OBJECTIVES

 GENERAL OBJECTIVE

At the end of topic presentation, the students will gain in-depth knowledge regarding

‘National Health Policy & National Population Policy’ & student will be able to

apply this knowledge in their practice.

 SPECIFIC OBJECTIVE

1) Define Health and Policy.

2) Describe about national health policy 1983.

3) Explain key elements of national health policy 1983

4) Discuss the national health policy: 2002

5) Elaborate objectives of National Health Policy 2002

6) Illustrate major issues being addressed by NHP 2002

7) Explain the aim, goals and objectives of national health policy 2017

8) Discuss about policy thrust of national health policy 2017.

9) Define population

10) Identify the important features of national population policy 1976

11) Explain about national population policy 2000

12) List the objectives and goals of national population policy 2000

13) List strategic themes

14) Enlist the promotional and motivational measures

 NATIONAL HEALTH POLICY

INTRODUCTION

HEALTH:

A state of complete physical, mental and social well-being and not merely the absence of
disease or infirmity.

POLICY:

Policy is a system, which provides the logical framework and rationality of decision making
for the achievements of intended objectives.

HEALTH POLICY:

Health policy of a nation is its strategy for controlling and optimizing the social uses of its
health knowledge and health resources.

Post independent India in its constitution has laid stress on four critical concepts: Equity,
Freedom, Justice and Dignity of the individual.

India has ventured to raise the standard of living and level of nutrition for elimination of ill
health, ignorance and poverty.

NATIONAL HEALTH POLICIES (NHP 1983:2002,2017)

Health policy is the expression of what the health care system should be so that is can meet
the health care needs of the people. Political forces play a major role in determining issues
and strategies like allocation of funds, manpower, infrastructure, geo graphical accessibility,
alternative medical technology etc.

India is committed to attaining the goal of "Health for All by the Year 2000 A.D." through the
universal provision of comprehensive primary health care services.

The primary objective of National Health Policy 1983 was to attain the goal of Health for All
by 2000AD by establishing an effective and efficient health care system which is accessible
to all the citizens, especially vulnerable groups like women, children and under privileged.

The National Health Policy strongly stressed the creation of primary health care
infrastructure, coordination with health-related services, the active involvement of voluntary
organizations, the provision of essential drugs and vaccines, qualitative improvement in
health and family welfare services, the provision of adequate training and medical research
on common health problems of the people.

Key Elements of NHP: 1983

 Creation of greater awareness of health problems in the community and means to

solve the problems by the community.
 Reduction of existing imbalance in health services by concentrating more on the rural
health infra- structure
 Supply of safe drinking water and basic sanitation using technologies that people can
afford
 Establishing dynamic health management information system to support health
planning and health programme implementation.
 Provision of legislative support to health protection and promotion
 Combat wide spread malnutrition
 Research in alternative methods of health care delivery system and low-cost health
technologies.
 Greater co-ordination of different systems of medicine.
 Based on global indicators and the targets recommended by the working group on
Health for All by 2000 AD, the National Health Policy 1983 laid down specific health
targets for Health for All to be achieved in phased manner.

They are:

a) Horizontal integration of vertical programmes.

b) Develop disease surveillance and response mechanism with focus on rapid
recognition, re- port and response at district level
c) Develop and implement integrated non-communicable disease control programme
d) Health impact assessment as a part of environ- mental impact assessment in
developmental projects
e) Implement appropriate management systems for emergency, disaster, accident
f) Screening for common nutritional deficiencies especially in vulnerable groups and
initiate ap- propriate remedial measures
g) Reduction in the population growth rate has been recognized as one of the priority
objectives. It will be achieved by meeting all felt-needs for contraceptives and by
 reducing the infant and maternal morbidity and mortality so that there is reduction in
the desired level of fertility.
h) Implementation of reproductive and child health programme by effective maternal
and child health care, increased access to contraceptive care; safe management of
unwanted pregnancies; nutritional services to vulnerable groups; prevention and
treatment of RTI/STD; reproductive health services for adolescents; prevention and
treatment of gynaecological problems; and screening and treatment of cancers,
especially that of uterine cervix and breast.

NATIONAL HEALTH POLICY: 2002

Considering the kind and level of progress and change in health problems and
circumferences, the department of health family welfare felt it necessary to formulate the new
policy framework as National Health Policy 2002.

The main objectives of National Health Policy 2002 are to achieve acceptable standard of
good health amongst the general population of the country. The approach would be to:

 To increase the access to the decentralized public health system by establishing new
infrastructure in deficit areas.

National Health Policy 2002 Goals to be achieved by 2015:

Eradicate Polio and Yaws 2005

Eliminate Leprosy 2005

Establish an integrated system of surveillance National Health Accounts

2005
and Health Statistics

Increase state sector health spending from 5.5% to 7% of the Budget 2005

Achieve Zero level growth of HIV / AIDS 2007

Eliminate Kala Azar 2010

Increase health expenditure by Government as a % of GDP from the
2010
existing 0.9% to 2.0%

Reduce morality by 50% on ac- - count of TB, Malaria and other vector
2010
and water borne diseases
Increase share of central grants to constitute at least 25% of total health 2010
 spending
Further increase to 8% of the Budget 2010
Eliminate Lymphatic Filariasis 2015
 Ensure equitable access to health services across the country.
 Increase contribution by Central Government to strengthen the capacity of public
health administration at state level.
 Enhance the contribution of private sector in providing health services to the
population who can afford.
 Rational use of drugs within allopathic system and traditional system of medicine

Major issues being addressed by NHP 2002 are as under:

 Increasing aggregate outlays for primary health sector to strengthen existing facilities
and opening additional Public Health Service outlets, consistent with the norms of
such facilities.
 The central Government to continue to perform a key role in designing National
Programmes with an active participation of State government till moderate levels of
prevalence of diseases like TB, Malaria, HIV/AIDS etc., is reached.
 Reviving primary health system by providing some essential drugs under Central
Government funding through the decentralized system
 Strengthening of primary health care infrastructure to provide quality services.
 Laying of reasonable user charges for certain Secondary and Tertiary Public Health
care services.
 Implementation Public Health Programmes through local self-Government. The State
Government to consider and decentralize implementation of health programmes by
2005. Financial incentive will be provided by the Central Government.

NATIONAL HEALTH POLICY -2017

INTRODUCTION

The National Health Policy of 1983 and the national policy of 2002 have served well in
guiding the approach for the health sector in five-year plans.

NHP 2017 builds on the progress made since the last NHP 2002. the developments have been
captured in the document "Backdrop to National Health Policy 2017- situational analysis",
Ministry of Health and Family Welfare, Government of India.
AIM OF NHP 2017

"To inform, clarify, strengthen and prioritize the role of government in shaping health
systems in all its dimensions- investments in health, organization of healthcare services.
prevention of diseases and promotion of good health through cross sectoral actions, access to
technologies, developing human resources, encouraging medical pluralism, building
knowledge base, developing better financial protection strategies, strengthening regulation
and health assurance".

GOAL of NHP

 Attainment of the highest possible level of health and well-being for all at all ages,
through a preventive and promotive health care orientation in all developmental
policies.
 Universal access to good quality health care services without anyone having to face
financial hardship as a consequence.
 The policy also recognizes the importance of Sustainable Development Goals (SDGs)
 The broad principles of the policy
 Professionalism, Integrity and Ethics
 Equity
 Affordability
 Universality
 Patient Cantered & Quality of Care
 Accountability and pluralism
 Decentralization
 Inclusive partnership.

OBJECTIVES OF NHP 2017

 Improve health status through concerted policy action in all sectors and expand
preventive, promotive, curative, palliative and rehabilitative services provided
through the public health sector with focus on quality.
 Universal health coverage
 Reinforcing trust in public health coverage
 Align the growth of private sector with public health goals

SPECIFIC QUANTITATIVE GOALS AND OBJECTIVES

1) Health status & programme impact-Life Expectancy and healthy life.
 Increase Life Expectancy at birth from 67.5 to 70 by 2025.
 Establish regular tracking of Disability Adjusted Life Years (DALY) Index as
a measure of burden of disease and its trends by major categories by 2022.
 Reduction of TFR to 2.1 at national and sub-national level by 2025.
2) Mortality by Age and/ or cause
 Reduce Under Five Mortality to 23 by 2025 and MMR from current levels to
100 by 2020.
 Reduce infant mortality rate to 28 by 2019.
 Reduce neo-natal mortality to 16 and still birth rate to "single digit" by 2025.
3) Reduction of disease prevalence/incidence
 Achieve global target of 2020 which is also termed as target of 90:90:90, for
HIV/AIDS i.e., 90% of all people living with HIV know their HIV status, -
90% of all people diagnosed with HIV infection receive sustained
antiretroviral therapy and 90% of all people receiving antiretroviral therapy
will have viral suppression.
 Achieve and maintain elimination status of Leprosy by 2018, Kala-Azar by
2017 and Lymphatic Filariasis in endemic pockets by 2017.
 To achieve and maintain a cure rate of >85% in new sputum positive patients
for TB and reduce incidence of new cases, to reach elimination status by 2025.
4) Health Systems performance
a) Coverage of health services
 Increase utilization of public health facilities by 50% by 2025
 Antenatal care coverage to be sustained above 90% and skilled
attendance at birth above 90 by 2025
 More than 90% of immunized
b) Health finance
 Increase health expenditure by Government as a percentage of GDP from
the existing 1.15% to 2.5% by 2025.
 Increase State sector health spending to > 8% of their budget by 2020. c)
Decrease in proportion of households facing catastrophic health
expenditure from the current levels by 25%, by 2025.
c) Health Infrastructure and Human Resource
  Ensure availability of paramedics and doctors as per Indian Public Health
Standard (IPHS) norm in high priority districts by 2020.
 Increase community health volunteers to population ratio as per IPHS
norm, in high priority districts by 2025.
 Establish primary and secondary care facility as per norms in high
priority districts (population as well as time to reach norms) by 2025.
d) Health Management Information
 Ensure district - level electronic database of information on health system
components by 2020.
 Strengthen the health surveillance system and establish registries for
diseases of public health importance by 2020.
 Establish federated integrated health information architecture, Health
Information Exchanges and National Health Information Network by
2025.
 To reduce the prevalence of blindness to 0.25/ 1000 by 2025 and disease
burden by one third from current levels.
 To reduce premature mortality from cardiovascular diseases, cancer,
diabetes or chronic respiratory diseases by 25% by 2025.

POLICY THRUST

1) Ensuring Adequate Investment

2) Preventive and promotive health
3) Organization of public health care delivery
4) Women's health and gender mainstreaming
5) Gender based violence
6) Supportive supervision
7) Emergency care and disaster preparedness
8) Mainstreaming the potential of AYUSH
9) Tertiary care services
10) Human resources for health
11) Financing of health care
12) Collaboration with non-governmental sector
13) Regulatory framework
14) Vaccine safety
 15) Medical technologies
16) Availability of drugs and medical devices
17) Digital health technology ecosystem
18) Application of digital health
19) Leveraging digital tools for AYUSH
20) Health surveys
21) Health research

NATIONAL POPULATION POLICY

POPULATION:
A population is a summation of all the organisms of the same group or species, which live in
the same geographical area, and have the capability of interbreeding.

POLICY

 Set of Ideas or Plans that is used as a basis for decision making;

 Attitude and actions of an organization regarding a particular issue;
 General Statement of understanding which guide decision making.

NATIONAL POPULATION POLICY

 The need for National Population Policy was felt since 70's. It was drafted in 1976.
Policy statement on family welfare program was also prepared in 1977. Both these
statements were tabled in the parliament but were never discussed or adopted.
 The National Health Policy of 1983 emphasized the need for securing the small
family norm through voluntary efforts and moving towards the goal of population
stabilization.

IMPORTANT FEATURES OF NATIONAL POPULATION POLICY

1976:

 Increase the age of marriage from 15 to 18 years for girls and from 18 to 21 years for
boys.
 Freeze the population figures at the 1971 level until 2001.
 Make some portion of central assistance provided to the states dependent upon their
performance in family planning.
 Give greater attention to education of girls.
 Ensure a proper place for population education in the total system of education.
 Involve all ministries and departments of the government in the family planning
program.
 Increase the monetary compensation for sterilization.
 Institute group awards incentives for various as organizations and bodies representing
the people at local levels, including Zillah Parishad and Panchayat Samiti.
 Encourage intimate association of voluntary organizations. Particularly those
representing women, with implementation of program.
 Impart more importance to research activities in the field of population control.
  Use mass media for motivation, particularly in rural areas, to increase the acceptance
of family planning methods.

NATIONAL POPULATION POLICY 2000

In 1998, a draft of National Population Policy was finalized after consultation it was
approved by the cabinet and was examined by groups of ministers. The draft was discussed in
cabinet on 19th Nov.1999. The suggestions were incorporated and the final draft of National
Population Policy was placed before the parliament. It was adopted by the government of
India on 15th Feb. 2000.

Milestones

 1946- Bhore committee report

 1952- Family planning programme
 1976-Statement of national population policy
 1977- Policy statement for family welfare programme.
 1983- National Health Policy emphasized need.
 1991- National development council appointed a committee.
 1993- Dr Swaminathan group prepared a draft and discussed by cabinet and then
parliament.
 1999-Another draft policy was finished and finalised on 19th November.
 15th February, 2000- National Population Policy was adopted.

OBJECTIVES OF NATIONAL POPULATION POLICY 2000

1) The immediate objectives are:

 To address the unmet needs for contraception, health care infrastructure, and
health personnel.
 To provide integrated service delivery for basic reproductive and child health
care.
2) The medium-term objective is:
 To bring the Total Fertility Rate to replacement levels by 2010, through
vigorous implementation of Intersectoral operational strategies.
3) The long-term objective is:
  To achieve a stable population by 2045, at a level consistent with the
requirements of sustainable socio-economic growth and developments and
environmental protection.

NATIONAL SOCIO- DEMOGRAPHIC GOALS FOR 2010

 Address the unmet needs for basic reproduction and child health services, supplies
and infrastructure.
 Make school education up to age of 14 free and compulsory and reduce drop outs
primary and secondary schools’ levels below 20% for both girls and boys.
 Reduce infant mortality rate to below 30 per 1000 live births.
 Reduce maternal mortality ratio to below 100 per 10,000 live births.
 Achieve universal immunization of children against all vaccine preventable diseases.
 Promote delayed marriage for girls, not earlier than age 18 and preferably after 20
years of age.
 Achieve 80 % institutional deliveries and 100 % deliveries by trained persons.
 Achieve universal access to information/counselling and services for fertility
regulation and contraception with a basket of choice.
 Achieve 100% registrations of births, death, marriage and pregnancy.
 Contain the spread of AIDS and promote greater integration between the management
of reproductive tract infection and sexually transmitted infections and the national
AIDS control organizations.
 Prevent and control communicable diseases.
 Integrate Indian system of medicine in the provision of reproductive and child health
services and in reaching out to the levels of total fertility rate.
 Promote vigorously the small family norm replacement levels of total fertility rate. to
achieve
 Bring about convergence in implementation of related social sector programs so that
family welfare becomes a people cantered program.

STRATEGIC THEMES

1. Decentralized planning and program implementation.

2. Convergence of service delivery at village levels.
3. Empowering women and for improved health nutrition.
4. Child survival and Child Health.
 5. Meeting the unmet needs for family welfare services.
6. Focus on Under-served population groups:
 Urban slums
 Tribal communities, hill area population and displaced and migrant
populations
 Adolescents
7. Involvement of men in planned parenthood.
8. Action through diverse health care's providers.
9. Collaboration with and commitments from non- government organizations and the
private sector.
10. Mainstreaming Indian Systems of Medicine and Homeopathy.
11. Contraceptive technology and research on reproductive and child health
12. Providing care for the Older Population.
13. Information, Education & Communication.

PROMOTIONAL AND MOTIVATIONAL MEASURES

In order to achieve the objectives and goals of the National Population Policy, 2000 the
following promotional and motivational measures are enumerated:

 Panchayats and Zila Parishads will be rewarded and honoured for exemplary
performance in universalizing the small family norm, achieving reduction in infant
mortality and birth rates and promoting literacy with completion of primary
schooling.
 Balika Samridhi Yojana run by the Department of Women and Child Development,
to promote survival and care of the girl child, will continue. A cash incentive of Rs.
500 is awarded at the birth of the girl child of birth order 1 or 2.
 Maternity benefit scheme run by the Department of Rural Development will
continue. A cash incentive of Rs. 500 is awarded to mothers who have their first child
after 19 years of age, for birth of the 1st and 2nd child only.
 A family Welfare- linked Health Insurance Plan will be established. Couples below
the poverty line, who undergo sterilization with not more than 2 living children's,
would become eligible for health insurance not exceeding Rs 5000, and a personal
accident insurance cover for the spouse undergoing sterilization.
 Couples below the poverty line, who marry after the legal age of marriage, register the
marriage, have their first child after the mother reaches the age of 21, accept the
family norm, and adopt a terminal method after birth of 2nd child, will be rewarded.
 A revolving fund will be set up for income- generation activities by village- level self-
help groups, who provide community- level health care services.
 Crèches of childcare centres will be opened in rural areas and urban slums. This will
facilitate and promote participation of women in paid employment.
 A wider and affordable choice of contraceptives will be made accessible at diverse
delivery points with counselling service.
 Facilities for safe abortion will be strengthened and expanded.
 Products and services will be made affordable through innovative social marketing
schemes.
 Local entrepreneurs at village levels will be provided soft loans and encouraged to run
ambulance services to supplement the existing arrangement for referral transportation.
 Increased vocational training schemes for girls, leading to self-employment, will be
encouraged.
RESEARCH STUDY

STUDY TITLE: A Critical Analysis and Evaluation of National Population

Policy
Prasanta Mujrai, Laxmi Tulasi Rao

ABSTRACT:

India's main goals are to reduce population size and improve people's quality of life. General
government goals include lowering the birth rate, mortality rate, and abortion laws. The
emphasis is on reaching the masses through various media to spread education. Decentralize
democratic plans through state legislatures, municipalities, and panchayats to eliminate
family welfare programmes vertically. A State Population and Social Development
Commission should be established to plan, implement, and oversee the country's population
policy. According to experts, lowering infant mortality could reduce birth rates by 20%. The
failure of states such as Uttar Pradesh, Madhya Pradesh, Bihar, Rajasthan, and others to
control their populations has resulted in an increase in the birth rate.

Abstract: India's main goals are to

reduce population size and
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3) Dr. Tulasi Vasundhara, Dr. Prasuna Gnana G, “Community Health Nursing-II”, 2nd

Edition, Frontline Publications; 2018. P. 49 to 51.

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Banarsidas bhanot publications; 2007.p:286-288.

5) Government of India, Ministry of Human Resource Development, Annual Report

2001-2002.

6) Mujrai P, Rao LT, editors. Review of Contemporary Scientific and Academic Studies.

Review of Contemporary Scientific and Academic Studies An International

Multidisciplinary Online Journal. 2022;2(2).

NATIONAL POPULATION POLICY MILESTONES

 1946- Bhore committee report

 1952- Family planning programme

 1976-Statement of national population policy

 1977- Policy statement for family welfare programme.

 1983- National Health Policy emphasized need.

 1991- National development council appointed a committee.

 1993- Dr Swaminathan group prepared a draft and discussed by cabinet

and then parliament.

 1999-Another draft policy was finished and finalised on 19th November.

 15th February, 2000- National Population Policy was adopted.

 National Health Policy 2002 Goals to be achieved by 2015:

Eradicate Polio and Yaws 2005

Eliminate Leprosy 2005

Establish an integrated system of surveillance National

2005
Health Accounts and Health Statistics

Increase state sector health spending from 5.5% to 7% of the

2005
Budget

Achieve Zero level growth of HIV / AIDS 2007

Eliminate Kala Azar 2010

Increase health expenditure by Government as a % of GDP

2010
from the existing 0.9% to 2.0%

Reduce morality by 50% on ac- - count of TB, Malaria and

2010
other vector and water borne diseases
Increase share of central grants to constitute at least 25% of
2010
total health spending

Further increase to 8% of the Budget 2010

Eliminate Lymphatic Filariasis 2015