Health Policy Issues and Health Programmes in ... - Amazon S3

National Health Programmes: An Overviewdiarrhoeal diseases, dengue fever, Japanese encephalitis (JE), vaccine-preventable diseases(VPDs) in particular, and measles. A concerted surveillance effort has been one of the majorforces behind the successful eradication/elimination of diseases in the past, such as smallpoxand guinea worm, the likely elimination of leprosy and neonatal tetanus, and the eradication ofpoliomyelitis and yaws. The Government of India has launched a national programme onsurveillance of selected diseases in a few districts.While it is appreciated that sophisticated computerized data for surveillance will be very usefulin programme management, it is too early to consider its implementation in the remote andbackward districts in a uniform manner, and hence, priority will be given to the manualgeneration of surveillance data on a regular basis for important health programmes.Need for Active Participation of the State GovernmentsThe National Health Policy (NHP) 2002 has envisaged a key role for the central government indesigning national health programmes with the active participation of the state governments.The extent of varying levels and patterns of needs/epidemiological characteristics of theproblems should be considered when planning the programmes with the involvement of stateauthorities. Even though financial and technical support comes from the central government,currently actual implementation is through the state system. Any additional inputs requiredshould come from the state government so that a true partnership, as well as a sense ofownership, is generated. The NHP 2002, however, suggests the need for distancing theimplementation of vertical programmes from the state health department to provide operationalflexibility. Merits/demerits, if any, of this suggestion needs to be reviewed/considered by thisexpert group.24Integration of ProgrammesIn the past, the basic philosophy was that independent vertical programmes, with separateinputs and machinery, were necessary for the initial phase of handling major priority problems.However, once the problem had been brought under a reasonable level of control, it wasrecommended that the interventions of the programme be integrated with general healthservices. In India, the same philosophy has been accepted and, under the multi-purpose worker(MPW) scheme, most of the hitherto vertical programmes were integrated, at least at the servicedelivery level. Programmes for malaria, TB, and family planning have been integrated under thisapproach, although in the long run, the effect has not been satisfactory according to manyprogramme managers. Recently, efforts have been initiated to integrate the Leprosy EradicationProgramme. Even when the decision is made for integration, it is important to specify the itemsto be integrated (resources, personnel, management information systems) and the level towhich the programme is to be integrated (primary health centre (PHC), district, state), becauseexperience has shown that integration of different programmes under the MPW scheme has notbeen accepted by all as having made a sufficiently useful impact. It is equally important toensure that the general health services system is prepared to take over the additionalresponsibility (technically and psychologically), for example, an integrated information system,appropriate resource pooling, and a logistics and supply system. Technical preparednessthrough training of all concerned, as well as managerial changes, is necessary.