Transcript Integration of Substance Abuse Disorders in National Rural Health

Dr. Rakesh Kumar, Dr. Kapil Yadav,
Dr. Chandrakant S Pandav,
Professor & Head,
Centre for Community Medicine,
All India Institute of Medical Sciences, New Delhi
•Take Home Messages
•Background
•Public Health Approach to Substance Abuse
•Principles of successful integration
•Integration in National Rural Health Mission
•Take Home Messages
•Substance abuse is common in rural area.
•Huge prevention and treatment gap in substance abuse.
•Public health approach can bring high dividends
•Integration into National Rural Health Mission for efficient
service delivery
Changes in the functioning of human mind and more
specifically leads to a state of intoxication
•Substance abuse is common in rural area.
•Huge prevention and treatment gap in substance abuse.
•Public health approach can bring high dividends
•Integration into National Rural Health Mission for efficient
service delivery
Drug Type
Alcohol
Rural
(n=31,159) %
20.1
Urban (N=
9538), %
18.3
Cannabis
3.1
1.3
Opiates
0.7
0.5
Source-NHS
Supply Reduction
Demand Reduction
To protect the health of people, particularly the most
vulnerable, from the dangerous effects of drug use
and from drug use disorders
Health Care
To reduce drug related diseases and social Consequences
Harm Reduction
Clinical Medicine
Public health
UNIT OF STUDY
• Individual
•Population/
Community
TARGET GROUP
• Mostly Patient –
with disease
• Diseased and healthy
individuals
VIEWPOINT OF
HEALTH SYSTEM
• Mostly passive
process
• Active process
TYPE OF CARE
• Major focus on
curative care
• Comprehensive care
• Majority by
private sector
• Both public & private
sector
• Short term benefits
• Obvious benefit
• Long term benefits
• Not obvious
SERVICE PROVIDERS
BENEFITS
In Public Health – Good work means no patients
•Prevention is better than cure
•Best should not be the enemy of good
•Good for many rather than best for few
•Primary health care is NOT primitive care
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•Awareness and education
•Management through motivational counseling, treatment,
follow-up and social reintegration of recovered patients
•Educated cadre of service providers – Drug abuse
prevention and rehabilitation training
•
•
•Proper policy and plans
•Advocacy
•Manpower training
•Realistic tasks
•Access to drugs
•Co-ordination with other sectors
•Proper support
Launched on 12 th April, 2005 with an objective to provide
effective health care to the rural population, by
•improving access,
•enabling community ownership
•strengthening public health systems for efficient service
delivery
•Enhancing equity and accountability
•Promoting decentralization
NRHM – Main Approaches
COMMUNITIZE
1. Hospital Management
Committee/ PRIs at all levels
2. Untied grants to community/
PRI Bodies
3. Funds, functions &
functionaries to local
community organizations
4. Decentralized planning,
5. Intersectoral Convergence
IMPROVED
MANAGEMENT
THROUGH CAPACITY
MONITOR,
PROGRESS AGAINST
STANDARDS
FLEXIBLE FINANCING
1. Untied grants to institutions
2. NGOs for public
Health goals
3. NGOs as implementers
4. Risk Pooling – money
follows patient
5. More resources for
more reforms
1. Block & District Health
Office with management skills
2. NGOs in capacity building
3. NHSRC / SHSRC / DRG / BRG
4. Continuous skill development
support
1. Setting IPHS Standards
2. Facility Surveys
3. Independent Monitoring
Committees at
Block, District & State
levels
INNOVATION IN
HUMAN RESOURCE
MANAGEMENT
1. More Nurses – local
Resident criteria
2. 24 X 7 emergencies by
Nurses at PHC. AYUSH
3. 24 x 7 medical emergency
at CHC
4. Multi skilling
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NRHM – Illustrative Structure
BLOCK LEVEL HEALTH OFFICE –---------------
Health Manager
Accountant
Store Keeper
Accredit private
providers for public
health goals
100,000
Population
100 Villages
BLOCK
LEVEL
HOSPITAL
Ambulance
Telephone
Obstetric/Surgical Medical
Emergencies 24 X 7
Round the Clock Services;
30-40 Villages
Strengthen Ambulance/
transport Services
Increase availability of Nurses
Provide Telephones
Encourage fixed day clinics
CLUSTER OF GPs – PHC LEVEL
3 Staff Nurses; 1 LHV for 4-5 SHCs;
Ambulance/hired vehicle; Fixed Day MCH/Immunization
Clinics; Telephone; MO i/c; Ayush Doctor;
Emergencies that can be handled by Nurses – 24 X 7;
Round the Clock Services; Drugs; TB / Malaria etc. tests
5-6 Villages
GRAM PANCHAYAT – SUB HEALTH CENTRE LEVEL
Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages;
Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic
VILLAGE LEVEL – ASHA, AWW, VH & SC
1 ASHA, AWWs in every village; Village Health Day
Drug Kit, Referral chains
•Assessment of Community needs
•Identification of high risk individuals.
•Counseling and education of such individuals.
•Handling crisis situations in the families.
•Providing moral support.
•Organizing and participating IEC/ Awareness programmes
for various groups such as high risk groups and schools.
•Linkages & Coordination with governmental health systems
and non-governmental organization.
•Creation and operationalizing self help groups
•Early diagnosis (case finding / screening) and treatment of
cases including referrals
•Helping the patient to identify substance abuse behavior and its
consequences.
•Offering constant support to the patients. .
•Encouraging the patients to participate in treatment programme
and continue.
• Referring the patients to appropriate agencies and organizations
for seeking economic support for starting some vocation.
•Minimizing the stigmatization and discrimination against the
patient by the community.
•Working in close liaison with governmental and non-
governmental organizations for rehabilitation of the patients
Thank You
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