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 -1983

• NHP 1983 stressed the need for providing primary health care with special emphasis on prevention, promotion and rehabilitation

• Suggested planned time bound attention to the following

i) Nutrition, prevention of Food Adulteration

ii) Maintenance of quality of drugs

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 1983- Goal suggested/achieved

Indicator Goal By 2000 Achieved by 2000

Till now

IMR 60 70 57/53(NFHSIII/SRS 2008)

Perit-Natal MR 33 46 37 (SRS2007)

CDR 9 8.7 7.4(NFHSIII)

7.3 (SRS2008)

MMR 2 4

Under Five MR 10 9.4 17 (SRS 2008)

Life Expectancy (SRS 2008)

Male 64 62.4 62.6

Female 64 63.4 64.2

NHP 1983- Goal suggested/achieved

Indicator Goal by 2000 Achievement by 2000

Till now

LBW 10% 26% 22% (NFHSIII)

CBR 21 26.1 23 (NFHSIII)

21.3 (SRS2008)

CPR 60% 46.2% 46.6%

NRR 1 1.45

Growth rate 1.2 1.93 -

Family size 2.3 3.1 2.8 (WHO 2006)

NHP 1983- Goal suggested/achieved

Indicators Goal by 2000

Achievement by 2000

NFHS III2006-07

AN Care 100% 67.2% any ANC 52% (3 CHECHK UPS)

TT Pregnant 100% 83% 72%

DPT 85% 87% 55% (DPT3)

OPV 85% 92% 78% (OPV 3 DOSES)

BCG 85% 82% 78% (OPV 3 DOSES)

Fully immunized 85% 56% 44%

Differentials in health status among rural/urban India

Sector BPL (%)

IMR Under 5MR

% of childrenUnderweight

MMR

India 26.1 70 94.9 408

Rural 27.09 75 103.7 -

Urban 23.62 44 63.1 -

Differentials in health status among states

Sector BPL(%) IMR UFMR MMR

Better performing states

Kerala 12.72 14 18.8 87

Maharashtra 25.02 48 58.1 135

TN 21.12 52 63.3 79

Low performing states

Orissa 47.15 97 104.4 498

Bihar 42.60 63 105,1 707

Rajasthan 15.28 81 114.9 607

UP 31.15 84 122.5 707

MP 37.43

37.43 90 137.6 498

Differentials in health status among socio-economic groups

Indicator IMR UFMRSchedule caste 83 119.3

Schedule tribe 84.2 126.6

Other disadvantaged

Others

76

61

103.1

82.6All India 70 94.9

Achievements Through The Years 1951-2000

Indicator 1951 1981 2000 Till now

Demographic Changes

     

Life Expectancy 36.7 54 64.6 (RGI)

Crude Birth Rate 40.8 33.9(SRS) 26.1(99 SRS) 23 (NFHSIII)21.3

(SRS2008)

Crude Death Rate 25 12.5(SRS) 8.7(99 SRS) 7.4(NFHSIII) 7.3 (SRS2008)

IMR 146 110 70 (99 SRS)

57/53(NFHS III/SRS 2008)

Achievements Through The Years 1951-2000

Epidemiological Shifts

 1951 1981  2000  Till now (CBHI)

Malaria (cases in million)

75 2.7 2.2 1366517 (2008)

Leprosy cases per 10,000 population

38.1 57.3 3.74 0.74 (2008)

Small Pox (no of cases)

>44,887 Eradicated  ---- ----

Guineaworm ( no. of cases)

  >39,792 Eradicated ----

Polio   29709 265 559 (2008)

Achievements Through The Years - 1951-2000

Infrastructure  1951 1981  2000  Till March 2007

SC/PHC/CHC 725 57,363 1,63,181 (99-RHS)

1,71687(RHS2007)

Dispensaries &Hospitals

( all)

9209 23,555 43,322 (95–96-CBHI)

-

Beds (Pvt & Public)

117,198 569,495 8,70,161 (95-96-CBHI)

Doctors(Allopathy)

61,800 2,68,700 5,03,900 (98-99-MCI)

767,500 (RHS 2007)

Nursing Personnel

18,054 1,43,887 7,37,000 (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 2002

1. Eradication of Polio & Yaws 2005

2. Elimination of Leprosy 2005

3. Elimination of Kala-azar 2010

4. Elimination of lymphatic Filariasis 2015

5. Achieve of Zero level growth 2007

of HIV/AIDS

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 <20% to > 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-2002Policy 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…..

55%35%

10%

Primary Secondary Tertiary

• 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 / 1 000 Health Ex penditure

% Public expenditure

India 44.2 % 70 5.2% 17.3%

China 18.5 % 31 2.7% 24.9%

Sri Lanka 6.6 % 16 3.0% 45.4%

UK - 6 5.8% 96.9%

USA - 7 13.7% 44.1%

Suggested norms for health personnelCategory of personnel Norms suggested

1 . Doctors 1 per 3,500 population

2. Nurses 1 per 5,000 population

3. Health worker (female and male)

1 per 5,000 population in plain area and 3000 population in tribal and hilly areas.

4. Trained dai 1per village

5. Health assistant (male and female)

1 per 30,000 population in plain area and 20000 population in tribal and hilly areas.

6. Health assistant (male and female)

provides supportive super vision to 6 health workers (male /female).

7. Pharmacists 1 per 10,000 population

8. Lab. technicians 1 per 10,000 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. 1 1 50 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 1983.

2. National Health Policy Government Of India Ministry Of Health & Family Welfare New Delhi 2002.

3. Gupta MC, Mahajan BK. Text Book Of Preventive and Social Medicine,3rd Edition .Jaypee Publication NewDelhi,p 454-72

4. Kishore J. National Health Programs Of India.8th Edition. Century Publication.New Delhi.p 545-559

5.  

• www.mohfw.nic.in/np2002.htm• www.mohfw.nic.in/kk/95/ii/95ii0101.htm• http://indiaonline.in/health/Statistics/• www.indg.in/health/current-health-scenario-in•  

miles to go before……..

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