HEALTH CARE FOR ALL: THE NATIONAL HEALTH POLICY 2017
Article 47 of Indian Constitution, the Directive Principles of State Policy says that it shall be the duty of the State to raise the level of nutrition and the standard of living and to improve public health. Health sector policy making in India is extremely challenging and complex. The backdrop for policy formulation is low public spending and high out of pocket expenditures. Despite India providing free care in public hospitals for maternity, new born and infant care, the burden of out of pocket expenditures remains quite high.
In 1943, the Joseph Bhor Committee Report envisaged one bed for every 550 people and one doctor for every 4600 people in every district. In 1946, Government resolved to make plans for establishing a Primary Health Centre for every 40,000 people, a Community Health Centre of 30 beds for every 5 Primary Health Centers and a 200 bedded District Hospital in every District) On the eve of Independence, India inherited a substantial
disease burden, with infant and maternal mortality, low life expectancy, inadequate number of doctors, nurses and midwives, poor health infrastructure and low budgetary allocations. During the first 3 decades
since Independence, India's health policy focus entailed controlling infectious diseases, family planning, creation of teaching hospitals like AIIMS to produce high quality human resources and promote infrastructure.
In 1978, India adopted the Alma-Ata Declaration for providing comprehensive primary health care to all its people. In 1983, India's first National Health Policy (NHP) was formulated with emphasis on primary health care and an integrated, vertical approach for disease control programs. The allocations for health sector became tighter during the difficult years of 1990s. The National Health Policy (NHP) 2002 broadly reiterated the earlier Policy's recommendations while advocating that the public investment be increased to 2 per cent of GDP. The NHP 2002 was followed by the launch of the National Rural Health Mission (NRHM) in 2005 designed on the principles of decentralisation and community engagement with focus on revitalizing primary care.
National Health Mission India's flagship health sector program, the National Health Mission (NHM) sought to revitalize rural and urban health sectors by providing flexible finances to State Governments. The National Health Mission comprises of 4 components namely the National Rural Health Mission, the National Urban Health Mission, Tertiary Care Programs and Human Resources for Health and Medical Education. The National Health Mission represents India's endeavor to expand the focus of health services beyond Reproductive and Child Health, so as to address the double burden of Communicable and Non- Communicable diseases as also improve the infrastructure facilities at District and Sub-District Levels.
The National Health Mission (NHM) brought together at National level the two Departments of Health and Family Welfare. The integration resulted in significant synergy in program implementation and enhancement in Health Sector allocations for revitalizing India's rural health systems. A similar integration was witnessed at State levels too. A post of Mission Director NRHM manned by a senior IAS Officer was created to administer the State Health Society. The NHM brought in considerable innovations into the implementation of Health Sector Programs in India. These included flexible financing, monitoring of Institutions against IPHS standards, Capacity Building by induction of management specialists and simplified HR management practices. The establishment of the National Health Systems Resource Center (NHSRC) helped design and formulate various initiatives. State
Health Systems Resource Centers have also been established in some States.
Reproductive and Child Health services were the primary focus of NHM. The successful implementation of JSY and ASHA programs had a significant impact on behavioral changes and brought pregnant women in large numbers to public health institutions. The NRHM flexi pool resources were utilized to create adequate infrastructure at public health institutions to cope with the heavy rush of maternity cases. Ambulance services were introduced for transportation of maternity cases to public health institutions and for emergency care.
The NHM created a people's' movement for health care. Accredited Social Health Activists Care (ASHA) workers were deployed as transformational change agents in every village. The ASHA workers acted as mobilizers for institutional deliveries, focused on integrated management of neonatal and childhood illness and advised on home based neonatal care. The NHM has also empowered people through Village Health and Sanitation Committees to formulate village health plans and exercise supervisory oversight of ASHA workers. At the PHC and CHC level, Rogi Kalyan Samitis have been activated to establish systems of oversight over the public health facilities for creating a patient friendly institution. Besides rural areas, the urban slums are now receiving attention with the launch of the National Urban Health Mission.
