National Health Policies National Health Policies and Programmesand Programmes

Dr. Dhruv Mankad

Sr. Consultant, School of Health Science, YCMOU, Nashik

National Health PoliciesNational Health Policies

National Population Policy 2000National Population Policy 2000 National Health Policy 2002National Health Policy 2002 National Nutrition Policy/Mission 2001National Nutrition Policy/Mission 2001 Others like Drug Policy, Vaccine PolicyOthers like Drug Policy, Vaccine Policy

National Health Policy 2002National Health Policy 2002NHP2002- Goals to be achieved   

Eradicate Polio and Yaws 2005

Eliminate Leprosy 2005

Eliminate Kala Azar 2010

Eliminate Lymphatic Filariasis 2015

Achieve zero level growth of HIV/AIDS 2007

Reduce Mortality on account of TB, malaria and other vector and water-borne diseases by 50 per cent

2010

Reduce prevalence of blindness to 0.5 per cent 2010

Reduce IMR to 30/1000 and MMR to 100/100,000 live births

2010

Increase utilisation of public health facilities from the current level of <20 per cent to >75 per cent

2010

Establish an integrated system of surveillance, national health accounts and health statistics.

2005

National Health Policy 2002National Health Policy 2002

ongoing demographic transition;ongoing epidemiological transition;

expansion of health care infrastructure;changes in health care seeking behaviour;

availability of newer technologies for management;

rising expectations of the population, escalating cost of health care.

National Population Policy National Population Policy 20002000

Demographic Indicators to enable the couples to achieve Demographic Indicators to enable the couples to achieve their reproductive goals;their reproductive goals;

Contraception method based targets to meeting of unmet Contraception method based targets to meeting of unmet needs for contraception to reduce unwanted pregnancies;needs for contraception to reduce unwanted pregnancies;

integrated health care for women and children;integrated health care for women and children; centrally defined targets centrally defined targets to to community need assessment and community need assessment and

decentraliseddecentralised area specific microplanning area specific microplanning and and implementation of health care for women and children to reduce implementation of health care for women and children to reduce infant mortality and reduce high desired fertility;infant mortality and reduce high desired fertility;

quantitative coverage quantitative coverage to emphasis on quality and content of to emphasis on quality and content of care;care;

predominantly women predominantly women centred centred programmes programmes supply driven service delivery to supply driven service delivery to need and demand driven need and demand driven

service; improved logistics for ensuring adequate and service; improved logistics for ensuring adequate and timely supplies to met the needs;timely supplies to met the needs;

service provision based on providers perceptionservice provision based on providers perception to addressing to addressing choices and conveniences of the couples.choices and conveniences of the couples.

National Population Policy National Population Policy 20022002

assess and meet the unmet needs assess and meet the unmet needs for contraception;for contraception;

achieve reduction in the high desired achieve reduction in the high desired level of fertility through programmes level of fertility through programmes for reduction in IMR and maternal for reduction in IMR and maternal mortality ratio (MMR); and mortality ratio (MMR); and

enable families to achieve their enable families to achieve their reproductive goals. reproductive goals.

National Population Policy National Population Policy 20022002

reduction in IMR to 45 per 1,000 live reduction in IMR to 45 per 1,000 live births by 2007 and 28 per 1,000 live births by 2007 and 28 per 1,000 live births by 2012;births by 2012;

reduction in maternal mortality ratio reduction in maternal mortality ratio to 2 per 1,000 live births by 2007 and 1 to 2 per 1,000 live births by 2007 and 1 per 1,000 live births by 2012; andper 1,000 live births by 2012; and

reduction in decadal growth rate of the reduction in decadal growth rate of the population between 2001-2011 to 16.2. population between 2001-2011 to 16.2.

National Nutrition MissionNational Nutrition Mission

Chronic energy deficiency and under-Chronic energy deficiency and under-nutritionnutrition

Micro-nutrient deficiencies Micro-nutrient deficiencies anaemia due to iron and folate anaemia due to iron and folate

deficiencydeficiencyVitamin A deficiencyVitamin A deficiencyIodine Deficiency DisordersIodine Deficiency Disorders

Chronic energy excess and obesityChronic energy excess and obesity

National Nutrition MissionNational Nutrition Mission Household food security and freedom from Household food security and freedom from

hunger to hunger to nutrition security for the nutrition security for the family and the individual family and the individual

Untargeted supplementation Untargeted supplementation to screening to screening of all the persons from vulnerable of all the persons from vulnerable groups, identification of those with groups, identification of those with various grades of under-nutrition and various grades of under-nutrition and their appropriate management.their appropriate management.

Lack of focused interventions on over-Lack of focused interventions on over-nutrition nutrition to promotion of appropriate to promotion of appropriate lifestyles and dietary intakes for lifestyles and dietary intakes for prevention and management of over prevention and management of over nutrition and obesitynutrition and obesity

National Nutrition MissionNational Nutrition Mission

Reduction in under nutritionReduction in under nutrition Reduction/elimination of micronutrient deficiencies - Reduction/elimination of micronutrient deficiencies -

iron, iodine and Vit Airon, iodine and Vit A Reduction in chronic energy deficiencyReduction in chronic energy deficiencyIn addition the Mission would co-ordinate and monitor In addition the Mission would co-ordinate and monitor Implementation of National Nutrition Policy;Implementation of National Nutrition Policy; Strengthening of existing programme;Strengthening of existing programme; R&D R&D Nutrition education and IEC ;Nutrition education and IEC ; Strengthening of ICDS and Mid Day Meal ProgrammeStrengthening of ICDS and Mid Day Meal Programme Relief in Natural Calamities. Relief in Natural Calamities.

National Nutrition Mission National Nutrition Mission 20012001

Ensuring production and availability of cereals, pulses Ensuring production and availability of cereals, pulses and vegetables to meet the nutritional needs.and vegetables to meet the nutritional needs.

Making them available at affordable cost through out Making them available at affordable cost through out the year to urban and rural population through the year to urban and rural population through reduction in post harvest losses and appropriate reduction in post harvest losses and appropriate processing.processing.

More cost effective and efficient targeting of the PDS More cost effective and efficient targeting of the PDS to address macro and micronutrient deficiencies to address macro and micronutrient deficiencies ( such as providing coarse grains, pulses and iodised ( such as providing coarse grains, pulses and iodised salt to BPL families through TPDS)salt to BPL families through TPDS)

Improve purchasing power by appropriate Improve purchasing power by appropriate programmes including food for work programmesprogrammes including food for work programmes

N H PsN H Ps

Revised National TB Control programRevised National TB Control program National Vector Borne Diseases Programs, National Vector Borne Diseases Programs,

eg Malaria, Urban Malaria, Dengue, eg Malaria, Urban Malaria, Dengue, Chikunguniya, Filaria, Chikunguniya, Filaria, Japanese Japanese Encephalitis, Swine FluEncephalitis, Swine Flu

National Leprosy Eradication ProgramNational Leprosy Eradication Program National AIDS control ProgrammeNational AIDS control Programme National STD Control ProgrammeNational STD Control Programme

N H PsN H Ps National Blindness Control Program eg Cataract National Blindness Control Program eg Cataract

Operations, Refractory Errors in school childrenOperations, Refractory Errors in school children National Iodine Deficiency Control Program by National Iodine Deficiency Control Program by

promoting iodated saltpromoting iodated salt National Mental Health ProgrammeNational Mental Health Programme National Cardio-vascular Diseases Control National Cardio-vascular Diseases Control

ProgrammeProgramme National Cancer Control ProgramNational Cancer Control Program National Occupation Disease Control ProgramNational Occupation Disease Control Program National Diabetes Control ProgramNational Diabetes Control Program

Revised National TB Control Revised National TB Control Programme (RNTCP)Programme (RNTCP)

About 1/3 of global burden of TB in About 1/3 of global burden of TB in IndiaIndia

About 20 lakh new cases detected, About 20 lakh new cases detected, about 10 lakh smear +veabout 10 lakh smear +ve

Govt detecting 12 lakhs, 25% smear Govt detecting 12 lakhs, 25% smear positive, equal from private sectorpositive, equal from private sector

Private sector involved for DOTS - Private sector involved for DOTS - PPPPPP

Revised National TB Control Revised National TB Control Programme (RNTCP)Programme (RNTCP)

Operational StructureOperational Structure Central Govt : Dy DGHS (TB)Central Govt : Dy DGHS (TB) State Govt : State TB Cell with STOState Govt : State TB Cell with STO District: DTU with DTODistrict: DTU with DTO Sub District – MO – TC ( 1 per 5/2.5 lakhs)Sub District – MO – TC ( 1 per 5/2.5 lakhs) Designated Microscopy Centre (DMC): for Med Designated Microscopy Centre (DMC): for Med

College, NGO, Pvt Hospital nodal point for College, NGO, Pvt Hospital nodal point for record report at Sub District Levelrecord report at Sub District Level

Peripheral Health InstPeripheral Health Inst Diagnostic Laboratory ServicesDiagnostic Laboratory Services Drug StoresDrug Stores

Revised National TB Control Revised National TB Control Programme (RNTCP) – Lab/DOTSProgramme (RNTCP) – Lab/DOTSCentral Laboratories with Central Laboratories with

international recognition at Chennai, international recognition at Chennai, Bangalore and DelhiBangalore and Delhi

DMC and Sputum Collection Centres DMC and Sputum Collection Centres networksnetworksCase Detection, finding and Diagnosis of Case Detection, finding and Diagnosis of

Lung TBLung TBDOTSDOTS

National Vector borne Diseases National Vector borne Diseases Control ProgramControl Program

Malaria, Urban MalariaMalaria, Urban MalariaFilariaFilariaDengueDengue Japanese EncephalitisJapanese EncephalitisChikunguniyaChikunguniyaKala azarKala azarSwine Flu!Swine Flu!

NVBDCPNVBDCP

Started as National Malaria Started as National Malaria Eradication ProgEradication Prog

Dramatic success – 75 million cases Dramatic success – 75 million cases (1952) reduced to 0.1 million cases (1952) reduced to 0.1 million cases (1965) and 0.8 million deaths to 0! (1965) and 0.8 million deaths to 0! Resurgence in 1976 with 6 million Resurgence in 1976 with 6 million casescases

Right now 1-3 million casesRight now 1-3 million cases

NVBDCPNVBDCP

Early Detection and treatmentEarly Detection and treatmentVector ControlVector ControlPersonal ProtectionPersonal Protection Identify and control epidemicIdentify and control epidemic IECIEC

National Leprosy Eradication National Leprosy Eradication ProgramProgram

The major leprosy elimination challenge is in five States which continued 71% of total country case load. Recorded cases in March 2000 were as follows:

Bihar - 149220 Uttar Pradesh - 100169 West Bengal - 42440 Madhya Pradesh - 36021 Orissa - 40717

Hidden cases are also likely to be high in these States.

With leprosy elimination defined as less than 1 per 10,000, these five States recorded the following prevalence rates by March 2000 :

Bihar - 15.20 Orissa - 11.46 West Bengal - 5.44 Uttar Pradesh - 6.02 Madhya Pradesh - 4.60

I D S ProgramI D S Program

Integrated Disease Surveillance Integrated Disease Surveillance ProgramProgramdecentralized, state baseddecentralized, state basedimprove information about improve information about

communicable and non communicable and non communicable diseasescommunicable diseases

identify major risk factors incl. identify major risk factors incl. environmental, social and politicalenvironmental, social and political

I D S ProgramI D S Program

It would alsoIt would alsoImprove laboratory support; Improve laboratory support; Train stakeholders in disease Train stakeholders in disease

surveillance and action; surveillance and action; Coordinate and decentralize surveillance Coordinate and decentralize surveillance

activitiesactivitiesInvolve private sectorInvolve private sector

Monitoring & EvaluationMonitoring & Evaluation

Habitation/ Village Health Register Habitation/ Village Health Register Periodic Health Facility Survey at Periodic Health Facility Survey at

SHC, PHC, CHC, District level SHC, PHC, CHC, District level Formation of Health Monitoring Formation of Health Monitoring

and Planning Committees at PHC, and Planning Committees at PHC, Block, District and State levels  Block, District and State levels  

Sample household and facility Sample household and facility surveyssurveys

Community based monitoringCommunity based monitoring

Monitoring & EvaluationMonitoring & Evaluation

 

 

 

 

Outputs/ Outcomes Objectively verifiable indicator (OVI)

 

I) General goals and objectives of NRHM

 Reduction in IMR, TFR and MMR

MMR reduced to 200 by 2010

IMR reduced by 20 by 2010

  Neonatal mortality rate reduced to 10 by 2010

  TFR brought down to 2.0 by 2010

Monitoring & EvaluationMonitoring & EvaluationSr.No. Overall Results Indicators Expected level of achievements

   Indicators Baseline 2006-7 2007-08 2010-11

1 Contraceptive prevalence rate (Current use of any contraceptive method among currently married women)

61.6 70 75

2.75 % Eligible couples using IUD for more than 12 months   57 60

3.6 % of mothers who delivered during past 3 years & who received IFA for 3+ months 36%  90 95

4.95 % Deliveries assisted by skilled attendants at birth One-fourth home births (36%)

83 95

5.95 % of 24hr PHCs conducting minimum 10 deliveries/ months  All 7 currently conducting >10

del

35 50

6.5 No. of Upgraded FRUs offering 24hr. emergency obstetric care services  28?   150

7.15 % of 12-23 months of age fully immunized children 84% 90 95

8.95 % of mothers and newborn children visited within 1 week of birth among non institutional deliveries

NA  50 60

9.6 % of children under 3 years of age with diarrhea in the previous 2 weeks who received oral dehydration salt

NA 45 60

10.6 % of children under 3 years of age with diarrhea in the previous 2 weeks who received oral dehydration salt

NA  45 60

11.6 Polio free status achieved since when Not yet  Polio-free   Polio-free

12 No. of institutions upgraded to IPHS Process begun 198 360

Selection and training of ASHA Starting year 1300  

Some Innovative SchemesSome Innovative Schemes

Safe MotherhoodSafe Motherhood ARTH model, ARTH model, Rajasthan Rajasthan

Chiranjeevi modelChiranjeevi model Waiting rooms at APWaiting rooms at AP Voucher pmt to pvt Voucher pmt to pvt

providers, Haryanaproviders, Haryana Delivery Huts, MPDelivery Huts, MP Escort rooms, TNEscort rooms, TN ISM medicines, TNISM medicines, TN

Some Innovative SchemesSome Innovative Schemes

Safe MotherhoodSafe Motherhood Janani Sahyogi Janani Sahyogi Yojana, MPYojana, MP

Ayushmati Yojana, Ayushmati Yojana, WB thru PPPWB thru PPP

Mamta, DelhiMamta, Delhi Saubhagyawati, Saubhagyawati,

Uttaranchal – full Uttaranchal – full package by pvt package by pvt providersproviders

Some Innovative SchemesSome Innovative Schemes

Safe MotherhoodSafe Motherhood

Health InsuranceHealth Insurance

PPP for PHC mgmtPPP for PHC mgmt

Impregnanted bednet Impregnanted bednet for pregnant women, for pregnant women, AssamAssam

Convergence NRHM-Convergence NRHM-NACO model, K’takaNACO model, K’taka

Arogyashri at APArogyashri at AP Yeshaswini, K’takaYeshaswini, K’taka

Karuna Trust-K’taka Karuna Trust-K’taka and ArP, others at ArPand ArP, others at ArP

Some Innovative SchemesSome Innovative Schemes

Procurement and Procurement and FinancingFinancing

WHAT NEXT?WHAT NEXT?

TNMSCTNMSC KMSCLKMSCL E-bankingE-banking Credit card to Credit card to

ASHAASHA INFINITE!!INFINITE!!