nationals policies for GNM and B.Sc students

national policies its made by the goverment of india.

1. NATIONAL POLICIES PLANS AND P R OGRAMME

2. NATIONALS POLICIES, PLANS,AND PROGRAMMES PRIMARY HEALTH CARE HEALTH FOR ALL BY 2000 HEALTHY PEOPLE BY 2010/2020 HEALTH AND FAMILY WELFARE COMMITTES NATIONAL HEALTH POLICY NATIONAL POPULATION POLICY NATIONAL HEALTH GOALS / INDICATORS MILLINEUM DEVELOPMENT GOALS /STRATEGIES

3. LEVELS OF HEALTH CARE: PRIMARY HEALTH CARE. Health service provided by Physicians, Nurses, Health workers/team. SECONDARY HEALTH CARE. Physicians and health team assessment and treatment of health related problems TERITIARY HEALTH CARE. Care usually given by specialist, Major surgery

4. “ ESSENTIAL HEALTH CARE made universally accessible to individuals and acceptable to them through their full participation and cost of the community and country can afford.” -Declaration of Alma Ata 1978

5. in post-independent era in 1947, when the bhore committee brought its recommendations . To provide comprehensive health services to the people in rural areas through the network of primary health centres. A short term plan was formulated. CONCEPT OF PRIMARY HEALTH CARE

6. C o n t… launched primary health care to incorporate and strengthen the primary health care with other sectors. The health services should be comprehensive. community participation and appropriate technology .

7. Co n t.. strengthen and support primary health care through various sectors. maximum care to the special risk groups. Training. proper use of resources. continuous supply of drugs and proper managerial process, includes planning, organizing, monitoring and evaluation of health services.

8. The Primary Health Care Movement towards Health for All by 2000AD Alma Ata, 1978 The International Conference on Primary Health Care calls for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world by the year 2000.

9. ELE M EN T S E - Education L - Locally endemic disease control E - expanded programme immunization. M - Maternal and child health E - Environment sanitation N - Nutritional services T - Treatment of minor ailments. S - School health services

10. PRINCIPLES OF PRIMARY HEALTH CARE 1.Equitable distribution. 2.Community participation. 3.Intersectoral coordination. 4.Appropriate technology .

11. 1.EQUITABLE DISTRIBUTION. Health services must be shared equally by all people irrespective of their ability to pay. Rich or poor / rural or urban must have access to health services. 80% percentage of people live in rural areas & only 20% live in the urban areas , but the proportion of the health services is grossly inversely propotionate.ie, 80% of people are catered by only 20% & 20% are catered by 80% of health services.

12. Cont..  This has been termed as social injustice.  Primary Health Care aims to correct this imbalance by shifting the centre of gravity of the health care system from cities to the rural areas, & bring these services as near people’s home as possible.

13. 2.COMMUNITY PARTICIPATION. Involvement of the individuals & community in promotion of their own health & welfare, is an essential ingredient of primary health care. There must be a continuing effort to secure meaningful involvement of the community in planning, implementing & maintenance of health services, besides maximum reliance on local resources such as manpower, money & materials.

14. Cont..  One approach – the VHG & Trained Dais has been successfully tried in India.  They are selected by the local community & trained locally in the delivery of primary health care to the community they belong.

15. Cont..  By overcoming cultural & communication barriers, they provide primary health care in ways that are acceptable to the community. It is now considered that “Health Guides” & “Trained Dais” are an essential feature of primary health care in India. These concepts are revolutionary. They have been greatly influenced by the experience in China where community participation in the from of “bare foot doctors” took place on an unprecedented scale.

16. 3.INTERSECTORAL COORDINATION. There is an increasing realization that PHC cannot be provided by the health sector alone. The declaration of Alma Ata states that primary health care involves in addition to health sector, all related sectors & aspects of national & community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communication & other sectors.

17. Co n t.. To achieve such cooperation, countries may have to review their administrative system, reallocate their resources & introduce suitable legislation to ensure that coordination can take place. This requires a strong political will to translate values into action. An important approach is the inter sectoral approach.

18. 4.APPROPRIATE TECHNOLOGY .  Appropriate technology has been defined as “technology that is scientifically sound, adaptable to local needs, & acceptable to those who apply it & for those whom it is used & that cab be maintained by the people themselves in keeping with the principles of self reliance with the resources the community & country can afford”.

19.  The term appropriate is emphasized because in some countries luxurious hospitals that are totally inappropriate to the local needs, are built, which absorb a major part of the national health budget, effectively blocking many improvement in general health services.

20. Examples of appropriate technology ORS instead of expensive intravenous replacement of fluids in mild and moderate dehydration Vaccine vial monitor (VVM) instead of lab testing of potency of vaccine due to possible exposure to heat Bio gas system in a small community rather than piped natural gas or LPG cylinders for clean fuel

21. For provision of safe drinking water  Pot chlorination (NEERI ,NAGPUR METHOD)  Chlorination with tablets in individuals houses in water containers. These are cheap from chemist

22. STRATEGIES OF PRIMARY HEALTH CARE Accessibility, Availability, Affordability and Acceptability of Health Services Health services delivered where the peoples are living one community health worker per 10-20 households Use of traditional medicines

23. Provision of quality, basic and essential health services Training. Attitudes, knowledge and skills developed. Regular monitoring and periodic evaluation.

24. Community Participation Awareness on health and health-related issues. Planning, implementation, monitoring and evaluation done through small group meetings Selection of community health workers Formation of health committees. Establishment of a community health organization. Mass health campaigns and mobilization

25. Self-reliance Community generates support for health programs. Use of local resources Training of community in leadership and management skills. Incorporation of income generating projects, cooperatives and small scale industries.

26. Recognition of interrelationship of health and development Convergence of health, food, nutrition, water, sanitation and population services. Integration of PHC into national, regional, provincial, municipal development plans. Coordination of activities with economic planning, education, agriculture, industry, housing, public works, communication and social services. Establishment of an effective health referral system.

27. Social Mobilization Establishment of an effective health referral system. Multi-sectoral and interdisciplinary linkage. Information, education, communication Collaboration between government and non- governmental organizations.

28. Decentralization Reallocation of budgetary resources. Reorientation of health professional and PHC. Advocacy for political and support from the national leadership down .

29. PRIMARY HEALTH CARE MODEL Health se r v i ces nutrition environment e c o n omic polit i cs Education & c o mmu n icat ion

30. PRIMARY HEALTH CARE STATUS IN INDIA Village level: Village health guides Local dais Anganwadi workers ASHA

31. Sub-centre level Maternal health care. Counseling and appropriate Adolescent health care. Assistance to school health services. Promotion of sanitation. Field visits. Community need assessment. Curative services. Training. Implementation of national health programmes

32. Primary health center level ACTIVITES include: Medical care. MCH including family planning. Safe water supply and basic sanitation. Prevention and control of locally endemic diseases. Collection and reporting of vital statistics. Education about health. National health programmes. Referral services. Training of health guides, health workers, local dais and health assistants. Basic laboratory services

33. Requirements for a sound PHC Appropriateness. Availability. Adequacy. Accessibility. Acceptability. Affordability. Accountability. Completeness. Comprehensiveness. Continuity

34. Community health centre level Care of routine and emergency. 24 hour delivery services. Essential and emergency obstetric care. Full range of family planning services. Safe abortion services. Newborn care. Routine and emergency care of sick children. foreign body removal, tracheostomy etc Implementation of national health programmes.

35. CURRENT TRENDS Combining country efforts and policy instruments with global reach Integrated service delivery models Financing universal coverage Human resources for health Medicines Infrastructure and technology Health governance

36. EXISTING WEAKNESS IN IMPLEMENTATION OF PRIMARY HEALTH CARE Minimal policy and organizational commitment Poorly defined functions Poor selection: Deficiencies in training and continuing education Lack of support and supervision Uncertain working conditions

37. EXISTING WEAKNESS IN IMPLEMENTATION OF PRIMARY HEALTH CARE Undetermined cost and sources of finance Lack of monitoring and evaluation Lack of transport facilities Insecurity of female staff Inadequate supply of drugs and stationeries Medical officers are not interested to work in rural areas

38. ISSUES AND CHALLENGES OF PHC IN INDIA Inadequate human resources Failure to deliver universally Failure to deliver effectively Poor leadership, public regard, and professional status Funding models that are unresponsive fail to ensure treatments are effectively distributed and universally available for common serious acute diseases Lack of effective information systems

39. CHALLENGES:  the changing environment  Advances in health and Technology  Lack of health personnel  The double burden of disease

40. The ultimate goal of primary health care is better health for all. WHO has identified five key elements to achieving that goal: reducing exclusion and social disparities in health (universal coverage reforms); organizing health services around people's needs and expectations (service delivery reforms); integrating health into all sectors (public policy reforms); pursuing collaborative models of policy dialogue (leadership reforms); and increasing stakeholder participation.

41. ROLE OF NURSE IN PRIMARY HEALTH CARE  Collaborator Advisor: Consultant Advocate: Preventer of illness

42. ROLE OF NURSE IN PRIMARY HEALTH CARE Promoter of health Care provider Team leader Participant: Observer Manager Potentiator

43. HEALTH FOR ALL:2000  health for all is ‘ the attainment of a level of health that will enable every individual to lead a socially and economically productive life.’ - WHO

44. SPECIFIC GOALS TO BE ACHIEVED BY 2000 AD : Reduction of infant mortality from the level of 125 to below 80. To raise the expectation of life at birth from the level of 52 years to 64 years. To reduce the crude death rate from the level of 14 per 1000 population to 9 per 1000 population. To reduce the crude bith rate from the level of 33 per 1000 population to 21 per 1000 population. To achieve a net reproduction rate of one To provide potable water to the entire rural population

45. Evaluation of HFA [1979-2006]: Insufficient political commitment. Failure to achieve equity in access to all PHC. The continuing low status of women. Slow socio economic development. Unbalanced distribution of resources. Wide spread inequality of health promotion efforts. Weak health information systems and lack of baseline data. Pollution, poor food safety and lack of water supply and sanitation.

46. Co n t.. Rapid demographic and epidemiological change. Inappropriate use and allocation of resources for high cost of technology. Natural and man-made disasters. Misinterpretation of the PHC concept. Misconception that PHC is the 2 nd rate of health care for the poor. Lack of political will. Centralized planning and management .

47. HEALTHY PEOPLE BY 2010/2020

48. What is Healthy People 2010? A comprehensive set of national health objectives for the decade Developed by a collaborative process Designed to measure progress over time. A public health document that is part strategic plan, part textbook on public health priorities

49. Healthy People Entering its Fourth Decade 1979—ASH/SG Julius Richmond establishes first national prevention agenda : Healthy People: Surgeon General’s Report on Health Promotion and Disease Prevention HP 1990—Promoting Health/Preventing Disease: Objectives for the Nation HP 2000—Healthy People 2000: National Health Promotion and Disease Prevention Objectives HP 2010—Healthy People 2010: Objectives for Improving Health Healthy People 2020 – Launched December 2010

50. HEALTHY PEOPLE-2010 Increase the quality and years of healthy life Eliminate health disparities

51. HEALTHY PEOPLE-2020 Elimination of preventable disease, disability, injury and premature death. Achievement of health equality. Elimination of health disparities. Creation of social and physical environment that will promote good health and healthy development and behaviour at every stage of life.

52. Targets to be achieved by the year 2020 are: Decrease infant mortality rate below 60 . To increase the expectation of life from 52 years to 64 years. To decrease the crude death rate from 14/1000 population to 9/1000 population. To achieve a net reproduction rate of 1. To provide water to the entire population

53. NATIONAL HEALTH POLICY respond to growing calls for strengthening health systems through Primary Health Care as a way of achieving the goal of better health for all. This requires action in four policy areas: moving towards universal coverage, reorienting conventional care towards people-centred care, integrating health in all policies, and ensuring more inclusive health governance; guide and steer the entire, pluralist health sector rather than being limited to command-and-control plans for the public sector alone; go beyond the boundaries of health systems, addressing the social determinants of health and the interaction between the health sector and other sectors in society.

54. OBJECTIVES Nutrition. Prevention of food adulteration and quality of drugs. Water supply and sanitation. Environment protection.

55. Co n t.. Immunization programmes. Maternal and child health services. School health programmes. Occupational health services

56. National health policy-GOALS To establish one HSC for every 5000 [3000 for hilly areas]. To establish one PHC for every 30,000 population. To establish one CHC for every 1,00000 population. To train village health guides selected by the community for 1,000 population in each village. To train TBAs in each village. Training of various categories of field functionaries

57. NHP 2002 – to be achieved by year 2015  Eradicate polio and yaws - 20 5  Eliminate leprosy -2005  Eliminate Kala- azar - 2010  Eliminate filariasis - 20 1 5  Zero level growth of HIV/AIDS - 20 7  Dec r ea s ing mortalit y of T B b y 50 % - 2010

58. NHP 2002 – to be achieved by year 2015 Decreasing malaria and other vector borne disease -2010 Decreasing prevalence of blindness 0.5% -2010 Increasing utilization of public health service from 20% to 75% -2010 Decreasing IMR to 30/1000 and MMR 100/1lakh -2010

59. GOALS SET AND ACHIEVED BY NATIONAL HEALTH POLICY-1983 Indicator Goals by 2000 Achieved by 2000 IMR 60 70 PNMR 33 46 CDR 9 8.7 MMR 2 4 UFMR 10 9.4 LIFE EXPECTANCY MALE 64 62.4 FEMALE 64 63.4 LBW 10% 26%

60. CBR 21 26.1 CPR 60% 46.2% NBR 1 1.45 Growth rate 1.2 1.93 Family size 2.3 3.1 AN care 100% 67.2% TT pregnant 100% 83% DPT 85% 87% OPV 85% 92% BCG 85% 82% Fully immunized 85% 56% Indicator Goal by 2000 Achieved by 2000

61. POPULATION IN INDIA

62. NATIONAL POPULATION POLICY WHICH INTEND TO DECREASE THE BIRTH RATE/GROWTH RATE IN APRIL 1976 INDIA FORMED FIRST POPULATION POLICY EMPHASIZING INCREASE IN THE LEGAL MINIMUM AGE AT MARRIAGE FROM 15-18 Yrs Not only with fertility and Mortality rates . Empowering , women's education, health and Nutrition's child survival health , family welfare services adolescent health participation of men in parenthood

63. Demographic goals by 2010 Address unmet needs of basic RCH services. Compulsory free education up to 14 yrs of age. Reduce IMR to below 30 per 1000 live births. Reduce MMR to below 100 per 100,000 live births. 100% protection against vaccine preventable disease for children Preferable age marriage for girls is 20 not earlier by 18 80% of deliveries in intuitions , 100% by trained personnel

64. 100% registration of births ,deaths , marriage, pregnancy Contain the spread of AIDS Integrate Indian system of Medicine Ensure peoples access to information / counseling and services for family planning include contraceptives clinical and surgical services Prevent and control communicable diseases Promote small family norm

65. HEALTH AND FAMILY WELFARE PROGRAMME National family planning programme was launched in 1952 Union ministry of health and family welfare. During first and second five year plan programme modest way with clinical approach emphasis of four components. Education Training Research

66. Co n t.. During third five year plan , the programme was reorganized after publication of 1961 census Which showed higher growth rate than expected Clinical approach was supplemented by an extension approach – family planning , service and supplies of contraceptives taken to the people. Setup state and district levels RFWC and sub centers were established with PHC During fourth five year plan priority to programme.

67. Post Partum Programme and MTP act was introduced. In fifth five year plan , approach integrate family welfare services (MCH) Sixth five year plan. NHP achieve under health and family welfare Major demographic Goal – replacement level of fertility (NRR=1) by the year of 2000 Universal immunization programme aimed in mortality and morbidity among clildren Oral – rehydration therapy also started –dehydration - death

68. Seventh five year plan – improve mothers health and young children, provide them facilities and treatment of major disease. Eighth five year plan -integrated child survival and safe motherhood. International conference Cairo (population and dev)- reducing cost of input -better out come Ninth five year plan- integrates all related problems of 8 th five year plan RCH concept -need based , client oriented , demand driven,high quality integrated services.

69. To eradicate extreme poverty and hunger

70. To achieve universal primary education

71. To promote gender equality and empower women

72. To reduce child mortality

73. To improve maternal health

74. To combat HIV/AIDS, M alaria and O ther D iseases

75. To ensure environmental sustainability

76. To develop a global partnership for development