By Jisha Krishnan
Published on Feb 7, 2017
Health Minister J.P. Nadda called the new National Health Policy a huge milestone in India’s history of health sector. The new policy has touched upon varied pertinent issues – from ‘Make in India’ for drugs and medical devices to making health, yoga and hygiene a part of the school curriculum; from raising the public health budget to establishment of National Digital Health Authority. Here’s looking at the best and worst of the policy.
More spending on public health
The new policy proposes to raise the public health expenditure from the present 1.5 percent to 2.5 per cent of the GDP by 2025.
Given that India’s public expenditure on healthcare increased only from 1.1 per cent of GDP in 1995 to 1.4 per cent in 2014, this is long overdue. However, we are nowhere close to countries like Sweden, which spend about 10 per cent of its GDP on health.
Health for all
The policy aims to achieve universal health coverage at affordable cost.Drugs, diagnostics and emergency care services are to be offered free of cost in all government hospitals.
For a country that has a ratio of 0.7 doctors and 1.5 nurses per 1,000 people, the plan is very ambitious. And inthe absence of a concrete roadmap, it’s hard to comprehend how this will work.
Public health goals
The policy seeks to establish registries for diseases of public health importance by 2020. Among key targets, it intends to reduce infant mortality rate (IMR) to 28 by 2019 and maternal mortality ratio (MMR) to 100 by 2020.
Sadly, these goals have remained largely unchanged. In India’s last health policy formulated in 2002, the aim was to reduce IMR(infant deaths per 1,000 live births) to 30 by 2010. In 2015-16, IMRstood at 41. Similarly, the target in 2002 was to reduce MMR (deaths of women per 100,000 live births) to 100 by 2010. In 2015-16, MMR was 167.
Health &wellness centres
The policy denotes important change from very selective to comprehensive primary healthcare package, which includes geriatric healthcare, palliative care and rehabilitative care services, through health and wellness centres. The plan is to provide most of the secondary care (currently available at medical college hospitals) at the district level.
In their new avatar as health and wellness centres, Primary Health Centres (PHCs) will be expected to do a lot more than immunisation and anti-natal check-ups. This can be a huge step in India’s defence against the growing menace of non-communicable diseases.
Public health institutions
The policy aims to reorient and strengthen thepublic health institutions across the country, so as to provide universal access to healthcare. It also envisages better access to AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) remedies through co-location in public facilities.
According to the National Sample Survey Office (NSSO), from January to June 2014, 243 people out of 1,000 sought medical treatment in government hospitals, while 756 people out of 1,000 chose to consult private medical practitioners. Despite free healthcare services offered by the government, poor patients prefer to visit private hospitals. What public health institutions in India need – apart from trained manpower and quality services – is an image makeover.
The policy seeks to ensure improved access and affordability of quality secondary and tertiary care services through a combination of public hospitals and strategic purchasing in healthcare deficit areas from accredited non-¬governmental healthcare providers.
In a country where 70 percent of healthcare is provided by the private sector, such public-private partnerships may be the only way forward. However, there needs to be some sort of accountability not only in terms of qualityof care, but also vis-à-vis cost. The need of the hour is to form regulatory and accreditation agencies for private healthcare providers in the country.
Still not a fundamental right
The policy advocates a “progressively incremental assurance-based approach” to achieve the highest possible level of good health and wellbeing.
In other words, unlike education - which is a fundamental right in India - health is still not within the ambit of justiciable rights.
All in all, the NHP, 2017 has touched upon varied pertinent issues – from ‘Make in India’ for drugs and medical devices to making health, yoga and hygiene a part of the school curriculum; from establishment of National Digital Health Authority (to regulate, develop and deploy digital health across the continuum of care) to the ‘giving back to society’ initiative that supports voluntary service in rural and under-served areas by healthcare professionals. The challenge, though, is to walk the talk. Our past health record isn’t really encouraging, is it?