Context
- The Union Cabinet in its meeting has approved the National Health Policy, 2017 (NHP, 2017).
- The Policy seeks to reach everyone in a comprehensive integrated way to move towards wellness.
- It aims at achieving universal health coverage and delivering quality health care services to all at affordable cost.
Background
- The National Health Policy, 2017 adopted an elaborate procedure for its formulation involving stakeholder consultations.
- Accordingly, the Government of India formulated the Draft National Health Policy and placed it in public domain on 30thDecember, 2014.
- Thereafter following detailed consultations with the stakeholders and State Governments, based on the suggestions received, the Draft National Health Policy was further fine-tuned.
- It received the endorsement of the Central Council for Health & Family Welfare, the apex policy making body, in its Twelfth Conference held on 27th February, 2016.
- The last health policy was formulated in 2002.
- The socio economic and epidemiological changes since then necessitated the formulation of a New National Health Policy to address the current and emerging challenges.
Objectives and Outlook of the Policy
- This Policy looks at problems and solutions holistically with private sector as strategic partners.
- It seeks to promote quality of care, focus is on emerging diseases and investment in promotive and preventive healthcare.
- The policy is patient centric and quality driven. It addresses health security and make in India for drugs and devices.
- The main objective of the National Health Policy 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 as a consequence.
Financial Protection
- In order to provide access and financial protection at secondary and tertiary care levels, the policy proposes free drugs, free diagnostics and free emergency care services in all public hospitals.
- The policy envisages strategic purchase of secondary and tertiary care services as a short term measure to supplement and fill critical gaps in the health system.
Prioritizing the role of the Government and engagement with the private sector
- The Policy recommends prioritizing the role of the Government in shaping health systems in all its dimensions.
- The roadmap of this new policy is predicated on public spending and provisioning of a public healthcare system that is comprehensive, integrated and accessible to all.
- The NHP, 2017 advocates a positive and proactive engagement with the private sector for critical gap filling towards achieving national goals.
- It envisages private sector collaboration for strategic purchasing, capacity building,skill development programmes, awareness generation, developing sustainable networks for community to strengthen mental health services, and disaster management.
- The policy also advocates financial and non-incentives for encouraging the private sector participation.
Raising public health expenditure
- The policy proposes raising public health expenditure to 2.5% of the GDP in a time bound manner.
- Policy envisages providing larger package of assured comprehensive primary health care through the Health and Wellness Centers’.
- This policy denotes important change from very selective to comprehensive primary health care package which includes geriatric health care, palliative care and rehabilitative care services.
- The policy advocates allocating major proportion (upto two-thirds or more) of resources to primary care followed by secondary and tertiary care.
- The policy aspires to provide at the district level most of the secondary care which is currently provided at a medical college hospital.
- The policy assigns specific quantitative targets aimed at reduction of disease prevalence/incidence, for health status and programme impact, health system performance and system strengthening.
- It seeks to strengthen the health, surveillance system and establish registries for diseases of public health importance, by 2020.
- It also seeks to align other policies for medical devices and equipment with public health goals.
Primary Aim
- The primary aim of the National Health Policy, 2017, is to inform, clarify, strengthen and prioritize the role of the Government in shaping health systems in all its dimensions.
- Like- investment in health, organization and financing of healthcare services, prevention of diseases and promotion of good health through cross sectoral action, access to technologies, developing human resources, encouraging medical pluralism, building the knowledge base required for better health, financial protection strategies and regulation and progressive assurance for health.
- The policy emphasizes reorienting and strengthening the Public Health Institutions across the country, so as to provide universal access to free drugs, diagnostics and other essential healthcare.
Pluralistic Health Care
- In order to leverage the pluralistic health care legacy, the policy recommends mainstreaming the different health systems.
- Towards mainstreaming the potential of AYUSH the policy envisages better access to AYUSH remedies through co-location in public facilities.
- Yoga would also be introduced much more widely in school and work places as part of promotion of good health.
- The policy supports voluntary service in rural and under-served areas on pro-bono basis by recognized healthcare professionals under a ‘giving back to society’ initiative.
- 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 across the continuum of care.
Critical Evaluation of the Policy
- Experience with past National Health Policy documents (we have had two in the past – one in 1983 and one in 2002) have not been particularly positive.
- In the past the policy has seldom been actually followed up by concrete actions on the ground to redeem promises made in these documents.
- It is however important to examine the new policy not necessarily because the targets set are likely to be met.
- But to understand how the current government is planning to roll out its priorities regarding healthcare services.
- It may be mentioned here that while the policy primarily focuses on proposed actions on healthcare delivery, a majority of health outcomes are not a function merely of available healthcare services but are fashioned by a wide range of social, economic, and environmental determinants.
- Thus food security, employment, education, housing, water and sanitation, gender relations, etc. all have a bearing on health outcomes.
- Clearly the realization of the targets set in the policy, such as lowering of child and maternal mortality rates, increase in life expectance, etc. depend crucially on attending to these determinants.
- Given that this government has been particularly aggressive in pushing a neoliberal agenda that has made savage cuts in welfare and entitlements is a cause for pessimism that the targets will be met.
- The NHP-2017 also glosses over the fact that over two-thirds of expenditure on health are made by states and states face a squeeze on funds because of neoliberal macroeconomic pressures – essentially low collection of revenues by taxing the rich.
- In fact right after the announcement of NHP-2017, the Parliamentary standing committee on health, in its report, has lamented that states are finding it difficult to raise allocations to health and some states have actually reduced allocation.
- The aggregate effect of low public finances is a public sector in healthcare that is starved of resources – financial, technical and human.
- In spite of some modest gains made through the National Rural Health Mission (NRHM) public facilities in most parts of the country fall far short of need.
- In spite of repeated claims public facilities in most parts of the country do not provide free access to medicines and diagnostics.
- There is a huge deficit of human resources and this rises to over 80% in the case of specialists.
Market mechanisms for ‘health assurance’
- Let us then look at what NHP-2017 tell us about how it proposes to organise healthcare services and how these proposals square up with evidence we have?
- In the NHP says: “The health policy recognizes that there are many critical gaps in public health services which would be filled by “strategic purchasing”.
- Such strategic purchasing would play a stewardship role in directing private investment towards those areas and those services for which currently there are no providers or few providers”.
- While the NHP claims that the priority would be to “purchase’ services from public facilities and not-for-profit private facilities”, it also foresees purchasing from for profit private facilities “as the last preference”.
- However past evidence with the public funded insurance schemes shows that when the concept of ‘purchasing’ is legitimized, majority of outsourcing is done to private for-profit facilities.
- Critiques of a public sector led model for health care provision point out that universalisation of access to care needs harnessing of private providers and facilities in India given its dominance in healthcare provision.
- What is not said is that the demise of public facilities has been brought about through deliberate neglect and now its incapacity is being used as an exercise of opening up healthcare for extraction of profits by private enterprises.
- This is an explicitly neoliberal project that should be understood.
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