Community participation and primary health care in India [Elektronische Ressource] / vorgelegt von Anja Welschhoff

Anja Welschhoff

Sujets

• Social work

Informations

• Publié par: ludwig-maximilians-universitat_munchen
• Publié le: 01 janvier 2006
• Nombre de lectures: 25
• Langue: English
• Poids de l'ouvrage: 3 Mo

Extrait

Community Participation and Primary Health Care in India




Dissertation

der
Fakultät für Geowissenschaften
der
Ludwig-Maximilians-Universität München


Vorgelegt von
Anja Welschhoff








Eingereicht am 14. Februar 2006
Community Participation and Primary Health Care in India























1. Gutachter: Prof. Dr. W. Mauser 2. Gutacher: Prof.Dr.H.-G.Bohle


Tag der mündlichen Prüfung: 22.05.2007
iiCommunity Participation and Primary Health Care in India

ACKNOWLEDGMENT


I want to thank all the staff from the GTZ Basic Health Programmes in Himachal Pradesh,
Maharashtra and West Bengal. Without their support this work would not have been
possible. My gratitude applies also to the State Health Departments of the respective
states, who granted me permission. Further thanks go to all interview partners for their
cooperation, to the GEOMED team for their critical appraisal and to my husband.
Financial support from GEOMED, Munich University, and from the Fachprogramm zur
Förderung der Chancengleichheit für Frauen in Forschung und Lehre, Munich University,
allowed me to pursue my dissertation.
Special thanks go to:
- Dr. J.P. Steinmann, GTZ Health Sector Coordinator for India
- Dr. Sattar Yoosuf, Head, Department of Sustainable Development and Health
Environment, World Health Organization, Regional Office for South-East Asia
- Prof. Surinder Aggarwal, Head, Department of Geography, Delhi University
- Sunil Nandraj, National Professional Officer EIP, World Health Organization India
- Dr. Erma Manoncourt, Deputy Director, Unicef India
- Tim Martineau, Senior Health Advicer, DFID India
- Dr. Sharmila Gosh Neogi, Programme Officer, Population Foundation of India
- Dr. Helmut Reifeld, Director, Konrad-Adenauer Stiftung India
- Dr. Shaloo Puri, Programme Officer, Voluntary Health Association of India
- Yasmin Zavery Roy, Programme Manager Health& Education, SIDA India
- Dr. Prakash Bhatlawande, State Project Director Reproductive& Child Health,
Government of Maharashtra
- Dr. Ashok Ladda, Assistant Director of Health Services, Government of
Maharashtra
- Rajan Mahajan, Executive Secretary, Himachal Pradesh Voluntary Health
Association
- Dr. R.N. Mahanta, Deputy Director Health, Government of Himachal Pradesh
- Prof. S.K. Basu, Director, Institute of Health and Family Welfare West Bengal
- Dr. Alok Gosh, Assistant Director Health Services, Government of West Bengal
- D.P. Poddar, Executive Director, West Bengal Voluntary Health Association
- Major K.P. Malla, Honorary Secretary, Indian Red Cross Society, Darjeeling
District Branch
- Dr. Suresh Armani, Senior Programme Officer & Coordinator Health, DANIDA
India

iiiCommunity Participation and Primary Health Care in India
CONTENTS
1 HEALTH CARE REFORM IN INDIA.......................................................................... 1
2 FRAMEWORK FOR HEALTH CARE REFORMS...................................................... 6
2.1. HEALTH SYSTEM RESEARCH AND GEOGRAPHY................................................. 6
2.2. PRIMARY HEALTH CARE APPROACH .................................................................. 14
2.2.1. Basic Principles of Comprehensive Primary Health Care .................................. 16
2.2.1.1. Equity ......................................................................................................... 16
2.2.1.2. Community Participation............................................................................. 18
2.2.1.3. The Multisectoral Approach ........................................................................ 21
2.2.1.4. Appropriate Technology.............................................................................. 22
2.2.1.5. Health-promotive and Preventive Approach................................................ 23
2.2.2. Selective Primary Health Care........................................................................... 23
2.2.3. Primary Health Care in India 24
2.2.3.1. Primary Health Care in India before Alma Ata............................................. 24
2.2.3.1.1. The Health Committees ....................................................................... 25
2.2.3.1.2. The Planning Commission ................................................................... 26
2.2.3.2. Primary Health Care in India after Alma Ata................................................ 27
2.2.3.2.1. The National Health Policy 1983.......................................................... 27
2.2.3.2.2. The Community Health Volunteer Scheme .......................................... 28
2.2.3.2.3. The Integrated Child Development Service Scheme............................ 29
2.2.3.2.4. The Universal Immunization Programme ............................................. 30
2.2.3.2.5. Non-governmental Organizations......................................................... 30
2.2.3.2.6. Conclusion........................................................................................... 31
2.3. DECENTRALIZATION OF HEALTH CARE.............................................................. 32
2.3.1. Frameworks for Decentralization ....................................................................... 32
2.3.1.1. The Public Administration Approach........................................................... 33
2.3.1.2. Local Fiscal Choice..................................................................................... 34
2.3.1.3. The Social Capital Approach ...................................................................... 34
2.3.1.4. The Principal Agent Approach .................................................................... 35
2.3.1.5. The Decision Space Approach ................................................................... 35
2.3.2. Benefits of Decentralization............................................................................... 37
2.3.2.1. Community Participation............................................................................. 38
2.3.2.2. Prerequisites for Successful Participation................................................... 39
2.3.2.3. Accountability ............................................................................................. 41
2.3.2.4. Responsiveness ......................................................................................... 41
2.3.3. Problems of Decentralization 42
2.3.4. Decentralization in India .................................................................................... 43

ivCommunity Participation and Primary Health Care in India
3 STATUS OF HEALTH CARE IN RURAL INDIA....................................................... 45
3.1. RURAL CHARACTERISTICS .................................................................................. 45
3.1.1. Burden of Disease............................................................................................. 46
3.1.2. Geographical Disparities ................................................................................... 49
3.1.3. Social, Cultural and Gender Disparities ............................................................. 55
3.1.4. Local Elites........................................................................................................ 59
3.1.5. Conclusion 60
3.2. PUBLIC HEALTH SYSTEM...................................................................................... 61
3.2.1. Structure of the Public Health System ............................................................... 62
3.2.1.1. Central Ministry of Health............................................................................ 62
3.2.1.2. Sub-national Agencies................................................................................ 63
3.2.1.3. Rural Public Health Care 64
3.2.2. Quality of Public Health Care............................................................................. 66
3.2.2.1. Rural Health Facilities................................................................................. 66
3.2.2.2. Public Health Personnel 67
3.2.2.3. Utilization of Public Health Services............................................................ 67
3.2.2.4. Access to Public Health Services................................................................ 69
3.2.2.5. Availability of Care...................................................................................... 70
3.2.3. National Health Programmes 71
3.2.3.1. Family Welfare Programme ........................................................................ 72
3.2.3.2. Participation in the Family Welfare Programme .......................................... 73
3.2.3.3. National Programmes for Communicable and Non-Communicable Diseases
................................................................................................................................ 74
3.2.3.4. National Programmes Related to Health..................................................... 76
3.2.4. Primary Health Care........................................