Healthcare and associated Policy In India

CONTEXT: Health policy is an important topic for UPSC prelims and mains.

National Health Policy aims for the development of social capital and to protect the health interest of Indian population. Health Policy supplemented by Ayushman Bharat Abhiyan and Ayushman Bharat Health Infrastructure Mission is an important step towards sustainable development of country and to counter the emerging health crises.

Various health care policies

National Health Policy 1983 -Indira Gandhi Government

• The Ministry of Health and Family Welfare, Govt. of India, initiated India’s first National Health Policy in 1983 i.e. 36 years after independence. It continued till 2002.
• The policy emphasized on preventive, promotive public health and rehabilitation aspects of healthcare.
• The policy stresses the need of establishing comprehensive primary health care services to reach the population in the remote area of the country.

Objectives of NHP 1983

• A phased, time-bound programme for setting up a well-dispersed network of comprehensive primary health care services, linked with extension and health education, designed in the context of the ground reality that elementary health problems can be resolved by the people themselves.
• Intermediation through ‘Health volunteers’ having appropriate knowledge, simple skills and requisite technologies;
• Establishment of a well worked out referral system to ensure that patient load at the higher levels of the hierarchy is not needlessly burdened by those who can be treated at the decentralized level;
• An integrated net-work of evenly spread specialty and super-specialty services; encouragement of such facilities through private investments for patients who can pay, so that the draw on the Government’s facilities is limited to those entitled to free use.

NATIONAL HEALTH POLICY-2002 by Atal Bihari Vajpayee Government

• A revised health policy for achieving better health care and unmet goals has been brought out by government of India- National Health Policy 2002.

Objectives of NHP 2002

• Primary Health Care Approach
• Decentralized public health system
• Convergence of all health programme under single field umbrella
• Strengthening and extending public health services.
• Enhanced contribution of private and NGO sector in health care delivery.
• Increase in public spending for health care.

National Health Policy 2017 by Narendra Modi Government

Aiming to provide healthcare in an “assured manner” to all, the NHP 2017 strives to address current and emerging challenges arising from the ever-changing socio-economic, technological and epidemiological scenarios.

Features

• The policy advocates a progressively incremental assurance-based approach.
• It denotes an important change towards a comprehensive primary health care package which includes care for major NCDs (non-communicable diseases), mental health, geriatric health care, palliative care and rehabilitative care services.
• It envisages providing larger package of assured comprehensive primary health care through the ‘Health and Wellness Centres’
• The policy proposes free drugs, free diagnostics and free emergency and essential health care services in all public hospitals in a bid to provide access and financial protection.
• It also envisages a three-dimensional integration of AYUSH systems encompassing cross referrals, co-location and integrative practices across systems of medicines.
• It also seeks an effective grievance redressal mechanism.
• Health Expenditure: The policy proposes raising public health expenditure to 2.5% of the GDP by 2025.

Targets:

• To increase life expectancy at birth from 67.5 to 70 by 2025 and reduce infant mortality rate to 28 by 2019.
• To reduce mortality of children under-five years of age to 23 by the year 2025.
• To allocate a major proportion of resources to primary care and intends to ensure availability of two beds per 1,000 population distributed in a manner to enable access within golden hour (the first hour after traumatic injury, when the victim is most likely to benefit from emergency treatment).
• To achieve the global 2020 HIV target under 90-90-90 UNAIDS Target according to which by 2020,
• 90% of all people living with HIV will know their HIV status.
• 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
• 90% of all people receiving antiretroviral therapy will have viral suppression.

Ayushman Bharat Scheme

• It is to address health issues at all levels - primary, secondary and tertiary. It is the largest Govt funded Healthcare program of World with ~ 50 crore beneficiaries.
• It is an integrated approach comprising of health insurance.

Key Features

• The government-sponsored health insurance scheme will provide free coverage of up to Rs 5 lakh per family per year at any government or even empanelled private hospitals all over India for secondary and tertiary medical care facilities.
• Modicare will be available for 74 crore beneficiary families and about 50 crore Indian citizens. Under the process, 80 percent of beneficiaries, based on the Socio-Economic Caste Census (SECC) data in the rural and the urban areas, have been identified.
• There is no restriction on the basis of family size, age or gender.
• The benefit cover includes both pre and post hospitalization expenses.
• The expenditure incurred in premium payment will be shared between Central and State Governments in a specified ratio. The funding for the scheme will be shared – 60:40 for all states and UTs with their own legislature, 90:10 in Northeast states and three Himalayan states of Jammu and Kashmir, Himachal and Uttarakhand and 100% Central funding for UTs without legislature.
• The NHPS will draw additional resources from the Health and Education Cess and also depend on funding from States to boost the Central allocation. The premiums are expected to be in the range of `Rs 1,000 – ` 1,200 per annum.
• The NHPM (National Health Protection Mission) will pay for the hospitalisation costs of its beneficiaries through strategic purchasing from public and private hospitals.

Components of PMJAY

• Health and Wellness Centers (for Primary healthcare)

1. 1.5 lakh HWCs by converting existing PHC and subcenters.
2. They are based on preventive care concept. They provide comprehensive primary health care (CPHC) including child and maternal health services, NCDs, and also diagnostic services and free essential drugs.

• PM Jan Arogya Yojana aka National Health Protection Scheme (For secondary and tertiary care)

1. It is the largest insurance program of the World. Beneficiaries to get cashless treatment from any empanelled hospital (both public and private).
2. It will give insurance cover of Rs. 5 lakh per year per family to 10 crore families based on SECC database.
3. It includes pre and post hospitalization expenses. It covers all pre- existing conditions. Transport allowance included.
4. It focuses on Cooperative Federalism and Flexibility to States. States would need to have State Health Agency to implement it.
5. AB-PMJAY is a completely cashless and paperless scheme.
6. The benefits under AB-PMJAY are portable across the country.
7. There is no cap on family size, or age or gender.

• The States/UTs have been provided with the flexibility to implement the scheme in the operational model best suited to the local conditions. Thus, AB-PMJAY is being implemented in Insurance mode, mixed mode and Trust mode.
• As regards procedure involved, AB-PMJAY is an entitlement-based scheme. All the eligible beneficiary families are covered from day one of the implementation of the scheme in the States/UTs. AB-PMJAY does not require enrolment. However, beneficiary verification process is being undertaken to verify the genuineness of the beneficiary. Ayushman cards are issued to all eligible beneficiaries as part of this process to ensure easy availing of health benefits.
• Targets are not fixed for AB-PMJAY as the scheme operates on the basis of beneficiary demand for healthcare services. All the eligible beneficiaries of the implementing States/UTs are entitled for free healthcare services under the scheme from the day of launch of the scheme.

The beneficiary families under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) have been identified from the Socio Economic Caste Census (SECC) of 2011 on the basis of select deprivation and occupational criteria across rural and urban areas.

Detailed list of criteria for eligibility under AB-PMJAY as per SECC 2011

Automatically included:

1. Households without shelter
2. Destitute/ living on alms
3. Manual scavenger families
4. Primitive tribal groups
5. Legally released bonded labour

Deprivation criteria in rural area:

• D1: Only one room with kucha walls and kucha roof
• D2: No adult member between age 16 to 59
• D3: Female headed households with no adult male member between age 16 to 59
• D4: Disabled member and no able-bodied adult member
• D5: SC/ST households
• D7: Landless households deriving major part of their income from manual casual labour

Occupational criteria in urban area:

• Rag picker
• Beggar
• Domestic worker
• Street vendor/ Cobbler/hawker / Other service provider working on streets
• Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/ Coolie and other head-load worker
• Sweeper/ Sanitation worker / Mali
• Home-based worker/ Artisan/ Handicrafts worker / Tailor
• Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/ Rickshaw puller
• Shop worker/ Assistant/ Peon in small establishment/ Helper/ Delivery assistant / Attendant/ Waiter
• Electrician/ Mechanic/ Assembler/ Repair worker/Washer-man/ Chowkidar

The Hindu : Public health infrastructure

About :The Ayushman Bharat Health Infrastructure Mission aims to build a robust public health infrastructure.

• COVID-19 overburdened the country’s health system and services. The inability of the private sector to share the burden drove the point home that healthcare services cannot be left to independent forces.
• The Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (ABHIM) was launched with an outlay of Rupees 64,180 crore over a period of five years.
• In addition to the National Health Mission, this scheme will work towards strengthening public health institutions and governance capacities for wide-ranging diagnostics and treatment.

The Mission includes :

• Establishment of critical care hospital blocks in 12 central institutions such as the All India Institute of Medical Sciences, and in government medical colleges and district hospitals in 602 districts
• Integrated district public health labs in 730 districts to provide comprehensive laboratory services. The current labs for different programmes shall be integrated to deliver clinical, public health surveillance and diagnostic services for predicting outbreaks, epidemics, and more.
• ABHIM will focus on supporting research on COVID-19 and other infectious diseases, including biomedical research to generate evidence to inform short-term and medium-term responses to such pandemics.
• The plan to achieve that bio-security preparedness and pandemic research strengthening would be realised via four regional National Institutes for Virology, the regional research platform for the World Health Organization Southeast Asia Region, and nine Biosafety Level III laboratories.
• For Boosting surveillance a network of surveillance labs will be developed at the block, district, regional and national levels for detecting, investigating, preventing, and combating health emergencies and outbreaks.

Way Forward

Integrated Health policy , insurance and robust health infrastructure with Surveillance will get a huge boost with 20 metropolitan surveillance units, five regional National Centre for Disease Control branches, and an integrated health promotion platform in all the States. It will also promote state-of-the-art national digital health ecosystem for IT-enabled healthcare service delivery and for managing the core digital health data.