Good morning
FASIL P
3rd year bds
“Large number of worlds people
perhaps more than half, have no
access to health care at all , and for
many of rest the care they receive
does not answer the problems they
have”………………JOHN BRYANT
health and the developing world
INTRODUCTION
 The value of health is not realized till it is lost . It
is not true only at individual level but even at the
community and governmental level.
 The understanding of health has been
articulated by WHO in 1948 as ” a state of
Complete physical ,social and mental well being
and not merely absence of disease or infirmity”
 In a developing country like India health has not
been given any priority or importance before
independence . After independence government
of India has undertaken various measures to
improve the health of the people
PLAN AHEAD-”it was not raining when NOAH built
the ark”
The ministry of health and family welfare evolved a NHP in
1983 keeping in view the national commitment to attain
the goal of health for all by the year 2000 AD through the
universal provision of comprehensive primary health care.
“Health For All” (HFA)
 It is defined as “ the attainment of a
level of health that will enable every
individual to lead a socially and
economically productive life”.
 Alma-Ata conference (1978) called for
acceptance of WHO goal of “HEALTH
FOR ALL” by 2000 AD.
And Primary Health Care as a way to
achieve health for all.
Health policy of a Nation is
its strategy for controlling
and optimizing the social
uses of its health knowledge
and human resources.
India had its first
national health policy
in 1983 i.e. 36 years
after independence.
History of NHP
1981 - expert
committee
appointed by
planning commission
submitted a report
about NHP.
1982 – NHP was
finalized by the
ministry of health
and family welfare.
1983 – NHP was
approved by
parliament.
2002 – NHP was
revised by the
ministry of health
and family welfare.
National Health Policy - 1983
 NHP 1983 stressed the need for
providing primary health care with
special emphasis on prevention,
promotion and rehabilitation.
 Suggested planned time bound
attention to following
National Health Policy 1983….
Water supply
and sanitation
nutrition ,
prevention of
food adulteration
& Maintenance of
quality of drugs
Occupational
health service
School health
programmes
and
Environmental
protection
Immunization
programme
Maternal and
child health
service
National Health Policy 1983….
For better
programme
planning NHP
1983 recommended
an effective
health information
system
NHP in brief
 NHP is a 17 page document consisting of 20 paras (strategies) and
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
an appendix .
Introductory
Our heritage
Progress achieved
Existing picture
Need for evolving a health policy
Population stabilization
Medical and health education
Need for providing primary health with special emphasis on
preventive, promotive and rehabilitative aspects
Reorientation of the existing health personnel
Private practice by governmental functionaries
Practitioners of indigenous and other systems of medicine And
their role in healthcare
12. Problems requiring urgent attention- (nutrition
13.
14.
15.
16.
17.
18.
19.
,prevention of food ,Adulteration and maintenance of
quality of drugs,water supply and sanitation,
environmental pollution,immunisation programmes ,
maternal and child health services , school health
programmes)
Health education
Management information system
Medical industry
Health insurance
Health legislation
Medical research
Intersectoral co-operation
Introductory
Constitution of India envisages the
establishment of a new social order based
upon equality freedom justice and the dignity
of freedom of the individual.
Successive five year plans have been providing
the framework within which the states may
develop their health service infrastructure ,
facilities for medical education , research etc.
Our heritage
India has a rich
heritage of medical
and health sciences
.The approach of our
ancient medical
systems was of a
holistic nature. It
took into account all
aspects of human
health and disease.
The philosophy of
ayurveda and the
surgical skills
enunciated by
charaka and
sushruta bear
testimony to our
ancient tradition in
the scientific health
care of our people.
Progress achieved
Small pox has been eliminated
Plague is no longer a problem
Mortality from cholera decreased
Malaria brought under control to
considerable extent
Mortality rate per 1000 of population
has been reduced from 27.4 to 14.8
Life expectancy at birth
increased from 32.7 to over
52
A large stock of medical
and health personel has
become available
Extensive network of
hospitals, dispensaries
and institutions has
developed
Significant indigenous
capacity has been achieved
for the production of drugs
and pharmaceuticals etc
The existing picture
The existing picture of the country still
constitute a cause for serious and urgent
concern with special reference to following
 High rate of population growth
 High mortality rate for women children and
infants
 Malnutrition
 High level of communicable and non
communicable diseases.
 Poor access of rural population to potable
water supply (31%) and basic sanitation
(0.5%)
 Poverty
 Ignorance
 Emphasis on hospital based cure oriented
approach and neglect of preventive
promotive public health.
 Failure to involve community in the
implementation and management of
various health related programmes
Need for evolving a health policy
Halfdan Mahlar
 India is committed to attaining the goal of “health for
all by the year 2000 ad” through the universal
provision of comprehensive primary health care
services.
 The basis of “HEALTH FOR ALL” strategy is primary
health care (Halfdan Mahlar ,1981)
 The adoption of “HEALTH FOR ALL” by govt. of india
implies a commitment to promote the advancement
of the all citizens on a broad front of development to
achieve a higher quality of life
Population stabilization
The efforts for improving the health status of the people
will not succeed unless success is achieved in in securing
the small family norm
It has to be achieved through voluntary efforts
In view of the vital importance of securing the balanced
growth of the population a separate national population
policy has been enunciated.
National population policy in general refers to policies
intended to decrease the birth rate. India formed the
first NPP in 1976 and it was modified in 1977 and 2000.
Medical and health education
The effective delivery of health care depend
very largely on the nature of education
,training and appropriate orientation towards
community health of all categories of medical
and health personnel and their capacity to
function as an integrated team.
It is necessary to formulate , separately ,a
national medical and health educational
policy.
Need for providing primary health with special
emphasis on the preventive promotive and
rehabilitative aspects
 The large majority of curative centres are located in the urban areas


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of the country.
The vast majority of people seeking medical relief have to travel long
distance to the nearest curative centres .
To put an end to this existing situation , it is urgently necessary to
restructure the health services.
The establishment of primary health care approach would involve
large scale of transfer of knowledge, simple skills and technologies to
help the volunteers selected by the communities
The success of decentralized primary health care system would
depend virtually on the effective community participation
The major focus of the governmental efforts should be upon primary
health care and public health service
Specialty and super specialty services are also need to be provided.
Reorientation of the existing health
personnel
A dynamic process of change and
innovation is required to be brought
about in entire approach to health
manpower development, ensuring the
emergence of fully integrated bands of
workers functioning within the “health
team” approach.
Private practice by governmental
functionaries
It is desirable for the states to take
steps to phase out the system of
private practice by medical personnel
in government service, providing at the
same time for payment of appropriate
compensatory non practicing
allowance.
Practitioners of indigenous and other systems
of medicine and their role in healthcare
 India has large stock health manpower comprising of

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

private practitioners in various systems . For example :Ayurveda ,Unani ,Sidha ,Homeopathy , Yoga , Naturopathy
etc…
This resource has not so far been adequately utilized .
The practitioners these various systems enjoy high local
acceptance and respect and consequently exert
considerable influence on health beliefs and practices .
It is necessary to integrate their services within specified
areas of responsibility ,specially in regard to preventive
promotive and public health objectives.
Well organized steps are necessary for meaningful
integration of indigenous and the modern systems.
Problems requiring urgent attention
 Priority areas of the NHP
1. small family norm : to be achieved by
voluntary
efforts and moving towards the goal of population
stabilization. For this separate policy was enunciated as
national population policy (NPP)
2.maternal and child health care : a vicious relationship
exist between high birth rate and high infant mortality
,contributing the desire for more children. Therefore highest
priority should be given to the programmes for the
improvement of maternal and child health.
Efforts should be directed to train the traditional
birth attendants to ensure that all deliveries are conducted by
trained persons
3.Immunisation programmes :-
 It is necessary to launch organized , nation- wide
immunization programmes .
 Immunisation programmes should aim at cent per cent
coverage of targeted population groups with vaccines
against preventable and communicable diseases.
4. Improvement of nutritional status
To ensure adequate nutrition for all sections
of population by directing the efforts at
improving the purchasing power of poorer
sections of the society through
Schemes like employment guarenttee
schemes
Promotion of breast feeding to infants
Measures aimed at improving the eating
habits , cooking practices :
5. Water supply and sanitation:-
The provision of safe drinking of water and
sanitary disposal of human and animal
wastes , both in urban and rural areas must
constitute an integrated package.
Intensive health education for the
improvement of personal hygiene and
community health should also be given
6. Environmental protection :-
This is to against haphazard exploitation of
resources causing ecological disturbances
leading to health hazards .
Environmental appraisal procedures must be
developed and strictly applied in according
clearance to the various industrial and
developmental projects
7. School health programmes :Organized school health services integrally
linked with the general , preventive and curative
services would require to be established within a
time limited programmes
8. Occupational health services :There is an urgent need for launching well
considered schemes to prevent and treat
diseases and injuries arising from occupational
hazards , not only in various industries but also
from agricultural fields
9. Prevention of food adulteration and
maintenance of quality of drugs :Effective legislation should be enacted to
check and prevent food adulteration at
various stages of their production ,
processing , storage , transport , distribution
etc…
Health education
National - wide health
education programmes , backed
by appropriate communication
strategies should be launched to
provide health information in
easily understandable form,to
motivate the development an
attitude for a healthy living
Management of information
system
The building up of a well conceived
health information system is necessary
for accessing medical health man power
requirements and taking timely decisions
on a continuing basis,regarding the man
power requirements in the future .
Medical industry
The country has build up sound technological and
manufacturing capability in the field of drugs
,vaccines, biomedical equipments etc..
We have to increase the production of essential and
life saving drugs and vaccines of proven quality to
fully meet the national requirements .
Effective mechanisms should be established to
manufacture biomedical equipments having only
reasonable prices for use at the health centres
Health insurance
It is necessary to device
well considered insurance
schemes, on state wise
basis or mobilizing
additional resources for
health promotion and
ensuring that the
community shares the
cost of services in keeping
with its paying capacity
Health legislation
It is necessary to urgently review all existing
legislation and work towards a unified ,comprehensive
legislation in the health field ,enforcable all over the
country
Medical research
The frontiers of the medical sciences are expanding at a
phenomenal pace . To maintain the country’s lead in this
field as well as to ensure self-efficiency and generation
of requisite competence in the future it is necessary to
have an organized programme for building up and
extension of fundamental and basic research in the field
of biomedical and allied sciences. Basic research efforts
should devote high priority to the discovery and
development of more effective treatment and
preventive procedures in regard to communicable and
tropical diseases. Blindness ,leprosy ,TB etc
Intersectoral cooperation
All health and human
development must
ultimately constitute
an integral component
of the socio economic
developmental process
in the country.
It is of vital importance
to ensure effective
coordination between
the health and related
sectors .
Monitoring and review of
progress
It would be of
crucial
importance to
monitor and
periodically
review the
success of the
efforts need
and the results
achieved
For this
purpose, it is
necessary to
urgently
identify the
baseline
situation and
to evolve a
a phased
programme
for the
achievement
of short and
long term
objectives in
the various
sectors of
activity
Comments about NHP 1983
The NHP is variable
document and provides a
clear framework for
national health planning.
However it has been
criticized on the following
ground .
National Health Policy 2002
Objectives:
Achieving an acceptable standard of good health of
Indian Population,
•
•Decentralizing public
health system by upgrading
infrastructure in existing institutions,
•Ensuring a more equitable access to health
service across the social and geographical
expanse of India
NHP 2002, Objectives……..
•Enhancing the
contribution of
private sector in
providing health
service for
people who can
afford to pay.
•Giving primacy
for prevention
and first line
curative
initiative.
•Emphasizing
rational use of
drugs.
•Increasing
access to tried
systems of
Traditional
Medicine
Goals NHP 2002
1. Eradication of Polio & Yaws
2. Elimination of Leprosy
3. Elimination of Kala-azar
4. Elimination of lymphatic Filariasis
5. Achieve of Zero level growth
of HIV/AIDS
2005
2005
2010
2015
2007
Goals – NHP 2002……
6.Reduction of mortality by 50%
2010
on account of Tuberculosis, Malaria, Other vector
and water borne Diseases
7.Reduce prevalence of blindness
2010
to 0.5%
Goals – NHP 2002……
8 . Reduction of IMR to 30/1000 &
MMR to 100/lakh
9. Increase utilisation of public
health facilities from current
level of <20% to > 75%
10. Establishment of an integrated
system of surveillance,
National Health Accounts and
Health Statistics
2010
2010
2007
Goals – NHP 2002……
11.Increase health expenditure
by government as a % of
GDP from the existing
0.9% to 2.0%
12. Increase share of Central
grants to constitute at least
25% of total health spending
2010
2010
Goals – NHP 2002……
13. Increase State Sector
Health spending from
5.5% to 7% of the budget
14. Further increase of
State sector
Health spending
from 7% to 8%
2005
2010
NHP-2002
Policy
prescriptions
Equity…..
•To overcome the social
inequality, 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
Delivery of national public
health programmes
•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.
Delivery of national public health
programmes…….
•Training and reorientation of
rural health staff and free hand
to district administration to
allocate the time of the rural
health staff between the various
programmes, depending on the
local need is stressed.
Delivery of national public health
programmes…….
•Therefore, the policy places reliance on
strengthening of public health
outcomes on equitable basis.
•It recognises the need of user charge for
secondary and tertiary public health
care for those who can afford to pay.
Extending public health services
•Expanding the pool of General
Practitioners to include a cadres of
licentiates including Indian systems of
Medicine and Homoeopathy is
recommended in the policy.
•In order to provide trained manpower
in under served areas it recommends
contract employment.
Education of health care
professionals
•NHP 2002 recommends setting up of a
Medical Grant Commission for funding
new government medical/dental
colleges.
•It suggests for a need based, skill
oriented syllabus with a more
significant component of practical
training.
Education of health care
professionals…..
•
The need for inclusion of contemporary medical
research and geriatric concern and creation of
additional PG seats in deficient specialties are
specified.
Need for specialists in 'public
health' and 'family medicine'
•For discharging public health
responsibilities in the country NHP 2002
recommends specialisation 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.
Nursing personnel
•NHP 2002 recognizes acute
shortage of nurses trained in
superspecialty disciplines.
•It recommends increase of
nursing personnel in public
health delivery centres and
establishment of training
courses for
superspecialties.
Urban health
•Migration has resulted in urban growth which is
likely to go up to 33%.
•It anticipates rising vehicle density which lead
to serious accidents.
•In this direction, 2002 NHP has recommended
an urban primary health care structure as under;
Urban health……
First Tier:•Primary centre cover 1 Lakh population
–It functions as OPD facilities.
–It provides essential drugs.
–It will carry out national health programmes.
Urban health……
Second Tier:-
•General Hospital a referral to primary centre
provides the care.
•The policy recommends a fully equipped hubspoke trauma care network to reduce accident
mortality.
Mental health
•Decentralized mental health
service for diagnosis and
treatment by general duty
medical staff is recommended.
•It also recommends securing
the human rights of mentally
sick.
Information Education and
Communication
•NHP 2002
has suggested
interpersonal
communicatio
n by folk and
traditional
media to bring
about
behavioral
change.
Information Education and
Communication…….
•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.
Health research
•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 up to 2% by
2010.
•New therapeutic
drugs and vaccines
for tropical disease
are given priority.
Role of private sector
•The policy welcomes the participation of the
private sector in all areas of health activities
primary, secondary and tertiary health care
services;
but recommended regularitory and accreditation of
private sector for the conduct of clinical practice.
•
Role of private sector…..
•It has suggested a social
health insurance scheme for
health service to the needy.
•It urges standard protocols in
day-to-day practice by health
professionals.
•It recommends tele-medicine
in tertiary care services.
Health statistics
•NHP 2002 has
recommended full
baseline estimate of
tuberculosis,
malaria and
blindness by 2005,
and
•In the long run for
cardiovascular
diseases, cancer,
diabetes, accidents,
hepatitis and G.E.
Women's health
•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.
Medical ethics
•In India we have guidelines
on professional medical on
ethics since 1960.
•This is revised in 2001.
•Government of India has
emphasized the importance of
moral and religious dilemma.
Medical ethics…….
•NHP 2002 has
recommended
notifying a
contemporary code
of ethics, which is
to be rigorously
implemented by
Medical Council of
India.
•The Policy has
specified the need
for a vigilant watch
on gene
manipulation and
stem cell research.
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.
Regulation of standards in
paramedical disciplines
•More and more training
institutions have come up recently
under paramedical board which do
not have regulation or monitoring.
•Hence, establishment of Statutory
Professional Council for
paramedical discipline is
recommended.
Environmental and occupational
health
•Government
has noted the
ambient
environment
condition like
unsafe
drinking
water,
unhygienic
sanitation and
air pollution.
•Child labour and
substandard working
conditions are causing
occupational linked
ailments.
Environmental and occupational
health…….
•NHP 2002 has suggested for an independent
state policy and programme for environment
apart from periodic health screening for high
risk associated occupation.
NRHM
•NATIONAL
RURAL
HEALTH
MISSION
•( NRHM)
•2005-2012.
Aim
•To provide accessible, affordable,
accountable, effective and reliable
primary health care and bridging the
gap in rural health care through
creation of ASHA. ( ACCREDITED SOCIAL
HEALTH ACTIVIST).
GOALS
1.Reducing IMR and MMR by 50 % in next 7
years.
2.Universal access to public health
services such as womens health, child
health, water, sanitation, hygiene,
immunization, nutrition.
3.Prevention and control of CD and NCD
4.Access to integrated comprehensive
primary health care.
5. population stabilization, gender and
demographic balance.
6. Revitalize local health traditions and
mainstream AYUSH.
7. Promotion of healthy life styles.
STRATEGIES.
•A. CORE
STRATEGY.
•B.
SUPPLEMENTARY
STRATEGY.
CORE STRATEGIES
1.Train and enhance
capacity of Panchayat
Raj institutions to own,
control and manage
public health services.
2.Promote access to
improved health care
at household level
through the female
health activist.
3.Health plan for each
village through village
health committee of
the panchayat.
4. Strengthening sub center through an united fund to
enable local planning and action and more MPW’s.
5. Strengthening existing PHC’s and CHC’c.
6. Preparation and implementation of an intersectoral
district health plan prepared by the district health
mission
7. Strengthening capacities for data
collection, assessment and review for
evidence based planning, monitoring
and supervision.
8. Developing capacities for preventive
health care at all levels by promoting
healthy life styles, reduction in tobacco
consumption, alcohol etc.
B. Supplementary strategy.
1.Regulation of private sector to ensure
availability of quality service to citizens
at reasonable cost.
2.Mainstreaming AYUSH – revitalizing
local health traditions.
3.Reorienting medical education to
support rural health issues
COMPONENTS OF NRHM
1.ASHA
-Resident of the village, a woman (M/W/D)
between 25-45 years, with formal education
upto 8th class, having communication skills
and leadership qualities.
-One ASHA per 1000 population.
-Around one lakh ASHA’s are already selected.
ASHA
-Chosen by the panchayat to act as the
interface between the community and the
public health system.
-Bridge between the ANM and the village.
-Honorary volunteer, receiving
performance based compensation .
Responsibility of ASHA
-To create awareness among the
community regarding nutrition, basic
sanitation, hygienic practices, healthy
living.
-Counsel women on birth preparedness,
imp of safe delivery, breast feeding,
complementry feeding, immunization,
contraception, stds….
Responsibility of ASHA…
-Encourage the community to get
involved in health related services.
-Escort/ accompany pregnant women,
children requiring treatment and
admissions to the nearest PHC’s.
-Primary medical care for minor ailment
such as diarrhea, fevers
-Provider of DOTS.
Responsibility of ASHA….
-ORS, IRON AND FOLIC ACID TABLETS,
CHOLORQUINE, ORAL PILLS,
CONDOMS,
-DRUG KIT – ALLOPATHIC AND AYUSH
-UNDERGO GRADED TRAINING.
-INFORMATION ABOUT BIRTHS AND
DEATHS.
-PROMOTE CONSTRUCTION OF
HOUSEHOLD TOILETS.
SUMMATION
 Crafting of a national health policy is rare




occasion.
Allow our dreams mingle with ground of
reality
Needs are enormous and the resources are
limited
Health needs are also dynamic and keep
changing over time .
Had to make hard choices between various
priorities
SUMMATION
NHP 2002 has given a continuum to NHP 1983,
where primary health care is adopted as the
main strategy through –
-Decentralization
-Equity
-Private sector – indigenous system
participation
-Rise in public investment
SUMMATION…
 The ultimate goal of achieving an acceptable
standard of good health of people of India
 The commitment of service providers and an
improved standard of governance is a
prerequisite for the success of any health policy
 NHP was a historic move by the government of
India . But till now we could not achieve the goal
of “HEALTH FOR ALL” let us hope that we will
achieve this goal in the near future through well
planned community programmes and
establishment of health centres through out the
country .
miles to go before……..
Reference
1. park’s textbook of preventive medicine – k
2.
3.
4.
5.
Park
Textbook of preventive and social medicine
- MC Gupta & BK Mahajan
Textbook of definitions of preventive and
community dentistry – SS Hiremath
Community medicine with recent advances
– AH Suryakantha
Community health nursing – BT
Basavanthappa