REASON FOR IMPLEMENTATION NEW GLOPAL HEALTH POLICY

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Dr.I.Selvaraj INDIAN
RAILWAY MEDICAL
SERVICE B.Sc., M.B.B.S., D.Ph., D.I.H.,
P.G.C.H.F.W (NIHFW, New Delhi)
Trained Epidemiologist
(CMC, vellore, T.N) Sr.
D.M.O/Health Unit/ S.Railway/Egmore/Chennai/
Tamil Nadu/ India
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Dr.I.Selvaraj
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HEALTH FOR ALL IN 21ST CENTURY
NEW GLOBAL HEALTH POLICY
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INTRODUCTION

• The member countries while attending a
  conference on Health For All And Primary
  Healthcare at Alma Ata, Kazakistan from 6th to
  12th September 1978, having committed to attain
  the goals of Health For All by the year 2000
  A.D. But it is now becoming very clear that the
  goal of Health For All by the year 2000 could
  not have been achieved. Two major factors are
  found for this failure.
• Biased and poor socio-economic development
  between developed and developing countries.
• Discriminative policies.

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THE REASON FOR IMPLEMENTATION OF NEW GLOPAL
HEALTH POLICY HEALTH FOR ALL IN 21ST
CENTURY  Unacceptably high mortality and high
morbidity rate. Increasing burden of
accidental trauma cases due to raising vehicular
density. Higher incidence of micro-macro
nutritional deficiencies disorders such as LBW
with serious consequential mental and physical
retarded growth. To ensure the broad based
availability of health services to the
poor, under privileged citizenry of the country
on the basis of ground realistic consideration.
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• Inadequate availability of personnel with
  specialization in the Public Health and Family
  medicine to discharge the Public Health
  responsibility in the country.
• The ratio of nursing personnel vis-à-vis
  doctors/beds is very low. There is also acute
  shortage of nurses trained in super specialty
  disciplines for deployment in tertiary care
  services.
• There is an apprehension that globalization will
  lead to raising trends in the overall health
  cost.
• The urban population is likely to go up to 33
  by 2010 resulting in urban slums without any
  infrastructure health support.

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• There is a serious bearing on the quality of life
  of the mentally affected persons and their
  Families because they are admitted in religious
  institution where reliance is placed on faith
  cure.
• There is no accountability for effectiveness of
  I.E.C programmes with regard to the productive
  Use of funds allotted for public health
  programmes.
• The urban population is likely to go up to 33
  by 2010 resulting in urban slums without any
  infrastructure health support.

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THRUST AREAS IDENTIFIED

• Nutrition
• PFA Act
• Environmental Health Hazards
• Immunization Programme
• MCH Services
• School Health Programme
• Industrial/Occupational Health Services
• Mental health services
• R.T.I / S.T.I Control Services

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IMPLEMENTATION OF NEW GLOBAL HEALTH POLICY
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VISION

• Health for all
  in 21st century

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OBJECTIVE

• TO PROVIDE A COMPREHENSIVE PRIMARY HEALTH CARE
  SERVICES WHICH IS AFFORDABLE,FREELY AVAILABLE,
  EASILY ACCESSIBLE AND ACCEPTABLE BY THE
  COMMUNITY WITH THE SPIRIT OF SELF RELIANCE AND
  SELF DETERMINATION

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GOAL

• 1. To achieve all the public health
  indicators
• 2. Health for all indicators
• 3. All National Health Programs indicators
  before the target years.

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TARGETS

• 1. IMPROVE THE HEALTH EQUITY BY 2005
• 2. INCREASE THE SURVIVAL BY 2020
• 1. M.M.R 100/100000 LIVE
  BIRTHS
• 2. I.M.R 45/1000 LIVE
  BIRTHS
• 3. LIFE EXPECTENCY gt 70 YEARS
  FOR ALL COUNTRIES
• 3. REVERSE GLOPAL TRENDS FOR FIVE MAJOR PANDEMICS
  by 2020 (TB, HIV/AIDS, MALARIA, TOBACCO RELATED
  DISEASES, and VIOLENCE/TRAUMA)
• 4. ERADICATE AND ELIMINATE CERTAIN DISEASES
  (Measles, Filariasis, Chagas disease/2010,
  Leprosy/2010, Trachoma, and Vitamin-A, / Iodine
  Deficiency by 2020)
• 5. IMPROVE ACCESS TO WATER, SANITATION, FOOD AND
  SHELTER BY 2020

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STRATEGY

• Bottom-up planning
• Decentralization of implementation
• Strengthening of infrastructure
• Capacity building at districts for planning,
  Implementation, Management Information System,
  and concurrent evaluation
• Quality up-gradation of services
• Appropriate system support for better management,
  co-ordination, and smooth flow of funds,
  transport, and procurement system

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PROGRAMME

• A need based
• Client centered
• Demand driven
• High quality integrated services
• Decentralized planning with ultimate aim of
  population stabilization

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ACTION PLAN FOR
IMPLEMENTATION

• To identify the unmet need of the population
• To select priorities among the felt needs
• To formulate the objectives
• Setting the goals
• Planning the programme
• Selection of suitable health personals
• Re-orientation course / training for the selected
  health personals
  Cont..

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• Mobilization of financial / material resources
• Behavioral changes by I.E.C activities
• Intersectoral coordination of sister
  organizations of Indian railways
• Monitoring and evaluation of the programme
• Feedback
• Reassessment of the programme

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MONITORING AND EVALUATION OF HEALTH PROGRAMME
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The indicators formulated by the public health
administrators to monitor and evaluate the
various activities are based on a valid,
reliable, reproducible, repeatable, sensitive,
specific and relevant data. The type of
indicators thus identified by the public health
administrators are given below
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PUBLIC HEALTH INDICATORS

• SOCIAL AND ECONOMICAL INDICATORS
• Per Capita Income Crude Birth Rate
• Crude Death Rate
• GNP/GDP
• Literacy Rate
• Unemployment Rate

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R.C.H PROGRAMME

• ACCESSIBILITY INDICATORS
• No. Of eligible couples registered.
• No. Of eligible couples motivated by staff nurse
  / ANM / midwife / CHI
• No. Of ANC sessions held
• No. Of immunization sessions held
• No. Of well baby clinic conducted
• No. Of Health Education sessions conducted
• No. Of school Health check up conducted
• Total number of population covered
• No. Of RTI/ STD special clinic conducted

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R.C.H PROGRAMME

• QUALITY INDICATORS
• No. Of ANC registered
• No. Of ANC with 3 Ante natal visits
• No. Of Ante natal cases receiving prophylactic/
  therapeutic FST tablets
• No. Of High risk Ante natal cases referred
• No. Of Ante natal cases received 2 doses of
  injection T.T
• No. Of Normal deliveries conducted
• No. Of high risk Ante natal referral cases
  followed up

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• No. Of Post natal cases with 3 post natal clinic
  visit
• No. Of Post natal case received Family Planning
  Counseling
• No. Of New born children fully immunized
• No. Of Infants with ADD treated
• No. Of Infants with ARI treated
• No. Of New born children given Vitamin A
  solution
• No. Of infants with malnutrition treated
• No. Of Eligible couples adapted temporary/
  permanent sterilization

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R.C.H PROGRAMME

• IMPACT INDICATORS
• IMR
• MMR
• NMR
• CPR (Couple Protection Rate)
• No. Of New born children given breast feeding
  within 6hrs of delivery
• No. Of New born children with LBW

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ACCESSIBLE INDICATOR OF COMPREHENSIVE HEALTH
CARE SERVICES

• Population/Health unit/Divisional
  hospitals/Zonal hospitals
• Population/per doctor/Health unit
• Population/per midwife/per Trained Birth
  Attendent
• Population within 5 km/Health
  unit/Sub.Divisional Hospital/Divisional
  Hospital/Zonal hospitals
• Population satisfied

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• General indicator of well being
•  
• Life expectancy

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Suggestion for improving the performance of all
public health programme

• 1. To conduct C.M.E programme and in-service
  training for the Medical Personals to update
  their knowledge in the management skills and
  subjects in the respective field
• 2. To involve N.G.O actively in the Health and
  Family Welfare activities
• 3. The hierarchical pattern has to be modified
  at the Divisional level to look after the
  curative and preventive services separately

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7. The Public Health Administrator has to be
nominated as Nodal Officer at Divisional level
for AIDS, TB, MALARIA and LEPROSY 8. The Public
Health Administrator has to be included in the
hospital infection control committee to monitor
the nosocomial infection in the zonal hospitals
9. To impart training to paramedical personals,
health inspectors, midwives and staff nurses in
the field of health and family welfare activities
at zonal level by the public health
administrators
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• 13. The following 50 comprehensive R.C.H
  services to be effectively carried out for the
  entire population
• M.C.H Services
• Nutritional Services
• Management of childhood diseases
• Referral Services
• Fertility Services
• Population control and sexuality educational
  Services
• R.T.I / S.T.I Control Services
• Health education regarding gender issues
• Formal and Non-formal education about
  public health
• Forty Plus Care etc.,

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ACTION PLAN FOR CARRYING OUT R.C.H PROGRAMME

• Goal Health For All
  Objective Population
  stabilization by 2045
  Target Total
  fertility rate to the replacement level by 2010
  and to achieve the other indicators of health
  for all
• Program Comprehensive R.C.H services
  Plan
  High quality, integrated, decentralized,
  needs based and holistic approach
  Monitoring Evaluation
  R.C.H indicators/Feedback data
•  

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ACTION PLAN FOR R.N.T.C.P

• Goal To extend the RNTCP to cover the entire
  population of the country by 2005
• Objective 1) To cure 85 of the sputum
  positive cases
• 2) To detect 70 of the
  estimated cases of T.B
• Target Three million cases have to be
  treated and 1.5 million cases have to be cured.
• Program RNTCP
• Strategy DOTS
• Monitoring Evaluation
• 1) Sputum conversion rate
  2) Cure rate

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CONCLUSION  The Public Health
Administrators have to prepare the action plan
for Implementation of all National Health
Programme. They have to identify the magnitude of
the problem existing in their respective zone.
The Zonal Hospital / Divisional Hospital has to
be made as sentinel center. The data collection
from this center will be utilized by the Public
Health Administrators to keep a continuous vigil
on the occurrence and distribution of diseases,
population dynamics, community behavior, and
environmental changes that result in an increased
risk of ill health in the community.
DR.I.SELVARAJ I.R.M.S