A background study of Indian health scenario Public Health Initiative

Indian Health Sector Data: Budget spending and Insurance Levels

  • The public expenditure on health sector remains a dismal show of only around 1.4% of the GDP.
  • The investment in health research has been low with a modest rate of 1% of the total public health expenditure.
  • Insurance coverage remains low as per the latest NSSO reports over 80% of India’s population remains uncovered by any health insurance scheme.
  • Under the centre run Rashtriya Swyasthya Bima Abhiyan, only 13% of the rural and 12% of the urban population had access to insurance cover.
  • There has been a stark rise in the out-of-pocket expenditure (6.9% in rural areas and 5.5% in urban areas – OOP in proportion to monthly expenditure). This led to an increasing number of households facing catastrophic expenditures due to health costs.

Indian Health Sector Data: IMR, MMR, Hunger, Non-Communicable diseases, and  Mental Diseases

  • India missed by close margins in achieving the millennium development goals of maternal mortality (India – 167, MDG – 139) and under 5 child mortality rate (India 49, MDG – 42). The rate of decrements in stillbirths and neonatal death cases has been slow.
  • Nutrition status has been dismal and is one of the causes of child mortality and morbidity. As per the global hunger index (by IFPRI), India ranks 78th among 118 developing countries (with 15% of our population being undernourished; about 15% under-5 children who are ‘wasted’ while the share of children who are `stunted’ is a staggering 39% and the under-5 mortality rate is 4.8% in India.)
  • While communicable diseases contribute 28% of the entire disease burden, non-communicable diseases (60%) show ample rise and injuries at (12%) now constitute the bulk of the country’s disease burden.
  • India ironically has to cater two extreme healthcare situations. They are (1) one arising out of exclusions (out of poverty or lack of proper healthcare facilities) (2) while the other as lifestyle diseases like diabetes and cardiac related problems.
  • There has been a steady rise in mental illnesses in the country. According to a recent publication, one in every four women and 10% men suffer from depression in India.
  • At the same time progress has been marked in the field of communicable diseases as such. Polio has been eradicated, leprosy has been curtailed and HIV – AIDS cases have met the MDG target of being reduced by half in number.

Indian Health Sector Data: Personnel Status

  • Health workforce density in India remains low.
  • India’s ratio of 7 doctors and 1.5 nurses per 1,000 people is dramatically lower than the WHO average of 2.5 doctors and nurses per 1,000 people.
  • The majority of the health workforce is concentrated in urban areas.
  • Furthermore, there is an acute shortage of paramedical and administrative professionals too.

Note: Taking cognisance of the prevailing situations, Government of India has been aiming to improve the health system via various policies and initiatives. The latest National Health Policy, 2017 highlights the future aims and agendas of the government which can be summarised as follows:

The National Health Policy 2017

The main objectives of the National Health Policy 2017 are as following:

  • To achieve Universal Health Coverage by assuring the availability of free, comprehensive primary health care services, ensuring improved access and affordability, of quality secondary and tertiary care, achieving a significant reduction in out of pocket expenditure due to health care costs.
  • To make a predictable, efficient, patient-centric, affordable and effective health care system.
  • Bringing in healthy and vital private sector contribution.
  • Bring a policy thrust by –
    1. By increasing public investment (raise it to 5% of the GDP).
    2. To coordinate various non-health departments to improve the environment for health (by linking areas like – Swatch Bharath, balanced diet, reduced stress at workplace, Yatri Suraksha etc).
    3. Incorporating health education as part of the curriculum, promoting hygiene and safe health practices within the school environs and by acting as a site of primary health care and also promoting healthy practices via AYUSH and Yoga at workplaces and schools.
    4. Organising public health care delivery.
  • To enhance National health programs.
  • Utilising the potential of AYUSH and mainstreaming it.
  • Improving women health and addressing gender violence.Initiatives like Janani Suraksha Yojana, new norms of addressing domestic violence, family planning program etc. can go a long way.
  • Enhancing tertiary care services – via specialized consultative and intensive care facilities, tertiary services via advanced medical colleges and health institutes.
  • Improving the healthcare personals by-
    1. providing better health education
    2. incentivising doctors for rural services
    3. enhancing nursing and other paramedical services
    4. developing and encouraging ASHA volunteers.
  • Collaborating with non-governmental organisations and private sector to –
  1. Train, encourage skill development programs
  2. Utilise and direct Corporate social responsibility into health investments
  3. Encourage the personnel training in mental health care and disaster management etc.
  • Establishing a strong regulatory framework to include regulation of clinical establishments, professional and technical education, food safety, medical technologies, medical products, clinical trials, research and implementation of other health-related laws.
  • Involving and providing more role to local self-governments, bringing in decentralisation and enhancing accountability of government institutions to ensure effective efficient delivery of services.

Out of these the key and specific objectives remain to Strengthen health system

  1. Increase Life Expectancy at birth from 67.5 to 70 by 2025.
  2. Establish regular tracking of Disability Adjusted Life Years (DALY) Index as a measure of the burden of disease and its trends by major categories by 2022.
  3. Reduction of TFR to 2.1 at national and sub-national level by 2025.
  4. Reduce under Five Mortality to 23 by 2025 and MMR from current levels to 100 by 2020.
  5. Reduce infant mortality rate to 28 by 2019.
  6. Reduce neonatal mortality to 16 and stillbirth rate to “single digit” by 2025.
  7. Achieve global target of 2020 which is also termed as the target of 90:90:90, for HIV/AIDS i. e,- 90% of all people living with HIV know their HIV status, – 90% of all people diagnosed with HIV infection receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have viral suppression.
  8. Achieve and maintain elimination status of Leprosy by 2018, Kala-Azar by 2017 and Lymphatic Filariasis in endemic pockets by 2017.
  9. To achieve and maintain a cure rate of >85% in new sputum positive patients for TB and reduce the incidence of new cases, to reach elimination status by 2025.
  10. To reduce the prevalence of blindness to 0.25/ 1000 by 2025 and disease burden by one-third from current levels.
  11. To reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by 25% by 2025.

Improve health system performance 

  1. Increase utilization of public health facilities by 50% from current levels by 2025.
  2. More than 90% of the newborn are fully immunized by one year of age by 2025
  3. The relative reduction in the prevalence of current tobacco use by 15% by 2020 and 30% by 2025.
  4. Reduction of 40% in the prevalence of stunting of under-five children by 2025.
  5. Access to safe water and sanitation to all by 2020 (Swachh Bharat Mission).
  6. Reduction of occupational injury by half from current levels of 334 per lakh agricultural workers by 2020.

Enhance health status and program impact

  1. Increase health expenditure by Government as a percentage of GDP from the existing 1.15% to 2.5 % by 2025.
  2. Ensure availability of paramedics and doctors as per Indian Public Health Standard (IPHS) norm in high priority districts by 2020.
  3. Establish primary and secondary care facility as per norms in high priority districts (population as well as time to reach norms) by 2025.
  4. Ensure district-level electronic database of information on health system components by 2020.
  5. Strengthen the health surveillance system and establish registries for diseases of public health importance by 2020.

Major national programs in this sector

The following highlights of recent initiatives in this field showcase our renewed effort to achieve the global standards.

 1.Mission Indradhanush: The Ministry of Health & Family Welfare has launched “Mission Indradhanush”, depicting seven colours of the rainbow, to fully immunise more than 89 lakh children who are either unvaccinated or partially vaccinated; those that have not been covered during the rounds of routine immunisation for various reasons. They will be fully immunised against seven life-threatening but vaccine preventable diseases which include:

  • Diphtheria
  • Whooping cough
  • Tetanus, polio
  • Tuberculosis
  • Measles and
  • Hepatitis-B. 

In addition, vaccination against Japanese Encephalitis and Haemophilus influenza type B will be provided in selected districts/states of the country. Pregnant women will also be immunised against tetanus.

The first round of the first phase started from 7 April 2015-World Health Day- in 201 high focus districts in 28 states and carried for more than a week. This was followed by three rounds of more than a week in the months of April, May June and July 2015, starting from 7th of each month. The 201 high focus districts account for nearly 50% of all unvaccinated or partially vaccinated children in the country. Of these, 82 districts are in just four states of UP, Bihar, Madhya Pradesh and Rajasthan and account for nearly 25% of all unvaccinated or partially vaccinated children of the country.

The preparation and learning during the implementation of the four rounds have led to health systems strengthening in terms of drawing up detailed micro plans; designing sturdy framework for stringent monitoring and evaluation of the immunisation rounds in the states(more than 3600 state and central level monitors have been deputed); training of nearly 9 lakh frontline workers; identification and analysis of limiting factors in different states leading to creating effective structures to mitigate them.

2. Maternal and Neonatal Tetanus Eliminated (MNTE): 

  • Maternal and Neonatal Tetanus Elimination (MNTE) is defined as less than one neonatal tetanus case per thousand live births per year in every district. In 1989, global deaths from Neonatal Tetanus (NT) were estimated at 7.87 lakh per year and India contributed to approximately 2 lakh deaths.
  • All the States/UTs of India have been validated for Maternal and Neonatal Tetanus Elimination (MNTE) well before the global target date of December, 2015. 
  • The Maternal and neonatal tetanus validation in India started in 2003 in a phased manner.
  • Andhra Pradesh was the first state to validate MNT elimination. Nagaland was the last state in the country where the validation exercise was completed on 17th April 2015.
  • India has achieved this validation through the system strengthening including improvement of institutional delivery, which is also a proxy indicator for clean delivery and clean cord care practices and by strengthening Routine Immunization. Strategies to improve clean delivery have been included in the innovative Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karayakaram (JSSK). 
  1. Decision to Introduce New Vaccines

  • In a bid to protect the children from more vaccine preventable diseases, new vaccines are proposed to be introduced as part of India’s Universal Immunisation Programme (UIP). Introduction of these vaccines will be done in a phased manner over a period of time, depending upon the field level assessments and preparedness.
  • In addition, it has been decided to introduce an adult vaccine against Japanese Encephalitis (JE) in the high burden districts. The new vaccines are:
  1. Inactivated Polio Vaccine (IPV).b.  Adult Japanese Encephalitis (JE) vaccine: 21 high burden districts have been identified in Assam, Uttar Pradesh and West Bengal for adult JE vaccination in the age-group of 15-65 years.  This will cut down deaths and morbidity due to Japanese Encephalitis in adults as well.

    c. Rotavirus vaccine: Rotavirus is the leading cause of severe diarrhoea among infants and young children in the world. Each year India loses approximately 2 lakh children to diarrhoea out of which 1 lakh deaths are caused by Rotavirus.

    d. Measles Rubella vaccine:  Measles Rubella vaccine eliminates measles and controls Rubella in the country. The vaccine will help to reduce incidence of Congenital Rubella Syndrome.

    4. Child Health

    I. Special New born Care Units (SNCUs)

  • In order to strengthen the care of sick, premature and low birth weight newborn Special New born Care Units (SCNU) have been established at District Hospitals and tertiary care hospitals. 
  • Each SNCU is expected to provide: Care at birth including resuscitation of asphyxiated newborn, sick newborn and routine postnatal care. 
  • Follow up of high risk newborn and Immunization/Referral Services are also provided for. 
  1. National Deworming Day: A Fixed Day Fixed Site strategyGovernment of India for effective deworming coverage
  • Like many other countries across the globe, India is also endemic for Soil Transmitted Helminths. More than 241 million children are estimated to be at risk of parasitic intestinal worm infections leading to impaired physical growth, cognitive development, fatigue, internal bleeding. They also cause micronutrient deficiencies leading to poor school performance and absenteeism in children. Albendazole tablets, once in 6 months, is a simple drug proven to reduce the worm load.
  • Understanding the negative impact of worm load in children effecting their growth and development, Government of India, ambitiously launched – National Deworming Day (NDD) on 10th February, 2015 
  • NDD was implemented in 277 districts across 11 States/UT 
  • In order to accelerate efforts towards reduction of Childhood mortality, which is one of the prime goals of National Health Mission. Diarrhoea contributes to around 11 percent under-five deaths in country- most of these deaths are clustered around Summer and Monsoon season.
  • To effectively address the issue, Intensified Diarrhoea Control Fortnight (IDCF) was implemented with an aim of achieving improved coverage of essential life-saving commodity of ORS, zinc dispersible tablets and practice of appropriate child feeding practices during diarrhoea.
  • The chief activities during IDCF involved doorstep ORS distribution by ASHA to house with under-five children, counselling for infant and young child feeding, referral of children with diarrhoea for treatment, capacity building of frontline workers for management of childhood diarrhoea, setting up of ORS-zinc corners along with multi-sectoral involvement of Anganwadi centres for growth monitoring of all children, PRI meetings on the subject of childhood diarrhoea, hand-washing sessions in schools.

3. Rashtriya Bal Swasthya Karyakram (RBSK)

  • The Rashtriya Bal Swasthya Karyakram (RBSK) has been launched to provide child health screening and early interventions services by expanding the reach of mobile health teams at block level.
  1. The strategic interventions to address birth defects, disabilities, delays and deficiencies are:Screening of children under RBSK- Child health screening and early intervention services to with an aim to improve the overall quality of life of children through early detection of birth defects, diseases, deficiencies, development delays including disability (4 Ds) and reduce out of pocket expenditure for the families.

    5. Maternal Health

    “Daksh”

  • For improving the skills of healthcare providers and to enhance their capacity to provide quality (Reproductive, Maternal, Neonatal, Child & Adolescent Health) RMNCH+A services, Government of India has  established five National Skills  lab ‘’Daksh’’
  • These skills lab will handhold and guide creating skills lab and also train state trainers. National Skills labs are being attached to all the states and UTs so that there is an optimum utilization of the National Skills lab. 

The objectives of Skills lab are to :

a) Facilitate acquisition/ reinforcement of key standardized technical skills and  knowledge by service providers for RMNCH+A services 

b) Ensures the availability of skilled personnel at health facilities

c) Improves the quality of pre service training 

d) Provides continuing Nursing education / Continuing medical education. The target audience of 6 days skills lab training are Obstetricians and Gynaecologists, Paediatricians, Medical Officers, staff Nurses, Auxiliary Nurse Midwife (ANM), state trainers and faculty of Nursing School/ colleges and Medical College who can adapt it for strengthening pre service teaching.

  1. Adolescent Healthi. Rashtriya Kishor Swasthya Karyakram (RKSK)
  • The Rashtriya Kishor Swasthya Karyakram (RKSK) was launched in January 2014 with an overarching aim to address sexual and reproductive health, nutrition, injuries and violence (including gender based violence), prevention of non-communicable diseases, mental health and substance misuse related concerns of  253 million adolescents of our country through effective and coherent implementation of programmes and schemes.
  • The short term goal is to ensure holistic health and development of adolescents and the long term outcome will be increased social and economic productivity of our nation.
  • The programme is underpinned by the principles of equity and inclusion; rights based approach, adolescent and community participation and strategic partnership. The key components of the program are community based interventions; facility based interventions; social and behavior change communication; and inter-sectoral convergence.
  • Peer Education Programme:To build a community of proactive and confident adolescents, who are well informed and are capable of taking appropriate decisions about their health and wellbeing, is one of the key drivers of RKSK programme.
  1. Weekly Iron Folic Acid Supplementation (WIFS) programme:
  • WIFS entails provision of weekly supervised IFA tablets to in-school boys and girls and out-of-school girls for prevention of iron and folic acid deficiency anaemia, and biannual albendazole tablets for helminthic control. 
  • The programme is being implemented across the country in both rural and urban areas, covering government, government aided schools, municipal schools and Anganwadi centres.
  • Screening of targeted adolescents population for moderate/ severe anaemia and referral of these cases to an appropriate health facility; and information and counselling for prevention of nutritional anaemia are also included in the programme. 

iii. Scheme for Promotion of Menstrual Hygiene among Adolescent Girls in Rural India:

  • The Ministry of Health and Family Welfare has launched Scheme for Promotion of Menstrual Hygiene among adolescent girls in the age group of 10-19 years in rural areas as part of the Adolescent Reproductive Sexual Health (ARSH) in RCH II, with specific reference to ensuring health for adolescent girls. The major objectives of the scheme are:
  • To increase awareness among adolescent girls on Menstrual Hygiene
  • To increase access to and use of high quality sanitary napkins to adolescent girls in rural areas.
  • To ensure safe disposal of Sanitary Napkins in an environmentally friendly manner.
  • Under the scheme a pack of 6 sanitary napkins is provided under the NRHM’s brand ‘Freedays’. These napkins are sold to the adolescents girls at Rs. 6 for a pack of 6 napkins in the village by the Accredited Social Health Activist (ASHA). On sale of each pack, the ASHA gets an incentive of Rs. 1 per pack besides a free pack of sanitary napkins per month. This initial model of the scheme was rolled out in 112 selected districts in 17 States through central supply of sanitary napkin packs.
  • Facility based interventions:-:Adolescent Friendly Health Clinics act as the first level of contact of primary health care services with adolescents. These clinics are being developed across all level of care to cater to diversified health and counselling need of adolescent girls and boys. These broad objectives will be achieved through establishment of optimally functional AFHCs at District Hospitals, Community Health Centres and Primary Health Care centres in prioritized districts. 
  1. Social and Behaviour Change Communication with focus on Inter Personal Communication:-:Communication material for WIFS, Menstrual Hygiene Program and issue related to Adolescent Pregnancy has been developed and shared with States.7. The National Health Mission (NHM)

The National Health Mission (NHM) encompasses its two Sub-Missions, the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM). The main programmatic components include Health System Strengthening in rural and urban areas, Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A), and Communicable and Non-Communicable Diseases. The NHM envisages achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people’s needs.

National Rural Health Mission (NRHM): NRHM seeks to provide accessible, affordable and quality health care to the rural population, especially the vulnerable groups. Under the NRHM, the Empowered Action Group (EAG) States as well as North Eastern States, Jammu and Kashmir and Himachal Pradesh have been given special focus. The thrust of the mission is on establishing a fully functional, community owned, decentralized health delivery system with inter-sectoral convergence at all levels, to ensure simultaneous action on a wide range of determinants of health such as water, sanitation, education, nutrition, social and gender equality.

National Urban Health Mission (NUHM): NUHM seeks to improve the health status of the urban population particularly urban poor and other vulnerable sections by facilitating their access to quality primary health care. NUHM covers all state capitals, district headquarters and other cities/towns with a population of 50,000 and above (as per census 2011) in a phased manner. Cities and towns with population below 50,000 will continue be covered under NRHM. 

Key Initiatives under NHM: 

  • Launch of National Quality Assurance Framework for Health facilities: To improve quality of health care in over 31000 public facilities and provide a clear roadmap to states, Quality Standards for District Hospitals (DHs), CHCs and PHCs under National Quality Assurance Framework were rolled out in November, 2014.
  • Launch of Kayakalp- an initiative for Award to Public Health Facilities: Kayakalp- initiative has been launched to promote cleanliness, hygiene and infection control practices in public health facilities. Under this initiative public healthcare facilities shall be appraised and such public healthcare facilities that show exemplary performance meeting standards of protocols of cleanliness, hygiene and infection control will receive awards and commendation.
  • Launch of National Family Health Survey (NFHS)–IV: NFHS-IV was launched in mid-2014 to provide essential data and information on important emerging health and family welfare elements to track progress on key parameters and provide evidence for policy and programme.
  • Launch of India Newborn Action Plan (INAP)
  • Launch of Mission Indradhanush
  • Approval of four new vaccines- Approval of four new vaccines namely rotavirus, Inactivated Polio Vaccine (IPV), Measles-Rubella vaccine, Japanese Encephalitis vaccine extended to adults. This will significantly reduce vaccine preventable morbidity, disability and mortality.
  • Free Drugs Service Initiative: An incentive of up to 5% additional funding (over and above the normal allocation of the state) under the NHM is provided to those States that introduce free medicines scheme.
  • Free Diagnostics Service Initiative: The NHM- Free Diagnostics Service Initiative was launched in 2013 to provide free essential diagnostic services at public health facilities under which substantial funding was provided to States within their resource envelope.
  • Bio Medical Equipment Maintenance: States have been asked to plan interventions for comprehensive equipment maintenance for all functional medical equipment/machinery.
  • Comprehensive Primary Health Care: Primary health care including preventive and promotive health care enables early detection and prompt treatment and serves a gate-keeping function to secondary and tertiary care, and also reduces the cost of care.    Nine areas for action to make primary health care comprehensive and universal are proposed. They include:
  • Strengthen Institutional Structures and Organization of Primary Health Care Services.
  • Improve access to technologies, drugs and diagnostics for comprehensive Primary Health Care
  • Increase utilization of Information, Communication and Technology (ICT) – empowering patients and providers
  • Promote Continuity of care- making care patient centric
  • Enhance Quality of Care
  • Focus on Social Determinants of Health
  • Emphasize Community Participation and Address Equity Concerns in Health
  • Develop a Human Resource Policy to support primary health care
  • Strengthen Governance including financing, partnerships and accountability.  

⇒  Kilkari & Mobile Academy: To create proper awareness among pregnant women, parents of children and field workers about the importance of Anti Natal Care (ANC), institutional delivery, Post-Natal Care (PNC) and immunization, it was decided to implement the Kilkari and Mobile Academy services in pan India in phased manner.
Kilkari is an Interactive Voice Response (IVR) based mobile service that delivers time-sensitive audio messages (Voice Call) about pregnancy and child health directly to the mobile phones of pregnant women, mothers of young children and their families. The service covers the critical time period – where the most maternal/infant deaths occur – from the 4th month of pregnancy until the child is one year old. Families subscribe to the service receive one pre-recorded system generated call per week. Each call will be 2 minutes in length and serve as reminders for what the family should be doing that week depending on woman’s stage of pregnancy or the child’s age. Kilkari services will be available to states in regional dialect.

⇒  Launch of Nationwide Anti-TB drug resistance survey: Drug resistant survey for 13 TB drugs was launched to provide a better estimate on the burden of Multi-Drug Resistant Tuberculosis in the community.

⇒ Kala Azar Elimination Plan : To reduce the annual incidence of Kala-Azar to less than one per 10,000 population at block PHC level by the end of 2015,

             8. National Programme for Control of Blindness 

  • India was the first country to launch the National Programme for Control of Blindness in 1976 as a 100% centrally sponsored scheme with the goal to reduce the massive burden of avoidable blindness, mainly due to cataract and trachoma,  to 0.3%  by 2020 from its current level of 1.49%.
  • The three signature blindness control activities that were undertaken at mega level included cataract operation by various partners, the collection of corneas from deceased eye donors and school eye screening scheme to pick up eye defect like refractive errors, squint and amblyopia, vitamin A deficiency with associated xero-phthalmia and night blindness.  A massive initiative was launched to treat and eradicate trachoma.
  1.  National Programme for Health Care of the Elderly (NPHCE)Keeping in view the recommendations made in the “National Policy on Older Persons” as well as the State’s obligation under the “Maintenance & Welfare of Parents & Senior Citizens Act 2007”, the Ministry of Health & Family Welfare has initiated the “National Programme for the Health Care of Elderly” (NPHCE) during the 11th Plan period to address various health related problems of elderly people.

    The objectives of the NPHCE are:- 

  • To provide easy access to preventive, promotive, curative and rehabilitative services to the elderly.
  • To make use of the community based primary health care approach and strengthen capacity of the medical and paramedical professionals as well as the care-takers within the family for caring practices of the elderly.
  • To identify health problems in the elderly and provide appropriate health interventions in the community with a strong referral backup support.
  • To provide referral services to the elderly patients through district hospitals, medical colleges and strengthen health manpower development in the field of geriatric medicine,
  • Development of treatment models for the elderly persons in our country.
  1.  National Programme for Prevention and Control of Fluorosis:The Government of India initiated the National Programme for Prevention and Control of Fluorosis (NPPCF) in 2008-09 with an aim to prevent and control fluorosis in the country.  So far, the programme has been expanded to cover 111 districts in 18 States in a phased manner.Objectives of NPPCF:
  • To collect, assess and use the baseline survey data of fluorosis of Ministry of Drinking Water and Sanitation  for starting the project;
  • Comprehensive management of fluorosis in the selected areas;
  • Capacity building for prevention, diagnosis and management of fluorosis cases.
  1. Oral Health Programme:India has a high prevalence of oral diseases and it is well established that oral diseases are a public health problem and have a great impact on systemic health. Poor oral health can cause poor aesthetics, affects mastication adversely, causes agonizing pain and can lead to loss of productivity due to loss of man-hours.Though India is producing a large number of dental graduates, most of the rural areas in the country do not have service providers for common oral diseases and hence about 72.6% of the rural population remains neglected. Apart from this fact, the issue of accessibility (reaching to the health services) also exists, as it becomes a costly affair for the rural population to seek oral health related treatment. Promotion of healthy lifestyles with respect to oral health needs to be considered. World Health Assembly in 2005 included Oral Health with other non-communicable diseases (NCDs) for health promotion & disease prevention strategies.

    Objectives:-

    a) Improvement in the determinants of oral health e.g. healthy diet, oral hygiene improvement etc and to reduce disparity in oral health accessibility in rural & urban population.

    b)  Reduce morbidity from oral diseases by strengthening oral health services at Sub district/district hospital to start with.

    c) Integrate oral health promotion and preventive services with general health care system and other sectors that influence oral health; namely various National Health Programmes (National Tobacco Control Program, School Health Programme, National Program for Prevention & Control of Fluorosis, National Program for Prevention & Control of CVD, Diabetes & Stroke etc) education, social welfare, women and child development, etc.

    d) Promotion of Public Private Partnerships (PPP) for achieving public health goals

    National Oral Health Programme

    Taking into account the oral health situation in the country, Government of India has initiated a National Oral Health Programme to provide integrated, comprehensive oral health care in the existing health care facilities with the following objectives:

    a. To improve the determinants of oral health

    b. To reduce morbidity from oral diseases

    c. To integrate oral health promotion and preventive services with general health care system

    d.To encourage Promotion of Public Private Partnerships (PPP) model for achieving better oral health.