National Health Policy 2017 and Erroneous Assumptions

National Health Policy 2017 and Erroneous Assumptions

The National Health Policy 2017 (NHP) is expected to rejuvenate the dilapidated health system in the country.

The government spends only 1.1% of GDP, which constitutes 28% of the total health expenditure. The lack of public health expenditure has forced people to seek health care from private sector providers, which result in catastrophic health payments.

The catastrophic healthcare expenditure has increased from 15% (2004-05) to 18% (2011-12).

As a result, nearly 63 million people in India are pushed to poverty line for spending on healthcare from their pocket.

The policy hence aims to “clarify, strengthen and prioritise the role of the government in shaping health systems in all dimensions - investments in health organisations, health care services, prevention of disease and promotion of good health …”.

The most welcome move in the policy is that the document is the recognition of the ‘catastrophic expenditure and the target to progressively achieve 2.5% of GDP as public health expenditure on health”. This is really good when compared to the current level of public expenditure of 1.1%. However, it is still only the half of a global average.

A country with double burden of disease by rising non-communicable disease share along with the burden of communicable disease and a majority of population with low purchasing power, the number is not even satisfactory. This limited budget aspires to remodel primary health centres to ‘health and wellness centres’.

The NHP identifies the unaffordability of secondary and tertiary healthcare systems, more than 10% of the monthly household income as catastrophic payment and aims to address this situation through purchasing selected benefit package of secondary and tertiary care services from public, not for profit and private sector, in respective order.

However, considering the skewed capacity in the public sector, tertiary care facilities in the private sector is expected to benefit out of this strategic purchase scheme. It is also worth noticing that many not-for-profit private sector tertiary care hospitals are working like corporate hospitals. Public health sector building did find a major space in the policy, however, whether it in the right direction is a debatable question.

It is quite obvious that with low quality standards and missing doctors, the major purchase shall be from the so-called not-for-profit and the private sector. The package system is never an optimal form to address cost-effective healthcare delivery.

Package system, being of a generalised nature, creates a perplexing situation of either providing more or providing less.

In the former situation, there is wastage of resource and public fund, well that is still fine, if it delivers good health to people, but the latter is sorrowing where the people in need of healthcare services that is outside the package so purchased by the government.

The person in need of healthcare is simply half the way of the treatment and is left astray of any support.

Further, purchase of health care services creates an over-reliance over non-governmental health care sector and contains a major risk of further drowning the common man into the cobweb of private sector exploitation. This is also detrimental to the public health care system as when compared to non-public healthcare providers, they lack the competitive edge, except a few such as AIIMS. Therefore, the solution is not purchasing of health package, but rather creating cutting edge accessible public health sector. In other words, if strategic purchase is the main strategy to address the situation of catastrophic payment situation, it is not clear how NHP is to achieve the stated target i.e., increase utilisation of public health facilities by 50% from current levels by 2025.

The inaccessibility to public healthcare facilities is not only due to infrastructure bottlenecks, but also due to a dearth of health care professionals. This is intended to be remedied by the policy through certificating ASHAs in nursing and paramedical courses.

Further, mid-level service providers, qualified through bridge courses and other quasi medical short courses are another idea in the policy.

Such haphazard human resource building shall not be an efficient mechanism to realise quality access to health care. The danger is quite more acute as such experimentations are happening in underserved area, i.e., places where the modern healthcare system has not penetrated enough, here the people are majorly illiterate and poor. They lack the skill and vigil to check on the quality of service they are provided and simply could be exploited. It is to be noted that such experimentation is coming at a moment when there is serious question over the quality of medical education and on the integrity of doctors.

With all emphasis on public healthcare, the NHP articulates an erroneous understanding on right to health. The NHP drops the idea of the adoption of health rights Bill.

It resolves “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 realising health care as a right in the future”.

However, it has been half-remedied through the introduction of a ‘health-in-all’ approach, complementing the idea of ‘health for all’.

This is a faulty understanding of right to health.

India, as a party to the international covenant on Economic Social and Cultural Rights (ICESCR), has an international obligation to respect, protect and fulfil right to health.

Further, the Supreme Court of India, through various decisions starting from Vincent Panikulangara case, has recognised right to health as part of right to life under Article 21. Therefore, right to health is justifiable in India and the Government of India has a constitutional obligation, irrespective of a statute of right to health.

The NHP needs to fully recognise the legal reality on right to health and change erroneous sentences, stating “ right to health cannot be perceived unless the basic health infrastructure like doctor patient –bed ratio nurses-patient ratio etc are near or above threshold level and uniformly spread across the geographical frontiers of the country”.

Sreenath Namboodiri pursues LLM (IPR) at the Inter University Centre for IPR Studies (IUCIPR), Cochin University of Science and Technology ( CUSAT)