National health policy

National health policy 1983,2001,2015

1. Dr. Priyanka Ravi III yr MDS Dept of Public Health Dentistry 1 NATIONAL HEALTH POLICY

2. CONTENTS INTRODUCTION HISTORY BASIC CONSIDERATIONS HEALTHCARE SYSTEM OVERVIEW NATIONAL HEALTH POLICY – 1983 NATIONAL HEALTH POLICY – 2001 ORAL HEALTH POLICY IN INDIA DRAFT OF NATIONAL HEALTH POLICY 2015 SUMMARY CONCLUSION REFERNCES 2

3. INTRODUCTION India is drawing the world’s attention, not only because of its population explosion but also because of its prevailing as well as emerging health profile and profound political, economic and social transformations. Despite several growth orientated policies adopted by the government, the widening economic, regional and gender disparities are posing challenges for the health sector. 3 Kulkarni A.P, Baride J.P, Doke P.P, Mulay P.Y. Text book of Community Medicine. Ch-15 Health Care in India- Part A. 4 th ed. Mumbai: Vora Medical Publications; 2013.

4. 75 % of health infrastructure , medical man power and other health resources are concentrated - urban areas where 27% of the populations live (Inverse care law). India has traditionally been a rural, agrarian economy . Nearly three quarters of the population, currently 1.2 billion, still live in rural areas. 4 Kulkarni A.P, Baride J.P, Doke P.P, Mulay P.Y. Text book of Community Medicine. Ch-15 Health Care in India- Part A. 4 th ed. Mumbai: Vora Medical Publications; 2013.

5. National health programs are launched by the government of India for control/ eradication of communicable disease, environmental sanitation, nutrition, population control and rural health . The National Health Policy 2002 (NHP2002) reviews the improvement in demographic trends, control of infectious diseases and growth of infrastructure, between 1981 and 2000. NHP 2002 envisages that by 2010 the public investment in health would reach 2% of the GDP. 5 Kulkarni A.P, Baride J.P, Doke P.P, Mulay P.Y. Text book of Community Medicine. Ch-15 Health Care in India- Part A. 4 th ed. Mumbai: Vora Medical Publications; 2013.

6. HISTORY 6

7. HISTORY Health planning in India can be seen as pre and post independence. Health planning in India - Pre independence Health planning in India - Post independence 7 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

8. Health planning in India – Pre independence 8 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013.  Local body act - for transferring and entrusting the responsibility for the health and sanitation of the people to the local authorities. For the purpose of providing basic frame work for the growth of public health policy and its administration. An Act to make provision for advancing the Public Health of the (State)* of Madras.

9. The British government established certain bureaus/ Institutions 9 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

10. The most comprehensive health policy was prepared in India on the eve of Independence in 1946 . This was the ‘Health Survey and Development Committee Report ’ popularly referred to as the Bhore Committee . This Committee prepared a detailed plan of a National Health Service for the country, which would provide a universal coverage to the entire population free of charges through a comprehensive state run salaried health service. 10 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013.  HISTORY

11. Health planning in India -Post independence 11 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

12. National health committees 12 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013.  1.Consolidation of advances made in first 2 Five years plans 2. Strengthening of district hospital with specialty services 3.Regional organization in each state 4. 1PHC=40000 population 5.Integration of medical and health services 6 . Constitution of All India Health Services Arrangement necessary for the maintenance phase of National Malaria Eradication Program. Appointed to review the strategy for the family planning program. Worked out for the details of BASIC HEALTH SERVICE Committee on integration of Health Services 1.Unififed cadre 2.Common seniority 3. Recognition of extra qualification 4. Equal pay for equal work 5. No private practice and good service condition. Committee on Multipurpose workers under health and family planning Group on Medical education and support manpower Involvement of medical college+PHC Reorientation training of multipurpose workers into unipurpose workers. Evolved fairly specific targets and indices to be achieved in the country by 2000 AD.

13. In the Five Year Plans, the health sector constituted schemes that had targets to be fulfilled. During the first two Five Year Plans the basic structural framework of the public health care delivery system remained unchanged . To evaluate the progress made in the first two plans and to draw up recommendations for the future path of development of health services the Mudaliar Committee was set up. 13 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013.  HISTORY

14. 1950s and 1960s - focus of the health sector was to manage epidemics. Mass campaigns - eradicate various diseases. 14 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013.  HISTORY

15. Separate countrywide campaigns with a techno-centric approach were launched against malaria , smallpox , tuberculosis , leprosy , filaria , trachoma and cholera . In India until 1983 there was no formal health policy statement. 15 HISTORY

16. BASIC CONSIDERATIONS 16

17. HEALTH Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. 17 Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya ( Medi ) Publishing House; 2013.

18. ORAL HEALTH The World Health Organization defines oral health as a “state of being free from chronic mouth and facial pain, oral and throat cancer, oral sores, birth defects such as cleft lip and palate, periodontal (gum) disease, tooth decay and tooth loss, and other diseases and disorders that affect the oral cavity”. 18 Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya ( Medi ) Publishing House; 2013.

19. POLICY Course or principle of action adopted by the Government . HEALTH POLICY Is an statement of an authority adopted by the Government or public in order to improve the health services. NATIONAL HEALTH POLICY It is an expression of goals for improving the health, the priorities among these goals, and the main directions for attaining them for a nation. 19

20. HEALTHCARE Multitude of services rendered to individuals, families or communities by the agents of the health services or professions, for the purpose of promoting, maintaining, monitoring or restoring health. 20

21. HEALTHCARE SYSTEM OVERVIEW 21

22. 22 Cabinet minister Minister of state Deputy health minister (Secretary of Govt of India – as executive head) - Director General of health services - Additional Director -Union Health minister – Chairman -State health ministers- members Minister and Deputy Minister of Health and Family welfare - Health Secretariat –official organ Director of Health Services Collector Assistant Collector Tehsildar Block Development officer Municipal Board Chairman Institution Of Rural Local Self Government

23. PANCHYATI RAJ It is a 3-tier structure of rural local self-government in India. It links the villages to the districts 23

24. HEALTH CARE SYSTEM PUBLIC HEALTH SECTOR PRIMARY HEALTH CARE PRIMARTY HEALTH CENTRES SUB- CENTRTES HOSPITALS/ HEALTH CENTERS COMMUNITY HEALTH CENTRES RURAL HOSPITALS DISTRICT HOSPITALS SPECIALIST HOSPITALS TEACHING HOSPITALS HEALTH INSURANCE SCHEMES EMPPLOYEES STATE INSURANCE CENTRAL GOVERNMENT HEALTH SCHEME OTHER AGENCIES DEFENCE SERVICES RAILWAYS PRIVATE HEALTH SECTOR PRIVATE HOSPITALS, POLYCYLINICS, NURSING HOMES AND DISPENSARIES GENERAL PRACTITIONERS AND CLINICS INDIGENOUS SYSTEMS OF MEDICINE AYURVEDA AND SIDDHA UNNAI AND TIBBI HOMEOPATHY UNREGISTERED PRACTITIONERS VOLUNTARY HEALTH AGENCIES NATIONAL HEALTH PROGRAMMES 24

25. Healthcare is one of India's largest service sectors. There has been a rise in both communicable/infectious diseases and non-communicable diseases, including chronic diseases. 25 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

26. P oliomyelitis , leprosy, and neonatal tetanus will soon be eliminated . S ome infectious diseases like dengue fever, viral hepatitis, tuberculosis, malaria and pneumonia have developed a stubborn resistance to drugs. 26 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

27. As Indians live more affluent lives and adopt unhealthy diets that are high in fat and sugar The country is experiencing a rapidly rising trend in non-communicable diseases such as hypertension, cancer, and diabetes. 27 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

28. In addition, the growing elderly population along with growing diseases will place an alert on India’s healthcare systems and services. 28 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

29. There are considerable shortages of hospital beds and trained medical staff such as doctors and nurses, and as a result public accessibility is reduced. 29 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

30. There is also a considerable rural-urban imbalance in which accessibility is significantly lower in rural compared to urban areas. Women are under-represented in the healthcare workforce. 30 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

31. NATIONAL HEALTH POLICY 31

32. Health Policy Formulation in India Ministry of Health identified the need for policy arising out of handling of the day-to-day problems related to various health programs and commitment to achieving the goals of HFA by 2000 AD. Ministry appointed a committee to review environment in the health sector and recommended a policy frame after needful consultation. 32

33. The draft policy document based on the recommendation of 5th Joint Conference of Central Council of Health and Family Welfare in October 1978 was thrown open to various individuals, groups, institutions and health related sectors for wider discussions and comments with a view to build inter-linkages between various Ministries and provide rationality, consis­tency in the content and suggest alternates within the possible resources , to improve the acceptability of the policy. 33

34. The revised draft was presented to subsequent Joint Council of Health and Family Welfare to get the views of Health Ministers of the States and later to National Development Council to get the views of the State Chief Ministers and their concurrence. The final draft was presented to the Cabinet for approval and adoption. 34

35. After the Cabinet's approval the document was presented in the National Parliament for ratification in December 1982. 35

36. NATIONAL HEALTH POLICY – 1983 36

37. The NHP-1983 gave a general exposition of the policies which required recommendation in the circumstances prevailing in the health sector. NHP-1983, in a spirit of optimistic empathy for the health needs of the people, particularly the poor and underprivileged, had hoped to provide ‘Health for All by the year 2000 AD ’, through the universal provision of comprehensive primary health care services. NHP-1983 37 Babu V.V.R.S. Review in Community Medicine. Ch-14 Public Health Administration and National Programmes. 2 nd ed. Hyderabad: Paras Medical Books. 1996

38. The noteworthy initiatives under that policy were :- A phased, time-based bound program for setting up a well dispersed network of comprehensive primary health care services, linked with extension and health education, designed in the context of the ground reality that elementary health problems can be resolved by the people themselves. NHP-1983 38 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

39. Government initiatives in the public health sector have recorded some noteworthy successes over time. Smallpox and Guinea Worm Disease have been eradicated from the country; Polio is on the verge of being eradicated; Leprosy , Kala Azar , and Filariasis can be expected to be eliminated in the future. NHP-1983 39 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

40. There has been a substantial drop in the Total Fertility Rate and Infant Mortality Rate. The success of the initiatives taken in the public health field are reflected in the progressive improvement of many demographic / epidemiological / infrastructural indicators over time. 40 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

41. In retrospect, it is observed that the financial resources and public health administrative capacity which it was possible to marshal, was far short of that necessary to achieve such an ambitious and holistic goal. NHP-1983 41 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

42. COMMENTS It does not speak about social injustice- an essential prerequisite for Health for All. No definite program – to promote community participation in health. No mention - health budget Does not emphasis on – accident prevention, geriatric care Non- communicable disease like obesity, coronary heart disease Disease related to use of tobacco, alcohol, drugs, etc. NHP-1983 42 Babu V.V.R.S. Review in Community Medicine. Ch-14 Public Health Administration and National Programmes. 2 nd ed. Hyderabad: Paras Medical Books. 1996

43. ACHIEVEMENTS THROUGH THE YEAR 1951-2000 INDICATOR 1951 1981 2000 Life Expectancy 36.7 54 64.6 CBR 40.8 33.9 26.1 CDR 25 12.5 8.9 IMR 146 110 70 43

44. NATIONAL HEALTH POLICY – 2002 44

45. 45

46. NHP-1983 served the purpose for some time but over the years the health scene of the country changed. New challenges could not be addressed within the framework of that policy - it necessitated a revision . The government of India initiated the process by holding wide ranging deliberations involving central and state governments, voluntary organizations and the central council of health and family welfare. NHP-2002 46 Dhaar GM. Robbani I. Foundations of Community Medicine. Ch 55- HEALTH CARE IN THE INDIAN CONTEXT. 1 st ed. Elsevier; 2006. INTRODUCTION – NHP 2002

47. INTRODUCTION – NHP 2002 A draft of national health policy was formulated and circulated for eliciting comments from responsible sources. A final shape was given to the policy and was eventually approved by the cabinet and launched as NATIONAL HEALTH POLICY – 2001. NHP-2002 47 Dhaar GM. Robbani I. Foundations of Community Medicine. Ch 55- HEALTH CARE IN THE INDIAN CONTEXT. 1 st ed. Elsevier; 2006.

48. The policy aims to achieve an acceptable standard of good health among the general population of the country and has set goals to be achieved by the year 2015. However , from a global perspective India’s public spending on health is extremely low. NHP-2002 48 Dhaar GM. Robbani I. Foundations of Community Medicine. Ch 55- HEALTH CARE IN THE INDIAN CONTEXT. 1 st ed. Elsevier; 2006. INTRODUCTION – NHP 2002

49. Goals to be achieved by 2000-2015 Eradicate Polio and Yaws 2005 Eliminate Leprosy 2005 Eliminate Kala Azar 2010 Eliminate Lymphatic Filariasis 2015 Achieve Zero level growth of HIV/AIDS 2007 Reduce Mortality by 50% on account of TB, Malaria and Other Vector and Water Borne diseases 2010 Reduce Prevalence of Blindness to 0.5% 2010 Reduce Infant Mortality Rate (IMR) to 30/1000 and Maternal Mortality Ratio ( MMR) to 100/Lakh 2010 NHP-2002 49 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

50. Increase utilization of public health facilities from current Level of <20 to >75% 2010 Establish an integrated system of surveillance, National Health Accounts and Health Statistics. 2005 Increase health expenditure by Government as a % of GDP from the existing 0.9 % to 2.0% 2010 Increase share of Central grants to Constitute at least 25% of total health spending 2010 Increase State Sector Health spending from 5.5% to 7% of the budget 2005 Further increase to 8% 2010 Goals to be achieved by 2000-2015 NHP-2002 50 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

51. NHP-2002 51 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

52. REVIEW OF THE HEALTH SITUATION CHANGING HEALTH SCENE: NHP , 2002 acknowledges the progress achieved in the health field of the country since independence as borne out by demo-graphic, epidemiological and infrastructural indicators. At the same time the policy appreciates the contribution made by health sectors like rural development, agriculture, sanitation, drinking water supply and education towards achieving progress in the health field. NHP-2002 52 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

53. DISPARITY IN HEALTH CARE: NHP , 2002 admits that although the main objective of planning was to achieve an equitable development, yet significant disparity exists in the health status of populations. The disparity is reflected in morbidity and mortality indicators between better performing and poor performing states, and also between rural and urban populations. This disparity is also visible among various socio-economic groups in relation to important child health indicators . NHP-2002 53 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

54. Access to, and benefits from, the public health system have been very uneven between the better-endowed and the more vulnerable sections of society. This is particularly true for women, children and the socially disadvantaged sections of society. NHP-2002 54 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

55. RELEVANCE OF NATIONAL HEALTH POLICY: NHP , 1983 is perceived as an idealistic document mainly addressed to achieve health for all by the year 2000 NHP , 2002 is realistic document based on a conceptional and operational framework that is consistent with the socio-economic realties prevailing in India. NHP-2002 55 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

56. OBJECTIVES OF THE POLICY It also specifies a time frame for the achievement of various goals NHP-2002 56

57. POLICY PRESCRICPTION NHP-2002 57

58. 58

59. 59

60. 1.FINANCIAL RESOURCES The Central Government will play a key role in augmenting public health investments. Taking into account the gap in health care facilities, it is planned, under the policy to increase health sector expenditure to 6 percent of GDP, with 2 percent of GDP being contributed as public health investment, by the year 2010. NHP-2002 60 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

61. The State Governments would also need to increase the commitment to the health sector. In the first phase, by 2005 , to increase the commitment of their resources to 7 percent of the Budget . In the second phase, by 2010 , to increase to 8 percent of the Budget. NHP-2002 61 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

62. 2.EQUITY To meet the objective of reducing various types of inequities and imbalances – inter-regional, 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 . NHP-2002 62 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

63. NHP-2002 sets out an increased allocation total public health investment for the primary health sector - 55 % the secondary sector - 35 % t he tertiary health sectors – 10 % The Policy projects that the increased aggregate outlays for the primary health sector will be utilized for strengthening existing facilities and opening additional public health service outlets, consistent with the norms for such facilities. NHP-2002 63 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

64. 3.DELIVERY OF NATIONAL PUBLIC HEALTH PROGRAMMES This policy is a key role for the Central Government in designing national programmes with the active participation of the State Governments . Also , the Policy ensures the provisioning of financial resources, in addition to technical support, monitoring and evaluation at the national level by the Centre. 64 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

65. However, 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 field administration . Vertical programmes for control of major diseases like TB, Malaria, HIV/AIDS, and Universal Immunization Programmes, would need to be continued till moderate levels of prevalence are reached. NHP-2002 65 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

66. The integration of the programmes will bring about a desirable optimization of outcomes through a convergence of all public health inputs. Also, the presence of State Government officials, social activists, private health professionals and MLAs/MPs on the management boards of the autonomous bodies will facilitate well-informed decision-making. NHP-2002 66 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

67. 4. THE STATE OF PUBLIC HEALTH INFRASTRUCTURE Decentralized Public health service outlets have become practically dysfunctional over large parts of the country. On account of resource constraints, the supply of drugs by the State Governments is grossly inadequate. The patients at the decentralized level have little use for diagnostic services, which in any case would still require them to purchase therapeutic drugs privately . 67 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

68. In some States like the four Southern States – Kerala, Andhra Pradesh, Tamil Nadu and Karnataka some quantum of drugs is distributed through the primary health system network, and the patients can approach the Public Health facilities. The Policy envisages restarting of the Primary Health System by providing some essential drugs under Central Government funding through the decentralized health system. NHP-2002 68 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

69. It is expected that the provisioning of essential drugs at the public health service centres will create a demand for other professional services from the local population. NHP-2002 69 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

70. Policy recognizes - frequent in-service training of public health medical personnel, at the level of medical officers as well as paramedics. Such training would help to update the personnel on recent advancements in science . NHP-2002 70 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

71. 5. EXTENDING PUBLIC HEALTH SERVICES The policy envisages the need for expanding the pool of medical practitioners to include practitioners of Indian Systems of Medicine and Homoeopathy . Simple services/procedures can be provided by such practitioners even outside their disciplines, as part of the basic primary health services in under-served areas. 71 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

72. Also, NHP-2002 envisages that the scope of the use of paramedical manpower of allopathic disciplines , in a prescribed functional area adjunct to their current functions, would also be examined for meeting simple public health requirements. These extended areas of functioning of different categories of medical manpower can be permitted, after adequate training, and subject to the monitoring of their performance through professional councils. NHP-2002 72 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

73. NHP-2002 also recognizes the need for States to simplify the recruitment procedures and rules for contract employment in order to provide trained medical manpower in under-served areas. NHP-2002 73 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

74. State Governments could also rigorously enforce a mandatory two-year rural posting before the awarding of the graduate degree. This would not only make trained medical manpower available in the underserved areas, but would offer valuable clinical experience to the graduating doctors. NHP-2002 74 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

75. 6. ROLE OF LOCAL SELF-GOVERNMENT INSTITUTIONS NHP-2002 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. NHP-2002 75 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

76. The Policy urges all State Governments to consider decentralizing the implementation of the programmes to local self- goveernment Institutions by 2005 . To achieve this, financial incentives will be provided by the Central Government. NHP-2002 76 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

77. 7. NORMS FOR HEALTH CARE PERSONNEL Minimal norms for the deployment of doctors and nurses in medical institutions need to be introduced urgently under the provisions of the Indian Medical Council Act and Indian Nursing Council Act. These norms can be progressively reviewed and made more stringent as the medical institutions improve their capacity for meeting better normative standards. NHP-2002 77 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

78. 8. EDUCATION OF HEALTH CARE PROFESSIONALS To eliminate the problems being faced on the uneven spread of medical and dental colleges in various parts of the country, this policy envisages the setting up of a Medical Grants Commission for funding new Government Medical and Dental Colleges in different parts of the country . NHP-2002 78 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

79. The Medical Grants Commission will fund the upgradation of the infrastructure of the existing Government Medical and Dental Colleges of the country, so as to ensure an improved standard of medical education . To enable fresh graduates to contribute effectively to the providing of primary health services as the physician of first contact, this policy identifies a significant need to modify the existing curriculum 79 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

80. A need-based, skill oriented syllabus, with a more significant component of practical training, for fresh doctors immediately after graduation. The Policy also recommends a periodic skill-updating of working health professionals through a system of continuing medical education . NHP-2002 80 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

81. The Policy emphasises the need to expose medical students, through the undergraduate syllabus, to the emerging concerns for geriatric disorders, as also to the cutting edge disciplines of contemporary medical research. The policy also envisages that the creation of additional seats for postgraduate courses should reflect the need for more manpower in the deficient specialities . NHP-2002 81 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

82. 9. NEED FOR SPECIALISTS IN ‘PUBLIC HEALTH’ AND ‘FAMILY MEDICINE’ 82 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

83. Specialization in Public health may be encouraged not only for medical doctors, but also for non-medical graduates from the allied fields of public health engineering, microbiology and other natural sciences. NHP-2002 83 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

84. Improving the skill -level of nurses , and on increasing the ratio of degree- holding nurses vis-à-vis diploma-holding nurses. Establishing training courses for super- speciality nurses required for tertiary care institutions . NHP-2002 84 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

85. 10. NURSING PERSONNEL In the interest of patient care, the policy emphasizes the need for an improvement in the ratio of nurses, doctors/beds. The public health delivery centers need to have a increased number of nursing personnel. NHP-2002 85 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

86. 11. USE OF GENERIC DRUGS AND VACCINES There is a need for basic treatment regimens , on a limited number of essential drugs. Cost-effective. Prohibit the use of proprietary drugs, except in special circumstances. 86 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

87. Not less than 50% of the requirement of vaccines/sera be sourced from public sector institutions. NHP-2002 87 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

88. 12. URBAN HEALTH Setting - organized urban primary health care structure . Adoption - population norms for its infrastructure . NHP-2002 88 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

89. The structure is two-tiered : The first-tier , covering a population of one lakh providing OPD facility with a dispensary and essential drugs, to enable access to all the national health programs The second-tier - at the level of the Government general hospital, reference from primary center. NHP-2002 89 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

90. Funding will be by the local, State and Central Governments. Establishment of fully-equipped ‘ hubspoke ’ trauma care networks in large urban agglomerations to reduce accident mortality. NHP-2002 90 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

91. 13. MENTAL HEALTH A network of decentralised mental health services for more common disorders . Diagnosis of common disorders, and the prescription of common drugs , by general duty medical staff. NHP-2002 91 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

92. Upgrading of the physical infrastructure of mental health institutions at Central Government expense. 92 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

93. 14. INFORMATION, EDUCATION AND COMMUNICATION (IEC) Information to those population groups which cannot be effectively approached by using only the mass media. The focus on the inter-personal communication of information and on folk and other traditional media to bring about behavioural change. NHP-2002 93 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

94. The community leaders- particularly religious leaders, are effective in imparting knowledge for behavioural change . NHP-2002 94 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

95. Annual evaluation of the performance of the non-Governmental agencies to monitor the impact of the programmes on the targeted groups. School health programs are the most cost-effective intervention - improves the level of awareness of future generation. NHP-2002 95 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

96. 15. HEALTH RESEARCH Increase in Government-funded health research to a level of 1% of the total health spending by 2005 and up to 2 % by 2010 . Domestic medical research would be focused on new therapeutic drugs and vaccines for TB and Malaria, also on the sub-types of HIV/AIDS prevalent in the country . NHP-2002 96 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

97. Emphasis on time-bound applied research for developing operational applications . This would ensure the cost-effective of existing / future therapeutic drugs/vaccines for the general population. NHP-2002 97 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

98. 16. ROLE OF THE PRIVATE SECTOR This Policy welcomes the participation of the private sector in all areas of health activities. A legislation for regulating minimum infrastructure and quality standards in clinical establishment of medical institutions by 2003. 98 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

99. Guidelines for clinical practice and delivery of medical services are to be developed. Setting up of private insurance instruments for increasing the scope of the coverage of the secondary and tertiary sector under private health insurance packages. NHP-2002 99 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

100. Non-governmental practitioners- in national disease control programmes Applications of tele -medicine in the health care sector. NHP-2002 100 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

101. 101

102. 17. THE ROLE OF CIVIL SOCIETY Contribution of NGOs and other institutions of the civil society in making available health services to the community. The disease control programmes should have a definite portion of budget. 102 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

103. 18. NATIONAL DISEASE SURVEILLANCE NETWORK Integrated disease control network from the lowest public health administration to the Central Government, by 2005. installation of data-base handling hardware In-house training for data collection. 103 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

104. 19. HEALTH STATISTICS Periodic updating of these baseline estimates through representative sampling, under an appropriate statistical methodology. NHP-2002 104 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

105. Access to data on the incidence of various diseases, with the objective of evidence-based policy-making . The need to establish national health accounts, conforming to the ` source-to-users ’ matrix structure . NHP-2002 105 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

106. National health accounts and accounting systems would pave the way for decision-makers to focus on relative priorities. NHP-2002 106 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

107. 20. WOMEN’S HEALTH Women - under-privileged groups with low access to health care . The expansion of primary health sector infrastructure- to facilitate the increased access of women to basic health care . NHP-2002 107 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

108. Highest priority of the Central Government to the funding - programmes relating to woman’s health. The need to review the staffing norms of the public health administration to meet the specific requirements of women in a more comprehensive manner. NHP-2002 108 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

109. 21.MEDICAL ETHICS A contemporary code of ethics be notified and rigorously implemented by the Medical Council of India . Medical research within the country in the different disciplines, such as gene- manipulation and stem cell research. NHP-2002 109 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

110. 22. ENFORCEMENT OF QUALITY STANDARDS FOR FOOD AND DRUGS Food and drug administration will be progressively strengthened , in terms of both laboratory facilities and technical expertise. 110 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

111. Domestic food handling / manufacturing facilities to undertake the necessary upgradation of technology Ultimately food standards will be close, if not equivalent, to Codex specifications ; and that drug standards will be at par with the most rigorous ones adopted elsewhere. 111 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

112. 23. REGULATION OF STANDARDS IN PARAMEDICAL DISCIPLINES Need for the establishment of professional councils for paramedical disciplines to register practitioners, maintain standards of training, and monitor performance. 112 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

113. 24. ENVIRONMENTAL AND OCCUPATIONAL HEALTH The periodic screening of the health conditions of the workers, particularly for high- risk health disorders associated with their occupation. NHP-2002 113 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

114. 25. PROVIDING MEDICAL FACILITIES TO USERS FROM OVERSEAS Health services on a payment basis to service seekers from overseas . The services to patients from overseas will be encouraged by extending to their earnings in foreign exchange. 114 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

115. 26. IMPACT OF GLOBALISATION ON THE HEALTH SECTOR The Policy takes into account the serious apprehension, expressed by several health experts , as a result of a sharp increase in the prices of drugs and vaccines . 115 Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013. 

116. COMMENTS Not much attention is paid to child, adolescent, Geriatrics health, gender, domestic violence . Ignored areas- Resource generation & allocation, management of work force, substance abuse management . 116 Kumar A, Gupta S. Health Infrastructure in India: Critical Analysis of Policy Gaps in the Indian Healthcare Delivery . Vivekananda International Foundation . 2012

117. Methodology of strengthening healthcare & functioning of health workers is not specified, creating “Paramedical Doctors”. Promoting QUACKERY . Literacy & its investment is not specified . Problem of population is not answered properly . School education has not yielded desired results. 117 Kumar A, Gupta S. Health Infrastructure in India: Critical Analysis of Policy Gaps in the Indian Healthcare Delivery . Vivekananda International Foundation . 2012

118. Achievements 2003 – Enactment of legislation for regulating minimum standard in clinical Establishment / Medical institution 2005- Eradication of Poliomyelitis is missed ,however there is zero reporting of yews since 2004. Leprosy has been declared eliminated according to the criteria fixed by WHO. However, more efforts are required. Integrated Disease Surveillance Project has been launched but establishment of National Health Accounts and Health Statistics is still lagging behind. IDSP is also going at a slow pace. 118

119. Spending of state Sector Health has not much increased as planned from 5.5% to7.7% of budget. Budget for medical research is not much increased as 1% of the total health budget for Medical Research has been targeted. Decentralization of implementation of public health Programs: National Rural Health Mission has been launched in this direction. 2007- Achieve of REDUCTION of HIV/AIDS 119

120. National Health Policy - 2015 Draft 120

121. 121

122. Need for National Health Policy 2015 Gaps in health outcomes continue to widen despite advances in medical care technology as well as economy in India. There is an urgent need to improve the performance of health systems ; in achieving Millennium Development Goals , and Universal Health Coverage. The context of Health has changed over the years and this needs a suitably revised Health policy responsive to these changes . 122

123. Change in the Health context: Health Priorities are changing. Emergence of a robust health care industry. Incidence of catastrophic expenditure due to health care costs is growing. Economic growth has increased the fiscal capacity available . 123

124. Situation Analysis Indicator Target Baseline 2012 2015 MMR 140/1000 560 178 141 Under 5 mortality 42/1000 live births 126 52 42 TFR 2.1 2.9 2.4 IMR 30/1000 Live Births 114 47.5 40 124

125. Over 90% of pregnant women receive one antenatal checkup 87 % of pregnant women received full TT immunization Only 31% of pregnant women had consumed more than 100 IFA tablets Only 61% of children (12 – 23 months) have been fully immunized In AIDS control, decline from a 0.41 % prevalence rate in 2001 to 0.27% in 2011 In tuberculosis, prevalence of 211 cases and 19 deaths per lakh population Overall, communicable diseases contribute to 24. 4% of the entire disease burden while maternal and neonatal ailments contribute to 13.8%. Non-communicable diseases (39.1%) and injuries (11.8%) now constitute the bulk of the country's disease burden. 125

126. The private sector today provides nearly 80% of outpatient care and about 60% of inpatient care. Tax exemptions for 5 years for rural hospitals; custom duty exemptions for imported equipment that are lifesaving; Income Tax exemption for health insurance; and active engagement through publicly financed health insurance which now covers almost 27 % of the population. The number of medical colleges added and the increase in seats for both undergraduate and postgraduate education has also been high. In 2014, the total number of medical colleges in India were 381. 126

127. The Government spending on healthcare in India is only 1.04% of GDP which is about 4 % of total Government expenditure, less than 30% of total health spending. 127

128. Goal, Principles and Objectives Goal: The attainment of the highest possible level of good health and wellbeing, 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. 128

129. Policy Principles: – Equity – Universality – Patient Centered & Quality of Care – Inclusive Partnerships – Pluralism – Subsidiarity – Accountability – Professionalism, Integrity and Ethics – Learning and Adaptive System – Affordability 129

130. Objectives: – Improve population health status – Achieve a significant reduction in out of pocket expenditure – Assure universal availability of free, comprehensive primary health care services – Enable universal access to free essential drugs, diagnostics, emergency ambulance services, and emergency medical and surgical care services in public health facilities – Ensure improved access and affordability of secondary and tertiary care services through a combination of public hospitals and strategic purchasing of services from the private health sector – Influence the growth of the private health care industry and medical technologies 130

131. Policy Directions Ensuring Adequate Investment Preventive and Promotive Health Organization of Public Health Care Delivery Primary Care Services & Continuity of Care Secondary Care Services Reorienting Public Hospitals Closing Gaps in Infrastructure and Human Resource/Skill Urban Health Care National Health Programs: RCH, Communicable Diseases , Non-Communicable Diseases , Mental Health, Emergency Care and Disaster preparedness 131

132. Swachh Bharat Abhiyan Balanced and Healthy diets(through Anganwadi centres and schools ) Nasha Mukti Abhiyan Yatri Suraksha Nirbhaya Nari 132

133. Reduced stress and improved safety in the workplace Reduction of indoor and outdoor air pollution Swasth Nagrik Abhiyan (social movement for health) Greater emphasis on school health and SCHOOL NOON MEAL PROGRAMME More support to ASHA workers(in palliative care, Community Mental Health, and in Village Health Sanitation and Nutrition Committees ) Yoga promotion at work place, schools and in the community 133

134. Governance Federal structure: Role of State and Role of Centre Role of Panchayat Raj Institutions Rogi Kalyan Samitis ( RKS) Village Health Sanitation and Nutrition Committee(VHSNC ) Addressing fiduciary risks and improving accountability Professionalizing Management and Incentivizing performance 134

135. Legal framework - Laws under review – Mental Health Bill – Medical Termination of Pregnancy Act – Bill regulating surrogate pregnancy and assisted reproductive technologies – Food Safety Act – Drugs and Cosmetics Act – Clinical Establishments Act 135

136. - National Health Rights Act has been proposed – Ensure health as a fundamental right, whose denial will be justiciable* _______________ *(of a state or action) subject to trial in a court of law. 136

137. Implementation and Way forward Past policies have faced innumerable constraints in implementation . Implementation framework would specify approved financial allocations and linked to this measurable numerical output targets and time schedules. 137

138. SWOT analysis Strengths: Increasing Public Health Expenditure to 2.5% of the GDP( Rs . 3800 per capita) Introduction of ambitious schemes like Swacch Bharat Abhiyan , Nirbhaya Nari Promotion of Indian systems of Medicine(AYUSH) 138

139. Weaknesses: Pushing the secondary and tertiary healthcare into private sector No mention of how private sector will be regulated. 139

140. Opportunities : International support and remote chances of war in near future Improving economy and increasing Foreign investments Health tourism is gaining momentum. Eradication of Polio has paved way and given a framework to follow for other vaccine preventable diseases. 140

141. Threats: Lack of private sector regulation can hamper public sector healthcare Health tourism may drain resources and peripheral most deserving population may be starved of resources Resurgence of epidemics may create panic and also divert resources 141

142. NATIONAL ORAL HEALTH POLICY 142

143. NATIONAL ORAL HEALTH POLICY The National Oral Health Policy has been formulated by the “Dental Council of India” through the inputs of two national workshops organized in 1991 and 1994 at Delhi and Mysore . 143 Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya ( Medi ) Publishing House; 2013

144. NEED FOR A NATIONAL ORAL HEALTH POLICY 144

145. 1.INCRESING PREVALENCE AND SEVERITY OF DENTAL DISEASES Dental caries has been increasing both in prevalence and severity over the last three decades . In 1940-1950, prevalence reported has been 40-50% with an average DMFT of 1.5 145 http:// www.mohp.gov.np/english/files/new_publications/9-2-National-Oral-Health-Policy.pdf. Last acessed 11/06/2014.

146. In 1980-1990, prevalence reported has been increased to80% with an average DMFT of 5 in urban and 4 in rural areas . Periodontal disease prevalence has been in the range of 90-100% in various age groups. The above facts have been stressed by a number of national level workshops. 146 http:// www.mohp.gov.np/english/files/new_publications/9-2-National-Oral-Health-Policy.pdf. Last acessed 11/06/2014.

147. 2.DENTIST POPULATION RATIO There were only 35,000 dentists serving the entire population of 90 crores in 1990’s . 90 % of them were in cities, only 10% in rural areas with a population of over 75%. 147 http:// www.mohp.gov.np/english/files/new_publications/9-2-National-Oral-Health-Policy.pdf. Last acessed 11/06/2014.

148. 3.CRIPPLING NATURE OF ORAL DISEASE 85 % of children and 95- 100% of adults were suffering from periodontal disease - people accept it as the disease of old age . 80-85 % of children were suffering from dental caries . The pus oozing pocket of periodontal disease of adults act as a focus of infection for other vital organs of body. 148 http:// www.mohp.gov.np/english/files/new_publications/9-2-National-Oral-Health-Policy.pdf. Last acessed 11/06/2014.

149. The dental caries with its crippling effect can lead to more malnutrition as the young adults would not be able to chew any coarse food . 35% of all body cancers are oral cancer, most of them are preventable . 35% of children suffer from malaligned teeth and jaws affecting proper function. 149 http:// www.mohp.gov.np/english/files/new_publications/9-2-National-Oral-Health-Policy.pdf. Last acessed 11/06/2014.

150. 4.IMPELLING ECONOMIC REASONS FOR EARLY RECOGNITION AND PREVENTION OF ORAL DIEASES Dental caries is an expensive disease which causes economic losses both to the individual and to the country . India spends approximately 1 to 1.5 % of total national budget on health and as there is no specific allocation for oral health . 150 http:// www.mohp.gov.np/english/files/new_publications/9-2-National-Oral-Health-Policy.pdf. Last acessed 11/06/2014.

151. 5.PREVENTION OF ORAL DISEASES THE ONLY ALTERNATIVE: The upward trend of dental caries could be effectively checked by the implementation of organized oral health preventive programmes at the community level. The methods used for primary prevention of dental caries also achieves primary prevention of periodontal disease and oral cancer. 151 http:// www.mohp.gov.np/english/files/new_publications/9-2-National-Oral-Health-Policy.pdf. Last acessed 11/06/2014.

152. THE COUNCIL HAS BROUGHT OUT A TEN POINT RESOLUTION 152

153. 1. urgent need for an Oral Health Policy for the nation as an integral part of the National Health Policy. 153 Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya ( Medi ) Publishing House; 2013

154. 2 . National Oral Health Program be launched to provide oral health care, both in the rural as well as urban areas due to deteriorating oral health conditions in the country as revealed by various epidemiological studies. Dentist / population ratio in the rural areas is only 1:3,00,000 , whereas, 80% of the children and 60% of the adults suffer from dental caries. More than 90% of the adults after the age of 30 years suffer from periodontal disease which also has its inception in childhood. 154 Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya ( Medi ) Publishing House; 2013

155. In addition, 35% of all body cancers are oral cancers . 35 % of the children suffer from maligned teeth and jaws affecting proper functioning. It is important to launch preventive, curative and educational oral health care program integrated into the existing system utilizing the existing health and educational infrastructure in the rural, urban and deprived areas. 155 Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya ( Medi ) Publishing House; 2013

156. 3.A post of full dental advisor at appropriate level in the Directorate General of Health Services ( Dte.G.H.S ) should be created. 156 Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya ( Medi ) Publishing House; 2013

157. 4.Urgent need to prevent the rising trend of dental disease in India. Achieving primary prevention of periodontal diseases and oral cancers . 157 Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya ( Medi ) Publishing House; 2013

158. 5. Preventive and promotive oral health services be introduced from the village level. Pilot project on oral health care may be launched by the Ministry of Health and Family Welfare 158 Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya ( Medi ) Publishing House; 2013

159. 6.warning on the wrappers and advertisement of sweets, chocolates and other retentive sugar eatables TOO MUCH EATING SWEETS MAY LEAD TO DECAY OF TOOTH . Similar measures are called for tobacco and pan masala related products . 159 Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya ( Medi ) Publishing House; 2013

160. 7. National Training Centre to be established or the existing centers be strengthened for training of various categories of oral health care personnel . 160 Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya ( Medi ) Publishing House; 2013

161. 8. All district hospitals and Community Health Centers should have dental clinics. All Dental Colleges should have courses on Dental Hygienists and Dental Technicians. 161 Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya ( Medi ) Publishing House; 2013

162. 9.The Council further resolves that the Pilot Project may be extended to all States at the rate of one District in every state. 162 Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya ( Medi ) Publishing House; 2013

163. 10.The Council also resolves that there is an urgent need to have a National Institute for Dental Research to guide oral health research appropriate to the needs of the country. 163 Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya ( Medi ) Publishing House; 2013

164. KARNATAKA STATE HEALTH POLICY- 2004 164

165. Karnataka Health Policy goals 165 http:// cphe.files.wordpress.com/2009/10/karnataka-state-integrated-health-policy-2001.pdf.last acessed on 11/7/014

166. Dental Health / Oral Health The awareness about dental health care is poor especially in rural areas. The increased life expectancy of the population and widespread prevalence of oral diseases warrants a serious thought for immediate strengthening of the existing oral health delivery system in the state. 166 http:// cphe.files.wordpress.com/2009/10/karnataka-state-integrated-health-policy-2001.pdf.last acessed on 11/7/014

167. The establishment of a three tier Oral Health Care delivery system in Karnataka would be planned, namely: 167 http:// cphe.files.wordpress.com/2009/10/karnataka-state-integrated-health-policy-2001.pdf.last acessed on 11/7/014

168. 168 http:// cphe.files.wordpress.com/2009/10/karnataka-state-integrated-health-policy-2001.pdf.last acessed on 11/7/014

169. OTHER NATIONAL HEALTH POLICIES 169

170. 170

171. CONCLUSION 171

172. CONCLUSION Public health has effectively remained a low priority for the Indian state in terms of financing and political attention. 172

173. Contributed to the slow and inadequate improvement in health of the population . 173

174. Replacing the current unhealthy and inequitable socio-economic system, by one that is far more just, humane and healthy, in the world of tomorrow is essential. 174

175. REFERNCES 175

176. REFERNCES 1.Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya ( Medi ) Publishing House; 2013. 2.Scheutz AM. India’s Healthcare System – Overview and Quality Improvements. Direct response. 2013:04. 3.Chandra S, Chandra S. Textbook of Community Dentistry. Ch-9 Oral Health Policy of Government of India. 1st ed. New Delhi: Jaypee Brothers Medical Publishers; 2000 . 176

177. 4.Dhaar GM. Robbani I. Foundations of Community Medicine. Chapter 55- HEALTH CARE IN THE INDIAN CONTEXT. 1 st ed . Elsevier; 2006. 5.Gangolli LV, Duggal R, Shukla A. Review of Healthcare In India. SECTION 2- PUBLIC HEALTH POLICIES AND PROGRAMMES. Mumbai: Centre for Enquiry into Health and Allied Themes; 2005 . 6.SATHE P.V., SATHE A.P., Epidemiology and Management for Health Care for All. Ch-2 Health for All by 2000 A.D. 2 nd ed. Mumbai: Popular Prakshan PVT Limited; 1997. REFERNCES 177

178. REFERNCES 7.Banerjee SR. Community and Social Pediatrics. Ch-6 Cild Health Care- The challenges for the Next Decade. Ist ed. New Delhi: Jaypee Brothers Medical Publishers; 1995. 8.Suryakantha AH. Community Medicine with Recent Advances. Ch - 39 National Health Policy. 3 rd ed. New Delhi: Jaypee Brothers Medical Publishers; 2014. 9.Babu V.V.R.S. Review in Community Medicine. Ch-14 Public Health Administration and National Programmes. 2 nd ed. Hyderabad: Paras Medical Books. 1996 178

179. REFERNCES 10.Kulkarni A.P, Baride J.P, Doke P.P, Mulay P.Y. Text book of Community Medicine. Ch-15 Health Care in India- Part A. 4 th e d. Mumbai: Vora Medical Publications; 2013. 11.Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services . 4th ed. New Delhi, Jaypee Brothers; 2013.   12.Kumar A, Gupta S. Health Infrastructure in India: Critical Analysis of Policy Gaps in the Indian Healthcare Delivery. Vivekananda International Foundation; 2012. 179

180. 13.http :// www.mohp.gov.np/english/files/new_publications/9-2-National-Oral-Health-Policy.pdf.Last acessed 11/06/2014. 14.http ://cphe.files.wordpress.com/2009/10/karnataka-state-integrated-health-policy-2001.pdf.last acessed on 11/7/014 . 180 REFERNCES

181. 181