Critical analysis of New Health Policy 2017

The Union Cabinet approved the National Health Policy 2017. It will replace the previous policy which was framed 15 years ago in 2002. Aiming to provide healthcare in an “assured manner” to all, the policy will strive to address current and emerging challenges arising from the ever-changing socio-economic, technological and epidemiological scenarios.

The new policy architecture:
The are four reasons for formulating a new policy –
1. The growing burden of noncommunicable diseases and infectious diseases,
2. Emergence of a vibrant health industry growing in double digits
3. Increasing impoverishment due to high cost of care
4. An enhanced fiscal capacity due to economic growth.

Key objective:
While the policy goal is to ensure universal access of comprehensive services (defined to consist of primary, secondary and tertiary and covering the full spectrum – preventive, promotive and curative) by enhancing access and improving quality and lowering costs, the key objective is to focus on preventive, curative and palliative care to be provided through ‘the public health sector with focus on quality’. 

Highlights:
1. Promises to increase public spending on health to 2.5 per cent of the GDP
2. Providing assured services in the form of free drugs and diagnostics
3. Allocating major proportion (upto two-thirds or more) of resources to primary care followed by secondary and tertiary care.
4. Mainstreaming the potential of AYUSH & Yoga would also be introduced much more widely in school and work places
5. National health cards to be issued
6. Proposes regular tracking of Disability Adjusted Life Years Index to measure the burden of diseases by major categories until 2020.
7. It proposes two beds per 1,000 of the population to enable access within the golden hour (the first 60 minutes after a traumatic injury).

To address the various implementation challenges, the policy has proposed the much needed and long overdue institutional reform such as the establishment of the National Institute for Chronic Diseases, National Health Standards Organization, National Allied Professional Council, medical tribunals, National Digital Authority, a system for health technology assessment and at the Centre and in states a multi-stakeholder institutional mechanisms in the form of autonomous societies or government-owned trusts to purchase services from the providers – government, not-for-profit and for profit, in that order – and a Common Sector Innovation Council as a platform for a more effective collaboration with the departments engaged in medical research and discovery.

The policy also recognises the need to strengthen the regulatory frameworks related to medical devices, clinical establishments and certification of public hospitals for ensuring adherence to quality benchmarks.

A clear departure from the previous two policies of 1983 and 2002 is the detailed elaboration of areas in which private sector services will be contracted: training, skill development, community training for mental health, disaster management, purchase of services to fill gaps and preferentially for Central Government Health Scheme members, and primary healthcare in urban areas. There will also be collaboration with the private sector for infectious disease control, immunisation services, disease surveillance and health information and manufacture of medical devices

Concerns:
On a quick reading, the NHP does seem to be a revved up version of the 2002 policy. A closer reading, however, indicates, as detailed above, several new opportunities and approaches. The NHP is grounded on the existing situation and is to that extent more realistic. However, there are many concerns.

First, there is no correlation between the ambition in the text and public investment proposed – from the current level of 1.15% of GDP to 2.5% of GDP by 2025. This level of public investment is inadequate for achieving the goals, targets and approaches proposed to achieving them.

Secondly, the health sector has faced chronic underfunding. Be it in times of 3% or 9% growth rate, public health spending has always been in the range of 0.9-1.2% of the GDP. These meagre funds are then responsible for the under performance and dysfunctionalism of the public health sector that struggles with poor infrastructure, obsolescent equipments, understaffed and overworked personnel and so on. International experts have estimated a requirement of 5% of GDP for providing the comprehensive primary care as envisaged in the Sustainable Development Goals.

A third concern is the liberal use of strategic repeatedly in the context of purchasing services from the private sector to fill gaps in the public healthcare service delivery chain. The further incentivising of an already highly privatised system within a weak regulatory framework that is incapable of enforcing the private sector compliance to rules, regulations and standards set by the government, will undoubtedly entail long term adverse consequences both in terms of denial of care and huge fiscal implications for government as is being witnessed in the US.

Fourthly, there are serious omissions. For example, there is no mention of reforming and restructuring the Medical Council Of India (MCI) or the Nursing and Dental Councils to be more accountable and less corrupt, despite the scathing report of the Standing Committee of Parliament on Health on the functioning of the MCI. A third serious omission is the strengthening of the Clinical Establishment Act to make it mandatory for the display of prices by private hospitals.

Lastly, the policy is silent on health as a fundamental right, something its draft had provided.

Practice Ques: "India’s New National Health Policy is ambitious on paper but lacks clarity". Critically comment.

By: Dr. Vivek Rana