Dr.I.Selvaraj Dr.I.Selvaraj INDIAN RAILWAY INDIAN RAILWAY

MEDICAL SERVICEMEDICAL SERVICEB.Sc., M.B.B.S., D.Ph., D.I.H., B.Sc., M.B.B.S., D.Ph., D.I.H.,

P.G.C.H.&F.W (NIHFW, New Delhi) P.G.C.H.&F.W (NIHFW, New Delhi) Trained Epidemiologist Trained Epidemiologist

(CMC, vellore, T.N) (CMC, vellore, T.N)Sr. D.M.O/Health Unit/ Sr. D.M.O/Health Unit/

S.Railway/Egmore/Chennai/ S.Railway/Egmore/Chennai/ Tamil Nadu/ India Tamil Nadu/ India

Dr.I.SelvarajDr.I.Selvaraj

““HEALTH FOR ALL” IN HEALTH FOR ALL” IN 2121STST CENTURY CENTURY

NEW GLOBAL HEALTH POLICYNEW GLOBAL HEALTH POLICY

INTRODUCTIONINTRODUCTION The member countries while attending a The member countries while attending a

conference on “Health For All And Primary conference on “Health For All And Primary Healthcare” at Alma Ata, Kazakistan from 6Healthcare” at Alma Ata, Kazakistan from 6thth to 12to 12thth September 1978, having committed to September 1978, having committed to attain the goals of “Health For All” by the year attain the goals of “Health For All” by the year 2000 A.D. But it is now becoming very clear 2000 A.D. But it is now becoming very clear that the goal of “Health For All” by the year that the goal of “Health For All” by the year 2000 could not have been achieved. Two 2000 could not have been achieved. Two major factors are found for this failure. major factors are found for this failure.

1.1. Biased and poor socio-economic development Biased and poor socio-economic development between developed and developing countries.between developed and developing countries.

2.2. Discriminative policies.Discriminative policies.

THE REASON FOR IMPLEMENTATION OF NEW THE REASON FOR IMPLEMENTATION OF NEW GLOPAL HEALTH POLICY “ HEALTH FOR ALL IN GLOPAL HEALTH POLICY “ HEALTH FOR ALL IN 2121STST CENTURY” CENTURY”  • • Unacceptably high mortality and high Unacceptably high mortality and high morbidity rate.morbidity rate.• • Increasing burden of accidental trauma Increasing burden of accidental trauma cases due to raising vehicular density.cases due to raising vehicular density.• • Higher incidence of micro-macro nutritional Higher incidence of micro-macro nutritional deficiencies disorders such as LBW with deficiencies disorders such as LBW with serious consequential mental and physical serious consequential mental and physical retarded growth.retarded growth.• • To ensure the broad based availability To ensure the broad based availability of health services to the poor, under of health services to the poor, under privileged citizenry of the country on the basis privileged citizenry of the country on the basis of ground realistic consideration.of ground realistic consideration.

• Inadequate availability of personnel with Inadequate availability of personnel with specialization in the Public Health and Family specialization in the Public Health and Family medicine to discharge the Public Health medicine to discharge the Public Health responsibility in the country.responsibility in the country.• The ratio of nursing personnel vis-à-vis The ratio of nursing personnel vis-à-vis doctors/beds is very low. There is also acute doctors/beds is very low. There is also acute shortage of nurses trained in super specialty shortage of nurses trained in super specialty disciplines for deployment in tertiary care disciplines for deployment in tertiary care services.services.• There is an apprehension that globalization There is an apprehension that globalization will lead to raising trends in the overall health will lead to raising trends in the overall health cost.cost.• The urban population is likely to go up to 33% The urban population is likely to go up to 33% by 2010 resulting in urban slums without any by 2010 resulting in urban slums without any infrastructure health support.infrastructure health support.

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

THRUST AREAS IDENTIFIEDTHRUST AREAS IDENTIFIED

• NutritionNutrition• PFA ActPFA Act• Environmental Health HazardsEnvironmental Health Hazards• Immunization ProgrammeImmunization Programme• MCH ServicesMCH Services• School Health ProgrammeSchool Health Programme• Industrial/Occupational Health ServicesIndustrial/Occupational Health Services• Mental health servicesMental health services• R.T.I / S.T.I Control ServicesR.T.I / S.T.I Control Services

IMPLEMENTATION OF IMPLEMENTATION OF NEW GLOBAL HEALTH NEW GLOBAL HEALTH

POLICYPOLICY

VISIONVISION

““Health for all” Health for all” in 21 in 21stst century century

OBJECTIVEOBJECTIVE

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

GOALGOAL

• 1. To achieve all the public health 1. To achieve all the public health indicatorsindicators

• 2. “Health for all” indicators2. “Health for all” indicators

3. All National Health Programs 3. All National Health Programs indicators before the target years.indicators before the target years.

TARGETSTARGETS1. IMPROVE THE HEALTH EQUITY BY 20051. IMPROVE THE HEALTH EQUITY BY 20052. INCREASE THE SURVIVAL BY 20202. INCREASE THE SURVIVAL BY 2020 1. M.M.R 100/100000 LIVE BIRTHS1. M.M.R 100/100000 LIVE BIRTHS 2. I.M.R 45/1000 LIVE BIRTHS2. I.M.R 45/1000 LIVE BIRTHS 3. LIFE EXPECTENCY > 70 YEARS FOR ALL 3. LIFE EXPECTENCY > 70 YEARS FOR ALL

COUNTRIESCOUNTRIES3. REVERSE GLOPAL TRENDS FOR FIVE MAJOR 3. REVERSE GLOPAL TRENDS FOR FIVE MAJOR

PANDEMICS by 2020 (TB, HIV/AIDS, MALARIA, PANDEMICS by 2020 (TB, HIV/AIDS, MALARIA, TOBACCO RELATED DISEASES, and VIOLENCE/TRAUMA)TOBACCO RELATED DISEASES, and VIOLENCE/TRAUMA)

4. ERADICATE AND ELIMINATE CERTAIN DISEASES 4. ERADICATE AND ELIMINATE CERTAIN DISEASES (Measles, Filariasis, Chaga’s disease/2010, (Measles, Filariasis, Chaga’s disease/2010, Leprosy/2010, Trachoma, and Vitamin-A, / Iodine Leprosy/2010, Trachoma, and Vitamin-A, / Iodine Deficiency by 2020)Deficiency by 2020)

5. IMPROVE ACCESS TO WATER, SANITATION, FOOD AND 5. IMPROVE ACCESS TO WATER, SANITATION, FOOD AND SHELTER BY 2020SHELTER BY 2020

STRATEGYSTRATEGY• Bottom-up planningBottom-up planning• Decentralization of implementationDecentralization of implementation• Strengthening of infrastructureStrengthening of infrastructure• Capacity building at districts for planning, Capacity building at districts for planning,

Implementation, Management Information Implementation, Management Information System, and concurrent evaluationSystem, and concurrent evaluation

• Quality up-gradation of servicesQuality up-gradation of services• Appropriate system support for better Appropriate system support for better

management, co-ordination, and smooth management, co-ordination, and smooth flow of funds, transport, and procurement flow of funds, transport, and procurement systemsystem

PROGRAMMEPROGRAMME

• A need basedA need based• Client centeredClient centered• Demand drivenDemand driven• High quality integrated servicesHigh quality integrated services• Decentralized planning with Decentralized planning with

ultimate aim of population ultimate aim of population stabilizationstabilization

ACTION PLAN FOR ACTION PLAN FOR IMPLEMENTATION IMPLEMENTATION

• To identify the unmet need of the To identify the unmet need of the population population

• To select priorities among the felt needsTo select priorities among the felt needs• To formulate the objectivesTo formulate the objectives• Setting the goalsSetting the goals• Planning the programmePlanning the programme• Selection of suitable health personalsSelection of suitable health personals• Re-orientation course / training for the Re-orientation course / training for the

selected health personals selected health personals Cont…….. Cont……..

•Mobilization of financial / material Mobilization of financial / material resourcesresources•Behavioral changes by I.E.C activitiesBehavioral changes by I.E.C activities•Intersectoral coordination of sister Intersectoral coordination of sister organizations of Indian railways organizations of Indian railways •Monitoring and evaluation of the Monitoring and evaluation of the programmeprogramme•FeedbackFeedback•Reassessment of the programmeReassessment of the programme

MONITORING AND MONITORING AND EVALUATION OF HEALTH EVALUATION OF HEALTH

PROGRAMMEPROGRAMME

The indicators formulated by the The indicators formulated by the public health administrators to public health administrators to monitor and evaluate the various monitor and evaluate the various activities are based on a valid, activities are based on a valid, reliable, reproducible, repeatable, reliable, reproducible, repeatable, sensitive, specific and relevant data. sensitive, specific and relevant data. The type of indicators thus identified The type of indicators thus identified by the public health administrators by the public health administrators are given below:are given below:

PUBLIC HEALTH INDICATORSPUBLIC HEALTH INDICATORS

SOCIAL AND ECONOMICAL INDICATORSSOCIAL AND ECONOMICAL INDICATORS

1.1. Per Capita Income Crude Birth RatePer Capita Income Crude Birth Rate

2.2. Crude Death RateCrude Death Rate

3.3. GNP/GDPGNP/GDP

4.4. Literacy RateLiteracy Rate

5.5. Unemployment RateUnemployment Rate

R.C.H PROGRAMMER.C.H PROGRAMME

ACCESSIBILITY INDICATORSACCESSIBILITY INDICATORS1.1. No. Of eligible couples registered.No. Of eligible couples registered.2.2. No. Of eligible couples motivated by staff No. Of eligible couples motivated by staff

nurse / ANM / midwife / CHInurse / ANM / midwife / CHI3.3. No. Of ANC sessions heldNo. Of ANC sessions held4.4. No. Of immunization sessions heldNo. Of immunization sessions held5.5. No. Of well baby clinic conducted No. Of well baby clinic conducted 6.6. No. Of Health Education sessions conducted No. Of Health Education sessions conducted 7.7. No. Of school Health check up conductedNo. Of school Health check up conducted8.8. Total number of population covered Total number of population covered 9.9. No. Of RTI/ STD special clinic conductedNo. Of RTI/ STD special clinic conducted

R.C.H PROGRAMMER.C.H PROGRAMME

QUALITY INDICATORSQUALITY INDICATORS• No. Of ANC registered No. Of ANC registered • No. Of ANC with 3 Ante natal visitsNo. Of ANC with 3 Ante natal visits• No. Of Ante natal cases receiving No. Of Ante natal cases receiving

prophylactic/ therapeutic FST tabletsprophylactic/ therapeutic FST tablets• No. Of High risk Ante natal cases referredNo. Of High risk Ante natal cases referred• No. Of Ante natal cases received 2 doses of No. Of Ante natal cases received 2 doses of

injection T.Tinjection T.T• No. Of Normal deliveries conductedNo. Of Normal deliveries conducted• No. Of high risk Ante natal referral cases No. Of high risk Ante natal referral cases

followed upfollowed up

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

R.C.H PROGRAMMER.C.H PROGRAMME

IMPACT INDICATORSIMPACT INDICATORS• IMR IMR • MMRMMR• NMRNMR• CPR (Couple Protection Rate)CPR (Couple Protection Rate)• No. Of New born children given breast No. Of New born children given breast

feeding within 6hrs of deliveryfeeding within 6hrs of delivery• No. Of New born children with LBWNo. Of New born children with LBW

ACCESSIBLE INDICATOR OF ACCESSIBLE INDICATOR OF COMPREHENSIVE HEALTH COMPREHENSIVE HEALTH CARE SERVICESCARE SERVICES

• % Population/Health unit/Divisional % Population/Health unit/Divisional hospitals/Zonal hospitalshospitals/Zonal hospitals

• % Population/per doctor/Health unit% Population/per doctor/Health unit• % Population/per midwife/per Trained % Population/per midwife/per Trained

Birth AttendentBirth Attendent• % Population within 5 km/Health % Population within 5 km/Health

unit/Sub.Divisional Hospital/Divisional unit/Sub.Divisional Hospital/Divisional Hospital/Zonal hospitalsHospital/Zonal hospitals

• % Population satisfied% Population satisfied

General indicator of well beingGeneral indicator of well being  

•Life expectancyLife expectancy

Suggestion for improving the Suggestion for improving the performance of all public health performance of all public health programmeprogramme

1. 1. To conduct C.M.E programme and in-To conduct C.M.E programme and in-service training for the Medical Personals to service training for the Medical Personals to update their knowledge in the management update their knowledge in the management skills and subjects in the respective fieldskills and subjects in the respective field

2. To involve N.G.O actively in the Health and 2. To involve N.G.O actively in the Health and Family Welfare activitiesFamily Welfare activities

3. The hierarchical pattern has to be modified 3. The hierarchical pattern has to be modified at the Divisional level to look after the at the Divisional level to look after the curative and preventive services separately curative and preventive services separately

7. The Public Health Administrator has to be 7. The Public Health Administrator has to be nominated as Nodal Officer at Divisional nominated as Nodal Officer at Divisional level for AIDS, TB, MALARIA and LEPROSYlevel for AIDS, TB, MALARIA and LEPROSY

8. The Public Health Administrator has to be 8. The Public Health Administrator has to be included in the hospital infection control included in the hospital infection control committee to monitor the nosocomial committee to monitor the nosocomial infection in the zonal hospitals infection in the zonal hospitals

9. To impart training to paramedical 9. To impart training to paramedical personals, health inspectors, midwives and personals, health inspectors, midwives and staff nurses in the field of health and family staff nurses in the field of health and family welfare activities at zonal level by the welfare activities at zonal level by the public health administratorspublic health administrators

13. The following 50 comprehensive R.C.H 13. The following 50 comprehensive R.C.H services to be effectively carried out for the services to be effectively carried out for the entire population:entire population:• M.C.H Services M.C.H Services • Nutritional ServicesNutritional Services• Management of childhood diseasesManagement of childhood diseases• Referral ServicesReferral Services• Fertility ServicesFertility Services• Population control and sexuality educational Population control and sexuality educational Services Services• R.T.I / S.T.I Control ServicesR.T.I / S.T.I Control Services• Health education regarding gender issuesHealth education regarding gender issues• Formal and Non-formal education about Formal and Non-formal education about public healthpublic health• Forty Plus Care etc.,Forty Plus Care etc.,

ACTION PLAN FOR CARRYING OUT ACTION PLAN FOR CARRYING OUT R.C.H PROGRAMMER.C.H PROGRAMME

GoalGoal:: “Health For All “Health For All ObjectiveObjective:: Population stabilization by 2045 Population stabilization by 2045 TargetTarget:: Total fertility Total fertility rate to the replacement level by 2010 and to rate to the replacement level by 2010 and to achieve the other indicators of health for allachieve the other indicators of health for all

Program:Program: Comprehensive R.C.H services Comprehensive R.C.H services PlanPlan:: High quality, High quality, integrated, decentralized, needs based and integrated, decentralized, needs based and holistic approachholistic approach Monitoring & Monitoring & Evaluation:Evaluation: R.C.H indicators/Feedback data R.C.H indicators/Feedback data

  

ACTION PLAN FOR R.N.T.C.PACTION PLAN FOR R.N.T.C.P• Goal:Goal: To extend the RNTCP to cover the entire To extend the RNTCP to cover the entire

population of the country by 2005population of the country by 2005• ObjectiveObjective:: 1) To cure 85% of the sputum positive cases1) To cure 85% of the sputum positive cases 2) To detect 70% of the estimated cases of 2) To detect 70% of the estimated cases of

T.BT.B• Target:Target: Three million cases have to be treated and Three million cases have to be treated and

1.5 million cases have to be cured.1.5 million cases have to be cured. Program:Program: RNTCP RNTCP Strategy:Strategy: DOTS DOTS Monitoring &Monitoring & Evaluation:Evaluation: 1) Sputum conversion rate 2) 1) Sputum conversion rate 2)

Cure rateCure rate

CONCLUSION: CONCLUSION: The Public Health Administrators have to The Public Health Administrators have to

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