Given India’s growing population, diversity and disease burden, providing quality healthcare to more than 1 billion people remains a daunting challenge. India has the second largest population in the world and is expected to overtake China within a decade. Currently, around 1.3 billion, India’s population has grown fourfold since independence.
Despite various measures by governments to improve healthcare services, access to care continues to be a neglected concept in India. However, over the past few decades, there has been ongoing movement in India toward recognizing health as a fundamental human right. In this regard, India has embarked upon a voyage of transforming its healthcare system with the goal of improving the quality of healthcare available to its population. Considering this, India’s newly approved National Health Policy (NHP) 2017 is a laudable step toward the goal of making healthcare accessible to all in India.
After a wait of 15 years since the last NHP was ratified, the Union Cabinet approved the new NHP on March 15, 2017 as explored in our Global Market Access Solution analysis. The policy will replace the 2002 NHP, which itself followed the first NHP issued in 1983. The earlier national health policies had the objective of achieving an acceptable standard of health among the general population. While progress was seen toward improving access to healthcare services, providing quality and affordable care to the entire population has remained an elusive goal. The socio-economic and epidemiological changes since that time demanded the formulation of the new NHP-2017 to address a host of emerging challenges.
The main objective of the NHP-2017 is to improve overall population health through a focus on health promotion and disease prevention. Primarily, the policy envisages achieving universal healthcare coverage and reducing the reliance on out-of-pocket spending. It emphasizes restructuring and strengthening the public healthcare institutions with the goal of providing free access to essential drugs, diagnostics, and emergency services.
The NHP also advocates positive and proactive engagement with the private sector in order to leverage the sector’s strengths to achieve public health goals. The policy has assigned specific quantitative targets aimed at reducing disease prevalence/incidence, increasing life expectancy, and decreasing infant mortality. It further seeks to reinforce the health surveillance system and develop digital registries for diseases of public health importance by 2020.
For drug makers, one of the key highlights of the NHP is the government’s proposal to raise public health expenditure to 2.5% of GDP. With the increase in healthcare expenditure, the government aims to provide access to all citizens, which should be a boon to drug manufacturers with increased utilization of prescription drugs expected to follow. The NHP will also attempt to stimulate innovation and drug discovery by allocating adequate public funding for research and development in the country.
NHP 2017 also affirms India’s commitment to developing an institutional framework and capacity for health technology assessment (HTA). Greater reliance on HTA is intended to assist healthcare decision makers through evidence-based, reliable, and transparent information on health technology effectiveness. This is a positive move as the development of HTA will ultimately aid in providing quality care, informing policy decisions, and supporting India’s goal of universal health coverage.
In addition, the policy targets integration of India’s AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) treatments across the healthcare system. The government hopes that mainstreaming of AYUSH will help India inch toward meeting the goal of universal healthcare by improving access and strengthening the healthcare delivery system, especially in remote areas. Given that this approach promotes a higher reliance among patients on these cost-effective alternatives to allopathy, the change stands to negatively impact the pharma sector. Although the government is serious about promoting AYUSH, considering its questionable scientific evidence and lack of a transparent regulatory framework, this policy should still need to overcome several obstacles to implementation.
A number of reforms will specifically impact the pharmaceutical sector. India seeks to promote drugs as part of the Make in India program aimed at encouraging companies to manufacture their products domestically. The NHP also targets timely revisions to the country’s National List of Essential Medicines (NLEM), along with appropriate price control mechanisms and increasing generic drug uptake. While detrimental to the international innovative pharmaceuticals sector, incentivizing local manufacturing and promoting generic use could potentially generate health system savings to fund innovative medicines down the line.
The NHP-2017 is a progressive step to addressing the mounting healthcare concerns facing India today. However, successful implementation of this policy will be the key. There is a strong need for monitoring mechanisms to check the policy’s success as it moves toward concrete solutions. The policy’s execution will surely be plagued by formidable challenges arising from India’s ever-changing socio-economic inequalities with respect to income, ethnicity, education, and occupation. Inequalities in access to healthcare are also prevalent across India’s healthcare landscape due to both urban-rural and inter-state disparities.
While patient-centric and quality driven, it is worth noting that the new policy includes many recycled ideas that have ultimately failed to see the light of day in the past. Most importantly, there is also a lack of correlation between the goals set and the proposed public investment. Although the NHP-2017 looks highly ambitious with targets that together demonstrate a clear vision for a healthy India, putting the policy into practice will require consensus, commitment, and coordination between the central and state governments.
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