Dr Anshuli Trivedi Ist Year PG Deptt.Community Medicine.

What is Health? 

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

What is Policy?
frame work & rationality of decision making for achievement of intended objectives. 

Policy is a system, which provides logical

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

Main objective is to-

´Achieve an acceptable standard of good health amongst general population of country.¶¶

Ref-national health policy//H:\Current Reviews - National Health Policy India.htmTextbook oNational Health programmes of
India by J KishoreDate-11/9/07

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

To increase public health investment by increasing
contribution from central govt. medicine. Rationalize use of allopathic drugs. Strengthening Public Health investment by increasing contribution from Central Govt. 

Increase access to tried & tested system of traditional 

Increase contribution from pvt.Sector in providing
health services for those who can afford it.

Goals to be achieved by 2000-2015 2000        

1)Eradicate Polio and Yaws by 2000-2015. 20002)Eliminate Leprosy by 2005. 3)Eliminate Kalaazar 2010. 4)Eliminate Lymphatic Filariasis 2015. 5)Achieve zero level growth of HIV/AIDS by 2007. 6)Reduce mortality by 50%on an account of TB, Malaria,Vector&Water borne disease by 2010. 7)Reduce Prevelance of blindness by 0.5%by 2010. 8)Reduce IMR to 30/1000and MMR to 100/lakh by 2010. 9)Increase utilization public health facilities from current level of <20% to >75%. 

10)Increase health expenditure from 0.9% to 2.0% by
2010.  11)Increase central health grants to at least 25% by 2010.  12)Increase health spending by state from 5.5%to 7% by 2005.

Ref-Textbook of PSM ²Park 19th ed Pg 726

Problems & Policies to be tackled Under NHP-2002 Financial Resource
sector expenditure to 6% of GDP of which 2% is to be used till 2010. Till 2005,expenditure on health by States should be increased to 7% in I st phase, & 8% by 2010 .This will increase contribution of Central Govt. from 15% to 25% by 2015. 

Their·s a recommendation to increase health 

%of GDP has declined from 1.3%(1990)to
0.9%(1999).States are expected to be a major contributor in public health services & will receive only supplementary input from Central resources.
Ref- C:\Documents and Settings\Administrator\Desktop\Current Reviews National Health Policy ²India.htm/Textbook of National Health Programme J Kishore pg 368

In centralized planning ²equitable, regional distribution was considered as major objective. 

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

35% for secondary health services. 10% for tertiary sector. This will be used in strengthening existing services & to
open new services.

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

Delivery of National Public Health Programmes 

Executive should design programme such that it gives enough flexibility to permit State Public Health Administration to craft action as per their needs. Vertical implementation structure has been effective in reducing Burden of Disease. Ex ²Malaria eradication, Disease. RNTCP, HIV ,RCH&UIP. Till moderate levels of Prevelance is reached.  

Convergence of all health programmes under a single

field administration. This require change in mindset of health administration. Retraining & re orientation of health staff.

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

State of Public Health Infrastructure
Facilities available are estimated «.  <20% persons have OPD facilities.  <45% persons indoor facilities.  Due toto‡ poor funding. ‡ Presence of less no. medical & paramedical personnel. ‡ Inadequate equipment. ‡ overcrowding. 

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

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

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

% of health expenditure should be at least 5.2% GDP.
Public expenditure on health should be at least 17.3% of total health expenditure.
Ref-C:\Documents and Settings\ Administrator\Desktop\CurrentReviews National Health PolicyIndia.htm/Textbook of NHP J Kishorepg 369.

Extending Public Health Services 

Shortage of medical personnels in less developed & rural areas. No incentives given to persons trained in alternate medicine. These persons can be used for implementing Central & State Govt. health programmes.As per suggested in 2002 NHP report. Recommends 2 year mandatory rural health posting before granting MBBS degree.   


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Role of local self governed institutes 

By devolving health programme & funds in
different level of Panchayati Raj & other local governing bodies has enabled ² 

Need based allocation of resources,  Supervision by elected representatives of
population in rural ,urban & rest of India. 

Ex ²Nirmal Gram Pariyojna.
C:\Documents and Settings\AdministratorDesktop\Current Reviews ² National Health Policy -India.htm Textbook of National Health Programmers J Kiishore-370

Education of Health care professionals 

Uneven geographical distribution of Medical Colleges. Theoretical subjects. Substandard quality of education Reluctance to rural service. Less exposure to community- health related activities. communityAbsence of skill & day to day practice, oriented practical training. Scarce availability of anesthesiologist, radiologists,FM experts. Nursing personnel-Low doctor : nurse ratio. Acute shortage of super specialties trained nurses.

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

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

Ensure need based & skill oriented syllabus after

Periodic skill updating by continuos medical education. Introduction of new concepts of Geriatics , Genetics,

Molecular Biology, FM, radio diagnosis, anesthesia should be highlighted. 

Prime Minister of India has launched PHFI i.e.. Public
Health Foundation Of India. To give world class health facilities & training to medical personnels.
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Need for Specialists in Public &Family Medicine 

In developing countries demand for trained
personnel in Public Health & Family Medicine is more than other disciplines.  Current UG&PG, syllabus is inappropriate to today·s need. More talented medical UG·s take up clinical disciplines,rest take up GP. Also availability of PG· seats is 50% of qualified UG·s.
C:\Documents and Settings\Administrator\Desktop\Current Reviews National Health Policy -India.htm/Textbook of NHP pg371

Medicine up to 1/4th for all available subjects. 

Recommends to increase seats of Pubic Health & Family 
Not only medical graduates but also student from other
disciplines. Ex-health engineering ,microbiologists, natural scientists, must be trained in Public Health. 

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

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

Use of generic Drugs & Vaccines 

Low cost Health care system of India is largely due to indigenous manufacture of drugs & vaccines. With Globalization there is likely increase in costs of drug. Hence the measures should be taken to keep costs affordable to ensure health security of country. There is likely to be increase in costs of drugs & vaccines. Hence NHP -02 recomm. National Patent Regime to ensure affordable access to latest medical & other therapeutic discoveries.

Impact of Globalization on Health Sector 

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

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

Production & sales of irrational drugs should be curbed. No less than 50% vaccines & sera should be provided by
public sector.

Enforcement of quality standards- NHP paid heed to maintain reasonable, quality & standards for food & drugs.

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

Urban Health   

Meagerly available.With no uniformity in organizational structure. Urban population is 30% and is likely to increase to 33% by 2010 due to migration. This will lead to development of slums, with poor percolation of public health facilities.

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Health Research & Development 

Limited Health Research in India.In govt. sector R&D is largely confined to ICMR. R&D should be focused on therapeutic drugs & vaccines for tropical disease.That are largely neglected by pharma companies due to limited profitability. Research esp. on genetics, genome based drugs, vaccines development, molecular biology is needed. similar institutes for R&D. Govt. aid for R &D should be increased to 1% of total health by 2005 & upto 2% by 2010. 2010.

Ensure greater participation of Medical Colleges & 

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

Role of private sector 
Contributes significantly to secondary & tertiary care.
Widespread perception that it is uneven in quality, frequently substandard.  Pvt. Health care are financially exploitive with poor observation of medical ethics.  With increase in their role-implementation of roleSTATUORY regulation & maintaining minimal STANDARDS in diagnostic medical institution is required.  Introduction of Telemedicine & social insurance schemes.
C:\Documents and Settings\Administrator\Desktop\Current Reviews National Health Policy -India.htm/Textbook of NHP pg371


Mental health problems are more prevalent than actually noted. Not mortal but seriously affect lives of patients, families. Commonly thought to be associated with ´SPIRITUAL AFFLICTION··.  

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

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

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Information, Education, Communication 

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

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

The present IEC is too fragmented-relies on mass- media. fragmentedmassBut those not benefited by them need addressal, by folk media ,interpersonal relations,NGO¶s/Trusts.Ex. Kalyani TV Show. With annual evaluation of their performances.
C:\Documents and Settings\Administrator\Desktop\Current Reviews ± National Healt hpolicy India.htm/Textbook of NHP PG 371 

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

IEC will address itself

& eliminate risk of inappropriate T/T.

Role of Civil Society
NGO¶S, Social Support Groups, voluntary health workers, no less than 10% of total task force, to carry out National & State level Health Programmes. 

It has been practiced to increase participation of 

Certain NHP µS require continuous supervision, lab diagnosis, regular follow up. etc. Ex. RNTCP for T/T of TB.
These can easily be taken up by voluntary workers. 
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Htm/Textbook of NHP JK ishore pg371

National Disease Surveillance Programme 

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

common diseases Ex., Malaria etc.& long term incidences for non communicable diseases. Ex-CVA, CHD, DM. To ensure future policy making.
efficient surveillance system. Hence there is need to have an effective, integrated disease ³ 

It is recommended to collect baseline incidences of 

Success story of Polio & HIV control is largely due to
Surveillance Network´.
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Current scenario has absence of a systematic, proper,
meaningful & scientific health statistics data base collection methodology.


NHP-2002 focuses on programme to put up a modern

Receive inadequate public health facilities, due to some socio-culturalsocio-cultural-economic factors.  NHP-2002 recognizes role of empowered women in NHPImproving over all health standard of community. ExEx-ASHA is used under NRHM. 

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

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

Medical ethics need a new vision esp. in area of sanctity
of human life & moral dilemma of new human life forms that can cause irreversible environmental change. ExExHuman Cloning.
C:\Documents and Settings\Administrator\Desktop\Current Reviews ²National Health Policy -India./Text book of NHP J Kishore pg372

Environmental ,Occupational & Educational Health   

Unsafe drinking water, unhygienic sanitation, air pollution contributes to urban population & exposes health risks to dwellers. Work conditions are substandard risking individual to occupation linked ailments leading to chronic morbidity ,particularly for child labour. Ex ²Coal Worker Pneumoconiosis,TB,Malignancy. NHP directs employers to take their own initiatives to control these factors in pvt.or public sectors. Ex ²by regular screening of workers particularly high risk groups.

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Providing medical facilities to overseas beneficiaries. 

Good quality & cost effective secondary & tertiary level of medical facilties & drugs are available, not only in allopathy but also in alternate medicine.Ex- Concept medicine.Exof Medical Tourism. Indian pharma. companies are manufacturing innovative, indigenous drugs & vaccines as per present patent laws. NHP had also set up guidelines to ensure availability of drugs vaccines, & T/T, cost effectively in this era of Globalization.  

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Under National Health Programme ´ is included. Due to its diversity,modest cost, low level technological input, growing popularity of plant based products.Esp. Useful in remote & tribal areas. Ex. Use of plant based drugs in allopathy ie.satavarex is ie.satavarex used in promoting lactation.


Population Growth & Health Standards 

Efforts are made to improvise Health standards to match rapidly growing population. It¶s recognized that population stabilization measures, general health initiatives etc«..when synchronized synergistically, maximize socio economic wellbeing of society. For this separate National Population PolicyPolicy2000 had been recommended.

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Not much attention is paid to child, adolescent, Geriatrics health, gender, domestic violence. Ignored areas- Resource generation & allocation, areasmanagement of work force, substance abuse management ,control of medical ads. Methodology of strengthening healthcare & functioning of health workers is not specified. Hence Doctorsµ. creating ´Half Baked Paramedical Doctorsµ. Promoting ´Half


Literacy & its investment is not specified. As per WHO 5% of GDP should be spent on health but till now no more than 0.9% to2% is spent on health. Problem of population is not answered properly. School education has not yielded desired results.

This is just a beginning««««««


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