Public Health in India

Context:

• NITI Aayog has unveiled a program in which the private providers will take charge of any tier1 and tier2 district.

Explanation: The public health system in India comprises a set of state-owned health care facilities funded and controlled by the government of India. Some of these are controlled by agencies of the central government while some are controlled by the governments of the states of India. Statistical Drawbacks:

• According to our analysis of District Level Household Survey (DLHS-4) data, up to 62% of government hospitals don’t have a gynecologist on staff and an estimated 22% of sub-centres are short of auxiliary nurse midwives (ANMs).
• As many as 65% of hospitals serve more patients than government standards require; the number rises to 95% if we include hospitals with a gynecologist on staff.
• According to government data, India continues to have the highest rate of infant mortality among BRICS nations, as India Spend reported in May 2016.
• According to Rural Health Statistics (RHS) data, a critical element of the public-health system continues to falter: There aren’t enough doctors and nurses.

Initiatives: NRHM:

• Launched on 12th April 2005 by Indian Prime Minister Manmohan Singh.

The goals of NRHM are outlined below:

• Reduction in Infant Mortality Rate and Maternal Mortality Ratio by at least 50% from existing levels in next seven years.
• Universalize access to public health services for Women’s health, Child health, water, hygiene, sanitation and nutrition.
• Prevention and control of communicable and non-communicable diseases, including locally endemic diseases.
• Access to integrated comprehensive primary healthcare.
• Ensuring population stabilization, gender and demographic balance.

NUHM:

• The National Urban Health Mission (NUHM) as a sub-mission of National Health Mission (NHM) has been approved by the Cabinet on 1st May 2013.

The goals of NUHM are outlined below:

• Resources for addressing the health problems in urban areas, especially among urban poor.
• Need based city specific urban healthcare system to meet the diverse health needs of the urban poor and other vulnerable sections
• Partnership with community for a more proactive involvement in planning, implementation, and monitoring of health activities.
• Institutional mechanism and management systems to meet the health-related challenges of a rapidly growing urban population.
• Framework for partnership with NGOs, charitable hospitals, and other stakeholders.

Current scenario: NITI Ayog:

• The NITI Aayog has recently unveiled a grand plan to effectively privatise district hospitals in Tier-I and Tier-II towns.
• It has developed what it calls a “model concessionaire agreement” for provision of healthcare services for cardiac and pulmonary (lung) diseases and cancers.
• It is proposed that public facilities in district hospitals would be outsourced to private providers.
• The private providers would be free to charge full treatment costs from patients who are not covered by government schemes (such as the Rashtriya Swasthya Bima Yojana) and the providers would be reimbursed by the government for treating patients referred by the government.

Key points of the initiative: negative impact

1. The proposal implies that most patients would have to pay for care even in public facilities.
2. Recent surveys which show that just 12-13% of people are covered by public-funded insurance.
3. The scheme will expose thousands of patients to unethical practices by private providers, compromises in quality and rationality of services and additional ‘top-up services’.
4. Private providers will concentrate on better-off districts, leaving the poor and remote districts for the public sector to manage.
5. Outsourcing of hospital care to private providers inevitably becomes increasingly unsustainable over time as they rise up demands on reimbursements and fees.

Suggestions:

• To ensure high-quality public services for all Indians, vacancies must stand alongside absenteeism as a critical area for improvement.
• Until these vacancies are filled, infrastructure investments and financial safety nets will fall short of ensuring adequate access to quality healthcare for the poorest Indians.
• Looking at the pace of achievements of the targets so far and future targets, it needs to focus more on framing of the policies in terms of building capacity of existing human resources, enhancing further allocation of finances dedicated toward newborn care and identifying areas for development through operational research.
• Other than giving authority to private providers the simple remedy could be to significantly enhance investment in public healthcare services,