PUBLIC POLICY IN HEALTH SECTOR

What is Public Health Policy?

Public health policy is defined as the laws, regulations, actions, and decisions
implemented within society in order to promote wellness and ensure that
specific health goals are met. Public health policies can range from formal
legislation to community outreach efforts. Public health policy plays a role in
multiple sectors, including:

• Health care
• Insurance
• Education
• Agriculture
• Business

A clear public health policy definition can be hard to pin down due to its
multidisciplinary nature. However, at the core of all public health policy is a
singular mission towards health.
Organizations such as the World Health Organization Centres for Disease
Control and Prevention , Food and Drug Administration and other
governmental and non-governmental agencies play a large role In public
health policy. These organizations perform research and implement education
and health initiatives for a population—creating laws and policies that ensure
the society has nutritious food to eat, clean water to drink, vaccines for the
sick, and access to health care.

Public policy in the health sector refers to the decisions, actions, and laws
that governments and institutions put in place to manage and improve the
health and well-being of their populations. It includes a wide range of
strategies, from healthcare delivery systems to regulations on health
behaviours and disease prevention, all aimed at promoting public health,
improving access to medical care, and ensuring the equitable distribution of
health services.

Here are some key components of public policy in the health sector:

1. Healthcare System Design and Access

Universal Health Coverage (UHC): Many countries aim to provide universal
access to healthcare, ensuring that all citizens, regardless of income,
geography, or social status, can receive essential health services without
financial hardship.
Insurance Policies: Public health policies often govern the creation of national
or regional health insurance programs, subsidized health plans, or mandates
for private insurance to ensure people can access medical care when needed.
2. Regulation and Legislation

Health Standards and Safety: Governments set regulations to ensure the

safety and efficacy of drugs, medical devices, food, and environmental health
standards.
Professional Licensing and Accreditation: Health policies also include rules
for the education, training, licensing, and regulation of healthcare
professionals to maintain quality standards.
3. Disease Prevention and Control
Vaccination Programs: Policies aimed at preventing the spread of infectious
diseases, such as mandatory immunization for children, are central to public
health policy.
Public Health Campaigns: Governments often run campaigns to promote
healthy behaviors, such as anti-smoking initiatives or campaigns to combat
obesity, alcohol consumption, and drug abuse.
 4. Health Equity and Social Determinants of Health
Addressing Inequities: Public policy focuses on reducing health disparities
across different demographic groups, including through access to education,
nutrition, sanitation, and income support.
Social Determinants of Health (SDH): Health policies may target broader
social and economic factors that influence health outcomes, such as
housing, employment, and education.
5. Financing and Resource Allocation
Budgeting for Health Services: Governments often allocate significant
portions of their budgets to the healthcare sector to build hospitals, hire
medical personnel, and ensure medicines and equipment are available.
Cost Control Mechanisms: Policies often include cost-control strategies to
manage rising healthcare expenses, such as price controls on drugs or
medical procedures, and the use of public-private partnerships.

Key public health policies in India

NATIONAL HEALTH POLICY 2017

The year 2017 saw the release of a new National Health Policy of the country
after a gap of 15 years. The Cabinet in its meeting held on 15 th March, 2017
approved the National Health Policy (NHP) 2017. NHP 2017 addresses the
current and emerging challenges necessitated by the changing socio-
economic, technological and epidemiological landscape. The process of
formulation of the new Policy entailed wide consultation with multiple
stakeholders and regional consultations before its approval by the Central
Council of Health and Family Welfare and Group of Ministers.
The major commitment of the NHP 2017 is raising public health expenditure
progressively to 2.5% of the GDP by 2025. It envisages providing larger
package of assured comprehensive primary healthcare through the Health
and Wellness Centres. The Policy aims to attain the highest possible level of
health and well-being for all at all ages through a preventive and primitive
healthcare and universal access to quality health 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. NHP 2017 advocates allocating major proportion (two-
thirds or more) of resources to primary care and aims to ensure availability of
two beds per 1,000 population distribute in a manner to enable access within
golden hour. The Policy also takes a fresh look at strategic purchase from the
private sector and leveraging their strengths to achieve national health goals
and seeks stronger partnership with the private sector.

National rural health mission

The National Rural Health Mission (NRHM) was launched by the Hon’ble
Prime Minister on 12th April 2005, to provide accessible, affordable and quality
health care to the rural population, especially the vulnerable groups. The
Union Cabinet vide its decision dated 1 st May 2013, has approved the launch
of National Urban Health Mission (NUHM) as a Sub-mission of an over-arching
National Health Mission (NHM), with National Rural Health Mission (NRHM)
being the other Sub-mission of National Health Mission.

NRHM seeks to provide equitable, affordable, and quality health care to the
rural population, especially the vulnerable groups. Under the NRHM, the
Empowered Action Group (EAG) States, as well as the North Eastern States,
Jammu and Kashmir and Himachal Pradesh, have been given special focus.
The thrust of the mission is on establishing a fully functional, community-
owned, decentralized health delivery system with inter-sectoral convergence
at all levels, to ensure simultaneous action on a wide range of determinants of
health such as water, sanitation, education, nutrition, social and gender
equality. Institutional integration within the fragmented health sector was
expected to provide a focus on outcomes, measured against Indian Public
Health Standards for all health facilities.

Ayushman Bharat Yojana

Ayushman Bharat Yojana (ABY), also known as the Pradhan Mantri Jan Arogya
Yojana (PMJAY), is a flagship healthcare scheme launched by the Government
of India in 2018. Here are some key aspects:

Objectives
1. Universal Health Coverage: Provide health insurance coverage to
economically vulnerable families, ensuring access to quality healthcare
services.
2. Reducing Out-of-Pocket Expenses: Decrease financial burdens on families
due to medical expenses.
3. Improving Health Outcomes: Enhance health outcomes by increasing
access to healthcare services.

Key Features
1. Health Insurance Coverage: Provides health insurance coverage up to ₹5
lakhs per family per year.
2. Cashless Treatment: Offers cashless treatment at empanelled hospitals.

3. Portability: Allows beneficiaries to access healthcare services across the

country.
4. Paperless: Uses Aadhaar-based verification for paperless transactions.

Eligibility

1. Socio-Economic Caste Census (SECC) Data: Families identified as

deprived under the SECC data are eligible.
2. Economically Vulnerable Families: Families with an annual income below
₹2.4 lakhs are eligible.

Integrated child development scheme

The Integrated Child Development Services (ICDS) is a government program in

India that aims to improve the health, nutrition, and education of children,
pregnant and lactating mothers, and women between the ages of 16 and 44.
The program was launched in 1975 and is considered the world’s largest
community-based program.

The ICDS provides the following services:

Nutritional meals, Preschool education, Primary healthcare, Immunization,
Health check-ups, and Referral services.
The ICDS’s objectives include:
Improving the health and nutritional status of children under 6 years of age
Laying the foundation for the child’s psychological, physical, and social
development
Reducing mortality, morbidity, malnutrition, and school dropout
Improving the mother’s ability to care for the child’s health and nutritional
needs

National Mental Health Program

National Mental Health Programme (NMHP) was started in 1982 with the
objectives to ensure availability and accessibility of minimum mental health
care for all, to encourage mental health knowledge and skills and to promote
community participate in mental health service development and to stimulate
self-help in the community.
Objectives of National Mental Health Programme
Minimum mental healthcare for all – To ensure the availability and
accessibility of minimum mental healthcare for all in the foreseeable future,
particularly to the most vulnerable and underprivileged sections of the
population;
Application of Mental Health Knowledge – To encourage the application of
mental health knowledge in general healthcare and in social development;
and
Community Participation – To promote community participation in the mental
health service development and to stimulate efforts towards self-help in the
community.
Under this Programme, the Government is implementing manpower
development schemes for establishment of Centres of Excellence and
strengthening/ establishment of Post Graduate (PG) Departments in mental
health specialties and District Mental Health Programme (DMHP) for
detection, management and treatment of mental disorders/ illness. The
activities covered under the DMHP include work place stress management,
life skills training, counselling in schools and colleges, community awareness,
prevention, promotion and long-term continuing care at different levels of
district healthcare delivery system, etc.

Mission Indradhanush
Mission Indradhanush, often referred to as Mission Rainbow, is a crucial
public health initiative launched by Union Health Minister JP Nadda on
December 25, 2014. This ambitious program is designed to enhance
immunization coverage in India, focusing on protecting children and pregnant
women from a range of dangerous diseases.

The mission aims to address gaps in immunization coverage and ensure that
essential vaccines reach those who need them most.
The primary objective of Mission Indradhanush is to provide comprehensive
immunization coverage to all children under the age of 2 years and pregnant
women across India. The program is an integral part of the broader health
mission programs that aim to improve health outcomes and prevent the
spread of infectious diseases.
By focusing on immunization, Mission Indradhanush seeks to protect
vulnerable populations from severe illnesses that can have devastating
effects on health and well-being.
Diseases Covered

Initially, Mission Indradhanush targeted seven major killer diseases, which

were considered critical for preventing high morbidity and mortality rates in
children. These diseases include:
Diphtheria: A bacterial infection that can lead to severe respiratory issues,
heart problems, and even death if not treated promptly.
Pertussis (Whooping Cough): A highly contagious respiratory disease known
for severe coughing fits that can lead to complications, especially in infants.
Tetanus: Caused by a bacterial toxin, tetanus can result in severe muscle
spasms and can be fatal if not treated.
Tuberculosis (TB): A bacterial infection that primarily affects the lungs but can
also impact other parts of the body.

Polio: A viral disease that can cause paralysis and, in severe cases, can be
life-threatening.
Hepatitis B: A viral infection that affects the liver and can lead to chronic liver
disease or liver cancer.
Meningitis and Pneumonia caused by Haemophilus influenzae: These are
serious infections that affect the brain and lungs, respectively, and can lead to
severe complications or death.

Pradhan Mantri Swasthya Suraksha Yojana

PMSSY was announced in 2003 with objectives of correcting regional
imbalances in the availability of affordable/reliable tertiary healthcare
services and also to augment facilities for quality medical education in the
country. Nodal Ministry: Ministry of Health and Family Welfare. Two
Components: Setting up of AIIMS like institutions. Upgradation of government
medical colleges in various states. The project cost for upgradation of each
medical college institution is shared by the Centre and the state. PMSSY
stands for Pradhan Mantri Swasthya Suraksha Yojana. It is an initiative
launched by the Government of India in 2003 with the aim of improving the
quality of healthcare in the country by establishing world-class healthcare
facilities. The focus of PMSSY is on the development of infrastructure in
medical colleges, institutions, and the improvement of healthcare systems,
particularly in underserved regions.

Key Objectives of PMSSY:

1. Establishment of AIIMS-like Institutions: The main goal is to create

high-quality medical institutions, often modelled after AIIMS (All India
Institute of Medical Sciences), to provide specialized healthcare
services and medical education.
2. Upgrade of Existing Medical Colleges: To upgrade existing medical
colleges and institutions to meet modern standards by providing
advanced infrastructure, equipment, and faculty.
 3. Provide Quality Healthcare: Ensuring that quality healthcare services
are accessible to all sections of society, particularly in rural and remote
areas.
4. Capacity Building in Medical Education: Enhancing the number of
medical professionals, including doctors, nurses, and other healthcare
staff, through modernized institutions and better training.

National program for healthcare for the elderly

The Ministry of Health & Family Welfare had launched the “National
Programme for the Health Care of Elderly” (NPHCE) during 2010-11 to address
various health related problems of elderly people. The National Programme
for the Health Care for the Elderly (NPHCE) is an articulation of the
International and national commitments of the Government as envisaged
under the UN Convention on the Rights of Persons with Disabilities
(UNCRPD), National Policy on Older Persons (NPOP) adopted by the
Government of India in 1999 & Section 20 of “The Maintenance and Welfare of
Parents and Senior Citizens Act, 2007” dealing with provisions for medical
care of Senior Citizen. The programme is State oriented and basic thrust of the
programme is to provide dedicated health care facilities to the senior citizens
(>60 year of age) at various level of primary, secondary and tertiary health
care.
Objectives:

• To provide accessible, affordable, and high-quality long-term,

comprehensive and dedicated care services to an Ageing population;
• Creating a new "architecture" for Ageing; to build a framework to create
an enabling environment for "a Society for all Ages";
• To promote the concept of Active and Healthy Ageing;
• Convergence with National Rural Health Mission, AYUSH and other line
departments like Ministry of Social Justice and Empowerment.
 Program Strategies:
• Community based primary health care approach including
domiciliary visits by trained health care workers.
• Dedicated services at PHC/CHC level including provision of
machinery, equipment, training, additional human resources (CHC),
IEC, etc
• Dedicated facilities at District Hospital with 10 bedded wards,
additional human resources, machinery & equipment, consumables
& drugs, training and IEC.
Ayushman Bharat Digital Mission
The Ayushman Bharat Digital Mission (ABDM) aims to develop the backbone
necessary to support the integrated digital health infrastructure of the
country. It will bridge the existing gap among different stakeholders of the
healthcare ecosystem through digital highways. Ayushman Bharat Digital
Mission will connect the digital health solutions of hospitals across the
country. This Mission will not only improve the processes of hospitals but also
will increase ease of living. The digital ecosystem will also enable a host of
other facilities like digital consultation, consent of patients in letting medical
practitioners access their records, etc. With the implementation of this
scheme, old medical records cannot get lost as every record will be stored
digitally. Ayushman Bharat Digital Mission will connect the digital health
solutions of hospitals across the country with each other. The Mission will not
only make the processes of hospitals simplified but also will increase ease of
living. The Digital Ecosystem will also enable a host of other facilities like
Digital Consultation, Consent of patients in letting medical practitioners
access their records, etc. With the implementation of this scheme, old
medical records cannot get lost as every record will be stored digitally.

Conclusion

Future Directions
 1. Digital Health
2. Preventive care
3. Health equity
4. Capacity building
By prioritizing these areas, public policy in the health sector can effectively
address the complex healthcare needs of the citizens, ensuring better health
outcomes, quality of life and overall, wellbeing.