POLICY ENVIRONMENT AND NATIONAL HEALTH PROGRAMMES: A CASE STUDY OF THE NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAMME (NIDDCP) IN INDIA

摘要

Contents:Objective: To understand the complex policy environment in which National Health Programmes are operating, using case study approachDesign: A case study approach applying the criteria of policy formulation and policy implementation to National IDD Control Programme.Setting: The decision-making process in policy making is based primarily on the recognition of a problem, for example a health problem, as a social or public health problem. The social problem and the policy governing its elimination is a multifactor process. The other factors involved, namely the information in hand, the values and beliefs of the population concerned and the formal and non-formal structure for decision making, are mainly influenced by the actual problem being tackled.Results: The main information source leading to the genesis and implementation of the National IDD Control Programme (Social Problem or issue) has come from the academic bodies. In the context of Indian programme, efforts were primarily focused on formal and informal institutional structure for decision making for formulating the policy of universal salt iodization. The political support and commitment, backed by administrative infrastructure contributed to the achievement of nearly 50% coverage of adequately iodized salt at the household level. However, the situation has remained static for the last six years. As per the National Family Health Survey (NFHS) 3 conducted during 2005-06 the coverage of adequately iodized salt is 51%. This is hardly an increase in comparison to NFHS 2 conducted during 1998-99 when the coverage was 49%. There was a major setback to the programme when the Government's act of revoking the ban on the sale of non-iodized salt meant for human consumption in 2000. This retrograde step had resulted in putting brakes to a successful and important nutrition program. The major limiting factor in the implementation of NIDDCP was that the community perceptions about IDD and iodized salt and their interests and beliefs (Values) were not explicitly considered as part of the implementation process. After five years of extensive re-advocacy to the government, the ban has been reinstated in 2005. However, the task now is to effectively implement the ban and build up a strong monitoring process linked to corrective decisions with participation of all key stakeholders.Conclusion: In formulating National Health Programmes in a policy environment, scientific inputs (information), political will and administrative support (institutional structure for decision making) are necessary but not sufficient. One of the issues to be considered, especially when programmes have to be sustainable is pro-active recognition and inclusion of beliefs and interests (Values) of key stakeholders, which is vital in formulation and implementation of sustainable programmes.