Factors that drive implementation of public healthcare policies

Public health has an enormous impact on the lives of people. Plans and public healthcare policies formed globally are based on various aspects and impeding factors. Health policy comprises of goals, rules, and actions. These have an impact on the health challenges and priorities that transcend individual countries and regions (Brugha, Bruen, & Tangcharoensathien, 2014). However, every country has its own ministry or authority that looks after proper implementation of policies.

The body responsible for public healthcare policies in India

The Ministry of Health and Family Welfare (MOHFW) manages and controls healthcare in India. Strategies to fight against public health-related challenges are mainly devised by MOHFW (Ministry of Health and Family Welfare, 2010). It mainly is focused on preventive measures for communicable diseases and control (Lakshminarayanan, 2011). It also focuses on social stratification according to income, education, occupation, gender, and race. These are in turn caused due to the social, economic and political impact. These lead to inequalities in the health conditions of the people of India. The factors mentioned in the previous article play a major role in assessing the efficiency of any health care policy to be implemented.

Timeline of the public healthcare policies

The figure below represents a time trend for all the policies that have been implemented to date. However, the policies are for the improvement of health care and services for the public. All health care related policies are a part of the 5-year plan. The first national health policy was implemented in 1983 and has been updated thrice. Moreover, national rural and urban health mission too was implemented in 2005 and 2014 respectively.

Timeline of the government policies formed for public health since independence (Planning Commision, 2017)

Timeline of the government policies formed for public health since independence (Planning Commision, 2017)

Review of public healthcare policies of India

The table presents a review of public healthcare policies. The table also presents the factors considered by the Government of India for the improvement of health care services. The duration of the public healthcare policies started back in 1951 and is updated every 5 years. The table also presents the list of objectives for each policy or plan.

The time between 1951 and 1974

Years

Plan

Objectives

Factors considered

1951-56 First five-year plan To improve the health status of the country. Diseases like malaria, TB, dysentery, and diarrhoea. Prevalence of disease, number of hospitals, healthcare expenditure by the public.
1956-61 Second five-year plan To control communicable diseases like malaria, filariasis, tuberculosis, leprosy, and venereal disease and expand health services to more people. Prevalence of disease, number of hospitals, healthcare expenditure by the public, private health centres.
1961-66 Third five-year plan Smallpox and malaria eradication program, providing supplies of safe drinking water to the rural and urban areas.

To control filarial cholera, TB, leprosy and other communicable diseases.

Prevalence of disease, number of hospitals, healthcare expenditure by the public, availability of drugs, availability of awareness programmes, vaccination and immunization statistics.
 

1969-74

Fourth five-year plan To control and eradicate communicable diseases and provide curative and preventive health services in rural areas.

To augment the training programs of medical and paramedical personnel.

Availability of preventive health services, awareness programmes, education, availability of trained personnel, the prevalence of disease.

The time between 1974 and 1990

Years

Plan

Objectives

Factors considered

1974-79 Fifth five-year plan Effective implementation of the National Leprosy Control Program.

Effective implementation of the National scheme for prevention of impairment of vision and control of blindness.

To develop strategies for control of filarial in rural areas. To establish combined food and drugs testing laboratory.

Prevalence of disease, Prevalence of mortality and morbidity, Epidemiology of disease, Availability of drugs and clinical researches
1983 First National health policy To provide cost-efficient primary health care services. Epidemiology of disease, Expenditure by Public, Availability of drugs, Availability of awareness programmes, Budget allotment capability, Availability of financial resources
1980-85 Sixth five-year plan National program for promotion of maternity and childcare was initiated.

In addition, promotion of vaccination against tetanus, whooping cough, diphtheria, tuberculosis and polio.

Prevalence of disease, Prevalence of mortality and morbidity, Epidemiology of disease, Availability of financial resources, Economic state
1985-90 Seventh five-year plan To launch a health development program.

Preventive and promotive aspects and on organizing effective and efficient health services.

Prevalence of disease, Prevalence of mortality and morbidity, Epidemiology of disease, Availability of preventive health services, Awareness programme

The time between 1992 and 2007

Years

Plan

Objectives

Factors considered

1992-1997 Eighth five-year plan Strengthening and development of rural health infrastructure.

Initiation of control/ eradication programs for various communicable disease and ex- vector borne diseases such as malaria, Kala azar and Japanese encephalitis.

Prevalence of mortality and morbidity, Epidemiology of disease, Availability of preventive health services, Availability of preventive health services, Awareness programmes.
1997-2002 Ninth five-year plan To develop disease surveillance and response mechanism with a focus on rapid recognition, report, and response at district levels.

Develop and implement integrated non-communicable disease control programs.

Moreover, to implement appropriate management systems for emergency, disaster, accidents and trauma care at all levels of health care.

Technological applicability, Epidemiology of disease, Preparedness to reoccurrence, Availability of financial resources.
2002 National health policy To focus on the disease burden by TB, Malaria, blindness and HIV/AIDS. Epidemiology of disease, Preparedness to reoccurrence, Availability of preventive health services, Awareness programmes, Availability of drugs and clinical researches.
2002-2007 Tenth five-year plan To improve the efficiency of the existing healthcare system, quality of care, logistics of supplies of drugs and diagnostics and promotion of the rational use of drugs.

To evolve, implement and evaluate systems of health care financing so that essential healthcare based on need is available to all at an affordable cost.

Preparedness to improve the healthcare system, Availability of preventive health services, Awareness programmes, Budget allocation, healthcare infrastructure, Epidemiology of disease.
2005 National rural health mission To increase the share of health sector form 0.9% of GDP to 2-3% of GDP.

To support the existing programs for malaria, blindness, iodine deficiency, filarial, kala-azar, TB and leprosy.

Preparedness to improve the healthcare system, Availability of preventive health services, Awareness programmes, Healthcare infrastructure, Epidemiology of disease, Availability of financial resources.

The time between 2007 and 2017

Years

Plan

Objectives

Factors considered

2007-2012 Eleventh five-year plan To decrease the maternal mortality ratio, infant mortality rate, and the total fertility rate. Decrease malnutrition among children and anaemia among women and girls.

Providing clean drinking water by 2009. Raising the sex ratio. In addition, formulation of NACP-III formulation for AIDS control.

Availability of preventive health services, Awareness programmes, Healthcare infrastructure, Epidemiology of disease, Availability of drugs and clinical researches.
2012-17 Twelfth five-year plan Access to public health services to the differently abled. Provide special services to vulnerable and disadvantaged people.

To improvise the monitoring and evaluation system. Furthermore, providing proper training for health and rehabilitation professors.

Public health services, Availability of financial resources, Healthcare infrastructure, Epidemiology of disease.
2014 National urban health mission To meet the health needs of urban-poor, especially the slum dwellers Healthcare infrastructure, Epidemiology of diseases.
2017 National health policy To improve the secondary and tertiary tier healthcare facilities. Healthcare infrastructure, Epidemiology of diseases, Availability of financial resources, Availability of preventive health services, Availability of drugs and clinical researches.

Factors driving preparation of public healthcare policies

In the previous section identification of the factors that led to update and implement public healthcare policies. Thus, the figure below presents a compilation of all the factors that lead to the preparation of public health policy.

Driving factors of public healthcare policies planning and implementation (Frieden, 2014)

Driving factors of public healthcare policies planning and implementation (Frieden, 2014)

Technical advantage along with effective management of data and statistics are key drivers. In addition, partnerships and coalitions with organizations improve the preparedness and infrastructure. Communication through awareness and education and political commitment to avail financial resources helps obtain effective and efficient public health policy. Similarly, continued effective planning helps solve healthcare-related challenges. Thus, the next article discusses the purposes of epidemiological studies.

References

  • Brugha, R., Bruen, C., & Tangcharoensathien, V. (2014). Understanding Global Health Policy. In Handbook of Global Health Policy (pp. 21–46). http://doi.org/10.1108/17554251011064837.
  • Frieden, T. R. (2014). Six components necessary for effective public health program implementation. American Journal of Public Health, 104(1), 17–22. http://doi.org/10.2105/AJPH.2013.301608.
  • Lakshminarayanan, S. (2011). Role of government in public health: Current scenario in India and future scope. Journal of Family and Community Medicine, 18(1), 26–30. http://doi.org/10.4103/1319-1683.78635.
  • Ministry of Health and Family Welfare, (2010). Statement on national health policy. Ministry of Health and Family Welfare, Government of India, New Delhi. Journal of Public Health Policy, 7(2), 248–264.
  • Planning Commission, (2017). Five year plan. https://planningcommission.gov.in/.

Diksha Tomer

Research Analyst at Project Guru
She is a bachelor in Botany honours from Miranda House (Delhi University) and is pursuing her master’s in Plant Biotechnology at TERI SAS. She is a recipient of Hemendra Kothari Scholarship and her interests lie in the field of Bioinformatics and Biotechnology.
Diksha Tomer

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