India’s National Health Policy 2017: Aligning with SDG 3

India’s National Health Policy 2017 marks a significant shift in the country’s approach to healthcare, aligning closely with the United Nations’ Sustainable Development Goal 3 (SDG 3) of ensuring healthy lives and promoting well-being for all. This comprehensive policy framework addresses critical healthcare challenges in India through a multifaceted approach that prioritizes equity, accessibility, and quality care for all citizens, particularly the underserved populations. The policy represents India’s commitment to achieving universal health coverage while tackling persistent health inequalities.

Understanding India’s National Health Policy 2017 🔗

The National Health Policy (NHP) 2017 replaced the previous policy of 2002, reflecting the changing healthcare landscape and emerging challenges in India. Approved by the Union Cabinet on March 16, 2017, this policy came after extensive stakeholder consultations and represents a progressive vision for India’s healthcare system. The policy recognizes health as a fundamental right and acknowledges the government’s responsibility to provide quality healthcare services to all citizens.

Key principles guiding the policy 🔗

The NHP 2017 is built upon several foundational principles that guide its implementation:

• Equity: Ensuring that healthcare services are accessible to all segments of society, regardless of socioeconomic status, geography, or other social determinants.
• Affordability: Making healthcare financially accessible to prevent catastrophic health expenditures, particularly for vulnerable populations.
• Universality: Working toward universal health coverage that leaves no one behind.
• Patient-centered care: Prioritizing the needs and preferences of patients in healthcare delivery.
• Quality: Ensuring that healthcare services meet certain standards of safety, effectiveness, and patient satisfaction.
• Accountability: Establishing mechanisms to hold healthcare systems and providers accountable for their performance.
• Pluralism: Recognizing the diverse healthcare traditions in India, including AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy).

Alignment with Sustainable Development Goal 3 🔗

SDG 3 aims to “ensure healthy lives and promote well-being for all at all ages.” The NHP 2017 demonstrates significant alignment with this global goal through various policy objectives and targets.

Shared vision for universal health coverage 🔗

Both the NHP 2017 and SDG 3 emphasize universal health coverage (UHC) as a central goal. The policy aims to provide essential health services to all Indian citizens without causing financial hardship. This aligns with SDG target 3.8, which calls for achieving universal health coverage, including financial risk protection and access to quality essential healthcare services.

The policy proposes to increase public health expenditure to 2.5% of GDP by 2025, up from the approximately 1.15% at the time of policy formulation. This increased investment is crucial for expanding healthcare coverage and improving service quality across the country.

Addressing maternal and child health 🔗

The NHP 2017 sets specific targets for reducing maternal and infant mortality, directly aligning with SDG targets 3.1 and 3.2:

• Maternal Mortality Ratio (MMR): The policy aims to reduce MMR to 100 per 100,000 live births by 2020, with further reductions targeted in subsequent years.
• Infant Mortality Rate (IMR): The policy targets reducing IMR to 28 per 1,000 live births by 2019.
• Under-5 Mortality Rate: The policy aims to reduce this to 23 per 1,000 live births by 2025.

These targets reflect India’s commitment to ending preventable deaths of newborns and children under five years of age, as well as reducing maternal mortality.

Tackling communicable and non-communicable diseases 🔗

The policy addresses both communicable and non-communicable diseases (NCDs), aligning with SDG targets 3.3 and 3.4:

• Communicable diseases: The policy aims to eliminate kala-azar and filariasis by 2017, leprosy by 2018, and measles by 2020. It also targets ending epidemic diseases like AIDS, tuberculosis, and malaria by 2030.
• Non-communicable diseases: The policy focuses on reducing premature mortality from cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases by 25% by 2025.

Key Policy Initiatives Supporting SDG 3 🔗

Universal health coverage through Ayushman Bharat 🔗

One of the most significant initiatives under the NHP 2017 is the Ayushman Bharat program, launched in 2018. This program has two main components:

• Pradhan Mantri Jan Arogya Yojana (PM-JAY): This scheme provides health insurance coverage of up to ₹5 lakhs per family per year for secondary and tertiary care hospitalization to over 100 million vulnerable families, covering approximately 500 million beneficiaries.
• Health and Wellness Centers (HWCs): The policy envisions transforming 150,000 sub-centers and primary health centers into Health and Wellness Centers to provide comprehensive primary healthcare, including preventive healthcare, screening, and management of non-communicable diseases.

These initiatives directly support SDG target 3.8 on achieving universal health coverage and financial risk protection.

Strengthening healthcare infrastructure 🔗

The NHP 2017 emphasizes the need to strengthen healthcare infrastructure, particularly in underserved areas. It proposes:

• Establishing at least 2 beds per 1,000 population: With a focus on increasing availability in currently underserved areas.
• District hospital upgradation: Ensuring that every district has a functional hospital that can provide a wide range of secondary care services.
• Public-private partnerships: Engaging the private sector strategically to fill gaps in public health services where needed.

These measures support SDG target 3.c, which calls for substantially increasing health financing and the recruitment, development, training, and retention of the health workforce in developing countries.

Health workforce development 🔗

Recognizing the critical shortage of healthcare professionals in India, the policy outlines several strategies to address this challenge:

• Medical education reforms: Increasing the number of medical, nursing, and allied health professional training institutions.
• Mid-level service providers: Creating a new cadre of healthcare professionals to bridge gaps in rural and underserved areas.
• Continuing education: Ensuring healthcare professionals stay updated with the latest knowledge and skills.

These initiatives align with SDG target 3.c, which focuses on health workforce development, particularly in developing countries.

Addressing Health Inequalities 🔗

Focus on marginalized populations 🔗

The NHP 2017 places special emphasis on reducing health inequalities by focusing on the needs of marginalized and vulnerable populations, including:

• Scheduled Castes and Scheduled Tribes: Addressing specific health challenges faced by these communities through targeted interventions.
• Rural populations: Improving healthcare access in rural areas through strengthened primary healthcare and digital health initiatives.
• Urban poor: Expanding healthcare services in urban slums and addressing the unique health challenges of the urban poor.
• Women and children: Prioritizing maternal and child health services to reduce mortality and improve health outcomes.

This focus on reducing health inequalities directly supports the SDG principle of “leaving no one behind” and addresses SDG target 3.8 on universal health coverage.

Addressing social determinants of health 🔗

The policy recognizes that health outcomes are influenced by various social, economic, and environmental factors. It advocates for a multisectoral approach to health, involving coordination with other sectors such as:

• Nutrition: Collaborating with nutrition programs to address malnutrition and its health impacts.
• Water and sanitation: Working with relevant departments to ensure access to clean water and sanitation facilities.
• Education: Promoting health education and awareness through educational institutions.
• Environment: Addressing environmental health hazards and promoting a clean environment.

This holistic approach aligns with the SDG framework, which recognizes the interconnectedness of various development goals.

Challenges in Implementation 🔗

Despite its comprehensive vision, the implementation of NHP 2017 faces several challenges:

Financial constraints 🔗

While the policy aims to increase public health expenditure to 2.5% of GDP, achieving this target remains challenging. Limited fiscal space, competing priorities, and the COVID-19 pandemic have further strained healthcare budgets. Without adequate financial resources, many of the policy’s ambitious goals may remain unfulfilled.

Healthcare workforce shortages 🔗

India continues to face a significant shortage of healthcare professionals, particularly in rural and remote areas. The doctor-to-population ratio remains well below the WHO recommendation of 1:1,000. Similarly, there are shortages of nurses, specialists, and allied health professionals. Addressing these shortages requires long-term investments in medical education and innovative approaches to healthcare delivery.

Urban-rural disparities 🔗

Significant disparities exist between urban and rural healthcare in terms of infrastructure, workforce, and service quality. Rural areas often lack specialist services, diagnostic facilities, and emergency care. The policy’s goal of reducing these disparities requires targeted interventions and resource allocation.

Impact of the COVID-19 pandemic 🔗

The COVID-19 pandemic has significantly impacted healthcare systems worldwide, including in India. While the pandemic highlighted the importance of robust public health systems, it also diverted resources from other health priorities and exposed gaps in healthcare infrastructure, surveillance systems, and emergency preparedness.

Progress and Way Forward 🔗

Since its adoption in 2017, the NHP has led to several significant developments in India’s healthcare system:

Achievements since policy adoption 🔗

• Launch of Ayushman Bharat: The world’s largest health insurance scheme, covering over 500 million vulnerable individuals.
• Expansion of Health and Wellness Centers: Transforming primary healthcare facilities to provide comprehensive services.
• Digital health initiatives: The National Digital Health Mission aims to create a digital health ecosystem with unique health IDs for all citizens.
• Improvements in health indicators: Gradual reductions in maternal and infant mortality rates, though regional disparities persist.

Future priorities for alignment with SDG 3 🔗

To fully align with SDG 3 targets by 2030, India needs to focus on:

• Increased health financing: Accelerating progress toward the 2.5% of GDP target for public health expenditure.
• Strengthening primary healthcare: Completing the transformation of primary healthcare facilities into comprehensive Health and Wellness Centers.
• Healthcare workforce development: Addressing shortages through increased training capacity and retention strategies.
• Quality improvement: Establishing and enforcing quality standards across all levels of healthcare.
• Digital health transformation: Leveraging technology to improve healthcare access, quality, and efficiency.
• Multisectoral collaboration: Strengthening coordination with other sectors to address social determinants of health.

Conclusion 🔗

India’s National Health Policy 2017 represents a significant step toward achieving SDG 3 goals of ensuring healthy lives and promoting well-being for all. The policy’s emphasis on universal health coverage, equity, quality, and accountability aligns closely with the global sustainable development agenda. Through initiatives like Ayushman Bharat, health workforce development, and addressing social determinants of health, India is working toward reducing health inequalities and improving health outcomes for all citizens.

However, challenges in implementation, particularly financial constraints, workforce shortages, and urban-rural disparities, need to be addressed for the policy to fully realize its potential. The COVID-19 pandemic has further highlighted the importance of robust healthcare systems and the need for continued investment in public health infrastructure and preparedness.

As India moves forward with implementing the NHP 2017, continued commitment to its principles and objectives will be crucial for making progress toward SDG 3 targets and ensuring that no one is left behind in the pursuit of health and well-being for all.

What do you think? How can India balance the competing priorities of expanding healthcare access while ensuring quality and financial sustainability? What role can technology play in bridging healthcare gaps in underserved regions while advancing the goals of both the National Health Policy 2017 and SDG 3?