National Health Policy

A welcome move in the healthcare industry

Suresh Ramu,  CEO, Cytecare Hospitals

The revision in the national health policy is a landmark event as this has been revised in India after 14 years. The policy highlights the increased spend in healthcare which will go up to 2.5 per cent of GDP, hopefully in the next 5 to 10 years. The policy also recognises that there are certain types of cancers which can be addressed early through screenings.

A health policy is a structured framework of a set of decisions and plan of action undertaken to achieve specific healthcare goals within the society. These health policies help the government to implement and monitor various health services across the country to ensure basic health benefits reach citizens across all demographic and economic class. While there are smaller health policies initiated on a need based approach, there is a master nation health policy in place which is essential in defining a country's vision, priorities, budgetary decisions and course of action for improving and maintaining the health of its people. Most countries have been using the development of national health policies, strategies, and plans for decades to give direction and coherence to their efforts to improve health.

Such a master health plan is paramount in India, especially due to the fragmented socio-economic structure and lack of education & awareness among the large pool of the population in the rural and small towns. While technology and infrastructure is slowly connecting these remote regions to development and better standards of living, having easy access to affordable and quality healthcare services is still an arduous task.

The National Health Policy was endorsed by the Parliament of India in 1983, updated in 2002 and recently it was largely amended in March this year, with the focus to provide healthcare to all, in light of the emerging challenges arising from the ever-changing socio-economic and epidemiological situation in the country. The amendment in the national health policy is a landmark event as it has been revised after 14 years and the key goals of the policy are expanding access to medical facilities, providing affordable treatment to the masses and improving the quality of medical services. With these three main objectives, this policy system encapsulates preventative methods without bounding anyone by financial shortcomings. This shows that our country is focused on creating a healthier India, as the PMO echoed the same sentiment by stating that the National Health policy marks a historic moment in their endeavour to create a healthy India where everyone has access to quality healthcare.

The policy highlights the increase in expenditure in the healthcare sector which is expected to go up by 2.5 per cent of GDP in the next 5 to 10 years. The vision of the policy is to bring about a positive and noticeable social, economic and technological change to strengthen India’s healthcare system. It involves reorientation of public hospitals where there is a cost recovery approach, access to free drugs and emergency services for people from all strata of the society.

The NHP passed this year is standing boldly on four pillars – clarity in objective, clarity in design, clarity in financing and clarity in incentives. The policy also puts light on investment and action in school health-by incorporating health education as part of the curriculum. Broadly the policy envisages providing assured comprehensive primary healthcare and indicates important change for major NCDs [non-communicable diseases], mental health, geriatric healthcare, palliative care and rehabilitative care services. In addition, the policy will look at offering free drugs, free diagnostics and free emergency and essential healthcare services in all public hospitals in a bid to provide access and financial protection. It also looks at a three-dimensional integration of AYUSH systems encompassing cross referrals, co-location and integrative practices across systems of medicines and also will develop their grievance redressal mechanism.

The ‘giving back to society’ initiative in the new Health Policy extends a helping hand by providing voluntary service in rural and under-served areas supported by recognised healthcare professionals. It believes in extensive deployment of digital tools for improving the efficiency and outcome of the healthcare system and proposes establishment of National Digital Health Authority (NDHA) to regulate, develop and deploy digital health across the country.

The Key Principles of This Policy are:

Professionalism, Integrity and Ethics that are to be to be maintained in the entire system of healthcare delivery in the country, supported by a credible, transparent and responsible regulatory environment

Equity: It would mean curtailing inequality on account of gender, poverty, caste, disability, other forms of social exclusion and geographical barriers. Pooling financial resources for the poor will also come under this

Affordability: Access to free drugs and emergency health services, making medical equipment cheap is also one of the key principles

Universality: This includes stoppage of exclusions on social, economic or on grounds of current health status Patient Centered & Quality of  Care:  Giving dignity and maintaining confidentiality on certain issues like gender sensitive, effective, safe, and convenient healthcare services is priority this time

Accountability: Transparent decision building and making healthcare systems both in public and private sectors corruption free is one most important reason of revision of the policy

Inclusive Partnerships: A multi-stakeholder  approach with partnership & participation of all non-health ministries and communities. This approach would include partnerships with academic institutions, not for profit agencies, and healthcare industry as well

Pluralism: AYUSH care providers are small extensions of the Government where patients get themselves treated for speedy process encouraging home and community based practices and thus meeting the national health goals and objectives through integrative practices

Decentralisation: With practical considerations and institutional capacity decentralisation of decision making to a level is a prudent principle of the policy.

Dynamism and Adaptiveness: Based on new knowledge that is from national and international knowledge partners there is a constant need of improving dynamic organisation of healthcare system in India.

Clearly different from the previous two policies; this time it is the detailed elaboration of areas in which private sector services will be contracted for training, skill development, community training for mental health, disaster management, purchase of services to fill gaps and preferentially for Central Government Health Scheme members, and primary healthcare in urban areas. Partnership with the private sector for infectious disease control, immunization services, disease surveillance and health information and manufacture of medical devices is taken in consideration. The policy also pursues to take steps to improve, upgrade and incentivize the quality of services being provided by the private sector in rural and remote areas and among underserved populations along with facilitating of diagnostic laboratory support.

Our health system is burdened by emerging and re-emerging diseases like drug-resistant TB, malaria, SARS, avian flu and the current H1N1 pandemic. The actions taken to protect public health of India had witnessed many hurdles in its attempt to improve the standard of living of its people. Since independence major public health problems like malaria have been curtailed through the health policy chalked by the government. For the first time the policy emphasised on , specific targets like the elimination of certain diseases like kala-azarby the end of this year, leprosy by next year and lastly the most important or rather the most challenging target of eliminating Tuberculosis by 2025. The policy also aims to reduce the fertility rate to 2.1 by 2025. There is a focused approach on AIDS awareness also and the NHP plans to attain ’90:90:90’ global target by 2020. This means that 90 per cent of all people living with HIV are aware of their HIV status, 90 per cent of people infected with HIV receive sustained antiretroviral therapy and about 90 per cent of those receiving the therapy will have viral suppression.

The policy also emphasizes on early detection through screening for certain types of cancers. To accelerate this process ASHA workers across the country are trained for oral, breast and cervical cancer treatment. This is a great initiative as it will help early detection and reduce mortality rate even in the lower strata of the society. The National Health Policy has a target to reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by 25 per cent and increases life expectancy at birth from 67.5 to 70 by 2025. Another major preposition in national health policy was to manage costs for generic drugs and medical devices in government hospitals, as a lot of patients currently prefer treatment from private institutions.

The policy also plans to reduce the prevalence of blindness by 2025 to 0.25 per 1000 persons. To provide a health card to every family, so that they have access to primary care facility as well as access to a well-defined package of services nationwide is also one of the aims on the NHP. This policy seeks to reduce neonatal mortality rate as well as stillbirth rate by improving home based facilities for sick newborns. Also an effort will be aimed towards pre-emptive care, so as to attain the most favorable levels of adolescent health. The policy is of the view that if they strengthen the existing medical colleges and if converted to new medical colleges it could increase the number of specialists and doctors in regions where there are a deficit doctors and other medical personnel. Rural areas are the ones that bear the brunt, hence the policy aims at starting with medical colleges in rural areas, mandatory rural postings etc. A continuous effort will be made so that the public health systems do not collapse and are able to retain the manpower. An outline of positive aspects and issues of the policy has been noted below.

Some Positive Aspects of the NHP

• The policy along private sector partners looks at problems and solutions at a universal level
• From the point of view of the less privileged population, the policy proposes to provide free medical aid right from free drugs to emergency healthcare services so forth and so on at public hospitals
• Aims at providing 2 beds per 1,000 populations. This will enable victims to get a bed within the first hour of injury, because that is the time which is most crucial for the victim and is most likely to benefit from treatment
• The policy seeks to provide easily accessible and affordable secondary and tertiary care medical services.

Some Issues of the NHP

• To make National Health Policy function flawlessly, the Centre has to get robust and updated health data
• To reduce high out-of-pocket spending, early deadlines should be set for public institutions essential medicines and diagnostic tests free to everyone
• The policy mentions an increase in health expenditure from 1.5 per cent to 2.5 per cent by 2025, which entailsa span of another 8 long years.

As a cancer care hospital, the policies introduced for Non-communicable Diseases (NCDs) are of prime importance to us. According to the World Health Organization, an Indian today has over twice the odds of dying of a NCDs than a communicable disease. As the cost involved in care and medical equipment of treating NCDs is extremely high, government’s focus onincreasing spend on non-communicable diseases will help to reach out to a larger scale of patients.

We need to give a push to innovative technology development, clinical trials and medical care in India itself. This will not only ensure timely care along with western countries but also reduction in cost.

Along with all of this, we also need to ensure that the cost of diagnostics and medical equipment is controlled. A widespread public awareness of voluntary donations is important particularly for cancer victims and other NCDs as it entails huge money.  After heart and lung disease, cancer is the third largest cause of death in the country. However the policy needs to have a separate section to address the issues in cancer care. The new policy needs to be executed so as to achieve a milestone especially in India where deaths per day is in thousands due to cancer and the majority of the population is under the poverty line.

--Issue 37--

Author Bio

Suresh Ramu

Suresh Ramu is also a Co-founder & Director of Cytespace Research and Co-founder of Medwell Ventures. Prior to establishing Cytespace in 2011, Mr Ramu spent 10+ years with Quintiles Transnational. As Vice President and Head – India, for Clinical Development Services, he managed all aspects of clinical trials conduct in the country. Holding diverse senior leadership positions, he was instrumental in creating two valuable assets for the organisation – the world’s largest multi-shift data management operations to process clinical trial data, and Asia’s largest cardiac safety lab. In his consulting role, Mr Ramu advised on process improvement, cost management and customer relations at PricewaterhouseCoopers. He was also an early team member at a telemedicine start-up in India. Mr Ramu has a Bachelor’s degree in Engineering from the Indian Institute of Technology in Madras, and a Master’s in Business Administration from the Indian Institute of Management – Calcutta. He is a member of the American Society of Clinical Oncology and has presented at various professional conferences in India and abroad.

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