National health policy

transcript

NATIONAL HEALTH POLICYPresented by: Dr. Heena Sharma

PG student

CONTENTS

• INTRODUCTION• ALMA- ATA DECLARATION• PRIMARY HEALTH CARE• NATIONAL HEALTH POLICY 1983• NATIONAL HEALTH POLICY 2002• COMMENTS/CRITICAL REVIEW• SUMMARY• REFRENCES

INTRODUCTION

HEALTH: A state of complete physical, mental and social

well being and not merely the absence of disease or infirmity.

POLICY: Policy is a system, which provides the logical

framework and rationality of decision making for the achievements of intended objectives.

HEALTH POLICY: Health policy of a nation is its strategy for

controlling and optimizing the social uses of its health knowledge and health resources.

• Post independent India in its constitution has

laid stress on four critical concepts: Equity,

Freedom, Justice and Dignity of the individual.

• India has ventured to raise the standard of

living and level of nutrition for elimination of

ill health , ignorance and poverty.

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

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.”

• 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

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

ALMA –ATA DECLARATION• Health is a fundamental human right and that the

attainment of the highest possible level of health is a most important worldwide social goal.

• The existing gross inequality in the health status of the people particularly between developed and developing countries is politically, socially and economically unacceptable.

• Economic and social development, based on a new international economic order is of basic importance to the fullest attainment of health for all.

• The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.

• Government have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures.

• All government should formulate national policies, strategies and plans of action to launch and sustain primary health care.

• All countries should cooperate in a spirit of partnership and service to ensure PHC for all people.

• An acceptable level of health for all the people of the world by the year 2000 can be attained through a further and better use of the world’s resources.

THE ALMA-ATA CONFERENCE defined that

“Primary health care is an essential health care based

on practical, scientifically sound and socially

acceptable methods and technology, made universally

accessible to individual and families in the

community, through their full participation and at a

cost that the community and the country can afford”.

Principles of Primary Health Care

1.Equitable distribution

2.Community participation.

3.Inter-sectoral coordination

4.Appropriate technology

1. Equitable distribution

• Health services must be shared equally by all irrespective of their ability to pay.

• At present most of the health services are mainly concentrated in the major towns and cities resulting in inequality of care to the people in rural areas.

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

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".

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"

National strategy for health for all ......

• As a signatory to alma- ata declaration in 1978, the Govt. Of India was committed to take steps to provide HFA to its citizens.

• In this connection two important reports appeared:

Report of study group on “HEALTH FOR ALL – on alternative strategy” sponsored by Indian council of social science research (ICSSR) and Indian council of medical research( ICMR)

Reports of working group on “HEALTH FOR ALL by 2000 A.D. ’’ sponsored by Ministry of health and family welfare, Govt. Of India.

• This health policy forms a basis of The National Health Policy Formulated By Ministry Of Health And Family Welfare, Govt . Of India In 1983.

NATIONAL HEALTH POLICY- 1983 • India had its first national health policy in 1983 i.e. 36

years after independence.• In the circumstances then prevailing, this policy provided

the initiatives like:a. Comprehensive health care linking with extension and

health education.b. Intermediation by health volunteers c. Decentralisation to reduce burden of high level referral

systemd. To make government facility limited to eligible poor, by

private investment for patients who can pay.

• NATIONAL HEALTH POLICY 1983 suggested the necessity of complete integration of all plans for human development with socio economic development.

• Health related sectors like Pharmaceuticals, Agriculture, Rural development, education, Social Welfare, Housing, Water supply and conservation of environment were integrated for joint venture.

• National health policy 1983 stressed the need for providing primary health care with special emphasis on prevention , promotion and rehabilitation aspects.

• Its emphasis is on team approach, ban on private practice by health professionals and use of our large stock of health manpower from alternative system of medicine like Ayurveda, Unani, Sidda, Homoeopathy, Yoga and Naturopathy.

• It suggested Planned time bound attention to the following

1.Nutrition, prevention of food adulteration.2.Mainatince of quality of drug3.Water supply and sanitation 4.Environmental protection 5.Immunisation Programme6.Maternal and Child Health Services7.School Health Programme 8.Occupational Health

• It also suggested the need for meeting National

requirements of life saving drugs and vaccines by

quality control, economic packages practice,

reduction in unit cost of medicine and well

considered health insurance schemes to allow

community to share the cost of the services, in

keeping with the paying capacity.

NATIONAL HEALTH POLICY 1983 GOALS SUGGESTED/

ACHIEVED

INDICATOR GOAL BY 2000

ACHIEVED BY 2000

1. INFANT MORTALITY RATE (IMR)

2. PERI NATAL MORTALITY RATE (PNMR)

3. CRUDE DEALTH RATE (CDR) 9 8.7

4. MATERNAL MORTALITY RATE (MMR)

5. UNDER FIVE MORTALITY RATE (UFMR)

10 9.4

6. LIFE EXPENTANCY BIRTH- MALE(yrs)

64 62.4

FEMALE(yrs) 64 63.4

7. LOW BIRTH WEIGHT %

10% 20%

8. CRUDE BIRTH RATE

21 26.1

9. COUPLE PROTECTION RATE

60% 46.2%

10. NET REPRODUCTION

1 1.45

11. GROWTH RATE 1.2 1.93

12. FAMILY SIZE 2.3 3.1

13. ANTE NATAL CARE (ANC)

100% 67.2% with ANC still less with full ANC

14. TT PREGNANT 100 83

15. DPT 85 87

16. OPV 85 92

17. BCG 85 82

18. TYPHOID NOT UPTO THE MARK

19. LEPROSY NOT UPTO THE MARK

20. TUBERCULOSIS NOT UPTO THE MARK

21. BLINDNESS NOT UPTO THE MARK

Future Goals

• Leprosy elimination by 2005

• Tuberculosis mortality 50%; reduction by 2010

• Blindness prevalence to 0.5% by 2010

Differentials In Health Status Among Rural/Urban India

Differentials In Health Status Among States

Differentials In Health Status Among Socio-economic Groups

Achievements Through The Years 1951-2000

Achievements Through The Years - 1951-2000

But by the end of 2000 century it was clear that the goals of health for all by the year 2000 AD

would not be achieved ......

• The observed progress suggested that we may need some new and additional strategy or new sizable intervention in achievement of an unacceptable health of the country.

Factors responsible for this failure were:

• Biased and poor socioeconomic development in the region where it was needed most.

• Discriminatory policies due to age, gender and ethnicity thus preventing access to health care surveillance.

NATIONAL HEALTH POLICY-2002

• A revised health policy for achieving better health care and unmet goals has been brought out by government of India- National Health Policy 2002.

• According to this revised policy, government and health professionals are obligated to render good health care to the society.

• Optimizing the use of health service to a large group rather than a small group is a foreseen event by the NHP 2002.

• Inclusion of social policies adds to the credit of the revised NHP 2002.

• NHP2002 has set out a new policy framework for the acceleration of Public Health goals in the socioeconomic circumstances currently prevailing in the country.

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.

• Enhancing the contribution of private sector in providing health service for people who can afford to pay.

• Emphasizing rational use of drugs.

• Increasing access to tried systems of Traditional Medicine

Goals to be Achieved by 2000-2015

2003 –• Enactment of legislation for regulating minimum

standard in clinical Establishment / Medical institution

2005 –• Eradication of Polio & Yaws

• Elimination of Leprosy • Increase State Sector health spending from 5.5% to

7% to of the budget.

• Establishment of an integrated system of surveillance, National Health Accounts and Health Statistics

• 1% of the total budget for Medical Research

• Decentralization of implementation of public health program

2007- • Achieve Zero level growth of HIV/AIDS

2010-• Elimination of Kala- Azar • Reduction of mortality by 50% on account of

Tuberculosis, Malaria, Other vector & water borne Diseases

• Reduce prevalence of Blindness to 0.5%

• Reduction of IMR to 30/1000 live births &MMR

to100/ Lakh live births

• Increase utilization of public health facilities from current level of <20% to > 75%

• Increase health expenditure by government from the existing 0.9% to 2.0% of GDP

• Increase share of Central grants to constitute at least 25% of total health spending

• Further increase of State sector Health spending from 7% to 8%

• 2% of the total health budget for medical Research

2015- • Elimination of lymphatic Filariasis

POLICY PRESCRIPTIONS

1. Financial Resources:

• 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.

2.Equity : 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.

55%35%

Primary Secondary Tertiary

3.Delivery Of National Public Health

Programs:• NHP 2002 envisages the gradual convergence

of all health programmers under a single field

administration.

• It suggests for a scientific designing of public

health projects suited to the local situation.

• Therefore, the policy places reliance on

strengthening of public health outcomes on

equitable basis.

• It recognizes the need of user charge for

secondary and tertiary public health care for

those who can afford to pay.

4. The state of public health infrastructure:

• The Policy envisages kick- starting the revival of the Primary

Health System by providing some essential drugs under

Central government funding through the decentralized health

system.

• This initiative under NHP-2002 is launched in this belief that

the creation of a decentralized public health system will ensure

a more effective supervision of the public health personnel

through community monitoring , than has been achieved

through the regular administrative line of control.

5.Extending public health services:

• Expanding the pool of general medical Practitioners

to include a cadre of licentiates of medical practice,

as also practitioners of Indian systems of Medicine

and Homoeopathy has been advocated in the policy.

• In order to provide trained manpower in under-served

areas, it recommends contract employment.

6. Role of local self- Government Institutions

• NHP-2002 lays great emphasis upon the

implementation of public health programs through

local self –government institutions.

• The policy urges all state governments to consider

decentralizing the implementation of the programs

by transfer power to such institutions by 2005.

7. Norms of Health care Professional:

• Minimal statutory norms with constant reviewing for the deployment of doctors and nurses in medical institutions need to be introduced urgently under the provision of the Indian Medical council Act and Indian Nursing Council Act , respectively.

8.Education of Health care Professional:

• National health policy 2002 recommends setting up of a medical grant commission for funding new medical/dental colleges.

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

• It suggests for a need based, skill oriented syllabus with a more significant component of practical training.

• For discharging public health responsibilities in the country NHP 2002 recommends specialization 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.

9.Need for specialists in 'Public Health' and 'Family Medicine’:

10.Nursing personnel:

• NHP 2002 recognizes acute shortage of nurses trained in superspeciality disciplines.

• It recommends increase of nursing personnel in public health delivery centers and establishment of training courses for superspecialities.

11. Use of Generic drugs and vaccines

• This Policy 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 be sourced from public sector institutions.

12. 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:

First Tier:-

Primary centre cover 1 Lakh population

It functions as OPD facilities.

It provides essential drugs.

It will carry out national health programmers.

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.

13.Mental health:

• Decentralized mental health service for diagnosis and

treatment by general duty medical staff is

recommended.

• It also recommends securing the human rights of

mentally sick.

14.Information Education and Communication:

• NHP-2002 has suggested interpersonal

communication by folk and traditional media to

bring about behavioral change.

• School children are covered for promotion of health

seeking behavior, which is expected to be the most

cost effective intervention where health awareness

extends to family and further to future generation.

15.Health research:

• The policy envisages an increase in govt. funded health

research to a level of 1% of the total health spending by

2005 and up to 2% by 2010.

• New therapeutic drugs and vaccines for tropical disease

are given priority.

16.Role of private sector:

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

• 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.

17. Role of civil Society:

• NHP 2002recognises institutions of civil society to

handle disease control programme earmarking not

less than 10% of the budget in respect of identified

programme.

18. National Disease Surveillance Network:

• NHP 2002 noted that absence of an efficient disease

surveillance network is a major handicap for cost

effective health care.

19.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 .

• It has suggested a national health accounts

conforming to the source to user matrix.

20.Women's health:

• The policy commits the highest priority of the central

government to the funding of the identified programs

relating to women’s health.

21.Medical Ethics:• In India we have guidelines on professional medical

ethics since 1960. • This is revised in 2001. • Government of India has emphasized the importance

of moral and religious dilemma. • 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.

22.Enforcement of Quality Standards for food and Drugs :

• NHP 2002 envisaged that Food and Drug

administration be strengthened in terms of laboratory

facilities and technical expertise.

23.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.

24. Environmental & Occupational Health:

• This policy envisages that the independently stated policies and programs of the environment related sectors be smoothly interfaced with the policies and the programs of the health sector.

• Child labor and substandard working conditions are causing occupational linked ailments.

• NHP 2002 has suggested for an independent state

policy and programme for environment apart from

periodic health screening for high risk associated

occupation.

25.Providing Medical Facilities to Users from Overseas (Health

Tourism) • The NHP-2002 Strongly encourages the providing of

such health services on a payment basis to service seekers from overseas. Recently large number of patients from overseas are coming to India for treatment (Medical Tourism).

26.Impact of Globalization on Health Sector:

• With adoption of trade related intellectual Property

(TRIPS) government is taking steps to overcome

possible adverse impact of impact of economic

globalisation on the health sector.

• NHP 2002 brings out the relevance of inter sectorial

contribution to health but limits itself to making

recommendations.

• NHP 2002 touches population growth and health standards. It has suggested synchronized implementation of National Population Policy and National Health Policy in improving health standard of the country.

• NHP 2002 focuses on building up creditability for the alternative systems of medicine through evidence based research and suggested a separate document.

RECENT DEVELOPMENT• The Prime Minister has launched the Public Health foundation

of India (PHFI), a public- private initiative in the health sector,

which seeks to establish world-class public health institutes to

train professional in the field.

• The PHFI plans to establish five seven world class and

relevant Indian Institute of Public Health (IIPH) within the

next five years, with the first two institutions opening by 2008.

• Funding for this project would total nearly Rs. 500-700 crore

over five to seven years.

ACHIVEMENTS

Following goals of National Health Policy are

achieved:

Year 2003

1. Enactment of legislation for regulating

minimum standard in clinical establishment/

Medical Institutions.

Year 2005:

• Eradication of Poliomyelitis is missed however there is zero reporting since 2004.

2. Leprosy has been declared eliminated according

to the criteria fixed by WHO. However more

efforts are required.

3. Integrated Disease surveillance Project has

been launched but establishment of National

Health Accounts and Health statistics is still

lagging behind. IDSP is also going at slow pace.

4. Spending of state sector Health has not much

increased as planned from 5.5% to 7% of the budget.

5. Budget for medical research is not much increased

as 1% of the total health budget for medical research

has been targeted.

6. Decentralization of implementation of public health

programs: National Rural Health Mission has been

launched in this direction.

Year 2007

1. Achievement of zero level growth of HIV/AIDS has

not been achieved and may require some more

years.

Goals failed to be achieved by 2005

Eradicate Poliomyelitis.

Establish an integrated system of surveillance,

National Health documents and Health statistics.

Increase state sector Health spending from 5.5% to 7%

of the budget.

1% of the total health budget for medical research.

Decentralization of implementation of public health

programs.

COMMENTS/ CRITICAL REVIEW

The NHP 2002 is indeed a well thoughtful and

comprehensive document.

NHP-2002 has got the opportunity to refer many documents

and reports like World Development Report 1993, National

Family Health Survey 1993-94 and 1998-1999, the census

of India 2001, World Health Report 2000, and favourable

environment like support of international health agencies,

economic and political reforms particularly 73rd and 74th

amendment of the constitution of India.

However, there are many constraints in the

implementation of this policy like 35% illiterate and one

quarter population is below poverty line, unstable

government, and reactive response to the health problem

and disasters.

NHP-2002 is a desirable and positive step for the

betterment of peoples health.

A substantial achievement has been acknowledged by

the government as far as the targets are concerned.

In spite of all good things in the policy it also suffers

some criticism which are as follows:

Policy

This policy did not refer to the women empowerment policy

2001 while describing measures to ensure women health.

There is a need to coordinate effectively with the Ministry of

Social Justice and Empowerment while dealing with

vulnerable section of the society like children, scheduled

caste, scheduled tribes etc.

Women’s health has not received enough attention in the

policy; similarly child health, adolescents, gender

discrimination and violence should have received adequate

concerns.

Old age group has got very less attention in the

policy. Life expectancy has crossed 60 years of age

and going to be 70 in the next decade, which

demands special health services for this group and

cannot be neglected.

Although a separate old age policy is existing but

national health policy must specify in which areas

there is need of coordination and convergence.

Ignored areas are : Resource generation mechanism,

allocation priorities band workforce management, how to

handle growing menace of substance abuse, updating of

intervention prescribed in national health programs according

to scientific development, abolition of private practice by

govt. Doctors , controlling medical advertisement etc.

Occupational and environmental health should have been

addressed properly as far as standards, safety measures and

recreational facilities is concerned.

School health programs have not achieved the

desired results in the majority of states. The programs

have become almost defence because of

administrative, managerial and logistic problems. In

recent evaluation by Delhi Government it is clearly

found government run school health services are not

cost effective as compared to run by NGO’S.

However more studies are required before advocating

private agency to run the school health services.

For decentralization: Role of local self government.

Institutions has been defined in the policy and should

have been achieved by 2005.

With exception of Kerala, decentralization has merely

been an attempt to delegate duties rather than

development of powers. Hence it is surprising that

despite attractive slogans like ‘peoples health in peoples

hands’ the real needs of the people have not been met.

MISMATCH SITUATION ANALYSIS AND POLICY PRESCRIPTIONS

Policy does not give importance to population control

however, blames the population explosion for nullifying

the impact of advancement of public health.

Policy ignores pharmaceuticals and their impact on health

care. There is no Drug Policy mentioned.

The impact of globalization may affect the basic

philosophy of equity. Heavily subsidized primary

healthcare, as it exists in India, would suffer the most.

Funding:

Increasing from 0.9% to 2% of GDP expenditure on health

is still low. This falls short of the 5% of GDP that has been

a long standing demand of the health movement and

recommended by the WHO long ago. The goal of the policy

to increase state sector health spending from 5.5% to 7% of

the budget by 2005 is failed.

The policy should have allocated funds and other resources

that can be made available from the health sector in case of

the disaster or natural calamities.

Health Tourism (Medical Tourism)

Public hospitals should also be encouraged to attract

medical tourists as envisaged in this policy but this is

problematic ,because existing public health facilities

are barely able to meet the requirement of the people

within the country.

CONCLUSION While the public health initiatives over the years have

contributed significantly to the improvement of the

health indicators, it is to be acknowledged that public

health indicators/ disease burden statistics are the

outcome of several complementary initiatives under the

wider umbrella of the developmental sector, covering

rural development, agriculture, food production,

sanitation, drinking water supply, education etc.

Despite the impressive public health gains, the

morbidity and mortality levels in the country are still

unacceptably high as compared to the developed

countries.

Further dedicated efforts are required to achieve goal

of ‘Health for All’ in 21st century’.

NHP 2002 will provide an impetus for achieving an

acceptable standard of good health of people of

India.

India Shinning

“India is shining ok for the glossy magazines, but if you just go outside metro you will see that everything about India shining is refuted [In the villages] alcoholism is rife and female infanticide and crime are rising. You have to bribe to get electricity, water. Yes, the middle and upper classes are taking off, but the 700 million who are left behind, all they see is gloom and darkness and despair. They are born to fulfil their destiny and have to live this way and die this way. The only thing that shines for them is the sun, and it is hot and unbearable and too many of them die of heatstroke.”

Let us work together for “Health for ALL.’’

REFRENCES• Alma-Ata, 1978- Primary Health Care :WHO, UNICEF.

• Government of India, Ministry of Human Resource

Development, Annual Report 2001-2002.

• K.J. National Health Programs of India. 11th Edition, 2014.

• K.Park Park’s Textbook of Preventive and Social

Medicine, 23rd Edition, 2009.

• Prabhakara GN Policies and Programmes of Health in

India. 1st Edition, 2005.

THANK YOU

National health policy

Healthcare