National Health Policy: Implementation remains the key

Half way into its current tenure, the BJP government has fulfilled the key health-related promise it had announced in its election manifesto --a national health policy (NHP).

Half way into its current tenure, the BJP government has fulfilled the key health-related promise it had announced in its election manifesto --a national health policy (NHP).

NHP 2017 also integrates the pre-poll health service vision of the party (BJP's 2014 manifesto document mentions health 58 times) with the government's agenda, aspiring "to achieve the highest possible level of good health and well-being through a preventive and promotive healthcare orientation in all developmental policies, and to achieve universal access to good quality healthcare services without anyone having to face financial hardship as a consequence".

Earlier, the manifesto had talked about empowering each and every Indian through health…by creating an enabling ecosystem of equal opportunity... with special focus on children, tribals, senior citizens and so on.

While political parties can get away by selling dreams in their manifestos, government policies are expected to be rational, specific and if possible, time-bound. And the NHP is not a big disappointment on that front. Unlike the manifesto, which hardly mentioned the dependency the government will have on the 'private sector' to fulfil its promises, the policy talks about a scenario where problems and solutions are looked at holistically, with the private sector acting as a strategic partner. It also emphasises the need for increased public spend, thereby proposing to increase public health expenditure to 2.5 per cent of the GDP from the current 1.4 per cent in a time-bound manner. In order to provide access and financial protection at secondary- and tertiary-care levels, the policy proposes free medicine, free diagnostics and free emergency-care services in all public hospitals.

On the role of the private sector, the policy advocates "a positive and proactive engagement for critical gap filling". It envisages private sector collaborations for strategic purchase, capacity building, skill development programmes, awareness generation, developing sustainable networks for community to strengthen mental health services and disaster management. The policy also advocates financial and other incentives for encouraging private sector participation.

According to Dr Kenneth E. Thorpe, who heads a health policy advocacy group called Partnership to Fight Chronic Disease, "The announcement is a clear indication of the government's long-term commitment to find sustainable solutions to address the growing burden of non-communicable diseases (NCDs) and a recognition of the socio-economic impact of NCDs on the country."

The policy assigns specific quantitative targets aimed at reduction of disease prevalence/incidence, to ensure health status and programme impact, health system performance and system strengthening. It also seeks to strengthen health and surveillance systems, and establish registries for diseases of public health importance, by 2020. It further aims to align other policies for medical devices and equipment with public health goals.

Among other things, the BJP manifesto had talked about the formation of a National Health Assurance Mission, with a clear mandate to provide universal healthcare. It called for a review of the role of various professional regulatory bodies in healthcare and promised to consider setting up an overarching lean body for healthcare. It also included modernising government hospitals, upgrading infrastructure technologies, reorganising the health ministry to converge various departments dealing in healthcare, food and nutrition, and pharmaceuticals, more medical and paramedical colleges and AIIMS-like institutes in every state--the list was long.

One specific proposal lifted from the manifesto is the thrust towards integrated medicine. The NHP recommends mainstreaming different health systems and envisages better access to AYUSH (ayurveda, yoga, unani, sidha and homoeopathy) remedies through colocation in public facilities.

However, it will be wrong to say that the NHP is BJP's first poll promise to be fulfilled. Swachh Bharat and other sanitation missions, which are already work-in-progress, are also part of its health-related promises.

The implementation of the policy is the next, and the most important step now.