Assignment Code: MDV-115 / TMA / July 2022 – January 2023

Course Code: MDV-115

Assignment Name: Health and Development

Year: 2022 - 2023

Verification Status: Verified by Professor

Answer all the questions. Each question carries 20 marks.

Q 1. Explain National Family Health Survey in India. Discuss its objectives, survey design, field work and its results for health care policy and programmes.

Ans) The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted in India to provide information on population, health, and nutrition-related indicators. The survey is conducted by the Ministry of Health and Family Welfare, Government of India, in collaboration with international and national institutions. The NFHS uses a two-stage stratified random sampling design and is conducted by trained survey teams using structured questionnaires. The results of the NFHS provide valuable information for the government and other stakeholders to design and implement health care policies and programs.

Objectives

The primary objective of the NFHS is to provide reliable and nationally representative data on a range of health and nutrition indicators. The survey provides information on various aspects of health, including fertility and reproductive health, maternal and child health, nutrition, infectious diseases, and access to health care. The NFHS also provides information on the determinants of health, such as education, economic status, and the availability of health services.

Survey Design

The NFHS is a large-scale, multi-round survey that is conducted in a representative sample of households across India. The sample is selected using a two-stage stratified random sampling design, with the first stage consisting of the selection of Primary Sampling Units (PSUs) and the second stage consisting of the selection of households within the PSUs. The sample is selected in such a way as to ensure that it is representative of the population at the national, state, and district levels.

Field Work

The field work for the NFHS is conducted by trained survey teams, who visit selected households and collect data using structured questionnaires. The questionnaires cover a wide range of topics, including demographic information, reproductive health, maternal and child health, nutrition, infectious diseases, and access to health care. The fieldwork is conducted using a door-to-door survey method, and the survey teams follow strict quality control procedures to ensure that the data collected is accurate and reliable

Results

The results of the NFHS provide valuable information on the health and nutrition status of the population and are used by the government and other stakeholders to design and implement health care policies and programmes.

Some of the key findings of the NFHS include:

1. Maternal and Child Health: The NFHS provides information on maternal and child health indicators, such as maternal mortality ratio, infant mortality rate, and under-five mortality rate. The results indicate that there has been some progress in reducing maternal and child mortality, but that there is still a long way to go to achieve the health-related Sustainable Development Goals (SDGs).

2. Nutrition: The NFHS provides information on the nutritional status of the population, including indicators such as undernutrition, stunting, wasting, and overweight and obesity. The results indicate that malnutrition continues to be a major public health problem in India, particularly among children.

3. Reproductive Health: The NFHS provides information on fertility and reproductive health indicators, such as the total fertility rate, contraceptive use, and maternal health care utilization. The results indicate that there has been some progress in increasing contraceptive use and maternal health care utilization, but that there are still significant disparities across different population groups.

4. Infectious Diseases: The NFHS provides information on the prevalence of infectious diseases, such as HIV/AIDS, tuberculosis, and malaria. The results indicate that there have been some successes in controlling these diseases, but that there is still a long way to go to achieve the health-related SDGs.

5. Access to Health Care: The NFHS provides information on access to health care, including the availability and utilization of health services. The results indicate that there are still significant disparities in access to health care across different population groups, with the poor and marginalized populations being the least likely to have access to quality health care services.

Q 2. What is 'age-sex structure’? Make a comparison between developed and developing countries in terms of population composition.

Ans) The age-sex structure refers to the distribution of a population by age and sex. It is a demographic characteristic of a population that provides insight into the current and future social and demographic patterns of a country. The age-sex structure can be represented graphically through a population pyramid, which is a visual representation of the distribution of a population by age and sex.

A population pyramid typically displays the population in five-year age groups and separates males and females. The shape of the pyramid indicates the demographic trends of a population, such as birth rate, death rate, and migration patterns. A pyramid with a broad base and a narrow top indicates a young population with a high birth rate, while a pyramid with a narrow base and a wide top indicates an aging population with a low birth rate.

The age-sex structure is an important factor in demographic analysis, as it provides information on the potential workforce, the size of the elderly population, and the potential demand for health care services. This information can be used by governments and organizations to plan and implement policies and programs aimed at improving the well-being of the population, such as education and job training programs, health care services, and pension plans.

Comparison between Developed and Developing Countries

The comparison between developed and developing countries in terms of population composition can be seen in their age-sex structure. Developed countries typically have a low birth rate and a high life expectancy, leading to an aging population. In these countries, the age-sex structure is characterized by a broad base, representing a large number of young people, which narrows as the age increases. The top of the pyramid represents a small number of older individuals.

In contrast, developing countries typically have a high birth rate and a lower life expectancy, resulting in a younger population. In these countries, the age-sex structure is characterized by a narrow base, representing a small number of young people, which widens as the age increases. The top of the pyramid represents a large number of older individuals.

The differences in the age-sex structure between developed and developing countries have significant implications for their respective economies and social structures. In developed countries, the aging population puts pressure on the health care system and the pension system, as the number of elderly individuals requiring care and support increases. The aging population also leads to a decline in the workforce, which can negatively impact economic growth.

In developing countries, the young population puts pressure on the education system and the job market, as the number of young people entering the workforce increases. The large number of young people can also lead to political instability, as young people are often more likely to participate in protests and demonstrations.

To address these challenges, both developed and developing countries have implemented various policies and programs aimed at addressing the implications of their respective age-sex structure. For example, developed countries have implemented policies to encourage immigration and increase the number of young people in the population, as well as policies to support the elderly population. Developing countries have implemented policies to promote family planning and reduce the birth rate, as well as policies to improve education and create job opportunities for young people.

In conclusion, the age-sex structure of a population is an important characteristic that provides insight into the demographic and social patterns of a country. The comparison between developed and developing countries in terms of population composition reveals significant differences in their respective age-sex structure, which have important implications for their economies and social structures. Addressing these challenges requires a combination of policies and programs aimed at promoting the well-being of all individuals, regardless of age and sex.

Q 3. Discuss inter-sectoral co-ordination. Why is there need a for co-ordination in primary health care?

Ans) Inter-sectoral coordination refers to the collaboration and coordination between different sectors or departments of a government or an organization to achieve a common goal or objective. The goal of inter-sectoral coordination is to ensure that all sectors work together in a coordinated manner to achieve the best possible outcomes. This type of coordination is essential in addressing complex problems and issues that cross sectoral boundaries, such as health, education, and the environment. It involves collaboration between sectors such as health, education, environment, economic development, and social welfare, to name a few. For example, in addressing the issue of malnutrition, the health sector may work with the education sector to develop nutrition education programs in schools, while the environment sector may work with to promote sustainable agriculture practices.

Health, family planning, and socio-economic developments are closely inter-related and inter-dependent. Success in the field of health and family welfare will largely depend on successful implementation of various programmes of social and economic change, particularly rural health, adult education, women’s education, rural water supply and sanitation, nutrition programme, rural development programme, etc. Therefore, close inter-sectoral linkages and proper coordination of programmes and activities of different sectors such as education, social welfare, agriculture, animal husbandry, food, industry, work and housing, communication, etc., would be very important.

Need for co-ordination in Primary Health Care

1. Comprehensive and Integrated Care: Primary health care provides comprehensive and integrated care that addresses the health needs of individuals and communities. However, to achieve this, there must be coordination between different levels of care and various health services, such as hospitals, clinics, and community health programs.

2. Improved Access to Care: Coordination between primary health care and other health services helps to ensure that people have access to the care they need, when they need it. This can be achieved by linking primary health care services with secondary and tertiary care services and by coordinating the delivery of health services across different levels of care.

3. Better Health Outcomes: Coordination in primary health care helps to improve health outcomes by ensuring that people receive the right care at the right time. This helps to prevent illnesses from becoming more serious and ensures that people receive the appropriate care for their health needs.

4. Efficient Resource Use: Coordination in primary health care helps to ensure that resources are used efficiently. By collaborating with other health services, primary health care can avoid duplication of effort and ensure that resources are used in the most effective and efficient manner.

5. Improved Quality of Care: Coordination in primary health care helps to improve the quality of care. By working together, health care providers can share best practices, provide support and guidance, and ensure that everyone is working towards the same goal of providing high-quality health care.

In conclusion, coordination in primary health care is essential for achieving comprehensive and integrated care, improved access to care, better health outcomes, efficient resource use, and improved quality of care. By collaborating and coordinating with other health services, primary health care can ensure that everyone has access to the care they need, when they need it, and that resources are used efficiently and effectively to improve the health and well-being of individuals and communities.

Q 4. Explain major steps in developing Health management information system (HMIS) in India.

Ans) The abbreviation "Health Management Information System" (HMIS) refers to an integrated system of information management that helps in the gathering, storing, analysing, and disseminating of data that is related to the field of medicine. This information can then be used to improve patient care. HMIS is an essential component in the process of improving the overall quality and efficiency of the delivery of health care because it provides information that is accurate and up to date and that can be used in the process of decision-making as well as in the planning of programmes.

The following are the major steps in developing a Health Management Information System (HMIS) in India:

1. Assessment of Needs: The first thing that needs to be done in order to create an HMIS is to determine what the requirements of the healthcare system are. This involves determining the appropriate methods for collecting and storing this information, as well as the data and information that are required for decision-making and the planning of programmes.

2. Stakeholder Engagement: It is absolutely necessary for the successful development and implementation of an HMIS to involve key stakeholders, such as those who provide medical care, those who work for the government, and those who represent the community. Participation from stakeholders helps to ensure that the Health Management Information System (HMIS) satisfies the requirements of the health care system and is sensitive to the requirements of the community.

3. Development of Data Collection and Management Tools: The next thing that needs to be done is to create the data collection and management tools that are required for the HMIS. In this context, "development" can refer to the creation of data collection forms, data management software, and data storage systems.

4. Data Collection and Management: The next step, which comes after the development of the tools for the data collection and management processes, is to collect and manage the data. This includes the implementation of data collection and management procedures, as well as the training of health care providers and community members on how to make use of these tools.

5. Data Analysis and Dissemination: The next step, following the collection and management of the data, is to perform an analysis on the information and then disseminate it. Specifically, this entails making use of the data to inform decision-making and programme planning, as well as the development of policies and programmes that are based on evidence.

6. Monitoring and Evaluation: The monitoring and analysis of the HMIS's performance constitutes the very last stage of its development. This entails conducting regular assessments of the quality and efficacy of the HMIS, locating areas in which it could be improved, and making any necessary adjustments to ensure that it continues to be effective.

In conclusion, the process of developing a Health Management Information System (HMIS) in India is complex and multifaceted, and it requires an approach that is methodical. Assessing the needs of the health care system, involving key stakeholders, developing data collection and management tools, collecting and managing the data, analysing and disseminating the information, and monitoring and evaluating the performance of the HMIS are the primary steps involved in developing an HMIS. In India, the Health Management Information System (HMIS) has the potential to significantly contribute to the enhancement of both the quality and the efficiency of the provision of medical care if the aforementioned steps are carried out.

Q 5. What are the major adolescent health problems? Describe the importance of adolescent health care in developing countries.

Ans) Adolescence is a critical period in the life cycle, characterized by physical, emotional, and psychological changes. During this period, young people face a range of health challenges that can impact their well-being and future prospects. Some of the major adolescent health problems are as follows:

Sexual and Reproductive Health Problems

There are numerous issues relating to sexual and reproductive health that have been ignored for a considerable amount of time that adolescents face. The spread of HIV and AIDS among adolescents and young people is one of the most significant consequences of irresponsible sexual behaviour, which is engaged in by a significant number of these individuals. Over thirty-five percent of all AIDS cases that have been reported in India have been found in young people between the ages of fifteen and twenty-four, and more than fifty percent of all new HIV infections have been found in young people. It is a well-known fact that sexual harassment can be found in public places, educational institutions, in and around the home, and in the workplace. This is yet another issue that predominantly affects young women. Ragging, child abuse, and other forms of bullying are also quite common, particularly among males. The gender stereotype that men and boys are inherently or hormonally violent and, as a result, are justified in using force against women and girls contributes to the reinforcement of this phenomenon.

Complications of Adolescent Pregnancy

The body of a teenage girl, which is still in the process of developing, is not prepared to handle the additional stress of pregnancy and childbirth from a physiological standpoint. The pelvic bones are not yet fully developed and cannot support the weight of labour and delivery. As it is, her developing body has specific dietary requirements that must be met during the adolescent stage. This places an additional burden on a young woman's shoulders, as she may not be mentally prepared for motherhood with all of the additional responsibilities that come along with it. This could lead to mental health issues such as depression. Pregnancy-induced hypertension and anaemia are two examples of pregnancy-related complications that are observed in adolescents at a rate that is significantly higher than that of adults.

Substance Abuse

Concerning trends have been observed in recent years regarding the use of tobacco and alcohol among young people. In India, it is estimated that there are approximately 3 million people who abuse drugs, the majority of whom are in the age range of 16 to 35. Almost 11% of people had their first experience with cannabis before the age of 15, and about 26% of people had their first experience between the ages of 16 and 20. According to the findings of the NFHS-3, forty percent of young men and five percent of young women in the age group of 15 to 24 had ever used tobacco, whereas twenty percent of young men and one percent of young women in the age group of 15 to 24 had ever consumed alcohol. Among young women, the percentages were reversed.

Injuries and Accidents

Injuries pose a significant challenge to the health of adolescents. Injuries are recognised as a major contributory factor to morbidity, disability, and health care costs, as well as other costs such as loss of future work and quality of life. This is in addition to the fact that injuries are a leading cause of death in young people, which is a significant factor in and of itself. Road traffic accidents (also known as RTAs) account for a significant portion of the overall number of unintentional injuries and deaths.

Acute and Chronic Diseases

The health of adolescents can be negatively impacted by conditions such as asthma, tuberculosis (TB), diabetes, and many others.

In conclusion, sexual and reproductive health problems are a major concern among adolescents. These problems can have serious health and social consequences and can impact their quality of life and future prospects. Addressing these health problems requires comprehensive sexual education and access to appropriate health services, as well as efforts to empower young people to make informed decisions about their sexual and reproductive health.