Year : 2017 | Volume
: 11 | Issue : 2 | Page : 37--39
National Health Policy 2017: Perspective of physiotherapy profession
A. G. K. Sinha
Professor, Department of Physiotherapy, Punjabi University, Patiala, Punjab, India
Prof. A. G. K. Sinha
Professor, Department of Physiotherapy, Punjabi University, Patiala, Punjab
|How to cite this article:|
Sinha A. National Health Policy 2017: Perspective of physiotherapy profession.Physiother - J Indian Assoc Physiother 2017;11:37-39
|How to cite this URL:|
Sinha A. National Health Policy 2017: Perspective of physiotherapy profession. Physiother - J Indian Assoc Physiother [serial online] 2017 [cited 2022 May 21 ];11:37-39
Available from: https://www.pjiap.org/text.asp?2017/11/2/37/223702
Management textbooks define policy as general statements of understandings which provide guidance in decision-making. Policies give a practical shape to the objectives by elaborating and directing the way in which predetermined goals are to be achieved. National policies outline the goals, objectives, and course of action government would take in coming years. The National Health Policy (NHP) plays an important role in restructuring the health service delivery system and redefining the role of different health-care professions. Therefore, it is important to examine NHP 2017 from the viewpoint of physiotherapy profession.
NHP 2017 launched after a gap of 15 years is the third NHP of independent India. The first NHP was launched in 1983 whereas the second was launched in 2002. The mention of physiotherapy is not found in the first NHP, whereas in the second NHP, it is mentioned only once. In the current policy which recognizes physiotherapy as superspecialized paramedical skill, the word physiotherapists is mentioned twice.
The attainment of the highest possible level of health and well-being for all at all ages, through a preventive and promotive health-care orientation in all developmental policies, and universal access to good quality health-care services without anyone having to face financial hardship as a consequence is the goal of NHP 2017. It lays down ten policy principles that include professionalism, integrity and ethics, equity, affordability, universality, patient centered and quality of care, accountability, inclusive partnerships, pluralism, decentralization, and dynamism and adaptiveness. Ensuring adequate investment, preventive and promotive health, organization of public health-care delivery, primary care services and continuity of care, secondary care services, reorienting public hospitals, closing infrastructure and human resource/skill gaps and urban health care are identified as the ten areas of policy thrust.
The broad objective of NHP 2017 is to improve health status through concerted policy action in all sectors and expand preventive, promotive, curative, palliative, and rehabilitative services provided through the public health sector with focus on quality.
The specific objectives are progressively achieve universal health coverage, reinforcing trust in public health-care system, and align the growth of private health-care sector with public health goals. Outlining specific quantitative goals and objectives under three broad components, namely, health status and program impact, health system performance, and health system strengthening can be described as the unique feature of this policy. Some of the quantitative objectives it sets to achieve in time bound manner include increased life expectancy at birth from 67.5 to 70 by 2025, establish regular tracking of disability-adjusted life year index as a measure of burden of disease and its trends by major categories by 2022, increase utilization of public health facilities by 50% from current levels by 2025, ensure availability of paramedics and doctors as per Indian Public Health Standards (IPHS) norm in high priority districts by 2020, strengthen the health surveillance system, and establish registries for diseases of public health importance by 2020 etc.
One of the major points in the policy that would have direct impact on the redefining the place of physiotherapy within current health-care delivery system is the emphasis on noncommunicable diseases (NCDs). Considering that a very large proportion of the disease burden of the country is due to NCD, the emphasis is well placed. The policy recognizes the need to halt and reverse the growing incidence of chronic diseases. The policy recommends to set up a national institute of chronic diseases including trauma, to generate evidence for adopting cost-effective approaches, and to showcase best practices. Further, this policy would support an integrated approach which involves screening for the most prevalent NCDs and integration with secondary prevention. This would make a significant impact on reduction of morbidity and preventable mortality.
Physiotherapy has a larger role in prevention and promotion of health in those afflicted with NCD. Timely exercise prescription has a potential to reduce the incidence of costly intervention such as joint replacement. Patients of chronic respiratory disease, cardiac ailment, and diabetes can all benefit from physiotherapy-guided lifestyle modification. Timely physiotherapy is known to reduce the complication and improve the quality of life. However, in India so far, a large population afflicted with various forms of arthritis, musculoskeletal trauma, chronic neurological ailments such parkinsonism, multiple sclerosis, and poststroke survival has no access to physiotherapy services. In this backdrop acknowledgment of the fact, in NHP2017 that there exists a huge potential for effective prevention and therapy, which is safe and cost-effective, provides hope for expansion of physiotherapy services. Further, the growing need for palliative and rehabilitative care for all geriatric illnesses is recognized, and the continuity of care across all levels has been advocated. Physiotherapy plays an indispensable role in this aspect. It is important that this aspect of physiotherapy is highlighted through focused research to gain the attention of policy-makers.
In the area of preventive and promotive health, NHP 2017 identifies coordinated action on seven priority areas for improving the environment for health out of which at least three areas, namely, balanced, healthy diets and regular exercises, reduced stress, and improved safety in the workplace, and Yatri Suraksha can benefit from the involvement of physiotherapists.
The policy recognizes catastrophic expenditure due to health-care costs as one of the major contributors to poverty. It considers household health expenditure exceeding 10% of its total monthly consumption expenditure as unacceptable. In the last decade, health-care system has witnessed an extraordinary expansion of private health-care system leading to establishment of state of the art hospitals across the county. This, on the one hand, increased the availability of quality advance health care, but on the other hand, it also contributed to excessive cost of health care which is often beyond the reach of common man. This situation defeats the objective of health care to all.
The health care is the issue related to human rights, and being welfare state, it should be the responsibility of the state to ensure that quality health care reaches its every citizen at the cost that an ordinary citizen can afford. NHP 2017 adopts two-pronged approach to provide affordable health care. The objective of NHP 2017 is to expand preventive, promotive, curative, palliative, and rehabilitative services provided through the public health sector. At the same time, it also provides for strategic purchasing of services in health-care deficit areas, especially in reference to secondary and tertiary care services. In simple words, it means that government will try to expand the public health system by opening of the new hospitals/creating new facilities in the existing hospitals; it would also utilize the services available in the private sector to the fill critical gaps in public health facilities by providing them subsides in various forms. NPH assumes that this step would create a demand for private health-care sector.
This step would certainly increase the availability of health services as due to high cost, many patients are not able to utilize the quality services available in the private hospitals; however, policy is silent on the question as to how these strategic purchase would be achieved and which health-care service would qualify for purchase. Would it be available to all the patients irrespective of financial status or the strategic purchase would be made for only for the patient of certain income groups. Further, even though the policy seeks to achieve a significant reduction in out-of-pocket expenditure due to health-care costs, it does not specify any mechanism for this. In context of utilization of physiotherapy services, it is well known that after major trauma and neurological disabilities such as stroke, multiple sclerosis, and stroke cerebral palsy, physiotherapy services are required for quite a long period, and often due to financial constraints, it is not possible for family to continue the care. It shall remain to be seen whether government would include physiotherapy services also under strategic purchase scheme or it would be left out. If the physiotherapy services are included, then it would open new avenue for entrepreneurship, and like the USA, India may also see the growth of privately owned companies available for outsourcing the physiotherapy services in far-flung areas.
With regard to job creation, this policy may benefit physiotherapists from two routes. One is by strengthen the public sector health-care service and second is through strategic purchasing of the services from private players and incentivizing the private sector. One of the quantitative objectives of NHP is to ensure availability of paramedics and doctors as per IPHS norm in high priority districts by 2020. IPHS are a set of uniform standards envisaged to improve the quality of health-care delivery in the country. These norms provide for essential inclusion of physiotherapists at district hospitals. It recommends one physiotherapist for 100–200-bedded hospitals, two physiotherapists for 300–400 bedded hospitals, and three physiotherapists for 500-bedded hospitals. This should create some jobs for physiotherapist in government sector. However, policy offers no definition of high priority districts, and it remains to be seen as to how many districts out of 707 districts of the country would be covered under this scheme.
IPHS norms do not include physiotherapists in PHC and CHC. However, the goal of providing comprehensive primary health-care package which includes geriatric health care, palliative care, and rehabilitative care services as envisaged in the policy cannot be satisfactorily fulfilled without inclusion of physiotherapy services. In order to cater to increasing human resource requirement at this level, the NHP 2017 recommends development of a cadre of mid-level care providers through courses such as a B. Sc. in community health and/or through competency-based bridge courses and short courses for graduates from different clinical and paramedical backgrounds such as AYUSH doctors, B. Sc. nurses, pharmacists, GNMs and equips them with skills to provide services at the subcenter and other peripheral levels. It is essential to ensure that physiotherapy graduates are not left out of this scheme. It is important to point out that since 2012 physiotherapists in UK are recognised as independent prescriber and are allowed to prescribe pain relief and other medicines without a doctor authorizing their decision. It is important to note that many of the registered physiotherapist in UK have received their physiotherapy education from India.
The policy acknowledges the demographic and diseases transition happening in the country and recognizes the role played by physiotherapists and allied health health professionals in tackling this situation. It also underlines the need to address the short fall of these professionals. Planned expansion of allied technical skills is a key policy direction. It intends to develop training courses and curriculum for superspecialty paramedical care (perfusionists, physiotherapists, occupational therapists, radiological technicians, audiologists, MRI technicians, etc.). The training courses and curriculum of physiotherapy are already developed, and about 250 universities are now offering bachelor, master, and doctoral level education in physiotherapy. Therefore, it is important not to waste time in designing new curriculum and courses with dubious credentials rather the need of the hour is to integrate the available human resources in the mainstream health-care system and strength the service delivery system.
The urgent need of regulatory body for physiotherapy profession has been depicted in several government documents., As a matter of fact the recommendation for the establishment of statutory professional councils for paramedical disciplines to register practitioners, maintain standards of training, and monitor performance was also made in NHP 2002. However, regulatory council of physiotherapy has so far remained a distant dream. NHP 2017 does not talk about independent physiotherapy council rather it supports setting up of National Allied Professional Council to regulate streamline and ensure quality standards of all allied health professionals including physiotherapists. The nature of job, qualification, and training curriculum of physiotherapists are quite different from several of professional that government considers as allied health profession. Therefore, it is important to segregate physiotherapy if not by providing independent council then by creating a separate board for the profession within the omnibus council.
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Conflicts of interest
There are no conflicts of interest.
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