India’s ambitious National Health Policy, which plans to increase public spending on health from 1.15% to 2.5% by 2025 and offer “assured healthcare to all”, is a step down from the policy’s original draft in 2015 that had proposed health be considered a fundamental right and set the deadline for raising spending on health to 2.5% by 2020.
The policy outlines an ambitious plan to optimise primary care delivery in the public sector and fill critical gaps by strategically purchasing secondary-care hospitalisation and tertiary care services from the public sector and NGOs. It also wants to reinforce trust in the public healthcare system by providing treatment for infections and chronic diseases, eliminating leprosy, kala-azar and lymphatic filariasis, lowering under-five deaths, stabilising population growth and increasing longevity.
It acknowledges the need to prioritise the prevention, diagnosis and management of non-communicable diseases (NCDs), which account for 39.1% of India’s disease burden and have replaced communicable diseases as the leading cause of death, and halve premature deaths from heart diseases, cancer, diabetes or chronic respiratory diseases by 25% by 2025.
Deadlines have been set for each deliverable, but what’s missing is the path India needs to take to meet these targets.
Union health and family welfare minister JP Nadda has reiterated that since public health, along with hospitals, dispensaries and sanitation is on the state list, the onus of implementing is with the states. The Centre will help, but each state will have to find more money to give their state’s health indices a boost.
The policy has scrapped the initial proposal to use taxation, including a special health cess, to finance the increased budget, and has instead suggested the state sector health spending to be increased to more than 8% of the state budget by 2020. Currently, the average annual health spending of most states is less than 5%, with only a handful — Delhi, Goa, Kerala and Rajasthan — spending more than 5% on their citizens’ health.
The health policy does not address key issues such as human resources gaps, especially in the rural areas, under-utilisation of resources, poor quality control and a patchy track record in scaling up experiments in public-private partnerships to meet challenges. With the poor implementation of existing legislation, such as the Clinical Establishment (Registration and Regulation Act), accountability and quality standards vary widely across India.
Close to one in three persons calling themselves allopathic doctors are educated to Class 12, while 57% practitioners had no medical qualification. India needs to fill gaps in healthcare delivery and meet infrastructure and human resource shortfalls in public centres to lower out-of-pocket spending and save people from catastrophic spending on health.