Healthcare has become one of India’s largest sectors, both in terms of revenue and employment. Healthcare comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance, and medical equipment. Due to improved services, coverage, and rising spending by both public and private entities, the Indian healthcare industry is expanding quickly. The public and private sectors make up the two main components of India's healthcare delivery system. The government, or public healthcare system, concentrates on establishing primary healthcare centres (PHCs) in rural areas while maintaining a small number of secondary and tertiary care facilities in major cities The private sector provides the majority of secondary, tertiary, and quaternary care institutions with a major concentration in metros, tier-I and tier-II cities.
This article aims at discussing the public healthcare system in India. Read on!
According to the Indian Constitution, the central and state governments are responsible for different aspects of health. State governments are in charge of infrastructure, jobs, and service delivery while the national government continues to be in charge of medical research and technical education. Issues that affect many states are included on the concurrent list (in the 9th schedule to the Indian Constitution), for example, stopping the spread of infectious or contagious diseases between states. Even though the states have a great deal of autonomy in running their healthcare systems, the national government has a lot of financial control over the state-run healthcare systems. Furthermore, the article deals with the schemes provided by the government and the problems associated with public healthcare in India.
GOVERNMENT HEALTHCARE SCHEMES
The Government of India has been operating a number of healthcare schemes and programmes aimed at all demographic groups through its various ministries, including the Ministry of Health and Family Welfare (MoHFW), Ministry of AYUSH, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, and others. According to the government, these plans and initiatives are designed to support SDG 3: "Good Health and Well-Being for All," which calls for universal access to affordable healthcare. Here are some of the major healthcare initiatives of the central government to boost public health in the country:
Ayushman Bharat Yojana (ABY):
The Ayushman Bharat Yojna, which was launched in September 2018, intends to offer primary, secondary, and tertiary healthcare as well as health insurance to the underprivileged. There are two sub-missions for the ABY:
Establishment of Wellness and Health Centers: These facilities are designed to increase access to primary-level healthcare that is both affordable and of high quality. These facilities offer Comprehensive Primary Health Care (CPHC), which includes free essential drugs and diagnostic tests and addresses non-communicable diseases, maternity, and child health services.
Pradhan Mantri Jan Arogya Yojana: It offers the underprivileged financial security so they can access secondary and tertiary healthcare services. The Ayushman Bharat card entitles its holders to access cashless medical care up to a maximum of Rs. 5 lakh in all government and private hospitals that have been empanelled for the programme. Ayushman Bharat cardholders cannot be turned away from these hospitals, and the programme covers all pre-existing conditions. The programme includes diagnostic treatment and medication costs. It also covers 3 days of pre-hospitalization and 15 days of post-hospitalization.
The Ministry of Health and Family Welfare (MoHFW) created the eSanjeevani OPD free teleconsultation system to allow people to receive medical consultations from the comfort of their homes in light of the COVID-19 pandemic. By registering on the eSanjeevaniOPD website, anyone with a laptop, a desktop computer with a camera, microphone, speaker, tablet or mobile phone with video chatting capability, and a mobile phone to receive one-time passwords, may use the service. One can check the official website to see the eOPD timings in each state and union territory.
National AIDS Control Programme:
NACP was established in 1992 to combat the HIV-AIDS pandemic and to provide HIV patients with quality care, treatment, and dignified life. The services offered through NACP include prevention programmes for high-risk populations like sex workers, drug injectors, and others; HIV counselling and testing services; parent-to-child transmission prevention; free antiretroviral treatment (ART) through ART centres; laboratory services for CD4 testing and other investigations; paediatric ART for children; and early infant diagnosis for HIV-exposed children and infants below six months of age. All government hospitals have ART centres.
National Mental Health Programme:
In 1982, the Indian government established the National Mental Health Programme (NMHP) with the intention of addressing mental diseases in the country. The main goal is to make mental health care readily available to everyone and easily accessible in order to lessen the distress, disability, and premature mortality caused by mental illness as well as to improve recovery from mental illness. The three primary facets of the National Mental Health Programme are the treatment of mentally ill people, rehabilitation, and prevention and promotion of good mental health.
Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) Programme:
The Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) programme primarily focuses on addressing the main causes of mortality among women and children as well as the delays in receiving and utilising health care and services. Additionally, it introduces brand-new programmes like the Score Card, which tracks health performance, the National Iron + Initiative, which aims to combat anaemia in all age groups, and Comprehensive Screening and Early Interventions for Birth Defects, Diseases, and Deficiencies in Children and Adolescents.
PROBLEMS WITH PUBLIC HEALTHCARE IN INDIA
India's healthcare system has been battling various issues, including the lack of institutions and insufficient human resources for quite a while now.
The Indian healthcare system was essentially defined by a three-tier structure: primary, secondary, and tertiary care services. According to the Indian Public Health Standards, sub-centres, primary health centres, and community health centres provide primary healthcare to rural residents while district and sub-district hospitals provide secondary care. On the other side, super speciality hospitals or regional/central level institutions provide tertiary care. While it is vital to concentrate on all three levels of healthcare—primary, secondary, and tertiary—the government must prioritize strengthening primary healthcare as a public good. The issues that public healthcare is facing are listed below:
Shortage of efficient and trained manpower:
The significant lack of qualified personnel in the medical stream, including doctors, nurses, paramedics, and basic healthcare workers, continues to be one of India's most serious concerns. The majority of India's population lives in rural areas, where the situation is still concerning. The problem can be effectively resolved by increasing the capacity of currently operating educational and training facilities while also eventually bringing on new ones.
Neglect of Rural Population:
The neglect of rural populations in India's health system is a severe flaw. Urban hospitals serve as the foundation of this service. The urban bias is evident despite the vast number of PHCs and rural hospitals. Additionally, doctors are reluctant to practise in remote areas. Instead of strengthening the periphery by developing a health system dependent on paramedicine. India has developed into a top-heavy society that is dependent on doctors.
Focus on Culture Method:
India's healthcare system is mostly based on western concepts that have been imported. It has no roots in the culture and tradition of the people. Most of the services are provided by urban hospitals. This has come at the expense of all people receiving thorough primary healthcare. However, it has utterly disregarded public health, pro-motivation, rehabilitation, and preventative measures.
Lack of infrastructure is undoubtedly the biggest problem affecting India's healthcare system today. An unmanageably overburdened national healthcare system results from a chronic undersupply of hospital beds, a lack of specialised faculty to treat serious diseases, and excessive out-of-pocket costs. The burden on this faltering healthcare system is now hanging by a thread due to the low rate of professional training compared to other nations.
Healthcare without a holistic approach:
There are many factors that affect health that is outside the purview of the health ministry, such as better access to clean water and sanitation, better nutrition, and the health and education of women and girls.
Health systems and policies have a crucial role in determining how health services are provided, utilised, and affect health outcomes. Despite the challenges facing Indian healthcare, there is a great deal of optimism and room for progress given the country's approach to healthcare education. To sum it up, there is a pressing need to increase operational transparency among healthcare service providers. This will make it easier to hold people and processes accountable for delivering improved healthcare services. Only then will the healthcare system be able to take a few deep breaths.