Context: India’s public health system is facing a crisis marked by inadequate policy focus on primary care, limited access to healthcare services for the underprivileged, and a growing emphasis on privatized healthcare models. Over the past decade, public health policies have not adequately addressed the real needs of the population, resulting in poor outcomes in both preventive and curative care. This editorial discusses the policy shortcomings that have weakened India’s public health sector, with an emphasis on primary care and public health infrastructure.
Relevance: General Studies Paper II and III, Governance and Healthcare
Mains Question: Analyze the causes of the weakened public health sector in India. What policy reforms are required to address the health needs of vulnerable populations while ensuring comprehensive access to healthcare services?
- Current Crisis in Public Health Policies:
- India’s public health system is plagued by policy paralysis, with a growing disconnect between the needs of the population and the policies implemented by the government. Recent public health initiatives have not adequately focused on the “felt needs” of the population, including diseases of poverty like tuberculosis, malnutrition, and waterborne diseases.
- Public health policies have become increasingly dependent on expert-driven decisions, leaving out the real experiences and needs of people, particularly the poor and vulnerable. These needs include better sanitation, access to clean water, and prevention of common infectious diseases.
- Primary Health Care: The Forgotten Sector:
- India’s focus on primary healthcare has declined in recent years. The National Health Mission (NHM), launched in 2005, and the National Rural Health Mission (NRHM) in 2013 initially aimed to strengthen primary care services across rural India. These programs emphasized the need for community-based healthcare and the role of Primary Health Centers (PHCs) and Community Health Centers (CHCs).
- However, subsequent government policies have focused on secondary and tertiary care services, leading to a reduction in the importance of primary health services. Data from NHM shows that India has about 1,53,655 sub-centers, 25,308 PHCs, and 5,396 CHCs, which are crucial for delivering primary care, especially in rural areas. However, the system’s capacity has remained underutilized.
- Commercialization of Health Services:
- India’s health sector has gradually shifted towards privatization, with the government promoting insurance-based models, such as the Ayushman Bharat scheme. However, such models often benefit the secondary and tertiary healthcare sectors, while leaving primary care underfunded.
- The Pradhan Mantri Jan Arogya Yojana (PMJAY) under Ayushman Bharat targets the poorest of the poor, but its coverage is limited. With only 2.5 crore people enrolled out of the targeted 50 crores, the scheme has not reached its full potential. Moreover, it primarily covers hospitalization, leaving preventive healthcare services underfunded.
- Public Health Infrastructure and Challenges:
- The last significant health policy reforms were aimed at transforming Sub-Centers (SCs) and PHCs into Health and Wellness Centers (HWCs) under the NHM 2015 initiative. The goal was to establish 1,50,000 HWCs, with only 17,000 established by 2019. Despite these efforts, the rural health infrastructure remains weak, and gaps in staffing, resources, and accessibility persist.
- Health outcomes in India remain poor compared to global standards. Maternal mortality and infant mortality rates continue to be high, especially in rural areas where access to healthcare is limited. India’s maternal mortality rate (MMR) was 103 per 100,000 live births in 2017-19, while the infant mortality rate (IMR) stood at 28 per 1,000 live births in 2020, highlighting the need for significant improvements in healthcare access and quality.
- Issues of Inequality in Healthcare Access:
- India’s public health sector faces deep inequalities, particularly in rural areas where poor infrastructure, lack of trained healthcare professionals, and inadequate facilities hinder access to quality healthcare. Rural areas are home to 70% of India’s population, yet receive less than 25% of the country’s health expenditure.
- Data from the National Sample Survey (NSS) indicates that out-of-pocket healthcare expenditures continue to be a significant burden for families, with healthcare expenses pushing nearly 7% of the population into poverty every year.
- The Role of Private Healthcare:
- The increasing role of private healthcare has led to an imbalance in the health system. While private hospitals cater to the middle class and wealthy, public healthcare institutions remain underfunded and overburdened. The health insurance schemes launched by the government cover mainly curative treatments, making preventive care and health promotion activities a “luxury” for the poor.
- The private sector accounts for nearly 70% of healthcare services in India, but its focus on profit-driven models leaves the majority of the population dependent on an ailing public health system.
Conclusion: India’s public health sector is in dire need of reform, with a focus on strengthening primary healthcare, reducing inequalities, and addressing the felt needs of vulnerable populations. Policy reforms should prioritize preventive healthcare, upgrade public health infrastructure, and ensure that both rural and urban areas receive adequate healthcare services. The National Health Mission and Ayushman Bharat, while well-intentioned, need to focus more on preventive services and widen their scope to cover essential primary care needs. A stronger public health system, with better resource allocation and equitable access, is essential for improving health outcomes and reducing the burden of disease in India.
