Kerry Needs asked:


You may be aware that the word 'whole' comes from the old English root word 'hal', which means 'health'. To be whole, then, is to be healthy. As we move toward a whole science, health is viewed as an irreducible whole that comprises all aspects of our being. This has already begun to happen. We are becoming aware of the relationships between individual and environmental health, social health and individual health, environmental health and the well being of society.

This new view of health means that we recognise all levels of our health are interconnected and depend on each other. So health as a whole becomes the main goal or aim of science. Because when we are physically, mentally and emotionally healthy then we can be happy. And happiness is what we all desire, do we not?

Let's look at the three main 'levels' of our health:

Individual:

A whole science view of individual health means that the individual takes responsibility for his or her own health. The reason being is as we live by the understanding of the mind-body connection, our mental and emotional health has a huge impact on our physical well being, much more than we had previously thought.

Therefore, as the individual would normally seek to strengthen their health from the 'outside', i.e. with drugs, medicines and the like, the individual now also places importance on strengthening their health from within. This is achieved through working through negative emotions and mindsets, to free them from the life-negating effect they have on the body. Extreme stress and depression are seen to be internal 'toxins' that the individual now takes responsibility to understand and break through.

What about the individual's connection to the social environment? Clearly, this is also considered as health is becoming recognised as a unified whole. If you are living on a crime-ridden estate suffering verbal abuse and maybe physical abuse, then clearly this has a knock-on effect on your emotional, and thus physical, well being.

In the same sense, we are beginning to recognise how the health of the planet has an effect on us. Making distinctions between the health of the earth and our own health now seems to be the same as separating the health of an ocean with the fish who live in it! So as our intake of fresh, natural based foods and medicines continues to grow, we learn that actually, as we take care of the environment, we are taking care of ourselves at the same time.

Social:

In moving towards greater health, we again understand that the health of our communities and countries are a reflection of the health of the individuals. Social health is seen to be something beyond our control, something most merely 'leave up to the government', but what would happen if each and every person took responsibility for the health of the community?

If we look at the social health of the UK as a whole, do you think we would score particularly high in the optimum health charts? The disintegration of communities and fracturing of society is seen to be a political issue, but what if your thoughts alone had an effect on society? A well known study by John Hagelin has brought down crime rates in a US state by meditating alone. Of course, it's not just as simple as wishful thinking, but it gives each person the responsibility to contribute to the health of the human race as a whole.

As the current evidence for this knowledge is inconclusive, more investigation is needed into the effects of group consciousness, particularly if it may contribute significantly to our social well being.

Environmental:

Our environmental health is now a matter of global concern, and we are beginning to explore the reciprocal relationships we humans have with the natural world and how our impact can enrich or destroy its well-being. Environmental health does not merely extend to the quality of our air, water and land; rather it also involves supporting the health of the interconnecting species that rely on earth for its survival.

Have you ever considered the source of where your clothes came from? The food you cook each night? Your daily cup of tea? These links have been severed by globalisation. Although globalisation is mainly a wonderful thing, unfortunately it means we often fail to remember how our very existence is fundamentally connected with the existence and well being of the earth.

As we move towards a more whole, holistic understanding of health, we can see that earth destruction and earth pollution, is on some level destroying the very conditions for which we depend upon for our health. Care of the environment, then, ultimately becomes caring for ourselves.

Copyright 2008 Whole Science ©

Emmanuel St-cyr asked:


Do you ever feel like you know just enough about Health Insurance to be dangerous? Let's see if we can fill in some of the gaps with the latest info from Health Insurance experts.

Health insurance is something that most people don't think about very often and yet it is something that when comes foremost to mind when a loved one is sick. Health Insurance coverage varies across the world, even across the different states in the United States of America.

Health insurance is a very specific type of insurance. With this type of insurance the insurer pays the medical costs of the insured if the insured becomes sick due to covered causes, or due to accidents. The insurer may be a private organization or a government agency. Health Insurance can protect a family from financial devastation in case of serious illness.

Today, according to statistics from the US Census Bureau, many Americans, approximately 85%, have some form of health insurance. Many people, about 60%, are insured through their place of employment or through health insurance acquired personally. For about a quarter of the population, federal or state government agencies provide the insurance. These agencies may include Medicare and Medicaid as well as various state funded health insurance plans.

I trust that what you've read so far has been informative. The following section should go a long way toward clearing up any uncertainty that may remain.

Today, health insurance costs are rising, which is a concern to many people. Because of ongoing advances in medical care and in technology, medical treatment is more expensive. These advances help people to live longer. Today there are more senior citizens than ever before – our population is aging. The elderly population is more frail and prone to illness thus requiring more medical care than a younger population that is healthier. This also causes an increase in the price of health insurance.

Health insurance costs are also rising due to personal health choices made by individuals. Poor eating habits, smoking, drug and alcohol abuse, a lack of exercise, obesity are some of these poor health choices. In addition, there are still rural areas where there is a lack of health professionals including doctors.

Today, health insurers offer discounts and incentives to people who love a healthy lifestyle. Often, a person will provide health information and a personal medical history when buying health insurance. This history may address questions such as smoking, weight, drug use, and disease history. The incentives offered by health insurance companies today may encourage individuals to quit smoking or make other positive changes in their lifestyle. Many times, heath insurers will not insure pre-existing medical conditions. The medical history provided will screen out such applicants.

Because of the concern over pre-existing medical conditions, there are now state and federal laws that help ensure that those individuals with pre-existing conditions can acquire or maintain health insurance, even if they need to change plans or providers. The Health Insurance Portability and Accountability Act (HIPAA) is a federal law ensuring that all health insurance plans nationally have a common set of standards. In addition, states can also have laws regulating health plans including group health insurance and individual health insurance. This means that the laws regulating your health insurance protections may vary from state to state. Keep in mind, that even with these laws, access to health insurance may not be protected in all situations.

COBRA continuation coverage can help you if you leave of change your job. Under COBRA, you may be able to remain in your old group health plan for a certain length of time. This can assist you in those times when you are between jobs or waiting for a new health insurance plan to cover your pre-existing condition. Under COBRA, there are limits to what you will need to pay to continue your coverage.

When word gets around about your command of Health Insurance facts, others who need to know about Health Insurance will start to actively seek you out.

Laxmi Wadhwa asked:


You want to buy the best health insurance plan, which will not only give you excellent policy benefits but also render you maximum tax savings. Choosing the right health insurance company should be the first step of applying for health insurance policies and plans. You need to know about the rate and quote of the health insurance company, in order to choose the best insurance plan.

India has witnessed major growth and development in the area of insurance, since 2001. National players have tied up with global insurance companies to earn more recognition. ICICI Lmobard, Tata AIG, BajajAllianz and others are some of the major players in the insurance sector. Some of best health insurance plan are offered by these major private health insurance companies.

ICICI Lombard GIC Ltd is a globally recognized company that provides General Insurance. The company is rewarded for the kind of service it provides to the customers and it offers a range of plans for people in various categories. Health Advantage Plus launched by ICICI Lombard is tax saving plan while Family Floater Health Insurance covers health needs of your entire family. Personal Accident policy protects you against accidental hospitalization. The chief benefits offered by these plans include coverage against terrorism and convenient online buying process without any paperwork.

A private health insurance company, Tata AIG Life Insurance Company Limited or Tata AIG Life is a tie up between the Tata group and the American International Group (AIG). It offers a variety of health plans and policies. Some of the major products of this private health insurance company include Tata AIG Life Health First, Tata AIG Life InvestAssure Care, Tata AIG Life Health Protector — 5 Year Guaranteed Renewal Accident and Health Plan, Tata AIG Life Health Investor and Tata AIG Life InvestAssure Health. The Tata AIG Health Insurance policy offers you benefits under Section 80D of the Income Tax Policy.    

You can insure the future of you and your family with a health insurance policy from Bajaj Allianz. Bajaj Allianz Life Insurance Company Limited is another big name amongst the private health insurance companies. The company is a tie-up between Allianz SE, a life insurance company and the Bajaj Auto, a leading name producing two and three-wheelers. This private player offers some of the best health care plans and policies.  Family Care First, Care First and Health Care are some of the major health care products offered by this company.

Get a quote and rate on health insurance to compare health care products. You can then take your decision accordingly. Browse online for the same, make a smart choice and save money!

Pardeep Kumar Sharma asked:


SOCIAL JUSTICE THROUGH HEALTH CARE

We hardly come across a person who may be fully satisfied with the health care delivery system run by either the government or the private sector. This is true not only for developing but for all the developed countries as well. Every law abiding, contributing individual has some legitimate expectations from the state. Disenchantment with present dispensation of health care compels people to seek better options across the borders. Even the present flow rate of patients from developed to developing countries has assumed the proportions of Medical tourism. Medical tourism is not a one-way traffic. Poor from India are known to visit Rashid Hospital at Lahore for kidney transplants. Medical tourism will definitely bring in world class equipment and services in our corporate hospitals. These corporate tertiary care hospitals can act as excellent referral hospitals. Lack of enough clinical material, as the patients are often referred to in medical parleyences is prompting the doctors from developed world into medical adventurism. Very recently two NGO's headed by renowned plastic surgeons of Indian origin were in India, claiming to their credit hundreds of cleft lip and palate surgeries conducted in one week. During my brief interaction when I asked them one basic question that how do you justify single step surgery by a single specialist for a clinical entity that require 3-5 set up surgeries by 10 specialists over a period of 20 years, there was no answer. On record local doctors conduct all these surgeries. These NGO's bring in a battery of trainee resident doctors for hands on training. Dumping of questionable services and drugs continues unabated in the absence of stringent regulations. Clear-cut up to date guidelines by health authorities have yet to be issued to safe guard the health interests of this nation. Most of the drugs banned in developed countries are still being dumped in the Indian market. Commerce alone dictates the policies of multinational companies in health sector of developing countries. State and national medical councils, the watch dogs of our national health interests are controlled by elected representatives from among the doctors. Competitive populism for being elected to these high offices takes away the very sting off these regulators. In this 'market forces' driven health sector, apart from other factors, size of the population, economic prosperity and literacy levels dictate the out look of key players. Subjective as well as objective assessments of the health care operations leave people confused with huge piles of data and endless interpretations. At the tail end of govt. health care delivery system is the rural dispensary or the slum revamping center, and the end user an illiterate or semi literate villager or a slum dweller. Dispensary is the humane face, the welfare state can present to its people. In yesteryears the service providers were from among the same social class they used to serve. Doctor can be a friend, philosopher and guide to the locals. Unfortunately the economic and social disparity between the service providing doctors and the service user population has grown enormously. Ad-hocism in health care delivery should be done away with immediate effect. Doctors and paramedical staff appointed on yearly contract basis are not showing any interest in the national programmes. Established private health care providers also have not shown any meaningful commitment for national programmes. Middle class itself has fragmented. Now it is fashionable to assign economic values to any issue like gender, but for social responsibility and justice. In this era of fast paced growth, the unorganized, silently suffering millions can not be wished away. Once reading on biodiversity I stumbled upon a very interesting quote, «only the species with economic importance will survive». In our active pursuit for magnetizing economy, we assigned economic values to any thing except for morals. Commercialization of education has produced a new breed of professionals who have scant regard for professional ethics. Privatization is the buzzword with governments, because it takes away government responsibility. Private sector players are eyeing many ‘viable’ health institutions. There are no takers for commercially non-viable rural institutions. Rural health institutions dispense social medicine. Very recently one of the key players from private sector health care quoted the cost of developing one bed in corporate hospital at Rs. 30-60 lacs. These corporate health services are definitely out of each of the common man. These type of hospitals are definitely required for a nation with the present rate of growth but 'bharat' definitely needs different kind of hospitals. There are very strong social under currents against the exploitive private healthcare, inadequate government sector health care resources and the indifferent approach of welfare state. Health for all is a very lofty but expensive proposition. There are ways and means to reduce the pressure from government institutions. Private-public partnership, health insurance, monitoring and regulation of private sector health care can all make the things bit easy. Preventive health care education can go a long way in improving the public health. Community participation in health care has produced few but wonderful examples. Complementary community participation can make up for minor but critical deficiencies in the government run health care system. Setting up of health system corporations with World Bank assistance has already improved the working of govt. sector health care institutions considerably. Community participation through NGO's can still improve the system, but most of the meaningful NGO's turn their back on govt. run health care institutions because of their doubts on the integrity of government officers. Government health care institution are increasingly seen not as caring hospitals but like police stations, where medico legal reports are written and postmortems conducted. Most of the government doctors' time is spent in courts appearing as medico legal experts witnesses. Emergency, post mortem, and then the VIP duties in addition hardly leave the doctors free for any meaningful job at government hospitals. There is an urgent need to have separate curative, preventive, legal, administrate and health intelligence wings. Government hospitals attract the poorest of the poor, mostly people from the unorganized sector. Their contribution to national GDP is by no means small. With the present growth rate, upward social mobility is seen in every strata of society. Many segments of this unorganized sector can be organised so that they also enjoy the patronage of welfare state in the form of health insurance policies. Apart from direct benefit to these segments of society, the state will benefit from the 'off loading' of burden from government run health care system and loading it on insurance driven private sector health care institutions. Poorest of the poor will repose faith in welfare state. Sanjivini, health insurance policy with the Punjab Milkmen Cooperative Societies is already a big success. ECHS (Ex servicemen Contributory Health Scheme) is an other success story. These success stories can be replicated with countless groups like, panwallas, dhabewallas, autorikshaw drivers etc. Simply organize the unorganized sector. There is no dearth of role models from among government doctors also. Their inclusion rather than drift after dissent from the present dispensation of health care will immensely improve the system. Stability of tenure is an excellent incentive government can give to its doctors without costing anything to exchequer. Yet tenure beyond decades should be discouraged as it leads to development of vested interests of the old incumbents and denial of chance to the youngsters. Resource mismatching is a major problem in the govt. run health care system. There are dispensaries where specialists are posted and still many more civil hospitals where non-specialist are posted. These mismatching result in defective and inefficient health care. Nodal Hospitals can be created for round the clock emergency services by cannibalizing defunct and sick institutions where equipment worth crores is lying unused and salary bills are bleeding the exchequer white. Most of the medical officers retire in the same administrate rank. This undue stagnation has forced many a brilliant doctors out of service. By simply seeking options for place of posting, honestly implementing with minimum displacement on merit can also revitalize the govt. doctors' cadres. Private sector health care delivery system is a totally market driven commercial enterprise. So called 'market forces' have least respect for ethical and moral value systems. Multi level marketing chains have evolved in the name of referral systems. End result is exploitation of the unsuspecting common man, who still regards his healer a holy person. This 'incentive' system is strengthening the hold of unqualified, unscrupulous and unregistered medical practitioners on illiterate masses. Not many qualified doctors are unscrupulous. A large section of private health care providers feel genuinely threatened by blackmailers of all sorts. Consumer protection act is a very convenient beating stick in the hands of their tormentors.

Under the constant threat of being blackmailed, the private health care providers are becoming more defensive in attitude. More patients are being referred to tertiary care institutions for this reason only, thereby flooding the referral institutions. People have a common feeling that sickness is an invitation for exploitation at the hands of private health care providers. Even the charitable hospitals are charging as heavily as fully private hospitals. Medical profession is fully responsible and capable of self-correction. Medical councils and associations can jointly evolve a fail-safe mechanism to keep their black sheep under check even without government help, but the buck stops with the government. Welfare state is duty bound not only in providing health care delivery system but also proper health care administration and social justice through its health care delivery mechanism.

Name : Dr. Pardeep Kumar Sharma

Email-ID : omfspardeep@yahoo.com.

(M) : 0988456296

Date of Birth : 12.02.1962

Education Qualifications : BDS (Bachelor of Dental Surgery)

MDS (Master of Dental Surgery in Oral and Maxillofacial Surgery)

Educational Institutes Attended

Govt. High School Bargari : Matriculation (1969—1977)

Distt. Faridkot, Punjab, India

DAV College Chandigarh : Pre-University (1973-79)

(Punjab University)

Barjindra College Faridkot : Pre-Medical (1980)

Dental Wing, Medical College : BDS (1981—1986)

Patiala

Dental College and Hospital : MDS (2003—2006)

Amritsar

Professional Experience

House Officer, Christian : 1987—1988

Medical College & Hospital,

Ludhiana

Research Officer, All India : Jan. 1989 to June 1989

Institute of Medical Science

AIIIMS, New Delhi

Dental Officer, Indian Armed : July 1989 to August 1994.

Forces in the Rank of Capt.

3

Medical Officer (Dental) : w.e.f. Nov. 1995 till date

in Punjab Civil Medical Service

(PCMS)

Research papers Published

«Role of Programmed cell death in dental anomalies associated with cleft lip and Palate». «Medical Hypotheses» Churchil Living Stone Publishers London-1991

Post traumatic polatoglossal adhesion, a case report stomatologica India (1990).

Research Project Undertakes

«Malocclusion and associated Factors among Delhi Children» a study sponsored by Indian Council of Medical Research (ICMR).

Areas of Interest : Environment, Health, Defence, International Affairs and Rationalism

shannon lokker asked:


Natural Health is Quality Health

In our hectic day to day world, our health is becoming a more important factor in merely keeping pace with the expectations that are demanded of us. More than 65% of Americans are actively seeking new ways to boost energy, contribute to their health in natural and effective ways, or to rearrange their lifestyle to bring more of nature’s balance to the forefront of their daily lives. Natural health carries a wide variety of interpretations, but everyone can agree that natural health is always the preference to chemically induced—symptom covering—pseudo health.

Finding Natural Health Products that Work

Business is booming in the natural health industry and of course there are ample products out there claiming to provide the benefits of natural health while providing a strong foot hold for energy increase and immune system balance. It can be difficult to find natural health products that live up to their promises. Many “energy drinks” on the market today provide nothing more than a significant amount of B 12 vitamin complexes and caffeine to make you feel as though you have a tremendous amount of energy, at least until that inevitable crash hits. It is not uncommon for those interested in finding natural health products that produce more energy and help balance out the body’s natural system to purchase the realm of available products only to find themselves discouraged and dissatisfied with the result. The average household can spend upwards of $700 per year trying out new products that claim to boost energy, revitalize the immune system, and provide a balanced and essential combination of natural ingredients to enhance mental and physical performance and still not find a product that they are satisfied with.

Many companies make a lot of promises. Whenever there is a new trend in the health market, there are more companies than a consumer can research ready and willing to market the next big miracle in natural health products. For consumers, relying on advertisements becomes a guessing game of integrity, and few companies deliver.

Natural Health Energy

Natural health energy comes from a high level of nutrition balanced with good habits and products that are formulated for providing long term energy derived from natural sources. Of course, caffeine is technically considered a “natural source” and consumers are advised to check the labels if they choose a different method of boosting their energy level. If a consumer is searching for a natural health energy product, their available choices shrink down to about literally ten different products. This type of energy is delivered to the body in a metabolizing manner that the body can process for real, honest results and a higher level of bodily care. Taking care of the body is definitely one guaranteed way to gain more energy.

Synthetic Health vs. Natural Health

With energy products marketed all over the place, there is a question for the results oriented individual whether there is a significant difference between synthetic health products versus natural health products. For some consumers, the only thing that matters is the bottom line; does it boost a person’s energy? An energy boost may be more important to some consumers than the origination of the product or how it is made. In all relevant studies, products that are designed around the natural health principles are able to deliver better results than those made of synthetic materials. It’s not rocket science. Any natural material is going to be absorbed more effectively and efficiently by the cellular structure of the human body than the man made synthetic components. This is true whether you are talking about energy products, health products, or even vitamins. Anything derived from a natural source is bound to provide a better platform for the body to absorb the potential benefits.

Natural health products that are designed to stabilize immunity and provide an increase in long term and short term energy generally have the additional effect of promoting youthful qualities in the body. The ability to eliminate free radicals and other age promoting factors is often a semi—intentional side effect of creating a natural health product that is so distinctly balanced.

Natural Health that Originates in History

As our productive powers, our technological advancements, and our societal expectations leap into the future, many scientists, physicians, and researchers are now starting to look backward to find answers to some of today’s most asked questions. Good health is not an accident. There are many cultures throughout the world that have been able to maintain a very high standard of health without the interference of Western medicine. Our technologically sound advancements now allow for enhanced study of these cultures, practices, and their traditional herbal and natural health remedies. There has been a great amount of success in bringing forth these historical facts and introducing them into our present day society.

Thus, everything we have learned so far as a society about natural health, rejuvenating the body’s cells and spirit, and of course, enhancing health and energy can be traced back to the historical ancestors of yester—year. Combining this new found age old information with the technology of today allows for the mass production of some of the most impressive natural health solutions to date.

Choosing Natural Health Products

When consumers choose natural health products, especially those with a claim for enhancing energy, most find that the research they can do on their own is sufficient provided they stick to all natural products. Natural health energy offers consumers a more advanced choice in today’s world of relentless media advertisements and self induced pressure to find the right product right away. Consumers need to be mindful of the fact that their choice of a natural health product is something that they are likely to introduce into their body on a daily basis, and thus their research should be thorough, involve a small amount of patience, and be able to be backed by an independent source.

Bestinsurance George asked:


The laws of Texas health insurance, also known as the portability and the Health Insurance Accountability Act, were established in 1996 by Congress to protect workers and their families to health insurance and establish standards for insurance providers and employers. Title I to protect workers if they change jobs or get fired from a current job. The protection extends to employees as family members. Title II covers a different aspect of the legislation on health insurance, requiring health care facilities, employees, insurance providers and health to meet the standards set nationally. Title II is also known as Administrative Simplification (AS), using electronic data systems in Texas and across the United States to issues of health care much more efficient than in the past.

Title I of the Texas Health Insurance main objective is to change the law on service of public health and retirement income of employees of the Security Act. Under Title I, the providers of health insurance in Texas and across the United States cannot judge eligible workers or not simply based on disability, genetics, or their medical history. Health insurance companies in Texas and other states to be able to impose restrictions on health insurance plans for workers who had pre-existing conditions. However, Title I limits of these restrictions that insurers are allowed to put on benefits for workers who fall into this category. In addition, Title I also prohibits providers of health insurance restrictions on coverage or refuse workers to pre-existing conditions.

Title II of HIPPA was created first for the simplification of administrative rules, which require the Department of Health and Human Services to help promote efficiency and effectiveness of health care system in Texas and all other states. Title II also includes two sets of criminal and civil penalties for those who violate the laws. The Department of Health and Human Services has established five key rules: security, privacy, laws, unique identifiers, and transactions and code sets rules.

The safety rule consists of three sections: administrative, physical and technical. Protective measures administrative guidelines for health care to be met, particularly regarding security issues. The Privacy Rule expands on this, imposing restrictions on disclosure of information concerning a person's health care status. The application of the Article sets of sanctions, primarily civil violations and fines for those who have violated HIPAA. The article attributes the unique ten-digit National Provider Identifier number to entities such as hospitals or doctors to promote the effectiveness of the health care system in Texas and across the U.S. Finally, the Code operations and establishes rules cover many aspects of health care such as requests for information on eligibility and benefits and the transmission of information on health care.

The HIPAA originally charged health care facilities at a cost to get «in conformity» with the HIPAA. Since its inception, the HIPAA laws have affected research and clinical care. Because HIPAA call for details on many forms, some patients complain that many things are extremely user-hostile. Other studies suggest that the HIPAA privacy rules May have adverse effects on costs and results of health research. The implementation of HIPAA also had effects on clinical care as well. Research shows that health facilities are often uncertain of privacy restrictions, so that May be made for patients as a very reluctant to disclose individual information.

One of the most important areas of HIPAA for those with pre-existing is to cover the requirements in Title I. Title I of the Texas forces individual insurance companies to offer guaranteed issue Texas HIPAA portability of health insurance plans for TX residents who meet certain criteria. If you have any major pre-existing conditions and feel that you May be eligible for a TX HIPAA health insurance plan then be sure and speak with a licensed insurance agent health in Texas to verify your eligibility.

Valipat Munpan asked:


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Mohd. Faim A. Ansari asked:


Health Maintenance Through Positive Thinking

Paper presented in National Seminar on Positive Perspectives of Health and Behaviour, Department of Psychology, M.D. University, Rohtak, February, 1&2, 2008.

 

M. FAIM A. ANSARI (RESEARCH SCHOLAR)       

ASIYA AIJAZ (READER)

DEPARTMENT OF PSYCHOLOGY             

THE ALIGARH MUSLIM UNIVERSITY                                     

ALIGARH

            



Health:

Psychological resources such as hope, optimism, personal control, sense of meaning, and subjective well-being are known to exercise a protective influence on health. The Greek physician Hippocrates anticipated that positive emotions and health outcomes may be linked through multiple pathways. In the developed and developing countries, health is seen as the most valuable asset for a good quality of life, particularly in later years of life. Good health of the citizen is key facilitator to contribute to society. Smith (1990) said, «In the past, good health meant the absence of disease.» Today the definition of health is high level wellness that goes beyond the absence of disease toward one’s maximum potential which includes mind, body and sprit. High level wellness is the integration of health component, i.e. emotional, physical, social, spiritual and mental.

The common origin of the word health from «hoelth», an English word meaning safe or sound and whole of body (Dolfman, 1973). There is no one contemporary meaning for the term. A nursing oriented definition of health consistent with the theme that the health is a subjective phenomenon that is operationalizable has been proposed by the Lynn. Lynn, 1990 defined health as a subjective representation of a person’s composite evaluation of somatic sense of self (how one is feeling) and functional ability (how one is doing).As such, health is manifested in the subjective judgment that one is experiencing wellness or illness. These subjective experiences are dynamic and are an outgrowth of person and environment interactions. As long as a person is capable of evaluating how he/she is feeling and doing at some level, the person has health.

The World Health Organization (WHO, 1948) defines health as a «state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity». Thus, the World Health Organization (WHO) has very clearly indicated that the absence of disease is not enough for health. This, definition emphasizes on positive and negative dimensions of health. Negative health or ill health has a subjective component expressed in the concept of illness and discomforts and an objective component express in concept of disease, injury, handicap or deformity. Positive health has two components: wellbeing and fitness. This state entails an appropriate balance of the physical, mental, social ingredients. Fitness can be considered as the objective physical components, where as, wellbeing can indicate the psychosocial component of positive health.

Lau (1995) found that when young healthy adults were asked to describe in their own words «what being healthy means to you?» their beliefs about health could be understood within the following dimensions:-

Ø     Physiological/Physical- good condition, having energy.

 

Ø     Pathological-happy, energetic, feels good psychologically.

 

Ø     Behavioural-eat and sleep properly.

 

Ø     Future consequence-live longer.

 

Ø     The absence of, e.g., sickness, disease & symptoms.

Kasl and Cobb (1966) states that health behaviour is any activity undertaken by a person believing himself to be healthy for the purpose of preventing disease or detecting it at an asymptomatic stage. Therefore, positive health can be defined as activities that may prevent disease, detect disease and disability at an early stage, promote and enhance health, or protect from risk of injury. Thus, "positive health can be defined as any activity undertaken by individual with a frequency or intensity that increases health or reduces disease
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As, we all know that the good health is a gift of God, but having good health is not sufficient but to maintain it also equally important. For this reason one should also focus on healthy lifestyle and positive thinking.

 

  ADOPT A HEALTHY LIFESTYLE

 



Exercise regularly. Physical activity plays a key role in reducing and preventing the effects of stress. Make time for at least 30 minutes of exercise, three times per week. Nothing beats aerobic exercise for releasing pent-up stress and tension.

Eat a healthy diet. Well-nourished bodies are better prepared to cope with stress, so be mindful of what you eat. Start your day right with breakfast, and keep your energy up and your mind clear with balanced, nutritious meals throughout the day.

Reduce caffeine and sugar. The temporary «highs» caffeine and sugar provide often end in with a crash in mood and energy. By reducing the amount of coffee, soft drinks, chocolate, and sugar snacks in your diet, you’ll feel more relaxed and you’ll sleep better.

Avoid alcohol, cigarettes, and drugs. Self-medicating with alcohol or drugs may provide an easy escape from stress, but the relief is only temporary. Don’t avoid or mask the issue at hand; deal with problems head on and with a clear mind.

Get enough sleep. Adequate sleep fuels your mind, as well as your body. Feeling tired will increase your stress because it may cause you to think irrationally.



 

The positive aspect of health is reflected in the Arabian proverb, «A man, who is healthy, has an optimistic view and who has an optimistic view, has everything» (Husain, 2005).

 

POSITIVE THINKING FOR GOOD HEALTH:

Happy people are always focusing on good events and worthy quality of life; they have optimistic view of life. Positive thinking can help people to gain peace of mind, obtain better health and attain an unceasing stream of energy. Positive thinking can have a beneficial effect on people’s health by increasing a person’s intellectual, physical, psychological, and social resources. Positive thinking leads to opportunity, Positive thinking is healthy. By practicing positive thinking one can enhance positive emotions, feeling and positive mental attitude which improve the quality of peoples lives and heal their bodies from illness and stresses.

According to Frederickson (2001) Positive emotions increase people’s physical, cognitive and social resources, which in turn help them cope more effectively with stressful experiences and live healthier.

   According to Nudel and Nudel, positive thinking is an effective way to achieve mastery of bio-energy healing. Maintenance of a positive energy level in a healer's own bio-energy field reduces stress and emotional tension in the healer and in others positive emotions and feelings and a positive mental attitude can improve the quality of people's lives and heal their bodies of illnesses and stresses.

 On the other hand, negative emotions and feelings bring poisonous toxins to the organism. Strong negative emotions such as anger, spite, envy, jealousy, and fear make the endocrine system accumulate poisons in the blood. Anxiety, depression, and doubt can also cause poisoning of the blood. Passive and lengthy negative emotions are even more dangerous for health than for active, sudden and momentary negative emotions. Negative emotions shorten the span of life. Treatment of physical symptoms with positive thoughts and statements was popularized in France a century ago, and it still has the power to overcome unwanted states (stress, tension, and unhappiness). Thoughts and feelings make up reality and add color to it. So, unhappiness brings a gray world and reality. To change a gray world and to overcome the feeling of unhappiness, anxiety, or tension, one needs to refocus the mind on positive, healing thoughts. When people predict that something wrong is going to happen to them, it is more likely to happen because negative thoughts will be reflected in their unconscious. Moreover, the person may develop psychosomatic illnesses (about 70% of all illnesses are psychosomatic, or caused by mental stress). Psychosomatic illnesses worsen when given special attention. Instead of paying direct attention to pain or illness, every time a negative thought occurs, say something like, «It will be better than I think.» When a wish of any desired condition is established in the mind, somehow the unconscious mind leads the wish to realization-not magically, but through mental programming. Besides healing illnesses, positive attitudes help one to withstand troubles and problems, make correct decisions, and overcome obstacles. Do not focus on negative events; try to discover a positive perspective. For example, individuals should understand that they need to read more or think more of others in order to find the ways of perfect communications. Because the thoughts of individuals are either positive or negative, they are reflected in their social or asocial behaviors. People should observe and conceive the world around them, as well as their inner worlds, with positive perceptions. Healers should have «a positive mind state» before they begin practicing bio-energy healing. Healers communicate with other people giving them energy. «Negative» energy cannot bring healing; only damage and it is destructive for both a healer and a healee. Healing energy is «a positive energy» sent by «a positive mind.» Your thoughts are in your control, and they can be very powerful.

Positive thoughts can motivate healthy behaviors, such as eating healthy food and being active. It's simple really. If you believe you can take 10,000 steps a day, you will be more likely to take an extra walk to meet your goal. If you know you can avoid holiday weight gain, you'll feel great when you pass the tempting dessert buffet, and fit comfortably in your winter clothes. If you set your mind to do something, you can do it. Positive thinking can also help you achieve and maintain healthy behaviors, such as becoming more physically active or limiting your sugar intake.

Peale (1996) has measured the success of positive-thinkers and found that those who think positively they can lose weight, or increase their physical activity, these people are more successful than people with less faith in themselves. The confidence you have in performing a certain behavior is called self-efficacy; and self-efficacy is a key in successful behavior change.

A «can-do» attitude may be just what it takes to jumpstart a healthier lifestyle. Best of all, your attitude is something you can control. You have the choice to have a positive outlook. Chances are when you choose to think positively, you'll feel better about yourself and be able to perform better in whatever you do.

 HOW TO STAY POSITIVE:

Positive thinkers admit when they feel frustrated or depressed. They don't ignore it. But they also don't blame themselves. Instead, they try to understand the negative thoughts and feelings and counter them with more positive ones. So how do you stay positive, maintain momentum and sustain healthy behaviors? Here are few tips given by Peale (1996):-

 Ø     Look for a good role model. There is always someone who seems to be doing just what you want to be doing. Maybe they've scheduled exercise into their workday and switched from coffee to herbal tea. Learn from a successful friend, family member or colleague. Ask them how they keep healthy and follow in their footsteps.

 Ø     Try some positive self-talk and avoid negative-talk. Take a minute to give yourself an ego boost. Repeat some motivational words out loud or to yourself. Negative talk, «I can't do it,» «I'm fat,» is dangerous for your well-being and healthy goals. Try to avoid the negative self-talk before it harms you. Remind yourself that you deserve happiness and can make positive changes.

 Ø     Get support. Tell your friends and family about your healthy habits. It helps to have an encouraging network.

 Ø     Reward yourself. Give yourself a pat on the back for your healthy efforts. Take a nice bath, get a massage, and enjoy a new DVD or CD.

 Ø     Have a plan. Making a plan to exercise or eat healthy lunches with a friend can mean the difference of sticking with your goals or falling off track. If you've planned for an activity, you'll likely stick with it. You may even find that writing down your goals and steps to achieve them can help you stay on track. Take it day by day or week by week. The process of writing down your personal action plan is a good way to keep you honest and watch your progress or pitfalls.

Positive thinking is mental attitude that enters into the mind through words and images that are conducive to growth, expansion and success. It is mental attitude that expects good and favorable results. A positive mind anticipates happiness, joy, health and a successful outcome of every situation and action, whatever the mind expects, it finds.

The power of positive thinking can change and improve your life. Maintaining positive thinking and attitude will drive you to success, healthy life and happiness. Positive thinking is a habit that is right practice. Positive thinking is something you have to do everyday as often as possible and whenever you can. By practicing positive thinking everyday, you create a state of mind where you are constantly positive- it becomes a state of being positive. By doing this at last you will find an amount of positive energy that will create a positive situation for you everyday. Positive emotions and feelings and a positive mental attitude can improve the quality of people’s lives and heal their bodies of illnesses and help to regain health.

One approach to positive thinking given by Martin (1991) is called the three C's: Commitment, Control and Challenge.

 Commitment: Make a positive commitment to yourself, to learning, work, family, friends, nature, and other worthwhile causes. Praise yourself and others, Always dream of success, Be enthusiastic.

Control: Keep your mind focused on important things. Set goals and priorities for what you think and do. Visualize practicing your actions. Develop a strategy for dealing with problems. Learn to relax. Enjoy successes. Be honest with yourself.

Challenge: Be courageous. Change and improve each day. Do your best and don't look back. See learning and change as opportunities. Try new things. Consider several options. Meet new people. Ask lots of questions. Keep track of your mental and physical health. Be optimistic.

Martin (1991) has shown that people with these characteristics are winners in good times and survivors in hard times. "……People who begin consciously to modify their inner conversations and assumptions report an almost immediate improvement in their performance. Their energy increases and things seem to go better…
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Commitment, control and challenge help build self-esteem, reduce stress, live healthier and promote positive thinking.

Mental and emotional expectations can influence medical outcomes. The effectiveness of any medical treatment depends in part on how useful you expect it to be. As we know that our feeling of ineffectiveness of recourses lead us to stressful situation, we can overcome this situation by maximizing our efforts and our positive thoughts like «I can do it, even with limited resources» «So what, if I am running short of recourses, I can manage this.» This thinking can only be developed through positive thinking.

Positive affirmations are created through positive thinking to counter negative thoughts. These affirmations neutralize negative thoughts and build your self confidence. Positive affirmations give ways to the opportunities that are always present to some degree in a difficult situation.

Positive thinking help one to withstand troubles and problems, make correct decisions and overcome obstacles, stresses, and remains healthy. People should observe and conceive the world around them, as well as their inner worlds, with positive perceptions.

Spiritual strength promotes positive thinking, positive ideas, positive habits, positive attitudes, and positive efforts. There are qualities that promote wisdom, physical and mental well-being. Positive emotions stimulate the nervous system that protects the heart and reduces blood pressure. A realistic assessment of one’s limitations, the development of autonomy, and an ability to cope effectively with stress enable individuals to boost their positive thinking. The ability to recognize, accept and manage our feelings plays an integral role in our emotional development.

Meaning in life is very important for developing positive thinking. Those who are having meaning in their life are more likely to develop positive thinking. It has been observed that people who have meaning in their lives are keener to reduce stress for healthy life.

To develop positive thinking the person should be open to new ideas, activities and doing new things and new innovations, so that they can be more positive in their thinking.

The positive thinking can be developed by positive self talk, healthy attitudes, following effective fitness programmes (healthy diet), financially sound, hopefulness, new ideas, sense of responsibility etc. we can also develop positive thinking by acquiring new knowledge through stimulating mental activities that allows us to create environment in which useful and productive lives can be enjoyed.

Practicing positive self-talk will improve your outlook. When your state of mind is generally optimistic, you're able to handle everyday stress in a constructive way. That ability may contribute to the widely observed health benefits of positive thinking. Positive thinking decreased negative stress. As it is very much clear that the people who think positively are more optimistic than the people who don’t.

 CONCLUSION:

It is very much clear from the above discussion that the people who think positively enjoy better and healthy life. Positive thoughts can motivate healthy behaviors, such as eating healthy food and being active. Positive thinking is the process of creating thoughts, that creates and focus energy into reality, to bring into creation a positive outcome, which you see as a benefit to yourself or others. This is a powerful gift that we all have but a lot of people are not aware of it.

Thus, we can say positive events are even sweeter when you see them as evidence of more to come, and see yourself as the master of your own fate.  Therefore, we can say those who habitually practice positive thinking tend to experience more success, which can add up to a less stressful and healthier life. The power of positive thinking can change and improve your life. Maintaining positive thinking and attitude will drive you to success, healthy life and happiness.

REFERENCES:

 

1.      Dolfman, M.L. (1973). The concept of health: A historic and Analytic examination. Journal of School Health, 43 (8), 491-497.

 

2.      Frederickson, B.L. (2001). The role of positive emotions in positive psychology: the broaden-and-build theory of positive emotions. American Psychologist, 56, 218-226.

 

3.      Husain, A. (2005). Islamic life styles: The right path for the maintenance of health. In R. Singh, A. Yadava and N.R. Sharma (Eds.) Health Psychology (pp. 329-339). New Delhi: Global Vision.

 

4.      Kasl, S. V. & Cobb, S. (1966). Health behaviour, illness behaviour and sick role behaviour I: Health & illness behaviour. Archives of Environmental Health, 12, 246-266.

 

5.      Lau, R.R. (1995). Cognitive representation of health and illness. In D. Gockman (Ed.), Handbook of Health Behaviour Research, Vol.I

 

6.      Lynn, B. (1990). Getting back on Track: Nursing’s autonomous Scope of Practice. In N. Chaska (Ed.), the nursing profession: Turning points (267-274). St. Louis, MO: C.V. Mosby.

 

7.      Martin, D (1991). How to be a Successful Student. http://www.suddenlyseparated.com/sub_menu.php?id=12

 

8.      Nudel, M. & Nudel, E. Positive Thinking for Your Health. http://www.bioenergy-services.com

 

9.      Peale, N.V. (1996). The Power of Positive Thinking. {Books available online at Barnes & Noble.com}, Random House Publications. http://www.aarp.org/health/fitness/get_motivated/positive_thinking.html

 

10.  Smith, S. (1990). Personal Health Choices. Boston: Jones and Bartlett Publishers.

11.  World Health Organization (1948). World Health Organization Constitution. In Basic documents, Geneva: Author.

 

 

       

Jennifer Salerno asked:


Gone are the days when people used to carry their health records in unwieldy files when visiting a doctor. The advances in technology made it is possible to carry the entire documents in pocket-sized devices like CD-ROMs, pen drives and now on dedicated websites who take the responsibility of saving and updating medical data. To keep a track of our medical history and share and use it when necessary, we need to create a personal health record. Let us try to understand what personal health records can do for us and how can they make our life easy.

A personal health record is the consolidated information related to health; stored and managed by an individual. Today, personal health records are also popularly known as, personal health diary, patient health record, or personal medical records. While the concept of personal health records is not new, it has evolved from a stage when these records were stored by the medical professionals and health care providers; to a stage where each person today is keeping their health records by using various technologies such as websites, personal health software and so on. The primary purpose of personal health records is:

· To keep a track on personal health and

· To help the doctors for providing better care through the valuable health information.

Ideally, a personal health record should contain every single bit of information related to your health. The information stored in your personal health record may differ according to the software or service providers, but any personal health records will contain the crucial health information. Some of the most common parameters that a personal health record contains are as follows:

· Name of the patient, birth date, blood type

· Date of last physical tests or screenings

· Major illnesses or diseases occurred in past with dates

· List of medicines and dosages taken by you

· Allergies and chronic diseases

· History of illnesses in your family

This piece of information can be very important in case of emergencies and can save your life.

Personal health records have numerous benefits not only to the users but also to the health care systems and physicians. A detailed health record can be used by physicians to take important decisions in time of emergencies. Some of the significant benefits of personal health records are as follows:

· Empowering patients: personal health record allows the patients to access, update and verify their own medical records. With the use of personal health records, one can also set reminders for health maintenance services.

· Improves patient-doctors relationship: this is especially true when you have a family doctor or a physician to whom you frequently visits. Doctors find it easy to communicate with patients who own personal health records.

· Improves patient’s safety: As the patient keeps updating their health records, it helps them to identify missed procedures and services, drug alerts, and important test results.

· Delivers efficient care: personal health records also avoid duplicative testing and unwanted or unnecessary services.

· Cost-effective tool: patients can save huge amounts which are otherwise spent unnecessary on malpractice costs.

· Privacy: personal health records can be kept confidential by using passwords. Today, most of us want our health records to be safe and secure in our hands so that no one misuses it. Personal health records allow patients to keep their health documents safe and secured.

The list of benefits of maintaining personal health records is never-ending and personal health records are slowly and steadily becoming a basic necessity to keep ourselves and our beloved ones healthy. After all, a small initiative towards health can reap great rewards. So, step ahead and create your Personal Health Record!!!!

Dr.v.sudhakaram asked:


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; © 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)