Ctamlouis Health

Health sector Reforms in Andhra Pradesh

    A review on Health sector reforms in India   The health sector reforms in India were started way back in 1970s . The Govt. of India identifies the need HSR and stated in the eighth five year plan. The Eighth Five Year Plan (1992-1997) was the first plan document to state the need for re-structuring of economic management systems, following the macro developments of the 1990s. During this period in the health sector, the concept of free medical care was revoked and people were required to pay, even if partially, for the health services (1). The Ninth Five Year Plan (1997-2002) emphasized the need to review the response of the public, voluntary and private sector health care providers as well as the population themselves to the changing health scenario, to reorganize health services to bring about greater efficiency and effectiveness and to introduce health system reforms to enable the population to obtain optimum care at affordable cost The Ninth Plan sought to increase the involvement of voluntary, private organizations and self-help groups in the provision of health care and ensure inter-sectoral coordination in implementation of health programmes and health-related activities as well as enable the Panchayati Raj Institutions (PRI) in planning and monitoring of health programmes at the local level so as to bring about greater responsiveness to health needs of the people and greater accountability; to promote inter-sectoral coordination and utilise local and community resources for health care(2) . The Tenth Five Year Plan (2002-2007) touches upon reforms at primary, secondary and tertiary level(3).                         Politics influence health systems in significant manner. The goals, priorities, and the strategies, variations in the commitment are largely decided through the political contingencies. There are competing demands on the health systems. The evolution of the health systems is largely shaped by the culture, history, and norms. Client satisfaction is very high. As per NFHS-2 data, an overwhelming majority of clients are satisfied by the services delivered by the public systems. May be the expectations are low or may be our people are so courteous. But on the hand, we have the report from Transparent International, ranked the health system in India is the most corrupt system (4)   The Government has taken several steps for improving the public health care institutions and Strengthening the primary health care infrastructure. However, the situation is compounded by severe resource constraints – financial, technical and human power related, which has resulted in policy makers as well as programme managers at differing levels being faced with difficult choices. In such a situation, attempts are being made through various reform initiatives to ensure that the health needs of the people are met One of the major reform initiatives underway is the Secondary Health System Strengthening Project funded by the World Bank in seven states (Andhra Pradesh, Karnataka, Punjab, West Bengal, Maharashtra, Orissa and Uttar Pradesh). The projects include strengthening FRUs/CHCs and district hospitals so as to improve the availability of emergency care services to patients, to reduce overcrowding at district and tertiary care hospitals, construction works, procurement of equipment, increased availability of ambulances, drugs; improvement in quality of services following skill up gradation training in clinical management, changes in attitudes and behavior of health care providers; reduction in mismatches in health personnel / infrastructure; improvement in hospital waste management, disease surveillance and response system. It is essential to assess both progress and problems in implementation of the reforms in each state and to appropriately modify the content and pace of implementation. Such an overview and analysis of all related issues is necessary to provide evidence to policy makers and other stakeholders in terms of the various dimensions and impact of health sector reform. (5) In the Indian Constitution, health is a state responsibility. During Adjustment, many state governments in India had recourse to Health Systems Development Project loans from the World Bank for carrying out health sector reforms (HSR), of which one of the key policies has been to raise public spending on health care from the abysmally low levels seen up to then. The Health Systems Development Project seeks to develop strategic management capacity; strengthen performance, accountability, and efficiency; and build implementation capacity. Further, it seeks to improve clinical service quality by renovating and expanding district, sub district, and community hospitals and improving access to services. In all seven reforming states, around 15% of the total project cost is borne by the state governments. All the project documents note the low levels of funding for secondary hospitals in the reforming states. This is attributed to the small share of overall public spending allotted to health, the limited portion of total health spending going to hospitals, and, within this, a skewed distribution of funds in favour of the tertiary hospitals. After analysis of the problems of the health sector, the governments of the reforming states have agreed-using terminology ranging from “assurances” to “commitments”-to several undertakings. These are: (i) to enhance the overall size of the health budget; (ii) to redress imbalances in public expenditure between secondary and tertiary care levels; (iii) to safeguard the operations and maintenance components of current expenditure allocations for the secondary health-care sector; (iv) to charge user fees for selected services; and (v) to address workforce issues. The Health Systems Development Project initiated in the seven states recognizes the need for enhanced public spending on health and identifies it as the foremost policy reform to be pursued. Nevertheless, such assurances and conditions have not succeeded in enhancing health sector budgets in states implementing HSR. Worse, HSR has not been able to arrest the decline in the share of health spending within total government spending. The Indian system is especially complicated, as the larger tax resources are controlled by the central government but the major responsibility for health-care spending is bestowed on the states (6). Andhra Pradesh is the first state to go with the HSR.               Health sector reforms in Andhra Pradesh   The state of Andhra Pradesh was formed on 1st November, 1956 under the States’ reorganization scheme. It is the fifth largest State with an area of 2, 76, 754 sq. km, accounting for 8. 4 % of India’s territory and also the fifth most populous state with a Population of 75 crores. The state has varied physiographic features ranging from high hills, undulating plains to a coastal deltaic environment. Administratively, Andhra Pradesh is divided into 23 districts, 79 revenue divisions, 1123 mandals, about 27000 villages and 264 towns. AP’s economy grew at 7. 2% during 2006-07 — the fourth consecutive year of 6% plus growth. The latest poverty headcount ratio stands at 16%, compared to 23% for India . the third-highest credit rating among the major Indian states; the third best investment climate in the country; and the fourth-lowest corruption level among Indian states Andhra Pradesh was the first Indian state to receive a multi-sector Bank operation – the Andhra Pradesh Economic Restructuring Program for US$ 550 million in 1997 – aimed at helping the state accelerate policy and institutional reforms across a wide range of sectors under a common fiscal framework. It is also the only Indian state where the Bank has disbursed three budget support operations – the First Andhra Pradesh Economic Reform Loan (APERL-1) in March 2002, the Second APERL in February 2004, and the Third APERL in January 2007 – that sought to support the state’s development program. (12) Within AP there are regional, social and gender disparities. Health outcomes are worst among Scheduled Castes (16% of population) and Scheduled Tribes (7% of population), especially those living in underserved areas in North tribal and South drought prone districts, and for women. Effective delivery of quality basic health services is hampered by demand and supply side issues, including poor health infrastructure and staffing. (15)     The reform history in health sector in the State can be traced to Andhra Pradesh First Referral Health System Project, one of the first World Bank aided health system projects in the country. This project, launched in 1995 had been implemented by AP Vaidya Vidhana Parishad (APVVP). Agencies like World Bank and DFID are supporting the reform process in the State. The Bank supported the AP Economic Restructuring Project which included improvement of primary health care as one of the component. (7) The priority reforms focus on improved access to quality and responsive health services, strengthened governance and management in health sector, improved institutional mechanisms for community participation and systems for accountability; and strengthened financial management systems. (15)  The government of Andhra Pradesh [GoAP 1999] Vision 2020 document identifies a seven-point set of priorities for health sector reform: providing universal access to primary healthcare; encouraging private investment in tertiary healthcare; focusing on specific programmes to promote family planning; focusing on improving health levels in disadvantaged groups and backward regions; ensuring a strong prevention focus; enhancing the performance of the public health system; and formulating a state information education and communication (IEC) programme to broadcast information on preventive healthcare. (13) The Government of Andhra Pradesh is embarking on a major health sector reforms to improve health care delivery in the State. D. F. I. D. has expressed its willingness to support these initiatives with a grant of 100 Million pounds over the next five years (2006-2011). The reform initiative will include measures to improve the effectiveness and accountability of public health services, measures to focus on community centric preventive healthcare system and enhance access to quality healthcare for the poorer sections of the population(14) DFID will provide up to £40 million health sector budget support to the DoHMFW, GoAP, over 3 years 2007 – 2010. The sector support will build synergy with National Rural Health Mission (NRHM) which is a health sector reform program of the central government for decentralisation, pro-poor focus, strengthening service delivery(15)     The health sector support will be provided over three years (2007-08 – 2009- 10). It aims at increased use of quality health services, especially by the poorest people and in underserved areas. (16) The main outputs will be: a) Improved access to quality and responsive services, especially in remote and interior areas; b) Governance and management of health sector strengthened; c) Institutional mechanisms for community participation and systems for accountability in functioning; and Financial management systems strengthened and improved public expenditure on health.   The performance of health services would be measured against(17)

* greater effectiveness and improved outcomes of existing programs;
* improved efficiency in the allocation of resources;
* greater access and equity; and
* consumer satisfacfion

Reforms underway in health sector   The major reforms underway are classified under these categories and the activities are noted below and we will look each of them in detail    (I) Reorganization and restructuring of existing government health care system

Establishment of Andhra Pradesh Vaidya Vidhana Parishad Strengthening of referral institutions and fixing of service norms Improvement in drug supplies Formation of Andhra Pradesh Health, Medical & Housing Infrastructure Development Corporation (APHM&HIDC) Strengthening of PHCs as 24-hour MCH centers Establishment of Comprehensive Obstetric & Neonatal Care (CEmONC) centres

(II) Changes in health system organisation, delivery and Management

Formation of Hospital Advisory Committee/ Hospital Development Societies for all PHCs and FRUs/ teaching hospitals Provision of free travel bus passes to pregnant women for antenatal check ups Public Private Partnership

(III) Changes in financing methods

Sukhibhava Scheme (Improvement of Institutional Delivery Services Scheme) User fees

(IV) Reforms related to human resources

Integration and responsibilities of functionaries for planning, implementation and monitoring of programmes of HM & FW department

(V) Involving community in health service delivery and Provision

Women Health Volunteers Scheme

(VI) Reforms to quality of care

Performance indicators for grading the PHCs Performance rating of secondary hospitals

    1. Reorganization and restructuring of existing government health care system   A)Andhra Pradesh Vaidya Vidhana Parishad   AP, has created the Andhra Pradesh Vaidya Vidhana Parishad (APVVP) by enacting an Act in the Legislative Assembly in 1986(8) This was done with the objective to lay greater emphasis on development of both preventive as well as curative health care  and to strengthen necessary linkages at appropriate levels to ensure comprehensive medical and health care services. APVVP has undertaken World Bank assisted Andhra Pradesh First Referral Health Systems Project (APFRHSP) in 1994 for a period of seven years. This has been one of the major projects undertaken by APVVP. The objectives of the project included improvement of efficiency in the allocation and use of health resources through policy and institutional developments and enhanced performance of health system by improving the quality, effectiveness and coverage of health services at the first referral level.   B)Strengthening of referral institutions and fixing of service norms   basic service norms for various categories of hospitals under the administrative control of APVVP have been fixed thereby creating a hierarchy of hospitals according to services and facilities. This system of service norms and referral linkages had been developed with a view to optimise utilisation of resources, avoid duplication and wastage of resources, regulate patient flow and reduce cost of treatment by reduction of patient burden at tertiary hospitals. the district hospital has been prescribed to provide services in eleven specialties for which 9 civil surgeon specialists, 18-20 civil assistant surgeons, 54-84 paramedical staff and other supporting staff have been Posted. C)Improvement in drug supplies To ensure regular supply of drugs at all times and in all situations, a system of three sources of drug supply has been put in place for the hospitals under APVVP: (a) centralised drug procurement system under which the institution has been allotted drugs worth a particular amount based on bed strength (Rs 2000 per bed per quarter); (b) an emergency provision for drugs (Rs 100 per bed per month) has been made to every institution from where emergency procurement of drugs is made; (c) drugs which are in short supply and for which regular rate contract suppliers are not available have been stocked at the office of District Coordinators of Health Service. Under the APFRHSP, const-ruction and repair of 160 hospitals including 81 CHCs, 58 area hospitals and 21 district hospitals had been undertaken. (10)         D)Formation of Andhra Pradesh Health, Medical & Housing Infrastructure Development Corporation (APHM&HIDC)   a separate corporation has been set up in 1987 exclusively for developing housing and other infrastructure for medical and paramedical staff and constructing sub centers, PHCs, hospitals, dispensaries, clinics and other health care centers One of the major projects undertaken by APHM&HIDC has been the World Bank assisted India Population Project-VIII launched for improving the medical care facilities in urban slums in 74 municipalities.   E)Strengthening of PHCs as 24-hour MCH centers   In a move to make available maternal and child health care at all times, 470 PHCs in backward districts have been designated as round the clock Mother and Child Health Centre (earlier called women health centres). One staff nurse, one ANM and three support staff have been appointed in each centre on contractual basis. Staff nurses have been trained to conduct normal deliveries and refer emergency cases. Additional facilities like telephone and vehicle have been provided to the PHCs in order to assist communication and transport for referral of emergency cases. Provision has been made to conduct fortnightly specialist clinics of gynaecology and paediatrics in these centres to detect high risk pregnancies and neonates for referral to FRUs.   F)Establishment of Comprehensive Obstetric & Neonatal Care (CEmONC) centres   The State Government has decided to establish 108, CEmONC centres spread across every district so that pregnant mothers requiring emergency care do not have to travel more than 40-50 kms to receive specialist care. Training of MBBS doctors in anaesthesia, neonatal care and blood transfusion is also planned to support this scheme.   2)Changes in health system organisation, delivery and Management A)Formation of Hospital Advisory Committee/ Hospital Development Societies for all PHCs and FRUs/ teaching hospitals   Hospital Development Societies have been constituted in all tertiary hospitals under the control of Directorate of Medical Education. (18) and after implementing NRHM rogi kalyam samithi at every PHC were formed to ensure the adequate participation of local institution,with an aim to improve effective and efficient services with allowed flexible financial powers. These societies are examples for decentralization . Activities of the society include maintenance of the hospital (including sanitation & water supply, electricity, building & civil works and equipment), purchase of drugs & medicine supplies and equipment. The government has set norms and limits for undertaking these works which are to be adhered to by the Society. The ‘system works’, observed an Unicef team which assessed the impact of RKS towards the end of 2000. The system, however, is not without any lacunae. For, it was pointed out that “overall control of the local RKS bodies remain in the hands of the collector and if he is not interested in health care then the whole thing might just drift(13)   B)Provision of free travel bus passes to pregnant women for antenatal check ups(19)   The Government of Andhra Pradesh has started an innovative scheme in order to enable pregnant women in rural areas to avail antenatal check ups at the nearest PHC/area hospital or FRU. It has tied up with the State Road and Transport Corporation to issue free transportation bus tickets pass to be utilised for three visits. The ANM issues the bus passes to the pregnant women on her house visits.       C)Public Private Partnership(20)   ·         Management of Urban Health Centers by NGOs   Under the World Bank assisted Andhra Pradesh Urban Slum Health Care Project (APUSHCP), 192 urban health centers (UHCs) have been established in 74 municipal towns in 21 districts covering 1848 slums. After withdrawal of support by the World Bank, the project has been funded by the state government since 2002. The outcomes of the project show marked improvement in ANC coverage, institutional deliveries, post natal care and immunisation in the slum population.   ·         108 emergency services                           Govt. has tied up with satyam computers to provide emergency transportation which proved to a most successful programme and many states are following the same like Gujarath. The objective of 108 Ambulances is to save people in life emergency . One ambulance is given for three mandals. Each ambulance fitted with equipment worth Rs. 17 lakhs renders its services in life emergencies, road and fire accidents (22)   ·         Rajiv arogya sree    The innovative Govt. insurance scheme to serve people of  poor from the serious ailments now attracting the nation as this programme succeeded. this scheme provides financial support to families of BPL upto 2 lakhs per anum for treating serious ailments. it is proposed to cover the entire state by 2nd October 2008 with the govt. paying the insurance premium for all the beneficiaries . an amount of rs. 450 crores are provided to implement the scheme during 2008-09. (21)       3)Changes in financing methods   A)Sukhibhava Scheme(23)   Under the Scheme, a cash assistance of Rs. 300 (Rs 200 towards transportation charges and Rs 100 for food and incidental expenses) is paid to pregnant women belonging to below poverty line families who come to government hospitals/APVVP hospitals/ teaching hospitals/PHCs/CHCs for delivery serv-ices. This assistance is payable only to those women with no living children or with one living child.   B)User fees:-   If user fees are charged their main use may lie in optimization of expenditure patterns and better allocation between facilities and within facilities(24). Reddy and Vandemoortele (1996), based on a comprehensive review of user financing of basic social services carried out for UNICEF, point to three other discouraging features of user fees: (1) user financing can result in a sharp reduction in the utilization of services, particularly among the poor; (2) gender biases, seasonal variations and regional economic disparities can aggravate the effects of user financing on equity; (3) user financing  quires adequate capacities, effective decentralisation and continued government support; and (4) user financing can undermine political support for the goal of universal coverage of basic social services. In 2001, the Commission on Macroeconomics and Health (2001) also reached a similar conclusion that user fees end up excluding the poor from essential healthservices, in 2005, the Millennium Project’s recent Report to the UN Secretary General (2005) titled “Investing in Development – A Practical Plan to Achieve the Millennium Development Goals” also forcefully argues for abandoning user fees. The health sector in India has acquired a notorious reputation for inefficiency and corruption at all levels. There is little accountability in both the public and private sectors. Quality standards are practically non-existent as are performance measures and honest reporting. A recent report on human resources for health brought out by Harvard University’s Global Equity Initiative (2004) argues that it is people – health workers alone – who can produce an effective health system and deliver good ealth. (25) 4)Reforms related to human resources Integration and responsibilities of functionaries for planning, implementation and monitoring of programmes of HM & FW department At district level, District Health Coordination Committee (DHCC) has been constituted to ensure proper planning, implementation and monitoring of all programmes/activities of HM&FW Department in the district.   The Committee has been entrusted with the primary responsibility of planning, finalizing, implementing and monitoring the District Health Action Plans and institutionwise health plans in a participatory manner including all concerned officials, other concerned departments and NGOs.   5)Involving community in health service delivery and Provision  

Women Health Volunteers Scheme

  One of the key components of the National Rural Health Mission is to provide every village in the country with a trained female community health activist – ‘ASHA’ or Accredited Social Health Activist. Selected from the village itself and accountable to it, the ASHA will be trained to work as an interface between the community and the public health system. Following are the key components of ASHA(26) A woman, usually a daughter-in-law of a house who has studied upto 7th class and preferably from SC/ST community has been selected as WHV by the Gram Panchayat Health Committee. The selected WHV has been given one month training in health care aspects of pregnancy, antenatal, delivery, post natal and new born care, immunisation, diarrhoea, acute respiratory infections, first-aid and treatment of minor ailments. The training has been provided at Telugu Mahila Pranganams for three weeks and one week field level training at PHCs. Academy of Nursing Studies has been designated as the nodal agency for providing training to WHVs.   6)Reforms to quality of care   A)Performance indicators for grading the PHCs   One of the components of World Bank assisted AP Economic Restructuring Project is improvement of primary health care. In order to improve the quality of primary health care services, a system of performance rating has been developed to rate PHCs and CHCs. The grading has been accorded A to C in descending order   B)Performance rating of secondary hospitals   A performance rating system for secondary hospitals under APVVP has been  introduced. The indicators related to general services (outpatients, inpatients, bed occupancy), emergency services (emergency-OP, emergency-IP, emergency major operations, emergency minor operations), clinical services (major/minor operations, tubectomy, deliveries) and diagnostic services (X-ray, ECG, lab tests and USG) have been developed for the purpose. Normative targets for each type of hospital (district hospital, area hospital, community health center) have been fixed against which the performance is measured and rating assigned. Highest grading is A while lowest grading is C. (27)   Conclusion:-   Introduction of user charges and subcontracting of services to the private sector are the main elements of health sector reforms. The health sector reforms are only a part of drastic reforms in other major sectors undertaken as a part of Andhra Pradesh Economic Restructuring Project (APERP) and the overall impact on the health conditions of people and their access to medical care depend more on the changes proposed outside the health sector. For instance, while exempting the white ration card holders i. e. the poor from the user charges in the government hospitals, it proposes to drastically reduce the number of white card holders to half in the state. The net affect would be to reduce the percent of population eligible for free treatment. (29)   On the other hand the success of 108 EMRI services and overwhelming response from Rajiv Arogya sree scheme are the examples for HSR success. Just like every thing has gots its own pros and cons HSR should be done in such a way where the need exist and according to necessities .   Referances:-   (Note:-most part of the article was taken from ref. no 28 otherwise reference specified)

(Government of India, Eighth Five Year Plan, (1992-1997) Planning Commission, New Delhi. ) (Government of India, Ninth Five Year Plan, (1997- 2002) Planning Commission, New Delhi ) ( Government of India, Tenth Five Year Plan (2002-2007) Planning Commission, New Delhi) ( D. Agarwal Health Sector Reforms: Relevance in India, Indian Journal of Community Medicine Vol. 31, No. 4, October-December, 2006) Health Sector Reforms in India, Initiatives from Nine States ( http://www. idrc. ca/en/ev-118491-201-1-DO_TOPIC. html. The international development research centre) http://www. worldbank. org. in  (The Andhra Pradesh Vaidya Vidhana Parishad Act 1986 (Act No. 29 of 1986 with Amendaments upto 31. 03. 1989  Dr. MCR Human Resource Development Institute of Andhra Pradesh (Undated). “Andhra Pradesh Vaidya Vidhana Parishad Departmental Manual”  6http://www. aponline. gov. in/apportal/departments/ departments. asp?dep=16&org=98 GoAP (2006), Response to Questionnaire on Health Sector Reforms from MOHFW, GoI. http://www. worldbank. org. in/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/INDIAEXTN/0,,contentMDK:20970681~pagePK:141137~piPK:141127~theSitePK:295584,00. html#Ongoing_projects Grish kumar,promoting PPP in health services,EPW commentary,july19,2002  (G. O. Ms. No. 130, HEALTH MEDICAL AND FAMILY WELFARE (K2) DEPARTMENT. Dated the 24th April, 2006)  ANDHRA PRADESH HEALTH SECTOR REFORM PROGRAMME (APHSRP) Terms of reference for Technical Cooperation (TC) to DoHMFW, GoAP  PRESS INFORMATION BUREAU GOVERNMENT OF INDIA, HEALTHCARE PROJECT IN AP FUNDED BY DFID, New Delhi, March 5, 2008) http://lnweb90. worldbank. org/oed/oeddoclib. nsf/DocUNIDViewForJavaSearch/0CFD6217A8A5BDA2852567F5005D32BD  G. O. Ms. No. 403, dated Sept 7th 1998  GoAP (2006), Response to Questionnaire on Health Sector Reforms from MOHFW, GoI. Power Point Presentation of Govt of AP at the 2nd Regional Workshop on Health Sector Reforms: Experiences of Select States at Hyderabad, 14-15th February 2005 and ECTA Working paper 2002/61 Public-Private Partnership: Operational Framework used in Andhra Pradesh and Assam http://www. scribd. com/doc/2208678/AP-Budget-Speech  http://pibhyd. ap. nic. in/er27070702. pdf  Dept. of Health Medical Family Welfare, GoAP (undated), “Sukhibhava (Improvement of Institutional Delivery Services Scheme): Implementation Guidelines to PHC/Hospital  http://mohfw. nic. in/NRHM/Documents/CRM_report_full_report_version. pdf   (A. K. Shiv Kumar,,Budgeting for health ,some considerations) Economic and Political Weekly April 2, 2005  http://mohfw. nic. in/NRHM/asha. htm#abt http://health. ap. nic. in/apvvp/apvvp_stat. html  (http://www. whoindia. org/linkfiles/health_sector_reform_hsr_vol_ii_-_andhra_pradesh. pdf)  (Impact Of Health Sector Reforms On Hospital Services In Andhra Pradesh – A Study Of Trends In The Structures Of Provision And Utilisation Pattern)(centre for economic and social studies) (http://www. cess. ac. in/cesshome/research6b. html)

Holistic remedies help thousands of people worldwide to overcome problems ranging from more serious diseases to the common cold. Holistic Therapist Nitchara Yimsuk answers some frequently asked questions, and tips us off about a versatile treatment called moxibustion.

What does holistic mean?

In holistic treatments we look at the whole person – physical, emotional and spiritual – rather than just treating the symptoms of the problem. We consider a person’s mind and body, diet and exercise, lifestyle and relationships, work and leisure, achievements and problems. Imbalances in any of these areas can contribute to illness.

Where do holistic treatments come from?

Holistic medicine is also known as alternative, integrative or complementary medicine, as it complements conventional practices. It may include, but is not limited to, the following disciplines: spiritual, religious, newly developed approaches to healing or pre-modern medical traditions. Chinese medicine, for instance, follows the holistic principle.

How do they work?

There are many approaches, from energy healing to the use of natural and plant products. The Taoist principles, on which Chinese medicine is based, stress the oneness of everything, the inseparability of solid matter and energy, the fact that there is a common source of all phenomena and experience.

What are some of Chiva-Som’s most popular holistic treatments?

The Detox Retreat is popular. It includes the Cleansing Diet, Colonic Hydrotherapy, Chi Nei Tsang and Acupressure Reflexology. Also high on the list are Flower Essence, Homeopathy and Moxibustion.

What is Moxibustion?

It’s a treatment from Traditional Chinese Medicine in which the herb Moxa Punk is burned on or above the skin at acupuncture points. Sometimes we use other herbs.

How does it work?

The heat warms the blood and the qi (the life force), which improves the flow within the energy channels of the body. Sometimes Moxibustion is recommended as a stand-alone treatment, at others it has a synergistic effect with acupuncture.

Why is it so effective?

The Moxa leaf is bitter and acrid and its nature is pure Yang. Depending on the amount used it produces a gentle warmth or a strong heat and expels cold and dampness.

What is Moxibustion recommended for?

It’s varied. It may be used in the treatment of acute diseases, cold syndromes, diseases of the channel and exterior syndromes, or chronic syndromes and diseases of the viscera (the internal organs). It’s frequently applied in treating arthralgia due to wind-cold-dampness. Also Yang collapse syndrome; Chronic Dysentery, Asthma, Phlegm Retention and Flaccidity Syndrome. It’s also good for some external syndromes, such as carbuncles and the common cold. Additionally, it can work in general health maintenance and disease prevention.

We hear it’s also useful in pregnancies?

Yes, Moxibustion has been used for centuries in China to turn breech babies. The theory behind this practice is that the heat travels up the bladder meridian, which is linked to the uterus. Additionally, it’s useful in treating some Gynaecological Diseases – such as Dysmenorrhea, Prolapse of the uterus, and Leucorrhoea – and Infantile Diseases, including Enuresis and Diarrhoea. Moxibustion is very versatile.

What are the latest holistic treatments that Chiva-Som is offering?

Vacuum-Cupping Massage and the Emotional Freedom technique are both new, and also Maya Massage, which is part of the Detox Retreat offered in the Spa.

How can people find out more about these remedies?

They can consult the website (www. chivasom. com), where there’s a list of holistic treatments and a brief description of each, or they can visit us here at Chiva-Som. All guests are welcome, and we are willing to make initial consultations for every individual who comes.

Our team of Naturopath Doctors and Practitioners work in a very secluded and peaceful environment.

Why we choose health insurance

We all tend to buy health insurance for the same reasons. We want to bypass the NHS waiting lists and receive treatment when we need it.

Going into hospital is a stressful occasion and as a patient you want to be as comfortable as possible, private health cover will often mean your own private room with en-suite and home comforts such as television, internet and a choice of food when you want it.

Health insurance is not designed to replace the NHS, a health plan is designed to provide cover for the treatment of acute conditions. The private sector has very limited resources for Accident and Emergency and the treatment of chronic conditions, so both will tend not to be covered on your health insurance.

Health insurance for women who are pregnant

If you take any of the leasing insurers and look through the policy terms the health insurance tends not to cover normal pregnancy.  In the majority of cases midwives and doctors carry out the everyday care of the pregnancy through the NHS.  A pregnant woman will have regular appointments and scans with their general practitioner and midwife to ensure the pregnancy progresses as it should and this will continue after the birth to ensure the baby and mother is in good health.

Now although a standard health plan may not cover normal pregnancy you do have the option of going private and paying for the services of a midwife and obstetrician should you require. However given the quality of the antenatal care through the NHS the private sector resources for everyday pregnancy care is limited.

Cover you can expect for pregnancy

Now although many plans will not cover normal pregnancy it is important to note that each insurer has its own terms and any cover relating to pregnancy can differ significantly. Some insurers provide cover for pregnancy related issues and it’s important to understand the differences between the policies.

Although health insurance for women is not technically specific below are some of the benefits you could expect from your insurance during pregnancy.

Cover for some complications of pregnancy and childbirth
Cash benefit if child is born using the NHS
Cover for certain obstetrics procedures.

If you are looking for health insurance for women which specifically covers pregnancy some of the more comprehensive plans after a period of membership, say 2 years include cover often capped at a monetary limit for private consultations and tests as long as you have a normal pregnancy.

Additional Health insurance options to consider

Outpatient cover

Health insurance is built around inpatient treatment, as a policy becomes more comprehensive so it provides a greater level of outpatient cover, with increasing levels of outpatient cover comes increasing premiums. It is important you read the terms of the policy to understand the level of cover it provides for your specific needs, cover for pregnancy will increase the more comprehensive your plan.

Alternative medicines

An additional option in many health plans which will add around 6% to your premiums, providing cover for complementary treatments such as physiotherapy and chiropractic treatment.

Excess

An excess can help reduce your monthly premiums, by including an excess you are agreeing to pay the value of the excess either pre policy year or per claim to help towards the cost of treatment. Excesses can range from as little as £50 up to £1,000. A £100 excess could reduce your premiums by approximately 5%.

[removed][removed]

[removed][removed]
[removed][removed]
[removed][removed]
[removed][removed]
[removed][removed]

[removed][removed]
[removed][removed]

The Consolidated Omnibus Budget Reconciliation Act of 1985, or COBRA, allows unemployed workers to keep their health insurance from their previous employer for up to 18 months.

Up until the 15-month subsidy was approved last year as part of the federal economic stimulus bill, laid-off workers were required to pick up the full premium. With the subsidy, the unemployed paid 35 percent of the cost.

That subsidy is now at risk while the U. S. Senate considers whether to extend it. It was eliminated from one jobs bill but is included in a second jobs bill. The Senate, however, has not decided which bill it plans to hear, said Cheryl Fish-Parcham, director of health-care policy for Families USA.

If the subsidy is allowed to expire, no one laid off after Feb. 28 will be eligible for the reduced premiums.

That could mean many won’t be able to afford the premiums and would join the growing rolls of the uninsured, according to Families USA, a national organization for health care consumers.

Throwing a lifeline

The federal subsidy “gives people a small margin of hope,” said Terra Eyl, a career transition specialist with the Larimer County Workforce Center in Fort Collins.

Without the subsidy, COBRA premiums can cost upwards of $1,000 a month making it unaffordable for most families trying to live on unemployment benefits.
Even with the subsidy, COBRA payments can be unaffordable for people, particularly those with lower incomes, Eyl said. “But a small margin of hope is better than no margin, in my opinion. ”

Families USA estimates an additional 57,500 Coloradans became uninsured last year when they lost their jobs. And, although economic recovery appears to be under way, economists agree job growth is still a long way off, meaning the unemployment rate is likely to rise this year.

One quarter of Larimer County residents between 18 and 65 were uninsured at some point from 2005 through the end of 2007, according to Health District of Northern Larimer County, the latest statistics available.

Spirulina is a variety of blue-green algae that has remained virtually unchanged since it first appeared on the earth more than 3. 5 billion years ago. So named because of its helix or “spiral” shape, Spirulina has gained prominence as nature’s green “superfood” because of its rich concentration of perfectly balanced amino acids (protein), fiber, vitamins, minerals and other essential nutrients.

Spirulina is also naturally “pumped” with vitamins, especially the carotenoids like beta-carotene, essential fatty acids (EFA’s), the important fatty acid gamma linolenic acid (GLA), digestive enzymes, minerals and the richest plant source of vitamin B12. Spirulina is the “must have” green food- a complete protein with all eight essential amino acids present. Its 60% protein content is four times greater than beef (18%)! In our society, where the concept of complete protein is meat and dairy, it is very reassuring to know that greens like Spirulina can provide all the high quality protein and other nutrients needed.

A single serving of Spirulina contains 45% of your daily value of vitamin B12. That’s good news and reassuring for vegetarians, many of who are incorrectly led to believe that eating animal food is critical to getting this essential blood building vitamin.

Spirulina also helps with a variety of other ailments. DNA repair, cholesterol, and communication between cells are all helped with just a little bit of this supplement.

One of the main benefits stands to gain is the improvement of immune system. There have been many studies conducted that have shown that spirulina greatly helps to increase not only red blood cell production, but also the activity of the cells of bone marrow. Even T cells and macrophages have been increased.

Other studies conducted by Japanese scientists have shown that the growth of herpes virus, measles, and influenza have all been stunted by spirulina. Polysaccharides, phycocyanin and beta carotene are the active components of spirulina, which work to improve the immune system.

Spirulina also manages to fight bacteria such as E. coli and encourages the growth of good bateria in order to ensure that our bodies function well.

Another great attribute of spirulina is that it detoxifies one’s system well. A study revealed that spirulina actually helps decrease the toxicity of certain other drugs on one’s kidneys.

It also works to increase good cholesterol and reduce bad cholesterol for those who have ingested just a few grams of it a day. Of course as with any other sort of supplement or drug, one should always consult their physician before taking taking it in order to avoid a possible allergic reaction.

Give spirulina a try. I believe you will find that it will improve your health and support your efforts at healthy living.

January 27, 2010

This Week in Health Reform–Federal Legislative Overview

House and Senate
Republican Scott Brown’s victory over Massachusetts Attorney General Martha Coakley (D) in the January 19 special election to fill the seat of the late Senator Edward Kennedy (D) is proving to be a game-changer for the health care reform debate.   It is now unclear what Democrats can do to pass President Obama’s most important legislative agenda item.   Even though the Democrats held a majority in the House and Senate this year, they failed to coalesce around a strategy to pass this legislation.   Initially after Brown’s win, there were two options under discussion for moving forward on the current legislation.

Have the House take up the Senate-passed bill and use the “reconciliation” bill process to “fix” several of the provisions the House finds unacceptable (e. g. , the “Cadillac” tax, etc. ).   If the House passes the Senate bill, it will go directly to the President for his signature, with no further action needed in the Senate.   A “reconciliation” bill, which would need only 51 votes in the Senate, could be passed either in tandem with the Senate bill or follow soon after.
.
Scale back the health care reform bill. A scaled-back bill could include health insurance reforms, exchanges, as well as several other provisions and possibly could attract bipartisan support.   While many Democrats are likely to view this approach as a major lost opportunity, leadership may determine this is the most viable approach.

However, Speaker of the House Nancy Pelosi (D-CA) publicly stated on January 21 that the House does not have the 218 votes needed to pass the Senate version of the health care reform bill, which takes option number one (above) off the table.

While numerous private discussions are reportedly being held on the matter, at the outset it seems that Democrats’ only option for keeping the current legislation alive is to reach across the aisle to their Republican counterparts, most notably, moderate Senator Olympia Snow (R-ME).   That would mean a more conservative bill, which could anger rank and file Democrats who are supportive of the legislation.

Although no plans have emerged for how to move forward, it now looks like Democrats will have to modify their plans.   On the night of Scott Brown’s win in Massachusetts, Rep. Anthony Weiner (D-NY) – one of the biggest proponents for a single-payer health care system – said: “The only way to go forward is to take a step back. If there isn’t any recognition that we got the message and we are trying to recalibrate and do things differently, we are not only going to risk looking ignorant but arrogant.   I don’t think it would be the worst thing to take a step back and say we are going to pivot to do a jobs thing,” and include elements of health care reform in it, he said.

Rep. David Camp (R-MI), Ranking Member on the House Ways and Means Committee, declared Democrats’ health care overhaul legislation “dead” and said that instead of full-scale change Congress should take a “first step toward comprehensive reform” of the nation’s health care system.

Issue Overview: Nebraska Medicaid Deal
While key elements of the health care reform legislation remain in flux, the Congressional Budget Office (CBO) released its cost estimate of the expansion of the State of Nebraska’s Medicaid Deal, negotiated by Senator Ben Nelson (D-NE) who then voted for the Senate’s Patient Protection and Affordable Care Act, HR 3590.

The letter responds to a request from Rep. Paul Ryan (R-WI)), Ranking Member, House Committee on the Budget, asking if the cost estimate of the Senate health reform bill would change if all states received the same level of federal assistance for Medicaid as Nebraska receives under the bill.

The CBO stated on January 21 that the net spending for the Senate legislation would increase by $35 billion over ten years if all states received the same level of assistance as Nebraska.

Under the Senate’s provisions, non-elderly individuals with incomes below 133 percent of the federal poverty level would be eligible for Medicaid beginning in 2014.    The federal government would pay the cost of covering newly eligible enrollees through 2016; and federal spending would be about 90 percent by 2019.   The Senate legislation states that it would pay all Medicaid expansion costs to Nebraska beginning in 2014.

Enhancing Services of Panchayat Raj in Public Health

* Ramaiah Bheenaveni

Panchayats in India are an age old institution for governance at village level. In 1992, through the enactment of the 73rd Constitutional Amendment, Panchayati Raj Institutions (PRI) were strengthened as local government organizations with clear areas of jurisdiction, adequate power, authority and funds commensurate with responsibilities.

Panchayats have been assigned 29 rural development activities, including several, which are related to health and population stabilization. The XI schedule includes Family Welfare, Health and Sanitation, (including hospitals, primary health centers, and dispensaries,) and the XII schedule includes Public Health.

“Thus the possible realm of influence of the Panchayats extends over a significant proportion of public health issues. The Gram Sabha, where empowered has the potential to act as a community level accountability mechanism to ensure that the functions of the village Panchayat in the area of public health and family welfare, actually respond to people’s needs”.

The 73rd Constitutional Amendment makes it mandatory that functions related to the provision of primary health care – maternal health and family welfare are the responsibility of the PRIs. Besides the various development sector departments come under the functional jurisdiction of the district panchayat. Creating a health system with the panchayats being made responsible for supervising and monitoring health services seems an ideal model.

The National Health Policy, 2001, also emphasizes implementation of public health programmes through local self-government institutions, especially relating to the national disease control programmes. The Planning Commission set up a Task Force to review PRI involvement in various sectors and to make recommendations on engagement of PRIs specific to each sector. A Task Force Report pertaining to five major programmes within HFW and the particular functions of PRI. The Task Force Report summarizes key functions for each of the tiers of the PRI in respect of five major programmes- Reproductive and Child Health (RCH), and programmes for Vector Borne Diseases, Blindness TB Control Programmes, and STI/AIDS. Many of the activities proposed are related to identification of people in need of services, in collaboration with the health system and monitoring of village level health workers, and Primary and secondary health care facilities. Currently the PRI are not equipped to take on such planning and monitoring functions, nor is there a cognizance in the health system of the role of PRI.

Critical Role of Panchayati Raj Institutions in the success of the National Rural Health Mission

PRIs are seen as critical to the planning, implementation, and monitoring of the NRHM. The NRHM is seen as a vehicle to ensure that preventive and promotive interventions reach the vulnerable and marginalized through expanding outreach and linking with local governance institutions. Key to the success of the NRHM are: intersectoral convergence, community ownership steered through village level health committees at the level of the Gram Panchayat, and a strong public sector health system with support from the private sector. Underlying this is a commitment to systemic reform within the health sector for better regulation of medical establishments, public health oriented medical education, strengthened management capacity, and effective and rational human resource policies. Success of the NRHM in achieving its outcomes is significantly dependent on well functioning gram, block and district level Panchayats. It is anticipated that in the NRHM, a Task Force will be set up to specifically recommend and study the centrality of PRIs to the NRHM.

ASHA, the mechanism to strengthen village level service delivery, will be a local resident and selected by the Gram Panchayat or the Village Health Committee (VHC). She will be supported in her work by the AWW, school teacher, members of local community based organizations, such as SHGs, and the Village Health committee. ASHA’s role would be to facilitate care seeking and serve as a depot holder for a package of basic medicines. She will be reimbursed on a performance based remuneration plan.

The Village Health Committee (VHC) will form the link between the Gram Panchayat and the community. The VHC would be responsible for working with the Gram Panchayat to ensure that the health plan is in harmony with the overall local plan. It is anticipated that this committee will prepare a Village Health Plan and maintain village level data, supervised by the Gram Panchayat. Engaging the Gram Sabha and other groups in planning and monitoring the Village Health Plan will presumably enforce transparency and accountability.

Under the NRHM, untied funds of about Rs. 5000-Rs. 10,000 are to be placed with the ANM to meet unanticipated expenditures and to ensure that lack of drugs and other consumables is not an issue. At the sub center level planning and use of these funds will be supported by the appropriate tier of the panchayat.

Effective health care is not within the realm of the health department alone. At the village level convergence is required with agencies providing nutrition, sanitation, education, livelihood/poverty alleviation and empowerment schemes at the very least. Beyond the functionaries of each of the line departments, the only institution at the village level which can coordinate all these functions is the PRI. In reality however there is little convergence at the village level in many states, much less an active role

for the PRI in facilitating convergence. At the District level a District Health Mission will coordinate NRHM functions. Sanitation will be aligned with the NRHM.

Several Health Programmes Monitoring by PRI:

ACCELERATED RURAL WATER SUPPLY PROGRAMME (ARWSP)

Under ARWSP, the Central Government is to supplement the efforts of the State Governments in providing access to safe drinking water to all rural habitations of the country.

The role of PRIs in implementation of this scheme are :

 Panchayati Raj Institutions should be involved in the implementation of schemes particularly in selecting the location of standpost, spot sources, operation and maintenance, fixing of cess/water tariff, etc.

 The implementation of the Sector Reform Projects in the identified pilot districts, are also to be carried out either by the District Panchayats or through the District Water and Sanitation Missions (DWSM), which are to be registered societies under the supervision, control and guidance of District Panchayat.

 Wherever PRIs are themselves firmly in place and willing to take up the responsibility and are strong enough to do so, they implement the projects themselves instead of DWSM.

 At the village level, the individual Rural Water Supply Schemes are to be implemented through Village Water and Sanitation Committees which should be committees of Gram Panchayats.

 Drinking water supply assets are transferred to the appropriate level of Panchayats and such Panchayats are to be empowered to undertake operation and maintenance of drinking water systems.

CENTRAL RURAL SANITATION PROGRAMME (CRSP)

This programme aims at improving the general quality of life in rural areas; accelerating coverage in rural areas; generating demand through awareness creation and health education; and controlling incidence of water sanitation related diseases.

The role of PRIs in implementation if this scheme are :-

 Total Sanitation Campain (TSC) is a community based programme where Panchayati Raj Institutons are in the forefront.

 As per TSC Guidelines, the implementation at the district level is to be done by the District Panchayats. Panchayats at block and village level are to be fully involved for implementation of the programme.

 Where District Panchayat is not in a position to implement the programme, it is being implemented by District Water & Sanitation Mission which is chaired by Chairperson of District Panchayat and the Village Committees are chaired by the Chairpersons of Gram Panchayats. In the later case, the Village Water & Sanitation Mission are part of the Gram Panchayat.

SWAJALDHARA

This programme aims at providing Community-based Rural Drinking Water Supply. The key elements of this programmes are namely, (i) demand-driven and community participation approach, (ii) panchayats / communities to plan, implement, operate, maintain and manage all drinking water schemes, (iii) partial capital cost sharing by the communities upfront in cash, (iv) full ownership of drinking water assets with Gram Panchayats and (v) full Operation and Maintenance by the users/ Panchayats.

The role of PRIs in implementation of this scheme are :-

 Gram Panchayat shall convene a Gram Sabha Meeting where the Drinking Water Supply Scheme of People’s choice including design and cost etc. must be finalized. Gram Panchayats are to undertake procurement of materials/services for execution of schemes and supervise the scheme execution.

 A resolution must be passed in the Gram Panchayat meeting calling for users/beneficiaries to contribute 10% of the capital expenditure. However, GP can remit towards community contribution from its tax revinue (Not from Government Grants) with the approval of Gram Sabha.

 Gram Panchayat will decide whether the Panchayat wants to execute Scheme on its own or wants the State Government Agency to undertake the execution.

 After completion of such schemes, the Gram Panchayat will take over the Schemes for Operation & Maintenance(O&M).

 Panchayat must decide on the user charges from the community so that adequate funds available with Panchayat to undertake O&M.

Conclusions:

However, the extent to which reproductive health care is enhanced by the panchayats depends on the funds and functions devolved to them for carrying out these responsibilities. Clarity in the separation of powers between the elected representatives and the bureaucracy at the local government are important in this context. While the development targets include reducing the incidence of maternal mortality and morbidity, the question still remains whether the institutional interventions and resources allocated are adequate to address these problems. Gram Panchayat has a supervisory role in ensuring proper delivery of services. Many of them were not aware of what comprised the role and responsibility of panchayats in healthcare service delivery.

References:

1. Manual on Target Free Approach, Department of Family Welfare, Ministry of Health and Family Welfare, Govt. of India

2. Panchayat Raj Institutions In India An Appraisal- National Institute Of Rural Development, 1995.

3. Vijayanand, S. M, Decentralization and Health, Paper presented at Role of Local Government Institutions in Population Stabilization, Institute of Social Sciences, New Delhi, February 2003.

4. Dash, Dhanlaxmi (2006) – Women Environment and Health, Manga Deep Publications, Delhi.

5. The Constitution ( Seventy-third Amendment) Act, 1992,

6. Rosenstock IM. What research in motivation suggests for public health. Am J. Public Health. 1960; 50:295-301.