Health Planning India & National Health policy 2017

Dr. Anuj Singh
Asst. Professor, Community Medicine
Health Planning India
&
National Health Policy

Health planning-
• is a part of national development planning.
• is necessary for economic utilisation of
money, material, manpower.
• Purpose is to improve the health services.

National Health planning-
Def-
“the orderly process of defining-
community health problems, identifying unmet
needs and surveying the resources to meet them,
establishing priority goals that are realistic and
feasible and projecting administrative action to
accomplish the purpose”

National Health planning-India
Evolution of Health Planning in
India

Evolution of Health Planning in India
Bhore
Committe
e (1946):
Mudaliar
Committee
(1962):
Chadha
Committee
(1963):
Mukerji
Committee
(1965):
Junglewala
Committee
(1967):

1. Bhore Committee (1946): Recommended a three-tier health care
system and emphasized preventive and curative services. Proposed
free healthcare through Primary Health Centres (PHCs).
2. Mudaliar Committee (1962): Highlighted deficiencies in PHCs and
recommended strengthening district hospitals and medical colleges.
3. Chadha Committee (1963): Introduced the concept of multipurpose
health workers.
4. Mukherjee Committee (1965): Suggested improving the efficiency
of the National Malaria Eradication Programme.
5. Junglewala Committee (1967): Recommended integrating health
services and removing program-based compartmentalization.
6. Shrivastav Committee (1975): Proposed the establishment of
community health workers and the introduction of a referral system.
Evolution of Health Planning in India

National Health Policy
• National Health Policy (1983, 2002, 2017):
Provided strategic direction for health system
development and public health interventions.

Five years plans of India
Third FYP
(1961-66)
Twelfth FYP
2012-17

Five-Year Plans- Highlights
Health planning in India was significantly
influenced by the Five-Year Plans (FYPs) under the
Planning Commission (1950-2014):
First FYP (1951-56): Focused on PHCs and medical
infrastructure.
Second FYP (1956-61): Strengthened medical
education and rural health services.

Five-Year Plans- cont..
Sixth FYP (1980-85): Introduced the Universal
Immunization Programme (UIP).
Eighth FYP (1992-97): Shifted focus towards family planning
and population stabilization.
Eleventh FYP (2007-12): Emphasized the National Rural
Health Mission (NRHM).
Twelfth FYP (2012-17): Focused on universal health
coverage and urban health mission.

Transition from Planning
Commission to NITI Aayog
(2015)

•The Planning Commission was replaced by NITI Aayog in 2015, shifting
from centralized to decentralized planning.
Transition from Planning
Commission to NITI Aayog (2015)

• Key contributions of NITI Aayog in health
planning:
– Proposed National Health Stack (NHS) to support
digital health initiatives.
– Developed the Health Index to assess state-level
health performance.
– Played a crucial role in Ayushman Bharat (2018),
which includes the Pradhan Mantri Jan Arogya Yojana
(PMJAY) and Health and Wellness Centres (HWCs).
– Suggested privatization of district hospitals to improve
healthcare delivery.
Transition from Planning Commission to NITI
Aayog (2015)

Current-
National Health Initiatives

Current National Health Initiatives
• Ayushman Bharat (2018): Comprehensive health coverage
for 10 crore poor and vulnerable families.
• National Digital Health Mission (2020): Establishing digital
health records for all citizens.
• PM Atmanirbhar Swasth Bharat Yojana (2021):
Strengthening healthcare infrastructure.
• National Health Mission (NHM): Includes NRHM (Rural)
and NUHM (Urban) for comprehensive healthcare services.

National Health Policy:
Background

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 NATONAL HEALTH POLICY according to their
own circumstances, to launch and sustain primary
health care as a part of national health system
The Alma-Ata Declaration of 1978 emerged as a
major milestone of the twentieth century in the field
of public health, and it identified primary health care
as the key to the attainment of the goal of "Health for
All" around the globe
6

ALMA–ATA DECLARATION:
8
1) Health state of complete physical, mental, and social
well-being, and not merely the absence of disease or
infirmity, is a fundamental human right and attainment
of the highest possible level of health is a most
important world-wide social goal .
2) The existing gross inequality in the health status of
between developed and developing countries as well as
within countries, is politically, socially, and economically
unacceptable and is, therefore, of common concern to
all countries.

3) The people have the right and duty to participate
individually and collectively in the planning and
implementation of their health care.
4) Government have a responsibility for the health of
their people which can be fulfilled only by the
provision of adequate health and social measures.
5) All government should formulate national policies,
strategies and plans of action to launch and sustain
primary health care.
9

6. All countries should cooperate in a spirit of
partnership and service to ensure PHC for all people.
10
7. An acceptable level of health for all the people of the
world by the year 2000 can be attained through a
further and better use of the world’s resources.

THE ALMA-ATA CONFERENCE
Defined that:
“Primary health care is an essential health care based
on practical, scientifically sound and socially
acceptable methods and technology, made universally
accessible to individual and families in the community,
through their full participation and at a cost that the
community and the country can afford”.
11

Principles of Primary Health Care
 Equitable distribution
 Community Participation
 Intersectoral coordination
 Appropriate technology

National Health Policy:
• Health- A state of complete physical, mental and social
merely the absence of disease or infirmity
• Policy- A set of plan of action i.e. what to do in
particular situation and that has been
agreed officially by group of people.

The National Health Policy:
 It aims to offer superior health services to
every age group and gender.
The policy focuses on providing universal
access to excellent quality health care services
at a reasonable cost. Promoting health care
orientation in every developmental policy.

NHP:
1983
NHP:
2002
NHP:
2017
History of NHP

• The NHP-1983 and NHP-2002 have served
well in guiding the approach for the health
sector in the Five-Year Plans.
• Now 14 years after the last health policy, the
context has changed in four major ways.

• First, the health priorities are changing.
Although maternal and child mortality have
rapidly declined, there is growing burden on
account of non-communicable diseases and
some infectious diseases.
• Second, important change is the emergence of
a robust health care industry estimated to be
growing at double digit.

• Third, change is the growing incidences of
catastrophic expenditure due to health care
costs, which are presently estimated to be one
of the major contributors to poverty.
• Fourth, a rising economic growth enables
enhanced fiscal capacity.
“Therefore, a new health policy responsive to
these contextual changes is required”

The primary aim of the NHP-2017:
 is to inform, clarify, strengthen and prioritize the role of
the Government in shaping health systems in all its
dimensions-
1) Investments & organization of healthcare services
2) Prevention of diseases and promotion of good health
3) Access to technologies, developing human resources
4) Encouraging medical pluralism
5) Building knowledge base
6) Developing better financial protection strategies
7) Strengthening regulation and health assurance

“NHP 2017 builds on the progress
made since the last NHP 2002”

NHP-2017: Goal-
 The policy envisages as its goal the attainment of the
highest possible level of health and well-being for all
at all ages, through a preventive and promotive health
care orientation and universal access to good quality
health care services without anyone having to face
financial hardship.
 This would be achieved through increasing access,
improving quality and lowering the cost of healthcare
delivery.

• 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.
NHP-2017: Objectives

Specific Quantitative Goal, and Objectives:
A) •Health status and programme impact
B) •Health system performance
C) •Health system strengthning

 1. Life Expectancy and healthy life
a. Increase Life Expectancy at birth from 67.5 to 70 by 2025.
b. 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.
c. Reduction of TFR to 2.1 at national and sub-national level
by 2025.
A) Health status and programme impact (NHP-2017: Goal , objective cont..)

2.Mortality by Age and/ or cause
a) Reduce Under Five Mortality to 23 by 2025
and MMR from current levels to 100 by 2020
b) Reduce infant mortality rate to 28 by 2019
c) Reduce neo-natal mortality to 16 and still
birth rate to “single digit” by 2025.

3. Reduction of disease prevalence/ incidence
a) 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.
b) Achieve and maintain elimination status of Leprosy
by 2018, Kala-Azar by 2017 and Lymphatic Filariasis
in endemic pockets by 2017.

c) 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.
d) To reduce the prevalence of blindness to 0.25/ 1000
by 2025 and disease burden by one third from
current levels
e) To reduce premature mortality from CVD, cancer,
diabetes or chronic respiratory diseases by 25% by
2025.

1. Coverage of Health Services-
a) Increase utilization of public health facilities
by 50% from current levels by 2025.
b) Antenatal care coverage to be sustained
above 90% and skilled attendance at birth
above 90% by 2025.
B) Health Systems Performance:
(NHP-2017: Goal , objective cont..)

c) More than 90% of the newborn are fully
immunized by one year of age by 2025.
d) Meet need of family planning above 90% at
national and sub national level by 2025.
e) 80% of known hypertensive and diabetic
individuals at household level maintain
controlled disease status by 2025

2.Cross Sectoral goals related to health
a) Relative reduction in prevalence of
current tobacco use by 15% by 2020 and
30% by 2025.
b) Reduction of 40% in prevalence of
stunting of under-five children by 2025.
B) Health Systems Performance:

c) Access to safe water and sanitation to all by
2020 (Swachh Bharat Mission).
d) Reduction of occupational injury by half from
current levels of 334 per lakh agricultural workers
by 2020.
e) National/ State level tracking of selected health
behaviour.

1.Health finance-
a) Increase health expenditure by Government as a
percentage of GDP from the existing 1.15% to 2.5 % by
2025.
b) 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 Systems strengthening :

2. Health Infrastructure and Human Resource
a) Ensure availability of paramedics and doctors as
per Indian Public Health Standard (IPHS) norm
in high priority districts by 2020.
b) Increase community health volunteers to
population ratio as per IPHS norm, in high
priority districts by 2025.
c) Establish primary and secondary care facility as
per norms in high priority districts (population
as well as time to reach norms) by 2025.

3.Health Management Information
a) Ensure district-level electronic database of
information on health system components by
2020.
b) Strengthen the health surveillance system and
establish registries for diseases of public health
importance by 2020.
c) Establish federated integrated health information
architecture, Health Information Exchanges and
National Health Information Network by 2025.

Health Planning India & National Health policy 2017

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