International Women’s Day 2024 carries the powerful theme of “Inspire Inclusion,” emphasising the overarching call to action to “Invest in Women: Accelerate Progress.” This theme underscores the significance of creating an inclusive society and empowering women. Amidst the celebrations, it is crucial to direct our attention to an often-neglected aspect—women’s health. As we delve into the importance of health for women, we unveil the challenges they face and the imperative for healthcare professionals to take the lead in fostering awareness and change.

The Health Imperative:

The famous Arabian proverb “He who has health has hope, and he who has hope has everything” resonates profoundly on International Women’s Day. Health is a fundamental aspect that transcends age, gender, and socioeconomic standards. Regrettably, despite its paramount importance, the health of women often takes a backseat in priorities.

Women and Health Disparities:

Studies consistently reveal that women encounter more health issues than men. The World Health Organization (WHO) highlights that in regions grappling with economic, societal, and cultural inequalities, women are more susceptible to significant health challenges. These issues not only impact their quality of life but also perpetuate a cycle of poverty and disease for women and their families.

The Role of Nurses:

Nurses, as frontline healthcare professionals, play a pivotal role in improving women’s health. By providing education, healthcare services, and raising awareness of key issues, they can contribute significantly to breaking the cycle of health disparities. It is essential for healthcare professionals to not only address existing health issues but also identify and address the root causes in the local healthcare practices.

Focus Areas in Women’s Health:

Maternal and newborn morbidity and mortality, reproductive health issues, sexually transmitted diseases, gender discrimination, lack of education, violence toward women, reproductive cancers, and restricted access to healthcare are among the common issues ailing women’s health. The prevention of reproductive cancers, particularly cervical cancer, emerges as a critical focus area due to its preventable nature.

Non-Communicable Diseases (NCDs):

Non-communicable diseases (NCDs) pose a significant threat to women’s health, especially in low- and middle-income countries. Cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes contribute to a staggering number of premature deaths. Lifestyle factors such as tobacco use, physical inactivity, unhealthy diets, and alcohol consumption significantly contribute to NCDs, making them modifiable risk factors.

Authors Biography

Dr. Raminder Kalra Ph.D. in Nursing from IGNOU, with 38+ years of experience, serves as the Principal at Holy Family College of Nursing. Recognized with prestigious accolades like the President’s Gold Medal and RULA Ratna Research Award 2019. She is a distinguished examiner for nursing examinations across multiple universities. Dr. Kalra has authored papers in renowned journals and contributed to the book “Postgraduate Psychiatry.”

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1. Formation of Bhore Committee in 1946:

In 1946, a committee (Health survey and development committee) was formed known as Bhore Committee. This committee gave some important recommendations which were implemented only after 1947;

• Integration o
• f preventive measures in every sector (Personal Hygiene, hand washing, environmental hygiene, Sanitation and disposal of waste)
• Development of PHC’s (more focus was on remote and rural areas)
• Recommendations were made for changes in medical education curriculum

2. Indian Public Health Association in 1956:

Indian Public Health Association (IPHA) was established in 1956 at Kolkata. This association helps the government to frame policy and promote public health measures in the country to provide best possible health care services to its citizens. IPHA also serves its role in publishing journals and articles in public health and preventive medicine.

3. Medical Education Committee in 1960:

Medical education committee was established in 1960 to upgrade and reform medical education in the country. It was established primarily to reform the curriculum of the medical students. Medical education committee was named as the Medical Council of India and then changed to the National Medical Commission in 2020 through an ordinance bill.

4. National Institute of Health and Family welfare in 1977:

NIHFW was established in 1977 by merging two national institutes. The institute aims at addressing various issues on health and family welfare through various departmental collaboration like Health administration, adult education, epidemiology, health management, hospital administration, Human development, family planning and demography. The main focus is around the major issues in line with Millennium Development Goals (MDGs).

5. Public Health Foundation of India:

PHFI was established in 2006 to strengthen training and education of public health professionals, research and policy development, affordable health care technologies, health promotion and formation of prioritised health settings in the area of public health in the country.

6. National (Rural, Urban) Health Mission:

National Rural and Urban Health Mission was started in 2005 to provide health care services both at rural and urban levels. The goals of the NR & UHM include reduction in Infant Mortality Rate (IMR) and Maternal Mortality, universal access to integrated and comprehensive public health services , child health, water, sanitation and hygiene and prevention and control of communicable and non-communicable diseases. It was later changed to the National Health Mission in 2013

Major Achievements in Public Health post Independence

• In the past five decades, life expectancy has increased from 50- 69 years ( 72 years in females and 69 years in males).
• Infant mortality rate came down from 57 to 30 per 1000 births (as of 2020).
• Fertility rate decreased from 5.5 to 2.2 live births (as of 2020).
• Establishment of PHC’S and CHC’S as part of rural primary health care.
• Prevention of maternal deaths due to improved institutional deliveries and better trained health attendees.
• Antenatal screenings to eliminate neonatal risks.
• Child health and nutrition through Food Fortification under National Food Security Act (NFSA – 2013).
• India is a Polio free country.( Declared Polio free in 2014)
• Target already set for Malaria and TB eradication.
• Malaria control through National Malaria Control Policy 1950.
• Establishment of DOTS program for TB eradication.
• HIV AIDS control through National Aids Control Organization ( NACO).
• Swachh Bharat Abhiyan, Cleanliness Drive Campaign was launched in 2014 to control open defecation and aimed at environmental Hygiene, personal hygiene and to reduce spread of diseases in the community. ( A great example of which is Asia’s Cleanest Village in Mawlynnong, Shillong-Meghalaya)
• To provide clean and easily accessible tap water to every household through the Jal Shakti Program (Har Ghar Jal Program).
• National Immunisation program for all children below 5 years to reduce mortality and morbidity.
• National Action Plan for Antimicrobial resistance (AMR): Antimicrobial resistance is an upcoming public health challenge. To prevent this, a National Action Plan was drafted in 2017 to counter Antimicrobial Resistance. The main objectives of the National Action Plan include public awareness, surveillance and collaborative efforts to counter AMR e.g. prescription is mandatory for most of the over-the-counter (OTC) drugs to prevent self medication which is probably a basic cause of AMR.
• Public Private partnership: Public Private partnership is important to restructure the poor quality health sector. Modern health care systems and services can only be achieved through public private partnership.
• Universal Health Coverage through PM- JAY: Pradhan Mantri Jan Arogya Yojna (PM-JAY) was launched in 2017 through National Health Policy. It is aimed to provide universal health coverage, free and easily accessible health care services and to provide free health insurance coverage to the poor in order to meet the requirements of Sustainable Development Goal’s (SDG’s).

There is a strong evidence that economic inequality and disparity among people is related to worse health outcomes.

India is presently going through a state of transition environmentally, economically, demographically and epidemiologically in terms of health. Since last decade, unprecedented economic development particularly in terms of Gross Domestic product (GDP) is significantly visible, but unfortunately this progress has created disparities between the rich and the poor. There is correlation between economy and health outcomes. There is a strong evidence that economic inequality and disparity among people is related to worse health outcomes. This in turn widens the gap between the rich and the poor and has damaging health and social consequences. Financial and social security measures are being implemented by the Government to bridge economic inequalities but there is need to do more.  Presently India is having a triple burden of disease;

• Some unfinished Infectious diseases and their disease burden like TB
• The challenge of non communicable Diseases (NCDs) which are linked with lifestyle changes and behaviour 
• Emergence of new infections due to population growth causing epidemics and pandemics. 

Diseases, like polio, tetanus have been eradicated due to successful vaccination programs and effective community participation.

In addition to these, the health care system is already substandard and needs to be strengthened to enable it to confront these challenges. In the health sector, India has made remarkable progress over the past decades. The life expectancy reached 67 years in males and 69 years in females, and infant as well as under-five mortality rates have declined subsequently over the years. Diseases, like polio, tetanus have been eradicated due to successful vaccination programs and effective community participation. In spite of this progress made, communicable diseases and their burden is expected to continue and to remain a major public health problem in the coming decades. Besides endemic diseases such as HIV/AIDS, Tuberculosis (TB), Malaria, and neglected tropical diseases, the communicable disease outbreaks will continue to challenge public health. Also vector-borne diseases, such as dengue and acute encephalitis syndrome, are of particular concern and need effective intervention. Antimicrobial resistance is one of the biggest public health challenges currently.

This has arisen due to uncontrolled drug policy and it must be tackled with all efforts in upcoming years. In addition, non-communicable diseases are now the leading cause of death in the country, contributing to 60% of deaths. Noncommunicable diseases (NCDs) like Heart disease, cancer, diabetes, and chronic pulmonary diseases are leading ones. Approximately 80% of all deaths are  due to these four diseases. These diseases have multiple causal factors like smoking, alcohol, unhealthy diet, and lack of exercise. Also important concern is the maternal mortality ratio and infant mortality rate (IMR) which still remain unacceptably high as compared to other South Asian Neighbouring countries except Pakistan. The IMR, which was 81 in 1990, according to the World Health Organization (WHO), declined to 30 Per 1,000 live births as of 2019. According to the sample registration system (SRS) report as of 2018 the IMR is 36 per 1,000 live births. Since mortality rates have declined significantly but the rate of incidence is still high, compared to that being achieved by other South Asian neighbours with exception of Pakistan.

A Framework To Strengthen Public Health Sector: Covid-19 Fallout

COVID-19 pandemic caused deleterious effects and is devastating nations and has incapacitated the health systems of nations globally. Nations weren’t fully prepared and the pandemic has been carried out with great losses both physically and economically. On one hand Developed nations were bearing the after effects of COVID-19 while on other hand developing countries are still taking steps to control the pandemic while facing economic hardships.

Universal health coverage is needed more than ever to recover from the effects of the current pandemic more importantly in developing countries like India. Post pandemic lessons need to be learnt which I already have mentioned especially for developing economies like India where the public healthcare system is not up to the mark.

COVID-19 pandemic has emphasized the need for strengthening public health care systems globally. The fate of COVID-19 pandemic in countries with well-established health systems stresses on the need for a strong public health system that goes beyond hospitals and health establishments. Government should take measures to develop sustainable capacity to respond to rapidly spreading epidemics and must recognize overlooked public health services as vital, and adequately finance them as part of the UHC model. The current framework is aimed to highlight the key concerns in the public healthcare system of India and areas that need prioritization learned from the pandemic.

WHO Leadership; An important element to support developing world

The World Health Organization, the world’s health body, has emphasized the importance of national health, works on its planning and monitors critical functions to improve health systems globally. There should be a sophisticated and robust approach to deal with any kind of pandemic without political interests and WHO should work on this uniquely and be autonomous. Developed nations need to fund this organisation without any interests and more focus should be emphasized to developing countries ( South East Asia, Middle East and Africa). WHO needs to adapt a policy to fund the developing countries with economic packages to counter economic hardships due to pandemic.

A national action plan for pandemic preparedness should be formulated for developing countries while taking all the key factors (economy, geography, climate change, population, health system) in account. India has already enforced many acts like Epidemic Diseases Act, Disaster Management Act, Essential Commodities Act, Healthcare Establishment Act, etc. as part of the action plan. Unfortunately many of such acts have their own drawbacks and these need to be modified for the current scenario.

Health care system and its Financing

The healthcare model in India was designed and aimed to provide basic health services as primary care to the population (prioritizing women’s and children’s health). But it came out more as an “Out of Pocket model” where the rich acquire high quality health care services and the poor suffer due to economic hardships and unreasonable high cost of private hospitals. To support the health care system and services, the Government of India launched Ayushman Bharat Scheme under National Health Policy 2017. It is aimed at two core issues, free accessible Health services under Health and Wellness Centres and free access to health insurance coverage under National Health Protection Scheme (NHPS). Health and Wellness Centres are working as foundation of the health system to provide basic primary care, free essential drugs and diagnostic services to all the citizens, whereas National Health Protection Scheme is working on to provide financial services to poor and vulnerable families which arises due to high costs at secondary and tertiary care hospitalization. The National Health protection Scheme should ensure financial protection also for marginal people when they seek treatment during pandemics.

The Indian government’s expenditure on health is merely around 2%, one of the lowest in the world. More than 60% of households in urban areas, and 50% of households in rural areas consult private hospitals when they need medical attention. During the pandemic, health expenditures rose because of the high cost offered by the private healthcare system which is unfortunately not regulated by the government. Health care budget should be given priority along with the education sector (prioritising maternal education). Policies should be made to invest in the health care sector, priority should be made to rural areas, up-gradation of hospitals to modern levels, all technological advancements should be made available and easily accessible and finally there should be Public private partnership which is an important step to formulate sophisticated modern health care system.

The country’s public healthcare system should have technological advancements with an easy accessibility and applicability to people.

Strengthening Public Health System

There is an immediate need for strengthening the public health system in India with priority focused on building public health professionals. Healthcare workers need to be strengthened by continuous capacity building and training in public health fields. There should be Public health laws to ensure active participation of the private health sector and other health related sectors. The country’s public healthcare system should have technological advancements with an easy accessibility and applicability to people. There is a need for cooperation between local and state public health agencies with the centre, in order to apply guidelines at its first phase and on priority basis. There should be robust and sophisticated mechanisms for data sharing especially during outbreaks. This will prove beneficial during challenging times.

Moreover there is a need to come up with policy development for public health education in India. Master of Public Health(MPH), which is a two year Master’s program mainly aimed at education of health care workers in the public health field. There’s more that needs to be done in terms of financing the public health education sector. Unfortunately uptil now there is no governing body or council to represent this field. There should be immediate action devised by the government.

Health care workforce

Manpower is important for every system to work properly. Public health care system can’t cope with the current challenges without a health care workforce. India has had a shortage of healthcare workers from the beginning and it still persists, as was visible during the pandemic. In order to cope up with the current challenges and a future policy, the government of India should come up with a policy to educate, train other health care workers (AYUSH, Nursing). The training should be focused mainly on modern medicine skills. Alternatively these professionals can be posted at rural areas to cope up with the shortage of health care workers and can also prove handy in challenging times like during pandemics.

Pandemics like COVID-19, Influenza, HIV have timely reminded us that public health systems are core social institutions for any country. The government has already made policies to overcome the issues in the public health system through schemes like the National Medical Commission Act, 2019, Pradhan Mantri Jan Arogya Yojana etc. However, there is more to be done to sophisticate the public health care system like in developed countries. First step is to go with an adequate investment in health care for creating a health system that can withstand any kind of public health challenges, can deliver universal health coverage at all levels by all means and can meet the targets of the Sustainable Development Goals.

Composed by: “Dr Sameer Ul Haq is an MBBS graduate and is pursuing Master’s in Public Health at Indian Institute of Public Health Shillong. He has many achievements to his badge in various fields like Public Health, Global Health, Epidemiology besides having Clinical skills too.”

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The critical care environment has undergone significant alterations in the past several years. This has happened because our lifestyles in the fast-paced lives of modern India are ensuring that most people, in the age group of 30-50 years are falling prey to life-threatening cardiac diseases and strokes, in addition to diabetes, hypertension, cancers, liver, kidney and lung diseases – these diseases being called Non-Communicable Diseases or NCDs. They are now responsible for killing more than 65% of our population says Dr Arvind Lal, known for his diagnostic labs across the country.

Flagging concerns on such trends, these patients need high-cost intensive care, be it for complications of heart attacks, strokes, diabetes, hypertension, cancer or lung diseases. This is where the importance of Point-of-care testing (POCT) comes in. It helps in almost diagnosing the patient instantly and improves the physician’s ability to take immediate corrective action and decreases hospital stay. One such test is Troponin – that has revolutionized cardiac care by diagnosing heart attacks or myocardial infarction.

This article is based on the keynote address on the occasion of 2nd Annual International InnoHEALTH Conference 2017 – ‘Transforming Healthcare Through Innovation’ in New Delhi, said there are numerous promising diagnostic technologies. The key message is that in a country where 70% of the population lives in rural surroundings, ‘it is our duty to rapidly adopt disruptive innovative affordable technologies including telemedicine. Thus, our underserved population would be able to avail of the best treatment possible and bring in massive visible change’. He said the importance of bringing quality healthcare needs no reminder and the time has come for India to change the direction of healthcare for the masses.

Healthcare is a right – and access to good healthcare should not depend on where one lives and how much he or she earns. But sadly, that is exactly what plagues India’s healthcare today, he lamented. India faces a severe shortage of both hard infrastructure and talent. With about one doctor and one functional bed per 1000 population, healthcare is truly underserved in India. Add to this the regional imbalances and variations in healthcare delivery. The healthcare infrastructure is skewed towards urban over rural India.

Although rural India accounts for about 70% of the population, it has less than one-third of the nation’s hospitals, doctors and beds, resulting in large disparities in health outcomes across urban and rural India. British Medical Journal (BMJ) has observed that there is a remarkable saving of lives in India if good healthcare facilities consisting of operation theatres, surgeons, anaesthetists, blood banks are available within 50 kilometres of the patient providing quality medical services within the ‘golden hour’.

Though there has been a sea change in the last five decades, India now needs to reinvent the field of diagnostics as laboratory tests are responsible for 70% of all clinical or medical decisions.

In today’s life where internet rules the roost, the patients have become very knowledgeable, thanks to the globalisation of healthcare, and are demanding very high-quality healthcare for themselves. They are insisting on a very wholesome and satisfying experience rather than being told that the ‘treatment is over’.

Soon, a time will come when the tests shall be ordered by the patients based on clinical history and clinical findings that shall be answered by an Artificial Intelligence (AI) application. Artificial intelligence has already found several areas in healthcare from the design of treatment plans to assist in repetitive jobs to medication management and drug designing. The most obvious application of artificial intelligence in healthcare is data management. Collecting it, storing it, normalizing it, tracing its lineage – it may well be the first step in revolutionizing the existing healthcare systems.

Recently, the AI research branch of the search giant, Google, launched its Google Deepmind Health project, which is used to mine the data of medical records in order to provide better and faster health services. The project is in its initial phase, and at present, they are working with Moorfields Eye Hospital of NHS Foundation Trust, UK to improve eye treatment.

Just a few years ago the patient after giving the sample used to come back in the evening to the lab to collect a physical copy of the test report. This was replaced by making the report available on the internet that could be downloaded by the patient in the comfort of his home. These days this has been further replaced by making available an App on his mobile phone wherein he can book an appointment for the sample to be collected at home and the report being later available on the same mobile App.

‘IBM Watson, whose headquarters I had the privilege of visiting a few months back in the Silicon Valley, is an AI-based engine that has launched its special program for oncologists to provide clinicians evidence-based treatment options. The program has an advanced ability to analyze the meaning and context of structured and unstructured data in clinical notes and reports in its encyclopedic memory that may be critical to selecting a treatment pathway’. IBM launched another algorithm called Medical Sieve. It is an ambitious long-term exploratory project to build a next-generation ‘cognitive health assistant’ that is able to analyze radiology images to spot and detect abnormalities faster and more reliably. This shall help radiologists in the future to look at the most complicated cases where human supervision is essential.

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The lab-on-a-chip (LOC) is another device that integrates one or several laboratory functions on a single integrated circuit (commonly called a “chip”) of only a few square centimetres to achieve automation and high throughput screening. Imagine that a patient comes to one of our 2,100 collection centres in the remote tier three or tier four towns in India with the high fever. We take a drop of blood from his finger and inform the clinician almost immediately that the patient is suffering from Chikungunya and not from Malaria or Typhoid, or Dengue fever or Japanese Encephalitis – all in a matter of minutes! The driving notion behind POCT is to bring the test conveniently and immediately to the patient. Needless to add, the patient’s data by POCT shall be made available to update the patient’s electronic health records (EHR).

Talking about POCT Instruments: Currently, two broad type of POCT instruments are available: Small benchtop analyzers (for example, blood gas and electrolyte systems) and handheld, single-use devices (such as urine albumin, blood glucose, and coagulation tests). Now let us talk about if POCT is Boon or Bane? The strong point of POCT is speed and the rapidity with which it shall save lives in emergencies. As India marches towards quality healthcare delivery, in course of time regulatory compliances shall have to be adhered to in the interest of the patient’s health.

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School-based screening of 104,105 children studying in 138 private schools has revealed some alarming trends in school students in Bengaluru. The study was conducted by AddressHealth, the provider of health services in schools for children in India. The survey data was compiled over the current academic year and revealed a significant degree of malnutrition (both over and undernutrition) among children – with 9.2% of children being obese and another 13.7% children falling into the overweight category (overnutrition) while about 8.5% of them are too thin for their age (undernutrition).

Also Read: Indoor Lifestyle Impacts the Diversity of Bugs

Apart from this, 28.6% of school children have dental caries (cavities) while 15.1% have newly detected/ worsening vision problems. In addition, more than 200 children had previously undetected cardiac murmurs, and 70 children had previously undetected hearing defects. Commenting on the survey results Dr. Anand Lakshman, Founder and CEO, AddressHealth, said, “Children are increasingly vulnerable due to a variety of lifestyle. And environmental factors such as the proliferation of fast food options, lack of physical activity, too much screen time etc.

We believe Contracting lifestyle disease in adulthood, reveals a recent study By InnoHealth Editorial Team 40 Volume 3 | Issue 3 | July-September 2018 Key findings of the survey :

• About 10% of primary school children are obese. Further 13% of children overweight and 9.4% of those in middle and secondary school are too thin;
• Vision problems are more common among children in the primary and secondary age group with 1 in 7 and 1 in 5 children affected, respectively;
• Dental caries has emerged as the most neglected chronic condition among children; and
• Nearly 8% of children have clinical signs of anemia

Schools and parents/guardians should place adequate emphasis on children’s health and well-being. Beyond the usual vaccines and episodes of sickness, failing which non-communicable diseases will only become more common in the younger generation. The times are changing, and new age problems need to be addressed proactively and continuously. The data from our mental health program also suggests a moderate risk of mental health conditions amongst school children such as emotional difficulties, behavioral issues and lack of social skills”.

“Schools are not just centers for imparting formal education but also institutions that influence values, beliefs and importantly practices. A healthy lifestyle including hygiene habits must be inculcated during childhood. These positive behaviors will last through to adulthood and for the rest of a person’s life. Children are naturally inquisitive and keen learners. They can thus become both the beneficiaries and the agents of change in the family,” added Dr. Lakshman.

AddressHealth has conducted surveys in 177 schools covering 1,26,467 children across 4 Indian cities including Bengaluru, and data points to similar trends across cities with a high likelihood of chronic diseases in adulthood.

The number of children covered by the surveys over the last 12 months. It includes 1,04,105 children in Bengaluru, 652 in Delhi, 18,422 in Hyderabad, and 3,288 in Pune. The prevalence of various conditions across these four cities is as follows: obese as per BMI for age standards (8.8%), over-weight but not obese (12.6%), low BMI (8.5%), risk of lifestyle diseases [Waist/Height Ratio>0.5] (14.6%), vision problems (14.6%), and dental caries (29.7%). About 219 and 9101 children are at risk of potential heart defects and clinical anemia, respectively.

Obesity is seen across income groups. But rising rapidly in the schools catering to higher income groups and primary and secondary school children. There is an increasing trend of the risk of lifestyle disease, due to reduced physical activity, which is reflected in the significant percentage of children with a higher than recommended waist-to-height ratio.

AddressHealth’s school health services are designed by a team of pediatricians, public health experts, child psychiatrists, psychologists, nutritionists and other health professionals. The services include Annual Health check-ups for children; Medical Room / Tele-infirmary; School Emotional/Mental Wellbeing Services (Nurturing Schools Program); and Health Education with Workbooks (Standard 1st to 8th). Currently AddressHealth’s services encompass ~ 200,000 children in over 200 schools in Bengaluru, Delhi NCR, Hyderabad & Pune The AddressHealth School Health Program is based on WHO guidelines for schools.

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