Reconnect Public Health With People’s Needs in India

Syllabus: GS2/Issues Related To Health

Context

• The efficacy of Ayushman Bharat Health and Wellness Centres (HWCs) and Ayushman Bharat Digital Mission (ABDM) has once again raised questions about the success of India’s public health policies in Universal Health Coverage (UHC).

About Public Health in India

• The public health system in India aims to provide universal healthcare access, focusing on preventive, promotive, and curative services.
• It operates through national health programs, state-level initiatives, and local healthcare delivery mechanisms.
• It is crucial in India due to the double burden of communicable and non-communicable diseases, as well as significant health disparities.
• Public health policies affect the health status by providing them with various preventive, promotive, curative and rehabilitative services.
  • It is absolutely essential for a nation such as India, which wants to take advantage of its demographic dividend.

Linkage to Universal Health Coverage (UHC)

• UHC makes sure that every individual gets quality healthcare without undergoing any kind of financial stress.
  • The idea of UHC is contained in SDG 3 (Good Health and Well-being).
• India’s dedication to UHC can be understood by:
  • National Health Policy (NHP), 2017, wherein the Indian Government commits itself to increasing public health expenditures up to 2.5 percent of GDP.
  • Ayushman Bharat Programme launched in 2018 as a major UHC programme.
  • Development of public health services through Health and Wellness Centres (HWCs).
• However, access to healthcare services is limited due to High Out-of-Pocket Expenditure (OOPE); inadequate public health infrastructure; and substandard quality of health care services.
• According to National Health Accounts (MoHFW), OOPE in India has declined from approximately 62.6 percent of total health expenditure (2014-15) to around 43.89 percent (2023).

Major Public Health Policies in India

• National Health Policy (NHP), 2017: Universal health coverage is among its goals. It emphasizes the significance of preventive/promotive health care services and it highlights the need to strengthen Primary Healthcare Organizations.
• Ayushman Bharat Programme (2018): It consists of two important pillars, which include:
  • Health and Wellness Centres (HWCs): HWCs have been developed to convert SCs, PHCs and CHCs into comprehensive Primary Health Centers. These centers will offer the following services:
    • Maternal and child health services;
    • Screening for Non-Communicable Diseases (NCD);
    • Mental health services;
    • Palliative and Geriatric care.
  • Pradhan Mantri Jan Arogya Yojana (PM-JAY): This scheme has been introduced by the Indian Government which will provide health insurance cover of ₹5 lakh per family per year for secondary/tertiary health care needs. This scheme is aimed at economically weaker sections of India.
• Ayushman Bharat Digital Mission (ABDM): In 2021, the Indian government launched ABDM with the aim of establishing an integrated digital health ecosystem in the following ways:
  • Ayushman Bharat Health Account (ABHA) ID;
  • Registry of health care facilities and health care professionals;
  • Electronic Health Records.
• National Digital Health Ecosystem (NDHE): It aims to facilitate the interoperability of digital health records along with portability and continuity of care.

Concerns and Issues Associated with Public Health Policies in India

• Shifting focus from Population Health to Individual Wellness: Implementation of ‘Health and Wellness’ concept has caused the focus to shift from population health strategies to individual wellness.
  • Issues include ambiguity in terms of the role of institutions; and the difficulty of measuring well-being because of its subjective nature.
  • Well-being, unlike indicators such as immunization coverage or maternal mortality, does not have any universally accepted measure at population level.
• Individualization of Health: The wellness framework increasingly makes individuals responsible for their health behavior.
  • The risk of this framework is that it tends to overlook poverty; malnutrition; poor sanitation; poor housing facilities; and the social determinants of health.
• Lack of Infrastructure for Primary Healthcare Facilities: Although some initiatives have been announced, SCs, PHCs, and CHCs still face:
  • Lack of doctors and specialists;
  • Lack of adequate diagnostic facilities;
  • Poor infrastructure;
  • Vacancies among health care providers;
  • Rural and tribal areas are particularly poorly served.
• Digitalization without Adequate Health Service Delivery: ABDM concentrates on generation of digital health information.
  • However, only health records will not ensure that care can be obtained, and digital data will not replace hospitals, medicines, health care workers, and diagnostic facilities.
  • Inadequate infrastructure decreases the usefulness of digital platforms.
• Continued Out-of-Pocket Expenditure: Private sector health care continues to be unaffordable for many families.
  • According to different health surveys, medicines and diagnostics continue to account for a large proportion of health expenditures of households; and catastrophic health expenditure drives many families into poverty annually.
• Policy-Making Is Not Necessarily Based on Evidence: Some health initiatives concentrate on innovation in administration and technology without solving people’s basic health care problems, including curative care. It can weaken efforts towards UHC.

Way Forward: Strengthening Public Health Policies

• Enhance Three-tier Public Health Infrastructure: Ensure adequate infrastructure, diagnostics and human resource development in SCs, PHCs and CHCs; and effective linkage.
• Increase Investment in Public Health: Hasten efforts to meet the target of 2.5% of GDP as per NHP; and make primary healthcare investments priority.
• Adopt Evidence-based Approach: Policymaking needs to be based on health indicators like IMR, MMR, disease burden, and health services provision.
• Strike Balance between Digital Health and Provision of Healthcare Services: The implementation of ABDM needs to enhance, not undermine, the healthcare provisions; and digital health needs to be linked with strong institutional arrangements.
• Focus on Social Determinants of Health: Ensure convergence with initiatives related to nutrition, sanitation, drinking water and social protection.
• Engage Communities: Local government bodies, ASHA and other community organizations need to be part of the health planning and monitoring process.

Conclusion

• The Indian journey towards UHC is beyond mere personal health and digitalization.
• The public health policies need to focus on access to quality and affordable healthcare services and social determinants of health.

Source: TH