New Delhi: The Union Cabinet chaired by Prime Minister Narendra Modi on Wednesday approved the National Health Policy, 2017 (NHP 2017), which aims to provide universal health coverage and deliver quality healthcare services at affordable cost to all the people of the country.
Terming the cabinet approval of the National Health Policy 2017 as a huge milestone in the history of public health in the country, Union Health Minister J P Nadda said, “The policy recommends prioritizing the role of the government in shaping health systems in all its dimensions.”
He said, “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. Further, it advocates a positive and proactive engagement with the private sector for critical gap filling towards achieving national goals.”
The broad principles of the policy are centred on professionalism, integrity and ethics, equity, affordability, universality, patient centric and quality of care, accountability and pluralism.
The policy is patient centric and quality driven. It looks at problems and solutions holistically with private sector as strategic partners. It addresses health security and make in India for drugs and medical devices. The focus is on emerging diseases and investment in promotive and preventive healthcare.
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. It recommends prioritizing the role of the government in shaping health systems in all its dimensions.
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-financial incentives for encouraging the private sector participation.
The policy proposes raising public health expenditure to 2.5% of the GDP in a time bound manner. It 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. It 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.
The policy aims to encourage medical pluralism and build the knowledge base required for better health. It 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.
It 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, achieve significant reduction in out of pocket expenditure and reinforce trust in public healthcare system.
The policy affirms commitment to pre-emptive care to achieve optimum levels of child and adolescent health. It envisages school health programmes as a major focus area as also health and hygiene being made a part of the school curriculum.
The policy recommends mainstreaming the different health systems. It envisages better access to AYUSH remedies through co-location in public facilities. It says yoga would 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.
The policy advocates a progressively incremental assurance based approach.
The policy focuses on tackling the emerging challenge of non-communicable diseases. It supports an integrated approach where screening for the most prevalent NCDs with secondary prevention would make a significant impact on reduction of morbidity and preventable mortality.
The policy envisages a three dimensional integration of AYUSH systems encompassing cross referrals, co-location and integrative practices across systems of medicines.
To improve and strengthen the regulatory environment, the policy seeks putting in place systems for setting standards and ensuring quality of health care. The policy is patient centric and empowers the patient for resolution of all their problems.
The policy also looks at reforms in the existing regulatory systems both for easing manufacturing of drugs and devices, to promote ‘Make in India’, as also for reforming medical education.
The policy advocates development of cadre of mid-level service providers, nurse practitioners, public health cadre to improve availability of appropriate health human resource.
It aims to ensure availability of 2 beds per 1000 population distributed in a manner to enable access within golden hour.
Some of the other key targets that the policy seeks to achieve are:
1. Life Expectancy and healthy life
a. Increase Life Expectancy at birth from 67.5 to 70 by 2025.
b. 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.
c. Reduction of TFR (total fertility rate) to 2.1 at national and sub-national level by 2025.
2. Mortality by age and/or cause
a. Reduce the Under Five Mortality Rate to 23 by 2025 and the MMR (Maternal Mortality Rate) from current levels to 100 by 2020.
b. Reduce infant mortality rate (IMR) to 28 by 2019.
c. Reduce neo-natal mortality to 16 and still birth rate to single digit by 2025.
3. Reduction of Disease Prevalence/Incidence
a. 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.
b. Achieve and maintain elimination status of Leprosy by 2018, Kala-Azar by 2017 and Lymphatic Filariasis in endemic pockets by 2017.
c. Achieve and maintain a cure rate of over 85% in new sputum positive patients for TB and reduce incidence of new cases to reach elimination status by 2025.
d. Reduce the prevalence of blindness to 0.25 per 1000 people by 2025 and disease burden by one third from the current levels.
e. Reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by 25% by 2025.
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,” according to an official statement.