National health policy

National Health Policy in India 1983, 2000, 2002 and 2017.
helpfull for GNM, B.Sc. Nursing and post Basic B. Sc. Nursing student

1. NATIONAL HEALTH POLICY BY : RINKAL PATEL

2. INTRODUCTION The ministry of health & family welfare, Government of India, made National Health Policy in 1983 to attain the health for all by the year 2002. The main objective of policy is to achieve an acceptable standard of good health amongst the general population of the country. The policy laid stress on the preventive, promotive, public health and rehabilitation aspects of care of health.

3. ELEMENTS OF HEALTH POLICY Solving of Health Problems. Supply of drinking water and basic sanitation, using technologies that the people can afford. Reduction of existing imbalance in health services by increasing Rural Infrastructure. Establishment of HIS (Health Information System). Provision of legislature support to health projection and health promotion. Concerted actions to combat widespread malnutrition. Research into alternative methods of health care delivery and low cost health technologies. Greater coordination of different systems of medicine.

4. COMPONENTS OF HEALTH POLICY Reduction of region disparities. Fuller employment. Elementary education. Integrated rural development. Population control. Welfare of women and children.

5. HEALTH STRATEGIES Restructuring of the health infrastructure. Development of health manpower. Research and development.

6. NEED FOR NATIONAL HEALTH POLICY Population stabilization. Medical and health education. Providing primary health care with special emphasis on the preventive, promotive and rehabilitative aspects. Reorientation of the existing health personnel. Practitioners of indigenous and other systems of medicine and their role in health care.

7. NATIONAL HEALTH POLICY-1983

8. To attain the objectives of health for all by 2000 AD. the union ministry of health & family welfare National Health Policy in 1983. In this policy objectives were fixed for the year……. 1985 1950 2000

9. National health policy 2000

10. Ministry of Health & Family Welfare declared new population policy on 15 th Feb, 2000 amending the policies declared earlier. New demographic objectives are defined in this policy.

11. National health policy 2002

12. National health policy 2002 has been formulated and accepted by Central Government in September 2002. It has five imp. Parts.. Introduction Current scenario Objectives Nhp-2002 policy prescriptions Summations.

13. 1. Introduction It emphasizes the importance of the basic philosophy, adopted by the Government of India towards health sector that is “India is committed to attain the goal of ‘Health for all, by year 2000 AD’”. Through the universal population of comprehensive primary health care services.

14. 2. Current Scenario This the 2 nd part of NHP-2002. It gives detailed information about present situation problem and future challenges of the various aspects of all health sector.

15. 3. Objectives To establish health care services with in the reach of population residing in remote areas. To view health and human developments as vital components of overall socioeconomic development.

16. Decentralize To decentralize health care delivery system with maximum and individual participation. To strengthen the capacity of the public health administration at the state level.

17. NHP-2002 POLICY PRESCRIPTIONS A brief account of policy prescriptions are given here:-

18. Financial resources:- The central Gov. will have to play a key role in augmenting public health & investment by the year 2010. Taking into account the gap in health care facilities, it is planned, under the policy to increase health, sector expenditure to 6% of GDP, with 2% of GDP being contributed as public health investment by the year 2010.

19. Equity:- To meet the objectives of reducing various types inequalities and imbalances interregional across the rural urban divide and between economic classes the most cost effective method would be to increase the sectoral outlay in the primary health sector.

20. Delivery of National Policy Health programme:- it envisages key role for the central gov. in designing national programmes with the active participation of the state gov. To optimize the utilization of the public health infrastructure at the primary level, NHP-2002 envisages the gradual convergence of all health programmes under a single filled administration. The policy also highlights the need for developing the capacity within the state public health administration for scientific designing of public health projects, suited to the local situation. It envisages that apart from the exclusive staff in a vertical structure for the diseases control programmes all rural health staff should be available for the entire range of public health activities at the decentralized level, irrespective of whether these activities are related to national programmes or other public health initiatives.

21. The state of public infrastructure This policy recognizes the need for frequent in service training of public health medical personal, at the level of medical officers as well as paramedics. Global experience has shown that the quality of public health services, as reflected in the attainment of improved public health indices is closely linked to the quantum and quality of investment through public funding in the primary health sector.

22. Role of local self government institutions:- It 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.

23. Norms for the health Care personal:- Mimumal statutory norms for the deployment of doctor’s & nurses in medical institution need to be introduce urgently under the provisional of Indian Medical Council, and Indian Nursing Council.

24. Education of the health care profaners:- This policy envisages the setting of a medical grand commotions fro funding a new government medical & dental collage in different parts of the countries. Enable fresh graduates to contribute effectively for providing primary health services and physician of first contact this policy is identifiable a significant need to modified to existing circular.

25. Need for specialist:- in public health & family medicine:- In order to acute shortage of medical personal with specialization in the discipline of public health & family medicine. The policy envisages the progressive implementation on mandatory norms to raise the proportion of post gradate sheet in the discipline in medical training institutions.

26. Nursing personal In the interest of the patient care the policy emphazise the need for and improvement in a ratio of nurses & doctor’s per beds. In order to discharge their responsibility as model provider of health services. The public health delivery centers need to made in beginning by increasing the number of nursing personal. The policy emphasized on increase the skill level of nurses and on increasing the ratio of the degree holding nurses vs diploma holding nurses.

27. Use of generic drugs and vaccines:- This policy emphasizes the need for basic treatment regimens, in both the public and private, domain, on a limited number of essential drugs of a generic nature. This is pre-requisite for cost effective public health care. The national programme for universal immunization against preventable diseases requires to be assured of an uninterrupted supply of vaccines at an affordable priece .

28. Urban health It envisages the setting up an organized urban primary health care structure. Since the physical features of urban settings are different from those in rural areas, it envisages the adoption of appropriate population norms for the urban public health infrastructure. It also envisaged the establishment of fully equipped ‘hub spoke’ trauma care networks in large urban agglomerations to reduce to accident mortality.

29. Mental health It envisages a network of decentralization mental health services. In regular to mental health institutes for in door treatment of patients, the policy envisaged the upgrading of the physical infrastructure of such institutions at central Gov. expense.

30. Information, education & communication It envisages the IEC policy, which maximizes the dissemination of information to those population groups which can not using only the mass media. It would set specific targets for the association of NGOs/ trusts in such activities. It gives priority to school health programme.

31. Health Research:- Domestic medical research would be focused on new therapeutic drugs and vaccines for tropical disease.

32. Role of the private sector:- It welcome the participation of the private sector in all areas of health activities. NHP-2002 envisages the cooperation of the non- gov practitioners in the national disease control programmes.

33. The role of civil society:- NHP-2002 recognizes the significant contribution made by NGOs and other institutions of the civil society in making available health services to the community.

34. Health Statistics:- It envisages the completion of baseline estimates for the incidence of the common disease- T.B., Malaria, Blindness by 2005.

35. Woman’s Health NHP-2002 envisages the identification of specific of specific programme targeted at women health.

36. Regulation of standards in paramedical disciplines:- It recognizes the need or the establishments of statutory protssionals councils for paramedical disciplines to register practitioners, maintain standards of training, and monitor performance.

37. Environment & occupational Health:- It envisaged the independently stated policies and programs of the environment related sectors be smoothly interfaced with the policies and the programme of the health sector, in order to reduce the health risk.

38. NATIONAL HEALTH POLICY-2017

39. INTRODUCTION The National Health Policy of 1983 and the National Health Policy of 2002 have served well in guiding the approach for the health sector in the Five-Year Plans. Now 14 years after the last health policy, the context has changed in four major ways. First, the health priorities are changing. Although maternal and child mortality have rapidly declined, there is growing burden on account of noncommunicable diseases and some infectious diseases. The second important change is the emergence of a robust health care industry estimated to be growing at double digit. The third change is the growing incidences of catastrophic expenditure due to health care costs, which are presently estimated to be one of the major contributors to poverty. Fourth, a rising economic growth enables enhanced fiscal capacity. Therefore, a new health policy responsive to these contextual changes is required.

40. The primary aim of the National Health Policy, 2017, is to inform, clarify, strengthen and prioritize the role of the Government in shaping health systems in all its dimensions- investments in health, organization of healthcare services, prevention of diseases and promotion of good health through cross sectoral actions, access to technologies, developing human resources, encouraging medical pluralism, building knowledge base, developing better financial protection strategies, strengthening regulation and health assurance.

41. NHP 2017 builds on the progress made since the last NHP 2002. The developments have been captured in the document “Backdrop to National Health Policy 2017- Situation Analyses”, Ministry of Health & Family Welfare, Government of India.

42. Goal The policy envisages as its goal the attainment of the highest possible level of health and wellbeing for all at all ages, through a preventive and promotive health care orientation in all developmental policies, and universal access to good quality health care services without anyone having to face financial hardship as a consequence. This would be achieved through increasing access, improving quality and lowering the cost of healthcare delivery.

43. The policy recognizes the pivotal importance of Sustainable Development Goals (SDGs). An indicative list of time bound quantitative goals aligned to ongoing national efforts as well as the global strategic directions is detailed at the end of this section.

44. Key Policy Principles I . Professionalism, Integrity and Ethics: The health policy commits itself to the highest professional standards, integrity and ethics to be maintained in the entire system of health care 2 delivery in the country, supported by a credible, transparent and responsible regulatory environment. II . Equity: Reducing inequity would mean affirmative action to reach the poorest. It would mean minimizing disparity on account of gender, poverty, caste, disability, other forms of social exclusion and geographical barriers. It would imply greater investments and financial protection for the poor who suffer the largest burden of disease.

45. III. Affordability: As costs of care increases, affordability, as distinct from equity, requires emphasis. Catastrophic household health care expenditures defined as health expenditure exceeding 10% of its total monthly consumption expenditure or 40% of its monthly non-food consumption expenditure, are unacceptable. IV. Universality: Prevention of exclusions on social, economic or on grounds of current health status. In this backdrop, systems and services are envisaged to be designed to cater to the entire population- including special groups.

46. V. Patient Centered & Quality of Care: Gender sensitive, effective, safe, and convenient healthcare services to be provided with dignity and confidentiality. There is need to evolve and disseminate standards and guidelines for all levels of facilities and a system to ensure that the quality of healthcare is not compromised. VI. Accountability: Financial and performance accountability, transparency in decision making, and elimination of corruption in health care systems, both in public and private.

47. VII. Inclusive Partnerships: A multistakeholder approach with partnership & participation of all nonhealth ministries and communities. This approach would include partnerships with academic institutions, not for profit agencies, and health care industry as well. VIII. Pluralism: Patients who so choose and when appropriate, would have access to AYUSH care providers based on documented and validated local, home and community based practices. These systems, inter alia, would also have Government support in research and supervision to develop and enrich their contribution to meeting the national health goals and objectives through integrative practices.

48. IX. Decentralization: Decentralization of decision making to a level as is consistent with practical considerations and institutional capacity. Community participation in health planning processes, to be promoted side by side. X. Dynamism and Adaptiveness: constantly improving dynamic organization of health care based on new knowledge and evidence with learning from the communities and from national and international knowledge partners is designed.

49. Health Status and Programme Impact Life Expectancy and healthy life a. Increase Life Expectancy at birth from 67.5 to 70 by 2025. b. Establish regular tracking of Disability Adjusted Life Years (DALY) Index as a measure of burden of disease and its trends by major categories by 2022. c. Reduction of TFR to 2.1 at national and sub-national level by 2025.

50. Mortality by Age and/ or cause a. Reduce Under Five Mortality to 23 by 2025 and MMR from current levels to 100 by 2020. b. Reduce infant mortality rate to 28 by 2019. c. Reduce neo-natal mortality to 16 and still birth rate to “single digit” by 2025.

51. Reduction of disease prevalence/ incidence a. Achieve global target of 2020 which is also termed as target of 90:90:90, for HIV/AIDS i . e,- 90% of all people living with HIV know their HIV status, - 90% of all people diagnosed with HIV infection receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have viral suppression. b. Achieve and maintain elimination status of Leprosy by 2018, Kala- Azar by 2017 and Lymphatic Filariasis in endemic pockets by 2017. c. To achieve and maintain a cure rate of >85% in new sputum positive patients for TB and reduce incidence of new cases, to reach elimination status by 2025. d. To reduce the prevalence of blindness to 0.25/ 1000 by 2025 and disease burden by one third from current levels. e. To reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by 25% by 2025.

52. Health Systems Performance Coverage of Health Services a. Increase utilization of public health facilities by 50% from current levels by 2025. b. Antenatal care coverage to be sustained above 90% and skilled attendance at birth above 90% by 2025. c. More than 90% of the newborn are fully immunized by one year of age by 2025. d. Meet need of family planning above 90% at national and sub national level by 2025. 5 e. 80% of known hypertensive and diabetic individuals at household level maintain „controlled disease status‟ by 2025.

53. Cross Sectoral goals related to health a. Relative reduction in prevalence of current tobacco use by 15% by 2020 and 30% by 2025. b. Reduction of 40% in prevalence of stunting of under-five children by 2025. c. Access to safe water and sanitation to all by 2020 (Swachh Bharat Mission). d. Reduction of occupational injury by half from current levels of 334 per lakh agricultural workers by 2020. e. National/ State level tracking of selected health behaviour.

54. Health Systems strengthening Health finance a. Increase health expenditure by Government as a percentage of GDP from the existing 1.15% to 2.5 % by 2025. b. Increase State sector health spending to > 8% of their budget by 2020. c. Decrease in proportion of households facing catastrophic health expenditure from the current levels by 25%, by 2025.

55. Health Infrastructure and Human Resource a. Ensure availability of paramedics and doctors as per Indian Public Health Standard (IPHS) norm in high priority districts by 2020. b. Increase community health volunteers to population ratio as per IPHS norm, in high priority districts by 2025. c. Establish primary and secondary care facility as per norms in high priority districts (population as well as time to reach norms) by 2025.

56. Health Management Information a. Ensure district-level electronic database of information on health system components by 2020. b. Strengthen the health surveillance system and establish registries for diseases of public health importance by 2020. c. Establish federated integrated health information architecture, Health Information Exchanges and National Health Information Network by 2025.

57. Policy Thrust Ensuring Adequate Investment The policy proposes a potentially achievable target of raising public health expenditure to 2.5% of the GDP in a time bound manner. It envisages that the resource allocation to States will be linked with State development indicators, absorptive capacity and financial indicators. The States would be incentivised for incremental State resources for public health expenditure. General taxation will remain the predominant means for financing care.

58. Preventive and Promotive Health The policy articulates to institutionalize inter- sectoral coordination at national and sub-national levels to optimize health outcomes, through constitution of bodies that have representation from relevant non-health ministries. This is in line with the emergent international “Health in All” approach as complement to Health for All. The policy prerequisite is for an empowered public health cadre to address social determinants of health effectively, by enforcing regulatory provisions.

59. The policy identifies coordinated action on seven priority areas for improving the environment for health: The Swachh Bharat Abhiyan Balanced, healthy diets and regular exercises. Addressing tobacco, alcohol and substance abuse Yatri Suraksha – preventing deaths due to rail and road traffic accidents Nirbhaya Nari –action against gender violence Reduced stress and improved safety in the work place Reducing indoor and outdoor air pollution

60. Organization of Public Health Care Delivery: In primary care – from selective care to assured comprehensive care with linkages to referral hospitals In secondary and tertiary care – from an input oriented to an output based strategic purchasing In public hospitals – from user fees & cost recovery to assured free drugs, diagnostic and emergency services to all In infrastructure and human resource development – from normative approach to targeted approach to reach under-serviced areas

61. In urban health – from token interventions to on-scale assured interventions, to organize Primary Health Care delivery and referral support for urban poor. Collaboration with other sectors to address wider determinants of urban health is advocated. In National Health Programmes – integration with health systems for programme effectiveness and in turn contributing to strengthening of health systems for efficiency. In AYUSH services – from stand-alone to a three dimensional mainstreaming