PUBLIC HEALTH PUBLIC HEALTH MANAGEMENT IN INDIAMANAGEMENT IN INDIA

PUBLIC HEALTH AND MANAGEMENTPUBLIC HEALTH AND MANAGEMENTThe science and practice of protecting and The science and practice of protecting and improving the health of a community throughimproving the health of a community through– preventive medicinepreventive medicine– health educationhealth education– control of communicable diseasescontrol of communicable diseases– application of sanitary measuresapplication of sanitary measures– monitoring of environmental hazardsmonitoring of environmental hazards

This is the goal of the public health system.This is the goal of the public health system.

Management involves with the planning, Management involves with the planning, implementation and control of the organization to implementation and control of the organization to reach its goal.reach its goal.

Why do we need the public health Why do we need the public health system? ....system? ....Facilitates economic growth and poverty Facilitates economic growth and poverty reductionreductionPoor public health conditions lead toPoor public health conditions lead to– Reduced attraction for investors and touristsReduced attraction for investors and tourists– continued expenditures on combating continued expenditures on combating

diseasesdiseases– Decrease in labor productivity Decrease in labor productivity

Health and hygienic measures were different in various Health and hygienic measures were different in various periods of Indian history.periods of Indian history.the public baths and highly developed water systems the public baths and highly developed water systems during the early Indus valley civilization.during the early Indus valley civilization.epidemics and illnesses must have been frequent, epidemics and illnesses must have been frequent, according to the available records.according to the available records.Traditional medicine recognized the concept of Traditional medicine recognized the concept of quarantine.quarantine.difficult to ascertain when hospitals were first begun. difficult to ascertain when hospitals were first begun. From the inscriptions from 3From the inscriptions from 3rdrd century B.C.(Asoka’s rule century B.C.(Asoka’s rule of Mauryan dynasty), there were statements that there of Mauryan dynasty), there were statements that there were hospitals for humans and some animals.were hospitals for humans and some animals.Charaka's principles.Charaka's principles.

PUBLIC HEALTH MANAGEMENT IN ANCIENT INDIA

PUBLIC HEALTH IN BRITISH INDIAPUBLIC HEALTH IN BRITISH INDIAPreventive medicine was exercised only to Preventive medicine was exercised only to – To keep the British and Indian troops healthyTo keep the British and Indian troops healthy– To maximize productivity of labour forceTo maximize productivity of labour force– To achieve social control of the local populationTo achieve social control of the local population

Sanitation and water supply was limited to army Sanitation and water supply was limited to army cantonments and British residential areas.cantonments and British residential areas.

‘‘Unable to persuade the government of the utility of these Unable to persuade the government of the utility of these (anti-mosquito) measures and prevented from (anti-mosquito) measures and prevented from continuing research, Ronald Ross left India in 1899, a continuing research, Ronald Ross left India in 1899, a disgruntled and bitter mandisgruntled and bitter man.’.’

- Harrison (Mosquito, Malaria and Man)- Harrison (Mosquito, Malaria and Man)

In spite of all these limited purposes, British rule In spite of all these limited purposes, British rule offered:offered:

Institutions for public health training and research Institutions for public health training and research (All-India School of Public Health and Hygiene, (All-India School of Public Health and Hygiene, Calcutta School of Tropical Medicine).Calcutta School of Tropical Medicine).

Public Health legislationPublic Health legislation

Sanitary Departments at national and provincial Sanitary Departments at national and provincial levels.levels.

Policy making and planning for public health services, Policy making and planning for public health services, done systematically to address all major threats to done systematically to address all major threats to the public health.the public health.

At the end of the colonial rule:At the end of the colonial rule:

the mortality spikes from epidemics were sharply the mortality spikes from epidemics were sharply reduced.reduced.

Mortality from diseases such as cholera and the plague Mortality from diseases such as cholera and the plague had fallen sharply.had fallen sharply.

malaria and gastro-enteric infections continued to take malaria and gastro-enteric infections continued to take heavy tolls.heavy tolls.

only 3 percent of households in India had toilets.only 3 percent of households in India had toilets.

much of the population lacked basic water, drainage and much of the population lacked basic water, drainage and waste disposal serviceswaste disposal services

PUBLIC HEALTH IN INDEPENDENT INDIAPUBLIC HEALTH IN INDEPENDENT INDIA

The capacity of the colonial public health systems to The capacity of the colonial public health systems to prevent outbreaks from occurring has atrophied.prevent outbreaks from occurring has atrophied.

Mass-production of antibiotics lead to a brief Mass-production of antibiotics lead to a brief stoppage of communicable diseases and stoppage of communicable diseases and environmental hygiene was neglected.environmental hygiene was neglected.

The intellectual cutting edge shifted from improving The intellectual cutting edge shifted from improving public health systems, to improving curative public health systems, to improving curative technologies and methods of health care financing.technologies and methods of health care financing.

Multilateral and other donor agencies have Multilateral and other donor agencies have encouraged creating separate institutional structures encouraged creating separate institutional structures and programs for controlling specific communicable and programs for controlling specific communicable diseases.diseases.

Other factors that atrophied the public health system...Other factors that atrophied the public health system...

The spread of democratic institutions also affected The spread of democratic institutions also affected public health services, because electorates typically public health services, because electorates typically prefer public funds to be used to provide private prefer public funds to be used to provide private goods rather than public goods.goods rather than public goods.

Elite Capture: In India, even more than most Elite Capture: In India, even more than most developing countries, public funds for health and developing countries, public funds for health and education have been funneled towards tertiary rather education have been funneled towards tertiary rather than primary levels.than primary levels.

Several policy thrusts of the newly-independent India Several policy thrusts of the newly-independent India also detracted from public health service provision.also detracted from public health service provision.

An inconsistency between Constitutional provisions An inconsistency between Constitutional provisions starved public health systems of funds. starved public health systems of funds.

Indian Public Health Assessment Using Indian Public Health Assessment Using Essential Public Health Function ModelEssential Public Health Function Model

A framework was developed to analyze the public A framework was developed to analyze the public systems in developed and developing countries, based systems in developed and developing countries, based on ‘Essential Public Health Functions’. (EPHF)on ‘Essential Public Health Functions’. (EPHF)

The EPHF assessment questionnaires are designed to The EPHF assessment questionnaires are designed to elicit a self-evaluation of the public health system, from elicit a self-evaluation of the public health system, from people who know the system well from within.people who know the system well from within.

The EPHF assessment questionnaires were completed by 119 respondents: 19 at the central level, 10 at state level, and 90 at district level

Potential source of error includes exaggerating performance or lack of familiarity with the issues.

Scores for Public Health Functions at Federal Level, India

www.ibef.org

HEALTH EXPENDITURE IN DIFFERENT COUNTRIES

www.ibef.org

RURAL HEALTH SYSTEMS IN INDIA

VACANCIES : A MAJOR PROBLEM IN RURAL HEALTH SYSTEM

Strong areas across EPHFsAvailability of technical expertiseWritten guidelines, protocols and standards Network of research and training institutions, and laboratories

Better performing EPHFs Epidemiological surveillance Health status monitoring Reducing health impact of emergencies

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ACHIEVEMENTS THROUGH THE YEARS

Public health regulations and their enforcementSocial participationEnsuring quality of servicesHuman resource developmentMonitoring and EvaluationDissemination and use of dataLearning and innovationCollaborative partnershipsSupport to sub-national levelsResource utilization

Attention should be given in the areas of .....

ReferencesReferences

India’s Public Health System : How Well Does It Function at the National Level?

World Bank Policy Research Working Paper 3447, November 2004 Public Health in India: An Overview

World Bank Policy Research Working Paper 3787, December 2005Information on http://mohfw.nic.in/