NATIONAL GOALS AND NATIONAL HEALTH POLICY

Presented by, Miss HetalChavda F.Y.M.Sc.Nsg.

INDIAN MILLENNIUM DEVELOPMENT GOALS (MDGS) :Introduction

Shri G. K. Vasan, Minister of State (independent charge), Ministry of Statistics and Programme Implementation, released the first Millennium Development Goals India Country Report for the year 2005 on 13th February 2006 in a simple function at Delhi.

THE MILLENNIUM DEVELOPMENT GOALS ARE:

Eradicate extreme poverty and hunger. Achieve universal primary education. Promote gender equality and empower women.

Reduce child mortality.

Improve maternal health. Combat HIV/ AIDS, malaria and other diseases. Ensure environmental sustainability and Develop a global partnership for development

INDIA'S POSITION WITH REFERENCE TO THE VARIOUS GOALS IS GIVEN BELOW

ERADICATE EXTREME POVERTY AND HUNGER

To achieve the Goal of eradicating extreme poverty and hunger, India must reduce by 2015 the proportion of people below poverty line from nearly 37.5 % in 1990 to about 18.75 %. As on 19992000, the poverty headcount ratio is 26.1 % with poverty gap ratio of 5.2 %, share of poorest quintile in national consumption is 10.1 % for rural sector and 7.9 % for urban sector and prevalence of underweight children is of the order of 47 %.

ACHIEVE UNIVERSAL PRIMARY EDUCATION

To achieve universal primary education under Goal-2, India should increase the primary school enrolment rate to 100 % and wipe out the drop-outs by 2015 against 41.96 % in 1991-92. The drop-out rate for primary education during 2002-03 is 34.89 %.

The gross enrolment ratio in primary education has tended to remain near 100 % for boys and recorded an increase of nearly 20 percentage points in the ten years period from 1992-93 to 2002-03 for girls (93 %). The literacy rate (7 years and above) has also increased from 52.2 % in 1992-93 to 65.4 % in 2000-01.

PROMOTE GENDER EQUITY AND WOMAN EMPOWERMENT

To ensure gender parity in education levels in Goal-3, India will have to promote female participation at all levels to reach a female male proportion of equal level by 2015. The female male proportion in respect of primary education was 71:100 in 1990-91 which has increased to 78:100 in 200001. During the same period, the proportion has increased from 49:100 to 63:100 in case of secondary education.

REDUCE CHILD MORTALITY

Goal 4 aims at reducing under five mortality rate (U5MR) from 125 deaths per thousand live births in 1988-92 to 42 in 2015. The U5MR has decreased during the period 1998-2002 to 98 per thousand live births and in 2012 it is 65 per thousand live birth. The infant mortality rate (IMR) has also come down from 80 per thousand live births in 1990 to 60 per thousand in 2003 and 46 per thousand in 2012 and the proportion of 1 year old children immunised against measles has increased from 42.2 % in 1992-93 to 58.5 % in 2002-03.

IMPROVE MATERNAL HEALTH

To achieve Goal-5, India should reduce maternal mortality (MMR) from 437 deaths per 100,000 live births in 1991 to 109 by 2015. The value of MMR for 1998 is 407 and in

2008 is 230 per 1 lakh population.

The proportion of births attended by skilled health personnel has been continuously increasing, (from 25.5 % in 1992-93 to 39.8% in 2002-03) thereby reducing the chances of occurrence of maternal deaths.

COMBAT HIV-AIDS, MALARIA AND OTHER DISEASES

Goal-6 is concerned, though India has a low prevalence of HIV among pregnant women as compared to other developing countries, yet the prevalence rate has increased from 0.74 per thousand pregnant women in 2002 to 0.86 in 2003.
The prevalence and death rates associated with malaria are consistently coming down. The death rate associated with TB has come down from 67 deaths per 100.000 population in 1990 to 33 per 100,000 population in 2003. The proportion of TB patients successfully treated has also risen from 81% in 1996 to 86% in 2003.

ENSURE ENVIRONMENTAL SUSTAINIBILITY

Goal-7 aims at ensuring environmental sustainability. As per assessment made in 2003, total land area covered under different forests has been 20.64% due to Government's persistent efforts to preserve the natural resources. The proportion of population without sustainable access to safe drinking water and sanitation is to be halved by 2015 and India is on track to achieve this target.

 DEVLOP

A GLOBAL PARTNERSHIP FOR

DEVELOPMET

Goal-8 is regarding the developing global partnership for development. It is basically meant for the Developed Countries to provide development assistance to developing countries.

With regard to one of the targets of the Goal 8, i.e. in cooperation with the private sector, make available the benefits of new

technologies, especially information and communications, India

has made substantial progress in recent years.

The Government of India holds the following views regarding the role

The financial support needed to achieve the targets under this Goal had been estimated for the least developed land locked and small countries by a highlevel panel on 'Financing for Development at an additional amount of US $ 50 billion which would be required for this purpose every year till 2015.

With regard to one of the targets of the Goal 8, i.e. in cooperation with the private sector, make available the benefits of new technologies, especially information and communications, India has made substantial progress in recent years.

NATIONAL HEALTH POLICY

Health policy of a Nation is its strategy for controlling and optimising the social uses of its health knowledge and health resources.

 India had its first national health policy in 1983 i.e. 36 years after independence.

Why ???

THE JOINT WHO UNICEF INTERNATIONAL CONFERENCE IN 1978 AT ALMA-ATA

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.

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

INTERNATIONAL CONFERENCE IN

1978

AT ALMA-ATA
Declared

that

the

existing gross inequalities in the

status of health of people particularly

between developed and developing

countries as well as within the countries

is politically, socially and economically

unacceptable.

The Alma-Ata conference called for acceptance of the WHO goal of

HEALTH FOR ALL

by 2000 AD

and Primary Health Care as a way to achieve Health For All

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.

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 cost

the community and country

can afford.

PRINCIPLES OF PRIMARY HEALTH CARE

1.Equitable distribution 2.Community participation.

3.Inter-sectoral coordination 4.Appropriate technology

1. EQUITABLE DISTRIBUTION

Some

thing for all and most for those who

need the most

Bahujan

hitae bahujan sukhae

2. COMMUNITY PARTICIPATION
There

must be a continuing effort to secure

meaningful involvement of the community in

the planning, implementation and maintenance

of health services, besides maximum reliance

on local resources such as manpower, money

and materials.

3.INTERSECTORAL COORDINATION
"primary

health care involves in addition to the

health sector, 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".

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 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 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 iii) Water supply and sanitation iv) Environmental protection v) Immunisation programme vi) Maternal and child health services vii) School health programme and viii) Occupational health services.

NHP 1983- GOAL SUGGESTED/ACHIEVED

Indicator
IMR PNMR CDR MMR UFMR LIFE EXPECTANCY MALE FEMALE

Goal by 2000
60 33 9 2 10

Achieved by 2000 70 46 8.7 4 9.4 62.4 63.4

64 64

NHP 1983- Goal suggested/achieved

Indicator
LBW CBR CPR NRR Growth rate Family size

Goal by 2000 Achievement by 2000 10% 26% 21 26.1 60% 46.2% 1 1.45 1.2 1.93 2.3 3.1

Indicators

Goal by 2000

AN Care
TT Pregnant DPT OPV

100%
100% 85% 85%

Achievement by 2000 67.2% any ANC 83% 87% 92%

BCG Fully immunized

85% 85%

82% 56%

NATIONAL HEALTH POLICY 2002

Objectives: Achieving an acceptable standard of good health of Indian Population, Decentralizing public health system by upgrading infrastructure in existing institutions, Ensuring a more equitable access to health service across the social and geographical expanse of India.

Enhancing the contribution of private sector in providing health service for people who can afford to pay. Giving primacy for prevention and first line curative initiative. Emphasizing rational use of drugs. Increasing access to tried systems of Traditional Medicine

GOALS NHP 2002

1. Eradication of Polio & Yaws 2. Elimination of Leprosy 3. Elimination of Kala-azar 4. Elimination of lymphatic Filariasis 5. Achieve of Zero level growth of HIV/AIDS 6.Reduction of mortality by 50% on account of Tuberculosis, Malaria, Other vector and water borne Diseases 7.Reduce prevalence of blindness to 0.5%

2005 2005 2010 2015 2007 2010

2010

8. Reduction of IMR to 30/1000 & MMR to 100/lakh 9. Increase utilisation of public health facilities from Current level of <20% to > 75% 10. Establishment of an integrated system of surveillance, National Health Accounts and Health Statistics

2010 2010

2007

11.Increase health expenditure by government as a % of GDP from the existing 0.9% to 2.0%
12. Increase share of Central grants to constitute at least 25% of total health spending 13. Increase State Sector Health spending from 5.5% to 7% of the budget 14. Further increase of State sector Health spending from 7% to 8%

2010

2010

2005

2007

Financial resource
Increase in health sector expenditure to 6% of GDP, with 2% by public health investment by 2010 is recommended by the policy. Existing 15% of central government contribution is to be raised to 25% by 2010. This will allow a good rise of current annual per capita public health expenditure of the country from Rs. 200/- by ten-fold say around Rs. 2000/-.

DELIVERY OF NATIONAL PUBLIC HEALTH

PROGRAMMES

NHP

2002 envisages the gradual convergence of all health programmes under a single field administration. It suggests for a scientific designing of public health projects suited to the local situation.

NHP 2002 noted that less than 20% of population which seek OPD services and less than 45% of that which seek indoor treatment avail of such services in public hospital.

In this backdrop, the 2002 NHP envisages kick starting of the revival of public health system by providing some essential drugs through decentralised health system.

The policy recognizes the need for more frequent in - service training.

NHP 2002 noted that improvement of public health indices is linked with quantum and quality of investment through public funding in public health sector.

DELIVERY OF NATIONAL PUBLIC HEALTH PROGRAMMES.

Therefore,

the policy places reliance on strengthening of public health outcomes on equitable basis. recognises the need of user charge for secondary and tertiary public health care for those who can afford to pay.

It

EXTENDING PUBLIC HEALTH SERVICES

Expanding

the pool of General Practitioners to include a cadres of licentiates including Indian systems of Medicine and Homoeopathy is recommended in the policy. In order to provide trained manpower in under served areas it recommends contract employment.

ROLE OF LOCAL SELF GOVERNMENT INSTITUTIONS

NHP

2002 emphasises implementation of health programmes through local self government institutions by 2005 with financial incentives.

NORMS FOR HEALTH CARE PERSONNEL

Indian

Medical Council Act and Indian Nursing Council Act provide minimal statutory norms for doctors and nurses in medical institutions. NHP 2002 suggests for review and making stringent statutory norms for meeting better normative standards.

Suggested norms for health personnel

Category of personnel
1 . Doctors 2. Nurses 3. Health worker female and male

Norms suggested
1 per 3,500 population 1 per 5,000 population 1 per 5,000 population in plain area and 3000 population in tribal and hilly areas. 1 per village 1 per 30,000 population in plain area and 20000 population in tribal and hilly areas.

4. Trained dai 5. Health assistant (male and female

6. Health assistant (male and female)

7. Pharmacists 8. Lab. technicians

provides supportive supervision to 6 health workers (male /female).

1 per 10,000 population 1 per 10,000 population

EDUCATION OF HEALTH CARE

PROFESSIONALS

NHP 2002 recommends setting up of a Medical Grant Commission for funding new government medical/dental colleges. It suggests for a need based, skill oriented syllabus with a more significant component of practical training. The need for inclusion of contemporary medical research and geriatric concern and creation of additional PG seats in deficient specialities are specified.

NEED FOR SPECIALISTS IN 'PUBLIC HEALTH' AND 'FAMILY MEDICINE'

For

discharging public health responsibilities in the country NHP 2002 recommends specialisation 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

NURSING
PERSONNEL
NHP 2002 recognises acute shortage of nurses trained in super speciality disciplines. It recommends increase of nursing personnel in public health delivery centres and establishment of training courses for super specialities.

USE OF
GENERIC DRUGS AND VACCINES

NHP 2002 recommends limited number of essential drugs of generic nature as a requisite for cost effective public health care.
To ensure long term national health security, NHP 2002 envisages that not less than 50% of the requirement of vaccine/sera be sourced from public sector institutions

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;

MENTAL
HEALTH
Decentralised mental health service for diagnosis and treatment by general duty medical staff is recommended. It also recommends securing the human rights of mentally sick.

INFORMATION EDUCATION AND COMMUNICATION

NHP 2002 has suggested interpersonal communication by folk and traditional media to bring about behavioural change. Associations of PRIs/NGOs/Trusts are given specific targets.

HEALTH
RESEARCH
2002 NHP noted the aggregate annual health expenditure of Rs. 80,000 crores and on research Rs. 1150 crores is quite low.
The policy envisages an increase in govt. funded health resources to a level of 1% total health spending by 2005 and upto 2% by 2010. New therapeutic drugs and vaccines for tropical disease are given priority.

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; recommended regularitory and accreditation of private sector for the conduct of clinical practice.

But

National disease surveillance network

NHP

2002 noted that absence of an efficient disease surveillance network is a major handicap for cost effective health care.
wants a network from lowest rung to central government by 2005 by installation of data base handling hardware, IT interconnectivity, in-house training for data collection and interpretation.

It

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 and G.E . It has suggested a national health accounts conforming to the source to users matrix.

WOMEN'S
HEALTH
After recognising 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.

MEDICAL ETHICS
In India we have guidelines on professional medical ethics since 1960. This is revised in 2001. Government of India has emphasised 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.

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.

ENVIRONMENTAL
AND OCCUPATIONAL HEALTH

Government has noted the ambient environment condition like unsafe drinking water, unhygienic sanitation and air pollution. NHP 2002 has suggested for an independent state policy and programme for environment apart from periodic health screening for high risk associated occupation.

IMPACT OF GLOBALISATION ON THE

HEALTH SECTOR
With

the adoption of Trade Related Intellectual Property Rights (TRIPS) government is taking steps to overcome possible adverse impact of economic globalisation on the health sector. NHP 2002 envisages a national patent regime for the future.
NHP

2002 brings out the relevance of intersectoral contribution to health but limits itself to making recommendations.

SUMMATION
Crafting

of a National Health Policy is a rare

occasion. allow our dreams to mingle with ground realities.

needs

are enormous and the resources are limited health needs are also dynamic and keep changing over time. had to make hard choices between various priorities

NHP 2002 has given a continuum to NHP 1983, where primary health care is adopted as the main strategy through Decentralization Equity Private sector/indigenous system participation Rise in public investment The ultimate goal is achieving an acceptable standard of good health of people of India. The commitment of the service providers and an improved standard of governance is a prerequisite for the success of any health policy.

miles to go before..

THE MAINTENANCE AND WELFARE OF PARENTS AND SENIOR CITIZENS BILL 2007
The government of India provides various concessions and facilities to its senior citizens. Union cabinet has approved this bill with the aim of serving the elderly live in self-respect and peace. This obligation applies to all Indian citizens, including those who live abroad.

HEALTH

Many government and private hospitals provide concessions to the older persons in the treatment of the diseases like cardiac problems, diabetes, kidney problems, blood pressure, joint problems and eye problems. There is also a condition for separate queuing of reservations for hospital beds.

BANKING

The Indian government gives high rates of interest to its senior citizens on certain savings plans which are run by the post offices and other private banks.

TRAVEL
Indian railways give 30% concessions in the ticket prices to all the persons aged 60 years and above. It is 50% for women aged over 60 years. Proof of age is required. There are also conditions of lower berth for older persons and also separate counters for booking and cancelling tickets to avoid rushes at the counters. Indian airlines provide 50% concessions in its economy class. Air India provides 45% concessions to older persons in wheel chairs and are allowed to board the plane first.

HOUSING

The Indian government provides housing facilities such as retirement homes and recreational or educational centers. These centers provide older persons with opportunities to spend their free time doing various activities. Most recreational centers have fitness clubs, yoga centers, parks, spiritual sessions, picnics, food fests for the health and entertainment of senior citizens. Some old age homes also have libraries other activities such as music classes, arts and crafts, quizzes and indoor games. These activities help to spiritually uplift seniors and can contribute to overall health improvements and mental stability.

PERSONAL LAWS

The moral duty to maintain parents is recognized by all people. However, so far as law is concerned, the position and extent of such liability varies from community to community.

(I) Hindus Laws: (II) Muslim Law: (III) Christian And Parsi Law:

(I)HINDUS LAWS:

Amongst the Hindus, the obligation of sons to maintain their aged parents, who were not able to maintain themselves out of their own earning and property, was recognized even in early texts. The statutory provision for maintenance of parents under Hindu personal law is contained in Sec 20 of the Hindu Adoption and Maintenance Act, 1956. This Act is the first personal law statute in India, which imposes an obligation on the children to maintain their parents. As is evident from the wording of the section, the obligation to maintain parents is not confined to sons only, and daughters also have an equal duty towards parents. It is important to note that only those parents who are financially unable to maintain themselves from any source, are entitled to seek maintenance under this Act.

II) MUSLIM LAWS

According to Mulla : (a) Children in easy circumstances are bound to maintain their poor parents, although the latter may be able to earn something for themselves. (b) A son though in strained circumstances is bound to maintain his mother, if the mother is poor, though she may not be infirm. (c) A son, who though poor, is earning something, is bound to support his father who earns nothing. Both sons and daughters have a duty to maintain their parents under the Muslim law.

(III) CHRISTIAN AND PARSI LAW:

The Christians and Parsis have no personal laws providing for maintenance for the parents. Parents who wish to seek maintenance have to apply under provisions of the Criminal Procedure Code.