This document presents India's proposed National Health Policy for 2017. It begins with an introduction noting India's large economy and healthcare interventions but lack of effective health system delivery. The aim and principles focus on universal access to quality healthcare. A situation analysis identifies challenges around disease burdens, social determinants, inequities, and quality of care. Goals and policy directions prioritize investment in preventive healthcare, strengthening primary care, ensuring access to services, and integrating national health programs. The document provides a comprehensive overview of India's healthcare system and proposed policies to address gaps.

1. NATIONAL HEALTH POLICY, 2017
PRESENTED BY : DR. VINI MEHTA
MDS III
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2. CONTENTS
 Introduction
 Aim
 Situation Analyses
 Goal
 Principles
 Objectives
 Policy directions
 National Health Programmes
 Conclusion
 References
2

3. INTRODUCTION
 India today, is the world’s third largest economy in terms of its Gross National Income
 It possesses, an arsenal of interventions, technologies and knowledge required for providing health care
 But the reality is, “The power of existing interventions is not matched by the power of health systems to
deliver them to those in greatest need, in a comprehensive way, and on an adequate scale”
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4. AIM
 To inform, clarify, strengthen and prioritize the role of the Government in shaping health systems in all its
dimensions (investment in health, organization and financing of healthcare services, prevention of diseases)
 Promotion of good health through cross sectoral action, access to technologies, developing human
resources, building the knowledge base required for better health, financial protection strategies, regulation
and legislation for health
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5. SITUATION ANALYSES
1. Achievement of Millennium Development Goals:
 India is set to reach the Millennium Development Goals (MDG) with respect to maternal and child survival
 The rate of decline of still-births and neonatal mortality has been lower than the child mortality on the
whole
 India has been able reduce proportion of under-weight children below five years of age from 29.4% in
2013-2014
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6. 2. Achievements in Population Stabilization:
 India has also shown consistent improvement in population stabilization, with a decrease in decadal
growth rates
 The national TFR (Total Fertility Rate) has declined from 2.9 to 2.4.
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7. 3. Burden of Diseases:
 There is an unfinished agenda of addressing infectious diseases, nutritional deficiencies, escalating epidemic of
non-communicable diseases, accidents/injuries.
 Communicable disease: 28% , NCDs: 60%
 Increased heat and stress also cause an impact on health
 Persistent levels of TB transmission and incidence of drug resistance are new challenges
 Anaemia in women : multiplier effect
 NCDs account for 60% of all deaths
 Injuries and communicable diseases common in 10-14 years age group
 Intersectoral action is required for nutrition, reproductive health, substance abuse, mental health and gender
based violence
 There is shortfall of 8500 psychiatrists, 6750 psychologists, 22600 psychiatric social workers and 2100
psychiatric nurses
 The elderly comprise 8.6% of total population and 8% of them are confined to bed.
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8. 4. Social Determinants of Health:
 Health of the population is determined largely by lifestyle (50%) followed by biological and environmental
factor (20%, each), whereas health systems related factors contribute 10%.
 Achievement of national health goals would require addressing all the social determinants in the context of
rapid economic growth and changing life styles with a focus on the most vulnerable group.
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9. 5. Inequities in Health Outcomes:
The Tanahashi framework identified 6 key points:
1) Limited availability of skilled human resources
2) Low coverage in marginalized communities with low skilled staff posting
3) Inadequate supportive supervision of front line workers
4) Low quality of training and skill building
5) Lack of focus on quality of services
6) Insufficient IEC on key family practices
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10. 6. Concerns on Quality of Care:
 Quality of care is a matter of serious concern as it compromises the effectiveness of care
 For institutional delivery, standard protocols are often not followed during labour
 Only 61% of children have been fully immunized
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11. 7. Performance in Disease Control Programmes:
 India’s progress on communicable disease control is mixed
 Even though there have been significant reductions, there is stagnation in leprosy, kala azar, HIV
 In tuberculosis, the challenge is high prevalence and rising problems of multi-drug resistantance
 Performance in disease control programmes is largely a reflection of the strengths of the public health
systems.
 Viral Encephalitis, Dengue and Chikungunya are on the increase, particularly in urban areas and as of now
we do not have effective measures to address them
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12. 8. Developments under the National Rural Health Mission:
 The National Rural Health Mission (NRHM) led to a significant strengthening of public health systems
 ASHA’s brought the community closer to public services, improving utilization of services and health
behaviors
 The NRHM deployed over 18,000 ambulances for free emergency response and patient transport services to
over a million patients monthly and added over 178000 health workers to the public health system.
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13. 9. NRHM- for strengthening state health systems:
 NRHM was intended to strengthen State health systems to cover all health needs
 In practice, however, it remained confined largely to national programme priorities
 Strengthening health systems for providing comprehensive care required higher levels of investment and
human resources
 The budget received and the expenditure there under was only about 40% of what was envisaged for a full
re-vitalization in the NRHM Framework
13

14. 10. Urban Health :
 Rapid urbanization- massive growth in number of the urban poor population, especially those living in
slums
 This population has poorer health outcomes due to adverse social determinants and poor access to health
care facilities, despite living in close proximity to many hospitals
 National Urban Health Mission was sanctioned in 2013- strong focus on strengthening primary health care
 NUHM needs substantial expansion of funding on a sustained basis in order to establish & operationalize
well functional primary health care system in the urban areas
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15. 11. Cost of Care and Efforts at Financial Protection:
 The failure of public investment in health to cover the entire spectrum of health care needs is reflected best
in the worsening situation in terms of costs of care
 All services available under national programmes are free to all and universally accessed with fairly good
rates of coverage
 Private markets have little contribution to make in most of these areas
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16. 12. Publicly Financed Health Insurance:
 A number of publicly financed health insurance schemes were introduced to improve access to
hospitalization services and to protect households from high medical expenses
 The Central Government under the Ministry of Labour & Employment, launched the Rashtriya
Swasthya Bima Yojana (RSBY) in 2008
 The population coverage under these various schemes increased from almost 55 million people
in 2003-04 to about 370 million in 2014, of which nearly two thirds (180 million) are those in
BPL category
 RSBY have improved utilization of hospital services, especially in private sector and among
the poorest 20% of households
16

17. 13. Healthcare Industry:
 The current growth rate is at 14% and is projected to be 21% in the next decade
 The Government have had an active policy in the last 25 years for building a positive economic climate for
the health care industry
 For International Finance Corporation, the Indian private health care industry is the second highest
destination for its global investments in health
 So there is a necessity and a rationale for the health Ministry to intervene and to actively shape the growth of
this sector for ensuring that it is aligned to its overall health policy goals, especially with regards to access
and financial protection
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18. 14. Private Sector in Health:
 The private sector today provides nearly 80% of outpatient care and about 60% of inpatient care
 72% of all private health care enterprises are own-account-enterprises (OAEs), which are household run
businesses
 But over time employment OAEs are declining and the number of medical establishments and corporate
hospitals is rising
 There are major ongoing efforts to organize such OAEs within the corporate sector
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19. 15. Realizing the Potential of AYUSH services:
 The National Policy on Indian Systems of Medicine and Homeopathy (2002)- mainstreaming of AYUSH
under the NRHM
 National AYUSH Mission has been launched for overall strengthening of AYUSH network in the public
sector
 There is need to recognize the contribution of the large private sector and not-for-profit organizations
providing AYUSH services
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20. 16. Human Resource Development:
 The last ten years have seen a major expansion of medical, nursing and technical education
 The challenge is to guide the expansion of educational institutions to provide skilled health workers to where
they are needed most, and with the necessary skills
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21. 17. Research and Challenges:
 Currently over 90% of the research publications from medical colleges come from only nine medical
colleges
 Funding of less than 1 % of all public health expenditure has resulted in limited progress
21

22. 18. Regulatory Role of Government:
 The Government’s regulatory role extends to the regulation of drugs through the CDSCO, food safety
through the office of the Food Safety and Standards Authority of India, professional education through the
four professional councils and clinical establishments by the National Council for the same
 Progress in each of these areas has been challenging
22

23. 19. Investment in Health Care:
 The total spending on healthcare in 2011 in the country is about 4.1% of GDP
 Spending at least 5–6% of its GDP is required to attain basic health care needs
 The Government spending on healthcare in India is only 1.04% of GDP which is about 4 % of total
Government expenditure
23

24. GOAL
The attainment of the highest possible level of good health and well-being, 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.
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.
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25. PRINCIPLES
1. Equity
2. Universality
3. Patient Centered & Quality of Care
4. Inclusive Partnerships
5. Pluralism
6. Decentralization
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26. 7. Accountability
8. Professionalism, Integrity and Ethics
9. Learning and Adaptive System
10. Affordability
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27. OBJECTIVES
1. Health Status and Programme Impact
a. Life expectancy and healthy life
b. Mortality by age and/ cause
c. Reduction of disease prevalence / incidence
2. Health Systems Performance
a. Coverage of Health Services
b. Cross sectoral goals related to health
3. Health Systems Strengthening
a. Health finance
b. Health infrastructure and human resource
c. Health management information
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28. POLICY DIRECTIONS
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29. 1. Ensuring Adequate Investment:
 Public health expenditure needed- 4 to 5% of the GDP
 Based on financial capacity of the country to provide this amount and the
institutional capacity to utilize the increased funding in an effective manner-
2.5% of the GDP is proposed
 Raising taxes on tobacco, alcohol and food having negative impact on health
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30. 2. Preventive and Promotive Health:
 Addresses the wider social & environmental determinants of health
 To realize this vision of attainment of highest level of health, “Health In All”
approach as complement to Health For All is needed
 All sectors would need to be convinced that preventive and promotive health
care approaches are not only a health gain but a first order economic gain as
well
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31.  Given the multiple determinants of health, a prevention agenda that addresses the social and economic
environment requires cross-sectoral, multilevel interventions that involve sectors
 Community support and capacity to enjoy good health, particularly among those who are most vulnerable
and have the least capacity to make choices and changes in their lifestyle is needed
 The policy recommends an expansion of scope of interventions to include early detection and response to
early childhood development delays and disability, behavior change with respect to tobacco and alcohol use,
screening, counseling for primary prevention and secondary prevention from common chronic illness
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32. Seven priority areas for improving the environment for health :
 The Swachh Bharat Abhiyan
 Balanced and Healthy Diets and regular exercises
 Addressing tobacco, alcohol and substance abuse
 Yatri Suraksha : preventing deaths due to rail and road traffic accidents
 Nirbhaya Nari: action against gender violence
 Reduced stress and improved safety in the work place
 Reducing indoor and outdoor air pollution
32

33.  The policy explicitly articulates the need for the development of strategies and
institutional mechanisms in each of these seven areas
 Taken together, this Health in all approach could be popularized as the Swasth
Nagrik Abhiyan- a social movement for health
 Policy recognizes the need for the holistic approach and cross sectoral
convergence in addressing social determinants of health
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34.  To lead these preventive measures, commitment and effectiveness in
addressing the health care needs where preventive action fails is needed
 Some aspects of disease prevention and health promotion are specific
services that are to be delivered as part of primary health care services
(Immunization, School health programs etc)
 Occupational Health also requires greater emphasis.
 Delivery of such an expanded range of services requires
1. moving from primary health care to comprehensive health care approach
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35. 2. The strengthening and transformation of the ASHA programme
3. Involvement of communities and multiple stakeholders
 The policy also recommends the setting up of seven “Task Forces” for formulation of a detailed “Preventive
and Promotive Care Strategy” in each of the seven priority areas for preventive and promotive action and to
set the indicators, targets and mechanisms for achievement in each of these areas
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36. 3. Organization of Public Health Care Delivery:
The 7 Key Policy Shifts:
a. In Primary Care: Selective to assured comprehensive care
b. In Secondary and Tertiary Care: Input oriented, budget line financing to an
output based strategic purchasing
c. In Public Hospitals: From user fees & cost recovery based public hospitals to
assured free drugs, diagnostic and emergency Services
d. In Infrastructure and Human Resource Development: From normative
approaches in their development to targeted approaches to reach under-
serviced areas
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37. e. In Urban Health: From token under-financed interventions to on-scale assured
interventions that reach the urban poor and establish linkages with national
programmes
f. In National Health Programmes- Integration with health systems for
effectiveness, and contributing to strengthening health systems for efficiency
g. In AYUSH services:
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38. NATIONAL HEALTH PROGRAMMES
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39. 1. RMNCH+A services:
Maternal and perinatal mortality is highest in population sub-groups which
are
 poorer
 more malnourished
 less educated
 have too many children or too soon
 This policy aspires to elicit developmental action of all sectors to support
maternal and child survival.
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40. 2. Child and Adolescent Health:
 Single digit neonatal mortality and stillbirth rates through community based intervention centered
around the ASHA and anganwadi worker and improved home based and facility based management of
sick newborns
 Adolescents (10 to 19 years) - reduction of obesity
 The scope of reproductive and sexual health should be expanded to address issues like inadequate
calorie intake, nutrition status and psychological problems.
40

41. 4. Universal Immunization Programme:
 Immunization coverage with quality and safety
 Vaccine security as per National Vaccine Policy 2011
 Introduction of new cost effective vaccines based on epidemiological considerations.
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42. Communicable Diseases under National
Disease control programmes
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43.  Comprehensive understanding of all communicable diseases in the respective areas
The approach is to integrate
 HIV, tuberculosis and leprosy, plus all the vector borne diseases and the expanded programme of
immunization
 Robust public health system
 Blood safety – HIV control
43

44. 1. Control of Tuberculosis:
 Disease transmission, rapid progression of the disease in infected patients and increase in incidence of drug
resistant tuberculosis
 Changing patterns of microbial sensitivity and medication compliance
Control of HIV/AIDS:
 Enhanced prevention and wider access to ART
44

45. 2. Control of HIV/AIDS:
 Policy recommends focused interventions on the high risk communities
 There is a need to support care and treatment for people living with HIV/AIDS through inclusion of
antiretroviral drugs.
45

46. Non-Communicable Diseases
 It recommends to set up a National Institute of Chronic diseases including trauma
 Screening for oral, breast, cervical cancer, COPD, HTN and diabetes will be focused.
 This is one area where research and protocol development for mainstreaming AYUSH
 Developing integrative medicine has huge potential for effective prevention and therapy that is also safe and
cost-effective, since NCDs often require life-long management.
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47. Mental Health:
 Increase creation of specialists through public financing
 Create network of community members to provide psycho-social support to strengthen mental health services
at primary level
 Digital technology: where access is difficult
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48. Population Stabilization:
 Maintaining a gender balance
 Strategic objectives now are better and safer contraceptive choices, with a further push back in age of
marriage
 Policy recognizes that improved access, education and empowerment would be the basis of successful
population stabilization.
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49. Women’ Health & Gender Mainstreaming:
There will be enhanced provisions for reproductive morbidities and health needs of
women beyond the reproductive age
Gender based violence (GBV):
Policy recommends that health care to the survivors/victims need to be provided
free and with dignity in the public and private sector.
49

50. Emergency Care and Disaster preparedness:
 Army of community members
 Burns, drowning, stampede during fairs and festivals, etc.
 Building earthquake and cyclone resistant infrastructures
 A network of emergency care that has an assured provision of life support ambulances linked to trauma
management centers- one per 30 lakh population in urban and one for every 10 lakh population in rural
areas will form the key to a trauma care policy
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51. Realizing the Potential of AYUSH:
 A large part of the population uses AYUSH remedies
 Making AYUSH drugs available and standardizing drugs and treatment protocols.
 YOGA to be introduced much more widely in school and work places.
 In many primary health centers however they are the only medical professionals available and therefore
they take care of both AYUSH and allopathic curative care
 Validating processes of health care promotion and cure
 Development of appropriate clinical protocols for primary, secondary and tertiary levels will be a part of
this approach
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52. Tertiary Care Services:
 Private sector
 It recommends that the Government should set up new Medical Colleges, Nursing institutions and AIIMS
52

53. Human Resources for Health:
 Continuous flow of faculty for the over 600 medical colleges
 Ensuring that doctors are attracted to work in remote areas
 Mandatory rural postings or mandatory rotational postings
 The requirement of patient care in super specialty services is very different from the general specialties with
regard to skills required to render effective care. This calls for developing human resources for super
specialty care, which would entail developing training centers for the same.
53

54. Medical Education:
 NEET for UG entrance at All India level
 Exist exam for all medical / nursing graduates, a regular renewal at periodic intervals with CME credits
 National Knowledge Network shall be used for Tele-education, Tele-CME, Tele-consultations and
access to digital library
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55. Paramedical skills:
 Training courses and curriculum for super specialty paramedical care
 (physiotherapists, occupational therapists, radiological technicians, MRI technicians, nurse practitioners,
and public health nurses )
 Tertiary care facilities like critical care, cardio-thoracic vascular care, neurological care, trauma care, etc.
requires specialized knowledge and skills. The policy recognizes the need for developing training courses
and curriculum in these areas.
 ASHA- activists, facilitators and providers of community level care across various contexts.
 Community based geriatric and palliative care
55

56. Financing of Health Care & Engaging the Private Sector:
 Tax based financing
 Raising resources for investing in health
 Improving efficiency of public sector expenditure and in the various forms of private sector
 Inclusion of cost-benefit and cost effectiveness studies in programme design and evaluation would also
contribute significantly to increasing efficiency of public expenditure.
 Resource allocation/payment mechanisms to public health facilities
 A robust National Health Accounts System needs to be operationalized to enable this
 Private Sector engagement would largely take the form of purchasing care from private hospitals on a
reimbursement basis- against cashless services
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57. ASHA:
 Policy supports certification programme for ASHAs for their preferential selection in ANM, nursing and
paramedical courses.
 Policy supports engagements with NGOs to support and training institutions for ASHAs
 Policy recommends revival and strengthening of Multipurpose Male community health worker .
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58. Regulatory Framework :
The regulatory role of the Ministry of Health and Family Welfare includes regulation of
 clinical establishments
 professional and technical education
 food safety
 medical technologies and medical products with reference to introduction, manufacture, quality
assurance and sales, clinical trials and research, and implementation of other health related laws.
58

59. Regulatory Framework for Professional Education:
 Policy advocates strengthening of 6 professional councils ( Medical, Ayurveda, Homeopathy, Nursing,
Dental and Pharmacy) through expanding membership of these councils between 3 key stakeholders –
doctors, patients and society in balanced numbers.
59

60. Clinical Trial Regulation:
 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
 Clinical trials - Drugs and Cosmetic Act for its regulation, transparent and objective procedures shall be
specified, and functioning of ethics and review committees strengthened.
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61. Medical Devices Regulation:
 Recommends strengthening regulation of medical devices and establishing a
regulatory body for medical devices.
 It supports harmonization of domestic regulatory standards with international
standards.
61

62. Drug Regulation:
 Government policy would be to both stimulate innovation and new drug discovery. Jan Aushadhi stores
are linked
 New drugs at affordable rates
 Education of public with regard to branded and non-branded generic drugs.
62

63. Medical Technologies:
 One of the challenges to ensuring access to free drugs and diagnostics though public services is the quality
of public procurement and logistics.
 National Pharmaceutical Pricing Authority (NPPA) under National Essential List of Medicines (NELM)
 Production of Active Pharmaceutical Ingredient (API) which is the back-bone of the generic formulations
industry
63

64. 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.
 Pharmaco-vigilance including prescription audit inclusive of antibiotic usage, in the hospital and
community, is a must in order to enforce change in existing practices.
64

65. 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.
 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.
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66. Collaboration with Non-Government Sector/ Engagement
with private sector:
 Capacity building:
 Corporate Social Responsibility:
 Mental healthcare programme:
 Disaster Management:
66

67. Strategic Purchasing as Stewardship
 Role of immunization:
 Disease surveillance:
 Tissue and organ transplantations:
 Make in India:
 Health Information System:
67

68. 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 to monitor the
impact of public health and disease interventions using digital tools for epidemiological surveys.
68

69. Health Research:
The National Health Policy recognizes the key role that health research plays in the development of a nation’s
health.
69

70. Knowledge for Health:
Two approaches
(i) research on country specific health problems necessary to formulate sound policies and plans for field
action;
(ii) contributions to global health research
In a knowledge based sector like health, where advances happen daily it is important to invest at least 5 % of all
health expenditure on health research.
The establishment of a Department of Health Research (DHR) in the Ministry of Health & Family Welfare was
in recognition of the key role that health research would play for the nation.
70

71.  Development of Information Databases: 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.
 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 involving nations of the Global South, to build
domestic institutional capacity in green-field innovation and for knowledge and skill generation could be
explored.
71

72. Governance:
1. Federal Structure- Role of State and Role of Center:
Though health is a State subject, the Center has accountability to Parliament for central
funding – which is about 36% of all public health expenditure and in some states over 50%.
72

73. 2. Role of Panchayati Raj Institutions:
 All elected local bodies- rural and urban would be enabled to provide leadership and participate in the
functioning of district and sub-district institutions.
 Most important of these are the Rogi Kalyan Samitis(RKS) and the Village Health Sanitation and
Nutrition Committee (VHSNC).
 In particular they would be in charge of, and could be financed for implementing a number of preventive
and promotive health actions that are to be implemented at the level of the community.
73

74. 3. Improving Accountability:
 The policy would be to increase horizontal accountability, by providing a greater role
and participation of local bodies and encouraging community monitoring and better
vertical accountability through better monitoring, grievance redressal systems and
programme evaluation.
4. Involving Communities:
 In the process of engagement with communities and empowering them to contribute,
non-governmental organizations with a tradition of working for community health have
an important contribution to make.
74

75. 5. Legal Framework for Health Care and the Right to Health:
 Mental Health Bill
 The Medical Termination of Pregnancy Act
 The bill regulating surrogate pregnancy and assisted reproductive technologies
 Food Safety Act
 Drugs and Cosmetics Act and the Clinical Establishments Act.
75

76. Concluding Note: Implementation Framework and the Way Forward.
 The National Health Policy therefore envisages that an implementation
framework be put in place to deliver on these policy commitments.
 Such an implementation framework would specify approved financial
allocations and linked to this measurable numerical output targets and time
schedules.
76

77.  The implementation framework would also reflect learning from past experience
 Identify administrative reforms required for more appropriate rules and regulations to governs
public financing, institutional design, human resource policies for this sector, re-structuring of
institutions required for better governance and management at national, state and district levels
 Measures for improving institutional capacity to deliver, and most important the division of
powers, functions and accountability between Center and States with respect to health sector
performance
77

78. REFERENCES
 http://www.mohfw.nic.in/showfile.php?lid=4275. Last accessed on 10th May 2017
at 4:00 pm.
 http://www.mohfw.nic.in/showfile.php?lid=4276. Last accessed on 10th May 2017
at 4:00 pm.
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79. THANK YOU
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