HEALTH CARE FOR ALL

THE NATIONAL HEALTH POLICY 2017

V.SRINIVAS12

NATIONAL HEALTH POLICY 2017 – KEY HIGHLIGHTS

 Gradually increasing public health expenditure to 2.5 percent of GDP
 Policy Shift in Primary Health Care from selective care to assured comprehensive care
 Establishing Health and Wellness Centers to transform PHCs from current limited
package of services to larger coverage of non-communicable diseases
 New policy formulation related to non-communicable diseases and mental health
 Retention of doctors in remote areas, health systems strengthening, health technologies
development and new institutions for research and development
 Strategic Purchases and engagement with private sector for critical gap filling
 Moving towards an assurance based approach, increasing access, affordability and
quality

Introduction

Article 47 of Indian Constitution, the Directive Principles of State Policy says that it shall
be the duty of the State to raise the level of nutrition and the standard of living and to improve
public health. Health sector policy making in India is extremely challenging and complex. The
backdrop for policy formulation is low public spending and high out of pocket expenditures.
Despite India providing free care in public hospitals for maternity, new born and infant care, the
burden of out of pocket expenditures remains quite high.

In 1943, the Joseph Bhor Committee report envisaged one bed for every 550 people and
one doctor for every 4600 people in every district. In 1946, Government resolved to make plans
for establishing a Primary Health Centre for every 40000 people, a Community Health Centre of
30 beds for every 5 Primary Health Centers and a 200 bedded District Hospital in every District.

1
V.Srinivas is an IAS officer of 1989 batch, he has served as Secretary to Government Department of Health and Family Welfare
Government of Rajasthan from 7/4/2008 to 14/9/2009 and as Deputy Director Administration All India Institute of Medical
Sciences New Delhi from 17/12/2014 to 21/3/2017.
2
The author acknowledges the support received from Dr. B.B.Dixit Library Staff of AIIMS for providing research inputs

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On the eve of Independence, India inherited a substantial disease burden, with infant and
maternal mortality, low life expectancy, inadequate number of doctors, nurses and midwives,
poor health infrastructure and low budgetary allocations. During the first 3 decades since
Independence, India’s health policy focus entailed controlling infectious diseases, family
planning, creation of teaching hospitals like AIIMS to produce high quality human resources and
promote infrastructure.

In 1978, India adopted the Alma-Ata Declaration for providing comprehensive primary
health care to all its people. In 1983, India’s first National Health Policy (NHP) was formulated
with emphasis on primary health care and an integrated, vertical approach for disease control
programs. The allocations for health sector became tighter during the difficult years of 1990s.
The National Health Policy (NHP) 2002 broadly reiterated the earlier Policy’s recommendations
while advocating that the public investment be increased to 2 percent of GDP. The NHP 2002
was followed by the launch of the National Rural Health Mission (NRHM) in 2005 designed on
the principles of decentralisation and community engagement with focus on revitalizing primary
care.

The National Health Mission

India’s flagship health sector program, the National Health Mission (NHM) sought to
revitalize rural and urban health sectors by providing flexible finances to State Governments.
The National Health Mission comprises of 4 components namely the National Rural Health
Mission, the National Urban Health Mission, Tertiary Care Programs and Human Resources for
Health and Medical Education. The National Health Mission represents India’s endeavor to
expand the focus of health services beyond Reproductive and Child Health, so as to address the
double burden of Communicable and Non-Communicable diseases as also improve the
infrastructure facilities at District and Sub-District Levels.
The National Health Mission (NHM) brought together at National level the two
Departments of Health and Family Welfare. The integration resulted in significant synergy in
program implementation and enhancement in Health Sector allocations for revitalizing India’s
rural health systems. A similar integration was witnessed at State levels too. A post of Mission
Director NRHM manned by a senior IAS Officer was created to administer the State Health
Society. The NHM brought in considerable innovations into the implementation of Health Sector
Programs in India. These included flexible financing, monitoring of Institutions against IPHS
standards, Capacity Building by induction of management specialists and simplified HR
management practices. The establishment of the National Health Systems Resource Center
(NHSRC) helped design and formulate various initiatives. State Health Systems Resource
Centers have also been established in some States.
Reproductive and Child Health services were the primary focus of NHM. The
successful implementation of JSY and ASHA programs had a significant impact on behavioral

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changes and brought pregnant women in large numbers to public health institutions. The NRHM
flexi pool resources were utilized to create adequate infrastructure at public health institutions to
cope with the heavy rush of maternity cases. Ambulance services were introduced for
transportation of maternity cases to public health institutions and for emergency care.
The NHM created a peoples’ movement for health care. Accredited Social Health Care
(ASHA) workers were deployed as transformational change agents in every village. The ASHA
workers acted as mobilizers for institutional deliveries, focused on integrated management of
neonatal and childhood illness and advised on home based neo-natal care. The NHM has also
empowered people through Village Health and Sanitation Committees to formulate village health
plans and exercise supervisory oversight of ASHA workers. At the PHC and CHC level Rogi
Kalyan Samitis have been activated to establish systems of oversight over the public health
facilities for creating a patient friendly institution. Besides rural areas, the urban slums are now
receiving attention with the launch of the National Urban Health Mission.

Government’s New Schemes

The Ministry of Health and Family Welfare has added several new schemes since 2014 to
enable implementation of the Health For All Vision for the Nation.
Mission Indradhanush, sought to achieve full immunization coverage of 90 percent
children by 2020. The mission has made good progress in improving immunization coverage by
6.7 percent since 2014. A basket of new vaccines has been added to the Universal Immunization
Program to increase the number of vaccines from 6 to 12. The prominent among them are the
Inactivated Polio Vaccine, the Rota Virus Vaccine, the Adult Japanese Encephalitis Vaccine and
the Rubella Vaccine as Measles Rubella Vaccine.
India New Born Action Plan with focus on reduction of neonatal mortality rate has
successfully established Special New Born Care Units at District level and New Born
Stabilization Units at Sub-District/ CHC level. The Mother’s Absolute Affection Program was
launched in 2016 with focus on promotion of breast feeding practices. The Rashtriya Bal
Suraksha Karyakram and the Rashtriya Kishore Swasthya Karyakram represent the major
screening programs of Government for early screening and interventions in children and
adolescent girls.
The Government has added the Pradhan Mantri Surakshit Matritva Abhiyan for assured
antenatal care. There is continued focus on the NHM activities of Mission Family Welfare,
Janani Shishu Suraksha Karyakram and Janani Suraksha Karyakram each of which aim at
reducing maternal and infant mortality by promotion of institutional deliveries.
The New Schemes in Health sector are Swach Swasth Sarvatra, the Pradhan Mantri
National Dialysis Program and Kayakalp. The Kayakalp initiative was launched in 2016 to
inculcate the practice of hygiene, sanitation, effective waste management and infection control in

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public health facilities. The competition for awards introduced under Kayakalp has been well
received by all the States and significant improvements in sanitation standards are being
witnessed.

The National Health Policy (NHP) 2017

The primary aim of the NHP is to strengthen and prioritize the role of the Government in
shaping health systems, make additional investments in health, healthcare services, prevention of
diseases and promotion of good health. The NHP seeks to raise the health sector spending to 2.5
percent of GDP, create patient centric institutions, empower the patients and lay down standards
for quality of treatment. It also seeks to strengthen health infrastructure to 2 beds/ 1000
population and provide free drugs, free diagnostics and essential health care in all public
hospitals. The NHP’s key goals are to improve the life expectancy at birth from 67.5 years to 70
years by 2025 and reduce the infant mortality to 28 by 2018. The other goals are elimination of
Leprosy, Kala Azar and Filariasis by 2017-18. From a baseline of 560 in 1990, the Nation has
achieved an MMR of 167 in 2011. From a baseline of 126 in 1990, the Nation has achieved an
U5MR of 39 in 2014. The challenges remain in the six large States of Bihar, Uttar Pradesh,
Rajasthan, Madhya Pradesh, Jharkhand and Chattisgarh which account for 42 percent of national
population and 56 percent of annual population increase.

Government has initiated policy interventions for implementing the NHP. Union Budget
2017 for health shows an appreciable increase of more than 27%, from Rs. 37061.55 cr in 2016-
17 to Rs. 47352.51 cr. India has a vast organization for public health care delivery and Primary
care services. The NHP lists infrastructure and human resource development in Primary and
Secondary Care Hospitals as a key priority area. The Government in the 2017 Union Budget has
sought to upgrade 1.5 lakh health sub-centers to health wellness centers and introduce a
nationwide scheme for pregnant women under which Rs. 6000/- for each case will be transferred.

The NHP seeks to reform medical education. Government has initiated major steps in this
direction. AIIMS is a national and global brand - built on more than six decades of evolution and
performance of our Institute. It is the bench mark for other centers of excellence in healthcare
and academics, and a fountainhead of best practices in education, research and clinical standards.
The unique status of AIIMSs has been reinforced by significant infusion of financial resources
for major expansion. The focus on medical education should enable India to address the
iniquitous utilization of modern health services. The Government has placed a lot of emphasis on
creation of several AIIMS like Institutions across India.

The NHP places a lot of emphasis on human resources as a vital component of India’s
health care. 5000 Post Graduate seats per annum have been created to ensure adequate
availability of specialist doctors to strengthen secondary and tertiary levels of healthcare. The

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increased availability of PG seats along with a centralized entrance exam represent major steps in
reform of medical education in the country. The expansion of postgraduate medical education is
a priority as the shortage of PG medical seats in the country affects not only the availability of
specialist doctors but also the ease of getting faculty for medical colleges. The introduction of a
uniform entrance examination at undergraduate and post-graduate level has brought transparency
to medical education. The Medical Council of India Amendment Act 2016 introduced a common
merit based entrance examination at National level. Government has notified the increase in
post-graduate seats in 435 medical colleges with the objective of increasing the number of
specialist doctors in India.

The NHP has placed a lot of emphasis on Digital Initiatives. Online registration system
has been introduced in 71 hospitals of India as part of the Digital India initiative. Digitization of
public hospitals had enabled a reduction of patient wait times and freed clinician times. A patient
centric feedback system called Mera Aspataal has been introduced. The data sets of Mera
Aspataal have flagged the important areas for patient dissatisfaction.

To conclude it can be said that the significant strides envisaged to be made in Health
Sector through the National Health Policy interventions will enable India to achieve the
objectives of Affordable Healthcare for All.

References:

1. Ministry of Health and Family Welfare, Government of India, Health Care for All, Three
Years of Transforming India May 2014 –April 2017., MOHFW pp 1-62
2. Ministry of Health and Family Welfare, Government of India, National Health Policy 2017,
New Delhi., pp 1-28
3. Ministry of Health and Family Welfare, Government of India, National Health Policy 1982.,
Journal of Public Health Policy., vol 7 No 2 (Summer 1986) pp 248-264
4. Ministry of Health and Family Welfare, Government of India, Highlights of National Health
Policy 2002., MOHFW Press Release dated May 3, 2002
5. Ministry of Health and Family Welfare, Government of India, Situation Analysis: Backdrop
of the National Health Policy 2017., MOHFW
6. Mathur, Manu Raj and Srinath Reddy K.., Will India’s National Health Policy deliver
Universal Health Coverage? Editorials BMJ 2015 dated 1 June 2015
7. Narayana, Muttur Ranganathan., India’s Proposed Universal Health Coverage Policy:
Evidence for Age Structure Transition Effect and Fiscal Sustainability., Applied Health
Economic Policy, dated 19 August 2016
8. Sundararaman T., National Health Policy 2017: a cautious move., Indian Journal of Medical
Ethics Vol II No 2 April – June 2017 pp 69-71

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