public health hospitals and community health.pdf

8/14/2019 Public Health Hospitals and Community Health.pdf

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u c ea ,

Communit Health and

Hospitals


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OverviewPublic Health:s are respons y or commun y

well-being through ongoing assessment,, .

The combination of science, practical

,the maintenance and improvement of the

health of all eo le.Sources: J. Last. Public Health and Human Ecology. 1998.

C.G. Sheps. Higher Education for Public Health. 1976.


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Determinants of Population Health

SOURCE: The Future of the Publics Health (IOM 2003).


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Vision: Health Peo le in Health Communities

Mission: Promote Physical and Mental Health& Prevent Disease, Injury, & Disability

Public Health

Prevents e idemics and the s read of disease

Protects against environmental hazards

Prevents injuries

Promotes and encourages healthy behaviors

Responds to disasters and assists communities in recovery

Assures the quality and accessibility of health services


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Essential Public Health Services

Monitor health status to identify community health problems

Diagnose and investigate health problems and health hazards in the community Inform, educate, and empower people about health issues

Mobilize community partnerships to identify and solve health problems

Develop policies and plans that support individual and community health efforts

Enforce laws and re ulations that rotect health and ensure safet

Link people to needed personal health services and assure the provision of

health care when otherwise unavailable

Assure a competent public health and personal health care workforce

Evaluate effectiveness, accessibility, and quality of personal and population-

based health services

Research for new insights and innovative solutions to health problems

Source: Public Health Functions Steering Committee. July, 1995.


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Source: Public Health Functions Steering Committee. July, 1995.


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Ten Core Practices of Public Health

Assessment1. Assess the health needs of the community

Policy Development

.

3. Analyze the determinants of identified health needs

. ,

community

5. Set priorities among health needs

6. Develop plans & policies to address priority health needs

7. Manage resources & develop organizational structure

8. Implement programs

9. Evaluate programs & provide quality assurance

10. Inform & educate the public

Source: Dyal, WW. American Journal of Preventive Medicine. 1995;11 (6 suppl):6-8.


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BiostatisticsBiostatistics

Health ServicesHealth Services

EnvironmentalEnvironmental

SocialSocial

Occupational HealthOccupational Health


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Profile of our Current

ommunity Work

DiseaseDiseaseSpecificSpecific

Advocacy &Advocacy &CommunityCommunity

MobilizationMobilization

Water,

Sanitation

Literacy &Education

Formal,

Basic

Health

Tuberculosis

Malaria

Non-formal,Vocational

are orcommonillness

Thrift/Savings

Micro-finance

Nutrition /Foodsecurity

Incomegeneration /Livelihood


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Village healthVillage health

planplan

Micro bir thMicro bir th

planplanAdvocacyAdvocacy

CommunityCommunity CommunityCommunity

usingusing

4 delays4 delays

MonitoringMonitoringMaternalMaternal

ChildChild

HealthHealth

CapacityCapacity ServiceService

SHG role/su ortSHG role/su ortCommunityCommunity

activitiesactivitieseveeve

sensitizationsensitization


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Immunisation


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Challen es & choicesChallen es & choices Shift from a hospital / disease focus toShift from a hospital / disease focus to

. .

Social

Determinants Health Preventive Primary Secondaryromo on Medicine Care eve are

n egra e rogrammes

Continuum of careContinuum of care


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reputation is important for entry in to thecommunit .

Administrative support

Health care

Trainin

Facilities shared reducing overheadex enses.


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initiatives with critical / emergency care.

Accountability Provide a faith community and family

support to community health programme

staff. Provide linka es with artners


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Suspicion or mistrust

on ct o nterests

sharing of resources Attitudes of hospital staff

Pre-conceived notions

Different time frameworks


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Changes in the context


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, ,

Mental Illness including substance,

Accidents, RTA and Suicide, Asthma

Dual burden of disease.

s -re uct on e av our c ange Need for inte rated continuum of

care programmes


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- .

the private sector of which 77.5% is from- .

Of the 5% of GDP spent on health care

.

which amounts to 0.9% of GDP.

ea care n n a s e mos pr va zein the world


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Medical expenses and

impoverishment

Survey conducted in 3 districts in Gujaratand Andhra Pradesh - 85% of the

households in Gujarat and 74% of those in

AP health expenses was the main reasonfor their economic decline.

World Bank estimates that OOP ushes

2.2 % health users in poverty and 1in 4

amon those hos italised.


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A adverse health condition that necessitates more

than 10% of the household income in medicalexpenses (Pradhan 2002)

ness ea s to oss o ncome an s gn cantextra expenditure. The combination pushes

.

9% of households in India experiencecatastrophic health expenditure

Catastrophic health expenditure is more commonin the low income group, but it can also effect the

.


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Access to Essential / Life Saving

drugs

95% of the health problems. 60 000 to 80 000 brands of various dru s in India

10 of the top 25 drugs sold in the Indian market

are non essential, irrational or hazardous. 56% of the people in India still do not have access

to essential drugs (WHO 2004)

Deregulation of drug price control has led tospiralling of costs with profit margins being

increased to 75-100%


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Medicine Brand Company

Price in

INR Difference

Ofloxacillin 200

mg.

Tarivid Aventis 31 969%

evo oxac n

500 mgLevoflox Cipla 6.82

Travanic Aventis 95 1392%

Amlodepine 5

Amolodac Zidus 1.51

mg Amlogar

d Pfizer 6 397%


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Disparities across income

groups

Indicator

Quintile

Quintile

risk ratioInfant Mortalit

Under 5 Mortality 155 54 2.8

Childhood

Underweight60 34 1.7

Total Fertili ty Rate(births/woman

4.1 2.1 2.0

-


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Can the principles of Primary

hospitals to synchronize them with

commun y ase programmes


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Applying the Principles of Primary

ea care o osp a s

Dem stif in medicine stren then atienteducation. Using patients to educate others inthe community.

community (volunteers) in caring for the patients.

Using the community as gatekeepers forrec ng serv ces.

Community advisory committee in hospitals

.

Vertical equity differential pricing / crosssubsidization


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Applying the Principles of Primary

ea care o osp a s

Use of only appropriate/ cost-effective.


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community based health programmes

community health programmes


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