The Health Policy at the grassroots

The National Health Policy (NHP) 2017 comes at a time when the burden of disease remains enormous and the health system is challenged by the lack of quality doctors, authentic medical colleges, kidney rackets and blood mafias. Can the NHP ensure that our generation will see India liberated from health constraints forever? For this to happen, the policy needs to trickle down from New Delhi to the forgotten corners of India, it needs to percolate deeply into primary healthcare centres (PHC). Closing the gap in our generation must happen by dedicated public health action. The policy speaks about collaborating with civil society organisations and leveraging CSR support to strengthen existing gaps. But the ministry’s willingness to commit to research and to facilitate foreign exchange programmes and competency development for health workers at the grassroots level and how it intends to deliver across partisan lines remains unclear. 

Most often, grassroots organisations face communication hurdles from the ministries and many projects are lost in bureaucratic red-tapism because of conflicting political priorities. Unless the policy seriously recognises that healthcare is an effort which requires fast tracking in every domain, the policy will remain rich in theory and lack implementation. With the global village adopting sustainable development goals till 2030, the policy needs to factor in these dialogues to ensure commitment levels remain intact and local health workers adapt to these ever-changing priorities. The policy is very encouraging in terms of raising the budget on health, given the historical record of health stagnancy that defined free India’s early decades. The NHP is also re-enforcing the Alma-Ata Declaration of 1978 by mainstreaming financing to consolidate and strengthen the primary health care domain. 

The policy fails to talk about the role of medical colleges and community medicine doctors specifically to boost the on-going effort. India has 422 medical colleges and every college has a community medicine department. The policy should have leveraged the human resource capital of community medicine doctors to create sustainable consciousness and deepen ties in order to strengthen community participation. In addition, the policy disappointingly fails to address tightening pharmaceutical lobbies and pharmacies who supply Schedule H drugs without a medical prescription. Organ transplantation and radioactive hospital waste disposal have gone ignored. 

Issues based on monitoring and quality control of district hospitals, Community Health Centres (CHCs), and PHCs do not find any discussion, nor do issues about the state of disrepair of government hospitals and medical colleges. From a public health perspective, the national health policy comes across as a very ambitious effort which deserves appreciation. But given the record of India’s implementation bottlenecks and bureaucratic lethargy, the policy may remain a document confined to the corridors of Nirman Bhavan. For the NHP 2017 to succeed; much depends on how soon the existing cadres can absorb the policy vision, how the government translates this into state and district level action plan and works in unison, taking into confidence civil society organisations. Lastly, could the policy have thought of a Universal Health Insurance for all Indians and link the same with Aadhaar? I leave you with this question.

The author is CEO, CHD Group, based in Mangaluru and a member of the Health Task Force, DDMA, Government of Karnataka.