The National Health Policy is a dramatic and welcome departure from similar past documents, insofar as it lays down a clear roadmap for primary and tertiary healthcare in the public sector. Its emphasis on revamping regulatory mechanisms, is especially welcome
The new National Health Policy (NHP) deserves appreciation. Not because it comes after a long wait, which tends to enhance its ‘value’ (a draft policy had been in the public domain since December 2014!), but because of its contents. The new policy lays down a clearer vision of the national Government, is quite comprehensive in its scope, lists various health goals to be achieved over next few years until 2025, and spells out policy choices and strategies to be pursued in achieving health goals. There are many good ideas articulated in the health policy. Here are some of them.
Strong emphasis on preventive and promotive care: Never before has this component received such strong emphasis as in this policy, and rightly so, as morbidity and mortality are not something given but are changeable by adopting healthy behaviour. Truly, a lot is in the hands of people themselves by way of adopting healthy lifestyle — doing regular physical exercise and eating a healthy diet. In keeping with Prime Minister Narendra Modi’s vision of a ‘new India’, the policy calls for creating a social movement for health.
On the role of Government in promotive and preventive care, the policy recognises the need to address social determinants of health (clean water and sanitation, nutrition, and so forth) as well as to improve the ‘environment for health’ through rail and road safety, workplace safety, prevention of gender violence and so forth. For this, the policy proposes to institutionalise inter-sectoral coordination at national and sub-national levels, and highlights the role of the public health cadre. Further, the policy proposes to expand the scope of interventions to respond to early childhood development delays/disability, adolescent and sexual health education, screening and counselling for primary and secondary prevention from common chronic illnesses, and so forth.
Strengthening public provision of care at all levels: The policy calls for reinforcing the trust of people in the public healthcare system by making the system efficient, affordable, patient-centric and effective. And how does it plan to achieve thisIJ At the primary level, it envisages a shift from selective to comprehensive package of services on assured basis by upgrading sub-centres into ‘health and wellness centres’ and re-orienting primary health centres to provide preventive, curative and rehabilitative services. For secondary and tertiary care, the policy proposes to ensure improved access and affordability to quality services through a combination of public hospitals and ‘strategic purchasing’ of care from the private sector, with preference given to not-for-profit providers.
One may wonder: What is different in the policy this time aroundIJ Haven’t these ideas been expressed in the public documents for a long time nowIJ
Well, the new policy suggests making a few ‘strategic shifts’ in the public healthcare system. For instance, it proposes to provide every family a health card that links them to a primary health facility and entitles them for a defined (expanded) package of services, including access to alternate systems of medicine (AYUSH).
For continuum of care, primary care would be linked to referral hospitals. Further, the operational costs for primary care would now be paid by way of reimbursement for the care provision on per capita basis with higher unit costs for more difficult areas (all other costs such as infrastructure development and maintenance, cost of personnel to continue on a fixed cost basis).
Similarly, in secondary and tertiary care, the policy suggests shifting to ‘strategic purchasing’ of services — paying hospitals on the basis of services they provide and not on the basis of financing inputs which is the current policy. These strategic shifts are expected to strengthen incentives and accountability mechanisms in the public healthcare delivery system. Besides, the policy acknowledges various gaps in the current public health delivery system and recognises what all it would take to plug those gaps. In the strengthening of public health facilities the Government proposes to place special emphasis on high priority districts.
Comprehensive regulation of the health sector: Health sector regulation has hitherto been a neglected function of the Government. For the first time, the health policy mentions about comprehensive regulation of the health sector. While the policy calls for strengthening regulatory functions across a range of areas such as food safety, drugs and medical devices, clinical trials, professional education, and so forth, it proposes to do so in a rational, transparent, consistent and effective manner.
Harnessing the power of digital technology: Recognising the role that technology can play in the health sector, the policy proposes to leverage the power of digital technology in system-strengthening as well as in providing continuum of care by establishing two-way systemic linkages between different levels of care. It proposes to set up a National Digital Health Authority to promote rational use of technology in the sector.
Greater clarity on the role of private sector: It seems the days of unbridled growth of the private healthcare providers are over. The policy commits to achieving highest professional standards, integrity and ethics in the entire health system — the public and the private system — and make the entire system accountable. The policy mentions that it would strive to influence the operation and growth of the private sector so as to ensure its alignment with public health goals. The policy also lists several areas in which the government would actively collaborate with the private sector.
Besides, the policy has many other good ideas, such as incentivising States to contribute to achieving the public health spending goal of 2.5 per cent of GDP by 2025, improving the supply of health personnel, attracting and retaining doctors in remote areas, moving away from using only population norm as the criteria for allocating public resources, making drugs and diagnostics and emergency care free for all in public health facilities, and so forth. These are all promising ideas that have the potential to change healthcare the health landscape in the country.
However, like any other public policy document, the NHP document is also not perfect. Yet, this is not the time to nitpick but to appreciate the good ideas that are contained in the document. Different arms of the Government now need to put their weight behind it, speak in one voice, and get down to implementing the policy in earnest. The Health Ministry is well advised to demonstrate quickly the policy in action, by getting at least a few States to take the lead in implementing it.
(The writer is a development economist, formerly with the Bill & Melinda Gates Foundation and the World Bank)