Syllabus
GS Paper 2 Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
Applications where to apply?
When asked about
– Issues related to public health
– Bottlenecks in public infrastructure
– Disease prevention and planning
– One health approach
Context
This article looks into public health challenges in India. It critiques the current system’s focus on immediate, politically motivated solutions over long-term preventive measures.
Source
The Hindu | Editorial dated 30 January 2024
Populism does not help public health
Public health in India stands at a crossroads, grappling with the tension between short-term political imperatives and the need for long-term, sustainable strategies.
India’s Public Health Structure
India’s public health structure is a complex and multi-layered system, encompassing various levels of government, institutions, and stakeholders. Here’s a breakdown of its key components:
Central Government:
- Ministry of Health and Family Welfare (MoHFW): Responsible for formulating and implementing national health policies and programs. It oversees various departments and agencies, including:
- Directorate General of Health Services (DGHS): Implements national health programs and provides technical assistance to states.
- Indian Council of Medical Research (ICMR): Conducts biomedical research and provides technical advice to the government.
- Central Drugs Standard Control Organization (CDSCO): Regulates the quality and safety of drugs and medical devices.
State Governments: Health being a state subject under schedule 7 of constitution, various initiatives has been taken by respective state governments
- State Health Departments: Responsible for implementing national health programs and formulating state-specific health policies.
- District Health Societies (DHSS): Coordinate health services at the district level.
- Community Health Centers (CHCs): Provide comprehensive healthcare services in rural areas.
- Primary Health Centers (PHCs): Provide basic healthcare services in rural areas.
Local Governments:
- Municipal Corporations: Responsible for public health in urban areas, including sanitation, waste management, and vector control.
- Gram Panchayats: Responsible for public health in rural areas, including sanitation, water supply, and immunization.
Other Stakeholders:
- Private healthcare providers: Play a significant role in delivering healthcare services, especially in urban areas.
- Non-governmental organizations (NGOs): Provide essential healthcare services, particularly in underserved areas.
- Community-based organizations (CBOs): Mobilize communities to participate in public health initiatives.
Challenges faced by India’s Public Health system
Key challenges faced by public health system are:
- Political influence over public health decisions: Political leaders prioritize short-term gains and populist health policies, neglecting long-term public health goals.
- This leads to unsustainable strategies and resource mismanagement.
- Gap between policy and implementation: The POSHAN Abhiyaan, for example highlights the disparity between ambitious targets and actual outcomes, indicating implementation gaps and resource constraints.
- Prime Minister’s Overarching Scheme For Holistic Nourishment (POSHAN) Abhiyan Scheme plans to reduce stunting by 2%, undernutrition by 2%, anaemia by 3%, and low birth weight by 2% every year. But the fifth National Family Health Survey found 35.5% of children under five were stunted and 32.1% were underweight in 201921. The prevalence of anaemic children aged 659 months increased from 58.6% to 67.1%, and 54.1% to 59.1% among women aged 1519 years.
- This disparity between prevalence and policy targets highlights a significant gap in public health efforts.
- Undue influence of pharmaceutical industry: There are concerns about the industry’s profit-driven motives potentially overshadowing public health priorities.
- Focus on curative medicine over prevention: the prioritization of new hospitals and emergency response over sanitation and disease surveillance. Which is crucial for long-term disease prevention.
- This reactive approach fails to address root causes and strains healthcare resources.
- Eg. Dengue, a disease that has only symptomatic treatments, and no definitive cure. When cases surge, political leaders often mobilise the State machinery to set up immediate relief camps at the expense of long term strategies such as understanding vector bionomics or developing effective vaccines.
- Limited Expertise: The lack of specialized courses in public health engineering and the physician-centric focus of the healthcare system hinder a multidisciplinary approach to public health management.
- Overlooking the crucial role of environmental science, sociology, urban planning, and economics in addressing health challenges.
- Socio economic factors and public health:
- Despite having the same medicines to fight tuberculosis (TB), India reported 21.4 lakh TB cases in 2021, an 18% increase from 2020, translating to an incidence of 210 cases per 1,00,000 population. In contrast, the United States reported only 8,331 TB cases in 2022, about 2.5 cases per 1,00,000 persons.
- This disparity is not merely a matter of the availability of medical treatment but is deeply linked to socioeconomic factors such as poverty, sanitation, and overcrowding (as a result of poorly organised urban housing) prevalent in India.
Possible Solutions:
- Multi-Sectoral Approach: Effective solutions require collaboration across sectors, including agriculture, health, education, and social welfare.
- Institutional autonomy: Establish a separate body for public health policymaking, free from political interference. This body should be guided by scientific evidence and long-term public health goals.
- A fair and effective health system requires freedom from political influence, focusing on policymaking and implementation driven by scientific evidence and longterm objectives
- An ideal solution would be to place Health Ministries directly under the leadership of elected officials, such as the Chief Minister or the Prime Minister, similar to the management of the space and the atomic energy departments
- Balancing Expertise and Representation: While scientific expertise is crucial, public health policies cannot be solely driven by technocrats. Citizen participation and addressing community concerns are vital for effective implementation.
- Strengthening implementation: Bridge the gap between policy and action by ensuring adequate funding, capacity building, and monitoring mechanisms.
- Addressing social determinants: Implement policies tackling poverty, and promoting healthy living environments to address the root causes of health issues.
- Strengthening Public Health Infrastructure: Invest in sanitation, disease surveillance, and public health education to lay a strong foundation for disease prevention.
- Effective communication: Combat misinformation and promote evidence-based health education through transparent communication and community outreach programs.
Conclusion
India’s public health challenges demand a multi-pronged approach. Prioritizing preventive measures, ensuring institutional autonomy, fostering a multidisciplinary approach, and striking a balance between expert and public voices are essential steps towards a healthier future for all.
RELATED TOPICS
National Health Mission (NHM)
- Financial and technical support is provided to States/UTs to strengthen their health care systems including setting-up/upgrading public health facilities and augmenting health human resource
- Provides equitable, affordable and quality healthcare with modern treatment methods and diagnostic facilities in the public healthcare facilities of the Country including rural areas based on requirements posed by the States in their Programme Implementation Plans (PIPs).
- NHM support is also provided for provision of a range of free services related to maternal health, child health, adolescent health, family planning, universal immunisation programme, and for major diseases such as Tuberculosis, vector borne diseases like Malaria, Dengue and Kala Azar, Leprosy etc.
- Other major initiatives supported under NHM include
- Janani Shishu Suraksha Karyakram (JSSK) (under which free drugs, free diagnostics, free blood and diet, free transport from home to institution, between facilities in case of a referral and drop back home is provided),
- Rashtriya Bal Swasthya Karyakram (RBSK) (which provides newborn and child health screening and early interventions services free of cost for birth defects, diseases, deficiencies and developmental delays to improve the quality of survival)
- implementation of Free Drugs and Free Diagnostics Service Initiatives, PM National Dialysis Programme and implementation of National Quality Assurance Framework in all public health facilities including in rural areas.
- Mobile Medical Units (MMUs) & Tele-consultation services are also being implemented to improve access to healthcare particularly in rural areas.
- As part of Ayushman Bharat, the Government is supporting the States for transformation of Sub Health Centres and Primary Health Centres into 1.5 lakh Health and Wellness Centres across the country
- Under this programme, CPHC services of an expanded range of services, that are universal and free to users, with a focus on wellness, are provided, closer to the community.
- Further Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) provides health coverage up to Rs 5 Lakh per family per year to around 10.74 crore poor and vulnerable families as per Socio Economic Caste Census (SECC).
- Financial support is also provided to States for providing hard area allowance, performance-based incentives, providing accommodation and transport facilities in rural and remote areas including tribal areas, sponsoring training programmes, etc to engaged human resources to address the issue of shortage of doctors and specialists in the public health facilities.
- In the 15 years of implementation, the NHM has enabled achievement of the Millennium Development Goals (MDGs) for health. It has also led to significant improvements in maternal, new-born, and child health indicators, particularly for maternal mortality ratio, infant and under five mortality rates, wherein the rates of decline in India are much higher than the global averages and these declines have accelerated during the period of implementation of NHM.
References
https://poshanabhiyaan.gov.in/
Practice Question
Public health policy in India is often criticized for focusing on immediate, politically expedient solutions. Critically examine this statement in the light of the challenges faced by India’s public healt system? [250 words]