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STATE AND NATIONAL HEALTH POLICIES PRESENTED BY HEENA MEHTA S.Y.M.SC NURSING OBSERVED BY MRS A.YONATANMADAM ASSOCIATE PROFESSER J G NURSING COLLEGE
NATIONAL HEALTH POLICY- 1983• Introduction• "A health policy generally describes funda-mental principles regarding which health providers 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 haves and have- nots and ultimately contributes to the quality of life.
• NHP 1983 stressed the need for providing primary health care with special emphasis on prevention, promotion and rehabilitation• •Suggested planned time bound attention to the following• i) Nutrition, prevention of Food• Adulteration• ii) Maintenance of quality of drugs
The Priorities of this policy• a. Nutrition• b. Prevention of food adulteration and quality of drugs• c. Water supply and sanitation• d. Environmental protection• e. Immunization programs• f. Maternal and child health services
• Other Aspects• 1. Health Education.• 2. Development of Managerial Information System (MIS).• 3. Production of Drugs and Equipments.• 4. Health Insurance and Legislation.• 5. Medical Research.• 6. Policy Formulation• i. Identifying Policy Needs• ii. Formulating Policy• iii. Designing Policy Strategies• iv. Reviewing the Policy
Health Policy Formulation in India• a. Ministry of Health identified the need for policy arising out of handling of the day-to- day problems related to various health programmes and commitment to achieving the goals of HFA by 2000 AD.• b. Ministry appointed a committee to review environment in the health sector and recommended a policy frame after needful consultation.
• The draft policy document based on the recommendation of 5th Joint Conference of Central Council of Health and Family Welfare in October 1978 was thrown open to various individuals, groups, institutions and health related sectors for wider discussions and comments with a view to build inter-linkages between various Ministries and provide rationality, consis-tency in the content and suggest alternates within the possible resources, to improve the acceptability of the policy.
• The revised draft was presented to subsequent Joint Council of Health and Family Welfare to get the views of Health Ministers of the States and later to National Development Council to get the views of the State Chief Ministers and their concurrence.• e. The final draft was presented to the Cabinet for approval and adoption.
• f. After the Cabinets approval the document was presented in the National Parliament for ratification in December 1982.
Elements• 1. Solving of Health Problems.• 2. Supply of drinking water and basic sanitation, using technologies that the people• can afford.• 3. Reduction of existing imbalance in health services by increasing Rural Infrastructure.
• 4. Establishment of HIS (Health Information System).• 5. Provision of legislature support to health projection and health promotion.• 6. Concerted actions to combat widespread malnutrition.• 7. Research into alternative methods of health care delivery and low cost health• technologies.• 8. Greater coordination of different systems of medicine.
Components• 1. Reduction of regional disparities.• 2. Fuller employment.• 3. Elementary education.• 4. Integrated rural development.• 5. Population control.• 6. Welfare of women and children.
Health Strategies• 1. Restructuring of the health infrastructure.• 2. Development of Health Manpower.• 3. Research and development.
Specific Goals• 1. To establish one HSC for every 5,000 (3,000 for hilly areas).• 2. To establish one PHC for every 30,000 population.• 3. To establish one CHC for every 100,000 population.• 4. To train Village Health guides selected by the community for 1000population in each village.• 5. To train TBAs in each village.• 6. Training of various categories of field
Sr. no NATIONAL HEALTH POLICY - 2002 GOALS TO BE ACHIEVED BY 2015 Year1 Eradicate Polio and Yaws 20052 Eliminate Leprosy 20053 Eliminate Kala-azar 2010 Eliminate Lymphatic Filariasis 20154 Achieve zero level growth of HIV / AIDS 20075 Reduce mortality by 50% on account of TB 20106 Malaria and other vector and water borne diseases 2010
7 Reduce prevalence of blindness to 0.5% 20108 Reduce IMR to 30/100 And MMR to 100/Lakh 20109 Increase utilization of public health facilities from 2005 current level of < 20% to > 75% Establish an integrated system of surveillance, 201010 National Health Accounts and Health Statistics. Increase health expenditure by Government as a 201011 % of GDP from the existing 0.9% to 2.0%12 Increase share of central grants to constitute at 2005 least 25% of total health spending13 Increase state sector health spending from 5.5% 2010 to 7% of the budget Further increase to 8% of the budget
NATIONAL HEALTH POLICY- 2001• National health policy 2001 for the accelerated achievement of public health goals in the contex of previling socio-economic circumstance.• The main objective of NHP-2001 is to achieve acceptable standard o good health amongst the general population of the country.
REDUCE MORTALITY BY 50% ON ACCOUNT OF TB 2010,MALARIAOTHER VECTOR BORN & WATER BORN 2010PREVENLENCEOF BLINDNESS TO 0.5%REDUCE IMR TO 30/1000& MMR TO 1 LAKH 2010IM PROVE NUTRITION & REDUCE LBW BABIES 2010FROM30%TO 10%INCREASE UTILIZATION OF PUBLIC HEALTHFACILITIES 2010FROM CURRENTLEVEL OF <20 TO >75%
ESTABLISH AN INTEGRATED 2005SYSTEM OF SURVELLANCE,NATIONAL HEALTH ACCOUNTAND HEALTH STATISTICSINCREASE HEALTH 2010EXPENDITURE BY GOVERNMENTAS A% GDP FROM 0.9 TO 2%B INCREASE SHARE OF CENTRAL 2005 GRANTS TO CONSTITUTE AT LEAST 25% OF TOTAL HEALTH SPENDINGC INCREASE STATE SECTOR HEALTH SPENDING FROM 5.5% TO 7% OF THE BUDGET
MAJOR ISSUE BEING ADDRESSED BY NHP 2001 ARE AS UNDER-• HAND OUT
NATIONAL HEALTH POLICY – 2002• GOALS TO BE ACHIEVED BY 2015•
Sr. no NATIONAL HEALTH POLICY - 2002 GOALS TO BE ACHIEVED BY 2015 Year1 Eradicate Polio and Yaws 20052 Eliminate Leprosy 20053 Eliminate Kala-azar 2010 Eliminate Lymphatic Filariasis 20154 Achieve zero level growth of HIV / AIDS 20075 Reduce mortality by 50% on account of TB 20106 Malaria and other vector and water borne 2010 diseases7 Reduce prevalence of blindness to 0.5% 2010
8 Reduce IMR to 30/100 And MMR to 2010 100/Lakh9 Increase utilization of public health 2005 facilities from current level of < 20% to > 75% Establish an integrated system of 201010 surveillance, National Health Accounts and Health Statistics. Increase health expenditure by 201011 Government as a % of GDP from the existing 0.9% to 2.0%12 Increase share of central grants to 2005 constitute at least 25% of total health spending13 Increase state sector health spending 2010
Objectives* The main objective of this policy is to achieve an acceptable standard of good health amongst the general population of the country.• Decentralized public health system by establishing new infrastructure in deficient areas, and by upgrading the infrastructure in the existing institutions.• Ensuring a more equitable access to health services across the social and
• Emphasis will be given to increasing the aggregate public health investment through a substantially increased contribution by the Central Government.• Strengthen the capacity of the public health administration at the State level to render effective service delivery.
NHP-2002 - Policy prescriptions• Financial resources• Equity• Delivery of national public health programmes• The state of public health infrastructure• Extending public health services• Role of local self-government institutions
Need for national health policy• Population stabilization• Medical and Health Education• Providing primary health care with special emphasis on the preventive, promotive and• rehabilitative aspects• Re-orientation of the existing health personnel• Practitioners of indigenous and other systems of medicine and their role in health care
IMPROVED HEALTH INDICATORS• In 2010, India has the lowest ever polio transmission levels, especially during the high transmission season, amidst high quality surveillance. There has been a sharp decline in the number of polio cases reported this year – only 41 polio cases in the country as on 30.11.2010 compared to 633 polio cases in the corresponding period of 2009.
• As per latest data made available by National AIDS Control Organization, the India HIV estimates 2008-09 highlight an overall reduction in adult HIV prevalence and HIV incidence (new infections) in India. Adult HIV prevalence at national level has declined from 0.41% in 2000 to 0.31% in 2009. The estimated number of new annual HIV infections has declined by more than 50% over the past decade.• Leprosy Prevalence Rate has been further reduced to 0.71/10,000 in March, 2010. 32 State/UTs have achieved elimination by March 2010, leaving onlyBihar, Chhattisgarh and
• TB mortality in the country has reduced from over 42/lakh population in 1990 to 23/lakh population in 2009 as per the WHO global report 2010. The prevalence of TB in the country has reduced from 338/lakh population in 1990 to 249/lakh population by the year 2009 as per the WHO global TB report, 2010.
NATIONAL NUTRITIONAL POLICY• Formultion and acceptance of national Nutitional Policy in 1993 by Government
SHORT TERM MEASURE• The NNP suggested and recommended to expand the nutritio intervention net through ICDS to cover 0 to 6 age children, which is 18% of the population. Out of this 51 million children come from below poverty line,since only 15.3 million children are covered atpresent, the remaining were to be covered by extending ICDS to another 2388 blocks by the year 2000.• Behaviour change By involving mothers in nutrition intervention like growth monitoring, supplementary nutrition, etc one can reduce severe and moderate malnutrition
• Reaching adolescent girls the policy suggested to include all adolescent girls from poor families under ICDS by 2000 in all community development blocks in rural ares and in 50% of urban slums.• Better coverage of lactating mothers The policy intended to acheve a target of 10% LBW by covering pregnant women from first trimester to one year after pregnancy under supplementary nutrition.
• Other short term inventions fortification of essential foods with appropriate nutrients popularization of low cost nutritionous foods involving local women,intensified programme of supplementation of Vit A ,iron folic acid and iodine among pregnant,lactating and 0-6 children to eradicate nutritional blindness by 2000 and to reduce anaemia among lactating mother to 25% by 2000.
LONG –TERM MEASURES BY NNP• -Food production to rise to 250 million tonners per year by 2000.• - Per capita food availability 215 kg/person/year• *Production for improvement of dietary pattern• -Increase in production of pulses,oilseed,other food crops• -Augmentation of production of protective foods.
• High yield variety cultivation recommended.• -Transit and storage wastage is minimized.• *Policy for Entitlement package• -Restructuring of poverty allevation programme like IRDP,Jawahar rozgar Yojana, Nehru• Rozgar Yojana and DWCRA.• -Additional employment of 100 days to rural landless family.• -Opportunities to slum dwellers and urbanpoor.• -PDS to distribute coarse grain, pulses, juggery, bedsides rice, wheat, and sugar and oil.
• Land reformation measures• -Tenural reforms• -Implementation of ceiling laws.• *Health services and FW service• -Health and nutrition are made inseparable parts.• -Provision of health care and FP care along with nutritional care.• *Health knowledge health education to the community, Nutritional education to the community
• *Strengthening of prevention of food adultration act.• *Nutrition monitoring food and nutrition board is made accountable for the monitoring of nutritional programme.• *Research NNP recommends research in various aspects of nutrition.• *Equal remuberation• -Stringent enforcement of equal Remnuneration Act.• -Expansion of employment opportunities to women
NATIONAL POLICY FOR EDUCATION• The Government of india considered the question of evolving a national policy for the welfare of children and accordingly in 1974 adopted National Policy for children.•
• Under National Educational Policy, the new thrust is elementary education. This emphasizes two aspects• 1-Universal enrolment and universal retention of children up to 14 age.• 2- It brings about improvement in quality of education
CHILD CENTERED APPROACH• At primary stage a child centered and activity based process of learning is dopted. The kids are allowed to set their own pace and given supplementary remedial instruction.At a later stage,component of cognitive learning is increased and skills are organized through practice.
NATIONAL POLICY FOR CHILDREN• Government of india adopted the National policy for children in August 1974.
• The basis of National policy for children is the United Nations Declaration of Rights of the child.• Following principle s are drawn from the UN declarations. – Child should have its right irrespective of nation, social origin and withoutdiscriminition of race ,sex and religion. – Healthy and normal environment are provided for child which can enjoy physical, mental , moral and spiritual.
– Name and nationality should be its birth right.– It should get access to social security, nutrition, recreation and medical services.– Special treatment, care and education should be given to a physically handicapped child.– Family, society and public are responsible for the tender care, love and understanding of the child.– It should receive free and compulsory elementary education thereby it can be a useful member of the society.– Protection and relief should be given to a child as first priority.– It must be protected from cruetly, exploitation and child labour.
• Following measures are recommended for adoption to attain the set objectives under the policy for children.• They are.• Children are covered by comprehensive health care programme.• Nutritional services to overcome nutritional deficiencies are adopted.• Care of pregnant and lactating takes care of general improvement of children
• Free and compulsory education is providedto children upton14 years of age.• A programme of informal education for girls and children of weaker section of society is undertaken.• Other form of education to children who do not take up formal education is advocated.• Games, sports and recreational activities are made compulsory in educational system.• Special assistance to SC,ST and economically weaker section is provided both in urban and rural areas.•
• They are protected against neglet, cruelty and exploitation.• No child labour is admitted on any account.• Physically handicapped ,emotionally disturbed and mentally retarded are provided facilities for treatment.• They are given priority in natural calamity.•
NATIONAL DRUG POLICY• In the year 1975 Hathi Committee listed 116 drugs as essential drugs.• Rational drug policy needs a National frug Formulary, through we have , it needs updating along the line of British Natioal Formulary. Drugs listing under following category is mandatory for an effective drug policy.•
• 1-Graded essential drugs• -for primary health care• -for secondary and tertiary care• -research and super speciality care• 2-Priority drugs• -drug for emergency• -drug for epidemic• -drug for national health programmes.• 3-Essential drugs which are national, scientifically proven, therapeutically effective.,economical and socially acceptable.
• 4- Rational Drugs accepted worldwide and are available for evidence based medicine.• Fole projected following objectives canan effective national grug policy,• a-Community need assessment allow the requirement of essential drugs for primary health care. This also eliminate toxic drugs.• b- Total quality control on production, price and quality I possible by the policy.• c-Drug information system can be developed.• d-It ensures ethical marketing of drugs
• e-The nation can develop self- sufficiency,reliance in drug technology and reduction in import quantum.• f-The policy can update exiting legislations to make it consistant with requirement of community health care and safety.• -The poisons Act,1919• -The Dangerous Drugs Act,1930• -The Drug and Cosmetics Act,1940, amended later in 1955,1962,1964,1972 and 1982.
NATIONAL ANTIBIOTIC POLICY• Objectives of the policy • Monitoring through refence laboratory for susceptibility and resistance. • Bioavailability studies , research and development of new antibiotics. • Uniformity in antibiotic use at hospital, PHC and General practitioners. • Survellance of antibiotis usage. • Development of national registry on sensitivity and resistance. • Proper and effective legislative enforcement.•
NATIONAL ALCOHOL POLICY• In an effort towards finding solution, World Health Organisation has begun to give• Emphasis to the development of National alcohol policy. They are also health problems and hence it is legitimate to include in national strategy.• The health problem that are seen are;• Liver cirrhosis
• Cancer of GI Tract• Road traffic accidents• Fires• Child abuse• Suicide• The second problem is seen with alcohol industry and its review, which cannot be tackled without a national consensus.
• Since a democratic country like india need background information, one can suggest the of following for the development of policy.• -Definition of alcoholism• -Response of the society• -Administrative responsibility• -Major alcohol problems, its magnitude.• -Influence of international alcohol market.• The country has to look into the political level for declaration, responsible office for implementation and a suitable system for implementation.
BIBLIOGRAPHY• 1. Basvanthappa : Community Health Nursing, 1st Ed. New Delhi, Jaypee Brothers Medical Publishers, Reprint 2003. Pp. :317- 318.• 2. Dr. Mrs. Rao Kasturi Sunder : An Introduction to Community Health Nursing, 4th Ed., Chennai, B.I. Publications, Reprinted 2005. Pp.: 574-579.
• 3. Gulani K. K. : Community Health Nursing- Principles & Practices. 1st Ed., Delhi, Kumar Publishing House, 2005. Pp.:322-325.• 4. Mahajan B. K. & Gupta M. C. : Textbook of Preventive & Social Medicine, 2nd Ed., New Delhi, Jaypee Brothers, 1995.• 5. Park J. E. : Textbook of Preventive & Social Medicine, 20th Ed., Jabalpur, M/s Banarsidas Bhanot, 2000. Pp.: 423- 424.