Public Health Administration PDF

UNIT XI PUBLIC HEALTH ADMINISTARTION  Organization and administration of Health Services at Centre, State, district and local level  Panchayati Raj  Public Health Laws Introd...

UNIT XI PUBLIC HEALTH ADMINISTARTION  Organization and administration of Health Services at Centre, State, district and local level  Panchayati Raj  Public Health Laws Introduction: Illness is a state in which a person’s physical, emotional, intellectual, social or spiritual functioning is diminished or impaired. Health is a state of complete Physical, Mental and Social well being and not merely an absence of disease or infirmity which allows a person to live a socio-economically productive life. Health care is multitude of services rendered to individuals or communities by the agents of health services or professional for the purpose of promoting, restoring and maintaining health. Embraces all the goods and services designed for “prevention, promotion and rehabilitation interventions” includes Medical Care. Health Care provider: A person or organization that provides services and/or health care personnel to deliver proper health care in a systematic way to any individual in need of health care services. Could be a government or the health care industry or a health care equipment company or an institution such as a hospital or laboratory. Health care professionals may include physicians, dentists, and other support staff. Health services: Permanent countrywide system of estabilished institutions with the objective of  coping with the various health needs and demands of population  thereby provide health care to individuals and community with preventive and curative activities  utilizing health care workers  System includes concepts, Ideas, Objects (e.g hospitals, health centres) and Persons (health care workers viz. physician, nurses). Together these forms a system interacting with each other, supporting and controlling each other. Components of healthcare delivery system: 1. Structure of health system: Aspects of the design of health services that influences the way in which they are delivered includes:  Number and type of personnel and staff  Way of these personnel organized to work  Nature and extend of facility and equipment  Range of services offered  System of management and amenities  Financing  Enumeration and determination of the eligible population for these services  Governance and decision making 2. Process of health care delivery: Consists of two parts:  Behavior of professionals  Recognition of the problem i.e diagnosis  Diagnostic procedure  Recommendation of treatment or management  Appropriate follow up  Participation of people  Utilization of services  Understanding the recommendations  Satisfaction with the services  Participation in decision making 3. Outcomes of health care : Aspects of health that results from interventions provided by the health system  4. Flow of patients in health care system:  Varies from country to country  India harbors a multistage (three tier) system, where majority of health care is delivered by community health care worker  Indian system is more cost effective if health workers are skilled and effectively supervised  Such system could one of the reason to reduced cost of health care in developing countries Alma-Ata international conference:  In 1977, World Health Assembly decided to launch a movement called “Health for all by 2000”  Fundamental principle of this concept was equity, an equal health status for all the people in all countries  This is to be ensured by equitable distribution of health resources  In 1978, the note of “Health for all” was reaffirmed and marked as the major social goal for every country  It was stated in the declaration that the best way to achieve HFA is by providing primary health care especially to vast size of underserved rural and urban poor Alma-Ata Declarations  A main social target of governments, international organizations and the whole world community in the coming decades should be the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. - “HEALTH FOR ALL BY 2000”  Primary health care is the key to attaining this target as part of development in the spirit of social justice  Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford   It forms an integral part of the country's health system, and of the overall social and economic development of the community  It is the first level of contact of individuals, the family and community with the national health system  All governments should formulate national policies, strategies and plans of action to launch and sustain primary health care as part of a comprehensive national health system and in coordination with other sectors. Health Care Delivery System in India:  India is a union of 29 states and 7 union territories  States are largely independent in matters relating to the delivery of health care to the people  Each state has developed its own system of health care delivery, independent of the Central Government  The Central Government’s responsibility consists mainly of policy making , planning , guiding, assisting, evaluating and coordinating the work of the State Health Ministries The official “organs” of health system at national level are I. At the central level 1. Union Ministry of Health and Family Welfare  Functions of MoHFW: i. Union list:  International health relations and administration of port quarantine  Administration of Central Institutes such as the All India Institute of Hygiene and Public Health, Kolkata; National Centre for Disease Control, Delhi etc  Promotion of research through research centres and other bodies  Regulation and development of medical, pharmaceutical, dental and nursing professions  Establishment and maintenance of drug standards  Census and collection and publication of other statistical data  Immigration and emigration  Regulation of labor in the working of mines and oil fields  Coordination with states and with other ministries for promotion of health ii. Concurrent List: the functions listed under the concurrent list are the responsibility of both the Union and State governments.  Prevention of extension of Communicable disease from one unit to another  Prevention of food adulteration of foodstuffs  Control of drug and poisons  Vital statistics  Labour welfare  Ports other than major  Economic and social planning  Population control and family planning 2. Directorate General of Health Services   The Directorate comprises of three main units: medical care and hospitals, public health and general administration Functions of Directorate General of Health services: i. General functions:  Surveys  Planning  Coordination  Programming and appraisal of all health matters ii. Specific function: a. International health relations and quarantine of all major ports in country and international airport. All the major ports in the country are directly controlled by Directorate General of Health Services. All matters relating to the obtaining the assistance from International agencies and the coordination of their activities in the country are undertaken by the Directorate General of health Services. b. Control of drug standards: The Drugs Control Organization is part of the Directorate General of Health Services, and is headed by the Drugs controller. Its primary function is to lay down and enforce standards and control the manufacture and distribution of drugs  through both central and state governments. The Drugs Act vests the Central Government with the powers to test the quality of imported drugs c. Maintain medical store depots: The Union Government runs medical store depots at Mumbai, Chennai, Kolkata, Karnal, Gauwahati and Hyderabad. These depots supply the civil medical requirements of the Central Government and of the various state governments. These depots also handle supplies from foreign agencies. The Medical Stores Organization endeavors to ensure the highest quality, cheaper bargain and prompt supplies. d. Post Graduate training:  Directorate General of Health Services is responsible for the administration of national institutes, which also provide post-graduate training to different categories of health personnel  Some of the institutes are: All India Institute of Hygiene and Public Health at Kolkata, All India Institute of Mental Health at Bangalore, College of Nursing at Delhi etc e. Medical Education:  Central Directorate is directly incharge of the following medical colleges in India: the Lady Hardinge, Maulana Azad and the medical colleges at Puducherry. Besides these, there are many medical colleges in the country which are guided and supported by the Centre. f. Medical Research:  Conducting medical research through Indian Council of Medical Research ( ICMR).  The council plays an important role in aiding, promoting and coordinating scientific research on human diseases, their causation, prevention and cure.  The research work is done through the Council’s several research institutes, research units, field surveys, and a large number of ad-hoc research enquiries financed by the council  It maintains Cancer Research Centre, Tuberculosis Chemotherapy Centre etc  The funds of the Council are wholly derived from the budget of the Union Ministry of Health  g. Central Government Health Schemes h. Implementation of national health programmes:  Various National Health Programmes for the eradication of malaria, and for the control of tuberculosis, filaria, leprosy, AIDS and other communicable diseases involves expenditure of crores of rupees  Health programmes of this kind can hardly success without the help of the Central Government  The Central Directorate plays an important part in planning, guiding and coordinating all the national health programmes in the country i. Central Health Education Bureau:  An outstanding activity of this Bureau is the preparation of the educational materials for creating health awareness among the people.  The Bureau offers training courses in health education to different categories of health workers j. Health Intelligence:  The Central Bureau of Health Intelligence was established in 1961 to centralize collection,compilation, analysis, evaluation and dissemination of all information on health statistics for the nation as a whole.  It disseminates epidemic intelligence to states and international bodies.  The Bureau has an Epidemiological unit, Health Economics unit, and a National Morbidity Survey Unit and Manpower Cell. k. National Medical Library:  The Central Medical library of the Directorate General Health Services was declared the National Medical Library in 1966.  The aim is to help in the advancement of medical, health and related sciences by collection, dissemination and exchange of information. 3. Central Council of health:  Central Council of Health was set up by a Presidential order on 9 August 1952 for promoting coordinated and concerted action between the Centre and the States in  the implementation of all the programmes and measures pertaining to the health of the nation. Functions:  To consider and recommend broad outlines of policy related to matters concerning health in all its aspects such as the provision of remedial and preventive care, environmental hygiene, nutrition, health education and the promotion of facilities for training and research.  To make proposals for legislation in field of activity relating to medical and public health matters and to lay down the pattern of development for the country as a whole  To make recommendations to the Central Government regarding distribution of grants-in- aid for health purpose to the States and to review periodically the work accomplished in different areas through the utilization of these grants-in-aid  To establish any organization or organizations invested with appropriate functions for promoting and maintain cooperation between the Central and State Health administrations. STATE HEALTH ADMINISTRATION: At present there are 29 states in India ,with each state having its own health administration. In all the states ,the management sector comprises the state ministry of health and a Directorate of health. 1. STATE MINISTRY OF HEALTH:  The state ministry of health is headed by a minister of Health and Family Welfare and a Deputy Minister of health and Family Welfare  In many states health minister is also in charge of other portfolios  The Health Secretariat is the official organ of State Ministry of Health and is headed by a Secretary who is assisted by a Deputy Secretaries, Under Secretaries and a large administrative staffs.  The secretary is the senior officer of Indian Administrative Service.  The Bhore committee in 1946 recommended that the Director of Health services should be the Secretary to the State Government to facilitate administration, but this recommendation has not been implemented. 2. STATE HEALTH DIRECTORATE:  For long time the medical and the public health departments were functioning in the states, the heads of these departments were known as Surgeon General and Inspector general of Civil hospitals and Director of Public Health respectively.  The Bhore committee in 1946 recommended that the medical and public health organization should be integrated in all levels and therefore should have the single administrative officer for the curative and the preventive departments of the health. RESPONSIBILITIES OF DIRECTOR OF HEALTH SERVICES :  The Director of Health Services is the chief technical advisor to the state government on all matters related to the medicine and public health   He also responsible for the organization and direction of all the health activities  The Director of the health services has been changed now a days to Director of Health services and the family welfare  A recent development in some states is the appointment of a Director Of Medical Education in a view of increasing number of medical colleges.  Some experts believe that there is no justification for the removal of the medical education from general health services because both goes hand in hand as the ultimate aim is the protection of the health of the people  Director Of Health and Family Welfare is assisted by the suitable number of deputies and assistants  The deputies and assistants are of two types-regional and functional  The Regional Directors inspect all the branches of public health within their jurishdiction, irrespective of their specialty.  The Functional Directors are usually specialists in a particular branch of public health such as mother and child health, family planning, nutrition, tuberculosis, leprosy, health education etc.  The Public Health Engineering Organisation in most states are the part of Public Works Department of the State Government.  It has been recommended by the experts in the public health that the public health engineering organization in every state should be the part of the State Health Department, and the Chief Engineer of Public Health should have the status of an Additional Director of Health Services AT DISTRICT LEVEL:  The principle unit of administration in India is the District under a Collector.  There are 707 (year 2016) districts in India. Within each district, there are 6 types of administrative areas. 1. Sub –division 2. Tehsils (Talukas) 3. Community Development Blocks 4. Municipalities and Corporations 5. Villages and 6. Panchayats  Most districts in India are divided into two or more sub-divisions, each in charge of an Assistant Collector or sub-collector  Each division is again divided into tahsils (taluks), incharge of a Tahsildar. A tehsil usually comprises between 200-600 villages  The rural areas of districts has been organized into Blocks, known as Community Development Blocks. The block is a unit of rural planning and development, and comprises approximately 100 villages and about 80000-120000 population, incharge of a Block Development Officer  Finally there are village panchayats, which are the institutions of rural local self- government  The urban areas of the district are organized into the following institutions of local self- government:   Town area committees (in areas with population ranging between 5000-10000). Town area committees are like panchayats. They provide sanitary services.  Municipal Boards (in areas with population ranging between 10000 to 2 lakhs): The Municipal Board are headed by a Chairman/President, elected usually by the members. The term of the Municipal Board ranges between 3-5 years. The functions are: construction and maintenance of roads, sanitation and drainage, street lighting, water supply, maintenance of hospitals and dispensaries, education, registration of birth and deaths etc  Corporations (with population above 2 lakhs): Corporations are headed by Mayors. The councilors are elected from different wards of the city. The executive agency includes the Commissioner, the Secretary, the Engineer and the Health officer. The activities are similar to those of the municipalities, but on a wider scale  Health Organization:  Under Multi-Purpose Workers Scheme, an integrated set up at the district level by having Chief Medical Officer with three Deputy CMO’s (existing Civil Surgeons, District Health Officers, and District family Welfare Officers) with each of the Deputy CMO’s being in-charge of one third of the district for all the health, family welfare and MCH Services  Planning Commission recommended that the District Hospitals should be converted into District Health Centres, each centre monitoring all preventive, promotive and curative services of one million populations. PANCHAYATHI RAJ The panchayathi Raj is the three tier system of rural local self-government in India, linking village to the district. 1. Panchayat at the village level 2. Panchayat Samiti at the Block level 3. Zilla Parishad at the district level  The Panchayati Raj institutions are accepted as agencies of public welfare. All developmental programmes are channeled through theses bodies. The Panchayati Raj institutions strengthen democracy at its root, and ensure more effective and better participation of the people in the government. 1. At the village level: The panchayathi Raj at the village level consists of: A. Grama Sabha:  It is the assembly of the all adults of the village, which meets atleast twice a year.  The gram sabha considers the proposals for taxation, discusses the annual programme and elects the members of the gram panchayat. B. Grama Panchayat:  It is the executive organ of the gram sabha, and an agency for planning and development at the village level  its strengths varies from 15-30 ,and population covered also varies widely from 5,000-15,000 or more.  The members of the panchayat hold the office for the period of 3-4yrs  Every Panchayat has an elected president ,a vice president, and a panchayat secretary.  The powers and functions of the panchayat secretary are wide –they cover the entire field of civic administration, including the sanitation and public health, and of social and economic development of the village 2. At the Block level   The block consists of 100 villages and a population of about 80.000 to 1,20,000.  The Panchayathi Raj agency at the block level is the Panchayat samithi/Janapada Panchayat.  The panchayat samithi consist of all sarpanchas (heads) of the village panchayats in the block, MLAs, MPs residing in the block area, representatives of the women, scheduled caste, scheduled tribes and cooperative societies.  The Block Development Officer (BDO) is the ex officio secretary of the Panchayat samithi.  The prime function of the panchayat samithi is the execution of the community development programme in the block.  The funds provided by the Government for Stage I and Stage II development are channeled through the Panchayat Samiti  The Block Development Officer and his staff give technical assistance and guidance to the village panchayats engaged in developmental work 3. At the District level:  The Zila Parishad/ Zila Panchayat is the agency of the rural local self-government at the district level  The members of the Zila Parishad include all the heads of the Panchayat samithi in the district, MPs, MLAs of the district, representatives of the scheduled caste and the scheduled tribes and the women and 2 persons of the experience in administration, public life and rural development.   The collector of the district is the nonvoting member. Thus the membership is fairly large varying from 40-70.  The Zilla Parishad is primarily supervisory and coordinating body  Its functions and powers vary from state to state PUBLIC HEALTH LAWS INTRODUCTION:  For improvement and protection of public health, an adequate health system is required, but with any system, public health laws are absolutely essential for proper and effective regulation of health system  The scope of public health is not limited to one area, but it is very extensive. Hence, public health laws are also wide based. In every aspects of community health, public health laws are important  Therefore , to solve public health problems, effective laws are utmost essential DEFINITION:- According to Gostin, “Public health laws are such legal forces and duties of organized society, by which conditions for maintaining citizen’s health are ensured.’’ Public health law refers to a statute, or rule or local ordinance that has the purpose of promoting or protecting the public health OBJECTIVES OF PUBLIC HEALTH ACT:-  To protect and promote public health  Control the risk to public health  Promote the control of infectious diseases  Prevent the spread of infectious diseases  Recognizes the role of local governments in protecting public health CHARACTERISTICS OF PUBLIC HEALTH LAWS: 1. GOVERNMENT- Public health activities are the primary responsibility of government  2. POPULATION- Public health focus on the health of populations 3. RELATIONSHIP- Public health contemplates the relationship between the state and the population 4. SERVICES- Public health deals with the provision of public health services. 5. COERCION- Public health possesses the power to coerce the individual for the protection of the community EFFECTIVENESS OF PUBLIC HEALTH LAWS: By simply making public health laws health problems cannot be solved. To make the health laws effective, the support of following factors are important:  Useful health system for proper solving  Proper economic policies  Community participation  Constitutional support  Periodic review of the health laws  Strong political will to implement health laws  Proper resources CONTENTS OF PUBLIC HEALTH LEGISLATION: 1. General information about laws  General health code, rules, laws, constitution, fundamental rights, duties etc  Social & economic aspects of health laws  Health care systems and the systems of implementing laws 2. Rules related to disease control and medical care  Non-infectious disease & Infectious disease 3. Mental health 4) Care of aged and handicapped persons 5) Laws related to smoking, tobacco, alcoholism and drug addiction 6) Legal implication in family health 7) Death and issues related to it. 8) Nutrition and food safety 9) Consumer protection 10) Drug preparation and different aspects related to it 11) Occupational health and safety 12) Environmental protection 13) Training of health personnel 14) Code of ethics and professional responsibilities IMPORTANCE OF PUBLIC HEALTH LAWS AT WORLD LEVEL  The chief objective of international health laws is to improve health status at international level  To eradicate health risks for global environment or minimize them  Legal intervention by making health policies and laws to prevent non-communicable disease, diabetes  Introduction and management of new techniques in area of health like biotechnologies , information etc  To prevent health risks which may happen due to international travel  To assist international agencies and institutions in health management and regulations.  To increase awareness and interest regarding health in the entire world. OBSTACLES OF PUBLIC HEALTH LAWS:  Health laws have to face many hindrances at local, regional, national and international levels  Hindrances produced due to social, political, administrative and economic fields are included in this  In addition to these obstacles, trade and commerce, communication, technical and such globalization related problems also create obstacle in implementing health laws properly PUBLIC HEALTH LAWS IN INDIA:  In India, health comes in the concurrent list. Hence making and implementation of health laws are the responsibility of state as well as central Govt.  In the enactment and implementation of health laws the following department of the state and central governments play important roles:  Ministry of health and family welfare  Labor ministry  Department of women and child welfare  Public works department  Department of local bodies  Central pollution control board  State pollution control board  Ministry of food  Department of transportation and communications  Ministry of forestry and environment NATIONAL IMPORTANCE OF PUBLIC HEALTH LAWS:  Strengthen the nation’s health infrastructure  Following the international health laws  Identification of government’s limitations in the area of health  Making necessary financial provision for health  Proper utilization of national resources  Maintaining economic discipline in the area of health  Protection environmental health  Protection of food and maintaining nutritional level  Protecting citizens from drug addiction, alcoholism etc  Protection to consumers health services  Protection from environmental pollution and other health risks  Following codes of ethics in health and medical services, education, Training and Research TYPES OF LAWS:  CIVIL LAW: Civil law deals matters concerning property, contracts, torts, trust, family, succession etc.  CRIMINAL LAW: Criminal law deals all matters related to any type of crime against individual, society or nation  LAW OF TORTS: The law of torts deals with those civil wrongs, which are independent of contract, being wrong for which remedy is unliquidated damages  LAW OF CONTRACTS: The act defines contract as an agreement enforceable by law. When patient approaches hospital or any health agency, the relationship between them is one of contractual in nature  LIABILITY FOR CIVIL NEGLIGENCE:- This is mainly concerned with the 4 D’s  DUTY: Existence of a duty of care by the nurse or doctor.  DERELICTION: The failure on the part of the nurse/ doctor to maintain proper care and skill.  DIRECT CAUSATION: The failure to exercise a duty of care must lead to damage.  DAMAGE: The damage which resulted must be reasonably foreseeable FUNCTIONS OF THE LAW IN NURSING  It differentiates the nurse’s responsibilities from other health professional.  It helps in maintaining standards of nursing practices.  It helps to set the limitations of independent nursing actions.  It provides guidance for nursing actions in the medico- legal cases Functions and Responsibilities of Nurses with Regard to Public Health Laws:   Active participation in the evaluation of public health laws.  If public health laws are broken, giving information to concern agencies which can take appropriate action.  Educating the public regarding the need and importance of public health laws.  Participation in reviews, workshops and seminars regarding public health laws.  Creating awareness in patients, families and society regarding public health laws.  Playing active role in implementing public health laws.  Keeping latest information regarding public health laws. CATEGORIES OF PUBLIC HEALTH LAWS: 1. Public registration to assess mortality and enumeration of population  The Census Act 1948  The Registration of Births and Deaths Act 1969 2. Legislation related to control of epidemics  The Epidemic Diseases Act 1897  Indian Air Craft (Public Health) Rules 1975 3. To improve and maintain high standards in the medical education and services  The Indian Medical Council Act 1956 and Regulation 2002  The Indian Nursing Council Act 1947  The Dentists Act, 1948  The Pharmacy Act, 1948  The Consumer Protection Act (COPRA) 1986 4. To prevent drug addiction and substance abuse and safe manufacturing of drugs, distribution and storage  The Narcotic Drugs and Psychotropic Substances Act 1985  The Cigarettes and Other Tobacco Products Act (COTPA) 2003  The Drugs and Cosmetics Act 1940  The Drugs & Magic Remedies Act 1948 5. For women empowerment and health  The Medical Termination of Pregnancy (MTP) Act 1971  The Maternity Benefit Act 1961   Domestic Violence Act 2005  Indecent Representation of Women (Prohibition) Act 1986 The Dowry Prohibition Act 1961  The Immoral Traffic (Prevention) Act 1956  The Pre Conception& Prenatal Diagnostic Technique Act 1994 (amended in 2003) 6. For child protection and Health  The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act 1992  The Child Labor (Prohibition and Regulation) Act 1986  The Child Marriage Restraint Act 1929  The Juvenile Justice (Care and Protection of children) Act 2000 7. For welfare of Older Persons  Maintenance and Welfare of Parents and Senior Citizens Act 2007 8. For welfare rehabilitation of disadvantaged  The Persons with Disabilities (Equal Opportunity, Protection of Rights and Full Participation) Act 1995  The National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation And Multiple Disabilities Act 1999 And Rules 2000  The Mental Health Act 1987 9. Occupational Health and legislation  The Factories Act 1948  The Mines Act 1952  The Employees State Insurance (ESI) Act 1948  The Workmen’s Compensation Act 1923  The Minimum Wages Act 1948  The Dangerous machine (Regulation) Act 1983  The Bonded Labor System (Abolition) Act 1976  The unorganized Sectors Worker’s Social Security Act  The plantation Labor act 1951 10. Environmental Health legislations   The Environment (Protection) Act 1986  The Biomedical Waste (Management and Handling) Rules 1998  The Municipal Solid Waste (Management and Handling) Rules 2000  The Hazardous Waste (Management and Handling) Rules 1989  The Motor Vehicle Act 1988  The national environment Tribunal Act 1995 11. Legislation related to other public health problems  The Transplantation of Human Organ Act 1994  Food safety and standard Act 2006  The Protection of Human Rights Act 1993  The Disaster Management Act 2005 12. To protect the rights of health and improve the health of nation in comprehensive manner  National Health Bill 2009 The Epidemic Disease Act, 1897  An Act to provide for the better prevention of the spread of Dangerous Epidemic Diseases.  The Act provides power to exercise for the control and to prevent any epidemic or spread of epidemic  The states may authorise any of its officers or agency to take such measures  Any person disobeying any regulation or order made under this Act shall be deemed to have committed an offence  If such disobedience causes or tends to cause obstruction, annoyance or injury- simple imprisonment upto 1 month or with fine upto 200 Rs, or with both; danger to human life, health or safety, a riot -imprisonment upto 6 months, or with fine upto 1000 Rs., or with both. The Indian Medical Council Act 1956 and Regulation 2002  The Medical Council of India (MCI) is a statutory body with the responsibility of establishing and maintaining high standards of medical education and recognition of medical qualifications in India   It registers doctors to practice in India, in order to protect and promote the health and safety of the public by ensuring proper standards in the practice of medicine.  The MCI is currently run by a Board of Governors with seven members.  MCI body was disbanded in May 2010 The MTP Act , 1971 Aims:  Protection to medical practitioners who otherwise would be penalized under the Indian Penal Code (sections 315-316).  De-criminalizes the abortion seeker  Promotes access to safe abortion services to women  Legalizes abortion services  to prevent large number of unsafe abortions When can pregnancies be terminated?  Opinion of two RMPs required for termination of pregnancy between 12 and 20 weeks  With the opinion of a registered medical practitioner, formed in good faith, under certain circumstances  If the women is below 18 years or is mentally ill, then with consent of a guardian  With the consent of the women.  Up to 20 weeks gestation Indications: 1. Therapeutic: Continuation of pregnancy constitutes risk to the life or grave injury to the physical or mental health of woman 2. Eugenic: Substantial risk of physical or mental abnormalities in the fetus as to render it seriously handicapped 3. Humanitarian: Pregnancy caused by rape 4. Social:  Contraceptive failure in married couple   When economic and social environment is not suitable for continuation of pregnancy 5. When pregnant woman is mentally not sound Place for conducting MTP :-  A place approved for the purpose of this Act by a District-level Committee   A hospital established or maintained by Government Who can perform?  A registered medical practitioner (RMP)  Who has such experience or training in Gynaecology and Obstetrics as prescribed by Rules made under the Act Training requirement:  For termination up to 12 weeks: A practitioner who has assisted a registered medical practitioner in performing 25 cases of MTP of which at least 5 were performed independently in a hospital established or maintained or a training institute approved for this purpose by the Government  For termination up to 20 weeks:  A practitioner who Holds a post-graduate degree or diploma in Obstetrics and Gynecology  Has completed six months house job in Obstetrics and Gynecology  Has at least one-year experience in practice of Obstetrics and Gynecology at a hospital which has all facilities  Registered in state medical register immediately before commencement of the Act, experience in practice of Obstetrics and Gynecology for a period not less than 3 yrs Punishment:  Penalty of two to seven years in prison if termination performed by a non- registered medical practitioner  Same penalty applies to those who perform abortions outside of hospitals or other approved  The Narcotic Drugs And Psychotropic Substances Act, 1985  Under the NDPS Act: the cultivation, production, manufacture, possession, sale, purchase, transportation, warehousing, consumption, inter-State movement, transshipment and import and export of narcotic drugs and psychotropic substances is prohibited, except for medical or scientific purposes and in accordance with the terms and conditions of any license, permit or authorization given by the Government.  The Narcotics Control Bureau (NCB) is the chief law enforcement and intelligence agency of India responsible for fighting drug trafficking and the abuse of illegal substances  It applies also- to all citizens of India outside India; to all persons on ships and aircrafts registered in India.  It extends to the whole of India The Consumer Protection Act (Copra), 1986 Objectives:  Better protection of interests of consumers  Protection of rights of consumers  Consumer Protection Councils  Quasi – judicial machinery for speedy redressal of consumer disputes. Under this Act, a complaint means any allegation in writing in regard to any of the following:  A loss or damage as a result of any unfair trade practice adopted by any trader;   The goods/service suffer from defects.  A trader has charged for the goods, a price in excess of the price which is fixed by the law or displayed on the goods. Doctors were like any other providers of service, and therefore are under the same obligation to compensate the patient for any deficiency in the quality of their services. But doctors in charitable clinics or government hospitals who are rendering free services are exempted  If the Cost of the Services and compensation asked for, is less than Rs. 2 lakh, then the complaint can be filed in the District Forum.  If the Cost of the Services and compensation asked is Rs. 2 lakh- 20 lakhs - the State Commission and for higher amount - the National Commission at New Delhi. There is no court fee and the consumer does not have to go through lawyers. The Environment (Protection) Act 1986  General law on environmental protection  cover uncovered gaps in the areas of major environmental hazards as the previous laws generally focused on specific types of pollution Objectives:  Protection and improvement of environment  Safeguards the forest and wildlife of the country  Empowers the Central Government to establish authorities and to tackle specific environmental problems  Applicable to whole India, including J & K Punishments:  Any person 1st time- With imprisonment upto 5 years, or fine upto 1 lakh rupees, or with both  In case of failure or subsequent contravention -Additional fine which may extend to 5000 Rs/day  If the failure or contravention continues beyond 1year after conviction- Imprisonment for a term which may extend to 7 years.   company or govt. departments- Person directly in charge or Head of the department shall be deemed to be guilty The Mental Health Act , 1987 Objectives :-  To provide for the custody of mentally ill persons who are unable to look after themselves and are dangerous for themselves and or, others   To establish central and state authorities for licensing and supervising the psychiatric hospitals.  To safeguard the rights of these detained individuals.  To regulate procedure of admission and discharge, on voluntary basis or on request.  To protect the society from dangerous manifestations of mentally ill.  To provide legal aid to poor mentally ill criminals at state expenses.  To provide for the maintenance charges of mentally ill persons undergoing treatment in such hospitals. Patients requesting discharge- are obliged to be done so by the MO I/C within 24 hours; after constituting a Board of two medical officers and seeking their opinion. If further treatment needed – continue it for a period not exceeding 90 days at a time. The Infant Milk Substitutes, Feeding Bottles And Infant Foods (Regulation Of Production, Supply &protection and promotion of breast feeding and Distribution) Act, 1992 (Amended in 2003) Aim :-  ensuring the proper use of Infant Foods  protection and promotion of breast feeding Provisions:-  No person shall  advertise,   take part in promotion of use or sale, supply of or donate or distribute infant milk substitutes or feeding bottles,  or give an impression or create a belief in any manner that feeding of infant milk substitutes is equivalent to or better than mother's milk.  Container of infant foods and milk substitutes must affix label clearly written in local language that:  "Mother's milk is best for your baby" ,  "Should be used only on the advice of a health worker",  "a warning sign if used replacing mother's milk".  Beside this all about manufacturing date, batch number, expiry date, compositions, etc. should also be written.  No picture of baby or mother shall be depicted on the containers.  All educational material whether audio, or visual shall contain the content of benefits and superiority of breast feeding.  Food inspector working under Prevention of Food Adulteration Act or any authorised person shall be responsible for inspection or seizing activities if he/she finds that there is violation of this Act.  No person other than health workers or institutions will demonstrate the need and feeding of milk substitute. Penalty:- The Preconception And Prenatal Diagnostic Techniques (Prohibition Of Sex Selection) Act, 1994 Aim :-  Prohibition of sex selection, before or after conception  Regulation of the use of prenatal diagnostic techniques Provisions :-  No genetic counselling centre, genetic clinic or medical geneticist, gynaecologist or registered medical practitioner shall conduct such test unless specified by the Central Supervisory Board at a place other than a place registered under the Act In following conditions these test can be conducted in a pregnant woman:  Age above 35 years;  Undergone two or more spontaneous abortions or fetal loss;  Exposed to potentially teratogenic agents  Family history of mental retardation or physical deformities such as spasticity or any other genetic diseases; and  Any other disease specified by the Central Supervisory Board  No test will be conducted on the willingness of husband or without written informed consent of the woman  Even any advertisement or publication on these facilities is an offense  No person shall sell ultrasound or any other machine or equipment capable of detecting sex of the fetus to any person or centre that is not registered under the act  The Transplantation Of Human Organs Act, 1994 Aim :-  For regulating the removal of organs from cadavers and living person and prohibiting commercial dealings in human organs Provisions :-  Any written authority given before his death or willingly given authority to any of his near relatives, can be accepted.  Any person more than 18 years or parents in case of less than 18 years authorises the removal, before his death, of any human organ of his body.  Before removal of body organs, a registered medical practitioners should certify that life or brain-stem function have ceased  A dead body lying in a hospital or prison and not claimed by any of the near relatives within 48 hours from the time of the death of concerned person, the person incharge or any other authorised person who strongly believe that body will not be claimed, can authorise for removal of body organs  No hospital or place is authorised to remove the human organs unless appropriate authority like state or central government authorises and register it Considered as an offence :-   Any illegal supply or giving commitment or publishing / advertisement to supply of human organs  Giving human organs on payment by an individual or society, or organisation, or agent. Punishment :-  Imprisonment 5 -10 years and Fine 5 - 20 lakhs  Removal of name of doctors from MCI or state council register for 2 years for 1st conviction, and permanently on subsequent conviction The Persons with Disabilities (Equal Opportunity, Protection of Rights and Full Participation) Act 1995 Aims and objectives:-  To spell out the responsibility of the state towards the - prevention of disabilities, protection of rights, provision of medical care, education, training, employment and rehabilitation of persons with disabilities  To create a barrier free environment  To counteract any situation of abuse and exploitation of persons;  To make special provision of the integration of persons with disabilities into the social mainstream Salient features:  Free education in an appropriate environment till 18 years of age.  The grant of scholarship to students with disabilities.  Promoting the integration of students with disabilities in normal schools  Promoting setting up of special schools in government and private sector  Transport facilities to the children with disabilities or in the alternative financial incentives to parents or guardians to enable their children with disabilities to attend schools  Setting up of appropriate forums for the redressal of grievances  At least 3% of vacancies in every government establishment are to be reserved for persons with disabilities   Preferential allotment of land at concessional rates for:- Housing, Setting up business Setting up special recreational centres, Establishment of special schools or research centres  Those who avail or attempt to avail benefit meant for disabled in a fraudulent manner are punishable with imprisonment upto 2 years or a fine up to 20,000 The Juvenile Justice (Care and Protection of children) Act 2000  State primary responsibility of ensuring that all the needs of children are met and that their basic human rights are fully protected  The Convention on the Right of child lays down four sets of rights:-  The Right to Survival  The Right to Protection  The Right to Development  The Right to Participation  This Act places children/juveniles in two categories : 1. Juvenile in ‘conflict with the law’ handled by State Governments/ ‘Juvenile Boards’ 2. Child in need of ‘care and protection’ to be looked after by State Governments/ ‘Child Welfare Committees’  An Act to consolidate and amend the law relating to juveniles in conflict with law Protection and treatment  Child-friendly approach.  Rehabilitation Institutions established JUVENILE JUSTICE BOARD:  Appointed by the State Government.  Panel of  Metropolitan Magistrate or Judicial Magistrate of the first class.  Two social workers of whom at least one shall be a women  Magistrate to have special knowledge or training in child psychology or child  Inquiry to be completed within 4 months. Order that may be passed regarding juvenile  Counsel parents/ guardian   Advise the child: by group counseling and similar activities  Payment of fine (>14 yrs age)  Release on probation of good conduct, and place under care of parent/ guardian or other fit person or fit institution  Direct the juvenile to be sent to a Special Home Order that may not be passed against juvenile:  Juvenile Cannot be sentenced to death/life imprisonment/committed to prison  Cannot be charged with/tried for offence with an adult  Prohibition of publication of name, etc., of juvenile involved in any proceeding. Cigarettes and Other tobacco products Act, 2003  Cigarettes and Other tobacco products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003  Applicable to all products containing tobacco in any form i.e. cigarettes, cigars, cheroots, bidis, gutka, pan masala (containing tobacco) khaini, mawa, mishri, snuff etc. as detailed in the schedule to the Act  The Act prohibits smoking of tobacco in public places, except in special smoking zones in hotels, restaurants and airports and open spaces  Display of prominent non smoking signs e.g. “Smoking here is strictly prohibited” is mandatory at all public places.  Sale of tobacco products is prohibited to persons under the age of 18 years and within a radius of 100 yards of any educational institution  A display board to be put up at the point of sale declaring that “sale of tobacco products to minors is prohibited”.  Prohibition of Advertisement, Promotion and Sponsorship of all Tobacco Products  Tobacco products must be sold, supplied or distributed in a package which shall contain an appropriate pictorial warning, (of a skull or scorpion or certain prescribed pictorial warnings along with the text SMOKING KILLS and TOBACCO CAUSES MOUTH CANCER) its nicotine and tar contents.  Warning signs and labels - in English or any other Indian language  .Required to cover 40% of the front of all cigarette packages, meaning 20% of the overall package space is appropriated to health warnings  Any police officer, not below the rank of Sub-Inspector or (any other officer, holding the equivalent rank or authorized by the Central/State Governments) has the power to search, seize and compound offences. Protection of Women from Domestic Violence Act 2005 The Act seeks to cover those women:  who are or have been in a relationship with the abuser where both parties have lived together in a shared household and are related by consanguinity, marriage or a relationship in the nature of marriage, or adoption; in addition relationship with family members living together as a joint family are also included.  Even those women who are sisters, widows, mothers, single women, or living with the abuser are entitled to get legal protection under the proposed Act.  "Domestic violence" includes actual abuse or the threat of abuse that is physical, sexual, verbal, emotional and economic  Harassment by way of unlawful dowry demands to the woman or her relatives would also be covered under this definition.  The Act provides for the woman’s right to reside in the matrimonial or shared household, whether or not she has any title or rights in the household  Appointment of Protection Officers and NGOs to provide assistance to the woman w.r.t medical examination, legal aid, safe shelter, etc  The Act provides for breach of protection order by the respondent as a cognizable and non-bailable offence punishable with imprisonment for a term which may extend to 1 year or with fine which may extend to 20,000 rupees or with both  Similarly, non-compliance or discharge of duties by the Protection Officer is also sought to be made an offence under the Act with similar punishment The Disaster Management Act 2005  The Act extends to the whole of India.  The Act provides for "the effective management of disasters and for matters connected therewith or incidental thereto”.  The Act calls for the establishment of National Disaster Management Authority (NDMA), with the Prime Minister of India as chairperson  The NDMA is responsible for "laying down the policies, plans and guidelines for disaster management" and to ensure "timely and effective response to disaster" Food Safety And Standards Act, 2006  Act consolidates the laws relating to food and to establish the Food Safety and Standards Authority of India for laying down science based standards for articles of food and to regulate their: manufacture, storage, distribution, sale and import, and to ensure availability of safe and wholesome food for human consumption  Following acts were repealed after commencement of this act:  Prevention of Food Adulteration Act, 1954  Fruit Products Order, 1955  Meat Food Products Order, 1973  Vegetable Oil Products (Control) Order, 1947  Edible Oils Packaging (Regulation)Order, 1988  Solvent Extracted Oil, De-Oiled Meal and Edible Flour (Control) Order, 1967  Milk and Milk Products Order, 1992  The Act establishes an independent statutory Authority – the Food Safety and Standards Authority of India with head office at Delhi Maintenance and Welfare of Parents and Senior Citizens Act 2007  The act defines senior citizen as any citizen of India aged 60+, whether living in India or not  Every Senior Citizen who is unable to maintain himself from his own income, can claim maintenance from his children  A childless Senior Citizen can claim maintenance from his relative who is in possession of, or would inherit his property   State Governments are to constitute "Maintenance Tribunal" at Sub divisional level  State Governments have designate the District Social Welfare Officer or an equivalent officer as Maintenance Officer, who can then represent a parent, on request, before a Maintenance or Appellate Tribunal  Maintenance Tribunal can award up to Rs. 10,000 per month as maintenance allowance payable to the senior citizen by his child/relative.  They’ve to give judgment in 90 days  If child/relative is neglecting the senior citizen after getting his property, then Tribunal Appeal can declare such property transfer null and void and return it to the senior citizen.  Abandonment of a Senior citizen is punishable with imprisonment up to 3 months and or Rs. 5000 National Health Bill 2009  The Bill had listed the obligations of the Central and State governments in healthcare delivery and also the individual rights.  It would also have made healthcare delivery far more transparent, accountable and inclusive Aim :-  protection and fulfilment of rights in relation to health and wellbeing  health equity and justice, including those related to all the underlying factors of health as well as health care;  And for achieving the goal of health for all; and for matters connected therewith. Important Features :-  Right to Healthcare  Good treatment  Emergency Care  Patient Complaints  Name of doctor involved in treatment  Summary & Second Opinion  Cost of Treatment  Rights of healthcare provider