Health Policies and Legislations: State Institute of Health and Family Welfare, Jaipur

Health Policies and Legislations
State Institute of Health and Family Welfare, Jaipur

Health Policies: India
Ø National Children Policy, August 22, 1974
Ø National Health Policy, 1983, 2002
Ø National Nutrition Policy,1993
Ø National Population Policy, 2000
Ø National Policy on Women Empowerment, 2001
Ø National Blood Policy, 2003
Ø National Policy for Persons with Disabilities, 2006
SIHFW: an ISO 9001: 2008 certified Institution 2

Introduction
Ø 1983 (36 yrs. After independence)
ØA phased, time-bound program for
setting network of comprehensive
primary health care services
ØIntermediation through ‘Health
volunteers’
ØEstablishment of a well-worked out
referral system
ØEvenly spread specialty and super-
specialty services; Private-public
partnership
Ø Outcome not as expected based on set
indicators for achievement by 2000

Basic Elements-NHP 1983
The basic elements and areas for action -
Ø Nutrition Ø Occupational health
Ø Preventing food Ø Health education
adulteration Ø MIS
Ø Maintaining drug quality Ø Medical industry
Ø Water supply and Ø Health insurance
sanitation Ø Health legislations
Ø Environmental protection Ø
Medical research
Ø Immunization Ø School health
Ø MCH services Ø
Ø SIHFW: an ISO 9001: 2008 certified Institution 4
NHP-2002 Realizes
Ø Averages of health indices hide wide disparities
Ø Large gap in facilities still persists
Ø Shortfall in the number of SCs/PHCs/CHCs is of
the order of 16 percent.
Ø ‘Vertical’ implementation structure - extremely
expensive
Ø The rural health staff has become a vertical
structure exclusively for the implementation of
family welfare activities
Ø 20% of the population seeking OPD services,
and less than 45% seeking indoor treatment,
avail of such services in public hospitals.

Ø Deployment of doctors and nurses is ad-hoc
and significantly short of the requirement for
minimal standards
Ø ISM can increase the reach of basic health care
Ø Need for specialists in ‘public health’ and
‘family medicine’
Ø Ratio of nursing personnel vis-à-vis
doctors/beds is very low
Ø Urban health- neglected

NHP-2002 Proposes
Ø Increase health sector expenditure to 6% of
GDP, with 2% of GDP being contributed as

public health investment, by the year 2010.
Ø State Governments by 2005 to increase the
commitment of their resources to 7% of the
Budget; and, in the second phase, by

2010, to increase it to 8% of the Budget
Ø Increased allocation of 55% of the total public
health investment for the primary health;
the secondary(35%) and tertiary health

(10%)
Ø Gradual convergence of all health programs
under a single field administration
Ø Vertical programs TB, Malaria, HIV/AIDS, RCH
and UIP, to continue till moderate levels of
prevalence are reached.
Ø Developing the capacity of State Public Health
administration
Ø District Health administration to allocate the
time of the rural health staff between the
various programs

Ø Creation of a beneficiary interest- provision of
some essential drugs will ensure community
monitoring
Ø More frequent in-service training of public health
medical personnel
Ø Quality of public health services is closely linked
to the quantum and quality of investment
through public funding in the primary health
sector

National Health Policy-2002
•
 NHP- 2002 to evolve a policy structure-

Ø Which reduces the inequities in existing

health services

Ø Allows the disadvantaged sections of

society a fairer access to public health
services
•

Issues Involved in NHP-1983
Formulation
Ø Re-orientation of Medical education
Ø Re-structuring and Re-organizing the
existing health care services
Ø Population stabilization
Ø Re-orientation of existing health personnel
Ø Role of practitioners of ISM in Health care
delivery
•

The Considerations for NHP-2002
Ø Health investment and expenditure declined

Ø Disparities in public health facilities and
health standards
Ø The infrastructure facilities fell short.
Ø Shortfall in the number of SCs/PHCs/CHCs
Ø Shortage of medical personnel
Ø Less population, seek OPD services, indoor
treatment and avail of such services in
public hospitals
Ø Need for Public health specialists and Family
Medicine
•
Ø Use of Generic drugs
Ø Urban health infrastructure
Ø Mental Health
Ø IEC
Ø Health research
Ø Private sector participation
Ø Disease surveillance
Ø Women health
Ø Medical ethics
Ø Quality standards for food and drugs
Ø Environment and Occupational health
Ø Synchronized implementation of NHP-2002
and NPP-2000
• SIHFW: an ISO 9001: 2008 certified Institution 13
Objective
Ø To achieve standard of good health

Ø To ensure equitable access to health
services
Ø To increase the aggregate public health
investment
Ø

Goals of NHP-2002

Policy Prescriptions-NHP-2002
Ø To increase health sector expenditure

Ø Strengthening of the primary health structure
Ø Program implementation through
autonomous bodies
Ø Frequent in-service training
Ø Government-funded health research
Ø Prohibiting the use of proprietary drugs

Ø An integrated disease control network
Ø National health accounts
Ø Strengthening deployment of health experts
Ø User-charges
Ø Contract employment
Ø Setting up of Medical Grants Commission
Ø Mental health services
Ø IEC
Ø Highest priority woman’s health.
Ø Food and drug standards
Ø Need to modify the existing curriculum
•
National Population Policy-2000

Population Growth in India
Ø High wanted fertility due to the high infant

mortality rate (IMR)

Ø Higher fertility due to unmet need for

contraception

Ø The large reproductive age-group cohort

•

Projected Growth in Population (M)
Year If current trend continues If TFR 2.1 achieved by

2010
Total Percent Total Percent
Population Increase Population Increase
1991 846.3 - 846.3 -
1996 934.2 17.6 934.2 17.6
1997 949.9 15.7 949.0 14.8
2000 996.9 15.7 991.0 14.0
2002 1027.6 15.4 1013.0 11.0
2010 1162.3 16.8 1107.0 11.75

Population Pyramid

21
Population Policy of India: Milestones
Ø 1946: Bhore Committee Report

Ø 1952: Family Planning Program
Ø 1976: Statement of National Population Policy
Ø 1977: Policy Statement on Family Welfare
 Program
Ø 1983: National Health Policy - "securing the
SFN, through voluntary efforts and moving
towards the goal of population
stabilization”

Ø 1991: The National Development Council
 appointed a Karunakaran Committee
Ø 1993: SwaminathanCommittee appointed,
 1994- report submitted

Ø 1997: Cabinet approved the draft National
 Population Policy document could not
be placed in either House of Parliament
Ø 1999: Another draft finalized placed before the
Cabinet; discussed & approved
Ø 2000: National Population Policy in existence


Salient Features of 1976 Statement
Statement focused on-

Ø Minimum needs program

Ø Family planning
Ø Raising age of marriage
Ø Adoption of small family norm
Ø Research in Reproductive health and
contraceptive technology
Ø Multi-media motivational strategy
Ø Education and Economic development
Ø
Suggestions for the Approach
Ø 8% of Central assistance linked to State
Ø Monetary compensation linked with
terminal methods and no. of children
Ø Compulsory sterilization after 3 children
Ø Rising the marriage age
Ø Increasing level of female education
Ø Involvement & support of voluntary
organizations

Ø Research in reproductive biology and
contraception
Ø Incentives for make Family Planning
movement
Ø Promotion of multi media communication
strategy
Ø Inclusion of population education in
education system
Ø Freezing the representation of States in
Parliament till 2026
Ø

National Population Policy
ØVoluntary and informed choice and

consent of citizens while availing RCH
services
ØContinuation of the target free approach
in administering family planning
services
Ø
Policy Objectives
Ø Immediate
ØTo address the unmet needs for
contraception, health care infrastructure,
health personnel
ØTo provide integrated service delivery for
basic RCH care
Ø Medium
ØTo bring the TFR to replacement levels by
2010
Ø Long term
ØTo achieve a stable population by 2045
National Socio-demographic Goals
for 2010
Ø Address the unmet needs for -
ØBasic RCH services
ØSupplies and infrastructure
Ø Increase school education and reduce drop
outs
Ø Reduce IMR& MMR
Ø Promote delayed marriage for girls, preferably
after 20 years of age
Ø Contain the spread of AIDS
Ø Prevent and control communicable diseases
Ø
Ø Integrate Indian Systems of Medicine (ISM)
Ø Promote vigorously the small family norm
Ø To make family welfare a people centered
program

To Achieve-

Ø Universal access to health related information

Ø 100% registration of births, deaths, marriage
and pregnancy
Ø Universal immunization of children
Ø 80% institutional deliveries and 100%
deliveries by trained persons
•
Strategic Themes of NPP-2000
Ø Decentralized Planning and Implementation
Ø Convergence of Service Delivery at all Levels
Ø Empowering Women for Improved Health
Ø Child Health and Survival
Ø Meeting the Unmet Needs for Family Welfare
Services
Ø Under-Served Population Groups
Ø Diverse Health Care Providers
Ø Collaboration with NGO and Private Sector
Ø Contraceptive Technology and Research on RCH
Ø Mainstreaming Indian Systems of Medicine
Ø Providing for the Older Population
Ø Information, Education, and Communication
Ø
Structure
 NPP 2000 to be largely implemented
and managed through PRIs in coordination
with the concerned State/UT administrations.
 Recommended structures:
ØNational Commission on Population
ØState/UT Commissions on Population
ØCoordination Cell in the Planning
Commission
ØTechnology Mission in the Department
of Family Welfare
•
Promotional and Motivational
Measures for Adoption of the SFN
Ø Panchayats and Zila Parishads will be rewarded

for -
Ø Performance in universalizing the small family
norm,
Ø Achieving reductions in IMR, CBR, promoting
literacy
Ø Reward to BPL Couples
Ø Who marry after the legal age of marriage
Ø Register the marriage
Ø Have first child after age of 21
Ø Accept the SFN
Ø Adopt aSIHFW:
terminal method
an ISO 9001: after
2008 certified the birth of the
Institution 33
Ø Promotion of survival and care of the girl
child,
Ø Rs. 500 is awarded at the birth of the girl
child
Ø Maternity Benefit Scheme
Ø A Family Welfare-linked Health Insurance
Plan
Ø Crèches and child care centers
Ø A wider, affordable accessible choice of
contraceptives
Ø Facilities for safe abortion

National Policy for Children

35
Child Welfare: Milestones
Ø UN Convention on the Rights of the Child on


11th Dec., 1992
Ø The National Policy for Children Aug. 22,1974
Ø UN Millennium Summit - MDG Sep. 30, 2000
Ø National Charter for Children, Feb. 2004
Ø National Plan of Action for Children 2005
Ø The Commissions for Protection of the Child
Rights Act 2005

36
National Children Policy, 1974
Ø Policy Measures
Ø Services before and after birth
Ø Children up to 14 years
Ø Comprehensive health services
Ø Nutrition services
Ø Free and compulsory education till 14 years
Ø Informal education to drop outs
Ø Equal opportunity to weaker sections,
physically challenged and delinquent
children
Ø Protection against neglect, cruelty and
exploitation
Ø <14 not to be engaged in hazardous
occupation
37
National Charter for Children, 2003
Ø Free & compulsory education to all children (6-14)
Ø No child <14 years - in hazardous employment
Ø Promoting High Standards of Health and Nutrition
Ø Assuring Basic Minimum Needs and Security
Ø Protection from Economic Exploitation and All Forms of
Abuse
Ø Protection of the Girl Child
Ø Empowering Adolescents
Ø Equality - Expression, Seek and Receive Information,
Association and Peaceful Assembly
Ø Protection of Children with Disabilities
Ø Family support – care, love, play, survival, growth,
development
38
National Plan of Action for Children 2005
Ø Reduce IMR to below 30 by 2010

Ø Reduce child mortality rate to below 31 by 2010
Ø Reduce MMR to below 100 by 2010
Ø Universal equitable access and use of safe
drinking water and improved access to
sanitary means of excreta disposal by 2010
Ø 100% rural population to have access to basic
sanitation by 2012

39
Ø Eliminate child marriages by 2010
Ø Eliminate disability due to poliomyelitis by 2007
Ø To reduce the proportion of infants infected with
HIV by 20 % by 2007 and by 50 % by 2010
ØEnsuring ANC to 80 per cent of
pregnant women
Ø95 per cent of men and women aged
15-24 have access to care,
counseling and other HIV and
prevention services.
Ø
40
National Policy for Persons with
Disabilities, 2006
Ø Policy focus of the
ØPrevention of Disabilities and
ØRehabilitation Measures
Ø Salient features
ØPhysical Rehabilitation
ØEducational Rehabilitation, vocational
training
ØEconomic Rehabilitation
Ø Special focus on women and children with
disabilities
41

National Policy for Empowerment of
Women
Ø V- FYP - shift from Women welfare to women
development and empowerment
Ø Mexico plan of Action (1975)
Ø Nairobi forward-looking strategies (1985)
Ø National Commission for Women (1990)
Ø Convention on Elimination of All forms of
Discrimination Against Women (CEDAW), 1993
Ø International Conference on Population and
Development (ICPD), Cairo (1994)
Ø Beijing Declaration and Platform for Action (1995)

42
Objectives
Ø Broad Objective
 To bring about the advancement,
development and empowerment of
Women

43
Ø Specific Objectives
Ø Creating an environment - positive economic and
social policies
Ø Enjoyment of all human rights
Ø Equal access, to participation and decision making
Ø Equal access to health care, education, employment,
remuneration, occupational health & safety, social
security and public office
Ø Strengthening of legal systems
Ø Changing societal attitude & community practices by
participation
Ø Mainstreaming gender perspective
Ø Elimination of discrimination and all kind of violence
Ø Building & strengthening of partnerships with civil
society
44
•
Policy Prescriptions
Ø Legal - judicial system will be made more

responsive and gender sensitive
Ø equality in power sharing and active participation
in decision making
Ø Mainstreaming a Gender Perspective in the
Development Process
Ø Economic & Social Empowerment of women

45
Institutional Mechanisms
Ø National and State Councils

Ø National and State Resource Centres
Ø Strengthen Self-Help Groups (SHGs)
Ø Women’s Component Plan adopted in IX
FYP
Ø Channelize private sector investments
Ø Reviewing and strengthening legal
system

46
Health Legislations in India

Pre-conception and pre-natal Diagnostic
Techniques (PCPNDT) Act
Ø Passed by the Indian Parliament and
came into force in 1994

Ø It regulates and prevents misuse of the

diagnostic techniques

Ø Amended again in 2003

•

Aim
Ø To prohibition of sex selection
Ø For regulation of pre-natal diagnostic
techniques for the purposes of
detecting-
ØGenetic abnormalities or
ØMetabolic disorders or
ØChromosomal abnormalities or
ØCertain congenital malformations or
ØSex-linked disorders
When its becomes an offence ?
Ø Service provider violating the Act.
Ø Service seeker (woman compelled to
undergo the test is not punishable)
Ø Advertiser of these technique
•
Complaints procedure
Ø Written complaint to Appropriate Authority

Ø AA to act within 15 days
Ø Delayed action to be addressed through
judiciary
•
 SIHFW: an ISO 9001: 2008 certified Institution 50
An Offence under the PCPNDT Act is Cognizable,
Non-bailable and Non-compoundable
First offence Subsequent offence
Service Imprisonment (3yrs.); penalty Imprisonment (5yrs.);

provider (Rs.10000); registration penalty (Rs.50000);
cancelled (5 yrs.) registration cancelled
(permanently.)
Service Imprisonment (3 yrs.); penalty Imprisonment (5 yrs.);

seeker (Rs. 50000) penalty (Rs. 100000);
Advertiser Imprisonment (3 yrs.); penalty

(Rs. 10000)

Structure of Implementing Machinery

Anti-Tobacco Act
•

Prepared by the Ministry of Health and Family
Welfare in consultation with the Law Ministry


The Tobacco Menace in India
Tobacco caused-

Ø 800,000 deaths every year

Ø 150,000 cancers per year
Ø 4.2 million heart diseases
Ø 3.7 million lung diseases in every year
Ø It kills more people than AIDS, alcohol,
cocaine, homicide, suicide, motor
vehicle crashes, and fires combined!
Ø
Ø 55,000 children every day in India start
using tobacco
Ø 5 million children under the age of fifteen
are addicted to tobacco.
Ø 10%- 40% of school students and 40%-
70% of students in colleges chew
gutka & paan masala.
Ø

Aim of Anti-Tobacco Legislation
Ø To ban advertisements on tobacco products
Ø To ban smoking in public places
Ø Prohibit sale of cigarettes to minors.
Ø Anti-tobacco health education to be provided
in schools and colleges
Ø Higher taxes on tobacco products
Ø Effective health warnings on the packaging
and labelling
•
•
Ø
Ø Stringent penal provisions to deal with
violators of the law
Ø
Ø Discontinue direct and indirect subsidies
and financial incentives to tobacco
farming and the tobacco industry.
•
•

Legislations Related to Health in
General
Ø The Epidemic Diseases Act, 1897

Ø Indian Air Craft (Public Health) Rules, 1954
Ø The Registration of Births and Deaths Act, 1969
Ø The Persons with Disabilities (Equal Opportunity,
Protection Of Rights And Full Participation)
Act, 1995
Ø The Biomedical Waste (Management And
Handling Rules 1998) Act
•

Legislation Related to Women Health
Ø Hindu Marriage Act, 1955
Ø The Special Marriage Act, 1954
Ø Hindu Succession Act, 1956
Ø The Maternity Benefits Act, 1961
Ø The Dowry Prohibition Act, 1961
Ø Hindu Adoption and Maintenance Act, 1956
Ø The Immoral Traffic (Prevention) Act, 1956;
amended in 1986
Ø The Medical Termination Of Pregnancy Act
1971(The MTP Rules, 1975)
Ø The Pre-natal Diagnostic Techniques (Regulation
& Prevention of misuse) Act, 1994 Rules,
November 26, 1996

Ø The Protection of Women against Sexual
Harassment At Work Place Bill, 2007
Ø Protection of Women from Domestic Violence Act,
2005 (Come into Force on 26/10/2006)
Ø Protection of Women from Domestic Violence Act,
2005
Ø Dowry Prohibition Act, 1961
Ø Dowry Prohibition Rules
Ø Indecent Representation of Women
Ø The Commission of Sati (Prevention) Act and rules
Ø National Commission for Women Act
Ø Amendment Proposed in Immoral Traffic
(Prevention) Act 1956
Ø The Immoral Traffic (Prevention) Amendment Bill,
2006
60
Ø
Legislations Related to Child Health
ØThe Child Marriage Restraint Act, 1929

ØChildren Act, 1960
ØThe Juvenile Justice Act, 1986
ØThe Child Labor (Prohibition and
Regulation) Act, 1986
ØInfant Milk substitute Act, 1992
ØThe Juvenile Justice (Care and Protection
of Children) Amendment Act 2006
ØThe Juvenile Justice (Care and Protection
of Children) Act 2000


Ø The Juvenile Justice (Care and Protection of
Children) Rules
Ø The Commissions for Protection of Child Rights
Act, 2005, 2006
Ø National Commission for protection of Child
Rights Rules, 2006
Ø The Child Marriage Restraint Act, 1929
Ø The Prohibition of Child Marriage Act, 2006
Ø The infant Milk Substitutes, Feeding Bottles and
infant Foods (regulation of Production, Supply
and Distribution) Act, 1992, 2003
Ø
62
Legislations Related to Environment
Ø Factory Act, 1947
Ø The Atomic energy Act, 1962
Ø The Insecticides Act, 1968
Ø The Wild Life (Protection) Act, 1972
Ø The Indian Forest Act, 1972
Ø The Water (Prevention and Control of Pollution) Act,
1974
Ø The Forest (Conservation) Act, 1980
Ø The Air (Prevention and Control of Pollution) Act, 1981
Ø The Environmental (Protection) Act, 1986
Ø The Motor Vehicle Act, 1988
Ø The Natural Environment Tribunal Act, 1995
• SIHFW: an ISO 9001: 2008 certified Institution 63
Legislations Related to Occupation
ØThe Workmen’s Compensation Act, 1923
(Amended In 1984)
ØThe Trade Union Act 1926
ØThe Factories Act, 1948
ØThe Employees States Insurance Act, 1948
ØThe Plantation Labor Act, 1951
ØMines Act, 1952
ØPlantation Labor Act, 1951
ØThe Employee State Insurance Act, 1948
ØThe Factories (Amendment) Act, 1976
ØThe Dangerous Machine (Regulation) Act,
1983 SIHFW: an ISO 9001: 2008 certified Institution 64
Legislations Related to Occupation
ØLegislations related o Human rights
ØThe Equal Remuneration Act, 1976
ØThe Contract Labor (Regulation and
Abortion) Act ,1976
ØIndecent Representation of Women
(Prohibition) Act, 1986
ØThe Commission on Sati (Prevention) Act,
1987
ØThe Minimum Wages Act, 1948
ØThe Consumer Protection Act (CPA) 1986
•
Legislations Related to Medical
Profession
ØThe Indian Nursing Council Act,

1947
ØThe Dentists Act, 1948
ØThe Pharmacy Act, 1948
ØThe Indian Medical Council Act,
1956 (Amended in 1964, 1993)
•

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Health Policies and Legislations

State Institute of Health and Family Welfare, Jaipur

SIHFW: an ISO 9001: 2008 certified Institution 2

SIHFW: an ISO 9001: 2008 certified Institution 3

SIHFW: an ISO 9001: 2008 certified Institution 5

SIHFW: an ISO 9001: 2008 certified Institution 6

SIHFW: an ISO 9001: 2008 certified Institution 8

SIHFW: an ISO 9001: 2008 certified Institution 9

Ø Which reduces the inequities in existing

Ø Allows the disadvantaged sections of

SIHFW: an ISO 9001: 2008 certified Institution 10

SIHFW: an ISO 9001: 2008 certified Institution 11

Ø Health investment and expenditure declined

Ø To achieve standard of good health

SIHFW: an ISO 9001: 2008 certified Institution 14

SIHFW: an ISO 9001: 2008 certified Institution 15

Ø To increase health sector expenditure

SIHFW: an ISO 9001: 2008 certified Institution 16

SIHFW: an ISO 9001: 2008 certified Institution 18

Ø High wanted fertility due to the high infant

Ø Higher fertility due to unmet need for

Ø The large reproductive age-group cohort

SIHFW: an ISO 9001: 2008 certified Institution 19

Year If current trend continues If TFR 2.1 achieved by

SIHFW: an ISO 9001: 2008 certified Institution 20

SIHFW: an ISO 9001: 2008 certified Institution 21

Ø 1946: Bhore Committee Report

SIHFW: an ISO 9001: 2008 certified Institution 22

 1994- report submitted

SIHFW: an ISO 9001: 2008 certified Institution 23

Ø Minimum needs program

SIHFW: an ISO 9001: 2008 certified Institution 25

SIHFW: an ISO 9001: 2008 certified Institution 26

ØVoluntary and informed choice and

Ø Universal access to health related information

Ø Panchayats and Zila Parishads will be rewarded

SIHFW: an ISO 9001: 2008 certified Institution 34

SIHFW: an ISO 9001: 2008 certified Institution 35

Ø UN Convention on the Rights of the Child on

SIHFW: an ISO 9001: 2008 certified Institution 36

Ø Reduce IMR to below 30 by 2010

SIHFW: an ISO 9001: 2008 certified Institution 39

SIHFW: an ISO 9001: 2008 certified Institution 42

SIHFW: an ISO 9001: 2008 certified Institution 43

Ø Legal - judicial system will be made more

SIHFW: an ISO 9001: 2008 certified Institution 45

Ø National and State Councils

SIHFW: an ISO 9001: 2008 certified Institution 46

SIHFW: an ISO 9001: 2008 certified Institution 47

Ø It regulates and prevents misuse of the

Ø Amended again in 2003

SIHFW: an ISO 9001: 2008 certified Institution 48

Ø Written complaint to Appropriate Authority

First offence Subsequent offence

Service Imprisonment (3yrs.); penalty Imprisonment (5yrs.);

Service Imprisonment (3 yrs.); penalty Imprisonment (5 yrs.);

Advertiser Imprisonment (3 yrs.); penalty

SIHFW: an ISO 9001: 2008 certified Institution 51

SIHFW: an ISO 9001: 2008 certified Institution 52

SIHFW: an ISO 9001: 2008 certified Institution 53

Ø 800,000 deaths every year

SIHFW: an ISO 9001: 2008 certified Institution 55