December 11, 2012

MH0051 [Health Administration] Set1 Q4 ii

Q.4. (ii) Goals and objectives of National health policy 2002.

Answer:

The main objective of the revised National Health Policy, 2002 is 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. The major policy prescriptions were as follows:

• Increase public expenditure from 0.9 percent to 2 percent by 2010. 
• Increase allocation of public health investment in the order of 55 percent for the primary health sector; 35 percent and 10 percent to secondary and tertiary sectors respectively.
• Gradual convergence of all health programmes, except the ones (such as TB, Malaria, HIV/AIDS, RCH), which need to be continued till moderate levels of prevalence are reached.
• Need to levy user charges for certain secondary and tertiary public health services, for those who can afford to pay.
• Mandatory two year rural posting before awarding the graduate medical degree.
• Decentralizing the implementation of health programmes to local self governing bodies by 2005.
• Setting up of Medical Grants Commission for funding new Government Medical and Dental colleges.
• Promoting public health discipline.
• Establishing two-tier urban healthcare system – Primary Health Centre for a population of one lakh and Government General Hospital.
• Increase in Government funded health research to a level of 2 percent 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.
• Co-option of NGOs in national disease control programmes.
• Promotion of tele-medicine in tertiary healthcare sector.
• Full operationalisation of National Disease Surveillance Network by
2005.
• Notification of contemporary code of medical ethics by Medical Council of India.
• 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.

The National Health Policy (NHP) of 1983 was revisited by the Government of India in 2002. The revisited policy reiterates to achieve an acceptable standard of good health amongst the general population of the country. The precise approach of the stated policy is to increase the access to decentralized public health system, ensure equitable access, increase the public health investment through contribution of central government, to enhance the contribution of NGO and private sector in health, to regulate the services of private and public sector, to initiate user charges and above all strengthen the delivery of primary health care in public sector. The policy has set time bound goals for identified national problems of malaria, tuberculosis, blindness, gastroenteritis, cholera and water vector borne diseases, leprosy, HIV/AIDS etc. The national health policy also identifies the other public health problems of concern such as trauma and accidents, macro and micro nutrient deficiencies, life style diseases and problems of aged to be tackled through efforts.

Comparative differences
The first National Health Policy framed in 1983 gave a general exposition of the policies which necessitated recommendation in the conditions then prevailing in the country’s health sector. The notable initiatives under that policy were as follows:
1. A phased, time-bound programme for setting up a well-dispersed network of Comprehensive Primary Health care services, associated with extension and health education, projected in the context of the ground reality that elementary health problems can be settled by the people themselves;
2. Intermediation through „Health volunteers having suitable knowledge, simple skills and needed technologies;
3. Establishment of a well-worked out referral system to make certain that patient load at the higher levels of the hierarchy is not unnecessarily burdened by those who can be treated at the decentralized level;
4. An integrated network of evenly spread speciality and super-speciality services; encouragement of such facilities through private investments for patients who can pay, so that the draw on the Government’s facilities is limited to those entitled to free use of those services.

Government initiatives in the pubic health sector have showed some remarkable successes over time. Smallpox and Guinea Worm Disease have been eradicated from the country; Polio is on the verge of being eradicated; Leprosy, Kala Azar, and Filariasis can be expected to be eliminated in the foreseeable future. There has been a substantial drop in the Total Fertility Rate and Infant Mortality Rate. The success of the initiatives taken in the public health field are reflected in the progressive improvement of many demographic/epidemiological/infrastructural indicators over time – (Table ).

Table : Achievements through the Years 1951-2000


RGI: Registrar General of India; SRS: Sample Registration System; SC: Sub Centers; PHC: Primary Health Center; CHC: Community Health Center; RHS: Rural Health Statistics; CBHI: Central Bureau of Health Intelligence; MCI: Medical Council of India; INC: Indian Nursing Council.

In India, there is no regular system for collecting data on non-communicable diseases (NCDs)-which can be said to be of adequate coverage or quality.
Thus, most of these estimates at best may be taken as approximation only. According to SRS-1998 estimates NCDs are responsible for 32% of all deaths in the country. Of these, cardiovascular diseases constituted 13%, injuries 8.7% and chronic respiratory diseases 6.7%. Cancers with 3.4% and diabetes with 0.2% were the other contributors. Rheumatic heart disease (RHD) is prevalent in the range of 5 to 7/1000 in the 5 to 15 years agegroup. RHD constitutes 20% to 30% of hospital admission due to all cardiovascular diseases (CVD) in India.

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