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By
DR.I.SELVARAJ, I.R.M.S
B.SC., M.B.B.S., D.P.H (MADRAS MEDICAL COLLEGE).,D.I.H.,PGCH&FW (NIHFW, New Delhi) Sr.D.M.O (SELECTION GRADE OFFICER) ON STUDY LEAVE
Post Graduate student in M.D Community Medicine SREE RAMACHANDRA MEDICAL COLLEGE & RESEARCH INSTITUTE,CHENNAI,TAMILNADU
Dr.I.Selvaraj
1.The effectiveness of public health service to the community depends on the way the public health laws prevailing in the community. 2. Political support 3. People co-operation 4.Public health laws includes very many acts (MTP Act, Prenatal Diagnostic sex determination act, Indian medical council Act ,Indian nursing council Act, Indian Pharmacy act, PFA Act, Public health Act etc.,) 5. In this presentation the importance public health act and its role in the health of the community will be discussed. 6. The public health managers and community medicine experts have to play a key role in this field 7. This presentation which I made it as a gift to public health personnel and community medicine experts in my country. This will enrich their knowledge while teaching undergraduates and post graduates in community medicine, and post graduate diploma in public health. 8. This presentation will be able to disseminate various sections and other provisions of Tamil Nadu public health act to the public health specialists and make them to understand their importance in the community.
PUBLIC HEALTH
Public health is what we, as a society, do collectively to assure the conditions for people to be healthy.
THE TAMIL NADU PUBLIC HEALTH ACT (1939) A Pioneering Act 1939 Steered by Great Scholar and Minister for Health Dr.T.S.S.Rajan The Death Relief Act To improve the Health of the people of Madras province
Highlights of Tamilnadu public health act Tamil Nadu is the first state in the country to enact a law for public health Tamil Nadu Public Heath Act 1939 remains as a model till today for the entire country. Amendments in 1941, 1944 and 1958 The Act was modified in 1970 The Act was translated in Tamil in the year 1986. Tamil Nadu to its credit had the first Act in the country for Food Adulteration also Tamil Nadu Prevention of Food Adulteration Act 1918. The Act was repealed by the Central Act, 1954. Constitution of the Public Health Board. Regulations for construction of new buildings. Powers of the Police Officers to arrest offenders Powers of the Executive Officers and Public Health Staff to arrest Offenders. Act to over right other Enactments Public Health Act is supreme Power to the Government to remove difficulties in implementation of the Act as and when they appear. Powers of the Government and of the Director of Public Health and his Staff to advise local authorities There is a provision in this act for Fairs and Festivals
Vision Healthy people in healthy community Mission To promote physical and mental health To prevent disease, injury, and disability Goal Prevention of disease Prolongation of life Improvement of quality of life Elimination of health disparity Organizing community efforts to achieve above
Chapter
section From To 3 7 16 26 36 40 51 61
I II
1 4 8
Short Title and Extent, Commencement and Definitions Public Health Board-Constitution and Functions Powers of Govt & DPH Public Health Establishments of Local Authorities Water Supply Drainage Sanitary Conveniences Abatement of Nuisances Prevention, Notification and Treatment of Diseases - Part - I: Infectious Diseases in general Part - II: Notified Infectious Diseases Part - III: Venereal Diseases Part - IV: Powers to Make Rules
III IV V VI VII
17 27 37 41 52
62 78 81
77 80
VIII
82
IX X
83 89 94 98
Mosquito Control Sanitation and Buildings Part - I : Residential Areas Part - II : Control over In Sanitary Buildings Part - III : Abatement of Overcrowding (Sce.97 omitted) Lodging House Food Control Fairs and Festivals Finance Rules, By-Laws, Penalties Etc., Miscellaneous: Appeals, Method of Serving Notice, Compounding, Punishment for malicious abuse of powers, Overriding etc
Schedule - I Schedule II
The Main Focus on: Environmental Health Communicable Disease Control Food Hygiene Maternity & Child Health measures
Environmental Health: Water Drainage Housing Rats, Mice and Mosquito control Nuisance Sanitation
Water Establishment of Technical Assistance for maintenance of Water works. Surveillance of Water sources Control over bottled water supply Govt. ensure local authority to provide adequate continuous, wholesome water (Sec. 17, 18, 19) Role of Govt. and other authorities in Water supply (Sec. 20, 21) Role of Railway Administration (Sec.22) Periodical Examination of Water (23) Action over the unsanitary sources (24) Prevention of Pollution of Water (36, 57) Supply of Water during Fair or Festival (120) Control over Private Water Sources (124)
Drainage: Responsibility of Local authority and private in construction of Drains and Cesspool (27, 28, 29, 30, 31, 32) Prevention of Let out of Sullage in the Streets (34) Prevention of Disposal of injurious refuse into the Drain (35)
1. Acute influenza pneumonia 2. Anthrax 3. Cerebrospinal fever 4. Chickenpox 5. Cholera 6. Diphtheria 7. Enteric fever 8.Leprosy
9.Measles 10. Plague 11. Rabies 12. Relapsing fever 13. Scarlet fever 14. Small pox 15. Tuberculosis 16. Typhus fever
List of Notified Diseases SECTION- (62) Cerebrospinal fever Chickenpox Cholera Diphtheria Leprosy Measles Plague Rabies Scarlet fever Small pox Tuberculosis Infectious Hepatitis Epidemic Influenza Whooping cough
Information by Medical practitioners (56) Persons responsible for giving information (64) Appointment of Health staff, medicines appliances (53) Isolation wards, ambulance (54, 155) Disposal of bodies of person died from notified diseases (74) Venereal diseases control (78,79) a) Provision of Diagnosis and Treatment (78) b) Education of Patients (79) Destruction of Rats and Mice (77) Prevention of spread of disease (57, 58, 59, 60, 61) To prevent spread of disease in public places (63, 65, 66, 67, 68, 69, 70, 71, 72, 75) Control of other Diseases during Epidemic and Endemic (81)
Mosquito control Prevention of Mosquito breeding (83) Protection of Anti Mosquito works (86) Power to entry and inspect (85,86) S a n i t a t i o n : Responsibility of Local authority to provide Sanitary conveniences (37, 40) Provision Sanitary arrangements during Fairs and Festival (120) Provision of Sanitary conveniences in Houses (28, 39) Maternity & child health Local authority is responsible in providing these services (82)
Food control
Section 107-A prohibition of sale of food without license in certain places (Hotel, Tea shop, Coffee house, Caf, Refreshment room, Mobile canteen, or catering establishment) Section-108 No person shall keep store or prepare for sale any animal intended for human consumption which is diseased If any child < 7 years of age commits offence u/s 108 (1), the employer or the parent of the child are punishable as if the offence was committed by him (Sec.109) Section -112 deals with the power of the health officer to enter premises used for food trade Section-113 deals with power of the health officer to deal with infected vendors Meat Hygiene (110, 111) Milk and Dairy products (114, 115) There is provision for prohibition of sale of unsound foods, power of the Health Officer to enter premises used for food and power of the Health Officer or a person duly authorized by him to destroy such food article and to incorporate expenses for such destruction from the owner himself.
Authorized Persons SECTION (122) HO or Authorized Persons to Seize & destroy any food believed to be unwholesome(& perishable or value does not exceed Rs3/-) If not destroyed by HO, to be produced to prescribed authority for destruction if unwholesome or for analysis to ascertain the fitness for human consumption In any case, the expenditure to be paid by the person concerned
SECTION 123
The local authority may, in case of emergency with the sanction of the District Collector, depute any person to enter upon, occupy and use, without resorting to Land Acquisition Act, 1894 any land or any building not being a Dwelling house in the notified Fair or Festival Centre which in the opinion of the Health Officer, is required and suitable for any purposes connected with the Fair or Festival, such as the construction of Pilgrim sheds, Water sheds, Hospitals, Segregation sheds, Latrines and the like.. This provision is unique for Public Health Act.
HO can direct to disinfect / close any Private Water Source (124) In default, HO can take necessary action and the expenditure to be recovered from the person (124) En route Arrangements, Where large number of persons halt on their way to or return from a festival site (125)
N u i s a n c e:
Nuisances and the powers of Health Officer for abatement of Nuisances (41 to 49) Any premises in such a state as to be prejudicial to health or a nuisance (41.1) Any pond, pool, latrine, watercourse which is so foul or in such a state as to be prejudicial to health or nuisance (41.2) Any accumulation or deposit of refuse which is prejudicial to health or a nuisance (41.4) Any factory or work place is not provided with adequate ventilation or not clean or not free from noxious effluence or over crowded while work is carried as to be prejudicial to health of those employed therein (41.5) Any fire place or furnace which does not as far as predictable consume the smoke arising from the combustible used therein (41.6) Any chimney sending forth smoke in such quantity as to be a nuisance (41.7) Any noise, vibration, dust, irritating smell or offensive odour produced by a factory or work place which is nuisance to the neighborhood(41.8) It deals with inspection from time to time to detect nuisance(42) Section-45 deals with power of the health officer to abate nuisance by serving notice to defaulter or the premises owner Section 47 deals with the powers of the health officer for disposal of articles removed it while abating nuisance Section-48 deals with the power of entry of any executive or any officer from the public health department Deposition of Rubbish in streets (51)
Power of Entry
Without any notice in cases of factories, workshops, work places, business houses After issuing a reasonable notice in other cases and in case of dwelling house
Entry relating to Mosquito Control: Section 88: Entry at reasonable time after issuing notice Entry relating to Lodging Houses: Section 106.2: Entry at all times Manager to allow Entry relating to Food Control: Section 112.1: Anytime Day or Night without notice Any person who prevents lawful entry shall be punishable with simple imprisonment (up to 1 month) or fine (Rs. Five Hundred) or both (section 135)
General Guidelines for Enforcement of the Act Periodic Inspection of the Places, Premises or Institutions etc., Investigation of Complaints related to Public Health matters Taking note of Violations, omissions, Nuisances, failure to adopt conditions or precautions etc., - if any Advising to rectify the above Taking action if required (64 penalties) described in this schedule Penalty ranges from 10 rupees to 1000 rupees)
Procedure for prosecution Make a report Enclose Inspection report Enclose Served copy of notice Enclose Reply received and the opinion thereupon (or the fact of nonreceipt of reply) Prepare and enclose Charge Sheets induplicate / triplicate Consult public prosecutor Submit for sanction of Prosecution Filing of the charge sheet in the court Conducting prosecution Obtaining a copy of the judgment Reviewing the judgment Renewed action if necessary Further prosecutions for continuing breach if any
Miscellaneous
Power to compound Offences (138.A) Power of Police Officer to arrest offenders (139) Power of Health officers, Public health Staff to arrest Offenders (140) Punishment for malicious abuse of powers (143)
Penalties Breach of rules (129) Breach o by-laws (132) Offences under the Act (134.1) &Schedule I &II Preventing entry (135)
Emerging and re-emerging diseases Increasing industries in food production Emerging social issues like Gender issues, adolescents, geriatric issues Increasing environmental hazards Ozone layer, weaning greenery, radiation, bio-degradation, environmental pollution due to changing life styles. Public Health Service Made as an essential service Control of Health Officer over Public Health staff need to be strengthened Education and Training of Public Health Staff
The Penalty provisions has to be increased Stringent action should be taken against those violating the act
Prohibition of Tobacco and Related items Establishment of Health Education units
Medical institutions to maintain register of communicable diseases. Control over disposal from Hospitals
Places of swimming pools, Holiday resorts, Holiday camps to be monitored Fixing standards of pollution (use of Plastics, Air, Noise and Radiation hazards
Schools, Hostels, Colleges and Factories to be inspected periodically
CONCLUSION:
The developing countries have to develop a model Public Health Act and modifications and amendments if and when necessary could be made at the appropriate time and appropriate level. Public Health Act if it has any weak areas, It has to be identified and modified by suitable amendment to suit the present needs.
Acknowledgement: 1.Supercourse 2.Dr .P. Krishnamurthy Rtd. Director of Public Health and Preventive Medicine, Government of Tamil Nadu - Chennai 600 006 3. Tamil Nadu Public health Act, 1939 4. Dr G. Palani, Professor, Department of community medicine, SRMC&RI