Public Health History in India

& Health situation in India

Dr. Sandeep A. Chavan

Public Health

• If the disease condition is avoided, the probability or the chance of death or disability can be reduced.

• Public Health is therefore described as the science and art of preventing diseases, prolonging life and promoting health (of individuals) through organised efforts and informed choices.

Components of Public Health

• Epidemiology– Measurement of disease conditions in relation to

the population at risk. • Statistics– Collection, presentation, analysis and

interpretation of epidemiological data.• Health Services– Services directed towards meeting the health

needs of the people.

Essential Public Health Functions

Public Health

• Public Health deals with the group of people rather than individuals.

• Dimensions of public health– Health promotion– Disease prevention– Early diagnosis and prompt treatment– Disability limitation– Rehabilitation

Evolution of health care services in India

• Christian Era – civilization started in Indus Valley

– Environmental sanitation, houses with drainage

• 1400 B.C. – Ayurveda and Siddha system

– Developed a comprehensive concept of health

• Post vedic – teaching of buddhism and Jainism

• Moghul empire – Arabic system of medicine (Unani)

• British Gov – British nationals, armed forces, civil servants.

Traditional Indian Approach

• The Indian approach to health is enshrined in the concepts and principles of Ayurveda which means the ‘science of life’.

• Ayurveda is one of the oldest system of health care in the World.

• Ayurveda deals with both preventive and curative aspects of health.

• Health defined by WHO is very similar to concepts of Ayurveda

Western Approach

• The western approach of avoiding diseases, death and disability, traditionally focused on personal hygiene and public sanitation during the 19th Century.

• This approach, combined with better food availability, paid rich dividend in the developed countries in reducing morbidity and mortality.

Public Health before the Colonial Period

• Little is known about public health activities before the colonial period

• Main stream system of health care was Ayurveda• Home-based care appeared to be the dominant

feature• There appeared little organised efforts or

institutional care to treat diseases and prevent deaths

Public Health during the British Period

• Although, public health efforts were restricted to British civilian and military establishment, they had impact on Indian masses.– Mortality spikes were sharply reduced.– Mortality from cholera and plague was sharply

reduced.– Diseases like malaria and gastro-enteritis

continued to take heavy toll.

Public Health in Independent India

• Evolution of public health care system in Independent India was shaped by two important factors:– The Report of First Health Survey and

Development Committee (Bhore Committee) constituted during the colonial rule.

– Emergence of modern medical technology for the prevention and control of diseases, especially communicable diseases.

Medical Technology

• Mass production of antibiotics.• Availability of vaccines for diseases having

high mortality and disability rates– Tetanus– Diphtheria– Pertussis (Whooping Cough)– Measles– Poliomyelitis

Role of different committees• 1946 – Bhore Committee (Health survey and development committee)

o Integration of preventive and curative serviceso Development of PHC o 3 months training in PSM – Social Physician

• 1962 – Mudaliar committee (Health survey and planning committee)o Strengthening of PHC and district hospital o Regional organizationo Constitution of all India Health Services (like IAS)

• 1963 – Chaddah committeeo Malaria program services to be part of primary healthcareo Basic health worker – for 10,000 populationo Family planning health assistant – for 3-4 BHWs

Role of different committees cont….

• 1965 – Mukerji committeeo Separate staff for the family planning programmeo De-link malaria activities from FP services

• 1967 – Jungalwala committeeo Committee on Integration of health serviceso Elimination of private practice by Gov. doctoro Special pay for specialized work

• 1973 – Kartar singho Committee on multipurpose worker o ANM replaced by female health worker. AT SC – 1 Male & 1 Female Healthworkero Basic health worker - replaced by male health worker – M H Supervisoro Lady health visitors designated as female health supervisor.

1975: Srivastava Committee ( On med education & support manpower)o Cadre of Health Assistant ( link between med. Practitioner and MPW)o Referral service complexo Creation of a para-professinal health workerso Setting up medical and health education commission (Like UGC)

1977 : Rural Health Schemeo Training of CHWso Reorienting medical education to the needs of rural poor

1981 – Report of the working group for Health For All

HEALTH SITUATION

IN INDIA

Progress from 1st Five year plan to 12th Five year plan

Parameters First Plan1951-56

12th Plan2012-2017

Total SCs 725 25,020Total PHCs NA 1,52,326Total CHCs - 5,363Total Bed strength 1,25,000 9,14,543Medical colleges 42 356Dental colleges 7 297Allopathic doctors 65000 9,18,303Nurses 18500 12,37,964ANMs 12,780 6,02,919

18

Crude Birth rate 21.6/1000 population per year

Crude death rate(SRS 2012) 7/1000 population per year

Infant mortaility rate(SRS 2012) 42/1000 live births

Maternal mortality ratio(2012) 178/100000 live births

Expectation of life at birth ( census2011)

Male: 67.3 years & Ffemale: 69.6 years

19

20

21

22

Nutritional Status Indicators Positive health indicator

Anthropometric measurements of pre-school children i. Weight ii. Height iii. Mid-arm circumference Growth Monitoring of

children Prevalence of low

birth weight

23

Health Care Delivery IndicatorsEquity of distribution of health resources in

different parts of the country and of the provision of health care

• Doctor-population Ratio – 1/1700 (Norm 1/1000)• Nurse-population ratio – 0.8/1000 (Norm 1/500)• Population-bed Ratio – 8.9/10000

24

25

The present doctor-population ratio is 0.5 per 1,000 and the target by 2025 is 0.8 per 1,000.

India produces 30,000 doctors, 18,000 specialists, 30,000 AYUSH graduates, 54,000 nurses, 15,000 ANMs and 36,000 pharmacists annually. Health ministry claims that there are about 6-6.5 lakh doctors available. But India would need about four lakh more by 2020 to maintain the required ratio of one doctor per 1,000 people.

26

27

28

29

30

Organizational structure in India• Health system has 3 main links

– Central, state and local or peripheral.

• India is a Union of 29 states and 7 territories.

• Health is the responsibility of state.

• Central responsibility – Policy making– Guiding– Assisting– Evaluating– Coordinating the work of state health ministries.

At the centre

• The union ministry of health and family welfareHeaded by Cabinet minister

Minister of state

Deputy health minister

The union ministry of health

and family welfare

The directorate general of health services

The central council of health and family welfare.

At the state level• The state health administration was started in the year 1919.

• The state list which become the responsibility of the state included– Provision of medical care – Preventive health services– Piligrim within the state

State - management sector

Directorate of health and family welfare services

State ministry of health

At the district level

• Principal unit of administration in India - District

• District health organization – identifies and provide the needs of expanding rural health and

family welfare programme

• Within each district again, there are administrative areas

• No uniform model of district health organization

Rural Urban

Villages

Panchayats

Community Development

Blocks

Corporations

Municipal Boards

Town area committees

Tahsil (Taluka)

District

Sub-division

Panchayati Raj – • 3 tier structure of rural local self government • Linking the village to the district

Panchayat Raj

Panchayat Panchayat Samiti Zilla Parishad

Gram Sabha Gram Panchayat

Widespread existence of preventable diseases and deaths is a disgrace to the society which tolerates it...