Health For All

Suhail Jeelani, PhD Scholar

Vector Control Research Centre Puducherry

Framework

Introduction Atma-ata declaration Primary Health care National Health Policies 1983 and 2002 Progress and Achievements Challenges Success Stories. References.

What is Health?

A state of complete physical, mental, and social well being and not merely absence of disease or infirmity.

What does health for all means?

Large numbers of the worlds people, perhaps more than half, have no access to health care at all, and for many of the rest the care they receive does not answer the problems they have.

John Bryant in his book Health and the Developing World

The Joint WHO UNICEF international conference in 1978 at Alma-Ata (USSR) Declared that

the existing gross inequalities in the status of health of people particularly between developed and developing countries as well as within the countries is politically, socially and economically unacceptable.

HEALTH FOR ALL

ATTAINMENT OF A LEVEL OF HEALTH THAT WILL ENABLE EVERY INDIVIDUAL LEAD A SOCIALLY AND ECONOMICALLY PRODUCTIVE LIFE

The 30th World Health Assembly in May 1977 resolved

The main social target of governments and WHO in the coming decades should be the attainment by all citizens of the world by the year 2000 AD of a level of health that will permit them to lead a socially and economically productive life.

HEALTH FOR ALL BY 2000 AD

The Joint WHO UNICEF international conference in 1978 at Alma-Ata (USSR)

Alma-Ata Declaration called on all the governments to formulate national health policies according to their own circumstances to launch and sustain primary health care as a part of national health system.

The Alma-Ata conference called for acceptance of the WHO goal of

HEALTH FOR ALL by 2000 AD

and Primary Health Care as a way to achieve Health For All

Alma ata 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 is politically, 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 and collectively in the planning and implementation of their health care.

Alma ata 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.

The Alma-Ata conference defined that

Primary health care is an essential health care based on practical, scientifically sound and socially acceptable methods and technology, made universally accessible to individual and families in the community, through their full participation and at a cost that the community and the country can afford.

Principles of primary health care

1.Equitable distribution 2.Community participation. 3.Inter-sectoral coordination

4.Appropriate technology

1. Equitable distribution

Some thing for all and most for those who need the most

Bahujan hitae bahujan sukhae

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

3.Intersectoral coordination
"primary health care involves in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communication and others sectors".

4. Appropriate technology
"technology that is scientifically sound, adaptable to local needs, and acceptable to those who apply it and those for whom it is used, and that can be maintained by the people themselves in keeping with the principle of self reliance with the resources the community and country can afford"

Elements of primary health care

1.Education concerning prevailing health problems and the methods of preventing and controlling them

2.Promotion of food supply and adequate nutrition

3.An adequate supply of safe water and basic sanitation

4.Maternal and child health care including family planning

5.Immunizat ion against the major infectious diseases

6.Preventio n and control of locally endemic diseases

7.Appropriat e treatment of common diseases and injuries

8.Provision of essential drugs

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 alternative strategy 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.

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

National Health Policy 1983

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.

NHP 1983- Goal suggested/achieved

NHP 1983- Goal suggested/achieved

Differentials in health status among rural/urban India

Differentials in health status among states

Differentials in health status among socio-economic groups

Achievements Through The Years 1951-2000

Achievements Through The Years 1951-2000

Achievements Through The Years - 1951-2000

But by the end of 2000 century it was clear that 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.

Millennium Development Goals

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 by 2015 being the core issue
Millennium Development Goals

Millennium Development Goals

8 goals 18 targets 48 indicators

Related to health 3 goals 8 targets 18 indicators

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.

NHP 2002, Objectives..

Enhancing the contribution of private sector in providing health service for people 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

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

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 from current level of <20% to > 75%

Goals NHP 2002....

10.Establishment of an integrated system of surveillance, National Health Accounts and Health Statistics-2007 11.Increase health expenditure by government as a % of GDP from the existing 0.9% to 2.0%2010 12. Increase share of Central grants to constitute at least 25% of total health spending- 2010

Goals NHP 2002....

13. Increase State Sector Health spending from 5.5% to 7% of the budget -2005 14. Further increase of State sector Health spending from 7% to 8%-2010

NHP-2002 Policy 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.

Suggested norms for health personnel

Equity

NHP 2002 has observed that the attainment of health indices has been very uneven across rural-urban divide,

Differentials in health status among rural/urban India

Equity..

To overcome the social inequality, NHP 2002 has set an increased allocation of 55% total public health investment for the primary health sector, 35% for secondary sector and 10% for tertiary

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 keep changing over time Had to make hard choices between various priorities

NHP 2002 has given a continuum to NHP 1983, where primary health care is adopted as the main strategy through

Decentralization

Equity

Private sector/indigenous system participation

Rise in public investment

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 health policy.

Steps Towards Health For All-India

1985 The universal immunization program (UIP) was launched to provide universal coverage of infants and pregnant women with immunization against identified vaccine preventable diseases. 1992-93 the UIP has been strengthened and expanded into 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.

Steps Towards Health For All-India

1997 Reproductive 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. 2005-2010 RCH-phase 2 aims at sector wide, outcome oriented, 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.

Steps Towards Health For All-India

2005-2012 National Rural Health Mission a major undertaking by the present united progressive alliance government. It is also from a strategic framework to implement the national health policy 2002. The NRHM subsumes key national programmes, Reproductive and child health -2 National disease control programme and integrated disease surveillance project.

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

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

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 middle and 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 is the sun, and it is hot and unbearable and too many of them die of heatstroke.

Let us work together for Health for ALL.

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 Human Development Report, 2004