Health in twelfth Five Year Plan (2012-2017)-An
overview
09-10-2018
Presenter
Dr. Ramadass S.
Senior Resident
Centre for Community Medicine
All India Institute of Medical Sciences, New Delhi
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Outline
• Introduction
• History of Planning commission
• Functions of planning commission
• Organisation
• Why 12th plan is important?
• HLEG on UHC
• Guiding principles
• Outcome indicators of 12th Plan
• Planning Commission to NITI Aayog
• Conclusion
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History of Planning Commission
• Set up by a Resolution of the Government of India in March 1950
• Objectives:
To promote a rapid rise in the standard of living of the people by
efficient exploitation of the resources of the country
Increasing production and offering opportunities to all for
employment in the service of the community
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Functions of Planning Commission
• Assessment of the material, capital and human resources of the country
• Formulate a Plan for the most effective and balanced utilisation of
country's resources
• Determination of priorities, stages to carry out plan and propose the
allocation of resources
• Indicate the factors which are tending to retard economic development
• Determine the nature of the machinery necessary for the successful
implementation of Plan
• Appraise from time to time the progress achieved
• Make recommendation for policy formulations
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Organization
1. Chairman – Prime Minister of India
2. Deputy Chairman
3. Minister of state (Planning)
4. Members
5. Member Secretary
6. Senior Officers
7. Grievance officer
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Why 12th Plan is Important?
• Millennium Development Goals - 2015
• The Prime Minister’s Independence day speech on 15th August.
• First time in the history of India widespread public consultation to
prepare the draft of 12th Five year plan.
• High level Expert Group on Universal Health Coverage
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High Level Expert Group on Universal Health
Coverage
• Chaired by Dr. K. S. Reddy
• Report submitted in October, 2011
• Mandates:
1. To address the need of Universal Health Coverage
2. To address the social determinants of health
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Definition of UHC by HLEG
• Ensuring equitable access for all Indian citizens
• Resident in any part of the country, regardless of,
Income level
Social status
Gender
Caste or religion
• To affordable, accountable, appropriate health services of assured quality
(promotive, preventive, curative and rehabilitative) as well as public health services
• Addressing the wider determinants of health delivered to individuals and
populations,
• With the government being the guarantor and enabler, although not necessarily the
only provider, of health and related services
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Guiding Principles
1. Universality
2. Equity
3. Non-exclusion and non-discrimination
4. Comprehensive care that is rational and of good quality
5. Financial protection
6. Protection of patients' rights that guarantee appropriateness of care
7. Patient choice
8. Portability and continuity of care
9. Consolidated and strengthened public health provisioning
10. Accountability and transparency
11. Community participation
12. Putting health in People’s hands.
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Vision for UHC
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The New Architecture for UHC
1. Health Financing and Financial Protection
2. Health Service Norms
3. Human Resources for Health
4. Community Participation and Citizen Engagement
5. Access to Medicines, Vaccines and Technology
6. Management and Institutional Reforms
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HEALTH FINANCING AND FINANCIAL
PROTECTION
• Increase public expenditures on health: 1.2% of GDP to 2.5% by the end of
the 12th plan, To at least 3% of GDP by 2022.
• Ensure availability of free essential medicines: – Increasing public spending
on drug procurement.
• Use general taxation as the principal source of health care financing –
complemented by additional mandatory deductions for health care from
salaried individuals and tax payers, either as a proportion of taxable income
or as a proportion of salary.
• Do not levy sector-specific taxes for financing.
• Do not levy fees of any kind for use of health care services under the UHC.
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HEALTH FINANCING AND FINANCIAL
PROTECTION
• Introduce specific purpose transfers to equalize the levels of per capita public
spending on health across different states
• Accept flexible and differential norms for allocating finances
• Expenditures on primary health care, should account for at least 70% of all
health care expenditures
• Do not use insurance companies or any other independent agents to
purchase health care services on behalf of the government
• Purchases of all health care services under directly by the Central and state
governments or autonomous agencies
• All government funded insurance schemes should, over time, be integrated
with the UHC system
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Health Services
• Develop a National Health Package
• Develop effective contracting-in guidelines for the provision of health care
by the formal private sector
• Reorient health care provision to focus significantly on primary health care
• Strengthen District Hospitals
• Ensure equitable access to functional beds for guaranteeing secondary and
tertiary care
• Ensure adherence to quality assurance standards at all levels of service
delivery
• Ensure equitable access to health facilities in urban areas
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HUMAN RESOURCES FOR HEALTH
• This recommendation has two implications,
• More equitable distribution of human resources
• Potential to generate around 4 million new jobs (including over a million community health workers) over the next
ten years
Recommendations:
• Ensure adequate numbers of trained health care providers and technical health care workers at different
levels by
a) Giving primacy to the provision of primary health care
b) Increasing HRH density to achieve WHO norms of at least 23 health workers per 10,000 populations (doctors,
nurses, and midwives)
More specifically the following is proposed:
• Community Health workers:
• Two community health workers (CHW's or Accredited Social Health Activists (ASHAs)) population in rural and tribal
areas
• At least one female
• Similarly trained CHW for every 1000 population among low-income vulnerable urban communities.
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HUMAN RESOURCES FOR HEALTH
Rural Health Care Providers:
Bachelor of Rural Health Care (BRHC)
Nursing staffs
AYUSH
Allied Health Professionals
Allopathic Doctors
Finally the manpower at different level
Village and community level
Two health worker (1 ASHA and 1 AWW with helper)
Similarly 1 CHW in vulnerable urban area
Sub centre
At least 2 ANM and one male health worker
Supplementation with Rural Medical Practitioners
Primary Health Centre
In addition to IPHS, AYUSH Pharmacist, dentist, additional doctor and Male health worker
Community Health Centres level
Increase no. of staff nurse to 19 and additional male health worker, Physiotherapist.
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HUMAN RESOURCES FOR HEALTH
• Enhance the quality of Health education and training by introducing
competency-based, health system-connected curricula and continuous
education.
• Invest in additional educational institutions
• Establish District Health Knowledge Institutes (DHKIs)
• Strengthen existing State and Regional Institutes of Family Welfare
• Establish a dedicated training system for Community Health workers
• Establish State Health Science Universities
• Establish the National Council for Human Resources in Health (NCHRH)
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COMMUNITY PARTICIPATION AND
CITIZEN ENGAGEMENT
• Transform existing Village Health Committees or Health and Sanitation
Committees into participatory Health Councils.
• Organize regular Health Assemblies.
• Enhance the role of elected representatives as well as Panchayati Raj
institutions (in rural areas and local bodies in urban areas).
• Strengthen the role of civil society and non-governmental
Organizations.
• Institute a formal grievance redressal mechanism at the block level
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ACCESS TO MEDICINES, VACCINES
AND TECHNOLOGY
Current Scenario:
• Almost 74% of private out-of-pocket expenditures
• Millions of Indian households have no access to medicines
• Drug prices have risen sharply in recent decades
• India's dynamic domestic generic industry is at risk of takeover by
multinational companies
• The market is flooded by irrational, nonessential, and even hazardous drugs
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Recommendations
• Enforce price controls and price regulation especially on essential drugs
• Revise and expand the Essential Drugs List
• Strengthen the public sector to protect the capacity of domestic drug and
vaccines industry to meet national needs
• Ensure the rational use of drugs
• Set up national and state drug supply logistics corporations
• Protect the safeguards provided by the Indian patents law and the TRIPS
Agreement against the country's ability to produce essential drugs
• Empower the Ministry of Health and Family Welfare to strengthen the drug
regulatory system
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Management and Institutional
Reforms
• Introduce All India and state level Public Health Service Cadres &
specialized state level Health Systems Management Cadre
• Adopt better human resource practices and assure career tracks for
competency-based professional advancement
• Develop a national health information technology network
• Ensure strong linkages and synergies between management and
regulatory reforms and ensure accountability to patients and
communities
• Establish financing and budgeting systems to streamline fund flow
• Invest in health research
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Management and Institutional
Reforms
• The committee recommend the establishment of the following
agencies:
• National Health Regulatory and Development Authority (NHRDA)
• The main functions of the NHRDA will be to regulate and monitor public and
private health care providers, with powers of enforcement and redressal.
• Three Units:
• The System Support Unit (SSU)
• The National Health and Medical Facilities Accreditation Unit (NHMFAU)
• The Health System Evaluation Unit (HSEU)
• National Drug Regulatory and Development Authority (NDRDA)
• National Health Promotion and Protection Trust (NHPPT)
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Actual framework for 12th Plan
• A renewed commitment to public health
• Review of the health system during the previous plan
• Identifying structural problems
• Goals for Health systems
• National Health Outcome goals for the 12th Plan
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Maternal Mortality Ratio
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Infant Mortality
Rate
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Total Fertility Rate
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Prevalence of Underweight Children under 3
years of age
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Prevalence of Anaemia in women age
15-49 years
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Child Sex Ratio ( 0 to 02
Year)
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National Health Programmes:
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Health Information
System
A composite HIS should incorporate the following:
• Universal registration of births, deaths and cause of death.
Maternal
and infant death reviews
• Nutritional surveillance, in women in the reproductive
age group and under six children, linked to the ICDS
Programme
• Disease surveillance
• Out-patient and in-patient information through Electronic
Medical Records (EMR)
• Data on Human Resource within the public health system
• Financial management in the public health system
• Use of Communication and Information Technology
(ICT) in medical education
• Tele-medicine and consultation support
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Health Information System
• Nation-wide registries of clinical establishments,
manufacturing units, drug-testing laboratories,
licensed drugs and approved clinical trials
• Access of public to their own health information and
medical records
• Programme Monitoring support for National Health
Programmes
• A computer with internet connectivity in every PHC and
all higher health facilities
• M-Health, the use of mobile phones to speed up
transmission of
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Convergence with other Social Sector
Programmes (Specially ICDS)
At the National and State Levels:
• National Mission Steering Group,
• Empowered Programme Committee,
• National Programme Consultative Committee,
and
• State level corresponding institutional
mechanisms (State Health Mission and State
Health Society) as nodal institutions to
undertake convergence initiatives.
District levels and below:
• Local Self Government Bodies
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Some areas of Convergence between ICDS
and Health
Suggested mechanism to achieve inter-sectoral
coordination and convergence with ICDS
• Harmonization of ICDS and Health Blocks
• Roles of grass root workers clearly delineated
• AWC for health and nutrition and ASHA for her
outreach activities
• Development of joint field operational plans
• Ensuring effective and efficient operation of
Village Health and Nutrition Days
• Creating a direct reporting relationship
between AWCs
and Sub-Centres
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Public Health Management
• The objective “fulfill society's interest in assuring conditions in which
people can be healthy.”
• The three core public health functions are:
– Assessment and monitoring in order to identify health problems and priorities;
– Formulation of public policies to solve local and national health problems and to set priorities
– To ensure that every person has access to appropriate and cost- effective care.
• Recommendations:
– Developing and deploying a Public Health Cadre
– Territorial responsibility of Public Health officials
– Training for Public Health functionaries at all levels
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Public Health Management
• Decentralization of responsibilities by involving Local Self- Government Bodies:
• Regular, institution based health checks:
• Attention to balanced nutrition:
• Health Education campaign:
• Standards, regulations and Acts for public health:
• Enhancing community participation in planning, implementation,
monitoring and evaluation
• Occupational health:
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Tertiary Care System:
Current Scenario:
Total No. of medical colleges = 335
Annual Training Capacity (UG) =
41569 Annual Training Capacity
(PG) = 20858 Bed Strength = 2
lac (approx.)
Private hospitals
Target:
• Doctor : Population = 1 : 2000
(approx.)
• Nurse : Population = 1 : 1130
• Nurse : Physician = 1.5 : 1
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Projected Scenario:
• Doctor –Population Ratio = 1:2000 (existing approx.)
• Registered doctors =7.5 lakhs
• Active =5.5 lakhs.
• Existing training capacity (MBBS) = 41569
• Targeted training capacity (MBBS) = 80,000 (By
2021)
• Existing training capacity (PG) = 20868
• Targeted training capacity (PG) = 45, 000 (By 2021)
• Doctor –Population Ratio = 1:1000 (Targeted)
• To achieve this, an additional 5.5 lakh doctors
required which will be available by 2020.
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Human resource for
health
• Estimated HR in Health care in
rural area
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Skilled health
workers
Four categories require expansion:
• Medical Graduates
• Medical and Surgical Specialists
• Para-medical workers for health facilities
• Public Health professionals and community-based
workers
Recommendations:
• Expansion of Medical, Public Health, Nursing and
paramedical education
• Central Cadre of Medical Teachers:
• New category of mid-level health workers through a 3
year training programme:
• Orienting medical education to the needs of society:
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• Integrating of non-qualified practitioners into
the health system after suitable training
• Mandate Continuing Medical Education to retain
license to practice
• Better Information on Human Resource in
Health
• Ensuring adequate human resource for key
tasks
• Human Resources Regulatory Functions
• Norms for Staffing of Public Facilities
• Management system for human resource in
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Regulation of Food, Drugs, Medical
Practice and Public Health
• Regulation of Drugs:
• Regulation of Medical Practice:
• Pre-Conception and Pre-Natal Diagnostic
Techniques (Prohibition of Sex Selection) Act,
1994:
• Public Health regulation:
• General regulatory issues:
Quality Council of India (QCI)
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Promoting Health Research
The Department of Health Research (DHR) created on
5th October 2007
• The strategies for health research in the 12th Plan
should be the
following:
• Address national health priorities:
• Maternal and child nutrition, health and survival;
• High fertility in parts of the country;
• Low child sex ratio and discrimination against girl
child;
• Prevention, early detection, treatment, rehabilitation
to reduce burden of diseases –
• Communicable, non-communicable (including mental
illnesses) and
injuries;
• Sustainable health financing aimed at reducing
household's out-of- pocket expenditure; 43/56
• HIS covering universal vital registration,
community based monitoring, disease
• Surveillance and hospital based information
systems for
prevention, treatment and teaching;
• Measures to address social determinants of health
and
inequity, particularly among marginalized
populations;
• Suggest and regularly update Standard Treatment
Guidelines which are both necessary and cost-
effective for wider adoption;
• Public health systems and their strengthening; and
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• Build Research Coordination Framework:
– Efficient research governance, regulatory and
evaluation
framework:
– Nurture development of research centres and labs:
– Utilize available research capacity by promoting
Extramural research:
– Build on strengths of Indian Systems of Medicine
and
Homeopathy:
– Develop Human Resources:
– Cost-effectiveness studies to frame Clinical
Treatment
Guidelines:
• AYUSH – Integration in Research, Teaching and 45/56
Inclusive Agenda
To meet the special needs of the marginalized, the Steering
Committee
recommends the following:
• Access to services:
• Special services for vulnerable populations:
• Disaggregated monitoring and evaluation systems:
• Including representatives of marginalized and
disadvantaged
segments of the population in community fora:
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Planning Commission to NITI
AAYOG
•National Institution for Transforming India Aayog
•Formed in 1st Jan. 2015
•Head Quarter – New Delhi
•Established by Prime Minister Narendra Modi after havingdissolved the Planning
Commission
• Aim - to foster involvement and participation in the economic
policy-making process by state governments of India.
•Chairperson - Prime Minister
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NITI Aayog mean:
•A group of people with authority entrusted by the government to formulate/regulate
policies concerning transforming India.
•It is a commission to help government in social and economic issues.
•Also it's an Institute of think tank with experts in it.
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NITI AAYOG: TRANSFORMING
INDIA
“Constant development is the law of life, and a man who always tries to maintain his dogmas in
order to appear consistent drives himself into a falseposition.”
– Mahatma Gandhi (as quoted in the Cabinet Resolution constituting NITI Aayog)
Planning January 2015
Commission
1. Five Year Plans
NITI Aayog
2. Fund Disburser
3. One size fits all model
1. Decentralised, bottom-up strategy
2. Generation of new ideas
1950
3.Team India: Centre and States
1
6
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Development as mass movement
Sabka
Saath,
Sabka Vikas 2047
SARVASHRESTH
2022 A BHARAT
2017 NEW INDIA
SANKALP
Do or
SE Time to
die! greater
SIDDHI generatemomentum to
1947 achieve New India by
INDEPENDENCE 2022
1942
QUIT INDIA Mahatma Gandhi ji’s1942
call galvanized India’s
1857
citizens, culminating
in independence in 3
1947
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Experts,
CHIEF lieutenant
specialis Chief
MINISTE Prime Vice- ExOfficio
ts and Executi
R governor Ministe Chairma member
of all practition ve
s of r n s
the ers Officer
Union
States Territories.
NITI AAYOG
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NEWINDIA @ 2022 – MODEL FOR THE
WORLD
• India’s nation builders chose to undertake the economic, political and
social transitions simultaneously
• By successfully completing these three transitions, India will emerge as a
model for the rest of the world
• 2017-2022: making development a mass movement
• Sankalp se Siddhi: For India to emerge as:
Swach
swastha
Shikshit
Bharat by 2022
Sampan
n
Saksham
Surakshit
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FOR 2022, NITI AAYOG RESOLVE
TO HAVE
Dirt & Corruptio
Poverty Squalor Free
Free n Free
India India
India
Terrorism Casteism Communalism
Free Free Free India
India India
2
0
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Functions of NITI
•To provide a critical, directional and strategic input into the development
process
•Emerge as a"think-tank“, provide Government at the central and state levels with
relevant strategic and technical advice across the spectrum of key elements of
policy
•Develop mechanisms to formulate credible plans to the village level and aggregate
these progressively at higher levels of government
•special attention to the sections of society that may be at risk of not benefitting
adequately from economic progress.
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Functions of NITI
•Will create a knowledge, innovation and entrepreneurial support system through a
collaborative community of national and international experts, practitioners and
partners
•Will offer a platform for resolution of inter-sectoral and inter-departmental issues in
order to accelerate the implementation of the development agenda
•Will monitor and evaluate the implementation of programmes, and focus on
technology upgradation and capacity building
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Thank you,
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