Universal health coverage as a concept was born in 1883 when Germany introduced health coverage for achieving health status of its young population.India, is still attempting to find a way for providing appropriate, affordable and accessible health care to its population.
The document discusses the history and definitions of health promotion. It provides:
1) The term "health promotion" was first used in 1974 and refers to strategies that tackle the wider determinants of health beyond just healthcare.
2) Health promotion aims to empower people to have more control over their health and aspects of their lives that affect it.
3) Key strategies of health promotion include building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services.
IEC (Information, Education, Communication) is an approach that aims to change or reinforce behaviors in a target audience regarding a specific health problem within a defined period. The goals of IEC include changing individual, family, and community health behaviors; creating awareness and support for public health activities; and facilitating education on issues like primary healthcare, disease prevention, and reproductive health. IEC draws from several approaches including diffusion theory, social marketing, behavior analysis, and anthropology. The key steps in planning an IEC campaign involve conducting a needs assessment, establishing behavioral objectives, identifying potential barriers, and creating an evaluation plan.
The document summarizes several national health policies of India, including the National Health Policy of 1983, 2002, and 2010. It outlines the goals of each policy, such as eradicating polio and other diseases, reducing mortality from tuberculosis, and increasing access to healthcare facilities. It also discusses the National Nutrition Policy and National Education Policy of India.
Understanding the concept of Universal Health Coverage (UHC) and how can we reach it, both globally and also in India. The presentation also includes HLEG report , which is the proposed architecture for India's guide to reach UHC.
Healthcare challenges & solutions in indiakripak93
This document discusses the key challenges facing India's healthcare system and potential solutions. The main challenges are the large burden of infectious and chronic diseases, high maternal and child mortality rates, lack of universal access to healthcare, shortage of resources, and inadequate healthcare financing. Proposed solutions include strengthening public health programs, improving access to healthcare in rural areas, providing incentives for medical professionals to work in underserved areas, leveraging public-private partnerships, and increasing public financing of healthcare.
The World Health Organization was founded on the principle of universal health coverage and achieving the highest level of health for all people. World Health Day on April 7th aims to inspire and guide countries toward achieving universal health coverage through a series of events in 2018. Currently half the world's population lacks access to needed health services, and countries need to extend coverage to one billion more people by 2023 to meet global targets. World Health Day will highlight the need for universal coverage and benefits it provides.
The International Health Regulations originated in 1851 to promote international cooperation and limit interference with trade during disease outbreaks. The IHR have been revised multiple times to address new public health challenges, including the 2005 revision to strengthen surveillance and response systems for infectious diseases and public health emergencies. The IHR (2005) require countries to develop core surveillance and response capacities and obligate information sharing during public health events of international concern in order to rapidly detect and respond to global health threats.
This document discusses health care financing. It begins by defining key terms related to health care financing sources, including public expenditures, external aid, and private expenditures. It then outlines the main mechanisms of health care financing: general revenue, social insurance contributions, private insurance premiums, community financing, and direct out-of-pocket payments. For each mechanism, it provides a brief definition and description. The document concludes by stating that the role of health financing should be recognized, that it cannot be dealt with separately from other factors like governance and economic growth, and that governments need to actively participate to avoid market failures.
Health economics is the study of how limited resources are used in the health care industry and how they affect health care systems. It aims to provide the best quality health care to as many people as possible given financial constraints. Key aspects of health economics include cost accounting, cost-benefit analysis, cost-effectiveness analysis, and analyzing the effects of factors like technology, population changes, and policies on health care systems. Resources in health care may be evaluated using quantitative techniques like cost minimization and cost-effectiveness analysis.
The document defines a health system as consisting of all organizations, people, and actions whose primary purpose is to promote, restore, or maintain health. It discusses health systems as complex adaptive systems with many interacting elements. It presents several conceptual frameworks for analyzing health systems, including the WHO health system building blocks and the Antwerp health system dynamics framework. It then discusses the concept of health system strengthening and changing global approaches to improving health systems over time, moving from a disease-focused approach to a more holistic health system strengthening approach.
The document summarizes India's national health policies from 1978 onwards. It discusses the key goals and principles of the 1978 Alma-Ata Declaration on Primary Health Care, including health as a fundamental right and reducing inequality. It outlines India's 1983 National Health Policy which aimed to provide primary health care and integrate related sectors. While some goals were achieved by 2000, many were not, prompting the 2002 National Health Policy to revise strategies and accelerate public health goals.
Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare.
The document summarizes India's National Health Policy adopted in 1983 and revised in 2002. The 1983 policy aimed to achieve health for all by 2000 through primary health care services and intersectoral coordination. It addressed issues like medical education, rural/urban imbalance, research, and monitoring progress. The 2002 policy updated targets and financing to further develop infrastructure, workforce, programs, and public-private partnerships to improve healthcare access and outcomes across India.
1. The document discusses the origins and history of primary health care from pre-colonial times through the colonial period and post-independence era, culminating in the 1978 Declaration of Alma-Ata which established primary health care as a global strategy.
2. The Declaration defined primary health care as including health promotion, disease prevention, treatment of common illnesses, and community participation at an affordable cost.
3. While the goals of primary health care were not fully realized due to lack of resources and commitment, the principles of equity, prevention and universal access remain important, and revitalizing primary health care is seen as critical to achieving health-related sustainable development goals.
Global burden of disease & International Health RegulationSujata Mohapatra
The document discusses global burden of disease and key concepts in global health. It summarizes that global burden of disease assessments measure years of life lost to premature mortality and disability worldwide. The leading causes of mortality globally are ischemic heart disease, stroke, lower respiratory infections and COPD, while the highest disease burdens come from lower respiratory infections, diarrheal diseases, depression and ischemic heart disease. Noncommunicable diseases like cardiovascular disease are responsible for most deaths globally.
The document discusses several models of health promotion:
1. Caplan and Holland's model examines how knowledge is generated about health and how society impacts health. It identifies four paradigms: radical humanist, humanist, radical structuralist, and traditional.
2. Beattie's model examines the type (authoritarian vs negotiated) and size (individual to community) of health promotion approaches. It categorizes four types of activities.
3. Tones et al's model identifies key psychological, social, and environmental factors influencing health behaviors. It shows education's role in setting agendas, raising critical consciousness, and empowering communities.
4. Tannahill's model focuses on health education,
The document summarizes healthcare financing in India. It discusses that healthcare financing aims to ensure access to health services. The key principles are generating revenue, pooling funds for cross-subsidization between rich/poor and healthy/sick, and purchasing efficient services. In India, healthcare is financed primarily through out-of-pocket payments by households, while government expenditure is low compared to other countries. Reforms like NRHM and RSBY aim to increase public allocation to healthcare. Challenges include expanding coverage with limited resources and improving spending efficiency.
Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behaviour in the production and consumption of health and health care.
In broad terms, health economists study the functioning of health care systems and health- affecting behaviour such as smoking.
It is the discipline of economics applied to the health care.
This document discusses universal health coverage (UHC) and India's progress toward achieving it. It provides background on UHC, including definitions, objectives, and the global momentum behind it. It then examines India's current scenario, including existing schemes to promote UHC. Key recommendations from the High Level Expert Group on UHC include increasing public health spending, developing a national health package, and strengthening human resources and community participation. Achieving UHC would lead to benefits like greater equity, efficiency, and improved health outcomes. The document outlines the new architecture needed to achieve UHC through reforms in six critical areas.
Universal health coverage was established in the WHO constitution of 1948 declaring health a fundamental human right.The goal of universal health coverage is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them.
The document discusses moving towards universal access to health care in India. It defines key concepts of universal health care and outlines principles like public funding playing a central role, comprehensive services for all, and no fees at point of access. It examines issues like what services should be covered, how it will be funded through taxes or insurance, and how services will be organized between public and private sectors. Specific challenges in India like the large private sector and funding mechanisms are also discussed.
Health financing strategies uhc 27 09 12Vikash Keshri
This document discusses health financing strategies for universal health coverage. It begins by defining universal health coverage and providing historical perspectives. It then discusses the current state of health financing in India, including low public spending, high private out-of-pocket expenditures, and variations between states. The document outlines that achieving universal health coverage requires raising sufficient funds, removing financial barriers, and using resources efficiently. It examines strategies for generating more health resources, utilizing resources effectively to prevent waste, and proposes the key recommendations of India's High Level Expert Group on universalizing access to affordable healthcare.
Article Type: Editorial
Title: Fairer world for a healthier and safer world
Year: 2021; Volume: 1; Issue: 1; Page No: 1 – 2
Author: Priyanka Raj CK
DOI: 10.55349/ijmsnr.2021.1112
Affiliation: Deputy Editor-In-Chief, IJMSNR, Associate Professor, Department of Public Health and Epidemiology, National University of Science & Technology, College of Medicine and Health Sciences, Sohar, Al Batinah North, Sultanate of Oman. Email ID: priyankaraj@nu.edu.om
Article Summary: Submitted: 02-August-2021
Revised : 30-August-2021
Accepted : 03-September-2021
Published: 30-September-2021
This document provides an overview of Universal Health Coverage (UHC) including:
- Definitions and concepts of UHC.
- A brief history of major UHC initiatives and policies around the world since the late 19th century.
- Monitoring and evaluation of UHC through indices like the UHC Service Coverage Index.
- India's initiatives toward UHC like the Ayushman Bharat program and various national health insurance schemes.
- Key principles and focus areas outlined in India's 2011 High Level Expert Group report on UHC.
The document summarizes India's national health policies from before independence to the present. It discusses key committees that shaped health policies, including the Bhore Committee in 1946. The National Health Policies of 1983 and 2002 are analyzed in depth, outlining their goals of expanding healthcare access and improving health indicators like life expectancy and rates of immunization, maternal and child mortality. The policies aimed to achieve 'Health for All' through strengthening primary healthcare and increasing investment in the health sector.
This document discusses universal health coverage and provides information on key facts, definitions, objectives, and challenges. It summarizes the evolution of universal health coverage in India through various committee reports and schemes. Key recommendations from the High Level Expert Group report on achieving universal health coverage in India include establishing a national health package, developing health service norms, increasing human resources for health, strengthening community participation, and improving access to medicines and technology. Monitoring progress and overcoming challenges such as inadequate services, varying quality, and affordability issues are important to achieve universal health coverage.
The document discusses India's evolving approach to healthcare, from the Bhore Committee's recommendation of comprehensive healthcare in 1946 to the Alma-Ata Declaration's emphasis on primary healthcare in 1978. It outlines the levels of healthcare in India, from primary to tertiary, and key policies and goals like Health for All by 2000, the Millennium Development Goals, and National Health Policies of 1983, 2002, and 2015. Primary healthcare is defined as essential care that is universally accessible, affordable, and participatory for communities.
This document discusses health for all as a goal and outlines steps needed for universal health coverage in India by 2022. It recommends increasing public health expenditure to at least 3% of GDP, developing a national health package with essential services, strengthening human resources for health, and ensuring access to affordable medicines for all through price controls and expanding the essential drugs list. The goal is to make affordable, quality health services accessible to all Indians.
The document discusses primary health care (PHC) as defined by the World Health Organization (WHO). It outlines the key principles of PHC established at the International Conference on PHC in Alma-Ata in 1978, including making essential health care universally accessible through community participation and affordable locally. The document also examines the history of the PHC movement and WHO's goal of "Health for All" by 2000. Finally, it identifies six pillars that PHC is built on: social justice, preventive health care, community participation, inter-sector cooperation, appropriate technology, and sustainable measures.
This document discusses healthcare in India and proposes ways to make it more affordable and accessible. It notes that healthcare costs are rising and most people rely on private healthcare, while public healthcare is underfunded and understaffed. It analyzes issues like disease burdens, the growth of private sector, health insurance schemes, use of generics, and medical tourism. It recommends increasing public spending on healthcare to at least 5% of GDP, improving infrastructure, enhancing the health workforce, and promoting primary healthcare to achieve universal coverage in an equitable manner.
1. The document discusses the principles and levels of healthcare, with a focus on primary healthcare. It emphasizes equitable access to healthcare, community participation, and using appropriate technologies.
2. Primary healthcare aims to shift resources from urban to rural areas to address inequalities. It relies on local resources and community involvement through village health workers.
3. The goals of "Health for All by 2000" and Millennium Development Goals placed universal health access at the forefront of development. Sustainable Development Goals from 2015 integrate economic, social and environmental dimensions.
The slides are a point of statement on the feasibility of Universal health coverage. It talks about what is UHC and can it be sustained by India over time
“Sarvé bhavantu sukhinaḥ, sarvé santu nirāmayāḥ, Sarvé bhadrāṇi pashyantu, mā kashchid_duḥkha-bhāg-bhavét”. The meaning of this Sanskrit Sloka is “All should/must be happy, be healthy, see good; may no one have sorrow. Mahatma Gandhi also says, “It is health which is real wealth, and not pieces of gold and silver”. Without robust health nobody can do anything. WHO emphasized on “Health for all” in this 21st Century in Geneva Conference in 1998. Government of India also committed to the goal of ‘Health for All’. WHO defined “health” as "State of complete physical, mental, and social well being, and not merely the absence of disease or infirmity". There are strong linkages between population, health and development. India’s health challenges are not only huge in magnitude due to its large population but they are complex due to its diversity and the chronic poverty and inequality. There are extreme inter-state variations, caused by not only the cultural diversity but because -the states are at different stages of demographic transition, epidemiological transition and socio economic development. Along with the old problems like persistence of communicable diseases and high maternal mortality in some parts, there is an urgent need to address the emerging issues like the threat of non-communicable diseases, HIV (AIDS) and health problems of the growing aged population. Accelerating demographic transition is not only necessary for the population stabilization but it is closely related to health goals. Despite substantial improvements in some health indicators in the past decade, India contributes disproportionately to the global burden of disease, with health indicators that compare unfavorably with other middle-income countries and India's regional neighbours. Large health disparities between states, between rural and urban populations, and across social classes persist. A large proportion of the population is impoverished because of high out-of-pocket health-care expenditures and suffers the adverse consequences of poor quality of health care. The obligation of the Government of India is to ensure the highest possible health status to its population and access to quality health care has been recognized by a number of its key policy documents. This paper attempts to study the over view of health care in India.
Key words: Health Care, National Health Policy, Access, Affordability, Equity, Urban Vs Rural-------------
The document discusses the history and principles of primary health care (PHC) in India. Key points include that PHC began in India in 1946 and aims to provide universal and equitable access to basic health services. PHC is focused on health promotion, prevention, and treatment of common illnesses and injuries. It also emphasizes community participation and multisectoral coordination. The document outlines the services provided by PHC in India and challenges faced in implementing the PHC strategy.
Prompted by the 20th anniversary of the 1993 World Development Report, a Lancet Commission revisited the case for investment in health and developed a new investment frame work to achieve dramatic health gains by 2035. Our report has four key messages, each accompanied by opportunities for action by national governments of low-income and middle-income countries and by the international community.
The document discusses primary health care. It begins by defining health and describing criticisms of current health care systems. It then explains the concept of health care versus medical care and describes different levels of health care including primary, secondary, and tertiary care. The document outlines principles of primary health care including equitable distribution, community participation, multisectoral coordination, appropriate technology, and prevention-focused care. It discusses the 1978 Alma-Ata Declaration which emphasized primary health care and described it as essential, universally accessible care that involves communities and is affordable.
The National Health Policy 2015 aimed to address inequities in India's health system and promote universal access to healthcare. It recognized achievements in reducing mortality rates but noted continued disparities between rural and urban areas. The policy sought to decentralize service delivery, strengthen primary healthcare, expand health insurance coverage, and increase investment in research. It also acknowledged the growing roles of the private healthcare sector and traditional medicine in meeting India's health needs.
Population medicine and changing concepts of diseaseDr.Hemant Kumar
The document discusses key concepts related to public health, population health, and the epidemiological transition from infectious to non-communicable diseases (NCDs). It defines public health, health surveillance, monitoring, and population health. It explains that population health looks at health outcomes within groups, while public health aims to promote health through organized community efforts. The document also discusses the global burden of NCDs, their increasing impact in India, and risk factors like tobacco use, unhealthy diets, physical inactivity, and alcohol. It notes that prevention is critical to addressing NCDs given their high treatment costs.
Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis that primarily affects the lungs. It is transmitted from person to person through droplets from the throat and lungs of people with active TB disease. TB has affected humans for thousands of years and was responsible for the deaths of millions of people in the 19th century. Today it remains a major global health problem, with 10 million new cases and 1.3 million deaths in 2016. India has the highest burden of TB cases globally. The WHO End TB Strategy aims to end the global TB epidemic with targets of reducing TB deaths by 95% and cutting new cases by 90% between 2015 and 2035.
Occupational health aims to promote and maintain workers' physical, mental, and social well-being. It involves addressing industrial hygiene, diseases, accidents, hazards, and rehabilitation. Components include preventing departure from health due to work conditions; protecting workers from health risks; and adapting the work environment and workers to their jobs. Key occupational hazards are physical, chemical, biological, mechanical, and psychosocial factors that can negatively impact health. The Factories Act and Employees' State Insurance Act are two important laws governing occupational health in India by establishing standards for facilities, hours, leave, diseases, and benefits like sickness payments and medical care.
Hepatitis B virus (HBV) infection is a major global public health problem, with an estimated 400-500 million people chronically infected worldwide. Each year there are around 10 million new cases and 1.3 million deaths, making HBV the 5th most common cause of cancer and 10th leading cause of death globally. India has an intermediate prevalence of HBV infection at around 3% of the population, or approximately 37 million carriers, and contributes significantly to the global disease burden.
The document discusses child and infant mortality rates globally and in India. It provides definitions for under-five mortality rate, infant mortality rate, and neonatal mortality rate. The three main causes of under-five mortality are neonatal mortality (0-4 weeks), post-neonatal mortality (1-12 months), and factors like low birth weight, prematurity, and infectious diseases. While global under-five mortality has decreased 53% from 1990-2015, Africa still has the highest rate. India accounts for 20% of global under-five deaths despite its rate decreasing 61% from 1990-2015. Preventive measures discussed include prenatal nutrition, immunizations, breastfeeding, and improved access to primary healthcare.
1. There are several barriers that can inhibit effective sanitation policy implementation in developing countries, including lack of human and technical capacity within governments, low ability of governments to absorb increased funding, lack of suitable service providers, and lack of access to affordable credit for households and communities.
2. Effective communication of health risks and promotion of behavior change can also be a challenge. Governments struggle to convey the strong links between sanitation, hygiene practices, and disease prevention.
3. Long-term sustainability requires arrangements for regular cleaning and maintenance of sanitation facilities, but developing countries often lack such arrangements, which can undermine improvements over time.
Pre-exposure prophylaxis (PrEP) involves using antiretroviral medications like Truvada to prevent HIV infection in HIV-negative people. PrEP is highly effective if taken consistently before and after exposure to HIV. It works by preventing the virus from establishing a permanent infection during the window of opportunity after exposure. PrEP is recommended for those at high risk of HIV infection, including men who have sex with men, transgender individuals, injection drug users, and heterosexual men and women with multiple partners or other risk factors.
population medicine has been referred to as hygiene, public health, preventive medicine, social medicine or community medicine. All these aim for promotion of health and prevention of disease.
1. Lymphatic filariasis, also known as elephantiasis, is a neglected tropical disease caused by filarial parasites transmitted to humans by mosquitoes. It affects over 120 million people globally.
2. Infection occurs when filarial parasites are transmitted to humans through the bites of infected mosquitoes. This leads to damage of the lymphatic system over time, causing lymphedema, elephantiasis, and hydrocele in up to 40 million people.
3. In India, over 1 billion people are at risk of infection, with areas of high endemicity including states like Bihar, UP, and Orissa. The national control program employs mass drug administration of DEC or iverme
INTEGRATED MANAGEMENT OF NEO-NATAL AND CHILDHOOD ILLNESSESDr.Hemant Kumar
This document discusses Integrated Management of Neonatal and Childhood Illness (IMNCI), a strategy developed to address high child mortality rates in developing countries. It notes that the majority of under-five deaths are caused by a handful of treatable conditions like pneumonia, diarrhea and malnutrition. IMNCI trains healthcare workers to recognize illness early and provide integrated treatment following an algorithmic approach. The goals are to reduce infant mortality and improve child health by managing the most common conditions in an integrated fashion. IMNCI was adapted in India as IMNCI and focuses on preventative, curative and health system aspects to address the major causes of child deaths.
The document discusses various types of food poisoning, including bacterial and non-bacterial causes. It describes common foodborne illnesses such as salmonella, staphylococcus, botulism, and clostridium perfringens poisoning. For each type, it covers the defining characteristics, causative agents, sources of contamination, incubation periods, mechanisms of toxicity, symptoms, and methods of diagnosis. Prevention strategies including proper food handling and cooking temperatures are also discussed.
This document discusses the ethics of war and conflict situations. It begins by defining ethics and outlining key ethical principles. It then poses three questions regarding the ethics of war: 1) Is it ever right to go to war? 2) When is it right to wage war? 3) What is the ethical way to fight a war? The document discusses concepts like just war theory and jus in bello. It outlines international conventions and laws that govern the ethics of war, including prohibitions on torture, inhumane experimentation, and attacks on civilians. The goal of international humanitarian law is to limit suffering during armed conflicts.
1. Coronary heart disease (CHD) is a chronic condition resulting from an imbalance between the heart's supply and demand for oxygenated blood. It is the leading cause of death globally, responsible for over 17 million deaths in 2016.
2. In India, CVDs have become the leading cause of mortality, affecting Indians a decade earlier than Western populations. Over half of CVD deaths in India occur before the age of 70.
3. The major risk factors for CHD include age, tobacco use, unhealthy diet, physical inactivity, and alcohol consumption. Addressing these behavioral risk factors through population-wide strategies can prevent most cardiovascular diseases.
Pre-exposure prophylaxis (PReP) is the new tool to fight and prevent the spread of HIV. Its a very useful strategy to prevent HIV for those who indulge in high risk sexual behavior and unsafe sex.
FISH BONE DIAGRAM IS OFTEN USED FOR SOLVING PROBLEMS AND IS ALSO AN IMPORTANT TOPIC FOR M.D. COMMUNITY MEDICINE POST GRADUATES .THIS PRESENTATION COULD BE OF SOME HELP TO THEM .
Social stratification refers to the division of a society into socioeconomic tiers based on factors like wealth, income, social status, occupation and power. It is a characteristic of all societies, both ancient and modern. In ancient societies, stratification typically divided people into an upper class of rulers/nobles and a lower class of peasants/slaves. Caste systems formalized stratification in places like India, assigning social status by birth. Modern stratification is typically analyzed using Max Weber's three dimensions of class, status and power or using Marx's view of class divisions based on ownership of resources and means of production. Education, income and occupation are commonly used indicators of socioeconomic position in stratified societies.
Non-communicable diseases (NCDs) such as heart disease, cancer, diabetes and respiratory diseases account for the majority of deaths worldwide. Over 38 million people die from NCDs each year, with 80% of deaths occurring in low- and middle-income countries. The main risk factors that drive NCDs are tobacco use, physical inactivity, unhealthy diets and harmful use of alcohol. In response, the WHO has created a global action plan to reduce premature NCD deaths by 25% by 2025 through targeting these key risk factors. National programs are also seeking to prevent and control NCDs through lifestyle changes, early diagnosis and management.
This document discusses cancer, including categories of cancer, signs and symptoms, frequency and common cancers worldwide and in India. It summarizes that carcinomas arise from epithelial cells, sarcomas from connective tissues, and lymphomas from immune/bone marrow cells. The highest global cancer rates occur in Northern Europe and Australia. Lung cancer is most common worldwide while breast cancer has the highest rate in Belgium. Primary prevention focuses on reducing environmental/lifestyle risk factors while secondary prevention utilizes cancer screening and registries.
1. Approximately 285 million people worldwide have visual impairments, with 246 million having low vision and 39 million being blind.
2. The leading causes of blindness are cataract (62%), refractive error (19.7%), and glaucoma (5.8%).
3. In India, there are 7.8 million blind people and 45 million with low vision, accounting for 20% of the world's blind population.
4. The National Programme for Control of Blindness was launched in 1976 with the goal of reducing blindness prevalence from 1.4% to 0.3% by 2020 through strengthening eye care services, training human resources, and increasing public awareness.
Influenza, commonly known as the flu, is a viral infection that affects the nose, throat, bronchi and occasionally the lungs. Common symptoms include fever, sore throat, muscle pains, coughing and fatigue. The influenza virus is classified into types A, B and C. Types A and B are responsible for seasonal flu epidemics and pandemics. The virus undergoes antigenic drift and shift, requiring new vaccines each year. At risk groups like the elderly are recommended for annual flu vaccination to prevent severe complications.
Factors influencing growth & development:
Growth & development depend upon multiple factors or determinants. They influence directly or indirectly by promoting or hindering the process.
The determinants can be grouped as Heredity & environment..
Heredity or genetic factors are also related to sex, race, & nationality. Environment includes both pre natal & post natal factors.
Definition of mental health nursing, terminology, classification of mental disorder, ICD-10, Indian Classification, Personality development, defense mechanism, etiology of bio psychosocial factors,
Osvaldo Bernardo Muchanga- MALE CIRCUMCISION, ITS Vs SOCIOCULTURAL BELIEFS (C...Osvaldo Bernardo Muchanga
MALE CIRCUMCISION consists of the surgical act of removing the foreskin (skin that covers the glans of the penis), leaving the glans more prominent and better cleanable.
MALE CIRCUMCISION itself has medical as well as sociocultural implications, as it has been proven to be an act that can minimize SEXUALLY TRANSMITTED INFECTIONS (STIs), especially HIV, but it also represents the SOCIOCULTURAL IDENTITY of some people, respectively.
Now, in a SERO-EPIDEMIOLOGICAL PROFILE like that of Mozambique where the prevalence of HIV is around 12.5% which corresponds to approximately 2 million people living with HIV, where the province of GAZA is the most seroprevalent with a positivity rate of 21% (INSIDA, 2021), it is extremely necessary to THOROUGHLY scrutinize all possibilities for preventing or minimizing the spread of HIV and other STIs.
Surgical Infection Powerpoint based on Scwartz Principlse of SurgeryMedicNerd
A presentation on surgical infections would encompass an in-depth examination of infections that occur post-surgery, highlighting their significance in clinical settings. It would cover the various types of surgical infections, such as superficial incisional infections, deep incisional infections, and organ/space infections, delving into their causes, including microbial contamination during surgery, patient-related factors, and procedural factors. The presentation would discuss diagnostic techniques, such as clinical evaluation, laboratory tests, and imaging studies, alongside treatment strategies that include antibiotic therapy, surgical intervention, and supportive care. Additionally, it would emphasize preventive measures, such as stringent aseptic techniques, preoperative skin antisepsis, and postoperative care protocols, to mitigate the incidence of these infections.
principles underlying microarray technology, explores the various types of mi...bniranjan0010
This PowerPoint presentation is designed to help students gain a comprehensive understanding of microarrays. It delves into the fundamental principles underlying microarray technology, explores the various types of microarrays, and provides a detailed overview of the procedures involved in their use. Additionally, the presentation examines the advantages and disadvantages of microarrays, offering a balanced perspective on their utility. Finally, it highlights the wide range of applications for microarray technology, showcasing its significance in various scientific and medical fields.
Subcutaneous nodules in rheumatic diseases Ahmed Yehia Assistant Professor of internal Medicine, Immunology, rheumatology and allergy
How to use subcutaneous nodules as a clue for diagnosis by completing the puzzle
THE MANAGEMENT OF PENILE CANCER. PowerPointBright Chipili
This PowerPoint includes all the relevant information and science about penile cancer and its management. Information is based on Campbell 12th edition and EAU 2024 updated guidelines.
This Presentation provides information on hyperlipidemic drugs. It begins with an introduction to hyperlipidemia and its causes. It then discusses various drug classes for treating hyperlipidemia, including their mechanisms of action, effects on lipid levels, pharmacokinetics, therapeutic uses, adverse effects and interactions. The major drug classes discussed are HMG-CoA reductase inhibitors (statins), bile acid sequestrants, fibrates, and niacin. For each class, specific drugs are highlighted and their properties compared.
These simplified lecture slides by Dr Sidra Arshad offer a concise look at the cardiovascular effects of heart failure:
1. Define cardiac failure, its pathophysiology and clinical manifestations
2. Differentiate between the factors causing hyper-effective and hypo-effective heart functions
3. Differentiate between right and left heart failure based on their presentation
4. Outline the physiology of treatment of cardiac failure
Introduction of mental health nursing, Perspective of mental health and mental health nursing, Evolution of mental health services, treatment and nursing practices Mental health team, Nature and scope of mental health nursing, Role & function of mental health nurse inn various settings and factors affecting the level of nursing practice, concept of normal and abnormal behavior
Introduction to Dental Implant for undergraduate studentShamsuddin Mahmud
Introduction to Dental Implant
Dr Shamsuddin Mahmud
Assistant Professor, Department of Prosthodontics
Nortth East Medical College (Dental Unit)
Definition of Dental Implant
A prosthetic device
made of alloplastic material(s)
implanted into the oral tissues beneath the mucosal and/or periosteal layer and
on or within the bone
to provide retention and support for a fixed or removable dental prosthesis.
Classification of Dental Implant
According to placement within the tissue
Blade/Plate form implant
According to Material Used
A) METALLIC IMPLANTS
Commercially pure Titanium
Cobalt chromium molybdenum
Titanium aluminum vanadium
Stainless steel
B) NON-METALLIC IMPLANT
Zirconium
Ceramic
Carbon
According to the ability of implant to stimulate bone formation
A) Bio active
Hydroxyapatite
Tri Calcium Phosphate
B) Bio inert
Metals
Parts of Dental Implant
Implant fixture
Implant mount
Cover screw
Gingival former/healing screw/healing abutment/permucosal extension
Impression post/impression transfer abutment
Implant analogue
Abutment
Fixation screw
Implant Fixture
Implant Mount
Connected to the fixture
Function: used to carry implant from its vital to the prepared osteotomy site either by hand or with a ratchet/ handpiece adaption
Cover Screw
component that is used to cover the implant connection during the submerged healing of the implant
Function: preserves the patency of the connection by preventing any soft tissue ingrowth in the connection
Gingival former/ Healing Abutment/ Healing screw
Screw/ abutment used to create the soft tissue emergence profile around the implant.
Time of placement:
During 1st surgery – One step surgery
After Osseointegration – Two step/stage surgery
Gingival former/ Healing Abutment/ Healing screw
Placed in the site 2-3 weeks for soft tissue healing
Function:
Create gingival emergence profile
Formation of biological width
Impression post/impression transfer abutment
component that is used to trans- fer the implant Hex position and orientation from the mouth to the working cast.
Types
Closed tray
Open tray
Implant analogue/
component which has a different body but its platform and connection are exactly similar to the implant. The analogue is used to replicate the implant platform and connection in the laboratory mode.
Abutment
Abutments
Advantages of Dental Implant Retained Prosthesis
Maintain bone height and width by preventing bone resorption
Maintain facial esthetics
Improve masticatory performance
Improve stability and retention of prosthesis
More esthetics
Increase survival times of prostheses
There is no need to alter adjacent teeth
Improve psychological health
Disadvantages of Dental Implant Retained Prosthesis
Very expensive.
Cannot be used in medically compromised patients who cannot undergo surgery.
Longer duration of treatment
Requires a lot of patient co-operation because of repeated recall visits are essential
INDICATION OF DENTAL IMPLANT
Dental implants can successfully restore all
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A medical treatment that uses high doses of radiation to kill cancer cells or shrink tumors by damaging their DNA. When the DNA is damaged, cancer cells can no longer divide and grow, and they eventually die.
HIV weakens the immune system, increasing the risk of TB in people with HIV. Infection with both HIV and TB is called HIV/TB coinfection. This presentation is an overview on "HIV-Tuberculosis Coinfection"
These are the class of Drugs that are used to treat and prevent cardiac arrhythmias by blocking ion channels involved in cardiac impulse generation and conduction. Class I drugs like quinidine and procainamide block sodium channels to prolong the action potential duration, while Class IB drugs like lignocaine shorten repolarization. Class III drugs like amiodarone block potassium channels to prolong the action potential. Calcium channel blockers like verapamil inhibit calcium influx. Other drugs include adenosine for paroxysmal supraventricular tachycardia, beta blockers for supraventricular arrhythmias, and atropine for bradycardias. Adverse effects vary between drugs but include arrhythmias, heart block and QT prolong
3. UNIVERSAL HEALTH COVERAGE
Also called as*
Universal Coverage
Social Health Protection
Universal Health Access
Universal Health Protection
3
*The world health report: health systems financing: the
path to universal coverage-2010
4. THE CONCEPT
Universal health coverage as a concept
was born in 1883 when Germany
introduced health coverage for
achieving health status of its young
population.
Later, in 2005, World Health Assembly
adopted the term "UHC" and in 2010,
World Health Report focused on health
systems financing for countries to build
a platform for UHC
4*HLEG
5. UHC is considered as a
standalone measure for
a country; as
conceptualized today
and attempts to provide
promotive, preventive,
diagnostic, curative and
rehabilitative services
without financial
hardships to its citizens.
The world health report:
health systems
financing: the path to
universal coverage-2010
5
The world health report: health systems financing: the
path to universal coverage-2010
6. DEFINITION:
Universal coverage (UC), or universal
health coverage (UHC), is defined as
“Ensuring that all people have access to
needed promotive, preventive, curative
and rehabilitative health services, of
sufficient quality to be effective, while also
ensuring that the use of these services
does not expose the user to financial
hardship”.
6
http://www.worldhealthsummit.org- 2013
7. This definition of UC embodies three
related objectives:
1. Equity in access to health services - those
who need the services should get them,
not only those who can pay for them;
2. that the quality of health services is good
enough to improve the health of those
receiving services; and
3. financial-risk protection - ensuring that the
cost of using care does not put people at
risk of financial hardship.
7http://www.worldhealthsummit.org -2013
8. 8
*The world health report: health systems financing: the
path to universal coverage-2010
9. Contd…
The global aspiration to
achieve UHC is evident as
countries having gross
domestic product (GDP)
less than that of India
have embarked upon and
adopted the concept.
China, Sri Lanka and
Bangladesh have also
adopted UHC and aim to
achieve 100% coverage in
times to come.
9
10. GLOBAL HEALTH SCENARIO AND
LEAD TO UHC
1948 Universal Declaration
of Human Rights states:
“Everyone has the right to a
standard of living adequate for
the health and wellbeing of
himself and of his family,
including food, clothing,
housing and medical care and
necessary social services.”
10
11. Contd.....
In 1966, member states
of the International
Covenant on Economic,
Social and Cultural
Rights recognised:
“the right of everyone to
the enjoyment of the
highest attainable
standard of physical and
mental health.”
11
http://www.refworld.org/docid/3ae6b36c0.html
13. Contd...
100 million people are
pushed into poverty
because of direct health
payments.*
79 countries devote less
than 10% of general
government expenditure to
health*
Health also frequently
becomes a political issue
as governments try to
meet peoples’
expectations
13*http://www.who.int/healthsystems/en/ Jun 2015
14. a. Member States of WHO
committed in 2005 to
develop their health
financing systems so
that all people have
access to health
services and do not
suffer financial hardship
paying for them.
b. This goal was defined as
universal coverage, or
universal health 14
15. The 2010 World
Health Report
builds upon the
2005 WHA
recommendations
and aims at
assisting countries
in quickly moving
towards Universal
Health Coverage.
15
17. India, is still attempting to
find a way for providing
appropriate, affordable and
accessible health care to
its population.
India was among the first
countries in the world that
enshrined in its constitution
the "socialist model of
health care for all”, being a
"Welfare state".
17
18. The Bhore Committee
suggested the norms at the
time of Independence for
implementing this
philosophy but till date
India has been struggling
to achieve "health care for
all".
Some progress was made
but the enormity of the task
presents huge challenges
for the public health system
across the country. 18
19. WHY IS HEALTH SYSTEM REFORM
NEEDED IN INDIA
19
18% of all episodes in rural
areas and 10% in urban areas
received no health care at all*.
28% of rural residents and 20%
of urban residents had no funds
for health care*.
Over 40% of hospitalized
persons have to borrow money
or sell assets to pay for their
care *.
*http://www.frontierweekly.com/articles/vol-46/46-51/46-
51-Health%20Coverage.html
20. Over 35% of hospitalized
persons fall below the poverty
line because of hospital
expenses* .
Over 2.2% of the population
may be impoverished because
of hospital expenses*.
The majority of the citizens who
did not access the health
system were from the lowest
income quintiles.
20
*http://www.frontierweekly.com/articles/vol-46/46-51/46-
51-Health%20Coverage.html
21. • India has Highest number of
malnourished and underweight
(46% under 3 yrs); children in
the world*
• Has high IMR of 50 per 1000
live births and MMR of 212 per
100 000 live births.*
• Has huge challenge to meet
national(MDG) goals of 28 per
1000 , (IMR) and 100 per 100
000 (MMR) by 2015.
Immunization coverage is
dismal > 44%*
21UHC: DR SABA
Source: World Health Organization (2011)
22. KEY HEALTH INDICATORS: INDIA COMPARED
WITH OTHER COUNTRIES
Indicator India China Brazil Sri Lanka
Thailand
IMR/1000 live-births 50 17 17 13 12
Under-5 mortality 66 19 21 16 13
Fully immunized (%) 66 95 99 99 98
Birth by SBA 47 96 98 97 99
(SKILLED BIRTH ATTENDANT)
22
Source: World Health Organization (2011)
23. Contd....
Rising burden of NCDs
2011 (in Millions) 2030 (in
Millions)
Diabetes 61 84
Hypertension 130 240
Tobacco Deaths 1+ 2+
23
Source: World Health Organization (2011)
24. Health situation is not
uniform across India.18 year
difference in life expectancy
between Madhya Pradesh
(56 years) and Kerala (74
years)
A girl born in rural Madhya
Pradesh, the risk of dying
before age 1 is around 6
times higher than that for a
girl born in rural Tamil Nadu
24
http://www.who.int/countryfocus/cooperation_str
ategy/ccs_ind_en.pdf
25. Health expenditure is
largely out of pocket
(OOP) 67%.
Public expenditure on
Health – 1.2% of GDP.
Lack of an efficient and
accountable public
health sector has led to
the burgeoning of a
highly variable private
sector.
25HLEG-2011
26. LOW PRIORITY TO PUBLIC SPENDING ON HEALTH
INDIA AND OTHER COUNTRIES : 2009
26
Total public
spending as %
GDP (fiscal
capacity)
Public spending
on health as % of
total public
spending
Public
spending on
health as % of
GDP
India 33.6 4.1 1.2
Sri Lanka 24.5 7.3 1.8
China 22.3 10.3 2.3
Thailand 23.3 14.0 3.3
http://uhc-india.org/reports/hleg_report_chapter_2.pdf
27. National programs like
National Rural Health
Mission (NRHM),
Rashtriya Swasthya
Bima Yojana (RSBY),
Janani Suraksha Yojana
(JSY), etc. have been
running in the country,
but they themselves are
insufficient to provide
and sustain UHC for the
nation at large.
27
28. With demographic transition,
rise in burden of NCDs is
another major area of
concern. Dual burden of
diseases in the country poses
huge economic losses. An
emerging economy like India
cannot afford such losses.
Therefore, urgent actions are
required to the reframe
existing infrastructure and in a
way to developments provide
UHC to the country.
28
30. Keeping in view the urgent requirement for
UHC , Planning Commission of India in
October 2010,constituted a High Level Expert
Group (HLEG) on Universal Health Coverage
(UHC):-
to develop a framework for providing easily
accessible and affordable health care to all.
review the experience of India’s health
sector
and suggest a 10-year strategy going
forward
30
31. 1. Develop a blue print for human
resource requirements to achieve
health for all by 2020.
2. Rework the financial norms
needed to ensure quality, universal
access of health care services,
particularly in under-served areas
and to indicate the relative role of
private and public service providers
in this context.
3. Suggest critical management
reforms in order to improve
efficiency, effectiveness and
accountability of the health delivery 31
32. 4. Develop guidelines for the
participation of
communities, local elected
bodies, NGOs, the private or-
profit and not-for-profit sector
in the delivery of health care.
5. Propose reforms in policies
related to the production,
import, pricing, distribution
and regulation of essential
drugs, vaccines and other
essential health care related
items, for enhancing their
availability and reducing cost .
32
33. Contd..
6. Explore the role of
health insurance
system that offers
universal access to
health services with
high subsidy for the
poor and a scope for
building up additional
levels of protection on
a payment basis.
33
34. EVOLUTION OF THE REPORT
Phase 1: An initial progress review
presented to the Planning
Commission at the end of January
2011.
Phase 2: Interim recommendations
developed by the HLEG at the end of
April 2011.
Phase 3: The final framework on
achieving Universal Health
Coverage for India was submitted on
the 21st of October, 2011
34
35. DEFINITION OF UNIVERSAL HEALTH
COVERAGE (UHC) BY HLEG
“Ensuring equitable access for all Indian
citizens, resident in any part of the country,
regardless of income level, social status, gender,
caste or religion, to affordable, accountable,
appropriate health services of assured quality
(promotive, preventive, curative and rehabilitative)
as well as public health services addressing
the wider determinants of health delivered to
individuals and populations, with the government
being the guarantor and enabler, although not
necessarily the only provider, of health and related
services.”
35
36. GUIDING PRINCIPLES FOR UHC
1. Universality
2. Equity
3. Non-exclusion and non-discrimination
4. Comprehensive care that is rational
and of good quality
5. Financial protection
36
37. 6. Protection of patients’
rights that guarantee
appropriateness of care,
patient choice, portability
and continuity of care.
7. Consolidated and
strengthened public
health provisioning.
8. Accountability and
transparency.
9. Community participation
&
10. Putting health in people’s
hands
37
38. UHC : FOCUS AREAS
38
1.Human Resource Requirements
2.Access to Health Care Services
3.Management Reforms
4.Community Participation
5.Access to Medicines
6.Health care Financing
7.Social Determinants of Health
39. ADDITIONAL FOCUS AREAS
39
8. Urban health
9. Female Gender
10. Public-Private Partnerships
11. Information Technology-enabled
Health services
41. 41
“Universal health entitlement for every
citizen - to a national health package
(NHP) of essential primary, secondary
& tertiary health care services funded
by the government”.
* Package to be defined periodically by an
Expert Group; can have state specific
variations
42. VISION OF HLEG FOR UHC
IT-enabled National Health Entitlement Card (NHEC)
42
44. PROVISIONING OF UHC
44
Strengthen Public Services
(Especially: Primary HealthCare- Rural
And Urban; District Hospitals)
Contract Private Providers (As Per
Need And Availability) – With Defined
Deliverables
Integrate primary, secondary and
tertiary Care through Network of
Providers (Public; Private; Public-
Private)
Regulate and Monitor For Quality,
Cost And Health Outcomes
45. PRE-REQUISITES
To achieve UHC, three basic prerequisites are of
paramount importance.
Firstly, sufficient resources are needed to cater for
the health service requirements.
Secondly, we need to reduce the financial risks and
barriers which obstruct the optimal usage of available
resources .
Thirdly, we need to focus on increasing the capability
of the population to effectively utilize the available
resources.
45HLEG-2011
46. Acknowledging the potential
of non-public sector in
achieving UHC.
HLEG recognizes that only
public sector cannot aim to
achieve UHC. Representation
from private sector is also
required to provide services.
These services can be
provided through two options.
46HLEG-2011
47. In the first option, all those private
providers who enroll themselves
under UHC will provide minimum
75% of outpatient department
services and 50% of in-patient
services to those entitled under
NHP.
The services will be cashless and
the provider will be reimbursed at
standardized rates.
For remaining portion of services
available, the institutions could
accept payments or provide
services through privately
purchased insurance policies.
47HLEG-2011
48. In the second option,
institutions enrolled under
UHC will provide only those
services, which are available
under NHP.
There are pros and cons of
both the options. Rigorous
monitoring and supervision
will be required for smooth
functioning of any of the
options.
48HLEG-2011
49. • However, HLEG
envisages that over time,
every citizen will be
issued an IT enabled
National Health
Entitlement Card
(NHEC)
• This will lead to greater
equity, improved health,
efficient and transparent
health system and
further reduction in
poverty, greater
productivity and financial 49HLEG-2011
51. Health finance is the
backbone of a self-sustaining
health care system.
The per capita health
expenditure of our country is
far less than that of Sri Lanka
and China and is around a
third of that in Thailand.
As a consequence, per capita
OOP expenditure in the
country has escalated to 67%
of total expenditure on health.
51HLEG-2011
52. Inequity among states as
far as public spending on
health (Kerala stands at
Rs. 498 when compared to
Rs. 163 in Bihar) further
suggests an urgent need
for substantial changes in
current health care system.
To streamline the health
care system, we need to
move from the concept of
insurance to assurance.
52HLEG-2011
54. 1:Central government
and states should
increase public
expenditures on
health from the
current level of 1.2%
of GDP to at least
2.5% by the end of
the 12th plan, and to
at least 3% of GDP
by 2022
54
56. 2: Ensure availability of free
essential medicines by
increasing public spending on
drug procurement.
3: Use general taxation as the
principal source of health
care financing –
complemented by additional
mandatory deductions from
salaried individuals and tax
payers, either as a proportion
of taxable income or as a
proportion of salary.
56
57. 4:Do not levy sector
specific taxes for
financing.
5:Do not levy fees of any
kind for use of health
care services under the
UHC.
6:Introduce specific
purpose transfers to
equalize the levels of
per capita public
57
58. 7: Accept flexible and
differential norms for
allocating finances so
that states can respond
better to their needs.
8: Expenditures on
primary health care,
should account for at
least 70% of all health
care expenditures.
58
59. 9:Do not use insurance
companies or any other
independent agents to
purchase health care
services .
10: Purchases of all
health care services
under the UHC system
should be undertaken
directly by the Central or
state governments .
59
60. 11:All government funded
insurance schemes should,
be integrated with the UHC
system.
All health insurance cards
should, in due course, be
replaced by National Health
Entitlement Cards.
The technical capacities
developed by the Ministry of
Labour for the RSBY should
be transferred to the Ministry
of Health and Family
Welfare.
60
62. 1:Develop a National Health
Package that offers every
citizen, essential health
services at different levels
of the health care delivery
system.
2.Develop effective
contracting-in guidelines
with adequate checks and
balances for the provision
of health care by the
formal private sector.
62
63. 3:Re-orient health care
provision to focus
significantly on primary
health care.
4: Strengthen District
Hospitals.
5: Ensure equitable access
to functional beds for
guaranteeing secondary and
tertiary care.
63
64. 6:Ensure adherence to
quality assurance
standards in the
provision of health care
at all levels .
7: Ensure equitable access
to health facilities in
urban areas by
rationalizing services and
focusing particularly on
the health needs of the
urban poor. 64
67. Millions of Indian households
have no access to medicines
as they can neither afford
them nor are these available at
government health facilities.
Almost 74% of private out-of-
pocket expenditures today are
on drugs.
Drug prices have risen sharply
in recent decades.
India’s domestic generic
industry is at risk of takeover
by multinational companies.
67
http://www.searo.who.int/publications/journals/seajph/is
sues/seajphv3n3p289.pdf
68. The market is flooded
by irrational, non-
essential, and even
hazardous drugs that
compromise health.
Despite available
expertise and
technology, health care
system has been facing
a huge challenge of
providing essential
medicines and vaccines
to those who require it.
68
69. Generic drug industry in India
provides lifesaving medicines
to many countries but at the
same time has been struggling
to increase access in our
country.
This has resulted largely from
lack of reliable drug supply
systems, irrational
prescriptions, stringent product
patent regimes as well as
limited availability of public
health facilities 69www.who.int/whr/en/report04_en.pdf
70. RECOMMENDATIONS
1:Enforce price controls and
price regulation especially on
essential drugs.
2:Revise and expand the
Essential Drugs List.
3:Strengthen the public sector
to protect the capacity of
domestic drug and vaccines
industry to meet national
needs.
70
71. 5: Set up national and state
drug supply logistics
corporations.
6:Protect the safeguards
provided by the Indian patents
law and the TRIPS Agreement
against the country’s ability to
produce essential drugs.
7:Empower the Ministry of
Health and Family Welfare to
strengthen the drug regulatory
system.
71
74. Required HRH were
recommended by Bhore
committee in 1948 up to
recent formulation of
Indian Public Health
Standards in 2010.
The country holds
largest number of
medical colleges than
anywhere in the world.
Despite this, the country
faces acute shortage of
HRH.
74
75. • In contrast to WHO
recommendation of 25
health workers per
10,000 population, India
stands at 52nd rank with
19 health workers per
10,000 population.
• The distribution of
medical colleges is
skewed with Kerala and
Bihar as extreme
examples. 75
76. In addition, the training
of health workforce
doesn’t address the
challenges of changing
dynamics of public
health.
This is apparent form
the fact that the time
allotted to Community
Medicine during
internship has been
reduced from 3 months 76
77. Launch of NRHM in 2005
gave a boost to the HRH
with creation of 8 lakhs
ASHAs with a target of
1/1000 population.
But, availability of
qualified practitioners is
lacking with gross
shortage of doctors and
nurses . 77
79. There are two implications of the
recommendations:-
1. It will result in a more equitable
distribution
of human resources
2. can potentially generate around 4 million
new jobs (including over a million
community health workers) over the next
ten years
79
80. 1:Increase HRH density to
achieve WHO norms of at
least 23 health workers per
10,000 population (doctors,
nurses, and midwives).
2.Establish a dedicated
training system for
Community Health
Workers under the aegis of
District Health Knowledge
Institutes(DHKIs)
80
81. 7:Establish State Health
Science Universities to award
degrees in health sciences
and prospectively add
faculties of health
management, economics,
social sciences and
information systems.
8:Establish the National Council
for Human Resources in
Health (NCHRH) to prescribe,
monitor and promote
standards of health
professional education.
81
83. • Structural and functional
improvements are
prerequisites for
achieving UHC in any
country.
• With the dismal state of
key health indicators,
there is a need to
regulate the vast private
sector existing in the
country. 83
84. There is a need to
provide adequate
hospital beds. As per
World Health Statistics,
India’s hospital bed
capacity has remained
among the lowest in the
world at 0.9 beds/1000
population against
average of 2.9
beds/1000 population
globally.
84planningcommission.nic.in/reports/genrep/rep_uhc2111.
86. Introduce All India and
state level Public
Health Service Cadres
and a specialized state
level Health Systems
Management Cadre in
order to give greater
attention to public
health and also
strengthen the
management of the
UHC system
86
MANAGERIAL REFORMS
HLEG 2011
87. INSTITUTIONAL REFORMS
Establish financing and
budgeting systems to
streamline fund flow: by
establishment of
National Drug
Regulatory Authority
(NDRDA) & National
Health Promotion and
Protection Trust
(NHPPT).
87HLEG 2011
88. a. National Drug Regulatory Authority
(NDRDA):
The main aim of NDRDA would be to
regulate pharmaceuticals and medical
devices and provide patients access to
safe and cost effective products.
b.National Health Promotion and
Protection Trust (NHPPT):
It will promote public awareness about
key health issues, track progress and
impact on the social determinants of
health, and provide technical expert
advice to the Ministry of Health
88HLEG 2011
90. Primary health care without
community participation is
incomplete.
For UHC, citizen engagement
needs scaling up for better
delivery of resources. ASHAs
have proved their worth under
NRHM.
NRHM has shown a positive
effect on mobilization of
community through civil
society organizations and
Panchayati Raj Institution
(PRIs). 90
ASHA WORKER
HLEG 2011
91. However, Village Health
and Sanitation
Committees and Rogi
Kalyan Samiti’s have
achieved limited
success.
In addition, lack of
knowledge of available
health services hampers
their optimal usage by
the population.
91HLEG 2011
92. Transformation of existing village
health committees into
participatory health councils is
required to be done.
92
94. UHC cannot be
achieved until we
address social
determinants of health.
The status of social
determinants including
nutrition, water and
sanitation, work security,
occupational health,
disasters, etc. remains
abysmal .
94www.who.int/contracting/UHC_Country_Support.pdf
95. RECOMMENDATIONS
1. Initiatives, both public and private, on the
social determinants of health and towards
greater health equity should be supported
2.A dedicated Social Determinants Committee
should be set up at the district, state and
national level
3. Include Social Determinants of Health in the
mandate of the National Health Promotion
and Protection Trust (NHPPT)
4.Develop and implement a Comprehensive
National Health Equity Surveillance
Framework, as recommended by the CSDH
95HLEG 2011
97. 1: Improve access to
health services for
women, girls and other
vulnerable genders
(going beyond maternal
and child health).
2:Recognize and
strengthen women’s
central role in health
care provision in both
the formal health system
and in the home. 97HLEG 2011
98. 3.Build up the capacity
of the health system to
recognize, measure,
monitor and address
gender concerns
through improved
monitoring .
4: Support and
empower girls, women
and other vulnerable
genders to realize their
health rights. 98HLEG 2011
100. Broad agreement on the
financing model for
health-care delivery.
Type and duration of
training for senior
functionaries in public
health,.
100
Challenge in fulfilling the objectives
of achieving UHC by 2022 :
101. Entitlement package
and the cost of
health-care
interventions.
Enactment of
National Health Bill
2009 as Health Act
and declining State
budget allocations for
public health.
101
104. The HLEG recommends having a
NHP. This will be through a
nationwide distribution of NHEC. A
difficult challenge as on December
2014, only 14.1% of Indians have
been issued PAN cards .
104http://www.incometaxindia.gov.in/PAN/Overview.
105. Looking toward
reimbursement to the
contracted-in private
hospitals the issue
itself will face a lot of
resistance.
As happened with
JSY, timely
reimbursement of
even Rs. 1400 for
beneficiaries was a
challenging issue.
105
107. The governments has
much higher capacities
to spend on health and
Political commitment
seems evident from the
fact that Prime Minister
of India, on the eve of
Independence day i.e.
15 Aug 2014 deaclred
health as “ Utmost
Priority.”
107
108. The Planning Commission has
acknowledged the same and recently
assured an increase in public health
spending to 2% of GDP from current
1.2% by end of 12th 5 years plan
108
109. Global experience has shown that
Universal Health-Care is affordable
and feasible.
Further, Clinical Establishments
(Registration Regulation) Act 2010,
Fundamental Right to Education Act
-2009 and Food Security Act- 2013
will help in reducing the burden of
illiteracy, poverty , unemployment and
disease .
109
110. CRITICAL ANALYSIS OF UNIVERSAL
HEALTH COVERAGE
People may not value free services.
Tax payers maybe unwilling to pay
extra taxes for the benefit of those who
cannot afford.
Services beyond the scope of the NHP
will have to be borne by the individuals.
Quality of services to those paying and
to the non-paying may differ.
State specific recommendations have
not been laid out.
110
112. The Indian people deserve, desire and
demand an efficient and equitable
health system which can provide UHC.
This needs sustained financial support,
strong political will and dedication of
public health functionaries and other
stake holders as well as active
participation of the community .
112
113. UHC is the way to move beyond health
care. It is the way for providing health
assurance to the country’s population.
Challenges are ahead but consistent
efforts can achieve the goal of UHC.
113
115. REFERENCES
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116