India’s Draft National Health Policy 2O15: Equity and Scientific Practices Overlooked

A Marthanda Pillaiac, Althaf Alib, Muhammed Shaffic

a. Indian Medical Association, New Delhi, India; b. Department of Community Medicine, Medical College, Thiruvananthapuram, Kerala, India; c. Global Institute of Public Health, Thiruvananthapuram, Kerala, India*

Corresponding Author: Muhammed Shaffi, Assistant Professor and Registrar, Global Institute of Public Health, Thiruvananthapuram, Kerala, India. Email: registrar@giph.in

The Ministry of Health has brought out the draft of a new National Health Policy, which is now in the public domain for discussions.1 The National Health Policies of 1983 and 2002 have served the country well, in guiding the approaches for health sector planning and for the programming of different schemes. Development of a more robust, effective, and credible new national health policy will definitely give direction and coherence to our efforts to further improve the health status of the nation. The new government needs to be congratulated for bringing out a new health policy within a few months of assuming power. However it looks like not enough homework has been done in the preparation of the draft policy and this is reflected in the fact that, unlike previous health policies, the new policy lacks overall direction as well as clear-cut goals and indicators.

Any attempt at revising the National Health Policy should give greater focus to preventive and rehabilitative care in the context of the rising burden of non-communicable diseases in the country. The policy has a reluctant approach toward increasing healthcare expenditure – proposing a modest increase to 2.5% of gross domestic product (GDP) – while acknowledging the need for an increase to 4-5% of GDP to have any real impact on the health sector.2 It is conspicuously silent on many crucial issues like improving the family planning program, medical education, setting up of a Medical Grants Commission, a need based and skill oriented medical curriculum, or health education in schools. There is no visible attempt towards establishing a permanent mechanism to monitor the utilization of funds and to ensure that funds reach the target population to meet the intended purpose. There is a need for inculcating better managerial skills in the form of an Indian Medical Service in the lines of Indian Administrative Service and Indian Revenue Service.

The policy seems to claim that in terms of comparative efficiency, public sector is value for money. This is an innocent misinterpretation of statistics. Value for money is a myth since even those who seek healthcare services from public sector have to spend out-of-pocket, more or less the same amount as in private due to the non-availability of diagnostic facilities and essential drugs. Under this policy, the poor who cannot afford corporate services shall have to continue depending on quacks for their healthcare needs.

In a situation where the private sector provides care for 70% of the population, it is high time we considered them as mainstream players and provided them with incentives for performance in line with national goals.3 Income tax, luxury tax, and service tax in hospitals and Value Added Tax on drugs goes contrary to the vision of making health a fundamental right. The policy should influence and encourage private health care establishments by exempting them from the purview of income taxes and providing subsidies to these institutions. Government, on the other hand, can demand at least 15% free care in these institutions for poor patients. This will reduce the cost of care, eventually avoiding catastrophic health expenses. Government also should provide water electricity and basic amenities at reduced rates to hospitals. This “aided hospital” model will be a cost-effective alternative to heavy investments required for insurance based health systems. The failure of the American model of insurance driven health care provisioning can be taken as a lesson. Given the fact that the majority of health care in the country is still delivered by small-scale healthcare institutions, these small players play a major role in moving the national health indices up or down.4 The policy should aim to sustain and promote these own-account-enterprises so that affordability and accessibility are not affected. Corporate culture in healthcare, which drives up the cost of treatment and limits accessibility, should be discouraged.

The concept of integrated medicine is again a misplaced thought process, which is not based on scientific evidence. It is a justifiable right of a citizen to seek health remedies from any system of medicine. By integrating different systems of medicines working on diametrically opposite basic principles, and by allowing practitioners of other systems of medicine to prescribe modern medicine drugs, the government is denying the public the option of accepting a different system of medicine in its pure form. Integration will only pave the way for dilution, degradation and extinction of other systems of medicine. Hence, the idea of mixing of systems should be avoided for the sake of all systems. Even in countries where best health indices have been achieved, they have done it by promoting the modern system of medicine. In a situation where the government finds it difficult to spend adequately on health, precious resources should not be diverted for promoting systems not based on scientific evidence. In modern society, propagating the potential of AYUSH remedies in different conditions should only be evidence-based and on the basis of strict monitoring of beneficial and adverse effects and not on sentimental grounds.

Entrusting alternate system practitioners to manage very sensitive areas like child healthcare as proposed by the policy may even worsen the situation. It is a fact that some of these systems by principle are against even such fundamental practices as immunization5 and similar life-saving preventive and promotive strategies. To leave the health of children and adolescents in the hands of ill-equipped personnel is detrimental and may nullify the results of years of hard work that the country has put into reducing child mortality and morbidity.

In these lights, the draft policy does not make a strong case for moving towards the national goal of universal access to affordable health-care services. There are a number of challenges to be overcome before the goal can be achieved. There should be serious deliberations and consultations with all stakeholders including professional associations before the policy is finalized.

End Note

Author Information

  1. Prof A Marthanda Pillai is the National President of Indian Medical Association. He is the Chairman and Senior Consultant Neurosurgeon at Ananthapuri Hospital and Research Center, Thiruvananthapuram and the Director of Global Institute of Public Health, Thiruvananthapuram, India, Email: dramp2014@gmail.com

  2. Althaf Ali, Assistant Professor, Department of Community Medicine, Medical College, Thiruvananthapuram, Kerala, India. Email: aalthaf@gmail.com

  3. Muhammed Shaffi, Assistant Professor and Registrar, Global Institute of Public Health, Thiruvananthapuram, Kerala, India. Email: registrar@giph.in

Conflicts of Interest

None declared.

References

1. Ministry of Health and Family Welfare. National health policy 2015 draft2014; Last accessed on 2015 Feb 15Available from: http://www.mohfw.nic.in/showfile.php?lid=3014.

2. Moreno-Serra R, Smith PC, Does progress towards universal health coverage improve population health?Lancet 2012; 8: 380917-23.[CrossRef]

3. Bhat R, The private/public mix in health care in IndiaHealth Policy Plan 1993; 8: 43-56.[CrossRef]

4. Baru RV, Gangolli LV, Duggal R, Shukla A, Private health sector in India – Raising inequitiesReview of Healthcare In India 2005; Mumbai: Centre for Enquiry into Health and Allied Themes

5. Varghese J, Kutty VR, Paina L, Adam T, Advancing the application of systems thinking in health: understanding the growing complexity governing immunization services in Kerala, IndiaHealth Res Policy Syst 2014; 26: 12-47.

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