1. AT RISK APPROACH
-IMPLEMENTATION IN
DIFFERENT STRATA IN
THE COMMUNITY
PRESENTED BY:- DR.NAVIN KUMAR

2. Why this presentation?
India with a population of more than 1.22
billion scattered in 28 states and 7 union
territories provide a unique ground for
studying population programs
management .
To provide any kind of service to its
citizens, it needs a huge investment and a
large manpower for its implementation.

3. This presentation aims at:-
1. Illustrating the definition of RISK;
2. Defining the population at risk;
3. Imparting knowledge on common
elements of population policies;
4. Implementation in different strata in
the community.
OBJECTIVES

4. WHAT IS RISK?
―Something with the potential to cause harm‖

5. WHAT IS RISK?
RISK:- The probability of harmful
consequences, or expected losses (deaths, injuries,
property, livelihood, economic activity disrupted
or environment damaged) resulting from
interactions between natural or human-induced
hazards and vulnerabilities.
 Risk is proportional to Hazard x Vulnerability /
Level of Preparedness.

6. R = H x V
RISK= Cross product of Hazard and Vulnerability.
HAZARD = The probability of an adverse outcome.
VULNERABILITY= The conditions determined
by physical, social, economic and environmental factors
or processes, which increase the susceptibility of a
community to the impact of hazards.

8. NOW
WHAT TO DO
NEXT?

9. ASSESSMENT OF RISK

10. RISK ASSESSMENT:- It is a
process of estimating the magnitude
of the risk and deciding if the risk is
tolerable or acceptable.
A tolerable RISK may not always be
acceptable.

11. RISK ASSESSMENT
It is a systematic procedure for describing and
quantifying the risk associated with hazardous
substance, process, action or event.
It involves:
# Identification of hazard
# Quantification of hazard
# Quantification of probability of occurrence of hazard
# Estimation of risk

12. RISK ASSESSMENT

13. What Risk Analysis Can Do?
Helps in:-
# Forecasting any unwanted situation.
# Estimating damage potential of such situation.
# Decision making to control such situation.
# Evaluating effectiveness of control measures.

14. GUIDELINES FOR DEFINING
GROUPS ―AT-RISK‖

15. BIOLOGICAL SITUATIONS:-
AGE GROUP—INFANTS with low birth
weight, ELDERLY etc.
SEX--FEMALES in reproductive age group.
PHYSIOLOGICAL STATE--
PREGNANCY, HTN, DM etc
GENETIC FACTORS– Family history.
OTHER HEALTH CONDITIONS--
Diseases, Physical functioning, Unhealthy
behavior.

16. PHYSIOLOGICAL SITUATION
-RURAL, URBAN, SLUMS.
-LIVING CONDITIONS, OVERCROEDING
-ENVIRONMENT: Water supply, Industries,
Pollution etc.

17. SOCIOCULTURAL AND
CULTURAL SITUATION.
-Social class.
-Ethnic and cultural group.
-Family disruption, Education, Housing.
-Customs, Habits and Behavior.
-Access to Health services.
-Lifestyle and Attitudes.

18. AT RISK APPROACH
AT “RISK APPROACH” DEALS WITH
THOSE INDIVIDUALS AND GROUPS
WHO ARE AT PERTICULAR HIGH
RISK AND EMERGENT NEED.
1PREVENTIVE
2PROMOTIVE
3MANAGEMENT

19. THE ULTIMATE GOAL

20. AT RISK IN FAMILIES
PREGNANT
WOMEN
LACTATING
MOTHERS
CHILDREN
< 2YEARS
SEVERELY
MALNURISHED
CHILDREN <5
YEARS
DISABLED
FAMILY
MEMBER

21. RAGHU PANDA
89 years old
Lives alone
Has no land, family lives out of state
History of heart disease
KAMLA
7 years old
Parents are undocumented
immigrants
MALTI DEVI
35 years old, Pregnant
Anaemic, weak, BPL,
Lives 4 children & unemployed
husband

22. AN EFFECTIVE ―AT RISK APPROACH‖
INVOLVES FIVE MAIN STAGES:-
A: Recruitment and Referral –
B: Comprehensive health assessment-
C: Setting appropriate target-
D : Implementing management strategies-
E : Monitoring reward and evaluation-

23. 23
A Simple Framework
Evaluate
& Take
Action
Establish
Objectives
Identify
Risks &
Controls
Assess
Risks &
Controls
Monitor
&
Report
Step 1 Step 2 Step 3 Step 4 Step 5
Communicate, learn, improve

24. Policies related to Health Sector
For population at Risk
National Health Policy
Nutrition Policy
Women Policy
Training Policy
Population Policy

25. Policy Interventions.
From Quantity to
Quality
Upgradation of Skills
Static Centres for
Improved access to
services
Upgradation of
facilities and
Operations Research
Integrated Services
for
Spacing Method
Antenatal Care
Deliveries
Post-natal Care
Immunization
RTI
Child Care

26. MODEL OF HEALTH CARE
SYSTEM
HEALTH
STATUS
0R
HEALTH
PROBLEMS
RESOURCES
CURATIVE
PREVENTIVE
PROMOTIVE
PUBLIC
PRIVATE
VOLUNTARY
INDIGENOUS
CHANGES
IN
HEALTH
STATUS

29. GOVT HAVE TO IDENTIFY THESE FAMILY AND
PROVIDE APPROPRIATE HELING HANDS TO THESE
FAMILY.
# JANANI SURAKSHA YOJANA.
# MAMTA SCHEME.
# RASHTRIYA SWASTH BIMA YOJANA.
# BPL CARDS

31. Population Program
Promotional Measures
 providing fertility regulating information/services.
 furnishing family life/sex education information.
 improving the status of women.
 improving health and nutritional status.
 providing incentives and disincentives.
 improving research and evaluation.
 carrying out specific legal reforms to influence.
internal and international migration.

32. REPRODUCTIVE AND
CHILD HEALTH (RCH)
– Conceptual frame work:
Client
centered
approach
Family welfare/Plan
CHILD
SURVIVAL &
SAFE
MOTHERHOOD
(1992) RTIs &STDs

33. RISK APPROACH IN
ANTENATAL CARE
AIM :- To identify the HIGH RISK
ANTENETAL CASES to provide specialized
care and appropriate level of care to others.

34. ASHA WORKERS AT THEIR DUTIES.

36. NEW BORNS & INFANTS
LOW BIRTH WEIGHT
PRE TERM BABIES
NEONATAL DEATHS
EARLY WEANING
RTI

37. UNDER FIVE AGE GROUP CHILDREN
 MALNUTRITION
 FOOD POISONING
 ACUTE DIARRHOEAL DISEASES
 PROTEIN-ENERGY MALNUTRITION
 INFECTIONS AND PARASITOSIS
 ACCIDENTS AND POISONING
 BEHAVIOURAL PROBLEMS
 RTI

38. Mid day meal programme
PRINCIPLES:
 1. Meal a supplement – not a
substitute.
 2. 1/3rd of total calorie requirement.
 ½ of total protein requirement.
 3. Ease of preparation.
 4. Locally available. Ingredients.
 5. Low cost.
 6. Menu should be changed frequently.

39. YOUNG & ADOLESCENCE AGE
GROUP
# GUTHKA CHEWING
# TOBACCO CHEWING
# ALCOHOL
# SMOKING
# UNSAFE SEX
# UNHEALTHY LIFE STYLE

40. OUTCOME
ORAL CANCER
LUNG CANCER
STD / HIV-AIDS / HPV
LIVER DISEASES
UN-EMPLOYMENT
MENTAL DISORDERS
RASH DRIVING - RTA

41. ROAD TRAFIC ACCIDENTS

42. RISK APPROACH
 BAN ON GUTHKA BY SEVERAL STATE GOVT.
 HEAVY SALES-TAX ON ALCOHOL, CIGARETTES AND ALL
TOBACCO PRODUCTS.
 BAN ON ALCOHOL IN GUJRAT.
 BAN ON SMOKING IN PUBLIC PLACES & PUBLIC
TRANSPORTS.
 PROPER LAW IMFORCEMENT TO FOLLOW TRFFIC
RULES.

43. Geriatric population
 1980- 5.3%
 2000- 7.7%
 2025- 13.3% ( 1.2 billion )
 71% - Developing World
 70 million population in India-2001
 177 million population -2025
 40% below poverty line
 73% illiterate

44. RISK OF GERIATRICS
 PRONE FOR INFECTIONS
 PRONE FOR INJURIES
 NEED SPECIAL ASSISTANCE
 PRONE FOR PSYCHOLOGICAL PROBLEMS
 PRONE FOR DEGENERATIVE DISORDERS
 INCREASED RISK FOR DISEASE
 INCREASED RISK OF DISABILITY
 INCRASED RISK OF DEATH

45. PREVENTION
Primordial prevention
 Pre geriatric care
Primary prevention
 Health education
 Exercise
Secondary prevention
 Annual medical check-up
 Early detection ( Universal approach, Selective approach)
 Treatment
Tertiary prevention
 Counseling and Rehabilitation
 Welfare activities (Sanjay Niradhar Yojana, Vridhashrama)
 Chiropody services
Improving quality of life
 Cultural programme
 Old age club
 Meals-on wheel service
 Economically support (Vridha pension Yojana )
 Old age home

46. SUMMARY
HEALTH CARE AND POLICY SHOULD
BE GUIDED TOWARDS PREVENTION
BY A NUMERICAL ASSESSMENT OF
FUTURE NEED.
 IEC IS MUST FOR IMPLEMENTATION
LAW IMFORCEMENT SHOULD BE
STRICT

47. HEALTH FOR ALL