National Health Policy-2017

How the problem was identified:

The National Health Policy (NHP) was last brought out in year 2002. Prior to that, NHP-1983 was
in operation. Both these policies had served well in guiding the approach for the health sector
in successive Five-Year Plans. The context of Health Sector had undergone significant changes
since then, including:

1. Changing health priorities- although maternal and child mortality had rapidly declined,
there was a growing burden on account of non- communicable diseases and some
infectious diseases.
2. Emergence of a robust health care industry estimated to be growing at double digit.
3. Growing incidences of catastrophic expenditure due to health care costs, which were
estimated to be one of the major contributors to poverty.
4. A sustained economic growth over the years, which enabled enhanced fiscal capacity of
the Government of India to undertake major reforms initiatives in the Health Sector.

Therefore, it was felt that a new health policy responsive to these contextual changes is
required (MoH&FW, 2017).

What was the evidence available for policy formulation:

Health Financing and protection: Various studies/reports had pointed out the growing
incidence of catastrophic expenditure due to health care costs. High Level Expert Group on
Universal Health Coverage for India, set up by the erstwhile Planning Commission, in its report
in 2011, pointed out that private expenditure accounted for 67% of the total expenditure on
health in India in the year 2009. The report also pointed out that Out-patient treatment, and
not hospital care, accounts for 74% of the private Out-of-pocket (OOP) expenditures. Further,
Medicines account for 72% of the total private OOP expenditure (Reddy & et.al, 2011).

Changing Health priorities: A plethora of evidence existed on the changing health dynamics in
India. As per the 2016 report “India: Health of the Nation's States — The India State-Level
Disease Burden Initiative”, the contribution of most major non-communicable disease
categories to the total disease burden had increased in all states since 1990. These include
cardiovascular diseases, diabetes, chronic respiratory diseases, mental health and neurological
disorders, musculoskeletal disorders, cancers, and chronic kidney disease (ICMR, PHFI, & IHME,
2017). A readily available data maintained by Institute of Health Metrics & Evaluation, in the
below mentioned figure, shows that Ischemic Heart disease, Chronic Obstructive Pulmonary
Disease and Stroke are now the three leading causes of death in India.

1
(Source: https://www.healthdata.org/disease-burden-india)

Key stakeholders and their interests:

Sr. Key Stakeholders Interests

No
1. Ministry of Health, To put in place a policy with the goal of Attainment of
Government of India (GoI) highest possible level of health and well-being, availability
of good quality health care without any financial
hardship.
2. Finance Ministry, GoI Ability to fund the financial commitments entailed in the
Health Policy
3. NITI Aayog Ensuring synergy between the Health Policy and other
social sector programmes/ schemes of GoI
4. Ministry of AYUSH, GoI Ensuring that Indian Systems of Medicine get due
encouragement and support through new policy initiative
5. Department of Regulatory framework and environment is conducive to
Pharmaceuticals, GoI growth and development of Pharmaceutical and Medical
Devices sector in India
6. State Governments Aligning of NHP with State health priorities, funding

2
 opportunities from GoI, Financial commitments on the
part of States
7. Pharmaceutical and Medical Facilitatory framework to support growth of
device Industry Pharmaceutical and Medical Devices sector in India
8. Medical Education Industry Facilitatory framework to support growth of their sector
(Private sector Medical
Colleges, Pharmaceutical/
Nursing colleges)
9. Private sector Healthcare Facilitatory framework to support growth of their sector
providers
10 NGOs/ Health Activists Attainment of highest possible level of health and well-
. being, availability of good quality health care without any
financial hardship.

Status of stakeholders’ engagement:

The NHP-2017 adopted an elaborate procedure for its formulation involving stakeholder
consultations. Accordingly, the Government of India formulated the Draft National Health Policy
and placed it in public domain on 30.12.2014. Thereafter following detailed consultations with
the stakeholders and State Governments, based on the suggestions received, the Draft National
Health Policy was further fine-tuned. It received the endorsement of the Central Council for
Health & Family Welfare, the apex policy making body, in its Twelfth Conference held
27.02.2016 (PIB, 2017). Thereafter, the policy underwent the process of Inter-Ministerial
Consultation and was also considered by a Group of Ministers before finally being approved by
the Union Cabinet.

Evaluation of the policy choice indicating criteria for evaluation:

The salient features of the National Health Policy-2017 are as follows (MoH&FW, 2017):

1. Goal: Attainment of highest possible level of health and well-being, availability of good
quality health care without any financial hardship.
2. The policy aims to achieve Universal health care progressively and reduce Out of Pocket
expenditures, advocates collaboration with NGO’s and Strategic purchase (Government
acting as a single purchaser) of services from Private sector as short-term measure to fill
critical gaps. Policy underlines that public sector needs to be strengthened and should
play a dominant role in shaping health care sector in India. Advocates aligning the growth
of private sector as per public health goals.

3
 3. Investment in Health: To increase Government’s Health investment from 1.15% of GDP
to 2.5% of GDP by 2020. General taxation, CSR, taxation on specific commodities –
tobacco, alcohol, specific food items proposed for raising resources. Advocates
appropriate taxation/cess so that earnings from medical tourism flow as a form of
resource mobilization for health sector.
4. Preventive and Promotive Health: Concrete action in 7 areas – Swachh Bharat Abhiyan;
Balanced and healthy diet and regular exercise; tobacco and alcohol abuse; safety in rail
and road traffic; action against gender violence; reduced stress in work places; reduction
in indoor and outdoor air pollution. Advocates developing implementation strategies and
institutional mechanism to launch Swasth Nagrik Abhiyaan. Stress on Yoga, School
health, occupational health, early diagnosis and prevention using ASHA network in NCD’s.
Suggests Health Impact assessment for development policies.
5. Primary Health: Free Comprehensive Primary Health Care (include Geriatric, palliative,
rehabilitative care) by public sector. Assured Primary care. Set up Health and Wellness
centres. Each family to have Health card linking them to primary care facility and will
make them eligible to avail defined package of services anywhere in the country. Also
advocates to put in place effective gate keeping mechanisms.
6. Secondary care: Medical college level services to be made available at District level with
about 10 Specialist skills at district levels and 4-5 specialist skills at sub-district levels.
Free drugs, diagnostics and emergency care in public hospitals. Strategic purchase from
non-government sector to fill critical gaps.
7. Tertiary care: Government to continue playing role in tertiary care, societal obligation of
private sector, purchase of services from private sector.
8. Urban Health: Focus on strengthening primary care, forging partnerships with Private
sector, work on determinants of Health like air pollution, solid waste management, vector
control etc.
9. Reorienting Public hospitals: Tax financed single payer health care system where care is
prepaid and cost efficient. Operating cost of hospitals to be given on per capita basis and
infrastructure/salaries to be given on fixed cost basis. Purchase of health care through
independent trusts/societies and an independent mechanism to ensure adherence to
standard treatment protocols. Establishing robust National Health Accounts.
10. Human resources and Health: Upgrading district hospitals to medical colleges, common
entrance and exit exams, revision of curriculum, mandatory rural postings. Mid-level care
providers with BSc community medicines or appropriate bridge course to provide
comprehensive primary care. Creation of a public health management cadre.
11. National health programmes: Important areas: Thrust on School health, Micro-nutrient
deficiencies through food fortification, Full immunisation, Control of communicable
diseases, Population stabilization through fixed day approach instead of camp based

4
 approach and increasing male sterilization from 5% to 30%. For NCD’s, screening through
primary health care network and setting up of National Institute of Chronic Disease. For
Mental health, focus on creation of network of community members to provide psycho
social support.
12. AYUSH: Co-location of facilities; promotion of Yoga in schools and work places,
standardization and validation of AYUSH drugs and their quality control, provision of
AYUSH services through ASHA and VHSNC.
13. Emergency and disaster management: Unified emergency response system, one for 30
lakh urban and one for 10 lakh rural population – to have dedicated universal access
number, network of emergency care and trauma centres and assured provision of life
support ambulances.
14. Quality: Eliminate risk of inappropriate treatment. National Health Standard Organisation
for developing evidence based standard guidelines for care.
15. Digital Health: Establishing National Digital Health Authority to regulate, develop and
deploy digital health. Establishing integrated health information networks.
16. Drugs and medical devices: Promotion of domestic API production (currently > 70%
imported), domestic manufacturing of medical devices under ‘Make in India’, enhancing
capacity of public undertakings for health security.
17. Involvement of Private sector: Capacity building for school health programmes, Skill
development programmes, CSR- awareness generation on various health issues, Mental
health care programmes, Disaster Management, Immunization, Disease surveillance,
Tissue and organ transplantation, Manufacture of Medical devices under Make in India
programme. As a Strategic purchaser, Government to Steward the investments for
priority areas.

NHP-2017 has been able to largely address the contextual requirements and the interests of
various stakeholders. On evaluation of the policy choices made in the NHP-2017, following are
the key takeaways:

1. Provides a roadmap for Health sector till 2025 with specific quantitative targets
including raising public investment to 2.5% of GDP.
2. Underlines the role of government in shaping overall health sector. Primary care mostly
by public health sector. Provision of Secondary and tertiary care by government.
Purchase of health care services from Private sector and NGOs to fill critical gaps.
3. Preventive and Promotive care with specific areas of action (tobacco and alcohol abuse;
safety in rail and road traffic; action against gender violence; reduced stress in
workplaces; reduction in indoor and outdoor air pollution). Focus on school health,
Yoga.

5
 4. Free Assured Primary care. Provision of Free treatment, Diagnosis and Emergency care
in public hospitals thus Progressively achieving Universal Health care and significant
reduction in Out-of-Pocket expenditures and catastrophic health expenditures.
5. Primary care: Predefined package of services, Adequate gatekeeping at primary level to
be developed.
6. Secondary and Tertiary care: Specialist services at District and sub district level, Expand
new medical colleges, AIIMS.
7. Focus on AYUSH: Co-location; promotion of Yoga; standardization, validation, and
quality control of AYUSH drugs.
8. Digital Health: Establish Health information networks; promote electronic medical
records.
9. Human resources: More medical colleges- expand District hospitals (DH’s), revision of
curriculum, common entrance and exit exams, More PG opportunities through National
board of exam at District hospitals, short trainings for specialist, Use of AYUSH/ Nurse
Practitioners with bridge course, Mid-level service providers, creation of public health
management cadre.
10. Drugs, Vaccines, Medical devices: Encourage domestic manufacture of Active
Pharmaceutical Ingredients (APIs) and medical devices, Vaccines production through
Public Sector Undertakings (PSU’s) for National health security, separate authority for
medical devices, improving quality of generic drugs.
11. Quality: National health standards organization for developing Standard Treatment
Guidelines, Medical tribunal for complaints regarding deficiency in services.

Bibliography
1. MoH&FW. (2017). National Health Policy. Retrieved September 2022, from
https://www.nhp.gov.in/nhpfiles/national_health_policy_2017.pdf

2. Reddy, K. S., & et.al. (2011). High Level Expert Group Report on Universal Health coverage for
India. Retrieved September 2022, from
https://niti.gov.in/planningcommission.gov.in/docs/reports/genrep/rep_uhc0812.pdf

3. ICMR, PHFI, & IHME. (2017). India: Health of the Nation's States — The India State-Level Disease
Burden Initiative. Retrieved September 2022, from
https://www.healthdata.org/sites/default/files/files/2017_India_State-
Level_Disease_Burden_Initiative_-_Full_Report%5B1%5D.pdf

4. PIB. (2017). PIB press release. Retrieved from https://pib.gov.in/newsite/PrintRelease.aspx?

relid=159380

*******