nutrition,
  • immunization,
  • health check-up,
  • referral services,
  • pre-school non-formal education and
  • Nutrition & health education.

IMMUNIZATION

UIP is under National Rural Health Mission (NRHM) since 2005. The program consists of vaccination for seven diseases- tuberculosis, diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, measles and Hepatitis B. Hepatitis B was added to the UIP in 2007. Thus, UIP has 7 vaccine preventable diseases in the program. [

On 2014 it was announced that four vaccines will be added to the program, namely rotavirus, rubella and Japanese encephalitis, as well as the injectable polio vaccine (to be introduced as it contains dead polio virus rather than attenuated polio virus which can cause induced polio in children).

Penta-valent Vaccine

Penta=five. So penta-valent vaccine=five vaccines in one.

  • Diphtheria
  • Pertussis
  • Tetanus,
  • Hepatitis-B
  • Hib. (Hib Haemophilus Influenzae Type B). It is Responsible For Pneumonia, Meningitis And Epiglottitis)

This is an “injection” (and not oral drops like polio vaccine.)

In India, pentavalent vaccine was introduced in Tamil Nadu and Kerala in December 2011, under the Universal immunization program. Recently Delhi and Jammu and Kashmir, Haryana, Puducherry, Goa and Gujarat also started using it.

MISSION INDRADHANUSH

Mission Indradhanush was launched on 25December 2014 with the aim of covering all those children who are either unvaccinated or are partially vaccinated against seven vaccine-preventable diseases which include diphtheria, whooping cough, tetanus, polio, tuberculosis, measles, and hepatitis B by 2020. The intensification of immunization activities will be carried out in 201 high focus districts in the first phase and 297 districts will be targeted for the second phase in 2015

AYUSH

With the goal of providing holistic health solutions, the erstwhile Department of AYUSH(Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy) has been elevated to a fullfledged ministry from 9 November 2014. The basic objective of the National AYUSH Mission (NAM) is to promote AYUSH medical systems through cost-effective AYUSH services and strengthening of educational systems. Steps are also underway for including yoga in the regular education curriculum. Paying heed to the Prime Minister’s exhortation during his address to the UN General Assembly in September 2014, the UN has declared 21 June International Yoga Day.

National Ayush Mission (NAM) 2014
Approved with following features:

  • Increase in number of AYUSH
  • Education institutions and manpower
  • Hospitals, pharmacies, labs, dispensaries
  • Raw material and drugs
  • Penetrate AYUSH more in the far flung areas.
  • Benefits of AYUSH: cheap, flexible, less side effects, accepted by large public.

OTHER MISCELLANEOUS TOPICS

Vector control

  • National Vector borne diseases control program (NVBDCP)
  • This is under National rural health mission.
  • Directorate at Delhi gives cash and commodity to state Governments for implementing this.
  • Government plans to eliminate kala-azar and filariasis by 2015.

Comprehensive program against vector borne diseases such as

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SWACCH BHARAT MISSION(MO drinking water and sanitation)
Launched on 2 oct 2014;this campaign aims to accomplish the vision of a ‘Clean India’ by 2 October 2019, the 150th birthday of Mahatma Gandhi

OBJECTIVES:

  • Elimination of open defecation
  • Conversion of unsanitary toilets to pour flush toilets (a type of pit latrine, usually connected to two pits)
  • Eradication of manual scavenging
  • 100% collection and processing/disposal/reuse/recycling of municipal solid waste
  • A behavioural change in people regarding healthy sanitation practices
  • Generation of awareness among citizens about sanitation and its linkages with public health
  • Supporting urban local bodies in designing, executing and operating waste disposal systems
  • Facilitating private-sector participation in capital expenditure and operation and maintenance costs for sanitary facilities.

How it is related to health:

  • General cleanliness and hygiene prevents communicable diseases (air borne, vector borne etc)
  • Contamination of land and water bodies through untreated waste, open defecation, uncollected garbage etc result in spread of diseases

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