Community pharmacy- Social and preventive pharmacy UNIT 5

Covered community pharmacy topic of the subject Social and preventive pharmacy for Diploma and Bachelor of pharmacy

1. GIPER, LIMB, SATARA 05/06/2024 1 Prepared by_ Ms. S. R. Dalavi Assistant professor SOCIAL & PREVENTIVE PHARMACY GIPER, Limb, Satara.

2. Unit V Community Services In Rural, Urban And School Health Functions Of PHC, 05/06/2024 SOCIAL & PREVENTIVE PAHARMACY 2

3. COMMUNITY HEALTH Community Services In Rural, Urban And School Health

4. 4 Community service is a non-payable job performed by one person or group of people for the benefit of their community. To become active members of their community & Has a lasting, positive impact on society at large. Community health- definition as per WHO “Environmental, social & economic resources to sustain emotional & physical well-being among people in ways that advance their aspirations and satisfy their need in their unique environment.”

5. COMMUNITY SERVICES A healthcare center, health center, or community health center is one of a network of clinics staffed by a group of general practitioners and nurses providing healthcare services to people in a certain area. Conference Presentation 5 The purpose of the health care services is to improve the health status of a population. Indian Pharmaceutical Association Community Pharmacy Division (IPA CPD) aims to enhance the role of a pharmacist and  raise professional standards of pharmacy practice through its activities  and aims to improve the public health through community pharmacists’ services.

6. INTRODUCTION Community Pharmacy A healthcare facility that is able to provide pharmacy services to people in a local area . A community pharmacy dispenses medicine, typically involving a registered pharmacist with the education, skills and competence to deliver professional service to the community. 8/05/20XX 6

7. Community Pharmacy Practice Community pharmacists counsel patients , Answer questions about prescription and over-the-counter drugs, such as possible adverse reactions and interactions , and Give patients health care advice . They also give advice about durable medical equipment , Home care and preventive care . Some community pharmacists offer disease management services for conditions such as diabetes, asthma, hypertension, etc. Some community pharmacists offer preventive health programs : smoking cessation, immunizations, screening for lipid disorders, etc. 8/05/20XX 7

8. PROBLEMS IN INDIA Population Food scarcity Maternal illness Illiteracy MALNUTRITION 60% Children- Undernutrition Overnutrition Protein-energy malnutrition LACK OF ENVIRONMENTAL SANITATION Excreta disposal Non-availability of safe drinking water High prevalence of communicable diseases Lack of medical care facilities 8 Communicable diseases Detection, diagnosis & treatment of illness Prevention of diseases Improving quality of life Increasing life expectancy,

9. 9 Curative Basic sanitation, housing Prevention of diseases COMPREHENSIVE HEALTH CARE (1946) “integrated promotive, curative & preventive health services from womb to tomb” Criteria for comprehensive health care: Service given at the doorstep of the community Community participation Available to one & all without considering their ability to pay Vulnerable & weaker sections are given preference At family & working place creation of healthy environment Health care services Should reach entire country with more focus on rural areas. CONCEPTS OF HEALTH CARE: A) Comprehensive health care (1946) B) Basic health care (1965) C) Total health care (all required health care) D) Integrated health care (curative + preventive) E) Primary health care (First contact care)

10. 1. Comprehensive. 2. Accessible. 3. Acceptable. 4.Provide scope for community participation. 5. Available at a cost the country & community can afford. 10 CHARACTERISTICS OF A GOOD HEALTH SERVICE

11. 11 In India it is represented by five major sectors or agencies which differ from each other by the health technology applied & by the source of funds for operation. AGENCIES OF HEALTH CARE 1. PUBLIC HEALTH SECTOR. 2. PRIVATE SECTOR. 3. INDIGENOUS SYSTEM OF MEDICINE. 4. VOLUNTARY HEALTH AGENCIES. 5. NATIONAL HEALT H PROGRAMMES

12. 12 1. PRIMARY HEALTH CARE : Primary Health Centers Sub Centers. 2. Hospitals & Health Centers Community Health Centers. Rural Hospitals. District Hospitals / Health Centre. Specialist Hospitals. Teaching Hospitals Public Health Sector HEALTH INSURANCE SCHEMES Employees State Insurance. Central Govt. Health Scheme 4 . OTHER AGENCIES Defense medical Services. Railways

13. 13 Private Hospitals, Polyclinics, Nursing Homes & Dispensaries. General Practitioners & Clinics II. Private Health Sector III. Indigenous system of medicine IV. Voluntary Health Agencies NGOs/ social groups V. National Health Program Ayurveda (Herbal) & Siddha (Plants & minerals). Unani & Tibbi _ Perso - Arabic traditional medicine Homeopathy_ Pseudoscientific system of alternative medicine Unregistered Practitioners

14. 8/05/20XX 14

15. 15 Community Development Programmes (NRHM, midday meals, women and child welfare, family welfare programmes, etc.,) can be launched to the village with the voluntary groups which will ensure a standard of living for the maintenance of the health. Dais (village health guides) and village guides (Area Nurse or ANM) can be trained adequately and their services can be utilized. Such workers can influence people very easily and deliver fundamental health services. Such health workers can reach the last man of the village often and deliver health services.

16. 16 Community Health Center (First Referral Unit) Each CHC covers 1,20,000 population (plains) 80,000- hilly/ tribal region. Total= 3222 CHCs in country. Covers about 3 to 4 PHCs. 30 beds; x-ray & lab facilities. Specialist in medicine, surgery & pediatrics. To establish effective convergence and linkages with citizen centric services, A CHC should be established at the community development block/ taluka / tehsil /circle level. This will also supplement the three-tier panchayati system (gram panchayat , block panchayat and zila panchayat ).

17. Staff for Community Health Centre

18. 18 PRIMARY HEALTH CARE IN INDIA In 1977 the Govt of India launched a Rural Health Scheme, based on the principles of “placing people’s health in people's hand " . It is a three tier system of health care delivery in rural areas based on the recommendation of the Srivatsav Committee(1975). Close on the heels of these recommendations an International Conference at Alma Ata (1978), set the goal of an acceptable level of Health For All the people of the world by the year 2000 through Primary health care approach As a signatory to the Alma Ata Declaration, the govt of India was committed to achieving the goal of Health for All through primary health care approach which seeks to provide universal comprehensive health care at a cost which is affordable. Keeping view the WHO goal of “ Health For All ” by 2000 AD, the govt of India evolved a National Health Policy based on primary health care approach. National Health Policy 2000, 2002 & National Rural Health Mission have been recently introduced.

19. Declaration of Alma-Ata International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978 The International Conference on Primary Health Care, meeting in Alma-Ata this 12 Sept 978, expressing the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world. Primary health care: Reflects and evolves from the economic conditions and sociocultural and political characteristics of the country and its communities and is based on the application of the relevant results of social, biomedical and health services research and public health experience; Addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly; Includes at least: education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs;

20. 4. Involves, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communications and other sectors; and demands the coordinated efforts of all those sectors; Requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care, making fullest use of local, national and other available resources; and to this end develops through appropriate education the ability of communities to participate; Should be sustained by integrated, functional and mutually supportive referral systems, leading to the progressive improvement of comprehensive health care for all, and giving priority to those most in need; Relies, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.

21. Conference Presentation 21 Primary health center

22. It is an outcome of Bhore committee report. 538 in Maharashtra. Total 24,855 PHCs in country. It covers about 5 subcentres.

23. 23 To provide comprehensive primary health care to community through PHCs. To achieve & maintain an acceptable standard of quality of care. To make the healthcare services more responsive & sensitive to the needs of the community. OBJECTIVES OF INDIAN PUBLIC HEALTH STANDARDS FOR PHCs:

24. 24 FUNCTIONS OF PHC Medical care Reproductive & child health care Family welfare planning Water supply & sanitation Control of communicable diseases Collection of vital statistics Health education Carry out national health programmes Referral services Training of auxiliary staff like HA, HW, health guides & local dais. Basic laboratory services Provision of essential drugs for PHC

25. 8/05/20XX Conference Presentation 25 It is an outpost attached to PHC covering a population of 5000. Total= 1,50,000 subcentres. MPW (M)- 1 MPW (F)- 1 Health assistant female supervises activity of MPW (F) Voluntary health guide- 1 SUB-CENTER

26. To implement this policy at the village level, the following schemes are in operation. Village Health Guide Scheme. Training of Local Dias. ICDS Scheme. Asha Scheme Community Health Guide (VILLAGE LEVEL)- literate volunteer Primary health care is universal coverage & equitable distribution of health resources.

27. I VILLAGE HEALTH GUIDES They act as a link between PHC & Public. A Village Health Guide is a person with an aptitude for social service & is not a full time government functionary. The Village Health Guide Scheme was introduces on 2 Oct 1977. It provide the first contact between the individual & the health system. TRAINING

28. The guidelines for their selection are : P ermanent local residents; preferable women. Able to read & write, having minimum formal education at least 6 th standard. They should be acceptable to all sections of the society. They should be able to spare at least 2 to 3 hrs every day for community health work. After selection, the Health Guides undergo a short training in primary health care. The training is arranges in the nearest PHC, SC for 200 hrs, spread over for a period of 3 months. During the training period they receive a stipend of Rs. 200 per month. On completion of their training, they receive a working manual & a kit. At present there are 3,24,000 CHG & the national target is to achieve 1 VHG for each village or 1000 rural population

29. Most deliveries in rural are handled by untrained dais. II DAIS ( Traditional Birth Attendants ) An extensive programme has been to undertaken under the Rural Health Scheme, to train all categories of local dais in the country to develop their knowledge in the elementary concepts of maternal & child health & sterilization , besides obstetric skills. The training is for 30 working days ( 1 month ). Each Dai is paid a stipend of Rs. 300 during her training period. Training is given at the PHC, Sub-centre or Maternal & Child Health centre for 2 days in a week & on the remaining 4 days of the week they accompany the Health Worker to the villages preferably in the dai’s own area.

30. During her training each dai is required to conduct at least 2 deliveries under the guidance & supervision of the HW (F), ANM (Auxiliary nurse midwife) or HA(F). The emphasis during training is on asepsis so that home deliveries are conducted under safe hygienic conditions thereby reducing the maternal & infant mortality . After successful completion of training, each dai is provided with a delivery kit & a certificate . These dais are also expected to play a vital role in propagating small family norm since they are more acceptable to the community. The national target is to train one local Dai in each village. She undergoes a training in various aspects of health, nutrition & child development for 4 months. She is a part time worker & is paid an honorarium of Rs 1500 per month for the service rendered, which include health checkups chart, immunization, supplementary nutrition, health education, non formal pre school education & referral services.

31. 10 rs . for every registered case of pregnancy 3 rs . for every registered infant. Total trained dais are about 7,00,000 in India. Each trained Traditional Birth Attendants covers 1000 population.

32. III. ANGANWADI WORKER Under Integrated Child Development Services   ( ICDS) scheme, there is anganwadi worker for a population of 1000. There are about 100 such workers in each ICDS project. An anganwadi worker is selected from the community she is expected to serve The beneficiaries are especially nursing mothers, pregnant women, other women (15 -45 yrs), children below the age of 6 yrs & adolescent girls. Anganwadi workers are the primary link with the health services & all other services for young children .

33. IV. ASHA Recognizing the importance of health in the process of economic & social development & to improve the quality of life of the citizens, the govt of India launched “NATIONAL RURAL HEALTH MISSION” (NRHM) on 5 April 2005. The main aim of NRHM is to provide accessible, affordable, accountable, effective & reliable primary health care through creation of a cadre of Accredited Social Health Activist (ASHA).

34. ASHA must be a resident of the village. A women (married/widow/divorced) preferably in the age group of 25-45 years with a formal education upto 8 class The general norm for selection of ASHA is 1 ASHA/1000 population. ASHA will take steps to create awareness & provide information to the community on determinants of health, information on existing health services, & the need for timely utilization of health & family welfare services. She will counsel women on birth preparedness, importance of safe delivery, breast feeding & complementary feeding, immunization, contraception & prevention of common infections including STD/RTI sexually transmitted Diseases; RTI, reproductive tract infection & care of a young child.

35. ASHA will provide primary medical care for minor ailments such as diarrhoea, fevers & first aid for minor injuries etc. She will also act as a depot holder for essential provisions being made available to every habitation like ORS kit, IFA (Iron folic acid) tab, disposable delivery kit, etc. She will inform about the births & deaths in her village, any unusual health problems in the community to the PHC. She will promote the construction of household toilets under total sanitation campaign. FUNCTIONS

36. Panchayat system The villagers managed their own affairs through the traditional institution of Panchayat .  With the attainment of freedom now fresh efforts are being made to strengthen the Panchayat system and made Panchayat play a better part in the work of national reconstruction. The 73rd Amendment Act, 1993 has led the foundation of strong and vibrant Panchayat Raj institution in the country. 37 Reason for declining panchayat raj The coming Zamindari system Establishment of police and judicial courts Industrial development and consequent shifting of rural population to cities The impact of materialistic and individualistic tendencies.

37. Functions of Panchayat Construction of village roads and provide for street lights. Extension of health services. Look after the property of the Panchayat . Maintain records of vital statistics, such as birth and death. Organize mela , exhibition, film shows etc., To provide facilities for primary and adult education. Development of agriculture. Providing facilities for safe drinking water. Make provision for better quality manure and seeds. Prevention of communicable diseases. Maternal and child welfare. Sanitation of the village . Through the Panchayat System medical camps can be organized for the early diagnosis and treatment of the disease 38

38. RURAL HEALTH IN INDIA India is in limelight at global front not only in terms of population burst but also in its health scenario. Even after celebrating its 70 years of independence, its population is still under the threat of degraded health system. There are approximately 85% of the populations who are still fighting for basic healthcare services in their area. This situation has been promoted by worsening living condition of rural habitats. The unhygienic and unhealthy conditions of household, unsafe drinking water, open defecation, magnify expansion of several diseases in these areas.

39. The scenario gets worse through the superstition practiced by ruralites . The blind faith of tribal that any disease may be cured by magic has subjugated the minds of rural population of India. Due to this kind of impression, the rural areas are under the influence of various malpractices which ultimately seal off the progress of modern pathology here. Inadequate human resources in health care system . The health institutions like Primary Health Centre (PHC), Sub- Centre (SC), and Community Health Centre (CHC) are facing huge problem because health professionals are absent . Doctors don’t want to work in rural areas either because of infrastructure inadequacy or lack of incentives. The condition get intensify with not or little qualified practitioner, minimal amount of expenditure on public healthcare which counts to be 17.9% of total expenditure.

40. About 37% of our under-five children are underweight, 39% are stunted (height for age), 21% are wasted (weight for height ) and 8% are severely-acutely malnourished , adds the joint study. The prevalence of underweight children was higher (38%) in rural areas compared to urban cities (29%). Only about 10% children under the age 6-23 months were reported to receive an adequate diet.

41. Challenges for Rural Health System in India- An Overview The poor state of health system in rural areas is a result of consolidated outgrowth of degraded system. It explains not only the distance between the existing policy and infrastructure but obstruction in development too. The expenditure on public health system has not only been ignored by the state but also by the common mass. People mostly prefer private practitioners and private hospitals over government run hospitals. Therefore, it is very essential for us to review primary elements for degradation of Public health system in India.

42. Challenges for Rural Health System in India- Inadequate human resources Inefficacious infrastructure Inclination towards Home Based Deliveries Lack of coordination between Medical Research and Health Service delivery Institutions High Infant Mortality Non-preparedness to fight with Epidemic in rural areas Unresponsive attitude of medical professionals Dominance of unregulated Private medical professionals Remedies in Rural Health System According to the defined norms by the WHO, the existing infrastructural setup for providing healthcare in India is far less in terms of required qualitative and quantitative availability. Still, the notion follow up here is ‘something is better than nothing’ . There have been various steps taken by government to improve the health scenario in rural areas. Several strategies and missions have been initiated for institutionalizing the prevailing rural health framework to uplift the health standard of common mass.

43. National Rural Health Mission (NRHM) National Rural Health Mission (NRHM) has been one of the central achievement in the field of rural healthcare. It was first initiated in the year 2005. Objective to deal with the problems and weakness across primary healthcare and enhance the status and system of rural area. It provides effective, accessible, accountable, inexpensive and reliable healthcare to the mass and in particular to those sections who are more poor, vulnerable and prone to health disease. Healthy Village | Healthy People | Healthy Nation

44. NRHM seeks to provide equitable, affordable and quality health care to the rural population, especially the vulnerable groups. Thrust of the mission is on establishing a fully functional, community owned, decentralized health delivery system with inter- sectoral union at all levels, to ensure simultaneous action on a wide range of determinants of health such as water, sanitation, education, nutrition, social and gender equality.

45. Maternal healthcare- antenatal care, intranatal care & postnatal care Child healthcare- breast feeding, immunization Family planning & contraception Safe abortion services-medical termination of pregnancy, follow up Curative services- minor ailments Adolescent healthcare-education, councelling , prevention & treatment Assistance to school health services Water quality monitoring Promotion of sanitation- use of toilet, waste disposal 46 SUB-CENTERS Services-

46. Field visits by health workers Community needs assessment Control & repairing of endemic diseases- malaria, JE, dengue. Training of traditional birth attendants/ASHA/CHVs. Coordinate services of AWW, ASHA, village health sanitation & nutrition committee. implementation of national health programs-NACP, IDSP, NLEP 47 SUB-CENTERS Services-

47. Medical care-OPD services, 24hrs emergency services Maternal & child healthcare including family planning- antenatal care, intranatal care & postnatal care, newborn care, care of the child, family welfare Medical termination of pregnancy- safe abortion, using manual vacuum aspiration (2 nd trimester) Management of reproductive tract infections/ sexually transmitted infections- health education & treatment Nutrition services School health services Adolscent healthcare Disease surveillance & control- endemic diseases 48 PHCs Services-

48. Collection & reporting of vital events Promotion of safe drinking water & sanitation Testing of water quality & disinfection of water sources Participation in national health programmes Referral services Basic laboratory & diagnostic services Record of vital statistics Health workers training Skill-based training to ASHAs. Initial & periodic training of doctors/paramedics Mainstreaming of AYUSH-based preventive, promotive & curative healthcare 49 PHCs Services-

49. Pradhan Mantri Matritva Vandana Yojana (PMMVY) PMMVY, previously known as Indira Gandhi Matritva Sahyog Yojna (IGMSY), introduced in the year 2010, is a maternity program run by the government of India. Objective to encourage women to follow Infant and Young Child Feeding (IYCF) practices including early and exclusive breast feeding for first six months . It is a conditional cash transfer scheme which is implemented through the State for pregnant and lactating women of 19 years of age or above for first two live births, from the Ministry of Women and Child Development.

50. Janani Suraksha Yojana (JSY) Janani Suraksha Yojana is a flagship program launched in year 2005 under the National Rural Health Mission (NRHM) of Government of India modifying the National Maternity Benefit Scheme (NMBS). It is intended to promote institutional delivery to reduce maternal and neo-natal mortality. It provide cash incentives to the women for delivering their child in government or other private medical facility over home-based deliveries.

51. Health Insurance through Rashtriya Swasthya Bima Yojana (RSBY) Rashtriya Swasthya Bima Yojana (RSBY) is one of the important schemes in the area of rural health. It was launched in the year 2008, which was earlier designed to target only the Below Poverty Line (BPL) households, but has been expanded to cover other defined categories of unorganized workers. Its objective is to provide financial aid for household affected by major health shocks and improve health outcomes.

52. Swachh Bharat Abhiyan (SBA) Swachh Bharat Abhiyan or Clean India Mission is a campaign in India initiated in the year 2014, Whose objective is to eliminate open defecation through the construction of household-owned and community owned toilets. Still in many parts of rural India open defecation is practice which cause the most common life taking diseases like diarrhea, typhoid, hepatitis, intestinal worm infections, cholera, etc.

53. Employment and food in rural areas to BPL Good road connectivity Rural development programme Continuous power supply Storage capacity with facilities to help farmers Assistance and subsidies to the villagers for building their houses

54. LEVELS OF HEALTHCARE

55. Health infrastructure in the municipalities is divided in four categories viz. Hospitals, health centres and sub- centres supported by the State Health Department. Facilities owned by the other government departments, Municipality controlled facilities and Private sector facilities. Key strategies Universal coverage – the entire urban population including both APL and BPL (Above/Below Poverty Line) to be covered, while keeping the focus on BPL. ™Strengthening service delivery through a uniform 3-tier service delivery model. Strengthening institutional arrangements and inter departmental union. Strengthening monitoring and evaluation. COMMUNITY SERVICES-URBAN AREA

56. Urbanization and its impact on health and health practices The common diseases among the slum dwellers are: Fever, Skin infections, Eye infections, Malnutrition, Viral infections, Chronic toxicity, STD (Sexual Transmitted Diseases), Accidents, Drug abuse, Alcoholism, Crime, Delinquency, Suicide, prostitution etc., 8/05/20XX 57 Causes for diseases Industrial pollution Over-crowding Poor hygienic practices Food and water contamination

57. 58 Encourage local agricultural-based industry Planning of road, office, residence to reduce traffic Development of green belt, park, trees Plans to reduce pollution Encourage use of biodegradable material for package. Library & recreation centers in residential areas Improvement of slum condition Health awareness on habit & lifestyle S ervices/welfare actions on urban area: Community participation Urban law implementation Healthy management of urban wastes.

58. 59 Theme broadcast in AIR/TV Future articles for good message Exhibitions & display on urban problem Use of folk media for awareness Cultural programmes imbibing urban message Competitions on city improvement activities S uggested education activity for urban society

59. 60 Slum improvement projects. Agency (ODA) Overseas Development Administration assisted effort & (UCD) Urban Community Development efforts- pilot project. World bank assisted Indian population projects (Mumbai, Chennai, Kolkata, Delhi, Bangalore, Hyderabad) Environmental Improvement Of Urban Slums (EIUS) Urban Basic Services For Poor (UBSP) SERVICE ON URBAN SLUM AREAS slum clearance to slum improvement programme

60. WATER SUPPLY AND SANITATION IN INDIA Drinking water supply and sanitation facilities are very important and crucial for achieving the goal of “HEALTH FOR ALL”. According to WHO, “poor sanitation and inadequate sewage disposal the nation’s biggest public health problems.” Approximately 60-70% of untreated sewage is discharged directly into rivers and streams , the main source water supply in cities.

61. WATER SUPPLY CONTINUITY According to INDIAN NORMS, access to improved water supply exists if at least 40 liter/ capita / day of safe drinking water are provided within a distance of 1.6km or 100 meter of elevation difference, to be relaxed as per field conditions. There should be at least one pump per 250 persons. SERVICE QUALITY

62. SANITATION In 2010, the UN estimated based on India statistics that 626 million people practice open defecation. In June 2012, minister of rural development JAIRAM RAMESH stated India is the words largests “ open air toilet.” Of the 2.5 Billion people in the world that defecate openly in India. ENVIRONMENT As of 2003, it was estimated that only 27% of India’s waste water was being treated, with the remainder flowing into rivers, canals, ground water or the sea. The lack of adequate sanitation and safe water has significant negative health impacts including diarrhea, chronic diseases, respiratory problems, skin disorders, allergies, headaches and eye infections.

63. RESPONSIBILTY FOR WATER SUPPLY AND SANITATION Water supply and sanitation is a state responsibility under the INDIAN CONSTITUTION. State may give the responsibility to the Panchayati Raj Institutions (PRI) in rural areas. In urban areas, - municipalities , called Urban Local Bodies ( ULB). The responsibility for water supply and sanitation at the central and state level is shared by various ministries. At the central level three ministries have responsibilities in the sector. The Ministry Of Drinking Water And Sanitation The Ministry Of Housing And Urban Poverty Alleviation The Ministry Of Urban Development. POLICY AND REGULATION

64. ROLE OF GOVERNMENT - INDIA 1954 – National Water Supply And Sanitation Programme 1972 – ARWSP (Accelerated Rural Water Supply Programme) 1981 – International Drinking Water Supply And Sanitation Programme 2002 – Swajaldhara 2008 – National Urban Sanitation Policy

65. NATIONAL WATER SUPPLY AND SANITATION PROGRAMME It was initiated in 1954. Objective : To providing safe water supply and adequate drainage facilities for the entire urban and rural population of the country. Targets : 100% urban and rural water supply. 50% urban sanitation. 25% rural sanitation.

66. ARWSP (ACCELERATED RURAL WATER SUPPLY PROGRAMME) In 1972, a special programme known as “ARWSP” was started as supplement to the national water supply and sanitation programme. The central government supports the efforts of the states in identifying problem villages through assistance under ARWSP. A ‘Problem village’ has been defined as one where no source of safe water is available within a distance of 1.6 km / 15 m deep, or where source has excess salinity iron, fluorides & other toxic elements, or where water is exposed to the risk of cholera.

67. SWAJALDHARA It was launched in 25 th D ec 2002 . It has certain reform principles needed to be adhered by the states governments. which AIM - To provide safe drinking water in rural areas, with full ownership of the community, building awareness among the village community on the management of drinking water projects, including better hygiene practices and encouraging water conservation practices along with rainwater harvesting. Swajaldhara has two components : Swajaldhara 1 (first dhara ) : is for gram panchayat or a group of panchayat (at block / tehsil level). Swajaldhara 2 (second dhara ) : has district as the project area.

68. ACTIVITIES Plan, implement, operate, maintain and manage all water supply and sanitation programme. Conservation measures : Rain water harvesting Ground water recharge system

69. NATIONAL URBAN SANITATION POLICY In November 2008 , the government of India launched a National Urban Sanitation policy. GOAL :- The main goal of this policy is creating “ totally sanitized cities” that are to treat all waste water to make free from open defecation to collect and dispose solid waste safety.

70. School Health Services School health is an imp aspect of any community health program. Its basic aim is to provide a comprehensive health care program for children of school going age (5 to 14 yr). General prevalence of morbidity: STATISTICS 40% students: healthy/ free from defects 24% school children: had disease/ defect 11 % children have such defects had to be referred to a specialist. Dental ailments 70-90% Malnutrition 40-75% Worm infections 20-40% Skin diseases 10% Eye diseases 4-8% Pulmonary TB 4-5%

71. milestones 1909 First school medical examination at Baroda city 1953 Secondary education committee emphasizes need of examination & school feeding. 1961 Submitted report; inadequate inputs. GOI constituted a task force “Intensive School Health Services” 1946 Health survey & development committee (Bhore committee) SCHOOL HEALTH SERVICES practically nonexisted 1960 GOI constituted SCHOOL HEALTH COMMITTEE To access stds of health & nutrition of school children & suggestive ways for health 73

72. Jan 1982 Task force submitted report 14/22 states made efforts to establish school health program (own budget) Checked PHCs 1337/3614. 2002 2007 Formal document h as been prepared & is waiting for clear ance which include widened version o f school health care 1997 t o 9 th five year pla n expected the progress of sch ool health care. 2003 t o 74 S S

73. 75 Early detection and care of students with health problems Development of healthy attitudes and healthy behaviours by students Ensure a healthy environment for children at school Prevention of communicable diseases at school OBJECTIVES OF SCHOOL HEALTH SERVICES

74. In School Health Services are occupied: • Paediatricians and General Practitioners working in the Primary Health Care • Health Visitors partially or fully occupied in this service The main activities of the School Health Service are: Screening Tests Prevention and investigation of Communicable Diseases Vaccination

75. School Health Program Objectives: Health consciousness among school children Providing health instructions in a healthy environment Prevention of disease: early detection, treatment & follow-up of defects Promotion of positive health Recognizing the child as a “change –agent” in the family. Components: Health education Healthy environment Health service

76. Health Education Healthy Environment Health Care Health promotion- Exercise, nutrition & personal hygiene. Health protection- Nutrition, immunization, guidelines. Curative services- Health cards, prompt treatment of defects, follow up & referral for special problems. Medical check-ups (periodic- twice a year) Treatments Location- Quite place Structure- Heat resistant Water supply- potable Drainage Urinals- 1 per 60 students latrines- 1 per 100 students Waste management Ventilation- window: 20% of floor area Playground Health lessons Insisting high stds of cleanliness in schools Improving water supplies & latrines; habits for their proper use. healthy practical diets in school lunch program Demonstrating personal hygiene Visits Observe Community health services Safety education Sex education

77. 81 Mid-day school meal & other nutritional service Development of school garden Special nutrients for dental caries, goiter, night blindness, anemia Mid-day school meal It is a supplement Provides 1/3 rd of energy (daily req.) Affordable & Simple cooking in acceptable form Balahar 70% wheat, 25% defatted groundnut meal & 5% skim milk (fat-free milk) Menu per child per day Cereal & millet 75 gm Pulses 30 gm Oil 8 gm Leafy vegetables 30 gm Nonleafy vegetables 30 gm