A weak prescription: New health policy is just old wine in new bottle

The Union Cabinet last week approved a new national health policy that will replace the existing one put in place by the previous National Democratic Alliance government in 2002. The 2017 policy was unveiled after a long series of discussions. While the official press release characterised it as a “huge milestone in the history of the health sector in the country”, Prime Minister Narendra Modi praised it on Twitter as “comprehensive & futuristic”. To be sure, on the face of it, there is little to not like in what the policy sets out to achieve. The big-ticket change is the promise that the government will spend 2.5 per cent of gross domestic product on health by 2025. Moreover, the policy also lays stress on the prevention of diseases, with a focus on non-communicable diseases, instead of just taking care of the sick. 

However, a detailed study of the targets suggests that they may not be as ambitious as the government is making them out to be. An analysis by IndiaSpend shows how the 2017 policy largely repackages the goals set out in the 2002 one. For instance, the infant mortality rate (IMR, or the infant deaths per 1,000 live births) target for 2019 has been set at 28. This is roughly the same as the 2002 policy’s target of an IMR of 30 by 2010. The IMR in 2015-16 was 41. Similarly, the target for the maternal mortality ratio (MMR, or the deaths of women per 100,000 live births) for 2020 has been set at 100. This is exactly the same target that the 2002 policy expected to achieve by 2010. The MMR in 2015-16 was 167. Broadly, this is true about other targets as well. The 2017 target is to eliminate leprosy by 2018, kala azar (black fever) by 2017 and lymphatic filariasis (elephantiasis) in endemic pockets by 2017. The 2002 policy targets for each of these were 2005, 2010 and 2015, respectively. 

Even on the central issue of Budget allocation, the 2017 policy falls well short of expectations. The 2002 policy aimed at reaching 2 per cent of the GDP level, which never really happened. Public funding for health care has languished around 1.1 per cent of GDP since 2002, well short of the global average of 4.9 per cent. Moreover, the new target is much weaker than the initial target carried in the original draft put out in 2014 by this government, which aimed at reaching the 2.5 per cent level by 2020. The fact is India has rarely met its targets on health. There are many targets that were set out in the first ever health policy in 1983 that have still not been met. 

The new policy mandates the creation of a National Healthcare Standards Organisation (NHSO) that will fix standards for health care institutions in the country. But given that health is a state subject, it is not clear if this organisation will have the teeth to be effective. The track record does not inspire much confidence. For example, except for four states, others have either ignored the Clinical Establishments Act, 2010, or have not framed rules that will be effective on the ground. Given this long history of underachievement, there is a lack of clarity on how these new targets will be attained and what will change in terms of implementation.