National health policy


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National health policy

  1. 1. <ul><li>National Health Policy and HMIS </li></ul><ul><li>Dr.Kishore Murthy </li></ul><ul><li>Director </li></ul><ul><li>Institute for Health Management Research Bangalore </li></ul>
  2. 2. Health Policies and HMIS <ul><ul><li>A Comprehensive, Integrated HMIS, spanning all levels of a health service is a KEY component of a modern health system, integrated to the effective and efficient management of coordination of resources. </li></ul></ul><ul><ul><li>Common thread is for quality information to drive and support processes in the management of resources . </li></ul></ul>
  3. 3. National Health Policy: India <ul><li>Review – National Health Policy: </li></ul><ul><li>First Evolution: 1983. Revised: 2002. </li></ul><ul><li>Objectives: </li></ul><ul><li>Acceptable Standard of Good Health in India. </li></ul><ul><li>Increase Access to Decentralized Public Health System. </li></ul><ul><li>Establishing New Infrastructure in the Existing Institutions. </li></ul><ul><li>More Equitable Access to Health Services across Entire Country. </li></ul><ul><li>Priority - Preventive & First Line Curative initiatives - Primary Health Level. </li></ul><ul><li>Emphasis – Rational Use of Drugs & Target – Burden able Diseases – TB, Malaria, Blindness, HIV/AIDS, MCH - Problems. </li></ul>
  4. 4. <ul><li>Objectives of NHP </li></ul><ul><li>To achieve an acceptable standard of good health amongst the general population of the country; </li></ul><ul><li>To increase access to the decentralized public health system by establishing new infrastructure in deficient areas, and by upgrading the infrastructure in the existing institutions. </li></ul>
  5. 5. <ul><li>To ensuring a more equitable access to health services across the social and geographical expanse of the country </li></ul><ul><li>To increase the aggregate public health investment through a substantially increased contribution by the Central Government </li></ul><ul><li>To strengthen the capacity of the public health administration at the State level to render effective service delivery </li></ul>
  6. 6. <ul><li>To enhance the contribution of the private sector in providing health services for the population group which can afford to pay for services </li></ul><ul><li>To rationalize use of drugs within the allopathic system; and </li></ul><ul><li>To increase access to tried and tested systems of traditional medicine </li></ul>
  7. 7. History of NHP <ul><li>Bhore committee 1943 </li></ul><ul><li>Necessity of sound information system as a support to various development activities </li></ul><ul><li>NHP 1983 </li></ul><ul><li>Appropriate decision making and program planning is not possible without establishing a sound HMIS and nationwide organizational set up is a must to procure essential health information to support local management of healthcare and effective decentralization of the activities </li></ul>
  8. 8. <ul><li>Health Policies / NHP </li></ul><ul><li>Old wine in new bottle </li></ul><ul><li>Bottom up policy planning not there </li></ul><ul><li>Ground realities not taken into account </li></ul><ul><li>Importance of HMIS is known </li></ul><ul><li>New programmes are created </li></ul>
  9. 9. <ul><li>Health Policies </li></ul><ul><li>Policy makers and implementation managers never sit together to design one programme. </li></ul><ul><li>In-coordination, Top down policy </li></ul><ul><li>Lack of leadership, team spirit, lack of dedication, speed money etc. are some reasons for non-implementation </li></ul><ul><li>NHP 1983 – Ambitious & Holistic goal was set to achieve HFA / 2000 AD through universal provision of comprehensive preliminary health care services, unable to achieve goals. </li></ul>
  10. 10. Data Agencies <ul><li>Central Bureau of Health intelligence </li></ul><ul><li>Statistics division of H & FW department </li></ul><ul><li>Sample Registration Scheme </li></ul><ul><li>Civil Registration Scheme </li></ul><ul><li>State level </li></ul><ul><li>HMIS version 1.0 1983 – 85 </li></ul><ul><li>HMIS version 2.0 1996 </li></ul>
  11. 11. National Policies related to health <ul><li>National Health Policy 2002 </li></ul><ul><li>National Population Policy 2000 </li></ul><ul><li>National AIDS Prevention and Control Policy 2002 </li></ul><ul><li>National Blood Policy 2002 </li></ul><ul><li>National Policy for the Empowerment of Women (2001) </li></ul>
  12. 12. <ul><li>National Policy and Charter for Children 2003 </li></ul><ul><li>National Youth Policy 2003 </li></ul><ul><li>National Policy for Old Person 1999 </li></ul><ul><li>National Nutrition Policy 1993 </li></ul><ul><li>National Health Research Policy Draft </li></ul>
  13. 13. <ul><li>National Policy on Education </li></ul><ul><li>National Pharmaceutical Policy </li></ul><ul><li>National Water Policy </li></ul><ul><li>National Environment Policy 2006 </li></ul><ul><li>National Housing and Habitat Policy 1998 </li></ul>
  14. 14. National Health Policy: India <ul><li>Goals: </li></ul><ul><li>Eradicate Polio & Yaws – 2005. </li></ul><ul><li>Eliminate Leprosy – 2005. </li></ul><ul><li>Eliminate Kala –azar – 2010. </li></ul><ul><li>Eliminate Lymphatic Filariasis – 2015. </li></ul><ul><li>Achieve zero level growth – HIV/AIDS – 2007. </li></ul><ul><li>Reduce Mortality by 50 % - TB, Malaria & other – Vector – borne, Water borne Diseases – 2012. </li></ul><ul><li>Reduce Prevalence of Blindness – 0.5% - 2010. </li></ul><ul><li>Reduce IMR to 30/1000 & MMR to 1/1000 Live Births – 2010. </li></ul><ul><li>Increase Utilization of Public Health Facilities from current level of < 20% to > 75% - 2010. </li></ul><ul><li>Establish an Integrated System of Surveillance, National Health Accounts & Health Statistics – 2005. </li></ul><ul><li>Increase Health Expenditure by Government as a % of GDP from the existing 0.9% to 2.0% - 2010. </li></ul><ul><li>Increase Share of Central Grants to Constitute at least 25% of Total Health Spending & Further Increase to 8% of the budget – 2010. </li></ul><ul><li>Increase State Sector Health Spending from 5.5% to 7 % of the budget – 2005. </li></ul>
  15. 15. Goals to be Achieved by 2000-2015 <ul><li>Enactment of legislation for regulating </li></ul><ul><li>minimum standard in Clinical Establishment and </li></ul><ul><li>Medical Institutions </li></ul><ul><li>Eradicate Poliomyelitis and Yaws </li></ul><ul><li>Eliminate Leprosy </li></ul><ul><li>Establish an integrated system for surveillance, </li></ul><ul><li>National Health Accounts and Health Statistics </li></ul>
  16. 16. <ul><li>2005 </li></ul><ul><li>Increase State Sector Health spending from 5.5% to </li></ul><ul><li>7% of the budget </li></ul><ul><li>1% of the total health budget for Medical Research </li></ul><ul><li>Decentralization of implementation of public health </li></ul><ul><li>programs </li></ul><ul><li>Achieve Zero level growth of HIV/AIDs </li></ul><ul><li>Eliminate Kala Azar </li></ul>
  17. 17. <ul><li>2010 </li></ul><ul><li>Eliminate Kala Azar </li></ul><ul><li>Reduce Mortality by 50% on account of TB, Malaria </li></ul><ul><li>and other Vector and Water Borne diseases </li></ul><ul><li>Reduce Prevalence of Blindness to 0.5% </li></ul><ul><li>Reduce IMR to 30/1000 and MMR to 100/Lakh </li></ul><ul><li>Increase utilization of public health facilities from </li></ul><ul><li>current level of <20 to >75% </li></ul>
  18. 18. <ul><li>2010 </li></ul><ul><li>Increase health expenditure by Government </li></ul><ul><li>from the existing 0.9% to 2.0% of GDP </li></ul><ul><li>2% of the total health budget for Medical </li></ul><ul><li>Research </li></ul><ul><li>Increase share of Central grants to constitute </li></ul><ul><li>at least 25% of total health spending </li></ul><ul><li>Further increase of State Sector health </li></ul><ul><li>spending to 8% </li></ul><ul><li>2015 </li></ul><ul><li>Eliminate Lymphatic Filariasis </li></ul>
  19. 19. NHP : Implementation – Gaps: <ul><li>Process of Health Information System. </li></ul><ul><li>Health Data –Input, </li></ul><ul><li>Recording, </li></ul><ul><li>Storing, </li></ul><ul><li>Retrieving, </li></ul><ul><li>Processing, </li></ul><ul><li>Out – put, </li></ul><ul><li>Decision – Making </li></ul><ul><li>Administrative Systems. </li></ul><ul><li>Routine Service Reporting. </li></ul><ul><li>Vital Registration </li></ul><ul><li>Epidemiological Surveillance. </li></ul><ul><li>Specific Program Reporting. </li></ul>
  20. 20. SWOT Analysis <ul><li>Strength </li></ul><ul><li>Policy identify many gross deficiencies of the existing healthcare scenario, proposes a substantial changes. Justification provided for the new policy are convincing and attempt to accelerate achievement for the set public health goals </li></ul>
  21. 21. <ul><li>Commitment to enhance the budget on health expenditure from 5.2% to 6% of GDP with the government contribution increasing from 0.9% to 2% by 2010/ </li></ul><ul><li>Availability of advance technology and proven public health strategies. </li></ul>
  22. 22. Weakness <ul><li>Lack of monitoring and evaluation </li></ul><ul><li>Lack of Government expenditure on public health </li></ul><ul><li>Gap in situation analysis and policy prescription </li></ul>
  23. 23. Opportunity <ul><li>Based on past experience of National Health Policy 1983 and long history of implementation of various programs, India get this opportunity to move ahead in health through Health Policy 2002 </li></ul><ul><li>Supportive environment and absence of obvious threat of war, unrest etc. </li></ul><ul><li>Policy initiative will provide a new impetus to the ‘development of the health sector’. </li></ul>
  24. 24. Threats <ul><li>Health tourism will drain the trained manpower to private sector and will encourage privatization in absence of regulation on private sector for encouragement could be dangerous for the public health. However, policy proposes regulation of the private sector but how and when is not described in detail. Private expenditure is already more in India as compare to other countries in the world. </li></ul>
  25. 25. <ul><li>Occurrence of unexpected natural calamities and catastrophes </li></ul><ul><li>Negative involvement of religious fundamentalists, for example polio sterility myth impending pulse polio program </li></ul><ul><li>Creation of a cadre of ‘half backed paramedical doctors’ is strengthening quackery </li></ul><ul><li>Financial autonomy of district societies may lead to corruption and need to be put under strict outer regulation and accountability </li></ul>
  26. 26. <ul><li>Issues </li></ul><ul><li>Too many registers </li></ul><ul><li>Too much repeat data collected </li></ul><ul><li>Data missing / sorting not done </li></ul><ul><li>Distance factor for collection of data </li></ul><ul><li>Grass root health workers ANM is the main person – too many registers for her </li></ul>
  27. 27. <ul><ul><li>Staff involved to be aware of need for appropriate and timely information to understand how to use it effectively. </li></ul></ul><ul><ul><li>Health workers are required to maintain large number of registers </li></ul></ul><ul><ul><li>Data generated rarely used as basis for management decisions. </li></ul></ul>
  28. 28. <ul><li>Meetings </li></ul><ul><li>PHC monthly meetings – routine </li></ul><ul><li>Data generated by health workers not disseminated / discussed or used in decision making / policy </li></ul><ul><li>Data transferred to THO – DHO – NIC – State HQ - GOI </li></ul>
  29. 29. <ul><li>New Outcomes / Indicators created based on funding by WB/UNICEF/DFID etc. </li></ul><ul><li>IPP-9 Evaluation – Role of ANMs </li></ul><ul><li>Search Surveys / SRS/CRS/ NHFs all conducted but none give detailed comprehensive complete data in given time – on time – delayed reports </li></ul>
  30. 30. <ul><li>Secretariat system of governance </li></ul><ul><li>Planning and Monitoring as central activity </li></ul><ul><li>H and FW administration centralized </li></ul><ul><li>Lack of awareness by policy makers the strategic importance of HMIS </li></ul><ul><li>No of programmes , surveys with no ground realities using the same HFW staff </li></ul>
  31. 31. <ul><li>Multiplicity of institutions collecting data </li></ul><ul><li>Fragmented Data collected </li></ul><ul><li>Some programmes have their own data collection sysytems </li></ul><ul><li>Vertical programmes own HMIS </li></ul><ul><li>Lack of effective coordination resulting in duplication and gaps in data collection </li></ul>
  32. 32. <ul><li>Exhaustive information collected but rarely used </li></ul><ul><li>PHC monthly report </li></ul><ul><li>ANM fills up many forms </li></ul><ul><li>Mostly incomplete , unreliable and unused non collatable data hardly used by planners and at local level for decision making </li></ul><ul><li>No verification of data </li></ul>
  33. 33. <ul><li>Only Aggregates are sent to higher levels </li></ul><ul><li>Details missed by policy makers /planners </li></ul><ul><li>Reliability of data </li></ul><ul><li>Data collected by bilateral agencies and multilateral agencies are different from govt. data : Project assessment and viability becomes difficult </li></ul>
  34. 34. National Health Policy: India <ul><li>National Health Policy: India: Implementation – Gaps: Bridging: </li></ul><ul><li>Technical Inputs – Public Private Partnership </li></ul><ul><li>Process of Health Information System. </li></ul><ul><li>Health Data –Input, </li></ul><ul><li>Recording, </li></ul><ul><li>Storing, </li></ul><ul><li>Retrieving, </li></ul><ul><li>Processing, </li></ul><ul><li>Out – put, </li></ul><ul><li>Decision – Making </li></ul><ul><li>Administrative Systems. </li></ul><ul><li>Routine Service Reporting. </li></ul><ul><li>Vital Registration </li></ul><ul><li>Epidemiological Surveillance. </li></ul><ul><li>Specific Program Reporting. </li></ul>
  35. 35. SWOT Analysis – National Population Policy <ul><li>Strength </li></ul><ul><li>Formulation of National Policy by the Health Ministry involving Planning Commission and Cabinet </li></ul><ul><li>Policy is passed by the parliament </li></ul><ul><li>Well planned and drafted after many deliberations particularly Swaminathan Committee and National health Policy 1983 </li></ul><ul><li>Long experience of National Family Welfare Program </li></ul>
  36. 36. <ul><li>Weakness </li></ul><ul><li>Some of the goals and targets are unrealistic </li></ul><ul><li>Many failures in achieving targets in the past </li></ul><ul><li>Lack of community involvement </li></ul><ul><li>Lack of resources and poor budgeting </li></ul><ul><li>Lack of well planned monitoring and evaluation </li></ul>
  37. 37. <ul><li>Opportunity </li></ul><ul><li>Provision of Research in RCH and Contraceptive that will handle the increasing demand </li></ul><ul><li>Integrated approach involving mother, adolescent, and child in the area of nutrition, health, education, involving other systems of medicine etc. </li></ul><ul><li>Decentralization and more autonomy for better implementation </li></ul>
  38. 38. <ul><li>Provision of legislation act as disincentive for large family size for legislature and councilors. Strict enforcement of Child Marriage Restraint Act and Pre-Natal Diagnostic Act is also provided </li></ul><ul><li>Adequacy of funding assured. </li></ul>
  39. 39. <ul><li>Threat </li></ul><ul><li>Reviving system of licensed medical practitioners may not be supported by Indian Medical Association and other professional bodies </li></ul><ul><li>Flexibility in NGOs functioning may give rise to more corruption and compromise in the achievement of targets </li></ul><ul><li>Cash incentive and heavy dependency on health care providers in government system would compromise the quality and increase financial burden. </li></ul><ul><li>More encouragement to private sector will make the India the most privatized health system in the world </li></ul>
  40. 40. Recommendation <ul><li>Reform health information system </li></ul><ul><li>Transition from reporting system to conscious use of information </li></ul><ul><li>Managerial decision making </li></ul><ul><li>Accuracy of Data </li></ul><ul><li>Facility wise performance </li></ul><ul><li>New computerized HIMS is expected to increase coverage & improve quality of services </li></ul>
  41. 41. <ul><li>The vision of a new HMIS is that it should be simple to operate & valuable to health staff. </li></ul><ul><li>The system is designed in such a way that health workers who collect the information must be able to use it also. The forms & formats developed should not be too many, bulky and complicated so as to avoid the temptation of not filling them. </li></ul>
  42. 42. <ul><li>HMIS to be meaningful must be </li></ul><ul><li>understood </li></ul><ul><li>from ANM to Health Secretary </li></ul><ul><li>and </li></ul><ul><li>Implemented and Utilized for </li></ul><ul><li>delivery of quality health care </li></ul>