National Health Policy

National Health policy 2017 with SWOC Analysis

1. 1 Dr Girish J Presenter: Dr Girish J AIIMS, New Delhi

2. Outline Introduction Goals Objectives Key policy principles Targets Policy Thrust SWOC analysis

3. Policy It is a system which provides the logical framework and rationality of decision making for the achievement of intended objectives. It sets priorities and guides resources allocations. Policy adequacy may be measured by the impact on population health.

4. National health policy (NHP) Why changed? Health priorities are changing (NCDs increase along with infectious diseases) E mergence of a robust health care industry (Double digit increase) G rowing incidences of catastrophic expenditure due to health care costs R ising economic growth enables enhanced fiscal capacity Year 1 st NHP 1983 2 nd NHP 2002 3 rd NHP 2017

5. Primary aim of NHP 2017 Is to inform, clarify, strengthen and prioritize the role of the Government in shaping health systems in all its dimensions Investments in health, organization of healthcare services, prevention of diseases and promotion of good health through cross sectoral actions, access to technologies, developing human resources, encouraging medical pluralism, building knowledge base, developing better financial protection strategies, strengthening regulation and health assurance

6. Goal The attainment of the highest possible level of health and wellbeing for all at all ages, 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 This would be achieved through increasing access, improving quality and lowering the cost of healthcare delivery The policy recognizes the pivotal importance of SDGs

7. 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 .

8. Key policy principles Professionalism, integrity and ethics. Equity Affordability Universality Patient centered & quality of care Accountability Inclusive of partnerships Pluralism Decentralization Dynamism and Adaptiveness Professionalism, Integrity And Ethics The h e al t h po l icy c o m m it s it s el f t o t h e h ighe s t pro f ess ion a l standards, integrity and ethics to be maintained in the entire system of hea lt h c are d e l i ve r y i n t h e co u n t r y , supp o r t ed by a c red i b le, transparent and responsible regulatory environment. Universality: systems and services are envisaged to be designed to cater to the entire population- including special groups

9. The indicative, quantitative goals and objectives are outlined under three broad components 1 Health status and programme impact 2 Health systems performance 3 Health system strengthening .

10. 1. Health Status and Programme Impact Life Expectancy and healthy life Increase Life Expectancy at birth from 67.5 to 70 by 2025 Establish regular tracking of Disability Adjusted Life Years (DALY) Index as a measure of burden of disease and its trends by 2022 Reduction of TFR to 2.1 at national and sub-national level by 2025 from 2.33 Mortality by Age and/ or cause Reduce Under Five Mortality to 23 by 2025 and MMR from current levels to 100 by 2020 Reduce infant mortality rate to 28 by 2019 Reduce neonatal mortality to 16 and still birth rate to “single digit” by 2025

11. 1. Health Status and Programme Impact (Contd..) Reduction of disease prevalence/ incidence Achieve global target of 2020 which is also termed as target of 90:90:90 Achieve and maintain elimination status of Leprosy by 2018, Kala-Azar by 2017 and Lymphatic Filariasis in endemic pockets by 2017. 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 and disease burden by one third from current levels. (i.e. To reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by 25% by 2025)

12. 2. Health Systems Performance Coverage of Health Services Increase utilization of public health facilities by 50% 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 the need of family planning above 90% at national and sub national level by 2025.

13. 2. Health Systems Performance (Contd..) Cross Sectoral goals related to health Relative reduction in prevalence of current tobacco use by 15% by 2020 and 30% by 2025 Reduction of 40% in prevalence of stunting of under-five children by 2025. Access to safe water and sanitation to all by 2020 (Swachh Bharat Mission). Reduction of occupational injury by half from current levels (334 per lakh agricultural workers) by 2020

14. 3. Health Systems strengthening Health finance Increase health expenditure by Government as a percentage of GDP from the existing 1.15% to 2.5 % by 2025. Decrease in proportion of households facing catastrophic health expenditure from the current levels by 25%, by 2025. Health Infrastructure and Human Resource Ensure availability of paramedics and doctors as per Indian Public Health Standard (IPHS) norm in high priority districts by 2020. Increase community health volunteers to population ratio as per IPHS norm, in high priority districts by 2025

15. 3. Health Systems strengthening(Contd..) Health Management Information Ensure district-level electronic database of information on health system components by 2020 Strengthen the health surveillance system and establish registries for diseases of public health importance by 2020

16. 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

17. Policy Thrust  Ensuring Adequate Investment - 2.5% of the GDP in a time bound manner Preventive and Promotive Health - institutionalize inter-sectoral coordination , Health for All  Promotion of healthy living and prevention strategies from AYUSH systems and Yoga at the work-place, in the schools and in the community ASHA will also be supported by other frontline workers like health workers (male/female) to undertake primary prevention for non-communicable diseases. Home based palliative care and mental health services  Policy thrust  is to reduce inequities in access to care and increase coverage, quality and use of health services so as to achieve a healthier national population.

18. Policy Thrust The policy envisages strategic purchase of secondary and tertiary care services as a short term measure. (P ublic sector > not-for profit private sector > commercial private sector) Policy recognizes the special health needs of tribal and socially vulnerable population groups, Tribal population in the country is over 100 million (Census 2011), and hence deserves special attention  Advocates enhanced outreach of public healthcare through Mobile Medical Units (MMUs), etc

19. Policy Thrust – 7 shifts In primary care – from selective care to assured comprehensive care like geriatric health care, palliative care and rehabilitative care services through upgradation of the existing sub-centres and reorienting PHCs with linkages to referral hospitals. larger package of comprehensive primary health care will be called “ Health and Wellness Centres ‟.  every family would have a health card that links them to primary care facility. accompanied by an effective feedback and follow-up mechanism  2. In secondary and tertiary care – from an input oriented to an output based strategic purchasing  Basic secondary care services, such as caesarean section and neonatal care would be made available at the least at sub-divisional level in a cluster of few blocks  To have at least two beds per thousand population distributed in such a way that it is accessible within golden hour rule. expanding the network of blood banks across the country to ensure improved access to safe blood 

20. Policy Thrust - 7 shifts 3. In public hospitals – from user fees & cost recovery to assured free drugs, diagnostic and emergency services to all  4. In infrastructure and human resource development – from normative approach to targeted approach to reach under-serviced areas  5. In urban health – To organize Primary Health Care delivery and referral support for urban poor (special focus on poor populations living in listed and unlisted slums, other vulnerable populations) 6. AYUSH services 7. In National Health Programmes – integration with health systems for programme effectiveness and in turn contributing to strengthening of health systems for efficiency 

21. SWOC Analysis- NHP 2017 SWOC Analysis is an examination and evaluation of an organization’s internal strengths and weaknesses, its opportunities for growth and improvements and the threats the external environment poses to its survival and working internal factors (Strengths & Weaknesses) and external factors (Opportunities & Challenges) The internal factors are considered relatively controllable and can be manipulated by organization itself. On the contrary, the external factors are somewhat out of the control of the organization (may be controllable up-to some extent) and imposed by the environment in which the organization operates

22. Strength & Weakness Strengths are those internal factors that support and illustrate extraordinary performance of a healthcare organization e.g. extra ordinary IT infrastructure, highly qualified and experienced healthcare professionals, excellent services, etc. On the contrary, weaknesses are those internal factors that hinder the working capability and negatively affect the performance of a healthcare organization. E.g. They can be mismanagement of resources, lack of financial resources, incompetent healthcare professionals, outdated equipment, etc

23. Opportunities & Challenges Opportunities are those factors that are external to healthcare organizations. They provide initiatives for improvements. E.g. collaborations with other organizations for better services, plans for better organization and management, new funding programs for better IT infrastructure, effective training and informative programs for community development . Challenges are those external factors which are considered to be potential risks or dangers that could cause harm to the quality of working and performance of healthcare organizations. E.g. budget deficits, rapidly changing technology and political insecurity

24. SWOT MATRIX

25. SWOC Analysis- NHP 2017 Strength (1/4) Rise in expenditure- The policy aims to increase health expenditure to 2.5 percent by 2025 from 1.15 presently. It also recommends states to enhance their budget expenditure on health to 8 percent by 2020. Shift from sickness to well being- Emphasis on preventive and protective care which marks a shift from curative care Selective care to Comprehensive package: wider coverage of major Non Communicable diseases, mental health, palliative care, geriatric care etc. Provision of Health card to families for basic medications in PHCs

26. Strength(2/4) Upgradation of District hospitals & expansion of institutional capacity. District hospitals to be strengthened to provide several tertiary care service alongside secondary care. Role of private sector - The government wanted to enroll private sector to fill critical gaps in delivery of health service to achieve health for all and also strategic purchasing from the private sector and leveraging their strengths. Improving efficiency & outcome of health care system - creation of national digital health authority (NDHA). (eHealth, mHealth, etc.) Mission-mode: Targeted and goals in areas of clean water and sanitation, U5 mortality, MMR, IMR, HIV leprosy, kala-azar and lymphatic filariasis

27. Strength(3/4) Focused approach : Health care services to underprivileged and socially vulnerable population groups To improve affordability, free drugs, free diagnostics and emergency care services in public hospitals. Universal access to health care, drugs and diagnostics. AYUSH- integrating it to research, teaching and therapeutic will make it more trustworthy Expanding the network of blood banks across the country to ensure improved access to safe blood

28. Strength(4/4) More investment in health research and drug discovery Application of digital health- telecommunication Addressed the issue of anti-microbial resistance Emphasis on generic medicine- Jan Asuhadhi Make in India- for indigenous medical drugs and devices (To improve the domestic production of drugs) More emphasis on Yoga Recommends to set up National Institute of chronic diseases

29. Weakness The policy fall short of providing health as a fundamental right Regulations on cost of treatment are not provided Not mentioned about recruitment of competent staff No emphasis on healthcare in rural area Opportunities Emergency obstetrical care training for FHWs Internet availability and enhanced bandwidth Learn from experiences

30. Challenges Raising population- health expenditure increase to 2.5% is not sufficient, may be due to lack of funds Raising number of Quack doctors 70% of healthcare providers in rural India have no formal medical training. 1 Data under security and hacking threats Rapid changes in technology and IT systems Shortage of human resources and untrained staff 1.Pulla P. Are India’s quacks the answer to its shortage of doctors? BMJ [Internet]. 2016 Jan 21 [cited 2021 Feb];352:i291. Available from: http://www.bmj.com/content/352/bmj.i291

31. Summary It aims to raise public healthcare expenditure to 2.5% of GDP, with more than two-thirds of those resources going towards primary healthcare. It foresee providing a larger package of assured comprehensive primary health care through the ‘ Health and Wellness Centers ’ It is a comprehensive package that will include care for major NCDs, geriatric healthcare, mental health, palliative care services

32. Summary It aims to improve and strengthen the regulatory environment by putting in place systems for setting standards and ensuring quality of healthcare It also looks at reforms in the existing regulatory systems both for easing drugs and devices manufacturing to promote Make in India and reforming medical education It proposes free diagnostics, free drugs and free emergency and essential healthcare services in all public hospitals in order to provide healthcare access and financial protection

33. Thank you Let us work together for “Health for ALL’’