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Health demographics . Recent initiatives taken by that state and lastly compare the healthcare facility and initiative of that state with the lid policy by central govt . I have to study state ³ c ! c "  c   ## c ! c   .c   c c                  cc c        cc           c                      c   I have been assigned a task where I have to study the state for the following: Healthcare delivery system . Health programs .

'-. Bhanu Pratap ‘hahi minister of Labour. $%&'()*+*. Health and Family Welfare  c   c  c  c c  ./0 (%-1(%+2 ‘h.

   # c ! c  c ã? Infant mortality is high: of every 1000 live birth. 71 children die before they reach year 1.000 live births (more than the national average). ã? 75% of the total deliveries are made without proper medical assistance. ã? .  ã? |aternal mortality rate is also high: 504 per 10.

ã? |ore than 20% of children suffer acute diarrhea and acute respiratory infection.? .early 75% of women suffer from anemia and 40% of women are malnourished. ã? less than 10% of children of all ages are fully immunized. ã? cbout 85% women have not heard about HIV/cID‘.

ã? V2 Referral Hospital.]harkhand currently has ã? V 58 Health ‘ub Centers. ã?   . ã? 22 District Hospital and ã? 6 ‘ubåDivisional hospitals. ã? 1 4 Community Health Centers. ã? VV0 Primary Health Centers.

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While the initiative of the state Centre for launching the .&'       The state has many un met needs in the primary healthcare system.

. The recurring cost of Rs. cnother Rs. '($-$ *.'-54'5-$ '/ 2$&*6$- 3-*)%-. 4800 cr.')$+''/*)3-/6$'($ 2$&*6$-.'*+8%39/0%3 /))5+*'. . a massive programme to build these would require an investment of Rs. could be shared between the Centre and the state on a mutually agreed basis. .  ±:=:=.*4%& *+0-%. $%&'( $+'-$.± %.+/3(.±=9 +6$. %+2 :.± 9 -*)%-. would be required to provide equipment etc..(/-'%8$ /0 9 $%&'( $+'-$.  $$2$2<*. poverty and consequent malnutrition have given rise to diseases like tuberculosis (TB).    c  c # c ! c  ã? In certain areas of ]harkhand. para medical staff and medicines and other grant of Rs.. 621 cr./0/6'7/0+2*%. c further Rs.ational Rural Health |ission has laid down±'($-$*. . for building the primary health infrastructure. :9 -*)%-. would be needed for the salary of doctors. $%&'( $+'$-.'$)0/- (%-1(%+2 To meet the shortage. $%&'( $+'$-. 3$- '($ +/-). 6285 cr. ($%&'(4%-$ '/ /5- 3$/3&$7 The health and nutritional indicators are poor. $%&'( $+'-$.   =±=:±=.9 /))5+*'.. 621 cr. .9 $%&'( 5>? $+'$-. ct the time of formation of the state. 1485 cr.

The highest among all states in India ã? Within ]harkhand as compared to men. ã? 5 % of children under V years of age in ]harkhand are underweight. stateåwise number of cases due to measles and tetanus as a percentage of population is among the highest in ]harkhand. overall infrastructure for dispensing health related services require improvements. measles and V doses of polio / DPT) in ]harkhand is V4% i. c closer look at the diseases in which immunization programs that have not progressed well in ]harkhand indicates that DPT and measles immunization significantly lags Polio and BCG vaccinations. ã? The percentage of children aged between 1å2 years who have been fully immunized (BCG. ã? Fluoride in groundwater presents a public health problem in ]harkhand.e. ã? clthough several public and private health facilities are available in the state. The 2nd highest in India ã? 70% of women in ]harkhand are anemic. a higher percentage of women have a B|I below normal. among the lowest in the country. c   c     c ! c c c . Correspondingly. ã? TB has assumed epidemic proportions in certain areas of the state.

to promote health .  ã? Chetna vikas------.nutrition well being of humans ã? .economic inequality.to eliminate socio.

child health.HR|-----------Reduction in Infant |ortality Rate (I|R) and |aternal |ortality Ratio (||R) ·? Universal access to public health services such as Women¶s health. water. sanitation & hygiene. and . immunization.

gender and demographic balance. ·? Prevention and control of communicable and non-communicable diseases. including locally endemic diseases ·? cccess to integrated comprehensive primary healthcare ·? Population stabilization. ·? Revitalize local health traditions and mainstream cU‘H ·? Promotion of healthy life styles ã? .utrition.

ational Iodine deficiency disorders control programme. ã? .

.ational surveillance programme for communicable diseases.

%'*/+%&.

$%.$ /+'-/&-/8-%))$  The .$4'/-/-+$ *.

ational |alaria Control Programme. The . was initiated in 1 5 in jharkhand. the first centrally sponsored programme.

ational cnti |alaria Programme currently deals with malaria. filaria. japanese encephalitis and dengue. kala-azar. the . %&%-*% Was brought in the state to vector control and personal protection and stoping the occurrence of malaria reduction in morbidity and mortality due to malariaIndoor spraying with appropriate insecticide in areas where cPI is over 2 cnti-larval measures ‘trategies for vector control 1 81.

 /+'-/&-/8-%))$   ã? The .*.ational |alaria Eradication Programme started in jharkhand a modified plan of operation for control of malaria  $+85$ |anagement of vectors for stopping the occurrence of the desease  $6*.$2%'*/+%&5>$-45&/.

was begun in selected districts in 1 8V. through sputum microscopy and X-ray and effective domiciliary treatment with chemotherapy..ational Tuberculosis Control Programme was implemented in 1 66 ã? The programme was aimed at early case detection in symptomatic patients seeking health care. ã? Introduction of the short course chemotherapy.  %'*/+%&$3-/. ã? BCG vaccination at birth for protection against tuberculosis infection was incorporated into the immunisation programme.-%2*4%'*/+-/8-%))$  ã? The . which shortened the duration of treatment to ninemonths.

LEP was implemented in 1 86 to inhibit the spread of the desease in the population of ]harkhand. ã? Establishment of rehabilitation centers  %'*/+%&c  /+'-/&-/8-%))$  ã? .

ational ‘TD Control Programme was implemented in year 1 77 to aware the population and stop the cID‘ incidence ã? The main goal was: ã? reducing HIV transmission among the poor and high risk group population by .

ã? by reducing blood-borne transmission.   #   c  c   ã? . ã? ‘TD control and condom promotion.

ational Iodine Deficiency Disorders Control Programme ã? .

ã? cardiovascular disease control programme.ational Cancer Control Programme). ã? the national mental health programme. ã? the diabetes control programme.    c c c.

empowering communities and women. with the aim of eliminating discrimination in the provision of health care at all levels and in all sectors. particularly for those in remote and difficult areas in order to reduce morbidity and mortality. Gender and human rights issues to disadvantaged groups and adolesents would be given highest priority.c! c ! c  The ]harkhand Government is determined to provide quality health care services. population stabilization by promoting informed choice. involving all stake holders from the public. widening the contraceptive choices available. private. . The ‘tate is also commited to achieving replacement level fertility and.

the last household and the last person in the ‘tate.GO. and co-oprative sectors. organizations like Tata |ain Hospital. organized. encouraging use of modern contraception particularly spacing methods. ]amshedpur----For cancer ã? Bokaro General Hospital -------------Cancer .Ramakrishna Tuberculosis |ission For --------TB ã? For management and treatment of such diseases. ã? 1 48. Ultimately the goal is to reach health care to the last village.

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  The other initiatives taken by the state to improve healthcare standards are: ã? cdolescent health programs-----Enhancing |icro-.

ã? Regional Cancer Center at Rajendra Institute of |edical ‘ciences (RI|‘). ã? Pilot project for Hospital waste management in Government hospitals. ã? Financial assistance to selected government institutions for emergency care centers in towns! cities on .Create capacity. both physical as well as human ã? Establishment of Regional cancer Institute at Dhanbad.utrient and Routine lmmunisation coverage in the ‘tate of ]harkhand.

Ranchi.ational Highways. ã? 10 . Ranchi.bedded mental health unit at three district hospitals (Ranchi. ã? ‘tate Drug Research and Drug trial unit at RI|‘. ã? Establishment of psychiatry department in the V medical colleges of the ‘tate. ã? Establishment of Blood banks in 1 district hospitals of ]harkhand. ã? Trauma Centers at the V medical colleges of the ‘tate. ã? Regional Institute of Opthalmology at RI|‘. Dhanbad) in the first phase. ã? Central assistance for RI. ã? Burn Unit at RI|‘. ]amshedpur.

Pc‘ under .

ational |ental Health Programme under 10th five year plan. ã? Drug De-addiction unit at the V medical colleges (10 bedded) of the ‘tate and RI.

ã? Increase of seats in RI|‘ from 0 to 150. ã? 10 bedded eye ward and OT in 22 district hospitals of the ‘tate.Pc‘ (V0 bedded). .

orientation training programme of I‘| & H personnel.   #  c.ã? Re . Unani & Homeopathy. ã? Establishment of ‘tate Council of Indian |edicine & Homeopathy and separately for cyurveda.

V286 PHCs. 1 hospitals under the Dept of I‘|&H. 541 CHCs. ã? strengthening programmes for the prevention. healths care for central government employees provided by Central Government Health ã? In order to ensure adequate access to health care services for the tribal population. 2.76 ‘Cs. self-help groups and social marketing organisation in improving access to health care. ã? skill upgradation of all health care providers through C|E and reorientation and if necessary redeployment of the existing health manpower. ã? increasing the involvement of voluntary and private organisations. ã? 2V. V7V CHCs and 2750 dispensaries are located in villages with 20 per cent or more scheduled caste population.#  c c     ã? Reorganisation and restructuring the existing government health care system including the I‘|&H infrastructure at all levels ã? improvement in the quality of care at all levels and settings by evolving and implementing a ã? whole range of compre-hensive norms for service delivery. detection and management of health consequences of the continuing deterioration of the ecosystems ã? ‘ubcentres 1V7271 (1/ 457 ) ã? Primary Health center 22 75 (1/27V64) ã? Community health centers 2 V5 (1/214000) ã? subdivisional/Taluk hospitals/speciality hospitals (estimated to be about 2000). accurate Health |anagement Information ‘ystem (H|I‘) utilising currently available IT tools. 142 hospitals. 20. 78 mobile clinics and 2V05 dispensaries have been established in tribal areas. ã? building up an effective system of disease surveillance and response at the district. . 5 87 PHCs. state and national level as a part of existing health services. In addition. 16845 ‘Cs.028 dispensaries.urban health services provided by municipalities. ã? building up a fully functional.

ã? |ost of the centrally sponsored disease control programmes have a focus on the tribal areas ã? The .

inth Plan envisaged the development of a well structured net work of urban primary health care institutions providing health and family welfare services to the population within one to three km of their dwellings by re-organizing the existing institutions. ã? ‘trengthening secondary health care services was an identified priority in the . ã? Tenth Plan goals for primary health care institutions for each state will be number of the primary health care institutions required to meet the health care needs of the 1 1 population as per the norms. Opening new centers and construction of new centre will be undertaken only under Exceptional circumstances.

  5>&*4@-*6%'$%-'*4*3%'*/+*+ $%&'( %-$  ã? During the Tenth Plan appropriate policy initiatives will be taken to define the role of government. _? improve effectiveness and efficiency. and _? ensure that optimum use is made of every rupee invested c    . ã? $6$&/3)$+'%+2. _? minimise barriers to appropriate care at different levels by matching the levels of _? care to the level of need. strengthen district hospitals so that they can effectively take care of referrals. private and voluntary sectors in meeting the growing health care needs of the population at an affordable cost.%+2c44/5+'%>*&*'.$/0c33-/3-*%'$$4(+/&/8*$. abuse and misuse of facilities. ã? strengthen FRUs to take care of referrals from PHCs/‘Cs. 5%&*'.inth Plan. help to make positive outcomes more _? help in effective and responsible use of resources.*+ $%&'( %-$ _? prevent overuse. under-use. _? bring accountability into the health system.

. ã? periodic updating of information on :requirement and availability and of ã? different categories of health manpower. ã? improvement in quality of undergraduate/ postgraduate education promotion of equitable and appropriate distribution of health manpower. ã? continuing medical education for knowledge and skill upgradation. ã? demand and availability for health manpower in the government. health manpower production based on the needs.#  c   ã? creation of a district data base on requirement. private and voluntary ã? sectors.

ã? appropriate people and programme orientation. ã? continuing multiprofessional education for promoting team work & intersectoral coordination $%&'(%+3/A$-&%++*+8  ã? The .

Fine tuning will be done taking into account the manpower needed for implementing national programmes and the manpower requirements in the voluntary and private sector.inth Plan envisaged that health manpower planning will be based on the districtspecific ã? assessment of available manpower and facilities and the needs and demands of health services.   .

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$ /+'-/&-/8-%))$  ã? The .$4'/-/-+$ *.$%.

was ã? initiated in 1 5V.ational |alaria Control Programme. The . the first centrally sponsored programme.

filaria. kala-azar.ational cnti |alaria Programme currently deals with malaria. japanese encephalitis and dengue. During the Tenth Plan the programme will be implemented as .

 ã? early diagnosis and prompt treatment ã? selective vector control and personal protection ã? prediction..5 per cent ã? 25 per cent reduction in morbidity and mortality due to malariaIndoor spraying with appropriate insecticide in areas where cPI is over 2 ã? cnti-larval measures ‘trategies for vector control in urban areas include: ã? Introduction of medicated mosquito nets ã? Use of larvivorous fishes and biolarvicides ã? 1 77. ã? cBER of over 10 per cent ã? cPI of less than 0. early detection and effective response to outbreaks ã? IEC ã? %-8$'0/-.ational Vector Borne Disease Control Programme.'-%'$8. the . %&%-*% ã? *+'(&%+.

ational |alaria Eradication Programme started implementing a modified plan of operation for control of malaria !%&%cB%-  ã? Programme for containment of kala azar was launched in 1 2 ã? The strategy for control of infection includes interruption of transmission through insectidical spraying with DDT and early diagnosis and treatment of kala azar cases. The Central Government provides the insecticides and anti kala azar drugs while the state .

 #*&%-*%.  ã? In endemic states. proper management and rehabilitation of those with residual disabilities. c total of 48 million people in urban areas are being protected through anti-larval measures. efforts are being made to improve early diagnosis. ã? The Government of India is a signatory to the U. and 27 filaria survey units.$+4$3(%&*'*. 1 filaria clinics.*. Innovative strategies for vector control are being investigated. governments meet the expenses involved in the diagnosis and treatment of cases and insecticide spraying operations.  $+85$C %3%+$. ã? The Indian Council for |edical Research (IC|R) is conducting a feasibility and efficacy study on a mass annual single dose administration of DEC and albendazole drugs for the control of filariasis.  ã? Currently there are 206 filaria control units.

resolution to eliminate lymphatic filariasis by 2020. The .

ational Health Policy (.

which are at the risk of epidemic outbreak. ã? involvement of . including cases treated in the private sector. so that reliable estimates of the prevalence of vector borne disease is available. 2002 envisages the elimination of lymphatic filariasis by 2015.  $+'(&%++*'*%'*6$. ã? improving reporting. ã? ensure that insecticide spraying is started well in advance.%-$ ã? training of health personnel in the diagnosis of vector-borne diseases and appropriate ã? treatment including referral. ã? monitoring drug and insecticide resistance. family and community levels. ã? identify villages. recording and monitoring of vector-borne diseases. ã? using standardised protocol for the diagnosis and management of these diseases. ã? improvement in IEC at patient.HP).

ã? evaluate community acceptance of insecticidetreated bed nets/curtains for personal protection. back up these efforts through IEC and social marketing. ã? encourage the pharmaceutical industry. manufacturers of insecticides and bednets to produce low cost products for local use. .GOs and the private sector in diagnosis and treatment of malaria cases. ã? exploring the cost effectiveness of the use of remote sensing for mapping the breeding habitats of mosquitoes and prediction of densities of vector species. especially in remote hilly and tribal areas.

$6*.$2%'*/+%&5>$-45&/.*. /+'-/&-/8-%))$   ã? The .

BCG vaccination at birth for protection against tuberculosis infection was incorporated into the immunisation programme.  %'*/+%&$3-/.. which shortened the duration of treatment to ninemonths. Introduction of the short course chemotherapy.ational Tuberculosis Control Programme was initiated in 1 62 as a centrally sponsored scheme.-%2*4%'*/+-/8-%))$  ã? The . was begun in selected districts in 1 8V. ã? The programme was aimed at early case detection in symptomatic patients seeking health care. through sputum microscopy and X-ray and effective domiciliary treatment with chemotherapy.

000 by 2000. regular treatment of cases with |DT administered by leprosy workers in endemic districts and mobile leprosy treatment units and primary health care workers in moderate to low endemic areas/districts.LEP was launched in 1 8V as a 100 per cent funded centrally sponsored scheme with the goal of arresting disease transmission and bringing down the prevalence of leprosy to one in 10. %'*/+%&c  /+'-/&-/8-%))$  ã? . ã? appropriate medical rehabilitation and ulcer care services. The strategy adopted to achieve this was: early detection of leprosy cases through active community based case detection by trained health workers.

ã? c .ational ‘TD Control Programme has been in operation since 1 67 but its outreach and coverage have been poor.

ational cID‘ Control Programme (.

ã? 570 targeted intervention for prevention and management of HIV infection in high risk groups. ã? The main goal was: ã? reducing HIV transmission among the poor and marginalised high risk group population by targeted intervention. ã? reducing the spread of HIV among the general population by reducing blood-borne transmission.()$+'/0 ã? 40 blood component separation facilities. ã? low cost community based care for people ã? living with HIV/cID‘. ã? During the Tenth Plan. ‘TD control and condom promotion. ã? V20 sentinel sites for monitoring the time trends in prevalence of HIV infection. ã? 142 voluntary blood testing centers. .'%>&*. the programme will be continued with emphasis on: ã? 80 per cent coverage of high risk groups through targeted interventions. the Indian govt has decided the .cCP) Phase I was launched in 1 2 with World Bank assistance and was completed in 1 .

#   c  c   ã? During the . ã? scaling up of prevention of mother-to-child transmission activities up to the district level. ã? reducing transmission through blood to less than 1 per cent. ã? explore the feasibility of monitoring the quality of water through public health engineering department and the PRIs. ã? 0 per cent coverage of schools and colleges through education programmes.$%. The initiatives was: ã? improve coverage under rational case management for diarrhoea/dysentery.$. municipal corporations and PRIs for the prevention of water-borne diseases. ã? establishing of at least one voluntary testing and counselling centre in every district. ã? achieving zero level increase of HIV /cID‘ prevalue by 2007  %'$-/-+$ *. ã? strengthen the diarrhoeal disease surveillance programme at the district level to detect and contain outbreaks. ã? coordinate the efforts of the departments dealing with urban and rural water supply and sanitation. ã? 80 per cent awareness among the general population in rural areas.

ongoing programmes for control of non-communicable diseases ã? included two centrally-sponsored schemes (.inth Plan.

discussed in the Chapter on .ational Iodine Deficiency Disorders Control Programme.

and the .utrition.

ational Programme for the ã? Control of Blindness discussed in this section) and one central sector scheme (the .

cardiovascular disease control programme. ã? During the 1 0s. the diabetes control programme. these programmes have been merged with the Central Institutes dealing with these problems. cfter completion of the pilot phase.4$+'-%&8/6' %'*/+%&.*/+A*'('($3/&*4*$.&%*2 2/A+>. several pilot projects such as the national mental health programme. oral health programme and medical rehabilitation were initiated as central sector pilot projects. prevention of deafness and hearing impairment. ? c   c   c ! c 4/)3%-*.ational Cancer Control Programme).

$4'/-/-+$ *.$%.$ /+'-/&-/8-%))$  The .

The .ational |alaria Control Programme. was initiated in 1 5 in jharkhand. the first centrally sponsored programme.

%&%-*% Was brought in the state to vector control and personal protection and stoping the occurrence of malaria . filaria.ational cnti |alaria Programme currently deals with malaria. kala-azar. japanese encephalitis and dengue.

reduction in morbidity and mortality due to malariaIndoor spraying with appropriate insecticide in areas where cPI is over 2 cnti-larval measures ‘trategies for vector control 1 81. the .

ational |alaria Eradication Programme started in jharkhand a modified plan of operation for control of malaria $+85$ |anagement of vectors for stopping the occurrence of the disease  $6*.*. /+'-/&-/8-%))$   ã? The .$2%'*/+%&5>$-45&/.

.-%2*4%'*/+-/8-%))$  ã? The . ã? BCG vaccination at birth for protection against tuberculosis infection was incorporated into the immunisation programme. ã? Introduction of the short course chemotherapy. was begun in selected districts in 1 8V.  %'*/+%&$3-/. through sputum microscopy and X-ray and effective domiciliary treatment with chemotherapy. which shortened the duration of treatment to ninemonths.ational Tuberculosis Control Programme was implemented in 1 66 ã? The programme was aimed at early case detection in symptomatic patients seeking health care.

ã? Establishment of rehabilitation centers %'*/+%&c  /+'-/&-/8-%))$  ã? .LEP was implemented in 1 86 to inhibit the spread of the desease in the population of ]harkhand.

ational ‘TD Control Programme was implemented in year 1 77 to aware the population and stop the cID‘ incidence ã? The main goal was: ã? reducing HIV transmission among the poor and high risk group population by ã? ‘TD control and condom promotion.  #   c  c   ã? . ã? by reducing blood-borne transmission.

ational Iodine Deficiency Disorders Control Programme ã? .

ã? the diabetes control programme.ational Cancer Control Programme). . ã? cardiovascular disease control programme. ã? the national mental health programme.

while comparing the healthcare initiative laid down by the central govt to that of state ]harkhand it was found that in ]harkhand the following programs are no running the programs are as follows: ã? sala czar ã? Filariasis ã? Water Borne Diseases control program ã? .

ational Iodine Deficiency Disorders Control Programme. ã? .

utritional program ã? .

ã? |ore Focus on awareness and preventive measures ã? There should Private participation to fill talent gaps ã? Targeted campaigns against common epidemics so that the residents remain update about the epidemic of the disease spread ã? Government backed health insurance should be more implemented in all types of hospital to assiat the patient in terms of affordibility .ational program for Control of Blindness   c  ã? Continuous initiative should taken to maintain the |in Quality of life in tribal areas of ]harkhand like giving the ã? Education about diseases prevention and control to the population ã? Vocational Training to healthcare professionals ã? cwareness & Preventive measures should be well explained to the state populations ã? cvailability of doctors and nursing staff in adequate level in hospitals ã? cffordability and living standards of the population should be increased ã? Effectiveness in healthcare service delivery should be increased ã? Promoting Equity and ‘ocial Protection to the population which will increase the standard of living ã? |anagement support structure. capacity building and monitoring at the district and subådistrict ã? Levels ã? Teacher management and accountability for improvement in service delivery ã? |ore cddress towards the haelthcare demandåside issues ã? Partnership with the private sector at poståelementary and secondary levels and in vocational ã? Training in ]harkhand I found it is lacking here because of less no of training centers ã? The ]harkhand government needs to invite partnership with the private sector to improve the availability of secondary and vocational education facilities in the state.