Subject: Science & Technology:
Topic: Health Sector

Health

World Health Organisation (1948) in the preamble to its constitution has defined health as a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity. The ability to lead a socially and economically productive life has been added to the definition in the recent years.

The WHO definition is criticised as being too broad, more an idealistic goal than a realistic proposition, and is not an operational definition (i.e.) it does not lend itself to direct measurement. Hence WHO study group (1957) has devised an ‘operational definition’. In this definition, health is viewed as being of two orders. In a broad sense, health can be seen as a condition or quality of human organism expressing the adequate functioning of organism in given conditions, genetic or environmental. In a narrow sense health means (a) there is no obvious evidence of disease and the person is functioning normally (b) the several organs of the body are functioning adequately and are in a state of homeostasis (or) equilibrium.

(a) Concept of Well-Being

The WHO definition of health introduces the concept of “well-being”. However, there is no satisfactory definition of well-being. Psychologists have pointed out that “wellbeing of an individual or groups of individuals have subjective and objective components. The objective components are described by the term “standard of living” while subjective component of “well being” (as expressed by each individual) is referred to as “Quality of Life”.

The WHO has proposed that income and occupation, standards of housing, sanitation and nutrition, the level of provision of health, educational, recreational and other services may all be used individually as measures of socio-economic status, and collectively as an index of the “Standard of Living”. The term “Quality of Life” refers to “a composite measure of physical, mental and social well being as perceived by each individual or by group of individuals — that is to say, happiness, satisfaction and gratification as it is experienced in such life concerns as health, marriage, family work, financial situation, self-esteem”.

(b) Physical Quality of Life Index (PQLI)

Physical Quality of Life Index (PQLI) is composite index that measures quality of life. It consolidates three indicators viz. infant mortality, life expectancy at age one and literacy. For each component, the performance of individual countries is placed on scale of 0 to 100 the composite index is calculated by averaging the three indicators, giving equal weight to each of them. The resulting PQLI thus also is scaled 0 to 100. PQLI does not take per capita GNP into consideration, so it does not measure economic growth. It measures the results of social, economic and political policies. It is intended to complement, not replace GNP.
Organisational Set Up/Management of Public Health

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Health System in India

(A) At Centre:

(a) Ministry of Health and Family Welfare

• Department of Health
• Department of Family Welfare
• Department of Ayush

(b) Directorate General of Health Services (DGHS)

(c) Central Council of Health and Family Welfare

(B) At State Level:

(a) State Ministry of Health

(b) State Health Directorate

(C) At District Level
Under the, Constitution of India, the States are largely independent in matters relating to the delivery of health care to the people. Each state, therefore, has developed its own system of health care delivery, independent of the Central Government. The Central Government is mainly responsible for policy making, planning, guiding, assisting, evaluating and co-ordinating the work of the State Health Ministries, so that health services cover every part of the country.

A. At the Centre:

The official organs of health system at national level consists of

1. Ministry of Health and Family Welfare
2. Directorate General of Health Services
3. The Central Council of Health and Family Welfare

(a) Ministry of Health and Family Welfare

The Ministry is headed by a Cabinet Minister, a Minister of State and a Deputy
Health Minister. The Ministry has 3 departments (1) Department of Health; (2) Department of Family Welfare created in 1966; and (3) Department of Ayush set up in 1995. The functions of Union Health Ministry are set out in Seventh Schedule of Article 246 of the Constitution of India.

(b) Directorate General of Health Services (DGHS)

DGHS is the principal advisor to Central Government in both medical and public heath matters. The Directorate comprises of 3 main units: medical care and hospitals, public health and general administration.

(c) Central Council of Health and Family Welfare

The Central Council of Health was set up by a Presidential Order under Article 26(b) of the Constitution for promoting co-ordinated and concerted action between the centre and states in the implementation of all programmes and measures pertaining to the health of the nation.

B. At State Level

(a) State Ministry of Health: The State Ministry of Health is headed by a Minister of Health and Family Welfare and a Deputy Minister. The Health Secretariat is the official organ of State Ministry of Health and is headed by a Secretary.

(b) State Health Directorate: The Director of Medical and Health Services is the Chief Technical Advisor to the State Government on all matters relating to public health and medicine. He is also responsible for organisation and direction of all health activities. In some states designation of Director of Medical and Health Services has been changed as Director of Health and Family Welfare.

C. At District Level

Since ‘health’ is a state subject, there is no uniform model of district health organisation in India, each state developed its own pattern to suit its policy and convenience.
Under the Multi-purpose Workers Scheme, it has been suggested to states to have an integrated set up at district level by having a Chief Medical Officer (CMO) with 3 Deputy CMO’s. The Working Group on Health for All by 2000 A.D. appointed by Planning Commission recommended that District Hospitals should be converted into District Health Centres, each Centre monitoring all preventive, promotive and curative services of one million population.

National Health Policy 2002

The National Health Policy announced recently aims at reviving and energising the ailing health system and increasing the primary health sector outlay to ensure a more equitable access to health services across the social and geographical expanse of the country. The government plans to increase its contribution to the health sector from 0.9 per cent of the GDP at present to 3 per cent of the GDP by 2012.

Need for a new health policy

1. The last health policy was formulated in 1983 and since then the health scene has changed dramatically requiring a more exhaustive approach. The policy of 1983 did not achieve any great success in its main goal of primary health care.

2. An ineffective public health infrastruc-ture, especially at the level of primary healthcare and basic services.

3. Falling research standards in healthcare related fields and low research expenditure, making it virtually impossible to make any dramatic break-through within the country, by way of new molecules and vaccines; and thereby developing optimal applications and appropriate public health strategies.

4. It is a widespread perception that private health services are very uneven in quality, sometimes even substandard and also financially exploitative, and they observe professional ethics only as an exception. With the increasing role of private health care, the implementation of statutory regulation, and the monitoring of minimum standards of diagnostic centres/medical institutions become imperative.

5. The current annual per capita public health expenditure in the country is no more than Rs.200. It is no surprise that the reach and quality of public health services has been below the desirable standard.

6. The attainment of health indices has been very uneven across the rural-urban divide. There are wide differences between the attainments of health goals in the better-performing states as compared to the low-performing states. For vulnerable sections of society in several states, access to public health services is nominal and health standards are grossly inadequate Access to, and benefits from, the public health system have been very uneven between the better-endowed and the more vulnerable sections of society. This is particularly true for women, children and the socially disadvantageous sections of society.

7. There is a general shortage of medical personnel in the country and this shortfall is disproportionately impacted on the less-developed and rural areas.

Ques. 1 : Point out the focus of the National Health Policy - 2002?

Ans. The Focus of the new health policy :

1. The policy envisages the setting up of an organized urban primary health structure to meet increased needs. It suggests a two-tiered structure, with the primary health centre providing the first tier and the government general hospital the second tier.

2. For improvement of the public health infrastructure it suggests revival of the primary health system by providing essential drugs, levying of user charges for certain secondary and tertiary public health care services for those who can afford to pay, expanding the pool of medical practitioners and simplification of the recruitment procedures for contract employment.

3. For funding and upgrading existing government medical and dental colleges, it has suggested setting up of a Medical Grants commission. Even the curriculum should be modified to make it more need-based, the policy has stressed. It has also suggested specialization in public health, which has been a neglected area, both for medical doctors and non-medical graduates from allied fields.

4. To boost medical research, it has suggested that government-funded medical research be increased to a level of one per cent of the total health spending by 2005 and up to 2 per cent by 2010. Medical research in the country needs to be focused on the therapeutic drugs/vaccines for tropical diseases, which are normally neglected by international pharmaceutical companies on account of their limited profitability potential. The thrust will need to be in the newly emerging frontier areas of research based on genetics, genome-based drug and vaccine development and molecular biology.

5. It also emphasises on improving the ratio of nurses vis-a-vis doctors, the number of hospital beds and to improve the skill level of nurses. The report said the government would work towards gradually merging all health programmes under a single field administration.

6. The policy has also chalked out a special role for the private sector for providing health care considering the economic restructuring under ay in the country. Currently, the contribution of private health care is principally through independent practitioners. Also, the private sector contributes significantly to secondary level care and some tertiary care. In order to ensure quality standards, professional ethics and financial reasonableness, the policy suggests a regulatory mechanism for the private sector. The policy will address the issues regarding establishment of a regulatory mechanism to ensure the maintaining of adequate standards by diagnostic centres/medical institutions, as well as the proper conduct of clinical, practice and delivery of medical services.

7. The policy focuses on building up credibility for the alternative systems of medicine, by encouraging evidence-based research to determine their efficacy, safety and dosage and also encouraging certification and quality-marking of products to enable wider popular acceptance of these systems of medicine. Under the overarching umbrella of the national health framework, the alternative systems of medicine — Ayurveda,. Unani, Siddha and Homoeopathy — have a substantial role. Because of inherent advantages, such as diversity, modest cost, low level of technological input and the growing popularity of natural plant-based products, these systems are attractive, particularly in the underserved, remote and tribal areas. The alternative systems will draw upon the substantial untapped potential of India as one of the eight global centres for plant diversity in medicinal and aromatic plants. The policy also envisages the consolidation of documentary knowledge contained in these systems to protect it against attack from foreign commercial entities by way of malafide action under patent laws in other countries.

8. It points out that no incentive system attempted so fare has induced private medical personnel to go to less-developed and rural areas and even in the public health sector, the effort to deploy medical personnel in under-served areas, has usually been a losing battle such a situation, the policy stresses, it becomes imperative to entrust some limited public health functions to nurses, paramedics and other personnel from the extended health sector after imparting adequate training to them.

9. It points out that effort made over the years for improving health standards have been partially neutralized by the rapid growth of population. It is well recognised that population stabilisation measures and general health initiatives, when effectively synchronise, synergisti-cally maximise the socio-economic well being of the people. The government has separately announced the ‘National Population Policy-2002’. The principal common features covered under the NPP 2002 and NHP 2002 relate to the prevention and control of communicable diseases; giving priority to the containment, of HIV/AIDS; the universal immunisation of children against all major preventable, diseases; addressing the unmet needs for basic and reproductive health services and supplementation of infrastructure. The synchronised implementation of these two policies will be the very cornerstone of any national structural plan to improve the health standards in the country.

10. As regards the impact of globalisation on the health sector, the policy admits that there are same apprehensions about the possible adverse impact of economic globalisation on the health sector. Pharmaceutical drugs and other health services have always been available in the country at extremely inexpensive prices. India has established a reputation around the globe for the innovative development of original process patents for the manufacture of wide- range of drugs and vaccines within the ambit of the existing patent laws. With the adoption of Trade Related Intellectual property Rights (TRIPS), and the subsequent alignment of domestic patent laws consistent with the commitments under TRIPS, there will be significant shift in the scope of the parameters regulating the manufacture of new drugs/vaccines. The -policy observes that global experience has shown that the introducing of a TRIPS-consistent patent regime for drugs in a developing country results in an across-the board increase in the cost of drugs and medical services. In this context, the policy merely states that it will address itself to the future imperatives of health security in the country, in the post TRIPS era.

Goals to be achieved by 2000-2015 as per the NHP 2002

Eradicate Polio and Yaws	2005
Eliminate Leprosy	2005
Eliminate Kala Azar	2010
Eliminate Lymphatic Filariasis	2015
Achieve Zero level growth of
HIV-AIDS	2007
Reduce mortality by 50% on
account of TB, Malaria and other
vector and water born diseases	2010
Reduce prevalence of blindness
to 0:5%	2010
Reduce IMR to 30/1000 and MMR
to 100/100000	2010
Increase utilisation of public
health facilities from current
level of 20% to 75%.	2010
Establish an integrated system of
surveillance, national health
accounts and health statistics	2005
Increase health expenditure by
government from 0.9 per cent of
the GDP at present to 3 per cen
of GDP	2012
The states to increase expenditure
on health sector from 5.5 per cent
to 7 per cent of their budget 2005
And further increase to 8%	2010
Increase share of Central grants,
to constitute at least 25% of the
total health spendisng	2010

Ques. 2 : Briefly discuss the challenges for successful implementation of National Health Policy?

Ans. Challenges for Successful Implemen-tation of NHP :

1. It doesn’t articulate any mechanism to regulate the exorbitant drug prices and the spiralling cost of health services to provide succour to a vast section of the population in the low-income group in the post TRIPS era. Already, prices of various essential drugs and formulations have gone up. This become the biggest challenge for the successful implemen-tation of the new health policy which the health authorities in the country should be paying more attention to in the coming years.

2. Under the constitutional structure, public health is the responsibility of the states. In this framework, it has been the expectation that the principal contri-bution for the funding of public health resources will be from the resources of the states, with some supplementary input from Central resources. The successful implementation will, to a large extent, depend on the extent to which the efforts of the centre and the state governments can be co-ordinated and the extent to which the centre can energise the state governments through frequent interactions and monitoring.

3. Some of the goals decided by the policy appear to be too ambitious, especially in the light of the current annual per capita public health expenditure of less than Rs.200.

4. The successful implementation will require not only huge financial commit-ment but more importantly it will require a system of regular monitoring and review of the progress, so that improvement of primary health care turns out to be more than a mere slogan this time.

Health Care System of India

The health care system is required so as to deliver the health care services. It constitutes the management sector and involves organisational matters. It operates in the context of the socio-economic and political framework of the country. In India, it is represented by five major sectors or agencies which differ from each other by the health technology applied and by the source of funds for operation. These are:

1. Public Health Sector

(a) Primary Health Care
- Primary Health Centres
- Sub-Centres
(b) Hospital/Health Centres
- Community Health Centres
- Rural Hospitals
- District Hospitals/Health Centre
- Specialist Hospital
- Teaching Hospital
(c) Health Insurance Schemes
- Employment State Insurance
- Central Government Health Scheme
(d) Other Agencies
- Defence Services
- Railways

2. Private Sector

(a) Private Hospitals, polyclinics, Nursing Homes and Dispensaries.
(b) General Practitioners and Clinics

3. Indigeneous System of Medicine

- Ayuryeda and Siddha
- Unani and Tibbi
- Homeopathy
- Unregistered Practitioners

4. Voluntary Health Agencies

5. National Health Programmes

Ques. 3 : Give an account of the Primary health care in India?

Ans. Primary Health Care In India : The International Conference at AIma-Ata, 1978 (USSR) has ushered in a new approach to, health care, known as “Primary Health Care”. Before Alma-Ala, primary health care was regarded as synonymous with “basic health services”, first contact care, “easily accessible care” etc. The Alma-Ata conference gave primary health care a wider meaning. The Alma-Ata Conference defined primary health care as “Primary Health Care is essential health care made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and country can afford.” The concept of primary health care has been accepted by all countries as the key to attainment of “Health for All” by 2000 A.D. It has also been accepted as an integral part of the country’s health system.

Elements of Primary Health Care

The Alma-Ala declaration has outlined eight (8) essential components of primary health care:

1. Education concerning prevailing health problems and the methods of preventing and controlling them.
2. Promotion of food supply and proper nutrition.
3. An adequate supply of safe water and basic sanitation.
4. Maternal and Child Health Care; including family planning.
5. Immunisation against major infectious diseases.
6. Prevention and control of locally endemic diseases.
7. Appropriate treatment of common diseases and injuries.
8. Provision of essential drugs.

Primary health care seeks to ensure universal coverage and equitable distribution of health resources. To implement this policy at Village Level, the following schemes are in operation:

1. Village Health Guide Scheme

A village health guide is a person with an aptitude for social service and is not a full-time government functionary. Health guides are mostly women. Health Guides come from and are chosen by the community in which they work. They serve as links between community and the govern-mental infrastructure. They provide the first contact between the individual and the health system.

2. Training of Local Dais

As most deliveries in small areas are conducted by untrained dai, under the Rural Health Scheme a programme for training dai’s in elementary concept of maternal and child health sterilisation and obstetric skills.

3. Anganwadi Workers (AW).

Under the ICDs (Integrated Child Development Services) Scheme, there s an Anganwadi Worker for a population of 1000. Anganwadi Worker is selected from the community she is expected to service. She is a past-time worker and renders services like health check-up, immunisation, supple-mentary nutrition, health education, non-formal pre-school education and referral services. Along with, village health guides, the Anganwadi Workers are the community’s primary link with the health services and all other services for young children.

Sub-Central Level

The sub-centre is the peripheral outpost of the existing health delivery system in rural areas. They are established on the basis of sub-centre for every 5000 population in general and one for every 3000 population in hilly, tribal and backward areas. Each sub-centre is manned by one male and one female multi-purpose health worker. The work at sub-centre is supervised by male and female health assistants. At present the functions of sub-centre are limited to mother and child health cafe, family planning and immunisation.

4. Primary Health Centre Level

The National Health Plan (1983) proposed reorganisation of primary health centres on the basis, of one primary health centre (PHC) for every 30,000 rural population in the plains and one PHC for every 20,000, population in hilly, tribal and backward areas for more effective coverage.

5. Community Health Centres

A community health.centre covers a population of 80,000 to 1,20,000 with 30 beds and specialists in surgery, medicine, obstetrics, gynaecology, paediatrics with x-ray and laboratory facilities.

Ques. 4 : Briefly discuss the levels of health care?

Ans. Health care services are described at 3 levels viz., primary, secondary and tertiary care levels. These levels represent different types of cases involving varying degrees of complexity.

1. Primary Care Level

It is the first Ievel of contact of individuals, the family and community with national health system, where primary health care is provided. In India, primary health care is provided by primary health centres and their sub-centres through the agency of multipurpose health workers, village health guides and local dais.

2. Secondary Care Level

At this level more complex health problems are dealt with. Such case is provided by district hospital and community health centres which also serve as the first referral level.

3. Tertiary Care Level

It is a more specialised level than secondary case level and requires specific facilities and attention of highly specialised health workers. This is provided by regional or central level institutions e.g., Medical College, Hospitals, All-India Institutes.

Ques. 5 : Comment on the following in not more than 50 words each:

1) Ayurveda 2) Siddha 3) Unani
4) Homeopathy 5) Yoga 6) Naturopathy

Ans.

1. AYURVEDA

Ayurveda (or science of life) originated in vedic period. The medical knowledge in Atharvaveda gradually developed into the science of Ayurveda. Celebrated authorities in Ayurveda are Atreya, Charakha, Shshruta and Vaghbhatt. According to ‘Tridosha theory of disease’ in Ayurveda, there are 3 doshas or humors: vata (wind), pitta (gall) and Kapha (mucus). Disease occurs when the equilibrium between these 3 humors is disturbed. Diagnosis in Ayurveda involves questioning, examination (of pulse, tongue, urine etc.) and inference treatment involves preventive measures and curative measures that include intake of drugs and medicines.

2. SIDDHA

The basic principles and doctrines of Siddha system are similar to those of Ayurveda. Both Ayurveda and Siddha are holistic systems of medicine dealing with mind, body, soul and phenomena of nature. Siddha was practised in southern part of India.

3. UNANI

Unani originated in Greece but was brought to India by Arabs and Persians. It is based on Humoral Theory which states that there are 4 humours blood, phlegm, yellow bile and black bile. These 4 humours have specific temperaments and their proportion determines the temperament of a human changes in balance of humour causes changes in temperament and consequently affect health of individual. The diagnosis of diseases and their treatment in Unani system of Medicine aims at re-establishing the original humoural constitution of individual.

4. HOMEOPATHY

Homeopathy is a system of medicine that cures natural diseases by administering drugs which have been experimentally proved to possess the power of producing similar artificial symptoms on healthy human beings. Homeopathy was discovered by German Physician Dr. Samuel Hahneman.

5. Yoga

Yoga is a way of life, propounded by Rishi Yajyavalkya and later systematised by Patanjali. The practice of Yoga improves, physical health, personal and social behaviour, provides relief from stress and strain, increases resistance power of body, etc.

6. Naturopathy

Naturopathy like Yoga is a way of life. It believes in the practise of applying the simple laws of nature to life. Particular attention is paid to eating and living habits, use of hydrotherapy, cold packs, mud packs, massage, etc: According to. Naturopathy also called drugless treatment system, an organised natural way of life is the key to health, energy and happiness.

 

Answer of Question 1: A

Answer of Question 2: B