National health policy (1983-2002)

India, evolved a NATIONAL HEALTH POLICY in 1983 till 2002. The policy stress on PREVENTIVE, PUBLIC HEALTH AND REHABILITATION ASPECTS OF HEALTHCARE. It also focus on need of establishing primary health care to reach in the remote area of the country.

1. National health policy (1983-2002) MADE BY ARMY COLLEGE STUDENTS FOR MORE VISIT – www.moashassamosa.in

2. Introduction HEALTH- a state of complete physical ,mental and social well being and not merely the absence of disease or infirmity POLICY – policy is a system ,which provide the logical framework and rationality of decision making for the achievements of intended objectives

3. Continue.. HEALTH POLICY – health policy refers to decisions ,plans and actions that are undertaken to achieve specific health care goals within a society

4. National health policy 1983 Health policy is the expression of what health care system should be so that it can meet healthcare needs of the people It should stressed on creation of primary health care infrastructure , co- ordination with health related services , involvement of voluntary organizations , the provision of essential drugs and vaccines , qualitative improvement in health and family planning services

5. Objectives of national health policy 1983 Primary objective was to attain the goal of health for all by 2000AD, by establishing an effective and efficient heath care system which is accessible to all the citizens especially vulnerable groups like women , children and under privileged

6. Elements of national health policy 1983 Creation of greater awareness of health problems and means to solve problems Supply of safe drinking water and basic sanitation using technologies that people can afford To reduce the imbalance in health services by concentrating more on the rural health infrastructure

7. Continue.. Establishing health management information system to support health planning and health programme Provision of legislative support to health promotion and protection Concerned actions to combat wide spread malnutrition Research is alternative method of health care delivery and low cost technologies Co-ordination of different system of medicine

8. National health policy 1983 targets Reduction in infant mortality rate from 125 in1983 to below 60 by 2000AD To raise the life expectancy at birth from 52.6 in 1983 to 64 by 2000AD To reduce c rude birth rate from around 35 in 1983 to 21 by 2000AD To reduce the death rate from 14 in1983 to 9 by 2000AD To achieve a net reproductive rate by 1 by 2000AD To provide potable water to the entire rural population by 2000AD

9. Reasons of failure of 1983 national health policy Insufficient political commitment to implementation on HEALTH FOR ALL Failure to achieve equity in access to all primary health care elements The continuing low status of women Slow socio economic development Unbalanced distribution of and weak support for human resources

10. Continue.. Widespread inadequacy of health promotion activities Weak health information system and no baseline data Pollution , poor food safety and lack of water supply and sanitation

11. National health policy 2002

12. Introduction According to this revised policy , government and health professionals are obligated to render good health care to the society Use of health services to a large group rather than a small group

13. Objectives Achieving an acceptable standard of good health of I ndian population Decentralizing public health system by upgrading infrastructure in existing institutions Ensuring a more equitable access to health services across the social and geographical expanse of india

14. Continue.. Enhancing the contribution of private sector in providing health services 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 system of traditional medicine

15. Goals of national health policy -2002 2003 – Enactment of legislation for regulating minimum standard in clinical establishment / medical institution 2005- Eradication of polio and yaws Elimination of leprosy Increase state sector health spending from 5.5% to 7% of the budget

16. 2005- Establishment of an integrated system of surveillance , national health accounts and health statistics 1% of the total budget for medical research Decentralization of implementation of pubic health program

17. 2007- Achieve zero level growth of HIV/AIDS 2010- Elimination of K ala- A zar Reduction of mortality by 50% on account of tuberculosis , malaria , other vector and water borne disease Reduce prevalence of blindness to 0.5%

18. 2010- Reduction of IMR to 30/1000 live births and MMR to 100/ lakh live births Increase utilization of pubic health facilities from current level of <20% to > 75% increase health expenditure by government from the existing 0,9%to 2.0% of GDP Increase share of central grants to constitute at least 25% of total health spending

19. 2010- Further increase of state sector health spending from 7%to 8% 2% of the totl health nudget for medical research 2015- Elimination of lymphatic filariasis

20. Major issues 1)Inequities and imbalance –to reduce his there is increasing number of outlays for the primary health sector to strengthen existing facilities and opening additional public health services outlets 2)TB, Malaria ,HIV /AIDS-for this the central government along with the participation of state government designed national programmes , however the ultimate aim is the coverage of all health programmes for the optimum use of public health structure at the primary level

21. 3)No recipient interest – for this reviving primary health system by providing some essential drugs under central government funding through decentralized system 4)No quality services- for this strengthening of primary healthcare infrastructure to provide quality services 5) Secondary and tertiary services – for this levying of reasonable user charges , for those who can afford to pay

22. 6)Decentralization – for this the local self government will implement public health programmes and financial incentive will be provided by the central government 7)Research – foe medical research purpose , government increased the funding for medical research especially in the areas of new therapeutic drugs and vaccines for tropical diseases such as TB , MALARIA , HIV/AIDS

23. 8)Reduce accident mortality – they established trauma care networks in large urban agglomeration 9)Setting up of an organized urban primary health care structure 10)NGO to be provide a definitive portion of budget in respect of identified programmes components to be implemented by these institutions

24. 11) Strengthening of quality standards for food and drugs 12) Periodic screening of the health conditions of the workers 13)Setting up of medical grant commission for funding new medical colleges and for up gradation of the existing government medical colleges to ensure standards

25. 14)Establishing a network of decentralized mental health services and upgrading physical infrastructure so as to secure the rights of the mentally ill patients 15)Establishing IEC policy , which maximizes the dissemination of information to those population groups which can not be effectively approached through the mass media alone

26. 16)Laying priority to school health programmes aiming at preventive health education , regular health checkups and promotion of health 17) Complete baseline estimation of the incidence of TB, malaria , blindness by 2005 and periodic updating of these data 18) Need for establishing national health accounts , confirming to the “source to users” matrix structure

27. 19)Identification of specific programmes targeted at women’s health 20) A contemporary code of ethics notified and implemented by the medical council of India in order to protect the common patient from irrational or profit driven medical regimens 21) Regulation of standards in paramedical discipline to maintain the standard of their training to register them and monitor their performances

28. Policy prescriptions Financial resources –increase in health sector expenditure to 6% of GDP with 2% by public health investment by 2010 is recommended - Existing 15% of central government contribution is to be raised to 25% by 2010

29. 2)Equity To reduce the inequity in between the interregional , across the rural urban divide and between economic classes NHP 2002 has set an increased allocation of 55% total public health investment for primary health sector , 35% for secondary sector and 10% for tertiary

30. 3)Delivery of national public health programs NHP 2002 envisages the gradual convergence of all health programmes under a single field administration Ts suggest for a scientific designing of public health projects suited to the local situations Policy places reliance on strengthening of public health outcomes on equitable basis It recognizes the need of user charges for secondary and tertiary public health care foe those who can afford to pay

31. 4)Extending public health services NHP 2002 envisages that the scope of the use of paramedical manpower of allopathic discipline functions would be examined for meeting simple public health needs in an area It recognizes the need for states to simplify the recruitment procedure and rues for contract employment in order to provide trained medical manpower in underserved areas

32. 5)Role of local self government It emphasis upon the implementation of public health programmes through local self government It urges all the state governments to consider decentralizing the implementation of the programs by transfer power to such instiution by 2005

33. 6) Norms of health care professionals Minimal statutory norms with constant reviewing fir the deployment of doctors and nurses in medical institutions need to be introduced urgently under the provision of the Indian medical council act and Indian nursing council act respectively

34. 7) Education of health care professionals NHP 2002 recommends setting up of a medical grant commission for funding new medical and dental colleges The need for inclusion of contemporary medical research and geriatric concern and creation of additional PG seats in deficient specialties are specified It suggest for a need based , skilled oriented syllabus with a more significant component of practical training

35. 8)Need for specialist in “public health” and “family medicine” For discharging public health responsibilities in the country NHP 2002 recommends specialization 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

36. 9)Nursing personnel NHP 2002 recognizes acute shortage of nurses trained in superspeciality disciplines It recommends increase of nursing personnel in public health delivery centers and establishment of training courses for superspecialities

37. 10)Use of generis drugs and vaccine This policy 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 be sourced from public sector institutions

38. 11)Urban health NHP 2002 envisages the setting up of an organized urban primary health care structured It also envisages the adoption of appropriate population norms for the urban public health infrastructure In this direction , 2002 NHP has recommended an urban primary health care structure as under-

39. Continue.. First tier- primary centre cover 1lakh population It functions as OPD facilities It provides essential drugs It will carry out national health programmers 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

40. 12)Mental health Decentralized mental health services for diagnosis and treatment by general duty medical staff is recommended It also recommends securing the human rights of mentally sick

41. 13)information, education and communication NHP 2002 has suggested interpersonal communication by folk and traditional media to bring about behavioral change School children are covered for promotion of health seeking behavior , which is expected to be the most cost effective intervention where health awareness extends to family and further to future generation

42. 14)Health research The policy envisages an increase in government funded health research to a level of 1% of the total health spending by 2005 and up to 2% by 2010 New therapeutic drugs and vaccines for tropical disease are given priority

43. 15)Role of private sector # It involves the private sectors in all the areas of health activities i.e primary ,secondary and tertiary health care services # It recommended regularitory and accreditation of private sector for the conduct of clinical practice # it has suggested a social health insurance scheme for health services to the needy

44. Continue.. It urges standards protocols in day to day practice by health professionals It recommends tele medicine in tertiary care services

45. 16)Role of civil sector NHP 2002 recognizes institutions of civil society to handle disease control programme earmarking not less than 10% of the budget in respect of identified programme

46. 17) National disease surveillance network NHP 2002 noted that absence of an efficient disease surveillance network is a major handicap for cost effective health care

47. 18) Health statistics NHP 2002 has recommended full baseline estimate of TB, malaria and blindness by 2005 and in the long run for cardiovascular disease , cancer , diabetes , accidents , hepatitis It has suggested a national health accounts conforming to the source to user matrix

48. 19) women’s health The policy commits the highest priority of the central government to the identified programs relating to women’s health

49. 20) Medical ethics In India we have guidelines on professional medical ethics since 1960 This is revised in2001 Government of India has emphasized the importance of mortal and religious dilemma 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

50. 21) Enforcement of quality standards for food and drugs NHP 2002 envisaged that food and drug administration be strengthened in terms of laboratory facilities and technical expertise

51. 22) 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 Establishment of statutory professional council for paramedical disciplines is recommended

52. 23) Environmental and occupational health It envisages that the independently stated policies and programs of the environment related sectors be smoothly interfaced with the policies and the programs of the health sector Child labor and substandard working conditions are causing occupational linked ailments

53. Continue.. NHP 2002 has suggested for an independent state policy and programme for environment apart from periodic health screening for high risk associated occupation

54. 24) Providing medical facilities to users from overseas ( health tourism ) The NHP 2002 strongly encourages the providing of such health services on a payment basis to services seekers from overseas Recently large number of patients from overseas are coming to India for treatment (MEDICAL TOURISM)

55. 25) Impact of globalization on health sector With adoption of trade related intellectual property (TRIPS) government is taking steps to overcome possible adverse impact of economic globalization on the health sector NHP 2002 brings out the relevance of inter sectorial contribution to health but limits itself to making recommendations

56. Continue.. NHP 2002 touches population growth and health standards. It has suggested synchronized implementation of national population policy and national health policy in improving health standard of the country NHP 2002 focuses on building up creditablilty for the alternative systems of medicine through evidence based research and suggested a separate document

57. 26) The state of public health infrastructure It envisages the revival of the primary health system by providing some essential drugs under central government funding through the decentralized health system This belief that the creation of a decentralized public health system will ensure a more effective supervision of the public health personnel through community monitoring , than has been achieved through the regular administrative line of control

58. Recent advancement NATIONAL HEALTH POLICY 2017 – NHP of 1983 and NHP 2002 have served well in guiding the approach for the health sector in the five years plan ,now 14 years after the last health policy , a new is introduced The primary aim of the NHP 2017 is to inform clarify , strengthen and prioritize the role of the government in shaping health system in all its dimensions

59. Objectives Progressively achieve universal health coverage – assuring availability of free , comprehensive primary health care services , for all aspects of reproductive , maternal ,child and adolescent health and for the most prevalent communicable and non communicable disease , occupational disease in the population - Ensuring improved access and affordability of quality secondary and tertiary care services

60. 2)Reinforcing trust in public health care system It can be done by making it predictable , efficient , patient centric , affordable and effective with a comprehensive package of services and products that meet immediate health care needs of most people

61. 3)Align the growth of private health care sector with public health goals Enable private sector contribution to making health care system more effective , efficient , rational , safe , affordable and ethical

62. Specific goals and objectives 1) health status and programme impact – Life expectancy and healthy life –increase life expectancy at birth from 67.5 to 70 by 2025 Mortality by age and cause- reduce under five mortality to 23 by 2025 and MMR from current levels to 100 by 2020 Reduce infant mortality rate at 28 by 2019 Reduce neonatal mortality to 16 and still birth rate to single digit

63. Continue.. Reduction of the disease – achieved global target of 2020 is also termed as target of 90:90:90:for HIV/AIDS Achieved elimination status of leprosy by 2015 , kala azar by 2017 and lymphatic filariasis in endemic pockets by 2017 To achieve and maintain a cure rate >85% in new sputum positive cases for TB and reduced incidence of new cases

64. Continue.. Reduce prevalence of blindness to 0.25/1000 by 2025 To reduce premature mortality rate for cardiovascular disease , cancer , diabetes or chronic disease by 25%by 2025

65. 2)Health system performance Coverage of health services – -Increased utilization of public health facility by 50% from current levels by 2025 -Antenatal care coverage to be sustained above 90% and skill attendance at birth above 90 by 2025 - Mora then 90% of the newborn are fully immunized by one year of age by 2025 - Meet need of family planning above 90% at national and sub national level by 2025

66. Needs of the new policy 1) health priorities are changing there is growing burden on account of non communicable disease and some infectious disease 2) Emergence of a robust health care industry estimated to be growing at double digit 3) Increasing healthcare cost 4) A rising economic growth

67. RESEARCH STUDIES India’s draft national health policy , 2015 improving policy to implementation effectiveness Nata menable and chanfrakant lahariya This editorial reviews the draft national haelth policy 2015 and purposes a few steps to improve implementation effectiveness. There are many persisting challenges such as , health services are quantitatively inadequate and quality often not known , low public expenditure , the burden of non communicable diseases

68. The goal ;health for all the commitment : all for health ,2004 , the editors , mens sana monographs , mumbai Primary health care was the means by which health for all by the year 2000AD was to be achieved and health for all was possible only if all were mobilized foe health. This meant not just government and medical establishments , but people themselves

69. Conclusion This comes as a short notes of 5 marks It has been came in2015, 2012 year question paper

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71. Thank you