NATIONAL

HEALTH POLICY
2017
Presenter: Jayraj Singh
Assistant lecture
JCN
 Health priorities are
changing, there is
growing burden on
account of non-
communicable diseases
and some infectious
diseases
A rising economic
growth enables The
enhanced fiscal emergence of
capacity. NEED OF A a robust
Therefore, a new NEW health care
health policy HEALTH industry
responsive to estimated to
these contextual POLICY
be growing at
changes is double digit
required
Growing incidences of
catastrophic
expenditure due to
health care costs, which
are presently estimated
to be one of the major
contributors to poverty.
 OBJECTIVES

Improve health status through concerted policy action

in all sectors and expand preventive, promotive,
curative, palliative and rehabilitative services
provided through the public health sector with focus
on quality.
 Principles Of The Policy
Professionalism, Integrity And
Ethics
The health policy commits itself to the highest professional

standards, integrity and ethics to be maintained in the

entire system of health care delivery in the country,

supported by a credible, transparent and responsible

regulatory environment.
 Equity
v Reducing inequity would mean affirmative action to
reach the poorest.

v It would mean minimizing disparity on account of

gender, poverty, caste, disability, other forms of social
exclusion and geographical barriers.
 Affordability

As costs of care increases, affordability, as distinct from

equity, requires emphasis. Catastrophic household
health care expenditures defined as health expenditure
exceeding 10% of its total monthly consumption
expenditure or 40% of its monthly non-food
consumption expenditure, are unacceptable.
 Universality
Prevention of exclusions on social, economic or on
grounds of current health status. In this backdrop,
systems and services are envisaged to be designed
to cater to the entire population- including special
groups
 Patient Centered & Quality Of Care

Gender sensitive, effective, safe, and convenient

healthcare services to be provided with dignity and
confidentiality. There is need to evolve and disseminate
standards and guidelines for all levels of facilities and a
system to ensure that the quality of healthcare is not
compromised.
 Accountability

Financial and performance accountability,

transparency in decision making, and
elimination of corruption in health care
systems, both in public and private.
 Inclusive Partnerships

v A multi stakeholder approach with partnership &

participation of all non-health ministries and
communities.

v This approach would include partnerships with

academic institutions, not for profit agencies, and
health care industry as well.
 Pluralism

v Patients who so choose and when appropriate, would

have access to AYUSH care providers based on
documented and validated local, home and community
based practices.
v These systems among other things, would also have
Government support in research and supervision to
develop and enrich their contribution to meeting the
national health goals and objectives through integrative
practices.
 Decentralization

Decentralisation of decision making to a level as is

consistent with practical considerations and
institutional capacity. Community participation in
health planning processes, to be promoted side by
side.
 Dynamism And Adaptiveness

Constantly improving dynamic organization of health

care based on new knowledge and evidence with learning
from the communities and from national and
international knowledge partners is designed.
The indicative, quantitative goals and
objectives are outlined under three
broad components viz.

• Health status and programme

1 impact

• Health systems performance

2
• Health system strengthening.
3
 Goals To Be Achieved

v Increase Life Expectancy from 67.5 to 70 by 2025.

v Establish regular tracking of Disability Adjusted Life Years
(DALY) Index as a measure of burden of disease by 2022.

v Reduction of TFR to 2.1 at national and sub-national level by

2025.

v Reduce Under Five Mortality to 23 by 2025 and MMR from

current levels to 100 by 2020.
v Reduce infant mortality rate to 28 by 2019.

v Reduce neo-natal mortality to 16 and still birth rate to

‘single digit’ by 2025.

v Achieve and maintain elimination status of Leprosy by

2018.

v Kala-Azar by 2017 and Lymphatic Filariasis in endemic

pockets by 2017.

v Achieve global target of 2020 which is also termed as

target of 90:90:90, for HIV/AIDS.
v To achieve and maintain a cure rate of >85% in new
sputum positive patients for TB and reduce incidence of
new cases, to reach elimination status by 2025.

v To reduce the prevalence of blindness to 0.25/ 1000 by

2025.

v To reduce premature mortality from cardiovascular

diseases, cancer, diabetes or chronic respiratory diseases
by 25% by 2025.
v Increase utilization of public health facilities by 50% from
current levels by 2025.
v Antenatal care coverage to be sustained above 90% and
skilled attendance at birth above 90% by 2025.
v More than 90% of the newborn are fully immunized by one
year of age by 2025.
v Meet need of family planning above 90% at national and sub
national level by 2025.
v 80% of known hypertensive and diabetic individuals at
household level maintain ‘controlled disease status’ by 2025.
v Relative reduction in prevalence of current tobacco use
by 15% by 2020 and 30% by 2025.

v 40% Reduction in prevalence of stunting of under-five

children by 2025.

v Safe water and sanitation to all by 2020 (Swachh

Bharat Mission).

v Reduction of occupational injury by half from current

levels of 334 per lakh agricultural workers by 2020.
v Increase health expenditure by Government from the
existing 1.15%(GDP) to 2.5 %(GDP) by 2025.

v Increase State sector health spending, to > 8% of their budget

by 2020.

v Decrease in proportion of households facing catastrophic

health expenditure from the current levels by 25%, by 2025.

v Ensure availability of paramedics and doctors as per IPHS

norm in high priority districts by 2020.
v Establish primary and secondary care facility in high
priority districts by 2025.

v Ensure district-level electronic database of information on

health system components by 2020.

v Strengthen the health surveillance system by 2020.

v Establish federated integrated health information

architecture, Health Information Exchanges and National
Health Information Network by 2025.
 Policy Thrust
Ensuring Adequate Investment
The policy proposes a potentially achievable target of
raising public health expenditure to 2.5% of the GDP in
a time bound manner. It envisages that the resource
allocation to States will be linked with State development
indicators, absorptive capacity and financial indicators.
General taxation will remain the predominant means for
financing care.
Preventive and Promotive Health

The policy articulates to institutionalize inter-

sectoral coordination at national and sub-national
levels to optimize health outcomes, through
constitution of bodies that have representation from
relevant non-health ministries.
 The Policy Identifies Coordinated Action On Seven
Priority Areas For Improving The Environment For
Health

v The Swachh Bharat Abhiyan

v Balanced, healthy diets and regular exercises.
v Addressing tobacco, alcohol and substance abuse
v Yatri Suraksha – preventing deaths due to rail and road
traffic accidents
v Nirbhaya Nari –action against gender violence
v Reduced stress and improved safety in the work place
v Reducing indoor and outdoor air pollution
 Organization of Public Health Care Delivery:
The seven key policy shifts in organizing health care
services are:
1. In primary care from selective care to assured
comprehensive care with linkages to referral hospitals.

2. In secondary and tertiary care from an input oriented to

an output based strategic purchasing .

3. In public hospitals from user fees & cost recovery to

assured free drugs, diagnostic and emergency services
to all.
4. In infrastructure and human resource development from
normative approach to targeted approach to reach
under-serviced area.
5. 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.

6. In National Health Programmes integration with

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

7. In AYUSH services from stand-alone to a three

dimensional mainstreaming.
 National Health Programmes

1 • RMNCH+A services

2 • Child and Adolescent Health

3 • Universal Immunization

4 • Communicable Diseases
5 • Mental Health
6 • Non-Communicable Diseases

7 • Population Stabilization
 RMNCH+A services

v This policy aspires to elicit developmental action of all

sectors to support Maternal and Child survival. The
policy strongly recommends strengthening of general
health systems to prevent and manage maternal
complications, to ensure continuity of care and
emergency services for maternal health
 Child and Adolescent Health

v The policy endorses the national consensus on

accelerated achievement of neonatal mortality targets
and 'single digit' stillbirth rates through improved home
based and facility based management of sick newborns .

v School health programmes as a major focus area, health

and hygiene being made a part of the school curriculum.

v It emphasis to the health challenges of adolescents and

long term potential of investing in their health care.
Interventions to Address Malnutrition and
Micronutrient Deficiencies

v The present efforts of Iron Folic Acid, calcium,

supplementation during pregnancy, iodized salt, Zinc and
ORS, Vitamin A supplementation, needs to be intensified
and increased .

v Focus would be on reducing micronutrient

malnourishment and augmenting initiatives like micro
nutrient supplementation, food fortification, screening for
anemia and public awareness.
Universal Immunization

v Priority would be to improve immunization coverage

with quality and safety, improve vaccine security as
per National Vaccine Policy 2011 and introduction of
newer vaccines based on epidemiological
considerations. The focus will be to build upon the
success of Mission Indradhanush and strengthen it.
 Communicable Diseases

v The policy recognizes the interrelationship between

communicable disease control programmes and public
health system strengthening .

v It advocates the need for districts to respond to the

communicable disease priorities of their locality .

v The policy acknowledges HIV and TB co infection and

increased incidence of drug resistant tuberculosis as key
challenges in control of Tuberculosis.
Non-Communicable Diseases
v An integrated approach for screening the most prevalent
NCDs with secondary prevention would make a significant
impact on reduction of morbidity and preventable
mortality. with incorporation into the comprehensive
primary health care network with linkages to specialist
consultations and follow up at the primary level.

v Screening for oral, breast and cervical cancer and Chronic

Obstructive Pulmonary Disease will be focused in addition
to hypertension and diabetes .
Mental Health
This policy will take action on the following fronts :
v Increase creation of specialists through public
financing and develop special rules to give preference to
those willing to work in public systems.
v Create network of community members to provide
psycho-social support to strengthen mental health services
at primary level facilities.
v Leverage digital technology in a context where access
to qualified psychiatrists is difficult.
 Population Stabilization

v Policy imperative is to move away from camp based

services to a situation where these services are
available on any day of the week.

v And to increase the proportion of male sterilization

from less than 5% to at least 30% and if possible much
higher.
Women’s Health & Gender Mainstreaming

v There will be enhanced provisions for reproductive

morbidities and health needs of women beyond the

reproductive age group (40+).

 Gender based violence

v Women’s access to healthcare needs to be strengthened

by making public hospitals more women friendly and
ensuring that the staff have orientation to gender –
sensitivity issues.

v health care to the survivors/ victims need to be

provided free and with dignity in the public and
private sector.
Supportive Supervision

v The policy will support innovative measures such as

use of digital tools and HR strategies like using

nurse trainers to support field workers .

 Emergency Care and Disaster
Preparedness
v Development of earthquake and cyclone resistant
health infrastructure.

v Development of mass casualty management protocols

for CHC and higher facilities and emergency response
protocols at all levels.

v Creation of a unified emergency response system,

with an assured provision of life support ambulances,
trauma management centres
Mainstreaming the Potential of AYUSH

v This policy ensures access to AYUSH remedies

through co-location in public facilities.

v Yoga would be introduced widely in school and work

places as part of promotion of good health.

 Human Resources for Health
This policy recommends that Medical and Para-medical
education be integrated with the service delivery system.

Medical Education:
v Strengthening existing medical colleges
v Increase the number of post graduate seats.
v A common entrance exam as NEET for UG entrance at all
India level.
v Attracting and Retaining Doctors in Remote Areas.
v Creation of specialist cadre and Performance linked
payments
Nursing and ASHA Education:
The policy recognises the need to improve regulation
and quality management of nursing education.

This policy supports certification programme for

ASHAs for their preferential selection into ANM,
nursing and paramedical courses. The policy
recommends revival and strengthening of
Multipurpose Male Health Worker cadre, in order to
effectively manage the emerging infectious and non-
communicable diseases at community level.
Paramedical Skills:
The policy would allow for multi-skilling with different
skill sets so that when posted in more peripheral
hospitals there is more efficient use of human resources.

Public Health Management Cadre

The policy recognizes the need to continuously nurture
certain specialized skills like entomology, housekeeping,
bio-medical waste management, bio medical engineering
communication skills, management of call centres and
even ambulance services.
Human Resource Governance and
leadership development:

Policy recommends development of leadership skills,

strengthening human resource governance in public
health system, through establishment of robust
recruitment, selection, promotion and transfer
postings policies
 Financing of Health Care:

v Allocating major proportion (upto two-thirds or

more) of resources to primary care followed by
secondary and tertiary care.

v Major reforms in financing for public facilities – where

operational costs would be in the form of
reimbursements for care provision and on a per capita
basis for primary care.
v The policy suggests collaboration for primary care services
with ‘not- for –profit’ organizations having a track record
of public services .

v It advocates strengthening of six professional councils

(Medical, Ayurveda Unani & Siddha, Homeopathy,
Nursing, Dental and Pharmacy).

v It advocates commissioning more research and

development for manufacturing new vaccines, including
against locally prevalent diseases.
v Next goal is making available good quality, free, essential,
generic Drugs and Diagnostics, at public health care
facilities. Encourage domestic production in consonance
with the “make in india” national agenda.

v Policy advocates extensive deployment of digital tools for

improving the efficiency and outcome of the healthcare
system.e.g Swasthya slate and use of “Aadhaar” as unique
ID.
 Health Surveys
v The scope of health, demographic and epidemiological
surveys would be extended to capture information
regarding costs of care, financial protection and evidence
based policy planning and reforms.

v Rapid programme appraisals and periodic disease specific

surveys to monitor the impact of public health and
disease interventions using digital tools for
epidemiological surveys.
 Health Research
vStrengthening the publicly funded health
research institutes.

vStimulate innovation and new drug discovery as

required.
 Governance
v Role of Centre & State: The policy recommends equity
sensitive resource allocation, strengthening institutional
mechanisms for consultative decision-making and coordinated
implementation

v Role of Panchayati Raj Institutions: This will be

strengthened to play an enhanced role at different levels for
health governance, including the social determinants of health.

v Improving Accountability: The policy would be to increase

both horizontal and vertical accountability of the health system
 Conclusion
While the public health initiatives over the years have
contributed significantly to the improvement of the
health indicators, it is to be acknowledged that public
health indicators/ disease burden statistics are the
outcome of several complementary initiatives under the
wider umbrella of the developmental sector, covering
rural development, agriculture, food production,
sanitation, drinking water supply, education etc.
v Despite the impressive public health gains, the
morbidity and mortality levels in the country are still
unacceptably high as compared to the developed
countries.

v Further dedicated efforts are required to achieve goal

of ‘Health for All’ in 21st century’.

v NHP 2017 will provide an impetus for achieving an

acceptable standard of good health of people of India.
THANK YOU

59
Let us work together for
“Health for ALL.’’