National Health Policy 2017

About National Health Policy

• The National Health Policy of 1983 and the National Health Policy of 2002 have served well in guiding the approach for the health sector in the Five-Year Plans.
• The current context has however changed in four major ways.
• First, the health priorities are changing.
• Although maternal and child mortality have rapidly declined, there is growing burden on account of non-communicable diseases and some infectious diseases.
• The second important change is the emergence of a robust health care industry estimated to be growing at double digit.
• The third change is the growing incidences of catastrophic expenditure due to health care costs, which are presently estimated to be one of the major contributors to poverty.
• Fourth, a rising economic growth enables enhanced fiscal capacity.
• Therefore, a new health policy responsive to these contextual changes is required.
• The National Health Policy, 2017 (NHP, 2017) 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.

Backdrop :

o   Budget spending and Insurance

• The public expenditure on health sector remains a dismal show of only around 1.4% of the GDP.
  • The investment in health research has been low with a modest rate of 1% of the total public health expenditure.
  • Insurance coverage remains low as per the latest NSSO reports over 80% of India’s population remains uncovered by any health insurance scheme.
  • Under the centre run Rashtriya Swyasthya Bima Abhiyan, only 13% of the rural and 12% of the urban population had access to insurance cover.
  • There has been a stark rise in the out-of-pocket expenditure (6.9% in rural areas and 5.5% in urban areas – OOP in proportion to monthly expenditure). This led to an increasing number of households facing catastrophic expenditures due to health costs.

o   IMR, MMR, Hunger, Non-Communicable diseases, and Mental Diseases Data

• India missed by close margins in achieving the millennium development goals of maternal mortality (India – 167, MDG – 139) and under 5 child mortality rate (India 49, MDG – 42). The rate of decrements in stillbirths and neonatal death cases has been slow.
• Nutrition status has been dismal and is one of the causes of child mortality and morbidity. As per the global hunger index (by IFPRI), India ranks 78th among 118 developing countries (with 15% of our population being undernourished; about 15% under-5 children who are ‘wasted’ while the share of children who are `stunted’ is a staggering 39% and the under-5 mortality rate is 4.8% in India.)
• While communicable diseases contribute 28% of the entire disease burden, non-communicable diseases (60%) show ample rise and injuries at (12%) now constitute the bulk of the country’s disease burden.
• India ironically has to cater two extreme healthcare situations. They are (1) arising out of exclusions (out of poverty or lack of proper healthcare facilities) (2) while the other as lifestyle diseases like diabetes and cardiac related problems.
• There has been a steady rise in mental illnesses in the country. According to a recent publication, one in every four women and 10% men suffer from depression in India.
• At the same time progress has been marked in the field of communicable diseases as such. Polio has been eradicated, leprosy has been curtailed and HIV – AIDS cases have met the MDG target of being reduced by half in number.

What National Health Policy 2017 offers?

• 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.

Specific Quantitative Goals and Objectives

o    Health Status and Programme Impact

1. Life Expectancy and healthy life
   • Increase Life Expectancy at birth from 67.5 to 70 by 2025.
   • Establish regular tracking of Disability Adjusted Life Years (DALY) Index as a measure of burden of disease and its trends by major categories by 2022.
   • Reduction of TFR to 2.1 at national and sub-national level by 2025.
2. Mortality by Age and/ or cause
   • Reduce Under Five Mortality to 23 by 2025 and MMR from current levels to 100 by 2020.
   • Reduce infant mortality rate to 28 by 2019.
   • Reduce neo-natal mortality to 16 and still birth rate to “single digit” by 2025.
3. Reduction of disease prevalence/ incidence
   • Achieve global target of 2020 which is also termed as target of 90:90:90, for HIV/AIDS i.e, – 90% of all people living with HIV know their HIV status, – 90% of all people diagnosed with HIV infection receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have viral suppression.
   • Achieve and maintain elimination status of Leprosy by 2018, Kala-Azar by 2017 and Lymphatic Filariasis in endemic pockets by 2017.
   • To achieve and maintain a cure rate of >85% in new sputum positive patients for TB and reduce incidence of new cases, to reach elimination status by 2025.
   • To reduce the prevalence of blindness to 0.25/ 1000 by 2025 and disease burden by one third from current levels.
   • To reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by 25% by 2025.

o   Health Systems Performance

1. Coverage of Health Services
   • Increase utilization of public health facilities by 50% from current levels by 2025.
   • Antenatal care coverage to be sustained above 90% and skilled attendance at birth above 90% by 2025.
   • More than 90% of the newborn are fully immunized by one year of age by 2025.
   • Meet need of family planning above 90% at national and sub national level by 2025.
   • 80% of known hypertensive and diabetic individuals at household level maintain “controlled disease status” by 2025.
2. Cross Sectoral goals related to health
   • Relative reduction in prevalence of current tobacco use by 15% by 2020 and 30% by 2025.
   • Reduction of 40% in prevalence of stunting of under-five children by 2025.
   • Access to safe water and sanitation to all by 2020 (Swachh Bharat Mission).
   • Reduction of occupational injury by half from current levels of 334 per lakh agricultural workers by 2020.
   • National/ State level tracking of selected health behaviour.

o   Health Systems strengthening

1. Health finance
   • Increase health expenditure by Government as a percentage of GDP from the existing 1.1 5 % to 2.5 % by 2025.
   • Increase State sector health spending to > 8% of their budget by 2020.
   • Decrease in proportion of households facing catastrophic health expenditure from the current levels by 25%, by 2025.
2. Health Infrastructure and Human Resource
   • Ensure availability of paramedics and doctors as per Indian Public Health Standard (IPHS) norm in high priority districts by 2020.
   • Increase community health volunteers to population ratio as per IPHS norm, in high priority districts by 2025.
   • Establish primary and secondary care facility as per norm s in high priority districts (population as well as time to reach norms) by 2025.
3. Health Management Information
   • Ensure district – level electronic database of information on health system components by 2020.
   • Strengthen the health surveillance system and establish registries for diseases of public health importance by 2020.
   • Establish federated integrated health information architecture, Health Information Exchanges and National Health Information Network by 2025.

Policy thrust

1. Ensuring Adequate Investment – The policy proposes a potentially achievable target of raising public health expenditure to 2.5% of the GDP in a time bound manner.
2. Preventive and Promotive Health – The policy identifies coordinated action on seven priority areas for improving the environment for health:
   • The Swachh Bharat Abhiyan
   • Balanced, healthy diets and regular exercises.
   • Addressing tobacco, alcohol and substance abuse
   • Yatri Suraksha – preventing deaths due to rail an d road traffic accidents
   • Nirbhaya Nari – action against gender violence
   • Reduced stress and improved safety in the work place
   • Reducing indoor and outdoor air pollution
3. Organization of Public Health Care Delivery – The policy proposes seven key policy shifts in organizing health care services.

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:
  • 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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