COUNTRY HEALTH PROFILE - INDIA 

SECTION 1: TRENDS IN POLICY DEVELOPMENT
 
India is currently in the process of developing a new national health policy (NHP- 2001). The existing national health policy (NHP) was adopted in 1983. Its main focus was the formulation of an integrated and comprehensive approach towards future development of health services, appropriately supported by medical education and research, with special emphasis on PHC and related support services. During the 7th five-year plan (FYP), there was considerable achievement in terms of establishment of a health infrastructure, especially in rural areas. The 8th FYP (1992-97) identified "human development" as its main focus, with health and population control listed as two of six priority objectives. It was emphasized that health facilities must reach the entire population by the end of the 8th plan. The plan also identified peoples’ initiative and participation as a key element. With the  enactment of the 73rd Constitutional Amendment Act (1992), Panchayati Raj Institutions (PRIs) were revitalized and a process of democratic decentralization ushered in, with similar provisions made for urban local bodies, municipalities and nargapalikas.

Recognizing the importance of sustainable development, a national conservation strategy and a policy statement on environment and development were formulated in 1992 to bring environmental considerations into the developmental process. Linkages were drawn between poverty, population growth and the environment. The NHP identified nutrition as a problem needing urgent attention and in 1993 a national nutrition policy was formulated with long and short-term strategies.

The vertically structured family welfare programme needed to be replaced by a more democratic, decentralized alternative. In 1994 a draft national population policy was submitted to parliament as well as a revised report in 1996. It advocated a holistic,
multisectoral approach towards population stabilization, with no targets for specific contraceptive methods except for achieving a national average total fertility rate (TFR) of 2.1 by the year 2010. This has resulted in a radical shift in implementation from centrally fixed targets to a target-free dispensation through a decentralized, participatory approach. A Population and Social Development Commission was also established in support of the population policy.

India has accepted the recommendations of the ICPD (1994) and has also ratified various international conventions for securing equal rights for women. Following the World Summit on Survival, Protection and Development of Children in 1990, India  formulated a Plan of Action for Children in 1992 with actions that directly and indirectly affect child health.

Despite the commitment to HFA, enormous health problems still need to be addressed. While overall mortality has declined considerably, living standards are still among the poorest in the world. The major constraints facing the health sector are lack of 
resources, lack of an integrated multisectoral approach, insufficient IEC support, poor involvement of NGOs, inadequate laboratory services, a manually operated health management information system (HMIS), poor disease surveillance and response systems, and the heavy investments needed in dealing with noncommunicable diseases. The problems of gender disparity still manifest themselves in various forms, as evidenced by the declining female to male population ratio, social stereotyping, violence at the domestic and social level, and continuing open discrimination against the girl child, adolescent girls and women. 

Thus the period after the last National Health Plan was announced in 1983 has seen major developments in India. There has been an increase in mortality through ‘life-style’ diseases- diabetes, cancer and cardiovascular diseases. The increase in life expectancy has increased the requirement for geriatric care. Similarly, the increasing burden of trauma cases is also a significant public health problem. The changed circumstances relating to the health sector of the country since 1983 have generated a situation in which the government has undertaken steps to formulate a new policy framework as the National Health Policy-2001. 

The draft NHP-2001 attempts to set out a new policy framework for the accelerated achievement of Public health goals in the socio-economic circumstances currently prevailing in the country.

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