National Health Policy (NHP) | Social Pharmacy Notes

National Health policy (NHP): Health policy of a nation is its strategy for controlling and optimizing the social uses of its health knowledge of intended objectives. The main aim of health policy is decide or complete physical health, mental health, social health. (किसी राष्ट्र की स्वास्थ्य नीति इच्छित उद्देश्यों के अपने स्वास्थ्य ज्ञान के सामाजिक उपयोगों को नियंत्रित करने और अनुकूलित करने की उसकी रणनीति है।|स्वास्थ्य नीति का मुख्य उद्देश्य शारीरिक स्वास्थ्य, मानसिक स्वास्थ्य, सामाजिक स्वास्थ्य को तय करना या पूर्ण करना है।)

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

The slogan Health for All (HFA) was given by the world health organization (WHO) in year 1977 (May). The WHO has established 12 global indicators as the basic point of reference for assessing the progress towards HFA

The joint WHO- UNICEF international conference in 1978 at Alma-Ata (USSR) declared that “the existing gross inequalities in the status of health of people particularly between developed and developing countries as well as within the countries is politically, socially, and economically unacceptable“.

Alma-Ata Declaration called on all the governments to formulate National Health Policies according to their own circumstances, to launch and sustain primary health care as a part of national health system. Primary health care as the key to the attainment of the goal of Health for All around the globes.

Three NHP was launched by the Ministry of health and family welfare, Govt of India.

• 1.   First National Health Policy(1983)
• 2.   Second National Health Policy(2002)
• 3.   Third National Health Policy(2017)

National Health Policy (NHP) 1983

• India had its first national health policy in 1983 i.e. 36 years after independence.
• The ministry of health and family welfare evolved a NHP in 1983 keeping in view the national commitment to attain the goal of health for all by the year 2000.

Features of the 1983 Health policy

• It was critical of the curative-oriented western model of health care
• Emphasized a preventive, promotive and rehabilitative primary health care approach
• Recommended a decentralized system of health care, the key features of which were low cost, deprofessionalisation (use of volunteers and paramedics), & community participation,
• expansion of the private curative sector which would help reduce the government’s burden

But by the end of 2000 century it was clear that the goals of health for all by the year 2000 AD would not be achieved

National Health Policy (NHP) 2002

A revised health policy, for achieving better health care and unmet goals was brought out by government of India- National Health Policy 2002.

Objectives & Key Strategies of NHP 2002

1. Primary Health Care Approach
2. Decentralized public health system
3. Convergence of all health programme under single field umbrella
4. Strengthening and extending public health services
5. Enhanced contribution of private and NGO sector in health care delivery.
6. Increase in public spending for health care.

Key Components of NHP 2002

1. Financial Resources
2. Equity
3. Delivery Of National Public Health Programs:
4. The state of public health infrastructure:
5. Extending public health services:
6. Role of local self- Government Institutions
7. Norms of Health care Professional: Indian Medical council Act and Indian Nursing Council Act
8. Education of Health care Professional
9. Need for specialists in ‘Public Health’ and ‘Family Medicine’
10. Nursing personnel
11. Use of Generic drugs and
12. Urban health: Urban Community Health Centre

First Tier:-Primary centre cover 1 Lakh population
It functions as OPD facilities.
It provides essential drugs.
It will carry out national health programmers

Second Tier:-
❖General Hospital a referral to primary centre provides the care.
❖The policy recommends a fully equipped hub-spoke trauma care network to reduce accident mortality.

13. Mental health:
14. Information Education and Communication: School children , and interpersonal communication by folk and traditional media to bring about behavioral change.
15. Health research
16. Role of private sector
17. Role of civil Society
18. National Disease Surveillance Network:
19. Health statistics:
20. Women’s health
21. 21.Medical Ethics
22. .Enforcement of Quality Standards for food and Drugs
23. Regulation of standards in paramedical disciplines:
24. Environmental & Occupational Health
25. Providing Medical Facilities to Users from Overseas (Health Tourism)

National Health Policy (NHP) 2017

The National Health Policy, 2017 was passed by the Union Cabinet at its meeting on March 15^th, 2017 (NHP, 2017). This is the third NHP government of India.

14 years after the last health policy (NHP 2002) the context has changed in four major ways to design NHP 2017 as below.

1. Ever Changing Health Priorities: Even with the rapid decline of maternal and child mortality rates, there has been a constant growth in the number of non-communicable and infectious diseases.
2. Growth Rate of the Health Care Industry: One significant change is the emergence of a robust health care industry that is estimated to grow in leaps and bounds.
3. Catastrophic Expenditure: The growing rate of catastrophic expenditure due to costs for healthcare is another reason. Poverty is said to be a result of these costs.
4. Economic Growth: The rise in economic growth enables enhanced fiscal capacity.

Goal of the NHP 2017 as follows

1. The Policy aims to attain the highest level of health and well-being possible for every individual at any given age group, through a preventive and promotive health care orientation in policies. (नीति का उद्देश्य निवारक (preventive)और प्रोत्साहक (promotive)स्वास्थ्य देखभाल उन्मुखीकरण नीतियों के माध्यम से किसी भी आयु वर्ग के प्रत्येक व्यक्ति के लिए स्वास्थ्य और कल्याण के उच्चतम स्तर को प्राप्त करना है।)
2. It also focuses on universal access to excellent quality health care services without anyone having to face financial hardship.इसके अतिरिक्त राष्ट्रीय स्वास्थ्य नीति 2017 वित्तीय कठिनाई का सामना किए बिना किसी को भी उत्कृष्ट गुणवत्ता वाली स्वास्थ्य देखभाल सेवाओं तक सार्वभौमिक पहुंच पर केंद्रित है।
3. To achieve these goal, there should be improve the quality and lowering the cost of healthcare delivery(इन लक्ष्यों को प्राप्त करने के लिए, गुणवत्ता में सुधार होना चाहिए और स्वास्थ्य सेवा वितरण की लागत कम होनी चाहिए।
4. The Policy recognises the importance of Sustainable Development Goals along with an indicative list of time-bound quantitative goals aligned to ongoing national efforts and global strategic directions.

Principles of NHM 2017

The following are the fundamental principles of the National Health Policy 2017.

1. Professionalism, Integrity and Ethics: The National Health Policy commits to offer the highest professional standards, integrity and ethics that can be provided. It aims to maintain the same through the entire system of the health care delivery services everywhere with the support of a credible, transparent and responsible regulatory environment.
2. Equity: It is essential to reduce inequity to reach the poorest. This means that disparity based on account of gender, caste, poverty, disability and any other forms of social exclusions and geographical barriers must be removed entirely. This means that higher investments and financial protection for people who are poor and suffer from heavy medical conditions or diseases.
3. Affordability: As costs of health care increases, affordability requires the utmost focus, as distinct from equity. Catastrophic household healthcare expenditures defined as health expenditures that exceed 10% of its total monthly consumption expenditures or 40% of its monthly non-food consumption expenditures are unacceptable.
4. Universality: Prevention of any exclusions concerning social, economic or on current health status. Here, systems and services are designed to cater to every individual, including special groups.
5. Patient-centred and Quality of Care: Gender-sensitive, safe, effective and convenient healthcare services are to be offered with confidentiality and dignity. There is a need to evolve and disseminate health standards and medical guidelines for every level of the facility along with a system to ensure that the quality of the same is not compromised.
6. Accountability: This includes financial and performance responsibility along with transparency in decision making and elimination of corruption in healthcare systems in both; public and private.
7. Inclusive Partnerships:  A multistakeholder approach is required where the partnership and participation of all non-health ministries and communities are achieved. This approach would include collaborations with various academic institutions, non-profit agencies, and the healthcare industry as well.
8. Pluralism: Individuals would have access to AYUSH care providers based on the documented and validated local, home and community-based practices. These systems, among others, would also have Government support with respect to research and the supervision to develop. This would enrich their contribution to achieving national health goals and objectives through various integrative practices.
9. Decentralisation: Decision-making has to be decentralised to a level that is consistent with practical considerations and institutional capacities. Community participation is to be promoted simultaneously along with health planning processes.
10. Adaptiveness and Dynamism: Constantly improvements on the dynamic organisation of healthcare, based on new knowledge and evidence with learning from communities, national and international knowledge partners is designed.

Health Status and Programme Impact under NHP 2017

Life Expectancy and Healthy Life

• Increase Life Expectancy of an individual from 67.5 to 70 by 2025.
• Establish regular tracking of the Disability Adjusted Life Years (DALY) Index as a measure for diseases and its trends in significant categories by 2022.
• Reduction of TFR to 2.1 at the national and sub-national level by 2025.

Mortality by Age and Cause

• Reduce the Mortality Rate of children under the age of 5, to 23 by 2025 and the current levels of MMR to 100 by 2020.
• Reduce the Infant Mortality Rate to 28 by 2019.
• Reduce the Neo-Natal Mortality Rate to 16 and the Still Birth Rate to as minimum as possible or to a single digit by 2025.

Reduction of disease prevalence/ incidence

• Achieve a global target of 2020; which is also termed as the target of 90:90:90 for HIV/ AIDS. This means that 90% of all individuals living with HIV are aware of their status, 90% of all individuals diagnosed with HIV receive sustained Anti-Retroviral Therapy, and 90% of all individuals receiving the Anti-Retroviral Therapy have viral suppression.
• Achieve and maintain an elimination status for Leprosy by 2018, Kala-Azar by 2017 and Lymphatic Filariasis by 2017.
• To achieve and maintain the cure rate of 85% and more in the new sputum-positive patients for Tuberculosis and reduce the incidence of new cases as well as reach an elimination status by 2025.
• To reduce the existence of blindness to 0.25 out of 1000 by 2025 and disease burden by one-third from its current levels.
• To decrease pre-mature mortality from Cardiovascular Diseases, Diabetes, Cancer or Chronic Respiratory Diseases by 25% by 2025.

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