Health care in india

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Health Care in Developing Countries: Challenges and Opportunities Dr. Jayesh Patidar www.drjayeshpatidar.blogspot.com

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Transcript of Health care in india

Page 1: Health care in india

Health Care in Developing

Countries:

Challenges and Opportunities

Dr. Jayesh Patidar

www.drjayeshpatidar.blogspot.com

Page 2: Health care in india

The challenge of caring for a billion

• India is the second most populous

country in the world

• The death rate has declined but birth rates

continue to be high in most of the states.

• Health care structure in the country is over-

burdened by increasing population

• Family planning programs need to be (re)activated4/26/2014 2www.drjayeshpatidar.blogspot.com

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Challenge: Burden of Disease

in the new millenium

India faces the twin epidemic of

continuing/emerging infectious diseases

as well as chronic degenerative diseases.

The former is related to poor

implementation of the public health

programs, and the latter to demographic

transition with increase in life expectancy.4/26/2014 3www.drjayeshpatidar.blogspot.com

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•Economic deprivation in a large segment of

population results in poor access to health care.

•Poor educational status leads to non-utilization

of scanty health services and increase

in avoidable risk factors.

•Both are closely related to life expectancy

and IMR.

•Advances in medicine are responsible for no more

than half of the observed improvement in health

indices.

Economic development, Education

and Health

4/26/2014 4www.drjayeshpatidar.blogspot.com

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Human Development Indicators:

A challenge for all• Longevity, literacy and GDP per capita are the

main indicators of human development

• Longevity is a measure of state of health, and

is linked to income and education

• Weakness in health sector has an adverse

effect on longevity

• India ranks low (115th) amongst world nations

judged by HDI4/26/2014 5www.drjayeshpatidar.blogspot.com

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High Burden of Disease• India faces high burden of disease because

of lack of environmental sanitation and

safe drinking water, under-nutrition, poor

living conditions, and limited access to

preventive and curative health services

• Lack of education, gender inequality and

explosive growth of population contribute

to increasing burden of disease

• Full impact of the HIV epidemic and

tobacco related diseases is yet to be felt4/26/2014 6www.drjayeshpatidar.blogspot.com

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Health Care in India

• Expenditure on health by the Government

continues to be low. It is not viewed as an

investment but rather as a dead loss!

• States under financial constraints cut

expenditure on health

• Growth in national income by itself is not

enough, if the benefits do not manifest

themselves in the form of more food, better

access to health and education: Amartyo K Sen4/26/2014 7www.drjayeshpatidar.blogspot.com

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Human health has probably improved more over the

past half century then over the previous three

millennia. This is a stunning achievement - never to be

repeated and, it is to be hoped, irreversible. Despite

the devastating impact that HIV/AIDS is having in

Africa and will increasingly have in south east Asia, it

is likely that, overall, human health will continue to

improve steadily during the coming decades. contd4/26/2014 8www.drjayeshpatidar.blogspot.com

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A dark cloud, however, threatens to blot out the sun

from this landscape. Almost everywhere, the poor

suffer poor health and the very poor suffer appallingly.

In addition the gap in health between rich and poor

remains very wide. Addressing this problem, both

between countries and within countries, constitutes

one of the greatest challenges of the new century.

Failure to do so properly will have dire consequences

for the global economy, for social order and justice,

and for the civilization as a whole.

Inequity in Health Care

4/26/2014 9www.drjayeshpatidar.blogspot.com

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Deaths by age groups in developed

and developing world

0

2

4

6

8

10

12

14

Deaths in

millions

0-4 5--14 15-29 30-44 45-59 60-69 >70

Age group in years Developed

Developing4/26/2014 10www.drjayeshpatidar.blogspot.com

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Distribution of 12 million deaths in

under 5 in developing countries, 1993

• ~10% disease burden

could be avoided by

access to safe water

• ~20% disease burden

could be avoided by

eliminating

malnutrition

27%

5%2%

25%

33%6%

2%

ARI ARI/Measles

Measles Diarrhoea

Other Malaria

ARI/Malaria4/26/2014 11www.drjayeshpatidar.blogspot.com

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2020

1990

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Distribution of deaths from three

groups of causes, by region: 1990

0%

20%

40%

60%

80%

100%

EME FSE CHN LAC OAI MEC IND SSA

GROUP 3

GROUP 2

GROUP 1

Murray and Lopez, 19944/26/2014 13www.drjayeshpatidar.blogspot.com

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Probability of death in males 0-14

years from three groups of causes

0

5

10

15

20

25

EME FSE CHN LAC OAI MEC IND SSA

GROUP 3

GROUP 2

GROUP 1

Murray and Lopez, 19944/26/2014 14www.drjayeshpatidar.blogspot.com

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Top causes of death in 1990

and 2020

Diseases Rank in

1990

Rank in

2020

Change in

ranking

IHD 1 1 0

CVD 2 2 0

LRI 3 4 -1

Diarrhoea 4 11 -7

Perinatal 5 16 -11

COAD 6 3 +34/26/2014 15www.drjayeshpatidar.blogspot.com

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Top causes of death in 1990

and 2020

Diseases Rank in

1990

Rank in

2020

Change in

ranking

TB 7 7 0

Measles 8 27 -19

RTA 9 6 +3

Ca lung 10 5 +5

Malaria 11 29 -18

Suicide 12 19 -24/26/2014 16www.drjayeshpatidar.blogspot.com

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Health Care in India

• India has 48 doctors per 100,000 persons

which is fewer than in developed nations

• Wide urban-rural gap in the availability of medical

services: Inequity

• Poor facilities even in large Government institutions

compared to corporate hospitals (Lack of funds, poor

management, political and bureaucratic interference,

lack of leadership in medical community)4/26/2014 17www.drjayeshpatidar.blogspot.com

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A day in hospital:

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Health Care in India:

Curative Health Services• Increasing cost of curative medical services

• High tech curative services not free even in

government hospitals

• Limited health benefits to employees

• Health insurance expensive

• Curative health services not accessible

to rural populations4/26/2014 19www.drjayeshpatidar.blogspot.com

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Health Care in India

• Private practitioners and hospitals major

providers of health care in India

• Practitioners of alternate systems of medicine

also play a major role

• Concerns regarding ethics, medical negligence,

commercialization of medicine, and incompetence

• Increasing cost of medical care and threat to

healthy doctor patient relationship4/26/2014 20www.drjayeshpatidar.blogspot.com

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There is a

marked

shortage of

trained nurses

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Health Care in India

• Prevention, and early diagnosis and treatment,

if feasible, are the most cost-effective strategies

for most diseases

• Promoting healthy life style from early life is a

‘no cost’ intervention which needs to be

incorporated in school curricula. There is need

for increasing public awareness of the benefits of

healthy life style4/26/2014 22www.drjayeshpatidar.blogspot.com

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Components of healthy life style

• Abstinence from tobacco use

• Regular physical exercise

• Balanced nutritious diet rich in vegetables

and fruits, and low in fats and refined sugar

• Avoidance of pre and extramarital sex

• Yoga and meditation

• Avoidance of alcohol and substance abuse4/26/2014 23www.drjayeshpatidar.blogspot.com

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Physical activity and Health Report of the

Surgeon General, 1996• All people benefit from regular physical activity

• Moderate physical activity for 30-45 minutes on all days

of the week is required

• Additional benefits can be gained from more strenuous

activity for longer periods

• Physical activity reduces the risk of premature death,

CAD, hypertension, diabetes and colon cancer. It also

improves mental health.

• A large number of adults including youths are not

regularly physically active

• Certain interventions to promote physical activity in

schools, work site and health care settings have been

found to be beneficial4/26/2014 24www.drjayeshpatidar.blogspot.com

Page 25: Health care in india

Interventions with a large potential

impact on health outcomes

• Immunization (EPI plus)

• DOTs for tuberculosis

• Maternal health and safe

motherhood

interventions

• Family planning

• School health

interventions

• HIV/AIDS prevention

• Integrated management

of childhood illnesses

• Treatment of STD

• Malaria control

• Tobacco control

4/26/2014 25www.drjayeshpatidar.blogspot.com

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4/26/2014 26www.drjayeshpatidar.blogspot.com

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Polio may soon be eradicated from

India and the globe4/26/2014 27www.drjayeshpatidar.blogspot.com

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Available vaccines against some

human pathogens

• Whooping cough

• Tetanus

• Diphtheria

• Polio

• Measles, rubella

• Cholera

• Tuberculosis ?

• S typhi

• N meningitidis C

• Smallpox

• Anthrax

• Strep pneumoniae

• H influenzae

• Hepatitis A and B

• Jap encephalitis

• Mumps

• Rabies

• Yellow fever

• Varicella-zoster

• Influenza A4/26/2014 28www.drjayeshpatidar.blogspot.com

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Vaccines undergoing phase 3

clinical trials*

• Leprosy

• Leishmania

• S typhi

• N meningitidis B

• Influenza B

• Rotavirus

* expected to be available in 5-10 years4/26/2014 29www.drjayeshpatidar.blogspot.com

Page 30: Health care in india

Vaccination coverage in India

continues to be low, and falls short of

the target of 90%. Recommended

vaccinations under EPI include DPT,

polio, BCG, measles. It is proposed

to add Hepatitis B and H influenzae

type b to this list.

Measles continues to cause 30% of

all vaccine preventable deaths,

mostly in developing countries.

Challenge is to increase the

immunization coverage to the

desired level.

Also to develop newer vaccines and

new modes of delivery.4/26/2014 30www.drjayeshpatidar.blogspot.com

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Number of deaths from pneumonia

per 100,000 children <15 years in US

Vaccination is not the only

answer!

4/26/2014 31www.drjayeshpatidar.blogspot.com

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Rational use of diagnostic tests

• Inappropriate and irrational use of high tech and

expensive diagnostic tests is widely prevalent in

developing countries (CT, serology for TB)

• Market forces, misinformation, desire to do something

• Governmental regulation not feasible; improved

diagnostic reasoning required

4/26/2014 32www.drjayeshpatidar.blogspot.com

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• There has been an

explosion of high

tech diagnostic,

therapeutic and

preventive

interventions in the

field of medicine and

surgery

• This has resulted in

physicians spending

less time in history

taking and physical

examination.4/26/2014 33www.drjayeshpatidar.blogspot.com

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4/26/2014 34www.drjayeshpatidar.blogspot.com

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Rational Drug Use

• Can prevent emergence of anti-microbial drug

resistance, and reduce drug toxicity, adverse

drug reactions, and the cost of treatment

• Requires coordinated approach: Patient and

physician education, antibiotic policy, hospital

infection control team, regional and national

antibiotic resistance surveillance4/26/2014 35www.drjayeshpatidar.blogspot.com

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Emergence of antibiotic resistant bacteria

Community-acquired

Hospital-acquired

Gram-negative rods

Enterococcus sp.

Shigella sp.

N. gonorrhoeae

H. influenzaeM. catarrhalis

S. pneumoniae

19501960197019801990

S. aureus

Cohen;Science 1992;257:10504/26/2014 36www.drjayeshpatidar.blogspot.com

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Pneumococcal Resistance Among

4,634 Invasive Isolates, U.S. 1995-6

Cetron;ASM 1997;abstract C-283

COTPCNMERERYTAXAMXTETCHLOFLCLI RIFVAN0

5

10

15

20

25

30

25.4

20.8

12.4

10.510.39.6

6.24.7

3.23.1

0.10

% Resistant

RESISTINTERM

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Drug susceptibility of Strep pneumoniae

IBIS Study4/26/2014 38www.drjayeshpatidar.blogspot.com

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Low cost interventions

have been successful in

reducing morbidity and

mortality from many

diseases.

DOTs for treatment of

tuberculosis is one such

intervention.

Behavioral interventions

for reducing transmission

of HIV inefction, and

management of STD and

RTI are also cost-

effective interventions.4/26/2014 39www.drjayeshpatidar.blogspot.com

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Health Care in Developing Countries

• Existing infrastructure for health care needs to be

strengthened. Health should be perceived as an

investment and receive greater budgetary allocation

• Education, safe water and sanitation need priority

• Vaccination coverage to be improved

• Better implementation of national health programs

• Judicious use of the scant resources by promoting

most cost-effective strategies for disease prevention

• Inclusion of all level of stakeholders in planning and

policy making using tremendous human resource

available in the country4/26/2014 40www.drjayeshpatidar.blogspot.com

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Thank you

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