National Health Policy

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National Health Policy

• Dr Prasanna Kumar K
• Asst Prof HOD
• Dept of Community Medicine
• FMHMCH, Deralakatte, Mangalore.

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

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• The ministry of health and family welfare evolved
  a NHP in 1983 keeping in view the national
  commitment to attain the goal of health for all
  by the year 2000.

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

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

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The Joint WHO UNICEF international conference
in 1978 at Alma-Ata (USSR)
Alma-Ata Declaration called on all the
governments to formulate national health policies
according to their own circumstances to launch
and sustain primary health care as a part of
national health system.
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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
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• 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

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The Alma-Ata conferencedefined that
Primary health care is essential health care
made universally accessible to individuals and
acceptable to them, through their full
participation and at the cost the community and
country can afford.
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Principles of primary health care

• Equitable distribution
• Community participation.
• Inter-sectoral coordination
• Appropriate technology

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1. Equitable distribution

• Some thing for all and most for those who need
  the most
• Bahujan hitae bahujan sukhae

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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.

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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".

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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"

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Elements of primary health care

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

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Elements of primary health care..

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

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National Health Policy -1983

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

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National Health Policy 1983

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

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National Health Policy 1983

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

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NHP 1983- Goal suggested/achieved
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NHP 1983- Goal suggested/achieved
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NHP 1983- Goal suggested/achieved
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Differentials in health status among rural/urban
India
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Differentials in health status among states
Sector BPL() IMR
UFMR MMR
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Differentials in health status among
socio-economic groups
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Achievements Through The Years 1951-2000
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Achievements Through The Years 1951-2000
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Achievements Through The Years - 1951-2000
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Millennium Development Goals

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

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Millennium Development Goals

• 8 goals
• 18 targets
• 48 indicators

• Related to health
• 3 goals
• 8 targets
• 18 indicators

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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.

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NHP 2002, Objectives..

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

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Goals NHP 2002

• 1. Eradication of Polio Yaws 2005
  
  
  
  
• 2. Elimination of Leprosy
  2005
• 3. Elimination of Kala-azar 2010
• 4. Elimination of lymphatic Filariasis 2015
• 5. Achieve of Zero level growth 2007
• of HIV/AIDS

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Goals NHP 2002

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

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Goals NHP 2002

• 8. Reduction of IMR to 30/1000 2010
• MMR to 100/lakh
• 9. Increase utilisation of public
  2010
• health facilities from current
• level of lt20 to gt 75
• 10. Establishment of an integrated 2007
• system of surveillance,
• National Health Accounts and
• Health Statistics

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Goals NHP 2002

• 11.Increase health expenditure 2010
• by government as a of
• GDP from the existing
• 0.9 to 2.0
• 12. Increase share of Central 2010
• grants to constitute at least
• 25 of total health spending

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Goals NHP 2002

• 13. Increase State Sector 2005
• Health spending from
  
• 5.5 to 7 of the budget
• 14. Further increase of 2010
• State sector
• Health spending
• from 7 to 8

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NHP-2002Policy prescriptions
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Differentials in health status among rural/urban
India
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Equity..

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

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Delivery of national public health programmes

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

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Delivery of national public health programmes.

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

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Public health spending in select countries
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Delivery of national public health programmes.

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

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Extending public health services

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

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Suggested norms for health personnel
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Education of health care professionals

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

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Education of health care professionals..

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

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

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

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Nursing personnel

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

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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

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Urban health

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

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Urban health

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

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Mental health

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

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Information Education and Communication

• NHP 2002 has suggested interpersonal
  communication by folk and traditional media to
  bring about behavioural change.

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Information Education and Communication.

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

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Health research

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

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Role of private sector

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

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Role of private sector..

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

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Health statistics

• NHP 2002 has recommended full baseline estimate
  of tuberculosis, malaria and blindness by 2005,
  and
• In the long run for cardiovascular diseases,
  cancer, diabetes, accidents, hepatitis and G.E.

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Women's health

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

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Medical ethics

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

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Medical ethics.

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

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Enforcement of quality standard for food and
drugs

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

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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.

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Environmental and occupational health

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

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Environmental and occupational health.

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

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NRHM

• NATIONAL RURAL HEALTH MISSION
• ( NRHM)
• 2005-2012.

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Aim

• To provide accessible, affordable, accountable,
  effective and reliable primary health care and
  bridging the gap in rural health care through
  creation of ASHA. ( ACCREDITED SOCIAL HEALTH
  ACTIVIST).

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• GOVT OF INDIA
• NECESSARY ARCHITECTURAL CORRECTION IN THE BASIC
  HELATH CARE DELIVERY SYSTEM.
• LAUNCHED ON APRIL 12 , 2005

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• SPECIAL FOCUS ON 18 STATES.
• Arunachal pradesh, Assam, Bihar, Chattisgarh,
  Himachal pradesh, Jharkand, JK, manipur,
  Mizoram, Meghalay, MP, Nagaland, Orissa,
  Rajasthan, Sikkiim, Tripura, Uttaranchal, UP.

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GOALS

• Reducing IMR and MMR by 50 in next 7 years.
• Universal access to public health services such
  as womens health, child health, water,
  sanitation, hygiene, immunization, nutrition.
• Prevention and control of CD and NCD
• Access to integrated comprehensive primary health
  care.

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• population stabilization,gender and demographic
  balance.
• Revitalize local health traditions and mainstream
  AYUSH.
• Promotion of healthy life styles.

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STRATEGIES.

• A. CORE STRATEGY.
• B. SUPPLEMENTARY STRATEGY.

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CORE STRATEGIES

• Train and enhance capacity of Panchayat Raj
  institutions to own, control and manage public
  health services.
• Promote access to improved health care at
  household level through the female health
  activist.
• Health plan for each village through village
  health committee of the panchayat.

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• 4. Stregthening subcenter through an united fund
  to enable local planning and action and more
  MPWs.
• 5. Stregthening existing PHCs and CHCc.
• 6. Preparation and implementation of an
  intersectoral district health plan prepared by
  the district health mission .

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• 7. Strengthening capacities for data collection,
  assessment and review for evidence based
  planning, monitoring and supervision.
• 8. Developing capacities for preventive health
  care at all levels by promoting healthy life
  styles, rdxn in tobacco consumption, alcohol etc.

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B. Supplementary strategy.

• Regulation of private sector to ensure
  availability of quality service to citizens at
  reasonable cost.
• Mainstreaming AYUSH revitalizing local health
  traditions.
• Reorienting medical education to support rural
  health issues

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COMPONENTS OF NRHM

• ASHA
• Resident of the village, a woman (M/W/D) between
  25-45 years, with formal education upto 8th
  class, having communication skills and leadership
  qualities.
• One ASHA per 1000 population.
• Around one lac ASHAs are already selected.

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ASHA

• Chosen by the panchayat to act as the interface
  between the community and the public health
  system.
• Bridge between the ANM and the village.
• Honorary volunteer, receiving performance based
  compensation .

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Responsibility of ASHA

• To create awareness among the community regarding
  nutrition, basic sanitation, hygienic practices,
  healthy living.
• Counsel women on birth preparedness, imp of safe
  delivery, breast feeding, complementry feeding,
  immunization, contraception, stds.

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• Encourage the community to get involved in health
  related services.
• Escort/ accompany pregnant women, children
  requiring treatment and admisssions to the
  nearest PHCs.
• Primary medical care for minor ailment such as
  diarrhoea, fevers
• Provider of DOTS.

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• ORS, IRON AND FOLIC ACID TABLETS, CHOLORQUINE,
  ORAL PILLS, CONDOMS,
• DRUG KIT ALLOPATHIC AND AYUSH
• UNDERGO GRADED TRAINING.
• INFORMATION ABOUT BIRTHS AND DEATHS.
• PROMOTE CONSTRUCTION OF HOUSEHOLD TOILETS.

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miles to go before..