PUBLIC HEALTH MANAGEMENT IN INDIA

PUBLIC HEALTH AND MANAGEMENT The science and practice of protecting and improving the health of a community through –preventive medicine –health education –control of communicable diseases –application of sanitary measures –monitoring of environmental hazards This is the goal of the public health system. Management involves with the planning, implementation and control of the organization to reach its goal.

Why do we need the public health system?.... Facilitates economic growth and poverty reduction Poor public health conditions lead to –Reduced attraction for investors and tourists –continued expenditures on combating diseases –Decrease in labor productivity

Health and hygienic measures were different in various periods of Indian history. the public baths and highly developed water systems during the early Indus valley civilization. epidemics and illnesses must have been frequent, according to the available records. Traditional medicine recognized the concept of quarantine. difficult to ascertain when hospitals were first begun. From the inscriptions from 3 rd century B.C.(Asoka’s rule of Mauryan dynasty), there were statements that there were hospitals for humans and some animals. Charaka's principles. PUBLIC HEALTH MANAGEMENT IN ANCIENT INDIA

PUBLIC HEALTH IN BRITISH INDIA Preventive medicine was exercised only to –To keep the British and Indian troops healthy –To maximize productivity of labour force –To achieve social control of the local population Sanitation and water supply was limited to army cantonments and British residential areas. ‘Unable to persuade the government of the utility of these (anti-mosquito) measures and prevented from continuing research, Ronald Ross left India in 1899, a disgruntled and bitter man.’ - Harrison (Mosquito, Malaria and Man)

In spite of all these limited purposes, British rule offered: Institutions for public health training and research (All-India School of Public Health and Hygiene, Calcutta School of Tropical Medicine). Public Health legislation Sanitary Departments at national and provincial levels. Policy making and planning for public health services, done systematically to address all major threats to the public health.

At the end of the colonial rule: the mortality spikes from epidemics were sharply reduced. Mortality from diseases such as cholera and the plague had fallen sharply. malaria and gastro-enteric infections continued to take heavy tolls. only 3 percent of households in India had toilets. much of the population lacked basic water, drainage and waste disposal services

PUBLIC HEALTH IN INDEPENDENT INDIA The capacity of the colonial public health systems to prevent outbreaks from occurring has atrophied. Mass-production of antibiotics lead to a brief stoppage of communicable diseases and environmental hygiene was neglected. The intellectual cutting edge shifted from improving public health systems, to improving curative technologies and methods of health care financing. Multilateral and other donor agencies have encouraged creating separate institutional structures and programs for controlling specific communicable diseases.

Other factors that atrophied the public health system... The spread of democratic institutions also affected public health services, because electorates typically prefer public funds to be used to provide private goods rather than public goods. Elite Capture: In India, even more than most developing countries, public funds for health and education have been funneled towards tertiary rather than primary levels. Several policy thrusts of the newly-independent India also detracted from public health service provision. An inconsistency between Constitutional provisions starved public health systems of funds.

Indian Public Health Assessment Using Essential Public Health Function Model A framework was developed to analyze the public systems in developed and developing countries, based on ‘Essential Public Health Functions’. (EPHF) The EPHF assessment questionnaires are designed to elicit a self-evaluation of the public health system, from people who know the system well from within. The EPHF assessment questionnaires were completed by 119 respondents: 19 at the central level, 10 at state level, and 90 at district level Potential source of error includes exaggerating performance or lack of familiarity with the issues.

Scores for Public Health Functions at Federal Level, India

HEALTH EXPENDITURE IN DIFFERENT COUNTRIES

RURAL HEALTH SYSTEMS IN INDIA

VACANCIES : A MAJOR PROBLEM IN RURAL HEALTH SYSTEM

Strong areas across EPHFs Availability of technical expertise Written guidelines, protocols and standards Network of research and training institutions, and laboratories Better performing EPHFs Epidemiological surveillance Health status monitoring Reducing health impact of emergencies

1 2 ACHIEVEMENTS THROUGH THE YEARS

Public health regulations and their enforcement Social participation Ensuring quality of services Human resource development Monitoring and Evaluation Dissemination and use of data Learning and innovation Collaborative partnerships Support to sub-national levels Resource utilization Attention should be given in the areas of.....

References India’s Public Health System : How Well Does It Function at the National Level? World Bank Policy Research Working Paper 3447, November 2004 Public Health in India: An Overview World Bank Policy Research Working Paper 3787, December 2005 Information on