India is making great progress in reducing health shocks caused by poverty and improving healthcare access. However, disparities in healthcare quality and the rise of non-communicable diseases remain challenges. To achieve universal healthcare, India must build on the successes of schemes like Ayushman Bharat and address these issues.
Analyzing the Household Consumption Expenditure Survey (HCES 2022-23) shows a positive trend in healthcare access. From 2011-12 to 2022-23, there was an increase in households incurring hospitalization expenses, indicating better healthcare access. The financial burden of hospitalization has decreased, with health expenditures in monthly household spending dropping from 10.8% to 9.4%.
Despite improvements, India faces obstacles to achieving universal healthcare. Disparities in access, quality, and affordability persist. Non-communicable diseases are rising, requiring focused attention. Sustaining momentum from schemes like Ayushman Bharat and addressing these issues is crucial for a healthier future.
| GS Paper | General Studies II |
| Topics for UPSC Prelims | Household Consumption Expenditure Survey, Non-communicable diseases, Ayushman Bharat, eSanjeevani, World Health Organization, Economic Survey 2023-24, Mental Healthcare Act 2017, Covid-19 pandemic, National Health Mission, National Digital Health Mission, Pradhan Mantri Swasthya Suraksha Yojana, Mission Indradhanush |
| Topics for UPSC Mains | Major Issues Related to India’s Healthcare Sector, Major Initiatives Related to Healthcare in India. |
Origin of the Article
This editorial is based on “Reducing the poor’s health burden,” published in The Indian Express on 09/08/2024. The article discusses the progress and challenges in India’s healthcare sector.
Relevancy for UPSC Students
Understanding this topic is crucial for UPSC aspirants as it covers essential aspects of governance and public health, aligning with GS Paper 2. Knowledge of healthcare policies, implementation, and ongoing challenges can aid in prelims and main examinations.
Why in News
The topic of India’s quest for universal health coverage is important for UPSC aspirants due to its multifaceted impact on governance, social justice, and economic stability. The recent Household Consumption Expenditure Survey (HCES 2022-23) offers valuable insights into poverty-induced health shocks and healthcare access, which are vital for understanding policy effectiveness. Additionally, this issue aligns with previous UPSC questions on healthcare disparities, government schemes, and public health initiatives, making it a pertinent and timely subject for examination.
Current Major Issues in India’s Healthcare Sector
India’s healthcare sector faces multiple challenges that impede progress towards universal health coverage. While infrastructural developments have been huge, systemic issues like misaligned priorities, the digital divide, brain drain, financial barriers, and neglected preventive healthcare contribute to persistent disparities. Recent reports and statistics provide a clear picture of these enduring issues that require immediate and strategic interventions.
Misaligned Priorities- The Infrastructure-Outcome Gap
Despite major investments in healthcare infrastructure, outcomes remain suboptimal. According to the CAG report 2023, discrepancies like patients marked as ‘dead’ receiving treatment under Ayushman Bharat highlight inefficiencies. Furthermore, 80% of public health facilities fail to meet essential standards. This gap is evident in high maternal mortality rates, which stand at 103 per UN MMEIG 2020, despite increased institutional deliveries.
The Digital Divide
The rapid adoption of telemedicine during the Covid-19 pandemic has exacerbated the urban-rural healthcare divide. While platforms like eSanjeevani have facilitated over 200 million consultations by early 2024, rural areas lag due to poor internet connectivity. As of 2023, nearly 45% of the rural population lacked internet access, hampering equitable healthcare delivery and widening the digital divide.
The Brain Drain and Skill Mismatch
India faces a severe shortage of qualified healthcare professionals. Although the doctor-population ratio is 1:834, surpassing the WHO standard of 1:1000, there is a critical shortage in specialized fields like geriatrics, with only 20 geriatricians graduating annually. This imbalance is further exacerbated by a preference for urban postings and specialized fields over rural healthcare and primary care.
The Out-of-Pocket Expense Trap
Despite schemes like Ayushman Bharat, out-of-pocket expenses remain a major barrier. Over 17% of Indian households face catastrophic health expenditures annually, according to a 2022 WHO report. This financial burden is a major obstacle to accessing necessary healthcare services, indicating the need for more comprehensive financial protection mechanisms.
Preventive Healthcare- The Neglected Public Health Approach
India’s healthcare system is predominantly reactive, focusing on treatment rather than prevention. Non-communicable diseases now account for 63% of all deaths, as per the Economic Survey 2023-24. The rise in sedentary lifestyles, poor dietary habits, and lack of early screening programs underscore the need for a robust preventive healthcare strategy.
Quality of Care- The Credibility Crisis
The variability in healthcare quality is a big concern. Poor care quality resulted in 1.6 million deaths in 2016, surpassing deaths due to lack of access. Cases of medical negligence and the absence of stringent regulatory frameworks exacerbate this issue, eroding public trust in the healthcare system.
Mental Health- The Neglected Crisis
Mental health remains critically under-addressed in India. With 60 to 70 million people suffering from mental disorders and India leading in global suicide rates, the implementation of the Mental Healthcare Act 2017 falls short. The ratio of 0.75 psychiatrists per 100,000 people starkly contrasts with the desirable 3 per 100,000, highlighting the urgent need for more mental health professionals.
Pharmaceutical Industry Issues
India’s pharmaceutical industry faces many challenges, including quality control and import dependency. Incidents like the WHO warning against India-made cough syrups in 2023, linked to child fatalities, underscore the need for stringent quality control and reduced dependency on foreign APIs to ensure global credibility.
Major Initiatives Related to Healthcare in India
The Indian government has launched several initiatives to address healthcare challenges and improve access to quality healthcare for its citizens. These initiatives encompass a range of services, from insurance coverage to digital health ecosystems.
Ayushman Bharat
Ayushman Bharat aims for universal health coverage through two components: Pradhan Mantri Jan Arogya Yojana (PM-JAY) provides health insurance coverage of ₹5 lakh per family annually for secondary and tertiary care hospitalization, while Health and Wellness Centers aim to establish 150,000 centers offering comprehensive primary healthcare.
National Health Mission (NHM)
NHM, comprising the National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM), focuses on improving healthcare infrastructure, reducing maternal and infant mortality, and enhancing access to quality healthcare services in both rural and urban areas.
National Digital Health Mission (NDHM)
NDHM aims to create a robust digital health ecosystem, including unique health IDs for all citizens, digitized health records, and a registry of doctors and healthcare facilities. This initiative seeks to streamline healthcare delivery and improve efficiency.
Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)
PMSSY addresses regional imbalances in healthcare by establishing new AIIMS institutions and upgrading existing government medical colleges. This initiative aims to enhance healthcare access and quality across different regions of the country.
Mission Indradhanush
Mission Indradhanush targets increasing immunization coverage among children and pregnant women, especially those who are partially vaccinated or unvaccinated. This program is crucial for preventing vaccine-preventable diseases and improving public health outcomes.
Janani Suraksha Yojana (JSY)
JSY promotes institutional delivery among poor pregnant women by providing cash assistance, aiming to reduce maternal and neonatal mortality. This initiative is a part of the broader National Health Mission focusing on maternal health.
Pradhan Mantri Bharatiya Janaushadhi Pariyojana (PMBJP)
PMBJP aims to provide quality medicines at affordable prices through Janaushadhi Kendras. This initiative helps reduce out-of-pocket expenditure on medicines, making healthcare more accessible and affordable for the population.
National Mental Health Program (NMHP)
NMHP focuses on providing accessible and affordable mental healthcare services. It aims to address the treatment and prevention of mental disorders, recognizing mental health as a critical component of overall health.
Measures to Revamp India’s Healthcare Sector
Revamping India’s healthcare sector requires a multi-pronged approach, addressing both systemic issues and emerging challenges. Strategic measures can help bridge existing gaps and enhance the overall efficiency and accessibility of healthcare services.
Bridging the Urban-Rural Divide
Implementing mobile health (mHealth) technologies and mobile health units can improve rural healthcare access. Successful models like the Mobile Medical Units in Tamil Nadu demonstrate the potential of such initiatives in providing telemedicine facilities, diagnostic tools, and essential medications to underserved areas.
Strengthening Primary Health Care
Upgrading Health and Wellness Centers and implementing a family physician model is crucial for comprehensive primary healthcare. Ensuring these centers offer a wide range of services, including NCD management, mental health support, and preventive care, can reduce the burden on secondary and tertiary facilities.
Public-Private Partnerships- Synergizing for Success
Public-private partnerships (PPPs) can play a vital role in improving healthcare delivery. Creating a robust framework for PPPs in areas like hospital management, diagnostic services, and specialized care can replicate successful models like Rajasthan’s partnership with Narayana Health across other states.
Digital Health Ecosystem- Interoperability for Impact
Building an interoperable digital health ecosystem is essential for improving healthcare efficiency. Expediting the implementation of the Ayushman Bharat Digital Mission, developing standardized Electronic Health Records (EHRs), and establishing a nationwide Health Information Exchange (HIE) can facilitate seamless data sharing and improve care coordination.
Boosting Indigenous Research and Development
Enhancing healthcare R&D spending and establishing biomedical research parks can foster innovation and develop context-specific, cost-effective solutions. Increasing R&D spending to 2.5% of GDP and fostering collaboration between academia, industry, and healthcare providers are crucial steps.
Enhancing Healthcare and Pharmaceutical Standards
Implementing strict quality control measures and accreditation systems for healthcare and pharmaceutical facilities is essential. Setting and enforcing robust standards for patient safety, clinical outcomes, and healthcare management, along with regular audits and transparent reporting, can drive quality improvement and enhance patient trust.
PESTEL Analysis
| Political: India’s government has launched several initiatives like Ayushman Bharat and the National Digital Health Mission to improve healthcare access. Political will is essential to sustain these programs and navigate the challenges of healthcare governance, such as addressing fraudulent activities and regulatory oversight of healthcare standards. Economic: Economic challenges include the high out-of-pocket expenses for many families despite government health insurance schemes. The need for major investment in healthcare infrastructure and the potential for public-private partnerships offer economic opportunities but also require careful financial management to avoid exacerbating economic disparities. Social: There is a rising burden of non-communicable diseases and a mental health crisis, highlighting the need for improved health education and community-based health initiatives. Sociocultural factors, such as varying health practices and stigmas associated with certain conditions, influence the effectiveness of healthcare policies. Technological: The digital divide poses a major barrier, especially in rural areas. Enhancing telemedicine platforms and digital health records is crucial. However, poor internet connectivity and low digital literacy limit the reach of such technologies, affecting the overall efficacy of digital health solutions. Environmental: Environmental factors, including pollution and climate change, impact health outcomes and increase the burden of diseases like asthma and other respiratory conditions. There is a need for integrated health and environmental policies. Legal: Legal challenges include the enforcement of healthcare regulations and standards. The implementation of laws such as the Mental Healthcare Act 2017 needs strengthening to ensure that rights and services are adequately provided. |
Conclusion
In conclusion, India’s journey towards universal healthcare is marked by major strides yet underscored by persistent challenges. Addressing disparities in access, enhancing the quality of care, and focusing on preventive health measures are critical for sustainable progress. As future civil servants, it is imperative to champion policies that bridge these gaps, ensuring a robust and equitable healthcare system for all.
| UPSC Civil Services Examination, Previous Year Questions (PYQs) Mains Q. Public health system has limitations in providing universal health coverage. Do you think that the private sector could help in bridging the gap? What other viable alternatives would you suggest? (GS Paper II, 2022). Q. Critically evaluate the effectiveness of the Mental Healthcare Act 2017 in addressing mental health issues in India. In light of the challenges posed by the COVID-19 pandemic, what additional measures are necessary to improve mental health services and accessibility? |
