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CM17.3-4 | CM17.3-4 | Primary Health Care and Health Policies — SDL Guide (Part 2)

National Health Policies — NHP 2017, NPP 2000, and MDG/SDG Commitments

India's national health policies translate PHC principles into measurable commitments. Understanding three policy generations is essential:

National Population Policy 2000 (NPP 2000): The NPP 2000 addressed India's population and reproductive health agenda, setting immediate, medium-term, and long-term targets:
- Immediate: provide integrated package of services for child survival, maternal health, and contraception
- Medium-term (by 2010): IMR ≤30/1,000 live births; MMR ≤100/100,000 live births; Total Fertility Rate (TFR) 2.1 (replacement level); Universal immunisation of children
- Long-term (by 2045): achieve stable population consistent with sustainable development

Millennium Development Goals (MDGs, 2000–2015): India committed to 8 MDGs; the health-relevant ones include:
- MDG 4: Reduce under-5 mortality rate (U5MR) by two-thirds between 1990 and 2015 (India's 1990 U5MR ~126/1,000; 2015 target ~42)
- MDG 5: Reduce maternal mortality ratio (MMR) by three-quarters between 1990 and 2015 (India's 1990 MMR ~556/100,000; 2015 target ~139)
- MDG 6: Halt and begin to reverse the spread of HIV/AIDS and malaria
- India made substantial progress on MDG 4 and 6 but did not fully achieve MDG 5.

National Health Policy 2017 (NHP 2017): India's most comprehensive health policy, framed around the SDG health goals. Key NHP 2017 targets by 2025:
- IMR ≤28/1,000 live births; U5MR ≤23/1,000; MMR ≤100/100,000
- TFR 2.1 nationally
- Health expenditure increased to 2.5% of GDP (from ~1.15% in 2017)
- Life expectancy at birth ≥70 years
- Progressive achievement of Universal Health Coverage (UHC)

Sustainable Development Goals (SDGs, 2015–2030): SDG 3 is 'Good Health and Well-Being'; specific targets:
- SDG 3.1: MMR <70/100,000 live births by 2030
- SDG 3.2: U5MR ≤25/1,000 by 2030; Neonatal Mortality Rate ≤12/1,000 by 2030
- SDG 3.8: Achieve Universal Health Coverage

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Policy / Framework	Year	Key Health Targets	Status (2024)
National Population Policy	2000	IMR ≤30, MMR ≤100, TFR 2.1 by 2010	TFR achieved; IMR ~27 (near); MMR ~97 (near)
National Health Policy	2002	Reinforce PHC, eliminate polio/leprosy	Largely achieved
Millennium Dev. Goals	2000–2015	U5MR ↓2/3, MMR ↓3/4	MDG 4 nearly achieved; MDG 5 partially
National Health Policy	2017	IMR ≤28, U5MR ≤23, MMR ≤100, GDP 2.5%	In progress
Sustainable Dev. Goals	2015–2030	MMR <70, U5MR ≤25, NMR ≤12, UHC	In progress

Monitoring and Evaluating PHC Programmes — Indicators and India's Progress

PHC programmes are monitored using a set of standardised health indicators that reflect the 8 elements and the outcomes they are intended to achieve. Understanding which indicator measures which PHC element allows a medical officer to rapidly identify programme gaps.

Core PHC monitoring indicators for India:

Indicator	Reflects PHC Element	India Value (NFHS-5 / SRS 2020)	SDG Target 2030
IMR (deaths <1 yr/1,000 LB)	MCH + immunisation + safe water	35.2 (SRS 2020)	≤12
U5MR (deaths <5 yr/1,000 LB)	MCH + nutrition + sanitation	41.9 (SRS 2019)	≤25
NMR (neonatal deaths/1,000 LB)	MCH + skilled birth attendance	25.5 (SRS 2019)	≤12
MMR (maternal deaths/100,000 LB)	MCH + skilled birth attendance	97 (SRS 2018-20)	<70
TFR (births/woman)	Family planning	2.0 (NFHS-5)	2.1 (replacement)
Full immunisation coverage	Immunisation element	76.4% (NFHS-5)	90%
Open defecation free status	Sanitation element	ODF declared 2019 (Swachh Bharat)	ODF
Stunting (<5 yrs)	Nutritional promotion	35.5% (NFHS-5)	<10%

India's Reproductive and Child Health Indicators: Progress and Remaining SDG Gaps (1990–2021)

Interpreting the data: India's TFR has reached replacement level (2.0 per NFHS-5), a historic demographic milestone. IMR has declined dramatically from ~80/1,000 in 1990 to ~35/1,000 but remains above the SDG target of ≤12. Stunting at 35.5% remains a major nutritional public health challenge despite ICDS and POSHAN Abhiyaan. These gaps define the current PHC agenda for India.

Process vs outcome indicators: In programme monitoring, process indicators (immunisation coverage, ANC registration rates, skilled birth attendance %) measure what the health system is doing; outcome indicators (IMR, MMR, TFR) measure what results the system is achieving. Both are needed: high process indicator values with poor outcomes signal quality issues; low process values immediately identify coverage gaps.

Applying PHC Principles to a District Health Scenario

Integrating PHC principles and national policy targets in a real-world scenario requires mapping observed gaps to their Alma-Ata element and the appropriate policy lever.

Scenario: You are the District Health Officer (DHO) of a district in Uttar Pradesh with the following profile (annual HMIS data): IMR = 48/1,000 (state average 43, national 35); full immunisation coverage = 52% (national target 90%); institutional delivery = 61% (national average 89%); open defecation = 22% of households; anaemia in women of reproductive age = 58%; TFR = 3.1.

PHC gap analysis:

Observed Gap	PHC Element	Policy Lever	Responsible Actor
Immunisation coverage 52%	Immunisation	UIP/Mission Indradhanush	CMHO, ANMs, ASHAs
Institutional delivery 61%	MCH	JSY/PMSMA/SUMAN	PHC/CHC medical officers, ANMs
High TFR 3.1	Family planning	NPP 2000/Mission Parivar Vikas	ASHA counselling, spacing methods
High anaemia 58%	Nutritional promotion	POSHAN Abhiyaan/IFA supplementation	ICDS, ANMs
OD 22% households	Safe water/sanitation	Swachh Bharat Mission	PRIs, Public Health Engineering

Application of PHC principles:
- Equitable distribution: identify the blocks with lowest immunisation and institutional delivery rates — target outreach specifically there
- Community participation: activate VHSNCs in low-performing villages; involve self-help groups in anaemia reduction
- Intersectoral coordination: convene District-level meetings with Education, PRI, ICDS and Water & Sanitation departments — anaemia and OD gaps cannot be solved by health sector alone
- Appropriate technology: iron-folic acid tablets, ORS, contraceptive spacing methods — all align with appropriate technology criteria
- Political commitment: present gap analysis at District Health Society meeting; seek budget allocation for Mission Indradhanush intensification rounds

This mapping exercise — from observed indicator gap to PHC element to policy programme to responsible actor — is the applied skill that PHC and policy literacy enable.