Source: The post Supreme Court order weakens protection for domestic violence victims has been created, based on the article “Reviving civic engagement in health governance” published in “The Hindu” on 12th August 2025. Strengthening community engagement in Indian health governance.
UPSC Syllabus Topic: GS Paper 2- Issues relating to development and management of Social Sector/Services relating to Health,
Context: The Makkalai Thedi Maruthuvam scheme in Tamil Nadu and Karnataka’s Gruha Arogya scheme aim to deliver healthcare at people’s doorsteps, especially for non-communicable diseases. While these initiatives expand access, they raise concerns about how far citizens can engage with and influence health governance at different levels.
Evolving Nature of Health Governance
- From Government-led to Multi-actor Systems: Health governance now includes civil society, professional associations, hospital bodies, and trade unions. It works through both formal and informal processes, where power dynamics affect participation.
- Importance of Public Engagement: Citizen involvement affirms dignity, counters epistemic injustice, and strengthens democracy. It ensures that people influence health decisions affecting them.
- Benefits for Service Delivery: Engaging communities improves accountability, reduces elite dominance, builds trust with providers, and enhances health outcomes.
Institutional Mechanisms for Participation
- National Rural Health Mission Platforms: The NHM (2005) created Village Health Sanitation and Nutrition Committees (VHSNCs) and Rogi Kalyan Samitis for inclusive participation, especially of women and marginalised groups, with untied funds for local initiatives.
- Urban Participation Structures: Urban equivalents include Mahila Arogya Samitis, Ward Committees, and NGO-led bodies.
- Challenges in Implementation: In some areas, committees are absent; in others, they face unclear roles, rare meetings, underused funds, poor coordination, and social hierarchies.
Barriers to Effective Engagement
- Perception of Citizens as Passive: Policymakers often see people as recipients, not co-creators. Performance is judged by target numbers, ignoring ground realities.
- Language and Framing Issues: Terms like “beneficiaries” reduce citizens to objects of intervention rather than rights-holders.
- Medicalised and Hierarchical Governance: Leadership is dominated by doctors trained in biomedical models. Promotions are often based on seniority, not public health expertise, creating a disconnect from community needs.
- Resistance to Participation: Concerns include extra workload, accountability pressure, dominance by medical or capitalist interests, and unequal influence in governance spaces.
Alternative Avenues for Citizen Voice
- Non-institutional Channels: Where formal platforms fail, citizens turn to protests, media campaigns, and legal action.
- Unmet Demand for Inclusion: These actions reflect a strong need for voice and accountability.
Path to Meaningful Community Engagement
- Mindset Transformation: Participation should be valued as much as outcomes. People must be seen as partners, not instruments.
- Empowering Communities: Spread health rights awareness, engage marginalised groups, build civic education early, and provide tools for decision-making.
- Sensitising Health Actors: Avoid blaming poor awareness for low service use. Address structural health inequities with communities.
- Strengthening Platforms: Existing mechanisms must be activated, improved, and made inclusive for lasting change.
Question for practice:
Examine the significance of meaningful community engagement in health governance in India and the challenges that hinder its effective implementation.
