This is the second article on India’s National Health Policy 2017, and will describe the policy thrust.

Key Messages:

Policy Thrust

Ensuring adequate investment

By  raising public health expenditure to 2.5% of the GDP in a time bound manner.

Preventive and Promotive Health

By enhancing inter-sectoral coordination, adherence to Health in All Policies (HiAP) approach.

Coordinated action on seven priority areas for improving the environment for health proposed:

• The Swachh Bharat Abhiyan
• Balanced, healthy diets and regular exercises.
• Addressing tobacco, alcohol and substance abuse
• Yatri Suraksha – preventing deaths due to rail and road traffic accidents
• Nirbhaya Nari –action against gender violence
• Reduced stress and improved safety in the work place
• Reducing indoor and outdoor air pollution

In addition, Swasth Nagrik Abhiyan –a social movement for health.

‘Health Impact Assessment’ of existing and emerging policies, of key non-health departments that directly or indirectly impact health would be taken up.

Organization of Public Health Care Delivery

The policy proposes seven key policy shifts in organizing health care services

• In primary care – from selective care to assured comprehensive care with linkages to referral hospitals.

  Change from very selective to comprehensive primary health care package which includes geriatric health care, palliative care and rehabilitative care services.

  Facilities providing comprehensive primary care to be called ‘Health and Wellness Centres‘.

• In secondary and tertiary care – from an input oriented to an output based strategic purchasing.

  Aspires to provide most of the care provided in medical colleges at the district level.

  Basic secondary care services, such as caesarian section and neonatal care would be made available at the least at sub-divisional level in a cluster of few blocks. To achieve this, policy therefore aims:
  -To have at least 2 beds/1000 population distributed in such a way that it is accessible within golden hour rule.
  -Purchasing care from non-Government hospitals as a short term strategy till public systems are strengthened.
  -To expand the network of blood banks across the country to ensure improved access to safe blood.

• In public hospitals – from user fees & cost recovery to assured free drugs, diagnostic and emergency services to all

  The public hospitals would provide universal access to a progressively wide array of free drugs and diagnostics with suitable leeway to the States to suit their context.

  The policy seeks to eliminate the risks of inappropriate treatment by maintaining adequate standards of diagnosis and treatment.

  Policy recognizes the need for an information system with comprehensive data on availability and utilization of services not only in public hospitals but also in non-government sector hospitals.

• In infrastructure and human resource development – from normative approach to targeted approach to reach under-serviced areas

  Financing for additional infrastructure or human resources would be based on needs of outpatient and inpatient attendance and utilization of key services in a measurable manner.

• In urban health – from token interventions to on-scale assured interventions, to organize Primary Health Care delivery and referral support for urban poor.

  Collaboration with other sectors to address wider determinants of urban health is advocated.

  Special focus on vulnerable populations
  
  Prioritize utilization of AYUSH personnel in urban health care

  An important focus area of the urban health policy will be achieving convergence among the wider determinants of health – air pollution, better solid waste management, water quality, occupational safety, road safety, housing, vector control, and reduction of violence and urban stress.

National Health Programmes

Integration with health systems for programme effectiveness and in turn contributing to strengthening of health systems for efficiency.

Strengthening of general health systems to prevent and manage maternal complications, to ensure continuity of care and emergency services for maternal health.

Improved home based and facility based management of sick newborns.

Pre-emptive care of children and adolescents.

School health programmes as a major focus area as also health and hygiene being made a part of the school curriculum.

“The scope of Reproductive and Sexual Health should be expanded to address issues like inadequate calorie intake, nutrition status and psychological problems interalia linked to misuse of technology, etc. ”

Screening for multiple micronutrient deficiencies is advocated.

The focus will be to build upon the success of Mission Indradhanush and strengthen it.

For Integrated Disease Surveillance Programme, the policy advocates the need for districts to respond to the communicable disease priorities of their locality.

The policy acknowledges HIV and TB co infection and increased incidence of drug resistant tuberculosis as key challenges in control of Tuberculosis. The policy calls for more active case detection, with a greater involvement of private sector supplemented by preventive and promotive action in the workplace and in living conditions.

The policy recommends focused interventions on the high risk communities for HIV/AIDS (MSM, Transgender, FSW, etc.) and prioritized geographies.

Leprosy: The proportion of grade-2 disability amongst new cases will become the measure of community awareness and health systems capacity.

The policy recommends to set-up a National Institute of Chronic Diseases including Trauma, to generate evidence for adopting cost effective approaches and to showcase best practices.

It emphasizes developing protocol for mainstreaming AYUSH as an integrated medical care.

Mental Health:  simultaneous action on the following fronts:
-Increase creation of specialists through public financing and develop special rules to give preference to those willing to work in public systems.
-Create network of community members to provide psycho-social support to strengthen mental health services at primary level facilities and
-Leverage digital technology in a context where access to qualified psychiatrists is difficult.

Population stabilization: move away from camp based services, to a situation where these services are available on any day of the week or at least on a fixed day.

Increase the proportion of male sterilization from less than 5% currently, to at least 30% and if possible much higher.

Useful Links:

Link to the National Health Policy 2017 policy document:

http://www.mohfw.nic.in/showfile.php?lid=4275

Link to WHO document describing Health in All Policies (HiAP):

Click to access 130509_hiap_framework_for_country_action_draft.pdf