Prevention and

UNIT 4 HEALTH AND POPULATION Management of Diseases

POLICY

Structure
4.1 Introduction
4.2 National Health Policies: Concept and Evolution
4.3 National Health Policy -1983
4.4 National Health Policy - 2002
4.5 National Population Policies: Concept and Evolution
4.6 National Population Policy-2000
4.7 State Population Policies
4.8 Let Us Sum Up
4.9 References and Selected Readings
4.10 Check Your Progress: Possible Answers

4.1 INTRODUCTION
People are a county’s greatest resource. They make singular contributions to
development And, therefore, governments formulate and implement policies and
programmes that are aimed at improving the quality of their human resources.
While population is a crucial factor with respect to development, the health of
the people plays a critical role in transforming them into a qualitative human
resource. That is why policies relating to health and population are considered
very important. The aim of this unit is to discuss health and population policies
adopted in India during pre- and post-independence periods. This unit also
discusses the National Health Programmes in the country.

Health has been accepted as a fundamental right of every one in the constitution
of the World Health Organization (WHO). The Universal Declaration of Human
Rights also incorporates it under Article 25. In view of this, formulation of national
health care policies by individual countries becomes imperative. This is said
because health care by the public sector is weaved through the state, central and
local governments. They enunciate polices, establish health care delivery systems,
set up goals with the major objective of economic and social development, and
improve the quality of life of the people.

In the Indian context, strategies towards preventative, curative and promotive

health care delivery system were initiated during pre-independence days. After
independence, a number of committees were set up to concretize ideas and
strategies for attaining health goals. Since the inception of the planning process
in the country, successive Five Year Plans have been providing the framework
within which the states are free to develop their health service infrastructure and
facilities for medical education. However, it took 36 years after independence to
formulate a comprehensive National Health Policy which was first announced
in 1983. Subsequently, in keeping with public expectations, available financial
resources, and an increase in public health administrative capacity, the National
Health Policy, 2002 was formulated and put into practice, like health, population
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Population and Health Care issues have also been an area of major concern for Indian policy makers. Rapid
population growth has been a major concern in the context of plans and policies
adopted for overall development of the country. In fact, a number of social
scientists hold the view that the large size of population is the mother of all the
problems in the country, and once the issue of rapid population growth is dealt
with, all other problems will automatically get solved. The country, thus, has a
lengthy history of t population policy. In 1952, the Government of India began,
in a modest way, one of the earliest national government sponsored family planning
efforts. A National Population Policy statement was released by the Government
of India on 16th April, 1976. The population strategies adopted after independence
went through many changes. It was only in 2000, that a comprehensive National
Population Policy was announced by Government of India.
After studying this unit you should be able to
• explain National Health Policies
• narrate National Population Policies

4.2 NATIONAL HEALTH POLICIES: CONCEPT

AND EVOLUTION
4.2.1 National Health Policy: The Concept
A health policy is an expression of what a health care system should be, so that
it can meet the health care needs of the people. The World Health Organization’s
concept of healthy public policy is placing health on the agenda of policy makers
in all sectors and at all levels, directing them to be aware of the health
consequences of their decisions, and to accept their responsibilities for health
(WHO 1986). Governments are ultimately responsible for providing or organizing
how the health services will be provided to their citizens. Health policies are
dynamic, and thus, need to be reviewed on a regular basis to ensure that these are
a reflection of government’s vision and priorities taking into account the changing
realities and socio-cultural circumstances of the country.

Health is a state subject in India. As India has a federal system of government, its
Constitution provides for a clear division of powers between States and the Centre
through three Lists, The Union List, the State List and the Concurrent List. The
State List consists of subjects of local interest such as Public Health, Police, etc.
However, health, today, forms an integral part of the national socio-economic
planning providing a holistic understanding of health with the framework that
States need to pursue to achieve the goals of development. A beginning was
made even during the colonial days. After independence, India adopted the welfare
state approach, wherein a national health system was envisaged. The State’s role
was to be central to providing services to the population. The health activities
for the State were formulated through the five year plans. Each plan period had
a number of schemes and every subsequent plan added a few more and dropped
a few others.

4.2.2 National Health Policy: The Evolution

The current National Health Policy has emerged from the continuous process of
reviews by various committees constituted at intervals to provide guidelines to
the government for national health planning. These committees are as follows.
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The Health Planning and Development Committee Report, popularly known as Health and Population
Policy
Bhore Committee Report, 1946, were on the lines of Britain’s National Health
Service Scheme. Sir Joseph Bhore made recommendations that formed the basis
for organization of basic health services in India. He made a case for social
orientation of medical practice coupled with high a level of public participation.
The following were the salient recommendations of the Bhore Committee
• Integration of preventive and curative services at all administrative levels
• Formation of Village Health Committees
• Provision of Social Doctor
• Intersectoral approach to development of health services
• Three month training programmes in preventive and social medicine to
prepare social physicians
Taking a clue from the Bhore Committee Report, a beginning was made in 1952
to set up primary health centres to provide integrated promotive, preventive,
curative, and rehabilitative services to the entire rural population of the country.
i) Health Survey and Planning Committee Report or Mudaliar Committee
Report, 1962 stressed on developing health services infrastructure and the
health cadre at the primary level. It also recommended setting up of grassroots
level workers in the form of auxiliary nurse midwife.
ii) Chadha Committee Report (1963) called for adoption of the malaria
eradication programme.
iii) Mukerji Committee Report (1966) worked out the details of the Basic Health
Services to be provided in rural and urban areas.
iv) Jungalwalla Committee Report (1967) recommended integration of all variety
of health services.
v) Kartar Singh Committee Report (1973) gave recommendations on procedure
for the distribution of health cadres at the primary level.
vi) Srivastava Committee Report (1975) on Medical Education and Support
Manpower recommended creation of bands of para professionals and semi
professional health workers from within the community, e.g., school teacher
and postmasters, to provide simple promotive, preventive, and curative health
services needed by communities. On the pattern of the University Grants
Commission, the establishment of a Medical and Health Education
Commission for planning and implementing reforms needed in health and
medical education was recommended.

Besides these committees, the implementation of a Rural Health Scheme, initiated

in 1977, made contributions to the improvement of health infrastructure and
services. Under this scheme medical colleges were involved in imparting total
health care to the selected PHCs, with the aim of reorienting medical education
to the needs of the rural people, and, also to provide training to multipurpose
workers engaged in the control of various communicable disease programmes.

Finally, with the widespread disillusionment with vertical programmes,

worldwide, and, the need to provide universal health services, came the Primary
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Population and Health Care Health Care Declaration at Alma Ata in 1978, which India was a signatory to.
Accordingly, steps were taken to promote education concerning prevailing health
problems; ensure adequate supply of safe water and basic sanitation; provide
maternal and child health care including family planning, and immunization;
ascertain prevention and control of locally endemic diseases; effect appropriate
treatment of common diseases and injuries; promote mental health; and, provide
essential drugs. On the whole, it emphasized an integration of preventive,
promotive, curative and rehabilitative health services that had to be made
accessible and available to the people. Evidently, by the end of 1980s, India had
built up a vast health infrastructure and initiated several national health
programmes, commissions, constituted and the Central Council of Health and
Family Welfare. However, there was a growing realization that public health
initiatives in the country did not meet with the desired success. In 1983, the
government made a major move in the health sector by announcing a National
Health Policy as a corrective measure.

In this section, you read the basic concept and evolution of the National Health
Policy in India. Now attempt the questions given in Check Your Progress-1.

Check Your Progress 1

Note: a) Write your answer in about 50 words.
b) Check your answer with possible answers given at the end of the unit.
1) Write a brief note on Health Committees constituted in India.
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4.3 NATIONAL HEALTH POLICY – 1983

The Alma Ata Declaration of 1978 propounded the concept of ‘Health for All’
by Year 2000. It was signed by 134 countries, including India, and 67 agencies.
The declaration advocated the provision of first contact services and basic medical
care with the framework of an integrated health services. The Declaration affirmed
that it is the responsibility of the State to provide comprehensive primary health
care to its people. This led to the formulation of India’s first National Health
Policy (NHP) in 1983. The major goal of NHP-1983 was to provide universal,
comprehensive primary health care services. It also underlined the role of private
and voluntary organizations towards integration of health services.

4.3.1 Feature of NHP-1983

Some of the important features of National Health Policy 1983 are
i) Need for providing primary health care with special emphasis on the
preventive, promotive and rehabilitative aspects.

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ii) Population stabilization- the policy emphasized small families through voluntary Health and Population
Policy
efforts and moving towards the goal of population stabilization.
iii) Medical and Health Education- emphasis was laid on the effective delivery of
health care services that would depend largely on the nature of education, training,
and appropriate orientation towards community health for all categories of medical
and health personnel, and their capacity to function as an integrated team.
iv) Re-orientation of the existing health personnel- The policy emphasized changes
and innovation that were required to be brought about in the entire approach to
health and manpower development, ensuring the emergence of fully integrated
bands of workers functioning within the “ Health Team” approach.
v) Practitioners of indigenous and other systems of medicine and their role in
healthcare- the policy envisaged that the country has a large stock of health
manpower comprising of private practitioners in various systems such as
Ayurveda, Unani, Sidha, Homeopathy, Yoga, Naturopathy, etc. These
resources have not so far been adequately utilized. The practitioners of these
systems enjoy high local acceptance and respect at the community level. It
is, therefore, necessary to initiate organized measures to enable each of these
systems of medicine and healthcare to develop in accordance with its genius.

4.3.2 Implications of NHP

In pursuance of this policy, an effective and efficient health care system for its
citizens, particularly for the vulnerable groups like women, children and the
underprivileged, was proposed to be established. This noteworthy initiative aimed
at reaching the entire population with a package of primary health care. Stress
was placed on the creation of an infrastructure for primary health care covering
related services and activities like nutrition, drinking water supply, and sanitation;
active involvement and participation of voluntary organizations; provision of
essential drugs and vaccines; qualitative improvement in health and family
planning services; and provision of adequate training and medical research. The
slogan of NHP-1983 ‘Health for All by 2000 AD’ could not be achieved due to
constraints of financial resources and inadequate capacity of health infrastructure.
However, the policy was successful in eradication of small pox and guinea worm
disease. Polio came on the verge of being eradicated. Leprosy, kala azar and
filariasis were expected to be wiped out in the foreseeable future. Meanwhile,
the deadly communicable disease- HIV/AIDs appeared on the scene. An
improvement in the life expectancy increased the requirement of care of older
people. A high incidence of macro and micro nutrient deficiencies, especially
among women and children persisted. Achievements in health services
infrastructure were quite high as an outcome of NHP-1983, but the system
continued to suffer from widening inequities in access to health care and quality
of care. Whenever public facilities for medical care were used, urban hospitals
are preferred (NSS, 1987, NCAER, 1992). The objectives of decentralization
were achieved to some extent but community participation was missing.
Epidemiological surveillance services, which the NHP, 1983 had strongly
recommended, were not adequately addressed. It became imperative to work on
another policy document which addresses the health concerns of the people
through more holistic and effective guidelines.

4.4 NATIONAL HEALTH POLICY – 2002

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Population and Health Care 4.4.1 Goal of NHP
The country could not achieve most of the goals in NHP-1983, despite some
notable gains made in health outcomes, and vast improvements in the availability
of health infrastructure. The second National Health Policy was announced in
2002. Demographic changes, transitions in the occurrence of new diseases,
technological advancements, rising aspirations of communities, and the rise in
the impact of globalization on the country necessitated the adoption of a new
policy. The major objective put forth by NHP-2002 is to achieve an acceptable
standard of good health among the general population. It aims to identify deficient
areas, establish requisite infrastructure, and ensure equitable access to health
services across the social and geographical expanse of the country. It expects to
strengthen the public health system at state level; encourage private sector
involvement in service delivery, particularly for the population groups that can
afford to pay; increase allocation to preventive services, strengthen curative
initiatives at the primary health level, and work for rational use of drugs.
The NHP-2002 specified several time-bound goals.
Major goals to be achieved Year
Eradicate polio and yaws 2005
Eliminate leprosy 2005
Eliminate kalaazar 2010
Eliminate lymphatic filariasis 2015
Achieve zero level growth of HIV/AIDS 2007
Reduce mortality by 50 per cent on account of TB, 2010
Malaria, Other Vector and Water Borne Diseases
Reduce prevalence of blindness to 0.5 per cent 2010
Reduce IMR to 30/1000 and MMR to 100/lakh 2010
Increase utilization of public health facilities from current 2010
level of < 20 per cent to > 75 per cent
Establish an Integrated System of Surveillance, National 2005
Health Accounts and Health Statistics
Increase health expenditure by government as a per cent 2010
of GDP from the existing 0.9 per cent to 2 per cent
Increase share of central grants to constitute at least 2010
25 per cent of total health spending
Increase state sector health spending from 5.5 per cent 2005
to 7 per cent of the budget
Further increase to 8 per cent 2010

4.4.2 Features/Measures of NHP-2002

The goals of NHP -2002 were to be addressed through following measures
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i) Financial Resources: the policy prescribes the role of Central government in Health and Population
Policy
augmenting public health investments and ensuring a fiscal health of the public
delivery system.

ii) Role of Private Sector: the policy hails the role of private sector in primary,
secondary and tertiary sectors. Private health insurance packages are
proposed to be encouraged. The use of telemedicine for enhancing the
capacity of professionals is favoured.

iii) Impact of Globalization on the Health Sector: in order to provide

affordable access to the medical and other associated facilities, the policy
envisages a national patent regime for the future, under its patent laws. It
also sets out that the Government will bring its full influence to contain the
adverse effects of the Trade Related Intellectual Property Rights (TRIPS)
on health sector.

iv) Role of Local Self-Government Institutions: different levels of the local

self-government are being enabled through the NHP-2002 to supervise and
ensure effective implementation of the health sector.

v) Role of Civil Society: the policy highlights the roles of NGOs and other
institutions of the civil society in the health sector. It also simplified the
procedures for augmenting the role of such institutions in supplementing
the public health services.

vi) Equity: an uneven divide is evident amongst the population in rural and
urban areas, and across different economic groups in terms of health indices,
including the population below the poverty line, infant mortality rate, under
five mortality, maternal mortality rate, leprosy, and malaria. To address this
issue, NHP-2002 prescribes increased allocation of 55 per cent of the public
investment in health in the primary health care sector, 35 per cent to the
secondary sector, and the remaining 10 per cent to the tertiary sector.

vii) Extending Public Health Services: the private practitioners are also to
contribute towards the underserved areas and the rural areas. In order to
ensure the availability of trained manpower in underserved areas, the policy
empowers the States to simplify the recruitment procedures. The State
governments may enforce a mandatory two-year rural posting before
awarding of the graduate degree. An effort to Indian System of Medicine is
also to be attempted through NHP-2002.

viii) The State of Public Health Infrastructure: NHP 2002 will assess the
quality and efficiency of the existing public health system in the field. The
rural health staff is required to be trained and reoriented to perform better.
While greater emphasis has been laid on strengthening of primary health
infrastructure, the policy recognises the need for levying reasonable user
charges for certain secondary and tertiary public health care services for
those who can afford to pay.

ix) Medical Ethics: the policy calls for adoption of a contemporary code of ethics
by the Medical Council of India to ensure that patients are not subjected to
profit-driven medical treatment.

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Population and Health Care x) Enforcement of Quality Standards for Food and Drugs: the policy proposes
strengthening of food and drug administration in terms of both laboratory facilities
and technical experts.

xi) Regulation of Standards in Paramedical Disciplines: the policy recognizes

the need for the establishment of statutory professional councils for paramedical
disciplines to register practitioners, maintain standards of training, and monitor
performance.

xii) Norms for Health Care Personnel: deficiencies with respect to the deployment
of doctors and nurses are to be effectively managed through the statuary norms
prescribed under the Indian Medical Council Act and Indian Nursing Council
Act.

xiii) Education of Health Care Professionals: the policy recommends setting up a

Medical Grants Commission for funding new government medical and dental
colleges in different parts of the country. A need to modify the existing curriculum
is also underlined.

xiv) Nursing Personnel: the policy calls for improving the ratio of nurses vis-à-vis
doctor/and beds, and strengthening their skill levels.

xv) Need for Specialists in Public Health and Family Medicine: highlighting the
role of Public Health and Family Medicine specialist’s vis-à-vis the clinical
specialists in a developing country like India, the policy recommends an allocation
of a reasonable number of seats for public health and family medicine candidates.

xvi) Use of Generic Drugs and Vaccines: the policy favours the production of low
cost and high quality indigenously manufactured generic drugs and vaccines. It
envisages that not less than half of the vaccines are supplied through public
sector institutions.

xvii) Urban Health: the policy envisages setting up of an organized urban primary
health care structure, particularly for the slum localities. It also suggests measures
to reduce mortality associated with accidents.

xviii) Mental Health: the policy intends to remove deficiencies in the existing physical
infrastructure and manpower related to mental health.

xix) Women’s Health: the policy favours health programmes meant for women. Such
programmes are to be given funding on a priority basis by the Central government.

xx) Information, Education and Communication: the policy highlights the need to
evolve an IEC policy, especially by inculcating health promoting behaviour among
school children.

xxi) Health Research: the policy looks for an increase in the government funding of
health research from a level of 1 per cent of total spending in 2005 to 2 per cent
by 2010. Cost effective applied research is noted as a critical area. Research
programmes need to be conducted in mission mode.

xxii) Health Statistics: NHP-2002 lays emphasis on generating accurate data-base

for various diseases for framing suitable strategies. The policy suggests the
establishment of national health accounts.
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xxiii) Delivery of National Public Health Programmes: NHP-2002 envisages the Health and Population
Policy
gradual convergence of all health programmes. It attempts to define the role of
the Central Government and the State Governments in this regard.

xxiv)National Disease Surveillance Network: The policy attempts to put in place

disease control network to manage seasonal outbreaks of diseases more
effectively. The intention is to promote timely spread of information from
institutions outside public system.

xxv) Environmental and Occupational Health: The policy observes that the
environmental policies and other related programmes should be framed in
such a way that these take care of the health of citizens. A periodic screening
of workers engaged in high risk labour activities is suggested.

xxvi)Providing Medical facilities to Users from Overseas: The policy favours

provisions of health services to overseas patients in secondary and tertiary
sectors to earn foreign exchange.

Thus, the new Health Policy-2002 highlights the need of improving the access
to health services among all social groups and in all areas. This is to be done by
setting up new facilities in deficient areas and improving the existing ones.
Recognizing that women and other underprivileged groups are most affected by
poor access to health care, it calls for special treatment to them. NHP-2002
proposes a substantial increment in government expenditure on health care. It,
however, represents a retreat from the fundamental concept of ‘Health for All’
by 2000 as laid down by NHP 1983. In contrast, NHP-2002 has omitted the
concept of comprehensive and universal health care. In fact, primary health care
has been reduced to primary level care. Nonetheless many of its formulations
paved the way for greater privatization of the system.

In this section, you read two national health policies 1983 and 2002. Now, answer
the question given in Check Your Progress 2.
Check Your Progress 2
Note: a) Write your answer in about 50 words.
b) Check your answer with possible answers given at the end of the unit.
1) What are the objectives of NHP-2002?
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4.5 NATIONAL POPULATION POLICIES:

CONCEPT AND EVOLUTION
4.5.1 Evolution
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Population and Health Care Rapid population growth was identified as matter of concern even before India became
independent. The National Planning Committee set up by the Indian National Congress
in 1935, under the Chairmanship of Pt. Jawahar Lal Nehru, had strongly supported
propagation of the knowledge and practice of family planning. The Bhore Committee,
constituted in 1946 voiced concern when it observed that the public health system, as
it existed in the country, would not be able to meet the demands posed by growing
population, and advocated a need for limiting the family size.
After independence, the Planning Commission, Government of India, highlighted the
urgency of the problem of family planning and population control. This constituted a
vital component of the First Five Year Plan. In 1952, India launched the National
Family Planning Programme. The overall emphasis was on family planning for lowering
the birth rate in order to ‘stabilize the population at a level consistent with the
requirements of national economy’.
Observance of the small family norm by all, thus, became the goal to be achieved
through family planning. In the beginning, modern contraceptive methods of
family planning methods were not inducted. Various efforts were made to make
people aware about the benefits of small family size through activities focused
on maternal and child health care. Adoption of natural methods of contraception
for limiting the family size was favoured.
This programme achieved limited success. The majority of the family planning
clinics established were located either in urban areas or in large villages, leaving
a sizeable population uncovered. Taking into account the shortcomings associated
with this, the clinic based approach was replaced in 1963 by the extension
approach. In the new approach, the Auxiliary Nurse Midwife (ANM) was to
visit the houses of married couples in order to provide family planning services
at their doorsteps. New methods of contraceptives were introduced.
The year 1966-67 marked a paradigm shift in the Family Planning Programme
when method-specific family planning targets were fixed and allocated. A number
of officials from the health department, along with other departments, were
assigned family planning targets to be achieved on an annual basis with the prime
goal of lowering the birth rate. However, this led to certain distortions. The
programme was plagued with fake reporting of the family planning achievements
by different officials in order to escape penalties associated with non-compliance
of fixed targets. The 1971 Census revealed that the demographic goals, set up in
1962, had not been achieved.
The experience of two years, 1975-77, during the period termed, The Emergency,
were monumental in the context of shaping of India’s population policy. In 1976,
the first statement towards National Population Policy spread its net beyond
family planning measures, which included measures like raising the marriageable
age limit, promoting female literacy, providing employment opportunities to
women, and reducing high infant mortality rate. The opening paragraphs of the
National Population Policy statement argued that
i) Reducing the rate of population increase “will be treated as a top national
priority and commitment”
ii) “To wait for education and economic development to bring about a drop in
fertility is not a practical solution”

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iii) Population control must play a crucial role in the movement towards independence Health and Population
Policy
and social transformation.

In actual fact, the Policy Statement on the Family Welfare Programme came in 1977.
It encouraged state governments to pass legislations to enhance community participation
for promoting small family size norms. Such statements, tabled in parliament were
neither discussed nor adopted. There were political implications of reduction of birth
rate at the state level. Since political representation in Parliament was determined by a
State’s population size, a fear was expressed that its slower population growth rate
would result in a loss of relative influence through a drop in the number of seats in the
national parliament. To safeguard against this possibility, representation in parliament,
as also in state legislatures was frozen up to the year 2001, retaining the population
enumerated at the 1971 Census as the base.

Motivation, which had been a part of the family planning programme, was supplemented
by coercion and with the use of incentives, and later with harsher measures. In 1975,
earnest efforts were made for the promotion of male-centred vasectomy to slow the
rate of population growth. A coercive campaign was adopted to sterilize couples who
already had three or more children. The programme got a severe setback due to the
overemphasis on vasectomies. The programme suffered due to the ill effects of a
coercive strategy. The number of vasectomy acceptors sharply declined after 1976-
77, making it more or less a female oriented programme.

In 1977-78, the Government of India took measures to shift away from coercive
actions, and the programme was to be implemented as an integral part of family
welfare, based on mass education and motivation. The name of the programme
was changed from National Family Planning Programme to National Family
Welfare Programme.

In another damage control exercise, the National Health Policy-1983 stressed

the need for adhering to small family norms through voluntary efforts. For
attaining the goal of population stabilization, the goal to achieve the replacement
level by 2000 was targeted. This has guided the Family Planning Programme
since then.

In the year 1992 population policy initiatives were adopted. The 73rd and 74th
Constitutional Amendments were introduced enabling the Panchayati Raj
Institutions (PRIs) and urban local bodies (ULBs), among others, to carry out
the task of primary health care and primary education. The provision of basic
amenities including the drinking water and roads, became the responsibility of
PRIs and ULBs. The focus of the programme shifted from population control to
community outreach services.

In 1994, the Swaminathan Committee was assigned the task of framing the new
population policy. The draft National Population Policy incorporated a number
of suggestions made at the International Conference on Population and Development
(ICPD) held in Cario in 1994. Unlike the earlier population policy statements of 1976
and 1977, the draft of the National Population Policy was widely circulated among
the members of Parliament and others. This was discussed by the cabinet, followed
by discussion in Parliament. Most notably, method specific contraceptive targets were
abolished in 1996 and were replaced by the Target-Free Approach, later renamed as
Community Needs Assessment Approach (CNAA). The agenda shifted from
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Population and Health Care population control to reproductive and child health (RCH) in 1997. In particular,
women’s empowerment gained momentum.

The draft national population policy was approved by the Cabinet with the direction
that this be placed before Parliament. Several suggestions were made during the
deliberations. On that basis, a fresh draft was submitted to the Cabinet. Finally, in
2000 the National Population Policy was announced.

4.6 NATIONAL POPULATION POLICY – 2000

The goals, objectives and strategies of the National Population Policy (2000) centre
on family planning and maternal and child health. It envisages development of one-
stop integrated and coordinated service delivery at the village level on these two
parameters. This involves partnership of the government with non-government voluntary
organizations.

The NPP 2000 has laid down objectives at three times frames: immediate, medium
term, and long term. The immediate objective is to cater to the unmet need for
contraception, health infrastructure, and health personnel, and to integrate service
delivery for basic reproductive and child health care.

The medium term objective is to effectively implement inter sectoral strategies

to bring down the total fertility rate (TFR) to a replacement level by 2010. The
long term objective is to achieve a stable population by 2045, at a level consistent
with the requirements of sustainable economic growth, social development and
eco-conservation.
A) National Socio-Demographic Targets to be achieved by 2010: Fourteen
such targets, as follows, were set to be achieved.
i) Fulfil the unmet need for basic reproductive and child health services,
supplies and infrastructure.
ii) Make school education free and compulsory for children up to 14 years,
and reduce the dropout rate for both boys and girls at primary and
secondary school levels to below 20 per cent.
iii) Bring infant mortality rate below 30 per 1000 live births.
iv) Bring maternal mortality ratio to below 100 per 100,000 live births.
v) Achieve 100 per cent immunization of children against all vaccine
preventable diseases.
vi) Encourage the increase in age-at—marriage of girls, not earlier than
age 18, and, preferably, after 20 years of age.
vii) Increase institutional deliveries to 80 per cent and deliveries by trained persons
to 100 per cent.
viii) Achieve universal access to information/counselling, and services for fertility
regulation and contraception with a wide basket of choices.
ix) Increase registration of births, deaths, marriage and pregnancy to 100 per
cent.
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 x) Enhance the IEC coverage for RTIs/STIs/AIDS to wider population. Health and Population
Policy
xi) Prevent and control communicable diseases.
xii) Integrate allopathic medicine with Indian Systems of Medicine (ISM) for
better provision of reproductive and child health services, and for reaching
out to households.
xiii) Encourage strongly the small family norm to achieve the replacement level of
TFR.
xiv) Coordinate the implementation of related social sector programs to make
family welfare programme people-centric.
B) Strategies for NPP-2000: the strategy for NPP includes the following 12
measures.
i) Decentralization of the Plan and Programme Implementation
ii) Convergence of service delivery points in villages
iii) Empowering women for mitigating health and nutrition problems
iv) Strengthening child health and survival care
v) Fulfilling the unmet need for family welfare
vi) Meeting the needs of the vulnerable and underserved population groups
constituting urban slums, tribal communities, hill area populations,
displaced and migrant populations, adolescents and men in planned
parenthood
vii) Providing encouragement and incentives to diverse health care
providers
viii) Collaborating with the Commitments from NGOs and private sector
ix) Channelling Indian Systems of Medicine and Homeopathy
x) Strengthening contraceptive technology and research on RCH
xi) Providing for older population
xii) Improving information, education, and communication technology for
health care services.
C) New Structures to be established under NPP-2000: four new structures,
as follow, were established under the policy.
i) National Commission on Population
ii) State/UT Commissions on Population
iii) Coordination Cell in the Planning Commission
iv) Technology Mission in the Department of Family Welfare
i) National Commission on Population: as recommended by NPP-2000, the
National Commission on Population was constituted on 11th May 2000, the
day when India reached one billion population marks. It has the Prime
Minister of India as its Chairman, Deputy Chairman Planning Commission
as Vice Chairman, Chief Ministers of all states, Ministers of the concerned
Central Ministries, Secretaries of the concerned Departments, eminent
demographers and representatives of the civil society as members. The
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Population and Health Care mandate of the Commission was to guide the implementation of the National
Population Policy in achieving the goals, to hasten population stabilization
by promoting synergy between health, educational environmental and
developmental programmes, to promote inter sectoral coordination in
planning and implementation of the programmes at the Centre and States,
and to facilitate the development of a vigorous people’s movement in support
of this national effort.

ii) State/UT Commissions on Population: State Population Commissions have

also been commissioned in as many as 21 States/ UTs. The initiation of the
process of policy formulation undertaken at the state level is expected to
achieve the goals setup in NPP – 2000 (MOHFW, 2008-2009).

iii) Coordination Cell in the Planning Commission: in place of a coordination

cell, a policy convergence has been set up.

iv) Technology Mission in the Department of Family Welfare: in place of a

Technology Mission in the Department of Family Welfare, an Empowered
Action Group (EAG) has been created.

D) Legislation
For pursuing the agenda for population stabilization of NPP-2000, the 42nd
Constitutional Amendment has frozen the number of seats in Lok Sabha and
Rajya Sabha till 2026, with the 1971 Census as the base.

E) Adoption of Small Family Norm Promotion Measures: twenty such

measures are summarized below.

NPP-2000 does not include disincentives. Rather, it has measures for promotion
and motivation for achieving the small family norm. In the past, the incentives
were linked with sterilizations. In the policy, these incentives are liked to poverty,
delayed marriage, delivery care, birth registration, birth of a girl child, and
immunization.
• Incentives to Panchayats and Zila Parishads for achieving small family
norms, especially by reducing infant mortality.
• Couples below the poverty line undergoing sterilization after two children
to be given health insurance
• Improving the status of women by giving some incentives at the birth of girl
child Contraceptive choice to be widened and made more accessible
• Safe abortion facilities to be expanded and strengthened
• Strict enforcement of legal reforms, including Child Marriage Restraint Act,
1976 and Pre-Natal Diagnostic Techniques Act, 1994

NPP recognized that there is a large need to augment and strengthen health care
services as well as to cater to the unmet needs for contraception. Though the
NPP-2000 mentioned sustainable development, quality of life, education, equity,
gender issues, and raising the age at marriage, the emphasis remained primarily
on the family planning programme. As such, the specific goal of achieving
replacement level fertility by the year 2010 appears quite unrealistic.
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 Health and Population
4.7 STATE POPULATION POLICIES Policy

In the spirit of NPP-2000, 17 States/ UTs including Andhra Pradesh, Bihar,

Chhattisgarh, Gujarat, Haryana, Madhya Pradesh, Rajasthan, Tamil Nadu, Uttar
Pradesh, Uttaranchal, Mizoram, Tripura, Andaman & Nicobar Islands,
Chandigarh, Dadar and Nagar Haveli, Daman and Diu, and Lakshadweep, have
formulated their own State Specific Population Polices, defining the strategies
and programmes to be followed to attain the goals set that have been outlined.

In this section, you studied the concept and evolution of population policies
followed at national as well as state level. Now, answer the questions given in
Check Your Progress 3.

Check Your Progress 3

Note: a) Write your answer in about 50 words.
b) Check your answer with possible answers given at the end of the unit
1) What are the major objectives of the National Population Policy-2000?
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
2) What are the new structures recommended by NPP-2000?
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................

4.8 LET US SUM UP

With the growing realization that public health initiatives had not met with the
desired success, a National Health Policy, in 1983, was adopted as a corrective
measure. NHP-1983 adopted the slogan ‘Health for All by 2000 AD’. This goal,
too, could not be achieved due to constrained financial resources and inadequate
capacity in the public health sector. The policy was, however, successful in the
eradication of small pox and guinea worm disease. Achievement of an acceptable
standard of good health for all became the hallmark of NHP-2002. Within three years
of its adoption, NRHM, a strategic framework to implement NHP-2002, was launched
in 2005 to provide effective health care to the rural population. It adopted the key
guidelines of NHP-2002.

It was realized that not much headway was likely to be made in improving the health
of people unless the population was stabilized. In order to achieve the desired growth
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Population and Health Care rate of population, a series of declarations on population issues were enunciated. A
formal National Population Policy was articulated in 2000. It underlined goals,
objectives and strategies centred around family planning and maternal and child health.
As envisaged in the policy, the National Commission on Population was set up in
2000 at the Centre. By now State and Union Territories Commissions on Populations
have also been put in place in as many as 21 States and Union Territories.

4.9 REFERENCES AND SELECTED READINGS

Kulkarni, P.M. (2009), Shaping India’s Population Policy and Programme: Internal
Factor and External Influences, Artha Vijnana, Vol. LI, No. 1, March 2009.

Ministry of Health and Family Welfare (1983), National Health Policy-1983,

Government of India, Nirman Bhawan, New Delhi.

Ministry of Health and Family Welfare (2002), National Health Policy-2002,

Government of India, Nirman Bhawan, New Delhi.

Ministry of Health and Family Welfare (2002), National Population Policy-2002,

Department of Family Welfare, Government of India, Nirman Bhawan, New
Delhi.

Ministry of Health and Family Welfare (2003), Annual Report- 2002-03,

Government of India, Nirman Bhawan, New Delhi.

Ministry of Health and Family Welfare (2009), Annual Report- 2008-09,

Government of India, Nirman Bhawan, New Delhi.

Srinivasan, K. (2006), Population Policies and Family Planning Programmes

in India: A Review and Recommendations. International Institute for Population
Sciences (IIPS), Newsletter, January 2006, Mumbai.

Stycos, J.M. (1977), Population Policy and Development, Population and

Development Review, Vo. 3, 1 /2 / 103-112.

4.10 CHECK YOUR PROGRESS: POSSIBLE

ANSWERS
Check Your Progress 1
1) Write a brief note on Health Committees constituted in India?
Ans. The various health committees constituted in India since independence.
Health Survey and Planning Committee Report or Mudaliar Committee
Report, 1962 laid stress on developing health services infrastructure and the
health cadre at the primary level. It also recommended setting up of grassroots
level workers in the form of auxiliary nurse midwives. Chadha Committee Report
(1963) called for the adoption of malaria eradication programme. The Mukerji
Committee Report (1966) worked out the details of the basic health services to
be provided in rural and urban areas.

Check Your Progress 2

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1) What are the objectives of NHP-2002? Health and Population
Policy
Ans. The major objective of NHP-2002 is to achieve an acceptable standard of
good health among the general population. It aims to identify deficient areas,
establish requisite infrastructure, and ensure equitable access to health services
across the social and geographical expanse of the country. It expects to strengthen
the public health system at the state level; encourage private sector involvement
in service delivery, particularly for the population groups that can afford to pay;
increase allocation to preventive services, strengthen curative initiatives at the
primary health level, and work for rational use of drugs.

Check Your Progress 3

1) What are the major objectives of the National Population Policy-2000?
Ans. The NPP 2000 has laid down objectives at three time frames: immediate,
medium term, and long term. The immediate objective is to cater to the
unmet need for contraception, health infrastructure, and health personnel,
and to integrate service delivery for basic reproductive and child health
care. The medium term objective is to effectively implement inter sectoral
strategies to bring down the total fertility rate (TFR) to a replacement level
by 2010. The long term objective is to achieve a stable population by 2045,
at a level consistent with the requirements of sustainable economic growth,
social development, and eco-conservation.

2) What are the new structures recommended by NPP-2000?

Ans. Four new structures, including the National Commission on Population,
State/UT Commissions on Population, Coordination Cell in the Planning
Commission, and Technology Mission in the Department of Family Welfare
were proposed to be established under the NPP-2000. The National
Commission on Population was set up in 2000. State Population
Commissions have also been commissioned in as many as 21 States/UTs.
In place of a coordination cell, a policy convergence has been setup. In
place of a Technology Mission in the Department of Family Welfare, an
Empowered Action Group (EAG) has been created.

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