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Five-Year Plans of India

Introduction:
From 1947 to 2017, the Indian economy was premised on the concept of planning.
This was carried through the Five-Year Plans, developed, executed, and monitored by
the Planning Commission (1951-2014) and the NITI Aayog (2015-2017). With the prime
minister as the ex-officio chairman, the commission has a nominated deputy chairman, who
holds the rank of a cabinet minister. Montek Singh Ahluwalia is the last deputy chairman of
the commission (resigned on 26 May 2014). The Twelfth Plan completed its term in March
2017.[1] Prior to the Fourth Plan, the allocation of state resources was based on schematic
patterns rather than a transparent and objective mechanism, which led to the adoption of
the Gadgil formula in 1969. Revised versions of the formula have been used since then to
determine the allocation of central assistance for state plans. [2] The new government led
by Narendra Modi, elected in 2014, has announced the dissolution of the Planning
Commission, and its replacement by a think tank called the NITI Aayog (an acronym for
National Institution for Transforming India.

History

Five-Year Plans (FYPs) are centralized and integrated national economic

programs. Joseph Stalin implemented the first Five-Year Plan in the Soviet Union in 1928.
Most communist states and several capitalist countries subsequently have adopted them.
China continues to use FYPs, although China renamed its Eleventh FYP, from 2006 to 2010,
a guideline (guihua), rather than a plan (jihua), to signify the central government's more
hands-off approach to development. India launched its First FYP in 1951, immediately after
independence, under socialist influence of the first prime minister, Jawaharlal Nehru.

The First Five-Year Plan was one of the most important, because it had a great role in
the launching of Indian development after Independence. Thus, it strongly supported
agriculture production and also launched the industrialization of the country (but less than the
Second Plan, which focused on heavy industries). It built a particular system of mixed
economy, with a great role for the public sector (with an emerging welfare state), as well as a

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growing private sector (represented by some personalities as those who published

the Bombay Plan)

First Plan (1951–1956)

The first Indian prime minister, Jawaharlal Nehru, presented the First Five-Year Plan
to the Parliament of India and needed urgent attention. The First Five-year Plan was launched
in 1951 which mainly focused in development of the primary sector. The First Five-Year
Plan was based on the Harrod–Domar model with few modifications.

The total planned budget of Rs.2069 crore (2378 crore later) was allocated to seven
broadareas: irrigation and energy (27.2%), agriculture and community development(17.4%), t
ransport and communications (24%), industry (8.4%), social services (16.6%), rehabilitation
of landless farmers (4.1%), and for other sectors and services (2.5%). The most important
feature of this phase was active role of state in all economic sectors. Such a role was justified
at that time because immediately after independence, India was facing basic problems—
deficiency of capital and low capacity to save.

The target growth rate was 2.1% annual gross domestic product (GDP) growth; the
achieved growth rate was 3.6% the net domestic product went up by 15%. The monsoon was
good and there were relatively high crop yields, boosting exchange reserves and the per
capita income, which increased by 8%. National income increased more than the per capita
income due to rapid population growth. Many irrigation projects were initiated during this
period, including the Bhakra, Hirakud, Mettur Dam and Damodar Valley dams. The World
Health Organization (WHO), with the Indian government, addressed children's health and
reduced infant mortality, indirectly contributing to population growth.

At the end of the plan period in 1956, five Indian Institutes of Technology (IITs) were
started as major technical institutions. The University Grants Commission (UGC) was set up
to take care of funding and take measures to strengthen the higher education in the country.
Contracts were signed to start five steel plants, which came into existence in the middle of the
Second Five-Year Plan. The plan was quasi-successful for the government.

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Second Plan (1956–1961)

The Second Plan focused on the development of the public sector and "rapid

Industrialisation". The plan followed the Mahalanobis model, an economic
development model developed by the Indian statistician Prasanta Chandra Mahalanobis in
1953. The plan attempted to determine the optimal allocation of investment between
productive sectors in order to maximise long-run economic growth. It used the prevalent
state-of-the-art techniques of operations research and optimization as well as the novel
applications of statistical models developed at the Indian Statistical Institute. The plan
assumed a closed economy in which the main trading activity would be centred on
importing capital goods.

Hydroelectric power projects and five steel plants at Bhilai, Durgapur,

and Rourkela were established with the help of Russia, Britain (the U.K) and West Germany
respectively. Coal production was increased. More railway lines were added in the north east.

The Tata Institute of Fundamental Research and Atomic Energy Commission of

India were established as research institutes. In 1957, a talent search and scholarship program
was begun to find talented young students to train for work in nuclear power.

The total amount allocated under the Second Five-Year Plan in India was
Rs.48 billion. This amount was allocated among various sectors: power and irrigation, social
services, communications and transport, and miscellaneous. The second plan was a period of
rising prices. The country also faced foreign exchange crisis. The rapid growth in population
slowed down the growth in the per capita income.

The target growth rate was 4.5% and the actual growth rate was 4.27%. The plan was
criticized by classical liberal economist B.R. Shenoy who noted that the plan's "dependence
on deficit financing to promote heavy industrialization was a recipe for trouble". Shenoy
argued that state control of the economy would undermine a young democracy. India faced
an external payments crisis in 1957, which is viewed as confirmation of Shenoy's argument.

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Third Plan (1961–1966)

The Third Five-year Plan stressed agriculture and improvement in the production of
wheat, but the brief Sino-Indian War of 1962 exposed weaknesses in the economy and shifted
the focus towards the defence industry and the Indian Army. In 1965–1966, India fought
a War with Pakistan. There was also a severe drought in 1965. The war led to inflation and
the priority was shifted to price stabilisation. The construction of dams continued.
Many cement and fertilizer plants were also built. Punjab began producing an abundance
of wheat.

Many primary schools were started in rural areas. In an effort to bring democracy to

the grass-root level, Panchayat elections were started and the states were given more
development responsibilities.State electricity boards and state secondary education boards
were formed. States were made responsible for secondary and higher education. State road
transportation corporations were formed and local road building became a state
responsibility.The target growth rate was 5.6%, but the actual growth rate was 2.4%.

Plan Holidays (1966–1969)

Due to miserable failure of the Third Plan the government was forced to declare "plan
holidays" (from 1966–67, 1967–68, and 1968–69). Three annual plans were drawn during
this intervening period. During 1966–67 there was again the problem of drought. Equal
priority was given to agriculture, its allied activities, and industrial sector. The government of
India declared "Devaluation of Rupee" to increase the exports of the country. The main
reasons for plan holidays were the war, lack of resources and increase in inflation.

Fourth Plan (1969–1974)

At this time Indira Gandhi was the prime minister. The Indira Gandhi

government nationalised 14 major Indian banks and the Green Revolution in India advanced
agriculture. In addition, the situation in East Pakistan (now Bangladesh) was becoming dire
as the Indo-Pakistan War of 1971 and Bangladesh Liberation War took funds earmarked for

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industrial development. India also performed the Smiling Buddha underground nuclear

test (Pokhran-1) in Rajasthan on May 18, 1974, partially in response to the United States
deployment of the Seventh Fleet in the Bay of Bengal. The fleet had been deployed to warn
India against attacking West Pakistan and extending the war.The target growth rate was
5.6%, but the actual growth rate was 3.3%.

Fifth Plan (1974–1979)

The Fifth Five-Year Plan laid stress on employment, poverty alleviation (Garibi

Hatao), and justice. The plan also focused on self-reliance in agricultural production and
defence. In 1978 the newly elected Morarji Desai government rejected the plan. The
Electricity Supply Act was amended in 1975, which enabled the central government to enter
into power generation and transmission. The Indian national highway system was introduced
and many roads were widened to accommodate the increasing traffic. Tourism also expanded.
The twenty-point programme was launched in 1975. It was followed from 1974 to 1979.

The Minimum Needs Programme (MNP) was introduced in the first year of the Fifth
Five-Year Plan (1974–78). The objective of the programme is to provide certain basic
minimum needs and thereby improve the living standards of the people. It is prepared and
launched by D.P.Dhar. The target growth rate was 4.4% and the actual growth rate was 4.8%.

Rolling Plan (1978–1980)

The Janata Party government rejected the Fifth Five-Year Plan and introduced a new
Sixth Five-Year Plan (1978–1980). This plan was again rejected by the Indian National
Congress government in 1980 and a new Sixth Plan was made. The Rolling Plan consisted of
three kinds of plans that were proposed. The First Plan was for the present year which
comprised the annual budget and the Second was a plan for a fixed number of years, which
may be 3, 4 or 5 years.

The Second Plan kept changing as per the requirements of the Indian economy. The
Third Plan was a perspective plan for long terms i.e. for 10, 15 or 20 years. Hence there was
no fixation of dates for the commencement and termination of the plan in the rolling plans.

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The main advantage of the rolling plans was that they were flexible and were able to
overcome the rigidity of fixed Five-Year Plans by mending targets, the object of the exercise,
projections and allocations as per the changing conditions in the country's economy. The
main disadvantage of this plan was that if the targets were revised each year, it became
difficult to achieve the targets laid down in the five-year period and it turned out to be a
complex plan. Also, the frequent revisions resulted in the lack of stability in the economy.

Sixth Plan (1980–1985)

The Sixth Five-Year Plan marked the beginning of economic liberalization. Price

controls were eliminated and ration shops were closed. This led to an increase in food prices
and an increase in the cost of living. This was the end of Nehruvian socialism. The National
Bank for Agriculture and Rural Development was established for development of rural areas
on 12 July 1982 by recommendation of the Shivaraman Committee.

 Family planning was also expanded in order to prevent overpopulation. In contrast to

China's strict and binding one-child policy, Indian policy did not rely on the threat of force.
More prosperous areas of India adopted family planning more rapidly than less prosperous
areas, which continued to have a high birth rate. Military Five-Year Plans became
coterminous with Planning Commission's plans from this plan onwards.

The Sixth Five-Year Plan was a great success to the Indian economy. The target
growth rate was 5.2% and the actual growth rate was 5.7%. [6] The only Five-Year Plan which
was done twice.

Seventh Plan (1985–1990)

The Seventh Five-Year Plan was led by the Congress Party with Rajiv Gandhi as the
prime minister. The plan laid stress on improving the productivity level of industries by
upgrading of technology.The main objectives of the Seventh Five-Year Plan were to establish
growth in areas of increasing economic productivity, production of food grains, and
generating employment through "Social Justice".As an outcome of the Sixth Five-Year Plan,
there had been steady growth in agriculture, controls on the rate of inflation, and favourable

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balance of payments which had provided a strong base for the Seventh Five-Year Plan to
build on the need for further economic growth. The Seventh Plan had strived towards
socialism and energy production at large.

The thrust areas of the Seventh Five-Year Plan were: social justice, removal of
oppression of the weak, using modern technology, agricultural development, anti-poverty
programmes, full supply of food, clothing, and shelter, increasing productivity of small- and
large-scale farmers, and making India an independent economy.

Based on a 15-year period of striving towards steady growth, the Seventh Plan was
focused on achieving the prerequisites of self-sustaining growth by the year 2000. The plan
expected the labour force to grow by 39 million people and employment was expected to
grow at the rate of 4% per year. Under the Seventh Five-Year Plan, India strove to bring
about a self-sustained economy in the country with valuable contributions from voluntary
agencies and the general populace. The target growth rate was 5.0% and the actual growth
rate was 6.01%.[10] and the growth rate of per capita income was 3.7%.

Annual Plans (1990–1992)

The Eighth Plan could not take off in 1990 due to the fast changing political situation
at the centre and the years 1990–91 and 1991–92 were treated as Annual Plans. The Eighth
Plan was finally formulated for the period 1992–1997.

Eighth Plan (1992–1997)

1989–91 was a period of economic instability in India and hence no Five-Year Plan
was implemented. Between 1990 and 1992, there were only Annual Plans. In 1991, India
faced a crisis in foreign exchange (forex) reserves, left with reserves of only about US$1
billion. Thus, under pressure, the country took the risk of reforming the socialist
economy. P.V. Narasimha Rao was the ninth prime minister of the Republic of India and
head of Congress Party, and led one of the most important administrations in India's modern
history, overseeing a major economic transformation and several incidents affecting national
security.

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At that time Dr. Manmohan Singh (later prime minister of India) launched India's free
market reforms that brought the nearly bankrupt nation back from the edge. It was the
beginning of liberalization, privatisation and globalization (LPG) in India.

Modernization of industries was a major highlight of the Eighth Plan. Under this plan,
the gradual opening of the Indian economy was undertaken to correct the
burgeoning deficit and foreign debt. Meanwhile, India became a member of the World Trade
Organization on 1 January 1995. The major objectives included, controlling population
growth, poverty reduction, employment generation, strengthening the infrastructure,
institutional building, tourism management, human resource development, involvement
of Panchayati rajs, Nagar Palikas, NGOs, decentralisation and people's participation.

Energy was given priority with 26.6% of the outlay. The target growth rate was 5.6%
and the actual growth rate was 6.8%.To achieve the target of an average of 5.6% per annum,
investment of 23.2% of the gross domestic product was required. The incremental capital
ratio is 4.1. The saving for investment was to come from domestic sources and foreign
sources, with the rate of domestic saving at 21.6% of gross domestic production and of
foreign saving at 1.6% of gross domestic production.

Ninth Plan (1997–2002)

The Ninth Five-Year Plan came after 50 years of Indian Independence. Atal Bihari
Vajpayee was the prime minister of India during the Ninth Plan. The Ninth Plan tried
primarily to use the latent and unexplored economic potential of the country to promote
economic and social growth. It offered strong support to the social spheres of the country in
an effort to achieve the complete elimination of poverty.

The satisfactory implementation of the Eighth Five-Year Plan also ensured the states'
ability to proceed on the path of faster development. The Ninth Five-Year Plan also saw joint
efforts from the public and the private sectors in ensuring economic development of the
country. In addition, the Ninth Five-Year Plan saw contributions towards development from
the general public as well as governmental agencies in both the rural and urban areas of the
country.

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New implementation measures in the form of Special Action Plans (SAPs) were
evolved during the Ninth Plan to fulfill targets within the stipulated time with adequate
resources. The SAPs covered the areas of social infrastructure, agriculture, information
technology and Water policy.

Budget:

The Ninth Five-Year Plan had a total public sector plan outlay of ₹859,200
crore (US$120 billion). The Ninth Five-Year Plan also saw a hike of 48% in terms of plan
expenditure and 33% in terms of the plan outlay in comparison to that of the Eighth Five-
Year Plan. In the total outlay, the share of the center was approximately 57% while it was
43% for the states and the union territories.

The Ninth Five-Year Plan focused on the relationship between the rapid economic
growth and the quality of life for the people of the country. The prime focus of this plan was
to increase growth in the country with an emphasis on social justice and equity. The Ninth
Five-Year Plan placed considerable importance on combining growth oriented policies with
the mission of achieving the desired objective of improving policies which would work
towards the improvement of the poor in the country. The Ninth Plan also aimed at correcting
the historical inequalities which were still prevalent in the society.

Objectives:

The main objective of the Ninth Five-Year Plan was to correct historical inequalities and
increase the economic growth in the country. Other aspects which constituted the Ninth Five-
Year Plan were:

 Population control.
 Generating employment by giving priority to agriculture and rural development.
 Reduction of poverty.
 Ensuring proper availability of food and water for the poor.
 Availability of primary health care facilities and other basic necessities.
 Primary education to all children in the country.
 Empowering the socially disadvantaged classes like Scheduled castes, Scheduled
tribes and other backward classes.

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 Developing self-reliance in terms of agriculture.

 Acceleration in the growth rate of the economy with the help of stable prices.

Strategies:

 Structural transformations and developments in the Indian economy.

 New initiatives and initiation of corrective steps to meet the challenges in the
economy of the country.
 Efficient use of scarce resources to ensure rapid growth.
 Combination of public and private support to increase employment.
 Enhancing high rates of export to achieve self-reliance.
 Providing services like electricity, telecommunication, railways etc.
 Special plans to empower the socially disadvantaged classes of the country.
 Involvement and participation of Panchayati Raj institutions/bodies and Nagar Palikas
in the development process.

Performance:

 The Ninth Five-Year Plan achieved a GDP growth rate of 5.4% against a target of
6.5%
 The agriculture industry grew at a rate of 2.1% against the target of 4.2%
 The industrial growth in the country was 4.5% which was higher than that of the
target of 3%
 The service industry had a growth rate of 7.8%.
 An average annual growth rate of 6.7% was reached.

The Ninth Five-Year Plan looks through the past weaknesses in order to frame the
new measures for the overall socio-economic development of the country. However, for a
well-planned economy of any country, there should be a combined participation of the
governmental agencies along with the general population of that nation. A combined effort of
public, private, and all levels of government is essential for ensuring the growth of India's
economy. The target growth was 7.1% and the actual growth was 6.8%.

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Tenth Plan (2002–2007)

The main objectives of the Tenth Five-Year Plan:

 Attain 8% GDP growth per year.

 Reduction of poverty rate by 5% by 2007.
 Providing gainful and high-quality employment at least to the addition to the labour
force.
 Reduction in gender gaps in literacy and wage rates by at least 50% by 2007.
 20-point program was introduced.
 Target growth: 8.1% – growth achieved: 7.7%.
 The Tenth Plan was expected to follow a regional approach rather than sectoral
approach to bring down regional inequalities.
 Expenditure of ₹43,825 crore (US$6.1 billion) for tenth five years.

Out of total plan outlay, ₹921,291 crore (US$130 billion) (57.9%) was for central

government and ₹691,009 crore (US$97 billion) (42.1%) was for states and union territories.

Eleventh Plan (2007–2012)

 It was in the period of Manmohan Singh as a prime minister.

 It aimed to increase the enrolment in higher education of 18–23 years of age group by
2011-12.
 It focused on distant education, convergence of formal, non-formal, distant
and IT education institutions.
 Rapid and inclusive growth (poverty reduction).
 Emphasis on social sector and delivery of service therein.
 Empowerment through education and skill development.
 Reduction of gender inequality.

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 Environmental sustainability.
 To increase the growth rate in agriculture, industry and services to 4%, 10% and 9%
respectively.
 Reduce total fertility rate to 2.1.
 Provide clean drinking water for all by 2009.
 Increase agriculture growth to 4%.

Twelfth Plan (2012–2017)

The Twelfth Five-Year Plan of the Government of India has been decided to achieve a

growth rate of 8.2% but the National Development Council (NDC) on 27 December 2012
approved a growth rate of 8% for the Twelfth Plan.

With the deteriorating global situation, the Deputy Chairman of the Planning
Commission Montek Singh Ahluwalia has said that achieving an average growth rate of 9
percent in the next five years is not possible. The Final growth target has been set at 8% by
the endorsement of the plan at the National Development Council meeting held in New
Delhi.

"It is not possible to think of an average of 9% [in the Twelfth Plan]. I think
somewhere between 8 and 8.5 percent is feasible," Ahluwalia said on the sidelines of a
conference of State Planning Boards and departments. The approached paper for the Twelfth
Plan, approved last year, talked about an annual average growth rate of 9%.

"When I say feasible... that will require major effort. If you don't do that, there is no
God given right to grow at 8 percent. I think given that the world economy deteriorated very
sharply over the last year...the growth rate in the first year of the 12th Plan (2012–13) is 6.5
to 7 percent."

He also indicated that soon he should share his views with other members of the
Commission to choose a final number (economic growth target) to put before the country's
NDC for its approval.

The government intends to reduce poverty by 10% during the 12th Five-Year Plan.
Ahluwalia said, "We aim to reduce poverty estimates by 9% annually on a sustainable basis
during the Plan period". Earlier, addressing a conference of State Planning Boards and

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Planning departments, he said the rate of decline in poverty doubled during the Eleventh
Plan. The commission had said, while using the Tendulkar poverty line, the rate of reduction
in the five years between 2004–05 and 2009–10, was about 1.5% points each year, which was
twice that when compared to the period between 1993–95 to 2004–05. [13] The plan aims
towards the betterment of the infrastructural projects of the nation avoiding all types of
bottlenecks.

The document presented by the planning commission is aimed to attract private

investments of up to US$1 trillion in the infrastructural growth in the 12th five-year plan,
which will also ensure a reduction in the subsidy burden of the government to 1.5 percent
from 2 percent of the GDP (gross domestic product). The UID (Unique Identification
Number) will act as a platform for cash transfer of the subsidies in the plan.

The objectives of the Twelfth Five-Year Plan were:

 To create 50 million new work opportunities in the non farm sector.

 To remove gender and social gap in school enrolment.
 To enhance access to higher education.
 To reduce malnutrition among children aged 0–3 years.
 To provide electricity to all villages.
 To ensure that 50% of the rural population have accesses to proper drinking water.
 To increase green cover by 1 million hectare every year.
 To provide access to banking services to 90% of households

With the Planning Commission dissolved, no more formal plans are made for the
economy, but Five-Year Defence Plans continue to be made. The latest is 2017-2022.
There will be no Thirteenth Five-Year Plan.

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National Health Policy

Introduction

The National Health Policy of 1983 and the National Health Policy of 2002 have
served well in guiding the approach for the health sector in the Five-Year Plans. Now 14
years after the last health policy, the context has changed in four major ways. First, the health
priorities are changing. Although maternal and child mortality have rapidly declined, there is
growing burden on account of non-communicable diseases and some infectious diseases.
The second important change is the emergence of a robust health care industry estimated to
be growing at double digit.

The third change is the growing incidences of catastrophic expenditure due to health
care costs, which are presently estimated to be one of the major contributors to poverty.
Fourth, a rising economic growth enables enhanced fiscal capacity. Therefore, a new health
policy responsive to these contextual changes is required.

The primary aim of the National Health Policy, 2017, is to inform, clarify, strengthen
and prioritize the role of the Government in shaping health systems in all its dimensions-
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.

NHP 2017 builds on the progress made since the last NHP 2002. The developments
have been captured in the document “Backdrop to National Health Policy 2017- Situation
Analyses”, Ministry of Health & Family Welfare, Government of India.

Goal, Principles and Objectives

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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.

The policy recognizes the pivotal importance of Sustainable Development Goals

(SDGs). An indicative list of time bound quantitative goals aligned to ongoing national
efforts as well as the global strategic directions is detailed at the end of this section.

Policy Principles

Professionalism, Integrity and Ethics: The health policy commits itself to the highest
professional standards, integrity and ethics to be maintained in the entire system of health
care delivery in the country, supported by a credible, transparent and responsible regulatory
environment.

Equity: Reducing inequity would mean affirmative action to reach the poorest. It would
mean minimizing disparity on account of gender, poverty, caste, disability, other forms of
social exclusion and geographical barriers. It would imply greater investments and financial
protection for the poor who suffer the largest burden of disease.

Affordability: As costs of care increases, affordability, as distinct from equity, requires

emphasis. Catastrophic household health care expenditures defined as health expenditure
exceeding 10% of its total monthly consumption expenditure or 40% of its monthly non-food
consumption expenditure, are unacceptable.

Universality: Prevention of exclusions on social, economic or on grounds of current health

status. In this backdrop, systems and services are envisaged to be designed to cater to the
entire population- including special groups.

Patient Centered & Quality of Care: Gender sensitive, effective, safe, and convenient
healthcare services to be provided with dignity and confidentiality. There is need to evolve
and disseminate standards and guidelines for all levels of facilities and a system to ensure that
the quality of healthcare is not compromised.

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Accountability: Financial and performance accountability, transparency in decision making,

and elimination of corruption in health care systems, both in public and private.

Inclusive Partnerships: A multistakeholder approach with partnership & participation of all

nonhealth ministries and communities. This approach would include partnerships with
academic institutions, not for profit agencies, and health care industry as well.

Pluralism: Patients who so choose and when appropriate, would have access to AYUSH care
providers based on documented and validated local, home and community based practices.
These systems, inter alia, would also have Government support in research and supervision to
develop and enrich their contribution to meeting the national health goals and objectives
through integrative practices.

Decentralization: Decentralization of decision making to a level as is consistent with

practical considerations and institutional capacity. Community participation in health
planning processes, to be promoted side by side.

Dynamism and Adaptiveness: constantly improving dynamic organization of health care

based on new knowledge and evidence with learning from the communities and from national
and international knowledge partners is designed.

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.

Progressively achieve Universal Health Coverage

 Assuring availability of free, comprehensive primary health care services, for all
aspects of reproductive, maternal, child and adolescent health and for the most
prevalent communicable, non-communicable and occupational diseases in the
population. The Policy also envisages optimum use of existing manpower and
infrastructure as available in the health sector and advocates collaboration with
non -government sector on pro-bono basis for delivery of health care services linked

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to a health card to enable every family to have access to a doctor of their choice from
amongst those volunteering their services.
 Ensuring improved access and affordability, of quality secondary and tertiary care
services through a combination of public hospitals and well measured strategic
purchasing of services in health care deficit areas, from private care providers,
especially the not-for profit providers
 C. Achieving a significant reduction in out of pocket expenditure due to health care
costs and achieving reduction in proportion of households experiencing catastrophic
health expenditures and consequent impoverishment.

Reinforcing trust in Public Health Care System: Strengthening the trust of the common
man in public health care system by making it predictable, efficient, patient centric,
affordable and effective, with a comprehensive package of services and products that meet
immediate health care needs of most people.

Align the growth of private health care sector with public health goals: Influence the
operation and growth of the private health care sector and medical technologies to ensure
alignment with public health goals. Enable private sector contribution to making health care
systems more effective, efficient, rational, safe, affordable and ethical. Strategic purchasing
by the Government to fill critical gaps in public health facilities would create a demand for
private health care sector, in alignment with the public health goals.

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.

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Health Status and Programme Impact

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

b. 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.

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

Mortality by Age and/ or cause

a. Reduce Under Five Mortality to 23 by 2025 and MMR from current levels to 100 by
2020.
b. Reduce infant mortality rate to 28 by 2019.
c. Reduce neo-natal mortality to 16 and still birth rate to “single digit” by 2025.

Reduction of disease prevalence/ incidence

a. 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.

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

c. 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.

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

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e. To reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic

respiratory diseases by 25% by 2025.

Health Systems Performance

Coverage of Health Services

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

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

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

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

e. 80% of known hypertensive and diabetic individuals at household level maintain

„controlled disease status‟ by 2025.

Cross Sectoral goals related to health

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

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

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

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

e. National/ State level tracking of selected health behaviour.

Health Systems strengthening

Health finance

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a. Increase health expenditure by Government as a percentage of GDP from the existing

1.15% to 2.5 % by 2025.

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

c. Decrease in proportion of households facing catastrophic health expenditure from the

current levels by 25%, by 2025.

Health Infrastructure and Human Resource

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

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

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

Health Management Information

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

2020.

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

c. Establish federated integrated health information architecture, Health Information

Exchanges and National Health Information Network by 2025.

Policy Thrust

Ensuring Adequate Investment The policy proposes a potentially achievable target of

raising public health expenditure to 2.5% of the GDP in a time bound manner. It envisages
that the resource allocation to States will be linked with State development indicators,
absorptive capacity and financial indicators. The States would be incentivised for incremental
State resources for public health expenditure.

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General taxation will remain the predominant means for financing care. The
Government could consider imposing taxes on specific commodities- such as the taxes on
tobacco, alcohol and foods having negative impact on health, taxes on extractive industries
and pollution. Funds available under Corporate Social Responsibility would also be leveraged
for well-focused programmes aiming to address health goals.

Preventive and Promotive Health The policy articulates to institutionalize inter-

sectoral coordination at national and sub-national levels to optimize health outcomes, through
constitution of bodies that have representation from relevant non-health ministries. This is in
line with the emergent international “Health in All” approach as complement to Health for
All. The policy prerequisite is for an empowered public health cadre to address social
determinants of health effectively, by enforcing regulatory provisions.

The policy identifies coordinated action on seven priority areas for improving the
environment for health: o The Swachh Bharat Abhiyan o Balanced, healthy diets and regular
exercises. o Addressing tobacco, alcohol and substance abuse o Yatri Suraksha – preventing
deaths due to rail and road traffic accidents o Nirbhaya Nari –action against gender violence
o Reduced stress and improved safety in the work place o Reducing indoor and outdoor air
pollution

The policy also articulates the need for the development of strategies and institutional
mechanisms in each of these seven areas, to create Swasth Nagrik Abhiyan –a social
movement for health. It recommends setting indicators, their targets as also mechanisms for
achievement in each of these areas.

The policy recognizes and builds upon preventive and promotive care as an under-
recognized reality that has a two-way continuity with curative care, provided by health
agencies at same or at higher levels. The policy recommends an expansion of scope of
interventions to include early detection and response to early childhood development delays
and disability, adolescent and sexual health education, behavior change with respect to
tobacco and alcohol use, screening, counseling for primary prevention and secondary
prevention from common chronic illness –both communicable and non-communicable
diseases.

Additionally the policy focus is on extending coverage as also quality of the existing
package of services. Policy recognizes the need to frame and adhere to health screening

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guidelines across age groups. Zoonotic diseases like rabies need to be addressed through
concerted and coordinated action, at the national front and through strengthening of the
National Rabies Control Programme.

The policy lays greater emphasis on investment and action in school health- by
incorporating health education as part of the curriculum, promoting hygiene and safe health
practices within the school environs and by acting as a site of primary health care. Promotion
of healthy living and prevention strategies from AYUSH systems and Yoga at the work-
place, in the schools and in the community would also be an important form of health
promotion that has a special appeal and acceptability in the Indian context.

Recognizing the risks arising from physical, chemical, and other workplace hazards,
the policy advocates for providing greater focus on occupational health. Work-sites and
institutions would be encouraged and monitored to ensure safe health practices and accident
prevention, besides providing preventive and promotive healthcare services.

ASHA will also be supported by other frontline workers like health workers
(male/female) to undertake primary prevention for non-communicable diseases. They would
also provide community or home based palliative care and mental health services through
health promotion activities. These workers would get support from local self-government and
the Village Health Sanitation and Nutrition Committee (VHSNC).

In order to build community support and offer good healthcare to the vulnerable
sections of the society like the marginalised, the socially excluded, the poor, the old and the
disabled, the policy recommends strengthening the VHSNCs and its equivalent in the urban
areas.

Health Impact Assessment‟ of existing and emerging policies, of key non-health

departments that directly or indirectly impact health would be taken up. 3.3 Organization of
Public Health Care Delivery: The policy proposes seven key policy shifts in organizing
health care services o In primary care – from selective care to assured comprehensive care
with linkages to referral hospitals o In secondary and tertiary care – from an input oriented to
an output based strategic purchasing o In public hospitals – from user fees & cost recovery to
assured free drugs, diagnostic and emergency services to all.

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In infrastructure and human resource development – from normative approach to

targeted approach to reach under-serviced areas o In urban health – from token interventions
to on-scale assured interventions, to organize Primary Health Care delivery and referral
support for urban poor. Collaboration with other sectors to address wider determinants of
urban health is advocated.

In National Health Programmes – integration with health systems for programme

effectiveness and in turn contributing to strengthening of health systems for efficiency. o In
AYUSH services – from stand-alone to a three dimensional mainstreaming

Free primary care provision by the public sector, supplemented by strategic purchase
of secondary care hospitalization and tertiary care services from both public and from non-
government sector to fill critical gaps would be the main strategy of assuring healthcare
services. The policy envisages strategic purchase of secondary and tertiary care services as a
short term measure. Strategic purchasing refers to the Government acting as a single payer.

The order of preference for strategic purchase would be public sector hospitals
followed by not-for profit private sector and then commercial private sector in underserved
areas, based on availability of services of acceptable and defined quality criteria. In the long
run, the policy envisages to have fully equipped and functional public sector hospitals in
these areas to meet secondary and tertiary health care needs of population, especially the
poorest and marginalized.

Public facilities would remain the focal point in the healthcare delivery system and
services in the public health facilities would be expanded from current levels. The policy
recognizes the special health needs of tribal and socially vulnerable population groups and
recommends situation specific measures in provisioning and delivery of services. The policy
advocates enhanced outreach of public healthcare through Mobile Medical Units (MMUs),
etc.

Tribal population in the country is over 100 million (Census 2011), and hence
deserves special attention keeping in mind their geographical and infrastructural challenges.
Keeping in view the high cost involved in provisioning and managing orphan diseases, the
policy encourages active engagement with nongovernment sector for addressing the situation.
In order to provide access and financial protection at secondary and tertiary care levels, the

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policy proposes free drugs, free diagnostics and free emergency care services in all public
hospitals.

To address the growing challenges of urban health, the policy advocates scaling up
National Urban Health Mission (NUHM) to cover the entire urban population within the next
five years with sustained financing. For effectively handling medical disasters and health
security, the policy recommends that the public healthcare system retain a certain excess
capacity in terms of health infrastructure, human resources, and technology which can be
mobilized in times of crisis.

In order to leverage the pluralistic health care legacy, the policy recommends
mainstreaming the different health systems. This would involve increasing the validation,
evidence and research of the different health care systems as a part of the common pool of
knowledge. It would also involve providing access and informed choice to the patients,
providing an enabling environment for practice of different systems of medicine, an enabling
regulatory framework and encouraging cross referrals across these systems.

Primary Care Services and Continuity of Care: This policy denotes important change
from very selective to comprehensive primary health care package which includes geriatric
health care, palliative care and rehabilitative care services. The facilities which start
providing the larger package of comprehensive primary health care will be called„Health and
Wellness Centers‟. Primary care must be assured.

To make this a reality, every family would have a health card that links them to
primary care facility and be eligible for a defined package of services anywhere in the
country. The policy recommends that health centres be established on geographical norms
apart from population norms. To provide comprehensive care, the policy recommends a
matching human resources development strategy, effective logistics support system and
referral backup.

This would also necessitate upgradation of the existing sub-centres and reorienting
PHCs to provide comprehensive set of preventive, promotive, curative and rehabilitative
services. It would entail providing access to assured AYUSH healthcare services, as well as
support documentation and validation of local home and community based practices. The
policy also advocates for research and validation of tribal medicines.

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Leveraging the potential of digital health for two way systemic linkages between the
various levels of care viz., primary, secondary and tertiary, would ensure continuity of care.
The policy advocates that the public health system would put in place a gatekeeping
mechanism at primary level in a phased manner, accompanied by an effective feedback and
follow-up mechanism.

Secondary Care Services: The policy aspires to provide at the district level most of the
secondary care which is currently provided at a medical college hospital. Basic secondary
care services, such as caesarian section and neonatal care would be made available at the least
at sub-divisional level in a cluster of few blocks.

To achieve this, policy therefore aims: To have at least two beds per thousand population
distributed in such a way that it is accessible within golden hour rule. This implies an
efficient emergency transport system. The policy also aims that ten categories of what are
currently specialist skills be available within the district. Additionally four or at least five of
these specialist skill categories be available at sub-district levels.

This may be achieved by strengthening the district hospital and a well-chosen, well
located set of sub-district hospitals. Resource allocation that is responsive to quantity,
diversity and quality of caseloads provided.

Purchasing care after due diligence from non-Government hospitals as a short term
strategy till public systems are strengthened.

Policy proposes a responsive and strong regulatory framework to guide purchasing of

care from non-government sector so that challenges of quality of care, cost escalations and
impediments to equity are addressed effectively.

In order to develop the secondary care sector, comprehensive facility development

and obligations with regard to human resources, especially specialists needs, are to be
prioritized. To this end the policy recommends a scheme to develop human resources and
specialist skills.

Access to blood and blood safety has been a major concern in district healthcare
services. This policy affirms in expanding the network of blood banks across the country to
ensure improved access to safe blood.

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Re-Orienting Public Hospitals: Public hospitals have to be viewed as part of tax financed
single payer health care system, where the care is pre-paid and cost efficient. This outlook
implies that quality of care would be imperative and the public hospitals and facilities would
undergo periodic measurements and certification of level of quality.

The policy endorses that the public hospitals would provide universal access to a
progressively wide array of free drugs and diagnostics with suitable leeway to the States to
suit their context. The policy seeks to eliminate the risks of inappropriate treatment by
maintaining adequate standards of diagnosis and treatment.

Policy recognizes the need for an information system with comprehensive data on
availability and utilization of services not only in public hospitals but also in non-government
sector hospitals. State public health systems should be able to provide all emergency health
services other than services covered under national health programmes.

Closing Infrastructure and Human Resources/Skill Gaps: The policy duly acknowledges
the roadmap of the 12th Five Year Plan for managing human resources for health. The policy
initiatives aim for measurable improvements in quality of care. Districts and blocks which
have wider gaps for development of infrastructure and deployment of additional human
resources would receive focus. Financing for additional infrastructure or human resources
would be based on needs of outpatient and inpatient attendance and utilization of key services
in a measurable manner.

Urban Health Care: National health policy prioritizes addressing the primary health care
needs of the urban population with special focus on poor populations living in listed and
unlisted slums, other vulnerable populations such as homeless, rag-pickers, street children,
rickshaw pullers, construction workers, sex workers and temporary migrants.

Policy would also prioritize the utilization of AYUSH personnel in urban health care.
Given the large presence of private sector in urban areas, policy recommends exploring the
possibilities of developing sustainable models of partnership with for profit and not for profit
sector for urban health care delivery.

An important focus area of the urban health policy will be achieving convergence
among the wider determinants of health – air pollution, better solid waste management, water
quality, occupational safety, road safety, housing, vector control, and reduction of violence

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and urban stress. These dimensions are also important components of smart cities. Healthcare
needs of the people living in the peri urban areas would also be addressed under the NUHM.

Further, Non-Communicable Diseases (NCDs) like hyper tension, diabetes which are
predominant in the urban areas would be addressed under NUHM, through planned early
detection. Better secondary prevention would also be an integral part of the urban health
strategy. Improved health seeking behavior, influenced through capacity building of the
community based organizations & establishment of an appropriate referral mechanism, would
also be important components of this strategy.

National Health Programmes

RMNCH+A services: Maternal and child survival is a mirror that reflects the entire
spectrum of social development. This policy aspires to elicit developmental action of all
sectors to support Maternal and Child survival.

The policy strongly recommends strengthening of general health systems to prevent

and manage maternal complications, to ensure continuity of care and emergency services for
maternal health. In order to comprehensively address factors affecting maternal and child
survival, the policy seeks to address the social determinants through developmental action in
all sectors.

Child and Adolescent Health: The policy endorses the national consensus on accelerated
achievement of neonatal mortality targets and „single digit‟ stillbirth rates through improved
home based and facility based management of sick newborns. District hospitals must ensure
screening and treatment of growth related problems, birth defects, genetic diseases and
provide palliative care for children.

The policy affirms commitment to pre-emptive care (aimed at pre-empting the

occurrence of diseases) to achieve optimum levels of child and adolescent health. The policy
envisages school health programmes as a major focus area as also health and hygiene being
made a part of the school curriculum.

The policy gives special emphasis to the health challenges of adolescents and long
term potential of investing in their health care. The scope of Reproductive and Sexual Health

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should be expanded to address issues like inadequate calorie intake, nutrition status and
psychological problems interalia linked to misuse of technology, etc.

Interventions to Address Malnutrition and Micronutrient Deficiencies: Malnutrition,

especially micronutrient deficiencies, restricts survival, growth and development of children.
It contributes to morbidity and mortality in vulnerable population, resulting in substantial
diminution in productive capacity in adulthood and consequent reduction in the nation‟s
economic growth and well-being.

Recognizing this, the policy declares that micronutrient deficiencies would be

addressed through a well planned strategy on micronutrient interventions. Focus would be on
reducing micronutrient malnourishment and augmenting initiatives like micro nutrient
supplementation, food fortification, screening for anemia and public awareness.

A systematic approach to address heterogeneity in micronutrient adequacy across

regions in the country with focus on the more vulnerable sections of the population, is
needed. Hence, screening for multiple micronutrient deficiencies is advocated. During the
critical period of pregnancy, lactation, early childhood, adolescence and old age, the
consequences of deficiencies are particularly severe and many are irreversible.

While dietary diversification remains the most desirable way forward,

supplementation and fortification require to be considered as short and medium term
solutions to fill nutrient gaps. The present efforts of Iron Folic Acid(IFA) supplementation,
calcium supplementation during pregnancy, iodized salt, Zinc and Oral Rehydration
Salts/Solution(ORS), Vitamin A supplementation, needs to be intensified and increased.
Sustained efforts are to be made to ensure outreach to every beneficiary, which in turn
necessitates that intensive monitoring mechanisms are put in place.

The policy advocates developing a strong evidence base, of the burden of collective
micronutrient deficiencies, which should be correlated with disease burden and in particular
for understanding the etiology of anemia. Policy recommends exploring fortified food and
micronutrient sprinkles for addressing deficiencies through Anganwadi centers and schools.

Recognizing the complementary role of various nutrition-sensitive interventions from

different platforms, the policy calls for synergy of inputs from departments like Women and
Child Development, Education, WASH, Agriculture and Food and Civil Supplies. Policy

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envisages that the MoHFW would take on the role of convener to monitor and ensure
effective integration of both nutrition-sensitive and nutrition-specific interventions for
coordinated optimal results.

Universal Immunization: Priority would be to further improve immunization coverage with

quality and safety, improve vaccine security as per National Vaccine Policy 2011 and
introduction of newer vaccines based on epidemiological considerations. The focus will be to
build upon the success of Mission Indradhanush and strengthen it.

Communicable Diseases: The policy recognizes the interrelationship between

communicable disease control programmes and public health system strengthening. For
Integrated Disease Surveillance Programme, the policy advocates the need for districts to
respond to the communicable disease priorities of their locality. This could be through
network of well-equipped laboratories backed by tertiary care centers and enhanced public
health capacity to collect, analyze and respond to the disease outbreaks.

1. Control of Tuberculosis: The policy acknowledges HIV and TB co infection and

increased incidence of drug resistant tuberculosis as key challenges in control of
Tuberculosis. The policy calls for more active case detection, with a greater involvement of
private sector supplemented by preventive and promotive action in the workplace and in
living conditions. Access to free drugs would need to be complemented by affirmative action
to ensure that the treatment is carried out, dropouts reduced and transmission of resistant
strains are contained.

2. Control of HIV/AIDS: While the current emphasis on prevention continues, the policy
recommends focused interventions on the high risk communities (MSM, Transgender, FSW,
etc.) and prioritized geographies. There is a need to support care and treatment for people
living with HIV/AIDS through inclusion of 1st, 2nd and 3rd line antiretroviral(ARV), Hep-C
and other costly drugs into the essential medical list.

3. Leprosy Elimination: To carry out Leprosy elimination the proportion of grade-2 cases
amongst new cases will become the measure of community awareness and health systems
capacity, keeping in mind the global goal of reduction of grade 2 disability to less than 1 per

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million by 2020. Accordingly, the policy envisages proactive measures targeted towards
elimination of leprosy from India by 2018.

4. Vector Borne Disease Control: The policy recognizes the challenge of drug resistance in
Malaria, which should be dealt with by changing treatment regimens with logistics support as
appropriate. New National Programme for prevention and control of Japanese Encephalitis
(JE)/Acute Encephalitis Syndrome (AES) should be accelerated with strong component of
inter-sectoral collaboration.

The policy recognizes the interrelationship between communicable disease control

programmes and public health system strengthening. Every one of these programmes requires
a robust public health system as their core delivery strategy. At the same time, these
programmes also lead to strengthening of healthcare systems.

Non-Communicable Diseases: The policy recognizes the need to halt and reverse the
growing incidence of chronic diseases. The policy recommends to set-up a National Institute
of Chronic Diseases including Trauma, to generate evidence for adopting cost effective
approaches and to showcase best practices.

This policy will support an integrated approach where screening for the most
prevalent NCDs with secondary prevention would make a significant impact on reduction of
morbidity and preventable mortality. This would be incorporated into the comprehensive
primary health care network with linkages to specialist consultations and follow up at the
primary level.

Emphasis on medication and access for select chronic illness on a „round the year‟
basis would be ensured. Screening for oral, breast and cervical cancer and for Chronic
Obstructive Pulmonary Disease (COPD) will be focused in addition to hypertension and
diabetes. The policy focus is also on research.

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It emphasizes developing protocol for mainstreaming AYUSH as an integrated

medical care. This has a huge potential for effective prevention and therapy, that is safe and
cost-effective. Further the policy commits itself to support programmes for prevention of
blindness, deafness, oral health, endemic diseases like fluorosis and sickle cell
anaemia/thalassemia,etc.

The National Health Policy commits itself to culturally appropriate community

centered solutions to meet the health needs of the ageing community in addition to
compliance with constitutional obligations as per the Maintenance and Welfare of Parents
and Senior Citizens Act, 2007.

The policy recognizes the growing need for palliative and rehabilitative care for all
geriatric illnesses and advocates the continuity of care across all levels. The policy recognizes
the critical need of meeting the growing demand of tissue and organ transplant in the country
and encourages widespread public awareness to promote voluntary donations.

Mental Health: This policy will take into consideration the provisions of the National
Mental Health Policy 2014 with simultaneous action on the following fronts: o Increase
creation of specialists through public financing and develop special rules to give preference
to those willing to work in public systems.

Create network of community members to provide psycho-social support to

strengthen mental health services at primary level facilities and o Leverage digital technology
in a context where access to qualified psychiatrists is difficult.

Population Stabilization: The National Health Policy recognizes that improved access,
education and empowerment would be the basis of successful population stabilization. The
policy imperative is to move away from camp based services with all its attendant problems
of quality, safety and dignity of women, to a situation where these services are available on
any day of the week or at least on a fixed day. Other policy imperatives are to increase the
proportion of male sterilization from less than 5% currently, to at least 30% and if possible
much higher.

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Women’s Health & Gender Mainstreaming: There will be enhanced provisions for
reproductive morbidities and health needs of women beyond the reproductive age group
(40+) This would be in addition to package of services covered in the previous paragraphs.

Gender based violence (GBV): Women’s access to healthcare needs to be strengthened by

making public hospitals more women friendly and ensuring that the staff have orientation to
gender – sensitivity issues. This policy notes with concern the serious and wide ranging
consequences of GBV and recommends that the health care to the survivors/ victims need to
be provided free and with dignity in the public and private sector.

Supportive Supervision: For supportive supervision in more vulnerable districts with

inadequate capacity, the policy will support innovative measures such as use of digital tools
and HR strategies like using nurse trainers to support field workers.

Emergency Care and Disaster Preparedness: Better response to disasters, both natural and
manmade, requires a dispersed and effective capacity for emergency management. It requires
an army of community members trained as first responder for accidents and disasters. It also
requires regular strengthening of their capacities in close collaboration with the local self-
government and community based organizations.

The policy supports development of earthquake and cyclone resistant health

infrastructure in vulnerable geographies. It also supports development of mass casualty
management protocols for CHC and higher facilities and emergency response protocols at all
levels. To respond to disasters and emergencies, the public healthcare system needs to be
adequately skilled and equipped at defined levels, so as to respond effectively during
emergencies.

The policy envisages creation of a unified emergency response system, linked to a

dedicated universal access number, with network of emergency care that has an assured

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provision of life support ambulances, trauma management centers–one per 30 lakh population
in urban areas and o one for every 10 lakh population in rural areas

Mainstreaming the Potential of AYUSH: For persons who so choose, this policy ensures
access to AYUSH remedies through co-location in public facilities. Yoga would be
introduced much more widely in school and work places as part of promotion of good health
as adopted in National AYUSH Mission (NAM).

The policy recognizes the need to standardize and validate Ayurvedic medicines and
establish a robust and effective quality control mechanism for AUSH drugs. Policy
recognizes the need to nurture AYUSH system of medicine, through development of
infrastructural facilities of teaching institutions, improving quality control of drugs, capacity
building of institutions and professionals.

In addition, it recognizes the need for building research and public health skills for
preventive and promotive healthcare. Linking AYUSH systems with ASHAs and VHSNCs
would be an important plank of this policy. The National Health Policy would continue
mainstreaming of AYUSH with general health system but with the addition of a mandatory
bridge course that gives competencies to mid-level care provider with respect to allopathic
remedies.

The policy further supports the integration of AYUSH systems at the level of
knowledge systems, by validating processes of health care promotion and cure. The policy
recognizes the need for integrated courses for Indian System of Medicine, Modern Science
and Ayurgenomics.

It puts focus on sensitizing practitioners of each system to the strengths of the others.
Further the development of sustainable livelihood systems through involving local
communities and establishing forward and backward market linkages in processing of
medicinal plants will also be supported by this policy. The policy seeks to strengthen steps
for farming of herbal plants.

Developing mechanisms for certification of „prior knowledge‟ of traditional

community health care providers and engaging them in the conservation and generation of
the raw materials required, as well as creating opportunities for enhancing their skills are part
of this policy.

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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
following this broad principle. Regional disparities in distribution of these institutions must
be addressed.

The policy supports periodic review and standardization of fee structure and quality of
clinical training in the private sector medical colleges. The policy enunciates the core
principle of societal obligation on the part of private institutions to be followed.

This would include: Operationalization of mechanisms for referral from public health system
to charitable hospitals. o Ensuring that deserving patients can be admitted on designated free /
subsidized beds.

The policy proposes to consider forms of resource generation, where corporate

hospitals and medical tourism earnings are through a high degree of associated hospitality
arrangements and on account of certain procedures and services, as a form of resource
mobilization towards the health sector.

The policy recommends establishing National Healthcare Standards Organization and

to develop evidence based standard guidelines of care applicable both to public and private
sector. The policy shows the way forward in developing partnership with non-government
sector through empaneling the socially motivated and committed tertiary care centers into the
Government efforts to close the specialist gap.

To expand public provisioning of tertiary services, the Government would

additionally purchase select tertiary care services from empaneled non-government sector
hospitals to assist the poor. Coverage in terms of population and services will expand
gradually. The policy recognizes development of evidence based standard guidelines of care,
applicable both to public and private sector as essential.

Human Resources for Health: There is a need to align decisions regarding judicious
growth of professional and technical educational institutions in the health sector, better
financing of professional and technical education, defining professional boundaries and skill

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sets, reshaping the pedagogy of professional and technical education, revisiting entry policies
into educational institutions, ensuring quality of education and regulating the system to
generate the right mix of skills at the right place.

This policy recommends that medical and para-medical education be integrated with
the service delivery system, so that the students learn in the real environment and not just in
the confines of the medical school. The key principle around the policy on human resources
for health is that, workforce performance of the system would be best when we have the most
appropriate person, in terms of both skills and motivation, for the right job in the right place,
working within the right professional and incentive environment.

Medical Education: The policy recommends strengthening existing medical colleges and
converting district hospitals to new medical colleges to increase number of doctors and
specialists, in States with large human resource deficit. The policy recognizes the need to
increase the number of post graduate seats.

The policy supports expanding the number of AIIMS like centers for continuous flow
of faculty for medical colleges, biomedical and clinical research. National Knowledge
Network shall be used for Tele-education, Tele-CME, Tele-consultations and access to digital
library. A common entrance exam is advocated on the pattern of NEET for UG entrance at
All India level; a common national-level Licentiate/exit exam for all medical and nursing
graduates; a regular renewal at periodic intervals with Continuing Medical Education (CME)
credits accrued, are important recommendations.

This policy recommends that the current pattern of MCQ (Multiple Choice Question)
based entrance test for post graduates medical courses- that drive students away from
practical learning- should be reviewed. The policy recognizes the need to revise the under
graduate and post graduate medical curriculum keeping in view the changing needs,
technology and the newer emerging disease trends.

Keeping in view, the rapid expansion of medical colleges in public and private sector
there is an urgent need to review existing institutional mechanisms to regulate and ensure
quality of training and education being imparted. The policy recommends that the discussion
on recreating a regulatory structure for health professional education be revisited to address
the emerging needs and challenges.

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Attracting and Retaining Doctors in Remote Areas: Policy proposes financial and non-
financial incentives, creating medical colleges in rural areas; preference to students from
under-serviced areas, realigning pedagogy and curriculum to suit rural health needs,
mandatory rural postings, etc. Measures of compulsion- through mandatory rotational
postings dovetailed with clear and transparent career progression guidelines are valuable
strategies.

A constant effort, therefore, needs to be made to increase the capacity of the public
health systems to absorb and retain the manpower. The total sanctioned posts of doctors in
the public sector should increase to ensure availability of doctors corresponding to the
accepted norms. Exact package of policy measures would vary from State to State and would
change over time.

Specialist Attraction and Retention: Proposed policy measures include - recognition of

educational options linked with National Board of Examination & College of Physicians and
Surgeons, creation of specialist cadre with suitable pay scale, up-gradation of short term
training to medical officers to provide basic specialist services at the block and district level,
performance linked payments and popularize MD (Doctor of Medicine) course in Family
Medicine or General Practice.

The policy recommends that the National Board of Examinations should expand the
post graduate training up to the district level. The policy recommends creation of a large
number of distance and continuing education options for general practitioners in both the
private and the public sectors, which would upgrade their skills to manage the large majority
of cases at local level, thus avoiding unnecessary referrals.

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

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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.

Nursing Education: The policy recognises 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 population 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.

ASHA: This policy supports certification programme for ASHAs for their preferential
selection into ANM, nursing and paramedical courses. While most ASHAs will remain
mainly voluntary and remunerated for time spent, those who obtain qualifications for career
opportunities could be given more regular terms of engagement.

Policy also supports enabling engagements with NGOs to serve as support and
training institutions for ASHAs and to serve as learning laboratories on future roles of
community health workers. The policy recommends revival and strengthening of
Multipurpose Male Health Worker cadre, in order to effectively manage the emerging
infectious and non-communicable diseases at community level.

Adding a second Community Health Worker would be based on geographic

considerations, disease burdens, and time required for multiple tasks to be performed by
ASHA/ Community Health Worker.

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Paramedical Skills: Training courses and curriculum for super specialty paramedical care
(perfusionists, physiotherapists, occupational therapists, radiological technicians,
audiologists, MRI technicians, etc.) would be developed. The policy recognises the role
played by physiotheraphists, occupational and allied health professionals keeping in view the
demographic and disease transition the country is faced with and also recognises the need to
address their shortfall.

Planned expansion of allied technical skills- radiographers, laboratory technicians,

physiotherapists, pharmacists, audiologists, optometrists, occupational therapists with local
employment opportunities, is a key policy direction. The policy would allow for multi-
skilling with different skill sets so that when posted in more peripheral hospitals there is more
efficient use of human resources.

Public Health Management Cadre: The policy proposes creation of Public Health
Management Cadre in all States based on public health or related disciplines, as an entry
criteria. The policy also advocates an appropriate career structure and recruitment policy to
attract young and talented multidisciplinary professionals.

Medical & health professionals would form a major part of this, but professionals
coming in from diverse backgrounds such as sociology, economics, anthropology, nursing,
hospital management, communications, etc. who have since undergone public health
management training would also be considered.

States could decide to locate these public health managers, with medical and non-
medical qualifications, into same or different cadre streams belonging to Directorates of
health. Further, the policy recognizes the need to continuously nurture certain specialized
skills like entomology, housekeeping, bio-medical waste management, bio medical
engineering communication skills, management of call centres and even ambulance services.

Human Resource Governance and leadership development: The policy recognizes that
human resource management is critical to health system strengthening and healthcare

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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.

Financing of Health Care: The policy advocates allocating major proportion (upto two-
thirds or more) of resources to primary care followed by secondary and tertiary care.
Inclusion of cost-benefit and cost effectiveness studies consistently in programme design and
evaluation would be prioritized.

This would contribute significantly to increasing efficiency of public expenditure. A

robust National Health Accounts System would be operationalized to improve public sector
efficiency in resource allocation/ payments. The policy calls for major reforms in financing
for public facilities – where operational costs would be in the form of reimbursements for
care provision and on a per capita basis for primary care.

Items like infrastructure development and maintenance, non-incentive cost of the

human resources i.e salaries and much of administrative costs, would however continue to
flow on a fixed cost basis. Considerations of equity would be factored in- with higher unit
costs for more difficult and vulnerable areas or more supply side investment in infrastructure.

Total allocations would be made on the basis of differential financial ability,

developmental needs and high priority districts to ensure horizontal equity through targeting
specific population sub groups, geographical areas, health care services and gender related
issues. A higher unit cost or some form of financial incentive payable to facilities providing a
measured and certified quality of care is recommended.

Purchasing of Healthcare Services: The existing Government financed health insurance

schemes shall be aligned to cover selected benefit package of secondary and tertiary care
services purchased from public, not for profit and private sector in the same order of
preference, subject to availability of quality services on time as per defined norms. The policy

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recommends creating a robust independent mechanism to ensure adherence to standard

treatment protocols by public and non-government hospitals.

In this context the policy recognizes the need of mandatory disclosure of treatment
and success rates across facilities in a transparent manner. It recommends compliance to right
of patients to access information about their condition and treatment.

For need based purchasing of secondary and tertiary care from non-government
sector, multistakeholder institutional mechanisms would be created at Centre and State levels
– in the forms of trusts or registered societies with institutional autonomy.

These agencies would also be charged with ensuring that purchasing is strategic -
giving preference to care from public facilities where they are in a position to do so - and
developing a market base through encouraging the creation of capacity in services in areas
where they are needed more. Private „not for profit‟ and „for - profit‟ hospitals would be
empanelled with preference for the former, for comparable quality and standards of care. The
payments will be made by the trust/society on a reimbursement basis for services provided.

Collaboration with Non-Government Sector/Engagement with private sector: The policy

suggests exploring collaboration for primary care services with „not- for -profit‟
organizations having a track record of public services where critical gaps exist, as a short
term measure.

Collaboration can also be done for certain services where team of specialized human
resources and domain specific organizational experience is required. Private providers,
especially those working in rural and remote areas or with under-serviced communities, could
be offered encouragement through provision of appropriate skills to meet public health goals,
opportunities for skill up-gradation to serve the community better, participation in disease
notification and surveillance efforts, sharing and supporting certain high value services.

The policy supports voluntary service in rural and under-served areas on pro-bono
basis by recognized healthcare professionals under a „giving back to society‟ initiative. The
policy advocates a positive and proactive engagement with the private sector for critical gap
filling towards achieving National goals. One form is through engagement in public goods,
where the private sector contributes to preventive or promotive services without profit- as
part of CSR work or on contractual terms with the Government.

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The other is in areas where the private sector is encouraged to invest- which implies
an adequate return on investment i.e on commercial terms which may entail contracting,
strategic purchasing, etc. The policy advocates for contracting of private sector in the
following activities:

Capacity building: Outsourcing of training of teachers to strengthen school health

programmes by adopting neighbourhood schools for quarterly training modules.

Skill Development programmes: Recognising that there are huge gaps in technicians,
nursing and para- nursing, para-medical staff and medical skills in select areas, the policy
advocates coordination between National Council for Skill Development, MOHFW and State
Government(s) for engaging private hospitals/private general medical practitioners in skill
development.

Corporate Social Responsibility (CSR): CSR is an important area which should be

leveraged for filling health infrastructure gaps in public health facilities across the country.
The private sector could use the CSR platform to play an active role in the awareness
generation through campaigns on occupational health, blood disorders, adolescent health,
safe health practices and accident prevention, micronutrient adequacy, anti-microbial
resistance, screening of children and ante-natal mothers, psychological problems linked to
misuse of technology, etc.

The policy recommends engagement of private sector through adoption of

neighborhood schools/ colonies/ slums/tribal areas/backward areas for healthcare awareness
and services.

Mental healthcare programmes- Training community members to provide psychological

support to strengthen mental health services in the country. Collaboration with Government
would be an important plank to develop a sustainable network for community/locality
towards mental health.

Disaster Management is another area where collaboration with private sector would enable
better outcomes especially in the areas of medical relief and post trauma
counseling/treatment. A pool of human resources from private sector could be generated to
act as responders during disasters. The private sector could also pool their infrastructure for
quick deployment during disasters and emergencies and help in creation of a unified

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emergency response system. Additionally sharing information on infrastructure and services

deployable for disaster management would enable development of a comprehensive
information system with data on availability and utilization of services, for optimum use
during golden hour and other emergencies.

Strategic Purchasing as Stewardship: Directing areas for investment for the commercial
health sector.

1. The health policy recognizes that there are many critical gaps in public health services
which would be filled by “strategic purchasing”. Such strategic purchasing would play a
stewardship role in directing private investment towards those areas and those services for
which currently there are no providers or few providers. The policy advocates building
synergy with “not for profit” organisations and private sector subject to availability of timely
quality services as per predefined norms in the collaborating organisation for critical gap
filling.

2. The main mechanisms of strategic purchasing are insurance and through trusts. Schemes
like Arogyasri and RSBY have been able to increase private participation significantly.
Payment is by reimbursement on a fee for service basis and many private providers have been
able to benefit greatly by these schemes. The aim would be to improve health outcomes and
reduce out of pocket payments while minimising moral hazards and - so that these schemes
can be scaled up and made more effective. The policy provides for preferential treatment to
collaborating private hospitals/institutes for CGHS empanelment and in proposed strategic
purchase by Government subject to other requirements being met.

3. For achieving the objective of having fully functional primary healthcare facilities-
especially in urban areas to reach under-serviced populations and on a fee basis for middle
class populations, Government would collaborate with the private sector for operationalizing
such health and wellness 21 centers to provide a larger package of comprehensive primary
health care across the country. Partnerships that address specific gaps in public services:
These would inter alia include diagnostics services, ambulance services, safe blood services,
rehabilitative services, palliative services, mental healthcare, telemedicine services,
managing of rare and orphan diseases.

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4. The policy advocates building synergy with “not for profit” organisations and private
sector subject to availability of timely quality services as per predefined norms in the
collaborating organization for critical gaps.

Enhancing accessibility in private sector: The policy recommends a better public private
healthcare interface and recognizes the need for engagement in operationalization of
mechanisms for referrals from public health system. Charitable hospitals and “not for profit”
hospitals may volunteer for accepting referrals from public health facilities. The private
sector could also provide for increased designated free/ subsidized beds in their hospitals for
the downtrodden, poor and others towards societal cause.

Role in Immunization: The policy recognizes the role of the private sector in immunization
programmes and advocates their continued collaboration in rendering immunization service
as per protocol.

Disease Surveillance: Towards strengthening disease surveillance, the private sector

laboratories could be engaged for data pooling and sharing. All clinical establishments would
be encouraged to notify diseases and provide information of public health importance.

Tissue and organ transplantations: Tissue and organ transplantations and voluntary
donations are areas where private sector provides services- but it needs public interventions
and support for getting organ donations. Recognizing the need for awareness, the private
sector and public sector could play a vital role in awareness generation.

Make in India: Towards furthering “Make in India”, the private domestic manufacturing
firms/ industry could be engaged to provide customized indigenous medical devices to the
health sector and in creation of forward and backward linkages for medical device
production. The policy also seeks assured purchase by Government health facilities from
domestic manufacturers, subject to quality standards being met.

Health Information System: The objective of an integrated health information system

necessitates private sector participation in developing and linking systems into a common
network/grid which can be accessed by both public and private healthcare providers.
Collaboration with private sector consistent with Meta Data and Data Standards and
Electronic Health Records would lead to developing a seamless health information system.

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The private sector could help in creation of registries of patients and in documenting diseases
and health events.

Incentivizing Private Sector : To encourage participation of private sector, the policy

advocates incentivizing the private sector through inter alia (i) reimbursement/ fees (ii)
preferential treatment to collaborating private hospitals/institutes for CGHS empanelment and
in proposed strategic 22 purchase by Government, subject to other requirements being met
(iii) Non-financial incentives like recognition/ acknowledgement/ felicitation and skill up
gradation to the private sector hospitals/practitioners for providing public health services and
for partnering with the Government of India/State Governments in health care delivery and
(iv) through preferential purchase by Government health facilities from domestic
manufacturers, subject to quality standards being met.

Private sector engagement goes beyond contracting and purchasing. Private providers,
especially those working in rural and remote areas, or with under-serviced communities,
require access to opportunities for skill up-gradation to meet public health goals, to serve the
community better, for participation in disease notification and surveillance efforts, and for
sharing and support through provision of certain high value services- like laboratory support
for identification of drug resistant tuberculosis or other infections, supply of some restricted
medicines needed for special situations, building flexibilities into standards needed for
service provision in difficult contexts and even social recognition of their work.

This would greatly encourage such providers to do better. Hitherto all public training
and skill provision has been only to public providers. The policy recognizes the need for
training and skilling of many small private providers and recommends the same.

Regulatory Framework: The regulatory role of the Ministry of Health and Family Welfare-
which includes regulation of clinical establishments, professional and technical education,
food safety, medical technologies, medical products, clinical trials, research and
implementation of other health related laws- needs urgent and concrete steps towards reform.
This will entail moving towards a more effective, rational, transparent and consistent regime.

1. Professional Education Regulation: The policy calls for a major reform in this area. It
advocates strengthening of six professional councils (Medical, Ayurveda Unani & Siddha,

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Homeopathy, Nursing, Dental and Pharmacy) through expanding membership of these

councils between three key stakeholders - doctors, patients and society in balanced numbers.
The policy supports setting up of National Allied Professional Council to regulate and
streamline all allied health professionals and ensure quality standards.

2. Regulation of Clinical Establishments: A few States have adopted the Clinical

Establishments Act 2010. Advocacy with the other States would be made for adoption of the
Act. Grading of clinical establishments and active promotion and adoption of standard
treatment guidelines would be one starting point. Protection of patient rights in clinical
establishments (such as rights to information, access to medical records and reports, informed
consent, second opinion, confidentiality and privacy) as key process standards, would be an
important step.

Policy recommends the setting up of a separate, empowered medical tribunal for

speedy resolution to address disputes /complaints regarding standards of care, prices of
services, negligence and unfair practices. Standard Regulatory framework for laboratories
and imaging centers, specialized emerging services such as assisted reproductive techniques,
surrogacy, stem cell banking, organ and tissue transplantation and Nano Medicine will be
created as appropriate.

Food Safety: The policy recommends putting in place and strengthening necessary network
of offices, laboratories, e-governance structures and human resources needed for the
enforcement of Food Safety and Standards (FSS) Act, 2006.

Drug Regulation: Prices and availability of drugs are regulated by the Department of
Pharmaceuticals. However, with regard to other areas of drugs and pharmaceuticals, this
policy encourages the streamlining of the system of procurement of drugs; a strong and
transparent drug purchase policy for bulk procurement of drugs; and facilitating spread of
low cost pharmacy chain such as Jan Aushadhi stores linked with ensuring prescription of
generic medicines.

It further recommends education of public with regard to branded and non-branded

generic drugs. The setting up of common infrastructure for development of the
pharmaceutical industry will also be promoted. The policy advocates strengthening and
rationalizing the drug regulatory system, promotion of research and development in the

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pharmaceutical sector and building synergy and evolving a convergent approach with related
sectors.

Medical Devices Regulation: The policy recommends strengthening regulation of medical

devices and establishing a regulatory body for medical devices to unleash innovation and the
entrepreneurial spirit for manufacture of medical device in India. The policy supports
harmonization of domestic regulatory standards with international standards. Building
capacities in line with international practices in our regulatory personnel and institutions,
would have the highest priority. Post market surveillance program for drugs, blood products
and medical devices shall be strengthened to ensure high degree of reliability and to prevent
adverse outcomes due to low quality and/or refurbished devices/health products.

Clinical Trial Regulation: Clinical trials are essential for new product discovery and
development. With the objective of ensuring the rights, safety and well-being of clinical trial
participants, while facilitating such trials as are essential, specific clause(s) be included in the
Drugs and Cosmetics Act for its regulation. Transparent and objective procedures shall be
specified, and functioning of ethics and review committees will be strengthened.

The Global Good Clinical Practice Guidelines, which specifies standards, roles and
responsibilities of sponsors, investigators and participants would be adhered to. Irrational
drug combination will continue to be monitored and controlled and appropriate regulatory
framework for standardization of AUSH drugs will be ensured. Clear and transparent
guidelines, with independent monitoring mechanisms, are the ways forward to foster a
progressive and innovative research environment, while safeguarding the rights and health of
the trial participants.

Pricing- Drugs, Medical Devices and Equipment: The regulatory environment around pricing
requires a balance between the patients concern for affordability and industry‟s concern for
adequate returns on investment for growth and sustainability. Timely revision of National
List of Essential Medicines (NLEM) along with appropriate price control mechanisms for
generic drugs shall remain a key strategy for decreasing costs of care for all those patients
seeking care in the private sector.

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An approach on the same lines but suiting specific requirements of the sectors would
be considered for price control with regard to a list of essential diagnostics and equipment.

Vaccine Safety: Vaccine safety and security would require effective regulation, research and
development for manufacturing new vaccines in accordance with National Vaccine Policy
2011. The policy advocates commissioning more research and development for
manufacturing new vaccines, including against locally prevalent diseases.

It recommends building more public sector manufacturing units to generate healthy

competition; uninterrupted supply of quality vaccines, developing innovative financing and
creating assured supply mechanisms with built in flexibility. Units such as the integrated
vaccine complex at Chengalpattu would be set up and vaccine, anti-sera manufacturing units
in the public sector upgraded with increase in their installed capacity.

Medical Technologies: India is known as the pharmacy of the developing world. However,
its role in new drug discovery and drug innovations including bio-pharmaceuticals and bio-
similars for its own health priorities is limited. This needs to be addressed in the context of
progress towards universal health care. Making available good quality, free essential and
generic drugs and diagnostics, at public health care facilities is the most effective way for
achieving the goal.

The free drugs and diagnostics basket would include all that is needed for
comprehensive primary care, including care for chronic illnesses, in the assured set of
services. At the tertiary care level too, at least for in-patients and outpatients in geriatric and
chronic care segments, most drugs and diagnostics should be free or subsidized with fair
price selling mechanisms for most and some co-payments for the “well-to-do”.

Public Procurement: Quality of public procurement and logistics is a major challenge to

ensuring access to free drugs and diagnostics through public facilities. An essential pre-
requisite that is needed to address the challenge of providing free drugs through public sector,
is a well-developed public procurement system.

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Availability of Drugs and Medical Devices: The policy accords special focus on production
of Active Pharmaceutical Ingredient (API) which is the back-bone of the generic
formulations industry. Recognizing that over 70% of the medical devices and equipments are
imported in India, the policy advocates the need to incentivize local manufacturing to provide
customized indigenous products for Indian population in the long run.

The goal with respect to medical devices shall be to encourage domestic production in
consonance with the “Make in India” national agenda. Medical technology and medical
devices have a multiplier effect in the costing of healthcare delivery. The policy recognizes
the need to regulate the use of medical devices so as to ensure safety and quality compliance
as per the standard norms.

Aligning other policies for medical devices and equipment with public health goals: For
medical devices and equipment, the policy recommends and prioritises establishing sufficient
labeling and packaging requirements on part of industry, adequate medical devices testing
facility and effective port - clearance mechanisms for medical products.

Improving Public Sector Capacity for Manufacturing Essential Drugs and Vaccines:
Public sector capacity in manufacture of certain essential drugs and vaccines is also essential
in the long term for the health security of the country and to address some needs which are
not attractive commercial propositions. These public institutions need more investment,
appropriate HR policies and governance initiatives to enable them to become comparable
with their benchmarks in the developed world.

Anti-microbial resistance: The problem of anti-microbial resistance calls for a rapid

standardization of guidelines, regarding antibiotic use, limiting the use of antibiotics as Over-
the-Counter medication, banning or restricting the use of antibiotics as growth promoters in
animal livestock. Pharmacovigilance including prescription audit inclusive of antibiotic
usage, in the hospital and community, is a must in order to enforce change in existing
practices.

Health Technology Assessment: Health Technology assessment is required to ensure that

technology choice is participatory and is guided by considerations of scientific evidence,
safety, consideration on cost effectiveness and social values. The National Health Policy
commits to the development of institutional framework and capacity for Health Technology
Assessment and adoption.

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Digital Health Technology Eco-System: Recognizing the integral role of

technology(eHealth, mHealth, Cloud, Internet of things, wearables, etc) in the healthcare
delivery, a National Digital Health Authority (NDHA) will be set up to regulate, develop and
deploy digital health across the continuum of care. The policy advocates extensive
deployment of digital tools for improving the efficiency and outcome of the healthcare
system. The policy aims at an integrated health information system which serves the needs of
all stake-holders and improves efficiency, transparency, and citizen experience. Delivery of
better health outcomes in terms of access, quality, affordability, lowering of disease burden
and efficient monitoring of health entitlements to citizens, is the goal.

Establishing federated national health information architecture, to roll-out and link

systems across public and private health providers at State and national levels consistent with
Metadata and Data Standards (MDDS) & Electronic Health Record (EHR), will be supported
by this policy. The policy suggests exploring the use of “Aadhaar” (Unique ID) for
identification. Creation of registries (i.e. patients, provider, service, diseases, document and
event) for enhanced public health/big data analytics, creation of health information exchange
platform and national health information network, use of National Optical Fibre Network, use
of smartphones/tablets for capturing real time data, are key strategies of the National Health
Information Architecture.

1. Application of Digital Health: The policy advocates scaling of various initiatives in the
area of teleconsultation which will entail linking tertiary care institutions (medical colleges)
to District and Subdistrict hospitals which provide secondary care facilities, for the purpose
of specialist consultations. The policy will promote utilization of National Knowledge
Network for Tele-education, Tele-CME, Teleconsultations and access to digital library.

2 Leveraging Digital Tools for AYUSH: Digital tools would be used for generation and
sharing of information about AYUSH services and AYUSH practitioners, for traditional
community level healthcare providers and for household level preventive, promotive and
curative practices.

Health Surveys: The scope of health, demographic and epidemiological surveys would be
extended to capture information regarding costs of care, financial protection and evidence
based policy planning and reforms. The policy recommends rapid programme appraisals and

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periodic disease specific surveys to monitor the impact of public health and disease
interventions using digital tools for epidemiological surveys.

Health Research: The National Health Policy recognizes the key role that health research
plays in the development of a nation‟s health. In knowledge based sector like health, where
advances happen daily, it is important to increase investment in health research.

1 Strengthening Knowledge for Health: The policy envisages strengthening the publicly
funded health research institutes under the Department of Health Research, the apex public
health institutions under the Department of Health & Family Welfare, as well as those in the
Government and private medical colleges. The policy supports strengthening health research
in India in the following fronts- health systems and services research, medical product
innovation (including point of care diagnostics and related technologies and internet of
things) and fundamental research in all areas relevant to health- such as Physiology,
Biochemistry, Pharmacology, Microbiology, Pathology, Molecular Sciences and Cell
Sciences.

Policy aims to promote innovation, discovery and translational research on drugs in

AUSH and allocate adequate funds towards it. Research on social determinants of health
along with neglected health issues such as disability and transgender health will be promoted.
For drug and devices discovery and innovation, both from Allopathy and traditional
medicines systems would be supported. Creation of a Common Sector Innovation Council for
the Health Ministry that brings together various regulatory bodies for drug research, the
Department of Pharmaceuticals, the Department of Biotechnology, the Department of
Industrial Policy and Promotion, the Department of Science and Technology, etc. would be
desirable.

Innovative strategies of public financing and careful leveraging of public procurement

can help generate the sort of innovations that are required for Indian public health priorities.
Drug research on critical diseases such as TB, HIV/AIDS, and Malaria may be incentivized,
to address them on priority. For making full use of all research capacity in the nation, grant-
in- aid mechanisms which provide extramural funding to research efforts is envisaged to be
scaled up.

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2 Drug Innovation & Discovery: Government policy would be to both stimulate innovation
and new drug discovery as required, to meet health needs as well as ensure that new drugs
discovered and brought into the market are affordable to those who need them most. Similar
policies are required for discovering more affordable, more frugal and appropriate point of
care diagnostics as also robust medical equipment for use in our rural and remote areas.
Public procurement policies and public investment in priority research areas with greater
coordination and convergence between drug research institutions, drug manufacturers and
premier medical institutions must also be aligned to drug discovery.

3 Development of Information Databases: There is also a need to develop information

data-bases on a wide variety of areas that researchers can share. This includes ensuring that
all unit data of major publicly funded surveys related to health, are available in public domain
in a research friendly format.

25.4 Research Collaboration: The policy on international health and health diplomacy should
leverage India‟s strength in cost effective innovations in the areas of pharmaceuticals,
medical devices, health care delivery and information technology. Additionally leveraging
international cooperation, especially involving nations of the Global South, to build domestic
institutional capacity in green-field innovation and for knowledge and skill generation could
be explored.

Governance

1 Role of Centre & State: One of the most important strengths and at the same time
challenges of governance in health is the distribution of responsibility and accountability
between the Centre and the States. The policy recommends equity sensitive resource
allocation, strengthening institutional mechanisms for consultative decision-making and
coordinated implementation, as the way forward.

Besides, better management of fiduciary risks, provision of capacity building,

technical assistance to States to develop State-specific strategic plans, through the active
involvement of local self-government and through community based monitoring of health
outputs is also recommended. The policy suggests State Directorates to be strengthened by

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HR policies, central to which is the issue that those from a public health management cadre
must hold senior positions in public health.

2 Role of Panchayati Raj Institutions: Panchayati Raj Institutions would be strengthened to

play an enhanced role at different levels for health governance, including the social
determinants of health. There is need to make Community Based Monitoring and Planning
(CBMP) mandatory, so as to place people at the centre of the health system and development
process for effective monitoring of quality of services and for better accountability in
management and delivery of health care services.

3 Improving Accountability: The policy would be to increase both horizontal and vertical
accountability of the health system by providing a greater role and participation of local
bodies and encouraging community monitoring, programme evaluations along with ensuring
grievance redressal systems.

Legal Framework for Health Care and Health Pathway

One of the fundamental policy questions being raised in recent years is whether to
pass a health rights bill making health a fundamental right- in the way that was done for
education. The policy question is whether we have reached the level of economic and health
systems development so as to make this a justiciable right- implying that its denial is an
offense.

Questions that need to be addressed are manifold, namely,

(a) whether when health care is a State subject, is it desirable or useful to make a Central law,
(b) whether such a law should mainly focus on the enforcement of public health standards on
water, sanitation, food safety, air pollution etc, or whether it should focus on health rights-
access to health care and quality of health care – i.e whether focus should be on what the
State enforces on citizens or on what the citizen demands of the State? Right to healthcare
covers a wide canvas, encompassing issues of preventive, curative, rehabilitative and
palliative healthcare across rural and urban areas, infrastructure availability, health human
resource availability, as also issues extending beyond health sector into the domain of
poverty, equity, literacy, sanitation, nutrition, drinking water availability, etc.

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Excellent health care system needs to be in place to ensure effective implementation

of the health rights at the grassroots level. Right to health cannot be perceived unless the
basic health infrastructure like doctor-patient ratio, patient-bed ratio, nurses-patient ratio, etc
are near or above threshold levels and uniformly spread-out across the geographical frontiers
of the country. Further, the procedural guidelines, common regulatory platform for public and
private sector, standard treatment protocols, etc need to be put in place.

Accordingly, the management, administrative and overall governance structure in the

health system needs to be overhauled. Additionally, the responsibilities and liabilities of the
providers, insurers, clients, regulators and Government in administering the right to health
need to be clearly spelt out. The policy while supporting the need for moving in the direction
of a rights based approach to healthcare is conscious of the fact that threshold levels of
finances and infrastructure is a precondition for an enabling environment, to ensure that the
poorest of the poor stand to gain the maximum and are not embroiled in legalities. The policy
therefore advocates a progressively incremental assurance based approach, with assured
funding to create an enabling environment for realizing health care as a right in the future.

Implementation Framework and Way Forward

A policy is only as good as its implementation. The National Health Policy envisages that an
implementation framework be put in place to deliver on these policy commitments. Such an
implementation framework would provide a roadmap with clear deliverables and milestones
to achieve the goals of the policy.

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National Health Committees Reports

Various committees of experts have been appointed by the government from time to
time to render advice about different health problems. The reports of these committees have
formed an important basis of health planning in India. The goal of National Health Planning
in India is to attain Health for all by the year 2000.

1. BHORE COMMITTEE. 1946.

This committee, known as the Health Survey & Development Committee, was
appointed in 1943 with Sir Joseph Bhore as its Chairman. It laid emphasis on integration of
curative and preventive medicine at all levels. It made comprehensive recommendations for
remodeling of health services in India. The report, submitted in 1946, had some important
recommendations like :-

 Integration of preventive and curative services of all administrative levels.

 Development of Primary Health Centers in 2 stages :

a. Short-term measure – one primary health centre as suggested for a population of

40,000. Each PHC was to be manned by 2 doctors, one nurse, four public health
nurses, four midwives, four trained dais, two sanitary inspectors, two health assistants,
one pharmacist and fifteen other class IV employees. Secondary health centre was
also envisaged to provide support to PHC, and to coordinate and supervise their
functioning.
b. A long-term programme (also called the 3 million plan) of setting up primary health
units with 75 – bedded hospitals for each 10,000 to 20,000 population and secondary
units with 650 – bedded hospital, again regionalized around district hospitals with
2500 beds.

 Major changes in medical education which includes 3 - month training in preventive

and social medicine to prepare “social physic

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2. MUDALIAR COMMITTEE. 1962.

This committee known as the “Health Survey and Planning Committee”, headed by
Dr. A.L. Mudaliar, was appointed to assess the performance in health sector since the
submission of Bhore Committee report. This committee found the conditions in PHCs to be
unsatisfactory and suggested that the PHC, already established should be strengthened before
new ones are opened.

  Strengthening of sub divisional and district hospitals was also advised. It was
emphasized that a PHC should not be made to cater to more than 40,000 population and that
the curative, preventive and promotive services should be all provided at the PHC. The
Mudaliar Committee also recommended that an All India Health service should be created to
replace the erstwhile Indian Medical service.

 
3. CHADHA COMMITTEE, 1963.

This committee was appointed under chairmanship of Dr. M.S. Chadha, the then
Director General of Health Services, to advise about the necessary arrangements for the
maintenance phase of National Malaria Eradication Programme. The committee suggested
that the vigilance activity in the NMEP should be carried out by basic health workers (one per
10,000 population), who would function as multipurpose workers and would perform, in
addition to malaria work, the duties of family planning and vital statistics data collection
under supervision of family planning health assistants.

4. MUKHERJEE COMMITTEE. 1965.

The recommendations of the Chadha Committee, when implemented, were found to

be impracticable because the basic health workers, with their multiple functions could do
justice neither to malaria work nor to family planning work. The Mukherjee committee
headed by the then Secretary of Health Shri Mukherjee, was appointed to review the
performance in the area of family planning. The committee recommended separate staff for
the family planning programme.

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The family planning assistants were to undertake family planning duties only. The
basic health workers were to be utilized for purposes other than family planning. The
committee also recommended to delink the malaria activities from family planning so that the
latter would received undivided attention of its staff.

5. MUKHERJEE COMMITTEE. 1966.

Multiple activities of the mass programmes like family planning, small pox, leprosy,
trachoma, NMEP (maintenance phase), etc. were making it difficult for the states to
undertake these effectively because of shortage of funds. A committee of state health
secretaries, headed by the Union Health Secretary, Shri Mukherjee, was set up to look into
this problem.

The committee worked out the details of the Basic Health Service which should be
provided at the Block level, and some consequential strengthening required at higher levels of
administration.

6. JUNGALWALLA COMMITTEE, 1967.

This committee, known as the “Committee on Integration of Health Services” was set
up in 1964 under the chairmanship of Dr. N Jungalwalla, the then Director of National
Institute of Health Administration and Education (currently NIHFW). It was asked to look
into various problems related to integration of health services, abolition of private practice by
doctors in government services, and the service conditions of Doctors. The committee
defined “integrated health services” as :-

 A service with a unified approach for all problems instead of a segmented approach
for different problems.
 
 Medical care and public health programmes should be put under charge of a single
administrator at all levels of hierarchy.

Following steps were recommended for the integration at all levels of health

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organization in the country

1. Unified Cadre
2. Common sanitary
3. Recognition of extra qualification
1. 4. Equal pay for equal work
5. Special pay for special work
6. Abolition of private practice by government doctors
7. Improvement in their service conditions

   
   
   

 
7. KARTAR SINGH COMMITTEE. 1973.

This committee, headed by the Additional Secretary of Health and titled the
"Committee on multipurpose workers under Health and Family Planning" was constituted to

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form a framework for integration of health and medical services at peripheral and supervisory
levels. Its main recommendations were :-

 Various categories of peripheral workers should be amalgamated into a single cadre

of multipurpose workers (male and female). The erstwhile auxiliary nurse midwives
were to be converted into MPW(F) and the basic health workers, malaria surveillance
workers etc. were to be converted to MPW(M). The work of 3-4 male and female
MPWs was to be supervised by one health supervisor (male or female respectively).
The existing lady health visitors were to be converted into female health supervisor.
 One Primary Health Centre should cover a population of 50,000. It should be divided
into 16 subcentres (one for 3000 to 3500 population) each to be staffed by a male and
a female health worker.

 
8. SHRIVASTAV COMMITTEE. 1975.

This committee was set up in 1974 as "Group on Medical Education and Support
Manpower" to determine steps needed to (i) reorient medical education in accordance with
national needs & priorities and (ii) develop a curriculum for health assistants who were to
function as a link between medical officers and MPWs. It recommended immediate action
for:

 Creation of bonds of paraprofessional and semiprofessional health workers from

within the community itself.
 Establishment of 3 cadres of health workers namely – multipurpose health workers
and health assistants between the community level workers and doctors at PHC.
 Development of a “Refferal Services Complex”
 Establishment of a Medical and Health Education Commission for planning and
implementing the reforms needed in health and medical education on the lines of
University Grants Commission.

  Acceptance of the recommendations of the Shrivastava Committee in 1977 led to the

launching of the Rural Health Service.

9. BAJAJ COMMITTEE, 1986.

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An "Expert Committee for Health Manpower Planning, Production and Management"

was constituted in 1985 under Dr. J.S. Bajaj, the then professor at AIIMS. Major
recommendations are :

1. Formulation of National Medical & Health Education Policy.

2. Formulation of national health manpower policy
3. Establishment of an educational commission for health sciences (ECHS) on the
lines of UGC
4. Establishment of health science universities in various states and union territories
5. Establishment of health manpower cells at centre and in the states
6. Vocationalisation of education at 10+2 levels as regards health related fields with
appropriate incentives, so that good quality paramedical personnel may be available
in adequate numbers.
7. Carrying out a realistic health manpower survey.
 
   
   
   
   
   

References:

1. Planning Commission, Government of India: Five Year Plans.

Planningcommission.nic.in. Retrieved on 2012-03-17.
2. Planning Commission (24 February 1997). "A Background Note on Gadgil
Formula for distribution of Central Assistance for State Plans" (PDF). Retrieved 17
September 2010.
3. Sony Pellissery and Sam Geall "Five Year Plans". Encyclopedia of
Sustainability. Volume 7 pp. 156–160

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4. Jalal Alamgir, India's Open-Economy Policy: Globalism, Rivalry, Continuity

(London and New York: Routledge 2008), Chapter 2.
5. Baldev Raj Nayar, Globalization And Nationalism: The Changing Balance Of
India's Economic Policy, 1950–2000 (New Delhi: Sage, 2001).
Jump up to:a b c d e
6.          L. N. Dash (2000). World bank and economic development of
India. APH Publishing. p. 375. ISBN 81-7648-121-1.
7. "A short history of Indian economy 1947-2019: Tryst with destiny & other
stories". Mint. 14 August 2019. Retrieved 15 August 2019.
8. "Archived copy" (PDF). Archived from the original (PDF) on 22 September
2013. Retrieved 21 September 2013.
9. https://idsa.in/idsacomments/13th-five-year-defence-plan-2017-
22_acowshish_310717
10. http://planningcommission.nic.in/plans/planrel/fiveyr/9th/vol1/v1c2-1.htm
11. Agrawal, A N (1995). Indian Economy: Problems of development and
planning. pune: Wishwa Prakashan. p. 676.
12. "National Development Council approves 12th Five Year Plan". Indian
Express. 27 December 2012. Retrieved 10 July 2013.

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