NATIONAL HEALTH POLICY - 2002

1. INTRODUCTORY

1.1 A National Health Policy was last formulated in 1983, and since

then there have been marked changes in the determinant

factors relating to the health sector. Some of the policy initiatives

outlined in the NHP-1983 have yielded results, while, in several

other areas, the outcome has not been as expected.

1.2 The NHP-1983 gave a general exposition of the policies which

required recommendation in the circumstances then prevailing in

the health sector. The noteworthy initiatives under that policy

were:-

(i) A phased, time-bound programme for setting up a welldispersed

network of comprehensive primary health care

services, linked with extension and health education, designed in

the context of the ground reality that elementary health problems

can be resolved by the people themselves;

(ii) Intermediation through ‘Health volunteers’ having appropriate

knowledge, simple skills and requisite technologies;

(iii) Establishment of a well-worked out referral system to ensure

that patient load at the higher levels of the hierarchy is not

needlessly burdened by those who can be treated at the

decentralized level;

(iv) An integrated net-work of evenly spread speciality and superspeciality

services; encouragement of such facilities through

private investments for patients who can pay, so that the draw on

the Government’s facilities is limited to those entitled to free use.

1.3 Government initiatives in the pubic health sector have

recorded some noteworthy successes over time. Smallpox and

Guinea Worm Disease have been eradicated from the country;

Polio is on the verge of being eradicated; Leprosy, Kala Azar, and

Filariasis can be expected to be eliminated in the foreseeable

future. There has been a substantial drop in the Total Fertility Rate

and Infant Mortality Rate. The success of the initiatives taken in

the public health field are reflected in the progressive

improvement of many demographic / epidemiological /

infrastructural indicators over time – (Box-I).

1.4 While noting that the public health initiatives over the years

have contributed significantly to the improvement of these health

indicators, it is to be acknowledged that public health indicators /

disease-burden statistics are the outcome of several

complementary initiatives under the wider umbrella of the

developmental sector, covering Rural Development, Agriculture,

Food Production, Sanitation, Drinking Water Supply, Education,

etc. Despite the impressive public health gains as revealed in the

statistics in Box-I, there is no gainsaying the fact that the morbidity

and mortality levels in the country are still unacceptably high.

These unsatisfactory health indices are, in turn, an indication of

the limited success of the public health system in meeting the

preventive and curative requirements of the general population.

1.5 Out of the communicable diseases which have persisted over

time, the incidence of Malaria staged a resurgence in the1980s

before stabilising at a fairly high prevalence level during the

1990s. Over the years, an increasing level of insecticide-resistance

has developed in the malarial vectors in many parts of the

country, while the incidence of the more deadly P-Falciparum

Malaria has risen to about 50 percent in the country as a whole. In

respect of TB, the public health scenario has not shown any

significant decline in the pool of infection amongst the

community, and there has been a distressing trend in the increase

of drug resistance to the type of infection prevailing in the

country. A new and extremely virulent communicable disease –

HIV/AIDS - has emerged on the health scene since the

declaration of the NHP-1983. As there is no existing therapeutic

cure or vaccine for this infection, the disease constitutes a serious

threat, not merely to public health but to economic development

in the country. The common water-borne infections –

Gastroenteritis, Cholera, and some forms of Hepatitis – continue

to contribute to a high level of morbidity in the population, even

though the mortality rate may have been somewhat moderated.

1.6 The period after the announcement of NHP-83 has also seen

an increase in mortality through ‘life-style’ diseases- diabetes,

cancer and cardiovascular diseases. The increase in life

expectancy has increased the requirement for geriatric care.

Similarly, the increasing burden of trauma cases is also a

significant public health problem.

1.7 Another area of grave concern in the public health domain is

the persistent incidence of macro and micro nutrient deficiencies,

especially among women and children. In the vulnerable subcategory

of women and the girl child, this has the multiplier effect

through the birth of low birth weight babies and serious

ramifications of the consequential mental and physical retarded

growth.

1.8 NHP-1983, in a spirit of optimistic empathy for the health needs

of the people, particularly the poor and under-privileged, had

hoped to provide ‘Health for All by the year 2000 AD’, through the

universal provision of comprehensive primary health care services.

In retrospect, it is observed that the financial resources and public

health administrative capacity which it was possible to marshal,

was far short of that necessary to achieve such an ambitious and

holistic goal. Against this backdrop, it is felt that it would be

appropriate to pitch NHP-2002 at a level consistent with our

realistic expectations about financial resources, and about the

likely increase in Public Health administrative capacity. The

recommendations of NHP-2002 will, therefore, attempt to

maximize the broad-based availability of health services to the

citizenry of the country on the basis of realistic considerations of

capacity. The changed circumstances relating to the health

sector of the country since 1983 have generated a situation in

which it is now necessary to review the field, and to formulate a

new policy framework as the National Health Policy-2002. NHP-

2002 will attempt to set out a new policy framework for the

accelerated achievement of Public health goals in the socioeconomic

circumstances currently prevailing in the country.

2. CURRENT SCENARIO

2.1 FINANCIAL RESOURCES

2.1.1 The public health investment in the country over the years

has been comparatively low, and as a percentage of GDP has

declined from 1.3 percent in 1990 to 0.9 percent in 1999. The

aggregate expenditure in the Health sector is 5.2 percent of the

GDP. Out of this, about 17 percent of the aggregate expenditure

is public health spending, the balance being out-of-pocket

expenditure. The central budgetary allocation for health over this

period, as a percentage of the total Central Budget, has been

stagnant at 1.3 percent, while that in the States has declined from

7.0 percent to 5.5 percent. The current annual per capita public

health expenditure in the country is no more than Rs. 200. Given

these statistics, it is no surprise that the reach and quality of public

health services has been below the desirable standard. Under the

constitutional structure, public health is the responsibility of the

States. In this framework, it has been the expectation that the

principal contribution for the funding of public health services will

be from the resources of the States, with some supplementary

input from Central resources. In this backdrop, the contribution of

Central resources to the overall public health funding has been

limited to about 15 percent. The fiscal resources of the State

Governments are known to be very inelastic. This is reflected in

the declining percentage of State resources allocated to the

health sector out of the State Budget. If the decentralized pubic

health services in the country are to improve significantly, there is

a need for the injection of substantial resources into the health

sector from the Central Government Budget. This approach is a

necessity – despite the formal Constitutional provision in regard to

public health, -- if the State public health services, which are a

major component of the initiatives in the social sector, are not to

become entirely moribund. The NHP-2002 has been formulated

taking into consideration these ground realities in regard to the

availability of resources.

2.2 EQUITY

2.2.1 In the period when centralized planning was accepted as a

key instrument of development in the country, the attainment of

an equitable regional distribution was considered one of its major

objectives. Despite this conscious focus in the development

process, the statistics given in Box-II clearly indicate that the

attainment of health indices has been very uneven across the

rural – urban divide.