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BMS-003: HEALTH CARE MANAGEMENT

Course Code : BMS-003
Course Title : Health Care Management
Assignment No. : 003/TMA/2022
Coverage : All Blocks
Max. Marks : 50

Note: There are five questions in this assignment. Attempt all the questions and send them to the Coordinator of
the Study Centre you are attached with. All questions carry equal marks.

1. Discuss different initiatives taken by Government of India under National Aids Control programme
(NACP).

Ans :- The National AIDS Control Programme (NACP), launched in 1992, is being implemented as a
comprehensive programme for prevention and control of HIV/ AIDS in India. Over time, the focus has shifted
from raising awareness to behaviour change, from a national response to a more decentralized response and to
increasing involvement of NGOs and networks of People living with HIV (PLHIV).

The NACP I started in 1992 was implemented with an objective of slowing down the spread of HIV infections so
as to reduce morbidity, mortality and impact of AIDS in the country.

In November 1999, the second National AIDS Control Project (NACP II) was launched to reduce the spread of HIV
infection in India, and (ii) to increase India’s capacity to respond to HIV/AIDS on a long-term basis.

NACP III was launched in July 2007 with the goal of Halting and Reversing the Epidemic over its five-year period.

NACP IV, launched in 2012, aims to accelerate the process of reversal and further strengthen the epidemic
response in India through a cautious and well defined integration process over the next five years.

NACP - IV - Objectives

• Reduce new infections by 50% (2007 Baseline of NACP III)

• Provide comprehensive care and support to all persons living with HIV/AIDS and treatment services for
all those who require it.

Key strategies

• Intensifying and consolidating prevention services, with a focus on HIgh Risk Groups (HRGs) and
vulnerable population.
• Increasing access and promoting comprehensive care, support and treatment

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• Expanding IEC services for (a) general population and (b) high risk groups with a focus on behaviour
change and demand generation.
• Building capacities at national, state, district and facility levels
• Strengthening Strategic Information Management System

Key priorities under NACP IV

• Preventing new infections by sustaining the reach of current interventions and effectively addressing
emerging epidemics
• Prevention of Parent to Child transmission
• Focusing on IEC strategies for behaviour change in HRG, awareness among general population and
demand generation for HIV services
• Providing comprehensive care, support and treatment to eligible PLHIV
• Reducing stigma and discrimination through Greater involvement of PLHA (GIPA)
• De-centralizing rollout of services including technical support
• Ensuring effective use of strategic information at all levels of programme
• Building capacities of NGO and civil society partners especially in states with emerging epidemics
• Integrating HIV services with health systems in a phased manner
• Mainstreaming of HIV/ AIDS activities with all key central/state level Ministries/ departments will be
given a high priority and resources of the respective departments will be leveraged. Social protection
and insurance mechanisms for PLHIV will be strengthened.

2. What are the important features of Janani Suraksha Yojna (JSY) as given in the National Rural Health
Mission?

Ans :- JananiSurakshaYojana (JSY) is a safe motherhood intervention under the National Health Mission. It is
being implemented with the objective of reducing maternal and neonatal mortality by promoting institutional
delivery among poor pregnant women. The scheme, launched on 12 April 2005 by the Hon’ble Prime Minister, is
under implementation in all states and Union Territories (UTs), with a special focus on Low Performing States
(LPS).

JSY is a centrally sponsored scheme, which integrates cash assistance with delivery and post-delivery care. The
Yojana has identified Accredited Social Health Activist (ASHA) as an effective link between the government and
pregnant women.

The scheme focuses on poor pregnant woman with a special dispensation for states that have low institutional
delivery rates, namely, the states of Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Madhya Pradesh,
Chhattisgarh, Assam, Rajasthan, Orissa, and Jammu and Kashmir. While these states have been named Low
Performing States (LPS), the remaining states have been named High Performing states (HPS).

LPS All pregnant women delivering in government health centres, such as Sub Centers (SCs)/Primary Health
Centers (PHCs)/Community Health Centers (CHCs)/First Referral Units (FRUs)/general wards of district or state
hospitals

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HPS All BPL/Scheduled Caste/Scheduled Tribe (SC/ST) women delivering in a government health centre, such
as SC/PHC/CHC/FRU/general wards of district or state hospital

LPS & HPS BPL/SC/ST women in accredited private institutions

Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission (NRHM)
being implemented with the objective of reducing maternal and neo-natal mortality by promoting institutional
delivery among the poor pregnant women. The Yojana, launched on 12th April 2005, by the Hon’ble Prime
Minister, is being implemented in all states and UTs with special focus on low performing states.

JSY is a 100 % centrally sponsored scheme and it integrates cash assistance with delivery and post-delivery care.
The success of the scheme would be determined by the increase in institutional delivery among the poor
families

The Yojana has identified ASHA, the accredited social health activist as an effective link between the
Government and the poor pregnant women in l0 low performing states, namely the 8 EAG states and Assam and
J&K and the remaining NE States. In other eligible states and UTs, wherever, AWW and TBAs or ASHA like activist
has been engaged in this purpose, she can be associated with this Yojana for providing the services.

a. The mother and the ASHA (wherever applicable) should get their entitled money at the heath centre
immediately on arrival and registration for delivery.

b. Generally the ANM/ ASHA should carry out the entire disbursement process. However, till ASHA joins, AWW
or any identified link worker, under the guidance of the ANM may also do the disbursement.

3. Differentiate between health and ill-health especially during the present COVID situation? Explain
giving examples.

Ans :- Influenza (flu) and COVID-19 are both contagious respiratory illnesses, but they are caused by different
viruses. COVID-19 is caused by infection with a coronavirus first identified in 2019. Flu is caused by infection
with a flu virus (influenza viruses).

From what we know, COVID-19 spreads more easily than flu. Efforts to maximize the proportion of people in the
United States who are up to date with their COVID-19 vaccines remain critical to ending the COVID-19
pandemic. More information is available about COVID-19 vaccines and how well they work.

Compared to flu, COVID-19 can cause more serious illnesses in some people. COVID-19 can also take longer
before people show symptoms, and people can remain contagious for longer periods of time. More information
about differences between flu and COVID-19 is available in the different sections below.

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We cannot tell the difference between flu and COVID-19 just by looking at the symptoms alone because they
have some of the same symptoms. That’s why testing is needed to tell what the illness is and to confirm a
diagnosis. Testing is also important because it can reveal if someone has both the flu and COVID-19 at the same
time.

While more is learned every day about COVID-19 and the virus that causes it, there are still things, such as post-
COVID conditions (also known as long COVID), that are unknown.

Similarities:

Both COVID-19 and flu can have varying degrees of symptoms, ranging from no symptoms (asymptomatic) to
severe symptoms. Common symptoms that COVID-19 and flu share include:

• Fever or feeling feverish/having chills

• Cough
• Shortness of breath or difficulty breathing
• Fatigue (tiredness)
• Sore throat
• Runny or stuffy nose
• Muscle pain or body aches
• Headache
• Vomiting
• Diarrhea

4. What are the various health indicators which are used to measure the health status of an individual?

Ans :- Health care is the prevention, treatment, and management of illness and the preservation of health
through the services offered by health care organisations and professionals. It includes all the goods and
services designed to promote health, including “preventive, curative and palliative interventions, whether
directed to individuals or to populations”.

Measures of health status

Health status can be measured using pathological and clinical measures and is usually observed by clinicians or
measured using instruments.

Types of disease measurement include:

• Signs - blood pressure, temperature, X-ray, tumour size

• Symptoms - disease specific checklists
• Co-morbidity - Charlson Index, ICED- index of co-existing disease (looks at both disease severity and
functional severity), adverse events – pain, bleeding, readmission, complications (e.g. using Clavien-
Dindo Classification of Surgical Complications).

It is always best to use an existing measure which has been tried and tested rather than inventing a new one.
Use an existing standardised measure with proven reliability, validity and responsiveness. Criteria which should
be applied when evaluating measures include:

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Psychometric criteria

• Acceptability - there should be a range across a measure with no floor or ceiling bias
• Reliability - test re-test (testing and retesting would give the same score), inter-rater (2 people assessing
someone separately would give the same score- measured by the Kappa statistic*), internal consistency
(Cronbach’s alpha - when series of questions are used to measure something e.g. the Oxford Hip Score,
scores for the answers are often on a scale and added up to give a single total numerical value. Scales
must have internal consistency i.e. the items should all measure the same thing. Cronbach’s alpha is a
coefficient for assessing internal consistency of a scale. [7])
• Validity – sensitivity (identify those with disease correctly) and specificity (identify those without the
disease correctly)
• Responsiveness - the degree to which a measure can detect change which is clinically meaningful.

Practical criteria

If the measure is intended for routine use as part of clinical practice:

• The measure should be appropriate/relevant

• The measure should be brief and simple to administer
• Feasible for routine use.

If it is not possible to use an existing measure, the next best thing is to adapt an existing measure, however it
must be re-evaluated for reliability, validity and responsiveness in the new circumstances. Otherwise, a new
measure needs to be developed and evaluated for reliability, validity and responsiveness.

Factors that can improve a test’s reliability include:

• Training of observers
• Clear definitions of terminology, criteria and protocols
• Regular observation and review of techniques
• Identifying causes of discrepancies and acting on them.

Methods that can increase validity include:

• Structured and standardised procedures for collecting clinical information

• Standardised protocols for scoring and interpreting
• Use of well-constructed instruments (i.e. with documented reliability and validity)
• Obtain appropriate reports of information.

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5. What is Coalition? Explain its importance for NGOs.

Ans :- A coalition occurs when two or more political parties enter into a formal agreement to cooperate with a
view to achieving a majority in parliament and, on that basis, form a government. The parties that agree to
govern in coalition share similar philosophies and policies, otherwise coalitions would not work.

• The desire to maximise NGO influence on advocacy targets in different countries, including helping
activists overcome obstacles at a national level by drawing on international support.
• The need to make the most of scarce human and financial resources and to avoid duplication of effort
among NGOs working on similar issues.
• The desire to ensure effective communications among key NGO actors working on a particular issue and
to pool the expertise available to NGOs.
• The desire to avoid NGO disunity on an issue. Opponents will be all too willing to exploit differences in
opinion among NGOs in order to undermine the overall goal being pursued.

Working in coalitions also provides a coordinated way for NGOs to forge and maintain strategic partnerships
with external actors. It is easier for a government to relate to a coalition as a single partner that represents the
range of civil society actors on an issue than to work out whom to interact with from among a host of
organisations.

However, coalitions also impose costs and constraints on member organisations. A key trade-off when working
in coalition is between the gains in effectiveness (stronger voice and wider reach) on the one hand and the
amount of time and resources spent in making a coalition work on the other. Coalitions have been described as
a ‘necessary bureaucracy’ and every coalition an NGO joins brings with it another set of communications,
another email list and another set of conference calls and meetings.

Coalition teams have strengthened work by:

• Providing a forum for improved information sharing and strategic consultations among members;
• Updating Coalition members on an ongoing basis;
• Facilitating a timely and consultative drafting process for papers that reflect major developments and
work by the States Parties and the ASP Bureau;
• Informing discussion on crosscutting issues.

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