NATIONAL HEALTH POLICY

Presented by: Dr. Heena Sharma

PG student

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 CONTENTS
• INTRODUCTION
• ALMA- ATA DECLARATION
• PRIMARY HEALTH CARE
• NATIONAL HEALTH POLICY 1983
• NATIONAL HEALTH POLICY 2002
• COMMENTS/CRITICAL REVIEW
• SUMMARY
• REFRENCES

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 INTRODUCTION
HEALTH:
A state of complete physical, mental and social
well being and not merely the absence of
disease or infirmity.
 POLICY:
Policy is a system, which provides the logical
framework and rationality of decision making
for the achievements of intended objectives.

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HEALTH POLICY:
Health policy of a nation is its strategy for
controlling and optimizing the social uses of
its health knowledge and health resources.

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• Post independent India in its constitution has
laid stress on four critical concepts: Equity,
Freedom, Justice and Dignity of the individual.

• India has ventured to raise the standard of

living and level of nutrition for elimination of
ill health , ignorance and poverty.

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 The 30th World Health Assembly
in May 1977 resolved

• “The main social target of governments and

WHO in the coming decades should be the
attainment by all citizens of the world by
the year 2000 AD of a level of health that
will permit them to lead a socially and
economically productive life.’’

HEALTH FOR ALL BY 2000 AD

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The Joint WHO – UNICEF international
conference in 1978 at Alma-Ata (USSR) declared
that:

“the existing gross inequalities in

the status of health of people
particularly between developed
and developing countries as well
as within the countries is
politically, socially and
economically unacceptable.”
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• Alma-Ata Declaration called on all the
governments to formulate National Health
Policies according to their own circumstances,
to launch and sustain primary health care as a
part of national health system

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The Alma-Ata conference called
for acceptance of the WHO goal of

HEALTH FOR ALL

by 2000 AD

and ‘Primary Health Care’ as a

way to achieve Health For All
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 ALMA –ATA DECLARATION
• Health is a fundamental human right and that the
attainment of the highest possible level of health is a
most important worldwide social goal.

• The existing gross inequality in the health status of

the people particularly between developed and
developing countries is politically, socially and
economically unacceptable.

• Economic and social development, based on a new

international economic order is of basic importance to
the fullest attainment of health for all. 10
• The people have the right and duty to participate
individually and collectively in the planning and
implementation of their health care.

• Government have a responsibility for the health of

their people which can be fulfilled only by the
provision of adequate health and social measures.

• All government should formulate national policies,

strategies and plans of action to launch and sustain
primary health care.

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• All countries should cooperate in a spirit of
partnership and service to ensure PHC for all people.

• An acceptable level of health for all the people of the

world by the year 2000 can be attained through a
further and better use of the world’s resources.

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THE ALMA-ATA CONFERENCE defined
that

“Primary health care is an essential health care based

on practical, scientifically sound and socially
acceptable methods and technology, made universally
accessible to individual and families in the community,
through their full participation and at a cost that the
community and the country can afford”.

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Principles of Primary Health Care

1.Equitable distribution
2.Community participation.
3.Inter-sectoral coordination
4.Appropriate technology
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 1. Equitable distribution

• Health services must be shared equally by all

irrespective of their ability to pay.

• At present most of the health services are mainly

concentrated in the major towns and cities resulting
in inequality of care to the people in rural areas.

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 2. Community participation

There must be a continuing effort to secure

meaningful involvement of the community in
the planning, implementation and maintenance
of health services, besides maximum reliance
on local resources such as manpower, money
and materials

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 3.Intersectoral coordination

“Primary health care involves in addition to the

health sector, all related sectors and aspects of
national and community development, in
particular agriculture, animal husbandry, food,
industry, education, housing, public works,
communication and others sectors".

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 4. Appropriate technology

“Technology that is scientifically sound,

adaptable to local needs, and acceptable to
those who apply it and those for whom it is
used, and that can be maintained by the people
themselves in keeping with the principle of
self reliance with the resources the community
and country can afford"

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National strategy for health for all ......

• As a signatory to alma- ata declaration in 1978, the

Govt. Of India was committed to take steps to
provide HFA to its citizens.
• In this connection two important reports appeared:

 Report of study group on “HEALTH FOR ALL – on

alternative strategy” sponsored by Indian council of
social science research (ICSSR) and Indian council of
medical research( ICMR)

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 Reports of working group on “HEALTH FOR ALL
by 2000 A.D. ’’ sponsored by Ministry of health and
family welfare, Govt. Of India.

• This health policy forms a basis of The National

Health Policy Formulated By Ministry Of Health And
Family Welfare, Govt . Of India In 1983.

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NATIONAL HEALTH POLICY- 1983
• India had its first national health policy in 1983 i.e. 36
years after independence.
• In the circumstances then prevailing, this policy provided
the initiatives like:
a. Comprehensive health care linking with extension and
health education.
b. Intermediation by health volunteers
c. Decentralisation to reduce burden of high level referral
system
d. To make government facility limited to eligible poor, by
private investment for patients who can pay.

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• NATIONAL HEALTH POLICY 1983 suggested the
necessity of complete integration of all plans for
human development with socio economic
development.

• Health related sectors like Pharmaceuticals,

Agriculture, Rural development, education, Social
Welfare, Housing, Water supply and conservation of
environment were integrated for joint venture.

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• National health policy 1983 stressed the need for
providing primary health care with special emphasis
on prevention , promotion and rehabilitation aspects.

• Its emphasis is on team approach, ban on private

practice by health professionals and use of our large
stock of health manpower from alternative system of
medicine like Ayurveda, Unani, Sidda, Homoeopathy,
Yoga and Naturopathy.

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• It suggested Planned time bound attention to the
following
1.Nutrition, prevention of food adulteration.
2.Mainatince of quality of drug
3.Water supply and sanitation
4.Environmental protection
5.Immunisation Programme
6.Maternal and Child Health Services
7.School Health Programme
8.Occupational Health

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• It also suggested the need for meeting National
requirements of life saving drugs and vaccines by
quality control, economic packages practice,
reduction in unit cost of medicine and well
considered health insurance schemes to allow
community to share the cost of the services, in
keeping with the paying capacity.

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NATIONAL HEALTH POLICY
1983 GOALS SUGGESTED/
ACHIEVED

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 INDICATOR GOAL BY ACHIEVED
2000 BY 2000
1. INFANT MORTALITY RATE 60 70
(IMR)

2. PERI NATAL MORTALITY 33 46

RATE (PNMR)
3. CRUDE DEALTH RATE (CDR) 9 8.7

4. MATERNAL MORTALITY 2 4
RATE (MMR)
5. UNDER FIVE MORTALITY 10 9.4
RATE (UFMR)
6. LIFE EXPENTANCY BIRTH- 64 62.4
MALE(yrs)
FEMALE(yrs) 64 63.4
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 7. LOW BIRTH 10% 20%
WEIGHT %

8. CRUDE BIRTH 21 26.1

RATE

9. COUPLE 60% 46.2%

PROTECTION RATE

10. NET 1 1.45

REPRODUCTION
RATE
11. GROWTH RATE 1.2 1.93

12. FAMILY SIZE 2.3 3.1

13. ANTE NATAL 100% 67.2% with ANC still

CARE (ANC) less with full ANC
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14. TT PREGNANT 100 83

15. DPT 85 87

16. OPV 85 92

17. BCG 85 82

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 18. TYPHOID NOT UPTO THE MARK

19. LEPROSY NOT UPTO THE MARK

20. TUBERCULOSIS NOT UPTO THE MARK

21. BLINDNESS NOT UPTO THE MARK

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 Future Goals
• Leprosy elimination by 2005

• Tuberculosis mortality 50%; reduction by 2010

• Blindness prevalence to 0.5% by 2010

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Differentials In Health Status Among
Rural/Urban India

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Differentials In Health Status Among
States

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Differentials In Health Status Among
Socio-economic Groups

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Achievements Through The Years
1951-2000

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Achievements Through The Years
1951-2000

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Achievements Through The Years -
1951-2000

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But by the end of 2000 century it was clear that
the goals of health for all by the year 2000 AD
would not be achieved ......

• The observed progress suggested that we

may need some new and additional strategy
or new sizable intervention in achievement of
an unacceptable health of the country.

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 Factors responsible for this failure
were:

• Biased and poor socio- economic development

in the region where it was needed most.

• Discriminatory policies due to age, gender and

ethnicity thus preventing access to health care
surveillance.

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 NATIONAL HEALTH POLICY-2002
• A revised health policy for achieving better health
care and unmet goals has been brought out by
government of India- National Health Policy 2002.
• According to this revised policy, government and
health professionals are obligated to render good
health care to the society.
• Optimizing the use of health service to a large group
rather than a small group is a foreseen event by the
NHP 2002.

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• Inclusion of social policies adds to the credit of the
revised NHP 2002.

• NHP2002 has set out a new policy framework for the

acceleration of Public Health goals in the
socioeconomic circumstances currently prevailing in
the country.

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 National Health Policy 2002
Objectives:

• Achieving an acceptable standard of good health of

Indian Population.

• Decentralizing public health system by upgrading

infrastructure in existing institutions.

• Ensuring a more equitable access to health service

across the social and geographical expanse of India.
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• Enhancing the contribution of private sector in
providing health service for people who can afford
to pay.

• Emphasizing rational use of drugs.

• Increasing access to tried systems of Traditional

Medicine

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 Goals to be Achieved by 2000-2015
2003 –
• Enactment of legislation for regulating minimum
standard in clinical Establishment / Medical
institution
2005 –
• Eradication of Polio & Yaws
• Elimination of Leprosy
• Increase State Sector health spending from 5.5% to
7% to of the budget.

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• Establishment of an integrated system of surveillance,
National Health Accounts and Health Statistics

• 1% of the total budget for Medical Research

• Decentralization of implementation of public health

program

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 2007-
• Achieve Zero level growth of HIV/AIDS

2010-
• Elimination of Kala- Azar

• Reduction of mortality by 50% on account of

Tuberculosis, Malaria, Other vector & water borne
Diseases

• Reduce prevalence of Blindness to 0.5%

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• Reduction of IMR to 30/1000 live births &MMR
to100/ Lakh live births

• Increase utilization of public health facilities from

current level of <20% to > 75%

• Increase health expenditure by government from the

existing 0.9% to 2.0% of GDP

• Increase share of Central grants to constitute at least

25% of total health spending
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• Further increase of State sector Health spending from
7% to 8%

• 2% of the total health budget for medical Research

2015-

• Elimination of lymphatic Filariasis

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POLICY PRESCRIPTIONS

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 1. Financial Resources:
• Increase in health sector expenditure to 6% of GDP,
with 2% by public health investment by 2010 is
recommended by the policy.
• Existing 15% of central government contribution is to
be raised to 25% by 2010.

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 2.Equity :
NHP 2002 has set an increased allocation of 55% total
public health investment for the primary health sector,
35% for secondary sector and 10% for tertiary sector.

10%

35% 55%

Primary Secondary T ertiary

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 3.Delivery Of National Public Health
Programs:
• NHP 2002 envisages the gradual convergence
of all health programmers under a single field
administration.

• It suggests for a scientific designing of public

health projects suited to the local situation.

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• Therefore, the policy places reliance on
strengthening of public health outcomes on
equitable basis.

• It recognizes the need of user charge for

secondary and tertiary public health care for
those who can afford to pay.

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 4. The state of public health
infrastructure:
• The Policy envisages kick- starting the revival of the
Primary Health System by providing some essential drugs
under Central government funding through the
decentralized health system.
• This initiative under NHP-2002 is launched in this belief
that the creation of a decentralized public health system will
ensure a more effective supervision of the public health
personnel through community monitoring , than has been
achieved through the regular administrative line of control.

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 5.Extending public health services:

• Expanding the pool of general medical Practitioners

to include a cadre of licentiates of medical practice,
as also practitioners of Indian systems of Medicine
and Homoeopathy has been advocated in the policy.

• In order to provide trained manpower in under-served

areas, it recommends contract employment.
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 6. Role of local self- Government
Institutions
• NHP-2002 lays great emphasis upon the
implementation of public health programs through
local self –government institutions.

• The policy urges all state governments to consider

decentralizing the implementation of the programs
by transfer power to such institutions by 2005.
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 7. Norms of Health care Professional:

• Minimal statutory norms with constant

reviewing for the deployment of doctors and
nurses in medical institutions need to be
introduced urgently under the provision of the
Indian Medical council Act and Indian Nursing
Council Act , respectively.

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 8.Education of Health care
Professional:
• National health policy 2002 recommends setting
up of a medical grant commission for funding
new medical/dental colleges.
• The need for inclusion of contemporary medical
research and geriatric concern and creation of
additional PG seats in deficient specialties are
specified.
• It suggests for a need based, skill oriented
syllabus with a more significant component of
practical training.
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9.Need for specialists in 'Public Health'
and 'Family Medicine’:
• For discharging public health responsibilities in the
country NHP 2002 recommends specialization in the
disciplines of Public Health and Family Medicine
where medical doctors, public health engineers,
microbiologists and other natural science specialists
can take up the course.

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 10.Nursing personnel:

• NHP 2002 recognizes acute shortage of nurses trained

in superspeciality disciplines.

• It recommends increase of nursing personnel in

public health delivery centers and establishment of
training courses for superspecialities.

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 11. Use of Generic drugs and vaccines
• This Policy recommends limited number of essential
drugs of generic nature as a requisite for cost
effective public health care.

• To ensure long term national health security 2002

NHP envisages that not less than 50% of the
requirement of vaccine be sourced from public sector
institutions.
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 12. Urban health :
• Migration has resulted in urban growth which is
likely to go up to 33%.

• It anticipates rising vehicle density which lead to

serious accidents.

• In this direction, 2002 NHP has recommended an

urban primary health care structure as under:

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First Tier:-

Primary centre cover 1 Lakh population

 It functions as OPD facilities.

 It provides essential drugs.

 It will carry out national health programmers.

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Second Tier:-

• General Hospital a referral to primary centre provides

the care.

• The policy recommends a fully equipped hub-spoke

trauma care network to reduce accident mortality.

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 13.Mental health:
• Decentralized mental health service for diagnosis and
treatment by general duty medical staff is
recommended.

• It also recommends securing the human rights of

mentally sick.

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 14.Information Education and
Communication:
• NHP-2002 has suggested interpersonal
communication by folk and traditional media to
bring about behavioral change.
• School children are covered for promotion of
health seeking behavior, which is expected to be
the most cost effective intervention where health
awareness extends to family and further to future
generation.
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 15.Health research:
• The policy envisages an increase in govt. funded health
research to a level of 1% of the total health spending by
2005 and up to 2% by 2010.

• New therapeutic drugs and vaccines for tropical disease

are given priority.

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 16.Role of private sector:

• The policy welcomes the participation of the private

sector in all areas of health activities i.e. primary,
secondary and tertiary health care services; but
recommended regularitory and accreditation of
private sector for the conduct of clinical practice.

• It has suggested a social health insurance scheme for

health service to the needy.

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• It urges standard protocols in day-to-day practice by
health professionals.

• It recommends tele-medicine in tertiary care services.

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 17. Role of civil Society:

• NHP 2002recognises institutions of civil society to

handle disease control programme earmarking not
less than 10% of the budget in respect of identified
programme.

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 18. National Disease Surveillance
Network:
• NHP 2002 noted that absence of an efficient disease
surveillance network is a major handicap for cost
effective health care.

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 19.Health statistics:
• NHP 2002 has recommended full baseline estimate of
tuberculosis, malaria and blindness by 2005, and in
the long run for cardiovascular diseases, cancer,
diabetes, accidents, hepatitis .

• It has suggested a national health accounts

conforming to the source to user matrix.

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 20.Women's health:

• The policy commits the highest priority of the central

government to the funding of the identified programs
relating to women’s health.

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 21.Medical Ethics:
• In India we have guidelines on professional
medical ethics since 1960.
• This is revised in 2001.
• Government of India has emphasized the
importance of moral and religious dilemma.
• NHP 2002 has recommended notifying a
contemporary code of ethics, which is to be
rigorously implemented by Medical Council of
India.
• The Policy has specified the need for a vigilant
watch on gene manipulation and stem cell
research.
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 22.Enforcement of Quality Standards
for food and Drugs :

• NHP 2002 envisaged that Food and Drug

administration be strengthened in terms of laboratory
facilities and technical expertise.

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 23.Regulation of standards in
paramedical disciplines:
• More and more training institutions have come up
recently under paramedical board which do not have
regulation or monitoring.

• Hence, establishment of Statutory Professional

Council for paramedical discipline is recommended.

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 24. Environmental & Occupational
Health:
• This policy envisages that the independently stated
policies and programs of the environment related
sectors be smoothly interfaced with the policies and
the programs of the health sector.

• Child labor and substandard working conditions are

causing occupational linked ailments.

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• NHP 2002 has suggested for an independent state
policy and programme for environment apart from
periodic health screening for high risk associated
occupation.

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 25.Providing Medical Facilities to
Users from Overseas (Health
Tourism)
• The NHP-2002 Strongly encourages the providing of
such health services on a payment basis to service
seekers from overseas. Recently large number of
patients from overseas are coming to India for
treatment (Medical Tourism).

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 26.Impact of Globalization on Health
Sector:
• With adoption of trade related intellectual Property
(TRIPS) government is taking steps to overcome
possible adverse impact of impact of economic
globalisation on the health sector.

• NHP 2002 brings out the relevance of inter sectorial

contribution to health but limits itself to making
recommendations.
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• NHP 2002 touches population growth and health
standards. It has suggested synchronized
implementation of National Population Policy and
National Health Policy in improving health standard
of the country.

• NHP 2002 focuses on building up creditability for the

alternative systems of medicine through evidence
based research and suggested a separate document.

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 RECENT DEVELOPMENT
• The Prime Minister has launched the Public Health
foundation of India (PHFI), a public- private initiative in
the health sector, which seeks to establish world-class
public health institutes to train professional in the field.
• The PHFI plans to establish five seven world class and
relevant Indian Institute of Public Health (IIPH) within
the next five years, with the first two institutions opening
by 2008.
• Funding for this project would total nearly Rs. 500-700
crore over five to seven years.
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ACHIVEMENTS

Following goals of National Health Policy are

achieved:

Year 2003

1. Enactment of legislation for regulating

minimum standard in clinical establishment/
Medical Institutions.

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Year 2005:

• Eradication of Poliomyelitis is missed however

there is zero reporting since 2004.

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2. Leprosy has been declared eliminated according
to the criteria fixed by WHO. However more
efforts are required.

3. 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 slow pace.
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4. Spending of state sector Health has not much
increased as planned from 5.5% to 7% of the budget.

5. Budget for medical research is not much increased

as 1% of the total health budget for medical research
has been targeted.

6. Decentralization of implementation of public health

programs: National Rural Health Mission has been
launched in this direction.

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Year 2007

1. Achievement of zero level growth of HIV/AIDS has

not been achieved and may require some more
years.

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Goals failed to be achieved by 2005
 Eradicate Poliomyelitis.
 Establish an integrated system of surveillance, National
Health documents and Health statistics.
 Increase state sector Health spending from 5.5% to 7%
of the budget.
 1% of the total health budget for medical research.
 Decentralization of implementation of public health
programs.

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COMMENTS/ CRITICAL REVIEW
 The NHP 2002 is indeed a well thoughtful and
comprehensive document.
 NHP-2002 has got the opportunity to refer many
documents and reports like World Development Report
1993, National Family Health Survey 1993-94 and 1998-
1999, the census of India 2001, World Health Report
2000, and favourable environment like support of
international health agencies, economic and political
reforms particularly 73rd and 74th amendment of the
constitution of India.
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 However, there are many constraints in the
implementation of this policy like 35% illiterate and
one quarter population is below poverty line, unstable
government, and reactive response to the health
problem and disasters.
 NHP-2002 is a desirable and positive step for the
betterment of peoples health.
A substantial achievement has been acknowledged
by the government as far as the targets are concerned.

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 In spite of all good things in the policy it also suffers
some criticism which are as follows:

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Policy
 This policy did not refer to the women empowerment
policy 2001 while describing measures to ensure women
health. There is a need to coordinate effectively with the
Ministry of Social Justice and Empowerment while
dealing with vulnerable section of the society like
children, scheduled caste, scheduled tribes etc.
 Women’s health has not received enough attention in the
policy; similarly child health, adolescents, gender
discrimination and violence should have received
adequate concerns.
92
 Old age group has got very less attention in the
policy. Life expectancy has crossed 60 years of age
and going to be 70 in the next decade, which demands
special health services for this group and cannot be
neglected.

Although a separate old age policy is existing but

national health policy must specify in which areas
there is need of coordination and convergence.

93
 Ignored areas are : Resource generation mechanism,
allocation priorities band workforce management, how to
handle growing menace of substance abuse, updating of
intervention prescribed in national health programs
according to scientific development, abolition of private
practice by govt. Doctors , controlling medical
advertisement etc.
 Occupational and environmental health should have been
addressed properly as far as standards, safety measures
and recreational facilities is concerned.

94
 School health programs have not achieved the
desired results in the majority of states. The programs
have become almost defence because of
administrative, managerial and logistic problems. In
recent evaluation by Delhi Government it is clearly
found government run school health services are not
cost effective as compared to run by NGO’S.
However more studies are required before advocating
private agency to run the school health services.
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 For decentralization: Role of local self government.
Institutions has been defined in the policy and should
have been achieved by 2005.
With exception of Kerala, decentralization has merely
been an attempt to delegate duties rather than
development of powers. Hence it is surprising that
despite attractive slogans like ‘peoples health in
peoples hands’ the real needs of the people have not
been met.

96
 MISMATCH SITUATION ANALYSIS
AND POLICY PRESCRIPTIONS
 Policy does not give importance to population control
however, blames the population explosion for
nullifying the impact of advancement of public health.
 Policy ignores pharmaceuticals and their impact on
health care. There is no Drug Policy mentioned.
 The impact of globalization may affect the basic
philosophy of equity. Heavily subsidized primary
healthcare, as it exists in India, would suffer the most.
97
Funding:
 Increasing from 0.9% to 2% of GDP expenditure on
health is still low. This falls short of the 5% of GDP that
has been a long standing demand of the health movement
and recommended by the WHO long ago. The goal of the
policy to increase state sector health spending from 5.5%
to 7% of the budget by 2005 is failed.
 The policy should have allocated funds and other
resources that can be made available from the health
sector in case of the disaster or natural calamities.
98
Health Tourism (Medical Tourism)

 Public hospitals should also be encouraged to attract

medical tourists as envisaged in this policy but this is
problematic ,because existing public health facilities
are barely able to meet the requirement of the people
within the country.

99
 CONCLUSION
 While the public health initiatives over the years have
contributed significantly to the improvement of the health
indicators, it is to be acknowledged that public health
indicators/ disease burden statistics are the outcome of
several complementary initiatives under the wider
umbrella of the developmental sector, covering rural
development, agriculture, food production, sanitation,
drinking water supply, education etc.

100
 Despite the impressive public health gains, the
morbidity and mortality levels in the country are still
unacceptably high as compared to the developed
countries.

 Further dedicated efforts are required to achieve goal

of ‘Health for All’ in 21st century’.

 NHP 2002 will provide an impetus for achieving an

acceptable standard of good health of people of
India.
101
India Shinning

“India is shining ok for the glossy magazines, but if you

just go outside metro you will see that everything about
India shining is refuted [In the villages] alcoholism is
rife and female infanticide and crime are rising. You
have to bribe to get electricity, water. Yes, the middle
and upper classes are taking off, but the 700 million
who are left behind, all they see is gloom and darkness
and despair. They are born to fulfil their destiny and
have to live this way and die this way. The only thing
that shines for them is the sun, and it is hot and
unbearable and too many of them die of heatstroke.”

102
Let us work together for “Health for
ALL.’’

103
 REFRENCES
• Alma-Ata, 1978- Primary Health Care :WHO, UNICEF.
• Government of India, Ministry of Human Resource
Development, Annual Report 2001-2002.
• K.J. National Health Programs of India. 11th Edition,
2014.
• K.Park Park’s Textbook of Preventive and Social
Medicine, 23rd Edition, 2009.
• Prabhakara GN Policies and Programmes of Health in
India. 1st Edition, 2005.
104
THANK YOU

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