NATIONAL HEALTH

POLICY-2002
Dr Anshuli Trivedi
Ist Year PG
Deptt.Community Medicine.
 What is Health?
 Health is a state of complete physical,
mental & social wellbeing & not merely
absence of disease or infirmity.
What is Policy?
Policy is a system, which provides logical
frame work & rationality of decision making
for achievement of intended objectives.

WHO definition of health pg-13 Text book of PSM-Park 18 th ed Textbook by J kishoreNational Health Programmers of India
 Objectives

Main objective is to-

“Achieve an acceptable standard of good

health amongst general population of
country.’’

Ref-national health policy//H:\Current Reviews - National Health Policy India.htmTextbook oNational Health programmes of
India by J KishoreDate-11/9/07
 OTHER OBJECTIVES…...
To increase access to decentralized public health system by
establishing new infrastructure in deficient areas & by
upgrading infrastructure in existing institutes .
To ensure a more equitable access to health services across
the social & geographical expanse of country.
To increase public health investment by increasing
contribution from central govt.
Increase access to tried & tested system of traditional
medicine.
Rationalize use of allopathic drugs.
Strengthening Public Health investment by increasing
contribution from Central Govt.
Increase contribution from pvt.Sector in providing
health services for those who can afford it.
TEXTBOOK OF NATIONAL HEALTH Programmer JKishore.pg 365
 Goals to be achieved by 2000-2015
 1)Eradicate Polio and Yaws by 2000-2015.
 2)Eliminate Leprosy by 2005.
 3)Eliminate Kalaazar 2010.
 4)Eliminate Lymphatic Filariasis 2015.
 5)Achieve zero level growth of HIV/AIDS by 2007.
 6)Reduce mortality by 50%on an account of TB,
Malaria,Vector&Water borne disease by 2010.
 7)Reduce Prevelance of blindness by 0.5%by 2010.
 8)Reduce IMR to 30/1000and MMR to 100/lakh by 2010.
 9)Increase utilization public health facilities from current level of
<20% to >75%.
  10)Increase health expenditure from 0.9% to 2.0% by
2010.
 11)Increase central health grants to at least 25% by
2010.
 12)Increase health spending by state from 5.5%to 7%
by 2005.

Ref-Textbook of PSM –Park 19th ed Pg 726

 Problems & Policies to be tackled
Under NHP-2002
Financial Resource
 Their’s a recommendation to increase health
sector expenditure to 6% of GDP of which 2%
is to be used till 2010.
Till 2005,expenditure on health by States should be increase
to 7% in I st phase, & 8% by 2010 .This will increase
contribution of Central Govt. from 15% to 25% by 2015.
 %of GDP has declined from 1.3%(1990)to
0.9%(1999).States are expected to be a major
contributor in public health services & will receive
only supplementary input from Central resources.
Ref- C:\Documents and Settings\Administrator\Desktop\Current Reviews National Health Policy –India.htm/Textbook of
National Health Programme J Kishore pg 368
 EQUITY
In centralized planning –equitable, regional distribution
was considered as major objective.
Allocation of 55% of Total Public Health investment
for primary health sector.
35% for secondary health services.
10% for tertiary sector.
This will be used in strengthening existing services &
to open new services.

Ref-C:\Documents and SettingsAdministrator\Desktop\Current Reviews - National Health Policy -India.htm/Textbook of NHP pg368
 Delivery of National Public Health
Programmes
 Executive should design programme such that it gives
enough flexibility to permit State Public Health
Administration to craft action as per their needs.

 Vertical implementation structure has been effective in

reducing Burden of Disease. Ex –Malaria eradication,
RNTCP, HIV ,RCH&UIP. Till moderate levels of
Prevelance is reached.

 Convergence of all health programmes under a single field

administration. This require change in mindset of health
administration. Retraining & re orientation of health staff.

Ref-C:\Documents and SettingsAdministrator\Desktop\Current Reviews - National Health Policy -India.htm/Textbook of

 State of Public Health Infrastructure
 Facilities available are estimated ….
 <20% persons have OPD facilities.
 <45% persons indoor facilities.
 Due to-
• poor funding.
• Presence of less no. medical & paramedical

personnel.
• Inadequate equipment.
• overcrowding.

Ref-C:\Documents and Settings\ Administrator\Desktop\Current Reviews National Health Policy -India.htm/Textbook of NHP
 Recommendations
Decentralized PUBLIC HEALTH SYSTEM will ensure
more effective supervision of public health services.

Need for more frequent in-service training ,of public

health & medical personnel, at the level of MO&
paramedical is required.

% of health expenditure should be at least 5.2% GDP.

Public expenditure on health should be at least 17.3% of
total health expenditure.
Ref-C:\Documents and Settings\ Administrator\Desktop\CurrentReviews National Health PolicyIndia.htm/Textbook of NHP
 Extending Public Health Services
 Shortage of medical personnels in less developed & rural
areas.

 No incentives given to persons trained in alternate medicine.

 These persons can be used for implementing Central & State

Govt. health programmes.As per suggested in 2002 NHP
report.

 Recommends 2 year mandatory rural health posting before

granting MBBS degree.

:\Documents and Settings\Administrator\Desktop\Current Reviews - National Health Policy -India.htm,/ Text book of NHP’S J Kishore
PG369C:\
 Role of local self governed institutes

By devolving health programme & funds in

different level of Panchayati Raj & other local
governing bodies has enabled –
Need based allocation of resources,
 Supervision by elected representatives of
population in rural ,urban & rest of India.
Ex –Nirmal Gram Pariyojna.
C:\Documents and Settings\AdministratorDesktop\Current Reviews – National Health Policy -India.htm Textbook of National
Health
 Education of Health care
professionals
 Uneven geographical distribution of Medical Colleges.
 Theoretical subjects.
 Substandard quality of education
 Reluctance to rural service.
 Less exposure to community- health related activities.
 Absence of skill & day to day practice, oriented
practical training.
 Scarce availability of anesthesiologist,
radiologists,FM experts.
 Nursing personnel-Low doctor : nurse ratio. Acute
shortage of super specialties trained nurses.

C:\Documents and Settings\Administrator\Desktop\Current Reviews - National Health Policy -India.htm,/ Text book of NHP’S J Kishore.
 Recommendations
Advocates setting of aMedical Grants Commission to
fund new medical & dental colleges & to upgrade
infrastructure.
Ensure need based & skill oriented syllabus after
graduation.
Periodic skill updating by continuos medical education.
Introduction of new concepts of Geriatics , Genetics,
Molecular Biology, FM, radio diagnosis, anesthesia should
be highlighted.

Prime Minister of India has launched PHFI i.e.. Public

Health Foundation Of India. To give world class health
facilities & training to medical personnels.
C:\Documents and Settings\Administrator\Desktop\Current Reviews - National Health Policy -India.htm,/ Text book of NHP’S J Kishore PG 372
 Need for Specialists in Public
&Family Medicine
 In developing countries demand for trained
personnel in Public Health & Family Medicine
is more than other disciplines.
 Current UG&PG, syllabus is inappropriate to
today’s need. More talented medical UG’s take
up clinical disciplines,rest take up GP.
Also availability of PG’ seats is 50% of
qualified UG’s.

C:\Documents and Settings\Administrator\Desktop\Current Reviews National Health Policy -India.htm/Textbook of NHP pg371
 RECOMMENDATIONS
Recommends to increase seats of Pubic Health & Family
Medicine up to 1/4th for all available subjects.
Not only medical graduates but also student from other
disciplines. Ex-health engineering ,microbiologists, natural
scientists, must be trained in Public Health.
Greater exposure to field work in Public Health.
Establishing rural Medical Colleges.
Regulation of Standards of Paramedical
Disciplines-
New paramedical institute have mushroomed particularly in
pvt. sector-Ex-lab technicians ,radio diagnostics, physios. etc
Policy recommends- Standardization ,Regulation,
Registration & Inspection & Monitoring of such institutes.
 Use of generic Drugs & Vaccines
 Low cost Health care system of India is largely due to
indigenous manufacture of drugs & vaccines.
 With Globalization there is likely increase in costs of
drug.
 Hence the measures should be taken to keep costs
affordable to ensure health security of country.
Impact of Globalization on Health Sector
 There is likely to be increase in costs of drugs &
vaccines. Hence NHP -02 recomm. National Patent
Regime to ensure affordable access to latest medical &
other therapeutic discoveries.

C:\Documents and Settings\Administrator\Desktop\Current Reviews – National HealthPolicy -India.htm /Textbook of NHP J Kisore PG 370
 Measures
Emphasis should be laid on use of ESSENTIAL
DRUGS in both pvt. & public sector.
Production & sales of irrational drugs should be curbed.
No less than 50% vaccines & sera should be provided
by public sector.
Standardization
Enforcement of quality standards- NHP paid heed to
maintain reasonable, quality & standards for food &
drugs.

C:\Documents and Settings\Administrator\Desktop\Current Reviews National Health Policy -India.htm/Textbook of NHP pg371
 Urban Health
 Meagerly available.With no uniformity in
organizational structure.
 Urban population is 30% and is likely to
increase to 33% by 2010 due to migration.
 This will lead to development of slums, with
poor percolation of public health facilities.

:\Documents and SettingsAdministrator\Desktop\Current Reviews – National Health Policy -India.htmTextbook of NHPJ Kshore pg 370
 Health Research & Development
 Limited Health Research in India.In govt. sector
R&D is largely confined to ICMR.
 R&D should be focused on therapeutic drugs &
vaccines for tropical disease.That are largely
neglected by pharma companies due to limited
profitability.
 Research esp. on genetics, genome based drugs,
vaccines development, molecular biology is needed.
Ensure greater participation of Medical Colleges &
similar institutes for R&D.
 Govt. aid for R &D should be increased to 1% of total
health by 2005 & upto 2% by 2010.

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Kishorepg 371
 Role of private sector
 Contributes significantly to secondary & tertiary care.
Widespread perception that it is uneven in quality,
frequently substandard.
 Pvt. Health care are financially exploitive with poor
observation of medical ethics.
 With increase in their role-implementation of
STATUORY regulation & maintaining minimal
STANDARDS in diagnostic medical institution is
required.
 Introduction of Telemedicine & social insurance
schemes.

C:\Documents and Settings\Administrator\Desktop\Current Reviews National Health Policy -India.htm/Textbook of NHP pg371
 MENTAL HEALTH
 Mental health problems are more prevalent than actually noted.
Not mortal but seriously affect lives of patients, families.

 Commonly thought to be associated with “SPIRITUAL

AFFLICTION’’.

 Hence promoting unlicensed mental institutions & religious

institution as a site of faith cure.

 Serious conditions require hospitalization & T/T under trained

supervision.

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371
 Information, Education,
Communication
 Information dissemination is central to providing Health
Care. Task of education is difficult as 35% of country ‘s
population is illiterate.
Untrained Health Service providers are treating large no. of pt.
at primary level for major diseases. Ex. QUACKS. Without any
standardization & scientific knowledge leading frequently to
drug resistance & complication
The present IEC is too fragmented-relies on mass- media.
But those not benefited by them need addressal, by folk media
,interpersonal relations,NGO’s/Trusts.Ex. Kalyani TV Show.
With annual evaluation of their performances.
C:\Documents and Settings\Administrator\Desktop\Current Reviews – National Healt hpolicy
India.htm/Textbook of NHP PG 371
 Hence schools & colleges are considered as prime targets
to intervene for IEC & help in promoting sound health
behavior. Ex –Dental Checkups.
IEC will address itself & eliminate risk of inappropriate
T/T.
Role of Civil Society
It has been practiced to increase participation of NGO’S,
Social Support Groups, voluntary health workers, no less than
10% of total task force, to carry out National & State level
Health Programmes.
Certain NHP ‘S require continuous supervision, lab
diagnosis, regular follow up. etc. Ex. RNTCP for T/T of TB.
These can easily be taken up by voluntary workers.
C:\Documents and Settings\Administrator\Desktop\Current Reviews –National Health Policy -India.
Htm/Textbook of NHP JK ishore pg371
 National Disease Surveillance
Programme
 Surveillance system of India is very rudimentary .Poor
flow of information about Facilties at State & Central
level. Hampering effective health care system &
planning.

 It is recommended to collect baseline incidences of

common diseases Ex., Malaria etc.& long term
incidences for non communicable diseases. Ex-CVA,
CHD, DM. To ensure future policy making.
Success story of Polio & HIV control is largely due to
efficient surveillance system.
Hence there is need to have an effective, integrated disease
“ Surveillance Network”.
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 .
HEALTH STATISTICS
.
Current scenario has absence of a systematic, proper,
meaningful & scientific health statistics data base
collection methodology.
NHP-2002 focuses on programme to put up a modern
& SCIENTIFIC HEALTH DATABASE & a
system of NATIONAL HEALTH ACCOUNTS.

WOMEN’S HEALTH
 Receive inadequate public health facilities, due to some
socio-cultural-economic factors.
 NHP-2002 recognizes role of empowered women in

Improving over all health standard of community.

Ex-ASHA is used under NRHM.
 Medical Ethics

Professional medical practice is now perceived to be

commercial & had lost its position of form of a social
service, bringing basic health service to fellow humans.
In 1960,ICMR carried out a research on MEDICAL
ETHICS & gave guidelines that were updated in 2001.
Medical ethics need a new vision esp. in area of sanctity
of human life & moral dilemma of new human life forms
that can cause irreversible environmental change. Ex-
Human Cloning.

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book of NHP J Kishore pg372
 Environmental ,Occupational & Educational
Health
 Unsafe drinking water, unhygienic sanitation, air
pollution contributes to urban population & exposes
health risks to dwellers.
 Work conditions are substandard risking individual to
occupation linked ailments leading to chronic
morbidity ,particularly for child labour.
 Ex –Coal Worker Pneumoconiosis,TB,Malignancy.
 NHP directs employers to take their own initiatives to
control these factors in pvt.or public sectors. Ex –by
regular screening of workers particularly high risk
groups.

C:\Documents and Settings\Administrator\Desktop\Reviews Nationalhealthpolicy/htm/Textbook of NHP J Kishore pg 372

 Providing medical facilities to
overseas beneficiaries.
 Good quality & cost effective secondary & tertiary level
of medical facilties & drugs are available, not only in
allopathy but also in alternate medicine.Ex- Concept of
Medical Tourism.

 Indian pharma. companies are manufacturing innovative,

indigenous drugs & vaccines as per present patent laws.

 NHP had also set up guidelines to ensure availability of

drugs vaccines, & T/T, cost effectively in this era of
Globalization.

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 ALTERENATE SYSTEM OF MEDICINE


Under National Health Programme “ is AYUSH”
included. Due to its diversity,modest cost, low level
technological input, growing popularity of plant based
products.Esp. Useful in remote & tribal areas.
Ex. Use of plant based drugs in allopathy ie.satavarex is used
in promoting lactation.
Population Growth & Health Standards

 Efforts are made to improvise Health standards to match

rapidly growing population.
 It’s recognized that population stabilization measures, general
health initiatives etc…..when synchronized synergistically,
maximize socio economic wellbeing of society. For this
separate National Population Policy-2000 had been
recommended.

C:\Documents and Settings\Administrator Desktop\Current Reviews – National Health Policy -India.htm

 LOOP HOLES
 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 ,control of medical ads.
 Methodology of strengthening healthcare & functioning of
health workers is not specified. Hence creating “ Half
Baked Paramedical Doctors”. Promoting QUACKERY.
 Literacy & its investment is not specified.
 As per WHO 5% of GDP should be spent on health but till
now no more than 0.9% to2% is spent on health.
 Problem of population is not answered properly.
 School education has not yielded desired results.
This is just a beginning………………
THANKS .
HAVE A NICE DAY.