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Indian state launches decentralised health scheme
POLICY AND PEOPLE
WHO tackles hearing disabilities in developing world of deafness and hearing impairment done in Asia and Africa showed that the prevalence of “disabling hearing impairment” or moderate or worse hearing impairment in the better ear was 2·1% in Oman, 4·6% in
Rights were not granted to include this image in electronic media. Please refer to the printed journal. AP
HO has joined forces with hearing aid manufacturers, charities, and aid agencies in an attempt to drastically reduce the price of hearing aids for people in developing countries. According to WHO, deafness is one of the most neglected disabilities and is worse in developing countries. Participants at the informal consultation on hearing aids for developing countries organised by WHO (Geneva, Switzerland; July 11–12 ) agreed to try “to find ways to enable the provision of affordable, appropriate hearing aids and the services to fit them in large numbers within 2 years”. “At least 250 million people globally have hearing loss, which is more than 4% of world’s population”, says Andrew Smith, a medical officer at WHO responsible for the prevention of deafness and hearing impairment. At least two-thirds of these people—about 165 million people—live in developing countries, he added. A hearing aid costs about US$200–500 and most people in developing countries cannot afford one. Recent population-based surveys
W
Cheap hearing aids would be very helpful
Indonesia, 5·9% in India, and 4·4–7·6% in Nigeria, says Smith. The Indian survey of poor rural communities near Vellore in the state of Tamil Nadu showed that 5·9% of the population had moderate or worse disabling hearing loss, says Smith. “If this 5·9% level for disabling hearing loss is extrapolated throughout India, this would mean that approximately 60 million people have disabling hearing loss, the vast majority of whom would benefit from
hearing aids”, Smith told The Lancet. “Chronic middle ear infection, which usually goes untreated there, often leads to life-long hearing disability”, says Smith. “Survivors of meningitis and other infections, are often left with profound hearing problems.” “We estimate that developing countries currently need more than 32 million hearing aids per year”, says Smith. “But at present they get only about three-quarters of a million.” “The cost of a hearing aid may represent several months’ salary or more [in the developing world]”, says Christian Garms, executive director of the German charity, Christian Blind Mission. “We need to find a way to bring down the price of appropriate hearing aids to US$10–20.” WHO published guidelines for hearing aids and services for developing countries on July 11, which provide detailed requirements for the manufacture of affordable and appropriate hearing aids, provision of services and training of personnel in developing countries. Sanjay Kumar
Indian state launches decentralised health scheme
O
ne of the largest states in north India (Madhya Pradesh) has launched an ambitious health scheme that will try to ensure community health services reach the state’s 51 000 villages. By December, 2002, the scheme proposes to assign a health worker and a midwife to each village. Policy makers hope that this will strengthen each community’s ability to provide basic health care. The health workers will monitor the immunisation status of children and provide antenatal care on a monthly basis to reduce infant mortality and maternal mortality rates. They will be authorised to prescribe non-scheduled drugs and sell contraceptives. In Madhya Pradesh, the mortality rate of children younger than 5 years old is among the highest in India. The reasons for the high mortality include deficiencies in rural health care, poor access to safe drinking water, and poor sanitation. “The focus would be to build health action from the grassroots
THE LANCET • Vol 358 • July 21, 2001
level. This will mean village level planning for health”, said state chief minister, Digvijay Singh. Health management will now shift from state level control to district level allowing authorities to address local priorities and use available financial resources, said Singh. More plans for district level care are in the pipeline. In each village a health survey has been completed. The results of these surveys will be used to create “village health registers”, which in turn will form the basis of district health plans. The registers will be updated annually and will be used to help formulate the following year’s district health plan. It seems that the problem with the current system is that plans are made at the state level and are implemented irrespective of local health needs. To ensure each plan meets the precise needs of the village a local health monitoring committee will be set up. Another important aspect of the new system will be that each plan will specify a time-
frame to guarantee implementation of basic services, such as safe drinking water, sanitation, nutrition, immunisation, health education, and training health workers. In each district, a health society working under the district authority will be formed to ensure that the health plans are supported by an appropriate level of funding and resources from the private sector. The state government will also create a fund for local health needs by making available money from budgets from various agencies that support community health programmes. “This decentralisaton of the primary health-care system is an attempt to bring people closer to health care. But its success depends on how far the mindset of the people implementing it can be changed”, says Mira Shiva, a community health specialist at the Voluntary Health Association of India, a non-government organisation. Dinesh C Sharma
219
For personal use. Only reproduce with permission from The Lancet Publishing Group.
WHO tackles hearing disabilities in developing world of deafness and hearing impairment done in Asia and Africa showed that the prevalence of “disabling hearing impairment” or moderate or worse hearing impairment in the better ear was 2·1% in Oman, 4·6% in
Rights were not granted to include this image in electronic media. Please refer to the printed journal. AP
HO has joined forces with hearing aid manufacturers, charities, and aid agencies in an attempt to drastically reduce the price of hearing aids for people in developing countries. According to WHO, deafness is one of the most neglected disabilities and is worse in developing countries. Participants at the informal consultation on hearing aids for developing countries organised by WHO (Geneva, Switzerland; July 11–12 ) agreed to try “to find ways to enable the provision of affordable, appropriate hearing aids and the services to fit them in large numbers within 2 years”. “At least 250 million people globally have hearing loss, which is more than 4% of world’s population”, says Andrew Smith, a medical officer at WHO responsible for the prevention of deafness and hearing impairment. At least two-thirds of these people—about 165 million people—live in developing countries, he added. A hearing aid costs about US$200–500 and most people in developing countries cannot afford one. Recent population-based surveys
W
Cheap hearing aids would be very helpful
Indonesia, 5·9% in India, and 4·4–7·6% in Nigeria, says Smith. The Indian survey of poor rural communities near Vellore in the state of Tamil Nadu showed that 5·9% of the population had moderate or worse disabling hearing loss, says Smith. “If this 5·9% level for disabling hearing loss is extrapolated throughout India, this would mean that approximately 60 million people have disabling hearing loss, the vast majority of whom would benefit from
hearing aids”, Smith told The Lancet. “Chronic middle ear infection, which usually goes untreated there, often leads to life-long hearing disability”, says Smith. “Survivors of meningitis and other infections, are often left with profound hearing problems.” “We estimate that developing countries currently need more than 32 million hearing aids per year”, says Smith. “But at present they get only about three-quarters of a million.” “The cost of a hearing aid may represent several months’ salary or more [in the developing world]”, says Christian Garms, executive director of the German charity, Christian Blind Mission. “We need to find a way to bring down the price of appropriate hearing aids to US$10–20.” WHO published guidelines for hearing aids and services for developing countries on July 11, which provide detailed requirements for the manufacture of affordable and appropriate hearing aids, provision of services and training of personnel in developing countries. Sanjay Kumar
Indian state launches decentralised health scheme
O
ne of the largest states in north India (Madhya Pradesh) has launched an ambitious health scheme that will try to ensure community health services reach the state’s 51 000 villages. By December, 2002, the scheme proposes to assign a health worker and a midwife to each village. Policy makers hope that this will strengthen each community’s ability to provide basic health care. The health workers will monitor the immunisation status of children and provide antenatal care on a monthly basis to reduce infant mortality and maternal mortality rates. They will be authorised to prescribe non-scheduled drugs and sell contraceptives. In Madhya Pradesh, the mortality rate of children younger than 5 years old is among the highest in India. The reasons for the high mortality include deficiencies in rural health care, poor access to safe drinking water, and poor sanitation. “The focus would be to build health action from the grassroots
THE LANCET • Vol 358 • July 21, 2001
level. This will mean village level planning for health”, said state chief minister, Digvijay Singh. Health management will now shift from state level control to district level allowing authorities to address local priorities and use available financial resources, said Singh. More plans for district level care are in the pipeline. In each village a health survey has been completed. The results of these surveys will be used to create “village health registers”, which in turn will form the basis of district health plans. The registers will be updated annually and will be used to help formulate the following year’s district health plan. It seems that the problem with the current system is that plans are made at the state level and are implemented irrespective of local health needs. To ensure each plan meets the precise needs of the village a local health monitoring committee will be set up. Another important aspect of the new system will be that each plan will specify a time-
frame to guarantee implementation of basic services, such as safe drinking water, sanitation, nutrition, immunisation, health education, and training health workers. In each district, a health society working under the district authority will be formed to ensure that the health plans are supported by an appropriate level of funding and resources from the private sector. The state government will also create a fund for local health needs by making available money from budgets from various agencies that support community health programmes. “This decentralisaton of the primary health-care system is an attempt to bring people closer to health care. But its success depends on how far the mindset of the people implementing it can be changed”, says Mira Shiva, a community health specialist at the Voluntary Health Association of India, a non-government organisation. Dinesh C Sharma
219
For personal use. Only reproduce with permission from The Lancet Publishing Group.