NATIONAL HEALTH POLICY FOR CHILDREN

INTRODUCTION OF HEALTH POLICY

Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society. According to the World Health Organization, an explicit health policy can achieve several things. It defines a vision for the future; it outlines priorities and the expected roles of different groups; and it builds consensus and informs people.

NATIONAL HEALTH POLICY FOR CHILDREN

The Government of India adopted a National Policy for children in August 1974, keeping in view the United Nations Declaration of the Rights of the child and the constitution provisions. The National Health Policy for Children 1974 is the first policy document concerning the needs and rights of children.

The Policy declares:

“It should be the policy of the state to provide adequate services to children, both before and after birth and through the period of growth, to ensure their full physical, mental and social development. The state shall progressively increase the scope of such services so that, within a reasonable time, all children in the country enjoy optimum conditions for their balanced growth.”

According to the declaration, the development of children has been considered as integral part of national development. The policy recognizes children as the “nation’s supremely important asset” and declares that the nation is responsible for their “nurture and solicitude”. It also emphasizes the priorities of children’s program and special focus on child health, child nutrition and welfare of the handicapped and destitute children.

A number of programs were introduced by the Govt. of India, after the declaration of national policy for children. The important programs are ICDS scheme, programs of supplementary feeding, nutrition education, production of nutritious food, welfare of handicapped children, national children’s fund, CSSM programs, etc.

The Principles of India’s National Policy for Children

·         A comprehensive health program for all children and provision of nutrition services for children.

·         Provision of health care, nutrition and nutrition education for expectant and nursing mothers.

·         Free and compulsory education up to the age of 14 years, informal education for preschoolers and efforts to reduce wastage and stagnation in schools.

·         Out of school education for those not having access to formal education.

·         Promotion of games, recreation and activities in schools and community centers.

·         Special programs for children from weaker sections.

·         Facilities for education, training and rehabilitation for children in distress.

·         Protection against neglect, cruelty and exploitation.

·         Banning of employment in hazardous occupations and in heavy work for children.

·         Special treatment, education, rehabilitation and care of physically handicapped, emotionally disturbed or mentally retarded children.

·         Priority for the protection and relief of children in times of national distress and calamity.

·         Special programs to encourage talented and gifted children, particularly from the weaker sections.

·         The paramount consideration in all relevant laws is the “interests of children.”

·         Strengthening family ties to enable children to grow within the family, neighborhood and community environment.

NATIONAL PLAN OF ACTION FOR CHILDREN, 2005

• Ministry of women and child welfare has prepared a National Plan of Action for Children 2005.

• The Prime Minister’s Office is quarterly monitoring the National Plan of Action for Children 2005 on the basis of eight parameters-

1.    Reduce IMR to below 30 per 1000 live births by 2010.

2.    Reduce Child Mortality Rate to below 31 per 1000 live births by 2010.

3.    To reduce Maternal Mortality Rate to below 100 per 100,000 live births by 2010.

4.    Universal equitable access and use of safe drinking water and improved access to sanitary means of excreta disposal by 2010.

5.    100% rural population to have access to basic sanitation by 2012.

6.    To eliminate child marriages by 2010.

7.    To eliminate disability due to poliomyelitis by 2007.

8.    To reduce the proportion of infants infected with HIV by 20 percent by 2007 and by 50 percent by 2010, by ensuring that 80 per cent of pregnant women have access to ante natal care, and 95 per cent of men and women aged 15-24 have access to care, counseling and other HIV and prevention services.

 NATIONAL POLICY FOR CHILDREN, 2013

The Government has adopted a new National Policy for Children, 2013 on 26th April, 2013. The Policy recognizes every person below the age of eighteen years as a child and covers all children within the territory and jurisdiction of the country. It recognizes that a multisectoral and multidimensional approach is necessary to secure the rights of children. The Policy has identified four key priority areas: survival, health and nutrition; education and development; protection and participation, for focused attention. As children’s needs are, interconnected and require collective action, the Policy calls for purposeful convergence and coordination across different sectors and levels of governance.

Salient Features of National Health Policy, 2013

·         It focuses on the prevention of disabilities. Since it has been estimated that a large percentage of disabilities in India are preventable, so it is expected that with early interventions, further disabilities could be treated and managed, after which rehabilitation and social support measures need to be provided.

·         It recognizes that, at times, children with disabilities are not given access to education and may be in need of additional care and protection. They are included in a larger group of vulnerable children who need to be tracked and have access to their right to education.

·         It highlights the need for schools to be inclusive and for the availability of trained teachers and special educators, appropriate pedagogy and education material, barrier-free access for mobility, functional toilets and co-curricular activities towards the development of a child’s fullest potential and autonomy, as well as dignity and self-worth.

·         It specifically states that the views of children with disabilities must be promoted and strengthened within the family, community, schools and institutions, different levels of governance, as well as in judicial and administrative proceedings concerning them.

·         It is the first policy document in India that specifically highlights “disability” as a ground for

discrimination that must be countered.

Key priorities in Policy:

·        Survival, Health and Nutrition:

The right to life, survival, health and nutrition is the right of every child and will receive the highest priority. The Policy ensures equitable access to comprehensive, and essential, preventive, promotive, curative and rehabilitative health care, of the highest standard, for all children before, during and after birth, and throughout the period of their growth and development. Every child has a right to adequate nutrition and to be safeguarded against hunger, deprivation and malnutrition. The State commits to securing this right for all children through access, provision and promotion of required services and supports for holistic nurturing and wellbeing, keeping in view their individual needs at different stages of their life.The State shall also take into account improving maternal health care, including antenatal care, safe delivery by skilled health personnel, post natal care and nutritional support. Providing information for making informed choices related to birth and spacing of children will be a priority along with providing adolescents access to information, support and services essential for their health and development. The Policy highlights preventing Survival, Health and Nutrition HIV infections at birth and ensuring infected children receive medical treatment, adequate nutrition and after-care, and are not discriminated against in accessing their rights.

·        Education and Development:

Every child has equal right to learning, knowledge and education. The State recognizes its responsibility to secure this right for every child, with due regard for special needs, through access, provision and promotion of required environment, information, infrastructure, services and supports, towards the development of the child’s fullest potential.

·        Protection:

Children have the right to be protected wherever they are. The State shall create a caring, protective and safe environment for all children, to reduce their vulnerability in all situations and to keep them safe at all places, especially public spaces. A safe, secure and protective environment is a precondition for the realization of all other rights of children. The State shall protect all children from all forms of violence and abuse, harm, neglect, stigma, discrimination, deprivation or any other activity that takes undue advantage of them, harms their personhood or affects their development. To secure the rights of children temporarily or permanently deprived of parental care, the State shall endeavour to ensure family and community-based care arrangements guaranteeing quality standards of care and protection.

The State commits to taking special protection measures to secure the rights and entitlements of children in need of special protection, characterized by their specific social, economic and geo-political situations, including their need for rehabilitation and reintegration. The State shall also promote child friendly jurisprudence, enact progressive legislation, build a preventive and responsive child protection system and promote effective enforcement of punitive legislative and administrative measures against all forms of child abuse and neglect.

·        Participation:

The State has the primary responsibility to ensure that children are made aware of their rights, and provided with an enabling environment, opportunities and support to develop skills, to form aspirations and express their views in accordance with their age, level of maturity and evolving capacities, so as to enable them to be actively involved in their own development and in all matters concerning and affecting them. The State shall promote and strengthen respect for the views of the child, especially those of the girl child, children with disabilities and of children from minority groups or marginalized communities, within the family; community; schools and institutions; different levels of governance; as well as in judicial and administrative proceedings that concern them. The State shall engage all stakeholders in developing mechanisms for children to share their grievances without fear in all settings; monitor effective implementation of children’s participation through monitorable indicators; develop different models of child participation; and undertake research and documentation of best practices.

·         Advocacy and Partnerships:

The policy affirms that the State shall encourage the active involvement and collective action of individuals, families, local communities, non-governmental and civil society organizations, media and private sector including government in securing the rights of the child. The State shall also make planned, coordinated and concerted efforts to raise public awareness on child rights and entitlements among the masses. Along with this all stakeholders are to promote the use of rights-based and equity-focused tools to generate awareness on child rights. This Policy will ensure that children’s best interests and rights are accorded the highest priority in areas of policy, planning, resource allocation, governance, monitoring and evaluation, and children’s voices and views are heard in all matters and actions which impact their lives. The State shall also ensure that service delivery and justice delivery mechanisms and structures are participatory, responsive and child-sensitive, thereby enhancing transparency and ensuring public accountability.

·         Coordination, Action and Monitoring:

Addressing the rights and needs of children requires programming across different sectors and integrating their impact on the child in a synergistic way. Community and local governance play a significant role in ensuring the child’s optimum development and social integration. The National Policy states that the Ministry of Women and Child Development (MWCD) will be the nodal Ministry for overseeing and coordinating the implementation of this Policy. A National Coordination and Action Group (NCAG) for Children under the Minister in charge of the Ministry of Women and Child Development will monitor the progress with other concerned Ministries as its members. Similar Coordination and Actions Groups will be formed at the State and District level.

The National Commission for Protection of Child Rights and State Commissions for Protection of Child Rights will ensure that the principles of this Policy are respected in all sectors at all levels in formulating laws, policies and programs affecting children.

·         Research, Documentation and Capacity Building:

The implementation of this Policy will be supported by a comprehensive and reliable knowledge base on all aspects of the status and condition of children. Establishing such a knowledge base would be enabled through child focused research and documentation, both quantitative as well as qualitative. A continuous process of indicator-based child impact assessment and evaluation will be developed, and assessment and evaluation will be carried out on the situation of children in the country, which will inform policies and programs for children. Professional and technical competence and capability in all aspects of programming, managing, working and caring for children at all levels in all sectors will be ensured through appropriate selection and well planned capacity development initiatives. All duty bearers working with children will be sensitized and oriented on child rights and held accountable for their acts of omission and commission.

·        Resource Allocation

To implement this policy efficiently the State has committed to allocate the required financial, material and human resources, and their efficient and effective use, with transparency and accountability.

NATIONAL HEALTH POLICY, 2017

The National Health Policy, 2017 (NHP, 2017) seeks to reach everyone in a comprehensive integrated way to move towards wellness.  It aims at achieving universal health coverage and delivering quality health care services to all at affordable cost.

Goal of NHP, 2017:

The policy envisages as its goal the attainment of the highest possible level of health and well-being for all at all ages, through a preventive and promotive health care orientation in all developmental policies, and universal access to good quality health care services without anyone having to face financial hardship as a consequence. This would be achieve through increasing access, improving quality and lowering the cost of health care delivery.

Objective of NHP, 2017:

Improve health status through concerted policy action in all sectors and expand preventive, promotive, curative, palliative and rehabilitative services provided through the public health sector which focus on quality.

Specific quantitative goals and objectives related to health of children:

v Health Status and Policy Impact:

Ø  Life expectancy and healthy life:

·         Increase life expectancy at birth from 67.5 to 70 by 2025.

Ø  Mortality by age and/or cause:

·         Reduce Under Five Mortality to 23 by 2025 and current levels to 100 by 2020.

·         Reduce infant mortality rate to 28 by 2019.

·         Reduce neonatal mortality to 16 and still birth rate to “Single digit” by 2025.

v  Health System Performance:

Ø  Coverage of health services:

·         Antenatal care coverage to be sustained above 90% and skill attendance at birth above 90% by 2025.

·         More than 90% of the newborn are fully immunized by one year of age by 2025.

·         Meet need of family planning above 90% at national and sub national level by 2025.

Ø  Cross Sectoral goals related to health:

·         Reduction of 40% in prevalence of stunting of under-five children by 2025.

INTELLECTUAL DISABILITY RELATED SCHEMES FOR CHILDREN

·         Sahyogi: It’s a new and revamped scheme of Caregivers Training and Deployment. A new training module has been designed and a system of training and deployment of caregivers has been provided for under the scheme.

·         Smarth: It’s a Centre Based Scheme which was introduced in July, 2005 for residential services- both short term and long term. Activities in a Samarth Centre should include early intervention, special education or integrated school, open school, pre-vocational and vocational training, employment oriented training, recreation sports etc.

·         Aspiration: This is an early intervention program for school readiness. The scheme is to work with children of 0-6 years with developmental disabilities, to make them ready for mainstream and special schools.

JANANI  SURAKSHA YOJANA  (JSY)

JSY is a safe motherhood intervention under the National Rural Health Mission (NHM). It is being implemented with the objective of reducing maternal and neonatal mortality by promoting institutional delivery among poor pregnant women. The scheme is under implementation in all states and Union Territories (UTs), with a special focus on Low Performing States(LPS).

Janani Suraksha Yojana was launched in April 2005 by modifying the National Maternity Benefit Scheme (NMBS). The NMBS came into effect in August 1995 as one of the components of the National Social Assistance Program (NSAP). The scheme was transferred from the Ministry of Rural Development to the Department of Health & Family Welfare during the year 2001-02. The NMBS provides for financial assistance of Rs. 500/- per birth up to two live births to the pregnant women who have attained 19 years of age and belong to the below poverty line (BPL) households. When JSY was launched the financial assistance of Rs. 500/- , which was available uniformly throughout the country to BPL pregnant women under NMBS, was replaced by graded scale of assistance based on the categorization of States as well as whether beneficiary was from rural/urban area. States were classified into Low Performing States and High Performing States on the basis of institutional delivery rate i.e. states having institutional delivery 25% or less were termed as Low Performing States (LPS) and those which have institutional delivery rate more than 25% were classified as High Performing States (HPS). Accordingly, eight erstwhile EAG states namely Uttar Pradesh, Uttarakhand, Madhya Pradesh, Chhattisgarh, Bihar, Jharkhand, Rajasthan, Odisha and the states of Assam & Jammu & Kashmir were classified as Low Performing States. The remaining States were grouped into High Performing States.

Cash incentive:

Sukhibhava & Janani Suraksha Yojana Incentive Schemes should be implemented in a combined manner (Rs.1000/- cash incentive for Institutional Delivery) from 1st November 2005.

Under the Janani Suraksha Yojana and Sukhibhava schemes put together, a total cash incentive amount of Rs.1000/- (i.e. Rs.700/- from JSY and Rs.300/- from Sukhibhava) will be paid to rural BPL pregnant women who fulfill the revised and combined eligibility guidelines under the two schemes.

This cash incentive should be paid only to those RURAL, BELOW-POVERTY-LINE women who undergo delivery in a Government healthcare institution i.e., Teaching Hospitals, District Head quarter Hospitals, Area Hospitals, Community Health Centers, 30 bedded and other Government Hospitals, and PHCs. 

                                                                   

Eligibility Conditions for JSY & Sukhibhava:

                                  

The following are the new guidelines for the combined “JSY + Sukhibhava” schemes:

·         Only below-poverty-line women from rural areas are eligible.

·         Women aged 19 years and above only are eligible.

·         Women giving birth to first and second child only are eligible.

·         Pregnant women who delivered twins in first delivery and undergoing second delivery are also eligible.

·         Women coming for delivery (otherwise eligible, i.e., rural, below poverty line, and 19 years or above in age), with only one living child, are also eligible.

JANANI SHISHU SURAKSHA KARYAKRAM

JSSK was launched on 1^st June, 2011. This scheme supplements the cash assistance given to a pregnant women under Janani Suraksha Yojana and is aimed at mitigating the burden of out of pocket expenses incurred by pregnant women and sick newborns.

The initiative entitles all pregnant women delivering in public health institutions are the followings:

·         Absolutely free and no expense delivery, including caesarean section.

·         Free drugs and consumables.

·         Free diet up to 3 days during normal delivery and up to 7 days for caesarean section.

·         Free diagnostics.

·         Free blood wherever required.

·         Free transport from home to institution, between facilities in case of a referral and drop back home, similar entitlements have been put in place for all sick newborns accessing public health institutions for treatment till 30 days after birth.

MISSION INDRADHANUSH                                  

Mission Indradhanush is a health mission of the Govt of India. It was launched by Union Health Minister J. P. Nadda on 25 December, 2014. It aims to immunize all children under the age of 2 years, as well as all pregnant women, against seven vaccine preventable diseases. The diseases being targeted are diphtheria, whooping cough, tetanus, poliomyelitis, tuberculosis, measles and hepatitis B. In addition to these, vaccines for Japanese Encephalitis and Haemophilus influenzae type B are also being provided in selected states. In 2016, four new additions have been madenamely Rubella, Japanese Enchephalitis, Injectable Polio Vaccine Bivalent and Rotavirus. 201 districts will be covered in the first phase. Of these, 82 districts are in states of Uttar Pradesh, Bihar, Rajasthan, and Madhya Pradesh. The 201 districts selected have nearly 50% of all unvaccinated children in the country. The mission follow planning and administration like PPI.

                                                                                                               

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