Hospitals and Community Health

1
Hospitals and Community Health Development

• Dr. Anil Cherian
• Director, Community Health Development
• Emmanuel Hospital Association
• India

2
Outline of the Presentation

• Community health development in EHA
• Role of the hospital
• Changes in the context. Redefining the
  relationship between hospitals and community
  based programmes.
• Principles of primary care that should be
  incorporated in to hospital services and care.

3
Emmanuel Hospital Association

• Federation of 20 Christian mission hospitals.
• Started in 1971 37 years old
• 15 hospitals are rural
• 5 hospitals semi-urban
• 29 community health development projects.
• 20 locations 18 are linked to hospitals and 2
  are stand alone.
• The projects cover 3 million people

4
Development Status Map
EHA Units in India
5
Development of Community Health in EHA

• 70s Hygiene education / Community Outreach.
• 80s Primary Health Care. 1984 EHAs first PHC
  project started (SHARE project started by Dr.Ted
  Lankaster.
• 90s Expansion of the Community Health
  involvement.
• 2000 Repositioning of Community Health Projects
  in the context of over all development.

6
EHA Vision for communities

• Empowered communities that are healthy,
  learning, prospering, caring, stewards of their
  natural resources, living in harmonious
  relationship, living in a clean and safe
  environment, worshiping the true and living God
  and reaching out to others in need.

Kacchwa, 2001
7
Determinants of health
8
(No Transcript)
9
EHA Organizational Objectives

• The major disease burden of the communities
  served by our institutions and projects are
  reduced equitably, through their participation
  and at a cost that they can afford.
• Communities prosper economically, demonstrating
  good stewardship of their available resources,
  living in a safe and clean environment,
  constantly learning, demonstrating mutual trust,
  cooperation and caring attitudes towards other
  communities.
• Individuals, families and communities become
  disciples of Jesus Christ

EHA Strategic Review December 2007
10
Profile of our Current Community Work
Advocacy Community Mobilization
Literacy Education Formal, Non-formal,
Vocational
Disease Specific HIV Tuberculosis Malaria
Water, Sanitation Hygiene
Basic Health Care for common illness
Thrift/Savings Micro-finance Income generation /
Livelihood
Nutrition / Food security
11
(No Transcript)
12
Reproductive Child Health
13
Reproductive Child Health
Immunisation
14
Womens literacy
15
Womens literacy
16
Participatory Learning Exercise
17
Women Action Group
18
Womens groups
19
Walk for malaria
20
CBOs initiative for Health facilities
21
Monthly Volunteers Meeting
22
Challenges choices

• Shift from a hospital / disease focus to a
  community health focus.

Social Determinants of health
Preventive Medicine
Health Promotion
Secondary Level Care
Primary Care
Rehabilitation
Integrated Programmes
Continuum of care
23
Role of the hospital

• Initiate the Community Project. Hospital
  reputation is important for entry in to the
  community.
• Administrative support
• Technical resource persons
• Health care
• Training
• Facilities shared reducing overhead expenses.

24
Role of the hospital

• Important to support communities initiatives with
  critical / emergency care.
• Financing
• Accountability
• Provide a faith community and family support to
  community health programme staff.
• Provide linkages with partners

25
Disadvantages

• Ownership
• Suspicion or mistrust
• Conflict of interests
• sharing of resources
• Attitudes of hospital staff
• Pre-conceived notions
• Different time frameworks
• Ghetto or mission compound mentality

26
A different drumbeat

• Changes in the context

27
Non communicable Diseases

• The new killers CVD, Diabetes, Mental Illness
  including substance abuse, Injuries which include
  Accidents, RTA and Suicide, Asthma and COPD
• Dual burden of disease.
• Risk-reduction / behaviour change
• Need for integrated continuum of care programmes

28
Health Care Financing -India

• 82.4 of health care expenditure occurs in the
  private sector of which 77.5 is from out-of
  pocket payments.
• Of the 5 of GDP spent on health care the
  government contribution is only 17.8 which
  amounts to 0.9 of GDP.
• Health care in India is the most privatized in
  the world

29
Medical expenses and impoverishment

• Survey conducted in 3 districts in Gujarat and
  Andhra Pradesh - 85 of the households in
  Gujarat and 74 of those in AP health expenses
  was the main reason for their economic decline.
• World Bank estimates that OOP pushes 2.2 health
  users in poverty and 1in 4 among those
  hospitalised.

30
(No Transcript)
31
Catastrophic Health Expenditure

• A adverse health condition that necessitates more
  than 10 of the household income in medical
  expenses (Pradhan 2002)
• Illness leads to loss of income and significant
  extra expenditure. The combination pushes people
  in to poverty.
• 9 of households in India experience catastrophic
  health expenditure
• Catastrophic health expenditure is more common in
  the low income group, but it can also effect the
  middle income group.

32
Access to Essential / Life Saving drugs

• WHO lists 270 drugs as essential take care of
  95 of the health problems.
• 60,000 to 80,000 brands of various drugs in India
• 10 of the top 25 drugs sold in the Indian market
  are non essential, irrational or hazardous.
• 56 of the people in India still do not have
  access to essential drugs (WHO 2004)
• Deregulation of drug price control has led to
  spiralling of costs with profit margins being
  increased to 75-100

33
Price variations in drugs
34
Income Inequalities
35
Disparities across income groups
36
Social Disparities IMR U5MR
37
Impact of Climate Change

• Migration of families in search of livelihood.
• Increase in natural disasters

38
Impact on the programs

• Health disparities Averages cannot the only way
  to summaries data and it is important to look at
  the data in different groups.
• Hospitals need to synchronize with community
  based initiatives. Joint planning
• Good quality health care is an important adjuvant
  to community programmes
• Engage with Government programmes
• Establish linkages with Government programme and
  to access available resources private-public
  partnerships.

39
Can the principles of Primary Health Care be
incorporated in to hospitals to synchronize them
with community based programmes?
40
Applying the Principles of Primary Health care
to hospitals

• Demystifying medicine strengthen patient
  education. Using patients to educate others in
  the community.
• Participation of the family and the larger
  community (volunteers) in caring for the
  patients.
• Using the community as gatekeepers for directing
  services.
• Community advisory committee in hospitals
• Making healthcare affordable.
• Vertical equity differential pricing / cross
  subsidization

41
Applying the Principles of Primary Health care
to hospitals

• Rational drug therapy
• Use of only appropriate/ cost-effective
  technology.

42
Conclusions

• Hospitals can be a good launch pad for community
  based health programmes
• There are potential synergies in having community
  health programmes

43
Thank you for listening