health for all-imp

7/30/2019 Health for All-Imp

1/54

Health For All

Suhail Jeelani, PhD ScholarVector Control Research Centre

Puducherry


2/54

Framework

Introduction

Atma-ata declaration

Primary Health care National Health Policies 1983 and 2002

Progress and Achievements

Challenges Success Stories.

References.


3/54

What is Health?

A state of complete physical, mental, and socialwell being and not merely absence of disease orinfirmity.


4/54

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?


5/54

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.


6/54

HEALTH FOR ALL

ATTAINMENT OF A LEVEL OF HEALTHTHAT WILL ENABLE EVERY INDIVIDUAL

LEAD A SOCIALLY AND ECONOMICALLYPRODUCTIVE LIFE


7/54

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


8/54

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.


9/54

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


10/54

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.


11/54

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.


12/54

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.


13/54

Principles of primary health care

1.Equitable distribution

2.Community participation.

3.Inter-sectoral coordination

4.Appropriate technology


14/54

1. Equitable distribution

Some thing for all

and most for those who need the most

Bahujan hitae bahujan sukhae


15/54

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


16/54

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".


17/54

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"


18/54

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


19/54

National strategy for health for all ......

As a signatory to almaata 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.


20/54

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


21/54

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.


22/54

NHP 1983- Goalsuggested/achieved


23/54

NHP 1983- Goalsuggested/achieved


24/54

Differentials in health statusamong rural/urban India


25/54

Differentials in health statusamong states


26/54

Differentials in health statusamong socio-economic groups


27/54

Achievements Through TheYears 1951-2000


28/54

Achievements Through TheYears 1951-2000


29/54

Achievements Through TheYears - 1951-2000


30/54

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.


31/54

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


32/54

Millennium DevelopmentGoals

8 goals

18 targets 48 indicators Related to health3 goals

8 targets

18 indicators


33/54

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.


34/54

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


35/54

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


36/54

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%


37/54

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


38/54

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


39/54

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.


40/54

Suggested norms for healthpersonnel


41/54

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


42/54

Differentials in health statusamong rural/urban India


43/54

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


44/54

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


45/54

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


46/54

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.


47/54

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.


48/54


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.


49/54


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.


50/54

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


51/54

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


52/54

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


53/54

Let us work together forHealth for ALL.


54/54

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

health for all-imp

Documents