National Health Policy 2017: Goals and Thrust Areas

In 2017, India took a significant step forward in reshaping its healthcare landscape with the introduction of the National Health Policy (NHP) 2017. This was the first major health policy update in 15 years, arriving after the 2002 policy, and it came at a time when the country’s health challenges had evolved dramatically. Rising non-communicable diseases, a booming private healthcare sector, and widespread financial distress caused by medical expenses demanded a fresh approach. The NHP 2017 set out to address these issues with a clear vision: achieving the highest possible level of health for all Indians, regardless of their economic status or where they live.

Policy goals and vision 🔗

The NHP 2017 established an ambitious goal centered on attaining the highest possible level of health and well-being for all at all ages. This vision is built on three core pillars: embedding preventive and promotive healthcare into all developmental policies, ensuring universal access to quality healthcare services, and providing financial protection so that medical expenses don’t push families into poverty.

The policy recognizes that good health outcomes cannot be achieved by the health sector alone. It advocates for a “Health in All Policies” approach, meaning that decisions in sectors like education, urban planning, agriculture, and environment should all consider their impact on public health. This marks a departure from viewing healthcare merely as treating the sick toward building systems that prevent illness in the first place.

Ten guiding principles 🔗

The NHP 2017 is grounded in ten key principles that guide its implementation:

Professionalism, integrity, and ethics form the foundation, committing the entire healthcare system to maintain the highest professional standards supported by transparent regulation. Equity calls for affirmative action to reach the poorest and minimize disparities based on gender, poverty, caste, disability, or geography.

Affordability receives special emphasis given the growing burden of healthcare costs on families. The policy defines catastrophic health expenditure as spending exceeding 10% of a household’s total monthly consumption or 40% of non-food consumption, and labels such situations as unacceptable. Universality ensures no one is excluded from healthcare based on social, economic, or health status.

Other guiding principles include patient-centered quality of care, accountability in both public and private sectors, inclusive partnerships with multiple stakeholders, pluralism in embracing traditional medicine systems like AYUSH, decentralization of decision-making, and dynamism in adapting to new knowledge and evidence.

Universal Health Coverage as the central objective 🔗

At its heart, the NHP 2017 aims to progressively achieve Universal Health Coverage (UHC). This means ensuring that every citizen has access to free, comprehensive primary healthcare services covering reproductive, maternal, child, and adolescent health, along with treatment for common communicable and non-communicable diseases. The policy also seeks to improve access and affordability of secondary and tertiary care services through public hospitals combined with strategic purchasing from private providers where gaps exist.

The ultimate aim is achieving a significant reduction in out-of-pocket expenditure and lowering the proportion of households experiencing catastrophic health expenditures. According to research published in PMC, reducing these financial burdens is crucial since healthcare costs remain one of the major contributors to poverty in India.

Quantitative objectives 🔗

Unlike previous health policies that were criticized for vague commitments, the NHP 2017 established specific, time-bound quantitative targets organized into three categories: health status and programme impact, health systems performance, and health systems strengthening.

Health status and programme impact targets 🔗

The policy set ambitious goals for improving key health indicators. For life expectancy, the target was to increase life expectancy at birth from 67.5 years to 70 years by 2025. The policy also called for establishing regular tracking of the Disability Adjusted Life Years (DALY) Index to measure the burden of disease by 2022.

On mortality reduction, the targets included reducing under-five mortality to 23 per 1,000 live births by 2025, bringing down the Maternal Mortality Ratio (MMR) to 100 per 100,000 live births by 2020, and reducing infant mortality rate to 28 by 2019. Neonatal mortality was targeted to be reduced to 16, and stillbirth rates to single digits by 2025.

Progress on these fronts has been encouraging. Recent data indicates that India has made significant strides, with MMR declining from 130 per 100,000 live births in 2017 to 97 in 2022, surpassing the 2020 target. Child mortality has also dropped substantially from 39 per 1,000 live births to 23.

Disease control objectives 🔗

The NHP 2017 addressed specific disease control targets aligned with global commitments. For HIV/AIDS, it adopted the 90:90:90 global target, meaning 90% of people living with HIV should know their status, 90% of diagnosed individuals should receive sustained antiretroviral therapy, and 90% of those on treatment should achieve viral suppression.

The policy targeted elimination of Leprosy by 2018, Kala-Azar by 2017, and Lymphatic Filariasis in endemic pockets by 2017. For tuberculosis, the goal was achieving and maintaining a cure rate above 85% in new sputum-positive patients while working toward elimination by 2025. The policy also aimed to reduce premature mortality from cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases by 25% by 2025.

Health systems performance targets 🔗

Beyond disease control, the policy set targets for how the health system should perform. It aimed to increase utilization of public health facilities by 50% from existing levels by 2025. Antenatal care coverage and skilled attendance at birth were both targeted to be sustained above 90% by 2025. Immunization coverage was targeted at more than 90% of newborns being fully immunized by one year of age.

The policy also addressed lifestyle-related health challenges with cross-sectoral goals: a 15% reduction in tobacco use prevalence by 2020 and 30% by 2025, a 40% reduction in stunting among under-five children by 2025, and universal access to safe water and sanitation through the Swachh Bharat Mission by 2020.

Investment and preventive focus 🔗

Perhaps the most discussed aspect of NHP 2017 is its commitment to substantially increase public health spending. The policy proposed raising public health expenditure to 2.5% of GDP in a time-bound manner, up from around 1.15% at the time. This target, while modest compared to global averages, represented a significant commitment given India’s historically low investment in public healthcare.

To finance this increase, the policy suggested that general taxation would remain the primary source. However, it also advocated for taxes on health-damaging products like tobacco and alcohol, along with leveraging Corporate Social Responsibility funds for focused health programmes. States were urged to increase their health spending to at least 8% of their total budgets by 2020.

Progress on health financing 🔗

According to recent statements in Parliament, government health expenditure as a percentage of GDP has increased from 1.13% in 2014-15 to 1.84% in 2021-22. While this falls short of the 2.5% target for 2025, it represents meaningful progress. Government spending on health as a share of total health expenditure has also improved from 29% in 2014-15 to 48% in 2021-22.

Emphasis on preventive and promotive healthcare 🔗

The NHP 2017 strongly emphasizes shifting focus from curative to preventive and promotive healthcare. The policy articulates the need for inter-sectoral coordination at national and sub-national levels, recognizing that health outcomes depend heavily on factors outside traditional healthcare like sanitation, nutrition, and workplace safety.

The policy identifies seven priority areas for coordinated action: the Swachh Bharat Abhiyan (cleanliness mission), promotion of balanced diets and regular exercise, addressing tobacco, alcohol, and substance abuse, Yatri Suraksha (preventing road and rail accidents), Nirbhaya Nari (action against gender violence), reducing workplace stress and improving safety, and reducing indoor and outdoor air pollution.

Health and Wellness Centers 🔗

A key innovation introduced by NHP 2017 was the concept of Health and Wellness Centers (HWCs). These represent a shift from very selective primary care to comprehensive primary healthcare that includes geriatric care, palliative care, and rehabilitative services. Implementation data shows that over 1.5 lakh Health and Wellness Centers have been established across the country as part of the Ayushman Bharat initiative launched in 2018.

The policy envisioned that every family would have a health card linking them to a primary care facility, entitling them to a defined package of services anywhere in the country. This reflects the policy’s emphasis on ensuring continuity of care and making healthcare services portable and accessible.

Empowered public health cadre 🔗

Recognizing that preventive healthcare requires specialized skills, the NHP 2017 advocates for creating an empowered public health cadre in all states. This cadre would include professionals from diverse backgrounds such as sociology, economics, anthropology, nursing, and hospital management who have undergone public health management training. The policy emphasizes that effective implementation of preventive strategies requires professionals who can enforce regulatory provisions and address social determinants of health.

The policy also supports strengthening frontline workers like ASHAs (Accredited Social Health Activists), who would be supplemented by other health workers to undertake primary prevention for non-communicable diseases and provide community-based palliative and mental health services.

Looking ahead 🔗

The NHP 2017 represents a comprehensive blueprint for transforming India’s health sector. Its emphasis on preventive care, universal coverage, and increased public investment addresses many longstanding challenges. However, as with any policy, its success depends on sustained commitment to implementation and adequate funding.

The COVID-19 pandemic further highlighted the importance of robust public health systems and validated many of the policy’s recommendations regarding health infrastructure, surveillance systems, and emergency preparedness. Moving forward, achieving the policy’s ambitious goals will require continued political will, innovative financing, and active participation from all stakeholders including the private sector and civil society.

What do you think? Given the policy’s emphasis on preventive healthcare and increased public spending, how can local communities play a more active role in achieving these health goals? And considering the progress made so far, what additional measures might be needed to reach the 2.5% GDP investment target?

References

1. https://nhsrcindia.org/sites/default/files/2021-07/National%20Health%20Policy%202017%20(English)%20.pdf
2. https://www.india.gov.in/national-health-policy-2017
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC11633271/
4. https://testbook.com/ias-preparation/national-health-policy
5. https://www.pmindia.gov.in/en/news_updates/cabinet-approves-national-health-policy-2017/
6. https://medicaldialogues.in/amp/news/health/national-health-policy-targets-25-per-cent-of-gdp-for-health-mos-health-tells-parliament-160279
7. https://vajiramandravi.com/current-affairs/national-health-policy/