Policy Matter

Improvement in performance of health systems is need of an hour

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The National Health Policy 2015 by the Ministry of Health and Family Welfare proposed the urgent need to improve the performance of health systems. It is being formulated at the last year of the millennium declaration and its goals, in the global context of all nations committed to moving towards universal health coverage.

Given the two-way linkage between economic growth and health status, the National Health Policy is a declaration of the determination of the Government to leverage economic growth to achieve health outcomes and an explicit acknowledgement that better health contributes immensely to improved productivity as well as to equity.

The primary aim of the National Health Policy, 2015, is to inform, clarify, strengthen and prioritize the role of the Government in shaping health systems in all its dimensions investment in health, organization and financing of healthcare services, prevention of diseases and promotion of good health through cross sectoral action, access to technologies, developing human resources, encouraging medical pluralism, building the knowledge base required for better health, financial protection strategies and regulation and legislation for health.

Key policy principles

Equity: Public expenditure in health care, prioritizing the needs of the most vulnerable, who suffer the largest burden of disease, would imply greater investment in access and financial protection measures for the poor. Reducing inequity would also mean affirmative action to reach the poorest and minimizing disparity on account of gender, poverty, caste, disability, other forms of social exclusion and geographical barriers.

Universality: Systems and services are designed to cater to the entire population- not only a targeted sub-group. Care to be taken to prevent exclusions on social or economic grounds.

Patient Centered & Quality of Care: Health Care services would be effective, safe, and convenient, provided with dignity and confidentiality with all facilities across all sectors being assessed, certified and incentivized to maintain quality of care.

Inclusive Partnerships: The task of providing health care for all cannot be undertaken by Government, acting alone. It would also require the participation of communities – who view this participation as a means and a goal, as a right and as a duty. It would also require the widest level of partnerships with academic institutions, not for profit agencies and with the commercial private sector and health care industry to achieve these goals.

Pluralism: Patients who so choose and when appropriate, would have access to AYUSH care providers based on validated local health traditions. These systems would also have 14 Government support and supervision to develop and enrich their contribution to meeting the national health goals and objectives. Research, development of models of integrative practice, efforts at documentation, validation of traditional practices and engagement with such practitioners would form important elements of enabling medical pluralism.

Subsidiarity: For ensuring responsiveness and greater participation, increasing transfer of decision making to as decentralized a level as is consistent with practical considerations and institutional capacity would be promoted. (Nothing should be done by a larger and more complex organization which can be done as well by a smaller and simpler organization.)

Accountability: Financial and performance accountability, transparency in decision making, and elimination of corruption in health care systems, both in the public systems and in the private health care industry, would be essential.

Professionalism, Integrity and Ethics: Health workers and managers shall perform their work with the highest level of professionalism, integrity and trust and be supported by a systems and regulatory environment that enables this.

Learning and Adaptive System: constantly improving dynamic organization of health care which is knowledge and evidence based, reflective and learning from the communities they serve, the experience of implementation itself, and from national and international knowledge partners.

Affordability: As costs of care rise, affordability, as distinct from equity, requires emphasis. Health care costs of a household exceeding 10% of its total monthly consumption expenditures or 40% of its non-food consumption expenditure- is designated catastrophic health expenditures- and is declared as an unacceptable level of health care costs. Impoverishment due to health care costs is of course, even more unacceptable.

Objectives

Improve population health status through concerted policy action in all sectors and expand preventive, promotive, curative, palliative and rehabilitative services provided by the public health sector.

Achieve a significant reduction in out of pocket expenditure due to health care costs and reduction in proportion of households experiencing catastrophic health expenditures and consequent impoverishment.

Assure universal availability of free, comprehensive primary health care services, as an entitlement, for all aspects of reproductive, maternal, child and adolescent health and for the most prevalent communicable and non-communicable diseases in the population.

Enable universal access to free essential drugs, diagnostics, emergency ambulance services, and emergency medical and surgical care services in public health facilities, so as to enhance the financial protection role of public facilities for all sections of the population.

Ensure improved access and affordability of secondary and tertiary care services through a combination of public hospitals and strategic purchasing of services from the private health sector.

Influence the growth of the private health care industry and medical technologies to ensure alignment with public health goals, and enable contribution to making health care systems more effective, efficient, rational, safe, affordable and ethical.

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