NATIONAL HEALTH POLICY IN INDIA DR KANUPRIYA CHATURVEDI

NATIONAL HEALTH POLICY IN INDIA DR. KANUPRIYA CHATURVEDI DR. KANUPRIYA

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. DR. KANUPRIYA

NHP 2002, Objectives……. . • Enhancing the contribution of private sector in providing health service for people who can afford to pay. • Giving primacy for prevention and first line curative initiative. • Emphasizing rational use of drugs. • Increasing access to tried systems of Traditional Medicine DR. KANUPRIYA

Goals – NHP 2002 1. Eradication of Polio & Yaws 2005 2. Elimination of Leprosy 2005 3. Elimination of Kala-azar 2010 4. Elimination of lymphatic Filariasis 2015 5. Achieve of Zero level growth 2007 of HIV/AIDS DR. KANUPRIYA

Goals – NHP 2002…… 6. Reduction of mortality by 50% on account of Tuberculosis, Malaria, Other vector and water borne Diseases 7. Reduce prevalence of blindness to 0. 5% DR. KANUPRIYA 2010

Goals – NHP 2002…… 8. Reduction of IMR to 30/1000 & MMR to 100/lakh 9. Increase utilisation of public health facilities from current level of <20% to > 75% 10. Establishment of an integrated system of surveillance, National Health Accounts and Health Statistics DR. KANUPRIYA 2010 2007

Goals – NHP 2002…… 11. Increase health expenditure by government as a % of GDP from the existing 0. 9% to 2. 0% 12. Increase share of Central grants to constitute at least 25% of total health spending DR. KANUPRIYA 2010

Goals – NHP 2002…… 13. Increase State Sector Health spending from 5. 5% to 7% of the budget 14. Further increase of State sector Health spending from 7% to 8% DR. KANUPRIYA 2005 2010

NHP-2002 Policy prescriptions DR. KANUPRIYA

Differentials in health status among rural/urban India DR. KANUPRIYA

Equity…. . • To overcome the social inequality, 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. DR. KANUPRIYA

Delivery of national public health programmes • NHP 2002 envisages the gradual convergence of all health programmes under a single field administration. • It suggests for a scientific designing of public health projects suited to the local situation. DR. KANUPRIYA

Delivery of national public health programmes……. • Training and reorientation of rural health staff and free hand to district administration to allocate the time of the rural health staff between the various programmes, depending on the local need is stressed. DR. KANUPRIYA

Public health spending in select countries IMR Population /1000 with income of less than one dollar per day Health expenditure to GDP Public expenditure on health to total health expenditure India 44. 2 % 70 5. 2% 17. 3% China 18. 5 % 31 2. 7% 24. 9% Sri Lanka 6. 6 % 16 3. 0% 45. 4% UK - 6 5. 8% 96. 9% USA - 7 13. 7% 44. 1% DR. KANUPRIYA

Delivery of national public health programmes……. • Therefore, the policy places reliance on strengthening of public health outcomes on equitable basis. • It recognises the need of user charge for secondary and tertiary public health care for those who can afford to pay. DR. KANUPRIYA

Extending public health services • Expanding the pool of General Practitioners to include a cadres of licentiates including Indian systems of Medicine and Homoeopathy is recommended in the policy. • In order to provide trained manpower in under served areas it recommends contract employment. DR. KANUPRIYA

Suggested norms for health personnel Category of personnel Norms suggested 1. Doctors 1 per 3, 500 population 2. Nurses 1 per 5, 000 population 3. Health worker female and male 1 per 5, 000 population in plain area and 3000 population in tribal and hilly areas. 4. Trained dai 1 per 5. Health assistant (male and female 1 per village 30, 000 population in plain area and 20000 population in tribal and hilly areas. provides supportive super vision to 6 health workers (male /female). 6. Health assistant (male and female) 7. Pharmacists 1 per 10, 000 population 8. Lab. technicians 1 per 10, 000 population DR. KANUPRIYA

Education of health care professionals • NHP 2002 recommends setting up of a Medical Grant Commission for funding new government medical/dental colleges. • It suggests for a need based, skill oriented syllabus with a more significant component of practical training. DR. KANUPRIYA

Education of health care professionals…. . • The need for inclusion of contemporary medical research and geriatric concern and creation of additional PG seats in deficient specialities are specified. DR. KANUPRIYA

Need for specialists in 'public health' and 'family medicine' • For discharging public health responsibilities in the country NHP 2002 recommends specialisation 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. DR. KANUPRIYA

Nursing personnel • NHP 2002 recognises acute shortage of nurses trained in superspeciality disciplines. • It recommends increase of nursing personnel in public health delivery centres and establishment of training courses for superspecialities. DR. KANUPRIYA

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; DR. KANUPRIYA

Urban health…… First Tier: • Primary centre cover 1 Lakh population – It functions as OPD facilities. – It provides essential drugs. – It will carry out national health programmes. DR. KANUPRIYA

Urban health…… 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. DR. KANUPRIYA

Mental health • Decentralised mental health service for diagnosis and treatment by general duty medical staff is recommended. • It also recommends securing the human rights of mentally sick. DR. KANUPRIYA

Information Education and Communication • NHP 2002 has suggested interpersonal communication by folk and traditional media to bring about behavioural change. DR. KANUPRIYA

Information Education and Communication……. • School children are covered for promotion of health seeking behaviour, which is expected to be the most cost effective intervention where health awareness extends to family and further to future generation. DR. KANUPRIYA

Health research • 2002 NHP noted the aggregate annual health expenditure of Rs. 80, 000 crores and on research Rs. 1150 crores is quite low. • The policy envisages an increase in govt. funded health resources to a level of 1% total health spending by 2005 and upto 2% by 2010. • New therapeutic drugs and vaccines for tropical disease are given priority. DR. KANUPRIYA

Role of private sector • The policy welcomes the participation of the private sector in all areas of health activities primary, secondary and tertiary health care services; • but recommended regularitory and accreditation of private sector for the conduct of clinical practice. DR. KANUPRIYA

Role of private sector…. . • It has suggested a social health insurance scheme for health service to the needy. • It urges standard protocols in day-to-day practice by health professionals. • It recommends tele-medicine in tertiary care services. DR. KANUPRIYA

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 and G. E. DR. KANUPRIYA

Women's health • After recognising the catalytic role of empowered women in improving the overall health standard of the country, NHP 2002 has recommended to meet the specific requirement of women in a more comprehensive manner. DR. KANUPRIYA

Medical ethics • In India we have guidelines on professional medical ethics since 1960. • This is revised in 2001. • Government of India has emphasised the importance of moral and religious dilemma. DR. KANUPRIYA

Medical ethics……. • 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. DR. KANUPRIYA

Enforcement of quality standard for food and drugs • NHP 2002 envisaged that Food and Drug administration be strengthened in terms of laboratory facilities and technical expertise. DR. KANUPRIYA

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. DR. KANUPRIYA

Environmental and occupational health • Government has noted the ambient environment condition like unsafe drinking water, unhygienic sanitation and air pollution. • Child labour and substandard working conditions are causing occupational linked ailments. DR. KANUPRIYA

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