In the pursuit of a healthier and more prosperous nation, the access to public healthcare in India emerges as a cornerstone. The World Medical Association defines health as a state of complete physical, mental, and social well-being, transcending mere absence of disease. In this discourse, we embark on a comprehensive exploration of India’s public healthcare system, traversing its historical evolution, contemporary challenges, and pragmatic solutions, with an overarching vision of fostering a healthier future for all.
In the nascent days of independence, India embarked on a welfare-centric approach to healthcare, with the state assuming the pivotal role in delivering quality healthcare. However, the journey was marred by issues such as rampant malnutrition, inadequate amenities, alarmingly high infant and maternal mortality rates, and a pervasive lack of education. In response, India formulated an inclusive health policy with a resolute focus on equity.
The year 1983 marked a significant milestone with the emergence of the National Health Policy (NHP), as a response to the Alma Ata Declaration’s clarion call for “Health for All by 2000.” The NHP underscored the inextricable link between healthcare access and development, placing a steadfast emphasis on achieving equity in healthcare delivery.
Fast forward to 2017, India’s National Health Plan envisioned comprehensive primary healthcare through the establishment of “Health and Wellness Centers,” with an unwavering focus on preventive and promotive healthcare and the aspiration of universal access. This plan delineated ten cardinal policy principles encompassing professionalism, ethics, equity, affordability, and a patient-centred approach.
Within this framework, seven paramount areas were identified as the keystones for enhancing public health:
1. Swachh Bharat Abhiyan: A nationwide crusade for sanitation. 2. Balanced Diets and Exercise: Promoting healthy lifestyles.
3. Tobacco, Alcohol, and Substance Abuse: Addressing addiction issues. 4. Yatri Suraksha: Mitigating rail and road accidents.
5. Nirbhaya Nari: Confronting gender violence.
6. Reducing Workplace Stress: Ensuring safer work environments. 7. Air Quality Improvement: Combating indoor and outdoor pollution.
The Ministry of Health and Family Welfare shoulders the responsibility for overseeing India’s public health infrastructure, steering diverse programs, managing communicable diseases, and advancing traditional medical systems.
The journey towards bolstering public healthcare in India commenced with the Community Development Programme in 1952, paving the way for the establishment of Primary Health Care Centers (PHCs) in rural areas. Complementing this initiative, the National Health Mission became another critical undertaking, primarily addressing healthcare gaps in underserved regions. Under this mission, Accredited Social Health Activists (ASHAs) emerged as essential connectors bridging the divide between communities and healthcare services. The Janani Shishu Suraksha Karyakram (JSSK) initiative ensured that pregnant women received free delivery services, including caesarean sections. Further, the Janani Suraksha Yojna (JSY) under the National Health Mission aimed to promote safe motherhood by incentivizing institutional deliveries among low-income pregnant women. The Free Drugs Initiative focused on establishing robust systems for the provision of quality essential drugs.
Notwithstanding these endeavours, India grapples with substantial challenges on its path to universal healthcare:
– Persistent Childhood Malnutrition: Rates have remained stable for nearly two decades, with 48% of children under five being stunted, 43% underweight, and 20% wasted.
– Rising Burden of Chronic Diseases: The increasing prevalence of chronic adult diseases and injuries strains the healthcare system.
– Slow Decline in Infant and Maternal Mortality: The rates of infant and maternal mortality are gradually decreasing, but the pace is inadequate to meet health-related Millennium Development Goals.
– Shortage of Qualified Medical Professionals: India faces a scarcity of adequately trained healthcare personnel.
– Low Public Health Spending: Insufficient funding coupled with a lack of accountability structures and performance-based incentives hampers public health effectiveness.
– Inadequate Health Insurance: A significant portion of the population lacks access to health insurance coverage.
– Health Communication: There’s a deficiency in communication efforts to promote health awareness and generate demand for medical services.
– Lack of Awareness: Many are unaware of their rights within the public healthcare system.
– Infrastructure and Funding Shortfalls: Modern infrastructure, human resources, and funding for advanced medical machinery are insufficient.
To surmount these challenges and fortify India’s public healthcare system, a range of recommendations emerge:
1. Infrastructure Standards: Enact legislation that explicitly outlines minimum infrastructure requirements for healthcare facilities.
2. Constitutional Amendment: Amend Part III of the Indian Constitution to incorporate the “Right to Access Public Health Care” effectively.
3. Budget Allocation: Dedicate a minimum of 5% of the GDP in federal and state budgets exclusively for the enhancement of public healthcare infrastructure and services.
4. Compulsory Service: Mandate that all medical professionals render at least three years of service within the public healthcare system following the completion of their degrees.
5. Information Accessibility: Prioritise citizens’ access to comprehensive information regarding the public healthcare system, ensuring transparency and awareness.
In conclusion, India’s quest to fortify its public healthcare system is a multifaceted undertaking with far-reaching implications. By addressing historical challenges, implementing innovative policies, and fostering a culture of health awareness, India can chart a course towards a healthier and more prosperous future for all its citizens. The cherished vision of “Health for All” can be realised, ensuring that India’s most valuable asset—its people—attain a state of complete physical, mental, and social well-being.
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Author Tanya Pandey