1 Goal:
The attainment of the highest possible level of good health and well-being, 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.
3.2.Key Policy Principles:
Equity: Public expenditure in health care, prioritizing the needs of the most vulnerable, who
suffer the largest burden of disease, would imply greater investment in access and financial
protection measures for the poor. Reducing inequity would also mean affirmative action to
reach the poorest and minimizing disparity on account of gender, poverty, caste, disability,
other forms of social exclusion and geographical barriers.
Universality: Systems and services are designed to cater to the entire population- not only a
targeted sub-group. Care to be taken to prevent exclusions on social or economic grounds.
Patient Centered & Quality of Care: Health Care services would be effective, safe, and
convenient, provided with dignity and confidentiality with all facilities across all sectors being
assessed, certified and incentivized to maintain quality of care.
Inclusive Partnerships: The task of providing health care for all cannot be undertaken by
Government, acting alone. It would also require the participation of communities – who view
this participation as a means and a goal, as a right and as a duty. It would also require the
widest level of partnerships with academic institutions, not for profit agencies and with the
commercial private sector and health care industry to achieve these goals.
Pluralism: Patients who so choose and when appropriate, would have access to AYUSH care
providers based on validated local health traditions. These systems would also have Government support and supervision to develop and enrich their contribution to meeting the
national health goals and objectives. Research, development of models of integrative practice,
efforts at documentation, validation of traditional practices and engagement with such
practitioners would form important elements of enabling medical pluralism.
Subsidiarity: For ensuring responsiveness and greater participation, increasing transfer of
decision making to as decentralized a level as is consistent with practical considerations and
institutional capacity would be promoted. (Nothing should be done by a larger and more
complex organization which can be done as well by a smaller and simpler organization.)
Accountability: Financial and performance accountability, transparency in decision making,
and elimination of corruption in health care systems, both in the public systems and in the
private health care industry, would be essential.
Professionalism, Integrity and Ethics: Health workers and managers shall perform their
work with the highest level of professionalism, integrity and trust and be supported by a
systems and regulatory environment that enables this.
Learning and Adaptive System: constantly improving dynamic organization of health care
which is knowledge and evidence based, reflective and learning from the communities they
serve, the experience of implementation itself, and from national and international knowledge
partners.
Affordability: As costs of care rise, affordability, as distinct from equity, requires emphasis.
Health care costs of a household exceeding 10% of its total monthly consumption expenditures
or 40% of its non-food consumption expenditure- is designated catastrophic health
expenditures- and is declared as an unacceptable level of health care costs. Impoverishment
due to health care costs is of course, even more unacceptable.
3.3.Objectives:3.3.1. Improve population health status through concerted policy action in all sectors and
expand preventive, promotive, curative, palliative and rehabilitative services provided by the
public health sector.
3.3.2. Achieve a significant reduction in out of pocket expenditure due to health care costs and
reduction in proportion of households experiencing catastrophic health expenditures and
consequent impoverishment.
3.3.3. Assure universal availability of free, comprehensive primary health care services, as an
entitlement, for all aspects of reproductive, maternal, child and adolescent health and for the
most prevalent communicable and non-communicable diseases in the populationEnable universal access to free essential drugs, diagnostics, emergency ambulance
services, and emergency medical and surgical care services in public health facilities, so as to
enhance the financial protection role of public facilities for all sections of the population.
3.3.5. Ensure improved access and affordability of secondary and tertiary care services through
a combination of public hospitals and strategic purchasing of services from the private health
sector.
3.3.6. Influence the growth of the private health care industry and medical technologies to
ensure alignment with public health goals, and enable contribution to making health care
systems more effective, efficient, rational, safe, affordable and ethical. .
EXPENDITURE
The National Health Policy accepts and endorses the understanding that a full achievement of
the goals and principles as defined would require an increased public health expenditure to 4 to
5% of the GDP. However, given that the NHP, 2002 target of 2% was not met, and taking
into account the financial capacity of the country to provide this amount and the institutional
capacity to utilize the increased funding in an effective manner, this policy proposes a
potentially achievable target of raising public health expenditure to 2.5 % of the GDP. It also
notes that 40% of this would need to come from Central expenditures. At current prices, a
target of 2.5% of GDP translates to Rs. 3800 per capita, representing an almost four fold
increase in five years. Thus a longer time frame may be appropriate to even reach this modest
target.
4.1.2. The major source of financing would remain general taxation. With the projection of a
promising economic growth, the fiscal capacity to provide this level of financing should
become available. The Government would explore the creation of a health cess on the lines of
the education cess for raising the necessary resources. Other than general taxation, this cess
could mobilise contributions from specific commodity taxes- such as the taxes on tobacco, and
alcohol, from specific industries and innovative forms of resource mobilization. Extractive
industries and development projects that result in displacement, or those that have negative
impacts on natural habitats or the resource base can be considered for special taxation thereby
allowing investment and job opportunities in education and health for affected communities.
4.1.3. Since about 50% of health expenditure goes into human resources for health, an equitous
growth of health and education sectors would also lead to increased employment in many areas
and communities, which do not otherwise benefit from the economic growth rate, particularly
where jobless growth is a phenomenon. High public investment in health care is one of the
most efficient ways of ameliorating inequities, and for this reason, this commitment to higher
public expenditures is essential.
The attainment of the highest possible level of good health and well-being, 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.
3.2.Key Policy Principles:
Equity: Public expenditure in health care, prioritizing the needs of the most vulnerable, who
suffer the largest burden of disease, would imply greater investment in access and financial
protection measures for the poor. Reducing inequity would also mean affirmative action to
reach the poorest and minimizing disparity on account of gender, poverty, caste, disability,
other forms of social exclusion and geographical barriers.
Universality: Systems and services are designed to cater to the entire population- not only a
targeted sub-group. Care to be taken to prevent exclusions on social or economic grounds.
Patient Centered & Quality of Care: Health Care services would be effective, safe, and
convenient, provided with dignity and confidentiality with all facilities across all sectors being
assessed, certified and incentivized to maintain quality of care.
Inclusive Partnerships: The task of providing health care for all cannot be undertaken by
Government, acting alone. It would also require the participation of communities – who view
this participation as a means and a goal, as a right and as a duty. It would also require the
widest level of partnerships with academic institutions, not for profit agencies and with the
commercial private sector and health care industry to achieve these goals.
Pluralism: Patients who so choose and when appropriate, would have access to AYUSH care
providers based on validated local health traditions. These systems would also have Government support and supervision to develop and enrich their contribution to meeting the
national health goals and objectives. Research, development of models of integrative practice,
efforts at documentation, validation of traditional practices and engagement with such
practitioners would form important elements of enabling medical pluralism.
Subsidiarity: For ensuring responsiveness and greater participation, increasing transfer of
decision making to as decentralized a level as is consistent with practical considerations and
institutional capacity would be promoted. (Nothing should be done by a larger and more
complex organization which can be done as well by a smaller and simpler organization.)
Accountability: Financial and performance accountability, transparency in decision making,
and elimination of corruption in health care systems, both in the public systems and in the
private health care industry, would be essential.
Professionalism, Integrity and Ethics: Health workers and managers shall perform their
work with the highest level of professionalism, integrity and trust and be supported by a
systems and regulatory environment that enables this.
Learning and Adaptive System: constantly improving dynamic organization of health care
which is knowledge and evidence based, reflective and learning from the communities they
serve, the experience of implementation itself, and from national and international knowledge
partners.
Affordability: As costs of care rise, affordability, as distinct from equity, requires emphasis.
Health care costs of a household exceeding 10% of its total monthly consumption expenditures
or 40% of its non-food consumption expenditure- is designated catastrophic health
expenditures- and is declared as an unacceptable level of health care costs. Impoverishment
due to health care costs is of course, even more unacceptable.
3.3.Objectives:3.3.1. Improve population health status through concerted policy action in all sectors and
expand preventive, promotive, curative, palliative and rehabilitative services provided by the
public health sector.
3.3.2. Achieve a significant reduction in out of pocket expenditure due to health care costs and
reduction in proportion of households experiencing catastrophic health expenditures and
consequent impoverishment.
3.3.3. Assure universal availability of free, comprehensive primary health care services, as an
entitlement, for all aspects of reproductive, maternal, child and adolescent health and for the
most prevalent communicable and non-communicable diseases in the populationEnable universal access to free essential drugs, diagnostics, emergency ambulance
services, and emergency medical and surgical care services in public health facilities, so as to
enhance the financial protection role of public facilities for all sections of the population.
3.3.5. Ensure improved access and affordability of secondary and tertiary care services through
a combination of public hospitals and strategic purchasing of services from the private health
sector.
3.3.6. Influence the growth of the private health care industry and medical technologies to
ensure alignment with public health goals, and enable contribution to making health care
systems more effective, efficient, rational, safe, affordable and ethical. .
EXPENDITURE
The National Health Policy accepts and endorses the understanding that a full achievement of
the goals and principles as defined would require an increased public health expenditure to 4 to
5% of the GDP. However, given that the NHP, 2002 target of 2% was not met, and taking
into account the financial capacity of the country to provide this amount and the institutional
capacity to utilize the increased funding in an effective manner, this policy proposes a
potentially achievable target of raising public health expenditure to 2.5 % of the GDP. It also
notes that 40% of this would need to come from Central expenditures. At current prices, a
target of 2.5% of GDP translates to Rs. 3800 per capita, representing an almost four fold
increase in five years. Thus a longer time frame may be appropriate to even reach this modest
target.
4.1.2. The major source of financing would remain general taxation. With the projection of a
promising economic growth, the fiscal capacity to provide this level of financing should
become available. The Government would explore the creation of a health cess on the lines of
the education cess for raising the necessary resources. Other than general taxation, this cess
could mobilise contributions from specific commodity taxes- such as the taxes on tobacco, and
alcohol, from specific industries and innovative forms of resource mobilization. Extractive
industries and development projects that result in displacement, or those that have negative
impacts on natural habitats or the resource base can be considered for special taxation thereby
allowing investment and job opportunities in education and health for affected communities.
4.1.3. Since about 50% of health expenditure goes into human resources for health, an equitous
growth of health and education sectors would also lead to increased employment in many areas
and communities, which do not otherwise benefit from the economic growth rate, particularly
where jobless growth is a phenomenon. High public investment in health care is one of the
most efficient ways of ameliorating inequities, and for this reason, this commitment to higher
public expenditures is essential.
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