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Tenth Five Year Plan 02-07

Tenth Five Year Plan 02-07

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Published by: Apollo Institute of Hospital Administration on Jun 16, 2009
Copyright:Attribution Non-commercial


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2.8.1Improvement in the health and nutritionalstatus of the population has been one of the majorthrust areas for the social development program-mes of the country. This was to be achieved throughimproving the access to and utilization of Health,Family Welfare and Nutrition services with specialfocus on under served and under privilegedsegments of the population. Over the last fivedecades, India has built up a vast health infra-structure and manpower at primary, secondary andtertiary care in government, voluntary and privatesectors. These institutions are manned by professio-nals and paraprofessionals trained in the medicalcolleges in modern medicine and ISM&H andparaprofessional training institutions. The populationhas become aware of the benefits of health relatedtechnologies for prevention, early diagnosis andeffective treatment for a wide variety of illnessesand accessed available services. Technologicaladvances and improvement in access to health caretechnologies, which were relatively inexpensive andeasy to implement, had resulted in substantialimprovement in health indices of the population anda steep decline in mortality (Table 2.8.1).
Table 2.8.1: Time Trends (1951-2000) in Health Care195119812000
SC/PHC/CHC72557,3631,63,181(99-RHS)Dispensaries & Hospitals (all)920923,55543,322 (95-96-CBHI)Beds (Pvt. & Public)117,198569,4958,70,161 (95-96-CBHI)Doctors (Modern System)61,8002,68,7005,03,900 (98-99-MCI)Nursing Personnel18,0541,43,8877,37,000 (98-99-INC)Malaria (cases in million)752.72.2Leprosy (cases/ 10,000 population) Pox (no. of cases)>44,887EradicatedGuineaworm (no. of cases)>39,792EradicatedPolio (no. of cases)29709265Life Expectancy (Years)36.75464.6 (RGI)Crude Birth Rate40.833.9 (SRS)26.1 (99 SRS)Crude Death Rate2512.5 (SRS)8.7 (99 SRS)IMR14611070 (99 SRS)
Source : 
National Health Policy - 2002
2.8.2The extent of access to and utilization ofhealth care varied substantially between states,districts and different segments of society; this to alarge extent, is responsible for substantialdifferences between states in health indices of thepopulation.2.8.3During the 1990s, the mortality ratesreached a plateau and the country entered anera of dual disease burden. Communicablediseases have become more difficult to combatbecause of development of insecticide resistantstrains of vectors, antibiotics resistant strains ofbacteria and emergence of HIV infection for whichthere is no therapy. Longevity and changing lifestyle have resulted in the increasing prevalenceof non-communicable diseases. Under nutrition,micro nutrient deficiencies and associated healthproblems coexist with obesity and non-communi-cable diseases. The existing health systemsuffers from inequitable distribution of institutionsand manpower. Even though the countryproduces every year over 17,000 doctors inmodern system of medicine and similar numberof ISM&H practitioners and paraprofessionals,there are huge gaps in critical manpower ininstitutions providing primary healthcare,especially in the remote rural and tribal areaswhere health care needs are the greatest. Someof the factors responsible for the poor functionalstatus of the system are:
mismatch between personnel andinfrastructure;
lack of Continuing Medical Education (CME)programmes for orientation and skillupgradation of the personnel;
lack of appropriate functional referral system;
absence of well established linkages betweendifferent components of the system.2.8.4In order to address these problems thecentre and the states have embarked on structuraland functional health sector reforms. However, thecontent and quality of reforms are sub-optimal andthe pace of implementation is slow.2.8.5As the country undergoes demographicand epidemiological transition, it is likely that largerinvestments in health will be needed even tomaintain the current health status because tacklingresistant infections and non-communicablediseases will inevitably lead to escalating health carecosts. Last two decades have witnessed explosiveexpansion in expensive health care related tech-nologies, broadening diagnostic and therapeuticavenues. Increasing awareness and risingexpectations to access these have widened thegap between what is possible and what is affordablefor the individual or the country. Policy makers andprogramme managers realise that in order toaddress the increasingly complex situationregarding access to good quality care at affordablecosts, it is essential to build up an integrated healthsystem with appropriate screening, regulatingaccess at different levels and efficient referrallinkages. However, both health care providers andhealth care seekers still feel more comfortable withthe one to one relationship with each other thanwith the health system approach.2.8.6Another problem is the popularperception that curative and preventive carecompete for available resources, with the formergetting preference in funding. Efforts to convincethe public that preventive and curative care areboth part of the entire spectrum of health careranging from health promotion, specificprotection, early diagnosis and prompt treatment,disability limitation and rehabilitation and that toimprove the health status of the population bothare equally essential have not been verysuccessful. Traditionally health service (bothgovernment and private) was perceived as asocial responsibility albeit a paid one. Growingcommercialisation of health care and medicaleducation over the last two decades has erodedthis commitment, adversely affecting the qualityof care, trust and the rapport between health careseekers and providers.
2.8.7In view of the importance of health as acritical input for human development there will becontinued commitment to provide:
essential primary health care, emergency lifesaving services, services under the NationalDisease Control Programmes and the NationalFamily Welfare Progra-mme totally free of costto all individuals and
essential health care service to people belowpoverty line based on their need and not ontheir ability to pay for the services.2.8.8Appropriate interventions to ease theexisting funding constraints at all levels of healthsystem and to promote the complete and timelyutilization of allocated funds will be taken up.Different models of health care financing at theindividual, family, institution and state level will beevolved, implemented and evaluated. Models foundmost suitable for providing essential health care toall will be replicated.
The focus during the Tenth Plan will be on
reorganisation and restructuring the existinggovernment health care system including theISM&H infrastructure at the primary,secondary and tertiary care levels withappro-priate referral linkages. Theseinstitutions will have the responsibility oftaking care of all the health problems(communicable, non-communicablediseases) and deliver reproductive and childhealth (RCH) services for people residing ina well-defined geographic urban and ruralarea;
development of appropriate two-way referralsystems utilising information technology (IT)tools to improve communication, consultationand referral right from primary care to tertiarycare level;
building up an efficient and effective logisticssystem for the supply of drugs, vaccines andconsumables based on need and utilisation;
horizontal integration of all aspects of thecurrent vertical programmes including supplies,monitoring, information educationcommunication and motivation (IECM),training, administrative arrangements andimplementation so that they are integralcomponents of health care; there will beprogressive convergence of funding,implementation and monitoring of all health andfamily welfare programmes under a single fieldof administration beginning at and below districtlevel;
improvement in the quality of care at all levelsand settings by evolving and implementing awhole range of compre-hensive norms forservice delivery, prescribing minimumrequirements of qualified staff, conditions forcarrying out specialised interventions and a setof established procedures for qualityassurance;
evolving treatment protocols for themanagement of common illnesses anddiseases; promotion of the rational use ofdiagnostics and drugs;
evolving, implementing and monitoringtransparent norms for quality and cost of carein different health care settings;
exploring alternative systems of health carefinancing including health insurance so thatessential, need based and affordable healthcare is available to all;
improving content and quality of education ofhealth professionals and para professionals sothat all health personnel have the necessaryknowledge, attitude, skills, programme andpeople orientation to effectively take care ofthe health problems, and improve the healthstatus of the people;
skill upgradation of all health care providersthrough CME and reorientation and ifnecessary redeployment of the existing healthmanpower, so that they can take care of theexisting and emerging health problems atprimary, secondary and tertiary care levels;
research and development to solve majorhealth problems confronting the country

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