Open Forum
New Delhi, 20 April 2017
Focus on Wellness
NATIONAL HEALTH
POLICY 2017
By Dr S Saraswathi
(Former Director, ICSSR, New
Delhi)
After a gap of 15 years, the new National Health Policy has
been announced which seeks to transform healthcare in India. In the
context of much publicised Obamacare in the US (popular label for the Patient
Protection and Affordable Care Act), people of India may be tempted to look forward to a new era of healthcare that
can be named as “Modicare” that will lessen one of their worst worries of daily life.
The policy shifts the focus from “sick care” to “wellness” –
a concept well known in indigenous systems of medicine in India. It
brings in inclusive partnership of medical, para-medical, and non-medical teams
in a joint endeavour. Good health and well-being is listed as Goal 3 in the
Sustainable Development Goals to be reached before 2030. It is supported by
another included as Goal 6 to ensure clean water and sanitation.
The policy seeks to strengthen health systems through action
in four directions – moving towards universal coverage, re-orienting
conventional care towards people-oriented care, integrating health in all
policies, and ensuring more inclusive health governance. The complexity of the
problem cannot be denied.
The WHO Report of 2016 has depicted India as one of the worst performing regions in
health after Africa. India’s rank in
any health related matter – nutrition, birth disorders, infant and maternal
mortality, air-borne disease, etc, is at the bottom. The Global Nutrition Report for 2016 ranks India at 114
among 132 countries with the incidence of stunting at 38.7 per cent. It is even
reported that India
bears one-fifth of world’s disease burden and fast becoming the centre of
non-communicable diseases like diabetes and high blood pressure.
Policy-makers, bound to address the situation, cannot remain
satisfied with adopting a policy as a ritual. Policies must realistically
approach the problem and show direction for action. The new Health Policy makes
an ambitious proposal to provide “assured health services to all” in the
country.
Important targets fixed in this policy include increasing
life expectancy from the current 67.5 years to 70 years by 2025; reducing total
fertility rate to 2.1 at national and sub-national levels; reducing mortality
rate of children under 5 years to 23 per 1,000 by 2025 from 40 in 2013, and
maternal mortality rate to 100 by 2020 from 167 in 2013; and neo-natal
mortality to 16 and “still birth rate’ to single digit by 2025.
The Universal Declaration of Human Rights of the UNO (1948)
includes health as a human right. India was also keen on declaring
health as a fundamental right in 2015, and also considered enacting a National
Health Rights Act, but in the course of debating the issue dropped it as not
feasible. With totally inadequate infrastructure, no government would be able
to grant and guarantee such a fundamental right. However, the Supreme Court has
held that the right to health is inherent in the right to life guaranteed under
fundamental rights. A Directive Principle also enjoins the government to regard
raising the standard of nutrition and the standard of living of its people and
the improvement of public health as among its primary duties.
The report of the WHO on the “Health Workforce in India” released in 2016 reveals that the density
of doctors of all schools is 80 per one lakh population compared to 130 in China. Using
the data of 2001 census, it says that 31 per cent of those who claimed to be
allopathic doctors had only secondary level education and 57 per cent had no
medical qualification. Situation was found much worse in rural India where
only 18.8 per cent of allopathic doctors had medical qualification. On the
whole, 42.7 per cent of allopathic doctors, 60.1 per cent of ayurvedic doctors,
41.8 per cent of homeopathy doctors, 45.8 per cent of unani doctors, and 42.3
per cent dentists had medical qualifications.
In India,
as in many developing countries, information on human resources in the health
sectors is incomplete and unreliable. Records showing the presence of
“unqualified doctors” practising the profession as well as huge shortage of
medical personnel, the policy faces a huge dilemma. We cannot bat for fakes and quacks, but
cannot overlook the positive contributions made by a number of technically
unqualified practitioners, who are available and approachable and within means
doing tremendous healthcare service.
We have to think of matching our needs with our human power
resources. There is need to utilise the knowledge and experience of
“unqualified doctors” in the proposed “wellness” service. For, wellness is a
much wider responsibility than cure of diseases in which wider participation of
people from different walks of life is possible and desirable. In promotional
and preventive aspects of healthcare, there is need for dedicated workforce
with background in health related work. The policy has rightly adopted
principles of professionalism, integrity, and ethics in health service.
The policy envisages three-dimensional integration of AYUSH
systems, that is, Ayurveda, Yoga, Unani, Siddha, and Homeopathy -- encompassing
cross referrals, co-location, and integrative practices across systems of
medicines. This needs to be pursued in right earnest as already, there is a
strong tendency among people to consult different schools of medicine and make
the best use of them.
Unhygienic atmosphere and pollution, lack of proper and
adequate tools, ill-paid and over-worked nurses are common problems everywhere.
The policy has responded to the situation by going beyond the boundaries of
health systems and addressing the social determinants of health and the interaction
between health and other sectors.
Public health expenditure is set to increase from the
present 1.4 per cent of the GDP to 2.5 per cent with two-thirds of the amount
going to primary healthcare. This is much below the figure recommended earlier
in the draft policy which calculated that public expenditure of 4 to 5 per cent
of the GDP was required to meet the millennium development goals.
It is much lower than the expenditure of many countries and
far below 6 per cent recommended by the WHO. Most of these resources are to be
spent on primary healthcare. Per capita expenditure on health was estimated by
the WHO as $267 in 2014 – a figure below even that of Indonesia and Sri Lanka not to mention European
countries spending several thousands.
The new policy seeks to reach everyone in a comprehensive
integrated way to move towards wellness. It aims at achieving universal health
coverage and delivery of quality healthcare services to all at affordable cost.
It promises a comprehensive package that will include care for non-communicable
diseases (NCDs), geriatric healthcare, mental health, palliative care, and
rehabilitative care services.
The policy proposes to introduce a system of health card for
every family to provide access to primary care facility and to a set package of
services throughout the country. Patient-centric approach is recommended. Further,
it proposes free diagnostics, free drugs, free emergency and essential care
services in all public hospitals.
The more we examine our requirements, and the actual
situation obtaining in the country, we cannot but admit that conditions are
going beyond control. Health is a recurring problem and also multiplies with
time. Without firm commitment on the part of health providers, health managers,
hospital staff, and pharmaceutical industry and trade, policies will not be
sufficient. ---INFA
(Copyright,
India News & Feature Alliance)
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