Draft National Health Policy 2015


Ajit Kumar AJIT KUMARWISDOM IAS, New Delhi.

The Draft National Health Policy 2015 addresses the urgent need to improve the performance of health systems. It has been formulated at the last year of the Millennium Declaration and its Goals, in the global context of all nations committed to moving towards universal health coverage. Given the two-way linkage between economic growth and health status, this National Health Policy is a declaration of the determination of the Government to leverage economic growth to achieve health outcomes and an explicit acknowledgement that better health contributes immensely to improved productivity as well as to equity.
Goal of the Policy
The attainment of the highest possible level of good health and well-being, through a preventive and promotive health care orientation in all developmental policies, and universal access to good quality health care services without anyone having to face financial hardship as a consequence.
Key Policy Principles
(i) Equity: Public expenditure in health care, prioritizing the needs of the most vulnerable, who suffer the largest burden of disease, would imply greater investment in access and financial protection measures for the poor. Reducing inequity would also mean affirmative action to reach the poorest and minimizing disparity on account of gender, poverty, caste, disability, other forms of social exclusion and geographical barriers.
(ii) Universality: Systems and services are designed to cater to the entire population- not only a targeted sub-group. Care to be taken to prevent exclusions on social or economic grounds. Patient Centered & Quality of Care: Health Care services would be effective, safe, and convenient, provided with dignity and confidentiality with all facilities across all sectors being assessed, certified and incentivized to maintain quality of care.
(iii) Inclusive Partnerships: The task of providing health care for all cannot be undertaken by Government, acting alone. It would also require the participation of communities – who view this participation as a means and a goal, as a right and as a duty. It would also require the widest level of partnerships with academic institutions, not for profit agencies and with the commercial private sector and health care industry to achieve these goals.
(iv) Pluralism: Patients who so choose and when appropriate, would have access to AYUSH care providers based on validated local health traditions. These systems would also have 14 Government support and supervision to develop and enrich their contribution to meeting the national health goals and objectives. Research, development of models of integrative practice, efforts at documentation, validation of traditional practices and engagement with such practitioners would form important elements of enabling medical pluralism.
(v) Subsidiarity: For ensuring responsiveness and greater participation, increasing transfer of decision making to as decentralized a level as is consistent with practical considerations and institutional capacity would be promoted. (Nothing should be done by a larger and more
complex organization which can be done as well by a smaller and simpler organization.
(vi) Accountability: Financial and performance accountability, transparency in decision making, and elimination of corruption in health care systems, both in the public systems and in the private health care industry, would be essential.
Professionalism, Integrity and Ethics: Health workers and managers shall perform their work with the highest level of professionalism, integrity and trust and be supported by a systems and regulatory environment that enables this.
(vii) Learning and Adaptive System: constantly improving dynamic organization of health care which is knowledge and evidence based, reflective and learning from the communities they serve, the experience of implementation itself, and from national and international knowledge partners.
(viii) Affordability: As costs of care rise, affordability, as distinct from equity, requires emphasis. Health care costs of a household exceeding 10% of its total monthly consumption expenditures or 40% of its non-food consumption expenditure- is designated catastrophic health expenditures- and is declared as an unacceptable level of health care costs. Impoverishment due to health care costs is of course, even more unacceptable.
Objectives of the Policy
(i) Improve population health status through concerted policy action in all sectors and expand preventive, promotive, curative, palliative and rehabilitative services provided by the public health sector.
(ii) Achieve a significant reduction in out of pocket expenditure due to health care costs and reduction in proportion of households experiencing catastrophic health expenditures and consequent impoverishment.
(iii) Assure universal availability of free, comprehensive primary health care services, as an entitlement, for all aspects of reproductive, maternal, child and adolescent health and for the most prevalent communicable and non-communicable diseases in the population.
(iv) Enable universal access to free essential drugs, diagnostics, emergency ambulance services, and emergency medical and surgical care services in public health facilities, so as to enhance the financial protection role of public facilities for all sections of the population.
(v) Ensure improved access and affordability of secondary and tertiary care services through a combination of public hospitals and strategic purchasing of services from the private health sector.
(vi)  Influence the growth of the private health care industry and medical technologies to ensure alignment with public health goals, and enable contribution to making health care systems more effective, efficient, rational, safe, affordable and ethical.
Ensuring Adequate Investment and Finance
(i) The National Health Policy accepts and endorses the understanding that a full achievement of the goals and principles as defined would require an increased public health expenditure to 4 to 5% of the GDP. However, given that the NHP, 2002 target of 2% was not met, and taking into account the financial capacity of the country to provide this amount and the institutional capacity to utilize the increased funding in an effective manner, this policy proposes a potentially achievable target of raising public health expenditure to 2.5 % of the GDP. It also notes that 40% of this would need to come from Central expenditures. At current prices, a target of 2.5% of GDP translates to Rs. 3800 per capita, representing an almost four fold increase in five years. Thus a longer time frame may be appropriate to even reach this modest target.
(ii) The major source of financing would remain general taxation. With the projection of a promising economic growth, the fiscal capacity to provide this level of financing should become available. The Government would explore the creation of a health cess on the lines of the education cess for raising the necessary resources. Other than general taxation, this cess could mobilise contributions from specific commodity taxes- such as the taxes on tobacco, and alcohol, from specific industries and innovative forms of resource mobilization. Extractive industries and development projects that result in displacement, or those that have negative impacts on natural habitats or the resource base can be considered for special taxation thereby allowing investment and job opportunities in education and health for affected communities.
(iii) Since about 50% of health expenditure goes into human resources for health, an equitous growth of health and education sectors would also lead to increased employment in many areas and communities, which do not otherwise benefit from the economic growth rate, particularly where jobless growth is a phenomenon. High public investment in health care is one of the most efficient ways of ameliorating inequities, and for this reason, this commitment to higher public expenditures is essential.
(iv) Corporate social responsibility has now been made mandatory- and this avenue should be maximally leveraged. Though actual CSR flows to health care may be modest in comparison to needs, these could be leveraged for well-focused programmes, communities or geographies with special levels of vulnerability which require special attention.
 

Wednesday, 31st Dec 2014, 08:10:37 PM

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