National Health Policy – Indian perspective.

Public and Private Health System in India, National Health Mission

National health policy – Indian perspective

Ministry of Health and Family Welfare, Government of India developed the first national health policies (NHP) in 1983. To date, the Government of India has developed three NHPs in 1983, 2002, and 2017. Government of India develops NHP to strengthen the healthcare system in India.

Goal of National Health Policy 2017: The goal aims

• 1. To attain the highest level of health and well-being for every individual.

• 2. To ensure the availability of an unbiased, affordable, and high-quality healthcare system to all citizens.

• 3. To address preventive, curative, and promotive measures of the healthcare system

Objectives of National Healthcare Policy 2017: Improvement of health status through policy action in all sectors. Implementation of quality services for preventive, promotive, curative, palliative, and rehabilitative services through the public health sector. The main objective of NHPs is to provide universal health coverage to all citizens. The following are key objectives to achieve it.

• 1. Universal Health Coverage (UHC): Ensure that all citizens have access to essential healthcare services without facing financial hardships.

• 2. Reinforcing trust in the Public Health Care System: Strengthening the trust of the common man in the public health care system. It is possible by the availability of efficient, patient-centric, affordable, and effective to meet the immediate healthcare needs of most people.

• 3. Health Infrastructure Development: Improvement of infrastructure and healthcare workforce at the grassroots level. It assures the availability of free, comprehensive primary health care services for reproductive, maternal, child, and adolescent health. Expansion and upgrade of healthcare infrastructure. Establishment of new healthcare facilities, medical colleges, and AIIMS.

• 4. Optimization: The Policy also ensures optimum use of existing manpower and infrastructure as available in the health sector

• 5. Reducing disease burden: Reduction of communicable, non-communicable, and occupational diseases in the population. Implementation of preventive measures, early detection, and effective treatment of these diseases.

• 6. Health financing: Availability of affordable healthcare financing mechanisms, and health insurance to reduce individual expenditure like Ayushman Bharat. Advocate collaboration of nongovernment sector to deliver healthcare system linked with health card. This enables every family to have access to a doctor of their choice.

• 7. Affordable and quality services: Ensuring improved access and affordability of quality secondary and tertiary care services. It is done through purchasing services from private healthcare providers, especially non-profit organizations.

• 8. Public-Private Partnership (PPP): Encouraging public-private partnership (PPP) to deliver healthcare. Protection of underprivileged population interest while developing PPP.

• 9. Align the growth of the private healthcare sector with public health goals: Promote the private healthcare system growth to meet public health demand. Enable them to make healthcare systems more effective, efficient, rational, safe, affordable, and ethical.

• 10. Quality Improvement: Enhancing the quality of healthcare system. Implementation of government regulatory system to ensure standards and quality of healthcare providers and institutions.

• 11. Community engagement: Promoting community participation in healthcare planning and delivery, especially in rural and underserved areas.

• 12. Human resources for health: Addressing the shortage of healthcare professionals. Improvement of healthcare professionals’ skills. Ensure equal distribution of healthcare professionals in urban and rural areas.

Public and Private Health System in India, National Health Mission

Public health system in India

The public health system in India is a complex network of healthcare infrastructure, services, and policies. It aims to promote the public well-being of citizens. It is established by the central and state governments.

The Public Health System in India is divided into the following two groups

• A. Ministry of Health

  • · Central Government Public health care systems

    • 1. Employees’ State Insurance Dispensaries and hospital

    • 2. The Central Government Health Scheme

    • 3. Medical College Hospital

    • 4. National Health Institutes/ Tertiary Hospitals

    • 5. Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy

  • · State Government Public health care systems

    • 1. Rural Hospitals

      • a) Community Health Centre

      • b) Primary Health Centre

      • c) Sub-centres

      • d) Accredited Social Health Activists

    • 2. Urban hospitals

      • a) Super specialty/Referral Hospital

      • b) Special Disease Hospital

      • c) District Hospital

      • d) Taluk Hospital

      • e) Government Medical Colleges.

• B. Ministry of Defense:

  • · Dispensary

  • · Base Hospital

  • · Specialty Hospital

  • · Army Medical College and Hospital

• C. Ministry of Railway

  • Q· Dispensaries

  • · Hospitals

• Private health system in India

  • 1. For Profit

    • · Multispecialty Hospital

    • · Specialty Hospital

    • · Nursing Home

    • · Private Clinic

• 2. Non Profit

  • · Charitable Trust Dispensary and Hospital (Religious Non-Religious)

  • · Non Government Organization (NGO) clinic.

• National Health Mission

National Health Mission (NHM) is a government initiative to provide accessible, affordable, and quality healthcare services to citizens at the grassroots level. It was launched in 2013 with the aim to control several healthcare challenges in India such as maternal and child health, immunization, disease control, and the development of infrastructure. It is divided into two parts

• 1. National Rural Health Mission (NRHM)

• 2. National Urban Health Mission (NUHM)

National Rural Health Mission (NRHM):

It aims to provide quality healthcare to the rural population. It focuses on establishing a community-owned, decentralized health delivery system. It ensures actions on several determinants of health such as sanitation, water, education, nutrition, and social and gender equality. Indian government provides financial support for NRHM.

Major Initiative under NRHM:

• 1. ASHA (Accredited Social Health Activists): They are facilitators, mobilizers, and providers at the community level of care. They proved their positive outcomes of an increase in institutional delivery, immunization, disease control programs (Malaria, Kala-azar, and filariasis), improved breastfeeding practices, and nutritional practices.

• 2. Rogi Kalyan Samiti/Hospital Management Society: It exists in Almost all District Hospitals, Sub District Hospitals, Community Health Centres and Primary Health Centres have

• 3. The Village Health Sanitation and Nutritional Committee: They address environmental and social determinants at the grassroots level.

• 4. Janani Surkchha Yojana: It aims to reduce maternal mortality among pregnant women. It encourages pregnant women to utilize government health facilities.

• 5. Janani Shishu Surkchha Karyakarm: It entitles all pregnant women to deliver in the public health system absolutely free. The free services are free drugs and consumables, free nutrition during a stay in the hospital, free diagnosis, free blood, free transportation from home and back to home,

• 6. Facility-based newborn care: It ensures every newborn receives essential care for the first 42 days of life.

• 7. National Mobile Medical Units: They are provided to support hospitals.

• 8. National Ambulance Services: They are used for transportation by calling them. Dial 102 to call an ambulance for essential services like transportation of pregnant women and ill children. Dial 108 for patients of critical care, trauma, and accident victims.

• 9. Mainstreaming of AYUSH: AYUSH facilities have been allocated to hospitals to mainstream it.

• 10. Launch of National Quality Assurance Framework for health facilities: It is launched to improve and maintain quality standards in hospitals.

• 11. Launch of Kayakalp: It is an award to public health facilities to promote cleanliness, hygiene, and infection control.

• 12. Free Drug Service Initiative: Up to an additional 5 percent funding is provided to the state government to introduce a free medicine scheme.

• 13. Free diagnostic service initiative: It provides free essential diagnostic services. It requires strengthening of Lab infrastructure, lab technicians, and equipment in the hospital.

• 14. Bio-Medical Equipment Maintenance: Funds are provided to maintain medical equipment in hospitals.

• 15. Compressive primary healthcare: There are actions actions under NHM to provide comprehensive primary healthcare. These are

  • · Improvement in infrastructure,

  • · Development of technology, drugs, and diagnostics,

  • · Increase utilization of information

  • · Enhance quality care

  • · Promote continuity of care

  • · Community participation

  • · Human resource development

  • · Strengthen governance

  • · State support

• 16. Kilkari: It was implemented to create proper awareness among pregnant women, parents of children, and field workers about the importance of Antenatal Care, Institutional delivery, Postnatal Care, and immunization.

• 17. Mobile Academy Services: It provides audio training courses on interpersonal communication skills. It can be accessed by the ASHA workers on mobile phones. It gives tips to ASHA workers to convince families.

National Urban Health Mission (NUHM): It aims to improve the health status of the urban population, especially the urban poor and vulnerable sections. It facilitates access to quality primary healthcare. It covers all cities with a population above 50,000. Cities and towns with less than 50,000 populations are covered under NRHM. Share of central and state government funding is 60:40. In seven metropolitan cities Mumbai, New Delhi, Chennai, Kolkata, Hyderabad, Bengaluru, and Ahmedabad NUHM is implemented by the Urban Local bodies. In other cities state health departments implement it. Asian Development Bank (ADB) provides support based on progress to certain indicators.

Alok Bains