NATIONAL HEALTH POLICY – 2002

NATIONAL HEALTH POLICY – 2002

1. INTRODUCTORY

 

1.1 A National Health Policy was last formulated in 1983, and since

then there have been marked changes in the determinant

factors relating to the health sector. Some of the policy initiatives

outlined in the NHP-1983 have yielded results, while, in several

other areas, the outcome has not been as expected.

 

1.2 The NHP-1983 gave a general exposition of the policies which

required recommendation in the circumstances then prevailing in

the health sector. The noteworthy initiatives under that policy

were:-

(i) A phased, time-bound programme for setting up a welldispersed

network of comprehensive primary health care

services, linked with extension and health education, designed in

the context of the ground reality that elementary health problems

can be resolved by the people themselves;

(ii) Intermediation through ‘Health volunteers’ having appropriate

knowledge, simple skills and requisite technologies;

(iii) Establishment of a well-worked out referral system to ensure

that patient load at the higher levels of the hierarchy is not

needlessly burdened by those who can be treated at the

decentralized level;

(iv) An integrated net-work of evenly spread speciality and superspeciality

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.

 

1.3 Government initiatives in the pubic health sector have

recorded some noteworthy 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 – (Box-I).

 

Box-1 : Achievements Through The Years – 1951-2000
Indicator	1951	1981	2000
Demographic Changes
Life Expectancy	36.7	54	64.6(RGI)
Crude Birth Rate	40.8	33.9(SRS)	26.1(99 SRS)
Crude Death Rate	25	12.5(SRS)	8.7(99 SRS)
IMR	146	110	70 (99 SRS)

 

 

Epidemiological Shifts
Malaria (cases in million)	75	2.7	2.2
Leprosy cases per 10,000 population	38.1	57.3	3.74
Small Pox (no of cases)	>44,887	Eradicated
Guineaworm ( no. of cases)		>39,792	Eradicated
Polio		29709	265
Infrastructure
SC/PHC/CHC	725	57,363	1,63,181
			(99-RHS)

 

 

Dispensaries &Hospitals( all)	9209	23,555	43,322 (95–96-CBHI)
Beds (Pvt & Public)	117,198	569,495	8,70,161
			(95-96-CBHI)
Doctors(Allopathy)	61,800	2,68,700	5,03,900
			(98-99-MCI)
Nursing Personnel	18,054	1,43,887	7,37,000
			(99-INC)

 

1.4 While noting that the public health initiatives over the years

have contributed significantly to the improvement of these health

indicators, it is to be acknowledged that public health indicators /

disease-burden statistics are the outcome of several

complementary initiatives under the wider umbrella of the

developmental sector, covering Rural Development, Agriculture,

Food Production, Sanitation, Drinking Water Supply, Education,

etc. Despite the impressive public health gains as revealed in the

statistics in Box-I, there is no gainsaying the fact that the morbidity

and mortality levels in the country are still unacceptably high.

These unsatisfactory health indices are, in turn, an indication of

the limited success of the public health system in meeting the

preventive and curative requirements of the general population.

 

1.5 Out of the communicable diseases which have persisted over

time, the incidence of Malaria staged a resurgence in the1980s

before stabilising at a fairly high prevalence level during the

1990s. Over the years, an increasing level of insecticide-resistance

has developed in the malarial vectors in many parts of the

country, while the incidence of the more deadly P-Falciparum

Malaria has risen to about 50 percent in the country as a whole. In

respect of TB, the public health scenario has not shown any

significant decline in the pool of infection amongst the

community, and there has been a distressing trend in the increase

of drug resistance to the type of infection prevailing in the

country. A new and extremely virulent communicable disease –

HIV/AIDS – has emerged on the health scene since the

declaration of the NHP-1983. As there is no existing therapeutic

cure or vaccine for this infection, the disease constitutes a serious

threat, not merely to public health but to economic development

in the country. The common water-borne infections –

Gastroenteritis, Cholera, and some forms of Hepatitis – continue

to contribute to a high level of morbidity in the population, even

though the mortality rate may have been somewhat moderated.

 

1.6 The period after the announcement of NHP-83 has also seen

an increase in mortality through ‘life-style’ diseases- diabetes,

cancer and cardiovascular diseases. The increase in life

expectancy has increased the requirement for geriatric care.

Similarly, the increasing burden of trauma cases is also a

significant public health problem.

1.7 Another area of grave concern in the public health domain is

the persistent incidence of macro and micro nutrient deficiencies,

especially among women and children. In the vulnerable subcategory

of women and the girl child, this has the multiplier effect

through the birth of low birth weight babies and serious

ramifications of the consequential mental and physical retarded

growth.

 

1.8 NHP-1983, in a spirit of optimistic empathy for the health needs

of the people, particularly the poor and under-privileged, had

hoped to provide ‘Health for All by the year 2000 AD’, through the

universal provision of comprehensive primary health care services.

In retrospect, it is observed that the financial resources and public

health administrative capacity which it was possible to marshal,

was far short of that necessary to achieve such an ambitious and

holistic goal. Against this backdrop, it is felt that it would be

appropriate to pitch NHP-2002 at a level consistent with our

realistic expectations about financial resources, and about the

likely increase in Public Health administrative capacity. The

recommendations of NHP-2002 will, therefore, attempt to

maximize the broad-based availability of health services to the

citizenry of the country on the basis of realistic considerations of

capacity. The changed circumstances relating to the health

sector of the country since 1983 have generated a situation in

which it is now necessary to review the field, and to formulate a

new policy framework as the National Health Policy-2002. NHP-

2002 will attempt to set out a new policy framework for the

accelerated achievement of Public health goals in the socioeconomic

circumstances currently prevailing in the country.

 

2. CURRENT SCENARIO

 

2.1 FINANCIAL RESOURCES

2.1.1 The public health investment in the country over the years

has been comparatively low, and as a percentage of GDP has

declined from 1.3 percent in 1990 to 0.9 percent in 1999. The

aggregate expenditure in the Health sector is 5.2 percent of the

GDP. Out of this, about 17 percent of the aggregate expenditure

is public health spending, the balance being out-of-pocket

expenditure. The central budgetary allocation for health over this

period, as a percentage of the total Central Budget, has been

stagnant at 1.3 percent, while that in the States has declined from

7.0 percent to 5.5 percent. The current annual per capita public

health expenditure in the country is no more than Rs. 200. Given

these statistics, it is no surprise that the reach and quality of public

health services has been below the desirable standard. Under the

constitutional structure, public health is the responsibility of the

States. In this framework, it has been the expectation that the

principal contribution for the funding of public health services will

be from the resources of the States, with some supplementary

input from Central resources. In this backdrop, the contribution of

Central resources to the overall public health funding has been

limited to about 15 percent. The fiscal resources of the State

Governments are known to be very inelastic. This is reflected in

the declining percentage of State resources allocated to the

health sector out of the State Budget. If the decentralized pubic

health services in the country are to improve significantly, there is

a need for the injection of substantial resources into the health

sector from the Central Government Budget. This approach is a

necessity – despite the formal Constitutional provision in regard to

public health, — if the State public health services, which are a

major component of the initiatives in the social sector, are not to

become entirely moribund. The NHP-2002 has been formulated

taking into consideration these ground realities in regard to the

availability of resources.

 

2.2 EQUITY

2.2.1 In the period when centralized planning was accepted as a

key instrument of development in the country, the attainment of

an equitable regional distribution was considered one of its major

objectives. Despite this conscious focus in the development

process, the statistics given in Box-II clearly indicate that the

attainment of health indices has been very uneven across the

rural – urban divide.

 

Sector	Population BPL (%)	IMR/ Per 1000 Live Births (1999-SRS)	<5Mort-ality per 1000 (NFHS II)	Weight For Age-% of Children Under 3 years (<-2SD)	MMR/ Lakh (Annual Report 2000)	Leprosy cases per 10000 popula-tion	Malaria +ve Cases in year 2000 (in thousands)
India	26.1	70	94.9	47	408	3.7	2200
Rural	27.09	75	103.7	49.6	–	–	–
Urban	23.62	44	63.1	38.4	–	–	–
Better Performing States
Kerala	12.72	14	18.8	27	87	0.9	5.1
Maharashtra	25.02	48	58.1	50	135	3.1	138
TN	21.12	52	63.3	37	79	4.1	56

 

 

Low Performing States
Orissa	47.15	97	104.4	54	498	7.05	483
Bihar	42.60	63	105.1	54	707	11.83	132
Rajasthan	15.28	81	114.9	51	607	0.8	53
UP	31.15	84	122.5	52	707	4.3	99
MP	37.43	90	137.6	55	498	3.83	528

 

Also, the statistics bring out the wide differences between the

attainments of health goals in the better- performing States as

compared to the low-performing States. It is clear that national

averages of health indices hide wide disparities in public health

facilities and health standards in different parts of the country.

Given a situation in which national averages in respect of most

indices are themselves at unacceptably low levels, the wide inter-

State disparity implies that, for vulnerable sections of society in

several States, access to public health services is nominal and

health standards are grossly inadequate. Despite a thrust in the

NHP-1983 for making good the unmet needs of public health

services by establishing more public health institutions at a

decentralized level, a large gap in facilities still persists. Applying

current norms to the population projected for the year 2000, it is

estimated that the shortfall in the number of SCs/PHCs/CHCs is of

the order of 16 percent. However, this shortage is as high as 58

percent when disaggregated for CHCs only. The NHP-2002 will

need to address itself to making good these deficiencies so as to

narrow the gap between the various States, as also the gap

across the rural-urban divide.

 

2.2.2 Access to, and benefits from, the public health system have

been very uneven between the better-endowed and the more

vulnerable sections of society. This is particularly true for women,

children and the socially disadvantaged sections of society. The

statistics given in Box-III highlight the handicap suffered in the

health sector on account of socio-economic inequity.

 

 

Box-III : Differentials in Health status Among Socio-Economic Groups
Indicator	Infant Mortality/1000	Under 5 Mortality/1000		% Children Underweight
India	70	94.9	47
Social Inequity
Scheduled Castes	83	119.3	53.5
Scheduled Tribes	84.2	126.6	55.9
Other Disadvantaged	76	103.1	47.3
Others	61.8	82.6	41.1

 

2.2.3 It is a principal objective of NHP-2002 to evolve a policy

structure which reduces these inequities and allows the

disadvantaged sections of society a fairer access to public health

services.

 

2.3 DELIVERY OF NATIONAL PUBLIC HEALTH

PROGRAMMES

2.3.1 It is self-evident that in a country as large as India, which has

a wide variety of socio-economic settings, national health

programmes have to be designed with enough flexibility to permit

the State public health administrations to craft their own

programme package according to their needs. Also, the

implementation of the national health programme can only be

carried out through the State Governments’ decentralized public

health machinery. Since, for various reasons, the responsibility of

the Central Government in funding additional public health

services will continue over a period of time, the role of the Central

Government in designing broad-based public health initiatives will

inevitably continue. Moreover, it has been observed that the

technical and managerial expertise for designing large-span

public health programmes exists with the Central Government in

a considerable degree; this expertise can be gainfully utilized in

designing national health programmes for implementation in

varying socio-economic settings in the States. With this

background, the NHP-2002 attempts to define the role of the

Central Government and the State Governments in the public

health sector of the country.

 

2.3.2.1 Over the last decade or so, the Government has relied

upon a ‘vertical’ implementational structure for the major disease

control programmes. Through this, the system has been able to

make a substantial dent in reducing the burden of specific

diseases. However, such an organizational structure, which

requires independent manpower for each disease programme, is

extremely expensive and difficult to sustain. Over a long timerange,

‘vertical’ structures may only be affordable for those

diseases which offer a reasonable possibility of elimination or

eradication in a foreseeable time-span.

 

2.3.2.2 It is a widespread perception that, over the last decade

and a half, the rural health staff has become a vertical structure

exclusively for the implementation of family welfare activities. As a

result, for those public health programmes where there is no

separate vertical structure, there is no identifiable service delivery

system at all. The Policy will address this distortion in the public

health system.

 

2.4 THE STATE OF PUBLIC HEALTH INFRA-STRUCTURE

2.4.1 The delineation of NHP-2002 would be required to be based

on an objective assessment of the quality and efficiency of the

existing public health machinery in the field. It would detract from

the quality of the exercise if, while framing a new policy, it were

not acknowledged that the existing public health infrastructure is

far from satisfactory. For the outdoor medical facilities in

existence, funding is generally insufficient; the presence of

medical and para-medical personnel is often much less than that

required by prescribed norms; the availability of consumables is

frequently negligible; the equipment in many public hospitals is

often obsolescent and unusable; and, the buildings are in a

dilapidated state. In the indoor treatment facilities, again, the

equipment is often obsolescent; the availability of essential drugs

is minimal; the capacity of the facilities is grossly inadequate,

which leads to over-crowding, and consequentially to a steep

deterioration in the quality of the services. As a result of such

inadequate public health facilities, it has been estimated that less

than 20 percent of the population, which seek OPD services, and

less than 45 percent of that which seek indoor treatment, avail of

such services in public hospitals. This is despite the fact that most

of these patients do not have the means to make out-of-pocket

payments for private health services except at the cost of other

essential expenditure for items such as basic nutrition.

 

2.5 EXTENDING PUBLIC HEALTH SERVICES

2.5.1 While there is a general shortage of medical personnel in the

country, this shortfall is disproportionately impacted on the lessdeveloped

and rural areas. No incentive system attempted so far,

has induced private medical personnel to go to such areas; and,

even in the public health sector, the effort to deploy medical

personnel in such under-served areas, has usually been a losing

battle. In such a situation, the possibility needs to be examined of

entrusting some limited public health functions to nurses,

paramedics and other personnel from the extended health sector

after imparting adequate training to them.

 

2.5.2 India has a vast reservoir of practitioners in the Indian

Systems of Medicine and Homoeopathy, who have undergone

formal training in their own disciplines. The possibility of using such

practitioners in the implementation of State/Central Government

public health programmes, in order to increase the reach of basic

health care in the country, is addressed in the NHP-2002.

 

2.6 ROLE OF LOCAL SELF-GOVERNMENT INSTITUTIONS

2.6.1 Some States have adopted a policy of devolving

programmes and funds in the health sector through different

levels of the Panchayati Raj Institutions. Generally, the experience

has been an encouraging one. The adoption of such an

organisational structure has enabled need-based allocation of

resources and closer supervision through the elected

representatives. The Policy examines the need for a wider

adoption of this mode of delivery of health services, in rural as well

as urban areas, in other parts of the country.

 

2.7 NORMS FOR HEALTH CARE PERSONNEL

2.7.1 It is observed that the deployment of doctors and nurses, in

both public and private institutions, is ad-hoc and significantly

short of the requirement for minimal standards of patient care.

This policy will make a specific recommendation in regard to this

deficiency.

 

2.8 EDUCATION OF HEALTH CARE PROFESSIONALS

2.8.1 Medical and Dental Colleges are not evenly spread across

various parts of the country. Apart from the uneven geographical

distribution of medical institutions, the quality of education is

highly uneven and in several instances even sub-standard. It is a

common perception that the syllabus is excessively theoretical,

making it difficult for the fresh graduate to effectively meet even

the primary health care needs of the population. There is a

general reluctance on the part of graduate doctors to serve in

areas distant from their native place. NHP-2002 will suggest policy

initiatives to rectify the resultant disparities.

 

2.8.2.1 Certain medical disciplines, such as molecular biology and

gene-manipulation, have become relevant in the period after the

formulation of the previous National Health Policy. The

components of medical research in recent years have changed

radically. In the foreseeable future such research will rely

increasingly on the new disciplines. It is observed that the current

under-graduate medical syllabus does not cover such emerging

subjects. The Policy will make appropriate recommendations in

respect of such deficiencies.

 

2.8.2.2 Also, certain speciality disciplines – Anesthesiology,

Radiology and Forensic Medicine – are currently very scarce,

resulting in critical deficiencies in the package of available public

health services. This Policy will recommend some measures to

alleviate such critical shortages.

 

2.9 NEED FOR SPECIALISTS IN ‘PUBLIC HEALTH’ AND

‘FAMILY MEDICINE’

2.9.1 In any developing country with inadequate availability of

health services, the requirement of expertise in the areas of

‘public health’ and ‘family medicine’ is markedly more than the

expertise required for other clinical specialities. In India, the

situation is that public health expertise is non-existent in the

private health sector, and far short of requirement in the public

health sector. Also, the current curriculum in the graduate / postgraduate

courses is outdated and unrelated to contemporary

community needs. In respect of ‘family medicine’, it needs to be

noted that the more talented medical graduates generally seek

specialization in clinical disciplines, while the remaining go into

general practice. While the availability of postgraduate

educational facilities is 50 percent of the total number of

qualifying graduates each year, and can be considered

adequate, the distribution of the disciplines in the postgraduate

training facilities is overwhelmingly in favour of clinical

specializations. NHP-2002 examines the possible means for

ensuring adequate availability of personnel with specialization in

the ‘public health’ and ‘family medicine’ disciplines, to discharge

the public health responsibilities in the country.

 

2.10 Nursing Personnel

2.10.1 The ratio of nursing personnel in the country vis-à-vis

doctors/beds is very low according to professionally accepted

norms. There is also an acute shortage of nurses trained in superspeciality

disciplines for deployment in tertiary care facilities. NHP-

2002 addresses these problems.

 

2.11 USE OF GENERIC DRUGS AND VACCINES

2.11.1 India enjoys a relatively low-cost health care system

because of the widespread availability of indigenously

manufactured generic drugs and vaccines. There is an

apprehension that globalization will lead to an increase in the

costs of drugs, thereby leading to rising trends in overall health

costs. This Policy recommends measures to ensure the future

Health Security of the country.

 

2.12 URBAN HEALTH

2.12.1.1 In most urban areas, public health services are very

meagre. To the extent that such services exist, there is no uniform

organizational structure. The urban population in the country is

presently as high as 30 percent and is likely to go up to around 33

percent by 2010. The bulk of the increase is likely to take place

through migration, resulting in slums without any infrastructure

support. Even the meagre public health services which are

available do not percolate to such unplanned habitations,

forcing people to avail of private health care through out-ofpocket

expenditure.

 

2.12.1.2 The rising vehicle density in large urban agglomerations

has also led to an increased number of serious accidents

requiring treatment in well-equipped trauma centres. NHP-2002

will address itself to the need for providing this unserved urban

population a minimum standard of broad-based health care

facilities.

 

2.13 MENTAL HEALTH

2.13.1 Mental health disorders are actually much more prevalent

than is apparent on the surface. While such disorders do not

contribute significantly to mortality, they have a serious bearing

on the quality of life of the affected persons and their families.

Sometimes, based on religious faith, mental disorders are treated

as spiritual affliction. This has led to the establishment of

unlicensed mental institutions as an adjunct to religious institutions

where reliance is placed on faith cure. Serious conditions of

mental disorder require hospitalization and treatment under

trained supervision. Mental health institutions are woefully

deficient in physical infrastructure and trained manpower. NHP-

2002 will address itself to these deficiencies in the public health

sector.

 

2.14 INFORMATION, EDUCATION AND COMMUNICATION

2.14.1 A substantial component of primary health care consists of

initiatives for disseminating to the citizenry, public health-related

information. IEC initiatives are adopted not only for disseminating

curative guidelines (for the TB, Malaria, Leprosy, Cataract

Blindness Programmes), but also as part of the effort to bring

about a behavioural change to prevent HIV/AIDS and other lifestyle

diseases. Public health programmes, particularly, need high

visibility at the decentralized level in order to have an impact. This

task is difficult as 35 percent of our country’s population is

illiterate. The present IEC strategy is too fragmented, relies too

heavily on the mass media and does not address the needs of this

segment of the population. It is often felt that the effectiveness of

IEC programmes is difficult to judge; and consequently it is often

asserted that accountability, in regard to the productive use of

such funds, is doubtful. The Policy, while projecting an IEC

strategy, will fully address the inherent problems encountered in

any IEC programme designed for improving awareness and

bringing about a behavioural change in the general population.

 

2.14.2 It is widely accepted that school and college students are

the most impressionable targets for imparting information relating

to the basic principles of preventive health care. The policy will

attempt to target this group to improve the general level of

awareness in regard to ‘health-promoting’ behaviour.

 

2.15 HEALTH RESEARCH

2.15.1 Over the years, health research activity in the country has

been very limited. In the Government sector, such research has

been confined to the research institutions under the Indian

Council of Medical Research, and other institutions funded by the

States/Central Government. Research in the private sector has

assumed some significance only in the last decade. In our

country, where the aggregate annual health expenditure is of the

order of Rs. 80,000 crores, the expenditure in 1998-99 on research,

both public and private sectors, was only of the order of Rs. 1150

crores. It would be reasonable to infer that with such low research

expenditure, it is virtually impossible to make any dramatic breakthrough

within the country, by way of new molecules and

vaccines; also, without a minimal back-up of applied and

operational research, it would be difficult to assess whether the

health expenditure in the country is being incurred through

optimal applications and appropriate public health strategies.

Medical Research in the country needs to be focused on

therapeutic drugs/vaccines for tropical diseases, which are

normally neglected by international pharmaceutical companies

on account of their limited profitability potential. The thrust will

need to be in the newly-emerging frontier areas of research

based on genetics, genome-based drug and vaccine

development, molecular biology, etc. NHP-2002 will address these

inadequacies and spell out a minimal quantum of expenditure for

the coming decade, looking to the national needs and the

capacity of the research institutions to absorb the funds.

 

2.16 ROLE OF THE PRIVATE SECTOR

2.16.1 Considering the economic restructuring under way in the

country, and over the globe, in the last decade, the changing

role of the private sector in providing health care will also have to

be addressed in this Policy. Currently, the contribution of private

health care is principally through independent practitioners. Also,

the private sector contributes significantly to secondary-level care

and some tertiary care. It is a widespread perception that private

health services are very uneven in quality, sometimes even substandard.

Private health services are also perceived to be

financially exploitative, and the observance of professional ethics

is noted only as an exception. With the increasing role of private

health care, the implementation of statutory regulation, and the

monitoring of minimum standards of diagnostic centres / medical

institutions becomes imperative. The Policy will address the issues

regarding the establishment of a comprehensive information

system, and based on that the establishment of a regulatory

mechanism to ensure the maintaining of adequate standards by

diagnostic centres / medical institutions, as well as the proper

conduct of clinical practice and delivery of medical services.

 

2.16.2 Currently, non-Governmental service providers are treating

a large number of patients at the primary level for major diseases.

However, the treatment regimens followed are diverse and not

scientifically optimal, leading to an increase in the incidence of

drug resistance. This policy will address itself to recommending

arrangements which will eliminate the risks arising from

inappropriate treatment.

 

2.16.3 The increasing spread of information technology raises the

possibility of its adoption in the health sector. NHP-2002 will

examine this possibility.

2.17 THE ROLE OF CIVIL SOCIETY

2.17.1 Historically, it has been the practice to implement major

national disease control programmes through the public health

machinery of the State/Central Governments. It has become

increasingly apparent that certain components of such

programmes cannot be efficiently implemented merely through

government functionaries. A considerable change in the mode of

implementation has come about in the last two decades, with

the increasing involvement of NGOs and other institutions of civil

society. It is to be recognized that widespread debate on various

public health issues has, in fact, been initiated and sustained by

NGOs and other members of the civil society. Also, an increasing

contribution is being made by such institutions in the delivery of

different components of public health services. Certain disease

control programmes require close inter-action with the

beneficiaries for regular administration of drugs; periodic carrying

out of pathological tests; dissemination of information regarding

disease control and other general health information. NHP-2002

will address such issues and suggest policy instruments for the

implementation of public health programmes through individuals

and institutions of civil society.

 

2.18 NATIONAL DISEASE SURVEILLANCE NETWORK

2.18.1 The technical network available in the country for disease

surveillance is extremely rudimentary and to the extent that the

system exists, it extends only up to the district level. Disease

statistics are not flowing through an integrated network from the

decentralized public health facilities to the State/Central

Government health administration. Such an arrangement only

provides belated information, which, at best, serves a limited

statistical purpose. The absence of an efficient disease

surveillance network is a major handicap in providing a prompt

and cost-effective health care system. The efficient disease

surveillance network set up for Polio and HIV/AIDS has

demonstrated the enormous value of such a public health

instrument. Real-time information on focal outbreaks of common

communicable diseases – Malaria, GE, Cholera and JE – and the

seasonal trends of diseases, would enable timely intervention,

resulting in the containment of the thrust of epidemics. In order to

be able to use an integrated disease surveillance network for

operational purposes, real-time information is necessary at all

levels of the health administration. The Policy would address itself

to this major systemic shortcoming in the administration.

 

2.19 HEALTH STATISTICS

2.19.1 The absence of a systematic and scientific health statistics

data-base is a major deficiency in the current scenario. The

health statistics collected are not the product of a rigorous

methodology. Statistics available from different parts of the

country, in respect of major diseases, are often not obtained in a

manner which make aggregation possible or meaningful.

 

2.19.2.1 Further, the absence of proper and systematic

documentation of the various financial resources used in the

health sector is another lacuna in the existing health information

scenario. This makes it difficult to understand trends and levels of

health spending by private and public providers of health care in

the country, and, consequently, to address related policy issues

and to formulate future investment policies.

2.19.2.2 NHP-2002 will address itself to the programme for putting

in place a modern and scientific health statistics database as well

as a system of national health accounts.

 

2.20 WOMEN’S HEALTH

2.20.1 Social, cultural and economic factors continue to inhibit

women from gaining adequate access even to the existing

public health facilities. This handicap does not merely affect

women as individuals; it also has an adverse impact on the

health, general well-being and development of the entire family,

particularly children. This policy recognises the catalytic role of

empowered women in improving the overall health standards of

the community.

 

2.21 MEDICAL ETHICS

2.21.1 Professional medical ethics in the health sector is an area

which has not received much attention. Professional practices

are perceived to be grossly commercial and the medical

profession has lost its elevated position as a provider of basic

services to fellow human beings. In the past, medical research

has been conducted within the ethical guidelines notified by the

Indian Council of Medical Research. The first document

containing these guidelines was released in 1960, and was

comprehensively revised in 2001. With the rapid developments in

the approach to medical research, a periodic revision will no

doubt be more frequently required in future. Also, the new frontier

areas of research – involving gene manipulation, organ/human

cloning and stem cell research _ impinge on visceral issues

relating to the sanctity of human life and the moral dilemma of

human intervention in the designing of life forms. Besides this, in

the emerging areas of research, there is the uncharted risk of

creating new life forms, which may irreversibly damage the

environment as it exists today. NHP – 2002 recognises that this

moral and religious dilemma, which was not relevant even two

years ago, now pervades mainstream health sector issues.

 

2.22 ENFORCEMENT OF QUALITY STANDARDS FOR FOOD

AND DRUGS

2.22.1 There is an increasing expectation and need of the

citizenry for efficient enforcement of reasonable quality standards

for food and drugs. Recognizing this, the Policy will make an

appropriate policy recommendation on this issue.

 

2.23 REGULATION OF STANDARDS IN PARA MEDICAL

DISCIPLINES

2.23.1 It has been observed that a large number of training

institutions have mushroomed, particularly in the private sector,

for para medical personnel with various skills – Lab Technicians,

Radio Diagnosis Technicians, Physiotherapists, etc. Currently, there

is no regulation/monitoring, either of the curriculae of these

institutions, or of the performance of the practitioners in these

disciplines. This Policy will make recommendations to ensure the

standardization of such training and the monitoring of actual

performance.

 

2.24 ENVIRONMENTAL AND OCCUPATIONAL HEALTH

2.24.1 The ambient environmental conditions are a significant

determinant of the health risks to which a community is exposed.

Unsafe drinking water, unhygienic sanitation and air pollution

significantly contribute to the burden of disease, particularly in

urban settings. The initiatives in respect of these environmental

factors are conventionally undertaken by the participants,

whether private or public, in the other development sectors. In

this backdrop, the Policy initiatives, and the efficient

implementation of the linked programmes in the health sector,

would succeed only to the extent that they are complemented

by appropriate policies and programmes in the other

environment-related sectors.

2.24.2 Work conditions in several sectors of employment in the

country are sub-standard. As a result, workers engaged in such

employment become particularly vulnerable to occupationlinked

ailments. The long-term risk of chronic morbidity is

particularly marked in the case of child labour. NHP-2002 will

address the risk faced by this particularly vulnerable section of

society.

 

2.25 PROVIDING MEDICAL FACILITIES TO USERS FROM

OVERSEAS

2.25.1 The secondary and tertiary facilities available in the country

are of good quality and cost-effective compared to international

medical facilities. This is true not only of facilities in the allopathic

disciplines, but also of those belonging to the alternative systems

of medicine, particularly Ayurveda. The Policy will assess the

possibilities of encouraging the development of paid treatmentpackages

for patients from overseas.

 

2.26 THE IMPACT OF GLOBALIZATION ON THE HEALTH SECTOR

2.26.1 There are some apprehensions about the possible adverse

impact of economic globalisation on the health sector.

Pharmaceutical drugs and other health services have always

been available in the country at extremely inexpensive prices.

India has established a reputation around the globe for the

innovative development of original process patents for the

manufacture of a wide-range of drugs and vaccines within the

ambit of the existing patent laws. With the adoption of Trade

Related Intellectual Property Rights (TRIPS), and the subsequent

alignment of domestic patent laws consistent with the

commitments under TRIPS, there will be a significant shift in the

scope of the parameters regulating the manufacture of new

drugs/vaccines. Global experience has shown that the

introduction of a TRIPS-consistent patent regime for drugs in a

developing country results in an across-the-board increase in the

cost of drugs and medical services. NHP-2002 will address itself to

the future imperatives of health security in the country, in the post-

TRIPS era.

 

2.27 INTER-SECTORAL CONTRIBUTION TO HEALTH

2.27.1 It is well recognized that the overall well-being of the

citizenry depends on the synergistic functioning of the various

sectors in the socio-economy. The health status of the citizenry

would, inter alia, be dependent on adequate nutrition, safe

drinking water, basic sanitation, a clean environment and primary

education, especially for the girl child. The policies and the mode

of functioning in these independent areas would necessarily

overlap each other to contribute to the health status of the

community. From the policy perspective, it is therefore imperative

that the independent policies of each of these inter-connected

sectors, be in tandem, and that the interface between the

policies of the two connected sectors, be smooth.

2.27.2 Sectoral policy documents are meant to serve as a guide

to action for institutions and individual participants operating in

that sector. Consistent with this role, NHP-2002 limits itself to

making recommendations for the participants operating within

the health sector. The policy aspects relating to inter-connected

sectors, which, while crucial, fall outside the domain of the health

sector, will not be covered by specific recommendations in this

Policy document. Needless to say, the future attainment of the

various goals set out in this policy assumes a reasonable

complementary performance in these inter-connected sectors.

 

2.28 POPULATION GROWTH AND HEALTH STANDARDS

2.28.1 Efforts made over the years for improving health standards

have been partially neutralized by the rapid growth of the

population. It is well recognized that population stabilization

measures and general health initiatives, when effectively

synchronized, synergistically maximize the socio-economic wellbeing

of the people. Government has separately announced the

`National Population Policy – 2000’. The principal common

features covered under the National Population Policy-2000 and

NHP-2002, relate to the prevention and control of communicable

diseases; giving priority to the containment of HIV/AIDS infection;

the universal immunization of children against all major

preventable diseases; addressing the unmet needs for basic and

reproductive health services, and supplementation of

infrastructure. The synchronized implementation of these two

Policies – National Population Policy – 2000 and National Health

Policy-2002 – will be the very cornerstone of any national

structural plan to improve the health standards in the country.

 

2.29 ALTERNATIVE SYSTEMS OF MEDICINE

2.29.1 Under the overarching umbrella of the national health

frame work, the alternative systems of medicine – Ayurveda,

Unani, Siddha and Homoeopathy – have a substantial role.

Because of inherent advantages, such as diversity, modest cost,

low level of technological input and the growing popularity of

natural plant-based products, these systems are attractive,

particularly in the underserved, remote and tribal areas. The

alternative systems will draw upon the substantial untapped

potential of India as one of the eight important global centers for

plant diversity in medicinal and aromatic plants. The Policy

focuses on building up credibility for the alternative systems, by

encouraging evidence-based research to determine their

efficacy, safety and dosage, and also encourages certification

and quality-marking of products to enable a wider popular

acceptance of these systems of medicine. The Policy also

envisages the consolidation of documentary knowledge

contained in these systems to protect it against attack from

foreign commercial entities by way of malafide action under

patent laws in other countries. The main components of NHP-2002

apply equally to the alternative systems of medicines. However,

the Policy features specific to the alternative systems of medicine

will be presented as a separate document.

 

3. OBJECTIVES

 

3.1 The main objective of this policy is to achieve an acceptable

standard of good health amongst the general population of the

country. The approach would be to increase access to the

decentralized public health system by establishing new

infrastructure in deficient areas, and by upgrading the

infrastructure in the existing institutions. Overriding importance

would be given to ensuring a more equitable access to health

services across the social and geographical expanse of the

country. Emphasis will be given to increasing the aggregate

public health investment through a substantially increased

contribution by the Central Government. It is expected that this

initiative will strengthen the capacity of the public health

administration at the State level to render effective service

delivery. The contribution of the private sector in providing health

services would be much enhanced, particularly for the

population group which can afford to pay for services. Primacy

will be given to preventive and first-line curative initiatives at the

primary health level through increased sectoral share of

allocation. Emphasis will be laid on rational use of drugs within the

allopathic system. Increased access to tried and tested systems of

traditional medicine will be ensured. Within these broad

objectives, NHP-2002 will endeavour to achieve the time-bound

goals mentioned in Box-IV.

 

 

Achieve Zero level growth of HIV/AIDS	2007
Reduce Mortality by 50% on account of TB, Malaria and Other Vector and Water Borne diseases	2010
Reduce Prevalence of Blindness to 0.5%	2010
Reduce IMR to 30/1000 And MMR to 100/Lakh	2010
Increase utilization of public health facilities from current Level of <20 to >75%	2010
Establish an integrated system of surveillance, National Health Accounts and Health Statistics.	2005
Increase health expenditure by Government as a % of GDP from the existing 0.9 % to 2.0%	2010
Increase share of Central grants to Constitute at least 25% of total health spending	2010
Increase State Sector Health spending from 5.5% to 7% of the budget Further increase to 8%	2005 2010

 

Establish an integrated system of surveillance,

National Health Accounts and Health Statistics.

2005

Increase health expenditure by Government as a %

of GDP from the existing 0.9 % to 2.0%

2010

Increase share of Central grants to Constitute at

least 25% of total health spending

2010

Increase State Sector Health spending from 5.5% to

7% of the budget

Further increase to 8%

2005

2010

 

4. NHP-2002 – POLICY PRESCRIPTIONS

 

4.1 FINANCIAL RESOURCES

4.1.1 The paucity of public health investment is a stark reality.

Given the extremely difficult fiscal position of the State

Governments, the Central Government will have to play a key

role in augmenting public health investments. Taking into account

the gap in health care facilities, it is planned, under the policy to

increase health sector expenditure to 6 percent of GDP, with 2

percent of GDP being contributed as public health investment,

by the year 2010. The State Governments would also need to

increase the commitment to the health sector. In the first phase,

by 2005, they would be expected to increase the commitment of

their resources to 7 percent of the Budget; and, in the second

phase, by 2010, to increase it to 8 percent of the Budget. With the

stepping up of the public health investment, the Central

Government’s contribution would rise to 25 percent from the

existing 15 percent by 2010. The provisioning of higher public

health investments will also be contingent upon the increase in

the absorptive capacity of the public health administration so as

to utilize the funds gainfully.

 

4.2 EQUITY

4.2.1 To meet the objective of reducing various types of inequities

and imbalances – inter-regional; across the rural – urban divide;

and between economic classes – the most cost-effective method

would be to increase the sectoral outlay in the primary health

sector. Such outlets afford access to a vast number of individuals,

and also facilitate preventive and early stage curative initiative,

which are cost effective. In recognition of this public health

principle, NHP-2002 sets out an increased allocation of 55 percent

of the total public health investment for the primary health sector;

the secondary and tertiary health sectors being targeted for 35

percent and 10 percent respectively. The Policy projects that the

increased aggregate outlays for the primary health sector will be

utilized for strengthening existing facilities and opening additional

public health service outlets, consistent with the norms for such

facilities.

 

4.3 DELIVERY OF NATIONAL PUBLIC HEALTH PROGRAMMES

4.3.1.1 This policy envisages a key role for the Central Government

in designing national programmes with the active participation of

the State Governments. Also, the Policy ensures the provisioning

of financial resources, in addition to technical support, monitoring

and evaluation at the national level by the Centre. However, to

optimize the utilization of the public health infrastructure at the

primary level, NHP-2002 envisages the gradual convergence of all

health programmes under a single field administration. Vertical

programmes for control of major diseases like TB, Malaria,

HIV/AIDS, as also the RCH and Universal Immunization

Programmes, would need to be continued till moderate levels of

prevalence are reached. The integration of the programmes will

bring about a desirable optimisation of outcomes through a

convergence of all public health inputs. The Policy also envisages

that programme implementation be effected through

autonomous bodies at State and district levels. The interventions

of State Health Departments may be limited to the overall

monitoring of the achievement of programme targets and other

technical aspects. The relative distancing of the programme

implementation from the State Health Departments will give the

project team greater operational flexibility. Also, the presence of

State Government officials, social activists, private health

professionals and MLAs/MPs on the management boards of the

autonomous bodies will facilitate well-informed decision-making.

4.3.1.2 The Policy also highlights the need for developing the

capacity within the State Public Health administration for scientific

designing of public health projects, suited to the local situation.

4.3.2 The Policy envisages that apart from the exclusive staff in a

vertical structure for the disease control programmes, all rural

health staff should be available for the entire gamut of public

health activities at the decentralized level, irrespective of whether

these activities relate to national programmes or other public

health initiatives. It would be for the Head of the District Health

administration to allocate the time of the rural health staff

between the various programmes, depending on the local need.

NHP-2002 recognizes that to implement such a change, not only

would the public health administrators be required to change

their mindset, but the rural health staff would need to be trained

and reoriented.

 

4.4 THE STATE OF PUBLIC HEALTH INFRASTRUCTURE

4.4.1.1 As has been highlighted in the earlier part of the Policy, the

decentralized Public health service outlets have become

practically dysfunctional over large parts of the country. On

account of resource constraints, the supply of drugs by the State

Governments is grossly inadequate. The patients at the

decentralized level have little use for diagnostic services, which in

any case would still require them to purchase therapeutic drugs

privately. In a situation in which the patient is not getting any

therapeutic drugs, there is little incentive for the potential

beneficiaries to seek the advice of the medical professionals in

the public health system. This results in there being no demand for

medical services, so medical professionals and paramedics often

absent themselves from their place of duty. It is also observed that

the functioning of the public health service outlets in some States

like the four Southern States – Kerala, Andhra Pradesh, Tamil Nadu

and Karnataka – is relatively better, because some quantum of

drugs is distributed through the primary health system network,

and the patients have a stake in approaching the Public Health

facilities. In this backdrop, the Policy envisages kick-starting the

revival of the Primary Health System by providing some essential

drugs under Central Government funding through the

decentralized health system. It is expected that the provisioning

of essential drugs at the public health service centres will create a

demand for other professional services from the local population,

which, in turn, will boost the general revival of activities in these

service centres. In sum, this initiative under NHP-2002 is launched

in the belief that the creation of a beneficiary interest in the

public health system, will ensure a more effective supervision of

the public health personnel through community monitoring, than

has been achieved through the regular administrative line of

control.

 

4.4.1.2 This Policy recognizes the need for more frequent in-service

training of public health medical personnel, at the level of

medical officers as well as paramedics. Such training would help

to update the personnel on recent advancements in science,

and would also equip them for their new assignments, when they

are moved from one discipline of public health administration to

another.

 

4.4.1.3 Global experience has shown that the quality of public

health services, as reflected in the attainment of improved public

health indices, is closely linked to the quantum and quality of

investment through public funding in the primary health sector.

Box-V gives statistics which clearly show that standards of health

are more a function of the accurate targeting of expenditure on

the decentralised primary sector (as observed in China and Sri

Lanka), than a function of the aggregate health expenditure.

 

Box-V: Public Health Spending in select Countries
Indicator	%Population with income of <$1 day	Infant Mortality Rate/1000	%Health Expenditure to GDP	%Public Expenditure on Health to Total Health Expenditure
India	44.2	70	5.2	17.3
China	18.5	31	2.7	24.9
Sri Lanka	6.6	16	3	45.4
UK	–	6	5.8	96.9
USA	–	7	13.7	44.1

 

Therefore the Policy, while committing additional aggregate

financial resources, places great reliance on the strengthening of

the primary health structure for the attaining of improved public

health outcomes on an equitable basis. Further, it also recognizes

the practical need for levying reasonable user-charges for certain

secondary and tertiary public health care services, for those who

can afford to pay.

 

4.5 EXTENDING PUBLIC HEALTH SERVICES

4.5.1.1 This policy envisages that, in the context of the availability

and spread of allopathic graduates in their jurisdiction, State

Governments would consider the need for expanding the pool of

medical practitioners to include a cadre of licentiates of medical

practice, as also practitioners of Indian Systems of Medicine and

Homoeopathy. Simple services/procedures can be provided by

such practitioners even outside their disciplines, as part of the

basic primary health services in under-served areas. Also, NHP-

2002 envisages that the scope of the use of paramedical

manpower of allopathic disciplines, in a prescribed functional

area adjunct to their current functions, would also be examined

for meeting simple public health requirements. This would be on

the lines of the services rendered by nurse practitioners in several

developed countries. These extended areas of functioning of

different categories of medical manpower can be permitted,

after adequate training, and subject to the monitoring of their

performance through professional councils.

 

4.5.1.2 NHP-2002 also recognizes the need for States to simplify the

recruitment procedures and rules for contract employment in

order to provide trained medical manpower in under-served

areas. State Governments could also rigorously enforce a

mandatory two-year rural posting before the awarding of the

graduate degree. This would not only make trained medical

manpower available in the underserved areas, but would offer

valuable clinical experience to the graduating doctors.

 

4.6 ROLE OF LOCAL SELF-GOVERNMENT INSTITUTIONS

4.6.1 NHP-2002 lays great emphasis upon the implementation of

public health programmes through local self-government

institutions. The structure of the national disease control

programmes will have specific components for implementation

through such entities. The Policy urges all State Governments to

consider decentralizing the implementation of the programmes

to such Institutions by 2005. In order to achieve this, financial

incentives, over and above the resources normatively allocated

for disease control programmes, will be provided by the Central

Government.

 

4.7 NORMS FOR HEALTH CARE PERSONNEL

4.7.1 Minimal statutory norms for the deployment of doctors and

nurses in medical institutions need to be introduced urgently

under the provisions of the Indian Medical Council Act and Indian

Nursing Council Act, respectively. These norms can be

progressively reviewed and made more stringent as the medical

institutions improve their capacity for meeting better normative

standards.

 

4.8 EDUCATION OF HEALTH CARE PROFESSIONALS

4.8.1.1 In order to ameliorate the problems being faced on

account of the uneven spread of medical and dental colleges in

various parts of the country, this policy envisages the setting up of

a Medical Grants Commission for funding new Government

Medical and Dental Colleges in different parts of the country.

Also, it is envisaged that the Medical Grants Commission will fund

the upgradation of the infrastructure of the existing Government

Medical and Dental Colleges of the country, so as to ensure an

improved standard of medical education.

 

4.8.1.2 To enable fresh graduates to contribute effectively to the

providing of primary health services as the physician of first

contact, this policy identifies a significant need to modify the

existing curriculum. A need-based, skill-oriented syllabus, with a

more significant component of practical training, would make

fresh doctors useful immediately after graduation. The Policy also

recommends a periodic skill-updating of working health

professionals through a system of continuing medical education.

4.8.2 The Policy emphasises the need to expose medical students,

through the undergraduate syllabus, to the emerging concerns

for geriatric disorders, as also to the cutting edge disciplines of

contemporary medical research. The policy also envisages that

the creation of additional seats for post-graduate courses should

reflect the need for more manpower in the deficient specialities.

 

4.9 NEED FOR SPECIALISTS IN ‘PUBLIC HEALTH’ AND ‘FAMILY

MEDICINE’

4.9.1 In order to alleviate the acute shortage of medical

personnel with specialization in the disciplines of ‘public health’

and ‘family medicine’, the Policy envisages the progressive

implementation of mandatory norms to raise the proportion of

postgraduate seats in these discipline in medical training

institutions, to reach a stage wherein ¼ th of the seats are

earmarked for these disciplines. It is envisaged that in the

sanctioning of post-graduate seats in future, it shall be insisted

upon that a certain reasonable number of seats be allocated to

`public health’ and `family medicine’. Since the `public health’

discipline has an interface with many other developmental

sectors, specialization in Public health may be encouraged not

only for medical doctors, but also for non-medical graduates from

the allied fields of public health engineering, microbiology and

other natural sciences.

 

4.10 NURSING PERSONNEL

4.10.1.1 In the interest of patient care, the policy emphasizes the

need for an improvement in the ratio of nurses vis-à-vis

doctors/beds. In order to discharge their responsibility as model

providers of health services, the public health delivery centres

need to make a beginning by increasing the number of nursing

personnel. The Policy anticipates that with the increasing

aspiration for improved health care amongst the citizens, private

health facilities will also improve their ratio of nursing personnel visà-

vis doctors/beds.

 

4.10.1.2 The Policy lays emphasis on improving the skill -level of

nurses, and on increasing the ratio of degree- holding nurses vis-àvis

diploma-holding nurses. NHP-2002 recognizes a need for the

Central Government to subsidize the setting up, and the running

of, training facilities for nurses on a decentralized basis. Also, the

Policy recognizes the need for establishing training courses for

super-speciality nurses required for tertiary care institutions.

 

4.11 USE OF GENERIC DRUGS AND VACCINES

4.11.1.1 This Policy emphasizes the need for basing treatment

regimens, in both the public and private domain, on a limited

number of essential drugs of a generic nature. This is a prerequisite

for cost-effective public health care. In the public health

system, this would be enforced by prohibiting the use of

proprietary drugs, except in special circumstances. The list of

essential drugs would no doubt have to be reviewed periodically.

To encourage the use of only essential drugs in the private sector,

the imposition of fiscal disincentives would be resorted to. The

production and sale of irrational combinations of drugs would be

prohibited through the drug standards statute.

 

4.11.1.2 The National Programme for Universal Immunization

against Preventable Diseases requires to be assured of an

uninterrupted supply of vaccines at an affordable price. To

minimize the danger arising from the volatility of the global

market, and thereby to ensure long-term national health security,

NHP-2002 envisages that not less than 50% of the requirement of

vaccines/sera be sourced from public sector institutions.

 

4.12 URBAN HEALTH

4.12.1.1 NHP-2002 envisages the setting up of an organised urban

primary health care structure. Since the physical features of urban

settings are different from those in rural areas, the policy

envisages the adoption of appropriate population norms for the

urban public health infrastructure. The structure conceived under

NHP-2002 is a two-tiered one: the primary centre is seen as the

first-tier, covering a population of one lakh, with a dispensary

providing an OPD facility and essential drugs, to enable access to

all the national health programmes; and a second-tier of the

urban health organisation at the level of the Government general

hospital, where reference is made from the primary centre. The

Policy envisages that the funding for the urban primary health

system will be jointly borne by the local self-government

institutions and State and Central Governments.

 

4.12.1. 2 The Policy also envisages the establishment of fullyequipped

‘hub-spoke’ trauma care networks in large urban

agglomerations to reduce accident mortality.

 

4.13 MENTAL HEALTH

4.13.1.1. NHP – 2002 envisages a network of decentralised mental

health services for ameliorating the more common categories of

disorders. The programme outline for such a disease would

involve the diagnosis of common disorders, and the prescription

of common therapeutic drugs, by general duty medical staff.

 

4.13.1. 2 In regard to mental health institutions for in-door

treatment of patients, the Policy envisages the upgrading of the

physical infrastructure of such institutions at Central Government

expense so as to secure the human rights of this vulnerable

segment of society.

 

4.14 INFORMATION, EDUCATION AND COMMUNICATION

4.14.1 NHP-2002 envisages an IEC policy, which maximizes the

dissemination of information to those population groups which

cannot be effectively approached by using only the mass media.

The focus would therefore be on the inter-personal

communication of information and on folk and other traditional

media to bring about behavioural change. The IEC programme

would set specific targets for the association of PRIs/NGOs/Trusts

in such activities. In several public health programmes, where

behavioural change is an essential component, the success of

the initiatives is crucially dependent on dispelling myths and

misconceptions pertaining to religious and ethical issues. The

community leaders, particularly religious leaders, are effective in

imparting knowledge which facilitates such behavioural change.

The programme will also have the component of an annual

evaluation of the performance of the non-Governmental

agencies to monitor the impact of the programmes on the

targeted groups. The Central/State Government initiative will also

focus on the development of modules for information

dissemination in such population groups, who do not normally

benefit from the more common media forms.

 

4.14.2 NHP-2002 envisages giving priority to school health

programmes which aim at preventive-health education,

providing regular health check-ups, and promotion of healthseeking

behaviour among children. The school health

programmes can gainfully adopt specially designed modules in

order to disseminate information relating to ‘health’ and ‘family

life’. This is expected to be the most cost-effective intervention as

it improves the level of awareness, not only of the extended

family, but the future generation as well.

 

4.15 HEALTH RESEARCH

4.15.1 This Policy envisages an increase in Government-funded

health research to a level of 1 percent of the total health

spending by 2005; and thereafter, up to 2 percent by 2010.

Domestic medical research would be focused on new

therapeutic drugs and vaccines for tropical diseases, such as TB

and Malaria, as also on the sub-types of HIV/AIDS prevalent in the

country. Research programmes taken up by the Government in

these priority areas would be conducted in a mission mode.

Emphasis would also be laid on time-bound applied research for

developing operational applications. This would ensure the costeffective

dissemination of existing / future therapeutic

drugs/vaccines in the general population. Private

entrepreneurship will be encouraged in the field of medical

research for new molecules / vaccines, inter alia, through fiscal

incentives.

 

4.16 ROLE OF THE PRIVATE SECTOR

4.16.1.1 In principle, this Policy welcomes the participation of the

private sector in all areas of health activities – primary, secondary

or tertiary. However, looking to past experience of the private

sector, it can reasonably be expected that its contribution would

be substantial in the urban primary sector and the tertiary sector,

and moderate in the secondary sector. This Policy envisages the

enactment of suitable legislation for regulating minimum

infrastructure and quality standards in clinical

establishments/medical institutions by 2003. Also, statutory

guidelines for the conduct of clinical practice and delivery of

medical services are targeted to be developed over the same

period. With the acquiring of experience in the setting and

enforcing of minimum quality standards, the Policy envisages

graduation to a scheme of quality accreditation of clinical

establishments/medical institutions, for the information of the

citizenry. The regulatory/accreditation mechanisms will no doubt

also cover public health institutions. The Policy also encourages

the setting up of private insurance instruments for increasing the

scope of the coverage of the secondary and tertiary sector

under private health insurance packages.

 

4.16.1.2 In the context of the very large number of poor in the

country, it would be difficult to conceive of an exclusive

Government mechanism to provide health services to this

category. It has sometimes been felt that a social health

insurance scheme, funded by the Government, and with service

delivery through the private sector, would be the appropriate

solution. The administrative and financial implications of such an

initiative are still unknown. As a first step, this policy envisages the

introduction of a pilot scheme in a limited number of

representative districts, to determine the administrative features of

such an arrangement, as also the requirement of resources for it.

The results obtained from these pilot projects would provide

material on which future public health policy can be based.

 

4.16.2 NHP-2002 envisages the co-option of the nongovernmental

practitioners in the national disease control

programmes so as to ensure that standard treatment protocols

are followed in their day-to-day practice.

 

4.16.3 This Policy recognizes the immense potential of information

technology applications in the area of tele-medicine in the

tertiary health care sector. The use of this technical aid will greatly

enhance the capacity for the professionals to pool their clinical

experience.

 

4.17 THE ROLE OF CIVIL SOCIETY

4.17.1 NHP-2002 recognizes the significant contribution made by

NGOs and other institutions of the civil society in making available

health services to the community. In order to utilize their high

motivational skills on an increasing scale, this Policy envisages that

the disease control programmes should earmark not less than 10%

of the budget in respect of identified programme components, to

be exclusively implemented through these institutions. The policy

also emphasizes the need to simplify procedures for government –

civil society interfacing in order to enhance the involvement of

civil society in public health programmes. In principle, the state

would encourage the handing over of public health service

outlets at any level for management by NGOs and other

institutions of civil society, on an ‘as-is-where-is’ basis, along with

the normative funds earmarked for such institutions.

 

4.18 NATIONAL DISEASE SURVEILLANCE NETWORK

4.18.1 This Policy envisages the full operationalization of an

integrated disease control network from the lowest rung of public

health administration to the Central Government, by 2005. The

programme for setting up this network will include components

relating to the installation of data-base handling hardware; IT

inter-connectivity between different tiers of the network; and inhouse

training for data collection and interpretation for

undertaking timely and effective response. This public health

surveillance network will also encompass information from private

health care institutions and practitioners. It is expected that realtime

information from outside the government system will greatly

strengthen the capacity of the public health system to counter

focal outbreaks of seasonal diseases.

 

4.19 HEALTH STATISTICS

4.19.1.1 The Policy envisages the completion of baseline estimates

for the incidence of the common diseases – TB, Malaria, Blindness

– by 2005. The Policy proposes that statistical methods be put in

place to enable the periodic updating of these baseline

estimates through representative sampling, under an appropriate

statistical methodology. The policy also recognizes the need to

establish, in a longer time-frame, baseline estimates for noncommunicable

diseases, like CVD, Cancer, Diabetes; and

accidental injuries, and communicable diseases, like Hepatitis

and JE. NHP-2002 envisages that, with access to such reliable

data on the incidence of various diseases, the public health

system would move closer to the objective of evidence-based

policy-making.

 

4.19.1.2 Planning for the health sector requires a robust

information system, inter-alia, covering data on service facilities

available in the private sector. NHP-2002 emphasises the need for

the early completion of an accurate data-base of this kind.

4.19.2 In an attempt at consolidating the data base and

graduating from a mere estimation of the annual health

expenditure, NHP-2002 emphasises the need to establish national

health accounts, conforming to the `source-to-users’ matrix

structure. Also, the policy envisages the estimation of health costs

on a continuing basis. Improved and comprehensive information

through national health accounts and accounting systems would

pave the way for decision-makers to focus on relative priorities,

keeping in view the limited financial resources in the health

sector.

 

4.20 WOMEN’S HEALTH

4.20.1 NHP-2002 envisages the identification of specific

programmes targeted at women’s health. The Policy notes that

women, along with other under-privileged groups, are

significantly handicapped due to a disproportionately low access

to health care. The various Policy recommendations of NHP-2002,

in regard to the expansion of primary health sector infrastructure,

will facilitate the increased access of women to basic health

care. The Policy commits the highest priority of the Central

Government to the funding of the identified programmes relating

to woman’s health. Also, the policy recognizes the need to review

the staffing norms of the public health administration to meet the

specific requirements of women in a more comprehensive

manner.

 

4.21 MEDICAL ETHICS

4.21.1.1 NHP – 2002 envisages that, in order to ensure that the

common patient is not subjected to irrational or profit-driven

medical regimens, a contemporary code of ethics be notified

and rigorously implemented by the Medical Council of India.

4.21.1. 2 By and large, medical research within the country in the

frontier disciplines, such as gene- manipulation and stem cell

research, is limited. However, the policy recognises that a vigilant

watch will have to be kept so that the existing guidelines and

statutory provisions are constantly reviewed and updated.

 

4.22 ENFORCEMENT OF QUALITY STANDARDS FOR FOOD AND

DRUGS

4.22.1 NHP – 2002 envisages that the food and drug

administration will be progressively strengthened, in terms of both

laboratory facilities and technical expertise. Also, the policy

envisages that the standards of food items will be progressively

tightened up at a pace which will permit domestic food handling

/ manufacturing facilities to undertake the necessary

upgradation of technology so that they are not shut out of this

production sector. The Policy envisages that ultimately food

standards will be close, if not equivalent, to Codex specifications;

and that drug standards will be at par with the most rigorous ones

adopted elsewhere.

 

4.23 REGULATION OF STANDARDS IN PARAMEDICAL

DISCIPLINES

4.23.1 NHP-2002 recognises the need for the establishment of

statutory professional councils for paramedical disciplines to

register practitioners, maintain standards of training, and monitor

performance.

 

4.24 ENVIRONMENTAL AND OCCUPATIONAL HEALTH

4.24.1 This Policy envisages that the independently -stated policies

and programs of the environment -related sectors be smoothly

interfaced with the policies and the programs of the health

sector, in order to reduce the health risk to the citizens and the

consequential disease burden.

 

4.24.2 NHP-2002 envisages the periodic screening of the health

conditions of the workers, particularly for high- risk health disorders

associated with their occupation.

 

4.25 PROVIDING MEDICAL FACILITIES TO USERS FROM

OVERSEAS

4.25.1 To capitalize on the comparative cost advantage enjoyed

by domestic health facilities in the secondary and tertiary sectors,

NHP-2002 strongly encourages the providing of such health

services on a payment basis to service seekers from overseas. The

providers of such services to patients from overseas will be

encouraged by extending to their earnings in foreign exchange,

all fiscal incentives, including the status of “deemed exports”,

which are available to other exporters of goods and services.

 

4.26 IMPACT OF GLOBALISATION ON THE HEALTH SECTOR

4.26.1 The Policy takes into account the serious apprehension,

expressed by several health experts, of the possible threat to

health security in the post-TRIPS era, as a result of a sharp increase

in the prices of drugs and vaccines. To protect the citizens of the

country from such a threat, this policy envisages a national

patent regime for the future, which, while being consistent with

TRIPS, avails of all opportunities to secure for the country, under its

patent laws, affordable access to the latest medical and other

therapeutic discoveries. The policy also sets out that the

Government will bring to bear its full influence in all international

fora – UN, WHO, WTO, etc. – to secure commitments on the part

of the Nations of the Globe, to lighten the restrictive features of

TRIPS in its application to the health care sector.

 

5. SUMMATION

 

5.1 The crafting of a National Health Policy is a rare occasion in

public affairs when it would be legitimate, indeed valuable, to

allow our dreams to mingle with our understanding of ground

realities. Based purely on the clinical facts defining the current

status of the health sector, we would have arrived at a certain

policy formulation; but, buoyed by our dreams, we have ventured

slightly beyond that in the shape of NHP-2002, which, in fact,

defines a vision for the future.

 

5.2 The health needs of the country are enormous and the

financial resources and managerial capacity available to meet

them, even on the most optimistic projections, fall somewhat

short. In this situation, NHP-2002 has had to make hard choices

between various priorities and operational options. NHP-2002

does not claim to be a road-map for meeting all the health

needs of the populace of the country. Further, it has to be

recognized that such health needs are also dynamic, as threats in

the area of public health keep changing over time. The Policy,

while being holistic, undertakes the necessary risk of

recommending differing emphasis on different policy

components. Broadly speaking, NHP – 2002 focuses on the need

for enhanced funding and an organizational restructuring of the

national public health initiatives in order to facilitate more

equitable access to the health facilities. Also, the Policy is focused

on those diseases which are principally contributing to the

disease burden – TB, Malaria and Blindness from the category of

historical diseases; and HIV/AIDS from the category of ‘newly

emerging diseases’. This is not to say that other items contributing

to the disease burden of the country will be ignored; but only that

the resources, as also the principal focus of the public health

administration, will recognize certain relative priorities. It is

unnecessary to labour the point that under the umbrella of the

macro-policy prescriptions in this document, governments and

private sector programme planners will have to design separate

schemes, tailor-made to the health needs of women, children,

geriatrics, tribals and other socio-economically under-served

sections. An adequately robust disaster management plan has to

be in place to effectively cope with situations arising from natural

and man-made calamities.

 

5.3 One nagging imperative, which has influenced every aspect

of this Policy, is the need to ensure that ‘equity’ in the health

sector stands as an independent goal. In any future evaluation of

its success or failure, NHP-2002 would wish to be measured against

this equity norm, rather than any other aggregated financial norm

for the health sector. Consistent with the primacy given to

‘equity’, a marked emphasis has been provided in the policy for

expanding and improving the primary health facilities, including

the new concept of the provisioning of essential drugs through

Central funding. The Policy also commits the Central Government

to an increased under-writing of the resources for meeting the

minimum health needs of the people. Thus, the Policy attempts to

provide guidance for prioritizing expenditure, thereby facilitating

rational resource allocation.

 

5.4 This Policy broadly envisages a greater contribution from the

Central Budget for the delivery of Public Health services at the

State level. Adequate appropriations, steadily rising over the

years, would need to be ensured. The possibility of ensuring this by

imposing an earmarked health cess has been carefully examined.

While it is recognized that the annual budget must

accommodate the increasing resource needs of the social

sectors, particularly in the health sector, this Policy does not

specifically recommend an earmarked health cess, as that would

have a tendency of reducing the space available to Parliament

in making appropriations looking to the circumstances prevailing

from time to time.

 

5.5 The Policy highlights the expected roles of different

participating groups in the health sector. Further, it recognizes the

fact that, despite all that may be guaranteed by the Central

Government for assisting public health programmes, public health

services would actually need to be delivered by the State

administration, NGOs and other institutions of civil society. The

attainment of improved health levels would be significantly

dependent on population stabilisation, as also on

complementary efforts from other areas of the social sectors – like

improved drinking water supply, basic sanitation, minimum

nutrition, etc. – to ensure that the exposure of the populace to

health risks is minimized.

 

5.6 Any expectation of a significant improvement in the quality of

health services, and the consequential improved health status of

the citizenry, would depend not only on increased financial and

material inputs, but also on a more empathetic and committed

attitude in the service providers, whether in the private or public

sectors. In some measure, this optimistic policy document is based

on the understanding that the citizenry is increasingly demanding

more by way of quality in health services, and the health delivery

system, particularly in the public sector, is being pressed to

respond. In this backdrop, it needs to be recognized that any

policy in the social sector is critically dependent on the service

providers treating their responsibility not as a commercial activity,

but as a service, albeit a paid one. In the area of public health,

an improved standard of governance is a prerequisite for the

success of any health policy.

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