A Critical Analysis of National Health Policies in India

I. Introduction

The Preamble of the Indian Constitution lays out essential values for establishing a social order in the country. An orderly society is built on the foundation of these essential ideals. To administer a democratic country like India, the ideals of equality, varied liberties, socioeconomic fairness, and individual dignity are critical. Under the policy approach, the common people's social rights will be preserved. Poverty and bad health are inextricably linked. The State is mandated by the Constitution to improve the level of nutrition, living standards, and public health. These are the primary responsibilities of the state: safeguarding employees from illness and providing varied facilities for children's healthy growth. These ideals can be established by enacting policies that promote social health. The policy framework is useful in achieving national progress goals. The policy framework is beneficial in achieving national progress goals.

II. Problem

The policy framework is beneficial in achieving national progress objectives. The concept of a healthy nation is gaining traction. When the situation was so dire, global health was given top priority. The United Nations Organization (UNO) and the World Health Organization (WHO) are two examples of multinational organisations. These organisations do public health research and development and, as a result, launch a variety of health-related programmes. As a signatory to all international declarations, covenants, conventions, and treaties, India has taken a variety of policy decisions to put the provisions of these international documents into effect. As a result, the Indian government has launched three national health policies to address existing health issues. However, the problem persists because certain aspects must be addressed. The issue of rejection of the right to health is the root cause of poor health-care conditions in India.

III. National health policy, 1983

The World Health Organization was founded in order to provide universal health care and WHO's coordinating mechanism for all member countries is guided by the United Nations Agenda on Health. All signatory states are bound by declarations, covenants, and conventions. One of its most famous declarations is the Alma Ata Declaration, which aims to strengthen primary health care, particularly in developing countries. The goal of the Alma Ata Declaration is to achieve "Health for All by 2000." Because India is a signatory to the declaration, an attempt was made to respond to it, and in 1983, the first National Health Policy was introduced.

The following were the main features of this policy:

(a) It was critical of the western health-care approach, which was centred on cures,

(b) It emphasised a primary health-care approach that is preventive, promotive, and rehabilitative,

(c) It advocated for a decentralised health-care system with low costs, de-professionalization, and participation of the community as key features,

(d) It argued that the private health-care sector should be expanded, as this would relieve the government of some of the load,

(e) It was suggested that a nationally network of epidemiological stations be established to assist the integration of various health initiatives, as well as a national network of epidemiological stations be established, and

(f) It established mostly demographic-based attainment targets.

This policy of 1983 did not adequately reflect the realities on the ground. The policy's goals were insufficient to address the needs of the general public, particularly those in rural regions. The 1983 policy’s goal of "universal, comprehensive, primary health care services" is still a long way off.

IV. National health policy, 2002

The National Health Program (NHP) was established in 1983 to expand primary health care services. It has been accomplished up to a point. The state of expansion differs from one state to the next. The community involvement and participation programme is unsatisfactory, as a specially designed plan for rural areas has failed due to the rural people's different treatment-seeking behaviour. The policy goal has been harmed because the rural population prefers private hospitals to public hospitals.

The rural population continues to use private care, and when they need primary care, they prefer to go to an urban hospital. It has prioritised curative health over preventive and promotional care.

Furthermore, public health spending is relatively low. The current annual health expenditure per capita was also very low. To address this situation, it was decided that a new policy approach, and thus NHP 2002, should be implemented. This policy was put in place to deal with the country's changing demographics. The need to revise the existing mechanism of NHP 1983 was felt.

Objectives of the 2002 policy:

• To establish a level of health for the Indian people that is acceptable.
• Decentralization of the public health system through infrastructure upgrades in existing institutions
• To guarantee that access to health care is more fair across India's socioeconomic and geographical divisions.
• To increase the private sector's contribution to providing health care for those who can afford it.
• To emphasise the prudent use of drugs.
• to broaden access to tried-and-true Traditional Medicine systems
• Priority should be given to prevention and first-line curative initiatives.

Goals of the Policy:

• Enactment of legislation governing minimum standards in clinical settings / medical institutions in 2005
• Polio and Yaws eradication
• Elimination of Leprosy
• Increase health spending in the state sector from 5.5 percent to 7 percent of the budget.
• Implementation of an integrated surveillance system, National Health Accounts, and Health Statistics
• Medical Research receives 1% of the total budget.
• 1% of total budget for Medical Research.

The availability of sufficient financial resources is essential to the success of any policy. By the year 2010, the NHP had increased health expenditure to 6% of GDP, with 2% of GDP allocated to public health investment. Furthermore, by 2005, the state should aim to raise public health spending to 7%, with an increase to 8% by 2010. By 2010, the central government's contribution would rise to 25% from the current 15%.

According to WHO data, public health spending accounts for 17.3 percent of total health spending in India, with the rest coming from clients' own pockets (82.7 percent ).²

In terms of overall planning, the current policy lacks an effective population control programme, a child nutrition programme, medical education regulation to deal with rural health care, and an insufficient financial goal for public spending.

V. National health policy, 2017

Various five-year plans (FYPs) and policies are used to develop the Indian health sector. The FYPs were guided by the NHPs 1883 and 2002, which helped them achieve their objectives.

There have been four major shifts in the context

(a) Health-care priorities are altering. Despite dramatic decreases in mother and infant mortality, noncommunicable illnesses and some infectious diseases are on the rise.

(b) The second big development is the creation of a vibrant health-care business, which is likely to grow at double-digit rates.

(c) The third shift is the growth in catastrophic expenditures as a result of rising health-care expenses, which are increasingly regarded one of the biggest causes of poverty.

(d) Rising economic growth enables more budgetary capacity. As a result, new health-policy solutions to these shifting conditions are needed.³

The present policy aims to clarify and strengthen the government's involvement in health-care spending and organised services, preventive and promotional health care, and health human resource development, among other things.

Key Policy Principles:

• Professionalism, Integrity and Ethics: The health policy pushes for the aforementioned values to be maintained across the full system of health care delivery in a credible and transparent regulatory framework.
• Equity: Policies should attempt to decrease gaps based on gender, poverty, caste, disability, other types of social exclusion, and geographic barriers, according to equity principles.
• Affordability: As health-care costs rise, affordability, rather than equity, becomes more important. Because the cost of treating a critical illness or a major illness is so high, the treatment costs must be made affordable.
• Universality: There should be no discrimination based on social, economic, or health status, according to the policy.
• Patient-centred & Quality of Care: All people should have access to patient-centered, safe, and convenient health care services in a dignified manner.
• Accountability: The health sector is crucial because the country's ultimate progress is determined by its health status. The system should be held accountable for having adequate financial resources and making decisions in a transparent manner.
• Inclusive Partnerships: For the goals to be met, the policy seeks to involve all educational institutions, non-profit organisations, and the health-care industries.
• Pluralism: The people who are sick have access to AYUSH care professionals that use documented and verified local, home, and community-based practises.
• Decentralisation: The previous NHP did not succeed in achieving active community participation in health planning. Practical considerations and institutional capacity support further decentralisation of decision-making to a specific level.
• Dynamism and Adaptiveness: A key principle for learning new knowledge from national and international partners is the dynamic organisation of health care.
• Ensuring Adequate Investment: The proposal outlines a timetable for boosting public health spending to 2.5 percent of GDP.

Preventive and Promotive Health:

The policy highlights seven areas in which concerted action is required to improve the health environment:

• Addressing tobacco, alcohol and substance abuse
• Reducing indoor and outdoor air pollution
• The Swachh Bharat Abhiyan
• Balanced, healthy diets and regular exercises.
• Nirbhaya Nari- action against gender violence
• Yatri Suraksha- preventing deaths due to rail and road traffic accidents
• Reduced stress and improved safety in the workplace

The delivery of public health care is organised in a certain way:

The concept proposes seven major policy reforms in the way health care services are organised.

1. In primary care, patients go from selected treatment to ensured comprehensive care with referrals to reference hospitals.

2. Strategic purchasing in secondary and tertiary care has changed from an input-oriented to an output-based strategy.

3. Everything is guaranteed at public hospitals, from user fees and cost collection to free drugs, diagnostics, and emergency services for everybody.

4. From a normative approach to a tailored strategy in infrastructure and human resource development to reach neglected regions.

5. From token interventions to on-scale guaranteed interventions in urban health, to organise Primary Health Care delivery and referral support for the urban poor.

6. To address the larger factors of urban health, collaboration with different sectors is recommended.

7. Integration with health systems in national health programmes for programme effectiveness and, as a result, to contribute to the strengthening of health systems for efficiency.

8. In AYUSH services, we've gone from stand-alone to three-dimensional mainstreaming.

VI. Conclusion

The right to life under Article 21 has been construed by the Supreme Court to encompass the right to health. The only thing that can meet the public health needs is the state's desire. Because India is a signatory to a number of international health treaties, The government is required by law to safeguard the right to health. Finally, it can be stated that making the best use of available resources and funds for public health will improve the state of public health to the point where the government will enact national legislation guaranteeing the right to health.

In a welfare state like India, the government's primary responsibility is to the people. Because the current situation is inadequate, the Union Government has categorically rejected making the Right to Health a legal right by enacting a special law. The current state of the health sector, for which both the federal and state governments are responsible, is one of the reasons why the right to health is not recognised as a justiciable right. It will only be possible if both the federal and state governments are willing to cooperate.

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VII. References

1. Ministry of Health and Family Welfare (Govt. of India), National Health Policy - 1983, New Delhi.

2. Ministry of Health & Family Welfare (Govt. of India), National Health Policy - 2002, New Delhi.

3. World Health Report 2000, Health Systems Improving Performance, Geneva: World Health Organisation; 2002.

4. Ministry of Health & Family Welfare (Govt. of India), National Health Policy- 2017, New Delhi.

5. GOPAKUMAR K. M. National Health Policy 2017 and Right to Health: Negation of Reality, available athttp://www.livelaw.in/national-health-policy-2017-right-health-negation-reality/

6. Gupta RK, Kumari R. National health policy 2017: an overview. JK Sci. 2017;19(3):135–136.

7. Kishore J. Legislation and health promotion in India. DRUNPP Rev Global Med Healthcare Res. 2012;3(2):75–87.

8. Brinkerhoff, D. W. (2004). Accountability and health systems: Toward conceptual clarity and policy relevance. Health Policy and Planning, 19(6), 371–379.

9. Shankardass, K., Muntaner, C., Kokkinen, L., Shahidi, F. V., Freiler, A., Oneka, G., … O’Campo, P. (2018). The implementation of Health in All Policies initiatives: A systems framework for government action. Health Research Policy and Systems, 16(1), 26.

10. Brinkerhoff, D. W. (2004). Accountability and health systems: Toward conceptual clarity and policy relevance. Health

11. Policy and Planning, 19(6), 371–37

12. Brinkerhoff, D. W. (2004). Accountability and health systems: Toward conceptual clarity and policy relevance. Health

13. Policy and Planning, 19(6), 371–379

14. Brinkerhoff, D. W. (2004). Accountability and health systems: Toward conceptual clarity and policy relevance. Health Policy and Planning, 19(6), 371–37

Footnotes

1. Author is an Advocate in India.

2. World Health Report 2000, Health Systems Improving Performance, Geneva: World Health Organisation; 2002. ↩

3. Ministry of Health & Family Welfare (Govt. of India), National Health Policy- 2017, New Delhi. ↩