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Public Health in India Moving Ahead?

Public Health in India Moving Ahead?. Prof. Shiv Chandra Mathur shiv_mathur@hotmail.com.

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Public Health in India Moving Ahead?

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  1. Public Health in IndiaMoving Ahead? Prof. Shiv Chandra Mathur shiv_mathur@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. Shiv Chandra Mathur

  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. Shiv Chandra Mathur

  4. Deaths In India (2005) Shiv Chandra Mathur 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 Shiv Chandra Mathur

  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 Shiv Chandra Mathur

  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 Shiv Chandra Mathur

  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 Shiv Chandra Mathur

  9. Shiv Chandra Mathur

  10. RISING CHRONIC DISEASE BURDENS Shiv Chandra Mathur

  11. SICK INDIVIDUALS ARISE FROM SICK POPULATIONS - Geoffrey Rose Shiv Chandra Mathur

  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 Shiv Chandra Mathur

  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 Shiv Chandra Mathur

  14. Handicaps Lack Of Sufficient Public Health Expertise needed for • Policy Development • Program Design, Delivery And Evaluation • Health System Management • Public Health Research Shiv Chandra Mathur

  15. BIOLOGICAL SCIENCES EPIDEMIOLOGY & ALLIED SCIENCES ECONOMICS AND MANAGEMENT PUBLIC HEALTH SOCIAL SCIENCES Shiv Chandra Mathur

  16. SCIENCE DISCOVERS TECHNOLOGY DEVELOPS PUBLIC HEALTH DELIVERS Shiv Chandra Mathur

  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. Shiv Chandra Mathur

  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. Shiv Chandra Mathur

  20. NRHM has created in each Indian Village • A worker : she is ASHA • An institution : that is VH&SC • An event : which is VHND. Shiv Chandra Mathur

  21. Examples of Innovations • Making PHCs 24X7 in Tamil Nadu – 3 Nurse model. • Assam’s initiative – Boat Clinics • Rajasthan’s initiative – CMJRK; SNCUs.;108 • MP’s initiative –HSC Delivery, SNCUs. • Haryana’s initiative – Free drugs, 102; surgery package. • Gujarat’s initiative – Chiranjeevi, 108, Shiv Chandra Mathur

  22. Examples of Innovations • Kerala’s initiative –Ban private practice; Quality. • Bihar – Block pooling; PPPs – Diagnostics. • Chhatisgarh – Mitanin, VHSCs. • Orissa – ASHAs; AYUSH doctors; • Andamans – High salary for Specialists; RKS. Shiv Chandra Mathur

  23. The impact of NRHM - 1 • MMR significantly down – 450 to 230 - SRS. • IMR decline – 60 in 2004; 53 in 2008; <50now • TFR steadily declining – 2.9 in 05 to 2.6 in 2008. • Institutional deliveries – 41% to 73% Shiv Chandra Mathur

  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. Shiv Chandra Mathur

  25. What Doctors in Public Systems can do further? Strengthen medical care Help strengthen HMIS Sanitary Stringency Induce Behavior Change Disease Surveillance Educate on Better Food Practices 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 Shiv Chandra Mathur

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