Why it is time to audit India’s National Health Policy 2017

India's National Health Policy (NHP) 2017 marked a significant step in the nation's journey towards achieving universal health coverage and improving overall health outcomes. To truly grasp its importance, we must first understand the historical context and the pressing health challenges that necessitated such a comprehensive policy. **Background Context and Historical Trajectory:** India's public health system has evolved significantly since independence. The Bhore Committee Report of 1946 laid the foundational principles for a comprehensive, integrated healthcare system focused on preventive and promotive services. Subsequent policies, like the National Health Policy 1983 and 2002, aimed to address the prevailing health issues, but often struggled with implementation, inadequate financing, and fragmented service delivery. By the early 21st century, India faced a dual burden of disease: persistent communicable diseases (like TB, malaria) and a rapidly rising incidence of non-communicable diseases (NCDs) such as diabetes, hypertension, and cardiovascular diseases. High out-of-pocket expenditure (OOPE) on health was pushing millions into poverty, and the public health infrastructure remained weak, particularly in rural areas. The NHP 2017 emerged from this backdrop, seeking to build upon previous efforts while addressing new challenges and aligning with global commitments like the Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being). **What Happened: NHP 2017's Vision and 2026 Assessment:** The National Health Policy 2017 was formulated with an ambitious vision: to achieve the highest possible level of health and well-being for all through a comprehensive healthcare system, preventive and promotive health orientation, and universal access to quality healthcare services without financial hardship. Key measurable milestones included increasing public health expenditure to 2.5% of GDP by 2025 (from around 1.15% at the time), achieving Universal Health Coverage (UHC), strengthening primary healthcare, reducing Infant Mortality Rate (IMR) to 28 by 2019 and Maternal Mortality Ratio (MMR) to 100 by 2020, and addressing the burden of NCDs. The policy also emphasized digital health, private sector engagement, and a 'health in all policies' approach. The article's premise, assessing the policy's status by 2026, suggests a mixed bag of progress. While India likely advanced on several fronts, such as improving some health indicators and expanding access to certain services (e.g., through initiatives like Ayushman Bharat), it also missed other crucial targets. Crucially, it encountered unforeseen risks, with the most prominent example being the COVID-19 pandemic, which severely tested and exposed vulnerabilities in the health system that were not fully imagined in 2017. This necessitated a re-evaluation of strategies and resource allocation. **Key Stakeholders Involved:** Implementing and auditing a national health policy involves a multitude of stakeholders. The **Ministry of Health & Family Welfare** is the primary architect and implementer at the central level, working in tandem with the **NITI Aayog** for policy formulation, monitoring, and evaluation. **State Health Departments** are critical, as health is a Concurrent List subject, making state-level implementation paramount. **Private healthcare providers** play a significant role, given their substantial presence in India's health ecosystem. **Pharmaceutical companies** are essential for drug availability. **International organizations** like the WHO and World Bank often provide technical assistance and funding. **Civil society organizations (CSOs)** and NGOs contribute to advocacy, service delivery, and community engagement. Finally, the **general public** as beneficiaries and contributors to health outcomes are the ultimate stakeholders. **Why This Matters for India:** An effective national health policy is fundamental to India's holistic development. Socially, it directly impacts the quality of life, reduces disease burden, and promotes equity by ensuring access to healthcare for all, especially vulnerable populations. Economically, a healthy workforce is a productive workforce, contributing to economic growth. High OOPE, which NHP 2017 aimed to reduce, is a major cause of poverty; thus, effective health financing can alleviate financial distress. Politically and for governance, the success of health policies reflects the government's commitment to its citizens' well-being and its ability to achieve national and international development goals. The audit of NHP 2017 is crucial for course correction, ensuring that public resources are effectively utilized and that the health system is resilient and responsive to evolving challenges. **Constitutional Provisions and Related Policies:** Health is not explicitly a Fundamental Right, but the Directive Principles of State Policy (DPSP) in Part IV of the Indian Constitution guide the state's responsibilities. **Article 47** explicitly states that the