CHAPTER-I

INTRODUCTION

The Government of India in association with the States has been implementing various programmes to provide universal access to quality health care and to
achieve an acceptable standard of good health amongst the general population in the country. The approach is to increase access to the decentralized public health
system by establishing new infrastructure in deficient areas and by upgrading the infrastructure in the existing institutions. The strategy focus is on increasing the
aggregate public health investment. In consonance with this objective, the 12th Plan has drawn a roadmap, to seamlessly integrate the primary, secondary and tertiary
sectors in the Health system. As a part of the plan process, many different programmes were consolidated under the broad National Health Mission, umbrella flagship
scheme which inter-alia consists of two sub missions, viz National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM) covers all cities and
towns with more than 30,000 population. Funding pattern is through flexible pools, viz. NRHM-RCH Flexible Pool, NUHM Flexible Pool, Flexible pool for
Communicable Diseases, Flexible Pool for Non-communicable Diseases, Injury and Trauma and Infrastructure maintenance schemes. The creation of these Pool
Funds is envisaged to provide greater financial flexibility and distribute more efficiently the funds, for the delivery of better health outcomes in the community. In
furthering the pursuit of better health outcomes in terms of reduction in the IMR, MMR and improvements in the life expectancy rate, etc. through improved efficiency,
equity of access and quality of health services, the Five Year Plans have increased the allocations for this sector substantially.

Vision, Mission & Objectives

The Departments of the Ministry comprise of Department of Health & Family Welfare (DoHFW) and Health Research (HR). The vision of the Ministry is
‘availability of quality healthcare on equitable, accessible and affordable basis across regions and communities with special focus on under-served population and
marginalized groups’. In this direction the Mission of the Ministry, encompasses establishing comprehensive primary healthcare delivery system and well-functioning
linkages with secondary and tertiary care health delivery system, improving maternal and child health outcomes, reducing the incidence of communicable diseases and
putting in place a strategy to reduce the burden of non-communicable diseases, ensuring a reduction in the growth rate of population with a view to achieving
population stabilization, developing the training capacity for providing human resources for health (medical, paramedical and managerial) with adequate skill mix at all
levels, regulating health service delivery through the Clinical Establishments (Registration & Regulation) Act 2010 and, promoting rational use of pharmaceuticals in the
country. The objectives to achieve the Mission are:

 Universal access to Primary Health Care services for all sections of society with effective linkages to secondary and tertiary health care.
 Improving Maternal and Child Health.
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 Focusing on Population stabilization in the Country

While the Department of Health and Family Welfare is responsible for, implementation of national level programmes for, control of communicable and non-
communicable diseases, HIV/AIDS control, hospitals, dispensaries and for medical education, the Department of Health Research is responsible for promotion of
medical and health research activities.

Thrust Areas of Department of Health And Family Welfare

The Government of India is supplementing the efforts of the State governments to provide accessible, affordable and accountable healthcare within the
framework of the National Health Policy 2002 in the area of preventive, promotive and curative health care in the spirit of cooperative federalism. The National Health
Mission (NHM) encompasses its two Sub-Missions, the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM). The NHM envisages
achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people’s needs. The main programmatic
components include Health System Strengthening in rural and urban areas, Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A) interventions
and control of Communicable and Non-Communicable Diseases. The various initiatives under NHM aim to bridge the Inter regional and interstate disparities to
promote delivery of health services with focus on equity. The NHM has been able to reduce overall morbidity, mortality and establish a fully functional community
owned decentralized health delivery system with flexibility for need based planning.

The Twelfth Five Year Plan builds on the achievements of the Eleventh Plan for extending outreach of public health services and for moving towards the long
term objective of establishing a system of Universal Health coverage through the National Health Mission. The Government plans to fill critical gaps in infrastructure
and manpower planning in recognition of fresh challenges being posed due to increasing migration from rural to urban areas. The approach under NHM is on, inter-
alia, augmentation of human resources; strengthening of health infrastructure; flexible financing and enhanced allocation of funds to health care facilities; provisioning
of health service delivery in unserved and underserved areas in both rural and urban areas; decentralized planning, initiatives to improve maternal and child health;
providing financial assistance to States for selection and training of Accredited Social Health Activist (ASHA) who act as a link between community and health care
facilities; prevention and control of vector borne diseases as well as of non-communicable diseases. The programs

and initiatives undertaken by the Department of Health and Family Welfare, like Janani Shishu Suraksha Karyakram (JSSK), Name based Mother and Child Tracking
System (MCTS), delivery of contraceptives to doorsteps, Menstrual Hygiene Scheme, Weekly Iron folic Acid Supplementation Programme, School Health Programme
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and Reproductive Maternal New born Child Health+A (RMNCH+A) services, etc would be taken forward. India Newborn Action Plan (INAP) is the country’s
commitment in response to the Global Every Newborn Action Plan (ENAP) launched at the 67th World Health Assembly in June 2014, which takes forward the Global
Strategy for Women’s and Children’s Health. INAP plans to end preventable newborn deaths, identifies ways to accelerate progress and scale up interventions that are
high-impact and cost-effective driven by epidemiological causes. It is aligned with Global Every New Born Action Plan, but also takes into account specific contextual
needs of India. Goals are set till 2035; however coverage targets and interventions are defined till 2020. Detailed review will be done in 2020 to recommend mid-course
corrections / changes. India strives to achieve single digit New-Natal Mortality Rate (NMR) by 2030.

The Department of Health and Family Welfare has executed some important structural reforms in recent years which has invigorated the system in providing a
minimum standard of health care services especially in the primary health care sector. To address critical gaps in human resources availability in the public health
delivery system expansion of medical schools /nursing colleges / paramedical institution would continue to receive priority. Government has taken several initiatives to
augment human resources in the health sector focusing on medical education, nursing education, paramedical education, etc. Reforms have been made in the MCI
norms, which include revision in the requirement of land for setting up medical colleges, bed strength, enhancement of age of faculty, increase in maximum ceiling in
age of intake for undergraduate students and revision of teacher student- ratio for the post graduate students. Government has also approved setting up of 132
Auxiliary Nurse Midwife (ANM) Schools and 137 General Nursing and Midwifery (GNM) Schools in various States in order to build capacity, improve the infrastructure
in nursing institutions and improve quality of nursing education, apart from initiating steps in setting up a National Institute of Paramedical Sciences and 8 Regional
Institutes of Paramedical Sciences.

To expand the availability of public health service at the level of tertiary care by Government of India, new AIIMS like institutions are being established under
PMSSY one each at Andhra Pradesh, Maharashtra, West Bengal, Uttar Pradesh, Jammu & Kashmir, Punjab, Tamil Nadu, Himachal Pradesh, Assam and Bihar in
addition to six AIIMS at Raipur, Bhopal, Patna, Bhubaneshwar, Rishikesh and Jodhpur. Existing 58 Medical Colleges were identified in 20 States/ UTs for upgradation
to increase 10,000 MBBS seats. Government seeks to provide free generic medicines in all public health facilities with a view to address concerns on the high ‘Out of
Pocket’ (OOP) expenditure being currently incurred. Further in keeping with the changing diseases profile within the country preventive, promotive and curative public
health interventions in the areas of non-communicable disease are being addressed.

The key strategies under the National AIDS Control Programme Phase-IV (2012-2017) includes intensifying and consolidating prevention services with a
focus on High Risk Groups (HRGs) and vulnerable population, increasing access and promoting comprehensive care, support and treatment, expanding IEC services
for general population and high risk groups with a focus on behaviour change and demand generation, building capacities at national, state and district levels and
strengthening the Strategic Information Management System. Prevention and Care, Support & Treatment (CST) form the two key pillars of all HIV/AIDS control efforts
in India. The focus is to accelerate the process of reversal and further strengthen the epidemic response in India.