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1. A working group on Health was constituted by the Planning Commission in 1980 with the Secretary, Ministry of Health and Family Welfare, as its Chairman, to identify, in programme terms, the goal for Health for All by 2000 AD and to outline with that perspective, the specific programmes for the sixth Five Year Plan.
2. The Working Group, besides identifying and setting out the broad approach to health planning during the sixth Five Year Plan, had also evolved fairly specific indices and targets to be achieved in the country by 2000 AD.
3. The Government of India set up a Planning Commission in 1950 to make an assessment of the material, capital and human resources of the country, and to draft developmental plans for the most effective utilization of these resources.
4. In 1957, the Planning Commission was provided with a Perspective Planning Division which makes projections into the future over a period of 20 to 25 years.
5. The Planning Commission consists of a Chairman, Deputy Chairman and 5 members. The Planning Commission works through 3 major divisions — Programme Advisers, General Secretariat and Technical Divisions which are responsible for scrutinizing and analyzing various schemes and projects to be incorporated in the Five Year Plans. Over the years, the Planning Commission has been formulating successive Five Year Plans. The planning process was decentralized towards Decentralized District Planning by the year 2000.
6. Since “health” is an important contributory factor in the utilization of manpower, the Planning Commission gave considerable importance to health programmes in the Five Year Plans. For purposes of planning, the health sector has been divided into the following subsectors
a. Water supply and sanitation
b. Control of communicable diseases
c. Medical education, training and research
d. Medical care including hospitals, dispensaries and primary health centres
e. Public health services
f. Family planning; and
g. Indigenous systems of medicine
7. Recognizing “health” as an important contributory factor in the utilization of manpower and the uplifting of the economic condition of the country, the Planning Commission gave considerable importance to health programmes in the five year plans. The broad objectives, of the health programmes during the five year plans have been
8. Control or eradication of major communicable diseases
9. Strengthening of the basic health services through the establishment of primary health centres and subcentres
10. population control
11. Development of health manpower resources.
In 1977, it was decided in the World Health Assembly to launch a movement known as “Health for All by the year 2000”. The fundamental principle of 1-IFA strategy is equity, that is, an equal health status for people and countries, ensured by an equitable distribution of health resources. The Member countries of WHO at the 30th World Health Assembly defined Health for All as
“attainment of a level of health that will enable every individual to lead a socially and economically productive life”
In 1978, the Alma—Ata International conference on Primary Health Care reaffirmed Health for All as the major social goal of governments, and stated that the best approach to achieve the goal of HFA is by providing primary health care, especially to the vast majority of underserved rural people and urban poor. It was envisaged that by the year 2000, at least essential health care should be accessible to all individuals and families in an acceptable and affordable way, with their full participation.
The Alma—Ata Conference called on all governments to formulate national policies, strategies and plans of action to launch and sustain primary health care as part of a national health system. It is left to each country to develop its norms and indicators for providing primary health care according to its own circumstances.
In 1981, a global strategy for HFA was evolved by WHO. The global strategy provides a global framework that is broad enough to apply to all Member States and flexible enough to be adapted to national and regional variations of conditions and requirements. This was followed by individual countries developing their own strategies for achieving HFA, and synthesis of national strategies for developing regional strategies.
The WHO has established 12 global indicators as the basic point of reference for assessing the progress towards HFA, as for example, a minimum life expectancy of 50 years and maximum IMR of 50 per 1000 live births.
The National Health Policy echoes the WHO call for HFA and the Alma—Ata Declaration. It had laid down specific goals in respect of the various health indicators by different dates such as 1990 and 2000 AD.
Foremost among the goals to be achieved by 2000 AD were:
1. Reduction of infant mortality from the level of 125 (1978) to below 60.
2. To raise the expectation of life at birth from the level of 52 years to 64.
3. To reduce the crude death rate from the level of 14 per 1000 population to 9 per 1000.
4. To reduce the crude birth rate from the level of 33 per 1000 population to 21.
5. To achieve a net reproduction rate of one.
6. To provide potable water to the entire population.
The Conference strongly reaffirms that health, which is a state of complete physical, mental and social well-being, and not merely the absence of disease of infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realisation requires the action of many other social and economic sectors in addition to the health sector.
The existing gross inequality in the health status of the people, particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries.
Economic and social development, based on a New International Economic Order, is of basic importance to the fullest attainment of health for all and to the reduction of the gap between the health status of the developing and developed countries. The promotion and protection of the health of the people is essential to sustained economic and social development and contributes to a better quality of life and to world peace.
The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.
Governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures. A main social target of governments international organisations and the whole world community in the coming decades should be attainment by all people of the world by the year 2000 a level of health that will permit them to lead a socially and economically productive life. Primary health care is the key to attaining this target as part of development in the spirit of social justice.
Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of t heir development in the spirit of self-reliance and self-determination. It forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible where people live and work, and constitutes the first element of a continuing health care process.
1. Reflects and evolves from the economic conditions and socio-cultural and political characteristics of the country and its communities and is based on the application of the relevant results of social, biomedical and health services research and public health experience;
2. Address the main health problems in t he community, providing promotive, preventive, curative and rehabilitative services accordingly;
3. Includes at least; education concerning prevailing health problems and the methods of preventing health problems and the methods of preventing and controlling t hem; promotion of food supply and proper nutrition and adequate supply of safe water and basic sanitation maternal and child health care, including family planning; immunization, against the major infectious disease; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs;
4. Involves, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communications and other sectors; and demands the coordinated efforts of all those sectors;
5. Requires and promotes maximum community and individual self-reliance and participation in the planning, organisation, operation and control of primary health care, making fullest use of local, national and other available resources; and to this end develops through appropriate education the ability of communities to participate;
7. Should be sustained by integrated, functional and mutually-supportive referral systems, leading to the progressive improvement of comprehensive health care for all, and giving priority to those must in need;
8. Reliefs, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.
All government should formulate national policies, strategies and plans of action to launch and sustain primary health care as part of a comprehensive national health system and in coordination with other sectors. To this end, it will be necessary to exercise political will to mobilize the country’s resources and to use available external resources rationally.
All countries should cooperate in a spirit of partnership and service to ensure primary health care for all people since the attainment of health by people in any one country directly concerns and benefits every other country. In this context, the join WHO/UNICEF report on primary health care constitutes a solid basis for the further development and operation of primary health care throughout the world.
An acceptable level of health for all the people of the world by the year 2000 can be attained through a fuller and better use of the world’s resources, a considerable part of which is now spent on armaments and military conflicts. A genuine policy of independence, peace, détente, and disarmament could and should release additional resources that could well be devoted to peaceful aims and in particular to the acceleration of social and economic development of which primary health care, as an essential part, should be allowed its proper share.
The thrust areas to be pursued during the Eleventh Five Year Plan are:
1. Improving health equity
a. NRHM
b. NUHM
2. Adopting a system-centric approach rather than a disease centric approach
a. Strengthening health system through up gradation of infrastructure and PPP.
b. Converging all programmes and not allowing vertical structures below district level under different programmes.
3. Increasing survival
a. Reducing maternal mortality and improving child sex ratio through gender responsive health care.
b. Reducing infant and child mortality through HBNC and IMNCI.
4. Taking full advantage of local enterprise for solving local health problems.
a. Integrating AYUSH in health system.
b. Increasing the role of RMPs.
c. Training the TBAs to make them SBAs.
d. Propagating low cost and indigenous technology.
5. Preventing indebtedness due to expenditure on health!
a. protecting the poor from health expenditures
b. Creating mechanisms for health insurance.
c. Health insurance for the unorganized sector.
6. Decentralizing governance
a. Increasing the role of PRIs, NGOs, and civil society.
b. Creating and empowering health committees at various levels.
7. Establishing e-Health
a. Adapting IT for governance.
b. Establishing e-enabled HMIS.
c. Increasing role of telemedicine.
8. Improving access to and utilization of essential and quality health care
a. Implementing flexible norms for health care facilities (based on population, distance, and terrain).
b. Reducing travel time to two hours for EmOC.
c. Implementing IPI-IS for health care institutions at all levels.
d. Accrediting private health care facilities and providers.
e. Re—developing hospitals/institutions. – –
f. Mirroring of centres of excellence like AIIMS.
9. Increasing focus on health human resources
a. Improving medical, paramedical, nursing, and dental education and availability.
b. Reorienting AYUSH education and utilization.
c. Reintroducing licentiate course in medicine.
d. Making India a hub for health care and related tourism.
10. Focusing on excluded/neglected areas
a. Taking care of the older persons.
b. Reducing disability and integrating disabled.
c. Providing humane mental health services.
d. Providing oral health services.
11. Enhancing efforts at disease reduction
a. Reversing trend of major diseases.
b. Launching new initiatives (Rabies, Fluorosis, Leptospirosis)
12. Providing focus to health system and bio-medical research
a. Focusing on conditions specific to our country.
b. Making research accountable.
c. Translating research into application for improving health.
d. Understanding social determinants of health behavior, risk taking behavior, and health care seeking behavior.
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