National health policy

national health policy 1983, 20002, 2017

1. NATIONAL HEALTH POLICY SUBMITTED BY - NISHA YADAV MSc NURSING 1 ST YEAR NINE, PGIMER CHANDIGARH

2. OUTLINE INTRODUCTION TO NHP NHP 1983 NHP 2002 NHP 2017

3. INTRODUCTION National - It describes something that belongs to or is typical of a particular country or nation Health - It is a state of physical, mental and social well being and not merely the absence of disease or infirmity. Policy - It is a system which provides the logical framework and rationality of decision making for the achievements of intended objectives Health policy- Decisions, plans, actions that are undertaken to achieve specific healthcare goals within a society

4. The joint WHO – UNICEF international conference in 1978 at Alma Ata (USSR) declared that: “ the existing gross inequalities in the status of health of people particularly between developing countries as well as within the countries is politically, socially and economically unacceptable .’’ The Alma Ata declaration of 1978 emerged as a major milestone of the 20 th century in the field of public health, and it identified primary health care as the key to the attainment of the goal of health for all around the goal.

5. Ministry of health identified the need for policy arising out of handling of day to day problems related to various health programs and commitment to achieving the goals of health for all by 2000 ad

6. NATIONAL HEALTH POLICY Blue print for future actions related to health AIMS Elimination of poverty Elimination of illiteracy Elimination of ill-health Elimination of inequality

7. NATIONAL HEALTH POLICY 1983 National health policy in India was not framed and announced until 1983. The ministry of health and family welfare evolved a National Health Policy in 1983, keeping in view the national commitment to attain the goal Health for all by 2000 A.D. The policy lays stress on the preventive, promotive, public health and rehabilitation aspects of health care

8. Key elements OF NHP 1983 Creation of awareness of health problems in the community and means to solve the problems by the community. Supply of safe drinking water and basic sanitation using technologies that people can afford. Reduction of existing imbalance in health services by concentrating more on the rural health infrastructure. Establishing of dynamic health management information system to support health planning and health program implementation. Provision of legislative support to health protection and promotion. Concerned actions to combat wide spread malnutrition. Research in alternative method of health care delivery and low-cost health technologies.

9. Other strategies of NHP 1983 Prohibition of private practice of government doctors Prohibition of exploitation of services by AYUSH system of medicine Health education programmes to help people to have healthful living habits Add nutrition promotion and population control technique in school curriculum Universal adult literacy education Promotion of herbal gardening and health industry to produce drugs,etc . Start state wise health insurance schemes for raising additional funds for health Promotion of basic and applied research Training of all categories of medical personnel

10. Factors interfering with the progress towards health for all Insufficient political commitment to the implementation on Health for All. Failure to achieve equity in access to all primary health care elements. The continuing low status of women. Slow socio-economic development. Difficulty in achieving intersectoral action for health. Unbalanced distribution of and weak support for human resources.

11. NATIONAL HEALTH POLICY 2002 The main objective of National Health Policy 2002 is to achieve acceptable standard of good health amongst the general population of the country . Other objectives- Increase access to health services by decentralizing public health services Establishing new health infrastructure Emphasizing primary level of health care Promoting rational use of drugs Increase primary health investment Increase Private sector Practice Partnership

12. NHP- 2017 INTRODUCTION The National Health Policy of 1983 and the national policy of 2002 have served well in guiding the approach for the health sector in five year plans. 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- situational analysis”, Ministry of Health and Family Welfare, Government of India.

13. AIM OF NHP 2017 “To inform, clarify, strengthen and prioritize the role of 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”.

14. GOAL of NHP Attainment of the highest possible level of health and well being for all at all ages, through a preventive and promotive health care orientation in all developmental policies Universal access to good quality health care services without anyone having to face financial hardship as a consequence. The policy also recognizes the importance of Sustainable Development Goals (SDGs)

15. The broad principles of the policy Professionalism , Integrity and Ethics Equity Affordability Universality Patient Centered & Quality of Care Accountability and pluralism Decentralization Inclusive partnership .

16. OBJECTIVES OF NHP 2017 Improve health status through concerted policy action in all sectors and expand preventive, promotive, curative, palliative and rehabilitative services provided through the public health sector with focus on quality. Universal health coverage Reinforcing trust in public health coverage Align the growth of private sector with public health goals

17. Specific quantitative goals and objectives Health status & programme impact-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) Index as a measure of burden of disease and its trends by major categories by 2022. Reduction of TFR to 2.1 at national and sub-national level by 2025.

18. 2. Mortality by Age and/ or cause Reduce Under Five Mortality to 23 by 2025 and MMR from current levels to 100 by 2020. Reduce infant mortality rate to 28 by 2019. Reduce neo-natal mortality to 16 and still birth rate to “single digit” by 2025. 3. Reduction of disease prevalence/incidence 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. Achieve and maintain elimination status of Leprosy by 2018, Kala-Azar by 2017 and Lymphatic Filariasis in endemic pockets by 2017 .

19. c) T o 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. 4. Health Systems performance Coverage of health services Increase utilization of public health facilities by 50% by 2025 Antenatal care coverage to be sustained above 90% and skilled attendance at birth above 90 by 2025 More than 90% of immunized

20. 2. Health finance Increase health expenditure by Government as a percentage of GDP from the existing 1.1 5 % to 2.5 % by 2025. Increase State sector health spending to > 8% of their budget by 2020. Decrease in proportion of households facing catastrophic health expenditure from the current levels by 25%, by 2025. 3. 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. Increase community health volunteers to population ratio as per IPHS norm, in high priority districts by 2025. Establish primary and secondary care facility as per norm s in high priority districts (population as well as time to reach norms) by 2025.

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

22. POLICY THRUST Ensuring Adequate Investment Preventive and promotive health Organization of public health care delivery Women’s health and gender mainstreaming Gender based violence Supportive supervision Emergency care and disaster preparedness Mainstreaming the potential of AYUSH Tertiary care services  

23. Human resources for health Financing of health care Collaboration with non-governmental sector Regulatory framework Vaccine safety Medical technologies Availability of drugs and medical devices Digital health technology ecosystem Application of digital health Leveraging digital tools for AYUSH Health surveys Health research

24. Fact check of main targets fixed by the national health policy of 2017 found The NHP 2017 sets a target of reducing infant mortality rate (IMR, or infant deaths per 1,000 live births) to 28 by 2019; the target set in the 2002 health policy was to reduce it to 30 by 2010. The IMR in 2015-16 was 41. The NHP 2017 sets the target for maternal mortality ratio– deaths of women per 100,000 live births–at 100 to be achieved by 2020; the target set in 2002 was to reduce it to 100 by 2010. The MMR in 2015-16 is 167.

25. Fact check of main targets fixed by the national health policy of 2017 found...... The NHP 2017 has set the target to eliminate leprosy by 2018, kala azar (black fever or visceral leishmaniasis) by 2017 and lymphatic filariasis (elephantiasis) in endemic pockets by 2017. The 2002 NHP had set the target of eliminating leprosy by 2005, kala azar by 2010 and lymphatic filariasis by 2015–none of which could be achieved yet.

26. Fact check of main targets fixed by the national health policy of 2017 found...... The NHP 2017 has set the target of reducing the incidence of new tuberculosis cases and reach elimination status by 2025. This would mean a reduction of 95 percent in new cases The 2002 document set the target of reducing mortality due to TB by 50 percent by 2010. The mortality rate for TB was 59.7 per 100,000 population in 2000, which reduced to 42.6 in 2010, missing the target set. In 2015, TB mortality rate was 35.9 per 100,000 population.

27. summary Introduction to NHP NHP 1983 NHP 2002 NHP 2017

28. Any doubts??

29. Question time Q1. What are the objectives of NHP 2017? Q2. What are the goals of NHP 2017?

30. Assignment Write an essay on NHP 2017.

31. REFERENCES Gulani KK. Community Health Nursing (Principles & practices. 2 nd ed. Kumar Publishing House. Health care concepts and trends; p 575-585. Suryakantha AH. Community medicine with recent advances. 5 th ed. Jaypee publishers. Health Policies in India; p 745-752 https://www.nhp.gov.in/nhpfiles/national_health_policy_2017.pdf https://nhm.gov.in/images/pdf/guidelines/nrhm-guidelines/national_nealth_policy_2002.pdf