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National Health Policy

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Title: National Health Policy


1
National Health Policy
  • Dr Prasanna Kumar K
  • Asst Prof HOD
  • Dept of Community Medicine
  • FMHMCH, Deralakatte, Mangalore.

2
  • Large numbers of the worlds people, perhaps
    more than half, have no access to health care at
    all, and for many of the rest the care they
    receive does not answer the problems they
    have..JOHN BRYANT

3
  • The ministry of health and family welfare evolved
    a NHP in 1983 keeping in view the national
    commitment to attain the goal of health for all
    by the year 2000.

4
  • Health policy of a Nation is its strategy for
    controlling and optimising the social uses of its
    health knowledge and health resources.

5
  • India had its first national health policy in
    1983 i.e. 36 years after independence.
  • Why ???

6
The Joint WHO UNICEF international conference
in 1978 at Alma-Ata (USSR)
Alma-Ata Declaration called on all the
governments to formulate national health policies
according to their own circumstances to launch
and sustain primary health care as a part of
national health system.
7
The 30th World Health Assembly in May 1977
resolved The main social target of governments
and WHO in the coming decades should be the
attainment by all citizens of the world by the
year 2000 AD of a level of health that will
permit them to lead a socially and economically
productive life. HEALTH FOR ALL BY 2000 AD
8
  • The Alma-Ata conference called for acceptance of
    the WHO goal of
  • HEALTH FOR ALL
  • by 2000 AD
  • and Primary Health Care as a way to achieve
    Health For All

9
The Alma-Ata conferencedefined that
Primary health care is essential health care
made universally accessible to individuals and
acceptable to them, through their full
participation and at the cost the community and
country can afford.
10
Principles of primary health care
  • Equitable distribution
  • Community participation.
  • Inter-sectoral coordination
  • Appropriate technology

11
1. Equitable distribution
  • Some thing for all and most for those who need
    the most
  • Bahujan hitae bahujan sukhae

12
2. Community participation.
  • There must be a continuing effort to secure
    meaningful involvement of the community in the
    planning, implementation and maintenance of
    health services, besides maximum reliance on
    local resources such as manpower, money and
    materials.

13
3.Intersectoral coordination
  • "primary health care involves in addition to
    the health sector, all related sectors and
    aspects of national and community development, in
    particular agriculture, animal husbandry, food,
    industry, education, housing, public works,
    communication and others sectors".

14
4. Appropriate technology
  • "technology that is scientifically sound,
    adaptable to local needs, and acceptable to those
    who apply it and those for whom it is used, and
    that can be maintained by the people themselves
    in keeping with the principle of self reliance
    with the resources the community and country can
    afford"

15
Elements of primary health care
  • 1. Education concerning prevailing health
    problems and the methods of preventing and
    controlling them
  • 2. Promotion of food supply and proper nutrition
  • 3. An adequate supply of safe water and basic
    sanitation
  • 4. Maternal and child health care, including
    family planning

16
Elements of primary health care..
  • 5. Immunization against major infectious diseases
  • 6. Prevention and control of locally endemic
    diseases
  • 7. Appropriate treatment of common diseases and
    injuries
  • 8. Provision of essential drugs.

17
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

18
National Health Policy 1983
  • iii) Water supply and sanitation
  • iv) Environmental protection
  • v) Immunisation programme
  • vi) Maternal and child health services
  • vii) School health programme and
  • viii) Occupational health services.

19
National Health Policy 1983
  • For better programme planning NHP 1983
    recommended an effective Health Information
    System.

20
NHP 1983- Goal suggested/achieved
21
NHP 1983- Goal suggested/achieved
22
NHP 1983- Goal suggested/achieved
23
Differentials in health status among rural/urban
India
24
Differentials in health status among states
Sector BPL() IMR
UFMR MMR
25
Differentials in health status among
socio-economic groups
26
Achievements Through The Years 1951-2000
27
Achievements Through The Years 1951-2000
28
Achievements Through The Years - 1951-2000
29
Millennium Development Goals
  • Millennium Summit held in September 2000 in New
    York
  • Representatives from 189 countries met to adopt
    the United Nations Millennium Declaration
  • Poverty eradication and development by 2015 being
    the core issue
  • Millennium Development Goals

30
Millennium Development Goals
  • 8 goals
  • 18 targets
  • 48 indicators
  • Related to health
  • 3 goals
  • 8 targets
  • 18 indicators

31
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.

32
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

33
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

34
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

35
Goals NHP 2002
  • 8. Reduction of IMR to 30/1000 2010
  • MMR to 100/lakh
  • 9. Increase utilisation of public
    2010
  • health facilities from current
  • level of lt20 to gt 75
  • 10. Establishment of an integrated 2007
  • system of surveillance,
  • National Health Accounts and
  • Health Statistics

36
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

37
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

38
NHP-2002Policy prescriptions
39
Differentials in health status among rural/urban
India
40
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.

41
Delivery of national public health programmes
  • NHP 2002 envisages the gradual convergence of all
    health programmes under a single field
    administration.
  • It suggests for a scientific designing of public
    health projects suited to the local situation.

42
Delivery of national public health programmes.
  • 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.

43
Public health spending in select countries
44
Delivery of national public health programmes.
  • Therefore, the policy places reliance on
    strengthening of public health outcomes on
    equitable basis.
  • It recognises the need of user charge for
    secondary and tertiary public health care for
    those who can afford to pay.

45
Extending public health services
  • Expanding the pool of General Practitioners to
    include a cadres of licentiates including Indian
    systems of Medicine and Homoeopathy is
    recommended in the policy.
  • In order to provide trained manpower in under
    served areas it recommends contract employment.

46
Suggested norms for health personnel
47
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.

48
Education of health care professionals..
  • The need for inclusion of contemporary medical
    research and geriatric concern and creation of
    additional PG seats in deficient specialities are
    specified.

49
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.

50
Nursing personnel
  • 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.

51
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

52
Urban health
  • First Tier-
  • Primary centre cover 1 Lakh population
  • It functions as OPD facilities.
  • It provides essential drugs.
  • It will carry out national health programmes.

53
Urban health
  • Second Tier-
  • General Hospital a referral to primary centre
    provides the care.
  • The policy recommends a fully equipped hub-spoke
    trauma care network to reduce accident mortality.

54
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.

55
Information Education and Communication
  • NHP 2002 has suggested interpersonal
    communication by folk and traditional media to
    bring about behavioural change.

56
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.

57
Health research
  • 2002 NHP noted the aggregate annual health
    expenditure of Rs. 80,000 crores and on
    research Rs. 1150 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 by 2010.
  • New therapeutic drugs and vaccines for tropical
    disease are given priority.

58
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 regularitory and accreditation of
    private sector for the conduct of clinical
    practice.

59
Role of private sector..
  • 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.

60
Health statistics
  • NHP 2002 has recommended full baseline estimate
    of tuberculosis, malaria and blindness by 2005,
    and
  • In the long run for cardiovascular diseases,
    cancer, diabetes, accidents, hepatitis and G.E.

61
Women's health
  • After recognising 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.

62
Medical ethics
  • In India we have guidelines on professional
    medical ethics since 1960.
  • This is revised in 2001.
  • Government of India has emphasised the importance
    of moral and religious dilemma.

63
Medical ethics.
  • NHP 2002 has recommended notifying a contemporary
    code of ethics, which is to be rigorously
    implemented by Medical Council of India.
  • The Policy has specified the need for a vigilant
    watch on gene manipulation and stem cell research.

64
Enforcement of quality standard for food and
drugs
  • NHP 2002 envisaged that Food and Drug
    administration be strengthened in terms of
    laboratory facilities and technical expertise.

65
Regulation of standards in paramedical disciplines
  • More and more training institutions have come up
    recently under paramedical board which do not
    have regulation or monitoring.
  • Hence, establishment of Statutory Professional
    Council for paramedical discipline is recommended.

66
Environmental and occupational health
  • Government has noted the ambient environment
    condition like unsafe drinking water, unhygienic
    sanitation and air pollution.
  • Child labour and substandard working conditions
    are causing occupational linked ailments.

67
Environmental and occupational health.
  • NHP 2002 has suggested for an independent state
    policy and programme for environment apart from
    periodic health screening for high risk
    associated occupation.

68
NRHM
  • NATIONAL RURAL HEALTH MISSION
  • ( NRHM)
  • 2005-2012.

69
Aim
  • To provide accessible, affordable, accountable,
    effective and reliable primary health care and
    bridging the gap in rural health care through
    creation of ASHA. ( ACCREDITED SOCIAL HEALTH
    ACTIVIST).

70
  • GOVT OF INDIA
  • NECESSARY ARCHITECTURAL CORRECTION IN THE BASIC
    HELATH CARE DELIVERY SYSTEM.
  • LAUNCHED ON APRIL 12 , 2005

71
  • SPECIAL FOCUS ON 18 STATES.
  • Arunachal pradesh, Assam, Bihar, Chattisgarh,
    Himachal pradesh, Jharkand, JK, manipur,
    Mizoram, Meghalay, MP, Nagaland, Orissa,
    Rajasthan, Sikkiim, Tripura, Uttaranchal, UP.

72
GOALS
  • Reducing IMR and MMR by 50 in next 7 years.
  • Universal access to public health services such
    as womens health, child health, water,
    sanitation, hygiene, immunization, nutrition.
  • Prevention and control of CD and NCD
  • Access to integrated comprehensive primary health
    care.

73
  • population stabilization,gender and demographic
    balance.
  • Revitalize local health traditions and mainstream
    AYUSH.
  • Promotion of healthy life styles.

74
STRATEGIES.
  • A. CORE STRATEGY.
  • B. SUPPLEMENTARY STRATEGY.

75
CORE STRATEGIES
  • Train and enhance capacity of Panchayat Raj
    institutions to own, control and manage public
    health services.
  • Promote access to improved health care at
    household level through the female health
    activist.
  • Health plan for each village through village
    health committee of the panchayat.

76
  • 4. Stregthening subcenter through an united fund
    to enable local planning and action and more
    MPWs.
  • 5. Stregthening existing PHCs and CHCc.
  • 6. Preparation and implementation of an
    intersectoral district health plan prepared by
    the district health mission .

77
  • 7. Strengthening capacities for data collection,
    assessment and review for evidence based
    planning, monitoring and supervision.
  • 8. Developing capacities for preventive health
    care at all levels by promoting healthy life
    styles, rdxn in tobacco consumption, alcohol etc.

78
B. Supplementary strategy.
  • Regulation of private sector to ensure
    availability of quality service to citizens at
    reasonable cost.
  • Mainstreaming AYUSH revitalizing local health
    traditions.
  • Reorienting medical education to support rural
    health issues

79
COMPONENTS OF NRHM
  • ASHA
  • Resident of the village, a woman (M/W/D) between
    25-45 years, with formal education upto 8th
    class, having communication skills and leadership
    qualities.
  • One ASHA per 1000 population.
  • Around one lac ASHAs are already selected.

80
ASHA
  • Chosen by the panchayat to act as the interface
    between the community and the public health
    system.
  • Bridge between the ANM and the village.
  • Honorary volunteer, receiving performance based
    compensation .

81
Responsibility of ASHA
  • To create awareness among the community regarding
    nutrition, basic sanitation, hygienic practices,
    healthy living.
  • Counsel women on birth preparedness, imp of safe
    delivery, breast feeding, complementry feeding,
    immunization, contraception, stds.

82
  • Encourage the community to get involved in health
    related services.
  • Escort/ accompany pregnant women, children
    requiring treatment and admisssions to the
    nearest PHCs.
  • Primary medical care for minor ailment such as
    diarrhoea, fevers
  • Provider of DOTS.

83
  • ORS, IRON AND FOLIC ACID TABLETS, CHOLORQUINE,
    ORAL PILLS, CONDOMS,
  • DRUG KIT ALLOPATHIC AND AYUSH
  • UNDERGO GRADED TRAINING.
  • INFORMATION ABOUT BIRTHS AND DEATHS.
  • PROMOTE CONSTRUCTION OF HOUSEHOLD TOILETS.

84
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