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/ 17
Points to be covered in this topic
1.1 INTRODUCTION
1.1.1 Definition social pharmacy
1.1.2 Social pharmacy as a discipline
1.2 CONCEPT OF HEALTH
1.2.1 WHO Definition
1.3 VARIOUS DIMENSIONS
1.4 DETERMINANTS
1.5 HEALTH INDICATORS
1.6 NATIONAL HEALTH POLICY (NHP)- INDIAN
PERSPECTIVE
1.7 PUBLIC AND PRIVATE HEALTH SYSTEM IN
INDIA
1.8 NATIONAL HEALTH MISSION
1.9 MILLENNIUM DEVELOPMENT GOALS (MDGS)
1.10 SUSTAINABLE DEVELOPMENT GOALS (SDGS)
1.11 FIP DEVELOPMENT GOAL (INTERNATIONAL
PHARMACEUTICAL FEDERATION) .
INTRODUCTION
Social pharmacy shows a broad understanding that the practice
of pharmacy does not just involve giving out prescription drugs
and advice to people who heed it blindly. Instead, the practice of
pharmacy can be seen as a social activity that involves both
pharmacists and the general population.
1.1.1 Definition Social Pharmacy
A science that addresses the social aspects of the pharmacy protession is
known as "social pharmacy," and it deals with the function of medicines
from social, scientific, and humanistic perspectives.
1.1.2 Social Pharmacy as a discipline
w
Pharmacy's fundamental knowledge base has historically consisted of
chemistry, biochemistry, physics, and physiology. The foundation of a
pharmacist’s professional skill is their understanding of drugs and their
effects. They are interconnected among families, organizations, and health
systems across various nations and cultural backgrounds.
Role of Pharmacist in Public Health
Review prescriptions: In addition to being able to verify that the
prescription is accurate and comprehensive, the pharmacist should
evaluate and handle prescriptions professionally.
Dispense prescription and non-prescription medicines: The Drugs
and Cosmetic Act, the pharmacist is supposed to be able to distribute
different prescription medications and medicines that the patient needs.
The pharmacist should also prescribe non-prescription, or over-the-
counter, medications with extreme caution.
Provide patient counseling: The patient should be able to get advice
from the pharmacist on the medications and drugs they take. It is also the
pharmacist's responsibility to inform patients about their condition and
the effects of their medications. Pharmacist’s should also educate patients
on the proper usage of their medications,
Hospital pharmacy management: Hospital pharmacist policies should
govern how the pharmacy operates the hospital's medication delivery
system. ot
Expertise on medication: Healthcare providers like doctors and nurses
should be able to get expert advice from pharmacists on how to use
medications safely and effectively.
6. Proficiency in pharmaceutical formulation: A pharmacist should be able
to explain the properties, types, advantages, and disadvantages of any
medicine that is utilized by the general public.
7. Deliver health care programs: It is recommended that pharmacist’s
organize a range of health initiatives, such as education on
pharmaceuticals, diseases, public health and hygiene.
8. Recording incidents of a disease in their community; Pharmacists ought
to have the ability to document any instances of a disease emerging in their
neighborhood.
9. Identifying adverse reaction of a drug: Any negative reaction or side
effect that a drug may have on a patient in their vicinity should be
recognized by the pharmacist. “as \
Yast)
a WR
1.2.1 WHO Definition = el
The World. Health Organization (WHO) defines health as "a state of
complete physical, mental, and social wellbeing and not merely an absence
of disease or infirmity" in its constitution.
Astate that is capable of leading a fruitful social and economic life has now
been included.
1.3 VARIOUS DIMENSIONS
1, Physical Health
* It refers to a person's constitutional health as well as their physical
integrity on both a structural and functional level.
It shows that every body organ is physically e
(anatomically) and functionally (physiologically) in a
normal state and that there is perfect coordination
between the organs and systems so that the bedy as a
whole is functioning optimally. N
. Mental Health
* Mental health has been defined as “a state of balance
between the individual and the surrounding world, a state
of harmony between oneself and others".
3. Social Health
* Health is a result of not only receiving medical care but also Cs
of society’s total integrated growth, including its cultural,
economic, educational, social, and political aspects.
* Thus, the dynamic link between the population, the area
they occupy, and the professional skills they have gained “s
for their needs determines the group's health,
AS
4. Spiritual Health
* The desires and aspirations of the patient are ignored by modern
medicine since it takes a mostly mechanistic. approach
treatment. c
* The spiritual connection between the spirit, mind, and
body is critical in providing for people, research has
recently shown. According to studies, altering a
person's way of life can assist to lowering the
prevalence of certain diseases.
DETERMINANTS
*® Determinants of health are factors that influence the health status of
individuals and populations. These determinants can be categorized into
several broad groups, and they interact in complex ways.
Tee gece Ue)
Individual CONT
Socioeconomic development, Political will
Fig. 1.1: Determinants of Health
Availability of health services| A. Individual
1. Genetics
* One of the causes of several diseases is hereditary factors.
Some types of illness are caused by hereditary traits that
people inherit from their parents.
« For eg-, there is a higher likelihood that the offspring of diabetic parents
may develop the disease. Therefore, a person's genetic makeup plays a rele
in their current condition of health.
2. Life cycle
* The style of life, attitude towards life, and knowledge of healthy living are
all factors that affect a person’s health.
* For eg, a person's behaviors (alcoholism and drug addiction) may cause
issues with leading a healthy lifestyle if there is a lack of health awareness.
B. Environment
1. Socioeconomic development
«© Humans are subject to a system of rules and regulations that have been
established and approved by the society in which they reside. A person's
health can be impacted by a variety of cultural practices and traditions.
poh Lowproduction of goods and services ———_
ay
More Disease”
[ ar Income subsidence
Low investment in medieal eare
Low efficacy ae )
Ly More investment in medical care Z
-
a | Poor nutrition. poor education, peor housing
~~ “
| isease | we
Fig. 1.2: Economic cycle of diseases
2. Political will
* Poverty is the main contributor to poor health, as can be seen,
if we examine the causes of illness. Disease agents target the
underprivileged population that resides in slums with low
hygiene conditions. 3. Availability of health care services
e [tis now widely acknowledged that the right to health is a fundamental one.
Therefore, it is in each nation's best interest for its citizens to be in good
health. Each country's government offers cheap health care to its citizens.
HEALTH INDICATO!
Indicators of Health
© Since there are various facets to health, there is also a wide variety of health
indicators. All elements that negatively impact health must be evaluated and
measured to describe the state of the community's health.
Many indicators are used to describe the health profile of the community
as follows:
1. Mortality Indicator: The indirect indicator of health is the mortality rate. A
community's health state can be determined by looking at mortality rates
for different age groups, such as newborn, child, and maternal mortality
rates as well as mortality rates for certain diseases and the overall death
rate.
2. Disability Rate: Between two extremities of mortality rates (about fatal
outcome) and morbidity rates (about suffering) there are persons who
remain disabled for some time or lifelong on recovery from disease/illness.
3. Health Care Services Indicators: As a measure of one's health, the
availability of medical services is determined by the doctor-to-pepulation
ratio, the population-to-bed ratio, and the population-to-health center ratio.
4. Sanitation Indicator: This term covers care of food, and water, disposal of
excreta and regulation of the environment. Thus, if adequate nutritional
requirements are not fulfilled, it will result in ill-health that can be
measured in terms of height, and weight measurements of school children.
5. Socioeconomic Indicator: The socioeconomic health of a community can
be determined by measuring socioeconomic development in terms of
population growth rate, per capita income, unemployment rate, literacy
rates, etc.
6. Quality of life Indicator: By characterizing the quality of life that each
person and the community as a whole lead, health status can be evaluated. 1.6 NATIONAL HEALTH POLICY (NHP-
INTRODUCTION
A National Health Policy is a comprehensive and strategic framework
developed by a country's government to guide the overall direction and
goals of its health sector. It serves as a roadmap for planning, implementing,
and evaluating health programs and initiatives.
(A) NATIONAL HEALTH POLICY (NHP) 1983
rs 1. First National Health Policy (1983)
, 2. Second National Health Policy (2002)
as 3. Third National Health Policy (2017)
Bi
Features of the 1983 Health Policy
It was critical of the curative-oriented western model of healthcare.
Emphasized a preventive, promotive and rehabilitative primary health
care approach.
e Recommended a decentralized system of health care, the key features of
which were low cost, deprofessionalization (use of volunteers and
paramedics), and community participation.
® Expansion of the private curative sector which would help reduce the
government's burden.
(B) NATIONAL HEALTH POLICY (NHP) 2002
A revised health policy for achieving better health care and unmet goals
was brought out by the government of India in National Health Policy
2002.
Objectives and Key Strategies of NHP 2002
Primary Health Care Approach
Decentralized public health system
Convergence of all health program under single field umbrella
Strengthening and extending public health services
Enhanced contribution of private and NGO sector in health care delivery
BP eee (C) NATIONAL HEALTH POLICY (NHP) 2017
The National Health Policy, 2017 was passed by the Union Cabinet at its
meeting on March 15th, 2017. This is the third NHP government of India. 14
years after the last health policy (NHP 2002) the context has changed in four
major ways to design NHP 2017 as below.
‘@ Ever Changing Health Priorities: Even with the rapid decline of maternal and child mortality
rates, there has been a constant growth in the number of non-communicable and infectious
diseases.
® Growth Rate of the Health Care Industry: One significant change is the emergence of a robust
health care industry that is estimated to grow in leaps and bounds.
© Catastrophic Expenditure: The growing rate of catastrophic expenditure due to costs for
"healthcare is another reason. Poverty is said to be a result of these costs.
@ Economic Growth: The rise in economic growth enables enhanced fiscal capacity.
L
The goal of the NHP 2017 are as follows
1. The policy aims to attain the highest level of health and well-being
possible for every individual in any given age group, through a preventive
and promotional healthcare orientation in policies.
2. It also focuses on universal access to excellent quality healthcare services
without anyone having to face financial hardship.
3. The Policy recognizes the importance of Sustainable Development Goals
along with an indicative list of time-bound quantitative goals aligned to
ongoing national efforts and global strategic directions.
Principles of the National Health Policy 2017
1. Professionalism, Integrity and Ethics: The health policy commits itself
to the highest professional standards, integrity and ethics to be
maintained in the entire system of health care delivery in the country.
2. Equity: Reducing inequity would mean affirmative action to reach the
poorest.
3. Affordability: As costs of care increase, affordability, as distinct from
equity, requires emphasis. Catastrophic household health care
expenditures defined as health expenditure exceeding 10% of its total
monthly consumption expenditure or 40% of its monthly non-food
consumption expenditure, are unacceptable. ¢)
a)
b)
a)
b)
Health Status and Programme Impact
Life Expectancy and Healthy Life
Increase Life Expectancy at birth from 67.5 to 70 by 2025.
Establish regular tracking of Disability Adjusted Life Years (DALY) Index as
a measure of the burden of disease and its trends by major categories by
2022.
Reduction of TFR to 2.1 at national and sub-national level by 2025.
Mortality by Age and/ or cause
Reduce Under-five mortality to 23 by 2025 and MMR from current levels
to 100 by 2020. Reduce infant mortality rate to 28 by 2019.
Reduce neo-natal mortality to 16 and stillbirth rate to “single digit” by
2025.
Reduction of disease prevalence/ incidence
Achieve the global target of 2020 which is also termed as the target of
90:90:90, for HIV/AIDS i.e, - 90% of all people living with HIV know their
HIV status, - 90% of all people diagnosed with HIV infection receive
sustained antiretroviral therapy and 90% of all people receiving
antiretroviral therapy will have viral suppression.
To achieve and maintain a cure rate of >85% in new sputum-positive
patients for TB and reduce the incidence of new cases, to reach
elimination status by 2025.
Health Systems Performance
Coverage of Health Services
Increase utilization of public health facilities by 50% from current levels by
2025.
Antenatal care coverage to be sustained above 90% and skilled attendance
at birth above 90% by 2025.
More than 90% of newborn are fully immunized by one year of age by
2025.
Meet the need for family planning above 90% at the national and sub-
national level by 2025.
80% of known hypertensive and diabetic individuals at the household level
maintain “controlled disease status” by 2025. a)
b)
¢)
a)
b)
c)
b)
)
Cross-Sectoral goals related to health
Relative reduction in prevalence of current tobacco use by 15% by 2020
and 30% by 2025. Reduction of 40% in prevalence of stunting of under-
five children by 2025.
Access to safe water and sanitation to all by 2020 (Swachh Bharat
Mission).
Reduction of occupational injury by half from current levels of 334 per
lakh agricultural workers by 2020.
Health Systems strengthening
Health finance
Increase health expenditure by the Government as a percentage of GDP
from the existing 1.15% to 2.5 % by 2025.
Decrease in the proportion of households facing catastrophic health
expenditure from the current levels by 25% by 2025
Health Infrastructure and Human Resource
Ensure the availability of paramedics and doctors as per the Indian Public
Health Standard (IPHS) norm in high-priority districts by 2020.
Increase community health volunteers to population ratio as per IPHS
norm, in high priority districts by 2025.
Establish primary and secondary care facility as per norms in high-
priority districts (population as well as time to reach norms) by 2025
Health Management Information
Ensure a district-level electronic database of information on health
system components by 2020.
Strengthen the health surveillance system and establish registries for
diseases of public health importance by 2020.
Establish federated integrated health information architecture, Health
Information Exchanges and National Health Information Network by
2025 *
wv
Policy Thrust
Preventive and Promotive Health: The policy aims to institutionalize
inter-sectoral coordination at national and sub-national levels to optimize
health outcomes, through the constitution of bodies that have
representation from relevant non-health ministries, The policy identifies
coordinated action on seven priority areas for improving the environment
for health:
The Swachh Bharat Abhiyan: One of the mest well-known and important
initiatives in Indian history is the Swachh Bharat Abhiyan. On October 2,
2014, Prime Minister Narendra Modi announced and started this
campaign in remembrance of Mahatma Gandhi's dream of a clean nation.
Addressing tobacco, alcohol and substance abuse: The success of Nasha
Mukti Abhiyan weuld be judged in terms of a measurable decrease in the
use of tobacco, alcohol and substance abuse.
Yatri Suraksha: The Indian Railway Protection Force (RPF), has launched
a pan-India operation known as Operation Yatri Suraksha. Under this
initiative, several steps are taken to provide round-the-clock security to
passengers.
| 1.7. PUBLIC AND PRIVATE HEALTH SYSTEM IN INDIA
Public Healthcare System:
The state and federal governments in India oversee public hospitals and
healthcare systems.
Every patient has the right to enter a public healthcare facility for
treatment, and these facilities are not permitted to turn away any patients.
The majority of Indians would rather use the public healthcare system
than the private one because the former requires significantly less funding
than the latter.
Almost every Indian city has access to a public healthcare system. (uasiayr ment)
ae)
wee)
sn) LA nmin)
a ) oo)
Lm)
= = —
[mecca] [wortmannin] Pa
Fig. 1.3: Public Health care system
2. Private Healthcare System:
. In India, patients receiving private healthcare receive individualized
attention and prompt treatment, but there is a cost associated with this.
. The cost of healthcare facilities in the private vs public sectors is
significantly higher.
. The private healthcare system is free to turn away individuals who they
believe are unable to pay for their care, but they cannot turn away
patients who are in urgent need of care.
een eee eit
-——(__ForProfit )
| multispecialty Mospitale
‘Speciality Hospitals
Charitable Trust | Non-Gover
dispensaries Orga
~ Wospitals (Religious
Non-religiows
Fig. 1.4: Public Health care system
f
Nursing Homes )
Private Clintes INTRODUCTION
The National Health Mission (NHM) is a flagship healthcare program
launched by the Government of India in 2005 to address the health needs
of the underserved and vulnerable populations in the country:
The goals for NHM have been set specifically for states
The National Health Mission (NHM) in India has several overarching goals
aimed at improving the health and well-being of the population. While
specific priorities may vary across states, the following are common goals
shared by the NHM:
Universal Immunization: Ensure universal immunization coverage to
protect children and adults against preventable diseases. This involves
expanding the reach of immunization services and increasing community
awareness about the importance of vaccination.
Promote Family Planning: Encourage and facilitate family planning
services to enable couples te make informed choices about the number and
spacing of their children. This contributes to population stabilization and
maternal health.
Contrel Communicable Diseases: Implement strategies to control the
spread of communicable diseases such as malaria, tuberculosis, and
HIV/AIDS. This involves prevention, diagnosis, treatment, and awareness
programs.
Address Non-Communicable Diseases: Develop strategies to address the
rising burden of non-communicable diseases (NCDs) such as diabetes,
cardiovascular diseases, and cancer. This includes prevention, early
detection, and management of NCDs.
The endeavor would be to ensure the achievement of indicators as
follows .
Reduce MMR (Maternal Mortality Ratio) to 1/1000 live births.
Reduce IMR (Infant Mortality Rate) to 25/1000 live births.
Reduce TFR (Total Fertility Rate) to 2.1.
Prevention and reduction of anemia in women aged 15-49 years
Prevent and reduce mortality and morbidity from communicable, non-
communicable; injuries and emerging diseases. Be
