Health for All by the year 2000

  • 1978: the Alma-Ata Declaration asked for “an acceptable level of health for all the people of the world by the year 2000”
  • India endorsed it
  • You were born after 2000

Did India get there?

WHO/UNICEF, Alma-Ata Conference Report (1978). International Conference on Primary Health Care (1978)

By the end of today, you will be able to

  1. Describe how Alma-Ata shaped NHP 1983
  2. Explain two changes made by NRHM 2005: the ASHA and JSY
  3. Outline the goal and key shifts of NHP 2017
  4. Compare the three policies on context, private sector and money
  5. Judge, using data, whether their targets were met, late or missed

Quick check

  1. How many people did Bhore want one PHC to serve in the short term?
  2. Is health on the Union, State or Concurrent list?

India’s health policy in three eras

Era Years The government’s main question What it left behind
1. Colonial 1859–1946 How do we protect soldiers, officials and trade? Health as a State subject · 1897 Act · research institutes
2. Nation-building 1946–2004 How do we give basic care to every village? PHC network · Community Medicine · NHP 1983, 2002
3. Missions & UHC 2005–now How do we fix gaps and protect people from health costs? NHM · ASHAs · NHP 2017 · Ayushman Bharat

A teaching framework, drawn from Duggal (2001) and Raj et al. (2024).

Alma-Ata and NHP 1983

Alma-Ata, 12 September 1978

  • Primary health care as the key to Health for All
  • Communities take part in their own health care
  • Health is linked to food, water, education and housing
  • In India, an ICSSR–ICMR group wrote “Health for All: An Alternative Strategy” (1981)

International Conference on Primary Health Care, Alma-Ata, 1978 · Courtesy World Health Organization, via NLM. International Conference on Primary Health Care (1978); ICSSR-ICMR Joint Study Group (1981)

National Health Policy, 1983

India’s first written health policy, 36 years after independence. Goals for the year 2000:

Indicator Goal for 2000
Infant mortality below 60 per 1,000 live births
Life expectancy 64 years
Crude birth rate 21 per 1,000
Crude death rate 9 per 1,000
Maternal mortality below 200 per 100,000 live births
Total fertility rate 2.1 (replacement level)

Norms: one PHC per 30,000 people (20,000 in hilly and tribal areas); one sub-centre per 5,000 (3,000)

Lok Sabha (2000) (official goals table); Ministry of Health and Family Welfare (2000); Duggal (2001)

How many PHCs?

1991 and NHP 2002

1991: the economic crisis

  • 1991: a balance-of-payments crisis led to liberalisation
  • Public health spending fell from 1.3% of GDP (1990) to 0.9% (1999)
  • The private sector grew. The gap between rich and poor in using health care widened

Manmohan Singh before the 1991 Union Budget · PIB, Govt of India · Wikimedia Commons (GODL-India). Ministry of Health and Family Welfare (2002); Sen et al. (2002)

National Health Policy, 2002

  • In 2002, only 17% of all health spending was public
  • Welcomed the private sector in all areas
  • 55% of public health spending for primary care
  • Critics noted it dropped the 1983 goal of universal, comprehensive care
  • Targets: polio and leprosy by 2005; IMR 30 and MMR 100 by 2010; public spending 2% of GDP by 2010

National Health Policy 2002 · Ministry of Health and Family Welfare. Ministry of Health and Family Welfare (2002); Sen Gupta (2002)

NRHM 2005: the bridge

NRHM 2005: why a mission?

  • NHP 2002 set targets but had no delivery vehicle
  • Rural PHCs were weak, most of all in the high-focus states
  • April 2005: the National Rural Health Mission (NRHM) began
  • Extra money went to states as untied funds, spent locally through Rogi Kalyan Samitis
  • 2013: NRHM became the National Health Mission (NHM), with an urban arm (NUHM)

NRHM Framework for Implementation 2005–2012 · MoHFW (to be cited after literature review)

NRHM: the ASHA and JSY

ASHA

Accredited Social Health Activist. A woman chosen by her village, about one per 1,000 people. Paid by task-based incentives, not a salary.

JSY

Janani Suraksha Yojana. Cash to a mother for delivering in a health facility. The ASHA helps her get there.

Institutional births: about 39% (NFHS-3, 2005–06), 79% (NFHS-4, 2015–16), 89% (NFHS-5, 2019–21)

NFHS-3, NFHS-4, NFHS-5 national reports · IIPS (to be cited after literature review)

Earlier proposals for a village health worker

  • Sokhey Committee (1940): a trained worker for the village
  • Shrivastav Group (1975): health workers from the community itself
  • 1977: Community Health Workers, one per village of about 1,000
  • 2005: the ASHA

The same worker was proposed in 1940, 1975 and 2005. What changed was the money and the political push.

Health Services and Medical Education: A Programme for Immediate Action (1975) · SOCHARA / Internet Archive. Group on Medical Education and Support Manpower (1975); Working Group on Health for All by 2000 A.D. (1981)

NHP 2017

NHP 2017: context and goal

  • 2011: High Level Expert Group (HLEG) on Universal Health Coverage
  • 2014–15: draft policy shared for comment
  • 2017: adopted, the first health policy in 15 years
  • Goal: the highest possible level of health and well-being for all, with universal access to good quality care without financial hardship

This is Bhore’s promise (1946), restated as universal health coverage.

National Health Policy 2017 · Ministry of Health and Family Welfare (goal paraphrased; to be cited after literature review)

NHP 2017: five key shifts

Shift What the policy says
More public money Public health spending to 2.5% of GDP by 2025
States spend more States to spend more than 8% of their budgets on health
Primary care first Two-thirds of resources to primary care
Comprehensive primary care Health and Wellness Centres
Strategic purchasing Government buys services from the private sector

National Health Policy 2017 · Ministry of Health and Family Welfare

NHP 2017: selected targets

Target By
IMR 28 2019
MMR 100 2020
Under-5 mortality 23 2025
TFR 2.1 2025
Households with catastrophic health spending down by 25% 2025
Public health spending 2.5% of GDP 2025

National Health Policy 2017 · Ministry of Health and Family Welfare

Three policies side by side

Comparing the three policies

NHP 1983 NHP 2002 NHP 2017
Context Alma-Ata; Health for All 1991 crisis; spending fell HLEG on UHC; rising out-of-pocket costs
Core idea State-led, comprehensive PHC Selective targets; mixed system UHC and financial protection
Private sector Not the focus Welcomed Government buys from it
Money promised Implicit 2% of GDP by 2010 2.5% of GDP by 2025

Ministry of Health and Family Welfare (1983); Ministry of Health and Family Welfare (2002); National Health Policy 2017 · Duggal (2001)

Did the targets work?

Grading the targets

Policy Target Deadline What happened
NHP 1983 Health for All 2000 Not achieved (NHP 2002 says so)
NHP 1983 IMR below 60 2000 68 in 2000; 58 in 2004
NHP 1983 Crude death rate 9 2000 8.6 in 1999
NHP 2002 Leprosy elimination 2005 Achieved nationally, December 2005
NHP 2002 IMR 30 2010 47 in 2010; 30 in 2019
NHP 2002 Spending 2% of GDP 2010 0.87% in 2010; 1.43% in 2022–23
NHP 2017 IMR 28 2019 30 in 2019; 28 in 2020
NHP 2017 MMR 100 2020 97 in 2018–20
NHP 2017 Spending 2.5% of GDP 2025 1.43% in 2022–23

Grade each one: met, late or missed?

Ministry of Health and Family Welfare (2002); Office of the Registrar General, India (2014); Office of the Registrar General, India (2026); Office of the Registrar General, India (2022); Directorate General of Health Services (2026); World Bank (2026); National Health Systems Resource Centre (2026). NHP 2017 outcomes to be verified.

The grades

Target Grade
Health for All by 2000 Missed
IMR below 60 Late (4 years)
Crude death rate 9 Met
Leprosy elimination Met
IMR 30 Late (9 years)
2% of GDP Missed
IMR 28 Late (1 year)
MMR 100 Met
2.5% of GDP Missed, so far

Pulse Polio, Delhi, 2009 · PIB / MoHFW · Wikimedia Commons (GODL-India). World Health Organization, Regional Office for South-East Asia (2026)

Government health spending

Campaigns and systems

Worked

Focused campaigns with one clear target: smallpox, leprosy, polio

Did not work

Targets that needed steady money everywhere: Health for All, 2% of GDP, 2.5% of GDP

Take-home messages

  1. Three policies, one unkept promise: steady public money
  2. NHP 1983 promised comprehensive PHC; NHP 2002 accepted a mixed system; NHP 2017 restated Bhore’s promise as UHC
  3. NRHM brought the ASHA and moved mothers into facilities
  4. Back to the opening question: Health for All by 2000 was missed

Written response: name one NHP target that was missed, and give one reason.

Next class: how NHP 2017 is being carried out. Ayushman Bharat and financial protection.

References

Directorate General of Health Services. 2026. National Leprosy Eradication Programme (NLEP). DGHS website, accessed 12 October 2026. https://dghs.mohfw.gov.in/nlep.php.
Duggal, Ravi. 2001. Evolution of Health Policy in India. Centre for Enquiry into Health; Allied Themes (CEHAT). https://www.cehat.org/uploads/files/a147.pdf.
Group on Medical Education and Support Manpower. 1975. Health Services and Medical Education: A Programme for Immediate Action. Allied Publishers for the Indian Council of Social Science Research. https://archive.org/details/PARI.health-services-and-medical-education-a-programme-for-immediate-action.
ICSSR-ICMR Joint Study Group. 1981. Health for All: An Alternative Strategy. Report of a Study Group Set up Jointly by the Indian Council of Social Science Research and the Indian Council of Medical Research. Indian Institute of Education.
International Conference on Primary Health Care. 1978. Declaration of Alma-Ata. WHO and UNICEF, Alma-Ata, USSR, 6-12 September 1978. https://archive.org/details/PARI.declaration-of-alma-ata.
Lok Sabha. 2000. Health for All. Unstarred Question No. 220, Answered 24 July 2000 (Minister of State Prof. Rita Verma), with Annexure "Goals for Health and Family Welfare Programme". Lok Sabha Debates, Parliament of India; mirrored on Internet Archive (eparlib.nic.in.451359). https://archive.org/details/eparlib.nic.in.451359.
Ministry of Health and Family Welfare. 1983. National Health Policy, 1983. Government of India, New Delhi.
Ministry of Health and Family Welfare. 2000. National Population Policy 2000. Government of India, New Delhi; copy hosted by NHSRC. https://www.nhsrcindia.org/sites/default/files/2021-07/7%20National%20Population%20Policy%202000.pdf.
Ministry of Health and Family Welfare. 2002. National Health Policy 2002. Government of India, New Delhi; copy hosted by National Health Systems Resource Centre. https://www.nhsrcindia.org/sites/default/files/2021-07/6%20National%20Health%20Policy%202002.pdf.
National Health Systems Resource Centre. 2026. National Health Accounts Estimates for India 2022-23. National Health Accounts Technical Secretariat, NHSRC, Ministry of Health; Family Welfare. https://nhsrcindia.org/sites/default/files/2026-05/NHA%202022-23%20Report.pdf.
Office of the Registrar General, India. 2014. Compendium of India’s Fertility and Mortality Indicators 1971-2013, Based on the Sample Registration System (SRS). Office of the Registrar General, India, Ministry of Home Affairs. https://censusindia.gov.in/nada/index.php/catalog/33218.
Office of the Registrar General, India. 2022. Special Bulletin on Maternal Mortality in India 2018-20. Sample Registration System, Office of the Registrar General, India. https://censusindia.gov.in/nada/index.php/catalog/44379.
Office of the Registrar General, India. 2026. Sample Registration System Statistical Report 2024. Office of the Registrar General, India, Ministry of Home Affairs. https://censusindia.gov.in/nada/index.php/catalog/47152.
Raj, Janak, Shauryavir Dalal, and Aashi Gupta. 2024. Evolution of the Healthcare Policy Framework in India. CSEP Working Paper No. 78. Centre for Social; Economic Progress. https://csep.org/working-paper/evolution-of-the-healthcare-policy-framework-in-india/.
Sen, Gita, Aditi Iyer, and Asha George. 2002. “Structural Reforms and Health Equity: A Comparison of NSS Surveys, 1986-87 and 1995-96.” Economic and Political Weekly 37 (14): 1342–52. https://repository.iimb.ac.in/handle/2074/10499.
Sen Gupta, Amit. 2002. “National Health Policy 2002: A Brief Critique.” National Medical Journal of India 15 (4): 215–16. https://nmji.in/nmji/archives/Volume-15/issue-4/viewpoints-2.pdf.
Working Group on Health for All by 2000 A.D. 1981. Report of the Working Group on Health for All by 2000 a.d. Ministry of Health; Family Welfare, Government of India. https://archive.org/details/PARI.report-of-the-working-group-on-health-for-all-by-2000-ad.
World Bank. 2026. Domestic General Government Health Expenditure (% of GDP), India (SH.XPD.GHED.GD.ZS), from WHO Global Health Expenditure Database. World Development Indicators API, last updated 8 October 2026, accessed 12 October 2026. https://data.worldbank.org/indicator/SH.XPD.GHED.GD.ZS?locations=IN.
World Health Organization, Regional Office for South-East Asia. 2026. Keeping the Polio Virus at Bay. WHO SEARO website, accessed 12 October 2026. https://www.who.int/southeastasia/activities/maintaining-polio-free-status/keeping-the-polio-virus-at-bay.