Q) Pandemics such as Covid-19 starkly remind us that public health systems are core social institutions in any society. In this context, discuss the need to revamp the public health system in India.
Why this Question?
Issue of current importance.
Key demand of the Question
Examine the need to revamp the health sector in India.
Directive
Discuss – This is an all-encompassing directive – you have to debate on paper by going through the details of the issues concerned by examining each one of them. You have to give reasons for both for and against arguments.
Deliberate – Weigh up to what extent something is true. Persuade the reader of your argument by citing relevant research but also remember to point out any flaws and counter- arguments as well. Conclude by stating clearly how far you agree with the original proposition.
Introduction
Start with a context of the question.
Body
In the first part, discuss the prevalent issues in India’s health sector.
In the next part, suggest the reforms that are needed to revamp the system.
Conclusion
Conclude with the importance of an efficient public health system in a developing country like India.
Model Answer
The determinants of good health are: access to various types of health services, and an individual’s lifestyle choices, personal, family and social relationships. India’s health care system consists of a mix of public and private sector providers of health services. Networks of health care facilities at the primary, secondary and tertiary level, run mainly by State Governments, provide free or very low-cost medical services. There is also an extensive private health care sector, covering the entire spectrum from individual doctors and their clinics, to general hospitals and super speciality hospitals.
Challenges with Public Health Systems in India
- Lack of Primary Healthcare Services: The existing public primary health care model in the country is limited in scope. Even where there is a well-functioning public primary health centre, only services related to pregnancy care, limited childcare and certain services related to national health programmes are provided. This represents only 15% of all morbidities for which people seek care.
- Supply-Side Deficiencies: Poor health management skills and lack of appropriate training and supportive supervision for health workers prevent delivery of the desired quality of health services.
- Inadequate Funding: Expenditure on public health funding has been consistently low in India (approximately 1.3% of GDP). As per OECD, India's total out-of-pocket expenditure is around 2.3 % of GDP.
- Overlapping Jurisdiction: There is no single authority responsible for public health that is legally empowered to issue guidelines and enforce compliance of the health standards.
- Sub-optimal Public Health System: Due to this, it is challenging to tackle Non-communicable Diseases, which is all about prevention and early detection. It diminishes preparedness and effective management for new and emerging threats such as pandemic like Covid-19.
- Inadequate availability of healthcare services including both public and private: There are 45 doctors/lakh populations while the desirable number is 85 and 75 nurses/lakh populations while desired number is 255. Also, there are geographical variations in availability of health services.
Steps to Be Taken
- Enabling Preventive Care: In order to promote preventive care, the Union government has announced the conversion of primary health care centres into Health and Wellness Centres (HWCs). These HWCs will act as the pillar of preventive care and ‘gateway’ for access to secondary and tertiary health services. Thus, there is a need to accelerate the establishment of a network HWCs, for this extra funding through Corporate Social Responsibility (CSR) can be mobilised.
- Bringing Behavioural Change: There is a need to ensure people eat right, sleep right, maintain good hygiene, exercise, and adopt a healthy lifestyle that necessitates concerted interventions at various levels of the system. In order to catalyse people’s participation for a healthy India, there is a need for Swasth Bharat Jan Andolan on lines of Swachh Bharat Abhiyan.
- Cooperative Federalism: Given the major role that States have to play in creating strong health systems across the country, allocations provided by the Finance Commission can become the critical catalyst for transforming the nation’s health. State governments should be incentivized to invest in creating a dedicated cadre for public health at the state, district and block levels.
- More Funding: Public funding on health should be increased to at least 2.5% of GDP as envisaged in the National Health Policy, 2017.
- Decentralisation: There is a need to make nutrition, water, sanitation and hygiene (WASH) part of the core functions of Panchayati raj institutions and municipalities.
- Creating a Nodal Health Agency: Creation of a designated and autonomous focal agency with the required capacities and linkages to perform the functions of disease surveillance, information gathering on the health impact of policies of key non-health departments, maintenance of national health statistics, enforcement of public health regulations, and dissemination of information to the public. In this pursuit, NITI Aayog’s National Health Stack is a step in the right direction, which needs to be operationalised as soon as possible.
Pandemics like Covid-19 remind us that public health systems are core social institutions in any society. The government has made several efforts to address the shortfall in the system through schemes like the National Medical Commission (NMC) Act, 2019, Pradhan Mantri Bhartiya Janaushadhi Pariyojana, Pradhan Mantri - Jan Arogya Yojana etc. However, the need of the hour is an adequate investment, for creating a health system that can withstand any kind of public health emergencies, deliver universal health coverage and meet the targets of the Sustainable Development Goals.
