“Essential health care based on
practical, scientifically sound and socially
acceptable methods and technology made
universally accessible to individuals and families in
the community through their full participation and
at a cost that the community and country can
afford to maintain every stage of their development
in the spirit of self-determination.”
Declaration of Alma Ata
“Essential health care made universally
accessible to individuals and acceptable to
them through their full participation and
cost of the community and country can
post-independent era in 1947, when
the bhore committee brought its
To provide comprehensive health
services to the people in rural areas
through the network of primary health
A short term plan was formulated.
primary health care
RECOMMENDATIONS OF ALMA ATA
to incorporate and strengthen the primary
health care with other sectors.
The health services should be
community participation and appropriate
and support primary health care
through various sectors.
maximum care to the special risk groups.
proper use of resources.
continuous supply of drugs and proper
managerial process, includes
planning, organizing, monitoring and
evaluation of health services.
for all is ‘ the attainment of a level of
health that will enable every individual to
lead a socially and economically productive
SPECIFIC GOALS TO BE ACHIEVED BY 2000 AD :
Reduction of infant mortality from the level of
125 to below 80.
To raise the expectation of life at birth from the
level of 52 years to 64 years.
To reduce the crude death rate from the level of
14 per 1000 population to 9 per 1000 population.
To reduce the crude bith rate from the level of
33 per 1000 population to 21 per 1000
To achieve a net reproduction rate of one
Evaluation of HFA [1979-2006]:
Insufficient political commitment.
Failure to achieve equity in access to all PHC.
The continuing low status of women.
Slow socio economic development.
Unbalanced distribution of resources.
Wide spread inequality of health promotion
Weak health information systems and lack of
Pollution, poor food safety and lack of water
supply and sanitation.
demographic and epidemiological
Inappropriate use and allocation of
resources for high cost of technology.
Natural and man-made disasters.
Misinterpretation of the PHC concept.
Misconception that PHC is the 2nd rate of
health care for the poor.
Lack of political will.
Centralized planning and management.
adulteration and quality of drugs.
Water supply and sanitation.
Maternal and child health services.
School health programmes.
establish one HSC for every 5000 [3000 for
To establish one PHC for every 30,000
To establish one CHC for every 1,00000
To train village health guides selected by the
community for 1,000 population in each
To train TBAs in each village.
Training of various categories of field
Goals by 2000
Goal by 2000 Achieved by
polio and yaws
Eliminate Kala- azar
Zero level growth of HIV/AIDS
Decreasing mortality of TB by 50% -2010
malaria and other vector
Decreasing prevalence of blindness 0.5%
Increasing utilization of public health
service from 20% to 75%
Decreasing IMR to 30/1000 and MMR
april, 2005 for a period of 7
main aim of NRHM is to provide
accessible, affordable, accountable,
effective and reliable primary
health care, and bridging gap in
rural health care through creation of
a cadre of Accredited social health
The goals to be achieved by NRHM:
mortality rate reduced to 30/1000
Maternal mortality ratio reduced to
Total fertility rate reduced to 2.1.
Malaria mortality rate reduction- 50% by
Kala-azar mortality reduction-100% by
rate reduction-70% by 2010.
Cataract operation: increasing to 46 lakhs per
year by 2012.
Leprosy prevalence rate: reduce from
1.8/10000 in 2005 to less than 1/10000
Tuberculosis DOTS services: maintain 85% cure
rate through entire mission period.
Upgrading community health centers to public
Increase utilization of first referral units from
less than 20% to 75%.
Engaging 250000 female ASHA in 10 states.
AT COMMUNITY LEVEL:
Health day at anganwadi .
Availability of generic drugs .
Good hospital care.
Improved access to universal
Improved facilities for institutional
Provision of household toilets.
Improved outreach services
disease, disability, injury and premature
Achievement of health equality.
Elimination of health disparities.
Creation of social and physical
environment that will promote good
health and healthy development and
behaviour at every stage of life.
targets to be achieved by the year
infant mortality rate below 60.
To increase the expectation of life from
52 years to 64 years.
To decrease the crude death rate from
14/1000 population to 9/1000
To achieve a net reproduction rate of 1.
To provide water to the entire
options of immunization.
Reproductive health needs.
Provision of essential technologies
Prevention and control of noncommunicable diseases.
Food safety and provision of
selected food supplements
in health care
Available to all.
Available by all.
Affordable by all
y and Acceptability of Health
Health services delivered where the
one community health worker per 1020 households
Use of traditional medicines
of quality, basic and
essential health services
Attitudes, knowledge and skills
Regular monitoring and periodic
Awareness on health and health-related
Planning, implementation, monitoring and
evaluation done through small group
Selection of community health workers
Formation of health committees.
Establishment of a community health
Mass health campaigns
Community generates support for health
Use of local resources
Training of community in leadership and
Incorporation of income generating
projects, cooperatives and small scale
of interrelationship of
health and development
health, food, nutrition, water, sanitation and
Integration of PHC into
national, regional, provincial, municipal
Coordination of activities with economic
planning, education, agriculture, industry, ho
using, public works, communication and
Establishment of an effective health
Establishment of an effective health
Multi-sectoral and interdisciplinary
Information, education, communicatio
Collaboration between government
and non-governmental organizations.
Reallocation of budgetary resources.
Reorientation of health professional
Advocacy for political and support
from the national leadership down.
Counseling and appropriate Adolescent
Assistance to school health services.
Promotion of sanitation.
Community need assessment.
Implementation of national
health center level
MCH including family planning.
Safe water supply and basic sanitation.
Prevention and control of locally endemic diseases.
Collection and reporting of vital statistics.
Education about health.
National health programmes.
Training of health guides, health workers,
local dais and health assistants.
Basic laboratory services.
health centre level
of routine and emergency.
24 hour delivery services.
Essential and emergency obstetric care.
Full range of family planning services.
Safe abortion services.
Routine and emergency care of sick
foreign body removal, tracheostomy etc
Implementation of national health
country efforts and
policy instruments with global
Integrated service delivery models
Financing universal coverage
Human resources for health
Infrastructure and technology
policy and organizational
Poorly defined functions
Deficiencies in training and
Lack of support and supervision
Uncertain working conditions
cost and sources of
Lack of monitoring and evaluation
Lack of transport facilities
Insecurity of female staff
Inadequate supply of drugs and
Medical officers are not interested
to work in rural areas
Failure to deliver universally
Failure to deliver effectively
Poor leadership, public regard, and
Funding models that are unresponsive
fail to ensure treatments are effectively
distributed and universally available for
common serious acute diseases
Lack of effective information systems
Advances in health and
Lack of health personnel
The double burden of disease