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 well-dispersed 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 super-speciality 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).

Box-1 : Achievements Through The Years - 1951-2000

Indicator 1951 1981 2000

Demographic Changes      

Life Expectancy 36.7 54 64.6(RGI)

Crude Birth Rate 40.8 33.9(SRS) 26.1(99 SRS)

Crude Death Rate 25 12.5(SRS) 8.7(99 SRS)

IMR 146 110 70 (99 SRS)

Epidemiological Shifts      

Malaria (cases in million) 75 2.7 2.2

Leprosy cases per 10,000 38.1 57.3 3.74

population

Small Pox (no of cases) >44,887 Eradicated  

Guineaworm ( no. of cases)   >39,792 Eradicated

Polio   29709 265

Infrastructure      

SC/PHC/CHC 725 57,363 1,63,181

(99-RHS)

Dispensaries &Hospitals( all) 9209 23,555 43,322 (95–96-

CBHI)

Beds (Pvt & Public) 117,198 569,495 8,70,161

(95-96-CBHI)

Doctors(Allopathy) 61,800 2,68,700 5,03,900

 (98-99-MCI)

Nursing Personnel 18,054 1,43,887 7,37,000

(99-INC)

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 sub-category 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 socio-economic 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.

Box II : Differentials in Health Status Among States

Sector Population IMR/ <5Mort- Weight MMR/ Leprosy Malaria

BPL (%) ality For Age- cases +ve Cases
Per 1000 Lakh per in year
per 1000 % of (Annual 2000 (in
thousands)
Live (NFHS Children Report 10000
Births II) Under 3 2000) popula-
(1999- years tion
SRS)
(<-2SD)

India 26.1 70 94.9 47 408 3.7 2200

Rural 27.09 75 103.7 49.6 - - -

Urban 23.62 44 63.1 38.4 - - -

Better              
Performing
States

Kerala 12.72 14 18.8 27 87 0.9 5.1

Maharashtra 25.02 48 58.1 50 135 3.1 138

 TN 21.12 52 63.3 37 79 4.1 56

Low              
Performing
States

Orissa 47.15 97 104.4 54 498 7.05 483

Bihar 42.60 63 105.1 54 707 11.83 132

Rajasthan 15.28 81 114.9 51 607 0.8 53

UP 31.15 84 122.5 52 707 4.3 99

MP 37.43 90 137.6 55 498 3.83 528

Also, the statistics bring out the wide differences between the attainments of health
goals in the better- performing States as compared to the low-performing States. It is
clear that national averages of health indices hide wide disparities in public health
facilities and health standards in different parts of the country. Given a situation in
which national averages in respect of most indices are themselves at unacceptably low
levels, the wide inter-State disparity implies that, for vulnerable sections of society in
several States, access to public health services is nominal and health standards are
grossly inadequate. Despite a thrust in the NHP-1983 for making good the unmet
needs of public health services by establishing more public health institutions at a
decentralized level, a large gap in facilities still persists. Applying current norms to
the population projected for the year 2000, it is estimated that the shortfall in the
number of SCs/PHCs/CHCs is of the order of 16 percent. However, this shortage is as
high as 58 percent when disaggregated for CHCs only. The NHP-2002 will need to
address itself to making good these deficiencies so as to narrow the gap between the
various States, as also the gap across the rural-urban divide.

2.2.2 Access to, and benefits from, the public health system have been very uneven
between the better-endowed and the more vulnerable sections of society. This is
particularly true for women, children and the socially disadvantaged sections of
society. The statistics given in Box-III highlight the handicap suffered in the health
sector on account of socio-economic inequity.

Box-III : Differentials in Health status Among Socio-Economic Groups

Indicator Infant Under 5 % Children

Mortality/1000 Mortality/1000 Underweight
 India 70 94.9 47

Social Inequity      

Scheduled Castes 83 119.3 53.5

Scheduled Tribes 84.2 126.6 55.9

Other Disadvantaged 76 103.1 47.3

Others 61.8 82.6 41.1

2.2.3 It is a principal objective of NHP-2002 to evolve a policy structure which

reduces these inequities and allows the disadvantaged sections of society a fairer
access to public health services.

2.3 DELIVERY OF NATIONAL PUBLIC HEALTH

PROGRAMMES

2.3.1 It is self-evident that in a country as large as India, which has a wide variety of
socio-economic settings, national health programmes have to be designed with
enough flexibility to permit the State public health administrations to craft their own
programme package according to their needs. Also, the implementation of the national
health programme can only be carried out through the State Governments’
decentralized public health machinery. Since, for various reasons, the responsibility of
the Central Government in funding additional public health services will continue
over a period of time, the role of the Central Government in designing broad-based
public health initiatives will inevitably continue. Moreover, it has been observed that
the technical and managerial expertise for designing large-span public health
programmes exists with the Central Government in a considerable degree; this
expertise can be gainfully utilized in designing national health programmes for
implementation in varying socio-economic settings in the States. With this
background, the NHP-2002 attempts to define the role of the Central Government and
the State Governments in the public health sector of the country.

2.3.2.1 Over the last decade or so, the Government has relied upon a ‘vertical’
implementational structure for the major disease control programmes. Through this,
the system has been able to make a substantial dent in reducing the burden of specific
diseases. However, such an organizational structure, which requires independent
manpower for each disease programme, is extremely expensive and difficult to
sustain. Over a long time-range, ‘vertical’ structures may only be affordable for those
diseases which offer a reasonable possibility of elimination or eradication in a
foreseeable time-span.

2.3.2.2 It is a widespread perception that, over the last decade and a half, the rural
health staff has become a vertical structure exclusively for the implementation of
family welfare activities. As a result, for those public health programmes where there
is no separate vertical structure, there is no identifiable service delivery system at all.
The Policy will address this distortion in the public health system.

2.4 THE STATE OF PUBLIC HEALTH INFRA-STRUCTURE

2.4.1 The delineation of NHP-2002 would be required to be based on an objective

assessment of the quality and efficiency of the existing public health machinery in the
field. It would detract from the quality of the exercise if, while framing a new policy,
it were not acknowledged that the existing public health infrastructure is far from
satisfactory. For the outdoor medical facilities in existence, funding is generally
insufficient; the presence of medical and para-medical personnel is often much less
than that required by prescribed norms; the availability of consumables is frequently
negligible; the equipment in many public hospitals is often obsolescent and unusable;
and, the buildings are in a dilapidated state. In the indoor treatment facilities, again,
the equipment is often obsolescent; the availability of essential drugs is minimal; the
capacity of the facilities is grossly inadequate, which leads to over-crowding, and
consequentially to a steep deterioration in the quality of the services. As a result of
such inadequate public health facilities, it has been estimated that less than 20 percent
of the population, which seek OPD services, and less than 45 percent of that which
seek indoor treatment, avail of such services in public hospitals. This is despite the
fact that most of these patients do not have the means to make out-of-pocket payments
for private health services except at the cost of other essential expenditure for items
such as basic nutrition.

2.5 EXTENDING PUBLIC HEALTH SERVICES

2.5.1 While there is a general shortage of medical personnel in the country, this
shortfall is disproportionately impacted on the less-developed and rural areas. No
incentive system attempted so far, has induced private medical personnel to go to such
areas; and, even in the public health sector, the effort to deploy medical personnel in
such under-served areas, has usually been a losing battle. In such a situation, the
possibility needs to be examined of entrusting some limited public health functions to
nurses, paramedics and other personnel from the extended health sector after
imparting adequate training to them.
2.5.2 India has a vast reservoir of practitioners in the Indian Systems of Medicine and
Homoeopathy, who have undergone formal training in their own disciplines. The
possibility of using such practitioners in the implementation of State/Central
Government public health programmes, in order to increase the reach of basic health
care in the country, is addressed in the NHP-2002.

2.6 ROLE OF LOCAL SELF-GOVERNMENT INSTITUTIONS

2.6.1 Some States have adopted a policy of devolving programmes and funds in the
health sector through different levels of the Panchayati Raj Institutions. Generally, the
experience has been an encouraging one. The adoption of such an organisational
structure has enabled need-based allocation of resources and closer supervision
through the elected representatives. The Policy examines the need for a wider
adoption of this mode of delivery of health services, in rural as well as urban areas, in
other parts of the country.

2.7 NORMS FOR HEALTH CARE PERSONNEL

2.7.1 It is observed that the deployment of doctors and nurses, in both public and
private institutions, is ad-hoc and significantly short of the requirement for minimal
standards of patient care. This policy will make a specific recommendation in regard
to this deficiency.

2.8 EDUCATION OF HEALTH CARE PROFESSIONALS

2.8.1 Medical and Dental Colleges are not evenly spread across various parts of the
country. Apart from the uneven geographical distribution of medical institutions, the
quality of education is highly uneven and in several instances even sub-standard. It is
a common perception that the syllabus is excessively theoretical, making it difficult
for the fresh graduate to effectively meet even the primary health care needs of the
population. There is a general reluctance on the part of graduate doctors to serve in
areas distant from their native place. NHP-2002 will suggest policy initiatives to
rectify the resultant disparities.

2.8.2.1 Certain medical disciplines, such as molecular biology and gene-manipulation,

have become relevant in the period after the formulation of the previous National
Health Policy. The components of medical research in recent years have changed
radically. In the foreseeable future such research will rely increasingly on the new
disciplines. It is observed that the current under-graduate medical syllabus does not
cover such emerging subjects. The Policy will make appropriate recommendations in
respect of such deficiencies.

2.8.2.2 Also, certain speciality disciplines – Anesthesiology, Radiology and Forensic

Medicine – are currently very scarce, resulting in critical deficiencies in the package
of available public health services. This Policy will recommend some measures to
alleviate such critical shortages.

2.9 NEED FOR SPECIALISTS IN ‘PUBLIC HEALTH’ AND

‘FAMILY MEDICINE’

2.9.1 In any developing country with inadequate availability of health services, the
requirement of expertise in the areas of ‘public health’ and ‘family medicine’ is
markedly more than the expertise required for other clinical specialities. In India, the
situation is that public health expertise is non-existent in the private health sector, and
far short of requirement in the public health sector. Also, the current curriculum in the
graduate / post-graduate courses is outdated and unrelated to contemporary
community needs. In respect of ‘family medicine’, it needs to be noted that the more
talented medical graduates generally seek specialization in clinical disciplines, while
the remaining go into general practice. While the availability of postgraduate
educational facilities is 50 percent of the total number of qualifying graduates each
year, and can be considered adequate, the distribution of the disciplines in the
postgraduate training facilities is overwhelmingly in favour of clinical specializations.
NHP-2002 examines the possible means for ensuring adequate availability of
personnel with specialization in the ‘public health’ and ‘family medicine’ disciplines,
to discharge the public health responsibilities in the country.

2.10 Nursing Personnel

2.10.1 The ratio of nursing personnel in the country vis-à-vis doctors/beds is very low
according to professionally accepted norms. There is also an acute shortage of nurses
trained in super-speciality disciplines for deployment in tertiary care facilities. NHP-
2002 addresses these problems.

2.11 USE OF GENERIC DRUGS AND VACCINES

2.11.1 India enjoys a relatively low-cost health care system because of the widespread
availability of indigenously manufactured generic drugs and vaccines. There is an
apprehension that globalization will lead to an increase in the costs of drugs, thereby
leading to rising trends in overall health costs. This Policy recommends measures to
ensure the future Health Security of the country.

2.12 URBAN HEALTH

2.12.1.1 In most urban areas, public health services are very meagre. To the extent
that such services exist, there is no uniform organizational structure. The urban
population in the country is presently as high as 30 percent and is likely to go up to
around 33 percent by 2010. The bulk of the increase is likely to take place through
migration, resulting in slums without any infrastructure support. Even the meagre
public health services which are available do not percolate to such unplanned
habitations, forcing people to avail of private health care through out-of-pocket
expenditure.

2.12.1.2 The rising vehicle density in large urban agglomerations has also led to an
increased number of serious accidents requiring treatment in well-equipped trauma
centres. NHP-2002 will address itself to the need for providing this unserved urban
population a minimum standard of broad-based health care facilities.

2.13 MENTAL HEALTH

2.13.1 Mental health disorders are actually much more prevalent than is apparent on
the surface. While such disorders do not contribute significantly to mortality, they
have a serious bearing on the quality of life of the affected persons and their families.
Sometimes, based on religious faith, mental disorders are treated as spiritual affliction.
This has led to the establishment of unlicensed mental institutions as an adjunct to
religious institutions where reliance is placed on faith cure. Serious conditions of
mental disorder require hospitalization and treatment under trained supervision.
Mental health institutions are woefully deficient in physical infrastructure and trained
manpower. NHP-2002 will address itself to these deficiencies in the public health
sector.

2.14 INFORMATION, EDUCATION AND COMMUNICATION

2.14.1 A substantial component of primary health care consists of initiatives for

disseminating to the citizenry, public health-related information. IEC initiatives are
adopted not only for disseminating curative guidelines (for the TB, Malaria, Leprosy,
Cataract Blindness Programmes), but also as part of the effort to bring about a
behavioural change to prevent HIV/AIDS and other life-style diseases. Public health
programmes, particularly, need high visibility at the decentralized level in order to
have an impact. This task is difficult as 35 percent of our country’s population is
illiterate. The present IEC strategy is too fragmented, relies too heavily on the mass
media and does not address the needs of this segment of the population. It is often felt
that the effectiveness of IEC programmes is difficult to judge; and consequently it is
often asserted that accountability, in regard to the productive use of such funds, is
doubtful. The Policy, while projecting an IEC strategy, will fully address the inherent
problems encountered in any IEC programme designed for improving awareness and
bringing about a behavioural change in the general population.

2.14.2 It is widely accepted that school and college students are the most
impressionable targets for imparting information relating to the basic principles of
preventive health care. The policy will attempt to target this group to improve the
general level of awareness in regard to ‘health-promoting’ behaviour.

2.15 HEALTH RESEARCH

2.15.1 Over the years, health research activity in the country has been very limited. In
the Government sector, such research has been confined to the research institutions
under the Indian Council of Medical Research, and other institutions funded by the
States/Central Government. Research in the private sector has assumed some
significance only in the last decade. In our country, where the aggregate annual health
expenditure is of the order of Rs. 80,000 crores, the expenditure in 1998-99 on
research, both public and private sectors, was only of the order of Rs. 1150 crores. It
would be reasonable to infer that with such low research expenditure, it is virtually
impossible to make any dramatic break-through within the country, by way of new
molecules and vaccines; also, without a minimal back-up of applied and operational
research, it would be difficult to assess whether the health expenditure in the country
is being incurred through optimal applications and appropriate public health
strategies. Medical Research in the country needs to be focused on therapeutic
drugs/vaccines for tropical diseases, which are normally neglected by international
pharmaceutical companies on account of their limited profitability potential. The
thrust will need to be in the newly-emerging frontier areas of research based on
genetics, genome-based drug and vaccine development, molecular biology, etc. NHP-
2002 will address these inadequacies and spell out a minimal quantum of expenditure
for the coming decade, looking to the national needs and the capacity of the research
institutions to absorb the funds.

2.16 ROLE OF THE PRIVATE SECTOR

2.16.1 Considering the economic restructuring under way in the country, and over the
globe, in the last decade, the changing role of the private sector in providing health
care will also have to be addressed in this Policy. Currently, the contribution of
private health care is principally through independent practitioners. Also, the private
sector contributes significantly to secondary-level care and some tertiary care. It is a
widespread perception that private health services are very uneven in quality,
sometimes even sub-standard. Private health services are also perceived to be
financially exploitative, and the observance of professional ethics is noted only as an
exception. With the increasing role of private health care, the implementation of
statutory regulation, and the monitoring of minimum standards of diagnostic centres /
medical institutions becomes imperative. The Policy will address the issues regarding
the establishment of a comprehensive information system, and based on that the
establishment of a regulatory mechanism to ensure the maintaining of adequate
standards by diagnostic centres / medical institutions, as well as the proper conduct of
clinical practice and delivery of medical services.

2.16.2 Currently, non-Governmental service providers are treating a large number of

patients at the primary level for major diseases. However, the treatment regimens
followed are diverse and not scientifically optimal, leading to an increase in the
incidence of drug resistance. This policy will address itself to recommending
arrangements which will eliminate the risks arising from inappropriate treatment.

2.16.3 The increasing spread of information technology raises the possibility of its
adoption in the health sector. NHP-2002 will examine this possibility.

2.17 THE ROLE OF CIVIL SOCIETY

2.17.1 Historically, it has been the practice to implement major national disease
control programmes through the public health machinery of the State/Central
Governments. It has become increasingly apparent that certain components of such
programmes cannot be efficiently implemented merely through government
functionaries. A considerable change in the mode of implementation has come about
in the last two decades, with the increasing involvement of NGOs and other
institutions of civil society. It is to be recognized that widespread debate on various
public health issues has, in fact, been initiated and sustained by NGOs and other
members of the civil society. Also, an increasing contribution is being made by such
institutions in the delivery of different components of public health services. Certain
disease control programmes require close inter-action with the beneficiaries for
regular administration of drugs; periodic carrying out of pathological tests;
dissemination of information regarding disease control and other general health
information. NHP-2002 will address such issues and suggest policy instruments for
the implementation of public health programmes through individuals and institutions
of civil society.

2.18 NATIONAL DISEASE SURVEILLANCE NETWORK

2.18.1 The technical network available in the country for disease surveillance is
extremely rudimentary and to the extent that the system exists, it extends only up to
the district level. Disease statistics are not flowing through an integrated network from
the decentralized public health facilities to the State/Central Government health
administration. Such an arrangement only provides belated information, which, at
best, serves a limited statistical purpose. The absence of an efficient disease
surveillance network is a major handicap in providing a prompt and cost-effective
health care system. The efficient disease surveillance network set up for Polio and
HIV/AIDS has demonstrated the enormous value of such a public health instrument.
Real-time information on focal outbreaks of common communicable diseases –
Malaria, GE, Cholera and JE – and the seasonal trends of diseases, would enable
timely intervention, resulting in the containment of the thrust of epidemics. In order to
be able to use an integrated disease surveillance network for operational purposes,
real-time information is necessary at all levels of the health administration. The Policy
would address itself to this major systemic shortcoming in the administration.

2.19 HEALTH STATISTICS

2.19.1 The absence of a systematic and scientific health statistics data-base is a major
deficiency in the current scenario. The health statistics collected are not the product of
a rigorous methodology. Statistics available from different parts of the country, in
respect of major diseases, are often not obtained in a manner which make aggregation
possible or meaningful.

2.19.2.1 Further, the absence of proper and systematic documentation of the various
financial resources used in the health sector is another lacuna in the existing health
information scenario. This makes it difficult to understand trends and levels of health
spending by private and public providers of health care in the country, and,
consequently, to address related policy issues and to formulate future investment
policies.

2.19.2.2 NHP-2002 will address itself to the programme for putting in place a modern
and scientific health statistics database as well as a system of national health accounts.

2.20 WOMEN’S HEALTH

2.20.1 Social, cultural and economic factors continue to inhibit women from gaining
adequate access even to the existing public health facilities. This handicap does not
merely affect women as individuals; it also has an adverse impact on the health,
general well-being and development of the entire family, particularly children. This
policy recognises the catalytic role of empowered women in improving the overall
health standards of the community.
2.21 MEDICAL ETHICS

2.21.1 Professional medical ethics in the health sector is an area which has not
received much attention. Professional practices are perceived to be grossly
commercial and the medical profession has lost its elevated position as a provider of
basic services to fellow human beings. In the past, medical research has been
conducted within the ethical guidelines notified by the Indian Council of Medical
Research. The first document containing these guidelines was released in 1960, and
was comprehensively revised in 2001. With the rapid developments in the approach to
medical research, a periodic revision will no doubt be more frequently required in
future. Also, the new frontier areas of research – involving gene manipulation,
organ/human cloning and stem cell research _ impinge on visceral issues relating to
the sanctity of human life and the moral dilemma of human intervention in the
designing of life forms. Besides this, in the emerging areas of research, there is the
uncharted risk of creating new life forms, which may irreversibly damage the
environment as it exists today. NHP – 2002 recognises that this moral and religious
dilemma, which was not relevant even two years ago, now pervades mainstream
health sector issues.

2.22 ENFORCEMENT OF QUALITY STANDARDS FOR FOOD

AND DRUGS

2.22.1 There is an increasing expectation and need of the citizenry for efficient
enforcement of reasonable quality standards for food and drugs. Recognizing this, the
Policy will make an appropriate policy recommendation on this issue.

2.23 REGULATION OF STANDARDS IN PARA MEDICAL

DISCIPLINES

2.23.1 It has been observed that a large number of training institutions have
mushroomed, particularly in the private sector, for para medical personnel with
various skills – Lab Technicians, Radio Diagnosis Technicians, Physiotherapists, etc.
Currently, there is no regulation/monitoring, either of the curriculae of these
institutions, or of the performance of the practitioners in these disciplines. This Policy
will make recommendations to ensure the standardization of such training and the
monitoring of actual performance.

2.24 ENVIRONMENTAL AND OCCUPATIONAL HEALTH

2.24.1 The ambient environmental conditions are a significant determinant of the
health risks to which a community is exposed. Unsafe drinking water, unhygienic
sanitation and air pollution significantly contribute to the burden of disease,
particularly in urban settings. The initiatives in respect of these environmental factors
are conventionally undertaken by the participants, whether private or public, in the
other development sectors. In this backdrop, the Policy initiatives, and the efficient
implementation of the linked programmes in the health sector, would succeed only to
the extent that they are complemented by appropriate policies and programmes in the
other environment-related sectors.

2.24.2 Work conditions in several sectors of employment in the country are sub-
standard. As a result, workers engaged in such employment become particularly
vulnerable to occupation-linked ailments. The long-term risk of chronic morbidity is
particularly marked in the case of child labour. NHP-2002 will address the risk faced
by this particularly vulnerable section of society.

2.25 PROVIDING MEDICAL FACILITIES TO USERS FROM

OVERSEAS

2.25.1 The secondary and tertiary facilities available in the country are of good quality
and cost-effective compared to international medical facilities. This is true not only of
facilities in the allopathic disciplines, but also of those belonging to the alternative
systems of medicine, particularly Ayurveda. The Policy will assess the possibilities of
encouraging the development of paid treatment-packages for patients from overseas.

2.26 THE IMPACT OF GLOBALIZATION ON THE HEALTH SECTOR

2.26.1 There are some apprehensions about the possible adverse impact of economic
globalisation on the health sector. Pharmaceutical drugs and other health services have
always been available in the country at extremely inexpensive prices. India has
established a reputation around the globe for the innovative development of original
process patents for the manufacture of a wide-range of drugs and vaccines within the
ambit of the existing patent laws. With the adoption of Trade Related Intellectual
Property Rights (TRIPS), and the subsequent alignment of domestic patent laws
consistent with the commitments under TRIPS, there will be a significant shift in the
scope of the parameters regulating the manufacture of new drugs/vaccines. Global
experience has shown that the introduction of a TRIPS-consistent patent regime for
drugs in a developing country results in an across-the-board increase in the cost of
drugs and medical services. NHP-2002 will address itself to the future imperatives of
health security in the country, in the post-TRIPS era.
2.27 INTER-SECTORAL CONTRIBUTION TO HEALTH

2.27.1 It is well recognized that the overall well-being of the citizenry depends on the
synergistic functioning of the various sectors in the socio-economy. The health status
of the citizenry would, inter alia, be dependent on adequate nutrition, safe drinking
water, basic sanitation, a clean environment and primary education, especially for the
girl child. The policies and the mode of functioning in these independent areas would
necessarily overlap each other to contribute to the health status of the community.
From the policy perspective, it is therefore imperative that the independent policies of
each of these inter-connected sectors, be in tandem, and that the interface between the
policies of the two connected sectors, be smooth.

2.27.2 Sectoral policy documents are meant to serve as a guide to action for
institutions and individual participants operating in that sector. Consistent with this
role, NHP-2002 limits itself to making recommendations for the participants operating
within the health sector. The policy aspects relating to inter-connected sectors, which,
while crucial, fall outside the domain of the health sector, will not be covered by
specific recommendations in this Policy document. Needless to say, the future
attainment of the various goals set out in this policy assumes a reasonable
complementary performance in these inter-connected sectors.

2.28 POPULATION GROWTH AND HEALTH STANDARDS

2.28.1 Efforts made over the years for improving health standards have been partially
neutralized by the rapid growth of the population. It is well recognized that population
stabilization measures and general health initiatives, when effectively synchronized,
synergistically maximize the socio-economic well-being of the people. Government
has separately announced the `National Population Policy – 2000’. The principal
common features covered under the National Population Policy-2000 and NHP-2002,
relate to the prevention and control of communicable diseases; giving priority to the
containment of HIV/AIDS infection; the universal immunization of children against
all major preventable diseases; addressing the unmet needs for basic and reproductive
health services, and supplementation of infrastructure. The synchronized
implementation of these two Policies – National Population Policy – 2000 and
National Health Policy-2002 – will be the very cornerstone of any national structural
plan to improve the health standards in the country.

2.29 ALTERNATIVE SYSTEMS OF MEDICINE

2.29.1 Under the overarching umbrella of the national health frame work, the
alternative systems of medicine – Ayurveda, Unani, Siddha and Homoeopathy – have
a substantial role. Because of inherent advantages, such as diversity, modest cost, low
level of technological input and the growing popularity of natural plant-based
products, these systems are attractive, particularly in the underserved, remote and
tribal areas. The alternative systems will draw upon the substantial untapped potential
of India as one of the eight important global centers for plant diversity in medicinal
and aromatic plants. The Policy focuses on building up credibility for the alternative
systems, by encouraging evidence-based research to determine their efficacy, safety
and dosage, and also encourages certification and quality-marking of products to
enable a wider popular acceptance of these systems of medicine. The Policy also
envisages the consolidation of documentary knowledge contained in these systems to
protect it against attack from foreign commercial entities by way of malafide action
under patent laws in other countries. The main components of NHP-2002 apply
equally to the alternative systems of medicines. However, the Policy features specific
to the alternative systems of medicine will be presented as a separate document.

3. OBJECTIVES

3.1 The main objective of this policy is to achieve an acceptable standard of good
health amongst the general population of the country. The approach would be to
increase access to the decentralized public health system by establishing new
infrastructure in deficient areas, and by upgrading the infrastructure in the existing
institutions. Overriding importance would be given to ensuring a more equitable
access to health services across the social and geographical expanse of the country.
Emphasis will be given to increasing the aggregate public health investment through a
substantially increased contribution by the Central Government. It is expected that this
initiative will strengthen the capacity of the public health administration at the State
level to render effective service delivery. The contribution of the private sector in
providing health services would be much enhanced, particularly for the population
group which can afford to pay for services. Primacy will be given to preventive and
first-line curative initiatives at the primary health level through increased sectoral
share of allocation. Emphasis will be laid on rational use of drugs within the
allopathic system. Increased access to tried and tested systems of traditional medicine
will be ensured. Within these broad objectives, NHP-2002 will endeavour to achieve
the time-bound goals mentioned in Box-IV.
Box-IV: Goals to be achieved by 2000-2015

Eradicate Polio and Yaws 2005

Eliminate Leprosy 2005

Eliminate Kala Azar 2010

Eliminate Lymphatic Filariasis 2015

Achieve Zero level growth of HIV/AIDS 2007

Reduce Mortality by 50% on account of TB, Malaria and 2010

Other Vector and Water Borne diseases

Reduce Prevalence of Blindness to 0.5% 2010

Reduce IMR to 30/1000 And MMR to 100/Lakh 2010

Increase utilization of public health facilities from current 2010

Level of <20 to >75%

Establish an integrated system of surveillance, National Health 2005

Accounts and Health Statistics.

Increase health expenditure by Government as a % of GDP 2010

from the existing 0.9 % to 2.0%

Increase share of Central grants to Constitute at least 25% of 2010

total health spending

Increase State Sector Health spending from 5.5% to 7% of the 2005

budget
2010
Further increase to 8%

4. NHP-2002 - POLICY PRESCRIPTIONS

4.1 FINANCIAL RESOURCES

4.1.1 The paucity of public health investment is a stark reality. Given the extremely
difficult fiscal position of the State Governments, the Central Government will have
to play a key role in augmenting public health investments. Taking into account the
gap in health care facilities, it is planned, under the policy to increase health sector
expenditure to 6 percent of GDP, with 2 percent of GDP being contributed as public
health investment, by the year 2010. The State Governments would also need to
increase the commitment to the health sector. In the first phase, by 2005, they would
be expected to increase the commitment of their resources to 7 percent of the Budget;
and, in the second phase, by 2010, to increase it to 8 percent of the Budget. 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. The provisioning of
higher public health investments will also be contingent upon the increase in the
absorptive capacity of the public health administration so as to utilize the funds
gainfully.

4.2 EQUITY

4.2.1 To meet the objective of reducing various types of inequities and imbalances –
inter-regional; across the rural – urban divide; and between economic classes – the
most cost-effective method would be to increase the sectoral outlay in the primary
health sector. Such outlets afford access to a vast number of individuals, and also
facilitate preventive and early stage curative initiative, which are cost effective. In
recognition of this public health principle, NHP-2002 sets out 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. The Policy projects that the increased aggregate outlays for the primary
health sector will be utilized for strengthening existing facilities and opening
additional public health service outlets, consistent with the norms for such facilities.

4.3 DELIVERY OF NATIONAL PUBLIC HEALTH PROGRAMMES

4.3.1.1 This policy envisages a key role for the Central Government in designing
national programmes with the active participation of the State Governments. Also, the
Policy ensures the provisioning of financial resources, in addition to technical support,
monitoring and evaluation at the national level by the Centre. However, to optimize
the utilization of the public health infrastructure at the primary level, NHP-2002
envisages 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 RCH and Universal Immunization Programmes, would need to
be continued till moderate levels of prevalence are reached. The integration of the
programmes will bring about a desirable optimisation of outcomes through a
convergence of all public health inputs. The Policy also envisages that programme
implementation be effected through autonomous bodies at State and district levels.
The interventions of State Health Departments may be limited to the overall
monitoring of the achievement of programme targets and other technical aspects. The
relative distancing of the programme implementation from the State Health
Departments will give the project team greater operational flexibility. Also, the
presence of State Government officials, social activists, private health professionals
and MLAs/MPs on the management boards of the autonomous bodies will facilitate
well-informed decision-making.

4.3.1.2 The Policy also highlights the need for developing the capacity within the
State Public Health administration for scientific designing of public health projects,
suited to the local situation.

4.3.2 The Policy envisages that apart from the exclusive staff in a vertical structure for
the disease control programmes, 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 reoriented.

4.4 THE STATE OF PUBLIC HEALTH INFRASTRUCTURE

4.4.1.1 As has been highlighted in the earlier part of the Policy, the decentralized
Public health service outlets have become practically dysfunctional over large parts of
the country. On account of resource constraints, the supply of drugs by the State
Governments is grossly inadequate. The patients at the decentralized level have little
use for diagnostic services, which in any case would still require them to purchase
therapeutic drugs privately. In a situation in which the patient is not getting any
therapeutic drugs, there is little incentive for the potential beneficiaries to seek the
advice of the medical professionals in the public health system. This results in there
being no demand for medical services, so medical professionals and paramedics often
absent themselves from their place of duty. It is also observed that the functioning of
the public health service outlets in some States like the four Southern States – Kerala,
Andhra Pradesh, Tamil Nadu and Karnataka – is relatively better, because some
quantum of drugs is distributed through the primary health system network, and the
patients have a stake in approaching the Public Health facilities. In this backdrop, 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. It is expected that the provisioning of essential drugs at the public
health service centres will create a demand for other professional services from the
local population, which, in turn, will boost the general revival of activities in these
service centres. In sum, this initiative under NHP-2002 is launched in the belief that
the creation of a beneficiary interest in the public health system, will ensure a more
effective supervision of the public health personnel through community monitoring,
than has been achieved through the regular administrative line of control.

4.4.1.2 This Policy recognizes the need for more frequent in-service training of public
health medical personnel, at the level of medical officers as well as paramedics. Such
training would help to update the personnel on recent advancements in science, and
would also equip them for their new assignments, when they are moved from one
discipline of public health administration to another.

4.4.1.3 Global experience has shown that the quality of public health services, as
reflected in the attainment of improved public health indices, is closely linked to the
quantum and quality of investment through public funding in the primary health
sector. Box-V gives statistics which clearly show that standards of health are more a
function of the accurate targeting of expenditure on the decentralised primary sector
(as observed in China and Sri Lanka), than a function of the aggregate health
expenditure.

Box-V: Public Health Spending in select Countries

Indicator %Population Infant %Health %Public

with income of Mortality Expenditure to Expenditure on
<$1 day Rate/1000 GDP Health to Total
Health
Expenditure

India 44.2 70 5.2 17.3

China 18.5 31 2.7 24.9

Sri Lanka 6.6 16 3 45.4

UK - 6 5.8 96.9

USA - 7 13.7 44.1

Therefore the Policy, while committing additional aggregate financial resources,

places great reliance on the strengthening of the primary health structure for the
attaining of improved public health outcomes on an equitable basis. Further, it also
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.

4.5 EXTENDING PUBLIC HEALTH SERVICES

4.5.1.1 This policy envisages that, in the context of the availability and spread of
allopathic graduates in their jurisdiction, 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. Simple services/procedures can be provided by such practitioners even
outside their disciplines, as part of the basic primary health services in under-served
areas. Also, NHP-2002 envisages that the 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. These extended areas of functioning of different categories of
medical manpower can be permitted, after adequate training, and subject to the
monitoring of their performance through professional councils.

4.5.1.2 NHP-2002 also recognizes the need for States to simplify the recruitment
procedures and rules for contract employment in order to provide trained medical
manpower in under-served areas. State Governments could also rigorously enforce a
mandatory two-year rural posting before the awarding of the graduate degree. This
would not only make trained medical manpower available in the underserved areas,
but would offer valuable clinical experience to the graduating doctors.

4.6 ROLE OF LOCAL SELF-GOVERNMENT INSTITUTIONS

4.6.1 NHP-2002 lays great emphasis upon the implementation of public health
programmes through local self-government institutions. The structure of the national
disease control programmes will have specific components for implementation
through such entities. The Policy urges 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.

4.7 NORMS FOR HEALTH CARE PERSONNEL

4.7.1 Minimal statutory norms for the deployment of doctors and nurses in medical
institutions need to be introduced urgently under the provisions of the Indian Medical
Council Act and Indian Nursing Council Act, respectively. These norms can be
progressively reviewed and made more stringent as the medical institutions improve
their capacity for meeting better normative standards.

4.8 EDUCATION OF HEALTH CARE PROFESSIONALS

4.8.1.1 In order to ameliorate the problems being faced on account of the uneven
spread of medical and dental colleges in various parts of the country, this policy
envisages the setting up of a Medical Grants Commission for funding new
Government Medical and Dental Colleges in different parts of the country. Also, it is
envisaged that the Medical Grants Commission will fund the upgradation of the
infrastructure of the existing Government Medical and Dental Colleges of the country,
so as to ensure an improved standard of medical education.

4.8.1.2 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. The Policy also recommends a periodic skill-updating
of working health professionals through a system of continuing medical education.

4.8.2 The Policy emphasises the need to expose medical students, through the
undergraduate syllabus, to the emerging concerns for geriatric disorders, as also to the
cutting edge disciplines of contemporary medical research. The policy also envisages
that the creation of additional seats for post-graduate courses should reflect the need
for more manpower in the deficient specialities.

4.9 NEED FOR SPECIALISTS IN ‘PUBLIC HEALTH’ AND ‘FAMILY

MEDICINE’

4.9.1 In order to alleviate the acute shortage of medical personnel with specialization
in the disciplines of ‘public health’ and ‘family medicine’, the Policy envisages the
progressive implementation of mandatory norms to raise the proportion of
postgraduate seats in these discipline in medical training institutions, to reach a stage
wherein ¼ th of the seats are earmarked for these disciplines. It is envisaged that in the
sanctioning of post-graduate seats in future, it shall be insisted upon that a certain
reasonable number of seats be allocated to `public health’ and `family medicine’.
Since the `public health’ discipline has an interface with many other developmental
sectors, specialization in Public health may be encouraged not only for medical
doctors, but also for non-medical graduates from the allied fields of public health
engineering, microbiology and other natural sciences.
 

4.10 NURSING PERSONNEL

4.10.1.1 In the interest of patient care, the policy emphasizes the need for an
improvement in the ratio of nurses vis-à-vis doctors/beds. In order to discharge their
responsibility as model providers of health services, the public health delivery centres
need to make a beginning by increasing the number of nursing personnel. The Policy
anticipates that with the increasing aspiration for improved health care amongst the
citizens, private health facilities will also improve their ratio of nursing personnel vis-
à-vis doctors/beds.

4.10.1.2 The Policy lays emphasis on improving the skill -level of nurses, and on
increasing the ratio of degree- holding nurses vis-à-vis diploma-holding nurses. NHP-
2002 recognizes a need for the Central Government to subsidize the setting up, and
the running of, training facilities for nurses on a decentralized basis. Also, the Policy
recognizes the need for establishing training courses for super-speciality nurses
required for tertiary care institutions.

4.11 USE OF GENERIC DRUGS AND VACCINES

4.11.1.1 This 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.
This is a pre-requisite for cost-effective public health care. In the public health
system, this would be enforced by prohibiting the use of proprietary drugs, except in
special circumstances. The list of essential drugs would no doubt have to be reviewed
periodically. To encourage the use of only essential drugs in the private sector, the
imposition of fiscal disincentives would be resorted to. The production and sale of
irrational combinations of drugs would be prohibited through the drug standards
statute.

4.11.1.2 The National Programme for Universal Immunization against Preventable

Diseases requires to be assured of an uninterrupted supply of vaccines at an affordable
price. To minimize the danger arising from the volatility of the global market, and
thereby to ensure long-term national health security, NHP-2002 envisages that not less
than 50% of the requirement of vaccines/sera be sourced from public sector
institutions.

4.12 URBAN HEALTH

4.12.1.1 NHP-2002 envisages the setting up of an organised urban primary health care
structure. Since the physical features of urban settings are different from those in rural
areas, the policy envisages the adoption of appropriate population norms for the urban
public health infrastructure. The structure conceived under NHP-2002 is a two-tiered
one: the primary centre is seen as the first-tier, covering a population of one lakh, with
a dispensary providing an OPD facility and essential drugs, to enable access to all the
national health programmes; and a second-tier of the urban health organisation at the
level of the Government general hospital, where reference is made from the primary
centre. The Policy envisages that the funding for the urban primary health system will
be jointly borne by the local self-government institutions and State and Central
Governments.

4.12.1. 2 The Policy also envisages the establishment of fully-equipped ‘hub-spoke’

trauma care networks in large urban agglomerations to reduce accident mortality.

4.13 MENTAL HEALTH

4.13.1.1. NHP – 2002 envisages a network of decentralised mental health services for
ameliorating the more common categories of disorders. The programme outline for
such a disease would involve the diagnosis of common disorders, and the prescription
of common therapeutic drugs, by general duty medical staff.

4.13.1. 2 In regard to mental health institutions for in-door treatment of patients, the
Policy envisages the upgrading of the physical infrastructure of such institutions at
Central Government expense so as to secure the human rights of this vulnerable
segment of society.

4.14 INFORMATION, EDUCATION AND COMMUNICATION

4.14.1 NHP-2002 envisages an IEC policy, which maximizes the dissemination of

information to those population groups which cannot be effectively approached by
using only the mass media. The focus would therefore be on the inter-personal
communication of information and on folk and other traditional media to bring about
behavioural change. The IEC programme would set specific targets for the association
of PRIs/NGOs/Trusts in such activities. In several public health programmes, where
behavioural change is an essential component, the success of the initiatives is
crucially dependent on dispelling myths and misconceptions pertaining to religious
and ethical issues. The community leaders, particularly religious leaders, are effective
in imparting knowledge which facilitates such 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. The Central/State Government initiative will also focus on the development of
modules for information dissemination in such population groups, who do not
normally benefit from the more common media forms.
4.14.2 NHP-2002 envisages 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. The school health programmes can
gainfully adopt specially designed modules in order to disseminate information
relating to ‘health’ and ‘family life’. This is expected to 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.

4.15 HEALTH RESEARCH

4.15.1 This Policy envisages an increase in Government-funded health research to a

level of 1 percent of the total health spending by 2005; and thereafter, up to 2 percent
by 2010. Domestic medical research would be focused on new therapeutic drugs and
vaccines for tropical diseases, such as TB and Malaria, as also on the sub-types of
HIV/AIDS prevalent in the country. Research programmes taken up by the
Government in these priority areas would be conducted in a mission mode. Emphasis
would also be laid on time-bound applied research for developing operational
applications. This would ensure the cost-effective dissemination of existing / future
therapeutic drugs/vaccines in the general population. Private entrepreneurship will be
encouraged in the field of medical research for new molecules / vaccines, inter alia,
through fiscal incentives.

4.16 ROLE OF THE PRIVATE SECTOR

4.16.1.1 In principle, this Policy welcomes the participation of the private sector in all
areas of health activities – primary, secondary or tertiary. However, looking to past
experience of the private sector, it can reasonably be expected that its contribution
would be substantial in the urban primary sector and the tertiary sector, and moderate
in the secondary sector. This Policy envisages the enactment of suitable legislation for
regulating minimum infrastructure and quality standards in clinical
establishments/medical institutions by 2003. Also, statutory guidelines for the conduct
of clinical practice and delivery of medical services are targeted to be developed over
the same period. With the acquiring of experience in the setting and enforcing of
minimum quality standards, the Policy envisages graduation to a scheme of quality
accreditation of clinical establishments/medical institutions, for the information of the
citizenry. The regulatory/accreditation mechanisms will no doubt also cover public
health institutions. The Policy also encourages the setting up of private insurance
instruments for increasing the scope of the coverage of the secondary and tertiary
sector under private health insurance packages.

4.16.1.2 In the context of the very large number of poor in the country, it would be
difficult to conceive of an exclusive Government mechanism to provide health
services to this category. It has sometimes been felt that a social health insurance
scheme, funded by the Government, and with service delivery through the private
sector, would be the appropriate solution. The administrative and financial
implications of such an initiative are still unknown. 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. The results obtained from these pilot projects would
provide material on which future public health policy can be based.

4.16.2 NHP-2002 envisages the co-option of the non-governmental practitioners in the

national disease control programmes so as to ensure that standard treatment protocols
are followed in their day-to-day practice.

4.16.3 This Policy recognizes the immense potential of information technology

applications in the area of tele-medicine in the tertiary health care sector. The use of
this technical aid will greatly enhance the capacity for the professionals to pool their
clinical experience.

4.17 THE ROLE OF CIVIL SOCIETY

4.17.1 NHP-2002 recognizes the significant contribution made by NGOs and other
institutions of the civil society in making available health services to the community.
In order to utilize their high motivational skills on an increasing scale, this Policy
envisages that the disease control programmes should earmark not less than 10% of
the budget in respect of identified programme components, to be exclusively
implemented through these institutions. The policy also emphasizes the need to
simplify procedures for government – civil society interfacing in order to enhance the
involvement of civil society in public health programmes. In principle, 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.

4.18 NATIONAL DISEASE SURVEILLANCE NETWORK

4.18.1 This Policy envisages the 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. This
public health surveillance network will also encompass information from private
health care institutions and practitioners. It is expected that 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.

4.19 HEALTH STATISTICS

4.19.1.1 The Policy envisages the completion of baseline estimates for the incidence
of the common diseases – TB, Malaria, Blindness – by 2005. The Policy proposes that
statistical methods be put in place to enable the periodic updating of these baseline
estimates through representative sampling, under an appropriate statistical
methodology. The policy also recognizes the need to establish, in a longer time-frame,
baseline estimates for non-communicable diseases, like CVD, Cancer, Diabetes; and
accidental injuries, and communicable diseases, like Hepatitis and JE. NHP-2002
envisages that, with access to such reliable data on the incidence of various diseases,
the public health system would move closer to the objective of evidence-based policy-
making.

4.19.1.2 Planning for the health sector requires a robust information system, inter-alia,
covering data on service facilities available in the private sector. NHP-2002
emphasises the need for the early completion of an accurate data-base of this kind.

4.19.2 In an attempt at consolidating the data base and graduating from a mere
estimation of the annual health expenditure, NHP-2002 emphasises the need to
establish national health accounts, conforming to the `source-to-users’ matrix
structure. Also, the policy envisages the 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.

4.20 WOMEN’S HEALTH

4.20.1 NHP-2002 envisages the identification of specific programmes targeted at

women’s health. The Policy notes that women, along with other under-privileged
groups, are significantly handicapped due to a disproportionately low access to health
care. The various Policy recommendations of NHP-2002, in regard to the expansion
of primary health sector infrastructure, will facilitate the increased access of women to
basic health care. The Policy commits the highest priority of the Central Government
to the funding of the identified programmes relating to woman’s health. Also, the
policy recognizes the need to review the staffing norms of the public health
administration to meet the specific requirements of women in a more comprehensive
manner.

4.21 MEDICAL ETHICS

4.21.1.1 NHP – 2002 envisages that, in order to ensure that the common patient is not
subjected to irrational or profit-driven medical regimens, a contemporary code of
ethics be notified and rigorously implemented by the Medical Council of India.

4.21.1. 2 By and large, medical research within the country in the frontier disciplines,
such as gene- manipulation and stem cell research, is limited. However, the policy
recognises that a vigilant watch will have to be kept so that the existing guidelines and
statutory provisions are constantly reviewed and updated.

4.22 ENFORCEMENT OF QUALITY STANDARDS FOR FOOD AND DRUGS

4.22.1 NHP – 2002 envisages that the food and drug administration will be
progressively strengthened, in terms of both laboratory facilities and technical
expertise. Also, the policy envisages that 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. The Policy envisages that 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.

4.23 REGULATION OF STANDARDS IN PARAMEDICAL

DISCIPLINES

4.23.1 NHP-2002 recognises the need for the establishment of statutory professional
councils for paramedical disciplines to register practitioners, maintain standards of
training, and monitor performance.

4.24 ENVIRONMENTAL AND OCCUPATIONAL HEALTH

4.24.1 This Policy envisages that the independently -stated policies and programmes
of the environment -related sectors be smoothly interfaced with the policies and the
programmes of the health sector, in order to reduce the health risk to the citizens and
the consequential disease burden.
4.24.2 NHP-2002 envisages the periodic screening of the health conditions of the
workers, particularly for high- risk health disorders associated with their occupation.

4.25 PROVIDING MEDICAL FACILITIES TO USERS FROM

OVERSEAS

4.25.1 To capitalize on the comparative cost advantage enjoyed by domestic health

facilities in the secondary and tertiary sectors, NHP-2002 strongly encourages the
providing of such health services on a payment basis to service seekers from overseas.
The providers of such services to patients from overseas will be encouraged by
extending to their earnings in foreign exchange, all fiscal incentives, including the
status of "deemed exports", which are available to other exporters of goods and
services.

4.26 IMPACT OF GLOBALISATION ON THE HEALTH SECTOR

4.26.1 The Policy takes into account the serious apprehension, expressed by several
health experts, of the possible threat to health security in the post-TRIPS era, as a
result of a sharp increase in the prices of drugs and vaccines. To protect the citizens of
the country from such a threat, this policy envisages 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. The policy also sets out that the Government will bring to
bear its full influence in all international fora – UN, WHO, WTO, etc. – to secure
commitments on the part of the Nations of the Globe, to lighten the restrictive features
of TRIPS in its application to the health care sector.

5. SUMMATION

5.1 The crafting of a National Health Policy is a rare occasion in public affairs when it
would be legitimate, indeed valuable, to allow our dreams to mingle with our
understanding of ground realities. Based purely on the clinical facts defining the
current status of the health sector, we would have arrived at a certain policy
formulation; but, buoyed by our dreams, we have ventured slightly beyond that in the
shape of NHP-2002, which, in fact, defines a vision for the future.

5.2 The health needs of the country are enormous and the financial resources and
managerial capacity available to meet them, even on the most optimistic projections,
fall somewhat short. In this situation, NHP-2002 has had to make hard choices
between various priorities and operational options. NHP-2002 does not claim to be a
road-map for meeting all the health needs of the populace of the country. Further, it
has to be recognized that such health needs are also dynamic, as threats in the area of
public health keep changing over time. The Policy, while being holistic, undertakes
the necessary risk of recommending differing emphasis on different policy
components. Broadly speaking, NHP – 2002 focuses on the need for enhanced
funding and an organizational restructuring of the national public health initiatives in
order to facilitate more equitable access to the health facilities. Also, the Policy is
focused on those diseases which are principally contributing to the disease burden –
TB, Malaria and Blindness from the category of historical diseases; and HIV/AIDS
from the category of ‘newly emerging diseases’. This is not to say that other items
contributing to the disease burden of the country will be ignored; but only that the
resources, as also the principal focus of the public health administration, will
recognize certain relative priorities. It is unnecessary to labour the point that under the
umbrella of the macro-policy prescriptions in this document, governments and private
sector programme planners will have to design separate schemes, tailor-made to the
health needs of women, children, geriatrics, tribals and other socio-economically
under-served sections. An adequately robust disaster management plan has to be in
place to effectively cope with situations arising from natural and man-made
calamities.

5.3 One nagging imperative, which has influenced every aspect of this Policy, is the
need to ensure that ‘equity’ in the health sector stands as an independent goal. In any
future evaluation of its success or failure, NHP-2002 would wish to be measured
against this equity norm, rather than any other aggregated financial norm for the
health sector. Consistent with the primacy given to ‘equity’, a marked emphasis has
been provided in the policy for expanding and improving the primary health facilities,
including the new concept of the provisioning of essential drugs through Central
funding. The Policy also commits the Central Government to an increased under-
writing of the resources for meeting the minimum health needs of the people. Thus,
the Policy attempts to provide guidance for prioritizing expenditure, thereby
facilitating rational resource allocation.

5.4 This Policy broadly envisages a greater contribution from the Central Budget for
the delivery of Public Health services at the State level. Adequate appropriations,
steadily rising over the years, would need to be ensured. The possibility of ensuring
this by imposing an earmarked health cess has been carefully examined. While it is
recognized that the annual budget must accommodate the increasing resource needs of
the social sectors, particularly in the health sector, this Policy does not specifically
recommend an earmarked health cess, as that would have a tendency of reducing the
space available to Parliament in making appropriations looking to the circumstances
prevailing from time to time.
5.5 The Policy highlights the expected roles of different participating groups in the
health sector. Further, it recognizes the fact that, despite all that may be guaranteed by
the Central Government for assisting public health programmes, public health services
would actually need to be delivered by the State administration, NGOs and other
institutions of civil society. The attainment of improved health levels would be
significantly dependent on population stabilisation, as also on complementary efforts
from other areas of the social sectors – like improved drinking water supply, basic
sanitation, minimum nutrition, etc. - to ensure that the exposure of the populace to
health risks is minimized.

5.6 Any expectation of a significant improvement in the quality of health services, and
the consequential improved health status of the citizenry, would depend not only on
increased financial and material inputs, but also on a more empathetic and committed
attitude in the service providers, whether in the private or public sectors. In some
measure, this optimistic policy document is based on the understanding that the
citizenry is increasingly demanding more by way of quality in health services, and the
health delivery system, particularly in the public sector, is being pressed to respond. In
this backdrop, it needs to be recognized that any policy in the social sector is critically
dependent on the service providers treating their responsibility not as a commercial
activity, but as a service, albeit a paid one. In the area of public health, an improved
standard of governance is a prerequisite for the success of any health policy.

----------------------------

NATIONAL HEALTH PROGRAMMES

1. National Vector Borne Disease Control  Programme (NVBDCP) (RTI ACT, 2005) NEW!!
2. National Filaria Control Programme
3. National Leprosy Eradication Programme
4. Revised National TB Control Programme
5. National Programme for Control of Blindness
6. National Iodine Deficiency Disorders Control Programme
7. National Mental Health Programme   
8. National Aids Control Programme
9. National Cancer Control Programme
10. Universal Immuization Programme (RTI ACT, 2005)NEW!!
11. National Programme for Prevention and Control of DeafnessNEW!!
12. Pilot Programme on Prevention and Control of Diabetes, CVD and Stroke
13. National Tobacco Control Programme
14 School Health Programme