12thPlan Strategy for Health
The Twelfth Plan seeks to expand the reach of health care and work towards the long term objective of establishing a system of Universal Health Coverage (UHC) in the country i.e. each individual would have assured access to a defined essential range of medicines and treatment at an affordable price, which should be entirely free for a large percentage of the population.The key elements of the strategy to be followed are:
- Substantial expansion and strengthening of the public sector health care system in order to meet the health needs of rural and even urban areas.As supply in the public sector increases, it will cause a shift towards public sector providers freeing the vulnerable population from dependence on high cost and often unreachable private sector health care.
- The expenditure on health as a percentage of GDP for the health sector related resources needs to be increased to 2.5 per cent by the end of the Twelfth Plan.
- Financial and managerial systems will be redesigned to ensure more efficient utilisation of available resources, and to achieve better health outcomes.
- Efforts would be made to find a workable way of encouraging cooperation between the public and private sector in achieving health goals.
- The present Rashtriya Swasthya Bima Yojana (RSBY) which provides ‘cash less’ in-patient treatment for eligiblebeneficiaries through an insurance based system will need to be reformed to enable access to a continuum of comprehensive primary, secondary and tertiary care.
- A large expansion of medical schools, nursing colleges, and so on, is necessary to ensure availability of skilled human resourcesand public sector medical schools must play a major role in the process.
- A series of prescription drugs reforms, promotion of essential, generic medicines, and making these universally available free of cost to all patients in public facilities as a part of the Essential Health Package will be a priority.
- Effective regulation in medical practice, public health, food and drugs is essential to safeguard people against risks, and unethical practices.

Inclusive Agenda for Health
In order to ensure health services with special attention to the needs of marginalised sections of the population the following will be emphasised in the Twelfth Plan:
- Access to services: Barriers to access would be recognised and overcome especially for the disadvantaged and people located far from facilities. Medical and public health facilities would be accessible to the differently-abled. They would be gender sensitive and child friendly.
- Special services: Special services should be made available for the vulnerable and disadvantaged groups. For example, counselling of victims of mental trauma in areas of conflict.
- Monitoring and evaluation systems: Routine monitoring and concurrent impact evaluations should collect disaggregated information on disadvantaged segments of the population.
- Representation in community fora: Wherever community-level fora exist or are being planned for, such as Rogi Kalyan Samitis, VHSNC, representation of the marginalised should be mandatory. Also, every Village Health Sanitation and Nutrition Committee would strive to have 50 per cent representation of women.
- Training: Training of health and rehabilitation professionals should incorporate knowledge of disability rights, as also the skills to deal with differences in perspectives and expectations between members of disadvantaged segments and the general population that may arise out of different experiences.

Universal Health Coverage
Universal health coverage include the following components:
- To ensure health services for all Indian citizens in any part of the country, regardless of income level, social status, gender, caste or religion
- Health services must be affordable, accountable and of high quality
- UHC also should be Promotive, preventive, curative and rehabilitative
- services should address the wider determinants of health delivered to individuals and populations
- Governmentmust the guarantor and enabler, although not necessarily the only providerof health and related servicesUHC must meet the objectives of improving coverage, expanding access, controlling cost, raising quality,and strengthening accountability.Challenges to achieve UHCare:
- Public sectoris severely underfunded.
- Private sector is growing buttheir rising high cost healthcare service is problematic.
- Our country is also facing serious issues ofinadequate quality and coverage.
- Ineffective regulationis a concerned area.
- Combining public and private providers effectively for meeting UHC goals in a manner that avoids perverse incentives, reduces providerinduced demand.
- Integratingdifferent types and levels of services—public health and clinical; preventive and promotive interventions along with primary,secondary, and tertiary clinical care.

National Health Mission
After the success of the National Rural health Mission, the National Health Mission (NHM) was announced in 2012 covering all the villages and towns in the country. The National Health mission has two sub-missions:
1.National Rural Health Mission
2.National Urban Health Mission

The core principles of NHM are:
- Universal CoverageoThe NHM shall extend all over the country, both in urban and rural areas and promote universal access to a continuum of cashless, health services from primary to tertiary care.
- Achieving Quality StandardsoStandards would include the complete range of conditions, covering emergency, RCH, prevention and management of Communicable and Non-Communicable diseases incorporating essential medicines, and Essential and Emergency Surgical Care (EESC). The objective would be to achieve a minimum norm of 500 beds per 10 lakh population in an average district.oFor ensuring access to health care among under-served populations, the existing Mobile Medical units would  be expanded to have a presence in each CHC.
- Continuum of CareoThe linkages between different health facilities would be built so that all health care facilities in a region are organically linked with each other, with medical colleges providing the broad vision, leadership and opportunities for skill up-gradation. The potential offered by tele-medicine for remote diagnostics, monitoring and case management needs to be fully realised.
- Decentralised PlanningoA key element of the new NHM is that it would provide considerable flexibility to States and Districts to plan for measures to promote health and address the health problems that they face.oNew health facilities would not be set up on a rigid, population based norm, but would aim to be accessible to populations in remote locations and within a defined time period.

National Rural Health Mission
    •    The National Rural Health Mission (NRHM) was launched in 2005, to provide accessible, affordable and quality health care to the rural population, especially the vulnerable groups.
    •    From 2013,NRHM is being implemented as a sub mission under the National Health Mission.
    •    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.

National Urban Health Mission
The National Urban Health Mission (NUHM) as a sub-mission of National Health Mission (NHM) was approved by the Cabinet in 2013.NUHM envisages to meet health care needs of the urban population with the focus on urban poor, by making available to them essential primary health care services and reducing their out of pocket expenses for treatment. NUHM would endeavour to achieve its goal through:
- Need based city specific urban health care system to meet the diverse health care needs of the urban poor and other vulnerable sections.
- Institutional mechanism and management systems to meet the health-related challenges of a rapidly growingurban population.
- Partnership with community and local bodies for a more proactive involvement in planning, implementation, and monitoring of health activities.
- Availability of resources for providing essential primary health care to urban poor.
- Partnerships with NGOs, for profit and not for profit health service providers and other stakeholders.NUHM would cover all State capitals, district headquarters and cities/towns with a population of more than 50000. It would primarily focus on slum dwellers and other marginalized groups like rickshaw pullers, street vendors, railway and bus station coolies, homeless people, street children, construction site workers.

Rashtriya Swasthya Bima Yojana (RSBY)
- The ‘Rashtriya Swasthya Bima Yojana’ (RSBY), introduced in 2007, was designed to meet the health insurance needs of the poor.
- RSBY provides for ‘cash-less’, smart card based health insurance cover of `30,000 per annum to each enrolled family, comprising up to five individuals.
- The beneficiary family pays only `30per annum as registration/renewal fee.
- The scheme covers hospitalisation expenses (Out-patient expenses are not covered), including maternity benefit, and pre-existing diseases.
- A transportation cost of `100 per visit is also paid.
- RSBY was originally limited to Below Poverty Line (BPL) families but was later extended to building and other construction workers, MGNREGA beneficiaries, street vendors, beedi workers, and domestic workers.
- Key feature of RSBY is that it provides for private health service providers to be included in the system, if they meet certain standards and agree to provide cash-less treatment which is reimbursed by the insurance company.
- The shortcomings of RSBY noted so far include high transaction costs due to insurance intermediaries, inability to control provider induced demand, and lack of coverage for primary health and out-patient care.
- The RSBY also does not take into account state specific variations in disease profiles and health needs.

AYUSH
AYUSH is the non-allopathic medical systems in Indiacomprising of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy.
Benefits of AYUSH system are:
- It addressesgaps in health services.
- It provides low cost services in far-flung areas.
- AYUSH can provide best care to elderly.
- Problem of tobacco and drug abuse can be tackled by AYUSHespeciallythrough Yoga.
- Useful in lifestyle diseases like diabetes and hypertension.
- Large part of the population prefers AYUSH as it is perceived to have lowerside effects, costs andconsiderationsof it being more natural.

Challengesin the present system are:
- Quality standards of Medicines–Scientificvalidation of AYUSH has not progressed in spite of dedicated expenditure in past.
- Lack of human resources –Practitioners are moving away from traditional system for better opportunities
- The existing infrastructure remains under-utilized.

National Health Policy, 2017: Salient Features:
• The Union Cabinet has approved The National Health Policy, 2017 replacing the previous  one, which was framed 15 years ago in 2002.
•The aim of the policy: It aims at providing healthcare in an “assured manner” to all and thus will address current and emerging challenges arising from the ever changing socio-economic,  technological and epidemiological scenarios.
•Highlights:
•It int ends on gradually increasing public health expenditure to 2.5% of the GDP.
•The government aims in shifting focus from “sick-care” to “wellness”, by promoting prevention and well-being.
•It aims to strengthen health systems by ensuring everyone has access to quality services and technology despite financial barriers. The policy proposes increasing access, improving quality and reducing costs.
•It proposes free drugs, free diagnostics and free emergency and essential healthcare services in public hospitals.
•It focuses on primary health care: The policy advocates allocating two-thirds (or more) of resources to primary care. It proposes two beds per 1,000 of the population to enable access within the golden hour (the first 60 minutes after a traumatic injury).
•It promotes ‘Make in India’ initiative by using drugs and devices manufactured in the country.
•It aims to reduce morbidity and preventable mortality of non-communicable diseases (NCDs) by advocating prescreening.
•It highlights AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy) as a tool for effective prevention and therapy that is safe and cost-effective. It proposes  introducing Yoga in more schools and offices to promote good health.
•Quantitative targets listed in the policy:
•Increase Life Expectancy at birth from 67.5 to 70 by 2025.
•Reduce Under Five Mortality to 23 by 2025.
•Reduce infant mortality rate to 28 by 2019.
•To reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by 25% by 2025.
•Achieve the global 2020 HIV target (also termed 90:90:90; 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).
•Reduction of TFR to 2.1 at national and sub-national level by 2025.
•Reduce neo-natal mortality to 16 and still birth rate to “single digit” by 2025.
•Achieve and maintain elimination status of Leprosy by 2018, Kala-Azar by 2017 and Lymphatic Filariasis in endemic pockets by 2017.
•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.
•To reduce the prevalence of blindness to 0.25/ 1000 by 2025 and disease burden by one third from current levels.
•It seeks to establish regular tracking of disability adjusted life years (DALY) Index as a measure of burden of disease and its major categories trends by 2022.

National Nutrition Strategy:
•To bring nutrition to the centre-stage of the national development agenda, government think tank NITI Aayog has drafted a National Nutrition Strategy.
•The strategy lays down a roadmap for effective action, among both implementers and practitioners, in achieving nutrition objectives.
•The nutrition strategy envisages a framework wherein the four proximate determinants of nutrition–uptake of health services, food, drinking water and sanitation and income and livelihoods–work together to accelerate decline of under nutrition in India.
•The nutrition strategy framework envisages a ‘Kuposhan Mukt Bharat’—linked to Swachh Bharat and Swasth Bharat. The aim is to ensure that states create customized state/district action plans to address local needs and challenges.
•The strategy enables states to make strategic choices, through decentralized planning and local innovation, with accountability for nutrition outcomes.

Key features of the strategy include:
•The Strategy aims to reduce all forms of malnutrition by 2030, with a focus on the most vulnerable and critical age groups. The Strategy also aims to assist in achieving the targets  identified as part of the Sustainable Development Goals related to nutrition and health.
•The Strategy aims to launch a National Nutrition Mission,similar to the National Health Mission. This is to enable integration of nutrition-related interventions cutting across sectors  like women and child development, health, food and public distribution, sanitation, drinking water, and ruraldevelopment.
•A decentralized approach will be promoted with greater flexibility and decision making at the state, district and local levels. Further, the Strategy aims to strengthen the ownership of Panchayati Raj institutions and urban local bodies over nutrition initiatives.This is to enable decentralised planning and local innovation along with accountability for nutrition outcomes.
•The Strategy proposes to launch interventions with a focus on improving healthcare and nutrition among children. These interventions will include:
(i) promotion of breastfeeding for the first six months after birth,
(ii) universal access to infant and young child care (including ICDS and crèches),
(iii) enhanced care, referrals and management of severely undernourished and sick children,
(iv) bi-annual vitamin A supplements for children in the age group of 9 months to 5 years, and
(v) micro-nutrient supplements and bi-annual de-worming for children.
•Measures to improve maternal care and nutrition include: (i) supplementary nutritional support during pregnancy and lactation, (ii) health and nutrition counselling, (iii) adequate consumption of iodised salt and screening of severe anaemia, and (iv) institutional childbirth, lactation management and improved post-natal care.
•Governance reforms envisaged in the Strategy include: (i) convergence of state and district implementation plans for ICDS, NHM and Swachh Bharat, (ii) focus on the most vulnerable communities in districts with the highest levels of child malnutrition, and (iii) service delivery models based on evidence of impact.

Health related targets in NITI Aayog’s three year short-term action Action Plan:
NITI Aayog has put forth three-year 'Action Agenda' from 2017-18 to 2019-20. This has replaced the five year plans of the Planning Commission.

The action plan states that:
•India faces a double burden of disease, wherein communicable diseases still account for a significant proportion of disease burden.
•In 2012, out of the total number of Disability-Adjusted Life Years (DALY) lost, 33% were attributable to these diseases. Non-communicable diseases accounted for 55% of DALYs with injuries accounting for the remaining 12% in the same year.
Disability-Adjusted life year:
The disability-adjusted life year (DALY) is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death. It was  developed in the 1990s as a way of comparing the overall health and life expectancy of different countries.

The action plan mainly lays down the following goals:
•Over the course of the next three years, the healthcare system in the country must prioritize public health and shift from being curative to preventive.
•Public Health is the science of protecting and improving the health of families and communities through promotion of healthy lifestyles, research for disease and injury prevention and detection and control of infectious diseases.
•Overall, public health is concerned with protecting the health of entire populations.
•Emphasis should be given on the stewardship role of the government. That is, setting and  enforcing rules/incentives to guide the behavior of the health system.
•Further, a data-driven and more decentralized approach to designing health system should be adopted.
•Government expenditure on public health should be increased significantly to cover the screenings for the entire population, active case detection and disease surveillance including from the private sector.
•An important role for preventive health is in targeting risk factors including smoking, high blood pressure and sanitation. Early screening must be promoted so that diseases can be prevented or treated at an early stage. This can help to avert costly hospital-based treatment.
•The practice of Yoga should be made a regular activity in schools through certified instructors. During the three-year period, a minimum of 10,000 Yoga instructors should be  certified.

The following box lists down specific Health Goals to be achieved by the Year 2020: