Syllabus: GS2/Health/Governance
Context
- The Union Health Minister J.P. Nadda, while addressing the Rajya Sabha, highlighted the government’s policy shift towards a comprehensive and inclusive healthcare model under the National Health Policy 2017.
Background
- India’s healthcare system has evolved from a curative approach (post-disease treatment) to a preventive and holistic approach (early detection and wellness promotion).
- Key Milestones in Healthcare Development:
- 1946 – Bhore Committee recommends universal healthcare.
- 1983 – First National Health Policy (NHP) prioritizes primary health.
- 2005 – National Rural Health Mission (NRHM) launched.
- 2017 – National Health Policy (NHP) shifts focus from curative to preventive healthcare.
- 2018 – Ayushman Bharat launched, marking a paradigm shift.
- The World Health Organization (WHO) recommends that countries spend at least 5% of GDP on healthcare.
| Year | India’s Healthcare Expenditure as % of GDP |
|---|---|
| 2013-14 | 1.15% |
| 2017 | 1.35% (Post National Health Policy) |
| 2025 | 1.84% (Target: 2.5%) |
Healthcare Sector of India
- Healthcare Sector: It comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment.
- India’s healthcare delivery system is categorised into two major components – public and private.
- Public Sector: It comprises limited secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of Primary Healthcare Centers (PHCs) in rural areas.
- Private Sector: The private sector provides the majority of secondary, tertiary, and quaternary care institutions with a major concentration in metros, tier-I, and tier-II cities.
Structure of Financing of Public Healthcare Sector in India
- In India, states bear the responsibility for public health and sanitation, including hospitals and clinics.
- The Ministry of Health and Family Welfare broadly takes responsibility for formulating policy for public health.
- It provides administrative and financial support to states to operate public health facilities and infrastructure, and to deal with specific health issues, such as maternal health and nutrition.
- It also establishes and manages Medical Institutes of National Importance, such as AIIMS, along with healthcare institutions in Union Territories, including Delhi.
- The Ministry comprises: The Department of Health and Family Welfare, which is responsible for implementing public health schemes and regulating medical education,
- And the Department of Health Research which is responsible for conducting medical research.
Concerns with Low Public Expenditure on Healthcare
- This has resulted in inadequate health infrastructure including human resources, and slow improvement in key health indicators.
- Limited Access to Healthcare Services: Low public spending hampers accessibility to healthcare services, particularly in rural and remote areas where infrastructure is already lacking.
- This exacerbates health disparities between urban and rural populations.
- Neglected Preventive and Primary Care: A large portion of healthcare spending in India is directed towards tertiary care, neglecting preventive and primary healthcare services.
- Higher Disease Burden: Low public spending on healthcare contributes to a higher burden of preventable diseases such as communicable diseases, malnutrition, and maternal and child health issues.
- Increased Out-of-Pocket Expenditure: The lack of public healthcare infrastructure has led people to use private health services more, and that has increased the financial burden on citizens.
Recent steps Taken by the Government for Strengthening Healthcare Sector
- National Health Policy 2017: It outlines the government’s vision to achieve the highest possible level of health and well-being for all and emphasizes preventive and promotive healthcare.
- Equal treatment for modern medicine and traditional systems (Ayurveda, Yoga, Unani, Siddha, Homeopathy).
- All India Institute of Medical Research is now promoting research on traditional medical systems and a comprehensive approach.
- Ayushman Arogya Mandirs: 1.75 lakh health centers functioning with 369 crore visits.
- Focus on screening hypertension, blood pressure, and diabetes for people over 30 years.
- National Digital Health Mission (NDHM): Launched in 2020, NDHM aims to create a digital health ecosystem, including health IDs for citizens and the establishment of a national digital health infrastructure.
- Health and Wellness Centers (HWCs): The government is working towards transforming primary health centers into HWCs to provide comprehensive primary healthcare services, including preventive and promotive care.
- Pradhan Mantri Swasthya Suraksha Yojana (PMSSY): PMSSY aims to enhance tertiary care capacities and strengthen medical education in the country by setting up new AIIMS institutions and upgrading existing government medical colleges.
- Research and Development Initiatives: The government has been encouraging research and development in healthcare, including support for the development of vaccines, drugs, and medical technologies.
- National Medical Commission (NMC) Act: The NMC Act, passed in 2019, aims to bring reforms in medical education and practice by replacing the Medical Council of India (MCI) and promoting transparency and accountability.
- Jan Aushadhi Scheme: The Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) aims to provide quality generic medicines at affordable prices through Jan Aushadhi Kendras.
Way Ahead
- The COVID-19 pandemic had shown the cracks in India’s health system and highlighted the need for increased public investment in healthcare.
- Effective primary health care can prevent the occurrence of more serious health issues, meaning that overall health outcomes can be improved significantly through investing in primary healthcare.
Source: TH