Na­tional Health Pol­icy, 2017

Game-changer for the Ail­ing Na­tion

Libertatem Magazine - - Front Page - By Vaib­hav Sharma

The Union Govern­ment has re­cently launched the Na­tional Health Pol­icy, 2017 which is go­ing to guide the na­tional health sys­tem in the com­ing days. The present pol­icy is a re­vi­sion of the 2002 Health Pol­icy which at­tempted to uni­ver­salise the Na­tional Ru­ral Health Mis­sion in or­der to pro­vide ba­sic health­care even in the re­motest ar­eas of the coun­try. The 2002 Pol­icy was suc­cess­ful in estab­lish­ing an ex­ten­sive net­work of Pri­mary Health Cen­tres/ Ru­ral Health Cen­tres to es­tab­lish the pri­mary level med­i­cal in­sti­tu­tions and to in­cul­cate a habit of for­mal med­i­cal sys­tem in the ru­ral ar­eas. The pre­cur­sor to the 2017 Pol­icy was em­bed­ded in the Bud­get Speech of the Fi­nance Min­is­ter which high­lighted the as­pects of uni­ver­sal­i­sa­tion of heath­care and ac­knowl­edged the need of ‘strong state in­ter­ven­tion’ to up­lift the ail­ing health­care sys­tem of the na­tion.

Back­drop of the Na­tional Heath Pol­icy 2017

The 2017 Pol­icy is a suc­ces­sor to the pre­vi­ous pol­icy guide­lines in the form of Na­tional Health Pol­icy of

1983 and Na­tional Health Pol­icy of 2002 which worked within the am­bit of the Five Year Plans to cater to the spe­cific tar­get au­di­ence for im­prov­ing the health in­fra­struc­ture across the na­tion. Along with the Na­tional Health Pol­icy of 2017, the Min­istry of Health and Fam­ily Wel­fare, Govern­ment of In­dia also re­leased a Re­port ti­tled ‘Sit­u­a­tion Analy­ses’ as a back­ground re­search for the novel pol­icy. The said re­port dis­cussed the achieve­ments of the 2002 Pol­icy in the light of the Mil­len­nium De­vel­op­ment Goals (MDGS) with re­spect to the ma­ter­nal mor­tal­ity and mor­tal­ity rate un­der 5 years of age. The tar­get of MDG-5 for the re­duc­tion of the Ma­ter­nal Mor­tal­ity Ra­tio (MMR) was to achieve a drop of three quar­ters be­tween 1990 and 2015. From the abysmal MMR of 556 in 1991, the na­tion was able to re­duce it sig­nif­i­cantly to 167 for the year 2011-12. For the un­der-5 mor­tal­ity rate (U5MR), the MDG tar­get is 42. The progress of the na­tion in this as­pect was 126 in 1990 to the ame­lio­rated to 49 in 2013. But the progress in the seg­ments of de­cline in birth-rate and neona­tal mor­tal­ity has been dis­ap­point­ing. There is also a wide state-level dis­par­ity with U5MR for As­sam be­ing 73 and an im­pres­sive 4 for Ker­ala. The na­tion has also not been able to achieve a head­way in the re­duc­tion of AIDS, malaria, etc. which con­tinue to loom as death threats for a large seg­ment of the poor pop­u­la­tion. The re­port stated that the na­tion is un­der­go­ing a rapid health tran­si­tion in the present times. The need of the hour is to aug­ment the re­sources in tar­geted ar­eas with spe­cific pol­icy guide­lines to con­tinue to tread the path of re­duc­ing the high in­ci­dence of com­mu­ni­ca­ble dis­eases in the na­tion. The need of the 2017 pol­icy in­creases in the wake of a resur­gent health in­dus­try de­vel­op­ment in the na­tion with a dou­ble digit growth rate. The clearer ef­forts to sup­ple­ment the in­creas­ing costs of even the pri­mary health care for the vul­ner­a­ble sec­tion of the pop­u­la­tion has led the pol­icy mak­ers to for­age a new pol­icy.

Salient Fea­tures of Na­tional Health Pol­icy 2017

The aim of the Na­tional Heath Pol­icy of 2017 is to in­form, strengthen and pri­ori­tise the role of the govern­ment in re­vamp­ing the health care sys­tem of the na­tion. It recog­nises the spe­cialised role of a large de­ci­sive in­vest­ment to be made to the ba­sic in­fra­struc­ture for re­duc­ing the num­ber of com­mu­ni­ca­ble dis­eases and for aid­ing the early screen­ing and di­ag­no­sis process. The aim is to pro­vide for uni­ver­sal ac­cess to health care by in­creas­ing

the qual­ity and in­fra­struc­ture and low­er­ing the cost of treat­ment. The pol­icy lays stress on the work ethics, pro­fes­sion­al­ism and in­tegrity in the health­care sec­tor for im­prov­ing the treat­ment of pa­tients. It high­lights the need for a ‘Pa­tient Cen­tred’ qual­ity of care and the revered goal of at­tain­ing ac­count­abil­ity in this piv­otal sec­tor.

It em­pha­sises on the goal of achiev­ing ‘Uni­ver­sal Health Cov­er­age’ across the mam­moth pop­u­la­tion by im­prov­ing the ac­cess, af­ford­abil­ity and ca­pac­ity build­ing of the sec­ondary and ter­tiary level in­sti­tu­tions. The aim is also to re­in­force the trust of the peo­ple in the pub­lic health sys­tem by up­grad­ing the qual­ity and de­liv­ery rate of ser­vices. It sets the tar­get to achieve 90% im­mu­ni­sa­tion lev­els for the new born ba­bies by the year 2025. It seeks to in­crease the util­i­sa­tion of pub­lic health­care sys­tems by 50% in the year 2025.

It ac­cepted the need to es­tab­lish the ‘State Pub­lic Health­care Cadre’ for bet­ter in­sti­tu­tional ac­count­abil­ity. It also moots the idea for ‘Na­tional Heath Stan­dards Or­gan­i­sa­tion’ to cater to the task of re­view­ing stan­dards for both pri­vate as well as pub­lic health­care seg­ments. It ad­vo­cates ‘Med­i­cal and Paramed­i­cal ed­u­ca­tion’ for bet­ter­ing the ser­vice de­liv­ery of the health sec­tor. One of the most ac­com­plished sug­ges­tions has been the recog­ni­tion of the idea that the tra­di­tional In­dian sys­tems of med­i­cal care ‘AYUSH’ needs to be in­te­grated with re­search pro­cesses and train­ing pro­grammes for in­creas­ing the pa­tient cov­er­age ar­eas.

Fo­cus on Men­tal Health

The is­sue of men­tal health­care in In­dia has been one of the most ne­glected ar­eas in the med­i­cal field. It is as­so­ci­ated with taboos and dog­mas with ut­ter ig­no­rance es­pe­cially in the ru­ral ar­eas. Peo­ple pre­fer not to dis­close their ail­ments for the fear of stig­ma­ti­sa­tion in the so­ci­ety. Even the ba­sic un­der­stand­ing and in­fra­struc­ture in the pub­lic health sec­tor is abysmal. But the 2017 Pol­icy at­tempts to achieve a paradigm shift in this as­pect. It is for the first time that the Na­tional Health Pol­icy of 2017 recog­nised the ‘Rights of Men­tally

Ill Per­sons’ to seek ac­cess to health­care and treat­ment in the govern­ment hos­pi­tals for the same. It also en­vi­sions to pro­vide pro­tec­tion from the in­hu­mane treat­ment for the men­tally chal­lenged in­di­vid­u­als. It in­tro­duces the ‘nom­i­nee rep­re­sen­ta­tive’ for the treat­ment of the men­tally ill pa­tients and al­lows in­formed choices to be made on be­half of the pa­tient dur­ing the course of their treat­ment. It puts an obli­ga­tion on the Cen­tre and State level med­i­cal in­sti­tu­tions to main­tain a list of the men­tally ill pa­tients un­der­go­ing treat­ment and to pre­pare a reg­is­ter of the pro­fes­sion­ally qual­i­fied per­son­nel to pro­vide health­care ser­vices.

The re­cently passed Men­tal Health­care Bill, 2016 pro­vides statu­tory right to the men­tally chal­lenged in the form of ‘Right to ac­cess men­tal health­care and treat­ment’. It also de­crim­i­nalises the ‘at­tempt to sui­cide’ which was ear­lier pun­ish­able un­der Sec­tion 309 of the In­dian Pe­nal Code, 1860. It also bans the use of ‘Elec­tro Con­vul­sive Ther­apy’ for the men­tally chal­lenged per­sons with the only ex­cep­tion be­ing the case of mus­cle re­lax­ants.

La­cu­nae of the 2017 Pol­icy

The Na­tional Heath pol­icy of 2017 is un­doubt­edly well in­ten­tioned to re­vamp the ail­ing health­care sys­tem of the na­tion, but it doesn’t pro­vide any con­clu­sive mea­sures for the same. Although it fo­cusses on at­tain­ing ‘Uni­ver­sal Health­care Ac­cess’, it would re­quire huge bud­getary al­lo­ca­tions and po­lit­i­cal will to ac­com­plish its ob­jec­tives. The same is the

case with ‘Na­tional Health Stan­dards Or­gan­i­sa­tions’ which is in­tro­duced to be a game changer to en­sure qual­ity health­care across the na­tion, but the process of estab­lish­ment and work­ing has not been spec­i­fied therein. It is per­ti­nent to note that the Cen­tral Govern­ment in the year 2010 en­acted the Clin­i­cal Ed­u­ca­tion Act, 2010 for the clin­i­cal stan­dards of health in­sti­tu­tions, but com­pli­ance with the same has been lack­lus­tre. It also doesn’t recog­nise ‘Health as a Jus­ti­cia­ble Right’ in or­der to re­duce the huge bur­den on the govern­ment ex­che­quer. The fo­cus sup­ple­mented to ‘AYUSH’ is com­mend­able, but the pol­icy is not able to dif­fer­en­ti­ate it from the Western med­i­cal sys­tems and fails to pro­vide clear di­rec­tions for the same.

Sug­ges­tions for 2017 Pol­icy

The Na­tional Health Pol­icy of 2017 is a brave at­tempt to es­tab­lish the role of state in­ter­ven­tion to achieve the goal of ‘Uni­ver­sal Health­care Ac­cess’. But the road for the achieve­ment of this cher­ished tar­get will be long and treach­er­ous given the present state of poor ru­ral health­care in­fra­struc­ture. The fo­cus on ‘pro­fes­sion­al­ism and work ethics’ for this novel pro­fes­sion is ad­mirable. It is worth quot­ing that last month the Doc­tors and Staff mem­bers at AIIMS, New Delhi show­cased great work ethics and pro­fes­sional com­mit­ment when they sab­o­taged an at­tempt of politi­cians and power hun­gry bu­reau­crats for estab­lish­ing a ‘VIP OPD Counter’ at AIIMS. It is only due to the united op­po­si­tion of the doc­tors, pro­fes­sors and staff mem­bers of AIIMS that such an un­scrupu­lous at­tempt to op­pose the ba­sic ‘Right to Health’ of the or­di­nary cit­i­zens of the na­tions in the grab of ob­nox­ious VIP Cul­ture is in­ca­pac­i­tated. The em­pha­sis on the men­tal health­care also needs ca­pac­ity build­ing with the present bed­ding ca­pac­ity of nadir level of 0.2 beds/lakh of pop­u­la­tion. There is a dearth of 4500 psy­chi­atrics and 12500 staff mem­bers to cater to the needs of the men­tally chal­lenged pa­tients. The estab­lish­ment of ‘Men­tal Health Re­view Com­mis­sion’ un­der the Men­tal Health­care Bill, 2016 is an at­tempt to stream­line the men­tal health­care de­liv­ery. The fact that the Na­tional Health Pol­icy of 2017 sets the time bound tar­gets for ac­cess cov­er­age and im­mu­niza­tion lev­els is ap­pre­cia­ble. The need is to ame­lio­rate the poor ef­fi­ciency of the health­care sec­tor by putting the ‘Clin­i­cal Es­tab­lish­ments’ in the Con­cur­rent List un­der the Sev­enth Sched­ule to the Con­sti­tu­tion of In­dia. If the ‘Na­tional Health Stan­dards Or­gan­i­sa­tion’ is able to func­tion ef­fec­tively, then the long cher­ished dream of pro­vid­ing the Health­care ser­vices even to the poor­est sec­tions of the pop­u­la­tion could come true. It is hoped that the Na­tional Heath Pol­icy of 2017 is able to achieve its tar­geted goals for build­ing a health­ier and stronger na­tion with re­duced bur­den of cur­ing com­mu­ni­ca­ble dis­eases and im­prov­ing mor­tal­ity rates.

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