Coming after 15 years of the last such policy document, the National Health Policy (NHP) 2017 had raised many expectations. Given that this is the Narendra Modi government’s first such policy statement on health, many experts also hoped that it would announce a radical shift in the government’s approach towards healthcare. However, no such radical shift came about, and in many ways NHP 2017 continues to be an extension of the previous two such policies (1983 and 2002). NHP 2002 also spoke about “enhanced healthcare spending” and “restructuring of the national public health initiatives” to achieve more “equitable access” to healthcare. It is interesting to note that the stress in the 2017 document continues to be on these very aspects. In fact, NHP 2017 also dropped the proposal of making health a fundamental right.
Having said that, there are some positive moves. This is perhaps the first time such a national policy document has recognized the shifting epidemiology of diseases, and put special focus on lifestyle diseases such as cardiovascular disease, cancer, diabetes, along with communicable diseases. Another notable announcement is the intent to make primary healthcare services more comprehensive and widen their net. Only time will tell if the policy document is implemented in spirit on the ground or whether we will read a recap of these noble intents in another document 15 years down the line.
Meanwhile, let’s take a look at some of the positives and the disappointments of NHP 2017.
Despite several years of strong economic growth, government spending on healthcare in India has only managed to touch 1.15% of gross domestic product (GDP). Compared to this, India spends around 2.4% of its GDP on defence.
Global evidence on health spending shows that unless a country spends at least 5-6% of its GDP on health, with government expenditure being a major part, basic healthcare needs are seldom met. NHP 2002 had underlined the government’s intent to increase public expenditure on healthcare to 2-3% of GDP. NHP 2017 again lays down a modest target of reaching public health expenditure of 2.5% of GDP by 2025. The policy document also targets bringing about an increase in the use of public health facilities by 50% from current levels by 2025 and making two beds available per 1,000 population. At a health expenditure of 2.5% of GDP, these targets look unrealistic and unachievable, not to talk about the goal of universal healthcare. If a sustained economic growth doesn’t bring about basic healthcare and living benefits for millions, it indicates a country is clocking empty growth, without significant development. A target of at least 3% of GDP by 2025 would have been welcome.
NHP 2017 envisages widening the net of basic healthcare services delivered through primary healthcare. It proposes moving from a very selective to a comprehensive primary healthcare package which includes geriatric healthcare, palliative care and rehabilitative care services. The policy advocates allocating a major proportion (up to two-thirds or more) of resources to primary care, followed by secondary and tertiary care. It also aspires to provide at the district level most of the secondary care which is currently provided at a medical college hospital.
This shift in policy is a positive change as it takes a holistic view of the health problems being faced by all sections of people, including the rural populations which often depend on public healthcare facilities for all kinds of treatments. Widening the net of primary healthcare services will enable coverage of a larger section of people through these services, and reduce the burden on district hospitals. However, while pledging to allot a major chunk of resources to primary healthcare with a widened net is a welcome move, this should not mean that the government starts withdrawing from secondary and tertiary healthcare.
NHP 2017 makes repeated references to strategic partnerships, and this is the first time a policy document has so clearly recognized the role of the private sector in taking healthcare to all. NHP 2017 envisages private sector collaboration for strategic purchasing, capacity building, skill development programmes, awareness generation, and developing sustainable networks for communities to strengthen mental health services.
Instead of investing in setting up new hospitals, the government can enter into public private partnerships (PPPs) in every district and help private hospitals subsidize costs for people below the poverty line. This will take much less investment than opening new hospitals as it will utilize the existing infrastructure of hospitals. The goal of universal healthcare can be achieved faster and more comprehensively if the public and private sectors launch long-term partnerships with a vision to reach the last citizen.
By far the most notable change in the policy document is the recognition that India needs to turn attention to preventing the rising burden of lifestyle diseases. Apart from the unfinished agenda of addressing infectious diseases, nutritional deficiencies, the escalating epidemic of non-communicable diseases (NCDs) has become a major concern. NCDs contribute to 60% of the disease burden in India today. In this light, the clear guidelines on finding sustainable solutions to fight the growing burden of NCDs is a welcome approach.
Dharminder Nagar is managing director of Paras Healthcare.
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