Policy Paralysis and the Weakened Public Health Sector (GS Paper 2, Health)
Context:
- In recent years, India’s public health sector has faced significant challenges, with a notable disparity between the growth of private healthcare and the inadequacies in primary care.
- This imbalance is indicative of a broader issue of policy paralysis and a weakened public health infrastructure.
Introduction:
- Public health policies are designed to address a population’s diverse health needs, which are influenced by both the lived experiences of individuals and the projections made by experts.
- Recent critiques of the Union Budget highlight a concerning lack of focus on the social sector, particularly public health.
- Over the past decade, public health policies have suffered from a lack of effective solutions tailored to the felt needs of the population, reflecting a broader trend of policy paralysis.
Felt Needs in Public Health:
Diseases of Poverty:
- Impact: Diseases such as tuberculosis, malaria, undernutrition, and water-borne infections disproportionately affect the poor and vulnerable populations. These issues are compounded by challenges related to livelihood and rights.
- Significance: Addressing these diseases is not only a matter of health but also of human rights and social equity.
Environmental Issues:
- Impact: Middle-class and affluent populations face health challenges related to environmental pollution, including air and water pollution, inadequate waste management, and poor food safety. These issues stem from inadequate infrastructure and market regulations.
- Significance: Effective management of environmental health risks is crucial for improving quality of life and preventing chronic illnesses.
Curative Care Needs:
Levels of Care:
- Primary Care: Essential for affordable and accessible healthcare, especially for the poor. Historically, primary care in the public sector has been crucial but remains under-resourced.
- Secondary Care: Often neglected and inadequate in many regions, exacerbated by shortages of infrastructure and healthcare professionals.
- Tertiary Care: Targeted by the Pradhan Mantri Jan Arogya Yojana (PMJAY) under Ayushman Bharat, focusing on high-cost treatments for the poor.
History of Indian Public Health Policies (Last Decade):
Commercialization of Healthcare:
- Shift: The National Rural Health Mission (2005) and National Health Mission (2013) marked a departure from the previous focus on commercialization of healthcare. These missions aimed to strengthen public sector healthcare, reversing earlier trends.
Architectural Correction and Capacity Building:
- Achievements: The NHM focused on reinforcing primary health care institutions and improving health infrastructure, including sub-centres, primary health centres (PHCs), and community health centres (CHCs).
Financial Support and Insurance Schemes:
- Focus: There has been a shift towards publicly funded health insurance schemes like PMJAY, while secondary and tertiary care in the public sector remains underdeveloped.
Private Healthcare System as the Real Beneficiary:
Health Insurance Coverage:
- Scope: India’s health insurance schemes primarily cover hospitalization costs, leaving other healthcare needs unmet. This design benefits private healthcare providers, who handle secondary and tertiary care services at market rates.
Outsourcing and Market Monopolization:
- Implication: The outsourcing of services to the private sector under government schemes acknowledges a failure to enhance public sector facilities. This scenario forces a large portion of the population to rely on costly private healthcare.
Transformation of Healthcare Centres:
- Changes: The conversion of sub-centres, PHCs, and CHCs into Health and Wellness Centres (HWCs) and later to ‘Ayushman Arogya Mandir’ has shifted their role from preventive to curative care, undermining their original mandate.
Threats to the Public Health System:
Vulnerable Populations:
- Challenges: For the poor and vulnerable, primary and secondary-level care is essential. However, prevention and health promotion often become secondary to addressing their immediate livelihood needs.
Loss of Trust:
- Public Perception: The public health system suffers from a lack of trust due to overcrowded and under-resourced public facilities, while private sector growth has often prioritized profit over patient care.
Way Forward:
Strengthening Public Health Infrastructure:
- Investment: There is a need to bolster secondary and tertiary care in the public sector and enhance primary care institutions to rebuild trust and effectiveness.
Diversification of Healthcare Services:
- Holistic Approach: Policies should focus on integrating preventive, promotive, and curative care, ensuring that all levels of healthcare are adequately funded and managed.
Enhancing Public-Private Collaboration:
- Partnerships: Develop frameworks for better collaboration between public and private sectors to address gaps and optimize resource utilization.
Conclusion:
- The Indian public health system faces significant challenges due to policy paralysis and a weakened public sector, exacerbated by the unchecked growth of private healthcare.
- Strengthening public health infrastructure, addressing disparities, and fostering effective public-private partnerships are essential steps towards a more equitable and functional healthcare system.
- Comprehensive policy interventions and continuous monitoring are necessary to ensure that public health needs are met and trust in the healthcare system is restored.
