National Health Policy

Dr. J.P. Majra Associate Professor Dept. of Community Medicine K.S. Hegde Medical Academy

Health policy of a Nation is its strategy for controlling and optimising the social uses of its health knowledge and health resources.

www.similima.com

India had its first national health policy in 1983 i.e. 36 years after independence.

Why ???
www.similima.com 3

The Joint WHO UNICEF international conference in 1978 at Alma-Ata (USSR)

Alma-Ata Declaration called on all the governments to formulate national health policies according to their own circumstances to launch and sustain primary health care as a part of national health system.
www.similima.com 4

The 30th World Health Assembly in May 1977 resolved The main social target of governments and WHO in the coming decades should be the attainment by all citizens of the world by the year 2000 AD of a level of health that will permit them to lead a socially and economically productive life.

HEALTH FOR ALL BY 2000 AD

www.similima.com 5

John Bryant in his book Health and the Developing World

Large numbers of the worlds people, perhaps more than half, have no access to health care at all, and for many of the rest the care they receive does not answer the problems they have.

www.similima.com

The Joint WHO UNICEF international conference in 1978 at Alma-Ata (USSR)

Declared that
the

existing gross inequalities in the status of health of people particularly between developed and developing countries as well as within the countries is politically, socially and economically unacceptable.

www.similima.com

The Alma-Ata conference called for acceptance of the WHO goal of

HEALTH FOR ALL

by 2000 AD

and Primary Health Care as a way to achieve Health For All

www.similima.com 8

Alma-Ata Declaration called on all the governments to formulate national health policies according to their own circumstances to launch and sustain primary health care as a part of national health system.

www.similima.com

The Alma-Ata conference defined that

Primary health care is essential health care made universally accessible to individuals and acceptable to them, through their full participation and at the cost the community and country can afford.

www.similima.com

10

Principles of primary health care

1. 2. 3. 4. Equitable distribution Community participation. Inter-sectoral coordination Appropriate technology

www.similima.com

11

1. Equitable distribution
Some thing for all and most for those who need the most Bahujan hitae bahujan sukhae

www.similima.com

12

2. Community participation.
There must be a continuing effort to secure meaningful involvement of the community in the planning, implementation and maintenance of health services, besides maximum reliance on local resources such as manpower, money and materials.
www.similima.com 13

3.Intersectoral coordination
"primary health care involves in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communication and others sectors".

www.similima.com

14

4. Appropriate technology
"technology that is scientifically sound, adaptable to local needs, and acceptable to those who apply it and those for whom it is used, and that can be maintained by the people themselves in keeping with the principle of self reliance with the resources the community and country can afford"
www.similima.com 15

Elements of primary health care

1. Education concerning prevailing health problems and the methods of preventing and controlling them 2. Promotion of food supply and proper nutrition 3. An adequate supply of safe water and basic sanitation 4. Maternal and child health care, including family planning
www.similima.com 16

Elements of primary health care..

5. Immunization against major infectious diseases 6. Prevention and control of locally endemic diseases 7. Appropriate treatment of common diseases and injuries 8. Provision of essential drugs.
www.similima.com 17

National Health Policy -1983

NHP 1983 stressed the need for providing primary health care with special emphasis on prevention, promotion and rehabilitation Suggested planned time bound attention to the following i) Nutrition, prevention of Food Adulteration ii) Maintenance of quality of drugs www.similima.com 18

National Health Policy 1983

iii) Water supply and sanitation iv) Environmental protection v) Immunisation programme vi) Maternal and child health services vii) School health programme and viii) Occupational health services.
www.similima.com 19

National Health Policy 1983

For better programme planning NHP 1983 recommended an effective Health Information System.

www.similima.com

20

NHP 1983- Goal suggested/achieved

Indicator IMR PNMR CDR MMR UFMR LIFE EXPECTANCY MALE FEMALE Goal by 2000 60 33 9 2 10 Achieved by 2000 70 46 8.7 4 9.4

64 64
www.similima.com

62.4 63.4
21

NHP 1983- Goal suggested/achieved

Indicator LBW CBR CPR NRR Growth rate Family size Goal by 2000 Achievement by 2000 10% 26% 21 60% 1 1.2 2.3www.similima.com 26.1 46.2% 1.45 1.93 3.1
22

NHP 1983- Goal suggested/achieved

Indicators AN Care TT Pregnant DPT OPV BCG Fully immunized Goal by 2000 Achievement by 2000 100% 67.2% any ANC 100% 85% 85% 85% 85%
www.similima.com

83% 87% 92% 82% 56%

23

Differentials in health status among rural/urban India

Sector India Rural Urban
BPL

(%)

IMR 70 75 44

UFMR 94.9 103.7 63.1

MMR 408 -

26.1 27.09 23.62

www.similima.com

24

Differentials in health status among states

Sector
Kerala TN

BPL(%)
12.72 21.12

IMR
14 48 52

UFMR
18.8 58.1 63.3

MMR
87 135 79

Better performing states

Maharashtra 25.02

Low performing states

Orissa Bihar Rajasthan UP MP 47.15 42.60 15.28 31.15 37.43 97 63 81 84
www.similima.com

104.4 105,1 114.9 122.5 137.6

498 707 607 707 498

25

90

Differentials in health status among socio-economic groups

Indicator Schedule caste Schedule tribe Other disadvantaged Others All India IMR 83 84.2 76 61 70
www.similima.com

UFMR 119.3 126.6 103.1 82.6 94.9

26

Achievements Through The Years 1951-2000

Indicator Demographic Changes Life Expectancy Crude Birth Rate 1951 1981 36.7 40.8 54 2000 64.6 (RGI)

33.9(SRS) 26.1(99 SRS) 12.5(SRS) 8.7(99 SRS) 110 70 (99 SRS)

27

Crude Death Rate 25 IMR 146

www.similima.com

Achievements Through The Years 1951-2000

Epidemiological Shifts Malaria (cases in million) Leprosy cases per 10,000 population Small Pox (no of cases) Guineaworm ( no. of cases) Polio 1951 75 38.1 1981 2.7 57.3 2000 2.2 3.74

>44,887 Eradicated --- >39,792 Eradicated 265

28

www.similima.com 29709

Achievements Through The Years - 1951-2000

Infrastructure SC/PHC/CHC Dispensaries &Hospitals( all) Beds (Pvt & Public) Doctors(Allopathy) Nursing Personnel 1951 725 9209 117,198 61,800 18,054 1981 57,363 23,555 569,495 2,68,700 1,43,887 2000 1,63,181 (99-RHS) 43,322 (9596-CBHI) 8,70,161 (95-96-CBHI) 5,03,900 (98-99-MCI) 7,37,000 (99-INC)
29

www.similima.com

Millennium Development Goals

Millennium Summit held in September 2000 in New York Representatives from 189 countries met to adopt the United Nations Millennium Declaration Poverty eradication and development by 2015 being the core issue

Millennium Development Goals

www.similima.com 30

Millennium Development Goals

Related to health

8 goals 3 goals 18 targets 8 targets 48 indicators 18 indicators

www.similima.com

31

National Health Policy 2002

Objectives: Achieving an acceptable standard of good health of Indian Population, Decentralizing public health system by upgrading infrastructure in existing institutions, Ensuring a more equitable access to health service across the social and geographical expanse of India.
www.similima.com 32

NHP 2002, Objectives..

Enhancing the contribution of private sector in providing health service for people who can afford to pay. Giving primacy for prevention and first line curative initiative. Emphasizing rational use of drugs. Increasing access to tried systems of Traditional Medicine
www.similima.com 33

Goals NHP 2002

1. Eradication of Polio & Yaws 2005

2. Elimination of Leprosy 3. Elimination of Kala-azar 4. Elimination of lymphatic Filariasis 5. Achieve of Zero level growth of HIV/AIDS www.similima.com

2005 2010 2015 2007

34

Goals NHP 2002

6.Reduction of mortality by 50% on account of Tuberculosis, Malaria, Other vector and water borne Diseases 7.Reduce prevalence of blindness to 0.5% 2010

2010

www.similima.com

35

Goals NHP 2002

8. Reduction of IMR to 30/1000 & MMR to 100/lakh 9. Increase utilisation of public health facilities from current level of <20% to > 75% 10. Establishment of an integrated system of surveillance, National Health Accounts and Health Statistics
www.similima.com

2010 2010

2007

36

Goals NHP 2002

11.Increase health expenditure by government as a % of GDP from the existing 0.9% to 2.0% 12. Increase share of Central grants to constitute at least 25% of total health spending
www.similima.com

2010

2010

37

Goals NHP 2002

13. Increase State Sector Health spending from 5.5% to 7% of the budget 14. Further increase of State sector Health spending from 7% to 8%
www.similima.com

2005

2010

38

NHP-2002 Policy prescriptions

www.similima.com

39

Financial resource
Increase in health sector expenditure to 6% of GDP, with 2% by public health investment by 2010 is recommended by the policy. Existing 15% of central government contribution is to be raised to 25% by 2010.

www.similima.com

40

Financial resource..
This will allow a good rise of current annual per capita public health expenditure of the country from Rs. 200/by ten-fold say around Rs. 2000/-.

www.similima.com

41

Equity
NHP 2002 has observed that the attainment of health indices has been very uneven across rural-urban divide, which can be seen from Tables

www.similima.com

42

Differentials in health status among rural/urban India

120 100 70 75 80 26.1 27.09 23.62 60 40 20 0 BPL IMR India UFMR Rural Wt. for age Urban
43

94.9 103.7 63.1

47.0 49.6

www.similima.com

38.4

44

Equity..
To overcome the social inequality, NHP 2002 has set an increased allocation of 55% total public health investment for the primary health sector, 35% for secondary sector and 10% for tertiary sector.
10%

35%

55%

Primary

Secondary

Tertiary

www.similima.com

44

Delivery of national public health programmes

NHP 2002 envisages the gradual convergence of all health programmes under a single field administration. It suggests for a scientific designing of public health projects suited to the local situation.

www.similima.com

45

Delivery of national public health programmes.

Training and reorientation of rural health staff and free hand to district administration to allocate the time of the rural health staff between the various programmes, depending on the local need is stressed.

www.similima.com

46

Delivery of national public health programmes.

NHP 2002 noted that less than 20% of population which seek OPD services and less than 45% of that which seek indoor treatment avail of such services in public hospital. In this backdrop, the 2002 NHP envisages kick starting of the revival of public health system by providing some essential drugs through decentralised health system.

www.similima.com

47

Delivery of national public health programmes.

The policy recognises the need for more frequent in - service training. NHP 2002 noted that improvement of public health indices is linked with quantum and quality of investment through public funding in public health sector (Table).
www.similima.com 48

Public health spending in select countries

IMR / Population 1000 with income of less than one dollar per day Health expenditure to GDP

Public expenditur e on health to total health expenditur e

17.3% 24.9% 45.4% 96.9% 44.1%
49

India China Sri Lanka UK USA

44.2 % 18.5 % 6.6 % -

70 31 16 6 7

5.2% 2.7% 3.0% 5.8% 13.7%

www.similima.com

Delivery of national public health programmes.

Therefore, the policy places reliance on strengthening of public health outcomes on equitable basis. It recognises the need of user charge for secondary and tertiary public health care for those who can afford to pay.

www.similima.com

50

Extending public health services

Expanding the pool of General Practitioners to include a cadres of licentiates including Indian systems of Medicine and Homoeopathy is recommended in the policy. In order to provide trained manpower in under served areas it recommends contract employment.

www.similima.com

51

Role of local self government institutions

NHP 2002 emphasises implementation of health programmes through local self government institutions by 2005 with financial incentives.

www.similima.com

52

Norms for health care personnel

Indian Medical Council Act and Indian Nursing Council Act provide minimal statutory norms for doctors and nurses in medical institutions. NHP 2002 suggests for review and making stringent statutory norms for meeting better normative standards.

www.similima.com

53

Suggested norms for health personnel

Category of personnel 1 . Doctors 2. Nurses 3. Health worker female and male 4. Trained dai 5. Health assistant (male and female 6. Health assistant (male and female) 7. Pharmacists 8. Lab. technicians 1 per 1 per Norms suggested 1 per 1 per 1 per 3,500 population 5,000 population 5,000 population in plain area and 3000 population in tribal and hilly areas. village 30,000 population in plain area and 20000 population in tribal and hilly areas. provides supportive supervision to 6 health workers (male /female). 10,000 population 10,000 population
54

1per 1 per

www.similima.com

Education of health care professionals

NHP 2002 recommends setting up of a Medical Grant Commission for funding new government medical/dental colleges. It suggests for a need based, skill oriented syllabus with a more significant component of practical training.
www.similima.com 55

Education of health care professionals..

The need for inclusion of contemporary medical research and geriatric concern and creation of additional PG seats in deficient specialities are specified.

www.similima.com

56

Need for specialists in 'public health' and 'family medicine'

For discharging public health responsibilities in the country NHP 2002 recommends specialisation in the disciplines of Public Health and Family Medicine where medical doctors, public health engineers, microbiologists and other natural science specialists can take up the course.

www.similima.com

57

Nursing personnel
NHP 2002 recognises acute shortage of nurses trained in superspeciality disciplines. It recommends increase of nursing personnel in public health delivery centres and establishment of training courses for superspecialities.

www.similima.com

58

Use of generic drugs and vaccines

NHP 2002 recommends limited number of essential drugs of generic nature as a requisite for cost effective public health care. To ensure long term national health security 2002 NHP envisages that not less than 50% of the requirement of vaccine/sera be sourced from public sector institutions
www.similima.com 59

Urban health
Migration has resulted in urban growth which is likely to go up to 33%. It anticipates rising vehicle density which lead to serious accidents. In this direction, 2002 NHP has recommended an urban primary health care structure as under;

www.similima.com

60

Urban health
First Tier: Primary centre cover 1 Lakh population
It functions as OPD facilities. It provides essential drugs. It will carry out national health programmes.

www.similima.com

61

Urban health
Second Tier: General Hospital a referral to primary centre provides the care. The policy recommends a fully equipped hub-spoke trauma care network to reduce accident mortality.

www.similima.com

62

Mental health
Decentralised mental health service for diagnosis and treatment by general duty medical staff is recommended. It also recommends securing the human rights of mentally sick.

www.similima.com

63

Information Education and Communication

NHP 2002 has suggested interpersonal communication by folk and traditional media to bring about behavioural change. Associations of PRIs/NGOs/Trusts are given specific targets.

www.similima.com

64

Information Education and Communication.

School children are covered for promotion of health seeking behaviour, which is expected to be the most cost effective intervention where health awareness extends to family and further to future generation.

www.similima.com

65

Health research
2002 NHP noted the aggregate annual health expenditure of Rs. 80,000 crores and on research Rs. 1150 crores is quite low. The policy envisages an increase in govt. funded health resources to a level of 1% total health spending by 2005 and upto 2% by 2010. New therapeutic drugs and vaccines for tropical disease are given priority.

www.similima.com

66

Role of private sector

The policy welcomes the participation of the private sector in all areas of health activities primary, secondary and tertiary health care services; but recommended regularitory and accreditation of private sector for the conduct of clinical practice.

www.similima.com

67

Role of private sector..

It has suggested a social health insurance scheme for health service to the needy. It urges standard protocols in day-to-day practice by health professionals. It recommends tele-medicine in tertiary care services.

www.similima.com

68

The role of civil society

NHP 2002 recognises institutions of civil society to handle disease control programme, earmarking not less than 10% of the budget in respect of identified programme.

www.similima.com

69

National disease surveillance network

NHP 2002 noted that absence of an efficient disease surveillance network is a major handicap for cost effective health care. It wants a network from lowest rung to central government by 2005 by installation of data base handling hardware, IT interconnectivity, in-house training for data collection and interpretation.

www.similima.com

70

Health statistics
NHP 2002 has recommended full baseline estimate of tuberculosis, malaria and blindness by 2005, and In the long run for cardiovascular diseases, cancer, diabetes, accidents, hepatitis and G.E. It has suggested a national health accounts conforming to the source to users matrix.

www.similima.com

71

Women's health
After recognising the catalytic role of empowered women in improving the overall health standard of the country, NHP 2002 has recommended to meet the specific requirement of women in a more comprehensive manner.

www.similima.com

72

Medical ethics
In India we have guidelines on professional medical ethics since 1960. This is revised in 2001. Government of India has emphasised the importance of moral and religious dilemma.

www.similima.com

73

Medical ethics.
NHP 2002 has recommended notifying a contemporary code of ethics, which is to be rigorously implemented by Medical Council of India. The Policy has specified the need for a vigilant watch on gene manipulation and stem cell research.
www.similima.com 74

Enforcement of quality standard for food and drugs

NHP 2002 envisaged that Food and Drug administration be strengthened in terms of laboratory facilities and technical expertise.

www.similima.com

75

Regulation of standards in paramedical disciplines

More and more training institutions have come up recently under paramedical board which do not have regulation or monitoring. Hence, establishment of Statutory Professional Council for paramedical discipline is recommended.

www.similima.com

76

Environmental and occupational health

Government has noted the ambient environment condition like unsafe drinking water, unhygienic sanitation and air pollution. Child labour and substandard working conditions are causing occupational linked ailments.

www.similima.com

77

Environmental and occupational health.

NHP 2002 has suggested for an independent state policy and programme for environment apart from periodic health screening for high risk associated occupation.

www.similima.com

78

Providing medical facilities to users from overseas

NHP 2002 encourages such facility on a payment basis to service seekers from overseas. This also shall include fiscal incentive and DEEMED EXPORTS licence to service givers.

www.similima.com

79

Impact of globalisation on the health sector

With the adoption of Trade Related Intellectual Property Rights (TRIPS) government is taking steps to overcome possible adverse impact of economic globalisation on the health sector. NHP 2002 envisages a national patent regime for the future.

www.similima.com

80

Impact of globalisation on the health sector.

NHP 2002 brings out the relevance of intersectoral contribution to health but limits itself to making recommendations. NHP 2002 touches population growth and health standards.

www.similima.com

81

Impact of globalisation .
NHP 2002 has suggested synchronised implementation of National population policy and national health policy in improving health standard of the country. NHP 2002 focuses on building up credibility for the alternative systems of medicine through evidence based research and suggested a separate document.

www.similima.com

82

Summation
Crafting of a National Health Policy is a rare occasion. allow our dreams to mingle with ground realities.

www.similima.com

83

Summation
needs are enormous and the resources are limited health needs are also dynamic and keep changing over time. had to make hard choices between various priorities

www.similima.com

84

Summation
NHP 2002 has given a continuum to NHP 1983, where primary health care is adopted as the main strategy through
Decentralization Equity Private sector/indigenous system participation Rise in public investment

www.similima.com

85

Summation
The ultimate goal is achieving an acceptable standard of good health of people of India. The commitment of the service providers and an improved standard of governance is a prerequisite for the success of any health policy.

www.similima.com

86

miles to go before..
www.similima.com

87