1. NATIONAL HEALTH POLICY 2002
DR. VAIBHAV GUPTA
MPH 1st year Student
Dept. of community medicine
JSSMC
10/05/2013
MODERATOR: DR. P.B.
Asst. Prof.
1
2. Plan of Presentation
Introduction
NHP 1983
Scenario Before National Health Policy 2002
Objective
Goals to be Achieved by 2000-2015
NHP -2002 Policy Prescription
Recent development
Achievements
Strength
Goals failed to be achieved by 2005
Critical review
2
3. INTRODUCTION
• Policy is a system, which provides the logical
framework and rationality of decision making for the
achievement of intended objectives.
• It is the statement that guide and provide discretion
within limited boundaries.
• Policy sets priorities and guide resources allocations.
Public health policy improves conditions under which
people live :
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4. CONT............
Secure, safe, adequate and sustainable livelihood
• Lifestyle and environments, including housing
• Education, nutrition, childcare, reproduction health
• Transportation, information and communication,
necessary community and personal social and health
services.
• Policy adequacy may be measured by its impact on
population health.
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5. NHP-1983
First formal NHP was formulated in 1983 and since then
there have been marked changes in the determinant factors
relating to the health sector.
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6. Scenario Before National Health Policy 2002
The public health investment in the country over the year
has been comparatively low and declining and as a
percentage of GDP has declined from 1.3% in 1990 to
9.9%in 1999.out of this , about 17% of the aggregate
expenditure is public health spending , the balance being
out-of- pocket expenditure. The States expenditure has
declined from 7.0% to 5.5% .
The current annual per capita public health expenditure in
the country is not more than Rs.200. The contribution of
Central resources to the overall public health funding has
been limited to about 15% .
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7. OBJECTIVES
To Achieve an acceptable standard of good health amongst
the general population of the country.
To increase access to the decentralizing public health system
by establishing new infrastructure in deficient areas and, by
upgrading the infrastructure in existing institutions.
To ensuring a more equitable access to health services
across the social and geographical expanse of the country.
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8. CONT…….
To enhance the contribution of the private sector in
providing health service for the population group which
can afford to pay for services.
To increase the aggregate public health investment
through a substantially increased by the central
government.
To strengthen the capacity of the public health
administration at the state level to render effective service
delivery.
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9. cont.........
To rationalize use of drugs within the allopathic system.
To increase access to tried and tested systems of
traditional Medicine.
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10. Goals to be Achieved by 2000-2015
2003 –
• Enactment of legislation for regulating minimum standard in
clinical Establishment / Medical institution
2005 –
• Eradication of Polio & Yaws
• Elimination Leprosy
• Increase State Sector health spending from 5.5% to 7% to of
the budget.
• 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 health program
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11. CONT........
2007-
• Achieve of 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
• Reduce prevalence of Blindness to 0.5%
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12. CONT....
• 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%
• Increase health expenditure by government from the
existing 0.9% to 2.0% of GDP
• Increase share of Central grants to constitute at least
25% of total health spending
12
13. cont…
• Further increase of State sector Health spending from
7% to 8%
• 2% of the total health budget for medical Research
2015-
• Elimination lymphatic Filariasis
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14. NHP -2002 Policy Prescription
1.Financial Resources :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.
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15. 2.Equity :
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.
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55%35%
10%
Primary Secondary T ertiary
16. 3.Delivery of national public health programs
NHP 2002 envisages the gradual convergence of all health
programmers under a single field administration.
It suggests for a scientific designing of public health
projects suited to the local situation.
Therefore, the policy places reliance on strengthening of
public health outcomes on equitable basis.
It recognizes the need of user charge for secondary and
tertiary public health care for those who can afford to pay.
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17. 4.The state of public health Infrastructure:
The Policy envisages kick- starting the revival of the Primary
Health System by providing some essential drugs under Central
government funding through the decentralized health system.
This initiative under NHP-2002 is launched in this belief that
the creation of a decentralized public health system will ensure
a more effective supervision of the public health personnel
through community monitoring , than has been achieved
through the regular administrative line of control.
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18. 5.Extending public health services:
Expanding the pool of medical Practitioners to include
a cadre of licentiates of medical practice, as also
practitioners of Indian systems of Medicine and
Homoeopathy has been advocated in the policy.
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19. 6. Role of local self- Government Institutions
NHP-2002 lays great emphasis upon the implementation
of public health programs through local self –government
institutions.
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20. 7. Norms of Health care Professional:
Minimal statutory norms with constant reviewing for the
deployment of doctors and nurses in medical institutions
need to be introduced urgently under the provision of the
Indian Medical council Act and Indian Nursing Council
Act , respectively.
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21. 8.Education of Health care Professional:
The need for inclusion of contemporary medical research
and geriatric concern and creation of additional PG seats
in deficient specialties are specified.
It suggests for a need based, skill oriented syllabus with a
more significant component of practical training.
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22. For discharging public health responsibilities in the country
NHP 2002 recommends specialization 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.
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9.Need for specialists in 'public health' and 'family
medicine’:
23. 10.Nursing personnel:
NHP 2002 recognizes acute shortage of nurses trained in
superspeciality disciplines.
It recommends increase of nursing personnel in public health
delivery centers and establishment of training courses for
superspecialities.
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24. 11. Use of Generic drugs and vaccines
This Policy emphasizes the need for basing treatment
regimens , in both the public and private domain, on a
limited number of essential drugs of a generic nature.
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25. 12. 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;
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26. cont…
First Tier:-
Primary centre cover 1 Lakh population
It functions as OPD facilities.
It provides essential drugs.
It will carry out national health programmers.
26
27. cont….
Second Tier:-
General Hospital a referral to primary centre provides the
care.
The policy recommends a fully equipped hub-spoke
trauma care network to reduce accident mortality.
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28. 13.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.
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29. 14.Information Education and Communication:
NHP-2002 has suggested interpersonal communication by
folk and traditional media to bring about behavioral
change.
School children are covered for promotion of health
seeking behavior, which is expected to be the most cost
effective intervention where health awareness extends to
family and further to future generation.
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30. 15.Health research:
• 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.
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31. 16.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.
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.
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32. 17. Role of civil Society:
The Policy envisages that the disease control Programs
should earmark not less than 10% of the budget in respect
of indentified program components ,to be exclusively
implemented through NGOs, and other civil institution.
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33. 18. National Disease Surveillance Network:
This Policy envisages the full operationalization of an
integrated disease control network by 2005.this public
health surveillance network will also encompass
information from private health care institutions and
practitioners.
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34. 19.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 .
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35. 20.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.
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36. 21.Medical Ethics:
In India we have guidelines on professional medical ethics
since 1960.
This is revised in 2001.
Government of India has emphasized the importance of
moral and religious dilemma.
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.
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37. 22.Enforcement of Quality Standards for food and
Drugs :
NHP 2002 envisaged that Food and Drug administration
be strengthened in terms of laboratory facilities and
technical expertise.
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38. 23.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.
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39. 24. Environmental &Occupational Health:
Government has noted the ambient environment condition
like unsafe drinking water, unhygienic sanitation and air
pollution.
Child labor and substandard working conditions are
causing occupational linked ailments.
NHP 2002 has suggested for an independent state policy
and programme for environment apart from periodic
health screening for high risk associated occupation.
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40. 25.Providing Medical Facilities to Users from
Overseas (Health Tourism)
The NHP-2002 Strongly encourages the providing of such
health services on a payment basis to service seekers from
overseas. Recently large number of patients from overseas
are coming to India for treatment (Medical Tourism).
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41. 26.Impact of Globalization on Health Sector:
Possible threat to health security in the post-TRIPS era, as
a result of a sharp increase in the prices of drugs and
vaccines has been acknowledged.
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42. Recent development
The Prime Minister has launched the Public Health
foundation of India (PHFI) , a public- private initiative in
the health sector, which seeks to establish world -class
public health institutes to train professional in the filed.
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43. Achievements
2003 –
• Enactment of legislation for regulating minimum standard in
clinical Establishment / Medical institution
2005-
• Eradication of Poliomyelitis is missed ,however there is zero
reporting of yews since 2004.
• Leprosy has been declared eliminated according to the criteria
fixed by WHO. However, more efforts are required.
• Integrated Disease Surveillance Project has been launched but
establishment of National Health Accounts and Health Statistics is
still lagging behind. IDSP is also going at a slow pace.
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44. CONT...
• Spending of state Sector Health has not much increased as
planned from 5.5% to7.7% of budget.
• Budget for medical research is not much increased as 1% of the
total health budget for Medical Research has been targeted.
• Decentralization of implementation of public health Programs:
National Rural Health Mission has been launched in this
direction.
2007-
• Achieve of Zero level growth of HIV/AIDS
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45. Strength
NHP-2002 has got the opportunity to refer many documents
and reports like World Development Report 1993.
National Family Health Survey 1993-94 and 1998-1999.
The census of India 2001.
World Health Report 2002, and favourable environment lick
support of international health agencies, economic and political
reforms particularly 73rd and 74th amendment of the
constitution of india.
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46. Goals failed to be achieved by 2005
Eradicate Poliomyelitis
Establish an integrated system of surveillance , National
Health Accounts and Health Statistics.
Increase State Sector Health spending from 5.5% to 7%
of the budget.
1% of the total health budget for Medical Research .
Decentralization of implementation of public health
programs.
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47. Critical review
The policy does not referred to the Women Empowerment
policy 2001 while describing measures to ensure women
health.
Women’s health has not received enough attention in the policy
similarly child health , adolescents ,gender discrimination and
violence should have received adequate concerns.
Old age group has got very less attention in the policy.
Ignored areas
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48. cont....
Integration of vertical program activities with general
health service ensure sustainability.
School Health programs have not achieved the desired
results in the majority of states.
For decentralization: Role of Local Self –Government
Institutions has been defined in the policy and should have
achieved by 2005.
Mismatch situation analysis and Policy Prescriptions.
48
49. cont...........
There is passing comment on strengthening primary
health care but how this can be achieved policy has not
specified. Its is also silent on village health workers.
Failing to brings Anganwadi workers and other grass root
level workers on one platform.
Medical Council of India: Contradictions and Dilution of
Standards
Posting Freshly graduate doctors in rural areas has been
failed to brings change and most of the places it is not
implemented at all.
ROME scheme is also failed.
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