Download - Health care delivery system
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ROLE OF WHO AND UNICEF IN HEALTH CARE DELIVERY SYSTEM IN INDIA
Presenter:Dr.S.PreethiGuide: Dr. Abhay S Nirgude Dr.Shivalli
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CONTENTS OF PRESENTATION
History
Present health care system
WHO
Current Mou of Rajasthan with WHO India
Unicef
Take home message
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HISTORY
Planned cities- drainage, public baths- Harappa
Spread of medical education – post Vedic period
Establishment of hospitals- Buddhist kings
British rule- Intro of various acts
- Establishment of various bureaus
Health survey and Development Committee (Bhore)
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HEALTH SYSTEM IN INDIA
Central , State and Local or peripheral
Central Ministry of health and family welfare Directorate general of health services The central council of Health and Family Welfare
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STATE LEVEL
Federal, Concurrent and state
Medical care, preventive health services
Provision of control of milk and food sanitation
Prevention of any outbreak and communicable disease
Promotion of health education & health programmes
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STATE LEVEL CONT………..
Supervision of PHC
Establishing training courses for health personnel
Co-Ordination of activities with other ministry of state such as
voluntary agency, minister of education and central health
minister.
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DISTRICT LEVEL
There are 593 districts and 6 types of admin
Sub divisions, taluks-(Tahsildars- 200-600 villages)
CDB-(100 villages, 80,000-1,20,000 population)
Municipality and corporation, villages and panchayath
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URBAN
Urban areas- town area committees(sanitary services)
municipal boards and corporation
Town area committees- 5,000-10,000 Municipal Boards- 10,000- 2 lac Corporation > 2 lac
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MUNICIPAL BOARD
Construction and maintenance of roads
Sanitation and drainage
Street lighting & water supply
Maintenance of hospitals and dispensaries
Education
Registration of births and deaths
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PANCHAYATH RAJ
Three tier system rural local self govt (village-district)
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HEALTH CARE DELIVERY SYSTEM
1. Government run health services
2. Private health sector
3. Industrial-organization-corporate sector, ESI
4. CGHS , Voluntary health organizations
5. Railway health services
6. AFMC & Indian System of medicine
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THREE TIER SYSTEM
Level Type of facility PopulationPrimary level •Sub centre( ANM/MPW)
•Primary health centre(MO)
•3,000- 5,000•20,000- 30,000
Secondary level •Community health centre(CHC)•District hospitals(DH)
80,000-1,20,000 or entire district
Tertiary level •Specialist hospitals•Regional/Central institutes/ Teaching Hospitals
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HEALTH CARE SYSTEM
At Village level-
VHG, Local Dais, Anganwadi workers, ASHA
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VILLAGE HEALTH GUIDES
Second Oct, 1977
Provide treatment of common minor ailments
First aid during accidents and emergency
MCH care
Family Planning
Health Education
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LOCAL DAIS
Training 30 working days- Rs 300 stipend
MCH care
FP and Immunization
Education about health service
Safe water and basic sanitation
Nutrition
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ANGANWADI WORKER
ICDS- 1000 population , training-4 month /Rs200-250
MCH care, FP & Immunization
Education about health
Referral services
Safe water and basic sanitation
Supplementary nutrition and non formal education
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ASHA/USHA
One ASHA- 1000 population
Women resident village- married/divorced/widow 25-45yrs
Formal education – 8th class
Create awareness on determinants of health
Birth preparedness/ safe delivery/BF/ immunization/ RTI
Mobilize (village/sub-centre/PHC)- ANC,PNC, ICDS
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IPH STANDARDS
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CHC
Block public health unit- BDO, Public health specialist and public
health nurse
Specialty services- Surgeon, physician, OBG, Pediatrician and
anesthetist
General duty medical officer, AYSH, Dental surgeon
Staff Nurse, Pharmacist
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WHO
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WHO-INDIA PROGRAMME OF WORK- GOI
Providing technical support developing NHP
Advocating UHC
Adopting evidence based public health interventions
Promote equity and accelerate movement UHC
WHO ( values, Functions)- equity, solidarity, participation
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WHO- OBSERVATIONS
World Health Report 2006 - countries (<23/10,000) fail to achieve
adequate coverage rates
target of at least 5% of GDP for health by 2000
WHO estimates that a minimum US$ 44 per person per year needs
to be spent to provide everyone access to a set of essential health
services.
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GLOBAL HEALTH AGENDA (2006-15) WHO'S ELEVENTH GENERAL PROGRAMME
(i) Investing in health to reduce poverty;
(ii) Building individual and global health security;
(iii) Promoting universal coverage
(iv) Tackling determinants of health;
(v) Strengthening health systems and equitable access;
(vi) Strengthening governance, leadership and accountability
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MISSION -WHO COUNTRY OFFICE FOR INDIA:
(i) Developing and sustaining its own health policies, health
systems and public health programmes;
(ii) Working to prevent and overcome threats to health;
(iii) Anticipating future challenges;
(iv) Advocating public health.
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TECHNICAL OFFICER-PRIMARY HEALTH CARE WHO-INDIA
Facilitating- implementation-work plans
Promote support evidence on primary health care services
Adaptation country context strategies, guidelines, SOPs
Monitoring evaluation policies, strategies & interventions
Intersectoral co-ordination
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CONT……….
Advise on matters regarding primary health care development,
financing and management
Technically review contractual proposals,
Support information brokering/exchange function of WCO India
Prepare administrative and technical reports
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EXAMPLE Polio cases (559 in 2008 to no case in 2012)
The Government, in partnership
UNICEF, WHO, the Bill & Melinda Gates Foundation
Rotary International & Centers for Disease Control & Prevention
Contributed to almost universal awareness
Vaccinate all children under five against polio
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WHO-GOAL HEATH FOR ALL
Universal coverage reforms
Service delivery reforms
Public policy reforms
Leadership reforms
Increasing stakeholder participation
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RAJASTHAN- CURRENT /MOU – WHO INDIA
Long-term technical collaboration accelerate progress towards UHC
Memorandum of Understanding (MoU) on 5 May 2015 at Jaipur,
WHO India provide broad technical support state
Designing innovative health financing mechanisms,
Improving quality of care and
Building on best practices and lessons state’s free medicines scheme.
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UNICEF- ACHIEVEMENTS
WHO Child Growth Standards - NRHM and ICDS
Operational Guidelines- SAM Malnutrition (MoHFW)
Nutrition Guidelines HIV-Exposed , Infected Children NACO-
prevent parent-to-child transmission of HIV and the launch of early infant diagnosis.
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UNICEF ACHIEVEMENTS CONT………..
(MWCD) launched nationwide Communication Campaign
Maternal and Child Nutrition in November 2012, jointly with Mr.
Aamir Khan,(UNICEF Ambassador - nutrition for children)
Largest public service campaigns country -people across India
Diverse means of communication 18 languages;
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UNICEF- ACHIEVEMENTS- CONT………..
Rural sanitation coverage (toilet construction) 48 % 2008 - 67 % 2010
Significant shift in the Nirmal Bharat Abhiyan (NBA) guidelines to
focus on sustained use of sanitation facilities.
Nirmal Gram Puraskar -increase of 19.7 million new toilet-users
Sarva Shiksha Abhiyan (SSA) gross completion rates (90 per cent in
2007-2008 to 102 per cent in 2010-2011)
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UNICEF ACHIEVEMENTS CONT……….
UNICEF helped the National Disaster Management
Post Disaster Reconstruction Guidelines
National Norms and Standards that set guide lines
For services like medical coverage and psychosocial care in relief
camps
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PROGRAMMES- PROPOSED FUNDING
The Child Development and Nutrition programme -national policies
and programmes -IYFP
RCH programme -ICDS (Village Health & Nutrition Days
WASH programme – Norms and Standards for Anganwadi Centres
Education programme support early childhood education
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CONT………..
PPE programme - ICDS - crèches and day care
Support to districts made from the states
Emerging issue -attention - support to children disabilities
UNICEF -identify strategic areas -play the role -“knowledge
broker” -children, adolescents and women
Thematic funded programme
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TAKE HOME MESSAGE
Health care “WHENEERS” W- Water H- Health E- Education N- Nutrition E- Economic E-
Environment R- Recreation S- Security
Needs satisfied with 3-tier system PHC- village level CHC- District level THC- Health institutions
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REFERENCES Bhalwar R. Text Book of Public Health and Community
Medicine. 1st ed. Pune: Dept of Community Medicine, AFMC. 2009.
Park.K. Text Book of Preventive and Social Medicine.22nd ed. Jabalpur: M/S. Banarasidas Bhonot Publishers;2013.
Measuring core health indicators in the SEARO 2014. Available on :http://www.who.int/healthsystems/topics/delivery/en.
Last retrieved on 12th June 2015.
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Thank You
Thank You