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“KARNATAKA MARCHES
TOWARDS HEALTH
PROMOTION IN
21st CENTURY”
FOCUS ON
HEALTH
PROMOTION
^FEASIBILITY AND MODALITIES
OF APPLICA TION OF PRINCIPLES
OF HEALTH PROMOTION AND ITS
INTEGRA TION WITH HEAL TH
EDUCATION'’
BY
DR. K. BASAPPA^AND
DR. G. NANJAPPA
INTERNATIONAL UNION FOR HEALTH PROMOTION AND
EDUCATION SOUTH EAST ASIA REGIONAL BUREAU
KARNATAKA CHAPTER
CONTENTS
SI No.
PAGES
I.
ACKNOWLEDGEMENTS
I
2.
PREFACE
1
3.
TOPIC
1
4.
THE PROCESS
5.
SECTION - I
4
6.
INTRODUCTION
4
7.
OBJECTIVES
4
8.
MATERIALS & METHODS
5
9.
SECTION-II
9
10.
NEED FOR HEALTH PROMOTION
9
11.
NEW CHALLENGES
12.
HEALTH PROMOTION
13.
OTTAWA CHARTER
12 - 16
14.
HEALTH EDUCATION
16- 19
15.
ADVOCACY
19
16.
SOCIAL SUPPORT
20
17.
EMPOWERMENT
20
IX.
FACTORS WHICH DETERMINE HEALTH
STATES
AND
MAIN
ACTORS
RESPONSIBLE - AN OVERVIEW
22
19.
20.
1 -2
9- 10
11
HEALTH PROMOTION & ITS BENEFITS
FROM CONTROL OF ENVIRONMENT
BENEFITS
FROM
BEHAVIOUR
CHANGES
23
21.
SECTION - III
28
22.
HEALTH EDUCATION BUREAU
28
23.
INTRODUCTION
28
24.
STRUCTURE OF SECTION - I
30-31
25.
STRUCTURE OF SECTION - II
32
26.
FUNCTIONS OF SECTION - I
33 - 37
27.
FUNCTIONS OF SECTION
II
37
28.
SCHOOL
HEALTH
EDUCATION
PROGRAMME
38
29.
GOALS AND OBJECTIVES
38
30.
ACTIVITIES
39
31.
PERFORMANCE
40-41
32.
RECOMMENDATIONS
41 -43
33.
SECTION - IV
34.
GRASS ROOT WORKERS
44-46
35.
HEALTH SUPERVISERS
47-50
36.
HEALTH EDUCATORS
52
37.
MEDICAL OFFICERS OF HEALTH &
SENIOR HEALTH ADMINISTRATORS
38.
RECOMMENDATIONS
39.
44
53-57
58
INTERACTION WITH OTHER HEALTH
RELATED DEPARTMENT
58
40.
INTERACTION
WITH
GOVERNMENT ORGANIZATION
41.
INTERACTION WITH PEOPLE
59
42.
SECTION - V
61
43.
VISION AND STRATEGY STATEMENT
61 -62
44.
SUMMARY
OF
THE
FINDINGS
DISCUSSION AND RECOMMENDATION
62 - 69
45.
SUMMARY
OF
IMPORTANT
RECOMMENDATIONS WITH REASONS
AND EXPLANATIONS
NON-
46.
EXISTING SCHOOL SYLLABUS ON
HEALTH AND COMMENTS ON THE
SAME
47.
MODEL SCHOOL HEALTH SERVICES
AND
COMPREHENSIVE
SCHOOL
CURRICULA ON HEALTH AT THE
LEVEL OF PRIMARY AND SECONDARY
EDUCATION
THE
NEED
COMPREHENSIVE
HEALTH SERVICE
FOR
SCHOOL
59
70 - 96
100
PRINCIPLES AND PRIORITIES OF
SCHOOL HEALTH SERVICE
101
FOCUS ON SCHOOL HEALTH
EDUCATION
ECONOMICS
OF
HEALTH SERVICE
SCHOOLS
STRATEGIC
PLANNING
OF
SCHOOL HEALTH PROGRAMMES
■
48.
TEACHERS TRAINING
108
RECOMMENDED
OUTLINE
OF
CURRICULUM
ON
HEALTH
FOR
PRIMARY AND SECONDARY SCHOOLS
GOALS AND OBJECTIVES
I 10
TOPICS AND AREAS OF STUDY
INCLUDED IN THE SYLLABUS
111
STANDARD - I
112
STANDARD - II
113
STANDARD - III
114
STANDARD - IV
115
STANDARD-V
1 16
STANDARD - VI
117
STANDARD - VII
118
STANDARD - VIII
I 19
STANDARD - LX
STANDARD - X
120
121
/
Task Force on Health and Family Welfare
Phone
Fax
E-mail
PHI Building Annex,
Ground Floor, Seshadri Road,
Bangalore - 560 001.
080-2271021
080 - 2277389
khsdp@vsnl.com
Chairman
Ref. No. :
TFHFW/261 / 2000
Date.....u^^pV‘2QQ0
Dr. H. Sudarshan
Members
i. Sri. P. Padmanabha
2.
Dr. S. Chandrashekar Shetty
3.
Dr. B. S. Ramesh
4.
Dr. T. Jacob John
5.
Dr. C. M. Francis
6. Dr. S. Nagalotimath
To Whom So Ever It May Concern:
Dear Sir,
The Karnataka State Task Force on Health and Family Welfare
is conducting a Action Research study on "A Proposal for
Research Study on the feasibility and Modalities of application
of principles of Health Promotion and its integration with Health
Education”. The research is conducted by Dr. K. Basappa.
I hereby request you to provide him with necessary information
and access to data regarding the topic under study.
7.
Dr. Latha Jagannathan
Thanking you.
8.
Dr. Jayaprakash Narayan
With regards.
9. Sri Swami Japananda
10. Dr. M. Maiya
11. Dr. Thelma Narayan
12. Dr. Kamini Rao
Member Convenor
Arvind. G. Risbud
(Dr. H. Sudarshan)
Chairman
-I-
INTERNATIONAL UNION FOR HEALTH PROMOTION AND
EDUCATION (IUHPE) - SOUTH EAST ASIA REGIONAL BUREAU
(SEARB) - KARNATAKA CHAPTER
ACKNOWLEDGEMENTS
International Union for Health Promotion and Education (IUHPE) - South East
Asia Regional Bureau (SEARB) - Karnataka Chapter Sincerely thanks and
appreciates the gesture of Karnataka Task Force on Health and Family Welfare for
having invited the Chapter fot conducting an action Research Study on “the
feasibility and modalities of application of principles of Health Promotion and its
integration with Health Education”. The Chapter thanks Dr. H. Sudarshan,
Chainnan of the Task Force, Dr. C.M. Francis and other Members of the Task
Force for their suggestions and guidance in completing the Research Study.
Thanks are also due to the Project Administrator, Karnataka Health System
Development Project for providing necessary funds for the Research Study.
Thanks of the Karnataka Chapter are also due to Dr. G.V. Nagaraj, Director of
Health and Family Welfare Services, Dr. Kurthkoti, Additional Director (Health
Education and Training) for their help and cooperation for organising the field
visits to Districts, Primary Health Centres and Sub-Centers.
Thanks are also due to the District Health and Family Welfare Officers and
Technical Staff of the Kolar, Bijapur, Bellary and Kodagu Districts for their
participation in the Research Study.
-ii -
The lUHPE-SEARB-Kamataka Chapter thanks Dr. K. Bassappa, Principal
Investigator of the Research Study and Professor, Community Medicine,
Adichunchunagir Institute of Medical Sciences, and Dr. G. Nanjappa, Member of
the Research Team, Project Coordinator and Professor Community Medicine,
AIMS for their relentless field work, analysis and writing the Project Report.
Tanks are also due to Dr. K. Ramachandra Sastry, Chairperson, Research
Division, SEARB and Retd. Chief of Research, Gandhigram Institute of Health
and Family Welfare Trust, Mr. N.R. Vaidyanathan, Chief, Budget and Finance,
SEARB, and Retd. UNICEF Field Officer and Mr. C.R. Premakumar, Member,
Executive Committee, Kamantaka Chapter and retired Public Health Executive
Engineer
for
collection
of information
and
interpretation
from
other
developmental sectors of the Government of Karnataka.
The Karnataka Chapter thanks Mr. Settappa, Joint Secretary of Karnataka Chapter
SEARB for having assisted the Investigators in the secretarial work and keeping
the accounting work of the project funds.
4
Dr. K. BASAPPAC
President
Karnataka Chapter-SEARB-IUHPE
PREFACE
Health promotion is defined a process of enabling people to increase control over
1 ff ^etenn'nantS
diseases and disability and improve their health by their own
The public policy and health policy in particular should be able to help people to
acquire health and sustain it for a long time, so that they remain productive for
more number of years and do not add to the burden f diseases and disability
Health promotional policy works in this direction.
The Task Force of Health and Family Welfare of Karnataka Government wanted
to apply these principles into the Karnataka State Health Care Service. A rapid
assessment of the State of art Health Education process was felt necessary and this
report is related to the assessment of the extent and method of implementation of
hea th promotion in Karnataka State Care System and to find out tire modalities of
Sreducabo!!16 PnnC’PleS °f hea,th Promotion ^th a view to integrate it with
Topic
Prn™°fIC iS ?f'easibility and lnodal>ties of application of principles of Health
Promotion and its integration with Health Education.
The Process
Hie Research Team after receiving the orders of assignment from the Karnataka
Task force on health and Family Welfare to take up rapid asses ment of the
“CVtiXeXrtT “
’"d
HcZeL X'
.o "he Task Force Afterprepar=d ’ search proposal and submifted
The assessmenHnvolved "PH"0'"
•'“‘en up.
2
1. Literature review on health promotion.
2. Field visits to 16 Primary Health Centers in 4 districts to know the state
of art of health education activities and to assess the competencies of the
health manpower at the district and Primary Health Centre levels and the
organization strengths and weaknesses.
3. Obtained the views of senior health experts who were closely associated
with the functioning of the Health Sector and present Health Education
practitioners in and outside the State.
4. Some data were collected from the Health Directorate and District Health
Officers about the structure and perfonnance of the health education
wing.
5. The data were analysed and discussed in the Seminar Organised for the
purpose.
6. This is the final report of the assignment.
3
LIST OF TABLES
1. Statement showing the Number of Respondents planned and contacted.
2. Number of l.E.C. Activities conducted from 1997 - 1999.
3. Number of School Health Education Activities - Target achieved.
4. Knowledge, Attitude & Practice of Grass root level Health Workers.
5. Knowledge, Attitude & Practice of Health Supervisor.
6. Knowledge, Attitude & Practice of Health Educators.
4
SECTION-I
A. INTRODUCTION
B. OBJECTIVES
C. METHODS & MATERIALS
Introduction and Objectives of the Study
A. INTRODUCTION
I
The Task Force on Health and Family Welfare, Government of Karnataka
invited the Karnataka Chapter of the South East Asia Regional Bureau of the
International Union for Health Promotion and Education to take up a rapid
assessment of the “FEASIBILITY AND MODALITIES OF APPLICATION
OF PRINCIPLES OF HEALTH PROMOTION AND THEIR INTEGRATION
WITH HEALTH EDUCATION/'
The Karnataka Chapter accepted the assignment and conducted the study. The
following is the report of the study.
B. OBJECTIVES
1. To develop a vision and strategy statement on health promotion for the
Karnataka State.
2. To examine the organizational structure and functions of Health Education
Bureau of the Directorate of Health and Family Welfare Services.
3. To Make a rapid assessment of capabilities of health staff to undertake
health promotional responsibilities with particular reference to
competencies of grass root level health staff and their supervisors, block
level health educators. District Health Education Officers, Medical Officers
of Health of the Primary Health Centres and District Health and Family
welfare officers.
4. To assess the existing inter-sectoral coordination related to health
promotional activities amongst the different development departments and
non-governmental organizations at primary Health Centre, District and
State level.
5
C. MATERIALS AND METHODS
A qualitative assessment was decided upon because of the time constraint
imposed by the task Force to complete the study. Though this is a qualitative
study and based on focus interviews and observations, care has been taken to
see that the interviews of relevant staff and observations have been made by
the experienced researchers themselves to ensure credibility and validity of the
report.
1. Literature about health promotion published in the International and
National journals and WHO documents have been reviewed. It include
global strategy for Health for All by the year 2000 and Alma Ata
Declaration ol 1978 on Health lor all (H F A) 2000 and primary health care
published by WHO and Ottawa Charter for health promotion (1986). And
other documents and reports Reviewed are Report of an International
Meeting on public Health (New challenges) and Ninth general Programme
of work (9GPW) published by W H O.
2. Infonnation about the structure and function of the Health Education
Bureau were collected from the Directorate of Health and Family Welfare
Services and the District Health and Family Welfare Offices of four District
who are looking after planning and implementation of health programmes
in their district. These information have been tabulated and analysed.
3. Date were also collected by interviews and from focus group discussions
and field observations of the primary health centre and District Health staff
regarding their competencies in health promotional activities.
4. Opinion of the health administrators, health researchers and health teachers
on some aspects of health promotion and practice, its importance and
feasibility and the competencies and skills required to implement health
promotional strategies have been collected by open-ended questionnaire
and analysed. Experts from the State of Karnataka and outside the state
were included in the study.
5. For field study one district from each of the four revenue divisions of the
State was selected. Sixteen Primary Health Centres, 4 from each district
were selected for observational study. The district are kolar from Bangalore
Division, Bijapur from Belgaum Division, Bellary from Gulbarga Division
and Kodagu from Mysore Division.
6. In order to know the existence and extent of intersectoral coordination and
cooperation and involvement, representatives of various development
6
departments and non-govemment organizations were also included in the
study.
7. Criteria used for assessing the competencies and skill of the staff of
implement health promotional activities and opinion of Public Health
Experts.
Criteria Used
Rank Assigned
KNOWLEDGE
Has a clear perception of the meaning of health
promotion. His/her job responsibility and that
of health department
High
2.
Has vague perception
Moderate
3.
I las no perception
Low
1.
ATTITUDE
1.
2.
3.
4.
He/she is very eager to promote health
promotion work.
High
He/she feels that it is worthwhile, but shows
indifference and not so enthusiastic about their
job.
Moderate
He/she feels rather not concerned about his job
responsibility and about health promotion or
health education
Low
OPINION ON STATEMENS
Strongly Agree
Consenses
Agree
Exist
Agree with reservation
Consenses
Disagree
Does not exist
7
STATEMENTS MADE ARE RELATED TO THE FOLLOWING.
1. Need for health promotion and Education.
2. Methods of planning health promotional activities.
3. Importance of social mobilisation activities.
4. Need for involving people in the health programmes.
5. Need for inter-action with
governmental organizations.
developmental
departments
and
non
6. Need for further training of health staff.
7. Additional training for Medical Officers of Primary Health Centres.
8. Need for re-orientation of syllabus in Community Medicine in MDBS and
MD courses.
9. Need for change in the attitude of policy makers towards public health and
health promotion.
8
TABLE - 1
STATEMENT SHOWING THE NUMBER OF RESPONDANTS
WITH THEIR DESIGNATION, PLANNED AND CONTACTED
SI.
No.
Designation
Number
Planned
No.
Contacted
1.
Director of Health and Family Welfare Service
1
1
2.
Additional Directors of Health & FW Services
4
3
3.
Joint Directors of Health of FW Services
6
6
4.
District Health and Family Welfare Services
4
4
5.
District Health Education Officers
4
4
6.
Dy. District Health Education Officers Block
Level Health Educates
20
14
Medical Officers of Health of Primary Health
Centres
16
12
8.
Health Supervisors, Male and Female
32
28
9.
Health Workers Male and Female (ANMs & Jr.
H. Asst.)
64
50
98
48
8
6
1) Education
1
I
2) Public Health Engineering
1
I
3) Agriculture
1
1
4) Horticulture
1
I
5) Women and Child Welfare
1
1
6) Infonnation and Publicity
1
1
262
182
7.
10.
Health
experts
Administrators
and
senior
11.
Non-Govt. Organizations
12.
Other Government Sector representatives
Health
9
SECTION -II
NEED FOR HEALTH PROMOTION
According to World Health Organization the definition of Health is “a state of
complete physical mental and social well-being and not merely the absence of
disease”. Despite this definition and its widespread usage, all over the world large
majority of people view the health in the context of curative medicine, often
described perhaps presumptually - as “modem scientific medicine”. Apart from
this, there is a pervasive misconception among health planners in many countries
especially in developing countries that good health is primarily a result of medical
intervention and hospital services and there has been a growing morginalisation of
public health.
NEW CHALLENGES
But the evidence available is quite the contrary. Makeown’s research has shown
that past improvement in health has been due mainly to modification of behaviour
and changes in the environment. For example, Mckepwn’s analysis of mortality
trends in U.K. between 1801 - 1971 has shown that mortality from infectious
diseases such as Tuberculosis, Bronchitis, Pneumonia, Influenza etc., as well as
from water borne and food borne diseases had already begun to decline even
before effective treatment became available.(l)
(l)Mckeown suggests that communities and Government should look into
factors (behavioural and environment ) to bring further advance in health
status of their countries.
(2) Studies have also shown that extreme poverty of some l/5th of the world
population is the greatest killer and largest cause of human suffering
Disparity in health exists between nations and the gap is increasing
Healthier countries are becoming more healthier and poor health countries
are becoming poorer in health status. Just like rich countries becoming rich
and poor countries becoming poor due to imbalance in the economic
development.^)
(3) In addition, grave dispanties in health condition remain within the
countries, communities and gender. For example poorer and less educated
people suffer from higher mortality and morbidity than those who are better
educated and have higher income within the country and communities.
10
Women carry the triple risk of death and disease because of reproductive
burden and gender inequality and social injustice in all walks of life.
Therefore, people who are relatively poorer, less educated and women
living in rural and semiurban and slums of big cities have less access to
health care system, suffer more from inequality and social injustice. (2)
(4) The emerging fourth challenge is the resurgence of old diseases like
Malaria and Tuberculosis and new diseases like HIV/AIDS and drug
resistance of insects and bacteria are all adding to the problem of health of
developing countries. (2)
(5) The fifth challenge causing alarming situation both in developing and
developed countries is the increased cost of medical care due to social and
commercialization of medicine, in the advent of advanced diagnostic and
technological knowledge. Inspite of these advances and costly treatment,
there has been no improvement of health of the people in relation to
expenditure. (2)
(6) The 6th factor causing concern is related to alcoholism, drug addiction,
tobacco smoking and tobacco chewing.
In the face of these challenges, the approach and strategy for maintaining and
improving the health of the people should concentrate more on the root cause of
illhealth and diseases. These root causes or determinants of health and diseases are
related to (1) income (2) Education (3) Employment (4) Nutrition (5) Housing (6)
Safe Water (7) Sanitation (8) Health environment (9) Health care infrastructure
(10) People’s participation (11) People’s awareness, and level of skill (12) Primary
health care (13) Prompt diagnostic and therapeutic services and (14) Rehabilitation
services, these are the direct cause. The indirect cause are many and they prevail
in all walks of life of governance. Some of them, are public policy health policy in
particular, right to heal th, access to health care infrastructure and quality of health
care providers, equity and social justice etc.
In these circumstances people’s health can be improved and sustained only by
comprehensive plan of action that cuts all roots and rootlets that cause illhealth.
For this to happen, all the people and the concerned government organizations,
voluntary organizations and religious organizations, Industries should come
together and work at all levels from the top policy makes (political, social and
religious leaders) to people’s representatives.
11
HEALTH PROMOTION
What is Health Promotion?
Health Promotion is defined broadly as a process of enabling people to increase
control over the determinants of illhealth and improve their health. In essence,
health promotion is Social and Political action. It seeks to empower people with
knowledge and understanding of health (health education) and creating conditions
conducive to healthy living and healthy life style (social support). It reaches and
involves people through the context of their every day lives, such as homes, work
places (Industries, offices) learning (schools and colleges), and play ground
recreation facilities, and eating establishment.
Health promotion takes a developmental approach to health, whereby health is
considered as the goal and is a result of the activities of all development sectors
like housing, local governments, education, industry, agriculture, transport
services etc. Development approach promotes stronger health programmes
characterized by greater relevance to various development sectors such as school
health, healthy cities, healthy villages, and healthy food markets etc.(3)
In her opening address to the 5,h global conference on health promotion in Mexico
Dr. Gro Herlem Brundtland, Director General, World Health Organization stated
that “Promoting health is about enabling people to keep their minds and bodies in
optimal condition for as long as possible. That means, that people know how to
keep healthy. It means that they have the power to make healthy decision - within
them selves, community, local government and within the State. (4)
The UNICEF “State of Health of World’s Children - 2000” (5) presents evidence
to show that India is not investing sufficiently in mother and child care despite the
fact that infant mortality rate and under 5 mortality rate are not showing any
decline in 2000 as compared to 1998-99.
12
II. OTTAWA CHARTER AND JAKARTA DECLARATION ON
HEALTH PROMOTION
Significant features of the Charter
1. Ottawa charter define health promotion as a process of enabling people
to increase control over the determinants of illhealth and to improve
their health.
2. Health is seen a resource for every day life and not objective of living.
3. Health promotion is not just securing of health, but goes beyond healthy
life styles to well-being.
4. Pre-requisite for health are: (1) income (2) food (3)shelter (4)
sustainable resources (5) social justice (6) equity (7) water supply and
sanitation(8) education. Improvement in health requires a solid and
secure foundation in all these basic needs.
5. Political, economic, social, cultural, environmental, behavioural and
biological factors can all favour health or may be harmful to it. Health
promotion action aims at making these conditions favourable to health
through advocacy.
6. Health improvements require secure foundation in (1) a supportive
environment (2) access to information (3) development of life skills and
opportunities for making healthy choices (4) equal opportunities for all
segment of the population to het free access to health and related
services irrespective of class, creed and gender difference. Health
promotion aims at enabling people to take control of those tilings which
derermine health.
7. Health pre-requites and health supportive accessories cannot be ensured
by health sector alone. It demands coordinated action by all concerned,
by governments, health and other social and economic sectors, by non
governmental and voluntary organizations, by local authorities, local
communities, families and individuals. Health promotion action aims at
bringing coordination between various sections and media, between
differing intersts in society for the pursuit of health.
13
Based on the above principles, the Ottawa Charter suggested the following action.
1. Build Healthy Public Policy
The health promotion agenda of the makers in all sectors, at all levels of
government and society directs them to be aware of consequences of their
decisions and accept their responsibility towards health. Health promotion
policy combines diverse, but complementary approaches like (1) legislation (2)
fiscal measures (3) taxation and (4) organizational changes. It is the
coordinated action that increases income, foster greater equity and social
justice to individual family that counts to improve health. The health
promotion policy requires the identification of obstacles to the adoption of
healthy public policy in both health and non-health sectors and finds ways and
means to remove them and thus helps policy makers to make healthier choice.
2. Create supporitive environment
Creation of an environment supportive and sustainable is a prerequisite for
health. Intricate links exist between people’s health and their environment and
this is the basis of socio-ecological approach to health. While conservation of
natural resources should be encouraged through out the world as a global
responsibility, the modification and creation of sustainable new resources for
health should be the responsibility of every nation and every community.
Supportive environment consists of two components. One is the physical
environment and the second is the social environment. As for as physical
environment is concerned, that every person and family must have work and
minimum income to possess and utilize the infrastructure. The way society
organizes work would help to create a healthy environment. Health promotion
should generate living and working conditions that are safe, stimulating,
satisfying and enjoyable.
Social environment is concerned with changing old behavior pattern or
adoption of new behavior pattern is of course possible only when man or
woman is motivated and committed to behavior change. But the process of
motivation and commitment can be made easier and quicker by creating social
environment which creates critical mass in the community. That is the opinion
of family, peer groups, formal and informal leaders and religious groups
14
should support a particular behaviour. It may be about small family norm,
giving up tobacco and alcohol, extramarital sex or age at marriage ect.
These health promotion activities help to create and sustain such social
pressure. The concept of supportive environment implies that action is oriented
towards determinants of the health of the population. This is used to build
bridges between sectors and professions, between theoretical concepts and
practical action for an improved countries.
Achieving supportive environment will require a new awareness of the
possibilities for improving health through environmental change. It will also
require a strong future orientation that links public health to sustainable
development and consequently require a new emphasis on strategic planning
and development of management skills to facilitate cooperation between
sectors.
3. Strengthen community action
Community action play a very significant role in making people believe in
what they do and how they do and behave. It cements their belief. Therefore,
community action programme, where they plan, take decisions, implement
them, mobilizing their own resources and take control over and won them
should be encouraged. Community development draws on existing human and
material resources in the community to enhance self help and social support
and to develop flexible systems for strengthening public participation and
direction of health matters. This requires, full and continuous access to
infonnation, learning opportunities for health as well as funding support.
4. Develop personal skills
Education for health and enhancing life skill development are important,
because they increase the options available for them to exercise more control
over their own health and their environment, which sustains health. Enabling
people to leam through out their lives, to prepare them for all stages of life and
cope with the illness and injuries are essential. This has to be facilitated in
schools (school health) home, work place (occupational health) and community
setting. Health promotional activities extends to these areas through
educational, professional commercial and voluntary bodies.
15
5. Reorient health services
Health sector and health professionals remains the sheet anchor of health
promotion, they must plan efficient system of primary health care service
through out the country from villages to metropolitan cities. They must
involve local governments and people to take control of them. They must
move increasingly in a health promotional direction beyond clinical and
curative services. Health sector and health professional need to embrace and
expanded mandate which is sensitive and respects cultural needs. This
mandate should support the needs of the individual and communities for a
healthier life and open channels of communication between the health sector
and broader social, political, economic and environment components. The
health sector and other sector of government, voluntary health organizations
and other groups in the community must work together and conhibute to the
pursuit of health.
Jakarta Declaration on Health Promotion into the 21” century.
The Jakarta Declaration on health promotion offers a vision and focus for health
promotion into the 21st century. Its main emphasis is to tackle health determinants
and for this, it draws upon widest range of resources from all sides. The
declaration recognizes that health promotion is an essential element for health
development.
Health promotion, through its investments and actions on
determinants of health, contributes significantly for the reduction f inequalities in
health, ensure human rights and build social capital which is so important for
health and well-being of people . The ultimate goal of health promotion, as
envisaged in the declaration is to increase in the health expectancy and to narrow
the gap in health expectancy.
The Jakarta declaration endorses all the five Ottawa Charter Strategies
Charter strategies:
•
Build healthy public policy
•
Create supportive environment
•
Strengthen community action
•
Develop personal skills
•
Reorient health services
16
In addition, the following five priorities for health promotion have been suggested.
•
Promote social responsibility for health of decision makers.
•
Increase investments for health development
•
Consolidate and expand partnership for health
•
Increase community capacity and empower the individual
•
Secure an infrastructure for health promotion.
The Declaration calls for action to speed up progress towards health promotion
giving priorities for the following:
1. Raising awareness about the changing determinants of health.
2. Supporting the development of collaboration and networks for health
development.
3. Mobilisation of resources for health promotion.
4. Accumulating knowledge on best practices.
5. Enabling shared learning.
6. Promoting solidarity in action.
7. Festering transparency and public accountability in health promotion.
Jakarta declaration called on W H O. to take the lead in building a global health
promotion alliance and enabling its member States to implement the action
programmes. A key part of this role is for W.H.O. to engage governments, non
governmental organizations, development banks, U.N. agencies, inter-regional
bodies, bilateral agencies, the labour movement and cooperative as well as private
sector in advancing the action priorities for health promotion.
III. HEALTH EDUCATION
The widely used definition of health education is “Health Education is a process
which affects change in the health practices of people and in the knowledge and
attitudes related to such changes”. (6). This definition implies that health
education is a process, it involves series of steps, it is concerned with establishing
changes in knowledge, attitude and behavior and also involves efforts by the
people. Aims of health education as formulated by W.H.O. (7) is to (1) ensure that
health as a valued asset to the community (2) equip people with skills, knowledge
17
and attitude to enable them solve their health problems by their won efforts and (3)
to promote the development and proper use of health services.
Health education in the context of health promotion concept.
According to a position paper on health education jointly prepared by International
Union for Hygiene Education and division of health education W.H.O. Geneva with support from Centre for communicable diseases Control U.S.A. (8), health
education is the combination of planned social action and learning experiences
designed to enable people to gain control over the determinants of health and
health behaviors and the health status of others.
Planning
1. Planning must be based on the consideration of relevant information. This
information must provide multiple factors that influence the behavior and
health related outcomes of interest and must account for the needs of
interests of the target people.
2. The people who use this data must be knowledgeable in isolating those
factors that affect health and also must possess skills to determine the
relative importance of these factors.
3. To ensure the needs and interest of the target population, they must be
involved in the planning process.
4. People’s participation assures that there is a rapport with people and a basis
for pursuing mutual efforts and partnership. It should be characterized as
doing something “with” rather than “to” the people.
5. Health programmes are more successful when target population perceive
the problem and solution in question to be the most important and
appropriate respectively. People are found to act on issues they judge to be
important them.
6. Creating demand for health is an important responsibility of health
education. For example, people may not judge a given problem or issue to
be important simply because they are unaware of its magnitude or
prospective and long-term effects.
18
Learning experiences
1. Numerous factors influence the learning process including literacy, access
to services and media resources, readiness for change health beliefs,
environmental and social barriers and social reinforcement. Therefore, the
health education programme planning must take into consideration not only
for technical education barriers such as illiteracy, but also for social and
economic barriers.
2. There are difference in the way people receive, process and act on
information. So health education programme must be prepared to offer a
variety of learning methods and strategies to maximize the probability of
attaining the desired educational and behavioral outcomes and necessary
social change.
3. Combination of health education methods are important in effective
communication. This depends upon the characteristics of the target
population, active involvement of collaborating organizations and
representatives of the community as partners, availability of resources and
competence of the persons conducting the health education programme.
4. There is no single model or method that holds universal superiority, health
education specialists, must understand a variety of educational, behavioral
and social sciences theories.
5. Those who plan health education programmes must be capable of adopting
educational strategies for various sub populations of the community of the
basis of characteristics that may be practically identified, such as age, sex,
neighborhood, ethnic and cultural identity
6. Therefore, the older concept of health education is not sufficient to meet the
needs of health promotional goals. It should strive to enable people to
identify the detenninants of healtli and take action to nullify their effects on
health and take control over the measures to protect, preserve and promote
health. The task of improving health is not only confined to health sector,
health professionals and health communicators, but to all developmental
sectors of government and non-govemment organizations, religious leaders,
traders, industrialists, politicians and all those concerned with governance
of the county and who matters for running the country towards
development, progress, and happiness.
Health sector, health professionals and health communicators have a special role
to play. They should act as coordinators, advocates and facilitators of health
promotion.
19
Action required for individual countries or states with in the
countries for health promotion.
In order to provide action plan for promotion of health in developing countries,
W.H.O. Working Group on Health Promotion convened a meeting of senior health
administrators in the region in 1989. The group identified the following areas for
action.
1. Enhancing health knowledge and understanding is the first essential step in
health supportive action by people.
2. Creating conditions - (social and environmental) that are conductive for
health is another essential requirement.
j.
These can become a reality when there is high level of awareness for health
among policy makers, politicians, economic planners Health Researches,
and the public people.
When the awareness is transferred into policies and legislative support, favorable
resource allocation for health would follow. Thus full mobilization of all social
forces for health will be needed for health promotion. In order to achieve these
goals, three fold strategies are recommended. They are (1) Advocacy (2) Social
and Environmental support for health and (3) Empowerment of people for health.
Brief description of Advocacy Social Support and empowerment.
1. Advocacy:
Advocacy is the process of providing evidence based knowledge to people so that
they become convinced and committed and take appropriate decision in favor of
the action required. Thus Advocacy is helpful in generating public demand and
bring about health issues in every day activities. It helps policy makers and elected
representatives to make right kind of decisions in the allocation of financial
resources for community health. It helps religious leaders to become more
committed and convinced and help spread scientific way of life to the people. It
convinces political leaders to realize the need for support people’s wishes and try
to reorient health system. Advocacy to professional people helps in creating
motivation and interest in researching problems that affect people’s health and
find scientifically based strategies to solve health problems. Finally Advocacy
helps create critical mass of interest and support positive health and makes people
to take healthier decisions.
20
Social support for health
Social support means creating and mobilizing favourable public opinion in favour
of health behaviour. This helps in legitimization of a particular action. It may be
small family nonn, giving up smoking or giving unhealthy habits and take
decision to build a sanitary latrine in the house. Public organizations and
institutions like. Youth Clubs, Mahila Madals, Panchayats and other social groups,
are very usefull in these matter.
Building health infrastructure in villages and towns and cities is another social
support system. Health infrastructure like (1) protected water supply (2) sanitation
and sewerage system (3) building health centers and hospitals within the easy
reach of the people and (4) provision of good roads and transport etc.
Empowerment of people for better health
Empowennent of people means, providing health literacy and spread of
knowledge to all and motivate and create interest in them so that every body
become self-supporting in health. Inculcation of knowledge and helping people to
develop required skill and capacity to acquire positive health and maintain it. It
includes suitable employment to every body equitable access to health,
infrastructure and health advise and health care services.
Thus favourable decisions of policy makers and those who allocate resources at
the State and Central levels are crucial. Followed by proper planning, strategy,
development for health promotional activities at State and District level are
essential. Directorate of Public Health must have adequate manpower and
resources to implement the programmes effectively and monitor and evaluate and
provide feedback to the programme managers. In addition, the people should
participate in planning, implementation and management of health programmes at
participate in planning, implementation and management of heal th programmes at
grass root level in every village, town and city if health promotion is to become a
reality.
Factors which determine health status of the population and main
actors responsible - An Overview
1
Individuals, Family and the Communities.
2. Local, District and State level government health Organization.
3. Sectors other than health.
4. Central Government.
21
HEALTH DETERMINANTS THAT NEED ATTENTION
While genetics cannot be changed, the
person's awareness, knowledge, skill life
style play an important role. Family decides
the way of living, nutrition standards, home
environment. Family also decides about
education, how many children are wanted,
handle family conflicts, how to care for
disabled members. The community influence
the health of its members through safe water
supply, sanitation, education, shelter,
handling violence and un-employment.
1.
Individuals Family and Community
2.
Health Ministry (State) Health System Health Ministry and health professionals arc
Services, Health research community. responsible for:
I
a. Health legislation.
b. Health policies and budgeting.
c. Health education.
d. Provide primary and secondary health
care.
e. Make available minimum health care
facility accessible for all.
f. Administer and manage health care
facility so that the services are actually
rendered on day to day basis.
g
Develop and maintain research health
planning, monitoring health programme,
implementation and determining health
impact of health programmes and to
provide needed evidence to the policy
makers and allocation of health
resources.
h. Training and maintaining pool of medical
and health personal of various levels of
expertise, health administration etc.
3.
Sectors other than health
1. Government Sector.
2. Non-Govt. Sectors.
Almost all sectors of economic activity have
an impact on health status of the community
through national or regional policies and
decisions. For example Farm and Food
Policies have a direct impact on health so
also water supply and sanitation and primary
education, environmental pollution and
degradation due to uncontrolled industrial
pollution have indirect impact.
Social security system for working people
and senior citizens, level of employment,
control of criminality and violence have
indirect effect.
Rural and urban development, housing
industry, energy and transport sectors have
both direct and indirect effect on health the
effectiveness
and
efficiency
of
administration and also measures to limit
corruption have additional impact on
community health.
4.
Central Government
Although Central Government is far away
from health situation of the individual, the
macro economic policies of the government
and principles of good governance in general
both have a direct impact on health.
Economic policies and the allocation of
budget between the various ministries, the
degree of commitment of the ministries for
their
missions,
the
efficiency
and
effectiveness of administration and the
research policies pursued by the government
have all impact on health problems.
23
Health Promotion and its benefits
A. Benefits from the Control of ENVIRONMENT
Experience of the western countries is striking to demonstrate the vast benefits of
health promotional activities (action on the root causes ) that accrue to mankind.
These countries brought down infant mortality rate from 200/1000 in 1880 to
about 70 by 1930. The morbidity and morality due to gastro-intestinal disease
came down markedly during the same period 60 to 70% of these improvements
are attributable to safe water supply and provision of sanitation, good housing
Nutrition, education and behaviour changes like personal hygiene and practice of
small family norm by majority of the people in those countries.
India missed Industrial Revolution so also Sanitary revolution that brought vast
improvements in the standards of health of Western Countries. India under the
foreign rule for over 200 years, with its deep entrenchment in tradition,
superstition etc. is still even in the wake of 21st century and independence is
experiencing the vary high preventable mortality, morbidity and disability. This is
because, very little attempts have been made, to act on the root causes of illhealth.
Even in the 21st century, nearly 40 to 45% of people do not have water supply
(70% do not have safe water supply) 65% do not have toilet facilities, 40% of
women between 15-49 years suffer from preventable anemia and 35 to 38% of
women have body mass index below 18.5 kg/m, and 44% of children under 3
years are underweight. These are the examples to show how the country’s health
system is neglecting the health promotion activities. The experience of the western
countries who are implementing some of the health promotional programmes in
their communities against chronic and behaviour related disease shown substantial
improvements in health of the population besides brining down the burden of
disease and social costs.
The evidence that health promotional policies and actions yield substantial health
benefits is being accumulated.
B. Benefits from behaviour modifications
I. School Health
School health programmes for promoting better health show clear evidence of
achieving higher literacy levels, reductions in dropout rates, cassation of smoking,
reduction in substance abuse, reduction in social consequences of teenage
pregnancy. School health promotional programmes can be effective in transmitting
knowledge, developing skill and supporting positive health choices. The evidence
25
mortality from coronary heart diseases, 11% less from cancer mortality. Among
pregnant women smokers cessation of smoking has resulted in lowering the risk of
low birth weight and reduction of obstetric complications. Smoking cessation is
found to most cost effective programme. The cost per life year gained from such
programmes ranged from 2000 to 5700 US $, where as the cost per year gained
from treatment for mild hypertension is up to 8600, and the cost of extensive drug
treatment per life year gained is more than 192,000 US $.
4. Mental Health and health promotional activities.
There is significant evidence to show that mental health promotion strategies have
reduced depression, reduced suicide rates and reduced behavioural problems.
Swedish Educational Programme have shown very positive results. For example,
there was reduction of suicide rates for 19.7 cases/100000 population to 7.1 cases
after 3 years of programme implementation. Besides there was economic benefit,
the number of inpatient days reduced by 70% and there was also savings in the
amount of tranquilizers and anti-depressant drugs used. Other mental health
promotional programmes have reduced teenage pregnancy HIV infections, 75%
reduction in pre-term delivery, reduction in low birth weight babies and babies
with brain damage.
5. Healthy Ageing
The real key to healthy ageing is to begin heal th promotion early in life. However,
there is evidence to show that application of health promotional activities like,
physical activity even at the age of 50 can bring down substantially cardiovascular
mortality and risk of falls and enhances cognitive function of the mind. The impact
on society is seen in keeping the elderly population active and therefore productive
for a longer period, reducing health and social costs. The available evidence show
that maintaining healthy life styles in old age is directly associated with health
gain.
6. Healthy Equity
Equity is health is gaining ground in recent years. WHO describes equity as a fair
opportunity provided for all people to enjoy health to their fullest potential. It does
not mean equal health status for every one, but it means reduction of differences
between people’s health as much as possible through equal opportunity for health.
There is evidence to show that socio-economic conditions related to income,
education and employment are at the root causes of illhealth. Even in Europe,
substantial number of people (57 million in 1993) lived in 23 million poor
26
households. Even in rich countries, people with means live several years longer
and have fewer diseases and disability than people without resources.
Relative deprivation has show to have profound effect on healthy rather than
absolute poverty. Relative deprivation can have poorer education, low skill
development, higher unemployment and lower capacity to deal with information
and lower material resources. There is strong evidence to show that relative
poverty is closely linked to poorer health. Many equity interventions for health are
found to have impact at community level. People can gain increases ability to
solve their problems at every stage of participation or involvement of the local
community.
Healthy cities concept of WHO’s Health for All strategy with hundreds of people
participating provides a strong multi-agency framework for development. Such
programmes have shown evidence of effectiveness including generating increased
income, through work opportunities improved community support with counseling
services and better community involvement etc.
Data also show that health and education are most important and powerful forces
for economic development in poorer countries. Basic investment in health and
education can produce positive economic outcomes. This kind of investment in
Trinidad, Cuba, Chile and Cost Rica has reduced poverty to less than 10% of the
population.
27
References:
I. McKeown T - The role of Medicine - Dream, Mirage, Lodon Nyffield
Provincial Hospital Trust 1976.
2. New challenges for Public Health - Report of an inter-regional meeting,
Geneva, 27-30 November 1995 (Page 7 & 8) from World Health Report 1995.
3. Ottawa Charter for Health Promotion.
4. Opening address of 5th Global Conference on Health Promotion - Mexico
2000. Promotion and Education Quarterly, 2000, Vol. VIII/3, Page - 15.
5. UNICEF State of World Children - 2000.
6. Society of Public Health Education (1966) Health Education Monographs No.
21, New York.
7. W.H.O. (1954) Tech. Rep. Ser. No. 89.
8. Extract from meeting Global Challenges - published IUHPE Board Meeting Souvenir - April 200 Page 23.
9. Development of Competency - based on University Health Promotion courses
by P. Howat, et al - Journal of Promotion and Education Vol. VII/1, 2000
Pages 34 - 35.
10. A Practical Frame work for setting priorities in Health Research.
1 1. Human Development - South Asia’s Educational Renaisance - UNESCO.
12. Health Promotion in Action - Voluntary Health Association of India.
13. Health Promotion - Dr. H. Nakajima, Director - General (Retd) W.H.O.
14. Malnutrition
Rhode.
A South Asia Enigma
Dr. Ramalingaswamy & Jonson & J.
15. A call for action - promotion Health in Developing countries - W.H.O.
28
SECTION-III
Health Education Bureau
1. Introduction and objectives
2. Structure of Section I
3. Structure of Section II
4. Functions of Section I
5. Functions of Section II
6. Recommendations
I. HEALTH EDUCATION BUREAU
1. Introduction and objectives
The State Health Education Bureau (SHEB) was started in the Directorates of
Health and Family Welfare Services in the year 1930. The Bureau was reorganised
in 1965 with the assistance of Government of India, W.H.O. and UNICEF.
Stewarts like Dr. V. Ramakrishna and others played a significant role in bringing
about the establishment of the SHEB in the Department of Public Health in the
Mysore State. It was nurtured and enriched by many eminent Directors of Public
Health of Mysore State and latter Karnataka State ever since. World Health
Organization, Rocke-feller Foundation and other International Health
Organisations also helped the growth of the State Health Education Bureau.
The Bureau developed a sound health education policy for the state and exerted its
influence in improving the health status THROUGH HEALTH EDUCATION.
The Bureau laid down long term and short term objectives, structure and functions
needed to reach those objectives.
A. Long term objectives
a. To help people to achieve health by their own actions and efforts.
b. To obtain people’s active support and participation for public health
programmes and policies.
c.
Io assist people to shoulder the responsibility for health.
d. To encourage people to demand more and better health services.
29
B. Short term objectives
a. To collect baseline data of the prevailing health conditions, health attitude,
beliefs and values etc.
b. To educate the people on health matters by various methods and evaluate
the relative effectiveness of the methods and channels of communication.
c. To provide in-service training in health education for all categories of
health staff.
d. To produce health education materials and reproduce them wherever
needed.
To reach the above objectives, the Bureau laid down the following activities.
1. Planning, organising and directing State-wide health education activities.
2. Conducting studies regarding baseline data, health educational needs,
resources, priorities etc.
3. Determine the appropriate channels of communication and develop
effective methods and materials for their use.
4. Training of the personnel of health and family Welfare Department on
health education methods.
5. Assisting, organising and conducting of seminars conferences, family group
teaching etc.
6. Fostering cordial intra and inter-departmental coordination and building
group relationship with non-governmental organizations.
7. Dissemination of scientific information for people, through various
channels of communication.
30
II.
STRUCTURE AND FUNCTIONS
A. STRUCTURE OF THE HEALTH BUREAU - I
The State Health Education Bureau consists of two Divisions. First Division is
headed by the Project Director. Reproductive and Child Health Services and
Second Division is headed by the Additional Director, Health Education and
Training. Functionally also the first Division is concentrating on health and family
welfare and the second Division is concentrating on School Health, Training
Nutrition etc.
Sanctioned
Working
Joint Director
I
1
2.
Deputy Director
2
1
3.
Field Publicity Officer
1
4.
Editor
1
5.
Assistant Editors
2
6.
Health Education Officer
1
7.
Health Educator
1
8.
Social Scientist
1
SI. No.
Categories
At State Level
1
1
At the District Level
1.
District Primary Health Centre Level
31
7
2.
Dy. Dist. Health Education Officers
104
78
782
517
At the Primary Health Centre Level
1.
Block Health Educators
Health Educators with Diploma in Health Education (DHE)
No. with DHE
No. without DHE
Total
State Level
10
District Level
130
5
135
Pry. Health Centre
51
466
517
Teaching StafT
26
Total
217
10
26
471
688
31
Comments
The strength of the staff and their qualifications at the State Level is adequate, but
the vacant posts should be filled up.
At the district level 104. posts have been sanctioned for 27 districts at the rate of
more than 3 per district. Whereas, only 782 posts of Block level Health Educators
have been sanctioned for 1685 Primary Health Centres. At the rate of one Block
Level Health Educator per primary Health Centre, still 903 posts are to be created.
This is very difficult to achieve in the near future, because, it involves heavy
expenditure and no trained and qualified Health Educators are available for
recruitment.
Besides taluka level health officer posts which are sanctioned recently to
strengthen the administration and management of health programmes in rural
areas. This is a good development and this taluk level health office should be
strengthened with posts of Health educators. Therefore, there is need to reorganise
the distribution of available Block Level Health Educators between talukas and
PHCs.
32
STRUCTURE OF THE HEALTH EDUCATION BUREAU - II
This action of State Health Education Bureau consists of the following staff.
Category’
SI No.
Sanctioned
Working
1.
Additional Director
1
I
2.
Joint Director
I
(vacant)
3?
Training Unit
1. Training Officer
1
1
2. Health Supervisor
I
I
1. Deputy Director
1
I
2. Assistant Director
3. Dist. Nursing Officer
1
1
1
v
4.
5.
Student Health Education Unit
V
Audio-Visual Unit
Technical Officer
2. Artist cum-photographer
3. Artist
4. Sub-Editor
1
v
1
1
v
5. Projectionist
I
Craftsman
1
Silk-Screen Technician
1
1.
6
7.
6.
1
V
V
Field Study & Demonstration Unit
1
1. Technical Officer
V
1
V
1
1
4. Home Science Assistant
1
1
5. Social Scientist
6. Teacher
1
1
1
1
1
v
2. Health Supervisor
3. Public Health Nurse
7.
1
Exhibition Unit
1. Technical Officer
33
FUNCTIONS
A. INTRODUCTION
The main function of the Division 1 of Health Education Bureau is to plan,
implement and monitor health education activities pertaining to family welfare in
rural areas of the State. These activities are implemented and monitored through
the District Health and Family Welfare Officer at the District level and Medical
Officers of Health at the Primary Health Centre level under the over all
supervision and control of respective Zilla Panchayats. The bulk of the work is
carried out by the grass root level workers and Health Supervisors. Block level
local non-government organisations and public people. He also guides Health
Workers and Supervisors and monitors the health education activities.
At the district level, the District Health Education Officer prepares a district plan
of IEC activities. He supervises and monitors all health education activities
throughout the district. He under takes tours and meet and discuss the health
education issues with other developmental sectors of the government and local
non-government organizations. He is also resource person for local NonGovemment Organisations for health education activities.
B. OBJECTIVES, STRATEGIES AND METHODS USED FOR THE 1EC
ACTIVITIES.
a. Objectives:
1. Promotion of higher age at marriage.
2. Promotion of spacing methods.
3. Promotion of terminal methods for those who are having more than two
children.
4. Involving people in IEC activities.
5. Motivating people to demand Reproductive and child health services.
6. Encouraging people’s participation.
7. Discouraging gender discrimination with respect to conception and child
care.
8. Encouraging 100% ante-natal registration and care.
9. Motivating and encouraging parents to care for infants and under 5 children
especially in the matter of nutrition and immunization.
34
b. Strategies used for IEC activities
Most of the IEC activities are 100% centrally funded and sponsored. They are
planned at the State level as per guidelines given by the Government of India and
given to the districts for implementation, monitoring and reporting. The number of
activities and methods to be used are fixed depending upon the total grants
received. At the district level, the number of IEC activities are divided among
several Primary Health Centres in the district and given to the Medical Officers of
Health for implementation.
c. Method used
All the standard methods of health education are used. They are:
a. Mass media. Door Darshan, Radio, Press, Video Films.
b. Folk media - Dramas and street plays.
c. Exhibition.
d. Personal communication by grass root level workers.
e. Group discussions:
1. Mother Swasthya Sangha (MSS)
2. Atte Sose Samvada
3. Village Health Committee
4. Village Panchayat
5. Local S.H.G. and youth and Yuvathi Mandals
35
TABLE - 2
Number of IEC activities by conducted in the last 3 years
Targeted & achievement during the last 3 years
1997, 1998 & 1999
SI No.
Target
IEC activity
Achievement
% of achievement
1.
Film Shows
14400
6198
43
2.
Film Strips
40500
40204
99
3.
TV & VCB
4050
2500
99
4.
Folk media programme
2700
2500
90
5.
Multi-media campign
-Nil-
169
6.
Press advertisements
-Nil-
<>79
7.
Press release
-Nil-
4273
8.
Exhibition - major
14400
5390
9.
Dramas
10.
Healthy Baby shows
10735
9222
86
11.
Mahila Vichara Vinimaya
12615
9770
77
12.
Mother-in-law and
Daughter-in-law program
8545
6921
81
13.
Mahila Dinacharini
6320
5073
80
14.
MSS Workshops. Taluka
175
160
90
9
9
100
37.3
32
District
15.
Folk Artist Workshop
(1997)
19
8
16.
Village level MSS Trng
programme (1997)
3215
2920
C. BUDGET MADE AVAILABLE FOR IEC ACTIVITIES
SI No.
Year
Budget
1.
1997- 98
2.
1998- 99
75.01 lakhs
90.86 lakhs
3.
1990-200
61.48 lakhs
90
36
D. REMARKS OF THE DIRECTOR, R.C.H.
Though IEC is the base for creating demand generation for Family Welfare and
Maternity and Child Health Services, the inadequacy of funds has become a major
barrier in the implementation of IEC strategy. On an average, Rs. 70 lakhs are
being spent on IEC per year under FW & MCH for a population of more than 5
crores in the State. This is a very meagre amount. However, there are various
thrust areas under FW & MCH which are not effectively covered.
With the introduction of Panchayathraj System in Karnataka, implementation of
IEC at district level has become very difficult. It is observed that a major portion
of amount eannarked for district levels activities remains unspent as the amount is
either released very late or not released to District Health and Family Welfare
Officer by Zilla Panchayats.
Many posts of health education personnel are remaining vacant at ail levels. Many
Primary Health Centres do not have sanctioned post of Block Health Educators
and even sanctioned, posts are not filled. 255 posts are vacant for 782 sanctioned
posts of Block Health Educators. With all these constraints, IEC activities have
played a vital role in popularising FW & MCH programme in Karnataka.
Inference on the data presented above and on the remarks of the Director.
IEC activities are planned depending upon the budget made available for health
education by the Central and State Governments. The budget allotted is too small
compared to the need. With so many eligible couple living in 27066 villages
spread over 1.92 lakh square kilometers it is impossible to reach them and create
awareness and motivate them. In fact, the progress made under RCH care
especially in promoting spacing methods is very low and so also increasing the
age at marriage. Percentage achieved under film show and exhibition is only 43%
and 37% respectively. This is not encouraging.
The progress achieved so far in brining down birth rate and increasing the couple
protection rate (58.6%) cannot be attributed solely for these IEC activities. Most of
the awareness about family limitation may be cumulative effect of all the formal
and informal health education activities and public opinion and social pressure that
were going on in the State over the years. The people in the State seems to have
realised that small family norm is best for their well-being and women in
particular are coming forward for permanent method even with one girl child.
However, the present progress in couple protection rate is entirely due to
permanent method, that too female sterilization. Therefore, efforts should be made
to remove the unmet needs of nearly 11.5% of eligible couples and popularise and
I
37
motivate people to accept spacing methods to improve their health as well as
reducing the infant and under 5 years childrens morbidity and mortality. This will
also help to being down maternal mortality and morbidity. The male participation
is also important in the community. Another crucial and important health
promotional measure is increasing the age at marriage of girls. This is important in
the long run. Both these measures are necessary to bring about sustainable
behaviour of people for small family nonn.
Further, progress in RCH is possible only by health promotional strategies of
advocacy, social support and empowennent. Therefore, the State Health Education
Bureau should gear up to the task in coming years,
Functions of H.E.B. II
The functioning of this section of Health Education Bureau is very important to
reach the long tenn goals set by the Bureau. However, the functioning of this
section is not very satisfactory. This Section consists of 5 State level units with
technical and non-technical staff. These units are (1) Audio-visual Unit (2) Field
Study and Demonstration Unit (3) School Health Unit (4) Exhibition unit and (5)
Training Unit. Some units are not working because of posts sanctioned are vacant
for a long time and sufficient grants are not made available for effective
functioning. Each of these have a definite function to perform.
For example (1) The Audio-visual unit is concerned with (a) training different
categories of health personnel in audio-visual education and preparation of A.V.
aids (b) Designing, production and procurement of A.V. aids and other educational
materials of use in the field (c) assisting in the evaluation of A.V. aids produced in
the Bureau. This section is not functioning because most of the key posts are
vacant for a long time.
(2) Functions of Field Study and Demonstration units are (a) To find out most
suitable, and cost-effective methods and media of health education (b) planning,
organising and implementing and demonstrating research- cum-action programmes
(c) investigation of various health education issues that may arise from time to
time and assist in solving them. Thus this unit is very essential for supporting
health education activities. This unit also is not functioning because of the absence
of the key staff for a very long time. The existing staff do carry out some in the
field demonstration unit, but it is negligible and not based on scientifically planned
studies.
Therefore, the staff for both these units should be found as early as possible and
these units should be energized. Both these units are very important to plan and
bring out scientifically based evidence for health promotional activities and
38
materials they produce and use and also to bring out relative cost effectiveness of
several media they use.
(3)Exhibition unit which is very7 important for planning health exhibitions for the State. It
is not functioning properly because of the absence of the key staff over a long time.
(4) Student School Health Education Unit and Training Units are however
functioning. Their performance is given below.
SCHOOL HEALTH EDUCATION PROGRAMME
School health programme is a State plan scheme and started in the 3rd 5 year plan
period. The objectives and goals were laid down as per recommendations of Suit.
Renuka Ray Committee Report in 1965. The school health programme first
covered 30 primary Health Centres in 1965 and extended gradually to cover 35
Primary Health Centres in 1969, 103 Primary Health Centres in 1973, additional
300 Primary Health Centres in 1980, 90 Primary Health Centres in 1985, 100
Primary Health Centres in 1985, 122 Primary Health Cnetres in 1987, 465 Primary
Health Centres in 1998 and thus by 1989, 1245 Primary Health Centres, out of the
present 1686.
Goals and objectives.
Goals:
To enhance and Promote health education of school children in
every possible manner to enable them to adopt measures to achieve
and remain healthy and develop in them a self reliance and social
responsibility and better quality of life not only as children of today,
but also as adults of tomorrow.
Objectives
1. Promotion of positive health.
2. Prevention of diseases.
3. Early diagnosis, treatment and follow up of defects.
4. Awakening health consciousness in children.
5. Provision of healthful school environment.
39
Activities
To reach the above goals and objectives, the following activities were planned to
be implemented.
1. Health appraisal of school children.
2. Remedial resources and following up.
3. Prevention of communicable diseases including vaccine preventable
diseases.
4. Healthful school environment.
5. Nutritional services.
6. Mental Health and Dental Health and Eye Health.
7. Health Education.
8. Health Education of the handicapped Children.
9. Teachers training.
10. Proper maintenance and use of school health record.
Organisation for implementing the school health scheme
School health service is one of the basic responsibility of State Health services and
it is incorporated in the functioning of primary health Centre throughout the State.
Therefore, the entire State health organization from sub-centre at the grass root
level to the head of the Health Education Section at the State level are responsible
for implementing the scheme. The primary health centre staff plan and implement
the school health programme in their areas, district health supervisery staff
(District Nursing superviser) and give guidance and monitors the progress.
The District Health and Family Welfare Officer reports to the head of the Health
Education and Training section of the State Health Education Bureau at the State
level. The District Health Education Officer plans and implements the health
education activity through the Block Level Health Educator. The Medical Officer
of Health of the Primary Health Centre is responsible for medical examination and
follow up of the health of the school children with the help and assistance of
I Icalth Workers under his/her control.
40
Performance.
Activities
Extent of Coverage
1.
Health appraisal
Only medical examination is carried out.
2.
Remedial measures and follow Done very superficially
up
3.
Prevention of communicable Only immunization services given to 1,4,
standard
children.
No
other
including
vaccine 7th
diseases
communicable diseases is detected or
preventable diseases
treated.
4.
Nutritional services
No programme.
5.
Health Education
Not carried out systematically
6.
Teacher training
Carried out, but not sufficient.
7.
Maintenance of school health Not done systematically
record
8.
School
environment,
supply and sanitation
water Nothing is done
As shown above, the performance is patchy and all activities are not carried out
except the medical examination and immunisation of 1, 4 7th standard children
Teachers training is also not sufficient and the progress is not satisfactory. No
attempt is made to take up any activity under school environment and sanitation in
schools. The follow up service is very unsatisfactory. Only activity that is canied
out under the school health service is medical examination and teachers training
which is given below
41
TABLE - 3
Showing performance is some activities of school health service during
1999-2000
Activities
1.
2.
Medical examination of school
children
Percentage of target achieved
1999, 2000
80%
Immunisation
> 1st standard
83%
> 7th standard
100%
> 10th standard
73.54%
3.
Teachers training
69.55%
4.
Medical defective found
17.63%
As per the records furnished by the Health Education and Training (HET) of the
State Health Education Bureau, only school medical examination, teachers
training and immunization services are monitored at the State level. The
perfonnance of each district is scrutinised and progress noted. The district which
lag behind are noted and remarks sent to the respective District Health and Family
Welfare Officers. Though the physical targets achieved are above 80%, the quality
of service appears to be very poor. During out visit to about 8 Primary Health
Centres in 4 districts, we had a chance to look into the school health records and to
discuss die matter with school head masters. Medical examination is done mostly
by Health Assistants and not by the Medical Officers except in Kodagu District.
There is no follow up services. The quality of training of teachers is not
satisfactory according to most of the teachers. Teachers also feel that it is an
additional job and many of them are burdened with other school regular curricular
activities. Health education in schools is not carried out regularly and it is very
unsatisfactory.
Recom mendations
School health service is one of the most important health promotional activity.
Though it is a regular activity of the Health Department and Medical Officer of
Health of Primary Health Centre is responsible for a least medical examination of
school children, it is not done properly.
42
Medical Officers of Health should be activated to take up school medical
examinations seriously and the perfonnance monitored by the District Health and
Family Welfare Officers and the MOHs who are lagging behind should be
reprimanded.
Health Education activity should be planned and every school in the Primary
Health Centre area should be covered. The Health Supervisers at the PHC level
must be made responsible and the District Nursing Superviser and the District
Health Education Officers should monitor the programme and report to the
District Health and Family Welfare Officers.
There is no attempt to improve school environment Water supply and toilet
facilities should be provided to every school. This should be taken up as a priority.
This involves substantial investment and efforts should be made to raise donations
in the villages by giving equal contribution from the Government. This may be
taken up a phased manner.
Teacher training should be intensified and quality of training improved. There
should be at least one trained teacher in every school in the State by the end of
2002.
The furniture, flooring in most of the schools is very poor and should be improved.
Though this programme a combined responsibility of Health and Education
Departments, the Education Deptt., is not evincing sufficient interest in the
programme. District Health and Family Welfare Officers must start advocacy
programme for District Education Officers and Zilla Panchayat President and the
District Executive Officer. The Additional Director of Health and Family Welfare
Services should meet his counter part at the State level and bring pressure on the
District Education Officers. The District School Health Councils and State Health
Councils should meet periodically and hold discussion on the perfonnance of
school health activities.
The government and Zilla Panchayats should be persuaded to invest in providing
toilet facilities in all schools in the State.
The vacant posts in Field Study and Demonstration Unit, Audio-Visual Unit,
Exhibition Unit should be filled up urgently and these units should be made
functional and energised.
Question of brining all IEC activities under the Health Education Bureau should
be closely examined because the health education work in there programmes
should not suffer when it is most needed. The programme directors know when
43
they should launch health education campaign and where. It is his responsibility to
achieve completion of the control programme. (Disease/Epidemic)
The routine health education programme covering all the areas of public health
should be the responsibility of State Health Education Bureau and special health
education campaign should be left to the respective programme Directors.
Recommendations on repositioning of Health Educators.
Ideally every PHC should have one Health Educator. Due to financial stringency
this may not be possible for the next few years. There fore one Health Educator
may be attached two PHC and stationed at taluka Health Office under the
supervision guidnes and control of taluka Health Officer
All the BLHEs should be deputed to acquire DHE qualification at the rate of at
least 50 every year.
At the District level one District Health Education Officer and one Deputy District
Health Education Officer may be retained.
At the Taluka level there is need for one senior Health Educator to coordinate the
work of PHC level Health Educators. This will strengthen the taluka level health
organization and enables them to plan and carry out effectively IEC activities
The Health Task Force may suggest to the Govt, to allocate at least 5 to 10% of
the health budget for health education purposes as approved by Central Health
Council.
44
SECTION -IV
1. Grass Root Level Workers
2. Health supervisors
3. Health Educators
4. Interaction with other Health Related Departments
5. Interaction with Non-Govemment Organisations
6. Interaction with people
1. GRASS ROOT LEVEL WORKERS
Total of 50 workers from 4 Districts posted to 16 Primary Health Centers were
interviewed and they were questioned about their knowledge and practice of
health education and observed their attitude towards the subject of health
education.
Competency
Most of them are aware of their responsibility (80%) and felt that health education
is one of their most important and frequently undertaken job. most of them (85%)
showed strong positive attitude towards the job. in fact many expressed, they are
able to do their job because of their health knowledge and their ability to talk to
them and convince them about the health benefits of their action. About 75% of
them know various methods of health education and social mobilization
techniques. However, they are not making any efforts to get the cooperation of the
Village Health Committee and local people. The people’s participation in
conducting health programme at the grass root level is not much appreciated by
the field workers and their efforts to involve them is almost absent. Participation
by members of the Mother Swasthya Sangha (MSS) is however appreciated by all
the workers. Most of the m are expressed they must have frequent meeting
involving mother-in-laws and daughter-in-laws and other elders, where they can
discuss common health problems and remove some doubts and misunderstanding,
superstition about child birth and child care.
Interaction with other Sectors
Grass root level workers get the maximum cooperation and help from the
Community Development Departments through Anganwadi workers. Inter
sectoral cooperation from other sectors is not appreciable except Revenue
Department from whom they get pregnancy allowance sanctioned to their clients.
45
Table-4
Grass root level workers, their level of knowledge and attitude on
various aspects of Health Promotion and Education Interviewed
SI
No.
1.
Percentage
Awareness of
responsibility
High
Moderate
Low
Total
Number
Responded
80
16
4
50
job
2.
Knowledge
80
12
4
50
3.
Attitude
75
14
6
50
4.
Need
capacity
76
14
10
50
80
12
8
50
60
30
10
50
70
10
20
50
80
16
4
50
20
40
40
50
10
30
60
50
10
20
70
50
5.
6.
7.
8.
9.
assessment
about
Knowledge
Education
health
method
Social
tactics
mobilisation
Knowledge about the
State of people and
N.G.O participation
Need for Inter-sectoral
Coordination
Methods to be used in
Health promotion
Advocacy
Social support
Empowerment
46
Inference and recommendations
The knowledge, attitude and practice of grass root level workers with regard to
health education as one of their prime duties and its importance in implementing
any health programme is satisfactory. However, they are not in a position to
appreciate and involve the local people in their planning or implementing health
programme in the villages. Though they understands the need and advantage of
involving local leaders in conducting health programmes, they do not have the
skill to do so. Therefore, there is a great need for training the grass root level
workers in development of skill as to how to involve the local people in the health
programme. People participation in health activities in health activities under the
primary health care strategy is one of the main function of the Primary Health
Centre as recommended by the Alma Ata Declaration. It has also been realized
throughout the world both in developed and developing countries that people’s
participation is sine qua non for the success of any health programme, and it
(people’s participation) should assumes greater significance in health promotion
strategy.
Mother Swasthya Sangha (M.S.S) activities were appreciated by all. This
progrmme should be strengthened and frequently arranged, but such programmes
will have to be monitored and supervised by the Health supervisors. These
meetings and contacts are conducted only once in a way or whenever the money
for it is released. This should not be the case. The programme should be a routine
duty of health workers. Health Workers male and female in every sub-centre
should plan their contact meeting per month in every village.
IEC activities in each village should be planned and conducted by making use of
local school children, teachers, retired people and other public spirited social
workers. Both male and female people should be encouraged to participate.
Organised community activities have better impact in creating awareness.
2. Health Supervisers
A total of 28 health superviser staff from 4 districts were interviewed. As shown in
table 5 all of them are aware of their over all responsibilities and they know that
health education is one of their duties. Conversation with them revealed that they
have good knowledge about supervision and guidance. They undertake frequent
tours of their area and help the grass root, health workers is difficult cases of
refusals of advice and resistant cases towards family limitation. Their knowledge
of supervision and guidance is only with reference to normal, routine personal
health education to the individuals. However, they also participate in group
education like M.S.S activities and jathas and video shows and baby shows. In
47
many places. Health Supervisors are resource personal for local NGO for their
education campaign. However they need training in health promotion strategies.
Problems of Health Supervisors
Many of them are quite senior people with 15 to 20 years of service. They do not
have promotional opportunities, because only few of them get a district
Supervisory position. This aspect has led them to feel frustrated and have become
less enthusiastic in their job. This should be halted by appropriate remedy. Most of
the health work at the grass root level is carried out by the grass root level workers
and their supervisors. The department is illoffered to neglect their services,
especially in the field of health education. In fact, in many PHCs, it is the senior
health supeivisor who manages the PHC activities because the Medical Officer of
Health is either absent or attends only to clinical work.
48
TABLE - 5
Health Supervisors, their level of knowledge ,attitude on various aspects
of health promotion.
SI
Percentage
High
Moderate
Low
Total
Number
Responded
80
15
5
28
No.
1.
Awareness
responsibility
of
job
2.
Knowledge
70
20
2
28
3.
Attitude
80
16
4
28
4.
Knowledge and ability in
need assessment
80
10
10
28
78
12
10
28
75
15
10
28
80
18
2
28
65
15
20
28
20
60
20
28
18
70
12
28
15
60
25
28
5.
Ability to supervise and
guide
6.
Social mobilisation capacity
7.
Knowledge about the need
and
role
of peoples
participation
8.
Inter-sectoral Coordination
9.
Knowledge on
Health
promotional strategies
Advocacy
Social support
Empowennent
49
Inference
Though Health Supervisors are important at PHCs level, for health education
programmes , there seem to be complacency in their attitude and practice. This
may be due to the (1) presence of Block Level Health Educator, who is
responsible for implementing the organized health education or IEC activities at
the PHC level and (2) also the Medical Officers of Health are not taking any
interest in administrative affairs of the PHC and leave everything to the Health
Supervisors. Health Education as an activity at PHC level is suffering from these
two constraints. Both these Constraints must be attended to by Medical Officers.
They must be made to take more interest in administration and management of
health programmes including health education at the PHC level.
There is need for proper supervision and monitoring of PHC performance from the
District Health Officers
Recommendations
The Health Supervisors must be made responsible for all health education
activities at the PHC level. The administration should activate these people more
particularly the Medical Officer of health must be made to take interest in
administration and management. This is possible by frequents visit of the District
Health and Family Welfare Officers to the PHCs and arranging seminars and
symposium at District level for all Medical Officers of health.
Block level Health Educators, District Health Education Officers and Deputy
District Health Education Officers
14 Block level Health Educators working at the Primary Health Centres, 4 districts
Health Education Officers and 4 Deputy District Health Education Officers
working at District level were interviewed and participated in focus group
discussions.
Competency
Health Educator is a facilitator for Health Promotion at grass root level. He has to
plan and organize Health promotion programmes and implement them through the
grass root level workers.
As shown in table 6 most of them aware of their job responsibilities and know the
job well. They have the right kind of attitude and appeared enthusiastic in their
50
job. They have sufficient skill to develop education programmes. However, they
are not making use of their skill in social mobilisation work and involving people
in health education activities. For Example, 90% of them have sufficient
knowledge about the need for inter-sectoral co-ordination and N.G.O involvement,
but only 30% of them are making efforts. When asked why it was so, many of
them expressed that they are neglected lot. There contribution is not recognized by
superior officers. Only 50% of them have right kind of communication skill and
40% of them are capable of talking to people on any subject. Their knowledge
about advocacy is satisfactory, but their ability to practice is doubtful. They do not
have sufficient knowledge about social support and empowerment. Except 5
District Health Education Officers, all others need intensive training in the
principles and strategies of health promotion.
Recommendations
Long Term
The Health Educator at the taluk and primary Health Centre Level and the district
Health Education Officers and the Deputy District Health Education Officers at
the District level are the key persons for planning and implementing IEC
activities. They should have sufficient knowledge about the community and
community leaders and should be enthusiastic and committed for the task of
spreading scientific knowledge to people and involve them in health programme.
In fact part of the reason for tardy progress of health programmes is attributable to
non-involvement and half hearted participation of people. This is the case in all
health programmes. It may be improper Malaria Education, poor Tuberculosis
control low couple protection rate etc. Therefore, training and retraining of the
health educators in social mobilisation methods and in various modem
communication technology is urgently required. Most of them take their job very
casually and do things very slowly. This may be due to lack of administrative
pressure from districts, which may be strengthen.
Short term
Immediately, there is a great need to arrange training programme for all health
Educators on health Promotion. A programme of reorientation for District Health
Education Officers and Deputy District health Education Officers and those
possessing DHE qualification may be organized at the state level in two or three
batches. The course may be of one week duration.
For those BLHEs without DHE qualification, a two week training programme may
be organized at the Divisional level so that all the Health Educators are trained and
51
equipped with skills to plan and implement 1EC activities under health promotion
strategies as recommended by the Ottawa Conference on Health promotion. More
specifically
they
need
training
in
group
dynamics,
motivation,
communication, interpersonal relationship, intersectoral coordination and
social mobilization. They should also be trained in modern electronic media
and utilization of computers.
Hp\“- io
U iy J
52
TABLE - 6
Block Level Health Educators. District Health Education Officers and the
Deputy District Health Education Officers their level of knowledge and
attitude and ability
Percentages
SI.
No.
High
Medium
Low
1.
Awareness of job responsibility
80
15
5
2.
Knowledge
90
7
3
3.
Attitude
95
4
1
4.
skill of collecting and analyzing health need
assessment
65
20
15
5.
Knowledge of health education methods
80
10
10
6.
Social mobilisation tactics
70
20
10
7.
Knowledge about the local leaders ,
religious groups and need to involve them
in health education activities
60
25
15
90
5
5
30
30
40
50
25
40
40
40
20
40
40
20
Knowledge about advocacy
40
45
15
Practice of advocacy
20
20
60
Knowledge about social support practice of
social support
60
30
10
20
30
50
Knowledge about empowerment practice of
empowerment measures
40
30
30
20
40
40
8.
Need for inter-sectoral co-operation and
NGO involvement
Knowledge
Practice
9.
Communication ability
10.
Ability to write, press release and talk to lay
people
11.
12.
13.
14.
Knowledge
activities
about
health
promotional
53
MEDICAL OFFICERS OF HEALTH
Twelve Medical officers of Health from 4 Districts participated in the
discussions. Opinion and their response to various issues is given below. Many
of them know the importance of health education and the need for extensive
health education efforts. They also know that health education is one of their
duties, but they did not show any enthusiasm and interest in health education
activities. Those who do not have much clinical practice do well in all health
programme including health education and those having good clinical work say
that they do not have enough time to do so much of non clinical work
including health education, in fact, medical officers who have good clinical
practice take help of health workers to assist him. Doing clinical work is good
for the people, because many patient need not go for distant places for primary
medical care. Therefore, the clinical practice should not be disturbed, the
principle of integrating clinical practice with non clinical work like
administrating and management of health programme has been a failure.
Now Taluk Health
Offices have been established and Taluka Health
Officers must be made Administrator of Health service in the Taluk and
all the Health Workers including Medical Officers of PHCs should come
under his administrative control.
54
THE MEDICAL OFFICERS WERE QUESTIONED AND THEIR
OPINION WAS COLLECTED. THE RESULTS OF THE ANALYSIS
IS AS FOLLOWS
SI No.
REMARKS
AREAS EXAMINED
ALL AGREED VERY STRONGLY.
1.
THE NEED FOR HEALTH PROMOTION.
2.
METHODS
OF
PLANNING
PROMOTIONAL ACTIVITIES
3.
IMPORTANCE OF SOCIAL MOBILISATION
MANY DO NOT HAVE ANY IDEA
OF
SOCIAL
MOBILISATION
STRATEGY
4.
NEED FOR INVOLVING PEOPLE IN HEALTH
PROGRAMMES
50% AGREED. BUT ANOTHER
50% SAID PEOPLE DO NOT
COOPERATE.
5.
NEED FOR FURTHER TRAINING OF HEALTH
STAFF
ALL AGREED THAT HEALTH
WORKERS SHOULD BE TRAINED
AND NOT THEMSELVES.
6.
QUALIFICATION
EDUCATORS
7
ADDITIONAL
TRAINING
OFFICERS OF HEALTH
HEALTH
ALL AGREED. BUT THEY DO
NOT WANT TO TAKE PART. IN
PLANNING PROGRAMMES
THEY
DHE
HEALTH
ALL
AGREED THAT
SHOULD
HAVE
QUALIFICATION
MEDICAL
MAY BE USE FULL ONCE IN 3
YEARS FOR UPDATING THE
RECENT ADVANCES
8.
NEED FOR ORIENTATION OF SYLLABUS OF
COMMUNITY MEDICINE IN MBBS COURSE
ALL AGREED THAT THEY MUST
BE EXPOSED MORE AND MORE
TO THE COMMUNITY. AND ALL
NATIONAL
HEALTH
PROGRAMMES
SHOULD
BE
DEMONSTRATED TO THEM IN
MORE DETAIL.
9.
NEED FOR CHANGE IN THE ATTITUDE OF
POLICY-MAKERS TOWARDS PUBLIC HEALTH
THEY AGREED THAT PUBLIC
HEALTH
WORK
IS
NOT
APPRECIATED
BY
MANY
DOCTORS IT IS RARELY THAT
GOOD
HEALTH
WORKER
(DOCTOR)
IS
APPRECIATED.
WHERE AS GOOD CLINICIAN IS
APPRECIATED
BY
ADMINISTRATORS
AND
POLITICAL LEADERS. ALIKE
REQUIRED
FOR
FOR
55
OPINIONS OF PUBLIC HEALTH EXPERTS ON SOME ISSUES OF
HEALTH PROMOTION
Health promotion is a part and parcel of public health. In fact the goal of public
health is to create the environment conducive, and mould the behaviour of all
people favorable to positive health. Health promotion comes even before the
primary level of prevention. It is also called primordial prevention. Therefore
Health promotion is not something different from the main stream of public Health
philosophy and public health Actions
Opinion of public Health experts was sought about some aspect of health
promotion. 98 people were approached in and out of the state and 48 people
responded. Their opinion is given below. Opinion expressed by experts is
overwhelmingly in favour of application of principles of Health Promotion in the
Public Health Action Programmes. Most of them also express that public health in
recent years in being neglected by policy makers and due status is not given to the
Public Health & Public Health experts.
This will have to be over come by appropriate advocacy programme for top-level
policy makers.
56
OPINION OF PUBLIC HEALTH EXPERTS
AGREED OR NOT (PERCENTAGE)
SL
STRONGLY AGREED DISAGREED
No.
STATEMENTS RELATED TO
1.
THE NEED FOR HEALTH
STRATEGIES
PROMOTIONAL
AND THE RATIONALE AND
OF
POSSIBILITIES
IN
IMPLEMENTING
DEVELOPING COUNTRIES
20
80
-NIL-
2.
METHODS OF PLANNING AND
IMPLEMENTATION
10
90
-NIL-
3.
IMPORTANCE
MOBILIZATION
5
90
5
4.
NEED FOR INVOLVING PEOPLE
IN
HEALTH
PROMOTION
PROGRAMME
3
90
7
NEED FOR TRAINING FOR
MEDICAL
OFFICERS
OF
HEALTH, & DISTRICT HEALTH
WELFARE
AND
FAMILY
HEALTH
OFFICERS
ON
PROMOTION
10
90
-NIL-
DESIRABILITY
OF
DHE
QUALIFICATION FOR HEALTH
EDUCATOR
AND
DPH
QUALIFICATION FOR HEALTH
&FAMILY WELFARE OFFICERS
5
90
5
NEED FOR STRENGTHENING
SYLLABUS IN COMMUNITY
MEDICINE FOR MBBS AND
DPH
3
90
7
NEED FOR CHANGE IN THE
ATTITUDE
OF
POLICY
MAKERS,
POLITICIANS
TOWARDS PUBLIC HEALTH
3
95
2
5.
6.
7.
8.
OF
SOCIAL
57
OPIMON ON SOME OF THE IMPORTANT STATEMENTS ON
PUBLIC HEALTH POLICY
si
No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
STATEMENTS
THE CONCEPT. PRACTICE AND IMPORTANCE GIVEN FOR
PUBLIC HEALTH BY HIGHEST DECISION MAKING PEOPLE
ARE FOR IMPLEMENTATION OF HEALTH PROMOTIONAL
STRATEGIES.
PERCENTAGES
DISAGREED
AGREED
100%
-NIL-
ONE OF THE MAJOR BARRIERS FOR IMPLEMENTING OF
THE HEALTH PROMOTIONAL STRATEGIES IS THE LACK OF
PROPERLY TRAINED PUBLIC HEALTH EXPERTS AT THE
HIGHEST DECISION MAKING LEVEL AND AT THE MIDDLE
PLANNING AND IMPLEMENTING LEVEL
98%
2%
PUBLIC HEALTH RESERCH IS NOT MAKING TOE
NECESSARY CONTRIBUTION TO PUBLIC POLICY. BECAUSE
OF ITS TENDANCY TO WANT TO BE SEEN AS EXCELLENT
RATHER THAN ANY RELEVANCE TO THE NEEDS OF
PUBLIC POLICY
70%
30%
MOST PUBLIC HEALTH PROFESSIONAL AND CLINICAL
PROFESSIONALS WORKING IN PUBLIC HEALTH POSITIONS
IN THE COUNTRYHAVE LITTLE TRAINING IN WIDER
ASPECTS OF HEALTH. THEIR EXPOSURE TO RELEVANT
SOCIAL SCIENCES AND HAVE HAD LITTLE OPPORTUNITY
TO LEARN FROM ROLE MODEL HOW TO ADDRESS THE
SOCIAL, ECONOMIC AND POLITICAL FORCES AFFECTING
HEALTH
60%
40%
POLICY MAKERS IN PUBLIC HEALTH AND HEALTH
PROFESSIONAL SHOULD MEET REGULARLY TO REVIEW
THE HEALTH PROBLEMS AND RESERCH EVIDENCE
AVAILABLE FOR THEIR DECISION MAKING
100%
-NIL-
90%
10%
100%
-NIL-
RESOURCE ALLOCATION FOR PUBLIC HEALTH MUST BE
MORE EQUITABLE CONSISTENT WITH ITS CONTRIBUTION
TO SOCIAL DEVELOPMENT AND NEW RESOURCES
SHOULD BE MOBILIZED
100%
-NIL-
THE GOVERNMENT SHOULD FIND WAYS AND MEANS TO
ENHANCE THE STATUS AND IMAGE OF PUBLIC HEALTH
CARE PROFESSIONALS CONSISTENT WITH THEIR CRUCIAL
ROLE IN HEALTH OF THE NATION
100%
-NIL-
IN ADDITION. THE PUBLIC HEALTH SPECIALIST NEEDS
SKILLS IN COMMUNICATION. PUBLIC POLICY ANALYSIS
AND DEVELOPMENT
SOCIAL PROGRAMMES (THIS INCLUDING HEALTH) ARE
OPERATING
UNDER
EVER
TIGHTER
RESOURCE
CONSTRAINTS. THEREFORE. THE CONTRIBUTION OF
GOOD HEALIH TO SOCIO-ECONOMIC DEVELOPMENT
MUST BE CONVINCINGLY DEMONSTRATED IF ADEQUATE
AND SUSTAINABLE RESOURCES ARE TO FLOW TO THE
HEALTH SECTOR
58
4. Interaction with other health related departments
Findings
Intersectoral coordination of all development departments of the government is
important for speedier and effective implementation of health promotional
programme. In this connection, the representatives of the following departments
were contacted and information collected by using structured questionnaire. They
are Education, public Health Engineering, Information and broadcasting.
Agriculture and Horticulture departments. Most of them agreed that there is
need for cooperation and coordination between health Departments, and
their departments but expect that their departments but except that the
health department to take inactive in the matter because health is the
business and concern of health sector. Many of them are not happy about the
attitude of doctors towards them.
Recommendations
First of all there is need to educate other departments to impress on them, that
health of the people is their concern also and if there is cooperation and
coordination, the health promotional programme can be implemented smoothly
and quickly. Moreover, the proper and successful implementation of health
programmes would also help other non health related programme substainlly,
because people take more and keen interest if the programme is health related.
Therefore, there is need for organizing advocacy programme for managers and
policy makers of other development departments at the State level, they should be
identified and educated. A programme for people can be effectively and efficiently
implemented, if all departments extends support and participate for example, the
success of family Welfare programme to some extent is due to the extensive
intersectoral coordination and cooperation. The benefits that flow from
intersectoral coordination is much more than die benefits that accrue when
departments work separately.
This is die fruit of interaction and this does not cost any thing more instead’
strengthens interpersonal bonds and Interdepartmental bonds and help cohesion
and purpose in government institutions. This is very important because people are
loosing confidence in government run programme.
5. Interaction with Non-Governmental Organisations
Eight non-govemment organization in 4 districts implementing some health
education activities were contacted. All of them are very much enthusiastic to do
59
health work and help people to improve their health. But most of them are
dependent on government for funds and projects. The projects managed by the
NGOs are better organized and people are satisfied by the services. Some of them
engage full time staff. These workers seem to be more serious about their
responsibility and duty and they have better rapport with the local people
performance of NGO seems to better than government organization but the budget
of NGO seems to be better than government organization.
In the long run it may be better to involve more and more NGOs and try to
encourage them. Unless socially spirited people come forward to manage non
government organization and if they are allowed to work only with full time
employees and work like any other profit oriented organizations, they would
become very soon as government run institutions. Therefore carefull verification
of non-govemment organization and the staff composition and the background of
people who run such organisationis required before entrusting any health related
projects to them.
6. Interaction with the people
It was possible to meet some people in village in all the 8 primary Health Centres
of 4 Districts Both men and women in their homes and in public places were
interacted to understand whether they know the health education and other health
programmes and whether they are getting adequate information about healtli.
Findings
Most of the respondents showed indifference to our questions on Probing further,
they reveled that the health worker come and talk to them on health matters
sometimes on family planning and antenatal care. Mothers expressed that ANMs
are advising them on diet and child care. They are not aware of any other Health
Education Campaign on other Health activities Except Aids/HIVs.
Many village are not satisfied by the services they receive when they go for the
Primary Health Centre for Treatment, except immunization services.
Nevertheless, it is surprising to know that many of the villagers have understood
the rationale of small family norm and they do not have much gender
discrimination and coming to sterilization camps even with one girl child. But
many are not male sterilization.
Most people want water supply at their doors through taps and some of them are
also willing to bear the expenditure on it, but they do not know why they want
60
piped water supply. They do not know the importance of sanitation and are not
interest to have toilet facilities in their homes.
Recommendations
Therefore, there is need to launch health education programme systematically and
continuously by the government. The television media and radio should be used
more frequently to reach large number of needy people. The messages should be
transmitted instead of scholarly talks through media. Prime time should be chosen
for telecasting messages and slogans. These programmes should be supplemented
by health workers in the field by way of clarification etc.
61
SECTION-V
1. Vision and Strategy Statement
2. Summary of the findings discussion and recommendations.
1. A vision strategy statement for improving the health status of
Karnataka State in 21s' Century
India including Kamataka State is facing a triple burden of diseases and disability
even after 50 years of development after attaining political independence. The first
burden is that many preventable disease and disability still persist as public health
problems. This is due to party, to administrative and technical problems in the
control of infectious and nutritional diseases and party due to failure in public
health policy.
In addition, due to demographic transition and increase in expectation of life,
people are surviving longer. Unfortunately they survive to suffer from costly
diagnostic facilities, costly drugs and longer hospital stay. Relatively, more health
budget is being spent on elderly people than young and working people. This is
the 2nd burden.
The third burden is the emergence of new diseases like HIV/AIDS, Alcoholism,
and Drug abuse.
These challenges together with higher infant mortality rate (70/1000), higher
proportion, low birth weight babies (30%) and higher mortality among under 5
children all pose a formidable disease burden to the state
In the face of these challenges, the health care system in the state is not that
efficient as revealed by slowing down of decline of IMR and under 5 year
mortality (1999-2000). In recent years incidence of malaria, tuberculosis and
HIV/AIDS have also shown increasing tendency.
Therefore, there is a clear indication that the present and past public health policies
and strategies are not sufficient to lesson the burden of disease and disability in
kamataka. This situation has lead the state to spend more and more for curative
services and get less and less in terms of health gain to the population. The
experiences of western countries from 1801 to 1971 has shown a similar trend.
Ottawa charter after considering all the above factors, has suggested to all
countries to apply the principles of health Promotion in their health policy. The
62
Karnataka State would do well to implement these strategies to achieve the
maximum benefits in terms of improved health. These strategies would help the
people and government to reach the determinants of illhealth and destroy the roots.
Even though this is a long, arduous and expensive task, it is the only way left for
reducing the burden of disease and disability, and to promote the health of the
state.
The 5 strategies suggested by the Character are:
1. Build healthy public policy
2. Create supportive environment
3. Strengthen community action
4. Develop personal skills
5. Reorient health services
Major areas of concern that should be adequately addressed are:
❖ Development of human resource
❖ Sustained action to build supportive environment for all people
❖ Fostering intersectoral action for health
❖ Forging partnership between non-govemment organisation and government
health sector.
With the application of principles of health promotion and hopefully improved,
health administration, the state may hope to improve health status of people of
Karnataka, sufficient enough to live a healthy, useful and procedure lives at least
by 2015 in 21st century.
2. Summary of the Findings, Discussion and Recommendations.
The study reveals that tlie Karnataka state Health Department has required
organizational infrastructure, manpower and skill to launch Health promotional
activities in the direction as suggested by the world health Organization’s 9th
General programme of work. However, some minor deficiencies and week
linkages have been found in the study and they are discussed below and remedial
measures suggested in the way of recommendations.
63
A. ORGANIZATIONAL STRUCTURE
The existing organizational structure in the state to take up the health promotional
activities at tlie State, District, Taluka and primary Health care center level is
adequate and no additions or modifications are required. The name of the state
Health Education Bureau. All the Health Education staff may be brought under
one division.
B. MANPOWER
State level
Some posts of Technical Officers of the Health education Bureau at the state level
are vacant for a long time. This has led to the disfunctioning of these units and
State health Education Bureau is very much handicapped without these Units. For
Example, the Audio visual Unit is essential for pre-testing all 1EC materials
before they are produced in large numbers to be cost effective. Likewise the field
study and demonstration Unit is essential because the health promotional activities
are field tested for their applicability to the population and the cost effectiveness is
determined before they are applied to a larger area.
Therefore the vacant posts in Audio-visual, field demonstration and Exhibition
units may be filled up urgently.
District level
At the district level, no addition is required. The posts of the District Health
Education officer and one Deputy District Health Education officer may be
continued.
Both of them should have DHE qualification (the state has sufficient number of
DHE qualified Health Educators). Their designation may be changed as District
Health promotion and Education Officer and Deputy District Health Promotion
and Education Officer.
Taluka Level
At Taluka level, there is no Health educator post are sanctioned at present.
Therefore, one Health Educator post may be sanctioned for every taluka. The State
has sufficient number of health educator for 175 talukas these post must be filled
with D.H.E qualified Health Educators.
64
Primary Health Centre Level
The State has 1685 Primary Health Centres (this may go up also) and there are 782
Health Educators. Therefore, there is shortage of nearly 900 posts. It is very
necessary that each Primary Health Centre should have one Health Educator and
therefore additional posts may be created in a phased manner at the rate of 200 per
year for the next 5 years.
C. TRAINING AND PROFESSIONAL EDUCATION
Training
The Study reveals that the Health Educators and Medical Officers need training in
the health promotional aspect. Short term training courses may be arranged for
District Health Education Officers, Deputy District Health Education Officers and
the Medical Officers of health of all Primary Health Centres at the State level and
at Divisional level. Hie training may be of one week duration.
The Health Educators, without DHE qualification may be sent for acquiring DHE
qualification at Gandhigram in a phased manner.
Professional Education
The Medical Offices of Health of Primary Health Centre or Health Administrators
at District and State level should have right kind of attitude and interest in health
promotion, because they are the kingpins in health care delivery system.
Therefore, their attitude and interest in health promotional activities are important
and essentional.
Since the medical students are molded in the philosophy of medical and health
practice and service at graduate level and it is here they form attitude and learn
and develop skills, for right kind of attitude and practices. The syllabus in
Community Medicine in MBBS and DPH and MD courses must be adjusted to
include Health Promotional aspect of health care in a substantial way. The
Community Medicine Department must have infrastructure to demonstrate the
operational aspect of Health Promotional activities. The Rajeev Gandhi University
of Health Sciences may be requested at issue guidelines and modify the syllabus in
Community Medicine for both at undergraduate, diploma and degree courses.
65
FUNCTIONS
IEC activities
Information, Education and Communication activities are very important and
essential for creating awareness of health and its importance in the minds of
people. This is the 1st essential step in any health education programme to enable
people to take control of determinants of illhealth in the community. At the
present moment, there are no sufficient routine IEC activities in the State except
centrally funded programmes. The State health sector should plan and carryout
Health Education Programmes as a routine function of the Department and
sufficient resources sould be earmarked for this in the annual health budget.
Sponsored programmes are also very few and they will not reach the people and
their impact is negligible.
School Health Programmes
This programme is very important in inculcating the health knowledge, moulding
childrens health attitude and develop right kind of healthy life style favorable for
healthy living. A comprehensive health programme which is already in existence
should be implemented in all schools in the State. Therefore, the Government may
be requested to issue orders to activate interdepartmental committee and
implement comprehensive school health programme. This programme should
include (1) health appraisal and follow up including medical examination (2)
teachers training (3) providing good, clean and well ventilated class rooms (4) safe
drinking water and toilet facilities to all schools and colleges in the state.
Further a comprehensive health education curriculum may be framed and taught
covering all aspects of health promotion in a graded manner to the 1st Standard to
XII Standard students as is being done in Europe, Australia and USA. The
curriculum should include environment, air pollution, green house gases, which
are causes of illhealth. Healthy life style, population elements, family welfare and
sex education HIV/AIDS etc. Health promotional measures required to be
cultivated and practiced by the individual, family and community. Their social
responsibility towards the health of others is very essential, for health promotion
of the population.
The Subject of health promotion may be made a compulsory curricular subject in
schools and appropriate educational material may be produced by State Health
Education Bureau in collaboration with Health, Health Education and Educational
Experts.
66
D. ETHICS, ADVOCACY, HEALTH RESEARCH AND PARTNERSHIP
FOR HEALTH PROMOTION.
a. Ethics
Bioethics cannot be limited to medical practice and organ transplant. Bioethics is,
in broader sense, includes all interventions upon human being whether in a group
setting or individual. Health Promotion and Health Education are to produce a
undoubtedly a type of intervention, to produce a modified life style, attitudes, and
desires, wishes and way of life. Health promotion also covers inequity and
injustice meted out to some section of society. In fact the rationale of application
of health promotional measures is to uphold the dignity of human being,
affirmation of human right and the freedom to empower himself to protect and
promote health. So ethically also the health promotional principles are sound and
the human right demands the application of these measures in civil society.
b. Advocacy:
For successful implementation of health promotional policies and activities, the
health sector should develop strategies for Advocacy at various levels. It should be
armed with solid evidence that health promotion works and is worthwile. The
health department should have a strong support and useful partnership with
industry and other non-govemment organizations.
Advocacy is required at all levels of governance. At the top level to policy makes,
legislature and decision makers (specially resource allocators). Health
administrators at the top level must be able to take strong leadership and plead
with policy makers and exert pressure on them to change the directions of policy
wherever it is not favourable for health promotion. For this to succeed, the health
administrators should have solid and convincing evidence.
c. Health Research and Partnership
How and where convincing evidence is available? The scientific evidence can
come only by health research. The State has vast potential for collaborative
research in health field. There are 23 medical colleges with well equipped fully
staffed, community medicine departments. The Government should foster
partnership between Medical Colleges and the District Health Administrators for
producing scientific evidence about the benefits of health, Promotional activities.
Collaborative action research is chapter and more usefull because it gives feed
back to the health programme manager to change the directions it required. This
67
is a highly potential area to develop and the Government can insist upon this while
handing over 3 PHCs to the Medical Colleges as contemplated recently.
d. Funds
The funds for IEC activities, Advocacy programmes and social mobilisation
programmes should be granted by the Government. It should be remembered that
money spent on health promotion activities can bring 10 times more dividend than
the money spent on drugs and purchase of sophisticated equipment. The
Government should proceed in the direction of allocating more and more taxfunds
for attacking root causes of diseases than treating diseases for cosmetic purposes.
The Central Health Council has already given guidelines to allot 5 to 10% of
health budget for health promotion. This should exclude the investment on water
supply and sanitation.
E. Intersectoral coordination
It is very clear and apparent from the literature and a decade of experience that
health promotional areas overlap between many developmental departments. And
the health promotion is possible only by developmental approach. Moreover,
health promotion is essentially a social and political action and therefore, the
health promotion goes beyond health sector and embraces all other developmental
sector of Government. Therefore, intersectoral cooperation and coordination
between departments becomes very necessary and crucial for successfull for
implementation of health promotional activities. Many case studies and opinion of
experts show that comprehensive multi-disciplinary health promotional
programme yield better results than programmes by single sector.
The study reveals that there is no strong linkage between health sector and other
development sectors both at the top and at the bottom levels. Therefore, modalities
should be found out and experimented to secure firm coordination and cooperation
amongst all developmental departments at the Ministerial, Secretary, Directors
level at the District level and at the grass root level. Health promotional committee
may be fonned with the State Health Council with the Chief Secretary as the
Chairman to oversee the policy directions, and matters of intersectoral cooperation
between various sectors. Developmental sectors which are very important and
whose activities comprises many health promotional components are the
following:
68
•
Education Department.
•
Information and Broadcasting Department.
•
Community Development Department.
•
Agriculture Department.
•
Department of Industry.
•
Social Welfare Department and
•
Public Health Engineering Department.
1. Education Department.
The study reveals that there is no strong linkage between Health and Education
Departments in the State. A close liaison is very much needed between these two
Departments because one of the most important health promotional programme in
the long run is the School Health Programme (SHPO. For successful
implementation of School Health Programm very close collaboration is essential.
Already existing committees at state & District levels may be given sufficient
responsibility & powers and resources.
2. Information & Broadcasting Department
This sector is very much relevant to day than ever before. Because of the
explosion of information on health promotion and multitude of media telecasting
such information. Many TV Stations in their enthusiasm to make T.V. shows
attractive especially to the youths include scenes and actions that actually convey
unhealthy life styles. Therefore, there must be a Watchdog Committee to
watch out such shows and bring it to the notice of controlling authority in the
State. Such a Committee should include public people also.
For purposes of telecasting health promotional activities by the governmental
media, a plan of telecasts has to be prepared by the Information and Broadcasting
Department and the health experts either from the Department of Health or from
non-govemment organizations doing health promotion work to be consulted
before telecasting.
Health Promotion and Education Bureau should prepare their own TV scripts and
request the Information and Broadcasting Department to telecast periodically.
Details may be worked out jointly by the two Departments. The Health
Department should gather public opinions about the television shows that have
health implications and bring die telecasts that gives mis information, wrong
69
information if any to the notice of the information and broadcasting department.
Health Department through its health promotion and education wing should
identify the health promotional elements in the programmes of these sectors and
discuss with the respective authorities.
Similarly, the directions by the Govenunent may be issued to all development
oriented Departments to have a close liaison with the Health Sector.
3. Collaboration with non-governinent organisation
Health promotional activities are carried out mostly at the level of people, in the
families, community, villages and slums. Proper understanding and cooperation
of local non-govemment organizations are very useful and essential. At present
there is no formal collaboration with the Non-Govemment Organizations. The
Government may issue directions to the health sector to establish firm and
sustainable
relationship
with
local
non-govemment
organizations
for
implementation of health promotional activities. These organizations are very
essential for social mobilisation, people’s contact and people’s participation in the
programme.
70
SUMMARY OF RECOMMENDATIONS WITH REASONS
AND EXPLANATIONS
Recommendation - 1
It is recommended to change the name of the Health
Education Bureau as “Health Promotion and Education Bureau”.
Reason:
First of all to confonn with the recent advances in the international
Health forum and secondly to add additional importance of health
promotional efforts of public health. Because the health promotion
incorporates other two fields of action in addition to health education. They
are social support and empowennent of people for better health. Therefore,
the organization that deals with health promotion should have the
appropriate name as “Health Promotion and Education Bureau”.
Action:
Ministry of Health and Family Welfare can issue an executive order to
this effect.
71
Recommendation - 2
The existing two divisions of Health Education Bureau should be
merged and all the health education staff at the Primary Health Centre,
District level and at the State level should be brought under the newly named
division of “Health Promotion and Education Bureau.” This division should
be headed by an Additional Director of Health and Family Welfare Services,
who will work directly under the Director of Health and Family Welfare
Services. However, the District Health Education Officer and Health
Educators at Primary Health Centre will work under the control of District
Health and Family Welfare Officer, Taluka Health Officers and Medical
Officer of Health of Primary Health Centres.
Reason:
Health promotion and education activities need special efforts and
attention of the health department. Health promotional strategies and
activities will have to be planned, executed and monitored at the State level.
District level, Taluka level and Primary Health Centre levels. Unless there
are designated personnel at various levels, the programmes cannot be
effectively implemented. Secondly, the health promotion and education is
becoming
a specialised field in view of advances in communication and
multi media. Therefore, communication specialists and well trained and
skilled specialists are required to understand and interpret various behaviour
changes taken place in the community as a result of health promotion and
education activities. Further, if all specially trained and qualified staff are
working under one direction and control, they would perfonn better and will
be more efficient and more productive because of their combined talents and
expertise.
72
Action:
Ministry of Health and Family Welfare can issue an executive order
merging the two divisions of Health Education Bureau into one division of
“Health Promotion and Education Bureau”.
Recommendation - 3
Every newly created Taluka Health Office should have
atleast one qualified Health Educator. His designation should be
Taluka Health Promotion and Education Officer. He has to work
under the control of Taluka Health Officer and under the technical
control of District Health Promotion and Education Officer. He is
responsible for planning, implementation and monitoring of all
health promotional activities with the help of Health Educators of
PHC and grass root level workers and their supervisors at the
Primary Health Centre.
Reason:
In the context of supervision and guidance of health promotion and
education activities, the existing District Health Education Officer is not
efficient because, of the vastness of the district and very large population to
be served. Therefore, a supervisory and guidance staff at Taluka level will
be good and can be more effective because he can contact the field staff
73
more frequently and the area he has to cover is reduced markedly. He can
guide and supervise all the activities in all the PHCs of the Taluka and report
to the District Health Education Officer (See also page 39 of the report)
These officers will have to be mobile because his/her activity involves
mostly touring and therefore they should be given traveling allowance and
loan to purchase two wheelers.
Action:
Regular Government order will have to be issued after obtaining
clearance from the Finance Department for the creation of 175 Taluka level
Health Promotion and Education Officers. Along with this order, the loan
for these officers for purchase of two wheelers should also be sanctioned.
Recommendation - 4
Ideally, there must be one Health Promoter and Educafpr for
every PHC. This requires more than 1600 Health Promoters for the
whole State. But there are only 782 Health Educators in the state at
present. To cover all PHCs with Health Promoters, it is
recommended to attach two PHCs per every Health Promoter and
Educator. But, he has to be attached to Taluka Health Office and
made to work under the control of Taluka Health Promotion and
Education Officer. And additional 273 Health Promoters post may
be sanctioned to cover all PHCs. This will ensures one Health
Promoters or every two PHCs.
74
Reason -1:
Now there are 782 sanctioned posts of Health Educators in the State.
Of these, 688 people are working and 94 posts are vacant. Of 688 persons
who are working, 217 people have DHE qualification and tire remaining 471
people do not have DHE qualification. These people may be posted as
Health Promoter and Educator and two PHCs may be attached to each
person, thus 942 PHCs can have Health Educators. The vacant posts of 94
may be filled up as soon as possible, so that another 198 PHCs can be
covered. Still 545 PHCs will go without Health Promoter and Educator and
to cover these PHCs 273 additional posts required to be sanctioned.
Reason - 2:
All India staffing pattern for PHC includes Health Educator. In
addition, there must be some person at the grass root level to initiate and
take leadership in a very vital area of public health. Health promotion is a
process of enabling people to increase their control over the Health
determinants. It involves people and host of other public persons. He/she
should be in constant touch with village formal and informal leaders to
secure their co-operation and use their influence in order to bring about
critical social pressure on general public to change their behaviour. People
will have to participate in a big and sustainable way to bring about this
revolutionary change in the human health behaviour and practice. He is a
grass root level worker at the PHC in health promotion and education and a
facilitator and an organizer. Unless there is one person with sociology
15
background with mass communication skill, all efforts made from the top in
the field of health promotion and education will be of no avail. Therefore,
one Health Promoter and Educator per Primary Health Centre is a must and
this staffing pattern should be continued and additional posts may be
sanctioned, in a phased manner.
Qualification for Health Promoter and Educator
He/she must have a basic (BA or MA) University Degree in sociology
and should have undergone training in health promotion and education. (A
six weeks training programme may be arranged for all those who have no
DHE qualification and for new recruits before they are posted as Health
Promoter and Educator)
Recommendation - 5
All vacant posts in Field Study and Demonstration Units,
Audiovisual Unit, Exhibition and Student Health Education Unit
should be filled up immediately and the above units should be
made functional and energized.
Reason:
These units are essential for any health promotion and education
organization. It is in these units innovative action programmes are tested
before they are employed on a large scale. They act as field laboratory for
pre-testing IEC materials and they are research-cum-action units to give feed
76
back in concurrent and terminal evaluation of an educational activity.
Therefore, all these units may be retained and vacant posts may be filled up.
These units are also important for planning, monitoring and evaluation of
health promotion and education activities (see also page 34-35 and 53 of the
report for further justification)
Action:
Director of Health and Family Welfare Services in consultation with
the Health Commissioner, can fill-up all the vacant posts.
Recommendation - 6
Now, the IEC activities are organized by several division like
RCH, IPP IX, AIDS, Tuberculosis and Eeprosy. It is recommended
that all IEC activities should come under the responsibility and
control of the Health Promotion and Education Division. This
division should implement and monitor all IEC activities.
Reason:
Health promotion and health education is a team activity with special
input by Health Promoter both at the implementation level and planning and
monitoring level. The division of health promotion and education is staffed
with people who have the skill to organise mass education campaigns and
group education programmes involving people and there are Administrators
at the taluka and district level to over see all IEC activities and give
77
appropriate guidance. Therefore, all LEC activities of all divisions should be
entrusted to the division of Health Promotion and Education to improve
efficiency (see also page 55 of the report)
Action:
An executive order from the Health Commissioner is required.
Because all programme Directors will have to surrender the funds from their
budget to this division for implementation of the health education activities.
Recommendation - 7
Routine health promotion and education programmes should
be organized in every PHC covering all villages. All the grass root
level workers and their supervisors must be responsible for
implementing these activities. These activities must be planned,
organised and monitored by the PHC Health Promoter and
Educator and supervised by Taluka Health Promotion and
Education Officers. Atleast Rs. 5000/- per PHC per annum may be
budgeted for health promotion and education.
Reason:
At present there is no organised routine health education activity to
perform either by the Health Educator or grass root level health workers
except personnel communication to pregnant mothers by ANM and
78
sponsored IEC programmes which are funded by Central or State funds.
This is not correct. This appears to be the reason why Health Educator at
PHC are used for other odd jobs by the Medical Officers because he has no
routine job to do till a sponsored programme is sanctioned and funds
released. The health promotion and education should be a routine Primary
Health Centre function. It is the duty of Health Promoter and Educator to
plan social mobilization programme, group education programme in every
village in the PHC and implement the plan with the help of local grass root
level workers and their supervisors. Some funds must be made available for
the PHC for health promotion and education activities. The Health Promoter
at the PHC may be allowed to raise funds from philanthropists for the
programmes. But the State should provide some seed money for the purpose.
The programmes like M.S.S. and self-help groups, jathas by school children
should become a routine activity in every village. Whoever the sponsored
programmes, they should also be implemented as and when there are
sanctioned by the state and central governments.
Action:
The Director of Health and Family Welfare Services should send the
proposal to Finance Ministry with the concurrence of Health Commissioner
and plead with the budget allocators to make provision of atleast Rs. 5000/per PHC per annum.
The Director of Health and Family Welfare Services should also issue
executive order to make IEC activity as a function of the Primary Health
Centre and the planning, implementation and monitoring should be the
79
responsibility of Health Promotion and Education Division. Of course the
District Health and Family Welfare Officer and Medical Officers of Health
are responsible in their jurisdiction for implementing these IEC activities
(see also page 55 of the report for justification)
Recommendation - 8
5 to 10% of the Health Budget of the State may be earmarked
for IEC and associated activities in the annual budget. This has
been already agreed upon by the Central Health Council a few
years ago.
Reason:
IEC activities which involves awareness programme. Advocacy
programmes require funds for organization and implementation. These
programmes are essential to implement the following suggestions envisaged
in the Ottawa and Jakarta Declarations. They are:
1. Raising
awareness
among
the
general
public
about
the
determinants of diseases and illhealth.
2. Promotion of social responsibility of people about the health of
others.
3. Encourage people to participate and take control over the root
causes of illhealth.
4. Secure infrastructure for health promotion by motivating people to
help build health infrastructure in all villages and towns.
80
5. Mobilization of resources and public opinion required for health
promotion in all cities, towns and villages.
6. Increase community capacity and empower the individual about
health promotion and others.
Apart from the above, the health promotional activity involves large
number of people and groups and not merely individuals. The health
promotional activities are aimed at and deal with apparently healthy
people with a view to help them to gain better health and become less
susceptible for diseases and thus saving lives, lessen the burden of
diseases, and
increases productivity. This in the long run help
communities to improve their health status, to stabiles the population size
by adopting small family norm.
Action:
Health Minister and Health Ministry of the State may be requested to
take initiative by putting the proposal before the cabinet and then to Finance
Ministry for concurrence.
Recommendation - 9
Advocacy programmes on Health Promotion and Education
may be organized throughout the State at various levels. The actors
and clienteles is given below. These programmes should be
conducted periodically and should become a annual or bi-annual
feature
of
the
Health
&
Family
Welfare
Department.
81
They should deal with appropriate health promotion.
Level
State Level
Actors
1. Director of Health & F.W.
Services.
Clienteles
1. Policy makers
2. Legislatators
2. Additional Director of Health &
3. Finance Ministry
FW
Services
of
Health
Officials
Promotion
and
Education
Division.
4. Top level Bureaucrats
3. Joint
Director
of Health 5. State level religious
Promotion and Education Dvn.
leaders
4. Deputy Director, IEC
6. Health Professionals
7. Health Researchers
District Level
1. Dist. Health and FW Officers.
1. Zilla Panchayat
President and Members.
2. Dist. Health Promotion and Edn.
Officers
2. Chief Executive Officer.
3. Dy, Dist. Health Promotion & 3. Local Religious Leaders.
Education Officers.
4. Local Legislators and
MPs.
Taluka Level
1. Taluka Health Officers.
1. Taluk Panchayat
President and Members.
2. Taluka Health Promotion and
Education Officers.
2. Taluka MLA.
3. Health Supervisors.
3. Religious Leaders.
4. Local Formal Leaders.
5. Local NGO.
Primary Health
Centre Level
1. Medical Officer of Health.
2. Health Promoter and Educator.
3. Health Supervisor.
1. Village Panchayat
President & Members.
2. Local Teachers.
3. Local NGOs.
4. Self help Group.
5. Village Health
Committee.
82
Reason:
Advocacy and lobbying have become useful mechanisms for
motivation and convincing policy makers and decision makers to take
rationalistic view and right decision. These programmes are also needed at
implementation level (see pages 16-17 and 49 of the report.)
Action:
Health Commissioner should issue direction to Health Department.
Recommendation - 10
A comprehensive School Health programme should be
implemented in all primary and secondary schools in the State.
Reason:
Now primary and secondary education is compulsory till tire age of 14
for both boys and girls. Therefore there is every possibility of reaching 90 to
95% of children (upto the age of 14) in the schools. School health
programme has become one of the most beneficial health promotion activity
not only for the present generation of children, but also for the next
generation of parents. Many case studies all over tire world have
accumulated evidence, to show that school health programme is the most
cost effective method of health promotion activity. To be effective, it should
83
be comprehensive and cover 90 to 95% of the target groups, (see also pages
17-18 of the report)
Action:
Government order may be issued directing the Health Department to
draw up a plan of action for implementing a comprehensive school health
programme in consultation with the Education Department.
Necessary
funds may also be made available. There is no need for special staff for the
Health Department for school Health services. The existing staff at the PHC
or Taluka level is sufficient. However some more Funds are required for
building toilets and water supply facilities in every school, which may be
sanctioned by Zilla Panchayat.
The existing State level and District level School Health Review
Committees may be activated or fresh Committees may be constituted with
Education Commissioner as Chairman at the State level and the Deputy
Director as Chainnan at the district level. The education department is ready
to collaborate, but the Health Department is not responding sufficiently to
plan and implement a comprehensive school health programme. Medical
officers must be made responsible to implement school health programme.
Recommendation -11
The syllabus for primary and secondary school education
may incorporate health knowledge and health practices topics in
the curriculum, so as to include all aspects of health, environment,
air pollution, population problem etc., and social responsibility of
84
the individual and of the society for community health, and the
need to take into account the equity and social justice to all
sections of people.
Reason:
There is great need to add health topics in school curriculum in a
graded way from 1st standard to 10th or 12th standards. The knowledge learnt
here is important and essential for proper healthy behaviour and develop
healthy life style for the entire life span of the individual. It helps children to
adopt good health habits and discard bad health habits and practices. Many
bad health habits are cultivated in childhood without knowing fully there
effects on health. Educated person should know desirable health habits,
behaviour and practice them by himself and educate his family. He must be
a model to others. Moreover, many personal habits and behaviour associated
with good health are formed during childhood, the neglect of which may be
the causes of illhealth in adult life or old age.
Therefore, scientific information and rationale behind good healthy
life style should be made available to every students then and there, and
from the early age. Enviromnent of schools should also be healthfull.
Action:
Education Ministry should give direction to curriculum committees to
involve Health promotion and Education Director while making reversion of
curriculum for primary and secondary education from 1st to 10th standard.
Out line of the proposed curriculum is given in the annexture
85
Recommendation - 12
Training for District Health and Family welfare Officers and
Taluka Health Officers and Medical Officers of Health in health
promotion and education may be organised at different levels as
follows:
1. State level
Dist. Health & Family welfare Officers
2. Dvnl. level
Taluka Health Officers
3. District level
Primary Health Centres doctors
Duration:
State level
2 days
Divisional level
1 week
District level
1 1/2 week
The topics should include all the elements of health promotion and education
and rationale behind this movement.
Reason:
District Health and Family Welfare Officers and Medical Officers are
the kingpins in the implementation of any public health programmes. Unless
they are motivated and takes professional interest in the matter, these
programmes cannot be implemented. Therefore, the training of these
personnel are very important.
86
Action:
Health Ministry should issue Government Order and direct the Health
Department to plan and implement the training programme as early as
possible.
Recommendation -13
The Government may be recommended to bring about
intersectoral
coordination
and
cooperation
among
all
Developmental Sectors of the Government.
Reason:
Health promotion and education is a developmental approach to
achieve better health for the people. All developmental programmes have the
same goal of achieving better standards of living to all people. Therefore,
intersectoral coordination is an essential strategy to achieve health
promotion. Further, when more sectors of Government are involved in
health programmes the health message spreads and reaches more people and
the programme is more likely to succeed than when it is done by one sector.
How it could be done
A Coordinator preferably Joint Director of Health Promotion and
Education may be appointed for this purpose. He will have to identify the
areas for discussion and coordination needed in implementing a particular
development programme, involving health component. He will then arrange
a discussion with the respective Departments and the Additional Director of
87
Health Promotion and Education and other public health experts, (see also
page 57-58 of the report)
Recommendation - 14
Government may involve non-govemment organizations in
health promotion and education programmes at all levels
Reason:
Non-Govemment organizations are another organizational resources
available to the government to bring about health promotion of people. The
health promotional programmes involves active participation of people,
ultimateltely they are the beneficiary of any health programme. The local
NGO know the local people better and they can raise additional resources
needed for the programme.
Action:
Health Ministry may direct the Health Departments to involve local
non-Govemment organizations to participate in all health programmes in a
substantial way.
How it can be done
The concerned Health Department official should give preference to
non-govemment organizations to preside over a function or to inaugurate a
group discussion and allow them to talk and discuss the issues and thus
encourage them to participate in awareness programmes or advocacy
programmes. There must be equal partnership between NGO and
88
government sector and the management of the programmes must be
transparent and open. The NGO also will be helpful to raise additional
resources whenever needed.
However
entrusting,
the
sole
responsibility
to
NGO
for
implementation of an health programme without proper control and check
may be counter productive in the long run.
Recommendation - 15
Recommended to the government to make public health
qualification like DPH or MD (CM) mandatory qualification for
appointment as District Health & Family Welfare Officer.
Reason:
Health promotion is a public health activity. It involves people. It is a
social and political action. It envisages a planned activity. The health
promotional programmes have to be planned, monitored and evaluated
scientifically. Besides, the public health expert should be able to exhibit
leadership qualities and should be an efficient manager. To acquire all this
knowledge and develop skill one has to undergo additional training and
education. A physician after his MBBS degree or with clinical postgraduate
degree will have no chance to acquire proper attitude, skill and theoretical
knowledge needed to become a technical administrator. Therefore, a public
health
administrator
should
have
public
health
qualification.
89
Action:
Government can change the cadre rules and incorporate the DPH or
MD (CM) to be promoted as District Health and Family Welfare Officer.
Recommendation - 16
The syllabus for MBBS course, DPH and MD(CM) may be
modified so as to include all the essential principles, strategies and
action programme of health promotion and education, so that these
professionals should be capable of being community leaders in
order to mobilize community participation.
Reason:
The new ideas and new developments in public health and preventive
medicine are many and they are increasing every decade. People in the
academic field are not so well versed about what is actually happening in the
field or community. Community medicine is changing much more than other
fields of medicine. Hence, there is need to incorporate these principles in the
curriculum of basic doctors and public health experts.
Action:
Rajeev Gandhi University of Medical Sciences Vice Chancellor can
direct the Curriculum Committee of the university to consider and
incorporate the principles and practicing of health promotion and education
in MBBS., MD and DPH courses.
90
Recommendation - 17
Training for State, District, Taluka and PHC level health
education staff should be organized at various levels.
SI
Level
No.
1.
State Level
2.
District Level
3.
District Level
Cadres
All State level and District level
staff._______________________
All Health Educators in the
District with DHE qualification.
For Health Educator without
| DHE qualification.
Duration
3 Days
I Week
6 weeks
Reason:
Health promotion and education process involves more than mere
education. The social support and empowennent are additional action
programmes that these people will have to undertake to implement health
promotion strategies.
Action:
Director of Health and Family Welfare Services can issue order for
training of these key officials for health promotion and education.
91
Recommendation - 18
Health Promotion and Education Division should have the
staffing pattern and the top level staff should have qualification
and e,xperience as follows:
1.
Additional Director of Health
and Family Welfare Service
• Number of posts
• Status
One
...
• Qualification
2.
3.
MBBS., DPH., or MD (CM)
should have worked atleast
15-20
years
as
Health
Administrator at the District or
State level. Qualification in
Communication is desirable.
One
Joint Director of Health and
Family Welfare services.
• Qualification
Head of the Division of Health
Promotion & Education.
•
MBBS., DPH., or MD (CM)
should have worked atleast 10
years as Health Administrator
at the District or State level.
Qualification
in
Communication is desirable.
Joint
Director
of Health
Promotion and Education.
• Number of Posts
...
One
...
Appointment
should
be
promotion by selection from
among the District Health
Promotion
and
Education
Cadre. Seniority should be the
92
criteria unless a person has an
outstanding achievement in
the field.
BA or MA in Sociology, DHE
and Degree or Diploma in
Communication and should
have had 10-15 years of
experience as District Health
Promotion
and
Education
Officer or equivalent post in
the
Division
of Health
Promotion and Education.
• Qualification
4.
Deputy Director of Health
Promotion and Education.
• Number Of Posts
4
...
One for RCH Training
One for School Health
One for Non-Communicable
diseases & AIDS
One
for
Communicable
Diseases & Research
BA or MA in Sociology and
DHE and should have not less
than
10 years of field
experience as District Health
Promotion
and
Education
Officer. Diploma or Degree in
Communication may be given
preference.
• Qualification
5.
District Health Promotion and
Education Officers
• Number of Posts
27 or as many as number of
Districts in the State.
...
By
promotion
among
the
93
Health
District
Deputy
&
Education
Promotion
Officers.
• Qualifications
6.
•••
BA or MA in Sociology and
DHE and should have had
atleast 5 years of experience as
District Officers. Degree or
Diploma in Communication
may be preferred.
...
27 or as many as number of
District in the State
Deputy
District
Health
Promotion & Education Officers
• Number of Post
Appointipent by promotion
from among Taluka Health
Promotion
and
Education
Officers.
• Qualifications
7.
...
BA or MA in Sociology and
DHE and atleast 5 years as
Taluka Health Promotion and
Education Officers
...
175 or as many as number of
Taluks in the State
...
Appointment by promotion
from among the Health
Promoters and Educators
• ••
BA or MA in Sociology and
DHE and atleast 5 years of
experience as Health Promoter
and Educator
Taluka Health Promotion and
Education Officers
• Number of Posts
• Qualifications
94
8.
Health Promoter and Educator
1635 or as many as number of
PHCs in the State
• Number of Posts
Appointment
by
fresh
recruitment from among the
applicants.
• Qualifications
...
BA or MA in Sociology, DHE
qualification or a Diploma or
degree in communication may
be
preferred.
Candidates
should possess:
> Good knowledge
Kannada
in
>
Should possess
communication
good
>
Should posses
leadership quality
good
>
good
Should
have
knowledge about the
group
community,
Lobbying,
dynamics,
negations etc.
> Preference
may
be
given to people who are
living in villages of the
respective Districts. The
Health
existing
Educators
may
be
as Health
absorbed
Promoters & Health
Educators and the rest
may be recruited
9.
Technical Officers
• Number of Posts
3
One for Audiovisual Unit
95
One for Field Study
Demonstration Unit
&
One for Exhibition Unit
10.
Health Supervisors
2
One of Training Unit
One for field Study
Demonstration Unit
11.
Nursing Officers/Public Health
Nurse
&
2
One for Training Unit
One for Field Study
Demonstration Unit
12.
Home Science Asstt.
One FS & DU
13.
Social Scientist
One FS & DU
14
Teacher
One FS & DU
15
Artist-cum-photographer
One
16.
Artist
One
17.
Sub-Editor
One
18.
Projectionist
One
19.
Craftsman
One
20.
Silk-screen Technician
One
&
Qualification and experience required for the above posts are already
existing in the Department, the same may be applied.
The following recommendations have been made to National
Governments by a W H O. international meeting held in Geneva - 27 - 30
November 1995. They may be considered by the Task Force wherever they
are applicable.
96
• Resource allocation for therapeutic medicine and for public health
must be more equitable, and new resources should be mobilized for
public health.
• Government should promote, facilitate and support voluntary public
health action and community participation in policy development.
• Governments should promote and facilitate intersectoral cooperation
in public health. In order to achieve an effective and coherent public
health policy, health ministries must recruit the partnership of other
departments such as trade, industry, agriculture, housing, public works
and so on, all of which have key roles in the development of the new
public health.
• Governments should find ways and means to enhance the status and
image of public health care professionals consistent with their crucial
role in the health of a nation; such status and image should not be less
than that of professionals offering predominantly curative care.
• Governments must seek an integrated approach to health, the
environment and socioeconomic development and, in the words of the
Saitama declaration, “improve solidarity in a global approach to
generate, distribute and utilize public resources for sustainable
development, promotion of health and protection of the environment.”
,Q <<■
c Gi !'
I' ■
98
6th Standard
7“' Standard
8,h Standard
Chapter 8.
Digestive System - Respiratory - Sense Organs.
Chapter 10.
Water Pollution
Chapter 13.
Man and Environment Pollution
Chapter 9.
Water Pollution
Chapter 10.
Air Pollution
Chapter 11.
Human Body
Chapter 12.
Food Health and disease - Nutritious Food - Food habits
- Food preservation - Adulterated Food - Habits Smoking - Drug Addiction - Personal hygiene
Part - II
Transmission of microbes from one person to another
person - Transmission through water and food - Cholera
- Tuberculosis - Tetanus - First Aid - Transmission Through Animals - Rabies - Immunisation - Pregnant
Mother Infant Preservation of Food Food Poisoning
Unit -1
9th Standard
Unit - III
Hormonal plants - Asthma
Part - I
Unit -1 : Ways of living
Chapter 14.
Human eye
Chapter 15.
Defects of eye
Chapter 16.
Colour vision
Part - II
Unit -1
Chapter 4.
Life Processes - Digestion in man
Transport - Excretion - Reproduction
Respiration -
Unit - II
The Story of Man - Evolution in Man
10th Standard
Part - II
Unit - II
Chapter 5.
Environmental Pollution
Chapter 6.
Constituents of Food C/F/MV/P/F - Mineral Salt
deficiency disease - Anaemia - Goitre - Balanced diet Food Adultration.
Chapter 10.
Factors affecting human health - Malfuctiong of Body
Parts - Genetic Factors - Hormoal Imbalanced - Allergy
- Malnutrion - Pathogens - Viruses - AIDS - Leprosy Malaria - Kala azar
99
COMMENTS ON THE EXISTING SYLLABUS AND NEED FOR A
CHANGE
The existing syllabus starts from 3rd Standard to 10th Standard. First Two standards
are left out. This is not correct. Students when they are admitted to First Standard
are already 6 Years old and they are capable of understanding some elementary
aspects of human body and environment. More over important aspects of living
style should be introduced as early as possible so that scientific information is
available to the student before he had any chance of imbibing unscientific view of
life style. There fore awareness about health should be started from the 1st
Standard itself.
The existing syllabus though includes some aspects of health information the
health matter is not sufficient and not scientifically arranged from 1sl Standard to
10lh Standard and the syllabus is not comprehensive. Syllabus do not emphasize
the acquisition of skills, it is not sequentially developed and do not reflect the
interdependence of students, peers, the family, and the community. Promotion of
health and well-being is not adequately treated. Classroom activities are not
supplemented by activities and projects at home and in the community that
enhance students understanding of the family and social underpinnings of health.
Further the syllabus do not include any thing about the individual, family, and
community responsibility for creating health facilities and maintaining community
health which is crucial for learning life skills and acquiring healthy habits.
The principles of education is to arrange syllabus from simple things to
complicated things gradually and in increasing sophistication. The subject matter
must be repeated at periodical intervals. The syllabus must be taught over an
extended period of time and it should be incorporated into the daily life activates
of the community. The existing syllabus do not conform to the educational
principles. Hence there is need for a thorough change in the syllabus.
REFERENCE:
Report of a WHO Expert Committee. WHO Technical Report Series - 870.
100
THE NEED FOR COMPREHENSIVE SCHOOL
HEALTH SERVICE.
EXPERIENCE OF U.S.A.
U.S.A, is implementing comprehensive School Health Education Curricula and
they have found by large scale evaluation studies the following benefits over the
years.
1. School Health Education Increases students knowledge of healthy
behaviour and risk behaviour.
2. Teacher training in health education has a significant effort on successful
achievement of health out - comes for children.
3. “Booster Shots” of health education is necessary every 2-3 years.
4. Significant gains in students knowledge can be achieved after 50 hours of
instruction and moderate improvement in students health related behaviour
can be achieved after 30 hours of instruction in a topic.
Reference:
W.H.O. Technical Report Series 870.
101
PRINCIPLES AND PRIORITIES OF SCHOOL
HEALTH SERVICES
Every school should provide a safe learning environment for students
and a safe workplace for staff:
To often the school environment itself can threaten physical and emotional health.
The school environment should:
•
provide safe water and sanitary facilities;
•
protect students from infectious diseases;
•
protect students from discrimination, harassment, abuse, and violence;
•
reject the use of tobacco, alcohol, and illicit drugs.
Every school should enable children and adolescents at all levels to
learn critical health and life skills:
•
focused, developmentally appropriate, skills-based health education in topics
such as infectious diseases, nutrition, preventive health care, and reproductive
health;
•
comprehensive, integrated, life-skills education that can enable young people
to make healthy choices and adopt healthy behaviour throughout their lives;
•
health education that enables young people to protect the well-being of the
families for which they will eventually become responsible and the
communities in which they reside.
Every school should more effectively serve as an entry point for health
promotion and a location for health interventions:
•
provide safe and nutritious food and micronutrients to combat hunger, prevent
disease, and foster growth and development;
•
establish prevention programmes to reduce the use of tobacco, alcohol, and
illicit drugs, as well as behaviour that promotes the spread of HIV infection;
•
treat, when possible, helminth, malarial, skin, and respiratory infections, as
well as other infectious diseases;
•
identify and treat, when possible, oral health, vision, and hearing problems;
HpCS -IO
07yb9
102
•
identify psychological problems and refer those affected for appropriate
treatment.
The community and the schools should work together to support health
and education:
Families, community members, health service agencies, and other institutions have
an important role to play improving the health of young people. At the same time,
the school can play an important role in improving the health of the community as
a whole. Such roles include:
•
advocacy and support by the community for the development of the school as a
healthy organization;
•
active consultation and collaboration between families, the community, and the
school to improve the health of children and adolescents who attend school, as
well as those who do not;
•
active participation by the school and its students in programmes to improve
the health and development of the entire community.
School health programmes should be well designed, monitored, and
evaluated to ensure their successful implementation and their desired
outcomes:
•
developing or adopting in each Member State the most appropriate and
affordable methods to collect data about children’s health, education, and
living conditions, by age-group and sex;
•
emphasizing, whenever possible, research that draws on the knowledge and
skills of local educators, students, families, and community members;
•
developing methods for the rapid analysis, dissemination, and utilization of data at the
local
level,
where
they
can
have
the
greatest
impact.
103
FOCUS
ON SCHOOL HEALTH EDUCATION
1. School Health Education (S.H.E.O will Focus on behaviour and conditions
that promote health.
2. Help Children to develop life skills needed to adopt healthy behaviour.
3. Inculcates knowledge, attitudes, believes and values related to the
development of healthy behaviour and health promoting conditions.
4. It will provide learning experience that allow students to practice skills and
model behaviour.
104
ECONOMICS OF SCHOOL HEALTH SERVICE
There is ample evidence that school health expenditures result in substantial
savings:
•
A study in the USA estimated that every' US $1.00 invested in schools on
effective tobacco education saves USS 18.80 in the costs of addressing health
and non-health problems caused by smoking. The study further estimated that
the benefit of every USS 1.00 spent on education for alcohol and other drug
abuse prevention saves USS 5.69. Furthennore, each USS 1.00 spent on
education to prevent early and unprotected sexual behaviour saves USS 5.10.
On average, the money saved by society for each USS 1.00 spent on these three
forms of health education is approximately USS 14(1).
•
Spending money on school health programmes can be justified on purely
economic grounds; schooling pays off in higher incomes and a healthier
workforce. (2).
•
A 1993 World Bank analysis (2) estimated that most regions of the world
could greatly benefit by implementing an “essential public health package”
consisting of the following five central elements:
>
an expanded programme on immunization;
>
school health programmes to treat worm infections and micronutrient
deficiencies and to provide health education;
>
programmes to increase public knowledge about family planning and
nutrition, about self-care or indications for seeking care, and about vector
control and disease surveillance activities;
>
programmes to reduce consumption of tobacco, alcohol, and other drugs;
>
AIDS-prevention programmes with a strong component on other sexually
transmitted diseases.
Although school health programmes are explicitly mentioned in only one of the
above elements, for a large portion of the world’s population, schools could
efficiently provide all five elements of the recommended package.
105
There is ample evidence that better health
performance:
improves academic
Throughout the world, there are many examples of the school-based treatment of
medical problems resulting in improved academic performance. In one, Jamaican
children who were treated for moderate whipwonn infections raised their test
scores, which had lagged by 15% up to tire level of uninfected children (2). School
food programmes also have a marked effect on attendance and school performance
(3).
There is ample evidence that school-based programmes can reach very
large populations of school-age children:
•
Schools can reach about one billion students worldwide and, through them,
their families and communities. As previously noted, “the formal education
system is . . . the developing world’s broadest and deepest channel for putting
information at the disposal of its citizens” (4).
•
School health programmes have improved the health of large populations when
implemented on a national scale. In the Republic of Korea, for example, the
prevalence of intestinal helminthes among children was reduced from 80% to
0.2% over 30 years through a school-community chemotherapy, health
education, and sanitation programme.
•
Teachers can have an immense impact on young people’s health. As reported
by UNESCO, there are almost 43 million teachers around the world at the
primary and secondary levels (23.9, primary; 18.8, secondary) (2). The size
alone of the teacher population is of public health significance.
There is ample evidence that health education and services have
far-reaching effects:
•
Studies in the USA have documented that carefully designed and implemented
comprehensive health education curricula can prevent certain adverse
behaviour, including tobacco use, illicit drug use, dietary practices that cause
disease, unsafe sexual behaviour, and physical inactivity. Further, such
curricula reduce school absences by reducing the impact of disease and drug
and alcohol abuse, and the number of injuries and unintended pregnancies;
they also improve cognitive performance through proper diet, exercise, sleep,
and stress reduction (5).
106
•
Healthy habits learned during early years (e.g. safe food handling) will be
applied throughout life (6).
•
School-based clinics show evidence of improving students’ knowledge about
how to be effective consumers of health services, reducing substance abuse,
and lowering hospitalization rates (7).
•
Health promotion for school staff, one of the least visible elements of school
health programmes but one of the most critical, can decrease teachers’
absenteeism and improve their morale and the quality of classroom instruction
(8). One programme for school staff in the USA demonstrated reductions in
body weight, resting pulse rate, serum cholesterol level, and blood pressure (9).
REFERENCE:
1. Rothman M et al. Is school health education cost effective? An exploratory
analysis of selected exemplary components. American journal of health
promotion (in press).
2. World development report, 1993. Investing in health. New York, Oxford
University Press, 1993:33-34.
3. Levinger B. Nutrition, health and education for all. Newton, MA,
Education Development Center and United Nations Development
Programme, 1994.
4. The state of the world’s children, 1988. New York, Oxford University Press
(for UNICEF), 1988.
5. Allensworth D, Kolbe L, eds. The comprehensive school health
programme: exploring an expended concept. Journal of school health, 1987,
57:409-473.
6. Motarjemi Y, Kaferstein FK. Food safety in the school setting. Geneva,
World Health Organization, 1995 (unpublished document available on
request from Programme of Food Safety and Food Aid, World Health
Organization, 1211 Geneva 27, Switzerlandf
7. Dryfoos J. School-based social and health services for at-risk students.
Urban education, 1991, 26(1): 118-137.
8. Jamison J. Health education in schools: a survey of policy and
implementation. Health education journal, 1993, 52(2):59-62.
Bishop N et al. The school district for health promotion. Health values, 1988,
1292):41-45.
107
Strategic Planning of School Health Programmes - from problems to
action
Published research on how schools change and accommodate innovation provides
convincing evidence that producing change in schools and communities is a long,
necessarily local, and evolutionary process that must involve the entire system.
So-called “quick fixes” do not work; the implementation and institutionalization of
reforms often take 20 years. According to new international study of the process of
change in educational reform, successful reform has three main ingredients:
•
a well planned and evolving national commitment, made concrete through
appropriate management practices and institutional support, sustained over at
least 10 years:
•
strong local capacity;
•
coherent linkages between central, district, and local school levels, by means of
infonnation, assistance, pressure, and rewards.
The Strategies are:
•
To promote public policies for school health that provide resources.
•
To foster supportive environments that are the result of assessment and
improvement of the physical and psychosocial environment of the school.
•
To encourage community action that supports the process of health promotion
and the linkages between the school and other relevant institutions.
•
To promote personal skills development (through both curriculum and the
teaching and learning process) that emphasizes specific health-related
behaviour, as well as the skills need to sport health throughout life.
•
To reorient health services.
>
provide enhanced access to services within the school as well as referral to
the external health system;
>
identify and implement specific health interventions that are best carried
out through the school;
>
integrate curative and preventive interventions.
108
TEACHERS TRAINING
Training for school personnel is an important aspect of school health promotion
programmes. Studies show that training teachers in the use of a health education
curriculum improves their implementation of it (l).l Teacher training also builds
the commitment, understanding, skills, and attitudes that enable teachers to use
curricula effectively and confidently. A complete training programme should have
the following five broad goals:
•
for teachers to have an appropriate understanding of the human organism and
causes of disease and injury;
•
for them to develop positive attitudes towards and commitment to a
comprehensive approach to school health;
•
to increase their understanding of the principles of behavioural change that are
effective in health education;
•
to improve their teaching skills in areas such as class discussion, role playing
cooperative group activities, small-group discussion, community-involvement
activities, family-communication activities, games, and simulations;
•
to prepare teachers to deal with sensitive issues and refer students with
additional needs.
Implementation issues
Training for teachers, supervisors, and school administrators can be offered for
curriculum development, the provision of school services, and improvement of the
school environment, as well as in specific content areas.
Successful teacher training:
•
addresses issues of concern identified by teachers;
•
is conducted as close as possible to teachers’ work plances;
•
covers theory and demonstration, includes practice teaching offers feedback on
performance, and emphasizes peer-coaching skills;
•
has the support of both teachers and the school administration;
•
enables participants to feel a sense of ownership of the programme;
109
•
uses adult-learning theory;
•
is conducted over an extended period of time;
•
provides opportunities for reflection and feedback;
•
involves a conscious commitment by participants;
•
builds specific skills;
•
works with groups rather than with individuals.
Strategies
The Expert Committee noted that accepted recommendations for teacher training
include the following:
•
teacher training should be reviewed and upgraded at pre-service, in-service,
and continuing-education levels;
•
teacher-training programmes should ensure that student teachers receive field
experience;
•
routine workshops seminars, and short courses should be carefully designed
and implemented;
•
health teachers and staff as well as non-teaching school personnel should be
trained;
•
mechanisms for continuing education and supportive supervision to maintain
and enhance the quality of teaching should be developed (2).
REFERENCE:
1. Ross JG & Nelson G. The role of teacher training and other factors in fidelity
and proficiency. Presented a the 63rd annual Convention, American School
Health Association, 19 October 1989, Chicago, IL.
2. Health education strategies in South-East Asia. Report of an Intercountry
Consultation on Health Education Strategies in South-East Asia in the context
of Health for All by the Year 2000 and with special reference to the prevention
and control of AIDS. New Delhi, 10-15 December 1990. New Delhi, World
Health Organization Regional Office for South-East Asia, 1991.
J C J. .'C
110
RECOMMENDED OUTLINE OF CURRICULUM ON HEALTH FOR
PRIMARY AND SECONDARY SCHOOLS - FIRST STANDARD TO
TENTH STANDARD.
Goal and Objectives
GOALS
To enhance the promote health knowledge and health practices of school
going children in every possible manner to enable to adopt measures to achieve
positives health and remain healthy and to develop in them a self reliance and
social responsibility and better quality of life not only as children, but also as
adults and parents of tomorrow.
OBJECTIVES
1. To create health consciousness and make them understand that health is
most precious possession and resources to realize the genetic potentialities
of every child.
2. To make them realize, that he, his parents family and community are
primarily responsible for his and community health.
3. To help him to acquire healthy habits, healthy behaviours and healthy life
style as he grows learns, and develop through out school going years.
4. To inculcate a sound scientific through as to root causes of diseases and
disability in man and rational of prevention of diseases and prevention of
promotion if health.
5. To make him realize the unnecessary burden of health care expenditure
resulting from negligence and not preventing preventable illness and
disability.
6. To make him realize his and community responsibility towards the
community and need for tearful, and wholehearted cooperation and achieve
participation in creating and maintaining health infrastructure in any human
settlement.
Ill
TOPIC AND AREAS OF STUDY INCLUDED IN THE SYLLABUS
1. Human Biology, Anatomy, Physiology, Growth and Development, Heridity
and Genetics.
2. Human Sociology and Psychology, Individual, Family and Community,
socialization. Interdependence; Friends; Peer groups; Social behaviour;
Psychological factors; and Mental Health.
3. Human Nutrition and Health.
4. Human environment, Physical-Environment, Biological environment and
social environment. Role of the individual and community in creating and
maintaining health environment.
5. Concept of health. Root causes of illhealth and promotion of health.
6. Concept of diseases, communicable and non-communicable diseases and
their control - role of individual and the local community in control and
prevention of diseases.
7. Responsibility for health of the individual and the community and family.
Community organizations local self government, State and Central
Governments. Village and ward Health Conunittees.
8. Accidents
home accidents, road accidents - Calamities - First Aid.
9. Common illnesses among infants - children - Adolescents and adults Home Remedies, proper use of common drugs.
10. Reproductive and Child Health and adolescent health.
11. Demography and Population.
12. Health Care System - Health care infrastructure - School Health Service.
13. National Health Programmes.
14. Health and Medical Care Institutions.
15. Voluntary Sector for Health Promotion and protection of community
Health.
16. Role of the individual and community in creating and maintaining health
facilities and health behaviour of people, in the local area.
z C Q 4z c c
112
STANDARD-I
1. Knowing the external parts of the human body and their functions. Writing
their names and functions.
2. Knowing the role of parents in growth and development - writing the Names
of parents - Family Tree - peer groups and their functions.
3. Making a list of Teachers and their role in learning and better Health.
4. Making a list of friends and need for interaction with friends and peer groups
for better health.
5. Making a list of food articles used at home.
6. Classification of foods - Body building, energy yielding and protective foods.
ACTIVITIES:
1. Teachers weekly observation and Record.
2. Drawing the external parts of the body and labeling them.
3. Health appraisal by Doctor. Every Child should be examined by the doctors
only.
4. Maintain Health Records.
/Cc< cr c
113
STANDARD - II
1. Method of caring for the external parts of the body - Washing - Bathing Wearing footwear - Change of Clothing - Use of cleaning agents - Local and
Home made materials.
2. Knowing the internal systems and their functions of the body - Skeleton
system - Circulatory - Respiratory & Excretory systems.
3. Human being as a social animal - need for family - parents - friends for
healthy growth and development.
4. Quantity of food required for different age, sex and occupational groups.
5. Healthy and Protective foods. Hand pounded rice - Germinating Grams Leafy vegetables - cooking of food to preserve nutrients and safety - Use of
left-overs - food poisoning.
6. Physical Environment of Man: Water - Sources - Pollution-diseases
transmitted - Purification of Water - Domestic purification - There is no need
for bottled mineral water except during tours and excurtion.
7. Biological Environment of man: Rodents - Dogs
Mosquitoes.
Cattle, Housefly and
8. External Parasites of man: Louse - Scabies - Mode of Spread and Prevention
and personal Hygiene.
9. Good & Bad Health habits & Health behaviours - Avoidance of Alcohol Smoking - Chewing tobacco.
ACTIVITIES:
1. Writing the Skeleton of Human body and Labeling.
2. Drawing the Circulatory and Respiratory systems and Labeling.
3. Teachers Weekly examination for cleanliness, early symptoms of illness.
4. Daily play and Exercise.
5. Health Appraisal by Health Assistant.
6. Parents report on Health habits and Healthy eating habits.
114
STANDARD - III
1. Knowing the digestive and Nervous systems of the body and their functions.
2. Social system and Social life in villages - Wards
Towns and Cities.
3. Quality of food - Balanced diet - uses of Milk, Vegetables - Eggs - Meat.
4. Solid and Liquid waste produced by human activities at home - Disposal from
houses - Soak pit - Compost - Garbage disposal.
5. Housefly - Breeding places - Life history - Diseases spread - control.
6. Meaning of I lealth and Diseases.
7. Factors that determine Health.
ACTIVITIES:
1. Excursion to show the physical environment - Demonstration of Housefly
breading places.
2. Weekly Teachers observation and Record.
3. Parents Report.
4. Health Appraisal by Health Assistant and identification of departure from
normal growth and development of habits.
5. Cleaning the Class Room.
6. Daily Exercises.
I<
-a
115
STANDARD-IV
1. Knowing the various digestive glands and their functions.
2. Socialization - Love - Affection - Hatred, Jealousy.
3. Malnutrition - Grades - Deficiency - Vitamin A and Vitamin C and ways to
prevent by using fruits and vegetables - Vitamin A Supplement.
4. Mosquitoes - Breeding Places - Life History - Diseases spread and control.
5. Physical Environment around the school and houses - Drains - Ponds - Water
collections and their effect on health.
6. Common communicable diseases in the locality - Method of Spread and
prevention.
7. Accidents - Home - Traffic.
8. Primary Treatment for common cold - Fever - Respiratory Tract infections Diarrhea.
ACTIVITIES:
1. Excursion to show drains - Ponds - Mosquitoes breeding places.
2. Demonstration of Housefly and Mosquitoes and their eggs and Larvae.
3. Teachers observation weekly and scrutiny of parents report.
4. Health appraisal by Health Assistants.
5. Physical Exercise.
Q-
116
STANDARD-V
1. Coordination between various systems in the body - Functioning of the body
as a whole - Refractive Errors - Hearing defects Hormones and their
functions.
2. Growth and Development - Physical growth of infants Adolescent Spurt. - Developmental Mile-Stones.
Toddlers
3. Friends - Relatives - Interaction with them - Behaviours - Society norms
Adjustability - Tolerance - Avoidance of Stress.
4. Healthy eating and Learning habits - Cultivation of good habits and avoidance
of bad habits.
5. Use of Vegetables and other nutritive foods.
Other tasty bites which are injurious to health.
Avoidance of Chocolates
6. Domestic Animals - Pet and Street Dogs - Diseases spread by dog bite.
7. Common cold - Fever - Cough - Diarrhea - their management at home.
8. Avoidance of Unnecessary medication. And use of simple bed rest - Aspirin or
paracetamol - oral Rehydration for diarrhea.
9. Routine Immunization Schedule for children.
10. Sanitary disposal of Human excreta - Toilets at home - Suitable in villages Towns - Cities.
ACTIVITIES:
1. Excursion to show the open air defecation - Soil Pollution
matter enters the food chain.
How the fecal
2. Writing the Health Needs of the Human being.
3. Teachers observation weekly.
4. Health Appraisal by Doctors.
5. Review of the Health Record by Health Assistant - Report to the Doctor Doctors Advise and follow-up.
117
STANDARD- VI
1. Knowing the Human Reproductive system and function.
2. Primary and Secondary Sexual characters and Health Problems of
Adolescent.
Social Values - Role of Individuals in creating and
3. Social behaviour
Maintaing community health.
4. Group living - Group Activities - Play - Aggressiveness - Isolation and
with drawing behaviour - Courage and boldness. Mental health.
5. Malnutrition
Grades - Iron and Iodine deficiencies - Root causes.
6. Community water supply - Deep wells shallow wells - Ponds and tanks as
sources water.
7. Common Non communicable diseases - Diabetes - Hypertension
Cancers - HIV/AIDS.
8. Healthful house minimum requirement for health of a family - Danger of
cattle Shed with in the dwelling house.
9. Growth of population and population explosion - Need for limitation of
population growth small family norm.
10. Health care System in the village - Primary Health Centre - Sub-Centres
and their functions.
11. Ignorance - Superstitions - Rituals - Poojas - Need to know the effects of
these on health and the scientific view of the causation of disease .
ACTIVITIES:
1. Visit to primary Health centre or subcentre and learning the uses of doctors and
Health assistants in maintaining health.
2. Measurement of Height and Weight of Friends
Records.
Keeping their own Health
3. Arranging group discussion and seminars on environment
4. Teachers observations.
5. Health Appraisal by Health Assistant.
Food - Water.
118
STANDARD-VII
1. Endocrine glands and their functions.
2. Heredity - Genetics and Genetic disorders.
3. Occupation and Health - Factory
child labour.
Small Work shops - Hotels - Abuse of
4. Habits dangerous to Health
Alcoholism - Smoking - Use of Drugs Chewing Tobacco - Their impact on Health - Social problems.
5. Mental Health Problems - Recognition and counseling - Parents interaction.
6. Air and Noice pollution - Impact on Health.
7. Cardiovascular diseases - Role of Diet - Exercises. - Smoking and stress.
8. Reproductive and Child Health - Age at Marriage - Age at Pregnancy - Child
Birth - Safe Delivery - Low Birth Weight babies - Antenatal and Natal Care Food and Health Care of Mother during pregnancy and lactation.
9. School Environment - Need for Toilets - Separate for boys and Girls Drinking Water - Sufficient Play Ground.
10. Role of the panchayet In maintaing Healthy Environment in and around the
Villages - Slums - Towns.
ACTIVITIES:
1. Taking part in Health Examination of Lower grade students - Measurement of
Height and Weight - Taking Pulse Rate - Eye Sight Examination.
2. Taking part in Health Teaching of Lower Classes - Pupil to Pupil Teaching.
3. Arranging debates on population - HIV/ADIS - Social Behaviour - Moral
Restraints - Superstitions - Wrong and dangerous beliefs - Scientific Temper.
4. Health Appraisal by doctors.
5. Review of follow-up measures by health assistance.
6. Parents report on Social Habits and Health Habits and counseling if required .
-
6
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I
1 19
STANDARD-VIII
1. S.T.D. HIV/AIDS - Mode of spread and prevention - Moral restraint.
2. Family - Family Norms - Family Controls - Sexual mis behaviour - Crimes delinquency.
3. Responsible parenthood - Sex education Family Size - Spacing of children.
4. Food Adultration and Food Preservation.
5. Sanitation of Public Places - femplcs - Bus & Railway Stations
Shandys - Play grounds and schools.
J ali as
6. Measurement of diseases in the community - Prevalence Survey.
7. Mortality and morbidity rates.
8. Secondary and Tertiary Health Care.
9. Health Needs of Infants - Toddlers - Handicapped - Sick - Old People.
ACTIVITIES:
1. Taking part in teaching Health to lower class children.
2. Helping in conducting school health services by health assistant.
3. Measurement of pulse and blood pressure.
4. Practice of First Aid Activities.
5. Conducting debates, seminars group discussion on health and social issues.
¥
120
STANDARD-IX
1. Health Assessment of the Individual.
2. Health Need Assessment of the Community.
3. Important National Health Programmes
them.
Role of the People in implementing
4. Village Health - Ward Health Communities.
5. Training of Dais on Safe delivery.
6. Anganawadi Kendars - Their function and management.
7. Family planning - Family Welfare - Family Planning Methods.
8. Role of Men and Women in Family limitation.
ACTIVITIES:
1. Visit to Anganawadi Kendars and Knowing the functions.
2. Visit to Health Centre and Subcentre and Knowing the facilities for safe
delivery.
3. Help in Health Teaching.
4. Participating School Health debate, Seminars and group discussion.
5. Health Appraisal by Health Assistant.
121
STANDARD-X
1. Voluntary Health Organization - Principles of Voluntary Health work - Social
Services - Need for Voluntary Organization for Health Care.
2. Private - Public Health Care Services.
3. Minimum Health Care Facilities in villages - Tows
Diagnostic facilities.
4. Peoples participation in organizing and managing health care services
Immunization - Antenatal care - Health Awareness campaign.
like
5. Identification and Management of Pulmonary Tuberculosis - Leprosy Malaria - Diabetes - Hypertension - At home following the doctors
consultation.
6. Poverty - Employment - Education and their relationship to health.
7. Equity and Empowerment of Weakers sections of people for better health of
the community.
8. Right to health - Constitutional Provision and States Responsibility.
ACTIVITIES:
1. Conducting W.H.O. Day on 7th April.
2. Helping School to conduct seminars, symposia on health.
3. Helping Teachers and Health Assistant to conduct Teachers observation and
Health Assessments.
4. Giving Health Talks to Children and Public People.
5. Health Appraisal by Doctors.
6. Review of His/her Health Through School years - Report by Health Assistant.
1
International Union For Health Promotion and Education
South East Asia Regional Bureau
KARNATAKA CHAPTER
590, 10th Main, 5th Block, Jayanagar Bangalore - 560 041.
Dr. K. Basappa, MBBS., DPH., Dr. P.H. (USA)
Professor of Community Medicine (Rtd)
President, Karnataka Chapter-IUHPE.,
And Head of the Research Team
Dear Doctor
As you know, the Government of Karnataka have appointed Task Force on Health and Family Welfare,
headed by Dr. H Sudarshan. They are in the process of formulating their recommendations for
strengthening the Health Department by way of increased inputs like manpower and other essential
resources. The Task Force have a higli opinion about the histon of Karnataka State Health Department and
its superiority and efficiency and as such they want to recommend to the Government to expand the
activities of public health and to cover the health promotional area in addition to disease prevention and
disease control programmes, in a substantial way. Health promotional area is a broad area which requires
action on health determinants and which goes beyond Health Sector alone. Therefore, they wanted the
International Union for Health Promotion and Education to take up a Rapid Assessment of the “feasibility’
and modalities of application of principles of health promotion and integrating it with the Health
Education”. We have accepted the assignment.
To do the task efficiently, we need the opinion and expertise of people of your eminence and therefore. I
request you kindly to give some of your time and thought and help us to provide data for realistic and
implementable recommendations.
I have enclosed a list of documents and data to be provided from your division for information and
analysis.
I have also enclosed herew ith copies of letters from the Director of Health and Family Welfare Sen ices
and Dr. H. Sudarshan's letter addressed to the Secretary to Government Health and Family Welfare
Department for your information and reference.
You are rcqucslcd to participate in the inteniew tliat the research Team is conducting for furnishing your
expertise and opinion on the matters. Your individual opinion and comments will be kept confidential and
will not reflect in the research report.
I hope, you would appreciate the need for your participation and cooperate with the Research Team to
complete the task early.
With kind regards.
Yours sincerely.
Dr. K. Basappa
OPENENDED QUESTIONAIRE FOR HEALTH ADMINISTRATORS AND
SPECIALISTS.
MARK:
Strongly Agree (SA), Agree (A), Agree with Reservation (AR), Do not Agree
(DA), against each statement.
1.
Health Education should be one of the important
activity of the Health Department.
2.
Health Education is a process of changing the health
behaviour of people.
Health education is only imparting health knowledge
to people.
4.
Change in health behaviour requires series of steps
which involve awareness, motivation, interest,
evaluation, persuation, peer group approval, approval
of parents, partners before adoption
5.
To bring about die change in behaviour in certain
areas for example family planning requires die
approval of religious leaders, formal and informal
leaders in the community
Change in behaviour can be brought out easily if all
the people in the same social circle agree upon the
idea.
6.
7.
Health behaviour is picked up quite early in childhood
and infant by parents own action and couple and peer
group action etc. For example, smoking, alcohol,
personal hygiene practices. Therefore formal school
health programmes are essential.
8.
Health behaviour for small family norm is favourable,
if their parents have small family and not so
favourable if their parents have large family.
9.
State and District level Health Education Programme
should be planned.
10.
While planning, all the people concerned with
implementation should be involved.
11.
For purposes of planning, a group consisting of all
interested sectors should be formed well in advance
and entrusted die job of planning and prepare the draft
plan.
12.
Draft plan prepared by the group should be discussed
by all the heads of different divisions and the final
draft should be agreed upon like RCH, Malaria, AIDS
etc.
State Health Education programme should be flexible
so as to include local difference at District or P.H.C.
level.
13.
Contd....2
-2-
14.
Health Education programme should include general
and specific subjects.
15.
Health Education is the job of Health Educator.
16.
Health Education is the job of all health staff of the
PHC/Hosp ital/Instituti on.
17.
Experts say that any Health Education programme
should take into consideration the level of education,
attitudes, beliefs, socio-cultural aspects existing
practices, misconceptions, traditional beliefs etc.
18.
Contents of health education should include the
activities that encourages the positive health like,
good nutrition basic sanitation. Reproductive and
. Child Health, favourable life style, small family norm,
higher age of marriage and higher age of Is’ pregnancy
and the like.
19.
Contents should also include conditions or disease
specific subjects like Immunization, Malaria, Leprosy
etc.
20.
Health Education is not merely imparting scientific
knowledge to people, but also includes to equip the
people with skills and attitude to enable them to solve
their health problems by their own action and efforts.
21.
Health Education also include to promote the
development and proper use of health care services.
22.
At the grassroot level community participation is the
key for success of health education programme.
23.
Community participation should start from the
planning, finding resources implementation and
evaluation of the programme.
24.
In programme planning, every tiling should be left for
the people, the Health Educator should act as a
stimulator or initiator and as a guide to them.
25.
Awareness creation about the needs and problems
about health in the people’s mind is the first step and
demand generation is the 2nd step for any successful
health education programme.
26.
To bring about the change in behaviours or accepting
and practicing new behaviour a kind of social pressure
has to be built up in the community.
27.
Health education programme can be made sustainable
in every community/village/group by forming
grassroot level Health Education Committee headed
Contd...3
-3by public spirited person in the local area and socially
concerned persons as Members.
28.
Health Committees should as far as possible exclude
village panchayat members and Chairmen as this is
likely inject the local politics. Health Committees
should be non-political, voluntary organizations.
29.
Members of the Health Committees should be given
training and retraining in the form of Workshop or
Seminar at Taluka level. This is important to keep
them their knowledge uptodated and keep them
encouraged to do social work.
30.
Holding Wokshop or Seminar for Health Committees
should be one of the functions of health services.
31.
Health education pogrammes should be organized at
group level and at community level to create
awareness and demand generation and at individual
level to synthesize and change the behaviour for better
health/small family norm.
32.
Social mobilization is an important aspect of health
education programmes and sufficient Rinds must be
made available for the purpose in the Health Services
budget.
33.
All modem media like, films, radio, television, printed
posters, flipcharts and also folk media like street
plays, folk songs, dramas etc., should be used in
health education programmes and adequate financial
provisions should be made in the health budget of the
PHC.
34.
a) Health Educator at the PHC level should be
responsible for carrying out health education
programme at the community and group level.
b) But the programmes are not fully successful
because there is no sufficient funds, transport and
equipments for implementing the health education
programmes effectively.
35.
One Health Educator for 30000 population or per
PHC is sufficient to carryout the health education
programme
36.
The knowledge and skills of Health Educator with
DHE qualification is sufficient to carryout the social
mobilization activities and to ensure community
participation.
37.
All Health Educators posts must be filled up only with
DHE qualified persons.
Contd....4
38.
District Health Education Officers are responsible for
administration, direction, guidance and evaluation of
the programmes.
39.
The lack of success and low performance of the
district in health education field is attributed to (a)
lack of trained staff (b) lack of supervision and
guidance (c) lack of funds and equipment- (d)
combination of all. (tick the true one in your opinion).
40.
To improve the programmes and quality and
effectiveness of health education programmes as a
short time measures, the existing Health Educators or
persons working as Health Educators should be given
short term training in social mobilization and
community organization and as a long time measure
all Health Educators to be qualified with DHE.
Effectiveness and quality of education programme can
be accelerated by strictly adhering to the advance
programmes, surprise visits and proper management
measures and concurrent evaluation of the programme
by DHEO.
DHE qualified persons can carry out the health
education activities more effectively and efficiently
than others.
41.
42.
43.
44.
45.
46.
DHE syllabus requires change to include more
knowledge and capacity building activities for social
mobilization
work
and
ensure
community
participation.
There is complete coordination between the health
education wing and general health services.
Central Health Education Bureau is helpful to
implement the health education programmes in the
State.
a) Government of India has accepted to adopt Health
Promotion as a public Health Policy as
recommended by Jakartha Declaration and has
made ambitious commitment for a global strategy
of Health for All (HFA) and to the principles of
Primary Health Care through Alma Ata
Declaration. This requires enormous resources
and additional responsibility on Health Sector,
because the main action is to tackle the
determinants of Health. Through Advocacy,
Social Support and Empowerment.
b) This Policy change in very good and if
implemented will
improve health
status
substantially.
(
47.
I
i
Five strategies suggested for achieving the objectives
of Health Promotion are:
1.
Build Healthy Public Policy.
2.
Create supportive environment.
3.
Develop personal skills.
4. Strengthen community action.
5. Reorient health services.
These strategies requires concerted efforts and
goes beyond health care services and is on the
agenda of policy makers in all sectors and at all
levels. The health sectors in addition to
reonenting its own services, should be able to
influence policymakers of other sectors to be
aware of health consequences of their decisions
and to accept their responsibility for health. This
is possible by well coordinated intersectoral
coordination at the State level, at the District
level and at the Grassroot level.
1. It is possible to take the additional responsibility
within the existing staffing pattern of Health
Department.
2. It is possible only with additional staff at the top
level.
3. It requires additional staff at the District and
PHC level also (tick the appropriate one in your
view).
4. In addition to additional staff, it quires stronger
attention to health research as well as changes in
professional education and training of the
existing staff both at State, District and PHC
levels.
48.
For implementation of Health promotional Strategy
the Medical Officers at the P.H.C. Level should also
be competent and equipped with organizational and
administrative skills.
49.
The existing curriculum of community medicine at the
graduate level (MDBS) is not sufficient to provide
needed impact on the minds of medical students and
required additional theoretical background and
practical demonstration at die field level.
50.
The syllabus of community medicine includes the
elements that impart knowledge and skills but it is not
properly implemented due to lack of trained man
power in die department of community medicine in all
medical colleges.
Could
6
51.
The teaching of social sciences including sociology,
health economics, health development, social
mobilization techniques should be strengthened in
community medicine, at MBBS, level and DPH level.
52.
To achieve the above, the present medical education
module should include socio economic, cultural and
behavioural sciences and management sciences in a
substantial way and in depth, for both MBBS & DPH.
53.
In addition the present Medical Officers of Health
should be given short term (Two weeks) courses in the
above area particularly in management of health
programmes like planning, supervision and evaluation
of programmes.
Diploma course for DPH qualification should be of
two years duration & syllabus should include more of
socially, economics administration and management.
54.
55.
The post of District Health &, Family Welfare officers
should be filled up only people with at least DPH.
Qualification.
-7
56.
For successful health promotion, the countries should
adapt the principles of New Public Health and
strategies and implement them sincerely.
57.
Health promotion as suggested above, requires
strategies to be planned and implemented at all levels
of public health organization, that is at State. District
and PHC levels.
58.
Health promotion cannot be achieved only by filling up
the vacant posts of Health Educators at various levels.
59.
Health promotion certainly cannot be achieved by
application of computer technology.
60.
Health promotion is something that requires very high
investment in money and manpower resources
61.
For health promotion, money resources can be found
from local resources and international funding
agencies.
62.
Main stumblic
block for successful
health
promotion, action will be the lack of committed
manpower, as on today.
63.
Public health workers should spearhead the
to
initiative
involve
communities
in
the
development of their public health policies and
programmes.
64.
Among the public health workers, it is the
Health
Administrators at the PHC, District and State level
who should take initiative both in Public Advocacy and
social mobilization.
65.
Public health expert should give strong
leadership
and involve himself for the cause of public health
improvement of his country.
66.
It is the lack of strong public health leadership and
commitment that is at the root cause of present low
status of public health.
-8-
67.
Public health organization in Karnataka State is a wellknit organization with the Director of Health Sen ices
as the chief executive assisted by Additional
Directors/Joint Directors as Programme Directors
including one for Health Education and Divisional,
District and PHC level health administrators.
68.
The existing public health organization is capable of
implementing the health promotional policies and
programmes.
69.
Resources for public health education and social
mobilization is not difficult to obtain, because the
international funding organizations like World Bank is
eager to fund as has been seen in AIDS, RCH and
Waler Supply and Sanitation programmes in Karnataka
State.
70.
There is urgent need to strengthen the State Public
Health Services Department with public health experts
with strong leadership capacities and capabilities.
71.
In recent years, in the State of Karnataka as well as in
the Centre, there has been growing sense that public
health as profession, as a governmental activity and as
a commitment to society, is not fully supported.
72.
The role and mission of public health for health
promotion should be clearly defined and adequately
supported to achieve the goal of Alma-Ata declaration
of primary health care and H.F. A.
73.
In the long run, the postgraduate courses in the
community medicine must produce public health
experts who could give strong leadership and put health
promotion in the forefront. There is need for
restructuring and reorienting postgraduate medical
education in community medicine.
74.
The report of an international meeting held in Geneva
27-30 November 1995 on <cNew Challenges for Public
Health” has made the following observation. Please
give your opinion whether you agree or not, if agree,
how strongly about the relevance of these
observations about the Indian Public Health.
-9-
75.
The concept, practice and importance given to public
health by highest decision making people are important
for implementation of health promotional strategies.
76.
One of the major barriers for implementing the health
promotional strategies is the lack of properly trained
public health experts at the highest decision making
level and at the middle planning and implementation
level.
77.
The criticism is that public health practice has swung
too far from its original sanitary orientation and
become too disease oriented.
For example, the
dominance or risk factor model of disease.
78.
Public health often remained on the periphery of
academic medicine and is desperate need of
recognition.
79.
Public health has become isolated both from scientific
advances and from efforts to organize better health
systems. And this has relegated public health for a
secondary role in areas if its application generating a
vicious circle between isolation and irrelevance.
80.
Public health research is not making the necessary
contribution to public policy, because of its tendency to
want to be seen as excellent rather than any relevance
to the needs of public policy.
81.
Most public health professional and clinical
professionals working in public health positions in the
country have little training in wider aspects of health.
Their exposure to relevant social sciences and have had
little opportunity to learn from role model how to
address the social, economic and political forces
affecting health.
82.
Community medicine or public health research and
training should be relevant to the growing complexity
of their surroundings.
83.
Policy makers in public health and health professionals
should meet regularly to review the health problems
and research evidence available for their decision
making.
-10-
84.
Many health researchers are ignorant of key issues and
developments in the health policy.
85.
WHO advocates radical change with respect to
curricula
of postgraduate courses in community
medicine to include subjects to understand the New
Public Health a focus on the health of the population on
a global and social model of health and health gain.
86.
Management training of public health workers is seen
as lacking in the developing countries.
87.
There is need for synthesis between public health
training and health management training.
88.
Public health managers and administrators require a
combination of specialist clinical skills and general
management skill, combination of these skills in a
group of individuals will be vital in the future in
meeting the challenges posed by health care system and
by policy makers.
89.
In addition, the public health specialist needs skills in
communication,
public
policy
analysis
and
development also.
90.
Social programmes (this includes health) are operating
under ever tighter resource constraints. Therefore, the
contribution of good health to socio-economic
development must be convincingly demonstrated if
adequate and sustainable resources are to flow to the
health sectors.
91.
Resource allocation for public health must be more
equitable consistent with its contribution to social
development and new resources should be mobilized.
92.
The Governments should find ways and means to
enhance the status and image of public health care
professionals consistent with their crucial role in health
of the Nation.
93.
You can suggest any thing you deem fit, on the subject
under discussion.
e-mail :
080-2870943,
dir_hfw@kar.nic.in
gvnagaraj_dr@usa.net
GOVFRNMFNT Of KARNATAKA
<■ k r-3. Cj.
r(’r-
Jo 5? . 5 . K tCC'1 cuC’
■ ' .'er-''
l/C.cJvjrC2j^.rj3
- 560 009.
I I
Dr.G.V.Nagaraj md., dph .pgdhm
l/c Director of Health and FW Services
DO.No.1)1 IS/
Directorate of Health & FW Services
AnandaRao Circle, Bangalore-560009
/2000-0I
DL06-10-2000
Dear Doctor,
Sid):-Rcscarch into the modalities of application of principles of I Icalth promotion in Karnataka
Stale and integrating it with Health i'ducation-rcg
Karnataka Chapter of the International Union for Hunllh Promotion am’ Educali in , South East
Asia Regional Bureau has been entrusted by the I Icalth I ask force, to assist in the conduct of the research
icquircd for realist and feasible recommendations to the Government .
In this connection, Dr.K.Bnsnppn President, Knrnntnkn chapter of SEARS, will be visiting your
district to collect the required information and access all data of (he district.
You arc hereby directed to extend necessary co-opcrntion in (he above innUcr. I am requesting
Dr.Basappa President Karnataka Chapter ofSEARS to meet you in person.
With regards.
i
Yours Sincerely ,
To.
Dr..
District Health
FW Officer
Ra^chur.BcIgauin, Kohir.Kodagu.Dnvangcrc.l I ass an
i
f-opy for kind information to
* IDr.Basappa
President Karnataka Chapter of SEARS
II 590. 10"' Main 51" Block.
Jayunagar, Bangalore-560 041
Copy -to nil the. Frc-ra’rne Officers of
f or no cd f ul oction-
th i s Di rec torn te
i
Questionnaire for Programme Directors and Specialists
NOTE: Please Mark: Strongly Agree - SA: Agree-A:
Agree with Reservation -AR
Do not Agree -DA.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Health Education is very important for successfully
implementing any Public Health programme
Health Education Programme to be effective it
must have been well planned and relevant to the
Health Programme to be implemented
All health programme have inbuilt Health
Education component
In order to obtain maximum cooperation from the
people, the Health Education activities must reach
all people in the community
Many health programme do not succeed, because
people do not participate fully, with programme
implementers
Because of illiteracy and traditional bent of mind,
people do not take interest and learn about health
It is very difficult to educate our people on health,
because many of them are superstitions and
indifferent and do not believe in what Health
Worker say.
Peoples participation in health programme means:
a. Obtaining the benefits only
b. Taking part in planning and organization
c. Taking over the control of implementing and
evaluating the programme
d. As of the above.
Health education programmes must be directed
only for those who are in need of it.
Health education programmes should be directed
for all people in the community.
Health Education is an activity that all Health
Workers should be entrusted with this
responsibility.
All Health Workers should do health education
work on all health issues at the grass-root level and
it should be continuous and regular
/
2
13.
14.
15.
16.,
17.
18.
19.
20.
21.
22.
23.
All grass root level Flealth Workers should be given
training in elements of health education techniques
and periodically their skills and knowledge should
be updated.
To organize health education programmes for the
community and groups, there must be one Health
Educator in every PHC/every taluk, who has DHE
qualification
Block/Taluk level Flealth Educators should
organize, plan and implement health education
programmes regularly with the assistance of grass
root level workers.
Regular health education programmes; should
include all health programmes of the PHC and not
only Family Welfare programmes.
These health education programmes should be
implemented with the active participation of people
in the area.
It is the responsibility of the Health Educator to
ensure people participation like, local Women’s
Swasthya Sangh, Village Health Committee,
Womens self help groups etc.
Money and material resource required for these
health education programmes should be raised
locally from local philanthropic people. This should
be the responsibility of Block level Health
Educators with the help of local Medical Officers
and local Village Health Committee.
Block level Health Educators should not be given
any other responsibility at the PFIC level other than
Health Education and Communication.
Medical Officers of Health and Taluks Health
Officers should monitor and evaluate monthly and
report to the District Health Officers.
Health
Educators
should
be
effective
communicators and have the knowledge and skill to
speak and write on health issues in local dialects of
Kannada.
Health Educators must be able to synthesize
information on different topics and issues and apply
interpersonal skills like, negotiations, lobbying and
demonstrate the leadership skill.
3
24.
25.
i
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
n
Health Educator must be able to build allience with
other professionals and organizations and
collaborate with them to implement health •••
education programmes.
He must be able to assess the health need and
determine priorities for health promotion activity.
He must be able to develop and select suitable
strategies for health promotion.
There is need for one District Health Education
Officer who should supervise and guide the Block
Level Health Educators.
The District Health Education Officer should be
from among the Block Level Health Educators with
Master Degree in Social Science and DHE
qualifications.
The District Health Education Officer should
undertake Advocacy programmes for district level
policy makers and technical programme officers of
other Departments.
The District Health Education Officer should assist
the District Health and Family Welfare Officer in
planning, implementing and monitoring district
health education programmes.
The District Health Education Officer should be
able to convince District Health and Family
Welfare Officer and through him the Zilla
Panchayat President and the Chief Executive
Officer for better treatment of health programmes
in terms of implementation and allocation of
resources.
The District Health Education Officer should be
able to plan, organize and monitor regular and
special health education programmes of the district.
The District Health Education Officer must be able
to study the district development plants and identify
the health components in them and bring it to the
notice of the District Health & Family Welfare
Officer.
The District Health Education Officer should be
incharge of film unit which is equipped with
transport.
The District Health Education Officer must be able
to produce IEC materials depending upon the local
requirement.
4
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
I
46.
47.
n
The District Health Education Officer should be
answerable to District Health and Family Welfare
Officer and the Programme Director at the State
level.
Health Education Programmes should be monitored
by the programme officers at the State level
regularly to infuse enthusiasm and discipline.
Health Education programmes should also be
planned for the State by the Planning Cell at the
Directorate.
The State Planning Unit should include all the
programme Directors and the plans should be
comprehensive and include all relevant health
issues.
Health Promotional strategics like. Advocacy,
Social Support and Empowerment must be
undertaken by the District Health Education Officer
at the district level and programme Director at the
State level.
The Programme Director at the State level should
be provided sufficient trained and qualified staff to
plan and monitor health promotional strategies on
continuing basis.
Programme Director should report regularly the
working of his Unit to the Director of Health
Services.
Programme Director should have direct control
over the DHEO.
The IEC production unit should also be under the
control and direction of the Programme Director.
The existing District Health and Education Officers
should be trained in the health promotional
strategies and programmes and communication and
skill development.
Training of District Health Education Officer
should include epiemiology of health issues; ability
to analyse the behavioral, political and
environmental influences on health, intersectoral
coordination, interprete and report evaluation
programmes etc.
Any other suggestions are welcome.
■■■
List of documents to be obtained from the Directorate of
Health and Family Welfare Services
I. Statement of Health Education Policy.
2. List of Health Education Staff
Sanctioned
Working
At the state level
At the district level
At the PHC level
3. Administrative chart of the health education wing.
4. Job responsibility of various staff mentioned in item 2.
5. List I EC activities, planned and achieved in the last 3 years.
6. List 1EC activities subject wise if available.
7. List of subjects covered in health education.
8. Health education action plans at the state level for the last 3 years and
achievements.
9. Budget allocation for health education for the last 3 years.
10. Feed back statistics in the performance of health education work as a whole for
the last 3 years.
11. Administrative circulars and guidelines issued from the Directorate for the last 3
years.
12. The list of Health Educators with D.H.E qualification and without D.H.E.
qualification.
13. List of IEC material produced in the last 3 years and the amount spent.
14. Any other information related to function of the Health Education Wing.
n
List of documents to be obtained from the District Health
and Family Welfare offices from each district
1. List of staff of Health Education Wing - DHEOs and HE s .
Sanctioned
Working
No. of working
months
1998
(
1999
2000
2. List of people with and without DHE qualification.
3. District action plans and achievements for the last 3 years.
4.
List of Health Educators undergone inservice training for the last 3 years.
5.
List of subjects covered in health education activities.
6. List of charts and diagrams, posters etc., prepared / received to the district.
7. Activities of District Health Education Officer.
8. List of IEC activities planned and achieved for the last 3 years.
9. Budget allocated for the IEC activities and the amount spent.
i*
10. List of statement of performance of the health wing for the last 3 years.
11. Any other activities related to health education.
n
HEALTH EDUCATION PRACTITIONERS
HEALTH EDUCATORS DHEO/BLHE
Remarks - 1. Strongly Agree (SA) 2. Agree (A) 3. Agree with Reservation (AR)
4. Do not agree (DA) 5. Not Done (ND)
1.
2.
3.
)
Usually Health Education programmes should be planned
at the State level every year and evaluated against the
objectives.
When planned, it should be preferably jointly done with
all other divisions of the Directorate, like RCH,
Communicable Diseases, AIDS etc.,
If there is no comprehensive plan of health education as
suggested above, how it is done at present. Tick the
appropriate ones.
4.
In the preparation of the health education programme
which of the following are considered at the State level.
5.
Health education programmes should be directed.
6.
Health education is usually targeted to individual persons,
groups and general public. In your opinion which one you
target most and least.
7.
To change the behavior of people, series of orderly steps
are required. Awareness, interest, motivation trial and
adoption. Do you follow these principles in organizing
health education programmes.
8.
How strongly you agree with the practicality of these
principles
9.
Following methods are used for health education:
(a) Talks (b) Group discussion (c) Seminars which one of
these you have used most and which least.
10. Visual media is said to be better. Which of the following
media you are in your daily work. (1) Flipchart (2) Flanel
graph (3) Posters (4) Wall paintings
11. How often you use mass media for health education for
awareness creation.
n
i. It is the concern of the individual
division
ii. Health education experts are not
consulted
iii. Usually health education experts are
included in the panel
iv. Health education programmes are
conducted as per guide lines given by the
Central Health Education Bureau for the
individual divisions.
1. Literacy level in the State.
2. Proportion of SC & ST in the
population.
3. General misconceptions, level of
awareness about the subject.
4. People’s attitude.
5. None of them are considered
6. All of the above should be
considered
1. towards all people and also
2. directed towards specific groups
like women - old-age - children and
also against specific diseases like
Malaria, Leprosy, Tuberculosis etc.
1. Most
2. Least
1. Yes
2. No
1. Talks (person to person)
2. Group discussion
3. Seminars
Often Very Often Rarely
Jathas
Film shows
Dramas
12.
In a week, how many days you are engaged in health
education activities
13.
Have you formed Health Committee in villages? Who are
the Members? How is their influence - (Great - Not much
- Useless)
14.
15.
16.
17.
18.
[1
How often the Committee Meet?
Once a month / 3 months / Not regularly
Do you know influential leaders in your area? What is
their contribution? Give their names if you remember.
Influence of opinion leaders of the local area is very
important in motivating people. How do you rate the
influence of the following people.
Informal leaders
Panchayat members
Religious leaders
Caste leaders
People in the neighbourhood
Family members
Among the family members, how do you rate the
influence of these:
Mother
Father
Mother-in-law
Father-in-law
Brother
Sister
Rank the role of the following local organisations in
creating social pressure on people to change their
behaviour.
1. Village Health Committee.
2. Self Help Groups.
3. Mahila & Youth Mandals.
Health promotion activities goes beyond Health Sector
and extends for the following other government sectors.
Do you use them in your activities ?
eg: Watery Supply
a) Engineering Sectors
b) Agriculture & Harticultural Sector eg: Growing fruits
and vegetables
c) Community Development Sector
eg: Income
generation, child
care, nutrition.
T.V. shows
Street plays
Health education activities
Organisation
Meetings
Supervision
Health talks
Others
Yes / No
Give ranking 1 2 3 4
Give ranking 1 2 3 4
Give ranking 1 2 3 4
Yes / No
SUPERVISORY LEVEL - STAFF
Lady Health Visitor
Senior Male Health Assistant
District Level
Block Level Health Educator
C!
1. Experience
2. Awareness of job responsibilities
3. Is health education one of their job
4. Attitude: General activities
towards health education activities
5. Knowledge about supervision
Guidance
6. Improvements of the above
7. Areas of supervision/guidance
8. Programme planning - is health education included
Ct
9. Improvement of planning
assessment
C 9
10. Social mobilization
Knowledge
Opinion
Methods
Skill in talking to people
Ability in mobilizing public opinion
11. Role of V.H.C. Panchayat
S.H.C. Mahila Mandals
Religious Leaders
12. Inter-Sectoral Coordination:
C.D.P.O.
Revenue
Engineering
Harticulture
Agriculture
13. How often you meet
Can this work
Can this be useful to you
!1
C 9
GRASS ROOT LEVEL WORKERS
Ranking: Highest to Lowest
A
1.
2.
3.
4.
5.
6.
Experience___________________
Awareness of job responsibility.
Health education as one of the job.
Attitude
General
Technical - all fields
_______ Health education fields
Knowledge in the fields:
General
_______ Health education._______
Areas of his/her concentration in
health education
7.
Level of Knowledge
8.
Use of Health Education methods
Knowledge
_______ Use/Practice___________________________
Social mobilization activities
Skill in talking to people
Knowledge about the local
people & their influence on people
What are the methods:
Jathas
Dramas
Folk songs
_________ Film & Video Films___________________
What is the role of Village Health Committee &
Panchayat. SHG, Mahila Mandals_________________
Advocacy - Generate public demand
Peoples participation
__________ Helps in social support________________
Inter-Sectoral-Coordination:
C.D.P.O
In what way they can help
Revenue
you and health
Engineering programmes - in your view
Harticulture
how can you help them in
Agriculture
their programmes.
9.
10.
11.
12.
R
C
D
R.H.
F.P. '
C.D.
R.H.
E. S.
Nutrition
R.H.
F. P.
C.D.
P.H.
E.S.
Nutrition
PuBLIC HELATH ENGINEERING DEPARTMENT
(Chief Engineers, Superintending Engineers/Executive Engineers of the
Public Health Engineering Department)
Remarks : Strongly Agree (SA), Agree(A), Agree with Reservation (AR)
Do not Agree ( DA)
1. Introduction of IUHPE-outline of
the Research Project.
2. Public Health Engineering works in
the long run results in improved
community health.
3. Engineering projects have health
impact both directly and
indirectly, for example. Big Dams,
Hydro-Electric Projects, Roads etc.,
have positive impact on health of the
people indirectly, whereas drinking
water supply and sanitation have
direct impact on health.
4. Engineering projects can also cause
ecological imbalance and affect the
health of the people adversely.
5. Engineering projects can also create
health hazards to people in the vicinity
of the Project by creating water stagnation
which help to breed mosquitoes
6. Many irrigation channels that run
closely to the villages can create
dampness in the residential houses and
thus have bad effects on health.
7. The above (5-6) illeffects on heath are
preventable if proper preventive measures
are taken at the time of construction.
M
8. In addition, there is need to use the
principles of public health engineering
in town planning and village planning.
9. There is a need to consult or avail the
public health advise both in the
planning and implementation stage
in public works.
10. Are there any consultation between
public health and public health
engineering departments in the State.
11 .How strongly you agree for the
suggestion that the public health
expertise should be sought where health
of the people is involved either directly
and indirectly.
12.Have you had any orientation of health
implications of engineering projects
during your B.E. course.
13.There is M.E.P.H. course in the
Engineering College. Do BE graduates
with MEPH are absorbed to public health
engineering sector.
14.1s there any need for inter-sectoral
coordination with health or public
in health Engineering sectctor
15. Suppose there is strong plea from
the public health expert for increased
allocation of resources for projects that
helps to improve public health or prevent
illeffects on health, what will be your reaction ?
16.If Health Expert is appointed to certify
that every engineering projects have been
completed without causing any harm to
public health. What will be your reaction ?
CL
‘
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Position: 2597 (2 views)