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Health Care

Ques 1: – Describe in detail healthcare delivery system in India? Ans: – The Healthcare delivery system broadly consists of the following sectors or agencies:-

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a) Primary Health Care
Primary health centres.
Sub- Centres.
b) Hospitals/Health Centres
Community Health Centres.
Rural hospitals.
District hospitals.
Teaching hospitals.
Specialist hospitals.
c) Health Insurance Schemes
Employees States Insurance Scheme (ESIS).
Central Government Health Scheme (CGHS).
d) Other agencies

a) Private hospitals, polyclinics, dispensaries and nursing homes.

b) General Practitioners and Clinics, Private hospital includes hospitals run on profit basis, no loss- no profit basis and corporate hospitals.

3. Voluntary Health Agencies.

4. National Health Programmes.

Primary health care:-
a) Villages level:-
i) Village Health Guide Scheme:- It was introduced on 2nd October,1977 and launches in all states except Kerala, Karnataka, Tamil Nadu, Arunachal Pradesh and Jammu Kashmir. A village health guide is a person with an aptitude for social services and is not a government functionary.

The health guides are mostly women now. They are chosen by the community in which they work and serve as links between community and governmental infrastructure.

Guidelines for their selection are:-
-Should be permanent residents of the local community.
-Should have minimum formal education of at least upto
VI standard.
– Should be acceptable to all sections of the community.
– Should be able to spare at least 2-3 hours per day for
community health work.
After selection, they undergo training in the nearest primary health centre for 200 hours spreads over a period of 3 months and receive Rs 200/- per month.

Duties assigned includes:-
-Treatment of simple medical ailments and activities in
first aid.
– Mother and child health including family planning.
– Health education.
– Sanitation.

ii) Local Dias:- Under the Rural Health Scheme, an extensive programme has to be undertaken to train all categories of local Dais (traditional birth attendants) to improve their knowledge in the elementary concepts of material and child health and sterilization. Training is at PHC, Subcentres or MCH centres for 2 days a week and remaining 4 days the accompany the Health Workers to the villages. During training each Dai is required to do 2 deliveries under the guidance of health worker, emphasis being on asepsis so that home deliveries are conducted under safe hygiene conditions thereby reducing maternal and infant mortality.

iii) Anganwadi Workers:- Under the integrated Child Development Service Scheme, there is an anganwadi workers for every 1000 population and one ICDS project has 1000 anganwadi workers. The anganwadi worker is selected by community she is expected to serve and is trained in various aspects of health, nutrition and child development for 4 months. She is paid Rs 200-250/- per month for services rendered which include health check-up, immunization, supplementary nutrition, health education, non-formal preschool education and referral services.

Sub-centre level:- It is the peripheral outpost of the existing health delivery system in rural areas. One sub-centre covers 5000 population in general and one for every 3000 population in hilly, tribal and backward areas. The functions of a sub-centre are limited to mother and child health care, family planning and immunization.

There are 2 functionaries at the level of the Subcentres:- i) Health Care Male.
ii) Health Care Female. One health assistant will supervise the work of 6 health workers. Six subcentres are located in each PHC area.

Primary Health Centre level:- The Bhore committee in 1946 gave the concept of a Primary Health Centre as a basic health unit , to provide, as close to the people as possible, an integrated, curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care. One PHC for every 30000 rural populations in the plains and one PHC for every 20000 population in hilly, tribal and backward areas have been proposed for effective coverage.

Functions of PHC are:-
-Medical care.
-MCH care including Family planning.
-Safe water supply and sanitation.
-Prevention and control of locally endemic diseases.
-Collection and reporting of vital statistics.
-Education about health.
-National health programme.
-Referral services.
-Training of health guides, health workers, local dias and health assistants. -Basic laboratory services.

b) Hospitals/Health Centres:-
Community health centres:- Some of the PHCs have been upgraded to function as Community Health Centres, each covering a population of 80,000 to 1.20 lakh. The staff at the CHC includes specialist in surgery, medicine, OBG and pediatrics, 7 nurses mid-wives, dresser, pharmacist, laboratory techanician, radiographer, 2 ward boys, dhobi, 3 sweepers, mali, chowkidar, aya and peon.

c) Health Insurance Scheme:-
Employees State Insurance Scheme: This scheme is run by contributions, employers and grants from Central and State Governments. The scheme covers employees drawing wages not exceeding Rs.6500/- per month. There is a provision for medical care inn cash and kind, benefits in the contingency of sickness, maternity, employement injury, pension for departments on the death of worker due to employment injury and also rehablitation. Medical care is provided by ESI hospitals, ESI dispensaries and through Insurance Medical Practitioners.

Central Health Government Schemes:- This was started in 1954 to provide comprehensive medical care to Central Government employees. The services include a) Out patient care.
b) Laboratory and x-ray investigations.
c) Domicillairy visits.
d) Hospitalization
e) Maternal and child health care.
f) Specialist consultation.
g) Supply of optical and dental aids.
h) Emergency treatment.
i) Family walfare services.etc
The scheme has been gradually extended over the years to cover the employees of the autonomous organizations, retired cental govt. servents, widows receiving family pension, members of parliament, ex-governors and retired judges. The employee nad the employer, to the mutual advantage of both, base CGHS scheme on the principle of co-operative effort.

d) Other agencies:-
Defence Medical Services:- Under “Armed Force Medical Services” integrated and comprehensive health care consisting of preventive, promotive and curative services and provided to the defence personnel and their family members free of cost. Out patient care, hospitalization, drug supply, specialist consultation, laboratory investigation, emergency care including transposrt facilities, artificial limbs are provided. The services are provided through the out post health centres, command hospitals at the base and the Armed Force Medical College.

Railways Medical Services:- Comprehensive health care is provided to all railway employees and their family members through the agency of railway clinics, Health Units and Hospitals. The lady medical officers, health visistors and mid-wives provide MCH and school health services. At the divisional hospitals, consultation is available.

2.PRIVATE SECTOR:- There are large number of private medical practitioners providing health care to a large section of the population. The general practitioners constitute majority of the medical profession. Most of the practitioners tend to congregate in urban areas. They provide mainly curative services. There are private clinics, dispensaries, nursing homes and hospitals, functions and activities of these private practitioners are regulated by some statutory bodies like Medical
Council Of india. The services of the private agencies are available to those who can pay.

3.Voluntary Health Agencies:- There are numerous voluntary agencies working in the field of health in india. There are voluntary agencies providing comprehensive care and leprosy services, antituberculosis services, immunization, emergency services, MCH, family planning services, health education etc. They include noth national and international health agencies. Some of the agencies working in India are:- 1.Indian Red Cross Society.

2.Hind Kust Nivaran Sangh.
3.Indian Council For Child Welfare.
4.Tuberculosis Association of India.
5.Bharat Sewak Samaj.
6.The Kastueba Memorial Fund.
7.Family Planning Association Of India.
8.The All India Blind Relief Society.
9.Rotary Clubs.
10.Professional Bodies.
11.International Agencies.
12.Health Programmes In India.

4.National Health Programmes:- Several measures have been undertaken by the National Government to improve the health of the people. List of National Health Programme:-
1. National TB Control Programme.
2. National Vector Borne Diseases Control Programme.
3. National Leprosy Eradication Programme.
4. National AIDS Control Programme.
5. Reproductive and Child Health programme.
6. National Polio Surveillance Project.
7. National Programme for Control of Blindness.
8. National Iodine Deficiency Disorders Control Programme. 9. National Diabetes Control Programme.
10. National Cancer Control Programme.
11. National Mental Health programme.
12. National Programme for Prevention and Control of

Ques 2:- Describe that National Health Policy in India. What goals were to be achieved? Ans:- A National Health Policy was last formulated in 1983, and since then there have been marked changes in the determinant factors relating to the health sector. Some of the policy initiatives outlined in the NHP-1983 have yielded result, while, in several other areas, the outcome has not been as expected. The changed circumstances relating to the health sector of the country since 1983 have made it necessary now to review the field and to formulate a new policy framework as the National Health Policy-2002. National Health Policy 2002 attempts to set out a new policy framework for the accelerated achievement of Public Health Goals in the socioeconomic circumstances currently prevailing in the country. Achivements Through The Year- 1951-2000

Demographic Changes
Life Expectancy
Crude Birth Rate
Crude Death Rate

In line with the changing health scenario and overall increasing role of privatisation in the national economy. “National Health Policy 2002” has been brought out by the Ministry of health and family welfare. Among the achievements in health sector reviewed in NHP2002 are eradicated of small pox and guineaworm, final steps towards eradication of polio, increase in life expectancy, decrease in death rate, infant mortality rate, birth rate, reduction in leprosy and malaria and development of health infrastructure. As in NHP 1983, the strategy of primary health care has been adopted as the key strategy in the new NHP2002, with emphasis on increasing the access to health services through -A decentralised Public Health System.

-Equitable access.
-Increasing Public Health Investment, with Greater allocation for Primary Health Level. -Enchanced contribution of Private and NGO sector targeted the groups which can afford to pay for services.

Goals to be achieved by 2005-10

Dispensaries & Hospitals
Beds (Pvt & Public)
Doctors (allopathy)
Nursing Personnel

Goals Year 1.Eradication of polio and yaws 2005 2.Elimination of Kala Azar and Leprosy 2010 3.Achieving Zero Growth of HIV/AIDS 2010 4.Reduction of 50% mortality due to TB,

Malaria and Water Borne Diseases 2010 5.Prevalence of Blindness to 0.5% 2010 6.Reduction of IMR to 30/1000 2010 7.Reduction of MMR to 100/1 lakh 2010 8.Reduction of LBW to 10% 2010 9.Increasing health expenditure to 2.0%

of GDP 2010 10. Establishing an integrated system of
surveillance, National Health and health 2005 statistics.

It is planned, under the policy to increase health sector expenditure to 6 percent of GDP, with 2 percent of GDP being contributed as public health investment, by the year 2010. The State Governments would also need to increase the commitment to the health sector. In the first phase, by 2005, they would be expected to increase the commintment of their resources to 7 percent of the Budget; In the second phase,
by 2010, to increase it to 8 percent of the Budget. With te stepping up of the public health investment, the Central Government’s contribution would rise to 25 percent from the existing 15 percent by 2010.

Ques 3:-
A) WHO:- World Health Organization.
Ans:- The World Health came into being on 7th April 1948, celebrated each year as “World Health Day”. The objective of the WHO is the “the attainment by all people of the highest level of health”.

In recent years, two major policy developments have influenced the WHO. First, the Alma-Ata confrence in 1978 on primary health care and Secondly, the Global strategy for Health for All by 2000.

Activities of WHO:-
1.Communicable disease control HIV, tuberculosis, malaria, yaws, yellow fever, viral hemorrhagic fevers, leishmaniasis, trypanosomiasis, sexually transmitted disease, zoonoses etc. -WHO aspires to eradicate poliomyelitis, dracunculosis and to eliminate leprosy in the very near future. -Immunization against common diseases of childhood is now a priority programme.

2.Non- Communicable disease control of cancer, cardiovascular diseases, genetic disorders, mental disorders, drug addiction nutritional disorders and dental diseases.

3.Family Health:- which includes maternal and child health care,human reproduction, nutritional and health education.

4.Occupational and Environmental Health Problem:- These are protection of the quality of air, water and food, health conditions of work, radiation protection etc.

5.Health Statistics:- Publishing a wide variety of morbidity and mortality statistics relating to health such as weekly epidemiological Record, World
Health Statistics, both quartely and annual, International Classification of Diseases.

6.Programmes dealing with Bio-Medical Research, education and training of health personnel,information and technolgy transfer and quality control of biological products and pharmaceutical products.

7.Collaboration with other organizations:- Such as with UN, U.S centres for Disease Control and Prevention, Public Health Laboratory Services in Uk, the Canadian Addiction Research Foundation and several others.

The headquaters of WHO is in Geneva. There are more six regional offices of WHO COUNTRY HEAD QUARTER -South- East Asia Region New Delhi,India. -Eastern Mediterranean Region Alexandria, Egypt. -Region of the Americas Washington D.C, USA. -Western Pacific Region Manila, Philippines. -African Region Brazzaville, Congo. -European Region Copenhagen, Denmark.

Purpose of WHO:-
WHO aim is “the attainment by all peoples of te highest possible level of health”. 1. To help governments strenghthen their health services.
2. To promote better teaching standards in medicine and its related professions. 3.To inform, advise and help in the field of health.
4. To promote- in cooperation with other specialized agencies where necessary- the improvement of nutrition, housing, sanitation, recreation, economic or working conditions and other aspects of environmental hygiene. 5. To promote cooperation among scientific and professional groupwhich advance the cause of good health. 6. To promote maternal and child health and welfare and foster the ability to live harmoniously in a changing environment. 7. To foster activities in the field of mental health, especially those affecting the harmony of human relation. 8. To promote and conduct research in the field of health.

9. To stimualate the eradiaction of epidemic, endemic and the other diseases. 10.To propose international conventions and agreements in health matters. 11.To develop international standard for food, biological and pharmaceutical products. 12.To assist in developing an informed public opinion among all peoples on matter of health.

B)UNICEF:- United Nations International Children’s
Emergency Fund.
Ans:- It was established as one of the specialized UN’s agencies in 1946. Now agency is known as ‘U.N.Children’s Fund’. Its headquater is in NewYork while its regional office for South Central Asia Region is in New Delhi. -UNICEF works in collabration with WHO and other specialized agencies of the United National like UNDP, FAO and USESCO. -UNISEF is active in the field of child health, child immunization, child nutrition, family and child welfare, child educattion etc. -Currently UNICEF is promoting a campaign known as GOBI campaign to encourage four strategies for “a child health revolution”. G for growth charts to better monitor child development.

O for oral rehydration to treat all mild nad moderate
B for breast feeding and
I for immunization against diphtheria, pertussis, tetanus, measles, polio and tuberculosis.

Functions of UNICEF:-
1.Child health: Reduction of infant mortality rate to less than 60 percent per 1000 live births and reduction of child mortality to less than 10 by 2000 AD. The objectives are:
a) Eradication of poliomyelitis by the year 2000.
b) Elimination of neonatal tetanus.
c) Reduction by 95% in measles death and reduction by 90% of measles cases compared to preimmunization levels. d) Maintainence of high level of immunization coverage at a level of 100% of infants against diptheria, pertussis, tetanus, measles, poliomylitis, tuberculosis and against tetanus
for women of child bearing age. e) Reduction by 50% in death due to diarrhoea in children under the age of 5 years and 25% of diarrhoea in incidence rate. f)Endeavour to reduce mortality rates due to acute respiratory infections among children under 5 BY 40% from present level.

1. Maternal Health:- Reduction in maternal mortality rate by half. The objectives are:
a) Special attention to the health and nutrition of the female child and to pregnant and lactating women. b) Access by all couples to information and services to prevent preganancies that are too early, too closely spaced, too late or too many. c) Universal access to primary education with special emphasis for girls and accelerated literacy programmes for women.

3. Nutrition:- Reduction in severe and moderate malnutrition among under 5 children by half of the levels in 1990. The objectives are:
a) Reduction in incidence of low birth weight(2.5 kg or less) babies to less than 10%. b) Reduction in iron deficiency anaemia in women by one-third. c) Control of iodine deficiency disorders.

d) Control of vitamin A deficiency and its consequences, including blindness. e) Empowerment of all women to breast feed their children exclusively for 4-6 months and to continue breastfeeding with complementary food, well into the second year. f) Growth promotion and its regular monitoring to be institutionalised. g) Dissemination of knowledge and supporting services to increase food production to ensur household food security.

4. Water and Sanitation:- Universal access to safe drinking water and improved access to sanitary means of excreta disposal. Eradiation of guineaworm diseases and providing safe water with flouride content within tolerable limits.

5. Education:- Universal involvement, retention, minimum level of learning, reduction of disparities and universalisation of effective access of schooling.

The objective are:
a) Universal enrolment of all children including girls, using both full time schools and part time non-formal arrangements. b) Reduction of drop out rate between class I to V and I to VII from the existing 45% and 60% to 20% and 40% respectively. c) Achievement of minimum level of learing by approximately all children at the primary level. d) Reduction in disparities by emphasis on girls education and special measures for children belonging to SC/ST. e) Expansion of Early Childhood Development activities including appropraite low cost family and community based interventions. f) Universalisation of effective access to schooling.

6.Children in Especially Difficult Circumstances:-
Provide improved protection of children in especially difficult circumstances and tackle the root cause leading to such situations.

7.Advocacy and People’s Participation: Advocacy for child as everyone’s concern and advocacy with policy makers, planners, programme implementors at national and subnational levels for focus on the child will be intergral to the achivement of the goals.

Ques 4:-
A) National Vector Borne diseases Control Programme.
Ans:- It earlier known as National Anti Malarial Programme is the country’s most comprehensive and multi-faceted public health activity. Following are the strategy for control of these diseases: 1.National Malaria Control Programme: At the time of independence malaria was responsible for an estimated 75 million cases and 0.8 million deaths anually. Government launches the National Malarial Programme in 1953. The strategy of malaria eradication was highly successful and the cases were reduced to about 100,000 and deaths due to malaria were eliminated by 1965-1966. Subsequently the programme faced various technical obstacles and financial and administrative constraits, which lead to countrywide increase in the number of cases. 6.47 million malaria cases were reported in 1976, the
highest since resurgence.

2.Current Anti Malaria Control Strategies: The main control strategies under the programme are:- – Early Case Detection and Prompt Treatment (ECDPT) to provide relief to the patient and reduce reservoir of the infection. – Selective Vector Control by appropriate insecticidal spray in rural areas and recurrent anti-larval measures including biological methods like use of larvivorous fish. -Promotion of personal prophylactic measures including use of Insecticides Treated Mosquito Nets (ITMN) etc. and promotion of bio-environmental control measure. – Emphasis on Information, Education and Communication (IEC) to promote community participitaion in the programme and Intersectoral collaboration. – Capacity building of optimal utilization of the techanical manpower for the programme. – Monitioring and evaluation of Efficient Management Information System (MIS) Under the National Anti Malaria programme, the following schemes/ projects being run in the country: a) Enhanced Malaria Control Project(EMCP): in the states of Andhra Pradesh, Chattisgarh, Gujrat, Jharkhand, Madhya Pradesh, Maharashtra, Rajasthan and Orrisa together contribute around 60-70% cases and deaths due to malaria. b) Urban Malaria Schemes(UMS): in 131 towns in the country. c) The World Health Organization is giving assistance to the National Anti Malaria Programme.

3. Dengue:-
– Epidemiological Surveillance of Dengue Cases.
– Entomological Surveillance of Aedes aegypti mosquitoes.
– Clinical management of reported cases.
– Control of mosquitoes through Integrated Vector Management including source reduction, use of larvivorous fishes, impregented bednets and selective fogging with pyrethrum. – Behaviour changes communication to changes behavior of the community about prevention of breeding of mosquitoes.

– Early diagnosis and complete treatment through Primary Health Care System. – Interruption of transmission through Vector control by undertaking residual insectisidal spraying in affected areas. – Health Education and
Community participation.

5.Japanese Encephalitis:-
– Vector control by insecticidal sparying with appropriate insecticide for outbreak containment. – Early diagnosis and prompt clinical management to reduce fatality. – Health Education.
– Training of Medical Personnel and Professionals.

-Annual Mass Drug Administration (MDA) with single dose of DEC to all eligible population at risk of Lymphatic Filariasis. -Home based management of Lymphodema Cases and

B) National AIDS Control Programme:
Ans:- The main regions affected are Tamil Nadu, Maharastra, Andhra Pradesh, Mumbai and Gujarat. It is estimated that about 3.8 million people are infected with HIV virus in the country. The sero-positive rate among screened general population has reached 27 per 1000. The National AIDS Control Organization (NACO) was established to closely monitor the programme. The overall objective of the programme is to arrest the spread of HIV/AIDS infection in the country with a view to reducing morbidity and mortality,minimize the socio-economic impact resulting from HIV/AIDS infection. Till 2005, a total of 110856 AIDS cases have been reported from the country. The Programme Strategy:-

a) Blood Safety: Testing of every unit of blood collected, is made mandatory. Profesional blood donation has been prohibited since January,1998. 154 Zonal Blood Testing Centres and 9 HIV Refrence Centres are functioning. HIV kits are supplied upto District Level Blood Banks.

b) Control of Sexually Transmitted Diseases: 5 Regional STD Reference centres and 504 STD clinics usually located at the district hospitals and the skin and STD departments of medical colleges are strengthened by
providing equipments materials, drugs, consumables and training of health personnel. Guidelines have been developed for samplified STD treatment through syndromic management. “Condom Promotion” has been taken up in a big way by NACO with regard to I) Quality of control of comdoms.

II) Social marketing of condoms.
III) Involvement of NGOs.

c) HIV Surveillance: A need based HIV/AIDS surveillance system has been established in the country and modified in response to the changing need and scenario. 62 Surveillance centres and 9 HIV Refrence Centres have been set up in the country. In order to know the trend of HIV infection amongest variotion groups, 115 addition sentinel sites were established.

d) Strenghtening Clinical mangement Capabilities and Reduction of Impact: This is accomplished by training of Counselors, setting up of community based care structure and improving access to health care fcilities for those affected. Health Care Providers are being trained and oriented to provide care to the infected or AIDS patients without discrimination.

e) Information, Education, Communication and Social Mobilization: The objective is to raise awareness, improve knowledge and understanding among the general public about AIDS infection and STD, routes of transmission and method of prvention. Change in behaviors, condom use. The mass multimedia like television, newspapers have played a big role in this regard. Ques 5:- Write about National Health Programme for Non-communicable diseases? Ans:- A non-communicable disease, or NCD, is a medical condition or disease which by definition is non-infectious and non-transmissible among people. NCDs may be chronic diseases of long duration and slow progression, or they may result in more rapid death such as some types of sudden stroke. They include autoimmune diseases, heart disease, stroke, many cancers, asthma, diabetes, chronic kidney disease, osteoporosis, Alzheimer’s disease, cataracts

1. National Cancer Control Programme (NCCP):
In India today there are an estimated 2.4 million cases of cancer and 0.7 million new cases are added every year. The initial activities included purchase of cobalt therapy units. The NCCP was started in 1976 with the following strategy:-

-Primary prevention.
-Early diagnosis.
-Upgradation of treatment facilities.
From 1990-91 onwards, establishment and development of oncology units at medical colleges/ hospitals were taken up. The schemes for district level projects for preventive, health education, early detection and pain relief measures were initiated; in addition financial assistance to NGOs for the purpose of undertaking health education and early detection activities against cancer was given.

2.National Diabetes Control Programme:
The prevelance of diabetes of today in india in adults is 2.4% in rural and 4.0 -11.6% in urban population. More than one lakh deaths every year are attributed to diabetes in the country. Considering the importance of the disease, during seventh five year plan National Diabetes Control Prgramme was Started on a pilot basis in some districts of Tamil Nadu, Karnataka and Jammu & Kashmir.

-Identification od high risk subjects at an early stage.
-Early diagnosis and management of cases of diabetes.
-Prevention, arrest or slowing of acute metabolic as well as chronic cardio vascular- renal complications of diabetes. -Health education.

3.National Mental Health Programme (NMHP):
Psychiatric symptoms are common in general population in both sides of the globe. These symptoms -Worry.
-Sleepness nights affect more than half of the adults at some time, while as many as one person in seven experiences some form of diagnosable neurotic
disorder. The government of India has launched the National Mental Health Programme in 1982.

-Prevention and treatment of mental and neurological disorders and their associated disabilities. -Use of mental health technology to improve general health services. -Application of mental health principles in total national development to improve quality of life.

1.To ensure availabilty and accessibility of minimum mental health care for all in the foreseeable future, particularly to the most vulnerable and underprivelaged sections of the population. 2.To encourage application of mental health knowledge in general health care and in social development. 3.To promote community participation in the mental health services development and to stimulate efforts towards self-help in the community.

1.Integration mental health with primary health care through the NMHP. 2.Provision of tertiary care institutions for treatment of mental disorders. 3.Eradicating stigmatisation of mentally ill patients and protecting their rights through regulatory institutions like the Central Mental Health Authority and State Mental Health Authority.

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