national health policy --2017---by Ramya Saju

1. RAMYA K A
MSc Nursing
Govt. College Of Nursing
Kozhikode

3. POLICY
Policy is a system which provides the logical
frame work and rationality for decision
making for the achievements of intended
objectives

4. Health policy
• Health policy of a nation is its strategy for
controlling and optimizing the social use of its
health knowledge and social resources.

5. • "A health policy generally describes funda-
mental principles regarding which health
providers are expected to make value
decisions.

9. Simon Commission 1927
• A commission(1927) under Sir John Simon, sent to
India to examine the effects of Montague-Chelmsford
Reforms(1919)
• A scheme of constitutional reforms, on the basis of
recommendations of Simon Commission was prepared
by the Government.
• The Congress and Muslim League both refused the
recommendations

10. Government of India Act 1935.
• The recommendations of round table conferences
published in 1933.
• Report of committee published in 1934 in a Bill of Law.
• After approval of British parliament, the Bill enforced as
Government of India Act,1935.
• The Act contained, 14 parts and 10 Schedules, consisted
of two parts

11. • The Government of India Act 1935 was the
last constitution of British India. It lasted until
1947, when British India was split into
Pakistan and India. The act.
Gave Indian provinces more independence. It
allowed the establishment of an All India
Federation.

12. • In 1938 the Indian National Congress
established a National Planning Committee
(NPC) under Jawaharlal Nehru.
• Its report, published in 1948, it was not as
well studied and it lacked in detailed analysis
of the existing health situation as well as of the
future plans

13. PLANNING COMMISSION
• • The planning commission is an organization
in the government of India which formulates
India's five year plan .
• • It was Set up on 15 Mar, 1950 with prime
minister Jawaharlal Nehru as the chairman.

14. • National health committees
• National planning commission
• Five year plans
• National health policy

15. Health policy formulation in India
• Ministry of health identified the need for
policy arising out of handling the day to day
problems related to various health programs
and commitment to achieving the goal of HFA
BY 2000 AD.
• After that ministry appointed committee to
review the environment in health sector and
recommended a policy frame after needful
consultation

16. • After that cabinet approved the document
presented in the national parliament for
ratification in December 1982
• NHP 1983,in a spirit of optimistic empathy for
health need of the people, particularly poor and
under privileged ,health for all by 2000AD”
through comprehensive and primary health
care.

17. Success of NHP 1983
• Small pox and guinea worm diseases have
been eradicated from India.
• Polio is on the verge of being eradicated.
• Leprosy , Kala Azar and Filariasis can be
expected to be eliminated in future

18. Drawback of NHP 1983

19. Achievements through the year
1951-2000

20. Goals of NHP 2002

22. ACHIEVEMENTS OF NHP

24. Critical review about NHP 2002

25. WEAKNESS OF NHP 2002
• Lack of monitoring and evaluation
• Lack of govt. expenditure on public health

26. NATIONAL HEALTH POLICY
2017

27. Health priority
1. Burden of non communicable diseases
2. Emergence of robust health care industry
3. Increased health care cost
4. Increased fiscal capacity

28. Primary aim of NHP
Inform, strengthen ,clarify and prioritize
the role of government in shaping health
system in all dimensions.
. --Organization of health care service.
promotion of health ,prevention of diseases,
building knowledge and better financial
protection

29. Goal
• Attainment of highest possible level of health
and well being for all at all age groups.

30. Key policy principles
• Professionalism. integrity and ethics
• Equity
• Affordability
• Universality
• Patient centered and quality care
• Accountability
• Inclusive partnership

31. • Pluralism(AYUSH)
• Decentralization
• Dynamism and adaptiveness

32. Objective
Improve health status through corrected policy
action in all sections.
a. Progressively achieve universal health
coverage
--Assuring avilability of free, comprehensive
primary health care services.
--Ensuring improved access and affordability.
--Reduce health care cost

33. B) Reinforcing trust in health care system
C)Align the growth of private health care sector
with public health goal

34. Specific Quantitative Goals and
Objectives
The indicative, quantitative goals and objectives
(a) Health status and programme impact.
(b) Health systems performance
(c) Health system strengthening.

35. Health status and programme impact.
1.Life Expectancy and healthy life.
• Increase Life Expectancy at birth from 67.5 to 70
by 2025
• Establish regular tracking of Disability Adjusted
Life Years (DALY )by 2022
• Reduction of TFR to 2.1 at national and sub-
national level by 2025

36. 2.Mortality by Age
a. Reduce Under Five Mortality to 23 by 2025
and MMR from current levels to100 by 2020
b. Reduce infant mortality rate to 28 by 2019
c. Reduce neonatal mortality to 16 and still birth
rate to “single digit” by 2025.

37. 3. Reduction of disease prevalence/ incidence
a. Achieve global target of 2020 which is also
termed as target of 90:90:90, for HIV/AIDS
b. Achieve and maintain eliminationstatus of
Leprosyby 2018, Kala-Azar by 2017 and
Lymphatic Filariasis in endemic pockets by
2017

38. c. To achieve and maintain a cure rate of >85% in new
sputum positive patients for TB and reduce incidence of
new cases to reach elimination status by 2025
d. To reduce the prevalence of blindness to 0.25/ 1000
by 2025 and disease burden by one third from current
levels.
e. To reduce premature mortality from cardiovascular
diseases, cancer, diabetes or chronic respiratory
diseases by 25% by 2025

39. Health Systems Performance
1.Coverage of Health Services
a. Increase utilization of public health facilities by 50%
from current levels by 2025.
b. Antenatal care coverage to be sustained above 90% and
skilled attendance at birth above 90% by 2025.
c. More than 90% of the newborn are fully immunized by
one year of age by 2025.

40. d. Meet need of family planning above 90% at
national and sub national level by 2025.
e. 80% of known hypertensive and diabetic
individuals at household level maintaine,
controlled disease status by 2025

41. 2. Cross Sectoral goals related to health.
a. Relative reduction in prevalence of current
tobacco use by 15% by 2020 and 30% by
2025.
b. Reduction of 40% in prevalence of stunting of
under-five children by 2025.
C .Access to safe water and sanitation to all by
2020 (Swachh Bharat Mission)

42. c. Reduction of occupational injury by half from
current levels of 334 per lakh agricultural
workers by 2020
e. National/ State level tracking of selected
health behaviour

43. Health Systems strengthening
1.Health finance
a. Increase health expenditure by Government as a
percentage of GDP from the existing 1.15% to 2.5 % by
2025
b. Increase State sector health spending to > 8% of their
budget by 2020
c. Decrease in proportion of households facing
catastrophic health expenditure from the current levels
by 25%, by 2025.

44. 2 Health Infrastructure and Human Resource
a. Ensure availability of paramedics and doctors as per
Indian Public Health Standard (IPHS) norm in high
priority districts by 2020
b. Increase community health volunteers to population
ratio as per IPHS norm, in high priority districts by
2025
c. Establish primary and secondary care facility as per
norms in high priority districts (population as well as
time to reach norms) by 2025.

45. 3. Health Management Information
a. Ensure district level electronic database of
information on health system components by
2020.
b. Strengthen the health surveillance system and
establish registries for diseases of public health
importance by 2020
c. Establish federated integrated health information
architecture, Health Information Exchanges and
National Health Information Network by 2025.

46. 3.POLICY THRUST
1.Ensuring Adequate Investment
The policy proposes a potentially
achievable target of raising public health
expenditure to 2.5% of the GDP in a time
bound manner.

47. 2. Preventive and Promotive Health
• The policy articulates to institutionalize
intersectoral coordination at national and sub
national levels to optimize health outcomes
• The policy identifies coordinated action on
seven priority areas are

48. • The Swachh Bharat Abhiyan
• Balanced healthy diets and regular exercises
• Addressing tobacco, alcohol and substance abuse
• Yatri Suraksha
• Preventing deaths due to rail and road traffic accidents
• Nirbhaya Nari
• Action against gender violence
• Reduced stress and improved safety in the work place
• Reducing indoor and outdoor air pollution

49. 3.Organization of Public Health Care Delivery
Primary Care Services and Continuity of Care:
• This policy denotes important change from very
selective to comprehensive primary health care --
geriatric health care, palliative care and rehabilitative
care services(Health and Wellness Centers)
• Upgradation of the existing subcentres and reorienting
PHCs
• AYUSH health care services
• Research and validation of tribal medicines.

50. Secondary Care Services
• The policy aspires to provide at the district
level
• At least two beds per thousand population
distributed in such a way that it is accessible
within golden hour rule.
• Resource allocation
• This expanding the network of blood

51. Reorienting Public Hospitals
• Free drugs and diagnostics with suitable
leeway to the States to suit their context.
• Need for an information system with
comprehensive data on availability and
utilization of services not only in public
hospitals but also in nongovernment sector
hospital.

52. Closing Infrastructure and Human
Resources/Skill Gaps
• Financing for additional infrastructure or
human resources would be based on needs of
outpatient and inpatient attendance and of key
services in a measurable manner.

53. Urban Health Care
• Addressing the primary health care needs of
the urban population with special focus on
poor populations living in listed and unlisted
slums
• AYUSH personnel

54. 4.National Health Programmes
1.RMNCH+A services
2. Child and Adolescent Health.
3.Interventions to Address Malnutrition and
Micronutrient Deficiencies.
4.Universal Immunization

55. 5. Communicable Diseases.
a. Control of Tuberculosis
b. Control of HIV/AIDS
C. Leprosy Elimination
d. Vector Borne Disease Control

56. 6. Non-communicable diseases
7. Mental health
8. Population stabilization

57. Women’s Health & Gender
Mainstreaming
Provisions for reproductive
morbidities and health needs of women
beyond the reproductive age group

58. Gender based violence (GBV)
• Making public hospitals more women friendly
• Recommends that the health care to the
survivors/ victims need to be provided free and
with dignity in the public and private sector.

59. Supportive Supervision
• For supportive supervision in more vulnerable
districts .
• Digital tools and HR strategies like using nurse
trainers to support field workers.

60. Emergency Care and Disaster
Preparedness
• The policy supports development of
earthquake and cyclone resistant health
infrastructure in vulnerable geographies
• Unified emergency response system
• One per 30 lakh population in urban areas and
• One for every 10 lakh population in rural areas

61. Mainstreaming
the Potential of AYUSH
• Yoga would be introduced much more widely
in school and work places as part of promotion
of good health as adopted in National AYUSH
Mission (NAM).
• Linking AYUSH systems with ASHAs and
VHSNCs would be an important plank of this
policy
• The policy seeks to strengthen steps for
farming of herbal plants

62. Tertiary care Services
• It recommends that the Government should set up new
Medical Colleges, Nursing Institutions and AIIMS in
the country.
• The policy enunciates the core principle of societal
obligation on the part of private institutions to be
followed.
This would include--Operationalization of mechanisms
for referral from public health system to charitable
hospitals
--Ensuring that deserving patients can be admitted
on designated free / subsidized beds

63. Human Resources for Health:
1. Medical Education
2. Attracting and Retaining Doctors in Remote Areas
3. Specialist Attraction and Retention
• The policy recommends that the National Board of
Examinations should expand the post graduate training up
to the district level.
• The policy recommends creation of a large number of
distance and continuing education options for general
practitioners in both the private and the public sectors,
which would upgrade their skills to manage the large
majority of cases at local level, thus avoiding unnecessary
referral

64. 4. Mid Level Service Providers
• Locale based selection, a special curriculum of
training close to the place where they live and
work conditional licensing, enabling legal
framework and a positive practice environment
will ensure that this new cadre is preferentially
available where they are needed most.

65. 5.Nursing Education
6. ASHA
7. Paramedical Skills.
8. Public Health Management Cadre
9.Human Resource Governance and leadership
development

66. Financing of Health Care
• The existing Government financed health
insurance schemes shall be aligned to cover
selected benefit package of secondary and
tertiary care services purchased from public,
not for profit and private sector in the same
order of preference subject to availability of
quality services on time as per defined norms.

67. 1.Purchasing of Healthcare Services
• The payments will be made by the
trust/society on a reimbursement basis for
services provided.

68. Collaboration with Non Government
Sector/Engagement with private sector
• The policy advocates for contracting of private
sector in the following activities:
1.Capacity building
2. Skill Development programmes
3. Corporate Social Responsibility (CSR)
4.Mental healthcare programmes

69. 5.Disaster Management
6. Strategic Purchasing as Stewardship
7. Enhancing accessibility in private sector
8. Role in Immunization
9. Disease Surveillance
10. Tissue and organ transplantations

70. Regulatory Framework
1. Professional Education Regulation
2. Regulation of Clinical Establishments
3. Food Safety
4. Drug Regulation
5. Medical Devices Regulation
6. Clinical Trial Regulation
7. Pricing Drugs, Medical Devices and Equipment

72. Vaccine Safety
• it recommends building more public sector
manufacturing units to generate healthy
competition; uninterrupted supply of quality
vaccines, developing innovative financing and
creating assured supply mechanisms with built
in flexibility

73. Medical Technologies
It ensure available good quality, free
essential and generic drugs and diagnostics, at
public health care facilities is the most
effective way for achieving the goal

74. Public Procurement
• It ensure well developed public procurement
system.

75. Aligning other policies for medical devices
and equipment with public health goals
• The policy accords special focus on production
of Active Pharmaceutical Ingredient (API)
which is the back bone of the generic
formulations industry.

76. • Improving Public Sector Capacity for
Manufacturing Essential Drugs and
Vaccines
• Prioritises establishing sufficient labeling and
packaging requirements on part of industry,
adequate medical devices testing facility and
effective port -clearance mechanisms for
medical products.

77. Antimicrobial resistance
• standardization of guidelines, regarding
antibiotic use, limiting the use of antibiotics

78. Health Technology Assessment
• The National Health Policy commits to the
development of institutional framework and
capacity for Health Technology Assessment
and adoption

79. Digital Health Technology Eco
System
• National Digital Health Authority (NDHA)
will be set up to regulate, develop and deploy
digital health across the continuum of care.
• The policy advocates extensive deployment of
digital tools for improving the efficiency and
outcome of the healthcare system

80. Health Surveys
• The policy recommends rapid programme
appraisals and periodic disease specific
surveys to monitor the impact of public health
and disease interventions using digital tools for
epidemiological surveys

81. Health Research
• The National Health Policy recognizes the key
role that health research plays in the
development of a nations health.

82. Governance
• Role of Centre & State
• Role of Panchayati Raj Institutions

83. Legal Framework for Health Care
and Health Pathway
• Excellent health care system needs to be in
place to ensure effective implementation of the
health rights at the grassroots level.
• Right to health cannot be perceived unless the
basic health infrastructure like doctor-patient
ratio, patient-bed ratio, nurses-patient ratio, etc
are near or above threshold levels and
uniformly spread-out across the geographical
frontiers of the country.

84. Implementation Framework and
Way Forward
• A policy is only as good as its implementation.
The National Health Policy envisages that an
implementation framework be put in place to
deliver on these policy commitments. Such an
implementation framework would provide a
roadmap with clear deliverables and
milestones to achieve the goals of the policy.