Health Care System in India

Context

Recentlygovernment has rolled out several schemes/programmesto improve health care system

Constitution Provision

• Health care delivery is in State List.
• Most provisions related to health are in Part-IV {Directive Principles}. These are: Article 38, 339(e), 41,42, 47 and 48 A
• Panchayats and Municipalities also have some provisions related to health. These include drinking water, health and sanitation, family welfare, women and child development, social welfare etc.
• The right to life provided under Art. 21 of the Constitution of India have been used time and again to demand access to health care.

Problem with heath system in India

1. Health Infrastructure

• Insufficiency of Hospital Beds: Penetration of healthcare infrastructure, much lower than that of developed countries and even lower than the global average, the bed density in the country is 0.7 per 1,000 population, far below the global average of 2.6 and WHO benchmark of 3.5.
• Shortage of staff: India faces a shortage of about 6 lakhs doctors, one million nurses, 2 lakhs dental surgeons and a large number of paramedical staff.

2. Less government spending on Public health: Government spending on public health- just about 1 per cent of its gross domestic product (GDP), compared to 3 per cent in China and 8.3 percent in the United States.
3. Dependency on Private Hospital: Private sector funding in India’s annual health burden is about 75%. It is amongst the highest in the world in percentage terms. Public spending on the other hand, is amongst the lowest and is even lower than the global average.

4. Neglect of Rural Population:According to health information 31.5% of hospitals and 16% hospital beds are situated in rural areas where 75% of total population resides. Moreover the doctors are also unwilling to serve in rural areas.

5. Neglect of traditional health care system:The health system of India depends almost on imported western models. It has no roots in the culture and tradition of the people.

6. Social Inequality: Rural, hilly and remote areas of the country are under served while in urban areas and cities, health facility is well developed. The SC/ST and the poor people are far away from modern health service.

7. Lack of Regulations: The lack of regulation by the government in private sector allows doctors and hospitals to adopt unethical practices.

8. Inadequate health Insurance: Government contribution to insurance stands at roughly 32%, as opposed to 83.5% in the UK. 75% of the Indian population paying for healthcare services from their own pockets, it puts tremendous financial burden

9. Geography of India: Sub Tropical Climate provides a ground for germination of diseases. Due to a cumulative effect of poverty, population load and climatic factors India’s population is seriously susceptible to diseases.

10. Fragmented Health Information System: Data is incomplete and often it is duplicated.

11. Poor educational status leads to non-utilisation of scanty health services and increase in avoidable risk factors.

12. States under financial constraints cut expenditure on health.

Committees/ Recommendation

NITI AayogAction plan

• It aimed at reducing the out-of-pocket spending on health to 50% by 2020 from 63.4% at present.
• It Recommend to focus on public health through significantly increasing government expenditure on it and prioritize preventive care rather than provide curative care
• NITI Aayogrecently released a comprehensive Health Index report. It aims to establish an annual systematic tool to measure and understand the heterogeneity and complexity of the nation’s performance in Health.

National Health Policy, 2017

• A health policy is the expression of what the health care system should be so that it can meet the health care needs of the people
• The changes since the last Health Policy in 2002 necessitated the formulation of a New National Health Policy to address the current and emerging challenges.

Key Objectives

• Progressively achieve Universal Health Coverage
• Strengthening the trust of the common manin public health care system by making it predictable, efficient, patient centric, affordable andeffective
• Align the growth of private health care sector with public health goals

Recommendations

• The policy proposes a potentially achievable target of raising public health expenditure to 2.5% of the GDP in a time bound manner
• Address the primary health care needs of the urban population with special focus on poor populations living in listed and unlisted slums and other vulnerable populations
• Strengthen existing medical colleges and converting district hospitals to new medical colleges
• Need to improve regulation and quality management of nursing education.
• Certification programme for ASHAs for their preferential selection into ANM, nursing and paramedical courses.
• Creation of Public Health Management Cadre in all States based on public health or related disciplines, as an entry criteria.
• Allocate two-thirds of resources to primary care followed by secondary and tertiary care.
• “Make in India” could be used to provide customized indigenous medical devices to the health sectorand in creation of forward and backward linkages for medical device production.
• Effective use of Health Information System
• It advocates strengthening of six professional councils (Medical, Ayurveda Unani& Siddha, Homeopathy, Nursing, Dental and Pharmacy) through expanding membership of these councils.
• Setting up of National Allied Professional Council to regulate and streamline all allied health professionals and ensure quality standards.
• The policy identifies coordinated action on seven priority areas for improving the environment for health:
  • The Swachh Bharat Abhiyan
  • Balanced, healthy diets and regular exercises.
  • Addressing tobacco, alcohol and substance abuse
  • YatriSuraksha – preventing deaths due to rail and road traffic accidents
  • NirbhayaNari –action against gender violence
  • Reduced stress and improved safety in the work place
  • Reducing indoor and outdoor air pollution

Challenges

• It reiterates health spend targets set by the High Level Expert Group (HLEG) set up by the erstwhile Planning Commission for the 12th Five Year Plan (which ends on March 31, 2017)
• It also fails to make health a justiciable right through National Health Rights Actlike the Right to Education Act 2005 did for school education. It has removed all reference to instituting a National Health Rights Act, which was mentioned in the 2015 draft
• A health cess was a path-breaking idea in the Health Ministry’s draft policy; it has been dropped out of the final policy
• Level of public investment(2.5% of GDP by 2025) is inadequate for achieving the goals, targets and approaches proposed to achieving them mentioned in NHP 2017

Steps Taken by Government

1.Support is provided to States/UTs under NRHM, to strengthen the health system including establishment/up-gradation/renovation of health infrastructure, engagement of Nurses, doctors and specialist on contractual basis

2.National Health Mission:

• National Health Mission (NHM) encompasses its two sub-missions, the National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM).
• The main programmatic components include:
• Health System Strengthening in rural and urban areas,
• Reproductive-Maternal Neonatal-Child and Adolescent Health (RMNCH+A)
• Communicable and Non-Communicable diseases.

3. Pradhan MantriSwasthyaSurakshaYojana (PMSSY)

It has two component

a) Setting up new AIIMS

b) Up gradation of government medical colleges

4. Ayushman Bharat

It has two component

Health and Wellness Centre:  

• These Centres will provide Comprehensive health care.
• It will be responsible for providing free essential Drug and diagnostics Services.

National Health Protection Mission:

• NHPM will subsume the on-going centrally sponsored schemes –RashtriyaSwasthyaBimaYojana (RSBY) and the Senior Citizen Health Insurance Scheme.

5. Jan Ausadhi

• Pradhan MantriBhartiya Jan AushadhiPariyojana Kendra (PMBJPK) have been set up to provide generic drugs, which are available at lesser prices but are equivalent in quality and efficacy as expensive branded drugs.
• This will help to reduce out of pocket expenditure

6. National Medical Commission Bill

• Replace the medical commission of India with national medical Commission as the top regulator of Medical Education
• AYUSH practitioner are allowed to practice allopathy after completing bridge course

7. States/UTs are being provided support for focused attention and greater resources per capita to high priority districts with relatively poor composite health index.
8. Financial assistance is provided to the States/UTs for selection and training of Accredited Social Health Activists (ASHA), who act as a link between community and healthcare facilities.
9. States/UTs are assisted to constitute Village Health, Sanitation and Nutrition Committees so as to ensure community participation and village level planning and monitoring of health activities.
10. To increase the availability of doctors, several initiatives have been taken to rationalize the norms in medical education, such as, relaxation in land requirements, bed strength, increase in ceiling for maximum intake for undergraduates, enhancement of teacher-student ratio in Post Graduate Courses, etc

Way Ahead

• The government should appoint a commission which makes recommendations for the healthcare system and monitors its performance.
• Integration of all three stages of health care: prevention, diagnosis and treatment
• Use of innovation to bridge intent and execution
• Access to health care services should be expanded and the quality of care improved
• More and better educated health professionals are required to improve access to health care
• Better use of drugs would improve the quality of health care and reduce out-of-pocket payments
• Devoting more public funds to health care and improving the effectiveness of spending
• Extending the coverage of government-sponsored insurance schemes
• State governments should draw up blueprints for universal health coverage and begin experimenting and innovating with pilot programmes
• There is need to strengthen transplantation of Organ regulation, mental health care bill etc
• Strong political commitment and effective stewardship