HEALTH CARE POLICY

I. INTRODUCTION

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 transformation

Despite several growth orientated policies adopted by the government,

the widening economic, regional and gender disparities are posing challenges
for the health sector.

National health programs are launched by the government of India for

control/eradication of communicable disease, environmental sanitation,
nutrition, population control and rural health.

II. a] DEFINITION OF HEALTH

“Health is a state of complete physical, mental and social well-being and

not merely the absence of disease or infirmity”.

WHO

Health is “A state of feeling sound in body, mind and spirit with a sense of
reserve power”

HS HAYMAN

Health is a quality of life, it is basic to human functions. It requires

independence and interdependence. The promotion of health is more important
than care of sick, individuals will achieve or maintain health if they have
necessary strength will or knowledge.

VIRGINIA HENDERSON
 b] DEFINITION OF NATIONAL HEALTH POLICY

Health policy of a nation is its strategy for controlling and optimizing the
social use of its health knowledge and health resources.

III. EVOLUTION OF NATIONAL HEALTH POLICY

During the British Period, for the services of elite people, interest was
paid to improve medical services through hospitals and dispensaries. There is
rapid growth of drug industry, commercialization. Public health was highly
neglected, resulting in high mortality and morbidity. After independence, health
services were based on the directions of the Bhore Committee and then the
subsequent committees. The formal health policy was formulated in the Year
1983. The ministry of health and family welfare evolved a national health
policy in 1983, keeping a view the national commitment to attain the goal
health for all by 2000 A.D.The policy lays stress on the preventive,
promotive, public health and rehabilitation aspects of health care. To attain
the objectives “Health for all by 2000 AD” the union Ministry of Health and
Welfare formulates National Health Policy. National health policy (NHP) is a
statement, enunciated By Government of India, as a ‘blue-print’ for further
action, about the manner in which the tasks related to health and allied subjects,
to be performed. It aims at the elimination of poverty, illiteracy, ill-health,
ignorance and inequality. India is one of the few countries in the world to have
come out with a national policy on health. In view of the commitment made by
the Government of lndia to achieve the global, social target HFA by 2000 AD,
the expert committee (appointed by the Planning Commission) submitted the
report in 1981, about assessing the health status of the country, in terms of
various indicators, which became the basis of National Health Policy.
 NHP was finalized by the Ministry of Health and Family Welfare in
1982, With the goal of HFA by 2000 AD and NHP was approved in August
1983. The main objective of the policy was to achieve HFA by 2000 AD.

IV.NATIONAL HEALTH POLICY

Goal ;

The attainment of the highest possible level of good health and well-
being, through a preventive and promotive health care orientation in all
developmental policies, and universal access to good quality health care
services anyone having to face financial hardship as a consequence

Objectives

The main objective of the National Health Policy is to achieve the

highest possible level of good health and well-being, through a preventive and
promotive health care orientation in all developmental policies, and to achieve
universal access to good quality health care services without anyone having to
face

Principles;

1. Equity:

Action to reach the poorest and minimizing disparity on account of gender,

poverty, caste, disability, other forms of social exclusion and geographical
barriers

2. Universality

Systems and services are designed to cater to the entire population- not only a
targeted sub- group. Care to be taken to prevent exclusions on social or
economic grounds
 3. Patient Centered & Quality of care

Health care services would be effective, safe, and convenient, provided

with dignity and confidentiality with all facilities across all sectors being
assessed, certified and incentivized to maintain quality of care.

4. Inclusive partnerships

The task of providing health care for all cannot be undertaken by

Government, acting alone. Participation of communities & partnerships with
academic institutions, not for profit agencies and with the commercial private
sector and health care industry to achieve these goals is required

5. Subsidiarity

For ensuring responsiveness and greater participation, increasing transfer

of decision making to as decentralized a level as is consistent with practical
consideration and institutional capacity would be promoted

6. Accountability

Financial and performance accountability, transparency in decision

making, and elimination of corruption in health care systems. Both in the public
systems and in the private health care industry, would be essential. Despite
variations in approaches to accountability, an accountability regime will always
be based on three elements: a clear definition of desirable goals or objectives
(the object of accountability), the ability to measure and monitor goal
achievement and a set of consequences for providers or organizations if
achievements regarding goals or objectives are not satisfactory. Defining goals
and objectives in healthcare is not easy, and is contested terrain. Quantitative
targets for volume of care say nothing about quality of care or patient
experience. Targets around the delivery of care may have only tenuous or very
indirect linkage with the improvement of the health and well-being of a
population. Monitoring the process or the outcomes of care requires proper,
adequate and on-time information if the objective is to provide useful feedback
to providers of care and services. The consequences of performance failure by
providers can be more or less coercive. An organization can face budgetary
cutbacks following poor performance, but may also receive support to develop
capacities to improve. While accountability is a key element in improving the
governance and management of healthcare organizations and systems, an
accountability relationship can be developed with a concern for learning and
improvement beyond control and sanctions

7. Professionalism, integrity and

Health works and managers shall perform their work with the highest level
of professionalism, integrity and trust and be supported by a systems and
regulatory environment that enables it

8. Learning and adaptive system

Constantly improving dynamic organization of health care which is knowledge

and evidence based, reflective and learning from the communities they serve,
the experience of implementation itself, and from national and international
knowledge partners

9. Affordability

As costs of care rise, affordability, as distinct from equity, requires emphasis.

Impoverishment due to health care costs is of course, even more unacceptable.
Healthcare systems the world over are facing significant financial pressures and
growing demands for services. Many nations have therefore set common goal of
improving the population’s health, the quality of the outcomes, and the
containment of costs

Strengths

Identified deficiencies of the policy, Advancement of technology and

proven public health strategies and Commitment to enhance the budget on
health expenditure.

Weakness

Lack of monitoring and evaluation is the drawback of national health

policy. There is no standardised tool to assess health care services. Lack of
government expenditure on public health also the weakness happened in the
heath for all system. Gap in situation analysis and problem prescription also
will negatively affect the national health policy.

Opportunities

1. Move ahead in health through health policy

2. Supportive environment and absence of obvious threat of water unrest etc
3. Policy initiative will provide a new impetus to the development of health
sector

Threats

Health tourism will drain the trained manpower to private sector and will
encourage privatization in absence of regulation on private sector for
encouragement could be dangerous for the public health. However, policy
proposes regulation of the private sector but how and when is not described in
detail. Private expenditure is already more in India as compare to other
countries in the world. Occurrence of unexpected natural calamities and
catastrophes. Negative involvement of religious fundamentalists, for example
polio sterility myth impending pulse polio program. Creation of a cadre of ‘half
backed paramedical doctors’ is strengthening quackery. Financial autonomy of
district societies may lead to corruption and need to be put under strict outer
regulation and accountability.

V. STATE HEALTH POLICY

Introduction

Kerala has achieved good health indictors compared to other Indian

states. A prime reason for this has been the stewardship role that successive
governments, before and after independence, have played. This has become
even more important at a time when the state is facing the emergence and re-
emergence of some of the communicable diseases along with problems resulting
from the epidemiological and demographic transition. In order to navigate the
sector through the multiple challenges faced in the health sector Government of
Kerala needs to articulate the policy framework under which all the
stakeholders can develop their strategies.
Definition

The World Health Organization defines health policy as "decisions, plans,

and actions that are undertaken to achieve specific health care goals within a
society.
Objectives :

1. To position good health as the product of development agenda

including
water supply, nutrition, sanitation, prevention of ecological degradation,
respect for citizens’ rights and gender sensitivity.
 2. To ensure availability of the needed financial, technical and human
resources to meet health needs of the state.

3. To effectively organise provision of health care from primary to

tertiary levels through referral networks managed by primary care
providers to maximize efficiency and reduce costs.

4. To regulate practice in health sector to ensure quality and patient

protection. The quality improvement is to help our performance of health
services.
Plan of action of state health policy in kerala- strategies

For achieving the above objectives this policy propose specific plan of action as
discussed in the following sub sections.

1. Determinants of health care:

Many of the factors that determine health status of the population lie outside
the purview of the health sector. These include clean drinking water, proper
management of solid and liquid waste, food safety. Many of these have been
delegated to local self governments under the 73rd and 74th amendments to
the constitution. Health department will leverage their representation in the
local administration to effect convergence of efforts to improve such
determinants.
(i) Clean drinking water:

Responsibility for provision of safe water is now shared between the

Kerala Water Authority, water resources department, local self governments
and a host of community based water supply schemes. There is scarcity of
drinking water in many parts of the state, leading to a host of health problems.
The state will continue the efforts to provide adequate drinking water of
good quality in these areas. Health department will access technologies to test
the quality of water being provided in all the schemes and by adhoc
providers in times of scarcity or natural calamity.

(ii) Sanitation facilities:

In addition to providing sanitary latrines in all houses Kerala has to deal

with issues created by first generation toilets which have no septic tanks and the
lack of scientific system for management of septage. In the absence of such a
system many agencies dump such waste abandoned areas and water bodies
causing serious public health hazard. Government will access and implement
technologies that can treat septage in water logged areas and high density
residential areas.

(iii) Solid Waste Management Policy, and Plan of action;

The system of collection of waste without segregation and dumping them

without a scientific system of management has resulted in an ecological and
social crisis. By legislative means and education of the public generators of the
waste, including households will be asked to assume responsibility for the
waste, segregate them and participate in decentralized scientific system of
management. Banning of thin plastic carry bags and other administrative,
managerial and legal measures will also be enforced.

(iv) Poverty: Poor persons have greater load of morbidity without the
means of paying for treatment. RSBY, Karunya Benevolent Fund, Janani Sishu
Suraksha Programme, free distribution of generic drugs and similar schemes
have increased financial risk protection in the state. However government will
also introduce other measures to ensure that the poor have access to preventive
and curative services free at the point of consumption.

2. Enforcement of regulations for good health.

Enforcement of enablingand preventive measures, if necessary by

coercive means remains a necessary element of public health anywhere in the
world. Due to outdated laws and poor enforcement public health in Kerala has
not benefited fully from such regulatory support. Government will
revise such laws and move towards their effective enforcement relying on
democratic institutions in the state to prevent their abuse.

(i) Food Safety.

With the passing of the FSSA in India now has a legal framework for
ensuring food safety. However the enforcement machinery lacks the capacity to
effectively implement the provisions of the act. In addition to strengthening the
Commissionerate of Food Safety Government will leverage capacities available
in other departments for technical support (e.g: Laboratory tests) or to
administer areas that fall into other areas as sanitation. To respond to
increased awareness of food safety and the demand for quality food
Government will scale up the machinery to ensure safe food and beverages.

(ii) Public Health Act:

Government proposes to enact a unified Kerala Public Health Act

combining the existing Travancore-Cochin Public Health Act 1955 and Madras
Public Health act 1939 and incorporating current public health needs. The
proposed health protection agency and the public health cadre will be able to
implement the provisions of the act effectively.

3. Reorganisation of Government Health System:

Government health services currently function as a conglomeration of

standalone institutions. This creates high degree of inefficiency. Government
will aim to link them in a networked care system with the primary care team
providing initial care and assisting individuals navigate through different
levels of health system. This calls a higher level of organization and
management than what health services currently possess.

i. Primary Care

The primary care system in Kerala has concentrated on family planning,

maternal and child care and prevention and management of communicable
diseases. It is not designed to respond to some of the current challenges as non
communicable diseases, mental health issues and geriatric care. Government
intends to revamp the primary care provision to make them assume
responsibility for population allotted to them. The primary care team will be
trained to function as a general practice team dealing with a smaller population.
Currently fresh graduates are assigned charge of primary care duties which in
many countries are discharged by family physicians with post graduate
qualifications and specialized training. Kerala will develop a cadre of primary
care providers like General Practitioners or Family Physicians. Initially they
would receive specialized training before posting.

Concurrently Kerala will start a PG course on Primary Care and gradually

create a cadre of qualified doctors to provide primary care. Using ICT the
Primary Care Team will keep track of health care needs of persons assigned to
their care. They will be trained to provide basic services themselves and to refer
to appropriate levels when specialist care is needed. Using ICT framework they
will develop appropriate messaging and track compliance. Since every
interaction of the referred patients with the government health system is tracked
and available on the central data server the primary care team will be able to
guide the patients on treatment compliance and prevention. Referral protocols
and systems will regulate their interaction with secondary and tertiary levels of
the health system. The Primary care team will be the prime managers of the
Electronic Health Record of every individual that will be developed from the
ICT framework. Developing the new system would involve identifying the
knowledge and skill sets needed by the crucial members of the primary care
team and building them; shifting some of the tasks currently discharged by the
medical practitioner to nurses and paramedics; fine tuning referral protocols and
developing the managed referral networks around Primary Care and developing
a monitoring framework.

 Primary health centres:

Staffing of Primary health centres will be reworked with three teams of a

doctor and a nurse managing a population of 10,000 each. Only OP and field
activities will be discharged in PHCs and OP would be managed in evening
hours by turn. The job responsibility of nurses will be revised to assign more
patient care responsibilities to them. Laboratory services will be available at all
PHCs. The primary care in difficult to reach areas will be configured
differently.
  Community Health centres:

Community Health Centres are the block level institutions expected to

provide basic specialty services. Considering shortages in specialists such
services will be provided only after the requirements of higher level institutions
are addressed. Facilities at the CHC would be utilised as Coordinating Centres
of Pain and Palliative Care, terminal care and Community Mental Health
Programme. Community Health Centre will be the lowest unit of the Health
Protection Agency and Public Health Cadre
 Taluk Head Quarters Hospital

A Taluk Head Quarters Hospital with all major and minor specialties,
with average bed strength of 300 provides an optimal level to provide secondary
care. It will have such supporting services as emergency services, laboratories,
bloodbank/blood storage centres, units for maintenance dialysis, physiotherapy
and rehabilitation and de-addiction centres.

 District/ General Hospitals

One District or General hospital in the district will have in addition to all
major and minor specialties a few super specialties built up over time subject to
availability of doctors. These would be Cardiology, Neurology, Nephrology and
Urology. To ensure adequate attention to the needs of mothers and children
Kerala will have a Women and Child Hospital in every district.

 Specialty Hospitals

With advances in pharmacology specialist hospitals like TB and Leprosy

have lost their relevance. Mental Health care is also increasingly being managed
at general hospitals. While it will not be possible to close them down now
increasingly their role would be brought down and the institution developed for
alternate uses.
 Medical College hospitals.

In time all districts in Kerala will have a government medical college.

Some of the existing medical college hospitals have become unmanageably
large. With better referrals linkages and teaching hospitals coming up in every
district it should be possible to restrict such hospitals to 1000 beds and
focussing on quality and research. All teaching hospitals, in addition to
providing specialist consultation services to other hospitals in the districts, will
also be involved in training and quality control of services in other hospitals.
They will provide the top most level of the networked care system managed by
primary care providers. Upgradation and renaming of hospitals without a clearly
spelt out norm has led to considerable confusion in health planning in the state.
For the purpose of planning of health care services the state will follow
mographic/administrative norms: a sub-centre catering to 5000 population or
the ward of a panchayat, a Primary Health Centre serving one Grama Panchayat
or 30,000 population, a Community Health Centre for a block panchayat or
1,00,000 population, Taluk Head Quarters Hospital for each Taluk and a
District Level Hospital for every district. Disparities that exist between hospitals
in different regions will be rectified before sanctioning or upgrading hospitals.

4. Other specialised services

(i) Public Health cadre and Health protection Agency:

The absence of a dedicated public health cadre with adequate skill and
knowledge to lead the public health functions of the health services department
is one of the reasons for the repeated failure of public health work which we
come across. Dedicated Public Health Cadre of doctors and other non medical
supervisors from block level and above is very much needed for this purpose. A
Medical Officer who is busy with the routine clinical works may not be able to
deliver the necessary public health functions at the field level. And he / she may
not be in a position to supervise guide and monitor the activities of the field
level functionaries and their supervisors. At the block level a post of Public
Healthcare doctor will be created and the candidate opting this cadre will have
opportunity to go for Public Health qualification. The block level supervisors
namely Health supervisors and Senior Public Health Nurse would be similarly
equipped with similar courses and the designation of the officers may be
appropriately changed.
At the district level also dedicated Medical officers and Non medical
Officers with public Health Qualifications would lead the team. Strengthening
of the Public Health cadre at the state level without bifurcating it as a separate
directorate would be done. Public Health laboratories and State Institute of
health and Family Welfare and SHSRC would be important partners in capacity
development of this cadre. Providing appropriate Public Health Qualifications
for around 250 doctors and 600 non medical public health cadre officers is a
major task requiring necessary course formulation, developing a mechanism for
providing the courses etc. It is to be provided in a time bound manner through
the medical colleges, public health institutes and the institutes referred above.
Effective enforcement of the Public health act would be the responsibility of
this cadre. Enactment of an updated public health act would further strengthen
the Public Health cadre.
 (ii) Communicable disease surveillance and execution of control
measures;

For last many years Directorate of Health Services is maintaining a daily

and weekly surveillance system of communicable diseases through the IDSP
system. There are many shortcomings in this system. Most of the data from the
private hospitals are not covered and many a time increase in the number of
cases is not timely detected. Under the leadership of the Public health cadre and
health protection agency referred above these activities need to be further
streamlined and strengthened. The IDSP system with the contract staff has its
inherent weakness of frequent changes and lack of motivation . The existing
posts of IDSP including the data entry operators, data managers,
epidemiologists etc at the district level, and the posts at the state level and the
laboratories need to be made regular posts so that over the years the system will
be improved.

The proposed health protection agency under the public health cadre will
have representation from the other health determining sectors like water
resources,LSGI, total sanitation mission, Social Justice departments and will be
empowered with the revised and updated Public health Act and other acts
through necessary enactments/rules.
(iii) Non communicable Disease control:
Considering the multiple dimensions of social determinants of Non
Communicable Diseases multiple levels of policy decisions and activity plan
from various departments LSGIs and other agencies would be required.
Intersectional actions for health promotion activities prevention and early
diagnosis are very critical. Educating and encouraging hotel and bakery group
for promoting NCD food and banning of junk foods in schools and Government
run canteens. School health screening / incentives for keeping fit/walking/
cycling/involving in outdoor exercises / health education in schools

The policy is to be crafted with an aim to improve the quality of health,

by restricting the incidence, prevention of complications and reduction in
mortality. Specialized diabetic, hypertensive clinics will have to be started in
General Hospitals, District hospitals and Taluk hospitals on a step by step
manner.Dedicated diet counsellors and other supporting staff to be provided in
these units to work with the specialist doctors as a team so that follow up of
cases,counseling, awareness generation etc are organised in a better manner.
The public health cadre and the health protection agencies would impart health
promotion activities at work places, schools and other institutions. Physical
fitness centres with adequate machineries and equipments for doing exercises
and for outdoor games to be started at LSGIs level and at major works sites,
offices etc. Promotion of household level backyard kitchen garden, linking the
ward level health and sanitation committee activities with exercise and outdoor
game promotion, group farming, community kitchen (with healthy diet) etc
would be other activities.

(iv) Cancer care

Cancer control programs in Health sector aims at decentralizing cancer

treatment from tertiary hospitals to district / general hospitals in districts and
organizing detection camps and screening programs for promoting early
detection of cancers. This year one major hospital in a district where there is no
cancer treatment facility in Government sector was provided with funds and
manpower for setting up day-care chemo therapy centres. Oral cancer detection
clinics were started in every district hospitals and funds were provided for
conducting cancer detection camps at the peripheral level as part of this
package. All these activities need to be more expanded and strengthened with
better community participation. Anti tobacco activities which was started in
recent years would be also part of this programme.

(v) Measures for reducing the Road Traffic Accidents other

trauma and developing systematic trauma care services:

Around 4000 road traffic deaths through 30000-40000 road traffic

accidents is the pattern seen in the recent years. The ongoing activities of the
Road Safety Authority at the state level and the limited activities at the district
level through the district Collectors are not yielding the expectant results.
Effective enforcement of the existing rules and regulations, and enactment of
new laws like giving registration for the vehicles only on the basis of the
available road facilities, restricting single passenger (own vehicles) in peak
hours, improving the road facilities and constitution of an “Act force “system
involving police, LSGI , voluntary workers etc at locations identified as black
sots with more probability of accidents to be attempted.
This policy envisages to extent the 108 Ambulance systems to all districts. For
the time being it is available only at Thiruvananthapuram and Alappuzha
districts only.
5. Community mental health care and services:

Considering the higher prevalence of the mental health problems suicides,

alcoholism etc department has already extended the District Mental Health
Programme and NRHM supported community mental health programmes to all
districts in the state by this year. But the integration of the activities with the
primary health care at the PHC, CHCs and with the health care providers
namely doctors and field workers has not materialised so far. This policy
envisages a package of preventive and primitive mental health activities through
the field workers, supervisors, ASHA etc at the field level and early
mobilisation of those requiring the counselling / treatment. Similarly for
providing effective systematic follow up, the patient is identified and treated at
the peripheral institutions. From the ASHAs in the block a selected group of
ASHA s will be given specific training and certification for the working as part
of the block level team and empowered with necessary skill and knowledge for
the household level counselling of the patients/ family members. As per the
policy frame work and activity plan proposed in the revised state mental health
policy activities would be conducted.

1. Ayurveda

Ayurveda is an integral part of Kerala’s health landscape, its treatments

ranging from common household remedies and prevention to specialized
treatment for stroke rehabilitation and cardio vascular care. However the system
faces many challenges today due to shortage of raw materials, lack of
enforcement of standards and diluting the system by unqualified providers.
Government will work with leading ayurveda practitioners to improve the
sector.

i. Research and documentation.

Ayurveda is considered efficacious to treat certain type of ailments and is

commonly accessed by most persons in the state. However due to poor
documentation and systematic research it has not been able to prove this.
Government, in partnership with leading Ayurveda practitioners, will support
systematic clinical trials to prove the comparative efficacy of such
treatment.Since Institutional Research Boards of any institution cannot approve
research proposals cutting across systems of medicine, Government or the
Kerala University of Health Sciences, will set up the IRBs and ethical
committees to oversee such research.

ii. Quality Assurance

Due to the popularity of Ayurveda treatment many spurious

manufacturers and treatment providers have sprung up in Kerala in recent years.
Due to poorly equipped and staffed enforcement agencies and legal loopholes
these manufacturers have been able to achieve spectacular growth affecting the
reputation of the Ayurveda system itself. Drug Regulatory facilities for
Ayurveda in the state will be separated and strengthened. Proper
implementation of Good Manufacturing Practices (GMP), Good Agricultural
and Collection Practices (GACP) etc. for proper manufacturing and marketing
of Ayurveda drugs will be supported. Government will work with joint
initiatives like care Keralam to achieve this. Standadisation of Ayurveda
hospitals will be achieved with the implementation of the Clinical
Establishment act including qualification of persons staffing these institutions.

iii. Support to manufacturing

Availability of raw materials for manufacture of Ayurveda medicines has

come down due to destruction of forest cover and reclamation of waste lands.
The State Medicinal Plants Board will work with cultivators and manufacturers
to augment availability of raw materials at required quantities. They will also be
supported to achieve quality parameters in preparation and packaging.
 iv. Awareness regarding the benefits of Ayurveda.

The overwhelming prominence given to treatments under modern medicine

has obscured the comparative advantage of Ayurveda for some conditions.
After these have been documented and validated government will endorse and
propagate these therapeutic procedures in India and abroad. Government will
also work with experts in the field to develop appropriate communication
strategies for better acceptability of Ayurveda.

2. Homeopathy

Homeopathy enjoys a long and honourable history in Kerala. In 1928 The

Maharaja of Travancore acknowledged Homoeopathy as an acceptable system
of treatment. First government facility for homeopathy as established 30 years
late. Currently government has a policy of providing a homeopathic institution
in every panchayat in the state. Now Homoeopathic health care services are
delivered through 31 Homoeopathic Hospitals, 611 Homoeopathic
Dispensaries, 348 NRHM Homoeo Dispensaries and 29 dispensaries at SC/ST
dominant areas, 5 Homoeopathic medical college hospitals, 13 dispensaries and
1 hospital under ESI and a few municipal and corporation dispensaries. Also
about 4000 Homoeopathic physicians are engaged with private sector.
According to Economic survey Report of the State Planning Board for the year
2011-12 24.39% of the patients utilized Homoeopathy.
Recently Department of Homoeopathy has evolved many such programmes
like, “Seethalayam”- gender bases programme for women health care,
“Ayushmanbhava”- an integrated approach of main AYUSH systems to
control NCDs, “Jyothirgamaya”- The School Health Programme, “Chethana”
the cancer palliative care programme, Adolescent health care programme,
Mother & Child care Programme, Regional Communicable Disease Prevention
Programme, Geriatric Care Programme. Government strategy on homeopathy
will seek to achieve in addition to increasing the availability of services the
improvement of homeopathic medical education and research and the
standardisation and growth of homeopathic drugs industry. In addition to
dispensaries in every Panchayat every Taluk will have a 25 bedded hospital and
district a 100 bedded one, both with specialized care. Experts in the field will be
brought together to develop standardize treatment protocols for management of
different health conditions. Clinical research that focuses on therapeutic out
comes and multi branched, individualized, interventions rather than single and
uniformly applied drugs will be encouraged. A drug testing and standardizing
unit for homeopathic drugs will be set up for homeopathy.

3. Oral Health
The prevalence of oral diseases is increasing especially among the poor and
disadvantaged population groups. Of concern are dental caries(especially
among young), periodontal disease, oral cancer, (more among
adults),malocclusion, and fluorosis and maxillofacial trauma. These problems
are exacerbated by lack of access to quality dental care and other equity issues.
Government will scale up the availability of dental care by opening dental
clinics in district and Taluk hospitals and making dental check up and treatment
part of the school health programme. Free dental treatment facilities to senior
citizens will be part of geriatric care programmes. Gradually District hospitals
will have the specialties of Oral Surgery, Prosthodontics, Orthodontics,
Conservative Dentistry, Periodontics and Pedodontics and supporting staff.
They will also unction as early detection centers for oral cancer and oral
manifestations of AIDS. The possibility of operating Mobile dental units will
also be explored. For skill up gradation of dentists their retraining at least in the
health services every five years will be made mandatory. Dental Colleges
should also serve as research centers focusing on popularizing and adapting
advanced clinical techniques and implementing projects of public health
importance. Faculty of the departments will be trained to sharpen their clinical
and research acumen.
The Kerala Dental Council will be encouraged to work on quality up
gradation of dental clinics with emphasis on infection control practices and
waste disposal and to assist clinics to obtain NABH accreditation.

4. Future developments

Quality up gradation in health sector

Since Kerala has had many achievements in conventional parameters it is time
to raise the bar and aspire towards higher levels of quality and efficiency.
Ensuring quality in every interaction with patients, being transparent, avoiding
medical errors, avoiding systemic pitfalls such as hospital acquired infections
and medical errors are some of the target the health sector in the state should
aspire to. This would mean evolving statements of standards to be maintained,
building capacity of service to comply with them, monitoring that they are
adhered to and taking corrective measures when they are not. Improving
efficiency to ensure better results and managerial efficiency to prevent
bottlenecks, giving autonomy for hospital management are also needed.
Technical support for these reforms may not be available in state. Kerala will
try to get such technical support from wherever needed but will try to build such
capacity in one of the institutions in the state with external support. Wherever
possible attempt will be made to put in place a certification programme for one
of the academic institutions so that technical capacity is institutionalised.
Universal Health Coverage
The High Level Expert Group on health set up by the Planning
Commission had recommended that India move gradually along the road to
achieve universal health coverage. This would involve the state using the
essential health care package, either building capacity to provide in government
sector or purchasing services from the private sector. Achieving universal health
coverage would call for substantially scaling up health expenditure. In view of
the low level of expenditure by the Government of India during the first two
years of the plan it is unlikely that the target would be realised at the end of the
12th plan. But Kerala will prepare a template for Universal Health Coverage.
Components of this package would get funded from available sources of health
financing such as RSBY, NRHM and funds for Local Self Government. Some
resources would also be freed up by efficiency improvements. To begin with the
persons below poverty line would be covered.
This would provide a goal of good health for all people that the state health
sector could move towards and achieve in future

Social determinants of health in kerala

1. Water supply
 Increased reclamation of wetlands and water bodies
 Increased pollution
2. Sanitation
 Problems of toilet construction in water logged areas
 Absence of appropriate models in areas of water scarcity
 Sanitary toilets without septic tank
3. Solid and liquid waste management system
 Accumulation of plastic waste
 Issue of thin plastic bags
 Ecological degradation
 Contamination of water bodies
 Misuse of pesticides
4. Climate change and public health
 challenges to control of infectious diseases
 seasonal changes in the availability of fresh water
 regional drop in food production
 rising sea level
5. other social determinants of health
 food and nutrition
 regular employment
 housing
 women empowerment

VI. NATIONAL HEALTH POLICY-1983

1] History

India had its first national health policy in 1983 i.e.36 years after
independence.“A health policy generally describes funda-mental
principles regarding which health provides are expected to make value
decisions”. ‘ health policy’ provides a broad framework of decisions for guiding
health actions that are useful to its community in improving their health,
reducing the gap between the health status of haven and have-nots and
ultimately contributes to the quality of life.

2] Elements

 Creation of greater awareness of health problems in the community and

means to solve the problems by the community.
 Supply of safe drinking water and basic sanitation using technologies that
people can afford
 Reduction of existing imbalance in health services by concentrating more
on the rural health infrastructure.
  Establishing of dynamic health management information system to
support health planning and health program implementation.
 Provision of legislative support to health protection and promotion.
 Concerned action to combat wide spread malnutrition.
 Research in alternative method of health care delivery and low cost health
technologies.
 Greater co-ordination of different system of medicine. The policy provide
commitment and support to the administration in taking decisions and
actions which were essential for attaining medicine through primary
health care approach.

3] Goals

 Leprosy elimination by 2005

 Tuberculosis mortality 50%; reduction by 2010
 Blindness prevalence to 0.5% by 2010

4] Objectives

To attain the goal of HFA by 2000 AD, by establishing an efficient health care
system, which is accessible to all citizens, especially vulnerable groups, like
women, children and the underprivileged.

• It strongly stresses on:

 Primary health care infrastructure

 Coordination with health-related services
 Active involvement of voluntary organization
 Provision of essential drugs and vaccines
 Qualitative improvement in health and family planning services
 Provision of adequate training
 Medical research on common health problem
• It has the following key elements:

 Creation of greater awareness of health problem by the community

 Supply of safe drinking water and basic sanitation using
technologies that people can afford
 Reduction of existing imbalance in health care by concentrating
rural health infrastructure
 Establishing dynamic HMIS which will help in health planning and
implementation of health programs
 Providing legislative support to health protection and promotion
 Concerned action to combat widespread malnutrition
 Research in alternative methods of health care delivery and low-
cost health technologies
 Greater coordination of different systems of medicine

Evaluation of the progress for HFA is done on the basis of achievement of the
targets which are defined globally by WHO and nationally by the respective
government. This is a substantial progress by 2000 A.D, There has also been a
decline in vaccine-preventable diseases due to an improvement in the
immunization coverage. ...Smallpox, Guinea worm, and polio have been
eradicated countrywide. Water-borne diseases are also much less than before.
But TB, malaria, malnutrition, diseases related to lifestyle, like oM, HTN are
still major public health problems.

5] Components

Reduction of regional disparities; In order to develop hilly areas, tribal areas,

drought- prone areas, specific plan schemes have been designed with full central
assistance. Besides, other schemes of rural development formulated for the
improvement of specific groups such as marginal farmers and agricultural
labourers were implemented in the backward regions.An area based approach of
‘Tribal Sub-Plans’ (TSPs) is now being implemented for the development of
scheduled tribes located in the backward rural areas. The Tribal Sub-Plans are
implemented through 194 Integrated Tribal Development Projects (ITDP) and
250 Modified Area Development Projects (MADP). In this manner, different
special schemes for particular target group located in the backward areas are
being included for block level planning for attaining integrated rural
development and considerable employment opportunities.

Fuller employment;

 education
 Integrated rural development
 Population control
 Welfare of women and children

VII. NATIONAL HEALTH POLICY-2002

1] History

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
NPH 2002.Inclusion of social policies adds to the credit of the revised NPH
2002.NPH 2002 has set out a new policy framework for the acceleration of
public health goals in the socioeconomic circumstances currently prevailing in
the count

2] Elements

In policy prescription, following areas were included:

  Equity
In order to meet the various types of inequities and imbalances
between regions, i.e. rural and urban, the most cost-effective method
is to strengthen the existing outlay and opening the additional public
health service outlets.
 Financial resources:

Taking into account the gap in health care facilities It is planned under the
policy to increase health sector expenditure to 6% GDP, with 2% of GDP being
contributed as public health involvement by the year 2010. For public heal th
investment, the central government’s contribution would rise to 25% from the
existing 15%.

 Public health programmes:

In this policy, the central government designs health program with active
participation of the state government. The central government provides
functional, technical, monitoring and evaluation services.

 Optimal utilization of public health infrastructure at primary

level.
 Vertical programs for control of major diseases, like TB,
malaria, HIV/ AIDS, RCH, immunization, etc. To be continued
till moderate level prevalence is reached.
 The rural health staff should be available for the entire range of
public health activities.

 Role of local self government institution:

Implementing public health programs through local self-government. The state

government to consider and decentralize implementation of health programs by
2005. Financial incentives will be provided by the central government.
  Norms for health care personnel:

Minimal statutory norms for the deployment of doctors and nurses in medical
institutions need to be introduced urgently under the provision of IMC Act
respectively.

 Nursing professional:

In the interest of patient care, it was emphasized to improve nurse vs doctor/bed

ratio.

 Increasing the number of nursing personnel

 Improvement of the skill level of the nurses
 Increasing the ratio of the degree-holding nuses, vs
Diploma- holding nurses
 NHP, 2002 recognizes a need for the central government to
stabilize the setting up and running of training facility for
nurses on a decentralized basis and the establishment of
super specialist nurses for the tertiary-level hospitals.
 Generic drug and vaccines;

Need-based treatment regimen in both Public and private sectors by providing

some essential drugs of generic nature. Universal immunization program for
preventable diseases by supply of vaccines in affordable prices.

 Urban health:

Migration has resulted in urban growth, which is likely to goup to 33%. It

anticipates the rising vehicle density, which leads to serious accidents. In this
direction, NHP, 2002 has recommended an urban primary health care structure
as under.

 Mental health:
Establishment of decentralized mental health services or ameliorating the more
common categories disorders. Upgradation of physical infrastructure
(development of IPO) at government expenses so as to secure human rights of
patients and with mental health problems.

 Health research:

NHP, 2002 noted the aggregate annual expenditure on health f 80,000 crores
and that on research 1150 crores is quite low. The policy envisages an increase
in government funded health resources to a level of 1% total health spending by
2005 and up to 2% by 2010. New therapeutic drugs, especially for TB, malaria,
HIV / AIDS and vaccines for tropical diseases are given priority.

 IEC:

Establishing IEC policies which maximize the dissemination of information to

those population groups which cannot be effectively approached through the
mass media alone. The focus would be given on interpersonal communication
of information and use of folk and other traditional media.

 Health statistics:

Statistical methods to be put in place to enable the periodic updation of these

baseline estimates. Complete baseline estimation of incidence of TB, malaria
and blindness by 2005. Establishing long-term baseline estimates for non
communicable diseases. Estimation of health cost on a continuation basis. Need
to establishing national health confirming to the ‘source-to-user matrix’
structure.

 Women’s health:

This policy emphasize on women health because for reducing IMR, MMR,
child mortality and morbidity status women health is important. The
Identification of specific programs targeted for womens health like RCH
Programme, Kisori Suraskha yojana, etc. Should be emphasizes.

 Role of civil society:

It recognizes a significant contribution made by the NGOs and other institutions

of the civil society in making available the health services to the community.

 Medical ethics a structure:

In order to ensure that the common patient is not subjected to irrational or

profit-driven medical regimens, a contemporary code of ethics be notified and
rigorously implemented by the medical council of india. Medical research in
certain disciplines, such as gene manipulation and stem-cell research should
have some discipline and guidelines that should be constantly reviewed and
updated.

3] Goals

Eradicate Polio and Yaws 2005

Eliminate Leprosy 2005
Eliminate Kala Azar 2010
Eliminate Lymphatic Filariasis 2015
Achieve Zero level growth of HIV/AIDs 2017
Reduce morality by 50% on account of TB Malaria 2010
and other vector and waterborne disease’s
Reduce Prevalence of Blindness to 0.5% 2010
Reduce IMR to 30/1000 and MMR to 100/lakh 2010
Increase utilization of public health facilities from 2010
current level of <20 to?75%
Establish an integrated system of surveillance, 2005
national health account and health statistics
 Increase health expenditure by government as a % 2010
of GDP from the existing 0.9% to 2.0%
Increase share of central grants to constitute at least 2010
25% of total health spending
Increase state sector health spending from 5.5% to 2005
7% of the budget
Further increase to8% 2010

4] 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
geographical expanse of India.
 Enhancing the contribution of private sector in providing health service
for people who can afford to pay.
 Emphasizing access to tried systems of traditional medicine.

5] Components

The various components of NHP-2002 and greater concern with the nursing
services. The policy prescription of NHP-2002, emphasize the need for:

 Ensuring better nurse-patient and nurse-doctor ratio in hospital and

private health care agencies.
 Improving the skill level of nurses.
 Adding super specialty training for nurses for tertiary care.
  Increasing the placement of nurses at primary health centres, and
 Increasing facilities for university level preparation for nurses.
 Adding super specialty training for nurses for tertiary care.
 Increasing the placement of nurses at primary health centres, and
 Increasing facilities for university level preparation for nurse.
On the lines of National Health Policy-2002, Central Govt. is working
in the following ways:
5. A resolution is passed by the Central Council of Health (CCH), related to
health issues.
 To improve training of nurses in clinical specialties.
 To open more post grate courses for nurse.
 To develop and correct staffing or for CNE (Continuing Nursing
Education)
 To Strengthen regulatory mechanism, and
 To fund for strengthening of nursing services.
6. In the educational field:
 Revision of syllabi for various nursing courses and preparation of
syllabi for speciality courses through INC.
 Opening of centres for Commission on Graduates of Foreign
Nursing School (CGFNS) in India is already agreed.

 A National consortium for Ph.D. in nursing is established to
augment ph.D level preparation for nurses.
7. Preparation of nursing standards for clinical practice is progressing
steadily.
8. For financial strengthening:
 Increased funding for nursing education services.
  WHO funding for specialty training for nurses is provided in
needed area.
9. Amended INC Act with more powers in pending with the govt. for
approval

VIII. NATIONAL HEALTH POLICY-2015

1] History

After the 15 years of the last National Health Policy-2002, the

context has changed in following four major ways:
 Health priorities are changing.
 Emergence of robust health care industries.
 Very large cost of treatment for catastrophic expenditure due to health
care costs (one of major contributors to poverty)
 Enhanced fiscal capacity.
Therefore Ministry of Health and Family Welfare (MOHFW),
Government of India included the contextual changes and declared the
National Health Policy-2017 on 17-March 2017. NHP-2017 build on the
progress made since the last NHP-2002.

3] Goal

The policy envisages as its goal the attained of the highest possible level
of health and wellbeing for all at all ages, through a preventive and promotive
health care orientation in all developmental policies, and universal access to
good quality health care services without anyone having to face financial
hardship as a consequence. This would be achieved through increasing access,
improving quality and lowering the cost of healthcare delivery
4] Objectives

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

A. Assuring availability of free, comprehensive primary health care services,

for all aspects of reproductive, material, child and adolescent health and
for the most prevalent communicable, non-communicable and
occupational diseases in the population. The policy also envisages
optimum use of existing manpower and infrastructure as available in the
health sector.
B. Ensuring improved access and affordability, of quality secondary and
tertiary care services through a combination of public hospitals and well
measured strategic purchasing of services in health care deficit areas,
from private care providers, especially the not-for profit providers.
C. Achieving a significant reduction in out of pocket expenditure due to
health care costs and achieving reduction in proportion of households
experiencing catastrophic health expenditure and consequent
impoverishment.

5] Components

i. Professionalist, Integrity and Ethics : Health policy commits, itself

to the highest professional standards, integrity and ethics to be
maintained in the entire system of health care delivery in the country,
supported by a credible, transparent and responsible regulatory
environment.

ii. Equity: Reducing inequity would mean affirmative action to reach the
poorest. It should mean minimizing disparately on account of gender,
 poverty, caste, disability, other forms of social exclusion and
geographic barriers, It would imply greater investment and financial
protection for the poor who suffer the largest burden of disease.

iii. Affordability: As costs of care increase, affordability, as distinct from

equity, requires emphasis. Catastrophic household health care
expenditure defined as health expenditure exceeding 10% of its total
monthly consumption expenditure of 40% OF its monthly non-food
consumption expenditure, are unacceptable.

iv. Universality : Prevention of exclusions on social, economic or on

grounds of current health status. In this backdrop, systems and
services are envisaged to be designed to cater to the entire population
including special groups.

v. Patient Centered & Quality of Care : Gender sensitive, effective,

safe, and convenient healthcare services to be provided with dignity
and confidentiality. These issued to evolve and disseminate standards
and guidelines for all levels of facilities and a system to ensure that the
quality of healthcare is not compromised. Accountability :Financial
and performance accountability, transparency in decision making, and
elimination of corruption in health care systems, both in public and
private.
vi. Inclusive Partnership : A multistake holder approach with
partnership & participation of all non-health ministries and
communities. This approach would include partnership with academic
institutions, not for profit agencies, and health care industry as well.
vii. Pluralism : Patients who so choose and when appropriate, would have
access to AYUSH care providers based on documented and validated
local, home and community based practice. These systems, inter alia,
would also have Government support in research and supervision to
develop and enrich their contribution to meeting the national health
goals and objectives through integrative practice.
viii. Decentralization : Decentralization of decision making to a level as is
consistent with practical consideration and institutional capacity.
Community participation in health planning processes to be promoted
side by side.
ix. Dynamism and Adaptoveness : Constantly improving dynamic
organization of health care based or new knowledge and evidence
with learning, from the communities and from national and
international knowledge partners in designed.

IX. NATIONAL HEALTH PROGRAMMES

RMNCH+A services
Child and adolescent health
Universal Immunization
Communicable diseases
Mental health
Non-communicable diseases
Population stabilization
RMNCH+A SERVICE

This policy aspires to elicit developmental action of all sectors to

support mental and child survival. The policy strongly recommends
strengthening of general health system to prevent and manage material
 complications, to ensure continuity of care and emergency services for
maternal health.

CHILD AND ADOLESCENT HEALTH

 The policy endorses the national consensus on accelerated achievement

of neonatal mortality targets and ‘single digit’ stillbirth rates through
improved home based and facility based management of sick newborns.

 School health programmes as a major focus area, health and hygiene

being made a part of the school curriculum.

 It emphasis to the health challenges of adolescents and long term

potential of investing in their health care.
UNIVERSAL IMMUNIZATION

Priority would be to improve immunization coverage with quality

and safety, improve vaccine security as per National vaccine policy 2011
and introduction of newer vaccines based on epidemiological
considerations. The focus will be to build upon the success of Mission
Indradhanush and strengthen it.

COMMUNICABLE DISEASES

 The policy recognizes the interrelationship between communicable

disease control programmes and public health system strengthening.

 It advocates the need for district to respond to the communicable disease

priorities of their locality.
 The policy acknowledges HIV and TB co infection and increased
incidence of drug resistant tuberculosis as key challenges in control of
Tuberculosis.

NON- COMMUNICABLE DISEASES

 An integrated approach for screening the most prevalent NCDs with

secondary prevention would make a significant impact on reduction of
morbidity and preventable mortality. With incorporation into the
comprehensive primary health care network with linkages to specialist
consultations and follow up at the primary level.

 Screening for oral, breast and cervical cancer and chronic obstructive
pulmonary disease will be focused in addition to hypertension and
diabetes.

MENTAL HEALTH

This policy will take action on the following fronts;

 Increase creation of specialists through public financing and develop

special rules to give preference to those willing to work in public system

 Create network of community members to provide psycho-social support

to strengthen mental health services at primary level facilities.

 Leverage digital technology in a context where access to qualified

psychiatrists is difficult.
 POPULATION STABILIZATION

 Policy imperative is to move away from camp based services to a

situation where these services are available on any day of the week.

 And to increase the proportion of male sterilization from less than 5% to

at least 30% and if possible much higher.

X. NATIONAL POPULATION POLICY

In 1952, India was the first country in world to launch a national programme,
emphasizing family planning is vital for reducing birth rates for stabilization of
population which in turn will influence the national economy. Though a drastic
decline in death rate was observed after 1952. The birth rate was static. In 1976,
during emergency, the Government of India launched National Population Policy
with the aims of:

 Proposing legislation by the government to raise the age of marriage to 18 for

girls and 21 for boys;
 Special measures to raise the level of female education in the states by the
government
 Provision of monetary compensation from May 1, 1976, as 150 for sterilization
(by men or women) if performed with 2 children.f 100 if performed with three
living children and 70 if performed with four or more children.

Achievement of National Population Policy

After a period of five decades, after launching the national family welfare
programme, India has achieved the following:
 Crude birth rate reduced from 40.8 (1951) to 26.4(1998) according Statistical
registration service; (SRs)
 Infant mortality rate reduced (IMR) from 146 per 1000 live births (1951) to 72
per 1000 live births in 1998,as per SRS
 Couple protection rate increased 4 times (CPR) from 10.4 percent (1971) to 44
percent ( 1999)
 Crude death rate reduced (CDR) from 25 (1 951) to 9.0 (1998), as per SRS
 From 37 years to 62 years; life expectancy increased
 There was an universal awareness observed and achieved to the maximum for
the need and methods of family planning
 eduction of total fertility rate was observed from 6.0 (1951) to 3.3 (1997,as per
SRS).

The National population policy, 2000 (NPP 2000) emphasized the commitment of
Government towards motivating couples for voluntary consent and infonraed choice
while accepting reproductive health care services and target free approach in
conduct of family planning services.

The NPP 2000 also prepared a policy framework for forwarding goals and
prioritizing strategies of reproductive and child health needs, achieve Total Fertility
rate (TFR) by 2010, child survival, maternal health, contraception, increasing
outreach and covera—ge of a comprehensive reproductive and child health services
by government and public private partnership.

Goals to be achieved in each case by 2010 are formulated as follows:

 Achieve the unmet needs for basic reproductive and child health servkes,
supplies and infrastructure for family planning.
 Compulsory and free school educations up to age of 14 and reduce drop outs
below 20% at primary and secondary schools boys and girls.
 One of the goals to be achieved was reduction of infant mortality rate to below
30 per 1000 live births.
 Reduction of maternal mortality ratio to below 100 per 100,000 live births was
imoortant goal of NPP.
 Achievement of universal immunization of children against all vaccine
preventable diseases was one of the targets.
 Age for marriage for girls to be delayed not earlier than 18 preferably 20 years
of age.
 Institutional deliveries to be achieved by 80% and deliveries by trained
personnel 100%.
 Achievement of universal access to information/ counselling, and services for
Family planning, fertility regulation and contraception of chokes are important
goals of NPP.
 To have proper statistics 100 per cent registration of births, deaths, marriage and
pregnancy is targeted.
 Reduction of spread of AIDS, reproductive tract infection and sexually
transmitted diseases.
 Prevent and control communicable diseases.
 Promote Indian Systems of Medicine (ISM).
 Promote the small family norm to achieve target rate of TFR.
 Promote the small family norm to achieve target rate of TFR.

The vast population of India is her greatest asset if they are provided with
the means to lead healthy and economically productive lives. Population
stzabilization is a multispeetral approach requiring constant and effective
coordination at all levels of the government and society. Today we need, increasing
availability of affordable reproductive and child health services, family welfare
service delivery at village levels, may enhance early achievement of the
sociodemographic goals.
 XI. NATIONAL HEALTH POLICY ON AYUSH AND PLANS
AYUSH stands for Ayurveda, Unani medicine, Siddha, and Homeopathy.
From ancient times AYUSH was practiced in India. Now it is universally accepted.
The basic philosophy of AYUSH system lies in preventive and promotive health
care, diseases and health condition relating to women and children, non
communicable diseases, stress management, palliative care, rehabilitation, etc.
AYUSH has very little side effect. In March 1995 the department of Indian system
of medicine and homeopathy was renamed as AYUSH by the Government of India.

The main aims of AYUSH are;

 Enhance and upgradation of AYUSH educational standards

 Quality control and standardization of drugs
 Improving the availability of medicinal plant material
 Research and development in AYUSH
 Awareness development of efficacy of systems.

Objectives of national policy on AYUSH 2002 including promotion of

good health and expand the outreach of health care ensuring affordable AYUSH
services to population; provision of availability of drugs and integration of AYUSH
in health care delivery system and national programmes. Plans for AYUSH and
infrastructure comprising of Medical colleges, for training, placement of registered
medical practitioners in hospitals and dispensaries, and developing drug
manufacturing unit is available in the country. The facilities available in the country
are:
 Institutionally trained practitioners: 488714
 Non Institutionally qualified practitioners: 200088
 Number of colleges: 437
 Admission capacity per annum in UG colleges: 23280
 Number of drug manufacturing units: 9832
 Number of hospitals: 3841
 Number of beds in hospitals: 65753

National institute setup by the central government for AYUSH

 National Institute of Ayurveda, Jaipur, Rajasthan

 National Institute of Unani Medicine, Bangalore, Kamataka
 National Institute of Homoeopathy, Kolkata, West Bengal
 National Institute of Naturopathy, Pune, Maharashtra
 Moratji Desai National Institute of Yoga, New Delhi
 National Institute of Siddha, Chennai, Tamil Nadu
 National Ayurveda Hospital, New Delhi.

Statutory Regulatory Bodies of AYUSH are a) Central Council of Indian

Medicine ( CCIM), b) Central Council of Homeopathy (CCH)to formulate
standards of education, and to ensure adherence to laid down standards. The council
also recommends to the Central Government for recognition and withdrawal of
medical qualifications awarded by Universities if standards are violated.

The Following are the Priority Program of AYUSH

 Standardization of Education and Continuing Medical Education (CME)

 Medicinal plant sector
 Research and Development
 Information, Education and Communication (IEC) and international
collaboration
 Standardization and Quality Control of Ayurveda, Siddha, Unani and
Homeopathy drugs
 Mainstreaming of AYUSH in National Health Care Delivery System.

Schemes for strengthening AYUSH

 Strengthening of existing Under Graduate Colleges.
 Assistance to Postgraduate Medical Education
 Reorientation Training Programme of AYUSH personnel
 Short-term Continuing Medical Education (CME) Programme for General
AYUSH Practitioners
 Scheme for Renovation and Strengthening of AYUSH Teaching Hospital
 Scheme for Establishing of Computer Laboratories internet facilities in selected
AYUSH Colleges
 U pgradation of AYUSH colleges to the status of State Model Institute of
Ayurveda, Siddha, Unani and Homeopathy.

XII SUMMARY

Health policy refers to decisions, plans, and actions that are undertaken
to achieve specific health care goals within a society. An explicit health policy
can achieve several things: it defines a vision for the future which in turn helps
to establish targets and points of reference for the short and medium term. It
outlines priorities and the expected roles of different groups; and it builds
consensus and informs people. Health policy is the expression of what health
care system should be, so that it can meet the health care needs of the people.
The Ministry of Health and family Welfare, Government of India evolved a
National Health Policy in 1983 to attain the objective of ‘health for all by 2000
AD. Health policy is not only linked with health but it also gives an emphasis
on other social developmental areas, like education, employment, population,
economics, etc.
 XIII. 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. 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 21 st century. NHP 2002
will provide an impetus for achieving an acceptable standard of good health of
people of India.
 XIV. BIBLIOGRAPHY

 Basavanthappa BT, Text book of fundamentals of nursing 1 st edition,

jaypee brother publications, 2002

 Dash Bijayalaskhmi. Text book of community health nursing, jaypee

publications,1st edition 2017,pp 325-345
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[3rd ed]. Jaypee medical brothers Pvt Ltd;2003.
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management, emmess publications, page no: 33-40
 Keshav Swarnkar. community Health Nursing [2 nd ed], N.R Brothers
publishers Pvt Ltd 2006

 Park .K. Textbook of preventive and social medicine;[16th ed], Banarasi

Bhanot Brothers;2007
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administration, 1st edition, jaypee publications, page no: 225-231

 Journal of Health Services Research & Policy

2017 Impact Factor: 1.866

2017 Ranking: 33/79 in Health Policy & Services

Source: Journal Citation Reports®, 2018 release, a Clarivate Analytics

product; Indexed in PubMed: MEDLINE

Website;
 www.slideshare.chantal.net.com
 www.pubmed.com
 www.wikipedia.com
VIJAYA COLLEGE OF NURSING
COURSE- IInd YEAR MSC (N)

SUBJECT : NURSING MANAGEMENT

UNIT : III

TOPIC :HEALTHPOLICY-NATIONAL&STATE
NATIONAL POPULATION POLICY, NATIONAL POLICY ON AYUSH
AND PLANS

NAMEOFTHE STUDENT : MRS MERIN SOLOMON

NAME OF THE HOD : MRS SMITHA MOHAN

NAME OF THE EVALUATOR : MRS SMITHA MOHAN

HOURS ALLOTED :3 HR

SUBMITTED TO : MRS SMITHA MOHAN

DATE OF SUBMISSION : 08-11-2019

INDEX

SL NO TABLE OF CONTENT PAGE

NO
HEALTH CARE POLICY-NATIONAL & STATE
I INTRODUCTION 1
II a] definition of health 1
b]definition of national health policy
III EVOLUTION OF NATIONAL HEALTHPOLICY 2-3
IV NATIONAL HEAL TH POLICY 3-7
 Goals
 Objectives
 Principles
 Strengths
 Weakness
 Opportunities
 Threats
V
STA TE HEAL TH POLICY 7-25
 Introduction
 Definition
 Objectives
 Plan of action of state health policy
VI
NATIONAL HEALTH POLICY-1983 25-28
 History
 Elements
 Goals
 Objectives
 Components
  Strength/weakness
VII
NATIONALHEALTH POLICY-2002 28-35
 History
 Elements
 Goals
 Objectives
 Components
VIII  Strength/weakness
NATIONAL HEALTH POLICY-2015 35-38
 History
 Elements
 Goals
 Objectives
IX  Components
X NATIONAL HEALTH PROGRAMMES 38-41
XI NATIONAL POPULATION POLICY 41-43
NATIONAL HEALTH POLICY ON AYUSH AND 44-46
XII PLANS
XIII SUMMARY 46
XIV RESEARCH ABSTRACT
XV CONCLUSION 47
BIBLIOGRAPHY 48
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