Health care in India,Public health care system and delivery systems-

Basics of Epidemiology, Public Health Administration in India

 COVID-19 BREAKDOWN
 COVID SURGE-Demand for hospitals
 HEALTH EMERGENCIES?
 PREPARED FOR EPIDEMIC AND PANDEMIC THREAT…!
 As per Global Health Security Index says “ all countries remain dangerously
unprepared for future epidemic and pandemic threats, including threats potentially
more devasting than COVID-19”
Measures-195 As per GHS Compliance
countries need Index assesses with
to prepare for countries Prevention Detection Reporting Rapid response Health system international
epidemic and across six norms and risk
pandemic. categories: environment
 India has improved in detection and reporting category, but there has been no
enhancement of its prevention protocols, health system or rapid response processes.
 The study says that although countries built new capacities during the Covid pandemic,
many of them are temporary.
India’s preparation for Third COVID wave
https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/kriya-
medical-tech-gets-icmr-approval-for-krivida-novus-covid-19-testing-
kit/articleshow/89012655.cms
The new Covid variant Omicron-led third Covid wave is knocking India's door. However,
the government has prepared a plan to establish a PSA (Pressure swing adsorption) plant in
each district hospital-separates N2 from air and provides purified O2
 The online digital solutions 'Oxygen Demand Aggregation system (ODAS)' and 'Oxygen Digital
Tracking System (ODTS)' have been developed to ascertain the demand for medical oxygen from all
medical facilities and to track their transportation.
https://www.andhrafriends.com/topic/915648-no-deaths-due-to-lack-of-oxygen-specifically-
reported-by-states-centre/
Centre is also planning to identify and train at least one 'Oxygen Steward'

"It will enhance the skills of our healthcare workers in Oxygen therapy with necessary focus on
essential knowledge and skills. This will also train our participants to avoid wastage or overuse of
oxygen in resource constraint settings.“
https://www.business-standard.com/article/current-affairs/centre-to-train-at-least-one-oxygen-
steward-in-each-district-nationwide-121122200728_1.html
Ways Ahead …!

According to the Healthcare Information and Management Systems Society's 'Future of Healthcare
Report', around 80 per cent of healthcare systems are aiming to increase their investment in digital
healthcare tools in the coming five years.
 Access to mobile apps has improved the digital healthcare space and even personalized
it. Today, the advances in telemedicine have made it possible to book an appointment,
video consult with a doctor, access health records, lab reports, appointment updates,
order wellness products and medicines from online pharmacies and receive those
medicines at home, all through an app.
 https://www.thenationalnews.com/opinion/comment/2023/01/05/the-digital-tools-in-the-
future-of-healthcare/

https://www.smart-academy.in/blog/digitalization-of-
medical-records/
 Public health care system-Needs to be efficient and effective for conglomeration activities
like prevent disease, prolong life and promote health and efficiency of its people.

Public Health care system

Maternal deaths Infant mortality

Early death Poor Immunization

 Public health initiatives that affect people in all states, such as the National Health Mission,
Ayushman Bharat, National Mental Health Program, are instilled by the Union Ministry of
Health and Family Welfare.
 NHP-National Health Policy insisted to primary care facilities on both public and private
clinics into the health sphere.
 Ayushman Bharat- Insurance for 5L per annum for low class people
 Public health funding has been directed to helping the middle and upper classes, as it targets
creating more health professional jobs, expanding research institutions, and improving
training.
 It creates the equal access for the lower class people too.
 Medical
Primary
Community District college and
Subcentres Health care
Health centres Hospitals research
centres
institutions
 Extremely rural areas-expense covered by national government-Mandates 2 staffs( M & F)-
Covers 5000 people in hilly areas-Educate healthy habits
PRIMARY HEALTH CENTRES-30,000 or more
 Developed rural areas-served with largest clinical staffs and paramedics

 State government funded- Health education and on large emphasis on preventive measures

COMMUNITY HEALTH CENTRES-1,20,000-urban areas

 CHS also called as First referral units-FHU- Mandatory to have obstetric care, newborn/child
care, blood storage capacities at all hours
DISTRICT HOSPITALS-referral for primary and secondary heath care service
One hospital/district
Occupied with 75 to 500 beds-depends on the population and demand.
MEDICAL COLLEGE AND RESEARCH INSTITUTION
 AIIMS-is owned and controlled by the central government. These are referral hospitals with
specialized facilities. Government Medical Colleges are owned and controlled by the respective
state governments and also function as referral hospitals.
GOVERNMENT PUBLIC HEALTH INITIATIVES
Community Health workers-Community health workers closely cooperate with each other and with
other types of health workers (such as auxiliary nurse midwives) to encourage care utilization and
deliver health services- trying to promote the inadequate training and resources
 Currently, India's largest community health worker program, started in 2005 and now subsumed in
the National Health Mission
 Health behaviors in women-reduce neonatal mortality-Positive changes includes active inclusion
and recruitment of a large portion of women in the community, engagement and participation
during skill development.
 Community health workers are not government employees but rather volunteers that state
governments are responsible for training and financially incentivizing.
 Low quality care- Misdiagnosis, under trained health professional, Incorrect
prescription, impoliteness
 Corruption-Regular pay
 Overcrowding of clinics- Understaffed, insufficient bed spacing, improper sanitation,
waste disposal
 Poor cooperation between public and private spheres
 Barriers of access
 Hospital fires-fire safety norms-large fire accidents occur
 https://en.wikipedia.org/wiki/Public_health_system_in_India#:~:text=The%20healthcare
%20system%20is%20organised,and%20smaller%20Sub%2DDistrict%20hospitals.
Definition:
The study of distribution and determinants of health-related states or events in specified
population, and the application of this study to the prevention and control of health
problems”-John M.Last(1988)

Derived from Greek word- ”Epi”- upon, ”demos”-people, ”logos”-study

 To eliminate or reduce the health problems in the community
 To promote the health and well being of society as a whole
 To identify the risk factors in the disease
 To provide the essential data to the planning, Implementation and evaluation of services for
the prevention ,control and treatment of disease and setting priorities among those services
1.Causation of the disease.
2. Natural history of the disease.
3. Health status of the population.
4. Evaluation of Interventions.
 Most of diseases are caused by interaction between genetic and environmental
factors. (Diabetes)
 Personal behaviors affect this interplay.
 Epidemiology is used to study their influence and the effects of preventive
interventions through health promotion.

NATURAL HISTORY OF THE DISEASE

 Epidemiology is also concerned with the course and outcome (natural history) of
diseases in individuals and groups.
 SANITATION
WEATHER
POLLUTION
POLITICAL

GENOTYPE
NUTRITION
IMMUNITY
BEHAVIOUR
BIOLOGICAL
CHEMICAL
PHYSICAL(INJURY/TRAU
MA)
SOCIAL/PATHOLOGICAL
HEALTH STATUS OF POPULATION
 Epidemiology is often used to describe the health status of population.

 Knowledge of the disease burden in populations is essential for health authorities.

 To use limited resources to the best possible effect by identifying priority

health programme for prevention and care.
 To evaluate the effectiveness and efficiency of health services.
 This means determining things such as —Impact of Contraceptive use on Population
Control.
 The efficiency of sanitation measures to control diarrheal diseases and the impact of
reducing lead additives in petrol.
 Applying epidemiological principles and methods to problems encountered in the
practice of medicine has led to the development of- “Clinical Epidemiology”
APPLICATIONS OF EPIDEMIOLOGY IN PUBLIC HEALTH
 Preventing disease and promoting health.
 Community health assessment (Community Diagnosis) and priority setting.
 Improving diagnosis, treatment and prognosis of clinical diseases-Stages in Cancer, education
about the particular disease.
 Evaluating health interventions and programme
 Epidemiology & Public health, refers to collective actions to improve population health.
 Physician is concerned with the disease in the individual patient, whereas Epidemiologist is
concern with the disease pattern in entire population. So, the Epidemiology is concern with
the both Sick &Healthy.
 In Clinical Medicine, the physician seeks to diagnosis for which he derives prognosis and
prescribes specific treatment. The Epidemiologist is confronted with the relevant data
derived from the particular epidemiological study. (Community Diagnosis)
 He seek to identify the source of infection, mode of transmission, and an etiological factor to
determine the future trends, prevention and control measure.
Epidemiologist, goes to the community to find out the disease pattern and suspected
causal factors in the question.Epidemiological approach
 Asking questions.

 Making Comparisons.
 Related to Health events Related to Health Actions

 What is the event?  What can be done to reduce(Problem)

 Where did happen? the problem?
 When did happen?  How can be prevented in. future?
 What action should be taken by
 Who are affected?
community?
 Why did it happen?
 What resources required?
 What difficulties may arise?

Epidemiology is “a means of learning by asking questions and getting

answers that lead to further questions.”
 Measurement of mortality.
 Measurement of morbidity-rate of disease in a population
 Measurement of disability.
 Measurement of natality.
 Measurement of presence or absence of attributes.
 Measurement of health care need.
 Measurement of environmental & other risk factors.
 Measurement of demographic variables.
 Rates : It measures the occurrence of some particular event in a population
during a period of time
 Ratios: A relation in size between two random quantities
 Proportions: It is a ratio indicating the relation in the magnitude of a part of a
whole
 Prevalence: All current cases (old &new) existing at a given point in time, or
over a period of time in a given population
 Incidence: Number of new cases, episodes or events occurring over a defined
period of time.
Incidence may change genuinely (increase or decrease)with the following factors:
 Introduction of new risk factors

 Changing in habits

 Selective migration of susceptible person in the endemic area, which increase the
incidence of the disease
These rates are typically obtained from cross-sectional studies,
It depends on two factors
 Previous incidence, and

 Duration of disease
 When both incidence and duration of a specific disease are relatively stable,

Prevalence(P)= Incidence(I) x Duration (D)

a)Common source of epidemics
-Originated from single source of infection
a)Point source or single Exposure Epidemic:
Eg: Bhopal gas tragedy, Food poisoning at the marriage party

b)Continuous or Multiple Exposure Epidemics

Until the destruction of source the epidemic study can’t cease the case
Eg: A contaminated well, Malaria, Cholera
 Infection diseases and some non-infectious diseases both tend to have an increased incidence
during the summer months and similarly the respiratory infectious during the winter months.
 Road traffic accidents in rainy seasons and asthma in spring.

 These are taken only in seasonal occasions.

CYCLICAL EPIDEMICS
 Some epidemics tend to occur in cycles which may repeat themselves in weeks, months or
years
 If the herd immunity is already there in the community, there is every likelihood that the
diseases would not take epidemic form.
 UNION MINISTRY OF HEALTH AND FAMILY WELFARE
 SEQUENCE OF AUTHORITY
 ROLES
 REAL TIME CASE EXPLANATION
 HOW IT WAS SOLVED OR IT WILL BE SOLVED-INPUT YOUR IDEAS
 Public health administration is the component of the field of public health that
concentrates on management of people and programs. On a day-to-day basis,
administration is needed to ensure that organizations operate efficiently and with
success.
 Public health is defined as the science of protecting the safety and improving the health
of communities through Education, policy making and research for disease and injury
prevention, finance allowance
 The field of PHA concerns itself with the administration, leadership, management of
health care systems, such as hospitals networks, and public health systems.
 Organized in the manner to improve the health of communities.
 PHA deals with plan, policy, & programs of public health including the management of
personnel, finance & other related matters.
 The plan and policy based on the population only not for an personnel.
 Focused on disease prevention, health promotion of community people- sanitation,
hygiene ,as well as the ongoing surveillance of health related issues within the
community.
 PUBLIC HEALTH ADMINISTRATOR ROLE
 HOW TO BECAME A PHA-QUALIFICATION, ROLES &
RESPONSIBILITY,JOB OPPURTUNTIES