What is Health

A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity Can include components like nutritional, spiritual and intellectual also

Health care in India

Entitlements by policy and not rights Focus on preventive and promotive care Grossly under-provided facilities Poor investments hitherto Declining public expenditures and new investments Structural Adjustment programming under World Bank dictate

Public Health
Public health is the science of protecting and improving the health of the communities through education, promotion of healthy lifestyles and research for diseases and injury prevention. It includes various disciplines such as biology, sociology, mathematics, anthropology, public policy, medicine, education, psychology, computer science, business, engineering and much more It focuses on entire populations rather than on individuals. These can be as small as a local neighborhood or as big as an entire country

Core functions of Public Health

Monitoring health situation Disease surveillance Health promotion Regulations Partnerships Planning & Policies HRD Reducing impact of emergencies on health

Public Health Dilemma:

Equity and Equality Quantity and Quality Public/Private/ Voluntary sector Education/ Persuasion/ Coercion Professional/ Para Prof/ Auxiliaries Privatization/ Disinvestment

Problems
Indirectly related to health
Environment Education Empowerment

Directly affecting Health

Diseases Communicable Non Communicable New emerging Fertility Population Growth rate Total Fertility Nutrition Malnutrition Obesity

Problems-Why
Access Availability Utilization

Challenges
Manpower- Number & Norms Rural / Urban differential Geographical divide across States

Accessibility/ reach
Gaps between Policy & Action Health sector expenditure Newer Infections

Role of Central Govt. in Health Care

Policy formulation Maintaining International health relations Administration of central health institutions Regulating Medical education through statutory bodies-MCI/DCI/Councils Medical & Public health research-funding Standards- laying & maintenance(Drugs/Education) Coordination-Other ministries/States/Statutory bodies Central Health Acts Negotiation with International agencies

NRHM
The National Rural Health Mission has been launched on 12th April, 2005 for a period of seven years (2005 2012) for providing integrated comprehensive Primary Health Care Services, specially to the poor and vulnerable sections of the society. The NRHM covers the entire country, with special focus on 18 states where the challenge of strengthening poor public health systems and thereby improve key health indicators is the greatest. These are Uttar Pradesh, Uttaranchal, Madhya Pradesh, Chhattisgarh, Bihar, Jharkhand, Orissa, Rajasthan, Himachal Pradesh, Jammu and Kashmir, Assam, Arunachal Pradesh, Manipur, Meghalaya, Nagaland, Mizoram, Sikkim and Tripura.

NRHM Great Expectations

Access to integrated comprehensive primary healthcare. Transform public health system into an equitable, accountable, accessible and affordable system of quality services. Reduction in IMR-MMR; Prevention and control of communicable and non-communicable diseases; Population stabilization. Focus on states with poor infrastructure Increase spending on health from 0.9 % of GDP to 2-3% Revitalize local health traditions; mainstream AYUSH Integration of health concerns with determinants of health such as nutrition, sanitation, etc. Decentralization of management of health

Performance of NRHN
Areas critical to the functioning of a comprehensive health system continue to be neglected Provision of limited package of services through government health services, as against improving and strengthening them for providing comprehensive health services Privatization being promoted; however existing massive private sector not being regulated the doctor-pharmaceutical company nexus Lack of staff

Unified Health Plan

The government is expected to launch a unified healthcare programme the National Health Mission (NHM) with a budgetary support of around Rs.15000 cr The new flagship scheme will be framed by merging UPA flagship venture National Rural Health mission (NRHM) and the yet-to-be launched National Urban Health Mission (NUHM). The new programme will focus on strengthening the entire public healthcare system primary, secondary and tertiary healthcare facilities to cater to both urban and rural poor across the country. Under the new health mission, which will be a centrallysponsored scheme, 100% central assistance will be provided for fiscal 2010-11