2. Introduction
Health policy defines health goals at the
international, national, or local level and specifies
the decisions, plans, and actions to be undertaken
to achieve these goals," according to the World
Health Organization (WHO).
3. Definition
National health policy is an initiative by the central
government to strengthen the health system in India.
This initiative molds various dimensions of health sectors like
disease prevention, promotion of good health via cross-
sectoral actions, health investment, strengthening human
resources, technological advancements and more.
There has been 3 NHPs by government of India.
The three NHPs are- NHP (1983), NHP (2002) and NHP (2017).
4. NATIONAL HEALTH POLICY(1983)
The first National Health Policy of 1983 was a response to
the commitment to the Alma Ata declaration to achieve
"Health for all by 2000" by the Union Ministry of Health
and Welfare.
It accepted that health was central to development and
had a focus on access to health services, especially for
vulnerable groups.
5. KEY ELEMENTS OF NATIONAL HEALTH
POLICY 1983:-
It strongly stresses on:
• Primary health care infrastructure
• Coordination with health-related services
• Active involvement of voluntary organization
• Provision of essential drugs and vaccines
• Qualitative improvement in health and family planning services
• Provision of adequate training
• Medical research on common health problems.
6. KEY ELEMENTS OF NATIONAL HEALTH
POLICY 1983:-
• Creation of greater awareness of health problem by the
community
• Supply of safe drinking water and basic sanitation
• Reduction of existing imbalance in health care
• Establishing dynamic HMIS
• Providing legislative support to health protection and
promotion
• Concerned action to combat widespread malnutrition
• Research in alternative methods of health care delivery and
low-cost health technologies
• Greater coordination of different systems of medicine.
8. cont..
• This is a substantial progress by 2000 .
• There has also been a decline in vaccine-preventable
diseases due to an improvement in the immunization
coverage.
• Smallpox, Guinea worm, and polio have been eradicated
countrywide.
• Water-borne diseases are also much less than before.
• But TB, malaria, malnutrition, diseases related to lifestyle,
like DM, HTN are still major public health problems.
9. FACTORS INTERFERING WITH THE PROGRESS
TOWARDS HEALTH FOR ALL:-
• Insufficient political commitment
• Failure to achieve equity in access to all primary health care elements.
• The continuing low status of women.
• Slow socio-economic development.
• Unbalanced distribution and weak support for human resources.
• Widespread inadequacy of health promotion activities.
• Weak health information system and no baseline data.
• Pollution, poor food, safety, and lack of water supply and sanitation.
• Rapid demographic and epidemiological changes.
• Inappropriate use and allocation of resources, high-cost technology.
• Natural and man-made disasters.
10. NATIONAL HEALTH POLICY 2002:-
Considering the kind and level of progress, the barriers and
the change in health problems and the circumstances, the
department of Health, Ministry of formulate a new health
policy frameworks.
The main objective of this National Health Policy was to
achieve acceptable standard of good health amongst the
general population of the country.
11. KEY COMPONENTS :
The National Health Policy-2002(NHP) gives prime
importance to ensure a more equitable access to
health services across the social and geographical
expanse of the country.
The highlights of the policy are:
12. 1. Increase health sector expenditure to 6 percent of GDP, with 2 percent of GDP being
contributed as public health investment, by the year 2010. An increased allocation of 55
percent of the total public health investment for the primary health sector.
2. The gradual convergence of all health programmes under a single field administration.
Vertical programmes for control of major diseases like TB, Malaria, HIV/AIDS.
The interventions of State Health Departments may be limited to the overall monitoring
of the achievement of programme targets and other technical aspects.
3. 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.
13. 4. State Governments would consider the need for 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.
States to simplify the recruitment procedures and rules for contract employment in order
to provide trained medical manpower in under-served areas.
5. Enforce a mandatory two-year rural posting before the awarding of the graduates
degree.This would not only make trained medical manpower available in the underserved
areas, but would offer valuable clinical experience to the graduating doctors.
This policy also recommends a periodic skill updating of working health professional
through a system of Continuing Medical Education.
14. 6. Panchayat bodies to be involved more in health care programmes. All State Governments to
consider decentralizing the implementation of the programmes to such institutions by 2005.
7. The policy emphasizes the need for an improvement in the ratio of nurses vis-à-vis doctors/beds.
8. The 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.
9. The setting up of an organized urban primary health care structure is contemplated with two-
tiered one: the primary center is seen as the first-tier, covering a population of one lakh, and a
second tier of the urban health organization at the level of government general hospital.
10. Establishment of fully equipped ‘hub-spoke’ trauma care networks in large urban agglomerations
to reduce accident mortality.
15. 11. The upgrading of the physical infrastructure of mental hospital / institutions at Central
Government expense so as to secure the human rights of this vulnerable segment of society.
12. The policy proposes to focus on the inter-personal communication of information and on folk
and other traditional media to bring about behavioural change.
13. Giving priority to school health programmes which aim at preventive health education, providing
regular health check-ups, and promotion of health-seeking behaviour among children.
14. An increase in Government funded health research to a level of 1 percent to the total health
spending by 2005, and thereafter up to 2 percent by 2010.
15. The setting up of private insurance instruments for increasing the scope of the coverage of
secondary and tertiary sector under private health insurance packages is being considered. A social
health insurance scheme, funded by the Government, and with service delivery through the private
sector, would be considered.
16. 16. Involvement of non-Governmental practitioners in the national diseases control programmes so as
to ensure that standard treatment protocols are followed in their day-to-day practice.
17. Significant contribution made by NGOs and other institution of the civil society in making
available health services to the community is recognised.
18. Full operationalization of an integrated disease control network from the lowest rung of public
health administration to the Central Government by 2005.
19. Baseline estimates for the incidence of the common diseases – TB, Malaria, Blindness would be
done by 2005. Baseline estimates for non-communicable diseases, like CVD, Cancer, Diabetes and
accidental injuries and communicable diseases like Hepatitis and JE would also be compiled.
20. The need to establish national health accounts, conforming to the ‘source-to-users’ matrix
structure would help in estimation of health costs on a continuing basis.
17. 21. The highest priority of the Central Government to the funding of the identified programmes relating to
woman’s health.
22. A comprehensive code of ethics be notified and rigorously implemented by the Medical Council of India. Establishment of
statutory professional councils to register practitioners, maintain standards of training, and monitor performance.
23. The standards of food items will be progressively tightened up at a pace, which will permit domestic food
handling/manufacturing facilities to undertake the necessary upgradation of technology.
24. The periodic screening of the health conditions of the workers, particularly for high-risk health disorders
associated with their occupation.
25. The providing of such health services on a payment basis to service seekers from overseas- Medical Tourism. Payment in
foreign exchange, all fiscal incentives, including the status of "deemed exports", which are available to other exports of goods
and services, would be extended.
26. A national patent regime for the future, which, while being consistent with TRIPS, avails of all opportunities to secure for the
country, under its patent laws, affordable access to the latest medical and other therapeutic discoveries.
18. GOALS TO BE ACHIEVED BY 2001-2002 TO 2015:-
• Eradicate Polio andYaws - 2005
• Eliminate Leprosy - 2005
• Eliminate Kala-Azar - 2010
• Eliminate Lymphatic Filariasis - 2015
• Achieve zero level growth of HIV/AIDS - 2007
• Reduce mortality by 50% On account of TB,Malaria and other vector borne and water borne
diseases- 2010
• Reduce prevalence of blindness to 0.5% - 2010
• Reduce IMR to 30/1000 and MMR to 100/lakh - 2010
• Increase the utilization of Public Health Facilities from current <20 to >75% - 2010
• Establish an integrated system of surveillance, national health accounts and statistics - 2005
• Increase health expenditure by government as a percentageof GDP from 0.09% to 2%increase
share of central -2010
• Increase central grants to constitute at least 25% of total health spending
• Increase state sector health spending from 5.5% to7 %of the budget-2005
• Further increase to 8%.
19. NATIONAL HEALTH POLICY 2017
Since NHP 1983, the current context has however 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
non-communicable 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.
20. Goal
The attainment of the highest possible level of health and
well-being 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.
21. Objectives
Improve health status through planned policy action in all
sectors and expand preventive, promotive, curative, palliative
and rehabilitative services provided through the public health
sector with focus on quality.
23. A.HEALTH STATUS AND PROGRAMME IMPACT
1.Life Expectancy and healthy life
• Increase Life Expectancy at birth from 67.5 to 70 by 2025.
• Establish regular tracking of DALY as a measure of burden of disease and its trends
by 2022
• Reduction of TFR to 2.1 at national and sub- national level by 2025.
2.Mortality by Age and/ or cause
• Reduce Under Five Mortality to 23 by 2025 and MMR from current levels to 100 by
2020.
• Reduce infant mortality rate to 28 by 2019.
• Reduce neo-natal mortality to 16 and still birth rate to “single digit” by 2025.
24. A.HEALTH STATUS AND PROGRAMME IMPACT
3.Reduction of disease prevalence/ incidence
• 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 -90%
of all people receiving antiretroviral therapy will have viral suppression.
• Achieve and maintain elimination status of Leprosy by 2018, Kala-Azar by 2017 and
Lymphatic Filariasis in endemic pockets by 2017.
• 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 and disease burden by
one third from current levels.
• To reduce premature mortality from cardiovascular diseases, cancer, diabetes or
chronic respiratory diseases by 25% by 2025.
25. B.Health systems performance
1. Coverage of health services
• Increase utilization of public health facilities by 50% from current levels by 2025.
• Antenatal care coverage to be sustained above 90% and skilled attendance at birth above 90% by
2025.
• More than 90% of the newborn are fully immunized by one year of age by 2025.
• Meet need of family planning above 90% at national and sub-national level by 2025.
• 80% of known hypertensive and diabetic individuals at household level maintain 'controlled disease
status' by 2025.
2. Cross sectoral goals related to health
• Relative reduction in prevalence of current tobacco use by 15% by 2020 and 30% by 2025.
• Reduction of 40% in prevalence of stunting of under-five children by 2025.
• Access to safe water and sanitation to all by 2020 (Swachh Bharat Mission).
• Reduction of occupational injury by half from current levels of 334 per lakh agricultural workers by
2020.
• National/state level tracking of selected health behaviour.
26. C.Health Systems strengthening
1.Health finance
• Increase health expenditure by Government as a percentage of GDP from the existing
1.15% to 2.5% by 2025.
• Increase state sector health spending to > 8% of their budget by 2020.
• Decrease in proportion of households facing catastrophic health expenditure from the
current levels by 25% by 2025.
2. Health infrastructure and human resource
• Ensure availability of paramedics and doctors as per Indian Public Health Standard (IPHS)
norm in high priority districts by 2020.
• Increase community health volunteers to population ratio as per IPHS norm, in high
priority districts by 2025.
• Establish primary and secondary care facility as per norms in high priority districts
(population as well as time to reach norms) by 2025.
3. Health management information
• Ensure district-level electronic database of information on health system components by
2020.
• Strengthen the health surveillance system and establish registries for diseases of public
healthimportance by 2020.
• Establish federated integrated health information architecture, health information
exchanges and national health information network by 2025.
27. POLICY THRUST
1.Ensuring Adequate Investment
• The policy proposes a potentially achievable target of raising public health expenditure to 2.5% of the GDP.
• The Government could consider imposing taxes on specific commodities- such as the taxes on tobacco,
alcohol and foods having negative impact on health, taxes on extractive industries and pollution
• Funds available under Corporate Social Responsibility would also be leveraged for well-focused programme.
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.
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
28. • The policy lays greater emphasis on investment and action in school
health- by incorporating health education as part of the curriculum,
promoting hygiene and safe health practices within the school
environment and by acting as a site of primary health care.
• Promotion of healthy living and prevention strategies from AYUSH
systems and Yoga at the work-place, in the schools.
• Recognizing the risks arising from physical, chemical, and other
workplace hazards, the policy advocates for providing greater focus
on occupational health.
• ASHA will also be supported by other frontline workers like health
workers (male/female) to undertake primary prevention for non-
communicable diseases.
• “Health Impact Assessment” of existing and emerging policies, of
key non-health departments that directly or indirectly impact health
would be taken up.
29. 3.Organisation of Public Health Care Delivery
The policy proposes seven key policy shifts in organizing health care services
1. In primary care – from selective care to assured comprehensive care with
linkages to referral hospitals
2. In secondary and tertiary care – from an input oriented to an output
based strategic purchasing
3. In public hospitals – from user fees & cost recovery to assured free
drugs, diagnostic and emergency services to all
4. In infrastructure and human resource development – from normative
approach to targeted approach to reach under-serviced areas
5. 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.
6. In National Health Programmes – integration with health systems for
programme effectiveness and in turn contributing to strengthening of health
systems for efficiency.
7. In AYUSH services – from stand-alone to a three dimensional
mainstreaming
30. 4.Primary Care Services & Continuity of Care
• Free primary care provision by the public sector, supplemented by strategic
purchase of secondary care hospitalization and tertiary care services from
both public and from non-government sector.
• The facilities which start providing the larger package of comprehensive
primary health care will be called „Health and Wellness Centers‟.
• To make this a reality, every family would have a health card that links them
to primary care facility and be eligible for a defined package of services
anywhere in the country.
5.Secondary Care Services
• Basic secondary care services, such as caesarean section and neonatal care
would be made available at the least at sub-divisional level in a cluster of few
blocks.
• To achieve this, policy therefore aims to have at least two beds per thousand
population distributed in such a way that it is accessible within golden hour
rule.
• This policy affirms in expanding the network of blood banks across the
country to ensure improved access to safe blood.
31. 7.Closing Infrastructure and Human Resource/Skill Gaps
• The policy initiatives aim for measurable improvements in quality
of care.
• Districts and blocks which have wider gaps for development of
infrastructure and deployment of additional human resources
would receive focus.
• Financing for additional infrastructure or human resources would
be based on needs of outpatient and inpatient attendance and
utilization of key services in a measurable
8.Urban Health Care
• Policy would also prioritize the utilization of AYUSH personnel in
urban health care.
• An important focus area of the urban health policy will be
achieving convergence among the wider determinants of health –
air pollution, better solid waste management, water quality,
occupational safety, road safety, housing, vector control, and
reduction of violence and urban stress.
• These dimensions are also important components of smart cities.
32. 9.National Health Programmes working towards :
• RMNCH+A services
• Child and Adolescent Health
• Interventions to address malnutrition and micronutrient deficiencies
• Universal Immunisation
• Communicable Diseases
• Non Communicable Diseases
• Mental Health
• Population Stabilisation
• District hospitals must ensure screening and treatment of growth related problems,
birth defects, genetic diseases and provide palliative care for children.
• The policy affirms commitment to pre-emptive care (aimed at pre-empting the
occurrence of diseases) to achieve optimum levels of child and adolescent health.
• There is a need to support care and treatment for people living with HIV/AIDS through
inclusion of 1st, 2nd and 3rd line antiretroviral(ARV), Hep-C and other costly drugs into
the essential medical list.
• Screening for oral, breast and cervical cancer and for Chronic Obstructive Pulmonary
Disease (COPD) will be focused in addition to hypertension and diabetes.
33. 10.Other aspects :
Emergency Care and Disaster Preparedness -The policy envisages creation of a
unified emergency response system, linked to a dedicated universal access number,
with network of emergency care that has an assured provision of life support
ambulances, trauma management centers– - one per 30 lakh population in urban
areas and - one for every 10 lakh population in rural areas
Mainstreaming the Potential of AYUSH- Yoga would be introduced much more
widely in school and work places as part of promotion of good health as adopted in
National AYUSH Mission (NAM).
Linking AYUSH systems with ASHAs and VHSNCs would be an important plank of this
policy.The National Health Policy would continue mainstreaming of AYUSH with
general health system but with the addition of a mandatory bridge course that gives
competencies to mid-level care provider with respect to allopathic remedies.
Tertiary care Services -It recommends that the Government should set up new
Medical Colleges, Nursing Institutions and AIIMS in the country following this broad
principle.
The policy recommends establishing National Healthcare Standards Organization and
to develop evidence based standard guidelines of care applicable both to public and
private sector.
Medical Education - The policy recommends strengthening existing medical colleges
and converting district hospitals to new medical colleges to increase number of
doctors and specialists, in States with large human resource deficit.
National Knowledge Network shall be used for Tele- education, Tele-CME, Tele-
consultations.
34. Attracting and Retaining Doctors in Remote Areas - Creating medical colleges in rural areas;
preference to students from under-serviced areas, and curriculum to suit rural health needs,
mandatory rural postings, etc.
Mandatory rotational postings.
Increase the capacity of the public health systems to absorb and retain the manpower.
The total sanctioned posts of doctors in the public sector should increase to ensure availability of
doctors corresponding to the accepted norms.
Implementation Framework and Way Forward- The National Health Policy envisages that an
implementation framework be put in place to deliver on these policy commitments.
Such an implementation framework would provide a roadmap with clear deliverables and milestones
to achieve the goals of the policy.
Salient Features
• Health card for all
• Free drugs, diagnostics & emergency care at CHC, PHC & district hospital by filling gaps through
strategic purchasing i.e engaging pvt sectors
• 66% hike in primary health spend
• 2 beds per 1000 population
• Involvement of private sectors to achieve goals
• Screening of NCDs (cancer at earliest stage)
• Conversion of sub centres/health centres into Wellness centre
35. SUMMARY
Through this topic we came to know about national
health policy 1983, 2002 and 2017, their goals , key
features and problems in achieveing them.
36. CONCLUSION
National health policy is an initiative by the central government to
strengthen the health system in India. This initiative molds various
dimensions of health sectors like disease prevention, promotion of
good health via cross-sectoral actions, health investment,
strengthening human resources, technological advancements and
more.
There has been 3 NHPs by government of India
37. REFRENCES
• Park, K. Parks Textbook of Preventive and Social
Medicine. 26th Edition. Jabalpur. M/S Banarsidas Bhanot
Publishers. 2021.
• Dash B. A comprehensive textbook of community health
nursing.Geriatric Care.First edition. New Delhi. Jaypee
brothers medical publishers. 2017
• GOI. National health policy 2017[Internt]. 2017. available
at
:https://www.nhp.gov.in/nhpfiles/national_health_policy_2
017.pdf
