1. Kingsuk Sarkar, MD
Asst. Professor,
Dept. of Community Medicine
DSMCH

2. Social agencies are an integral part of socio-
cultural tradition of India
 they are coordinated & assisted by Ministry of
Social Welfare & Women’s Affairs
Autonomous Central Social Welfare Board
implements women oriented programs
Women centered activities are :
training, welfare, provision of health
care, women’s hostel, legal aid & support to
women against exploitation by employers or by
their own families.

3. All India Women’s conference
National Council for Women
National Association for Rural Women
Indian Social Institute
Centre of Science for Villages
Eastern India Women’s Association

5.  centre:
- 28 states & union territories
- Indian constitution came into effect from
26.01.1950
- President, vice President, Prime
Minister, Council of Ministers→ Union
Executives
•India: sovereign, Republic with
parliamentary democracy
•Parliament: President & two Houses – the
Rajya Sabha & Lok Sabha
•Parliament assisted by several committes
•Lok sabha members get elected every 5
years

6. State:
-Closely resembles center
-Governor, Council of Ministers with a
Chief Minister as Head→ State Executive
-Governor appointed by president for 5
years
-Vidhan Sabha: Legislative Assembly;
members chosen by direct election
-Vidhan Parishad: Legislative
Council, Upper House
-Union territories are governed by the
President through

7. Local Government:
1) Urban:
- Corporation, Municipal
Committee, Council
- Corporations headed by elected
Mayors, Municipalities headed by
Presidents
- Executive power of the corporation lies on
the hands of the Commissioners
- Corporation deals with public health &
sanitation, maintenance of
roads, bridges, markets, playgrounds, parks
& education

8. •Process of Democratic
Decentralization:
oGram Panchayats→ elected by Gram
Sabhas( entire adult pop. Of village)
oPanchayats responsible for: agricultural
production, relief, rural
industries, MCH, maintenance of roads, tanks
& sanitation
oPanchayats exercise control over
schools, PHCs
oVillage Courts/ Judicial Panchayats→ speedy
disposal of
Panchayati Raj Institutions
Level Institution
Village Gram Panchayat
Block Panchayat Samiti
District Zilla Parishad

9. •Laws:
-Some came into existence out of sheer tradition
- few enacted by Parliament & State Legislatures
- Constitution is the Supreme
-Important laws in the field of community health :
a) The Prevention of Food Adulteration Act,1954
b) The MTP Act,1971
c) The ESI Act,1948
d) The Indian factories Act,1948
e) The Central maternity Benefit Act,1961
f) The Children Act,1960
g) The central Birth & Death Registration Act, 1969
h) The Epidemic Diseases Act, 1897
i) Juvenile Justice Act,1986

10. •Cooperatives:
-A form of conducting business in
the society
-After the recovery of costs, profits
are distributed among members
-Government encourages
establishment of cooperatives for
uplifting poor by providing loans at
easier terms (soft loans)
-Societies on dairy, poultry, irrigation
projects, consumer societies

11. •Educational Services:
-Obtaining basic education: fundamental
rights
-Education: important community service
-Education socialize children to implant social
values & norms & prepare for future role as
citizen
-Education is a state responsibility
-Constitution guarantees free & compulsory
education up to 14 years
-Central government determines & controls
educational standard, technical & scientific
education , research
-MCI prescribes standards of medical
education
-Ministry of Education: State & Central level

12. •Recreation & Cultural Activities:
-Three National Academies to
promote Indian Art, Music, Drama
-State Academies also promote art
-AIR & Doordarshan are influential
mass media even in remote areas
-Indian movies are largest in volume
-Documentary movies expresses life,
art, culture of Indian people
belonging to various regions

14. •Resources of India:
-India is rich in both natural resources
& manpower
1) Agriculture: mainstay of economy,
employs 70% of population
2) Forestry: 20% land covered by
forests which are a major source of
timber, resins, gum, bamboo,
canes, tendu leaves, rubber, dyes,
honey
3) Fisheries: marine product help to
bring coveted foreign exchange
4) Minerals: coal, bauxite, mica, iron,
manganese, nickel, copper,
5) Manpower: greatest resource,
accounts for 16% of global pop.

15. Principal categories of Industrial Workers
Nam of the Industry
Primary Sector
Agricultural & Allied Activities
Mining & quarrying
Secondary Sector
Manufacturing
Electricity, Gas, Water supply
Construction
Tertiary Sector
Wholesale & Retail Trade, Hotel & Restaurant
Transport, storage & communities
Other Services

16. •Challenges of industrialization:
-principal industries were jute, cotton, coal
-Emerging industries: steel, sugar, cement,
chemicals, glass, vanaspati, soap, heavy
electrical, machine tools
-Shifting of rural to urban population
-Community Health problems of
urbanizations: slum dwelling, air & water
pollution, accidents, increases incidence
of communicable diseases like tb & STDs,
mental health problems
-Social problems: alcoholism, drug
dependence, prostitution, gambling,
generalized crime

17. Health has a price
Sickness has cost
Resources are scarce & hence
to be allotted in a priority basis
Principle of Health Economics:
-“best ways to spend limited
resources available in a country
for Health Care”
India ranks low among
developed & developing
countries in per capita health
expenditure

18. Financial impact of Tuberculosis in
India
-India’s biggest health as well as social
problem
-Man days lost due to tuberculosis:
- Indian worker with tuberculosis lost
an average of 83 work days because
of disease
-2 million new cases reported in India
-National loss per year→166 million lost
work days at a cost of $200 million

19. •If we add indirect cost, TB costs India
Rs.12000 crores annually
•Non –disease costs 300000 school dropouts
due to TB
•High cost for diagnosis & successful
treatment of TB→ account more than half
of avg, income of daily wage earner
•Rejection of married women by their
families
•>80% TB patients are in economically
productive age group

20. Economic impact of Tobacco
Use:
-Another economic burden
-cost f treating tobacco related
disorders e.g., COPD, CAD,
cancers are very high
-It offsets the monetary effects
earned as revenue or
employment opportunities in
tobacco industries

21. Cost:
-Value of resources used to
produce something, including a
specific or a set of health
services
-The patient should be
considered as customer & he
wants ‘value for the money
spent’

22. Benefit:
-Refers to ‘outcomes’ which can be
measured I terms of money
-Outcomes may be:
oProducts & Services(output)
oImproved KAP(effects)
oImprovement in health status
oReduction in- morbidity, mortality & fertility
oImprovement n nutritional status(outcome)
-effectiveness or effects are outcomes in a
natural way which are not expressed in
natural terms; e.g,, no. of lives saved by a
health intervention or life years gained or
no. of heart attacks prevented

23. Cost by Input:
Capital Cost:
-Vehicles: bicycles, motorcycles, trucks
-Equipments:
refrigerators, sterilizers, manufacturing
machinery, scales, equipments
-Buildings: health
centres, hospitals, training
schools, administrative office, storage
facilities
-Trainings: non-recurrent training
activities for health personnel which
occur rarely
-Social mobilization: non-recurrent
social mobilization activities, e.g.
promotion & publicity campaigns

24. Recurrent Cost:
-Personal cost- supervisors, health workers,
administrators, consultants, casual labor
-Supplies: drugs, vaccines, syringes, small
equipments
-Vehicle operation & maintenance: petrol,
diesel, lubricants, tyres, spare parts,
registration & insurance
-Building operation & maintenance:
electricity, water, heating, fuel, telephone,
telex, insurance, cleaning, painting, repairs
of electrical supply & appliances,
plumbing, roofing
-Training:
-Social mobilization: operational costs
-Other operational costs not mentioned
above

25. Opportunity Cost:
-Central concept in economic analysis
-Explains the consequences of
choosing between two alternatives
•E.g. among two possible
interventions; a cancer screening
program & a smoking cessation
program, only one can be funded
with the view to limited budget
- The opportunity cost of funding 1st
program will be the benefits we forgo
by not choosing the 2nd plan i.e. no. of
life years that could have been
gained through smoking cessation
program

26. Average Cost:
- Total cost for intervention ∕ total
no. of units provided for
treatment;
e.g. average cost of OPD
treatment at PHC per patient per
day
incremental Cost:
- Difference in cost between two
interventions i.e. the intervention
& its comparator

27. Marginal Cost:
-An additional cost or extra cost
of producing one unit of output
or expanding a program
-E.g. additional cost of adding
MMR vaccine to the universal
immunisation program
-Increasing hospital stay by single
day

28. i. Cost minimization analysis (CMA)
ii. Cost-effectiveness analysis (CEA)
iii. Cost utility analysis (CUA)
iv. Cost benefit analysis (CBA)

29. Cost Minimization Analysis(CMA)
-CMA compares the costs of
different interventions which are
assumed to provide equivalent
benefits
-Here only the costs are compared
, not the benefits
-Cheaper the intervention, better
the value for money
-It is rarely found for two health
interventions to churn out exactly
same benefits

30. Cost Effectiveness Analysis:
-Here benefits are measured in natural units
-E.g. heart attacks avoided, life years
gained (no. of years by which the life is
extended as a result of intervention),
-CEA presented as ratio
-CEA=Cost/No. of lives saved
-Effectiveness is an expression of desired
effect of a program, service or institution or
support activity to reduce a health
problem or to improve a health situation

31. -Effectiveness measures degree
of attainment of predetermined
objectives & targets of a
program, service or institution
-Population based services e.g.
nutrition, immunization, fertility, to
bacco & other drugs, household
& external environments[ indoor
air pollution, provision of safe
water & sanitation, vector
control], HIV/AIDS ---highly cost
effective

32. Cost Utility Analysis (CUA):
-CUA can be used to compare the costs
& benefits of health technologies where
treatments can influence both quality &
quantity of life in a multidimensional way
-Most widely used QALY, DALY, healthy
year equivalent
-CUA=Cost/QALY gained or DALY
averted
-Dominant intervention: an intervention
both cheaper & more effective than its
comparators
-To select between 2 treatments,
incremental cost-effectiveness ration
(ICER) should be calculated

33. Cost Benefit analysis:
-benefits measured in monetary
terms
-Final result expressed as net
monetary gain(or loss) or Cost
Benefit Ratio
-CBA= Cost in Monetary
terms/Benefits in Monetary terms
-Two main methods to measure
health gains from CBA, human
capital approach & willingness to
pay approach

34. Efficiency:
-An input-output ratio
-An expression of relationships
between the results obtained
from the health program/activity
and the efforts obtained in terms
of human, financial & other
resources, health
processes, technology & time
-Assessment of technology→
aimed at improving
implementation

35. Quality Adjusted Life Years
• a common measure of benefit
that combines quantity & quality of
life
•Calculated by estimating the total
no. Of life years gained from
treatment & weighing each other
with a quality of life score to
represent the quality of life in that
year
•E.g. a patient living for 10 years
with a quality of life of 0.6 on a
scale of 0-1 (with 0 as death & 1 as
perfect health), would live for six
(0,6X10) Quality of Life Years

36. Disability Adjusted Life Years (DALYs)
-Used to determine disease burden
-Another indicator similar to QALY
-Developed by World Bank & WHO to quantify global
burden of disease
-Incorporates both quality & quantity of life in a common
measure
-It measures losses of healthy life rather than life years
gained
-One DALY≈ one year of healthy life lost