The National Health Policy of India, 2017

The scenario of healthcare has changed in the past few years in the following ways:

  1. The health priorities are changing. There is a growing burden on account of non-communicable infectious diseases.
  2. The second important change is the emergence of a robust health care industry estimated to be growing at double digit.
  3. The rapidly growing health care costs is estimated to be one of the major contributors to poverty.
  4. A rising economic growth enables enhanced fiscal capacity.

Therefore, a new health policy responsive to these contextual changes is required.

The National Health Policy, 2017 (NHP, 2017)

It seeks to reach everyone in a comprehensive integrated way to move towards wellness.  It aims at achieving universal health coverage and delivering quality health care services to all at affordable cost.

Goal

The policy envisages as its goal the attainment of the highest possible level of health and well-being for all at all ages, through a preventive and promotive health care orientation in all developmental policies, and universal access to good quality health care services without anyone having to face financial hardship as a consequence. This would be achieved through increasing access, improving quality and lowering the cost of healthcare delivery.

Objectives

Improve health status through concerted policy action in all sectors and expand preventive, promotive, curative, palliative and rehabilitative services provided through the public health sector with focus on quality.

Specific Quantitative Goals and Objectives

Health Status and Programme Impact

  1. Life Expectancy and healthy life
    • Increase Life Expectancy at birth from 67.5 to 70 by 2025.
    • Establish regular tracking of Disability Adjusted Life Years (DALY) Index as a measure of burden of disease and its trends by major categories by 2022.
    • Reduction of TFR to 2.1 at national and sub-national level by 2025.
  2. Mortality by Age and/ or cause
    • Reduce Under Five Mortality to 23 by 2025 and MMR from current levels to 100 by 2020.
    • Reduce infant mortality rate to 28 by 2019.
    • Reduce neo-natal mortality to 16 and still birth rate to “single digit” by 2025.
  3. Reduction of disease prevalence/ incidence
    • Achieve global target of 2020 which is also termed as target of 90:90:90, for HIV/AIDS i.e, – 90% of all people living with HIV know their HIV status, – 90% of all people diagnosed with HIV infection receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have viral suppression.
    • Achieve and maintain elimination status of Leprosy by 2018, Kala-Azar by 2017 and Lymphatic Filariasis in endemic pockets by 2017.
    • To achieve and maintain a cure rate of >85% in new sputum positive patients for TB and reduce incidence of new cases, to reach elimination status by 2025.
    • To reduce the prevalence of blindness to 0.25/ 1000 by 2025 and disease burden by one third from current levels.
    • To reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by 25% by 2025.

Health Systems Performance

  1. Coverage of Health Services
    • Increase utilization of public health facilities by 50% from current levels by 2025.
    • Antenatal care coverage to be sustained above 90% and skilled attendance at birth above 90% by 2025.
    • More than 90% of the newborn are fully immunized by one year of age by 2025.
    • Meet need of family planning above 90% at national and sub national level by 2025.
    • 80% of known hypertensive and diabetic individuals at household level maintain “controlled disease status” by 2025.
  2. Cross Sectoral goals related to health
    • Relative reduction in prevalence of current tobacco use by 15% by 2020 and 30% by 2025.
    • Reduction of 40% in prevalence of stunting of under-five children by 2025.
    • Access to safe water and sanitation to all by 2020 (Swachh Bharat Mission).
    • Reduction of occupational injury by half from current levels of 334 per lakh agricultural workers by 2020.
    • National/ State level tracking of selected health behaviour.

Health Systems strengthening

  1. Health finance
    • Increase health expenditure by Government as a percentage of GDP from the existing 1.1 5 % to 2.5 % by 2025.
    • Increase State sector health spending to > 8% of their budget by 2020.
    • Decrease in proportion of households facing catastrophic health expenditure from the current levels by 25%, by 2025.
  2. Health Infrastructure and Human Resource
    • Ensure availability of paramedics and doctors as per Indian Public Health Standard (IPHS) norm in high priority districts by 2020.
    • Increase community health volunteers to population ratio as per IPHS norm, in high priority districts by 2025.
    • Establish primary and secondary care facility as per norm s in high priority districts (population as well as time to reach norms) by 2025.
  3. Health Management Information
    • Ensure district – level electronic database of information on health system components by 2020.
    • Strengthen the health surveillance system and establish registries for diseases of public health importance by 2020.
    • Establish federated integrated health information architecture, Health Information Exchanges and National Health Information Network by 2025.

Policy thrusts

  1. Ensuring Adequate Investment – The policy proposes a potentially achievable target of raising public health expenditure to 2.5% of the GDP in a time bound manner.
  2. Preventive and Promotive Health – The policy identifies coordinated action on seven priority areas for improving the environment for health:
    • The Swachh Bharat Abhiyan
    • Balanced, healthy diets and regular exercises.
    • Addressing tobacco, alcohol and substance abuse
    • Yatri Suraksha – preventing deaths due to rail an d road traffic accidents
    • Nirbhaya Nari – action against gender violence
    • Reduced stress and improved safety in the work place
    • Reducing indoor and outdoor air pollution
  3. Organization of Public Health Care Delivery – The policy proposes seven key policy shifts in organizing health care services
  • In primary care – from selective care to assured comprehensive care with linkages to referral hospitals
  • In secondary and tertiary care – from an input oriented to an output based strategic purchasing
  • In public hospitals – from user fees & cost recovery to assured free drugs, diagnostic and emergency services to all
  • In infrastructure and human resource development – from normative approach to targeted approach to reach under-serviced areas
  • In urban health – from token interventions to on-scale assured interventions, to organize Primary Health Care delivery and referral support for urban poor. Collaboration with other sectors to address wider determinants of urban health is advocated.
  • In National Health Programmes – integration with health systems for programme effectiveness and in turn contributing to strengthening of health systems for efficiency.
  • In AYUSH services – from stand-alone to a three dimensional mainstreaming.

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