National health policy 2017

national health policy --2017---by Ramya Saju

1. RAMYA K A MSc Nursing Govt. College Of Nursing Kozhikode WELCOME

2. POLICY Policy is a system which provides the logical frame work and rationality for decision making for the achievements of intended objectives

3. Health policy Health policy of a nation is its strategy for controlling and optimizing the social use of its health knowledge and social resources.

4. "A health policy generally describes funda -mental principles regarding which health providers are expected to make value decisions.

5. Simon Commission 1927 A commission(1927 ) under Sir John Simon, sent to India to examine the effects of Montague-Chelmsford Reforms(1919) A scheme of constitutional reforms, on the basis of recommendations of Simon Commission was prepared by the Government. The Congress and Muslim League both refused the recommendations

6. Government of India Act 1935. The recommendations of round table conferences published in 1933. Report of committee published in 1934 in a Bill of Law. After approval of British parliament, the Bill enforced as Government of India Act,1935. The Act contained, 14 parts and 10 Schedules, consisted of two parts

7. The  Government of India Act 1935  was the last constitution of British  India . It lasted until 1947, when British  India  was split into Pakistan and  India . The  act . Gave  Indian  provinces more independence. It allowed the establishment of an All  India Federation.

8. In 1938 the Indian National Congress established a National Planning Committee (NPC) under Jawaharlal Nehru. Its report, published in 1948, it was not as well studied and it lacked in detailed analysis of the existing health situation as well as of the future plans

9. PLANNING COMMISSION • The planning commission is an organization in the government of India which formulates India's five year plan . • It was Set up on 15 Mar, 1950 with prime minister Jawaharlal Nehru as the chairman.

10. National health committees National planning commission Five year plans National health policy

11. Health policy formulation in India Ministry of health identified the need for policy arising out of handling the day to day problems related to various health programs and commitment to achieving the goal of HFA BY 2000 AD. After that ministry appointed committee to review the environment in health sector and recommended a policy frame after needful consultation

12. After that cabinet approved the document presented in the national parliament for ratification in December 1982 NHP 1983,in a spirit of optimistic empathy for health need of the people, particularly poor and under privileged ,health for all by 2000AD” through comprehensive and primary health care.

13. Success of NHP 1983 Small pox and guinea worm diseases have been eradicated from India. Polio is on the verge of being eradicated. Leprosy , Kala Azar and Filariasis can be expected to be eliminated in future

14. Drawback of NHP 1983

15. Achievements through the year 1951-2000

16. Goals of NHP 2002

17. ACHIEVEMENTS OF NHP

18. Critical review about NHP 2002

19. WEAKNESS OF NHP 2002 Lack of monitoring and evaluation Lack of govt. expenditure on public health

20. NATIONAL HEALTH POLICY 2017

21. Health priority Burden of non communicable diseases Emergence of robust health care industry Increased health care cost Increased fiscal capacity

22. Primary aim of NHP Inform , strengthen ,clarify and prioritize the role of government in shaping health system in all dimensions. . --Organization of health care service. promotion of health ,prevention of diseases, building knowledge and better financial protection

23. Goal Attainment of highest possible level of health and well being for all at all age groups.

24. Key policy principles Professionalism. integrity and ethics Equity Affordability Universality Patient centered and quality care Accountability Inclusive partnership

25. Pluralism(AYUSH) Decentralization Dynamism and adaptiveness

26. Objective Improve health status through corrected policy action in all sections. Progressively achieve universal health coverage --Assuring avilability of free, comprehensive primary health care services. --Ensuring improved access and affordability. --Reduce health care cost

27. B) Reinforcing trust in health care system C)Align the growth of private health care sector with public health goal

28. Specific Quantitative Goals and Objectives The indicative, quantitative goals and objectives Health status and programme impact. (b) Health systems performance (c) Health system strengthening.

29. Health status and programme impact. 1.Life Expectancy and healthy life . Increase Life Expectancy at birth from 67.5 to 70 by 2025 Establish regular tracking of Disability Adjusted Life Years (DALY )by 2022 Reduction of TFR to 2.1 at national and sub-national level by 2025

30. 2.Mortality by Age a. Reduce Under Five Mortality to 23 by 2025 and MMR from current levels to100 by 2020 b. Reduce infant mortality rate to 28 by 2019 c. Reduce neonatal mortality to 16 and still birth rate to “single digit” by 2025.

31. 3. Reduction of disease prevalence/ incidence Achieve global target of 2020 which is also termed as target of 90:90:90, for HIV/AIDS b. Achieve and maintain eliminationstatus of Leprosyby 2018, Kala- Azar by 2017 and Lymphatic Filariasis in endemic pockets by 2017

32. 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

33. Health Systems Performance 1.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.

34. d. Meet need of family planning above 90% at national and sub national level by 2025. e. 80% of known hypertensive and diabetic individuals at household level maintaine , controlled disease status by 2025

35. 2. 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)

36. c. 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

37. Health Systems strengthening 1.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.

38. 2 Health Infrastructure and Human Resource 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.

39. 3. 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.

40. 3.POLICY THRUST 1.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.

41. 2. Preventive and Promotive Health The policy articulates to institutionalize intersectoral coordination at national and sub national levels to optimize health outcomes The policy identifies coordinated action on seven priority areas are

42. 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

43. 3.Organization of Public Health Care Delivery Primary Care Services and Continuity of Care : This policy denotes important change from very selective to comprehensive primary health care --geriatric health care, palliative care and rehabilitative care services(Health and Wellness Centers ) Upgradation of the existing subcentres and reorienting PHCs AYUSH health care services Research and validation of tribal medicines.

44. Secondary Care Services The policy aspires to provide at the district level At least two beds per thousand population distributed in such a way that it is accessible within golden hour rule. Resource allocation This expanding the network of blood

45. Reorienting Public Hospitals Free drugs and diagnostics with suitable leeway to the States to suit their context. Need for an information system with comprehensive data on availability and utilization of services not only in public hospitals but also in nongovernment sector hospital.

46. Closing Infrastructure and Human Resources/Skill Gaps Financing for additional infrastructure or human resources would be based on needs of outpatient and inpatient attendance and of key services in a measurable manner.

47. Urban Health Care Addressing the primary health care needs of the urban population with special focus on poor populations living in listed and unlisted slums AYUSH personnel

48. 4.National Health Programmes 1.RMNCH+A services 2. Child and Adolescent Health. 3.Interventions to Address Malnutrition and Micronutrient Deficiencies. 4. Universal Immunization

49. 5. Communicable Diseases . a. Control of Tuberculosis b. Control of HIV/AIDS C. Leprosy Elimination d. Vector Borne Disease Control

50. 6. Non-communicable diseases 7. Mental health 8. Population stabilization

51. Women’s Health & Gender Mainstreaming Provisions for reproductive morbidities and health needs of women beyond the reproductive age group

52. Gender based violence (GBV) Making public hospitals more women friendly Recommends that the health care to the survivors/ victims need to be provided free and with dignity in the public and private sector.

53. Supportive Supervision For supportive supervision in more vulnerable districts . Digital tools and HR strategies like using nurse trainers to support field workers.

54. Emergency Care and Disaster Preparedness The policy supports development of earthquake and cyclone resistant health infrastructure in vulnerable geographies Unified emergency response system One per 30 lakh population in urban areas and One for every 10 lakh population in rural areas

55. Mainstreaming the Potential of AYUSH Yoga would be introduced much more widely in school and work places as part of promotion of good health as adopted in National AYUSH Mission (NAM). Linking AYUSH systems with ASHAs and VHSNCs would be an important plank of this policy The policy seeks to strengthen steps for farming of herbal plants

56. Tertiary care Services It recommends that the Government should set up new Medical Colleges, Nursing Institutions and AIIMS in the country. The policy enunciates the core principle of societal obligation on the part of private institutions to be followed. This would include-- Operationalization of mechanisms for referral from public health system to charitable hospitals --Ensuring that deserving patients can be admitted on designated free / subsidized beds

57. Human Resources for Health: 1. Medical Education 2. Attracting and Retaining Doctors in Remote Areas 3. Specialist Attraction and Retention The policy recommends that the National Board of Examinations should expand the post graduate training up to the district level. The policy recommends creation of a large number of distance and continuing education options for general practitioners in both the private and the public sectors, which would upgrade their skills to manage the large majority of cases at local level, thus avoiding unnecessary referral

58. 4. Mid Level Service Providers Locale based selection, a special curriculum of training close to the place where they live and work conditional licensing, enabling legal framework and a positive practice environment will ensure that this new cadre is preferentially available where they are needed most.

59. 5.Nursing Education 6. ASHA 7. Paramedical Skills. 8. Public Health Management Cadre 9.Human Resource Governance and leadership development

60. Financing of Health Care The existing Government financed health insurance schemes shall be aligned to cover selected benefit package of secondary and tertiary care services purchased from public, not for profit and private sector in the same order of preference subject to availability of quality services on time as per defined norms.

61. 1.Purchasing of Healthcare Services The payments will be made by the trust/society on a reimbursement basis for services provided.

62. Collaboration with Non Government Sector/Engagement with private sector The policy advocates for contracting of private sector in the following activities: 1.Capacity building 2. Skill Development programmes 3. Corporate Social Responsibility (CSR) 4. Mental healthcare programmes

63. 5.Disaster Management 6. Strategic Purchasing as Stewardship 7. Enhancing accessibility in private sector 8. Role in Immunization 9. Disease Surveillance 10. Tissue and organ transplantations

64. Regulatory Framework Professional Education Regulation 2. Regulation of Clinical Establishments 3. Food Safety 4. Drug Regulation 5. Medical Devices Regulation 6. Clinical Trial Regulation 7. Pricing Drugs, Medical Devices and Equipment

65. Vaccine Safety it recommends building more public sector manufacturing units to generate healthy competition; uninterrupted supply of quality vaccines, developing innovative financing and creating assured supply mechanisms with built in flexibility

66. Medical Technologies It ensure available good quality, free essential and generic drugs and diagnostics, at public health care facilities is the most effective way for achieving the goal

67. Public Procurement It ensure well developed public procurement system.

68. Aligning other policies for medical devices and equipment with public health goals The policy accords special focus on production of Active Pharmaceutical Ingredient (API) which is the back bone of the generic formulations industry.

69. Improving Public Sector Capacity for Manufacturing Essential Drugs and Vaccines Prioritises establishing sufficient labeling and packaging requirements on part of industry, adequate medical devices testing facility and effective port -clearance mechanisms for medical products.

70. Antimicrobial resistance standardization of guidelines, regarding antibiotic use, limiting the use of antibiotics

71. Health Technology Assessment The National Health Policy commits to the development of institutional framework and capacity for Health Technology Assessment and adoption

72. Digital Health Technology Eco System \ National Digital Health Authority (NDHA) will be set up to regulate, develop and deploy digital health across the continuum of care. The policy advocates extensive deployment of digital tools for improving the efficiency and outcome of the healthcare system

73. Health Surveys The policy recommends rapid programme appraisals and periodic disease specific surveys to monitor the impact of public health and disease interventions using digital tools for epidemiological surveys

74. Health Research The National Health Policy recognizes the key role that health research plays in the development of a nations health.

75. Governance Role of Centre & State Role of Panchayati Raj Institutions

76. Legal Framework for Health Care and Health Pathway Excellent health care system needs to be in place to ensure effective implementation of the health rights at the grassroots level. Right to health cannot be perceived unless the basic health infrastructure like doctor-patient ratio, patient-bed ratio, nurses-patient ratio, etc are near or above threshold levels and uniformly spread-out across the geographical frontiers of the country.

77. Implementation Framework and Way Forward A policy is only as good as its implementation. The National Health Policy envisages that an implementation framework be put in place to deliver on these policy commitments. Such an implementation framework would provide a roadmap with clear deliverables and milestones to achieve the goals of the policy.

78. THANK YOU