Introduction
The National Health Policy of 1983 and the National Health Policy of 2002 have served well
in guiding the approach for the health sector in the Five-Year Plans. Now 14 years after the last health
policy, the context has changed in four major ways. First, the health priorities are changing. Although
maternal and child mortality have rapidly declined, there is growing burden on account of noncommunicable
diseases and some infectious diseases. The second important change is the emergence
of a robust health care industry estimated to be growing at double digit. The third change is the
growing incidences of catastrophic expenditure due to health care costs, which are presently estimated
to be one of the major contributors to poverty. Fourth, a rising economic growth enables enhanced
fiscal capacity. Therefore, a new health policy responsive to these contextual changes is required.
The primary aim of the National Health Policy, 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.
NHP 2017 builds on the progress made since the last NHP 2002. The developments have
been captured in the document “Backdrop to National Health Policy 2017- Situation Analyses”,
Ministry of Health & Family Welfare, Government of India.
2. Goal, Principles and Objectives
2.1 Goal
The policy envisages as its 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 Sustainable Development Goals (SDGs). An
indicative list of time bound quantitative goals aligned to ongoing national efforts as well as the global
strategic directions is detailed at the end of this section.
2.2 Key Policy Principles
I. Professionalism, Integrity and Ethics: The health policy commits itself to the highest
professional standards, integrity and ethics to be maintained in the entire system of health care
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delivery in the country, supported by a credible, transparent and responsible regulatory
environment.
II. Equity: Reducing inequity would mean affirmative action to reach the poorest. It would mean
minimizing disparity on account of gender, poverty, caste, disability, other forms of social
exclusion and geographical barriers. It would imply greater investments and financial protection for
the poor who suffer the largest burden of disease.
III. Affordability: As costs of care increases, affordability, as distinct from equity, requires emphasis.
Catastrophic household health care expenditures defined as health expenditure exceeding 10% of
its total monthly consumption expenditure or 40% of its monthly non-food consumption
expenditure, are unacceptable.
IV. Universality: Prevention of exclusions on social, economic or on grounds of current health status.
In this backdrop, systems and services are envisaged to be designed to cater to the entire
population- including special groups.
V. Patient Centered & Quality of Care: Gender sensitive, effective, safe, and convenient healthcare
services to be provided with dignity and confidentiality. There is need to evolve and disseminate
standards and guidelines for all levels of facilities and a system to ensure that the quality of
healthcare is not compromised.
VI. Accountability: Financial and performance accountability, transparency in decision making, and
elimination of corruption in health care systems, both in public and private.
VII. Inclusive Partnerships: A multistakeholder approach with partnership & participation of all nonhealth
ministries and communities. This approach would include partnerships with academic
institutions, not for profit agencies, and health care industry as well.
VIII. Pluralism: Patients who so choose and when appropriate, would have access to AYUSH care
providers based on documented and validated local, home and community based practices. These
systems, inter alia, would also have Government support in research and supervision to develop
and enrich their contribution to meeting the national health goals and objectives through
integrative practices.
IX. Decentralization: Decentralisation of decision making to a level as is consistent with practical
considerations and institutional capacity. Community participation in health planning processes, to
be promoted side by side.
X. Dynamism and Adaptiveness: constantly improving dynamic organization of health care based
on new knowledge and evidence with learning from the communities and from national and
international knowledge partners is designed.
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2.3 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.
2.3.1 Progressively achieve Universal Health Coverage
A. Assuring availability of free, comprehensive primary health care services, for all aspects of
reproductive, maternal, child and adolescent health and for the most prevalent communicable,
non-communicable and occupational diseases in the population. The Policy also envisages
optimum use of existing manpower and infrastructure as available in the health sector and
advocates collaboration with non -government sector on pro-bono basis for delivery of health
care services linked to a health card to enable every family to have access to a doctor of their
choice from amongst those volunteering their services.
B. Ensuring improved access and affordability, of quality secondary and tertiary care services
through a combination of public hospitals and well measured strategic purchasing of services in
health care deficit areas, from private care providers, especially the not-for profit providers
C. Achieving a significant reduction in out of pocket expenditure due to health care costs and
achieving reduction in proportion of households experiencing catastrophic health expenditures
and consequent impoverishment.
2.3.2 Reinforcing trust in Public Health Care System: Strengthening the trust of the common man
in public health care system by making it predictable, efficient, patient centric, affordable and
effective, with a comprehensive package of services and products that meet immediate health care
needs of most people.
2.3.3 Align the growth of private health care sector with public health goals: Influence the
operation and growth of the private health care sector and medical technologies to ensure
alignment with public health goals. Enable private sector contribution to making health care
systems more effective, efficient, rational, safe, affordable and ethical. Strategic purchasing by the
Government to fill critical gaps in public health facilities would create a demand for private health
care sector, in alignment with the public health goals.
2.4 Specific Quantitative Goals and Objectives: The indicative, quantitative goals and objectives are
outlined under three broad components viz. (a) health status and programme impact, (b) health
systems performance and (c) health system strengthening. These goals and objectives are aligned to
achieve sustainable development in health sector in keeping with the policy thrust.
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2.4.1 Health Status and Programme Impact
2.4.1.1 Life Expectancy and healthy life
a. Increase Life Expectancy at birth from 67.5 to 70 by 2025.
b. Establish regular tracking of Disability Adjusted Life Years (DALY) Index as a measure of
burden of disease and its trends by major categories by 2022.
c. Reduction of TFR to 2.1 at national and sub-national level by 2025.
2.4.1.2 Mortality by Age and/ or cause
a. Reduce Under Five Mortality to 23 by 2025 and MMR from current levels to 100 by 2020.
b. Reduce infant mortality rate to 28 by 2019.
c. Reduce neo-natal mortality to 16 and still birth rate to “single digit” by 2025.
2.4.1.3 Reduction of disease prevalence/ incidence
a. Achieve global target of 2020 which is also termed as target of 90:90:90, for HIV/AIDS i. e,-
90% of all people living with HIV know their HIV status, - 90% of all people diagnosed with
HIV infection receive sustained antiretroviral therapy and 90% of all people receiving
antiretroviral therapy will have viral suppression.
b. Achieve and maintain elimination status of Leprosy by 2018, Kala-Azar by 2017 and Lymphatic
Filariasis in endemic pockets by 2017.
c. 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.
d. To reduce the prevalence of blindness to 0.25/ 1000 by 2025 and disease burden by one third
from current levels.
e. To reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic
respiratory diseases by 25% by 2025.
2.4.2 Health Systems Performance
2.4.2.1 Coverage of Health Services
a. Increase utilization of public health facilities by 50% from current levels by 2025.
b. Antenatal care coverage to be sustained above 90% and skilled attendance at birth above 90%
by 2025.
c. More than 90% of the newborn are fully immunized by one year of age by 2025.
d. Meet need of family planning above 90% at national and sub national level by 2025.
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e. 80% of known hypertensive and diabetic individuals at household level maintain „controlled
disease status‟ by 2025.
2.4.2.2 Cross Sectoral goals related to health
a. Relative reduction in prevalence of current tobacco use by 15% by 2020 and 30% by 2025.
b. Reduction of 40% in prevalence of stunting of under-five children by 2025.
c. Access to safe water and sanitation to all by 2020 (Swachh Bharat Mission).
d. Reduction of occupational injury by half from current levels of 334 per lakh agricultural
workers by 2020.
e. National/ State level tracking of selected health behaviour.
2.4.3 Health Systems strengthening
2.4.3.1 Health finance
a. Increase health expenditure by Government as a percentage of GDP from the existing 1.15%
to 2.5 % by 2025.
b. Increase State sector health spending to > 8% of their budget by 2020.
c. Decrease in proportion of households facing catastrophic health expenditure from the current
levels by 25%, by 2025.
2.4.3.2 Health Infrastructure and Human Resource
a. Ensure availability of paramedics and doctors as per Indian Public Health Standard (IPHS)
norm in high priority districts by 2020.
b. Increase community health volunteers to population ratio as per IPHS norm, in high priority
districts by 2025.
c. Establish primary and secondary care facility as per norms in high priority districts (population
as well as time to reach norms) by 2025.
2.4.3.3 Health Management Information
a. Ensure district-level electronic database of information on health system components by 2020.
b. Strengthen the health surveillance system and establish registries for diseases of public health
importance by 2020.
c. Establish federated integrated health information architecture, Health Information Exchanges
and National Health Information Network by 2025.
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3. Policy Thrust
3.1 Ensuring Adequate Investment The policy proposes a potentially achievable target of raising
public health expenditure to 2.5% of the GDP in a time bound manner. It envisages that the
resource allocation to States will be linked with State development indicators, absorptive capacity and
financial indicators. The States would be incentivised for incremental State resources for public
health expenditure. General taxation will remain the predominant means for financing care. The
Government could consider imposing taxes on specific commodities- such as the taxes on tobacco,
alcohol and foods having negative impact on health, taxes on extractive industries and pollution cess.
Funds available under Corporate Social Responsibility would also be leveraged for well-focused
programmes aiming to address health goals.
3.2 Preventive and Promotive Health The policy articulates to institutionalize inter-sectoral
coordination at national and sub-national levels to optimize health outcomes, through constitution of
bodies that have representation from relevant non-health ministries. This is in line with the emergent
international “Health in All” approach as complement to Health for All. The policy prerequisite is
for an empowered public health cadre to address social determinants of health effectively, by
enforcing regulatory provisions.
The policy identifies coordinated action on seven priority areas for improving the
environment for health:
o The Swachh Bharat Abhiyan
o Balanced, healthy diets and regular exercises.
o Addressing tobacco, alcohol and substance abuse
o Yatri Suraksha – preventing deaths due to rail and road traffic accidents
o Nirbhaya Nari –action against gender violence
o Reduced stress and improved safety in the work place
o Reducing indoor and outdoor air pollution
The policy also articulates the need for the development of strategies and institutional
mechanisms in each of these seven areas, to create Swasth Nagrik Abhiyan –a social movement for
health. It recommends setting indicators, their targets as also mechanisms for achievement in each of
these areas.
The policy recognizes and builds upon preventive and promotive care as an under-recognized
reality that has a two-way continuity with curative care, provided by health agencies at same or at
higher levels. The policy recommends an expansion of scope of interventions to include early
detection and response to early childhood development delays and disability, adolescent and sexual
health education, behavior change with respect to tobacco and alcohol use, screening, counseling for
primary prevention and secondary prevention from common chronic illness –both communicable and
non-communicable diseases. Additionally the policy focus is on extending coverage as also quality of
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the existing package of services. Policy recognizes the need to frame and adhere to health screening
guidelines across age groups. Zoonotic diseases like rabies need to be addressed through concerted
and coordinated action, at the national front and through strengthening of the National Rabies
Control Programme.
The policy lays greater emphasis on investment and action in school health- by incorporating
health education as part of the curriculum, promoting hygiene and safe health practices within the
school environs and by acting as a site of primary health care. Promotion of healthy living and
prevention strategies from AYUSH systems and Yoga at the work-place, in the schools and in the
community would also be an important form of health promotion that has a special appeal and
acceptability in the Indian context.
Recognizing the risks arising from physical, chemical, and other workplace hazards, the policy
advocates for providing greater focus on occupational health. Work-sites and institutions would be
encouraged and monitored to ensure safe health practices and accident prevention, besides providing
preventive and promotive healthcare services.
ASHA will also be supported by other frontline workers like health workers (male/female) to
undertake primary prevention for non-communicable diseases. They would also provide community
or home based palliative care and mental health services through health promotion activities. These
workers would get support from local self-government and the Village Health Sanitation and
Nutrition Committee (VHSNC).
In order to build community support and offer good healthcare to the vulnerable sections of
the society like the marginalised, the socially excluded, the poor, the old and the disabled, the policy
recommends strengthening the VHSNCs and its equivalent in the urban areas.
„Health Impact Assessment‟ of existing and emerging policies, of key non-health departments
that directly or indirectly impact health would be taken up.
3.3 Organization of Public Health Care Delivery: The policy proposes seven key policy shifts in
organizing health care services
o In primary care – from selective care to assured comprehensive care with linkages to referral
hospitals
o In secondary and tertiary care – from an input oriented to an output based strategic purchasing
o In public hospitals – from user fees & cost recovery to assured free drugs, diagnostic and
emergency services to all
o In infrastructure and human resource development – from normative approach to targeted
approach to reach under-serviced areas
o In urban health – from token interventions to on-scale assured interventions, to organize
Primary Health Care delivery and referral support for urban poor. Collaboration with other
sectors to address wider determinants of urban health is advocated.
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o In National Health Programmes – integration with health systems for programme effectiveness
and in turn contributing to strengthening of health systems for efficiency.
o In AYUSH services – from stand-alone to a three dimensional mainstreaming
Free primary care provision by the public sector, supplemented by strategic purchase of
secondary care hospitalization and tertiary care services from both public and from non-government
sector to fill critical gaps would be the main strategy of assuring healthcare services. The policy
envisages strategic purchase of secondary and tertiary care services as a short term measure. Strategic
purchasing refers to the Government acting as a single payer. The order of preference for strategic
purchase would be public sector hospitals followed by not-for profit private sector and then
commercial private sector in underserved areas, based on availability of services of acceptable and
defined quality criteria. In the long run, the policy envisages to have fully equipped and functional
public sector hospitals in these areas to meet secondary and tertiary health care needs of population,
especially the poorest and marginalized. Public facilities would remain the focal point in the healthcare
delivery system and services in the public health facilities would be expanded from current levels. The
policy recognizes the special health needs of tribal and socially vulnerable population groups and
recommends situation specific measures in provisioning and delivery of services. The policy advocates
enhanced outreach of public healthcare through Mobile Medical Units (MMUs), etc. Tribal population
in the country is over 100 million (Census 2011), and hence deserves special attention keeping in mind
their geographical and infrastructural challenges. Keeping in view the high cost involved in
provisioning and managing orphan diseases, the policy encourages active engagement with nongovernment
sector for addressing the situation. In order to provide access and financial protection at
secondary and tertiary care levels, the policy proposes free drugs, free diagnostics and free emergency
care services in all public hospitals. To address the growing challenges of urban health, the policy
advocates scaling up National Urban Health Mission (NUHM) to cover the entire urban population
within the next five years with sustained financing.
For effectively handling medical disasters and health security, the policy recommends that the
public healthcare system retain a certain excess capacity in terms of health infrastructure, human
resources, and technology which can be mobilized in times of crisis.
In order to leverage the pluralistic health care legacy, the policy recommends mainstreaming
the different health systems. This would involve increasing the validation, evidence and research of
the different health care systems as a part of the common pool of knowledge. It would also involve
providing access and informed choice to the patients, providing an enabling environment for practice
of different systems of medicine, an enabling regulatory framework and encouraging cross referrals
across these systems.
3.3.1 Primary Care Services and Continuity of Care:
This policy denotes important change from very selective to comprehensive primary health
care package which includes geriatric health care, palliative care and rehabilitative care services. The
facilities which start providing the larger package of comprehensive primary health care will be called
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„Health and Wellness Centers‟. Primary care must be assured. To make this a reality, every family
would have a health card that links them to primary care facility and be eligible for a defined package
of services anywhere in the country. The policy recommends that health centres be established on
geographical norms apart from population norms. To provide comprehensive care, the policy
recommends a matching human resources development strategy, effective logistics support system
and referral backup. This would also necessitate upgradation of the existing sub-centres and
reorienting PHCs to provide comprehensive set of preventive, promotive, curative and rehabilitative
services. It would entail providing access to assured AYUSH healthcare services, as well as support
documentation and validation of local home and community based practices. The policy also
advocates for research and validation of tribal medicines. Leveraging the potential of digital health for
two way systemic linkages between the various levels of care viz., primary, secondary and tertiary,
would ensure continuity of care. The policy advocates that the public health system would put in place
a gatekeeping mechanism at primary level in a phased manner, accompanied by an effective feedback
and follow-up mechanism.
3.3.2 Secondary Care Services:
The policy aspires to provide at the district level most of the secondary care which is currently
provided at a medical college hospital. Basic secondary care services, such as caesarian section and
neonatal care would be made available at the least at sub-divisional level in a cluster of few blocks. To
achieve this, policy therefore aims:
o To have at least two beds per thousand population distributed in such a way that it is accessible
within golden hour rule. This implies an efficient emergency transport system. The policy also aims
that ten categories of what are currently specialist skills be available within the district. Additionally
four or at least five of these specialist skill categories be available at sub-district levels. This may be
achieved by strengthening the district hospital and a well-chosen, well located set of sub-district
hospitals.
o Resource allocation that is responsive to quantity, diversity and quality of caseloads provided.
o Purchasing care after due diligence from non-Government hospitals as a short term strategy till
public systems are strengthened.
Policy proposes a responsive and strong regulatory framework to guide purchasing of care
from non-government sector so that challenges of quality of care, cost escalations and impediments to
equity are addressed effectively.
In order to develop the secondary care sector, comprehensive facility development and
obligations with regard to human resources, especially specialists needs, are to be prioritized. To this
end the policy recommends a scheme to develop human resources and specialist skills.
Access to blood and blood safety has been a major concern in district healthcare services. This
policy affirms in expanding the network of blood banks across the country to ensure improved access
to safe blood.
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3.3.3 Re-Orienting Public Hospitals:
Public hospitals have to be viewed as part of tax financed single payer health care system,
where the care is pre-paid and cost efficient. This outlook implies that quality of care would be
imperative and the public hospitals and facilities would undergo periodic measurements and
certification of level of quality. The policy endorses that the public hospitals would provide universal
access to a progressively wide array of free drugs and diagnostics with suitable leeway to the States to
suit their context. The policy seeks to eliminate the risks of inappropriate treatment by maintaining
adequate standards of diagnosis and treatment. Policy recognizes the need for an information system
with comprehensive data on availability and utilization of services not only in public hospitals but also
in non-government sector hospitals. State public health systems should be able to provide all
emergency health services other than services covered under national health programmes.
3.3.4 Closing Infrastructure and Human Resources/Skill Gaps:
The policy duly acknowledges the roadmap of the 12th Five Year Plan for managing human
resources for health. The policy initiatives aim for measurable improvements in quality of care.
Districts and blocks which have wider gaps for development of infrastructure and deployment of
additional human resources would receive focus. Financing for additional infrastructure or human
resources would be based on needs of outpatient and inpatient attendance and utilization of key
services in a measurable manner.
3.3.5 Urban Health Care:
National health policy prioritizes addressing the primary health care needs of the urban
population with special focus on poor populations living in listed and unlisted slums, other vulnerable
populations such as homeless, rag-pickers, street children, rickshaw pullers, construction workers, sex
workers and temporary migrants. Policy would also prioritize the utilization of AYUSH personnel in
urban health care. Given the large presence of private sector in urban areas, policy recommends
exploring the possibilities of developing sustainable models of partnership with for profit and not for
profit sector for urban health care delivery. An important focus area of the urban health policy will be
achieving convergence among the wider determinants of health – air pollution, better solid waste
management, water quality, occupational safety, road safety, housing, vector control, and reduction of
violence and urban stress. These dimensions are also important components of smart cities.
Healthcare needs of the people living in the peri urban areas would also be addressed under the
NUHM. Further, Non-Communicable Diseases (NCDs) like hyper tension, diabetes which are
predominant in the urban areas would be addressed under NUHM, through planned early detection.
Better secondary prevention would also be an integral part of the urban health strategy. Improved
health seeking behavior, influenced through capacity building of the community based organizations
& establishment of an appropriate referral mechanism, would also be important components of this
strategy.
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4. National Health Programmes
4.1 RMNCH+A services: Maternal and child survival is a mirror that reflects the entire spectrum of
social development. This policy aspires to elicit developmental action of all sectors to support Maternal
and Child survival. The policy strongly recommends strengthening of general health systems to prevent
and manage maternal complications, to ensure continuity of care and emergency services for maternal
health. In order to comprehensively address factors affecting maternal and child survival, the policy
seeks to address the social determinants through developmental action in all sectors.
4.2 Child and Adolescent Health: The policy endorses the national consensus on accelerated
achievement of neonatal mortality targets and „single digit‟ stillbirth rates through improved home
based and facility based management of sick newborns. District hospitals must ensure screening and
treatment of growth related problems, birth defects, genetic diseases and provide palliative care for
children. The policy affirms commitment to pre-emptive care (aimed at pre-empting the occurrence of
diseases) to achieve optimum levels of child and adolescent health. The policy envisages school health
programmes as a major focus area as also health and hygiene being made a part of the school
curriculum. The policy gives special emphasis to the health challenges of adolescents and long term
potential of investing in their health care. The scope of Reproductive and Sexual Health should be
expanded to address issues like inadequate calorie intake, nutrition status and psychological problems
interalia linked to misuse of technology, etc.
4.3 Interventions to Address Malnutrition and Micronutrient Deficiencies: Malnutrition, especially
micronutrient deficiencies, restricts survival, growth and development of children. It contributes to
morbidity and mortality in vulnerable population, resulting in substantial diminution in productive
capacity in adulthood and consequent reduction in the nation‟s economic growth and well-being.
Recognising this, the policy declares that micronutrient deficiencies would be addressed through a wellplanned
strategy on micronutrient interventions. Focus would be on reducing micronutrient
malnourishment and augmenting initiatives like micro nutrient supplementation, food fortification,
screening for anemia and public awareness. A systematic approach to address heterogeneity in
micronutrient adequacy across regions in the country with focus on the more vulnerable sections of
the population, is needed. Hence, screening for multiple micronutrient deficiencies is advocated.
During the critical period of pregnancy, lactation, early childhood, adolescence and old age, the
consequences of deficiencies are particularly severe and many are irreversible. While dietary
diversification remains the most desirable way forward, supplementation and fortification require to be
considered as short and medium term solutions to fill nutrient gaps. The present efforts of Iron Folic
Acid(IFA) supplementation, calcium supplementation during pregnancy, iodized salt, Zinc and Oral
Rehydration Salts/Solution(ORS), Vitamin A supplementation, needs to be intensified and increased.
Sustained efforts are to be made to ensure outreach to every beneficiary, which in turn necessitates that
intensive monitoring mechanisms are put in place. The policy advocates developing a strong evidence
base, of the burden of collective micronutrient deficiencies, which should be correlated with disease
burden and in particular for understanding the etiology of anemia. Policy recommends exploring
fortified food and micronutrient sprinkles for addressing deficiencies through Anganwadi centers and
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schools. Recognising the complementary role of various nutrition-sensitive interventions from
different platforms, the policy calls for synergy of inputs from departments like Women and Child
Development, Education, WASH, Agriculture and Food and Civil Supplies. Policy envisages that the
MoHFW would take on the role of convener to monitor and ensure effective integration of both
nutrition-sensitive and nutrition-specific interventions for coordinated optimal results.
4.4 Universal Immunization: Priority would be to further improve immunization coverage with quality
and safety, improve vaccine security as per National Vaccine Policy 2011 and introduction of newer
vaccines based on epidemiological considerations. The focus will be to build upon the success of
Mission Indradhanush and strengthen it.
4.5 Communicable Diseases: The policy recognizes the interrelationship between communicable disease
control programmes and public health system strengthening. For Integrated Disease Surveillance
Programme, the policy advocates the need for districts to respond to the communicable disease
priorities of their locality. This could be through network of well-equipped laboratories backed by
tertiary care centers and enhanced public health capacity to collect, analyze and respond to the disease
outbreaks.
4.5.1 Control of Tuberculosis: The policy acknowledges HIV and TB co infection and increased incidence
of drug resistant tuberculosis as key challenges in control of Tuberculosis. The policy calls for more
active case detection, with a greater involvement of private sector supplemented by preventive and
promotive action in the workplace and in living conditions. Access to free drugs would need to be
complemented by affirmative action to ensure that the treatment is carried out, dropouts reduced and
transmission of resistant strains are contained.
4.5.2 Control of HIV/AIDS: While the current emphasis on prevention continues, the policy recommends
focused interventions on the high risk communities (MSM, Transgender, FSW, etc.) and prioritized
geographies. There is a need to support care and treatment for people living with HIV/AIDS through
inclusion of 1st, 2nd and 3rd line antiretroviral(ARV), Hep-C and other costly drugs into the essential
medical list.
4.5.3 Leprosy Elimination: To carry out Leprosy elimination the proportion of grade-2 cases amongst new
cases will become the measure of community awareness and health systems capacity, keeping in mind
the global goal of reduction of grade 2 disability to less than 1 per million by 2020. Accordingly, the
policy envisages proactive measures targeted towards elimination of leprosy from India by 2018.
4.5.4 Vector Borne Disease Control: The policy recognizes the challenge of drug resistance in Malaria,
which should be dealt with by changing treatment regimens with logistics support as appropriate. New
National Programme for prevention and control of Japanese Encephalitis (JE)/Acute Encephalitis
Syndrome (AES) should be accelerated with strong component of inter-sectoral collaboration.
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The policy recognizes the interrelationship between communicable disease control
programmes and public health system strengthening. Every one of these programmes requires a
robust public health system as their core delivery strategy. At the same time, these programmes also
lead to strengthening of healthcare systems.
4.6 Non-Communicable Diseases: The policy recognizes the need to halt and reverse the growing
incidence of chronic diseases. The policy recommends to set-up a National Institute of Chronic
Diseases including Trauma, to generate evidence for adopting cost effective approaches and to
showcase best practices. This policy will support an integrated approach where screening for the most
prevalent NCDs with secondary prevention would make a significant impact on reduction of
morbidity and preventable mortality. This would be incorporated into the comprehensive primary
health care network with linkages to specialist consultations and follow up at the primary level.
Emphasis on medication and access for select chronic illness on a „round the year‟ basis would be
ensured. Screening for oral, breast and cervical cancer and for Chronic Obstructive Pulmonary
Disease (COPD) will be focused in addition to hypertension and diabetes. The policy focus is also on
research. It emphasizes developing protocol for mainstreaming AYUSH as an integrated medical care.
This has a huge potential for effective prevention and therapy, that is safe and cost-effective. Further
the policy commits itself to support programmes for prevention of blindness, deafness, oral health,
endemic diseases like fluorosis and sickle cell anaemia/thalassemia,etc. The National Health Policy
commits itself to culturally appropriate community centered solutions to meet the health needs of the
ageing community in addition to compliance with constitutional obligations as per the Maintenance
and Welfare of Parents and Senior Citizens Act, 2007. The policy recognizes the growing need for
palliative and rehabilitative care for all geriatric illnesses and advocates the continuity of care across all
levels. The policy recognizes the critical need of meeting the growing demand of tissue and organ
transplant in the country and encourages widespread public awareness to promote voluntary
donations.
4.7 Mental Health: This policy will take into consideration the provisions of the National Mental Health
Policy 2014 with simultaneous action on the following fronts:
o Increase creation of specialists through public financing and develop special rules to give
preference to those willing to work in public systems.
o Create network of community members to provide psycho-social support to strengthen
mental health services at primary level facilities and
o Leverage digital technology in a context where access to qualified psychiatrists is difficult.
4.8 Population Stabilization: The National Health Policy recognises that improved access, education
and empowerment would be the basis of successful population stabilization. The policy imperative is
to move away from camp based services with all its attendant problems of quality, safety and dignity
of women, to a situation where these services are available on any day of the week or at least on a
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fixed day. Other policy imperatives are to increase the proportion of male sterilization from less than
5% currently, to at least 30% and if possible much higher.
5. Women’s Health & Gender Mainstreaming: There will be enhanced provisions for reproductive
morbidities and health needs of women beyond the reproductive age group (40+) This would be in
addition to package of services covered in the previous paragraphs.
6. Gender based violence (GBV): Women‟s access to healthcare needs to be strengthened by making
public hospitals more women friendly and ensuring that the staff have orientation to gender –
sensitivity issues. This policy notes with concern the serious and wide ranging consequences of GBV
and recommends that the health care to the survivors/ victims need to be provided free and with
dignity in the public and private sector.
7. Supportive Supervision: For supportive supervision in more vulnerable districts with inadequate
capacity, the policy will support innovative measures such as use of digital tools and HR strategies like
using nurse trainers to support field workers.
8. Emergency Care and Disaster Preparedness: Better response to disasters, both natural and
manmade, requires a dispersed and effective capacity for emergency management. It requires an army
of community members trained as first responder for accidents and disasters. It also requires regular
strengthening of their capacities in close collaboration with the local self-government and community
based organisations. The policy supports development of earthquake and cyclone resistant health
infrastructure in vulnerable geographies. It also supports development of mass casualty management
protocols for CHC and higher facilities and emergency response protocols at all levels. To respond to
disasters and emergencies, the public healthcare system needs to be adequately skilled and equipped at
defined levels, so as to respond effectively during emergencies. The policy envisages creation of a
unified emergency response system, linked to a dedicated universal access number, with network of
emergency care that has an assured provision of life support ambulances, trauma management centers–
o one per 30 lakh population in urban areas and
o one for every 10 lakh population in rural areas
9. Mainstreaming the Potential of AYUSH: For persons who so choose, this policy ensures access to
AYUSH remedies through co-location in public facilities. Yoga would be introduced much more
widely in school and work places as part of promotion of good health as adopted in National AYUSH
Mission (NAM). The policy recognizes the need to standardize and validate Ayurvedic medicines and
establish a robust and effective quality control mechanism for AUSH drugs. Policy recognizes the
need to nurture AYUSH system of medicine, through development of infrastructural facilities of
teaching institutions, improving quality control of drugs, capacity building of institutions and
professionals. In addition, it recognizes the need for building research and public health skills for
preventive and promotive healthcare. Linking AYUSH systems with ASHAs and VHSNCs would be
an important plank of this policy. The National Health Policy would continue mainstreaming of
AYUSH with general health system but with the addition of a mandatory bridge course that gives
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competencies to mid-level care provider with respect to allopathic remedies. The policy further
supports the integration of AYUSH systems at the level of knowledge systems, by validating processes
of health care promotion and cure. The policy recognizes the need for integrated courses for Indian
System of Medicine, Modern Science and Ayurgenomics. It puts focus on sensitizing practitioners of
each system to the strengths of the others. Further the development of sustainable livelihood systems
through involving local communities and establishing forward and backward market linkages in
processing of medicinal plants will also be supported by this policy. The policy seeks to strengthen
steps for farming of herbal plants. Developing mechanisms for certification of „prior knowledge‟ of
traditional community health care providers and engaging them in the conservation and generation of
the raw materials required, as well as creating opportunities for enhancing their skills are part of this
policy.
10. Tertiary care Services: The policy affirms that the tertiary care services are best organized along lines
of regional, zonal and apex referral centers. It recommends that the Government should set up new
Medical Colleges, Nursing Institutions and AIIMS in the country following this broad principle.
Regional disparities in distribution of these institutions must be addressed. The policy supports
periodic review and standardization of fee structure and quality of clinical training in the private sector
medical colleges. The policy enunciates the core principle of societal obligation on the part of private
institutions to be followed. This would include:
o Operationalization of mechanisms for referral from public health system
to charitable hospitals.
o Ensuring that deserving patients can be admitted on designated free /
subsidized beds.
The policy proposes to consider forms of resource generation, where corporate hospitals and
medical tourism earnings are through a high degree of associated hospitality arrangements and on
account of certain procedures and services, as a form of resource mobilization towards the health
sector. The policy recommends establishing National Healthcare Standards Organization and to
develop evidence based standard guidelines of care applicable both to public and private sector. The
policy shows the way forward in developing partnership with non-government sector through
empaneling the socially motivated and committed tertiary care centers into the Government efforts to
close the specialist gap.
To expand public provisioning of tertiary services, the Government would additionally
purchase select tertiary care services from empaneled non-government sector hospitals to assist the
poor. Coverage in terms of population and services will expand gradually. The policy recognizes
development of evidence based standard guidelines of care, applicable both to public and private
sector as essential.
11. Human Resources for Health: There is a need to align decisions regarding judicious growth of
professional and technical educational institutions in the health sector, better financing of professional
and technical education, defining professional boundaries and skill sets, reshaping the pedagogy of
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professional and technical education, revisiting entry policies into educational institutions, ensuring
quality of education and regulating the system to generate the right mix of skills at the right place. This
policy recommends that medical and para-medical education be integrated with the service delivery
system, so that the students learn in the real environment and not just in the confines of the medical
school. The key principle around the policy on human resources for health is that, workforce
performance of the system would be best when we have the most appropriate person, in terms of both
skills and motivation, for the right job in the right place, working within the right professional and
incentive environment.
11.1 Medical Education: The policy recommends strengthening existing medical colleges and converting
district hospitals to new medical colleges to increase number of doctors and specialists, in States with
large human resource deficit. The policy recognizes the need to increase the number of post graduate
seats. The policy supports expanding the number of AIIMS like centers for continuous flow of faculty
for medical colleges, biomedical and clinical research. National Knowledge Network shall be used for
Tele-education, Tele-CME, Tele-consultations and access to digital library. A common entrance exam is
advocated on the pattern of NEET for UG entrance at All India level; a common national-level
Licentiate/exit exam for all medical and nursing graduates; a regular renewal at periodic intervals with
Continuing Medical Education (CME) credits accrued, are important recommendations. This policy
recommends that the current pattern of MCQ (Multiple Choice Question) based entrance test for post
graduates medical courses- that drive students away from practical learning- should be reviewed. The
policy recognizes the need to revise the under graduate and post graduate medical curriculum keeping
in view the changing needs, technology and the newer emerging disease trends. Keeping in view, the
rapid expansion of medical colleges in public and private sector there is an urgent need to review
existing institutional mechanisms to regulate and ensure quality of training and education being
imparted. The policy recommends that the discussion on recreating a regulatory structure for health
professional education be revisited to address the emerging needs and challenges.
11.2 Attracting and Retaining Doctors in Remote Areas: Policy proposes financial and non-financial
incentives, creating medical colleges in rural areas; preference to students from under-serviced areas,
realigning pedagogy and curriculum to suit rural health needs, mandatory rural postings, etc. Measures
of compulsion- through mandatory rotational postings dovetailed with clear and transparent career
progression guidelines are valuable strategies. A constant effort, therefore, needs to be made to increase
the capacity of the public health systems to absorb and retain the manpower. The total sanctioned posts
of doctors in the public sector should increase to ensure availability of doctors corresponding to the
accepted norms. Exact package of policy measures would vary from State to State and would change
over time.
11.3 Specialist Attraction and Retention: Proposed policy measures include - recognition of educational
options linked with National Board of Examination & College of Physicians and Surgeons, creation of
specialist cadre with suitable pay scale, up-gradation of short term training to medical officers to
provide basic specialist services at the block and district level, performance linked payments and
popularise MD (Doctor of Medicine) course in Family Medicine or General Practice. The policy
recommends that the National Board of Examinations should expand the post graduate training up to
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the district level. The policy recommends creation of a large number of distance and continuing
education options for general practitioners in both the private and the public sectors, which would
upgrade their skills to manage the large majority of cases at local level, thus avoiding unnecessary
referrals.
11.4 Mid-Level Service Providers: For expansion of primary care from selective care to comprehensive
care, complementary human resource strategy is the development of a cadre of mid-level care providers.
This can be done through appropriate courses like a B.Sc. in community health and/or through
competency-based bridge courses and short courses. These bridge courses could admit graduates from
different clinical and paramedical backgrounds like AYUSH doctors, B.Sc. Nurses, Pharmacists, GNMs,
etc and equip them with skills to provide services at the sub-centre and other peripheral levels. Locale
based selection, a special curriculum of training close to the place where they live and work, conditional
licensing, enabling legal framework and a positive practice environment will ensure that this new cadre
is preferentially available where they are needed most, i.e. in the under-served areas.
11.5 Nursing Education: The policy recognises the need to improve regulation and quality management of
nursing education. Other measures suggested are - establishing cadres like Nurse Practitioners and
Public Health Nurses to increase their availability in most needed areas. Developing specialized nursing
training courses and curriculum (critical care, cardio-thoracic vascular care, neurological care, trauma
care, palliative care and care of terminally ill), establishing nursing school in every large district or cluster
of districts of about 20 to 30 lakh population and establishing Centers of Excellence for Nursing and
Allied Health Sciences in each State. States which have adequate nursing institutions have flexibility to
explore a gradual shift to three year nurses even at the sub-centre level to support the implementation
of the comprehensive primary health care agenda.
11.6 ASHA: This policy supports certification programme for ASHAs for their preferential selection into
ANM, nursing and paramedical courses. While most ASHAs will remain mainly voluntary and
remunerated for time spent, those who obtain qualifications for career opportunities could be given
more regular terms of engagement. Policy also supports enabling engagements with NGOs to serve as
support and training institutions for ASHAs and to serve as learning laboratories on future roles of
community health workers. The policy recommends revival and strengthening of Multipurpose Male
Health Worker cadre, in order to effectively manage the emerging infectious and non-communicable
diseases at community level. Adding a second Community Health Worker would be based on
geographic considerations, disease burdens, and time required for multiple tasks to be performed by
ASHA/ Community Health Worker.
11.7 Paramedical Skills: Training courses and curriculum for super specialty paramedical care
(perfusionists, physiotherapists, occupational therapists, radiological technicians, audiologists, MRI
technicians, etc.) would be developed. The policy recognises the role played by physiotheraphists,
occupational and allied health professionals keeping in view the demographic and disease transition the
country is faced with and also recognises the need to address their shortfall. Planned expansion of allied
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technical skills- radiographers, laboratory technicians, physiotherapists, pharmacists, audiologists,
optometrists, occupational therapists with local employment opportunities, is a key policy direction.
The policy would allow for multi-skilling with different skill sets so that when posted in more peripheral
hospitals there is more efficient use of human resources.
11.8 Public Health Management Cadre: The policy proposes creation of Public Health Management
Cadre in all States based on public health or related disciplines, as an entry criteria. The policy also
advocates an appropriate career structure and recruitment policy to attract young and talented multidisciplinary
professionals. Medical & health professionals would form a major part of this, but
professionals coming in from diverse backgrounds such as sociology, economics, anthropology,
nursing, hospital management, communications, etc. who have since undergone public health
management training would also be considered. States could decide to locate these public health
managers, with medical and non-medical qualifications, into same or different cadre streams belonging
to Directorates of health. Further, the policy recognizes the need to continuously nurture certain
specialized skills like entomology, housekeeping, bio-medical waste management, bio medical
engineering communication skills, management of call centres and even ambulance services.
11.9 Human Resource Governance and leadership development: The policy recognizes that human
resource management is critical to health system strengthening and healthcare delivery and therefore the
policy supports measures aimed at continuing medical and nursing education and on the job support to
providers, especially those working in professional isolation in rural areas using digital tools and other
appropriate training resources. Policy recommends development of leadership skills, strengthening
human resource governance in public health system, through establishment of robust recruitment,
selection, promotion and transfer postings policies.
12. Financing of Health Care: The policy advocates allocating major proportion (upto two-thirds or more)
of resources to primary care followed by secondary and tertiary care. Inclusion of cost-benefit and cost
effectiveness studies consistently in programme design and evaluation would be prioritized. This would
contribute significantly to increasing efficiency of public expenditure. A robust National Health
Accounts System would be operationalized to improve public sector efficiency in resource allocation/
payments. The policy calls for major reforms in financing for public facilities – where operational costs
would be in the form of reimbursements for care provision and on a per capita basis for primary care.
Items like infrastructure development and maintenance, non-incentive cost of the human resources i.e
salaries and much of administrative costs, would however continue to flow on a fixed cost basis.
Considerations of equity would be factored in- with higher unit costs for more difficult and vulnerable
areas or more supply side investment in infrastructure. Total allocations would be made on the basis of
differential financial ability, developmental needs and high priority districts to ensure horizontal equity
through targeting specific population sub groups, geographical areas, health care services and gender
related issues. A higher unit cost or some form of financial incentive payable to facilities providing a
measured and certified quality of care is recommended.
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12.1 Purchasing of Healthcare Services: The existing Government financed health insurance schemes
shall be aligned to cover selected benefit package of secondary and tertiary care services purchased from
public, not for profit and private sector in the same order of preference, subject to availability of quality
services on time as per defined norms. The policy recommends creating a robust independent
mechanism to ensure adherence to standard treatment protocols by public and non-government
hospitals. In this context the policy recognizes the need of mandatory disclosure of treatment and
success rates across facilities in a transparent manner. It recommends compliance to right of patients to
access information about their condition and treatment. For need based purchasing of secondary and
tertiary care from non-government sector, multistakeholder institutional mechanisms would be created
at Centre and State levels – in the forms of trusts or registered societies with institutional autonomy.
These agencies would also be charged with ensuring that purchasing is strategic - giving preference to
care from public facilities where they are in a position to do so - and developing a market base through
encouraging the creation of capacity in services in areas where they are needed more. Private „not for
profit‟ and „for - profit‟ hospitals would be empanelled with preference for the former, for comparable
quality and standards of care. The payments will be made by the trust/society on a reimbursement basis
for services provided.
13. Collaboration with Non-Government Sector/Engagement with private sector: The policy
suggests exploring collaboration for primary care services with „not- for -profit‟ organizations having a
track record of public services where critical gaps exist, as a short term measure. Collaboration can also
be done for certain services where team of specialized human resources and domain specific
organizational experience is required. Private providers, especially those working in rural and remote
areas or with under-serviced communities, could be offered encouragement through provision of
appropriate skills to meet public health goals, opportunities for skill up-gradation to serve the
community better, participation in disease notification and surveillance efforts, sharing and supporting
certain high value services. The policy supports voluntary service in rural and under-served areas on
pro-bono basis by recognised healthcare professionals under a „giving back to society‟ initiative. The
policy advocates a positive and proactive engagement with the private sector for critical gap filling
towards achieving National goals. One form is through engagement in public goods, where the private
sector contributes to preventive or promotive services without profit- as part of CSR work or on
contractual terms with the Government. The other is in areas where the private sector is encouraged to
invest- which implies an adequate return on investment i.e on commercial terms which may entail
contracting, strategic purchasing, etc. The policy advocates for contracting of private sector in the
following activities:
13.1 Capacity building: Outsourcing of training of teachers to strengthen school health programmes by
adopting neighbourhood schools for quarterly training modules.
13.2 Skill Development programmes: Recognising that there are huge gaps in technicians, nursing and
para- nursing, para-medical staff and medical skills in select areas, the policy advocates coordination
between National Council for Skill Development, MOHFW and State Government(s) for engaging
private hospitals/private general medical practitioners in skill development.
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13.3 Corporate Social Responsibility (CSR): CSR is an important area which should be leveraged for
filling health infrastructure gaps in public health facilities across the country. The private sector could
use the CSR platform to play an active role in the awareness generation through campaigns on
occupational health, blood disorders, adolescent health, safe health practices and accident prevention,
micronutrient adequacy, anti-microbial resistance, screening of children and ante-natal mothers,
psychological problems linked to misuse of technology, etc. The policy recommends engagement of
private sector through adoption of neighbourhood schools/ colonies/ slums/tribal areas/backward
areas for healthcare awareness and services.
13.4 Mental healthcare programmes- Training community members to provide psychological support to
strengthen mental health services in the country. Collaboration with Government would be an
important plank to develop a sustainable network for community/locality towards mental health.
13.5 Disaster Management is another area where collaboration with private sector would enable better
outcomes especially in the areas of medical relief and post trauma counselling/treatment. A pool of
human resources from private sector could be generated to act as responders during disasters. The
private sector could also pool their infrastructure for quick deployment during disasters and
emergencies and help in creation of a unified emergency response system. Additionally sharing
information on infrastructure and services deployable for disaster management would enable
development of a comprehensive information system with data on availability and utilization of
services, for optimum use during golden hour and other emergencies.
13.6 Strategic Purchasing as Stewardship: Directing areas for investment for the commercial health
sector.
13.6.1 The health policy recognizes that there are many critical gaps in public health services which would
be filled by “strategic purchasing”. Such strategic purchasing would play a stewardship role in
directing private investment towards those areas and those services for which currently there are no
providers or few providers. The policy advocates building synergy with “not for profit”
organisations and private sector subject to availability of timely quality services as per predefined
norms in the collaborating organisation for critical gap filling.
13.6.2 The main mechanisms of strategic purchasing are insurance and through trusts. Schemes like
Arogyasri and RSBY have been able to increase private participation significantly. Payment is by
reimbursement on a fee for service basis and many private providers have been able to benefit
greatly by these schemes. The aim would be to improve health outcomes and reduce out of pocket
payments while minimising moral hazards and - so that these schemes can be scaled up and made
more effective. The policy provides for preferential treatment to collaborating private
hospitals/institutes for CGHS empanelment and in proposed strategic purchase by Government
subject to other requirements being met.
13.6.3 For achieving the objective of having fully functional primary healthcare facilities- especially in urban
areas to reach under-serviced populations and on a fee basis for middle class populations,
Government would collaborate with the private sector for operationalizing such health and wellness
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centres to provide a larger package of comprehensive primary health care across the country.
Partnerships that address specific gaps in public services: These would inter alia include diagnostics
services, ambulance services, safe blood services, rehabilitative services, palliative services, mental
healthcare, telemedicine services, managing of rare and orphan diseases.
13.6.4 The policy advocates building synergy with “not for profit” organisations and private sector subject
to availability of timely quality services as per predefined norms in the collaborating organisation for
critical gaps.
13.7 Enhancing accessibility in private sector: The policy recommends a better public private
healthcare interface and recognizes the need for engagement in operationalization of mechanisms for
referrals from public health system. Charitable hospitals and “not for profit” hospitals may volunteer
for accepting referrals from public health facilities. The private sector could also provide for increased
designated free/ subsidized beds in their hospitals for the downtrodden, poor and others towards
societal cause.
13.8 Role in Immunization: The policy recognizes the role of the private sector in immunization
programmes and advocates their continued collaboration in rendering immunization service as per
protocol.
13.9 Disease Surveillance: Towards strengthening disease surveillance, the private sector laboratories
could be engaged for data pooling and sharing. All clinical establishments would be encouraged to
notify diseases and provide information of public health importance.
13.10 Tissue and organ transplantations: Tissue and organ transplantations and voluntary donations are
areas where private sector provides services- but it needs public interventions and support for getting
organ donations. Recognising the need for awareness, the private sector and public sector could play a
vital role in awareness generation.
13.11 Make in India: Towards furthering “Make in India”, the private domestic manufacturing firms/
industry could be engaged to provide customized indigenous medical devices to the health sector
and in creation of forward and backward linkages for medical device production. The policy also
seeks assured purchase by Government health facilities from domestic manufacturers, subject to
quality standards being met.
13.12 Health Information System: The objective of an integrated health information system necessitates
private sector participation in developing and linking systems into a common network/grid which
can be accessed by both public and private healthcare providers. Collaboration with private sector
consistent with Meta Data and Data Standards and Electronic Health Records would lead to
developing a seamless health information system. The private sector could help in creation of
registries of patients and in documenting diseases and health events.
13.13 Incentivising Private Sector : To encourage participation of private sector, the policy advocates
incentivizing the private sector through inter alia (i) reimbursement/ fees (ii) preferential treatment
to collaborating private hospitals/institutes for CGHS empanelment and in proposed strategic
22
purchase by Government, subject to other requirements being met (iii) Non-financial incentives like
recognition/ acknowledgement/ felicitation and skill upgradation to the private sector
hospitals/practitioners for providing public health services and for partnering with the Government
of India/State Governments in health care delivery and (iv) through preferential purchase by
Government health facilities from domestic manufacturers, subject to quality standards being met.
13.14 Private sector engagement goes beyond contracting and purchasing. Private providers, especially
those working in rural and remote areas, or with under-serviced communities, require access to
opportunities for skill up-gradation to meet public health goals, to serve the community better, for
participation in disease notification and surveillance efforts, and for sharing and support through
provision of certain high value services- like laboratory support for identification of drug resistant
tuberculosis or other infections, supply of some restricted medicines needed for special situations,
building flexibilities into standards needed for service provision in difficult contexts and even social
recognition of their work. This would greatly encourage such providers to do better. Hitherto all
public training and skill provision has been only to public providers. The policy recognises the need
for training and skilling of many small private providers and recommends the same.
14. Regulatory Framework: The regulatory role of the Ministry of Health and Family Welfare- which
includes regulation of clinical establishments, professional and technical education, food safety, medical
technologies, medical products, clinical trials, research and implementation of other health related lawsneeds
urgent and concrete steps towards reform. This will entail moving towards a more effective,
rational, transparent and consistent regime.
14.1 Professional Education Regulation: The policy calls for a major reform in this area. It advocates
strengthening of six professional councils (Medical, Ayurveda Unani & Siddha, Homeopathy, Nursing,
Dental and Pharmacy) through expanding membership of these councils between three key
stakeholders - doctors, patients and society in balanced numbers. The policy supports setting up of
National Allied Professional Council to regulate and streamline all allied health professionals and ensure
quality standards.
14.2 Regulation of Clinical Establishments: A few States have adopted the Clinical Establishments Act
2010. Advocacy with the other States would be made for adoption of the Act. Grading of clinical
establishments and active promotion and adoption of standard treatment guidelines would be one
starting point. Protection of patient rights in clinical establishments (such as rights to information,
access to medical records and reports, informed consent, second opinion, confidentiality and privacy) as
key process standards, would be an important step. Policy recommends the setting up of a separate,
empowered medical tribunal for speedy resolution to address disputes /complaints regarding standards
of care, prices of services, negligence and unfair practices. Standard Regulatory framework for
laboratories and imaging centers, specialized emerging services such as assisted reproductive
techniques, surrogacy, stem cell banking, organ and tissue transplantation and Nano Medicine will be
created as appropriate.
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14.3 Food Safety: The policy recommends putting in place and strengthening necessary network of offices,
laboratories, e-governance structures and human resources needed for the enforcement of Food Safety
and Standards (FSS) Act, 2006.
14.4 Drug Regulation: Prices and availability of drugs are regulated by the Department of
Pharmaceuticals. However, with regard to other areas of drugs and pharmaceuticals, this policy
encourages the streamlining of the system of procurement of drugs; a strong and transparent drug
purchase policy for bulk procurement of drugs; and facilitating spread of low cost pharmacy chain such
as Jan Aushadhi stores linked with ensuring prescription of generic medicines. It further recommends
education of public with regard to branded and non-branded generic drugs. The setting up of common
infrastructure for development of the pharmaceutical industry will also be promoted. The policy
advocates strengthening and rationalizing the drug regulatory system, promotion of research and
development in the pharmaceutical sector and building synergy and evolving a convergent approach
with related sectors.
14.5 Medical Devices Regulation: The policy recommends strengthening regulation of medical devices
and establishing a regulatory body for medical devices to unleash innovation and the entrepreneurial
spirit for manufacture of medical device in India. The policy supports harmonization of domestic
regulatory standards with international standards. Building capacities in line with international practices
in our regulatory personnel and institutions, would have the highest priority. Post market surveillance
program for drugs, blood products and medical devices shall be strengthened to ensure high degree of
reliability and to prevent adverse outcomes due to low quality and/or refurbished devices/health
products.
14.6 Clinical Trial Regulation: Clinical trials are essential for new product discovery and development.
With the objective of ensuring the rights, safety and well-being of clinical trial participants, while
facilitating such trials as are essential, specific clause(s) be included in the Drugs and Cosmetics Act for
its regulation. Transparent and objective procedures shall be specified, and functioning of ethics and
review committees will be strengthened. The Global Good Clinical Practice Guidelines, which specifies
standards, roles and responsibilities of sponsors, investigators and participants would be adhered to.
Irrational drug combination will continue to be monitored and controlled and appropriate regulatory
framework for standardization of AUSH drugs will be ensured. Clear and transparent guidelines, with
independent monitoring mechanisms, are the ways forward to foster a progressive and innovative
research environment, while safeguarding the rights and health of the trial participants.
14.7 Pricing- Drugs, Medical Devices and Equipment: The regulatory environment around pricing
requires a balance between the patients concern for affordability and industry‟s concern for adequate
returns on investment for growth and sustainability. Timely revision of National List of Essential
Medicines (NLEM) along with appropriate price control mechanisms for generic drugs shall remain a
key strategy for decreasing costs of care for all those patients seeking care in the private sector. An
approach on the same lines but suiting specific requirements of the sectors would be considered for
price control with regard to a list of essential diagnostics and equipment.
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15 Vaccine Safety: Vaccine safety and security would require effective regulation, research and
development for manufacturing new vaccines in accordance with National Vaccine Policy 2011. The
policy advocates commissioning more research and development for manufacturing new vaccines,
including against locally prevalent diseases. It recommends building more public sector manufacturing
units to generate healthy competition; uninterrupted supply of quality vaccines, developing innovative
financing and creating assured supply mechanisms with built in flexibility. Units such as the integrated
vaccine complex at Chengalpattu would be set up and vaccine, anti-sera manufacturing units in the
public sector upgraded with increase in their installed capacity.
16 Medical Technologies: India is known as the pharmacy of the developing world. However, its role in
new drug discovery and drug innovations including bio-pharmaceuticals and bio-similars for its own
health priorities is limited. This needs to be addressed in the context of progress towards universal
health care. Making available good quality, free essential and generic drugs and diagnostics, at public
health care facilities is the most effective way for achieving the goal. The free drugs and diagnostics
basket would include all that is needed for comprehensive primary care, including care for chronic
illnesses, in the assured set of services. At the tertiary care level too, at least for in-patients and outpatients
in geriatric and chronic care segments, most drugs and diagnostics should be free or subsidized
with fair price selling mechanisms for most and some co-payments for the “well-to-do”.
17. Public Procurement: Quality of public procurement and logistics is a major challenge to ensuring
access to free drugs and diagnostics through public facilities. An essential pre-requisite that is needed to
address the challenge of providing free drugs through public sector, is a well-developed public
procurement system.
18. Availability of Drugs and Medical Devices: The policy accords special focus on production of
Active Pharmaceutical Ingredient (API) which is the back-bone of the generic formulations industry.
Recognizing that over 70% of the medical devices and equipments are imported in India, the policy
advocates the need to incentivize local manufacturing to provide customized indigenous products for
Indian population in the long run. The goal with respect to medical devices shall be to encourage
domestic production in consonance with the “Make in India” national agenda. Medical technology and
medical devices have a multiplier effect in the costing of healthcare delivery. The policy recognizes the
need to regulate the use of medical devices so as to ensure safety and quality compliance as per the
standard norms.
19. Aligning other policies for medical devices and equipment with public health goals: For medical
devices and equipment, the policy recommends and prioritises establishing sufficient labeling and
packaging requirements on part of industry, adequate medical devices testing facility and effective port -
clearance mechanisms for medical products.
20. Improving Public Sector Capacity for Manufacturing Essential Drugs and Vaccines: Public
sector capacity in manufacture of certain essential drugs and vaccines is also essential in the long term
for the health security of the country and to address some needs which are not attractive commercial
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propositions. These public institutions need more investment, appropriate HR policies and governance
initiatives to enable them to become comparable with their benchmarks in the developed world.
21. Anti-microbial resistance: The problem of anti-microbial resistance calls for a rapid standardization of
guidelines, regarding antibiotic use, limiting the use of antibiotics as Over-the-Counter medication,
banning or restricting the use of antibiotics as growth promoters in animal livestock. Pharmacovigilance
including prescription audit inclusive of antibiotic usage, in the hospital and community, is a
must in order to enforce change in existing practices.
22. Health Technology Assessment: Health Technology assessment is required to ensure that technology
choice is participatory and is guided by considerations of scientific evidence, safety, consideration on
cost effectiveness and social values. The National Health Policy commits to the development of
institutional framework and capacity for Health Technology Assessment and adoption.
23. Digital Health Technology Eco - System: Recognising the integral role of technology(eHealth,
mHealth, Cloud, Internet of things, wearables, etc) in the healthcare delivery, a National Digital Health
Authority (NDHA) will be set up to regulate, develop and deploy digital health across the continuum of
care. The policy advocates extensive deployment of digital tools for improving the efficiency and
outcome of the healthcare system. The policy aims at an integrated health information system which
serves the needs of all stake-holders and improves efficiency, transparency, and citizen experience.
Delivery of better health outcomes in terms of access, quality, affordability, lowering of disease burden
and efficient monitoring of health entitlements to citizens, is the goal. Establishing federated national
health information architecture, to roll-out and link systems across public and private health providers
at State and national levels consistent with Metadata and Data Standards (MDDS) & Electronic Health
Record (EHR), will be supported by this policy. The policy suggests exploring the use of “Aadhaar”
(Unique ID) for identification. Creation of registries (i.e. patients, provider, service, diseases, document
and event) for enhanced public health/big data analytics, creation of health information exchange
platform and national health information network, use of National Optical Fibre Network, use of
smartphones/tablets for capturing real time data, are key strategies of the National Health Information
Architecture.
23.1 Application of Digital Health: The policy advocates scaling of various initiatives in the area of teleconsultation
which will entail linking tertiary care institutions (medical colleges) to District and Subdistrict
hospitals which provide secondary care facilities, for the purpose of specialist consultations. The
policy will promote utilization of National Knowledge Network for Tele-education, Tele-CME, Teleconsultations
and access to digital library.
23.2 Leveraging Digital Tools for AYUSH: Digital tools would be used for generation and sharing of
information about AYUSH services and AYUSH practitioners, for traditional community level
healthcare providers and for household level preventive, promotive and curative practices.
24. Health Surveys: The scope of health, demographic and epidemiological surveys would be extended to
capture information regarding costs of care, financial protection and evidence based policy planning
and reforms. The policy recommends rapid programme appraisals and periodic disease specific surveys
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to monitor the impact of public health and disease interventions using digital tools for epidemiological
surveys.
25. Health Research: The National Health Policy recognizes the key role that health research plays in the
development of a nation‟s health. In knowledge based sector like health, where advances happen daily,
it is important to increase investment in health research.
25.1 Strengthening Knowledge for Health: The policy envisages strengthening the publicly funded
health research institutes under the Department of Health Research, the apex public health institutions
under the Department of Health & Family Welfare, as well as those in the Government and private
medical colleges. The policy supports strengthening health research in India in the following frontshealth
systems and services research, medical product innovation (including point of care diagnostics
and related technologies and internet of things) and fundamental research in all areas relevant to healthsuch
as Physiology, Biochemistry, Pharmacology, Microbiology, Pathology, Molecular Sciences and Cell
Sciences. Policy aims to promote innovation, discovery and translational research on drugs in AUSH
and allocate adequate funds towards it. Research on social determinants of health along with neglected
health issues such as disability and transgender health will be promoted. For drug and devices discovery
and innovation, both from Allopathy and traditional medicines systems would be supported. Creation
of a Common Sector Innovation Council for the Health Ministry that brings together various regulatory
bodies for drug research, the Department of Pharmaceuticals, the Department of Biotechnology, the
Department of Industrial Policy and Promotion, the Department of Science and Technology, etc.
would be desirable. Innovative strategies of public financing and careful leveraging of public
procurement can help generate the sort of innovations that are required for Indian public health
priorities. Drug research on critical diseases such as TB, HIV/AIDS, and Malaria may be incentivized,
to address them on priority. For making full use of all research capacity in the nation, grant- in- aid
mechanisms which provide extramural funding to research efforts is envisaged to be scaled up.
25.2 Drug Innovation & Discovery: Government policy would be to both stimulate innovation and new
drug discovery as required, to meet health needs as well as ensure that new drugs discovered and
brought into the market are affordable to those who need them most. Similar policies are required for
discovering more affordable, more frugal and appropriate point of care diagnostics as also robust
medical equipment for use in our rural and remote areas. Public procurement policies and public
investment in priority research areas with greater coordination and convergence between drug research
institutions, drug manufacturers and premier medical institutions must also be aligned to drug
discovery.
25.3 Development of Information Databases: There is also a need to develop information data-bases on
a wide variety of areas that researchers can share. This includes ensuring that all unit data of major
publicly funded surveys related to health, are available in public domain in a research friendly format.
25.4 Research Collaboration: The policy on international health and health diplomacy should leverage
India‟s strength in cost effective innovations in the areas of pharmaceuticals, medical devices, health
care delivery and information technology. Additionally leveraging international cooperation, especially
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involving nations of the Global South, to build domestic institutional capacity in green-field innovation
and for knowledge and skill generation could be explored.
26. Governance
26.1 Role of Centre & State: One of the most important strengths and at the same time challenges of
governance in health is the distribution of responsibility and accountability between the Centre and the
States. The policy recommends equity sensitive resource allocation, strengthening institutional
mechanisms for consultative decision-making and coordinated implementation, as the way forward.
Besides, better management of fiduciary risks, provision of capacity building, technical assistance to
States to develop State-specific strategic plans, through the active involvement of local self-government
and through community based monitoring of health outputs is also recommended. The policy suggests
State Directorates to be strengthened by HR policies, central to which is the issue that those from a
public health management cadre must hold senior positions in public health.
26.2 Role of Panchayati Raj Institutions: Panchayati Raj Institutions would be strengthened to play an
enhanced role at different levels for health governance, including the social determinants of health.
There is need to make Community Based Monitoring and Planning (CBMP) mandatory, so as to place
people at the centre of the health system and development process for effective monitoring of quality
of services and for better accountability in management and delivery of health care services.
26.3 Improving Accountability: The policy would be to increase both horizontal and vertical
accountability of the health system by providing a greater role and participation of local bodies and
encouraging community monitoring, programme evaluations along with ensuring grievance redressal
systems.
27. Legal Framework for Health Care and Health Pathway
One of the fundamental policy questions being raised in recent years is whether to pass a health rights
bill making health a fundamental right- in the way that was done for education. The policy question is
whether we have reached the level of economic and health systems development so as to make this a
justiciable right- implying that its denial is an offense. Questions that need to be addressed are manifold,
namely, (a) whether when health care is a State subject, is it desirable or useful to make a Central law,
(b) whether such a law should mainly focus on the enforcement of public health standards on water,
sanitation, food safety, air pollution etc, or whether it should focus on health rights- access to health
care and quality of health care – i.e whether focus should be on what the State enforces on citizens or
on what the citizen demands of the State? Right to healthcare covers a wide canvas, encompassing
issues of preventive, curative, rehabilitative and palliative healthcare across rural and urban areas,
infrastructure availability, health human resource availability, as also issues extending beyond health
sector into the domain of poverty, equity, literacy, sanitation, nutrition, drinking water availability, etc.
Excellent health care system needs to be in place to ensure effective implementation of the health rights
at the grassroots level. Right to health cannot be perceived unless the basic health infrastructure like
doctor-patient ratio, patient-bed ratio, nurses-patient ratio, etc are near or above threshold levels and
uniformly spread-out across the geographical frontiers of the country. Further, the procedural
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guidelines, common regulatory platform for public and private sector, standard treatment protocols, etc
need to be put in place. Accordingly, the management, administrative and overall governance structure
in the health system needs to be overhauled. Additionally, the responsibilities and liabilities of the
providers, insurers, clients, regulators and Government in administering the right to health need to be
clearly spelt out. The policy while supporting the need for moving in the direction of a rights based
approach to healthcare is conscious of the fact that threshold levels of finances and infrastructure is a
precondition for an enabling environment, to ensure that the poorest of the poor stand to gain the
maximum and are not embroiled in legalities. The policy therefore advocates a progressively
incremental assurance based approach, with assured funding to create an enabling environment for
realizing health care as a right in the future.
28. Implementation Framework and Way Forward
A policy is only as good as its implementation. The National Health Policy envisages that an
implementation framework be put in place to deliver on these policy commitments. Such an
implementation framework would provide a roadmap with clear deliverables and milestones to achieve
the goals of the policy.
Friday 17 March 2017
CRITIQUE H P
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