| INDICATORS OF HEALTH | DECE2 UNIT 3 | IGNOU | DECE |

INDICATORS OF HEALTH

Structure
Indicators of Health
3.2.1 Characteristics of an Indicator
3.2.2 Mortality Indicators
3.2.3 Morbidity Indicators
3.2.4 Disability Rates
3.2.5 Nutritional Status Indicators
3.2.6 Health Care Delivery Indicators
3.2.7 Utilization Rates
3.2.8 Indicators of Social and Mental Health .
3.2.9 Environmental Indicators
3.2.10 Indicators of Quality of Life
3.2.1 1 Health Policy Indicators
3.2.12 Socioeconomic Indicators
3.3 Health Situation in India
3.3.1 Demographic Profile
3.3.2 . Mortality Profile
3.3.3 Morbidity Profile
3.3.4 Health Care Facilities and Personnel
3.4 National Health Policy
3.5. Health Care Services-Basic Concepts
3.5.1 Levels of Health Care
3.5.2 Health Team Concept
3.5.3 Health for All
3.5.4 Primary Health Care
3.6 Health Care Delivery System in Our Country

3.3 Health Situation in India

Now, let’s shift our focus to the health situation in India. Understanding the demographic profile, mortality profile, morbidity profile, and the status of health care facilities and personnel is crucial for effective health planning and interventions.

3.3.1 Demographic Profile

Demographic factors play a significant role in determining the health status of a population. Key indicators include population size, age distribution, sex ratio, and population density. These factors influence the demand for health services, the prevalence of diseases, and the overall health infrastructure required.

3.3.2 Mortality Profile

Analyzing mortality indicators, such as crude death rate, infant mortality rate, child mortality rate, under-5 mortality rate, and maternal mortality rate, provides insights into the overall health conditions. Comparing these rates with national averages or international standards helps in identifying areas that may require targeted health interventions.

3.3.3 Morbidity Profile

Examining the morbidity profile through incidence and prevalence rates of diseases provides a comprehensive understanding of the burden of illnesses in the population. This information is vital for designing preventive measures, allocating resources, and planning health care services.

3.3.4 Health Care Facilities and Personnel

Assessing the availability of health care facilities and personnel, including doctors, nurses, and other health workers, is crucial for determining the accessibility of health services. Population-to-doctor ratios, the distribution of health facilities, and their quality contribute to the overall health care delivery system.

3.4 National Health Policy

Understanding the key components and objectives of the National Health Policy provides insights into the government’s priorities and strategies for promoting health in the country. It outlines the principles and guidelines that govern the health care system, resource allocation, and community participation.

3.5 Health Care Services – Basic Concepts

Exploring the basic concepts of health care services, such as levels of health care, the health team concept, health for all, and primary health care, sheds light on the foundational principles that guide health interventions and service delivery.

3.5.1 Levels of Health Care

Understanding the hierarchy of health care levels, including primary, secondary, and tertiary care, helps in organizing health services to address different health needs effectively.

3.5.2 Health Team Concept

Recognizing the collaborative nature of health care delivery, involving various professionals such as doctors, nurses, and public health workers, ensures a comprehensive and coordinated approach to health services.

3.5.3 Health for All

The goal of achieving “Health for All” emphasizes universal access to essential health care services. It advocates for equitable distribution and accessibility of health services across all sections of the population.

3.5.4 Primary Health Care

Primary health care, as a fundamental component of health services, focuses on preventive and basic health care, emphasizing community participation and addressing health determinants at the grassroots level.

3.6 Health Care Delivery System in Our Country

Examining the existing health care delivery system in India provides insights into its strengths, challenges, and areas requiring improvement. Analyzing the utilization rates and accessibility of health services helps in identifying gaps and formulating targeted interventions.

3.7 Summing Up

Summarizing the key points discussed in this unit, including health indicators, the health situation in India, and basic concepts of health care services, enhances understanding and prepares the groundwork for further exploration.

3.8 Bibliography

Referencing relevant sources and literature ensures the credibility and reliability of the information presented in this unit. It encourages further reading and research for a more in-depth understanding of health indicators and the health situation in India.

**Demographic Profile:**
India, the second most populous country, has a high birth rate, surpassing the declining death rate, leading to population expansion. The birth rate is still relatively high, contributing to a pyramid-shaped population distribution. The literacy rate is lower compared to other countries. In 1991, the total population was 846 million, with a crude birth rate of 29.0, crude death rate of 9.6, and a literacy rate of 52.2%.

**Mortality Profile:**
India has witnessed changes in mortality patterns, with a focus on maternal and child health. The Infant Mortality Rate (IMR) decreased from 105 in 1982 to 79 in 1992. Life expectancy has increased, reaching 61.7 years for females and 60.6 years for males in 1994. Childhood deaths due to diseases like diarrhoea and measles have declined. Age-specific death rates vary across rural and urban areas.

**Morbidity Profile:**
Emphasis on immunization has led to a decline in the prevalence of six killer diseases of childhood. Communicable diseases like leprosy and guinea worm disease are decreasing, but some, like falciparum malaria, AIDS, and drug-resistant tuberculosis, show an increasing trend. Non-communicable diseases such as blindness, hypertension, diabetes, and cancer are on the rise. Malnutrition remains a concern, with nutritional anaemia persisting.

**Health Care Facilities and Personnel:**
Since independence, India has made strides in healthcare infrastructure, establishing primary health centers and sub-centers systematically. The National Health Policy (1983) aimed to achieve “Health for All by 2000 AD.” Presently, primary health centers form the nucleus of rural health services. Despite progress, there’s an unequal distribution of healthcare infrastructure, with concerns about manpower availability.

**National Health Policy:**
The National Health Policy (1982) focuses on preventive and promotive health care, doorstep availability, medical and health education policy, involvement of non-government organizations, integration of traditional medicine, organized services for school students, management information system, indigenous manufacture of biomedical equipment, health insurance schemes, and attention to nutrition and food distribution.

**Health for All (HFA):**
India, a signatory to the HFA Declaration (1978), aims for equitable health, focusing on accessibility and socio-economic development. The HFA goals for 2000 AD include reducing infant mortality rate, crude death rate, preschool child mortality rate, maternal mortality rate, and achieving various percentages for immunization, family planning, and disease control.

**Primary Health Care:**
The Alma-Ata Declaration envisions primary health care as essential, accessible, and community-oriented. Primary health care in India includes preventive, promotive, curative, and rehabilitative services. It is based on community participation, intersectoral coordination, appropriate technology, and equitable distribution.

**Health Care Delivery System:**
India’s health care delivery system follows a hierarchical structure with primary health centers at the grassroots, providing basic services. Sub-centers and primary health centers cover rural populations, and community health centers offer specialized services. Urban areas have hospitals providing curative services, with a focus on municipality/corporation-led healthcare.

In summary, while India has made progress in various health indicators, challenges such as unequal distribution of healthcare facilities and emerging non-communicable diseases persist. The emphasis on preventive and primary health care remains crucial to achieving health goals.

Primary Health Care

The Alma-Ata Declaration visualized primary health care as the nucleus of a
country’s health system to make essential health care universally accessible. What
is primary health care? According to the Declaration, primary health care is
“essential health care based on practical, scientifically sound, and socially acceptable methods and technology made universally accessible to individuals and families In the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.

Primary health care stands on four pillars i.e. community participation,
intersectoral coordination, appropriate technology, and equitable distribution. It is based on the principle of self-reticence which can be called ‘placing people’s health in people’s hands.

The Declaration of Alma-Ata state that primary health care comprises providing
promotive, preventive, curative, and rehabilitative services and includes at least the following:
– education about prevailing health problems and methods of preventing and
controlling them;
– promotion of food supply and proper nutrition;
– adequate supply of safe water and basic sanitation;
– maternal and child health care, and family planning;
– immunization against the major infectious diseases;
– prevention and control of endemic diseases;
– appropriate treatment of common diseases and injuries; and
– provision of essential drugs.

प्राथमिक स्वास्थ्य देखभाल

अल्मा-अता घोषणा ने प्राथमिक स्वास्थ्य देखभाल को a . के केंद्र के रूप में देखा
आवश्यक स्वास्थ्य देखभाल को सार्वभौमिक रूप से सुलभ बनाने के लिए देश की स्वास्थ्य प्रणाली। क्या
प्राथमिक स्वास्थ्य देखभाल है? घोषणा के अनुसार, प्राथमिक स्वास्थ्य देखभाल है
“व्यावहारिक, वैज्ञानिक रूप से ध्वनि और सामाजिक रूप से स्वीकार्य तरीकों और प्रौद्योगिकी पर आधारित आवश्यक स्वास्थ्य देखभाल को समुदाय में व्यक्तियों और परिवारों के लिए उनकी पूर्ण भागीदारी के माध्यम से सार्वभौमिक रूप से सुलभ बनाया गया है और समुदाय और देश उनके हर स्तर पर बनाए रखने के लिए खर्च कर सकते हैं। आत्मनिर्भरता और आत्मनिर्णय की भावना में विकास।

प्राथमिक स्वास्थ्य देखभाल चार स्तंभों यानी सामुदायिक भागीदारी पर आधारित है,
अंतरक्षेत्रीय समन्वय, उपयुक्त प्रौद्योगिकी और समान वितरण। यह आत्ममुग्धता के सिद्धांत पर आधारित है जिसे ‘लोगों के स्वास्थ्य को लोगों के हाथों में सौंपना’ कहा जा सकता है।

अल्मा-अता की घोषणा में कहा गया है कि प्राथमिक स्वास्थ्य देखभाल में प्रदान करना शामिल है
प्रोत्साहक, निवारक, उपचारात्मक और पुनर्वास सेवाएं और इसमें कम से कम निम्नलिखित शामिल हैं:
– प्रचलित स्वास्थ्य समस्याओं और रोकथाम के तरीकों के बारे में शिक्षा और
उन्हें नियंत्रित करना;
– खाद्य आपूर्ति और उचित पोषण को बढ़ावा देना;
– सुरक्षित पानी और बुनियादी स्वच्छता की पर्याप्त आपूर्ति;
– मातृ एवं शिशु स्वास्थ्य देखभाल, और परिवार नियोजन;
– प्रमुख संक्रामक रोगों के खिलाफ टीकाकरण;
– स्थानिक रोगों की रोकथाम और नियंत्रण;
– आम बीमारियों और चोटों का उचित उपचार; और
– आवश्यक दवाओं की व्यवस्था।

NATIONAL HEALTH POLICY

The Ministry of Health and Family Welfare evolved a ‘National Health Policy’ in
1982 keeping in view the national commitment for attaining the goal of ‘Health for All by 2000 AD’. The policy was approved in 1983. Keeping in mind the present health situation, it sets goals and targets to be achieved by 1985, 1990 and 2000 AD.

The emphasis is on achieving health for all by 2000 AD through primary health
care. 

The important points highlighted in the National Health Policy are :
1) Emphasis on preventive and promotive aspects of health care.
2) Emphasis on availability of health care at doorstep.
3) Development of a National Medical and Health Education Policy.
4) Formation of a Health Committee at every village to project health needs of
the community.
5) Involvement of non-government organizations in health care delivery.
6) Greater involvement of Indian systems of medicine and homeopathy in the
health system by phased integration with modern system.
7) Organised services for school students.
8) Built up management information system for assessing manpower
requirements and taking timely decisions.

9) Indigenous manufacture of essential biomedical equipment.
10) Starting health insurance schemes on statewise basis.
11) Priority attention to be given to nutrition and distribution of food to rural and
slum population.
12) Prevention pf food adulteration.
13) Strengthening of MCH services which includes training of traditional birth
attendants or dais and referral of all complicated cases to experts.
14) Phasing out of private practice by doctors by providing non-practising
allowance.
15) Formation of a separate national population policy.

राष्ट्रीय स्वास्थ्य नीति

स्वास्थ्य और परिवार कल्याण मंत्रालय ने में एक ‘राष्ट्रीय स्वास्थ्य नीति’ विकसित की है
1982 ‘2000 ई. तक सभी के लिए स्वास्थ्य’ के लक्ष्य को प्राप्त करने की राष्ट्रीय प्रतिबद्धता को ध्यान में रखते हुए। नीति को 1983 में मंजूरी दी गई थी। वर्तमान स्वास्थ्य स्थिति को ध्यान में रखते हुए, यह 1985, 1990 और 2000 ईस्वी तक प्राप्त करने के लिए लक्ष्य और लक्ष्य निर्धारित करता है।

प्राथमिक स्वास्थ्य के माध्यम से 2000 ई. तक सभी के लिए स्वास्थ्य प्राप्त करने पर जोर दिया गया है
देखभाल।

राष्ट्रीय स्वास्थ्य नीति में जिन महत्वपूर्ण बिंदुओं पर प्रकाश डाला गया है वे हैं:
1) स्वास्थ्य देखभाल के निवारक और प्रोत्साहक पहलुओं पर जोर।
2) घर के दरवाजे पर स्वास्थ्य देखभाल की उपलब्धता पर जोर।
3) राष्ट्रीय चिकित्सा और स्वास्थ्य शिक्षा नीति का विकास।
4) प्रत्येक गांव में स्वास्थ्य संबंधी जरूरतों को पूरा करने के लिए एक स्वास्थ्य समिति का गठन
समुदाय।
5) स्वास्थ्य देखभाल वितरण में गैर-सरकारी संगठनों की भागीदारी।
6) चिकित्सा और होम्योपैथी की भारतीय प्रणालियों की अधिक से अधिक भागीदारी
आधुनिक प्रणाली के साथ चरणबद्ध एकीकरण द्वारा स्वास्थ्य प्रणाली।
7) स्कूली छात्रों के लिए संगठित सेवाएं।
8) जनशक्ति के आकलन के लिए निर्मित प्रबंधन सूचना प्रणाली
आवश्यकताओं और समय पर निर्णय लेना।

9) आवश्यक बायोमेडिकल उपकरणों का स्वदेशी निर्माण।
10) राज्यवार स्वास्थ्य बीमा योजनाएं शुरू करना।
11) ग्रामीण क्षेत्रों में पोषण और भोजन के वितरण पर प्राथमिकता से ध्यान दिया जाना चाहिए
झुग्गी आबादी।
12) रोकथाम पीएफ खाद्य अपमिश्रण।
13) एमसीएच सेवाओं का सुदृढ़ीकरण जिसमें पारंपरिक जन्म का प्रशिक्षण शामिल है
परिचारक या मंच और सभी जटिल मामलों का विशेषज्ञों को रेफरल।
14) गैर-अभ्यास प्रदान करके डॉक्टरों द्वारा निजी प्रैक्टिस से बाहर करना
भत्ता।
15) एक अलग राष्ट्रीय जनसंख्या नीति का गठन।

2) **Four Basic Components of Primary Health Care (As per Alma-Ata Declaration):**
a) Education about prevailing health problems and methods of prevention.
b) Promotion of food supply and proper nutrition.
c) Adequate supply of safe water and basic sanitation.
d) Maternal and child health care, family planning, immunization, and disease prevention.

3) **Four Targets set-up by India for Health for All by 2000 AD:**
a) Infant mortality rate target: 60.
b) Crude death rate target: 9.0.
c) Preschool child (1-5 yrs) mortality rate target: 10.
d) Maternal mortality rate target: 2.