The new National Health Policy (2017) released last week presents a clear vision of how India’s sluggish health system can be galvanised to deliver health and well-being to all by 2030, to meet the Sustainable Development Goal on health. The real challenge lies in its operational amplification and effective implementation which call for cementing consensus, catalysing commitment and channelling close coordination for steering Centre and the States together to deliver on this vision.
After a gestation period of over two years, that saw extensive public comment and sharp debate within the government, the policy has finally emerged as a well-crafted document that lays the path for Universal Health Coverage (UHC). Though the right to health proposed in the earlier draft has been disappointingly deleted, effective implementation of the various measures proposed in the NHP should place us on the path towards the realisation of that right. While espousing a strong public health approach and commitment to strengthening the public sector, the policy aims to draw upon the diverse systems of medicine and the different sectors of health-care providers that characterise our mixed health system, for providing much-needed health services across India.
A rise in spending
The policy acknowledges the need for increasing the level of public financing for health, stating that the government must spend 2.5% of GDP by 2025. While this is sub-optimal and projects a farther date than public health advocates had hoped for, the promise to double public financing over next eight years is still welcome, given that government funding was virtually stagnant for several decades. However, Central budgets from now on must reflect a steady rise annually, to give credence to this promise. It also remains to be seen how States will conform to the recommendation that spending on health must rise above 8% of their budgets by 2020. Primary health care is rightly prioritised for two-thirds or more of all public funding. Free drugs, diagnostic and emergency services would be provided to all in public hospitals.
There is an assurance of primary health services which are needed for comprehensive care and promotion of well-being. These are to be available anywhere in the country on the basis of a family card, which also connects them to a ‘health and wellness centre’ that provides basic services, referral linkages and performs a gatekeeper function for advanced care. AYUSH systems would be mainstreamed. The much-delayed National Urban Health Mission is to be imparted speed and scale to address the unmet needs of urban primary health care while reaching out to the urban poor.
Secondary and tertiary health care will be provided through strengthened public services, with gap filling through strategic purchasing of services from private providers. While a ‘capitation’ fee model — of fixed annual payment for full health care of a person — has been proposed for primary health care, a ‘fee for service’ system has been proposed for secondary and tertiary care. It remains to be seen how these will gel in an integrated model.
Strengthening health care
District hospitals are to be strengthened, to provide several elements of tertiary care alongside secondary care. Sub-district hospitals too would be upgraded. A National Healthcare Standards Organisation is proposed to be established to develop evidence-based standard management guidelines. A National Health Information Network also would be established by 2025. A National Digital Health Authority would be set up to develop, deploy and regulate digital health across the continuum of care.
Expanded institutional capacity as well as new courses and cadres are proposed to overcome the shortages of skilled human resources in the health system. Public Health Management cadres are to be created in all States. BSc in Community Health and MD in Family Medicine are marked for scale-up and a variety of specialised nursing and paramedical courses are proposed, even as Accredited Social Health Activists (ASHAs) can career-track to become auxiliary nurse midwives.
A variety of disease control measures and targets have been proposed to tackle challenges ranging from HIV-TB co-infection to trauma and screening for chronic conditions such as hypertension, diabetes and common cancers. Control of indoor and outdoor air pollution has been accorded high priority with water, sanitation and nutrition, while multi-sectoral action will be aided by analytic capacity for health impact assessment.
All of these augur well for moving the health agenda forward. However, the real challenges lie in how quickly the government can strengthen the public sector, how well it can regulate the partnering private sector, how effectively it can ramp up the health workforce to reach all sections of the population and how efficiently the Central and State governments can team up. Fingers crossed!
K. Srinath Reddy is President, Public Health Foundation of India. The views expressed are personal
