“ VISION OF THE FUTURE ARE BETTER THAN DREAMS OF THE PAST ”
INDIA Population 1,21,01,93,422. Males 62,37,24,248. Females 58,64,69,174. census 2011
DEFINITIONS HEALTH Health is a state of complete physical, mental & social wellbeing & not merely absence of disease or infirmity. ( WHO)
DEFINITIONS (cont…) POLICY Policy is a system, which provides logical framework & rationality of decision making for achievement of intended objectives.
DEFINITIONS (CONT..) HEALTH POLICY Health policy of a nation is its strategy for controlling and optimizing the social uses of its health knowledge and health resources
DEFINITIONS (CONT..) NATIONAL HEALTH POLICIES National health policies are the government’s mandate to shape, strengthen, support and sustain a health system where every citizen has access to readily available, qualitatively appropriate and adequately wide ranging health services at affordable costs
HEALTH POLICIES IN INDIA “ Health is not mainly an Issue of doctors, Social services and hospitals. It is an issue of social justice."
POLICIES BEFORE INDEPENDENCE There were no health policies as such for colonial India
In most provinces, there were sanitary commissioners or directors of public health responsible for sanitation and control of small pox, cholera and plague; in some areas guinea worm control and malaria control.
POLICIES BEFORE INDEPENDENCE (CONT..) Death rates were high close to 30 to 40 per 1000 population; very high during major epidemics.
In 1943, for the first time, a committee headed by Sir: John Bhore was appointed to study the existing health conditions and make recommendations to prevent communicable diseases, promote health and provide basic health care.
It submitted its report in 1946, called the Bhore Committee report, and the major recommendations therein still form the basis of the Indian public health system.
BASIC RECOMMENDATIONS OF THE BHORECOMMITTEE The Bhore Committee concentrated on preventive medicine and tried to link health with social justice.
BASIC RECOMMENDATIONS OF THE BHORECOMMITTEE (CONT..) Population based national net work
BASIC RECOMMENDATIONS OF THE BHORECOMMITTEE (CONT..) Sub-centers (SC-one for 20,000 population) Primary health center ( PHC-one for 1 lakh population) Secondary center , also called the referral center ( SHC-1 for each taluka or teshil) Specialized hospital with teaching facilities at the district level
BASIC RECOMMENDATIONS OF THE BHORECOMMITTEE (CONT..) Basic maternal care, family planning services, immunizations against small pox, cholera and plague, vector control for prevention of malaria and treatment of tuberculosis.
POLICIES AFTER INDEPENDENCE IN 1947 In 1950 according to the constitution of India, in the allocation of responsibilities between the center and the state, health became a state responsibility
POLICIES AFTER INDEPENDENCE IN 1947 (CONT..) In the initial setting up of the SC, CHCs, UNICEF provided assistance to the state and the central governments in the design and construction of buildings, providing vehicles to PHCs, and drugs and equipments
Many other Committees set up by followed up Bhore Committee Government of India. The Mudaliar Committee that gave its report in 1962 concentrated on medical education and development of training infrastructure for static medical units
OTHER COMMITTES The Shrivastav Committee that gave its report in 1975 urged the training of a cadre of health assistants to serve as links between qualified medical practitioners and multipurpose workers (e.g. school teachers, postmasters, gram-sevaks, etc.) Kartar Singh committee and Jungalwalla Committee to look into the specific issues of service delivery at different levels
Right to Health global movements Russia was the first country to give its citizens a constitutional right to all health services The French Constitution of 1946 guarantees to all... protection of health In 1965-66, the Social Legislation in the United States declared health a human right.
Right to Health global movements(Cont..) The 89th US Congress Medicare and Medicaid, and Comprehensive Health Planning from ‘the womb to the tomb'
The Joint WHO – UNICEF international conference in 1978 at Alma-Ata (USSR) Alma-Ata Declaration called on all the governments to formulate national health policies according to their own circumstances to launch and sustain primary health care as a part of national health system.
“ The main social target of governments and WHO in the coming decades should be the attainment by all citizens of the world by the year 2000 AD of a level of health that will permit them to lead a socially and economically productive life.”
HEALTH FOR ALL BY 2000 AD
John Bryant in his book “Health and the Developing World”
“ Large numbers of the world’s people, perhaps more than half, have no access to health care at all, and for many of the rest the care they receive does not answer the problems they have. ”
The Joint WHO – UNICEF international conference in 1978 at Alma-Ata ( USSR ) Declared that “ The existing gross inequalities in the status of health of people particularly between developed and developing countries as well as within the countries are politically, socially and economically unacceptable.”
The Alma-Ata conference called for acceptance of the WHO goal of HEALTH FOR ALL by 2000 AD and ‘Primary Health Care’ as a way to achieve Health For All. The Alma-Ata conference defined that “ Primary health care is essential health care made universally accessible to individuals and acceptable to them, through their full participation and at the cost the community and country can afford.” .
NATIONAL HEALTH POLICY 1983 The NHP, 1983, was the first attempt to synthesise recommendations of three important earlier committees, the Bhore Committee of 1946 (Government of India, 1946), the Mudaliar Committee of 1962 (Government of India, 1962), and the Shrivastav Committee of 1975 (Government of India, 1975, 1976) and the Alma Ata declaration of global demand of Health for All by 2000.
NHP 1983, Suggested planned time bound attention
i) Nutrition, prevention of Food Adulteration
ii) Maintenance of quality of drugs
iii) Water supply and sanitation
iv) Environmental protection
NHP 1983, Suggested planned time bound attention (cont..)
v) Immunization programme
vi) Maternal and child health services
vii) School health programme
viii) Occupational health services
NHP 1983- Goal suggested/achieved 62.4 63.4 64 64 LIFE EXPECTANCY MALE FEMALE 9.4 10 UFMR 4 2 MMR 8.7 9 CDR 46 30 PNMR 70 60 IMR Achieved by 2000 Goal by 2000 Indicator
NHP 1983- Goal suggested/achieved 82% 85% OPV 87% 85% DPT 83% 100% TT Pregnant 67.2% any ANC 100% AN Care 3.1 2.3 Family size Achieved by 2000 Goal by 2000 Indicator
NHP 1983- Goal suggested/achieved 56% 85% FULLY IMMUNIZED 82% 85% BCG Achieved by 2000 Goal by 2000 Indicator
National Health Policy 2002 Nearly twenty years after the first health policy, the II nd"National Health Policy -2002 (NHP 2002) was formulated and accepted by central government in September, 2002) and it closely followed on the heels of the National Population Policy 2000 (NPP 2000)
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. This will be used in strengthening existing services & to open new services.
Key role of the central government in designing national programmes with active participation of the state governments
The policy ensures the provisioning of financial resources , in addition to technical support, monitoring and evaluation at the national level by the centre
Delivery of national public health programmes( CONT..)
Convergence of all health programmes under a single field administration
To optimize the utilization the public health infrastructure at the primary level, 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.
Executive should design programme such that it gives enough flexibility to permit State Public Health Administration to craft action as per their needs.
Delivery of national public health programmes( CONT..)
Retraining & re orientation of health staff.
Vertical implementation structure has been effective in reducing Burden of Disease. Ex –Malaria eradication, RNTCP, HIV ,RCH&UIP would need to be continued till moderate levels of prevalence are reached.
Public health spending in select countries 44.1% 13.7% 7 - USA 96.9% 5.8% 6 - UK 45.4% 3.0% 16 6.6 % Sri Lanka 24.9% 2.7% 31 18.5 % CHINA 17.3% 5.2% 70 44.2 % India Public expenditure on health to total health expenditure Health expenditure to GDP IMR /1000 Population with income of less than one dollar per day
CUMULATIVE IMPACTS OF PROGRAMMES -DATA ON SELECTED INDICATORS AT NATIONAL LEVEL FOR RECENT YEARS ( demographic )
Population and vital statistics
Total population(inthousands): 1210million
Population density (persons per sq km): 382 per sq. km
Sex ratio (females per 1000 males) 940 females per 1000 males
Population under 15 years estimated 31 (%) in 2011
Population 60 years and above estimated 8 (%) in 2011
Crude birth rate (per 1000 population) 22.8 in 2008
Crude death rate (per 1000 population) 7.4 in 2008
Natural (population) growth rate (%) 1.54 in 2008 and 1.64 during 2001-11
Total fertility rate (per woman) estimate 2.7 in 2005-06
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.
India has witnessed an increase in institution delivery recently, from 25.4 per cent in 2001 to 34.9 per cent in 2006. The MMR per 100,000 live births has also declined significantly from 407 in1997-1998 to 301 in 2001-2003 and to 254 during 2004-2006 .
A systematic analysis using data from National Family Health Surveys, District Level Household Surveys and Sample Registration System has also revealed a significant decline in MMR from 677 in 1980 to 254 in 2008 and 212 per one lakh in 2009.
There is a strong association between increase in percentage of institutional deliveries and reduction in MMR values across the country even in less developed states as Bihar and Chattisgarh.
Infant Mortality rates Infant Mortality Rate has dropped by three points from 53 during 2008 to 50 infant deaths per 1000 live births during 2009. The IMR for rural areas has dropped by three points from 58 to 55 infant deaths per 1000 live births The state Goa reported the lowesr IMR of 11, followed by Kerala 12 infant deaths per 1000 live births during 2009
NHP 2002 emphasizes implementation of health programmes through local self government institutions by 2005 with financial incentives.
Role of local self governed institutes (cont..)
Nirmal Gram Pariyojna.
A "Nirmal Gram" is an "Open Defecation Free" village where all houses, Schools and Anganwadis having sanitary toilets and awareness amongst community on the importance of maintaining personal and community hygiene and clean environment
Role of local self governed institutes (cont..)
By devolving health programme & funds in different level of Panchayati Raj & other local governing bodies has enabled –
Need based allocation of resources,
Supervision by elected representatives of population in rural ,urban & rest of India.
Advocates setting of a Medical Grants Commission to fund new medical & dental colleges & to upgrade infrastructure.
Ensure need based & skill oriented syllabus after graduation.
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.
Need for specialists in 'public health' and '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.
Nursing personnel NHP 2002 recognizes 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 .
Need for specialists in 'public health' and 'family medicine'
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
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
Associations of PRIs/NGOs/Trusts are given specific targets.
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.
But those not benefited by them need addressal, by folk media ,interpersonal relations,NGO’s/Trusts.
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 Treatment
Role of Civil Society "Government is just one part of governance-civil society is the other part“
It has been practiced to increase participation of NGO’S, Social Support Groups, voluntary health workers, no less than 10% of total task force, to carry out National & State level Health Programmes.
Certain NHP ‘S 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
NHP 2002 recognises institutions of civil society to handle disease control programme, earmarking not less than 10% of the budget in respect of identified programme
Health Research & Development • 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
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
Under National Health Programme “ AYUSH” 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 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 Policy-2000 had been recommended.