AT RISK APPROACH-IMPLEMENTATION IN DIFFERENT STRATA IN

THE COMMUNITY

PRESENTED BY:- DR.NAVIN KUMAR

Why this presentation?India with a population of more than 1.22 billion scattered in 28 states and 7 union territories provide a unique ground for

studying population programs management .

To provide any kind of service to its citizens, it needs a huge investment and a large manpower for its implementation.

This presentation aims at:-1. Illustrating the definition of RISK;2. Defining the population at risk;3. Imparting knowledge on common

elements of population policies;4. Implementation in different strata in the community.

OBJECTIVES

WHAT IS RISK?

“Something with the potential to cause harm”

WHAT IS RISK?

RISK:- The probability of harmful consequences, or expected losses (deaths, injuries, property, livelihood, economic activity disrupted or environment damaged) resulting from interactions between natural or human-induced hazards and vulnerabilities.

Risk is proportional to Hazard x Vulnerability / Level of Preparedness.

R = H x V RISK= Cross product of Hazard and Vulnerability.

HAZARD = The probability of an adverse outcome.

VULNERABILITY= The conditions determined by physical, social, economic and environmental factors or processes, which increase the susceptibility of a community to the impact of hazards.

NOW WHAT TO DONEXT?

ASSESSMENT OF RISK

RISK ASSESSMENT:- It is a process of estimating the magnitude of the risk and deciding if the risk is tolerable or acceptable. A tolerable RISK may not always be acceptable.

RISK ASSESSMENTIt is a systematic procedure for describing and quantifying the risk associated with hazardous substance, process, action or event. It involves:

# Identification of hazard

# Quantification of hazard

# Quantification of probability of occurrence of hazard

# Estimation of risk

RISK ASSESSMENT

What Risk Analysis Can Do?

Helps in:-# Forecasting any unwanted situation.

# Estimating damage potential of such situation. # Decision making to control such situation.

# Evaluating effectiveness of control measures.

GUIDELINES FOR DEFINING GROUPS “AT-RISK”

BIOLOGICAL SITUATIONS:-AGE GROUP—INFANTS with low birth

weight, ELDERLY etc.

SEX--FEMALES in reproductive age group.

PHYSIOLOGICAL STATE-- PREGNANCY, HTN, DM etc

GENETIC FACTORS– Family history.

OTHER HEALTH CONDITIONS-- Diseases, Physical functioning, Unhealthy behavior.

PHYSIOLOGICAL SITUATION

-RURAL, URBAN, SLUMS.

-LIVING CONDITIONS, OVERCROEDING

-ENVIRONMENT: Water supply, Industries, Pollution etc.

SOCIOCULTURAL AND CULTURAL SITUATION. -Social class. -Ethnic and cultural group. -Family disruption, Education, Housing. -Customs, Habits and Behavior. -Access to Health services. -Lifestyle and Attitudes.

AT RISK APPROACH

AT “RISK APPROACH” DEALS WITH THOSE INDIVIDUALS AND GROUPS WHO ARE AT PERTICULAR HIGH RISK AND EMERGENT NEED.

1PREVENTIVE

2PROMOTIVE

3MANAGEMENT

THE ULTIMATE GOAL

RISK

AT RISK IN FAMILIES

PREGNANT WOMEN

LACTATING MOTHERS

CHILDREN < 2YEARS

SEVERELY MALNURISHED

CHILDREN <5 YEARS

DISABLED FAMILY

MEMBER

RAGHU PANDA89 years oldLives aloneHas no land, family lives out of stateHistory of heart disease

KAMLA7 years oldParents are undocumentedimmigrants

MALTI DEVI35 years old, PregnantAnaemic, weak, BPL,Lives 4 children & unemployed husband

AN EFFECTIVE “AT RISK APPROACH” INVOLVES FIVE MAIN STAGES:-

A: Recruitment and Referral –

B: Comprehensive health assessment-

C: Setting appropriate target- D : Implementing management strategies-

E : Monitoring reward and evaluation-

23

A Simple Framework

Evaluate & Take Action

Evaluate & Take Action

EstablishObjectives

EstablishObjectives

IdentifyRisks & Controls

IdentifyRisks & Controls

AssessRisks & Controls

AssessRisks & Controls

Monitor&

Report

Monitor&

Report

Step 1 Step 2 Step 3 Step 4 Step 5

Communicate, learn, improve

Policies related to Health SectorFor population at Risk

National Health Policy Nutrition Policy Women Policy Training Policy Population Policy

Policy Interventions.

From Quantity to Quality

Upgradation of Skills Static Centres for Improved access to services Upgradation of facilities and Operations Research

Integrated Services for Spacing Method Antenatal Care Deliveries Post-natal Care Immunization RTI Child Care

MODEL OF HEALTH CARE SYSTEMHEALTH STATUS 0R

HEALTH PROBLEMS

RESOURCES

CURATIVE

PREVENTIVE

PROMOTIVE

PUBLICPRIVATEVOLUNTARY

INDIGENOUS

CHANGES IN HEALTH STATUS

GOVT HAVE TO IDENTIFY THESE FAMILY AND PROVIDE APPROPRIATE HELING HANDS TO THESE FAMILY.# JANANI SURAKSHA YOJANA.# MAMTA SCHEME.# RASHTRIYA SWASTH BIMA YOJANA.# BPL CARDS

Population Program Promotional Measures providing fertility regulating information/services. furnishing family life/sex education information. improving the status of women. improving health and nutritional status. providing incentives and disincentives. improving research and evaluation. carrying out specific legal reforms to influence.

internal and international migration.

REPRODUCTIVE AND CHILD HEALTH (RCH)

– Conceptual frame work:

Client centered approach

Family welfare/Plan

CHILD SURVIVAL & SAFE MOTHERHOOD (1992)

RTIs &STDs

RISK APPROACH IN ANTENATAL CARE AIM :- To identify the HIGH RISK

ANTENETAL CASES to provide specialized care and appropriate level of care to others.

ASHA WORKERS AT THEIR DUTIES.

NEW BORNS & INFANTS

LOW BIRTH WEIGHT PRE TERM BABIES NEONATAL DEATHS EARLY WEANING RTI

UNDER FIVE AGE GROUP CHILDREN

MALNUTRITION FOOD POISONING ACUTE DIARRHOEAL DISEASES PROTEIN-ENERGY MALNUTRITION INFECTIONS AND PARASITOSIS ACCIDENTS AND POISONING BEHAVIOURAL PROBLEMS RTI

Mid day meal programme

PRINCIPLES: 1. Meal a supplement – not a substitute. 2. 1/3rd of total calorie requirement. ½ of total protein requirement. 3. Ease of preparation. 4. Locally available. Ingredients. 5. Low cost. 6. Menu should be changed frequently.

YOUNG & ADOLESCENCE AGE GROUP

# GUTHKA CHEWING# TOBACCO CHEWING# ALCOHOL# SMOKING# UNSAFE SEX# UNHEALTHY LIFE STYLE

OUTCOME

ORAL CANCER LUNG CANCER STD / HIV-AIDS / HPV LIVER DISEASES UN-EMPLOYMENT MENTAL DISORDERS RASH DRIVING - RTA

ROAD TRAFIC ACCIDENTS

RISK APPROACH

BAN ON GUTHKA BY SEVERAL STATE GOVT. HEAVY SALES-TAX ON ALCOHOL, CIGARETTES AND ALL

TOBACCO PRODUCTS. BAN ON ALCOHOL IN GUJRAT. BAN ON SMOKING IN PUBLIC PLACES & PUBLIC

TRANSPORTS. PROPER LAW IMFORCEMENT TO FOLLOW TRFFIC

RULES.

Geriatric population 1980- 5.3% 2000- 7.7% 2025- 13.3% ( 1.2 billion ) 71% - Developing World 70 million population in India-2001 177 million population -2025 40% below poverty line 73% illiterate

RISK OF GERIATRICS

PRONE FOR INFECTIONS PRONE FOR INJURIES NEED SPECIAL ASSISTANCE PRONE FOR PSYCHOLOGICAL PROBLEMS PRONE FOR DEGENERATIVE DISORDERS INCREASED RISK FOR DISEASE INCREASED RISK OF DISABILITY INCRASED RISK OF DEATH

PREVENTION

Primordial prevention Pre geriatric carePrimary prevention Health education ExerciseSecondary prevention Annual medical check-up Early detection ( Universal approach, Selective approach) TreatmentTertiary prevention Counseling and Rehabilitation Welfare activities (Sanjay Niradhar Yojana, Vridhashrama) Chiropody servicesImproving quality of life Cultural programme Old age club Meals-on wheel service Economically support (Vridha pension Yojana ) Old age home

SUMMARY

HEALTH CARE AND POLICY SHOULD BE GUIDED TOWARDS PREVENTION BY A NUMERICAL ASSESSMENT OF FUTURE NEED.

IEC IS MUST FOR IMPLEMENTATION LAW IMFORCEMENT SHOULD BE

STRICT

HEALTH FOR ALL