National Health Policy 632s4p

NATIONAL HEALTH POLICY

The Governement of India adopted a National Health Policy in August 1983.  India is one of the few countries in the world to have come out with a national policy on health.  The policy is a 17 page document consisting of 20 paras and an appendix setting the goals for health and family welfare programme.

NHP 1983  India is one of the countries which has signed the Alma Ata declaration.It is therefore,commited to the goal of Health For All by the year 2000.  In order to reach the goal the Government of India has evolved a National Health Policy in 1983

ELEMENTS 1. creation of awareness in the community about the health problems.Creation of means to solve the problems in the community itself.

2. Supply of safe drinking water and sanitation with affordable technology. 3. Reducation in the rural/urban imbalance of health services.

4.Establishment of up to date health information system to health planning and evaluation.promulgation of health legislation to protect and promote health.

5.Promotion of research for the alternate/low cost health interventions. 6.Improvement in co-ordination of the different systems of medicine.

1. 2. 3. 4. 5. 6.

IVE ACTIVITIES FOR HEALTH FOR ALL Reduction in the imbalance of health care(viz.rural/urban) Integrated rural development. Stress on elementary education. Activities for welfare of women and children. Population control. Reduction in un-employment.

STRATEGIES FOR IMPLEMENTATION OF HEALTH POLICY I. Restructuring of health infrastructure; This hopefully will remove the existing imbalance. II. Development of health manpower; this includes creation of a band of paraprofessionals like health workers,trained dais,anganwadi workers,village health guides etc.It also includes periodic training of the existing manpower.

3.Research and development; Stress is to be given on evolving the low cost health interventions and research on alternative approaches for health problems.

OPERATIONAL TARGETS 1)Establishment of one subcentre for every 5000 popultaion in rural and 3000 population in hilly/tribal areas. 2)Establishment of one PHC for every 30,000 population in rural area and for 20,000 population in hilly tribal area.

3)One community health centre per lakh population. 4)One village health guide for 1000 population and one trained birth attendant in each village. 5)Training of various categories of paramedical personnel.

POLICY PRESCRIPTIONS OF NHP 1983

MEDICAL AND HEALTH EDUCATION 1. Sets out the changes required to be brought about in the curricular contents and training programme of medical and health personnel,at various levels of functioning. 2. Takes into the need for establishing the extremely essential interrelations between functionaries of various grades.

3)Provides guidelines for the production of health personnel on the basis of realistically assessed manpower requirements. 4)Seeks to resolve the existing sharp regional imbalances in their availability. 5)Ensures that personnel at all levels are socially motivated towards the rendering of community health services.

PRIMARY HEALTH CARE WITH SPECIAL EMPHASIS ON THE PREVENTIVE, PROMOTIVE AND REHABILITATIVE ASPECTS. a) A well dispersed network of comprehensive primary health care services with the organized of volunteers,auxiliaries,para-medics and adequately trained multipurpose workers. b) The quality of training of health guides/workers.

c)Organized building up of individual self reliance and effective community participation.The provision of organized back up of the secondary and tertiary levels of the health care services,providing adequate logistical and technical assistance. d)Establishment of a well worked out referral system to provide adequate expertise nearest to the community.

e)Establish a nationwide chain of sanitary – cum-epidemiological stations.The location and functioning of these stations may be between the primary and secondary levels of the hierarchial structure.Each station would require to have suitably trained staff equipped to identify,plan and provide preventive,promotive and mental health care services.

f)The location of curative centers should be related to densities of population,distances,topography and transport connections.To maximize the utilization of available resources,new and additional curative centers should be established. g)Increased investment by nonGovernmental agencies in establishing curative centers and by offering logistical,financial and technical to voluntary agencies in the health field.

h)Special,well-coordinated programmes should be launched to provide mental health care as well as medical care and the physical and social rehabilitation of those who are mentally retarded,deaf,blind,physically disabled,infirm and the aged.Also suitably organized programme would require to be launched to ensure the prevention of various disabilities.

i)In the establishment of the reorganized services,the first priority should be accorded to provide services to those residing in the tribal,hill and backward areas as well as to endemic disease affected populations and the vulnerable sections of the society. j)In the reorganized health services scheme,efforts should be made to ensure adequate mobility of personnel at all levels of functioning.

REORIENTATION OF THE EXISTING HEALTH PERSONNEL A dynamic process of change and innovation is required to be brought about in the entire approach to health manpower development,ensuring the emergence of fully integrated bands of workers functioning within the “health team” approach.

PRIVATE PRACTICE BY GOVERNMENTAL FUNCTIONARIES It is desirable for the States to take steps to phase out the system of private practice by medical personnel in Government service,providing at the same time for payment of appropriate compensatory non practicing allowances.

PRACTITIONERS OF INDIGENOUS AND OTHER SYSTEMS OF MEDICINE AND THEIR ROLE IN HEALTH CARE  It is necessary to initiate organized measures to enable each of the various systems of medicine and health care to develop in accordance with its genius.  Simultaneously,planned efforts should be made to dovetail the functioning of the practitioners of these various systems and integrate their services,at the appropriate levels,within specified areas of responsibility and functioning.

PROBLEMS REQUIRING URGENT ATTENTION 1) Nutrition 2) prevention of food adulteration and maintenance of quality of drugs 3) water supply and sanitation 4) environmental protection;

5)immunization programme 6)maternal and child health services

7)school health programmes 8)occupational health services;

HEALTH EDUCATION  The public health education programmes should be supplemented by health,nutrition and population education programmes in all educational institutions at various levels.

 Simultaneously,efforts would require to be made to promote universal education,specially adult and family education.

MANAGEMENT INFORMATION SYSTEM Appropriate decision making and programme planning in the health and related fields is not possible without establishing an effecetive health information system.

MEDICAL INDUSTRY Efforts should be made to increase the production of essential and life saving drugs and vaccines. The production of the essential,life saving drugs under their generic names and the adoption of economical packaging practices In view of the low cost of indigenous and herbal medicines,organized efforts may be launched to establish herbal gardens,producing drugs of certified quality and making them easily available.

HEALTH INSURANCE It would be necessary to devicse wellconsidered health insurance schemes,on a Statewise basis,for mobilizing additional resources for health promotion and ensuring that the community shares the cost of the services,in keeping with its paying capacity.

HEALTH LEGISLATION It is necessary to urgently review all existing legislation and work towards a unified,comprehensive legislation in the health field,enforceable allover the country

MEDICAL RESEARCH 1) Containment and eradication of the existing,widely prevelant diseases. 2) Translation of available knowhow into simple,low cost,appropriate technologies 3) Applied operational research for improving cost effective delivery of health services 4) More effective treatment and preventive procedures for blindness,leprosy and TB. 5) Contraceptive research 6) Nutrition research

INTERSECTORAL COOPERATION It is necessary to secure intersectoral coordination of the various efforts in the fields of  health and family planning medical education and research drugs and pharmaceuticals agriculture ,food water supply,drainage,housing, Education,social welfare, rural development.

MONITORING AND REVIEW OF PROGRESS

It would be of crucial importance to monitor and periodically review the success of the efforts made and results achieved.

LIMITATIONS OF NATIONAL HEALTH POLICY 1983

The policy talks of poverty alleviation(eg.through the minimum needs program) as a necessary precondition of Health for All.However,the policy does not speak even once about social justice(in health and in other fields such as land reforms and wages)which is an essential prerequisite for Health for All. No definite programme has been suggested for promoting community participation in health. The policy is totally silent about health budget.

The health policy is not an integral part of a broad movement of radical redistribution of economic assets and political power,and of deep transformation of ideas,attitudes and values,which are essential for achieving Health for All by 2000AD.This is because the Health for all is intimately linked with eradication of poverty,ignorance and inequality.

It is either silent or does not give adequate emphasis to certain areas such as accident prevention,geriatric care and prevention of non communicable diseases like obesity,coronary heart disease and diseases related to use of tobacco,alcohol,drugs etc.

NATIONAL HEALTH POLICY 2002

OBJECTIVES 1. To achieve an acceptable standard of good health amongst the general population of the country. 2. To increase access to decentralized public health system by establishing new infrastructure in the existing institutions.

3. To ensure a more equitable access to health services across the social and geographical expanse of the country.

4)Priority to preventive and first line curative initiatives at primary level. 5)Focus on diseases that are causing burden such as TB,malaria,blindness,HIV/AIDS. 6)Emphasis on rational use of drugs.

TARGETS YEAR 2005 1.Eradication of polio 2.Eradication of Yaws 3.Establishment of integrated system of surveillance,national health s and health statistics. 4.Increase health sector health spending to from 5% to 7%

YEAR 2007 1.Achieve zero level growth of HIV/AIDS

YEAR 2010

1.Eliminate Kala-azar 2.Reduction in mortality due to malaria,other vector borne diseases and TB by 50% 3.Reduce prevalence of blindness to 0.5%

4.Reduction in IMR to less than 30 per 1000 and MMR to below 100 per 100,000 live births. 5.Increase utilization of health facilities to 75% 6.Increase health expenditure by Govt. as % of GDP to 2% from current level of 0.9% 7.Increase central grants to constitute atleast 25% of total health spending

YEAR 2015

Eliminate lymphatic filariasis

POLICY PRESCRIPTIONS NHP 2002

FINANCIAL RESOURCES  Increase the health sector expenditure to 6% of GDP,with 2% of GDP being contributed as public health investment,by the year 2010. The State Govt. would also need to increase the commitment to the health sector.

EQUITY NHP 2002 sets out an increased allocation of 55% of the total public health investment for the primary health sector,the secondary and tertiary health sectors being targeted for 35% and 10% respectively.

DELIVERY OF NATIONAL PUBLIC HEALTH PROGRAMMES  NHP -2002 envisages the gradual convergence of all health programmes under a single field istration.  Programme implementation be effected through autonomous bodies at State and district levels.  The policy also highlights the need for developing the capacity within the State Public Healthy istration for scientific deg of public health projects,suited to the local situation.

The policy envisages that apart from the exclusive staff in a vertical structure for the disease control programmes,all rural health staff should be available for the entire gamut of public health activities at the decentralized level.

THE STATE OF PUBLIC HEALTH INFRASTRUCTURE The policy envisages kick starting the revival of the primary health system by providing some essential drugs under Central Govt. funding through the decentralized health system. This policy recognizes the need for more frequent in-service training of public health medical personnel,at the level of medical officers as well as paramedics.

EXTENDING PUBLIC HEALTH SERVICES The policy envisages that,in the context of the availability and spread of allopathic graduates in their jurisdiction,State Govt. would consider the need for expanding the pool of medical practitioners to include a cadre of licentiates of medical practice,as also practitioners of Indian Systems of Medicine and Homeopathy.

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. It also recognize 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.

State Govt. could also rigorously enforce a mandatory 2 year rural posting before the awarding of the graduate degree.

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.

 The policy urges all State Governments to consider decentralizing the implementation of the programs to such institutions by 2005.

NORMS FOR HEALTH CARE PERSONNEL Minimal statutory norms for the development 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.

EDUCATION OF HEALTH CARE PROFESSIONALS Setting up of a Medical Grants commission for funding new Govt. Medical and dental colleges in different parts of the country A need based skill oriented syllabus with a more significant component of practical training,would make fresh Doctors useful immediately after graduation. Periodic skill-updating of working health professionals through a system of continuing medical education.

NEED FOR SPECIALISTS IN PUBLIC HEALTH AND FAMILY MEDICINE The policy envisages the progressive implementation of mandatory norms to raise the proportion of post graduate seats in public health and family medicine in medical training institutions,to reach a stage wherein 1/4th of the seats are earmarked for these disciplines.

NURSING PERSONNEL  The policy emphasizes the need for an improvement in the ratio of nurses vis-à-vis doctors/beds.  The public health delivery centers need to increase the number of nursing personnel.  Improve the skill level of nurses,and increase the ratio of degree holding nurses vis-à-vis diploma holding nurses.  Establish training courses for super speciality nurses required for tertiary care institutions.

USE OF GENERIC DRUGS AND VACCINES The policy emphasize the need for basing treatment regimens,in both the public and private domain,on a limited number of essential drugs of a generic nature. The national programme for Universal Immunization assure of an uninterrupted supply of vaccines at an affordable price.

URBAN HEALTH

• Setting up of an organized urban primary health care structure. • Adoption of appropriate population norms for the urban public health infrastructure.

• The structure conceived under NHP2002 is a two-tiered one; the primary centre is seen as the first tier,covering a population of one lakh,with a dispensary providing an OPD facility and essential drugs,to enable access to all the national health programmes -a second tier of the urban health organization at the level of the Govt. general hospital,where reference is made from the primary centre.

• The funding for the urban primary health system will be tly borne by the local self Govt. institutions and State and Central Govt.

MENTAL HEALTH

A network of decentralized mental health services for ameliorating the more common categories of disorders.

INFORMATION EDUCATION AND COMMUNICATION NHP-2002 envisages an IEC policy,which maximizes the dissemination of information to those population groups which can not be effectively approached by using only the mass media. Give priority to school health programmes which aim at preventive health education,providing regular health check ups and promotion of health seeking behavior among children.

HEALTH RESEARCH This policy envisages an increase in Govt.funded health research to a level of 1%of the total health spending by 2005;and thereafter,up to 2%by 2010. Domestic medical research would be focused on new therapeutic drugs and vaccines for tropical diseases,such as TB and malaria,as also on the sub types of HIV/AIDS prevalent in the country. Emphasis would also be laid on time bound applied research for developing operational applications.

ROLE OF THE PRIVATE SECTOR

Policy welcomes the participation of the private sector in all areas of health activities-primary,secondary or tertiary.

ROLE OF CIVIL SOCIETY NHP2002 recognizes the significant contribution made by NGOs and other institutions of the civil society in making available health services to thye community.

NATIONAL DISEASE SURVEILLANCE NETWORK The policy envisages the full operationalization of an integrated disease control network from the lowest rung of public health istration to the central govt. by 2005.

HEALTH STATISTICS

The policy envisages the completion of baseline estimates for the incidence of the common diseases-TB,malaria,blindness by 2005

WOMEN’S HEALTH The various policy recommendations of NHP-2002 in regard to the expansion of primary health sector infrastructure,will facilitate the increased access of women to basic health care.

MEDICAL ETHICS

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

OTHERSa) Enforcement of quality standards for food and drugs b) Regulation of standards in paramedical disciplines c) Environmental and occupational health d) Providing medical facilities to s from overseas. e) Impact of globalization on the health sector

NATIONAL POPULATION POLICY

In April 1976 India formed its first-National Population Policy policy was modified in 1977 The national health policy approved by the parliament in 1983 had set the long term demographic goals of achieving a net reproductive rate of one by the year 2000 National population policy 2000 is the latest in this series.

NPP 2000 deals with women education empowering women for improved health and nutrition child survival and health the unmet needs for family welfare services health care for the under-served population groups like urban slums,tribal community,hill area population and displaced and migrant population

adolescent’s health and education increased participation of men in planned parenthood collaboration with NGOs.

OBJECTIVES Immediate objective To address the unmet needs for contraception,health care infrastructure,and health personnel and to provide integrated service delivery for basic reproductive and child health care

Medium term objective To bring the TFR to replacement levels by 2010,through vigorous implementation of inter sectoral operational strategies.

Long term objective To achieve a stable population by 2045,at a level consistent with the requirements of sustainable economic growth,social development and environmental protection

NATIONAL SOCIO DEMOGRAPHIC GOALS FOR 2010 1. Address the unmet needs for basic reproductive and child health services,supplies and infrastructure. 2. Make school education upto age 14 free and compulsory,and reduce drop outs at primary and secondary school levels to below 20% for both boys and girls. 3. Reduce infant mortality rate to below 30 per 1000 live births. 4. Reduce maternal mortality ratio to below 100 per 100,000 live births.

5)Achieve universal immunization of children against all vaccine preventable diseases. 6)Promote delayed marriage for girls,not earlier than the age 18 and preferably after 20 years of age. 7)Achieve 80 % institutional deliveries and 100%deliveries by trained persons. 8)Achieve universal to information/counseling,and services for fertility regulation and contraception with a wide basket of choices.

9)Achieve 100% registration of births,deaths,marriage and pregnancy. 10)Contain the spread of AIDS,and promote greater integration between the management of reproductive tract infections and sexually transmitted infections and the National AIDS control organization. 11)Prevent and control communicable diseases.

12)Integrate Indian Systems of Medicine(ISM)in the provision of reproductive and child health services,and in reaching out to households. 13)Promote vigorously the small family norm to achieve replacement levels of TFR. 14)Bring about convergence in implementation of related social sector programs so that family welfare becomes a people centered program

STRATEGIES 1) Decentralized planning and programme implementation. 2) Convergence of service delivery at village levels. 3) Empowering women for improved health and nutrition. 4) Child health and survival. 5) Meeting the unmet needs for family welfare services.

6)Under served population groups(urban slums,tribals,hill areas,adolescents) 7)Diverse health care providers 8)Collaboration with and commitments from non-Govt. organizations and the private sector. 9)Mainstreaming Indian syatems of medicine and homeopathy. 10)Contraceptive technology and research on reproductive and child health. 11)Providing for the older population 12)Information,education,and