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Healthcare in India

2022 DEC 9

Mains   > Social justice   >   Health   >   Women and Child issues

IN NEWS:

  • 15th Finance Commission chairman N K Singh suggested a slew of measures for the health sector, such as the inclusion of middle-class households in the flagship Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme, a Uniform Health Code and a dedicated financial institution for the sector.

HEALTHCARE IN INDIA:

  • The WHO defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Constitutional Provisions on health:

  • Fundamental Rights:
    • Article 21: Supreme Court of India in many cases interpreted the right to health under Article 21. Eg: Bandhua Mukti Morcha v/s Union of India.
  • Directive Principles of State Policies:
    • Article 39(e): Securing health of workers, men and women.
    • Article 41: Public assistance basically for those who are sick and disable.
    • Article 42: To protect the health of infant and mother by maternity benefit.
    • Article 47: Raising of the level of nutrition and standard of living of its people and improvement of public health

CHALLENGES FACED BY INDIA’S HEALTH SECTOR:

  • Declining public spending:
    • According to the 2022 National Health Accounts Estimates (NHAE) report, total health expenditure of the government was 3.2% of the GDP in 2018, the lowest since 2004-05.
  • More focused on curative healthcare:
    • India has traditionally focused on curative care as opposed to preventive care. However, since the COVID-19 pandemic, preventive care has increased in importance across India.
  • Shortfalls in infrastructure:
    • The healthcare ecosystem in India lacks basic infrastructure to cater to the demands of a large population. For example, India has only 8.5 beds for every 10,000 citizens.
  • Human resource deficit:
    • In India, doctor to patient (1 per 1456 patients) and nurse to patient (1.7 per 1000 patients) ratios are much lower than the WHO standards of 1/1000 in the case of doctor and 3/1000 in the case of nurses.
  • High out of pocket expenditure:
    • According to the National Health Accounts, the proportion of OOPE on health stood at 48.21 per cent in 2018-2019. This is much higher than the global average of 18.1 per cent as of 2019.
    • High expenditure on health is impoverishing 55 million Indians annually, says WHO.
  • Administrative hurdles:
    • Health is a subject under the state list. This poses issues in ensuring coordination and uniformity across the country.
    • There is no single authority responsible for public health that is legally empowered to issue guidelines and enforce compliance of the health standards.
  • Regional and gender disparities:
    • There are male-female, rural-urban, inter-state and intra-state disparities in healthcare.
    • Eg: Per capita health spending of Bihar, Uttar Pradesh and Jharkhand is about half that of Kerala and Tamil Nadu.
    • Eg: DALY rates in rural areas of India are at least twice those of urban areas and males accounted for 54.3% of all DALYs.
  • Low health insurance coverage:
    • More than 80% of the population still does not have any significant health insurance coverage.
  • Presence of quacks:
    • The IMA claims that India has about 1 million quacks performing medicine among which 600,000 offer allopathic treatments.
  • Fragmented Health Information System:
    • There is no unified database having information about patients, doctors, hospitals, services offered etc. This affects the quality of healthcare as well as the mobility of social security measures like health insurance.

IMPACT:

  • Poor health outcomes:
    • According to the Global Multidimensional Poverty Index, progress in health outcomes in the country seems to be lagging. This is evident from the Disability Adjusted Life Years (DALY) levels in India. Eg: The direct impact of COVID-19 in 2020 in India was responsible for 14,106,060 DALYs.
    • NOTE: One DALY represents the loss of the equivalent of one year of full health. DALYs for a disease or health condition are the sum of the years of life lost to due to premature mortality (YLLs) and the years lived with a disability (YLDs) due to prevalent cases of the disease or health condition in a population.
  • New and emerging challenges:
  • Poor maternal & child health:
    • India is home to one in three of the world’s malnourished children and has the second highest level of wasting among children globally. Women in India have the highest prevalence of anemia globally. This contributes to high levels of maternal and infant mortality in India.
  • Loss of demographic dividend:
    • India has one of the youngest populations and the window of demographic dividend opportunity in India is available for five decades from 2005-06 to 2055-56. However, poor health outcomes restrict the effective utilization of this potential.  
  • ‘The missing middle’:
    • It refers to the people who are not rich enough to buy private health cover nor poor enough to qualify for government schemes. Due to the disparities in healthcare, it is this group that misses out the most.
  • Exploitation by private hospitals:
    • Eg: During the pandemic, there were several instances of beds reserved for COVID-19 patients in private hospitals being sold at exorbitant rates.

GOVERNMENT EFFORTS:

  • Since public health is a State subject, the responsibility lies with the respective State/ UT Governments.
  • However, National Health Mission (NHM) – a flagship programme of the Ministry with its two Sub-Missions, National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM), supports States /UTs to strengthen their health care systems.
  • Major programmes/schemes are run by government under National Health Mission are:
  • Reproductive, Maternal, Neonatal, Child and Adolescent health
    • Janani Shishu Suraksha Karyakaram (JSSK)
    • Rashtriya Kishor Swasthya Karyakram (RKSK)
    • Rashtriya Bal Swasthya Karyakram (RBSK)
    • Universal Immunisation Programme
    • Mission Indradhanush (MI)
    • Janani Suraksha Yojana (JSY)
    • Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)
    • National Programme for Family planning
    • LaQshya programme (Labour Room Quality Improvement Initiative)
  • National Nutritional Programmes
    • National Iodine Deficiency Disorders Control Programme
    • MAA (Mothers’ Absolute Affection) Programme for Infant and Young Child Feeding
    • National Iron Plus Initiative for Anaemia Control
  • Communicable diseases
    • Integrated Disease Surveillance Programme (IDSP)
    • Revised National Tuberculosis Control Programme (RNTCP)
    • National Leprosy Eradication Programme (NLEP)
    • National Vector Borne Disease Control Programme (NVBDCP)
    • National AIDS Control Programme (NACP)
    • Pulse Polio Programme
    • National Programme on Containment of Anti-Microbial Resistance (AMR)
  • Non-communicable diseases
    • National Tobacco Control Programme (NTCP)
    • National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS)
    • National Mental Health Programme
    • National Programme for the Health Care for the Elderly (NPHCE)
  • Other efforts:
    • National Health Policy 2017:
      • Aims to attain universal health coverage and deliver quality health care services to all at affordable cost.
      • Features:
        • Gradually increase public health expenditure to 2.5% of the GDP, with two-thirds of resources to be allocated to primary care.
        • To provide a larger package of assured comprehensive primary healthcare through the ‘Health and Wellness Centers’
        • Proposes development of infrastructure, free drugs, free diagnostics and free emergency and essential healthcare services in public hospitals.
        • Attain targeted reduction in indicators such as mortality, fertility rates etc.
    • Ayushman Bharat:
      • ABY or National Health Protection Mission is a national initiative launched to achieve the vision of Universal Health Coverage.
      • Comprises of two components:
        • Pradhan Mantri Jan Arogya Yojana (PMJAY): It aims to reduce out of pocket expenses by providing health insurance coverage upto Rs.5 lakh/family/year for secondary and tertiary care hospitalization.
        • Health and Wellness Centre: Aim to provide preventive, rehabilitative and curative care for an expanded range of services encompassing reproductive and child health services, communicable diseases, non-communicable diseases, palliative care and elderly care, oral health, ENT care, and basic emergency care.
    • Financial assistance to patients living below poverty line for life threatening diseases under the schemes such as Rashtriya Arogya Nidhi (RAN), Health Minister’s Cancer Patient Fund (HMCPF) and Health Minister’s Discretionary Grant (HMDG).
    • Affordable Medicines and Reliable Implants for Treatment (AMRIT) Deendayal outlets.

WAY FORWARD:

  • Need a fundamental shift in the approach:
    • Instead of viewing it as spending, we have to see it as a high-yield investment that can considerably cut down future out-of-pocket costs and also increase output.
  • Increase health financing:
    • Government should increase public expenditure on health to at least 3% of GDP. A dedicated financial institution may also be established.
  • Coordination between the centre and states:
  • Focus on primary health care:
    • Primary health care should receive more allocation in the budget and doctor and paramedic strength should be increased.
  • Gender and Health:
    • Improve access to health services for women, girls and other vulnerable genders which goes beyond the maternal and child health.
  • Access to services that are determinants of health:
    • Ensure access to services that are determinants of health, such as safe drinking water and sanitation, wholesome nutrition, basic education, safe housing and hygienic environment are of utmost importance.
  • Dedicated cadre:
    • All India and State Level Public Health Service Cadres and a specialized State level Health Systems Management Cadre should be introduced in order to give greater attention to Public Health.
  • Adopt one health approach:
    • One Health is "the collaborative efforts of multiple disciplines working locally, nationally, and globally, to attain optimal health for people, animals and our environment".

PRACTICE QUESTION:

Q. Public health system has limitations in providing universal health coverage. Do you think that the private sector could help in bridging the gap? What other viable alternatives would you suggest? (GS 2, 2014)