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National health policy 1983, 2002, 2017

1. NATIONAL HEALTH POLICY Submitted by : Arushi Negi M.Sc. Nursing IV sem Submitted to : Ms. Rajlaxmi Tutor RCON Jamia Hamdard

2. Introduction Health policy defines health goals at the international, national, or local level and specifies the decisions, plans, and actions to be undertaken to achieve these goals," according to the World Health Organization (WHO).

3. Definition National health policy is an initiative by the central government to strengthen the health system in India. This initiative molds various dimensions of health sectors like disease prevention, promotion of good health via cross-sectoral actions, health investment, strengthening human resources, technological advancements and more. There has been 3 NHPs by government of India. The three NHPs are- NHP (1983), NHP (2002) and NHP (2017).

4. NATIONAL HEALTH POLICY(1983) The first National Health Policy of 1983 was a response to the commitment to the Alma Ata declaration to achieve "Health for all by 2000" by the Union Ministry of Health and Welfare. It accepted that health was central to development and had a focus on access to health services, especially for vulnerable groups.

5. KEY ELEMENTS OF NATIONAL HEALTH POLICY 1983:- It strongly stresses on: Primary health care infrastructure Coordination with health-related services Active involvement of voluntary organization Provision of essential drugs and vaccines Qualitative improvement in health and family planning services Provision of adequate training Medical research on common health problems.

6. KEY ELEMENTS OF NATIONAL HEALTH POLICY 1983:- Creation of greater awareness of health problem by the community Supply of safe drinking water and basic sanitation Reduction of existing imbalance in health care Establishing dynamic HMIS Providing legislative support to health protection and promotion Concerned action to combat widespread malnutrition Research in alternative methods of health care delivery and low-cost health technologies Greater coordination of different systems of medicine.

7. GOALS: INDICATOR TARGET BY 2000 ACHIVEMENT CBR 21 26.1 CDR 9 8.7 IMR <60 70 PMR 30-35 44.2 Under 5 mortality 10 23.7 MMR <2 4 Life expectancy 64 64.6 Family size 2.8 3 NRR 1 1.5 Couple protection rate 60 43.5 Annual growth rate 1.22 2.1 TT for pregnant 100 79 DPT 85 92.5 Polio 85 93.4 BCG 85 99.1

8. cont.. This is a substantial progress by 2000 . There has also been a decline in vaccine-preventable diseases due to an improvement in the immunization coverage. Smallpox, Guinea worm, and polio have been eradicated countrywide. Water-borne diseases are also much less than before. But TB, malaria, malnutrition, diseases related to lifestyle, like DM, HTN are still major public health problems.

9. FACTORS INTERFERING WITH THE PROGRESS TOWARDS HEALTH FOR ALL:- Insufficient political commitment Failure to achieve equity in access to all primary health care elements. The continuing low status of women. Slow socio-economic development. Unbalanced distribution and weak support for human resources. Widespread inadequacy of health promotion activities. Weak health information system and no baseline data. Pollution, poor food, safety, and lack of water supply and sanitation. Rapid demographic and epidemiological changes. Inappropriate use and allocation of resources, high-cost technology. Natural and man-made disasters.

10. NATIONAL HEALTH POLICY 2002:- Considering the kind and level of progress, the barriers and the change in health problems and the circumstances, the department of Health, Ministry of formulate a new health policy frameworks. The main objective of this National Health Policy was to achieve acceptable standard of good health amongst the general population of the country.

11. KEY COMPONENTS : The National Health Policy-2002(NHP) gives prime importance to ensure a more equitable access to health services across the social and geographical expanse of the country. The highlights of the policy are:

12. GOALS TO BE ACHIEVED BY 2001-2002 TO 2015:- Eradicate Polio andYaws - 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 borne and water borne diseases- 2010 Reduce prevalence of blindness to 0.5% - 2010 Reduce IMR to 30/1000 and MMR to 100/lakh - 2010 Increase the utilization of Public Health Facilities from current <20 to >75% - 2010 Establish an integrated system of surveillance, national health accounts and statistics - 2005 Increase health expenditure by government as a percentageof GDP from 0.09% to 2%increase share of central -2010 Increase central grants to constitute at least 25% of total health spending Increase state sector health spending from 5.5% to7 %of the budget-2005 Further increase to 8%.

13. NATIONAL HEALTH POLICY 2017 Since NHP 1983, the current context has however changed in four major ways: First, the health priorities are changing. Although maternal and child mortality have rapidly declined, there is growing burden on account of non-communicable diseases and some infectious diseases.  The second important change is the emergence of a robust health care industry estimated to be growing at double digit.  The third change is the growing incidences of catastrophic expenditure due to health care costs, which are presently estimated to be one of the major contributors to poverty.  Fourth, a rising economic growth enables enhanced fiscal capacity. Therefore, a new health policy responsive to these contextual changes is required.

14. Goal  The 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, and universal access to good quality health care services without anyone having to face financial hardship as a consequence.

15. Objectives  Improve health status through planned policy action in all sectors and expand preventive, promotive, curative, palliative and rehabilitative services provided through the public health sector with focus on quality.

16. Specific Quantitative Goals and Objectives 

17. A.HEALTH STATUS AND PROGRAMME IMPACT 1.Life Expectancy and healthy life  Increase Life Expectancy at birth from 67.5 to 70 by 2025. Establish regular tracking of DALY as a measure of burden of disease and its trends by 2022 Reduction of TFR to 2.1 at national and sub- national level by 2025. 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.

18. A.HEALTH STATUS AND PROGRAMME IMPACT 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 -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.  To achieve and maintain a cure rate of >85% in new sputum positive patients for TB and reduce incidence of new cases, to reach elimination status by 2025.  To reduce the prevalence of blindness to 0.25/ 1000 by 2025 and disease burden by one third from current levels. To reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by 25% by 2025.

19. B.Health systems performance 1. Coverage of health services Increase utilization of public health facilities by 50% from current levels by 2025. Antenatal care coverage to be sustained above 90% and skilled attendance at birth above 90% by 2025. More than 90% of the newborn are fully immunized by one year of age by 2025. Meet need of family planning above 90% at national and sub-national level by 2025. 80% of known hypertensive and diabetic individuals at household level maintain 'controlled disease status' by 2025. 2. Cross sectoral goals related to health Relative reduction in prevalence of current tobacco use by 15% by 2020 and 30% by 2025. Reduction of 40% in prevalence of stunting of under-five children by 2025. Access to safe water and sanitation to all by 2020 (Swachh Bharat Mission). Reduction of occupational injury by half from current levels of 334 per lakh agricultural workers by 2020. National/state level tracking of selected health behaviour.

20. C.Health Systems strengthening  1.Health finance Increase health expenditure by Government as a percentage of GDP from the existing 1.15% 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. 2. Health infrastructure and human resource Ensure availability of paramedics and doctors as per Indian Public Health Standard (IPHS) norm in high priority districts by 2020. 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 norms in high priority districts (population as well as time to reach norms) by 2025. 3. 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 healthimportance by 2020. Establish federated integrated health information architecture, health information exchanges and national health information network by 2025.

21. POLICY THRUST 1.Ensuring Adequate Investment The policy proposes a potentially achievable target of raising public health expenditure to 2.5% of the GDP. The Government could consider imposing taxes on specific commodities- such as the taxes on tobacco, alcohol and foods having negative impact on health, taxes on extractive industries and pollution Funds available under Corporate Social Responsibility would also be leveraged for well-focused programme. 2.Preventive and Promotive Health : The policy articulates to institutionalize inter- sectoral coordination at national and sub-national levels to optimize health outcomes, through constitution of bodies that have representation from relevant non-health ministries. The policy identifies coordinated action on seven priority areas for improving the environment for health: The Swachh Bharat Abhiyan Balanced, healthy diets and regular exercises. Addressing tobacco, alcohol and substance abuse Yatri Suraksha – preventing deaths due to rail and road traffic accidents Nirbhaya Nari –action against gender violence Reduced stress and improved safety in the work place Reducing indoor and outdoor air pollution

22. The policy lays greater emphasis on investment and action in school health- by incorporating health education as part of the curriculum, promoting hygiene and safe health practices within the school environment and by acting as a site of primary health care. Promotion of healthy living and prevention strategies from AYUSH systems and Yoga at the work-place, in the schools. Recognizing the risks arising from physical, chemical, and other workplace hazards, the policy advocates for providing greater focus on occupational health. ASHA will also be supported by other frontline workers like health workers (male/female) to undertake primary prevention for non-communicable diseases. “Health Impact Assessment” of existing and emerging policies, of key non-health departments that directly or indirectly impact health would be taken up.

23. 3.Organisation of Public Health Care Delivery The policy proposes seven key policy shifts in organizing health care services 1. In primary care – from selective care to assured comprehensive care with linkages to referral hospitals 2. In secondary and tertiary care – from an input oriented to an output based strategic purchasing 3. In public hospitals – from user fees & cost recovery to assured free drugs, diagnostic and emergency services to all 4. In infrastructure and human resource development – from normative approach to targeted approach to reach under-serviced areas 5. In urban health – from token interventions to on-scale assured interventions, to organize Primary Health Care delivery and referral support for urban poor. Collaboration with other sectors to address wider determinants of urban health is advocated. 6. In National Health Programm es – integration with health systems for programme effectiveness and in turn contributing to strengthening of health systems for efficiency. 7. In AYUSH services – from stand-alone to a three dimensional mainstreaming

24. 4.Primary Care Services & Continuity of Care Free primary care provision by the public sector, supplemented by strategic purchase of secondary care hospitalization and tertiary care services from both public and from non-government sector.  The facilities which start providing the larger package of comprehensive primary health care will be called „Health and Wellness Centers‟.  To make this a reality, every family would have a health card that links them to primary care facility and be eligible for a defined package of services anywhere in the country. 5.Secondary Care Services Basic secondary care services, such as caesarean section and neonatal care would be made available at the least at sub-divisional level in a cluster of few blocks.  To achieve this, policy therefore aims to have at least two beds per thousand population distributed in such a way that it is accessible within golden hour rule. This policy affirms in expanding the network of blood banks across the country to ensure improved access to safe blood.

25. 7.Closing Infrastructure and Human Resource/Skill Gaps The policy initiatives aim for measurable improvements in quality of care.  Districts and blocks which have wider gaps for development of infrastructure and deployment of additional human resources would receive focus.  Financing for additional infrastructure or human resources would be based on needs of outpatient and inpatient attendance and utilization of key services in a measurable 8.Urban Health Care Policy would also prioritize the utilization of AYUSH personnel in urban health care. An important focus area of the urban health policy will be achieving convergence among the wider determinants of health – air pollution, better solid waste management, water quality, occupational safety, road safety, housing, vector control, and reduction of violence and urban stress. These dimensions are also important components of smart cities.

26. 9.National Health Programmes working towards :  RMNCH+A services Child and Adolescent Health Interventions to address malnutrition and micronutrient deficiencies Universal Immunisation Communicable Diseases Non Communicable Diseases Mental Health Population Stabilisation District hospitals must ensure screening and treatment of growth related problems, birth defects, genetic diseases and provide palliative care for children.  The policy affirms commitment to pre-emptive care (aimed at pre-empting the occurrence of diseases) to achieve optimum levels of child and adolescent health.  There is a need to support care and treatment for people living with HIV/AIDS through inclusion of 1st, 2nd and 3rd line antiretroviral(ARV), Hep-C and other costly drugs into the essential medical list.  Screening for oral, breast and cervical cancer and for Chronic Obstructive Pulmonary Disease (COPD) will be focused in addition to hypertension and diabetes.

27. 10.Other aspects : Emergency Care and Disaster Preparedness - The policy envisages creation of a unified emergency response system, linked to a dedicated universal access number, with network of emergency care that has an assured provision of life support ambulances, trauma management centers– - one per 30 lakh population in urban areas and - one for every 10 lakh population in rural areas Mainstreaming the Potential of AYUSH- Yoga would be introduced much more widely in school and work places as part of promotion of good health as adopted in National AYUSH Mission (NAM). Linking AYUSH systems with ASHAs and VHSNCs would be an important plank of this policy.The National Health Policy would continue mainstreaming of AYUSH with general health system but with the addition of a mandatory bridge course that gives competencies to mid-level care provider with respect to allopathic remedies. Tertiary care Services - It recommends that the Government should set up new Medical Colleges, Nursing Institutions and AIIMS in the country following this broad principle. The policy recommends establishing National Healthcare Standards Organization and to develop evidence based standard guidelines of care applicable both to public and private sector. Medical Education - The policy recommends strengthening existing medical colleges and converting district hospitals to new medical colleges to increase number of doctors and specialists, in States with large human resource deficit. National Knowledge Network shall be used for Tele- education, Tele-CME, Tele-consultations.

28. Attracting and Retaining Doctors in Remote Areas - Creating medical colleges in rural areas; preference to students from under-serviced areas, and curriculum to suit rural health needs, mandatory rural postings, etc. Mandatory rotational postings.  Increase the capacity of the public health systems to absorb and retain the manpower. The total sanctioned posts of doctors in the public sector should increase to ensure availability of doctors corresponding to the accepted norms. Implementation Framework and Way Forward- The National Health Policy envisages that an implementation framework be put in place to deliver on these policy commitments. Such an implementation framework would provide a roadmap with clear deliverables and milestones to achieve the goals of the policy. Salient Features  Health card for all  Free drugs, diagnostics & emergency care at CHC, PHC & district hospital by filling gaps through strategic purchasing i.e engaging pvt sectors  66% hike in primary health spend  2 beds per 1000 population  Involvement of private sectors to achieve goals  Screening of NCDs (cancer at earliest stage)  Conversion of sub centres/health centres into Wellness centre

29. SUMMARY Through this topic we came to know about national health policy 1983, 2002 and 2017, their goals , key features and problems in achieveing them.

30. CONCLUSION National health policy is an initiative by the central government to strengthen the health system in India. This initiative molds various dimensions of health sectors like disease prevention, promotion of good health via cross-sectoral actions, health investment, strengthening human resources, technological advancements and more. There has been 3 NHPs by government of India

31. REFRENCES Park, K. Parks Textbook of Preventive and Social Medicine. 26th Edition. Jabalpur. M/S Banarsidas Bhanot Publishers. 2021. Dash B. A comprehensive textbook of community health nursing.Geriatric Care.First edition. New Delhi. Jaypee brothers medical publishers. 2017 GOI. National health policy 2017[Internt]. 2017. available at :https://www.nhp.gov.in/nhpfiles/national_health_policy_2017.pdf

32. THANK YOU