Public Health in India Moving Ahead Prof Shiv

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

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. 3/26/2011 Shiv Chandra Mathur 2

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. 3/26/2011 Shiv Chandra Mathur 3

Deaths In India (2005) 3/26/2011 Shiv Chandra Mathur Source : WHO 4

Children Under 3 Who Are Underweight All India 1998 -99 2005 -06 46. 7% 45. 9% Negligible change in 7 years Source: NFHS – 3, 2005 -06 3/26/2011 Shiv Chandra Mathur 5

Anemia Married women (15 -49 years) who are anemic (%) 1998 -99 2005 -06 51. 8% 56. 1% Situation worsened in 13 states; improves in 7 Source: NFHS – 3, 2005 -06 3/26/2011 Shiv Chandra Mathur 6

Children (6 -35 months) who are Anemic (%) All India 1998 -99 2005 -06 74. 2% 79. 1% Situation worsened in 13 states; improves in 7 Source: NFHS – 3, 2005 -06 3/26/2011 Shiv Chandra Mathur 7

Children 12 -23 months fully immunized (BCG, measles and 3 doses each of polio/DPT) All India 1998 -99 2005 -06 42. 0% 43. 5% Negligible improvement … Source: NFHS – 3, 2005 -06 3/26/2011 Shiv Chandra Mathur 8

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RISING CHRONIC DISEASE BURDENS 2000 2025 No. of Persons with 118 Million HYPERTENSION 214 Million No. of Persons with 32 Million DIABETES 69. 8 Million No. of Persons Dying from TOBACCO 2 Million + 3/26/2011 900, 000 Shiv Chandra Mathur 10

SICK INDIVIDUALS ARISE FROM SICK POPULATIONS - Geoffrey Rose 3/26/2011 Shiv Chandra Mathur 11

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 3/26/2011 Shiv Chandra Mathur 12

“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 3/26/2011 Shiv Chandra Mathur Upper Silesia, 1848 13

Handicaps Lack Of Sufficient Public Health Expertise needed for • Policy Development • Program Design, Delivery And Evaluation • Health System Management • Public Health Research 3/26/2011 Shiv Chandra Mathur 14

BIOLOGICAL SCIENCES EPIDEMIOLOGY & PUBLIC HEALTH ALLIED SCIENCES ECONOMICS AND MANAGEMENT SOCIAL SCIENCES 3/26/2011 Shiv Chandra Mathur 15

SCIENCE DISCOVERS TECHNOLOGY DEVELOPS 3/26/2011 PUBLIC HEALTH DELIVERS Shiv Chandra Mathur 16

CRAFTING CREDIBLE PUBLIC SYSTEMS IN HEALTH NRHM - MAKING MDGs ACHIEVEABLE

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. 3/26/2011 Shiv Chandra Mathur 18

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. • • • 3/26/2011 Shiv Chandra Mathur 19

NRHM has created in each Indian Village 1. A worker : she is ASHA 2. An institution : that is VH&SC 3. An event : which is VHND. 3/26/2011 Shiv Chandra Mathur 20

Examples of Innovations • Making PHCs 24 X 7 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, 3/26/2011 Shiv Chandra Mathur 21

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. 3/26/2011 Shiv Chandra Mathur 22

The impact of NRHM - 1 • MMR significantly down – 450 to 230 - SRS. • IMR decline – 60 in 2004; 53 in 2008; <50 now • TFR steadily declining – 2. 9 in 05 to 2. 6 in 2008. • Institutional deliveries – 41% to 73% 3/26/2011 Shiv Chandra Mathur 23

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. 3/26/2011 Shiv Chandra Mathur 24

What Doctors in Public Systems can do further? 1. 2. 3. 4. 5. 6. 7. Strengthen medical care Help strengthen HMIS Sanitary Stringency Induce Behavior Change Disease Surveillance Educate on Better Food Practices Rational Drug Use

A Health Professional Must ELUCIDATE - As a health researcher EDUCATE As an informed facilitator ALLEVIATE - ADVOCATE - As a care giver As a health activist and if need be AGITATE 3/26/2011 - As a concerned citizen Shiv Chandra Mathur 26