Communicable Diseases Essay Example for Free

Communicable Diseases Essay Improvement in the health status of the population has been one of the major thrust areas for the social development programmes of the country. This was to be achieved through improving the access to and utilization of Health, Family Welfare and Nutrition Services with special focus on under served and under privileged segment of population. Main responsibility of infrastructure and manpower building rests with the State Government supplemented by funds from the Central Government and external assistance. Major disease control programmes and the Family Welfare Programmes are funded by the Centre (some with assistance from external agencies) and are implemented through the State infrastructure. The food supplementation programmes for mothers and children are funded by the State and implemented through the ICDS infrastructure funded by the Central Government. Safe drinking water and environmental sanitation are essential pre-requisites for health. Initially these two activities were funded by the Health Department, but subsequently Dept. of Urban and Rural Development and Dept. of Environment fund these activities both in the State and Centre. Health and health care development has not been a priority of the Indian state. This is reflected in two significant facts. One, the low level of investment and allocation of resources to the health sector over the years about one percent of GDP with clear declining trends over the last decade. And second the uncontrolled and very rapid development of an unregulated private health sector, especially in the last two decades.This does not mean that there was no health policy all these years. At the state government level there is no evidence of any policy initiatives in the health sector. The Central government through the Council of Health and Family Welfare and various Committee recommendations has shaped health policy and planning in India. It has directed this through the Five Year Plans through which it executes its decisions. The entire approach has been program based. The Centre designs national programs and the states have to just accept them. The Centre assures this through the fiscal control it has in distribution of resources. So, essentially what is a state subject the Centre takes major decisions. However it is important to note that this Central control is largely over preventive and promotive programs like the Disease Control programs, MCH and Family Planning, which together account for between half and two-thirds of state budgets. Curative care, that is hospital and dispensaries, has not been an area of Central influence and in this domain investments have come mostly from the state’s own resources. Structured health policy making and health planning in India is not a post-independence phenomena. In fact, the most comprehensive health policy and plan document ever prepared in India was on the eve of Independence in 1946. Especially the 80% population residing in rural areas. It is only an embarrassment for the Indian nation that more than half a century later there is no evidence of development of health care services to an expected level. The enclave pattern of development of the health sector continues even today – the poor, the villagers, women and other underprivileged sections of society, in other words the majority, still do not have access to affordable basic health care of any credible quality. This Research Paper includes analysis of existing Health Planning and the development of health status of the society in the past decade 2001 to 2011 . Census of India 2001 and Census of India 2011 used. Decline of Fertility rate,Maternal Mortality rate ,Infant Mortality rate and other developments are studied .At the same time Upgrowing Trend of fatality of some communicable diseases (Dengue,Malaria,Cholera) and Noncommunicable Diseases (Heart Diseases,Diabetic ) are also studied and analysed in this paper. Key Words : Health planning,development,IMR,MMR,TFR,Upgrowing CDs and NCDsDiseases. Health planning and policies : Good health is a basic requirement for quality of life. It is the foundation for social and economic development. The objective of the government is to ensure that health care services are rendered, keeping in view the core principles of accessibility, equity, quality and affordability. This will be accomplished through strengthening of the health care network throughout the state to deliver not only curative but also preventive and rehabilitative care. To achieve the above objectives, the budget allocation of the Health and Family Welfare Department has been fixed at Rs 5569.28 crores for the financial year 2012-13 as against the provision of Rs.3889 crores for the year 2010-11 registering an increase of more than 40%. Tamil Nadu fares well on the health indicators which form a part of the Human Development Index (HDI) as compared to other Indian states.Government policy interventions and funding have played an important role in the State’s better health outcomes. Tamil Nadu has implemented various programmes with special focus on maternal and child health which has resulted in the reduction of vital indicators such as the Maternal Mortality Ratio (MMR), Infant Mortality Rate (IMR) and Total Fertility Rate (TFR). However, the state willcontinue its efforts to improve its performance in the health sector by benchmarking itself against higher targets. The recently released â€Å"Vision 2023â€Å" envisages Tamil Nadu to become not only the numero uno State in India in terms of social indicators, but also reach the levels attained by developed countries in human development by ensuring universal access to health facilities† This Government will continue to give prominence to the health of women and children. Promotion of institutional deliveries by strengthening the Primary Health Centres and Health Sub-Centres with qualified and trained manpower, establishment of upgraded Primary Health Centres in each block with 30 beds, an operation theatre and various other facilities, provision of 24 hours delivery care services by positioning 3 staff nurses in each Primary Health Centre, provision of emergency obstetric care in the CEmONC Centres established in the district and select taluk hospitals, ensuring availability of an Emergency Response System through 108 ambulances with inter facility transfer, provision of safe blood at the upgraded Primary Health Centres, provision of neo-natal ambulances for the transportation of neo-natal emergencies, establishment of Neo-natal Intensive Care Units (NICUs) with trained Doctors and Staff Nurses in each district are all schemes which would no doubt help to achieve go od progress in the further reduction of MMR and IMR, in the coming years. The benefit under the Dr.Muthulakshmi Reddy Maternity Benefit Assistance Scheme has been enhanced to Rs.12,000, which is the highest in the country. This has come as a boon to the poor beneficiaries who deliver in government health facilities. The three phase payment has also strengthened antenatal, postnatal care and improved child immunization. The scheme would have a major impact on further improving the maternal and child health indicators in the State. An allocation of Rs.720 crores has been provided for this scheme in 2012-2013. This Government has announced a path breaking new scheme for free distribution of sanitary napkins to rural adolescent girls. This scheme which has been launched by the Hon’ble Chief Minister on 27th March 2012, will benefit over 41 lakh adolescent girls in the 10-19 age group in rural areas covering all the districts of the state. Sanitary napkins will be distributed through schools and Anganwadis. This initiative will go a long way to improve personal hygiene, prevent future complications such as infertility and promote the health of the future mothers. An amount of Rs.55 crores has been provided for this scheme in this financial year. State-wide programmes have been launched for the management of iron deficiency anaemia and gestational diabetes. The State has been the first to introduce the use of injection iron sucrose in the public sector for reducing severe anaemia in pregnant women following a protocol developed by senior obstetricians and specialists. Addressing these major underlying causes will no doubt help to reduce maternal morbidity and mortality further. The Chief Minister’s Comprehensive Health Insurance Scheme has been launched on 11th January 2012 to provide insurance coverage for life threatening ailments to the poor people of Tamil Nadu. This scheme has enhanced the sum assured to rupees one lakh per year and Rs.4 lakhs for a period of four years and h as also extended the coverage to more diseases and included diagnostic procedures. Special provisions have also been incorporated to strengthen the role of Government hospitals in implementing the scheme. So far, 26,172 beneficiaries have undergone treatments costing Rs.70.53 crores. A sum of Rs.750 crores has been provided for the implementation of this scheme in 2012-2013. As new initiatives, during 2012-2013, the infrastructure for operation theatres in district and medical college hospitals will be improved at a cost of Rs.20 crores. Post-mortem facilities will be improved at a cost of Rs.10 crores. To improve the services available to the public, diagnostic equipment will be provided at a cost of Rs.10 crores and MRI facilities will be provided in 5 Medical Colleges through Public Private Partnership. The Burns centre in Kilpauk Medical College Hospital will be upgraded as a Centre of Excellence at a cost of Rs.5 crores. The incidence of cancer as a disease hasgradually been increasing and it has become a major cause of morbidity and mortality in the State. A State Cancer Registry to collect details of all the cancer cases in the State will be put in place fromthis year. Further, most forms of cancer are treatable if detected early. Seventy percent of various types of patients seek treatment in an advanced stage. There is only one exclusive cancer hospital in the Government sector i.e. Arignar Anna Cancer Hospital at Karapettai, Kancheepuram is providing treatment to the patients. Considering the increasing need for specialized cancer care, Government has decided to establish Regional Cancer Centres at the Government Rajaji Hospital, Madurai and Coimbatore Medical College Hospital at a cost of Rs.15 crores per centre. These cancer centres will address the needs of the cancer patients in the Southern and Western region of the State. A new programme to screen the high risk population for oral cancer and to diagnose it at an early stage will also be launched. The King Institute of Preventive Medicine and Research, Guindy, Chennai, is one of the premier institutions of this country. It is also a teaching and research centre. The Virology department of this Institute is recognized by Government of India and the World Health Organisation as the National Polio Laboratory. This institute was manufacturing vaccines and serum which was stopped some years back. It is now proposed to revive the vaccine production and create a Tissue bank in the KingInstitute of Preventive Medicine and Research, Guindy, Chennai, at a cost of Rs.5 crores. Special focus will be provided on non communicable diseases like diabetes, hypertension, cardiovascular diseases and cancer of breast and cervix which are emerging as major causes of morbidity and mortality. A two pronged strategy wil be adopted to tackle these diseases. While awareness creation for prevention through life style changes will be taken up at various levels, infrastructure facilities for early detection and treatment will be created. After the success of the pilot schemes in two districts, this activity has been scaled up to the entire State in phases. During phase -I, the programme has been taken up for implementation in 16 districts and during phase-II, the programme will be implemented in the remaining 16 Districts during the later part of the year. Rs.158 crores has been earmarked to the Health Systems Project for implementing the programmes during this year. Considering the growing urbanization of the State it is necessary to address urban health challenges, especially in small urban towns. 60 urban primary health centres already sanctioned under NRHM and the newly sanctioned 75 urban primary health centres have been brought under the control of Director of Public Health and Preventive Medicine. Strengthening of these centres with appointment of Medical Officers, Staff Nurses, ANMs, Pharmacists etc., is now taking place. The Medical Services Recruitment Board, which is the first of its kind in India, has been formed exclusively for the Health and Family Welfare Department to recruit candidates to fill up medical and para medic al vacancies in the Government Hospitals and Primary Health Centres. The Board is taking action to recruit candidates for ten major categories of posts which will no doubt improve the functioning of the government health institutions.The objective of Vision 2023 is to build a healthy society that will be able to take part in and share the fruits of economic development. The various schemes launched by this Government during the last year and the new schemes proposed now for this year would build a beginning to achieve the objectives of the Vision 2023. This includes Rs.5413.75 crores on the Revenue Account and Rs.154.62 crores on the Capital Account. The provision on the Revenue Account works out to 5.51% of the total Revenue Expenditure of Rs.98213.85 crores in the Tamil Nadu State Budget for the year 2012 -2013. Note: Apart from the above provision, funds towards Civil Works being undertaken by Public Works Department have been provided to the tune of Rs.323.68 crores under Demand No.39. The Directorate-wise provision for 2012-2013 made under Demand No.19 Health and Family Welfare Department is as follows: (Rupees in lakhs) Decadal Population growth rate as shown below : Current Status of Communicable Diseases in India India is undergoing an epidemiologic, demo-graphic and health transition. The expectancy of life has increased, with consequent rise in degenerative diseases of aging and life-styles. Nevertheless, communicable diseases are still dominant and constitute major public health issues. New viral and bacterial infections have been identified. Monitoring of anti-microbial resistance to commonly used drugs is being extended to include more organisms. Disease surveillance at the molecular level has been expanded and strengthened. Studies to assess disease burden not only in terms of morbidity and mortality but also economic are high on the Council’s agenda. Feasibility of effective strategies under field conditions for control of infectious diseases is being demonstrated. Research support to eradicate target diseases has been intensified. Development and evaluation of diagnostic tools, drugs and vaccines is being undertaken. Programme relevant research to strengthen the national health programmes and human resource development are an integral part of the efforts of the Council towards control of communicable diseases. It is evident that inspite of the declining mortality and changing morbidity pattern, India still has the â€Å"unfinished agenda† of combating the traditional infectious diseases that continue to contribute to a heavy disease burden and take a sizeable toll. Along with these, the country has to deal with the â€Å"emerging agenda† which includes chronic and newer diseases induced by the changing age structure, changing lifestyles and environmental pollution. We need to prepare ourselves to face the challenges of widening disparities between sections of the population in terms of access to good health. Till date, the diseases we have been able to eradicate in India are smallpox (in 1977) and guinea worm (in 2001) though we have many more in the agenda (polio, leprosy, yaws). Diseases like yaws and plague have been under control. During 1997, as many as 8515 cases of yaws were reported and treated. While during 2001, only 168 cases have been reported and treated4 i.e. 50 times reduction in four years time. Epidemics of cholera are not that frequent as in old days. Reported cases of cholera were 176,307 with 86,997 deaths in 1950.1 However, now total number of cases in a year is about 5,000 and mortality is also low. Dengue was predominantly an urban problem but now cases and outbreaks have been reported from rural areas also. There has been a decline in dengue fever/dengue hemorrhagic fever (DHF) incidence after 1996 outbreak in Delhi. However during 2001, outbreaks have been reported from Rajasthan, Tamil Nadu, Karnataka and Gujurat.4 Malaria is still a public health problem till today. The programme for eradication of malaria has been in place for the past 50 years under different names in our country. At the peak level of the success of programme in 1964, malaria was contained to less than 100,000 cases and no deaths. However, the situation slipped out of control and by 1976 we had 6,467,215 cases of malaria with 99 deaths.4 The total number of leprosy cases has dropped substantially from 2.91 million in 1981 to 0.44 million cases reported in March 2002. The prevalence rate has reduced from 57 per 10,000 in 1981 to 4.2 cases per 10,000 population in 2002. However, it is still much higher than the target, which is 1 case per 10,000 populations, of National Leprosy Elimination Programme. With these limited progresses, we have failed on many counts. Some diseases, which were once thought to have been conquered, have re-emerged in the recent years. Plague, which was a public health problem in the 1940s, speedily declined as a result of large scale application of dichlorodiphenyl- trichloroethane (DDT) in the year 1946.There was no laboratory confirmed plague in India during 1966 to 1993. However, during 1994, an outbreak of pneumonicplague was reported from Surat, Gujarat. Recently, in February 2002, an outbreak of plague was reported from Shimla, Tuberculosis : Tuberculosis accounts for a loss of approximately 11 million disability adjusted life years (DALYs). The burden of disease may increase further with the emergence of the HIV epidemic. The Revised National TB Control Programme (RNTCP) which covers more than 120 million population has successfully treated approximately 80% of patients in 48 districts of 16 states and Union Territories. Treatment success rates have more than doubled and death rates have decreased by 75 per cent. The ICMR’s Tuberculosis Research Centre (TRC) at Chennai is providing research support to the RNTCP through the conduct of basic, applied and operational research to develop better tools and training strategies for tuberculosis control. Diarrhoeal Diseases The National Institute of Cholera and Enteric Diseases (NICED), Calcutta and RMRC, Bhuban-eswar continued to pursue their research goals on different facets of diarrhoeal diseases. The NICED, Calcutta has earned an important affiliation with the Japanese International Collaborating Programme. Its active surveillance programme continues to monitor the newly emerging diarrhoeal pathogens Entamoeba histolytica,Rotavirus,Vibrio cholera and V.parahaemolyticus and addresses unknown frontiers in clinical diagnosis and disease management.A double-blind, randomized, controlled clinical trial was conducted by NICED,. These results suggest that zinc supplementation as an adjunct therapy to ORS has beneficial effects on the clinical course of dehydrating acute diarrhoea. Malaria The emergence of chloroquin resistance in P.falciparum and vector resistance to commonly used insecticides are the main obstacles in the control of malaria in the country. New technologies are being introduced for malaria control under Enhanced Malaria Control Programme. The roll back malaria programme has been launched simultaneously in all malaria endemic countries. These have thrown new challenges in malaria research. The Council’s institutes viz. Malaria Research Centre (MRC), Vector Control Research Centre (VCRC) and other institutes are making efforts to address these problems through focused research in vector and parasite biology and ecology, development of malaria control tools, drug development, testing and validation of new technologies. Disease Control Programmes – Non Communicable Diseases National Programme of Prevention Control of Cancer, Diabetes, Cardiovascular Diseases Stroke Programme (NPCDCS) . A new National Programme of Prevention Control of Cancer, Diabetes, and Cardiovascular Diseases Stroke (NPCDCS) was approved in July, 2010. This programme will cover 100 districts selected on the basis of their backwardness, inaccessibility and poor health indicators, spread over 21 States, during 2010-11 and 2011-12. The focus of the programme is on promotion of healthy life styles, early diagnosis and management of diabetes, hypertension, cardiovascular diseases and common cancers e.g. cervix cancer, breast cancer, and oral cancer and will cover about 200 million persons in all the districts. Conclusion: Our findings clearly establish the significant influence of the various Health planning studied on the health status of the society. They also show that this influence was more pronounced in the case of some health indicators maternal mortality rate,population growth rate, death rate, infant mortality rate than some communicable diseases survilance. The findings suggest that appropriate strategies and programmes need to be worked out to prevent CDs and control NCDs. especially to avoid upgrowing trend of some diseases like acute respiratory infection ,acute diarrhoeal disease,pulmonary tuberlosis , malaria,enteric fever , Pneumonia ect.. These would include awareness creation regarding sanitation more knowledge about the diseases and treatment and prevention through mass media and interpersonal channels. Healthy environment, especially safe drinking water supply, sanitary disposal of excreta and other wastes, and pollution-free housing and work places. Adequate nutrition, which in tu rn depends on production and availability, accessibility, affordability and intrafamilial distribution of food. Control over communicable disease. Lifestyle changes that influence the occurrence of non communicable diseases.The services of Government as well as non-governmental organizations could be sought for more effective implementation of such strategies and programmes. The management of the Health and family welfare programme at the grossroots level,which is likely to vary with the managerial skills of the programme manager, and its impact on the realization of the objectives of the health planning and programme . As management quality has been recognized as a critical factor in determining the success of Health planning implementation, staff recruitment and effective functioning of the PHC and sub-centres could be increased and thus the health plan could be more successful. 1.Associate Professor in Economics , Sri Parasakthi women College, Courtalam. 2. Research Scholar in Health economics , M.S.University, Tirunelveli. REFERENCES 1. Deodhar NS. Health situation in India: 2001.Voluntary Health Association of India. New Delhi. 2. Last JM. A dictionary of epidemiology. Third edition, Oxford University Press.1995. 3. GOI. National Health Policy 2002. Ministry of Health and Family Welfare, Government of India (GOI), New Delhi. 4. GOI. Annual Report 2001-2002. Ministry of Health and Family Welfare, Government of India (GOI), New Delhi. 5. World Health Organization 2002. Weekly Epidemiological Report. No 9:1st March 2002. 6. GOI. Combating HIV/AIDS in India 2000-2001. Ministry of Health and Family Welfare, National AIDS Control Organization. Government of India (GOI), New Delhi. 7. World Health Organization. NCD in South-East Asia region A profile WHO New Delhi 2002. 8. National Institute of Health and Family Welfare. National Health Programmes on Non Communicable Diseases, New Delhi. 2003. 9.http://www.who.int/. [Last assessed on 2012 July 31] 10. World Health Organization. Global Status Report on non-communicable diseases 2010. 11. Beaglehole et al. Priority actions for the non-communicable disease crises. THE LANCET 2011; 377:9775; 1438-1447. 12. World Health Organization. Non-communicable Diseases Country Profile 2011. 13. World Health Organization. Global Health Observatory, 2011. 14. World Health Organization, Regional Office for South-East Asia. Non-communicable Diseases in the South-East Asia Region: Situation and response 2011 15. Beaglehole R. Globalization and the Prevention and control of non-communicable disease: the neglected chronic diseases of adults. THE LANCET 2003; 362:9387; 903-908. 16. Nongkynrih B, Ratro B K, Pandav C S. Current Status of Communicable and Non-Communicable Diseases in India. Journal of The Association of Physicians of India 2004; 52; 118-123. 17. Ministry of Health and Family Welfare (2011). Rural Health Statistics in India. New Delhi: Ministry of Health and Family Welfare. 18. World Health Organization (WHO). World Health Statistics, 2012 19. Ministry of Health and Family Welfare, Government of India. National Rural Health Mission (NRHM) 20. Ministry of Health Family Welfare. NCD Section. [Last assessed on 2012 July 31] 21. Ministry of Health Family Welfare, Government of India.Journal of National Cancer Control Programme2012. 22. Ministry of Health Family Welfare, Government of India. National Tobacoo Cont rol Programme. 23. Directorate General of health Services, Ministry of Health and Family Welfare, Government of India. Operational guidelines for Prevention and Control of Cancer, Daibetes, CVD and Stroke (NPCDCS). 24. Ministry of Health Family Welfare, Government of India. Indian Public Health Standards. http://www.mohfw.nic.in/NRHM/iphs.htm. [Last assessed on 2012 July 31] 25. The World Bank, South Asia Human Development, Health Nutrition and Population. NCDs Policy Brief: India, 2011 26.Srivastava R K, Bachani D. Burden of NCDs, Policies and Programmes for Prevention and Control of NCDs in India. Indian Journal of Community Medicine 2011; 36: S7-12 27.Health and family welfare department Demand No .19 Policy note 2012-2013 Dr.Vijay Minister for Health