National Health Policy

NATIONAL HEALTH NATIONAL HEALTH POLICY-2002POLICY-2002

Dr Anshuli TrivediDr Anshuli Trivedi

Ist Year PG Ist Year PG

Deptt.Community Medicine.Deptt.Community Medicine.

What is Health?What is Health?

Health is a state of complete physical, Health is a state of complete physical, mental & social wellbeing & not merely mental & social wellbeing & not merely absence of disease or infirmity.absence of disease or infirmity.

WHO definition of health pg-13 Text book of PSM-Park 18 th ed Textbook by J kishoreNational Health Programmers of India

What is Policy?

Policy is a system, which provides logical frame work & rationality of decision making for achievement of intended objectives.

Objectives

Main objective is to-

“Achieve an acceptable standard of good health amongst general population of country.’’

Ref-national health policy//H:\Current Reviews - National Health Policy India.htmTextbook oNational Health programmes of

India by J KishoreDate-11/9/07

To increase access to decentralized public health system by establishing new infrastructure in deficient areas & by upgrading infrastructure in existing institutes .To ensure a more equitable access to health services across the social & geographical expanse of country.

To increase public health investment by increasing contribution from central govt.

Increase access to tried & tested system of traditional medicine.Rationalize use of allopathic drugs.Strengthening Public Health investment by increasing contribution from Central Govt.Increase contribution from pvt.Sector in providing health services for those who can afford it.

.

OTHER OBJECTIVES…...

TEXTBOOK OF NATIONAL HEALTH Programmer JKishore.pg 365.

Goals to be achieved by 2000-2015Goals to be achieved by 2000-2015 1)Eradicate Polio and Yaws by 2000-2015.1)Eradicate Polio and Yaws by 2000-2015. 2)Eliminate Leprosy by 2005.2)Eliminate Leprosy by 2005. 3)Eliminate Kalaazar 2010.3)Eliminate Kalaazar 2010. 4)Eliminate Lymphatic Filariasis 2015.4)Eliminate Lymphatic Filariasis 2015. 5)Achieve zero level growth of HIV/AIDS by 2007.5)Achieve zero level growth of HIV/AIDS by 2007. 6)Reduce mortality by 50%on an account of TB, 6)Reduce mortality by 50%on an account of TB,

Malaria,Vector&Water borne disease by 2010.Malaria,Vector&Water borne disease by 2010. 7)Reduce Prevelance of blindness by 0.5%by 2010.7)Reduce Prevelance of blindness by 0.5%by 2010. 8)Reduce IMR to 30/1000and MMR to 100/lakh by 8)Reduce IMR to 30/1000and MMR to 100/lakh by

2010.2010. 9)Increase utilization public health facilities from 9)Increase utilization public health facilities from

current level of <20% to >75%.current level of <20% to >75%.

10)Increase health expenditure from 0.9% 10)Increase health expenditure from 0.9% to 2.0% by 2010.to 2.0% by 2010.

11)Increase central health grants to at 11)Increase central health grants to at least 25% by 2010.least 25% by 2010.

12)Increase health spending by state from 12)Increase health spending by state from 5.5%to 7% by 2005.5.5%to 7% by 2005.

Ref-Textbook of PSM –Park 19th ed Pg 726

Financial ResourceFinancial Resource

%of GDP has declined from 1.3%(1990)to %of GDP has declined from 1.3%(1990)to 0.9%(1999).States are expected to be a 0.9%(1999).States are expected to be a major contributor in public health major contributor in public health services & will receive only services & will receive only supplementary input from Central supplementary input from Central resources.resources.

Problems & Policies to be tackled Under NHP-2002

Financial Resource

Ref- C:\Documents and Settings\Administrator\Desktop\Current Reviews National Health Policy –India.htm/Textbook of National Health Programme J Kishore pg 368

Their’s a recommendation to increase health sector expenditure to 6% of GDP of which 2% is to be used till 2010.Till 2005,expenditure on health by States should be increased

to 7% in I st phase, & 8% by 2010 .This will increasecontribution of Central Govt. from 15% to 25% by 2015.

EQUITYEQUITYIn centralized planning –equitable, regional distribution was considered as major objective.

Ref-C:\Documents and SettingsAdministrator\Desktop\Current Reviews - National Health Policy -India.htm/Textbook of NHP pg368

Allocation of 55% of Total Public Health investment for primary health sector.

35% for secondary health services.

10% for tertiary sector.

This will be used in strengthening existing services & to open new services.

Delivery of National Public Health Programmes

Executive should design programme such that it Executive should design programme such that it gives enough flexibility to permit State Public gives enough flexibility to permit State Public Health Administration to craft action as per their Health Administration to craft action as per their needs.needs.

Vertical implementation structure has been Vertical implementation structure has been effective in reducing effective in reducing Burden of DiseaseBurden of Disease. Ex. Ex – –Malaria eradication, RNTCP, HIV ,RCH&UIP. Till Malaria eradication, RNTCP, HIV ,RCH&UIP. Till moderate levels of Prevelance is reached.moderate levels of Prevelance is reached.

Convergence of all health programmes under a Convergence of all health programmes under a single field administration. This require change in single field administration. This require change in mindset of health administration. Retraining & re mindset of health administration. Retraining & re orientation of health staff.orientation of health staff.

Ref-C:\Documents and SettingsAdministrator\Desktop\Current Reviews - National Health Policy -India.htm/Textbook of NHP pg368

State of Public Health State of Public Health InfrastructureInfrastructure

Facilities available are estimated ….Facilities available are estimated …. <20% persons have OPD facilities.<20% persons have OPD facilities. <45% persons indoor facilities.<45% persons indoor facilities. Due to- Due to- • poor funding.poor funding.• Presence of less no. medical & Presence of less no. medical &

paramedicalparamedical personnel.personnel.• Inadequate equipment.Inadequate equipment.• overcrowding.overcrowding.

Ref-C:\Documents and Settings\ Administrator\Desktop\Current Reviews National Health Policy -India.htm/Textbook of NHP J Kishorepg 369.

RecommendationsDecentralized PUBLIC HEALTH SYSTEM will ensure more effective supervision of public health services.

Need for more frequent in-service training ,of public health & medical personnel, at the level of MO& paramedical is required.

% of health expenditure should be at least 5.2% GDP. Public expenditure on health should be at least 17.3% of total health expenditure.

Ref-C:\Documents and Settings\ Administrator\Desktop\CurrentReviews National Health PolicyIndia.htm/Textbook of NHP J Kishorepg 369.

Extending Public Health Extending Public Health ServicesServices

Shortage of medical personnels in less developed & rural Shortage of medical personnels in less developed & rural areas.areas.

No incentives given to persons trained in alternate medicine.No incentives given to persons trained in alternate medicine.

These persons can be used for implementing Central & State These persons can be used for implementing Central & State Govt. health programmes.As per suggested in 2002 NHP Govt. health programmes.As per suggested in 2002 NHP report. report.

Recommends 2 year mandatory rural health posting before Recommends 2 year mandatory rural health posting before granting MBBS degree.granting MBBS degree.

\ \

:\Documents and Settings\Administrator\Desktop\Current Reviews - National Health Policy -India.htm,/ Text book of NHP’S J Kishore PG369C:\PG369C:\

Role of local self governed Role of local self governed institutesinstitutes

C:\Documents and Settings\AdministratorDesktop\Current Reviews – National Health Policy -India.htm Textbook of National Health Programmers J Kiishore-370

By devolving health programme & funds in different level of Panchayati Raj & other local governing bodies has enabled –

Need based allocation of resources,

Supervision by elected representatives of population in rural ,urban & rest of India.

Ex –Nirmal Gram Pariyojna.

Education of Health care professionals

Uneven geographical distribution of Medical Uneven geographical distribution of Medical Colleges.Colleges.

Theoretical subjects.Theoretical subjects. Substandard quality of educationSubstandard quality of education Reluctance to rural service.Reluctance to rural service. Less exposure to community- health related Less exposure to community- health related

activities.activities. Absence of skill & day to day practice, oriented Absence of skill & day to day practice, oriented

practical training.practical training. Scarce availability of anesthesiologist, Scarce availability of anesthesiologist,

radiologists,FM experts.radiologists,FM experts. Nursing personnel-Low doctor : nurse ratio. Acute

shortage of super specialties trained nurses.

C:\Documents and Settings\Administrator\Desktop\Current Reviews - National Health Policy -India.htm,/ Text book of NHP’S J Kishore.

RecommendationsAdvocates setting of a Medical Grants Commission to fund new medical & dental colleges & to upgrade infrastructure.

Ensure need based & skill oriented syllabus after graduation.

Periodic skill updating by continuos medical education.

Introduction of new concepts of Geriatics , Genetics, Molecular Biology, FM, radio diagnosis, anesthesia should be highlighted.

Prime Minister of India has launched Prime Minister of India has launched PHFIPHFI i.e.. Public i.e.. Public Health Foundation Of India. To give world class health Health Foundation Of India. To give world class health facilities & training to medical personnels.facilities & training to medical personnels.

C:\Documents and Settings\Administrator\Desktop\Current Reviews - National Health Policy -India.htm,/ Text book of NHP’S J Kishore PG 372

Need for Specialists in Need for Specialists in Public &Family MedicinePublic &Family Medicine

In developing countries demand for In developing countries demand for trained personnel in Public Health & trained personnel in Public Health & Family Medicine is more than other Family Medicine is more than other disciplines.disciplines.

Current UG&PG, syllabus is Current UG&PG, syllabus is inappropriate to today’s need. More inappropriate to today’s need. More talented medical UG’s take up clinical talented medical UG’s take up clinical disciplines,rest take up GP. disciplines,rest take up GP.

Also availability of PG’ seats is 50% of Also availability of PG’ seats is 50% of qualified UG’s.qualified UG’s.

C:\Documents and Settings\Administrator\Desktop\Current Reviews National Health Policy -India.htm/Textbook of NHP pg371

RECOMMENDATIONSRecommends to increase seats of Pubic Health & Family Medicine up to 1/4th for all available subjects.

Not only medical graduates but also student from other

disciplines. Ex-health engineering ,microbiologists, natural

scientists, must be trained in Public Health.

Greater exposure to field work in Public Health. Establishing rural Medical Colleges.

Regulation of Standards of Paramedical Disciplines-

New paramedical institute have mushroomed particularly in pvt. sector-Ex-lab technicians ,radio diagnostics, physios. etc Policy recommends- Standardization ,Regulation, Registration & Inspection & Monitoring of such institutes.

Use of generic Drugs & Use of generic Drugs & VaccinesVaccines

Low cost Health care system of India is largely due to Low cost Health care system of India is largely due to indigenous manufacture of drugs & vaccines.indigenous manufacture of drugs & vaccines.

With Globalization there is likely increase in costs of With Globalization there is likely increase in costs of drug.drug.

Hence the measures should be taken to keep costs Hence the measures should be taken to keep costs

affordable to ensure health security of countryaffordable to ensure health security of country. .

Impact of Globalization on Health Sector

There is likely to be increase in costs of drugs & vaccines. Hence NHP -02 recomm. National Patent Regime to ensure affordable access to latest medical & other therapeutic discoveries.

C:\Documents and Settings\Administrator\Desktop\Current Reviews – National HealthPolicy -India.htm /Textbook of NHP J Kisore PG 370

Emphasis should be laid on use of ESSENTIAL DRUGS in both pvt. & public sector.

Production & sales of irrational drugs should be curbed.

No less than 50% vaccines & sera should be provided by public sector.

Standardization Standardization Enforcement of quality standards- NHP paid

heed to maintain reasonable, quality & standards for food & drugs.

MeasuresMeasures

C:\Documents and Settings\Administrator\Desktop\Current Reviews National Health Policy -India.htm/Textbook of NHP pg371

Urban HealthUrban Health

Meagerly available.With no Meagerly available.With no uniformity in organizational uniformity in organizational structure.structure.

Urban population is 30% and is Urban population is 30% and is likely to increase to 33% by 2010 likely to increase to 33% by 2010 due to migration.due to migration.

This will lead to development of This will lead to development of slums, with poor percolation of slums, with poor percolation of public health facilities.public health facilities.

:\Documents and SettingsAdministrator\Desktop\Current Reviews – National Health Policy -India.htmTextbook of NHPJ Kshore pg 370

Health Research & Health Research & DevelopmentDevelopment

Limited Health Research in India.In govt. Limited Health Research in India.In govt. sector R&D is largely confined to ICMR. sector R&D is largely confined to ICMR.

R&D should be focused on therapeutic drugs R&D should be focused on therapeutic drugs & vaccines for tropical disease.That are & vaccines for tropical disease.That are largely neglected by pharma companies due largely neglected by pharma companies due to limited profitability.to limited profitability.

Research esp. on genetics, genome based Research esp. on genetics, genome based drugs, vaccines development, molecular drugs, vaccines development, molecular biology is needed. biology is needed.

EEnsure greater participation of Medical nsure greater participation of Medical Colleges & similar institutes for R&D.Colleges & similar institutes for R&D.

Govt. aid for R &D should be increased to 1% Govt. aid for R &D should be increased to 1% of total health by 2005 & upto 2% by 2010of total health by 2005 & upto 2% by 2010..

C:\Documents and Settings\Administrator\Desktop\Current Reviews –National Health Policy -India.htm/Textbook of NHP J Kishorepg 371

Role of private sectorRole of private sector Contributes significantly to secondary & Contributes significantly to secondary &

tertiary care. Widespread perception that it tertiary care. Widespread perception that it is uneven in quality, frequently substandard.is uneven in quality, frequently substandard.

Pvt. Health care are financially exploitive Pvt. Health care are financially exploitive with poor observation of medical ethics.with poor observation of medical ethics.

With increase in their role-implementation of With increase in their role-implementation of STATUORYSTATUORY regulation & maintaining regulation & maintaining minimal minimal STANDARDSTANDARDS in diagnostic S in diagnostic medical institution is required.medical institution is required.

Introduction of Telemedicine & social Introduction of Telemedicine & social insurance schemes.insurance schemes.

C:\Documents and Settings\Administrator\Desktop\Current Reviews National Health Policy -India.htm/Textbook of NHP pg371

MENTAL HEALTHMENTAL HEALTH Mental health problems are more prevalent than Mental health problems are more prevalent than

actually noted. Not mortal but seriously affect actually noted. Not mortal but seriously affect lives of patients, families.lives of patients, families.

Commonly thought to be associated with Commonly thought to be associated with “SPIRITUAL“SPIRITUAL AFFLICTION’’.AFFLICTION’’.

Hence promoting unlicensed mental institutions Hence promoting unlicensed mental institutions & religious institution as a site of faith cure.& religious institution as a site of faith cure.

Serious conditions require hospitalization & T/T Serious conditions require hospitalization & T/T under trained supervision.under trained supervision.

C:\Documents and Settings\Administrator\Desktop\Current Reviews – National Health Policy -India.htm/Textbook of NHP PG 371

Information, Education,Information, Education,CommunicationCommunication

Information dissemination is central to providing Health Information dissemination is central to providing Health Care. Task of education is difficult as 35% of country ‘s Care. Task of education is difficult as 35% of country ‘s population is illiterate.population is illiterate.

Untrained Health Service providers are treating large no. of pt. at primary level for major diseases. Ex. QUACKS. Without any standardization & scientific knowledge leading frequently to drug resistance & complication

The present IEC is too fragmented-relies on mass- media. The present IEC is too fragmented-relies on mass- media.

But those not benefited by them need addressal, by folk media But those not benefited by them need addressal, by folk media ,interpersonal relations,NGO’s/Trusts.Ex. Kalyani TV Show. ,interpersonal relations,NGO’s/Trusts.Ex. Kalyani TV Show.

With annual evaluation of their performancesWith annual evaluation of their performances..C:\Documents and Settings\Administrator\Desktop\Current Reviews – National Healt hpolicy India.htm/Textbook of NHP PG 371

Hence schools & colleges are considered as prime targets to intervene for IEC & help in promoting sound health behavior. Ex –Dental Checkups.

IEC will address itself & eliminate risk of inappropriate T/T.

Role of Civil SocietyRole of Civil SocietyIt has been practiced to increase participation of NGO’S, Social Support Groups, voluntary health workers, no less than 10% of total task force, to carry out National & State level Health Programmes.

Certain NHP ‘S require continuous supervision, lab

diagnosis, regular follow up. etc. Ex. RNTCP for T/T of TB. These can easily be taken up by voluntary workers.C:\Documents and Settings\Administrator\Desktop\Current Reviews –National Health Policy -India.Htm/Textbook of NHP JK ishore pg371

National Disease National Disease Surveillance ProgrammeSurveillance Programme

Surveillance system of India is very rudimentary .Poor Surveillance system of India is very rudimentary .Poor flow of information about Facilties at State & Central flow of information about Facilties at State & Central level. Hampering effective health care system & level. Hampering effective health care system & planning.planning.

It is recommended to collect baseline incidences of common diseases Ex., Malaria etc.& long term incidences for non communicable diseases. Ex-CVA, CHD, DM. To ensure future policy making.

Success story of Polio & HIV control is largely due to efficient surveillance system.Hence there is need to have an effective, integrated disease

“Surveillance Network”.

:\DocumentsettingsAdministrator\Desktop\CurrentRews – NationalHealth Policy -India.htmTextbook of NHPJ Kshore pg 370

.

.HEALTH STATISTICSCurrent scenario has absence of a systematic, proper, meaningful & scientific health statistics data base collection methodology.

NHP-2002 focuses on programme to put up a modern & SCIENTIFIC HEALTH DATABASE & a system of NATIONAL HEALTH ACCOUNTS.

WOMEN’S HEALTHWOMEN’S HEALTH Receive inadequate public health facilities, due to some Receive inadequate public health facilities, due to some socio-cultural-economic factors. socio-cultural-economic factors. NHP-2002 recognizes role of empowered women in NHP-2002 recognizes role of empowered women in Improving over all health standard of community. Improving over all health standard of community. Ex-ASHA is used under NRHM.Ex-ASHA is used under NRHM.

Medical EthicsMedical Ethics

Professional medical practice is now Professional medical practice is now perceived to be commercial & had lost its perceived to be commercial & had lost its position of form of a social service, bringing position of form of a social service, bringing basic health service to fellow humans.basic health service to fellow humans.

In 1960,ICMR carried out a research on In 1960,ICMR carried out a research on MEDICAL ETHICS & gave guidelines that MEDICAL ETHICS & gave guidelines that were updated in 2001.were updated in 2001.

Medical ethics need a new vision esp. in Medical ethics need a new vision esp. in area of sanctity of human life & moral area of sanctity of human life & moral dilemma of new human life forms that can dilemma of new human life forms that can cause irreversible environmental change. Ex-cause irreversible environmental change. Ex-Human Cloning.Human Cloning.

C:\Documents and Settings\Administrator\Desktop\Current Reviews –National Health Policy -India./Text book of NHP J Kishore pg372

Environmental ,Occupational & Environmental ,Occupational & Educational HealthEducational Health

Unsafe drinking water, unhygienic Unsafe drinking water, unhygienic sanitation, air pollution contributes to urban sanitation, air pollution contributes to urban population & exposes health risks to population & exposes health risks to dwellers.dwellers.

Work conditions are substandard risking Work conditions are substandard risking individual to occupation linked ailments individual to occupation linked ailments leading to chronic morbidity ,particularly for leading to chronic morbidity ,particularly for child labour.child labour.

Ex –Coal Worker Ex –Coal Worker Pneumoconiosis,TB,Malignancy.Pneumoconiosis,TB,Malignancy.

NHP directs employers to take their own NHP directs employers to take their own initiatives to control these factors in pvt.or initiatives to control these factors in pvt.or public sectors. Ex –by regular screening of public sectors. Ex –by regular screening of workers particularly high risk groups.workers particularly high risk groups.C:\Documents and Settings\Administrator\Desktop\Reviews Nationalhealthpolicy/htm/Textbook of NHP J Kishore pg 372

Providing medical facilities Providing medical facilities to overseas beneficiaries.to overseas beneficiaries.

Good quality & cost effective secondary & Good quality & cost effective secondary & tertiary level of medical facilties & drugs are tertiary level of medical facilties & drugs are available, not only in allopathy but also in available, not only in allopathy but also in alternate medicine.Ex- Concept of Medical alternate medicine.Ex- Concept of Medical Tourism.Tourism.

Indian pharma. companies are manufacturing Indian pharma. companies are manufacturing innovative, indigenous drugs & vaccines as per innovative, indigenous drugs & vaccines as per present patent laws.present patent laws.

NHP had also set up guidelines to ensure NHP had also set up guidelines to ensure availability of drugs vaccines, & T/T, cost availability of drugs vaccines, & T/T, cost effectively in this era of Globalization.effectively in this era of Globalization.

C:\Documents and Settings\Administrator\Desktop\Reviews Nationalhealthpolicy/htm/Textbook of NHP J Kishore pg 372

ALTERENATE SYSTEM OF ALTERENATE SYSTEM OF MEDICINEMEDICINE

Under National Health Programme Under National Health Programme ““AYUSH”AYUSH” is is included. Due to its diversity,modest cost, low level included. Due to its diversity,modest cost, low level technological input, growing popularity of plant based technological input, growing popularity of plant based products.Esp. Useful in remote & tribal areas. products.Esp. Useful in remote & tribal areas.

Ex. Use of plant based drugs in allopathy ie.Ex. Use of plant based drugs in allopathy ie.satavarexsatavarex is is used in promoting lactation.used in promoting lactation.

Population Growth & Health Standards Population Growth & Health Standards

Efforts are made to improvise Health standards to match Efforts are made to improvise Health standards to match rapidly growing population.rapidly growing population.

It’s recognized that population stabilization measures, It’s recognized that population stabilization measures, general health initiatives etc…..when synchronized general health initiatives etc…..when synchronized synergistically, maximize socio economic wellbeing of synergistically, maximize socio economic wellbeing of society. For this separate National Population Policy-2000 society. For this separate National Population Policy-2000 had been recommended. had been recommended.

C:\Documents and Settings\Administrator Desktop\Current Reviews – National Health Policy -India.htm

LLOOOOP P HOLESHOLES Not much attention is paid to child, adolescent, Not much attention is paid to child, adolescent,

Geriatrics health, gender, domestic violence.Geriatrics health, gender, domestic violence. Ignored areas- Resource generation & allocation, Ignored areas- Resource generation & allocation,

management of work force, substance abuse management of work force, substance abuse management ,control of medical ads.management ,control of medical ads.

Methodology of strengthening healthcare & functioning Methodology of strengthening healthcare & functioning of health workers is not specified. Hence creating “of health workers is not specified. Hence creating “Half Half Baked Paramedical DoctorsBaked Paramedical Doctors”. Promoting ”. Promoting QUACKERY.QUACKERY.

Literacy & its investment is not specified.Literacy & its investment is not specified. As per WHO 5% of GDP should be spent on health but As per WHO 5% of GDP should be spent on health but

till now no more than 0.9% to2% is spent on health.till now no more than 0.9% to2% is spent on health. Problem of population is not answered properly.Problem of population is not answered properly. School education has not yielded desired results.School education has not yielded desired results.

This is just a beginning………………

THANKS .

HAVE A NICE DAY.