Analysis: National Health Policy 2017

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Following Article analyzes the National Health Policy (NHP, 2017):

Context

It is 15 years since we had a National Health Policy (NHP) modified. The last policy was formulated in 2002. Now the Cabinet has cleared the latest NHP 2017 to address the address current and emerging challenges rising from changing socio-economic and epidemiological environments.

Let us look at some of the features of the new policy and whether it is futuristic as described by the Prime Minister, Narendra Modi in his tweet.

Major features of the policy that aims to transform healthcare in India:

• The policy aims for attainment of highest possible level of health and well-being for every citizen through a preventive and promotive healthcare orientation.
• It seeks to provide and deliver healthcare services, particularly to underprivileged and socially vulnerable groups of people in the country.
• Under the policy, every family will have a health card for access to primary care facility as well as to defined package of services nationwide.
• Health and hygiene to become part of school curriculum – Yoga would be introduced much more widely in schools and work places as part of promotion of good health.
• The policy envisages a three dimensional integration of AYUSH systems by promoting cross referrals, co-location and integrative practices across systems of medicines.
• The policy also seeks to address health security and promotes Make in India for drugs and devices.
• It seeks to establish a Public Health Management Cadre (PHMC) in all states.
• It also proposes rising public health expenditure to 2.5% of the GDP in a time bound manner.
  

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Targets set under the NHP 2017

1. Increasing life expectancy to 70 years from 67.5
2. Reduce fertility rate to 2.1 (Replacement levels) by 2025.
3. Reduce infant mortality rate to 28 by 2019.
4. Reduce Under Five Mortality to 23 by 2025.
5. Reducing premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by 25% by 2025
6. The policy seeks to achieve ’90:90:90′ global target by 2020 – implying that 90% of all people living with HIV know their HIV status, 90% of those diagnosed with HIV infection receive sustained antiretroviral therapy and 90% of those receiving antiretroviral therapy will have viral suppression.
7. Reducing the prevalence of blindness to 0.25 per 1000 persons by 2025 and
8. The disease burden to be reduced by one third from the current levels.
9. Elimination of leprosy by 2018, kala-azar by 2017 and lymphatic filariasis in endemic pockets by 2017.
   

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Positives of the Policy

• The broad principles of the policy is centered on Professionalism, Integrity and Ethics, Equity, Affordability, Universality, Patient Centered & Quality of Care, Accountability and pluralism.
• This Policy looks at problems and solutions holistically with private sector as strategic partners
• The Policy advocates a progressively incremental assurance-based approach for GDP allocation increase to 2.5% instead of a hollow rhetoric.
• It envisages providing a larger package of assured comprehensive primary health care through the ‘Health and Wellness Centres’ and denotes an important change from very selective to comprehensive primary health care package which includes care for major NCDs [non-communicable diseases], mental health, geriatric health care, palliative care and rehabilitative care services.
• It aims to ensure availability of 2 beds per 1,000 population distributed in a manner to enable access within golden hour [the first hour after traumatic injury, when the victim is most likely to benefit from emergency treatment].
• In order to provide access and financial protection, it proposes free drugs, free diagnostics and free emergency and essential health care services in all public hospitals
  

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Criticism of the Policy

• The policy duplicates portions of the Health section 2017 Budget speech.
• It reiterates health spend targets set by the High Level Expert Group (HLEG) set up by the erstwhile Planning Commission for the 12th Five Year Plan (which ends on March 31, 2017)
• It also fails to make health a justiciable right through National Health Rights Act like the Right to Education Act 2005 did for school education.
• A health cess was a path-breaking idea in the Health Ministry’s draft policy; it has now been dropped out of the final policy
• The government through 2002 policy promised it would increase health spending to 2 percent of GDP, which never happened either under the National Democratic Alliance (NDA-1) or during 10 years of the United Progressive Alliance (UPA) administration.
• Old Targets and New Deadlines: Look at the Graphic below.
  • The IMR in 2015-16 was 41.
  • The MMR in 2015-16 is 167.
  • The 2002 NHP had set the target of eliminating leprosy by 2005, kala azar by 2010 and lymphatic filariasis by 2015–none of which could be achieved yet.
    

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1. The latest National Health policy has more misses than hits. What are the lacunae in the policy?

2. Enumerate important features of the National Health Policy 2017.

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