2. INTRODUCTION
The ministry of health & family welfare, Government
of India, made National Health Policy in 1983 to attain
the health for all by the year 2002.
The main objective of policy is to achieve an
acceptable standard of good health amongst the
general population of the country.
The policy laid stress on the preventive, promotive,
public health and rehabilitation aspects of care of
health.
3. ELEMENTS OF HEALTH POLICY
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.
4. COMPONENTS OF HEALTH POLICY
1. Reduction of region disparities.
2. Fuller employment.
3. Elementary education.
4. Integrated rural development.
5. Population control.
6. Welfare of women and children.
6. NEED FOR NATIONAL HEALTH
POLICY
1. Population stabilization.
2. Medical and health education.
3. Providing primary health care with special emphasis
on the preventive, promotive and rehabilitative
aspects.
4. Reorientation of the existing health personnel.
5. Practitioners of indigenous and other systems of
medicine and their role in health care.
7.
8. To attain the objectives of health for all by 2000 AD.
the union ministry of health & family welfare National
Health Policy in 1983.
In this policy objectives were fixed for the year…….
1985
1950
2000
9.
10. Ministry of Health & Family Welfare declared new
population policy on 15th Feb, 2000 amending the
policies declared earlier.
New demographic objectives are defined in this policy.
11.
12. National health policy 2002 has been formulated and
accepted by Central Government in September 2002.
It has five imp. Parts..
1. Introduction
2. Current scenario
3. Objectives
4. Nhp-2002 policy prescriptions
5. Summations.
13. 1. Introduction
It emphasizes the importance of the basic philosophy,
adopted by the Government of India towards health
sector that is “India is committed to attain the goal of
‘Health for all, by year 2000 AD’”.
Through the universal population of comprehensive
primary health care services.
14. 2. Current Scenario
This the 2nd part of NHP-2002.
It gives detailed information about present situation
problem and future challenges of the various aspects
of all health sector.
15. 3. Objectives
To establish health care services with in the reach of
population residing in remote areas.
To view health and human developments as vital
components of overall socioeconomic development.
16. Decentralize
To decentralize health care delivery system with
maximum and individual participation.
To strengthen the capacity of the public health
administration at the state level.
18. Financial resources:-
The central Gov. will have to play a key role in
augmenting public health & investment by the year
2010.
Taking into account the gap in health care facilities, it
is planned, under the policy to increase health, sector
expenditure to 6% of GDP, with 2% of GDP being
contributed as public health investment by the year
2010.
19. Equity:-
To meet the objectives of reducing various types
inequalities and imbalances interregional across the
rural urban divide and between economic classes the
most cost effective method would be to increase the
sectoral outlay in the primary health sector.
20. Delivery of National Policy Health
programme:-
it envisages key role for the central gov. in designing
national programmes with the active participation of the
state gov.
To optimize the utilization of the public health
infrastructure at the primary level, NHP-2002 envisages the
gradual convergence of all health programmes under a
single filled administration.
The policy also highlights the need for developing the
capacity within the state public health administration for
scientific designing of public health projects, suited to the
local situation.
It envisages that apart from the exclusive staff in a vertical
structure for the diseases control programmes all rural
health staff should be available for the entire range of
public health activities at the decentralized level,
irrespective of whether these activities are related to
national programmes or other public health initiatives.
21. The state of public infrastructure
This policy recognizes the need for frequent in service
training of public health medical personal, at the level
of medical officers as well as paramedics.
Global experience has shown that the quality of public
health services, as reflected in the attainment of
improved public health indices is closely linked to the
quantum and quality of investment through public
funding in the primary health sector.
22. Role of local self government
institutions:-
It lays great emphasis upon the implementation of
public health programmes through local self
government institutions.
The structure of the national disease control
programmes will have specific components for
implementation through such entities.
23. Norms for the health Care
personal:-
Mimumal statutory norms for the deployment of
doctor’s & nurses in medical institution need to be
introduce urgently under the provisional of Indian
Medical Council, and Indian Nursing Council.
24. Education of the health care
profaners:-
This policy envisages the setting of a medical grand
commotions fro funding a new government medical &
dental collage in different parts of the countries.
Enable fresh graduates to contribute effectively for
providing primary health services and physician of
first contact this policy is identifiable a significant
need to modified to existing circular.
25. Need for specialist:- in public
health & family medicine:-
In order to acute shortage of medical personal with
specialization in the discipline of public health &
family medicine.
The policy envisages the progressive implementation
on mandatory norms to raise the proportion of post
gradate sheet in the discipline in medical training
institutions.
26. Nursing personal
In the interest of the patient care the policy emphazise
the need for and improvement in a ratio of nurses &
doctor’s per beds.
In order to discharge their responsibility as model
provider of health services. The public health delivery
centers need to made in beginning by increasing the
number of nursing personal.
The policy emphasized on increase the skill level of
nurses and on increasing the ratio of the degree
holding nurses vs diploma holding nurses.
27. Use of generic drugs and vaccines:-
This policy emphasizes the need for basic treatment
regimens, in both the public and private, domain, on a
limited number of essential drugs of a generic nature.
This is pre-requisite for cost effective public health
care.
The national programme for universal immunization
against preventable diseases requires to be assured of
an uninterrupted supply of vaccines at an affordable
priece.
28. Urban health
It envisages the setting up an organized urban primary
health care structure.
Since the physical features of urban settings are
different from those in rural areas, it envisages the
adoption of appropriate population norms for the
urban public health infrastructure.
It also envisaged the establishment of fully equipped
‘hub spoke’ trauma care networks in large urban
agglomerations to reduce to accident mortality.
29. Mental health
It envisages a network of decentralization mental
health services.
In regular to mental health institutes for in door
treatment of patients, the policy envisaged the
upgrading of the physical infrastructure of such
institutions at central Gov. expense.
30. Information, education &
communication
It envisages the IEC policy, which maximizes the
dissemination of information to those population
groups which can not using only the mass media.
It would set specific targets for the association of
NGOs/ trusts in such activities.
It gives priority to school health programme.
31. Health Research:-
Domestic medical research would be focused on new
therapeutic drugs and vaccines for tropical disease.
32. Role of the private sector:-
It welcome the participation of the private sector in all
areas of health activities.
NHP-2002 envisages the cooperation of the non-gov
practitioners in the national disease control
programmes.
33. The role of civil society:-
NHP-2002 recognizes the significant contribution
made by NGOs and other institutions of the civil
society in making available health services to the
community.
34. Health Statistics:-
It envisages the completion of baseline estimates for
the incidence of the common disease- T.B., Malaria,
Blindness by 2005.
35. Woman’s Health
NHP-2002 envisages the identification of specific of
specific programme targeted at women health.
36. Regulation of standards in
paramedical disciplines:-
It recognizes the need or the establishments of
statutory protssionals councils for paramedical
disciplines to register practitioners, maintain
standards of training, and monitor performance.
37. Environment & occupational
Health:-
It envisaged the independently stated policies and
programs of the environment related sectors be
smoothly interfaced with the policies and the
programme of the health sector, in order to reduce the
health risk.
38.
39. INTRODUCTION
The National Health Policy of 1983 and the National Health
Policy of 2002 have served well in guiding the approach for the
health sector in the Five-Year Plans.
Now 14 years after the last health policy, the context has changed
in four major ways.
First, the health priorities are changing.
Although maternal and child mortality have rapidly declined,
there is growing burden on account of noncommunicable
diseases and some infectious diseases.
The second important change is the emergence of a robust
health care industry estimated to be growing at double digit.
The third change is the growing incidences of catastrophic
expenditure due to health care costs, which are presently
estimated to be one of the major contributors to poverty.
Fourth, a rising economic growth enables enhanced fiscal
capacity. Therefore, a new health policy responsive to these
contextual changes is required.
40. The primary aim of the National Health Policy, 2017, is
to inform, clarify, strengthen and prioritize the role of
the Government in shaping health systems in all its
dimensions- investments in health, organization of
healthcare services, prevention of diseases and
promotion of good health through cross sectoral
actions, access to technologies, developing human
resources, encouraging medical pluralism, building
knowledge base, developing better financial
protection strategies, strengthening regulation and
health assurance.
41. NHP 2017 builds on the progress made since the last
NHP 2002. The developments have been captured in
the document “Backdrop to National Health Policy
2017- Situation Analyses”, Ministry of Health & Family
Welfare, Government of India.
42. Goal
The policy envisages as its goal the attainment of the
highest possible level of health and wellbeing for all at
all ages, through a preventive and promotive health
care orientation in all developmental policies, and
universal access to good quality health care services
without anyone having to face financial hardship as a
consequence. This would be achieved through
increasing access, improving quality and lowering the
cost of healthcare delivery.
43. The policy recognizes the pivotal importance of
Sustainable Development Goals (SDGs). An indicative
list of time bound quantitative goals aligned to
ongoing national efforts as well as the global strategic
directions is detailed at the end of this section.
44. Key Policy Principles
I. Professionalism, Integrity and Ethics: The health
policy commits itself to the highest professional
standards, integrity and ethics to be maintained in the
entire system of health care 2 delivery in the country,
supported by a credible, transparent and responsible
regulatory environment.
II. Equity: Reducing inequity would mean affirmative
action to reach the poorest. It would mean minimizing
disparity on account of gender, poverty, caste,
disability, other forms of social exclusion and
geographical barriers. It would imply greater
investments and financial protection for the poor who
suffer the largest burden of disease.
45. III. Affordability: As costs of care increases,
affordability, as distinct from equity, requires
emphasis. Catastrophic household health care
expenditures defined as health expenditure exceeding
10% of its total monthly consumption expenditure or
40% of its monthly non-food consumption
expenditure, are unacceptable.
IV. Universality: Prevention of exclusions on social,
economic or on grounds of current health status. In
this backdrop, systems and services are envisaged to be
designed to cater to the entire population- including
special groups.
46. V. Patient Centered & Quality of Care: Gender
sensitive, effective, safe, and convenient healthcare
services to be provided with dignity and
confidentiality. There is need to evolve and
disseminate standards and guidelines for all levels of
facilities and a system to ensure that the quality of
healthcare is not compromised.
VI. Accountability: Financial and performance
accountability, transparency in decision making, and
elimination of corruption in health care systems, both
in public and private.
47. VII. Inclusive Partnerships: A multistakeholder
approach with partnership & participation of all
nonhealth ministries and communities. This approach
would include partnerships with academic
institutions, not for profit agencies, and health care
industry as well.
VIII. Pluralism: Patients who so choose and when
appropriate, would have access to AYUSH care
providers based on documented and validated local,
home and community based practices. These systems,
inter alia, would also have Government support in
research and supervision to develop and enrich their
contribution to meeting the national health goals and
objectives through integrative practices.
48. IX. Decentralization: Decentralization of decision
making to a level as is consistent with practical
considerations and institutional capacity. Community
participation in health planning processes, to be
promoted side by side.
X. Dynamism and Adaptiveness: constantly
improving dynamic organization of health care based
on new knowledge and evidence with learning from
the communities and from national and international
knowledge partners is designed.
49. Health Status and Programme
Impact
Life Expectancy and healthy life
a. Increase Life Expectancy at birth from 67.5 to 70 by
2025.
b. Establish regular tracking of Disability Adjusted Life
Years (DALY) Index as a measure of burden of disease
and its trends by major categories by 2022.
c. Reduction of TFR to 2.1 at national and sub-
national level by 2025.
50. Mortality by Age and/ or cause
a. Reduce Under Five Mortality to 23 by 2025 and
MMR from current levels to 100 by 2020.
b. Reduce infant mortality rate to 28 by 2019.
c. Reduce neo-natal mortality to 16 and still birth rate
to “single digit” by 2025.
51. Reduction of disease prevalence/ incidence
a. Achieve global target of 2020 which is also termed as target of
90:90:90, for HIV/AIDS i. e,- 90% of all people living with HIV
know their HIV status, - 90% of all people diagnosed with HIV
infection receive sustained antiretroviral therapy and 90% of all
people receiving antiretroviral therapy will have viral
suppression.
b. Achieve and maintain elimination status of Leprosy by 2018,
Kala-Azar by 2017 and Lymphatic Filariasis in endemic pockets
by 2017.
c. To achieve and maintain a cure rate of >85% in new sputum
positive patients for TB and reduce incidence of new cases, to
reach elimination status by 2025.
d. To reduce the prevalence of blindness to 0.25/ 1000 by 2025
and disease burden by one third from current levels.
e. To reduce premature mortality from cardiovascular diseases,
cancer, diabetes or chronic respiratory diseases by 25% by 2025.
52. Health Systems Performance
Coverage of Health Services
a. Increase utilization of public health facilities by 50%
from current levels by 2025.
b. Antenatal care coverage to be sustained above 90%
and skilled attendance at birth above 90% by 2025.
c. More than 90% of the newborn are fully immunized
by one year of age by 2025.
d. Meet need of family planning above 90% at
national and sub national level by 2025. 5
e. 80% of known hypertensive and diabetic
individuals at household level maintain „controlled
disease status‟ by 2025.
53. Cross Sectoral goals related to health
a. Relative reduction in prevalence of current tobacco
use by 15% by 2020 and 30% by 2025.
b. Reduction of 40% in prevalence of stunting of
under-five children by 2025.
c. Access to safe water and sanitation to all by 2020
(Swachh Bharat Mission).
d. Reduction of occupational injury by half from
current levels of 334 per lakh agricultural workers by
2020.
e. National/ State level tracking of selected health
behaviour.
54. Health Systems strengthening
Health finance
a. Increase health expenditure by Government as a
percentage of GDP from the existing 1.15% to 2.5 % by
2025.
b. Increase State sector health spending to > 8% of
their budget by 2020.
c. Decrease in proportion of households facing
catastrophic health expenditure from the current
levels by 25%, by 2025.
55. Health Infrastructure and Human Resource
a. Ensure availability of paramedics and doctors as per
Indian Public Health Standard (IPHS) norm in high
priority districts by 2020.
b. Increase community health volunteers to population
ratio as per IPHS norm, in high priority districts by
2025.
c. Establish primary and secondary care facility as per
norms in high priority districts (population as well as
time to reach norms) by 2025.
56. Health Management Information
a. Ensure district-level electronic database of
information on health system components by 2020.
b. Strengthen the health surveillance system and
establish registries for diseases of public health
importance by 2020.
c. Establish federated integrated health information
architecture, Health Information Exchanges and
National Health Information Network by 2025.
57. Policy Thrust
1. Ensuring Adequate Investment
The policy proposes a potentially achievable target of
raising public health expenditure to 2.5% of the GDP
in a time bound manner. It envisages that the
resource allocation to States will be linked with State
development indicators, absorptive capacity and
financial indicators. The States would be
incentivised for incremental State resources for
public health expenditure. General taxation will
remain the predominant means for financing care.
58. 2. Preventive and Promotive Health
The policy articulates to institutionalize inter-sectoral
coordination at national and sub-national levels to
optimize health outcomes, through constitution of
bodies that have representation from relevant non-
health ministries.
This is in line with the emergent international “Health in
All” approach as complement to Health for All.
The policy prerequisite is for an empowered public
health cadre to address social determinants of health
effectively, by enforcing regulatory provisions.
59. The policy identifies coordinated action on seven
priority areas for improving the environment for
health:
The Swachh Bharat Abhiyan
Balanced, healthy diets and regular exercises.
Addressing tobacco, alcohol and substance abuse
Yatri Suraksha – preventing deaths due to rail and road
traffic accidents
Nirbhaya Nari –action against gender violence
Reduced stress and improved safety in the work place
Reducing indoor and outdoor air pollution
60. Organization of Public Health Care Delivery:
In primary care – from selective care to assured
comprehensive care with linkages to referral hospitals
In secondary and tertiary care – from an input
oriented to an output based strategic purchasing
In public hospitals – from user fees & cost recovery
to assured free drugs, diagnostic and emergency
services to all
In infrastructure and human resource
development – from normative approach to targeted
approach to reach under-serviced areas
61. In urban health – from token interventions to on-
scale assured interventions, to organize Primary
Health Care delivery and referral support for urban
poor. Collaboration with other sectors to address wider
determinants of urban health is advocated.
In National Health Programmes – integration with
health systems for programme effectiveness and in
turn contributing to strengthening of health systems
for efficiency.
In AYUSH services – from stand-alone to a three
dimensional mainstreaming
