Exploring National Health Policy and Goals in India

India’s healthcare journey has been shaped significantly by its National Health Policy (NHP), a comprehensive framework that guides the country’s approach to public health. Since its first formulation in 1983, this policy has evolved through multiple iterations to address changing health challenges, demographic shifts, and emerging diseases. Understanding these policies is essential for nursing professionals who work at the frontlines of healthcare delivery across the nation.

What is a national health policy?
National Health Policy 1983: the foundation
Core objectives of NHP 1983
Infrastructure development
National Health Policy 2002: addressing emerging challenges
Key strategies and objectives
Time-bound goals
National Health Policy 2017: towards universal health coverage
Vision and core objectives
Specific quantitative goals
Key policy thrust areas
Implementation and achievements
Role of nursing professionals
Challenges and the way forward

What is a national health policy?

A national health policy serves as a master plan that guides a government’s efforts to improve the health of its population. According to the World Health Organization, health policy defines health goals and specifies decisions, plans, and actions needed to achieve these goals. It clarifies values, establishes future vision, and helps set short and medium-term targets. In India, the central government periodically publishes a National Health Policy to guide future health programs and initiatives.

India has had three major National Health Policies: in 1983, 2002, and 2017. Each policy was designed to address the specific health challenges of its time while building upon the foundation laid by its predecessor.

National Health Policy 1983: the foundation

India’s first formal National Health Policy was introduced in 1983, 36 years after independence. This landmark policy emerged as India’s response to the Alma-Ata Declaration of 1978, which advocated for primary healthcare as the key to achieving health equity worldwide.

Core objectives of NHP 1983

The primary objective of the 1983 policy was to achieve the ambitious goal of “Health for All by the Year 2000 A.D.” through universal provision of comprehensive primary health care services. The policy envisioned achieving this through a fully integrated planning framework that would provide universal, comprehensive primary health care that people could afford.

Key initiatives under NHP 1983 included establishing a phased, time-bound programme for setting up a network of primary health care services. The policy focused on prevention, promotion, and rehabilitation aspects of healthcare. It recommended a decentralised system featuring low cost services, use of volunteers and paramedics, and community participation. The expansion of the private curative sector was encouraged to help reduce the government’s burden.

Infrastructure development

One of the most significant steps under NHP 1983 was the expansion of Primary Health Centres across the country. Each PHC was designed to serve a population of 30,000 in plain areas and 20,000 in hilly, tribal, and desert areas. The policy also established a structured referral system connecting primary, secondary, and tertiary levels of healthcare.

The policy emphasised integration of health services with family welfare programs, recognising the interconnected nature of health and population issues. It also focused on immunisation campaigns, family planning practices, and nutrition programs to improve overall population health.

National Health Policy 2002: addressing emerging challenges

By the early 2000s, significant changes in India’s health landscape necessitated a revised approach. The National Health Policy 2002 was formulated to address these evolving challenges while acknowledging that the goal of “Health for All by 2000” remained largely unachieved.

Key strategies and objectives

The main objective of NHP 2002 was to achieve an acceptable standard of good health for the general population through comprehensive healthcare systems that were affordable, equitable, and accessible to all citizens. The policy recognised that public health investment had declined from 1.3 percent of GDP in 1990 to just 0.9 percent in 1999.

Primary strategies included the Primary Health Care Approach, decentralised public health system, and convergence of all health programmes under a single field umbrella. The policy also emphasised strengthening public health services and enhanced contribution from private and NGO sectors in healthcare delivery.

Time-bound goals

NHP 2002 set ambitious targets including eradication of polio and yaws by 2005, elimination of leprosy by 2005 and kala-azar by 2010. The policy aimed to reduce mortality from tuberculosis, malaria, and other vector-borne diseases by 50% by 2010. It targeted reducing infant mortality rate to 30 per 1000 live births and maternal mortality rate to 100 per lakh live births by 2010.

The policy also proposed increasing health expenditure by government from 0.9% to 2.0% of GDP by 2010. It recommended that the Central Government’s contribution to overall public health funding should rise to 25% from the existing 15%.

National Health Policy 2017: towards universal health coverage

The most recent iteration, approved by the Union Cabinet on March 15, 2017, represents India’s strategic roadmap for achieving Universal Health Coverage. This policy was formulated after extensive stakeholder consultations and addresses current and emerging challenges arising from changing socio-economic and epidemiological scenarios.

Vision and core objectives

The policy envisions attaining the highest possible level of health and well-being for all at all ages through preventive and promotive health care orientation. It aims to provide universal access to good quality health care services without anyone facing financial hardship as a consequence.

According to the Ministry of Health and Family Welfare, the policy’s primary aim is to inform, clarify, strengthen and prioritise the role of government in shaping health systems across all dimensions-investment in health, organisation and financing of healthcare services, disease prevention, and health promotion.

Specific quantitative goals

NHP 2017 sets several time-bound targets aligned with Sustainable Development Goals. Key goals include increasing life expectancy at birth from 67.5 to 70 years by 2025, and reducing total fertility rate to 2.1 at national and sub-national levels by 2025. The policy aims to reduce under-five mortality to 23 per 1000 live births and maternal mortality rate to 100 per lakh live births by 2020.

The policy targets reducing infant mortality rate to 28 per 1000 by 2019 and neo-natal mortality to 16 per 1000 by 2025. It also aims to achieve the global 90:90:90 target for HIV/AIDS by 2020 and reduce blindness prevalence to 0.25 per 1000 by 2025.

Key policy thrust areas

The 2017 policy proposes raising public health expenditure to 2.5% of GDP in a time-bound manner. It advocates allocating two-thirds or more of resources to primary care, followed by secondary and tertiary care. The policy emphasises providing larger packages of assured comprehensive primary health care through Health and Wellness Centres.

A significant departure from previous policies is the shift from selective to comprehensive primary health care packages, which now include geriatric health care, palliative care, and rehabilitative care services. The policy also emphasises free drugs, free diagnostics, and free emergency care services in all public hospitals.

Implementation and achievements

The National Health Policies have led to several flagship programs and measurable improvements in India’s health indicators. India has made significant progress in reducing maternal and child mortality rates. The Maternal Mortality Rate declined from 130 in 2017 to 97 in 2022, surpassing the NHP 2017 target. Child mortality rate dropped significantly from 39 per 1,000 live births to 23.

Major programs launched under these policies include Ayushman Bharat, which provides health coverage to economically vulnerable families. The National Rural Health Mission launched in 2005 and the National Urban Health Mission approved in 2013 were combined under the National Health Mission umbrella. Over 1.5 lakh Health and Wellness Centres have been established across the country.

Role of nursing professionals

Nursing professionals play a crucial role in implementing these health policies at the grassroots level. The policies recognise the need for improving the ratio of nurses to doctors and beds, and emphasise upgrading nursing skills. NHP 2002 specifically identified the need for training super-speciality nurses for tertiary care institutions and increasing degree-holding nurses compared to diploma-holding nurses.

Community health nurses are particularly vital for primary health care delivery, health education, maternal and child health services, and disease surveillance-all key components of India’s National Health Policies.

Challenges and the way forward

Despite significant progress, challenges remain in fully implementing the National Health Policy goals. These include resource constraints, infrastructure limitations in rural areas, shortage of trained healthcare professionals, and difficulties in coordinating between central, state, and local governments. The target of increasing public health expenditure to 2.5% of GDP remains a work in progress.

The evolution of India’s National Health Policy from 1983 to 2017 demonstrates the country’s commitment to improving healthcare for all citizens. As health challenges continue to evolve-including the rise of non-communicable diseases, mental health concerns, and emerging infections-these policies provide the framework for a responsive and inclusive health system.

What do you think? How can nursing professionals contribute more effectively to achieving the goals outlined in the National Health Policy 2017? What changes would you like to see in future iterations of India’s health policy to better address community health needs?

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Table of Contents

What is a national health policy? 🔗

National Health Policy 1983: the foundation 🔗

Core objectives of NHP 1983 🔗

Infrastructure development 🔗

National Health Policy 2002: addressing emerging challenges 🔗

Key strategies and objectives 🔗

Time-bound goals 🔗

National Health Policy 2017: towards universal health coverage 🔗

Vision and core objectives 🔗

Specific quantitative goals 🔗

Key policy thrust areas 🔗

Implementation and achievements 🔗

Role of nursing professionals 🔗

Challenges and the way forward 🔗