[Policy] Draft National Health Policy - 2015

Provisions of Draft National Health Policy 2015 :

• The draft National Health Policy, 2015 has proposed a target of raising public health expenditure to 2.5 % from the present 1.2% of GDP. It also notes that 40% of this would need to come from central expenditure.

• The draft policy suggests making health a fundamental right similar to education and denial of the same could be punishable. The Centre shall enact, after due discussion and on the request of three or more states a National Health Rights Act, which will ensure health as a fundamental right, whose denial will be justiciable.

• The draft policy has been placed in the public domain until 28 February, 2015 for public consultation. The new policy is being introduced almost 13 yearsafter the last health policy was drafted. 

•  As per the draft document, government plans to rely mostly on general taxation for financing health care expenditure.With the projection of a promising economic growth, the fiscal capacity to provide this level of financing should become available. 

• The government is also keen to explore the creation of a health cess on the lines of education cess for raising money needed to fund the expenditure it would entail. Other than general taxation, this cess could mobilize contributions from specific commodity taxes such as the taxes on tobacco, and alcohol, from specific industries and innovative forms of resource mobilization.

• While there is an intent to increase spend on health care, the draft policy also stresses on the role of private sector. While the public sector is to focus on preventive and secondary care services, the document recommends contracting out services like ambulatory care, imaging and diagnostics, tertiary care down to non-medical services such as catering and laundry to the private sector.
  

 The draft document highlights the urgent need to improve the performance of health systems 

• with focus on improving maternal mortality rate, 
• controlling infectious diseases, 
• tackling the growing burden of non-communicable diseases,
• bringing down medical expenses among other things.

Maternal mortality currently accounts for 0.55% of all deaths and 4% of all female deaths in the 15 to 49 year age group.

• The policy statement also assures universal access to free drugs and diagnostics in government-run hospitals. However, it proposes to pose public health system as pre-paid services instead of social service. 

        

 A Step in the Right Direction :

• The policy is a first step in achieving universal health coverage by advocating health as a fundamental right, whose “denial will be justiciable”. 

• The current government spending on health care is a dismal 1.04 per cent of gross domestic product (GDP), one of the lowest in the world; this translates to Rs.957 per capita in absolute terms. The draft policy has addressed this critical issue by championing an increase in government spending to 2.5 per cent of GDP (Rs.3,800 per capita) in the next five years.

Suggestions & Concerns :

• The national programmes provide universal coverage only with respect to certain interventions such as maternal ailments, that account for less than 10 per cent of all mortalities. 
• Over 75 per cent of the communicable diseases are outside their purview and only a limited number of non-communicable diseases are covered. 
• It is, therefore, crucial for the Union government to undertake proactive measures to upgrade the health-care services of poorly performing States such as Bihar and Uttar Pradesh. 
• As it stands, health will be recognised as a fundamental right through a National Health Rights Act only when three or more States “request” it. Since health is a State subject, adoption by the respective States will be voluntary. 
• Though a different approach has been taken to improve adoption and implementation by States, the very objective of universal health coverage that hinges on portability will be defeated in the absence of uniform adoption across India. 

Why the new National Health Policy is a step in the wrong direction ? (Counter view)

• To meet the expenses, the policy draft wants to introduce a complex system that relies largely on tax collection but also proposes tapping the services of not-for-profit ventures and trusts.

• An assortment of secondary and tertiary services are proposed to be bought by the government from public and private healthcare facilities -- though it is unclear how this differs from the present system of 'empanelled' private hospitals.This system has not proved very effective for various reasons, including delayed and inadequate reimbursement of the costs.Indeed private provision and public financing is everywhere a recipe for disaster, and will serve no interests but that of private healthcare providers.

•  The new policy acknowledges that the present concept of primary healthcare covers hardly 20 per cent of the health needs and that heavy out-of-pocket health expenditure is pushing nearly 63 million people into poverty every year.It has, consequently, done well to broaden the definition of primary healthcare to include more services related to reproductive and child health as well as several infectious and non-communicable diseases.But although bringing down medical expenses has been listed among the major objectives of the new policy, it has no ideas on how to do it.

•  It is silent, for example, on regulating the private healthcare sector.
•  Though healthcare is a state subject, most states starve it of resources.

In the end, good healthcare is about effective and well-administered public provision of the basics.The Centre and states must expand public healthcare infrastructure, recruit more doctors and paramedical staff, set up new diagnostic laboratories, and revamp procurement, stocking and distribution of drugs.