National health policy

1

Dr. Priyanka Ravi

III yr MDS

Dept of Public Health Dentistry

NATIONAL HEALTH POLICY

2

CONTENTS1. INTRODUCTION

2. HISTORY

3. BASIC CONSIDERATIONS

4. HEALTHCARE SYSTEM OVERVIEW

5. NATIONAL HEALTH POLICY – 1983

6. NATIONAL HEALTH POLICY – 2001

7. ORAL HEALTH POLICY IN INDIA

8. DRAFT OF NATIONAL HEALTH POLICY 2015

9. SUMMARY

10. CONCLUSION

11. REFERNCES

3INTRODUCTION India is drawing the world’s attention, not only because

of its population explosion but also because of its prevailing as well as emerging health profile and profound political, economic and social transformations.

Despite several growth orientated policies adopted by the government, the widening economic, regional and gender disparities are posing challenges for the health sector.

Kulkarni A.P, Baride J.P, Doke P.P, Mulay P.Y. Text book of Community Medicine. Ch-15 Health Care in India- Part A. 4 th ed. Mumbai: Vora Medical Publications; 2013.

475% of health infrastructure, medical man power and other health resources are concentrated - urban areas where 27% of the populations live (Inverse care law).

India has traditionally been a rural, agrarian economy.Nearly three quarters of the population, currently 1.2

billion, still live in rural areas.


5National health programs are launched by the government of India for control/ eradication of communicable disease, environmental sanitation, nutrition, population control and rural health.

The National Health Policy 2002 (NHP2002) reviews the improvement in demographic trends, control of infectious diseases and growth of infrastructure, between 1981 and 2000.

NHP 2002 envisages that by 2010 the public investment in health would reach 2% of the GDP.


6

HISTORY

7HISTORY

Health planning in India can be seen as pre and post independence.

Health planning in India - Pre independence

Health planning in India - Post independence

Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013.

8

Health planning in India – Pre independence1825- Quarantine Act(1st Public health Act)

1880- Vaccination Act

1864- Public health community

1873- The Birth and Death registration Act

1886 – Plague Commission

1887- The epidemic Disease Act

1939- The Madras Public Health Act Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013.

Local body act - for transferring and entrusting

the responsibility for the health and sanitation of the

people to the local authorities.

For the purpose of providing basic

frame work for the growth of public health policy and its

administration.

An Act to make provision for

advancing the Public Health of the (State)* of

Madras.

9The British government established certain bureaus/ Institutions

Central Malaria Bureau- 1909

Indian Research Fund Association- 1911

The All India Institute of Hygiene and Public Health- 1930

The rural health training center- 1939


10

The most comprehensive health policy was prepared in India on the eve of Independence in 1946.

This was the ‘Health Survey and Development Committee Report’ popularly referred to as the Bhore Committee.

This Committee prepared a detailed plan of a National Health Service for the country, which would provide a universal coverage to the entire population free of charges through a comprehensive state run salaried health service.


HISTORY

11Health planning in India -Post independence

National health committees

Planning Commission

Five year plans

National Health Policy


12

National health committeesMudliar

Committee - 1962

Chadah Committee –

1963

Mukerjee Committee –

1965

Mukerjee Committee –

1966

Jungalwala Committee –

1967

Kartar Singh Committee –

1973

Shrivastav Committee –

1975

Rural Health Scheme –

1977

Health for All by 2000 AD- Report of the working group,

1981Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013.

1.Consolidation of advances made in first 2 Five years plans2. Strengthening of district hospital with specialty services3.Regional organization in each state4. 1PHC=40000 population5.Integration of medical and health services6. Constitution of All India Health Services

Arrangement necessary for the

maintenance phase of National Malaria

Eradication Program.

Appointed to review the strategy for the family planning program.

Worked out for the details of BASIC

HEALTH SERVICE

Committee on integration of Health Services

1.Unififed cadre2.Common seniority

3. Recognition of extra qualification

4. Equal pay for equal work5. No private practice and good

service condition.

Committee on Multipurpose

workers under health and family

planning

Group on Medical education and

support manpower

1. Involvement of medical college+PHC

2. Reorientation training of multipurpose workers into

unipurpose workers.

Evolved fairly specific targets

and indices to be achieved in the country by 2000

AD.

13

In the Five Year Plans, the health sector constituted schemes that had targets to be fulfilled.

During the first two Five Year Plans the basic structural framework of the public health care delivery system remained unchanged.

To evaluate the progress made in the first two plans and to draw up recommendations for the future path of development of health services the Mudaliar Committee was set up.


HISTORY

14

1950s and 1960s - focus of the health sector was to manage epidemics.

Mass campaigns - eradicate various diseases.


HISTORY

15

Separate countrywide campaigns with a techno-centric approach were launched against malaria, smallpox, tuberculosis, leprosy, filaria, trachoma and cholera.

In India until 1983 there was no formal health policy statement.

HISTORY

16

BASIC CONSIDERATIONS

17HEALTH Health is a state of complete physical, mental, and social

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

Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya(Medi) Publishing House; 2013.

18ORAL HEALTH The World Health Organization defines oral health as

a “state of being free from chronic mouth and facial pain, oral and throat cancer, oral sores, birth defects such as cleft lip and palate, periodontal (gum) disease, tooth decay and tooth loss, and other diseases and disorders that affect the oral cavity”.

Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya(Medi) Publishing House; 2013.

19

POLICY

Course or principle of action adopted by the Government.

HEALTH POLICY

Is an statement of an authority adopted by the Government or public

in order to improve the health services.


It is an expression of goals for improving the health, the priorities

among these goals, and the main directions for attaining them for a

nation.

20

HEALTHCARE

Multitude of services rendered to individuals, families or communities by the agents of the health services or professions, for the purpose of promoting, maintaining, monitoring or restoring health.

21

HEALTHCARE SYSTEM OVERVIEW

22

HEALTH SYSTEM IN INDIAAT THE CENTRE

UNION MINISTRY OF HEALTH AND FAMILY WELFARE

THE DIRECTORATE GENERAL OF HEALTH SERVICES

THE CENTRAL COUNCIL OF HEALTH AND FAMILY WELFARE

AT THE STATE

STATE MINISTRY OF HEALTH

STATE HEALTH DIRECTORATE

LOCAL OR PHERIPHERAL

(AT THE DISTRICT LEVEL)SUB- DIVISIONS

TEHSILS

COMMUNITY DEVELOPMENT BLOCK

MUNICIPALITIES AND CORPORATIONS

VILLAGES

PANCHAYATS

Cabinet ministerMinister of stateDeputy health minister(Secretary of Govt of India – as executive head)

- Director General of health services- Additional Director

-Union Health minister – Chairman-State health ministers- members

Minister and Deputy Minister of Health and Family welfare- Health Secretariat –official organ

Director of Health

Services

Collector

Assistant Collector

Tehsildar

Block Development

officerMunicipal

Board Chairman

Institution Of Rural Local Self

Government

23

PANCHYATI RAJ It is a 3-tier structure of rural local self-government

in India. It links the villages to the districts

Panchayat- at the village level

Panchayat Samiti – at the block level

Zilla Parishad- at the district level

24

HEALTH CARE SYSTEMPUBLIC HEALTH SECTOR

PRIMARY HEALTH CARE PRIMARTY HEALTH CENTRES SUB- CENTRTES

HOSPITALS/ HEALTH CENTERS COMMUNITY HEALTH CENTRES RURAL HOSPITALS DISTRICT HOSPITALS SPECIALIST HOSPITALS TEACHING HOSPITALS

HEALTH INSURANCE SCHEMES EMPPLOYEES STATE INSURANCE CENTRAL GOVERNMENT HEALTH SCHEME

OTHER AGENCIES DEFENCE SERVICES RAILWAYS

PRIVATE HEALTH SECTOR PRIVATE HOSPITALS, POLYCYLINICS, NURSING HOMES AND DISPENSARIES GENERAL PRACTITIONERS AND CLINICS

INDIGENOUS SYSTEMS OF MEDICINE AYURVEDA AND SIDDHA UNNAI AND TIBBI HOMEOPATHY UNREGISTERED PRACTITIONERS

VOLUNTARY HEALTH AGENCIESNATIONAL HEALTH PROGRAMMES

25

Healthcare is one of India's largest service sectors. There has been a rise in both communicable/infectious

diseases and non-communicable diseases, including chronic diseases.


26

Poliomyelitis, leprosy, and neonatal tetanus will soon be eliminated.

Some infectious diseases like dengue fever, viral hepatitis, tuberculosis, malaria and pneumonia have developed a stubborn resistance to drugs.


27As Indians live more affluent lives and adopt unhealthy diets that are high in fat and sugar

The country is experiencing a rapidly rising trend in non-communicable diseases such as hypertension, cancer, and diabetes.


28 In addition, the growing elderly population along with growing diseases will place an alert on India’s healthcare systems and services.


29

There are considerable shortages of hospital beds and trained medical staff such as doctors and nurses, and as a result public accessibility is reduced.


30There is also a considerable rural-urban imbalance in which accessibility is significantly lower in rural compared to urban areas.

Women are under-represented in the healthcare workforce.


31


32

Health Policy Formulation in India

Ministry of Health identified the need for policy arising out of

handling of the day-to-day problems related to various

health programs and commitment to achieving the goals of

HFA by 2000 AD.

Ministry appointed a committee to review environment in the

health sector and recommended a policy frame after

needful consultation.

33

The draft policy document based on the recommendation of

5th Joint Conference of Central Council of Health and Family

Welfare in October 1978 was thrown open to various

individuals, groups, institutions and health related sectors for

wider discussions and comments with a view to build inter-

linkages between various Ministries and provide rationality,

consis tency in the content and suggest alternates within the

possible resources, to improve the acceptability of the policy.

34

The revised draft was presented to subsequent Joint Council

of Health and Family Welfare to get the views of Health

Ministers of the States and later to National

Development Council to get the views of the State Chief

Ministers and their concurrence.

The final draft was presented to the Cabinet for approval and

adoption.

35

After the Cabinet's approval the document was

presented in the National Parliament for ratification

in December 1982.

36

NATIONAL HEALTH POLICY – 1983

37

The NHP-1983 gave a general exposition of the policies which required recommendation in the circumstances prevailing in the health sector.

NHP-1983, in a spirit of optimistic empathy for the health needs of the people, particularly the poor and underprivileged, had hoped to provide ‘Health for All by the year 2000 AD’, through the universal provision of comprehensive primary health care services.

NHP-1983

Babu V.V.R.S. Review in Community Medicine. Ch-14 Public Health Administration and National Programmes. 2 nd ed. Hyderabad: Paras Medical Books. 1996

38The noteworthy initiatives under that policy were:-A phased, time-based bound program for setting up a

well dispersed network of comprehensive primary health care services, linked with extension and health education, designed in the context of the ground reality that elementary health problems can be resolved by the people themselves.

NHP-1983


39

Government initiatives in the public health sector have recorded some noteworthy successes over time. Smallpox and Guinea Worm Disease have been eradicated

from the country; Polio is on the verge of being eradicated; Leprosy, Kala Azar, and Filariasis can be expected to be

eliminated in the future.

NHP-1983


40

There has been a substantial drop in the Total Fertility Rate and Infant Mortality Rate.

The success of the initiatives taken in the public health field are reflected in the progressive improvement of many demographic / epidemiological / infrastructural indicators over time.


41

In retrospect, it is observed that the financial resources and public health administrative capacity which it was possible to marshal, was far short of that necessary to achieve such an ambitious and holistic goal.

NHP-1983


42

COMMENTS It does not speak about social injustice- an essential

prerequisite for Health for All.No definite program – to promote community

participation in health.No mention - health budgetDoes not emphasis on –

accident prevention, geriatric care Non- communicable disease like obesity, coronary heart

disease Disease related to use of tobacco, alcohol, drugs, etc.

NHP-1983

Babu V.V.R.S. Review in Community Medicine. Ch-14 Public Health Administration and National Programmes. 2 nd ed. Hyderabad: Paras Medical Books. 1996

43

ACHIEVEMENTS THROUGH THE YEAR 1951-2000

INDICATOR 1951 1981 2000

Life Expectancy 36.7 54 64.6

CBR 40.8 33.9 26.1

CDR 25 12.5 8.9

IMR 146 110 70

44

NATIONAL HEALTH POLICY – 2002

45

INTRODUTION

GOALS

REVIEW OF THE HEALTH SITUATION

OBJECTIVES OF THE POLICY

POLICY PRESCRIPTION

COMMENTS

46

NHP-1983 served the purpose for some time but over the years the health scene of the country changed.

New challenges could not be addressed within the framework of that policy- it necessitated a revision.

The government of India initiated the process by holding

wide ranging deliberations involving central and state governments, voluntary organizations and the central council of health and family welfare.

NHP-2002

Dhaar GM. Robbani I. Foundations of Community Medicine. Ch 55- HEALTH CARE IN THE INDIAN CONTEXT. 1 st ed. Elsevier; 2006.

INTRODUCTION – NHP 2002

47INTRODUCTION – NHP 2002A draft of national health policy was formulated and

circulated for eliciting comments from responsible sources.

A final shape was given to the policy and was eventually approved by the cabinet and launched as NATIONAL HEALTH POLICY – 2001.

NHP-2002


48

The policy aims to achieve an acceptable standard of good health among the general population of the country and has set goals to be achieved by the year 2015.

However, from a global perspective India’s public spending on health is extremely low.

NHP-2002


INTRODUCTION – NHP 2002

49Goals to be achieved by 2000-2015Eradicate 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 by 50% on account of TB, Malaria and Other Vector and Water Borne diseases

2010

Reduce Prevalence of Blindness to 0.5% 2010

Reduce Infant Mortality Rate (IMR) to 30/1000 and Maternal Mortality Ratio (MMR) to 100/Lakh

2010

NHP-2002


50

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

2010

Establish an integrated system of surveillance, National Health Accounts and Health Statistics.

2005

Increase health expenditure by Government as a % of GDP from the existing 0.9 % to 2.0%

2010

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

2010

Increase State Sector Health spending from 5.5% to 7% of the budget

2005

Further increase to 8%2010

Goals to be achieved by 2000-2015

NHP-2002


51

NHP, 2002 is composed

of 3 components

•Review of the health situation•Objectives of the policy•Policy prescription

NHP-2002


52REVIEW OF THE HEALTH SITUATIONCHANGING HEALTH SCENE: NHP, 2002 acknowledges the progress achieved in the

health field of the country since independence as borne out by demo-graphic, epidemiological and infrastructural indicators.

At the same time the policy appreciates the

contribution made by health sectors like rural development, agriculture, sanitation, drinking water supply and education towards achieving progress in the health field.

NHP-2002


53DISPARITY IN HEALTH CARE:

NHP, 2002 admits that although the main objective of planning was to achieve an equitable development, yet significant disparity exists in the health status of populations.

The disparity is reflected in morbidity and mortality indicators between better performing and poor performing states, and also between rural and urban populations.

This disparity is also visible among various socio-economic groups in relation to important child health indicators.

NHP-2002


54

Access to, and benefits from, the public health system have been very uneven between the better-endowed and the more vulnerable sections of society.

This is particularly true for women, children and the socially disadvantaged sections of society.

NHP-2002


55RELEVANCE OF NATIONAL HEALTH POLICY: NHP, 1983 is perceived as an idealistic document mainly

addressed to achieve health for all by the year 2000

NHP, 2002 is realistic document based on a conceptional and operational framework that is consistent with the socio-economic realties prevailing in India.

NHP-2002


56OBJECTIVES OF THE POLICYTo achieve

decentralization of health services.

To strengthen and upgrade the

health care infrastructure.

To emphasize primary level of

health care.

To promote rational use of

drugs.

To ensure equitable access

to health services.

To increase primary health

investment.

To enhance private sector participation.

It also specifies a time frame for the achievement of various goals

NHP-2002

57

POLICY PRESCRICPTION

NHP-2002

581.FINANCIAL RESOURCES

2.EQUITY

3.DELIVERY OF NATIONAL PUBLIC HEALTH PROGRAMMES

4. THE STATE OF PUBLIC HEALTH INFRASTRUCTURE

5. EXTENDING PUBLIC HEALTH SERVICES

6. ROLE OF LOCAL SELF-GOVERNMENT INSTITUTIONS

7. NORMS FOR HEALTH CARE PERSONNEL

8. EDUCATION OF HEALTH CARE PROFESSIONALS

9. NEED FOR SPECIALISTS IN ‘PUBLIC HEALTH’ AND ‘FAMILY MEDICINE’

10. NURSING PERSONNEL

11. USE OF GENERIC DRUGS AND VACCINES

12. URBAN HEALTH

13. MENTAL HEALTH

5914. INFORMATION, EDUCATION AND COMMUNICATION

15. HEALTH RESEARCH

16. ROLE OF THE PRIVATE SECTOR

17. THE ROLE OF CIVIL SOCIETY

18. NATIONAL DISEASE SURVEILLANCE NETWORK

19. HEALTH STATISTICS

20. WOMEN’S HEALTH

21.MEDICAL ETHICS

22. ENFORCEMENT OF QUALITY STANDARDS FOR FOOD AND DRUGS

23. REGULATION OF STANDARDS IN PARAMEDICAL DISCIPLINES

24. ENVIRONMENTAL AND OCCUPATIONAL HEALTH

25. PROVIDING MEDICAL FACILITIES TO USERS FROM OVERSEAS

26. IMPACT OF GLOBALISATION ON THE HEALTH SECTOR

601.FINANCIAL RESOURCES

The Central Government will play a key role in augmenting public health investments.

Taking into account the gap in health care facilities, it is planned, under the policy to increase health sector expenditure to 6 percent of GDP, with 2 percent of GDP being contributed as public health investment, by the year 2010.

NHP-2002


61The State Governments would also need to increase the commitment to the health sector.

In the first phase, by 2005, to increase the commitment of their resources to 7 percent of the Budget.

In the second phase, by 2010, to increase to 8 percent of the Budget.

NHP-2002


622.EQUITYTo meet the objective of reducing various types of

inequities and imbalances – inter-regional, across the rural – urban divide and between economic classes – the most cost-effective method would be to increase the sectoral outlay in the primary health sector.

NHP-2002


63NHP-2002 sets out an increased allocation total public health investment for

the primary health sector - 55 %the secondary sector - 35 %the tertiary health sectors – 10 %

The Policy projects that the increased aggregate outlays for the primary health sector will be utilized for strengthening existing facilities and opening additional public health service outlets, consistent with the norms for such facilities.

NHP-2002


643.DELIVERY OF NATIONAL PUBLIC HEALTH PROGRAMMESThis policy is a key role for the Central Government in

designing national programmes with the active participation of the State Governments.

Also, the Policy ensures the provisioning of financial

resources, in addition to technical support, monitoring and evaluation at the national level by the Centre.


65However, to optimize the utilization of the public health infrastructure at the primary level, NHP-2002 envisages the gradual convergence of all health programmes under a single field administration.

Vertical programmes for control of major diseases like TB, Malaria, HIV/AIDS, and Universal Immunization Programmes, would need to be continued till moderate levels of prevalence are reached.

NHP-2002


66The integration of the programmes will bring about a desirable optimization of outcomes through a convergence of all public health inputs.

Also, the presence of State Government officials, social activists, private health professionals and MLAs/MPs on the management boards of the autonomous bodies will facilitate well-informed decision-making.

NHP-2002


674. THE STATE OF PUBLIC HEALTH INFRASTRUCTURE

Decentralized Public health service outlets have become practically dysfunctional over large parts of the country.

On account of resource constraints, the supply of drugs by the State Governments is grossly inadequate.

The patients at the decentralized level have little use for diagnostic services, which in any case would still require them to purchase therapeutic drugs privately.


68 In some States like the four Southern States – Kerala, Andhra Pradesh, Tamil Nadu and Karnataka some quantum of drugs is distributed through the primary health system network, and the patients can approach the Public Health facilities.

The Policy envisages restarting of the Primary Health System by providing some essential drugs under Central Government funding through the decentralized health system.

NHP-2002


69 It is expected that the provisioning of essential drugs at the public health service centres will create a demand for other professional services from the local population.

NHP-2002


70Policy recognizes - frequent in-service training of public health medical personnel, at the level of medical officers as well as paramedics.

Such training would help to update the personnel on recent advancements in science.

NHP-2002


71

5. EXTENDING PUBLIC HEALTH SERVICES

The policy envisages the need for expanding the pool of medical practitioners to include practitioners of Indian Systems of Medicine and Homoeopathy.

Simple services/procedures can be provided by such practitioners even outside their disciplines, as part of the basic primary health services in under-served areas.


72Also, NHP-2002 envisages that the scope of the use of paramedical manpower of allopathic disciplines, in a prescribed functional area adjunct to their current functions, would also be examined for meeting simple public health requirements.

These extended areas of functioning of different categories of medical manpower can be permitted, after adequate training, and subject to the monitoring of their performance through professional councils.

NHP-2002


73NHP-2002 also recognizes the need for States to simplify the recruitment procedures and rules for contract employment in order to provide trained medical manpower in under-served areas.

NHP-2002


74

State Governments could also rigorously enforce a mandatory two-year rural posting before the awarding of the graduate degree.

This would not only make trained medical manpower available in the underserved areas, but would offer valuable clinical experience to the graduating doctors.

NHP-2002


75

6. ROLE OF LOCAL SELF-GOVERNMENT INSTITUTIONSNHP-2002 lays great emphasis upon the implementation of

public health programmes through local self-government institutions.

The structure of the national disease control programmes will have specific components for implementation through such entities.

NHP-2002


76The Policy urges all State Governments to consider decentralizing the implementation of the programmes to local self- goveernment Institutions by 2005.

To achieve this, financial incentives will be provided by the Central Government.

NHP-2002


77

7. NORMS FOR HEALTH CARE PERSONNELMinimal norms for the deployment of doctors and nurses in

medical institutions need to be introduced urgently under the provisions of the Indian Medical Council Act and Indian Nursing Council Act.

These norms can be progressively reviewed and made more stringent as the medical institutions improve their capacity for meeting better normative standards.

NHP-2002


788. EDUCATION OF HEALTH CARE PROFESSIONALS

To eliminate the problems being faced on the uneven spread of medical and dental colleges in various parts of the country, this policy envisages the setting up of a Medical Grants Commission for funding new Government Medical and Dental Colleges in different parts of the country.

NHP-2002


79

The Medical Grants Commission will fund the upgradation of the infrastructure of the existing Government Medical and Dental Colleges of the country, so as to ensure an improved standard of medical education.

To enable fresh graduates to contribute effectively to the providing of primary health services as the physician of first contact, this policy identifies a significant need to modify the existing curriculum


80A need-based, skill oriented syllabus, with a more significant component of practical training, for fresh doctors immediately after graduation.

The Policy also recommends a periodic skill-updating of working health professionals through a system of continuing medical education.

NHP-2002


81The Policy emphasises the need to expose medical students, through the undergraduate syllabus, to the emerging concerns for geriatric disorders, as also to the cutting edge disciplines of contemporary medical research.

The policy also envisages that the creation of additional seats for postgraduate courses should reflect the need for more manpower in the deficient specialities.

NHP-2002


82

9. NEED FOR SPECIALISTS IN ‘PUBLIC HEALTH’ AND ‘FAMILY MEDICINE’

To alleviate the acute shortage of medical personnel with

specialization in the disciplines of ‘public health’ and ‘family medicine’.

implementation of mandatory norms to raise the proportion of postgraduate seats in these discipline in medical training institutions, to reach a stage wherein ¼ th of the seats are for these

disciplines.


83Specialization in Public health may be encouraged not only for medical doctors, but also for non-medical graduates from the allied fields of public health engineering, microbiology and other natural sciences.

NHP-2002


84 Improving the skill -level of nurses, and on increasing the ratio of degree- holding nurses vis-à-vis diploma-holding nurses.

Establishing training courses for super-speciality nurses required for tertiary care institutions.

NHP-2002


8510. NURSING PERSONNEL

In the interest of patient care, the policy emphasizes the need for an improvement in the ratio of nurses, doctors/beds.

The public health delivery centers need to have a increased number of nursing personnel.

NHP-2002


86

11. USE OF GENERIC DRUGS AND VACCINES

There is a need for basic treatment regimens, on a limited number of essential drugs.

Cost-effective.

Prohibit the use of proprietary drugs, except in special circumstances.


87

Not less than 50% of the requirement of vaccines/sera be sourced from public sector institutions.

NHP-2002


8812. URBAN HEALTHSetting - organized urban primary health care structure.

Adoption - population norms for its infrastructure.

NHP-2002


89The structure is two-tiered : The first-tier, covering a population of

one lakhproviding OPD facilitywith a dispensary and essential drugs, to enable access to all the national

health programs

The second-tier - at the level of the Government general hospital, reference from primary center.

NHP-2002


90Funding will be by the local, State and Central Governments.

Establishment of fully-equipped ‘hubspoke’ trauma care networks in large urban agglomerations to reduce accident mortality.

NHP-2002


9113. MENTAL HEALTH

A network of decentralised mental health services for more common disorders.

Diagnosis of common disorders, and the prescription of common drugs, by general duty medical staff.

NHP-2002


92

Upgrading of the physical infrastructure of mental health institutions at Central Government expense.


93

14. INFORMATION, EDUCATION AND COMMUNICATION (IEC) Information to those population groups which cannot be

effectively approached by using only the mass media.

The focus on the inter-personal communication of information and on folk and other traditional media to bring about behavioural change.

NHP-2002


94

The community leaders- particularly religious leaders, are effective in imparting knowledge for behavioural change.

NHP-2002


95Annual evaluation of the performance of the non-Governmental agencies to monitor the impact of the programmes on the targeted groups.

School health programs are the most cost-effective intervention - improves the level of awareness of future generation.

NHP-2002


9615. HEALTH RESEARCH Increase in Government-funded health research

to a level of 1% of the total health spending by 2005 and up to 2 % by 2010.

Domestic medical research would be focused on new therapeutic drugs and vaccines for TB and Malaria, also on the sub-types of HIV/AIDS prevalent in the country.

NHP-2002


97

Emphasis on time-bound applied research for developing operational applications.

This would ensure the cost-effective of existing / future therapeutic drugs/vaccines for the general population.

NHP-2002


9816. ROLE OF THE PRIVATE SECTOR

This Policy welcomes the participation of the private sector in all areas of health activities.

A legislation for regulating minimum infrastructure and quality standards in clinical establishment of medical institutions by 2003.


Guidelines for clinical practice and delivery of medical services are to be developed.

Setting up of private insurance instruments for increasing the scope of the coverage of the secondary and tertiary sector under private health insurance packages.

NHP-2002

99


100Non-governmental practitioners- in national disease control programmes

Applications of tele-medicine in the health care sector.

NHP-2002


101

10217. THE ROLE OF CIVIL SOCIETYContribution of NGOs and other institutions of the civil

society in making available health services to the community.

The disease control programmes should have a definite portion of budget.


103

18. NATIONAL DISEASE SURVEILLANCE NETWORK Integrated disease control network from the lowest

public health administration to the Central Government, by 2005.

installation of data-base handling hardware

In-house training for data collection.


10419. HEALTH STATISTICS

Periodic updating of these baseline estimates through representative sampling, under an appropriate statistical methodology.

NHP-2002


105

Access to data on the incidence of various diseases, with the objective of evidence-based policy-making.

The need to establish national health accounts, conforming to the `source-to-users’ matrix structure.

NHP-2002


106

National health accounts and accounting systems would pave the way for decision-makers to focus on relative priorities.

NHP-2002


10720. WOMEN’S HEALTH

Women - under-privileged groups with low access to health care.

The expansion of primary health sector infrastructure- to facilitate the increased access of women to basic health care.

NHP-2002


108Highest priority of the Central Government to the funding - programmes relating to woman’s health.

The need to review the staffing norms of the public health administration to meet the specific requirements of women in a more comprehensive manner.

NHP-2002


10921.MEDICAL ETHICS

A contemporary code of ethics be notified and rigorously implemented by the Medical Council of India.

Medical research within the country in the different disciplines, such as gene- manipulation and stem cell research.

NHP-2002


110

22. ENFORCEMENT OF QUALITY STANDARDS FOR FOOD AND DRUGS

Food and drug administration will be progressively strengthened, in terms of both laboratory facilities and technical expertise.


111

Domestic food handling / manufacturing facilities to undertake the necessary upgradation of technology

Ultimately food standards will be close, if not equivalent, to Codex specifications; and that drug standards will be at par with the most rigorous ones adopted elsewhere.


112

23. REGULATION OF STANDARDS IN PARAMEDICAL DISCIPLINES

Need for the establishment of professional councils for paramedical disciplines to register practitioners, maintain standards of training, and monitor performance.


113

24. ENVIRONMENTAL AND OCCUPATIONAL HEALTH

The periodic screening of the health conditions of the workers, particularly for high- risk health disorders associated with their occupation.

NHP-2002


114

25. PROVIDING MEDICAL FACILITIES TO USERS FROM OVERSEASHealth services on a payment basis to service seekers from

overseas.

The services to patients from overseas will be encouraged by extending to their earnings in foreign exchange.


11526. IMPACT OF GLOBALISATION ON THE HEALTH SECTOR

The Policy takes into account the serious apprehension, expressed by several health experts, as a result of a sharp increase in the prices of drugs and vaccines.


116COMMENTSNot much attention is paid to child, adolescent, Geriatrics

health, gender, domestic violence.

Ignored areas- Resource generation & allocation, management of work force, substance abuse management.

Kumar A, Gupta S. Health Infrastructure in India: Critical Analysis of Policy Gaps in the Indian Healthcare Delivery. Vivekananda International Foundation . 2012

117Methodology of strengthening healthcare & functioning of health workers is not specified, creating “Paramedical Doctors”. Promoting QUACKERY.

Literacy & its investment is not specified.

Problem of population is not answered properly.

School education has not yielded desired results.

Kumar A, Gupta S. Health Infrastructure in India: Critical Analysis of Policy Gaps in the Indian Healthcare Delivery. Vivekananda International Foundation . 2012

Achievements2003 –

• Enactment of legislation for regulating minimum standard in clinical Establishment / Medical institution

2005-

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

• Leprosy has been declared eliminated according to the criteria fixed by WHO. However, more efforts are required.

• 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 a slow pace.

118

119• Spending of state Sector Health has not much

increased as planned from 5.5% to7.7% of budget.

• Budget for medical research is not much increased as

1% of the total health budget for Medical Research has

been targeted.

• Decentralization of implementation of public health

Programs: National Rural Health Mission has been

launched in this direction.

2007-

• Achieve of REDUCTION of HIV/AIDS

120

National Health Policy - 2015 Draft

121NEED FOR NATIONAL HEALTH POLICY 2015

SITUATIONAL ANALYSIS

GOALS,PRINCIPLES & OBJECTIVES

POLICY DIRECTIONS

REGULATORY FRAMEWORK

GOVERNANCE

IMPLEMENTATION AND WAY FORWARD

Need for National HealthPolicy 2015

Gaps in health outcomes continue to widen despite advances in

medical care technology as well as economy in India.

There is an urgent need to improve the performance of health

systems; in achieving Millennium Development Goals, and

Universal Health Coverage.

The context of Health has changed over the years and this needs

a suitably revised Health policy responsive to these changes.

122

123

Change in the Health context:

Health Priorities are changing.

Emergence of a robust health care industry.

Incidence of catastrophic expenditure due to health care

costs is growing.

Economic growth has increased the fiscal capacity available.

124

Situation AnalysisIndicator Target Baseline 2012 2015

MMR 140/1000 560 178 141

Under 5 mortality

42/1000 live births

126 52 42

TFR 2.1 2.9 2.4

IMR 30/1000 Live Births

114 47.5 40

125 Over 90% of pregnant women receive one antenatal checkup

87% of pregnant women received full TT immunization

Only 31% of pregnant women had consumed more than 100 IFA tablets

Only 61% of children (12 – 23 months) have been fully immunized

In AIDS control, decline from a 0.41 % prevalence rate in 2001 to

0.27% in 2011

In tuberculosis, prevalence of 211 cases and 19 deaths per lakh

population

Overall, communicable diseases contribute to 24. 4% of the entire

disease burden while maternal and neonatal ailments contribute to

13.8%.

Non-communicable diseases (39.1%) and injuries (11.8%) now

constitute the bulk of the country's disease burden.

126

The private sector today provides nearly 80% of outpatient care and

about 60% of inpatient care.

Tax exemptions for 5 years for rural hospitals; custom duty exemptions

for imported equipment that are lifesaving; Income Tax exemption for

health insurance; and active engagement through publicly financed

health insurance which now covers almost 27% of the population.

The number of medical colleges added and the increase in seats for

both undergraduate and postgraduate education has also been high.

In 2014, the total number of medical colleges in India were 381.

127

The Government spending on healthcare in India is only 1.04% of GDP which is about 4 % of total Government expenditure, less than 30% of total health spending.

128

Goal, Principles and Objectives

Goal:

The attainment of the highest possible level of good health

and wellbeing, through a preventive and promotive health

care orientation in all developmental policies, and universal

access to good quality health care services without anyone

having to face financial hardship as a consequence.

129

Policy Principles:

– Equity

– Universality

– Patient Centered & Quality of Care

– Inclusive Partnerships

– Pluralism

– Subsidiarity

– Accountability

– Professionalism, Integrity and Ethics

– Learning and Adaptive System

– Affordability

130

Objectives:

– Improve population health status

– Achieve a significant reduction in out of pocket expenditure

– Assure universal availability of free, comprehensive primary health

care services

– Enable universal access to free essential drugs, diagnostics,

emergency ambulance services, and emergency medical and surgical

care services in public health facilities

– Ensure improved access and affordability of secondary and tertiary

care services through a combination of public hospitals and strategic

purchasing of services from the private health sector

– Influence the growth of the private health care industry and medical

technologies

131

Policy Directions Ensuring Adequate Investment

Preventive and Promotive Health

Organization of Public Health Care Delivery

Primary Care Services & Continuity of Care

Secondary Care Services

Reorienting Public Hospitals

Closing Gaps in Infrastructure and Human Resource/Skill

Urban Health Care

National Health Programs: RCH, Communicable Diseases, Non-

Communicable Diseases, Mental Health, Emergency Care and

Disaster preparedness

132

Swachh Bharat Abhiyan

Balanced and Healthy diets(through Anganwadi centres and

schools)

Nasha Mukti Abhiyan

Yatri Suraksha

Nirbhaya Nari

133

Reduced stress and improved safety in the workplace

Reduction of indoor and outdoor air pollution

Swasth Nagrik Abhiyan(social movement for health)

Greater emphasis on school health and SCHOOL NOON

MEAL PROGRAMME

More support to ASHA workers(in palliative care, Community

Mental Health, and in Village Health Sanitation and Nutrition

Committees)

Yoga promotion at work place, schools and in the community

134

Governance Federal structure: Role of State and Role of Centre

Role of Panchayat Raj Institutions

Rogi Kalyan Samitis (RKS)

Village Health Sanitation and Nutrition Committee(VHSNC)

Addressing fiduciary risks and improving accountability

Professionalizing Management and Incentivizing

performance

135

Legal framework- Laws under review

– Mental Health Bill

– Medical Termination of Pregnancy Act

– Bill regulating surrogate pregnancy and assisted reproductive

technologies

– Food Safety Act

– Drugs and Cosmetics Act

– Clinical Establishments Act

136

- National Health Rights Act has been proposed

– Ensure health as a fundamental right, whose denial will be justiciable*

_______________

*(of a state or action) subject to trial in a court of law.

137

Implementation and Way forward

Past policies have faced innumerable constraints in

implementation.

Implementation framework would specify approved financial

allocations and linked to this measurable numerical output

targets and time schedules.

138

SWOT analysis

Strengths:

Increasing Public Health Expenditure to 2.5% of the GDP(Rs.

3800 per capita)

Introduction of ambitious schemes like Swacch Bharat

Abhiyan, Nirbhaya Nari

Promotion of Indian systems of Medicine(AYUSH)

139

Weaknesses:

Pushing the secondary and tertiary healthcare into private

sector

No mention of how private sector will be regulated.

140

Opportunities:

International support and remote chances of war in near

future

Improving economy and increasing Foreign investments

Health tourism is gaining momentum.

Eradication of Polio has paved way and given a framework to

follow for other vaccine preventable diseases.

141

Threats:

Lack of private sector regulation can hamper public sector

healthcare

Health tourism may drain resources and peripheral most

deserving population may be starved of resources

Resurgence of epidemics may create panic and also divert

resources

142

NATIONAL ORAL HEALTH POLICY

143

NATIONAL ORAL HEALTH POLICY

The National Oral Health Policy has been formulated by the “Dental Council of India” through the inputs of two national workshops organized in 1991 and 1994 at Delhi and Mysore.

Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya(Medi) Publishing House; 2013

144

NEED FOR A NATIONAL ORAL HEALTH POLICY

1451.INCRESING PREVALENCE AND SEVERITY OF DENTAL DISEASESDental caries has been increasing both in prevalence

and severity over the last three decades.

In 1940-1950, prevalence reported has been 40-50% with an average DMFT of 1.5

http://www.mohp.gov.np/english/files/new_publications/9-2-National-Oral-Health-Policy.pdf. Last acessed 11/06/2014.

146 In 1980-1990, prevalence reported has been increased to80% with an average DMFT of 5 in urban and 4 in rural areas.

Periodontal disease prevalence has been in the range of 90-100% in various age groups.

The above facts have been stressed by a number of national level workshops.


1472.DENTIST POPULATION RATIO

There were only 35,000 dentists serving the entire population of 90 crores in 1990’s.

90% of them were in cities, only 10% in rural areas with a population of over 75%.


148

3.CRIPPLING NATURE OF ORAL DISEASE

85% of children and 95- 100% of adults were suffering from periodontal disease - people accept it as the disease of old age.

80-85% of children were suffering from dental caries.

The pus oozing pocket of periodontal disease of adults act as a focus of infection for other vital organs of body.


149The dental caries with its crippling effect can lead to more malnutrition as the young adults would not be able to chew any coarse food.

35% of all body cancers are oral cancer, most of them are preventable.

35% of children suffer from malaligned teeth and jaws affecting proper function.


150

4.IMPELLING ECONOMIC REASONS FOR EARLY RECOGNITION AND PREVENTION OF ORAL DIEASES

Dental caries is an expensive disease which causes economic losses both to the individual and to the country.

India spends approximately 1 to 1.5 % of total national budget on health and as there is no specific allocation for oral health.


1515.PREVENTION OF ORAL DISEASES THE ONLY ALTERNATIVE:

The upward trend of dental caries could be effectively checked by the implementation of organized oral health preventive programmes at the community level.

The methods used for primary prevention of dental caries also achieves primary prevention of periodontal disease and oral cancer.


152

THE COUNCIL HAS BROUGHT OUT A TEN POINT RESOLUTION

1531. urgent need for an Oral Health Policy for the nation as an integral part of the National Health Policy.


1542. National Oral Health Program be launched to provide oral health care, both in the rural as well as urban areas due to deteriorating oral health conditions in the country as revealed by various epidemiological studies.

Dentist/ population ratio in the rural areas is only 1:3,00,000, whereas, 80% of the children and 60% of the adults suffer from dental caries.

More than 90% of the adults after the age of 30 years suffer from periodontal disease which also has its inception in childhood.


155 In addition, 35% of all body cancers are oral cancers.

35% of the children suffer from maligned teeth and

jaws affecting proper functioning.

It is important to launch preventive, curative and educational oral health care program integrated into the existing system utilizing the existing health and educational infrastructure in the rural, urban and deprived areas.


1563.A post of full dental advisor at appropriate level in the Directorate General of Health Services (Dte.G.H.S) should be created.


1574.Urgent need to prevent the rising trend of dental disease in India.

Achieving primary prevention of periodontal diseases and oral cancers.


1585. Preventive and promotive oral health services be introduced from the village level.

Pilot project on oral health care may be launched by the Ministry of Health and Family Welfare


1596.warning on the wrappers and advertisement of sweets, chocolates and other retentive sugar eatables TOO MUCH EATING SWEETS MAY LEAD TO DECAY OF TOOTH.

Similar measures are called for tobacco and pan masala related products.


1607.National Training Centre to be established or the existing centers be strengthened for training of various categories of oral health care personnel.


1618. All district hospitals and Community Health Centers should have dental clinics.

All Dental Colleges should have courses on Dental Hygienists and Dental Technicians.


1629.The Council further resolves that the Pilot Project may be extended to all States at the rate of one District in every state.


16310.The Council also resolves that there is an urgent need to have a National Institute for Dental Research to guide oral health research appropriate to the needs of the country.


164

KARNATAKA STATE HEALTH POLICY- 2004

165Karnataka Health Policy goals To provide integrated and comprehensive primary health care

To establish a credible and sustainable referral system

To establish equity in delivery of quality health care

To encourage greater public private partnership in provision of quality health care in order to better serve the underserved areas.

To address emerging issues in public health

To strengthen health infrastructure

To develop health human resources

To improve the access to safe and quality drugs at affordable prices

To increase access to systems of alternative medicine.

http://cphe.files.wordpress.com/2009/10/karnataka-state-integrated-health-policy-2001.pdf.last acessed on 11/7/014

166

Dental Health / Oral Health

The awareness about dental health care is poor especially in rural areas.

The increased life expectancy of the population and widespread prevalence of oral diseases warrants a serious thought for immediate strengthening of the existing oral health delivery system in the state.


167

The establishment of a three tier Oral Health Care delivery system in Karnataka would be planned, namely:

Primary Oral Health Care

•(a) Health Education for promotion of oral health and •(b) Preventive Procedures for Oral Health care by qualified dental surgeons at Community Health Centers and Taluk level Hospitals.

Secondary Oral Health care

•both Preventive and Curative treatments at hospitals.

Tertiary Oral Health Care

•specialty treatment, will be made available at each District level hospital.


168

Other strategies include: • Proper utilization of mass media

for regular Oral Health Education

• Involvement of local non-governmental agencies in programme operation for better implementation of the programme

• Programme for increasing awareness amongst School teachers regarding Oral Health.


169

OTHER NATIONAL HEALTH POLICIES

170

NATIONAL

NUTRITIONAL

POLICY

NATIONAL POLICY

FOR EDUCATI

ON

NATIONAL POLICY

FOR CHILDRE

N

NATIONAL DRUG POLICY

NATIONAL

ALCOHOL

POLICY

171

CONCLUSION

172CONCLUSIONPublic health has effectively remained a low priority for

the Indian state in terms of financing and political attention.

173Contributed to the slow and inadequate improvement in health of the population.

174

Replacing the current unhealthy and inequitable socio-economic system, by one that is far more just, humane and healthy, in the world of tomorrow is essential.

175

REFERNCES

176

REFERNCES

1.Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya(Medi) Publishing House; 2013.

2.Scheutz AM. India’s Healthcare System – Overview and Quality Improvements. Direct response. 2013:04.

3.Chandra S, Chandra S. Textbook of Community Dentistry. Ch-9 Oral Health Policy of Government of India. 1st ed. New Delhi: Jaypee Brothers Medical Publishers; 2000.

177

4.Dhaar GM. Robbani I. Foundations of Community Medicine. Chapter 55- HEALTH CARE IN THE INDIAN CONTEXT. 1st ed. Elsevier; 2006.

5.Gangolli LV, Duggal R, Shukla A. Review of Healthcare In India. SECTION 2- PUBLIC HEALTH POLICIES AND PROGRAMMES. Mumbai: Centre for Enquiry into Health and Allied Themes; 2005.

6.SATHE P.V., SATHE A.P., Epidemiology and Management for Health Care for All. Ch-2 Health for All by 2000 A.D. 2nd ed. Mumbai: Popular Prakshan PVT Limited; 1997.

REFERNCES

178

REFERNCES

7.Banerjee SR. Community and Social Pediatrics. Ch-6 Cild Health Care- The challenges for the Next Decade. Ist ed. New Delhi: Jaypee Brothers Medical Publishers; 1995.

8.Suryakantha AH. Community Medicine with Recent Advances. Ch- 39 National Health Policy. 3rd ed. New Delhi: Jaypee Brothers Medical Publishers; 2014.

9.Babu V.V.R.S. Review in Community Medicine. Ch-14 Public Health Administration and National Programmes. 2nd

ed. Hyderabad: Paras Medical Books. 1996

179

REFERNCES10.Kulkarni A.P, Baride J.P, Doke P.P, Mulay P.Y. Text book

of Community Medicine. Ch-15 Health Care in India- Part A. 4th ed. Mumbai: Vora Medical Publications; 2013.

11.Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013.

12.Kumar A, Gupta S. Health Infrastructure in India: Critical Analysis of Policy Gaps in the Indian Healthcare Delivery. Vivekananda International Foundation; 2012.

180

13.http://www.mohp.gov.np/english/files/new_publications/9-2-National-Oral-Health-Policy.pdf.Last acessed 11/06/2014.

14.http://cphe.files.wordpress.com/2009/10/karnataka-state-integrated-health-policy-2001.pdf.last acessed on 11/7/014 .

REFERNCES

181

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