health care delivery concerns, national health programme, family welfare programme, intersectoral...

HEALTH CARE DELIVERY CONCERNS

NATIONAL HEALTH PROGRAMME

FAMILY WELFARE PROGRAMME

INTERSECTORAL COORDINATION

ROLE OF NGO

By:- firoz qureshiDept. psychiatric nursing

INTRODUCTION

Community health nursing occurs in context of

health care delivery system and this system influence

community health nursing practice. Due to lack of

emphasis on health promotion in health care delivery

system increases the need for health promotion

efforts by community health nurses .Therefore Heath

and health care concern throughout the world has

developed a system for addressing these concerns.

Health care delivery concernsThroughout the world

approximately 4.5 million children die each year from diarrheal diseases, while communicable diseases of all kinds remains a serious problem in the last 10 years . An assessment of the health status is required to make a plan for the Health care delivery services. This assessment will bring out major health problem which are the major health care concerns.

Health Concerned Areas

1.Communicated disease Problem

Malaria ,TB, Diarrhoeal diseases, Acute Respiratory Infection, Leprosy, Filaria , AIDS , Kala Azar, Meningitis, Viral Hepatitis ,Japanese Encephalitis , Enteric Fever, Helmenthis infection , Immunization problem.

2.Nutrional problem

• Protein- Energy Malnutrition

•Nutritional Anaemia

• Low Birth Weight

•Iodine Deficiency Disorder

•Endemic Flurosis

Health Concerned Areas Cont...

3. Medical Care Problems

Lack of medical care professionals.

Over– crowding in hospital as a result of migration of

people from rural areas.

Scarcity of resources.

Inequitable distribution of services.

Chronic Diseases and Mental health problem.

Adolescent Pregnancy.


4.Evironmental Sanitation Problem

Lack of Safe water.

Primitive method of excreta disposal.

Global concern over radiation.

Destruction of Ozone layer.

Air pollution.

Lead poisoning.

Chemical contamination of food supplies.


5. Population Problems

The population explosion has inevitable consequences

in all aspects of development, employment, education,

housing, health care, sanitation and environment .The

country’s growth is 1.93% and the Government’s goal is

to reduce it to 1%.

6.Human Response to Disasters

Natural and manmade disasters are affecting large

number. e.g. Toxic chemical leak in Bhopal in 1985.

International efforts coordinated by WHO and

International Red Cross have lead to the development of

disaster planning groups throughout the world.

NATIONAL HEALTH PROGRAMMES

To improve the health status of people, to control communicable diseases, improvement of environment sanitation, control of population etc. the Central Government launched the National Health Programmes.

A)Programmes for Communicable Diseases1. National Vector Borne Diseases Control Programme

(NVBDCP)2. Revised National Tuberculosis Control Programme3. National Leprosy Eradication Programme4. National AIDS Control Programme5. Universal Immunization Programme6. National Guinea worm Eradication Programme7. Yaws Control Programme8. Integrated Disease Surveillance Programme

NATIONAL HEALTH PROGRAMMES

Cont...

B)Programmes for Non Communicable Diseases

1. National Cancer Control Program

2. National Mental Health Program

3. National Diabetes Control Program

4. National Program for Control and treatment of Occupational Diseases

5. National Program for Control of Blindness

6. National program for control of diabetes, cardiovascular disease and stroke

7. National program for prevention and control of deafness

NATIONAL HEALTH PROGRAMMES Cont...

C)National Nutritional Programmes

Integrated Child Development Services Scheme

Midday Meal Programme

Special Nutrition Programme (SNP)

National Nutritional Anemia Prophylaxis Programme

National Iodine Deficiency Disorders Control Programme


D)Programs related to System Strengthening

/Welfare

1. National Rural Health Mission

2. Reproductive and Child Health Programme

3. National Water supply & Sanitation Programme

4. 20 Points Programme


1. National Anti-Malarial Programme (NMCP)

National Malarial Programme was launched in

April 1953 and was based on spraying with DDT .

It also paid rich dividends to the country in

different fields like agriculture, land projects and

industry which changed the strategy and launched

National Malaria Eradication Programme in 1958

and renamed as National Anti-Malarial Programme

in 1999 .


2. National Filaria Control Programme

It has been in operation since 1955.It was merged with the

urban malaria scheme for maximum utilisation of available

resources. It includes vector control through anti-larval

operations, source reduction, detection and treatment of

microfilaria carriers, morbidity management and IEC.

3. National Leprosy Eradication Programme

National Leprosy Control Programme has been in operation

since 1955, as a centrally aided programme to achieve control

of Leprosy through early detection of cases and DDS

(Dapsone) monotherapy on an ambulatory basis.


3.National Leprosy Eradication Programme Cont...

In 1983, it was redesigned as National Leprosy Eradication

Programme which was based on yearly detection of cases( by

Population surveys, school surveys and voluntary referrals),

short term multi drug therapy, health education, ulcer and

deformity care and rehabilitation activities.

4. National Tuberculosis Programme

It has been in operation since 1962 and its objectives were to

reduce tuberculosis in the community to that level when it

ceases to be a public health problem and to detect the

maximum number of TB cases,to vaccinate newborns and

infants with BCG and to undertake the objectives in an

integrated manner through all the existing health institutions

in the country.


4. National Tuberculosis Programme Cont...

In 1992, the government of India, WHO, and World Bank together reviewed the NTP and this programme is known as Revised National Tuberculosis Control Programme which aims augmentation of case finding activities, involvement of NGOs, IEC and improved operational research.

5. National AIDS Control Programme

It was launched in 1987 which aimed at to reduce the spread of HIV infection in India and to strengthen India’s capacity to respond to HIV/AIDS on the long term basis.

• In April 2002, National AIDS Prevention and control policy were approved by government of India, which aimed in reduction of the impact of epidemic and to bring about a zero transmission rate of AIDS by the year 2007.


5.National AIDS Control Programme Cont...

In April 2002, National AIDS Prevention and control

policy were approved by government of India, which

aimed in reduction of the impact of epidemic and to bring

about a zero transmission rate of AIDS by the year 2007.

6.National Programme for Control of Blindness

It was launched in 1976 which aimed to strengthen service

delivery, developing human resources for eye care,

promoting out reach activities and public awareness; and to

establish eye care facilities for every 5 lakh persons.

• Vision 2020:The Right to Sight –to reduce avoidable

blindness by the year 2020.


7.Iodine Deficiency Disorders Control Programme

It is in operation since 1962.Its essential component are use of iodized salt in place of common salt, monitoring and surveillance, manpower training and mass communication.

8. Universal Immunisation Programme.

In 1974, the WHO launched its “Expanded programme on Immunisation”(EPI) against six preventable childhood diseases(Diphtheria, Pertusis, tetanus, polio, TB and Measles).

Universal Immunisation Programme, was started in India in 1985.It has two vital components: Immunisation of pregnant women against tetanus, and immunisation against six EPI targeted childhood diseases.

Introduction of Hepatitis-B Vaccine, Urban Measles Campaign and Neonatal Tetanus Elimination.


9. National Cancer Control Programme

• It was launched in 1975-76 with objectives of prevention, early diagnosis, treatment.

• It was revised in 1984-85 with objective of primary, secondary, tertiary prevention.

10. National Water Supply And Sanitation Programme

It was launched in 1954 with object of providing safe water supply and adequate drainage facilities for the entire urban and rural population of the country.

11.Minimum Need Programme

It was introduced in the first year of the Fifth Five Year Plan (1974-1978) with the objective to provide certain basic minimum needs and thereby improve the living standards of the people.


12. 20-Point Programme

It was launched in 1975, by the Government of India with

the objective to promote social justice and economic growth.

Point 1:Attack on rural poverty

Point 7:Clean drinking water

Point 15:Improvement of slums

Point 17:Protection of the environment

13.National Mental Health Programme

It was launched during 1982 with a view to ensure

availability of Mental Health Care Services for all, especially

at risk and underprivileged section of the population, to

encourage and social development.


13.National Mental Health Programme Cont...

Aims

Prevention and treatment of mental and neurological disorders and their disabilities.

Use of mental health technology to improve general health services.

Application of mental health principles in total national development to improve quality of life.

14. Reproductive and Child Health Programme

It was launched on 15 October 1997 which incorporated family planning, child survival and safe motherhood component, client approach to health care and prevention / management of reproductive tract infection, STD and AIDS.


14. Reproductive and Child Health Programme continued.....

The main highlights of RCH Programme are:

1.It integrates all interventions of fertility regulation, maternal and child health with reproductive health for both men and women.

2. The services to be provided are client oriented, high quality and based on needs of community.

3. It envisages up gradation of the level of facilities for providing various intervention and quality of care. The First Referral Units (FRUs) being set up at sub-district level provide comprehensive emergency obstetric and new born care.

4. Facilities of obstetric care, MTP and IUD insertion in the

PHCs level are improved. IUD facilities are also available at

sub-centres.

5. The programme aim at improving the out-reach of services primarily for the vulnerable group of population.


14. Reproductive and Child Health Programme continued.....

• RCH Phase II

It began form 1st April 2005.whose focus is to reduce maternal and child morbidity and mortality with emphasis on rural health care. Its component include essential and emergency obstetric care and strengthening referral system.

15. National Guinea-Worm Eradication Programme

India launched this Programme in 1984 with technical assistance from WHO.

16.Degue Fever Control Programme:

An outbreak was reported in1996.Since then dengue has been reported. It includes all aspect of control measure like identification of outbreak, vector control, case management, IEC activities, monitoring and reporting, etc.


17.National surveillance Programme For Communicable

Diseases:

It was launched by Ministry of Health and Family Welfare for

detection of early warning signals of outbreak emerging and

re-emerging infectious diseases, and rapid response for

prevention and control of these outbreak and diseases.

18.National Rural Health Mission:

The Government of India launched this programme on 5th

April, 2005 for a period of 7 years (2005-2012). The main aim

is to provide accessible, affordable, accountable, effective and

reliable primary health care, and bridging the gap in the rural

health care through creation of a cadre of Accredited Social

Health Activist(ASHA).


19.Nutritional Programme:

A)Vitamin A Prophylaxis Programme:

One of the component of National Programme for Control of

Blindness is to administer single dose of vitamin A containing

200,000 IU orally to all to al preschool children in the

community every 6 month through peripheral health workers.

B)Prophylaxis against nutritional anaemia:

It consist of distribution of iron and folic acid tablets to

pregnant women and young children (1-12 years). MCH in

urban centres in urban areas, primary health centres in rural

areas and ICDS project are engaged in the implementation of

this programme.

C)Control of iodine deficiency disorder.


D)Special nutritional programme

It was started in 1970 for the nutritional benefit of children

below 6 years of age, pregnant and nursing mother. The

supplementary food supplies about 300kcal and 10-12grams of

protein per child per day .The mother receive daily 500kcal

and 25grams of protein. It is provided for 300 days in a year.

E)Balwadi nutritional programme:

It was started in 1970 for the benefit of children in the age group

of 3-6 years in rural areas. It provides 300kcal and 10 grams of

protein per child per day.

F) ICDS(Integrated Child Development Scheme):

It was started in 1975 for preschool children below 6 years and

adolescent girls 11-18 years, pregnant and lactating mother.


G)Mid- day meal programme is also known as School Lunch

Programme:

It has been in operation since 1961 with the objective to attract

more children for admission to schools and retain them so that

literacy improvement of children could be brought.

20. Kala Azar Control Programme:

A centrally sponsored programme was launched in 1990-91

with 3 strategies which includes reducing vector population,

insecticidal spray twice annually, early diagnosis and complete

treatment and health education for community awareness.


21.Japanese Encephalitis Control Programme:

It is a disease with high mortality rate. The strategies are care of patient, development of safe and standard vaccine, to identify high risk group by measuring blood level of antibodies, epidemiological monitoring of disease for implementation of prevention and control measures.

22.National Diarrheal disease Control Programme:

It was launched in 1981 with strategies as follows-

a)ORS packet available. At each sub centre 300 packets/ year are stocked. Each village health guide is given 100 packets a year.

b)Mass education is imparted to make people aware of correct feeding of preschool children and prevention of dehydration through liberal use of home available fluids.

NATIONAL FAMILY WELFARE PROGRAMME

India launched the National Family Welfare Programme in

1951 with the objective of reducing the birth rate to the extent

necessary to stabilize the population at level consistent with the

requirement of National economy. The Family Welfare

Programme in India is recognised as a priority area, and is

being implemented as a 100%centrally sponsored programme.

During 3rd Five Year Plan(1961-1966) – Family was declared

as the very centre of planned development. The emphasis was

laid on “education approach” for motivating the people for

acceptance of “small family norm”.

1965-Introduction of Lippes Loop

1966-Department of Family Planning by Ministry of Health.

1966-1969-The Family planning infrastructure (PHCs, sub

centres ,district and state bureaus) was strengthened.


4th Five Year Plan(1969-74)-The Government of India gave

top priority to programme which was made an integral part of

MCH activities of PHCs and sub centre.

1970-An All India Postpartum Programme introduced.

1972-The Medical Termination Of Pregnancy(MTP) was

introduced.

5th Five YEAR Plan(1975-1980)-Major changes.

April 1976-The country framed “National Population Policy”.

1977-The Ministry of Family Planning was renamed as

“Family Welfare”. The launching of Rural Health Scheme and

involvement of local people (e.g. Health Guides, trained Dais)

in Family Welfare Programme at grass root level were aimed

at accelerating the pace of progress of programme.


1978-Alma Ata Declaration.

Sixth Five Year Plan(1980-1985)

1982-National Health Policy formed and was approved by parliament in 1983. It laid a goal to attain 2-child family norm through the attainment of birth rate of 21 and death rate of 9 per thousand population by the year 2000.

Seventh Five Year Plan(1985-90)

1985-86- The Universal Immunisation Programme aimed in reduction of mortality and among infants and children due to vaccine preventable disease.

The oral rehydration therapy was also started in view of diarrhoea was a leading cause of death in children.

MCH was implemented to improve health status of mother.


For spacing births:

a) Condoms

b) Oral Contraceptive Pill

c) Intra Uterine Devices (IUD)

Terminal Methods:

a) Tubectomy ;i ) Mini Lap Tubectomy ii) Lapro Tubectomy

b)Vasectomy; i ) Conventional Vasectomy ii) No-Scalpel Vasectomy

1992-Child Survival and Safe Motherhood (CSSM) Programme.

1994-Implementation of Unified Reproductive and Child Health Programme (RCH).


Ninth Five Year Plan(1997-2002)-The concept of RCH is to

provide need based, client oriented, demand driven, high

quality integrated services.

2000-The Government of India evolved a more detailed and

comprehensive National Population Policy to promote family

welfare.

X Five Year Plan objectives: Reduction in the decadal rate of

population growth between 2001 and 2011 to 16.2%; Increase

in Literacy Rates to 75 per cent within the Tenth Plan period

(2002 to 2007) Reduction of Infant mortality rate (IMR) to 45

per 1000 live births by 2007 and to 28 by 2012.


• Goals: XI FYP; Reducing MMR to 100, Reducing IMR to 28, Reducing TFR to 2.1. Providing clean drinking water for all by 2009. Reducing malnutrition among children of age group 0–3 to half its present level. Reducing anaemia among women and girls by 50%. Raising the sex ratio for age group 0–6 to 935 by 2011–12 and 950 by 2016–17.

Ancillary Measures

The age for marriage has been raised to 18 years for girls and 21 for boys.

Group incentives are offered to Doctors, Panchayats, teachers and cooperative societies to promote family welfare.

Donation to government, local bodies and recognised NGOs for family welfare work are exempt from income tax.


Impact

The awareness about family planning was nil

before the launching of the programme has gone

up to 60% in rural and almost 90% in urban

areas.

The pregnancy rate has declined by more than

50% , particularly in urban areas. The birth rate

has declined to 27/1000 population.


Intersectoral Coordination is the primary health care.

It is a crucial component for promotion of intersectoral

linkages which is required for effective implementation of

health services throughout the country.

It ensure convergence of basic social service in order to bring

all health sector services providers into closer and more

responsive working relationships for the benefit of the

society.

This will enable better equity and wider coverage.


The Health Care System is intended to deliver health care services. It operates in context of socio-economic and political framework of country. In India, it is represented by 5 major sectors which differ from each other.

1.Public Sector(PHC, Hospitals, Insurance Scheme etc.)

2.Private Sector(Private hospitals, polyclinics, Nursing homes, dispensaries, general practitioners and clinics)

3.Indegeneous System of Medicine (Ayurveda, Unani, Homeopathy, Siddha etc)

4.Voluntary Agencies

5.National Health Programmes

Intersectoral Coordination Cont.. Voluntary Health Agencies

“A Voluntary Health Agency is defined as an organisation that

is administered by an autonomous board which holds meetings,

collect funds for its support chiefly from private sources and

expends money whether with or without paid worker, in

conducting a programme directed primarily to furthering the

public health by providing health services or education, or by

advancing research or legislation for health, or by a

combination of these activities”.

Functions

1. Supplementing the work of government agencies.

2. Pioneering

3. Education

Intersectoral Coordination Cont...

Function cont...

3.Demonstration

4.Guarding the work of Government Agencies

5.Advancing Health Legislation

Voluntary Health Agencies are

Indian Red Cross Society in 1920.

Hind Kusht Nivaran Sangh in 1950 with headquarters in

New Delhi.

Indian Council for Child Welfare in 1952.

Tuberculosis Association Of India in 1939.

Bharat Sevak Samaj in 1952.

Voluntary Health Agencies cont...

Central Social Welfare Board in August 1953.

The Kasturba Memorial Fund in 1944.

Family Planning Association of India in 1949 with

headquarters at Mumbai.

All India Women’s Conference, 1926.

The All India Blind Relief Society, 1949.

Professional Bodies

International agencies.

NON-GOVERNMENTAL ORGANISATION

DEFINITION

UN says “A non-governmental organization (NGO) is a not-for-profit, voluntary citizens’ group, which is organized on a local, national or international level to address issues in support of the public good”.

Some of the Ngo’s are Rockefeller Foundation, Ford Foundation, International Red Cross, TNAI, All India Women’s conference, Indian Medical Association, World Federation of Medical Education etc.

ROLE OF NGO

Development and Operation of Infrastructure:

Community-based organizations and cooperatives can acquire,

subdivide and develop land, construct housing, provide

infrastructure and operate and maintain infrastructure such as

wells or public toilets and solid waste collection services. They

can also develop building material supply centres and other

community-based economic enterprises. In many cases, they

will need technical assistance or advice from governmental

agencies or higher-level NGOs.

Supporting Innovation, Demonstration and Pilot Projects:

NGO have the advantage of selecting particular places for

innovative projects and specify in advance the length of time

which they will be supporting the project - overcoming some

of the shortcomings that governments face in this respect.

ROLE OF NGO

Supporting Innovation, Demonstration and Pilot Projects Cont...

NGOs can also be pilots for larger government projects by virtue of their ability to act more quickly than the government bureaucracy.

Facilitating Communication:

NGOs use interpersonal methods of communication, and study the right entry points whereby they gain the trust of the community they seek to benefit. They would also have a good idea of the feasibility of the projects they take up. The significance of this role to the government is that NGOs can communicate to the policy-making levels of government, information about the lives, capabilities, attitudes and cultural characteristics of people at the local level.

ROLE OF NGO Cont....

Facilitating Communication Cont...

NGOs can facilitate communication upward from people to the government and downward from the government to the people. Communication upward involves informing government about what local people are thinking, doing and feeling while communication downward involves informing local people about what the government is planning and doing. NGOs are also in a unique position to share information horizontally, networking between other organizations doing similar work.

Technical Assistance and Training:

Training institutions and NGOs can develop a technical assistance and training capacity and use this to assist both CBOs and governments.


Research, Monitoring and Evaluation:

Innovative activities need to be carefully documented and

shared - effective participatory monitoring would permit the

sharing of results with the people themselves as well as with the

project staff.

Advocacy for and with the Poor:

In some cases, NGOs become spokespersons or ombudsmen

for the poor and attempt to influence government policies and

programmes on their behalf. This may be done through a

variety of means ranging from demonstration and pilot projects

to participation in public forums and the formulation of

government policy and plans, to publicizing research results

and case studies of the poor.


Advocacy for and with the Poor Cont...

Thus NGOs play roles from advocates for the poor to

implementers of government programmes; from agitators and

critics to partners and advisors; from sponsors of pilot projects to

mediators.

Provides valuable resources in promoting health care.

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