|
OJHAS Vol. 10, Issue 2:
(Apr-Jun 2011) |
|
|
| Health Informatics,
Sustainable Health Care Development
and Malnutrition in India |
|
|
RS Balgir, Division of Human Genetics,
Regional Medical Research Centre (Indian Council of Medical Research),
Chandrasekharpur, Bhubaneswar-751 023, Odisha, India |
|
|
| |
|
|
|
|
|
|
Address for Correspondence |
Scientist F/Deputy Director (Senior Grade) and Head,
Department
of Biochemistry,
Regional Medical Research Centre for Tribals (ICMR),
Near
NSCB Medical College and Hospital,
Post Garha, Nagpur Road, Jabalpur-482 003,
Madhya Pradesh, India.
E-mail:
balgirrs@yahoo.co.in |
|
|
|
|
|
Balgir RS. Health Informatics,
Sustainable Health Care Development
and Malnutrition in India. Online J Health Allied Scs.
2011;10(2):1 |
|
|
|
|
Submitted: May 27,
2011; Accepted: Jul 10, 2011; Published: Jul 30, 2011 |
|
|
|
|
|
|
|
| |
|
| Abstract: |
|
Health informatics aims at studying the principal computer applications
related to technology in developing human health care and solving the
existing problems to facilitate efficient management. It helps in decision
making process, hospital administration and system management and in
catering the needs of clients/patients and doctors. However, the inadequacy
of skilled manpower, resources and economy are the major hurdles to
exploit the full potential of the technology and medical health facilities.
Malnutrition and related causes are adversely affecting the nation from
several angles. An integral approach would be able to mitigate the human
sufferings.
Key Words:
Health informatics;
Health care; Sustainable development; Malnutrition.
|
|
Health
informatics is an evolving scientific discipline that deals with the
collection, storage, retrieval, communication and optimal use of health
care related data, information and knowledge. The discipline utilises
the methods and technologies of the information sciences for the purposes
of problem solving and decision-making, thus assuring quality healthcare
in all basic and applied areas of biomedical sciences.(1) Health informatics
is concerned primarily with the processing of data, information and
knowledge in all aspects of healthcare. It aims to study the principle
applications to provide solutions to the existing problems. The domains
of Health informatics are the research, academia, operations and commercial;
and are delivered by operational health practitioners, managers/administrators,
academics, researchers, educators, scientists and technologists.(2)
|
|
|
|
|
|
|
|
Use of Health Informatics |
Computers
in Health Care are well accepted the world over as telemedicine, clinical
and diagnostic aids, to improve patient care, tone up administration,
facilitate accounting and enable effective management control. An important
application has been in hospital management, where computers have been
an effective tool for doctors, nurses, administration and management.
The
major uses of Health Informatics in Health System Management are:
Informatics application
in Hospital Management:
All
over the world, the health challenges and needs are increasing and becoming
more complex. The demands and pressures on the hospitals and health
care institutions are also increasing. At the same time, the resources
are becoming increasingly limited. Achievement of goals, efficiently,
effectively, and economically is the primary responsibility of all the
administrators. This can be achieved through business, medical, telemedicine
and technical management systems in hospitals.
Decision making-Decision
support system in health care:
There
is a growing trend to apply computers for tasks other than tabulation.
The health care providers are increasingly interested in the feasibility
of applying the "expert system technology" to assist improved
health care delivery through telemedicine. The earliest research contributions
in the area of artificial intelligence were a program to simulate expert
behavior in the selection of an antibiotic for an infection. The trend
of research in Medical Informatics is increasingly in the area called
expert systems/decision support systems/telemedicine.
Informatics application
in health system management:
The
deployment and development of health services have been less influenced
by the collection of specific data than by what has been referred to
as "Impressionistic Planning" a process wherein information
may be minimal and the basis for decision making is intuitive and political,
the end results being determined by past experience, popular pressures
and rough estimates and guess work. Health professionals tended to cooperate
more readily and communicate more freely working and a local level and
this promoted the free exchange of health activities and information.
At the central level, the need to coordinate and control health service
development was governmental largely by the constraints of the resources
available. The emphasis, until recent years, has been that if there
were enough staff, facilities, equipment and finance, the public health
and health care services could be expanded and the health status of
the population would automatically be improved.(3) In the early 1960s,
it became apparent to most health administrators that health expenditure
was not infinite and that the emphasis in planning and development must
focus on the more effective and efficient use of the limited resources
available. When the time came to transmit priorities and proposed programs
into actual operation it soon became evident that there was a serious
deficit in relevant information. The major areas in which health service
data either lacking or readily not available were health workforce development
programming, and the evaluation of service effectiveness and efficiency.
Heath managers found that they urgently required this information to
enable them to initiate and control the progress and outcomes of the
program operation. The establishment of health information unit enables
the health organization to have a single focus for the coordination
and collation of any forms and sources of data available within the
health systems.(2)
Since the
mid-nineties, India’s population program has seen a paradigm shift, at least at
the policy level. Changes have included on increased emphasis on quality,
privacy to client choice rather than demographic objectives, and an expansion of
services beyond family planning and maternal and child health to address a wider
range of reproductive health needs.(4) The primary management tool used thus
far centrally defined contraceptive specific targets for health workers, was
replaced by the concept of community needs assessment and response. An attempt
has now been made to decentralize program design and management.
However,
these policy changes have not been transformed into action at the grassroots
level. Health workers at the field level, and their managers at the
district level, are unclear about their new roles and responsibilities.
Decades of centralized planning and centrally driven programs have left
administrators at the district and periphery ill equipped to handle
these newer responsibilities. Moreover, inflexible administrative systems,
a pre-occupation with reporting requirements and administrative procedures,
meager budgets, and the slow pace of social change have caused many
mid-level managers to be disheartened.(2) This is compounded by a situation
where good work is usually not recognized, and rarely rewarded.
Nevertheless,
there are several public sector health staff that are committed and
skilled, and have brought about change in their program areas. They
have achieved some degree of success in reaching under-served groups,
improving quality of services, building effective alliances with other
development workers, or maintaining the motivation levels and performance
of their field staff. They have demonstrated leadership qualities in
the face of heavy odds. Such persons need to be supported to continue
and extend their efforts. Without such leadership, public sector health
programs will find it more difficult to increase access to health services,
improve quality, or respond to client needs.(5)
The
non-government organization (NGO) sector has been better able to internalize
the policy changes discussed above and to transform them into action.
In fact, it has been the NGO sector, which provoked and led the policy
change. However, NGO capacity is highly varied, and many health
service NGOs need an enhancement of selected management skills. The
demands of the new paradigm require that NGOs and Government work together
more closely, and staff both of NGOs and of government need to build
capacities and skills for under-standing and working with each other.
Thus,
there is a need for building management and leadership skills within
public sector health programs as well as in NGOs.
|
|
|
|
|
|
|
|
Sustainable Health Care
Development |
Providing
the people adequate healthcare was never as important as it is today.
Considering the fact that India spends only 5-6% of its $720 billion
worth (gross domestic product) GDP on healthcare, the wonder why we
do not talk about health so much? Here are some proving statistics.
According to India Brand Equity Foundation (IBEF), in a country of 1,000
million people, there are only 8,70,161 hospital beds in a meager number
of 5,097 hospitals. Currently, there are 5,03,900 certified doctors
and 7,37,000 nurses churned out by a miniscule 162 medical colleges.
If we simply think further then it is surprising to note that India
just has over 10 beds for every 10,000 of its citizens, now combine
this with less than one doctor per 1,000 people!
On
the contrary, it is surprising that India is home to the best medical
facilities in the world. Growing at an enviable 25% annually, medical
tourism in India is worth an ever-burgeoning $350 million and is expected
to reach an estimated $2 billion within the next six years.
At
present, it is estimated that India needs to spend a colossal $49 billion
to reach China’s level of the sustainable healthcare, considered under-developed
by the Western standards. At present, there is a shortfall of 9, 20,000
hospital beds for the somewhat lesser affluent Indians. The current
healthcare infrastructure in India is poor. The overall number of beds
is low compared to other developing countries in the world. The situation
is worse in case of tertiary beds. To meet the expected demand in 2012,
an additional investment of Rs. 1, 00,000 crore to 1, 40,000 crore is
required. An additional 7, 50,000 beds will be required (from 1.5 million
to 2.25 million in 2012), of which 1, 50,000 beds need to be tertiary
beds. So in the heat of our economic boom, we are forgetting the most
important factor of our subsistence.
|
|
|
|
|
|
|
|
How to tackle
Malnutrition? |
India
is one of the most under-nourished countries in the world, the level
of malnutrition being nearly twice of what prevails in Sub-Saharan Africa.
Out of 1000 children, 640 suffer from many kinds of incurable diseases.
Similarly, out of 1000 women, 722 are under-nourished. Malnourishment
rates are high in India, 54% among scheduled castes and scheduled tribes;
and 50% among rural children are malnourished. In India 2000-3000 children
die of malnutrition everyday. The required calorie intake of adults
is only 1345 Kcal; which is far below for a healthy body. These are
the statistics of the World Health Organization (WHO) released in January
2009. In view of this deplorable kind of state of affairs
that a National Food Security Act need to be enacted as the malnutrition
has emerged as a major health challenge needing urgent response. In
this context, a think-tank of experts, activists, NGOs and administrators
have brought the notice that poverty is a prominent, but not the sole
cause of malnutrition. Malnutrition is an extremely complex, inter-generational
phenomenon with multiple causes, that is, physical – poverty, hunger,
calorie or micronutrient deficit, infection and disease; attitudinal
or socio-cultural – gender-discrimination in society and intra-family
food consumption, early marriage of girls, frequent pregnancies, superstition
or ignorance regarding proper maternal and child care and feeding practices;
governance related, mainly - inadequate nutrition or health services
for women and children, low access to safe drinking water and hygienic
sanitation and lack of social inclusion.(6)
Malnutrition
causes economic loss to the nation, due to reduced physical or cognitive
growth and learning capability, and lower physical work output. It is
indicated that India loses around 4% of Grand Domestic Product (GDP)
due to calorie/energy deficit. It is stressed that malnutrition is huge
human resource calamity and high energy; low-cost food should be made
available to the poor. Malnutrition is caused by deficiencies of micro-nutrient
like iron deficiency anemia (IDA), vitamin A deficiency (VAD), iodine
deficiency disorders (IDD). About 70% of pre-school children suffer
from IDA. Further low birth-weight (LBW) is one of the key causes of
under-nutrition in India, where about 30% of the children are born with
LBW largely due to poor maternal nutrition. Almost a third of the women
in India have a body mass index (BMI) below normal and the prevalence
of anemia among the pregnant women is around 60%.(7) The United Nations has
defined malnutrition as a state in which an individual can no longer maintain
natural bodily capacities such as growth, pregnancy, lactation, learning
abilities, physical work and resisting and recovering from disease.
On
continuing high malnutrition and failure of on-going programmes to improve
it, the expert group concluded that India has no comprehensive national
programme with the objectives of eradicating malnutrition. Several nutrition–related
programmes address some but not all aspects and causes of it.
Though
India’s malnutrition is deeply rooted in an inter-generational cycle,
the current nutritional interventions do not address the issue related
to inter-generation. Thirty per cent of India’s population suffers
from high protein-calorie deficit. The general population lacks adequate
awareness regarding proper nutritional practices. Crucial prescriptions
of the National Nutrition Policy 1993 in India were not translated into
programmes and popularization of low-cost nutritious foods, reaching
adolescent girls, fortification of essential foods and control of micronutrient
deficiencies. Most importantly the political will for addressing malnutrition
with high priority needs articulation. No single intervention can eradicate
malnutrition. The package of interventions must be widely inter-sectoral
and addressed at least, a majority of causes; they must be simultaneous
so that the benefit of one intervention is not lost on an account of
the absence of another; and they must cover the entire life-cycle of
women and children to create immediate impact within one generation
on the nutritional status of the three critical links of malnutrition,
viz., children, adolescent girls, and women. Only then can the benefits
be sustainable enough to break the inter-generational cycle, and pass on to the
next generation.
The fact is
that even though our economic development could reach double digits, if we do
not give an enabled, medically satisfied labor force, the whole so called
‘economic vicious cycle’ would be rendered useless. This is enough for us to
think about and plan our future!
Author
is grateful to Dr. V.M. Katoch, Secretary, Department of Health Research,
Government of India and Director General, Indian Council of Medical
Research, New Delhi for providing the necessary facilities.
- Balgir RS. Human genetics
in community health practice in India: an urgent need of action.
In: Genes, Environment and Health: Anthropological Perspectives. Sharma
K, Pathak RK,
Mehta S and Talwar I Eds. New Dehli: Serials Publications. 2007;171-186.
- Balgir RS. Medical genetics
in public health administration in India: a handicap of bureaucracy,
bias and corruption. Health Administrator (Theme: Health of the Educational
Systems) 2005;17:101-109.
- Balgir RS. An upsurge of
biotechnology in India: a commitment towards human health and disease.
Indian J Multidiscip Res 2005;1:153-164.
- Balgir RS. Infant mortality
and reproductive wastage associated with different genotypes
of haemoglobinopathies in Orissa, India. Ann Hum Biol 2007;34:16-25.
- Balgir RS. Intervention
and prevention of hereditary hemolytic disorders in India: a case study
of two major ethnic communities of Sundargarh district in Orissa. J Asso Phys India
2008;56:851-858.
- Balgir RS. Genetic disease
burden, nutrition and determinants of tribal health care in Chhattisgarh
state of Central-East India: A status paper. Online J Health Allied Scs 2011;10(1):4.
Available at
http://www.ojhas.org/issue37/2011-1-4.htm
- Balgir RS. Hematological
profile of pregnant women with carrier status of hemoglobin disorders
in coastal Odisha, India. Intl J Child Health Develop 2011;4:325-332.
|
