Posts Tagged ‘National health Programmes’

All India Public Health Service Cadre: Special cadre for health services mooted

October 24, 2011 Leave a comment

NEW DELHI: India must put in place a new army of health workers – the Public Health Service Cadre – to fight the public health threats.

The Planning Commission’s high-level expert group (HLEG) on universal health coverage (UHC) says, a national and state-level Public Health Service Cadre and a specialized state-level Health Systems Management Cadre needs to be put in place. This will help provide greater attention to public health and also strengthen the UHC system’s management.

A new cadre, comprising public health professionals with multi-disciplinary education, would improve the functioning of the system by enhancing the efficacy, efficiency and effectiveness of healthcare delivery.

“We recommend the creation of an All India Public Health Service Cadre that should be responsible for all public health functions starting at the block level and going up to the state and national level. This cadre should be supported by a state level public health cadre. This would be akin to the civil services, which provide for both all India and state-level officers,” the HLEG’s final report, submitted to the government on Saturday, said.

The state-level cadre will provide the operational framework of public health services, the All-India cadre will not only health strengthen state services with a high level of professional expertise, but also provide strong connectivity between state and Central planning.

The HLEG has recommended the creation of a new Health Systems Management Cadre.

Quality assessment and assurance for health facilities will be a key function for the cadre. The health system managers would take over many of the administrative responsibilities in areas such as IT, finance, human resources, planning and communication that are currently performed by medical personnel.

“We further recommend the appointment of appropriately trained hospital managers at sub-district, district hospitals and medical college hospitals so as to improve the managerial efficiency and also enable medical officers to concentrate on clinical activities. Appropriate training of these new cadres is likely to significantly enhance the management capacities at all levels and end the practice of untrained personnel being assigned to manage health institutions,” the report added.

India faces an acute shortage of allopathic doctors. HLEG’s estimates say the number of allopathic doctors registered with the Medical Council of India has increased since 1974 to 6.12 lakhs in 2011 – a ratio of 1 doctor for 1,953 people or a density of 0.5 doctors per 1,000 population.

It will take India at least 17 more years before it can reach the World Health Organization’s recommended norm of one doctor per 1,000 population.

The HLEG has predicted the availability of allopathic doctors to one doctor per 1000 population by 2028, which can be achieved by setting up of 187 medical colleges in 17 high focus states during the 12th and 13th Five Year plan.

Sources:- Times Of India


Accessible, affordable healthcare in the offing

August 25, 2011 Leave a comment

New Delhi : India’s Twelfth Five Year Plan (2012-2017) will give more teeth to healthcare by emphasising on accessibility and affordability, a member of the plan panel said here Wednesday.

“Health and manufacturing affordable means of healthcare will be priority areas. The medical technology industry needs to understand the demands of the Indian market for innovation in the health sector,” Planning Commission member Arun Maira said at the fourth conference on medical technology organised by the Confederation of Indian Industry (CII).

“With over 80 percent of healthcare services met by corporations, a large part of the populace still finds itself outside the ambit of delivery mechanisms,” he noted.

While Prime Minister Manmohan Singh, in his Independence Day speech, announced that health would be deemed a priority area, experts said indigenous players in the health sector will have to be given more suport to achieve the target.

“With a population of 1.2 billion, support should be given to indigenous manufacturers in addressing the issues of quality and narrowing the technology gap we have in healthcare,” said Naresh Trehan, chairman of the CII National Committee on Healthcare.

With greater education and wealth come greater risks for India’s unborn females


NEW DELHI— From Tuesday’s Globe and Mail

Published Tuesday, May. 24, 2011 1:30AM EDT

In India, the practice of aborting female fetuses increases as women become better educated and wealthier, defying the predicted decline of a widespread cultural preference for sons.

And as many as 12 million girls have gone “missing” from the population since 1985 because of the practice, according to new research released Tuesday by the leading medical journal The Lancet.

“There is really no change in stated son preference over the last 10 to 15 years,” said Prabhat Jha, an epidemiologist at the University of Toronto who led the study. “Fertility has dropped substantially due to economic growth and increases in literacy, which are all very good things, but that has also meant that ultrasound use and access is increasing. Families appear to be saying, ‘If nature – or God, if they’re religious – gives us a first boy, then we will have one more child and that’s it, but if we have a first girl we will use ultrasound [and abortion] to ensure our second and last child is a boy.’ ”

Recently released data mean he and colleagues are able to study the trends since 1985, when ultrasound gender testing was introduced here. “And it isn’t slowing down.”

The researchers used census data, and 265,000 birth histories collected in India’s National Family Health Survey, to estimate differences in the girl-boy ratio for second births in families in which the first-born child had been a girl. They found that the girl-boy ratio fell from 906 girls per 1,000 boys in 1990 to 836 in 2005.

But in cases where the first child born was a boy, there was no drop in the girl-boy ratio for the second child: evidence that parents are selectively aborting girls if their first-born child is a girl, Dr. Jha said.

This difference in the ratio of girls to boys born was much sharper in mothers with 10 or more years of education than in mothers with no education; the difference is also greater in better-off households compared with poorer ones.

The study says that there is not yet clear evidence of the selective abortion of first-born female fetuses, as is common in China, where son preference is also strong and where state policy restricts families to only one child. But that may come as growing numbers of families choose to have only one child, particularly in urban areas.

Dr. Jha, who directs the U of T’s Centre for Global Health Research, said the study makes clear that the steps taken by the government to end sex-selective abortion have not been successful. The law banning prenatal sex determination is a good one, he said, but the private health-care sector in India is so minimally regulated that the law has had little impact.

To calculate the number of female fetuses aborted for sex selection since the introduction of ultrasound gender determination in 1985, the authors calculated the expected number of births of girls, based on the ratio of 950-975 girls born to 1,000 boys in societies without son preference, and compared it against the actual number of births of girls enumerated by the censuses, done every 10 years.

After adjusting for excess mortality rates in girls, the authors estimated that there were between zero and two million selective abortions of girls from about 1985 to 1990; 1.2 million to 4.1 million in the 1990s, and 3.1 million to six million in the 2000s – for a total of between four million and 12 million by 2010.

Before the release of 2011 census data last month, there was speculation here that rising income levels and education levels for women, combined with public education campaigns and efforts at enforcement by government over the past 15 years, would show a slowing of sex-selective abortion.

“I was quite surprised that the ratios had gone down further,” said Dr. Jha, who has worked on this subject for a number of years.

In an interview in Delhi, he noted, sounding rueful, that he and his colleagues “can’t really explain why” son preference is persisting with such dramatic consequences, as they were not studying causes. Analysts in the Indian media frequently cite the practice of paying dowry for brides, which has been illegal for decades but is still widespread, as one possible explanation.

A further finding of the research is that a majority of Indians now live in states where selective abortion of girls is common. Until this year’s census data, which showed a decline in sex ratios in a majority of states, it had been believed that the practice was largely confined to a handful of states with deeply rooted cultural aversions to female children.

Source: The Globe and Mail

Study backs national rotavirus vaccination plan

April 21, 2011 Leave a comment

Ramya Kannan

A national rotavirus vaccination programme in India would prevent substantial deaths due to the rotavirus and would be highly cost-effective, a recent article in the Clinical Infectious Diseases journal has recommended.

The article, penned by experts in the Centers for Disease Control and Prevention, in association with the department of Gastrointestinal Sciences, Christian Medical College, Vellore, aimed at assessing the value of such a vaccination in India. The rotavirus is said to be the most common cause of severe dehydrating gastroenteritis in children under five years globally. It causes an estimated 5,27,000 deaths in India, the paper said, quoting sources. It is also clear that improvement in sanitation and hygiene have not had substantial effects on the incidence, and therefore, vaccination is considered the best means of controlling the disease, authors Douglas Esposito, Jacqueline Tate, Gagandeep Kang and Umesh Parashar, have said.

The WHO now recommends inclusion of rotavirus vaccine in the vaccination schedule across the world.

Such a national vaccination programme would prevent about 44,000 deaths, at least 2,93,000 hospitalisations and nearly 3,28,000 outpatient visits annually, the authors have concluded. With an estimated 50 per cent effectiveness of the vaccine available, and factoring in Disability-Adjusted Life-Year (DALY), it was estimated that the reductions in rotavirus disease brought about by vaccination would save the health care system in India about US $ 20.6 million annually in medical treatment costs (US $ 19.7 million in hospitalisation and US $ 0.9 million in outpatient visit costs) working out to about US $ 0.76 per child.

The authors further added that although rotavirus vaccination is likely to have substantial public health impact in India, their analyses indicated that only approximately one third of the estimated rotavirus-associated deaths would be averted by vaccination. “Efforts to improve the vaccination coverage rates in India could further enhance the life-saving benefits and public health impact of this intervention.”


Nothing to Quack About in India.

April 21, 2011 Leave a comment

Private rural practitioners, or “quacks,” deliver the vast majority of healthcare in many countries around the world; there is a real opportunity to improve the health and wellbeing of millions of poor families if we can figure out how to best engage with these providers to improve their practice.

I was in India last month and had the opportunity to meet Mr. Nagendra in Jamsaut village – a small village in a rural part of the state of Bihar, in Northern India. Mr. Nagendra is a private healthcare provider who runs a private practice for villagers. He utilizes a mix of practices along with good “bedside manner” that engenders the trust of the people.

Mr. Nagendra’s story is an important one because all across India, particularly in the northern states, there are millions of entrepreneurs just like him – about one per village – who are providing the majority of healthcare in the country. In rural India, about 80-90 percent of healthcare is provided by these private local providers with no formal training, often called Rural Medical Practitioners (RMPs). Read the full story here

66% of worldwide stillbirths occurs in India

April 14, 2011 Leave a comment
Kounteya Sinha, TNN | Apr 14, 2011, 07.04am IST

NEW DELHI: Four lakh fewer children died while still in their mother’s womb in 2009 — in India, Bangladesh and China — as compared to 1995.

However, India is among 10 countries, which, though, contributes 54% of total worldwide births, 66%, or 1.8 million of all stillbirths.

India’s stillbirth — death after 28 weeks’ of gestation — figures have reduced over the past decade. Be that as it may, it’s still shameful — 22 stillbirths per 1,000 births. In some states, it varies from 20 to 66 per 1,000 births.

According to a series on stillbirth, published in “The Lancet” on Wednesday, more than 7, 200 babies are stillborn every day. Around 2.6 million stillbirths occur worldwide each year during the last trimester of pregnancy, and 98% of them occur in low and middle-income countries. High-income countries, too, report stillbirths with one in 320 babies stillborn.

Sadly, the number of stillbirths worldwide has declined by only 1.1% per year — from 3 million (1995) to 2.6 million (2009). The global stillbirth rate, in turn, has reduced from 22 stillbirths per 1,000 to 19.

Dr Monir Islam, World Health Organization’s (WHO) South-East Asia director on family health, said, “Though India has made some progress, what worries me most are the intra-partum deaths (a child being alive all through the nine months inside a mother’s womb but dying during labour). Around 50% of stillbirths are such cases, which is unacceptable.”

WHO says, one in every two stillbirths in developing countries occurs during birth (intra-partum). Worldwide, 1.2 million babies die during labour and most of these are term babies who should survive if born alive and whose deaths are often associated with lack of obstetric care.

“If every woman had access to a skilled birth attendant – a mid-wife and if necessary a physician – for both essential care and for procedures such as emergency caesarean sections, we would see a dramatic decrease in the number of stillbirths,” Dr Carole Presern, director of The Partnership for Maternal, Newborn & Child Health (PMNCH) said.

In India, 60% women have access to skilled care during child birth.

The main causes of stillbirth are childbirth complications, infections during pregnancy, disorders — especially hypertension and diabetes — fetal growth restriction and congenital abnormalities.

Globally, the rate of stillbirths ranges from 2 per 1,000 total births in Finland to more than 47 per 1,000 in Pakistan. The stillbirth rate varies sharply across the world — such as Nigeria (42), Bangladesh (36) and Djibouti and Senegal (34).

In developed nations, risks are clear. Up to 58% of women of childbearing age are overweight or obese, which is a major risk factor for stillbirth. Around half of all pregnant women consume alcohol during pregnancy, raising the risk of stillbirth by 40%. Any smoking during pregnancy increases the risk of stillbirth by 40%.

Can India prevent 200 children dying every hour? Op-Ed

April 14, 2011 Leave a comment

Can India prevent 200 children dying every hour?

Poonam Khetrapal-Singh

It is estimated that India lost 1.8 million children under five in 2008. That is more than 200 child deaths every hour, each day, or more than three deaths every minute. Out of about 25 million babies born every year in India, one million die. Most who survive do not get to grow up and develop well. About 48 per cent are stunted (sub-normal height) and 43 per cent are under-weight. Additionally, about one-third of babies are born with a low birth weight of less than 2,500 grams.

MDG target

In South-East Asia, the Maldives, Sri Lanka and Thailand have reduced newborn and childhood mortality significantly. India has also demonstrated steady progress. Under-five mortality decreased from about 150 per 1,000 live births in 1990 to 74 per 1,000 live births in 2005-06. But at this rate of decline, India will not be able to achieve the Millennium Development Goal 4 (MDG) target of 50 under-five deaths per 1,000 live births by 2015. Moreover, progress has been uneven in various States in the country.


The causes of death among children are well understood in India. Newborn mortality (death within the first 28 days of life) contributes to more than half of under-five mortality. In newborns they are asphyxia (inability to breathe at the time of delivery), infections and prematurity. After 28 days of life, they are the result of acute respiratory infections (pneumonia) and diarrhoea. Undernutrition contributes to 35 per cent of deaths. In addition to these, immediate causes of childhood deaths, there are several socio-cultural factors including poverty, poor water and sanitation facilities, illiteracy (especially among women), the inferior status of women in society, and pregnancy during adolescence (that can be attributed to early marriage). Child mortality rates are also higher among rural populations when compared to their urban counterparts.

We know what needs to be done to save these precious lives. Newborn deaths can be prevented by ensuring nutrition of adolescent girls; delaying pregnancy beyond 20 years of age and ensuring a gap of three-five years between pregnancies; skilled care during pregnancy, childbirth and post-natal care; and improved newborn care practices that include early (within first hour of birth) and exclusive breastfeeding; preventing low body temperature and infections; and early detection of sickness and prompt treatment. Childhood deaths can be prevented by exclusive breastfeeding for six months and complementary feeding from six months of age with continued breastfeeding for two years; immunisation; and early treatment of pneumonia, diarrhoea and malaria. In addition, it is important for the mother and other caretakers at home to invest in appropriate child caring practices, right from birth to support early childhood development and lay a foundation to maximise human potential.

India needs to provide these life-saving interventions to most, if not all, newborn and children who need them. However, their (interventions) coverage has been quite low. For example, in 2005-06 (the National Family Health Survey – NFHS 3 report), the rate of initiation of breastfeeding within an hour of birth was only 26 per cent and exclusive breastfeeding at six months was just 46 per cent. Yet these two interventions have the potential to prevent 19 per cent of deaths. The use of oral rehydration salts in cases of diarrhoea, the most recommended treatment, was just 43 per cent and only 13 per cent cases of suspected pneumonia received antibiotics. Immunisation coverage has been relatively better, suggesting that high coverage is achievable.


The main causes of poor coverage of interventions include ineffective planning and implementation, mainly due to weaknesses in the health system. To address the systemic challenges, India launched a flagship programme, the National Rural Health Mission in 2005-06, to strengthen the health system in rural areas. Commendable initiatives have been put in place such as training about 8,00,000 village level health volunteers (Accredited Social Health Activist, or ASHA), hiring additional staff, strengthening the infrastructure of health facilities, augmenting programme management capacity at State and district levels, and enhancing community participation. However, much more needs to be done to minimise health inequities that exist among different subpopulations in the country.

Public health expenditure in India has remained at a low — about one per cent of GDP — for quite some time. This needs to be scaled up. Considering that about 70 per cent of health care is accessed from the private sector in the country, better regulation and participation of private health service providers must be ensured. Synergy between the health and nutrition sectors must be fostered through better coordination between the Ministry of Health and the Ministry of Women and Child Development, which are responsible for the ICDS (Integrated Child Development Services) programme.

To reach unreached newborns and children, there is a strong case for providing home-based newborn care as well as community-based management of non-severe pneumonia and diarrhoea in children by trained ASHAs and other community health workers. This initiative needs to be supported by provision of incentives, necessary drug supplies, close supervision and appropriate referral linkages. At the same time, the quality of health services at first-level health facilities and referral hospitals must continue to be strengthened.

Fortunately, there is renewed commitment at the global and national levels towards achievement of MDG 4. To save newborns and children, national governments, development agencies, civil society and other stakeholders must work in close collaboration.

( Dr. Poonam Khetrapal-Singh is WHO Deputy Regional Director for South-East Asia Region.)