India is home to 1.2 billion and is projected to be the third largest economy in the next decade.1 India also accounts for 33 percent of the total population living in poverty, according to the UN2 and spends 1.3% percent of its GDP on health compared to 3 percent by China and 8.6 percent by the United States.
While poverty and population growth (from 1.97 to 1.64 percent) rates have declined, sustained public-private investments in infrastructure development, energy efficiency, agriculture, health,3 education and skill development are vital to sustainable and inclusive growth. Considerable progress still needs to be made to meet MDG’s, particularly on reducing hunger and promoting gender equality. There are wide disparities across the country with variations in maternal and child health, burden of communicable and non-communicable diseases, health infrastructure and it is necessary to view the NHP 2015 through this lens. Does the policy provide comprehensive strategic direction to address these challenges? Does it promote attitudinal and behavioral changes which are crucial for progress on human development in India?
a. SEVEN TASK FORCES ON PREVENTIVE AND PROMOTIVE CARE STRATEGY
Under Section 4.2.17 of NHP 2015, it is intended to setup up seven Task Forces on Preventive and Promotive Care.
- Ensure that the task force adopts a multi-stakeholder approach to ensure participation from NGOs and Civil Society. DEF with support from UNICEF India has initiated the Mobile for Social and Behaviour Change (MSBC) project which is aimed at exploring the concept of ‘mobile as a communication tool for development’ in areas of information dissemination, interpersonal communication (IPC), and monitoring and tracking. NGOs with similar expertise may be considered for the task force.
b. URBAN AND RURAL INDIA: PARTICIPATORY APPROACH TO PLANNING
The rural-urban divide is stark, differences exist at various levels. There are two different realities and way of life in urban and rural India, as mentioned under Section 2.3 of the National Health Policy 2015, referred to as “NHP 2015,” hereafter. (Source: Section 2.3 of NHP 2015)
- Strengthen policy and programmatic planning at the central level need to incorporate local gaps, challenges, needs and feedback, through a participatory approach at the state level(s).
- Adopt a localized and customized approach as each village, community and locality has its own distinct identity, language, culture, customs, traditions and challenges. This is also evident through DEF’s work to provide digital access and connectivity across 100 locations in urban and rural India. Non-institutional determinants of poor health / social differentials are rarely addressed and as such there should be stronger affirmative action in health as in education and other spheres. Determinants such as discrimination require strong political will, not just investments.
c. RIGHT TO HEALTH
- Introduce, as questioned under Section 12.2 of NHP 2015, a comprehensive healthcare bill that makes health a fundamental right in India. To that end, it is further recommended that Right to Health be mentioned in all national and state level policies, frameworks, strategies and programs.
- Introduce a comprehensive health care bill to address challenges around medical malpractice promote transparency and accountability in the public health sector and foster Professionalism, Integrity and Ethics, as outlined under Section 3.2 of NHP 2015
- Develop and disseminate a Know Your Rights, Citizens Charter and/or Code of Conduct related to health care, in regional languages, to inform and educate citizens of their health rights through various platforms, including ICT tools and Village Health Sanitation and Nutrition Committee at the Panchayat level.
d. HEALTHY LIFE-STYLE AND HOLISTIC WELL-BEING
Due to non-communicable diseases, India is expected to lose $4.58 trillion between 2012 and 2030, according to the World Economic Forum. In addition, India lost 9.2 million productive years of life due to cardiovascular deaths in the 35-64 age-groups in 2000 and is projected to lose 18 million years by 2030. Under Section 4.2.14, the policy emphasizes the role of yoga in school, work and communities for general well-being.4
- Linkage between economic growth and health status: The NHP 2015 clearly acknowledges the linkages between economic growth and improved health status, productivity and equity in the country, under Section 1.1 of the National Health Policy 2015. It is important to recognize health and well-being, as a pre-condition, to achieve positive outcomes for the country’s overall development agenda and to ensure future growth—specifically the linkage between health well-being and skills development.
- Emphasize and promote work-life balance in urban cities, physical activity, lifestyle and dietary changes to promote holistic health and well-being—at the household level, school and community centers, places of worship, workplace, village and district level— and communicate the effects of healthy lifestyle on standard of life, education, environment, and economic well-being.