HISTORICAL

DEVELOPMENTS OF
COMMUNITY HEALTH
NURSING IN THE WORLD

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 HISTORICAL DEVELOPMENTS OF
COMMUNITY HEALTH NURSING IN THE
WORLD:-

ANCIENT PERIOD:- The history of public

health and public health nursing can be traced
far back in the past. In earliest times people
struggled for their survival by devising their
own methods to deal with life events such as
births, deaths etc.

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 HISTORICAL DEVELOPMENTS OF
COMMUNITY HEALTH NURSING IN THE
WORLD:-
 people were concerned about diseases and had
some knowledge of its treatment. Medical carte
was given by religious leaders or priests who
were revered by the society.
Record history of ancient civilization such as
Babylonian, Hebrew, greek and roman reveals
that they possessed knowledge of personal
hygiene, community responsibility and medicine.

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 HISTORICAL DEVELOPMENTS OF
COMMUNITY HEALTH NURSING IN THE
WORLD:-
 They had well developed system of
environmental sanitation such as safe
water supply, drainage and sewage
disposal system. They also had
understanding of contagious nature of
diseases.

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 HISTORICAL DEVELOPMENTS OF
COMMUNITY HEALTH NURSING IN THE
WORLD:-
 This resulted in rigid public health
measures like isolation of the
sick, quarantine of the families and some
times of the communities.
 The philosophy of the time was that the
individual should provide for the basic
needs for himself and his family

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 HISTORICAL DEVELOPMENTS OF
COMMUNITY HEALTH NURSING IN THE
WORLD:-
 his responsibility included the provison of
food,shelter and clothing and care in case
of illness. The community responsibility
was to protect the individual and his
family against illness that might be due to
communal life.

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 HISTORY OF PUBLIC HEALTH
AND PUBLIC HEALTH NURSING
IN BRITAIN:-
 The development of modern public health
and nursing took place from the middle of
19th century both in England and America
and various other countries as a result of
occurance of great epidemics of bubonic
plague, leprosy, small pox, cholera etc.

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 HISTORY OF PUBLIC HEALTH
AND PUBLIC HEALTH NURSING
IN BRITAIN:-
 During 18th century and early 19th
century England faced industrial revolution
which created tremendous social impacts
in terms of socio-economic
imbalance, exploitation of
workers, slums, overcrowding, poor
sanitation, broken families, child
abuse, maternal and child health
problems.
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 HISTORY OF PUBLIC HEALTH
AND PUBLIC HEALTH NURSING
IN BRITAIN:-
 During 19th century inspite of the act
being passed and implemented to improve
the environmental sanitation, these
diseases continued to occur time and
again in the western world. This was
bcause of the fact that epidemiology of
the diseases were not fully understood.

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 HISTORY OF PUBLIC HEALTH
AND PUBLIC HEALTH NURSING
IN BRITAIN:-
 Ms. Florence Nightingle has been
recognized as one of the foremest
pioneers in the public health and public
health nursing movements in England.
She is acclaimed as the founder of modern
nursing. She began her work when
nursing services which were established
by religious order, had withered away with
the decline of church power and influence
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 HISTORY OF PUBLIC HEALTH
AND PUBLIC HEALTH NURSING
IN BRITAIN:-
 She began her work when nursing
services which were established by
religious order, had withered away with
the decline of church power and influence.
Florence Nightingle created an atmosphere
of dignity and self respect for nursing.

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 HISTORY OF PUBLIC HEALTH
AND PUBLIC HEALTH NURSING
IN AMERICA:-
 In America, similar developments took
place in the field of public health and
public health movement gained
momentum in 1850, when lemuel
Shattuck, a publisher and book
seller, submitted a report on sanitary
conditions of Massachusetts to its
legislature and also published the same.

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 HISTORY OF PUBLIC HEALTH
AND PUBLIC HEALTH NURSING
IN AMERICA:-
 Inhis report he put forward specific
recommendations regarding a system
of sanitary inspection, collection of
vital statistics school health
programme.

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 HISTORY OF PUBLIC HEALTH
AND PUBLIC HEALTH NURSING
IN AMERICA:-
 In 1872, American health association, a
national level profession organization of
community health workers was
established. This association initiates
various public health campaigns and has
consistently worked for improving
standars of community health services.

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 HISTORY OF PUBLIC HEALTH
AND PUBLIC HEALTH NURSING
IN AMERICA:-
 The field of public health bradend under
the influence of scientific advances in
microbiology, social and behavioral
sciences. Thus in late 19th century and at
the beginning of 20th century a new
concept began to take impetus that state
has the direct responsibility for the health
of people.

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 HISTORY OF PUBLIC HEALTH
AND PUBLIC HEALTH NURSING
IN AMERICA:-
 Public health activities not only included
the activities of improved sanitation and
control of communicable diseases but
aalso preventive and promotive services to
mothers,children,school children,workers
and elderly.

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 HISTORY OF PUBLIC HEALTH
AND PUBLIC HEALTH NURSING
IN AMERICA:-
 The need for the application of principles
of personal hygiene, care and health
teaching was felt in all these public health
services for controlling mortality and
morbidity among mothers, children and
workers etc. and improve and promote
their health.

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 HISTORY OF PUBLIC HEALTH
AND PUBLIC HEALTH NURSING
IN AMERICA:-
 This phase of public health gave origin to
public health nursing. During this period,
the foundation of district nursing through
private, voluntary efforts was laid.

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 HISTORY OF PUBLIC HEALTH
AND PUBLIC HEALTH NURSING
IN AMERICA:-
 By 1890, twenty one such organizations
existed in USA. In 1893, Lillian wald, the
pioneer in public health nursing, founded
the hennery street settlement, which grew
in to a well organized health centre with
visiting nurse services for the surrounding
community.

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 HISTORY OF PUBLIC HEALTH
AND PUBLIC HEALTH NURSING
IN AMERICA:-
 The rockfellers foundation of new york
established in 1913, adepted public health
as one of its field of interest. This
foundation assisted in establishment of
schools of public health in united states
and other countries.

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 HISTORY OF PUBLIC HEALTH
AND PUBLIC HEALTH NURSING
IN AMERICA:-
 The American red cross society, the
common wealth fund and kelogg
foundation were the other volutary and
private bodies which were very active in
the development of public health and
public health nursing services.

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 HISTORY OF PUBLIC HEALTH
AND PUBLIC HEALTH NURSING
IN AMERICA:-
 During the early part of 20th
century, there were specialized nurses in
the field of public healthy like nurses in
maternal and chil;d health, veneral
diseases, other communicable
diseases, tuberculosis control etc.

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 HISTORY OF PUBLIC HEALTH
AND PUBLIC HEALTH NURSING
IN AMERICA:-
 public health had entered a newera. It
was faced with new emergent health
problems which were more serious but
chronic and degenerative such as
cardiovascular
diseases, cancer, stroke, mental illness
and metasbolic disorders.

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 HISTORY OF PUBLIC HEALTH
AND PUBLIC HEALTH NURSING
IN AMERICA:-
 Thus public health deal with wide range of
health problems and its activities moved
beyond the traditional basic seven services
which included communicable disease
control, environmental
sanitation, maternal and child
health, health education, medical and
nursing care, nutrition, & vital statistics.

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 HISTORY OF PUBLIC HEALTH
AND PUBLIC HEALTH NURSING
IN AMERICA:-
 The field of public health, broadend,
increasing emphasis was given on primary
health care and preventive and promotive
services, further as a result of ALMA Ata
declaration of the “ goal of health for
all’ through primary health care by WHO
and UNICEF in 1975.

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HISTORICAL DEVELOPMENT OF
PUBLIC HEALTH NURSING IN
INDIA:-
 ANCIENT PERIOD:- The development of
public health nursing in India started
much later as compared to developed
countries of the west. But public health in
India was in practice much before its
development in western countries.

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HISTORICAL DEVELOPMENT OF
PUBLIC HEALTH NURSING IN
INDIA:-
 The Indian history revealed its public
health practice as early as 5000BC. The
period can be classified as vedic period
and post vedic period. During the vedic
period the sacred books Upanishads and
Vedas- especially the atharveda
documented all the knowledge about
medicine,personal hygiene,prevention of
sickness etc.
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HISTORICAL DEVELOPMENT OF
PUBLIC HEALTH NURSING IN
INDIA:-
 The post vedic period (500BC to 700)
started with the rise of
Buddhism, Buddhism emboied the
principles of nonviolence, helping the
sick,poor and needy people, self
discipline,self education, charity towards
all men etc.

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HISTORICAL DEVELOPMENT OF
PUBLIC HEALTH NURSING IN
INDIA:-
 BRITISH PERIOD ( 18TH century to
1947):- The british had estabilished its
rule in India in 1757 by establishing civil
and military services. In 1859, the
administration of India was taken over by
the crown from east India company.

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 HISTORICAL DEVELOPMENT OF
PUBLIC HEALTH NURSING IN
INDIA:-
 In 1859, a royal commission which came
to India to study the
problem, recommended to establish
sanitary commission of five persons each
in Bengal, Bombay and madras.

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HISTORICAL DEVELOPMENT OF
PUBLIC HEALTH NURSING IN
INDIA:-
 In1896, following the out break of
epidemic of plague, aplague commission
was set up to investigate its
epidemiological aspects. As result of
investigation and suggestion,

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HISTORICAL DEVELOPMENT OF
PUBLIC HEALTH NURSING IN
INDIA:-
 In1912, the local government bodies
were made responcible to execute various
health services according to over all plans
and directions of central government.

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HISTORICAL DEVELOPMENT OF
PUBLIC HEALTH NURSING IN
INDIA:-
 In 1939 some very important
developments took place. The madras
public health act was passed for the first
time in the country. The first rural health
training centers was established at singur
near Calcutta with the support of
Rockfeller Foundations.

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HISTORICAL DEVELOPMENT OF
PUBLIC HEALTH NURSING IN
INDIA:-
 In 1943, health survey and development
committee existing health conditions and
health organization in the country and to
make recommendations about the
developments in future.

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HISTORICAL DEVELOPMENT OF
PUBLIC HEALTH NURSING IN
INDIA:-
 DEVELOPMENT SINCE
INDEPENDENCE( 1947ONWARDS):-
Before India attained independence on
15th august 1947, some of the provinces
and princely states of India were parted to
constitute Pakistan.

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HISTORICAL DEVELOPMENT OF
PUBLIC HEALTH NURSING IN
INDIA:-
 This effected change in demographic,
Political and socio-economic aspects. At
the same time, a large number of people
from Pakistan migrated to India.

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HISTORICAL DEVELOPMENT OF
PUBLIC HEALTH NURSING IN
INDIA:-
 The government of India at that time
faced a large number of socio-economic
and public health problems. But because
of new constitutional policies and the
enthusiastic attitude of political
leaders, administrators and the people in
general, the government could manage to
overcome initial difficulties,implement
strict public health measures to prevent
epidemics.
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HISTORICAL DEVELOPMENT OF
PUBLIC HEALTH NURSING IN
INDIA:-
 planning commission was constituted top
help government to plan out integrated
development plan for the entire country
with in the available resourses for a
defined period of five years for its socoi-
economic progress. The planning
commission has been responsible for ten “
five year plans”.

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COMMUNITY HEALTH NURSING
ISSUES:-
 The professional issues challenging
community health nursing . first of all
empowered community health nurses
need to be able to address the following
questions.

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COMMUNITY HEALTH NURSING
ISSUES:-
 who is assessed by community health
nurses: the individual, family, group, or
community ?
 what do community health nurses assess
?
 what nursing diagnosis do community
health nurses use ?

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COMMUNITY HEALTH NURSING
ISSUES:-
 what types of nursing interventions do
community health nurses use in practice
? differ with differences in client focus ?
 how do interventions differ with
differences in client focus

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COMMUNITY HEALTH NURSING
ISSUES:-
 how is community health nursing
evaluated for quality of
care, cost, effectiveness, and outcomes
assessment?

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COMMUNITY HEALTH NURSING
ISSUES:-
 ASSESSMENT:- the previously listed
questions, which challenge
community health nurses suggest
that there may be wide variety of
areas that are considered
appropriate and necessary for
assessment in community health
nursing.

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COMMUNITY HEALTH NURSING
ISSUES:-
 DIAGNOSIS:- with the lake of clarity in
terms of nursing assessment in community
health nursing, it follows that nursing
diagnosis in community health nursing is
equally undeveloped

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COMMUNITY HEALTH NURSING
ISSUES:-
Muecke (1984) critiques the concept of
community health diagnosis and
proposes the following steps to identify
the community of concern
 identification of the health risk of the
community.

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COMMUNITY HEALTH NURSING
ISSUES:-
 specification of the characteristics of the
community and its environment that are
etiologically associated with the risk
 specification of the health indicators that
verify the risk.

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 COMMUNITY HEALTH NURSING
ISSUES:-
GOALS:- goeppingere (1984) examines the
principles issues of community helth nursing
from the perspective of the following questions
 what are the goals of community health nursing
practice ?
 what are the target system that community
health nurses intend to change ?
 in what setting do community health nurses
practice

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COMMUNITY HEALTH NURSING
ISSUES:-
 INTERVENTIONS:- A major nursing
intervention issue is that of the
measurement of costs of community
health nursing in the home health care
setting. Kovner categorizes alternatives in
to four models. Per visit, acuity of
care, hourly, and by diagnosis.

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COMMUNITY HEALTH NURSING
ISSUES:-
 The setting for community health nursing
practice leads to a question of weather
community health nursing is setting
specific. Is it community- oriented because
it emphasizes the collective need ? three
newer and related delopments in nursing
community setting have been the nursing
entrepreneurship, and parish nursing.

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 COMMUNITY HEALTH NURSING
ISSUES:-
EVALUATION:- measurement of the outcomes
of community health nursing care leads to
avariety of questions and issues.
 what are the consequences of organizing care
around reimbursement guidelines rather than a
theory- based approach?
 what level of focus of community health nursing
is most cost-effective: individual, families, group
or communities?

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COMMUNITY HEALTH NURSING
ISSUES:-
 what are the effects of changes in
referral patterns, level of illness of clients
referred,intensity of services
required, and quality of services
delivered ?
 what measures of patient outcomes in
terms of behavioral or functional
changes can be used to evaluate the
interventions of community health
nurses ?
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COMMUNITY HEALTH NURSING
ISSUES:-
 what are the effects of different
management procedures for specific
types of clients ?
 what is the effect of various
management structures and types of
agencies on the way home care is
delivered ?

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 CURRENT ISSUES
 school nurses have played a significant
part in school health programs. They need
to be flexible, creative, and involved in
revising their role to fit with new
directions, otherwise, the role of the
school nurse may be jeopardized.
Economic justification for services is
necessary and therefore, the value of the
school nurse must be ascertained.
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 CURRENT ISSUES
 National health objectives for the year
2000 seek to increase school- based
education to prevent human
immunodeficiency virus infection, alcohol
and other drug use, tobacco
use, injury, and sexually transmitted
diseases.

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 CURRENT ISSUES
 Health education has proven to be
effective at reducing risk behaviors
associated with the leading causes of
death, that is heart
diseases, cancer, stroke, C.O.P.D. un
intentional injuries, AIDS.etc.
responsibility needs to be a fundamental
component of health care reform.

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 TRENDS IN COMMUNITY
HEALTH NURSING
The major forces for shaping
nursing’ role in the health care
environment are considered to be.
 Shifting payment system.
 increased proportion of the aged
population.
 increased competition among
health care providers.
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 TRENDS IN COMMUNITY
HEALTH NURSING
 increased complexity of client needs and
severity of client conditions.
 government intervention in cost
containment.

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 TRENDS IN COMMUNITY
HEALTH NURSING
 TRENDS IN HEALTH CARE DELIVERY
 CONSUMER TRENDS
 NURSES AND PRACTICE
 LEADERSHIP AND CHANGE

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SCOPE OF COMMUNITY HEALTH
NURSING
Areas of activities of community health falls
in to four catagories described below.
 those areas where activities must be on
a community basis
 the supervision of food, water and milk
supply of a community basis.

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SCOPE OF COMMUNITY HEALTH
NURSING
 those areas dealing with preventable
illness, disabilities or premature death.
 communicable diseases including
infestations, for example
diphtheria, pertusis, tetanus, TB, measles, p
oliomyelitis, worm infestation etc.

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SCOPE OF COMMUNITY HEALTH
NURSING
 nutritional deficiences for example the
conditions of mal-nutrition like
marasmus, kwashiorkor, night-
blindness, goiter, nutritional anaemia etc.
 substance abuse, for example drug abuse
and other substances abuse like alcohol.
 Mental health and illness i.e. disorders of
emotion, personality, behaviour etc.

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SCOPE OF COMMUNITY HEALTH
NURSING
 Occupational health includes prevention and
treatment of occupational illness & hazards.
 Non-communicable diseases and conditions
like cancer, cardio- vascular
diseases, diabetes and accidents.
 Dental health

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SCOPE OF COMMUNITY HEALTH
NURSING
 Maternal & child health
 Rehabilitation of victims of accidents and
illness.
 Problem of old age

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SCOPE OF COMMUNITY HEALTH
NURSING
Those areas of health , medical and nursing
which need organized official leadership.
 providing facilities for under
graduates, postgraduates and continuing
education programmes in concerned
fields
 promoting of equitable distribution of
health man power and facilities
 research. www.drjayeshpatidar.blogspot.in
 HEALTH TECHNOLOGY
DEFINITION:-
Health technologies are evidence-
based when they meet well-defined
specifications and have been
validated through controlled clinical
studies or rest on a widely accepted
consensus by experts.

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 HEALTH TECHNOLOGY
HEALTH TECHNOLOGY ASSESSMENT
(HTA)
Basic HTA Orientations
 Technology-oriented assessments
 Problem-oriented assessments
 Project-oriented assessments

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 PURPOSES OF HTA
 Regulatory agencies such as the Food
and Drug Administration (FDA) about
whether to permit the commercial use
(e.g. marketing) of a drug, device or
other technology

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 PURPOSES OF HTA
 Clinicians and patients about the
appropriate use of health care
interventions for a particular patient’s
clinical needs and circumstances
 Health professional associations about
the role of a technology in clinical
protocols or practice guidelines

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 PURPOSES OF HTA
 Health care payers, providers, and
employers about whether technologies
should be included in health benefits
plans or disease management
programs, addressing coverage (whether
or not to pay) and reimbursement (how
much to pay)

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 PURPOSES OF HTA
 Hospitals, health care networks, group
purchasing organizations, and other
health care organizations about decisions
regarding technology acquisition and
management

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 HEALTH TECHNOLOGY
ASSESSMENT PROGRAM (HTA)
The primary goals are to make:
 Health care safer by relying on scientific
evidence and a committee of practicing
clinicians
 Coverage decisions of state agencies more
consistent
 State purchased health care more cost
effective
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 OHTAC
CRITERIA :-
 Technology must improve the net
health outcome and/or safety for
patients and/or providers or
improve health systems efficiency.
 Technology must be at least as
beneficial as any established
alternative
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 OHTAC
1. Technology must be licensed by Health
Canada and have received other
applicable licensing or approvals from
appropriate governmental or regulatory
bodies (e.g. the Canadian Nuclear Safety
Commission).

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 HEALTH TECHNOLOGIES AND
DECISION MAKING:

 How evidence (particularly HTA-based

evidence) is produced and used in
decision making.
 How aspects of health-care systems
facilitate or impede the implementation of
decisions.

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Thank you

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