India's Quest for Universal Health Coverage

• 10 Aug 2024

This editorial is based on “Reducing the poor’s health burden” which was published in The Indian Express on 09/08/2024. The article highlights a positive trend in reducing poverty-induced health shocks and improving healthcare access in India but emphasizes the need to address ongoing disparities and the rise of non-communicable diseases to achieve universal healthcare.

For 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

For Mains: Major Issues Related to India’s Healthcare Sector, Major Initiatives Related to Healthcare in India.

The analysis of the recent Household Consumption Expenditure Survey (HCES 2022-23) reveals a positive trend in the country's battle against poverty-induced health shocks. From 2011-12 to 2022-23, there was an increase in the proportion of households incurring hospitalization expenses, indicating better access to healthcare. More importantly, the financial burden of hospitalization on these households has decreased, with the share of health expenditure in monthly household spending dropping from 10.8% to 9.4% for those experiencing hospitalization.

However, the road to universal healthcare is still fraught with obstacles. Disparities in healthcare access, quality, and overall affordability continue to plague many regions. The emergence of non-communicable diseases as a growing health burden demands focused attention. India must sustain its momentum, building upon the successes of schemes like Ayushman Bharat while addressing these persisting issues to ensure a healthier future for all its citizens.

What are the Current Major Issues Related to India’s Healthcare Sector?

• Misaligned Priorities-The Infrastructure-Outcome Gap: While India has made strides in healthcare infrastructure, outcomes have not kept pace.
  • The National Health Mission has increased the number of health centers, but nearly 80% of public health facilities in India do not meet the minimum essential standards.
  • The CAG report 2023 reveals that under Ayushman Bharat, patients marked as 'dead' are still receiving treatment, and 9.85 lakh Ayushman Bharat-Pradhan Mantri Jan
  • Arogya Yojana (PMJAY) beneficiaries are linked to the same mobile number.
  • The focus on quantity over quality has led to a situation where more Indians have access to health facilities, but the care received often falls short.
• This misalignment of priorities is evident in the persistently high maternal mortality rate, which stood at 103 as per UN MMEIG 2020 report, despite increased institutional deliveries.
• The Digital Divide: The Covid-19 pandemic accelerated India's adoption of telemedicine, with the government's eSanjeevani platform crossing 200 million consultations in early 2024.
  • However, this digital leap has inadvertently widened the healthcare gap. While urban, tech-savvy populations benefit, rural areas with poor internet connectivity and low digital literacy are left behind.
• Nearly 45% of the rural population did not have access to the internet as of 2023,highlighting the uneven access to digital health services.
• The Brain Drain and Skill Mismatch: India's healthcare system continues to grapple with a severe shortage of qualified professionals.
  • Although, the doctor-population ratio in the country stands at 1:834 which is better than the WHO standard of 1:1000, but it's not even in all healthcare fields.
    • For example, India is home to 1/4th of the world's elderly however it only gets 20 geriatricians/year.
  • Furthermore, there's a mismatch between medical education and primary care needs, with fewer new medical graduates opting for careers in family medicine or rural healthcare.
• The Out-of-Pocket Expense Trap: Despite initiatives like Ayushman Bharat, which aims to provide healthcare to 500 million Indians, out-of-pocket expenses remain a major barrier to healthcare access.
  • More than 17% of Indian households incur catastrophic levels of health expenditures every year, a March 2022 report by the World Health Organization found.
• Preventive Healthcare-The Neglected Public Health Approach: India's healthcare system remains largely reactive rather than preventive.
  • While communicable diseases are declining, non-communicable diseases (NCDs) are on the rise, accounting for 63% of all deaths in India.
  • The lack of emphasis on health education, lifestyle interventions, and early screening programs has led to a surge in preventable conditions.
  • The Economic Survey 2023-24 highlights that social media, screen time, sedentary habits, and unhealthy food together pose a serious threat to public health, productivity, and India's economic potential.
• Quality of Care-The Credibility Crisis: The quality of healthcare services in India varies widely, with concerns about substandard care, medical negligence, and lack of standardization.
  • Poor care quality leads to more deaths than insufficient access to healthcare, 1.6 million Indians died due to poor quality of care in 2016 more than those who died from lack of access to healthcare.
  • The absence of a robust regulatory framework for private healthcare providers, who account for a major chunk of outpatient care, exacerbates this issue.
• Scandals, such as the 2017 case of overcharging and medical negligence at a prominent Delhi hospital, have further eroded public trust in the healthcare system.
• Mental Health-The Neglected Crisis: Mental health remains a severely neglected aspect of India's healthcare system.
  • Close to 60 to 70 million people in India suffer from common to severe mental disorders.
    • It is alarming to know that India is the world's suicide capital with over 2.6 lakh cases of suicide in a year.
  • Despite the implementation of the Mental Healthcare Act 2017, which guarantees the right to mental healthcare, there's a critical shortage of mental health professionals.
    • India has only 0.75 psychiatrists per 100,000 people, compared to the desirable ratio of 3 per 100,000.
    • The Covid-19 pandemic has further exacerbated mental health issues, with studies reporting increased rates of anxiety and depression.
• Pharmaceutical Industry Issues: India's pharmaceutical industry, often called the "pharmacy of the world," plays a crucial role in global healthcare.
  • However, the industry faces challenges such as quality control issues, over-dependence on China for active pharmaceutical ingredients (APIs), and stringent price controls.
  • In 2023, the World Health Organization issued a warning against the use of two India-made cough syrups linked to the deaths of at least 20 children in Uzbekistan.

What are the Major Initiatives Related to Healthcare in India?

• Ayushman Bharat: This flagship program aims to achieve universal health coverage and consists of two main components:
  • Pradhan Mantri Jan Arogya Yojana (PM-JAY): Provides health insurance coverage of ₹5 lakh per family per year for secondary and tertiary care hospitalization.
  • Health and Wellness Centers: Aims to establish 150,000 centers to provide comprehensive primary healthcare.
• National Health Mission (NHM): An umbrella program that includes:
  • National Rural Health Mission (NRHM)
  • National Urban Health Mission (NUHM)
  • Focuses on improving healthcare infrastructure, reducing maternal and infant mortality, and enhancing access to quality healthcare services in rural and urban areas.
• National Digital Health Mission (NDHM): Aims to create a digital health ecosystem with unique health IDs for all citizens, digitized health records, and a registry of doctors and health facilities.
• Pradhan Mantri Swasthya Suraksha Yojana (PMSSY): Focuses on correcting regional imbalances in healthcare by:
  • Setting up new AIIMS (All India Institute of Medical Sciences) institutions
  • Upgrading existing government medical colleges
• Mission Indradhanush: A vaccination program aimed at increasing immunization coverage among children and pregnant women, targeting those who are partially
• vaccinated or unvaccinated.
• Janani Suraksha Yojana (JSY): A safe motherhood intervention under the NHM, promoting institutional delivery among poor pregnant women by providing cash assistance.
• Pradhan Mantri Bharatiya Janaushadhi Pariyojana (PMBJP): Aims to provide quality medicines at affordable prices through dedicated retail outlets known as Janaushadhi Kendras.
• National Mental Health Program (NMHP): Focuses on providing accessible and affordable mental healthcare services, including the treatment and prevention of mental disorders.

What Measures can India Adopt to Revamp its Healthcare Sector?

• Bridging the Urban-Rural Divide: India can leverage mobile health (mHealth) technologies to bridge the urban-rural healthcare gap.
  • Implementing a nationwide network of mobile health units equipped with telemedicine facilities, diagnostic tools, and essential medications could significantly improve ruralhealthcare access.
  • These units can be supported by ASHA Workers and Common Service Centres.
  • Successful models like the Mobile Medical Units in Tamil Nadu can be scaled nationwide.
• Strengthening Primary Health Care: Revitalizing India's primary healthcare system is crucial for overall health improvement.
  • The government should focus on upgrading and fully staffing all 150,000 Health and Wellness Centres promised under the Ayushman Bharat scheme by 2025.
  • These centers should offer a comprehensive range of services, including NCD management, mental health support, and preventive care.
  • Implementing a family physician model, where each center has a dedicated doctor responsible for a defined population, can ensure continuity of care and reduce the burden on secondary and tertiary facilities.
• Public-Private Partnerships-Synergizing for Success: India can harness the potential of public-private partnerships (PPPs) to improve healthcare delivery.
  • The government should create a robust framework for PPPs in healthcare, focusing on areas like hospital management, diagnostic services, and specialized care.
  • Successful models like the Rajasthan government's partnership with Narayana Health for cardiac care can be replicated across states.
• Digital Health Ecosystem-Interoperability for Impact: Building a comprehensive, interoperable digital health ecosystem is essential for improving healthcare efficiency and accessibility.
  • The government should expedite the implementation of the Ayushman Bharat Digital Mission.
  • Developing standardized Electronic Health Records (EHRs) and ensuring their adoption across public and private healthcare providers is crucial.
  • Implementing a nationwide Health Information Exchange (HIE) can facilitate seamless data sharing, reducing duplicate tests and improving care coordination.
  • Boosting Indigenous Research and Development-Made in India, for India: Enhancing India's healthcare R&D capabilities is vital for developing context-specific, cost-effective solutions.
  • The government should increase healthcare R&D spending to 2.5% of GDP.
    Establishing a network of biomedical research parks, similar to the successful Made-in-Thailand Medical Innovation, can foster collaboration between academia, industry, and healthcare providers.
  • Enhancing Healthcare and Pharmaceutical Standards: Implementing robust quality control measures and accreditation systems for healthcare and pharmaceutical facilities is essential.
  • This involves setting and enforcing stringent standards for patient safety, clinical outcomes, and healthcare management.
  • Regular audits, transparent reporting mechanisms, and a system of rewards and penalties can drive quality improvement.
  • Encouraging patient feedback and involving them in healthcare decision-making can further enhance the quality of care.

Drishti Mains Question:

What are the major challenges in achieving universal healthcare in India? Highlight measures to address these challenges with special focus on bridging the gap between urban and rural healthcare access

.

UPSC Civil Services Examination, Previous Year Question (PYQ)

Prelims

Q. Which of the following are the objectives of ‘National Nutrition Mission’? (2017)

1. To create awareness relating to malnutrition among pregnant women and lactating mothers.
2. To reduce the incidence of anaemia among young children, adolescent girls and women.
3. To promote the consumption of millets, coarse cereals and unpolished rice.
4. To promote the consumption of poultry eggs.

Select the correct answer using the code given below:

(a) 1 and 2 only

(b) 1, 2 and 3 only

(c) 1, 2 and 4 only

(d) 3 and 4 only

Ans: (a)

Mains

Q. “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse. (2021)