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School of Pharmaceutical Management

MBA Pharmaceutical Management
Batch-13th (2021-2023)
Second Year, Term 6 End Term Examination, March 2023
PHRM-749 Drug and Public Health Policy
Time - 3 Hour Maximum Marks: 50 (Minimum Marks: 20)

This question paper contains 1 printed page.

Answer ANY FIVE of following in maximum 350 words each.
Q1. Define Health System. What are the building blocks of a Health System? Name any four
models of health systems and describe the Bismarck Model in detail.
Definition of Health System
A health system consists of all organizations, people, and resources that provide healthcare
services to improve and maintain public health. The WHO defines it as “all organizations,
institutions, and resources whose primary purpose is to improve health.”
Building Blocks of a Health System (WHO Framework)
The WHO framework identifies six key components essential for an effective health system:
1. Service Delivery: Ensures accessible, quality healthcare services for all.
2. Health Workforce: Availability of trained healthcare professionals.
3. Health Information Systems: Collects and analyzes data for decision-making.
4. Access to Essential Medicines: Ensures affordable and effective medications.
5. Healthcare Financing: Sustainable funding for universal health coverage.
6. Leadership and Governance: Policy-making and regulation for an efficient system.
Four Major Health System Models
1. Beveridge Model: Government-funded through taxation; public healthcare providers (e.g.,
UK, Spain).
2. Bismarck Model: Insurance-based system funded by employer-employee contributions
(e.g., Germany, Japan).
3. National Health Insurance Model: Government-run insurance, private healthcare
providers (e.g., Canada, South Korea).
4. Out-of-Pocket Model: Individuals pay directly for healthcare services (e.g., India,
Nigeria).
Bismarck Model – Social Health Insurance Model
Overview:
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Developed in Germany by Otto von Bismarck, this model is based on mandatory health
insurance funded through payroll contributions from employers and employees.
Key Features:
• Insurance-Based: Non-profit sickness funds manage insurance.
• Universal Coverage: Every working citizen is covered.
• Public and Private Providers: Hospitals operate privately but follow government-set
regulations.
• Cost Control: Prices are regulated to prevent excessive costs.
• Financial Contributions: Employees and employers share insurance premiums.
Advantages:
• Ensures universal healthcare access.
• Regulated prices keep healthcare affordable.
• High-quality care with private provider options.
Disadvantages:
• High administrative costs due to multiple insurers.
• Employment-linked coverage may exclude the unemployed.
The Bismarck Model balances public and private healthcare efficiently, providing universal
access while maintaining competition and quality standards.

Q2. Explain the concepts of Health and Disease with suitable definitions. What is DALY, How is
DALY calculated?
Answer: Concept of Health
Health is a state of complete physical, mental, and social well-being, and not merely the absence of
disease or infirmity (WHO, 1948). It includes:
• Physical Health – Proper body functioning without illness.
• Mental Health – Emotional and psychological stability.
• Social Well-being – Ability to interact and function in society.
Concept of Disease
Disease is an abnormal condition affecting the body’s structure or function, often characterized by
specific signs and symptoms. It can be classified as:
1. Infectious Diseases – Caused by pathogens (e.g., tuberculosis, COVID-19).
2. Non-Communicable Diseases (NCDs) – Chronic conditions (e.g., diabetes, heart disease).
3. Deficiency Diseases – Caused by nutrient deficiencies (e.g., scurvy from Vitamin C
deficiency).
4. Genetic Disorders – Inherited conditions (e.g., sickle cell anemia).

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Disability-Adjusted Life Years (DALY)
DALY (Disability-Adjusted Life Years) is a measure used to assess the total burden of disease by
combining:
• Years of Life Lost (YLL) due to premature death.
• Years Lived with Disability (YLD) due to illness or injury.
Formula:
DALY=YLL+YLD
Where:
• YLL (Years of Life Lost) = (Life Expectancy – Age at Death) × Number of Deaths
• YLD (Years Lived with Disability) = Number of Cases × Disability Weight × Duration of
Disease
Example:
If a person dies at 40, but life expectancy is 70, YLL = 30 years. If 100 people live with a disability for
10 years with a disability weight of 0.3, then YLD = 100 × 10 × 0.3 = 300 years. Thus, DALY = 30 +
300 = 330 years lost due to disease.
Significance of DALY:
• Helps in prioritizing healthcare policies and interventions.
• Assists in resource allocation to control major diseases.
• Used in global health comparisons by WHO and public health organizations.
DALY is essential in understanding disease burden and guiding health policies for better public health
outcomes.

Q3. Compare Incidence and Prevalence.

Answer: Incidence and prevalence are key epidemiological measures used to assess the burden of
diseases in a population. While both measure disease occurrence, they serve different purposes in
public health analysis.

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Key Differences
• Incidence is used for acute diseases (e.g., flu, COVID-19 outbreaks).
• Prevalence is used for chronic conditions (e.g., diabetes, hypertension).
Conclusion
Both incidence and prevalence are crucial for healthcare planning. Incidence helps in disease
prevention, while prevalence is essential for resource allocation and managing chronic illnesses.

Q4. What is Health Policy? Describe in brief the policy triangle.

Answer: What is Health Policy?
Health policy refers to decisions, plans, and actions undertaken by governments or organizations to
achieve specific healthcare goals within a society. It defines a vision for the future, outlines priorities,
and establishes roles for different stakeholders in the healthcare system.
Key Objectives of Health Policy:
1. Ensure Universal Healthcare Access – Provide affordable and quality healthcare to all.
2. Improve Public Health Outcomes – Reduce disease burden through preventive and curative
measures.
3. Regulate Healthcare Services – Implement standards for medical facilities and professionals.
4. Enhance Healthcare Infrastructure – Develop hospitals, primary health centers, and digital
health systems.
5. Promote Research and Innovation – Encourage advancements in medical treatments and
pharmaceuticals.
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The Policy Triangle
The Walt and Gilson Policy Triangle is a widely used framework for analyzing health policies. It
helps understand how policies are formulated, implemented, and evaluated.
Components of the Policy Triangle:
1. Actors:
• Individuals and organizations involved in policy-making.
• Includes governments, healthcare providers, private sector, civil society, and
international bodies like WHO.
2. Context:
• The environment in which policy is developed, including political, economic, and
social factors.
• Example: Economic conditions, public health crises (e.g., COVID-19), and social
determinants of health.
3. Content:
• The specific details of the policy, including its goals, strategies, and regulations.
• Example: The National Health Policy 2017 focuses on universal healthcare and
digital health.
4. Process:
• The stages of policy-making, from formulation to implementation and evaluation.
• Involves agenda-setting, stakeholder engagement, decision-making, and policy
enforcement.
Significance of the Policy Triangle
• Provides a structured approach to understanding health policies.
• Helps policymakers analyze challenges and improve healthcare reforms.
• Ensures comprehensive policy development by considering all influencing factors.
By applying the policy triangle, governments can design and implement effective health policies that
cater to the needs of the population.

Q5. Describe the Goal of the current National Health Policy of India. Briefly explain the key policy
principles.
Answer: The National Health Policy (NHP) 2017 was introduced by the Government of India to strengthen
the healthcare system and ensure universal health coverage. It aims to provide accessible, affordable, and quality
healthcare services to all citizens.
Goal of the National Health Policy 2017
The primary goal of NHP 2017 is:
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"Attainment of the highest possible level of health and well-being for all at all ages through
preventive and promotive healthcare, universal access to good quality healthcare services
without financial hardship."
Key Objectives of the Policy:
1. Reduce Maternal and Infant Mortality Rates: Improve maternal and child healthcare.
2. Control Non-Communicable Diseases (NCDs): Focus on lifestyle-related diseases like
diabetes and hypertension.
3. Strengthen Primary Healthcare Infrastructure: Improve rural and urban healthcare
services.
4. Increase Public Health Expenditure: Target to increase government spending on healthcare
to 2.5% of GDP.
5. Universal Health Coverage: Ensure equitable access to healthcare services.
6. Improve Medical Research and Innovation: Promote advancements in healthcare technology
and medicine.
Key Policy Principles of NHP 2017
1. Equity & Affordability:
o Prioritizes healthcare access for vulnerable and disadvantaged populations.
o Aims to reduce out-of-pocket expenditure on medical services.
2. Preventive & Promotive Healthcare:
o Focuses on health awareness, immunization, sanitation, and lifestyle changes.
o Strengthens disease prevention strategies.
3. Quality of Care:
o Establishes national health standards for hospitals and clinics.
o Encourages accreditation of healthcare facilities.
4. Digital Health & Innovation:
o Promotes the use of technology for telemedicine and e-health records.
o Encourages research in healthcare technology and drug development.
5. Public-Private Partnership (PPP):
o Involves private players to expand healthcare services.
o Encourages collaboration in diagnostics, treatment, and insurance.
6. Human Resource Development:
o Strengthens medical education and training programs.
o Focuses on skill development for healthcare workers.
7. Decentralization of Healthcare:
o Empowers state and district-level authorities for effective policy implementation.
By focusing on these principles, NHP 2017 aims to build a robust healthcare system that ensures better
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health outcomes for all Indians.
Q6. List the key components of the National Rural Health Mission and write in brief about the
profile and key responsibilities of ASHA.
Answer: The National Rural Health Mission (NRHM) was launched in 2005 to strengthen rural
healthcare services and improve public health outcomes. It focuses on accessible, affordable, and
quality healthcare, especially for vulnerable populations.
Key Components of NRHM:
1. Accredited Social Health Activist (ASHA):
o Community-based health worker to improve maternal and child healthcare services.
2. Strengthening Rural Healthcare Infrastructure:
o Upgrading Sub-Centers, Primary Health Centers (PHCs), and Community Health
Centers (CHCs) for better service delivery.
3. Janani Suraksha Yojana (JSY):
o Provides financial incentives to promote institutional deliveries and reduce maternal
and infant mortality.
4. Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A):
o Focuses on comprehensive healthcare from pregnancy to adolescence.
5. National Mobile Medical Units (MMUs):
o Provides mobile healthcare services in remote areas.
6. Free Drugs & Diagnostics Services:
o Ensures availability of essential medicines and diagnostic facilities.
7. Village Health and Nutrition Days (VHNDs):
o Regular health check-up camps at the village level.
8. Public-Private Partnership (PPP):
o Engages private healthcare providers to strengthen services.
ASHA (Accredited Social Health Activist) – Profile & Key Responsibilities
Profile of ASHA:
ASHA is a trained female community health worker selected from the village to act as a bridge
between the healthcare system and rural populations. She plays a crucial role in promoting health
awareness and delivering basic healthcare services.
Key Responsibilities:
1. Maternal & Child Health Support:
o Encourages institutional deliveries and antenatal check-ups.
o Promotes immunization programs for newborns.
2. Health Awareness & Counseling:
o Educates the community on hygiene, nutrition, and disease prevention.
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o Spreads awareness about family planning and reproductive health.
3. Home-Based Newborn and Childcare Services:
o Assists in postnatal care and monitors newborn health.
4. Facilitating Access to Health Services:
o Guides people to healthcare facilities and ensures treatment adherence.
5. Community Mobilization:
o Organizes village health meetings and promotes government schemes.
ASHA plays a vital role in ensuring last-mile delivery of healthcare, significantly improving maternal
and child health indicators in rural India.

Q7. Enumerate any four most important mortality indicators used in revicwing health status.
Describe Maternal Mortality Ratio in detail.
Answer: Mortality indicators are crucial for assessing a population’s health status and guiding
healthcare policies. The four most important mortality indicators are:
1. Crude Death Rate (CDR):
• Measures the number of deaths per 1,000 people in a population annually.
• Formula:

• It provides a general idea of overall mortality but does not specify causes.
2. Infant Mortality Rate (IMR):
• Indicates the number of deaths of infants under one year per 1,000 live births.
• Reflects healthcare access, maternal health, and socio-economic conditions.
3. Under-Five Mortality Rate (U5MR):
• Measures deaths of children under five per 1,000 live births.
• Used to evaluate child healthcare services and disease control programs.
4. Maternal Mortality Ratio (MMR):
• The number of maternal deaths per 100,000 live births due to pregnancy-related
causes.
• Highlights the quality of maternal healthcare services.

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Maternal Mortality Ratio (MMR) in Detail
Definition:
MMR refers to the number of maternal deaths during pregnancy, childbirth, or within 42 days of
termination per 100,000 live births.
Formula:

Causes of Maternal Mortality:

1. Direct Causes:
• Hemorrhage (excessive bleeding)
• Sepsis (infection)
• Eclampsia (high blood pressure complications)
• Unsafe abortions
• Obstructed labor
2. Indirect Causes:
• Malnutrition
• Anemia
• Pre-existing diseases like diabetes and heart conditions
Significance of MMR in Public Health:
• Indicator of Healthcare Quality: Reflects the availability and effectiveness of
maternal healthcare services.
• Helps in Policy Formulation: Guides government strategies to improve maternal
health.
• Monitors Healthcare System Performance: Low MMR suggests effective healthcare
interventions.
Strategies to Reduce MMR:
1. Strengthening Maternal Healthcare Services: Ensure access to skilled birth attendants.
2. Improving Emergency Obstetric Care: Provide timely medical intervention for
complications.
3. Enhancing Family Planning Services: Prevent high-risk pregnancies.
4. Education and Awareness: Promote antenatal care and institutional deliveries.
A lower MMR indicates improved maternal and child healthcare, leading to better public health
outcomes.

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