Second
Edition
Public Health
Management
Principles and Practice
15
12
G
3
Sunder Lal
Vikas
CBS Dedicated to Education
CBS Publishers & Distributors Pvt Ltd
Public Health
Management
Principles and Practice
Second Edition
Book Review
1. Very concise and informative book on public health management for UG, PG medical students and teachers as well.
2. This book covers almost all the topics relevant to changing paradigm, as far as what is expected from a community
medicine graduate.
3. Language is very simple so easy to understand.
4. Topics are covered in compact manner which might be useful in examinations as well.
Geeta Kedia
Professor and Head
Department of Community Medicine
BJ Medical College
Ahmedabad, Gujarat
Public Health
Management
Principles and Practice
Second Edition
Dr (Brig) Sunder Lal MBBS, DPH, MD
Former
Professor and Head , Department of Social and Preventive Medicine
Pt BD Sharma Postgraduate Institute of Medical Sciences , Rohtak
Adesh Institute of Medical Sciences and Research, Bathinda, Punjab
Professor, Community Medicine at MM University, Mullana, Ambala
Deputy Director- General, TA (Medical)
Chairman, Board of Studies of Medicine and Allied Sciences, MDU, Rohtak
Member, National Commission on Population, Gol ; Consultant, ICDS
Member, National Technical Advisory Group on Immunization and Child Health
Member, Technical Resource Group on Women, Children and ICDS
NSS Programme Officer
Honorary Professor, IMACGP
President, IAPSM
Vikas BDS, MDS
Professor and Head
Department of Orthodontics
JN Kapoor DAV Centenary Dental College
Yamuna Nagar, Haryana
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Public Health
Management
Principles and Practice
Second Edition
ISBN: 978-93-87742-93-2
Copyright © Authors and Publisher
Second Edition: 2018
First Edition: 2016
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Foreword
The book Public Health Management: Principles and Practice is pertinent to the needs of health care delivery
Thesystems in India. Eleven chapters were identified after a long and sustained process of consultation
with many premier public health institutions of the country, namely National Institute of Health and
Family Welfare (NIHFW); National Institute of Public Cooperation and Child Development (NIPCCD); Indira
Gandhi National Open University (IGNOU), New Delhi; Public Health Foundation of India (PHFI), Gurgaon;
School of Public Health, Postgraduate Institute for Medical Education and Research (PGIMER), Chandigarh;
Ministry of Health and Family Welfare, Government of India, New Delhi; various dental, medical and nursing
colleges in the country, apart from health organizations at state, district, CHC/ PHC/SC and community
organizations at field level.
Broadly , the areas covered are highly contextual and have bearing on the acceptable principles and
practice of health management. These areas include health system reforms, policies, health system
organizations, principles of health management, management of national health programmes, and services,
health management information system, community organization, community diagnosis, community
participation in health management, human resources in health, logistic and supply chain management,
health financing and budgeting, hospital statistics, disaster management, health planning, supervision,
monitoring and evaluation, SWOT analysis, strategic planning, health management problems and their
causes , international health regulation and international statistical classifications of diseases and related
health problems.
The book fulfils the long standing needs of health policymakers, health managers (top, middle and lower
levels) at various levels of health care delivery system, teaching, training and research faculty of medical,
dental and nursing colleges and department of public health/community medicine/community public health
training institutes at national, regional, state and district levels and also hospital management, research
institutes and libraries . Best practices in health management and case studies are the unique features of this
book, included in the text to enhance the learning of health management. Feedback to authors shall be most
valuable to improve the future editions .
Rajesh Kumar
Professor and Head
School of Public Health
Dean, Postgraduate Institute of
Medical Education and Research
Chandigarh
Preface to the Second Edition
Inviewof
imperativefast
needto changes in thethe
track revise/update field
first
ofedition.Accordingly
health care delivery system and health policy, there was an
the updated second edition incorporates
recent developments like sanitation coverage, disease burden measured in terms of DALYs losses by major
disease groups (2016), neglected tropical diseases, Revised National Immunization Schedule, WHO Global
Action Plan and monitoring framework for prevention and control of non-communicable diseases, National
Mental Health Survey in India 2015–16, NITI Aayog, National Health Policy 2017, life saving commodities in
RMNCH+A, India Newborn Action Plan, health manpower in India, management of inventory, health
care financing in India, health spending in India, revised health management information in India, ANMOL,
Kilkari, Mobile Academy, universal health coverage, comprehensive primary health care, managing quality
in health services, sustainable development goals and evaluation of management system. Hopefully the
updated/revised learning resource material meets the expectations of the users. Constructive criticism and
suggestions are most welcome to improve the future editions of the book.
Sunder Lal
Vikas
Preface to the First Edition
ublic health management teaching and training programmes are woefully a neglected area, both during
Publi
the undergraduate and postgraduate education of doctors, dentists, and nurses. There is a paucity of
learning resource materials on health management; it is available in bits and pieces, and the faculties or
trainers have limited access to such material. Teaching and training on health management through didactic
methods (theory lectures) make the subject high and dry beyond one's capacity to absorb and learn.
Practitioners of public health management in healthcare delivery system face a plethora of problems to
manage human and other resources with the consequence of poor performance of the workforce and
suboptimal performance of the programmes and the system as a whole.
The current book Public Health Management: Principles and Practice is a bold attempt to compile and present
the most recent available material on the subject of public health management. Eleven chapters run in a
sequential manner and present the most relevant and practical aspects of health management in an easy -to-
understand language, avoiding purposely the theoretical details . The material is relevant to health problems
and programmes in India and many of its states . Domains of public health management are specific in
nature, the necessary overlap has been reduced to minimum. Written in a lucid, easy-to-read and understand
style in a sequential manner, the textbook is intended primarily for undergraduate, postgraduate medical,
dental and nursing students and professionals . It can serve as a useful learning resource material for teachers
of community medicine, public health managers and administrators, policy makers and decision makers in
the healthcare delivery system. Using standard case studies and work experiences in different areas will
enhance and enrich the public health management learning. Best practices and nine case studies have been
incorporated in the text to enrich the learning of health management.
Sunder Lal
Vikas
Acknowledgements
We sincerely acknowledge the Aga Khan Foundation (AKF); Director General Health Services, Ministry
of Health and Family Welfare, Government of India, for referring and using their published material
in public domain.
The continuous support, guidance, encouragement, and material help from learned colleagues like
Dr Rajesh Kumar, Professor and Head, School of Public Health, Postgraduate Institute for Medical Education
and Research (PGIMER), Chandigarh, Prof Sanjay Zodpey, Director, Indian Institute of Public Health,
Gurgaon. Dr Shankar Prinja, Associate Professor, PGIMER, Chandigarh; SB Arora, Professor, School of Health
Sciences (SOHS), Indira Gandhi National Open University (IGNOU), Delhi; Dr D Bachani, Professor and
Head, Department of Community Medicine, Lady Hardinge Medical College (LHMC), New Delhi; Dr Manish
Goyal, Associate Professor, Department of Community Medicine, LHMC, New Delhi; and Dr A Khera, Deputy
Commissioner, Maternal and Child Health, Nirman Bhawan, New Delhi, are sincerely acknowledged.
Sunder Lal
Vikas
Contents
V
Foreword by Rajesh Kumar
Preface to the Second Edition vii
Preface to the First Edition ix
Abbreviations XV
1. Determinants of Health, Major Health Problems and Disease Burden in India 1
Dimensions of Health 1
Determinants of Health 3
Health Indicators 7
Measurement of Health Status and Health Indicators 10
Disease Burden 11
Major Health Problems in India (2001–2016 ) 12
India's Share in Global Health Problems 12
Changing Pattern of Infectious/Communicable Diseases in India 13
Emerging Infectious Diseases ( IDs )—New IDs 13
Reducing Incidence and Control of CCDs (Infectious Diseases) 14
National Immunization Schedule 15
Neglected Tropical Diseases 16
Non-communicable Diseases ( NCDs ) 16
Strategies for Prevention and Control of Non-communicable Diseases ( NPCDCS) 17
Ten Voluntary NCDs Targets to be Achieved by 2025 17
Prevention and Control of Non -communicable Diseases ( NCDs ) 18
Sustainable Development Goals ( UNs Sept 2015) for Control of Communicable and Non-communicable Diseases 19
2. Evolution of Health Reforms and Health Policy Development in India 21
Development of Public Health Policy and Services in Independent India 21
Overlapping Reforms in Health System 21
National Health Policy ( NHP ) 1983 : “ Health for All ” 23
National Population Policy ( NPP)-2000 25
Social Marketing Programme (SMP) in Health and Family Welfare 30
Revised National Health Policy ( NHP)-2002 32
National Health Policy 2017 34
Health Reforms in Policy and Strategies through RCH and National Health Mission 37
National Rural Health Mission ( NRHM ) 2005–2012 Public Health Management Challenges 42
Improving Maternal and Child Health Through RMNCH + A Approach 47
Principles of RMNCH + A_47
Life saving commodities in RMNCH + A Programme 48
India Newborn Action Plan 49
Reforms in Health Sector through RCH and NRHM Strategies 49
3. Public Health Management Sciences, Organization of Health Services, 51
Health Management Functions and Resources in Health
Management Sciences for Public Health 51
Public Health 53
What is Management? 53
xii Public Health Management
Approaches to Management 54
Health Systems 55
System Approach to Public Health 55
Health Care Delivery Systems 56
Organizing—A Management Function 56
Organization/Structure of Health Services 56
Public Health Domains 59
Health Management Functions 62
Case Study on Health Management Functions 63
Principles of Health Management 66
Decision Making—A Management Function 69
Controlling—A Management Function 70
Human Resources in Health System 71
Health Team (Public Health Team) 75
Job Descriptions 75
Logistics and Supply Chain Management 81
Health Care Financing in India 84
Budgeting and Financial Management 87
Flexible Financing 90
Cost in Health Care and Methods of Economic Evaluation 92
4. Key Health Management Functions and Best Practices I 97
Community Organization—A Management Function 97
Rural Community—Case Study 99
Urban Community—Case Study 100
Tribal Community 101
Community Diagnosis—A Management Function 101
Community Participation in Health Management and Development 104
Mahila Mandals—Case Study 106
ICDS—Case Study 107
Organizational Behaviour (Leadership, Group Dynamics and Motivation) 110
Leadership—A Health Management Function 110
Motivation—Health Management Function 112
Behaviour Change Communication (BCC)—A Management Function 116
Communication in Public Health Management 120
Planning, Implementation and Evaluation of Health Communication Programme 125
Counselling in Health and Disease 128
What is Integrated Counselling and Testing Centre? 132
5. Key Health Management Functions and Best Practices II 135
Planning of Health Services 135
Steps in Planning of Subcentre Action Plan 135
Methods of Assessment of Health Problems (Needs)—A Case Study 136
Decentralized Participatory Planning 138
Demography of India—Census 2011: A Base for Planning Health Services 148
Strategic Planning in Health 152
District Health Action Plan (DHAP) Under NRHM 153
SWOT Analysis of National Rural Health Mission for DHAP (District Health Action Plan) 153
Contents xiii
6. Supportive Supervision, Monitoring and Evaluation, and HMIS as 157
Health Management Functions
Methods of Supervision 157
Health System Monitoring—A Management Function 160
Evaluation of Health Programme or Health Services—A Management Function 165
Programme Evaluation and Review Technique (PERT) 167
Management Problems and their Root Causes 167
Health Management Information System (HMIS) 170
Hospital Statistics 180
Hospital Administration/Management 183
Preventive and Promotive Health Services in Hospitals 183
7. Health Care Delivery Systems in India and Sustainable Development Goals 185
From Primary Health Care to Universal Health Coverage 185
Various Health Care Systems 185
Government Health Services 185
Primary Health Care (PHC) 186
Primary Health Care System in Rural Areas 188
Subcentres (SCs)—First Tier of Primary Health Care 189
Primary Health Centre (PHC)—2nd Tier of Primary Health Care 192
Community Health Centre—3rd Tier of Primary Health Care 194
Urban Primary Health Care Services 198
National Urban Health Mission (NUHM) 199
Urban Primary Health Centre (UPHC) Model 201
Primary Health Care in Tribal Areas 203
Essential Drugs and Medicines and Rational Use of Drugs 203
Affordable Medicines and Reliable Implants for Treatment (AMRIT) Stores 204
Free Diagnostics Service Initiative 204
Secondary Health Care 204
Tertiary Health Care 206
Referral System 207
Referral Policy 208
Private Health Sector 208
Health Insurance 209
Central Government Health Services (CGHS) Scheme 212
Other Sectors 213
Health Care Utilization 215
Consumer Satisfaction 215
Managing Quality in Health Services 216
Minimum Needs Programme and 20-Point Programme 218
Millennium Development Goals (MDGs) 219
Sustainable Development Goals by 2030 220
8. Application of Principles of Epidemiology in Health Management and Management of 222
National Health Programmes
Application of Principles of Epidemiology in Health Management 222
Epidemiological Surveillance of Diseases 222
Integrated Disease Surveillance Programme (IDSP) 227
Management of National Health Programmes (NHP) 232
E-Health (Telemedicine)—E-Governance 236
xiv Public Health Management
9. Disaster Preparedness and Management (Emergency Epidemiology) 237
Global Phenomenon 237
Disaster Preparedness 237
Natural Disasters in India 238
Response to Disaster 240
Nodal Agency and Organization 240
Case Study 242
National Disaster Management Authority and Disaster Preparedness (Prevention and Planning) 242
Bioterrorism (Biological Warfare) 244
10. Medical Ethics and Research in Public Health Management 245
Ethics in Medicine and Consumer Protection Act 245
Hippocratic Oath 245
Nuremberg Code of Ethics in Medical Research 246
Declaration of Helsinki 247
Research 249
Research in Health Management 250
Management Training in Medical Colleges 250
Operational Research (OR) 251
Case Study 252
11. International Health and International Health Regulations 257
World Health Organization (WHO) 257
United Nations International Children’s Emergency Fund (UNICEF) 258
Colombo Plan 259
Technical Cooperation Mission (TCM) 259
Rockefeller Foundation 259
Ford Foundation 260
FAO, CARE, World Bank, DFID, UNFPA, USAID, IRCS 260
International Health Regulations (IHR) 261
International Statistical Classification of Diseases and Related Health Problems (ICD-10) 264
Index 267
Second Sec
Edit
Public Health
Principles and Practice
Management Edition
is the thoroughly revised and updated edition of the basic text, written in an easy to read style ,
which aptly describes the principles and practice of public health management . It makes use of
real -life field situations of health care delivery systems in India . Case study method of learning
has been introduced to highlight the best practices of health management, and to facilitate
learning of health management science and management functions in the context of the
Indian scenario . The text includes most current information and latest data on health and health
services .
The book is intended primarily for • undergraduate medical students and • postgraduate
students of community medicine | public health , community dentistry and community health
nursing . It is expected to serve as a valuable resource material for • health officers or managers
at the state , district, community health centre, primary health centre levels and • teachers of
community medicine and training institutes of public health at various levels .
Sunder Lal MBBS, DPH, MD
is an eminent public health expert who served as Professor and Head , Department of Social and
Preventive Medicine, Postgraduate Institute of Medical Sciences , Rohtak, Haryana . He has over
47 years of experience in teaching , training and research in the field of community medicine . Не
has been ICDS Consultant for over 25 years, honorary chief editor of Indian Journal ofCommunity
Medicine, Secretary-General of Indian Association of Preventive and Social Medicine (IAPSM) for 9 years ,
and distinguished himself as Fellow of IAPSM . He has published 182 research papers in various national
and international journals of repute and served on editorial boards of several scientific journals. He retired
as Deputy Director- General (Medical) , TA, with meritorious service award . He is recipient of Dhanwantari
Oration Award , Harcharan Singh Oration Award , Srivastava Award , and prestigious Amrut Mody Unichem
Prize awarded by ICMR for research work on maternal and child health . He has served as President of
IAPSM (2010–11 ) . The revised fifth edition of his other popular CBS book Textbook of Community
Medicine | PSM with recent update has been released .
Vikas BDS , MDS
is currently Professor and Head , Department of Orthodontics, JN Kapoor DAV (C) Dental College,
Yamunanagar. He completed his BDS from Manipal College of Dental Sciences (Manipal
Academy of Higher Education), Mangalore , and then pursued his MDS in orthodontics from the
same institute . He has been the recipient of prestigious TMA Pai Gold Medal for being the best
outgoing student for 2000 and was also awarded the 'student plaque ' by International College of Dentists .
He is a recognized undergraduate and postgraduate teacher and has guided postgraduate students for
over 13 years and is actively involved in teaching , training and research . He is a reviewer for the
prestigious American Journal ofOrthodontics and Dentofacial Orthopedics. He has published 10 papers
in national and 7 papers in international peer- reviewed journals and is regularly presenting scientific
papers in the national conferences . He is on the panel of examiners for various universities .
Dedicated
Education
to
ISBN : 978-93-87742-93-2
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