Matters of Good Health

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Neighbourhood News Desk: Fourteen long years after the last health policy, the government is taking some healthy steps towards better medical care for all

The new government took over in the country, change was the new mantra and it affected India’s Health Policy as well in four major ways.

Firstly, the health priorities are changing. Although maternal and child mortality have rapidly declined, there is growing burden on account of non-communicable diseases and some infectious diseases.

The second important change is the emergence of a robust health care industry estimated to be growing at double digit.

Following that is the growing incidences of catastrophic expenditure due to health care costs, which are presently estimated to be one of the major contributors to poverty.

Lastly, a rising economic growth enables enhanced fiscal capacity.

The primary aim of the National Health Policy, 2017, is to inform, clarify, strengthen and prioritize the role of the Government in shaping health systems in all its dimensions.

Attainment of the highest possible level of health and wellbeing for all at all ages is the prime goal of the policy. The policy also recognizes the pivotal importance of Sustainable Development Goals (SDGs).

However, the prime objective of the Policy is to 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.

Main objectives of the policy are defined here for better understanding:

Progressively achieve Universal Health Coverage

a) Assuring availability of free, comprehensive primary health care services, for all aspects of reproductive, maternal, child and adolescent health and for the most prevalent communicable, non-communicable and occupational diseases in the population. The Policy also envisages optimum use of existing manpower and infrastructure as available in the health sector and advocates collaboration with non -government sector on pro-bono basis for delivery of health care services linked to a health card to enable every family to have access to a doctor of their choice from amongst those volunteering their services.

b) Ensuring improved access and affordability, of quality secondary and tertiary care services through a combination of public hospitals and well measured strategic purchasing of services in health care deficit areas, from private care providers, especially the not-for profit providers

c) Achieving a significant reduction in out of pocket expenditure due to health care costs and achieving reduction in proportion of households experiencing catastrophic health expenditures and consequent impoverishment.

Reinforcing trust in Public Health Care System:

Strengthening the trust of the common man in public health care system by making it predictable, efficient, patient centric, affordable and effective, with a comprehensive package of services and products that meet immediate health care needs of most people.

Align the growth of private health care sector with public health goals:

Influence the operation and growth of the private health care sector and medical technologies to ensure alignment with public health goals. Enable private sector contribution to making health care systems more effective, efficient, rational, safe, affordable and ethical. Strategic purchasing by the Government to fill critical gaps in public health facilities would create a demand for private health care sector, in alignment with the public health goals.

Specific Quantitative Goals and Objectives:

The indicative, quantitative goals and objectives are outlined under three broad components viz.

(a) Health status and programme impact,

(b) Health systems performance and

(c) Health system strengthening. These goals and objectives are aligned to achieve sustainable development in health sector in keeping with the policy thrust.

Key Policy Principles

1. 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.
2. Equity: Reducing inequity would mean affirmative action to reach the poorest. It would mean minimizing disparity on account of gender, poverty, caste, disability, other forms of social exclusion and geographical barriers. It would imply greater investments and financial protection for the poor who suffer the largest burden of disease.
3. 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.
4. 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.
5. 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.
6. Accountability: Financial and performance accountability, transparency in decision making, and elimination of corruption in health care systems, both in public and private.
7. 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 health care industry as well.
8. Pluralism: 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. These systems, inter alia, 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.
9. 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.
10. 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.

For a conclusive implementation of the policy government has clearly defined governance parameters at various levels.

One of the most important strengths and at the same time challenges of governance in health is the distribution of responsibility and accountability between the Centre and the States. The policy recommends equity sensitive resource allocation, strengthening institutional mechanisms for consultative decision-making and coordinated implementation, as the way forward.

Role of Panchayati Raj Institutions: Panchayati Raj Institutions would be strengthened to play an enhanced role at different levels for health governance, including the social determinants of health. There is need to make Community Based Monitoring and Planning (CBMP) mandatory, so as to place people at the centre of the health system and development process for effective monitoring of quality of services and for better accountability in management and delivery of health care services.

Improving Accountability: The policy would be to increase both horizontal and vertical accountability of the health system by providing a greater role and participation of local bodies and encouraging community monitoring, programme evaluations along with ensuring grievance redressal systems.

By: Vigyan Arya

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