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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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