Download - Prof. D K Gupta Vice Chancellor-CSMMU, (KGMU), LKO Professor and Head, Dept of Pediatric Surgery
Prof. D K GuptaVice Chancellor-CSMMU, (KGMU), LKO Professor and Head, Dept of Pediatric Surgery
AllMS, New Delhi
Health Care in developing world
A Road Map to Paradigm Shift
Where are we - todayWhere are we - today
• Health – Major Disparity in the world• India: Poverty, illiteracy, hygiene• Population explosion• Basic needs : ?? Food, water, education• New Epidemic: DM, HT, Trauma, Obesity, psychiatric
problems• Cancers: Infants, Children, adults, old age• 1 million pts. die globally /year : No help
• High expectations – why not ??
Chronic Disease BurdenChronic Disease Burden
• CDs result for 60% of deaths in 2005.
• >80% of deaths in low to middle income
countries (LMIC).
• NCDs are killing more people in their
prime adult years.
• TB, HIV and malaria account for 10% of
the global deaths.
Age at death region wiseAge at death region wise
Source: Global Burden of Disease, 2004 Update, used by permission
Major Causes of Death, World areaMajor Causes of Death, World area
Source: The Global Burden of Disease: 2004 update, WHO
Disease or InjuryDeaths/
million% of total
deaths
1 Ischemic heart disease 7.2 12.2
2 Cerebrovascular disease 5.7 9.7
3 Lower respiratory infections 4.2 7.1
4 COPD 3 5.1
5 Diarrheal diseases 2.2 3.7
6 HIV/AIDS 2 3.5
7 Tuberculosis 2.5 1.5
8 Trachea, bronchus, lung cancers 1.3 2.3
9 Road traffic accidents 1.3 2.210 Prematurity and low birth weight 1.2 2
Lack of Physical exerciseLack of Physical exercise• 2 million deaths worldwide annually. • A causal factor for;
• 10-16% breast , colon cancers, diabetes
• 22% of ischemic heart disease.
WHO Report: 2.3 billion overweight adults in the world
Over 700 million of them will be obese by 2015.
Overweight & Overweight & ObesityObesity
HypertensionHypertension
• Responsible for 13% of deaths world-wide.
• 26% of adults had hypertension in 2000,
• Expected to jump to 30% by 2025 globally
• 2/3 with HTN live in developing world.
Source: WHO Report on Global Tobacco Epidemic, 2008
Disease association with Disease association with Tobacco useTobacco use
Health Problems in developing Health Problems in developing worldworld
• 2/3rd Population is in developing world• 2 Billion children malnourished• Infection, diarrhoea, Malnutrition : ???• Congenital malformations (2%)• Cancers – presenting quite late• Trauma – common, 90% preventable• Life style disorders – common, early age
- Hypertension, Diabetes, Obesity, - Psychiatric / mental health disorders
Indian medical scenarioIndian medical scenario
• Vast country – limited health facilities• Facilities - Mostly in urban areas• Long distances / time to travel• Specialized services only to 20%
population• Expensive hospital stay/ medical services• Limited health insurance • No insurance for serious Cong. Mal.,
cancers, • High IMR, MMR, TFR
Indian scenarioIndian scenario• Population: 1.2 billion • India will cross China in 2030 ( 1.45 bn.)• > 400 million children <14 yr age• GDP health Share : 1.2%• Now increased from 1.2% to 2%
Special health issues Special health issues
• 80% villages: Poor overall development • Poor state of Primary, community &
district• Poor state of Medical college, Hospitals • Poor vaccination – in rural sector• Poor education, hygiene, literacy,
schooling• Inadequate Medical & Paramedical staff
Special health problems in Special health problems in IndiaIndia
• Mean Age : M- 65 : F- 57 yr• Old age: No shelter homes• Communicable diseases - • Snake bites• Disasters – Tsunami, Earth quakes, floods• Very high trauma – 90% preventable
Indian scenarioIndian scenario
- Preventive & Control programs : Govt. - Primary / Tertiary Health Care : Govt.- 80% OPD services by Private sector- 60% indoor beds in private sector• 80%: No access to modern health care• 70% cost born by the patient himself • Every 7th in the world - is an Indian
Medical/ Dental CollegesMedical/ Dental Colleges(recognized / un-recognized)(recognized / un-recognized)
Govt. sector
Private sector
Medical colleges ~ 360 in India
~160Mostly Old
~ 200- Mostly in 10 yrs
Dental Colleges ~ 357 in India
~ 38 ~ 320- Mostly in 20 yrs
Medical Graduation – 6 years
Post-Graduation -3 yrs more
Super-specialty – 3 yrs more ( Total 12 years) + Fellowship ??
Tough Life of a Institutional Tough Life of a Institutional Doctor Doctor
• Doctors are trusted & kept in high esteem • High expectations from the Role Models• Sacrifice – personal & family life• No working hours for doctors - indoor service • Tough life before, during and after operations• Must know Recent advances • Seminars, Journal clubs during training period• Preparing for Lectures, Conferences,
workshops,
What do people want from Govt.What do people want from Govt.
• Reliable & Affordable Medical services• Free treatment for major problems
- Cancer, Heart, Liver, kidney, transplant • Free treatment to all those who are poor• Institutions to be only as a referral
center• Availability of good quality Medicines
( 30-40% medicines are spurious)• Free Medicines to all pts. in PHC / CHC
( Generic: cost, control of quality, confidence)
Emphasis is on now ; Emphasis is on now ;
• Improvement in Mother & child care• Improve IMR from 57 to 37• Improve MMR from 388 to 200• Reduce TFR from 3.8 to 2.5• Filling the medical / staff vacant posts• Develop work ethos and culture• Improve competency level
Strategies to improve healthStrategies to improve health• Preventive and Therapeutic : Govt.
Responsibility(Polio eradicated recently)
• More doctors, nurses and paramedics• Medical college each of 626 districts• Generic and quality medicines – free to all• Corporate Hospitals – super-speciality• Medical Tourism
Additional health PlanningAdditional health Planning• Budget increased from 1.2% to 2%• Ambulance : Free services, Joint Control
rooms• Mid day meals for school children• Free Health for all Girl students• National Rural health Mission• National urban health Mission• Public Health Foundation – BPL, Insurance • Janani Baccha Suraksha Yojna (MCH Services) • National Disaster Management Authority
Govt. Recent efforts - Govt. Recent efforts -
• 6 new AIIMS like Institutes• Incentives for PG seats for rural doctors
(10 marks for 1 yr , max. 30 marks for 3 yr service)
• New Medical Colleges – Govt. / Pvt.• PPP Model for the Rural sector• Corporate Hospitals to have PG seats.• DNB – PG seats in Big hospitals• 13000 UG and 4000 NEW PG seats
Govt. New IncentivesGovt. New Incentives
• New Colleges of Nursing • Regional Institutes of Paramedical sc. 8
RIPS• BRHC- Bachelor Rural Health Care: 3 yr
course• 18 wk training for obst. and
anesthesiologists • 1 yr course in Cardiology, DM, Dialysis, • Insurance cover for all• Aadhar / BPL cards to poor population
Improving Health servicesImproving Health services
• Health services – PHC, CHC, District• Teaching Institutions – Govt. / Pvt.• Private sector - Major share in OPD & Indoor• 4 Tier Health care delivery Model - PHC, CHC, District, - State Level with specialists- National level Hospitals for referred cases- Institutes: Transplant, Heart, Liver, Kidney,
children
Improvement of Health servicesImprovement of Health services
Incentives to workers in PHC/CHC:• Local staff- others• Pharmacist, Ambulance driver• Physicians and Surgeon
Minimal available Medical infrastructure• Minimal facilities for the staff/ doctors• Due respect & responsibility • Trust, freedom and Autonomy
Alternate model - Alternate model - difficultdifficultCurative and Preventive Role• PHC : Doctors in Mobile Units, staff• Counseling on Preventive programs• National disease control program• Vaccinations – mother & child care • Distributing free medicines • Referring serious pts. to higher center• NGOs, teleconferencing for help• Visitor Nurses / paramedics for FU
Education and Awareness - Education and Awareness - Parental counselingParental counseling
• Keeping children away from cooking area • Away from industrial hazards • Keeping medicines / acids away• Ban on strong acids and alkalis • Ban on washing soda• Use of Seat belts in vehicles • Use of Cycle helmets and reflecting lamps
Core Group Recommendations ;Core Group Recommendations ;
• Better designs : Roads, flyovers, school buses,
• Better House designs: with high walls, better doors, windows, toilet sheets, glass panes
• Adequate Covers – manholes, wells, • No to fire crackers around Deewali• No Kite flying from roof topsGupta DK. Chairman –
Core Group Recommendations to the Ministry, 3rd World Congress on Pediatric Esophagus , AIIMS, New Delhi. 2002
Other health related concernsOther health related concerns
• Safe drinking water to public• Garbage disposal from city & villages• Technically sound Roads and streets• Construction of Public toilets• Proper sewage disposal• Proper hygiene at Rly. stations• Measures to prevent CDs/ NCDs• Awareness on preventing trauma
Health indicators continue to be poor and Health indicators continue to be poor and high mortality rates of infants and pregnant high mortality rates of infants and pregnant
women women have been a cause of serious have been a cause of serious concern. concern.
“Government has decided to continue theNational Rural Health Mission for next five
years.
We are now proposing a new National Urban Health Mission in order to focus on the
health challenges in our towns and cities,“
Prime Minister of India, 2012
Increase in health Budget & Facilities
Give Respect &Responsibility
Road Map to improvement
Have Trust & commitment
Competency and care