The final version of the National Health Policy sees huge reversals made on many proposals on the Draft National Health Policy, 2015. For instance, as per the new policy, health is not a fundamental right. A proposal has been made to increase the health budget to 2.5% of GDP, but that’s going to happen only by 2025.

The National Health Policy was presented by the Union Health Minister, J P Nadda on Thursday.

Health not a fundamental right

As for dropping the proposal to make health a fundamental right, the minister mentioned the apprehension that if it’s a guaranteed right, chances exist that the state may not always be able to provide it. The health secretary, C.K Mishra said that it’s imperative to provide the necessary infrastructure first if such rights are to be ensured.

But the reason notwithstanding, it’s a clear deviation from the draft policy in which it was explained that health should be recognized as a basic human right. In fact, the draft stated that it’s a “goal that the nation must set itself.” Offsetting such goals has been something of a trend in the previous policy drafts. However, this government, with the clear majority that it enjoys had an historical opportunity to move things forward. Granted that infrastructure is lacking in many parts of the country. But still, that’s no excuse for not utilizing the existing infrastructure for the greater cause of bringing quality health care to as many people as possible. That certainly is a viable option which the government didn’t seem to have explored in its final policy.

The nearest the policy comes to it is in the proposed transformation of primary health centres. The primary health centres of the country would now be termed as “health and wellness centres.” They will provide care for NCDs, geriatric care, mental health care, palliative care and rehabilitative care services.

Related to this, we must also look at how India was able to make education a right with the Right to Education Act, 2009. In fact, the draft policy explicitly stated that “To move forward with determination,” the Act should “ensure health as a fundamental right and whose denial will not be justifiable.”

Rise in budget in a “phased manner”

As for raising the health budget to 2.5% of GDP, it’s in line with the draft version. But the distant point in time set for it to happen is disheartening. The health minister said that the scale up would happen in a “time bound manner.” No clear time line has been mentioned for this. Apparently, the scale up is to happen in a “phased manner, depending on how well the budget was being utilized.”

In other words, it’s all too vague.

A curious thing that the health minister said was that “There is no dearth of money. We don’t need to raise money for this through taxes.” Whether there’s no dearth of money or not, there certainly seems to be a dearth of clarity in health policy.

Focus on NCDs, but lacking in details

The earlier policy versions were drafted in 1983 and 2002. Nadda said that the new version brings a renewed focus on non-communicable diseases. NCDs make up 39.1% of the disease burden of India. There is also a focus on wellness which includes prevention as well as promoting health- in other words, a shift from caring for the sick to preventing sickness. The new policy also has fixed targets to eliminate diseases including filariasis and kala-azar, unlike the previous health policies, according to the minister.

The focus on NCDs certainly makes sense in India where thankfully, the communicable diseases have been pushed back to a good extent. But it would certainly have been better of there was a little more clarity in the document regarding the exact measures that are going to be taken to fight NCDs. The same is to be said for the “prevention is better than a cure” strategy.

The private sector will have a greater role to play, as per the policy. The private sector apparently is called in for situations where the public sector lacks- either in terms of making services available or in providing services at adequate quality. The minister said that there’s a need to “regulate and synergize” the role of the private sector in the realm of public health.

No plan to use taxation

An earlier proposal for using taxation to finance a higher budget has also been reversed. This brings up a debatable point in the larger political backdrop of contemporary India. The government’s interest in catering to a growing middle class has been apparent ever since it came into power in 2014. From a rigorous focus on good PR with foreign countries- while gaining very little in terms of policies and alliances, to tax policies that placate the middle and upper classes, without giving way to subsidy- point to this fact. It’s hard to imagine that the government has a different reasoning behind reversing the proposal for taxation in this context.

Since health is more important and immediate an issue for people than most other problems that  tackled with governance, this ought to have been a scenario where the government has braved to use taxation for the public good. In fact, dropping the option completely makes one wonder of the government is complacent with the ‘health- let it come on its own time’ attitude adopted by many of the previous governments.

A rehash of the 2002 health policy

Though the Prime Minister, Narendra Modi has termed the National Health Policy as “futuristic” the policy, in fact looks a lot like a rehash of the 2002 policy.

Indeed, many of the targets and funding commitments seem to be similar in both the documents. Look at these facts, for instance:

The targets for infant and maternal mortality and disease elimination targets rolled out in the new policy are the same as 15 years ago. And the said targets were supposed to be gained by 2010. The new policy has set the target of 2019 or later for the same.

The new policy says the health spend would be increased. The proposed figure of 2.5 % of GDP (Rs, 2.83 lakh crore) is almost as much as the budget for defense spending for 2017-18. As per the 2002 policy(drafted at a time when BJP’s Atal Bihari Vajpayee was the Prime Minister) proposed increasing health spend to 2% of GDP. The proposed raise didn’t happen- neither under the NDA or the UPA governments.

Further comparisons between the two policies would help bring out the rate of progress(or lack thereof) of healthcare initiatives in India. Here are a few to sample:

To bring down infant mortality, the current policy sets a target IMR of 28 by 2019. In the 2002 policy, it was 30 by 2010. In 2015-16, the IMR was 41.

For maternal mortality ratio, a target of 100 is set by the new policy- to be achieved by 2020. The target in 2002 was to touch the number 100 by 2010. The MMR was 167 in 2015-16.

The new policy has set target to eliminate leprosy by 2018, black fever by 2017 and elephantiasis by 2017. In the 2002 version, the target for leprosy was 2005, for kala azar, it was 2010 and elephantiasis by 2015.

For eliminating tuberculosis, the new policy has set the target of 2025. The 2002 policy set a 2010 target to cut down mortality from TB by half. The mortality rate for tuberculosis was 59.7 per lakh people in 2000. This was brought down to 42.6 in 2010, meaning the target was missed. The TB mortality rate in 2015 was 35.9 per lakh people.

The bottom line is that the new National Health Policy offers very little that’s new or truly hopeful.

Image credits: indianexpress.com

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