INTRODUCTION:

National Health Policies, Strategies and Plans (NHPSPs) play an essential role in defining a country's vision, policy directions and strategies for ensuring the health of its population. NHPSPs provide a framework in almost every country for dealing with the complex range of issues needed to improve health outcomes, including those related to the Sustainable Development Goals and to other national priority health problems, such as non communicable diseases.

National health policy 2017:

The Union Cabinet, Government of India had approved the National Health Policy 2017 on 16 March 2017. This is the India’s third National Health policy (NHP). Earlier NHPs were released in 1983 and 2002.

From the national health policy 2002, there have been many changes occurred in the health status India which are improvement in Maternal mortality rate (MMR), Infant mortality rate, morbidity rates of various communicable diseases, but non-communicable diseases are became a burden. The high cost of medical care pushing people into state of poverty, and rising economy of India has not been able to transform the public health infrastructure across the vast stretches of the country. To overcome this the National Health Policy, 2017, aims to inform, clarify, strengthen and prioritize the role of the Government in shaping health systems in all its dimensions such as investments in health, organization of healthcare services, prevention of diseases and promotion of good health through cross sectoral actions, access to technologies, developing human resources, encouraging medical pluralism, building knowledge base, developing better financial protection strategies, strengthening regulation and health assurance.

Goal:

The policy envisages as its goal the 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. This would be achieved through increasing access, improving quality and lowering the cost of healthcare delivery.

Key Policy Principles:

NHP 2017 proposes ten key policy principles to attain policy objectives. These key policy principles are: 1) Professionalism, Integrity and Ethics, 2) Equity, 3) Affordability, 4) Universality, 5) Patient Centred & Quality of Care, 6) Accountability, 7) Inclusive Partnerships, 8) Pluralism, 9) Decentralization, and 10) Dynamism and Adaptiveness. NHP 2017 states that these key policy principles will help in reducing mortality and morbidity as well as in improving wellness in population.

Objectives:

Objectives Improve health status through concerted policy action in all sectors and expand preventive, promotive, curative, palliative and rehabilitative services provided through the public health sector with focus on quality.

Specific Quantitative Goals and Objectives:

The indicative, quantitative goals and objectives are outlined under three broad components viz. (a) health status and programme impact, (b) health systems performance and (c) health system strengthening. These goals and objectives are aligned to achieve sustainable development in health sector in keeping with the policy thrust.

(a) Health Status and Programme Impact:

1. Life Expectancy and healthy life:

· Increase Life Expectancy at birth from 67.5 to 70 by 2025.

· Establish regular tracking of Disability Adjusted Life Years (DALY) Index as a measure of burden of disease and its trends by major categories by 2022.

· Reduction of TFR to 2.1 at national and sub-national level by 2025.

2. Mortality by Age and/ or cause:

· Reduce Under Five Mortality to 23 by 2025 and MMR from current levels to 100 by 2020.

· Reduce infant mortality rate to 28 by 2019.

· Reduce neo-natal mortality to 16 and still birth rate to “single digit” by 2025.

3. Reduction of disease prevalence/ incidence:

· Achieve global target of 2020 which is also termed as target of 90:90:90, for HIV/AIDS i.e. 90% of all people living with HIV know their HIV status, - 90% of all people diagnosed with HIV infection receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have viral suppression.

· Achieve and maintain elimination status of Leprosy by 2018, Kala-Azar by 2017 and Lymphatic Filariasis in endemic pockets by 2017.

· To achieve and maintain a cure rate of >85% in new sputum positive patients for TB and reduce incidence of new cases, to reach elimination status by 2025.

· To reduce the prevalence of blindness to 0.25/ 1000 by 2025 and disease burden by one third from current levels.

· To reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by 25% by 2025.

(b) Health Systems Performance:

1. Coverage of Health Services:

· Increase utilization of public health facilities by 50% from current levels by 2025.

· Antenatal care coverage to be sustained above 90% and skilled attendance at birth above 90% by 2025.

· More than 90% of the newborn are fully immunized by one year of age by 2025.

· Meet need of family planning above 90% at national and sub national level by 2025.

· 80% of known hypertensive and diabetic individuals at household level maintain "controlled disease status" by 2025.

2. Cross Sectoral goals related to health:

· Relative reduction in prevalence of current tobacco use by 15% by 2020 and 30% by 2025.

· Reduction of 40% in prevalence of stunting of under-five children by 2025.

· Access to safe water and sanitation to all by 2020 (Swachh Bharat Mission).

· Reduction of occupational injury by half from current levels of 334 per lakh agricultural workers by 2020.

· National/ State level tracking of selected health behaviour.

(c) Health Systems strengthening:

1. Health Finance:

· Increase health expenditure by Government as a percentage of GDP from the existing 1.1 5 % to 2.5 % by 2025.

· Increase State sector health spending to > 8% of their budget by 2020.

· Decrease in proportion of households facing catastrophic health expenditure from the current levels by 25%, by 2025.

2. Health Infrastructure and Human Resource:

· Ensure availability of paramedics and doctors as per Indian Public Health Standard (IPHS) norm in high priority districts by 2020.

· Increase community health volunteers to population ratio as per IPHS norm, in high priority districts by 2025.

· Establish primary and secondary care facility as per norm s in high priority districts (population as well as time to reach norms) by 2025.

3. Health Management Information:

· Ensure district - level electronic database of information on health system components by 2020.

· Strengthen the health surveillance system and establish registries for diseases of public health importance by 2020.

· Establish federated integrated health information architecture, Health Information Exchanges and National Health Information Network by 2025.

The government passes various acts and laws to promote healthy lives for all. These acts pertain to nursing profession and education. There are 25 key components and or policy prescriptions, in that the following were related to Nursing Service and Education;

Nursing Education:

· The policy recognizes the need to improve regulation and quality management of nursing education. Other measures suggested are - establishing cadres like Nurse Practitioners and Public Health Nurses to increase their availability in most needed areas.

· Developing specialized nursing training courses and curriculum (critical care, cardio-thoracic vascular care, neurological care, trauma care, palliative care and care of terminally ill).

· Establishing nursing school in every large district or cluster of districts of about 20 to 30 lakh populations and establishing Centers of Excellence for Nursing and Allied Health Sciences in each State.

· States which have adequate nursing institutions have flexibility to explore a gradual shift to three year nurses even at the sub-centre level to support the implementation of the comprehensive primary health care agenda.

· The Indian Nursing Council (INC) implemented a Nurse Practitioner in the critical care (NPCC) program from 2017 and Nurse Practitioner (NP) in Primary Health Care (NPPHC) Program from 2018 with the approval of the MoHFW all over the country to expand the role of registered nurses.

Mid-Level Service Providers:

· For expansion of primary care from selective care to comprehensive care, complementary human resource strategy is the development of a cadre of mid-level care providers. This can be done through appropriate courses like a B.Sc. in community health and/or through competency-based bridge courses and short courses. These bridge courses could admit graduates from different clinical and paramedical backgrounds like AYUSH doctors, B.Sc. Nurses, Pharmacists, GNMs, etc and equip them with skills to provide services at the sub-centre and other peripheral levels. Locale based selection, a special curriculum of training close to the place where they live and work, conditional licensing, enabling legal framework and a positive practice environment will ensure that this new cadre is preferentially available where they are needed most, i.e. in the under-served areas.

Human Resource Governance and leadership development:

· The policy recognizes that human resource management is critical to health system strengthening and healthcare delivery and therefore the policy supports measures aimed at continuing medical and nursing education and on the job support to providers, especially those working in professional isolation in rural areas using digital tools and other appropriate training resources. Policy recommends development of leadership skills, strengthening human resource governance in public health system, through establishment of robust recruitment, selection, promotion and transfer postings policies.

Tertiary care Services:

· The policy affirms that the tertiary care services are best organized along lines of regional, zonal and apex referral centers. It recommends that the Government should set up new Medical Colleges, Nursing Institutions and AIIMS in the country.

REFERENCES:

1. National Health Policy 2017, Ministry of Health and Family Welfare, Government of India. Available from: https://www.nhp.gov.in/nhpfiles/national_health_policy_2017.pdf

2. G Bhuvaneswari. Salient Features of the National Health Policy-2017. Tamilnadu Nursing and Midwifes Council Journal of Community Health Nursing. 2019; 7(2):39-40. Available From: https://www.researchgate.net/publication/345337909_Salient_Features_of_The_National_Health_Policy_-_2017

3. National Health Policy - 2017. Available from: https://main.mohfw.gov.in/sites/default/files/9147562941489753121.pdf

4. Grover A, Singh RB. Health Policy, Programmes and Initiatives. Urban Health and Wellbeing. 2019; 251 -266. Available From: https://link.springer.com/chapter/10.1007/978-981-13-6671-0_8

5. Gudipati Rajendra Kumar. Understanding the National Health Policy. The Hans India. 2017. Available from: https://www.thehansindia.com/posts/index/Hans/2017-03-31/Understanding-the-National-Health-Policy-2017/289965

6. Supporting National Health Policies, Strategies, Plans, WHO. Available From: https://www.who.int/activities/supporting-national-health-policies-strategies-plans

Received on 09.06.2023 Modified on 13.07.2023

Int. J. of Advances in Nur. Management. 2023; 11(4):234-236.

DOI: 10.52711/2454-2652.2023.00053