Public Health in India Moving Ahead?

1
Public Health in IndiaMoving Ahead?

• Prof. Shiv Chandra Mathur
• shiv_mathur_at_hotmail.com

2

• 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
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.

4
Deaths In India (2005)
Source WHO
5
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
6
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, 2005-06
7
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
8
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
9
(No Transcript)
10
RISING CHRONIC DISEASE BURDENS
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
11

• SICK INDIVIDUALS
• ARISE FROM
• SICK POPULATIONS
• - Geoffrey Rose

12
NEGLECTED CHRONIC DISEASES CARRY ECONOMIC COSTS

• 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
13
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
14
Handicaps

• Lack Of Sufficient Public Health Expertise
• needed for
• Policy Development
• Program Design, Delivery And Evaluation
• Health System Management
• Public Health Research

15
BIOLOGICAL SCIENCES
EPIDEMIOLOGY ALLIED SCIENCES
ECONOMICS AND MANAGEMENT
PUBLIC HEALTH
SOCIAL SCIENCES
16
SCIENCE DISCOVERS
TECHNOLOGY DEVELOPS
PUBLIC HEALTH DELIVERS
17
CRAFTING CREDIBLE PUBLIC SYSTEMS IN HEALTH

• NRHM - MAKING MDGs ACHIEVEABLE

18
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.

19
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.

20
NRHM has created in each Indian Village

• A worker she is ASHA
• An institution that is VHSC
• An event which is VHND.

21
Examples of Innovations

• Making PHCs 24X7 in Tamil Nadu 3 Nurse model.
• Assams initiative Boat Clinics
• Rajasthans initiative CMJRK SNCUs.108
• MPs initiative HSC Delivery, SNCUs.
• Haryanas initiative Free drugs, 102 surgery
  package.
• Gujarats initiative Chiranjeevi, 108,

22
Examples of Innovations

• Keralas initiative Ban private practice
  Quality.
• Bihar Block pooling PPPs Diagnostics.
• Chhatisgarh Mitanin, VHSCs.
• Orissa ASHAs AYUSH doctors
• Andamans High salary for Specialists RKS.

23
The impact of NRHM - 1

• MMR significantly down 450 to 230 - SRS.
• IMR decline 60 in 2004 53 in 2008 lt50now
• TFR steadily declining 2.9 in 05 to 2.6 in
  2008.
• Institutional deliveries 41 to 73

24
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.

25
What Doctors in Public Systems can do further?

1. Strengthen medical care
2. Help strengthen HMIS
3. Sanitary Stringency
4. Induce Behavior Change
5. Disease Surveillance
6. Educate on Better Food Practices
7. Rational Drug Use

26
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