health planning in India

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Health Planning in India...:

Health Planning in India...

Health planning…:

6/8/2012 2 Health planning… National Health Planning has been defined as “the orderly process of defining community health problems, identifying unmet needs & surveying the resources to meet them, establishing priority goals that are realistic & feasible and projecting administrative action to accomplish the purpose of the proposed programme”.

Health needs & demands:

6/8/2012 3 Health needs & demands The community health needs includes need for medical care, safe water supply, adequate nutrition, immunization, family planning etc.

Resources:

6/8/2012 4 Resources the manpower money material skills knowledge techniques & time

Objectives, Targets & Goals:

6/8/2012 5 Objectives, Targets & Goals Describes the end results of planning

Plan:

6/8/2012 6 Plan Planning results in the formulation of a plan. “Plan” is a blue print for taking action 5 major elements Objectives Policies Programmes Schedules budget

Planning cycle:

6/8/2012 7 Planning cycle The process of analyzing a system, or defining a problem, assessing the extent to which the problem exists as a need, formulating goals & objectives to alleviate those identified needs, examining & choosing from among alternative interventions strategies, initiating the necessary action for its implementation& monitoring the system to ensure proper implementation of the plan & evaluating the results of intervention in the light of stated objectives.

Planning process - 8 steps:

6/8/2012 8 Planning process - 8 steps Analysis of the health situation Establishment of objectives & goals Assessment of resources Fixing priorities Write-up of formulated plan Programming & implementation Monitoring Evaluation

History of health planning in India…:

History of health planning in India…

Planning commission (1950):

6/8/2012 10 Planning commission (1950) Health planning in India is an integral part of national socioeconomic planning. Planning commission was set up by Govt of India on 15 th March 1950, to raise the standard of health & living of the people by efficient exploitation of the resources of the country, increasing production and offering opportunities to all for employment in the service of the community .

National Development Council(1952):

6/8/2012 11 National Development Council(1952) It is headed by Prime minister, constitutes chief ministers & members of planning commission. Main objective is to formulate the five year plans for development of the National economy. Priorities during FYP were fixed based on the individual schemes & availability of resources.

Organizational set up::

6/8/2012 12 Organizational set up: Chairmen Dy. Chairmen Minister of State and Dy. Minister Members of Planning Commission Member Secretaries/ Secretaries of Planning Commission

Organizational set up…:

6/8/2012 13 Organizational set up… The Prime Minister is the Chairman of the Planning Commission, which works under the overall guidance of the National Development Council. The Deputy Chairman and the full time Members of the Commission, as a composite body, provide advice and guidance to the subject Divisions for the formulation of Five Year Plans, Annual Plans, State Plans, Monitoring Plan Programmes, Projects and Schemes.

The planning process:

6/8/2012 14 The planning process The planning commission lays down long term goals which are approved by the Govt. 5 yr goals are tentatively formulated by planning commission The sector-wise working groups, headed by secretary/ add sec/ Director general/advisor planning commission, are set up & work out detail policies & programmes to achieve goals & targets PC prepares a short memorandum of 5 year plan in the form of “Approach paper”

The planning process…:

6/8/2012 15 The planning process… This paper is placed before the cabinet & NDC where it is discussed & approved The guidelines are sent to the states to develop state plans The planning dept of each state prepares its plan on the basis of plan of each sectors in the state Each sectors get input from the districts & blocks The complete plan is submitted to the planning commission The PC discusses & scrutinizes the plans in detail

The planning process…:

6/8/2012 16 The planning process… The priorities are decided & funds are recommended The final allocation of funds is decided in a meeting bet the Dy. chairman & the chief minister of a respective state The draft FYP is prepared which states the objectives, essential resources, targets & programmes The draft is placed before NDC for approval It is placed in & presented before the parliament Then it becomes an official plan to be implemented by various depts of central & state govts.

Five Year Health Plans in India:

Five Year Health Plans in India

Five Year Plans…:

6/8/2012 18 Five Year Plans… The first Five-year Plan was launched in 1951 and two subsequent five-year plans were formulated till 1965, when there was a break because of the Indo-Pakistan Conflict. Two successive years of drought, devaluation of the currency, a general rise in prices and erosion of resources disrupted the planning process and after three Annual Plans between 1966 and 1969, the fourth Five-year plan was started in 1969.

Five Year Plans…:

6/8/2012 19 Five Year Plans… The Eighth Plan could not take off in 1990 due to the fast changing political situation and the years 1990-91 and 1991-92 were treated as Annual Plans. The Eighth Plan was finally launched in 1992. For the first eight Plans the emphasis was on a growing public sector with massive investments in basic and heavy industries For Ninth Plan in 1997, the emphasis on the public sector has become less pronounced and the current thinking on planning in the country, in general, is that it should increasingly be of an indicative nature.

Broad objectives of the health programmes during the five year plans are: :

6/8/2012 20 Broad objectives of the health programmes during the five year plans are: Control or eradication of major communicable diseases Strengthening of the basic health services through the establishment of PHCs and Subcentres Population control Development of health manpower resources.

1st five year plan:

6/8/2012 21 1st five year plan Aim : -to fight against diseases, malnutrition, and unhealthy environment -to build up health services for rural population and for mothers & children in order to improve general health status of the people. Outlay: Total- 2356 crores For health sector- 140 crores (5.9%)

Achievements during 1st FYP :

6/8/2012 22 Achievements during 1st FYP The central council of health was constituted -1952 National malaria control programme-1953 National family planning programme-1953 National leprosy control programme- 1954 National water supply & sanitation programme- 1954 National filarial control programme-1955 The prevention of food adulteration act -1954 Contributory health services scheme-1954

2nd five year plan: :

6/8/2012 23 2nd five year plan: Aim: to expand existing health services to bring them with in the reach of people so as to promote progressive improvement of nation’s health. Outlay: Total – 4800 crores For health programmes – 225crores (5%)

Achievements during 2nd FYP:

6/8/2012 24 Achievements during 2nd FYP National malaria control programme was switched over to national malaria eradication programme-1958 Institutions established-Central health education bureau-1956, National Tuberculosis institute, Bangalore-1956

3rd five year plan: :

6/8/2012 25 3rd five year plan: Aim: to remove the shortages & deficiencies which were observed at the end of the 2nd five yr plan in the field of health. These were pertaining to institutional facilities especially in rural areas, shortages of trained personnel & supplies, lack of safe drinking water in rural areas and inadequate drainage system Outlay: Total- 7500 crores For health programmes- 342 crores( 4.3%)

Achievements during 3rd FYP: :

6/8/2012 26 Achievements during 3rd FYP: National small pox eradication programme -1962 National goiter control programme -1962 School health programme- 1962 District TB control programme- 1962 National Trachoma control programme- 1963 Institutes: Central bureau of health intelligence (1961), National Institute of Communicable diseases (1963), National institute of health administration & Education (1964)

Annual Plans 1966-69:

6/8/2012 27 Annual Plans 1966-69 The 4th FYP which was to commence from 1966 was postponed till 1969 due to uncertain economic situation in the country due to Indo-Pak War. This intervening period was covered by annual plans with an outlay of 6756cores, of which 316 crores (4.7%) were allotted for health programmes

4th five year plan: :

6/8/2012 28 4th five year plan: Aim: To strengthen PHC network in the rural areas for undertaking preventive, curative, family planning services & to take over the maintenance phase of communicable diseases. Outlay: Total -16774 crores For health programmes- 1156 crores (7.2%)

Achievements during 4th FYP: :

6/8/2012 29 Achievements during 4th FYP: Chittaranjan mobile hospitals (1970) Postpartum family planning programme (1970) Medical termination of pregnancy facility (1971) Multipurpose health workers scheme (1973) National programme of minimum needs (1973)

5th five year plan: :

6/8/2012 30 5th five year plan: Aim: To provide minimum level of well integrated health, MCH & FP, nutrition & immunization to all the people with special reference to vulnerable groups especially children, pregnant women, & nursing mothers, through a network of infrastructure in all the blocks & well structured referral system. Outlay: Total- 37250 crores For health programmes- 3277 crores (8.8%)

Achievements during 5th FYP: :

6/8/2012 31 Achievements during 5th FYP: Rural health scheme (1977) Integrated child development scheme (1975) Community health workers scheme (1977) National malaria eradication programme was replaced by modified plan of operation (1977) 20 point programme (1975) National programme for prevention of blindness (1976) Reorientation of medical education scheme (1977) Expanded programme of immunization (1978) Parliament approved child marriage restraint act (1978)

6th five year plan: 1980-1985 :

6/8/2012 32 6th five year plan: 1980-1985 Aim: To work out alternative strategy & plan of action for primary health care as part of national health system, which is accessible to all section of society. Outlay: Total- 97500 crores For health programmes- 1822 crores (5.4%)

Achievements during 6th FYP: :

6/8/2012 33 Achievements during 6th FYP: Alma Ata Declaration on PHC -1979 HFA/2000 AD -1981 National health policy – 1983 The national drinking water & sanitation decade -1981 Leprosy control programme switched over to leprosy eradication programme – 1983 Guinea worm eradication programme -1983

7th five year plan: 1985-1990:

6/8/2012 34 7th five year plan: 1985-1990 Aim : To plan & provide primary health care& medical services to all with special consideration of vulnerable groups and to attain health for all by 2000AD. Outlay: Total- 180,000 crores For health programmes- 3392 crores (1.9%)

Achievements during 7th FYP: :

6/8/2012 35 Achievements during 7th FYP: Universal immunization programme -1985 National Diabetes control programme – 1987 National AIDS control programme – 1987 Control of acute respiratory infection programme – 1990

8th five year plan: 1992-1997 :

6/8/2012 36 8th five year plan: 1992-1997 Aim: To continue organization & strengthening of health infrastructure & medical services accessible to all especially to vulnerable groups and those living in tribal, hilly, remote rural areas etc. Outlay: Total- 79,800 crores For health programmes- 7576 crores (9.5%)

Achievements during 8th FYP: :

6/8/2012 37 Achievements during 8th FYP: Child survival & safe motherhood programme -1992 Reproductive & child health programme – 1994 Announcement of revised National Drug Policy – 1995 Revised national TB Control programme – 1997 Act on infant feeding & Infant foods- 1992

9th five year plan: 1997-2002 :

6/8/2012 38 9th five year plan: 1997-2002 Aim: "Growth with Social Justice and Equity" Same as 8th FYP. Nursing education and nursing services have been given a high priority in order to bridge the large gap between requirement and availability of nurses and ensure quality of nursing training. Efforts are made to meet the increasing demand for nurses with specialised training in speciality and sub-speciality areas intensive medical and surgical care in hospitals and for public health nurses in health care system. Outlay: Total- 859,200 crores For health programmes- 10818 crores (1.25%)

Achievements during 9th FYP::

6/8/2012 39 Achievements during 9th FYP: Intensive Pulse Polio immunization programme -1999 National Population Policy – 2000 National health policy-2000 Guinea worm disease was eradicated.

10th five year plan: 2002 - 2007:

6/8/2012 40 10th five year plan: 2002 - 2007 Aim: To improve the efficiency of existing health care infrastructure at primary, secondary and tertiary care setting Attain universal primary education Gender equality Outlay: Total- 9,21,291 crores For health programmes- 9,253 crores (1%)

New Initiatives in the Tenth Plan: :

6/8/2012 41 New Initiatives in the Tenth Plan: The Reproductive and Child Health Programme, Phase II (2005-10), Janani Suraksha Yojana Support for six tertiary-level institutions on the lines of AIIMS, Delhi in the six backward states of Bihar, Madhya Pradesh, Orissa, Rajasthan, Chhattisgarh and Uttaranchal Integrated Disease Surveillance Project National Mental Health Programme A Capacity Building Project Expanding outreach of AYUSH Two new national programmes - National Programme on Diabetes and Cardiovascular Diseases & National Programme on Hearing and Speech Impairment

Recommendations :

6/8/2012 42 Recommendations Implement a National Rural Health Mission Implement a National Mission on Sanitation and Public Health Provide access to maternity health Insurance and community risk pooling Systematise insurance at secondary health care levels through reform of the CGHS Institutionalise public private partnerships in health care Set up a Public Health Development Authority Set up a National Authority for Drugs and Therapeutics

11th five year plan: 2007 - 2012:

6/8/2012 43 11th five year plan: 2007 - 2012 Aim: To achieve an overall growth rate of 7.6%. To reduce poverty levels from 38% to 25% To achieve the literacy rate of 84% by the end of the Plan and reduce gender gap in literacy to 14%. To achieve reduction in drop out rate from 46.8% in 2003-04 to 20% by 2011-12 and eliminate gender disparity in elementary education. To bring down population growth rate to 1.62% by 2012. To improve health parameters-reduce MMR to 125, IMR to 40

11th five year plan: 2007 – 2012 …:

6/8/2012 44 11th five year plan: 2007 – 2012 … To improve the sex ratio (0–6 years) to 950 females per 1000 males. To reduce malnutrition to 30% and anemia to 30%. To provide sustainable access to safe portable drinking water to all independent habitations. To empower women through their socio-economic development To strengthen social, economic and political empowerment of weaker sections of the society through welfare of SCs/STs, OBCs, minorities and poor.

11th five year plan: 2007 - 2012:

6/8/2012 45 11th five year plan: 2007 - 2012 Outlay: Total - Rs. 69,33,800 crores For Health - Rs 2,24,030 crore

INTERVENTIONS RECOMMENDED FOR IMPLEMENTATION DURING THE ELEVENTH PLAN:

6/8/2012 46 INTERVENTIONS RECOMMENDED FOR IMPLEMENTATION DURING THE ELEVENTH PLAN Launch a Sarwa Swasthya Abhiyan National Authority for Drugs and Therapeutics (NADT) Public Health Development Authority (PHDA)

Recommendations for engendering the 11th FYP:

6/8/2012 47 Recommendations for engendering the 11th FYP Promote the idea of Women-Governance Better accountability and monitoring mechanisms -Sex desegregated data Strong enforcement mechanisms Reconstruct ‘poverty line’ to reflect reality  - goal of "a hunger-free India" or "food and nutrition security for all”. Eliminate all forms of Violence against Women (VAW) Redefine ‘work’ and ‘recognise’ women in the workforce

Bajaj committee (1986):

6/8/2012 48 Bajaj committee (1986 ) An “Expert Committee for Health Manpower Planning, Production and Management” was constituted in 1985 under Dr. J.S. Bajaj, the then professor at AIIMS.

Major recommendations:

6/8/2012 49 Major recommendations Formulation of national medical & health education policy. Formulation of national health manpower policy-staffing norms for nursing services & requirements for CHCs & PHCs. Establishment of an educational commission for health sciences (ECHS) on the lines of UGC. Establishment of health science universities in various states and union territories.

Major recommendations…:

6/8/2012 50 Major recommendations… Establishment of health manpower cells at centre and in the states. Vocationalization of education at 10+2 levels as regards health related fields with appropriate incentives, so that good quality paramedical personnel may be available in adequate numbers. Carrying out a realistic health manpower survey.

Hospital nursing services:

6/8/2012 51 Hospital nursing services NS 1:2000 beds DNS 1:300 beds Dept Nsg supervisors 7:1000 beds + 1 add for every 100 bed Ward Nsg supervisors 8:200 + 30%leave reserve Staff nurse for wards 1:3(1:9 / shift) Staff, OPD 1:100 Staff, ICU 1:1 (1:3/shift) Staff special dpt OT, LR 8:200

Community infrastructure:

6/8/2012 52 Community infrastructure 1CHC 1,00,000 population 1PHC 30,000 in plains 1PHC 20,000 in hilly area 1SC 5000 in plain 1SC 3000 in hilly area

Nursing manpower in rural areas (2006):

6/8/2012 53 Nursing manpower in rural areas (2006) Manpower INC registry 2005 Rural Health Statistics in India 2006 LHV 50715 17107 ANM 521,593 149695 GNM 908,962

High power committee on nursing & nursing profession (1989):

6/8/2012 54 High power committee on nursing & nursing profession (1989) Recommendations: To have 2 levels of nsg personnel, viz. professional nurse with university degree & auxillary nurse / vocational nurse to work both in community setting To have higher education in nursing which include MSc & PhD in nursing and also specialized courses at postgraduate level. To have definite policy of continuing education & staff development Strengthening of nursing structure at the central, state & district level with adequate no of well qualified nursing personnel.

National population policy (2000):

6/8/2012 55 National population policy (2000) 1983 - Parliament emphasized the need for a separate National Population Policy. 1991 -The National Development Council appointed a Committee on Population with Shri Karunakaran as Chairman Recommended that "a National Policy of Population should be formulated by the Government and adopted by Parliament” 1993 - An Expert Group headed by Dr. M.S. Swaminathan was asked to prepare a draft of a national population policy Final draft is adopted by GOI on 15 th Feb 2000.

Objectives of NPP 2000:

6/8/2012 56 Objectives of NPP 2000 The intermediate objectives: To address the unmet needs of contraception, health care infrastructure & health personnel To provide integrated service delivery for basic reproductive & child health care The medium term objectives: To bring the TFR to replacement levels by 2010 The long term objectives: To achieve a stable population by 2045

Health related Millennium Development Goals in India:

6/8/2012 57 Health related Millennium Development Goals in India Eradicate extreme poverty and hunger Achieve universal primary education Promote gender equality Reduce child mortality Improve maternal health Combat HIV/AIDS, malaria & other communicable diseases Ensure environmental sustainability Develop a global partnership for development

New National Health Policy(2002):

6/8/2012 58 New National Health Policy(2002) Objective: to achieve a level of health that will enable every individual a productive life. Priority areas of policy: Small family norm MCH Immunization Improvement of nutritional status Water supply & sanitation Environmental protection

Goals of NHP by 2010 AD:

6/8/2012 59 Goals of NHP by 2010 AD Indicators By 2000 By 2010 IMR 60 30 CBR 21 18 MMR <2 1 Life expectancy 64 70 NRR 1 <1 Annual growth rate 1.2 1 TFR 2.3 2.1

Other goals of NHP 2002:

6/8/2012 60 Other goals of NHP 2002 Eradicate polio -2005 Eliminate leprosy -2005 Eliminate kala-azar -2010 Eliminate lymphatic filariasis - 2015 Achieve zero level growth of HIV/ AIDS -2007 Reduce the prevalence of blindness to 0.5% -2010

National Rural health mission in India (2005-2012):

6/8/2012 61 National Rural health mission in India (2005-2012) Recognizing the importance of Health, the Govt. of India has resolved to launch the NRHM to carry out necessary architectural correction in the basic health care delivery system The Goal of the Mission is to improve the availability of and access to quality health care It seeks to provide effective health care to rural population through out the country with special focus on 18 states.

GOALS :

6/8/2012 62 GOALS Reduction in IMR &MMR Universal access to public health services such as Women’s health, child health, water, sanitation & hygiene, immunization, and Nutrition Prevention &control of communicable &non communicable diseases Access to integrated comprehensive primary health care Population stabilization, gender & demographic balance Revitalize local health traditions & mainstream AYUSH Promotion of healthy life styles

Public health foundation of India:

6/8/2012 63 Public health foundation of India The central Govt established PHFI with the support of private sector in March 2006. Aim: To strengthen public health system in India by establishing new institutes of public health & enhancing capacity & output of the existing institutes. To promote research in key areas of public health & facilitate suitable policy development

Research inputs :

6/8/2012 64 Research inputs Shiffman J, Ved RR. The state of political priority for safe motherhood in India . BJOG. 2007 Jul;114(7):785-90. By 2005, evidence had accumulated that maternal mortality in India was stagnating and that existing initiatives were not addressing the problem effectively. Also in that year, national government officials and donors came to a consensus on a strategy to address the problem. This paper draws on public policy theory to analyse the Indian experience and to develop guidance for safe motherhood policy communities.

Research Inputs…:

6/8/2012 65 Research Inputs… Dhillon GP. NLEP--current situation and strategy during the 11th plan period (2007-2012). J Indian Med Assoc. 2006 Dec;104(12):671-2. The prevalence rate of leprosy was found to be 0.95/10,000 population by December 2005, a success in the elimination of leprosy. On 30th September 2006 the rate on record is 0.89/10,000 population During 2005-06 the annual new case detection rate was 14.27 per 100,000 population which was 23.4 during 2004-05 During the 11th plan period the government proposes to carry on the leprosy programme with the same intensity further to achieve annual new case detection rate less than 10 cases per 100,000 population

References :

6/8/2012 66 References K. Park, preventive & social Medicine, 16th edn., pg:613-630 Lakshmi Kant, Principles & Practice of preventive & social Medicine, 1st edn, 368-371 Mahajan B K, text book of preventive & social Medicine 2nd ed., 476-488 Ghai, Essential preventive medicine, pg: 845-874 http://planningcommission.nic.in/midterm/english-pdf/chapter-02b.pdf http://planningcommission.nic.in/plans/planrel/11thf.htm http://www.southasianmedia.net/cnn.cfm?id=416597&category=Social%20Sectors&Country=INDIA www.mohfw.nic.in www.pubmed.com

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6/8/2012 67 Thank you

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