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1
Dr. Priyanka Ravi
III yr MDS
Dept of Public Health Dentistry
NATIONAL HEALTH POLICY
2
CONTENTS1. INTRODUCTION
2. HISTORY
3. BASIC CONSIDERATIONS
4. HEALTHCARE SYSTEM OVERVIEW
5. NATIONAL HEALTH POLICY – 1983
6. NATIONAL HEALTH POLICY – 2001
7. ORAL HEALTH POLICY IN INDIA
8. DRAFT OF NATIONAL HEALTH POLICY 2015
9. SUMMARY
10. CONCLUSION
11. REFERNCES
3INTRODUCTION 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.
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.
475% 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.
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.
5National 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.
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
7HISTORY
Health planning in India can be seen as pre and post independence.
Health planning in India - Pre independence
Health planning in India - Post independence
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 independence1825- Quarantine Act(1st Public health Act)
1880- Vaccination Act
1864- Public health community
1873- The Birth and Death registration Act
1886 – Plague Commission
1887- The epidemic Disease Act
1939- The Madras Public Health Act 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.
9The British government established certain bureaus/ Institutions
Central Malaria Bureau- 1909
Indian Research Fund Association- 1911
The All India Institute of Hygiene and Public Health- 1930
The rural health training center- 1939
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.
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
11Health planning in India -Post independence
National health committees
Planning Commission
Five year plans
National Health Policy
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 committeesMudliar
Committee - 1962
Chadah Committee –
1963
Mukerjee Committee –
1965
Mukerjee Committee –
1966
Jungalwala Committee –
1967
Kartar Singh Committee –
1973
Shrivastav Committee –
1975
Rural Health Scheme –
1977
Health for All by 2000 AD- Report of the working group,
1981Roy 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 plans2. Strengthening of district hospital with specialty services3.Regional organization in each state4. 1PHC=40000 population5.Integration of medical and health services6. 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 cadre2.Common seniority
3. Recognition of extra qualification
4. Equal pay for equal work5. No private practice and good
service condition.
Committee on Multipurpose
workers under health and family
planning
Group on Medical education and
support manpower
1. Involvement of medical college+PHC
2. 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.
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.
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.
HISTORY
16
BASIC CONSIDERATIONS
17HEALTH Health is a state of complete physical, mental, and social
well-being and not merely the absence of disease or infirmity.
Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya(Medi) Publishing House; 2013.
18ORAL 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”.
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.
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.
21
HEALTHCARE SYSTEM OVERVIEW
22
HEALTH SYSTEM IN INDIAAT THE CENTRE
UNION MINISTRY OF HEALTH AND FAMILY WELFARE
THE DIRECTORATE GENERAL OF HEALTH SERVICES
THE CENTRAL COUNCIL OF HEALTH AND FAMILY WELFARE
AT THE STATE
STATE MINISTRY OF HEALTH
STATE HEALTH DIRECTORATE
LOCAL OR PHERIPHERAL
(AT THE DISTRICT LEVEL)SUB- DIVISIONS
TEHSILS
COMMUNITY DEVELOPMENT BLOCK
MUNICIPALITIES AND CORPORATIONS
VILLAGES
PANCHAYATS
Cabinet ministerMinister of stateDeputy 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
officerMunicipal
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
Panchayat- at the village level
Panchayat Samiti – at the block level
Zilla Parishad- at the district level
24
HEALTH CARE SYSTEMPUBLIC 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 AGENCIESNATIONAL HEALTH PROGRAMMES
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.
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
Poliomyelitis, leprosy, and neonatal tetanus will soon be eliminated.
Some infectious diseases like dengue fever, viral hepatitis, tuberculosis, malaria and pneumonia have developed a stubborn resistance to drugs.
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.
27As 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.
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.
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.
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.
30There 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.
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
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.
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,
consis tency in the content and suggest alternates within the
possible resources, to improve the acceptability of the policy.
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.
35
After the Cabinet's approval the document was
presented in the National Parliament for ratification
in December 1982.
36
NATIONAL HEALTH POLICY – 1983
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
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
38The 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
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
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.
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
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 budgetDoes 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
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
44
NATIONAL HEALTH POLICY – 2002
45
INTRODUTION
GOALS
REVIEW OF THE HEALTH SITUATION
OBJECTIVES OF THE POLICY
POLICY PRESCRIPTION
COMMENTS
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
Dhaar GM. Robbani I. Foundations of Community Medicine. Ch 55- HEALTH CARE IN THE INDIAN CONTEXT. 1 st ed. Elsevier; 2006.
INTRODUCTION – NHP 2002
47INTRODUCTION – NHP 2002A 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
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
Dhaar GM. Robbani I. Foundations of Community Medicine. Ch 55- HEALTH CARE IN THE INDIAN CONTEXT. 1 st ed. Elsevier; 2006.
INTRODUCTION – NHP 2002
49Goals to be achieved by 2000-2015Eradicate 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
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
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 is composed
of 3 components
•Review of the health situation•Objectives of the policy•Policy prescription
NHP-2002
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.
52REVIEW OF THE HEALTH SITUATIONCHANGING 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
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.
53DISPARITY 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
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
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.
55RELEVANCE 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
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.
56OBJECTIVES OF THE POLICYTo achieve
decentralization of health services.
To strengthen and upgrade the
health care infrastructure.
To emphasize primary level of
health care.
To promote rational use of
drugs.
To ensure equitable access
to health services.
To increase primary health
investment.
To enhance private sector participation.
It also specifies a time frame for the achievement of various goals
NHP-2002
57
POLICY PRESCRICPTION
NHP-2002
581.FINANCIAL RESOURCES
2.EQUITY
3.DELIVERY OF NATIONAL PUBLIC HEALTH PROGRAMMES
4. THE STATE OF PUBLIC HEALTH INFRASTRUCTURE
5. EXTENDING PUBLIC HEALTH SERVICES
6. ROLE OF LOCAL SELF-GOVERNMENT INSTITUTIONS
7. NORMS FOR HEALTH CARE PERSONNEL
8. EDUCATION OF HEALTH CARE PROFESSIONALS
9. NEED FOR SPECIALISTS IN ‘PUBLIC HEALTH’ AND ‘FAMILY MEDICINE’
10. NURSING PERSONNEL
11. USE OF GENERIC DRUGS AND VACCINES
12. URBAN HEALTH
13. MENTAL HEALTH
5914. INFORMATION, EDUCATION AND COMMUNICATION
15. HEALTH RESEARCH
16. ROLE OF THE PRIVATE SECTOR
17. THE ROLE OF CIVIL SOCIETY
18. NATIONAL DISEASE SURVEILLANCE NETWORK
19. HEALTH STATISTICS
20. WOMEN’S HEALTH
21.MEDICAL ETHICS
22. ENFORCEMENT OF QUALITY STANDARDS FOR FOOD AND DRUGS
23. REGULATION OF STANDARDS IN PARAMEDICAL DISCIPLINES
24. ENVIRONMENTAL AND OCCUPATIONAL HEALTH
25. PROVIDING MEDICAL FACILITIES TO USERS FROM OVERSEAS
26. IMPACT OF GLOBALISATION ON THE HEALTH SECTOR
601.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
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.
61The 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
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.
622.EQUITYTo 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
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.
63NHP-2002 sets out an increased allocation total public health investment for
the primary health sector - 55 %the secondary sector - 35 %the 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
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.
643.DELIVERY OF NATIONAL PUBLIC HEALTH PROGRAMMESThis 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.
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.
65However, 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
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.
66The 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
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.
674. 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.
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
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
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.
70Policy 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
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.
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.
72Also, 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
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.
73NHP-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
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
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 INSTITUTIONSNHP-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
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.
76The 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
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77
7. NORMS FOR HEALTH CARE PERSONNELMinimal 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
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.
788. 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
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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
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.
80A 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
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.
81The 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
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’
To alleviate the acute shortage of medical personnel with
specialization in the disciplines of ‘public health’ and ‘family medicine’.
implementation of mandatory norms to raise the proportion of postgraduate seats in these discipline in medical training institutions, to reach a stage wherein ¼ th of the seats are for these
disciplines.
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.
83Specialization 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
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
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.
8510. 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
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.
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87
Not less than 50% of the requirement of vaccines/sera be sourced from public sector institutions.
NHP-2002
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.
8812. URBAN HEALTHSetting - organized urban primary health care structure.
Adoption - population norms for its infrastructure.
NHP-2002
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.
89The structure is two-tiered : The first-tier, covering a population of
one lakhproviding OPD facilitywith 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
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.
90Funding 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
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.
9113. 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
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92
Upgrading of the physical infrastructure of mental health institutions at Central Government expense.
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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
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94
The community leaders- particularly religious leaders, are effective in imparting knowledge for behavioural change.
NHP-2002
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.
95Annual 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
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.
9615. 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
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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
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.
9816. 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.
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.
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.
100Non-governmental practitioners- in national disease control programmes
Applications of tele-medicine in the health care sector.
NHP-2002
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101
10217. THE ROLE OF CIVIL SOCIETYContribution 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.
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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.
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.
10419. HEALTH STATISTICS
Periodic updating of these baseline estimates through representative sampling, under an appropriate statistical methodology.
NHP-2002
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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
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106
National health accounts and accounting systems would pave the way for decision-makers to focus on relative priorities.
NHP-2002
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.
10720. 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
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.
108Highest 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
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.
10921.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
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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.
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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.
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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.
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
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114
25. PROVIDING MEDICAL FACILITIES TO USERS FROM OVERSEASHealth 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.
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11526. 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.
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.
116COMMENTSNot much attention is paid to child, adolescent, Geriatrics
health, gender, domestic violence.
Ignored areas- Resource generation & allocation, management of work force, substance abuse management.
Kumar A, Gupta S. Health Infrastructure in India: Critical Analysis of Policy Gaps in the Indian Healthcare Delivery. Vivekananda International Foundation . 2012
117Methodology 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.
Kumar A, Gupta S. Health Infrastructure in India: Critical Analysis of Policy Gaps in the Indian Healthcare Delivery. Vivekananda International Foundation . 2012
Achievements2003 –
• 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
120
National Health Policy - 2015 Draft
121NEED FOR NATIONAL HEALTH POLICY 2015
SITUATIONAL ANALYSIS
GOALS,PRINCIPLES & OBJECTIVES
POLICY DIRECTIONS
REGULATORY FRAMEWORK
GOVERNANCE
IMPLEMENTATION AND WAY FORWARD
Need for National HealthPolicy 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.
124
Situation AnalysisIndicator 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
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.
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.
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.
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.
129
Policy Principles:
– Equity
– Universality
– Patient Centered & Quality of Care
– Inclusive Partnerships
– Pluralism
– Subsidiarity
– Accountability
– Professionalism, Integrity and Ethics
– Learning and Adaptive System
– Affordability
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
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
132
Swachh Bharat Abhiyan
Balanced and Healthy diets(through Anganwadi centres and
schools)
Nasha Mukti Abhiyan
Yatri Suraksha
Nirbhaya Nari
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
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
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
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.
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.
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)
139
Weaknesses:
Pushing the secondary and tertiary healthcare into private
sector
No mention of how private sector will be regulated.
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.
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
142
NATIONAL ORAL HEALTH POLICY
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.
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
1451.INCRESING PREVALENCE AND SEVERITY OF DENTAL DISEASESDental 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
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.
http://www.mohp.gov.np/english/files/new_publications/9-2-National-Oral-Health-Policy.pdf. Last acessed 11/06/2014.
1472.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%.
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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.
http://www.mohp.gov.np/english/files/new_publications/9-2-National-Oral-Health-Policy.pdf. Last acessed 11/06/2014.
149The 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.
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.
http://www.mohp.gov.np/english/files/new_publications/9-2-National-Oral-Health-Policy.pdf. Last acessed 11/06/2014.
1515.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.
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
1531. urgent need for an Oral Health Policy for the nation as an integral part of the National Health Policy.
Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya(Medi) Publishing House; 2013
1542. 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.
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.
Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya(Medi) Publishing House; 2013
1563.A post of full dental advisor at appropriate level in the Directorate General of Health Services (Dte.G.H.S) should be created.
Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya(Medi) Publishing House; 2013
1574.Urgent need to prevent the rising trend of dental disease in India.
Achieving primary prevention of periodontal diseases and oral cancers.
Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya(Medi) Publishing House; 2013
1585. 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
Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya(Medi) Publishing House; 2013
1596.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.
Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya(Medi) Publishing House; 2013
1607.National Training Centre to be established or the existing centers be strengthened for training of various categories of oral health care personnel.
Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya(Medi) Publishing House; 2013
1618. All district hospitals and Community Health Centers should have dental clinics.
All Dental Colleges should have courses on Dental Hygienists and Dental Technicians.
Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya(Medi) Publishing House; 2013
1629.The Council further resolves that the Pilot Project may be extended to all States at the rate of one District in every state.
Peter S. Essentials of preventive and community dentistry. Ch-10 Health Care Delivery. 5th ed. New Delhi: Arya(Medi) Publishing House; 2013
16310.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.
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
165Karnataka Health Policy goals To provide integrated and comprehensive primary health care
To establish a credible and sustainable referral system
To establish equity in delivery of quality health care
To encourage greater public private partnership in provision of quality health care in order to better serve the underserved areas.
To address emerging issues in public health
To strengthen health infrastructure
To develop health human resources
To improve the access to safe and quality drugs at affordable prices
To increase access to systems of alternative medicine.
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.
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The establishment of a three tier Oral Health Care delivery system in Karnataka would be planned, namely:
Primary Oral Health Care
•(a) Health Education for promotion of oral health and •(b) Preventive Procedures for Oral Health care by qualified dental surgeons at Community Health Centers and Taluk level Hospitals.
Secondary Oral Health care
•both Preventive and Curative treatments at hospitals.
Tertiary Oral Health Care
•specialty treatment, will be made available at each District level hospital.
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Other strategies include: • Proper utilization of mass media
for regular Oral Health Education
• Involvement of local non-governmental agencies in programme operation for better implementation of the programme
• Programme for increasing awareness amongst School teachers regarding Oral Health.
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OTHER NATIONAL HEALTH POLICIES
170
NATIONAL
NUTRITIONAL
POLICY
NATIONAL POLICY
FOR EDUCATI
ON
NATIONAL POLICY
FOR CHILDRE
N
NATIONAL DRUG POLICY
NATIONAL
ALCOHOL
POLICY
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CONCLUSION
172CONCLUSIONPublic health has effectively remained a low priority for
the Indian state in terms of financing and political attention.
173Contributed to the slow and inadequate improvement in health of the population.
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.
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REFERNCES
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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.
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4.Dhaar GM. Robbani I. Foundations of Community Medicine. Chapter 55- HEALTH CARE IN THE INDIAN CONTEXT. 1st 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. 2nd ed. Mumbai: Popular Prakshan PVT Limited; 1997.
REFERNCES
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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. 3rd 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. 2nd
ed. Hyderabad: Paras Medical Books. 1996
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REFERNCES10.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. 4th ed. 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.
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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 .
REFERNCES
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