National health policy

Health Policy Formulation in India
• Ministry of Health identified the need for policy arising
out of handling of day-to-day problems related to various
health programs and commitment to achieving the goals
of HFA by 2000 AD.
• Ministry appointed a committee to review environment in
the health sector and recommended a policy frame after
needful consultation.
2

• The draft policy document based on the recommendation of 5th
Joint Conference of Central Council of Health and Family Welfare in
October 1978 was thrown open to various individuals, groups,
institutions and health related sectors for wider discussions and
comments with a view to build inter-linkages between various
Ministries and provide rationality, consistency in the content and
suggest alternates within the possible resources, to improve the
acceptability of the policy.
3

• The revised draft was presented to subsequent Joint Council
of Health and Family Welfare to get the views of Health
Ministers of the States and later to National Development
Council to get the views of the State Chief Ministers and their
concurrence.
• The final draft was presented to the Cabinet for approval and
adoption.
4

• After the Cabinet's approval the document was
presented in the National Parliament for ratification in
December 1982.
5

NATIONAL HEALTH POLICY – 1983
6

• The NHP-1983 gave a general exposition of the
policies which required recommendation in the
circumstances prevailing in the health sector.
• NHP-1983, in a spirit of optimistic empathy for the
health needs of the people, particularly the poor and
underprivileged, had hoped to provide ‘Health for All
by the year 2000 AD’, through the universal
provision of comprehensive primary health care
services.
NHP-1983
7
Babu V.V.R.S. Review in Community Medicine. Ch-14 Public Health Administration and National Programmes. 2nd ed. Hyderabad: Paras Medical Books. 1996

ACHIEVEMENTS THROUGH THE YEAR
1951-2000
INDICATOR 1951 1981 2000
Life Expectancy 36.7 54 64.6
CBR 40.8 33.9 26.1
CDR 25 12.5 8.9
IMR 146 110 70
8

NATIONAL HEALTH POLICY – 2002
9

INTRODUTION
GOALS
REVIEW OF THE HEALTH SITUATION
OBJECTIVES OF THE POLICY
POLICY PRESCRIPTION
COMMENTS
10

• NHP-1983 served the purpose for some time but
over the years the health scene of the country
changed.
• New challenges could not be addressed within the
framework of that policy- it necessitated a revision.
• The government of India initiated the process by
holding wide ranging deliberations involving central
and state governments, voluntary organizations
and the central council of health and family welfare.
NHP-2002
11Dhaar GM. Robbani I. Foundations of Community Medicine. Ch 55- HEALTH CARE IN THE INDIAN CONTEXT. 1st ed. Elsevier; 2006.
INTRODUCTION – NHP 2002

• A draft of national health policy was formulated
and circulated for eliciting comments from
responsible sources.
• A final shape was given to the policy and was
eventually approved by the cabinet and launched
as NATIONAL HEALTH POLICY – 2001.
NHP-2002

• The policy aims to achieve an acceptable standard of good
health among the general population of the country and
has set goals to be achieved by the year 2015.
• However, from a global perspective India’s public spending
on health is extremely low.
NHP-2002

Goals to be achieved by 2000-2015
Eradicate Polio and Yaws 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 and Water Borne diseases
2010
Reduce Prevalence of Blindness to 0.5% 2010
Reduce Infant Mortality Rate (IMR) to 30/1000 and Maternal
Mortality Ratio (MMR) to 100/Lakh
2010
NHP-2002
14
Roy R, Saha I. Mahajan and Gupta Textbook of Preventive and Social Medicine. Part-IV Health Care and Services. 4th ed. New Delhi, Jaypee Brothers; 2013.

Increase utilization of public health facilities from current Level of
<20 to >75%
2010
Establish an integrated system of surveillance, National Health
Accounts and Health Statistics.
2005
Increase health expenditure by Government as a % of GDP from the
existing 0.9 % to 2.0%
2010
Increase share of Central grants to Constitute at least 25% of total
health spending
2010
Increase State Sector Health spending from 5.5% to 7% of the
budget
2005
Further increase to 8%
2010
Goals to be achieved by 2000-2015NHP-2002
15

NHP, 2002 is
composed
of 3
components
•Review of the
health situation
•Objectives of the
policy
•Policy
prescription
NHP-2002
16

REVIEW OF THE HEALTH SITUATION
CHANGING HEALTH SCENE:
• NHP, 2002 acknowledges the progress achieved in the
health field of the country since independence as borne
out by demo-graphic, epidemiological and infrastructural
indicators.
• At the same time the policy appreciates the contribution
made by health sectors like rural development, agriculture,
sanitation, drinking water supply and education towards
achieving progress in the health field.
NHP-2002
17

DISPARITY IN HEALTH CARE:
NHP, 2002 admits that although the main objective of
planning was to achieve an equitable development, yet
significant disparity exists in the health status of
populations.
 The disparity is reflected in morbidity and mortality
indicators between better performing and poor performing
states, and also between rural and urban populations.
 This disparity is also visible among various socio-economic
groups in relation to important child health indicators.
NHP-2002
18

 Access to, and benefits from, the public health system
have been very uneven between the better-endowed and
the more vulnerable sections of society.
 This is particularly true for women, children and the
socially disadvantaged sections of society.
NHP-2002
19

RELEVANCE OF NATIONAL HEALTH POLICY:
• NHP, 1983 is perceived as an idealistic document mainly
addressed to achieve health for all by the year 2000
• NHP, 2002 is realistic document based on a conceptional and
operational framework that is consistent with the socio-
economic realties prevailing in India.
NHP-2002
20

OBJECTIVES OF THE POLICY
To achieve
decentralization of
health services.
To strengthen
and upgrade the
health care
infrastructure.
To emphasize
primary level of
health care.
To promote
rational use of
drugs.
To ensure
equitable access
to health services.
To increase
primary health
investment.
To enhance
private sector
participation.
It also specifies a time frame for the achievement of various goals
NHP-2002
21

1.FINANCIAL RESOURCES
2.EQUITY
3.DELIVERY OF NATIONAL PUBLIC HEALTH PROGRAMMES
4. THE STATE OF PUBLIC HEALTH INFRASTRUCTURE
5. EXTENDING PUBLIC HEALTH SERVICES
6. ROLE OF LOCAL SELF-GOVERNMENT INSTITUTIONS
7. NORMS FOR HEALTH CARE PERSONNEL
8. EDUCATION OF HEALTH CARE PROFESSIONALS
9. NEED FOR SPECIALISTS IN ‘PUBLIC HEALTH’ AND ‘FAMILY MEDICINE’
10. NURSING PERSONNEL
11. USE OF GENERIC DRUGS AND VACCINES
12. URBAN HEALTH
13. MENTAL HEALTH
23

14. INFORMATION, EDUCATION AND COMMUNICATION
15. HEALTH RESEARCH
16. ROLE OF THE PRIVATE SECTOR
17. THE ROLE OF CIVIL SOCIETY
18. NATIONAL DISEASE SURVEILLANCE NETWORK
19. HEALTH STATISTICS
20. WOMEN’S HEALTH
21.MEDICAL ETHICS
22. ENFORCEMENT OF QUALITY STANDARDS FOR FOOD AND DRUGS
23. REGULATION OF STANDARDS IN PARAMEDICAL DISCIPLINES
24. ENVIRONMENTAL AND OCCUPATIONAL HEALTH
25. PROVIDING MEDICAL FACILITIES TO USERS FROM OVERSEAS
26. IMPACT OF GLOBALISATION ON THE HEALTH SECTOR
24

1.FINANCIAL RESOURCES
• The Central Government will play a key role in augmenting
public health investments.
• Taking into account the gap in health care facilities, it is
planned, under the policy to increase health sector expenditure
to 6 percent of GDP, with 2 percent of GDP being contributed as
public health investment, by the year 2010.
NHP-2002
25

• The State Governments would also need to increase the
commitment to the health sector.
• In the first phase, by 2005, to increase the commitment of
their resources to 7 percent of the Budget.
• In the second phase, by 2010, to increase to 8 percent of
the Budget.
NHP-2002
26

2.EQUITY
• To meet the objective of reducing various types of inequities
and imbalances – inter-regional, across the rural – urban
divide and between economic classes – the most cost-
effective method would be to increase the sectoral outlay in
the primary health sector.
NHP-2002
27

• NHP-2002 sets out an increased allocation total public
health investment for
 the primary health sector - 55 %
 the secondary sector - 35 %
 the tertiary health sectors – 10 %
• The Policy projects that the increased aggregate outlays for
the primary health sector will be utilized for strengthening
existing facilities and opening additional public health
service outlets, consistent with the norms for such facilities.
NHP-2002
28

3.DELIVERY OF NATIONAL PUBLIC HEALTH
PROGRAMMES
• This policy is a key role for the Central Government in designing
national programmes with the active participation of the State
Governments.
• Also, the Policy ensures the provisioning of financial resources, in
addition to technical support, monitoring and evaluation at the
national level by the Centre.
29

• However, to optimize the utilization of the public health
infrastructure at the primary level, NHP-2002 envisages the
gradual convergence of all health programmes under a
single field administration.
• Vertical programmes for control of major diseases like TB,
Malaria, HIV/AIDS, and Universal Immunization
Programmes, would need to be continued till moderate
levels of prevalence are reached.
NHP-2002
30

• The integration of the programmes will bring about a
desirable optimization of outcomes through a convergence of
all public health inputs.
• Also, the presence of State Government officials, social
activists, private health professionals and MLAs/MPs on the
management boards of the autonomous bodies will facilitate
well-informed decision-making.
NHP-2002
31

4. THE STATE OF PUBLIC HEALTH
INFRASTRUCTURE
• Decentralized Public health service outlets have become
practically dysfunctional over large parts of the country.
• On account of resource constraints, the supply of drugs by the
State Governments is grossly inadequate.
• The patients at the decentralized level have little use for
diagnostic services, which in any case would still require them
to purchase therapeutic drugs privately.
32

• In some States like the four Southern States – Kerala, Andhra
Pradesh, Tamil Nadu and Karnataka some quantum of drugs is
distributed through the primary health system network, and
the patients can approach the Public Health facilities.
• The Policy envisages restarting of the Primary Health System
by providing some essential drugs under Central Government
funding through the decentralized health system.
NHP-2002
33

• It is expected that the provisioning of essential drugs at the
public health service centres will create a demand for other
professional services from the local population.
NHP-2002
34

• Policy recognizes - frequent in-service training of public
health medical personnel, at the level of medical officers as
well as paramedics.
• Such training would help to update the personnel on recent
advancements in science.
NHP-2002
35

5. EXTENDING PUBLIC HEALTH SERVICE
• The policy envisages the need for expanding the pool of medical
practitioners to include practitioners of Indian Systems of Medicine
and Homoeopathy.
• Simple services/procedures can be provided by such practitioners
even outside their disciplines, as part of the basic primary health
services in under-served areas.
36

• Also, NHP-2002 envisages that the scope of the use of
paramedical manpower of allopathic disciplines, in a
prescribed functional area adjunct to their current functions,
would also be examined for meeting simple public health
requirements.
• These extended areas of functioning of different categories of
medical manpower can be permitted, after adequate training,
and subject to the monitoring of their performance through
professional councils.
NHP-2002
37

• NHP-2002 also recognizes the need for States to simplify the
recruitment procedures and rules for contract employment
in order to provide trained medical manpower in under-
served areas.
NHP-2002
38

• State Governments could also rigorously enforce a mandatory
two-year rural posting before the awarding of the graduate
degree.
• This would not only make trained medical manpower
available in the underserved areas, but would offer valuable
clinical experience to the graduating doctors.
NHP-2002
39

6. ROLE OF LOCAL SELF-GOVERNMENT
INSTITUTIONS
• NHP-2002 lays great emphasis upon the implementation of
public health programmes through local self-government
institutions.
• The structure of the national disease control programmes will
have specific components for implementation through such
entities.
NHP-2002
40

• The Policy urges all State Governments to consider
decentralizing the implementation of the programmes to
local self- goveernment Institutions by 2005.
• To achieve this, financial incentives will be provided by the
Central Government.
NHP-2002
41

7. NORMS FOR HEALTH CARE PERSONNEL
• Minimal norms for the deployment of doctors and nurses in
medical institutions need to be introduced urgently under the
provisions of the Indian Medical Council Act and Indian Nursing
Council Act.
• These norms can be progressively reviewed and made more
stringent as the medical institutions improve their capacity for
meeting better normative standards.
NHP-2002
42

8. EDUCATION OF HEALTH CARE
PROFESSIONALS
• To eliminate the problems being faced on the uneven spread
of medical and dental colleges in various parts of the country,
this policy envisages the setting up of a Medical Grants
Commission for funding new Government Medical and
Dental Colleges in different parts of the country.
NHP-2002
43

• The Medical Grants Commission will fund the upgradation of
the infrastructure of the existing Government Medical and
Dental Colleges of the country, so as to ensure an improved
standard of medical education.
• To enable fresh graduates to contribute effectively to the
providing of primary health services as the physician of first
contact, this policy identifies a significant need to modify the
existing curriculum
44

• A need-based, skill oriented syllabus, with a more significant
component of practical training, for fresh doctors
immediately after graduation.
• The Policy also recommends a periodic skill-updating of
working health professionals through a system of continuing
medical education.
NHP-2002
45

• The Policy emphasises the need to expose medical students,
through the undergraduate syllabus, to the emerging
concerns for geriatric disorders, as also to the cutting edge
disciplines of contemporary medical research.
• The policy also envisages that the creation of additional
seats for postgraduate courses should reflect the need for
more manpower in the deficient specialities.
NHP-2002
46

9. NEED FOR SPECIALISTS IN ‘PUBLIC
HEALTH’ AND ‘FAMILY MEDICINE’
To alleviate the acute shortage of
medical personnel with specialization
in the disciplines of ‘public health’ and
‘family medicine’.
implementation of mandatory norms
to raise the proportion of
postgraduate seats in these discipline
in medical training institutions, to
reach a stage wherein ¼ th of the
seats are for these disciplines.
47

• Specialization in Public health may be encouraged not only
for medical doctors, but also for non-medical graduates
from the allied fields of public health engineering,
microbiology and other natural sciences.
NHP-2002
48

• Improving the skill -level of nurses, and on increasing the
ratio of degree- holding nurses vis-à-vis diploma-holding
nurses.
• Establishing training courses for super-speciality nurses
required for tertiary care institutions.
NHP-2002
49

10. NURSING PERSONNEL
• In the interest of patient care, the policy emphasizes the
need for an improvement in the ratio of nurses,
doctors/beds.
• The public health delivery centers need to have a
increased number of nursing personnel.
NHP-2002
50

11. USE OF GENERIC DRUGS AND
VACCINES• There is a need for basic treatment regimens, on a limited
number of essential drugs.
• Cost-effective.
• Prohibit the use of proprietary drugs, except in special
circumstances.
51

• Not less than 50% of the requirement of vaccines/sera be
sourced from public sector institutions.
NHP-2002
52

12. URBAN HEALTH
• Setting - organized urban primary health care structure.
• Adoption - population norms for its infrastructure.
NHP-2002
53

• The structure is two-tiered :
The first-tier, covering a population of one
lakh
providing OPD facility
with a dispensary and essential drugs,
to enable access to all the national
health programs
The second-tier - at the level of the
Government general hospital, reference
from primary center.
NHP-2002
54

• Funding will be by the local, State and Central Governments.
• Establishment of fully-equipped ‘hubspoke’ trauma care
networks in large urban agglomerations to reduce accident
mortality.
NHP-2002
55

13. MENTAL HEALTH
• A network of decentralised mental health
services for more common disorders.
• Diagnosis of common disorders, and the
prescription of common drugs, by general
duty medical staff.
NHP-2002
56

• Upgrading of the physical infrastructure of mental health
institutions at Central Government expense.
57

14. INFORMATION, EDUCATION
AND COMMUNICATION (IEC)
• Information to those population groups which cannot be
effectively approached by using only the mass media.
• The focus on the inter-personal communication of
information and on folk and other traditional media to bring
about behavioural change.
NHP-2002
58

• The community leaders- particularly religious leaders,
are effective in imparting knowledge for behavioural
change.
NHP-2002
59

• Annual evaluation of the performance of the non-
Governmental agencies to monitor the impact of the
programmes on the targeted groups.
• School health programs are the most cost-effective
intervention - improves the level of awareness of future
generation.
NHP-2002
60

15. HEALTH RESEARCH
• Increase in Government-funded health research
– to a level of 1% of the total health spending by 2005 and
– up to 2 % by 2010.
• Domestic medical research would be focused on new
therapeutic drugs and vaccines for TB and Malaria, also on the
sub-types of HIV/AIDS prevalent in the country.
NHP-2002
61

• Emphasis on time-bound applied research for developing
operational applications.
• This would ensure the cost-effective of existing / future
therapeutic drugs/vaccines for the general population.
NHP-2002
62

16. ROLE OF THE PRIVATE SECTOR
• This Policy welcomes the participation of the private sector in
all areas of health activities.
• A legislation for regulating minimum infrastructure and quality
standards in clinical establishment of medical institutions by
2003.
63

• Guidelines for clinical practice and delivery of medical services
are to be developed.
• Setting up of private insurance instruments for increasing the
scope of the coverage of the secondary and tertiary sector
under private health insurance packages.
NHP-2002
64

• Non-governmental practitioners- in national disease control
programmes
• Applications of tele-medicine in the health care sector.
NHP-2002
65

17. THE ROLE OF CIVIL SOCIETY
• Contribution of NGOs and other institutions of the civil
society in making available health services to the
community.
• The disease control programmes should have a definite
portion of budget.
67

18. NATIONAL DISEASE SURVEILLANCE
NETWORK• Integrated disease control network from the lowest public
health administration to the Central Government, by 2005.
• installation of data-base handling hardware
• In-house training for data collection.
68

19. HEALTH STATISTICS
• Periodic updating of these baseline estimates through
representative sampling, under an appropriate statistical
methodology.
NHP-2002
69

• Access to data on the incidence of various diseases, with
the objective of evidence-based policy-making.
• The need to establish national health accounts,
conforming to the `source-to-users’ matrix structure.
NHP-2002
70

• National health accounts and accounting systems would
pave the way for decision-makers to focus on relative
priorities.
NHP-2002
71

20. WOMEN’S HEALTH
• Women - under-privileged groups with low access to health
care.
• The expansion of primary health sector infrastructure- to
facilitate the increased access of women to basic health
care.
NHP-2002
72

• Highest priority of the Central Government to the funding -
programmes relating to woman’s health.
• The need to review the staffing norms of the public health
administration to meet the specific requirements of women
in a more comprehensive manner.
NHP-2002
73

21.MEDICAL ETHICS
• A contemporary code of ethics be notified and rigorously
implemented by the Medical Council of India.
• Medical research within the country in the different
disciplines, such as gene- manipulation and stem cell
research.
NHP-2002
74

22. ENFORCEMENT OF QUALITY STANDARDS FOR FOO
AND DRUGS
• Food and drug administration will be progressively
strengthened, in terms of both laboratory facilities and
technical expertise.
75

• Domestic food handling / manufacturing facilities to
undertake the necessary upgradation of technology
• Ultimately food standards will be close, if not equivalent, to
Codex specifications; and that drug standards will be at par
with the most rigorous ones adopted elsewhere.
76

23. REGULATION OF STANDARDS IN
PARAMEDICAL DISCIPLINES
• Need for the establishment of professional councils for
paramedical disciplines to register practitioners, maintain
standards of training, and monitor performance.
77

24. ENVIRONMENTAL AND OCCUPATIONA
HEALTH
• The periodic screening of the health conditions of the workers,
particularly for high- risk health disorders associated with their
occupation.
NHP-2002
78

25. PROVIDING MEDICAL FACILITIES TO
USERS FROM OVERSEAS
• Health services on a payment basis to service seekers from
overseas.
• The services to patients from overseas will be encouraged by
extending to their earnings in foreign exchange.
79

26. IMPACT OF GLOBALISATION ON
THE HEALTH SECTOR
• The Policy takes into account the serious apprehension,
expressed by several health experts, as a result of a sharp
increase in the prices of drugs and vaccines.
80

COMMENTS
• Not much attention is paid to child, adolescent, Geriatrics
health, gender, domestic violence.
• Ignored areas-
– Resource generation & allocation,
– management of work force,
– substance abuse management.
81
Kumar A, Gupta S. Health Infrastructure in India: Critical Analysis of Policy Gaps in the Indian Healthcare Delivery. Vivekananda International Foundation . 2012

• Methodology of strengthening
healthcare & functioning of health
workers is not specified, creating
“Paramedical Doctors”. Promoting
QUACKERY.
• Literacy & its investment is not
specified.
• Problem of population is not
answered properly.
• School education has not yielded
desired results.
82
Kumar A, Gupta S. Health Infrastructure in India: Critical Analysis of Policy Gaps in the Indian Healthcare Delivery. Vivekananda International Foundation . 2012

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.
83

• 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 REDUCTION of HIV/AIDS
84

National Health Policy - 2015 Draft
85

86
NEED FOR NATIONAL HEALTH POLICY 2015
SITUATIONAL ANALYSIS
GOALS,PRINCIPLES & OBJECTIVES
POLICY DIRECTIONS
REGULATORY FRAMEWORK
GOVERNANCE
IMPLEMENTATION AND WAY FORWARD

Need for National Health
Policy 2015
• Gaps in health outcomes continue to widen despite advances in
medical care technology as well as economy in India.
• There is an urgent need to improve the performance of health
systems; in achieving Millennium Development Goals, and
Universal Health Coverage.
• The context of Health has changed over the years and this needs
a suitably revised Health policy responsive to these changes.
87

Change in the Health context:
• Health Priorities are changing.
• Emergence of a robust health care industry.
• Incidence of catastrophic expenditure due to health care costs is
growing.
• Economic growth has increased the fiscal capacity available.
88

Situation Analysis
Indicator Target Baseline 2012 2015
MMR 140/1000 560 178 141
Under 5
mortality
42/1000 live
births
126 52 42
TFR 2.1 2.9 2.4
IMR 30/1000 Live
Births
114 47.5 40
89

• Over 90% of pregnant women receive one antenatal checkup
• 87% of pregnant women received full TT immunization
• Only 31% of pregnant women had consumed more than 100 IFA tablets
• Only 61% of children (12 – 23 months) have been fully immunized
• In AIDS control, decline from a 0.41 % prevalence rate in 2001 to 0.27% in
2011
• In tuberculosis, prevalence of 211 cases and 19 deaths per lakh
population
• Overall, communicable diseases contribute to 24. 4% of the entire disease
burden while maternal and neonatal ailments contribute to 13.8%.
• Non-communicable diseases (39.1%) and injuries (11.8%) now constitute
the bulk of the country's disease burden.
90

• The private sector today provides nearly 80% of outpatient
care and about 60% of inpatient care.
• Tax exemptions for 5 years for rural hospitals; custom duty
exemptions for imported equipment that are lifesaving;
Income Tax exemption for health insurance; and active
engagement through publicly financed health insurance
which now covers almost 27% of the population.
• The number of medical colleges added and the increase in
seats for both undergraduate and postgraduate education
has also been high. In 2014, the total number of medical
colleges in India were 381. 91

• 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.
92

Goal, Principles and Objectives
Goal:
• The attainment of the highest possible level of good
health and wellbeing, 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.
93

• Policy Principles:
– Equity
– Universality
– Patient Centered & Quality of Care
– Inclusive Partnerships
– Pluralism
– Subsidiarity
– Accountability
– Professionalism, Integrity and Ethics
– Learning and Adaptive System
– Affordability
94

• Objectives:
– Improve population health status
– Achieve a significant reduction in out of pocket expenditure
– Assure universal availability of free, comprehensive primary health care
services
– Enable universal access to free essential drugs, diagnostics, emergency
ambulance services, and emergency medical and surgical care services in
public health facilities
– Ensure improved access and affordability of secondary and tertiary care
services through a combination of public hospitals and strategic
purchasing of services from the private health sector
– Influence the growth of the private health care industry and medical
technologies
95

Policy Directions
• Ensuring Adequate Investment
• Preventive and Promotive Health
• Organization of Public Health Care Delivery
• Primary Care Services & Continuity of Care
• Secondary Care Services
• Reorienting Public Hospitals
• Closing Gaps in Infrastructure and Human Resource/Skill
• Urban Health Care
• National Health Programs: RCH, Communicable Diseases, Non-
Communicable Diseases, Mental Health, Emergency Care and Disaster
preparedness 96

• Swachh Bharat Abhiyan
• Balanced and Healthy diets(through Anganwadi centres
and schools)
• Nasha Mukti Abhiyan
• Yatri Suraksha
• Nirbhaya Nari
97

• Reduced stress and improved safety in the workplace
• Reduction of indoor and outdoor air pollution
• Swasth Nagrik Abhiyan(social movement for health)
• Greater emphasis on school health and SCHOOL NOON MEAL
PROGRAMME
• More support to ASHA workers(in palliative care, Community
Mental Health, and in Village Health Sanitation and Nutrition
Committees)
• Yoga promotion at work place, schools and in the community
98

Governance
• Federal structure: Role of State and Role of Centre
• Role of Panchayat Raj Institutions
• Rogi Kalyan Samitis (RKS)
• Village Health Sanitation and Nutrition Committee(VHSNC)
• Addressing fiduciary risks and improving accountability
• Professionalizing Management and Incentivizing performance
99

Legal framework
- Laws under review
– Mental Health Bill
– Medical Termination of Pregnancy Act
– Bill regulating surrogate pregnancy and assisted
reproductive technologies
– Food Safety Act
– Drugs and Cosmetics Act
– Clinical Establishments Act
100

- National Health Rights Act has been proposed
– Ensure health as a fundamental right, whose denial will be justiciable*
_______________
*(of a state or action) subject to trial in a court of law.
101

Implementation and Way forward
• Past policies have faced innumerable constraints in
implementation.
• Implementation framework would specify approved
financial allocations and linked to this measurable
numerical output targets and time schedules.
102

SWOT analysis
Strengths:
• Increasing Public Health Expenditure to 2.5% of the
GDP(Rs. 3800 per capita)
• Introduction of ambitious schemes like Swacch Bharat
Abhiyan, Nirbhaya Nari
• Promotion of Indian systems of Medicine(AYUSH)
103

Weaknesses:
• Pushing the secondary and tertiary healthcare
into private sector
• No mention of how private sector will be
regulated.
104

Opportunities:
• International support and remote chances of war in near future
• Improving economy and increasing Foreign investments
• Health tourism is gaining momentum.
• Eradication of Polio has paved way and given a framework to follow
for other vaccine preventable diseases.
105

Threats:
• Lack of private sector regulation can hamper public sector
healthcare
• Health tourism may drain resources and peripheral most deserving
population may be starved of resources
• Resurgence of epidemics may create panic and also divert resources
106

National health policy

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