2. Contents Definition
Policy Vs Programme and Legislation
History
Situational Analysis
Need for NHP 2017
Goal
Key Policy Principles
Objectives
Policy Thrust
National health programmes
Other areas
Critical analysis
NHP-2017 and Covid-19
3. DEFINITION
• Policy is statement which lays down the stated agreement of a government
regarding the strategy and broad course of actions that will be taken to
address a problem.
4. Policy Vs Programme & Legislation
Policy Programme Legislation
Vision Interventions Rights
Values Resources Do’s & Don’ts
Principles Budget Accountability
Broad objectives Specific Punishment
8. Situational analysis
MDG’s 2015- Achieved reasonably
Population stabilizing, except for sex ratio
Burden of disease
Inequities- Exists Urban- Rural & across states
Quality of care (Pregnancy care, abortions practices etc.)
Disease control programs- Mixed results
9. NRHM- strengthened public health systems well, but Uneven and
limited to RCH and National programmes
NUHM- Sanctioned in 2013.
Catastrophic Health expenditure- Increasing
Publicly Financed Health Insurance
Private health care industry
Ongoing push for AYUSH.
Situational Analysis
10. Human resource development
Health research
Regulatory role of Government
Investment in health care
Major expansion of med/ nursing/ technical education
Situational analysis- Health industry
11. Health Expenditure in Selected Countries
Year Total health
expenditure per
capita USD-2011
Total health
expenditure as % of
GDP-2011
Govt. Health
expenditure as % of
Total health
expenditure
India $62 3.8% 30.5%
Thailand $214 4.1% 77.7%
Sri Lanka $93 3.3% 42.1%
China $274 5.1% 45.7%
UK $3659 9.4% 82.8%
Situational Analyses report-2017
12. Need for
NHP 2017
Changing health care
priorities
Emergence of a
robust health care
industry
Growing incidences of
catastrophic
expenditure due to
health care costs
Enhanced fiscal
capacity
13. Goal
• Attainment of the highest possible level of health and
wellbeing 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.
14. Key Policy Principles
Professionalism,
Integrity and
Ethics
A.Equity Affordability Universality
Patient Centered &
Quality of Care
A.Accountability
A.Inclusive
Partnerships
Pluralism
A.Decentralization
Dynamism and
Adaptiveness
15. Objectives
Progressively achieve Universal Health Coverage
Reinforcing trust in Public Health Care System
Align the growth of private health care sector with
public health goals
16. Specific Quantitative Goals and Objectives
Health status and
programme impact
Life Expectancy and
healthy life
Mortality by Age and/
or cause
Reduction of disease
prevalence/ incidence
Health Systems
Performance
Coverage of Health
Services
Cross Sectoral goals
related to health
Health Systems
strengthening
Health finance
Health Infrastructure
and Human Resource
Health Management
Information
17. Health Status and Programme Impact
INDICATOR TARGET YEAR
Life Expectancy and healthy life Life Expectancy at birth 67.5 to 70 2025
regular tracking of DALY index 2022
Reduction of TFR 2.1 2025
Mortality by Age and/ or cause Under Five Mortality 23 2025
MMR 100 2020
IMR 28 2019
Neonatal mortality 16 2025
Still birth Single digit 2025
Reduction of disease prevalence/
incidence
HIV/AIDS 90:90:90 2020
18. Health Systems Performance
INDICATOR TARGET YEAR
Coverage of health services Increase utilization of public health facilities by 50% 2025
skilled attendance at birth Above 90 % 2025
Fully immunized new-borns Above 90 % 2025
Meet need of family planning Above 90 % 2025
80% of known HTN & DM „controlled disease status‟ 2025
Cross sectoral goals related to
health
prevalence of current tobacco use To be reduced by 30 % 2025
prevalence of stunting of under-five children To be reduced by 40% 2025
Access to safe water and sanitation to all 2020
Reduction of occupational injury 2020
19. Health Systems strengthening
INDICATOR TARGET YEAR
Health finance Increase health expenditure by Government 1.15%-2.5% of GDP 2025
Increase State sector health spending 8% OF THEIR
BUDGET
2020
Health Infrastructure and
Human Resource
Ensure availability of paramedics and doctors as per Indian Public
Health Standard (IPHS)
norm in high priority
districts
2020
Increase community health volunteers 2025
Establish primary and secondary care facility 2025
Health Management
Information
district-level electronic database
establish registries for diseases of public health
importance
******************************
22. Preventive and Promotive Health
Swachh Bharat
Abhiyan
Balanced,
healthy diets
and regular
exercises.
Addressing
tobacco, alcohol
and substance
abuse
Yatri Suraksha
Nirbhaya Nari
Reduced stress
and improved
safety in the
work place
Reducing air
pollution
SWASTH NAGRIK ABHIYAN
23. Organization of Public Health Care Delivery
Primary care Selective care
Comprehensive
care
Secondary and
tertiary care
Input oriented
Output based
strategic
purchasing
Public hospitals
User fees & cost
recovery
Assured free
sevices
Infrastructure and
HR development
Normative
approach
Targeted
approach
key policy shifts
26. National Health Programmes
RMNCH+A
services
Child and
Adolescent
Health
Intervention
to address
Malnutrition
Universal
immunization
Communica
ble diseases
Control of
tuberculosis
Control of
HIV/AIDS
Leprosy
elimination
Vector
Borne
disease
control
Noncommu
nicable
diseases
Mental
health
Population
stabilization
27. • Elicit developmental action of all
sectors to support Maternal and
Child survival.
• Strengthening of general health
systems to prevent and manage
maternal complications
• Ensure continuity of care and
emergency services for maternal
health.
• Address the social determinants
through developmental action in all
sectors.
• Accelerated achievement of
neonatal mortality targets and
“single digit” stillbirth rates
• District hospitals- screening and
treatment of children
• Pre-emptive care
• School health programmes- health
and hygiene – part of curriculum
• Expansion of scope of
Reproductive and Sexual Health
RMNCH+A services Child and Adolescent Health
28. • Reducing micronutrient malnourishment.
• Augmentation of Micro nutrient
supplementation, food fortification,
screening for anemia and public
awareness.
• Screening
• Intensify the present efforts (IFA,vit-A,
ORS,Calcium, Iodized salt etc.
• Effective integration of both nutrition-
sensitive and nutrition-specific
interventions for coordinated optimal
results.
• Improve immunization coverage
with quality and safety, improve
vaccine security as per National
Vaccine Policy 2011
• Introduction of newer vaccines
• Success of Mission Indradhanush
Intervention to address
Malnutrition
Universal
immunization
29. • For Integrated Disease
Surveillance Programme-
response of districts to the
communicable disease priorities
• Active case detection
• Greater involvement of private
sector supplemented by
preventive and promotive action
• Access to free drugs
Communicable diseases Control of tuberculosis
30. • Focused interventions on the
high-risk communities (MSM,
Transgender, FSW, etc.) and
prioritized geographies.
• Support care and treatment for
people living with HIV/AIDS
• Proactive measures targeted
towards elimination of leprosy
from India by 2018
Control of HIV/AIDS Leprosy elimination
31. • Changing treatment regimens of
drug resistance in Malaria
• National Programme for prevention
and control of Japanese
Encephalitis (JE)/Acute
Encephalitis Syndrome (AES)
acceleration with inter-sectoral
collaboration.
• Set-up a National Institute of Chronic
Diseases including Trauma
• Integrated approach where screening for the
most prevalent NCDs with secondary
prevention
• Comprehensive primary health care
network - specialist consultations + follow
up at the primary level.
• Research
• Developing protocol for mainstreaming
AYUSH -Integrated medical care.
• Geriatric care (Maintenance and Welfare of
Parents and Senior Citizens Act, 2007)
• Public awareness to promote voluntary
tissue and organ donation
Vector Borne disease
control
Noncommunicable diseases
32. • Provisions of the National
Mental Health Policy 2014
• Increase creation of specialists
to work in public systems
• Strengthen mental health
services at primary level
• Leverage digital technology in a
context where access to qualified
psychiatrists is difficult
• Camp based services Any day
of the week / A fixed day
• Increase the proportion of male
sterilization <5% 30% and if
possible much higher.
Mental health Population stabilization
33. Other areas
1. Women’s health & Gender based violence
2. Supportive Supervision
3. Emergency Care and Disaster Preparedness
4. Mainstreaming the Potential of AYUSH
5. Tertiary care Services
34. 6. Human Resources for Health
Medical Education
Attracting and Retaining Doctors in Remote Areas
Specialist Attraction and Retention
Mid-Level Service Providers
Nursing Education
ASHA
Paramedical Skills
Public Health Management Cadre
Human Resource Governance and leadership development
Other areas
35. Other areas
7. Financing of Health Care (National health account system)
Purchasing of Healthcare Services
8. Collaboration with Non-Government Sector/Engagement with private sector
Capacity building
Skill Development programmes
Corporate Social Responsibility (CSR)
Mental healthcare programmes
Disaster Management
Strategic Purchasing as Stewardship
Enhancing accessibility in
private sector
Role in Immunization
Disease Surveillance
Tissue and organ
transplantations
Make in India
Health Information System
Incentivising Private Sector
36. Other areas
9. Regulatory Framework
Professional Education Regulation
Regulation of Clinical Establishments
Food Safety
Drug Regulation
Medical Devices Regulation
Clinical Trial Regulation
Pricing- Drugs, Medical Devices and Equipment
10. Vaccine safety
11.Medical Technologies
12. Public Procurement
13. Availability of Drugs and Medical Devices
14. Aligning other policies for medical devices and equipment with public health goals
15. Improving Public Sector Capacity for Manufacturing Essential Drugs and Vaccines
37. Other areas
16. Anti-microbial resistance
17. Health Technology Assessment
18. Digital Health Technology Eco –
System
Application of Digital
Health
Leveraging Digital Tools
for AYUSH
18. Health surveys
19. Health Research
Strengthening Knowledge
for Health:
Drug Innovation &
Discovery
Development of Information
Databases
Research Collaboration
20. Governance
Role of Centre & State
Role of Panchayati Raj
Institutions
Improving Accountability
21. Legal Framework for Health Care and
Health Pathway
22. Implementation Framework and Way
Forward
40. Quantitative objectives
INDICATOR TARGET By YEAR LATEST DATA
Life expectancy at birth 67.5 to 70 2025 69.6 (2019- World bank data)
Reduction of TFR 2.1 2025 2 (2019-NFHS 5)
Under five mortality 23 2025 42 (2019 NFHS 5)
MMR 100 2020 103 (2019 SRS DATA-2019)
IMR 28 2019 30 (2019-NFHS 5)
Neonatal mortality 16 2025 25(2019-NFHS 5)
Still birth Single digit 2025 13.9(2019 WHO report)
HIV/AIDS 90:90:90 2020 77:65:55(2021-UNAIDS report)
Increase utilization of public health
facilities
by 50% 2025
Prevalence of current tobacco use To be reduced by 30 %
(32.2-2015-world Bank Data)
2025 27.2%(2019)
Prevalence of stunting of under-five
children
To be reduced by 40% (38%-NFHS
4)
2025 35.5%(NFHS 5)
Increase health expenditure by
government
1.15%-2.5% of GDP 2025
Increase state sector health spending 8% OF THEIR BUDGET 2020
44. Poverty
‘Emerging’ health challenges such as high blood pressure, diabetes
and mental illness
Chronic anemia and malnutrition among children
lack of infrastructure, insufficient spending, lack of trained medical
personnel poor outcome
Investment is well below the World Health Organisation (WHO)
guidelines in both qualitative and quantitative terms
Implementation Challenges in ABP
Will it be possible to achieve
universal health coverage by
2030?
45. • Health financing being neglected (GHE is 1.4% of
GDP)
National health policy 2017: Can it lead to
achievement of sustainable development goals?
46. Sri Lanka - 3.25%
Bangladesh - 3.7%
Pakistan - 2.8%
India -1.4%
South-East Asian
region countries
Government health
expenditure (% of GDP)
47. Year Total health
expenditure per
capita
Total health
expenditure as % of
GDP
Govt. Health
expenditure as % of
Total health
expenditure
2015 $62 3.9% 30.5%
2019 $63.75 3.01% 32.79%
Health Outcomes and Health expenditures in India
World bank data-2019
48. • Health financing being neglected (GHE is 1.4% of
GDP)
• Need to relook our strategies to reduce maternal
and child mortality
National health policy 2017: Can it lead to
achievement of sustainable development goals?
50. Ref: According to the latest Sample Registration System (SRS) special bulletin on maternal mortality in
India (2017-19), brought out by the office of the Registrar General of India.
51.
52. • Health financing being neglected (GHE is 1.4% of
GDP)
• Need to relook our strategies to reduce maternal and
child mortality
• Over reliance on private sector
National health policy 2017: Can it lead to
achievement of sustainable development goals?
53. Household social consumption in India: Health NSS 75th round (July, 2017 – June, 2018)
[Internet]. [cited 2022 Oct 8]. Available from:
https://pib.gov.in/newsite/PrintRelease.aspx?relid=194918
55%
42%
3%
Inpatiant care
Private hospitals
Public Hospitals
Charitable/Trust/NGO run hospitals
69%
30%
1%
Outpatient care
Private Hospitals
Public hospitals
Utilization of public and private hospitals in inpatient and outpatient healthcare
54. Comparison of per episode treatment cost
(INR) in Public and Private Facilities
Hospitals Treatment cost
Inpatient
Treatment cost
outpatient
Public 4451.9 331.4
Private 31845.4 1062.2
Charitable/Trust/NGO 24452.4 732.4
Household social consumption in India: Health NSS 75th round (July, 2017 – June, 2018)
[Internet]. [cited 2022 Oct 8]. Available from:
https://pib.gov.in/newsite/PrintRelease.aspx?relid=194918
55. • Health financing being neglected (GHE is 1.4% of
GDP)
• Need to relook our strategies to reduce maternal and
child mortality
• Over reliance on private sector
• Uniform health insurance system for the country is
the need of the hour
National health policy 2017: Can it lead to
achievement of sustainable development goals?
57. Facility is only provided for indoor patients
The scheme covers all public health institutes, which generally lack
infrastructure and human resources
Scale up the scheme with Rajiv Arogyasri scheme and Enrollment of
many corporate hospitals under it.
A large portion of the financial resources is spent on paying the
premium and reimbursement money to the insurance providers and the
beneficiaries respectively
58. • Health financing being neglected (GHE is 1.4% of
GDP)
• Need to relook our strategies to reduce maternal and
child mortality
• Over reliance on private sector
• Uniform health insurance system for the country is the
need of the hour
• Inequities & Inter and intra State variations.
National health policy 2017: Can it lead to
achievement of sustainable development goals?
63. Country Life expectancy at
Birth
India 66
Thailand 75
Sri Lanka 75
Brazil 74
China 75
Russia 69
South Africa 59
USA 79
UK 81
Germany 82
France 82
Norway 82
Denmark 80
Japan 84
Life expectancy at birth in different countries
Ref: Situational analysis-2017
64.
65. Indicators
NHP 2002 target
(year) (MoHFW, 2002)
NHP 2017 target
(year) (MoHFW, 2017)
Current status
(year)
Maternal mortality ratio 100 (2010) 100 (2020) 113 (2016–2018)
Leprosy Elimination by 2005 Elimination by 2018 8.38 new cases detected
per 100 000 population
(2019)
Kala-azar Elimination by 2010 Elimination by 2017 Reported cases: 1967,
deaths: 6 (2020)
Lymphatic filariasis Elimination by 2015 Elimination by 2017 (in
endemic pockets)
Average microfilaria rate
(2014): 0.44%
Public spending on health 2% of GDP (2010) 2.5% of GDP (2025) 1.2% GDP (2016– 2017)
Increase state sector
health spending
8% of budget by 2010 8% of budget by 2020 6.3% of total revenue
expenditure (20192020)
Srivastava S, Karan AK, Bhan N, Mukhopadhya I, World Health Organization. India: health
system review. Health Systems in Transition. 2022;11(1).
68. What happened during Covid-19 pandemic?
Main target of NHP 2017 Universalization of health care
“Health in All approach”
Private healthcare
system Vs Public
health care system
69. Private healthcare
system’s cooperation
was less in support
with public health
care
High admissions in
private hospitals
Higher numbers of
private hospitals have
been empaneled on
board than public
hospitals
Private healthcare system during Covid 19
Government funds are
being used to subsidize
the private health
sector
Fraudulent practices by
the private hospitals
due to illiteracy among
Indians
70. Public healthcare system during covid-19
Lack of healthcare
infrastructure
Non-availability of skilled
human resources
Low expenditure on health
SDGs healthcare targets like
“healthy living and well-being
for all; universal health
coverage, not covering the
entire population
Less trust of people in the
public hospitals
73. • Where the policy is lagging behind?
• What can be done to achieve the targets by
2030?
• What should be added in future policies?
74. References
1. National health policy -2017 report (MoHFW)
2. National health policy- 2002 (MoHFW)
3. Situational analysis-Backdrop to the nationalhealth policy-2017
4. Kaur H, Rathi SK. National Health Policies in Practice: An Explorative Analysis for India. Journal of
Health Management. 2019 Sep;21(3):372-82.
5. Sundararaman T. National Health Policy 2017: a cautious welcome. Indian Journal of Medical Ethics.
2017 Apr 4;2(2):69-71.
6. Sharma S, Singh M, Pal R, Ranjan R, Pal S, Ghosh A. National Health Policy 2017: Can it lead to
achievement of sustainable development goals. Al Ameen J Med Sci. 2018;11(1):4-11
7. Gupta RK, Kumari R. National health policy 2017: an overview. JK Science. 2017 Jul 1;19(3):135-6.
8. Grover A, Singh RB. Health policy, programmes and initiatives. InUrban Health and Wellbeing 2020 (pp.
251-266). Springer, Singapore.
9. Gauttam P, Patel N, Singh B, Kaur J, Chattu VK, Jakovljevic M. Public health policy of India and COVID-
19: Diagnosis and prognosis of the combating response. Sustainability. 2021 Mar 19;13(6):3415.
10. Srivastava S, Karan AK, Bhan N, Mukhopadhya I, World Health Organization. India: health system
review. Health Systems in Transition. 2022;11(1).
11. Annual report-2021-22
12. NFHS-5 data
Editor's Notes
Policy is statement which lays down the stated agreement of a government regarding the strategy and broad course of actions that will be taken to address a problem.
National Leprosy Eradication Programme was introduced in 1983
HIV- prevalence 2019-23.49%
ninety-five per cent of the population is still in the low-income category who are extremely vulnerable to health shocks and unexpected out-of-pocket expenditures (at sixty per cent, one of the highest in the world)
Distant memory but chronic anaemia and malnutrition among children continue to be recurring problems with the latest Global Hunger Index (GHI, 2019) ranking India at 102 out of 117 nations
However, eleven per cent of Sub Health Centres, sixteen per cent of Primary Health Centres and sixteen per cent Community Health Centres suffer from poor infrastructure, understaffing, lack of equipment and medicines (Government of India, 2017a, 2017b)
India is a country where bed density is low (less than 0.9 per 1,000 persons as compared to WHO guidelines of three) with perennial doctor shortages plaguing the medical system. India was ranked at 154 of 195 countries on health service delivery index in 2017 (Health in India, 2017)
Considering the budget allocation made by the Government of India for the health sector, the targets mentioned in the NHP seem overambitious. The expenditure for health in India is one of the lowest in the world at 1.4% of the Gross Domestic Product (GDP). The NHP-2017 aims to increase this to about 2.5%, which again is much less than the required 5-6%. The money allocated for health in the Union Budget 2017, is nowhere near to achieving the target of even 2.5%.
Considering the budget allocation made by the Government of India for the health sector, the targets mentioned in the NHP seem overambitious. The expenditure for health in India is one of the lowest in the world at 1.4% of the Gross Domestic Product (GDP). The NHP-2017 aims to increase this to about 2.5%, which again is much less than the required 5-6%. The money allocated for health in the Union Budget 2017, is nowhere near to achieving the target of even 2.5%.
the health policy relies on the same strategies of ‘Janani Surakksha Yojana’ and ‘Janani Shishu Suraksha Karyakram’ for the reduction of maternal and neonatal mortality
delayed identification of high risk conditions leading to maternal death, delay in reaching the correct health facility for timely action and the delay in managing a complication after reaching the appropriate health facility, are responsible for the high proportion of maternal deaths
Social development indicators are stronger than many states across the country, which is a reflection of the sustainable development model being followed by Kerala wherein more importance is given to the public and social service sectors.
Kerala has made substantial investments in setting up high dependency units in every district and in improving 39 delivery points under the Union Health Ministry’s LaQshya initiative.
Second, the Confidential Review of Maternal Deaths (an initiative by the Kerala Health Department since 2004-05) laid the foundation for all maternal health improvement initiatives. This initiative was further strengthened by maternal near-miss audits in all districts, to analyze the critical events which nearly resulted in maternal deaths.
Third, it developed the Quality Standards in Obstetric Care in 2012-13 to focus on the management of some of the common causes of maternal deaths — postpartum hemorrhage (PPH), pregnancy-induced hypertension (PIH), sepsis and amniotic fluid embolism.
Another target of reducing under five mortality ahead of time can only be achieved when the infant mortality or more specifically neonatal mortality rate is reduced..
The progress in reduction of neo-natal mortality has been slow in our country.
However another important contributor to this mortality is the shortcomings in the health delivery system of the country. Improving India’s health system functioning is vital not just for reducing under-five mortality, but also for addressing other health priorities.
The private sector in the country provides 70% of the health care services, most of which are secondary and tertiary care
on one hand the NHP aims to improve the use of public health system in the country by 50% of current levels by the year 2025, at the same time, the government intends to hire services of the private sector in order to bridge the gap.
This involvement of the private sector would be for secondary and tertiary care services, besides involving them in providing immunization services, disease surveillance, tissue and organ transplantations and purchase of medical devices from indigenous firms [4]. Such an arrangement raises a question on the quality of services which the private providers would render in the public sector, when their personal interests would lie in their own private concerns. The financial burden on the already starved resources is another matter of concern, as this money can be better utilized in strengthening the public sector infrastructure. Moreover most of the targets enlisted in the policy can be better achieved by strengthening the primary care services of the country. Countries such as Chile, Brazil and Thailand have shifted focus from hospital centric care to primary care in their efforts to achieve universal health care
The private sector in the country provides 70% of the health care services, most of which are secondary and tertiary care
on one hand the NHP aims to improve the use of public health system in the country by 50% of current levels by the year 2025, at the same time, the government intends to hire services of the private sector in order to bridge the gap.
This involvement of the private sector would be for secondary and tertiary care services, besides involving them in providing immunization services, disease surveillance, tissue and organ transplantations and purchase of medical devices from indigenous firms [4]. Such an arrangement raises a question on the quality of services which the private providers would render in the public sector, when their personal interests would lie in their own private concerns. The financial burden on the already starved resources is another matter of concern, as this money can be better utilized in strengthening the public sector infrastructure. Moreover most of the targets enlisted in the policy can be better achieved by strengthening the primary care services of the country. Countries such as Chile, Brazil and Thailand have shifted focus from hospital centric care to primary care in their efforts to achieve universal health care
Out of pocket expenditure as a percentage of current health expenditure
Health insurance in the country is available to only 10% of the people [19].
Insurance is either available to the state or the central government employees or those being covered by the Employees State insurance act. In order to provide insurance to poor families, the government has launched the Rashtriya Suraksha Bima Yojana (RSBY) since 2008 for the below poverty line (BPL) families. The scheme provides cashless treatment for the beneficiary with the help of a smart card up to Rs 30,000/ in one year [
facility is only provided for indoor patients; hence the outpatient department patients still have to bear the expenses out of their own pocket
hence the quality of services is compromised.
With the expansion of the scheme country wide, the increasing burden of expenditure is to be tackled only with the single source of income, namely taxes
Rajiv Arogyasari scheme also provides a cover of two lakhs to BPL families has been very popular social insurance scheme with a private public partnership model to deal with the problems of catastrophic medical expenditures at tertiary level care for the poor households- mainly for tertiarycare.
The private sector in the country provides 70% of the health care services, most of which are secondary and tertiary care
on one hand the NHP aims to improve the use of public health system in the country by 50% of current levels by the year 2025, at the same time, the government intends to hire services of the private sector in order to bridge the gap.
This involvement of the private sector would be for secondary and tertiary care services, besides involving them in providing immunization services, disease surveillance, tissue and organ transplantations and purchase of medical devices from indigenous firms [4]. Such an arrangement raises a question on the quality of services which the private providers would render in the public sector, when their personal interests would lie in their own private concerns. The financial burden on the already starved resources is another matter of concern, as this money can be better utilized in strengthening the public sector infrastructure. Moreover most of the targets enlisted in the policy can be better achieved by strengthening the primary care services of the country. Countries such as Chile, Brazil and Thailand have shifted focus from hospital centric care to primary care in their efforts to achieve universal health care
The under-five mortality rate is higher in rural areas than in urban areas (46 deaths per 1,000 live births versus 32 deaths per 1,000 live births).
The under-five mortality rate is highest in Uttar Pradesh (60 deaths per 1,000 live births) and lowest in Kerala and Puducherry (5 and 4 deaths per 1,000 live births, respectively) The under-five mortality rate for scheduled tribes (50 deaths per 1,000 live births), scheduled castes (49 deaths per 1,000 live births), and other backward classes (41 deaths per 1,000 live births) are considerably higher than for those who are not from scheduled castes, scheduled tribes, or other backward classes (33 deaths per 1,000 live births). The under-five mortality rate also declines with increasing household wealth. The under-five mortality rate declined from 59 deaths per 1,000 live births in the lowest wealth quintile to 20 deaths per 1,000 live births in the highest wealth quintile. 7.2 BIODEMOGRAPHIC RISK FACTORS Researchers have identified multiple risk factors for infant and child mortality based on the characteristics of the mother and child and the circumstances of the birth. Table 7.3 and Figure 7.3 illustrate the relationship between these risk factors and neonatal, infant, and under-five mortality. Boys are slightly more likely to die before their fifth birthday than girls. The gender gap is most pronounced in the neonatal period (within one month after birth). Shorter birth intervals are associated with higher under-five mortality. The under-five mortality rate for children born less than 2 years after the preceding birth is more than twice as high as that for children born 3 years after their preceding sibling. Children reported to be very small at the time of birth are more than four times as likely to die during the first month of life as children reported to be average size or larger (96 deaths per 1,000 live births versus 20 deaths per 1,000 live births). Children of birth order seven or more are more than twice as likely to die in the first five years of life than children of the first birth order (Figure 7.3). 109 95 74 50 42 79 68 57 41 35 49 43 39 30 25 NFHS-1 NFHS-2 NFHS-3 NFHS-4 NFHS-5 Under-five mortality Infant mortality Neonatal mortality Figure 7.1 Trends in Early Childhood Mortality Rates Deaths per 1,000 live births in the five-year period before the survey 243 Any method of measuring childhood mortality that relies on the mothers’ reports (i.e., birth histories) assumes that female adult mortality is not high, or if it is high, that there is little or no correlation between the mortality risks of the mothers and those of their children. Selected indicators of the quality of the mortality data on which the estimates of mortality given in this chapter are presented in Appendix E (Tables E.4-E.6). 7.1 INFANT AND CHILD MORTALITY Neonatal mortality: The probability of dying within the first month of life. Postneonatal mortality: The probability of dying between the first month of life and the first birthday (computed as the difference between infant and neonatal mortality). Infant mortality: The probability of dying between birth and the first birthday. Child mortality: The probability of dying between the first and fifth birthday. Under-five mortality: The probability of dying between birth and the fifth birthday. For the five-year period before the 2019-21 NFHS, the neonatal mortality rate was 25 deaths per 1,000 live births. This means that one in 40 live births died during the neonatal period. The infant mortality rate was 35 deaths per 1,000 live births. The under-five mortality rate was 42 deaths per 1,000 live births (Table 7.1 and Figure 7.1). This indicates that one in 24 children in India die before their fifth birthday. More than fourfifths (83%) of these deaths occur during infancy. Trends: The neonatal mortality rate declined from 49 deaths per 1,000 live births in the five years before the 1992-93 NFHS survey to 25 deaths per 1,000 live births in the five years before the 2019-21 NFHS survey. The neonatal mortality rates in the five years before the 1998-99 survey, 2005-06 survey, and the 2015-16 survey were 43, 39, and 30 deaths per 1,000 live births, respectively. The infant mortality rate declined from 79 deaths per 1,000 live births in the five years before the 1992-93 NFHS survey to 35 deaths per 1,000 live births in the five years before the 2019-21 NFHS survey. During the same period, the under-five mortality rate declined from 109 deaths per 1,000 live births to 42 deaths per 1,000 live births. The infant mortality rate decreased by 56 percent over a period of 28 years. The decline in the under-five mortality rate is slightly higher than the decline in the infant mortality rate during this period (a decrease of 62 percent). Patterns by background characteristics The under-five mortality rate is higher in rural areas than in urban areas (46 deaths per 1,000 live births versus 32 deaths per 1,000 live births). The under-five mortality rate is highest in Uttar Pradesh (60 deaths per 1,000 live births) and lowest in Kerala and Puducherry (5 and 4 deaths per 1,000 live births, respectively) (Figure 7.2). The under-five mortality rate declines with an increase in mother’s schooling (Table 7.2). The under-five mortality rate for scheduled tribes (50 deaths per 1,000 live births), scheduled castes (49 deaths per 1,000 live births), and other backward classes (41 deaths per 1,000 live births) are considerably higher than for those who are not from scheduled castes, scheduled tribes, or other backward classes (33 deaths per 1,000 live births)
Goals can be ambitious, the objectives to achieve those goals should specific as well as goal oriented.
The private healthcare system has not been proved reliable during
the emergency. Only the public health system is suitable for the country wherein the population’s
substantial size is rural and poor
Under PMJAY, the states that have registered the most hospitalizations are Rajasthan, Gujarat, Jharkhand, Chhattisgarh, and Kerala. However, the irony is that admissions in private hospitals were higher than those in public hospitals. The numbers of hospitals registered/empaneled under the private sector scheme are also higher than in the public sector [65]. The key argument against the PMJAY model is that government funds are being used to subsidize the private health sector, where healthcare expenditures are nearly double or even three times in public hospitals
the Ayushman Bharat scheme also has been proving public funds for private benefits because this policy ensures a publicly funded and privately managed health insurance scheme. Though the objective of the scheme is universal health coverage as recommended by NHP-2017.
1.Given the privately controlled health infrastructures, India’s health system is not universalistic to deal with the pandemic situation. The adequate availability of public healthcare infrastructures, particularly in hospitals, primary and community health centers, beds, ICUs, ventilators, etc., still has not been congruent to the size of the country’s population
2. healthcare expenditure in India is one of the lowest in the world. The severity of the situation can be best understood by the fact, according to the WHO Expenditure Database 2016, India ranks 170 out of 188 countries in domestic general government spending on health as a percentage of GDP. Now, the question is how the government would achieve these lofty objectives with a mere expenditure of 2.5 percent of GDP?
Early diagnosis, effective treatment and preventive measures form the cornerstones in disease containment thereby reducing its rapid spread, high morbidity and economic impact on the health systems Undoubtedly, some of the states in India did very well in containing the spread of COVID-19. However, in the long run, the GOI needs to focus on reshaping the health policy to make India well-prepared for health emergencies like COVID-19.