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VI Monograph: National Health Policies (NHP, 1983; NHP, 2002)

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NATIONAL  HEALTH  POLICIES (NHP 1983; 2002)

The NHP, 1983, was a half-hearted attempt to synthesise recommendations of three important earlier committees, the Bhore Committee of 1946 (Government of India, 1946), the Mudaliar Committee of 1962 (Government of India, 1962), and the Shrivastav Committee of 1975 (Government of India, 1975, 1976). The Bhore Committee, 1946, set up before India’s independence, concentrated on preventive medicine and tried to link health with social justice. It gave some surprisingly pragmatic directions. The Mudaliar Committee (1962) concentrated on medical education and development of training infrastructure for  static medical units. The Shrivastav Committee (1975) urged the training of a cadre of health assistants to serve as links between qualified medical practitioners and multipurpose workers (e.g. school teachers, post masters, gram-sevaks, etc.). While the NHP 1983 reiterated the pious resolution of taking health services to the doorstep of the people and ensuring fuller cooperation of the community, it failed to even declare health care as a fundamental right of the people. The WHO in its Preamble (1948) states, ‘The enjoyment of the highest attainable standard of health is one of the fundamental Rights of every human being without distinction of race, religion, political belief, economic or social condition’. The General Assembly of the UN in its Universal Declaration of Human Rights the same year listed the Right to better living conditions and the Right to Health and Medical Service as vital Articles. But the NHP 1983 of India failed to say so categorically. This, when the Directive Principles of State Policy of the Constitution of India (Part IV) state, ‘The State shall regard the raising of the level of nutrition and standard of living of its people and the improvement of public health as among its primary duties’.

Russia was the first country to give its citizens a constitutional right to all health services. The French Constitution of 1946 ‘guarantees to all... protection of health’. In 1965-66, the Social Legislation in the United States declared health a human right. The 89th US Congress changed the concept of health maintenance from an individual to a social responsibility by enacting Medicare and Medicaid, and Comprehensive Health Planning from the womb to the tomb’.Most nations are continuously planning newer strategies to put the Right toHealth and Medical Service into practical use. But both the NHP of India 1983and 2002, failed to even confer the status of a ‘Right’ to Health. Both have some worthwhile proposals, no doubt, but the major social thrust and vision to convert their commitment into a Right is still lacking. This is due to poor awareness amongst the planners and bureaucratic circles, lesser demand from a community unaware of its fundamental rights and a medical establishment which seeks to wallow in its short-sighted establishment propagation strategies. While goals of medicine  worldwide have changed from curative to preventive, preventive to social, and social to community medicine, India has still to reap the benefits of this philosophy to any significant degree. Community participation in health is an aphorism that still awaits genuine realisation in many countries of the world, notably of the third world. India unfortunately is no exception. This, in spite of the fact that through the framework of the Ninth Five Year Plan (1997-2002), new initiatives were supposed to be taken to achieve the following (Park, 2003; p638) :

a. Horizontal Integration of vertical programmes;

b. Develop disease surveillance and response mechanism with focus on rapid recognition report and response at district level;

c. Develop and implement integrated non-communicable disease control programme;

d. Health impact assessment as a part of environmental impact assessment in developmental projects.

e. Implement appropriate management systems for emergency, disaster, accident;

f. Screening for common nutritional deficiencies especially in vulnerable groups and initiate appropriate remedial measures;

g. Reduction in the population growth rate has been recognized as one of the priority objectives. It will be achieved by meeting all felt-needs for contraceptives and by reducing the infant and maternal morbidity and mortality so that there is reduction in the desired level of fertility; and

h. Implementation of reproductive and child health programme by effective maternal and child health care, increased access to contraceptive care; safe management of unwanted pregnancies; nutritional services to vulnerable groups; prevention and treatment of RTI/STD; reproductive health services for adolescents; prevention and treatment of gynaecological problems; and screening and treatment of cancers, especially that of uterine cervix and breast;

 

National Health Policy - 2002            Goals to be achieved by 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 morality by 50% on account of TB Malaria and other vector and water borne diseases --------------------------------2010

- Establish an integrated system of surveillance National Health Accounts and Health Statistics --------------------------2005

- Increase health expenditure by Government as a % of GDP from the existing 0.9% to 2.0% ------------------------------------2010*

- Increase share of central grants to constitute at least 25% of total health spending -------------------------------------------2010

- Increase state sector health spending from 5.5% to 7% of  the Budget -----------------------------------------------------2005

- Further increase to 8% of the Budget -----------------2010

  (Adapted from Park, 2003, p635).

Mens Sana Monographs [MSM]: A Mens Sana Research Foundation Publication

In the concept of positive health, man must cease to be the target of disease or preventive measures. He becomes a collaborator, an active person who accepts responsibility for his own health. Hence greater involvement of families and communities in health matters is a must. Here health care for the people changes to health care by the people. As the eminent medical historian Henry Sigerist said way back in 1941 (Sigerist, 1941):

The people’s health ought to be the concern of the people themselves. They must struggle for it and plan for it. The war against disease and for health cannot be fought by physicians alone. lt is a people’s war in which the entire population must be mobilised permanently.

In the past, people were neglected as a health resource. They were merely looked upon as sources of pathology or victims of pathology and consequently as targets for preventive and therapeutic services. This negative view of people’s  role in health has slowly but surely changed. Now people work towards keeping their own health, they struggle and plan for it and take proper responsibility of looking after it.

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* The government does realize that health spending as % of GDP must increase to 2% but it depends on the people to voice this need strongly enough for power wielders to be motivated to act. - eds.

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