Implementation and Achievements:
The key strategies in National Health Policy have been Primary
Health Care Approach, decentralised public health system, the convergence of
all health programmes under a single field umbrella, strengthening and
extending public health services and enhanced contribution of private and NGO
sector in health care delivery. It also recommends an increase in public
spending on health care.
Launch of National Rural Health Mission (NRHM) in 2005 is a major step towards the adoption of these strategies. Most health programmes have been integrated under NRHM. State and District Programme Implementation Plans are being developed to effect decentralisation. However planning at the grassroots, i.e., at the village level, is yet in its infancy. Working towards Indian Public Health Standards will strengthen the service delivery, improve its quality and ensure public accountability through Patient Welfare Committees and Citizens Charter. Already substantial progress has been made in this regard as described in implementation and evaluation sections of the chapter on NRHM. For an autonomous action, society model has been adopted at the state and district level under NRHM and other programmes. Universalisation of Integrated Child Development Services (ICDS) Scheme and revised liberal norms for setting up of anganwadis and mini-anganwadis will further strengthen health and nutrition services in the country and increase access of vulnerable groups of the population to these services. In line with the National Health Policy, states are coming up with different models of Public Private Partnership as detailed in NRHM. A variety of schemes for Community Based Health Insurance and social risk pooling are coming up in different states. Rashtriya Swasthya Bima Yojana which covers BPL workers in the unorganised sector and their families is a major step in this direction.
The outlay for the health sector in the twelfth five-year plan is 3.35 times that of the eleventh plan, the maximum increase being for the Department of AIDS Control at 2.5% of GDP.
The financial management reform process has begun with starting of the system of National Health Accounts and financial allocation as a single package for all health programmes, on the basis of District and State Programme Implementation Plans. It is hoped that this will overcome the problem of different budget heads and five-year financial cycles.
In the Twelfth Plan, mental health programme has been envisaged to be strengthened and expanded fürther. For better occupational health, training of physicians has been recommended.
To ensure health manpower requirements and quality health care Twelfth plan has recommended setting up of National Commission for Human Resources and Health (NCHRH) as an overarching regulatory body for medical education and allied health sciences with the dual purpose of reforming the current regulatory framework and senior human resource in the health sector. The proposed Commission would subsume many functions of the existing councils. It has also called for legislation for registration of clinical establishments.
For achieving integrated surveillance, Integrated Disease Surveillance Project was launched in 2004. There has been considerable progress in reporting by the districts as well as reporting units. A nation-wide network of computers, linking districts with states and centre through broadband and satellite and use of information technology has revolutionised data transmission and analysis. The current priority of the program is to get data on a regular basis from large hospitals and laboratories, both in government as well as to detect outbreaks at an early stage. As a result of these measures, there has been increasing in the early detection of outbreaks in various parts of the country. The system has helped containment of Avian and Pandemic Influenza.
Malaria has shown a decline from about 2 million cases per year
in the nineties to 1.31 million cases per annum in 2011. However, increasing
the proportion of P. falciparum and continuing high morbidity and drug
resistance in North Eastern states and tribal belt of other states is a matter
of concern. Dengue is expanding in newer areas but there has been a decline in
the Case of Fatality Rate from 3.3 in 1996 to 0.9 in 2011 due to better case
management. The number of deaths due to Kala-azar has declined from 1419 (1992)
to 105 in 2010, but morbidity situation is nowhere close to elimination which
was to be achieved by 2010. The annual Mass Drug Administration started in
endemic districts in 2004 has brought down microfilaria rate to 0.4% in 2010.
The sustained decline in the next 3-4 consecutive years will indicate whether
we can achieve the goal of elimination of Lymphatic Filariasis by 2015. The
vaccination of children 1-15 years has been started against the Japanese.
Encephalitis in the endemic districts. The effect of this and other measures should be visible in the form of a decline in cases and deaths in the coming years.
With the intensification of Polio eradication activities and the introduction of BOPV, there has not been any case of confirmed polio due to wild poliovirus in India since 13 January 2011. As the country has not reported any case due to wild poliovirus for almost three years, the process of certification for polio-free India is near completion.
Infant and Maternal Mortality continue to be high in relation to Health Policy goals. However, efforts under NRHM in recent years on increasing institutional deliveries and providing emergency obstetric care through government health facilities or Public Private Partnership models have brought down the Maternal Mortality Rate from 400 to 212 per lakh live births. Infant Mortality Rate has decreased rapidly with skilled attendance at birth, home-based newborn care and implementation of IMNCI. According to SRS 2012, Infant Mortality Rate in the country is 42 per thousand live births.
Improvement in health indicators in the coming years needs sustained political commitment, further increase in financial support, improved management, active public participation in management of public health facilities and accountability of health system to people at large The reforms in the form of decentralized management, convergence in provision of services under various programmes, social health insurance schemes and Public-Private Partnerships need to continue and be strengthened further.