POLICY PLAN - COUNTRY X
PROBLEMS IDENTIFIED:
1. Very high MMR, high IMR.
2. Inequality in health and health services.
3. High incidence of communicable diseases, with a good number of endemic diseases.
4. High prevalence of non-communicable diseases.
5. Poor environmental sanitation.
6. Population growth rate over the desired level.
7. Poor dental health.
8. Work-related accidents and illnesses (respiratory, skin and musculoskeletal).
9. Mental health problems - alcohol and drugs.
10. Health infrastructure problems - inefficient organization of the health care delivery network, staffing problems, poor performance.
GOALS: By the year _____, to have a socially and economically productive population with longer life, lower deaths among infant and mothers, less disability, adequate food, shelter, clothing, education, and means of livelihood.
HEALTH POLICY OBJECTIVES:
1. To promote maternal and child health.
The high level of maternal mortality especially in areas III and II is unacceptable. While the overall infant mortality rate is slightly below 50/1000, the rates in all the provinces of area III are over sixty. The causes of maternal and infant mortality are all highly vulnerable to existing technology in use by the health department. It is also to be noted that malnutrition is occurring largely among pregnant women, newborns and elementary
school children.
The improvement of the health of mothers and children is by itself its own justification. It is a social obligation that need no economic justification. The efforts of the health department should be re-enforced by cooperative endeavors on the part of the educational and social welfare sector.
2. To control communicable diseases.
The leading health problems are diarrhea, acute respiratory infections, tuberculosis and malaria. The diseases of early childhood such as measles, whooping cough, chickenpox, polio, and diphtheria are still important contributors to morbidity and mortality. Viral hepatitis, and its important sequelae (and possibly with the help of alcohol intake) cirrhosis, has caused significant concern on the part of the public. Schistosomiasis and filariasis remain as scourge of farmers and families in a few provinces.
Needless to say, the reduction of communicable diseases will be a principal factor in the achievement of the overall goal.
This reduction is technically feasible because of the availability of inexpensive but effective technologies for the most of them. Operational constraints hindering their application, however, need to be overcome. The control programme will require closer cooperation of the education, environment, agriculture, and local government department.
3. To reduce the leading degenerative diseases.
Diseases of the heart is second cause of sickness and third cause of death. Cerebrovascular disease, mainly due to hypertension is 9th cause of death. Malignant neoplasm is 5th cause of death and 9th cause of sickness.
The most common heart disease is coronary heart disease and is related to the following factors all occuring in country X --smoking habit, high fat, and high salt diet, inadequate physical exertion, emotional tension, and hypertension. The latter in turn is similarly influenced to a large extent by diet and tension. In the case of malignant neoplasm, the control lies in early detection.
For the control of the three important degenerative diseases, the support of the media, industry, and education sectors will be very important.
4. To regulate fertility.
The population is growing at 1.4% annually. On the other hand, GNP growth rate is 5.1% in 1987, with an inflation rate of 9%. It is to be noted that the population growth is highest in the poorer segment of society which comprises 65% of the population. On the other hand, the growth of income occurs in or involves largely the segment of the population which is better off -- 35%.
Stronger action will have to be taken by the Population Commission, the health and education departments, and major non-governmental organizations.
5. To promote a healthy environment.
Only 70% of the population are served with safe drinking water. Areas III and I are very much below this national average. Only 57% of the population are using sanitary toilets. Refuse disposal is good in area II, fair in area I, and poor in area III. As a consequence, there is high incidence of diarrhea, intestinal parasitism, and skin diseases, and the perpetuation of schistosomiasis in the endemic areas.
There are 16,869 food establishments located mostly in the major towns. Of these, 30% are without sanitary permits.
Pollution of the environment, particularly of the air due to automobile emissions and industrial air pollutants is a growing problem. Pollution of major rivers in area I by the discharge of industrial wastes now poses as a health and economic hazards.
Action to solve the above problems lie mainly with the water works and sewerage authority, environment department, the department of industries, pollution commission of land transportation office, and the municipal governments. The role of the health department will be mainly that of advocacy, monitoring, health education, facilitation, etc.
6. To improve dental health.
The results of the dental survey conducted in 1986 shows that so much needs to be done in dental health especially among children. Only the dental units of the government are doing public health dentistry. Each of the provincial hospital has at least one dental clinic which does clinical dentistry only. There is no school dental health programme and no fluoridation programme of any kinds.
The support of the education department, possibly the water works authority as well, would be indispensible.
7. To reduce work-related illnesses and injuries.
A good number of the reported accidents are work-related. A survey conducted in 1987 revealed various forms of work-related diseases and injuries which have reduced considerably the worker's productivity, and consequently, industrial production and worker's earnings.
Review of the reported cases of bronchitis, pneumonias, disease of the joints and muscles, and neoplasm suggest that a good number is work-related.
8. To reduce alcohol-related diseases and drug dependence.
Alcohol-related diseases and drug dependence are the most serious mental health problem in Country X, affecting mainly the adolescents and young adults. Initially observed in the slum areas, they are now widespread in the big population centers, especially among the high school students.
GUIDING PRINCIPLES:
The health policy objectives will be achieved through the development of a health system which functions efficiently and effectively, covering the total population, and with the following major characteristics:
1. Active participation of the community.
2. Effective intersectoral coordinated efforts and partnership between the public and the private health subsectors.
3. Equitable distribution of health resources, resulting in primary health care being accessible at all times to the population through widely spread peripheral health units situation close to the people and adequately supported by facilities of higher capability.
4. Use of appropriate technology. The technology must be effective, affordable, and acceptable, giving due regard to the culture and tradition of the country. Traditional medical practices and indigenous medicine when
scientifically validated are to be integrated into the health practice of the country. For reasons of affordability, standards for health facilities need to be realistically adapted to the socio-economic status of the country. Sophisticated and expensive health services must be limited in number and strategically located.
5. Sound managerial practice including strong research, information and legislative support, integrated health care delivery, and decentralization of decision-making. Sound practice should also include the preference when feasible, of treating patients on ambulatory basis; emphasis of preventive and promotive health care; and integration and regionalization in the administration and delivery of health services.
6. Development of necessary health manpower, including leadership qualities and training capabilities of institutions. It should also consider the use of less skilled health manpower when applicable.
7. Priority to underserved and vulnerable population including cultural minorities and handicapped people.
SCENARIO:
Every citizen will have access to appropriate health care. This will be provided by an adequately functioning health service network accessible to all in terms of reach and financial considerations, delivering an acceptable level of health care with active involvement of the people. The health care to be provided shall be comprehensive, including health promotion, prevention, treatment, and rehabilitation.
In each community, it is expected that there will be an active health council participating in health activities and contributing to policy formulation. At each level of the political hierarchy, it is expected that there will be an
effective mechanism for intersectoral coordination.
The impact of the network will be reflected by the improvement of the health status. In particular, it is expected that the infant and maternal mortality rates would have been reduced considerably at par with those of the more progressive countries in the region. The function of conceiving, giving births, and after care would be a pleasant and safe experience as it should be. Mothers, infants, and children would be well- nourished, fully protected from the dangers of communicable diseases.
Safe drinking water will be available and accessible to all at affordable cost. All families will be using sanitary toilets. Refuse and garbage and animal wastes will be properly disposed. There will be minimal pollution of the air, streams, and rivers.
Communicable diseases will no longer be problems. The following will be absent: smallpox, diphtheria, tetanus neonatorum, poliomyelitis, measles, whooping cough, and advanced stage of filariasis. The following would have been controlled - schistosomiasis, filariasis, malaria, tuberculosis, parasitic infestations of the skin and intestines, viral hepatitis B and tetanus. The following will no longer be major public health problems - diarrheal diseases and respiratory infections of children.
Cardiovascular diseases, cerebrovascular diseases, and malignancy will be reduced. The risk factors of cardiovascular diseases would have been controlled. Those with diseases of the heart and hypertension would be under appropriate medical supervision. Those with cerebrovascular diseases would be receiving the necessary care including rehabilitative services. Measures for the early detection of common malignancies would
have been in place and appropriate interventions as necessary are available and affordable.
Oral hygiene would be effectively taught in schools and practiced thereat at home. The general population would have developed appropriate dental health habits and would have access to dental care when needed. Dental health will be monitored especially among pregnant women and children.
It is expected that workers' productivity would be increased as a result of improved health. Places of work would have measures to reduce considerably the dangers of work-related injuries and illnesses.
The growth rate of the population would have been reduced. The population would have access to information and to safe and effective fertility regulatory services. The incidence of pregnancy in adolescents would have been reduced.
INDICATIVE BUDGET ALLOCATION:
The operating budget is expected to increase in real terms on the basis of the economic growth rate. A review of external contributors to the health development budget in the past and the conditions of loans offered by international banks will give a rough idea of what funds may be expected within the ten-year period. Discussions with representatives of these external contributors have assured that at least, the same level of
contributions as in the past two years will be possible. At a more optimistic assumption, the contributions may increase by 10%. The external sources are: (Enumerate).
ROJ@17may12