Recently Ministry of Health and Family Welfare, Government of India came out with the much awaited National Health Policy, 2017. The above policy comes in the wake of first National Health Policy of 1983 and the second National Health Policy of 2002. The above policy is drafted and designed to prepare India for its march towards Universal Health Coverage .Given this background, one needs to appreciate the concept of Universal Health Coverage. Universal Health coverage has been defined by WHO “ as ensuring that all people have access to needed health services – prevention, promotion , treatment and rehabilitation-without facing financial ruin because of the need to pay for them. The thrust of universal health coverage is to ensure that all people obtain the health services they need – prevention, promotion, treatment, rehabilitation and palliation– without risk of financial ruin or impoverishment, now and in the future. The diversity and expanse of health services as given in the above definition is both enormous and lofty –thus very difficult to achieve .All WHO member nations including India made the commitment to universal health coverage, since 2005, The first bold measure made in this direction was made through the initiatives of Millennium Development Goals (MDGs), that impacted the health status significantly, yet this progress, falls far short of universal health coverage expectation. A simple fact that nearly 150 million people suffer financial catastrophe each year because they have to pay out-of-pocket for health services. India is no exception to this cruel fact.
The second major initiative has been undertaken by WHO member nations from January 2016, onward when it set the agenda for 2030 through Sustainable Development Goals.(SDG) 3: Ensure healthy lives and promote well-being for all at all ages
The third goal of SDG is to ‘ensure healthy lives and promote well-being for all at all ages’ The goal according to SDG report 2016’ aims to ensure health and well-being for all at all ages by improving reproductive, maternal and child health; ending the epidemics of major communicable diseases; reducing non-communicable and environmental diseases; achieving universal health coverage; and ensuring access to safe, affordable and effective medicines and vaccines for all’
The goal of National Health Policy, 2017 aims to attain 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. Thus we find that the goal of National Health Policy, 2017 is in keeping with the goal of Sustainable Development Goal.
If we look at the goal, we find that the thrust of the health policy, 2017 is preventive and promotive health care orientation. The driving force has to be primary health care.
The VI( sixth) declaration of Alma –Ata states that “Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. It forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process”
We find community participation in the spirit of self reliance and self determination is driver of primary healthcare movement. If a country wants to move towards universal coverage with preventive and promotive healthcare orientation- the community participation has to be the real enabler. The healthcare delivery structure has to be built around and with community participation.
A close examination of the objective of National Health Policy -2017, reveals that it is very exhaustive. The objectives revolve around 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. The objective moves from preventive and promotive healthcare as enshrined in the ‘Goal Statement’ to more exhaustive, elusive and expensive healthcare areas i.e. curative, palliative and rehabilitative healthcare .The objective statement is far wider and comprehensive than the goal statement. The goal seems to be attainable as it focuses on primary health care. The universal health care should be initially developed around Primary healthcare. The moment the government policy starts addressing curative care – the chances of its breakdown looms large. The American healthcare is a glaring example on this count.
If we take a close look at the primary aim of the National Health Policy, 2017, we find it is very holistic and inclusive. in the sense that it aims to inform, clarify, strengthen and prioritize the role of the Government in shaping health systems in all its dimensions– investments in health, organization of healthcare services, prevention of diseases and promotion of good health through cross sectoral actions, access to technologies, developing human resources, encouraging medical pluralism, building knowledge base, developing better financial protection strategies, strengthening regulation and health assurance. It is very evident that government wants to play pivotal role in developing and nurturing an all inclusive health delivery mechanism.
The objective of the policy emphasises upon achieving Universal Health Coverage in a progressive manner. The National Health Policy, 2017 lays emphasis on collaboration with private or non-government sector on pro-bono basis to deliver health care services .The idea is to ensure optimum use of the existing manpower and infrastructure and garner the additional resources through collaboration. The policy very rightly advocates for reinforcing trust in Public Health Care System: The effort will be to strengthen the trust of the common man in public health care system. It is a tall task. At the moment, people have no or little faith in public healthcare system. In rural areas in particular, the system is even more pathetic. The three tier healthcare system in rural area has failed to instil the confidence of the rural population. Access to healthcare is a daunting challenge in rural area even today. Therefore , the task of making the public healthcare system predictable, efficient, patient centric, affordable and effective, with a comprehensive package of services and products that meet immediate health care needs of most people( as documented in the policy) calls for methodical and measurable intervention.
Along with primary care in the form preventive and promotive care , the policy also wants to ensure improved access and affordability, of quality secondary and tertiary care services through a combination of public hospitals and well measured strategic purchasing of services in health care deficit areas, from private care providers, especially the not-for profit providers. The policy talks about strategic purchasing of healthcare services in deficit areas. This would be altogether a new dimension in the existing healthcare framework. A novel idea but calls for immense acumen and expertise. If used properly, it can change the face of healthcare in India.
The objective of the policy also emphasises on achieving a significant reduction in out of pocket expenditure due to health care costs .This is a huge problem. India’s out of pocket expenditure on health is one of the highest in the world and, therefore, achieving reduction in proportion of households experiencing catastrophic health expenditures and consequent impoverishment is a daunting task.
Author : Dr.Abhijit K.Chattoraj
