Kurukshetra July 2017 Comprehensive Summary / Gist: Rural Health (Download PDF)

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Highlights: Of 121 crore population, 83.3 crore is rural population, Maternal & Neonatal Tetanus Elimination (MNTE) in Apr 2015 ahead of target in Dec 2015, Declared Yaws free in 2016 (WHO target 2020), Universal Immunization Program (UIP) – from 6 to 12, Eliminate Kala-Azar & Filariasis by 2017, Eliminate Leprosy by 2018, Eliminate Measles by 2020, Eliminate TB by 2025, Increase budget for health, 5000 PG seats per year to be introduced, National Health Policy 2017 after 15 years – increase health expenditure to 2.5%, Mental Health Policy, 2017, From fitness to wellness, Rural Uttarakhand & Rural Haryana to be 4th & 5th states which are ODF, International Yoga Day – 21 June.

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Kurukshetra July 2017 Summary: Rural Health (In English)

Dr. Manishika Jain in this lecture presents the summary of Kurukshetra July 2017 edition. The edition focused on Rural Health.

UIP (By Minister of Health & Family Welfare)

  • Reduce mortality
  • Healthy and longer life
  • Movement of migrant workers & movement of pathogens
  • Part of Child Survival& Safe Motherhood program in 1992
  • Since 1997, part of National Reproductive & Child Health Program
  • Since 2005, under National Health Mission
  • Mission Indradhanush – 2.6 crore children immunized, immunization coverage increased from 1 % to 5 - 7%, 505 districts covered & 555.9 lakh pregnant women vaccinated for tetanus toxoid, 52.2 lakh ORS packets & 183.1 zinc tablets to children
  • 11 vaccines: Diptheria, Pertussis, Tetanus, Meningitis, Pneumonia by Haemophilus influenza type B (Hib), Childhood TB, Polio, Hepatitis B, Measles, Rubella & Rotavirus (prevent diarrhea) in selected districts & Japanese Encephalitis in endemic areas in 2006 – Assam, UP & W. Bengal.
  • 90 lakh immunization sessions
  • 27,000 cold chain points across India
  • Polio last case in India - 13th Jan 2011
  • South East Asia Region certified polio free on 27th March 2014
  • Measles as part of Routine Immunization in 1985,2nd dose in 2010 in 22 states, now all states have 2 does of measles
  • Hepatitis B piloted in 2002 - 03 & throughout India in 2010
  • Pentavalent Vaccine: Hepatitis B + DPT + Hib – initially in 2 states of Kerala & Tamil Nadu in 2011 & now all states
  • Now Rubella as Measles Rubella (MR) in 2017 – 3.32 children covered with 97 % coverage
  • Aim to launch Pneumococcal Conjugate Vaccine in HP, UP & Bihar in 1st phase
  • As of 25th April 2016: India switched from trivalent OPV to bivalent OPV for polio
  • Inactivated Polio Vaccine launched in Nov 2015
  • Rotavirus launched in 2016

National Health Policy 2017 (Basis)

  • Article 47, DPSP – duty of state to raise level of living
  • 1943: Joseph Bhor Committee – one bed for 550 people & 1 doctor for 4600 people
  • 1946: PHC for 40,000 people, CHC for 5 PHCs & 30 beds, District Hospital with 200 beds
  • Decrease IMR & MMR
  • Increase life expectancy
  • Family planning
  • 1978: primary health care to all people
  • 1983: 1st National Health Policy
  • 2002: National Health Policy – increase public investment to 2 % of GDP
  • 2005: National Rural Health Mission

National Health Mission

  • It had 4 components:
  1. National Rural Health Mission
  2. National Urban Health Mission
  3. Tertiary Care Programs
  4. Human Resources for Health & Medical Education
  • Beyond Reproductive and Child Health to Communicable & Non-Communicable diseases
  • Has two departments as Health & Family Welfare – flexible financing, monitor institutions, capacity building, simplified HR practices
  • Establish National Health Systems Resource Center (NHRSC)
  • Ambulance service for maternity & emergency cases
  • ASHA (Accredited Social Health Activists Care) workers deployed
  • At PHC & CHC: Rogi Kalyan Samiti
  • Health for all – Vision for nation
  • Mission Indradhanush – 90 % coverage by 2020
  • India Newborn Action Plan – to reduce neonatal mortality rate – single digit NMR by 2030 & single digit still birth rate by 2030 – 661 special newborn units, 2321 newborn stabilization units & 18,323 newborn care corneers
  • 2016: Mother’s Absolute affection program to promote breastfeeding
  • Rashtriya Bal Suraksha Program -4Ds – Deficiency, Disease, Development delays & Disability
  • Rashtriya Kishore Swasthya Karyakram – adolescent programs- 3.2 crore children given weekly iron folic acid (SABLA scheme), 1.8 lakh peer educators
  • Pradhan Mantri Surakshit Matritva Abhiyan (2016) – antenatal care & counselling, services by medical officer & OBGY specialist – 11,000 facilities & 33 lakh antenatal checkups
  • Mission Family Welfare
  • Janani Shishu Suraksha Karyakram: free transport to & from govt hospital within 48 hours of delivery, free drugs, free blood & free diet – duration stay in hospital for 3 days in normal & 7 days in caesarean
  • Janani Suraksha Yojana: in 2005 under NHRM for delivery at public hospitals – reduction of 3.7 perinatal deaths per 1000 pregnancies & 2.3 neonatal deaths per 1000 live births
  • Swach Swasth Sarvatra
  • Pradhan Mantri National Dialysis Program
  • Kayakalp Program in 2016 – for hygiene, sanitation and waste management

National Health Policy 2017

  • Health sector spending to 2.5%
  • 2 beds per 1000 population
  • Free drugs & diagnostics in all public hospitals
  • Increase life expectancy to 70 years by 2025
  • Reduce IMR to 28 by 2018
  • 6 states – Bihar, UP, MP, Rajasthan, Jharkhand & Chattisgarh have 42 % population & 56 % annual population increase
  • Upgrade 1.5 lakh health sub centers
  • Scheme for pregnant women to get Rs. 6000 – in Jan 2017 (1000 for registration, 2000 after 6 months of pregnancy & 2000 after child’s first vaccinations are done) – barriers to availability, accessibility and utilization
  • Build AIIMS as national & global brand
  • One nation, one examination – NEET – amended by MCI
  • Increase 5000 PG seats per year
  • Online registrations in 71 hospitals
  • Patient centric feedback system – Mera Aspataal
  • Affordable healthcare for all
  • Shift from PHC to comprehensive care
  • Retain doctors in remote areas
  • Assurance based approach with more accessibility and affordability
  • Focus on Active Pharmaceutical Ingredient (API)
  • Promote tele-consultation – National Knowledge Network for same
  • Introduction of Electronic Health Record
  • System strengthening & strategic engagements

IMR & MMR

  • Highest in the world
  • 1/5th of global MMR
  • MMR: maternal deaths per 100,000 live births
  • 2013: MMR - 167, IMR – 41/1000 live births, NMR – 27/1000 live births
  • 70 % infant deaths & half of under-5 in neonatal period
  • Maximum deaths in 8 EAGs + Assam
  • 3 million deaths by malnutrition per year’165 million children remain stunted with cognitive & physical capabilities
  • Neeonatal deaths – 52 % due to complications in pregnancy & 48 % as post neonatal cause
  • Main cause of under-5 deaths: Pneumonia (16%) & Diarrhoea (12%) – both of these cause 56 % post neonatal deaths
  • Determinants of Maternal & Child Health
  1. Educational opportunities
  2. Employment for women
  • RMNCH + A (Reproductive, maternal, neonatal, child & adolescent health strategy) – continuum of care for adolescent, mother & child – in 3 areas – facility based, outreach & home & community
  • VHSNC: Village Health Sanitation & Nutrition Committee
  • VHNDs: Village Health Nutrition Days – 1st contact primary health care – once every month at anganwadis – Vitamin A, anti-TB drugs, IFA, calcium tablets

WASH (Water, Sanitation & Hygiene)

  • India – 27.4 per lakh mortality associated with WASH
  • Only 18 % of rural households get treated water supply – very low in Bihar, Assam, Jharkhand, W. Bengal & Odisha
  • 70 % rural areas have open defecation
  • UN vowed to eliminate open defecation by 2025
  • Open defecation is main cause of diarrhea – 2000 children aged less than 5 succumb to diarrhea & every 40 second a life is lost
  • As of UNICEF, India accounts for 90 % in S. Asia & 59 % in world who practice open defecation
  • Irrigation efficiency is low – 50 - 60%, wasteful water & excess fertilizers
  • Health facilities
  • Sub-Health Centers: 3000 in tribal & hilly areas & 5000 in plains – covers 4 villages (20)
  • PHC: 20,000 in tribal & hilly areas & 30,000 in plains – covers 25 villages (122)
  • CHC: 80,000 in tribal & hilly areas & 120,000 in plains – covers 119 villages (563)

Programs

  • National Rural Drinking Water Program (2009) by Ministry of drinking water & sanitation
  • National Rural Drinking Water Quality Monitoring & Surveillance Program (2005)
  • Jalmani Program (2008): for safe drinking water
  • Swachh Bharat Mission (Gramin) – 2014
  • PURA – 2003
  • National Rurban Mission by Ministry of rural development in 2015
  • Separate toilets for girls in schools

Health Hazards in Rural Areas & Works

  • As of 2005: shortfall of 12 % SHC, 16 % PHC, 50 % CHC
  • 86 % medical visits by ruralites who travel more than 100 km
  • 70 - 80 % expense is born out of pocket
  • Water related diseases kill 5 million people per year
  • Cholera, typhoid and diarrhea (2.2 million death per year) by contaminated water
  • Mosquito born diseases – 1 million die every year due to it
  • Health issues to be addressed: reproductive health, inadequate nutrition, HIV/AIDS (2.4 million people of which 39 % are women), high IMR & MMR, malnutrition, Protein Energy Malnutrition, Iodine deficiency
  • SDG -3: Good Health & well being
  • SDG -6: Clean water & sanitation
  • National Deworming day – dose of albendazole since 2014 to 75 crore students between 1 - 19 years
  • ICDS: Integrated Child Development Scheme
  • Nirmal Bharat Abhiyan: universal toilet coverage by 2022
  • National Disease Control Program
  • Preventive, Promotive, curative & specialized services
  • Biggest challenge is shortfall of services
  • 8774 positions are vacant at PHCs
  • CHC as referral and specialist services
  • Vacant positions: 1811 surgeons, 1859 OBGY, 1989 physicians, 1758 pediatricians & 1955 radiologists
  • Government developed Indian Public Health Standards

Rural-Urban Divide

Table Contain Shows the Rural-Urban Divide

Table Contain Shows the Rural-Urban Divide

Type

Rural

Urban

Ante-natal care

17%

31.1%

Postnatal Care

58%

72%

Under-5 Underweight

38%

29%

Knowledge of HIV

29%

37%

Improved Sanitation

36.7%

70.3%

Clean fuel for cooking

24%

80.6%

Adolescent Health

  • 200 million in India & 60 % in rural areas
  • 33 % diseases & 60 % premature deaths due to bad habits in adolescence
  • Increase accessibility, availability and partnership in rural areas
  • Balika Samridhi Scheme: Change negative attitude towards girls
  • Rajiv Gandhi Scheme for Empowerment of Adolescent girls
  • ARSH clinic: Adolescent Reproductive & Health Services
  • 40 - 60 minutes physical activity in schools per day
  • Health communication and inter-sectoral convergence

Telemedicine

  • Connecting remote areas with metros
  • 1925: Hugo Gernsback – robot fingers and radio technology – teledactyl
  • NASA – 1960 – telemedicine to space
  • Bluetooth, Wi-Fi
  • iOT (Internet of Things) – network physical devices, vehicles as connected devices and smart devices
  • Preventive & reactive health care
  • Remote consultation
  • Remote monitoring
  • Health kiosks & PHCs without physical doctor run by paramedic
  • e-AUSHADI: purchase, inventory management & distribution of drugs
  • e-RAKT KOSH: for all licensed blood banks in public and private health facilities – piloted in MP & W. Bengal
  • Platforms: Practo, Lybrate, Askapollo, Doctorsinsta – 24 × 7 online consultation
  • Online Apps: Docsapp & Curefy – 1st consultation free of cost
  • Evolko Systems: offline-online model with AIIMS, Patna
  • Startup: Doctorkepaas – PHCs in remore areas of Andhra Pradesh
  • Sehat: consult doctor online & order drugs online
  • Teleconsultation with Apollo & Medanta
  • Consist of VSAT system, ECG machines, X-ray
  • Rural India has 500 million wireless telephone subscribers & growing at 1.05 % per month
  • National Telemedicine Network: service to remote areas like PHC, CHC etc.
  • Communication in rural areas by 3 steps: make people realize the problem, initial cost and call for action
  • Pulse Polio Mission – Do Boond Zindagi ki
  • Family planning – Hum Do Humare Do
  • Dangal – articulated gender stereotyping of girls
  • Mozambique – awareness of immunization by door to door canvassing

AYUSH

  • Ayurveda, Yoga, Unani, Siddha & Homeopathy
  • India: Highest practitioners and users for homeopathy in world
  • Indian System of Medicine: diversity, accessibility, affordability, acceptance in public, low cost, low technology & great potentials
  • 6000 - 8000 species of medicinal plants are documented in medical literature
  • 300 species of medicinal fauna
  • 70 metals and minerals by AYUSH
  • Ayurveda gram: cluster of 10 - 100 villages for cultivation of medicinal plants
  • Enormous medicinal wealth in NE states, Jharkhand, Uttarakhand & Chattisgarh needs to be harnessed
  • Therapies like panchkarmas & yoga and ashrams for holistic care – medical tourism
  • AYUSH education and AYUSH drugs, technology upgradation, professional education, using human resources
  • Yoga: In list of intangible cultural heritage of humanity in UNESCO – increased acceptance of Indian Traditional Medicine System with WHO
  • Sowa-Rigpa: oldest surviving health tradition of world with 2500 years in Leh & Ladakh, HP, Arunachal Pradesh & Sikkim – 5 cosmological physical elements in formation of human body
  • Lessons from China: Popularized & preserved indigenous medicines in western countries
  • Lakulish Yoga University by Life Mission Trust of Gujarat: Claimed to be first ever private sector self-financed institution in India
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Kurukshetra July 2017 Summary: Rural Health (In Hindi)

Dr. Manishika Jain in this lecture presents the summary of Kurukshetra July 2017 edition. The edition focused on Rural Health.

- Published/Last Modified on: November 22, 2017

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