{"id":38608,"date":"2025-03-06T18:34:43","date_gmt":"2025-03-06T13:04:43","guid":{"rendered":"https:\/\/www.nextias.com\/ca\/?p=38608"},"modified":"2025-03-06T19:12:14","modified_gmt":"2025-03-06T13:42:14","slug":"over-centralisation-threatens-federal-health-policy","status":"publish","type":"post","link":"https:\/\/www.nextias.com\/ca\/editorial-analysis\/06-03-2025\/over-centralisation-threatens-federal-health-policy","title":{"rendered":"Over-Centralisation Threatens Federal Health Policy"},"content":{"rendered":"\n<p><strong>Syllabus: GS2\/Issues Related To Health; Governance<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Context<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Recent trends indicate increasing centralisation in health policymaking, raising concerns about states&#8217; autonomy and the effectiveness of federal health policies.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>About the India&#8217;s Health Governance<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>It follows a <strong>quasi-federal structure<\/strong>, where both the central and state governments share responsibilities.<\/li>\n\n\n\n<li>Under the <strong>Indian Constitution<\/strong>, <strong>health is a state subject<\/strong>, meaning that <strong>states have the primary responsibility<\/strong> for healthcare delivery.\n<ul class=\"wp-block-list\">\n<li>However, the central government plays a significant role through policy frameworks, funding, and national health programs.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Key Incidents of Centralisation of Health Policy<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Striking Down Domicile-Based Reservations in Post-Graduate Medical Admission: <\/strong>Recently, the<strong> Supreme Court of India<\/strong> declared domicile-based reservations in post-graduate (PG) medical admissions unconstitutional for <strong>violating Article 14 of the Constitution.<\/strong>\n<ul class=\"wp-block-list\">\n<li>Decision is grounded in the <strong>principle of meritocracy and the constitutional right to equality.<\/strong>&nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Introduction of the National Health Mission (2005):<\/strong> The National Rural Health Mission (NRHM) was launched in 2005, later expanded as the National Health Mission (NHM) to include urban areas.\n<ul class=\"wp-block-list\">\n<li>It gave the central government a stronger role in funding and shaping health services in states.<\/li>\n\n\n\n<li>While states still had implementation responsibilities, funding allocations and guidelines were largely controlled by the Centre.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Epidemic Act &amp; Disaster Management Act:<\/strong> Laws that empower the Centre to intervene in public health emergencies.<\/li>\n\n\n\n<li><strong>Ayushman Bharat Digital Mission:<\/strong> While aiming for a unified health database, its implementation requires strong state cooperation.\n<ul class=\"wp-block-list\">\n<li>However, states have limited control over its design and data-sharing mechanisms.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Ayushman Bharat (2018): <\/strong>It provides financial support for secondary and tertiary healthcare to economically weaker sections.\n<ul class=\"wp-block-list\">\n<li>The scheme reduced the role of state-run health insurance programs, increasing the Centre\u2019s influence over healthcare funding and service delivery.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>National Medical Commission (NMC) Act (2019): <\/strong>Replaced the Medical Council of India (MCI) with the National Medical Commission (NMC).\n<ul class=\"wp-block-list\">\n<li>The Centre gained greater control over medical education and licensing, reducing state authority in regulating medical institutions.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>One Nation, One Health System Approach:<\/strong> A proposed framework to unify state and central health insurance schemes.\n<ul class=\"wp-block-list\">\n<li>States fear loss of autonomy over health financing and service delivery.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>How Over-Centralisation Weakens Federal Health Policy?<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Limited Flexibility in Addressing Local Health Needs:<\/strong> Health challenges vary widely across states due to differences in demographics, disease burden, and infrastructure. A <strong>one-size-fits-all approach<\/strong> imposed by the Centre often ignores local priorities. <strong>For example:<\/strong>\n<ul class=\"wp-block-list\">\n<li>States like Kerala require policies focusing on ageing populations, while Bihar and Uttar Pradesh need more focus on maternal and child health.<\/li>\n\n\n\n<li>Imposing uniform schemes without state-specific customisation weakens healthcare outcomes.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Reduced State Autonomy in Healthcare Governance:<\/strong> Centralisation has led to states losing decision-making power in key health schemes.\n<ul class=\"wp-block-list\">\n<li>AB-PMJAY is a clear example where states have limited flexibility in implementation, despite healthcare being a state subject.<\/li>\n\n\n\n<li>Many states preferred their own insurance models, yet they had to align with central directives.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Bureaucratic Delays and Inefficiencies:<\/strong> Excessive dependence on the Centre for funds and approvals often results in bureaucratic bottlenecks.\n<ul class=\"wp-block-list\">\n<li>States have reported delays in fund disbursements under NHM, affecting the timely execution of health programs.<\/li>\n\n\n\n<li>During the COVID-19 pandemic, <strong>vaccine distribution and oxygen supply were heavily centralised<\/strong> initially, leading to logistical challenges and delays.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Financial Dependence on the Centre:<\/strong> States heavily rely on centrally sponsored schemes (CSS) for healthcare funding.\n<ul class=\"wp-block-list\">\n<li>The <strong>15th Finance Commission\u2019s health grants<\/strong> have been criticised for imposing central conditions on how states should spend resources.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Weakening of Grassroots Public Health Systems:<\/strong> Strong state and local health systems are critical for effective service delivery.\n<ul class=\"wp-block-list\">\n<li>Over-centralisation often sidelines state health departments and local governance structures like panchayats and municipal bodies, which are better positioned to manage public health at the ground level.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Way Forward: Balancing Centralisation and State Autonomy<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Greater Fiscal Autonomy for States:<\/strong> Allow states more flexibility in utilizing central funds for healthcare based on regional priorities.<\/li>\n\n\n\n<li><strong>State-specific Policy Frameworks:<\/strong> Encourage states to develop localized strategies rather than imposing uniform national policies.<\/li>\n\n\n\n<li><strong>Strengthening State Health Capacities &amp; Local Governance:<\/strong> Investing in state health departments and local governance structures can improve service delivery.\n<ul class=\"wp-block-list\">\n<li>Empower municipalities and panchayats to manage primary healthcare services efficiently.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Cooperative Federalism in Health Planning:<\/strong> Establish mechanisms for collaborative decision-making between the Centre and states, ensuring inclusive policy formulation.<\/li>\n\n\n\n<li><strong>Investing in Capacity Building:<\/strong> Providing technical and financial support to states can help them strengthen their healthcare infrastructure and workforce.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Conclusion<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Over-centralisation in health policy poses significant risks to India&#8217;s federal structure and the effectiveness of its healthcare system.&nbsp;<\/li>\n\n\n\n<li>By fostering a balanced approach that respects state autonomy while leveraging central support, India can build a more equitable and efficient healthcare system.<\/li>\n\n\n\n<li>As the nation continues to navigate the complexities of health governance, it is crucial to prioritise cooperative federalism to ensure the well-being of all its citizens.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-background\" style=\"background-color:#fff2cc\"><tbody><tr><td><strong>Daily Mains Practice Question<\/strong><br><strong>[Q]<\/strong> Critically analyze how over-centralization impacts federal health policy in India. Discuss the potential challenges it poses to state autonomy, healthcare delivery, and resource allocation.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><a href=\"https:\/\/www.thehindu.com\/opinion\/lead\/over-centralisation-threatens-federal-health-policy\/article69295183.ece\" rel=\"nofollow noopener\" target=\"_blank\">Source: TH<\/a><\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/www.nextias.com\/ca\/wp-content\/uploads\/2025\/03\/UPSC-Editorial-Analysis-6-March-2025.pdf.pdf\">Download PDF<\/a><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Recent trends indicate increasing centralisation in health policymaking, raising concerns about states&#8217; autonomy and the effectiveness of federal health policies.<\/p>\n","protected":false},"author":15,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[22],"tags":[],"class_list":["post-38608","post","type-post","status-publish","format-standard","hentry","category-editorial-analysis"],"acf":[],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/posts\/38608","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/users\/15"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/comments?post=38608"}],"version-history":[{"count":5,"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/posts\/38608\/revisions"}],"predecessor-version":[{"id":38653,"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/posts\/38608\/revisions\/38653"}],"wp:attachment":[{"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/media?parent=38608"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/categories?post=38608"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/tags?post=38608"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}