INCREASE IN GOVERNMENT EXPENDITURE IN HEALTH SECTOR THRUST ON PRIMARY HEALTH CENTRES

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HIGHLIGHTS OF NATIONAL HEALTH POLICY-2002

The National Health Policy-2002(NHP) gives prime importance to ensure a more equitable access to health services across the social and geographical expanse of the country. Emphasis has been given to increase the aggregate public health investment through a substantially increased contribution by the Central Government. Priority would be given to preventive and curative initiatives at the primary health level through increased sectoral share of allocation. The highlights of the policy are:

1. Increase health sector expenditure to 6 percent of GDP, with 2 percent of GDP being contributed as public health investment, by the year 2010. 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. 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.

2.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 Reproductive and Child Health and Universal Immunization Programmes, would need to be continued till moderate levels of prevalence are reached. Programme implementation be effected through autonomous bodies at State and district level. The interventions of State Health Departments may be limited to the overall monitoring of the achievement of programme targets and other technical aspects. The presence of State Government officials, social activists, private health professionals and MLAs/MPs on the management boards on the autonomous bodies will facilitate well-informed decision-making. 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 re-oriented.

3.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. 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.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.Such practitioners even outside their disciplines can provide simple services/procedures. 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. They would be subjected to the monitoring of performance through professional councils. States to simplify the recruitment procedures and rules for contract employment in order to provide trained medical manpower in under-served areas.

5.Enforce a mandatory two-year rural posting before the awarding of the graduates degree.This would not only make trained medical manpower available in the underserved areas, but would offer valuable clinical experience to the graduating doctors. The policy envisages the setting up of a Medical Grants Commission for funding new Government Medical and Dental Colleges in different parts of the country. 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. This policy also recommends a periodic skill updating of working health professional through a system of Continuing Medical Education. The policy also envisages that the creation of additional seats for post-graduate courses should reflect the need for more manpower in the deficient specialties. The policy envisages the progressive implementation of mandatory norms to raise the proportion of postgraduate seats in these disciplines in medical training institutions, to reach a stage wherein 1/4th of the seats are earmarked for Public Health/Family Medicine.

6. Panchayat bodies to be involved more in health care programmes. 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.

7. The policy emphasizes the need for an improvement in the ratio of nurses vis-à-vis doctors/beds.

8. The 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. To encourage the use of only essential drugs in the private sector, the imposition of fiscal disincentive would be resorted to. The production and sale of irrational combinations of drugs would be prohibited through the drug standards statute. Not less than 50% of the requirement of vaccines/sera would be sourced from public sector institutions so that the country is not dependent on imports.

9. The setting up of an organized urban primary health care structure is contemplated with two-tiered one: the primary center is seen as the first-tier, covering a population of one lakh, and a second tier of the urban health organization at the level of government general hospital. The funding for the urban primary health system will be jointly borne by the local self-government institutions and state and central governments.

10. Establishment of fully equipped ‘hub-spoke’ trauma care networks in large urban agglomerations to reduce accident mortality.

11. The upgrading of the physical infrastructure of mental hospital/institutions at Central Government expense so as to secure the human rights of this vulnerable segment of society.

12. In view of the over dependence on mass media, the policy proposes to focus on the inter-personal communication of information and on folk and other traditional media to bring about 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.

13. Giving priority to school health programmes which aim at preventive health education, providing regular health check-ups, and promotion of health-seeking behaviour among children. It would 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.

14. An increase in Government funded health research to a level of 1 percent to the total health spending by 2005, and thereafter up to 2 percent by 2010. Research programmes taken up by the Government in drug/vaccine development would be conducted in a mission mode. Time bound applied research for developing operational applications would be undertaken. Regulating minimum infrastructure and quality standards in clinical establishments/medical institutions by 2003. Guidelines for the conduct of clinical practice and delivery of medical services are targeted to be developed over the same period. The policy envisages graduation to a scheme of quality accreditation of clinical establishments/medical institutions, for the information of citizenry.

15. The setting up of private insurance instruments for increasing the scope of the coverage of secondary and tertiary sector under private health insurance packages is being considered. A social health insurance scheme, funded by the Government, and with service delivery through the private sector, would be considered. 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.

16. Involvement of non-Governmental practitioners in the national diseases control programmes so as to ensure that standard treatment protocols are followed in their day-to-day practice.

17. Significant contribution made by NGOs and other institution of the civil society in making available health services to the community is recognised. The disease control programmes would earmark not less than 10% of the budget in respect of identified programme components, to be exclusively implemented through these institutions. 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.

18.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 in-house training for data collection and interpretation for undertaking timely and effective response. Real-time information from outside the government system will greatly strengthen the capacity of the public health system to counter focal outbreaks of seasonal diseases.

19.Baseline estimates for the incidence of the common diseases – TB, Malaria, Blindness would be done by 2005. Baseline estimates for non-communicable diseases, like CVD, Cancer, Diabetes and accidental injuries and communicable diseases like Hepatitis and JE would also be compiled. NHP-2002 envisages that with access to such reliable data on the incidence of various diseases the public health system would be closer to the objective of evidence-based policy-making.

20.The need to establish national health accounts, conforming to the ‘source-to-users’ matrix structure would help in 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.

21.The highest priority of the Central Government to the funding of the identified programmes relating to woman’s health.

22.A comprehensive code of ethics be notified and rigorously implemented by the Medical Council of India. Establishment of statutory professional councils for paramedical disciplines to register practitioners, maintain standards of training, and monitor performance.

23.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. 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.

24.The periodic screening of the health conditions of the workers, particularly for high-risk health disorders associated with their occupation.

25.The providing of such health services on a payment basis to service seekers from overseas- Medical Tourism. Payment in foreign exchange, all fiscal incentives, including the status of "deemed exports", which are available to other exports of goods and services, would be extended.

26.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.