The Union Government has recently launched the National Health Policy, 2017 which is going to guide the national health system in the coming days. The present policy is a revision of the 2002 Health Policy which attempted to universalise the National Rural Health Mission in order to provide basic healthcare even in the remotest areas of the country. The 2002 Policy was successful in establishing an extensive network of Primary Health Centres/ Rural Health Centres to establish the primary level medical institutions and to inculcate a habit of formal medical system in the rural areas. The precursor to the 2017 Policy was embedded in the Budget Speech of the Finance Minister which highlighted the aspects of universalisation of heathcare and acknowledged the need of ‘strong state intervention’ to uplift the ailing healthcare system of the nation.
Backdrop of the National Heath Policy 2017
The 2017 Policy is a successor to the previous policy guidelines in the form of National Health Policy of 1983 and National Health Policy of 2002 which worked within the ambit of the Five Year Plans to cater to the specific target audience for improving the health infrastructure across the nation. Along with the National Health Policy of 2017, the Ministry of Health and Family Welfare, Government of India also released a Report titled ‘Situation Analyses’ as a background research for the novel policy. The said report discussed the achievements of the 2002 Policy in the light of the Millennium Development Goals (MDGs) with respect to the maternal mortality and mortality rate under 5 years of age. The target of MDG-5 for the reduction of the Maternal Mortality Ratio (MMR) was to achieve a drop of three quarters between 1990 and 2015. From the abysmal MMR of 556 in 1991, the nation was able to reduce it significantly to 167 for the year 2011-12. For the under-5 mortality rate (U5MR), the MDG target is 42. The progress of the nation in this aspect was 126 in 1990 to the ameliorated to 49 in 2013. But the progress in the segments of decline in birth-rate and neonatal mortality has been disappointing. There is also a wide state-level disparity with U5MR for Assam being 73 and an impressive 4 for Kerala. The nation has also not been able to achieve a headway in the reduction of AIDS, malaria, etc. which continue to loom as death threats for a large segment of the poor population.
The report stated that the nation is undergoing a rapid health transition in the present times. The need of the hour is to augment the resources in targeted areas with specific policy guidelines to continue to tread the path of reducing the high incidence of communicable diseases in the nation. The need of the 2017 policy increases in the wake of a resurgent health industry development in the nation with a double digit growth rate. The clearer efforts to supplement the increasing costs of even the primary health care for the vulnerable section of the population has led the policy makers to forage a new policy.
Salient Features of National Health Policy 2017
The aim of the National Heath Policy of 2017 is to inform, strengthen and prioritise the role of the government in revamping the health care system of the nation. It recognises the specialised role of a large decisive investment to be made to the basic infrastructure for reducing the number of communicable diseases and for aiding the early screening and diagnosis process. The aim is to provide for universal access to health care by increasing the quality and infrastructure and lowering the cost of treatment. The policy lays stress on the work ethics, professionalism and integrity in the healthcare sector for improving the treatment of patients. It highlights the need for a ‘Patient Centred’ quality of care and the revered goal of attaining accountability in this pivotal sector.
It emphasises on the goal of achieving ‘Universal Health Coverage’ across the mammoth population by improving the access, affordability and capacity building of the secondary and tertiary level institutions. The aim is also to reinforce the trust of the people in the public health system by upgrading the quality and delivery rate of services. It sets the target to achieve 90% immunisation levels for the new born babies by the year 2025. It seeks to increase the utilisation of public healthcare systems by 50% in the year 2025.
It accepted the need to establish the ‘State Public Healthcare Cadre’ for better institutional accountability. It also moots the idea for ‘National Heath Standards Organisation’ to cater to the task of reviewing standards for both private as well as public healthcare segments. It advocates ‘Medical and Paramedical education’ for bettering the service delivery of the health sector. One of the most accomplished suggestions has been the recognition of the idea that the traditional Indian systems of medical care ‘AYUSH’ needs to be integrated with research processes and training programmes for increasing the patient coverage areas.
Focus on Mental Health
The issue of mental healthcare in India has been one of the most neglected areas in the medical field. It is associated with taboos and dogmas with utter ignorance especially in the rural areas. People prefer not to disclose their ailments for the fear of stigmatisation in the society. Even the basic understanding and infrastructure in the public health sector is abysmal. But the 2017 Policy attempts to achieve a paradigm shift in this aspect. It is for the first time that the National Health Policy of 2017 recognised the ‘Rights of Mentally Ill Persons’ to seek access to healthcare and treatment in the government hospitals for the same. It also envisions to provide protection from the inhumane treatment for the mentally challenged individuals. It introduces the ‘nominee representative’ for the treatment of the mentally ill patients and allows informed choices to be made on behalf of the patient during the course of their treatment. It puts an obligation on the Centre and State level medical institutions to maintain a list of the mentally ill patients undergoing treatment and to prepare a register of the professionally qualified personnel to provide healthcare services.
The recently passed Mental Healthcare Bill, 2016 provides statutory right to the mentally challenged in the form of ‘Right to access mental healthcare and treatment’. It also decriminalises the ‘attempt to suicide’ which was earlier punishable under Section 309 of the Indian Penal Code, 1860. It also bans the use of ‘Electro Convulsive Therapy’ for the mentally challenged persons with the only exception being the case of muscle relaxants.
Lacunae of the 2017 Policy
The National Heath policy of 2017 is undoubtedly well intentioned to revamp the ailing healthcare system of the nation, but it doesn’t provide any conclusive measures for the same. Although it focuses on attaining ‘Universal Healthcare Access’, it would require huge budgetary allocations and political will to accomplish its objectives. The same is the case with ‘National Health Standards Organisations’ which is introduced to be a game changer to ensure quality healthcare across the nation, but the process of establishment and working has not been specified therein. It is pertinent to note that the Central Government in the year 2010 enacted the Clinical Education Act, 2010 for the clinical standards of health institutions, but compliance with the same has been lacklustre. It also doesn’t recognise ‘Health as a Justiciable Right’ in order to reduce the huge burden on the government exchequer. The focus supplemented to ‘AYUSH’ is commendable, but the policy is not able to differentiate it from the Western medical systems and fails to provide clear directions for the same.
Suggestions for 2017 Policy
The National Health Policy of 2017 is a brave attempt to establish the role of state intervention to achieve the goal of ‘Universal Healthcare Access’. But the road for the achievement of this cherished target will be long and treacherous given the present state of poor rural healthcare infrastructure. The focus on ‘professionalism and work ethics’ for this novel profession is admirable. It is worth quoting that last month the Doctors and Staff members at AIIMS, New Delhi showcased great work ethics and professional commitment when they sabotaged an attempt of politicians and power hungry bureaucrats for establishing a ‘VIP OPD Counter’ at AIIMS. It is only due to the united opposition of the doctors, professors and staff members of AIIMS that such an unscrupulous attempt to oppose the basic ‘Right to Health’ of the ordinary citizens of the nations in the grab of obnoxious VIP Culture is incapacitated.
The emphasis on the mental healthcare also needs capacity building with the present bedding capacity of nadir level of 0.2 beds/lakh of population. There is a dearth of 4500 psychiatrics and 12500 staff members to cater to the needs of the mentally challenged patients. The establishment of ‘Mental Health Review Commission’ under the Mental Healthcare Bill, 2016 is an attempt to streamline the mental healthcare delivery. The fact that the National Health Policy of 2017 sets the time bound targets for access coverage and immunization levels is appreciable. The need is to ameliorate the poor efficiency of the healthcare sector by putting the ‘Clinical Establishments’ in the Concurrent List under the Seventh Schedule to the Constitution of India. If the ‘National Health Standards Organisation’ is able to function effectively, then the long cherished dream of providing the Healthcare services even to the poorest sections of the population could come true. It is hoped that the National Heath Policy of 2017 is able to achieve its targeted goals for building a healthier and stronger nation with reduced burden of curing communicable diseases and improving mortality rates.