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Posts Tagged ‘health outcome indicators’

Healthcare for the needy: Opinion

November 24, 2011 Leave a comment

The announcement by the Health and Family Welfare Minister L  Jayantakumar while inaugurating the Primary Health Centre at Kakwa to initiate the process for the recruitment of 270 doctors is yet another much needed move towards making health accessible to the general public. With liberal funding from the centre, the state did see some development in terms of strengthening health delivery system, a number of Primary Health Centres (PHC) and Community Health Centres (CHC) in various parts of the state came up during this period. But there have been numerous complaints from the people of the localities where they have been set up about the non- functioning of the same. While the building stands, these centres are sometimes without the most basic component of any health delivery system – doctors and nurses. The most oft repeated answer from the government in answer to non posting of doctors to these remote and rural areas is the inadequacy of doctors at its disposal. Hopefully this latest recruitment of doctors will be able to address the problem to a great extent. And if this proves insufficient the state government should go in for recruitment of more doctors, there should not be any compromise on ensuring access to health care to the most needy. But even after the government has the adequate number of doctors at its disposal to man the various health centres and district hospitals, the problem of absentee doctors and nurses would still persist. This, our past experience tell us. Most of the doctors who get posted to rural and remote areas try their level best not to go there and use every means at their disposal to avoid going to these places. And in most cases, an open secret here, this works to the advantage of those at the helm of affairs who can affect these transfers. There have been numerous cases of transfers being revoked, transferred doctors getting deputed to some other duties, some going on study leave etc. On the ground people are still deprived of the services of the doctors even after their posting at their concerned health centres. To ensure doctors are present where they are needed, the government or those in charge of the Health department should work out effective policies so that doctors posted in rural and remote areas do not view these posting as discriminatory or punishment. For starters, those who passes out from the state medical college, JNIMS can be made to serve for a certain number of years as part of their internship. Along with this, it should be made mandatory for all the doctors in the service of government of Manipur to serve in rural and remote areas for certain number of years for certain number of times, the exact modalities can be worked out by an expert committee. Whatever means the government adopts, the important thing is to ensure health care services is available to the people. But here again, it is clear that no policy will bring any relieve or pan out advantageously for the public, if those who are responsible for implementing the same are not sincere. Side by side, the practitioners of the medical profession usually termed a noble profession for its ability to give life and hope to the sick and infirm, should reignite the willingness to come to the aid of the most needy and not be perpetually distracted by considerations of career and financial returns.

Sources:- Hueiyen Lanpao

Measles catch-up campaign

October 8, 2011 Leave a comment

Measles is a highly infectious and potentially fatal viral infection mainly affecting children.
Immunization against measles directly contributes to the reduction of under-five child
mortality and hence to the achievement of Millennium Development Goal number 4.
Deaths from measles occur mainly due to complications of measles. Infants and young children, especially those who are malnourished, are at highest risk of dying. The immunization Strategic Advisory Group of Experts (SAGE-2008) and WHO currently recommend that two doses of measles vaccine should be the standard for all national immunization programmes.
With the introduction of measles vaccine in the National Universal Immunization Programme (UIP) from 1985, which is given at 9 to 12 months of age, the disease burden has reduced and this reduction can be further accelerated by improving the coverage of the 1st dose of measles which stands at 69.6% as per DLHS-3 survey and providing second opportunity for measles vaccination.
The Millennium Development Goal (MDG) 4 aims to reduce by two thirds between 1990 and 2015 the under-five mortality rate (U5MR) in the  world. One of the key interventions to decrease U5MR and accelerate achievement of MDG4 is to strengthen measles control activities. As per the draft comprehensive Multi Year Strategic Plan (cMYP, 2010-17) for immunization of India the country aims to reduce by 90%, measles related mortality by 2013 when compared to 2000.
Measles catch-up campaign in India:
India is conducting Measles Catch-up Campaigns as a part of global effort to reduce measles morbidity and mortality. Target age group of this campaign is 9 months to <10 years children irrespective of their previous measles vaccination status or measles infection. Estimated 134 million children will be immunized in 14 states. The 14 states included in the measles catch up campaign are Chattisgarh, Gujarat, Jharkhand, Haryana, Rajasthan, Arunachal Pradesh, Assam, Manipur, Madhya Pradesh, Bihar, Meghalaya, Tripura, Uttar Pradesh and Nagaland.
Along with other technical and operational issues, two major challenges in this campaign are huge target group and mass vaccination with injectable antigen. India has a unique health infrastructure at primary care level. These primary care level health facilities are the strength of this campaign. Another strength is availability of a large number of trained vaccinators in health and family planning wings of the Ministry of Health & family Welfare. Ensuring the participation of these trained vaccinators is crucial to overcome the challenge of mass vaccination with injectable antigen considering injection safety of very large target group.
The measles catch up campaign will be a three weeks campaign wherein the 1st week will be held at educational institutes; while the 2nd and 3rd week in existing UIP outreach sites.
The key strategies being followed to achieve the goal are:
• Improving and sustaining high routine immunization coverage;
• Providing second dose of measles vaccine through catch-up immunization campaigns and or routine second dose/follow up immunization campaigns;
• Establishing sensitive laboratory supported surveillance;
• Appropriate case management, including administration of vitamin A.
Rationale for Measles Catch-up Campaign
Analysis of measles outbreak data for the period 2006 to 2009, in states with outbreak surveillance reveals that around 90% of the measles cases were in the age group of <10 years. Although reported coverage for measles vaccination is high, previous CES revealed that it never exceeded 70%. As measles vaccination does not confer 100% protection and seroconversion rate is only 85% when given at 9 months of age, a substantial number of children remain unprotected even if they are vaccinated. Supplementary activities like measles catch-up campaign is required to sustain high measles vaccination coverage and also for providing a second opportunity for the unprotected children. Lessons learnt from this campaign will be useful for future immunization activities.

Measles catch up campaign in Manipur

A measles catch-up campaign, organised by District Health Society, Imphal East is currently underway in different parts of the district.

The campaign was kicked off on October 10 last and would continue till October 31.

With the opening of 606 session sites across the district, it targets to benefit 90553 children at the age group of 9 months to 10 years.

Whom to vaccinate?
• All susceptible children and adults for whom measles vaccination is not contraindicated.
• Asymptomatic HIV infection is an indication, not a contraindication, for measles vaccination. Ideally, the vaccine should be offered as early as possible in the course of HIV infection.
• HIV-infected infants should receive measles vaccine at 6 months of age, followed by an  additional dose at 9 months, in case they are not severely immune-compromised.
• The first dose is given through routine immunization between 9 and 12 months of age and a second dose is given after one year of age.
• In SIA campaigns all children in the target age group (9 months – <10 years) are vaccinated irrespective of previous immunization status or history of measles disease.
COORDINATION AND HIGH LEVEL OVERSIGHT FOR MEASLES CATCH-UP CAMPAIGN
1. Overall strategy for catch-up campaign
The highest level of political, administrative ownership, commitment and support needs to be sustained for successfully implementing measles catch-up campaigns. The Central Government, the State Governments, and international and national development partners need to work together and complement each other’s strengths. Measles catch-up campaigns are a one time activity and therefore coverage must be near 100% in the target age-group to impact on disease transmission and rapidly build up population immunity.
State level
At the state level there will be two committees as below.
a) State Steering Committee (SSC)
At the state-level, the State Steering Committee for the campaign will be established under the chairmanship of the State Health Secretary. The role of the State Steering Committee is to mobilize human / other resources and coordinate planning and implementation of activities with other government departments and partner agencies. The State Steering Committee will coordinate activities among Government departments like Education, Women and Child Development (WCD), Social welfare, NRHM, Defence, Youth Affairs, Urban development, Commerce, Labour, PRI etc. to mobilize human and other resources. The SSC will also coordinate with civil society organizations like Rotary, Lions etc; professional bodies like IMA, IAP, IAPSM, etc and partners like WHO, National Polio Surveillance Project (NPSP), UNICEF, USAID, Red Cross and other organizations.
b) State Operations Group (SOG)
The SOG will lead planning and implementation activities at the state. The Mission Director/
DG /Director, Family Welfare will chair the Operations Group. The State Immunization Officer (SIO) will be the member-secretary. State level representatives of key Departments such as Social Welfare, Education, IDSP, Panchayati Raj Institutions, WCD, Transport, Media and partners such as WHO-NPSP, UNICEF, Red Cross, Professional bodies like IMA, IAP etc, religious leaders, minority groups should be invited to attend coordination committee meetings.
District level
District Task Force (DTF)
DTF should be formed under the chairmanship of the District Collector/ Magistrate in each district, CMO/DIO should be the member secretary. District level officers from Education,
ICDS, Police, Media, BDOs, VHCs, Local bodies like municipalities, councils etc, professional bodies and partner organizations along with representatives from religious groups and opinion leaders should be the participating members of DTF.
The role of the district task force is to support, supervise, monitor and ensure implementation of the highest quality measles campaign in the district.
The Department of Health & Family Welfare appeals to all sections of the people including co-ordinating departments, partnering organisations, NGOs, churches, educational institutions, municipal bodies, professional bodies, media etc to join hands with the department in this state-wide effort to contain  measles infection in our state during the three week campaign.

Call to Action on Preserving the Power of Antibiotics

October 5, 2011 Leave a comment

Despite having one of the fastest growing economies in the world, India continues to lag in terms of both antibiotic access and controlling antibiotic resistance, according to the 1st Global Forum on Bacterial Infections: Balancing Treatment Access and Antibiotic Resistance that is being held in the capital. The Global Forum has brought together Health Ministers and Public Health experts from across the globe to share path-breaking research on bacterial infections and antibiotic resistance, which together lead to lakhs of preventable deaths. The meeting’s inaugural session, which featured speeches from health officials including Hon. Dr Ghulam Nabi Azad, Minister of Health and Family Welfare of the Government of India, also saw the release of the New Delhi Call to Action on Preserving the Power of Antibiotics, a document acknowledging the high toll of antibiotic resistance while supporting strategies to contain it. The Global Forum was co-organised by the Public Health Foundation of India (PHFI) and the Center for Disease Dynamics, Economics & Policy (CDDEP).

“Antibiotic use is increasing in the developing world in countries like India and China, which is a positive sign as it indicates that there is increased access to life-saving treatments. No one should be denied antibiotics to cure a bacterial infection, but the drugs are also used inappropriately, which drives antibiotic resistance,” said Dr Ramanan Laxminarayan, Vice President for Research and Policy at the Public Health Foundation of India and Director of the Center for Disease Dynamics, Economics & Policy. “We have to expand access while making sure that these valuable drugs are available for future generations.”

Every use of antibiotics contributes to the development of antibiotic-resistant bacteria, and inappropriate use speeds their evolution. Between 2005 and 2009, antibiotic consumption in India rose by about 40%. How much of this increase was due to unnecessary use is not known, but the sharp increase in resistance during this period highlights the need to ensure that antibiotic effectiveness is not depleted.

Research discussed at the Global Forum highlighted opportunities to expand access to treatment while preserving the effectiveness of first-line drugs. “At the same time that Kenya is experiencing higher levels of antibiotic resistance, pneumococcal disease still accounts for 20 percent of all deaths of children under five,” said Hon Professor Peter Anyang’ Nyong’o, Minister of Medical Services of the Republic of Kenya. “Most of these deaths are preventable with appropriate antibiotic treatment, and we take seriously our responsibility to make sure these children have access to affordable, effective antibiotics, now and in the future.”

The need to develop sensible antibiotic policies inspired the creation of the Global Antibiotic Resistance Partnership (GARP) which works in countries around the world to help create national policies to fight drug resistance.

The GARP-India working group revealed at the meeting that India is experiencing a growing problem with antibiotic resistance. GARP-India research estimates that of the approximately 190,000 neonatal deaths in India each year due to sepsis – a bacterial infection that overwhelms the bloodstream -, over 30 percent are attributable to antibiotic resistance. In addition, antibiotic resistant hospital infections are also a serious concern in India. Because antibiotics are used intensely in hospitals compared with the community, and frequent use drives the development of highly resistant bacteria, these infections can be especially deadly. Anywhere from 11 percent to 83 percent of hospitalised patients in India acquire these infections.

GARP recommendations include enforcing hospital infection control measures, expanding vaccination efforts, encouraging judicious antibiotic prescribing and regulating the use of antibiotics in livestock, an area where India lags behind. There is no regulation in India on the use of antibiotics even in food animals such as poultry, dairy cows and buffaloes that are raised for domestic consumption. The “Prevention of Food Adulteration Rules, 1995-part XVIII: Antibiotic and other Pharmacologically Active Substances” applies only to the use of antibiotics in certain types of seafood, and the Export Inspection Council of India only prohibits the use of certain antibiotics in the feed and medication of poultry intended for export.

The New Delhi Call to Action issued at the 1st Global Forum on Bacterial Infections acknowledged antibiotics as a shared common resource and put forth a commitment to preserve the power of these drugs through encouraging appropriate drug prescribing, dispensing and use, strengthening and enforcing regulation to ensure drug quality, implementing surveillance for resistant bacteria and for antibiotic use patterns and stimulating R&D for new antibiotics, among other measures.

“This Call to Action is an important stepping off point for India and other nations to take seriously the need to preserve antibiotics to improve public health,” said Dr David Heymann, Chair of the Health Protection Agency, UK. “Antibiotics are a global resource. We need to work together to conserve their effectiveness.”… Read More

via Call to Action on Preserving the Power of Antibiotics

Indian cities experiencing ‘acute’ respiratory problems: WHO

September 27, 2011 Leave a comment

Cities in India and China drowned in a sea of automobiles are experiencing maximum health issues, like “acute” as well as “chronic” respiratory problems and lung cancers, due to air pollution, a United Nations body has said.

The rising population of SUVs (sports utility vehicles), cars and two-wheelers in Indian cities where it is a status symbol for middle classes to posses the latest automobiles are having a deathly impact on people, the global body said.

The World Health Organisation (WHO) estimates that around 1.34 million premature deaths from respiratory diseases and cancers were caused due to polluted air in 2008.

Rapidly industrialising cities in China, India, and other growing developing countries are the epicentre for the lung diseases.

“If the WHO guidelines had been universally met, an estimated 1.09 million deaths could have been prevented in 2008,” said Maria Neira, WHO Director for Public Health and Environment.

In its latest report, data on air quality data was compiled from 1,100 cities across 91 countries. It did not rank cities according to the highest pollution.

The report said categorically that countries which are experiencing maximum growth and industrialisation, particularly “China and India,” are experiencing the maximum health problems due to polluted air.

“Yes, cities in India and China are facing air pollution that is threatening public health,” said Ms. Neira. “Lack of clean air is causing ‘acute’ as well as ‘chronic’ respiratory problems in these countries,” she said, arguing that these countries would experience highest number of heart, lung, cancer and asthma and acute lower respiratory infections if the air quality is not improved on a war footing.

“The largest contributions to urban outdoor air pollution include motor transport, small scale manufacturers and other industries, burning biomass and coal for cooking and heating, as well as coal-fired power plants.”

“PM10 particles, which are particles of 10 micrometres or less, which can penetrate into the lungs and may enter the bloodstream, can cause heart disease, lung cancer, asthma, and acute lower respiratory infections,” said Ms. Neira, adding that there is a growing need for public awareness.

Most of the cities compiled in the WHO’s report have breached the global health body’s air quality guidelines for PM10 which is 20 micrograms per cubic metre as an annual average.

But cities in China and India should average PM10 to the order of 300 micrograms per cubic meter. There is growing awareness of the problem in both China and India, said Carlos Dora, WHO co-ordinator for interventions for Health Environments. … Read More

via The Hindu

RIMS should lead the way

September 17, 2011 Leave a comment

The establishment of RIMS, then RMC on April 14, 1972 was a watershed moment in Manipur’s story of progress and development. For, its coming into being made a significant difference in the health scenario in Manipur. The health sector saw a sea change. Before the establishment of RIMS, the health care sysytem in Manipur was in a rudimentary stage. The state lacked infrastructure, equipments, there were few doctors and nurses. Specialised doctors with PG degrees could be counted on the fingertips. Vellore, Dibrugarh used to be familiar names because, that was where patients form Manipur used to head to for treatment. All these have changed now. And RIMS in its 39 years of existance played a major role in this much improved health scenario in Manipur. The RIMS hospital now has all the major spcialised departments, patients no longer need to go to far off places for treatment of many of the ailments. This has gone a long way in making health care accessible to many people who do not have the means to go out of the state for treatment. RIMS has proved to be a boon for not only the people of the state but also for a large number of patients from neighbouring Nagaland, Mizoram and other states. Another very important contribution of RIMS is the thousands of doctors who have passed out of its portal.  These doctors, mostly from the north eastern region have fanned out to their respective states, teaching in Medical colleges, working in hospitals, practicing privately, all of them engaged in enchancing medical care in the region.

With the upgardation of to Regional Institute of Medical Sciences and having come directly under the Union Ministry of Health andFamily Welfare, one can look forward to much improved infrastructure, latest medical equipments, much better trained personnel, many more departments of specialisation and super-specialisation. According to the Director of RIMS, a Dental college is set to commence in the next academic sesssion, the Blood Bank has been upgraded to Blood Transfusion Department, intake capacity in MBBS and PG courses have been increased, advanced technology CT scan machine etc have been acquired, among other things. All this is very good news and will definite contribute significantly to further enhancing the medical care delivery system. Ultimately, it will save more lives.

But there are some issues which need to be look into.  The first on our list is the rampant indulgence in private practice by the doctors/ teaching staff of the institute. It is illegal, which we suppose everyone of them know, and it is unethical. Besides, the trend of private practice has greatly affected the working of the hospital. Exploitation of patients for financial gains is another serious consequence of this trend. Another issue, is the lack of professionalism and shoddy service in the hospital. Despite the best of facilities, highly qualified and specialist doctors, exeprienced nurses and other staff, many patients (though mostly from the economically better off section) prefer to go to private hospitals. A trust deficit in the working of the hospital is slowly creeeping in among the people. Then there is the question of hospital environment which leaves much to be desired in terms of cleanliness and hygiene.

RIMS authority should look into these issues, bring about a change in the mindset of its employees, a change in the working of he hospital so that it provides a more professional and caring service to the patients. RIMS given all that is at its disposal in terms of man, machine and expertise, should lead the way in providing better health care facilities not only to the people of the state but to the rest of the region. And who knows, it might even become the favoured medical tourism destination for our South East Asian brethrens.

Sources:- Hueiyen Lanpao

Plan to double health spend over next 5 yrs: Ahluwalia

September 10, 2011 Leave a comment

NEW DELHI (Reuters) – India plans to more than double its health budget over the next five years, a move that would expand access to much-needed health care and reach more voters ahead of 2014 national elections, but could also further stretch government finances.

The UPA government led by Manmohan Singh, under fire from the opposition and civil society groups over various corruption scams and inflation, is trying to win back voters, as it has to face elections in five states next year.

“In the 12th plan…we will be able to increase both centre and state spending (on health) as percentage of GDP somewhere upto 2.5 percent from a little over 1 percent,” said Montek Singh Ahluwalia, deputy chairman of the planning commission, on Friday.

India’s plan panel — which recommends the allocation of federal funds for key national programmes — is expected to finalise the spending plan for the next five years to March 2017 by December.

Private households contribute to about three-fourth of total healthcare spending, which is at about 4 percent of the GDP – estimated at $1.6 trillion.

The government is struggling to meet a deficit target of 4.6 percent of GDP.

The World Bank has said despite improvement in health indicators in the country, slow progress has failed to match the impressive gains in economic growth during the past decade.

Ahluwalia said the government could focus on the poor – about 50 percent of the total 1.2 billion population – who could not afford health services, while partly subsidising the middle income groups.

A committee appointed by the Prime Minister to suggest universal health insurance coverage for all Indians is expected to submit its report by month end, Ahluwalia said.

Under the proposed universal health insurance scheme, the premium may be linked to income levels of the beneficiaries, although the government may pay the entire premium for those below the poverty line, he said.

(Reporting by Manoj Kumar; Editing by Aradhana Aravindan)

Womb Cancer Risk Linked to Cakes

September 9, 2011 Leave a comment

Cakes, biscuits and buns can significantly increase women’s chances of developing womb cancer reveals a study.

Women who indulge in sweets two to three times a week were at 33 percent higher risk of developing womb cancer. Study further revealed women who snack on cakes, biscuits and buns more than three times a week are 42 percent more likely to suffer from the disease.

However, people with sweet tooth need not be disappointed as the researchers describe this degree of effect to be modest and warrant further investigations.

Scientists of the Stockholms Karolinska Institute revealed that excess sugar release more insulin , this can result in excessive cell growth in the inner membrane of womb.

Swedish scientists studied thousands of women to know the link between sugary food and womb cancer. Between 1987 and 1990, women were asked dozens of question related to their general health, diet, lifestyle and weight. After 10 years, these women answered more extensive questions related to their eating habits and lifestyle. In 2008, all the information was matched with their medical records, especially the diagnoses of endometrial cancer (most common form of womb cancer).

Out of 61,226 women 729 developed cancer. Women who snacked on cakes, bun and biscuits were 42 per cent more likely to develop cancer than those who had less of them. High sugar items such as sweet, soft drinks, colas and marmalade pose little or no risk of womb cancer, researcher said.

According to British cancer experts it is too early to draw any firm conclusion.