The first National Health Policy (1983) has guided the development of the health sector for the last two decades.
In the National
Health Policy achievements in the health sector during the last 50 years have
been reviewed. Notable among these is the eradication of smallpox and country
certified free of guinea worm, final steps towards the eradication of
poliomyelitis, increase in life expectancy, decrease in death rate, infant
mortality rate, birth rate, massive reduction in leprosy and malaria and
development of vast health infrastructure.
Providing continuum to the Health Policy 1983, the strategy of primary health care has been adopted as the key strategy in the new Health Policy, with emphasis on health services through:
– A decentralized public health system.
– The greater allocation for primary health level.
– Strengthening and extending public health services.
– Enhanced contribution of private and NGO sector targeted towards the groups which can afford to pay for services.
The overall objective of the new health policy is to achieve an
acceptable standard of good health amongst the general population of the
Within this broad objective, specified time bound goals have also been defined.
DETERMINANTS OF ACCESS TO HEALTH SERVICES
Financial Resources: Over the years, the proportion of Central Government budgetary allocation for health out of the total budget remains stagnant at 1.3%. In the states, this proportion has progressively declined from 7.0% to 5.5 %. It has been felt that the inability to provide adequate resources for Social infrastructure like health has contributed to the overall decline in public spending on health care infrastructure in the country.
Taking this into consideration, it is planned to increase health sector expenditure to 6.0% of GDP, with 2.0% of GDP being appropriated to public health investment by the year 2010. The states should try not only to arrest the declining trend in public health expenditure but should restore it to 7% of the budget by 2005 and 8% by 2010. To help the states, it envisages increasing the central share in total health spending of the states from the present 15% to 25% by 2010.
Human Resource Development:
Medical and Dental Colleges: In order to overcome the problem of uneven distribution of medical and dental colleges in various parts of the country, the policy envisages the setting up of a Medical Grants Commission for funding new government medical and dental colleges in different parts of the country. The Medical Grants Commission will also fund upgradation of the infrastructure of existing colleges so as to ensure improved standard of medical education, The need for inclusion of geriatric disorders and disciplines of contemporary medical research has also been emphasized. It has also been suggested that additional postgraduate seats should be created in the disciplines where manpower is deficient.
Nursing Personnel: In the interest of patient care, the policy emphasizes the need for improvement in the ratio of nurses vis-a-vis doctors/beds. To meet the increased demand in the government and private sector, the need for a central government subsidy for setting up and running of training facilities on a decentralized basis has been recognized. The need for setting up of training courses for super-specialty nurses been recognized. Besides increasing the ratio of degree-holding vis-a-vis diploma holding nurses, it is envisaged to improve the skill level of nurses.
Delivery of National Public
Health Programmes: The policy envisages a key role for
the central government in designing national programmes with the active
participation of states. The centre is also to provide financial support
besides technical support, monitoring and evaluation at the national level.
For optimal utilisation of Public Health infrastructure at the primary level, gradual convergence of all health programmes under a single field umbrella is envisaged. However vertical programmes on major diseases are to continue till moderate levels of prevalence are reached.
Involvement of Non-Government Organisations: In principle, the state would encourage handing over of public health service outlets at any level for management by NGOs and other institutions of civil society, on ‘as-is-where-is’ basis, along with the normative funds earmarked for such institutions.
Involvement of Private Sector: The policy welcomes the participation of the private sector at all levels of health care i.e. primary, secondary and tertiary. However, based on past experience, its contribution is expected mostly in the urban primary and tertiary sectors and moderate in the secondary sector.
Drugs and Vaccines: For cost-effective public health care, the policy favors treatment regimens based on a limited number of essential drugs of generic nature, The use of proprietary drugs will be prohibited in the government sector while in the private sector use of non-essential drugs will be discouraged through fiscal disincentives. Production and sale of irrational combinations of drugs would be prohibited through drug standards statute.
Population stabilization: Population stabilization and general health initiatives, when effectively synchronized, have a synergistic effect on the socio-economic well being of the people. Therefore the synchronized implementation of the National Health Policy and National Population Policy has been emphasized. In line with this, the health policy has adopted socio-demographic and health goals set up in the National Population Policy, in order to realize its objective of achieving an acceptable standard of good health of the general population of the country.
Intersectoral Contribution to
Health: The health status of people depends on adequate nutrition,
safe drinking water, basic sanitation, a clean environment, and primary
education, especially the girl child and access to basic health services.
The health policy has emphasized that the interface should be smooth between the independent policies of these interconnected sectors. However, no guidelines or recommendations have been made for these sectors, as it is in the domain of their respective policies
Information Education Communication: The emphasis is on dispelling myths and dissemination of information to those population groups which cannot be effectively approached by using only the mass media. This will be effected through inter-personal communication and folk and other traditional media to bring about a behavior change.