By:

Health Policy of

Siddharth Reddy (014) Ankit Gupta (023) Sahil Kulkarni (029) Himaja Manda (034) Parin Shah (046) Ramya Shrivastava (048) Anshul Gupta (123)

National Health Policy in India-1983

It is felt that an integrated, comprehensive approach towards the future development of medical education, research and health services requires to be established to serve the actual health needs and priorities of the country.

Alma-Ata Declaration -1978

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

National Health Policy 2002

Objective : To achieve an acceptable standard of good health amongst the general population of the country Launch of NRHM(National Rural Health Mission) in 2005

Indian Health Policy: Vision

Health as a right for all citizens is the goal that the Ministry will strive towards. A comprehensive approach that encompasses individual health care, public health, sanitation, clean drinking water, access to food, and knowledge of hygiene, and feeding practices. To transform public health care into an accountable, accessible, and affordable system of quality services. Convergence and development of public health systems and services that are responsive to the health needs and aspirations of the people.

Indian Health Policy: Goals

To rise public spending on health from 1.2 per cent of GDP to 2-3 per cent of GDP, with improved arrangement for community financing and risk pooling. To undertake architectural correction of the health system to enable it to effectively handle increased allocations and promote policies that strengthen public health management and service delivery in the country.

Structure of Indian Health Care Services

Different system of medicines 1. Allopathy 4. Unani Health Sector 1. Private Sector - mostly provides curative services a. Not-for-profit Sector- NGOs, charitable institutions, trusts etc b. For-Profit Sector 2. Government Sector provides publicly financed and managed promotive, preventive and curative health services 2. Ayurvedic 5. Siddha 3. Homoepathy

Structure of Indian Health Care Services

Public Health Sector :
1 Central Government 3 Municipal 2 State Government 4 Local level bodies

National Health Policy : 3 Tier Structure

1. Primary Tier a. Sub-Centre (SC) for a population of 3000-5000 b. Primary Health Centre (PHC) for 20000 to 30000 people

c. Community Health Centre (CHC) as referral centre for every four PHCs covering a population of 80,000 to 1.2 lakh
2. Secondary Tier - The district hospitals were to function as the secondary tier for the rural health care, and as the primary tier for the urban population. 3. Tertiary Tier - The tertiary health care was to be provided by health care institutions in urban areas which are well equipped with sophisticated diagnostic facilities.

Structure of Ministry of Health and Family Welfare

Department of Health and Family Welfare - responsible for
implementation of national level programmes for control of communicable and non- communicable diseases, hospitals and dispensaries and medical education medicine such as Ayurveda, Homeo, Unani, Siddha and ongoing research in indigenous medicine medical and health activities

Department of AYUSH - takes care of promotion of indigenous systems of

Department of Health Research mainly concerned with research in

Department of National AIDS Control Organization - responsible for planning and implementation of programmes for prevention and control of AIDS.

Human Resources for Health

Shortage of human resources is a distressing feature of Indias healthcare services Several initiative taken to overcome shortage of human resources in this sector 1. Medical Education New Medical colleges, increase intake in existing Colleges 2. Nursing Education 3. Para Medical Education

Major Stakeholders In Health Care System

Government

Government In India
Ministry of Health

Indian Healthcare System

Department of Health & Family welfare

Department of Health Research

Department of AIDS Control

Department of Ayurveda, Yoga & naturopathy

Non Government

Government as a Major Stakeholder

Universal access to primary health care services for all sections of society Improving Maternal and child health Focusing on population stabilisation in the country Reducing overall disease burden of the society Regulate health service delivery, and promote rational use of pharmaceuticals. Policy Formulation on issues relating to health and family welfare sectors. Effective management of health institutions under the control of the health & Welfare department.

Non-Governmental Stakeholders
Public Major health initiatives are taken for public Access, Affordable & Quality Universally available to all Citizens

Health Care Providers

Medical doctors Dentists Specialty practioners

Bajaj Allianz General Insurance HSBC Health Insurance Provider Health Insurance Apollo Insurance Provider Providers Pharmaceutical Industries Rising Health care cost leads to increased insurance cost forcing business to assume greater financial burden

Business & Industry

Implementation & Achievements

National Rural Health Mission
Reproductive and child health programs National Disease control programs

Reproductive and child health

Janani Suraksha Yojna
a safe motherhood intervention for promoting institutional delivery number of beneficiaries has increased from 7.39 lakh in 2005-06 to about 1.13 crore in 2010-11

Janani Shishu Suraksha Karyakram

Provides free and cashless health care services to pregnant women in govt health institutes

Mother and Child Tracking system

for Ante-Natal Care and immunisation

Annual Health Surveys

Covered 284 districts

National Disease Control Programme

Communicable diseases
National TB Control Programme National Vector Borne Disease Control Programme (provision of long lasting insecticidal nets and rapid diagnostic kits)

HIV prevention and control

Leprosy Lymphatic Filaria Kala-azar

Acute encephalitis syndrome

National Disease Control Programme

Non-communicable diseases
National Programme of Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke Programme (NPCDCS) National Mental Health Programme

Programme for Prevention of Burn Injuries

The National Programme for the Health Care for the Elderly

National Disease Control Programme

Pradhan mantri swasthya suraksha yojana
Construction of six AIIMS like institutes Upgrading of 13 medical institutes

Medical education
4442 MBBS seats and 2398 Post Graduate seats were added to the existing seats in the recognized colleges

Legislations
Clinical Establishments Bill, 2010

Cigarettes and Other Tobacco Products (Packaging and Labeling) Rules

Progress on Key Indicators

Demographics & Mortality Scenario
1. Population & Avg. Annual Exponential Growth Rate (AAEGR)
Population of 1.21 Billion (17.5 % of worlds population) Rural: 68.84% & Urban: 31.16%

AAEGR dropped from 1.97% to 1.64%

Progress on Key Indicators

Demographics & Mortality Scenario
2. Sex Ratio
Haryana: 830 girls per 1000 boys Punjab: 846 girls per 1000 boys

J&K: 859 girls per 1000 boys

Progress on Key Indicators

Demographics & Mortality Scenario
3. Life expectancy at birth
Currently close to 65, increased from 63.5 in 2006-10 Decrease in death rate

Improvement in quality of health services

Kerala: 74 years while in Bihar, Assam, Madhya Pradesh, Uttar Pradesh: 58-62 years

4. Total Fertility Rate

Average number of children that would be born to a woman over her lifetime Indias TFR is at 2.5 Bihar, Madhya Pradesh, Rajasthan, Uttar Pradesh, Meghalaya & D&N Haveli: TFR is more than 3

Progress on Key Indicators

Demographics & Mortality Scenario
5. Crude Birth Rate
No. of births per 1000 people per year 29.5 births per 1000 population in 1991 to 22.1 births per 1000 population in 2010

Rural: 23.7 & Urban: 18.00

Highest: Uttar Pradesh (28.3) & Lowest: Goa (13.2)

6. Crude Death Rate

No. of deaths per 1000 people per year 9.8 deaths per 1000 population in 1991 to 7.2 deaths per 1000 population in 2010 Rural: 7.7 & Urban: 5.8 Highest: Odisha (7.8) & Lowest: Nagaland (3.6)

Progress on Key Indicators

Demographics & Mortality Scenario
7. Maternal Mortality Rate
The ratio of the number of maternal deaths per 100,000 live births during a given time-period Has reduced from 254 in 2004-06 to 212 in 2007-09 Lowest: Kerala & Tamil Nadu ( Less than 100 ) & Highest: Assam (390)

Progress on Key Indicators

Demographics & Mortality Scenario
8. Infant Mortality Rate
Higher in females (49) than males (46) Urban: 31 & Rural: 51

Best performing state: Kerala (13)

9. Child Mortality Rate

Rural: 14.9 & Urban: 7.8 Highest: Madhya Pradesh (20) Lowest: Kerala (2.9)

Progress on Key Indicators

Reproductive & Child Health (RCH)

Progress on Key Indicators

Disease Burden

Progress on Key Indicators

Disease Burden
Communicable Diseases

Up Trends Dengue, Chikungunya Cholera O139 Japanese Encephalatis Leptospirosis Emerging: Influenza A H5N1 Emerging: Influenza A Pandemic H1N1

Down Trends Polio Tuberculosis Neonatal Tetanus Measles Eradicated: Small Pox, Leprosy Eradicated: Yaws, Guinea Worm

Progress on Key Indicators

Disease Burden
Non-communicable Diseases
1. 2. National Cancer Control Program (NCCP) National Mental Health Program (NMHP)

3.
4. 5.

National Program for Health Care of Elderly (NPHCE)

National Tobacco Control Program (NTCP) National Program for Prevention & Control of Deafness (NPPCD)

Global Comparison
Indicators Annual Population Growth Rate US 0.9% India 1.31% China 0.47% Bangladesh 1.59%

Percentage of expenditure spent by Govt. on the healthcare Gross National Income per Capita Sex Ratio Life Expectancy Infant Mortality Rate

17.6% of GDP

4.1% of GDP

7% of GDP

7.9% of the total govt expenditure

50,120 USD 952 per 1000 males 77.97 5.9 per 1,000

1,530 USD 940 per 1000 males 65 44

9,210 USD 926 per 1000 males 73.49 15.2

770 USD 1052 per 1000 males 69 59

Maternal Mortality Rate

9.1 maternal deaths per 100,000 live births

200

37 maternal deaths per 100,000 live births

170

Global Comparison
Indicators Total Fertility Rate US India China 1.58 births per woman Bangladesh 2.6 births per woman 1.89 births per woman 2.59 births per woman Arthritis Diabetes Mellitus Coronary Heart dengue fever, Disease hepatitis, tuberculosis, Chronic Obstructive malaria and Pulmonary Disease pneumonia

Most Prevalant Diseases

Tuberculosis, Hepatitis A, typhoid fever

Malaria, Leptospirosis, Dengue

Crude Birth Rate Crude Death Rate No. of doctors (per 1000 ppl) No. of nurses (per 1000 ppl)

13 per 1,000 people 8 per 1,000 people 2.4 9.8

22 8 0.6 1

12 7 1.8 1.7

20 6 0.4 0.14

No. of hospital beds (per 1000 ppl)

0.9

3.8

0.33

Suggestions
Central and State Governments
Protect poor against ill health and exploitation Promote social health insurance Scale up financial resources

Improve management and accountability of public health services

Ensure quality improvement through standards and accreditations Strengthen the base of the pyramid Further improvements in tax benefit plans, import duty concessions and purchase of medical devices

Suggestions
Corporate Sector
Widen the scope of CSR activities Develop mechanisms of cross subsidising the poor through earnings from well-off sections

Provide hub and spoke model for both treatment and diagnostic care delivery
Encourage provision locum medical staff wherever required Take on responsibility of medical education

Suggestions
Non government and non profit sector
Enter into mutually beneficial partnerships with the corporate and government sectors

Academic and Research institutions

Medical colleges should facilitate updating technical knowledge
Bio-medical research organizations should be keen to improving the medical technology Contributions by Public health and management training institutions and management institutions

Stay Healthy!
Thank You