national health policy

1. Presented by: shagun
Msc nursing 1st year student

2. CONTENTS:
2
• Introduction
• Alma- Ata Declaration
• Primary Health Care
• National Health Policy 1983
• National Health Policy 2002
• National Health Policy 2015
• National Health Policy 2017
• Conclusion

3. INTRODUCTION:
3
HEALTH:
A state of complete physical, mental and
social well being and not merely the
absence of disease or infirmity.

4. CONTD:
 POLICY:
Policy is a system, which provides the
logical framework and rationality of
decision making for the achievements of
intended objectives.

5. The 30th World Health
Assembly in May
1977 resolved
HEALTH FORALLBY 2000AD
5

6. HEALTH POLICY:
Health policy of a nation is its strategy
for controlling and optimizing the
social uses of its health knowledge and
health resources.
6
CONTD…

7. THE ALMA-ATA
CONFERENCE DEFINED
“Primary health care is an essential health
care based on practical, scientifically
sound and socially acceptable methods
and technology, made universally
accessible to individual and families in the
community, through their full
participation and at a cost that the
community and the country can afford”.
7

8. Principles of Primary Health
Care:
1.Equitable distribution
2.Community participation.
3.Inter-sectoral coordination
4.Appropriate technology
8

9. 1. Equitable distribution
9
• Health services must be shared
equally .
• At present most of the health services
are mainly focus on the major towns
and cities resulting in inequality of
care.

10. 2. Community participation
There must be a continuing effort to secure
meaningful involvement of the community
in the planning, implementation and
maintenance of health services, besides
maximum reliance on local resources such
as manpower, money and materials.
10

11. 3.Intersectoral coordination
“Primary health care involves in addition to
the health sector, all related sectors and
aspects of national and community
development, in particular agriculture,
animal husbandry, food, industry,
education, housing, public works,
communication and others sectors".
11

12. 4. Appropriate technology
12
“Technology that is scientifically sound,
adaptable to local needs, and acceptable
to those who apply it and those for
whom it is used, and that can be
maintained by the people themselves in
keeping with the principle of self
reliance"

13. National strategy for health for all
......
13
• As a signatory to alma- ata declaration
in 1978, the Govt. Of India was
committed to take steps to provide
HFA to its citizens.
• In this connection two important reports
appeared:

14. CONTD…
 Report of study group on “HEALTH
FOR ALL – on alternative strategy”
sponsored by Indian council of social
science research (ICSSR) and Indian
council of medical research( ICMR)

15. Reports of working group on “HEALTH
FOR ALL by 2000 A.D. ’’sponsored
by Ministry of health and family
welfare, Govt. Of India.
 This health policy forms a basis of The
National Health Policy Formulated By
Ministry Of Health And Family
Welfare, Govt . Of India In 1983.
15
CONTD..

16. NATIONAL HEALTH POLICY
1. National health policy 1983
2. National health policy 2002
3. National health policy 2015
4. National health policy 2017

17. NATIONAL HEALTH POLICY- 1983

18. NATIONAL HEALTH POLICY-
1983
18
• India had its first national health policy
in 1983 i.e. 36 years after
independence.
• In the circumstances then prevailing, this
policy provided the initiatives like:
a. Comprehensive health care linking
with extension and health education.

19. CONTD…
a. Intermediation by health volunteers.
b. Decentralization to reduce burden of
high level referral system.
c. To make government facility limited to
eligible poor, by private investment for
patients who can pay.

20. • NATIONAL HEALTH POLICY 1983
suggested the necessity of complete
integration of all plans for human
development .
20
CONTD…

21. The Alma-Ata conference
called for acceptance of the
WHO goal of
HEALTH FORALL
by 2000AD
and ‘Primary Health Care’ as a
way to achieve Health ForAll
21

22. • National health policy 1983 stressed the
need for providing primary health care
with special emphasis on prevention ,
promotion and rehabilitation aspects.
22
• Its emphasis is on team approach, ban on
private practice by health professionals.
CONTD…

23. CONTD…
• and use of our large stock of health
manpower from alternative system of
medicine like Ayurveda, Unani, Siddha,
Homoeopathy, Yoga and Naturopathy.
• It suggested Planned time bound attention
to the following:
1.Nutrition, prevention of food
adulteration.

24. CONTD…
2.Mainatince of quality of drug
3.Water supply and
sanitation
4.Environmental
Protection
24

25. CONTD..
5.Immunisation Programme
6.Maternal and Child Health
Services
7.School Health Programme
8.Occupational Health

26. NATIONAL HEALTH POLICY
1983 GOALS SUGGESTED/
ACHIEVED:
26

27. INDICATOR GOAL BY
2000
ACHIEVED
BY 2000
1. INFANT MORTALITY RATE
(IMR)
60 70
2. PERI NATALMORTALITY
RATE (PNMR)
33 46
3. CRUDE DEALTH RATE (CDR) 9 8.7
4. MATERNAL MORTALITY
RATE (MMR)
2 4
5. UNDER FIVE MORTALITY
RATE (UFMR)
10 9.4
6. LIFE EXPENTANCY BIRTH-
MALE(yrs)
64 62.4
FEMALE(yrs) 64 63.4
27

28. 7. LOW BIRTH
WEIGHT %
10% 20%
8. CRUDE BIRTH
RATE
21 26.1
9. COUPLE
PROTECTION RATE
60% 46.2%
10. NET
REPRODUCTION
RATE
1 1.45
11. GROWTH RATE 1.2 1.93
12. FAMILY SIZE 2.3 3.1
13. ANTENATAL
CARE (ANC)
100% 67.2% with ANC still
less with fullANC
28

29. 14. TT PREGNANT 100 83
15. DPT 85 87
16. OPV 85 92
17. BCG 85 82
29

30. 18. TYPHOID NOT UPTO THE MARK
19. LEPROSY NOT UPTO THE MARK
20. TUBERCULOSIS NOT UPTO THE MARK
21. BLINDNESS NOT UPTO THE MARK
30

31. Future Goals
31
• Leprosy elimination by 2005.
• Tuberculosis mortality 50%;
reduction by 2010.
• Blindness prevalence to 0.5% by
2010.

32. Differentials In Health Status
Among Rural/Urban India
32

33. Differentials In Health Status
Among States
33

34. Differentials In Health Status
Among Socio-economic Groups
34

35. Achievements Through The Years
1951-2000
35

36. Achievements Through The Years
1951-2000
36

37. Achievements Through The Years
- 1951-2000
37

38. But by the end of 2000 century it was
clear that the goals of health for all by
the year 2000 AD would not be achieved.
• The observed progress suggested that an
additional strategy or new sizable
intervention in achievement of an
unacceptable health of the country.
CONTD…
38

39. Factors responsible for this failure
were:
39
• Biased and poor socio- economic
development in the region where it was
needed most.
• Discriminatory policies due to age,
gender and ethnicity thus preventing
access to health care surveillance.

40. NATIONAL HEALTH POLICY-
2002

41. CONTD…
41
• A revised health policy for achieving
better health care and unmet goals has
been brought out by government of
India- National Health Policy 2002.
• The government and health
professionals are obligated to render
good health care to the society.

42. CONTD…
42
• NHP 2002 has set out a new policy
framework for the acceleration of Public
Health goals in the socioeconomic
circumstances currently prevailing in the
country.

43. 43
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 .

44. • Enhancing the contribution of private
sector who can afford to pay.
CONTD…
44
• Emphasizing rational use of drugs.
• Increasing access to tried systems of
Traditional Medicine.

45. Goals to be Achieved by 2000-2015

46. 2003- Enactmentof legislation for
regulating minimum standard in clinical
establishment .
46
• Eradication of Polio & Yaws
• Elimination of Leprosy
• Increase State Sector health spending
from5.5% to 7% to of the budget.

47. • Establishment of an integrated system of
surveillance, National Health Accounts
and Health Statistics.
• 1% of the total budget for Medical
Research.
• Decentralization of implementation of
public program.
CONTD…
47

48. 2007-
• Achieve Zero level growth of
HIV/AIDS
2010-
• Elimination of Kala- Azar
• Reduction of mortality by 50% on
account of Tuberculosis , Malaria, Other
vector & water borne Diseases.
CONTD…
48

49. • Reduction of IMR to 30/1000 live
births &MMR to100/ Lakh live births.
• Increase utilization of public health
facilities from current level of
<20% to > 75%
CONTD…
49

50. CONTD…
• Increase health expenditure by
government from the existing 0.9% to
2.0% of GDP.
• Further increase of State sector Health
spending from 7% to 8%

51. • 2% of the total health budget for medical
Research.
2015-
• Elimination of lymphatic Filariasis.
51

52. NATIONAL HEALTH POLICY
2015

53. INTRODUCTION;
India today, is the world 3rd largest
economy in terms of its gross national
income . The reality is straightforward .The
power of existing interventions is not
matched by the power of health systems to
deliver them to those in greatest need, in a
comprehensive way, and on an adequate
scale.

54. CONTD...
1. Changing health priorities : maternal
mortality now accounts for 0.55% of all
deaths and 4% of all female deaths in
the 15 to 49 years age groups and
demands that the commitments to
further reduction.
2. Emergence of a robust health care

55. CONTD…
2. industry growing at 15% compound
annual growth rate (CAGR)
3.Incidence of catastrophic expenditure due
to health care costs is growing and is how
estimated to be one of the major contributes
to poverty.

56. CONTD…
4.Economic growth has increased the fiscal
capacity .

57. The primary aim of the NHP 2015 is:

58. CONTD…
o To inform , clarify , strengthen and
primitize the role of the government in
shaping health systems in all its
dimensions.
o Promotion of good health through
cross-sectional action, access to
technologies , developing human

59. CONTD...
o resources, encouraging medical
pluralism , building the knowledge base
required for better health , financial
protection strategies.

60. Situation analysis
1. Achievement of Millennium
Development Goals:
• India is set to reach the Millennium
Development Goals (MDG) with respect to
maternal and child survival.

61. CONTD…
While the narrowing of these gaps
demonstrate a significant effort, we could
have done better.
2. Achievements in Population
Stabilization:

62. CONDT…
l
• Twelve of the 21 large States for which
recent TFR of at or below the replacement
rate of 2.1 and three are likely to reach this
soon.
• The challenge is now in the remaining six
states which accounts for 42 % of the

63. CONTD…
national population and 56 % of the annual
population increases.
3.Inequities in Health Outcomes:
o There are urban-rural inequities and
there are inequities across states.

64. CONTD….
• A number of many in tribal areas, perform
poorly even in those states where overall
averages are improving.
• Outreach and service delivery for the urban
poor, even for immunization services has
been inadequate.

65. 4. Concerns on Quality of Care:
• For example, though over 90% of pregnant
women receive one antenatal check up and
87 % received full TT immunization, only
about 68.7 % of women have received the
mandatory three antenatal check ups.

66. CONTD…
Only 61% of children have been fully
immunized.
5. Performance in Disease Control
Programmes:
• India’s progress on communicable disease
control is mixed.

67. CONTD…
• Even though there have been significant
reductions, there is stagnation ( Leprosy,
Kala Azar, Lymphatic Filariasis, HIV etc.,)
• In tuberculosis the challenge is high
prevalence and rising problems of multi-
drug resistant tuberculosis.

68. • Viral Encephalitis, Dengue and Chikungunya
are on the increase, particularly in urban
areas and as of now we do not have
effective measures to address them.
CONDT…

69. CONTD…
7. Burden of Disease:
• Disease conditions for which national
programmes provide universal coverage
account for less than 10% of all
mortalities and only for about 15% of

70. CONTD….
all mortalities and only for about 15% of all
morbidities.
• Over 75% of communicable diseases are not
part of existing national programmes and
non-communicable diseases (39.1%) and
injuries (11.8%) now constitute the bulk of
the country’s disease burden.

71. 8. Urban Health:
• Rapid urbanization- massive growth in
number of the urban poor population,
especially those living in slums.
• National Urban Health Mission was
sanctioned in 2013- strong focus on
strengthening primary health care.

72. CONTD…
• NUHM needs substantial expansion of
funding on a sustained basis in order to
establish & operationalize well
functional primary health care system in
the urban areas.
• 9. Cost of Care and Efforts at
Financial Protection:

73. CONTD...
• The failure of public investment in health to
cover the entire spectrum of health care
needs is reflected best in the worsening
situation in terms of costs of care and
impoverishment due to health care costs.

74. CONTD…
• All services available under national
programmes are free to all and
universally accessed with fairly good
rates of coverage.
10. Publicly Financed Health
Insurance:
• A number of publicly financed health
insurance schemes were introduced to

75. CONTD…
improve access to hospitalization services and
to protect households from high medical
expenses.
• The Central Government under the Ministry
of Labour & Employment, launched the
RSBY in 2008.

76. CONTD…
11. Healthcare Industry:
• The current growth rate of at 14% and is
projected to be 21% in the next decade.
• The Government has had an active policy
in the last 25 years of building a positive
economic climate for the health care
industry.

77. CONTD….
12. Private Sector in Health:
• The private sector today provides nearly
80% of outpatient care and about 60% of
inpatient care.

78. CONTD….
• 72% of all private health care enterprises are
own- account-enterprises (OAEs), which are
household run businesses.
• But over time employment OAEs are
declining and the number of medical
establishments and corporate hospital.

79. 13. Realizing the Potential of AYUSH
services:
• The National Policy on Indian Systems of
Medicine and Homeopathy (2002)-
mainstreaming of AYUSH under the
NRHM.

80. CONTD…
• There is need to recognize the
contribution of the large private sector
and not-for-profit organizations
providing AYUSH services.
• 14. Human Resource
Development:
• The last ten years have seen a major

81. CONTD…
expansion of medical, nursing and technical
education.
• The challenge is to guide the expansion of
educational institutions to provide skilled
health workers to where they are needed
most, and with the necessary skills.

82. 15. Research and Challenges:
• The Department of Health Research was
established in 2006 to strengthen Indian
efforts in health research.
• Currently over 90% of the research
publications from medical colleges come
from only nine medical colleges.

83. CONTD..
• Funding of less than 1 % of all
public health expenditure has
resulted in limited progress.
16. Investment in Health Care:
• The total spending on healthcare in
2011 in the country is about 4.1% of
GDP.

84. CONTD..
• Spending at least 5–6% of its GDP is
required to attain basic health care needs.
• The Government spending on healthcare in
India is only 1.04% of GDP which is about
4 % of total Government expenditure, less
than 30% of total health spending (Rs. 957
per capita)

85. Goal, objectives and principles:
Goal:
The attainment of the highest possible level
of good health and well-being, 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.

86. Objectives:
1. Improve population health status.
2. Achieve a significant reduction in out of
pocket expenditure due to health care
costs.

87. CONTD...
3. Assure universal availability of free,
comprehensive primary health care services
,as an entitlement.
4. Enable universal access to free essential
drugs ,diagnostics, emergency and surgical
care services in public health facilities.

88. Principles:
Equity:
• Action to reach the poorest and
minimizing disparity on account of
gender, poverty, caste, disability, other
forms of social exclusion and
geographical barriers.

89. CONTD…
• Universality:
• Systemsand services are designed to
cater to the entire population- not
only a targeted sub-group.
• Patient Centered & Quality of
Care:

90. CONTD…
• Health Care services would be effective,
safe, convenient provided with dignity
and confidentiality with all facilities
across all sectors being assessed,
certified and incentivized to maintain
quality of care.

91. • Inclusive Partnership
– Participation of institution not for profit
agencies and to achieve these goals is
required.
CONDT…

92. • Pluralism:
–Patients would have access to AYUSH care
providers based on validated local health
traditions.

93. • Subsidiarity:
–For ensuring responsiveness and
greater participation, increasing
transfer of decision making to as
decentralized a level as is consistent
with practical considerations.

94. • Accountability:
–Financial and performance accountability,
transparency in decision making, and
elimination of corruption in health care
systems, both in the public systems and in
the private health care industry, would be
essential.

95. • Professionalism, Integrity and
Ethics:
–Health workers and managers shall
perform their work with the highest
level of professionalism, integrity and
trust .

96. • Learning and Adaptive System:
–Constantly improving dynamic
organization of health care which is
knowledge and evidence based, reflective
and learning from the communities they
serve, the experience of implementation
itself, and from national and international
knowledge partners.

97. • Affordability:
–As costs of care rise, affordability, as
distinct from equity, requires
emphasis.

98. NATIONAL HEALTH POLICY
2017

99. INTRODUCTION;
The primary aim of the national health
policy 2017, is to inform , clarify ,
strengthen and prioritize the role of the
govt. in shaping health systems in all its
dimensions .

103. 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.

104. 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.

105. 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.
It also support in research and supervision
to develop and enrich their contribution to
meeting the national health goals.

106. Decentralization:
Decentralisation 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.

107. The indicative, quantitative goals and
objectives are outlined under three
broad components viz.
1
• Health status and programme impact
2
• Health systems performance
3
• Health system strengthening.

108. Goals To Be Achieved:
Increase Life Expectancy from 67.5 to
70 by 2025.
Establish regular tracking of Disability
Adjusted Life Years (DALY) Index as a
measure of burden of disease by 2022.

109. CONTD…
 Reduction of TFR to 2.1 at national and
sub-national level by 2025.
 Reduce neo-natal mortality to 16 and
still birth rate to‘single digit’ by
2025.

110. Reduce infant mortality rate to 28 by
2019.
Achieve and maintain elimination
status of Leprosy by 2018.
Kala-Azar by 2017 and Lymphatic
Filariasis in endemic pockets by 2017.
CONTD…

111. 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.
To reduce the prevalence of blindness to
0.25/ 1000 by 2025.
CONTD…

112. CONTD…
 To reduce premature mortality from
cardiovascular diseases, cancer,
diseases by 25% by 2025.
 Increase State sector health spending, to
> 8% of their budget by 2020.

113. Relative reduction in prevalence of current
tobacco use by 15% by 2020 and 30% by
2025.
40% Reduction in prevalence of stunting
of under-five children by 2025.
Safe water and sanitation to all by 2020
(Swachh Bharat Mission).
CONTD…

114. CONTD…
 Reduction of occupational injury by
half of current levels of 334 per lakhs
agricultural workers by 2020.
 Increase health expenditure by
government from the existing
1.15%(GDP) to 2.5%(GDP) by 2025.

115. Decrease in proportion of households
facing catastrophic health expenditure
from the current levels by 25%, by 2025.
Ensure availability of paramedics and
doctors as per IPHS norm in high priority
districts by 2020.
CONTD…

116. Ensure district-level electronic database of
information on health system components
by 2020.
Establish federated integrated health
information architecture and National Health
Information Network by 2025.
CONTD…

117. National Health Programmes
1 • RMNCH+A services
2 • Child and Adolescent Health
3 • Universal Immunization
4 • Communicable Diseases
5 • Mental Health
6 • Non-Communicable Diseases
7 • Population Stabilization

118. RMNCH+A services:
This policy aspires to elicit developmental
action of all sectors to support Maternal
and Child survival. The policy strongly
recommends strengthening of general
health systems to prevent and manage
maternal complications, to ensure
continuity of care and for maternal health.

119. Child and Adolescent Health:
 Its aim are to reduce neonatal mortality
and promotes the care for newborn.
School health programmes as a majorfocus
area, health and hygiene being made a part
of the school curriculum.

120. Universal Immunization:
 To improve immunization coverage with
quality and safety, improve vaccine
security as per National Vaccine Policy
2011 and introduction of newer vaccines
based on epidemiological considerations.
The focus will be to build upon the
success of Mission Indradhanush and
strengthen it.

121. Communicable Diseases:
The policy recognizes the interrelationship
between communicable disease control
programmes and public health system
strengthening.
The policy acknowledges HIV and TB co
infection and increased incidence of drug
resistant tuberculosis .

122. Mental Health:
Create network of community members to
provide psycho-social support to strengthen
mental health services at primary level
facilities.
Leverage digital technology where access to
qualified psychiatrists is difficult.

123. Non-Communicable Diseases:
Its impact on reduction of morbidity and
preventable mortality with incorporation into
the comprehensive primary health care at the
primary level.
Screening for oral, breast and cervical
cancer and COPD will be focused in addition
to hypertension and diabetes .

124. Population Stabilization:
Policy imperative is to move away from
camp based services to a situation where
these services are available on any day of
the week.
To increase the male sterilization from
less than 5% to at least 30% and if
possible much higher.

125. CONCLUSION:
 While the public health initiatives over
the years have contributed significantly
to the improvement of the health
indicators, it is to be acknowledged that
public health indicators/ disease burden
statistics are the
125

126. CONTD…
outcome of several complementary
initiatives under the wider umbrella of the
developmental sector, covering rural
development, agriculture, food production,
sanitation, drinking water supply,
education etc.
 Despite the impressive public health
gains, the morbidity and mortality
levels in the country

127. CONTD…
are still unacceptably high as compared to
the developed countries.
Further dedicated efforts are required to
achieve goal of ‘Health for All’ in 21st
century’.
NHP 2002 will provide an impetus for
achieving an acceptable standard of
good health of people of India.
127

128. Let us work together for “Health
for ALL.’’
128

129. REFRENCES
129
• Alma-Ata, 1978- Primary Health Care
:WHO, UNICEF.
• Government of India, Ministry of
Human Resource Development,
Annual Report 2001-2002.
• K.J. National Health Programs of
India. 11th Edition, 2014.
• K.Park , 23rd Edition, 2009.

130. THANK YOU
130