Dr. Rakesh Kumar, Dr. Kapil Yadav, Dr. Chandrakant S Pandav, Professor & Head, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi

Take Home Messages Background Public Health Approach to Substance Abuse Principles of successful integration Integration in National Rural Health Mission Take Home Messages

Substance abuse is common in rural area. Huge prevention and treatment gap in substance abuse. Public health approach can bring high dividends Integration into National Rural Health Mission for efficient service delivery

Changes in the functioning of human mind and more specifically leads to a state of intoxication

Substance abuse is common in rural area. Huge prevention and treatment gap in substance abuse. Public health approach can bring high dividends Integration into National Rural Health Mission for efficient service delivery

Drug TypeRural (n=31,159) % Urban (N= 9538), % Alcohol Cannabis Opiates Source-NHS

Demand ReductionSupply Reduction To protect the health of people, particularly the most vulnerable, from the dangerous effects of drug use and from drug use disorders Health Care To reduce drug related diseases and social Consequences Harm Reduction

Clinical MedicinePublic health UNIT OF STUDY Individual Population/ Community TARGET GROUP Mostly Patient – with disease Diseased and healthy individuals VIEWPOINT OF HEALTH SYSTEM Mostly passive process Active process TYPE OF CARE Major focus on curative care Comprehensive care SERVICE PROVIDERS Majority by private sector Both public & private sector BENEFITS Short term benefits Obvious benefit Long term benefits Not obvious In Public Health – Good work means no patients

Prevention is better than cure Best should not be the enemy of good Good for many rather than best for few Primary health care is NOT primitive care

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Awareness and education Management through motivational counseling, treatment, follow-up and social reintegration of recovered patients Educated cadre of service providers – Drug abuse prevention and rehabilitation training

Proper policy and plans Advocacy Manpower training Realistic tasks

Access to drugs Co-ordination with other sectors Proper support

Launched on 12 th April, 2005 with an objective to provide effective health care to the rural population, by improving access, enabling community ownership strengthening public health systems for efficient service delivery Enhancing equity and accountability Promoting decentralization

NRHM – Main Approaches 21 COMMUNITIZE 1. Hospital Management Committee/ PRIs at all levels 2. Untied grants to community/ PRI Bodies 3. Funds, functions & functionaries to local community organizations 4. Decentralized planning, 5. Intersectoral Convergence IMPROVED MANAGEMENT THROUGH CAPACITY 1. Block & District Health Office with management skills 2. NGOs in capacity building 3. NHSRC / SHSRC / DRG / BRG 4. Continuous skill development support FLEXIBLE FINANCING 1. Untied grants to institutions 2. NGOs for public Health goals 3. NGOs as implementers 4. Risk Pooling – money follows patient 5. More resources for more reforms INNOVATION IN HUMAN RESOURCE MANAGEMENT 1. More Nurses – local Resident criteria X 7 emergencies by Nurses at PHC. AYUSH x 7 medical emergency at CHC 4. Multi skilling MONITOR, PROGRESS AGAINST STANDARDS 1. Setting IPHS Standards 2. Facility Surveys 3. Independent Monitoring Committees at Block, District & State levels

BLOCK LEVEL HOSPITAL Villages Strengthen Ambulance/ transport Services Increase availability of Nurses Provide Telephones Encourage fixed day clinics Ambulance Telephone Obstetric/Surgical Medical Emergencies 24 X 7 Round the Clock Services; BLOCK LEVEL HEALTH OFFICE – Accountant CLUSTER OF GPs – PHC LEVEL 3 Staff Nurses; 1 LHV for 4-5 SHCs; Ambulance/hired vehicle; Fixed Day MCH/Immunization Clinics; Telephone; MO i/c; Ayush Doctor; Emergencies that can be handled by Nurses – 24 X 7; Round the Clock Services; Drugs; TB / Malaria etc. tests GRAM PANCHAYAT – SUB HEALTH CENTRE LEVEL Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages; Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic VILLAGE LEVEL – ASHA, AWW, VH & SC 1 ASHA, AWWs in every village; Village Health Day Drug Kit, Referral chains 100,000 Population 100 Villages 5-6 Villages Accredit private providers for public health goals Health Manager Store Keeper NRHM – Illustrative Structure

Assessment of Community needs Identification of high risk individuals. Counseling and education of such individuals. Handling crisis situations in the families. Providing moral support.

Organizing and participating IEC/ Awareness programmes for various groups such as high risk groups and schools. Linkages & Coordination with governmental health systems and non-governmental organization. Creation and operationalizing self help groups

Early diagnosis (case finding / screening) and treatment of cases including referrals Helping the patient to identify substance abuse behavior and its consequences. Offering constant support to the patients.. Encouraging the patients to participate in treatment programme and continue.

Referring the patients to appropriate agencies and organizations for seeking economic support for starting some vocation. Minimizing the stigmatization and discrimination against the patient by the community. Working in close liaison with governmental and non- governmental organizations for rehabilitation of the patients

Thank You 29