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Ncp2002model powerpoint

  1. 1. Presented By. Arun Kumar.S.K IInd Year M.Sc.Nursing V.N.S.S College Of Nursing NATIONAL HEALTH POLICIES
  3. 3. INDIA Population 1,21,01,93,422. Males 62,37,24,248. Females 58,64,69,174. census 2011
  4. 4. DEFINITIONS HEALTH Health is a state of complete physical, mental & social wellbeing & not merely absence of disease or infirmity. ( WHO)
  5. 5. DEFINITIONS (cont…) POLICY Policy is a system, which provides logical framework & rationality of decision making for achievement of intended objectives.
  6. 6. 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
  7. 7. 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
  8. 8. HEALTH POLICIES IN INDIA “ Health is not mainly an Issue of doctors, Social services and hospitals. It is an issue of social justice.&quot;
  9. 9. POLICIES BEFORE INDEPENDENCE There were no health policies as such for colonial India
  10. 10. POLICIES BEFORE INDEPENDENCE (CONT..) <ul><li>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. </li></ul>
  11. 11. POLICIES BEFORE INDEPENDENCE (CONT..) Death rates were high close to 30 to 40 per 1000 population; very high during major epidemics.
  12. 12. POLICIES BEFORE INDEPENDENCE (CONT..) <ul><li>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. </li></ul><ul><li>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. </li></ul>
  13. 13. BASIC RECOMMENDATIONS OF THE BHORECOMMITTEE The Bhore Committee concentrated on preventive medicine and tried to link health with social justice.
  14. 14. BASIC RECOMMENDATIONS OF THE BHORECOMMITTEE (CONT..) Population based national net work
  15. 15. 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
  16. 16. 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.
  17. 17. 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
  18. 18. 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
  19. 19. 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
  20. 20. 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
  21. 21. 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.
  22. 22. Right to Health global movements(Cont..) The 89th US Congress Medicare and Medicaid, and Comprehensive Health Planning from ‘the womb to the tomb'
  23. 23. 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.
  24. 24. The 30th World Health Assembly in May 1977 <ul><li>“ 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.” </li></ul><ul><li>HEALTH FOR ALL BY 2000 AD </li></ul>
  25. 25. John Bryant in his book “Health and the Developing World” <ul><li>“ 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. ” </li></ul>
  26. 26. 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.”
  27. 27. 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.” .
  28. 28. 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.
  29. 29. NHP 1983, Suggested planned time bound attention <ul><li>i) Nutrition, prevention of Food Adulteration </li></ul><ul><li>ii) Maintenance of quality of drugs </li></ul><ul><li>iii) Water supply and sanitation </li></ul><ul><li>iv) Environmental protection </li></ul>
  30. 30. NHP 1983, Suggested planned time bound attention (cont..) <ul><li>v) Immunization programme </li></ul><ul><li>vi) Maternal and child health services </li></ul><ul><li>vii) School health programme </li></ul><ul><li>viii) Occupational health services </li></ul>
  31. 31. 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
  32. 32. NHP 1983- Goal suggested/achieved 1.93 1.2 Growth rate 1.45 1 NRR 46.2% 60% CPR 26.1 21 CBR 26% 10% LBW Achieved by 2000 Goal by 2000 Indicator
  33. 33. 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
  34. 34. NHP 1983- Goal suggested/achieved 56% 85% FULLY IMMUNIZED 82% 85% BCG Achieved by 2000 Goal by 2000 Indicator
  35. 35. National Health Policy 2002 Nearly twenty years after the first health policy, the II nd&quot;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)
  36. 36. NHP 2002 <ul><li>A) Introductory </li></ul><ul><li>B) Current Scenario </li></ul><ul><li>C) Objectives </li></ul><ul><li>D) NHP-2002-Policy Prescriptions </li></ul><ul><li>E) Summation </li></ul>
  37. 37. A) Introductory <ul><ul><ul><ul><ul><li>In this part the goals and plans , formulated for NHP-1983 , have been described in detail . </li></ul></ul></ul></ul></ul>
  38. 38. B) Current Scenario <ul><li>It gives detailed information about present situation, problem and future challenges of the various aspects of health sector. </li></ul>
  39. 39. Objectives: NHP 2002 <ul><li>An objective is a more specific target set in order to achieve the goal on a larger front </li></ul><ul><li>Main objective is to- </li></ul><ul><li>“ Achieve an acceptable standard of good health amongst general population of country.’’ </li></ul>
  40. 40. OTHER OBJECTIVES OF NHP 2002 <ul><li>To increase access to decentralized public health system by establishing new infrastructure in deficient areas and by upgrading infrastructure in existing institutes </li></ul><ul><li>Ensuring a more equitable access to health service across the social and geographical expanse of India. </li></ul><ul><li>Enhancing the contribution of private sector in providing health service for people who can afford to pay </li></ul>
  41. 41. OTHER OBJECTIVES OF NHP 2002 <ul><li>To increase public health investment by increasing contribution from central govt. </li></ul><ul><li>Giving primacy for prevention and first line curative initiative. </li></ul><ul><li>Emphasizing rational use of drugs. Increasing access to tried systems of Traditional Medicine. </li></ul><ul><li>Increase contribution from private sector in providing health services for those who can afford it. </li></ul>
  42. 42. Goals to be achieved by 2000-2015 <ul><li>Eradicate Polio and Yaws by 2000-2015. </li></ul><ul><li>Eliminate Leprosy by 2005. </li></ul><ul><li>Eliminate Kalaazar 2010. </li></ul><ul><li>Eliminate Lymphatic Filariasis 2015. </li></ul><ul><li>Achieve zero level growth of HIV/AIDS by 2007. </li></ul><ul><li>Reduce mortality by 50%on an account of TB, Malaria,Vector&Water borne disease by 2010. </li></ul><ul><li>Reduce Prevelance of blindness by 0.5%by 2010. </li></ul><ul><li>Reduce IMR to 30/1000and MMR to 100/lakh by 2010. </li></ul><ul><li>Increase utilization public health facilities from current level of <20% to >75%. </li></ul>
  43. 43. Goals to be achieved by 2000-2015 (CONT..) <ul><li>Increase health expenditure from 0.9% to 2.0% by 2010. </li></ul><ul><li>Increase central health grants to at least 25% by 2010. </li></ul><ul><li>Increase health spending by state from 5.5%to 7% by 2005 </li></ul>
  44. 44. NHP-2002 Policy prescriptions <ul><li>PROBLEMS & POLICIES TO BE TACKLED UNDER NHP-2002 </li></ul><ul><li>Financial Resource </li></ul><ul><li>Their’s a recommendation to increase health sector expenditure to 6% of GDP of which 2% is to be used till 2010. </li></ul><ul><li>Till 2005,expenditure on health by States should be increased to 7% in I st phase, & 8% by 2010 .This will increase contribution of Central Govt. from 15% to 25% by 2015. </li></ul><ul><li>%of GDP has declined from 1.3%(1990)to 0.9%(1999).States are expected to be a major contributor in public health services & will receive only supplementary input from Central resources. </li></ul>
  45. 45. Financial Resource (CONT..) This will allow a good rise of current annual per capita public health expenditure of the country from Rs. 200/- by ten-fold say around Rs. 2000
  46. 46. Differentials in health status among rural/urban India
  47. 47. EQUITY <ul><li>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. </li></ul>
  48. 48. Delivery of national public health programmes <ul><li>Key role of central Government </li></ul><ul><li>Key role of the central government in designing national programmes with active participation of the state governments </li></ul><ul><li>Financial supports </li></ul><ul><li>The policy ensures the provisioning of financial resources , in addition to technical support, monitoring and evaluation at the national level by the centre </li></ul>
  49. 49. Delivery of national public health programmes( CONT..) <ul><li>Convergence of all health programmes under a single field administration </li></ul><ul><li>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. </li></ul><ul><li>It suggests for a scientific designing of public health projects suited to the local situation. </li></ul><ul><li>Executive should design programme such that it gives enough flexibility to permit State Public Health Administration to craft action as per their needs. </li></ul>
  50. 50. Delivery of national public health programmes( CONT..) <ul><li>Retraining & re orientation of health staff. </li></ul><ul><li>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. </li></ul>
  51. 51. 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
  52. 52. CUMULATIVE IMPACTS OF PROGRAMMES -DATA ON SELECTED INDICATORS AT NATIONAL LEVEL FOR RECENT YEARS ( demographic ) <ul><li>Population and vital statistics </li></ul><ul><li>Total population(inthousands): 1210million </li></ul><ul><li>Population density (persons per sq km): 382 per sq. km </li></ul><ul><li>Sex ratio (females per 1000 males) 940 females per 1000 males </li></ul><ul><li>Population under 15 years estimated 31 (%) in 2011 </li></ul><ul><li>Population 60 years and above estimated 8 (%) in 2011 </li></ul><ul><li>Crude birth rate (per 1000 population) 22.8 in 2008 </li></ul><ul><li>Crude death rate (per 1000 population) 7.4 in 2008 </li></ul><ul><li>Natural (population) growth rate (%) 1.54 in 2008 and 1.64 during 2001-11 </li></ul><ul><li>Total fertility rate (per woman) estimate 2.7 in 2005-06 </li></ul><ul><li>Source: Census 2011 </li></ul>
  53. 53. Health Inputs –Facilities and Personnel <ul><li>Facilities </li></ul><ul><li>Number of hospital beds : 683545 in 2006 </li></ul><ul><li>Hospital beds per 10,000 population 9 in 2006 </li></ul><ul><li>Number of health centres: Sub Centre 137371 in 2001 </li></ul><ul><li>Primary Health Centres 22842 in 2001 </li></ul><ul><li>Community Health Centres 3043 in 2001 </li></ul>
  54. 54. Health Inputs –Facilities and Personnel (cont..) <ul><li>Community Health Centres 3043 in 2001 </li></ul><ul><li>Human resources </li></ul><ul><li>Physicians per 10,000 population 7 in 2005 </li></ul><ul><li>Nurses per 10,000 population: </li></ul><ul><li>Professional nurses 7.85 in 2004 </li></ul><ul><li>Budgetary resources </li></ul><ul><li>Total Expenditure on Health (THE) as % of GDP 4.8 in 2003 </li></ul><ul><li>Public Expenditure on Health (PHE) as % of Total Expenditure on Health (THE) ---25 in 2003 </li></ul><ul><li>Private Expenditure on Health (PvtHE) as % of Total Expenditure on Health (THE) was 75 in 2003. </li></ul>
  55. 55. Health Inputs –Facilities and Personnel (cont..) <ul><li>Health Outcomes </li></ul><ul><li>Only 51% of Pregnant women received at least three antenatal checkups during pregnancy in 2005-06 </li></ul><ul><li>Only 48 % of deliveries were attended by trained personnel in 2005-06 </li></ul><ul><li>Contraceptive prevalence rate was 56.3 % in 2005-06 </li></ul><ul><li>Only 44% of Infants reach first birthday fully immunized against diphtheria, tetanus, and whooping cough in 2005-06 </li></ul><ul><li>70% of Infants reach their first birthday fully immunized against poliomyelitis in 2005-06 </li></ul>
  56. 56. Health Inputs –Facilities and Personnel (cont..) <ul><li>56% of infants reach their first birthday fully immunized against measles in 2005 </li></ul><ul><li>73% of Infants reach their first birthday fully immunized against tuberculosis in 2005 </li></ul><ul><li>71% of Women have been immunized with tetanus toxoid (TT) during pregnancy in 2005 </li></ul><ul><li>85% of Population had access to improved water source in 2001 </li></ul><ul><li>Only 52% of Population had access to improved sanitation in 2001. </li></ul>
  57. 57. AIDS control <ul><li>As per latest data made available by National AIDS Control Organization, the </li></ul><ul><li>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. </li></ul>
  58. 58. Leprosy and TB <ul><li>Leprosy Prevalence Rate has been further reduced to 0.71/10,000 in March 2010. </li></ul><ul><li>• 32 State/UTs have achieved elimination by March 2010, leaving only Bihar, Chhattisgarh and Dadra & Nagar Haveli. </li></ul><ul><li>• Similar progress of elimination has also been in 81% of districts and 77% of Block PHC in the country. </li></ul><ul><li>• 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. </li></ul><ul><li>• 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. </li></ul>
  59. 59. Maternal Mortality Rates <ul><li>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 . </li></ul><ul><li>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. </li></ul>
  60. 60. Maternal Mortality Rates (cont..) <ul><li>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. </li></ul>
  61. 61. 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
  62. 62. State of Public Health Infrastructure <ul><li>Facilities available are estimated …. </li></ul><ul><li><20% persons have OPD facilities. </li></ul><ul><li><45% persons indoor facilities. </li></ul><ul><li>Due to- </li></ul><ul><li>poor funding. </li></ul><ul><li>Presence of less no. medical & paramedical </li></ul><ul><li>personnel. </li></ul><ul><li>Inadequate equipment. </li></ul><ul><li>overcrowding. </li></ul>
  63. 63. Recommendations <ul><li>Decentralized PUBLIC HEALTH SYSTEM will ensure more effective supervision of public health services. </li></ul><ul><li>Need for more frequent in-service training ,of public health & medical personnel, at the level of MO& paramedical is required. </li></ul><ul><li>% of health expenditure should be at least 5.2% GDP. Public expenditure on health should be at least 17.3% of total health expenditure. </li></ul>
  64. 64. Extending public health services <ul><li>Shortage of medical personnels in less developed & rural areas. </li></ul><ul><li>No incentives given to persons trained in alternate medicine. </li></ul>
  65. 65. Extending public health services (cont..) <ul><li>These persons can be used for implementing Central & State Govt. health programmes as per suggested in 2002 NHP report. </li></ul><ul><li>Recommends 2 year mandatory rural health posting before granting MBBS degree. </li></ul>
  66. 66. Extending public health services (cont..) <ul><li>Expanding the pool of General Practitioners to include a cadres of licentiates including Indian systems of Medicine and Homoeopathy is recommended in the policy. </li></ul><ul><li>In order to provide trained manpower in under served areas it recommends contract employment. </li></ul>
  67. 67. Role of local self governed institutes <ul><li>NHP 2002 emphasizes implementation of health programmes through local self government institutions by 2005 with financial incentives. </li></ul>
  68. 68. Role of local self governed institutes (cont..) <ul><li>Nirmal Gram Pariyojna. </li></ul><ul><li>A &quot;Nirmal Gram&quot; is an &quot;Open Defecation Free&quot; 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 </li></ul>
  69. 69. Role of local self governed institutes (cont..) <ul><li>By devolving health programme & funds in different level of Panchayati Raj & other local governing bodies has enabled – </li></ul><ul><li>Need based allocation of resources, </li></ul><ul><li>Supervision by elected representatives of population in rural ,urban & rest of India. </li></ul><ul><li>Ex –Nirmal Gram Pariyojna. </li></ul>
  70. 70. Norms for health care personnel <ul><li>Indian Medical Council Act and Indian Nursing Council Act provide minimal statutory norms for doctors and nurses in medical institutions. </li></ul><ul><li>NHP 2002 suggests for review and making stringent statutory norms for meeting better normative standards. </li></ul>
  71. 71. Suggested norms for health personnel <ul><li>Category of personnel Norms suggested </li></ul><ul><li>1 . Doctors 1 per 3,500 population </li></ul><ul><li>2. Nurses 1 per 5,000 population </li></ul><ul><li>3. Health worker female and </li></ul><ul><li>male 1 per 5,000 population in plain area and 3000 population in tribal and hilly areas. </li></ul><ul><li>4. Trained dai 1per village </li></ul><ul><li>5. Health assistant (male and </li></ul><ul><li>female 1 per 30,000 population in plain area and 20000 population in tribal and hilly areas. </li></ul><ul><li>6. Health assistant (male </li></ul><ul><li>and female) provides supportive super ­ vision to 6 health workers (male /female). </li></ul><ul><li>7. Pharmacists </li></ul><ul><li> 1 per 10,000 population </li></ul><ul><li>8. Lab. technicians 1 per 10,000 population </li></ul>
  72. 72. Education of Health care professionals <ul><li>NHP 2002 recommends setting up of a Medical Grant Commission for funding new government medical/dental colleges. </li></ul><ul><li>It suggests for a need based, skill oriented syllabus with a more significant component of practical training. </li></ul>
  73. 73. Education of health care professionals….. <ul><ul><ul><ul><ul><li>The need for inclusion of contemporary medical research and geriatric concern and creation of additional PG seats in deficient specialties are specified </li></ul></ul></ul></ul></ul>
  74. 74. Education of health care professionals….. <ul><li>Uneven geographical distribution of Medical Colleges. </li></ul><ul><li>Theoretical subjects. </li></ul><ul><li>Substandard quality of education </li></ul><ul><li>Reluctance to rural service. </li></ul><ul><li>Less exposure to community- health related activities. </li></ul><ul><li>Absence of skill & day to day practice, oriented practical training. </li></ul><ul><li>Scarce availability of anesthesiologist, radiologists,FM experts. </li></ul><ul><li>Nursing personnel- Low doctor : nurse ratio. Acute shortage of super specialties trained nurses. </li></ul>
  75. 75. Recommendations <ul><li>Advocates setting of a Medical Grants Commission to fund new medical & dental colleges & to upgrade infrastructure. </li></ul><ul><li>Ensure need based & skill oriented syllabus after graduation. </li></ul><ul><li>Periodic skill updating by continuos medical education. </li></ul><ul><li>Introduction of new concepts of Geriatics , Genetics, Molecular Biology, FM, radio diagnosis, anesthesia should be highlighted. </li></ul><ul><li>Prime Minister of India has launched PHFI i.e.. Public Health Foundation Of India. To give world class health facilities & training to medical personnels. </li></ul>
  76. 76. Need for specialists in 'public health' and 'family medicine‘…….. <ul><li>In developing countries demand for trained personnel in Public Health & Family Medicine is more than other disciplines. </li></ul><ul><li>Current UG&PG, syllabus is inappropriate to today’s need. More talented medical UG’s take up clinical disciplines,rest take up GP. </li></ul><ul><li>Also availability of PG’ seats is 50% of qualified UG’s. </li></ul>
  77. 77. 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 .
  78. 78. Need for specialists in 'public health' and 'family medicine' <ul><li>For discharging public health responsibilities in the country NHP 2002 recommends specialization in the disciplines of Public Health and Family Medicine </li></ul><ul><li>• where medical doctors, public health engineers, microbiologists and other natural science specialists can take up the course </li></ul>
  79. 79. RECOMMENDATIONS <ul><li>Recommends to increase seats of Pubic Health & Family Medicine up to 1/4th for all available subjects. </li></ul><ul><li>Not only medical graduates but also student from other </li></ul><ul><li>disciplines. Ex-health engineering ,microbiologists, natural </li></ul><ul><li>scientists, must be trained in Public Health. </li></ul><ul><li>Greater exposure to field work in Public Health. Establishing rural Medical Colleges. </li></ul>
  80. 80. Regulation of Standards of Paramedical Disciplines- <ul><li>New paramedical institute have mushroomed particularly in pvt. Sector </li></ul><ul><li>-Ex-lab technicians ,radio diagnostics, physios. etc Policy recommends- Standardization ,Regulation, Registration & Inspection & Monitoring of such institutes. </li></ul>
  81. 81. Regulation of standards in paramedical disciplines…. <ul><li>More and more training institutions have come up recently under paramedical board which do not have regulation or monitoring. </li></ul><ul><li>Hence, establishment of Statutory Professional Council for paramedical discipline is recommended </li></ul>
  82. 82. Use of generic drugs and vaccines <ul><li>Low cost Health care system of India is largely due to indigenous manufacture of drugs & vaccines. </li></ul><ul><li>With Globalization there is likely increase in costs of drug. </li></ul><ul><li>Hence the measures should be taken to keep costs affordable to ensure health security of country . </li></ul>
  83. 83. Use of generic drugs and vaccines…. <ul><li>NHP 2002 recommends limited number of essential drugs of generic nature as a requisite for cost effective public health care. </li></ul><ul><li>To ensure long term national health security 2002 NHP envisages that not less than 50% of the requirement of vaccine/sera be sourced from public sector institutions </li></ul>
  84. 84. 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
  85. 85. Impact of Globalization on Health Sector <ul><li>With the adoption of Trade Related Intellectual Property Rights (TRIPS) government is taking steps to overcome possible adverse impact of economic globalisation on the health sector. </li></ul><ul><li>• NHP 2002 envisages a national patent regime for the future. </li></ul>
  86. 86. Impact of Globalization on Health Sector…… <ul><li>&quot; INNOVATIONS AND GROWTH ARE THE KEYS TO SUCCESS IN A GLOBALAZED WORLD&quot; </li></ul><ul><li>NHP 2002 brings out the relevance of intersectorial contribution to health but limits itself to making recommendations. </li></ul><ul><li>• NHP 2002 touches population growth and health standards </li></ul>
  87. 87. Impact of globalisation … <ul><li>NHP 2002 has suggested synchronized implementation of National population policy and national health policy in improving health standard of the country. </li></ul><ul><li>• NHP 2002 focuses on building up credibility for the alternative systems of medicine through evidence based research and suggested a separate document. </li></ul>
  88. 88. Impact of globalisation … <ul><li>Measures </li></ul><ul><li>Emphasis should be laid on use of ESSENTIAL DRUGS in both pvt. & public sector. </li></ul><ul><li>Production & sales of irrational drugs should be curbed. </li></ul><ul><li>No less than 50% vaccines & sera should be provided by public sector. </li></ul><ul><li>Standardization </li></ul><ul><li>Enforcement of quality standards- NHP paid heed to maintain reasonable, quality & standards for food & drugs. </li></ul>
  89. 89. Urban health <ul><li>Migration has resulted in urban growth which is likely to go up to 33%. </li></ul><ul><li>• It anticipates rising vehicle density which lead to serious accidents. </li></ul><ul><li>• In this direction, 2002 NHP has recommended an urban primary health care structure as under; </li></ul>
  90. 90. Urban health…. <ul><li>First Tier:- </li></ul><ul><li>• Primary centre cover 1 Lakh population </li></ul><ul><li>– It functions as OPD facilities. </li></ul><ul><li>– It provides essential drugs. </li></ul><ul><li>– It will carry out national health programmes. </li></ul>
  91. 91. Urban health…. <ul><li>Second Tier:- </li></ul><ul><li>• General Hospital a referral to primary centre provides the care. </li></ul><ul><li>• The policy recommends a fully equipped hub-spoke trauma care network to reduce accident </li></ul>
  92. 92. Urban health…. <ul><li>Meagerly available.With no uniformity in organizational structure. </li></ul><ul><li>Urban population is 30% and is likely to increase to 33% by 2010 due to migration. </li></ul><ul><li>This will lead to development of slums, with poor percolation of public health facilities. </li></ul>
  93. 93. Mental health <ul><li>• Decentralised mental health service for diagnosis and treatment by general duty medical staff is recommended. </li></ul><ul><li>• It also recommends securing the human rights of mentally sick </li></ul>
  94. 94. Mental health…. <ul><li>Mental health problems are more prevalent than actually noted. Not mortal but seriously affect lives of patients, families. </li></ul><ul><li>Commonly thought to be associated with “SPIRITUAL AFFLICTION’’. </li></ul><ul><li>Hence promoting unlicensed mental institutions & religious institution as a site of faith cure. </li></ul><ul><li>Serious conditions require hospitalization & T/T under trained supervision. </li></ul>
  95. 95. Information Education and Communication <ul><li>NHP 2002 has suggested interpersonal communication by folk and traditional media to bring about behavioral change. </li></ul><ul><li>Information dissemination is central to providing Health Care. Task of education is difficult as 35% of country ‘s population is illiterate. </li></ul>
  96. 96. Information Education and Communication….. <ul><li>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 </li></ul><ul><li>Associations of PRIs/NGOs/Trusts are given specific targets. </li></ul>
  97. 97. Information Education and Communication….. <ul><li>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 </li></ul><ul><li>The present IEC is too fragmented-relies on mass- media. </li></ul><ul><li>But those not benefited by them need addressal, by folk media ,interpersonal relations,NGO’s/Trusts. </li></ul><ul><li>Hence schools & colleges are considered as prime targets to intervene for IEC & help in promoting sound health behavior. Ex –Dental Checkups. </li></ul><ul><li>IEC will address itself & eliminate risk of inappropriate Treatment </li></ul>
  98. 98. Role of Civil Society &quot;Government is just one part of governance-civil society is the other part“ <ul><li>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. </li></ul><ul><li>Certain NHP ‘S require continuous supervision, lab diagnosis, regular follow up. etc. </li></ul><ul><li>Ex. RNTCP for T/T of TB. These can easily be taken up by voluntary workers </li></ul>
  99. 99. Role of Civil Society…. <ul><li>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 </li></ul>
  100. 100. 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
  101. 101. Health Research & Development…. <ul><li>Limited Health Research in India.In govt. sector R&D is largely confined to ICMR. </li></ul><ul><li>R&D should be focused on therapeutic drugs & vaccines for tropical disease.That are largely neglected by pharma companies due to limited profitability. </li></ul><ul><li>Research esp. on genetics, genome based drugs, vaccines development, molecular biology is needed. </li></ul><ul><li>E nsure greater participation of Medical Colleges & similar institutes for R&D. </li></ul><ul><li>Govt. aid for R &D should be increased to 1% of total health by 2005 & upto 2% by 2010 . </li></ul>
  102. 102. Role of private sector <ul><li>Contributes significantly to secondary & tertiary care. Widespread perception that it is uneven in quality, frequently substandard. </li></ul><ul><li>Pvt. Health care are financially exploitive with poor observation of medical ethics. </li></ul><ul><li>With increase in their role-implementation of STATUORY regulation & maintaining minimal STANDARD S in diagnostic medical institution is required. </li></ul><ul><li>Introduction of Telemedicine & social insurance schemes. </li></ul>
  103. 103. Role of private sector… <ul><li>The policy welcomes the participation of the private sector in all areas of health activities primary, secondary and tertiary health care services; </li></ul><ul><li>• but recommended regulatory and accreditation of private sector for the conduct of clinical practice. </li></ul>
  104. 104. Role of private sector… <ul><li>It has suggested a social health insurance scheme for health service to the needy. </li></ul><ul><li>• It urges standard protocols in day-to-day practice by health professionals. </li></ul><ul><li>• It recommends tele-medicine in tertiary care services. </li></ul>
  105. 105. National disease surveillance <ul><li>NHP 2002 noted that absence of an efficient disease surveillance network is a major handicap for cost effective health care. </li></ul><ul><li>• It wants a network from lowest rung to central government by 2005 by installation of data base handling hardware, IT interconnectivity, in-house training for data collection and interpretation. </li></ul>
  106. 106. National disease surveillance… <ul><li>Surveillance system of India is very rudimentary .Poor flow of information about Facilities at State & Central level. Hampering effective health care system & planning. </li></ul><ul><li>It is recommended to collect baseline incidences of common diseases Ex., Malaria etc.& long term incidences for non communicable diseases. Ex-CVA, CHD, DM. To ensure future policy making. </li></ul><ul><li>S uccess story of Polio & HIV control is largely due to efficient surveillance system. </li></ul><ul><li>Hence there is need to have an effective, integrated disease “ Surveillance Network ”. </li></ul>
  107. 107. Health statistics <ul><li>NHP 2002 has recommended full baseline estimate of tuberculosis, malaria and blindness by 2005, and </li></ul><ul><li>• In the long run for cardiovascular diseases, cancer, diabetes, accidents, hepatitis and G.E. </li></ul><ul><li>• It has suggested a national health accounts conforming to the source to users matrix </li></ul>
  108. 108. Health statistics… <ul><li>Current scenario has absence of a systematic, proper, meaningful & scientific health statistics data base collection methodology. </li></ul><ul><li>NHP-2002 focuses on programme to put up a modern & SCIENTIFIC HEALTH DATABASE & a system of NATIONAL HEALTH ACCOUNTS </li></ul>
  109. 109. Women's health <ul><li>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 </li></ul>
  110. 110. Women's health….. <ul><li>Receive inadequate public health facilities, due to some </li></ul><ul><li>socio-cultural-economic factors. </li></ul><ul><li>NHP-2002 recognizes role of empowered women in </li></ul><ul><li>Improving over all health standard of community. </li></ul><ul><li>Ex-ASHA is used under NRHM. </li></ul>
  111. 111. Medical Ethics <ul><li>In India we have guidelines on professional medical ethics since 1960. </li></ul><ul><li>• This is revised in 2001. </li></ul><ul><li>• Government of India has emphasised the importance of moral and religious dilemma </li></ul>
  112. 112. Medical Ethics…. <ul><li>Professional medical practice is now perceived to be commercial & had lost its position of form of a social service, bringing basic health service to fellow humans. </li></ul><ul><li>In 1960,ICMR carried out a research on MEDICAL ETHICS & gave guidelines that were updated in 2001. </li></ul><ul><li>Medical ethics need a new vision esp. in area of sanctity of human life & moral dilemma of new human life forms that can cause irreversible environmental change. Ex-Human Cloning. </li></ul>
  113. 113. Medical Ethics…. <ul><li>NHP 2002 has recommended notifying a contemporary code of ethics, which is to be rigorously implemented by Medical Council of India. </li></ul><ul><li>• The Policy has specified the need for a vigilant watch on gene manipulation and stem cell research. </li></ul>
  114. 114. Environmental ,Occupational & Educational Health <ul><li>Government has noted the ambient environment condition like unsafe drinking water, unhygienic sanitation and air pollution. </li></ul><ul><li>• Child labor and substandard working conditions are causing occupational linked ailments </li></ul><ul><li>NHP 2002 has suggested for an independent state policy and programme for environment apart from periodic health screening for high risk associated occupation. </li></ul>
  115. 115. Environmental ,Occupational & Educational Health…. <ul><li>Unsafe drinking water, unhygienic sanitation, air pollution contributes to urban population & exposes health risks to dwellers. </li></ul><ul><li>Work conditions are substandard risking individual to occupation linked ailments leading to chronic morbidity ,particularly for child labour. </li></ul><ul><li>Ex –Coal Worker Pneumoconiosis,TB,Malignancy. </li></ul><ul><li>NHP directs employers to take their own initiatives to control these factors in pvt.or public sectors. Ex –by regular screening of workers particularly high risk groups. </li></ul>
  116. 116. Providing medical facilities to overseas beneficiaries <ul><li>NHP 2002 encourages such facility on a payment basis to service seekers from overseas. </li></ul><ul><li>• This also shall include fiscal incentive and DEEMED EXPORTS license to service givers </li></ul>
  117. 117. Providing medical facilities to overseas beneficiaries <ul><li>Good quality & cost effective secondary & tertiary level of medical facilities & drugs are available, not only in allopathy but also in alternate medicine.Ex- Concept of Medical Tourism. </li></ul><ul><li>Indian pharma. companies are manufacturing innovative, indigenous drugs & vaccines as per present patent laws. </li></ul><ul><li>NHP had also set up guidelines to ensure availability of drugs vaccines, & T/T, cost effectively in this era of Globalization. </li></ul>
  118. 118. ALTERENATE SYSTEM OF MEDICINE <ul><li>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. </li></ul><ul><li>Ex. Use of plant based drugs in allopathy ie. satavarex is used in promoting lactation. </li></ul><ul><li>Population Growth & Health Standards </li></ul><ul><li>Efforts are made to improvise Health standards to match rapidly growing population. </li></ul><ul><li>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. </li></ul>
  119. 119. Summation <ul><li>Crafting of a National Health Policy is a rare occasion. </li></ul><ul><li>allow our dreams to mingle with ground realities. </li></ul><ul><li>needs are enormous and the resources are limited </li></ul><ul><li>health needs are also dynamic and keep changing over time. </li></ul><ul><li>had to make hard choices between various priorities </li></ul>
  120. 120. Summation… <ul><li>needs are enormous and the resources are limited </li></ul><ul><li>health needs are also dynamic and keep changing over time. </li></ul><ul><li>had to make hard choices between various priorities </li></ul>
  121. 121. Summation….. <ul><li>NHP 2002 has given a continuum to NHP 1983, where primary health care is adopted as the main strategy through </li></ul><ul><li>– Decentralization </li></ul><ul><li>– Equity </li></ul><ul><li>– Private sector/indigenous system participation </li></ul><ul><li>– Rise in public investment </li></ul>
  122. 122. Summation….. <ul><li>The ultimate goal is achieving an acceptable standard of good health of people of India. </li></ul><ul><li>The commitment of the service providers and an improved standard of governance is a prerequisite for the success of any health policy. </li></ul>
  123. 123. L OO P HOLES <ul><li>Not much attention is paid to child, adolescent, Geriatrics health, gender, domestic violence. </li></ul><ul><li>Ignored areas- Resource generation & allocation, management of work force, substance abuse management ,control of medical ads. </li></ul><ul><li>Methodology of strengthening healthcare & functioning of health workers is not specified. Hence creating “ Half Baked Paramedical Doctors ”. Promoting QUACKERY. </li></ul><ul><li>Literacy & its investment is not specified. </li></ul><ul><li>As per WHO 5% of GDP should be spent on health but till now no more than 0.9% to2% is spent on health. </li></ul><ul><li>Problem of population is not answered properly. </li></ul><ul><li>School education has not yielded desired results. </li></ul>
  124. 124. conclusion miles to go before……..
  125. 125. Bibliography <ul><li>Books </li></ul><ul><li>1)Park.K (2011) Park's TEXTBOOKOF PREVENTIVE AND SOCIALMEDICIN 21 st edition,M/s BANARSIDAS BHANOT Publishers, Jabalpur Pg.No521 </li></ul><ul><li>2)Swarankar Keshav(2010), Community Health Nursing ,(includes behavioural sciences and personal hygiene second edition, N.R.Brothers,Indore Pg.532 </li></ul><ul><li>3) . Dhar.G.M,Robbani.(2009) Fundamentals of Community medicine.2nd edition. Elsevier publishers., Newdelhi. Pg.No 919 </li></ul><ul><li>4) Gulani K.K,(2008) community Health nursing principles and practices, Kumar publishing house , PP 181-220 </li></ul><ul><li>5)Basavanthappa B.T(2005) Community Health Nursing, second edition Jaipee Brothers, Newdelhi. Pg.No 710 </li></ul><ul><li>6)Lucita Mary(2008) Nursing: Practice and public health Administration Current functions and trends second edition , Elsevier publishers., Newdelhi. Pg.No 171 </li></ul>
  126. 126. Bibliography…. <ul><li>JOURNALS </li></ul><ul><li>Government perspective of NHP, Annual report by Ministry of Health and family welfare 2004-2005 ,NNT, vol 2 Jan 2006 </li></ul><ul><li>Human Resources for Health, Overcoming the crisis - Joint Learning Initiative (JLI), WHO2006-2015 </li></ul><ul><li>Sample Registration System Statistical Report 2008 Office of the Registrar General, India, </li></ul><ul><li>Ministry of Home Affairs. </li></ul><ul><li>Net Referrance </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li>www. </li></ul>
  127. 127. This is just a beginning………………
  128. 128. THANKS . HAVE A NICE DAY .