Analyzing the National Health Policy, 2017: Goals and Challenges

Healthcare in India has always stood at a crossroads between public obligation and private growth. After nearly fifteen years of relying on the 2002 framework, the Union Cabinet approved a new blueprint in March 2017 that promised to reshape how the country delivers, funds, and thinks about health. The National Health Policy (NHP) 2017 did not just refresh old targets, it attempted a philosophical pivot from treating illness to promoting wellness. Yet for all its ambition, the policy continues to spark debate about whether its goals are achievable in practice or simply aspirational on paper.

Why a new policy was needed in 2017 🔗

The healthcare context in India had changed dramatically since 2002. The country was grappling with a double burden of disease, rising non-communicable illnesses like diabetes and cancer alongside persistent infectious diseases, while the private sector had grown into a dominant provider of care. Economic growth had also expanded fiscal capacity, making more resources theoretically available for public health investment. Out-of-pocket expenditure remained catastrophically high, pushing millions of families into poverty each year.

The policy was formulated through an elaborate consultation process. The draft was placed in the public domain in December 2014, and after extensive discussions with stakeholders and state governments, it received endorsement from the Central Council for Health and Family Welfare in February 2016 before Cabinet approval in March 2017.

The core vision of NHP 2017 🔗

At its heart, the policy articulates a simple but powerful vision. Its primary aim is to inform, clarify, strengthen and prioritize the role of the government in shaping health systems across investments, service organization, disease prevention, and health promotion. This represents a deliberate shift from sick-care to wellness, placing preventive and promotive healthcare at the centre of the national agenda.

The policy rests on achieving Universal Health Coverage (UHC), ensuring every citizen can access good-quality healthcare without facing financial hardship. To make this concrete, it proposes free drugs, free diagnostics, and free emergency services across all public hospitals, a commitment that directly attacks the out-of-pocket spending problem.

Key guiding principles 🔗

The policy is built around several principles that shape its approach. Equity is foundational, aiming to reduce disparities based on caste, gender, disability, and economic status. Affordability addresses the financial burden of illness, while universality demands that healthcare reach every corner of the country. Patient-centricity and quality emphasise that care should not only be available but also dignified and effective. Finally, accountability and pluralism encourage integration of AYUSH systems alongside modern medicine, recognising the value of India’s traditional health heritage.

Measurable goals and targets 🔗

What sets NHP 2017 apart from its predecessors is its commitment to specific, time-bound targets. These numerical goals serve as benchmarks against which progress can be evaluated.

Health status and life expectancy 🔗

The policy aims to increase life expectancy at birth from 67.5 to 70 years by 2025. It also envisages establishing regular tracking of the Disability Adjusted Life Years (DALY) Index as a measure of disease burden, and reducing the Total Fertility Rate to 2.1 at both national and sub-national levels by 2025.

Mortality reduction 🔗

Targets for mortality are equally ambitious. The policy commits to reducing Under-Five Mortality to 23 per 1,000 live births by 2025, Maternal Mortality Ratio to 100 per 100,000 live births by 2020, and Infant Mortality Rate to 28 by 2019. Neonatal mortality is targeted to drop to 16 and stillbirth rates to single digits by 2025.

Public health expenditure 🔗

Perhaps the most widely discussed target is the financial one. The NHP 2017 proposed to increase public health expenditure to 2.5% of GDP by 2025, a figure that remains elusive. Public health spending did rise from 0.9% of GDP in 2015-16 to 1.6% in 2021-22, meaningful progress but still well short of the policy’s target.

Strengthening primary healthcare 🔗

One of the most substantive shifts under NHP 2017 is the move towards comprehensive primary healthcare. Earlier policies focused on selective primary care, targeting specific diseases or demographic groups. The new policy expands this significantly. It envisages providing a larger package of assured comprehensive primary health care through Health and Wellness Centres, including geriatric care, palliative care, and rehabilitative services.

This vision eventually took operational form through the Ayushman Bharat programme, which transformed existing sub-centres and primary health centres into Health and Wellness Centres offering an expanded bouquet of services. The idea is that most healthcare needs can and should be addressed close to where people live, reducing pressure on hospitals and preventing small problems from becoming large ones.

The role of the private sector 🔗

Few aspects of NHP 2017 generated as much discussion as its approach to the private sector. The policy openly acknowledges that India’s healthcare delivery is dominated by private providers and seeks to engage them strategically rather than ignore this reality.

Strategic purchasing 🔗

The policy introduces the concept of strategic purchasing, where the government uses public funds to buy secondary and tertiary care services from private providers in areas where public facilities fall short. NHP 2017 calls for harnessing the private sector through strategic purchase of secondary and tertiary care to fill critical gaps in public sector provision. This approach underpins schemes like PM-JAY, which covers hospitalisation costs for vulnerable families.

Aligning private growth with public goals 🔗

The policy also aims to influence how the private healthcare industry operates, encouraging alignment with public health priorities through regulation, accreditation, and incentives. Critics, however, point out that the regulatory architecture needed to make this work, particularly around clinical establishments and professional councils, remains underdeveloped.

Digital health and innovation 🔗

NHP 2017 was ahead of its time in recognising digital tools as essential to healthcare transformation. The policy advocates extensive deployment of digital tools for improving the efficiency and outcome of the healthcare system, aiming at an integrated health information system serving all stakeholders. This vision has since materialised through initiatives like the Ayushman Bharat Digital Mission, which creates unique health IDs and digital health records for every citizen.

The policy also promotes a Make in India approach for drugs and medical devices, incentivising local manufacturing to reduce import dependence and make healthcare inputs more affordable for the Indian population.

Mainstreaming AYUSH 🔗

In a nod to India’s pluralistic medical heritage, the policy gives special emphasis to Ayurveda, Yoga, Unani, Siddha, and Homeopathy. AYUSH systems are to be integrated within the broader healthcare framework, providing patients with wider treatment options while preserving traditional knowledge. The policy particularly highlights yoga, with proposals to introduce it in schools and colleges for the mental and physical wellbeing of children.

The challenges that hold NHP 2017 back 🔗

For all its strengths, the policy has faced significant headwinds in implementation. These challenges are both structural and strategic.

The funding gap 🔗

The 2.5% of GDP target remains the most visible shortfall. Slow progress towards this benchmark makes many downstream goals difficult to achieve. Without adequate public investment, infrastructure expansion, workforce strengthening, and free drug provision all suffer.

Human resources shortage 🔗

India continues to face a severe shortage of doctors, nurses, and specialists, especially in rural areas. While the policy proposes strategies for retention and incentives, structural problems around training capacity, working conditions, and career progression in public service have proved stubborn.

Federal complexity 🔗

Health is a state subject under the Indian Constitution, which means the central government can guide and incentivise but cannot mandate. Each state is free to design its own health system and proceed at its own pace in improving health outcomes. This leads to wide variations in implementation quality and pace across states, making uniform progress difficult.

Concerns about private sector dominance 🔗

Critics argue that the policy leans too heavily on the private sector without adequate regulatory guardrails. The absence of robust mechanisms to regulate clinical establishments and professional councils raises concerns that public funds may end up subsidising private profits without corresponding accountability for quality or equity.

Silence on health as a right 🔗

Perhaps the most philosophical critique is that NHP 2017 stops short of declaring health a fundamental, justiciable right. For many public health advocates, this represents a missed opportunity to embed healthcare entitlements in a stronger legal framework.

Impact and ongoing relevance 🔗

Despite its challenges, NHP 2017 has shaped the trajectory of Indian healthcare in concrete ways. It provided the foundation for Ayushman Bharat, including both the Health and Wellness Centres and the PM-JAY insurance scheme. It pushed digital health from a peripheral concern to a central pillar. It normalised the language of universal health coverage in Indian policy discourse and set measurable benchmarks that keep the government accountable.

The COVID-19 pandemic tested the policy’s assumptions severely, exposing weaknesses in public health infrastructure and emergency preparedness that the policy had identified but not fully addressed. At the same time, the pandemic accelerated investments in health, particularly in digital infrastructure and vaccine manufacturing, that align with NHP 2017’s vision.

The road ahead 🔗

As 2025 milestones approach, the gap between promise and performance becomes sharper. Achieving the remaining targets will require not just more money but better governance, stronger state-centre coordination, and a genuine commitment to regulating the private sector in the public interest. The policy itself acknowledges that a policy is only as good as its implementation, and that wisdom remains the central challenge nearly a decade after its approval.

What do you think? Should India revise NHP 2017 to reflect post-pandemic realities, or focus entirely on implementing what is already promised? And how should the balance between public provision and strategic purchasing from private providers evolve as the country moves closer to Universal Health Coverage?

References

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC7122919/
2. https://www.pib.gov.in/newsite/Printrelease.aspx?relid=159376
3. https://nhsrcindia.org/sites/default/files/2021-07/National%20Health%20Policy%202017%20(English)%20.pdf
4. https://testbook.com/ias-preparation/national-health-policy
5. https://www.orfonline.org/expert-speak/national-health-policy-2017-addressing-fragmentation-challenge
6. https://www.pib.gov.in/PressReleaseIframePage.aspx?PRID=1513000