The long awaited National Health Policy (NHP), announced a few days ago, proposes to raise public health expenditure as a percentage of the GDP from the current 1.15% to 2.5% by 2025. The resource allocation to individual States will be linked with their development indicators, absorptive capacity and financial indicators. “There will be higher weightage given to States with poor health indicators and they will receive more resources. The Policy aims to end inequity between States. But at the same time, States will be incentivised to increase public health expenditure,” says Manoj Jhalani, Joint Secretary — Policy, Ministry of Health and Family Welfare.
While public health expenditure as a percentage of GDP will reach 2.5% only by 2025, many of the goals listed in the Policy have a deadline of 2025, some of them even sooner.
Preventive healthcare
The policy stresses preventive healthcare by engaging with the private sector to offer healthcare services and drugs that are affordable to all. It wants to reduce out-of-pocket “catastrophic” health expenditure by households by 25% from current levels by 2025. It wants to increase the utilisation of public health facilities by 50% from the current levels by 2025.
The Centre is working on introducing a health card — an electronic health record of individuals. “The health card will be for retrieving and sharing health data by lower [Primary Health Centre] and higher [secondary and tertiary] healthcare facilities,” says Mr. Jhalani. “It will be launched in six months to one year’s time in those States that show interest to roll it out in certain districts or across the State.”
Like the Health Ministry’s national strategic plan for tuberculosis elimination 2017-2025 report, the Policy wants to reduce the incidence of new TB cases to reach elimination by 2025. In a similar vein, the policy has set 2017 as the deadline to eliminate kala-azar and lymphatic filariasis in endemic pockets, and 2018 in the case of leprosy. In the case of chronic diseases such as diabetes, cancer and cardiovascular diseases, it envisages a 25% reduction in premature mortality by 2025.
Challenging ambitions
The policy “aspires” to provide secondary care right at the district level and reduce the number of patients reaching tertiary hospitals. For the first time, there is a mention of public hospitals and facilities being periodically measured and certified for quality.
But the most ambitious target is providing access to safe water and sanitation by all by 2020. As per the January 2016 Ministry of Drinking Water and Sanitation’s country paper, sanitation coverage was only 48%.
Other challenging targets set by the Policy include reducing the infant mortality rate to 28 per 1,000 live births by 2019 and under five mortality to 23 per 1,000 live births by 2025. According to the National Family Health Survey 4 (NFHS-4), IMR was 41 in 2015-16; it took 10 years to reduce IMR from 57 to 41.
As against 62% children 12-23 months old, who were fully immunised in 2015-16 according to the NFHS-4 data, the Policy has set a target of 90% by 2025.
