Comprehensive Overview of the National Health Policy, 2017

For nearly a decade and a half, the way the government approached the nation’s health remained largely unchanged. Then, on 15 March 2017, the Union Cabinet approved a document that would reshape how healthcare is imagined and delivered: the National Health Policy (NHP) 2017. Arriving after a gap of 15 years since the previous policy of 2002, NHP 2017 marked a decisive move away from a system focused on treating the sick towards one built around keeping people well. It is a foundational text for understanding public health administration today, and this post walks you through its vision, goals, mechanisms, and the gaps that remain.

Why a new health policy was needed 🔗

The previous health policies of 1983 and 2002 had guided the sector through the era of Five-Year Plans. But by 2017, the ground had shifted dramatically. Three changes made a fresh approach unavoidable.

First, the disease burden had transformed. While maternal and child mortality had declined steadily, non-communicable diseases such as diabetes, heart disease and cancer were rising sharply, alongside persistent infectious diseases. Second, a robust private healthcare industry had emerged, growing at double-digit rates and increasingly shaping where and how people sought care. Third, and most worryingly, catastrophic health expenditure had become a major driver of poverty. With over 60% of healthcare costs paid directly out of patients’ pockets, a single hospitalisation could push a family below the poverty line.

The policy was the product of wide consultation. It involved regional consultations with multiple stakeholders and approval from the Central Council of Health and Family Welfare and a Group of Ministers before reaching the Cabinet.

The central vision and guiding principles 🔗

At its heart, NHP 2017 sets a single, ambitious goal. It seeks the attainment of the highest possible level of health and well-being for all, at all ages, through a preventive and promotive healthcare orientation and universal access to good-quality care without anyone facing financial hardship as a result. The phrase “without financial hardship” is the key here. The policy is not only about curing illness; it is about ensuring that seeking treatment does not bankrupt a household.

The principles that anchor the policy 🔗

The policy rests on a clear set of values. These include professionalism, integrity and ethics; equity; affordability; universality; a patient-centred and quality-driven approach; accountability; and pluralism. Equity deserves special attention. The policy commits to reducing disparities based on gender, caste, poverty, disability, and geography, with greater investment directed towards the poor and those facing heavy medical needs.

From sick care to wellness: the seven policy shifts 🔗

Perhaps the most significant feature of NHP 2017 is how it reorganises the delivery of public healthcare. The policy proposes seven key policy shifts to align services with the goal of universal health coverage. Three of these are especially important to understand.

In primary care, the shift is from “selective care” to assured comprehensive care with linkages to referral hospitals. Earlier, primary health centres offered only a narrow basket of services. The new approach promises a fuller range of care closer to where people live.

In public hospitals, the shift is from user fees and cost recovery to assured free drugs, diagnostics and emergency services for all. This directly reverses the cost-recovery logic introduced during the structural reforms of the 1990s.

In secondary and tertiary care, the shift moves from an input-oriented model to output-based strategic purchasing, where the government can buy services from both public and private providers to fill gaps.

Assured services: free drugs, diagnostics and emergency care 🔗

One of the most concrete commitments of the policy is the promise of free essential services in public facilities. The policy envisions free drugs, diagnostics and emergency care at sub-centres, primary health centres, community health centres and district hospitals, with gaps filled through strategic purchasing from the private sector where needed.

This commitment is the operational backbone of the policy’s promise to reduce financial hardship. When medicines and diagnostic tests are provided free in public hospitals, families no longer have to choose between treatment and other essentials. The policy also proposes a benchmark of two hospital beds per 1,000 population to address infrastructure shortfalls.

The financial heart of the policy 🔗

No health policy can succeed without money behind it. NHP 2017 tackles this head-on through two interlinked financial targets.

Raising public health expenditure to 2.5% of GDP 🔗

The headline financial commitment is raising public health expenditure progressively to 2.5% of GDP by 2025. At the time the policy was framed, government spending hovered around just 1.15% of GDP. The policy also calls on state governments to raise their health spending to above 8% of their budgets.

Cutting out-of-pocket expenditure 🔗

The second financial goal targets the burden borne by ordinary families. The policy aims to lower out-of-pocket expenditure and reduce the proportion of households facing catastrophic health costs. It seeks to decrease the proportion of households facing catastrophic health expenditure by 25% by 2025. Catastrophic expenditure here means health spending that exceeds a large share of a household’s total consumption.

Specific health targets: tracking IMR and MMR 🔗

What distinguishes NHP 2017 from a mere statement of intent is its use of measurable, time-bound targets. These provide a yardstick for accountability. Among the most important are the mortality goals.

The policy aimed to reduce the Infant Mortality Rate (IMR) to 28 per 1,000 live births by 2019 and the Maternal Mortality Ratio (MMR) to 100 per 100,000 live births by 2020. It also set goals to bring under-five mortality down to 23 by 2025 and to reduce the Total Fertility Rate to 2.1 by the same year. On the broader front, the policy targets raising life expectancy at birth from 67.5 to 70 years by 2025. It also commits to eliminating diseases such as Kala-Azar and Lymphatic Filariasis and maintaining the elimination status of Leprosy.

Mainstreaming AYUSH and embracing digital health 🔗

The policy looks beyond conventional medicine in two notable directions.

Integrating traditional systems of medicine 🔗

NHP 2017 continues the mainstreaming of AYUSH systems within the general health system, the term covering Ayurveda, Yoga, Unani, Siddha and Homoeopathy. It proposes integrating these systems at the level of knowledge and validating their methods of health promotion and cure. It even suggests a bridge course to equip mid-level providers with competencies in allopathic remedies, and supports introducing yoga in schools and colleges.

Leveraging digital tools 🔗

The policy recognises the transformative potential of technology. It envisions creating a digital health ecosystem, including electronic health records and a National Health Information Network by 2025. These digital initiatives are particularly valuable for extending care to remote and underserved areas through telemedicine and mobile health applications, an idea later carried forward through the digital health mission.

Public-private collaboration and preventive action 🔗

NHP 2017 explicitly treats the private sector as a strategic partner rather than a rival. Recognising that the private sector delivers a large share of healthcare, the policy advocates strategic purchasing of services to fill gaps in public provision, particularly in secondary and tertiary care.

The preventive dimension is equally striking. The policy identifies coordinated action across seven priority areas to improve the environment for health, linking initiatives such as the Swachh Bharat Abhiyan, balanced diets and exercise, action against tobacco and alcohol abuse, road and rail safety, action against gender violence, reduced workplace stress, and lower air pollution. This reflects the understanding that health is determined as much outside hospitals as within them.

How far has the policy come? 🔗

Several years on, the record is mixed. On health outcomes, there has been genuine progress. MMR fell from around 130 in 2017 to 97 in 2022, and child mortality indicators have improved well beyond several of the original targets. The flagship Ayushman Bharat programme, launched in 2018, operationalised much of the policy’s vision through health insurance and a vast network of Health and Wellness Centres.

The financing picture, however, tells a more sobering story. A peer-reviewed analysis found that public health expenditure rose only marginally, from around 0.9% to 1.6% of GDP between 2015-16 and 2021-22, well short of the 2.5% target. There is encouraging news on the burden borne by families, though. According to National Health Accounts data, out-of-pocket spending fell to about 39.4% of total health expenditure as government spending finally overtook it, a significant structural shift even if the journey to the policy’s goals is far from complete.

What do you think? Given that public health spending still falls short of the 2.5% of GDP target, where should the bulk of new investment go first: strengthening primary health infrastructure or expanding insurance coverage for hospitalisation? And how much should India rely on the private sector as a partner in delivering universal health coverage?

References

1. https://www.pib.gov.in/newsite/PrintRelease.aspx?relid=159376
2. https://www.tnpscthervupettagam.com/articles-detail/national-health-policy-2017
3. https://www.pib.gov.in/PressReleaseIframePage.aspx?PRID=1513000
4. https://nhsrcindia.org/sites/default/files/2021-07/National%20Health%20Policy%202017%20(English)%20.pdf
5. https://www.shankariasparliament.com/current-affairs/national-health-policy-2017
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7. https://www.slideshare.net/Ruchita1989/nhp-2017
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9. https://www.slideshare.net/slideshow/national-health-policy-2017-240319351/240319351
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