National Health Policy 2017

        The government of India has recently announced a new 'National Health Policy'. This is the third such instance after 1983 and 2002. Health, along with education and food security is one of the three main pillars for any country. India with its huge population of 1.3 billion represents around one-sixth of world's population. With such huge representation and promising growth, many experts see 21st century as the century of India and China. With huge power, also comes, huge responsibility. Economic Survey (ES) 2016-17, elucidates on how India's demographic dividend might recede sooner than expected. China, with its one child policy was successfully able to curb the population growth. The cracks in this policy appeared, soon after, with rapidly aging population. The Asian giant has since, shown signs of slowing economic growth triggering currency devaluation led trade power and dwindling global growth scenario. This may be attributed to many direct and indirect factors including population aging. Other countries like Japan & many in Europe are already facing repercussions of population decline.  India, on the other hand has emerged as the sweet spot in the abysmal global growth story. In India too, average age has already started to shift towards the higher end of spectrum in some states (ES). The national average age is expected to show inflection within a decade. Thus, one may conclude that, India has a bright road ahead, provided it learns from the mistake of its counterparts,

        Health (Right to Life) is a fundamental right, but health care is part of Directive Principles of State Policy in our constitution, Health care is a state subject with center providing for regulatory mechanism, policy guidelines & additional funds to needy states. Limited financial resources at the time of independence deterred the constitution makers to make health care a fundamental right. It is saddening that the vast amount of population is the country is still without health care net. India recognized the need of public sector heath care pretty early. The plan was laid out in the first planning commission based on the recommendation of Bhore Commission (1943). The numbers suggest a mixed scenario of the progress, seven decades after independence. The life expectancy at birth (LE) had a meteoric rise from 32 to 67.5. The infant mortality rate (IMR) declined from 150(1947) to 50 but still remains among the highest in the world. Small Pox has been eliminated and prevalence rates of Leprocy, TB, Malaria have gone down. Polio immunization program has received much accolades worldwide. The number of hospitals and dispensaries have more than quadrapuled although their accessibility in rural centres remains a source a worry. The sanitation & bio-waste disposal mechanism at hospitals have been dismal, but the Swachh Bharat Mission (SBM, since 2014) has been a positive change, Institutions providing health education have spread resulting in increased manpower. China, with the communist party at helm after the civil war in 1949 has shown much better improvement. India's transformation with people's representation & participation remains equally laudable,

        Like many countries, Indian healthcare system is divided into primary, secondary & tertiary. Since independence, The primary sector has received maximum public sector intervention among three. In the purview of rampant poverty that independent India inherited, primary sector required maximum attention.  A high proportion of population dwelled in rural areas, and communicable diseases had a huge share in total disease profile. A lot has changed since then especially in the last two decades. The disease profile has had an epidemiological transition, seen in many developed countries. The share of non-communicable diseases like hypertension, diabetes & cancer has risen, whereas others like TB have mutated in more severe form of MDR-TB & TB in HIV infected persons. With the rising middle class, demand of motorized vehicle, ACs, electric generators have increased. The Delhi smog, Bengaluru lake fires, Chennai floods have raised alarms. Arsenic impurities in ground water, especially in the regions of Ganga basin has worried experts. The rising number of breathing related ailments & deaths in Delhi exemplifies the health effects of pollution. The knee-jerk policies like odd-even show how grave the situation is! This necessitates the need for a new policy to remove any mismatch in resource allocation and coming after a gap of 14 years, the National Health Policy 2017 provides a breath of fresh air,

        India spend 8% of its GDP in healthcare compared to 16%-18% of OECD countries, The share of central government is only 1.5% of GDP. This inadvertently leaves a huge burden of health financing on individuals. This catastrophic out-of-pocket expenditure has pushed many families into poverty. India cannot afford this at this moment of its history. It sabotages the efforts of different poverty alleviation programs. With continuous economic growth and efforts of govt. to curb black money through Jan-dhan, Aadhar & Mobile (JAM) the fiscal capacity is bound to rise. Considering this, the decision to raise health care expenditure to 2.5% of GDP is a welcome step. The intention is to reduce out-of-pocket expenditures by burden sharing with the public sector & increasing insurance net. Apart from this many quantitative targets like increasing LE to 70 by 2025, reducing IMR,MMR shows India's commitment to its mothers and children. When it comes to health, everything counts! Thus, the impetus is also on the cross-ministerial schemes on improving healthcare. Sanitation (SBM) & pollution control (Namami Gange, International Solar Alliance) are expected to have long lasting effects. This will help India to fulfill its nationally determined contributions of Paris climate treaty as well as achieving targets set in Agenda2030 of UN.

        A shift in focus from selective to comprehensive health care in primary sector is called for. Thus, all aspects of healthcare i.e. preventive, palliative & curative will be improved. India's growth story is mainly due to its service sector unlike China's growth impetus of last two decades coming from labor oriented manufacturing sector. Thus, demographic transition might not be this hard for India economically, but it will have indirect effects. A large number of old-age population requires more health care compared to younger one. Thus a shift from curative to preventive care is need of hour. Besides, the strategy also helps in countering non-communicable disease like hypertension, diabetes etc. Health education & yoga programs will be encouraged in schools to spread awareness. The sanitation in schools will be linked to SBM for sensitization through participation. Strategic buying of resources in secondary & tertiary sector will share the financial burden and address the demand-research mismatch in the private sectors in the short term. The long term goal will be to establish a wide public sector infrastructure in secondary health care as well. The geographic equity will be considered for the location of hospitals along with population equity. The tribal population of 100 million must not be alienated and all planning will be based on urban, rural & tribal areas. Diseases like HIV will get specific impetus with the 90:90:90 target. Doctors will be encouraged to take rural postings through appropriate incentives. Tobacco & alcohol use will be gradually reduced. Free emergency care will be provided to all at public hospitals. Infrastructure will be improved to provide emergency care within the golden hour rule. AYUSH systems (Ayurveda, Yoga, Unani, Siddha & Homeopathy) will be integrated with the public health centres and schemes like ASHA to mainstream their usage. The govt. will continue its commitment of providing free medicines at hospitals and dispensaries.

        Thus, NHP 2017 touches all the policy levers at the govt.'s disposal with the emphasis on 'Health for all' in primary health care, and burden sharing to reduce the health costs to manageable levels in secondary health care. The policy measures have been welcomed by the experts & individuals alike barring some criticisms regarding the 'Right to Health Care' not being recognized as fundamental right. If at all its shows Indian democracy in bright colors, with people in constant conversation with their representatives. If the vision set out in the policy is turned into a mission during its implementation, it will go a long way to enhance the prosperity and well-being of one-sixth of humanity.