The Union Cabinet recently approved the National Health Policy (NHP 2017), which proposes to provide assured health services to all in the country. Prime Minister Narendra Modi put it, “The National Health policy marks a historic moment in our endeavor to create a healthy India where everyone has access to quality healthcare.” The main objective of the National Health Policy (NHP) 2017 is to achieve the highest possible level of good health and well-being, through a preventive and promotive health care orientation in all developmental policies, and to achieve universal access to good quality health care services without anyone having to face financial hardship. Speaking at Surat later, he said prices of stents and 700 medicines have been reduced. According to Health Minister, the proposed NHP is expected to reach healthcare to all corners of the country, particularly the underserved and underprivileged. The policy envisages a time-bound implementation framework and focuses on upgrading district hospitals with clear deliverable and milestones to achieve the policy goals. Following are ten important highlights of the National Health Policy 2017. The policy aims to raise public healthcare expenditure to 2.5% GDP with more than two-thirds of those resources going towards primary healthcare. The policy forecasts in providing a comprehensive package for major non-communicable diseases (NCDs), mental health, geriatric healthcare, palliative care and rehabilitative care services. It also aims to ensure availability of 2 beds per 1000 population distributed in a manner to enable access within a golden hour. It also proposes free drugs, free diagnostics and free emergency and essential healthcare services in all public hospitals. Reduction of total fertility rate (TFR) to 2.1 at national and sub-national level is also envisaged. The NHP intends to reduce the mortality rate of children under 5 years of age to 23, infant mortality rate to 28 by 2019 and neonatal mortality to 16 and stillbirth rate to ‘single digit’ by 2025. The policy tends to improve and strengthen the regulatory environment and seeks to ensure quality healthcare. The policy also looks to reform the existing regulatory systems for easing manufacturing of drugs and devices. The policy advocates development of nurse practitioners and public health cadre to improve the availability of appropriate health human resource as per ‘India today’.
It is heartening to note that many of the recommendations made by SPEAK (Society for promotion of ethical and affordable health care) to Prime minister of India in 2016 find place in the NHP 2017 e g Emphasis on health care over care of the sick, raising the funding to 6% ( at least 2.5%) of GDP, free medicines and investigation to all in need, reduction in the prices of medical devices and drug formulations, introduction of ethics as a part of curriculum, checking corruption in sick care.
The broad principles of the policy is centered on Professionalism, Integrity and Ethics, Equity, Affordability, Universality, Patient Centered & Quality of Care, Accountability and pluralism. The policy advocates extensive deployment of digital tools for improving the efficiency and outcome of the healthcare system and proposes establishment of National Digital Health Authority (NDHA) to regulate, develop and deploy digital health.
The inadequacies of public hospitals force the public to seek out private healthcare at a cost. So 70% of Outpatient services and 60% of inpatient services are managed in private hospitals. The Lancet recently published an article, Health in India 2017, which was scathing in its assessment. India ranks 143 out of 184 countries for health-related Goals. At 17% of the world’s population, India contributes disproportionally to the global burden of disease, more deaths of children below 5 (1·25 million), a quarter of the world’s tuberculosis, unhealthy lifestyles, premature cardiovascular disease, and an epidemic of diabetes, cirrhosis and lung diseases.
Public financed universal health coverage (UHC) may be an answer. But successive governments have lacked either the spine or the heart to act. The new policy indicates that public health care expenditure is set to increase to 2.5% of GDP by 2025. Even if this is achieved, it will be half of what the World Health Organization recommends. What is positive in the new policy is the focus on primary healthcare. The government intends to spend 2/3rd of its healthcare budget on primary care and purchase private care to subsidize out of pocket expenses for major illnesses in private hospitals. The new policy proposes an “assurance-based approach”, means people should be accountable for their own health and not take public health services for granted. When accountability is present, the focus would be more on preventive strategies. Central government promises to provide free drugs, free diagnostic tests, emergency care and essential services. They are aiming to provide secondary level care at the district level reducing the patient care burden at tertiary hospitals like PGI. To attain the goal of universal health care, a separate law is needed to make public health a right. “Many patients do not get proper treatment, because it’s often unaffordable for them. Private healthcare is expensive and public hospitals are over-burdened to facilitate treatment,” it is said.
In 2010 Government committed a faux pas by passing a central legislation in a hurry and without any discussion in the Parliament, ‘Clinical establishment Act 2010’, where the responsibility of providing healthcare was passed on to the doctors unilaterally. Doctors were neither involved in any discussion nor were they promised any compensation. It was big eyewash by the govt. Similarly quack remedies are being advertised as AYUSH system to mislead and confuse masses. Many Sadhus and saints are minting big money from unsuspecting citizens in the name of indigenous system of medicine. This needs to be undone. Taking to healthy lifestyle to preserve health is also necessary.