1.NATIONAL HEALTH POLICY 2002 DR. VAIBHAV GUPTA MPH 1st year Student Dept. of community medicine JSSMC 10/05/2013 MODERATOR: DR. P.B. Asst. Prof. 1

2. Plan of Presentation Introduction NHP 1983 Scenario Before National Health Policy 2002 Objective Goals to be Achieved by 2000-2015 NHP -2002 Policy Prescription Recent development Achievements Strength Goals failed to be achieved by 2005 Critical review 2 3. INTRODUCTION Policy is a system, which provides the logical framework and rationality of decision making for the achievement of intended objectives. It is the statement that guide and provide discretion within limited boundaries. Policy sets priorities and guide resources allocations. Public health policy improves conditions under which people live : 3 4. CONT............ Secure, safe, adequate and sustainable livelihood Lifestyle and environments, including housing Education, nutrition, childcare, reproduction health Transportation, information and communication, necessary community and personal social and health services. Policy adequacy may be measured by its impact on population health. 4 5. NHP-1983 First formal NHP was formulated in 1983 and since then there have been marked changes in the determinant factors relating to the health sector. 5 6. Scenario Before National Health Policy 2002 The public health investment in the country over the year has been comparatively low and declining and as a percentage of GDP has declined from 1.3% in 1990 to 9.9%in 1999.out of this , about 17% of the aggregate expenditure is public health spending , the balance being out-of- pocket expenditure. The States expenditure has declined from 7.0% to 5.5% . The current annual per capita public health expenditure in the country is not more than Rs.200. The contribution of Central resources to the overall public health funding has been limited to about 15% . 6 7. OBJECTIVES To Achieve an acceptable standard of good health amongst the general population of the country. To increase access to the decentralizing public health system by establishing new infrastructure in deficient areas and, by upgrading the infrastructure in existing institutions. To ensuring a more equitable access to health services across the social and geographical expanse of the country. 7 8. CONT. To enhance the contribution of the private sector in providing health service for the population group which can afford to pay for services. To increase the aggregate public health investment through a substantially increased by the central government. To strengthen the capacity of the public health administration at the state level to render effective service delivery. 8 9. cont......... To rationalize use of drugs within the allopathic system. To increase access to tried and tested systems of traditional Medicine. 9 10. Goals to be Achieved by 2000-2015 2003 Enactment of legislation for regulating minimum standard in clinical Establishment / Medical institution 2005 Eradication of Polio & Yaws Elimination Leprosy Increase State Sector health spending from 5.5% to 7% to of the budget. Establishment of an integrated system of surveillance, National Health Accounts and Health Statistics 1% of the total budget for Medical Research Decentralization of implementation of public health program 10 11. CONT........ 2007- Achieve of Zero level growth of HIV/AIDS 2010- Elimination of Kala- Azar Reduction of mortality by 50% on account of Tuberculosis, Malaria, Other vector & water borne Diseases Reduce prevalence of Blindness to 0.5% 11 12. CONT.... Reduction of IMR to 30/1000 live births &MMR to100/ Lakh live births Increase utilization of public health facilities from current level of 75% Increase health expenditure by government from the existing 0.9% to 2.0% of GDP Increase share of Central grants to constitute at least 25% of total health spending 12 13. cont Further increase of State sector Health spending from 7% to 8% 2% of the total health budget for medical Research 2015- Elimination lymphatic Filariasis 13 14. NHP -2002 Policy Prescription 1.Financial Resources :It is planned , under the policy to increase health sector expenditure to 6% of GDP with 2% of GDP being contributed as public health investment by the year 2010. 14 15. 2.Equity : NHP 2002 has set an increased allocation of 55% total public health investment for the primary health sector, 35% for secondary sector and 10% for tertiary sector. 15 55%35% 10% Primary Secondary T ertiary 16. 3.Delivery of national public health programs NHP 2002 envisages the gradual convergence of all health programmers under a single field administration. It suggests for a scientific designing of public health projects suited to the local situation. Therefore, the policy places reliance on strengthening of public health outcomes on equitable basis. It recognizes the need of user charge for secondary and tertiary public health care for those who can afford to pay. 16 17. 4.The state of public health Infrastructure: The Policy envisages kick- starting the revival of the Primary Health System by providing some essential drugs under Central government funding through the decentralized health system. This initiative under NHP-2002 is launched in this belief that the creation of a decentralized public health system will ensure a more effective supervision of the public health personnel through community monitoring , than has been achieved through the regular administrative line of control. 17 18. 5.Extending public health services: Expanding the pool of medical Practitioners to include a cadre of licentiates of medical practice, as also practitioners of Indian systems of Medicine and Homoeopathy has been advocated in the policy. 18 19. 6. Role of local self- Government Institutions NHP-2002 lays great emphasis upon the implementation of public health programs through local self government institutions. 19 20. 7. Norms of Health care Professional: Minimal statutory norms with constant reviewing for the deployment of doctors and nurses in medical institutions need to be introduced urgently under the provision of the Indian Medical council Act and Indian Nursing Council Act , respectively. 20 21. 8.Education of Health care Professional: The need for inclusion of contemporary medical research and geriatric concern and creation of additional PG seats in deficient specialties are specified. It suggests for a need based, skill oriented syllabus with a more significant component of practical training. 21 22. For discharging public health responsibilities in the country NHP 2002 recommends specialization in the disciplines of Public Health and Family Medicine where medical doctors, public health engineers, microbiologists and other natural science specialists can take up the course. 22 9.Need for specialists in 'public health' and 'family medicine: 23. 10.Nursing personnel: NHP 2002 recognizes acute shortage of nurses trained in superspeciality disciplines. It recommends increase of nursing personnel in public health delivery centers and establishment of training courses for superspecialities. 23 24. 11. Use of Generic drugs and vaccines This Policy emphasizes the need for basing treatment regimens , in both the public and private domain, on a limited number of essential drugs of a generic nature. 24 25. 12. Urban health : Migration has resulted in urban growth which is likely to go up to 33%. It anticipates rising vehicle density which lead to serious accidents. In this direction, 2002 NHP has recommended an urban primary health care structure as under; 25 26. cont First Tier:- Primary centre cover 1 Lakh population It functions as OPD facilities. It provides essential drugs. It will carry out national health programmers. 26 27. cont. 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. 27 28. 13.Mental health: Decentralized mental health service for diagnosis and treatment by general duty medical staff is recommended. It also recommends securing the human rights of mentally sick. 28 29. 14.Information Education and Communication: NHP-2002 has suggested interpersonal communication by folk and traditional media to bring about behavioral change. School children are covered for promotion of health seeking behavior, which is expected to be the most cost effective intervention where health awareness extends to family and further to future generation. 29 30. 15.Health research: The policy envisages an increase in govt. funded health resources to a level of 1% total health spending by 2005 and up to 2% by 2010. New therapeutic drugs and vaccines for tropical disease are given priority. 30 31. 16.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. 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. 31 32. 17. Role of civil Society: The Policy envisages that the disease control Programs should earmark not less than 10% of the budget in respect of indentified program components ,to be exclusively implemented through NGOs, and other civil institution. 32 33. 18. National Disease Surveillance Network: This Policy envisages the full operationalization of an integrated disease control network by 2005.this public health surveillance network will also encompass information from private health care institutions and practitioners. 33 34. 19.Health statistics: NHP 2002 has recommended full baseline estimate of tuberculosis, malaria and blindness by 2005, and In the long run for cardiovascular diseases, cancer, diabetes, accidents, hepatitis . 34 35. 20.Women's health: After recognizing 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. 35 36. 21.Medical Ethics: In India we have guidelines on professional medical ethics since 1960. This is revised in 2001. Government of India has emphasized the importance of moral and religious dilemma. NHP 2002 has recommended notifying a contemporary code of ethics, which is to be rigorously implemented by Medical Council of India. The Policy has specified the need for a vigilant watch on gene manipulation and stem cell research. 36 37. 22.Enforcement of Quality Standards for food and Drugs : NHP 2002 envisaged that Food and Drug administration be strengthened in terms of laboratory facilities and technical expertise. 37 38. 23.Regulation of standards in paramedical disciplines: More and more training institutions have come up recently under paramedical board which do not have regulation or monitoring. Hence, establishment of Statutory Professional Council for paramedical discipline is recommended. 38 39. 24. Environmental &Occupational Health: Government has noted the ambient environment condition like unsafe drinking water, unhygienic sanitation and air pollution. Child labor and substandard working conditions are causing occupational linked ailments. NHP 2002 has suggested for an independent state policy and programme for environment apart from periodic health screening for high risk associated occupation. 39 40. 25.Providing Medical Facilities to Users from Overseas (Health Tourism) The NHP-2002 Strongly encourages the providing of such health services on a payment basis to service seekers from overseas. Recently large number of patients from overseas are coming to India for treatment (Medical Tourism). 40 41. 26.Impact of Globalization on Health Sector: Possible threat to health security in the post-TRIPS era, as a result of a sharp increase in the prices of drugs and vaccines has been acknowledged. 41 42. Recent development The Prime Minister has launched the Public Health foundation of India (PHFI) , a public- private initiative in the health sector, which seeks to establish world -class public health institutes to train professional in the filed. 42 43. Achievements 2003 Enactment of legislation for regulating minimum standard in clinical Establishment / Medical institution 2005- Eradication of Poliomyelitis is missed ,however there is zero reporting of yews since 2004. Leprosy has been declared eliminated according to the criteria fixed by WHO. However, more efforts are required. Integrated Disease Surveillance Project has been launched but establishment of National Health Accounts and Health Statistics is still lagging behind. IDSP is also going at a slow pace. 43 44. CONT... Spending of state Sector Health has not much increased as planned from 5.5% to7.7% of budget. Budget for medical research is not much increased as 1% of the total health budget for Medical Research has been targeted. Decentralization of implementation of public health Programs: National Rural Health Mission has been launched in this direction. 2007- Achieve of Zero level growth of HIV/AIDS 44 45. Strength NHP-2002 has got the opportunity to refer many documents and reports like World Development Report 1993. National Family Health Survey 1993-94 and 1998-1999. The census of India 2001. World Health Report 2002, and favourable environment lick support of international health agencies, economic and political reforms particularly 73rd and 74th amendment of the constitution of india. 45 46. Goals failed to be achieved by 2005 Eradicate Poliomyelitis Establish an integrated system of surveillance , National Health Accounts and Health Statistics. Increase State Sector Health spending from 5.5% to 7% of the budget. 1% of the total health budget for Medical Research . Decentralization of implementation of public health programs. 46 47. Critical review The policy does not referred to the Women Empowerment policy 2001 while describing measures to ensure women health. Womens health has not received enough attention in the policy similarly child health , adolescents ,gender discrimination and violence should have received adequate concerns. Old age group has got very less attention in the policy. Ignored areas 47 48. cont.... Integration of vertical program activities with general health service ensure sustainability. School Health programs have not achieved the desired results in the majority of states. For decentralization: Role of Local Self Government Institutions has been defined in the policy and should have achieved by 2005. Mismatch situation analysis and Policy Prescriptions. 48 49. cont........... There is passing comment on strengthening primary health care but how this can be achieved policy has not specified. Its is also silent on village health workers. Failing to brings Anganwadi workers and other grass root level workers on one platform. Medical Council of India: Contradictions and Dilution of Standards Posting Freshly graduate doctors in rural areas has been failed to brings change and most of the places it is not implemented at all. ROME scheme is also failed. 49 50. Thank you 50