A policy document is essentially the expression of ideas of those governing to establish what they perceive is the will of the people. A health policy is thus the expression of what the health care system should be so that it can meet the health care needs of the people. Until 1983 there was no formal health policy, the latter being reflected in the discussions of the National Development Council and the Central Council of Health and Family Welfare, and the Five Year Plan documents and/or occasional committee reports. As a consequence of the global debate on alternative strategies during the seventies, the signing of the Alma Ata Declaration on primary health care, and the recommendations of the ICMR-ICSSR Joint Panel, the government decided that the above fora may have served the needs in the past, but a new approach was now required. The health policy of 1983 was the first effort at an official policy statement. There are three questions that need addressing. Firstly, have the tasks enlisted in the 1983 NHP been fulfilled as desired? Secondly, were these tasks and the actions that ensued adequate enough to meet the basic goal of the 1983 NHP of providing "universal, comprehensive primary health care services, relevant to actual needs and priorities of the community"? And thirdly, did the 1983 NHP sufficiently reflect the ground realities in health care provision? The conclusion is that the present paradigm of health care development has in fact raised inequities, and in the current scenario of structural adjustment the state of health care is only getting worse. Hence, the need for a new policy framework to bring about health sector reforms which would make primary health care accessible to all without any social, geographical or financial inequities. The paper begins with a review and critique of the 1983 health policy, develops a rationale for a new health policy, defines a framework for health sector reforms, argues for structural changes within the context of a universal health care approach and evolves the framework of a model. Further, the paper projects resource requirements of the reformed structure and how it could be financed. And finally it raises policy issues that will need to be addressed in order to make such a system work.

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