Integration of Substance Abuse Disorders in National Rural Health Mission (NRHM)

Dr. Rakesh Kumar, Dr. Kapil Yadav, Dr. Chandrakant S Pandav,

Professor & Head,Centre for Community Medicine,

All India Institute of Medical Sciences, New Delhi

•Take Home Messages

•Background

•Public Health Approach to Substance Abuse

•Principles of successful integration

•Integration in National Rural Health Mission

•Take Home Messages

•Substance abuse is common in rural area.

•Huge prevention and treatment gap in substance

abuse.

•Public health approach can bring high dividends

•Integration into National Rural Health Mission for

efficient service delivery

Changes in the functioning of human mind and more specifically leads to a state of intoxication

•Substance abuse is common in rural area.

•Huge prevention and treatment gap in substance

abuse.

•Public health approach can bring high dividends

•Integration into National Rural Health Mission for

efficient service delivery

Drug Type Rural (n=31,159) %

Urban (N= 9538), %

Alcohol 20.1 18.3

Cannabis 3.1 1.3

Opiates 0.7 0.5

Source-NHS

Demand Reduction Supply Reduction

To protect the health of people, particularly the most vulnerable, from the dangerous effects of drug use

and from drug use disorders

Health Care

To reduce drug related diseases and social Consequences

Harm Reduction

Clinical Medicine Public health

UNIT OF STUDYUNIT OF STUDY • Individual•Population/ Community

TARGET GROUPTARGET GROUP• Mostly Patient – with disease

• Diseased and healthy individuals

VIEWPOINT OF VIEWPOINT OF

HEALTH SYSTEMHEALTH SYSTEM

• Mostly passive process

• Active process

TYPE OF CARETYPE OF CARE• Major focus on curative care

• Comprehensive care

SERVICE PROVIDERSSERVICE PROVIDERS• Majority by private sector

• Both public & private sector

BENEFITSBENEFITS

• Short term benefits• Obvious benefit

• Long term benefits • Not obvious

In Public Health – Good work means no patients

•Prevention is better than cure

•Best should not be the enemy of good

•Good for many rather than best for few

•Primary health care is NOT primitive care

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•Awareness and education

•Management through motivational counseling,

treatment, follow-up and social reintegration of

recovered patients

•Educated cadre of service providers – Drug

abuse prevention and rehabilitation

training

•

•

•Proper policy and plans

•Advocacy

•Manpower training

•Realistic tasks

•Access to drugs

•Co-ordination with other sectors

•Proper support

Launched on 12 th April, 2005 with an objective to provide effective health care to the rural population, by •improving access,•enabling community ownership•strengthening public health systems for efficient service delivery•Enhancing equity and accountability •Promoting decentralization

NRHM – Main Approaches

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COMMUNITIZE

1. Hospital Management Committee/ PRIs at all levels2. Untied grants to community/

PRI Bodies3. Funds, functions &

functionaries to local community organizations

4. Decentralized planning,5. Intersectoral Convergence

IMPROVEDMANAGEMENT

THROUGH CAPACITY

1. Block & District HealthOffice with management skills2. NGOs in capacity building

3. NHSRC / SHSRC / DRG / BRG4. Continuous skill development

support

FLEXIBLE FINANCING

1. Untied grants to institutions 2. NGOs for public

Health goals3. NGOs as implementers

4. Risk Pooling – moneyfollows patient

5. More resources formore reforms INNOVATION IN

HUMAN RESOURCEMANAGEMENT

1. More Nurses – localResident criteria

2. 24 X 7 emergencies byNurses at PHC. AYUSH

3. 24 x 7 medical emergencyat CHC

4. Multi skilling

MONITOR,PROGRESS AGAINST

STANDARDS

1. Setting IPHS Standards2. Facility Surveys

3. Independent MonitoringCommittees at

Block, District & Statelevels

BLOCKLEVEL

HOSPITAL

30-40 Villages

Strengthen Ambulance/transport ServicesIncrease availability of NursesProvide TelephonesEncourage fixed day clinics

AmbulanceTelephone

Obstetric/Surgical MedicalEmergencies 24 X 7

Round the Clock Services;

BLOCK LEVEL HEALTH OFFICE –--------------- Accountant

CLUSTER OF GPs – PHC LEVEL

3 Staff Nurses; 1 LHV for 4-5 SHCs;Ambulance/hired vehicle; Fixed Day MCH/Immunization

Clinics; Telephone; MO i/c; Ayush Doctor;Emergencies that can be handled by Nurses – 24 X 7;

Round the Clock Services; Drugs; TB / Malaria etc. tests

GRAM PANCHAYAT – SUB HEALTH CENTRE LEVEL

Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages;Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic

VILLAGE LEVEL – ASHA, AWW, VH & SC

1 ASHA, AWWs in every village; Village Health DayDrug Kit, Referral chains

100,000 Population

100 Villages

5-6 Villages

Accredit private providers for public health goals

Health Manager

Store Keeper

NRHM – Illustrative Structure

•Assessment of Community needs

•Identification of high risk individuals.

•Counseling and education of such individuals.

•Handling crisis situations in the families.

•Providing moral support.

•Organizing and participating IEC/ Awareness

programmes for various groups such as high risk

groups and schools.

•Linkages & Coordination with governmental

health systems and non-governmental

organization.

•Creation and operationalizing self help groups

•Early diagnosis (case finding / screening) and

treatment of cases including referrals

•Helping the patient to identify substance abuse

behavior and its consequences.

•Offering constant support to the patients. .

•Encouraging the patients to participate in treatment

programme and continue.

• Referring the patients to appropriate agencies and organizations for seeking economic support for starting some vocation.

•Minimizing the stigmatization and discrimination

against the patient by the community.

•Working in close liaison with governmental and non-

governmental organizations for rehabilitation of the

patients

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