Why family needs to be at the heart of India’s health system

Source: The post is based on the article “Why family needs to be at the heart of India’s health system” published in the Indian Express on 13^th August 2022.

Syllabus: GS 2 Issues Relating to Development and Management of Social Sector/Services relating to Health, Education, Human Resources.

Relevance: Health Reforms; Kerala Model.

News: Since Independence, India has been striving to establish a comprehensive primary healthcare care system. The Covid pandemic once again highlighted the need for an effective primary healthcare system.

About the history of healthcare reforms in India

The Bhore Committee Report of 1946, the Kartar Singh Committee Report of 1973, the National Rural Health Mission (NRHM) of 2005 and the Ayushman Bharat Mission of 2019 are significant landmarks in this endeavour.

The NRHM: (1) The Mission has set the Indian Public Health Standards (IPHS) for physical infrastructure, human resources and service delivery, and (2) a three-fold increase in budget.

Health Care System in India: The system comprises a multi-tiered structure. It means at the block-level, there is a 30-bed community health centre is operated by four specialists and at the village-level, a community worker operates and provides services covering 12 diseases/needs.

Some good outcomes as a result of the NRHM Healthcare reforms

(1) Institutional deliveries went up from 41% in 2005 to 89% in 2021,

(2) The maternal mortality ratio (MMR) went down from 407 per one lakh women in 2,000 to 113 per one lakh women in 2021,

(3) The infant mortality ratio reduced from 58/1,000 live births in 2005 to about 28/1,000 live births in 2021,

(4) There has been increased availability of drugs, diagnostics and doctors,

(5) The healthcare system’s footfall has registered an impressive improvement in states like Bihar and UP.

What are the shortcomings of NRHM?

Despite the launch of the mission, still less than 10% of the public health care facilities match up to the IPHS Standards.

The primary healthcare system continues to be plagued with gaps and deficiencies and the current facilities serve two to ten times the population they are designed to cater to.

One reason for the deficit is that public spending on healthcare is barely 1.1 per cent of the GDP and the other reason is the wavering political support for primary care.

The Kerala Model -Healthcare system

It has revamped its health care system based on the UK’s GP (general practitioners) system in the state.

Kerala appears to be the only state in India which has revamped its primary healthcare system (PHC) along the foundational principles of comprehensive primary care, i.e., a community-anchored delivery system, a continuum of care, and patient-centred, protocol-driven, evidence-based treatment.

This comprehensive approach has been enabled by a tripartite partnership between the state’s health department, women’s collectives and community-level bodies.

The Primary health centre (PHC) facilities have been renamed as family health centres (FHCs) which underlines the centrality of the family in the endeavour.

A series of coordinated interventions were made, like changing timings, redesigning the centres and equipping them with the patient and people-friendly facilities, providing intensive training to the staff to undertake new functions and responsibilities, etc.

The Family Health Centre’s (FHCs) in Kerala provide a wide range of drugs and medical services, including nebuliser treatment for asthma patients, mobile teams provide palliative care at home.

What should be done?

For Kerala: The state government should focus on deepening the reforms, and instituting the accountability framework related to the doctors, paramedics and frontline workers, needs to be strengthened.

For Rest of India: National policy should be nimble and allow for differential strategies because a single system may not be apt for the entire country.

The Centre should adopt the principles of flexibility, decentralisation and provides the space for innovation to states and districts to plan, design and implement primary care in accordance with local needs. The Centre government’s role should be limited to measuring outcomes.

Rest of the state government should learn from a proactive primary healthcare system that is working in Kerala. They should reset their approach and change the design of their health care system.