Two National Health Policies in India Before 2015

Following the international Conference on Primary Health Care, held in Alma-Ata, Kazakhstan, in 1978, which was attended by almost all the member nations of the World Health Organization (WHO) and UNICEF, India formulated its first National Health Policy (NHP) in 1983 which was in place till 2002. It is important to note that it took more than three and a half decades for India, after independence, to declare a formal national health policy statement. Prior to this, the successive governments at the Centre formulated policies and programmes related to health through the Council of Health and Family Welfare and various Committee recommendations which the states had to just accept despite the fact that health is a state subject. The entire approach was programme based like Disease Control Programme, Family Planning etc. which were designed and reflected only through the Five Year Plans. Each plan period had a number of schemes and every subsequent plan incorporated some new and dropped a few. Though, curative care like hospitals and dispensaries were not under Central influence. Thus, for an essential state subject the Centre used to take major decisions.

In the era of liberalization-privatization-globalization, the opening up of the economy allowed state governments to directly negotiate with agencies like World Bank for mobilizing their health sector resources. Many state governments had set up policy groups to facilitate policy making and planning for the health sector. Though, such policies were largely dictated by the lending agency. During the period under review, one can see a declining role of the Centre in the health sector.

Though the Alma-Ata Declaration of 1978 identified primary health care (PHC) as the key to attain the goal of “Health for All by 2000 A.D.” which is considered as the major milestone of the twentieth century in the field of public health, but the achievement remained far off from its objective. It was needed to redress along with other issues. Therefore, in September, 2000, the Millennium Summit adopted the UN Millennium Declaration to achieve the eight international development goals by the target date of 2015. It was the largest gathering of world leaders in history bringing all 189 United Nations member states at that time and at least 22 international organizations together. The eight Millennium Development Goals (MDGs) are:

1.      To eradicate extreme poverty and hunger

2.      To achieve universal primary education

3.      To promote gender equality and empower women

4.      To reduce child mortality

5.      To improve maternal health

6.      To combat HIV/AIDS, malaria, and other diseases

7.      To ensure environmental sustainability

8.      To develop a global partnership for development

Each goal had specific targets, and dates were decided for achieving those targets. In accordance with MDGs, to be achieved by 2015, India formulated its second NHP in 2002. Since the MDGs are inter-related, hence, it was believed that achieving one goal would make it easier to achieve the rest and would reduce the government’s expenditure. 

Despite its commitment towards achieving “Health for All by 2000 A.D.” as per Alma Ata declaration, India failed miserably. Its renewed pledge further, in 2002, to achieve Millennium Development Goals by 2015 also did not yield desired result. For both the occasions, an improved, integrated and decentralized governance was needed which would have accommodated pro-poor and pro-development policies and have wider political support. Instead, there were lack of comprehensive planning, delay in execution and deficiency in policy making in overall socio-economic domain.

Now, the question why India needed a new National Health Policy? The draft NHP 2015 noted --- ‘13 years after the last health policy, the context has changed in four major ways.’

Firstly - Health Priorities are changing……..

The second important change in context is the emergence of a robust health care industry growing at 15% compound annual growth rate (CAGR)………

Thirdly, incidence of catastrophic expenditure due to health care costs is growing and is now being estimated to be one of the major contributors to poverty………

The fourth and final change in context is that economic growth has increased the fiscal capacity available………

‘Therefore, the country needs a new health policy that is responsive to these contextual changes. Other than these objective factors, the political will to ensure universal access to affordable healthcare services in an assured mode – the promise of Health Assurance – is an important catalyst for the framing of a New Health Policy.’

If the above “contextual changes” were the backdrop for formulating NHP 2015, then why the same has been shelved for so long? Moreover, the achievements towards Millennium Development Goals with regard to "health as an integral part of development" and "universal health coverage" were much below than the international average. Any efficient, effective and accountable administration would have acted fast to ensure public well being. Whether the government at the Centre can take enough measure to solve the health related issues concerning the common Indians are to be thoroughly scrutinized. Before that, let us go through certain health related Constitutional provisions to understand whether Narendra Modi government can make health as fundamental right under the Constitution rather than treating it as ‘entitlement’.

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