National Health Policy- 2017

1. NATIONAL
HEALTH
POLICY-
2017
Mrs. Namita Batra Guin
Associate Professor
Deptt. of Community Health Nursing

2. INTRODUCTION
A health policy generally describes fundamental principles
regarding which health providers are expected to make value decisions." Health
Policy provides a broad framework of decisions for guiding health actions that are
useful to its community in improving their health, reducing the gap between the
health status of haves and have- not and ultimately contributes to the quality of life.

3. INTRODUCTION
CONTD..
The National Health Policy of 1983 and the National Health Policy of 2002 have
served well in guiding the approach for the health sector in the Five-Year Plans. Now
14 years after the last health policy, a new is introduced.
The primary aim of the National Health Policy, 2017, is to inform, clarify, strengthen
and prioritize the role of the Government in shaping health systems in all its
dimensions

4. Health priorities are
changing,there is growing
burden on account of non-
communicable diseases and
some infectious diseases
NEED OFA
NEW
HEALTH
POLICY
Arising
economic
growth enables
enhanced fiscal
capacity.
Therefore, anew
health policy
responsive to
these contextual
changes is
required
The emergence
of a robust
health care
industry
estimated to be
growing at
double digit
Growing incidences of
catastrophic expenditure due
to health care costs, which are
presently estimated to be one
of the major contributors to
poverty.

5. GOAL
The policy envisages as its goal the attainment of the highest
possible level of health and well-being for all at all ages, through a
preventive and promotive health care orientation in all
developmental policies, and universal access to good quality health
care services without anyone having to face financial hardship as a
consequence. This would be achieved through increasing access,
improving quality and lowering the cost of healthcare delivery.

6. OBJECTIVE
Improve health status through concerted policy action in all sectors
and expand preventive, promotive, curative, palliative and
rehabilitative services provided through the public health sector with
focus on quality

7. SPECIFIC QUANTITATIVE
GOALS AND OBJECTIVES
Health Status and Programme Impact
Expectancy and healthy life
Mortality by Age and/ or cause
Reduction of disease prevalence/ incidence
Health Systems Performance
Utilization of Health services
Cross sectoral goals related to health

8. SPECIFIC QUANTITATIVE
GOALS AND OBJECTIVES
Health systems strengthening
Finance
Health infrastructure and Human resource
Health management information

9. PRINCIPL
ES OF
THE
POLICY
1. Professionalism, integrity and ethics
2. Equity
3. Affordability
4. Universality
5. Patient centered and quality of care
6. Accountability
7. Inclusive partnership
8. Pluralism
9. Decentralization
10. Dynamism and adaptiveness

10. POLIC
Y
THRUS
T
1. Adequate Investment: The policy proposes a potentially
achievable target of raising public health expenditure to
2.5% of the GDP in a time bound manner.
2. Preventive and Promotive Health: The policy identifies
coordinated action on seven priority areas for improving
the environment for health:
The Swachh Bharat Abhiyan
Balanced, healthy diets and regular exercises.
Addressing tobacco, alcohol and substance abuse
Yatri Suraksha – preventing deaths due to rail and RTA
Nirbhaya Nari – action against gender violence
Reduced stress and improved safety in the work place
Reducing indoor and outdoor air pollution
3. Organization of Public Health care Delivery: The policy
proposes seven key policy shifts in organizing health care
services.

11. The seven key policy shifts in organizing health care services are:
1. In primary care from selective care to assured comprehensive care
with linkages to referral hospitals.
2. In secondary and tertiary care from an input oriented to an output
based strategic purchasing .
3. In public hospitals from user fees & cost recovery to assured free
drugs, diagnostic and emergency services to all.
4. In infrastructure and human resource development from normative
approach to targeted approach to reach under-serviced area.

12. 5. In urban health from token interventions to on-scale assured
interventions, to organize Primary Health Care delivery and
referral support for urban poor. Collaboration with other sectors to
address wider determinants of urban health is advocated.
6. In National Health Programmes integration with health systems
for programme effectiveness and in turn contributing to
strengthening of health systems for efficiency.
7. In AYUSH services from stand-alone to a three dimensional
mainstreaming.

13. POLICY
PRESCRIPTIO
NS FOR
NATIONAL
PROGRAMS
• RMNCH+A
• Child and Adolescent Health
• Malnutrition and Micronutrient
deficiency
• Universal Immunization
• Communicable Diseases
• Control of Tuberculosis
• Control of HIV/AIDS
• Leprosy Elimination
• Vector Borne disease Control
• Non-Communicable Diseases
• Mental Health
• Population Stabilization

14. RMNCH+A
The policy strongly recommends strengthening of general health
systems to prevent and manage maternal complications, to ensure
continuity of care and emergency services for maternal health. In
order to comprehensively address factors affecting maternal and
child survival, the policy seeks to address the social determinants
through developmental action in all sectors.

15. CHILD AND ADOLESCENT
HEALTH
• The policy endorses the national consensus on accelerated achievement of
neonatal mortality targets and „single digit‟ stillbirth rates through
improved home based and facility based management of sick newborns.
• District hospitals must ensure screening and treatment of growth related
problems, birth defects, genetic diseases and provide palliative care for
children.
• The policy affirms commitment to pre-emptive care to achieve optimum
levels of child and adolescent health
• The policy gives special emphasis to the health challenges of adolescents
and long term potential of investing in their health care

16. MALNUTRITION AND
MICRONUTRIENT
DEFICIENCY
• The policy declares that micronutrient deficiencies would be addressed through a
well-planned strategy on micronutrient interventions.
• Focus would be on reducing micronutrient malnourishment and augmenting
initiatives like micro nutrient supplementation, food fortification, screening for
anemia and public awareness.
• A systematic approach to address heterogeneity in micronutrient adequacy across
regions in the country with focus on the more vulnerable sections of the
population, is needed.
• Screening for multiple micronutrient deficiencies is advocated.
• Policy recommends exploring fortified food and micronutrient sprinkles for
addressing deficiencies through Anganwadi centers and schools

17. UNIVERSAL
IMMUNIZATION PROGRAM
• Priority would be to further improve immunization coverage with quality
and safety, improve vaccine security as per National Vaccine Policy 2011
and introduction of newer vaccines based on epidemiological
considerations.
• The focus will be to build upon the success of Mission Indradhanush and
strengthen it.

18. COMMUNICABLE
DISEASES
• The policy recognizes the interrelationship between communicable
disease control programmes and public health system strengthening.
• For Integrated Disease Surveillance Programme, the policy advocates
the need for districts to respond to the communicable disease priorities
of their locality.
• This could be through network of well-equipped laboratories backed by
tertiary care centers and enhanced public health capacity to collect,
analyze and respond to the disease outbreaks.

19. CONTROL OF
TUBERCULOSIS
• The policy acknowledges HIV and TB co infection and increased
incidence of drug resistant tuberculosis as key challenges in control of
Tuberculosis.
• The policy calls for more active case detection, with a greater
involvement of private sector supplemented by preventive and promotive
action in the workplace and in living conditions.
• Access to free drugs would need to be complemented by affirmative
action to ensure that the treatment is carried out, dropouts reduced and
transmission of resistant strains are contained.

20. CONTROL OF HIV/AIDS
• The policy recommends focused interventions on the high risk
communities (MSM, Transgender, FSW, etc.) and prioritized geographies.
• There is a need to support care and treatment for people living with
HIV/AIDS through inclusion of 1st, 2nd and 3rd line antiretroviral(ARV),
Hep-C and other costly drugs into the essential medical list.

21. LEPROSY ELIMINATION
• To carry out Leprosy elimination the proportion of grade-2 cases
amongst new cases will become the measure of community awareness
and health systems capacity, keeping in mind the global goal of
reduction of grade 2 disability to less than 1 per million by 2020.
• Accordingly, the policy envisages proactive measures targeted towards
elimination of leprosy from India by 2018.

22. VECTOR BORNE DISEASE
CONTROL
• The policy recognizes the challenge of drug resistance in Malaria, which
should be dealt with by changing treatment regimens with logistics
support as appropriate.
• New National Programme for prevention and control of Japanese
Encephalitis (JE)/Acute Encephalitis Syndrome (AES) should be
accelerated with strong component of inter-sectoral collaboration.

23. NON-COMMUNICABLE
DISEASES
• The policy recommends to set-up a National Institute of Chronic Diseases
including Trauma, to generate evidence for adopting cost effective approaches
and to showcase best practices.
• This policy will support an integrated approach where screening for the most
prevalent NCDs with secondary prevention would make a significant impact on
reduction of morbidity and preventable mortality.
• The National Health Policy commits itself to culturally appropriate community
centered solutions to meet the health needs of the ageing community.
• The policy recognizes the growing need for palliative and rehabilitative care for
all geriatric illnesses and advocates the continuity of care across all levels

24. MENTAL HEALTH
• This policy will take into consideration the provisions of the National
Mental Health Policy 2014 with simultaneous action on the following
fronts:
• Increase creation of specialists through public financing and develop special
rules to give preference to those willing to work in public systems.
• Create network of community members to provide psycho-social support to
strengthen mental health services at primary level facilities and
• Leverage digital technology in a context where access to qualified psychiatrists
is difficult.

25. POPULATION
STABILIZATION
• The National Health Policy recognises that improved access, education
and empowerment would be the basis of successful population
stabilization.
• The policy imperative is to move away from camp based services with all
its attendant problems of quality, safety and dignity of women, to a
situation where these services are available on any day of the week or at
least on a fixed day.
• Other policy imperatives are to increase the proportion of male
sterilization from less than 5% currently, to at least 30% and if possible
much higher.

26. POLICY PRESCRIPTION:
OTHER AREAS
• Women’s Health: There will be enhanced provisions for reproductive morbidities
and health needs of women beyond the reproductive age group (40+)
• Gender Based Violence: Women’s access to healthcare needs to be strengthened by
making public hospitals more women friendly and ensuring that the staff have
orientation to gender –sensitivity issues.
• Supportive supervision: For supportive supervision in more vulnerable districts with
inadequate capacity, the policy will support innovative measures such as use of
digital tools and HR strategies like using nurse trainers to support field workers

27. POLICY PRESCRIPTION:
OTHER AREAS
• Emergency care and Disaster Preparedness: The policy supports development of
earthquake and cyclone resistant health infrastructure in vulnerable geographies. It
also supports development of mass casualty management protocols for CHC and
higher facilities and emergency response protocols at all levels.
• Mainstreaming of AYUSH: The National Health Policy would continue mainstreaming
of AYUSH with general health system but with the addition of a mandatory bridge
course that gives competencies to mid-level care provider with respect to allopathic
remedies

28. POLICY PRESCRIPTION:
OTHER AREAS
• Tertiary Care Services: The policy affirms that the tertiary care services are best
organized along lines of regional, zonal and apex referral centers. It recommends
that the Government should set up new Medical Colleges, Nursing Institutions and
AIIMS in the country following this broad principle.
• To expand public provisioning of tertiary services, the Government would additionally
purchase select tertiary care services from empaneled non-government sector
hospitals to assist the poor. Coverage in terms of population and services will
expand gradually. The policy recognizes development of evidence based standard
guidelines of care, applicable both to public and private sector as essential.

29. POLICY PRESCRIPTION:
OTHER AREAS
• Human Resource for Health: This policy recommends that medical and para-
medical education be integrated with the service delivery system, so that the
students learn in the real environment and not just in the confines of the medical
school.
• The key principle around the policy on human resources for health is that, workforce
performance of the system would be best when we have the most appropriate
person, in terms of both skills and motivation, for the right job in the right place,
working within the right professional and incentive environment.

30. POLICY PRESCRIPTION:
OTHER AREAS
• Medical Education: The policy supports expanding the number of AIIMS like centers for
continuous flow of faculty for medical colleges, biomedical and clinical research. National
Knowledge Network shall be used for Tele-education, Tele-CME, Tele-consultations and
access to digital library.
• A common entrance exam is advocated on the pattern of NEET for UG entrance at All India
level; a common national-level Licentiate/exit exam for all medical and nursing graduates;
a regular renewal at periodic intervals with Continuing Medical Education (CME) credits
accrued, are important recommendations.
• The policy recognizes the need to revise the under graduate and post graduate medical
curriculum keeping in view the changing needs, technology and the newer emerging
disease trends.

31. POLICY PRESCRIPTION:
OTHER AREAS
• Mid-Level Service Providers: For expansion of primary care from selective care to
comprehensive care, complementary human resource strategy is the development of a
cadre of mid-level care providers.
• This can be done through appropriate courses like a B.Sc. in community health and/or
through competency-based bridge courses and short courses. These bridge courses could
admit graduates from different clinical and paramedical backgrounds like AYUSH doctors,
B.Sc. Nurses, Pharmacists, GNMs, etc and equip them with skills to provide services at the
sub-centre and other peripheral levels.
• Locale based selection, a special curriculum of training close to the place where they live
and work, conditional licensing, enabling legal framework and a positive practice
environment will ensure that this new cadre is preferentially available where they are
needed most, i.e. in the under-served areas.

32. POLICY PRESCRIPTION:
OTHER AREAS
• Nursing education: The policy recognises the need to improve regulation and quality
management of nursing education.
• Other measures suggested are - establishing cadres like Nurse Practitioners and
Public Health Nurses to increase their availability in most needed areas. Developing
specialized nursing training courses and curriculum (critical care, cardio-thoracic
vascular care, neurological care, trauma care, palliative care and care of terminally
ill), establishing nursing school in every large district or cluster of districts of about
20 to 30 lakh population and establishing Centers of Excellence for Nursing and
Allied Health Sciences in each State.
• States which have adequate nursing institutions have flexibility to explore a gradual
shift to three year nurses even at the sub-centre level to support the implementation
of the comprehensive primary health care agenda.

33. POLICY PRESCRIPTION:
OTHER AREAS
• ASHA: This policy supports certification programme for ASHAs for their
preferential selection into ANM, nursing and paramedical courses
• Policy also supports enabling engagements with NGOs to serve as support and
training institutions for ASHAs and to serve as learning laboratories on future
roles of community health workers. The policy recommends revival and
strengthening of Multipurpose Male Health Worker cadre, in order to
effectively manage the emerging infectious and non-communicable diseases
at community level

34. POLICY PRESCRIPTION:
OTHER AREAS
• Public Health management cadre: The policy proposes creation of Public Health
Management Cadre in all States based on public health or related disciplines, as an
entry criteria.
• The policy also advocates an appropriate career structure and recruitment policy to
attract young and talented multi-disciplinary professionals.
• Medical & health professionals would form a major part of this, but professionals
coming in from diverse backgrounds such as sociology, economics, anthropology,
nursing, hospital management, communications, etc. who have since undergone
public health management training would also be considered.

35. POLICY
PRESCRIPTIONS
The policy suggests collaboration for primary care services with ‘not- for –profit’
organizations having a track record of public services .
It advocates strengthening of six professional councils (Medical, Ayurveda Unani & Siddha,
Homeopathy, Nursing, Dental and Pharmacy).
It advocates commissioning more research and development for manufacturing new
vaccines, including against locally prevalent diseases.

36. POLICY
PRESCRIPTIONS
Next goal is making available good quality, free, essential, generic Drugs and
Diagnostics, at public health care facilities. Encourage domestic production in
consonance with the “make in india” national agenda.
Policy advocates extensive deployment of digital tools for improving the efficiency
and outcome of the healthcare system.e.g Swasthya slate and use of “Aadhaar” as
unique ID.

37. POLICY
PRESCRIPTIONS
HEALTH SURVEY
The scope of health, demographic and epidemiological surveys would be extended to
capture information regarding costs of care, financial protection and evidence based
policy planning and reforms.
Rapid programme appraisals and periodic disease specific surveys to monitor the impact
of public health and disease interventions using digital tools for epidemiological surveys.

38. POLICY
PRESCRIPTIONS
HEALTH RESEARCH
Strengthening the publicly funded health research institutes
Stimulate innovations and new rug discovery as required.

39. GOVERNANCE
ROLE OF CENTER AND STATE
• The policy recommends equity sensitive resource allocation,
strengthening institutional mechanisms for consultative decision-
making and coordinated implementation, as the way forward.
• The policy suggests State Directorates to be strengthened by HR
policies, central to which is the issue that those from a public
health management cadre must hold senior positions in public
health.

40. GOVERNANCE
ROLE OF PANCHAYAT RAJ INSTITUTIONS
• Panchayati Raj Institutions would be strengthened to play an
enhanced role at different levels for health governance, including the
social determinants of health.
• There is need to make Community Based Monitoring and Planning
(CBMP) mandatory, so as to place people at the centre of the health
system and development process for effective monitoring of quality of
services and for better accountability in management and delivery of
health care services.

41. GOVERNANCE
IMPROVING ACCOUNTABILITY
• The policy would be to increase both horizontal and vertical
accountability of the health system by providing a greater role
and participation of local bodies and encouraging community
monitoring, programme evaluations along with ensuring
grievance redressal systems.

42. THAT’S ALL