National health policy

Dr. Priyanka Ravi
III yr MDS
Dept of Public Health Dentistry
1
NATIONAL HEALTH
POLICY

CONTENTS
1. 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
2

INTRODUCTION
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.
3
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.

75% 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.
4

National 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.
5

HISTORY
Health planning in India can be seen as pre and
post independence.
Health planning in India - Pre
independence
Health planning in India - Post
independence
7
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.

Health planning in India – Pre independence
1825- 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
8
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.

The 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
9

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.
10
HISTORY

Health planning in India -Post independence
National health committees
Planning Commission
Five year plans
National Health Policy
11

National health committees
Mudliar
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, 1981
12
1.Consolidation of advances made in first 2
Five years plans
2. Strengthening of district hospital with
specialty services
3.Regional organization in each state
4. 1PHC=40000 population
5.Integration of medical and health services
6. 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 cadre
2.Common seniority
3. Recognition of extra
qualification
4. Equal pay for equal work
5. 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.

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.
13
HISTORY

1950s and 1960s - focus of the health sector was to
manage epidemics.
Mass campaigns - eradicate various diseases.
14
HISTORY

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.
15
HISTORY

HEALTH
Health is a state of complete physical, mental, and social
well-being and not merely the absence of disease or
infirmity.
17
Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya(Medi) Publishing House; 2013.

ORAL 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”.
18
Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya(Medi) Publishing House; 2013.

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.
NATIONAL HEALTH POLICY
 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.
19

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.
20

HEALTH SYSTEM IN
INDIA
AT 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
22
Cabinet minister
Minister of state
Deputy 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
officer
Municipal
Board
Chairman
Institution Of Rural
Local Self
Government

PANCHYATI RAJ
It is a 3-tier structure of rural local self-government
in India.
It links the villages to the districts
23
Panchayat- at the village
level
Panchayat Samiti – at the
block level
Zilla Parishad- at the district
level

HEALTH CARE SYSTEM
PUBLIC 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 AGENCIES
NATIONAL HEALTH PROGRAMMES
24

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.
25

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.
26

As 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.
27

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

There are considerable shortages of hospital beds and
trained medical staff such as doctors and nurses, and as
a result public accessibility is reduced.
29

There 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.
30

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.
32

 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, consistency
in the content and suggest alternates within the possible
resources, to improve the acceptability of the policy.
33

 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.
34

After the Cabinet's approval the document was
presented in the National Parliament for ratification
in December 1982.
35

NATIONAL HEALTH POLICY – 1983
36

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
37
Babu V.V.R.S. Review in Community Medicine. Ch-14 Public Health Administration and National Programmes. 2nd ed. Hyderabad: Paras Medical Books. 1996

The 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
38

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
39

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.
40

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
41

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 budget
Does 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
42
Babu V.V.R.S. Review in Community Medicine. Ch-14 Public Health Administration and National Programmes. 2nd ed. Hyderabad: Paras Medical Books. 1996

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
43

NATIONAL HEALTH POLICY – 2002
44

INTRODUTION
GOALS
REVIEW OF THE HEALTH
SITUATION
OBJECTIVES OF THE POLICY
POLICY PRESCRIPTION
COMMENTS
45

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
46
Dhaar GM. Robbani I. Foundations of Community Medicine. Ch 55- HEALTH CARE IN THE INDIAN CONTEXT. 1st ed. Elsevier; 2006.
INTRODUCTION – NHP 2002

A 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
47

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
48

Goals to be achieved by 2000-2015
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 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
49

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
50

NHP, 2002
is composed
of 3
components
• Review of the
health situation
• Objectives of
the policy
• Policy
prescription
NHP-2002
51

REVIEW OF THE HEALTH SITUATION
CHANGING 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
52

DISPARITY 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
53

 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
54

RELEVANCE 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
55

OBJECTIVES OF THE POLICY
To 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
56

1.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
58

14. 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
59

1.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
60

The 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
61

2.EQUITY
To 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
62

NHP-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
63

3.DELIVERY OF NATIONAL PUBLIC
HEALTH PROGRAMMES
This 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.
64

However, 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
65

The 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
66

4. 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.
67

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
68

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
69

Policy 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
70

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.
71

Also, 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
72

NHP-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
73

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
74

6. ROLE OF LOCAL SELF-
GOVERNMENT INSTITUTIONS
NHP-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
75

The 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
76

7. NORMS FOR HEALTH CARE
PERSONNEL
Minimal 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
77

8. 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
78

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
79

A 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
80

The 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
81

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.
82

Specialization 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
83

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
84

10. 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
85

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.
86

Not less than 50% of the requirement of vaccines/sera
be sourced from public sector institutions.
NHP-2002
87

12. URBAN HEALTH
Setting - organized urban primary health care structure.
Adoption - population norms for its infrastructure.
NHP-2002
88

The structure is two-tiered :
The first-tier, covering a population of
one lakh
providing OPD facility
with 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
89

Funding 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
90

13. 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
91

Upgrading of the physical infrastructure of mental
health institutions at Central Government expense.
92

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
93

The community leaders- particularly religious
leaders, are effective in imparting knowledge for
behavioural change.
NHP-2002
94

Annual 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
95

15. 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
96

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
97

16. 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.
98

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

Non-governmental practitioners- in national disease
control programmes
Applications of tele-medicine in the health care sector.
NHP-2002
100

17. THE ROLE OF CIVIL SOCIETY
Contribution 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.
102

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.
103

19. HEALTH STATISTICS
Periodic updating of these baseline estimates through
representative sampling, under an appropriate statistical
methodology.
NHP-2002
104

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
105

National health accounts and accounting systems would
pave the way for decision-makers to focus on relative
priorities.
NHP-2002
106

20. 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
107

Highest 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
108

21.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
109

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.
110

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.
111

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.
112

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
113

25. PROVIDING MEDICAL FACILITIES
TO USERS FROM OVERSEAS
Health 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.
114

26. 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.
115

COMMENTS
Not much attention is paid to child, adolescent, Geriatrics
health, gender, domestic violence.
Ignored areas-
 Resource generation & allocation,
 management of work force,
 substance abuse management.
116
Kumar A, Gupta S. Health Infrastructure in India: Critical Analysis of Policy Gaps in the Indian Healthcare Delivery. Vivekananda International Foundation . 2012

Methodology 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.
117
Kumar A, Gupta S. Health Infrastructure in India: Critical Analysis of Policy Gaps in the Indian Healthcare Delivery. Vivekananda International Foundation . 2012

Achievements
2003 –
• 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

• 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
119

National Health Policy - 2015
Draft
120

121NEED FOR NATIONAL HEALTH POLICY
2015
SITUATIONAL ANALYSIS
GOALS,PRINCIPLES & OBJECTIVES
POLICY DIRECTIONS
REGULATORY FRAMEWORK
GOVERNANCE
IMPLEMENTATION AND WAY
FORWARD

Need for National Health
Policy 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

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.
123

Situation Analysis
Indicator 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
124

 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.
125

 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.
126

 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.
127

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.
128

 Policy Principles:
– Equity
– Universality
– Patient Centered & Quality of Care
– Inclusive Partnerships
– Pluralism
– Subsidiarity
– Accountability
– Professionalism, Integrity and Ethics
– Learning and Adaptive System
– Affordability
129

 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
130

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
131

 Swachh Bharat Abhiyan
 Balanced and Healthy diets(through Anganwadi centres and
schools)
 Nasha Mukti Abhiyan
 Yatri Suraksha
 Nirbhaya Nari
132

 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
133

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
134

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
135

- 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.
136

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.
137

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)
138

Weaknesses:
 Pushing the secondary and tertiary healthcare into private
sector
 No mention of how private sector will be regulated.
139

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.
140

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
141

NATIONAL ORAL HEALTH
POLICY
142

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.
143
Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya(Medi) Publishing House; 2013

NEED FOR A NATIONAL
ORAL HEALTH POLICY
144

1.INCRESING PREVALENCE AND
SEVERITY OF DENTAL DISEASES
Dental 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
145
http://www.mohp.gov.np/english/files/new_publications/9-2-National-Oral-Health-Policy.pdf. Last acessed 11/06/2014.

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.
146

2.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%.
147

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.
148

The 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.
149

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.
150

5.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.
151

THE COUNCIL HAS BROUGHT
OUT A TEN POINT RESOLUTION
152

1. urgent need for an Oral Health Policy for the nation
as an integral part of the National Health Policy.
153

2. 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.
154

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.
155

3.A post of full dental advisor at appropriate level in
the Directorate General of Health Services
(Dte.G.H.S) should be created.
156

4.Urgent need to prevent the rising trend of dental
disease in India.
Achieving primary prevention of periodontal diseases
and oral cancers.
157

5. 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
158

6.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.
159

7.National Training Centre to be established or the
existing centers be strengthened for training of
various categories of oral health care personnel.
160

8. All district hospitals and Community Health Centers
should have dental clinics.
All Dental Colleges should have courses on Dental
Hygienists and Dental Technicians.
161

9.The Council further resolves that the Pilot Project
may be extended to all States at the rate of one District
in every state.
162

10.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.
163

KARNATAKA STATE
HEALTH POLICY- 2004
164

Karnataka 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.
165
http://cphe.files.wordpress.com/2009/10/karnataka-state-integrated-health-policy-2001.pdf.last acessed on 11/7/014

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.
166

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.
167

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.
168

OTHER NATIONAL HEALTH
POLICIES
169

NATIONAL
NUTRITIONAL
POLICY
NATIONAL
POLICY FOR
EDUCATION
NATIONAL
POLICY FOR
CHILDREN
NATIONAL
DRUG POLICY
NATIONAL
ALCOHOL
POLICY
170

CONCLUSION
Public health has effectively remained a low priority for
the Indian state in terms of financing and political
attention.
172

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

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.
174

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.
176

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
177

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
178

REFERNCES
10.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.
179

13.http://www.mohp.gov.np/english/files/new_publi
cations/9-2-National-Oral-Health-Policy.pdf.Last
acessed 11/06/2014.
14.http://cphe.files.wordpress.com/2009/10/karnat
aka-state-integrated-health-policy-2001.pdf.last
acessed on 11/7/014 .
180
REFERNCES

National health policy

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Andere mochten auch

Andere mochten auch (20)

Ähnlich wie National health policy

Ähnlich wie National health policy (20)

Mehr von Dr.Priyanka Sharma

Mehr von Dr.Priyanka Sharma (17)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

National health policy