National Health Policy 1983

Dr Kumar Dharmendra Singh

Senior Resident, Dept of Hospital Administration
SGPGIMS
What is Policy
A policy is typically described as a
principle or rule to guide decisions and
achieve rational outcome (s).
It is a "Statement of Intent"
or a "Commitment".
National Health Policy
Although Health policy of a Nation is its
strategy for controlling and optimizing the
social uses of its health knowledge and health
resources.

India had its first national health policy in
1983…….36 years after independence.
 
The 30th World Health Assembly in May 1977 resolved

“The main social target of governments and WHO in

the coming decades should be the attainment by all
citizens of the world by the year 2000 AD of a level
of health that will permit them to lead a socially
and economically productive life.” 

HEALTH FOR ALL BY 2000 AD

The Joint WHO – UNICEF internationa
conference in 1978 at Alma-Ata (USSR)
 
Alma-Ata Declaration called on all the
governments to formulate national health
policies according to their own
circumstances to launch and sustain
primary health care as a part of national
health system.

 
Primary health care

The Alma-Ata conference defined that

“Primary health care is essential health
care made universally accessible to
individuals and acceptable to them,
through their full participation and at
the affordable cost.”
Principles of primary health care

[Link] distribution
[Link] participation.
[Link]-sectoral coordination
[Link] technology
Principles of primary health care……

1. Equitable distribution

Some thing for all and most for those
who need the most
2. Community participation.
community in the planning,
implementation and maintenance of
health services
Principles of primary health care……
[Link] coordination
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".
Principles of primary health care……

4. Appropriate technology

"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 with the resources
the community and country can afford"
Elements of primary health care

1. Education (IEC)concerning prevailing health

problems and the methods of preventing and
controlling them
2. Promotion of food supply and proper
nutrition
3. An adequate supply of safe water and basic
sanitation
4. Maternal and child health (MCH)care,
including family planning
Elements of primary health care…..

5. Immunization against major infectious

diseases
6. Prevention and control of locally
endemic diseases
7. Appropriate treatment of common
diseases and injuries
8. Provision of essential drugs.
National Health Policy -1983

NHP 1983 stressed the need for providing

primary health care with special emphasis on
prevention, promotion and rehabilitation
Suggested planned time bound attention
to the following
i) Nutrition, prevention of Food Adulteration
ii) Maintenance of quality of drugs
National Health Policy 1983……

iii)Water supply and sanitation

iv) Environmental protection
v) Immunization programme
vi) Maternal and child health services
MCH
vii) School health programme and
viii) Occupational health services.
National Health Policy 1983……
For better program planning NHP 1983
recommended an effective Health
Information System.
 NHP 1983- Goal suggested/achieved
[Link] Indicator Goal by 2000 Achieved by
2000
1 IMR 60 70
2 MMR 2 4
3 Life Expectancy 64/64 62.4/63.4
M/F
4 LBW 10% 26%
5 CBR 21 26.1
6 Family size 2.3 3.1
7 AN Care 100% 67.2%
8 DPT 85% 87%
9 OPV 85% 92%
10 BCG 85% 82%
11 Complete 85% 56%
Immunization
NATIONAL HEALTH POLICY
2002
Main Objective
Achieve an acceptable standard of good
health amongst the general population of
the country.
Scenario before NHP 02
The public health investment has been low
and further declining.
Percentage of GDP has declined from 1.3%
(1990) to 0.9% (1999) out of this 17% has
been public health spending rest out of
pocket expenditure.
The per capita public health expenditure is
not more than Rs 200.
Vertical approach of Health delivery system
was expensive and non sustainable.
Scenario before NHP 02
Shortage of professional manpower and
resources.
Community acceptable systems of
medicine were not involved or utilized.
Medical education needed a change in
strategy.
Public Health, Social Health and Health
Research were Neglected areas.
Scenario before NHP 02
Major concerns:
Population explosion
Urbanization
Decreasing sex ratio
Women & child health
Mental health
Poor IEC & Surveillance system
35% illitrate population
 NATIONAL HEALTH POLICY
2002
Defined as a vision for the future.
focuses on the need for enhanced funding
and an organizational restructuring of the
national public health initiatives.
Recommends a focus principally on diseases
mainly contributing to the disease burden –
TB,
Malaria
Blindness
HIV/AIDS
NATIONAL HEALTH POLICY
2002…..
An adequately robust disaster
management plan to effectively cope with
situations arising from natural and man-
made calamities.
To ensure that ‘equity’ in the health sector
stands as an independent goal
Expanding and improving the primary
health facilities
essential drugs through Central funding.
NATIONAL HEALTH POLICY
2002……
Provide guidance for prioritizing
expenditure, thereby facilitating rational
resource allocation.
Greater contribution from the Central
Budget for the delivery of Public Health
services at the State level.
Population stabilization –National
Population Policy
Social sectors – like improved drinking
water supply, basic sanitation, minimum
nutrition,
NATIONAL HEALTH POLICY
2002……
More empathetic and committed attitude
in the service providers, whether in the
private or public sectors
Increase allocation of public health
investment in the order of
55 percent for the primary health sector;
35 percent secondary sectors
10 percent to tertiary sectors
 Major policy prescriptions
Gradual convergence of all health programs,
(except ) TB,
Malaria,
HIV/AIDS,
RCH
Mandatory two year rural posting before
awarding the graduate medical degree.
Promoting public health discipline.
Major policy prescriptions…..
Decentralizationof health programmes
implementation by 2005.
Medical Grants Commission for funding new
Government Medical and Dental colleges.
Two-tier urban healthcare system –
Primary Health Centre for a population of one
lakh and Government General Hospital.
Major policy prescriptions…..
Health research funding to increase to 2% of
the total health spending by 2010.
Appreciation of the role of private sector in
health, and enactment of legislation by 2003
for regulating private clinical establishments.
Formulation of procedures for accreditation
of public and private health facilities.
Major policy prescriptions…..
Co-option of NGOs in national disease
control programmes.
Promotion of tele-medicine in tertiary
healthcare sector.
Full operationalization of National
Disease Surveillance Network by 2005.
Notification of contemporary code of
medical ethics by Medical Council of
India.
Major policy prescriptions…..
Encouraging setting up of private
insurance instruments to bring secondary
and tertiary sectors into its purview.
Promotion of medical services for
overseas users.
Encouragement and promotion of Indian
System of Medicine.
GOALS TO BE ACHIEVED
2003
Regulatory act for minimum standard in
clinical establishment /Medical Institutions
2005
Eradicate: Polio, Yaws (eliminated in 2006)
Eliminate: Leprosy (Elimination of leprosy as public health problem
at National level by Dec 2005
Establish Integrated system of surveillance
State Health Expenditure 5.5% to 7%
Decentralization of program implementation
2007
Zero growth HIV/AIDS
GOALS TO BE ACHIEVED
2010:
Eliminate Kala Azar
50% mortality reduction in TB, vector &
water born diseases
Blindness prevalence reduction to 5%
Reduction IMR/MMR by 30*/100#
Public Health Utilization; <20% to >75%
Health Expenditure ; 0.9% to 2% of GDP
Medical Research; 2% of Health budget
25% total health Expenditure ; Central grant
State Health Expenditure ; 8% of Health
budget
GOALS TO BE ACHIEVED
2015
Eliminate Lymphatic filiarisis
GOALS TO BE ACHIEVED
Eradicate polio & Yaws 2005
Eliminate Leprosy 2005
Eliminate Kala Azar 2010
Eliminate Lymphatic Filariasis 2015
Zero Growth HIV/AIDS 2007
50% mortality decrease in TB,
vector & water born diseases 2010
GOALS TO BE ACHIEVED
Reduce Blindness prevalence to 5% 2010
Reduce IMR/MMR to 30/100 2010
Health Expenditure: 0.9 to 2.0% 2010
25% increase : Central grant 2010
State health spending: 5.5 to 7% 2005
Further increase to 8% of budget 2010
The National Health Policy 2017
Goal
To attainment of the highest possible level of
health and well-being for all at all ages, through
a preventive and promotive health care.
3. Objectives:
Improve health status through concerted policy
action in all sectors and expand preventive,
promotive, curative, palliative and rehabilitative
services provided through the public health
sector with focus on quality.
Preventive and Promotive Health
policy identifies coordinated action on seven priority
areas for improving the environment for health
1. The Swachh Bharat Abhiyan
2. Balanced, healthy diets and regular exercises.
3. Addressing tobacco, alcohol and substance abuse
4. Yatri Suraksha–preventing deaths due to rail and road
traffic accidents
5. Nirbhaya Nari –action against gender violence

6. Reduced stress and improved safety in the work place

7. Reducing indoor and outdoor air pollution
 Policy Principles

Professionalism, Integrity and Ethics

Equity
Affordability
Universality
Patient Centered & Quality of Care
Accountability
Inclusive Partnerships
Pluralism
Decentralization
Dynamism and Adaptiveness
 Health Status and Programme Impact
 Increase Life Expectancy at birth from 67.5 to 70 by 2025.
 Reduction of TFR to 2.1 at national and sub-national level
by 2025
 Reduce Under Five Mortality to 23 by 2025 and MMR
from current levels to100 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
 Achieve global target of 2020 which is also termed as
target of [Link], for HIV/AIDS
 chieve and maintain eliminationstatus of Leprosyby 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.
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.
Health Systems strengthening

 GDP from the existing 1.15% to 2.5 % by 2025

 Increase State sector health spending to > 8% of
theirbudget by 2020
 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
Indian Public Health Standard (IPHS) norm in high
priority districts by 2020
 Strengthen the health surveillance system and establish
registries for diseases of public health importance by
2020
 Organization of Public Health Care Delivery
In primary care – from selective care to assured
comprehensive care with linkages to referral
hospitals
In secondary and tertiary care – from an input
oriented to an output based strategic purchasing
In public hospitals – from user fees & cost
recovery to assured free drugs, diagnostic and
emergency services to all
In infrastructure and human resource development
In urban health-
In National Health Programmes –
National population policy
 Population policy: An Overview
 Population

o All inhabitants of a country, territory, or geographic area, for a given sex

and/or age group, at a specific point of time

o In demographic terms it is the number of inhabitants of a given sex and/or

age group that actually live within the border limits of the country, territory,
or geographic area at a specific point of time, usually mid- year

o The mid-year population refers to the actual population at 1st July

The Population of India: 2011

• Population Commission
 Population policy: An Overview
 What is a Policy?

 Set of Ideas or Plans that is used as a basis for decision making

 Attitude and actions of an organization regarding a particular issue
 General Statement of understanding which guide decision making
 It is more than mere statement of goals:
o How the stated goals can be achieved?
o Who will carry out the tasks?

o In what manner?

 Basis for a Policy

o Set of Values
o Commitments
o Assessment of current situation
o Image of a desired future situation
 Population policy: An Overview

 What is Population Policy?

 “A deliberate effort by a national government to influence the

demographic variables like fertility, mortality and
migration”(organski & organski 1961)

 Measures formulated by a range of social institution including

Government which may influence the size, distribution or
composition of human population (Driver ,1972)
 Why a Population Policy?
 On 11th May, 2000, India had 1 billion (100 crores) people, i.e., 16
percent of the world’s population on 2.4 percent of the globe’s land area

 If current trends continue, India may overtake China by 2045, to

become the most populous country in the world

 Global population : ↑ 3 folds during this century (from 2 to 6 billion)

 Population of India : ↑ nearly 5 times (from 238 million to 1 billion),

during the same period

 Stabilizing population is an essential requirement for promoting

sustainable development with more equitable distribution
Why a Population Policy?
 Why a Population Policy?

 In 1952, India was the first country in the world to launch a

national programme emphasizing family planning

 to the extent necessary for reducing birth rates "to stabilize the
population at a level consistent with the requirement of national
economy”

 After1952, sharp declines in death rates were, however, not

accompanied by a similar drop in birth rates
 Why a Population Policy?

 TheNational Population Policy 2000 affirms the commitment of

government towards

 voluntary and informed choice and consent of citizens while availing of

reproductive health care services, and continuation of the target free approach in
administering family planning services

 The NPP 2000 provides a policy framework for

 advancing goals and prioritizing strategies during the next decade, to meet the
reproductive and child health needs and to achieve net replacement levels (TFR,
2.1) by 2010
 National Population Policy 2000
OBJECTIVES

 The immediate
 To address the unmet needs for contraception
 Strengthening health care infrastructure, and health personnel
 To provide integrated service delivery for basic reproductive and child health
care

 The medium-term
 To bring the TFR (2.1) to replacement levels by 2010, through vigorous
implementation of inter-sectoral operational strategies

 The long-term
 To achieve a stable population by 2045, at a level consistent with the
requirements of sustainable economic growth, social development, and
environmental protection
 National Population Policy 2000
National Socio-demographic goals for 2010
 Address the unmet needs for basic RCH services: supplies and
infrastructure

 Make school education up to age of 14 years free and

compulsory and reduce drop outs at primary and secondary
school levels to <20% for boys and girls

 Reduce IMR to <30 per 1000 live births

 Reduce MMR <1 per 1000 live births

 Achieve universal immunization of children against all Vaccine

Preventable Disease (VPD)
 National Population Policy 2000
National Socio-demographic goals for 2010
 Promote delayed Marriage age for girls, #18 (20)

 Achieve Institutional delivery 80% and by trained personal 100%

 Achieve universal access to information/ counseling services for

fertility regulation and contraceptive with a wide basket of choices

 Achieve 100% registration of births, deaths, marriage and

pregnancy

 Containment of AIDS, greater integration between the

management of AIDS & STD
 National Population Policy 2000
National Socio-demographic goals for 2010
 Prevent and control communicable diseases

 Integrate Indian Systems of Medicine (ISM) in the provision of

reproductive and child health services, and in reaching out to
households

 Promote vigorously the small family norm to achieve replacement

levels of TFR

 Bring about convergence in implementation of related social sector

 Programs so that family welfare becomes a people centered

programmed
 MAJOR STRATEGIC THEMES : NPP-2000

 Decentralized planning and programme implementation

 Availability of services delivery at village levels

 Empowering women for improved health and nutrition

 Child survival and child health

 Meeting the unmet needs for Family Welfare Services

 Diverse health care providers

 MAJOR STRATEGIC THEMES: NPP-2000

 Greater emphasis for underserved population group

o Urban Slums
o Tribal communities, Hill Area populations and displaced and
migrant populations
o Adolescents
o Increased participation of men in planned parenthood

 Collaboration with the commitments from private agencies and

NGOs
 MAJOR STRATEGIC THEMES: NPP-2000

 Involvement of Indian system of medicine in delivery of RCH

services
 Contraceptive technology and research in RCH
 Providing health care and support for the older population
 Information, Education and Communication
THANK YOU