Public Health in India
Public Health in IndiaAalok Ranjan ChaurasiaOutlineHealth and
Public HealthPublic Health in IndiaBefore the Colonial periodDuring
the Colonial periodAfter the colonial periodEssential Public Health
FunctionsMortality transition in India
HealthThe World Health Organisation defines Health (of an
individual) as the state of complete physical mental and social
well-being and not merely the absence of disease or infirmity.
World Health Organisation, however, does not define Public
Health.DeathDeath, on the planet Earth, is inevitable.
A large number of deaths are premature.
A substantial proportion of deaths can be avoided.
Public Health is related to preventing premature and unavoidable
deaths.A Model of HealthExposure to Risk FactorsBody resistancePoor
HealthManifestationDisease ConditionDisabilityDeathPublic HealthIf
the disease condition is avoided, the probability or the chance of
death or disability can be reduced.
Public Health is therefore described as the science and art of
preventing diseases, prolonging life and promoting health (of
individuals) through organised efforts and informed choices.Public
HealthPublic Health deals with the group of people rather than
individuals.Dimensions of public healthHealth promotionDisease
preventionEarly diagnosis and prompt treatmentDisability
limitationRehabilitationTraditional Indian ApproachThe Indian
approach to health is enshrined in the concepts and principles of
Ayurveda which means the science of life.Ayurveda is one of the
oldest system of health care in the World.Ayurveda deals with both
preventive and curative aspects of health.Health defined by WHO is
very similar to concepts of Ayurveda.Western ApproachThe western
approach of avoiding diseases, death and disability, traditionally
focused on personal hygiene and public sanitation during the 19th
Century.
This approach, combined with better food availability, paid rich
dividend in the developed countries in reducing morbidity and
mortality.Components of Public HealthEpidemiologyMeasurement of
disease conditions in relation to the population at risk.
StatisticsCollection, presentation, analysis and interpretation of
epidemiological data.Health ServicesServices directed towards
meeting the health needs of the people.Public Health before the
Colonial PeriodLittle is known about public health activities
before the colonial period.Main stream system of health care was
Ayurveda.Home-based care appeared to be the dominant feature.There
appeared little organised efforts or institutional care to treat
diseases and prevent deaths.Public Health during the Colonial
PeriodEvolution of public health system during the colonial period
followed the same path that was followed in Britain.Public health
efforts were focused largely on protecting British civilians and
army cantonments.Sanitation was given the top priority.Focus was
also on early detection and control of contagious diseases cholera
and plague.
Public Health during the British PeriodTraining and research
Institutions in public health.Public health legislation.Sanitary
departmentsAscertaining local sanitary conditions.Vital
registration.Monitoring disease trends.Vaccination
programmes.Technical advice on control of epidemics.
Public Health during the British PeriodRestriction of public
health efforts to British civilians and military established was a
major constraint.Majority of Indian masses remained deprived of the
dividends of these efforts.At the time of Independence only 3 per
cent households in India had toilets.Water, drainage and waste
disposal services were utterly lacking.Public Health during the
British PeriodAlthough, public health efforts were restricted to
British civilian and military establishment, they had impact on
Indian masses.Mortality spikes were sharply reduced.Mortality from
cholera and plague was sharply reduced.Diseases like malaria and
gastro-enteritis continued to take heavy toll.Public Health in
Independent IndiaEvolution of public health care system in
Independent India was shaped by two important factors:The Report of
First Health Survey and Development Committee (Bhore Committee)
constituted during the colonial rule.Emergence of modern medical
technology for the prevention and control of diseases, especially
communicable diseases.Bhore CommitteeAppointed in 1943.Recommended
comprehensive remodeling of health services.Integration of
preventive and curative health services at all
levels.Hospital-based health care system.Development of primary
health centres in two stages.Training in Preventive and Social
Medicine.
Bhore CommitteeThe short-term planA PHC for every 40000
population.PHC to be manned by 2 doctors, 4 PHN, 4 Midwife, 1
Nurse, and others.The long-term planA primary health unit for every
10-20 thousand population with 75 beds.Secondary unit with 650
bedded hospital.District unit with 2500 bedded hospital.Medical
TechnologyMass production of antibiotics.Availability of vaccines
for diseases having high mortality and disability
ratesTetanusDiphtheriaPertussis (Whooping
Cough)MeaslesPoliomyelitisPublic Health in Independent IndiaThe
recommendations of Bhore Committee and the availability of
preventive and curative medical technology resulted in the
evolution of hospital-based public health system.The public health
arrangements created during the colonial period were replaced by
hospitals and health centres.Public health services were merged
with the medical services.Public Health in Independent IndiaBhore
Committees recommendations were accepted only partially.One primary
health centre for every 30 thousand population.Only 6 beds in each
primary health centre.Only one doctor.Truncated paramedical
staff.The situation has remained largely unchanged.Public Health in
Independent IndiaSince Bhore Committee, numerous committees were
constituted to evolve the public health system.Some of the
recommendations of these committees were adopted; some were not by
the government.All committees retained the core of the model
recommended by the Bhore Committee. Public Health in IndiaMudalliar
Committee(1962)Strengthen PHCs before establishing new ones.PHC
should provide preventive, promotive and curative
services.Strengthen sub-divisional and district hospitals.Creation
of All India Health Services.Chaddha Committee (1963)Malaria worker
to function as multipurpose worker.Public Health in IndiaMukherjee
Committee (1965)Separate staff for family planning
programme.Malaria activities to be de-linked from family planning
activities.Jungalwala Committee (1967)A unified approach for all
problems instead of a segmented approach for different
problems.Medical care and public health programmes to be put under
charge of a single administrator.Public Health in IndiaKartar Singh
CommitteeConcept of MPW(M) and MPW(F).One PHC to catre 50 thousand
population.Each PHC should have 16 SHC (3-3.5 thousand
population).Shrivastav CommitteeCreation of bonds of
paraprofessional and semiprofessional health workers from within
the community itself.Development of a Referral Services
Complex.Public Health in IndiaBajaj CommitteeFormulation of
National Medical & Health Education Policy.Formulation of
National Health Manpower Policy.Educational Commission for Health
Sciences.Health Science Universities in various states.Health
manpower cells.Vocationalisation of education at 10+2 levels as
regards health related fields.Realistic health manpower survey.
Public Health System in IndiaA population based normative
approach is adopted for establishing hospitals and health
centresSHC One for every 5000 (3000 in hilly/tribal areas)
population.PHC One for every 30000 population (20000 in difficult
areas) with 4-6 indoor/observation beds.CHC One for every 80-120
thousand population with 30 beds.Public Health System in IndiaThe
norms are for government institutions and are for the rural areas
only.For the urban areas, no norms have been defined.Nearly all
government civil and district hospitals and most of the CHCs are
located in the urban areas.No information is available about the
private health system.Public Health System in
IndiaInstitutionReferenceNumberSHC2007145272More than 6 SHC for
each PHC, on averagePHC200722370More than 5 PHC for every CHC, on
averageCHC20074045Rural hospitals20076298Beds in rural
hospitals2007142396About 23 beds per rural hospitalUrban
hospitals20072774Beds in urban hospitals2007324206About 117 beds
per urban hospitalPublic Health in Independent IndiaOne fall out of
the hospital-based public health approach was the neglect of public
health legislation.A Model Public Health Act was drafted in 1950 by
the Government of India. It was revised in 1987.This Act is yet to
be adopted by any of the constituent state of the country.
Public Health in Independent IndiaThe hospital-based public
health system led to the medicalisation of the system.The focus has
been on medical services.Public health services have largely been
neglected.Poor public health services result in high cost of
illness, debility and death.The main sufferer are the people,
especially the poor and deprived.
Public Health in IndiaThe epidemiological and statistical
dimensions of public health have been grossly neglected.Lack of
epidemiological and statistical database affected public health
planning.In the absence of necessary information, planning reduced
to a normative, mechanical exercise, often out of context to
peoples needs.Public Health in IndiaThe problem gets complicated
because of social, economic, cultural and environmental diversity
that leaves normative planning virtually redundant.
Decentralisation of the health system could not succeed because of
the lack of epidemiological and statistical information necessary
for planning for public health services.Public Health in
IndiaPublic health in India is hospitalised.Health planning is
concerned more with the health of the health care delivery system
(hospitals and health centres) then the health of the people.The
remedy was sought in terms of specific National health and disease
control programmes.There are numerous such programmes.
Public Health in IndiaReproductive and child health
programme.National tuberculosis control programme.National malaria
control programme.National blindness control programme.National
water born disease control programme.National leprosy eradication
programme.National iodine deficiency control programme.Public
Health in IndiaAll National disease control programmes are
implemented through the existing government hospitals and health
centres.Over the years, a campaign approach has been evolved to
implement many of the national health and disease control
programme.Successful campaigns have often been followed by
unsuccessful maintenance.Public Health in IndiaFocus on medical
services.Neglect of public health services.No modern public health
regulation.Lack of systematic planning.Poor sustainability of
public health efforts.Absence of epidemiological and statistical
skills at district and below district level.No micro-level
planning, no public health action.Essential Public Health
Functions
Essential Public Health Functions in IndiaMortality Transition
in India
Public Health in IndiaWidespread existence of preventable
diseases and deaths is a disgrace to the society which tolerates
it.
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