National Health Policy.pptx nursing health

Editor's Notes

• #4: Policy is statement which lays down the stated agreement of a government regarding the strategy and broad course of actions that will be taken to address a problem.
• #34: Inactivated Polio Vaccine (IPV) Rotavirus vaccine (RVV Measles Rubella (MR) vaccine Pneumococcal Conjugate Vaccine (PCV) Tetanus and adult diphtheria (Td) vaccine
• #36: National Leprosy Eradication Programme was introduced in 1983
• #46: HIV- prevalence 2019-23.49%
• #50: ninety-five per cent of the population is still in the low-income category who are extremely vulnerable to health shocks and unexpected out-of-pocket expenditures (at sixty per cent, one of the highest in the world) Distant memory but chronic anaemia and malnutrition among children continue to be recurring problems with the latest Global Hunger Index (GHI, 2019) ranking India at 102 out of 117 nations However, eleven per cent of Sub Health Centres, sixteen per cent of Primary Health Centres and sixteen per cent Community Health Centres suffer from poor infrastructure, understaffing, lack of equipment and medicines (Government of India, 2017a, 2017b) India is a country where bed density is low (less than 0.9 per 1,000 persons as compared to WHO guidelines of three) with perennial doctor shortages plaguing the medical system. India was ranked at 154 of 195 countries on health service delivery index in 2017 (Health in India, 2017)
• #51: Considering the budget allocation made by the Government of India for the health sector, the targets mentioned in the NHP seem overambitious. The expenditure for health in India is one of the lowest in the world at 1.4% of the Gross Domestic Product (GDP). The NHP-2017 aims to increase this to about 2.5%, which again is much less than the required 5-6%. The money allocated for health in the Union Budget 2017, is nowhere near to achieving the target of even 2.5%.
• #52: Considering the budget allocation made by the Government of India for the health sector, the targets mentioned in the NHP seem overambitious. The expenditure for health in India is one of the lowest in the world at 1.4% of the Gross Domestic Product (GDP). The NHP-2017 aims to increase this to about 2.5%, which again is much less than the required 5-6%. The money allocated for health in the Union Budget 2017, is nowhere near to achieving the target of even 2.5%.
• #54: the health policy relies on the same strategies of ‘Janani Surakksha Yojana’ and ‘Janani Shishu Suraksha Karyakram’ for the reduction of maternal and neonatal mortality
• #55: delayed identification of high risk conditions leading to maternal death, delay in reaching the correct health facility for timely action and the delay in managing a complication after reaching the appropriate health facility, are responsible for the high proportion of maternal deaths
• #56: Social development indicators are stronger than many states across the country, which is a reflection of the sustainable development model being followed by Kerala wherein more importance is given to the public and social service sectors. Kerala has made substantial investments in setting up high dependency units in every district and in improving 39 delivery points under the Union Health Ministry’s LaQshya initiative. Second, the Confidential Review of Maternal Deaths (an initiative by the Kerala Health Department since 2004-05) laid the foundation for all maternal health improvement initiatives. This initiative was further strengthened by maternal near-miss audits in all districts, to analyze the critical events which nearly resulted in maternal deaths.  Third, it developed the Quality Standards in Obstetric Care in 2012-13 to focus on the management of some of the common causes of maternal deaths — postpartum hemorrhage (PPH), pregnancy-induced hypertension (PIH), sepsis and amniotic fluid embolism.
• #57: Another target of reducing under five mortality ahead of time can only be achieved when the infant mortality or more specifically neonatal mortality rate is reduced.. The progress in reduction of neo-natal mortality has been slow in our country. However another important contributor to this mortality is the shortcomings in the health delivery system of the country. Improving India’s health system functioning is vital not just for reducing under-five mortality, but also for addressing other health priorities.
• #58: The private sector in the country provides 70% of the health care services, most of which are secondary and tertiary care on one hand the NHP aims to improve the use of public health system in the country by 50% of current levels by the year 2025, at the same time, the government intends to hire services of the private sector in order to bridge the gap. This involvement of the private sector would be for secondary and tertiary care services, besides involving them in providing immunization services, disease surveillance, tissue and organ transplantations and purchase of medical devices from indigenous firms [4]. Such an arrangement raises a question on the quality of services which the private providers would render in the public sector, when their personal interests would lie in their own private concerns. The financial burden on the already starved resources is another matter of concern, as this money can be better utilized in strengthening the public sector infrastructure. Moreover most of the targets enlisted in the policy can be better achieved by strengthening the primary care services of the country. Countries such as Chile, Brazil and Thailand have shifted focus from hospital centric care to primary care in their efforts to achieve universal health care
• #61: The private sector in the country provides 70% of the health care services, most of which are secondary and tertiary care on one hand the NHP aims to improve the use of public health system in the country by 50% of current levels by the year 2025, at the same time, the government intends to hire services of the private sector in order to bridge the gap. This involvement of the private sector would be for secondary and tertiary care services, besides involving them in providing immunization services, disease surveillance, tissue and organ transplantations and purchase of medical devices from indigenous firms [4]. Such an arrangement raises a question on the quality of services which the private providers would render in the public sector, when their personal interests would lie in their own private concerns. The financial burden on the already starved resources is another matter of concern, as this money can be better utilized in strengthening the public sector infrastructure. Moreover most of the targets enlisted in the policy can be better achieved by strengthening the primary care services of the country. Countries such as Chile, Brazil and Thailand have shifted focus from hospital centric care to primary care in their efforts to achieve universal health care
• #62: Out of pocket expenditure as a percentage of current health expenditure Health insurance in the country is available to only 10% of the people [19]. Insurance is either available to the state or the central government employees or those being covered by the Employees State insurance act. In order to provide insurance to poor families, the government has launched the Rashtriya Suraksha Bima Yojana (RSBY) since 2008 for the below poverty line (BPL) families. The scheme provides cashless treatment for the beneficiary with the help of a smart card up to Rs 30,000/ in one year [
• #63: facility is only provided for indoor patients; hence the outpatient department patients still have to bear the expenses out of their own pocket hence the quality of services is compromised. With the expansion of the scheme country wide, the increasing burden of expenditure is to be tackled only with the single source of income, namely taxes Rajiv Arogyasari scheme also provides a cover of two lakhs to BPL families  has been very popular social insurance scheme with a private public partnership model to deal with the problems of catastrophic medical expenditures at tertiary level care for the poor households- mainly for tertiarycare.
• #64: The private sector in the country provides 70% of the health care services, most of which are secondary and tertiary care on one hand the NHP aims to improve the use of public health system in the country by 50% of current levels by the year 2025, at the same time, the government intends to hire services of the private sector in order to bridge the gap. This involvement of the private sector would be for secondary and tertiary care services, besides involving them in providing immunization services, disease surveillance, tissue and organ transplantations and purchase of medical devices from indigenous firms [4]. Such an arrangement raises a question on the quality of services which the private providers would render in the public sector, when their personal interests would lie in their own private concerns. The financial burden on the already starved resources is another matter of concern, as this money can be better utilized in strengthening the public sector infrastructure. Moreover most of the targets enlisted in the policy can be better achieved by strengthening the primary care services of the country. Countries such as Chile, Brazil and Thailand have shifted focus from hospital centric care to primary care in their efforts to achieve universal health care
• #65: The under-five mortality rate is higher in rural areas than in urban areas (46 deaths per 1,000 live births versus 32 deaths per 1,000 live births). The under-five mortality rate is highest in Uttar Pradesh (60 deaths per 1,000 live births) and lowest in Kerala and Puducherry (5 and 4 deaths per 1,000 live births, respectively) The under-five mortality rate for scheduled tribes (50 deaths per 1,000 live births), scheduled castes (49 deaths per 1,000 live births), and other backward classes (41 deaths per 1,000 live births) are considerably higher than for those who are not from scheduled castes, scheduled tribes, or other backward classes (33 deaths per 1,000 live births).  The under-five mortality rate also declines with increasing household wealth. The under-five mortality rate declined from 59 deaths per 1,000 live births in the lowest wealth quintile to 20 deaths per 1,000 live births in the highest wealth quintile. 7.2 BIODEMOGRAPHIC RISK FACTORS Researchers have identified multiple risk factors for infant and child mortality based on the characteristics of the mother and child and the circumstances of the birth. Table 7.3 and Figure 7.3 illustrate the relationship between these risk factors and neonatal, infant, and under-five mortality.  Boys are slightly more likely to die before their fifth birthday than girls. The gender gap is most pronounced in the neonatal period (within one month after birth).  Shorter birth intervals are associated with higher under-five mortality. The under-five mortality rate for children born less than 2 years after the preceding birth is more than twice as high as that for children born 3 years after their preceding sibling.  Children reported to be very small at the time of birth are more than four times as likely to die during the first month of life as children reported to be average size or larger (96 deaths per 1,000 live births versus 20 deaths per 1,000 live births).  Children of birth order seven or more are more than twice as likely to die in the first five years of life than children of the first birth order (Figure 7.3). 109 95 74 50 42 79 68 57 41 35 49 43 39 30 25 NFHS-1 NFHS-2 NFHS-3 NFHS-4 NFHS-5 Under-five mortality Infant mortality Neonatal mortality Figure 7.1 Trends in Early Childhood Mortality Rates Deaths per 1,000 live births in the five-year period before the survey 243  Any method of measuring childhood mortality that relies on the mothers’ reports (i.e., birth histories) assumes that female adult mortality is not high, or if it is high, that there is little or no correlation between the mortality risks of the mothers and those of their children. Selected indicators of the quality of the mortality data on which the estimates of mortality given in this chapter are presented in Appendix E (Tables E.4-E.6). 7.1 INFANT AND CHILD MORTALITY Neonatal mortality: The probability of dying within the first month of life. Postneonatal mortality: The probability of dying between the first month of life and the first birthday (computed as the difference between infant and neonatal mortality). Infant mortality: The probability of dying between birth and the first birthday. Child mortality: The probability of dying between the first and fifth birthday. Under-five mortality: The probability of dying between birth and the fifth birthday. For the five-year period before the 2019-21 NFHS, the neonatal mortality rate was 25 deaths per 1,000 live births. This means that one in 40 live births died during the neonatal period. The infant mortality rate was 35 deaths per 1,000 live births. The under-five mortality rate was 42 deaths per 1,000 live births (Table 7.1 and Figure 7.1). This indicates that one in 24 children in India die before their fifth birthday. More than fourfifths (83%) of these deaths occur during infancy. Trends: The neonatal mortality rate declined from 49 deaths per 1,000 live births in the five years before the 1992-93 NFHS survey to 25 deaths per 1,000 live births in the five years before the 2019-21 NFHS survey. The neonatal mortality rates in the five years before the 1998-99 survey, 2005-06 survey, and the 2015-16 survey were 43, 39, and 30 deaths per 1,000 live births, respectively. The infant mortality rate declined from 79 deaths per 1,000 live births in the five years before the 1992-93 NFHS survey to 35 deaths per 1,000 live births in the five years before the 2019-21 NFHS survey. During the same period, the under-five mortality rate declined from 109 deaths per 1,000 live births to 42 deaths per 1,000 live births. The infant mortality rate decreased by 56 percent over a period of 28 years. The decline in the under-five mortality rate is slightly higher than the decline in the infant mortality rate during this period (a decrease of 62 percent). Patterns by background characteristics  The under-five mortality rate is higher in rural areas than in urban areas (46 deaths per 1,000 live births versus 32 deaths per 1,000 live births).  The under-five mortality rate is highest in Uttar Pradesh (60 deaths per 1,000 live births) and lowest in Kerala and Puducherry (5 and 4 deaths per 1,000 live births, respectively) (Figure 7.2).  The under-five mortality rate declines with an increase in mother’s schooling (Table 7.2).  The under-five mortality rate for scheduled tribes (50 deaths per 1,000 live births), scheduled castes (49 deaths per 1,000 live births), and other backward classes (41 deaths per 1,000 live births) are considerably higher than for those who are not from scheduled castes, scheduled tribes, or other backward classes (33 deaths per 1,000 live births)
• #70: Goals can be ambitious, the objectives to achieve those goals should specific as well as goal oriented.
• #73: The private healthcare system has not been proved reliable during the emergency. Only the public health system is suitable for the country wherein the population’s substantial size is rural and poor
• #74: Under PMJAY, the states that have registered the most hospitalizations are Rajasthan, Gujarat, Jharkhand, Chhattisgarh, and Kerala. However, the irony is that admissions in private hospitals were higher than those in public hospitals. The numbers of hospitals registered/empaneled under the private sector scheme are also higher than in the public sector [65]. The key argument against the PMJAY model is that government funds are being used to subsidize the private health sector, where healthcare expenditures are nearly double or even three times in public hospitals the Ayushman Bharat scheme also has been proving public funds for private benefits because this policy ensures a publicly funded and privately managed health insurance scheme. Though the objective of the scheme is universal health coverage as recommended by NHP-2017.
• #75: 1.Given the privately controlled health infrastructures, India’s health system is not universalistic to deal with the pandemic situation. The adequate availability of public healthcare infrastructures, particularly in hospitals, primary and community health centers, beds, ICUs, ventilators, etc., still has not been congruent to the size of the country’s population 2. healthcare expenditure in India is one of the lowest in the world. The severity of the situation can be best understood by the fact, according to the WHO Expenditure Database 2016, India ranks 170 out of 188 countries in domestic general government spending on health as a percentage of GDP. Now, the question is how the government would achieve these lofty objectives with a mere expenditure of 2.5 percent of GDP? Early diagnosis, effective treatment and preventive measures form the cornerstones in disease containment thereby reducing its rapid spread, high morbidity and economic impact on the health systems Undoubtedly, some of the states in India did very well in containing the spread of COVID-19. However, in the long run, the GOI needs to focus on reshaping the health policy to make India well-prepared for health emergencies like COVID-19.