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The announcement of the National Health Policy 2017 is one of the many progressive strides being made by our country. It is one of the several long due activities that has fructified under NDA Government’s mandate of ‘sabka saath, sabka vikas’ under the visionary leadership of Shri. Narendra Modi ji.
The NHP 2017 has several highlights and features but at its core, as its main focus is ‘comprehensive and universal wellness’. To achieve the goals enunciated in the NHP 2017, various steps are being taken. Two very significant and patient centric initiatives have recently received approval of the Parliament i.e. the Mental Healthcare Act 2017 and the HIV & AIDS Prevention and Control Act, 2017.
After much debate and discussion in the Rajya Sabha and Lok Sabha, the two Acts have reached their finality in being implemented at the last mile. Both show tremendous scope in improving the circumstances of mental health care patients and those affected by HIV and AIDS. The Policy was passed and subsequently the Acts because the new National Health Policy paves way for ensuring that the provisions of the Acts are being met, as well as adequate financing (from both the Centre and the state) flows down to the relevant institutes and health care providers. This is decidedly so, given the matching targets of the Acts and the Policy to encourage a patient-centric, multi-sectoral approach in healthcare provisioning in the country.
The Acts are one of the many sub components of the NHP 2017, as the Policy seeks to reach everyone in a comprehensive integrated way to move towards wellness. The main objective of the National Health Policy 2017 is to achieve the highest possible level of good health and well-being, through a preventive and promotive health care orientation in all developmental policies, and to achieve universal access to good quality health care services as well as stringent monitoring mechanisms for both private and public health institutes; the Mental Healthcare Act and the HIV/AIDS Prevention & Control Act would ensure the same. Also since the Policy proposes a focus on prevention and treatment in addition to the earlier model of sick-care only services, we are moving along with sick care to wellness. To achieve this, the Policy has strongly emphasised the patient’s awareness and involvement in their diagnosis as well cost-effective access to top health-care infrastructure and treatments. The shift from primarily public services to new, strategic partnerships with private health providers further opens up opportunities for the best treatments with the prospect to fill the gaps in public and private services in health care; the Acts will therein play their role of ensuring patients right while accessing the services being provisioned at public and/or private facilities.
Now to elaborate exclusively about the individual items, I would like to start with the Mental Healthcare Act, 2017. A 2015 study placed nearly 6-7 per cent of the Indian population under the category of mental health illness – this could be significantly higher given that mental illnesses often go underreported due to the associated stigma. Given that a significant proportion of the population suffers from illnesses under mental health, the Act adopts a rights based legislation on mental health and to strengthen equality and equity in provision of mental healthcare services. It is important to protect the rights of people with mental health problem to ensure that they are able to receive optimum care and are able to live a life of dignity and respect. The Act, proposes a more progressive and humane approach towards mental health. It gives more value to the lived experiences, decisions and perspectives of an individual person and opposes adoption of a tunnelled vision of providing only institutional based medical services (in line with NHPs focus on wellness). It talks about the role of carers, community-based rehabilitation, rights, choice to decide treatment and level of support needed, access to legal support and make provisions for additional care that is needed by children and women suffering from mental health problem. It strengthens the institutional mechanisms for upholding the rights of person with mental health problems to access quality and appropriate mental healthcare and other services. Through rigorous penalties and systemic checks, the Act increases accountability of both government and private sectors in delivery of mental healthcare. Representation of person with mental health problem and their care-givers in statutory authorities such as Central and State Mental Health Authority further highlights participatory and inclusive approach under the new Act.
Next is the HIV and AIDS Prevention and Control Act, 2017 which has been drafted to safeguard the rights of people living with HIV and affected by HIV. The provisions of the Act seek to address HIV-related discrimination, strengthen the existing programme by bringing in legal accountability and establish formal mechanisms for inquiring into complaints and redressing grievances. It seeks to prevent and control the spread of HIV and AIDS, prohibits discrimination against persons with HIV and AIDS, provides for informed consent and confidentiality with regard to their treatment, places obligations on establishments to safeguard rights of persons living with HIV arid create mechanisms for redressing complaints. The Act also aims to enhance access to health care services by ensuring informed consent and confidentiality for HIV-related testing, treatment and clinical research. It lists various grounds on which discrimination against HIV positive persons and those living with them is prohibited. It proposes a strong grievance redressal mechanism like appointing Complaint Officer in establishments of more than 100 persons and 20 in case of healthcare settings. Also, the Act makes provision for appointment of an ombudsman by State Governments to inquire into complaints related to the violation of the Act and penal actions in case of non-compliance, all towards enabling an environment of safety and care, the same larger philosophy of NHP 2017.
As I mentioned at the start, in alignment with these provisions, the National Health Policy hopes to act as an umbrella framework to monitor their efficient roll out and reach across the country. Further, it opens up access to public resources (financially and otherwise) to meet the provisions of the Acts.
I would also take this opportunity to state that taking from the renewed focus of the National Health Policy and the immediate need for the implementation of the Acts in question, the responsibility lies both with the Centre and the States in meeting the targets. Given the ambit of resources via the health and non-health government schemes, and recent trends of fiscal devolution from the Centre, the horizon looks positive. It is equally important for governments to understand the requirements for implementation, allocated adequate resources and (most importantly) train and support public health care providers and administrators to roll out the provisions. This along with the design and implementation of large scale awareness programmes for both mental health and HIV/AIDS, can help uplift the communities from societal stigma and other hindrances. With the collective commitment to realize the Policy and effective implementation of the Acts in a holistic and efficient manner, India can build an eco-system to safeguard the experience of vulnerable patients and provide the best care in its ability.