Insights into Editorial: Breathing life into health care in India
The National Health Policy, 2017, was recently approved by the Union Cabinet. After considering suggestions from the public, state governments and others, the new policy will replace the previous one, which was framed 15 years ago in 2002. The policy, which aims at providing healthcare in an “assured manner” to all, will address current and emerging challenges arising from the ever changing socio-economic, technological and epidemiological scenarios.
- The government aims in shifting focus from “sick-care” to “wellness”, by promoting prevention and well-being.
- It intends on gradually increasing public health expenditure to 2.5% of the GDP.
- It aims to strengthen health systems by ensuring everyone has access to quality services and technology despite financial barriers. The policy proposes increasing access, improving quality and reducing costs. It proposes free drugs, free diagnostics and free emergency and essential healthcare services in public hospitals.
- It also focusses on primary health care: The policy advocates allocating two-thirds (or more) of resources to primary care. 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).
- It aims to reduce morbidity and preventable mortality of non-communicable diseases (NCDs) by advocating pre-screening.
- It highlights AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy) as a tool for effective prevention and therapy that is safe and cost-effective. It proposes introducing Yoga in more schools and offices to promote good health.
- The policy also lists quantitative targets regarding life expectancy, mortality and reduction of disease prevalence in line with the objectives of the policy.
- Increase Life Expectancy at birth from 67.5 to 70 by 2025.
- Reduce infant mortality rate to 28 by 2019.
- Reduce Under Five Mortality to 23 by 2025.
- 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).
- To reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by 25% by 2025.
What’s good about the policy?
The World Health Organization (WHO) was established in 1948 with the promise of realising ‘Health for all’. Almost seven decades later, both WHO and India are still striving towards achieving the vision of universal health coverage. Universal health coverage is fundamental to achieving the health objective under the Sustainable Development Goals (SDGs). Yet, about 400-million people – one out of every 17 of the world’s citizens – lack access to essential health services. With a population of 1.2 billion, India has a remarkable opportunity to take on a leadership role in addressing this major gap and providing assured health services to all its citizens.
- Considering this, the Indian government’s newly-approved National Health Policy is a laudable step in this direction. The policy seeks to promote universal access to good quality healthcare services while ensuring that no one faces financial hardship, and to ensure that public hospitals provide universal access to a wide array of free drugs and diagnostics. This policy can help realise the vision of achieving universal health coverage and ‘health for all’ in India.
- If carefully implemented, the policy’s proposed steps such as a health card for every family, which will enable access to primary care facilities and a defined package of services nationwide, will certainly help improve health outcomes in India. The recommended grading of clinical establishments and active promotion and adoption of standard treatment guidelines can also help improve the quality of healthcare delivery in India.
- The policy faces the challenging task of ensuring affordable, quality medical care to every citizen. 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.
- Among the most glaring lacunae in the present context 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.
- Although a major capacity expansion to produce MBBS graduates took place between 2009 and 2015, and more initiatives were announced later, this is unlikely to meet policy goals since only 11.3% of registered allopathic doctors were working in the public sector as of 2014, and even among these, the number in rural areas was abysmally low. More health professionals need to be deployed for primary care in rural areas.
What needs to be done now?
- More health professionals need to be deployed for primary care in rural areas. Availability of trained doctors and nurses would help meet the new infant mortality and maternal mortality goals, and build on the gains from higher institutional deliveries, which exceeded 80% in recent years.
- Contracting of health services from the private sector may be inevitable in the short term, given that about 70% of all outpatient care and 60% of inpatient treatments are provided by it. But this requires accountability, both on the quality and cost of care.
- No more time should be lost in forming regulatory and accreditation agencies for healthcare providers at the national and State levels as suggested by the expert group on universal health coverage of the Planning Commission more than five years ago. Without such oversight, unethical commercial entities would have easy backdoor access to public funds in the form of state-backed insurance.
- It should also be mandatory for all health institutions to be accredited, and to publish the approved cost of treatments, in order to remove the prevailing asymmetry of information.
- For the new policy to start on a firm footing, the Centre has to get robust health data. Currently this is fragmented because inputs from multiple sources and sample surveys are not reconciled, and the private sector is often not in the picture.
- To reduce high out-of-pocket spending, early deadlines should be set for public institutions to offer essential medicines and diagnostic tests free to everyone. This was estimated in 2011 to require a spending increase of only 0.4% of GDP, which is within the 2.5% that the Centre is talking about.
The policy 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.