NATIONALS POLICIES, PLANS, AND PROGRAMMES

NATIONAL POLICIES PLANS AND PROGRAMME

PAUL EBENEZER.P1st Yr M.Sc Nursingcommunity health DepartmentCMC vellore.

NATIONALS POLICIES, PLANS,AND PROGRAMMESPRIMARY HEALTH CARE HEALTH FOR ALL BY 2000HEALTHY PEOPLE BY 2010/2020HEALTH AND FAMILY WELFARE COMMITTESNATIONAL HEALTH POLICY NATIONAL POPULATION POLICY NATIONAL HEALTH GOALS / INDICATORS MILLINEUM DEVELOPMENT GOALS /STRATEGIES

What is Policy ?

1.Politics:(1) The basic principles by which a government is guided.(2) The declared objectives that a government or party seeks to achieve and preserve in the interest of national community. See alsopublic policy.2.Insurance: The formal contract issued by an insurer that contains terms and conditions of the insurance cover and serves as its legal evidence.3.Management: The set of basic principles and associated guidelines, formulated and enforced by the governing body of an organization, to direct and limit its actions in pursuit of long-term goals. See alsocorporate policy.

What is programme ?A planned series of future events or performances.

What is plan?

1.an intention or decision about what one is going to do.2.a detailed proposal for doing or achieving something.

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LEVELS OF HEALTH CARE:PRIMARY HEALTH CARE.Health service provided by Physicians,Nurses, Health workers/team.SECONDARY HEALTH CARE.Physicians and health team assessment and treatment of health related problems TERITIARY HEALTH CARE. Care usually given by specialist, Major surgery

PRIMARY HEALTH CAREESSENTIAL HEALTH CARE made universally accessible to individuals and acceptable to them through their full participation and cost of the community and country can afford. -Declaration of Alma Ata 1978

DEFINITIONS

in post-independent era in 1947, when the bhore committee brought its recommendations.To provide comprehensive health services to the people in rural areas through the network of primary health centres.A short term plan was formulated.

CONCEPT OF PRIMARY HEALTH CARE

Contlaunched primary health care to incorporate and strengthen the primary health care with other sectors.The health services should be comprehensive.community participation and appropriate technology.

Cont..strengthen and support primary health care through various sectors.maximum care to the special risk groups.Training.proper use of resources.continuous supply of drugs and proper managerial process, includes planning, organizing, monitoring and evaluation of health services.

The Primary Health Care Movement towards Health for All by 2000ADAlma Ata, 1978

The International Conference on Primary Health Care calls for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world by the year 2000.

ELEMENTSE- EducationL- Locally endemic disease controlE- expanded programme immunization.M- Maternal and child healthE- Environment sanitationN- Nutritional servicesT- Treatment of minor ailments.S- School health services

PRINCIPLES OF PRIMARY HEALTH CARE1.Equitable distribution.2.Community participation.3.Intersectoral coordination.4.Appropriate technology.

1.EQUITABLE DISTRIBUTION.Health services must be shared equally by all people irrespective of their ability to pay.Rich or poor / rural or urban must have access to health services.80% percentage of people live in rural areas & only 20% live in the urban areas, but the proportion of the health services is grossly inversely propotionate.ie, 80% of people are catered by only 20% & 20% are catered by 80% of health services.

Cont..This has been termed as social injustice.

Primary Health Care aims to correct this imbalance by shifting the centre of gravity of the health care system from cities to the rural areas, & bring these services as near peoples home as possible.

2.COMMUNITY PARTICIPATION.Involvement of the individuals & community in promotion of their own health & welfare, is an essential ingredient of primary health care.There must be a continuing effort to secure meaningful involvement of the community in planning, implementing & maintenance of health services, besides maximum reliance on local resources such as manpower, money & materials.

Cont..One approach the VHG & Trained Dais has been successfully tried in India.

They are selected by the local community & trained locally in the delivery of primary health care to the community they belong.

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Cont..By overcoming cultural & communication barriers, they provide primary health care in ways that are acceptable to the community.

It is now considered that Health Guides & Trained Dais are an essential feature of primary health care in India.

These concepts are revolutionary. They have been greatly influenced by the experience in China where community participation in the from of bare foot doctors took place on an unprecedented scale.

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3.INTERSECTORAL COORDINATION.There is an increasing realization that PHC cannot be provided by the health sector alone.The declaration of Alma Ata states that primary health care involves in addition to health sector, all related sectors & aspects of national & community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communication & other sectors.

Cont..To achieve such cooperation, countries may have to review their administrative system, reallocate their resources & introduce suitable legislation to ensure that coordination can take place.This requires a strong political will to translate values into action.An important approach is the inter sectoral approach.

4.APPROPRIATE TECHNOLOGY.Appropriate technology has been defined as technology that is scientifically sound, adaptable to local needs, & acceptable to those who apply it & for those whom it is used & that cab be maintained by the people themselves in keeping with the principles of self reliance with the resources the community & country can afford.

The term appropriate is emphasized because in some countries luxurious hospitals that are totally inappropriate to the local needs, are built, which absorb a major part of the national health budget, effectively blocking many improvement in general health services.

Examples of appropriate technology

ORS instead of expensive intravenous replacement of fluids in mild and moderate dehydration Vaccine vial monitor (VVM) instead of lab testing of potency of vaccine due to possible exposure to heat Bio gas system in a small community rather than piped natural gas or LPG cylinders for clean fuel

For provision of safe drinking water

Pot chlorination (NEERI ,NAGPUR METHOD)Chlorination with tablets in individuals houses in water containers. These are cheap from chemist

STRATEGIES OF PRIMARY HEALTH CAREAccessibility, Availability, Affordability and Acceptability of Health Services Health services delivered where the people areone community health worker per 10-20 householdsUse of traditional medicines

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Provision of quality, basic and essential health services Training.Attitudes, knowledge and skills developed.Regular monitoring and periodic evaluation.

Community Participation Awareness on health and health-related issues.Planning, implementation, monitoring and evaluation done through small group meetingsSelection of community health workers Formation of health committees.Establishment of a community health organization.Mass health campaigns and mobilization

Self-reliance

Community generates support for health programs.Use of local resourcesTraining of community in leadership and management skills.Incorporation of income generating projects, cooperatives and small scale industries.

Recognition of interrelationship of health and development

Convergence of health, food, nutrition, water, sanitation and population services.Integration of PHC into national, regional, provincial, municipal development plans.Coordination of activities with economic planning, education, agriculture, industry, housing, public works, communication and social services.Establishment of an effective health referral system.

Social Mobilization

Establishment of an effective health referral system.Multi-sectoral and interdisciplinary linkage.Information, education, communication Collaboration between government and non-governmental organizations.

Decentralization

Reallocation of budgetary resources.Reorientation of health professional and PHC.Advocacy for political and support from the national leadership down.

PRIMARY HEALTH CARE MODEL

Health servicesnutritionenvironmenteconomicpoliticsEducation & communication

PRIMARY HEALTH CARE STATUS IN INDIAVillage level:Village health guidesLocal daisAnganwadi workersASHA

Sub-centre level

Maternal health care.Counseling and appropriate Adolescent health care.Assistance to school health services.Promotion of sanitation.Field visits.Community need assessment.Curative services.Training. Implementation of national health programmes

Primary health center level

ACTIVITES include:Medical care.MCH including family planning.Safe water supply and basic sanitation.Prevention and control of locally endemic diseases.Collection and reporting of vital statistics.Education about health.National health programmes.Referral services.Training of health guides, health workers, local dais and health assistants.Basic laboratory services

Requirements for a sound PHC

Appropriateness.Availability.Adequacy.Accessibility.Acceptability.Affordability.Accountability.Completeness.Comprehensiveness.Continuity

Community health centre level

Care of routine and emergency.24 hour delivery services.Essential and emergency obstetric care.Full range of family planning services.Safe abortion services.Newborn care.Routine and emergency care of sick children. foreign body removal, tracheostomy etcImplementation of national health programmes.

CURRENT TRENDSCombining country efforts and policy instruments with global reachIntegrated service delivery modelsFinancing universal coverageHuman resources for healthMedicinesInfrastructure and technologyHealth governance

EXISTING WEAKNESS IN IMPLEMENTATION OF PRIMARY HEALTH CARE

Minimal policy and organizational commitmentPoorly defined functionsPoor selection:Deficiencies in training and continuing educationLack of support and supervisionUncertain working conditions

EXISTING WEAKNESS IN IMPLEMENTATION OF PRIMARY HEALTH CARE

Undetermined cost and sources of financeLack of monitoring and evaluationLack of transport facilitiesInsecurity of female staffInadequate supply of drugs and stationeriesMedical officers are not interested to work in rural areas

ISSUES AND CHALLENGES OF PHC IN INDIA

Inadequate human resources Failure to deliver universallyFailure to deliver effectively Poor leadership, public regard, and professional statusFunding models that are unresponsive fail to ensure treatments are effectively distributed and universally available for common serious acute diseases Lack of effective information systems

CHALLENGES:

the changing environment Advances in health and Technology Lack of health personnel The double burden of disease

The ultimate goal of primary health care is better health for all. WHO has identified five key elements to achieving that goal:

reducing exclusion and social disparities in health (universal coverage reforms);organizing health services around people's needs and expectations (service delivery reforms);integrating health into all sectors (public policy reforms);pursuing collaborative models of policy dialogue (leadership reforms); andincreasing stakeholder participation.

ROLE OF NURSE IN PRIMARY HEALTH CARECollaborator

Advisor:

Consultant

Advocate:

Preventer of illness

ROLE OF NURSE IN PRIMARY HEALTH CAREPromoter of healthCare providerTeam leaderParticipant:ObserverManagerPotentiator

HEALTH FOR ALL:2000health for all is the attainment of a level of health that will enable every individual to lead a socially and economically productive life.-WHO

SPECIFIC GOALS TO BE ACHIEVED BY 2000 AD :

Reduction of infant mortality from the level of 125 to below 80.To raise the expectation of life at birth from the level of 52 years to 64 years.To reduce the crude death rate from the level of 14 per 1000 population to 9 per 1000 population.To reduce the crude bith rate from the level of 33 per 1000 population to 21 per 1000 population.To achieve a net reproduction rate of oneTo provide potable water to the entire rural population

Evaluation of HFA [1979-2006]:

Insufficient political commitment.Failure to achieve equity in access to all PHC.The continuing low status of women.Slow socio economic development.Unbalanced distribution of resources.Wide spread inequality of health promotion efforts.Weak health information systems and lack of baseline data.Pollution, poor food safety and lack of water supply and sanitation.

Cont..Rapid demographic and epidemiological change.Inappropriate use and allocation of resources for high cost of technology.Natural and man-made disasters.Misinterpretation of the PHC concept.Misconception that PHC is the 2nd rate of health care for the poor.Lack of political will.Centralized planning and management.

HEALTHY PEOPLE BY 2010/2020

What is Healthy People 2010?A comprehensive set of national health objectives for the decadeDeveloped by a collaborative processDesigned to measure progress over time.A public health document that is part strategic plan, part textbook on public health priorities

Healthy PeopleEntering its Fourth Decade1979ASH/SG Julius Richmond establishes first national prevention agenda: Healthy People: Surgeon Generals Report on Health Promotion and Disease Prevention

HP 1990Promoting Health/Preventing Disease: Objectives for the Nation

HP 2000Healthy People 2000: National Health Promotion and Disease Prevention Objectives

HP 2010Healthy People 2010: Objectives for Improving Health

Healthy People 2020 Launched December 2010

For 3 decades, Healthy People has provided a comprehensive set of national 10-year objectives that have served as a framework for public health activities at all levels and across the public health community. Healthy People has evolved as the Nations public health priorities have changed.

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HEALTHY PEOPLE-2010 2 GoalsIncrease the quality and years of healthy lifeEliminate health disparities28 Focus Areas467 specific objective

The number of objectives has increased with each decade. Healthy People 1990 set forth 226 objectives, Healthy People 2000 included 312 objectives, Healthy People 2010 identified 467 objectives with 1,000 measures, and Healthy People 2020 has nearly 600 objectives with 1,200 measures.

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HEALTHY PEOPLE-20204 GoalsElimination of preventable disease, disability, injury and premature death.Achievement of health equality.Elimination of health disparities.Creation of social and physical environment that will promote good health and healthy development and behaviour at every stage of life.42 Focus Areas

1200 specific objectives

Targets to be achieved by the year 2020 are:

Decrease infant mortality rate below 60.To increase the expectation of life from 52 years to 64 years.To decrease the crude death rate from 14/1000 population to 9/1000 population.To achieve a net reproduction rate of 1.To provide water to the entire population

NATIONAL HEALTH POLICYrespond to growing calls for strengthening health systems through Primary Health Care as a way of achieving the goal of better health for all. This requires action in four policy areas: moving towards universal coverage, reorienting conventional care towards people-centred care, integrating health in all policies, and ensuring more inclusive health governance;guide and steer the entire, pluralist health sector rather than being limited to command-and-control plans for the public sector alone;go beyond the boundaries of health systems, addressing the social determinants of health and the interaction between the health sector and other sectors in society.

OBJECTIVES

Nutrition.Prevention of food adulteration and quality of drugs.Water supply and sanitation.Environment protection.

Cont..

Immunization programmes.Maternal and child health services.School health programmes.Occupational health services

National health policy-GOALSTo establish one HSC for every 5000 [3000 for hilly areas].To establish one PHC for every 30,000 population.To establish one CHC for every 1,00000 population.To train village health guides selected by the community for 1,000 population in each village.To train TBAs in each village.Training of various categories of field functionaries

NHP 2002 to be achieved by year 2015Eradicate polio and yaws -2005Eliminate leprosy -2005Eliminate Kala- azar -2010Eliminate filariasis -2015Zero level growth of HIV/AIDS -2007Decreasing mortality of TB by 50% -2010

NHP 2002 to be achieved by year 2015Decreasing malaria and other vector borne disease -2010

Decreasing prevalence of blindness 0.5% -2010

Increasing utilization of public health service from 20% to 75% -2010

Decreasing IMR to 30/1000 and MMR 100/1lakh -2010

GOALS SET AND ACHIEVED BY NATIONAL HEALTH POLICY-1983

IMRPNMRCDRMMRUFMRLIFE EXPECTANCYMALEFEMALELBW6033 9210

646410%70468.749.4

62.463.426%

IndicatorGoals by 2000Achieved by 2000

CBRCPRNBRGrowth rateFamily sizeAN careTT pregnantDPTOPVBCGFully immunized2160%11.22.3100%100%85%85%85%85%26.146.2%1.451.933.167.2% 83%87%92%82%56%

IndicatorGoal by 2000Achieved by 2000

POPULATION IN INDIA

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NATIONAL POPULATION POLICYWHICH INTEND TO DECREASE THE BIRTH RATE/GROWTH RATEIN APRIL 1976 INDIA FORMED FIRST POPULATION POLICY EMPHASIZING INCREASE IN THE LEGAL MINIMUM AGE AT MARRIAGE FROM 15-18 YrsNot only with fertility and Mortality rates .Empowering ,women's education, health and Nutrition's child survival health , family welfare servicesadolescent healthparticipation of men in parenthood

Demographic goals by 2010Address unmet needs of basic RCH services.Compulsory free education up to 14 yrs of age. Reduce IMR to below 30 per 1000 live births.Reduce MMR to below 100 per 100,000 live births.100% protection against vaccine preventable disease for children Preferable age marriage for girls is 20 not earlier by 1880% of deliveries in intuitions , 100% by trained personnel

100% registration of births ,deaths , marriage, pregnancyContain the spread of AIDSIntegrate Indian system of MedicineEnsure peoples access to information / counseling and services for family planning include contraceptives clinical and surgical services Prevent and control communicable diseasesPromote small family norm

HEALTH AND FAMILY WELFARE PROGRAMME National family planning programme was launched in 1952Union ministry of health and family welfare.During first and second five year plan programme modest way with clinical approach emphasis of four components.EducationTraining Research

Cont.. During third five year plan , the programme was reorganized after publication of 1961 census Which showed higher growth rate than expectedClinical approach was supplemented by an extension approach family planning , service and supplies of contraceptives taken to the people. Setup state and district levelsRFWC and sub centers were established with PHCDuring fourth five year plan priority to programme.

Post Partum Programme and MTP act was introduced. In fifth five year plan , approach integrate family welfare services (MCH)Sixth five year plan. NHP achieve under health and family welfare Major demographic Goal replacement level of fertility (NRR=1) by the year of 2000Universal immunization programme aimed in mortality and morbidity among clildrenOral rehydration therapy also started dehydration -death

Seventh five year plan improve mothers health and young children, provide them facilities and treatment of major disease.Eighth five year plan-integrated child survival and safe motherhood.International conference Cairo (population and dev)- reducing cost of input -better out come Ninth five year plan-integrates all related problems of 8th five year plan RCH concept-need based , client oriented , demand driven,high quality integrated services.

To eradicate extreme poverty and hunger

To achieve universal primary education

To promote gender equality and empower women

To reduce child mortality

To improve maternal health

To combat HIV/AIDS, malaria and other diseases

To ensure environmental sustainability

To develop a global partnership for development

THANK YOU