Context
The National Health Accounts (NHA) 2021–22 reveal marginal increases in public healthcare expenditure, even as India faces complex public health challenges like NCDs, AMR, and mental health issues. This necessitates reforms for a holistic, trusted, and accessible public health system.
Relevance : GS 2(Health ,Governance)
Key Issues in India’s Public Health System
- Emerging Challenges:
- Rise in Non-Communicable Diseases (NCDs) (60%+ of deaths globally).
- Antimicrobial Resistance (AMR), zoonotic outbreaks, and mental health concerns.
- Urbanisation, lifestyle changes, and environmental factors affecting health-seeking behaviour.
- Structural Gaps:
- Marginal rise in public health expenditure (as per NHA 2021–22).
- High reliance on private sector for healthcare due to better infrastructure and trust.
- Persistent out-of-pocket expenditure (OOPHE) though declining.
Government Initiatives
- Ayushman Bharat (2018): Three components—
- PM-JAY: ₹5 lakh health insurance for economically weaker sections.
- Ayushman Arogya Mandirs (AAMs): Focus on primary health care through 1.75 lakh+ operational Health and Wellness Centres (HWCs) offering holistic care.
- PM-ABHIM (2021): Strengthening public health infrastructure for long-term resilience.
- National Quality Assurance Standards (NQAS):
- Based on ISQua benchmarks.
- Emphasises patient rights, infection control, clinical care, and overall service quality.
- National Health Mission (NHM):
- Complements State efforts for rural and urban health care development.
Concerns Highlighted
- Trust Deficit:
- Public preference for private healthcare due to perceived better quality and consistency.
- Trust in healthcare affects health-seeking behaviour and service utilisation.
- Visibility and Experience:
- Absence of user experience metrics in current data reporting.
- Need to publicly publish findings to build community confidence.
- Basic Infrastructure ≠ High Quality:
- As per Lancet Global Health Commission, merely having physical infrastructure doesn’t guarantee quality.
- Need systems that are responsive, valued, and outcome-oriented.
Way Forward
Revise Public Health Standards:
- Shift focus from Indian Public Health Standards (2007) to NQAS-based upgrades.
Build Trust through Transparency:
- Collect and disseminate user experience and satisfaction data.
- Enable citizen feedback mechanisms for accountability.
Strengthen Primary Healthcare:
- Expand AAMs with community engagement and continuous care (preventive to palliative).
- Promote health literacy and behavioural change programs.
Integrated, Holistic Approach:
- Address social determinants of health (sanitation, nutrition, education, environment).
- Adopt a “One Health” approach for zoonotic and AMR challenges.
Increase Public Health Spending:
- Aim for the National Health Policy 2017 target of 2.5% of GDP on health.
Prelims Pointers
- Catastrophic Health Expenditure (CHO) – WHO defines it as OOPHE >40% of the capacity to pay.
- PM-JAY – World’s largest government-funded health insurance scheme.
- NQAS – Based on ISQua standards; ensures quality across 8 domains.
