Note4Students

Indian health sector is meddled with a host of issues. Poor strata of population have denied proper health care. NHP policy tries to achieve over all development of health sector with private sector as an active partner. So NHP is very important for coming mains exam.

Introduction

1. The main objective of the National Health Policy 2017 is to achieve the highest possible level of good health and well-being, through a preventive and promotive health care orientation in all developmental policies,
2. to achieve universal access to good quality health care services without anyone having to face financial hardship as a consequence.
3. The broad principles of the policy are centred on professionalism, equity, affordability, universality, patient centred quality care, accountability and pluralism.

Analysis

Objectives

Major Highlights of National Health Policy, 2017

1. Assurance Based Approach– Policy advocates progressively incremental Assurance based Approach with focus on preventive and promotive healthcare
2. Health Card linked to health facilities– Policy recommends linking the health card to primary care facility for a defined package of services anywhere in the country.
3. Patient Centric Approach– Policy recommends the setting up of a separate, empowered medical tribunal for speedy resolution to address disputes /complaints regarding standards of care, prices of services, negligence and unfair practices. Standard Regulatory framework for laboratories and imaging centres, specialized emerging services, etc.
4. Micronutrient Deficiency- Focus on reducing micronutrient malnourishment and systematic approach to address heterogeneity in micronutrient adequacy across regions.
5. Quality of Care– Public hospitals and facilities would undergo periodic measurements and certification of level of quality. Focus on Standard Regulatory Framework to eliminate risks of inappropriate care by maintaining adequate standards of diagnosis and treatment.
6. Make in India Initiative- Policy advocates the need to incentivize local manufacturing to provide customized indigenous products for Indian population in the long run.
7. Application of Digital Health- Policy advocates extensive deployment of digital tools for improving the efficiency and outcome of the healthcare system and aims at an integrated health information system which serves the needs of all stake-holders and improves efficiency, transparency, and citizen experience.
8. Private Sector engagement for strategic purchase for critical gap filling and for achievement of health goals.
9. It aims to allocate major proportion of resources to primary care and intends to ensure availability of two beds per 1,000 population distributed in a manner to enable access within golden hour [the first hour after traumatic injury, when the victim is most likely to benefit from emergency treatment].

Key Targets

1. Achieve the global 2020 HIV target (also termed 90:90:90; 90 per cent of all people living with HIV know their HIV status, 90 per cent of all people diagnosed with HIV infection receive sustained antiretroviral therapy and 90 per cent of all people receiving antiretroviral therapy will have viral suppression)

Why NHP is Important

1. With a fifth of the world’s disease burden, a growing incidence of non-communicable diseases such as diabetes, and poor financial arrangements to pay for care, India brings up the rear among the BRICS countries in health sector performance. Against such a laggardly record, the policy now offers an opportunity to systematically rectify well-known deficiencies through a stronger National Health Mission.
2. Among the most glaring lacunae is the lack of capacity to use higher levels of public funding for health. Rectifying this in partnership with the States is crucial if the Central government is to make the best use of the targeted government spending of 2.5% of GDP by 2025, up from 1.15% now.

Concerns

NHP failed to make health a justiciable right in the way the Right to Education 2005 did for school education.

Investement

1. 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
2. In the primary healthcare space, the policy commits itself to strengthening the public health infrastructure in underserved areas in accordance with the Indian Public Health Standards (IPHS). Estimates of the ministry indicate a financial requirement of 1.4 lakh crores (2014 prices) for meeting the gaps in IPHS. Of this, over 75% is required in just the 300 districts that would qualify as underserved. Against such a huge deficit in capital investment, over the last ten years not more than Rs 10,000 crores may have been incurred and that too by the better off states.
3. 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 equipment, understaffed and overworked personnel and so on. Optimising this infrastructure to achieve the quality standards that the policy proposes will require substantial investments again.

Strategic purchasing

1. The policy envisages that strategic purchasing will be in the short term, though it nowhere defines how short the term is likely to be.
2. Evidence shows that public and private sector cannot coexist in the same space given the highly competitive environment. Evidence also shows that in such environments, the public sector has always lost out, more in the area of perception and non-provision of level playing fields. We have seen this in all sectors of development where the private sector has been co-opted under the public-private partnership mode. In all these frameworks, the risk is borne by the government with little liability on the private provider and necessitating action for non-compliance entailing elaborate litigation.

Institutional Capabilities

1. The NHP is silent on establishing an autonomous, independent drug regulator and more importantly dealing with the long pending and contentious issue of bringing drug regulation under the central control. State drug controllers are playing havoc with the licensing and drug quality assurance aspects and in oversight of pharmacies, contributing to the rampant misuse of antibiotics.
2. A serious omission is the strengthening of the Clinical Establishment Act to make it mandatory for the display of prices by private hospitals.
3. The National Pharmaceutical Pricing Authority has recently done yeoman service in capping the price of stents. How does this get enforced? In other words, making regulations is one aspect; enforcement is another that calls for substantial expenditures in establishing trained inspectorates and close monitoring. Similar regulations and enforcement are required for ensuring the proper maintenance of the diagnostic equipment, timely calibrations and utilisation. This too requires frequent inspections and monitoring by trained manpower and the co-option of technical institutions. The NHP is silent about this aspect as well, focusing only on the domestic manufacture of medical devices.

Conclusion

1. A policy is only as good as its implementation.” The next steps may not lie in creating yet another document called an implementation framework.
2. It would be better served by the creation of a number of multi-stakeholder implementation task forces or working groups around some of these new ideas and priorities – with the secretariat of these task forces housed in a corresponding division of the ministry- so that the ministry gets down to the implementation without any further time lost. It is a pragmatic policy- but only if work on implementation begins at once.

Questions

Q. National health policy is a panacea for the all challenges of Indian public health sector, critically comment