DNA Edit: New Health Policy promises better healthcare. Will execution improve?

The National Health Policy (NHP) 2017, is an opportunity for India to get down to the task of improving access to public health services and making private healthcare more affordable to citizens. The policy has been unfairly criticised for watering down the provisions in a 2015 draft that proposed to make healthcare a fundamental right. But in a situation where most primary health centres are in a state of disrepair or are only notionally functional, it makes sense for the government to back away from offering rights that it is in no position to fulfil. Rather than make a mockery of constitutional rights, the government has rightly focussed on progressively achieving universal health coverage, and roping in the private sector in healthcare deficit areas to provide affordable access.

The NHP is also ambitious in its scope by visualising primary health centres as “health and wellness centres,” offering a comprehensive package of health services, encompassing preventive, promotive, curative and rehabilitative services, rather than the barebone structures they are right now offering very selective services. This will require a drastic ramping up of public spending in healthcare, but successive governments have failed on this count. In 2002, health expenditure as a percentage of the GDP was 0.9 per cent, and the NHP-2002 promised to raise this to 2 per cent by 2010. Cut to 2017, health spending is just 1.15 per cent of the GDP and the NHP-2017 promises to incrementally raise it to 2.5 per cent by 2025. In contrast, private spending on health care is nearly 4.2 per cent of the GDP, which places a huge burden on poor families. 

The NHP proposes to reduce the proportion of households facing “catastrophic health expenditure” from the current levels by 25 per cent by 2025. For this to succeed, the government must ensure that the strategic purchase of secondary and tertiary care hospitalisation from the private sector is operationalised. In sectors like education, state governments have arguably had greater success in regulating and reminding the private sector of their responsibilities. In much of rural India, primary, community and district health centres are beset by crippling shortages of doctors, support staff, equipment and medicines. With health a state subject, central governments have struggled to dictate terms on how funds are to be spent and monitoring their usage. Like the leakages in the PDS, the corruption in state health departments is no less and has contributed to undermining many central initiatives like the National Rural Health Mission.

The time has come for the Union Health Ministry to double down on corruption and instill financial accountability. The NHP has also set various targets for eliminating diseases like leprosy and tuberculosis and reducing the incidence of communicable and non-communicable diseases. Most of the targets are clearly unachievable at the present rate. DNA had reported how the Centre’s target of eliminating tuberculosis by 2025 was impossible and it would, in fact, take a whopping 183 years to eliminate the disease. Over the past 24 years, the incidence of TB had merely declined at 0.91 per cent per year over the past 24 years (from 216 to 167 per 1 lakh people).

The NHP-2017 signs off by stating that any policy is only as good as its implementation. The Modi government has promised to do a better job of execution than its predecessors. Now is the time to deliver on its promises.