National Health Policies and Programmes

1. National Health Policies and Programmes Dr. Dhruv Mankad Sr. Consultant, School of Health Science, YCMOU, Nashik

2. National Health Policies • National Population Policy 2000 • National Health Policy 2002 • National Nutrition Policy/Mission 2001 • Others like Drug Policy, Vaccine Policy

3. National Health Policy 2002

4. National Health Policy 2002 ongoing demographic transition; ongoing epidemiological transition; expansion of health care infrastructure; changes in health care seeking behaviour; availability of newer technologies for management; rising expectations of the population, escalating cost of health care.

5. National Population Policy 2000 • Demographic Indicators to enable the couples to achieve their reproductive goals; • Contraception method based targets to meeting of unmet needs for contraception to reduce unwanted pregnancies; • integrated health care for women and children; • centrally defined targets to community need assessment and decentralised area specific microplanning and implementation of health care for women and children to reduce infant mortality and reduce high desired fertility; • quantitative coverage to emphasis on quality and content of care; • predominantly women centred programmes • supply driven service delivery to need and demand driven service; improved logistics for ensuring adequate and timely supplies to met the needs; • service provision based on providers perceptionto addressing choices and conveniences of the couples.

6. National Population Policy 2002 • assess and meet the unmet needs for contraception; • achieve reduction in the high desired level of fertility through programmes for reduction in IMR and maternal mortality ratio (MMR); and • enable families to achieve their reproductive goals.

7. National Population Policy 2002 • reduction in IMR to 45 per 1,000 live births by 2007 and 28 per 1,000 live births by 2012; • reduction in maternal mortality ratio to 2 per 1,000 live births by 2007 and 1 per 1,000 live births by 2012; and • reduction in decadal growth rate of the population between 2001-2011 to 16.2.

8. National Nutrition Mission • Chronic energy deficiency and under-nutrition • Micro-nutrient deficiencies • anaemia due to iron and folate deficiency • Vitamin A deficiency • Iodine Deficiency Disorders • Chronic energy excess and obesity

9. National Nutrition Mission • Household food security and freedom from hunger to nutrition security for the family and the individual • Untargeted supplementation to screening of all the persons from vulnerable groups, identification of those with various grades of under-nutrition and their appropriate management. • Lack of focused interventions on over-nutrition to promotion of appropriate lifestyles and dietary intakes for prevention and management of over nutrition and obesity

10. National Nutrition Mission • Reduction in under nutrition • Reduction/elimination of micronutrient deficiencies - iron, iodine and Vit A • Reduction in chronic energy deficiency In addition the Mission would co-ordinate and monitor • Implementation of National Nutrition Policy; • Strengthening of existing programme; • R&D • Nutrition education and IEC ; • Strengthening of ICDS and Mid Day Meal Programme • Relief in Natural Calamities.

11. National Nutrition Mission 2001 • Ensuring production and availability of cereals, pulses and vegetables to meet the nutritional needs. • Making them available at affordable cost through out the year to urban and rural population through reduction in post harvest losses and appropriate processing. • More cost effective and efficient targeting of the PDS to address macro and micronutrient deficiencies ( such as providing coarse grains, pulses and iodised salt to BPL families through TPDS) • Improve purchasing power by appropriate programmes including food for work programmes

12. N H Ps • Revised National TB Control program • National Vector Borne Diseases Programs, eg Malaria, Urban Malaria, Dengue, Chikunguniya, Filaria, Japanese Encephalitis, Swine Flu • National Leprosy Eradication Program • National AIDS control Programme • National STD Control Programme

13. N H Ps • National Blindness Control Program eg Cataract Operations, Refractory Errors in school children • National Iodine Deficiency Control Program by promoting iodated salt • National Mental Health Programme • National Cardio-vascular Diseases Control Programme • National Cancer Control Program • National Occupation Disease Control Program • National Diabetes Control Program

14. Revised National TB Control Programme (RNTCP) • About 1/3 of global burden of TB in India • About 20 lakh new cases detected, about 10 lakh smear +ve • Govt detecting 12 lakhs, 25% smear positive, equal from private sector • Private sector involved for DOTS - PPP

15. Revised National TB Control Programme (RNTCP) • Operational Structure • Central Govt : Dy DGHS (TB) • State Govt : State TB Cell with STO • District: DTU with DTO • Sub District – MO – TC ( 1 per 5/2.5 lakhs) • Designated Microscopy Centre (DMC): for Med College, NGO, Pvt Hospital nodal point for record report at Sub District Level • Peripheral Health Inst • Diagnostic Laboratory Services • Drug Stores

16. Revised National TB Control Programme (RNTCP) – Lab/DOTS • Central Laboratories with international recognition at Chennai, Bangalore and Delhi • DMC and Sputum Collection Centres networks • Case Detection, finding and Diagnosis of Lung TB • DOTS

17. National Vector borne Diseases Control Program • Malaria, Urban Malaria • Filaria • Dengue • Japanese Encephalitis • Chikunguniya • Kala azar • Swine Flu!

18. NVBDCP • Started as National Malaria Eradication Prog • Dramatic success – 75 million cases (1952) reduced to 0.1 million cases (1965) and 0.8 million deaths to 0! Resurgence in 1976 with 6 million cases • Right now 1-3 million cases

19. NVBDCP • Early Detection and treatment • Vector Control • Personal Protection • Identify and control epidemic • IEC

20. National Leprosy Eradication Program The major leprosy elimination challenge is in five States which continued 71% of total country case load. Recorded cases in March 2000 were as follows: • Bihar - 149220 • Uttar Pradesh - 100169 • West Bengal - 42440 • Madhya Pradesh - 36021 • Orissa - 40717 Hidden cases are also likely to be high in these States. With leprosy elimination defined as less than 1 per 10,000, these five States recorded the following prevalence rates by March 2000 : • Bihar - 15.20 • Orissa - 11.46 • West Bengal - 5.44 • Uttar Pradesh - 6.02 • Madhya Pradesh - 4.60

21. I D S Program • Integrated Disease Surveillance Program • decentralized, state based • improve information about communicable and non communicable diseases • identify major risk factors incl. environmental, social and political

22. I D S Program It would also • Improve laboratory support; • Train stakeholders in disease surveillance and action; • Coordinate and decentralize surveillance activities • Involve private sector

23. Monitoring & Evaluation • Habitation/ Village Health Register • Periodic Health Facility Survey at SHC, PHC, CHC, District level • Formation of Health Monitoring and Planning Committees at PHC, Block, District and State levels   • Sample household and facility surveys • Community based monitoring

24. Outputs/ Outcomes Objectively verifiable indicator (OVI) I) General goals and objectives of NRHM  Reduction in IMR, TFR and MMR MMR reduced to 200 by 2010 IMR reduced by 20 by 2010 Neonatal mortality rate reduced to 10 by 2010 TFR brought down to 2.0 by 2010 Monitoring & Evaluation

25. Sr.No. Overall Results Indicators Expected level of achievements  Indicators Baseline 2006-7 2007-08 2010-11 1 Contraceptive prevalence rate (Current use of any contraceptive method among currently married women) 61.6 70 75 2.75 % Eligible couples using IUD for more than 12 months 57 60 3.6 % of mothers who delivered during past 3 years & who received IFA for 3+ months 36%  90 95 4.95 % Deliveries assisted by skilled attendants at birth One-fourth home births (36%) 83 95 5.95 % of 24hr PHCs conducting minimum 10 deliveries/ months  All 7 currently conducting >10 del 35 50 6.5 No. of Upgraded FRUs offering 24hr. emergency obstetric care services  28? 150 7.15 % of 12-23 months of age fully immunized children 84% 90 95 8.95 % of mothers and newborn children visited within 1 week of birth among non institutional deliveries NA  50 60 9.6 % of children under 3 years of age with diarrhea in the previous 2 weeks who received oral dehydration salt NA 45 60 10.6 % of children under 3 years of age with diarrhea in the previous 2 weeks who received oral dehydration salt NA  45 60 11.6 Polio free status achieved since when Not yet  Polio-free   Polio-free 12 No. of institutions upgraded to IPHS Process begun 198 360 Selection and training of ASHA Starting year 1300 Monitoring & Evaluation

26. Safe Motherhood ARTH model, Rajasthan Chiranjeevi model Waiting rooms at AP Voucher pmt to pvt providers, Haryana Delivery Huts, MP Escort rooms, TN ISM medicines, TN Some Innovative Schemes

27. Safe Motherhood Janani Sahyogi Yojana, MP Ayushmati Yojana, WB thru PPP Mamta, Delhi Saubhagyawati, Uttaranchal – full package by pvt providers Some Innovative Schemes

28. Safe Motherhood Health Insurance PPP for PHC mgmt Impregnanted bednet for pregnant women, Assam Convergence NRHM-NACO model, K’taka Arogyashri at AP Yeshaswini, K’taka Karuna Trust-K’taka and ArP, others at ArP Some Innovative Schemes

29. Procurement and Financing WHAT NEXT? TNMSC KMSCL E-banking Credit card to ASHA INFINITE!! Some Innovative Schemes

30. Thanks!