National Health Policy Manish

National Health Policy The Constitution of India AIMS – elimination ill-health and directs the State to regard the – raising of the level of nutrition and the standard of living of its people and the – improvement of public health as among its primary duties, securing the health and strength of workers, men and women, – specially ensuring that children are given opportunities and facilities to develop in a healthy manner.

National Health Policy 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

iii) Water supply and sanitation iv) Environmental protection v) Immunization programme vi) Maternal and child health services vii) School health programme and viii) Occupational health services. National Health Policy -1983…..

NHP Goal suggested/achieved IndicatorGoal By 2000Achieved by 2000 Till now IMR607057/53 (NFHSIII / SRS 2008) Perit-Natal MR (SRS2007) CDR (NFHSIII) 7.3 (SRS2008) MMR24 Under Five MR (SRS 2008) Life Expectancy (SRS 2008) Male Female

NHP Goal suggested/achieved IndicatorGoal by 2000Achievement by 2000 Till now LBW10%26%22% (NFHSIII) CBR (NFHSIII) 21.3 (SRS2008) CPR60%46.2%46.6% NRR11.45 Growth rate Family size (WHO 2006)

NHP Goal suggested/achieved IndicatorsGoal by 2000 Achievement by 2000 NFHS III AN Care100%67.2% any ANC52% (3 CHECHK UPS) TT Pregnant100%83%72% DPT85%87%55% (DPT3) OPV85%92%78% (OPV 3 DOSES) BCG85%82%78% (OPV 3 DOSES) Fully immunized85%56%44%

Differentials in health status among rural/urban India SectorBPL (%) IMRUnder 5 MR % of children Under weight MMR India Rural Urban

Differentials in health status among states SectorBPL(%) IMRUFMRMMR Better performing states Kerala Maharashtra TN Low performing states Orissa Bihar ,1707 Rajasthan UP MP

Differentials in health status among socio-economic groups IndicatorIMRUFMR Schedule caste Schedule tribe Other disadvantaged Others All India

Achievements Through The Years Indicator Till now Demographic Changes Life Expectancy (RGI) Crude Birth Rate (SRS)26.1(99 SRS)23 (NFHSIII) 21.3 (SRS2008) Crude Death Rate2512.5(SRS)8.7(99 SRS)7.4(NFHSIII) 7.3 (SRS2008) IMR (99 SRS) 57/53 (NFHS III/ SRS 2008)

Achievements Through The Years Epidemiologi cal Shifts Till now (CBHI) Malaria (cases in million) (2008) Leprosy cases per 10,000 population (2008) Small Pox (no of cases) >44,887Eradicated ---- Guineaworm ( no. of cases) >39,792Eradicated---- Polio (2008)

Achievements Through The Years Infrastructure Till March 2007 SC/PHC/CHC72557,3631,63,181 (99-RHS) 1,71687 (RHS2007) Dispensaries &Hospitals ( all) ,55543,322 (95–96-CBHI) - Beds (Pvt & Public) 117,198569,4958,70,161 (95-96-CBHI) Doctors (Allopathy) 61,8002,68,7005,03,900 (98-99-MCI) 767,500 (RHS 2007) Nursing Personnel 18,0541,43,8877,37,000 (99-INC) 928,149 (RHS 2007)

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

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

Goals – NHP Eradication of Polio & Yaws Elimination of Leprosy Elimination of Kala-azar Elimination of lymphatic Filariasis Achieve of Zero level growth 2007 of HIV/AIDS

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%

8. Reduction of IMR to 30/1000 & 2010 MMR to 100/lakh 9. Increase utilisation of public 2010 health facilities from current level of 75% 10.Establishment of an integrated 2007 system of surveillance, National Health Accounts and Health Statistics 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 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% Goals – NHP 2002…

NHP-2002 Policy prescriptions Financial resource Increase in health sector expenditure to 6% of GDP, with 2% by public health investment by 2010 is recommended by the policy Existing 15% of central government contribution is to be raised to 25% by 2010

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.

Delivery of national public health programmes NHP 2002 envisages the gradual convergence of all health programmes under a single field administration It suggest that for a scientific designing of public health projects suited to the local situation 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

Delivery of national public health programmes……. NHP 2002 noted that less than 20% of population which seek OPD services and less than 45% of that which seek indoor treatment avail of such services in public hospital In this backdrop, the 2002 NHP envisages kick starting of the revival of public health system by providing some essential drugs through decentralised health system

Delivery of national public health programmes……. The policy recognises the need for more frequent in - service training. NHP 2002 noted that improvement of public health indices is linked with quantum and quality of investment through public funding in public health sector

Public health spending in select countries Indicators% population income < $ 1 day IMR / Health Ex penditure % Public expenditure India 44.2 % 705.2%17.3% China 18.5 % 312.7%24.9% Sri Lanka 6.6 % 163.0%45.4% UK %96.9% USA %44.1%

Suggested norms for health personnel Category of personnelNorms suggested 1. Doctors1 per3,500 population 2. Nurses1 per5,000 population 3. Health worker (female and male) 1 per5,000 population in plain area and 3000 population in tribal and hilly areas. 4. Trained dai1per village 5. Health assistant (male and female) 1 per30,000 population in plain area and population in tribal and hilly areas. 6. Health assistant (male and female) provides supportive super­ vision to 6 health workers (male /female). 7. Pharmacists1 per10,000 population 8. Lab. technicians1 per10,000 population

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

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. 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

Use of generic drugs and vaccines NHP 2002 recommends limited number of essential drugs of generic nature as a requisite for cost effective public health care. To ensure long term national health security 2002 NHP envisages that not less than 50% of the requirement of vaccine/sera be sourced from public sector institutions

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;

 First Tier:-  Primary centre cover 1 Lakh population  It functions as OPD facilities  It provides essential drugs  It will carry out national health programmes  Second Tier:-  General Hospital a referral to primary centre provides the care The policy recommends a fully equipped equipped. hub-spoke, trauma care network in large urban agglomerations to reduce accident mortality Urban health

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

Information Education and Communication NHP-2002 has suggested interpersonal communication by folk and traditional media to bring about behavioural change Association of PRIs/NGOs/Trusts are given specific targets

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

Health research NHP 2002 noted the aggregate annual health expenditure of Rs. 80,000 crores and on research Rs 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% by2010 New therapeutic drugs and vaccines for tropical disease are given priority

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 regularity and accreditation of private sector for the conduct of clinical practice. 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.

National disease surveillance network NHP 2002 noted that absence of an efficient disease surveillance network is a major handicap for cost effective health care. It wants a network from lowest rung to central government by 2005 by installation of data base handling hardware, IT interconnectivity, in-house training for data collection and interpretation

Woman Health Recognizing 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

References: 1.National Health Policy Government Of India Ministry Of Health & Family Welfare New Delhi National Health Policy Government Of India Ministry Of Health & Family Welfare New Delhi Gupta MC, Mahajan BK. Text Book Of Preventive and Social Medicine,3 rd Edition.Jaypee Publication NewDelhi,p Kishore J. National Health Programs Of India.8 th Edition. Century Publication.New Delhi.p

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