In India, communicable and non-communicable diseases pose threat to achievement of SDGs and lead to and also remain leading causes of immense human sufferings and poverty. Overall, communicable and non-communicable diseases contribute to 24.4% and 39.1% of the entire disease burden, respectively; while maternal and neonatal ailments contribute to 13.8% followed by injuries (11.8%). Today, immense suffering and loss of lives are also witnessed frequently following natural and man-made disasters.
Communicable Diseases: India is still home to a huge number of patients affected by communicable diseases such as HIV, TB, and malaria. Although, progress is noted in reducing the burden of these diseases in recent years, the sheer number is still huge that impedes the pace of development.
India is estimated to have around 86,000 new HIV infections in 2015, showing 32% decline from 2007. Since 2007, when the number of AIDS related deaths started to show a declining trend, the annual number of AIDS related deaths has declined by 54%. Yet, India continues to portray a concentrated epidemic of HIV AIDS. India has achieved the MDG of trend reversal in HIV prevalence. The TB prevalence per lakh population has reduced from 465 in year 1990 to 195 in 2013. In absolute numbers, prevalence has reduced from 40 lakhs to 25 lakhs annually. There is 55% reduction in TB prevalence rate and 58% reduction in TB mortality rate by 2014 as compared to 1990 level. India has achieved the MDG and STOP TB target of 50% reduction in TB prevalence and mortality due to TB.
Malaria is a public health problem in India but it is preventable and curable. The malaria cases have consistently declined from 2.08 million in 2001 to 0.74 million in 2016 (provisional). The confirmed deaths due to malaria have been fluctuating during this period between 1707 in 2001 to 188 in 2016 (provisional). Reduction of 45% in malaria morbidity and 69% in malaria mortality was achieved between 2000 and 2015. Presently, 80% of malaria occurs among 20% of the people classified as “high risk”, although approximately 82% of the country’s population lives in malaria transmission risk areas. In line with the commitment for SDGs and the Asia Pacific Leaders Malaria Alliance Roadmap, a National Framework for Malaria Elimination in India (NFME) 2016-2030 was launched in February 2016. However, challenges of sustaining the gains, precluding emergence of resistant strains, already evident in neighbouring countries, in a disease known for its cyclical reemergence and focal outbreaks, remain.
Non-Communicable diseases: Non-communicable diseases (NCDs) are a group of diseases that affect individuals over an extended period of time causing socio-economic burden to the nation. Changes in life style, behavioural factors (unhealthy diet, lack of physical activity, and use of tobacco and alcohol), and pollutants are majorly responsible in addition to other factors including ageing, rapid unplanned urbanization and globalization. In India, every year, roughly 5.8 million Indians die from heart and lung diseases, stroke, cancer and diabetes. Amongst the NCDs, cancers have severe health consequences, and a leading cause of deaths worldwide. In India, cancer is responsible for about 3 lakhs deaths per year. It is estimated that in India 7,00,000 people are affected with cancer every year and the estimated number of people living with cancer is around 2.5 million. According to the Indian Council of Medical Research (ICMR), estimated total burden of cancer for the year 2016 was around 14.5 lakh new cases during 2016 and 17.3 lakh new cases in 2020 with cancers of breast, lung and cervix topping the list.
Disasters and Health Care: Many locations in India often face natural and manmade disasters and emergencies. Floods, cyclones, drought, landslides, earthquake, social and communal tension, environmental degradation and disasters, etc. force millions every year to suffer the worst in their lives. In 2012-13, nearly 1,000 lives were lost and huge numbers of cattle, houses, tracts of agricultural land were ravaged. In such situations, water borne diseases spread. Moreover, many disasters leave a lot of waste -breeding ground for diseases. The survivors of such disasters have to go through a lot of mental and emotional stress to accept and cope with the losses. Hence, mental health and psycho-social care are quite imperative.
Mental Health: Good mental health is related to mental and psychological well-being. It is estimated that at any given time, 10% of global population suffers from some form of mental illness. By 2020, depression will be the second leading cause of disability, trailing only ischemic heart disease. The accurate figures for India are not available. The theme of the World Health Day 2017 is: Depression. The slogan is: ‘Depression: let’s talk’. At worst, depression can lead to suicide, now the second leading cause of death among 15-29-year olds. Yet, depression can be prevented and treated.
Maternal and Child Health: Since the creation of the MDGs, there have been historic achievements in reducing child mortality and improving maternal health. Since 1990, there has been an over 50 percent decline in preventable child deaths globally. Maternal mortality also fell by 45 percent worldwide. Despite this incredible progress, more than 6 million children still die before their fifth birthday every year. Every day hundreds of women die during pregnancy or from childbirth related complications, and, in developing regions, only 56% of births in rural areas are attended by skilled professionals. An estimated 12.7 lakhs children die every year before completing 5 years of age. Of these, 81% of under-five child morality takes place within one year of the birth which accounts nearly 10.5 lakh infant deaths whereas 57% of under-five deaths take place within first one month of life accounting to 7.3 lakh neo-natal deaths every year. Infant Mortality Rate currently stands at 40 /1000 live births (SRS 2013), against the MDG target of 29 /1000 live births by 2015. 15 States/UTs have already achieved MDG. MMR in India is 167 per lakh (in 2013) according to SRS 2013. The number of maternal deaths per 100,000 live births – reduced from 212 in 2007 to 178 in 2012.
Community Based & Led Approach to Health Care: With much of the health services being privatized and public health care service delivery yet to be optimal, poor, marginalized and vulnerable communities are finding it increasingly difficult to access quality and affordable care. The National Rural Health Mission (NRHM) led to a significant strengthening of public health systems by involving a close to 900,000 community health volunteers, the ASHAs, who brought the community closer to public services. However, such development remains uneven and more than 80% of the increase in services is likely to have been contributed by less than 20% of the public health facilities. It is well recognized that whilst improvements in health systems continue, communities have a right and duty to participate in their health care and health programmes would be designed to provide them the role to do so. The Village Health, Sanitation and Nutrition Committee is one major institutional mechanism for ensuring this. Involvement of community based organizations and representatives in decision-making consultative bodies are also encouraged. In the process of engagement with communities and empowering them to contribute, non-governmental organizations have an important contribution to make.
CARITAS INDIA AND COMMUNITY HEALTH INTERVENTIONS
Caritas India was established in October 1962. Caritas India is an organization with 171 local counterparts who are the Diocesan Social Service Societies (DSSS) and other NGO partners reaching out to poor and marginalized communities including those in hard to reach areas. Caritas India is a member of a global confederation of Caritas Internationalis active in 200 countries. The current Strategic Plan of Caritas India (2013 – 2018) highlights ‘Community Health’ as one of the priority strategic goals (Goal 5). Towards realizing the goal, Caritas India continues to take many initiatives in rural and urban areas. A glimpse of Caritas India’s recent initiatives to foster health and wellbeing at community level is presented below.
Malaria: As a complementary partner of the National Vector Borne Disease Control Programme, the nodal organization of Government of India, in the fight against malaria; Caritas India is engaged in service delivery in nearly 8,000 villages in 46 districts in seven North East states and Odisha (out of 119 districts) that are mostly hard to reach rural, tribal areas having limited access to quality health care, communication and other basic facilities. Buoyed by the promise of declining trend of malaria, the NVBDCP launched the paradigm shift of elimination initiative, & Caritas India continues to partner in the journey as a civil society consortium. The goal of the Global Fund supported Intensified Malaria Control Project-3 (IMCP-3) is to reduce malaria related mortality by at least 50% and morbidity by at least 50% (in 08 states) by 2017 as compared to 2012. Interventions in terms of prevention, diagnosis & treatment, surveillance & M&E, Behaviour Change Communication (BCC) and community mobilization, capacity building, are being applied through 16 partner FBOs and NGOs & National Institute of Malaria Research.
HIV/AIDS: Caritas India partnered with the Gujarat State AIDS Control Society and ushered ‘Link Worker Scheme’ at a scale in identified areas and contributed effectively to control HIV/AIDS and achievement of MDG. The scheme aimed at building a rural community model to address the complex needs of rural HIV prevention. Currently, Caritas India partners have adopted such partnership model and are applying interventions in the slums of Delhi.
Cancer: Caritas India and her partners have launched a massive campaign called ‘ASHAKIRNAM’ to create awareness on causes of cancer and support the treatment of cancer patients through more than 12000 dedicated volunteers. The campaign is lauded as one of the critical initiatives that spans across Kerala.
Disaster response: Health care in the times of disasters entails provision of water, sanitation and hygiene besides medical interventions. Caritas India is well recognized in this domain and has significantly contributed to foster WASH and psycho-social care through her emergency relief and recovery programmes.
Health Systems Strengthening: Caritas India and her partners have been engaged in the training of trainers for ASHAs in Bihar and ASHAs themselves (on malaria) in north eastern states in collaboration with the respective state governments, thereby contributing to capacity building & strengthening of the health systems at community level.
Caritas India endeavours to sensitize, enhance awareness, share learning and success stories, best practices and create knowledge bank on barriers and enablers through multi-stakeholder engagements. Caritas India proposes to convene a health conference and bring stakeholders to the platform for productive exchange, and devise a strategic plan of action and disseminate a compendium of learning, successes, best practices that would pave the way to combat the challenges and advancement to the desired goals.
I. Access and affordability to health systems
II. Communicable and non-communicable diseases: Progress, success, best practices, innovation and learning, way forward
III. Health care in disasters
IV. Socio-Economic Equities in Health care
The participants include: Senior government officials from the MOH&FW, State Governments, non-health Ministries & Departments; representatives from multilateral and bilateral agencies, donors & funders, research and academia, civil society organizations, corporate sector, professional bodies, individual experts and community leaders, health workforce.
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