National health policy 2017

important features of national health policy 2017

1. NATIONAL HEALTH POLICY 2017 Presenter: Dr Shalu Garg (1 st year PG) Moderator: Dr Amrit Virk (Professor)

2. INTRODUCTION A health policy generally describes fundamental principles regarding which health providers are expected to make value decisions." Health Policy provides a broad framework of decisions for guiding health actions that are useful to its community in improving their health, reducing the gap between the health status of haves and have- not and ultimately contributes to the quality of life.

3. The National Health Policy of 1983 and the National Health Policy of 2002 have served well in guiding the approach for the health sector in the Five-Year Plans. Now 14 years after the last health policy, a new is introduced. 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

4. 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.

5. 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.

6. 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.

7. 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 .

8. 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

9. 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.

10. Accountability Financial and performance accountability, transparency in decision making, and elimination of corruption in health care systems, both in public and private.

11. 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.

12. 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 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.

13. 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.

14. 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.

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

16. Goals To Be Achieved   Increase Life Expectancy from 67.5 to 70 by 2025. Establish regular tracking of Disability Adjusted Life Years (DALY) Index as a measure of burden of disease by 2022. Reduction of TFR to 2.1 at national and sub-national level by 2025. Reduce Under Five Mortality to 23 by 2025 and MMR from current levels to 100 by 2020.

17. Reduce infant mortality rate to 28 by 2019. Reduce neo-natal mortality to 16 and still birth rate to ‘single digit’ by 2025. Achieve and maintain elimination status of Leprosy by 2018. Kala- Azar by 2017 and Lymphatic Filariasis in endemic pockets by 2017. Achieve global target of 2020 which is also termed as target of 90:90:90 , for HIV/AIDS.

18. 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. To reduce the prevalence of blindness to 0.25/ 1000 by 2025. To reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by 25% by 2025.

19. Increase utilization of public health facilities by 50% from current levels by 2025. Antenatal care coverage to be sustained above 90% and skilled attendance at birth above 90% by 2025. More than 90% of the newborn are fully immunized by one year of age by 2025. Meet need of family planning above 90% at national and sub national level by 2025. 80% of known hypertensive and diabetic individuals at household level maintain ‘controlled disease status’ by 2025.

20. Relative reduction in prevalence of current tobacco use by 15% by 2020 and 30% by 2025. 40% Reduction in prevalence of stunting of under-five children by 2025. Safe water and sanitation to all by 2020 (Swachh Bharat Mission). Reduction of occupational injury by half from current levels of 334 per lakh agricultural workers by 2020.

21. Increase health expenditure by Government from the existing 1.15%(GDP) to 2.5 %(GDP) by 2025. Increase State sector health spending, to > 8% of their budget by 2020. Decrease in proportion of households facing catastrophic health expenditure from the current levels by 25%, by 2025. Ensure availability of paramedics and doctors as per IPHS norm in high priority districts by 2020.

22. Establish primary and secondary care facility in high priority districts by 2025. Ensure district-level electronic database of information on health system components by 2020. Strengthen the health surveillance system by 2020 . Establish federated integrated health information architecture, Health Information Exchanges and National Health Information Network by 2025.

23. 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.

24. 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.

25. The Policy Identifies Coordinated Action On Seven Priority Areas For Improving The Environment For Health The Swachh Bharat Abhiyan Balanced, healthy diets and regular exercises. Addressing tobacco, alcohol and substance abuse Yatri Suraksha – preventing deaths due to rail and road traffic accidents Nirbhaya Nari –action against gender violence Reduced stress and improved safety in the work place Reducing indoor and outdoor air pollution

26. Organization of Public Health Care Delivery: The seven key policy shifts in organizing health care services are: In primary care from selective care to assured comprehensive care with linkages to referral hospitals. In secondary and tertiary care from an input oriented to an output based strategic purchasing . In public hospitals from user fees & cost recovery to assured free drugs, diagnostic and emergency services to all. In infrastructure and human resource development from normative approach to targeted approach to reach under-serviced area.

27. 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. In National Health Programmes integration with health systems for programme effectiveness and in turn contributing to strengthening of health systems for efficiency. In AYUSH services from stand-alone to a three dimensional mainstreaming.

28. National Health Programmes

29. RMNCH+A services 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

30. Child and Adolescent Health 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 . School health programmes as a major focus area, health and hygiene being made a part of the school curriculum. It emphasis to the health challenges of adolescents and long term potential of investing in their health care.

31. Interventions to Address Malnutrition and Micronutrient Deficiencies 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 . Focus would be on reducing micronutrient malnourishment and augmenting initiatives like micro nutrient supplementation, food fortification, screening for anemia and public awareness.

32. Universal Immunization 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.

33. Communicable Diseases The policy recognizes the interrelationship between communicable disease control programmes and public health system strengthening . It advocates the need for districts to respond to the communicable disease priorities of their locality . The policy acknowledges HIV and TB co infection and increased incidence of drug resistant tuberculosis as key challenges in control of Tuberculosis.

34. Non-Communicable Diseases 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. Screening for oral, breast and cervical cancer and Chronic Obstructive Pulmonary Disease will be focused in addition to hypertension and diabetes .

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

36. Population Stabilization Policy imperative is to move away from camp based services to a situation where these services are available on any day of the week. And to increase the proportion of male sterilization from less than 5% to at least 30% and if possible much higher.

37. Women’s Health & Gender Mainstreaming There will be enhanced provisions for reproductive morbidities and health needs of women beyond the reproductive age group (40+).

38. Gender based violence 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. health care to the survivors/ victims need to be provided free and with dignity in the public and private sector.

39. Supportive Supervision The policy will support innovative measures such as use of digital tools and HR strategies like using nurse trainers to support field workers .

40. Emergency Care and Disaster Preparedness Development of earthquake and cyclone resistant health infrastructure. Development of mass casualty management protocols for CHC and higher facilities and emergency response protocols at all levels. Creation of a unified emergency response system, with an assured provision of life support ambulances, trauma management centres

41. Mainstreaming the Potential of AYUSH This policy ensures access to AYUSH remedies through co-location in public facilities. Yoga would be introduced widely in school and work places as part of promotion of good health.

42. Human Resources for Health This policy recommends that Medical and Para-medical education be integrated with the service delivery system. Medical Education : Strengthening existing medical colleges Increase the number of post graduate seats. A common entrance exam as NEET for UG entrance at all India level. Attracting and Retaining Doctors in Remote Areas. Creation of specialist cadre and Performance linked payments

43. 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.

44. 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. .

45. 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

46. Financing of Health Care: Allocating major proportion ( upto two-thirds or more) of resources to primary care followed by secondary and tertiary care. 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.

47. The policy suggests collaboration for primary care services with ‘not- for –profit’ organizations having a track record of public services . It advocates strengthening of six professional councils (Medical, Ayurveda Unani & Siddha , Homeopathy, Nursing, Dental and Pharmacy). It advocates commissioning more research and development for manufacturing new vaccines, including against locally prevalent diseases.

48. 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. 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.

49. Health Surveys 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. Rapid programme appraisals and periodic disease specific surveys to monitor the impact of public health and disease interventions using digital tools for epidemiological surveys .

50. Health Research Strengthening the publicly funded health research institutes. Stimulate innovation and new drug discovery as required.

51. Governance Role of Centre & State: The policy recommends equity sensitive resource allocation, strengthening institutional mechanisms for consultative decision-making and coordinated implementation 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. Improving Accountability: The policy would be to increase both horizontal and vertical accountability of the health system

52. 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.

53. Despite the impressive public health gains, the morbidity and mortality levels in the country are still unacceptably high as compared to the developed countries. Further dedicated efforts are required to achieve goal of ‘Health for All’ in 21 st century’. NHP 2017 will provide an impetus for achieving an acceptable standard of good health of people of India .

54. THANK YOU 55

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