HEALTH FOR ALL.pptx

health for all, primary health care

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2. HEALTH FOR ALL 2 Presented By: Dr.Rohma Yusuf

3. CONTENTS 3 Introduction Health Health system Levels of health care Changing concepts of health care Health for All Alma Ata declaration Primary health care National health policy1983 Millennium development goals National health policy 2002, 2015 PHC reform Conclusion References

4. INTRODUCTION Health has been declared a fundamental human right. This implies that the state has a responsibility for the health of its people. National governments all over the world are striving to expand and improve their health care services. The present concern in both developed and developing countries is not only to reach the whole population with adequate health care services, but also to secure an acceptable level of Health for All, through the application of primary health care programmes. 4

5. HEALTH WHO Defines Health as” A state of complete physical, mental, and social well being and not merely the absence of disease or infirmity . 5

6. Health system Health services are designed to meet the health needs of the community through the use of available knowledge and resources. The health services are delivered by the ‘Health system’ which constitutes the management sector and involves organizational matters. 6

7. Two major themes have emerged in recent years in the delivery of health services: Health services should be organized to meet the needs of entire populations and not merely selected groups. Health services should cover the full range of preventive , curative, and rehabilitation services. b) To provide health care to the vast majority of underserved rural people and urban poor is to develop effective “primary health care” services supported by an appropriate referral system. 7

8. LEVELS OF HEALTH CARE 1.Primary care level : Ist level of contact of individuals, the family and community with the national health system, where “primary health care” (essential health Care) is provided. As a level of care, it is close to the people, where most of their health problems can be dealt with and resolved. Health care will be most effective within the context of the area’s needs and limitations. In India context, primary health care is provided by the primary health centers and their sub centers through the agency of multipurpose health workers, village health guides and trained dais. 8

9. 2. Secondary care level : At this level more complex problems are dealt with. In India this kind of care is generally provided in district hospitals and community health centers which also serve as the first referral level. 3. Tertiary care level : The tertiary level is a more specialized level than secondary care level and requires specific facilities and attention of highly specialized health workers . This care is provided by the regional or central level institutions. 9

10. CHANGING CONCEPTS Comprehensive health care: this term Ist used by the Bhore Committee in 1946. By comprehensive services committee meant provision of integrated preventive, curative, and promotional health services from “Womb to Tomb” to every individual residing in a defined geographic area. The Bhore committee defined comprehensive health care as having the following criteria: Provide adequate preventive, curative, and promotive health services. B e as close to the beneficiaries as possible H as the widest cooperation between the people , the service and the profession. I s available to all irrespective of their ability to pay. L ook after specifically the vulnerable and weaker sections of the community Create and maintain a healthy environment both in homes as well as working places. 10

11. 2) Basic health services- In 1965 this term was used by UNICEF/WHO in their joint health policy. “A basic health service is understood to be a network of coordinated, peripheral and intermediate health units capable of performing effectively a selected group of functions essential to the health of an area and assuring the availability of component professional and auxiliary personnel to perform these functions. The change in terminology from comprehensive to basic health services did not affect quality or content of health services. 11

12. 3. Primary health care : A new approach to health care came into existence in 1978, following an international conference at Alma-Ata(USSR). This is known as " Primary health care” Before Alma-Ata, primary health care was regarded as synonymous with “Basic health services”, “First contact care”, “Easily accessible care” , “services provided by generalists”, 12

13. HEALTH FOR ALL 13

14. The 30th World Health Assembly in May 1977 resolved “The main social target of governments and WHO in the coming decades should be the attainment by all citizens of the world by the year 2000 AD of a level of health that will permit them to lead a socially and economically productive life.’’ HEALTH FOR ALL BY 2000 AD 14

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16. Alma –Ata declaration Health is a fundamental human right and that the attainment of the highest possible level of health is a most important worldwide social goal. The existing gross inequality in the health status of the people particularly between developed and developing countries is politically, socially and economically unacceptable. Economic and social development, based on a new international economic order is of basic importance to the fullest attainment of health for all. The people have the right and duty to participate individually and collectively in the planning and implementation of their health care. 16

17. Alma –Ata declaration Government have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures. All government should formulate national policies, strategies and plans of action to launch and sustain primary health care. All countries should cooperate in a spirit of partnership and service to ensure PHC for all people. An acceptable level of health for all the people of the world by the year 2000 can be attained through a further and better use of the world’s resources. 17

18. PRIMARY HEALTH CARE 18 Alma Ata defined primary health care: “Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individual and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self- determination.” This approach has been described as “Health by the people”and “placing people’s health in people’s hands”

19. ELEMENTS OF PRIMARY HEALTH CARE: . 19

20. 20 1.Education concerning prevailing health problems and the methods of preventing and controlling them.

21. 21 2.Promotion of food supply and proper nutrition.

22. 3.An adequate supply of safe water and basic sanitation.

23. 4.Maternal and child health care, including family planning.

24. 5.Immuniza ion against major infectious diseases.

25. 6.Prevention and control of locally endemic diseases. Appropriate treatment of common diseases and injuries.

26. 7.Provision of essential drugs

27. PRINCIPALS OF PRIMARY HEALTH CARE 27

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29. 1. Equitable distribution Equitable distribution of health services i.e Health services must be shared equally by all people irrespective of their ability to pay and all (rich, poor, urban or rural)must have access to health services. 29

30. 2. Community participation There must be a continuing effort to secure meaningful involvement of the community in the planning, implementation and maintenance of health services, besides maximum relay on local resources such as manpower, money and materials 30

31. 3.Intersectoral coordination "primary health care involves in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture , food , industry , education , housing , public works , communication and others sectors" . 31

32. 4. Appropriate technology "technology that is scientifically sound , adaptable to local needs, and acceptable to those who apply it and those for whom it is used, and that can be maintained by the people themselves in keeping with the principle of self reliance with the resources the community and country can afford " 32

33. National Health Policy -1983 NHP 1983 stressed the need for providing primary health care with special emphasis on prevention, promotion and rehabilitation Suggested Planned time bound attention to the following 1.Nutrition, prevention of food adulteration. 2.Mainatince of quality of drug 3.Water supply and sanitation 4.Environmental protection 5.Immunisation programme 6.Maternal and Child Health Services 7.School Health Programme 8.Occupational Health 33

34. National Health Policy 1983…… India had its first national health policy in 1983 i.e. 36 years after independence. For better programme planning NHP 1983 recommended an effective Health Information System. 34

35. Differentials in health status among rural/urban India 35

36. Differentials in health status among socio-economic groups 36

37. Achievements Through The Years 1951-2000 37

38. Achievements Through The Years 1951-2000 38

39. Millennium Development Goals 8 goals 18 targets 48 indicators Related to health •3 goals •8 targets •18 indicators 39

40. Goal 1: Eradicate Extreme Poverty and Hunger Goal 2: Achieve Universal Primary Education Goal 3: Promote Gender Equality and Empower Women Goal 4: Reduce Child Mortality Goal 5: Improve Maternal Health Goal 6: Combat HIV/AIDS, Malaria and TB Goal 7: Ensure Environmental Sustainability Goal 8: Develop Global Partnership for Development

41. National Health Policy 2002 Objectives: Achieving an acceptable standard of good health of Indian Population, Decentralizing public health system by upgrading infrastructure in existing institutions, Ensuring a more equitable access to health service across the social and geographical expanse of India . 41

42. NHP 2002, Objectives…….. Enhancing the contribution of private sector in providing health service for people who can afford to pay. Giving primacy for prevention and first line curative initiative . Emphasizing rational use of drugs . Increasing access to tried systems of Traditional Medicine 42

43. Goals – NHP 2002 43

44. Goals – NHP 2002.... 44

45. Goals – NHP 2002.... 45

46. Goals – NHP 2002.... 46

47. Financial resource 1.Increase in health sector expenditure to 6% of GDP, with 2% by public health investment by 2010 is recommended by the policy. 2.Existing 15% of central government contribution is to be raised to 25% by 2010. 47

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49. NHP 2002 has observed that the attainment of health indices has been very uneven across rural-urban divide, 49

50. National Health Policy 2015 Performance In Disease Control Programmes The most acclaimed success of this period is the complete elimination of POLIO . Reported last on Jan 2011 and success has been sustained for 2 years and in early 2014, India certified free from WPV transmission Kala- Azar and lymphatic filariasis are expected to decline below the threshold for certifying by 2015 In AIDS control, Decline of cases from 0.4% in 2002 to 0.27% in 2012 Tuberculosis And Malaria have shown significant decline whereas Dengue And Chikungunya are on the increase specially in urban areas 50

51. 1985 – The universal immunization program (UIP) was launched to provide universal coverage of infants and pregnant women with immunization against identified vaccine preventable diseases. 1992-93 – the UIP has been strengthened and expanded into the child survival and safe motherhood (CSSM) project . It involves sustaining the high immunization coverage level under UIP, and augmenting activities under oral rehydration therapy, prophylaxis for control of blindness in children and control of ARI. 51

52. 1997 – Reproductive and child health (RCH-phase1 ) program was launched which incorporated child health, maternal health, family planning, treatment and control of reproductive tract infection and adolescent health. 2005-2010 – RCH-phase 2 aims at sector wide, outcome oriented, program based approach with emphasis on decentralization , monitoring and supervision which brings about a comprehensive integration of family planning into safe motherhood and child health . 52

53. 2005-2012 – National Rural Health Mission a major undertaking by the present united progressive alliance government. It is also from a strategic framework to implement the national health policy 2002 . The NRHM subsumes key national programmes, Reproductive and child health -2 National disease control programme and integrated disease surveillance project. 53

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56. Trends in Maternal Deaths 56

57. Levels of MMR by region,1999-2009 57

58. Under Five Mortality Rate India,1990-2009 58

59. Trends in Total Fertility Rate Bihar reported the highest TFR (3.9) while Kerala and Tamil Nadu, the lowest (1.7) • 59

60. 60 HEALTH CARE DELIVERY MODEL

61. 1.Inverse care: People with the most means – whose needs for health care are often less – consume the most care. 2.Impoverishing care: Wherever people lack social protection and payment for care is largely out-of-pocket at the point of service, they can be confronted with catastrophic expenses. Over 100 million people annually fall into poverty because they have to pay for health care. 61 Five common shortcomings of health-care delivery

62. 3.Fragmented and fragmenting care: The excessive specialization of health-care providers and the narrow focus of many disease control programmes discourage a holistic approach to the individuals and the families they deal with and do not appreciate the need for continuity in care. Health services for poor and marginalized groups are often highly fragmented and severely under-resourced, while development aid often adds to the fragmentation 62

63. 4.Unsafe care: Poor system design that is unable to ensure safety and hygiene standards leads to high rates of hospital-acquired infections , along with medication errors and other avoidable adverse effects that are an underestimated cause of death and ill-health Lack of Health care staff. 63

64. 5.Misdirected care: Resource allocation clusters around curative services at great cost, neglecting the potential of primary prevention and health promotion to prevent up to 70% of the disease burden . The current criticism against health care services is that they are (a) Predominantly urban oriented (b) Mostly curative in nature (c) Accessible mainly to small part of the population 64

65. HEALTH CARE SYSTEM 65 A.PUBLIC HEALTH SECTOR. 1. PRIMARY HEALTH CARE -Primary health center -Sub center 2. HOSPITALS / HEALTH CENTERS - Community health centers - Rural hospital - District Hospital/ health center - Specialist hospital - Teaching hospitals 3.HEALTH INSURANCE SCHEMES. - Employees State Insurance. - Central Govt. Health Scheme 3.

66. 66 4. OTHER AGENCIES. -Defense Services. -Railways. B.PRIVATE SECTOR -Private Hospitals, Polyclinics, Nursing Homes & Dispensaries. -General Practitioners & Clinics C.INDIGENOUS SYSTEM OF MEDICINE - Ayurveda and Siddha - Unani and Tibbi - Homoeopathy - Unregistred practitioners D.VOLUNTARY HEALTH AGENCIES. E. NATIONAL HEALTH PROGRAMMES.

67. PRIMARY HEALTH CARE IN INDIA 67 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 four tier system of health care delivery in rural areas based on the recommendation of the Shrivastsav Committee(1975). Services provided at the level of - Village - Sub centre - Primary health centre - Community health centre

68. 68 Community health center Number Population served 80,000-1,20,000 3076 Primary health care 30,000-plains 20,000- Hilly, tribal and backward areas 22,936 Sub centre 5000-plains 3000-Hilly, tribal and backward areas 1,38,638 Village level Anganwadi worker Dai Village Health guide Diagram Depicting Primary health care system in India

69. VOLUNTARY HEALTH AGENCIES IN INDIA 70 Indian Red Cross Society – it was established in 1920. Activities are: Relief work Milk and medical supplies Armed forces Maternal and child welfare services Family planning Blood bank and first aid 2. Hind Kush Nivaran Sangh - it was founded in 1950 with its headquarter in New Delhi . It includes Rendering of financial assistance to various leprosy homes and clinics, Health education, Training of medical workers and physiotherapists, organizing “All India Leprosy Workers conferences and publication of “Leprosy in India “.

70. 71 3. Indian Council for Child Welfare – It was established in 1952. The services of I.C.CW are devoted to secure for india’s children those ‘ oppurtunities and facilities, by law and other means” 4. Tuberculosis Association of India- Formed in 1939. The following institutions are under the management of association: The New Delhi Tuberculosis Centre, The Lady Linlithgow Sanatorium at Kasauli The king Edward VII Sanatorium at Dharampur The tuberculosis Hospital at Mehrauli 5.Bharat Sevak Samaj - It is a non political and non- official organization was formed in 1952. Objective- T o help people to achieve health by their actions and efforts. -Improvement of sanitation in villages

71. 72 6. Central Social Welfare Board It was set up by Govt. of India in August 1953 . The Board initiated in 1968,”Family and child Welfare Services "in rural areas for the welfare of women and children. Function- 1) Surveying the needs and requirement of voluntary welfare organizations in the country. 2) Promoting and setting up of social welfare organizations on a voluntary basis. 3) Rendering of financial aid to deserving existing organizations and institutions. The Kasturba Memorial Fund - created in commemoration Of Kasturba Gandhi, after her death in 1944. Main object of this fund is improving the lot of women, especially in the villages, through gram- sevikas

72. 73 8. Family planning association of India It was formed in 1949 with headquarter at Mumbai. It has done pioneering work in propagating family planning in India. 9. All India women’s conference Established in 1926 Most of the branches are running M.C.H clinics, Medical centers, and adult education centers, milk centers and family planning clinics.

73. FOUR SETS OF PHC REFORMS Needed for an effective response to the health challenges of today’s world UNIVERSAL COVERAGE REFORMS: systems contribute to health equity, social justice. SERVICE DELIVERY REFORMS : health services as primary care , i.e. around people’s needs and expectations. PUBLIC POLICY REFORMS: reforms that secure healthier communities, by integrating public health actions with primary care and by pursuing healthy public policies across sectors LEADERSHIP REFORMS: Reforms that replace disproportionate reliance on command and control on one hand, and laid faire disengagement of the state on the other, by the inclusive, participatory, negotiation-based leadership required by the complexity of contemporary health systems 74

74. 75 EARLY ATTEMPTS AT IMPLEMENTING PHC CURRENT CONCERNS OF PHC REFORMS Extended access to a basic package of health interventions and essential drugs for the rural poor Transformation and regulation of existing health systems, aiming for universal access and social health protection Concentration on mother and child health Dealing with the health of everyone in the community Focus on a small number of selected diseases, primarily infectious and acute A comprehensive response to people’s expectations and needs, spanning the range of risks and illnesses Improvement of hygiene, water, sanitation and health education at village level Promotion of healthier lifestyles and mitigation of the health effects of social and environmental hazards

75. 76 Simple technology for community health workers v olunteer , non-professional Teams of health workers facilitating access to and appropriate use of technology and medicines Participation as the mobilization of local resources and health-centre management through local health Committees Institutionalized participation of civil society in policy dialogue and accountability mechanisms Government-funded and delivered services with a centralized top-down management Pluralistic health systems operating in a globalized context Management of growing scarcity and downsizing Guiding the growth of resources for health towards universal coverage Bilateral aid and technical assistance Global solidarity and joint learning Primary care as the antithesis of the hospital Primary care as coordinator of a comprehensive response at all levels PHC is cheap and requires only a modest investment PHC is not cheap: it requires considerable investment, but it provides better value for money than its alternatives

76. CONCLUSION 77 Public health is concerned with the health problems of the community and providing promotive , preventive, curative and rehabilitative services as required. Tremendous social changes are taking place in the country and in the world. Attitudes towards health care have also changed with a growing concern that health care is a basic human right. Now is the time for both Governmental and non- Governmental agencies to examine it’s policies in relation to education, Clinical practice, research administration, so as to produce a primary health services available to total populations in the countries of the world.

77. REFERENCES: 78 1.) Peter S. Essentials of Preventive and Community Dentistry. 3 rd Edn . 2006. 2.)Park K . Park’s Textbook of Preventive and Social Medicine.23 rd Edition. Banarsidas Bhanot Publishers. 2015 3.) Hiremath SS. Textbook of Preventive and Community Dentistry. Elsevier Publishers, 2007 4.)http://censusindia.gov.in/vital_statistics/SRS_Bulletins/MMR_release_070711.pdf 5.)http://www.mohfw.nic.in/WriteReadData/l892s/18048892912105179110National%20Health%20policy-2002.pdf 6.)Health for all docx . 7.)Planningcommission.nic.in/reports/ genrep /bkpap2020/26_bg2020.doc 8.) Lakshminarayanan S. Role of government in public health: Current scenario in India and future scope J Family Community Med. 2011 ; 18(1): 26–30. 9)http://www.data.gov.in/NHP 2015

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