Mains Practice Questions

Approach

• Start with the situation of the public health system during Covid-19 pandemic.
• Discuss the issues associated with the Public health system.
• Suggest measures to improve the health system in India.

Introduction

For the Indian population, the availability of functional public health systems is literally a question of life and death.

A robust government health-care service is translated into a more effective outreach, timely testing, early case detection and more rational treatment for Covid patients. This is evident by comparing two States— Maharashtra and Kerala.

Their per capita gross State domestic product (GSDP) is similar. However, their Covid-19 case fatality rates are hugely different — this being 0.48% for Kerala and 2.04% for Maharashtra.

Body

Issues With Current Healthcare System

• Lack of Primary Healthcare Services: The existing public primary health care model in the country is limited in scope.
  
  • Even where there is a well-functioning public primary health centre, only services related to pregnancy care, limited childcare and certain services related to national health programmes are provided.
• Supply-Side Deficiencies: Poor health management skills and lack of appropriate training and supportive supervision for health workers prevent delivery of the desired quality of health services.
• Inadequate Funding: Expenditure on public health funding has been consistently low in India (approximately 1.3% of GDP). As per OECD, India's total out-of-pocket expenditure is around 2.3 % of GDP.
• Sub-optimal Public Health System: Due to this, it is challenging to tackle Non-communicable Diseases, which is all about prevention and early detection.
  
  • It diminishes preparedness and effective management for new and emerging threats such as pandemic like Covid-19.

Measures to improve health system

• Focus On Public Health:
  
  • Need for a larger programme which requires the immediate attention is the National Health Mission (NHM); since 2017-18, Union government allocations for the NHM have declined in real terms, resulting in inadequate support to States for core activities such as immunisation, while systemic gaps affect the delivery of Covid-19 vaccination.
• Private Sector Regulation:
  
  • Another clear priority that has been highlighted during the Covid-19 pandemic is the need to regulate rates and standards of care in the private sector.
  • Massive hospital bills have caused untold distress even among the middle class.
  • The central government should take necessary steps to promote the implementation of the Clinical Establishments (Registration and Regulation) Act (CEA).
• NITI Aayog Prescriptions:
  
  • The NITI Ayog document states that ‘in the hospital segment, the expansion of private players to Tier 2 and Tier 3 locations, beyond metropolitan cities, offers an attractive investment opportunity’.
  • Manufacturing of medical devices and equipment, expansion of diagnostic and pathology centres and miniaturized diagnostics have high growth potential.
  • Technology advancements such as Artificial Intelligence, wearables and other mobile tech, along with the Internet of Things, also offer numerous avenues for investment.
• More Funding: Public funding on health should be increased to at least 2.5% of GDP as envisaged in the National Health Policy, 2017.
• Decentralisation: There is a need to make nutrition, water, sanitation and hygiene (WASH) part of the core functions of Panchayati raj institutions and municipalities.

Conclusion

Existing evidence from the Covid-19 pandemic provides a clear message that a neglect of public health systems can mean large-scale, avoidable losses of lives; hence, public health services must be upgraded rapidly and massively as a topmost priority