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Health For All
Suhail Jeelani, PhD ScholarVector Control Research Centre
Puducherry
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Framework
Introduction
Atma-ata declaration
Primary Health care National Health Policies 1983 and 2002
Progress and Achievements
Challenges Success Stories.
References.
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What is Health?
A state of complete physical, mental, and socialwell being and not merely absence of disease orinfirmity.
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John Bryant in his book Health and the Developing World
Large numbers of the worlds
people, perhaps more than half,have no access to health care atall, and for many of the rest the
care they receive does not answer
the problems they have.
What does health for all means?
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The Joint WHO UNICEFinternational conference in 1978at Alma-Ata (USSR)
Declared that
the existing gross inequalities in the statusof health of people particularly between
developed and developing countries as wellas within the countries is politically,
socially and economically unacceptable.
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HEALTH FOR ALL
ATTAINMENT OF A LEVEL OF HEALTHTHAT WILL ENABLE EVERY INDIVIDUAL
LEAD A SOCIALLY AND ECONOMICALLYPRODUCTIVE LIFE
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The 30th World Health Assemblyin May 1977 resolved
The main social target of governments
and WHO in the coming decades shouldbe the attainment by all citizens of theworld by the year 2000 AD of a level ofhealth that will permit them to lead asocially and economically productive
life.
HEALTH FOR ALL BY 2000 AD
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The Joint WHO UNICEF internationalconference in 1978 at Alma-Ata (USSR)
Alma-Ata Declaration called on all thegovernments to formulate national health
policies according to their own circumstances
to launch and sustain primary health care as
a part of national health system.
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The Alma-Ata conference called for
acceptance of the WHO goal of
HEALTH FOR ALLby 2000 AD
andPrimary Health Care as a wayto achieve Health For All
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Almaata declaration
Health is a fundamental human right and that the attainment of the
highest possible level of health is a most important worldwide social
goal.
The existing gross inequality in the health status of the people
particularly between developed and developing countries ispolitically, socially and economically unacceptable.
Economic and social development, based on a new international
economic order is of basic importance to the fullest attainment of
health for all.
The people have the right and duty to participate individually andcollectively in the planning and implementation of their health care.
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Almaata declaration
Government have a responsibility for the health of their
people which can be fulfilled only by the provision of
adequate health and social measures.
All government should formulate national policies,strategies and plans of action to launch and sustain
primary health care.
All countries should cooperate in a spirit of partnership
and service to ensure PHC for all people. An acceptable level of health for all the people of the
world by the year 2000 can be attained through a further
and better use of the worlds resources.
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The Alma-Ata conference definedthat
Primary health care is an essential health care
based on practical, scientifically sound andsocially acceptable methods and technology,made universally accessible to individual andfamilies in the community, through their full
participation and at a cost that the community andthe country can afford.
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Principles of primary health care
1.Equitable distribution
2.Community participation.
3.Inter-sectoral coordination
4.Appropriate technology
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1. Equitable distribution
Some thing for all
and most for those who need the most
Bahujan hitae bahujan sukhae
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2. Community participation
There must be a continuing effort to secure
meaningful involvement of the community in
the planning, implementation and
maintenance of health services, besides
maximum reliance on local resources such as
manpower, money and materials
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3.Intersectoral coordination
"primary health care involves in addition to the
health sector, all related sectors and aspects
of national and community development, in
particularagriculture, animal husbandry,
food, industry, education, housing, public
works, communication and others sectors".
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4. Appropriate technology
"technology that is scientifically sound,
adaptable to local needs, and acceptableto
those who apply it and those for whom it is
used, and that can bemaintained by the
people themselves in keeping with the
principle of self reliance with the resourcesthe community and country can afford"
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Elements of primary health care
1.Educationconcerningprevailing
healthproblems andthe methodsof preventing
and
controllingthem
2.Promotionof food
supply andadequatenutrition
3.Anadequatesupply of
safe waterand basicsanitation
4.Maternaland child
health careincluding
familyplanning
5.Immunization againstthe majorinfectiousdiseases
6.Prevention and
control oflocally
endemicdiseases
7.Appropriate treatmentof commondiseases
and injuries
8.Provisionof essential
drugs
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National strategy for health for all ......
As a signatory to alma- ata declaration in 1978, the Govt. Of India
was committed to taking steps to provide HFA to its citizens.
In this connection two important reports appeared:
Report of study group on HEALTH FOR ALL on alternativestrategy sponsored by Indian council of social science research
(ICSSR) and Indian council of medical research( ICMR)
Reports of working group on HEALTH FOR ALL by 2000 A.D.
sponsored by Ministry of health and family welfare, Govt. Of India.
This health policy forms a basis of the national health policy
formulated by ministry of health and family welfare, Govt . Of India in
1983.
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National Health Policy -1983 NHP 1983 stressed the need for providing primary health
care with special emphasis on prevention, promotion and
rehabilitation
Suggested Planned time bound attention to the following
1.Nutrition, prevention of food adulteration.2.Mainatince of quality of drug
3.Water supply and sanitation
4.Environmental protection
5.Immunisation programme
6.Maternal and Child Health Services
7.School Health Programme
8.Occupational Health
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National Health Policy1983
India had its first national health policy in
1983 i.e. 36 years after independence.
For better programme planning NHP 1983
recommended an effective Health Information
System.
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NHP 1983- Goalsuggested/achieved
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NHP 1983- Goalsuggested/achieved
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Differentials in health statusamong rural/urban India
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Differentials in health statusamong states
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Differentials in health statusamong socio-economic groups
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Achievements Through TheYears 1951-2000
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Achievements Through TheYears 1951-2000
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Achievements Through TheYears - 1951-2000
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But by the end of 2000 century it was clearthat the goals of health for all by the year
2000 AD would not be achieved ......
Factors responsible for this failure
were: Biased and poor socio- economic development in
the region where it was needed most.
Discriminatory policies due to age, gender and
ethnicity thus preventing access to health care
surveillance.
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Millennium DevelopmentGoals
Millennium Summit held in September
2000 in New York
Representatives from 189 countries met to
adopt the United Nations Millennium
Declaration
Poverty eradication and development by2015 being the core issue
Millennium Development Goals
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Millennium DevelopmentGoals
8 goals
18 targets 48 indicators Related to health3 goals
8 targets
18 indicators
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National Health Policy 2002
Objectives:
Achieving an acceptable standard of good
health of Indian Population,
Decentralizing public health system by
upgrading infrastructure in existing institutions,
Ensuring a more equitable access to health
service across the social and geographical
expanse of India.
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NHP 2002, Objectives..
Enhancing the contribution of private
sectorin providing health service forpeople who can afford to pay.
Giving primacy for prevention and first
line curative initiative.
Emphasizing rational use of drugs.
Increasing access to tried systems of
Traditional Medicine
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Goals NHP 2002
1. Eradication of Polio & Yaws-2005
2. Elimination of Leprosy-2005
3. Elimination of Kala-azar- 2010
4. Elimination of lymphatic Filariasis- 2015
5. Achieve Zero level growth of HIV/AIDS-2007
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Goals NHP 2002....
6.Reduction of mortality by 50% on account of Tuberculosis,Malaria, Other vector and water borne Diseases-2010
7.Reduce prevalence of blindness to 0.5%-2010
8. Reduction of IMR to 30/1000 & MMR to 100/lakh -2010
9. Increase utilisation of public 2010 health facilities fromcurrent level of 75%
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Goals NHP 2002....
10.Establishment of an integrated system ofsurveillance, National Health Accounts and
Health Statistics-2007
11.Increase health expenditure by governmentas a % of GDP from the existing 0.9% to 2.0%-
2010
12. Increase share of Central grants to constituteat least 25% of total health spending- 2010
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Goals NHP 2002....
13. Increase State Sector Health spendingfrom 5.5% to 7% of the budget -2005
14. Further increase of State sector Healthspending from 7% to 8%-2010
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NHP-2002Policy prescriptions
Financial resource
1.Increase in health sector expenditure to 6%of GDP, with 2% by public health investment
by 2010 is recommended by the policy.
2.Existing 15% of central government
contribution is to be raised to 25% by 2010.
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Suggested norms for healthpersonnel
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Equity
NHP 2002 has observed that the attainment
of health indices has been very uneven
across rural-urban divide,
Diff ti l i h lth t t
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Differentials in health statusamong rural/urban India
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Equity..
To overcome the social inequality, NHP2002 has set an increased allocation of55% total public health investment forthe primary health sector, 35% for
secondary sector and 10% for tertiary
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Summation
Crafting of a National Health Policy is a rare
occasion.
Allow our dreams to mingle with ground realities
that needs are enormous and the resources are
limited
Health needs are also dynamic and keepchanging over time
Had to make hard choices between various
priorities
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NHP 2002 has given a continuum to NHP 1983,where primary health care is adopted as the mainstrategy through
Decentralization
Equity
Private sector/indigenoussystem participation
Rise in public investment
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Summation
The ultimate goal is achieving an acceptable
standard of good health of people of India.
The commitment of the service providers and
an improved standard of governance is a
prerequisite for the success of any healthpolicy.
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Steps Towards Health For All-India
1985The universal immunization program (UIP) waslaunched to provide universal coverage of infants and
pregnant women with immunization against identified
vaccine preventable diseases.
1992-93 the UIP has been strengthened and expandedinto the child survival and safe motherhood (CSSM)
project. It involves sustaining the high immunization
coverage level under UIP, and augmenting activities
under oral rehydration therapy, prophylaxis for control of
blindness in children and control of ARI.
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Steps Towards Health For All-India
1997Reproductive and child health (RCH-phase1)program was launched which incorporated child health,
maternal health, family planning, treatment and control of
reproductive tract infection and adolescent health.
2005-2010RCH-phase 2 aims at sector wide, outcomeoriented, program based approach with emphasis on
decentralization, monitoring and supervision which
brings about a comprehensive integration of family
planning into safe motherhood and child health.
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Steps Towards Health For All-India
2005-2012National Rural Health Mission amajor undertaking by the present united
progressive alliance government. It is also from
a strategic framework to implement the nationalhealth policy 2002. The NRHM subsumes key
national programmes,
Reproductive and child health -2
National disease control programme and
integrated disease surveillance project.
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Evaluation of HFA : 1979-2006
Reasons for slow progress:
Insufficient political commitment
Failure to achieve equity in access to all PHC
components
Slow socio- economic development
Difficulty in achieving inter sectoral action for
Health
Unbalanced distribution of resources
R f l
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Reasons for slow progress(contd.)
Weak health information systems and lack of
baseline data
Pollution, poor food safety, and lack of water supply
and sanitation
Rapid demographic and epidemiological changes
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India Shinning
India is shining ok for the glossy magazines,
but if you just go outside metro you will see that
everything about India shining is refuted [In
the villages] alcoholism is rife and female
infacticide and crime are rising. You have to
bribe to get electricity, water. Yes, the middleand upper classes are taking off, but the 700
million who are left behind, all they see is gloom
and darkness and despair. They are born to fulfil
their destiny and have to live this way and die
this way. The only thing that shines for them isthe sun, and it is hot and unbearable and too
many of them die of heatstroke.
Let us work together for
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Let us work together forHealth for ALL.
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References
Primary health care, report of the international conference on primary health care
Alma Ata, USSR, 6-12 September 1978, WHO,1978.
Primary health care Volume 1,2,3, PR Dutt. The Gandhigram Institute of Rural Health
& Family Welfare Trust, Tamilnadu 1993.
Kishor J. National health programs of India;10th ed.
Detels R, MacEwan J, Beaglehole R, Tanaka H. Oxford textbook of public health, 4th
edition. Oxford: Oxford university press; 2002.
Agarwal S. Public Health and Community Medicine Related Policies in India.
Textbook of Public Health and Community Medicine, Dept of Community Medicine,
AFMC, Pune in collaboration with WHO, India office, New Delhi; 1st edition,2009.
From Alma Ata to the year 2000, WHO, 1988.
National Family Health Survey (NFHS) I (1992-93), II (1998-99) Census of India 2011, Houses, Household Amenities and Assets Series: India
http://www.indexmundi.com/g/r.aspx?c=in&v=2223 www.parliamentofindia.nic.in
UNCTAD, E Commerce and Development Report, 2002 11, Ministry of HRD, Gol,
Annual Report, 2001-02
Government of India, Ministry of HRD, Annual Report, 2001-02
http://www.indexmundi.com/g/r.aspx?c=in&v=2223http://www.parliamentofindia.nic.in/http://www.parliamentofindia.nic.in/http://www.indexmundi.com/g/r.aspx?c=in&v=2223